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Liver cancer | Liver cancer | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Liver cancer Liver cancer About liver cancer Causes of liver cancer Diagnosing liver cancer Treating liver cancer About liver cancer Primary liver cancer is an uncommon but serious type of cancer that begins in the liver. This is a separate condition from secondary liver cancer, which occurs when cancer that first develops in another part of the body spreads to the liver. The rest of this article refers to primary liver cancer only. The Macmillan Cancer Support website has more information about secondary liver cancer . Signs and symptoms Symptoms ofliver cancer are often vague and dont appear until the cancer is at an advanced stage. They caninclude: unexplained weight loss loss of appetite feeling very full after eating, even if the meal was small feeling sick and vomiting pain or swellingin your abdomen (tummy) jaundice (yellowing of your skin and the whites of your eyes) itchy skin feeling very tired and weak Speak to your GP if you notice any of these symptoms. Although they are more likely to be the result of a more common condition, such as an infection, its best to have them checked. You should also contact your GP if you have previously been diagnosed with a condition known to affect the liver, such as cirrhosis or a hepatitis C infection, and your health suddenly deteriorates. What causesliver cancer? The exact cause of liver cancer is unknown, but most cases are associated with damage and scarring of the liver known as cirrhosis. Cirrhosis can have a number of different causes, including drinkingexcessive amounts of alcohol overmany years and having a long-term hepatitis B or hepatitis C viral infection. It is also believed obesity and an unhealthy dietcan increase the risk of liver cancer because this can lead to non-alcoholic fatty liver disease . By avoiding or cutting down on alcohol, eating healthily and exercising regularly , and taking steps to reduce your risk of becoming infected with hepatitis B and C, you may be able to significantly reduce your chances of developing liver cancer. Read more about the causes of liver cancer . Who is affected? Despite being a common type of cancer worldwide, liver cancer is relatively uncommon in the UK. However, the chances of developing the condition are high for people with risk factors for the condition. The number of people affected by liver cancer rises sharply with age, with around 8 in every 10 cases diagnosed in people aged 60 or older, although it also affects many people younger than this. Around 2 in every 3 cases affect men. Over the past few decades, rates of liver cancer in the UK have risen considerably, possibly as a result of increased levels of alcohol intake and obesity. Diagnosis and screening Liver cancer is usually diagnosed after a consultation with a GP and a referral to a hospital specialist for further tests, such as scans of your liver. However, regular check-ups for liver cancer (known as surveillance) are often recommended for people known to have a high risk of developing the condition, such as those with cirrhosis. Having regular check-ups helps ensure the condition is diagnosed early. The earlierliver cancer is diagnosed, the more effectivetreatment is likely to be. Readmore about diagnosing liver cancer . How liver cancer is treated Treatment for liver cancer depends on the stage the condition is at. If diagnosedearly, it may be possible to remove the cancer completely. Treatment options in the early stages of liver cancer include: surgical resection surgery to remove a section of liver liver transplant where the liver is replaced with a donors liver microwave or radiofrequency ablation where microwaves or radio waves are used to destroy the cancerous cells However, only a small proportion of liver cancers are diagnosed at a stage where these treatments are suitable. Most people are diagnosed when the cancer has spread too far to be removed or completely destroyed. In these cases, treatments such as chemotherapy will be used toslow downthe spread of the cancer and relieve symptoms such as pain and discomfort. Read more about treating liver cancer . Causes of liver cancer The exact cause of liver cancer is unknown, but many cases are linked to a problem with the liver called cirrhosis . This is where the tissue of the liver has become scarred and cannot perform many of its usual functions. Cancer is a conditionwhere cells in a specific part of the body grow and reproduce uncontrollably, producing a lump of tissue known as a tumour. In cases of liver cancer, it is uncertain why and how the cells of the liver are affected, but it appears that cirrhosis can increase a persons chances of developing the condition. However, most cases of cirrhosis do not lead to liver cancer, and people without cirrhosis canalso develop liver cancer. Common causes of cirrhosis Heavy and harmful drinking The liver is a tough and resilient organ. It can endure a high level of damage that would destroy other organs and is capable of regenerating itself. But despite the livers resilience, excessive alcohol intake over many years can damage it. Every time you drink alcohol, your liver filters out the poisonous alcohol from your blood and some of the liver cells die. The liver can regenerate new cells, but if you drink heavily for many years, your liver will lose the ability to do this and it can become damaged and scarred over time. Non-alcoholic fatty liver disease Non-alcoholic fatty liver disease occurs when small deposits of fat build up inside the tissue of the liver.Its acommon condition and causes no noticeable symptoms in most people. However, in some people, high levels of fat can make the liver inflamed. Over time, the inflammationcan scar the liver. The exact cause of non-alcoholic fatty liver disease is unclear, but it is associated with obesity and type 2 diabetes . Hepatitis C A long-term infection of hepatitis C can cause inflammation and scarring of the liver. Hepatitis C is spread by blood contact. The mostcommon ways this happens worldwideinclude poor medical practice with the use of contaminated needles, or injected drug use, where any item of injecting equipment (not just needles) is shared. If you smoke or regularly drink alcohol and have hepatitis C, your risk of developing liver cancer further increases. Early treatment of long-term hepatitis C with antiviral medication can prevent the liver from becoming scarred. Othercauses of cirrhosis Hepatitis B Hepatitis B is a virus that can be spread through contaminated blood and other types of bodily fluids, such as saliva, semen and vaginal fluids. Like hepatitis C, hepatitis B is spread through blood contact. It is most commonly spread from mother to child at birth or from child to child in early life (usually in areas outside the UK where the infection is very common), and very rarely sexually or through injecting drugs. It affects about1 in every 200 peoplein the UK. Most of those infected were born inparts of the world where the hepatitis Bvirus is very common. As with hepatitis C, hepatitis B can also cause inflammation and scarring of the liver over time. If you smoke or drink and have hepatitis B, your risk of developing liver cancer further increases. Early treatment of long-term hepatitis B with antiviral medication is not always needed, but can substantially reduce the risk of the liver becoming scarred. Haemochromatosis Haemochromatosisis a genetic condition where the body stores too much iron from food. The excess levels of iron have a poisonous effect on the liver and cause scarring over time, although treatment can reduce the risk of the condition leading to liver cancer. Primary biliary cirrhosis Primary biliary cirrhosisis a rare and poorly understood liver condition. One of the main functions of the liver is to create afluid called bile, used by the body to help break down fat. The bile is transported to the digestive system via a series of tubes called bile ducts. For reasons that are unclear, in cases of primary biliary cirrhosis, the bile ducts gradually becomedamaged. This eventually leads to a build-up of bile inside the liver, which damages the liver and causes cirrhosis. Diagnosing liver cancer For many people, the first stage of diagnosing liver cancer is a consultation with a GP, although people at risk are usually tested regularly for the condition. If you visit your GP, they will ask about your symptoms,when they started, and when they are noticeable. They will also examine you. If they feelyou need further tests, they will refer you to a hospital specialist. Surveillance for liver cancer If you are in a high-risk group for developing liver cancer, regular screening known as surveillance is often recommended. This is because the earlier the cancer is diagnosed, the greater the chance there is of curing it. Surveillance is usually carried out every 6 months andoften involves: ultrasound scans high-frequency sound waves are used to create an image of your liver, which can highlight any abnormalities blood tests your blood is tested for a protein calledalpha-fetoprotein (AFP), which isfound in some people with liver cancer Surveillance is usually recommended if you have cirrhosis (scarring of the liver), although there are other factors that can also affect your risk of livercancer. The potential benefits of surveillance shouldbe discussed with you beforeyou enterany screening programme. Further testing The tests above can also be used to look for liver cancer in people who are not being routinely screened. If these initialtests suggest there is a chance you could have liver cancer, one or multiple tests will usually be recommended to confirm the diagnosis. The further tests include: computerised tomography (CT) scans a series of X-rays of your liver aretaken to givea more detailed three-dimensional image magnetic resonance imaging (MRI) scans uses a strong magnetic field and radio waves to build up a picture of the inside of your liver biopsy a needle is inserted into your abdomen (tummy)to remove a small sample of liver tissue, which is then tested in a laboratory for cancerous cells laparoscopy a small incision is made in your abdomen under general anaesthetic (where you are asleep) and a flexible camera called an endoscope is used to examine your liver Afterthese tests have been carried out, it will usually be possible to confirm a diagnosis of liver cancer and determine the conditions stage. Staging liver cancer Staging is a term used to describe how far a particular cancer has spread. There are a number of different systems used to stage liver cancer. Many liver cancer specialists use combination staging systems that include features of both the cancer and the underlying liver function to stage a persons condition. This is because the length of time a person lives and how well theytolerate potential treatments will be determined not only by how advanced their cancer is, but also by their level of health and how good their underlying liver function is. One combination system for staging liver cancer is known as the Barcelona Clinic Liver Cancer (BCLC) staging system. The BCLC staging system consists of 5 stages. These are: stage 0 the tumour is less than 2cm (20mm) in diameter and the person is very well and has normal liver function stage A a single tumour has grown but is less than 5cm (50mm) in diameter, or there are 3 or fewer smaller tumoursless than 3cm (30mm) in diameter and the person is very well with normal liver function stage B there are multiple tumours in the liver, but the person is well and their liver function is unaffected stage C any of the above circumstances, but the person is not so well and their liver function is not so good, or where the cancer has started to spread into the main blood vessel of the liver, nearby lymph nodes or other parts of the body stage D where the liver has lost most of its functioning abilities and the person begins to have symptoms of end-stage liver disease, such as a build-up of fluid inside their abdomen Treating liver cancer The treatment for liver cancer depends on the stage of the condition. Treatment can include surgery and medication. Cancer treatment teams Most hospitals use multidisciplinary teams (MDTs) to treat liver cancer. These are teams of specialists that work together to make decisions about the best way to proceed with your treatment. Deciding which treatment is best for you can often be confusing. Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours. Your treatment plan Your recommended treatment plan will depend on the stage your liver cancer is at. If your cancer is at stage A when diagnosed, a complete cure may be possible. The 3 main ways this can be achieved are: removing the affected section of liver known as a resection having a liver transplant an operation to remove the liver and replace it with a healthy one using heat to kill cancerous cells known as microwave or radiofrequency ablation (RFA) If your cancer is at stage B or C, a cure is not usually possible. However, chemotherapy can slow the progression of the cancer, relieve symptoms, and prolong life for months or, in some cases, years. There is also a medication called sorafenib thatcan help prolong life. If your cancer is at stage D when diagnosed, it is usually too late to slow down the spread of the cancer. Instead, treatment focuses on relievinganysymptoms of pain and discomfort you may have. Surgical resection If damage to your liver is minimal and the cancer is contained in a small part of your liver, it may be possible to remove the cancerous cells during surgery. This procedure is known as surgical resection. As the liver can regenerate itself, it may be possible to remove a large section of it without seriously affecting your health. However, in the majority of people with liver cancer, their livers regenerative ability may be significantly impaired and resection may be unsafe. Whether or not a resection can be performed is often determined by assessing the severity of your cirrhosis (scarring of the liver). If a liver resection is recommended, it will be carried out under a general anaesthetic , which means you will be asleep during the procedure and wont feel any pain as it is carried out. Most people are well enough to leave hospital within a week or two of having surgery. However, depending on how much of your liver was removed, it may take several months for you to fully recover. Risks Liver resection is a complicated surgery and can have a considerable impact on your body. There is a significant risk of complications occurring during and after surgery. Possible complications of liver resection include: infection at the site of the surgery bleeding after the surgery blood clots that develop in your legs the medical term for this is deep vein thrombosis (DVT) bile leaking from the liver further surgery may be required to stop the leak jaundice (yellowing of the skin and whites of the eyes) liver failure (where your liver is no longer able to function properly) Liver resection can also sometimes cause fatal complications, such as a heart attack. Liver transplant A liver transplant involves removing a cancerous liver and replacing it with a healthyliver from a donor. This is a major operation and there is a risk of potentially life-threatening complications. A liver transplant may be suitable for you if you: only have a single tumour less than 5cm (50mm) in diameter have 3 or fewer small tumours, each less than 3cm (30mm) have responded exceptionally well to other treatments, with no evidence of tumour growth for 6 months If you have multiple tumours or a tumour larger than 5cm, the risk of the cancer returning is usually so high that a liver transplant will be of no benefit. If you are suitable for a liver transplant, you will normally need to be placed on a waiting list until a donor liver becomes available. The average waiting time for a liver transplant is 142 days for adults. In some cases, a small part of the liver of a living relative can be used. This is known as a living donor liver transplant. The advantage of using a living donor liver transplant is that the person receiving the transplant can plan the procedure with their medical team and relative, and will not usually have to wait very long. Read more about liver transplants . Microwave or radiofrequency ablation Microwave or radiofrequency ablation (RFA) may be recommended as an alternative to surgery to treat liver cancer at an early stage, ideally when the tumour or tumours are smaller than 5cm (50mm) in diameter. They can also be used to treat tumours larger than this, but the treatment may need to be repeated in such cases. These treatments involve heating the tumours with microwaves or radio waves produced by small, needle-like electrodes. This heat kills the cancer cells and causes the tumours to shrink. Similar procedures using lasers or freezing can also achieve the same result. There are 3 main ways microwave ablation or RFA can be carried out: where the needles are passed through the skin (percutaneously) where the needles are inserted through small incisions in your abdomen keyhole surgery (laparoscopy) where the needles are inserted through a single large incision made in your abdomen open surgery Continuous ultrasound or computerised tomography (CT) scans are used to make sure the needles are guided into the correct position. Microwave ablation or RFA can be carried out under general anaesthetic or local anaesthetic (where you are awake but the area being treated is numbed), depending on the technique used and the size of the area being treated. How long it takes to carry out the treatment depends on the size and number of tumours being treated, but it usually takes between 1 and 3 hours in total. Most people need to stay overnight in hospital. You may experience some minor discomfort and flu -like symptoms, such as chills and muscle pains, for a few days after the procedure. The risk of complications occurring with microwave ablation or RFA is low, but possible problems can include bleeding, infection, minor burns and damage to nearby organs. Chemotherapy Chemotherapyuses powerful cancer-killing medications to slow the spread of liver cancer. A type of chemotherapy called transcatheter arterial chemoembolisation (TACE) is usually recommended to treat cases of stage B and C liver cancer. In these cases, the treatment can prolong life, but cannot cure the cancer. TACE may also be used to help prevent cancer spreading out of the liver in people waiting for a liver transplant. Itis not recommended for stage D liver cancer because it can make the symptoms of liver disease worse. TACE procedure During TACE a fine tube called a catheter is insertedinto the main blood vessel in your groin (femoral artery) and passed along the arteryto the main blood vessel that carries blood to the liver (hepatic artery). Chemotherapy medication is injected directly into the liver through the catheter and either a gel or small plastic beads are injected into the blood vessels supplying the tumours to help slow down the speed they grow. TACE usually takes one to 2 hours to complete. After the procedure, you will stay in hospital overnight before returning home. This procedure can be completed several times if necessary. Side effects Injecting chemotherapy medications directly into the liver, rather than into the blood, has the advantage of avoiding the wide range of side effects associated with conventional chemotherapy, such as hair loss and tiredness. However, the procedure is not free of side effects and complications. The most common side effect is post-chemoembolisation syndrome, which can cause abdominal (tummy) pain and a high temperature (fever), as well as making you vomit or feel sick. These symptoms may last for a few weeks after a TACE session. Read more about chemotherapy . Alcohol injections If you only have a few small tumours, alcohol (ethanol) injections may be used as a treatment.A needle passes through the skin to inject alcohol into the cancerous cells. This dehydrates the cells and stops their blood supply. In most cases, this is carried out under a local anaesthetic, meaning you will be awake, but the affected area is numbed so you wont feel any pain. Sorafenib Sorafenib is a medication given in tablet form that can disrupt the blood supply to liver tumours and slow down their growth. It is sometimes used as a treatment for advanced cases of liver cancer, although it is not routinely available on the NHS because the National Institute for Health and Care Excellence (NICE) has said the cost of the medication is high for the limited benefit it offers. Whether or not you are eligible for sorafenib will be decided by your medical team, and will depend on the likelihood of whetheryou will significantly benefit from the medication. For more information, see the NICE guidelines on sorafenib for the treatment of advanced hepatocellular carcinoma . Advanced liver cancer Treatment for advanced liver cancer focuses on relieving symptoms such as pain and discomfort, rather than attempting to slow down the progression of the cancer. Some people with advanced liver cancer require strong painkillers, such as codeine or possibly morphine. Nausea and constipation are common side effects of these types of painkillers, so you may also be given an anti-sickness tablet and a laxative. Read more about end of life care . Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Cirrhosis Other health sites Cancer Research UK: Liver cancer Macmillan Cancer Support: Liver cancer British Liver Trust: liver cancer Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Liver disease | Liver disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Liver disease Liver disease There are more than 100 different types of liver disease, which together affect at least 2 million people in the UK. The liver The liver is the second largest organ in the body. It works hard, performing hundreds of complex functions, including: fighting infections and illness removing toxins (poisons), such as alcohol ,from the body controllingcholesterol levels helping blood to clot (thicken) releasing bile, a liquid that breaks down fats and aids digestion Liver disease doesnt usually cause any obvious signs or symptoms until its fairly advanced and the liver is damaged. At this stage, possible symptoms can include loss of appetite, weight loss and jaundice. Types of liver disease Listedon this page are some specific types of liver disease. The links provide more detailed information about each type: alcohol-related liver disease where the liver is damaged after years of alcohol misuse, this can lead to cirrhosis (scarring of the liver) Non-alcoholic fatty liver disease a build-up of fat within liver cells, usually seen in overweight people or those who are obese hepatitis which is inflammation (swelling) of the liver caused by a viral infection or exposure to harmful substances such as alcohol haemochromatosis an inherited disorder where theres a gradual build-up of iron in the body, usually around the liver primary biliary cirrhosis a rare, long-term type of liver disease that damages the bile ducts in the liver All types of liver disease can cause cirrhosis (scarring of the liver), not just alcohol-related liver disease. Significant health problem In the UK, liver disease is on the increase. The 3 main causes of liver disease are: obesity undiagnosed hepatitis infection alcohol misuse These causes of liver disease are all preventable. Do make sure youre a healthy weight for your height avoid drinking excessive amounts of alcohol take the appropriate measures to prevent getting hepatitis, such as getting vaccinated if youre at risk Source: NHS 24 - Opens in new browser window Last updated: 13 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Alcohol-related liver disease Cirrhosis Body mass index (BMI) Low-risk drinking guidelines Other health sites British Liver Trust: diet and liver disease NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Liver tumours | "Liver tumours | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in children Liver tumours Liver tumours Liver tumours can be non-cancerous (benign) or cancerous (malignant).Boys are affected more commonly than girls. There are 2 main types of primary liver cancer. Hepatoblastoma This usually occurs in children under 5 years old. Hepatocellular carcinoma (HCC) This is rarer and usually occurs in older children. More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Its devastating to hear that your child has cancer. At times it can feel overwhelming but there are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your childs specialist will give you more detailed information and if you have any questions its important to ask the specialist doctor or nurse who knows your childs individual situation. The liver The liver is the largest organ in the body. Its surrounded by a fibrous capsule and is divided into sections called lobes. It lies across the upper part of the abdomen and is larger on the right-hand side of the body than on the left. Its surrounded, and protected from injury, by the lower ribs. The liver is an extremely important organ that has many functions. One of these functions is to produce proteins that circulate in the blood. Some of the proteins help the blood to clot and prevent excessive bleeding. Others are essential for maintaining the balance of fluid in the body. The liver also destroys harmful substances. It breaks down waste products not used by the body so that they can be passed out in the urine or stools (bowel motions). The liver is responsible for breaking down food containing carbohydrates (sugars) and fats, so they can be used by the body for energy. It stores substances such as glucose and vitamins so that they can be used by the body when needed. The liver also produces bile, a substance that breaks down the fats in food so that they can be absorbed from the bowel (intestine). The liver is connected to the small intestine (duodenum) by a tube called the bile duct. This duct takes the bile produced by the liver to the intestine. The liver has an amazing ability to repair itself. It can function normally even if only a small part of it is working. Causes The cause of most primary liver tumours in the western world is unknown. However, in other parts of the world, hepatocellular cancer (HCC) is commonly related to the presence of liver infection. This happens in countries where mothers commonly have hepatitis B and vaccination is not readily available at birth for their children. Children who are infected with hepatitis B have a higher risk of developing HCC in late childhood than uninfected children. Signs and symptoms The most common symptom is a lump or swelling in the abdomen, which can be painful. Other possible symptoms include weight loss, a loss of appetite, feeling sick (nausea) and being sick (vomiting). How liver tumours are diagnosed A variety of tests and investigations may be needed to diagnose a liver tumour. An ultrasound scan and X-rays will be taken, which can show if there is a tumour in the liver. Further tests, including CT (computerised tomography) scans or MRI (magnetic resonance imaging) scans , will be done to find out the extent of the disease, both inside and outside the liver. Blood tests will also be carried out. Most hepatoblastomas and hepatocellular carcinomas produce a protein that is released into the bloodstream. This protein is known as alpha-fetoprotein (AFP). Its possible to measure levels of AFP in the blood, which can be a useful indicator of whether the liver tumour is responding to treatment or whether it may have come back after treatment. AFP is also known as a tumour marker. Any tests and investigations that your child needs will be explained to you. Grouping To assess the extent of the cancer, a grouping system called PRETEXT (pre-treatment extent of disease) is used. It uses an MRI scan to measure the amount of cancer in the liver at diagnosis. Its also used to help establish the best treatment for each child. This grouping system is unique to liver tumours and is increasingly used all over the world. This grouping process is essential because liver tumours need to be removed surgically. Grouping divides the liver into four surgical areas (sectors) and gives an indication of the kind of surgery that is needed to remove the tumour. Grouping also helps doctors decide whether a liver transplant surgeon needs to be involved from the start or not. PRETEXT 1 1liver sector is affected and the tumour can be removed by straightforward surgery PRETEXT 2 2adjoining sectors are affected and the tumour can be removed with more extensive surgery PRETEXT 3 2or 3 sectors are affected with no 2 adjoining sectors free of disease, and the tumour can be removed with major surgery PRETEXT 4 all 4 sectors of the liver are affected, and the tumour cannot be removed without replacing the liver with a donor liver transplant Doctors also look at the extent of the spread of cancer beyond the liver. In the blood vessels Sometimes the tumour gets into the blood vessels that are entering or leaving the liver. This may affect the type of surgery needed to remove the tumour. In the abdomen Sometimes the tumour spreads outside the liver and into the abdomen (tummy). The tumour cannot be removed completely. In the lungs or other organs If the tumour spreads outside the liver through the bloodstream (metastatic disease), it usually goes to the lungs. About 1 in 5 children are found to have affected lungs when they are diagnosed. Doctors use X-rays and CT or MRI scans to assess whether the lungs are affected. Treatment The diagnosis is made by taking a sample of cells from the tumour ( biopsy ). This is done under a general anaesthetic. Once the diagnosis and staging have been confirmed, plans for treatment will be made. Hepatoblastoma For hepatoblastoma, the type of treatment will depend on the PRETEXT staging and whether the cancer has spread to other parts of the body (metastatic disease). PRETEXT 1, 2 and 3 tumours are called standard risk. PRETEXT 4 is called high risk and includes tumours that have spread to other parts of the body. Treatment is broadly similar for all PRETEXT stages. Chemotherapy (anti-cancer drugs) is given first. The aim of chemotherapy is to shrink the tumour in the liver and hopefully get rid of any metastatic tumours. Surgery to remove any of theremaining tumour will take place after a few weeks of chemotherapy. Further chemotherapy is usually given after surgery. Your childs doctor will give you more detailed information about the chemotherapy drugs and their side effects. Hepatocellular carcinoma For hepatocellular carcinoma, treatment is a little different. The role of chemotherapy is less certain and surgery is the main treatment. Doctors usually recommend removing the tumour (if its small enough) at diagnosis. Chemotherapy may be given afterwards. However in many situations the tumour is too large to remove at first, and so chemotherapy is given to shrink the tumour so that surgery can be done later. Hepatocellular tumours dont always respond to chemotherapy as well as hepatoblastomas. For this reason, other treatments, such as chemoembolisation and targeted treatments, may be used. Chemoembolisation This refers to the giving of drugs directly into the artery going into the liver. Very occasionally, this may be used for hepatocellular cancer. Targeted drugs Targeted drugs are a group of treatments that work in a different way to conventional chemotherapy. Some drugs may cause cancer cells to die directly. Others act to cut off the blood supply to the tumour cells (antiangiogenesis drugs). Some drugs, called multi-targeted agents, work in both ways. Research is looking into how useful targeted treatments are on their own and in combination with chemotherapy. Your childs doctor may talk to you more about this research. Surgery All children, if they are able to, will have surgery following chemotherapy. If theres cancer in the lungs, which hasnt completely disappeared with the chemotherapy, the lungs will be operated on first. If the liver tumour can be surgically removed, the operation to do so will follow, usually a week or two later. If the tumour involves all 4 sectors of the liver (PRETEXT 4), a liver transplant will be necessary. This is recommended for hepatoblastoma but only in particular circumstances for hepatocellular carcinoma. In a transplant, the whole liver is removed and replaced with a liver from another person. This will be discussed with you from the beginning, and you will be given the opportunity to think about donating half of your liver, or for your child to have a liver from a donor. The transplant team will be there to answer all of your questions. A liver transplant is only possible if all the cancer outside the liver has gone. Side effects of treatment Treatment often causes side effects, and your childs doctor will discuss these with you before treatment starts. Side effects can include: feeling sick (nausea) and being sick (vomiting) hair loss an increased risk of infection bruising and bleeding tiredness diarrhoea Late side effects The chemotherapy used to treat liver cancer can cause late side effects. These may include hearing problems, kidney problems and possibly heart problems. There will be a slightly increased risk of your child developing another type of cancer later in life. Most children will develop some late effects and need to have some follow-up tests. Your childs doctor or nurse will tell you more about any possible late side effects. Recurrence If the cancer comes back after initial treatment, this is known as a recurrence. It can come back in the liver or in other parts of the body. If the cancer comes back, often (before anything is seen on scans) the levels of alpha-fetoprotein (AFP) in the childs blood will start to rise again and reaches levels of over 100. Small rises in AFP can occur in the weeks after surgery, as the liver regenerates as much as it can. Clinical trials Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for childrens cancer. If appropriate, your childs medical team will talk to you about taking part in a clinical trial and will answer any questions you have. Written information is often provided to help explain things. Taking part in a research trial is completely voluntary, and youll be given plenty of time to decide if its right for your child. Treatment guidelines Sometimes, clinical trials are not available for your childs tumour. This may be because a recent trial has just finished, or because the tumour is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Childrens Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care When the treatment ends, your child will have regular blood tests to measure the level of AFP in the blood (if appropriate), as well as scans and chest X-rays. More than three quarters of children with hepatoblastoma are cured, and for children with small tumours that are confined to the liver, the outlook is even better. The outcome for hepatocellular carcinoma is not quite as good. The staff at the hospital can give you information about the likely outcome for your child. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Its not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young Peoples Cancer; A Parents Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience with cancer. The Parents Guide discusses these further and talks about how you can support your child. Source: Children's Cancer and Leukaemia Group - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852" | null | null | null | null | null | null | null | null | null | null | null | null | null |
Loss of libido | Loss of libido | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Sexual and reproductive Loss of libido Loss of libido Loss of libido (sex drive) is a common problem affecting up to 1 in 5 men and even more women at some point in their life. Its often linked to professional and personal stress, orimportant life-changing events such as pregnancy, childbirth or breastfeeding. However, an unexpected loss of libidoespecially when it lasts for a long time or keeps returningcan also indicate an underlying personal, medical or lifestyle problem,which can be upsetting to both partners in a relationship. If youre concerned about your libido, especially if your diminished sex drive distresses you or affects your relationship, make an appointment to see your GP to discuss any underlying causes and possible medical or psychological treatments. Doctors at your nearest family planning clinic , Integrated Sexual Health clinic, or Contraceptive and Sexual Health (CASH) clinic may also be able to help. In the meantime, you may find the following information useful. It explains some of the most common reasons for loss of libido. Relationship problems The first thing you should consider is whether youre happy in your relationship. Do you have any doubts or worries that may be the real reason for your loss of sexual desire? If youve been in a relationship for a long time, you may have become overfamiliar with your partner and feel a degree of erotic dissatisfaction. This is quite common and can have a negative effect on your sex drive. Relationship problems are among the most common causes of loss of libido. For help and advice, youmay find it useful to contact the relationship support charity Relationships Scotland . Another thing to consider is whether the problem is a performance issue that makes sex difficult or unfulfilling. For example, many men experience ejaculation problems or erectile dysfunction , and women can experience painful sex or vaginismus (when the muscles around the vagina tighten involuntarily before penetration). See your GP if these problems are an issue, as theyre often treatable. Your GP may feel you will benefit from psychosexual counselling. This is a form of relationship therapy where you and your partner can discuss any sexual or emotional issues that may be contributing to your loss of libido. Stress, anxiety and exhaustion Stress, anxiety and exhaustion can be all-consuming and have a major impact on your happiness. If you feel youre constantly tired, stressed or anxious, you may need to make some lifestyle changes or speak to your GP for advice. For more information and advice read about beating stress at work and 10 stress busters Depression Depression is very different from simply feeling unhappy, miserable or fed up for a short while. Its a serious illness where you may have feelings of extreme sadness that can last for a long time. These feelings are severe enough to interfere with your daily life, including your sex life. Youre probably depressed if youre feeling low or hopeless, or youve lost interest or pleasure in doing things you used to enjoy. In this case its really important to see your GP. They may feel youll benefit from antidepressants . However, low sex drive can also be a side effect of many antidepressants. Speak to your GP if youre already taking antidepressants and think they may be causing your problems, as you may be able to switch to a different medication. Drugs and alcohol Drinking excess amounts of alcohol can reduce your sex drive, so its a good idea to moderate your intake to no more than three to four units a day if youre a man, and no more than two to three units a day if youre a woman. Read more about alcohol misuse and find out how to get support for a drinking problem . Drug misuse is also linked to a loss of sex drive. Read more about drugs for information and advice. Getting older Many people lose some interest in sex as they get older, mainly as a result of falling levels of sex hormones, age-related health problems, or the side effects of medication. Older men especially can develop low testosterone levels, which can cause fatigue, depression and a reduced sex drive. Speak to your GP if youre concerned about this. They may carry out a blood test to check your testosterone level and can tell you about treatments if your level is low. As women start to approach the menopause , levels of the female hormone oestrogen begin to fall, which can affect libido. Women can also suffer from low testosterone levels, especially after a hysterectomy . Testosterone is another hormonethat can affect sex drive. Speak to your GP if youre concerned the menopause may be having an effect on your libido. They may be able to offer you a trial of hormone replacement therapy(HRT) if its suitable for you. Hormonal problems Less commonly, low libido may be caused by an underactive thyroid . This is where your thyroid gland (located in the neck) doesnt produce enough hormones. Common signs of an underactive thyroid are tiredness, weight gain and feeling depressed. An underactive thyroid is easily treated by taking hormone tablets to replace the hormones your thyroid isnt making. Learn more about treating underactive thyroid . A hormonal problem called hyperprolactinaemia can also have a negative effect on your sex drive. This is where you have a raised level of a substance called prolactin in your blood. Contraception Some women have reported a decreased sex drive while usingsome types of hormonalcontraception, such as: combined contraception, including the combined pill , vaginal ring ,or contraceptive patch the progestogen-only pill the contraceptive implant the Depo-Provera injection However, side effects of these contraceptivestend toimprove within a few months and theyre generally well tolerated. Speak to your GP or local contraceptive (or family planning) clinic if youre worriedyour contraceptionis causing a loss of libido. They may suggest trying an alternative method. Read more about choosing a method of contraception Other medical conditions Long-term (chronic) medical conditions such as cardiovascular disease , diabetes and obesity can also have a negative effect on your libido. Medication Certain medications can sometimes reduce libido, such as: medication for high blood pressure , including diuretics medications for depression, including SSRI antidepressants medications for seizures (fits) medications commonly used to treat psychosis (a mental condition where a person cant distinguish between reality and their imagination), such as haloperidol, as well as many other conditions medicines such as cimetidine, finasteride and cyproterone, which block the effects or reduce the production of testosterone See your GP if youre worried that medication youre taking is responsible for your reduced sex drive. They can review your medication and switch your prescription to something less likely to affect your libido if necessary. Find your local GP practice Last updated: 20 January 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Find your local GP practice Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Lung cancer | Lung cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Lung cancer Lung cancer About lung cancer Symptoms of lung cancer Causes of lung cancer Diagnosing lung cancer Treating lung cancer Living with lung cancer Preventing lung cancer About lung cancer Lung cancer is one of the most common and serious types of cancer. There are usually no signs or symptoms in the early stages of lung cancer, but many people with the condition eventually develop symptoms including: a persistent cough coughing up blood persistent breathlessness unexplained tiredness and weight loss an ache or pain when breathing or coughing You should speak to your GP if you have these symptoms. Read more about the symptoms of lung cancer Types of lung cancer Cancer that begins in the lungs is called primary lung cancer. Cancer that spreads from the lungs to another place in the body is known as secondary lung cancer. Thispage is aboutprimary lung cancer. There are 2 main types of primary lung cancer.These are classified by the type of cells in which the cancer starts. They are: non-small-cell lung cancer the most common type, accounting for more than 80% of cases; can be eithersquamous cell carcinoma, adenocarcinoma or large-cell carcinoma small-cell lung cancer a less common type thatusually spreadsfaster than non-small-cell lung cancer The type of lung cancer you have determines which treatments are recommended. Read more about diagnosing lung cancer Whos affected Lung cancer mainly affects older people.Itsrare in people younger than 40, and the rates of lung cancer rise sharply with age. Lung cancer is most commonlydiagnosed in people aged 70to 74. Although people who have never smoked can develop lung cancer, smoking is the main cause (accounting for over 85% of cases). This is because smoking involves regularly inhaling a number of different toxic substances. Read more about: causes of lung cancer preventing lung cancer Treating lung cancer Treatment depends on the type of cancer, how far its spread and how good your general health is. If the condition is diagnosed early and the cancerous cells are confined to a small area, surgery to remove the affected area of lung is usually recommended. If surgery is unsuitable due to your general health, radiotherapy to destroy the cancerous cells may be recommended instead. If the cancer has spread too far for surgery or radiotherapy to be effective, chemotherapy is usually used. Read more about treating lung cancer Symptoms of lung cancer Symptoms of lung cancer develop as the condition progresses and there are usually no signs or symptoms in the early stages. The main symptoms of lung cancer are: a cough that doesnt go away after 2 or 3 weeks a long-standing cough thatgets worse persistent chest infections coughing up blood an ache or pain when breathing or coughing persistent breathlessness persistent tiredness or lack of energy loss of appetite or unexplained weight loss Less common symptoms of lung cancer include: changes in the appearance of your fingers, such as becoming more curved or their ends becoming larger (this is known as finger clubbing) a high temperature (fever) of 38C (100.4F) or above difficulty swallowing or pain when swallowing wheezing a hoarse voice swelling of your face or neck persistent chest or shoulder pain If you have any of these, you should speak to your GP. Read further information: Cancer Research UK: Symptoms of lung cancer Macmillan Cancer Support: Signs and Symptoms of lung cancer Causes of lung cancer Most cases of lung cancer are caused by smoking, although people who have never smoked can also develop the condition. Smoking Smoking cigarettes is the single biggest risk factor for lung cancer.Its responsible for more than 85% of all cases. Tobacco smoke contains more than 60 different toxic substances, which canlead tothe development of cancer. These substances are known to be carcinogenic (cancer-producing). If you smoke more than 25 cigarettes a day, you are 25 times more likely to get lung cancer than a non-smoker. While smoking cigarettes is the biggest risk factor, using other types of tobacco products can also increase your risk of developing lung cancer and other types of cancer, such as oesophageal cancer and mouth cancer . These products include: cigars pipe tobacco snuff (a powdered form of tobacco) chewing tobacco Smoking cannabis has also been linked to an increased risk of lung cancer. Most cannabis smokers mix their cannabis with tobacco.While they tend to smoke less than tobacco smokers, they usually inhale more deeply and hold the smoke in their lungs for longer. Its beenestimated that smoking 4 joints (homemade cigarettes mixed with cannabis) may be as damaging to the lungs as smoking 20 cigarettes. Even smoking cannabis without mixing it with tobacco is potentially dangerous. This is because cannabis also contains substances that can cause cancer. Passive smoking If you dont smoke, frequent exposure to other peoples tobacco smoke (passive smoking) can increase your risk of developing lung cancer. For example, research has found that non-smoking women who share their house with a smoking partner are 25% more likely to develop lung cancer than non-smoking women who live with a non-smoking partner. Radon Radon is a naturally occurring radioactive gas thatcomes from tiny amounts of uranium present in all rocks and soils. It can sometimes be found in buildings. If radon is breathed in, it can damage your lungs, particularly if youre a smoker. Occupational exposure and pollution Exposure to certain chemicals and substances used in several occupations and industries has been linked to a slightly higher risk of developing lung cancer. These chemicals and substances include: arsenic asbestos beryllium cadmium coal and coke fumes silica nickel Read more information about asbestosis and silicosis. Researchalso suggests that being exposed to large amounts of diesel fumes for many years may increase your risk of developing lung cancer by up to 50%. One study has shown that your risk of developing lung cancer increases by about a third if you live in an area with high levels of nitrogen oxide gases (mostly produced by cars and other vehicles). Read further information about the causes and risk factors for lung cancer Diagnosing lung cancer Speak to your GP if you have symptoms of lung cancer , such as breathlessness or a persistent cough. Your GP will ask about your general health and what symptoms youve been experiencing. They may examine you and ask you to breathe into a device called a spirometer, which measures how much air you breathe in and out. You may be asked to have a blood test to rule out some of the possible causes of your symptoms, such as a chest infection . In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of lung cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected lung cancer. Chest X-ray A chest X-ray is usually the first test used to diagnose lung cancer. Most lung tumours show up on X-rays as a white-grey mass. However, chest X-rays cant give a definitive diagnosis because they often cant distinguish between cancer and other conditions, such as a lung abscess (a collection of pus that forms in the lungs). If your chest X-ray suggests you may have lung cancer, you should be referred to a specialist (if you havent already) in chest conditions such as lung cancer. A specialist can carry out more tests to investigate whether you have lung cancer and, if you do,what type it isand how much its spread. CT scan A computerised tomography (CT) scan is usually carried out after a chest X-ray. A CT scanuses X-rays and a computer to create detailed images of the inside of your body. Before having a CT scan, youll be given an injection of a contrast medium. This is a liquid containing a dye that makes the lungs show up more clearly on the scan. The scan is painless and takes 10 to 30 minutes to complete. PET-CT scan A PET-CT scan (which stands for positron emission tomography-computerised tomography) may be carried out if the results of the CT scan show you have cancer at an early stage. The PET-CT scan can show where there are active cancer cells. This can help with diagnosis and treatment. Before having a PET-CT scan, youll be injected with a slightly radioactive material. Youll be asked to lie down on a table, which slides into the PET scanner. The scan is painless and takes around 30 to 60 minutes. Bronchoscopy and biopsy If the CT scan shows there might be cancer in the central part of your chest, youll have a bronchoscopy. A bronchoscopy is a procedurethat allowsa doctor or nurse toremove a small sample of cells from inside your lungs. During a bronchoscopy, a thin tube called a bronchoscope is used to examine your lungs and take a sample of cells ( biopsy ). The bronchoscope is passed through your mouth or nose, down your throat and into the airways of your lungs. The procedure may be uncomfortable, but youll be given a mild sedative beforehand to help you relax and a local anaesthetic to make your throat numb. The procedure is very quick and only takes a few minutes. Other types of biopsy If youre not able to have one of the biopsies described above, or youve had one and the results werent clear, you may be offered a different type of biopsy. This may be a type of surgical biopsy such as a thoracoscopy or a mediastinoscopy, or a biopsy carried out using a needle inserted through your skin. Percutaneous needle biopsy A percutaneous needle biopsy involves removing a sample from a suspected tumour to test it at a laboratory for cancerous cells. The doctor carrying out the biopsy will use a CT scanner to guide a needle to the site of a suspected tumour through the skin. A local anaesthetic is used to numb the surrounding skin, and the needle is passed through your skin and into your lungs. The needle will then be used to remove a sample of tissue for testing. Thoracoscopy A thoracoscopy is a procedure that allows the doctor to examine a particular area of your chest and take tissue and fluid samples. Youre likely to need a general anaesthetic before having a thoracoscopy. Two or three small cuts will be made in your chest to pass a tube (similar to a bronchoscope) into your chest. The doctor will use the tube to look inside your chest and take samples. The samples will then be sent away for tests. After a thoracoscopy, you may need to stay in hospital overnight while any further fluid in your lungs is drained out. Mediastinoscopy A mediastinoscopy allows the doctor to examine the area between your lungs at the centre of your chest (mediastinum). For this test, youll need to have a general anaesthetic and stay in hospital for a couple of days. The doctor will make a small cut at the bottom of your neck so they can pass a thin tube into your chest. The tube has a camera at the end, which enables the doctor to see inside your chest. Theyll also be able to take samples of your cells and lymph nodes at the same time. The lymph nodes are tested because theyre usually the first place that lung cancer spreads to. Staging Once tests have been completed, it should be possible to work out what stage your cancer is, what this meansfor your treatment and whether its possible tocompletely cure the cancer. Non-small-cell lung cancer Non-small-cell lung cancer (the most common type)usually spreads more slowly than small-cell lung cancer and responds differently to treatment. Stage 1 The cancer is contained within the lung and hasnt spread to nearby lymph nodes. Stage 1 can also be divided into two sub-stages: stage 1A the tumour is less than 3cm in size (1.2 inches) stage 1B the tumour is 3-5cm (1.2-2 inches) Stage 2 Stage 2 is divided into 2 sub-stages: 2A and 2B. In stage 2A lung cancer, either: the tumour is 5to 7cm the tumour is less than 5cmand cancerous cells have spread to nearby lymph nodes In stage 2B lung cancer, either: the tumour is larger than 7cm the tumour is 5to 7cm and cancerous cells have spread to nearby lymph nodes the cancer hasnt spread to lymph nodes, but has spread to surroundingmuscles or tissue the cancer has spread to one of the main airways (bronchus) the cancer has caused the lung to collapse there are multiple small tumours in the lung Stage 3 Stage 3 is divided into 2 sub-stages: 3A and 3B. In stage 3A lung cancer, the cancer has either spread to the lymph nodes in the middle of the chest or into the surrounding tissue. This can be: the covering of the lung (the pleura) the chest wall the middle of the chest other lymph nodes near the affected lung In stage 3B lung cancer, the cancer has spread to either of the following: lymph nodes on either side of the chest, above the collarbones another important part of the body, such as the gullet (oesophagus), windpipe (trachea), heart or into a main blood vessel Stage 4 In stage 4 lung cancer, the cancer has either spread to both lungs or to another part of the body (such as the bones, liver or brain), or the cancer has caused fluid-containing cancer cells to build up around your heart or lungs. Small-cell lung cancer Small-cell lung cancer is less common than non-small-cell lung cancer. The cancerous cells responsible for the condition are smaller in size when examined under a microscope than the cells that cause non-small-cell lung cancer. Small-cell lung cancer onlyhas 2 possible stages: limited disease the cancer has not spread beyond the lung extensive disease the cancer has spread beyond the lung Cancer Research UK has further information on types of lung cancer . Treating lung cancer Treatment for lung cancer is carried out by a team of specialists who will work together to provide the best possible treatment. This team contains all the specialists required to make a proper diagnosis, to stage your cancer and to plan the best treatment. If you want to know more, ask your specialist about this. The type of treatment youll receive for lung cancer depends on several factors, including: the type of lung cancer you have (non-small-cell or small-cell cancer) the size and position of the cancer how far advanced your cancer is (the stage) your overall health Deciding what treatment is best for you can be difficult. Your cancer team will make recommendations, but the final decision will be yours. The main treatment options include surgery, radiotherapy and chemotherapy . Depending on your type of cancer and how advanced it is, you may receive a combination of these treatments. Your treatment plan Your treatment plan depends on whether you have non-small-cell lung cancer or small-cell lung cancer. Non-small-cell lung cancer If you have non-small-cell lung cancer thats confined to one lung and youre in good general health, youll probably have surgery to remove the cancerous cells. This may be followed by a course of chemotherapy to destroy any cancer cells that may have remained in the body. If the cancer hasnt spread too far but surgery isnt possible (for example, if your general health means you have an increased risk of developing complications), radiotherapy to destroy the cancerous cells will usually be recommended. In some cases, this may be combined with chemotherapy (known as chemoradiotherapy). If the cancer has spread too far for surgery or radiotherapy to be effective, chemotherapy is usually recommended. If the cancer starts to grow again after initial chemotherapy treatment, another course of treatment may be recommended. In some cases, a treatment called biological or targeted therapy may be recommended as an alternative to chemotherapy, or after chemotherapy. Biological therapies are medications that can control or stop the growth of cancer cells. Small-cell lung cancer Small-cell lung cancer is usually treated with chemotherapy, either on its own or in combination with radiotherapy. This can help to prolong life and relieve symptoms. Surgery isnt usually used to treat this type of lung cancer. This isbecause the cancer has often already spread to other areas of the body by the time its diagnosed. However, if the cancer is found very early, surgery may be used. In these cases, chemotherapy or radiotherapy may be given after surgery to help reduce the risk of the cancer returning. Surgery There are3 types of lung cancer surgery: lobectomy whereoneor more large parts of the lung (called lobes) are removed your doctors will suggest this operation if the cancer is just in 1 section of 1 lung pneumonectomy where the entire lung is removed this is used when the cancer is located in the middle of the lung or has spread throughout the lung wedge resection or segmentectomy where a small piece of the lung is removed (this procedure isonly suitable for a small number of patients, as it is only used if your doctors think your cancer is small and limited to one area of the lung this isusually very early-stage non-small-cell lung cancer) People are naturally concerned that they wontbe able to breathe if some or all of a lung is removed, but its possible to breathe normally with 1 lung. However, if you have breathing problems before the operation, such as breathlessness, its likely that these symptoms will continue after surgery. Tests before surgery Before surgery can take place, youll need to have a number of tests to check your general state of health and your lung function. These may include: an electrocardiogram (ECG) electrodes are used to monitor the electrical activity of your heart spirometry youll breathe into a machine called a spirometer, which measures how much air your lungs can breathe in and out How its performed Surgery is usually performed by making a cut (incision)in your chest or side, and removing a section or all of the affected lung. Nearby lymph nodes may also be removed if its thought that the cancer may have spread to them. In some cases, an alternative to this approach, called video-assisted thoracoscopic surgery (VATS), may be suitable. VATS is a type of keyhole surgery, where small incisions are made in the chest. A small fibre-optic camera is inserted into one of the incisions, so the surgeon can see images of the inside of your cheston a monitor. After the operation Youll probably beable to go home 5 to 10 days after your operation. However, it can take many weeks to recover fully from a lung operation. After your operation, youll be encouraged to start moving about as soon as possible. Even if you have to stay in bed, youll need to keep doing regular leg movements to help your circulation and prevent blood clots from forming. A physiotherapist will show you breathing exercises to help prevent complications. When you go home, youll need to exercise gently to build up your strength and fitness. Walking and swimming are good forms of exercise that are suitable for most people after treatment for lung cancer. Talk to your care team about which types of exercise are suitable for you. Complications As with all surgery, lung surgery carries a risk of complications. These are estimated to occur in 1 out in 5 cases. These complications can usually be treated using medication or additional surgery, which may mean you need to stay in hospital for longer. Complications of lung surgery can include: inflammation or infection of the lung ( pneumonia ) excessive bleeding a blood clot in the leg ( deep vein thrombosis ), which could potentially travel up to the lung (pulmonary embolism) Radiotherapy Radiotherapy is a type of treatment that uses pulses of radiation to destroy cancer cells. There are a number of ways it can be used to treat people with lung cancer. An intensive course of radiotherapy, known as radical radiotherapy, can be used to try to cure non-small-cell lung cancer if the person isnt healthy enough for surgery. For very small tumours, a special type of radiotherapy called stereotactic radiotherapy may be used instead of surgery. Radiotherapy can also be used to control the symptoms and slow the spread of cancer when a cure isnt possible (this is known as palliative radiotherapy). A type of radiotherapy known as prophylactic cranial irradiation (PCI) is also sometimes used during the treatment of small-cell lung cancer. PCI involves treating the whole brain with a low dose of radiation. Its used as a preventative measure because theres a risk that small-cell lung cancer will spread to your brain. The 3 mainways that radiotherapy can be given are described below: conventional external beam radiotherapy a machine is used to direct beams of radiation at affected parts of your body stereotactic radiotherapy a more accurate type of external beam radiotherapy where several high-energy beams are used to deliver a higher dose of radiation to the tumour, while sparing the surrounding healthy tissue as much as possible internal radiotherapy a catheter (thin tube) is inserted into your lung asmall piece of radioactive material is placed inside the catheter and positioned against the site of the tumour before being removed after a few minutes For lung cancer, external beam radiotherapy is used more often than internal radiotherapy, particularly if its thought that a cure is possible. Stereotactic radiotherapy may be used to treat tumours that are very small, as its more effective than standard radiotherapy alone in these circumstances. Internal radiotherapy only tends to be used as a palliative treatment when the cancer is blocking or partly blocking your airway. Courses of treatment A course of radiotherapy treatment can be planned in several different ways. Radical radiotherapy is usually given 5 days a week, with a break at weekends. Each session of radiotherapy lasts 10to 15 minutes and the course usually lasts 4 to 7 weeks. Continuous hyperfractionated accelerated radiotherapy (CHART) is an alternative method of delivering radical radiotherapy. CHART is given 3 times a day for 12 days in a row. For stereotactic radiotherapy, fewer treatment sessions are needed because a higher dose of radiation is delivered with each treatment. People having conventional radical radiotherapy are likely to have around 20to 32 treatment sessions, whereas stereotactic radiotherapy typically only requires anything from 3 to 10 sessions. Palliative radiotherapy usually only requires 1 to 5 sessions to control your symptoms. Side effects Side effects of radiotherapy to the chestinclude: chest pain fatigue persistent cough that may bring up blood-stained phlegm (this is normal and nothing to worry about) difficulties swallowing (dysphagia) redness and soreness of the skin, which looks and feels like sunburn hair losson your chest Side effects should pass once the course of radiotherapy has been completed. Chemotherapy Chemotherapy uses powerful cancer-killing medication to treat cancer. There are several different ways that chemotherapy can be used to treat lung cancer. For example, it can be: given before surgery to shrink a tumour, which can increase the chance of successful surgery(this is usually only done as part of a clinical trial) given after surgery to prevent the cancer returning used to relieve symptoms and slow the spread of cancer when a cure isnt possible combined with radiotherapy Chemotherapy treatments are usually given in cycles. A cycle involves taking the chemotherapy medication for several days, then having a break for a few weeks to let your body recover from the effects of the treatment. The number of cycles of chemotherapy you need will depend on the type and the grade of your lung cancer. Most people require four to 6 courses of treatment over 3 to 6 months. Chemotherapy for lung cancer involves taking a combination of different medications. The medications are usually delivered through a drip into a vein (intravenously), or into a tube connected to one of the blood vessels in your chest. Some people may be given capsules or tablets to swallow instead. Side effects Side effects of chemotherapy can include: fatigue nausea vomiting mouth ulcers hair loss These side effects should gradually pass once your treatment has finished, or you may be able to take other medicines to make you feel better during your chemotherapy. Chemotherapy can also weaken your immune system, making you more vulnerable to infection.Tell your care team or GP as soon as possible if you have possible signs of an infection, such as a high temperature (fever) of 38C (100.4F) or more, or you suddenly feel generally unwell. Other treatments As well as surgery, radiotherapy and chemotherapy, there are a number of other treatments that are sometimes used to treat lung cancer. Biological therapies Biological therapiesare newer medications. Theyre sometimes recommended as an alternative treatment to chemotherapy for non-small-cell cancer that has spread too far for surgery or radiotherapy to be effective. Examples of biological therapies includeerlotinib and gefitinib. These are also calledgrowth factor inhibitors because they work by disrupting the growth of the cancer cells. Biological therapies are only suitable for people who havecertain proteinsin their cancerous cells. Your doctor may be able to request tests ona smallsample of cells removed from your lung (biopsy) to determine whether these treatmentsare likely to be suitable for you. Radiofrequency ablation Radiofrequency ablation is a new type of treatment that can treat non-small-cell lung cancer diagnosed at an early stage. The doctor carrying out the treatment uses a computerised tomography (CT) scanner to guide a needle to the site of the tumour. The needle will be pressed into the tumour and radio waves will be sent through the needle. These waves generate heat, which kills the cancer cells. The most common complication of radiofrequency ablation is that a pocket of air gets trapped between the inner and outer layer of your lungs (pneumothorax). This can be treated by placing a tube into the lungs to drain away the trapped air. Cryotherapy Cryotherapy is a treatment that can be used if the cancer starts to block your airways. This is known as endobronchial obstruction, and it can cause symptoms such as: breathing problems a cough coughing up blood Cryotherapy is performed in a similar way to internal radiotherapy, except that instead of using a radioactive source, a device known as a cryoprobe is placed against the tumour. The cryoprobe can generate very cold temperatures, which help to shrink the tumour. Photodynamic therapy Photodynamic therapy (PDT)is a treatment that can be used to treat early-stage lung cancer when a person is unable or unwilling to have surgery. It can also be used to remove a tumour thats blocking the airways. Photodynamic therapy is carried out in 2 stages. Firstly, youll be given an injection of a medication that makes the cells in your body very sensitive to light. The next stage is carried out 24to 72 hours later. A thin tubewill be guided to the site of the tumour, and a laser will be beamed through it. The cancerous cells, which are now more sensitive to light, will be destroyed by the laser beam. Side effects of photodynamic therapy can include inflammation of the airwaysand a build-up of fluid in the lungs. Both these side effects can cause symptoms of breathlessness and lung and throat pain. However, these symptoms should gradually pass as your lungs recover from the effects of the treatment. Living with lung cancer Breathlessness is common in people who have lung cancer, whether it is a symptom of the condition or a side effect of treatment. Inmany cases, breathlessness can beimproved with some simple measures such as: breathing in slowly through your nose and out through your mouth (after treatment for lung cancer, you may see a physiotherapist, who can teach you some simple breathing exercises) making daily activities easier for example, using a trolley when you go shopping or keeping things you often need downstairs so you dont need to regularly walk up and down the stairs using a fan to direct cool air towards your face eating smaller and more frequent meals, and taking smaller mouthfuls Ifmeasures like these arent enough to control your breathlessness, you may need further treatment.There are a number of medications that can help improve breathlessness. Home oxygen treatmentmay be an option in more severe cases. If your breathlessness is caused by another condition, such as a chest infection ora fluid build-up around the lungs (a pleural effusion), treating thisunderlyingcausemayhelp your breathing. Read further information: Macmillan Cancer Support: Managing breathlessness Cancer Research UK: Coping with breathlessness The Roy Castle Lung Cancer Foundation: Managing lung cancer symptoms Pain Some people with lung cancer have pain, while others never have any. About 1 in 3 people who are treated forcancer experience some pain. Pain isnt related to the severity of the cancer it varies from person to person. What causes cancer pain isnt thoroughly understood, but there are ways of treating it so the pain can be controlled. Peoplewith advanced lung cancer may need treatment for pain as their cancer progresses. This can be part of palliative care and is often provided by doctors, nurses and other members of the palliative care team. You can have palliative care at home, in hospital, in a hospice or other care centre. Read further information: Macmillan Cancer Support: Controlling cancer pain Macmillan Cancer Support: Pain Emotional effects and relationships Having cancer can lead to a range of emotions. These may include shock, anxiety, relief, sadness and depression. People deal with serious problems in different ways. Its hard to predict how living with cancer will affect you. Being open and honest about how you feel and what your family and friends can do to help you may put others at ease. But dont feel shy about telling people that you need some time to yourself, if thats what you need. Read further information: Macmillan: Cancer and your emotions Talk to others Your GP or specialist nurse may be able to reassure you if you have questions, or you may find it helpful to talk to a trained counsellor, psychologist or specialist phone helpline. Your GP practice will have information on these. You may find it helpful to talk about your experience of lung cancer with others in a similar position at a local support group. Patient organisations have local groups where you can meet other peoplewho have been diagnosed with lung cancer and had treatment. If you have feelings of depression , talk to your GP they can provide advice and support. Read further information: The Roy Castle Lung Cancer Foundation: Lung cancer support groups Macmillan Cancer Support: Depression Money and financial support If you have to reduce or stop work because of cancer, you may find it hard to cope financially. If you have cancer or youre caring for someone with cancer, you may be entitled to financial support. If you have a job but cant work because of your illness, you are entitled to Statutory Sick Pay from your employer. If you dont have a job and cant work because of your illness, you may be entitled to Employment and Support Allowance . If youre caring for someone with cancer, you may be entitled to Carers Allowance . You may be eligible for other benefits if you have children living at home or you have a low household income. Its a good idea to find out early on what help is available to you. You could ask to speak to the social worker at your hospital, whocangive you the information you need. Read further information: GOV.UK: Carers and disability benefits . Macmillan Cancer Support: Money, finance and insurance Palliative care If you have a lot of symptoms caused by lung cancer, your GP and healthcare team will need to give you support and pain relief. This is called palliative care. Support is also available for your family and friends. As your cancer progresses, your doctor should work with you to establish a clear management plan based on your (and your carers) wishes. This includes whether youd prefer to go to hospital, a hospice, or be looked after at home as you become progressively more ill. It will take account of what services are available to you locally, whats clinically advisable and your personal circumstances. More about palliative care Read further information: NICE: Supportive and palliative care for adults with cancer Macmillan Cancer Support: Looking after | null | null | null | null | null | null | null | null | null | null | null | null | null |
omeone with cancer Marie Curie Cancer Care: Support for patients Preventing lung cancer If you smoke | the best way to prevent lung cancer and other serious conditions is to stop smoking as soon as possible. However long you have been smoking | its always worth quitting. Every year you dont smoke decreases your risk of getting serious illnesses | such as lung cancer. After 10 years of not smoking | your chances of developing lung cancer falls to half that of someone who smokes. Quit Your Way Scotland can offer advice and encouragement to help you quit smoking. Your GP or pharmacist can also give you help and advice about giving up smoking. Diet Research suggests that eating a low-fat | high-fibre diet | including at least 5 portions a day of fresh fruit and vegetables and plenty ofwhole grains | can reduceyour risk of lung cancer | as well as other types of cancer and heart disease. More about eating well Exercise Theresstrong evidence to suggest that regular exercise can lower the risk of developing lung cancer and other types of cancer. Adults should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity each week. More about keeping active Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name | location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Other health sites Cancer Research UK: Lung cancer Macmillan Cancer Support: Lung cancer The Roy Castle Lung Cancer Foundation British Lung Foundation: Lung cancer Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852" | null | null | null | null | null |
Lupus | "Lupus | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Immune system Lupus Lupus About lupus Symptoms of lupus Causes of lupus Diagnosing lupus Treating lupus Complications of lupus About lupus Lupus is a complex and poorly understood condition that affects many parts of the body and causes symptoms ranging from mild to life-threatening. Types of lupus There are some types of lupus that just affect the skin such as discoid lupus erythematosus and subacute cutaneous lupus erythematosus. Some medications can also cause lupus-like side effects. However, the term lupus is most often used to describe a more severe form of the condition called systemic lupus erythematosus (SLE), which can affect many parts of the body, including the skin, joints and internal organs. Symptoms range from mild to severe, and many people will have long periods with few or no symptoms before experiencing a sudden flare-up, where their symptoms are particularly severe. Even mild cases can be distressing and have a considerable impact on a persons quality of life. The rest of this article will focus on SLE. Signs and symptoms SLE can cause a wide range of symptoms, depending on the areas of the body that are affected. The most common symptoms are: fatigue (extreme tiredness) rashes particularly on the face, wrists and hands joint painand swelling As thesymptoms of SLE can be similar to a number of other conditions, many of which are more common, it can be difficult to diagnose. If youhave persistent or troublesome symptoms that you think could be caused by SLE, you should see your GP so they can try to determine the cause. Read more about the symptoms of lupus and diagnosing lupus . What causes lupus? SLEis an autoimmune condition, which means it is caused by problems with the immune system. For reasons not yet understood, the immune system in people with SLE starts to attack and inflame healthy cells, tissue and organs. As with other more common autoimmune conditions, such as rheumatoid arthritis , it is thought a combination of genetic and environmental factorsmay beresponsible for triggeringSLE in certain people. Read moreabout the causes of lupus . Who is affected SLE is an uncommon condition where a round 90% of cases occur in women. The condition is most common in women of childbearing age (between the ages of 15 and 50), but it can also affect people of other ages. The condition tends to be less common in people of white European origin and more common in those of African, Caribbean or Asian origin. Howlupus is treated There is currently no cure for SLE, but there are different medications that can help relieve many of the symptoms and reduce the chances of organ damage. These medications include: hydroxychloroquine a medicine that has historically been used to treat malaria , but can also help treat some symptoms of SLE corticosteroids anti-inflammatory medications immunosuppressants a group of medicines that suppress your immune system With good levels of support from friends, family and healthcare professionals, many people with SLE are able to manage their condition effectively. Read moreabout treating lupus . Outlook A few decades ago SLE was regarded as a terminal condition, as many people would die of an associated complication within a few years of being diagnosed. As a result of early diagnosis and advances in treatment, however, the outlook for SLE is now much better. The vast majority of people diagnosed with the condition will have a normal or near-normal life expectancy. However, some people with SLE are still at risk of life-threatening complications as a result of damage to internal organs and tissues, such as heart attack or stroke . SLE, and some of the treatments for it, can also increase your risk of developing potentially serious infections. Read more about the complications of lupus . Symptoms of lupus Symptoms of systemic lupus erythematosus (SLE) can vary widely from person to person. Some people may only experience a few mild symptoms, whereas others may be more severely affected. Even if you usually have mild symptoms, SLE can flare-up, with symptoms becoming more severe or new symptoms developing. Mainsymptoms The 3main symptoms of SLE are fatigue, joint pain andrashes. Fatigue Fatigue is one of the most common symptoms of SLE. You may feel very tired even though youget plenty of sleep. Carrying out everyday tasks, such as housework or office work, can leave you feeling exhausted. Many people with SLE find that fatigue is the most distressing and disruptive aspect of SLE because it has a negative impact ontheir work and social life. Joint pain If you have SLE, you are likely to experience joint pain in your hands and feet. You may find the pain changes from one set of joints to another quite quickly, and is usually worse in the morning. Unlike some other conditions that affect the joints, SLE is unlikely to cause your joints to become permanently damaged or deformed. Rashes Many people with SLE develop rashes on their skin most commonly on the face, wrists and hands. A rash over the cheeks and the bridge of the nose is particularly common and is known as a butterfly rash or malar rash. Rashes caused by SLE mayget betterafter a few days or weeks, but can last longer or even be permanent. Rashes caused by SLE can sometimes be itchy or painful, and they may get worse if they are exposed to sunlight. This is known as photosensitivity. Other symptoms SLE can also cause a wide range of symptoms.However, youre unlikelyto have all of the symptoms listed below, and many people with the condition will only experiencethe main symptoms. Otherfeatures of SLE may include: a fever (high temperature) swollen lymph glands (small glands found throughout your body, including in your neck, armpits and groin) recurring mouth ulcers hair loss(alopecia) high blood pressure (hypertension) headaches and migraines stomach (abdominal) pain chest pain depression dry eyes memory loss seizures (fits) problems thinking clearly and difficulty telling the difference between reality and imagination ( psychosis ) shortness of breath Raynauds phenomenon a condition that limits the blood supply to your hands and feetwhen it is cold ankle swelling and fluid retention (oedema) When to seek medical advice You should see your GP if you have persistent or troublesome symptoms that you think could be caused by SLE. While it is likely that your symptoms are being caused by a more common condition, it is important to see a doctor for a diagnosis. Read more about diagnosing lupus . Causes of lupus Systemic lupus erythematosus (SLE) is an autoimmune condition, which means it is caused by problems with the immune system. The immune system is the bodys natural defence against illness and infection. When the immune system detects the presence of an infectious agent, such as bacteria or a virus, it sends white blood cells and antibodies to attack it. In cases of SLE, antibodies released by the immune system can attack healthy tissue, cells and organs. Its not clear exactly why this happens, although most experts think SLE has more than one cause. It has been suggested that there may be a number of genetic factors that make people more susceptible to the condition, and that it also takes one or more environmental factors to trigger SLE in those who are susceptible. Possible genetic and environmental factors are discussed in more detail below. Genetic factors Brothers and sisters of people with SLE are much more likely to develop the condition than the population at large. Researchers have identified a number of different genetic mutations that seem to make people more susceptible to developing SLE. A genetic mutation occurs when normal instructions carried in certain genes become scrambled, resulting in the bodys processes not working normally. Most faulty genes are associated with regulating certain functions of the immune system, which may explain why the immune system in people with SLE starts to malfunction. Environmental factors A number of environmental factors may be responsible for triggering SLE in vulnerable individuals, although the evidence for many of these is limited. Possible environmental factors that have been suggested include: exposure to sunlight (ultraviolet light) hormonal changes that occur during a womans lifetime, such as duringpuberty or pregnancy certain infections, such as by theEpstein-Barr virus (EBV) a common viral infection that doesnt usually cause any symptoms smoking Diagnosing lupus Systemic lupus erythematosus (SLE) can be difficult to diagnose, as it has similar symptoms to several other, far more common, conditions. Diagnosis may also be difficultbecausesymptoms can vary greatly from person to person, and they may change over time. For example, there may be periods where your symptoms are not very noticeable, or times when they flare up and become more severe. For a confident diagnosis of SLE to be made, you will need to have several symptoms of lupus and a number of blood tests may need to be carried out. Blood tests Some of the blood tests that may be carried out are described below. Erythrocyte sedimentation rate (ESR) test A blood test called theerythrocyte sedimentation rate (ESR) test can be used todetermine whether there is any inflammation in your body. This can be useful in diagnosing SLE because the condition can causemany areas of the body to become inflamed (swell), includingthe joints and internal organs. The test works by measuring how long it takes for red blood cells to fall to the bottom ofa test tube. The quicker they fall, the more likely it is that there are high levels of inflammation. Anti-nuclear antibody test An anti-nuclear antibody test checkswhether there is a certain type of antibody cell in your blood, known as the anti-nuclear antibody. Approximately 95% of people with SLE have this antibody. However, it is possible to have the anti-nuclear antibody without having SLE, so the anti-nuclear antibody test is not a definitive way of testing for the condition.Other blood tests will also be needed to confirm the diagnosis. Anti-DNA antibody test An anti-DNA test also checks for a certain type of antibody in your blood, known as the anti-DNA antibody. If you have the anti-DNA antibody, it is highly likely that you have SLE. However, the antibody is only found in around 70% of people with the condition. The level of anti-DNA antibodies increases when SLE is more active, so during a flare-up of symptoms your reading from this test may be greater than normal. Complement level test Complement is a chemical in the blood that forms part of your immune system.The level of this chemical may be tested to check how active your SLE is. The level of complement in your blood decreases when SLE is more active. Other tests Once you have been diagnosed with SLE, you will normally need regularmonitoring to seehow the condition is affecting your body. If you have SLE it is possible you maydevelop other conditions, such as kidney problems. Monitoring your condition will allow your doctor to check for these complications and, if necessary, treat them as soon as possible. You may need to have scans, such as an X-ray , ultrasound scan, magnetic resonance imaging (MRI) scan or a computerised tomography (CT) scan to check whether SLE is affecting your internal organs. Read more about the complications of lupus . Treating lupus There is currently no cure for systemic lupus erythematosus (SLE), but treatments that can ease the symptoms and make it easier to live with are available. In most cases, treatment will involve a combination of self-care measures and medication. Protecting yourself from the sun Exposure to sunlight can sometimes make symptoms such as rashes worse, and itsimportant to protect your skin whenin the sun. This means wearing clothing that covers your skin, a wide-brimmed hat and sunglasses. You will also need to apply sunscreen with a high SPF to prevent sunburn. However, some people with lupusare not sun-sensitive and do not need to take extra precautions. As people get most of theirvitamin Das a result ofdirect sunlight onthe skin, there is a risk youmay not get enough of this vitamin if you need to avoid sun exposure.This means you may need to make an extra effort to include good sources of vitamin D in your diet to avoid problems such as osteoporosis (weakened bones), and you may be advised to take vitamin D supplements. Non-steroidal anti-inflammatory drugs (NSAIDs) Non-steroidal anti-inflammatory drugs (NSAIDs) are a common painkilling medication that reduces inflammation in the body. If you experience joint or muscle pain as a result of SLE, you may be prescribed a NSAID to help ease your symptoms. Commonly prescribed NSAIDs for SLE include ibuprofen , naproxenand diclofenac. You can buy some NSAIDs, such as ibuprofen, over the counter. These NSAIDs may be suitable if your joint or muscle pain is mild. For more severe pain, you will need stronger medication prescribed by your GP. NSAIDs may not be suitable for people who have stomach, kidney or liver problems, or have had these problems in the past. They may also be unsuitable for people with asthma. Your GP will adviseabout which NSAID is rightfor you. Side effects If taken in high doses or over long periods of time, NSAIDs can damage your stomach lining, which may cause internal bleeding. If you need to take NSAIDs on a long-term basis, your GP will carefully monitor you to check for any problems, and you may be prescribed an additional medication called a proton pump inhibitor (PPI) to protect your stomach. Hydroxychloroquine Hydroxychloroquineis a medicinethat has beenused to treat malaria , butis also effective in treating some of the symptoms of SLE, such as rashes, joint and muscle pain, and fatigue. You will usually have to take hydroxychloroquine for 6 to 12 weeks before younotice any benefit. Most expert doctors recommendpeople with SLE take hydroxychloroquine on a long-term basis as a way of controlling their symptoms, helping to prevent flare-ups and to prevent development of more serious problems from lupus. Side effects Side effects of hydroxychloroquine are uncommon, but may include indigestion , diarrhoea , headaches andrashes. Hydroxychloroquine may also cause more serious side effects in a small number of people. For example, in rare cases, this medicine can causeeye damage. Contact your GP or specialist immediately if you experience vision problems while taking hydroxychloroquine. If your GP or specialist feels it is necessary, you may need regular eye examinations. Corticosteroids Corticosteroids area type of medicine that help reduce inflammation quickly. They can be very effective in treating symptoms of SLE, but are usually only prescribed if the condition is severe. If you have severe symptoms of SLE, or if you are experiencing a flare-up, you may be given a large dose of corticosteroids to help bring your symptoms under control. As your symptoms ease, your dosage can gradually be reduced. Side effects When prescribing corticosteroids, the lowest effective dosage is always given. This is because high doses or long-term use of corticosteroids can cause side effects. These may include: thinning of your bones thinning of your skin weight gain high blood pressure (hypertension) Corticosteroids are a safe and effective form of treatment, providedthey are taken correctly and under the supervision of your GP or specialist. They will tailor the steroid dose to your disease activity, to minimise side effects while effectively controlling the condition. Immunosuppressants Immunosuppressants are a type of medicine that suppress your immune system. They can help improve your symptoms of SLE by limiting the damageyour immune system causes when it attacks healthy parts of your body. Commonly prescribed immunosuppressant medicines include azathioprine,methotrexate, mycophenolate mofetiland cyclophosphamide. Immunosuppressants are sometimes used in conjunction with corticosteroids (see above) because these medicines may ease your symptoms more effectively when used together. Alternatively, the use of immunosuppressant medication may allow your corticosteroid dose to be reduced. Side effects Immunosuppressant medication is usually only prescribed if you have severe SLE. This is because this type of medication is powerful and can cause side effects such as: loss of appetite vomiting diarrhoea swollen gums bruising or bleeding more easily headache acne extra hair growth weight gain liver damage an increased risk of infection (see below) Methotrexate, mycophenolate mofetil and cyclophosphamide can also cause birth defects if they are taken during pregnancy, so you should use a reliable form of contraception if you are taking these medications and are sexually active. If you are trying to become pregnant, an alternative medication such as azathioprine can be used. Tell your GP if a side effect becomes particularly troublesome, asit may mean your dose needs to be adjusted. Infection risk Taking immunosuppressant medication can increase your risk of developing an infection. This is a particularly seriousconcern for people with SLE, because the organ damage that can occur as a resultof the condition means infections are more likely to be life-threatening. It is thereforevery important to report anysymptoms of a possible infection to your GP immediately. Symptoms of infection may sometimes be similar to a flare up ofSLE and include: a fever (high temperature) a cough or breathlessness burning when passing urine orpassing blood inyour urine diarrhoea You should also try to avoid contact with anyone known to have an infection even if it is an infection you were previously immune to, such as chickenpox or measles .This is because your previous immunity to these conditions will probably be suppressed (lowered). Rituximab Rituximabis a new type of medicationused in people with severe SLEthatdoesnt respond to other treatments. Rituximab was originally designed to treat certain types of cancer, such as lymphoma , but it has since proved effective in treating a number of autoimmune conditions, such as SLE and rheumatoid arthritis . Rituximab works by locking on to and killing cells called B-cells, which produce antibodies responsible for the symptoms of SLE. It is administered directly into your vein over the course of several hours, known as an infusion. Rituximab is not currently licensed for treating SLE in the UK, but your specialist may consider it an appropriate treatment for you. If your doctor suggests using rituximab, they should tell you that there are currently some uncertainties about how effective or safeit is in treating SLE. Side effects Common side effects of rituximab include: flu -like symptoms, such as chills and a high temperature dizziness vomiting In rare cases, rituximab can cause a more serious allergy-like reaction. Most reactions occur during or shortly after the treatment is given, so you will be closely monitored once your treatment begins. Belimumab Belimumab is a new medication given to people with active SLE who dont respond to other treatments. Itworks by binding to growth factors that are needed for the survival of B-cells. It is given directly into your vein over several hours, known as an infusion. The first 3doses are given 14 days apart, andthe medication is usually given once a month thereafter. Belimumab is licensed for treating SLE in the UK, and there may be instances where your specialist may consider it an appropriate treatment for you. If your doctor suggests using belimumab, they should tell you that there are currently some uncertainties about how effective or safe it is in treating SLE. Side effects Common side effects of belimumab include: flu-like symptoms, such as chills and a high temperature nausea and diarrhoea headache difficulty sleeping ( insomnia ) a cough, sore throat and blocked or runny nose joint pain increased risk of infections changes in blood pressure In rare cases, belimumab can cause a more serious allergy-like reaction. Most reactions occur during or shortly after the treatment is given, so you will be closely monitored once your treatment begins. Complications of lupus If your symptoms of systemic lupus erythematosus (SLE) are mild or well-controlled, you may find it barely affects your day-to-day life and that you do not have any complications. However, for some people, SLE can be a more serious conditionthat can cause life-threatening complications. Some ofthesecomplications are outlined below. Kidney problems Around 1in every 3people with SLEwill develop a potentially serious kidney disease called lupus nephritis, which is caused by prolonged inflammation of the kidneys. Lupus nephritis tends to develop relatively early in the course of SLE, usually within five years of diagnosis. Symptoms of lupus nephritis can include: swelling of your feet (oedema) headaches dizziness blood in your urine a frequent need to urinate Lupus nephritis can also cause high blood pressure (hypertension). If left untreated, it can put you at risk of developing life-threatening problems such as a heart attack or stroke . In many cases, lupus nephritis does not cause any noticeable symptoms. However, this does not mean the condition is not dangerous, as the kidneys could still be being damaged. If you have SLE, it is likely you will need to have regular blood tests so the condition of your kidneys can be carefully monitored. If you develop lupus nephritis, it can usually be successfully controlled using immunosuppressants such as mycophenolate mofetil or cyclophosphamide. In a small number of cases, the kidney damage can become severe enough to require treatment with dialysis (where a machine is used toreplicates many of the kidneys functions) or a kidney transplant. Cardiovascular disease Cardiovascular disease (CVD) is a general term for any type of health condition that affects the heart and arteries. It is often associated withblood clots andatherosclerosis(hardening and narrowing of the arteries). Examples of CVD include coronary heart disease , angina (chest pain caused by the heartnot receiving enough blood), heart attack and stroke. People with SLE are more likely to develop CVDthan the general population, because SLE can cause your heart and arteries to become inflamed and damaged. If you have SLE, you can reduce your risk of CVD by making health lifestyle chances, such as: stopping smoking if you smoke eating a healthy, balanced diet low in saturated fat, sugar and salt, and containing at least five portions of fruit and vegetables a day maintaining a healthy weight exercising regularly at least150 minutes (two-and-a-half hours) a week of exercise strenuous enough to leave you slightly out of breath is recommended cutting down on your alcohol consumption Pregnancy complications SLE does not usually affect fertility, but it can increase your risk of experiencing pregnancy complications, such as: pre-eclampsia (a condition that causes high blood pressure during pregnancy) premature delivery miscarriage stillbirth Some children of women with SLE can also be born with heart block (where electrical pulses that control the beating of the heart are disrupted) and rashes. This is known as neonatal lupus syndrome. If you have SLE and are thinking of having a baby, it is best to plan this carefully with your doctors if possible. The risk of complications is higher if you become pregnant during periods where your symptoms are particularly severe, so you will usually be advised to try to avoid getting pregnant until your symptoms are better controlled. If you do become pregnant, you will need to be monitored closely by your specialist andby an obstetrician, so they can check for any problems. Source: NHS 24 - Opens in new browser window Last updated: 22 February 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Arthritis Sjogren's syndrome Other health sites Lupus UK NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852" | null | null | null | null | null | null | null | null | null | null | null | null | null |
Lyme disease | Lyme disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Lyme disease Lyme disease Learn about the symptoms, causes, treatment, and when to speak to your GP. What is Lyme disease? Lyme disease is a bacterial infection spread to humans by infected ticks. Its also known as Lyme borreliosis. Ticks are tiny spider-like creatures found in woodland and moorland areas. They feed on the blood of birds and mammals, including humans. Lyme disease is usually easier to treat the earlier its diagnosed. Find out more about tick bites and how to treat them Symptoms of Lyme disease Many people with early symptoms of Lyme disease develop a circular rash around the tick bite . The rash: usually develops around 3 to 30 days after youve been bitten is often described as looking like a bulls-eye on a dart board will be red and the edges may feel slightly raised may get bigger over several days or weeks is typically around 15 cm (6 inches) across, but it can be much larger or smaller Some people may develop several rashes in different parts of their body. Around 1 in 3 people with Lyme disease wont develop a rash. Other symptoms of Lyme disease Some people with Lyme disease also have flu-like symptoms in the early stages, like: tiredness (fatigue) muscle pain joint pain headaches a high temperature (fever) chills neck stiffness When to contact your GP Speak to a GP if: Youve been bitten by a tick and you: develop a rash have flu-like symptoms Remember to tell them youve been bitten by a tick. Later symptoms of Lyme disease More serious symptoms may develop if Lyme disease is left untreated or is not treated early. These can include: pain and swelling in the joints nerve problems such as numbness or pain in your limbs memory problems difficulty concentrating heart problems Some of these problems will get better slowly with treatment. But they can persist if treatment is started late. A few people with Lyme disease go on to develop long-term symptoms similar to those of fibromyalgia or chronic fatigue syndrome.This is known as post-infectious Lyme disease. Its not clear exactly why this happens. Its likely to be related to overactivity of your immune system rather than continued infection. How you get Lyme disease If a tick bites an animal carrying the bacteria that cause Lyme disease, the tick can become infected. The tick can then transfer the bacteria to a human by biting them. Ticks dont jump or fly. They climb on to your clothes or skin if you brush against something theyre on. They then bite into the skin and start to feed on your blood. Generally, youre more likely to become infected if the tick is attached to your skin for more than 24 hours. Ticks are very small and their bites are not painful, so you may not realise you have one attached to your skin. Where are ticks found? Ticks are found throughout the UK and in other parts of Europe and North America. There are a high number of ticks in the Scottish Highlands. They can be found in any areas with deep or overgrown plants where they have access to animals to feed on. Theyre common in woodland and moorland areas, but can also be found in gardens or parks. Whos at risk of Lyme disease? The risk of getting Lyme disease is higher: for people who spend time in woodland or moorland areas from March to October because more people take part in outdoor activities Its thought only a small proportion of ticks carry the bacteria that cause Lyme disease. Being bitten doesnt mean youll definitely be infected. However, its important to be aware of the risk and speak to a GP if you start to feel unwell. Diagnosing Lyme disease Diagnosing Lyme disease is often difficult as many of the symptoms are similar to other conditions. There are 2 kinds of blood test use to diagnose Lyme disease. The tests are not always accurate in the early stages of Lyme disease. So you may need tested more than once if you still have symptoms after a negative result. Treating Lyme disease If you have symptoms of Lyme disease, youll normally be given antibiotics . If youre prescribed antibiotics, its important you finish the course even if youre feeling better. Thisll help ensure all the bacteria are killed. If your symptoms are particularly severe, you may need antibiotic injections (intravenous antibiotics). Some of the antibiotics used to treat Lyme disease can make your skin more sensitive to sunlight. You should avoid prolonged exposure to the sun and not use sunbeds until after you have finished the treatment. Theres currently no agreement on the best treatment for post-infectious Lyme disease. This is because the underlying cause is not yet clear. Be wary of internet sites offering alternative diagnostic tests and treatments. These may not be supported by scientific evidence. Preventing Lyme disease Theres currently no vaccine available to prevent Lyme disease. The best way to prevent it is to adopt easy habits when youre in the countryside or near wildlife. Do try to stick to hard paths wear long trousers in overgrown areas tuck your trousers into your socks wear insect repellent check for ticks on your body after walking or camping NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Lymphoedema | Lymphoedema - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Blood and lymph Lymphoedema Lymphoedema About lymphoedema Symptoms of lymphoedema Causes of lymphoedema Diagnosing lymphoedema Treating lymphoedema Complications of lymphoedema Preventing lymphoedema About lymphoedema Lymphoedema is a chronic (long-term) condition that causes swelling in the bodys tissues. It can affect any part of the body, but usually develops in the arms or legs. Other symptoms of lymphoedema can include an aching, heavy feeling in affected body parts and difficulty moving them. Lymphoedema can get worse if its not treated, so you should speak to a doctor if you think you may have the condition. Read more about the symptoms of lymphoedema and diagnosing lymphoedema What causeslymphoedema? Lymphoedema is caused by a problem with the lymphatic system. This is a network of vessels and glands distributed throughout the body. Its major functions are helping to fight infection and drain excess fluid from tissues. Abnormal development of the lymphatic system, damage to it, and/or an increase in fluid in the body tissues can all lead to lymphoedema. There are two main types of lymphoedema: primary lymphoedema caused by faulty genes affecting the development of the lymphatic system; it can develop at any age, but usually occurs in early adulthood secondary lymphoedema caused by damage to the lymphatic system or problems with the movement and drainage of fluid in the lymphatic system, often due to an infection, injury, cancer treatment, inflammation of the limb or a lack of limb movement Read more about the causes of lymphoedema Who is affected A recent study has suggested that over 200,000 people in the UK may be living with lymphoedema. Secondary lymphoedema has been shown to affect approximately one in five women after breast cancer treatment. Primary lymphoedema is less common than secondary lymphoedema, and is estimated to affect around one in every 6,000 people. How lymphoedema is treated There is no cure for lymphoedema, but it is usually possible to control the main symptoms using techniques to minimise fluid build-up and stimulate the flow of fluid through the lymphatic system. These include wearing compression garments, taking good care of your skin, moving and exercising regularly, having a healthy diet and lifestyle, and using specialised massage techniques. Read more about treating lymphoedema and preventing lymphoedema Complications The build-up of fluid in the tissues of people with lymphoedema means they are more vulnerable to infection. In particular, a bacterial infection of the skin called cellulitis is commonly reported in people with the condition. Read more about the complications of lymphoedema Symptoms of lymphoedema The main symptom of lymphoedema is swelling in all or part of a limb or another part of the body, which can cause problems fitting into clothes, or jewellery and watches starting to feel tight. At first, the swelling may come and go. It may get worse during the day and then go down overnight. Without treatment, it will usually become more severe and persistent. Other symptoms in an affected body part can include: an aching, heavy feeling difficulty with movement repeated skin infections the skin becoming hard and tight folds developing in the skin wart-like growths developing on the skin a leakage of fluid through the skin When these symptoms start depends on what is causing the condition. If lymphoedema is caused by abnormal development of the lymphatic system (a network of channels and glands distributed throughout the body that remove unwanted bacteria and particles from the body), the symptoms can develop at any age, but most commonly start during infancy, adolescence or early adulthood. In these cases, the swelling may start on one side of the body to begin with, although the other side will usually become swollen as well over time particularly the lower leg. If lymphoedema is caused by damage to the lymphatic system, the symptoms can develop at any time. For example, if your lymphatic system is damaged due to treatment for breast cancer , lymphoedema may not develop for several months or even years. Read more about the causes of lymphoedema When to seek medical advice If you are at risk of developing lymphoedema because you have had treatment for cancer , you may be offered an assessment for the condition as part of your treatment aftercare plan. Speak to your consultant or specialist nurse if you have any concerns. If you think you may have lymphoedema, but not as a result of treatment for cancer, see your GP. Read more about diagnosing lymphoedema Causes of lymphoedema There are two types of lymphoedema, called primary and secondary lymphoedema, which have different causes. The main causes of primary and secondary lymphoedema are outlined below. Primary lymphoedema Primary lymphoedema is caused by alterations (known as mutations) in genes responsible for the development of the lymphatic system (a network of channels and glands distributed throughout the body that help fight infection and remove excess fluid from the body). These faulty genes result in the parts of the lymphatic system responsible for draining fluid not developing properly or not working as they should. Primary lymphoedema usually runs in families, but not every child born to someone with the condition will develop it themselves. Secondary lymphoedema Secondary lymphoedema develops in people who previously had a normal lymphatic system. It can have a number of different causes. Some of the most common causes are explained below. Surgical treatment of cancer Cancer cells can spread around the body through the lymphatic system, so part of the treatment for the condition can involve surgically removing sections of the lymphatic system potentially containing cancerous cells. Although the surgeon will try to ensure limited damage to your lymphatic system, this isnt always possible. There is a particular risk of lymphoedema occurring as a complication of treatment for: breast cancer melanoma skin cancer gynaecological cancers such as cervical cancer and vulval cancer genitourinary cancers suchas prostate cancer or penile cancer Radiotherapy Radiotherapy uses controlled doses of high-energy radiation to destroy cancerous tissue, but it can also damage healthy tissue. If its necessary to use radiotherapy to destroy cancerous cells in your lymphatic system, there is a risk that the system could become permanently damaged and unable to drain fluid properly. Infections In some cases, an infection can cause lymphoedema. Cellulitis is a bacterial skin infection that can cause lymphoedema. Severe cellulitis can damage the tissue around the lymphatic system, causing it to become scarred. Another infectious cause of lymphoedema is a parasitic infection called filariasis. This is a common cause of lymphoedema worldwide, but is not a risk in the UK. Inflammation Conditions that cause tissue to become inflamed (red and swollen) can also permanently damage the lymphatic system. Medical conditions that can cause lymphoedema include: rheumatoid arthritis which causes pain and swelling in the joints eczema which causes the skin to become itchy, reddened, dry and cracked Venous diseases Venous diseases, which affect the flow of blood through the veins, can cause lymphoedema in some people. The abnormal or damaged veins can result in excessive fluid leaking from the blood into the tissue spaces. This overwhelms and eventually exhausts the parts of the lymphatic system responsible for draining this fluid. Some venous diseases that can lead to lymphoedema include: deep vein thrombosis (DVT) a blood clot in one of the deep veins in the body varicose veins (swollen and enlarged veins) where poor drainage of blood in the veins causes higher vein pressure, and more fluid passes into the surrounding tissues Obesity People who are obese, particularly those who are severely obese, have an increased risk of developing lymphoedema. Its not clear exactly why this is, but it has been suggested that the extra fatty tissue affects the lymphatic channels in some way, reducing the flow of fluid through them. In these cases, weight loss is an important part of treatment and even just starting to lose weight can make a big difference. Trauma and injury In a small number of cases, lymphoedema can be caused by an accidental injury to the lymphatic system. For example, lymphoedema can sometimes occur after extensive soft tissue loss or bruising. Immobility Movement and exercise helps lymph drainage, as muscle activity surrounding the lymphatic vessels massages fluid into and along them. Therefore, reduced movement can lead to lymphoedema, because the fluid in the lymphatic system does not get moved on, causing swelling. For example, people who are unable to move fully for a long time due to an illness or surgery may be at risk of lymphoedema. Diagnosing lymphoedema If youre being treated for cancer and are at risk of developing lymphoedema, youll be monitored for the condition afterwards. Otherwise, see your GP if you experience symptoms of swelling. There are a number of specialist lymphoedema treatment centres in the UK. Your doctor may refer you to one of these for further assessment. A list of treatment centres near you is available from the Lymphoedema Support Network. In many cases, its possible to make a diagnosis of lymphoedema by: asking about your symptoms and medical history examining the affected body part and measuring the distance around it to see if its enlarged Further tests Although not necessary in most cases, further tests may occasionally be used to assess and monitor your condition. These tests are explained below. Measuring limb volume In some cases, tests to calculate the volume of an affected limb may be carried out. These may include: a tape measure to measure the circumference of the limb at certain intervals, to calculate its volume water displacement where you place the affected limb in a tank of water and the amount of water that is displaced is measured to calculate the volume of the limb perometry infrared light is used to measure the outline of an affected limb and calculate its volume Bioimpedance testing During a bioimpedance test, electrodes (small metallic discs) are placed on different parts of your body. The electrodes release a small and painless electric charge that is measured using a handheld device. Changes in the strength of the current can indicate the presence of fluid in your tissue. Imaging tests Imaging tests may also be used to help diagnose and monitor lymphoedema. These include: a lymphoscintigraph you are injected with a radioactive dye that can be tracked using a special scanner; this shows how the dye moves through your lymphatic system and can check for any blockages a magnetic resonance imaging (MRI) scan which uses a strong magnetic field and radio waves to produce detailed images of the inside of your body an ultrasound scan which uses high-frequency sound waves to create an image of the inside of your body a computerised tomography (CT) scan which uses X-rays and a computer to create detailed images of the lymph nodes These scans can be used to create a clearer picture of the affected tissue. Treating lymphoedema The recommended treatment for lymphoedema is decongestive lymphatic therapy (DLT). DLT is not a cure for lymphoedema, but it can help control the symptoms. Although it takes time and effort, the treatment can be used to effectively control your lymphoedema. Decongestive lymphatic therapy (DLT) There are four components to DLT: compression bandages and garments to move fluid out of the affected limb and minimise further build-up skin care to keep the skin in good condition and reduce the chances of infection exercises to use muscles in the affected limb to improve lymph drainage specialised massage techniques known as manual lymphatic drainage (MLD) to stimulate the flow of fluid in the lymphatic system and reduce swelling Each of these components is described in more detail below. DLT usually begins with an intensive phase of therapy, during which you may receive daily treatment for several weeks to help reduce the volume of the affected body part. This is followed by the second phase, known as the maintenance phase. During this, you will be encouraged to take over your own care by carrying out simple self-massage techniques, wearing compression garments and continuing to exercise. This phase of treatment aims to maintain the reduced size of the affected body part. You may then have reviews every few months to check how your treatment is progressing. Compression bandages and garments Unlike the blood circulation system, there is no central pump, such as the heart, to move fluid around the lymphatic system. Instead, the lymphatic system uses the massaging effect of surrounding muscles to move the fluid. If you have lymphoedema, you will have special bandages or garments (such as sleeves, gloves, stockings or tights) fitted over any affected limbs. These will support the affected muscles during exercise and encourage them to move fluid out of the affected limb. These may also be applied after a session of MLD, to prevent fluid accumulating in the limb again. This use of compression bandages and garments is known as multilayer lymphoedema bandaging. Velcro wraps may be used instead of bandages and have the advantage that the person with lymphoedema can apply them themselves. You will be taught how to correctly apply your own bandages and compression garments, so you can continue to use them during the maintenance period. Skin care Taking good care of your skin is important, because it will reduce your risk of developing an infection, such as cellulitis . Read our page on preventing lymphoedema for more skin care advice. Movement and exercises Your lymphoedema care team will help devise an exercise and movement plan designed to strengthen and stimulate the muscles involved in lymph drainage. They will also help you to lose weight, if you are overweight. This will be tailored to your requirements and ability. Your plan may involve specific limb exercises, as well as gentle activities that involve the whole body, such as swimming, cycling and walking. Massage To begin with, you may receive specialised massages called manual lymphatic drainage (MLD) usually carried out by a specialist therapist to move fluid from the swollen areas into working lymph nodes, where it can be drained. Your lymphoedema therapist will also teach you a range of simpler massage techniques that you or your carer can use during the maintenance phase of treatment, to help keep the swelling down. These self-massage techniques are known as simple lymphatic drainage (SLD). Surgery In a small number of cases, surgery may be considered to treat lymphoedema. There are three main types of surgery that may be useful for the condition: the removal of sections of excess skin and underlying tissue (debulking) the removal of fat from the affected limb (liposuction) see below the restoration of the flow of fluid around the affected section of the lymphatic system for example, by connecting the lymphatic system to nearby blood vessels (lymphaticovenular anastomosis) These treatments may help to reduce the size of areas of the body affected by lymphoedema, but some are still experimental particularly lymphaticovenular anastomosis and are not in widespread use. Liposuction Liposuction is where a thin tube is inserted through small incisions in the skin to suck fat out of tissue. It can be used to remove excess fat from an affected limb to help reduce its size. Once the surgery is complete, you will have to wear a compression garment on the affected limb day and night for at least a year to help keep the swelling down. The National Institute for Health and Care Excellence (NICE) states that liposuction for chronic (long-term) lymphoedema appears to be safe, and may be effective in the short term. However, NICE says there is not enough evidence of its long-term effectiveness and safety. Access to liposuction for lymphoedema may be limited, depending on what is available from your local NHS Clinical Commissioning Group (CCG). Complications of lymphoedema Cellulitis is the most common complication of lymphoedema, but psychological issues can also occur as a result of the condition. These complications are explained below. Cellulitis Many people with lymphoedema experience repeated episodes of cellulitis (also known as erysipelas). Cellulitis is a bacterial infection of the deep layer of skin (dermis) and the layer of fat and soft tissues (the subcutaneous tissues) that lie underneath the skin. Cellulitis can occur as a result of lymphoedema and can also cause the condition. Symptoms of cellulitis can include: redness and a feeling of heat in the skin pain in the affected area a high temperature (fever) chills Cellulitis can usually be successfully treated with antibiotics , although severe cases may need to be treated in hospital. In some cases, you may be provided with a short supply of antibiotic tablets to use as soon as you notice symptoms of cellulitis. Alternatively, you may be given a long-term course of antibiotics to take to prevent infection. Psychological impact Living with a chronic (long-term) condition that affects your appearance, such as lymphoedema, can cause a great deal of distress and lead to periods of depression . If you have been feeling particularly down for the last few months and you no longer take pleasure in the things you usually enjoy, you may be depressed. If this is the case, talk to your GP or members of your lymphoedema treatment team, because there are effective treatments for depression. Talking to other people who also have lymphoedema can be reassuring and decrease feelings of isolation, stress and anxiety. The Lymphoedema Support Network offers information and advice, and can put you in touch with a support group in your area. Remember: if you persevere with your treatment plan, your symptoms should eventually become less noticeable. Read more about treating lymphoedema Preventing lymphoedema Its not possible to completely prevent lymphoedema, but the following steps may help reduce your chances of developing the condition. If you already have lymphoedema, this advice may stop it getting worse. Skin care The part of your body affected by lymphoedema is more vulnerable to infection of the build-up of fluid within the tissues. Any cuts in your skin can allow bacteria to enter your body and may quickly develop into an infection. Skin infections can also damage your lymphatic system and cause lymphoedema to develop. You can reduce your chances of developing skin infections by: not having injections or blood pressure readings in the affected area whenever possible treating cuts and scratches immediately with an antiseptic cream using insect repellents to prevent insect bites moisturising the skin daily to keep it supple your GP can prescribe a suitable cream avoiding very hot baths and showers the heat from saunas, steam rooms and sun beds may also increase the swelling using sun cream with a high sun protection factor (SPF) to prevent sunburn wearing gloves for gardening and household tasks to avoid cuts, if your upper limbs are affected using anti-fungal powder to prevent fungal infections in your skin or feet, if your lower limbs are affected cutting your nails with nail clippers seeing a chiropodist for foot and nail care but make sure you tell them you have lymphoedema wearing shoes that fit correctly and provide support on the top of your feet, if your lower limbs are affected using an electric razor if you need to shave to reduce the risk of cutting yourself not wearing tight-fitting clothes or jewellery Contact your GP as soon as possible if you develop symptoms of a possible skin infection, such as redness and a feeling of heat in the skin. Healthy lifestyle Adopting a healthy lifestyle may also help reduce your risk of developing lymphoedema, and may help control the condition if you already have it. This includes: eating a healthy diet maintaining a healthy weight exercising regularly Source: NHS 24 - Opens in new browser window Last updated: 09 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Breast cancer (female) Radiotherapy Other health sites Lymphoedema Support Network Cancer Research UK: Lymphoedema Macmillan Cancer Support: Lymphoedema Breast Cancer Care: lymphoedema NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Lymphogranuloma venereum (LGV) | Lymphogranuloma venereum (LGV) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Sexual and reproductive Lymphogranuloma venereum (LGV) Lymphogranuloma venereum (LGV) British Sign Language (BSL) | | Polski | Romn | slovenina Lymphogranuloma venereum (LGV) is a sexually transmitted infection. Its caused by a strain of chlamydia bacteria. LGV is rare in Scotland and is mostly found in men who have sex with men . LGV in women is very rare. Symptoms of LGV Most people with LGV dont notice any symptoms and dont know they have it. So its important to get tested if you think youre infected. If you do develop symptoms, you may experience: swollen lymph glands in the groin (in one or both sides) an ulcer or sore on the penis, vagina or around the anus You may notice some anal symptoms such as: blood or pus from the anus on underwear or toilet paper pain in the anal area when pooing or having receptive anal sex constipation, painful straining or diarrhoea when trying to poo a feeling of incomplete emptying after pooing Testing for LGV If you think you might have LGV, get tested for free by: booking an appointment at your local sexual health service contacting your GP practice for an appointment What does the LGV test involve? If you test positive for chlamydia , and your symptoms suggest that you might have LGV, the lab will do a further test for LGV. The test for LGV is simple, painless and very reliable. It involves sending a sample from the area of the body thought to be infected to a lab for analysis. This can take up to 3 weeks. The 2 main ways the sample can be collected are: using a swab a small cotton bud is gently wiped over the area that might be infected, such as inside the vagina, throat, or inside the anus urine sample this should ideally be done at least 1 or 2 hours after you last peed Your partner (s) for the past 3 months should also be tested for LGV. Treatment for LGV Antibiotics will treat the LGV infection. The result of the LGV test can take 3 weeks to come back, so your doctor may advise you to start treatment before the final result is available. If left untreated, LGV can cause scarring and swelling of the skin. It can also cause permanent swelling of the genitals. Rectal infection can also cause swelling and scarring resulting in the risk of long-term bowel complications. Rarely the infection may spread via the bloodstream causing inflammation of the joints or liver. To avoid passing LGV on to your partner(s) you should avoid having sex until both you and your partner have finished your treatment. How LGV is passed on You can get LGV by having unprotected vaginal, anal or oral sex (sex without a condom). Your risk of getting LGV may be increased by: chemsex having group sex fisting sharing sex toys that arent washed or covered with a new condom each time theyre used How to prevent LGV The best way to reduce your risk of STIs is to practice safer sex . This means using a condom for vaginal, anal and oral sex. Other STIs If you have been diagnosed with LGV you should get tested for all STIs including: gonorrhoea syphilis HIV Source: Scottish Government - Opens in new browser window Last updated: 26 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Other languages and formats British Sign Language (BSL) | | Polski | Romn | slovenina British Sign Language (BSL) | | Polski | Romn | slovenina Add this page to\n Info For Me Also on NHS inform Book a sexual health appointment online Lymphogranuloma venereum (LGV) (BSL) Lymphogranuloma venereum (LGV) (Chinese) Lymphogranuloma venereum (LGV) (Polish) Lymphogranuloma venereum (LGV) (Romanian) Lymphogranuloma venereum (LGV) (Slovak) Other health sites BASHH: sexual health NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Malaria | Malaria | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Malaria Malaria About malaria Preventing and treating malaria About malaria Malaria is a serious tropical disease spread by mosquitoes. If it isnt diagnosed and treated quickly, it can be fatal. A single mosquito bite is all it takes for someone to become infected. Symptoms of malaria Its important to be aware of the symptoms of malaria if youre travelling to areas where theres a high risk of the disease. This means that you can get medical attention quickly. Symptoms are similar to those of flu and usually appear 6 to 30 days after the mosquito bite, but it can sometimes take up to a year for symptoms to start. The initial symptoms of malaria include: a high temperature (fever) headache sweats chills muscle aches or pains vomiting and or diarrhoea These symptoms can start mild and may be difficult to identify as malaria. When to seek medical attention Malaria is a serious illness that can get worse very quickly. It can be fatal if not treated quickly. The effects of malaria are usually more severe in: babies young children pregnant women older people Phone 111 or go to A&E if: you or your child develop symptoms of malaria during or after a visit to an area where the disease is found, even if it has been several weeks, months or a year after you return from travelling You must tell the healthcare professional that you have been in a country with a risk of malaria, including any brief stopovers. What causes malaria? Malaria is caused by the Plasmodium parasite. The parasite is spread to humans through the bites of infected mosquitoes. There are 5 different types of Plasmodium parasite that cause malaria in humans. They are found in different parts of the world (but do overlap in certain areas) and vary in terms of how severe the infection can be. All malaria infections cause the same symptoms and require immediate medical attention. Its not possible to find out which type of malaria you have from symptoms alone. Types of malaria parasite Plasmodium falciparum mainly found in Africa, its the most common type of malaria parasite and is responsible for most malaria deaths worldwide, though treatment does cure the infection. Plasmodium vivax mainly found in Asia and South America, this parasite causes milder symptoms but it can stay in the liver for years which can result in symptoms reoccurring if it isnt treated properly. Plasmodium ovale fairly uncommon and usually found in West Africa. Plasmodium malariae this is quite rare and usually only found in Africa. Plasmodium knowlesi this is very rare and found in parts of southeast Asia. How malaria is spread The Plasmodium parasite is spread by mosquitoes. These are known as night-biting mosquitoes because they most commonly bite between sunset and sunrise. When a mosquito bites a person already infected with malaria, it becomes infected and spreads the parasite to the next person it bites. Malaria cant be spread directly from person to person. When an infected mosquito bites, the parasite enters the blood and travels to the liver. In the liver, it develops for days to weeks before re-entering the blood. This is the point where symptoms develop and urgent treatment is required. Although it is very rare, malaria can also be spread from a person with the infection through blood transfusions and sharing needles. Where is malaria found? Malaria is found in tropical and subtropical regions of the world. It is not found in the UK or Europe. The fitfortravel website has more information about the risk of malaria in individual countries . Complications of malaria Malaria is a serious illness that can be fatal if not diagnosed and treated quickly. Severe complications of malaria can occur within hours or days of the first symptoms. This means it is important to seek urgent medical help as soon as possible. Anaemia The destruction of red blood cells by the malaria parasite can cause severe anaemia . Anaemia is a condition where the red blood cells are unable to carry enough oxygen to the bodys muscles and organs. This can leave you feeling drowsy, weak and faint. Cerebral malaria In rare cases, malaria can affect the brain. This is known as cerebral malaria which can cause your brain to swell, sometimes leading to permanent brain damage. It can also cause fits (seizures) or coma. Other complications Other complications that can arise as a result of severe malaria include: liver failure and jaundice yellowing of the skin and whites of the eyes shock a sudden drop in blood pressure pulmonary oedema a build-up of fluid in the lungs acute respiratory distress syndrome (ARDS) abnormally low blood sugar hypoglycaemia kidney failure swelling and rupturing of the spleen dehydration Malaria in pregnancy If you get malaria while pregnant, you and your baby have an increased risk of developing serious complications like: premature birth birth before 37 weeks of pregnancy low birth weight restricted growth of the baby in the womb stillbirth miscarriage death of the mother Pregnant women are advised to avoid travelling to regions with a risk of malaria. Visit your GP, midwife, obstetrician or travel health advisor for a full discussion if youre pregnant and are thinking of travelling to a high-risk area. Not all antimalarial tablets are safe in pregnancy and its important you get specific advice. Preventing and treating malaria If you travel to an area that has malaria, you are at risk of the infection. Its very important that you take precautions to prevent the disease and get treatment immediately if symptoms do develop. Preventing malaria Malaria can often be avoided using the ABCD approach to prevention, which stands for: Awareness of risk find out whether youre at risk of getting malaria Bite prevention use insect repellent, cover your skin with clothing, and use a mosquito net to avoid mosquito bites Check whether you need to take antimalarial prevention tablets by visiting a travel health clinic if you do, make sure you take the right antimalarial tablets at the right dose and finish the course Diagnosis seek immediate medical advice if you have malaria symptoms, including up to a year after you return from travelling Being aware of the risks Check whether youre travelling to a malaria risk area on the fitfortravel website Visit your local travel clinic for malaria advice as soon as you know that you are travelling to a risk area. If you grew up in a country where malaria is common, any natural protection will be quickly lost when you move. This means you need to protect yourself from infection if youre now travelling to a risk area, even if thats where you grew up. Further information about travel health and vaccinations . Preventing mosquito bites Avoiding mosquito bites is one of the best ways to prevent malaria. This is particularly important during early evening and at night when mosquitoes bite. There are several steps you can take to avoid being bitten. Do mosquitoes cant bite through clothing so wear light, loose-fitting clothing that will cover your arms and legs apply insect repellent to all areas of your skin that are not covered by clothing, including your face and neck remember to reapply insect repellent frequently sleep under a mosquito net thats been treated with an insecticide, or in a room with effective air conditioning The most effective repellents contain 50% diethyltoluamide (DEET). These are available in: sprays roll-ons sticks creams Theres no evidence to suggest that other remedies protect against malaria, such as homeopathic remedies, electronic buzzers, vitamins B1 or B12 , garlic, yeast extract spread (Marmite), tea tree oils or bath oils. Further information on mosquito bite prevention is available from the fitfortravel website. Antimalarial tablets Antimalarial tablets can help prevent you from developing a malaria infection. For the best protection, you must also follow mosquito bite prevention advice. You must start taking antimalarial tablets before travel and continue taking them whilst travelling in the risk area. Antimalarial tablets must also be taken for a period of time after you have left the risk area. How long antimalarial tablets should be taken will depend on which tablet is used. Antimalarial tablets dont stop malaria from entering your body. However, they do stop the infection from developing inside your body and prevent you from getting ill. If you stop taking your antimalarial tablets early (even when you are back in the UK) you could still become ill with malaria. Taking antimalarial medication You may need to take a short trial course of antimalarial tablets before travelling. This is to check that side effects do not occur and that you do not have an adverse reaction. If you do, alternative antimalarials can be prescribed before you leave. Do make sure you get the right antimalarial tablets before you go visit a travel health clinic for advice on which is the best antimalarial for you follow the instructions included with your tablets carefully make sure you complete the full course of tablets Theres currently no vaccine available that offers protection against malaria. Types of antimalarial medication The type of antimalarial tablets that you will be recommended is based on the following information: where youre going any relevant family medical history your medical history, including any allergies to medication any medication youre currently taking any problems youve had with antimalarial medicines in the past your age whether youre pregnant If youve taken antimalarial medication in the past, dont assume its suitable for future trips. The type of antimalarial that you will need to take depends on which strain of malaria is carried by the mosquitoes in an area. It will also depend on whether theyre resistant to certain types of antimalarial medication. The main types of antimalarials used to prevent malaria are: Atovaquone plus proguanil (also known as Maloff protect or Malarone) Doxycycline (also known as Vibramycin-D) Mefloquine (also known as Lariam) To find out what type of antimalarial medication is best for you, visit your local travel clinic. Treating malaria If malaria is diagnosed and treated quickly, you should fully recover. Treatment should be started as soon as possible. Treatment begins in a hospital to make sure complications dont suddenly develop. Treatment is with tablets or capsules. If someone is very ill, treatment will be given through a drip into a vein in the arm (intravenously). Treatment for malaria can leave you feeling very tired and weak for several weeks. The type of medicine and how long you need to take it will depend on: the type of malaria you have the severity of your symptoms whether you took preventative antimalarial tablets your age whether youre pregnant Source: NHS 24 - Opens in new browser window Last updated: 04 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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Malignant brain tumour (cancerous) | Malignant brain tumour (cancerous) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Malignant brain tumour (cancerous) Malignant brain tumour (cancerous) About malignant brain tumours Symptoms of malignant brain tumours Causes of malignant brain tumours Diagnosing malignant brain tumours Treating malignant brain tumours Recovering from malignant brain tumours About malignant brain tumours A malignant brain tumour is a fast-growing cancer that spreads to other areas of the brain and spine. Generally, brain tumours are graded from 1 to 4, according to their behaviour, such as how fast they grow and how likely they are to grow back after treatment. A malignant brain tumour is either grade 3 or 4, whereas grade 1 or 2 tumours are usually classed as benign or non-cancerous. Most malignant tumours are secondary cancers, which means they started in another part of the body and spread to the brain. Primary brain tumours are those that started in the brain. These pages focus on high-grade brain tumours. For information about grade1 or2 tumours, read our pages on low-grade (benign) brain tumours . Signs andsymptoms The symptoms of a malignant brain tumour depend on how big it is and where it is in the brain. Common symptoms include: severe, persistent headaches seizures (fits) persistent nausea, vomiting and drowsiness mental or behavioural changes, such as memory problems or changes in personality progressive weakness or paralysis on one side of the body, vision problems, or speech problems Speak to your GP if you have persistent symptoms of a brain tumour. While its unlikely to be a tumour, its best to be sure by getting a proper diagnosis. Read more about the symptoms ofmalignant brain tumours and diagnosingmalignant brain tumours . Types of malignant tumours Mostmalignant brain tumours develop from the glialtissue, which supports the brains nerve cells.These tumours are known asgliomas. Gliomas can be separated further, depending on the cells they developed from. For example: an astrocytoma develops from cells thought to provide the brains framework an oligodendroglioma develops from the cells that produce the fatty covering of nerves an ependymoma develops from the cells that line the cavities in the brain Its also possible to have a malignant tumour thats a mixture of these types or developed in a different part of the brain. Who is affected Brain tumours can affect people of any age, including children, although they tend to be more common in older adults. The exact cause of primary malignant brain tumours is unknown, although its thought that certain genetic conditions and previous radiotherapy treatment to the head may increase the risk of one developing. Read more about the causes of malignant brain tumours . How malignant brain tumours are treated A primary malignant brain tumour needs to be treated as soon as possible, because it can spread and damage other parts of the brain and spinal cord. Surgery will usually need to be carried out to remove as much of the tumour as possible. This may befollowed byradiotherapyand/or chemotherapy to kill any cancerous cells left behind and reduce the chances of the tumour regrowing. However, malignant tumours will often eventually return after treatment. If this happens, or if you have a secondary tumour, a cure isnt usually possible and treatment can instead be used to improve symptoms and prolong life. Readmore about treating malignant brain tumours . Living with a brain tumour Living with a brain tumour is not easy.You may feelworried and anxious about whats going to happen to you and your family. This is perfectly normal. It can help to seek accurate medical information about your specific tumour and its treatment, make sure youre closely involved in decisions about your care, and ask your care team about anything youre not sure about. You can read more about living with a brain tumour on The Brain Tumour Charitys website . Your doctormay be able torefer you to a counsellor if you want to talk about the emotional aspects of diagnosis and treatment. There are also many organisations and helplines that can help, such as The Brain Tumour Charity and Brain Tumour Research . Support for carers Being a carer is not an easy role. When you are busy responding to the needs of others, it can deplete your reserves of emotional and physical energy, and make it easy for you to forget your own health and mental wellbeing. Research on carers health shows that high numbers of carers suffer health effects through caring. If you are trying to combine caring with a paid job or looking after a family, this can cause even more stress. However, neglecting your own health doesnt work in the long term. If youre caring for someone else, its important to look after yourself and get as much help as possible. Its in your best interests and those of the person you are caring for. For more information on the support available to you and benefits you may be entitled to, visit Care Information Scotland . Symptoms of malignant brain tumours The symptoms of a malignant brain tumour depend on how big it is and where it is in the brain. When symptoms do occur, it is because the brain tumour is either putting pressure on the brain or preventing an area of the brain from functioning properly. Signs of increased pressure on the brain Common symptoms of increased pressure within the skull include: severe, persistent headaches which are typically worse in the morning or when bending over or coughing persistent nausea and vomiting drowsiness vision problems such asblurred vision,floaters andloss of vision that may come and go seizures (fits) which may affect the whole body or just involve a twitch in one area Symptoms caused by the position of a tumour Different areas of the brain control different functions, so the symptoms caused by a brain tumour will depend on where the tumour is located. For example, a tumour affecting: the frontal lobe may cause changes in personality, weakness in one side of the body and loss of smell the temporal lobe may causeforgetfulness,language problems (aphasia) and seizures the parietal lobe may cause aphasia andnumbness or weakness in one side of the body the occipital lobe may cause loss of vision on one side the cerebellum may cause a loss of co-ordination, flickering of the eyes, vomiting and a stiff neck the brain stem may cause unsteadiness and difficulty walking, facial weakness, double vision, and difficulty speaking (dysarthria) and swallowing ( dysphagia ) When to speak to your GP Its important to speak to a doctor if you develop persistent and worrying symptoms that may be caused by a brain tumour. While its unlikely that you have a tumour, its best to be sure by getting a proper diagnosis. If your GP is unable to identify a more likely cause of your symptoms, they may refer you to a neurologist for further assessment and tests, such as a brain scan. Read more about diagnosingmalignant brain tumours . Causes of malignant brain tumours Most malignant brain tumours are caused by a cancer that started somewhere else in the body and spread to the brain, through the bloodstream. These are known as secondary tumours. Cancers that can spread to the brain include lung cancer , breast cancer , bowel cancer and melanoma skin cancer . Some primary malignant brain cancers(cancerous tumours that start in the brain) are caused by a previously benign brain tumour becoming cancerous, but usually the exact reason why a primarytumour develops is unknown. Age Brain tumours affect people of all ages, including children, but the risk tends to increase as you get older. Most tumours affect people over 50 years of age. Family history People with a family history of brain tumours may be at a slightly increased risk of developinga brain tumour themselves. Radiotherapy If your brain is exposed to radiation during radiotherapy , your risk of developingcertain types ofbrain tumour later on is increased. Genetic conditions Some genetic conditions can increase your risk of a brain tumour, such as: neurofibromatosis type 1orneurofibromatosis type 2 tuberous sclerosis Turcot syndrome Li-Fraumeni cancer syndrome von Hippel-Lindau syndrome Gorlin syndrome Unlike most brain tumours, tumours associated with these conditions tend to developin childhood or early adulthood. Can mobile phones cause brain tumours? There have beenreports in the media about a possible connection between brain tumours and the radiofrequency (RF) energy emitted by mobile phones. RF energy produces heat, which can increase body temperature and damage tissue exposed to it. However, its thought that the amount of RF energy people are exposed to from mobile phones is too low to produce significant tissue heating or an increase in body temperature. Research is underway to establish whether RF energy has any long-term health effects, but the balance of evidence currently available suggests that its unlikelymobile phones cause health problems. Diagnosing malignant brain tumours Speak to your GP if you develop any of the symptoms of a malignant brain tumour , such as a persistent and severe headache. Your GP willexamine you and ask about your symptoms. They may also carry out a simple neurological examination. If they suspect you may have a tumour, or they are not sure whats causing your symptoms, youll probably be referred to a neurologist (brain and nerve specialist). Neurological examination Your GP or neurologist maycarry out a test of your nervous system, called a neurological examination, to look for problems associated with abrain tumour. Thismay involve tests of your: hand and limb strength reflexes, such as your knee-jerk reflex hearing and vision skin sensitivity balance and co-ordination memory and mental agility (using simple questions or arithmetic) A neurologist may also recommend one or morefurther tests. Further tests Other tests you may have to help diagnose a brain tumour include: a computerised tomography (CT) scan this produces a detailed picture of your brain using a series of X-rays a magnetic resonance imaging (MRI) scan this produces a detailed picture of your brain using a strong magnetic field and radio waves an electroencephalogram (EEG) where electrodes attached to your scalp record your brain activity to look for any abnormalities If a tumour is suspected, a biopsy (surgical removal of a small piece of tissue) may be taken to establish the type of tumour and the most effective treatment. Under anaesthetic, a small hole (known as a burr hole) is made in the skull and a very fine needle is used to obtain a sample of tumour tissue. Youll probably need to stay in hospital for a few days afterwards. Treating malignant brain tumours If you have a malignant brain tumour, youll usually need surgery to remove as much of it as possible. Radiotherapy and/or chemotherapy may then be used to treat any remaining cancerous tissue. The aim of this is to remove or destroy as much of the tumour as possible, ideally getting rid of thecancerous cells completely. However, this isnt always possible and mostmalignantbrain tumours will eventually return after treatment. If your tumour does return after treatment, or youhave a secondary brain tumour (where cancer has spread to your brain from another part of your body), a cure isnt usually possible. Treatmentcan insteadbe usedto control your symptoms andprolong life. Your treatment plan There are a number of different treatments formalignant brain tumours, and deciding on what you feel is the best treatment can be confusing. A group of different specialists called a multidisciplinary team (MDT) will be involved in your care and will recommend what they think is the best treatment option for you, but the final decision will be yours. Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions that youd like to ask. For example, you may want to find out the advantages and disadvantages of particular treatments. Surgery Surgery will be recommended for most people with a malignant brain tumour. If the size or position of the tumour mean surgery is not possible, one or more of the treatments described below may be recommended instead. The main operation used to treat people with brain tumours is called a craniotomy. You will be given a general anaesthetic so you are asleep while theprocedure is carried out. An area of your scalp will be shaved and a section of the skull is cut out as a flap to reveal the brain and tumour underneath. The surgeon can then remove asmuch of the tumour as possible and secure the flap of skull back in place with metal screws. After surgery, treatment withradiotherapyand/or chemotherapy may be recommended to kill any cancer cells left behind and reduce the risk of the tumour coming back. Radiotherapy Radiotherapy is a treatment where a beam ofhigh-energy radiationis focused on the tumour to kill the cancerous cells. It can be used after surgery or as the main treatment for tumours thatare difficult to remove. Radiotherapy isusually given in several doses (fractions) spread over the course of a week. An entire course of treatment will usually last up to 6 weeks in total. Possible side effects of radiotherapy for a brain tumour include nausea, temporary hair loss, tiredness and red, sore skin. Read more about the side effects of radiotherapy . In a smallnumber of cases, a similar treatment calledproton beam therapy may be recommended. However, this is only suitable in very specific cases and currently, youll need to be referredfor treatment abroad if your doctor thinks its appropriate. Chemotherapy Chemotherapy is a medication used to kill cancerous cells. It may beused alongside radiotherapy or on itsown, eitherto help kill any cancerous cells leftbehind after surgery or to help relieve your symptoms when a cure is not possible. Chemotherapy medication for brain tumours can be given in a number of ways, including as: tablets (orally) temozolomide and procarbazineare given in this way injections into a vein (intravenously) vincristine is given in this way small, disc-likeimplants placed in the brain during surgery carmustinecan begiven in this way, but isonly recommended if90% or more of the tumour has beenremoved The side effects of chemotherapy largely depend on the specific medication youre taking. Common general side effects include tiredness, headaches, temporary hair loss and nausea. Read more about the side effects of chemotherapy . For more information about some of the treatments used, see the guidelines from theNational Institute for Health and Care Excellence (NICE) on carmustine implants to treat gliomas and temozolomide for recurrent malignant glioma . Radiosurgery Stereotactic radiosurgery (SRS) is a special type of radiotherapy thats sometimes used to treat brain tumours that cant be safely removed with surgery. During the treatment, several small beams of radiation are used to very accuratelydeliver a high dose of radiation to the tumour,usually in a single treatment session. As the radiation beams can be aimed very precisely, a high dose of radiation can be delivered to the tumour with minimal damage to the surrounding healthy cells. This means youre less likely to experience many of the usual side effects of radiotherapy. Recoverytends to be much fasterand an overnight stay isnt usuallynecessary. However, radiosurgery is currently only available in a few specialised centres across the UK and is only suitable for certain people, based on the characteristics of their tumour. Treating symptoms You may also be given medication to relieve some of the symptoms you mayhave as a result of yourbrain tumour. These may include: anticonvulsants to prevent seizures (fits) corticosteroids to reduceswelling and pressure in the brain painkillers to treat headaches anti-emetics to prevent vomiting Depending on your circumstances, these medications may be given before, after, or instead of surgery. Choosing not to have treatment If your tumour is at an advanced stage or in a difficult place in the brain, a cure may not be possible and treatment may only be able to control the cancer for a period of time. This means you will be getting the side effects of treatment without getting rid of the tumour. In this situation, it may be difficult to decide whether or not to go ahead with treatment. Talk to your doctor about what will happen if you choose not to be treated, so you can make an informed decision. If you decide not to have treatment, you will still be given palliative care , which will control your symptoms and make you as comfortable as possible. Recovering from malignant brain tumours After being treated for a brain tumour, you may need additional care to monitor and treat any further problems. Follow-up appointments Malignantbrain tumours often grow back after treatment, so regular follow-up appointments will be recommended to look for signs that this may have happened. These appointments may include a discussion of any worrying new symptoms you experience, a physical examination, andoccasionally a brain scan. You willusuallyhave follow-up appointments at least every few months to begin with, but they may be needed less frequently over time if no problems develop. Supportive treatment Problems caused by a brain tumourdont always resolve as soon asthe tumour is removed or treated. For example, some people have persistent weakness, seizures (fits), difficulty walking and speech problems. In these cases,you may needextra support to help you overcome or adapt toany problems you have. This may includetherapies such as: physiotherapy to help with any movement problems you have occupational therapy to identify any problems youre having with daily activities andarrange forany equipment or alterations to your home that may help speech therapy to help you with anycommunication or swallowing problems Some people may also need to continue taking medication for seizures for a few months or more after their tumour has been treated or removed. The National Institute for Health and Care Excellence (NICE) has made recommendations on the standards of care that brain tumour patients should receive. For more information, see the service guidance for improving outcomes for people with brain and other central nervous system tumours. Drivingand travelling You may not be allowed to drive for a while after youve had a brain tumour. This willdepend on things such asthe type of brain tumour you had, where it was in the brain, and what symptoms you have. If you are required to give up your driving licence and notify the DVLA , they will speak to your GP or specialistto determine when you can drive again. With up-to-date scans and advice from your medical team, you may be allowed to drive again once an agreed period has passed and you have successfully completed a medical test to determine your ability to control a vehicle. You can find out about brain tumours and driving on the Cancer Research UK website. Flying is usually possible from 3 months after treatment. Sports and activities After you have been treated for a brain tumour, you must permanently avoid contact sports, such as rugby and boxing. You can start other activities again, with the agreement of your doctor, once you have recovered. Swimming unsupervised is not recommended for around 1 year after treatment, as there is a risk you could have anepileptic fit while in the water. Sex and pregnancy Its safe to have sex after treatment for a brain tumour. Women may be advised to avoid becoming pregnant for 6 months or more after treatment.If youre planning to become pregnant, you should discuss this with your medical team. Going back to work Youll usually tiremore easily following treatment for a brain tumour. You may wish to return to work and normal life as soon as possible, but its probably a good idea to return part-time to begin with and only go back full-time when you feel able to. If youve experienced seizures,you shouldntwork with machinery or at heights. Emotional support A brain tumour is often life-changing. You may feel angry, frightened and emotionally drained. If it will help, your doctor or specialist may be able to refer you to a social worker and counsellor for help with the practical and emotional aspects of your diagnosis. There are also many organisations that canprovide information and support, such as The Brain Tumour Charity and Brain Tumour Research . Social support If you have been diagnosed with a brain tumour, your treatment and medical care will probably be the first thing on your mind. But there are other aspects of your life to think about and it is important to know exactly what kind of assistance is available and where you can get it. If you are finding it hard to cope with day-to-day life, talk about your needs with your doctor or nurse, who will refer you to a social worker. Your social worker will assess exactly the kind of help you need. Help you may need might include: a care attendant, who can help with housework, dressing and washing, or even just keep you company and give your carer a break a meals on wheels service income support, disability living allowance or attendance allowance equipment andadaptationsfor your home For more information about whathelp youmight need and how you can access it, visit Care Information Scotland . Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Brain tumours: Children Brain tumours: Teenagers and young adults Brain tumours Other health sites The Brain Tumour Charity Brain Tumour Research Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Malnutrition | "Malnutrition | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Nutritional Malnutrition Malnutrition Malnutrition means poor nutrition. Most commonly this is caused by not eating enough (undernutrition) or not eating enough of the right food to give your body the nutrients it needs. A balanced diet should provide enough nutrients like calories, protein and vitamins, to keep you healthy. Without this, you may not be getting all the nutrients you need and this can lead to malnutrition. Malnutrition can result in: unplanned weight loss muscle loss a low body mass index (BMI) vitamin and mineral deficiencies This can leave you feeling tired, weak and affect your ability to recover from an illness. Symptoms of malnutrition Malnutrition can be difficult to recognise. It can happen very gradually, which can make it very difficult to spot in the early stages. Common signs and symptoms of malnutrition include: loss of appetite and lack of interest in food or fluids unplanned weight loss this might cause clothing, rings, watches or dentures to become loose tiredness or low energy levels reduced ability to perform everyday tasks like showering, getting dressed or cooking reduced muscle strength for example, not being able to walk as far or as fast as usual changes in mood which might cause feelings of lethargy and depression poor concentration poor growth in children increased risk of infection, recurrent infections, taking longer to recover and poor wound healing difficulty keeping warm dizziness Speak to your GP if: you have any of the symptoms of malnutrition you notice a drop in weight or youve lost weight without trying Conditions that cause malnutrition Sometimes, medical conditions cause your body to need more nutrients. Some medical conditions can lead to your body being unable to absorb or use nutrients. These may include: cancer and liver disease that can cause a lack of appetite, persistent pain or nausea COPD , pulmonary fibrosis and emphysema, which cause your body to need more nutrients but can reduce your appetite mental health conditions, like depression or schizophrenia , which may affect your ability to look after yourself Crohns disease , ulcerative colitis or cystic fibrosis that disrupt your bodys ability to digest food or absorb nutrients burns, fractures and post major surgery, due to increased demand for nutrients dementia people with dementia may be unable to communicate their needs, may use up a lot of calories pacing or may experience a loss of appetite dysphagia a condition that makes swallowing difficult or painful persistent vomiting or diarrhoea Some types and combinations of medication can increase your risk of developing malnutrition. Always check your medicines information and speak to a healthcare professional for advice if you have a concern. Do not stop taking your medication without advice from a healthcare professional. Other causes of malnutrition Physical, social and ageing issues can also cause malnutrition. Physical issues Physical issues can contribute to malnutrition. For example: if your teeth are in a poor condition, if your dentures do not fit, or if you have a sore mouth, eating can be difficult or painful you may lose your appetite as a result of losing your sense of smell and taste you may have a physical disability or other physical impairment that makes it difficult for you to cook or shop for food yourself Social factors Social issues that can contribute to malnutrition include: living alone and being socially isolated having limited knowledge about nutrition or cooking reduced mobility alcohol or drug use low income or poverty reliance on food banks Ageing As we get older we might become more likely to experience malnutrition. This might be because of how we feel, and physical and social factors. The risk also increases because were more likely to have one or more medical conditions as we get older. Diagnosing malnutrition A healthcare professional can assess you for malnutrition using a screening tool like Malnutrition Universal Screening Tool (MUST) . Screen yourself for malnutrition Treating malnutrition If youve lost weight or your appetite is poor, you can make simple changes to your meals, snacks and drinks to help treat malnutrition. Choosing nutrient-dense food and drinks can help improve your calorie intake. This might not be suitable for everyone, especially those with other conditions like dysphagia. Ask your GP, dietitian or nurse for further advice if youre unsure. You should speak to a healthcare professional if youve had to limit the fat and sugar you eat in the past due to a health condition like high cholesterol or diabetes. Ways to increase your calories Try the following ideas to help you to increase the amount of calories and protein in your diet. Do eat little and often 3 small meals a day with 2-3 snacks in-between meals include protein like meat, fish, chicken, eggs, beans or lentils in each meal add high calorie ingredients like full cream milk, cheese, butter, ghee, olive oil and cream to meals and drinks include puddings after your lunch and dinner like creamy yoghurts, custards, rice pudding, milk puddings or ice-cream try ready meals if you dont feel like cooking choose nourishing milky drinks like malted drinks, hot chocolate, milky coffee and milkshakes choose high sugar drinks like fruit juice, smoothies, fizzy drinks or squash (you can also add egg powder to juice to increase its nutrients) try including 1 pint of full cream milk each day you can fortify (add extra nutrients to) this by adding 4 tablespoons of dried milk powder and use this in drinks, cooking, cereals and puddings Dont do not have drinks just before meals because this can make you feel fuller quicker do not choose low fat, sugar-free, diet foods and drinks for example skimmed milk If youre using vegan alternatives to cheese, butter, cream or milk, try to choose the highest calorie option. How to add extra nutrients to milk Watch this video to find out how to fortify your milk with milk powder. You can then use this instead of your usual milk. How to add extra nutrients to juice Watch this video to find out how to fortify your juice using egg powder. Easy ways to fortify your food There are ways you can use every day food and drinks to fortify (add extra nutrients to) your food. Butter Add extra butter to: sandwiches or toast mashed potatoes vegetables sauces baked potatoes snacks like pancakes, crumpets and scones biscuits or crackers Sugar, jam and honey Add sugar, jam or honey to: puddings hot drinks milkshakes or smoothies glazed vegetables creamy yogurts fruit porridge or cereal Cream, chocolate spread, peanut butter or nuts Add cream, chocolate spread, peanut butter or nuts to: porridge fruit sauces soups smoothies or milkshakes snacks (toast, pancakes, crumpets, scones, waffles, rice cakes) ice cream or puddings Vegetarian and vegan food If you follow a vegetarian or vegan diet, you can use the following foods to fortify your diet: nut butters vegan cheese vegan cream dairy free milks like oat, soya and nut milks (try to choose the sweetened options that provide the most calories) hemp and pea protein powders avocado plant based spreads Try to choose the highest calorie and protein options available. Snacks Try to eat high calorie and protein snacks like: crackers or oatcakes with cheese, pate, hummus or avocado crumpets, scones and pancakes with butter and jam thick and creamy yoghurts soya yoghurts or desserts milk jelly, chocolate pots and mousses custard, trifle and rice pudding pots dried fruit nuts and seeds cereal bar and flapjacks mini pork pie, sausage roll, scotch egg and spring rolls chocolate, biscuits, pastries and cakes crisps with dip fruit with chocolate spread or peanut butter Food fortification video Watch this video for ideas of how to add extra nutrients to your food. The British Dietetic Association (BDA) Malnutrition factsheet provides more useful practical advice. Watch this video on Vimeo for more tips on how to fortify your food Oral nutritional supplements Oral nutritional supplements (ONS) are a range of liquid and powder products that help support better nutrition. They contain calories, protein, vitamins and minerals to help increase your intake. Theyre designed to be taken alongside your diet and the food first advice above to promote progress with your weight. Tube feeding (enteral feeding) Depending on how severe your symptoms are, your healthcare professional might recommend a feeding tube. There are different types of tubes. Which one is best for you depends on your diagnosis and symptoms. The most common types of feeding tube include: nasogastric through your nose and into your stomach nasojejunal though your nose and further into your digestive tract percutaneous endoscopic gastrostomy (PEG) a tube is placed directly into the stomach via your abdomen Depending on your condition alternative routes of nutrition may be considered. Source:\r\n The Scottish Dietetic Prescribing Support Group - Opens in new browser window Last updated: 21 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Alzheimer's disease Depression Cancer Dysphagia (swallowing problems) Dementia COPD Crohn's disease Ulcerative colitis Cystic fibrosis Liver disease Other health sites Age UK Macmillan Cancer Support: Information and support Alzheimer Scotland NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852" | null | null | null | null | null | null | null | null | null | null | null | null | null |
Measles | Measles | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Measles Measles Measles is an infection that spreads very easily. Its unpleasant and can sometimes have serious complications. Having the measles, mumps and rubella (MMR) vaccine is the best way to prevent it. Anyone can get measles if they havent been vaccinated or they havent had it before. Its most common in young children. Measles usually clears in around 7 to 10 days. Symptoms of measles The first symptoms of measles develop around 10 days after youre infected. These can include: cold-like symptoms, such as a runny nose, sneezing, and a cough sore, red eyes that may be sensitive to light watery eyes swollen eyes a high temperature (fever), which may reach around 40C (104F) small greyish-white spots in the mouth aches and pains loss of appetite tiredness, irritability and a general lack of energy The measles rash appears around 2 to 4 days after the initial symptoms and normally fades after about a week. The rash: is made up of small red-brown, flat or slightly raised spots that may join together into larger blotchy patches usually first appears on the head or neck, before spreading outwards to the rest of the body is slightly itchy for some people Measles rash Go to A&E or phone 999 if: You or your child have measles and: shortness of breath a high temperature that does not come down after taking paracetamol or ibuprofen is coughing up blood drowsiness confusion fits (convulsions) Phone your GP urgently if: you think you or your child might have measles youve been in close contact with someone who has measles and youve not been fully vaccinated (had 2 doses of the MMR vaccine) or havent had the infection before even if you dont have any symptoms youve been in close contact with someone who has measles and youre pregnant measles can be serious in pregnancy you have a weakened immune system and think you have measles or have been in close contact with someone with measles If your GP is closed, phone 111. You should phone your GP first before visiting. They can make arrangements to reduce the risk of spreading the infection to others. Is measles serious? Measles can be unpleasant, but will usually pass in about 7 to 10 days without causing any further problems. Once youve had measles, your body builds up resistance (immunity) to the virus. Its highly unlikely youll get it again. However, measles can lead to serious and potentially life-threatening complications in some people. These include infections of the lungs (pneumonia) and brain (encephalitis). How measles is spread The measles virus is contained in tiny droplets that come out of the nose and mouth when an infected person coughs or sneezes. You can easily catch measles by breathing in these droplets. Or, if the droplets have settled on a surface, by touching the surface and then placing your hands near your nose or mouth. The virus can survive on surfaces for a few hours. People with measles are infectious from when the symptoms develop until about 4 days after the rash first appears. How to prevent spreading measles to others If you have measles: stay off school or work for at least 4 days from when the rash first appears regularly wash your hands with soap use and dispose of tissues when you sneeze avoid close contact with anyone who isnt fully vaccinated How measles can be prevented Measles can be prevented by having the MMR vaccine . This is given in 2 doses as part of the NHS childhood vaccination programme. You can be vaccinated at any age if you havent been fully vaccinated before. If the MMR vaccine isnt suitable for you, a treatment called human normal immunoglobulin (HNIG) can be used if youre at immediate risk of catching measles. Treatment for measles There are things you can do to help relieve your symptoms. Do take paracetamol or ibuprofen to relieve fever, aches and pains aspirin should not be given to children under 16 years old drink plenty of water to avoid dehydration close the curtains to help reduce light sensitivity use damp cotton wool to clean the eyes In severe cases, especially if there are complications, you or your child may need to be admitted to hospital for treatment. Source: NHS 24 - Opens in new browser window Last updated: 01 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform MMR vaccine MMR against measles NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Meningitis | Meningitis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Meningitis Meningitis About meningitis Causes of meningitis Treating meningitis Complications of meningitis Preventing meningitis About meningitis Meningitis is an infection of the protective membranes that surround the brain and spinal cord (meninges). It can affect anyone, but is most common in babies, young children, teenagers and young adults. Meningitis can be very serious if not treated quickly. It can cause life-threatening blood poisoning (septicaemia) and result in permanent damage to the brain or nerves. A number of vaccinations are available that offer some protection against meningitis. Symptoms of meningitis Symptoms of meningitis develop suddenly and can include: a high temperature (fever) over 37.5C (99.5F) being sick a headache a blotchy rash that doesnt fade when a glass is rolled over it (this wont always develop) a stiff neck a dislike of bright lights drowsiness or unresponsiveness seizures (fits) These symptoms can appear in any order and some may not appear. When to get medical help You should get medical advice as soon as possible if youre concerned that you or your child could have meningitis. Trust your instincts and dont wait until a rash develops. Phone 999 for an ambulance or go to your nearest accident and emergency (A&E) department immediately if you think you or your child might be seriously ill. Phone 111 or your GP practice for advice if youre not sure if its anything serious or you think you may have been exposed to someone with meningitis. How meningitis is spread Meningitis is usually caused by a bacterial or viral infection. Bacterial meningitis is rarer but more serious than viral meningitis. Infections that cause meningitis can be spread through: sneezing coughing kissing sharing utensils, cutlery and toothbrushes Meningitis is usually caught from people who carry these viruses or bacteria in their nose or throat but arent ill themselves. It can also be caught from someone with meningitis, but this is less common. Read more about the causes of meningitis Vaccinations against meningitis Vaccinations offer some protection against certain causes of meningitis. These include the: meningitis B vaccine offered to babies aged 8 weeks, followed by a second dose at 16 weeks, and a booster at 1 year 6-in-1 vaccine offered to babies at 8, 12 and 16 weeks of age pneumococcal vaccine offered to babies at 12 weeks and between 12 and 13 months old meningitis C vaccine offered at 12 weeks of age, 1 year MMR vaccine offered to babies at 1 year and a second dose at 3 years and 4 months meningitis ACWY vaccine offered to teenagers who are in S3 (around 14 years of age) at school. Young people who are in S4-S6 and missed the opportunity to get immunised last year, may also get the vaccine at school this year Read more about the meningitis vaccinations Treatments for meningitis People with suspected meningitis will usually have tests in hospital to confirm the diagnosis and check whether the condition is the result of a viral or bacterial infection. Bacterial meningitis usually needs to be treated in hospital for at least a week. Treatments include: antibiotics given directly into a vein fluids given directly into a vein oxygen through a face mask Viral meningitis tends to get better on its own within 7 to 10 days and can often be treated at home. Getting plenty of rest and taking painkillers and anti-sickness medication can help relieve the symptoms in the meantime. Read more about how meningitis is treated Outlook for meningitis Viral meningitis will usually get better on its own and rarely causes any long-term problems. Most people with bacterial meningitis who are treated quickly will also make a full recovery, although some are left with serious, long-term problems. These can include: hearing loss or vision loss, which may be partial or total problems with memory and concentration recurrent seizures (epilepsy) co-ordination, movement and balance problems loss of limbs amputation of affected limbs is sometimes necessary Overall, its estimated that up to 1 in every 10 cases of bacterial meningitis is fatal. Read more about the complications of meningitis Causes of meningitis Meningitis is usually caused by a viral or bacterial infection. Viral meningitis is the most common and least serious type. Bacterial meningitis is rare but can be very serious if not treated. Severaldifferent viruses and bacteria can cause meningitis, including: meningococcal bacteriathere are several different types, called A, B, C, W, X, Y and Z pneumococcal bacteria Haemophilus influenzae type b (Hib) bacteria enteroviruses viruses that usually only cause a mild stomach infection the mumps virus the herpes simplex virus a virus that usually causes cold sores or genital herpes A number of meningitis vaccinations provide protectionagainst many of the infections that cancause meningitis. How meningitis is spread The viruses and bacteria that cause meningitis can be spread through: sneezing coughing kissing sharing utensils, cutlery and toothbrushes The infection is usually spread by people who carry these viruses or bacteria in their nose or throat, but arent ill themselves. The infection can also be spread by someone with meningitis, although this is less common. Its possible to get meningitis more than once. Whos most at risk? Anyone can potentially get meningitis, but its more common in: babies and young children teenagers and young adults elderly people people with a weak immune system for example, those with HIV and those having chemotherapy You can reduce therisk of getting meningitis by ensuring all your vaccinations are up-to-date. Read more about meningitis vaccinations Treating meningitis People with suspected meningitis will usually need to have tests in hospital and may need to stay in hospital for treatment. Tests in hospital Several tests may be carried out to confirm the diagnosis and check whether the condition is the result of a viral or bacterial infection. These tests may include: a physical examination to look for symptoms of meningitis a blood test to check for bacteria or viruses a lumbar puncture where a sample of fluid is taken from the spine and checked for bacteria or viruses a computerised tomography (CT) scan to check for any problems with the brain, such as swelling As bacterial meningitis can be very serious, treatment with antibiotics will usually start before the diagnosis is confirmed and will be stopped later on if tests show the condition is being caused by a virus. Treatment in hospital Treatment in hospital is recommended in all cases of bacterial meningitis, as the condition can cause serious problems and requires close monitoring. Severe viral meningitis may also be treated in hospital. Treatments include: antibiotics given directly into a vein fluids given directly into a vein to prevent dehydration oxygen through a face mask if there are any breathing difficulties steroid medication to help reduce any swelling around the brain, in some cases People with meningitis may need to stay in hospital for a few days, and in certain cases, treatment may be needed for several weeks. Even after going home, it may be a while before you feel completely back to normal. Additional treatment and long-term support may also be required if any complications of meningitis occur, such as hearing loss . Treatment at home Youll usually be able to go home from hospital if you or your child has mild meningitis and tests show its being caused by a viral infection. This type of meningitis will normally get better on its own without causing any serious problems. Most people feel better within 7 to 10 days. In the meantime, it can help to: get plenty of rest take painkillers for a headache or general aches take anti-emetic (anti-sickness) medicine for any vomiting Preventing the spread of infection The risk of someone with meningitis spreading the infection to others is generally low. But if someone is thought to be at high risk of infection, they may be given a dose of antibiotics as a precautionary measure. This may include anyone who has been in prolonged close contact with someone who developed meningitis, such as: people living in the same house pupils sharing a dormitory a boyfriend or girlfriend People who have only had brief contact with someone who developed meningitis wont usually need to take antibiotics. Complications of meningitis Most people make a full recovery from meningitis, but it can sometimes cause serious, long-term problems and can be life threatening. This is why its so important to get medical help as soon as possible if you think you or your child has symptoms of meningitis ,and why meningitis vaccinations are offered to certain groups. Its estimated up to1 person inevery2 or 3 who survives bacterial meningitisis left with 1 or more permanent problems. Complications are much rarer after viral meningitis. Main complications Some of the most common complications associated with meningitis are: hearing loss ,which may be partial or totalpeoplewho have had meningitis will usually have ahearing test after a few weeks to check for anyproblems recurrent seizures (epilepsy) problems with memory and concentration co-ordination, movementand balanceproblems learning difficulties and behavioural problems vision loss, which may be partial or total loss of limbsamputationis sometimes necessary to stop the infection spreading through the body and remove damaged tissue bone and joint problems, such as arthritis kidney problems Overall, its estimated up to 1 in every 10 cases of bacterial meningitis is fatal. Treatment and support Additional treatment and long-term support may berequired if you or your child experience complications of meningitis. For example: cochlear implants, which are small devices that are inserted into the ears to improve hearing,may be needed in cases of severe hearing loss read more about treatment for hearing loss prosthetic limbs and rehabilitation supportmay helpif it was necessary to amputate any limbs read more about recovering after an amputation counselling and psychological support may help if the trauma of having meningitiscauses problems such as disturbed sleep, bedwetting,or fear of doctors and hospitals You may alsofindit useful to get in touch with organisations such as the Meningitis Research Foundation or Meningitis Now forsupport and advice about life after meningitis. Preventing meningitis Meningitis can be caused by a number of different infections, so several vaccinations offer some protection against it. Children should receive most of these as part of the NHS vaccination schedule. Speak to your GP if youre not sure whether your or your childs vaccinations are up-to-date. Meningitis B vaccine The meningitis B vaccine offers protection against meningococcal group B bacteria, which are a common cause of meningitis in young children in the UK. The vaccine is recommended for babies aged8 weeks, followed by a second dose at 16 weeks, and a booster at one year. 6-in-1 vaccine The 6-in-1 vaccine, also known as the DTaP/IPV/Hib/HepB vaccine, offers protection against diphtheria, tetanus, whooping cough , polio, Haemophilus influenzae type b (Hib) and hepatitis B. Hib are a type of bacteria that can cause meningitis. The vaccine is given on three separate occasions when babies are 8, 12 and 16 weeks old. More about the 6-in-1 vaccine Pneumococcal vaccine The pneumococcal vaccine offers protection against serious infections caused by pneumococcal bacteria, including meningitis. Babies receive the pneumococcal vaccine as2 separate injections, at12 weeks and between 12 and 13 months old. More about the pneumococcal vaccine Hib/Men C vaccine The meningitis C vaccine offers protection against a type of bacteria meningococcal group C bacteria that can cause meningitis. Babies are offered a combined Hib/Men C vaccine at 1 year of age. Teenagers and first-time university students are also offered vaccination against meningococcal group C bacteria as part of the combined meningitis ACWY vaccine. More about the Hib/Men C vaccine MMR vaccine The MMR vaccine offers protection against measles , mumps and rubella . Meningitis can sometimes occur as a complication of these infections. The vaccine is usually given to babies at 1 year of age. Theyll then have a second dose when theyre 3 years and 4 months old. More about the MMR vaccine Meningitis ACWY vaccine The meningitis ACWY vaccines offers protection against 4 types of bacteria that can cause meningitis meningococcal groups A, C, W and Y. Young people who are in S3 (around 14 years of age) at school are advised to have the vaccination. Young people who are in S4 to S6 and missed the opportunity to get immunised last year, may also get the vaccine at school this year. More about the meningitisACWY vaccine Source: NHS 24 - Opens in new browser window Last updated: 04 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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Menopause | "Later years | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Healthy living Women's health Later years (around 50 years and over) Later years (around 50 years and over) In this period of life, some women experience more complex health needs. Mental health Mental health Includes stress, depression, insomnia and eating disorders Mental health self-help guides Self-help guides that use cognitive behavioural therapy (CBT) Mental wellbeing Advice dealing with low mood, anxiety, phobias, stress and where you can get help Menopause and post menopause health Menopause An overview of menopause, including peri and post menopause Early and premature menopause Information about early and premature menopause Signs and symptoms of menopause Information around the symptoms of menopause After the menopause Find out about how things might change when you are postmenopause Menopause and your mental wellbeing Information about how menopause can impact your mental wellbeing Treating menopause symptoms Information about the options available to treat symptoms of menopause Hormone replacement therapy (HRT) Information about hormone replacement therapy (HRT) Menopause and the workplace Information on menopause and the workplace Sexual wellbeing, intimacy and menopause Information about sexual wellbeing during and after the menopause Supporting someone through the menopause Find out about how you can support someone through the menopause Menopause videos Videos about menopause including common myths and how to talk to your GP Self-help tool: Menopause and mental wellbeing Help with anxiety, stress, depression, anger, self-esteem and sleep Periods and menstrual health Periods (menstruation) Information about periods including pain and PMS Choosing period products Information about period products and where to get them Stuck or lost tampon Learn how to remove a stuck tampon yourself and when to get help Periods (menstruation) videos Videos about periods including irregular periods and PMS Delayed start to periods Information about delayed and irregular periods Periods and pregnancy Information about how periods are linked to fertility Period pain (dysmenorrhoea) Information about period pain including ways to help Premenstrual Syndrome (PMS) Information about PMS and PMDD Heavy periods Information about irregular periods including possible causes and when to speak to your doctor Irregular periods Information about irregular periods including possible causes and when to speak to your doctor Paused periods Information about why you may have stopped your period Adenomyosis Information about adenomyosis including diagnosis and treatment Endometriosis Learn about endometriosis symptoms and treatments Fibroids Learn about fibroids symptoms and treatments Ovarian cyst Learn about ovarian cyst symptoms and treatments Polycystic ovary syndrome (PCOS) Information about polycystic ovary syndrome (PCOS) symptoms and treatment Self-help tool: Periods and mental wellbeing Help with anxiety, low mood, anger, self-esteem, sleep problems and social anxiety Sexual health and contraception Sexual health Information about sexually transmitted infections (STIs) Contraception Find out where to get contraception, how to use it and which types are available Pelvic health Pelvic floor muscles Learn how to exercise your pelvic floor muscles Pelvic organ prolapse Learn about pelvic organ prolapse symptoms and treatments Transvaginal mesh implants Information on transvaginal mesh implants which are used for treating pelvic organ prolapse or stress urinary incontinence Urinary incontinence in women Learn about symptoms and treatments of urinary incontinence in women Urinary tract infection (UTI) Urinary tract infections (UTIs) are common infections that affect the bladder, kidneys and connected tubes. Screening Cervical screening Who'll be offered a smear test in Scotland and what happens next if the test finds changes that need further investigation Bowel screening Who'll be offered bowl screening in Scotland and how it's done Breast screening Who'll be offered breast screening in Scotland and how a mammogram is done Long term conditions Cancer Information on different cancer types and advice on living with cancer Chronic pain Information about pain that lasts longer than 12 weeks, or beyond the natural healing time Irritable bowel syndrome (IBS) Learn about irritable bowel syndrome symptoms and treatments Lipoedema Information about lipoedema, a long term (chronic) condition of fat and connective tissue Thyroid Underactive thyroid Learn about underactive thyroid symptoms and treatments Overactive thyroid Learn about overactive thyroid symptoms and treatments Thyroid cancer Learn about thyroid cancer, a rare type of cancer that affects the thyroid gland located at the base of the neck Women's heart health Womens heart health Heart disease affects women as well as men. It's important to know the symptoms of heart disease and when to get help. Medical devices Breast and cosmetic implants Learn about breast and cosmetic implants and when they're used Breast and Cosmetic Implant Registry Learn about the Breast and Cosmetic Implant Registry and why it's useful Essure contraceptive device Essure is a contraceptive medical device that's no longer offered Vaginal health Managing genital symptoms Advice about common genital symptoms including pain, spots and itching Vaginal discharge Learn about vaginal discharge, changes to look for, and when to speak to a doctor Support after rape or sexual assault Turn to SARCS The NHS Scotland sexual assault self-referral phone service can help to arrange care for you in the days following a rape or sexual assault Where to find support if youve been raped or sexually assaulted Support is available from NHS Scotland, Police Scotland, charities and support organisations Supporting someone who has been raped or sexually assaulted Information to help people support someone who has experienced sexual violence NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852" | null | null | null | null | null | null | null | null | null | null | null | null | null |
Mesothelioma | Mesothelioma - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Mesothelioma Mesothelioma Mesothelioma is a type of cancer that develops in the lining that covers the outer surface of some of the bodys organs. Its usually linked to asbestos exposure. Mesothelioma mainly affects the lining of the lungs (pleural mesothelioma), although it can also affect the lining of the tummy (peritoneal mesothelioma), heart or testicles. Most cases are diagnosed in people aged 60to 80 and men are affected more commonly than women. Unfortunately, its rarely possible to cure mesothelioma, although treatment can help control the symptoms. Symptoms of mesothelioma The symptoms of mesothelioma tend to develop gradually over time. They typically dont appear until several decades after exposure to asbestos. Symptoms of mesothelioma in the lining of the lungsinclude: chest pain shortness of breath fatigue (extreme tiredness) a high temperature (fever) and sweating, particularly at night a persistent cough loss of appetite and unexplained weight loss clubbed (swollen) fingertips Symptoms of mesothelioma in the lining of the tummyinclude: tummy pain or swelling feeling or being sick loss of appetite and unexplained weight loss diarrhoea or constipation Speak to your GP if you have any persistent or worrying symptoms. Tell them about any exposure to asbestos you may have had in the past. What causes mesothelioma? Mesothelioma is almost always caused by exposure to asbestos, agroup of minerals made of microscopic fibres thatused to be widely used in construction. These tiny fibres can easily get in the lungs, where they get stuck, damaging thelungsover time.It usually takes a while for this to cause any obvious problems, with mesotheliomatypically developing more than20 yearsafter exposure to asbestos. The use of asbestos was completely banned in 1999, so the risk of exposure is much lower nowadays. However,materials containing asbestos are still found in many older buildings. Read more about asbestos and people at risk of exposure and avoiding exposure to asbestos . How mesothelioma is diagnosed If your GP suspects mesothelioma, they will refer you to a hospital specialist for some tests. Anumber of different tests may need to be carried out, including: an X-ray of your chest or tummy a computerised tomography (CT) scan a number of X-ray images are taken tocreate a detailed image of the inside of the body fluid drainage if theres a build-up of fluid around the lungs or in the tummy, a sample may be removed using a needle inserted through the skin so the fluid can be analysed a thoracoscopy or laparoscopy the inside of your chest or tummy is examined with a long, thin camera thats inserted through a small cut (incision) under sedation or anaesthetic ; a sample of tissue ( biopsy ) may be removed so it can be analysed These tests can help diagnose mesothelioma and show how far it has spread. Treatments for mesothelioma The best treatment for mesothelioma depends on several factors, including how far the cancer has spread and your general health. As mesothelioma is often diagnosed at an advanced stage, treatment is usually focused on controlling the symptoms and prolonging life for as long as possible.This is known as palliative or supportive care . Possible treatments include: chemotherapy this is the main treatment for mesothelioma and involves using medicine to help shrink the cancer radiotherapy this involves usinghigh-energy radiation to kill cancer cells and it may be used to slow the cancer down and keep it under control surgery an operation to remove the cancerous area can be done if mesothelioma is detected at a very early stage, although its not clear whether surgery is helpful Youll alsoprobably have treatment for your individual symptoms to help you feel as comfortable as possible. For example, regularly draining fluid from your chest may help your breathing and strong painkillers may helprelieveyour pain. Sometimes, a procedure is carried out to stop the fluid coming back again by making the outside of the lungs stick to the inside of your chest (pleurodesis), or a tube is put in your chest to drain the fluid regularly at home. Your doctors should discuss these treatments with you. Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Asbestosis Other health sites Mesothelioma UK Asthma and Lung UK: Mesothelioma Cancer Research UK: Mesothelioma Macmillan Cancer Support: Mesothelioma Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Middle ear infection (otitis media) | Middle ear infection (otitis media) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Ears, nose and throat Middle ear infection (otitis media) Middle ear infection (otitis media) Otitis media is an infection of the middle ear. It causes inflammation (redness and swelling) and a build-up of fluid behind the eardrum. Anyone can develop a middle ear infection, but theyre most common in young children. You do not always need to see a GP as most ear infections get better on their own within 3 to 5 days. Symptoms of a middle ear infection The main symptoms of a middle ear infection include: earache a high temperature (fever) being sick a lack of energy slight hearing loss if the middle ear becomes filled with fluid In some cases, a hole may develop in the eardrum (perforated eardrum) and pus may run out of the ear. The earache, which is caused by the build-up of fluid stretching the eardrum, then resolves. Signs in young children Young children and babies with an ear infection may also: rub or pull their ear not react to some sounds be irritable or restless be off their food keep losing their balance When to get medical advice Speak to your GP practice if: You or your child has: symptoms that do not improve within 2 or 3 days regular ear infections a lot of pain a discharge of pus or fluid from the ear an underlying health condition, such as cystic fibrosis or congenital heart disease , which could make complications more likely If your GP practice is closed, phone 111. Treatment for middle ear infections Most ear infections get better on their own within 3 to 5 days and do not need any specific treatment. If needed, paracetamol or ibuprofen can be used to relieve pain and a high temperature. Always read the leaflet that comes with your medicine before taking it. Follow the recommended dosage instructions. If youre not sure which treatments are suitable for you or your child, speak to a pharmacist for advice. Placing a warm cloth over the affected ear may also help relieve pain. Antibiotics are not usually used to treat middle ear infections. What causes middle ear infections? Most middle ear infections occur when an infection, such as a cold , leads to a build-up of mucus in the middle ear. This causes the Eustachian tube (a thin tube that runs from the middle ear to the back of the nose) to become swollen or blocked. The mucus cant drain away properly, making it easier for an infection to spread into the middle ear. An enlarged adenoid (soft tissue at the back of the throat) can also block the Eustachian tube. The adenoid can be removed if it often causes ear infections. Middle ear infections are more common in younger children because: the Eustachian tube is smaller in children than in adults a childs adenoids are relatively larger than an adults Certain conditions can also increase the risk of middle ear infections, including: having a cleft palate having Downs syndrome Can middle ear infections be prevented? Its not possible to prevent middle ear infections. There are some things you can do that may reduce your childs risk of developing one. Do make sure your child is up-to-date with their routine vaccinations particularly the pneumococcal vaccine and the DTaP/IPV/Hib/HepB (6-in-1) vaccine if possible, feed your baby with breast milk rather than formula milk Dont do not expose your child to smoky environments (passive smoking) do not give your child a dummy once theyre older than 12 months old do not feed your child while theyre lying flat on their back Children who go to nursery or school can pick up infections from other children who are unwell. Complications of middle ear infections Complications of middle ear infections are fairly rare, but can be serious. Most complications are the result of the infection spreading to another part of the ear or head. Rarely, infections can leave a perforation or hole in the eardrum. If complications do develop, they often need to be treated immediately with antibiotics in hospital. Source: ENT Scotland - Opens in new browser window Last updated: 07 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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Migraine | Migraine | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Migraine Migraine Migraine is a common health condition. It affects around 1 in every 5 women and around 1 in every 15 men. They usually begin in early adulthood. A migraine is usually a moderate or severe headache felt as a throbbing pain on one side of the head. Many people also have symptoms like nausea, vomiting and increased sensitivity to light or sound. There are several types of migraine, including: migraine with aura where there are warning signs before the migraine begins, like seeing flashing lights migraine without aura the most common type, where the migraine occurs without warning signs migraine aura without headache, also known as silent migraine where an aura or other migraine symptoms are experienced, without a headache Some people have frequent migraines up to several times a week. Other people only have occasional migraines. Its possible for years to pass between migraine attacks. Symptoms of a migraine The main symptom of a migraine is usually an intense headache on one side of the head. In some cases, the pain can occur on both sides of your head and may affect your face or neck. The pain is usually a moderate or severe throbbing sensation. The pain gets worse when you move and may prevent you from carrying out normal activities. Other symptoms associated with a migraine include: nausea vomiting increased sensitivity to light and sound which is why many people with a migraine want to rest in a quiet, dark room Some people experience other symptoms, including: sweating poor concentration feeling very hot or very cold abdominal (tummy) pain diarrhoea dizziness (light headedness) Not everyone with a migraine experiences these additional symptoms. Some people may experience them without having a headache . The symptoms of a migraine usually last between 4 hours and 3 days. You may feel very tired for up to a week afterwards. Symptoms of aura About1 in 3 people with migraines have temporary warning symptoms, known as aura, before a migraine. These include: visual problems such as seeing flashing lights, zig-zag patterns or blind spots numbness or a tingling sensation like pins and needles which usually starts in one hand and moves up your arm before affecting your face, lips and tongue difficulty speaking Sometimes, you might also experience: feeling dizzy or off balance loss of consciousness although this is unusual Aura symptoms typically develop over the course of about 5 minutes and last for up to an hour. The aura might start before the headache or you might experience it at the same time as a headache. Some people may experience aura followed by only a mild headache or no headache at all. Speak to your GP if: you have frequent or severe migraine symptoms Phone 999 if you or someone youre with experiences: paralysis or weakness in one or both arms and/or one side of the face slurred or garbled speech a sudden agonising headache resulting in a blinding pain unlike anything experienced before headache along with a high temperature (fever), stiff neck, mental confusion, seizures, double vision and a rash These symptoms may be a sign of a more serious condition, like a stroke or meningitis . You should be assessed by a doctor as soon as possible. Causes of a migraine The exact cause of migraines is unknown. Theyre thought to be the result of abnormal brain activity temporarily affecting nerve signals, chemicals and blood vessels in the brain. Around half of all people who experience migraines have a close relative with the condition. This suggests that genes may play a role. Migraine triggers It may help to keep a diary to see if you can identify a consistent trigger. It can be difficult to tell if something is a trigger or if what youre experiencing is an early symptom of a migraine attack. There might not always be a trigger for your headache. Possible migraine triggers include: Hormonal changes Some women experience migraines around the time of their period. This might be because of changes in the levels of hormones like oestrogen around this time. These types of migraines usually occur between 2 days before the start of your period to 3 days after. Some women only experience migraines around this time. This is known as pure menstrual migraine. Most women experience them at other times too. This is called menstrual related migraine. Some women find their migraines become worse during perimenopause. However, they might improve or disappear a few years after your last period. Emotional triggers stress anxiety tension shock depression excitement Physical triggers tiredness poor quality sleep shift work poor posture neck or shoulder tension jet lag fasting or low blood sugar ( hypoglycaemia ) strenuous exercise, if youre not used to it Dietary triggers missed, delayed or irregular meals dehydration alcohol the food additive tyramine (found in some cheeses and cured meat) caffeine products, such as tea and coffee lack of caffeine (if youre used to regular caffeine) specific foods such as chocolate, citrus fruit and cheese Some people crave chocolate before a migraine begins. This can be a sign that youre about to have a migraine rather than the chocolate being the trigger for the migraine. Environmental triggers bright lights flickering screens, such as a television or computer screen smoking (or smoky rooms) loud noises strong smells changes in weather (windy weather or stuffy atmosphere) Medication some types of sleeping tablets the combined contraceptive pill hormone replacement therapy (HRT) , sometimes used to relieve symptoms of the menopause There are other types of medications that can cause some people to experience migraines. Speak to your GP if you start to experience migraines after starting to take new medication. Diagnosing migraines Theres no specific test to diagnose migraines. For an accurate diagnosis, your GP must identify a pattern of recurring headaches along with the associated symptoms. Migraines can be unpredictable, sometimes occurring without the other symptoms. Obtaining an accurate diagnosis can sometimes take time. Your GP might do a physical examination and check your vision, co-ordination, reflexes and sensations. These will help rule out some other possible underlying causes of your symptoms. Your GP may ask if your headaches are: on one side of the head a pulsating pain severe enough to prevent you carrying out daily activities made worse by physical activity or moving about accompanied by nausea and vomiting accompanied by sensitivity to light and noise Migraine diary To help with the diagnosis, it can be useful to keep a diary of your migraine attacks for a few weeks. Note down details like: the date time what you were doing when the migraine began how long the attack lasted what symptoms you experienced what medication you took (if any) Taking too many painkillers is a reason why migraines can become difficult to treat. This is called medication overuse headache.Keep a record of what painkillers you take and how often you take them. You shouldnt take painkillers on more than 10 days every month in the long-term. It can be helpful to make a note when your start your period, if you have one. This can help your GP identify potential triggers. Read more about keeping a migraine diary on The Migraine Trust website. Referral to a specialist Your GP may decide to refer you to a neurologist (a specialist in conditions affecting the brain and nervous system). Theyll do further assessments and offer treatment if: a diagnosis is unclear you experience significant migraines not controlled by your current treatment Treating migraines Theres no cure for migraines. There are treatments available to help reduce the symptoms. During an attack, many people find that sleeping or lying in a darkened room can also help. It may take time to work out the best treatment for you. You may need to try different types or combinations of medicines before you find the most effective ones. If you cant manage your migraines using over-the-counter medicines, your GP may prescribe something stronger. Always make sure you read the medication instructions and follow the dosage recommendations. Children under 16 shouldnt take aspirin unless its under the guidance of a healthcare professional. Aspirin and ibuprofen are not recommended for adults who have a history of stomach problems, like stomach ulcers , liver problems or kidney problems. Painkillers Many people find that over-the-counter painkillers, like paracetamol , aspirin or ibuprofen , can help to reduce their symptoms. They tend to be most effective if taken at the first signs of a migraine attack. This gives them time to absorb into your bloodstream and ease your symptoms. You shouldnt wait until the headache worsens before taking painkillers as its often too late for the medication to work. Soluble painkillers (tablets you dissolve in a glass of water) are a good option because theyre absorbed quickly by your body. Taking too many painkillers can lead to medication overuse headache. You should not take them more than 15 days per month. If you cant swallow painkillers because of nausea or vomiting, you should speak to your GP about anti sickness medication or suppository options. Suppositories are capsules that you insert into the anus (back passage). Opiates like codeine should not be prescribed as a treatment for migraines. Theyre not any more effective than triptans and painkillers and can cause nausea and medication overuse headache. Triptans If over the counter medication is not helping your symptoms, your GP might recommend a triptan and/or anti sickness medication. Triptan medicines are a specific painkiller for migraine headaches. Theyre thought to work by reversing the changes in the brain that may cause migraine headaches. Triptans are available as tablets, injections and nasal sprays. Common side effects of triptans include: warm-sensations tightness tingling flushing and light headedness feelings of heaviness in the face, throat, limbs or chest Some people also experience nausea, dry mouth and drowsiness. These side effects are usually mild and improve on their own. Taking too many triptans can lead to medication overuse headache. You should not take them more than 10 days per month. Your GP will usually recommend having a follow-up appointment once youve finished your first course of treatment. This is so you can discuss their effectiveness and whether you had any side effects. If treatment is not effective or causes unpleasant side effects, your GP may try prescribing a different type of triptan. Everyone reacts differently to each type of triptan. Triptans can be taken at the same as painkillers and/or anti-sickness tablets to improve their effectiveness. Your GP will discuss this with you. Anti-sickness medicines Anti-sickness medicines, known as anti-emetics, can treat migraine in some people. They can be effective even if you dont experience nausea or vomiting. They can be taken alongside painkillers and triptans. Anti-sickness medicines work better if taken as soon as your migraine symptoms begin. They usually come in the form of a tablet. Side effects of anti-emetics include drowsiness and diarrhoea . Some anti-sickness medication can cause involuntary movements, normally in the face. Speak to your GP if you experience involuntary movements. Combination medicines You can buy some combination medicines for migraine without a prescription at your local pharmacy. These medicines contain both painkillers and anti-sickness medicines. If youre not sure which one is best for you, ask your pharmacist. It can also be very effective to combine a triptan with another painkiller, like ibuprofen. Many people find combination medicines convenient. However, the dose of painkillers or anti-sickness medicine may not be enough to relieve your symptoms. If this is the case, it may be better to take painkillers and anti-sickness medicines separately. This allows you to control the doses of each. Opiates like codeine should not be prescribed as a treatment for migraines. Theyre not any more effective than triptans and painkillers and can cause nausea and medication overuse headache. Treatment during pregnancy and breastfeeding In general, migraine treatment with medicines should be limited as much as possible when youre pregnant or breastfeeding. Instead, trying to identify and avoid potential migraine triggers is recommended. If medication is essential, paracetamol and sumatriptan are safe to take during pregnancy and when breastfeeding. If youre pregnant or breastfeeding, speak to your GP or midwife: if youre getting regular migraines before taking medication High doses of aspirin should not be taken to treat headaches during pregnancy. Preventing migraines Its important to maintain a generally healthy lifestyle, including: regular exercise, sleep and meals ensuring you stay well hydrated limiting your intake of caffeine limiting your intake of alcohol One of the best ways of preventing migraines is recognising the things that trigger an attack and trying to avoid them. Preventative medication Medication is available to help prevent migraines. These medicines are usually used if your migraines remain frequent (more than 1 migraine per week) following a period of avoiding possible triggers. The following medications can be prescribed by your GP. If theyre not effective, youll be referred to a neurologist. The neurologist will consider what advanced therapies might be best to try next. Medications used to prevent migraines are taken every day to reduce the severity and frequency of headaches. It takes a few weeks to reach the right dose and you might need to take it for several weeks (usually 8 weeks once the right dose is reached) to find out if it works. Propranolol Propranolol is a medication used to treat angina and high blood pressure. Its also effective in preventing migraines. It is taken every day in tablet form, regardless of whether you have a headache or not. Propranolol is not suitable for people with asthma , chronic obstructive pulmonary disease (COPD) and some heart problems. It should be used with caution in people with diabetes . Side effects of propranolol can include: cold hands and feet pins and needles problems sleeping tiredness light headedness Tricyclic antidepressants You might be prescribed tricyclic antidepressants like amitriptyline or nortriptyline. This is a type of medication used for depression but at lower doses can also help prevent migraines. The side effects can include: drowsiness a dry mouth weight gain difficulty passing urine Topiramate Topiramate is a type of medication originally developed to prevent seizures in people with epilepsy . Its now much more commonly used in migraine. Its been shown to help prevent migraines. It is taken every day in tablet form regardless of whether you have a headache or not. Topiramate should be used with caution in people with kidney stones, liver problems or glaucoma. You should not take topiramate during pregnancy as it can harm your unborn baby. You must be on an effective form of contraception when taking topiramate. Topiramate can reduce the effectiveness of hormonal contraceptives. Your GP should discuss alternative methods of contraception if youre prescribed topiramate. Side effects of topiramate can include: decreased appetite and weight loss nausea and vomiting constipation or diarrhoea tingling sensation memory problems and difficulty finding words problems sleeping Candesartan You might be prescribed Candesartan. Candesartan is a medication used for high blood pressure. Candesartan can cause lightheadedness due to low blood pressure, tiredness and cough. It should not be used if youre pregnant or trying for a baby. Other oral preventive medications Other less common options of oral preventative medications for migraine include: pizotifen flunarizine Complementary therapies and supplements There are some complementary therapies and supplements which might help to prevent your migraine symptoms. These include: magnesium vitamin B2 (rivoflavin) coenzyme Q10 acupuncture You should discuss any complementary therapies youd like to try with your GP. Medical devices There are some devices that have been developed that might help treat migraines. These include: transcranial magnetic stimulation external trigeminal nerve stimulator non-invasive vagus nerve stimulation Read more about medical devices Advanced therapies for migraine The following medicines are advanced therapies for migraine that can only be prescribed by a neurologist. Botulinum toxin type A Botulinum toxin type A is used to prevent headaches in some adults with chronic migraines. Chronic migraines mean you have headaches more than 15 days per month and at least half of them are migraines, over a period of 3 months. Botulinum toxin type A is a type of neurotoxin (nerve toxin) that paralyses muscles. Its not exactly clear why this treatment can be effective for migraine. SIGN recommend this treatment as an option for people who have chronic migraine that hasnt responded to at least three previous preventative medical treatments. Botulinum toxin type A should be injected to between 31 and 39 sites around the head and back of the neck. A new course of treatment can be given every 12 weeks. Calcitonin Gene-Related Peptide (CGRP) monoclonal antibodies CGRP might be prescribed if other medication has not prevented your migraines. This medication has been created specifically for migraines. CGRP monoclonal antibodies are given by an injection into the skin on your thigh or abdomen (tummy) once per month. Youll have to self administer this treatment meaning youll need to learn how to deliver the injection yourself. Read more about CGRP Preventing menstrual-related migraines Menstrual-related migraines usually occur between 2 days before the start of your period to 3 days after. They can be preventable using either non-hormonal or hormonal treatments. Non-hormonal treatments The non-hormonal treatments that are recommended are: non-steroidal anti-inflammatory drugs (NSAIDs) a common type of painkiller (usually naproxen) triptans a type of medication used to treat a migraine attack (usually naratriptan or frovatriptan) These medications are taken as tablets 2 to 4 times a day from either the start of your period or 2 days before, until the last day of bleeding. Hormonal treatments Hormonal treatments that may be recommended include: combined hormonal contraceptives, like the combined contraceptive pill , patch or vaginal ring (usually taken continuously for at least 3 months) progesterone-only contraceptives, such as progesterone-only pills , implants or injections oestrogen patches or gels, which can be used from 3 days before the start of your period and continued for 7 days Hormonal contraceptives like the combined contraceptive pill or vaginal ring are not used if you have migraines with aura symptoms. This is because this can increase your risk of having a stroke . Migraine clinic If the treatments above arent controlling your migraines, you might be referred to a specialist migraine clinic for further investigation and treatment. A specialist might recommend other treatments like transcranial magnetic stimulation devices or greater occipital nerve blocks. Complications of migraines Migraines are linked to a very small increased risk of mental health problems. Migraines with aura are associated with a small increased risk of ischaemic strokes. Stroke An ischaemic stroke occurs when the blood supply to the brain is blocked by a blood clot or fatty material in the arteries. People who experience migraines with aura have about twice the risk of having an ischaemic stroke compared to people without migraines. However, this risk is still small. The risk increases significantly if you smoke and take the combined contraceptive pill. Its unclear why ischaemic strokes are linked to migraine. Contraceptive pill The risk of having an ischaemic stroke is increased by the use of the combined contraceptive pill . Medical professionals generally advise women who experience migraine with aura not to use the combined contraceptive pill. Women who have migraine without aura can usually take the combined contraceptive pill safely, unless they have other stroke risk factors like high blood pressure or a family history of cardiovascular disease . Talk to your GP about alternative forms of contraception if you experience aura symptoms and are taking the combined contraceptive pill. Mental health problems Migraine is associated with a very small increased risk of mental health problems, including: depression bipolar disorder anxiety disorder panic disorder Source: Scottish Government - Opens in new browser window Last updated: 14 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Other health sites The Migraine Trust NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Miscarriage | Miscarriage | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Pregnancy and childbirth Miscarriage Miscarriage A miscarriage is the loss of your baby before 24 weeks. Early miscarriages happen in the first 12 weeks of pregnancy. Late miscarriages happen between 12 and 24 weeks. Most of the time theres no clear reason why it happens, but its very unlikely to be caused by anything you did or didnt do. About 1 out of 5 pregnancies miscarry. Since many miscarriages arent recorded the figure might be higher. Always get medical help if: youre bleeding from your vagina youve got strong, cramping pain your waters break your babys movements have changed, or you havent felt them move for a while If youre registered, contact your midwife or local maternity unit. If youre not registered, contact your GP or the NHS 24 111 service. What causes a miscarriage? Doctors think most miscarriages are caused when the building blocks controlling the development of a baby (the chromosomes) arent right. Babies with too many or not enough chromosomes wont develop properly. This leads to a miscarriage. Miscarriages can also be caused by: issues with your placenta cervical weakness when your cervix (neck of your womb) starts to open Early miscarriages An early miscarriage happens in the first 12 weeks of pregnancy. Most women who miscarry do so in the first 12 weeks of their pregnancy. Many women have a miscarriage before they even know theyre pregnant. If this happens it can feel like a late period with heavy bleeding. Symptoms of an early miscarriage You might be having an early miscarriage if: youre bleeding from your vagina youve cramps in your lower abdomen these can feel like bad period pains theres fluid or tissue coming from your vagina your breasts are no longer tender and any morning sickness has passed Bleeding Having some light bleedings fairly common in the first 12 weeks of pregnancy and doesnt necessarily mean youre having a miscarriage. If you start bleeding, you should always contact your GP or midwife and get advice about what to do. What happens during an early miscarriage If youre in the early weeks of pregnancy: youll probably be asked to go to the early pregnancy unit at your local hospital straight away youll have some tests and usually an ultrasound scan your body usually completes the miscarriage naturally Depending on your stage of pregnancy, you may deliver a small baby. That can be a shock and is an understandably upsetting time. Late miscarriages A late miscarriage happens after 12 weeks and before 24 weeks. For many parents who lose their baby after a late miscarriage, the word miscarriage doesnt properly express the impact of their loss. The loss of a baby at any times a terrible shock and a late miscarriage can be especially hard. Symptoms of a late miscarriage You might be having a late miscarriage if: youre bleeding from your vagina this can be heavy and you might have blood clots youve strong, cramping pains Always get medical help if: youre bleeding your babys movements have changed or you havent felt any movements for a while. your waters break and your babys born very quickly Contact your midwife or local maternity unit if youre registered with them. If youre not registered, contact your GP or phone the NHS 24 111 service. What happens during a late miscarriage If youre later on in pregnancy: you may be asked to go to the maternity ward youll have some tests and usually an ultrasound scan youre likely to go through labour in hospital and might have your labour induced While you deliver your baby youre likely to have heavier bleeding and labour-like pains. Making difficult decisions If youre having a miscarriage, your doctor or midwife will: talk to you about what will happen next help you, and your partner if you have one, decide what youd like to do You may have many difficult decisions to make at this time and will have overwhelming emotions. Take your time. Your midwife or doctor can help, and there are many organisations that can support you, your babys father and your family. Get support from SANDS Get support from SiMBA After a miscarriage Depending on your circumstances and stage of pregnancy, your midwife or doctor may ask if youd like to see or hold your baby. Some parents decide they dont want to see their baby, and others choose not to for faith or cultural reasons. This is a decision only you can make. It can be very hard when youre feeling overwhelmed. Whatever you decide is okay. If youre worried about what your baby looks like, your midwife or doctor can describe them to help you decide. If your symptoms continue Youll probably have some bleeding for a week or two. If you continue to have symptoms after your miscarriage, it may mean that some of the pregnancy tissues still in your womb. Some women may need medicine or a short operation to treat this. If youre worried about seeking treatment, maybe a friend can come with you. Having supports really important at this difficult time. Taking time off work Many women will want to take time off work after having a miscarriage. If you have a miscarriage before the end of the 24th week, youre entitled to: take sick leave any sick pay youd normally qualify for If you lose your baby after the end of the 24th week, youre entitled to: take maternity leave any maternity pay you qualify for Speak to your employer about which choices may be right for you and your family. Working Families has more about your rights at work after a miscarriage Repeated miscarriages Most women go on to have a successful pregnancy and a healthy baby after a miscarriage. But unfortunately, some women have repeated miscarriages. If youve had: 1 or 2 miscarriages youre not more likely than anyone else to have another one 3 or more miscarriages your GP can refer you to a specialist to see whether theres a specific cause Source:\r\n Public Health Scotland - Opens in new browser window Last updated: 07 December 2022 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Motor neurone disease (MND) | "Motor neurone disease (MND) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Motor neurone disease (MND) Motor neurone disease (MND) Motor neurone disease (MND) is a rare condition that progressively damages parts of the nervous system. This leads to muscle weakness, often with visible wasting. Amyotrophic lateral sclerosis (ALS) is the most common form of MND. MND happens when specialist nerve cells in the brain and spinal cord, called motor neurones, stop working properly and die prematurely. This is known as neurodegeneration. Motor neurones control muscle activity like: gripping walking speaking swallowing breathing As MND progresses, it can become more difficult to do some or all of these activities. Symptoms of motor neurone disease The symptoms of MND start gradually over weeks and months. They tend to appear on one side of the body first and get progressively worse. Speak to your GP if: you have early symptoms of MND Being referred to a specialist as early as possible can help you access the right support. There are usually 3 stages of symptoms. Early symptoms Sometimes the early symptoms are mistaken for similar conditions that also affect the nervous system. Limb-onset disease In about two-thirds of people with MND, the first symptoms are in the arm or leg. This is sometimes called limb-onset disease. The symptoms include: a weakened grip, which can cause problems picking up or holding objects weakness at the shoulder, making lifting your arm above your head difficult tripping up over your foot because of weakness at your ankle or hip These symptoms are usually painless. You might also experience widespread twitching of the muscles (fasciculations) or muscle cramps. You might also see wasting of the muscles with significant weight loss. Bulbar-onset disease In 1 out of 4 cases, the first MND symptoms will affect the muscles used for speaking and swallowing. These problems might initially affect the muscles used for speech and swallowing. Increasingly slurred speech (dysarthria) is usually the first sign of this type of MND. It might be misdiagnosed as a stroke . As the condition progresses, it may become increasingly difficult to swallow (dysphagia). This might be misdiagnosed as a blockage in the throat. Respiratory-onset disease In rare cases, MND starts by affecting the lungs, rather than affecting them at the end of the condition. This is called respiratory-onset disease. In some cases the initial symptoms like breathing difficulties and shortness of breath are more obvious. You might suffer from a lack of sleep and a headache in the morning. This might be because your body isnt getting rid of the carbon dioxide you normally breathe out. Advanced symptoms As MND becomes more advanced, more parts and functions of the body are affected. This can make you more likely to experience infections, like chest infections, which can cause your condition to get worse quicker. Muscular symptoms The limbs will become weaker. The muscles in the limbs may become thinner. As a result, the person will find it increasingly difficult to move the affected limbs. The limbs may also become stiff. This is known as spasticity. Both muscle wasting and stiffness can also cause joint aches and pains. Speaking and swallowing difficulties Speaking and swallowing can become increasingly difficult as MND progresses. Choking episodes can be distressing but they arent usually the cause of death. Saliva problems Reduced swallowing can cause excess saliva. This can cause drooling. Thicker saliva can sometimes be difficult to clear from the chest or throat. This is because the muscles that control coughing become weak. Excessive yawning Some people with MND have episodes of uncontrollable excessive yawning. This can happen even when theyre not tired. It can sometimes cause jaw pain. Emotional changes MND can cause changes in your ability to control your emotions. This is more likely when theres weakness in the muscles that control speech and swallowing. One of the most common signs is when a person has episodes of sudden uncontrollable crying or, more rarely, laughter. This is sometimes called emotional lability or emotionality. Changes to mental abilities Sometimes, people with MND have significant difficulties with: concentration planning communication behavioural changes. This is where the condition is causing a type of dementia (usually frontotemporal dementia). Up to 15% of people with MND develop more profound frontotemporal dementia. This usually happens soon after, or sometimes before, their first muscle-related symptoms. Someone with MND might not be aware that there are problems with their behaviour or personality. Breathing difficulties Breathing might become less efficient as the nerves and muscles that help control the lungs become more damaged. This might mean you feel short of breath after doing every day tasks like walking up the stairs. Over time, you might become even more out of breath when youre resting. Shortness of breath can become a problem at night. Some people find it difficult to breathe when theyre lying down. Others might wake in the night because they feel breathless. As breathlessness increases, breathing support can help reduce this symptom. This is usually given by non-invasive ventilatory (NIV) support. It can be useful at night to improve your sleep quality. This can help reduce drowsiness during the day. End-stage symptoms As MND progresses to its final phase, you might experience: increasing body paralysis, which means youll need help with most daily activities significant shortness of breath Eventually, non-invasive breathing assistance wont be enough to make up for the loss of normal lung function. At this stage, more medication can help to reduce symptoms of breathlessness and anxiety related to it. Most people with MND become increasingly drowsy before falling into a deep sleep, where they usually die peacefully. Secondary symptoms Some people with MND have other symptoms that arent directly caused by the condition, but are related to the stress of living with it. These might include depression , insomnia and anxiety . Causes of motor neurone disease MND occurs when specialist nerve cells (motor neurones) in the brain and spinal cord progressively fail. Its not clear why this happens. Genetic causes One known cause of MND is an error in your genes with 20% of cases linked to genetic causes.Half of genetic caseswill be in people who have a family history of MND. The other half of genetic cases will occur in those without a family history. Having a family history of frontotemporal dementia can also increase the risk of inheriting MND. The error in the gene affects the cells ability to perform normally and survive. If you have a genetic form of MND, theres a chance that you could pass the risk of developing MND on to your child. The risk of them developing the condition can be affected by many factors like age. Not everyone who has the genetic mutation will develop MND in their lifetime. Typically, the longer you live, the more likely you are to develop the condition. If you have a parent with MND with no other family history of the disease, youre at a slight increased risk of MND of about 1.4%. The risk to the general population of MND is about 0.3%. Other possible causes of motor neurone disease Its unclear why the motor neurones begin to lose function. Most experts believe that its a combination of factors that affect either the motor neurones or the cells that support them. There are some theories involving different cell processes including: Aggregates and RNA processing Aggregates are abnormal clumps of protein that develop inside motor neurones. Theyre found in nearly all cases of MND and may disrupt the normal working of the motor neurones. It can also be a marker that the cell is under stress. The protein TDP-43 is most commonly found in these aggregates. This is a protein involved in the processing of the genetic instructions for the cell through a molecule known as RNA. Mutations in the gene (TARDBP) coding for this protein can be a cause of genetic cases of MND. Cell transport disruption All cells have transport systems that move nutrients and other chemicals into the cell and waste products out of the cell. Research suggests that the transport systems in motor neurones become disrupted. Over time, toxic waste can build up in cells as a natural by-product of normal cell activity and aging. The body gets rid of the toxic waste by waste disposal systems that can be affected by ageing and the environment. Glial cells Glial cells surround and support motor neurones and provide them with nutrients. When they dont work properly the motor neurones no longer receive the support and nutrition they need to function normally. Their involvement in MND is still being researched. Glutamate Nerve cells use special messenger chemicals called neurotransmitters to pass information between cells. One of the neurotransmitters is called glutamate. It excites neurones and one theory is that too much activity through this causes damage to the neurones. Riluzole, a drug used to treat MND reduces the level of neuronal activity by blocking the action of Glutamate. Mitochondria Mitochondria are the batteries of cells. They provide the energy that a cell needs to carry out its normal function. Mitochondria in the motor neurones of people with MND might not function properly. Diagnosing motor neurone disease Speak to your GP if you experience the initial symptoms of MND. After hearing about your symptoms and an initial exam, your GP might refer you to a neurologist (a doctor who specialises in conditions affecting the brain and nervous system). Diagnosing MND can be difficult during the early stages. This is because many of the first symptoms can be caused by other more common health conditions like: a trapped nerve wear and tear of the bones in the spine can sometimes cause nerves to become trapped under the spine peripheral neuropathy where part of the nervous system is damaged by another condition, like type 2 diabetes swallowing difficulties caused by narrowing or inflammation of the gullet speech difficulties due to problems with the voice box damage to the brain by stroke or other neurological conditions like multiple sclerosis (MS) in younger people Initial testing MND is usually diagnosed by a neurologist based on the symptoms and a physical examination. Theres no single test for MND. Various tests might be used to rule out other possible causes of the your symptoms. Tests might include: blood tests these can be used for several reasons, like checking that organs are working, or to look for a marker of muscle damage (creatinine kinase) magnetic resonance imaging (MRI) scan to give a detailed picture of your brain and spinal cord electromyography (EMG) measures the electrical activity in your muscles, which shows how well your motor neurones are working and connecting to the muscles nerve conduction test similar to an EMG but measures how quickly your nerves can conduct an electrical signal lumbar puncture a sample of spinal fluid might be tested to exclude an inflammatory or nerve condition caused by an infection muscle biopsy in rare cases, a small sample of muscle might be removed for testing to determine whether the problem lies in the muscles Gene tests can be used to support the diagnosis in some individuals. They might provide an explanation of why theyve developed the disorder. Your GP can give you more information about specialists who can help with genetic testing. Confirming the diagnosis There are many reasons why there may be delays in diagnosis. The initial symptoms might not appear to be serious. Or symptoms might not be recognised as being related to the nervous system so a neurologist isnt consulted at first. Sometimes, the diagnosis of MND is clear without the need for further tests. Confirming a diagnosis can sometimes be time-consuming even for an experienced neurologist. They might need a period of observation to be sure, particularly in cases where the condition progresses slowly. MND can only be diagnosed if the symptoms are clearly getting worse (progressive). Receiving the diagnosis Being told you have MND can be devastating and the news can be difficult to take in at first. After youre diagnosed you should be provided with contact details of an MND care specialist. These are healthcare professionals with specialist experience caring for people with MND. Theyll be able to give you (and your family) extra support after the diagnosis and during your time with the illness. Talking to a counsellor or a trained clinical psychologist might help with feelings of depression and anxiety . Its not unusual to have thoughts of taking your own life, although very few people with MND go on to do this. You should discuss these thoughts with your doctor. Taking antidepressants or medicines to reduce anxiety may help. Your care team will be able to tell you about this. Treating motor neurone disease Although theres no cure for MND, there are treatments available to help relieve the symptoms. A team of healthcare professionals will work together to help care for you. This multidisciplinary team typically includes: a neurologist and an MND care specialist a specialist in breathing (respiratory specialist) physiotherapists to advise on mobility aids occupational therapists to assess the need for adaptations to living environments speech and language therapist to provide help with communication and swallowing dieticians to support nutrition As the conditions advances, you might also need palliative care. Riluzole Riluzole is the only licensed medication in the UK thats shown a survival benefit for people with MND. Riluzole is thought to slow down the damage to the motor neurone cells by reducing their sensitivity to the nerve transmitter glutamate. In medical research, riluzole extended survival by 2 to 3 months on average. Side effects of riluzole are usually mild and can include nausea, tiredness and, less commonly, a rapid heartbeat. Very rarely, riluzole has been known to cause liver damage. If youre prescribed riluzole youll need to have blood tests for the first few months to check your liver is working properly. If youve had significant liver disease, riluzole may not be suitable for you. Treating symptoms There are treatments available that can help relieve many of the symptoms of MND and improve your quality of life. Muscle cramps Physiotherapy can help muscle cramps. In some cases, a medication called quinine can help treat muscle cramps too. They often improve later in the condition. Quinine can cause side effects like: hearing and vision problems tinnitus the perception of noise in one ear, both ears or inside the head vertigo a sensation that you, or the environment around you, is moving Quinine will usually only be used if the potential benefits are thought to outweigh the risks. Muscle stiffness Muscle stiffness, also known as spasticity, can be treated using medication like baclofen. This helps to help relax the muscles. Side effects can include increased weakness or tiredness. Drooling Medication is available to treat drooling of saliva. One option is a hyoscine hydrobromide skin patch. Alternative medicines used to control drooling include: amitriptyline atropine eye drops applied to the tongue glycopyrronium botulinum toxin injections into the glands that produce saliva Communication difficulties Not everyone with MND will have significant speech problems. There are ways to help people who find it hard to communicate. A speech and language therapist can teach you techniques to make your voice as clear as possible. As the disease progresses, you may need assistive technology to help you communicate. A range of communication aids is available. Your therapist will be able to tell you about the most effective communication aids for you. Swallowing difficulties Not everyone with MND will have significant swallowing problems (dysphagia). For those that do, it can prevent normal eating and drinking. This can lead to you feeling more tired. If food or fluid goes down the wrong way into the lungs it can cause chest infections (called aspiration). One common treatment for dysphagia is a feeding tube known as a gastrostomy tube. The tube is surgically implanted into your stomach through a small cut on the surface of the stomach. It shouldnt restrict your daily activities. You can continue to bathe and swim if you wish. Ideally you should have the tube inserted before you become too frail. This is so you can get the best out of it and to give yourself the best chance of recovering from the procedure. If you have thick secretions (fluids) you cant cough up yourself, medicine like carbocisteine and acetylcysteine might help. Breathing difficulties As MND progresses, the muscles that help you breathe will become weaker. Your breathing will become increasingly shallow, with a weaker cough. Breathing difficulties usually develop gradually. Theyre sometimes the first sign of MND, although this is rare. Its important to discuss breathing problems with your GP before they occur. Your GP or neurologist should be able to refer you to a respiratory (breathing) specialist or a palliative care specialist, depending on your needs. You might benefit from non-invasive mechanical ventilation (NIV) to support your breathing. Room air (not oxygen) is sucked into a small box. Its filtered and then gently pumped into the lungs through a face mask or nasal tube each time you take a breath. NIV may not be suitable for everyone with MND. Your healthcare team will be able to discuss the options available to you. Advance decision making Many people with MND draw up an advance decision (sometimes called an advanced directive). This is where you decide your treatment preferences in advance in case you cant communicate your decisions later because youre too ill. Issues that can be covered by an advance decision include: whether you want to be treated at home, in a hospice or in a hospital once you reach the final stages of MND the type of medication youd be willing to take in certain circumstances whether youd be willing to consider a feeding tube if you were no longer able to swallow food and liquid if you have respiratory failure (loss of lung function), whether you wish to have artificial resuscitation, like having a permanent breathing tube inserted into your throat (known as a tracheostomy) whether youd be willing to donate any of your organs after you die (the brain and spinal cord of people with MND are very important for ongoing research) Your care team will be able to provide you with more information and advice about making an advance decision. Read more about end of life care Research and drug trials You might be given the opportunity to take part in research, including drug trials. Your MND care specialist and neurology consultant can provide further information on this. Advice for carers Caring for someone with MND can be both physically and emotionally demanding. Its likely youll need a wide range of support. For information and advice about all aspects of caring, visit Care Information Scotland Source: Scottish Government - Opens in new browser window Last updated: 21 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Other health sites Brain and Spine Foundation: Motor neurone disease Motor Neurone Disease Scotland My Name'5 Doddie Foundation NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852" | null | null | null | null | null | null | null | null | null | null | null | null | null |
Mouth cancer | Mouth cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Mouth cancer Mouth cancer About mouth cancer Symptoms of mouth cancer Causes of mouth cancer Diagnosing mouth cancer Treating mouth cancer Complications of mouth cancer Living with mouth cancer About mouth cancer Mouth cancer, also known as oral cancer, is where a tumour develops on the surface of the tongue, mouth, lips or gums. Tumourscan also occur in the salivary glands, tonsils and the pharynx (the part of the throat from your mouth to your windpipe) but these are less common. Symptoms of mouth cancerinclude: red or white patches on the lining of your mouth or tongue ulcers a lump Speak to your GP if these symptomsdo not heal within 3 weeks, especially if youre a heavy drinker or smoker. Types of mouth cancer A cancer that develops on the inside or outside layer of the body is called a carcinoma and these types of cancer are categorised by the type of cells the cancerstarts in. Squamous cell carcinoma is the most common type of mouth cancer, accounting for nine out of 10 cases. Squamous cells are found in many places around the body, including the inside of the mouth and under the skin. Less common types of mouth cancer include: oral malignant melanoma where the cancer starts in cells called melanocytes, which help give skin its colour adenocarcinomas cancers that develop inside the salivary glands What causes mouth cancer? Mouth cancer occurs when something goes wrong with the normal cell lifecycle, causing them to grow and reproduce uncontrollably. Risk factorsfor developing mouth cancer include: smoking or using products that contain tobacco drinking alcohol smokers who are also heavy drinkers have a much higher risk compared to the population at large infection with the human papilloma virus (HPV), the virus that causes genital warts Read more about the causes of mouth cancer Who is affected by mouth cancer? Mouth cancer is an uncommon type of cancer. Most cases of mouth cancer first develop in older adults who are aged between 50and 74 years old. Mouth cancer can occur in younger adults, but its thought that HPV infection may be responsible for the majority of cases that occur in younger people. Mouth cancer is more common in men than in women. This is thought to be due to the fact that, on average, men drink more alcohol than women. Treating mouth cancer There are 3 main treatment options for mouth cancer. They are: surgery where the cancerous cells are surgically removed and, in some cases, some of the surrounding tissue chemotherapy where powerful medications are used to kill cancerous cells radiotherapy where high energy X-rays are used to kill cancerous cells These treatments are often used in combination. For example, a course of radiotherapy and chemotherapy may be given after surgery to help prevent the cancer returning. Read more about treating mouth cancer Complications of mouth cancer Both surgery and radiotherapy can make speaking and swallowing difficult ( dysphagia ). Dysphagia can be a potentially serious problem. If small pieces of food enter your airways and become lodged in your lungs, it could trigger a chest infection, known as aspiration pneumonia . Read more about the complications of mouth cancer Reducing the risk The three most effective ways to prevent mouth cancer from developing or prevent it reocurring after successful treatment are: not smoking keeping to the recommended limits for alcohol consumption eating a Mediterranean-style diet, with plenty of fresh vegetables (particularly tomatoes), citrus fruits, olive oil and fish (read more about healthy eating ) Its also important that you have regular dental check-ups because dentists can often spot the early stages of mouth cancer. Symptoms of mouth cancer Mouth cancer can develop on most parts of the mouth, including the lips, gums and occasionally, the throat. The most common symptoms of mouth cancer include: red or white patches in the mouth or throat a lump ulcers Other symptoms may include: persistent pain in the mouth pain or difficulty when swallowing ( dysphagia ) changes in your voice, or speech problems swollen lymph nodes (glands) in your neck unexplained weight loss bleeding or numbness in the mouth a tooth, or teeth, that becomes loose for no obvious reason difficulty moving your jaw When to seek medical advice Many of these symptoms canbe caused by less serious conditions, such as minor infections. But its strongly recommended that you visit your GP if any of these symptoms have lasted for more than 3 weeks. Its especially important to seek medical advice if youre a heavy drinker or smoker. Dental check-ups Mouth cancer tends not to cause any noticeable symptoms during the initial stages of the disease. This is why its important to have regular dental check-ups, particularly if you are a smoker, a heavy drinker or a betel chewer, because a dentist may often be able to detect the condition during an examination. You should have a dental check-up at least every year. However, more frequent check-ups may be recommended if you have a history of tooth decay or gum disease . Causes of mouth cancer The 2 leading causes of mouth cancer in the UK are drinking too much alcohol and smoking. Both alcohol and tobacco are carcinogenic, which means they contain chemicals that can damage the DNA in cells and lead to cancer . The risk of mouth cancer increases significantly in somebody who is both a heavy smoker and heavy drinker. Exactly what triggers the changes in DNA that lead to mouth cancer and why only a small number of people develop mouth cancer is still uncertain. How mouth cancer spreads There are 2 ways mouth cancer can spread: directly the cancer can spread out of the mouth and into nearby tissues, such as surrounding skin or into the back of the jaw via the lymphatic system the lymphatic system is a series of glandsfound throughout your body whichproduce many specialised cells needed by your immune system to fight infection Mouth cancer that spreads to another part of the body is known as metastatic oral cancer. Other risk factors Otherrisk factors for mouth cancer mayinclude: chewing tobacco or other smokeless tobacco products like snus chewingbetel nuts with or without tobacco a poor diet the human papilloma virus (HPV) poor oral hygiene Smokeless tobacco There is a range of smokeless tobacco products including: chewing tobacco snuff powdered tobacco designed to be snorted snus a type of smokeless tobacco popular in Sweden, which is placed under your upper lip Smokeless tobacco products are not harmless and may increase your risk of developing mouth cancer, as well as other cancers, such as liver cancer, pancreatic cancer and oesophageal cancer. Betel nuts Betel nuts are mildly addictive seeds taken from the betel palm tree, and are widely used in many southeast Asian ethnic communities, such as people of Indian and Sri Lankan origin. They have a stimulant effect similar to coffee. Betel nuts also have a carcinogenic effect, which can increase the risk of mouth cancer. This risk is made worse as many people enjoy chewing betel nuts along with tobacco. Due to the tradition of using betel nuts, rates of mouth cancer are much higher in ethnic Indian and Sri Lankan communities than in the population at large. Diet There is evidence that a poor diet may increase your risk of some types of mouth cancer. A healthy, balanced diet with plenty of fruit and vegetables is thought to reduce your risk of developing mouth cancer. Human papilloma virus (HPV) The human papilloma virus (HPV) is a family of viruses that affect the skin andmoist membranes that line your body, such as those in your cervix, anus, mouth and throat. You can contract an HPV infection by having sexual contact with a person already infected you do not have to have full sex; just close skin-to-skin contact. There is evidence that in rare cases,certain types of HPV can cause abnormal tissue growth inside the mouth, triggering mouth cancer. Poor oral hygiene There is evidence that poor oral hygiene, such as having tooth decay , gum disease , not brushing your teeth regularly and having ill-fitted dentures (false teeth) can increase your risk of mouth cancer. Diagnosing mouth cancer If you have symptoms of mouth cancer, your GP will carry out a physical examination and ask about your symptoms. If mouth cancer is suspected, you will be referred to hospital for further tests or to speak to a specialist head and neck surgeon. In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of mouth cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected mouth cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral . Biopsy It may be necessary to remove a small sample of affected tissue to check for the presence of cancerous cells. This procedure is known as a biopsy . There are 3 main methods used to carry out a biopsy in cases of suspected mouth cancer. Punch biopsy A punch biopsy may be used if the suspected affected area of tissue is in an easily accessible place, such as your tongue or the inside of your mouth. The area is first injected with a local anaesthetic to numb it. The doctor will then cut away a small section of affected tissue and remove it with tweezers. The procedure is not painful, but can feel a little uncomfortable. Fine needle aspiration (FNA) A fine needle aspiration (FNA) is a type of biopsy used if it is suspecteda swelling in your neck is the result of mouth cancer. Your neck is numbed and aneedle is usedto draw out a small sample of tissue and fluids from the lump. The sample is thenchecked for cancerous cells. FNA is not painful butit can be uncomfortable and cause bruising. Panendoscopy Apanendoscope is used if the suspected tissue is at the back of your throat or inside one of your nasal cavities. This is a long thin tubewith acamera and a lightwhichis guided throughthe nose, then used to remove a small section of tissue for the biopsy. The panendoscope can also check whether cancer has spread from your mouth to further down your throat, such as your larynx (voice box), oesophagus (gullet) or trachea (windpipe). Further tests If the biopsy confirms cancer you will need further tests to check what stage it has reached. If the cancer is diagnosed late it can have spread from your mouth into the lymphatic system a series of glands throughout your body which produce many of the specialised cells needed by your immune system. Once the cancer reaches the lymphatic system, it is capable of spreading to any other part of your body, including your bones, blood and organs. However, its uncommon for mouth cancer to spread further than the lymph nodes near your mouth, although in some cases it may also spread to surrounding bones, such as the jaw bone, and in some cases your lungs. Therefore, the tests will examine your lymph nodes, bones and the tissue near the site of your initial tumour to check for the presence of other tumours. These tests may include: an X-ray a magnetic resonance imaging (MRI) scan a computerised tomography (CT) scan a positron emission tomography (PET) scan Further biopsies on nearby lymph nodes may also be carried out. Staging and grading Once these tests have been completed it should be possible to tell what stage and grade your cancer is: staging is a measure of how far the cancer has spread the grade describes how aggressive the cancer is and how fast it is likely to spread in future This will help determine whether you have: early mouth cancer (usually curable) intermediate mouth cancer (may be curable) or advanced mouth cancer (not usually curable, but it is usually possible to slow the spread of the cancer and extend lifespan) There are 3 grades of mouth cancer: low-grade (the slowest), moderate-grade and high-grade (the most aggressive). Grading your cancer helps the doctor decide how quickly you need to be treated. Read more about treating mouth cancer . Treating mouth cancer Your treatment will depend on the type and size of the cancer, the grade and how far its spread as well as your general health. Your treatment plan If the cancer hasnt spread beyond the mouth or the oropharynx (the bit of your throat at the back of your mouth), a complete cure may be possible using a combination of surgery, radiotherapy and chemotherapy. If the cancer has spread to other parts of the body, then a cure is unlikely but it will be possible to slow the progress of the cancer and help relieve symptoms by using surgery, radiotherapy and chemotherapy. Deciding what treatment is best for you can be difficult. Your care team will make recommendations, but the final decision will be yours. Before going to hospital to discuss your treatment options, you may find it useful to write a list of questions to ask the specialist. For example, what are the advantages and disadvantages of particular treatments. Before treatment begins Radiotherapy makes the teeth more sensitive and vulnerable to infection so before treatment begins, youll be given a full dental examination and any necessary work will be carried out. If you smoke or drink, stopping will increase the chances of your treatment being successful. Your specialist nurse and your GP can provide help and support if you are finding it difficult to quit smoking and drinking. Read more about quitting smoking and cutting down on alcohol Surgery For mouth cancer, the aim of surgical treatment is to remove any affected tissue while minimising damage to the rest of the mouth. Photodynamic therapy (PDT) If the cancer is in its very early stages, it may be possible to remove any tumours using a type of laser surgery known as photodynamic therapy (PDT). PDT involves taking a medicine that makes your tissue sensitive to the effects of light. A laser is then used to remove the tumour. Other forms of surgery If your cancer is more advanced, it may be necessary to remove part of your mouth lining and, in some cases, facial skin, which can be replaced using skin grafted from your forearm or chest. If your tongue is affected, part of the tongue will have to be removed. This is known as a partial glossectomy. The tongue is then reconstructed using grafted tissue. If the cancer has spread to your jawbone it will need to be surgically removed. The jawbone can be replaced by taking bone from another part of your body and grafting it in place. Occasionally, other bones, such as cheekbones, may have to be removed to completely remove the cancer. These can be replaced with plastic prosthetic bones which are usually very realistic, leaving your physical appearance largely unaffected. During surgery, your surgeon may also remove lymph nodes near the site of the initial tumour. This is often done as a preventative measure in case they contain small numbers of cancerous cells that cant be detected. Radiotherapy Radiotherapy uses doses of radiation to kill cancerous cells. It may be possible to remove the cancer using radiotherapy alone, but it is usually used after surgery to prevent the cancer from reocurring. The treatment is normally given every day over the course of three to seven weeks, depending on the size of the cancer and how far it has spread. While it kills cancerous cells, radiotherapy can also affect healthy tissue, and it has a number of side effects, including: sore, red skin (like sunburn) mouth ulcers sore mouth and throat dry mouth loss of, or changes in taste loss of appetite tiredness feeling sick stiff jaw bad breath Any side effects will be monitored by your care team and treated where possible. The side effects of radiotherapy can be distressing, but most of them will pass once the radiotherapy is complete. Internal radiotherapy Internal radiotherapy also called brachytherapy is often used to treat cancers of the tongue that are in their early stages. It involves placing radioactive implants directly into the tumour while you are under a general anaesthetic. They will be left for between 1 and 8 days during which time the cancer cells will receive a much higher dose of radiation than the rest of your mouth. Visits by friends and family will need to be restricted due to radiation and pregnant women and children wont be able to visit you. The radioactive implants will cause your mouth to become swollen, and you will experience some pain 5 to 10 days after the implants are removed. Chemotherapy Chemotherapy is sometimes used in combination with radiotherapy when the cancer is widespread, or if it is thought there is a significant risk of the cancer returning. Chemotherapy involves the use of powerful cancer-killing medicines. These medicines damage the DNA of the cancerous cells, interrupting their ability to reproduce. Medicines used in chemotherapy can sometimes damage healthy tissue as well as the cancerous tissue. Adverse side effects are common and include: fatigue (tiredness) sore mouth mouth ulcers feeling sick being sick hair loss tiredness The side effects should stop once the treatment has finished. Chemotherapy also weakens your immune system and makes you more vulnerable to infection. Cetuximab Cetuximab is a new type of medication, known as a biologic, used to treat advanced cases of mouth cancer. It is usually used in combination with radiotherapy or chemotherapy. Cetuximab targets proteins on the surface of cancer cells, known as epidermal growth factor receptors. These receptors help the cancer to grow, so by targeting these proteins, cetuximab prevents the cancer from spreading. The National Institute for Health and Care Excellence (NICE) ruled that cetuximab did not represent a cost-effective treatment in most cases and has recommended it only be used in people who: are in a good state of health (likely to make a good recovery if treated) are unable to have chemotherapy for medical reasons (for example, because they have kidney disease or are pregnant) Complications of mouth cancer Complications of treatment for mouth cancer can include dysphagia (difficulty swallowing), speech problems and emotional disruption. Difficulty swallowing Dysphagia is the medical term for difficulty swallowing. Its easy to take your ability to swallow food and liquidfor granted,but in reality, the process relies on a complex interaction of muscles, which can be easily disrupted. Surgery and radiotherapy can affect your tongue, mouth or throat, resulting in dysphagia. Dysphagia is a potentially serious problem because, aside from the risk of malnutrition, there is a chance that small particles of food could enter your airways and become lodged in your lungs. This can trigger a chest infection, known as aspiration pneumonia. If you are having problems swallowing, a speech and language therapist (SLT) will need to assess your swallowing reflex. One way an SLT can do this is to perform a test known as a videofluoroscopy, which involves adding a special dye to liquid and food that you swallow. The dye highlights your swallowing reflexes and by using X-rays your SLT can see if there is a risk of food entering your lungs. If this is the case, it may be necessary for the short term to provide you with a feeding tube, which will be directly connected to your stomach. The SLT will teach you exercises so you can relearn how to swallow properly. Your ability to swallow will improve as you learn the exercises and the damaged tissue is allowed to heal. However, there is a chance your swallowing reflex will never fully recover. In some circumstances, you may have to alter your diet to make swallowing easier. Adietitian can give you dietary advice. Read more detailed information about how dysphagia istreated Speech Much like swallowing, your ability to speak clearly is governed by a complex interaction of muscles, bones and tissue, including your tongue, teeth, lips and soft palate (a section of tissue found at the back of the mouth). Radiotherapy and surgery can affect this process and make it difficult to pronounce certain sounds. In severe cases, you may have problems making yourself understood. An SLT will help you improve your verbal communication skills by teaching you a series of exercises that develop your range of vocal movements and teach you new ways of producing sounds. Emotional impact The emotional impact of living with mouth cancer can be significant. Many people report experiencing a roller coaster effect. For example, you may feel down when you receive a diagnosis, but feel up whenthe cancer responds to treatment.Then you may feel down again as you try to come to terms with the side effects and after effects of your treatment. This type of emotional disruption can sometimes trigger depression. Signs that you may be depressed include: feeling down or hopeless during the past month no longer taking pleasure in the things you used to enjoy Contact your GP for advice if you thinkyou may be depressed. There are a range of effective treatments for depression, including antidepressant medication and talking therapies, such ascognitive behavioural therapy (CBT). Read more about depression and coping with cancer Living with mouth cancer Having mouth cancer doesnt necessarily mean youll have to give up work, but you may need quite a lot of time off, and you may not be able to carry on as you did before treatment. If you have cancer youre covered by the Disability Discrimination Act . This means that your employer is not allowed to discriminate against you because of your illness. They have a duty to make reasonable adjustments to help you cope. Examples of these include: allowing you time off for treatment and medical appointments allowing flexibility with working hours, the tasks you have to perform or your working environment The definition of what is reasonable depends on the situation. For example, how much it would affect your employers business. It will help if you give your employer as much information as possible about how much time you will need off and when. Talk to your human resources department if you have one. Your union or staff association representative should also be able to give you advice. If youre having difficulties with your employer, you may be able to receive help from your union or your local Citizens Advice Bureau . Relationships with others It is not always easy to talk about cancer, either for you or your family and friends. You may sense that some people feel awkward around you or avoid you. Being open about how you feel and what your family and friends can do to help may put them at ease. Do not feel shy about telling them that you need some time to yourself, if that is what you need. Money and financial support If you have to stop work or go part-time because of your cancer, you may find it hard to cope financially. If you have cancer or you are caring for someone with cancer, you may be entitled to financial support: if you have a job, but cannot work because of your illness, you are entitled to Statutory Sick Pay from your employer if you dont have a job and cannot work because of your illness, you may be entitled to Employment and Support Allowance if you are caring for someone with cancer, you may be entitled to Carers Allowance you may be eligible for other benefits if you have children living at home or if you have a low household income Find out as early as possible what help is available to you. Speak to the social worker at your hospital who can give you the information you need. Talk to others If you have questions, your GP or nurse may be able to reassure you. You may find it helpful to talk to a trained counsellor or psychologist, or to someone at a specialist helpline. Your GP surgery will have information on these. Some people find it helpful to talk to other people who have mouth cancer, either at a local support group or in an internet chatroom, such as: Cancer Research UK: Cancer chat Macmillan Cancer Support: Head and neck cancer forum Caring for others with mouth cancer Being a carer is not an easy role. When you are busy responding to the needs of others it can deplete your reserves of emotional and physical energy and make it easy for you to neglect your own health and mental wellbeing. Research on carers health shows that high numbers of carers suffer health effects through caring. If you are trying to combine caring with a paid job or looking after a family, this can cause even more stress. If you are caring for someone else, it is important to look after yourself and get as much help as possible. It is in your best interests and those of the person you are caring for. Look after your health Eat regularly and healthily. If you do not have time to sit down for every meal, try to make time to sit down for at least 1 of your days meals. Instead of relying on fast food snacks, go for healthier options, such as fruit. Look after your emotional health As well as exhaustion, isolation andworries about the person you are caring for, it is understandable if there are times when you feel resentful and then guilty for feeling like this. These feelings are natural. Look for support Friends and family may not always understand what you are going through and it can be helpful to talk to people in the same situation. Care Information Scotland has a lot of useful information on its website. Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Other health sites Oral Health Foundation: Mouth cancer awareness month Cancer Research UK: Mouth and oropharyngeal cancer Macmillan Cancer Support: Oropharyngeal cancer Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Mouth ulcer | Mouth ulcer | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mouth Mouth ulcer Mouth ulcer Mouth ulcers are painful sores that appear in the mouth. Theyre uncomfortable but theyre usually harmless. Most clear up by themselves within 1 to 2 weeks. Mouth ulcers are common and can usually be managed at home, without seeing your dentist or GP. What does a mouth ulcer look like? Mouth ulcers are usually round or oval sores that commonly appear inside the mouth on the: cheeks lips tongue They can be white, red, yellow or grey in colour and swollen. You may have more than one mouth ulcer at a time and they may spread or grow. Mouth ulcers shouldnt be confused with cold sores , which are small blisters that develop on the lips or around the mouth. Cold sores often begin with a tingling, itching or burning sensation around your mouth. When to get help Speak to a pharmacist if: you have a mouth ulcer They can give you advice and treatment. If you have a dental problem you should always phone your dentist first. If youre not registered with any dental practice then you should read our advice on dental emergencies . Your pharmacist may advise that you see your GP or dentist if: your mouth ulcer has lasted 3 weeks you keep getting mouth ulcers the mouth ulcer grows bigger than usual or is near the back of your throat your mouth ulcer becomes more painful or red this could be a sign of a bacterial infection, which may need treatment with antibiotics Mouth ulcers are also a possible symptom of hand, foot and mouth disease . Speak to your GP or phone 111 if youre unsure. How to treat mouth ulcers Most mouth ulcers clear up by themselves within 1 to 2 weeks without treatment. However, treatment can help to reduce swelling and ease any discomfort. This may help if you keep getting mouth ulcers or your mouth ulcer affects eating and drinking. Self care There are things you can do to speed up healing. Do use a soft toothbrush to brush your teeth drink cool drinks through a straw eat softer foods get regular dental check-ups eat a healthy, balanced diet try to reduce stress and anxiety Dont do not eat very spicy, salty or acidic food do not eat rough, crunchy food, such as toast or crisps do not drink very hot or acidic drinks, such as fruit juice do not use chewing gum do not use toothpaste containing sodium lauryl sulphate Pharmacy medicines You can get several types of mouth ulcer treatment from a pharmacy. Speak to your pharmacist about the best treatment for you. Treatment from a dentist or GP A GP or dentist may prescribe stronger medicine to treat severe, persistent or infected mouth ulcers. Possible treatments include: steroid mouth spray or steroid tablets that dissolve in your mouth painkilling gels, ointments, sprays or tablets mouthwashes to kill or remove any germs in your mouth What causes mouth ulcers? In many cases, the reason for mouth ulcers is unclear. Most single mouth ulcers are caused by damage to the lining inside of the mouth. For example: accidentally biting the inside of your cheek or a sharp tooth poorly fitting dentures hard food a faulty filling Its not always clear what causes mouth ulcers that keep returning, but triggers are thought to include: stress and anxiety hormonal changes some women develop mouth ulcers during their monthly period eating certain foods such as chocolate, spicy foods, coffee, peanuts, almonds, strawberries, cheese, tomatoes and wheat flour toothpaste containing sodium lauryl sulphate stopping smoking when you first stop smoking, you may develop mouth ulcers Your genes are also thought to have a role. Around 40% of people who keep getting mouth ulcers report that it runs in their family. Medical conditions Mouth ulcers can sometimes be caused by certain medical conditions, such as: viral infections including the cold sore virus , chickenpox , and hand, foot and mouth disease vitamin B12 or iron deficiency crohns disease a long-term condition that causes inflammation of the lining of the digestive system coeliac disease a common digestive condition where a person has an adverse reaction to gluten reactive arthritis a condition that causes inflammation in various places in the body, usually as a reaction to an infection weakened immune system for example, due to HIV or lupus behets disease a rare and poorly understood condition that also causes swelling of the blood vessels Medications and treatments Mouth ulcers can sometimes be caused by certain medications or treatments, such as: non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen nicorandil a medication sometimes used to treat angina beta-blockers used to treat conditions such as angina, high blood pressure and abnormal heart rhythms a side effect of chemotherapy or radiotherapy this is known as mucositis Is it mouth cancer? In a few cases, a long-lasting mouth ulcer can be a sign of mouth cancer . If mouth cancer is detected early, the chances of a complete recovery are good. Regular dental check-ups are the best way to detect the early signs. Source: NHS 24 - Opens in new browser window Last updated: 20 October 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Search for a pharmacy near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Multiple myeloma | Multiple myeloma - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Multiple myeloma Multiple myeloma About multiple myeloma Symptoms of multiple myeloma Causes of multiple myeloma Diagnosing multiple myeloma Treating multiple myeloma About multiple myeloma Multiple myeloma, also known as myeloma, is a type of bone marrow cancer. Bone marrow is the spongy tissue found atthe centre of somebones. It produces the bodys blood cells. Multiple myelomaaffects the plasma cells (a type of blood cell) inside the bone marrow. Myeloma does notusually take the form ofa lump or tumour. Instead, the myeloma cells divide and expand within the bone marrow, damaging the bones and affecting the production of healthy blood cells. Myelomaoftenaffects many places in the body, which is why it is called multiple myeloma. Commonly affected areas include the spine, skull, pelvis and ribs. Signs and symptoms In the early stages, myeloma may not cause any symptoms. Its often only suspected or diagnosed aftera routine blood or urine test. However, myeloma will eventually cause a wide range ofproblems, including: a persistent dull ache or specific areas of tenderness in your bones weak bones thatbreak (fracture)easily tiredness, weakness and shortness of breath (caused by anaemia ) repeated infections less commonly, bruisingand unusual bleeding such as frequent nosebleeds , bleeding gums andheavy periods Read more about the symptoms of multiple myeloma When to speak to your GP Speak to your GP if you have any of these symptoms. While theyre unlikely to be caused by cancer, its best toget aproper diagnosis. Your GP will examine you to check for bone tenderness, bleeding, signs of infection, and any other symptoms that suggest you may have myeloma. They may also arrangebloodand urine tests that can detectabnormal proteins produced by myeloma cells. If myeloma is suspected, you will bereferred to a consultant haematologist (a specialist in blood conditions) for further tests and treatment. Read more about diagnosingmultiple myeloma Who is affected? Multiple myeloma is anuncommontype of cancer. Its not known exactly what causes the condition, although its more common in: people withmonoclonal gammopathy of unknown significance (MGUS)an excess number of protein molecules called immunoglobulins in your blood men adults over 60 most cases are diagnosed at around the age of 70,and cases affecting people under the age of 40 are rare black peoplemultiple myeloma is about twice as common in black populations compared with white and Asian populations Read more about the causes of multiple myeloma . How multiple myeloma is treated There is currently no cure for multiple myeloma, but treatment can often help control it for several years. Treatment will often involve: acombination of anti-myeloma medications todestroy the myeloma cells medicines and procedures to prevent and treat problems caused by myeloma, such as bone pain, fracturesand anaemia anti-myeloma medicines to control the cancerwhen it comes back (relapses) As part of your treatment, you may be asked if you want to take part in a clinical trialto help researchers develop better treatments for multiple myeloma. Read more about treating multiple myeloma Support groups If youve been diagnosed with multiple myeloma, you may find it useful tocontact a local or national support group, such as Myeloma UK . Support groups can offer more information and advice. They can also often put you in touch with other people in a similar situation so you can share advice and talk about your experiences. TheMyeloma UK website has more information about how they can help youand finding a local support group . Symptoms of multiple myeloma In the early stages, multiple myeloma may not cause any symptoms or complications, and may only be diagnosed after a routine blood or urine test. However, it will eventually cause a wide range of problems. Bone pain Multiple myeloma can cause pain in affected bones, most often the back, ribs or hips. The pain isfrequently a persistent dull ache,which may be made worse by movement. Bone fractures and spinal cord compression Multiple myeloma can weaken the bones and make them more likely to break (fracture). The spine and ribs are most often affected. Fractures of the spine can cause the sections of the spine to collapse, leading to pain and occasionally compression of the spinal cord (the main column of nerves running down the back). Compression of the spinal cord can causepins and needles, numbness and weakness in the legs and feet, and sometimes problems controlling your bladder and bowels. Anaemia Multiple myeloma can affect the production of blood cells in our bone marrow, which can lead to a lack of red blood cells ( anaemia ). This can also occur as a side effect of myeloma treatment. If you have anaemia, you may feel very tired, weak and breathless. Repeated infections People with multiple myeloma are particularly vulnerable to infection because the condition interferes with the immune system (the bodys natural defence against infection and illness). You may find you get infections frequently and that they last for a long time. Raised calcium levels in the blood A high level of calcium in the blood (hypercalcaemia) can develop in people with multiple myeloma because too much calcium is released from affected bones into the bloodstream. Symptoms of hypercalcaemia can include extreme thirst , feeling sick, needing to urinate frequently, constipation , confusion and drowsiness. Unusual bleeding Bruising and unusual bleeding (haemorrhage) such as frequent nosebleeds , bleeding gums andheavy periods sometimes occurs in multiple myeloma because the cancer cells in your bone marrow can stop blood clotting cells called platelets being made. Thickened blood In some people, multiple myeloma can cause the blood to become thicker than normal. This is known as hyperviscosity, which can cause problems such as blurred vision, headaches , dizziness , bleeding from the gums or nose, and shortness of breath . Kidney problems Kidney damage can occur in people with multiple myeloma for several reasons. Abnormal proteins produced bythe cancercells can damage the kidneys, as can other complications, such as hypercalcaemia. Some medications used to treat multiple myeloma can alsocause kidney damage. Eventually, the kidneys may stop working properly. This is known as kidney or renal impairment, or kidney or renal failure. Signs of kidney failure can include: weight lossand poor appetite swollen ankles, feet or hands tiredness and a lack of energy shortness of breath itchy skin feeling sick When to seek medical advice You should speak to your GP if you have symptoms of multiple myeloma. While theyre unlikely to be caused by cancer, its best to be sure by getting a proper diagnosis. You should seek immediate medical help if you have symptoms of spinal cord compression, hypercalcaemia or kidney failure, as these are medical emergencies that need to be investigated and treated as soon as possible. Read more about diagnosing multiple myeloma and treating multiple myeloma Causes of multiple myeloma In multiple myeloma, cells inside the bone marrow called plasma cells become cancerous. Bone marrow is the spongy tissue found at the centre of some bones. It produces the bodys blood cells. Plasma cells are normally produced ina controlled way. In cases of multiple myeloma, large numbers of abnormal plasma cells are produced. These fill up the bone marrow and interfere with the production of other cells, such as red and white blood cells. The exact reason why this happens is unknown, but multiple myeloma is closely associated with a condition called monoclonal gammopathy of unknown significance (MGUS), and there are certain things that can increase your risk of developing it. Monoclonal gammopathy of unknown significance (MGUS) In almost all cases, multiple myeloma occurs in someone who previously had MGUS. MGUS is the name for having an excess number of protein molecules called immunoglobulins in your blood. This does not cause any symptoms and treatment is not required. However, every year around1 in every 100 people with MGUS go on to develop multiple myeloma. There is no known way to delay or prevent this, soongoing outpatienttests to check for cancer will usually be recommended if you have MGUS. Other factors As well as MGUS, certain things can increase your risk of developing multiple myeloma, including: age your risk of developing multiple myeloma increases as you get older; most cases are diagnosed at around the age of70, and cases affecting people under 40 are rare gender men are more likely to develop multiple myeloma than women ethnicity multiple myeloma is about twice as common in black populations compared with white and Asian populations It has also been suggested that having a family history of MGUS or multiple myeloma, having reduced immunity (for example, because of medication or HIV ), being overweight or obese , and being exposed to radiation or certain chemicals may increase your risk of multiple myeloma. However, a link between these factors and the condition is less clear. Diagnosing multiple myeloma Multiple myeloma can be difficult to diagnose because its an uncommon type of cancer that initially has few or no symptoms. Your GP will examine you and ask about your symptoms, medical history and overall health. During the examination, your GP will look for things such as bleeding, signs of infection and specific areas of bone tenderness. You may need urine and blood tests to check for certain types of antibodies and proteins (immunoglobulins). If multiple myeloma is suspected,youwill bereferred to a haematologist (a doctor who specialises in conditions affecting the blood) for further tests andscans. Blood tests A number of blood tests are used to help diagnose multiple myeloma, and they may need to be repeated to monitor the condition. These may include: erythrocyte sedimentation rate (ESR) or plasma viscosity (PV) if you have multiple myeloma, your ESR or PV will usually be raised tests to measure the type and number of abnormal antibodies produced by the cancerous plasma cells a full blood count (FBC) to check levels of different types of blood cells your doctor will be looking for a low number of red blood cells and platelets liver and kidney function blood calcium level Urine tests A urine sample will be checked for the abnormal proteins produced by the cancerous plasma cells. The abnormal proteins are known as monoclonal light chains,or Bence Jones protein. These proteins can damage your kidneys as they pass through them from your blood to your urine. You may be asked to collect your urine over a 24-hour period. This will be used to check the quantity of proteins being produced and how well your kidneys are working. X-rays and other scans You will have X-rays taken of your long bones (arms and legs), skull, spine and pelvis to look for any damage. Other scans, such as computerised tomography (CT) scans and magnetic resonance imaging (MRI) scans , may also be carried out. Bone marrow biopsy A bone marrow biopsy is usually needed to confirm multiple myeloma. A needle will be used to take a small sample of bone marrow from one of your bones, usually the pelvis. A sample of bone may also be removed. This is carried out using a local anaesthetic (the area where the needle is inserted is numbed). The sample of bone marrow and bone will be usedto check for cancerous plasma cells. Treating multiple myeloma If you have multiple myeloma, you will be cared for by a team, which is usually led by a consultant haematologist who specialises in myeloma. The team will discuss your condition and recommend the best treatment for you. However, the final decision will be yours. Before visiting hospital to discuss your treatment options, it may be useful to write a list of questions to ask the specialist. For example, you may want to find out the advantages and disadvantages of a particular treatment. There are 2 main aims in treating multiple myeloma: to bring the myeloma under control to prevent and treat problems associated with myeloma, such as anaemia and bone pain While treatment can often control myeloma and improve quality of life, myeloma usually cant be cured. This means additional treatment is needed when the cancer comes back (a relapse). Not everyone diagnosed with myeloma will need immediate treatment if the condition is not causing any problems. This is sometimes referred to as asymptomatic, or smouldering myeloma . If you dont need treatment, youll be monitored for signs the cancer is beginning to cause problems. If you do need treatment, the following options are most commonly used. Bringing myeloma undercontrol The initial treatment for multiple myeloma may be either: non-intensive for older or less fit patients (this is more common) intensive for younger or fitter patients (thought to be too toxic for older or less fit patients) The decision about which treatment is appropriate for you is usually based on your biological age or fitness. As a general rule, people younger than 65 are more likely to be candidates for intensive therapy. For those over 70, non-intensive treatment is more likely to be recommended. Those aged in between will be given careful consideration as to what treatment group they fall into. Both non-intensive and intensive treatments involve taking a combination of anti-myeloma medicines. Intensive treatment involves much higher doses and is followed by a stem cell transplant. The medicines usually include a chemotherapy medicine, a steroid medicine, and either thalidomide or bortezomib. Chemotherapy Chemotherapy medicines kill the myeloma cells. The most common types used to treat myeloma are melphalan and cyclophosphamide. These treatments are mostly taken in tablet form. They are reasonably well tolerated and side effects are mild. Possible side effects include: increased risk of infections feeling sick vomiting hair loss Your clinician will give you advice and information about your risk of developing potentially serious infections, andtell you what you can do to reduce your risk of picking up infections during your treatment. Steroids Steroid medications ( corticosteroids )help destroy myeloma cells and make chemotherapy more effective.The 2 most common types used to treat myeloma are dexamethasone andprednisolone. Steroids are taken orally (by mouth) after eating. Possible side effects include heartburn , indigestion , increased appetite, mood changes and problems falling asleep. Thalidomide Thalidomide can help kill myeloma cells. You takeit as a tablet every day, usuallyin the eveningas it can make you feel sleepy. Other common side effects include: constipation dizziness rashes numbness or tingling in the hands and feet ( peripheral neuropathy ) Thalidomide can cause birth defects, so it should not be taken by pregnant women, and a reliable form of contraception such as a condom must be used during treatment. There is also a risk you may develop a blood clot when taking thalidomide, so you may be given medication to help prevent this. Contact your care team immediately if you develop symptoms of a blood clot, such as pain or swelling in one of your legs, or chest pain and breathlessness . Bortezomib Bortezomib (Velcade) can help kill myeloma cells by causing protein to build-up inside them. There are some limitations as to who can have bortezomib, but a member of your care team will discuss this with you. The medication is given by injection, usually under the skin.Possible side effects include: tiredness nausea diarrhoea numbness or tingling in your hands and feet (peripheral neuropathy) Stem cell transplant After initial therapy with primarily outpatient-based treatments, people receiving intensive treatment will be given a much higher dose of chemotherapy medication as an inpatient to potentially help destroy a larger number of myeloma cells. This aims to achieve a longer period of remission (where there is no sign of active disease in your body). However, these high doses also affect healthy bone marrow, so astem cell transplantwill be needed to help your bone marrow recover. In most cases, the stem cells will be collected from you before treatment (autologous transplantation). In rare cases, they are collected from a sibling or an unrelated donor. Treating relapses Further treatment is needed if myeloma returns. Treatment for relapses is generally similar to initial treatment, although non-intensive treatment is often preferred to further intensive treatment. Additional medications such as lenalidomide, pomalidomide and other chemotherapy medicines may be added, or usedagain as your haematologist feels is appropriate. You may also be asked if you want to participate in clinical trial research intonew treatments for multiple myeloma. Lenalidomide and pomalidomide Lenalidomide and pomalidomide are similar to thalidomide. Theyre both taken by mouth, and both canhave an effect on the cells produced by your bone marrow, which can cause: increased risk of infection asa result ofa low number of white blood cells anaemia caused bya low number of red blood cells bruising and bleeding because ofa low platelet count They may also increase your risk of developing a blood clot and have other side effects similar to thalidomide. Let your care team know if you experience any problems or unusual symptoms while taking lenalidomide or pomalidomide. Treating symptoms and complications of myeloma As well as the main treatments for multiple myeloma, you may also need treatment to help relieve some of the problems caused by the condition. For example: painkillers may be given to reduce pain radiotherapy may be used to relieve bone painor help healing after a bone is surgically repaired bisphosphonate medication eithergiven as tablets or by injection, this mayhelp prevent bone damage and reduce the levels of calcium in your blood blood transfusions orerythropoietin medication may be usedto increase your red blood cell count andtreat anaemia surgery may be carried outto repair or strengthen damaged bones, or treat compression of the spinal cord (the main column of nerves running down the back) dialysis may berequired if you develop kidney failure plasma exchange treatment to remove and replace a blood component called plasma may be carried out if you have unusually thick blood (hyperviscosity) These treatments can each cause side effects and complications, so make sure you discuss the potential risks and benefits with your treatment team beforehand. Clinical trials and research Research is ongoing to find new treatments for multiple myeloma and work out ways to improve the use of existing ones. To help with this, you may be asked to take part in a clinical trialduring your treatment. Clinical trials usually involve comparing a new treatment with an existing one to see whether the new treatment is more or less effective. Its important to remember, however, that if you are given a new treatment, there is no guarantee it will be more effective than an existing treatment. There will never be any pressure for you to take part in a trial if you do not want to. Search clinical trials for multiple myeloma Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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Multiple sclerosis (MS) | Multiple sclerosis (MS) | NHS inform | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Multiple sclerosis (MS) Multiple sclerosis (MS) Multiple sclerosis (MS) is a condition that affects the brain and/or spinal cord. It can cause symptoms like problems with vision, arm or leg movement, sensation or balance. Its a lifelong condition that can sometimes cause serious disability. In many cases, its possible to treat symptoms. Average life expectancy is slightly reduced for people with MS. MS Society estimates that there are more than 130,000 people diagnosed with MS in the UK. Its often diagnosed in people in their 20s and 30s, although it can develop at any age. Its about two to three times more common in women than men. Symptoms of multiple sclerosis Multiple sclerosis (MS) can cause a wide range of symptoms and can affect any part of the body. It affects everyone differently. The symptoms are unpredictable. Some peoples symptoms develop and worsen over time, while for others, they come and go. Periods when symptoms get worse are known as relapses. Periods when symptoms improve or disappear are known as remissions. Some of the most common symptoms include: Muscle spasms, stiffness and weakness MScan cause yourmuscles to: feel weak become stiff and resistant to movement (spasticity) contract tightly and painfully (spasm) Vision problems In around 1 in 4 cases of MS, the first noticeable symptom is a problem with one of your eyes (optic neuritis). You may experience: some temporaryloss of vision in the affected eye, usually lasting for days to weeks colour blindness eye pain, which is usually worse when moving the eye flashes of light when moving the eye You might also experience double vision or involuntary eye movements, which can make it seem as though objects are jumping around. Abnormal sensations You might have persistent numbness or tingling in different parts of your body which can last a few days to weeks. Mobility problems MS can make walking and moving around difficult, particularly if you also have muscle weakness and spasticity. You may experience: clumsiness difficulty with balance and co-ordination (ataxia) shaking of the limbs (tremor) dizziness and vertigo , which can make it feel as though everything around you is spinning Pain Some people with MS experience pain which can take two forms. Pain caused by MS itself (neuropathic pain) This is pain caused by damage to the nervous system, and can include: stabbing pains in the face stabbing sensations in the torso (body) and limbs feeling like youre burning pins and needles feeling like youre being hugged or squeezed Muscle spasms can sometimes be painful. Musculoskeletal pain This can be back, neck and joint pain particularly if you have problems walking or moving around. Bladder problems Bladder problems are common in MS. They may include: having to pee more often having a sudden, urgent need to pee, which can lead to unintentionally passing urine ( urge incontinence ) difficulty emptying the bladder completely having to get up during the night to pee recurrent urinary tract infections These problems can also have a range of causes other than MS. Bowel problems Many people with MS also have problems with their bowel function. Constipation is the most common problem. You may find passing stools (poo) difficult and pass them much less than normal. Bowel incontinence is less common, but is often linked to constipation. If a poo becomes stuck, it can irritate the wall of the bowel, causing it to produce more fluid and mucus that can leak out of your bottom. Some of these problems arent specific to MS and can be the result of medications. Sexual problems MS can have an effect on sexual function. For women, problems include difficulty reaching orgasm. They might experience decreased vaginal lubrication and sensation. Men with MS might find it hard to get or maintain an erection ( erectile dysfunction ). They may also find it takes a lot longer to ejaculate when having sex or masturbating. They might lose the ability to ejaculate altogether. Both men and women with MS may find theyre less interested in sex than they were before. This could be directly related to MS, a mood disorder like depression, or it could be the result of living with the condition. Speech and swallowing difficulties Some people with MS have difficulty chewing or swallowing ( dysphagia ) at some point. They might also slur their speech or be difficult to understand (dysarthria). Fatigue Feeling fatigued is a common and troublesome symptom of MS. It can cause an overwhelming sense of exhaustion that means its a struggle to carry out simple tasks. Fatigue tends to get worse: towards the end of each day in hot weather after exercising during illness Mental health issues Many people with MS experience periods of depression. Its unclear if this is directly caused by MS, or is due to the stress of having to live with a long-term condition, or both. Anxiety can also be a problem for people with MS, possibly due to the unpredictable nature of the condition. In rare cases, people with MS can experience rapid and severe mood swings. Problems with thinking, learning and planning Some people with MS have problems with thinking, learning and planning. This is known as cognitive dysfunction and can include: problems learning and remembering new things although long-term memory is usually unaffected slowness in processing lots of information or multi-tasking a shortened attention span getting stuck on words problems with understanding and processing visual information, such as reading a map difficulty with planning and problem solving people often report that they know what they want to do, but cant grasp how to do it problems with reasoning, such as mathematical laws or solving puzzles Many of these problems arent specific to MS. They can be caused by other conditions, including depression and anxiety or medication. Speak to your GP if: you think you have symptoms of MS The symptoms can be similar to severalother conditions, so theyre not necessarily caused by MS. What happens when someone has multiple sclerosis MS is an autoimmune condition. This means your immune system mistakes part of your body for a foreign substance and attacks it. In the case of MS, it attacks the myelin sheath in the brain and/or spinal cord. This is the layer that surrounds your nerves, protecting them and helping electrical signals travel from the brain to the rest of the body. The attacks cause the myelin sheath to become inflamed in small patches (plaques or lesions). This can be seen on a magnetic resonance imaging (MRI) scan . These patches of inflammation can disrupt the messages travelling along the nerves. It can slow them down, jumble them, send them the wrong way, or stop them from getting through completely. This disruption leads to the symptoms and signs of MS. When the inflammation goes away, it can leave behind scarring of the myelin sheath (sclerosis). These attacks, particularly if frequent and repeated, can lead to permanent damage. What causes multiple sclerosis? Exactly why someone develops multiple sclerosis (MS) isnt known. Its not caused by anything youve done and its not clear if you can prevent it. Its likely to be partly caused by genes you inherit from your parents and partly by outside factors that may trigger the condition. Some of the factors that might cause MS include: Your genes MS isnt directly inherited, but if youre related to someone withthe condition youre more likely to develop it. The chance of a sibling or child of someone with MS also developing it is around 2-3%. Lack of sunlight and vitamin D MS is more common in countries far from the equator. This couldmean that a lack of sunlight and low vitamin D levels may play a role in the condition. Its not clear whether vitamin D supplements can help prevent MS. Smoking People who smoke are about twice as likely to develop MS compared tothose who dont smoke. Viral infections Infections, particularly those caused by the Epstein-Barr virus, (responsible for glandular fever ), might trigger the immune system, leading to MS in some people. More research will help us understandwhy MS occurs and whether it can be prevented or not. Diagnosing multiple sclerosis It can be hard to tell if you have multiple sclerosis (MS) because some of the symptoms are like other conditions. You may need to rule out other possible causes of your symptoms first. If your GP thinks you could have MS, you should see a neurologist(a specialist in conditions of the nervous system) for a specialist assessment. Some of the tests you may need to confirm MS are: neurological examination magnetic resonance imaging (MRI) scan lumbar puncture blood test Types of multiple sclerosis Once you have a diagnosis of MS, your neurologist might be able to identify which type of MS you have either relapsing remitting MS or primary progressive MS. This will largely be based on: the pattern of your symptoms like whether you experience periods when your symptoms get worse (relapses) then improve (remissions), or whether they get steadily worse (progress) the results of an MRI scan It can take some time to find out which type of MS you have because the symptoms are so varied. It can take a few years to make an accurate diagnosis of progressive MS, as the condition usually worsens slowly. Treating multiple sclerosis Phone your specialist MS nurse or GP if: you think youre having a relapse Treatment with disease-modifying therapies Although there isnt a cure for MS, there are medicines that can help to reduce the number and severity of relapses in some people. These are called disease-modifying therapies or disease modifying drugs. These reduce the amount of damage and scarring to the myelin sheath (layer surrounding your nerves), associated with MS relapses. These treatments reduce the chances of developing progressive symptoms of MS. They might also help to slow worsening disability in MS. Disease-modifying therapies are not suitable for everyone with MS. Theyre only prescribed to those with either: relapsing remitting MS secondary progressive MS who meet certain criteria, like the number of relapses theyve had primary progressive MS who meet certain criteria like new lesions found by an MRI scan People without relapses are less likely to benefit from the treatments and could still experience side effects from them. Treatment of a relapse of multiple sclerosis Sometimes an infection can cause a flare up of symptoms rather than a relapse, so your nurse or GP will check for other possible causes. Treatment for a relapse might involve a five-day course of steroid tablets taken at home. Steroids can help speed up your recovery from a relapse. They dont prevent further relapses or stop MS getting worse over time. Steroids are only given for a short period of time to avoid possible steroid side effects . The side effects could include infection, mood disturbance, stomach ulceration, osteoporosis (weak bones) , weight gain and diabetes . Not using steroids more than three times a year (if possible) will help to reduce the risk of side effects. Treatment for multiple sclerosis symptoms There are different treatments available for MS symptoms. Fatigue Your healthcare professional should give you advice about ways to manage fatigue. This might include exercise, keeping healthy sleep patterns and energy-saving techniques. Your healthcare professional might suggest avoiding medications that can worsen fatigue. Specialist fatigue management courses or therapy, such as cognitive behavioural therapy (CBT), might also help. Visual problems MS-related visual problems will often improve on their own, usually within a few weeks. If your symptoms are particularly severe, your healthcare professional might prescribe steroids. If you have problems with involuntary eye movements, medication like gabapentin can sometimes help. Some people with double vision need help from ophthalmologists (eye specialists). Muscle spasms and stiffness Physiotherapy can help improve muscle spasms and stiffness. Techniquessuch as stretching exercises can help if your movement is restricted. If your muscle spasms are more severe, you may be prescribed a medicine that can relax your muscles. This will usually be either baclofen, gabapentin or tizanidine. These medicines all have side effects. You might experience dizziness, weakness, nausea and diarrhoea. Discuss which of these would be best for you with yourspecialist MS nurse. Mobility problems Mobility problems are often the result of muscle spasms and spasticity. Muscle weakness, or problems with balance or dizziness can also cause mobility problems. If you have problems with mobility, your healthcare professional might suggest: an exercise programmesupervised by a physiotherapist special exercises called vestibular rehabilitation, if you have problems with balance medication for dizziness or tremors mobility aids, such as a walking stick, or a wheelchair home adaptations such as stair lifts or railings An occupational therapist can carry out an assessment of your home and suggest adaptations. Musculoskeletal pain Living with MS can cause stresses and strains to the muscles and joints in your body. A physiotherapist might be able to help withthis pain by suggesting exercises or better seating positions. If your pain is more severe, you may be prescribed painkillers. Or, you might have a transcutaneous electrical nerve stimulation (TENS) machine that stimulates your nerves. Neuropathic pain Neuropathic pain is caused by damage to your nerves and is usually sharp and stabbing. It can also occur in the form of extreme skin sensitivity, or a burning sensation. This type of pain can be treated using neuropathic painkillers. Problems with thinking, learning and memory Your MS healthcare professionals can assess your thinking, learning and memory problems and suggest ways to manage them. Emotional problems People with MS who have depression or anxiety can be treated with antidepressants or therapy, such as CBT. If you have emotional outbursts, such as laughing or crying for no clear reason, you should be assessed by a specialist. They may suggest treatment with an antidepressant. Bladder problems Medication might help if you have an overactive bladder or need to pee frequently during the night. If you find it difficult to empty your bladder, advice from a continence nurse or physiotherapist can help. Hand-held external stimulators can help some people to start peeing or to empty the bladder. Sometimes a catheter can empty the bladder when needed. You might be taught how to do intermittent self catheterisation (ISC). In rare cases, people with MS may need a long-term catheter to keep the bladder emptying safely. You might be referred to a continence adviser or urologist, for specialist treatment and advice. Read more about treating urinary incontinence . Bowel problems It might be possible to treat mild to moderate constipation by changing your diet or taking laxatives . More severe constipation may need to be treated with suppositories, which are inserted into your bottom, or an enema. During an enema, liquid medication is rinsed through your bottom and large bowel, which softens and flushes out your stools. Anti diarrhoea medication or pelvic floor exercises might help bowel incontinence. Sexual problems If you experience problems with less interest in sex or difficulty reaching orgasm, relationship counselling or seeing a sex therapist might help. If you have MS and find it hard to get or maintain an erection ( erectile dysfunction ) you may be prescribed medication to increase the blood flow to the penis. Speech and swallowing difficulties Aspeech and language therapist can help you find ways to overcome problems with speech and swallowing. For example, they can offer advice about foods that are easy to swallow. They might recommend exercises to strengthen the muscles used in speech and swallowing. Complementary and alternative therapies for MS Some people with MS find that complementary therapies help them feel better. Complementary treatments and therapies claim to ease symptoms, although scientific evidence is often not clear about how effective they are. Many people think that complementary treatments have no harmful effects. However, people can experience problems. Its not a good idea to use them as an alternative to medicines prescribed by your doctor. If youre considering an alternative treatment, its important to let your doctor know. Clinical trials Clinical trials have helped to improve the treatments available for MS. Speak to your care team if youre interested in taking part in a clinical trial. Support for living with multiple sclerosis Coming to terms with a long-term condition like MS can put a strain on you, your family and your friends. Be honest about how you feel and let your family and friends know what they can do to help. If you have any questions, yourMS nurse or GP can help and will let you know what support is available. If you find it difficult to look after yourself, your local authority may be able to provide you with some help.Ask for a care and support needs assessment. For more information, read about assessing your care and support needs . Having a baby Being diagnosed with MS shouldnt affect your ability to have children. Women with MS can have a normal pregnancy, deliver a healthy baby and breastfeed. Some of the medications prescribed for MS arent suitable for taking during pregnancy or breastfeeding and might affect fertility inmales and females.If youre considering starting a family, discuss it with your healthcare team. Having a baby doesnt affect the long-term course of MS. Relapses can be less common in pregnancy, but they can be more common in the months after giving birth. Money and financial support If you have to stop work or work part-time because of your MS, you may find it hard to cope financially. You might be able to get financial support . Driving If you have MS, you must tell the Driver and Vehicle Licensing Agency (DVLA) and inform your insurance company. You might be able to continue driving, but youll be asked to complete a form providing more information about your condition. Youll be asked for details of your doctors and specialists. The DVLA will use this to decide whether youre fit to drive. Source: Scottish Government - Opens in new browser window Last updated: 21 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Other health sites Brain and Spine Foundation: Multiple sclerosis MS Trust MS Society Revive MS Support Neurological Alliance of Scotland NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Mumps | Mumps | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Mumps Mumps Mumps is an infection that spreads easily. It used to be common in children before the introduction of the measles, mumps and rubella (MMR) vaccine . Mumps usually clears within 1 or 2 weeks. Symptoms of mumps The symptoms of mumps usually develop 14 to 25 days after youre infected. Mumps causes painful swellings at the side of the face under the ears (the parotid glands). It gives a distinctive hamster face appearance. Other symptoms of mumps can include: headaches joint pain feeling sick dry mouth mild stomach (abdominal) pain feeling tired loss of appetite a high temperature (fever) of 38C (100.4F), or above These may develop a few days before the swelling of the parotid glands. Sometimes, mumps doesnt cause any noticeable symptoms. Phone your GP if: you think you or your child might have mumps youve been in close contact with someone who has mumps and youre pregnant, and havent been fully vaccinated Mumps is not usually serious, but it has similar symptoms to more serious types of infection, such as glandular fever and tonsillitis . You should phone your GP first before visiting. They can make arrangements to reduce the risk of spreading the infection to others. Diagnosing mumps Your GP can usually make a diagnosis after: seeing and feeling the swelling looking at the position of the tonsils in the mouth checking your temperature to see if its higher than normal If your GP suspects mumps, they should notify your local health protection team (HPT). Whos affected? Most cases of mumps occur in people aged between 17 and 34 who have not received 2 doses of the MMR vaccine . Once youve had mumps, your body builds up resistance (immunity) to the virus. Its highly unlikely youll get it again. How mumps is spread The mumps virus is contained in tiny droplets that come out of the nose and mouth when an infected person coughs or sneezes. You can easily catch mumps by breathing in these droplets. Or, if the droplets have settled on a surface, by touching the surface and then placing your hands near your nose or mouth. A person is most contagious a few days before the symptoms develop and for a few days afterwards. How to prevent spreading mumps to others If you have mumps: stay off school or work for at least 5 days after your symptoms first develop regularly wash your hands with soap use and dispose of tissues when you sneeze avoid close contact with anyone who isnt fully vaccinated How mumps can be prevented Mumps can be prevented by having the MMR vaccine . This is given in 2 doses as part of the NHS childhood vaccination programme. You can be vaccinated at any age if you havent been fully vaccinated before. Treatment for mumps There are things you can do to help relieve your symptoms. Do get plenty of bed rest drink plenty of water to avoid dehydration use pain relief such as paracetamol or ibuprofen aspirin shouldnt be given to children under 16 apply a warm or cool compress to the swollen glands to help relieve pain eat foods that dont need a lot of chewing, such as soup, mashed potatoes and scrambled eggs Complications of mumps Mumps usually passes without causing serious damage to a persons health. Serious complications are rare. However, mumps can lead to viral meningitis if the virus moves into the outer layer of the brain. Other complications include swelling of the testicles in males or the ovaries in females if the affected person has gone through puberty. About 1 in 20 cases of mumps lead to acute pancreatitis . This is usually mild, but you may be admitted to hospital so your body functions can be supported until your pancreas recovers. About 1 in 20 people with mumps experience some temporary hearing loss , but permanent loss of hearing is rare. Source: NHS 24 - Opens in new browser window Last updated: 11 January 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform MMR vaccine NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Menieres disease | "Mnire's disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Ears, nose and throat Menieres disease Menieres disease Mnires disease is a rare inner ear condition that can affect your balance and hearing. It cannot be cured, but treatments can usually help your symptoms. Mnires disease most commonly affects people aged 20 to 60. Its slightly more common in women than men. Symptoms of Mnires disease The symptoms and severity of Mnires disease vary widely from person to person. The main symptoms of Mnires disease are: vertigo the feeling that you, or the environment around you, is moving or spinning tinnitus hearing sounds from inside your body, rather than from an outside source hearing loss , with a particular difficulty hearing deep or low sounds a feeling of pressure or fullness deep inside the ear feeling or being sick Symptoms typically last around 2 to 3 hours. But it can take a day or two for the symptoms to disappear completely. These symptoms usually only affect one ear at first, but both ears may become affected over time. Other symptoms include: sensitivity to sound (hyperacusis) distorted sound When to get medical advice Speak to your GP practice if: You or your child: have any of the symptoms of Mnires disease Diagnosing Mnires disease Theres no single test for Mnires disease. It can be difficult to distinguish from other conditions with similar symptoms. Your GP will ask you to describe your symptoms to find out if theres a pattern. For Mnires disease to be diagnosed, youll have had: at least 2 episodes of vertigo lasting 20 minutes or more within a single Mnires disease attack tests that confirm that hearing loss is caused by damage to the sensitive hair cells inside the cochlea (the coiled tube in the inner ear) tinnitus or a feeling of pressure in your ear Your GP may also carry out a physical examination to rule out other possible causes of your symptoms. If needed, your GP can refer you to an ear nose and throat (ENT) specialist for further tests. Treatment for Mnires disease Mnires disease cannot be cured, but treatment can usually help your symptoms. Possible treatments include: medicines to treat the symptoms and prevent attacks changes to your eating habits, such as a low-salt diet treatment for tinnitus treatment for hearing loss balance training (vestibular rehabilitation) relaxation techniques surgery only rarely, in more severe cases Your mental health Some people with Mnires disease also find that it affects their mental health. Speak to your GP practice if youre finding it difficult to cope with the effect Mnires disease is having on your life. There are also support groups that can help you. Safety If you have vertigo, there are some safety issues to consider. For example: you should tell your employer if your job involves operating machinery or climbing ladders you may have a higher chance of falling read about preventing falls for advice on reducing your risk Driving and vertigo If you drive, you must tell the DVLA about your vertigo. Get more information on driving with vertigo on GOV.UK What causes Mnires disease? The exact cause of Mnires disease is unknown. Its thought to be caused by a problem with pressure deep inside the ear. Factors that can increase your risk of developing Mnires disease include: a family history of the condition a chemical imbalance in the fluid in your inner ear Source: ENT Scotland - Opens in new browser window Last updated: 05 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852" | null | null | null | null | null | null | null | null | null | null | null | null | null |
Myasthenia gravis | Myasthenia gravis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Myasthenia gravis Myasthenia gravis Myasthenia gravis is a long term (chronic) condition that causes muscle weakness and fatigue. Its a rare condition that commonly affects the muscles that control the eyes and eyelids. It can also affect the face, speaking, chewing, swallowing and other parts of the body. It can affect people at any age, but is most often found in women under 40 and men over 60. There are other rarer types of myasthenia which you can read about on myaware . If you drive, you must inform the DVLA that you have myasthenia gravis. Symptoms of myasthenia gravis The first symptoms of myasthenia gravis are often droopy eyelids or double vision. It usually affects the eyes first and may spread to other parts of the body. It can take weeks, months or years for symptoms to develop in other parts of the body. The severity of the symptoms is different for each person. Its likely that your symptoms will tend to get worse when youre tired. The symptoms might improve after resting. Symptoms can include: Eyes You might experience droopy eyelids affecting one or both eyes, and double vision. In some people, only the eye muscles are affected (ocular myasthenia). In most people, the symptoms will spread to affect other parts of the body over time. Swallowing, speaking and breathing You might experience: slurred speech difficulty swallowing difficulty making facial expressions like smiling problems with chewing a change in your voice choking or accidentally inhaling food which can cause chest infections shortness of breath Limbs and neck The muscle weakness might spread to other parts of the body like your arms, legs and neck. You might experience: weakness in your arms, legs, neck or other parts of your body difficulty holding your head up aching muscles problems with tasks like climbing stairs or washing your hair Myasthenic crisis Some people can experience severe breathing and swallowing difficulties, which require immediate hospital treatment. This is called a myasthenic crisis. Its possible for patients to experience a myasthenic crisis before they know they have myasthenia gravis. Phone 999 for an ambulance if: youre experiencing severe breathing or swallowing problems You might need emergency hospital treatment. You should avoid activities that could become dangerous if you experience sudden weakness, like swimming alone. Diagnosing myasthenia gravis It can be difficult to diagnose myasthenia gravis. Your doctor will ask about your medical history and symptoms. You might need several tests to rule out other causes of your symptoms before you can be diagnosed with myasthenia gravis. Blood test A blood test will look for a high level of antibodies (made by your immune system) which might be causing myasthenia gravis. You might be offered another blood test at a later date if your initial blood test is normal but you continue to experience worsening symptoms. Electromyography You might have electromyography (an EMG) to test your nerves and muscles. During electromyography, youll have small needles inserted into your muscles to measure their electric activity. These are usually inserted around your eyes, forehead or arms. The test will measure the signals from the nerves to the muscles. If the test detects a disruption in the signals, this might be a sign of myasthenia gravis. Scans You might have a computerised tomography (CT) scan to check if the thymus gland in your chest is bigger than expected or has grown abnormally (a thymoma). The thymus gland is part of your immune system. Problems with the thymus gland like inflammation (swelling), can be linked to myasthenia gravis. An magnetic resonance imaging (MRI) scan might be used to check if your symptoms are being caused by an issue in your brain. Treating myasthenia gravis There are treatments available that can help reduce the affects of your symptoms. If your symptoms get worse following certain triggers, you should try to avoid those triggers as much as possible. Triggers might include: stress tiredness infections medicines surgery Treatment might include: Medicine Pyridostigmine Sometimes myasthenia gravis can be treated with pyridostigmine alone. It works by temporarily improving the nerve to muscle transmission to help muscle strength. It can reduce muscle weakness and for some people this is the only medication they need to control the condition. Its effects do not last long and it needs to be taken periodically throughout the day to give the best results. Side effects can include stomach upset, diarrhoea and drooling. Steroids You might be advised to take steroid tablets like prednisolone if pyridostigmine isnt helping. Steroid tablets work by reducing the activity of your immune system to stop it attacking the communication between your nerves and muscles. Its likely youll be advised to take the tablets every other day. Youre likely to start at a low dose which will be built up quickly. This might gradually be reduced once your symptoms are under control. Its important that you do not stop your steroids suddenly, as this can make you very ill. Using steroids long term can cause side effects including osteoporosis (weak bones) , weight gain, infection and diabetes . Read more about the side effects of steroids Immunosuppressants Immunosuppressants work by reducing the activity of your immune system. Your healthcare team might suggest taking immunosuppressants if: steroids arent controlling your symptoms you need a high dose of steroids to control your symptoms Commonly used immunosuppressants include azathioprine, mycophenolate mofetil and methotrexate. Youll need to take the tablets every day and it can take at least 9 months to feel the full effect. Youll be advised to take steroids at first. Immunosuppressants night cause side effects like: loss of appetite and tiredness feeling sick increased risk of infections Youll have regular blood tests to check the the medicine isnt causing any harm. You might be able to stop taking immunosuppressants if they keep your symptoms under control over a few years. Surgery Your healthcare team might recommend surgery to remove the thymus gland (thymectomy). Symptoms should improve within the first few months after surgery and can continue to improve for up to 2 years. Surgery can reduce: the dose of steroids the need to take other immunosuppressants the chances of needing to go to hospital because of worsening symptoms Surgery might not help myasthenia symptoms in someone that has a thymoma. Your healthcare team might still recommend having your thymus gland removed because it can cause problems if it keeps growing. Your thymectomy will usually be carried out through keyhole surgery. The thymus is removed using surgical instruments inserted through small cuts (incisions) in the chest. Plasma exchange and IVIG Plasma exchange and IVIG (intravenous immunoglobulin) can offer a quick improvement (within a few days) for people with myasthenia gravis who are particularly unwell or are having a myasthenic crisis. Plasma exchange is an emergency treatment that removes antibodies from your own blood. This treatment is given in hospital and the benefits can last around 6 weeks. IVIG treatment involves an injection of normal antibodies from donated blood to temporarily change the way your immune system works. The two treatments are similar and your healthcare team will decide which is the best option for you. Although the benefits only last a few weeks, it can give time for the longer term treatments to take effect and help improve symptoms. You might find that, during pregnancy or after having a baby, your myasthenia gravis worsens. If youre planning a pregnancy or become pregnant, you should speak to your healthcare team. Dont stop taking your medications without first speaking to your healthcare professional. Source: Scottish Government - Opens in new browser window Last updated: 25 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Other health sites Myaware NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Nasal and sinus cancer | Nasal & sinus cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Nasal and sinus cancer Nasal and sinus cancer Nasal and sinus cancer affects the nasal cavity (the space behind your nose) and the sinuses (small, air-filled cavities inside your nose, cheekbones and forehead). Its a rare type of cancer that most often affects men aged 50to 60. Nasal and sinus cancer is different to cancer in the area where the nose and throat connect. This is called nasopharyngeal cancer . Symptoms of nasal and sinus cancer The most common symptoms of nasal and sinus cancer are: a persistent blocked nose, which usually only affects 1 side nosebleeds mucus draining from the nose, which may be blood-stained a decreased sense of smell These symptoms can be similar to more common and less serious conditions, such asa cold or sinusitis . At a later stage, symptoms can include: pain or numbness in the face swollen glands in the neck partial loss of vision ordouble vision a bulging or persistently watering eye a lump or growth on yourface, nose or roof ofyour mouth When to speak to your GP Speak to your GP if you notice any unusual or persistent symptoms. Theyre very unlikely to be caused bynasal or sinus cancer, but are worth getting checked out. If your GP thinks you might need some tests to determine whats causing your symptoms, youll usually be referred to an ear, nose and throat (ENT) consultant in hospital. Tests you may have include: a nasalendoscopy where a long, thin, flexible tube attached to a light source is inserted into your nose to examine the area a computerised tomography (CT) scan and a magnetic resonance imaging (MRI) scan a biopsy (where a small sample of tissue is removed and examined) this may be done during an endoscopy orusing a needle Whos at risk of nasal and sinus cancer Several factors are known to increase the risk of developing nasal and sinus cancer, including: your gender men are more likely to develop nasal and sinus cancer than women prolonged exposure to certain substances through your work, including wood dust, leather dust, nickel, chromium and formaldehyde smoking the more you smoke, the higher your risk of developing several types of cancer, including nasal and sinus cancer human papilloma virus (HPV)a group of viruses that affect the skin and moist membranes, such as the mouth and throat The Health and Safety Executive (HSE) has produced a report on the risk of occupational nasal and sinus cancer inGreat Britain(PDF, 2Mb) . Treatments for nasal and sinus cancer The best treatment depends on several factors, including how far the cancer has spread and your general health. Treatment may include: surgery to remove a tumour which can be performed using surgical incisions (open surgery) or as keyhole surgery through the nose (endoscopic microsurgery) radiotherapy wherehigh-energy radiation is usedto kill the cancerous cells, shrink a tumour before surgery, or destroy small amounts of a tumour that may be left after surgery chemotherapy where medicine is usedto help shrink or slow down the growth of a tumour, or to reduce the risk of the cancer returning after surgery Your treatmentwill be organised by a head and neck cancer multidisciplinary team (MDT), who will discuss the treatment options with you.A combination of treatments will often be recommended. Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Nasopharyngeal cancer Other health sites Cancer Research UK: Nasal and paranasal sinus cancer Macmillan Cancer Support: Paranasal sinus cancer Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Nasopharyngeal cancer | Nasopharyngeal cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Nasopharyngeal cancer Nasopharyngeal cancer Nasopharyngeal cancer is a rare type of cancer that affects the part of the throat connecting the back of the nose to the back of the mouth (the pharynx). Nasopharyngeal cancer shouldnt be confused with other types of cancer that also affect the throat, such as laryngeal cancer and oesophageal cancer . Symptoms of nasopharyngeal cancer Its often difficult to recognise nasopharyngeal cancer because the symptoms are similar to other, less serious conditions. Also, many people with nasopharyngeal cancer dont have any symptoms until the cancer reaches an advanced stage. Symptoms of nasopharyngeal cancer can include: alump in the neck hearing loss usually only in 1 ear tinnitus hearing sounds that comefrom inside the body rather than from an outside source a blocked or stuffy nose nosebleeds Speak to your GP if you develop any worrying symptoms, particularly if they dont improve aftera few weeks. While theyre very unlikely to be caused by nasopharyngeal cancer, its best to get them checked out. What causes nasopharyngeal cancer? The exact cause of nasopharyngeal cancer is unknown, buta number of factors can increase your risk of developing the condition. These include: being of south Chinese or north African descent having a diet very high in salt-cured meats and fish being exposed to the Epstein-Barr virus (EBV), a common virus that causes glandular fever having a job where youre regularly exposed to hardwood dust having a first-degree relative, such as a parent, whos had the condition Being exposed to thehuman papilloma virus (HPV)may also increase your risk of developing certain types of nasopharyngeal cancer. About 3 times as many men as women are affected by nasopharyngeal cancer. The average age at diagnosis is about 50. Diagnosing nasopharyngeal cancer If you see your GP with symptoms that could indicate nasopharyngeal cancer, theyll usually ask about your symptoms and carry out some examinations. This may involve examining your throat using a small mirror and a light. If your GP thinks further tests are necessary, theyll refer you to hospital. At hospital, a number of different tests may be carried out to check for nasopharyngeal cancer and rule out other conditions. Some of the tests you may have include: a nasendoscopy where a thin, flexible telescope (endoscope)is inserted up your nose and passed down your throat to look for any abnormalities; its carried out while youre awake, but local anaesthetic can be used to numb your nose and throat imaging scans magnetic resonance imaging (MRI) scans or computerised tomography (CT) scans can be used to check for tumours and determine whether the cancer has spread a panendoscopy a more detailed examination of your nose and throat carried out under general anaesthetic (where youre unconscious) using a series of small, rigid telescopes connected together a biopsy where a small tissue sample is removed during a panendoscopy so it can be examined in a laboratory Once these tests are complete, your doctors will be able to confirm whether you have nasopharyngeal cancer. Theyll also be able to stage the cancer, which means giving it a score to describe how large it is and how far it has spread. The Cancer Research UK website has more information about the stages of nasopharyngeal cancer . How nasopharyngeal cancer is treated If youre diagnosed with nasopharyngeal cancer, youll be cared for by a team of different specialists who work together called a multidisciplinary team (MDT). Members of your MDT will discuss with you what they think the best treatment option is in your case. The 2 main treatments for nasopharyngeal cancer are: radiotherapy whereradiationis used to kill cancer cells chemotherapy where medication is used to kill cancer cells In most cases, a combination of radiotherapy and chemotherapy will be used. Surgery isnt usually used to treat nasopharyngeal cancer as its difficult for surgeons to access the affected area. Radiotherapy Radiotherapy is the most commonly used treatment for nasopharyngeal cancer. It can be used on its own to treat very early-stage cancers, or in combination with chemotherapy for more advanced cancers. In most cases, external radiotherapy is used. This involves using a machine to focus high-energy radiation beams on to the area that requires treatment. In nasopharyngeal cancer, an advanced form of external radiotherapy called intensity-modulated radiation therapy (IMRT) is used. Itinvolves aiming radiation beams of different strengths at a tumour from several different angles. This helps maximise the dose delivered to the tumour, while minimising the effect on the surrounding healthy tissue. Stereotactic radiotherapy is another way of giving radiotherapy externally and may be used to target a specific area where the cancer has returned. External radiotherapy is often given in short sessions, once a day from Monday to Friday, with a break at weekends. This is usually carried out for up to7 weeks. You wont need to stay in hospital overnight betweenthese appointments. In some cases, internal radiotherapy may be requiredwhere nasopharyngeal cancer has returned after initial treatment. A radioactive source is placed into or near the cancerous area and left in place for anywhere from a few minutes to a few days. Depending on the type of treatment you have, you may need to stay in hospital for a short period of time. Radiotherapy itself is painless, but it can have some significant side effects, such as: red and soreskin in the treatment area feeling sick changes to your sense of taste dry mouth hair loss These side effects are usually temporary, but some can be permanent. Let your care team know if you experience these problems as treatment is often available to help. Read more about how radiotherapy is performed and the side effects of radiotherapy Chemotherapy Chemotherapy may be used before or alongside radiotherapy for more advanced nasopharyngeal cancers. Its usually given through a drip into a vein (intravenous chemotherapy), with sessions every 3 to 4 weeks spread over several months. You wont usually need to stay in hospitalovernightduring treatment. Like radiotherapy, chemotherapy can cause a number of significant side effects, such as: feeling sick diarrhoea sore mouth tiredness These side effects are usually temporary, but theres also a risk of longer-term problems, such as infertility.You should discuss any concerns you have about the potential side effects of treatment with your care team before treatment begins. Read more about how chemotherapy is performed and the side effects of chemotherapy Follow-up After your course of treatment ends, youll need to have regular follow-up appointments and scans to monitor your recovery and check for any signs of the cancer returning. To start with, these appointments will be every few weeks or months, but theyll become gradually less frequent over time. Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Oesophageal cancer Laryngeal (larynx) cancer Other health sites Cancer Research UK: Nasopharyngeal cancer Macmillan Cancer Support: Nasopharyngeal cancer Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Neuroblastoma: Children | "Neuroblastoma: Children | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in children Neuroblastoma: Children Neuroblastoma: Children Most children who have neuroblastoma are younger than 5 years old. Itsthe most common solid tumour in children that occurs outside of the brain and makes up 8% of the total number of childrens cancers. More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Its devastating to hear that your child has cancer. At times it can feel overwhelming, but there are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has, and the treatments that may be used, can often help parents to cope. Your childs specialist will give you more detailed information and, if you have any questions, its important to ask the specialist doctor or nurse who knows your childs individual situation. Neuroblastoma develops from the cells left behind from a babys development in the womb. The cells that it develops from are called neuroblasts. Neuro means nerve Blast means cells in early development Oma means a group of cells, or a tumour Neuroblastoma can occur anywhere in the body. The site of origin is either in 1 of the 2 adrenal glands situated in the abdomen (tummy) or in nerve tissue that runs alongside the spinal cord, in the neck, chest, abdomen or pelvis. The adrenal glands are specialised glands that are found above the right and left kidney. The adrenal glands normally release hormones to maintain blood pressure, and enable us to respond to stress. In some cases, neuroblastoma can spread to tissues beyond the original site such as the bone marrow, bone, lymph nodes, liver, and skin. Causes As with most cancers, the cause of neuroblastoma is unknown. It is not infectious and cannot be passed on to other people. Signs and symptoms The symptoms vary, depending on where your childs neuroblastoma tumour is: if the tumour is in the abdomen, your childs tummy may be swollen and they may complain of constipation or have difficulty passing urine (peeing) if the tumour affects the chest area, your child may be breathless and have difficulty swallowing if the tumour occurs in the neck, its often visible as a lump and occasionally affects breathing and swallowing occasionally, there are deposits of neuroblastoma in the skin that appear as small, blue-coloured lumps if the tumour is pressing on the spinal cord, children may have weakness in the legs and walk unsteadily if your child is not yet walking, you may notice reduced leg movements; they may also have constipation or difficulty passing urine (peeing) your child may be found to have high blood pressure very rarely, children may have jerky eye and muscle movements, and general unsteadiness associated with the neuroblastoma There are often symptoms of tiredness, being pale, loss of appetite, weight loss, bone pain and generalised discomfort. How is neuroblastoma diagnosed? A variety of tests and investigations will be needed to diagnose neuroblastoma. These include a biopsy of the tumour, blood and bone marrow tests, X-rays, CT or MRI scans, and a special nuclear medicine scan called an MIBG scan. These tests are carried out to confirm the diagnosis of neuroblastoma, and to find the exact position of the original site of neuroblastoma within the body and to see whether it has spread. This process is known as staging. A specific type of urine test will also be done. Nearly all children with neuroblastoma (9 out of 10) will have substances called vanillylmandelic acid (VMA), or homovanillic acid (HVA), in their urine. Measuring the VMA and HVA in the urine can help to confirm the diagnosis. Your child will also have their VMA and HVA levels checked during and after treatment. The levels of these substances will fall if the treatment is working. As these chemicals are produced by the tumour cells, and can be used to measure tumour activity, they are sometimes known as tumour markers. Most children will have an MIBG (meta-iodo-benzyl guanidine) scan. MIBG is a substance thats taken up by neuroblastoma cells. Its given by injection into the blood stream. Attaching a small amount of radioactive iodine to the MIBG enables any neuroblastoma tissue to be seen by a radiation scanner. Sometimes MIBG can be used as a treatment. Biopsy A small sample of cells (a biopsy ) is usually taken from the tumour during an operation under a general anaesthetic. These cells are then examined under a microscope. Other tests collectively referred to as tumour biology, look at the chromosomes and biological markers in the tumour cells. One of these markers is called MYCN. The presence of a certain amount of MYCN in the cells (known as MYCN amplification) can suggest that the neuroblastoma may be a more aggressive type. In this situation, the treatment needs to be more intensive. Staging The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site. Knowing the particular type and stage of the cancer helps the doctors to decide on the best treatment for your child. Stage 1 The cancer is contained within 1 area of the body (localised) and theres no evidence of it having spread. It can be completely removed by surgery, or there may be very small (microscopic) amounts of tumour left. Stage 2A The cancer is localised and has not begun to spread, but cannot be completely removed by surgery. Stage 2B The cancer is localised and has begun to spread into nearby lymph nodes. Stage 3 The cancer has spread into surrounding organs and structures, but has not spread to distant areas of the body. Stage 4 The cancer has spread to distant lymph nodes, bone, bone marrow, liver, skin or other organs. Stage 4S (also called special neuroblastoma) This stage of neuroblastoma is found in children under 1 year old. The cancer is localised (as in stage 1, 2A or 2B) and has begun to spread to the liver, skin or bone marrow. A newer staging system has been developed by the International Neuroblastoma Risk Group (INRG). This system is now widely used. It looks at whether or not certain image-defined risk factors are present in a neuroblastoma tumour before treatment. These risk factors can be detected by scans and help doctors understand the extent of the disease. Your doctor can explain more about this. Stage L1 The tumour is localised and has not spread into important areas (vital structures) nearby. It can be removed by surgery. Stage L2 The tumour is localised but has image-defined risk factors and cant be safely removed by surgery. Stage M The tumour has spread to other parts of the body. Stage MS The tumour has spread to the skin, liver and/or the bone marrow in children younger than 18 months old. If the cancer has spread to distant parts of the body, this is known as secondary or metastatic cancer. If the cancer comes back after initial treatment, this is known as recurrent or relapsed cancer. Treatment The treatment of neuroblastoma depends on the age of the child, the size and position of the tumour, the tumour biology (including the MYCN status) and whether the neuroblastoma has spread. Surgery For tumours that have not spread (localised tumours), the treatment is usually surgery. If the tumour is at an early stage and there is no evidence that it has spread to the lymph nodes or any other parts of the body, an operation to remove the tumour, or as much of it as possible, will be undertaken. If the tumour is, at first, too large or in too difficult a position to remove safely, chemotherapy will be given to shrink it before surgery. A cure is usually possible for children with localised tumours. However, if a localised tumour is classed as high-risk, due to the tumour biology results, additional treatment with chemotherapy and usually radiotherapy will be needed. Chemotherapy If the tumour has already spread by the time of diagnosis, or is indicated as being high-risk by the tumour biology result, intensive chemotherapy is needed. Chemotherapy is the use of anti-cancer drugs to destroy cancer cells. Its usually given as an infusion into a vein. Your child will have a semi-permanent cannula called a central venous line inserted under a general anaesthetic to minimise the distress caused by intravenous injections. Your childs specialist will discuss with you the type and amount of chemotherapy needed. High-dose chemotherapy with stem cell rescue If the neuroblastoma has spread to several parts of the body, or is high-risk with MYCN amplification, high dose chemotherapy with peripheral blood stem cell rescue is used after the initial courses of chemotherapy. High-dose chemotherapy will wipe out any remaining neuroblastoma cells but will also wipe out the bodys bone marrow, where blood cells are made. To prevent the problems this causes, stem cells (blood cells at their earliest stages of development) are collected from your child through a drip before the chemotherapy is given. These stem cells are then frozen and stored until required. After the high-dose chemotherapy, the stem cells are given back to your child through a drip. They make their way into the bone marrow, where they grow and develop into mature blood cells over a period of 14 to 21 days. Monoclonal antibody treatment Monoclonal antibodies can destroy some types of cancer cells while causing little harm to normal cells. In the UK, patients with high-risk neuroblastoma treated in the (SIOPEN) European high-risk clinical trial receive immunotherapy with a monoclonal antibody called anti-GD2 after their high dose therapy. There is good evidence from a clinical trial (research study) carried out in America, which was first reported on in 2009, that this may be a promising therapy when given alongside standard treatment for neuroblastoma. The anti GD2 is either given on its own or with cytokines. It is not yet a standard treatment for patients with neuroblastoma as it has very unpleasant side effects, the benefits need to be fully proven and the best way to administer it needs to be established. It is therefore currently only available to patients in the UK who are being treated within a clinical trial. Your childs specialist will be able to tell you much more about this treatment. Radiotherapy External beam radiotherapy may be given if the neuroblastoma is high-risk, or has spread to several parts of the body. This uses high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells. External beam radiotherapy is given from a machine outside the body. Internal radiotherapy may sometimes be given using radioactive MIBG. Radioactive MIBG is similar to the MIBG used in an investigation to diagnose neuroblastoma, but uses higher doses of radioactivity to kill the cancer cells. Younger children Children under 18 months old with neuroblastoma often have low-risk tumours, and as long as there is no MYCN amplification, their outlook is excellent. Most children in this age group are cured. Children with Stage 4S disease almost always get better with very little treatment or none at all. These tumours either regress spontaneously or after chemotherapy, which is only given if there are symptoms from the tumour. They disappear completely or develop into a non-cancerous (benign) tumour, called a ganglioneuroma. Many of these children, after their initial diagnostic tests and staging investigations, will just need careful monitoring for some years. Ganglioneuromas are usually harmless and will not cause any problems and do not need any treatment. Side effects of chemotherapy treatment Chemotherapy often causes side effects, and your childs doctor will discuss this with you before the treatment starts. The side effects will depend upon the actual drugs being given. Immediate side effects can include: feeling sick (nausea) and being sick (vomiting) diarrhoea weight loss hair loss increased risk of infection bruising and bleeding tiredness Late side effects A small number of children may develop late side effects, sometimes many years after treatment. These include a change in the way the heart and kidneys work, hearing problems, fertility problems, a possible reduction in bone growth if radiotherapy has been given, and a slightly increased risk of developing another cancer in later life. Your childs doctor or nurse will talk to you about any possible late side effects. Clinical trials Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors organise many trials for childrens cancer. Children in the UK with neuroblastoma can take part in national and European studies. The European research group is called SIOPEN. If appropriate, your childs medical team will talk to you about taking part in a clinical trial, and will answer any questions you have. Written information is provided to help explain things. Taking part in a research trial is completely voluntary, and youll be given plenty of time to decide if its right for your child. Treatment guidelines Sometimes, clinical trials are not available for your childs tumour. This may be because a recent trial has just finished, or because the tumour is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Childrens Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care Follow-up after treatment usually involves regular visits to the hospital outpatients department, with scans and urine tests as necessary. For children who have had chemotherapy and/or radiotherapy, more specialised tests may also be carried our. For example, hearing tests, kidney and heart function tests, and checking hormone levels. These will be repeated until your child is grown up. If you have specific concerns about your childs condition and treatment, its best to discuss them with your childs doctor, who knows their situation in detail. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Its not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young Peoples Cancer; A Parents Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience with cancer. The Parents Guide discusses these further and talks about how you can support your child. Source: Children's Cancer and Leukaemia Group - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852" | null | null | null | null | null | null | null | null | null | null | null | null | null |
Neuroendocrine tumours | Neuroendocrine tumours - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Neuroendocrine tumours Neuroendocrine tumours Neuroendocrine tumours (NETs) are rare tumours that can occur in the cells of the neuroendocrine system. The neuroendocrine system consists of nerve and gland cells. It produces hormones and releases them into the bloodstream. NETs are tumours (abnormal growths) that develop in the cells of the neuroendocrine system. NETs can be malignant (cancerous) or benign (non-cancerous) and oftenbut not always grow slowly. There are a number of different types of NET, depending on the specific cells affected. Types of neuroendocrine tumours Gastroenteropancreatic neuroendocrine tumours (GEP NETs) are tumours that develop in the gut or pancreas. Gastrointestinal neuroendocrine tumours (GI NETs) develop in the digestive system, which includes the bowel, stomach or oesophagus. Pancreatic neuroendocrine tumours (pNETs) develop in the pancreas. Pulmonary neuroendocrine tumours develop in the lungs. Rarely, NETs can also develop in other parts of the body, including in the liver, gallbladder, bile ducts, kidneys, ovaries, or testicles. Some NETs, known as functioning tumours, produce hormones that cause specific symptoms. Tumours that dont cause symptoms are known as non-functioning tumours. Symptoms of neuroendocrine tumours The symptoms ofaneuroendocrine tumourcan vary depending on where it is and what hormones it produces. For example,atumour in the digestive system may cause diarrhoea , constipation or tummy pains. A tumour in the lung may cause wheezing or a persistent cough . Some tumours (functioning tumours) may cause abnormally large amounts of hormones to be released into the bloodstream. This cancause symptoms such as diarrhoea, flushing, cramps, wheezing, low blood sugar (hypoglycaemia), changes in blood pressure and heart problems. What causesneuroendocrine tumours? What causes neuroendocrine tumours isnt fully understood. However,your chance of developing a NET is increasedif you have one of the following rare conditions or syndromes: multiple endocrine neoplasia type 1 (MEN 1) a rare inherited condition where tumours in the endocrine system develop, most commonly in the parathyroid glands, pituitary gland and the pancreas neurofibrmatosis type 1a group of genetic conditions that cause tumours to grow along your nerves Von Hippel-Lindau syndrome (VHL) an inherited condition that causes blood vessels to grow abnormally Research has also shown that your risk of developing a NET is slightly increased if one of your parents has had one in the past. Diagnosingneuroendocrine tumours There are many tests that canbe used to diagnose NETs, including blood tests , urine tests, scans, and a biopsy (where a small tissue sample is taken for closer examination). Different types of scans may also be used to identify or examine tumours. These include: ultrasound scans including echocardiograms and endoscopic ultrasound scans computerised tomography (CT) scans magnetic resonance imaging (MRI) scans positron emission tomography (PET) scans octreotide scans where mild radioactive liquid is injected into your veins anda special camera is used to highlightany cancerous cells Treating neuroendocrine tumours How a neuroendocrine tumour is treated will depend on yourindividual circumstances. For example, your treatment will depend on: where the tumour is how advanced your condition is your overallhealth Unfortunately, many people are only diagnosed after other parts of their body are affected. However, it may still be possible tosurgically remove the tumour, even if it has spread to other parts of your body. If surgery cant be used to completely cure your condition, it may be used to help manage and reduce any symptoms that you have. It may also be possible to shrink the tumour or stop further growth using treatments that block the blood supply to the tumour (embolisation),or chemotherapy , radiotherapy or radiofrequency ablation (where heat is used to destroy the cells). The Cancer Research UK website has more information about neuroendocrine tumours (NETs) . Information about you If you haveneuroendocrine tumours, your clinical team will pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the register . Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Other health sites Cancer Research UK: Neuroendocrine tumours (NETs) Macmillan Cancer Support: Neuroendocrine tumours (NETs) Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Non-alcoholic fatty liver disease (NAFLD) | Non-alcoholic fatty liver disease (NAFLD) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Non-alcoholic fatty liver disease (NAFLD) Non-alcoholic fatty liver disease (NAFLD) Non-alcoholic fatty liver disease (NAFLD) is the term for a range of conditions caused by a build-up of fat in the liver. Its usually seen in people who are overweight or obese. A healthy liver should contain little or no fat. Its estimated that up to 1 in every3 people in the UK has early stages of NAFLD where there are small amounts of fat in their liver. Early-stage NAFLD doesnt usually cause any harm, but it can lead to serious liver damage, including cirrhosis , if it gets worse. Having high levels of fat in your liver is also associated with an increased risk of problems such as diabetes , heart attacks and strokes . If detected and managed at an early stage, its possible to stop NAFLD getting worse and reduce the amount of fat in your liver. Stages of NAFLD NAFLD develops in 4main stages. Most people will only everdevelop the first stage, usually without realising it. In small number of cases itcan progress and eventually lead to liver damage if not detected and managed. The main stages of NAFLD are: simple fatty liver (steatosis) a largely harmless build-up of fat in the liver cells that may only be diagnosed during tests carried out for another reason non-alcoholic steatohepatitis (NASH) a more serious form of NAFLD, where the liver has become inflamed; this is estimated to affect up to 5% of the UK population fibrosis where persistent inflammationcauses scar tissue around the liver and nearbybloodvessels, but the liver is still able to function normally cirrhosis the most severe stage, occurring afteryears of inflammation, where the liver shrinks and becomes scarred and lumpy; this damage is permanent and canlead toliver failure (where your liver stops working properly) and liver cancer It can take years for fibrosis or cirrhosisto develop. Its important to make lifestyle changes toprevent the disease from getting worse. Am I at risk of NAFLD? Youre at an increased risk of NAFLD if you: are obese or overweight particularly if you have a lot of fat around your waist (an apple-like body shape) have type 2 diabetes have high blood pressure have high cholesterol are over the age of 50 smoke However, NAFLD has been diagnosed in people without any of these risk factors, including young children. Although its very similar to alcohol-related liver disease (ARLD) , NAFLD isnt caused by drinking too much alcohol. Symptoms ofNAFLD There arent usually any symptoms of NAFLD in the early stages. You probably wont know you have it unless its diagnosed during tests carried out for another reason. Occasionally, people with NASH or fibrosis (more advanced stages of the disease) may experience: a dull or aching pain in the top right of thetummy (over the lower right side of the ribs) fatigue (extreme tiredness) unexplained weight loss weakness If cirrhosis (the most advanced stage) develops, you can get more severe symptoms such as yellowing of the skin and the whites of the eyes (jaundice), itchy skin, and swelling in the legs, ankles, feetor tummy. Read more about the symptoms of cirrhosis . How NAFLD is diagnosed NAFLD is often diagnosed aftera blood test called aliver function test produces an abnormal result and other liver conditions, such as hepatitis, are ruled out. However, blood tests dont always pick up NAFLD. The condition may also be spotted during an ultrasound scan of your tummy. This is a type of scan where sound waves are used to create an image of the inside of your body. If youre diagnosed with NAFLD, further tests may be needed to determine which stage you have. This may involve a special blood test or having another type of ultrasound scan (Fibroscan). Some people may also need a small sample of liver tissue ( biopsy ) taken using a needle to have it analysed in a laboratory. Treatment for NAFLD Most people with NAFLD wont develop any serious problems, but if youre diagnosed with the condition its a good idea to take steps to stop it getting any worse. Theres currently no specific medication for NAFLD, but making healthy lifestyle choices can help and treatment may be recommended for associated conditions (high blood pressure, diabetes and cholesterol) or complications. You may be advised to have regular appointments with yourdoctor to check your liver function andlook for signs of any new problems. Healthy diet and lifestyle Adopting a healthy lifestyle is the main way of managing NAFLD.The following can allhelp. Lose weight you should aim for a BMI of 18.5-24.9. Losing more than 10% of your weight can remove some fat from the liver and improve NASH if you have it. Eat a healthy diet try to have abalanced diethigh in fruits, vegetables, protein and carbohydrates, but low in fat, sugar and salt. Eating smaller portions of food can help too. Exerciseregularly aim to do at least 150 minutes ofmoderate-intensity activity, such as walking or cycling, a week. All types of exercise can help improve NAFLD, even if you dont lose weight. Stop smoking if you smoke, stopping can help reduce your risk of problems such as heart attacks and strokes. NAFLD isnt caused by alcohol, butdrinking may make the condition worse. Its therefore advisable to cut down or stop drinking alcohol. Read some tips on cutting down on alcohol . Medication There isnt currently any medication that can treat NAFLD, butvarious medicines can be useful in managing the problems associated with the condition. For example, your doctor may recommend medication to treat high blood pressure , treat high cholesterol , treat type 2 diabetes and/or treat obesity . Liver transplant If you developsevere cirrhosis and yourliver stops working properly, you may need to be put on the waiting list for a liver transplant. For adults,the average waiting time for a liver transplant is 145 days for transplants from recently deceased donors. Alternatively, it may be possible to have a transplant usinga section of liverremoved from a living donor. Asthe liver can regenerate itself, both the transplanted section and the remaining section of the donors liver are able to regrow to a normal size. Read more about liver transplants . Source: NHS 24 - Opens in new browser window Last updated: 29 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Non-Hodgkin lymphoma | Non-Hodgkin lymphoma - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Non-Hodgkin lymphoma Non-Hodgkin lymphoma About non-Hodgkin lymphoma Symptoms of non-Hodgkin lymphoma Causes of non-Hodgkin lymphoma Diagnosing non-Hodgkin lymphoma Treating non-Hodgkin lymphoma Complications of non-Hodgkin lymphoma About non-Hodgkin lymphoma Non-Hodgkin lymphoma is an uncommon cancer that develops in the lymphatic system, which is a network of vessels and glands spread throughout your body. The lymphatic system is part of your immune system. Clear fluid called lymph flows through the lymphatic vessels and contains infection-fighting white blood cells known as lymphocytes. In non-Hodgkin lymphoma, the affected lymphocytes start to multiply in an abnormal way and begin to collect in certain parts of the lymphatic system, such as the lymph nodes (glands). The affected lymphocytes lose their infection-fighting properties, making you more vulnerable to infection. The most common symptom of non-Hodgkin lymphoma is a painless swelling in a lymph node, usually in the neck, armpit or groin. Read more about the symptoms of non-Hodgkin lymphoma . Whos affected? Non-Hodgkin lymphoma can occur at any age, but your chances of developing the condition increase as you get older, with most cases diagnosed in people over 65. Slightly more men than women are affected. What causes non-Hodgkin lymphoma? The exact cause of non-Hodgkin lymphoma is unknown. However, your risk of developing the condition is increased if you: have a medical condition that weakens your immune system take immunosuppressant medication have previously been exposed to a common virus called the Epstein-Barr virus which causes glandular fever You also have a slightly increased risk of developing non-Hodgkin lymphoma if a first-degree relative (such as a parent or sibling) has had the condition. Read more about the causes of non-Hodgkin lymphoma . How non-Hodgkin lymphoma is diagnosed The only way to confirm a diagnosis of non-Hodgkin lymphoma is by carrying out a biopsy . This is a minor surgical procedure where a sample of affected lymph node tissue is removed and studied in a laboratory. Read more about diagnosing non-Hodgkin lymphoma . Treatment and outlook There are many subtypes of non-Hodgkin lymphoma, but they can generally be put into one of 2 broad categories: high-grade or aggressive non-Hodgkin lymphoma where the cancer develops quickly and aggressively low-grade or indolent non-Hodgkin lymphoma where the cancer develops slowly, and you may not experience any symptoms for many years The outlookfor non-Hodgkin lymphoma varies greatly, depending on the exact type,grade and extent of the lymphoma, and the persons age. Low-grade tumours dont necessarily require immediate medical treatment, but are harder to completely cure. High-grade lymphomas need to be treated straight away, but tend to respond much better to treatment and can often be cured. The main treatments used for non-Hodgkin lymphoma are: chemotherapy radiotherapy atype of targeted treatment called monoclonal antibody therapy Overall, most cases of non-Hodgkin lymphoma are considered very treatable. You can read more detailed information about the outlook for non-Hodgkin lymphoma on the Cancer Research UK website. However, theres a risk of long-term problems after treatment, including infertility and an increased risk of developing another type of cancer in the future. Read more about: treating non-Hodgkin lymphoma complications of non-Hodgkin lymphoma Information about you If you havenon-Hodgkin lymphoma, your clinical team will pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the register . Symptoms of non-Hodgkin lymphoma The most common symptom of non-Hodgkin lymphoma is a painless swelling in a lymph node, usually in the neck, armpit or groin. Lymph nodes, also known as lymph glands,are pea-sized lumps of tissue found throughout the body. Theycontain white blood cells that help to fight against infection. The swelling is caused by a certain type of white blood cell,known aslymphocytes,collecting inthe lymph node. However, its highly unlikely you have non-Hodgkin lymphoma if you have swollen lymph nodes , as these glands often swell as a response to infection. Other symptoms Some people with non-Hodgkin lymphoma also have other more general symptoms. These can include: night sweats unintentional weight loss a high temperature (fever) a persistent cough or feeling of breathlessness persistent itching of the skin all over the body Other symptoms depend on where in the body the enlarged lymph glands are. For example, if the abdomen (tummy) is affected, you may have abdominal pain or indigestion . A few people with lymphoma have abnormal cells in their bone marrow when theyre diagnosed. This may lead to: persistent tiredness or fatigue an increased risk of infections excessive bleeding such as nosebleeds ,heavy periods and spots of blood under the skin When to seek medical advice Speak to your GP if you have any of these symptoms, particularly if you have persistently swollen glands with no other signs of infection. While the symptoms are unlikely to be caused by non-Hodgkin lymphoma, its best to get them checked out. Causes of non-Hodgkin lymphoma Non-Hodgkin lymphoma is caused by a change (mutation) in the DNA of a type of white blood cell called lymphocytes. The exact reason why this happens isnt known. DNA gives cells a basic set of instructions, such as when to grow and reproduce. The mutation in the DNA changes these instructions, so the cells keep growing. This causes them to multiply uncontrollably. The abnormallymphocytesusually begin to multiply in one or more lymph nodes in a particular area of the body, such as your neck or groin. Over time, its possible for the abnormal lymphocytes to spread into other parts of your body, such as your: bone marrow spleen liver skin lungs However, in some cases, non-Hodgkin lymphoma first develops in an organ orsomewhere else outside the lymphatic system (the network of lymph vessels and glands found throughoutthe body). Whos most at risk? While the cause of the initial mutation that triggers non-Hodgkin lymphoma is unknown, a number of factors can increase your risk of developing the condition. These include: having a medical condition that weakens your immune system, such as HIV having medical treatment that weakens your immune system for example, taking medication to suppress your immune system after an organ transplant having an autoimmune condition (a condition caused by problems with the immune system), such as rheumatoid arthritis , lupus or Sjogrens syndrome being previously exposed to the Epstein-Barr virus a common virus that causes glandular fever being previously exposed to the Human T-cell lymphotropic virus (HTLV) having a Helicobacter pylori infection a common bacterial infection that usually infects the lining of the stomach and small intestine having received chemotherapy or radiotherapy for an earlier cancer having coeliac disease an adverse reaction to gluten that causes inflammation of the small bowel Non-Hodgkin lymphoma isnt infectious and isnt thought to run in families, although your risk may be slightly increased if a first-degree relative (such as a parent or sibling) has had lymphoma. Non-Hodgkin lymphoma can occur at any age, but most cases are diagnosed in people over 65. The condition is slightly more common in men than women. Diagnosing non-Hodgkin lymphoma If you see your GP because youre concerned about symptoms of non-Hodgkin lymphoma, theyll ask about your health and carry out a simple physical examination. If necessary, your GP will refer you to hospital for further tests. In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of non-Hodgkin lymphoma and refer people for the right tests faster. To find out if you should be referred for further tests for suspectednon-Hodgkin lymphoma, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral . If youre referred to hospital, a biopsy will usually be carried out, as this is the only way to confirm a diagnosis of non-Hodgkin lymphoma. Biopsy A biopsy involves removing some or all of an affected lymph node, which is then studied in a laboratory. Biopsies are small operations that can often be carried out under a local anaesthetic (where the area is numbed). In some cases,the affected lymph node isnt easily accessible and a general anaesthetic may be required (where youre asleep). A pathologist (an expert in the study of diseased tissue) will then check the tissue sample for the presence of cancerous cells. If they find cancerous cells, they can also identify exactly which type of non-Hodgkin lymphoma you have, which is an important factor in planning your treatment. Types of non-Hodgkin lymphoma There are more than 30 types of non-Hodgkin lymphoma, including: diffuse large B-cell lymphoma follicular lymphoma extranodal marginal zone B-cell (MALT) mantle cell lymphoma Burkitt lymphoma mediastinal large B-cell lymphoma nodal marginal zone B-cell lymphoma small lymphocytic lymphoma lymphoplasmacytic lymphoma peripheral T-cell lymphoma skin (cutaneous) lymphomas anaplastic large-cell lymphoma lymphoblastic lymphoma The Macmillan Cancer Support website has more detailed information on the different types of non-Hodgkin lymphoma . Further testing If a biopsy confirms a diagnosis of non-Hodgkin lymphoma, further testing will be required to check how far the lymphoma has spread. This allows a doctor to diagnose the stage of your lymphoma. Further tests may include: blood tests samples of blood will be taken throughout your diagnosis and treatment to check your general health, the levels of red and white cells and platelets in your blood, and how well organs such as your liver and kidney are working bone marrow sample another biopsy may be carried out to see if the lymphoma has spread to your bone marrow; this involves using a long needle to remove a sample of bone marrow from your pelvis and can be done using a local anaesthetic chest X-ray this can check whetherthe cancerhas spread to your chest or lungs computerised tomography (CT) scan this scan takes a series of X-rays that build up a 3D picture of the inside of the body to check the spread ofthe cancer magnetic resonance imaging (MRI) scan this scan uses strong magnetic fields to build up a detailed picture of areas of your body to check the spread of the cancer positron emission tomography (PET) scan this scan measures the activity of cells in different parts of the body andcan check the spread of the cancer and the impact of treatment; its usually taken at the same time as a CT scan to show precisely how the tissues of different sites of the body are working lumbar puncture using a thin needle, a sample of spinal fluid is taken and examined to see if it contains any lymphoma cells Stages ofnon-Hodgkin lymphoma When the testing is complete, it should be possible to determine the stage of your lymphoma. Staging means scoring the cancer by how far its spread. The main stages of non-Hodgkin lymphoma are. stage 1 the cancer is limited to 1 group of lymph nodes, such as your neck or groin nodes either above or below your diaphragm (the sheet of muscle underneath the lungs) stage 2 2 or more lymph node groups are affected, either above or belowthe diaphragm stage 3 thecancer has spread to lymph node groups above and below the diaphragm stage 4 the lymphoma has spread through the lymphatic system and is now present in organs or bone marrow Health professionals also add the letter A or B to your stage to indicate whether or not you have certain symptoms. Ais put after your stage if you have no additional symptoms other than swollen lymph nodes. B is put after your stage if you have additional symptoms of weight loss, fever or night sweats. In some cases, health professionals also use additional letters to indicate where the cancer first developed. For example, E (extranodal) means the cancer developed outside the lymphatic system. Grading non-Hodgkin lymphoma Testing can also help health professionals decide the grade of the cancer. There are two main grades of non-Hodgkin lymphoma: low-grade or indolent non-Hodgkin lymphoma is where the cancer develops slowly, and you may not experience any symptoms for many years high-grade or aggressive non-Hodgkin lymphoma is where the cancer develops quickly and aggressively Low-grade tumours dont necessarily require immediate medical treatment, but are harder to completely cure. High-grade lymphomas need to be treated immediately, but tend to respond much better to treatment and can often be cured. In some cases, low-grade lymphomas can develop into high-grade lymphomas over time. Read more about treating non-Hodgkin lymphoma . Treating non-Hodgkin lymphoma Non-Hodgkin lymphoma is usually treated with cancer-killing medication or radiotherapy, although some people may not need treatment straight away. In a few cases,if the initial cancer isvery smalland can be removed duringa biopsy , no further treatment may be needed. Your treatment plan The recommended treatment plan will depend on your general health and age,as many of the treatments can put atremendous strain on the body. Discussions about your treatment plan will usually take place with several doctors and other health professionals who specialise in different aspects of treating lymphoma. This is known as a multidisciplinary team (MDT). Your MDT will recommend the best treatment options for you. However, you shouldnt be rushed into making a decision about your treatment plan. Before deciding, you may wish to talk to friends, family and your partner. Youll be invited back to see your care team for a full discussion about the risks and benefits of any treatments planned before treatment begins. You can ask yourcare teamif a clinical trialis available to take part in. Wait-and-see approach If the disease is low-grade (slow developing) and youre well, a period of watchful waiting is often recommended. This is because some people take many years to develop troublesome symptoms and starting treatment immediately is often felt to be unnecessary. If watchful waiting is recommended, youll be seen regularly for reviews and invited to come back at any stage if you feel your symptoms are getting worse. Chemotherapy Chemotherapy is a widely used treatment for non-Hodgkin lymphoma, which involvesusing medicine to kill cancer cells. It may be used onits own, combined with biological therapy and/or combined with radiotherapy (see below). The medication can be given in a number of different ways, depending on the stage of your cancer. If doctors think your cancer is curable, youll normally receive chemotherapy through a drip directly into a vein (intravenous chemotherapy).If a cure is unlikely, you may only need to take chemotherapy tablets to help relieve your symptoms. If theres a risk of the cancer spreading to your brain, you may have chemotherapy injections directly into the cerebrospinal fluid around your spine. Chemotherapy is usually given over a period of a few months on an outpatient basis, which means you shouldnt have to stay in hospital overnight. However, there may be times when your symptoms or the side effects of treatment become particularly troublesome, and a longer hospital stay may be needed. Chemotherapy can have several side effects, the most significant of which is potential damage to your bone marrow. This can interfere with the production of healthy blood cells and cause the following problems: fatigue breathlessness increased vulnerability to infection bleeding and bruising more easily If you experience these problems, treatment may need to be delayed so you can produce more healthy blood cells. Growth factor medicines can also stimulate the production of blood cells. Other possible side effects of chemotherapy include: nausea and vomiting diarrhoea loss of appetite mouth ulcers tiredness skin rashes hair loss infertility , which may be temporary or permanent Most side effects should pass once your treatment has finished. Tell your care team if side effects become particularly troublesome, as there are treatments that can help. Read more about the side effects of chemotherapy . High-dose chemotherapy If non-Hodgkin lymphoma doesnt get better with initial treatment (known as refractory lymphoma), you may have a course of chemotherapy at a stronger dose. However, this intensive chemotherapy destroys your bone marrow, leading to the problems mentioned above. Youll need a stem cell orbone marrow transplants to replace the damaged bone marrow. Radiotherapy Radiotherapy ismostoftenused to treat early-stage non-Hodgkin lymphoma, where the cancer is only in 1 part of the body. Treatment is normally given in short daily sessions, Monday to Friday, over several weeks. You should not have to stay in hospital between appointments. Radiotherapy itself is painless, but it can have some significant side effects. These can vary, depending on which part of your body is being treated. For example, treatment to your throat can lead to a sore throat, while treatment to the head can lead to hair loss. Other common side effects include: sore and red skin in the treatment area tiredness nausea and vomiting dry mouth loss of appetite Most side effects are temporary, but theres a risk of long-term problems, including infertility and permanently darkened skin in the treatment area. Read more about: side effects of radiotherapy complications of non-Hodgkin lymphoma Monoclonal antibodytherapy For some types of non-Hodgkin lymphoma, you may have a type of medication called a monoclonal antibody. These medications attach themselvesto the surface of cancerous cells and stimulate the immune system to attack and kill the cells. Theyre often given in combination with chemotherapy to make the treatment more effective. For some types of non-Hodgkin lymphoma, you may continue having monoclonal antibody treatment regularly for up to 2 years after initial treatment, in combination withchemotherapy. This can reduce the chances of the cancer coming back in the future. One of the mainmonoclonal antibody medications used to treat non-Hodgkin lymphoma is called rituximab.This medicationis administered directly into your vein over the course of a few hours. Side effects of rituximab can include: flu -like symptoms, such as headaches , fever and chills tiredness nausea an itchy rash You may be given additional medication to prevent or lessen these side effects. Side effects should improve over time, as your body gets used to rituximab. Asrituximab has been so successful in treating non-Hodgkin lymphoma, scientists are working hard to make more monoclonal antibody treatments for lymphoma, and some of these are already at an advanced stage in clinical trials. You may be asked if you want to participate in one of these trials during your treatment. Steroid medication Steroid medication is commonlyused in combination with chemotherapy to treat non-Hodgkin lymphoma. This is because research has shown that using steroids makes the chemotherapy more effective. The steroid medication is normallygiven as tablets, usually at the same time as your chemotherapy. A short course of steroids, lasting no more than a few months, is usually recommended, as this limits the number of side effects you could have. Common side effects of short-term steroid use include: increased appetite, which can lead to weight gain indigestion problems sleeping feeling agitated On rare occasions, you may have to take steroids on a long-term basis. Side effects of long-term steroid use include weight gain and swelling in your hands, feet and eyelids. The side effects of steroid medication usually start to improve once treatment finishes. Follow-up After your course of treatment ends, you may have a repeat scan to see how well the treatment has worked. Following this, youll need regular follow-up appointments to monitor your recovery and check for any signs of the cancer returning (known as a relapse). These appointments will start off being every few weeks or months, but become less frequent over time. Read furtherinformation: Cancer Research UK: treating non-Hodgkin lymphoma Cancer Research UK: living with non-Hodgkin lymphoma Macmillan: treating non-Hodgkin lymphoma Macmillan: living with non-Hodgkin lymphoma Complications of non-Hodgkin lymphoma Some people treated for non-Hodgkin lymphoma experience long-term problems, even if theyve been cured. Weakened immune system Having a weakened immune system is a common complication of non-Hodgkin lymphoma and it can become more severe while youre being treated. However, your immune system will usually recover in the months and years after treatment. If you have a weak immune system, youre more vulnerable to infections, and theres an increased risk of developing serious complications from infections. In some cases, you may be advised to take regular doses of antibiotics to prevent infections occurring. Its also important to report any symptoms of an infection to your GP or care team immediately, because prompt treatment may be needed to prevent serious complications.This is particularly important in the first few months after treatment. Symptoms of infection include: a high temperature (fever) headache aching muscles diarrhoea tiredness a painful blistering rash Vaccination You should make sure that all of your vaccinations are up to date. However, its important to speak to your GP or care team about this because it may not be safe for you to have live vaccines (vaccines containing a weakened form of the virus or organism being vaccinated against) until several months after your treatment finishes. Examples of live vaccines include the: shingles vaccine BCG vaccine (against tuberculosis) MMR vaccine (against measles , mumps and rubella) Infertility Chemotherapy and radiotherapy for non-Hodgkin lymphoma can cause infertility . This is sometimes temporary, but it can be permanent. Your care team will estimate the risk of infertility in your specific circumstances and let you know your options. In some cases, it may be possible for men to store samples of their sperm and for women to store their eggs before treatment, so these can be used to try for a baby afterwards. Second cancers Having treatment for non-Hodgkin lymphoma can increase your risk of developing another type of cancer in the future. This is known as a second cancer. The risk of getting cancer is particularly increased after cancer treatment because chemotherapy and radiotherapy damage healthy cells, as well as cancer cells. This damage can then cause the affected cells to become cancerous many years after treatment. You can help to reduce your risk of a second cancer by adopting a healthy lifestyle by not smoking, maintaining a healthy weight with a balanced diet, and getting regular exercise. You should report any symptoms that might suggest another cancer to your GP at an early stage and attend any cancer screening appointments youre invited to. Other health problems Treatment for non-Hodgkin lymphoma can increase your risk of getting certainconditionsat a younger age than normal, such as: heart disease lung disease kidney disease thyroid disease diabetes cataracts Having a cancer diagnosis can also increase your risk of depression . You should report unexpected symptoms, such as increased shortness of breath, to your GP. Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Radiotherapy Hodgkin lymphoma Other health sites Cancer Research UK: Non-Hodgkin lymphoma Macmillan Cancer Support: Non-Hodgkin lymphoma Blood cancer UK: Lymphoma Lymphoma Action Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Non-Hodgkin lymphoma: Children | "Non-Hodgkin lymphoma: Children | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in children Non-Hodgkin lymphoma: Children Non-Hodgkin lymphoma: Children Non-Hodgkin lymphoma is a type of blood cancer. Its more common in boys than girls. More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Its devastating to hear that your child has cancer. At times it can feel overwhelming and there are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your childs specialist will give you more detailed information. If you have any questions its important to ask the specialist doctor or nurse who knows your childs individual situation. The lymphatic system is part of the immune system, the bodys natural defence against infection and disease. This is a complex system made up of the bone marrow, thymus, spleen, and lymph nodes throughout the body. The lymph nodes are connected by a network of tiny lymphatic vessels. Lymph nodes are also known as lymph glands, and the ones that youre most likely to notice are those in the neck, armpit and groin. The number of lymph nodes varies from one part of the body to another. In some parts there are very few, whereas under your arm there may be 20 to 50 nodes. Cancers that start in the lymphatic system are called lymphomas. There are 2 main types of lymphoma: Hodgkin lymphoma non-Hodgkin lymphoma (NHL) Although theyre both types of lymphoma, there are differences between them, which means they need different treatment. There are 2 main types of NHL. B-cell NHL usually involves the lymph nodes in the abdomen and intestines, but may involve nodes in the head and neck. T-cell NHL usually affects lymph nodes in the chest. Occasionally, NHL can develop in unusual places outside the lymph nodes. This is called extranodal lymphoma. Causes We dont know what causes NHL but there is research going on all the time to try to find out. Its important to remember that nothing you have done has caused the cancer. Signs and symptoms The first sign of NHL is usually a lump somewhere in the body, which is caused by swollen lymph nodes. This can cause different symptoms, depending on where the swollen lymph nodes are. If glands in the abdomen are affected, this may cause a feeling of being full after meals and some stomach pain. Other symptoms of NHL include a high temperature (fever), tiredness, weight loss, and loss of appetite. In a few children, lymphoma cells may be found in the bone marrow or in the fluid around the spinal cord (cerebrospinal fluid). How its diagnosed A variety of tests and investigations may be needed to diagnose NHL. Part, or all, of a swollen lymph gland, may be removed so that the cells can be examined in the laboratory ( biopsy ). This involves a small operation that is usually done under a general anaesthetic. Tests such as X-rays, ultrasound scans, MRI scans, CT scans, blood tests and bone marrow samples may be carried out to find out the extent of the disease. This is known as staging. Any tests and investigations that your child needs will be explained to you.The Childrens Cancer and Leukaemia Group (CCLG) has more information about what the tests and scans involve. Staging The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site. The type of treatment your child receives depends on the stage of the disease. Stage 1 One group of lymph nodes is affected, or theres a single extranodal tumour. Stage 2 Two or more groups of nodes are affected, or there is a single extranodal tumour that has spread to nearby lymph nodes, or there are two single extranodal tumours, but only on one side of the diaphragm (the sheet of muscle under the lungs, which plays a large part in our breathing). Stage 3 Theres lymphoma on both sides of the diaphragm (either in two or more groups of nodes) or there are two single extranodal tumours or the lymphoma is affecting the chest. Stage 4 The lymphoma has spread beyond the lymph nodes to other organs of the body such as the bone marrow or nervous system. Treatment Treatment for NHL has a very good success rate and many people are cured. Chemotherapy is the most important treatment for children with NHL. Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Its common for a combination of drugs to be used and treatment may last a number of months or years. The treatment will be planned according to your childs particular type of NHL and the stage of the disease. B-cell NHL is treated with 4to 8 courses of intensive chemotherapy. T-cell NHL is treated for about 2 years. Your childs doctor will discuss the treatment options with you. NHL can sometimes affect the brain and spinal cord. To stop this, chemotherapy may be injected directly into the fluid around the spinal cord. This is called intrathecal chemotherapy. Very rarely, radiotherapy is also necessary. Radiotherapy treats cancer by using high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells. High-dose chemotherapy with a bone marrow transplant is sometimes used (again very rarely) if the NHL comes back (recurs) after initial treatment. Side effects of treatment Treatment for NHL can cause different side effects, and your childs doctor will discuss these with you before the treatment starts. Any possible side effects will depend on the part of the body thats being treated and what treatment is being used. Some children have just a few side effects, while others experience more. Side effects can include: feeling sick (nausea) and vomiting a sore mouth temporary hair loss a low blood count leading to an increased risk of infection, bruising and bleeding (sometimes blood and/or platelet transfusions are needed) tiredness diarrhoea Late side effects Months or years later some children will develop late side effects from the treatment they have had. These include a possible reduction in bone growth, a change in the way the heart, lungs and kidneys work, and a small increase in the risk of developing another cancer in later life. After treatment with chemotherapy, some children particularly boys may become infertile. Older boys, and their parents, should be aware of the option of sperm banking. In this situation, sperm can be stored for possible use in later years. Your childs doctor or nurse will talk to you about any possible late side effects and will keep a close eye on possible long-term side effects in follow-up clinics. Clinical trials Many children have their treatment as part of a clinical research trial. Cancer research trials are carried out to try to find new and better treatments for cancer. Clinical trials mean there are now better results for curing childrens cancers compared with just a few years ago. Your childs medical team will talk to you about taking part in a clinical trial and will answer any questions you have. Written information is provided to help explain things. Taking part in a research trial is completely voluntary, and youll be given plenty of time to decide if its right for your child. Treatment guidelines Sometimes, clinical trials are not available for your childs tumour. This may be because a recent trial has just finished, or because the tumour is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Childrens Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care Once treatment has finished, the doctors will monitor your child closely with regular appointments in the hospital outpatient department. If you have specific concerns about your childs condition and treatment, its best to discuss them with your childs doctor, who knows the situation in detail. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Its not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young Peoples Cancer; A Parents Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience with cancer. The Parents Guide discusses these further and talks about how you can support your child. Source: Children's Cancer and Leukaemia Group - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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Norovirus | Norovirus | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Norovirus Norovirus Norovirus causes diarrhoea and vomiting and is one of the most common stomach bugs in the UK. Its also called the winter vomiting bug because its more common in winter, but you can catch it at any time of the year. Norovirus can be very unpleasant but usually clears up by itself in a few days. You can normally look after yourself or your child at home. Avoid going to your GP, as norovirus can spread to others very easily. Phone your GP practice or NHS 24 on 111 if youre concerned or need advice. Phone 999 or go to A&E if you or your child: vomit blood or have vomit that looks like ground coffee have green vomit (adults) have yellow-green or green vomit (children) might have swallowed something poisonous have a stiff neck and pain when looking at bright lights have a sudden, severe headache or stomach ache Find your nearest A&E Phone 111 now if: youre worried about a baby under 12 months your child stops breast or bottle feeding while theyre ill a child under 5 years has signs of dehydration such as fewer wet nappies you or your child (over 5 years) still have signs of dehydration after using oral rehydration sachets you or your child keep being sick and cannot keep fluid down you or your child have bloody diarrhoea or bleeding from the bottom you or your child have diarrhoea for more than 7 days or vomiting for more than 2 days Symptoms of norovirus Youre likely to have norovirus if you experience: suddenly feeling sick projectile vomiting watery diarrhoea Some people also have a slight fever, headaches , painful stomach cramps and aching limbs. The symptoms appear 1 to 2 days after you become infected and typically last for up to 2 or 3 days. How is norovirus spread? Norovirus spreads very easily in public places such as hospitals, nursing homes and schools. You can catch it if small particles of vomit or stools (poo) from an infected person get into your mouth through: close contact with someone with norovirus who may breathe out small particles of the virus that you then inhale touching contaminated surfaces or objects, as the virus can survive outside the body for several days eating contaminated food, which can happen if an infected person doesnt wash their hands before preparing or handling food Norovirus is most infectious from the start of symptoms until 48 hours after all symptoms have stopped. You may also be infectious for a short time before and after this. You can get norovirus more than once because the virus is always changing and your body is unable to build up long-term resistance to it. Preventing norovirus Its not always possible to avoid getting norovirus, but following the advice can help stop the virus spreading. You should: stay off work or school until at least 48 hours after the norovirus symptoms have stopped avoid visiting anyone in hospital during this time wash your hands frequently and thoroughly with soap and water particularly after using the toilet and before preparing or handling food be aware alcohol-based hand gels dont kill the virus Maintain basic hygiene and cleaning to help stop the spread of norovirus by: disinfecting any surfaces or objects that could be contaminated, using a bleach-based household cleaner. washing any items of clothing or bedding that could have become contaminated separately on a hot wash (60C) to ensure the virus is killed. not sharing towels and flannels flushing any poo or vomit in the toilet and cleaning the surrounding area with a bleach-based household cleaner avoiding eating raw, unwashed food only eating oysters from a reliable source as they can carry norovirus What to do if you have norovirus If you experience sudden diarrhoea and/or vomiting, the best thing to do is to stay at home until youre feeling better. Theres no treatment for norovirus, so you have to let it run its course. You dont usually need to get medical advice unless theres a risk of a more serious problem. To help ease your own or your childs symptoms drink plenty of fluids to avoid dehydration. You need to drink more than usual to replace the fluids lost from vomiting and diarrhoea as well as water, adults could also try fruit juice and soup. Avoid giving fizzy drinks or fruit juice to children as it can make their diarrhoea worse. Babies should continue to feed as usual, either with breast milk or other milk feeds. You can also: take paracetamol for any fever or aches and pains get plenty of rest use special rehydration drinks, available from community pharmacies if you have signs of dehydration , such as a dry mouth or dark urine If you feel like eating, try plain foods, such as soup, rice, pasta and bread. Babies and young children, especially under a year old, have a greater risk of becoming dehydrated. When to get medical advice You dont normally need to see your GP if you think you or your child has norovirus, as theres no specific treatment for it. Antibiotics wont help because norovirus is caused by a virus. Source: NHS National Services Scotland - Opens in new browser window Last updated: 01 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Nosebleed | Nosebleed | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Ears, nose and throat Nosebleed Nosebleed Nosebleeds are not usually a sign of anything serious. You can often treat them at home. During a nosebleed, blood flows from one or both nostrils. It can be heavy or light. It can last from a few seconds to 15 minutes or more. How to stop a nosebleed To stop a nosebleed: Sit down at a table, lean forward and firmly pinch the soft part of your nose, just above your nostrils, for at least 10 to 15 minutes. Lean forward and breathe through your mouth. Spit out any blood that collects in your throat or mouth into a bowl. Do not swallow any blood. Place an ice pack or bag of frozen vegetables covered by a towel on your forehead or back of your neck. Stay upright or seated, rather than lying down, to reduce the blood pressure in the blood vessels of your nose and help reduce further bleeding. If the bleeding eventually stops, you wont usually need to seek medical advice. But in some cases you may need further treatment from your GP or in hospital. When to get medical advice Go to A&E or phone 999 if: the bleeding continues for longer than 20 minutes the bleeding is heavy and youve lost a lot of blood youre having difficulty breathing youre feeling weak or dizzy you swallow a large amount of blood that makes you vomit the nosebleed developed after a serious injury, such as a car crash Speak to your GP practice if: youre taking a blood-thinning medicine (anticoagulant) such as warfarin you have a condition that means your blood cannot clot properly, such as haemophilia you have symptoms of anaemia such as heart palpitations, shortness of breath and a pale complexion a child under 2 has a nosebleed you have nosebleeds that come and go regularly If your GP practice is closed, phone 111. What causes nosebleeds? There are delicate blood vessels in your nose that can become damaged and bleed quite easily. Common causes of nosebleeds include: picking your nose blowing your nose very hard recently drinking alcohol a minor injury to your nose changes in humidity or temperature causing the inside of the nose to become dry and cracked Occasionally, bleeding can come from the blood vessels deeper within the nose. This can be caused by a blow to the head, recent nasal surgery or hardened arteries (atherosclerosis). Who gets nosebleeds? Nosebleeds are fairly common. Most people will get them every now and again. Anyone can get a nosebleed, but they most often affect: children aged between 2 and 10 elderly people pregnant women people who take blood thinning medication such as aspirin or anticoagulants, such as warfarin people with blood clotting disorders, such as haemophilia Preventing nosebleeds There are things you can do to prevent nosebleeds. Do avoid picking your nose and keep your fingernails short blow your nose as little as possible and only very gently keep your home humidified wear a head guard during activities in which your nose or head could get injured always follow the instructions that come with nasal decongestants overusing these can cause nosebleeds Talk to your GP if you often get nosebleeds and arent able to prevent them. Treatment for nosebleeds If you see your GP or go to hospital with a nosebleed, youll be assessed to find out how serious your condition is and whats likely to have caused it. This may involve: looking inside your nose measuring your pulse and blood pressure carrying out blood tests asking about any other symptoms you have If needed, your doctor will discuss additional treatments with you. For example, ointments for your nose, cautery to seal blood vessels in your nose or nasal packing may be required. Source: ENT Scotland - Opens in new browser window Last updated: 05 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform High blood pressure (hypertension) Iron deficiency anaemia First aid Other health sites St John Ambulance: Nosebleeds NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Obesity | Obesity causes & treatments - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Nutritional Obesity Obesity About obesity Causes of obesity Diagnosing obesity Treating obesity About obesity The term obese describes a person whos very overweight, with a lot of body fat. Its a common problem in the UK thats estimated to affectaround one in every four adults and around one in every five children aged 10 to 11. Defining obesity There are many ways in which a persons health in relation to their weight can be classified, but the most widely used method is body mass index (BMI). BMI is a measure of whether youre a healthy weight for your height. You can use the BMI healthy weight chart to work out yourscore. For most adults, a BMI of: 18.5 to 24.9 means youre a healthy weight 25 to 29.9 means youre overweight 30 to 39.9 means youre obese 40 or above means youre severely obese BMI isnt used to definitively diagnose obesity, because people who are very muscular sometimes have a high BMI without excess fat.But for most people, BMI is a useful indication of whether theyre a healthy weight, overweight or obese. A better measure of excess fat is waist circumference, which can be used as an additional measure in people who are overweight (with a BMI of 25 to 29.9) or moderately obese (with a BMI of 30 to 34.9). Generally, men with a waist circumference of 94cm (37in) or more and women with a waist circumference of 80cm (about 31.5in) or more are more likely to develop obesity-related health problems. Read more about diagnosing obesity Risks of obesity Its very important to take steps to tackle obesity because, as well as causingobvious physical changes, itcan lead to a number of serious and potentially life-threatening conditions, such as: type 2 diabetes coronary heart disease some types of cancer, such as breast cancer and bowel cancer stroke Obesity can also affect your quality of life and lead to psychological problems, such as depression andlow self-esteem (see below for more information about the health problems associated with obesity). Causes of obesity Obesity is generally caused by consuming more calories particularly those in fatty and sugary foods than you burn off through physical activity.The excess energy is stored by the body as fat. Obesity is an increasingly common problem because for many people modern living involves eating excessive amounts of cheap, high-calorie food and spending a lot of time sitting down, at desks, on sofas or in cars. There are also some underlying health conditions that can occasionally contribute to weight gain, such as an underactive thyroid gland (hypothyroidism) , although these type of conditions dont usually cause weight problems if theyre effectively controlled with medication. Read more about the causes of obesity Treating obesity The best way to treat obesity is to eat a healthy, reduced-calorie diet and exercise regularly . To do this you should: eat a balanced, calorie-controlled diet as recommended by your GP or weight loss management health professional (such as a dietitian) join a local weight loss group take up activities such as fast walking , jogging, swimming or tennis for 150 to 300minutes (two-and-a-half to five hours) a week eat slowly and avoid situations where you know you could be tempted to overeat You may also benefit from receiving psychological support from a trained healthcare professional to help change the way you think about food and eating. If lifestyle changes alone dont help you lose weight, a medication called orlistat may be recommended. If taken correctly, this medication works by reducing the amount of fat you absorb during digestion. Your GP will know whether orlistat is suitable for you. In rare cases, weight loss surgerymay be recommended. Read more about how obesity is treated Other obesity-related problems Obesity cancause anumber of further problems, including difficulties with daily activities and serious health conditions. Day-to-day problems related to obesity include: breathlessness increased sweating snoring difficultydoingphysical activity often feeling very tired joint andback pain low confidence and self-esteem feeling isolated The psychological problems associated with being obese can also affect your relationships with family and friends, and may lead to depression. Serious health conditions Being obese can also increase your risk of developing many potentially serioushealth conditions, including: type 2 diabetesa condition that causes a persons blood sugar level to become too high high blood pressure high cholesterol andatherosclerosis (where fatty deposits narrow your arteries), which can lead to coronary heart disease andstroke asthma metabolic syndrome a combination of diabetes, high blood pressure and obesity several types of cancer , including bowel cancer, breast cancerand womb cancer gastro-oesophageal reflux disease (GORD) where stomach acid leaks out of the stomach and into the oesophagus (gullet) gallstones small stones, usually made of cholesterol, that form in the gallbladder reduced fertility osteoarthritis a condition involving pain and stiffness in your joints sleep apnoea a condition that causes interrupted breathing during sleep, which can lead to daytime sleepiness with an increased risk of road traffic accidents, as well as a greater risk of diabetes, high blood pressure and heart disease liver disease and kidney disease pregnancy complications,such as gestational diabetes orpre-eclampsia (when a woman experiences a potentially dangerous rise in blood pressure during pregnancy) Obesity reduces life expectancy by an average of3 to10 years, depending on how severe it is. Its estimated that obesity and being overweight contribute to at least1 in every 13 deaths in Europe. Outlook Theres no quick fix for obesity. Weight loss programmes take time and commitment, and work best when fully completed. The healthcare professionals involved with your care should provide encouragement and advice about how to maintain the weight loss achieved. Regularly monitoring your weight, setting realistic goals and involving your friends and family with your attempts to lose weightcan also help. Remember that even losing what seems like a small amount of weight, such as 3% or more of your original body weight, and maintaining this for life, can significantly reduce your risk of developing obesity-related complications like diabetes and heart disease. Causes of obesity Obesity is generally caused by eating too much and moving too little. If you consume high amounts of energy, particularly fat and sugars, but dont burn off the energy through exercise and physical activity, much of the surplus energy will be stored by the body as fat. Calories The energy value of food is measured in units called calories. The average physically active man needs about 2,500 calories a day to maintain a healthy weight, and the average physically active woman needs about 2,000 calories a day. This amount of calories may sound high, but it can be easy to reach if you eat certain types of food. For example, eating a large takeaway hamburger, fries and a milkshake can total 1,500 calories and thats just one meal. Another problem is that many people arent physically active, so lots of the calories they consume end up being stored in their body as fat. Poor diet Obesity doesnt happen overnight. It develops gradually over time, as a result of poor diet and lifestyle choices, such as: eating large amounts of processed or fast food thats high in fat and sugar drinking too much alcohol alcohol contains a lot of calories, and people who drink heavily are often overweight eating out a lot you may be tempted to also have a starter or dessert in a restaurant, and the food can be higher in fat and sugar eating larger portions than you need you may be encouraged to eat too much if your friends or relatives are also eating large portions drinking too many sugary drinks including soft drinks and fruit juice comfort eating if you have low self-esteem or feel depressed, you may eat to make yourself feel better Unhealthy eating habits tend to run in families. You may learn bad eating habits from your parents when youre young and continue them into adulthood. Read more about eating well Lack of physical activity Lack of physical activity is another important factor related to obesity. Many people have jobs that involve sitting at a desk for most of the day. They also rely on their cars, rather than walking or cycling . Forrelaxation, many people tend to watch TV, browse the internet or play computer games, and rarely take regular exercise . If youre not active enough, you dont use the energy provided by the food you eat, and the extra energy you consume is stored by the body as fat. The Department of Health recommends that adults do at least 150 minutes (two-and-a-half hours) of moderate-intensity aerobic activity, such as cycling or fast walking, every week. This doesnt need to be done allin one go, but can be broken down into smaller periods. For example, you could exercise for 30 minutes a day for five days a week. If youre obese and trying to lose weight , you may need to do more exercise than this. It may help to start off slowly and gradually increase the amount of exercise you do each week. Read more about the physical activity guidelines for adults Genetics Some people claimtheres no point trying to lose weight because it runs in my family or its in my genes. While there are some rare genetic conditions that can cause obesity, such asPrader-Willi syndrome, theres no reason why most people cant lose weight. It may be true that certain genetic traits inherited from your parentssuch as having a large appetitemay make losing weight more difficult, but it certainly doesnt make it impossible. In many cases, obesity is more to do with environmental factors, such as poor eating habits learned during childhood. Medical reasons In some cases, underlying medical conditions may contribute to weight gain. These include: an underactive thyroid gland (hypothyroidism) where your thyroid gland doesnt produce enough hormones Cushings syndromea rare disorder that causes the over-production of steroid hormones However, if conditions such as these are properly diagnosed and treated, they should pose less of a barrier to weight loss. Certain medicines, including some corticosteroids , medications for epilepsy and diabetes , and some medications used to treat mental illness including antidepressants and medicines for schizophrenia can contribute to weight gain. Weight gain can sometimes be a side effect of stopping smoking Diagnosing obesity Body mass index (BMI) is widely used as a simple and reliable way of finding out whether a person is a healthy weight for their height. For most adults, having a BMI of 18.5 to 24.9 means youre considered to be a healthy weight. A person with a BMI of 25 to 29.9 is considered to be overweight, and someone with a BMI over 30 is considered to be obese. While BMI is a useful measurement for most people, its not accurate for everyone. For example, the normal BMI scores may not be accurate if youre very muscular because muscle can add extra pounds, resulting ina high BMI when youre not an unhealthy weight. In such cases, your waist circumference may be a better guide (see below). Whats considered a healthy BMI is also influenced by your ethnic background. The scores mentioned above generally apply to people with a white Caucasian background. If you have an ethnic minority background, the threshold for being considered overweight or obese may be lower. BMI shouldnt be used to work out whether a child is a healthy weight, becausetheir bodies are still developing.Speak to your GP if you want to find out whether your child is overweight. Visiting your GP If youre overweight or obese,visit your GP for advice about losing weight safely and to find out whether you have an increased risk of health problems. Your GPmay ask about: your lifestyle particularly your diet and how much physical activity you do; theyll also ask you whether you smoke and how muchalcohol you drink any possible underlying causes for your obesity for example, if youre taking medication or have a medical condition that may contribute toweight gain how you feel about being overweight for example, if it makes you feel depressed how motivated you are to lose weight your family history as obesity and other health conditions, such as diabetes , are often more common in families As well as calculating your BMI, your GP may also carry out tests to determine whether youre at increased risk of developing health complications because of your weight. These could includemeasuring your: blood pressure glucose (sugar) and cholesterol levels in a blood sample waist circumference (the distance around your waist) People with very large waists generally, 94cm (37in) or more in men and 80cm (about 31.5in) or more in women are more likely to develop obesity-related health problems. Your GP may also take your ethnicity into account because it can affect your risk of developing certain conditions. For example, some people of Asian, African or Afro-Caribbean ethnicity may be at increased risk of high blood pressure (hypertension) . Healthy waist measurements can also be different for people from different ethnic backgrounds. After your assessment, youll be offered an appointment to discuss the results in more detail, ask any questions that you have, and fully explore the treatment options available to you. Treating obesity If youre obese, speak to your GP for advice about losing weight safely. Your GP can advise you about losing weight safely by eating a healthy, balanced diet and regular physical activity . They can also let you know aboutother useful services, such as: local weight loss groups these could be provided by your local authority, the NHS, or commercial services you may have to pay for exercise on prescription where youre referred to a local active health team for a number of sessions under the supervision of a qualified trainer If you have underlying problems associated with obesity, such as polycystic ovary syndrome (PCOS), high blood pressure , diabetes or obstructive sleep apnoea , your GP may recommend further tests or specific treatment. In some cases, they may refer you to a specialist. Read more about how your GP can help you lose weight Diet Theres no single rule that applies to everyone, but to lose weight at a safe and sustainable rate of 0.5 to 1kg (1lb to 2lbs) a week, most people are advised to reduce their energy intake by 600 calories a day. For most men, this will mean consuming no more than 1,900 calories a day, and for most women, no more than 1,400 calories a day. The best way to achieve thisis to swap unhealthy and high-energy food choices such as fast food, processed food and sugary drinks (including alcohol) for healthier choices. A healthy diet should consist of: plenty of fruit and vegetables plenty of potatoes, bread, rice, pasta and other starchy foods (ideally you should choose wholegrain varieties) somemilk and dairy foods some meat, fish, aggs,beansand other non-dairy sources of protein just small amounts of food and drinks that are high infatandsuagr Try to avoidfoods containing high levels of salt because they can raise your blood pressure, which can be dangerousfor people who are already obese. Youll also need to checkcalorie information for each type of food and drink you consume to make sure you dont go over your daily limit. Some restaurants,cafs and fast food outlets provide calorie information per portion, although providing this information isnt compulsory. Be carefulwhen eating out because some foods can quickly take you over the limit, such as burgers, fried chicken, and some curries or Chinese dishes. Diet programmes andfad diets Avoidfad diets that recommend unsafe practices, such as fasting (going without food for long periods of time) or cutting out entire food groups. These types of dietsdont work, can make you feel ill, and arent sustainable because they dont teach you long-term healthy eating habits. This isnt to say that all commercial diet programmes are unsafe. Many are based on sound medical and scientific principles and can work well for some people. A responsible diet programme should: educate you about issues such as portion size, making behavioural changesand healthy eating not be overly restrictive in terms of the type of foods you can eat be based on achieving gradual, sustainable weight loss rather than short-term rapid weight loss, which is unlikely to last Very low calorie diets Avery low calorie diet (VLCD) is where you consume less than 800 calories a day. These diets can lead to rapid weight loss, butthey arent a suitable or safe method for everyone, and they arent routinely recommended for managing obesity. VLCDs are usually only recommended if you have an obesity-related complication that would benefit from rapid weight loss. VLCDsshouldnt usually be followed for longer than 12 weeks at a time, and they should only be used under the supervision of a suitably qualified healthcare professional. Speak to your GP first ifyoure considering this type of diet. Exercise Reducing the amount of calories in your diet will help you lose weight, but maintaining a healthy weight requires physical activity to burn energy. As well as helping you maintain a healthy weight, physical activity also has wider health benefits. For example, it can help prevent and manage more than20 conditions, such as reducing the risk oftype 2 diabetes by 40%. The Chief Medical Officers recommend that adults should do at least 150 minutes (two-and-a-half hours) of at least moderate-intensity activity a week for example, five 30-minute bouts a week. Something is better than nothing, and doing just 10 minutes of exercise at a time is beneficial. Moderate-intensity activity is any activity that increases your heart and breathing rate, such as: brisk walking cycling recreational swimming dancing Alternatively, you could do 75 minutes (one hour, fifteen minutes) of vigorous-intensity activitya week, or a combination of moderate and vigorous activity. During vigorous activity, breathing is very hard, your heart beats rapidly and you may be unable to hold a conversation. Examples include: running most competitive sports circuit training You should also do strength and balance training two days a week. This could be in the form of agym workout, carrying shopping bags, or doing an activity such as tai chi .Its also critical that you break up sitting (sedentary) time by getting up and moving around. Read more about strengthandbalance exercises . Your GP, weight loss adviser or staff atyour local sports centre can help you create a plan suited to your own personal needs and circumstances, with achievable and motivating goals. Start small and build up gradually. Its alsoimportant to find activities you enjoy and want to keep doing. Activities with a social element or exercising with friends or family can help keep you motivated. Make a start today its never too late. Read more about the physical activity guidelines for adults and the physical activity guidelines for older adults . Other useful strategies Evidence has shown that weight loss can be more successful if it involves other strategies, alongside diet and lifestyle changes. This could include things like: setting realistic weight loss goals if youre obese, losing just 3% of your original body weight can significantly reduce your risk of developing obesity-related complications eating more slowly and being mindful of what and when youre eating for example, not being distracted by watching TV avoiding situations where you know you may be tempted to overeat involving your family and friends with your weight loss efforts they can help to motivate you monitoring your progress for example, weigh yourself regularly and make a note of your weight in a diary Getting psychological support from a trained healthcare professional may alsohelp you change the way you think about food and eating. Techniques such as cognitive behavioural therapy (CBT)can be useful. Avoiding weight regain Its important to remember that as you lose weight your body needs less food (calories), so after a few months, weight loss slows and levels off, even if you continue to follow a diet. If you go back to your previous calorie intake once youve lost weight, its very likely youll put the weight back on. Increasing physical activity to up to 60 minutes a day and continuing to watch what you eat may help you keep the weight off. Medication Manydifferent types of anti-obesity medicines have been tested in clinical trials, but only one has proved to be safe and effective: orlistat. You can only use orlistat if a doctor or pharmacist thinks its the right medicine for you. In most cases, orlistat is only available on prescription. Only one product (Alli) is available over the counter directly from pharmacies, under the supervision of a pharmacist. Orlistat works by preventingaround a third of the fat from the food you eat being absorbed. The undigested fat isnt absorbed into your body and is passed out with your faeces (stools). This will help you avoid gaining weight, but wont necessarily cause you to lose weight. A balanced diet and exercise programme should be started before beginning treatment with orlistat, and you should continue this programme during treatment and after you stoptaking orlistat. When orlistat should be used Orlistat will usually only be recommended if youve made a significant effort to lose weight through diet, exercise or changing your lifestyle. Even then, orlistat is only prescribed if you have a: body mass index (BMI) of 28 or more, and other weight-related conditions,such as high blood pressure or type 2 diabetes BMI of 30 or more Before prescribing orlistat, your doctor will discuss the benefits and potential limitations with you, including any potential side effects (see below). Treatment with orlistat must be combined with a balanced low-fat diet and other weight loss strategies, such as doing more exercise.Its important that the diet is nutritionally balanced over three main meals. If youre prescribed orlistat, youll also be offered advice and support about diet, exercise and making lifestyle changes. Orlistat isnt usually recommended for pregnant or breastfeeding women. Dosage and duration of treatment One orlistat capsule is taken with water immediately before, during or up to one hour after, each main meal (up to a maximum of three capsules a day). If you miss a meal, or the meal doesnt contain any fat, you shouldnt need to take the orlistat capsule. Your doctor should explain this to you, or you can check the patient information leaflet that comes with your medicine. Treatment with orlistat should only continue beyond three months if youve lost 5% of your body weight. It usually starts to affect how you digest fat withinone to twodays. If you havent lost weight after taking orlistat forthree months, its unlikely to be an effective treatment for you. Consult your doctor or pharmacist, as it may be necessary to stop your treatment. Taking orlistat with other health conditions See your GP before starting treatment with orlistat if you have another serious health condition, such as type 2 diabetes, high blood pressure, or kidney disease, which youre taking medication for. It may be necessary to change the dose of your medicine. If you havetype 2 diabetes, it may take you longer to lose weight using orlistat, so your target weight loss after three months may therefore be slightly lower. If orlistat has helped you lose weight after three months, your prescription may be continued for up to a year. After that, your GP will carry out a review and decide whether you should continue taking it. Side effects Common side effects of orlistat include: fatty or oily stools needing the toilet urgently passing stools more frequently an oily discharge from your rectum (you may have oily spots on your underwear) flatulence (wind) stomach pain headaches upper respiratory tract infections, such as a cold These side effects are much less likely to occur if you stick to a low-fat diet. Women takingthe oral contraceptive pill should use an additional method of contraception , such as a condom , if they experience severe diarrhoea while taking orlistat. This is because the contraceptive pill may not be absorbed by your body if you have diarrhoea, so it may not be effective. Surgery Weight loss surgery, also called bariatric surgery, is sometimes used to treat people who are severely obese. Bariatric surgery is usually only available on the NHS to treat people with severe obesity who fulfil all of the following criteria: they have a BMI of 40 or more, or between 35 and 40 and another serious health condition that could be improved with weight loss, such as type 2 diabetesorhigh blood pressure all appropriate non-surgical measures have been tried, but the person hasnt achieved or maintained adequate, clinically beneficial weight loss the person is fit enough to have anaesthesia and surgery the person has been receiving, or will receive, intensive management as part of their treatment the person commits to the need for long-term follow-up Bariatric surgery may also be considered as a possible treatment option for people with a BMI of 30 to 35 who have recently (in the last 10 years) been diagnosed with type 2 diabetes. In rare cases, surgery may be recommended as the first treatment (instead of lifestyle treatments and medication) if a persons BMI is 50 or above. Treating obesity in children Treating obesity in children usually involves improvements to diet and increasing physical activity using behaviour change strategies. The amount of calories your child should eat each day will depend on their age and height. Your GP should be able to advise you about a recommended daily limit, and they may also be able to refer you to your local family healthy lifestyle programme. Children over the age of five should ideally get at least one hour (60 minutes) of vigorous-intensity exercise a day, such as running or playing football or netball. Sedentary activities, such as watching television and playing computer games, should be restricted. Read more about the physical activity guidelines for children and young people Referral to a specialist in treating childhood obesity may be recommended if your child develops an obesity-related complication, or theres thought to be an underlying medical condition causing obesity. The use of orlistat in children is only recommended in exceptional circumstances, such as if a child is severely obese and has an obesity-related complication. Bariatric surgery isnt generally recommended for children, but may be considered for young people in exceptional circumstances, and if theyve achieved, or nearly achieved, physiological maturity. Source: NHS 24 - Opens in new browser window Last updated: 21 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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Obsessive compulsive disorder (OCD) | Obsessive compulsive disorder (OCD) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mental health Obsessive compulsive disorder (OCD) Obsessive compulsive disorder (OCD) Obsessive compulsive disorder (OCD) is a mental health condition. It causes a person to have obsessive thoughts and carry out compulsive activity. This can be distressing and can have a big impact on your life. Treatment can help you keep it under control. Symptoms of OCD OCD affects people differently. It usually causes a particular pattern of thought and behaviour. This pattern has 4 main steps: Obsession where an intrusive, distressing thought, image or urge repeatedly enters your mind. Anxiety the obsession provokes a feeling of intense anxiety or distress. Compulsion repetitive behaviours or mental acts that you feel you have to do as a result of the anxiety and distress caused by the obsession. Temporary relief the compulsive behaviour brings temporary relief, but the obsession and anxiety return, causing the cycle to begin again. Obsessive thoughts Almost everyone has unpleasant or unwanted thoughts at some point in their life. This might be a concern that youve forgotten to lock the door of the house or that you might get a disease from touching other people. It could be sudden unwelcome violent or offensive mental images. Most people are able to put these types of thoughts and concerns into context. They can then carry on with their day-to-day life. They do not repeatedly think about worries they know have little substance. If you have persistent and unwanted thoughts that dominates your thinking, you may have developed an obsession. Some common obsessions that affect people with OCD include: fear of deliberately harming yourself or others for example, fear you may attack someone else, even though this type of behaviour disgusts you fear of harming yourself or others by mistake or accident for example, fear you may set the house on fire by accidentally leaving the cooker on fear of contamination by disease, infection or an unpleasant substance a need for symmetry or orderliness for example, you may feel the need to ensure all the tins in your cupboard face the same way Compulsive behaviour Compulsions happen as a way of trying to reduce or prevent the harm of the obsessive thought. However, this behaviour is either excessive or not connected at all. For example, a person who fears becoming contaminated with dirt and germs may wash their hands repeatedly. Or someone with a fear of causing harm to their family may have the urge to repeat an action multiple times to try to neutralise the thought of harm. This type of compulsive behaviour is particularly common in children with OCD. Most people with OCD realise that such compulsive behaviour is irrational. They might know it makes no logical sense, but they cannot stop acting on their compulsion. Not all compulsive behaviours will be obvious to other people. Related problems Some people with OCD may also have or develop other mental health problems, including: depression eating disorders generalised anxiety disorder a hoarding disorder People with OCD and severe depression might also have suicidal feelings. Causes of OCD The exact cause of OCD is not known. There are some factors that could make a person more likely to have OCD. These factors might include: genetics life events personality traits chemical differences in the brain Diagnosing OCD Diagnosis and treatment can help to reduce the impact of OCD on your day-to-day life. Speak to your GP if: you think you might have OCD Many people do not tell their GP about their symptoms because they feel ashamed or embarrassed. They may also try to disguise their symptoms from family and friends. If you have OCD, you should not feel ashamed or embarrassed. Like diabetes or asthma , its a long-term health condition, and its not your fault you have it. Your GP will probably ask you a series of questions to see if its likely you have OCD. If the results of the initial screening questions suggest you have OCD, the severity of your symptoms will be assessed. Either your GP or a mental health professional will carry out the assessment. Its important youre open and honest. Accurate and truthful responses will ensure you receive the most appropriate treatment. If you think someone you know may have OCD, its a good idea to: talk to them carefully about your concerns suggest they speak to their GP Treating OCD Treatment for obsessive compulsive disorder (OCD) depends on the how much the condition is affecting your daily life. The 2 main treatments are: cognitive behavioural therapy (CBT) medication If your OCD has a severe impact on your daily life, youll usually be referred to a specialist mental health service. Here youll likely receive a combination of intensive CBT and a course of antidepressants called selective serotonin reuptake inhibitors (SSRIs) . Children with OCD are usually referred to a healthcare professional with experience of treating OCD in children. It can take several months before a treatment has a noticeable effect. Further treatment You might be offered specialist treatment if youve tried other treatments and your OCD is still not under control. Most people improve after receiving treatment. OCD Action have online support groups where you can connect with other people with similar experiences. Source: NHS 24 - Opens in new browser window Last updated: 04 April 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Obsessive compulsive disorder (OCD) self-help guide Selective serotonin reuptake inhibitors (SSRIs) Depression Anxiety disorders in children Other health sites OCD-UK Choice and Medication: Obsessive compulsive disorder (OCD) OCD Action NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Obstructive sleep apnoea | Obstructive sleep apnoea (OSA) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Lungs and airways Obstructive sleep apnoea Obstructive sleep apnoea About obstructive sleep apnoea Diagnosing obstructive sleep apnoea Treating obstructive sleep apnoea About obstructive sleep apnoea Obstructive sleep apnoea (OSA) is a relatively common condition where the walls of the throat relax and narrow during sleep, interrupting normal breathing. Thismay lead to regularlyinterrupted sleep, which can have a big impact on quality of life and increases the risk of developing certain conditions. Apnoea and hypopnoea There are two types of breathing interruption characteristic of OSA: apnoea where the muscles and soft tissues in the throat relax and collapse sufficiently to cause a total blockage of the airway; its called an apnoea when the airflow is blocked for 10 seconds or more hypopnoea a partial blockage of the airway that results in an airflow reduction of greater than 50% for 10 seconds or more People with OSA may experience repeated episodes of apnoea and hypopnoea throughout the night.These events may occur around once every one or twominutes in severe cases. Asmany people with OSA experience episodes of both apnoea and hypopnoea, doctors sometimes refer to the condition as obstructive sleep apnoea-hypopnoea syndrome, or OSAHS. The term obstructive distinguishes OSA from rarer forms of sleep apnoea, such as central sleep apnoea, which is caused by the brain not sendingsignals to the breathing muscles during sleep. Symptoms of OSA The symptoms of OSA are often first spotted by a partner, friend or family member who notices problems while you sleep. Signs of OSA in someone sleeping can include: loudsnoring noisy and laboured breathing repeated short periodswhere breathing is interrupted by gasping or snorting Some people with OSA may also experiencenight sweats and may wake up frequently during the night to urinate. During an episode, the lack of oxygentriggers your brain to pull you out of deep sleep either to a lighter sleep or to wakefulnessso your airway reopens and you can breathe normally. These repeated sleep interruptions can make youfeel very tired during the day. Youll usually have no memory of your interrupted breathing, so youmay be unaware you have a problem. When to seek medical advice See your GP if you think you might have OSA. Theycan check for other possible reasons for your symptoms and can arrange for an assessment of your sleep to be carried out through a local sleep centre. As someone with OSA may not notice they have the condition, it often goes undiagnosed. Read more about diagnosing OSA . Causes of OSA Its normal for the muscles and soft tissues in the throat to relax and collapse to some degree while sleeping. For most people this doesnt cause breathing problems. In people with OSA the airway has narrowed as the result of a number of factors, including: being overweight excessive body fat increases the bulk of soft tissue in the neck, which can place a strain on the throat muscles; excess stomach fat can also lead to breathing difficulties, which can make OSA worse being male its not known why OSA is more common in men than in women, but it may be related to different patterns of body fat distribution being 40 years of age or more although OSA can occur at any age, its more common in people who are over 40 having a large neck men with a collar size greater than around 43cm (17 inches) have an increased risk of developing OSA taking medicineswith a sedative effect such as sleeping tablets or tranquillisers having an unusual inner neck structure such as a narrow airway, large tonsils, adenoidsor tongue, or a small lower jaw alcohol drinking alcohol, particularly before goingto sleep,can make snoring and sleep apnoea worse smoking youre more likely to develop sleep apnoea if you smoke the menopause (in women) the changes in hormone levels during the menopause may cause the throat muscles to relax more than usual having a family history of OSA there may be genes inherited from your parents that can make you more susceptible to OSA nasal congestion OSA occurs more often in people with nasal congestion, such as a deviated septum, where the tissue in the nose that divides the two nostrils is bent to one side, or nasal polyps, which may bea result of the airways being narrowed Treating OSA OSA is a treatable condition, and thereare a variety of treatment options that canreduce the symptoms. Treatment optionsfor OSA include: lifestyle changes such aslosing excess weight, cutting down on alcohol and sleeping on your side usingacontinuouspositive airway pressure (CPAP) device these devicesprevent your airway closing while you sleep by delivering a continuous supply of compressed air through a mask wearing amandibular advancement device (MAD) this gum shield-like device fits around your teeth, holdingyour jaw and tongue forward to increase the space at the back of your throat while you sleep Surgery may also be an option if OSA is thought to be the result of a physical problem that can be corrected surgically, such as an unusual inner neck structure. However, for most people surgery isnt appropriate and may only be considered as a last resort if other treatments havent helped. Read more about treating OSA . Complications of OSA The treatments mentioned above can often help control the symptoms of OSA, although treatment will need to be lifelong in most cases. If OSA is left untreated, it can have a significant impact on your quality of life, causing problems such aspoor performance at work and school, and placing a strain on your relationships with others. Poorly controlled OSAmay alsoincrease your risk of: developing high blood pressure (hypertension) having a stroke or heart attack developing an irregular heartbeat such as atrial fibrillation developing type 2 diabetes although its unclear if this is the result of an underlying cause, such as obesity Research hasshown someone who has been deprived of sleep because of OSA may be up to 12 times more likely to be involved in a car accident. If youre diagnosed with OSA, itmay mean your ability to drive is affected. Its your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA) about a medical condition that could have an impact on your driving ability. Once a diagnosis of OSA has been made, you shouldnt drive untilyour symptoms are well controlled. The GOV.UK website has advice about how to tell the DVLA about a medical condition . Preventing OSA Its not always possible to prevent OSA, but making certain lifestyle changesmay reduce your risk of developing the condition. These include: losing weight if youre overweight or obese limitinghow much alcohol you drink and avoiding alcoholin the evening stopping smoking if you smoke avoiding the use of sleeping tablets and tranquillisers Diagnosing obstructive sleep apnoea Obstructive sleep apnoea (OSA) can usually be diagnosed after youve been observed sleeping at a sleep clinic, or by using a testing device worn overnight at home. If you think you have OSA, its important to visit your GP in case you need to be referred to a sleep specialist for further tests and treatment. Before seeing your GP it may be helpful toask a partner, friend or relative to observe you while youre asleep, if possible. If you have OSA, they may be able to spot episodes of breathlessness. It may also help to fill out an Epworth Sleepiness Scale questionnaire. Thisaskshow likely youll be todoze off in a number of different situations, such as watching TV orsitting in a meeting. The final score will help your doctordetermine whether you may have a sleep disorder. For example,a score of 16-24 means youre excessively sleepy and should consider seeking medical attention. A score of eight to nine is considered average during the daytime. An online version of the Epworth Sleepiness Scale can be found on the British Lung Foundation website. Seeing your GP When you see your GP, theyll usuallyask a number of questions about your symptoms, such as whether you regularly fall asleep during the day against your will. Your blood pressure will be measured and a blood sample probably sent off to help rule out other conditions that could explain your tiredness, such asan underactive thyroid gland ( hypothyroidism ). The next step is to observe you while youre asleep at a local sleep centre. Your GP can refer you to specialist clinics or hospital departments that help treat people with sleep disorders. The Sleep Apnoea Trust Association has a list of NHS sleep clinics in Scotland . Observing your sleep The sleep specialists at the sleep centre may ask you about your symptoms and medical history, and carry out a physical examination. This may include measuring your height and weight to work out your body mass index (BMI) , as well as measuringyour neck circumference. This is because being overweight and having a large neck can increase your risk of OSA. The sleep specialists will then arrange foryour sleep tobe assessed overnight, either by spending the night at the clinic or taking some monitoring equipment home with you and bringing it back the next day for them to analyse. Testing at home In many cases the sleep centre will teach you how to use portable recording equipment while you sleep at home. The equipment you are given may include: a breathing sensor sensors to monitor your heart rate bands that are placed around your chest oxygen sensors that are puton your finger The equipment records oxygenlevels, breathing movements, heart rate and snoring through the night. If more information about sleep quality is required, a more detailed investigation calledpolysomnographywill be required, which will be carried out at the sleep centre. Testing at a sleep centre The main test carried out to analyse your sleep at a sleep centre is known aspolysomnography. During the night, several different parts of your body will be carefully monitored while you sleep. Bands and small metallic discs called electrodesare placed on the surface of your skin anddifferent parts of your body. Sensors are also placed on your legs and an oxygen sensor will be attached to your finger. A number of different tests will be carried out during polysomnography, including: electroencephalography (EEG) this monitors brain waves electromyography (EMG) this monitors muscle tone recordings of movements in your chest and abdomen recordings of airflow through your mouth and nose pulse oximetry this measures your heart rate and blood oxygen levels electrocardiography (ECG) this monitors your heart Sound recording and video equipment may also be used. If OSA is diagnosed during the early part of the night, you may be given continuous positive airway pressure (CPAP) treatment. CPAP involves using a mask that delivers constant compressed air to the airway and stops it closing, which prevents OSA. Read about treating OSA for more information about CPAP. Once the tests have been completed, staff at the sleep centre should have a good idea about whether or not you have OSA. If you do, they can determine how much it is interrupting your sleep and recommend appropriate treatment. Determining the severity of OSA The severity of OSA is determined by howoften your breathing is affected over the course of an hour. These episodes are measured using the apnoea-hypopnoea index (AHI). Severity is measured using the following criteria: mild an AHI reading of 5 to 14 episodes an hour moderate an AHI reading of 15 to 30 episodes an hour severe an AHI reading of more than 30 episodes an hour Current evidence suggests treatment is most likely to be beneficial in people with moderate or severe OSA. However, some research has suggested treatment may also help some people with mild OSA. Treating obstructive sleep apnoea Treatment for obstructive sleep apnoea (OSA) may include making lifestyle changes and using breathing apparatus while you sleep. OSA is a long-term condition and many cases require lifelong treatment. Lifestyle changes Inmost cases ofOSA youll be advised to make healthy lifestyle changes,suchas: losing weight if youre overweight or obese stopping smoking if you smoke limiting your alcohol consumption, particularly before going to bed the NHS recommends not regularly drinking more than 14 units of alcohol a week; if you drink as much as 14 units a week, its best to spread this evenly over three or more days avoidingsedative medications and sleeping tablets Losing weight, reducing the amount of alcohol you drink and avoiding sedativeshave allbeen shown tohelp improve the symptoms of OSA. Although itsless clear whether stopping smoking can improve the condition,youll probablybe advised to stop for general health reasons. Sleeping on your side, rather than on your back, may also help relieve the symptoms of OSA. Continuous positive airway pressure (CPAP) As well asthe lifestyle changes mentioned above, people with moderate to severe OSAusuallyneed touse a continuous positive airway pressure (CPAP) device. This is a small pumpthatdelivers a continuous supply of compressed air through a mask thateither covers your nose or your nose and mouth. The compressed air prevents your throat closing. CPAP can feel peculiar to start with andyou may be tempted to stop using it.But people who persevereusually soonget used toit and their symptoms improve significantly. CPAP is available on the NHS and is the most effective therapy for treating severe cases of OSA. As well as reducing symptoms such as snoring and tiredness, it can also reduce the risk ofcomplications of OSA, such as high blood pressure . Possible side effects of using a CPAP device can include: mask discomfort nasal congestion, runny nose or irritation difficulty breathing through your nose headaches and ear pain stomach pain and flatulence (wind) Earlier versions of CPAP also often caused problems such as nasal dryness and a sore throat. However, modern versions tend to include humidifiers, a device that increases moisture, which helps reduce these side effects. If CPAP causes you discomfort, inform your treatment staffas the device can be modified to make it more comfortable. For example, you can try using a CPAP machine that starts with a low air pressure and gradually builds up to a higher air pressure as you fall asleep. Mandibular advancement device (MAD) A mandibular advancement device (MAD) is a dental appliance, similar to a gum shield, sometimes used to treat mild OSA. Theyre not generally recommended for more severe OSA, although they may be an option if youre unable to tolerate using a CPAP device. An MAD is worn over your teeth when youre asleep. Its designed to hold your jaw and tongue forward to increase the space at the back of your throat and reduce the narrowing of your airway that causes snoring. Off-the-shelf MADs are available from specialist websites, but most experts dont recommend them, as poor-fitting MADs can make symptoms worse. Its recommended you have an MAD made for you by a dentist with training and experience in treating sleep apnoea. MADs arent always available on the NHS, so you may need to pay for the device privately through a dentist or orthodontist. An MAD may not be suitable treatment for you if you dont have many or anyteeth. If you have dental caps, crowns or bridgework, consult your dentist to ensure they wont be stressed or damaged by an MAD. Surgery for OSA Surgery to treat OSA isnt routinely recommended because evidence shows its not as effective as CPAP at controlling the symptoms of the condition. It also carriesthe risk of more serious complications. Surgery is usually only considered as a last resort when all other treatment options have failed, and also if the conditionis severely affecting your quality of life. Arange of surgical treatmentshave been used to treat OSA. These include: tonsillectomy where the tonsils are removed if theyre enlarged and blocking your airway when you sleep adenoidectomy where the adenoids, small lumps of tissueat the back of the throat above the tonsils, are removed if theyre enlarged and are blocking the airway during sleep tracheostomy where a tube is inserted directly into your neck to allow you to breathe freely, even if the airways in your upper throat are blocked weight loss (bariatric) surgery where the size of the stomach is reduced if youre severely obese andthis is making your sleep apnoeaworse Surgery toremove excess tissue in the throat to widen your airway (uvulopalatopharyngoplasty) used to be a common surgical treatment for OSA, but its performed less often nowadays. This isbecause more effective treatments are available, such as CPAP. This type of surgery can mean youre unable to use a CPAP device properly in the future if you need to. Soft palate implants Soft palate implants make the soft palate, part of the roof of the mouth, stiffer and less likely to vibrate and cause an obstruction. The implants are inserted into the soft palate under local anaesthetic . The National Institutefor Health and Care Excellence (NICE) has said soft palate implants are safe, but theyre not currently recommended for treating OSAas theres a lack of evidence about their effectiveness. However, this form of treatment is recommended for treating snoring associated with OSA in exceptional cases. Support groups OSA can have a significant impact on the quality of life for someone with the condition, as well as their friends and families. As well as causing physical problems such as tiredness and headaches, the condition can have a significant emotional impact and affect your relationships with others. For support and advice about living with OSA, you may find it helpful to contact a support group, such as: British Lung Foundation Sleep Apnoea Trust Source: NHS 24 - Opens in new browser window Last updated: 17 January 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Other health sites British Lung Foundation: Obstructive sleep apnoea NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Oesophageal cancer | Oesophageal cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Oesophageal cancer Oesophageal cancer About oesophageal cancer Symptoms of oesophageal cancer Causes of oesophageal cancer Diagnosing oesophageal cancer Treating oesophageal cancer Living with oesophageal cancer About oesophageal cancer Oesophageal cancer is a type of cancer affecting the oesophagus (gullet) the long tube that carries food from the throat to the stomach. It mainly affects people in their 60s and 70s and is more common in men than women. Symptoms of oesophageal cancer Oesophageal cancer doesnt usually cause any symptoms in the early stages when the tumour is small. Its only when it gets bigger that symptoms tend to develop. Symptoms of oesophageal cancer can include: difficulty swallowing persistent indigestion orheartburn bringing up food soon after eating loss of appetite andweight loss pain or discomfort inyour upper tummy, chest or back Read more about the symptoms of oesophageal cancer When to get medical advice Speak to your GP if you experience: swallowing difficulties heartburn on most days for three weeks or more any other unusual or persistent symptoms The symptoms can be caused byseveral conditions and in many cases wont be caused by cancer but its a good idea to get them checked out. If your GP thinks you need to have some tests, they can refer you to a hospital specialist. Read about how oesophageal cancer is diagnosed Causes of oesophageal cancer The exact cause of oesophageal cancer is unknown, but the following things can increase your risk: persistent gastro-oesophageal reflux disease (GORD) smoking drinking too much alcohol over a long period of time being overweight or obese having an unhealthy diet thats low in fruit and vegetables Stopping smoking, cutting down on alcohol, losing weight and having a healthy diet may help reduce your risk of developing oesophageal cancer. Read more about the causes of oesophageal cancer Treatments for oesophageal cancer If oesophageal cancer is diagnosed at an early stage, it may be possible to cure it with: surgery to remove the affected section of oesophagus chemotherapy , with or without radiotherapy (chemoradiation), to kill the cancerous cells and shrink the tumour If oesophageal cancer is diagnosed at a later stage, acure may not be achievable. But in these cases, surgery, chemotherapy and radiotherapy can be used to help keep the cancer under control and relieve any symptoms you have. Read more about how oesophageal cancer is treated and living with oesophageal cancer Symptoms of oesophageal cancer Oesophageal cancer doesnt usually have any symptoms at first. But as the cancer grows, it can cause swallowing problems and other symptoms. Difficulty swallowing Difficulty swallowing is the most common symptom of oesophageal cancer. The cancer can narrow the oesophagus, making it difficult for food to pass down. It may feel as though food is getting stuck and sometimes swallowing may be uncomfortable or painful. You may have to chew your food more thoroughly, or you can only eat soft foods. If the tumour continues to grow, even liquids may become difficult to swallow. Other symptoms Other symptoms of oesophageal cancer can include: persistent indigestion or heartburn bringing up food soon after eating loss of appetite and weight loss persistentvomiting pain or discomfort inyour upper tummy, chest or back a persistent cough hoarseness tiredness, shortness of breath and pale skin vomiting bloodorcoughing up blood although this is uncommon When to get medical advice Speak to your GP if you experience: swallowing difficulties heartburn on most days for three weeks or more any other unusual or persistent symptoms The symptoms can be caused byseveral conditions and in many cases wont be caused by cancer but its a good idea to get them checked out. Read about how oesophageal cancer is diagnosed Causes of oesophageal cancer The exact cause of oesophageal cancer is unknown, but certain things can increase the risk of it developing. GORD and Barretts oesophagus Gastro-oesophageal reflux disease (GORD) is a condition in which a weakness in the muscles above the stomach means stomach acid can travel up into the oesophagus. In around 1 in 10 people with GORD,repeated damage from stomach acid over many years can eventually cause changes in the cells lining the oesophagus. This is called Barretts oesophagus. These abnormal cells are at an increased risk of becoming cancerous in the future, although the risk is still small.Its estimated that 1 in every 10to 20 people with Barretts oesophagus will develop cancer within 10 to 20 years. Alcohol Drinking too much alcoholcauses irritation and inflammation in the lining of the oesophagus. If the cells in the lining of your gullet become inflamed,theyre more likely to become cancerous. Read more about alcohol and drinking , including tips on cutting down Smoking Tobacco smoke contains many harmful toxins and chemicals. These substances irritate the cells that make up the lining of the oesophagus, which increases the likelihood that they will become cancerous. The longer you smoke, the greater your risk of developing oesophageal cancer. Read more about getting help to stop smoking Obesity If youre overweight or obese , your risk of developing cancer of the oesophagus is higher thanpeopleof a healthy weight.The more overweight you are, the higher the risk. This may be partly because obese people are more at risk of developing GORD and Barretts oesophagus (see above). Read more information and advice about losing weight Diet Not eating enough fruit and vegetables may increase your risk of getting oesophageal cancer. You should aim to eat at least 5 portions of fresh fruit and vegetables every day. Read more about havinga healthy diet Other medical conditions Certain rare medical conditions can also increase your chances of developing cancer of the oesophagus, including: achalasia wheretheoesophagus loses the ability to move food along, causing vomiting and acid reflux Paterson-Brown Kelly syndrome (also called Plummer Vinson syndrome) a condition that can cause iron deficiency anaemia and small growths in the throat tylosis an inherited skin condition Diagnosing oesophageal cancer Speak to your GP if you experience symptoms of oesophageal cancer . They will carry out an initial assessment and decide whether you need to have any further tests. Seeing your GP Your GP may: ask about the symptoms youre experiencing carry out a physical examination take a look at your medical history Ifyour GPthinks you need to have some tests, they can refer you to a hospital specialist. This will usually be a gastroenterologist (specialist in conditions affecting the digestive system). Tests to diagnose oesophageal cancer The 2 main tests used todiagnose oesophageal cancer are: anendoscopy this is the most common test a barium swallow or barium meal Endoscopy An endoscopy is a procedure that allows your doctor to see inside your oesophagus so they can check forcancer. Athin, flexibletube with alight and camera at the end(an endoscope) is passed into your mouth and down towards your stomach. Small samples of tissue are also removed fromyour oesophagus so they can be checked for cancer under a microscope. This is called a biopsy . Youll be awake whilean endoscopy is carried out. It shouldnt be painful, but may be a bit uncomfortable. Youll normally be given local anaesthetic to numb your throatand possibly asedative to help you relax. Barium swallowor barium meal A barium swallow or barium meal involves drinking a harmless white liquid called barium before several X-rays are taken. The barium coats the lining of your oesophagus so it shows up on the X-ray. This can show whether theres anything blockingyour oesophagus, which may be a sign of cancer. This test isnt used to diagnose oesophageal cancer very often nowadays because the best way to confirm a diagnosis is to use tissue samples taken during an endoscopy. Further tests Ifyou have oesophageal cancer, further tests willberecommended to determine how far the cancer has spread known as called the stage. These tests may include: a computerised tomography (CT) scan where a series of X-rays are taken and put together by a computer to create a detailed picture of the inside of your body an endoscopic ultrasound scan where a small probethat produces sound waves is passed down your throat to create an image of your oesophagus and the surrounding area a positron emission tomography (PET) scan a scan that can help show how far the cancer has spread alaparoscopy a type of keyhole surgery performed under general anaesthetic (where youre asleep), in which a thin tube with a camera at the end is inserted through a cut in your skin to examine the area around your oesophagus Stages of oesophageal cancer The most widely used system for staging oesophageal cancer is the TNM system. This involves scoring the cancer in 3 categories: T (tumour) the location and size of the tumour N (node) whether the cancer has spread to the lymph nodes (a network of glands throughout the body) M (metastasis) whether the cancer has spread to other parts of the body, such as the lungs, liver or bones Scores for eachcategory are then often used in a simpler number system, ranging from stage 1 (early cancer) to stage 4 (advanced cancer). Knowing the stage of your cancer will help yourcare teamwork out the best treatment for you. Read more about treatments for oesophageal cancer Read further information: Cancer Research UK: diagnosing oesophageal cancer Cancer Research UK: stages and grades of oesophageal cancer Macmillan: how oesophageal cancer is diagnosed Macmillan: staging oesophageal cancer Treating oesophageal cancer The main treatments for oesophageal cancer are surgery, chemotherapy and radiotherapy. Your treatment plan Youll be cared for by a group of different healthcare professionals and your team will recommend a treatment plan they feel is most suitable for you,although final treatment decisions will be yours. Your plan will largely depend on how far your cancer has spread known as the stage. stage 1 to 3 oesophageal cancer is usually treatedwith surgery to remove the affected section of oesophagus(oesophagectomy) chemotherapy and sometimes radiotherapy may be given before surgery to make it more effective or is sometimes used instead of surgery stage 4 oesophageal cancer has usually spread too far for a cure to be possible, but chemotherapy, radiotherapy and other treatments can slow the spread of the cancer and relieve symptoms Surgery There are 3 main types of surgery for oesophageal cancer. Oesophagectomy An oesophagectomy is themain treatment for early-stage oesophageal cancer. During the procedure, your surgeon will remove the section of your oesophagus that contains the tumour and, if necessary, the nearby lymph nodes.A small portion of your stomach may also need to be removed. The remaining section of your oesophagusis thenreconnected to your stomach. To access your oesophagus, your surgeon will either make incisions (cuts) in yourtummy and chest, or in yourtummy and neck. Endoscopic mucosal resection (EMR) A procedure called endoscopic mucosal resection (EMR)may sometimes be an option instead ofan oesophagectomy if oesophageal cancer is diagnosed very early on. It involvescutting outthe tumour using a loop of wire at the end of a thin flexible tube (endoscope). The endoscope is passed down your throat so no incisions are made in your skin. Sometimes radiowaves may also be used to destroy the cancerous tissue (called radiofrequency ablation or RFA). Stents For more advanced cases of oesophageal cancer that are causing swallowing difficulties,a procedure to insert a hollow tube called a stent into the oesophagus may be recommended. The stent expands once in place and holds the oesophagus open. Chemotherapy Chemotherapy involves taking medicines that kill the cancer cells or stop them multiplying. It may be used: before and sometimes after surgery, eitherwith or without radiotherapy to shrink the cancer and reduce therisk of it coming back instead of surgery incombination with radiotherapy (called chemoradiation) to relieve your symptoms ifcurative treatmentisnt possible The medicines can begiven into a veinor taken as tablets. Youll usually have the treatmentevery 3 weeksover aperiod of6to 18 weeks. Side effects Common side effects of chemotherapy include: feeling sick loss of appetite losing weight diarrhoea feeling very tired increased risk ofinfections bleeding and bruising easily These side effects should improve gradually after treatment stops. Read more about the side effects of chemotherapy Radiotherapy Radiotherapy involves usingradiation to kill cancer cells and shrink tumours. It may be used: in combination with chemotherapy before surgery to shrink the cancer and reduce therisk of it coming back instead of surgery usually in combination with chemotherapy (called chemoradiation) to relieveyour symptoms if curative treatment isnt possible Radiotherapy is most often given using an external machine that directs beams of radiation at your oesophagus, or sometimes by temporarily placing a small piece of radioactive material in your oesophagus (brachytherapy). Side effects Common side effects of radiotherapy include: tiredness temporary soreness when swallowing temporary worsening of swallowing difficulties a dry throat feeling or being sick reddening of the skin and loss of body hair in the treatment area These side effects should improve gradually after treatment stops. Read more about the side effects of radiotherapy Read further information: Cancer Research UK: treatments for oesophageal cancer Macmillan: treatments for oesophageal cancer Living with oesophageal cancer Having oesophageal cancer can have a big impact on your life, but support is available to help you cope. Eating and swallowing You may haveswallowing difficultiesduring and after treatment for oesophageal cancer. There are treatments that can help including surgery to place a hollow tube (stent) in your oesophagus,or a combination of chemotherapy and radiotherapy although they may not work immediately. You might need to have a temporary feeding tube placed or fluids given through a drip inserted in a vein to begin with, before moving onto fluids by mouth and soft foods. You may eventually be able to eat solid food. Aspeech and language therapist can assess yourability to swallow andsuggest ways to overcome any problems.A dietitian can also help with any changes you need to maketo your diet. Read further information: Cancer Research UK: eating and oesophageal cancer Macmillan: swallowing problems Support and advice Coping with a diagnosis of cancer can be very difficult.You may find ithelpful to: talk to your friends and family be open about how you feel and what your family and friends can do to help may put you and them at ease communicate with others in the same situation you may want to contact a local support group or join a forum such as the HealthUnlocked forum for oesophageal patients or Cancer Chat find out more about your condition check websites such as Cancer Research UK or Macmillan , or speak to yourcare team or GP if you have any questions about your condition take time out for yourself dont feel shy about telling friends and family if you want sometime to yourself Read further information: Cancer Research UK: coping with oesophageal cancer Macmillan: coping with oesophageal cancer Work Having oesophageal cancer doesnt necessarily mean youll have to give up work, althoughyou may need quite a lot of time off. During treatment, you may not be able to carry on as you did before. If you have cancer, youre covered by the Disability Discrimination Act . This means that your employer isnt allowed to discriminate against you because of your illness. They have a duty to make reasonable adjustments to help you cope, such as: allowing you time off for treatment and medical appointments allowing flexibility with working hours, the tasks you have to perform, or your working environment You should give your employer as much information as possible about how much time youll need off and when. Speak toa member of your human resources department, if you have one. If youre having difficulties with your employer youmay be able to get help fromyour union,association representative or local Citizens Advice Bureau . Read further information: Macmillan: work and cancer Money and benefits If you have to reduce or stop work because of your cancer, you may find it difficult to cope financially.You may be entitled to financial support: if you have a job but cant work because of your illness, youre entitled to Statutory Sick Pay from your employer if you dont have a job and cant work because of your illness, you may be entitled to Employment and Support Allowance if youre caring for someone with cancer, you may be entitled to Carers Allowance you may be eligible for other benefits if you have children living at home or you have a low household income Its a good idea to find out what help is available as soon as possible. You could ask to speak to the social worker at your hospital, who can give you the information you need. Read further information: GOV.UK: benefits information Macmillan: benefits and financial support Palliative care If youre told there is nothing more that can be done to treat your oesophageal cancer or you decide to decline treatment, your GP or care team will provide you with support and pain relief. This is called palliative care. You can choose to receive palliative care: at home in a care home in hospital in a hospice Your doctor or care teamshould work with you to establish a clear plan based on your wishes. Read further information: End of life care Cancer Research UK: coping with advanced cancer Caring for someone with cancer Being a carer isnt easy. It can beemotionally andphysically draining, and make it easy for you to forget your own health and mental wellbeing. But putting yourself last doesnt work in the long-term. If youre caring for someone else, its important to look after yourself and get as much help as possible. Its in your best interests, as well as those of the person you are caring for. Read more about getting care and support on the Care Information Scotland website. Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Dysphagia (swallowing problems) Other health sites Cancer Research UK: Oesophageal cancer Macmillan Cancer Support: Oesophageal cancer Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Oral thrush in adults | Oral thrush in adults | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Oral thrush in adults Oral thrush in adults Oral thrush is a fungal infection of the mouth. Its not contagious and is usually successfully treated with antifungal medication. Its also called oral candidosis (or candiasis) because its caused by a group of yeasts called Candida. Contact your GP practice if: You develop symptoms of oral thrush, which can include: white patches (plaques) in the mouth that can often be wiped off, leaving behind redareas that may bleed slightly loss of taste or an unpleasant taste in the mouth redness inside the mouth and throat cracks at the corners of the mouth a painful, burning sensation in the mouth In some cases, the symptoms of oral thrush can make eating and drinking difficult. If left untreated, the symptoms will often persist and your mouth will continue to feel uncomfortable. In severe cases that are left untreated, there is also a risk of the infection spreading further into your body, which can be serious. Your GP will usuallybe able to diagnose oral thrush simply by examining your mouth. Sometimes they may also recommend blood tests to look for certain conditions associated with oral thrush, such as diabetes and nutritional deficiencies. What causes oral thrush? Low numbers of the fungus Candida are naturally found in the mouth and digestive system of most people. They dont usually cause any problems, but can lead to oral thrush if they multiply. There are a number of reasons why this may happen, including: taking a course of antibiotics , particularly over a long period or at a high dose taking inhaled corticosteroid medication for asthma wearing dentures (false teeth), particularly if they dont fit properly having poororal hygiene having a dry mouth, either because of a medicalcondition or a medication you are taking smoking having chemotherapy or radiotherapy to treat cancer Babies, young children and elderly people are at a particularly high risk of developing oral thrush, as are people with certain underlying conditions, including diabetes, an iron deficiency or vitamin B12 deficiency , an underactive thyroid (hypothyroidism) and HIV . As most people already have Candida fungi living in their mouth, oral thrush is not contagious. This means it cannot be passed to others. Treating oral thrush Oral thrush can usually be successfully treated with antifungal medicines. These usually come in the form of gels or liquid that you apply directly inside your mouth (topical medication), although tablets or capsules are sometimes used. Topical medication will usually need to be used several times a day for around7 to 14 days. Tablet or capsules are usually taken once daily. These medications dont oftenhave side effects, although some can causenausea (feeling sick), vomiting, bloating, abdominal (tummy) pain and diarrhoea . If antibiotics or corticosteroids are thought to be causing your oral thrush, the medicine or the way it is delivered may need to be changed or the dosage reduced. Preventing oral thrush There are a number of things you can do to reduce your chances of developing oral thrush. Do rinse your mouth after meals brush your teeth twice a day with a toothpaste that contains fluoride floss regularly visit your dentist regularly for check-ups, even if you wear dentures or have no natural teeth remove your dentures every night and clean them with paste or soap and water before soaking them in a solution of water and denture-cleaning tablets brush your gums, tongue and inside your mouth with a soft brush twice a day if you wear dentures or have no or few natural teeth visit your dentist if your dentures do not fit properly stop smoking if you smoke rinse your mouth with water and spit it out after using a corticosteroid inhaler, and use a spacer (a plastic cylinder that attaches to the inhaler) when you take your medicine ensure that any underlying condition you have, such as diabetes, is well controlled If you have a condition or are receiving treatment that could put you at a high risk of developing oral thrush, your doctormay recommend taking a course of antifungal medication to prevent this happening. Read more about taking care of your oral health Source: NHS 24 - Opens in new browser window Last updated: 15 June 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Antibiotics Corticosteroids Taking care of your oral health Other health sites Diabetes UK Oral Health Foundation: Thrush Oral Health Foundation: Dentures NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Osteoporosis | Osteoporosis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Muscle, bone and joints Conditions Osteoporosis Osteoporosis About osteoporosis Causes of osteoporosis Treating osteoporosis Preventing osteoporosis Living with osteoporosis About osteoporosis Osteoporosis is a condition that weakens bones, making them fragile and more likely to break. It develops slowly over several years and is often only diagnosed when a minor fall or sudden impact causes a bone fracture. The most common injuriesin people with osteoporosis are: wrist fractures hip fractures fractures of the spinal bones (vertebrae) However, they can also occur in other bones, such as inthe arm or pelvis.Sometimes a cough or sneeze can cause a rib fracture or the partial collapse of one of the bones of the spine. Osteoporosisisnt usually painful until a fracture occurs,but spinal fracturesare a common cause oflong-term (chronic) pain. Although a fracture is the first sign of osteoporosis,some older people developthe characteristic stooped (bent forward) posture. It happens when the bones in the spinehave fractured, making it difficult to support the weight of the body. Whos affected? Osteoporosis affects over three million people in the UK. More than500,000 people receive hospital treatment for fragility fractures (fractures that occur from standing height or less) every year as a result of osteoporosis. Causes of osteoporosis Losing bone is a normal part of the ageing process, but some people lose bone density much faster than normal. This can lead to osteoporosis and an increased risk of fractures. Women also lose bone rapidly in the first few years after the menopause (whenmonthlyperiodsstop and the ovaries stop producing an egg). Women are more at risk of osteoporosis than men, particularly if the menopause begins early (before the age of 45). Many other factors can also increase the risk of developing osteoporosis, including: long-term use of high-doseoral corticosteroids other medicalconditions such as inflammatory conditions, hormone-related conditions, or malabsorption problems a family history of osteoporosisparticularly history of a hip fracture in a parent long-term use of certain medications which can affect bone strength or hormone levels having a low body mass index (BMI) heavy drinking and smoking Read more about the causes of osteoporosis . Diagnosing osteoporosis Risk assessment tools If your doctor suspects you have osteoporosis, they can make an assessment using anonline programme, such as FRAX or Q-Fracture. These tools help to predicta persons risk of fracture between the ages of40 and 90.The algorithmsused give a 10-year probability of hip fracture and a 10-year probability of amajor fracture in the spine, hip, shoulder or forearm. DEXA scan They may also refer youfor a DEXA (DXA) scanto measure your bone mineral density. Its a short, painless procedure that takesaboutfive minutes, depending on the part of the body being scanned. Your bone mineral densitycan becomparedto the bone mineral density of a healthy young adult and someone whos the same age and sex as you.The difference iscalculated as a standard deviation (SD) and is calleda T score. Standard deviation is a measure of variability based on an average or expected value. A T score of: above -1 SDisnormal between -1 and -2.5 SDis defined as decreased bone mineral density compared withpeak bone mass below -2.5 isdefined as osteoporosis Osteopenia You may be diagnosed with osteopenia if bone density tests show you have decreasedbone density, but not enough to be classed as osteoporosis. Your doctor may still recommend some of the treatments described below,depending on your results and your risk of fracture. Treating osteoporosis Treatment for osteoporosis is based on treating and preventing fractures, and using medication to strengthen bones. The decision about whether you needtreatment depends on your risk of fracture. This will bebased on a number of factorssuch as your age, sexand the results of your DEXA scan. If you need treatment, your doctor can suggest the safest and most effective treatment plan for you. Read moreabout how osteoporosis is treated . Preventing osteoporosis If youre at risk of developing osteoporosis, you shouldtake steps to help keep your bones healthy. This may include: taking regular exercise healthy eating includingfoods rich in calcium and vitaminD making lifestyle changessuch as giving up smoking and reducing your alcohol consumption Read more about preventing osteoporosis . Living with osteoporosis If youre diagnosed with osteoporosis, there are steps you can taketo reduce your chances of a fall, such asremoving hazards from your home and having regular sight tests and hearing tests. To help you recover from a fracture, you can try using: hot and coldtreatmentssuch as warm baths and cold packs transcutaneous electrical nerve stimulation (TENS)where a small battery-operated device is used to stimulate the nerves and reduce pain relaxation techniques Speak to your GP or nurse if youre worried about living with a long-term condition. They may be able to answer any questions you have. You may also find it helpful to talk to a trained counsellor or psychologist, or other peoplewith the condition. The Royal Osteoporosis Society can put you in touch with local support groups . Read more about living with osteoporosis . Causes of osteoporosis Osteoporosis causes bones to become less dense and more fragile. Some people are more at risk than others. Bones are at their thickest and strongest in your early adult life and their density increases until your late 20s. You gradually start losing bone densityfrom around the age of35. This happensto everyone, but some peopledevelop osteoporosis and lose bone density much faster than normal. This means theyre at greater risk of a fracture. Risk groups Osteoporosis can affect men and women.Its more common in older people, but it can also affect younger people. Women Women are more at risk of developing osteoporosis than men becausethe hormone changes that occur in the menopause directly affect bone density. The female hormone oestrogen is essential for healthy bones. After the menopause (when monthlyperiods stop), oestrogen levels fall. This canlead to a rapid decrease in bone density. Women are at even greater risk of developing osteoporosis if they have: anearly menopause (before the age of 45) ahysterectomy (removal of the womb) before the age of 45, particularly when the ovaries are also removed absent periodsfor more than six months as a result of overexercising or too much dieting Men In most cases, the cause ofosteoporosis in men is unknown. However, theres a link to the male hormone testosterone, which helps keep the bones healthy. Men continue producingtestosterone into old age, but the risk of osteoporosis is increased inmen with low levels of testosterone. In around half of men, the exact cause of low testosterone levelsis unknown, but known causes include: the use of certain medications, such as oral corticosteroids alcohol misuse hypogonadism(a condition that causes abnormally low testosterone levels) Risk factors Many hormones in the body can affect the process of bone turnover. If you have a conditionof the hormone-producing glands, you may have a higher risk of developing osteoporosis. Hormone-related conditions that can trigger osteoporosis include: hyperthyroidism (overactive thyroid gland) disorders of the adrenal glands, such asCushings syndrome reducedamounts of sex hormones (oestrogen and testosterone) disorders of the pituitary gland hyperparathyroidism (overactivity of the parathyroid glands) Other risk factors Other factors thought toincrease the risk of osteoporosis and broken bones include: a family history of osteoporosis a parental history ofhip fracture a body mass index (BMI) of 19 or less long-term use of high-doseoral corticosteroids (widely used for conditions such as arthritis and asthma ), which can affect bone strength having an eating disorder, such as anorexia or bulimia heavy drinking and smoking rheumatoid arthritis malabsorption problems, as experienced in coeliac disease and Crohns disease some medications used to treat breast cancer and prostate cancer which affect hormone levels long periods of inactivity, such as long-term bed rest You can read more about whos at risk of osteoporosis and broken bones on the Royal Osteoporosis Society website . Treating osteoporosis Treatment overview Although a diagnosis of osteoporosis is based on the results of your bone mineral density scan (DEXA or DXA scan), the decision about what treatment you need if any is also based on a number of other factors. These include your: age sex risk of fracture previous injury history If youve been diagnosed with osteoporosis because youve had a fracture, you should still receive treatment to try to reduce your risk of further fractures. You may not need or want to take medication to treat osteoporosis. However, you should ensure youre maintaining sufficientlevels of calcium andvitamin D. To achieve this, your healthcare team will ask you about your diet and may recommend making changes or taking supplements. NICE recommendations The National Institute for Health and Care Excellence (NICE)has made some recommendations about who should be treated with medication for osteoporosis. Anumber of factors are taken into consideration before deciding which medication to use. These include your: age bone mineral density (measured by your T score) risk factors for fracture NICE has summarised its guidance for two groups of people: postmenopausal women with osteoporosis who havent had a fracture (primary prevention) postmenopausal women with osteoporosis who have had a fracture (secondary prevention) You can read the NICE guidance by clicking on the links below. NICE guidance: Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragilityfractures in postmenopausal women NICE guidance: Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women Medication for osteoporosis Anumber of different medications are used to treat osteoporosis. Your doctor will discuss the treatments available andmake sure the medicines are right for you. Bisphosphonates Bisphosphonates slow down the rate at which bone is broken down in your body. This maintains bone density and reduces the risk of fracture. There are a number of different bisphosphonates, including alendronate etidronate ibandronate risedronate zolendronic acid Theyre given as a tablet orinjection. You should always take bisphosphonateson an empty stomach with a full glass of water. Stand or sit upright for 30 minutes after taking them. Youll also need to wait between 30 minutes and two hours before eating food or drinking any other fluids. Bisphosphonates usually take 6 to 12 months to work and you may need to take themfor five years orlonger. You may also be prescribed calcium and vitamin D supplements to take at a different time to the bisphosphonate. The main side effects associated with bisphosphonates include: irritation to the oesophagus (the tube that food passes through from the mouth to the stomach) swallowing problems (dysphagia) stomach pain Not everyone will experience these side effects. Osteonecrosis of the jaw is arare side effect thats linked with the use of bisphosphonates, althoughmost frequently with high-dose intravenous bisphosphonate treatment for cancer and not for osteoporosis. Inosteonecrosis, the cells in the jaw bone die, which can lead to problems with healing. If you have a history of dental problems, you may need a check-up before you start treatment with bisphosphonates. Speak to your doctor if you have any concerns. Strontium ranelate Strontium ranelate appears to have an effect on both the cellsthat break down bone and the cellsthat create new bone (osteoblasts). It can be used as an alternative treatment if bisphosphonates are unsuitable. Strontium ranelate is taken as a powder dissolved in water. The main side effects of strontium ranelate are nausea and diarrhoea . A few people have reported a rare severe allergic reaction to the treatment. If you develop a skin rash while taking strontium ralenate, stop taking it and speak to your doctor immediately. Selective oestrogen receptor modulators (SERMs) SERMs are medications that have a similar effect on bone as the hormone oestrogen. They help to maintain bone density and reduce the risk of fracture, particularly of the spine. Raloxifene is the only typeof SERM thats available for treating osteoporosis. Its taken as a tablet every day. Side effects associated with raloxifene include: hot flushes leg cramps a potential increased risk of blood clots Parathyroid hormone (teriparatide) Parathyroid hormone is produced naturally in the body.It regulates the amount of calcium in bone. Parathyroid hormone treatments (human recombinant parathyroid hormone or teriparatide) are used to stimulate cells that create new bone (osteoblasts). Theyre given by injection. Whileother medicationcan only slow down the rate of bone thinning, parathyroid hormone can increase bone density. However, its only used in a small number of people whose bone density is very low and when other treatments arent working. Nausea and vomiting are common side effects of the treatment. Parathyroid hormone treatments should only be prescribed by a specialist. Calcium and vitamin D supplements Calciumis the major mineral found in bone, and having enough calcium as part of a healthy, balanced diet is important for maintaining healthy bones. For most healthy adults, the recommended amount of calcium is 700 milligrams (mg) of calcium a day, which most people should be able to get from a varied diet that contains good sources of calcium. However, if you have osteoporosis you may need more calcium, which will usually be in the form of supplements. Ask your GP for advice about taking calcium supplements. Vitamin Dis needed to help the body absorb calcium. Its difficult to get enough vitamin D from your diet alone because few foods contain vitamin D. In the UK, most healthy adults obtain vitamin D from exposing the skin to summer sunlight. However, for people at risk of not getting enough vitamin D, supplementation with 10 micrograms of vitamin D a day (400 international units [IU]) isrecommended to prevent deficiency. At-risk groups include people over 65 years of age,and people who arent exposed to much sunlight because they cover their skin for cultural reasons, are housebound, or who stay indoors for long periods. If youre found to lack vitamin D, your GP may prescribe supplements at a higher dose than the above recommendation to correct the deficiency. Hormone replacement therapy (HRT) HRT is sometimes recommended for women who are experiencing the menopause , as it can help control symptoms. HRT has also been shown to maintain bone density and reduce the risk of fracture during treatment. However, HRT isnt specifically recommended for treating osteoporosis and it isnt often used for this purpose. This is because HRT slightly increasesthe riskof developing certain conditions, such as breast cancer , endometrial cancer , ovarian cancer , stroke and venous thromboembolism more than it lowers the risk of osteoporosis. Discuss the benefits and risks of HRT with your GP. Read more about the risks of HRT . Testosterone treatment In men, testosterone treatment can be useful when osteoporosis is caused by insufficient production of male sex hormones (hypogonadism). Preventing osteoporosis Your genes are responsible for determining your height and the strength of your skeleton, but lifestyle factors such as diet and exercise influence how healthy your bones are. Regular exercise Regular exerciseis essential.Adults aged 19 to 64 should doat least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity, such as cycling or fast walking , every week. Weight-bearing exercise and resistance exercise are particularly important for improving bone density and helping to prevent osteoporosis. As well as aerobic exercise, adults aged 19 to 64 should also do muscle-strengthening activities on two or more days a week byworking all the major muscle groups, including the legs, hips, back, abdomen, chest, arms and shoulders. If youve been diagnosed with osteoporosis, its a good idea to talk to your GP or health specialist before starting a new exercise programme to make sure its right for you. Read more about the physical activity guidelines for adults . Weight-bearing exercises Weight-bearing exercises are exercises where your feet and legs support your weight. High-impact weight-bearing exercises, such as running , skipping, dancing, aerobics, and even jumping up and down on the spot, are all useful ways to strengthen your muscles, ligaments and joints. When exercising,wear footwear that provides your ankles and feet with adequate support, such as trainers or walking boots. Peopleover the age of 60 can also benefit from regular weight-bearing exercise. This can include brisk walking, keep-fit classes or a game of tennis. Swimming and cycling arent weight-bearing exercises, however. Read more about physical activity guidelines for older adults . Resistance exercises Resistance exercises use muscle strength, where the action of the tendons pulling on the bones boosts bone strength. Examples include press-ups, weightlifting or using weight equipment at a gym. If youve recently joined a gym orhavent been for a while, your gym will probably offer you an induction. This involves being shown how to use the equipment and having exercise techniques recommended to you. Always ask an instructor for help if youre not sure how to use a piece of gym equipment or how to do a particularexercise. Healthy eating Eating a healthy, balanced diet is recommended for everyone. It can help prevent many serious health conditions, including heart disease , diabetes and many forms of cancer , as well as osteoporosis. Calciumis importantfor maintaining strong bones. Adults need 700mg a day, which youshould be able to get from your daily diet. Calcium-rich foods include: leafy green vegetables dried fruit tofu yoghurt Vitamin Dis also important for healthy bones and teeth becauseit helps your body absorb calcium. Vitamin D can be found in: eggs milk oily fish However, most vitamin D is made in the skin in response to sunlight. Short exposure to sunlight without wearingsunscreen (10 minutes twice a day) throughout the summer should provide you with enough vitamin D for the whole year. Certain groups of people may be at risk of not getting enough vitamin D. These include: people who are housebound or particularly frail people with a poor diet people who keep covered up in sunlight because they wear total sun block or adhere to a certain dress code women who are pregnant or breastfeeding If youre at risk of not getting enough vitamin D through your diet or lifestyle, you can take a vitamin D supplement. For adults, 10 micrograms a day of vitamin D is recommended. The recommended amount for children is 7 micrograms for babies under six months, and 8.5 micrograms for children aged six months to three years.Talk to your GP for more information. Read moreabout healthy eating . Other factors Other lifestyle factors that can help prevent osteoporosis include: quitting smoking smoking is associated with an increased risk of osteoporosis limiting your alcohol intake the NHS recommends not drinking more than 14 units of alcohol a week; its also important to avoid binge drinking Read more about healthy bones on theNational Osteoporosis Society website. Living with osteoporosis Getting support Your GP or nurse may be able to answerany questions you have about living with osteoporosis andcan reassure you if youre worried. You may also find it helpful to talk to a trained counsellor or psychologist, or to someone at a specialist helpline. Your GP surgery will have information about these. Some people find it helpful to talk to others with osteoporosis, either at a local support group or in an internet chat room. Osteoporosis support The Royal Osteoporosis Society providesa helpline service run by nurses with specialist knowledge of osteoporosis and bone health. Call 0808 800 0035. You can also email them at nurses@theros.org.uk They can provide you with details of local support groups . Recovering from a broken bone Broken bones usually take six to eight weeks to recover. Having osteoporosis doesnt affect how long this takes. Recovery depends on the type of fracture you have. Some fractures heal easily, while others mayneed more intervention. If you have a complicatedwrist fracture or hip fracture, you may need an operation to make sure the bone is set properly. Hip replacements are often neededafter hip fractures, and some people may lose mobility as a result of weakened bones. Osteoporosis can cause a loss of height due to fractures in the spinal column. This means the spine is no longer able to support your bodys weight and causes a hunched posture. This can be painful when it occurs, but it may also lead tolong-term (chronic)pain. Your GP or nurse may be able to help with this. During the healing process, you may need the help of a physiotherapist or occupational therapist so you can make as full a recovery as possible. Read more about occupational therapy . Coping with pain Everyone experiences pain differently, so what works for you may differ from what works for someone else. There are different ways to manage pain, including: medication heat treatment,such aswarm baths or hot packs cold treatment,such ascold packs transcutaneous electrical nerve stimulation (TENS) this is thought to reduce pain by stimulating the nerves simple relaxation techniques ,massage or hypnosis You can use more than one of these techniques at the same timeto manage your pain for example, you could combine medication, a heat pack and relaxation techniques. Working and money You should be able to continue working ifyou have osteoporosis. Its very important that you remain physically active and have a fulfilled lifestyle. This will help keep your bones healthy and stop you focusing too much on your potential health problems. However, if your work involves the risk of falling or breaking a bone, seek advice from your employer,GP and the Royal Osteoporosis Society about how to limit your risk of having an accident or injury that could lead to a bone break. If you cant continue working, you may be eligible for the Personal Independence Payment . People over 65 who are severely disabled may qualify for a disability benefit called Attendance Allowance . Help for carers You may also be entitled to certain benefits if you care for someone with osteoporosis. Read more about benefits for carers . More information Care Information Scotland GOV.UK: Carers and disability benefits Money Advice Service Source: MSK Expert Panel - Opens in new browser window Last updated: 20 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Scans and X-rays Keeping active Exercise, diet and healthy living with cancer Other health sites healthtalk.org: osteoporosis real stories Lab Tests Online UK: bone markers Royal Osteoporosis Society Age UK: osteoporosis Menopause Matters: osteoporosis Versus Arthritis NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Osteosarcoma | "Osteosarcoma | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in children Osteosarcoma Osteosarcoma Osteosarcoma is a type of bone cancer. Osteosarcomas occur more commonly in older children and teenagers and are very rarely seen in children under 5. More children than ever are surviving childhood cancer. There are new and better drugs and treatments. But it remains devastating to hear that your child has cancer, and at times it can feel overwhelming. There are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your childs specialist will give you more detailed information. If you have any questions its important to ask the specialist doctor or nurse who knows your childs individual situation. Osteosarcoma often starts at the end of the long bones, where new bone tissue forms as a young person grows. Any bone in the body can be affected. The most common sites are in the arms and legs, particularly around the knee and shoulder joints. There are several different types of osteosarcoma. Most occur in the centre of the bone. There are also rare subtypes, such as parosteal, periosteal, telangiectatic, and small cell osteosarcoma. Causes There has been a lot of research into the causes of osteosarcoma but, like most childhood cancers, a definite cause is unknown. There are a few risk factors that have been associated with osteosarcoma. Children who have hereditary retinoblastoma (a rare tumour of the eye) have an increased risk of developing osteosarcoma. Children who have previously had radiotherapy and chemotherapy also have an increased risk of developing osteosarcoma. It is not caused by injuries or damage to the bone, although an injury may draw attention to a bone tumour. Signs and symptoms Pain in the affected bone is the most common symptom. This pain may initially come and go, and then gradually become more severe and constant especially at night. There may also be swelling around the affected bone. Osteosarcoma is sometimes discovered when a bone that has been weakened by cancer breaks after the person has had a minor fall or accident. Some patients may develop a limp if the tumour is in the leg or pelvis. These symptoms can be caused by many things other than cancer. However, any persistent bone pain should be checked by your childs doctor. Symptoms are often attributed to a sporting injury. How osteosarcoma is diagnosed Usually you begin by seeing your GP, who will examine your child and may arrange tests or X-rays.If a bone tumour is suspected, the doctor will refer your child directly to a specialist hospital or bone tumour centre for further tests. The doctor at the hospital will take your childs full medical history. They will then do a physical examination. This will include an examination of the painful bone to check for any swelling or tenderness. Your child will probably have a blood test to check their general health. A variety of tests and investigations may be needed to diagnose osteosarcoma. An X-ray of the painful part of the bone will usually identify a tumour, although sometimes they can be difficult to see. A small piece of the tumour will be removed and looked at under a microscope. This is called a biopsy. Its a small operation, performed under a general anaesthetic. Other tests are done to check whether the cancer has spread to other parts of the body. These include a chest X-ray , blood tests , a bone scan and an MRI or CT scan . Any tests and investigations that your child needs will be explained to you. Grading Grading refers to the appearance of the cancer cells under the microscope, and gives an idea of how quickly the cancer may develop. Low-grade cancer cells are usually slow-growing and less likely to spread. In high-grade tumours the cells are likely to grow quickly and are more likely to spread. Most osteosarcomas are high-grade, but a type known as parosteal osteosarcoma is usually low-grade. Staging The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site. Knowing the particular type and stage of the cancer helps the doctors to decide on the most appropriate treatment. Most patients are grouped depending on whether cancer is found in only one part of the body (localised disease), or whether the cancer has spread from one part of the body to another (metastatic disease). A staging system commonly used for osteosarcomas is described below: Stage 1A The cancer is low-grade and is only found within the hard coating of the bone. Stage 1B The cancer is low-grade, extending outside the bone and into the soft tissue spaces that contain nerves and blood vessels. Stage 2A The cancer is high-grade and is completely contained within the hard coating of the bone. Stage 2B The cancer is high-grade and has spread outside the bone and into surrounding soft tissue spaces that contain nerves and blood vessels. Most osteosarcomas are stage 2B. Stage 3 The cancer can be low or high-grade and is either found within the bone or extends outside the bone. The cancer has spread to other parts of the body, or to other bones not directly connected to the bone where the tumour started. If the cancer comes back after initial treatment, this is known as recurrent or relapsed cancer. Treatment Treatment will depend on a number of factors including the size, position, and stage of the tumour. Chemotherapy Chemotherapy is a very important part of treatment for osteosarcoma. Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells, and is usually given to shrink the main tumour before surgery. Its also given after the tumour has been removed by surgery, to help reduce the risk of the cancer coming back (recurring). Its common for a combination of drugs to be used. Radiotherapy Radiotherapy may occasionally be given. This treats cancer by using high energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells. Surgery The type and extent of surgery depends on the position and size of the tumour in the body. This surgery will need to be carried out at a specialist orthopaedic centre, and your child should be referred to one. Surgery may include removing the whole limb (amputation) or part of the affected bone, which is then replaced by some form of false limb (prosthesis). If only part of the affected bone is removed, this is known as limb-sparing surgery. Most children will be considered for limb-sparing surgery. Amputation Sometimes amputation of the limb is unavoidable if the cancer is affecting the surrounding blood vessels and nerves. After amputation, a false limb will be fitted and will be regularly adjusted as your child grows. False limbs can work very well. It should be possible for your child to join in with normal activities and even sports. Limb-sparing surgery There are 2 ways that limb-sparing surgery may be done: replacing the bone with a prosthesis (a specially designed artificial part) replacing the affected bone with bone taken from another part of the body (bone graft) After this type of surgery, children will usually be able to use their limbs almost normally. However, they are advised not to participate in any contact sports. This is because any damage to the bone graft or prosthesis may require another major operation to repair or replace it. If your child is growing, the limb prosthesis will need to be lengthened as the bone grows. This may mean there are extra short stays in hospital, although some prostheses can be lengthened as an outpatient procedure. New treatments for osteosarcoma Mifamurtide, also called Mepact, is a new type of biological therapy treatment. It may be offered to your child if they have had a surgical resection to remove the osteosarcoma and the tumour has not spread. It will be given along with chemotherapy after surgery to try and stop the osteosarcoma coming back. Mifamurtide is a relatively new drug and so more research needs to be done to fully understand its side effects and how to use it best. Side effects of treatment Treatment often causes side effects, and your childs doctor will discuss these with you before the treatment starts. Any possible side effects will depend upon the treatment being given and the part of the body thats being treated. Chemotherapy side effects Some general side effects of chemotherapy can include: feeling sick (nausea) and being sick (vomiting) hair loss increased risk of infection bruising and bleeding tiredness diarrhoea Radiotherapy side effects Radiotherapy can cause irritation or soreness of the skin in the area being treated and general tiredness. Surgery side effects If your child is having surgery, the surgeon will explain the possible complications of the surgery that your child is having. Late side effects A small number of children may develop late side effects, sometimes many years later. These include a reduction in bone growth, reduced fertility, a change in heart function, and a slight increase in the risk of developing another cancer in later life. Your childs doctor or nurse will talk to you and monitor your child for any potential late effects. Clinical trials Many children have their treatment as part of a clinical research trial, if there is a suitable one open. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for childrens cancer. If appropriate, your childs medical team will talk to you about taking part in a clinical trial, and will answer any questions you have. Written information will be provided to help explain things. Taking part in a research trial is completely voluntary, and youll be given plenty of time to decide if its right for your child. Your childs doctor can tell you if there are any trials available that might be suitable for your child. Treatment guidelines Sometimes, clinical trials are not available for your childs tumour. This may be because a recent trial has just finished, or because the tumour is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Childrens Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care Many children with osteosarcoma are cured. However, your child may need to have surgery to lengthen the affected limb as they grow. Your child will have regular check-ups and X-rays in the paediatric or adolescent oncology clinic, and at the orthopaedic centre. If you have specific concerns about your childs condition and treatment, its best to discuss them with your childs doctor, who knows the situation in detail. Source: Children's Cancer and Leukaemia Group - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852" | null | null | null | null | null | null | null | null | null | null | null | null | null |
Outer ear infection (otitis externa) | Outer ear infection (otitis externa) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Ears, nose and throat Outer ear infection (otitis externa) Outer ear infection (otitis externa) Otitis externa is an infection that causes inflammation (redness and swelling) of the ear canal, which is the tube between the outer ear and the eardrum. Otitis externa is often called swimmers ear because regularly getting water in your ear can make inflammation more likely. Symptoms of otitis externa Symptoms of otitis externa include: ear pain itching and irritation in and around your ear canal redness and swelling of your outer ear and ear canal a feeling of pressure and fullness inside your ear scaly skin in and around your ear canal, which may peel off discharge from your ear, which can be either thin and watery or thick and pus-like tenderness when you move your ear or jaw swollen and sore glands in your throat some hearing loss Usually, only one ear is affected. With treatment, these symptoms should clear up within a few days. Some cases can persist for several months or longer. When to get medical advice Pharmacists can give advice and treatment about outer ear infections. Find your local pharmacy Your pharmacist may advise you to speak to your GP practice if needed. Diagnosing otitis externa Your pharmacist or GP will ask about your symptoms and whether you regularly put things into your ears, such as hearing aids or ear plugs. They may also examine inside your ear using an instrument called an otoscope. If you have otitis externa often, and treatment doesnt help, your GP may take a swab of the inside of your ear. This will be tested to help check what type of infection you have, if any, so the right medication can be prescribed. What causes otitis externa? Most cases of otitis externa are caused by a bacterial infection. It can also be caused by: irritation fungal infections allergies There are a things that can make you more likely to develop otitis externa, including: damaging the skin inside your ear for example by scratching or picking your ear regularly getting water in your ear for example by swimming Getting water in your ear can cause you to scratch inside your ear, and the moisture also provides an ideal environment for bacteria to grow. Who is affected? Otitis externa is quite common. Its estimated that around 1 in 10 people will be affected by it at some point in their lives. The condition is slightly more common in women than men and is most often diagnosed in adults 45 to 75 years of age. People with certain long-term (chronic) conditions are at greater risk of developing the condition. These include: eczema dermatitis Treatment for otitis externa Otitis externa sometimes gets better without treatment, but it can take several weeks. Things you can do to help your symptoms To help your symptoms and help prevent complications, you should: avoid getting your affected ear wet wearing a shower cap while showering and bathing if you arent washing your hair can help avoid swimming until the condition has fully cleared remove any discharge by gently swabbing your outer ear with cotton wool do not stick cotton wool or a cotton bud inside your ear remove anything from your affected ear that may cause an allergic reaction, such as hearing aids, ear plugs and earrings use pain relief such as paracetamol or ibuprofen to relieve ear pain these arent suitable for everyone, so make sure you check the information leaflet that comes with the medication first and if youre still unsure, check with your GP, practice nurse or pharmacist if your condition is caused by a boil in your ear, placing a warm flannel or cloth over the affected ear can help it heal faster Ear drops Your pharmacist or GP can prescribe ear drops that usually improve symptoms within a few days. There are different types of ear drops that may be used to treat otitis externa. You usually use them several times a day for about a week. Your GP may refer you to a specialist for further treatment and advice if your symptoms are severe, or treatment does not help. How to prevent otitis externa There are things you can do to reduce your chances of developing otitis externa. Do consider wearing a swimming cap or using ear plugs if youre a regular swimmer but make sure you insert ear plugs carefully and dont use them if they irritate your ears if earwax build-up is a problem, have it removed by a healthcare professional keep your ears dry and clean turn your head from side to side after getting out of water this helps water drain from your ears Dont do not insert cotton wool buds or other things into your ears (including your fingers) this can damage the sensitive skin in your ear canal do not swim in polluted water You should also try to avoid getting water, soap or shampoo into your ears when you have a shower or bath. Source: ENT Scotland - Opens in new browser window Last updated: 05 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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Ovarian cancer | Ovarian cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Ovarian cancer Ovarian cancer About ovarian cancer Symptoms of ovarian cancer Causes of ovarian cancer Diagnosing ovarian cancer Treating ovarian cancer Living with ovarian cancer Preventing ovarian cancer About ovarian cancer Ovarian cancer is most common in women and anyone with ovaries who hasbeen throughthe menopause (usually over the age of 50). It can affect women and anyone with ovaries of any age. As the symptoms of ovarian cancer can be similar to those of other conditions, it can be difficult to recognise. However, there are early symptoms to look out for, such aspersistent bloating, pain in the pelvis and lower stomach, and difficulty eating. Its important to speak to your GP if you experience these symptoms, particularly over along period of time. Read more about how ovarian cancer is diagnosed . The ovaries are a pair of small organs in the female reproductive system that contain and release an egg once a month. This is known as ovulation. Different types of ovarian cancer affect different parts of the ovaries. Epithelial ovarian cancer, which affects the surface layers of the ovary, is the most common type. This topic focuseson epithelial ovarian cancer. What causes ovarian cancer? The exact cause of ovarian cancer is unknown, but certain things are thought to increase a womans risk of developing the condition, such as age, the number of eggs the ovaries release and whether someone in your family has had ovarian or breast cancer in the past.However, only 1 in 10 cases of ovarian cancer has a genetic link. Read more about the causes of ovarian cancer Treating ovarian cancer The treatment you receive for ovarian cancer will depend on several things, including the stage of yourcancer and your general health. Chemotherapy is the main treatment for ovarian cancer, but your treatment will usually involve a combination of surgery and chemotherapy. Read more about how ovarian cancer is treated As with most types of cancer, the outlook for ovarian cancer will depend on the stage its at when diagnosed that is, how far the cancer has advanced. Being diagnosed withovarian cancer can affect daily life in many ways. However, support is available for many aspects ofliving withovarian cancer, including emotional, financial and long-term health issues. Ovarian cancer screening There are methods of screening for ovarian cancer but, currently, they havent been fully tested. Screeningis only available for women and anyone with ovaries who are at high risk of developing the condition due to a strong family history or inheritance of a particular faulty gene.Clinical trials in the UK are currently being carried out to assess the effectiveness of screening in high-risk groups and in the general population. A cervical screening test , which used to be called a smear test, cant detect ovarian cancer. Read more about preventing ovarian cancer Symptoms of ovarian cancer The symptoms of ovarian cancer can be difficult to recognise, particularly in its early stages. This is because they are often the same as symptoms of other less serious conditions, such as irritable bowel syndrome (IBS) or pre-menstrual syndrome (PMS). However, 3 main symptoms are more frequent: increased abdominal size and persistent bloating (not bloating that comes and goes) persistent pelvic and abdominal pain difficulty eating and feeling full quickly, or feeling nauseous Other symptoms, such as back pain,needing to pass urine more frequently than usual, and pain during sex may be the result of other conditions in the pelvic area. However, they may bea sign of ovarian cancer. If you have these types of symptoms, try keeping a diary to record how many of these symptoms you have over a longer period. Bear in mindthat ovarian cancer is rare in women and anyone with ovaries under 40 years of age. Speak to your GP if you have these symptoms regularly (on most days for 3 weeks or more). Although its unlikely theyre being caused by a serious problem, its best to check. If youve already seen your GP and the symptoms continue or get worse, you should go back and explain this. You know your body better than anyone. Causes of ovarian cancer Several possible causes of ovarian cancer have been identified, along with risks that may make developing the condition more likely. Cancer begins with a change (mutation) in the structure of the DNA in cells, which can affect how they grow. This means that cells grow and reproduce uncontrollably, producing a lump of tissue called a tumour. In ovarian cancer, cells in the ovary start to change and grow abnormally. If the cancer isnt identified at an early stage, it can spread to the abdomen and pelvis, including other parts of the female reproductive system. Increased risk The exact cause of epithelial ovarian cancer (the main type) isnt known, but certain things may increase your risk of developing it. Age Your risk of ovarian cancer increases with age, with most cases occurring after the menopause . Most cases of ovarian cancer occur in women and anyone with ovaries who are over 50 years of age. Family history If you have 2 or more close relatives (mother, sister or daughter) who developed ovarian cancer or breast cancer , your risk of also developing the condition may be increased. If your relatives developed cancer before the age of 50, its more likely it was the result of an inherited faulty gene. BRCA1 and BRCA2 are faulty genes that are linked to ovarian cancer. Theyre also known to increase the risk of breast cancer. Having relatives with ovarian cancer doesnt mean you definitely have a faulty gene in the family the cancer could have happened by chance. Only1 in 10 (10%) of ovarian cancers are thought to be caused by a faulty gene. You may be at high risk of having a faulty gene if you have: 1 relative diagnosed with ovarian cancer at any age and at least 2 close relatives with breast cancer whose average age is under 60; all of these relatives should be on the same side of your family (either your mothersor fathers side) 1 relative diagnosed with ovarian cancer at any age and at least 1 close relative diagnosed with breast cancer under the age of 50; both of these relatives should come from the same side of your family 2 relatives from the same side of the family diagnosed with ovarian cancer at any age If youre at a higher risk of having a faulty gene, your GP can refer you for tests to check for faulty BRCA1 and BRCA2 genes. Ovulation and fertility Every time an egg is released into the reproductive system, the surface of the ovary breaks to let it out. The surface of the ovary is damaged during this process and needs to be repaired. Each time this happens, theres a greater chance of abnormal cell growth during the repair. This may be why the risk of ovarian cancer decreases if you take the contraceptive pill , or have multiple pregnancies or periods of breastfeeding. At these times, eggs arent released. Theres no strong evidence to show that those who have infertility treatment have an increased risk of developing ovarian cancer. However, its thought that infertility itself may increase ovarian cancerrisk and research into this area is being carried out. Hormone replacement therapy (HRT) Women and anyone with ovaries who takehormone replacement therapy (HRT) have been shown to have a small increased risk of developing ovarian cancer. However, if HRT is stopped, after 5 years the risk is reduced to the same level as those whove never taken HRT. Endometriosis Endometriosis may also increase your risk of ovarian cancer. In endometriosis, the cells that usually line the womb grow elsewhere in the body. These endometrial cells behave as if they were in the womb, so thickening and bleeding that usually occurs during menstruation,occurs in other parts of the body. Theres no way for this endometrial tissue to leave the body so it becomes trapped, leading to pain, swelling and bleeding in that area. Read further information: Cancer Research UK: Ovarian cancer risks and causes Diagnosing ovarian cancer Speak to your GP as soon as possible if you have any symptoms of ovarian cancer . Your GP will gently feel your tummy (abdomen) and ask you about your symptoms, general health and whether theres a history of ovarian or breast cancer in your family. They may carry out an internal examination and may take a blood sample or refer you for an ultrasound scan . If needed, you may also be referred to a specialist (a gynaecologist or gynaecological oncologist) at a hospital. In 2015, the National Institute for Health and Care Excellence ( NICE ) published guidelines to help GPs recognise the signs and symptoms of ovarian cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected ovarian cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral . Blood test (CA125) You may have a blood test to look for a protein called CA125 in your blood. CA125 is produced by some ovarian cancer cells.A very high level of CA125 may indicate that you have ovarian cancer. However, CA125 isnt specific to ovarian cancer and it can be raised in conditions including endometriosis , fibroids , pelvic inflammatory diseaseand pregnancy, soa raised CA125 level doesnt definitely mean you have ovarian cancer. The Lab Tests Online UK website has more informationon the CA125 test . TheNational Institute for Health and Care Excellence (NICE) has producedguidance that recommends testing for CA125 if you frequently experience: bloating feeling full quickly and/or loss of appetite pelvic or abdominal pain needing to urinate urgently and/or frequently Read the full NICE guidance about the recognition and initial management of ovarian cancer (PDF, 179kb) . If you experience unexplained weight loss, fatigue or changes in your bowel habits, such as diarrhoea or constipation , you may also be tested for CA125. If youre 50 or over and youve experienced symptoms that could suggest irritable bowel syndrome (IBS) in the last 12 months, such as bloating, abdominal pain or changes in your bowel habits, your GP should test your CA125 level. Around halfof all women and anyone with ovaries with early-stage ovarian cancerhave a raised level of CA125 in their blood. If your CA125 level is raised,youll be referred for an ultrasound scan. Ultrasound scan An ultrasound scan uses high-frequency sound waves to create an image of your ovaries. You may have an internal ultrasound where the ultrasound probe is inserted into your vagina, or you may have an external ultrasound, where the probe is put next to your stomach. The image produced can show the size and texture of your ovaries, plus any cysts or other swellings that are present. Further tests If youve been diagnosed with ovarian cancer, you may have further tests to see how large the cancer is andif its spread. This is called staging. Other tests you may have include: a chest X-ray a CT scan or MRI scan abdominal fluid aspiration a thin needleis passed into your abdomen, so that a fluid sample can be taken and tested for cancerous cells laparoscopy a thin tube with a camera on the endisinserted through a small incision in your lower abdomen, so that your ovaries can be examined; a small tissue sample may also be taken from your ovaries for testing (a biopsy ) Staging helps your doctors to decide on the best kind of treatment for your condition. However, its important to remember that the stage of your ovarian cancer alone cannot predict how your condition will progress. TheCancer Research UK website has more informationon further tests for ovarian cancer . Stages and grades of ovarian cancer Staging If your test results indicate that you have ovarian cancer,it will be given a stage. The stage describes the size of the cancer and how far it has spread. The 4 commonly used stages of ovarian cancer are: stage 1 where the cancer only affects one or both of the ovaries stage 2 where the cancer has spread from the ovary and into the pelvis orwomb stage 3 where the cancer has spread to the lining of the abdomen, the surface of the bowel and the lymph nodes in the pelvis stage 4 where the cancer has spread to other parts of the body, such as theliver, spleen or lungs This is a simplified guide. Each stage is further divided into categories A, B and C.Ask your doctor if youre not sure what stage you have. Grading The grade of cancer refers to the appearance ofcells under a microscope. The grades are as follows: low grade although abnormal, cells appear to be slow-growing moderate grade cells look more abnormal than low-grade cells high grade cells look very abnormal and are likely to be fast-growing TheCancer Research UK website has more informationon the stages and grading of ovarian cancer . Treating ovarian cancer Surgery Most people with ovarian cancer willbe considered forsurgery. It sometimes isnt possible to confirm the stage of the cancer until surgery is carried out. Your doctor will discuss what will happen during surgery. It will probably involve removing: both ovaries and the fallopian tubes (a bilateral salpingo-oophorectomy) the womb(a total abdominal hysterectomy) the omentum a fatty layer of tissue within the abdomen (an omentectomy) The surgeon may also remove the lymph nodes from your pelvis and abdomen, and samples of nearby tissue, to find out whether the cancer has spread. If it has spread, the surgeon will try to remove as much of it as possible. This is known as debulking surgery. If the cancer is confined to 1 or both ovaries, you may only need to have the ovary or ovaries removed, leaving your womb intact. This means you may still be able to carry a pregnancy. You will probably be ready to go home 3 to 7 days after your operation, but it can take many weeks to fully recover. When you go home, youll need to exercise gently to build up your strength and fitness. Walking and swimming are good exercises that are suitable for most people after treatment for ovarian cancer. Discuss the types of exercise that are suitable for youwith your doctor or physiotherapist. Read further information: Cancer Research UK: Surgery for ovarian cancer Macmillan Cancer Support: Ovarian cancer surgery Chemotherapy Chemotherapy involves using anti-cancer (cytotoxic) medication to kill cancer cells. Its often given after surgery for ovarian cancer. In some cases, it can be given before surgery to help shrink the tumour and make it easier to remove. This is called neoadjuvant chemotherapy. Several different medicines can be used in chemotherapy. A combination is often given. The choice of medicine and how and when its given depends on thestage of your cancer and how much it has spread. The most common treatment for ovarian cancer is a platinum-containing medicine (carboplatin), which is used alone or in combination with another medicine called paclitaxel. Chemotherapy is usually given asa dripinto the vein, but is sometimes given as tablets. Some studies have looked at giving chemotherapy directly into the abdomen called intraperitoneal chemotherapy. It is not currently established routine practice in the UK, but its being assessed in clinical trials. Youll usually have chemotherapy as an outpatient, but you may sometimes need a short stay in hospital. Its usually given in cycles, with a period of treatment followed by a period of rest, to allow the body to recover. Most women and anyone with ovaries have 6 cycles of chemotherapy. Is chemotherapy working? Over the course of your chemotherapy, youll have tests to monitor how the cancer is responding to treatment. This can be done in a number of ways. For example: if you had higher than normal levels of theprotein CA125 in your blood when diagnosed, you may have blood tests to see whether the levels are falling if you had a tumour visible on a CT scan or ultrasound scan whendiagnosed, you may have repeated scans to see whether it has shrunk you may have another small operation, known as second-look surgery, which is carried out in the same way as a laparoscopy After your chemotherapy treatment, if all of your tests are clear of cancer, youll be in remission. This means the cancer is under control. Side effects of chemotherapy Side effectsof chemotherapyinclude: infections loss of appetite nausea and vomiting tiredness hair loss sore mouth Many side effects can be prevented or controlled with medicines your doctor can prescribe. Chemotherapy for recurring cancer Ovarian cancer can come back (relapse) after treatment. If this happens, you may have another course of chemotherapy. This is called second-line treatment. Read further information: Cancer Research UK: Chemotherapy for ovarian cancer Macmillan Cancer Support: Chemotherapy for ovarian cancer Radiotherapy Radiotherapyuses high energy X-rays . Like chemotherapy, it works by targeting rapidly growing cancer cells. Radiotherapy isnt usually used to treat ovarian cancer. However, the multidisciplinary team may occasionally recommendit to treatovarian cancer under very specific circumstances, such as treating pain and bleeding from a localised tumour mass. Read further information: Cancer Research UK: radiotherapy for ovarian cancer Macmillan Cancer Support: Ovarian cancer treatment Clinical trials In recent years,much progress has been made in ovarian cancer treatment. More women and anyone with ovaries are living longer and experiencing fewer side effects. These advances were discovered throughclinical trials,where new medicines and combinations of medicines are compared with standard treatment. All cancer trials in the UK are subject to careful monitoring,to ensure the trial is worthwhile and safely conducted. Participants in clinical trials canoften do better overall than in routine care. If youre asked about taking part in a trial, youll be offered an information sheet. If you wish to take part, youll be asked to give your consent (permission)by signing a form. Youre always free to refuse or withdraw from a clinical trial without it affecting your care. Read further information: Cancer Research: ovarian cancer research . Psychological help Dealing with cancer can be a huge challenge for patients and their families. It can bring emotional and practical difficulties. It often helps to talk about your feelings or other difficulties with a trained counsellor or therapist. You can ask for this kind of help at any stage of your illness. There are various ways to find help and support. For example: your hospital doctor, specialist nurse or GP can refer you to a counsellor;talk to your GP ifyoure feeling depressed;a course of antidepressants may help, or your GP can arrange for you to see a counsellor or psychotherapist it can help to talk to someone whos been through the same thing as you; many organisations have helplines and online forums; they can also put you in touch with other people who have had cancer treatment Read further information: Macmillan Cancer Support Living with ovarian cancer Recovery and follow-up Many women and anyone with ovaries with ovarian cancer have a hysterectomy. This is a major operation and takes around 6 to 12 weeks to recover from. During this time, youll have to avoid lifting things, such as children and heavy shopping bags, and doing heavy housework. You wont be able to drive for 3 to 8weeks after the operation. Youll usually need 4 to 12 weeks off work after a hysterectomy. If your ovaries have been removed and you havent already been through the menopause , youll experience themenopause after your treatment. You may decide to take hormone replacement therapy (HRT) to control your symptoms. Your GP willhelp you decide whats best for you. Some treatments for ovarian cancer, particularly chemotherapy , can make you feel very tired. You may need a break from your normal activities for a while. Dont be afraid to ask for practical help from family and friends if you need it. Practical help may alsobe available from your local authority. Ask your doctor or nurse who to contact. After your treatment has finished, youll be invited for regular check-ups to see how well you are responding to treatments. These are usually every 2 to 3 months to begin with. Sex and relationships Relationships with friends and family Having cancer isnt always easy to talk about, either for you oryour family and friends. You may sense that some people avoid you or feel awkward around you. Being open about how you feel and what your family and friends can do to helpmay put them at ease. However, dont feel shy about telling them you need some time to yourself. Read further information: Talking to your kids about cancer Macmillan Cancer Support:Talking about cancer Your sex life Ovarian cancer and its treatment can affect your sex life in several ways. Early menopause If you havent already been through the menopause, removing your ovaries means youll have an early menopause. Youre likely to have symptoms of the menopause , which can include vaginal dryness and loss of sexual desire . Not feeling like sex Its common to lose interest in sex after treatment for ovarian cancer. Your treatment may leave you feeling very tired, andyou may feel shocked, confused or depressed about being diagnosed with cancer. You may also feel grief about the loss of your fertility. Its understandable that you may not feel like having sex while coping with all this. Share your feelings with your partner. If your feelings about sex arent improving with time, you may want to consider speaking to a counsellor or sex therapist. Money and benefits If you have to reduce or stop working due to your cancer, you may find it difficult to cope financially. If you have cancer or youre caring for someone with cancer, you may be entitled to financial support. For example: if you have a job but cant work because of your illness, youre entitled to statutory sick pay (SSP) from your employer if you dont have a job and cant work because of your illness, you may be entitled to employment and support allowance (ESR) if youre caring for someone with cancer, you may be entitled to carers allowance you may be eligible for other benefits if you have children living at home, or have a low household income Its a good idea to find outas soon as possiblewhat help is available to you. You could ask to speak to the social worker at your hospital, whocangive you the information you need. Read further information: Money Advice Service Target Ovarian Cancer: Financial hardship for women with ovarian cancer Dealing with dying If youre toldthat nothing more can be done to treat your ovarian cancer,care will focus on controlling your symptoms and helping you feel as comfortable as possible. This is called palliative care . It also includes psychological, social and spiritual support for you and your family or carers. Read further information: Marie Curie Cancer Care: support for people dying at home Preventing ovarian cancer Theres currently no reliable screening test for ovarian cancer. However, there are a number of things that may help to prevent ovarian cancer. Stopping ovulation and the contraceptive pill Each time you ovulate, your ovaries are damaged by the egg as it breaks through the surface of the ovary and isreleased into your reproductive system. The cells that make up the surface of your ovaries divide and multiply rapidly to repair the damage caused by the egg. Its this rapid cell growth that can occasionally go wrong and result in ovarian cancer. Anything that stops the process of ovulation can help to minimise your chances of developing ovarian cancer. This includes: pregnancyand breastfeeding the contraceptive pill hysterectomy surgery (removal of the ovaries) Diet and lifestyle Ovarian cancer may be linked to being overweight or obese . Losing weight through regular exercise and a healthy, balanced diet may help lower your risk of getting ovarian cancer. Aside from this, regular exercise and a healthy, low-fat diet are extremely beneficial to your overall health, and can helpto prevent all forms of cancerand heart disease . Screening for ovarian cancer At present, theres no screening methodfor ovarian cancer that is reliable enough to be used by all women and anyone with ovaries in the UK.Clinical trials into this are continuing. You may be eligible for screening if youre at high risk of developing the condition due to a strong family history, or if youveinherited aspecific abnormal gene. If youre at high risk, your GP can refer you to your local genetics service or family cancer clinic. You may be screened for ovarian cancer when youreover the age of 35, or when youre 5 years away from the age at which your youngest relative was diagnosed with the condition. From this point, youll be screened again once a year. The screening tests for ovarian cancer are the same as those routinely used to diagnose it. The tests are: a blood test for higher-than-normal levels of CA125 (a protein produced by cancer cells) a transvaginal ultrasound where anultrasound probe is inserted into your vagina so that the size and texture of your ovaries can be seen, as well as any ovarian cysts that may be present The tests are used together to produce results that are as accurate as possible. However, as these screening methods are still in the process of being tested, theres no guaranteetheyll identify every case of ovarian cancer. A cervical screening test , previously known as a smear test, cant detect ovarian cancer. Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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Ovarian cancer: Teenagers and young adults | Ovarian cancer | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in teenagers and young adults Ovarian cancer: Teenagers and young adults Ovarian cancer: Teenagers and young adults Introduction Germ cell tumours of the ovary Having tests for ovarian cancer Treatment for germ cell tumours of the ovary Introduction This section is for teenagers and young adults. Its about a type of cancer called ovarian cancer. We have more info for young people about: germ cell tumours of the ovary causes and symptoms having tests for ovarian cancer treating ovarian cancer For more information about ovarian cancer in women of all ages, read our general ovarian cancer section. Ovarian cancer starts in the ovaries, which are part of the reproductive system. This is in the lower part of your tummy (abdomen), in the area between your hips (called the pelvis). Your reproductive system is made up of your vagina and the organs involved in getting pregnant and having a baby. Your reproductive system Your reproductive system is made up of the: vagina the passage from the cervix to outside your body cervix the opening from the womb to the vagina womb (also called uterus) where a baby grows during pregnancy fallopian tubes which connect your ovaries to the womb ovaries which store all your eggs and release one every month after puberty Facts about ovaries You have2 ovaries 1 on each side of your womb. Theyre about 4cm long. At puberty your ovaries start making hormones called oestrogen and progesterone. These cause your breasts to grow and your periods to start. Every month after puberty, your ovaries release an egg, which travels down the fallopian tubes to the womb. The wombs lining gets thicker, ready for an egg to be fertilised by a mans sperm. If this doesnt happen, the wombs lining comes out of your vagina as blood. This is a period. When a woman is about 50 her periods stop because her ovaries have run out of eggs so they stop making hormones. This is called the menopause. Types of ovarian cancer There are 3 types of ovarian cancer: epithelial tumours, germ cell tumours and stromal cell tumours. Teenagers are mostly affected by the germ cell tumour type. You may hear your type of germ cell tumour being called: dysgerminoma teratoma yolk sac tumour Germ cell tumours of the ovary are rare. They start in the egg-producing cells of the ovary. Treatment will usually cure germ cell tumours. Your specialist will explain more about the type of germ cell tumour that you have. If you have a type of ovarian cancer or germ cell tumour thats not listed here, you can talk to one ofMacmillans cancer support specialists to find out more. Germ cell tumours of the ovary This section is for teenagers and young adults. Germ cell tumours of the ovary are the most common type of ovarian cancer in teenagers and young women. If you have a different type of ovarian cancer and want to know more you can talk to Macmillan Cancer Support . Germ cell tumours are a rare type of ovarian cancer. They start in the egg-producing cells of the ovary in girls and young women (aged 10 to 30). Tumours are often only in1 ovary. They can usually be successfully treated, even if theyve spread to other places in the body. Germ cell tumours can also develop in teenage boys or mens testicles, or rarely in other parts of the body. This page is about germ cell tumours that start in the ovary, but we have more information about testicular cancer . Causes The cause of germ cell tumours is unknown. Research into possible causes is going on all the time. Germ cells are a normal part of the ovary, but something causes them to change. This makes them grow too quickly and make a tumour. Signs and symptoms pain or swelling in your tummy (abdomen) afeeling of fullness or bloating in your tummy needing to pee more often irregular periods Remember these symptoms happen for lots of reasons other than cancer. But if you have any of them its important to speak to your GP. If youre worried about ovarian cancer If you think you might have some of these symptoms, go and see your GP. Theyll be able to talk to you about your symptoms. If they think they could be because of cancer, they can do some tests to find out more. We have more information for young people about: having tests for ovarian cancer treatment of overian cancer If youre looking for information about ovarian cancer in women of all ages, read our general ovarian cancer section. Having tests for ovarian cancer There are some tests that you might have at your doctors or at the hospital, to help them see if you have ovarian cancer. Visiting your GP If you think you might have any symptoms of ovarian cancer , you should speak to your GP. Theyll be able to talk to you about your symptoms. If they think these could be because of cancer they can do tests to find out more. Tests These might include: a blood test an ultrasound of the ovaries an internal examination, to check the organs in your pelvis For an internal examination, you lie on your back with your feet together and your knees apart. The doctor will gently put1 or2 fingers inside your vagina and press a little on your lower tummy. It shouldnt be painful but it can feel uncomfortable. This test might make you feel embarrassed, but doctors are used to doing this investigation and its over quickly. If a male doctor examines you, there will usually be a female nurse present, but if not you can ask for one. You can have someone you feel close to with you during the examination, or if you prefer you can ask whoever is with you to go out until its over. You can do whatever makes you feel most comfortable. After these tests, your GP may arrange for you to see a doctor at the hospital who specialises in problems of the reproductive system (a gynaecologist). At the hospital The specialist will carry out an internal examination to check if theres anything unusual in the shape and position of your ovaries and womb. Your GP may have already done an internal examination. More tests The specialist will arrange for you to have some more tests. Different tests are used to diagnose germ cell tumours of the ovary. Blood tests check for chemicals in the blood called tumour markers. Some germ cell tumours produce high levels of these. Ultrasound scans use sound waves to build up a picture of your ovaries and the area around them on a computer screen. The person doing the scan will rub some gel on your tummy and gently move a small device over your tummy to produce the picture. You may also have an ultrasound scan done through the vagina (transvaginal ultrasound), to get a clearer picture. A small probe about the size of a tampon is gently put inside your vagina. Its not painful but it can be a bit uncomfortable. You can have someone with you during the test if you want to. CT scans take a series of X-rays, which build up a 3D picture of the area of the body being scanned. It can show up the size and position of a tumour. Laparoscopy is a test thats sometimes done to look inside your tummy at your ovaries. Its done under a general anaesthetic. You can usually go home the same day. The surgeon makes 3 to 4 small cuts in the skin in your lower tummy (just above the bikini line). Then they put a thin, flexible tube with a camera on the end (called a laparoscope) through one of the cuts to look at the ovaries. Sometimes the surgeon will remove the ovary at the same time as the laparoscopy but they will discuss this with you before you have the surgery. The removedovarywill be looked at under a microscope to find out exactly what type of tumour it is. Having tests and waiting for the results can be an anxious time. Talking about how you feel and getting support from family, friends, your specialist nurse or your doctor can help. Weve got more information for young people about: germ cell tumours of the ovary causes and symptoms treatment of ovarian cancer living with and after ovarian cancer If youre looking for information about ovarian cancer in women of all ages, read our ovarian cancer section. Treatment for germ cell tumours of the ovary Most girls and young women can be cured of germ cell tumours of the ovary. Your treatment will depend on the type of germ cell tumour you have and whether it has spread outside the ovaries. Treatment is usually a combination of surgery and chemotherapy, although you may only need surgery. Before you have treatment, your specialist needs to know the type of germ cell tumour you have and what stage it is. The stage of a cancer describes the size of the tumour and whether it has spread outside the ovary to any other parts of your body. Your specialist will tell you the exact stage of the cancer after the operation to remove your ovary. Most germ cell tumours are diagnosed early when theyre in one or sometimes both ovaries but havent spread anywhere else in the body. Waiting to hear about the stage of the cancer can be worrying. But this information is important because it helps your doctors plan the right treatment. Another important part of ovarian cancer treatment is to try to make sure it doesnt make you infertile (unable to get pregnant). Your doctors will think very carefully about this when planning your treatment. Surgery You may have an operation to remove the affected ovary and the fallopian tube. If its a very early germ cell tumour this might be the only treatment you need. After your operation youll come back to the clinic for regular checks. If there are any signs of the cancer coming back, its treated straight away. Having the affected ovary and fallopian tube removed wont stop you from having a baby in the future. You can still get pregnant with only1 ovary. Before surgery youll have a general anaesthetic. During the operation, the surgeon will make a cut in the lower tummy. The ovary is removed through this cut. The operation is called a laparotomy. If the cancer has spread, the surgeon may still do an operation to try to remove as much of the tumour as they can. If possible they will try to leave the other ovary and the womb. You will have more treatment after your operation to treat any of the tumour that they could not remove. Removing both ovaries and the womb is only done if theres no other way of successfully treating the cancer. Unfortunately this means you will not be able to get pregnant in the future. This can be very upsetting news. You may not have thought about having children yet, so it may be difficult to take in. If this happens there will be lots of support to help you. Chemotherapy Chemotherapy is given after your operation to: get rid of any cancer cells that werent removed with surgery stop the cancer from coming back Your specialist will explain more about this to you. Germ cell tumours are very sensitive to chemotherapy and this treatment cures most girls. If its a very early germ cell tumour you might not even need chemotherapy. Germ cell tumours are often treated with the drugs bleomycin, etoposide and cisplatin. When these are given together its called BEP for short. Chemotherapy is given in cycles of treatment that usually take 3 weeks. Youll have 3 to 4 cycles. Youll spend the first 3 to 5 days of each cycle having your chemotherapy. Youll usually stay in hospital for those days. Youll come back to the clinic for another injection of chemotherapy a week later, and then again the following week. Different chemotherapy drugs cause different side effects. Some girls just have a few side effects, and others have more. Most side effects are temporary and gradually disappear once treatment stops. The most common side effects are: hair loss tiredness feeling sick or being sick (this can often be controlled with medicine) being more at risk of getting an infection Doctors cant be certain whether youll be able to get pregnant (fertility) in the future after youve had chemotherapy. They may talk to you about storing your eggs before chemotherapy starts. Stored eggs can be used with fertility treatments when youre ready to try to get pregnant. Read more inMacmillans section on fertility in young women . Surgery and chemotherapy Youll usually have chemotherapy after your surgery. You might have more surgery after youve finished chemotherapy if theres still some tumour left behind. Radiotherapy Radiotherapy treats cancer by using high-energy X-rays to destroy cancer cells. Some types of germ cell tumour are sensitive to radiotherapy, but it is rarely used. Wehavemore information about: germ cell tumours of the ovary causes and symptoms having tests for ovarian cancer If youre looking for information about ovarian cancer in women of all ages, read our general ovarian cancer information. Source: Macmillan - Opens in new browser window Last updated: 20 January 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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Ovarian cyst | "Ovarian cyst | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Healthy living Women's health Middle years (around 25 to 50 years) Periods and menstrual health Ovarian cyst Ovarian cyst An ovarian cyst is a fluid-filled sac that develops on an ovary. Theyre very common and do not usually cause any symptoms. Most ovarian cysts are generally harmless and disappear without treatment in a few months. Small cysts are normal in the ovary. There may only be a problem is there are a large number of cysts, theyre persistent, or become particularly large. Ovarian cysts may affect both ovaries at the same time, or they may only affect one. What are ovaries? The ovaries are part of the female reproductive system. They are 2 small, bean-shaped organs, one each side of the womb (uterus). The ovaries have 2 main functions. They are: to release an egg around every 28 days as part of the menstrual cycle to release the female sex hormones, oestrogen and progesterone Types of ovarian cyst The 2 main types of ovarian are: functional ovarian cysts (most common) develop as part of the menstrual cycle and are usually harmless and short-lived pathological ovarian cysts (much less common) occur due to abnormal cell growth Ovarian cysts can sometimes also be caused by an underlying condition, such as endometriosis . The vast majority of ovarian cysts are non-cancerous (benign). But a small number are cancerous (malignant). Signs and symptoms Most cysts are found by chance during a scan. Theyre unlikely to cause any symptoms unless theyre large or abnormal. An ovarian cyst will usually only cause symptoms if it splits (ruptures), is very large, or it blocks the blood supply to the ovaries. Contact your GP practice if: you have sudden, severe pelvic pain If your GP is closed, phone 111. Contact your GP practice if: Youre worried about your symptoms or you regularly have: pelvic pain this can range from a dull, heavy sensation to a sudden, severe and sharp pain pain during sex difficulty having a poo a frequent need to urinate heavy periods , irregular periods or lighter periods than normal bloating and a swollen tummy feeling very full after only eating a little difficulty getting pregnant If your GP practice is closed, phone 111. Useful information for your doctor It can be helpful to keep a note of your period dates and symptoms using a calendar, a diary or an app. You can then discuss this with your doctor who can decide if any tests or treatments might be needed. If youre seeing your doctor, there are some useful pieces of information to think about beforehand: the first day of your last period (when it started) how many days your period usually lasts what was the shortest time between your periods (from the first day of one period to the first day of the next) what was the longest time between your periods (from the first day of one period to the first day of the next) how often you need to change your period products on a heavy day if you are over 25, when you had your last smear test Diagnosing ovarian cysts If your GP thinks you may have an ovarian cyst, you may be referred for an ultrasound scan . This is carried out by using a probe placed inside your vagina. As this is a very intimate examination, the doctor who performs it will have another person (chaperone) present. You can ask for a female doctor to carry it out. If there isnt a female doctor available, you can ask if theres a female health professional who could carry out the examination. If a cyst is identified during the ultrasound scan, you may need to have this monitored with a repeat ultrasound scan in a few weeks. Or your doctor may refer you to a gynaecologist, who specialises in female reproductive health. Your doctor may also arrange blood tests to check for any other conditions. Treatment In most cases, ovarian cysts disappear in a few months without treatment. A follow-up ultrasound scan may be used to confirm this. Most ovarian cysts do not need treatment or surgery. Treatment will depend on: size and appearance of the cysts whether you have any symptoms whether youre post-menopausal (due to the slightly higher risk of ovarian cancer ) If youre post-menopausal, youll usually have regular ultrasound scans and blood tests over the course of a year to monitor the cyst. Large cysts, those causing symptoms, and those that could be cancerous, may need to be surgically removed. Your care team can talk with you about what to expect, and answer any questions you have. Types of surgery There are 2 types of surgery used to remove ovarian cysts: laparoscopy laparotomy These are usually carried out under general anaesthetic . Laparoscopy Most cysts can be removed using laparoscopy. This is a type of keyhole surgery. Small cuts are made in your tummy and gas is blown into the pelvis to allow the surgeon to access your ovaries. A laparoscopy is a procedure where a camera (a laparoscope) is inserted into the pelvis via a small cut near the belly button so the surgeon can see your internal organs. The surgeon then removes the cyst through the small cuts in your skin. After the cyst has been removed, the cuts will be closed using dissolvable stitches. A laparoscopy is preferred because it causes less pain and has a quicker recovery time. Youll usually be able to go home on the same day or the following day. Laparotomy If your cyst is particularly large, or there is a chance it could be cancerous, a laparotomy may be recommended. During a laparotomy, a single, larger cut is made in your tummy to give the surgeon better access to the cyst. The whole cyst and ovary may be removed and sent to a laboratory to check whether its cancerous. Stitches or staples will be used to close the incision. You may need to stay in hospital for a few days after the procedure. After the surgery After the ovarian cyst has been removed, youll feel pain in your tummy. This should improve in a day or two. If you have had a laparoscopy, youll probably need to take things easy for 2 weeks. Recovery after a laparotomy will usually take longer, possibly around 6 to 8 weeks. If the cyst has been sent for testing, the results should come back in a few weeks. Your doctor will discuss with you whether you need any further treatment. Contact your GP if you notice the following symptoms after surgery, as they may indicate an infection: heavy bleeding severe pain or swelling in your abdomen a high temperature (fever) dark or smelly vaginal discharge Your fertility after surgery If you have not been through the menopause, your surgeon will try to preserve as much of your reproductive system as they can. Make sure you discuss your fertility concerns with your surgeon before your operation. Its often possible to just remove the cyst and leave both ovaries intact, which means your fertility should be largely unaffected. If one of your ovaries needs to be removed, the remaining ovary will still release hormones and eggs as usual. Your fertility shouldnt be significantly affected. But you may find it slightly harder to get pregnant. Occasionally, it may be necessary to remove both ovaries. This will trigger an early menopause . Youll no longer produce any eggs and will not be able to get pregnant. It may still be possible to have a baby by having a donated egg implanted into your womb. You can speak to your doctor for more information about this. If youve been through the menopause, both ovaries may be removed because they no longer produce eggs. Source: Scottish Government - Opens in new browser window Last updated: 03 March 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Menopause Early and premature menopause Women's health Other health sites RCOG: ovarian cysts before the menopause (PDF, 294kb) NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852" | null | null | null | null | null | null | null | null | null | null | null | null | null |
Overactive thyroid | Overactive thyroid - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Glands Overactive thyroid Overactive thyroid About overactive thyroids Symptoms of an overactive thyroid Causes of an overactive thyroid Diagnosing an overactive thyroid Treating an overactive thyroid Complications of an overactive thyroid About overactive thyroids Overactive thyroid (also known as hyperthyroidism) is a relatively common hormonal condition that occurs when there is too much thyroid hormone in the body. Excess levels of thyroid hormones can then speed up the bodys metabolism, triggering a range of symptoms, such as: nervousness and anxiety hyperactivity where a person cant stay still and is full of nervous energy unexplained or unplanned weight loss swelling of the thyroid gland, which causes a noticeable lump, known as a goitre, to form in the throat The severity, frequency and range of symptoms can vary from person to person. Read more about the symptoms of an overactive thyroid gland What causes an overactive thyroid gland? The thyroid gland is found in the neck. It produces hormones that are released into the bloodstream to control the bodys growth and metabolism. These hormones are called thyroxine and triiodothyronine. They affect processes such as heart rate and body temperature, and help convert food into energy to keep the body going. In hyperthyroidism, the thyroid gland produces too much thyroxine or triiodothyronine, which speeds up the bodys metabolism. There are several possible underlying causes, the most common being Graves disease, in which the bodys immune system targets the thyroid gland and causes it to produce too much of the thyroid hormones. Read more about the causes of an overactive thyroid gland Treatment An overactive thyroidusually responds well to treatment, and most people are able to control their symptoms. The 3 most widely used treatments for an overactive thyroid gland are: thionamides a group of medications, includingcarbimazole and methimazole,that stop the thyroid gland producing too much thyroid hormone radioiodine treatment a radioactive substance called iodine that helps shrink the thyroid gland, reducing its activity (the radiation contained in iodine is a very low dose and does not pose a threat to health) surgery in a small number of cases surgery may be required to remove some or all of thethyroid gland, particularly if there is a large goitre Beta-blockers may alsosometimes be usedto temporarily relieve many symptoms of an overactive thyroid gland, although it doesnt target the thyroid gland itself. Its common for treatment to lead to the thyroid not producing enough hormones. This is known as having an underactive thyroid gland (hypothyroidism) .However, anunderactive thyroid is notusually serious andis easily treated. Read more about the treatment of an overactive thyroid gland Complications Around 1 in 20 people with Graves disease will also develop symptoms affecting their eyes, such as: double vision sensitivity to light (photophobia) tearing (excess production of tears) This is known as Graves ophthalmopathy and should be seen by a doctor who specialises in treating eye conditions (an ophthalmologist). A rarer and more serious complication is asudden and severe flare-up of symptoms, known as a thyroid storm. A thyroid stormcan belife-threatening, as it causes severe dehydration and heart problems. Read more about the complications of an overactive thyroid gland Who is affected Women are 10 times more likely to have an overactive thyroid gland than men. In most cases, symptoms will begin somewhere between the ages of 20 and 40, though they can start at any age, including in childhood. An overactive thyroid gland occurs most frequently in white and Asian people, and less frequently inAfrican-Caribbeanpeople. Symptoms of an overactive thyroid An overactive thyroid (hyperthyroidism) has many signs and symptoms, although it is unlikely you would develop all of them. Symptoms of hyperthyroidism If you have hyperthyroidism, you may experience some of the following symptoms: hyperactivity mood swings such as anxiety , irritability and nervousness difficulty sleeping (insomnia) feeling tired all the time (fatigue) muscle weakness needing to poo or pee morefrequently excess fats in your poo which can make them greasy and difficult to flush down the toilet (steatorrhoea) sensitivity to heat and excess sweating unexplained or unexpected weight loss despite having an increased appetite (though in a small number of cases, the increase in appetite can lead to weight gain) very infrequent or light periods, or periods stopping altogether infertility loss of interest in sex If you have diabetes , your diabetic symptoms, such as extreme thirst and tiredness, may be made worse by hyperthyroidism. Signs of hyperthyroidism If you have hyperthyroidism, you may have some of the following physical signs: a swelling in your neck caused by an enlarged thyroid gland (goitre) irregular and/orunusually fast heart rate ( palpitations ) trembling or shaking (tremor) warm, moist skin redness on the palms of your hands loosening of your nails in their nail beds hives (urticaria) patchy hair loss (alopecia) twitching in your face and limbs When to seek medical advice See your GP if you are experiencing any of these symptoms. They may not be the result of an overactive thyroid gland, but they will need further investigation. It might be useful to make a list of your symptoms, as this can often be helpful in determining the correct diagnosis. Causes of an overactive thyroid Overactive thyroid (hyperthyroidism) occurs when your thyroid gland produces too much of the thyroid hormones thyroxine or triiodothyronine. Overproduction of thyroid hormones can be caused by a number of conditions. Graves disease Graves disease is the most common cause of overactive thyroid. It can run in families and can occur at any age, although it is most common in women aged 20 to 40 years old. You are more likely to develop Graves disease if you smoke. Graves disease is an autoimmune condition.This means the immune system mistakessomethingin the body for a toxic substance and attacks it. InGraves disease,it attacks thethyroid gland, whichleads to an overproduction of the thyroid hormones. It is not known what triggers the immune system to do this. Like many autoimmune conditions, it is thought that a combination of both genetic and environmental factors could be involved. If you have Graves disease, your eyes may also be affected, causing discomfort and double vision. This is known as Graves ophthalmopathy. You may findyour eyes bulge out or appear more prominent. For more information on Graves ophthalmopathy, read complications of an overactive thyroid gland . Thyroid nodules It is possible for lumps to develop in your thyroid gland. These are known as nodules. It is not known why nodules develop, but they are usually non-cancerous (benign). However, the nodules can contain abnormal thyroid tissue, which affects the normal production of thyroxine or triiodothyronine, causing an overactive thyroid. Nodules that contain abnormal thyroid tissue are described as toxic. Toxic thyroid nodules account for about1 in 20 cases of hyperthyroidism. Iodine supplements Iodine contained in the food you eat is used by your thyroid gland to produce the thyroid hormones thyroxine and triiodothyronine. However, taking additional iodine in supplements can cause your thyroid gland to produce too much thyroxine or triiodothyronine. This is known as iodine-induced hyperthyroidism sometimes referred to as Jod-Basedow phenomenon. It usually only occurs if you already have nodules in your thyroid gland. Amiodarone Amiodarone is a type of medication known as an anti-arrhythmic, which helps to control an irregular heartbeat (atrial fibrillation) . If you have non-toxic nodules in your thyroid gland, taking amiodarone can cause hyperthyroidism because it contains iodine. Amiodarone can cause a type of hyperthyroidism usually more severe and difficult to treat through a harmful effect on thyroid tissue. This type of hyperthyroidism is called amiodarone-induced hyperthyroidism. Follicular thyroid cancer In rare cases, you may develop an overactive thyroid as a result of thyroid cancer that starts in your thyroid follicles. This can occur if cancer cells in your thyroid gland begin to produce thyroxine or triiodothyronine. This is also known as functioning thyroid cancer. Diagnosing an overactive thyroid See your GP if you think you may have an overactive thyroid gland (hyperthyroidism). A diagnosis will be based on your symptoms and the results of blood tests that assess how well your thyroid gland is working. These are known as thyroid function tests. Thyroid function tests Your GP will take a sample of your blood and test it for levels of: thyroid-stimulating hormone (TSH) thyroxine and triiodothyronine (the thyroid hormones) TSH is made in the pituitary gland in your brain and controls the production of thyroxine and triiodothyronine. When the level of thyroxine and triiodothyronine in your blood are normal, your pituitary gland releases a normal level of TSH. When thyroid hormone production becomes excessive, the pituitary gland stops releasing TSH. When the level of thyroxine or triiodothyronine drops, the pituitary gland produces more TSH to boost it. If you have an overactive thyroid, the thyroid function test will show that levels of TSH in your blood are consistently lower than normal. Low levels of TSH mean your thyroid gland is overactive andlikely to be makingexcessive thyroid hormones. This is the first part of the thyroid function test. Your GP will then test your blood for levels of thyroxine and triiodothyronine. If you have an overactive thyroid, you will have higher than normal levels of both these hormones. Subclinical overactive thyroid gland In some cases, tests may show you havenormal thyroid hormone levels, but low or suppressed levels of TSH. This is known a subclinical overactive thyroid gland. If you are diagnosed with subclinical overactive thyroid, you may not need treatment. In most cases, the reduced level of TSH in your blood returns to normal within a couple of months and your subclinical hyperthyroidism will resolve by itself. However, you will need a further thyroid function test so your condition can be monitored. Determining the underlying cause If tests confirm an overactive thyroid gland, you may be referred for further tests to determine the underlying cause. An additional test that may be used is an isotope thyroid scan. This involves swallowing small amounts of a radioactive substance (an isotope), usually technetium, in capsule or liquid form. A scan is then used to measure how much of the isotope has been absorbed by your thyroid gland. If your thyroid gland absorbs a high amount of the isotope, it is likelythe underlying cause is either Graves disease or thyroid nodules. If the amount is low, the underlying cause could be due to: swelling (inflammation) of the thyroid gland (thyroiditis), often caused by your immune system mistakenly attacking thyroid tissue or, less commonly, by infection having too much iodine in your diet in rare cases, thyroid cancer Treating an overactive thyroid If you are diagnosed with an overactive thyroid gland (hyperthyroidism), your GP will refer you to a specialist in hormonal conditions (endocrinologist) to plan your treatment. Thionamides Thionamides, such as carbimazole and propylthiouracil, are a common treatment. They are a type of medication that stops your thyroid gland producing excess amounts of thyroxine or triiodothyronine. As thionamides affect the production of thyroid hormone rather than their current levels, you will need to take them for several weeks before you notice an improvement (usually between 4 to 8 weeks). Once the production of thyroid hormones is under control, your specialist may gradually reduce your medication. You may need to continue taking thionamides for a long time, until the condition is under control. Around 1 in 20 people will experience side effects when they first start taking thionamides, such as: itchy skin rash joint pain These side effects should pass once your body is used to the effects of the medication. In rare cases (around 1 in 500), thionamides cause a sudden drop in white blood cells (agranulocytosis), which can make you extremely vulnerable to infection. Symptoms of agranulocytosis include: fever gum pain, swelling and bleeding sore throat mouth ulcers persistent cough shortness of breath If you are taking thionamides and you experience any of the symptoms above, phone your GP immediately for advice and an urgent blood test. If this is not possible, phone 111 or your local out-of-hours service. Beta-blockers Beta-blockers, such as propranolol or atenolol, can relieve some of the symptoms of an overactive thyroid, including tremor (shaking and trembling), rapid heartbeat and hyperactivity. Your specialist may prescribe you a beta-blocker while the condition is being diagnosed, or untilthionamide brings your thyroid gland under control. However, beta-blockers are not suitable if you have asthma. Beta-blockers can sometimes cause side effects, including: feeling sick feeling tired all the time (fatigue) cold hands and feet trouble sleeping, sometimes with nightmares Radioiodine treatment Radioiodine treatment is a form of radiotherapy used to treat most types of overactive thyroid. Radioactive iodine shrinks your thyroid gland, reducing the amount of thyroid hormone it can produce. Radioiodine treatmentisgiven either as a drink or a capsule to swallow. The dose of radioactivity in the radioiodine is very low and is not harmful. Radioiodine treatment is not suitable if you are pregnant or breastfeeding, and may not be suitable if you have eye problems, such as double vision or prominent (bulging) eyes. Women should avoid getting pregnant for at least 6 months after having radioiodine treatment. Men should not father a child for at least 4 months after having radioiodine treatment. Most people only require a single dose of radioiodine treatment. If a further follow-up dose is required, it is usually given 6 to 12 months after the first dosage. A short course of thionamides treatment may be given a few weeks before radioiodine treatment, as this can lead to a more rapid relief of symptoms. Thionamides or radioiodine? In some cases, a particular treatment may be recommended based on factors such as your age, symptoms and the amount of extra thyroid hormone in your blood. However, there may be circumstances when you are offered a choice between a long-term course of thionamides or radioiodine treatment. Both treatments have advantages and disadvantages. Advantages of thionamides include: they are straightforward to take and you do not have to go to hospital to take them there is less risk of getting an underactive thyroid gland (hypothyroidism) as a result of treatment Disadvantages of thionamides include: treatmentmay not be as successful as radioiodine treatment there is a higher risk of side effects Advantages of radioiodine treatment include: treatment is usually very successful Disadvantages of radioiodine treatment include: there isa higher chance of your thyroid gland becoming underactive as a result of treatment radioiodine treatment is usually not suitable for people with additional symptoms affecting their eyes (Graves ophthalmopathy) women have to avoid getting pregnant for at least 6 months, and men should not father a child for at least 4 months after treatment You should discuss the potential risks and benefits of both types of treatment with the specialist in charge of your care. Surgery Surgery to remove all or part of the thyroid gland is known as a total or partial thyroidectomy. It is a permanent cure for recurrent overactive thyroid. Your specialist may recommend surgery if your thyroid gland is severely swollen (a large goitre) and is causing problems in your neck. Other reasons for surgery include: a person cannot be treated with radioiodine treatment as they are pregnant and are unable or unwilling to takethionamides a person has a severe form of Graves ophthalmopathy the symptoms return (relapse) after a previous successful course of treatment with thionamides It is normally recommended that the entire thyroid gland is removed, as this meansthere will be no chance of a relapse. However, you will need to take medication for the rest of your life to compensate for the lack of a functioning thyroid gland these will be the same medications used to treat an underactive thyroid gland . Complications of an overactive thyroid Several complications can occur with an overactive thyroid (hyperthyroidism), particularly if the condition is not treated. Graves ophthalmopathy If you have Graves disease, you may have problems with your eyes. This is known as Graves ophthalmopathyand is thought to be caused by the immune system mistakenly attacking the tissues of the eyes. Itaffects around1 in 20 people with Graves disease. Symptoms of Graves ophthalmopathy include: eyes feeling dry and gritty sensitivity to light (photophobia) excessive tearing double vision some loss of vision a feeling of pressure behind the eyes In more severe cases, your eyes can bulge prominently from your eye sockets. If you do develop Graves ophthalmopathy, you will probably be referred to an eye specialist (ophthalmologist) for treatment. Treatment options include: eyedrops to ease the symptoms sunglasses to protect the eyes against bright lights corticosteroids to reduce inflammation radiotherapy surgery Pregnancy and overactive thyroid Some women are pregnant when they are first diagnosed with an overactive thyroid gland. Becoming pregnant can lead to a relapse of symptoms, especially in someone with a history of Graves disease. Pregnant women with an overactive thyroid areat an increasedrisk of developing complications during pregnancy and birth, such as miscarriage and eclampsia . They are also more at risk of going into labour prematurely and having a baby with a low birthweight. Pregnant women will need specialist treatment, so the condition should be managed using medicationsthat dont affect the baby. This is likely to be a medication called propylthiouracil. Underactive thyroid In many cases, treatment causes the thyroid gland to releaselevels of hormones that are too low. This is known as having an underactive thyroid gland (hypothyroidism) . Sometimes this will only be a temporary side effect of treatment, but it can often be permanent. Symptoms of an underactive thyroid gland include: being sensitive to cold weight gain constipation depression tiredness An underactive thyroid gland is treated using medications to help replicate the effects of the thyroid hormones. Read more about the treating an underactive thyroid gland Thyroid storm An undiagnosed or poorly controlled overactive thyroid can lead to a rare but serious reaction called a thyroid storm. Itaffects around 1 in 100 people with an overactive thyroid gland. A thyroid storm is a severe and sudden flare-up of symptoms caused by the metabolism going into overdrive, often due to triggers such as: infection pregnancy not taking your medication as directed damage to the thyroid gland, such as a punch to the throat Symptoms of a thyroid storm include: a very rapid heartbeat (over 140 beats a minute) fever (a temperature higher than 38C/100.4F) dehydration , with diarrhoea and vomiting jaundice a yellow tinge to your skin and eyes severe agitation and confusion hallucinations seeing or hearing things that are not real psychosis being unable to tell the difference between reality and your imagination excessive sweating chest pain muscle weakness A thyroid storm is a medical emergency. If you think you or someone in your care is experiencing this complication, you need to phone 999 for an ambulance. Source: NHS 24 - Opens in new browser window Last updated: 01 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Underactive thyroid Other health sites British Thyroid Foundation NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Pagets disease of the nipple | "Paget's disease of the nipple - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Pagets disease of the nipple Pagets disease of the nipple About Pagets disease of the nipple Diagnosing Pagets disease of the nipple Treating Pagets disease of the nipple Preventing Pagets disease of the nipple About Pagets disease of the nipple Pagets disease of the nipple, also known as Pagets disease of the breast, is a rare type of breast cancer. The term Pagets disease of the nipple is used to distinguish the condition fromPagets disease of the bone, whichoccurs when the normal cycle of bone growth is disrupted, leading to the bones becoming weak and deformed. A similar type of skin cancer can also occur in other parts of the body. The rest of this section will use the term Pagets disease to refer to Pagets disease of the nipple or breast. Symptoms of Pagets disease Pagets disease usually affects the skin of one nipple andproduces eczema-like symptoms , appearing as an itchy, red rash on the nipple that can extend to the darker area of surrounding skin (the areola). It can also appear as a small ulcer or dry, red, flaky patches of skin similar to psoriasis . Other possible symptoms include: itchiness or a burning sensation alongside visible changes to the nipple bleeding from the skin of the nipple If youre experiencing itchiness, burning or bleeding but the nipple looks normal and isnt red, dry or scaly this is extremely unlikely to be Pagets disease but should still be checked by a doctor. Causes of Pagets disease Pagets disease is usually a sign of breast cancer in tissue behind the nipple, or breast tissue away from the nipple. The breast cancer can either be: invasive where cancerous cells invade the surrounding breast tissue non-invasive where the cancerous cells are contained in one or more areas of the breast and are unable to spread In a small amount of cases, the only evidence of Pagets disease is the nipple changes. In about half of all cases of Pagets disease of the nipple, a lump is found in the breast. The majority of people with a lump will have invasive breast cancer, although this does not necessarily mean it has spread. Most people with Pagets disease of the nipple who dont have a lump will have non-invasive breast cancer. Diagnosing Pagets disease You should visit your GP if you notice any changes in the skin of your nipple or areola (the darker area of skin around the nipple). As Pagets disease is a form of breast cancer, the sooner its diagnosed, the better the outcome is likely to be. Speak to your GP if you develop a lump in your breast. While most breast lumps are not cancerous, its importantyou have it checked out. Read more about: the symptoms of breast cancer how Pagets disease is diagnosed Treating Pagets disease Pagets disease is treated in the same way as breast cancer. Surgery isusually the first line of treatment but unlike other forms of breast cancer, it involves removing breast tissue that includes the nipple and areola. This may be followed by a combination of: chemotherapy where powerful medication is used to destroy cancerous cells radiotherapy where controlled doses of high-energy radiation are used to destroy cancerous cells biological or hormone therapy which can be used to treat certain types of cancer If Pagets disease is detected and treated in its early stages, theres a good chance of recovery. Read more about how Pagets disease is treated. Preventing Pagets disease Modifying certain lifestyle factors, such as reducing alcohol intake and regular exercise, may reduce your risk of developing certain types of cancer , including breast cancer. However, these factors remain controversial. Screening is also used to help detect breast cancer early. The NHS Breast Screening Programme provides free breast screening every 3 years for all women in the UK who are 47 years of age or over. Read more about preventing breast cancer . Risk factors for breast cancer There are a number of factors that can increase your risk of developing breast cancer. These include: age your risk of developing breast cancer increases as you get older family history if you have a number of close relatives with breast cancer, your chances of also developing the condition are increased previously being diagnosed with breast cancer previously having a benign breast lump certain types of benign lump may slightly increase your risk but this is only seen in a small number of women being overweight which is especially significant in post-menopausal women alcohol your risk of developing breast cancer can increase with the amount of alcohol you drink Information about you If you have Pagets disease of the nipple, your clinical team will pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the register . Diagnosing Pagets disease of the nipple As Pagets disease of the nipple is usually a sign of breast cancer, its very important you speak to your GP if you notice changes to the tissue or skin of your breast. In particular, you should tell your GP if you notice any changes to: the skin of your nipple or areola (the darker area of skin around thenipple) your breasts, particularlylumps in your breast Pagets disease of the nipple can sometimes be confused with eczema , a skin condition that alsocauses red, itchy and dry skin. Therefore, you should visit your GP for a diagnosis ratherthan assuming you have eczema. Pagets disease is a formof breast cancer andthe sooner its diagnosed, the better the outcome is likely to be. Your GP will examine both breasts, even if you only have a problem withone of them. They may also ask you: about your symptoms and how long you have had them whether you have a history of eczema, or have eczema anywhere else on your body whether you have a personal or family history of breast cancer your age and whether you have experienced the menopause (when a womans monthly periods stop) whether youre taking any medication, including hormone replacement therapy (HRT) , which is used to treat some of the symptoms of the menopause, or the oral contraceptive pill how much alcohol you drink how much you weigh and if you have recently gained weight If your GP thinks you may have breast cancer, they will refer you to a specialist breast clinic for tests. Breast clinic When you visit a breast clinic you will have tests to find out whether you have breast cancer and, if you have,what type of breast cancer. Staff at the clinic may take photographs of your breasts to record their current appearance and to help identify any further changes that may occur. Tests carried out at the clinic may include the following: an examination of your breast to check for lumps or other abnormalities amammogram (if you are35 years of age or over) an ultrasound scan which is the first line of investigation used in younger women a skin biopsy will be carried out if Pagets disease is suspected Mammogram A mammogram is a simple procedure that uses X-rays to create an image of the inside of your breasts. It can identify early changes in your breast tissue when it may be difficult to feel a lump. Younger women oftenhave denser breasts than older women, which can make identifying changes more difficult. Therefore, mammograms are not as effective in women under 35 years of age. If youre under 35, your doctor may suggest you have a breast ultrasound instead. However after a diagnosis of Pagets disease has been confirmed, mammography will become an important part of pre-surgery assessment. Duringa mammogram, the radiographer will position 1 of your breasts on a flat X-ray plate. A second X-ray plate will press down on your breast from above, so that it is temporarily compressed and flattened between the 2 plates. An X-ray will be taken, which will give a clear image of the inside of your breast. The procedure will then be carried out on your other breast. Having a mammogram can be slightly uncomfortable or even painful, but the procedure will only take a few minutes. Your doctor will examine the image produced by a mammogram for indications of cancer. Breast ultrasound If you are under35 years of age, a breast ultrasound may be recommended. This is because your breast tissue may be too dense for a mammogram. Your doctor may also suggest a breast ultrasound if they need to find out whether a lump in your breast is solid or contains liquid. Ultrasound uses high-frequency sound waves to produce an image of the inside of your breasts. An ultrasound probe or sensor will be placed over your breasts to create an image on a screen. The image will show any lumps or abnormalitiespresent in your breasts. Skin biopsy Askin biopsy is used to diagnose Pagets disease. A biopsy is where a small sample of tissue is taken for examination under a microscope and tests to see if it is cancerous. Further tests There are a number of other tests that can be used if a diagnosis of breast cancer is confirmed and help determine what types of treatment might be used. Treating Pagets disease of the nipple Pagets disease of the nipple is often associated with other forms of breast cancer. Its usuallytreated in the same way as more common types of breast cancer, either by removing the cancerous section of the breast or sometimes by removing the entire breast a procedure known as a mastectomy. You can discuss any concerns you have with your oncologist (cancer specialist) who will be able to explain each phase of your treatment. Surgery If youre diagnosed with Pagets disease, surgery is often the first form of treatment you will receive. There are 2 main types of surgery. They are: mastectomy surgery to remove the whole breast, which can be followed by reconstructive surgery to recreate the removed breast breast-conserving surgery surgery to remove the cancerous lump (tumour) in your breast These types of surgery will also involve removing your nipple and the darker area of skin surrounding it (the areola). Mastectomy A mastectomy removes all your breast tissue, including your nipple. You may need to have a mastectomy if: the tumour is large or in the centre ofyour breast there is more than one area of breast cancer breast-conserving surgery (see below) is not able to provide acceptable results If lymph nodes (small glands) are removed from your armpit during a mastectomy, the scarring may block the filtering action of the lymph nodes, resulting in a condition called lymphoedema. This is a long-term condition, but can be treated with: massage compression sleeves tightly fitting bandages that push excess fluid out of your arm Lymphoedema can develop months or sometimes years after surgery. See your breast care nurse or GP if you notice any swelling in your arm or hand on the side of your operation. Breast-conserving surgery Breast-conserving surgery aims to save as much of your breast as possible while removing the cancer with a rim of healthy tissue. If you have Pagets disease, your nipple and areola will be removed. You should be offered reconstructive surgery to improve the appearance of your breast after surgery. If you have breast-conserving surgery, the amount of breast tissue removed will depend on: the size of the tumour in relation to the size of your breast whether the tumour is in one place or scattered throughout your breast Your surgeon will remove an area of healthy breast tissue around the cancer so it can be tested for traces of cancer. If cancer cells are found in the surrounding tissue, you may need to have more tissue surgically removed from your breast. After having breast-conserving surgery, its likely you will need radiation treatment ( radiotherapy ) to destroy any remaining cancer cells. Breast reconstruction If you have a mastectomy, you may be able to have reconstructive surgery to recreate your breast. This can be done by: inserting a breast implant using tissue from another part of your body to create a new breast The reconstruction can be carried out at the time of your mastectomy or at a later stage. You should discuss your options fully with your surgeon and breast nurse before making a decision. For example, it may be possible to have reconstructive surgery after breast-conserving surgery to improve the appearance of your breast and create a nipple. Creating a nipple A nipple can be created by: having a nipple tattooed onto the skin using your own body tissue, such as tissue from your other nipple, although around half of these flatten out and shrink over time using a stick-on latex (rubber) nipple, which can be made from a mould of your other nipple so thatthey are identical; you stick it on every day with glue and it can be removed for washing Prostheses If you decide not to have breast reconstruction, you can wear a false breast or breast prosthesis, which are available free on the NHS. After having a mastectomy, you may have a temporary, fibre-filled prosthesis and a permanent prosthesis made from silicone, which can be replaced every 2 years. Further treatment After your surgery, you may need further treatment if you have invasive breast cancer, where the cancerous cells have spread into other tissue in your breast. If you had non-invasive breast cancer, where the breast cancer cells were contained in one area of your breast, surgery may be all the treatment you need. Other types of treatment for breast cancer include: chemotherapy cytotoxic medication that prevents cancer cells from dividing and growing is used to destroy cancer cells radiotherapy where controlled doses of high-energy radiation, usually X-rays , are used to destroy cancer cells biological therapy if your breast cancer is HER2 positive, biological therapy, usually a medication called trastuzumab, can be used to treat the cancer by stopping the effects of HER2 and helping your immune system fight off cancer cells hormone therapy if your breast cancer is hormone-receptor positive, hormone therapy can be used to treat the cancer by lowering the levels of hormones in your body or stopping their effects Preventing Pagets disease of the nipple A number of factors can help reduce your risk of developing breast cancer, including Pagets disease of the nipple. Diet and lifestyle Exercising regularly and eating a healthy, balanceddiet are knownto help preventmany forms of cancer, as well as other serioushealth conditions, such as heart disease and diabetes . Studies have looked at the link betweenbreast cancerand diet and, although there are no definite conclusions at the moment, there are benefits for women who maintain a healthy weight , do regular exercise and who have a low intake of saturated fat and alcohol . It has been suggested that exercising regularly (a minimum of 150 minutes or 2 hours 30 minutes a week)can reduce your risk of developing breast cancer byup toa third. If you have been through the menopause (when your monthly periods stop), its particularly important you are not overweight or obese. This is because these conditions cause more oestrogen to be produced, which can increase the risk of breast cancer. Breastfeeding Studies have shown that women who breastfeed are statistically less likely to develop breast cancer than those who dont. The reasons are not fully understood, but it could be because women dont ovulate as regularly while they are breastfeeding and oestrogen levels remain stable. Medication In June 2013, the National Institute for Health and Care Excellence (NICE) announced that two medications, called tamoxifen and raloxifene, would be available on the NHS for women who have an increased risk of developing breast cancer. Either tamoxifen or raloxifene can be used in women who have been through the menopause, but only tamoxifen should be used in women who havent. These medications may not be suitable if in the past you have had blood clotsor womb cancer , or if you have an increased risk of developing these problems in the future. Women who have already had a mastectomy to remove both breasts wont be offered these medications because their risk of developing breast cancer is so small. A course of treatment with tamoxifen or raloxifene will usually involve taking a tablet every day for 5 years. Raloxifene can cause side effects including flu-like symptoms, hot flushes and leg cramps. Side effects of tamoxifen can include hot flushes and sweats, changes to your periods and nausea and vomiting. Your chances of giving birth to a child with birth defects increases while youre taking tamoxifen, so youll be advised to stop taking it at least 2 months before trying for a baby. The medication can also increase your risk of blood clots so you should stop taking it 6 weeks before any planned surgery. Currently, these 2 medications are not licensed for the purpose of reducing the risk of breast cancer in women with an increased risk of developing the condition. However, they can still be used if you understand the benefits and risks and your doctor believes the treatment will be helpful. Breast screening Breast screening can pick up breast cancer before it forms a lump. The procedure uses mammograms, where X-rays are taken,to create an image of the inside of your breasts. TheNHS Breast Screening Programme provides free breast screening every 3 years for all women in the UK who are 50 years of age or over. The NHS has recently extended the breast screening age range so that all women who are 47to 73 years of age will be eligible for breast screening. NHS breast screening is not usually available for women under 47 years of age. This is because younger women tend to have denser breast tissue which makes mammograms less effective at identifying abnormalities. Speak to your GP if you are below screening age, worried about changes in your breasts, orhave a family history of breast cancer. Read more information about breast cancer screening . 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Pancreatic cancer | Pancreatic cancer | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Pancreatic cancer Pancreatic cancer About pancreatic cancer Treating pancreatic cancer Symptoms of pancreatic cancer Causes of pancreatic cancer Diagnosing pancreatic cancer Recovering pancreatic cancer About pancreatic cancer Pancreatic cancer is caused by the abnormal and uncontrolled growth of cells in the pancreas a large gland thats part of the digestive system. Around half of all new cases are diagnosed in people aged 75 or over. Its uncommonin people under 40 years of age. Symptoms of pancreatic cancer In the early stages, a tumour in the pancreas doesnt usually cause any symptoms, whichcan make it difficult to diagnose. Its important to remember that these symptoms can be caused by many different conditions, and arent usually the result of cancer.But you should contact your GP if youre concerned, or if these symptoms start suddenly. The first noticeable symptoms of pancreatic cancer are often: pain in the back or stomach areawhich may come and go at first and is often worse when you lie down or after youve eaten unexpected weight loss jaundice the most obvious sign is yellowing of the skin and whites of the eyes;it also causes your urine to be dark yellow or orange and your stools (faeces) to be pale-coloured Other possible symptoms of pancreatic cancer include: nausea and vomiting bowel changes fever and shivering indigestion blood clots You may also develop symptoms of diabetes if you havepancreatic cancer, because it can produce chemicals that interfere with the normal effect of insulin. Endocrine pancreatic cancer There are also anumber of different endocrine tumours that cause different symptoms, depending on the hormone the tumour produces. Causes of pancreatic cancer Its not fully understood what causes pancreatic cancer, but a number of risk factors for developing the condition have been identified. Risk factors for pancreatic cancer include: ageit mainly affects people who are 50 to 80 years of age smoking around 1 in 3 casesis associated with using cigarettes, cigars or chewing tobacco having a history of certain health conditionssuch as diabetes , chronic pancreatitis (long-term inflammation of the pancreas), stomach ulcer and Helicobacter pylori infection (a stomach infection) In about 1 in 10 cases, pancreatic cancer is inherited from a persons parents. Certain genes also increase your chances of getting pancreatitis, which in turn increases your risk of developing cancer of the pancreas. Cancer Research UK has more information on risk factors and causes on their website Diagnosing pancreatic cancer Your GP will first ask about your general health and carry out a physical examination. Theymay examine your tummy (abdomen) for a lump and to see whether your liver is enlarged. Theyll also check your skin and eyesfor signs ofjaundice andmay request a urine sample and blood test . If your GP suspects pancreatic cancer, youll usually be referred to a specialist at a hospital for further investigation. You may have either: an ultrasound scan a computerised tomography (CT) scan a magnetic resonance imaging (MRI) scan apositron emission tomography (PET) scan where youre given an injection of a very small amount of radioactive medication, known as a tracer, which helps to show up cancers in an image Depending on the results of a scan, further tests may include: anendoluminal ultrasonography (EUS)endoscopy a type of endoscopywhich allowsclose-up ultrasound pictures to be taken of your pancreas an endoscopic retrograde cholangiopancreatography (ERCP) a type of endoscopywhich is used to inject a special dye into your bile and pancreatic ducts; the dye will show up on an X-ray and highlight any tumours alaparoscopy a surgical procedure that allows the surgeon to see inside your body using a laparoscopy(a thin,flexible microscope) A biopsy , where a small sample is taken from a suspected tumour, may also be carried out during these procedures. NICE guidelines In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of pancreatic cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected pancreatic cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral . Treating pancreatic cancer Cancer of the pancreas is difficult to treat. Itrarely causes any symptoms in the early stages, so its often not detected until the cancer is fairly advanced. If the tumour islarge, treating the cancer will be more difficult. If youve been diagnosed with pancreatic cancer, your treatmentwill depend on the type and location of your cancer, and how far its advanced. Your age, general health and personal preferences will also be taken into consideration. The first aim will be to completely remove the tumour and any other cancerous cells. If this isnt possible, treatment will focus on preventing thetumour growing and causing further harm to your body. The 3 main treatments for pancreatic cancer are: surgery chemotherapy radiotherapy Some types of pancreatic cancer only require one form of treatment, whereas others may require2types of treatment or a combination of all 3. Read more about treating pancreatic cancer . Recovering from surgery Recovering from pancreatic cancer surgery can be a long and difficult process. Youll probably experience some pain after your operation. The staff at your hospital will make sure you have adequate pain relief. After any type of surgery to your digestive system, your bowel will temporarily stop working. This means you wont be able to eat or drink straight away. Youll gradually be able to sip fluids, before eventually being able to drink and eat more regularly. You maybe referred to a dietitian, who can advise you about what foods you should eat following your operation. After the tumour has been removed, youll probably have a six-month course of chemotherapy , which greatly increases your chance of being cured.But becausecancer of the pancreas is difficult to diagnose and treat, many people dont recovercompletely. Treatment can be very effective in helping to ease symptoms and make you as comfortable as possible. Chemotherapy can help shrink your tumour and slow down its growth. Treating pancreatic cancer Treatment for pancreatic cancer depends on the type, location and stage of your cancer (how far its spread). Your age, general health and personal preferences will also be taken into consideration when deciding on your treatment plan. The first aim will be to completely remove the tumour and any other cancerous cells in your body. If this isnt possible, the focus will be on preventing the tumour growing and causing further harm. Sometimes its notpossible to get rid of the cancer or slow it down,so treatment will aim to relieve your symptoms and make you as comfortable as possible. Cancer of the pancreas is very difficult to treat. In its early stages, this type of cancer rarely causes symptoms, so its often not detected until its quite advanced. If the tumour is large or has spread, treating or curing the cancer is much harder. Discussing your treatment Deciding what treatment is best for you can be a difficult process. Theres a lot to take in, so its important to talk about the possible alternatives with a family member or friend. You should also have an in-depthdiscussion with your doctor, who can tell you the pros andcons of the treatments available to you. If at any stage you dont understand the treatment options being explained to you, make sure you ask your doctor for more details. There are 3 main ways that cancer of the pancreas can be treated: surgery chemotherapy radiotherapy Some types of pancreatic cancer only require one form of treatment, whereas others may require 2 or a combination of all 3. Cancer Research UKhas more information about types of treatment for pancreatic cancer . Surgery Surgery is usually the only waypancreatic cancer can be completely cured. However, as the condition is usually advanced by the time its diagnosed, surgery is only suitable for around 15 to 20% of people. However, this isnt a suitable optionif your tumour has wrapped itself around important blood vessels. If your cancer has spread to other areas of the body, surgically removing the tumour wont cure you. Surgery for pancreatic cancer is usually only an option for people who have a good general level ofhealth. This is because pancreas surgery is often long and complex, and the recovery process can be slow. Sometimesthe risks of surgerycan outweigh the potential benefits. Your doctor will discuss with you whether surgery is a suitable option. Whipple procedure The Whipple procedure is the most common operation used to treat pancreatic cancer, and involves removing the head of the pancreas. Your surgeon must also remove the first part of your small intestine (bowel), your gall bladder (which storesbile)and part of your bile duct. Sometimes, part of the stomach also has to be removed. The end of the bile duct and the remaining part of your pancreas is connected to your small intestine. Thisallows bile and the hormones and enzymes produced by the pancreas to still be released intoyour system. After this type of surgery, about one in three people need to take enzymes to help them digest food. The Whipple procedure involves long and intensive surgery, but its easier to recover from than a total pancreatectomy. Distal pancreatectomy A distal pancreatectomy involvesremoving the tail and body of your pancreas. Your spleen will usually also be removed at the same time. Part of your stomach, bowel, left adrenal gland, left kidney and left diaphragm (the muscle that separates the chest cavity from the abdomen) may also be removed. Like the Whipple procedure, a distal pancreatectomy is a long and complex operationthat wont be carried outunless your doctor thinks its necessary. Total pancreatectomy During a total pancreatectomy, your entire pancreas will be removed. This is sometimes necessary due to the position of the tumour. Your surgeon will also remove your: bile duct gall bladder spleen part of your small intestine part of your stomach (sometimes) surrounding lymph nodes (part of the immune system) After a total pancreatectomy, youll need to take enzymes to help your digestive system digest food. Youll also have diabetes for the rest of your life because the pancreas produces insulinthe hormone that regulates blood sugar. Removing your spleen can increase your risk of developing infections and may also affect your bloods ability to clot. This means youll be on penicillin (or an alternative antibiotic if youre allergic to it) for the rest of your life, and youll need to have regular vaccinations. Sometimes, you may need to take tablets for a short period to stop the platelets in your blood sticking to each other. Platelets are a type of bloodcellthat cause your blood to clot (thicken). Surgery to ease your symptoms Although surgery may not be a suitable way of removing your tumour, you may be offeredit to help ease your symptoms. This type of surgery wont cure your cancer, but will mean that your condition is easier to manage, and it will make you more comfortable. To help control jaundice, a stent can be placed in your bile duct using endoscopic retrograde cholangiopancreatography (ERCP). This will help keep the bile duct open and prevent bilirubinthe yellow chemical in bilefrom building up and causing jaundice. If a stent isnt a suitable option for you, you may need an operation to bypass your blocked bile duct. Your surgeon will cut the bile duct just above the blockage and reconnect it to your intestine, which allows your bile to drain away. These types of surgery are much less intensive than surgery carried out on the pancreas. The recovery time is much quicker, andpeople find that theirjaundice improves significantly. Chemotherapy Chemotherapyis a type of cancer treatment that uses anti-cancer medicines to either kill the cancerous (malignant) cells in your body or stop themmultiplying. Chemotherapy treatment is often used alongside surgery and radiotherapy (see below) to help ensure that as much of the cancer is treated as possible. Chemotherapy may be given: before surgeryto try to shrink the cancer, so theres a greater chance of the surgeon being able to remove all of the cancer after surgeryto help reduce the risk of the cancer coming back when surgery isnt possibleto try to shrink the cancer, slow its growth and relieve your symptoms Some chemotherapy medicines can be taken orally (by mouth), but some need to be given directly into a vein (intravenously). Chemotherapy also attacksnormal, healthy cells, which is why this type of treatment can have many side effects. The most common side effects include: vomiting nausea mouth sores fatigue increased risk of infection These are usually only temporary, and should improve once youve completed your treatment. The chemotherapy medications can also be used in combination, so your doctor may suggest using one medication or a combination of 2 or 3. Combining chemotherapy medications can give a better chance of shrinking or controlling the cancer, but increases the chance of side effects.Sometimes, the risks of chemotherapy can outweigh the potential benefits. Read more about chemotherapy Radiotherapy Radiotherapyis a form of cancer therapy that uses high-energy beams of radiation to help shrink your tumour and relieve pain. Side effects of radiotherapycan include: fatigue skin rashes loss of appetite diarrhoea nausea or vomiting These side effects are usually only temporary, and should improve after your treatment has been completed. Read more about radiotherapy Symptoms of pancreatic cancer In its early stages, pancreatic cancer rarely causes symptoms. The pancreas is actually 2 glands in one, and symptoms depend on which part is affected. This is because: the exocrine pancreas produces digestive enzymes, which break down food so they can be absorbed by your body the endocrine pancreas produces hormones including insulin, which keeps your blood sugar levels stable Most casesof pancreatic cancer arein the exocrine pancreas, and the 3 most common symptoms are: pain in the stomach orback jaundice weight loss Its important to remember that these symptoms can be caused by many different health conditions and arent usually the result of cancer.However, you should contact your GP if youre concerned, or if yousuddenly develop these symptoms. Pain in the stomach orback Pancreatic cancer can cause a dull pain in your upper tummy (abdomen), which mayspread to your back. To begin with, the pain may come and go, but as the tumour becomes larger and more advanced, the pain may be more constant and last longer. The pain is often worse when you lie down or after youve eaten. You may also have pain or tenderness in your abdomen if your liver, pancreas or gallbladder are enlarged. Weight loss Many types of cancer cause weight loss, because the cancerous cells deprive your healthy cells of the nutrients they need. Pancreatic cancer is more likely to cause weight loss than some other cancers because the pancreas produces digestive enzymes, which help food to be absorbed into your body. If a tumour disrupts that production, your body will find it harder to digest food, particularly high-fat foods. This can cause you to lose weight and becomemalnourished. Jaundice Jaundice is caused by a build-up of a yellowish-brown substance called bilirubin in the blood and tissues of the body. The most obvious sign of jaundice is yellow skin and yellowing of the whites of the eyes. It also causes your urine to be dark yellow or orange and your stools (faeces) to be pale-coloured. Bilirubin is a waste product produced by the liver, and passed out of the body through the bile duct andinto the intestine. Jaundice is more often a sign of conditions such as gallstones or hepatitis than it is of cancer. However, a tumour can sometimes develop in the head of the pancreas and block the bile duct, causing bilirubin to build upin the body. Diabetes The pancreas produces thehormoneinsulin. Without it, the body cant move glucose (sugar) out of the blood and into your cells. The main symptoms of diabetes include: excessive thirst urinating frequently particularly at night extreme tiredness weight loss and loss of muscle bulk You may develop diabetes if you havepancreatic cancer, because it can produce chemicals that interfere with the normal effect of insulin. Other possible symptoms Other possible symptoms of pancreatic cancer include: itching (if you have jaundice) nausea and vomiting bowel changes fever and shivering indigestion blood clots Endocrine pancreatic cancer Endocrine pancreatic tumours, also known as neuroendocrine tumours, are uncommon. There are a number of different endocrine tumours that cause different symptoms, depending on the hormone the tumour produces. Causes of pancreatic cancer The exact cause of pancreatic cancer isnt fully understood. However, there are a number of risk factorsthat can increase your chances of developing it. Age Pancreatic cancer can affect people of any age, but itmainly affects people who are aged 50 to 80. Almost 50% of people diagnosed with cancer of the pancreas are aged 75 or over. Smoking Research has found that about one in three cases of pancreatic cancer is associated with smoking and other tobacco use. Smoking cigarettes, cigars or chewing tobacco can all increase your risk of developing cancer of the pancreas. This is because tobacco smoke contains harmful chemicals and toxins that can cause irritation and inflammationwithin your bodys organs andtissues. Diabetes If you have diabetes , your risk of developing pancreatic cancer is thought to beincreased. However, its important to remember that diabetes is very common and most people with diabetes wont develop pancreatic cancer. As well as diabetes being a risk factor for pancreatic cancer, its also thought that a cancerous tumour that grows in the pancreas could be responsible for some cases of diabetes. Chronic pancreatitis and hereditary pancreatitis Chronicpancreatitis (long-term inflammation of the pancreas) increases your risk of getting pancreatic cancer, butisnt responsible for many cases. Chronic pancreatitis is often caused by long-term alcohol misuse . Although its a veryrare condition, if you have hereditary pancreatitis, yourrisk of developing pancreatic cancer is 50 times greater than the rest of the population. Helicobacter pylori infection Helicobacter pylori are bacteria that cause stomach ulcers, and is a known risk factor for stomach cancer. Research has shown that a Helicobacter pylori infection may slightlyincrease your risk of getting pancreatic cancer. However, the risk is thought to be small because most people withthis infection dont get cancer of the pancreas. Other known risk factors There are also a number of other factors that have been associated with an increased risk of pancreatic cancer. These are: long-term hepatitis tooth or gum disease heavy alcohol use a previous history of certain types of cancer previously having radiotherapy diet , weight and level of physical activity The Cancer Research UK website hasmore information about these other possible risk factors for pancreatic cancer . Diagnosing pancreatic cancer In the early stages, pancreatic cancer often causes no symptoms. This can make it difficult to diagnose. If you visit your GP with symptoms of pancreatic cancer ,they will probably examine your eyes and skin for signs of jaundice. They may also test your urine for bile, or carry out a blood test . This is because jaundice can sometimes be a sign of pancreatic cancer. Your GP may also examine your tummy (abdomen) to feel for any swelling or abnormality. The pancreas is quite well-hidden within the body because its covered by part of the bowel. This can make it difficult to feel for tumours during a physical examination. Ifyour GP suspects pancreatic cancer, youll be referred for further testing at a hospital. In 2015, the National Institute for Health and Care Excellence ( NICE ) published guidelines to help GPs recognise the signs and symptoms of pancreatic cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected pancreatic cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral . Ultrasound scan An ultrasound scan is a painless procedure that uses high-frequency sound waves to produce an image of the inside of your body. Ifpancreatic cancer is suspected, youll be referred for an ultrasound scan of your abdomen to see if your pancreas appears abnormal. However, this type of scan can often miss pancreatic cancer, because ultrasound waves arent very goodat penetrating deep into body tissues. Computerised tomography (CT) scan A computerised tomography (CT)scan produces a detailed image of the inside of your body using a series of X-ray images. Your doctor can use the results of a CTscan to check for abnormalities and assess the size of the tumour. Magnetic resonance imaging (MRI) scan A magnetic resonance imaging (MRI) scan also produces an image of the inside of your body, but it uses strong magnetic and radio waves instead of X-rays. MRI scans are carried out in a tube-shapedMRI scanner. Its a noisy procedure thatcan feel claustrophobic. It also takes longer than other types ofscans. Like a CT scan, an MRI scan allows your doctor to check for signs of cancer in other parts of the body. Positron emission tomography (PET) scan A positron emission tomography (PET) scan can help to show where the cancer is and whether it has spread to other parts of the body. Before the scan, youll be given an injection of a very small amount of a radioactive medication, known asa tracer. The amount ofradiation is very small and no more than you would receive from a normal X-ray. The most common tracer used is a radioactive form of glucose (sugar).Youll then rest for about an hour to allow the tracer to travel to areas in your body where glucose is used for energy. The scan itself can take up to an hour and produces an image of the tracer in your body. The tracer shows up cancers because they use glucose in a different way to normal tissue. Endoluminal ultrasonography (EUS) If a small shadow is seen on a CT or MRI scan but its not obvious what itis, another test called endoluminal ultrasonography (EUS) can be carried out. During EUS, a thin, flexibleinstrument calledan endoscope is passed through your mouth and guided towards your stomach. An ultrasound probe attached to the tip of the endoscope will then be used to take close-up pictures of your pancreas. Before the procedure, you may be given a sedative to help you relax. EUS can also be used to take a biopsy for further examination. Endoscopic retrograde cholangiopancreatography (ERCP) Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure used to insert a plastic tube or stent into the bile duct ifsomeone hasjaundice. During ERCP, an endoscope is passed through your mouth and guided towards your stomach. The endoscope can then be used to inject a special dye into your bile and pancreatic ducts. After the dye has been injected, an X-ray will be taken. The dye will show up on the X-ray and will highlight any tumour thats blocking the bile and pancreatic ducts. During the procedure, tissue samples may be taken. These samples can be looked at under a microscope to see whether the cells are cancerous. ERCP can take 30 to 60 minutes. As with EUS, youll usually be given a sedative to help you relax. Laparoscopy Alaparoscopy is a surgical procedure that allows the surgeon to access the inside of your abdomen and pelvis. During the procedure, a smallincision will be made in your abdomen, and a laparoscope (a thin,flexible microscope) will be inserted. This will allow the surgeon to see inside your body and make sure the tumour hasnt spread before recommending its removal. This procedure will be carried outunder a general anaesthetic (where youre put to sleep so you dont feel any pain or discomfort). Biopsy A biopsy involves taking a sample from a suspected tumour, whichcan then be tested to see if its cancerous (malignant) or non-cancerous (benign). A biopsy can be carried out during an EUS, ERCP or laparoscopy usinga small instrument attached to the endoscope to collect a number of cells. Its also possible for abiopsy to be carried out using a long, thin needle thats passed through your abdomen. The needle will be guided towards the tumour using an ultrasound or CT scan. Recovering pancreatic cancer Recovering from pancreatic cancer surgery can be a long and difficult process. Youll probably experience some pain after your operation. The staff at your hospital will make sure you have adequate pain relief. After any type of surgery to your digestive system, your bowel will temporarily stop working. This means you wont be able to eat or drink straight away. Youll gradually be able to sip fluids, before eventually being able to drink and eat more regularly. You maybe referred to a dietitian, who can advise you about what foods you should eat following your operation. After the tumour has been removed, you will probably have a 6-month course of chemotherapy , which greatly increases your chance of being cured. However, as cancer of the pancreas is difficult to diagnose and treat, many people dont recovercompletely. Treatment can be very effective in helping to ease symptoms and make you as comfortable as possible. Chemotherapy can help shrink your tumour and slow down its growth. Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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Panic disorder | Panic disorder | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mental health Panic disorder Panic disorder Introduction Symptoms Causes Diagnosis Treatment Things you can do to help yourself Complications Introduction Panic disorder is where you have recurring and regular panic attacks, often for no apparent reason. Everyone experiences feelings ofanxiety and panic at certain times during their lifetime. Its a natural response to stressful ordangerous situations. However, for someone with panic disorder, feelings of anxiety, stress and panic occur regularly and at any time. Anxiety Anxiety is a feeling of unease. It can range from mild to severe and can include feelings of worry and fear. There are several conditions that can cause severe anxiety including phobias an extreme or irrational fear of an object, place, situation, feeling or animal generalised anxiety disorder (GAD) a long-term condition that causes excessive anxiety and worry relating to a variety of situations post-traumatic stress disorder a condition with psychological and physical symptoms caused by distressing or frightening events Panic attacks A panic attack occurs when your body experiences a rush of intense psychological (mental) and physical symptoms. You may experience an overwhelming sense of fear, apprehension and anxiety. As well as these feelings, you may also have physical symptoms such as: nausea sweating trembling a sensation that your heart is beating irregularly (palpitations) The number of panic attacks you have will depend on how severe your condition is. Some people may have one or two attacks each month, while others may have several attacks a week. Read more about the symptoms of panic disorder . Panic attacks can be very frightening and intense, but theyre not dangerous. An attack wont cause you any physical harm, and its unlikely that youll be admitted to hospital if youve had a panic attack. What causes panic disorder? As with many mental health conditions, the exact cause of panic disorder isnt fully understood. However, its thought the condition is probably linked to a combination of physical and psychological factors. Read about the possible causes of panic disorder . Its important to be aware that some physical conditions and disorders can have similar symptoms to those of anxiety. For example: mitral valve prolapse postural orthostatic tachycardic syndrome (POTS) anaemia paroxysmal atrial tachycardia episodes of rapid and regular heartbeats that begin and end abruptly thyrotoxicosis where large amounts of thyroid hormones are released into the bloodstream, causing rapid heartbeat, sweating , tremor and anxiety poorly controlled diabetes adrenal tumours growths that develop on the adrenal glands (two triangular-shaped glands that form part of the kidneys) carcinoid syndrome a set of symptoms caused by some carcinoid tumours that can develop in the cells of the endocrine system (glands that produce and secrete hormones) Zollinger-Ellison syndrome causes overproduction of insulin and low blood sugar ( hypoglycaemia ) Diagnosing panic disorder See your GP if you have symptoms of anxiety or panic disorder (see above). You may be diagnosed with panic disorder if you experience recurrent and unexpected panic attacks followed by at least one month of continuous worry or concern about having further attacks. Read more about how panic disorder is diagnosed . Treating panic disorder The aim of treating panic disorder is to reduce the number of panic attacks you have and ease the severity of your symptoms. Psychological therapy and medication are the two main types of treatment for panic disorder. Read more about treating panic disorder and things you can do to help yourself during a panic attack . Having panic disorder may affect your ability to drive. Its your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA) about a medical condition that could have an impact on your driving ability. GOV.UK has further information and advice about driving with a disability or health condition . Complications of panic disorder Panic disorder is treatable, but to make a full recovery its important that you seek medical help as soon as possible. Treatment for panic disorder is much more effective if its given at an early stage. Left untreated, panic disorder can become a very debilitating and isolating illness. It can also increase your risk of developing other mental health conditions, such as agoraphobia or other phobias . Agoraphobia is a fear of being in situations where escape might be difficult, or help wouldnt be available if things go wrong. Read more about the complications of panic disorder . Symptoms The symptoms of a panic attack can be very frightening and distressing. Symptoms tend to occur suddenly, without warning and often for no apparent reason. As well as overwhelming feelings of anxiety, a panic attack can also cause a variety of othersymptoms, including: a sensation that your heart is beating irregularly ( palpitations ) sweating trembling hot flushes chills shortness of breath a choking sensation chest pain nausea dizziness feelingfaint numbness orpins and needles dry mouth a need to go to the toilet ringing in your ears a feeling of dread or a fear of dying a churning stomach a tingling sensation in your fingers shivering shaking The physical symptoms of a panic attack are unpleasant, and they can also be accompanied by thoughts of fear and terror. For this reason, people with panic disorder start to fear the next attack, whichcreates acycle of living in fear of fear and adds to the sense of panic. Sometimes, the symptoms of a panic attack can be so intense they can make you feel like youre having a heart attack . However, its important to be aware that symptoms such as a racing heartbeat and shortness of breath wont result in you having a heart attack. Although panic attacks can often be frightening, they dont cause any physical harm. People who have had panic disorder for some time usually learn to recognise this heart attack sensation andbecome more aware of how to control their symptoms. Most panic attacks last for five to 20 minutes.Some attacks have been reported to have lasted up to an hour. However, its likely that in these cases one attack occurred straight after another or high levels of anxiety were felt after the first attack. Recurrent panic attacks People with panic disorder have panic attacks on a recurring basis. Some people have attacks once or twice a month, while others have them several times a week. People with panic disorder also tend to have ongoing and constant feelings of worry and anxiety. The panic attacks associated with panic disorder can be very unpredictable. If you have panic disorder, you may alsofeelanxious about when your next attack will be. Depersonalisation During a panic attack your symptoms can be so intense and out of your control that you canfeel detached from the situation, your body and your surroundings. It can almost feel as if youre an observer, making the situation seem very unreal. This sense of detachment is known as depersonalisation. Being detached from the situation doesnt provide any relief or make a panic attack less frightening. Instead, it often makes the experience more confusing and disorientating. Causes As with many mental health conditions, the exact cause of panic disorder isnt fully understood. Its thought that panic disorder is probably caused by a combination of physical and psychological factors. Some of these factors are outlined below. Traumatic life experiences A trauma, such as bereavement , can sometimes trigger feelings of panic and anxiety. These feelings may be obvious soon after the event or they may be triggered unexpectedly years later. Genetics Having a close family member with panic disorder is thought to increase a persons risk of developing it. However, the precise nature of the risk isnt known. Neurotransmitters Neurotransmitters are chemicals that occur naturally in the brain. Its thought that an imbalance of these chemicals may increase your risk of developing conditions such as panic disorder. Increased sensitivity to carbon dioxide Some experts believe that panic disorder is linked to an increased sensitivity to carbon dioxide. Breathing in air with high carbon dioxide levels can bring on panic attacks, and breathing techniques can help to relieve or stop panic attacks. Catastrophic thinking Another theory is that people who experience panic attacks tend to focus onminor physical symptoms and interpret them in a catastrophic way. This triggers a nervous system response that causes the panic attack. Diagnosis Everyone who has panic disorder will experience panic attacks. However, not everyone who haspanic attacks is diagnosed with panic disorder. Panic attacks Some people have panic attacks in response to specific situations. For example, they may have a phobia (overwhelming fear) of enclosed spaces (claustrophobia) and have a panic attack when faced with an enclosed space. While most people with phobias only experience panic attacks when faced with the thing thattriggers their fear, the panic attacks of people with panic disorder usually occur without warning and for no obvious reason. This means that panic disorder will only be diagnosed after experiencing recurrent and unexpected panic attacks, and if the attacks are followed by at least one month of continuous worry or concern about having further attacks. Talk to your GP Your GP will ask you to describe the symptoms youve been experiencing. Theyll also ask you how often your symptoms occur and in what situations. Its important to tell your GP about how youve been feeling and how your symptoms have affected you. Although it can sometimes be difficult to talk to someone else about your feelings, emotions and personal life,try not to feel anxious or embarrassed. Your GP needs to gain a good understanding of your symptoms tomake the correct diagnosis and recommend the most appropriate treatment for you. Physical examination Your GP may also want to carry out a physical examination to look for signs of any physical conditions that could be causing your symptoms. For example, an overactive thyroid gland (hyperthyroidism) can sometimes cause similar symptoms to a panic attack. By ruling out any underlying medical conditions, your GP will be able to make the correct diagnosis. Treatment The main aim in treating panic disorder is to reduce the number of panic attacks and ease the severity of symptoms. Psychological therapy and medication are the two main types of treatment for panic disorder. Depending on your individual circumstances, you may need one of these treatment types or a combination of the two. If youre offered psychological therapy, it will probably be in the form of cognitive behavioural therapy (CBT). If this doesnt work, medication may be recommended. Before starting any form of treatment, your GP will discuss all of the options with you, outlining the advantages of each type and making you aware of any possible risks or side effects. No single treatment works for everyone and you may need to try a number of treatments before finding one that works for you. The treatment thats recommended will depend on your general level of health, the severity of your condition and your personal preferences. Its important you understand what your treatment will involve. If you dont understand something your GP has told you, ask them to explain it in more detail. Cognitive behavioural therapy Psychological therapy has proven long-term benefits and its recommended for treating panic disorder. It will usually take the form of cognitive behavioural therapy (CBT). CBT is thought to be one of the most effective psychological treatments for panic disorder. It involves having regular sessions with a therapist. The therapist may discuss with you how you react when you have a panic attack and what you think about when youre experiencing an attack. Once you and your therapist have identified any negative thoughts and beliefs, you can work on replacing them with more realistic and balanced ones. Your therapist can also teach you ways of changing your behaviour, making it easier for you to deal with future panic attacks. For example, they may be able to show you breathing techniques that can be used to help keep you calm during a panic attack. The National Institute for Health and Care Excellence (NICE) recommends a total of seven to 14 hours of CBT to be completed within a four month period. Treatment will usually involve having a weekly one to two hour session. NICE also recommends that in certain situations a shorter programme of CBT may be appropriate. This can involve a reduced number of hours of CBT with homework being set between sessions so that you can practice what youve learnt after each session. You should visit your GP regularlywhile youre having CBT so that they can assess your progress and see how youre doing. Support groups Support groups can provide useful information and advice about how you can effectively manage your panic disorder. Theyre also a good way of meeting other people whove had similar experiences of the condition. Panic attacks can sometimes be frightening and isolating, so it can be helpful to know that other people are experiencing the same feelings and emotions as you. Anxiety UK and Triumph Over Phobia (TOP UK) are UK-based charities that provide information and support for people with anxiety disorders. Support groups often involve face-to-face meetings where you can talk about your problems and difficulties with others. Many can also provide support and guidance over the telephone or in writing. Ask your GP about support groups for panic disorder near you. You can also use the services directory to find anxiety services in your area . Antidepressants Antidepressants are often associated with depression , but they can also be used to treat a number of other psychological conditions. Antidepressants can take two to four weeks before becoming effective. Its therefore important to continue taking them, even if you feel theyrenot working. You should only ever stop taking prescribed medication if your GP specifically advises you to do so. Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants are two types of antidepressants that are often recommended for treatingpanic disorder. When starting a new type of medication, you should be regularly assessed by your GP at two, four, six and 12 week intervals. This will allow you to discuss any issues that you have with your medication, and enables your GP to assess which treatment is most effective. It will also provide you with the opportunity to try a different type of medication if you want to. Selective serotonin reuptake inhibitors (SSRIs) Selective serotonin reuptake inhibitors(SSRIs) are a type of antidepressant that work by increasing the level of a chemical called serotonin in your brain. Theyre the most commonly prescribed type of antidepressant for treating panic disorder. Theyre usually started at a low dose before gradually being increased as your body adjusts to the medicine. Common side effects of SSRIs include: nausea headaches low sex drive(loss of libido) blurred vision diarrhoea or constipation dizziness dry mouth loss of appetite sweating feeling agitated insomnia (sleep problems) abdominal pain When you first start taking SSRIs, your feelings ofanxiety and panic may get slightly worse. In most cases, this is temporary and your symptoms will start to return to normal levels within a few days of taking the medicine. Speak to your GP if you feel that your symptoms have got worse and that theyre not showing signs of returning to normal levels after a few days. After you start to take a SSRI, you should visit your GP after two, four, six, and 12 weeks so that they can check on your progress and see whether youre responding to the medicine. Not everyone responds well to antidepressant medicines, so its important that your progress is carefully monitored. If your GP feels it necessary, you may require regular blood tests or blood pressure checks when taking antidepressants. If after 12 weeks of taking the medication you dont show any signs of improvement, your GP may prescribe an alternative SSRI to see if it has any effect. The length of time that youll have to take a SSRI for will vary depending on how well you respond to the treatment. Even if you feel that your panic disorder has been successfully treated, its likely that youll need to keep taking the medication for at least six to 12 months. If you stop taking your medication before this time, the risk of your symptoms recurring may be increased. Some people may have to take SSRIs for longer than the usual six to 12 month period. When you and your GP decide that its appropriate for you to stop taking SSRIs, you will gradually be weaned off them by slowly reducing your dosage. As with antidepressants, you should never stop taking SSRIsunless your GP specifically advises you to. Stopping your medication straight away without being weaned off, or without seeking advice from your GP, may result in withdrawal symptoms such as: dizziness numbness and tingling nausea and vomiting headache anxiety sleep disturbances sweating These symptoms can also occur if you miss a dose of medication, or if your dose is reduced. The symptoms are usually mild, but they can be severe if the medication is stopped suddenly. For some people, this means having to take SSRIs on a long-term basis. For others, a course of CBT can help to reduce the risk of their symptoms recurring. Contact your GP if you experience troublesome side effects thatdont ease. Tricyclic antidepressants If SSRIs arent suitable, or if your symptoms dont improve after a 12 week course of SSRIs, your GP may try prescribing a different type of antidepressant. Tricyclic antidepressants work in a similar way to SSRIs. They regulate the levels of the chemicals noradrenaline and serotonin in your brain, which has a positive effect on your feelings and mood. Imipramineandclomipramine are two tricyclic antidepressants that are often prescribed to treat panic disorder. Tricyclic antidepressants arent addictive. SSRIs are usually prescribed before tricyclic antidepressants because they have fewer side effects. Common side effects of tricyclic antidepressants include: constipation difficulty urinating blurred vision dry mouth weight gain or weight loss drowsiness sweating lightheadedness skin rash The side effects should ease after seven to 10days as your body starts to get used to the medication. However, see your GP if they become troublesome and dont ease. Pregabalin Pregabalin is another medication thats often used to treat panic disorder. Its an anticonvulsant thats also used to treat epilepsy (a condition that causes repeated seizures). However, its also been found to be beneficial in treating anxiety. Side effects of pregabalin can include: drowsiness dizziness increased appetite and weight gain blurred vision headaches dry mouth vertigo the sensation that you, or the environment around you, are moving or spinning Pregabalin is less likely to cause nausea or a low sex drive than SSRIs. Clonazepam Clonazepam is another medication thats often used to treat epilepsy and is also sometimes prescribed for panic disorder. It can cause a wide variety of side effects including lethargy (lack of energy), abnormal eye movement (nystagmus), confusion and allergic reactions. Referral You may be referred to a mental health specialist if treatments such as attending a support group, CBT and medication dont improve your symptoms of panic disorder . A mental health specialist will carry out an overall reassessment of your condition. Theyll ask you about your previous treatment and how effective you found it. They may also ask you about things in your life that may be affecting your condition, or how much support you get from family and friends. The specialist will be able to devise a treatment plan for you, which will aim to effectively treat your symptoms. The type of mental health specialist that youll be referred to will depend on your individual situation. For example, you may be referred to a: psychiatrist a trained medical doctor who specialises in mental health; a psychiatrist is one of the only mental health specialists who is able to prescribe medication clinical psychologist who is trained in the scientific study of human behaviour and mental processes and focuses solely on the assessment and treatment of mental health conditions; a clinical psychologist will help you to find ways of effectively managing your anxiety and panic attacks Things you can do to help yourself There are several self-help techniques you can use to help treat the symptoms of panic disorder yourself. Some of these techniques are listed below. Stay where you are If possible, you should stay where you are during a panic attack. The attack could last up to an hour, so you may need to pull over and park where its safe to do so if youre driving. Focus If you have a panic attack, remind yourself that the frightening thoughts and sensations will eventually pass. During an attack, try to focus on something thats non-threatening and visible, such as the time passing on your watch or items in a supermarket. Slow deep breathing While youre having a panic attack, try to focus on your breathing. Feelings of panic and anxiety can get worse if you breathe too quickly. Try breathing slowly and deeply while counting to three on each breath in and out. Challenge your fear When you have a panic attack, try to identify what it is you fear and challenge it. You can achieve this by constantly reminding yourself that what you fear isnt real and that it will pass in a few minutes. Creative visualisation Many things can go through your mind during a panic attack for example, some people think about disaster or death. Instead of focusing on negative thoughts, try to concentrate on positive images. Think of a place or a situation that makes you feel peaceful, relaxed or at ease. Once you have this image in your mind, try to focus your attention on it. It should help distract you from the situation and may also help ease your symptoms. Thinking positively can be difficult, particularly if youve got used to thinking negatively over a long period of time. Creative visualisation is a technique that requires practice, but you may gradually notice positive changes in the way you think about yourself and others. Dont fight a panic attack Fighting a panic attack can often make it worse. Trying to resist the attack and finding youre unable to can increase your sense of anxiety and panic. Instead, during a panic attack, reassure yourself by accepting that although it may seem embarrassing, and your symptoms may be difficult to deal with, the attack isnt life-threatening. Focus on the fact that the attack will evetually end and try your best to let it pass. Relaxation If you have panic disorder, you may feel constantly stressed and anxious, particularly about when your next panic attack may be. Learning to relax can help to relieve some of this tension, and it may also help you to deal more effectively with your panic attacks when they occur. Some people find complementary therapies, such as massage and aromatherapy, help them to relax. Activities, such as yoga and pilates , can also be helpful. You can also practise breathing and relaxation techniques, which you can use during a panic attack to help ease your symptoms. Exercise Regular exercise , particularly aerobic exercise, will help reduce stress and release tension. It can also encourage your brain to release the chemical serotonin, which can help improve your mood. Itsrecommended that adults aged 19-64 years should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity, such as cycling or fast walking , every week. They should also do muscle-strengthening activities on two or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders and arms). Visit your GP for a fitness assessment before starting a new exercise programme if you havent exercised before or for a long time. Read more about the physical activity guidelines for adults . Diet Unstable blood sugar levels can contribute to the symptoms of a panic attack . Therefore, you should maintain a healthy, balanced diet , eat regularly and avoid eating sugary food and drinks. Also, avoid caffeine, alcohol and smoking because they can all contribute to panic attacks. Complications Panic disorder is a treatable condition, but to make a full recovery its very important you seek medical help as soon as possible. This is because treatment for panic disorder is much more effective if its given at an early stage. Left undiagnosed and untreated, panic disorder can become a debilitating and isolating illness. It can also increase your risk of developing other psychological conditions. Agoraphobia and other phobias Agoraphobiais a fear of being in situations where escape might be difficult, or help wouldnt be available if things go wrong. If you have agoraphobia, leaving home, going out in public and travelling alone can cause intense anxiety. Many people with agoraphobia avoid everyday activities because of their phobia. Agoraphobia isone of theconditions that can develop alongside panic disorder. People with panic disorder can develop agoraphobia because of their fear of having a panic attack in a public place. You may worry that a panic attack in a public place will be embarrassing, or that youll have difficulty getting help if you need it. You may also worry about public places that you would have difficulty leaving, such as a train, if you were to have a panicattack. If you have agoraphobia, you may find it difficult to leave the house, particularly if youre not with a trusted family member or a friend. If you have panic disorder, you may also develop other fears andphobias , which can often seem irrational. For example, you may start to worry about a particular object or action that triggers your attacks and become fearful of those things. Children Panic disorder is more common in teenagers than in younger children. Panic attacks can be particularly debilitating for children and young people. Severe panic disorder may affect their development and learning. The fear of having a panic attack may stop children from going to school and engaging in a social life. They may also find it difficult to concentrate on their schoolwork. Diagnosing panic disorder in children is usually a case of taking a detailed medical history and carrying out a thorough physical examinationto rule out any physical causes for the symptoms. Screening for other anxiety disorders may also be needed to help determine whats causing your childs panic attacks. Panic attacks in children are often dramatic events, including screaming and crying and an increased breathing rate (hyperventilation). If your child displays the signs and symptoms of panic disorder over a prolonged period of time, your GP may refer them to a specialist for further assessment and treatment. The specialist may recommend a course of psychotherapy for your child, such ascognitive behavioural therapy (CBT). Drug and alcohol misuse Some studies have shown that conditions that cause intense anxiety, such as panic disorder, can also increase your risk of developing an alcohol or drug problem. The side effects or withdrawal symptoms of both prescribed medication andillegal drugs can increase the symptoms of anxiety . Smoking and caffeine can also make your anxiety symptoms worse, so you should try to give up smoking (if you smoke) and limit the amount of caffeine in your diet. Source: NHS 24 - Opens in new browser window Last updated: 03 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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Parkinsons disease | "Parkinson's disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Parkinsons disease Parkinsons disease About Parkinsons disease Symptoms of Parkinsons disease Causes of Parkinsons disease Diagnosing Parkinsons disease Treating Parkinsons disease Living with Parkinsons disease About Parkinsons disease Parkinsons disease is a condition in which parts of the brain become progressively damaged overmany years. The three main symptoms of Parkinsons disease are: involuntary shaking of particular parts of the body (tremor) slow movement stiff and inflexible muscles A person with Parkinsons disease can also experience a wide range of other physical and psychological symptoms, including: depression and anxiety balance problemsthismay increase the chance of a fall loss of sense of smell anosmis problems sleeping ( insomnia ) memory problems Read more about the symptoms of Parkinsons disease Seeking medical advice See your GP if youre concerned that you may have symptoms of Parkinsons disease. Your GP will ask about the problems youre experiencing and mayrefer you to a specialist for further tests. Read more about diagnosing Parkinsons disease Causes of Parkinsons disease Parkinsons disease is caused by a loss of nerve cells in part of the brain called the substantia nigra. Thisleads to a reductionin a chemical called dopamine in the brain. Dopamine plays a vital role in regulating the movement of the body. A reduction in dopamine is responsible for many of the symptoms of Parkinsons disease. Exactly what causes the loss of nerve cells is unclear. Most experts think that a combination of genetic and environmental factors is responsible. Read more about the causes of Parkinsons disease Whos affected? Its thought around 1 in 500 people are affected by Parkinsons disease, which meansthere are an estimated 127,000 people in the UK with the condition. Most people with Parkinsons start to develop symptoms when theyre over 50, although around 1 in 20 people with the condition first experience symptomswhen theyre under 40. Men are slightly more likely to get Parkinsons disease than women. TreatingParkinsons disease Although theres currently no cure for Parkinsons disease, treatments are available to help reduce the main symptoms and maintain quality of life for as long as possible. These include: supportive treatments such as physiotherapyand occupational therapy medication in some cases, brainsurgery You may not need any treatment during the early stages of Parkinsons disease, as symptoms are usually mild. However, you may need regular appointments with your specialist so your condition can be monitored. Read more about treating Parkinsons disease Outlook As the condition progresses,the symptoms of Parkinsons diseasecan get worse and it can become increasingly difficult to carry out everyday activities without assistance. Manypeople respond well to treatment and only experience mild to moderate disability, whereas the minority may not respond as well and can, in time, becomemore severely disabled. Parkinsons diseasedoesnt directly cause people to die, but the condition can place great strain on the body, and can make some people more vulnerable to serious and life-threatening infections. However, with advances in treatment, most people with Parkinsons disease now have a normal or near-normal life expectancy. Read more about living with Parkinsons disease It may alsobe useful to read your guide to care and support written for people with care and support needs, as well as their carers and relatives. Symptoms of Parkinsons disease The symptoms of Parkinsons disease usually develop gradually and are mild at first. There are many different symptoms associated with Parkinsons disease. Some of the more common symptoms are described below. However,the order in which these develop and their severity is different for each individual.Its unlikely thata personwith Parkinsons disease would experience all ormost of these. Main symptoms The three main symptoms of Parkinsons disease affect physical movement: tremor shaking, which usually begins in the hand or arm and is more likely to occur when the limb is relaxed andresting slowness of movement (bradykinesia) where physical movements are much slower than normal, which can make everyday tasks difficult and can result in a distinctive slow, shuffling walk with very small steps muscle stiffness (rigidity) stiffness and tension in the muscles, which can make it difficult to move around and make facial expressions, and can result in painful muscle cramps ( dystonia ) These mainsymptoms are sometimes referred to by doctors as parkinsonism as there can be causes other than Parkinsons disease. Other symptoms Parkinsons disease can also cause a range of other physical and mental symptoms. Physical symptoms balance problems these can make someone with the condition more likely to have a fall and injure themselves loss of sense of smell (anosmia) sometimes occurs several years before other symptoms develop nerve pain can cause unpleasant sensations, such as burning, coldness or numbness problems with urination such as having to get up frequently during the night to urinate orunintentionally passing urine ( urinary incontinence ) constipation an inability to obtain or sustain an erection ( erectile dysfunction )in men difficulty becoming sexually aroused and achieving an orgasm(sexual dysfunction) in women dizziness , blurred vision or faintingwhen moving from a sitting or lying position to a standing onecaused by a sudden drop in blood pressure excessive sweating ( hyperhidrosis ) swallowing difficulties ( dysphagia )this can lead to malnutrition and dehydration excessive production of saliva (drooling) problems sleeping ( insomnia ) this can result in excessive sleepiness during the day Cognitive and psychiatric symptoms depression and anxiety mild cognitive impairment slight memory problems and problems with activities that require planning and organisation dementia a group of symptoms, including more severe memory problems, personality changes,seeing things that arent there (visual hallucinations) andbelieving things that arent true (delusions) When to seek medical advice See your GP if youre concerned you may have symptoms of Parkinsons disease. Your GP will ask about your symptoms and your medical history to help them decide whether its necessary to refer you to a specialist for further tests. Read more about diagnosing Parkinsons disease Causes of Parkinsons disease Parkinsons disease is caused by a loss of nerve cells in the part of the brain called the substantia nigra. Nerve cells in this part of the brain are responsible for producing a chemical called dopamine. Dopamine acts as a messenger between the parts of the brain and nervous system that help control and co-ordinate body movements. If these nerve cells die or become damaged, the amount of dopamine in the brain is reduced. This means the part of the brain controlling movement cant work as well as normal, causing movements to become slow and abnormal. The loss of nerve cells is a slow process.The symptoms of Parkinsons diseaseusually only start to develop when around 80% of the nerve cells in the substantia nigra have been lost. What causes the loss of nerve cells? Its not known why the loss of nerve cells associated with Parkinsons disease occurs, although research is ongoing to identify potential causes. Currently, its believed a combination of genetic changes and environmental factors may be responsible for the condition. Genetics A number of geneticfactors have been shown toincrease a persons risk of developing Parkinsons disease, although exactly how these make some people more susceptible to the condition is unclear. Parkinsons disease can run in families as a result of faulty genes being passed toa child by their parents. However, its rare for the disease to be inherited this way. Environmental factors Some researchers also feel environmental factors may increase a persons risk of developing Parkinsons disease. Its been suggested that pesticides and herbicides used in farmingand traffic or industrial pollution may contribute to the condition. However, the evidence linking environmental factors to Parkinsons disease is inconclusive. Other causes of parkinsonism Parkinsonism is the umbrella term used to describe the symptoms of tremors, muscle rigidity and slowness of movement. Parkinsons disease is the most common type of parkinsonism, but there are also some rarer types where a specific cause can be identified. These include parkinsonism caused by: medication (drug-induced parkinsonism) where symptoms develop after taking certain medications, such as some types of antipsychotic medication, and usually improve once the medication is stopped other progressive brain conditions such as progressive supranuclear palsy, multiple systems atrophy, andcorticobasal degeneration cerebrovascular disease where a series of small strokes cause several parts of the brain to die You can read more about parkinsonism on the Parkinsons UK website. Diagnosing Parkinsons disease No tests can conclusively show that you have Parkinsons disease. Your doctor will base a diagnosis on your symptoms, medical history and a detailed physical examination. Your GP willtalk toyouabout the problems youre experiencing and mayask you to perform some simple mental or physical tasks, such as moving or walking around,to help with the diagnosis. In the early stages, your GP may find it difficult to say whether you definitely have the condition because symptoms are usually mild. Referral to a specialist If your GP suspects Parkinsons disease, youll be referred to a specialist. This will usually be: a neurologist a specialist in conditions affecting the brain and nervous system a geriatrician a specialist in problems affecting elderly people If your GP thinks you may be in the early stages of Parkinsons disease, you should see a specialist within six weeks. If they think you may be in the later stages, you should see a specialist within two weeks. The specialist will most likely ask you to perform a number of physical exercises so they can assess whether you have any problems with movement. A diagnosis of Parkinsons disease is likely if you have at least two of the three following symptoms: shaking or tremor in a part of your body that usually only occurs at rest slowness of movement (bradykinesia) muscle stiffness (rigidity) If your symptoms improve after taking a medication called levodopa, its more likely you have Parkinsons disease. Special brain scans, such as asingle photon emission computed tomography (SPECT) scan, may also be carried out in some casesto try torule outother causes ofyour symptoms. Receiving the diagnosis Being told you have Parkinsons disease can be emotionally distressing, and the news can often be difficult to take in. This means its important that you have the support of your family and a care team who will be able to help you come to terms with the diagnosis. You may find it useful to contactParkinsons UK,the Parkinsons support and research charity. They can be contacted by: free helpline on 0808 800 0303 (Monday to Friday, 9am to 7pm, and 10am to 2pm onSaturdays) email: hello@parkinsons.org.uk Parkinsons UKbrings people with Parkinsons, their carers and families together througha network of local groups , as well as online resources and a confidential helpline. The Parkinsons UK website provides information and support on every aspect of living with Parkinsons. Treating Parkinsons disease There are several therapies that can make living with Parkinsons disease easier and help you deal with your symptoms on a day-to-day basis. There are efforts underway to try to increase the availability of these supportive therapies for Parkinsons patients on the NHS. Your local authority may be able to advise and help you. Ask your local authority for a care and support needs assessment. Physiotherapy A physiotherapist can work with you to relieve muscle stiffness and joint pain through movement (manipulation) and exercise. The physiotherapist aims to make moving easier, and improve your walking and flexibility. They also try to improve your fitness levels and ability to manage things for yourself. Occupational therapy An occupational therapist can identify areas of difficulty in your everyday lifefor example, dressing yourself or getting to the local shops. They can help you work out practical solutions, and ensure your home is safe and properly set up for you. This will help you maintain your independence for as long as possible. Read more about occupational therapy Speech and language therapy Many people with Parkinsons disease have swallowing difficulties ( dysphagia )and problemswith their speech. A speech and language therapist can often helpyou improve these problems by teaching speaking and swallowing exercises, or by providing assistive technology. Diet advice For some people with Parkinsons disease, making dietary changes can help improve some symptoms. These changescan include: increasing the amount of fibre in your diet and making sure youre drinking enough fluid to reduce constipation increasing the amount of salt in your diet and eating small, frequent meals to avoid problems with low blood pressure , such as dizziness when you stand up quickly making changes to your diet to avoidunintentional weight loss You may see a dietitian, a healthcare professional trained to give diet advice, if your care team thinks youmay benefit from changing your diet. Medication Medicationcan be used toimprove the main symptoms of Parkinsons disease, such as shaking (tremors) and movement problems. However, not all the medications available are useful for everyone, and the short- and long-term effects of each are different. Three main types of medication are commonly used: levodopa dopamine agonists monoamine oxidase-B inhibitors Your specialist can explain your medication options, including the risks associated with each medication, and discuss which may be best for you. Regular reviews will be required as the condition progresses and your needs change. Read on to learn about the treatments you may be offered. You can also see a summary of the pros and cons of treatments for Parkinsons disease, where you can compare your options. Levodopa Most people with Parkinsons disease eventually need a medication called levodopa. Levodopa is absorbed by the nerve cells in your brain and turned into the chemical dopamine, which is used to transmit messages between the parts of the brain and nerves that control movement. Increasing the levels of dopamine using levodopa usually improves movement problems. Itis usually taken as a tablet or liquid, and is often combined with other medication, such as benserazide or carbidopa. These medications stop the levodopa being broken down in the bloodstream before it has a chance to get to the brain. They also reduce the side effects of levodopa, which include: feeling sick (nausea) or vomiting tiredness dizziness If youre prescribed levodopa, the initial doseis usually very small and will be gradually increased until it takes effect. At first, levodopa can cause a dramatic improvement in the symptoms. However, its effects can be less long-lasting over the following yearsas more nerve cells in the brain are lost, there are fewer of them to absorb the medicine. This means the dose may need to be increased from time to time. Long-term use of levodopa is also linked to problems such as uncontrollable, jerky muscle movements (dyskinesias) and on-off effects, where the person rapidly switches between being able to move (on) and being immobile (off). Dopamine agonists Dopamine agonists act as a substitute for dopamine in the brain and have a similar but milder effect comparedwith levodopa. They can often be given less frequently than levodopa. Theyare often taken as a tablet, but are also available as a skin patch (rotigotine). Sometimes dopamine agonists are taken at the same time as levodopa, as this allows lower doses of levodopa to be used. Possible side effects of dopamine agonists include: nausea or vomiting tiredness and sleepiness dizziness Dopamine agonists can also cause hallucinations andincreased confusion, so they need to be used with caution, particularly in elderly patients, who are more susceptible. For some people, dopamine agonists have been linked to the development of compulsive behaviours,especially at high doses, including addictive gambling and an excessively increased libido. Talk to your healthcare specialist if you think you may be experiencing these problems. As the person themselves may not realise the problem, its key that carers and family members also note any abnormal behaviour and discuss it with an appropriate professional at the earliest opportunity. If youre prescribed a course of dopamine agonists, the initial dose is usually very small to prevent nausea and other side effects. The dosage is gradually increased over a few weeks. If nausea becomes a problem, your GP may prescribe anti-sickness medication. A potentially serious, but uncommon, complication of dopamine agonist therapy is sudden onset of sleep. This generally happens as the dose is being increased and tends to settle once the dose is stable. People areusually advised toavoid driving while the dose is being increased in case this complication occurs. Monoamine oxidase-B inhibitors Monoamine oxidase-B (MAO-B) inhibitors, including selegiline and rasagiline, are another alternative to levodopa for treating early Parkinsons disease. They block the effects of an enzyme orbrain substance that breaks downdopamine (monoamine oxidase-B), increasing dopamine levels. Both selegiline and rasagiline can improve the symptoms of Parkinsons disease, although their effects are small compared with levodopa. They can be used alongside levodopa or dopamine agonists. MAO-B inhibitors are generally very well tolerated, but can occasionallycause side effects, including: nausea headache abdominal pain high blood pressure Catechol-O-methyltransferase inhibitors Catechol-O-methyltransferase (COMT) inhibitors are prescribed for people in later stages of Parkinsons disease. They prevent levodopa from being broken down by the enzyme COMT. Side effects of COMT inhibitors include: nausea or vomiting diarrhoea abdominal pain Non-oral therapies When Parkinsons symptoms become difficult to control with tablets alone, a number of other treatments can be considered. Apomorphine A dopamine agonist called apomorphine can be injected under the skin (subcutaneously) eitherby: a single injection, when required a continuous infusionusing a small pump carried around on your belt, under your clothing, or in a bag Duodopa If you have severe on-off fluctuations, a type of levodopa called duodopa may be used. This medication comes as a gel thats continuously pumped into your gut through a tube inserted through your abdominal wall. Theres an external pump attached to the end of the tube, which you carry around with you. About 25 specialist neuroscience centres in the UK offer this treatment.This treatment is only available if you have very severe on-off fluctuations or involuntary movements. Surgery Most people with Parkinsons disease are treated with medication, although a type of surgery called deep brain stimulation isused in some cases. This surgery is also available in specialist neuroscience centres around the UK, but its not suitable for everyone. Ifsurgery isbeing considered, your specialist will discuss the possible risks and benefits with you. Deep brain stimulation Deep brain stimulation involves surgically implanting a pulse generator similar to a heart pacemaker into your chest wall. This is connected to one or two fine wires placed under the skin, and isinserted precisely into specific areas in your brain. A tiny electric current is producedby the pulse generator, which runs through the wire and stimulates the part of your brain affected by Parkinsons disease. Although surgery doesnt cure Parkinsons disease, it can ease the symptoms for some people. Treating additional symptoms As well asthe main symptoms of movement problems, people with Parkinsons disease can experience a wide range of additional symptoms that may need to be treated separately. These include: depression and anxiety this can be treated with self care measures such as exercise, psychological therapy or medication; read more about treating depression problems sleeping (insomnia) this can be improved by making changes to your normal bedtime routine; read more about treating insomnia erectile dysfunction this can be treated with medication; read more about treating erectile dysfunction excessive sweating (hyperhidrosis) this can be reduced using a prescription antiperspirant,or surgery in severe cases; read more about treating hyperhidrosis swallowing difficulties (dysphagia) this can be improved by eating softened food, or by using a feeding tube in more severe cases; read more about treating dysphagia excessive drooling this can be improved with swallowing exercises, or surgery or medication in severe cases urinary incontinence this can be treated with exercises to strengthen the pelvic floor muscles, medication, or surgery in severe cases; read more about treating urinary incontinence dementia this can be treated with cognitive therapies and medication in some cases; read more about treating dementia Clinical trials Much progress has been made in the treatment of Parkinsons diseaseas the result ofclinical trials,where new treatments and treatment combinations are compared with standard ones. All clinical trials in the UK are carefully overseen to ensure they are worthwhile and safely conducted. Participants in clinical trials sometimes do better overall than those in routine care. If you are asked if you want to take part in a trial, you will be given an information sheet about the trial. If you want to take part, you will be asked to sign a consent form. You can refuse to take part or withdraw from a clinical trial without it affecting your care. Complementary and alternative therapies Some people with Parkinsons disease findcomplementary therapies help them feel better. Many complementary treatments and therapies claim to ease the symptoms of Parkinsons disease. However, theres no clinical evidence theyre effective in controlling the symptoms of Parkinsons disease. Most people think complementary treatments have no harmful effects. However, some can be harmful and they shouldnt be used instead of the medicines prescribed by your doctor. Some types of herbal remedies, such as St Johns wort, can interact unpredictably if taken with some types of medication used to treat Parkinsons disease. If youre considering using an alternative treatment along with your prescribed medicines, check with your care team first. Living with Parkinsons disease Its important to do what you can to stay physically and mentally healthy if you have Parkinsons disease. Exercise and healthy eating Regular exercise is particularly important in helping relieve muscle stiffness, improving your mood, and relieving stress. There are many activities you can do to help keep yourself fit, ranging from more active sports like tennis and cycling , to less strenuous activities such as walking , gardening and yoga . You should also try to eat a balanced diet containing all the food groups to give your body the nutrition it needs to stay healthy. Vaccinations Everyone with a long-term condition is encouraged to get a yearly flu jab each autumn. The pneumococcal vaccination is also usually recommended, which is a one-off injection that protects against a serious chest infection called pneumococcal pneumonia. Relationships and support Being diagnosed with a long-term conditionlike Parkinsons disease can put a strain on you, your family and friends. It can be difficult to talk to people about your condition, even if theyre close to you. Dealing with the deterioration of symptoms, such as increasing difficulty with movement, may make you feel frustrated and depressed. Spouses, partners or carers will inevitably feel anxious or frustrated as well. Be open about how you feel, and let your family and friends know what they can do to help. Dont feel shy about telling them you need some time to yourself, if thats what you want. Support If you have any questions about your condition, your GP or Parkinsons disease specialist nurse may be able to help. You may also find it helpful to talk to a trained counsellor or psychologist, or someone at a specialist helpline. Your GP surgery will have details of these. Some people find it helpful to talk to others with Parkinsons disease, either at a local support group or in an internet chat room. Care and support services Its worth taking time to think about your specific needs and what would help you achieve the best quality of life. For example, you may wish to consider equipment, help in your home,and home adaptations. Parkinsons UK Parkinsons UK is the main Parkinsons support and research charity in the UK. They can offer thesupport and advice you may need if youre living with Parkinsons disease, and can let you know about support groups in your local area. They can becontacted by: free confidential helpline on 0808 800 0303 (Monday to Friday, 9am to 7pm, and 10am to 2pm on Saturdays) email: hello@parkinsons.org.uk The Parkinsons UKwebsite also features all the latest news, publications and research updates, as well as an online community where you can share your experiences of living with Parkinsons. Work and finances Being diagnosed with Parkinsons doesnt mean you have to stop working. Many people with the condition keep working for years after their diagnosis. You may find it hard to cope financially if you do have to stop work or work part-time because of your condition. However, you may be entitled to one or more of the following types of financial support: You are entitled to Statutory Sick Pay from your employer if you have a job but cant work because of your illness. You may be entitled to Employment and Support Allowance (ESA) if you dont have a job and cant work because of your illness. You may be eligible for Personal Independence Payment (PIP) , which replaced the Disability Living Allowance (DLA) , if youre aged 64 and under and need help with personal care or have walking difficulties. You may be able to get Attendance Allowance if youre aged 65 or over. You may be entitled to Carers Allowance if youre caring for someone with Parkinsons disease. You may be eligible for other benefits if you have children living at home or if you have a low household income. Driving If youve been diagnosed with Parkinsons disease, you must inform the Driver and Vehicle Licensing Agency (DVLA) and your insurance company. You wont necessarily have to stop driving. Youll be asked to complete a form providing more information about your condition, as well as details of your doctors and specialists. The DVLA will use this to decide whether youre fit to drive. Complex Parkinsons disease and palliative care ComplexParkinsons disease is defined as the stage when treatment is unable to consistently control symptoms, or the person has developeduncontrollable jerky movements (disabling dyskinesia). These problems can still be helped by adjustment or addition of some of the medications used to treat Parkinsons disease ,under thesupervisionof a doctor with a specialist interest in Parkinsons disease. As Parkinsons disease progresses, youll be invited to discuss the care you wantwith your healthcare team as you near the end of your life. This is known as palliative care. When theres no cure for an illness, palliative care tries to alleviate symptoms, and is also aimed at making the end of a persons life as comfortable as possible. This is done by attempting to relieve pain and other distressing symptoms, while providing psychological, social and spiritual support for you and your family. Palliative care can be provided at home orin a hospice, residential home or hospital. You may want to consider talking to your family and care team in advance about where youd like to be treated and what care you wish to receive. Source: NHS 24 - Opens in new browser window Last updated: 16 June 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Other health sites Brain and Spine Foundation: Parkinson's disease Healthtalk.org: Parkinson's disease Parkinson's UK NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852" | null | null | null | null | null | null | null | null | null | null | null | null | null |
Pataus syndrome | "Patau's syndrome | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Chromosomal conditions Pataus syndrome Pataus syndrome Pataus syndrome, also known as Trisomy 13, is a rare but serious genetic condition. It begins to affect babies when theyre in the womb, and will continue to cause health problems throughout their life. In the UK, around 2 in every 10,000 births are affected by Pataus syndrome. What is Pataus syndrome? When a baby is conceived (made), they inherit genetic material from both their parents. This genetic material is called a chromosome. Humans normally have 23 pairs of chromosomes. In each pair, 1 of the chromosomes is inherited from the mother and 1 is inherited from the father. If a baby has Pataus syndrome, they have inherited an extra copy of chromosome 13. This extra copy can be present in some or all of the babys cells and can lead to health problems for the baby. There are 3 different forms of Pataus syndrome: Full form In full form Pataus syndrome, the baby has inherited a complete extra copy of chromosome 13. This extra copy is present in all of the babys cells. Around 80% of babies born with Pataus syndrome have the full form of the syndrome. Mosaic form In mosaic form Pataus syndrome, the baby has inherited a complete extra copy of chromosome 13, but the copy is only present in some of the babys cells. Partial form In partial form Pataus syndrome, the baby has only inherited part of an extra copy of chromosome 13. This is a very rare form of Pataus syndrome. Why does Pataus syndrome happen? Most cases result from a random change in the egg or sperm in healthy parents. This change is not caused by anything the parents did before or during pregnancy. Effects of Pataus syndrome on pregnancy Screening for Pataus syndrome Youll be offered screening for Pataus syndrome when youre between 11 and 14 weeks pregnant. The screening test will show if your baby has a high or low chance of having Pataus syndrome. If screening shows that theres a high chance your baby has Pataus syndrome,you can choose to have a further diagnostic test if you wish. No test can tell if your baby has full, mosaic or partial Pataus syndrome, or how theyll be affected. Risk of miscarriage and stillbirth Around 7 in 10 (70%) of pregnancies diagnosed with Pataus syndrome from screening tests will end in miscarriage or stillbirth . The risk of miscarriage decreases as the pregnancy progresses, but theres still a risk of stillbirth. Effects of Pataus syndrome on babies If your baby is affected by Pataus syndrome, its likely they will have some health conditions. Exactly how your baby is affected will depend on the form of Pataus syndrome they have. Babies with full form Pataus syndrome Full form Pataus syndrome is considered to be a life-limiting condition. This means it can affect how long a baby can live. Around 4 in 10 (43.1%) babies with full form Pataus syndrome will live longer than 1 week. Around 1 in 10 (9.7%) will live longer than 5 years. Babies born with full form Pataus syndrome will have a learning disability that may be severe. Theyre also likely to have a wide range of health conditions, some of which can be serious. Statistically: around 8 in 10 (80%) will have heart issues around 6 in 10 (60%) will have cleft lip and/or palate around 6 in 10 (60%) will have issues with brain development around 5 in 10 (50%) will have seizures around 5 in 10 (50%) will have hearing loss around 5 in 10 (50%) will have joint contractures (shortening of muscle tissue that can cause a deformity) around 5 in 10 (50%) will have eye issues or an absent eye Babies with mosaic form and partial form Pataus syndrome Currently we cant predict how babies with mosaic or partial forms of Pataus syndrome will be affected. This is because it depends on: how many cells contain the extra chromosome (mosaic) how much of the extra chromosome they have (partial) Some babies may have severe health problems like those seen in full form Pataus syndrome. Other babies may have much less serious health issues. There are even cases where the baby seems to have no health issues at all. Most babies with a form of Pataus syndrome will have some form of learning disability. The life expectancy for babies with mosaic or partial forms of Pataus syndrome is also very variable. Some will live long lives, while others will have a much shorter life expectancy. Living with Pataus syndrome Each child is unique, and Pataus syndrome will affect each child differently. Like all children they will have their own personalities, likes and dislikes, and things that make them who they are. Babies with full form Pataus syndrome usually have a low birthweight and are considered medically fragile. This means they are at high risk of infections and complications that require treatment in hospital. They may also: have difficulty feeding and may need fed by a tube have difficulty breathing and have apnoea (pauses in their breathing) Despite their complex needs, children with Pataus syndrome can make progress with their development, although slowly. Many children are reported to be able to communicate their needs, show awareness of surroundings, and some can sit and stand supported. There are also cases of older children attending school. Feedback from many parents suggests that children with Pataus syndrome have a good quality of life and are valued members of the family. Congenital and rare condition register Babies with Pataus syndrome are included in the secure congenital and rare condition (CARDRISS) register. The register is maintained by Public Health Scotland. The register records how many babies have this condition, and some relevant personal information. Its also used to support the planning and improvement of health, care, and other public services. Read more about CARDRISS Further information and support You can find out more information about Pataus syndrome, including stories from parents of a child with the syndrome, at SOFT UK (Support Organisation for Trisomy 13/ 18) Source:\r\n SOFT UK - Opens in new browser window Last updated: 21 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Screening for Downs syndrome, Edwards syndrome and Pataus syndrome Other health sites SOFT UK NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852" | null | null | null | null | null | null | null | null | null | null | null | null | null |
Pelvic inflammatory disease | Pelvic inflammatory disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Sexual and reproductive Pelvic inflammatory disease Pelvic inflammatory disease British Sign Language (BSL) | | Polski | Romn | slovenina Pelvic inflammatory disease (PID) is a bacterial infection. It affects the female reproductive system including the womb, fallopian tubes and ovaries. Symptoms of PID PID often does not cause any obvious symptoms. Most symptoms are mild, making it difficult to diagnose. Symptoms include: pain around the pelvis or lower tummy discomfort or pain during sex that is felt deep inside the pelvis pain when peeing bleeding between periods or after sex heavy periods painful periods unusual vaginal discharge Less common symptoms include: severe tummy pain a high temperature (fever) feeling and being sick When to get medical advice Speak to your GP practice or local sexual health clinic if: you have symptoms of PID youre worried about your symptoms Testing for PID If you think you might have PID, get checked for free by: booking an appointment at your local sexual health service contacting your GP practice for an appointment What does a PID test involve? There is no single test for diagnosing PID. Your doctor or nurse will discuss your symptoms before you have an internal examination. This shouldnt be painful, but you may experience some discomfort. When your doctor examines you, theyll look for tenderness in your pelvic region and an abnormal vaginal discharge. The doctor will usually take swabs from inside your vagina and cervix. These will be sent to a lab for analysis. However, a swab test cant be relied on to diagnose PID, as some women with PID have a negative swab result. You may have an ultrasound scan. Scans can identify severe PID but will not show up mild disease. Its possible to have a normal scan and still have PID. Treatment for PID If its diagnosed at an early stage, oral antibiotics will treat PID. Youll probably be given these to take for at least 2 weeks. In more severe cases, you may be admitted to hospital for observation and treatment with antibiotic injections. Always see your doctor or nurse if you think you might have PID, as the sooner you are treated, the better. If youre given treatment, always make sure that you take all of your antibiotics and finish the entire course. Your partner(s) should also be treated and you should avoid sex until your treatment is completed. How PID is passed on Most cases of PID are caused by a bacterial infection thats spread from the vagina or the cervix to the reproductive organs higher up. Many different types of bacteria can cause PID. However, most cases are the result of a chlamydia or gonorrhoea infection. In some cases, the cause of the infection that leads to PID is unknown. Such cases may be the result of normally harmless bacteria found in the vagina. These bacteria can sometimes get past the cervix and into the reproductive organs. Complications of PID If left untreated, PID can cause serious conditions including: pelvic abscesses long-term pelvic pain, or pelvic pain that keeps coming back reduced fertility or infertility ectopic pregnancy How to prevent PID The best way to reduce your risk of STIs is to practice safer sex . This means using a condom for vaginal, anal and oral sex. STIs If you have been diagnosed with PID you should get tested for all STIs including: chlamydia gonorrhoea syphilis Find your local sexual health clinic Source: Scottish Government - Opens in new browser window Last updated: 26 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Other languages and formats British Sign Language (BSL) | | Polski | Romn | slovenina British Sign Language (BSL) | | Polski | Romn | slovenina Add this page to\n Info For Me Also on NHS inform Book a sexual health appointment online Pelvic inflammatory disease (PID) (BSL) Pelvic inflammatory disease (PID) (Chinese) Pelvic inflammatory disease (PID) (Polish) Pelvic inflammatory disease (PID) (Romanian) Pelvic inflammatory disease (PID) (Slovak) Other health sites BASHH: sexual health NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Pelvic organ prolapse | "Pelvic organ prolapse | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Sexual and reproductive Pelvic organ prolapse Pelvic organ prolapse Pelvic organ prolapse is when one or more of the pelvic organs (your womb, bladder or bowel) slip from their usual position. This causes the vaginal wall to bulge into, or out of, the vagina. Pelvic organ prolapse isnt life-threatening. In some cases it can cause little or no problems. However, in more severe cases, it may feel very uncomfortable. It might stop you doing the things that you enjoy, and affect your quality of life. Like incontinence, prolapse isnt inevitable part of ageing. Speak to your doctor if you think you might have a prolapse. You dont need to suffer or feel embarrassed. Many women can experience prolapse, but it can be treated. Symptoms Some women with a pelvic organ prolapse dont have any symptoms at all. The condition may only discovered during an internal examination for another reason. For example, during a cervical screening test (smear test) . Other women will experience symptoms. Its normal for your symptoms to feel more or less severe at different times of the day. Speak to your doctor if: You think you might have a prolapse or you have symptoms of a prolapse such as: a feeling of a bulge or something coming down the vagina a feeling of a bulge or something coming out the vagina, which sometimes needs pushed back up (you may be able to see this with a mirror) discomfort during sex problems peeing a slow stream, a feeling of not emptying your bladder fully, needing to go to the toilet a lot or leaking Diagnosis A prolapse is a common condition. Seeing your doctor earlier may help you manage it more easily. Your doctor will need to carry out a pelvic examination, which will include an internal examination of your vagina. Your doctor will discuss this with you and you can ask any questions that you might have. As this is an intimate examination, the doctor may have another person (chaperone) present. You can ask for a female doctor or health professional if you prefer. The internal examination is similar to a smear test and should only take a few minutes. Your doctor will discuss with you if they think any further tests are needed. Types of prolapse Pelvic organ prolapse can affect the front, top or back of vagina. The main types of prolapse are: anterior prolapse (cystocele) where the bladder bulges into the front wall of the vagina prolapse of the womb and / or cervix (the opening between the vagina and the womb) where the womb and / or cervix bulges down in to the vagina vault prolapse this can be as a result of a total hysterectomy where the new top of the vagina bulges downwards posterior wall prolapse (rectocoele or enterocoele) when the bowel bulges forward into the back wall of the vagina You can have more than one of these types of prolapse at the same time. A number system of 1 to 4 is usually used to describe how severe a pelvic organ prolapse is. For example, a 4 means a severe prolapse. You can ask your healthcare professional what this means for you, and any other questions you may have. Causes There isnt usually one cause, but the risk of developing pelvic organ prolapse is increased by: age prolapse is more common as you get older, but its not an inevitable part of ageing childbirth particularly if you had a long or difficult labour, or have given birth to a large baby or multiple babies menopause related to lower levels of oestrogen or weaker tissue being overweight having large fibroids or pelvic cysts which create a lot of pressure in the pelvis previous surgery on the pelvis such as a hysterectomy repeated heavy lifting or manual work long term coughing or sneezing (caused by smoking, a lung condition or allergies) straining too much when going to the toilet for a poo because of long term constipation Prevention There are things you can do to reduce the risk of pelvic organ prolapse. Exercising your pelvic floor Do regular pelvic floor exercises to strength pelvic floor muscles maintain a healthy weight eat a high-fibre diet to avoid constipation or straining when you go to the toilet for a poo adopt good toilet habits avoid heavy lifting How to exercise your pelvic floor muscles Treatment Treatment will depend on how much the issue is affecting your normal day to day activities. In mild cases of prolapse, your doctor may recommend lifestyle changes. For example, regular pelvic floor exercises and maintaining a healthy weight. Vaginal pessary A vaginal pessary is a device inserted into your vagina, which holds your vaginal walls in place and so pushes the prolapse back. Pessaries are usually made of latex (rubber) or silicone, and come in different shapes and sizes. A pessary might not be right for everyone. Your doctor will discuss with you to find out if its the best option, and you can ask any questions you may have. Some side effects can include: vaginal discharge irritation, bleeding or sores inside your vagina stress incontinence difficulty with bowel movements difficulty having sex (although most women can have sex without problems) an imbalance of the usual bacteria found in your vagina If you have a pessary and experience any of these symptoms, speak to your healthcare professional. They can usually be treated. Hormone Replacement Therapy (HRT) HRT replaces the female hormones that are at a lower level as you experience the menopause. There is little evidence that HRT can directly treat pelvic organ prolapse, but it can relieve some of the symptoms associated with it. For example, vaginal dryness or discomfort during sex. Depending on your symptoms, you may wish to ask your doctor for more advice on whether this would be a suitable treatment option for you. Surgery Depending on your circumstances and how severe your symptoms are, your doctor may discuss with you whether a surgery might be helpful. They will go through the options with you. Its ok to ask any questions about your care to help you get the information you might need. You can then take some time to decide what the best option is for you. Source: Scottish Government - Opens in new browser window Last updated: 25 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Pelvic floor muscles It's OK to Ask Other health sites Pelvic Organ Prolapse: A physiotherapy guide for women Pelvic, Obstetric and Gynaecological Physiotherapy: Mens pelvic health NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852" | null | null | null | null | null | null | null | null | null | null | null | null | null |
Penile cancer | Penile cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Penile cancer Penile cancer Penile cancer is a rare type of cancer that occurs on the skin of the penis or within the penis. Over the last 30 years, the number of penile cancer cases has increased by more than 20%, possibly due to changes in sexual practices. However, improvements in diagnosis, staging and treatment have led to a similar reduction in the number of deaths resulting from the condition. Signs and symptoms Youshould be aware of any abnormalities or signs of penile cancer, including: a growth or sore on the penis that doesnt heal within 4 weeks bleeding from the penis or from under the foreskin a foul-smelling discharge thickening of the skin of the penis or foreskin that makes it difficult to draw back the foreskin (phimosis) a change in the colour of the skin of the penis or foreskin a rash on the penis If you experience these symptoms, its important that theyre checked by your GP as soon as possible. Its unlikely theyll becaused by cancer of the penis, but they need tobe investigated. Any delay in diagnosing penile cancer could reduce the chances of successful treatment. Types of penile cancer The penis is made up of many different types of tissue. The type ofpenile cancer you have will depend on the typeof cell thecancer developed from. The most common types of penile cancer include: squamous cell penile cancer which accounts for more than 90% of cases and starts in the cells that cover the surface of the penis carcinoma in situ (CIS) a particular type of squamous cell cancer where only the cells in the skin of the penis are affected and it hasnt spread any deeper adenocarcinoma cancer that starts in the glandular cells of the penis that produce sweat melanoma of the penis where the cancer develops in the skin cells that give the skin its colour The Cancer Research UK website has more information about the different types of penile cancer . What causes penile cancer? The cause of penile cancer isnt known, but certain risk factors can increase your chances of getting it. Men who carry thehuman papilloma virus (HPV)have an increased risk of developing penile cancer, which is the virus that causes genital warts . Age is also a risk factor for cancer of the penis. The condition rarely affects men and anyone with a penis under 40 years of age. It most commonly occurs in men and anyone with a penis aged over 60. Smoking is the mostsignificant lifestyle factor associated with penile cancer. Chemicals found in cigarettes can damage cells in the penis, which increases yourrisk of getting the condition. Conditions that affect the penis, such as phimosis, whichmakes the foreskindifficult to retract, increase your chances of developing infections such as balanitis. Repeated infections are linked to a higher risk of developing some types of penile cancer, because they can weaken your immune system. The Cancer Research UK website has more information about the risks and causes of penile cancer . Diagnosing penile cancer Your GP will ask you about any symptoms you have and when they occur. Theyll also examine your penis for signs of penile cancer. In 2015, the National Institute for Health and Care Excellence ( NICE ) published guidelines to help GPs recognise the signs and symptoms of penile cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected penile cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral . If your GP suspects penile cancer, theymay refer you toa specialist usually a urologist (a doctor who specialises in conditions that affect the urinary system and genitals). The specialist will ask about your symptomsand check your medical history. They may also check for any physical signs of penile cancer. A blood test may be carried out to check your general health and the number of blood cells. To confirm a diagnosis of penile cancer, you may need to have a biopsy . Asmall tissue sample will be removed so it can be examined under a microscopefor cancerous cells. Treating penile cancer Treatment for penile cancer will depend on the size of the affected area and the rate at which the cancer hasspread. For example, in most cases of carcinoma in situ (CIS), where only the skin cells of the penis are affected, treatment will usually involve either using achemotherapy cream or having laser surgery to remove the affected area of skin. You will usually haveaskin graft after surgery. The main treatments for penile cancer that isnt at a very early stage are: surgery radiotherapy chemotherapy Surgery will involve removing the cancerous cells and possibly some of the surrounding tissue. In most cases, any physical changes to your penis after an operation can be corrected with reconstructive surgery. Skin and muscle can be taken from elsewhere in the body to recreate a functioning penis. However, with early diagnosis and modern surgical techniques, your surgeon will usually be able to preserve as much penile tissue as possible. As part of most treatments for penile cancer, the lymph glands (small organs that are part of the immune system) in the groin will be assessed to determine if the cancer has spread. The test thats used, known as a sentinel nodebiopsy, is widely available in the UK. In some cases, the lymph glands may need to be surgically removed. As with most types of cancer, the outlook for individual cases depends largely on how far the cancer has advanced at the time of diagnosis. The Cancer Research UK website has more information about staging penile cancer and the types of treatment for cancer of the penis . You can also read about penile cancer on the male cancer website Orchid . They also have a helpline you can phone 0203 465 5766 (Monday to Friday, 9amto 5.30pm). Prevention It isnt always possible to prevent penile cancer, but you can reduce your chances of getting it. Oneof the mainways you can reduceyour chances of developing penile cancer is to give up smoking (if you smoke). Its also important to maintaingood penis hygiene to prevent the bacterial and viral infections thatcan increase the risk of penile cancer. This is easier if you were circumcised as a child, but there are steps you can take if you havent been circumcised. Simple penis hygiene can include: using condoms to help reduce the possibility of catching HPV regularlywashing your penis with warm water, including under the foreskin Theres little evidence to suggest that being circumcised as an adult will reduce your chances of developing penile cancer. However, if you have sores that dont heal, or if its becoming increasingly difficult toclean under your foreskin, seek advice from your GPabout the possibility of circumcision. Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Other health sites Cancer Research UK: Penile cancer Macmillan Cancer Support: Penile cancer Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Peripheral neuropathy | Peripheral neuropathy - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Peripheral neuropathy Peripheral neuropathy About peripheral neuropathy Symptoms of peripheral neuropathy Causes of peripheral neuropathy Diagnosing peripheral neuropathy Treating peripheral neuropathy Complications of peripheral neuropathy About peripheral neuropathy Peripheral neuropathy develops when nerves in the bodys extremities such as the hands, feet and arms are damaged. The symptoms depend on which nerves are affected. In the UK, its estimated that almost1 in 10 peopleaged 55 or over are affected by some degree of peripheral neuropathy. The peripheral nervous system Theperipheral nervous system is the network of nerves that lieoutside the central nervous system (the brain and spinal cord). It includes different types of nerves with their own specific functions, including: sensory nerves responsible for transmitting sensations, such as pain and touch motor nerves responsible for controlling muscles autonomic nerves responsible for regulating automatic functions of the body, such as blood pressure and bladder function Symptoms of peripheral neuropathy The main symptoms can include: numbness and tingling in the feet or hands burning, stabbing or shooting pain in affected areas loss of balance and co-ordination muscle weakness, especially in the feet These symptoms are usually constant, but may come and go. Read more about symptoms of peripheral neuropathy When to see your GP Its important to see your GP if you experience the early symptoms of peripheral neuropathy, such as: pain, tingling or loss of sensation in the feet loss of balance or weakness a cut or ulcer on your foot that isnt getting better Its recommended that people at highest riskof peripheral neuropathy, such as people withdiabetes, have regular check-ups. Your GP will ask about your symptoms and may arrange some teststo help identify the underlying cause. You may be referred to a hospital to see a neurologist(a specialist in conditions affecting the nervous system). Generally, the sooner peripheral neuropathy is diagnosed, the better the chance of limiting the damage and preventing further complications. Read more about diagnosing peripheral neuropathy Causes of peripheral neuropathy In the UK,diabetes (both type 1 and type 2) is the most common cause of peripheral neuropathy. Over time, the high blood sugar levels associated with diabetes can damage the nerves. This type of nerve damage is known as diabetic polyneuropathy. Peripheral neuropathy can also have a wide range of other causes. For example, it can be caused by: physical injury to the nerves aviral infection such as shingles a side effect of certain medications ordrinking too muchalcohol People who are known to be at anincreased risk of peripheral neuropathy may have regular check-ups so their nerve function can be assessed. Read more about thecauses of peripheral neuropathy Treatingperipheral neuropathy Treatment for peripheral neuropathy depends on the symptoms and underlying cause. Only some of the underlying causes of neuropathy can be treated. For example, if you have diabetes it may help to gain better controlof yourblood sugar level, stop smoking, and cut down on alcohol. Nerve pain may be treated with prescribed medications called neuropathic pain agents, as standard painkillers are often ineffective. If you have other symptoms, these may need to be treated individually. For example, treatment for muscle weakness may involve physiotherapyand the use of walking aids. Read more about treating peripheral neuropathy . Complications of peripheral neuropathy The outlook for peripheral neuropathy varies, depending on the underlying cause and which nerves have been damaged. Some cases may improve with time if the underlying cause is treated, whereasin some people the damage may be permanent or may get gradually worse with time. If the underlying cause of peripheral neuropathy isnt treated, you may be at risk of developing potentially serious complications, such as a foot ulcer that becomes infected. This can lead to gangrene (tissue death) if untreated, and in severe cases may mean the affected foot has to be amputated. Peripheral neuropathy mayaffect the nerves controlling the automatic functions of the heart and circulation system (cardiovascular autonomic neuropathy). You may need treatment to increase your blood pressure or,in rare cases, a pacemaker . Read more about complications of peripheral neuropathy Symptoms of peripheral neuropathy Symptoms vary according to the type of peripheral neuropathy and may develop quickly or slowly. The main types of peripheral neuropathy include: sensory neuropathydamage to the nerves that carry messages of touch, temperature, pain and other sensations to the brain motor neuropathydamage to the nerves that control movement autonomic neuropathydamage tothe nerves that control involuntary bodily processes, such as digestion, bladder function and control of blood pressure mononeuropathy damage to a single nerve outside of the central nervous system In many cases, someone with peripheral neuropathy may have more than one of these types at the same time. Acombination of sensory and motor neuropathy is particularly common (sensorimotor polyneuropathy). The symptoms of the main types of peripheral neuropathy are described below. Sensory neuropathy Symptoms of sensory neuropathy can include: prickling and tingling sensation in the affected body partpins and needles numbness and less of an ability to feel pain or changes in temperature, particularly in your feet a burning or sharp pain, usually in the feet feeling pain from something that should not be painful at all, such as a very light touch (allodynia) loss of balance or co-ordination caused by less ability to tell the position of the feet or hands (sensory ataxia) Motor neuropathy Symptoms of motor neuropathy can include: twitching and muscle cramps muscle weakness orparalysis affecting one or more muscles thinning (wasting) of muscles foot drop difficulty lifting up the front part of your foot and toes, particularly noticeable when walking Autonomic neuropathy Damage to the autonomic nerves can result in a wide range of symptoms depending on where in the body the damage occurs. Symptoms of autonomic neuropathy caninclude: constipation or diarrhoea , particularly at night feeling sick, bloating and belching low blood pressure (postural or orthostatic hypotension), which can make you feel faint or dizzy when standing up rapid heartbeat (tachycardia) excessive sweating or a lack of sweating problems with sexual function, such as erectile dysfunction in men difficulty fully emptying your bladder of urine bowel incontinence (loss of bowel control) Mononeuropathy Depending on the specific nerve affected, symptoms of mononeuropathy can include: altered sensation or weakness in the fingers double vision or other problems with focusing your eyes, sometimes with eye pain weakness of one side of your faceBells palsy foot or shin pain, weakness or altered sensation The most common type of mononeuropathy iscarpal tunnel syndrome (CTS). The carpal tunnel is a small tunnel in your wrist. In CTS, the median nerve becomes compressed where it passes through this tunnel, which may cause tingling, pain or numbness in the fingers. Causes of peripheral neuropathy Diabetes is the most common cause of peripheral neuropathy in the UK. Neuropathy can also be caused by other health conditions andcertain medications. In some cases, no causecan beidentifiedand this is termed idiopathic neuropathy. Diabetes Peripheral neuropathycaused byeither type 1 diabetes or type 2 diabetes is called diabetic polyneuropathy.Its probably caused by high levels of glucose in your blood damaging the tiny blood vessels that supply your nerves. Peripheral neuropathy becomes more likely the longer youve had diabetes. Up to1 in every4 people with the condition experience some pain caused by nerve damage. If you have diabetes, your risk of polyneuropathy is higher if your blood sugar is poorly controlled or you: smoke regularly consume large amounts of alcohol are over 40 years old If you have diabetes, you should examine your own feet regularly to check for ulcers (open wounds or sores) or chilblains. Other causes As well as diabetes, there are many other possible causes of peripheral neuropathy. Health conditions Some of the health conditions that can cause peripheral neuropathy include: excessive alcohol drinking for years low levels of vitamin B12 or other vitamins physical damage to the nervessuch as from an injury or during surgery an underactive thyroid gland (hypothyroidism) certain infectionssuch as shingles , Lyme disease , diphtheria, botulism and HIV inflammation of the blood vessels (vasculitis) chronic liver disease or chronic kidney disease monoclonal gammopathy of undetermined significance (MGUS) the presence of an abnormal protein in the blood certain types of cancer, such as lymphoma (a cancer of the lymphatic system) and multiple myeloma (a type of bone marrow cancer) Charcot-Marie-Tooth (CMT) diseaseand other types of hereditary motor sensory neuropathygenetic conditions that cause nerve damage, particularly in the feet having high levels of toxins in your body, such as arsenic, lead or mercury Guillain-Barr syndromea rare condition that causes rapid onset of paralysis within days amyloidosisa group of rare but serious conditions caused by deposits of abnormal protein called amyloid in tissues and organs throughout the body conditions caused by overactivity of the immune system such as rheumatoid arthritis , lupus or Sjogrens syndrome Medication A few medications may sometimes cause peripheral neuropathy as a side effect in some people. These include: some types of chemotherapy for cancer especially for bowel cancer , lymphoma or myeloma some antibiotics, if taken for months such as metronidazole ornitrofurantoin phenytoin used to treat epilepsy if taken fora long time amiodarone and thalidomide Diagnosing peripheral neuropathy A number of tests may be used to diagnose peripheral neuropathy and its underlying cause. When you see your GP,theyllask about your symptoms and examine the affected area of your body. This may involve testing sensation, strength and reflexes. Your doctor mayalso arrange blood tests, especially to check forcauses such as diabetes or vitamin B12 deficiency . Confirming if you have a neuropathy Some people may need to see a neurologist (a specialist in conditions affecting the nervous system)in hospital for further tests such as: a nerve conduction test (NCS)wheresmall metal wires called electrodes are placed on your skin which release tiny electric shocks that stimulate your nerves; the speed and strength of the nerve signal is measured electromyography(EMG)where a small needle is inserted through your skin into your muscle and used to measure the electrical activity of your muscles NCS and EMGare usually carried out at the same time. Identifying the cause of a neuropathy Your GP can usually identify the underlying cause of a peripheral neuropathy. If diabetes is suspected, they can usually make a confident diagnosis based onyour symptoms, a physical examination and checking the levels of glucose in your blood and urine. If youre taking a medication known to cause peripheral neuropathy, your GP maytemporarily stop or reduce your dose to see whether your symptoms improve. If the cause is uncertain, you may be referred to a neurologist for more extensive blood tests to check: whether you have a rare acquired cause that may be responsible whether you have a genetic abnormality, such as Charcot-Marie-Tooth disease You may need a lumbar puncture to test the cerebrospinal fluid (a clear, colourless fluid that surrounds and supports the brain and spinal cord) for inflammation. Further tests Occasionally, a nerve biopsy may be carried out as part of your diagnosis. This is a minor surgical procedure where a small sample of a peripheral nerve is removed from near your ankle so it can be examined under a microscope. Its then checked for changesthat could be a sign of certain types of peripheral neuropathy. However, nerve biopsies are rarely needed. You may also needa scan to look for any underlying cause of your neuropathy, such as: an X-ray a computerised tomography (CT) scan a magnetic resonance imaging (MRI) scan Treating peripheral neuropathy Treatment for peripheral neuropathymay includetreating any underlying cause or any symptoms youre experiencing. Treatment may be more successfulfor certain underlying causes.For example,ensuring diabetes is well controlled may help improve neuropathy or at least stop it getting worse. Treating the underlying cause There are many different possible causes of peripheral neuropathy , some of which can be treated in different ways. For example: diabetes can sometimes be controlled by lifestyle changes, such as stopping smoking, cutting downon alcohol, maintaining a healthy weight and exercising regularly vitamin B12 deficiency can be treated with B12 injections or tablets peripheral neuropathy caused by a medication youre taking may improve if the medication is stopped Some less common types of peripheral neuropathy may be treated with medication, such as: corticosteroids powerful anti-inflammatory medication immunosuppressants medications that reduce the activity of the immune system injections of immunoglobulin mixture of blood proteins called antibodies made by the immune system However, the underlying cause may not always be untreatable. Relieving nerve pain You may also require medication to treat any nerve pain (neuropathic pain)youre experiencing. Unlike most other types of pain, neuropathic pain doesnt usually get better with common painkillers, such as paracetamol and ibuprofen and other medications areoften used. These should usually be started at the minimum dose, with the dose gradually increased until you notice an effect, becausethe ideal dose for each person is unpredictable. Higher doses may bebetter at managing the pain, but are also more likely to cause side effects. The most common side effects are tiredness, dizziness or feeling drunk. If you get these, it may be necessary to reduce your dose. Dont drive or operate machineryif you experience drowsiness or blurred vision. You also may become more sensitive to the effects of alcohol. The side effects should improve after a week or two as your body gets used to the medication. However, if your side effects continue, tell your GPas it may be possible to change to a different medication that suits you better. Even if the first medication tried doesnt help, others may. Many of these medications may also be used for treating other conditions, such as depression, epilepsy, anxiety or headaches. If youre given an antidepressant , this may treat pain even if youre not depressed.This doesnt mean your doctor suspects youre depressed. The main medications recommended for neuropathic pain include: amitriptyline also used for treatment of headaches and depression duloxetinealso used for treatment of bladder problems and depression pregabalin and gabapentin also usedto treat epilepsy , headaches or anxiety There are also some additional medications that can be used to relieve pain in a specific area of the body or to relieve particularly severe pain for short periods. These are described below. Capsaicin cream If your pain is confined to a particular area of your body and you cant, or would prefer not to,take the medications above, you may benefit from using capsaicin cream. Capsaicin is the substance that makes chilli peppers hot and is thought to work in neuropathic pain by stopping the nerves sending pain messages to the brain. A pea-sized amount of capsaicin cream is rubbed on the painful area of skin three or four times a day. Side effects of capsaicin cream can include skin irritation and a burning sensation in the treated area when you first start treatment. Dont use capsaicin cream on broken or inflamed skin and always wash your hands after applying it. Lidocaine plaster This is a large sticking plaster that contains a local anaesthetic. Its useful when pain affects only a small area of skin. Its stuck over the area of painful skin and the local anaesthetic is absorbed into the skin thats covered. Tramadol Tramadol is a powerful painkiller related to morphine that can be used to treat neuropathic pain that doesnt respond to other treatments your GP can prescribe. Like all opioids, tramadol can be addictive if its taken for a long time. It will usually only be prescribed for a short time.Tramadol can be useful to take at times when your pain is worse. Common side effects of tramadol include: feeling sick orvomiting dizziness constipation Treating other symptoms In addition to treating pain, you may also require treatment to help you manage other symptoms youre experiencing as a result of peripheral neuropathy. For example, if you have muscle weakness, you may need physiotherapyto learn exercises to improve your muscle strength. You may also need to wear splints to support weak ankles or use walking aids to help you get around. Other problems associated with peripheral neuropathymay be treatable with medication, such as: erectile dysfunction constipation the slow movement of food through your stomach (gastroparesis) In some cases, you may need more invasive treatment, such as botulinum toxin injections for hyperhidrosis or urinary catheterisation if you have problems emptying your bladder. Complications of peripheral neuropathy Peripheral neuropathy can sometimes cause other medical problems, such as foot ulcers and heart rhythm changes, and blood circulation problems. These complications vary depending on the underlying cause of the condition. Diabetic foot ulcer A diabetic foot ulcer is an open wound or sore on the skinthats slow to heal. These are common in people with diabetic polyneuropathy. If you have numb feet, its easy to cut your foot by stepping on something sharp. An ulcer can also occur if you unknowingly develop a blister caused bybadly fitting shoes. If you dont feel any pain, you may continue walking without protecting the blister. If the cut or blister gets worse, it may develop into an ulcer. High blood sugar can damage your blood vessels, causing the blood supply to your feet to become restricted. A reduced blood supply to the skin on your feet means it receives a lower number of infection-fighting cells, which can mean wounds take longer to heal and can lead to gangrene. Gangrene If you do develop a wound infection in one of your feet as a result of peripheral neuropathy, theres a risk this couldlead to gangrene(death of part of the skin or underlying tissues). If gangrene does develop, you may need surgery to remove the damaged tissue (known as debridement) and antibiotics to treat any underlying infection. In severe cases your toe or foot may need to be amputated. If you have diabetes, you should take extra care of your feet. Get your feet checked regularly by a podiatrist (a medical professional, also known as a chiropodist, who specialises in foot care). Cardiovascular autonomic neuropathy (CAN) Cardiovascular autonomic neuropathy (CAN) is another potentially serious problem thats common in people with diabetic polyneuropathy. CAN occurs when damage to the peripheral nerves disrupts the automatic functions that control your blood circulation and heartbeat. The two main noticeable symptoms of CAN are: an inability to exercise for more than a very short period of time orthostatic hypotension a type of low blood pressure that can make you feel dizzy or faint when you stand up Treating CAN You may be able to control the symptoms of orthostatic hypotension by using a number of self care techniques, such as: standing or sitting up slowly and gradually drinking plenty of fluids to increase the volume of your blood and raise your blood pressure wearing compression stockings to help prevent blood falling back down into your legs tilting your bed by raising it at the head end In some cases, medication may be required to treat orthostatic hypotension. Two widely used medications are: fludrocortisonewhich works by increasing the volume of your blood midodrinewhich works by tightening your blood vessels A more serious concern with CAN is that your heart may suddenly develop an abnormal pattern of beating (arrhythmia), which could lead to a cardiac arrest,where your heart stops beating altogether. To prevent this, you may be prescribed medication to help regulate the beating of your heart, such as flecainide, beta-blockers or amiodarone. If you have CAN, youll probably need to have regular check-ups so your heart function can be monitored. Source: NHS 24 - Opens in new browser window Last updated: 16 June 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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Personality disorder | Personality disorder | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mental health Personality disorder Personality disorder Personality disorders are conditions where an individual differs significantly from an average person. This may be related to how they: think perceive feel relate to others Changes in how a person feels and distorted beliefs about other people can lead to odd behaviour. This can be distressing and may upset others. Common features of a personality disorder Common features of a personality disorder include: being overwhelmed by negative feelings like distress, anxiety, worthlessness or anger avoiding other people feeling empty and emotionally disconnected odd behaviour difficulty maintaining stable and close relationships, especially with partners, children and professional carers periods of losing contact with reality Some people may also have difficulty managing negative feelings without self-harming. This can include abusing drugs and alcohol or taking overdoses. In rare cases, it may include threatening other people. People with personality disorders often experience other mental health problems. This includes depression and substance misuse. Symptoms typically get worse with stress . When and why personality disorders occur Personality disorders are common mental health problems. They usually emerge in adolescence and continue into adulthood. They may be mild, moderate or severe. People may have periods of remission where they function well. Personality disorders may be associated with genetic and family factors. Experiences of distress or fear during childhood, like neglect or abuse, are common. Many people have only mild conditions so only need help at times of stress (such as bereavement). People with more severe problems may need specialist help for longer. Types of personality disorder There are different types of personality disorders. Paranoid personality disorder A person with a paranoid personality disorder is extremely distrustful and suspicious. Other features include: thinking other people are lying to them or trying to manipulate them feeling they cannot trust their friends and associates worrying that any confidential information shared with others will be used against them thinking there are hidden meanings in remarks most would regard as innocent worrying that their spouse or partner is unfaithful, despite a lack of evidence Schizoid personality disorder Someone with a schizoid personality disorder may appear cold and detached. They may also avoid making close social contact with others. Other features include: preferring to take part in activities that do not need interaction with others having little desire to form close relationships, including sexual relationships being uninterested when receiving criticism or praise having a limited ability to experience pleasure or joy Schizotypal personality disorder A person with a schizotypal personality disorder is likely to: have poor social skills have delusional thoughts behave in unusual ways Other features include: believing in special powers like telepathy or the ability to influence other peoples emotions and actions having unusual ways of speaking like long, rambling vague sentences or going off on a tangent experiencing excessive anxiety in social situations even if theyve known a particular person or group of people for a long time A person may also attach undue and misguided significance to everyday events. For example, thinking newspaper headlines are secret messages to them. Antisocial personality disorder A person with an antisocial personality disorder sees other people as vulnerable. This means they may intimidate or bully others without remorse. Symptoms include: lack of concern, regret or remorse about other peoples distress irresponsibility and disregard for normal social behaviour difficulty in sustaining long-term relationships little ability to tolerate frustration and control their anger lack of guilt, or not learning from their mistakes blaming others for problems in their lives Borderline personality disorder A person with borderline personality disorder: is emotionally unstable has impulses to self-harm has very intense and unstable relationships with others Histrionic personality disorder A person with a histrionic personality disorder is anxious about being ignored. As a result, they feel an overwhelming urge to be noticed. They also have the urge to be the centre of everyones attention. Features include: displaying excessive emotion, yet appearing to lack real emotional sincerity dressing provocatively and engaging in inappropriate flirting or sexually seductive behaviour moving quickly from one emotional state to another being self-centred and caring little about other people constantly seeking reassurance and approval from other people Symptoms and signs may co-exist with borderline and narcissistic personality disorders. Narcissistic personality disorder A person with narcissistic personality disorder swings between: seeing themselves as special, and fearing theyre worthless They may act as if they have an inflated sense of their own importance. They may also show an intense need for other people to look up to them. Other symptoms include: exaggerating their achievements and abilities thinking theyre entitled to be treated better than other people exploiting other people for their own personal gain lacking empathy for other peoples weaknesses looking down on people they feel are beneath them feeling deeply envious of people they see as being above them Avoidant personality disorder A person with avoidant personality disorder: appears painfully shy is socially inhibited feels inadequate is extremely sensitive to rejection Unlike people with schizoid personality disorders, they desire close relationships with others. However, they lack the confidence and ability to form them. Dependent personality disorder A person with dependent personality disorder feels they cant be independent. They may show an excessive need for others to look after them and are clingy. Other features include: finding it difficult to make decisions without other peoples guidance needing others to take responsibility over what should be their own life choices not being able to express disagreement with other people finding it difficult to start new activities due to a lack of confidence going to extremes to get support and comfort feeling helpless and uncomfortable when alone urgently needing to start a new relationship when one comes to an end having an unrealistic and constant fear theyll be left alone to fend for themselves Obsessive compulsive personality disorder A person with obsessive compulsive personality disorder is: anxious about issues that seem out of control or messy preoccupied with orderliness and ways to control their environment They may come across to others as a control freak. Other features include: having an excessive interest in lists, timetables and rules perfectionism being so focused on completing a task perfectly that they struggle to finish it being a workaholic having very rigid views about issues like morality, ethics and how a person should behave hoarding items that seem to have no monetary or sentimental value being unable to delegate tasks to other people disliking spending money, as they think its always better to save for a rainy day Differences to obsessive compulsive disorder (OCD) This personality disorder differs from obsessive compulsive disorder (OCD) . People with OCD are aware that their behaviour is abnormal and are anxious about it. Whereas, most people with obsessive compulsive personality disorder think their behaviour is acceptable. They usually have no desire to change it. Some people with OCD feel the need to carry out rituals. For example, having to touch every second lamppost as they walk down the street. This is not usually the case with people with obsessive compulsive personality disorder. People with OCD may feel the need to make lists or organise items in their house, but feel anxious about doing so. People with obsessive compulsive personality disorder feel less anxiety through such tasks. They may become irritated when prevented from doing so. Treating a personality disorder Many people recover from personality disorders over time. Treatment usually involves a course of psychological therapy tailored to the individual. This treatment usually lasts at least 6 months. But, it may last longer depending on the severity of the condition and other problems. Psychological therapies Psychotherapy involves discussing thoughts, emotions and behaviours with a trained professional. The aim is to improve peoples ability to regulate their thoughts and emotions. Some therapies focus on dysfunctional thoughts. Others focus on self-reflection and being aware of how your mind works. Some therapies, especially group therapies, help people understand social relationships better. Psychological therapies can be effective for many personality disorders. But, they should only be delivered by a trained professional. They should have experience working with personality disorders and other conditions. This is because personality disorders can be associated with high-risk behaviours, like self-harm. The psychotherapist will listen and discuss important issues with you. They can also suggest strategies to resolve problems. If necessary, theyll help you change your attitudes and behaviour. A range of different psychotherapies are used to treat personality disorders. Read more about types of counselling and therapy Medication No medications are currently licensed for the treatment of any personality disorder. But, medications may be prescribed to treat associated problems, like: depression anxiety psychotic symptoms Source: NHS 24 - Opens in new browser window Last updated: 12 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Pleurisy | Pleurisy | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Lungs and airways Pleurisy Pleurisy About pleurisy Causes of pleurisy Treating pleurisy About pleurisy Pleurisy is inflammation of the sheet-like layers that cover the lungs (the pleura). The most common symptom of pleurisy is a sharpchest pain when breathing deeply. Sometimes the pain is also felt in the shoulder. The pain may be worse when you cough, sneeze or move around, and it may be relieved by taking shallow breaths. Other symptoms can includeshortness of breathand a dry cough . Visit your GP if youexperience the above symptoms.Seek immediate medical help if your chest pain is severe, particularly if you also have other symptoms, such as coughing up blood, nausea or sweating. Seeing your GP Pleurisy can usually be diagnosed by studying your symptoms. Your GP can listen to your chest to check for the distinctive dry, crunching sound that suggests you may have pleurisy. Further tests may beneeded to identify the underlying cause of your pleurisy and to assess how severe it is. These can include: blood tests to determine whether you have an infection or an autoimmune condition chest X-rays an ultrasound scan a computerised tomography (CT) scan a biopsy a small sample of pleural or lung tissue is removed for further testing What causes pleurisy? Most cases are the result of aviral infection (such as the flu ) ora bacterial infection (such as pneumonia ). In rarer cases, pleurisy can be caused by conditionssuch asa blood clot blocking the flow of blood into the lungs (pulmonary embolism)or lung cancer . Pleurisy can affect people of all ages, but people of 65 years and over are most at risk, because theyre more likely to develop a chest infection . Read more about the causes of pleurisy . How is pleurisy treated? Treatment for pleurisy depends on the underlying cause. For example, pleurisy caused by a viral infection will often resolve itself without treatment.However, pleurisy caused by a bacterial infection is usually treated with antibiotics , and people who are frail or already in poor health may be admitted to hospital. Non-steroidal anti-inflammatory drugs (NSAIDs) , such as ibuprofen , are often used to relieve the chest pain associated with pleurisy. If excess fluid builds up between the pleural layers, it may be necessary to drain the fluid to prevent breathing difficulties. Read more about treating pleurisy . Causes of pleurisy Pleurisy is inflammation of the pleura. Its usually caused by another condition, such as an infection, but sometimes no cause can be identified. The pleura are two thin sheets of tissuethat separate the lungs and ribcage. One is attached to the ribcage and the other is attached to the lungs. Between the pleural sheets is a thin layer of liquid that lubricates the pleura, helping to reducefriction when you breathe in and out. When theres inflammation, the surfaces of the two layers can become rough and the fluid can become sticky. This can cause the layers to rub together, resulting in pain and discomfort. Infection An infection is the most common cause of pleurisy.Any type of infection has the potential to spread to the pleura, but viral infections are usually responsible. Viruses known tocausepleurisy include: the influenza (flu) virus the Epstein-Barr virus whichcauses glandular fever cytomegalovirus (CMV) a common virus found in most people, which doesnt usually cause any noticeable symptoms parainfluenza the virus that causes the childhood condition croup In some cases, pleurisy is caused by bacteria, such as: streptococcal bacteria often associated with pneumonia , throat infections and some types of skin infections, such as impetigo and cellulitis staphylococcal bacteria often associated with skin infections, food poisoning and, more seriously, blood poisoning (sepsis) Meticillin-resistant Staphylococcus aureus (MRSA) can cause pleurisy, especially inhospital patients. MRSA is a type of bacteriawith a resistance to a number of commonly used antibiotics. Other causes Other possible causes of pleurisy include: injury if the ribs are bruised or fractured, the pleura can become inflamed pulmonary embolism a blood clot developing inside the lungs sickle cell anaemia a blood disorder that usually affectspeople of African or Caribbean descent chemotherapy and radiotherapy HIV or AIDS lung cancer mesothelioma a type of cancer caused by inhaling asbestos Autoimmune conditions, such as rheumatoid arthritis and lupus , are other possible causes of pleurisy. In these conditions, something goes wrong with the immune system (the bodys natural defence against infection and illness)and it begins to attack healthy tissue. Treating pleurisy Treatment for pleurisy usually involves relieving pain and treating the underlying cause of the condition. If treated promptly, pleurisyoften resolves without any lasting damage to the lungs. Treating pain The chest pain associated with pleurisy can be treated usinga type of painkiller known as non-steroidal anti-inflammatory drugs (NSAIDs) . Most often, ibuprofen is used. If NSAIDs are ineffective or unsuitable, you may be prescribed another painkiller, such as paracetamol or codeine. It may seem strange, but lying down on the side of your chest that hurts may also helpto reduce the pain. Treating the underlying cause It may also be necessary to treat the underlying cause of your pleurisy. If you have pleurisycaused by a bacterial infection, youll need a course of antibiotics . Depending on the severity of your symptoms, this may be eithertablets or injections. Combinations of different antibiotics are sometimes used. However, ifyour pleurisy is caused by a viral infection, further treatment may not be required,as the infection usually resolves itself after a few days. In cases where your symptoms are particularly severe or youre already in poor health, you may need to be admitted to hospital soyour bodys functions can be supported until your condition stabilises. Pleural effusion In some cases, pleurisy causes a build-up of excess fluid around the lungs called pleural effusion. Pleural effusion canresult inshortness of breath that gets progressively worse. Thisis more likely in cases of pleurisy caused by pulmonary embolism or a bacterial infection. If pleural effusion doesnt clear up as your pleurisy is treated, or if youre very short of breath, a tube will need to be inserted so the fluidcan be drained away. The tubemaybe inserted usingeither general anaesthetic (where youre asleep) or local anaesthetic (the area where the tube is inserted is numbed). If a lot of fluid has to be drained away,you may need to stay in hospital for a few days. Source: NHS 24 - Opens in new browser window Last updated: 02 February 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Flu Pneumonia Pleurisy NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Pneumonia | Pneumonia | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Lungs and airways Pneumonia Pneumonia About pneumonia Treating pneumonia About pneumonia Pneumonia is swelling (inflammation) of the tissue in one or both lungs. Its usually caused by a bacterial infection. At the end of the breathing tubes in your lungsare clusters of tiny air sacs. If you have pneumonia, these tiny sacs become inflamed and fill up with fluid. Symptoms of pneumonia The symptoms of pneumoniacan develop suddenly over 24 to 48 hours, or they may come on more slowly over several days. Commonsymptomsof pneumoniainclude: a cough which may be dry, or produce thick yellow, green, brown or blood-stainedmucus (phlegm) difficulty breathing your breathing may be rapid and shallow, and you may feel breathless, even whenresting rapid heartbeat fever feeling generally unwell sweating and shivering loss of appetite chest pain which gets worse when breathing or coughing Less common symptoms include: coughing up blood (haemoptysis) headaches fatigue nausea or vomiting wheezing joint and muscle pain feeling confused and disorientated, particularly in elderly people When to see your GP See your GP if youfeel unwell and you have typical symptoms of pneumonia. Seek urgent medical attention if youre experiencing severe symptoms, such asrapid breathing,chest painor confusion. Whos affected? In the UK, pneumonia affects around8in 1,000 adults each year. Its more widespreadin autumn and winter. Pneumonia can affect people of any age, but its more common and can be more seriousin certain groups of people, such as the very young or the elderly. People in these groups are more likely to need hospital treatment if they develop pneumonia. What causes pneumonia? Pneumonia is usually the result ofapneumococcal infection, caused by bacteria calledStreptococcus pneumoniae. Many different types of bacteria, includingHaemophilus influenzae and Staphylococcus aureus, can also cause pneumonia, as well as viruses and, more rarely, fungi. As well as bacterial pneumonia, other types include: viral pneumonia most commonly caused by the respiratory syncytial virus (RSV) and sometimes influenza type A or B; viruses are a common cause of pneumonia in young children aspiration pneumonia caused by breathing in vomit,a foreign object, such as a peanut,or a harmful substance, such as smoke or a chemical fungal pneumonia rare in the UK and more likely to affect people with a weakened immune system hospital-acquired pneumonia pneumonia that develops in hospital while being treated for another condition or having an operation; people in intensive careon breathing machines are particularly at risk of developing ventilator-associated pneumonia Risk groups The following groups have an increased risk of developing pneumonia: babies and very young children elderly people people who smoke people with other health conditions, such as asthma , cystic fibrosis , or a heart, kidney or liver condition people with a weakened immune system for example, as a result of a recent illness, such as flu , having HIV or AIDS , having chemotherapy ,or taking medication following an organ transplant Diagnosing pneumonia Your GP may be able to diagnose pneumonia by asking about your symptoms and examining your chest. Further tests may be needed in some cases. Pneumonia can be difficult to diagnose because it shares many symptoms with other conditions, such as the common cold , bronchitis and asthma . To help make a diagnosis, your GP may ask you: whetheryou feel breathless or youre breathing faster than usual how long youve had your cough,and whether youre coughing up mucus and what colour it is if the pain in your chest is worse when you breathe in or out Your GP may also take your temperature and listen to your chest and back with a stethoscope to check for any crackling or rattling sounds. They may also listen to your chest by tapping it. Lungs filled with fluid produce a different soundfrom normal healthy lungs. If you have mild pneumonia, you probably wontneed to have a chest X-ray or any other tests. You may need a chestX-ray or other tests, such as a sputum (mucus) test or blood tests ,if your symptoms havent improved within 48 hours of starting treatment. Treating pneumonia Mild pneumonia can usually be treated at home by: getting plenty of rest taking antibiotics drinking plenty of fluids If you dont have any other health problems, you should respond well to treatment and soon recover, although your cough may last for some time. As pneumonia isnt usually passed from one person to another, its safe to be around others, including family members. However, people with a weakened immune system should avoid close contact with a person with pneumonia until they start to get better. For at-risk groups, pneumonia can be severe and may need to be treated in hospital. This is because it can lead to serious complications, which in some cases can be fatal, depending on a persons health and age. Read more about treating pneumonia . Complications of pneumonia Complications of pneumonia are more common in young children, the elderlyand those with pre-existing health conditions, such as diabetes . Possible complications of pneumonia include: pleurisy where the thin linings between your lungs and ribcage (pleura) become inflamed, which can lead to respiratory failure a lung abscess a rare complication thats mostly seen in people with a serious pre-existing illness or a history of severe alcohol misuse blood poisoning (septicaemia) also a rare but serious complication Youll be admitted to hospital for treatment if you develop one of these complications. Preventing pneumonia Although most cases of pneumonia are bacterial and arent passed on from one person to another, ensuring good standards of hygiene will help prevent germs spreading. For example, you should: cover your mouth and nose with a handkerchief or tissue when you cough or sneeze throw away used tissues immediately germs can live for several hours after they leave your nose or mouth wash your hands regularly to avoid transferring germs to other people or objects A healthylifestyle can also help prevent pneumonia. For example, you should avoid smokingas it damages your lungs and increases the chance of infection. Find outhow to stop smoking . Excessive and prolongedalcohol misuse also weakens your lungs natural defences against infections, making you more vulnerable to pneumonia. People at high risk of pneumoniashould be offered the pneumococcal vaccineand flu vaccine. Treating pneumonia Mild pneumonia can usually be treated at home with rest, antibiotics and by drinking plenty of fluids. More severe cases may need hospital treatment. Unless a healthcare professional tells you otherwise, you should always finish taking a prescribed course of antibiotics, even if you feel better. If you stop taking an antibiotic part way through a course, the bacteria can become resistant to the antibiotic. After starting treatment, your symptoms should steadily improve. However, how quickly they improve will depend on how severe your pneumonia is. As a generalguide, after: one week fever should have resolved four weeks chest pain and mucus production should have substantially reduced six weeks cough and breathlessness should have substantially reduced three months most symptoms should have resolved, but you may still feel very tired (fatigue) six months most people will feel back to normal Treatment at home Visit your GP if your symptoms dont improve within three days of starting antibiotics . Symptoms may not improve if: the bacteria causing the infection is resistant to antibiotics your GP may prescribe a different antibiotic, or they may prescribe a second antibiotic for you to take with the first one avirus is causing the infection, rather than bacteria antibiotics have no effect on viruses, andyour bodys immune system will have to fight the viral infection by creating antibodies Painkillers, such as paracetamol or ibuprofen , may help relievepain and reducefever. However, you shouldnt take ibuprofen if you: are allergic to aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) have asthma , kidney disease, a history of stomach ulcers or indigestion Cough medicines arent recommended as theres also little evidence they are effective. A warm honey and lemon drink can help relieve discomfort caused by coughing. Yourcough may persist for two to three weeks after you finish your course ofantibiotics,and you may feel tired for even longer as your body continues to recover. Drink plenty of fluids to avoid dehydration , and get plenty of rest to help your body recover. If you smoke,its more important than ever to stop, as smoking damages your lungs. Read more about stop smoking treatments and how to stop smoking . See your GP if, after following the above self-help measures, your condition is deteriorating or isnt improving as expected. Pneumonia isnt usually passed from one person to another, so its safe to be around others, including family members. However, its best for people with a weakened immune system to avoid close contact with a person with pneumonia until they start to get better. Follow-up Your GP will probably arrange a follow-up appointment for you about six weeks after you start your course of antibiotics. In some cases, they may arrange follow-up tests, such as a chest X-ray , if: your symptoms havent improved your symptoms have come back you smoke youre over the age of 50 Some people may be advised to have a flu vaccination or pneumococcal vaccination after recovering from pneumonia. Read more about preventing pneumonia . Treatment in hospital You mayneed treatment inhospital ifyour symptoms are severe. Youll be given antibiotics and fluids intravenously through a drip, and you may need oxygen to help breathing. In very serious cases of pneumonia, breathing assistance through a ventilator in an intensive care unit (ICU)may be required. Read more about the complications of pneumonia . Source: NHS 24 - Opens in new browser window Last updated: 07 December 2022 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Quit Your Way Scotland Pneumonia Pleurisy Shortness of breath NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Polycystic ovary syndrome (PCOS) | "Polycystic ovary syndrome (PCOS) Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Healthy living Women's health Girls and young women (puberty to around 25) Periods and menstrual health Polycystic ovary syndrome (PCOS) Polycystic ovary syndrome (PCOS) | | Polski | | | Easy Read Return to Symptoms Enter age Last Updated: Next Review Date: Review my answers Find your local services Search for a service near you by entering your postcode below. Please input your postcode in the following format: A12 1BC GP Practices Dental Services Pharmacies Opticians Postcode Search NHS inform has more information on this condition. Read more Previous Start guide Review my answers You told us your credentials were: : You said: Based on the information you gave us, we made the following recommendation: Close Keep a copy View PDF Polycystic ovary syndrome (PCOS) is a condition that affects how your ovaries work. Despite the name, there are no cysts on the ovaries. During ovulation, an egg is released once a month. PCOS can have an impact on this and cause irregular ovulation, or no ovulation at all. If you want to have a family, PCOS can make it difficult to get pregnant. PCOS can also affect your metabolism (the chemical reactions in the bodys cells that change food into energy) making it easier to gain weight and more difficult to lose weight. Symptoms You are born with PCOS, but symptoms often start during puberty although for some people this can be later, up to their early twenties. There are lots of different symptoms that can be caused by PCOS. The main symptoms are: irregular periods you should have at least 3 or 4 periods a year to keep the womb healthy if youre not using hormonal contraception excess facial or body hair which is caused by slightly higher levels of male hormones in your body (androgen) Other symptoms can include: weight gain hair loss or hair thinning oily skin or acne difficulty or delays getting pregnant People who have PCOS can also struggle with depression and with their mental health as a result of the condition. PCOS can increase your risk of certain health conditions, including type 2 diabetes and high cholesterol. You should speak to your doctor if you are experiencing these symptoms and you are not pregnant or on hormone treatment. Causes The exact cause of PCOS isnt known but its thought to be caused by a hormone and metabolic (the chemical reactions in the bodys cells that change food into energy) imbalance in the body. PCOS can run in families so if someone in your family has the condition, its more likely you may have it too. You should let your doctor know if this is the case for you. People with PCOS have a higher risk of developing health problems in later life, such as type 2 diabetes and high cholesterol levels, as PCOS can make it easier to gain weight and more difficult to lose weight. Diagnosis Your doctor will talk to you about your symptoms to help rule out any other health conditions. It can be helpful to keep a note of your period dates and symptoms using a calendar, a diary or an app. This can help you track how the symptoms are affecting your life, and will give your doctor more of an insight. Your doctor might recommend you have some hormone and/or blood tests, to rule out any other hormone-related conditions. You might also need to have an ultrasound scan, as this will help them to diagnose PCOS. If youre diagnosed with PCOS, you may be referred to a specialist. Treatment Treatment can vary depending on your symptoms. Although theres no cure, there are lots of treatment options available to help manage your symptoms. Treatments can also help prevent complications and, if you want to have a family, improve your chances of getting pregnant. If you dont want to become pregnant you should still use contraception as you may still ovulate sometimes. Your doctor can discuss the options so that you can decide whats best for you, and you can ask any questions that you might have. Having a healthy diet and exercising regularly can significantly help your PCOS symptoms. It can also reduce your chances of developing other health conditions, including type 2 diabetes and high cholesterol. You should try to: eat lots of fruit and vegetables eat more fibre drink plenty of water eat oilyfish reduce meat and dairy products avoid sugary food and drink avoid or limit alcohol going for regular walks keeping active, in particular aerobic exercise If youre struggling with managing your symptoms, your doctor can provide further support. Source: Scottish Government - Opens in new browser window Last updated: 30 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Other languages and formats | | Polski | | | Easy Read | | Polski | | | Easy Read Add this page to\n Info For Me Also on NHS inform Type 2 diabetes High cholesterol Food and nutrition Keeping active Self-help tool: Periods and mental wellbeing Other health sites Verity UK British Fibroid Trust PCOS Relief PCOS Relief: video NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852" | null | null | null | null | null | null | null | null | null | null | null | null | null |
Polymyalgia rheumatica | Polymyalgia rheumatica | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Muscle, bone and joints Conditions Polymyalgia rheumatica Polymyalgia rheumatica About polymyalgia rheumatica Symptoms of polymyalgia rheumatica Diagnosing polymyalgia rheumatica Treating polymyalgia rheumatica About polymyalgia rheumatica Polymyalgia rheumatica (PMR) is a condition that causes pain, stiffness and inflammation in the muscles around the shoulders, neck and hips. The main symptom is musclestiffness in the morning that lasts longer than 45 minutes. It may also causeother symptoms, including: high temperature (fever) and sweating extreme tiredness (fatigue) loss of appetite weight loss depression If you have pain and stiffness that lasts longer than a week, you should see your GP so the cause can be investigated. Diagnosing polymyalgia rheumaticacan be difficult because the symptoms are similar to those of many other conditions, including rheumatoid arthritis . These conditions will need to be ruled out before polymyalgia rheumatica is diagnosed. Read more about the symptoms of polymyalgia rheumatica and diagnosing polymyalgia rheumatica . What causes polymyalgia rheumatica? The cause of polymyalgia rheumatica is unknown, but a combination of genetic and environmental factorsis thought to be responsible. Polymyalgia rheumatica is relatively common in the UK. Its estimated that one in every 1,200 people develop the condition every year. Polymyalgia rheumatica isage-related. Most people who are diagnosed with the condition are over 70. Its extremely rare in people younger than 50. Its also more common in women than men. Treating polymyalgia rheumatica The main treatment forpolymyalgia rheumatica is a coritcosteroid medication called prednisolone, which is used to help relieve the symptoms. Youllinitiallybe prescribed a high dose of prednisolone, which will be reduced gradually over time. Most people with polymyalgia rheumatica will need to take a long-term course of corticosteroid treatment(lasting 18 months to two years) to prevent their symptoms returning. Read more about treating polymyalgia rheumatica . Symptoms of polymyalgia rheumatica The most common symptom of polymyalgia rheumatica (PMR) is pain and stiffness in the shoulder muscles, which develops quickly over a few days or weeks. The muscles in the neck andhips are also often affected. Both sides of the body are usually affected. The stiffness often feelsworse first thing in the morning after you wake up and starts to improve after about 45 minutes as you become more active. Some people withpolymyalgia rheumatica have additional symptoms, including: a mild high temperature (fever) of 37-38C (98.6-100.4F) depression fatigue (extreme tiredness) loss of appetite weight loss When to seek medical advice If you have symptoms of pain and stiffness that last longer than a week, you should make an appointment to see your GP so that the cause can be investigated. When to seek immediate medical advice You should seek immediate medical advice if you have been diagnosed with polymyalgia rheumatica (or the condition is suspected) and you suddenly develop: a persistent and severe headache jaw pain or cramping in your jaw muscles which is worse when youre eating pain in the tongue when chewing vision lossor vision disturbances, such asdouble vision These symptoms may indicate a more serious condition called giant cell arteritis (temporal arteritis). Call your GP immediately for adviceif you have any of the above symptoms. If this isnt possible,contact your local out of hours service or call theNHS 24 111 service. Diagnosing polymyalgia rheumatica Diagnosing polymyalgia rheumatica (PMR) can often be quite a lengthy process that involves several different tests. This is because the condition shares many symptoms with more common health conditions, such as rheumatoid arthritis , which need to be ruled out first. Tests Theres no specific test for polymyalgia rheumatica, but its likely that a series of blood tests will be carried out. Two blood tests erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) can be used to check the levels of inflammation in your body. If the ESR and CRP test results are normal, its unlikely that polymyalgia rheumatica will be diagnosed because your doctor wont want to prescribe a long-term course of steroids if the diagnosis is uncertain. Sometimes, the ESR may be normal and CRP may be raised, which would be more likely to indicate a positive diagnosis. This is why both tests are usually carried out at the same time. As inflammation is a characteristic of many conditions, high levels dont automatically mean that you have polymyalgia rheumatica. Further tests may be needed to help rule out other conditions that cause inflammation. For example, a test for rheumatoid factor and anti-CCP antibodies , may be carried out to rule out rheumatoid arthritis. Blood tests can also help determine: whether theres an infection in your blood how well some of your organs, such as your kidneys, are working whether you have an overactive thyroid gland or an underactive thyroid gland (both conditions can cause muscle pain) You may also have a urine test to check how well your liver is functioning. X-rays and ultrasound scans may also be used to look at the condition of your bones and joints. Symptom checklist After other possible causes of your symptoms have been ruled out, a checklist can be used to see whether your symptoms match those most commonly associated with polymyalgia rheumatica. A confident diagnosis of polymyalgia rheumatica can usually be made if you meet all of the following criteria: youre over 50 years of age you have pain in your shoulders or your hips you have stiffness in the morning that lasts longer than 45 minutes your symptoms have lasted longer than two weeks blood tests show raised levels of inflammation in your body your symptoms rapidlyimprove after treatment with corticosteroids Read more about treating polymyalgia rheumatica . Treating polymyalgia rheumatica Steroid medication ( corticosteroids ) is the preferred treatment for polymyalgia rheumatica (PMR). A type of corticosteroid calledprednisolone is usually prescribed. Prednisolone Prednisolone works by blocking the effects of certain chemicals that cause inflammation inside your body. It doesnt cure polymyalgia rheumatica, but it can helprelieve the symptoms. When used to treat polymyalgia rheumatica, prednisolone is taken as a tablet. Most people will be prescribed several tablets to take once a day. Youll be prescribed a high dose of prednisolone initially, and the dose will be gradually reduced every one to two months. Although your symptoms should improve within a few days of starting treatment, youll probablyneed to continue takinga low dose of prednisolone forabout two years. In many cases, polymyalgia rheumatica improves on its own after this time. However, theres a chance that the condition will return (relapse)once treatment stops. Dont suddenly stop taking steroid medication unless a doctor in charge of your care tells you its safe to do so. Suddenly stopping treatment with steroids can make you feel very ill. Side effects of prednisolone Aboutone in 20 people who take prednisolone will experience changes in their mental state when they take the medication. You may feel depressed and suicidal , anxious or confused. Some people also experience hallucinations (seeing or hearing things that arent there). Contact your GP as soon as possible if you experience changes to your mental state. Other side effects of prednisolone include: increased appetite that often leads to weight gain increased blood pressure mood changes, such as becoming aggressive orirritable with people weakening of the bones ( osteoporosis ) stomach ulcers increased risk of infection, particularly with thevaricella-zoster virus (the virus that causes chickenpox and shingles ) Seek immediate medical advice if you think youve been exposed to the varicella-zostervirus, or if a member of your household develops chickenpox or shingles. The risk of these side effects should improve as your dose of prednisolone is decreased. See side effects of corticosteroids for more information about how these side effects may affect you and how theyre treated. Other medications Sometimes, other medicines may be combined with corticosteroids to help prevent relapses or to allow your dose of prednisolone to be reduced. Some people are prescribed immunosuppressant medication, such as methotrexate. This is used to reduce or suppress the immune system (the bodys defence against infection and illness). It may be helpful for people with polymyalgia rheumatica who have frequent relapses or dont respond to normal steroid treatment. Your doctor may recommend painkillers, such as paracetamol , or non-steroidal anti-inflammatory drugs (NSAIDs) , to help relieve pain and stiffness while your dose of prednisolone is reduced. Follow-up Your GP will ask you to attend regular follow-up appointments to check how well youre responding to treatment, whether your dose of prednisolone needs to be adjusted, and how well youre coping with the side effects of the medication. During these appointments, youll have blood tests to check the levels of inflammation inside your body. Follow-up appointments are usually recommended every few weeks for the first three months and then at three- to six-monthly intervals after this time. Contact your GP if your symptoms returnduring any part of your treatment. Your dosage may need to be adjusted. Source: MSK Expert Panel - Opens in new browser window Last updated: 13 June 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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Post-polio syndrome | Post-polio syndrome | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Post-polio syndrome Post-polio syndrome Post-polio syndrome is a slow progressive condition that affects some people that have had polio . Its not life threatening but it can cause problems in your ability to carry out daily activities. Polio is a serious viral infection that used to be common in the UK and worldwide. Its rarer now because it can be prevented with vaccination. In around 1 in 100 people, the polio virus causes paralysis, which in rare cases can be life threatening. Cases of polio in the UK fell dramatically when routine vaccination was introduced in the mid-1950s. Symptoms of post-polio syndrome The symptoms of post-polio syndrome include: muscle weakness shrinking of the muscles (atrophy) tight joints (contractures) pain in muscles or joints chronic fatigue including physical tiredness and brain fatigue swallowing and speech problems respiratory problems like breathlessness and sleep apnoea cramps and muscle twitching being sensitive to cold temperatures The muscle weakness and atrophy usually affects muscles that were previously affected by polio. Sometimes it affects other muscles. This can impact your mobility and your ability to do everyday tasks like brushing your teeth or drying your hair. Chronic fatigue is one of the most common and troublesome symptoms of post-polio syndrome. This can be physical fatigue (tiredness) and brain fatigue. Brain fatigue can cause problems with concentration, attention and memory. MRI scans can show white spots in the brains of polio survivors which may be related to brain fatigue. The symptoms can gradually get worse over many years. There are supportive treatments that can help with symptoms. Although post-polio syndrome is rarely life threatening, some people can develop breathing and swallowing difficulties that can lead to serious problems like chest infections . Some people experience a sensitivity to some types of anaesthesia causing them to take longer to recover from having anaesthesia. Causes of post-polio syndrome Post-polio syndrome is caused by the polio virus. It only affects people whove had polio although it can take 15 40 years after the infection for it to develop. Its not known if theres anything that can be done to prevent it. The exact cause behind wholl experience post-polio syndrome after having the polio virus is unclear. It could be because of gradual degeneration (breaking down) of nerve cells (motor neurones) in the brainstem or spinal cord that were damaged by the polio virus. This gradual change explains why it can take years for post-polio syndrome symptoms to appear. During recovery from polio, surviving motor neurone cells grow new nerve ends to connect with other muscle fibres. This helps to regain muscle strength as someone recovers from the polio virus. Over time, these new nerve ends put the motor neurone cell under stress. The cells slowly break down, resulting in the loss of muscle strength. People who have had severe polio at a young age or during adolescence (teenage years) might be more likely to experience post-polio syndrome. People who had a more serious infection in early adulthood are also more likely to develop post-polio syndrome. Post-polio syndrome is not contagious. Diagnosis of post-polio syndrome It can be difficult to diagnose post-polio syndrome. There are no specific tests for it, and it can be mistaken for other conditions. Your GP might suspect post-polio syndrome if: you had polio followed by a long period of stable symptoms (usually 15 years) your symptoms have developed gradually The symptoms of post-polio syndrome are slow and progressive. The sudden appearance of symptoms is more likely to be caused by something else. A prolonged period of bed rest as a result of another illness or serious injury can trigger post-polio syndrome symptoms. There are some tests that can be done to rule out conditions with similar symptoms. You might be offered blood tests and scans of your spine. Other tests that might be offered include: electromyography (EMG) tests these will measure the electrical activity in your nerves and muscles and detect damage that may have been caused by having polio sleep studies if youre experiencing sleep apnoea or youre feeling unusually tired tests to check your heart function and heart rate a magnetic resonance imaging (MRI) scan or computerised tomography (CT) scan of your brain, spine and muscles lung function tests like a spirometry to measure your breathing test to investigate dysphagia (swallowing problems) Treatment of post-polio syndrome As theres no cure for post-polio syndrome, treatment will help you manage your symptoms and quality of life. Its likely youll have a multidisciplinary team of healthcare professionals working together to care for you including: neurologists respiratory specialists physiotherapists orthotists psychologists pain management specialists occupational therapists Theyll discuss the most suitable plan for your care which might include a mixture of the following: Exercise and rest Exercise can help slow down the progressive muscle weakness that post-polio syndrome causes. However, being active can become difficult because your symptoms might become worse after exercise or activity. Any exercise should be pain free because too much exercise can cause more damage. You should pace yourself to avoid becoming exhausted from exercise. Your healthcare team might suggest you try using pacing techniques. This might involve: prioritising tasks finding different ways of doing tasks which prevent pain or exhaustion getting help from others to do particularly exhausting tasks taking regular breaks and having rest periods regularly throughout your day doing some regular gentle exercise that you can gradually build up and stopping before you become exhausted Pacing can help you prevent becoming worn out. It can help to space out activities throughout the day to allow for rest periods where you can recover in between. Making effective and efficient use of your muscles and strength in this way can help them to last longer. Painkillers Medication to relieve pain might be used in addition to pacing techniques. Your healthcare team might suggest over the counter painkillers like aspirin, paracetamol or ibuprofen . Other stronger anti-inflammatory drugs and opiates might be considered too depending on individual needs. Talk to your GP if youre taking over the counter medicines as they shouldnt be used long term. They can cause complications like stomach ulcers if taken over a long period of time. Your healthcare team or GP might suggest medication like gabapentin or pregabalin for your pain if over the counter medications arent working. When taking medication for your pain, you might not feel the damage being caused to your muscles and joints through too much activity. This means its important you follow your pacing routine even when you dont feel tired or arent in any pain. Mobility aids You might benefit from a mobility aid like: braces to support weakened muscles and joints, prevent falls and improve posture walking sticks to help you balance and prevent falls an electric scooter a wheelchair Your healthcare team will discuss the most suitable options for you depending on your needs. Many mobility aids are provided for free by the NHS. Treatment of breathing problems If you have breathing problems, you might benefit from treatment or lifestyle changes. Your breathing problems will be assessed to identify the cause. For example, your breathing problems might be caused by stiff ribs, scoliosis or weak respiratory muscles. Finding the cause will help to choose the correct treatment for you. You might be offered a machine to deliver pressurised air into your lungs through a mask during sleep. This is to help stop your airways closing if you have sleep apnoea . There are exercises you can do to increase the strength of your breathing muscles. A respiratory physiotherapist will help you to find suitable and safe exercises for you. Your healthcare team might suggest you have the pneumococcal vaccination , COVID-19 vaccines and annual flu jab . This is to reduce your risk of getting chest infections which can cause further complications. If you smoke, stopping smoking can help improve your breathing too. Healthy eating and weight control If youre overweight, you might be putting your weakened muscles under further pressure. This can cause problems with your energy levels and overall health. Losing weight (if youre overweight) can help improve your symptoms and general health. Your healthcare team can tell you about specific exercises suitable for you. Eating a healthy, balanced diet can help you reduce and control your weight. Itll also improve your general health. Following a plan that includes healthy foods that provide energy thats released slowly over time can help improve your symptoms. Read our Eatwell Guide: How to eat a healthy balanced diet Coping with psychological factors The symptoms of post-polio syndrome can be distressing. Developing post-polio syndrome after living with the polio virus as a child can cause anxiety, isolation and stress. This can lead to depression . Speak to your GP if youre feeling down and you no longer enjoy things you used to. Source: Scottish Government - Opens in new browser window Last updated: 16 June 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Polio Coping with fatigue Anxiety self-help guide Depression self-help guide Other health sites Scottish Muscle Network Scottish Post-Polio Network NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Post-traumatic stress disorder (PTSD) | Post-traumatic stress disorder (PTSD) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mental health Post-traumatic stress disorder (PTSD) Post-traumatic stress disorder (PTSD) Introduction Symptoms Causes Treatment Complex PTSD Self-help guide Introduction Post-traumatic stress disorder (PTSD) is an anxiety disorder caused by very stressful, frightening or distressing events. Someone with PTSD often relives the traumatic event through nightmares and flashbacks, and may experience feelings of isolation, irritability and guilt. They may also have problems sleeping, such as insomnia, and find concentrating difficult. These symptoms are often severe andpersistent enough to have a significant impact on the persons day-to-day life. Read more about the symptoms of PTSD . Causes of PTSD The type of events that can cause PTSD include: serious road accidents violent personal assaults, such as sexual assault, mugging or robbery prolonged sexual abuse, violence or severe neglect witnessing violent deaths military combat being held hostage terrorist attacks natural disasters, such as severe floods, earthquakes or tsunamis PTSDcan develop immediatelyafter someone experiences adisturbing event or itcan occur weeks, months or even years later. PTSD is estimated to affect about 1 in every 3 people who have a traumatic experience, but its not clear exactly why some people developthe conditionand others dont. Read more about the causes of PTSD . Complex PTSD People who repeatedly experience traumatic situations such as severe neglect, abuse or violence may be diagnosed with complex PTSD. Complex PTSD can cause similar symptoms to PTSD and may not develop until years after the event. Its often more severe if the trauma was experienced early in life as this can affect a childs development. Read more about complex PTSD . When to seek medical advice Its normal to experience upsetting and confusing thoughts after a traumatic event, but most people improve naturally over a few weeks. You should visit your GP if you or your child are still having problems about four weeks after the traumatic experience, or if the symptoms are particularly troublesome. If necessary, your GP can refer you to mental health specialists for further assessment and treatment. HowPTSD is treated PTSD can be successfully treated, even when itdevelops many years aftera traumatic event. Any treatment depends on the severity ofsymptoms and how soon theyoccur after the traumatic event.Any of the following treatment options may be recommended: Watchful waiting monitoring yoursymptoms to see whether they improve or get worse without treatment. Psychotherapy such as trauma-focusedcognitive behavioural therapy (CBT)or eye movement desensitisation and reprocessing (EMDR). Antidepressants such asparoxetine ormirtazapine. Read more about treatingPTSD . Symptoms The symptoms of post-traumatic stress disorder (PTSD) can have a significant impact on your day-to-day life. In most cases, the symptoms develop during the first month after a traumatic event. However, in a minority of cases, there may be a delay of months or even years before symptoms start to appear. Some people with PTSD experience long periods when their symptoms are less noticeable, followed by periods where they get worse. Other people have constant, severe symptoms. The specific symptoms of PTSD can vary widely between individuals, but generally fall into the categories described below. Re-experiencing Re-experiencing is the mosttypical symptom of PTSD. This is when a person involuntarily and vividly re-lives the traumatic eventin the form of: flashbacks nightmares repetitive and distressing images or sensations physical sensations such as pain, sweating, nausea or trembling Somepeople haveconstant negative thoughts about their experience, repeatedly asking themselves questions that prevent them from coming to terms with the event. For example, they may wonder why the event happened to them and if they could have done anything to stop it, which can lead to feelings of guilt or shame. Avoidance and emotional numbing Trying to avoid beingreminded of the traumatic eventis anotherkey symptom of PTSD. This usuallymeans avoiding certain people or places that remind you of the trauma, or avoiding talking to anyone about your experience. Many people withPTSD try to push memories of the event out of their mind, often distracting themselves with work or hobbies. Some people attempt to deal with their feelings by trying not to feel anything at all. This is known as emotional numbing. This can lead to the person becoming isolated and withdrawn, and they may also give up pursuing activities they used to enjoy. Hyperarousal (feeling on edge) Someone withPTSD may be veryanxious and find it difficult to relax. Theymay be constantly awareof threats and easily startled.This state of mindis known ashyperarousal. Hyperarousaloftenleads to: irritability angry outbursts sleeping problems ( insomnia ) difficulty concentrating Other problems Many people with PTSD also have a number of other problems, including: other mental health problems such as depression , anxietyor phobias self-harming or destructive behaviour such as drug misuseor alcohol misuse other physical symptoms such as headaches , dizziness,chest pains and stomach aches PTSD sometimes leads to work-related problems and the breakdown of relationships. PTSD in children PTSDcan affect children as well as adults. Children withPTSD can have similar symptoms to adults, such as having trouble sleeping and upsetting nightmares. Like adults, children with PTSD may also lose interest in activities they used to enjoy and may have physical symptoms such as headaches and stomach aches . However, there are some symptoms that are more specific to children with PTSD, such as: bedwetting beingunusually anxious about being separated froma parent or other adult re-enactingthe traumatic event(s) through their play When to seek medical advice Its normal to experience upsetting and confusing thoughts after a traumatic event, but in most people these improve naturallyover a few weeks. You should visit your GP if you or your child are still having problems about four weeks afterthe traumatic experience, or ifthe symptoms areparticularly troublesome. Your GP will want to discuss your symptoms with you in as much detail as possible. Theyll ask whether youve experienced a traumatic event in the recent or distant past and whether youve re-experienced the event through flashbacks or nightmares. Your GP can refer you to mental health specialists if they feel youd benefit from treatment. See treating PTSD for more information. Causes Post-traumatic stress disorder (PTSD) can develop after a very stressful, frightening or distressing event, or after a prolonged traumatic experience. Types of events that can lead to PTSD include: serious road accidents violent personal assaults, such as sexual assault, mugging or robbery prolonged sexual abuse, violence or severe neglect witnessing violent deaths military combat being held hostage terrorist attacks natural disasters, such as severe floods, earthquakes or tsunamis a diagnosis of a life-threatening condition an unexpected severe injury or death of a close family memberor friend PTSDisnt usually related tosituations that are simply upsetting, such as divorce, job loss or failing exams. PTSD develops in about 1 in 3 people who experience severe trauma. It isnt fully understood why some people develop the condition while others dont. However, certain factors appear to make some people more likely to develop PTSD. If youve had depression oranxiety in the past, or you dont receive much support from family or friends, youre more susceptible to developing PTSD after a traumatic event. There may also be a genetic factor involved in PTSD. For example, having a parent with a mental health problemis thought to increase your chances of developing the condition. Possible causes Although its not clear exactly why people develop PTSD, a number of possible reasons have been suggested. These are described below. Survival mechanism One suggestion is that the symptoms of PTSD are the result of an instinctivemechanismintended tohelp you survive further traumatic experiences. For example, the flashbacks many people with PTSD experience may force you to think about the event in detail so youre better prepared if it happens again. The feeling of being on edge (hyperarousal) may develop to help you react quickly in another crisis. However, whilethese responses may be intended to help you survive, theyre actually very unhelpful in reality because you cant process and move on fromthe traumatic experience. Adrenaline levels Studies have shown that people with PTSD have abnormal levels of stress hormones. Normally, when in danger,the body produces stress hormones such as adrenaline totrigger a reaction in the body. This reaction,often known as the fight or flight reaction, helps to deaden the senses and dull pain. People with PTSD have been found to continue to produce high amounts of fight or flight hormones even when theres no danger. Its thought this may be responsible for the numbed emotions and hyperarousal experienced by some people with PTSD. Changes in the brain In people with PTSD, parts of the brain involved in emotional processing appear different in brain scans. One part of the brain responsible for memory and emotions is known as the hippocampus. In people with PTSD, the hippocampus appears smaller in size. Its thought thatchanges in this part of the brain may be related to fear and anxiety, memory problems and flashbacks. The malfunctioning hippocampus may prevent flashbacks and nightmares from being properly processed, so the anxiety they generate doesnt reduce over time. Treatment of PTSD results in proper processing of the memories so, over time, the flashbacks and nightmares gradually disappear. Treatment The main treatments for post-traumatic stress disorder (PTSD) are psychotherapy and medication. Traumaticevents can be very difficult to come to terms with, but confronting your feelings and seeking professional help is often the only way of effectively treating PTSD. Its possible for PTSD to besuccessfully treated many years after the traumatic event occurred, which means its never too late to seek help. Assessment Before having treatment forPTSD, a detailed assessment of your symptoms will be carried out to ensure treatment is tailored to your individual needs. Your GP will often carry out an initial assessment, but youll be referred to a mental health specialist for further assessment and treatmentifyouve had symptoms of PTSD for more than four weeks or your symptoms are severe. There are a number of mental health specialists you may see if you have PTSD, such as: a psychologist an expert in how the mind works a community psychiatric nurse a nurse who specialises in mental healthcare a psychiatrist a mental health specialist who diagnoses and treats mental health conditions Watchful waiting If you have mild symptoms of PTSD, or youve had symptoms for less than four weeks, an approach called watchful waiting may be recommended. Watchful waiting involves carefully monitoring your symptoms to see whether they improve or get worse. Itssometimes recommended because 2 in every 3 people whodevelop problems after a traumatic experience get better within a few weeks without treatment. If watchful waiting is recommended, you should have a follow-up appointment within one month. Psychotherapy If you have PTSD that requires treatment, psychotherapy is usually recommended first. A combination ofpsychotherapy and medication may be recommendedif you have severe or persistent PTSD. Psychotherapyis a type of therapy oftenused totreat emotional problems and mental health conditions such as PTSD, depression , anxiety and obsessive compulsive disorder . The treatmentis carried out bytrained mental health professionals who listen to you and helpyou come upwith effective strategies to resolve your problems. The main types of psychotherapy used to treat people with PTSD are described below. Cognitive behavioural therapy (CBT) Cognitive behavioural therapy (CBT) is a type of therapy that aims to help you manage your problems by changing how you think and act. Trauma-focused CBT uses a range of psychological treatment techniques to help you come to terms with the traumatic event. For example, your therapist may ask you to confront your traumatic memories by thinking about your experience in detail. During this process your therapist helps you cope with any distress youfeel, whileidentifying any unhelpful thoughts or misrepresentations you have about the experience. Your therapist can help you gain control of your fear and distress by changing the negative way you think about your experience. For example,feelingyoureto blame for what happened or fear that it may happen again. You may also be encouraged to gradually restart any activities youve avoided since your experience, such as driving a car if you had an accident. Youll usually have8-12 weekly sessions of trauma-focused CBT, although fewer may be needed. Sessions usually last for around 60-90 minutes. Eye movement desensitisation and reprocessing (EMDR) Eye movement desensitisation and reprocessing (EMDR) is a relatively new treatment which has been found to reduce the symptoms of PTSD. It involves making side-to-side eye movements, usually by following the movement of your therapists finger, while recalling the traumatic incident.Other methodsmay includethe therapist tapping their finger or playing a tone. Its not clear exactly how EMDR worksbut it may help you to change the negative way you think about a traumatic experience. Group therapy You may also be offered group therapy as some people find it helpfulto speak about their experiences with other peoplewho also have PTSD. Group therapy can be used to teach you ways to manage your symptoms and help you understand the condition. There are also a number of charitieswhich providecounselling and support groups for PTSD. For example: Combat Stress a military charity specialising in helping ex-servicemen and women Rape Crisis a charity providing a range of services for women and girls who have experienced abuse, domestic violence and sexual assault Victim Support providing support and information to victims or witnesses of crime CRUSE a UK charity providing support and information for people who have experienced bereavement Medication Antidepressants such asparoxetine, sertraline, mirtazapine, amitriptyline or phenelzineare sometimes used to treat PTSD in adults. Of these medications, paroxetine and sertraline are the only ones licensed specifically for the treatment of PTSD. However, mirtazapine, amitriptyline and phenelzine have also been found to be effective and may berecommended as well. However, thesemedications will only be used if: you choose not to have trauma-focused psychological treatment psychological treatment wouldnt be effective because theres an ongoing threat of further trauma (such as domestic violence) youve gained little or no benefit from a course of trauma-focused psychological treatment you have an underlying medical condition, such as severe depression, that significantly affects your ability to benefit from psychological treatment Amitriptyline or phenelzine will usually only be used under the supervision of a mental health specialist. Antidepressantscan also be prescribed to reduce any associated symptoms of depression and anxiety and to help with sleeping problems. However,theyre not usually prescribedfor people younger than18 unless recommended by a specialist. If medication for PTSD is effective, its usually be continued for a minimum of 12 months before being gradually withdrawn over the course of four weeks or longer. If a medicationisnt effective at reducing your symptoms,your dosage may be increased. Before prescribing a medication, your doctor should inform you about possible side effects you may have while taking it, along with any possible withdrawal symptoms when the medication is withdrawn. For example, commonside effects of paroxetine include feeling sick, blurred vision, constipation and diarrhoea. Possible withdrawal symptoms associated with paroxetine include sleep disturbances, intense dreams, anxiety and irritability. Withdrawal symptoms are less likely if the medication is reduced slowly. Children and young people Forchildren and young people with PTSD, trauma-focused CBT is usually recommended. This normally involvesa course of 8-12 sessions that have been adapted to suit the childs age, circumstances and level of development. Where appropriate, treatment includes consulting with and involving the childsfamily. Treatment with medication isnt usually recommended for children and young people with PTSD. Complex PTSD Complex PTSD may be diagnosed in adults or children who have repeatedly experienced traumatic events, such as violence, neglect or abuse. Complex PTSD is thought to be more severe if: the traumatic events happened early in life the trauma was caused by a parent or carer the person experienced the trauma for a long time the person was alone during the trauma there is still contact with the person responsible for the trauma Asitmay take years for the symptoms of complex PTSD to be recognised,a childsdevelopment, including their behaviour and self-confidence, can be altered as they get older. Adults with complex PTSD may lose their trust in people and feel separated from others. Symptoms of complex PTSD The symptoms of complex PTSD are similar to symptoms of PTSD but may include: feelings of shame or guilt difficulty controlling your emotions periods of losing attention and concentration this is known as dissociation physical symptoms such as headaches, dizziness, chest pains and stomach aches cutting yourself off from friends and family relationship difficulties destructive or risky behaviour such as self-harm, alcohol misuse or drug abuse suicidal thoughts Treating complex PTSD One of the key symptoms of complex PTSD is losing trust in people. If possible, people with complex PTSD are recommended to slowly start doing regular activities such as: finding friends getting a job regular exercise taking on hobbies Its important to try and develop some feelings of trust.It may take some time, but atrusting relationship with a therapistwill helptreat complex PTSD. Treatment from a therapist may be given in three stages, described below. Stabilisation One of the first steps in treating complex PTSD may involve speaking with a therapist to learn how to control feelings of distrust and lose the feeling of being disconnected from friends and family. Certain techniques, known as grounding techniques, may be able to help you separate an abusive or traumatic past from the present. The aim is to make the past seem less frightening and reduce the amount of flashbacks you experience. With time, you can begin to experience less anxiety and learn to cope with daily life. Trauma-focused therapy Trauma-focused therapymay include: certain types of psychotherapy cognitive behavioural therapy (CBT) eye movement desensitisation and reprocessing (EMDR) These treatments may help you to control any distressing thoughts but must be approached carefully to avoid making the situation worse. Reintegration The final stage is to begin to use these skills and techniques todevelop better relationships with other people. Medication, such as antidepressants , may still be recommended if psychotherapy isnt possible or you feel unsafe. You can read more information about complex PTSD on the Royal College of Psychiatrists website . Self-help guide If you think youre experiencing post-traumatic stress disorder (PTSD) or complex post-traumatic stress disorder (CPTSD), its important for you to visit your GP and discuss your concerns. The PTSD and CPTSD self-help guide can help with managing symptoms while you wait for an assessment by your GP or a mental health professional. This guide aims to help you: consider whether youre experiencing symptoms of PTSD or CPTSD understand more about PTSD andCPTSD think about ways to manage or recover from PTSD or CPTSD The PTSD and CPTSD self-help guide is based on Trauma-Focused Cognitive Therapy (TF-CT). TF-CT aims to help people who have been through trauma and adversity to make sense of what theyve experienced, and become less distressed and affected by it. PTSD and CPTSD self-help guide Work through a self-help guide for PTSD and CPTSD based on Trauma-Focused Cognitive Therapy (TF-CT). PTSD and CPTSD self-help guide Source: NHS 24 - Opens in new browser window Last updated: 27 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Post-traumatic stress disorder (PTSD) (BSL) PTSD and CPTSD self-help guide Anxiety Depression Counselling and psychotherapy Other health sites BABCP - What is CBT? 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Postnatal depression | Postnatal depression | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mental health Postnatal depression Postnatal depression Postnatal depression is a type of depression. Many parents experience it after having a baby. Its a common problem, affecting more than 1 in every 10 mothers within a year of giving birth. It can also affect fathers and partners, although this is less common. With the right support, which can include self-help strategies and therapy, most people make a full recovery. Symptoms of postnatal depression Postnatal depression affects everyone differently. It can start at any point in the first year after giving birth. It can continue from depression in pregnancy. It may develop suddenly or gradually. Many people feel a bit down, tearful or anxious in the first week after giving birth. This is often called the baby blues and is so common that its considered normal. The baby blues dont last for more than 2 weeks after giving birth. If your symptoms last longer or start later, you could have postnatal depression. The main symptoms of postnatal depression include: a persistent feeling of sadness and low mood loss of interest in the world around you no longer enjoying things that used to give you pleasure lack of energy and feeling tired all the time trouble sleeping at night feeling sleepy during the day feeling that youre unable to look after your baby problems concentrating and making decisions loss of appetite or an increased appetite (comfort eating) feeling agitated, irritable or very apathetic (you cant be bothered) feelings of guilt, hopelessness and self-blame difficulty bonding with your baby feeling of indifference and no sense of enjoyment in their company frightening thoughts, for example, about hurting your baby these can be scary, but theyre very rarely acted upon thinking about suicide and self-harm These symptoms can affect your day-to-day life and your relationships with your baby, family and friends. Speak to your GP or health visitor as soon as possible if: you think you have postnatal depression Dont struggle on alone and hope the problem will go away. It can take a lot longer to feel better if its not addressed. Spotting the signs of postnatal depression Postnatal depression can develop gradually and it can be hard to recognise. Some parents may avoid talking to family and friends about how theyre feeling. This may be because they worry theyll be judged for not coping or not appearing happy. Signs for partners, family and friends to look out for in new parents include: frequently crying for no obvious reason having difficulty bonding with their baby getting no pleasure from playing with them or feeling no good as a parent withdrawing from contact with other people speaking negatively all the time and claiming that theyre hopeless neglecting themselves, like not washing or changing their clothes losing all sense of time, like being unaware whether 10 minutes or 2 hours have passed losing their sense of humour constantly worrying that something is wrong with their baby, regardless of reassurance from others If you think someone you know is depressed, encourage them to talk about their feelings. This could be to talk to you, a friend, their GP or their health visitor. Causes of postnatal depression The cause of postnatal depression isnt completely clear. Some of the factors it has been associated with include: a history of mental health problems, particularly depression, earlier in life or during pregnancy having no close family or friends to support you a poor relationship with your partner recent stressful life events, like a bereavement experiencing the baby blues Even if you dont have any of these symptoms, having a baby is a life-changing event that can sometimes trigger depression. It often takes time to adapt to becoming a new parent. Looking after a small baby can be stressful and exhausting. Treating postnatal depression Postnatal depression can be lonely, distressing and frightening. But, support and treatments are available. With the right treatment and support, most people make a full recovery, although it can take time. Talk to your GP about the pros and cons of different treatments so you can decide together whats best for you. Your GP might also want to check your physical health to see if there are any problems that may need to be addressed as well. For example, you may be anaemic after giving birth. This could add to any feelings of depression you might have. Psychological treatments for postnatal depression Psychological therapies are usually the first treatment recommended for postnatal depression. Guided self-help Guided self-help involves working through a book or an online course. You can do this on your own or with some help from a therapist. It focusses on the issues you might be facing, with practical advice on how to deal with them. The courses typically last 9 to 12 weeks. Cognitive behavioural therapy Cognitive behavioural therapy (CBT) is a type of talking therapy. Its based on the idea that unhelpful and unrealistic thinking leads to negative behaviour. CBT aims to break this cycle and find new ways of thinking that can help you behave in a more positive way. CBT can be carried out either one-to-one with a therapist or in a group. Treatment will often last 3 to 4 months. Interpersonal therapy Interpersonal therapy (IPT) involves talking to a therapist about the problems youre experiencing. It aims to identify problems in your relationships with family, friends or partners. It then looks at how they might relate to your feelings of depression. Treatment also usually lasts 3 to 4 months. Antidepressants Antidepressants may be recommended if: you have moderate or severe depression you dont want to try psychological treatment psychological treatment doesnt help you have mild postnatal depression and a previous history of depression They can help ease symptoms like: low mood irritability lack of concentration sleeplessness This helps you to function normally and helps you cope better with your new baby. Antidepressants usually need to be taken for at least a week before the benefit starts to be felt. This means its important to keep taking them even if you dont notice an improvement straight away. Youll usually need to take them for around 6 months after you begin to feel better. If you stop too early, your depression may return. If youre breastfeeding, talk to your doctor about suitable medicines. Some types of antidepressants are safe to take while breastfeeding. Your doctor should explain any risks of taking antidepressants. You should be offered the type with the least risk for you and your baby. Self-help There are many things you can try yourself to improve your symptoms and help you cope. Do talk to your partner, friends and family to help them understand how youre feeling talk to your loved ones about what they can do to support you accept help from others when its offered ask your loved ones if they can help look after the baby and do tasks like housework, cooking and shopping make time for yourself try to do activities that you find relaxing and enjoyable rest when you can although it can be difficult when youre looking after a baby, try to sleep whenever you get the chance follow good sleeping habits ask your partner to help with the night-time work exercise regularly this has been shown to help boost mood in people with mild depression eat regular, healthy meals Dont do not go for long periods without eating do not drink alcohol or take drugs, as this can make you feel worse Support groups Ask your health visitor about support services in your area. They may be able to put you in touch with a social worker, counsellor or local support group. It can be reassuring to meet other people who are going through something similar. Find postnatal depression support and information in your area Treatments for severe postnatal depression You might be referred to a specialist perinatal mental health team if your depression: is very severe doesnt respond to treatment like antidepressants, self-help or therapy Your team might be able to offer other treatments, like: more intensive CBT other psychological treatments, like psychotherapy therapies such as baby massage which can improve depression and help build your relationships with your baby different medications electroconvulsive therapy (ECT) where electrodes are placed on your head and pulses of electricity are sent through the brain For a small number of people, coming into hospital can help speed up recovery. You may be offered a place in a Mother and Baby Unit , where you can continue to look after your baby while you get the best treatment for your illness. Source: NHS 24 - Opens in new browser window Last updated: 24 October 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Depression Depression self-help guide Other health sites SIGN: Mood disorders during pregnancy and after the birth of your baby NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Pregnancy and baby | "Ready Steady Baby! 0 Home Ready Steady Baby! Ready Steady Baby! Your guide to pregnancy, labour and birth and early parenthood up to 8 weeks Pregnancy Health problems in pregnancy Including common ailments and conditions that occur before and during pregnancy Looking after yourself and your baby Including how to eat well, keep active and prevent illness in pregnancy Preparing for parenthood Including benefits, housing support and your rights at work during and after pregnancy Relationships and wellbeing in pregnancy Including looking after your mental wellbeing and bonding with baby during pregnancy Your antenatal care Including tests, scans and checks and who'll be looking after you and your baby Your babys development Including the first signs of pregnancy and how your baby develops week to week Labour and birth After the birth Including newborn tests and examination and help for babies born sick or premature Assisted birth Including assisted birth by forceps or ventouse delivery, or caesarean section Getting ready for the birth Including making a birth plan and deciding where to give birth Giving birth Including what happens during the birth at full term and if your labour's premature Labour Including signs that labour has started and options for pain relief during labour and birth Meeting your new baby Including having skin-to-skin contact with your baby and the first feeds Early parenthood Caring for your new baby Including how to bathe your baby, change their nappies and soothe them when they cry Getting to know your baby Including how to bond with your baby and talk, sing and read to them Going home Including keeping your baby safe at home and how to help them sleep safely If your baby's ill When to see your GP or pharmacist, or phone 999 if your baby's unwell Your babys development from 2 to 12 months Your baby will develop many new skills in its first year Your growing family Including how and when to introduce your baby to friends and family Your wellbeing after the birth Including looking after your mental health and helping your body recover after the birth Other languages and formats Easy Read Ready Steady Baby information in Easy Read Other languages Ready Steady Baby information in other languages NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852" | null | null | null | null | null | null | null | null | null | null | null | null | null |
Pressure ulcers | Pressure ulcers - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Pressure ulcers Pressure ulcers About pressure ulcers Symptoms of pressure ulcers Causes of pressure ulcers Diagnosing pressure ulcers Treating pressure ulcers Complications of pressure ulcers Preventing pressure ulcers About pressure ulcers Pressure ulcers are an injury that breaks down the skin and underlying tissue. They are caused when an area of skin is placed under pressure. They are sometimes known as bedsores or pressure sores. Pressure ulcers can range in severity from patches of discoloured skin to open wounds that expose the underlying bone or muscle. Read more about the symptoms of pressure ulcers . How pressure ulcers develop Pressureulcers candevelop when a large amount of pressure is applied to an area of skin over a short period of time. They can also occur when less pressure is applied over a longer period of time. The extra pressure disrupts the flow of blood through the skin. Without a blood supply, the affected skin becomes starved of oxygen and nutrients, and begins to break down, leading to an ulcer forming. Pressure ulcers tend to affect people with health conditions that make it difficult to move, especiallythose confined to lying ina bed or sitting for prolonged periods of time. Conditions that affect the flow of blood through the body, such as type 2 diabetes , can also make a person more vulnerable to pressure ulcers. Learn moreabout the causes of pressure ulcers . Who is affected? Its estimated that just under half a million people in the UK will develop at least 1pressure ulcer in any given year. This is usually people with an underlying health condition for example, around1 in 20 people who are admitted to hospital with a sudden illness will develop a pressure ulcer. People over 70 years old are particularly vulnerable to pressure ulcers, as they are more likely to have mobility problems and ageing skin. Treating and preventing pressure ulcers Treatment for pressure ulcers includes the use of dressings, creams and gels designed to speed up the healing process and relieve pressure. Surgery is sometimes recommended for the most serious cases. For some people, pressure ulcers are an inconvenience that require minor nursing care. For others, they can be seriousand lead to life-threatening complications, such as blood poisoning organgrene. Read more about the complications of pressure ulcers . Pressure ulcers can be unpleasant, upsetting and challenging to treat. Therefore, a range of techniquesis used to prevent them developing in the first place. These include: regularly changing a persons position using equipment to protect vulnerable parts of the body such as specially designed mattresses and cushions Read about treating pressure ulcers and preventing pressure ulcers for more information. Unfortunately, even with the highest standards of care, its not always possible to prevent pressure ulcers in particularly vulnerable people. Symptoms of pressure ulcers The parts of the body most at risk of developing pressure ulcers are those that are not covered by a large amount of body fat and are in direct contact with a supporting surface, such as a bed or a wheelchair. For example, if you are unable to get out of bed, you are at risk of developing pressure ulcers on your: shoulders or shoulder blades elbows back of your head rims of your ears knees, ankles, heels or toes spine tail bone (the small bone at the bottom of your spine) If you are a wheelchair user, you are at risk of developing pressure ulcers on: your buttocks the back of your arms and legs the back of your hip bone Severityof pressure ulcers Healthcare professionals use several grading systems to describe the severity of pressure ulcers. The most common is the European Pressure Ulcer Advisory Panel (EPUAP) grading system. The higher the grade, the more severe the injury to the skin and underlying tissue. Grade1 A grade 1pressure ulcer is the most superficial type of ulcer. The affected area of skin appears discoloured it is red in white people, and purple or blue in people with darker-coloured skin. Grade 1pressure ulcers do not turn white when pressure is placed on them. The skin remains intact, but it may hurt or itch. It may alsofeel either warm and spongy, or hard. Grade2 In grade 2pressure ulcers, some of the outer surface of the skin (the epidermis) or the deeper layer of skin (the dermis) is damaged, leading to skin loss. The ulcer looks like an open wound or a blister. Grade3 In grade 3pressure ulcers, skin loss occurs throughout the entire thickness of the skin. The underlying tissue is also damaged, although the underlying muscle and bone are not. The ulcer appears as a deep, cavity-like wound. Grade4 A grade 4pressure ulcer is the most severe type of pressure ulcer. The skin is severely damaged and the surrounding tissue begins to die (tissue necrosis). The underlying muscles or bone may also be damaged. People with grade 4pressure ulcers have a high risk of developing a life-threatening infection. Causes of pressure ulcers Pressure ulcers are caused by sustained pressure being placed on a particular part of the body. This pressure interrupts the blood supply to the affected area of skin. Blood contains oxygen and other nutrients that are needed to help keep tissue healthy. Without a constant blood supply, tissue isdamagedand will eventually die. The lack of blood supply also means that the skin no longer receives infection-fighting white blood cells. Once an ulcer has developed, it can become infected by bacteria. People with normal mobility do not develop pressure ulcers, as their body automatically makes hundreds of regular movements that prevent pressure building up on any part of their body. For example, you may think that you are lying still when asleep, but you may shift position up to 20 times a night. Pressure ulcers can be caused by: pressure from a hard surface such as a bed or wheelchair pressure that is placed on the skin through involuntary muscle movements such as muscle spasms moisture which can break down the outer layer of the skin (epidermis) The time it takes for a pressure ulcer to form will depend on: the amount of pressure how vulnerable a persons skin is to damage Grade 3or 4pressure ulcers can develop quickly. For example, in susceptible people, a full-thickness pressure ulcer can sometimes develop in just 1or 2hours. However, in some cases, the damage will only become apparent a few days after the injury has occurred. Increased risk There areseveral factorsthat increase the risk ofdeveloping pressure ulcers. These include: mobility problems anything that affects your ability to move some or all of your body poor nutrition for your skin to remain healthy, it requires nutrients that can only be supplied by eating a nutritious diet an underlying health condition that disrupts your blood supply or makes your skin more vulnerable to injury and damage being over 70 years old urinaryincontinence and/or bowel incontinence serious mental health conditions These are discussed in more detail below. Mobility problems Possible reasons for having a mobility problem are: having a spinal cord injury that causes some or all of your limbs to beparalysed brain damage caused by an event such as a stroke or severe head injury , which results in paralysis having a condition that is causing progressive damage to the nerves your body uses to move parts of the body such as Alzheimers disease , multiple sclerosis (MS) or Parkinsons disease having severe pain that makes it difficult to move some or all of your body having a fractured or broken bone recovering from the effects of surgery being in a coma having a conditionthat makes it difficult to move your joints and bones such as rheumatoid arthritis Poor nutrition Reasons that your diet may lack nutrition include: anorexia nervosa a mental health condition where a person has an unhealthy obsession with maintaining a low body weight dehydration you do not have enough fluids in your body dysphagia difficulty swallowing food Health conditions Health conditions that can make you more vulnerable to pressure ulcers include: type 1 diabetes and type 2 diabetes the high levels of blood sugar associated with diabetes can disrupt normal blood flow peripheral arterial disease (PAD) blood supply in the legs becomes restricted due to a build-up of fatty substances in the arteries heart failure previous damage to the heart means it is no longer able to pump enough blood around the body kidney failure the kidney loses most or all of its functions,which can lead to a build-up of dangerous toxins (poisons) in the blood thatcan cause tissue damage chronic obstructive pulmonary disease (COPD) a collection of lung diseases; the low levels of oxygen in the blood associated with COPD can make the skin more vulnerable to damage Ageing skin There are several reasons why ageing skin is more vulnerable to pressure ulcers. These include: with age, the skin loses some of its elasticity (stretchiness), which makes it more vulnerable to damage reduced blood flow to the skin, due to the effects of ageing the amount of fat under the skin tends to decrease as people get older Incontinence Both urinary incontinence (inability to control your bladder) and bowel incontinence (inability to control your bowels) can cause certain areas of the skin to become moist and vulnerable to infection. This can cause pressure ulcers to form. Mental health conditions People with severe mental health conditions such as schizophrenia (a condition where people have problems telling the difference between reality and imagination) or severe depression have an increased risk of pressure ulcers for a number of reasons. These include: their diet tends to be poor they often have other physical health conditions, such as diabetes or incontinence they may neglect their personal hygiene, making their skin more vulnerable to injury and infection Diagnosing pressure ulcers Pressure ulcers are easily diagnosed by looking at them. However, health professionals prefer to prevent ulcers developing in the first place, so its important to assess a persons risk of developing them. As part of the risk assessment process, the following will be considered: your general health your ability to move whether you have any problems that may affect your posture whether you have any symptoms that may indicate an infection your mental health whether you have had pressure ulcers in the past whether you have urinary incontinence or bowel incontinence your diet how well your blood circulation system is working As part of the risk assessment, you may be referred for blood and urine tests. Blood tests can be a good way of assessing your general state of health and whether your diet is providing enough nutrition. Urine tests can be used to check how well your kidneys are working and whether you have a urinary tract infection , which can be a causefor concern if you are incontinent or if you have had spinal damage. Self-assessment If you are thought to be at risk of developing pressure ulcers, but you are not staying in a hospital or care home, you may be advised to regularlycheck for early signs of the condition. Look out for areas of discolouration and patches of skin that feel unusually spongy or tough to the touch. Use a mirror to check parts of your body that can be difficult to see, such as your back or buttocks. Contact your GP or your healthcare team if you notice any signs of damage. Treating pressure ulcers Treatment for pressure ulcers can vary, depending on the grade of the ulcer. Treatment options may include regularly changing your position, or using special mattresses and dressings to relieve pressure or protect the skin. In some cases, surgery may be needed. Your care team Pressure ulcers are a complex health problem arising from many interrelated factors. Therefore, your care may be provided by a team comprising different types of healthcare professionals. This type of team is sometimes known as a multidisciplinary team (MDT). Your MDT may include: a tissue viability nurse (a nurse who specialises in wound care and prevention) a social worker a physiotherpist an occupational therapist a dietitian medical and surgical experts with experience in pressure ulcer management Changing position Its important to avoid putting pressure on areas that are vulnerable to pressure ulcers or where pressure ulcers have already formed. Moving and regularly changing your position helps to prevent pressure ulcers developing and relieves the pressure onthe ulcers that have developed. After your risk assessment is completed, your care team will draw up a repositioning timetable, which states how often you need to be moved. For some people, this may be as often as once every 15 minutes. Others may need to be moved only once every 2hours. The risk assessment will also consider the most effective way of avoiding putting any vulnerable areas of skin under pressure whenever possible. You may also be given training and advice about: correct sitting and lying positions how you can adjust your sitting and lying position how often you need to move or be moved how best to support your feet how to maintain good posture the special equipment you should use and how to use it Mattresses and cushions There are a range of special mattresses and cushions that can relieve pressure on vulnerable parts of the body. Your care team will discuss the types of mattresses and cushions most suitable for you. Thosethought to be at risk of developing pressure ulcers, or who have pre-existing grade 1or 2pressure ulcers, usually benefit from aspecially designed foam mattress, which relieves the pressure on their body. People with a grade 3or 4pressure ulcer will require a more sophisticated mattress or bed system. For example, there are mattresses that can be connected to a constant flow of air, which is automatically regulated to reduce pressure as and when required. Dressings Specially designed dressings and bandagescan be used to protect pressure ulcers and speed up the healing process. Examples of these types of dressings include: hydrocolloid dressings these contain a special gel that encourages the growth of new skin cells in the ulcer, while keeping the surrounding healthy area of skin dry alginate dressings these are made from seaweed and contain sodium and calcium, which are known to speed up the healing process Creams and ointments Topical preparations, such as creams and ointments, can be used to help speed up the healing process and prevent further tissue damage. Antibiotics If you have a pressure ulcer, you will not routinely be prescribed antibiotics. These are usually only prescribed to treat an infected pressure ulcer and prevent the infection from spreading. Antiseptic cream may also be applied directly to pressure ulcers to clear out any bacteria that may be present. Nutrition Certain dietary supplements, such as protein, zinc and vitamin C, have been shown to accelerate wound healing. If your diet lacks these vitamins and minerals, your skin may be more vulnerable to developing pressure ulcers. As a result of this, you may be referred to a dietitian so that a suitable dietary plan can be drawn up for you. Debridement In some cases, it may be necessary to remove dead tissue from the ulcer to help stimulate the healing process. This procedure is known as debridement. If there is a small amount of dead tissue, it may be possible to remove it using specially designed dressings and paste. Larger amounts of dead tissue may be removed using mechanical means. Some mechanical debridement techniques include: cleansing and pressure irrigation where dead tissue is removed using high-pressure water jets ultrasound dead tissue is removed using low-frequency energy waves laser dead tissue is removed using focused beams of light surgical debridement dead tissue is removed using surgical instruments, such as scalpels and forceps A local anaesthetic will be used to numb the area of skin and tissue around the ulcer so that debridement does not cause any pain or discomfort. Maggot therapy Maggot therapy, also known as larvae therapy, is an alternative method of debridement. Maggots are ideal for debridement because they feed on dead and infected tissue without touching healthy tissue. They also help to fight infection by releasing substances that kill bacteria and stimulate the healing process. During maggot therapy, the maggots are mixed into a wound dressing and the area is covered with gauze. After a few days, the dressing is taken off and the maggots are removed. Many people may find the idea of maggot therapy off-putting, but research has found that it is often more effective than more traditional methods of debridement. Surgery Its not always possible for a grade 3or 4pressure ulcer to heal. In such cases, surgery will be required to seal the wound and prevent any further tissue damage occurring. Surgical treatment involves cleaning the wound and closing it by bringing together the edges of the wound (direct closure), or by using tissue moved from a nearby part of the body (flap reconstruction). Pressure ulcer surgery can be challenging, especially because most people who have the procedure are already in a poor state of health. There is a risk of a large number of possible complications occurring after surgery, including: infection tissue death of the implanted flap muscle weakness blisters (small pockets of fluid that develop inside the skin) recurrence of the pressure ulcers blood poisoning infection of the bone (osteomyelitis) internal bleeding abscesses(painful collections of pus that develop inside the body) deep vein thrombosis (a blood clot that develops inside the veins of the leg) Despite the risks, surgery is often a necessity to prevent life-threatening complications, such as blood poisoning and gangrene (the decay or death of living tissue). Complications of pressure ulcers Even with the best possible medical care, complications can arise from grade 3or grade 4pressure ulcers and can occasionally be life-threatening. These complications are discussed below. Cellulitis Infection can spread from the site of the pressure ulcer to a deeper layer of skin. This type of infection is called cellulitis. It causes symptoms of pain and redness, plus swelling of the skin. It will need to be treated with a course of antibiotics. Read more informationabout cellulitis . Left untreated, there is a risk that the infection can spread to the blood (see below) or the underlying bone or joint. In rare cases, where pressure ulcers involve the lower back, tail bone and spine, the pressure ulcer can spread to the membranes that surround the spine and brain. This is known as meningitis . Blood poisoning If a person with a weak immune system has a pressure ulcer that becomes infected, there is a risk that the infection will spread into their blood and other organs. This is known as blood poisoning or septicaemia. In the most serious cases of blood poisoning, damage to multiple organs can lead to a large drop in blood pressure, known as septic shock , which can be fatal. Symptoms include cold skin and an increased heart beat. Blood poisoning is a medical emergency. It requires immediate treatment in an intensive care unit (ICU), so that the functions of the body can be supported while the infection is treated with antibiotics or antiviral medication. Read more informationabout blood poisoning . Bone and joint infection Infection can also spread from a pressure ulcer into underlying joints (septic arthritis) and bones (osteomyelitis). Both of these infections can damage the cartilage, tissue and bone. They may also affect the joints and limbs. Antibiotics are required to treat bone and joint infections. In the most serious of cases, infected bones and joints may need to be surgically removed. Necrotising fasciitis Necrotising fasciitis, commonly known as flesh-eating bacteria, is a serious skin infection that causes rapid tissue death. It can occur when a pressure ulcer becomes infected with a particular type of bacteria,such asGroup A streptococci. Emergency treatment is required. It involves a combination of antibiotics and surgical debridement of the dead tissue. Gas gangrene Gas gangrene is a serious but rare form of infection that occurs when a pressure ulcer becomes infected with the clostridium bacteria. The bacteria thrive in environments where there is little or no oxygen. They produce gases and release dangerous toxins. Symptoms of gas gangrene include severe pain and rapid swelling of the skin. Gas gangrene requires immediate treatment with surgical debridement. In the most serious of cases, it may be necessary to amputate the affected body part to prevent the gangrene from spreading to the rest of the body. Preventing pressure ulcers As part of your treatment plan, your care team will discuss with you the best way to prevent pressure ulcers. This will be based on your individual circumstances. However, you may find that the general advice outlined below is helpful. Changing position Making regular and frequent changes to your position is one of the most effective ways of preventing pressure ulcers. If a pressure ulcer has already developed, regularly changing position will help to avoid putting further pressure on it, and give the wound the best chance of healing. As a general rule, wheelchair users will need to change their position at least once every 15 to 30 minutes. People who are confined to bed will need to change their position at least once every 2hours. Once you have developed a pressure ulcer, its important that you minimise or avoid putting any further pressure on it to give the wound the best chance of healing. If you are unable to change position yourself, a carer or relative will need to assist you. For more information and advice about positional changes, read about treating pressure ulcers . Nutrition Eating a healthy, balanced diet that contains an adequate amount of protein and a good variety of vitamins and minerals can help prevent skin damage and speed up the healing process. You may be referred to a dietitian so that a dietary plan can be drawn up for you. If you currently have a reduced appetite due to a pre-existing health condition, the following advice may be useful: Try eating smaller meals throughout the day, rather than 2or 3larger meals. Set a timetable for when you should eat, rather than waiting until you feel hungry. This should ensure that you receive the necessary nutrition. Avoid drinking large amounts of fluids just before you are about to eat, as this will make you feel fuller than you actually are. If you find swallowing difficult, try drinking specially made nutritional drinks or pured foods and soups. If you are a vegetarian, its important to eat high-protein alternatives to meat. Cheese, yoghurt, peanut butter, custard, beans and nuts are all good sources of protein. Read more informationabout healthy eating for more advice. Checking your skin If you have known risk factors for pressure ulcers, its important that you check your skin on a daily basis for any signs of pressure ulcers, such as discoloured areas of skin. This is particularly important if you have an underlying condition, such as nerve damage or diabetes, which may dampen or numb feelings of pain in certain parts of your body. You can use a mirror to check the parts of your body that are difficult to see, such as your bottom and the heels of your feet. If you notice any damage, report it to your care team. If you are at home, contact your GP or community nurse. If you are in hospital or a nursing home, inform one of your nurses or carers. Quit smoking If you are a smoker, giving up is one of the most effective ways of preventing pressure ulcers. Smoking reduces the levels of oxygen in your blood. It also weakens your immune system, which increases your risk of developing pressure ulcers. Read about quitting smoking for further information and advice about giving up smoking. Source: NHS 24 - Opens in new browser window Last updated: 09 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Prostate cancer | Prostate cancer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Prostate cancer Prostate cancer About prostate cancer Symptoms of prostate cancer Causes of prostate cancer Diagnosing prostate cancer Testing for prostate cancer Treating prostate cancer Living with prostate cancer About prostate cancer Prostate cancer is the most common cancer in men and anyone with a prostate in the UK. Prostate cancer usually develops slowly, so there may be no signs you have it for many years. Symptoms often only become apparent when your prostate is large enough to affect the urethra (the tube that carries urine from the bladder to the penis). When this happens, you may notice things like an increased need to urinate, straining while urinating and a feeling that your bladder has not fully emptied. These symptoms shouldnt be ignored, but they do not mean you definitely have prostate cancer. It is more likely that they are caused by something else, such as benign prostatic hyperplasia (also known as BPH or prostate enlargement ). Read more about the symptoms ofprostate cancer What is the prostate? The prostate is a small gland in the pelvis. About the size of a satsuma, its located between the penis and the bladder andsurrounds the urethra. The main function of the prostate is to help in the production of semen. It produces a thick white fluid that is mixed with the sperm produced by the testicles, to create semen. Why does prostate cancer happen? The causes of prostate cancer are largely unknown. However, certain thingscan increase your risk of developing the condition. The chances of developing prostate cancer increase as you get older. Most cases develop in men and anyone with a prostate aged 50 or older. For reasons not yet understood, prostate cancer is more common in men and anyone with a prostate of African-Caribbean African descent. Its less common in men and anyone with a prostate of Asian descent. Men and anyone with a prostate who havefirst-degreemale relatives (such as a father or brother) affected by prostate cancer are also at a slightly increased risk. Read more about the causes of prostate cancer Tests for prostate cancer There is no single test for prostate cancer. All the tests used to help diagnose the condition have benefits and risks, which your doctor should discuss with you. The most commonly used tests for prostate cancer are blood tests , a physical examination of your prostate (known as a digital rectal examination or DRE ) and a biopsy . The blood test, known as aprostate-specific antigen (PSA) test, measures the level of PSA and may help detect early prostate cancer. Men and anyone with a prostate are not routinely offered PSA tests to screen for prostate cancer, as results can be unreliable. This is because the PSA blood test is not specific to prostate cancer. PSA can be raised due to a large non-cancerous growth of the prostate (BPH), a urinary tract infection or inflammation of the prostate, as well as prostate cancer. Raised PSA levels also cannot tell a doctor whether a man has life-threatening prostate cancer or not. This means a raised PSA can lead to unnecessary tests and treatment. However, you can ask to be tested for prostate cancer once the benefits and risks have been explained to you. Read more about diagnosing prostate cancer and PSA screening for prostate cancer How is prostate cancer treated? In many cases,treatment is not immediately necessary. If the cancer is at an early stage andnot causing symptoms, a policy of watchful waiting or active surveillance may be adopted. This involves carefully monitoring your condition. Some cases of prostate cancer can be cured if treated in the early stages. Treatments include surgically removing the prostate, radiotherapy and hormone therapy. Some cases are only diagnosed at a later stage when the cancer has spread. If the cancer spreads to other parts of the body, typically the bones, it cannot be cured and treatment is focused on prolonging life and relieving symptoms. All treatment options carry the risk of significant side effects, including erectile dysfunction and urinary incontinence . For this reason, many people choose to delay treatment until there is a risk the cancer might spread. Newer treatments,such ashigh-intensity focused ultrasound (HIFU)or cryotherapy, aim to reduce these side effects.Some hospitals may offer them as an alternative to surgery, radiotherapy or hormone therapy. However, the long-term effectiveness of these treatments are not yet known. Read more about treating prostate cancer Living with prostate cancer Asprostate cancer usually progresses very slowly, you can live for decades without symptoms or needing treatment. Nevertheless, it can have an effect on your life. As well as causing physical problems such as erectile dysfunction and urinary incontinence , a diagnosis of prostate cancer can understandably make you feel anxious or depressed . You may find it beneficial to talk about the condition with your family, friends, a family doctor and other people with prostate cancer. Financial support is also available if prostate cancer reduces your ability to work. Read more about living with prostate cancer Symptoms of prostate cancer Prostate cancer does not normally cause symptoms until the cancer has grown large enough to put pressure on the urethra. This normally results in problems associated with urination. Symptoms can include: needing to urinate more frequently, often during the night needing to rush to the toilet difficulty in starting to pee (hesitancy) straining or taking a long time while urinating weak flow feeling that your bladder has not emptied fully Your prostate mayget larger as you get older due to a non-cancerous condition known as prostate enlargement or benign prostatic hyperplasia. Symptoms that the cancer may have spread include bone and back pain, a loss of appetite, pain in the testicles and unexplained weight loss. Read further information: Cancer Research UK: prostate cancer symptoms Causes of prostate cancer Its not known exactly what causes prostate cancer, although a number of things can increase your risk of developing the condition. These include: age riskrises as you get older andmost cases are diagnosed inmen and anyone with a prostate over 50 years of age ethnic group prostate cancer is more common among men and anyone with a prostate of African-Caribbean and African descent thanin men and anyone with a prostate of Asian descent family history having a brother or father who developed prostate cancer under the age of 60 seems to increase the risk of you developing it; having a close female relative who developed breast cancer may also increase your risk of developingprostate cancer obesity there may be a link between obesity and prostate cancer exercise men and anyone with a prostate who regularly exercises have also been found to be at lower risk of developing prostate cancer diet research is ongoing into the links between diet and prostate cancer; a diet high in calcium is linked to an increased risk of developing prostate cancer In addition, some research has shown that prostate cancer rates appear to be lower inmen and anyone with a prostate who eat foods containing certain nutrients including lycopene, found in cooked tomatoes and other red fruit, and selenium, found in brazil nuts. However, more research is needed. Read further information: Prostate Cancer UK: who is at risk of prostate cancer Cancer Research UK: prostate cancer risks and causes Diagnosing prostate cancer If you have symptoms that could be caused by prostate cancer, you should visit your GP. There is no single, definitive test for prostate cancer, so your GPwill discuss the pros and cons of the various tests with you to try to avoid unnecessary anxiety. Your doctor is likely to: ask for a urine sample to check for infection take ablood sample to test your level of prostate-specific antigen (PSA) examine your prostate ( digital rectal examination ) In 2015, the National Institute for Health and Care Excellence ( NICE ) published guidelines to help GPs recognise the signs and symptoms of prostate cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected prostate cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral . PSA testing PSA is a protein produced by the prostate gland. All men and anyone with a prostate have a small amount of PSA in their blood, and it increases with age. Prostate cancer can increase the production of PSA, and so a PSA test looks for raised levels of PSA in the blood that maybe a sign of the conditionin its early stages. However, PSA testing is not a specific test for prostate cancer. Most men and anyone with a prostate who has prostate cancer will not have a raised PSA level. Most peoplewith a raised PSA level will not have cancer, as PSA levels rise in all men and anyone with a prostate as they get older. Read more about PSA screening for prostate cancer Digital rectal examination (DRE) The next step is a DRE, which can be done by your GP. During a DRE, your GP will insert a lubricated and gloved finger into your rectum. The rectum is close to your prostate gland, so your GP can check to feel if the surface of the gland has changed. This will feel a little uncomfortable, but should not be painful. Prostate cancer can make the glandhard and bumpy. However, in most cases, the cancer causes no changes to the gland and a DRE may not be able to detect the cancer. DRE is useful in ruling out prostate enlargement caused by benign prostatic hyperplasia, as this causes the gland to feel firm and smooth. Biopsy Your GP will assess your risk of having prostate cancer based on a number of factors, including your PSA levels, the results of your DRE, and your age, family history and ethnic group. If you are at risk, youshould be referred to hospital to discuss the options of further tests. The most commonly used test is a transrectal ultrasound-guided biopsy (TRUS). A biopsy may also be taken during a cystoscopy examination or through the skin behind the testicles (perineum). During a TRUS biopsy, an ultrasound probe (a machine that uses sound waves to build a picture of the inside of your body) is inserted into your rectum. This allows the doctor or specialist nurse to see exactly where to pass a needle through the wall of your rectum to take small samples of tissue from your prostate. The procedure can be uncomfortable and sometimes painful, so you may be given a local anaesthetic to minimise any discomfort. As with any procedure, there may be complications, including bleeding and infection. Although it is more reliable than a PSA test, the TRUS biopsycan haveproblems. It can miss up to 1 in 5 cancers, because the location of the cancer is unknown when it is carried out. The doctors can see the prostate using the ultrasound scan, but not the tumour(s) if they are present. You may need another biopsy if your symptoms persist, or your PSA level continues to rise. Your doctor mayrequest an MRI scan of the prostate before another biopsy. The TRUS biopsy can also find small low-risk cancers that do not need treatment, but may cause you anxiety. Many people often choose to undergo surgery or radiotherapy that may not benefit them but causes side effects, such as incontinence and erectile dysfunction . The samples of tissue from the biopsy are studied in a laboratory. If cancerous cells are found, they can be studied further to see how quickly the cancer will spread. This process is known as staging and grading and helps doctors to decide which treatment is the most appropriate. Read further information: Cancer Research UK: the stages of prostate cancer Macmillan: grading and staging of prostate cancer Further testing If there is a significant chancethe cancer has spread from your prostate to other parts of the body, further tests may be recommended. These include: a magnetic resonance imaging (MRI) or computerised tomography (CT) scan these scans build a detailed picture of the inside of your body an isotope bone scan this can tell if the cancer has spread to your bones; a small amount of radiation dye is injected into the vein andcollects in parts of the bone where there are any abnormalities Read further information: Cancer Research UK: prostate cancer tests Testing for prostate cancer There is currently no screening programme for prostate cancer in the UK. This is because it has not been proved that the benefits would outweigh the risks. PSA screening Routinely screening all men and anyone with a prostate to check their prostate-specific antigen (PSA) levels is a controversial subject in the international medical community. There are several reasons for this: PSA tests are unreliable and can suggest prostate cancer when no cancer exists (a false-positive result) this means that many men often have invasive and sometimes painful biopsies for no reason the PSA test can find aggressive prostate cancer that needs treatment, but it can also find slow-growing cancer that may never cause symptoms or shorten lifesome men and anyone with a prostate may therefore face difficult decisions about treatment treating prostate cancer in its early stages can be beneficial in some cases but theside effects of the various treatments are potentially so serious that men may choose to delay treatment until it is absolutely necessary although screening has been shown to reduce a mans chance of dying from prostate cancer, it would mean many people receive treatment unnecessarily More research is needed to determine whether a screening programme would provide men and anyone with a prostate with more benefit than harm. One European study showed deaths from prostate cancer could be reduced by 20% if there was a screening programme, but this needs to be balanced against the harms of: overdiagnosis people being diagnosed with a cancerthat will never cause symptoms or death during their lifetime overtreatment people being treated unnecessarily for tumours that would beunlikely tobe harmful Improving the test As there are many reasons why PSA levels may be high at any one time, researchers are trying to make the PSA test, or a variation of it, more accurate. This includes looking at how PSA levels change over time and comparing the PSA level to prostate size. Researchers are also looking at whether new imaging tests, such as MRI scans, or other blood and urine tests, can be used to decide which people with an elevated PSA should have a biopsy. Instead of a national screening programme, there is an informed choice programme called prostate cancer risk management for healthy men and anyone with a prostate aged 50 or over who ask their GP about PSA testing. It aims to give men and anyone with a prostate good information on the pros and cons of a PSA test. If youre aged50 or over with a prostate and decide to have your PSA levels tested after talking to your GP, theywill be able to arrange for it to be carried out for free on the NHS. If results show you have araised level of PSA, your GP may suggest further tests. Should I have a PSA test? Because the results of the PSA test are not as reliable as doctors would like, other tests and investigations are needed to diagnose prostate cancer. A PSA test cannot identify prostate cancer on its own, and changes in PSA levels alone are not a good reason to start treatment. If you are thinking about asking for a PSA test, it is important that you first discuss whether it is right for youwith your GP so you understand what the results might mean. The Prostate Cancer Risk Management Programme has information on the risks and benefits of the PSA test to help you decide whether or not to have it. Treating prostate cancer Staging of prostate cancer Doctors will use the results of your prostate examination, biopsy and scans to identify thestage of your prostate cancer (how far the cancer has spread). The stage of the cancer will determine which types of treatments will be necessary. A widely used method of staging isanumber staging system. The stages are: stage 1 the cancer is very small and completely within the prostate gland stage 2 the cancer is within the prostate gland, but is larger stage 3 the cancer has spread from the prostate and may have grown into the tubes that carry semen stage 4 the cancer has spread into the lymph nodes or another part of the body, including the bladder, rectum or bones; about 20 to 30% of cases are diagnosed at this stage If prostate cancer is diagnosed at an early stage, the chances of survival are generally good. Read further information: Cancer Research UK: the stages of prostate cancer Watchful waiting Watchful waitingis often recommended for older men and anyone with a prostate when it is unlikely that the cancerwill affect your natural life span. If the cancer is in its early stages and not causing symptoms, you may decide to delay treatment, and wait to see if any symptoms of progressive cancer develop. If this happens, pain medication and hormone medication to control prostate cancer are usually used. Watchful waiting may also be recommended for people with a higher risk of prostate cancer if: your general health means you are unable to receiveany form of treatment your life expectancy means you will die with the cancer rather than from it In this case, hormone treatment may be started if there are symptoms caused by the prostate cancer. Active surveillance Active surveillance aims to avoid unnecessary treatment of harmless cancers, while still providing timely treatment for men and anyone with a prostate who needs it. When they are diagnosed, around half to two-thirds of men and anyone with a prostate with low-risk prostate cancer do not needtreatment. Surveillance is a safe strategy that provides a period of observation to gather extra information over time to see whether the disease is changing. Active surveillance involves you having regular PSA tests andoften severalbiopsies to ensureany signs of progression are found as early as possible. Sometimes, MRI scans may also be carried out. If these tests reveal the cancer is changing or progressing,you can then make a decision about further treatment. About 1 in 3 people who undergo surveillance will later have treatment. This does not mean they made the wrong initial decision. Good evidence showsthat active surveillance is safe over an average of 6 years. Men undergoing active surveillancewill have delayed any treatment-related side effects, and those who eventually need treatmentwill be reassuredthat it was necessary. Radical prostatectomy A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing localised prostate cancer and locally-advanced prostate cancer. Like any operation, this surgery carries some risks, and there may be some side effects: some people have problems with urinary incontinence t his can range from leaking small drips of urine, to leaking larger amounts but this usually clears up within 3 to 6 months of the operation some men have problems getting an erection ( erectile dysfunction ) t his sometimes improves with time, but around half will have long-term problems in extremely rare cases, problems arising after surgery can be fatal For many men and anyone with a prostate, having a radical prostatectomy will get rid of the cancer cells. However, for around 1 in 3 people, the cancer cells may not be fully removed, and the cancer cells may return sometime after the operation. Radiotherapy after prostate removal surgery may increase the chances of a cure, although research is still being carried out into when it should be used after surgery. After a radical prostatectomy, you will no longer ejaculate during sex. This meansthat you will not be able to have a child through sexual intercourse. You may want to ask your doctors about storing a sperm sample before the operation, soit can be used later for in vitro fertilisation (IVF). Read further information: Macmillan: surgery for early prostate cancer Radiotherapy Radiotherapy involves using radiation to kill cancerous cells. This treatment is an option for curing localised prostate cancer and locally-advanced prostate cancer. Radiotherapy can also be used to slow the progression of metastatic prostate cancer and relieve symptoms. Radiotherapy is normally given as an outpatient at a hospital near you. It is done in short sessions for 5 days a week, for 4 to 8 weeks. There are short-term and long-term side effects associated with radiotherapy. You may receive hormone therapy before undergoing radiotherapy to increase the chance of successful treatment. Hormone therapy may also be recommended after radiotherapy to reduce the chances of cancerous cells returning. Short-term effects of radiotherapy can include: discomfort around the rectum and anus (the opening through which stools pass out of your body) diarrhoea loss of pubic hair tiredness cystitis an inflammation of the bladder lining, which can cause you to urinate frequently; urination may be painful Possible long-term side effects can include: an inability to obtain an erection urinary incontinence back passage problems (diarrhoea, bleeding, discomfort) As with radical prostatectomy, there is a 1 in3 chance the cancer will return. In these cases, medication is usually used to control the cancer instead of surgery. This is because there is a higher risk of complications from surgery in men and anyone with a prostate who have previously had radiotherapy. Some hospitals now offer new minimally invasive treatments if radiotherapy fails to work, sometimesas part of a clinicaltrial. These new treatments are called high-intensity focused ultrasound (HIFU) and cryotherapy. These treatments have fewer side effects, but the long-term outcomes are not yet known. Read further information: Macmillan: radiotherapy for early prostate cancer Brachytherapy Brachytherapy is a form of radiotherapy where the radiation dose is delivered inside the prostate gland. It is also known as internal or interstitial radiotherapy. The radiation can be delivered using a number of tiny radioactive seeds that are surgically implanted into the tumour. This is called low dose-rate brachytherapy. The radiation can also be delivered through hollow, thin needles placed inside the prostate. This is called high dose-rate brachytherapy. This method has the advantage of delivering a high dose of radiation to the prostate, while minimising damage to other tissues. However, the risk of sexual dysfunction and urinary problems is the same as with radiotherapy, although the risk of bowel problems is slightly lower. Read further information: Cancer Research UK: internal radiotherapy (brachytherapy) for prostate cancer Hormone therapy Hormone therapy is often used in combination with radiotherapy. For example, you may receive hormone therapy before undergoing radiotherapy to increase the chance of a successful treatment. Hormone therapy may also be recommended after radiotherapy to reduce the chances of cancerous cells returning. Hormone therapy alone should not normally be used to treatlocalised prostate cancer inpeople who are fit and willing to receive surgery or radiotherapy. This is because it does not cure the cancer on its own.Hormone therapycan be used to slow the progression of advanced prostate cancer and relieve symptoms. Hormones control the growth of cells in the prostate. In particular, prostate cancer needs the hormone testosterone to grow. The purpose of hormone therapy is to block the effects of testosterone, either by stopping its production or by stopping your body being able to use testosterone. Hormone therapy can be given as: injections to stop your body making testosterone, called luteinising hormone-releasing hormone (LHRH) agonists tablets to block the effects or reduce the production of testosterone, called anti-androgen treatment combined LHRH and anti-androgen treatment The main side effects of hormone treatment are caused by their effects on testosterone. They usually go away when treatment stops. They includeloss of sex drive and erectile dysfunction (this is more common with LHRH agonists than anti-androgens). Other possible side effects include: hot flushes sweating weight gain swelling and tenderness of the breasts An alternative to hormone therapy is to surgically remove the testicles, called orchidectomy. The operation does not cure prostate cancer, but by removing the testosterone, it controls the growth of the cancer and its symptoms. Read further information: Cancer Research UK: hormone therapy for prostate cancer Trans-urethral resection of the prostate (TURP) DuringTURP, athin metal wire with a loop at the end is inserted into your urethra (the tube that carries urine from your bladder to your penis) and pieces of the prostate are removed. This is carried out under general anaesthetic or a spinal anaesthetic (epidural). This is done to relieve pressure from the urethra to treat any problematic symptoms you may have with urination. It does not cure the cancer. Read more information about transurethral resection of the prostate (TURP) . High intensity focused ultrasound (HIFU) HIFU is sometimes used to treat men and anyone with a prostate with localised prostate cancer that has not spread beyond their prostate. An ultrasound probeinserted into the rectum releases high-frequency sound waves through the wall of the rectum. These sound waves kill cancer cells in the prostate gland by heating them to a high temperature. The risk of side effectsfrom HIFUisusually lower than other treatments. However, possible effects can include impotence (in 5 to 10 in every 100) or urinary incontinence (in less than 1 in every 100). Back passage problems are rare. Fistulas (an abnormal channel between the urinary system and rectum) are also rare, affecting less than 1 in every 500. This is because the treatment targets the cancer area only and not the whole prostate. However, HIFU treatment is still going through clinical trials for prostate cancer.In some cases, doctors can carry out HIFU treatment outside of clinical trials. HIFU is not widely available and its long-term effectiveness has not yet been conclusively proven. Read further information: Cancer Research UK: high intensity focused ultrasound (HIFU) for prostate cancer Cryotherapy Cryotherapy is a method of killing cancer cells by freezing them. It is sometimes used to treat men and anyone with a prostate with localised prostate cancer that has not spread beyond their prostate gland. Tiny probes called cryoneedles are inserted into the prostate gland through the wall of the rectum. They freeze the prostate gland and kill the cancer cells, but some normal cells also die. The aim is to kill cancer cells while causing as little damage as possible to healthy cells. The side effects of cryotherapy can include: erectile dysfunction this can affect between 2 and 9 in every 10 incontinence this affects less than 1 in 20 It is rare for cryotherapy to causerectal problems or fistulas. Cryotherapyis still undergoing clinical trials for prostate cancer. In some cases, doctors can carry out cryotherapy treatment outside of clinical trials.Itis not widely availableand its long-term effectiveness has not yet been conclusively proven. Treating advanced prostate cancer If the cancer has reached an advanced stage, it is no longer possible to cure it. However, it may be possible to slow its progression, prolong your life and relieve symptoms. Treatment options include: radiotherapy hormone treatment chemotherapy If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss. Chemotherapy Chemotherapy is mainly used to treat prostate cancer that has spread to other parts of the body (metastatic prostate cancer) and which is not responding to hormone therapy. Chemotherapy destroys cancer cells by interfering with the way they multiply. Chemotherapy does not cure prostate cancer, but can keep it under control and reduce symptoms (such as pain) so everyday life is less affected. The main side effects of chemotherapy are caused by their effects on healthy cells, such as immune cells. They include infections, tiredness, hair loss, sore mouth, loss of appetite, nausea and vomiting. Many of these side effects can be prevented or controlled with other medicines, which your doctor can prescribe for you. Steroids Steroid tablets are used when hormone therapy no longer works because the cancer is resistant to it. This is called hormone-refractory cancer. Steroids can be used to try to shrink the tumour and stop it from growing. The most effective steroid treatment is dexamethasone. Other medical treatments There are a number of new medications that could be used if hormones and chemotherapy fail. Your medical teamcan tell you if these are suitable and available for you. NICE has recently issued guidance on medications called abiraterone andenzalutamide. Read the NICE guidelines on: enzalutamide for metastatic hormone-relapsed prostate cancer previously treated with docetaxel abiraterone for castration-resistant metastatic prostate cancer previously treated with a docetaxel-containing regimen Deciding against treatment As many of the treatments above have unpleasant side effects that can affect your quality of life, you may decide against treatment. This may be especially true if you are at an age when you feel that treating the cancer is unlikely to significantly extend your life expectancy. This is entirely your decision, and your MDT will respect it. If you decide not to have treatment, your GP and hospital team will still give you support and pain relief. This is called palliative care . Support is also available for your family and friends. Living with prostate cancer Impact on everyday activities If you have no symptoms, prostate cancer should have little or no effect on your everyday activities. You should be able to work, care for your family, carry on your usual social and leisure activities, and look after yourself. However, you may be understandably worried about your future. This may make you feel anxious or depressed ,and affect your sleep. If your prostate cancer progresses, you may not feel well enough to do all the things you used to. After an operation or other treatment, such as radiotherapy or chemotherapy, you will probably feel tired and need time to recover. If you have advanced prostate cancer that has spread to other parts of your body, you may have symptoms that slow you down and make it difficult to do things. You may have to reduce your working hours or stop working altogether. Whatever stage your prostate cancer has reached, try to give yourself time to do the things you enjoy and spend time with those who care about you. Read further information: Cancer Research UK: coping with prostate cancer Complications of prostate cancer Erection problems If you have erectile dysfunction , speak to your GP. It may be possible to treat you with a type of medicine known as phosphodiesterase type 5 inhibitors (PDE5). PDE5s work by increasing the blood supply to your penis. The most commonly used PDE5 is sildenafil (Viagra). Other PDE5s are available if sildenafil is not effective. Another alternative is a device called a vacuum pump. It is a simple tube connected to a pump. You place your penis in the tube and then pump out all the air. This creates a vacuum, which causes the blood to rush to your penis. You then place a rubber ring around the base of your penis. This keeps the blood in place and allows you to maintain an erection for around 30 minutes. Urinary incontinence If your urinary incontinence is mild, you may be able to control it by learning some simple exercises. Pelvic floor exercises can strengthen your control over your bladder. To carry out pelvic floor exercises: Sit or lie comfortably with your knees slightly apart. Squeeze or lift at the front as if you were trying to stop the passage of urine, then squeeze or lift at the back as if you were trying to stop the passage of wind. Hold this contraction for as long as you can (at least 2 seconds, increasing up to 10 as you improve). Relax for the same amount of time before repeating. If your urinary incontinence is more severe, it may be possible to treat it with surgery. This would involve implanting | null | null | null | null | null | null | null | null | null | null | null | null | null |
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n artificial sphincter a sphincter is a muscle used to control the bladder. Read further information: Prostate Cancer UK: sex and prostate cancer Prostate Cancer UK: urinary problems and prostate cancer Relationships Beingdiagnosed with prostate cancer often brings families and friends closer | although it can put pressure on relationships too. Most people want to help | though they may not know what to do. A few people find it hard to talk to someone with prostate cancer | and may try to avoid them. Being open and honest about how you feel and what your family and friends can do to helpmay put others at ease. But do not feel shy about telling people thatyou need some time to yourself | if that is what you need. Read further information: Macmillan: emotional effects of cancer Talking to your kids about cancer Talk to others If you have questions | your doctor or nurse may be able to reassure you | or you may find it helpful to talk to a trained counsellor | psychologist or specialist helpline. Your GP practice will have information on these. You may find it helpful to talk to others with prostate cancer at a local support group or through an internet chat room. Read further information: Prostate Cancer UK: online community Prostate Cancer UK: confidential helpline on 0800 074 8383to speak toa specialist nurse Money and financial support If you have to reduce or stop work because of your prostate cancer | you may find it hard to cope financially. If you have prostate cancer or are caring for someone with prostate cancer | you may be entitled to financial support. if you have a job but cannot work because of your illness | you are entitled to Statutory Sick Pay from your employer if you do not have a job and cannot work because of your illness | you may be entitled to Employment and Support Allowance if you are caring for someone with cancer | you may be entitled to Carers Allowance you may be eligible for other benefits if you have children living at home or if you have a low household income Find out early what help is available to you. Speak to the social worker at your hospital | who can give you the information you need. Read further information: GOV.UK: benefits Carers Direct: benefits for carers and benefits for the person you care for Find your nearest Citizens Advice bureau Money Advice Service Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name | location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Other health sites Lab Tests Online UK: PSA Malecare Prostate Cancer UK NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852" |
Psoriasis | Psoriasis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Psoriasis Psoriasis About psoriasis Symptoms of psoriasis Causes of psoriasis Treating psoriasis Living with psoriasis About psoriasis Psoriasis is a skin condition that causes red, flaky, crusty patches of skin covered with silvery scales. These patches normally appear on your elbows, knees, scalp and lower back, but can appear anywhere on your body.Most people are only affected with small patches. In some cases, the patches can be itchy or sore. Psoriasis affects around 2% of people in the UK. It can start at any age, but most often develops in adults under 35 years old. The condition affects men and women equally. The severity of psoriasis varies greatly from person to person. For some people its just a minor irritation, but for others it can havea major impact on their quality of life. Psoriasis is a long-lasting (chronic) disease that usually involves periods when you have no symptoms ormild symptoms, followed by periods when symptoms are more severe. Read more about the symptoms of psoriasis . Psoriasis causes areas of red, flaky and crusty skin. Source: https://dermnetnz.org/ Why it happens People with psoriasis have anincreased production of skin cells. Skin cells are normallymade and replaced every 3to 4weeks, but in psoriasis this process only lasts about 3to 7days. The resulting build-up of skin cells is what creates the patches associated with psoriasis. Although the process isnt fully understood, its thoughtto be related to a problem with the immune system. The immune systemis your bodys defence against disease and infection, but for people with psoriasis, it attacks healthy skin cells by mistake. Psoriasis can run in families,although the exact role that genetics plays in causing psoriasis is unclear. Many peoples psoriasis symptoms start or become worse because of a certain event, known as a trigger. Possible triggers of psoriasis includean injury to your skin, throat infections and using certain medicines. The condition isnt contagious, so it cant be spread from person to person. Read more about the causes of psoriasis . How psoriasis is diagnosed A GP canoften diagnose psoriasis based on the appearance of your skin. In rare cases, a small sample of skin, called a biopsy , will be sent to the laboratory for examination under a microscope. This determines the exact type of psoriasis and rules out other skin disorders, such as seborrhoeic dermatitis, lichen planus , lichen simplex and pityriasis rosea. You may be referred to a dermatologist (a specialist in diagnosing and treating skin conditions) if your doctor is uncertain about your diagnosis, or if your condition is severe. If your doctor suspects you have psoriatic arthritis, which is sometimes a complication of psoriasis, you may be referred to a rheumatologist (a doctor who specialises in arthritis). You may have blood tests to rule out other conditions, such as rheumatoid arthritis , and X-rays of the affected joints may be taken. Treating psoriasis Theres no cure for psoriasis, but a range of treatments can improve symptoms and the appearance of skin patches. In most cases, the first treatment used will be a topical treatment, such as vitamin D analogues or topical corticosteroids . Topical treatments are creams and ointments applied to the skin. If these arent effective, or your condition is more severe, a treatment called phototherapy may be used. Phototherapy involves exposing your skin to certain types of ultraviolet light. In severe cases, where the above treatments are ineffective, systemic treatments may be used. These are oral or injected medicines that work throughout the whole body. Read more about treating psoriasis . Living with psoriasis Although psoriasis is just a minor irritation for some people, it can have a significant impact on quality of life for those more severely affected. For example,some people with psoriasis have low self-esteem because of the effect the condition has on their appearance. Its also quitecommonto developtenderness, pain and swelling in the joints and connective tissue. This is known as psoriatic arthritis. Speak to your GP or healthcare team if you have psoriasis and youhave any concerns about your physical and mental wellbeing. Theycan offer advice and further treatment if necessary. There are also support groups for people with psoriasis, such as The Psoriasis Association , where you can speak to other people with the condition. Read more about living with psoriasis . Further information You can find support and information from organisations like: Changing Faces a charity for people who have a visible difference or facial disfigurement, who can be contacted on 0300 012 0275 for counselling and advice The Psoriasis Association provides support groups for people with psoriasis where you can speak to other people with the condition Symptoms of psoriasis Psoriasis typically causes patches of skin that are dry, red and covered in silver scales. Some people find their psoriasis causes itching or soreness. There are several different types of psoriasis. Many people have onlyoneform of psoriasis at a time, although 2different types can occur together. One type may change into another type, or become more severe. Most cases of psoriasis go through cycles, causing problems for a few weeks or months before easing or stopping. You should see your GP if you think you may have psoriasis. Psoriasis often occurs on the elbow area. Source: https://dermnetnz.org/ Common types of psoriasis Plaque psoriasis (psoriasis vulgaris) This is the most common form, accounting for about 80% of cases. Its symptoms are dry, red skin lesions, known as plaques, which are covered in silver scales. They normally appear on your elbows, knees, scalp and lower back, but can appear anywhere on your body. The plaques can be itchy, sore or both. In severe cases, the skin around your joints may crack and bleed. Scalp psoriasis This can occur on parts of your scalp or on the whole scalp. It causes red patches of skin covered in thick silvery-white scales. Some people find scalp psoriasis extremely itchy, while others have no discomfort. In extreme cases it can cause hair loss, although this is usually only temporary. Nail psoriasis In about half of all people with psoriasis, the condition affects the nails. Psoriasis can cause your nails to develop tiny dents or pits, become discoloured, or grow abnormally. Nails can oftenbecome loose and separate from your nail bed. In severe cases, your nails may crumble. Guttate psoriasis Guttate psoriasis causes small (less than 1cm or 1/3 inch) drop-shaped sores on your chest, arms, legs and scalp. Theres a good chance that guttate psoriasis will disappear completely after a few weeks, but some people go on to develop plaque psoriasis. Thistype of psoriasis sometimesoccurs after a streptococcal throat infection and is more common among children and teenagers. Inverse (flexural) psoriasis This affects folds or creases in your skin, such as the armpits, groin, between the buttocks and under the breasts. It can cause large, smooth red patches in some or all of these areas. Inverse psoriasis is made worse by friction and sweating, so it can be particularly uncomfortable in hot weather. Pustular psoriasis Pustular psoriasis is a rarer type of psoriasis that causes pus-filled blisters (pustules) to appear on your skin. Different types of pustular psoriasis affect different parts of the body. Generalised pustular psoriasis or von Zumbusch psoriasis This causes pustules on a wide area of skin, which develop very quickly. The pus consists of white blood cells and is not a sign of infection. The pustules may reappear every few days or weeks in cycles. During the start of these cycles, von Zumbusch psoriasis can cause fever, chills, weight loss and fatigue. Palmoplantar pustular psoriasis This causes pustules to appear on the palms of your hands and the soles of your feet. The pustules gradually develop into circular brown, scaly spots, which then peel off. Pustules may reappear every few days or weeks. Acropustulosis This causes pustules to appear on your fingers and toes. The pustules then burst, leaving bright red areas that may ooze or become scaly. These may lead to painful nail deformities. Erythrodermic psoriasis Erythrodermic psoriasis is a rare form of psoriasis that affects nearly all the skin on the body. This can cause intense itching or burning. Erythrodermic psoriasis can cause your body to lose proteins and fluid, leading to further problems such as infection, dehydration , heart failure ,hypothermia and malnutrition . Causes of psoriasis Psoriasis occurs when skin cells are replaced more quickly than usual. Its not known exactly why this happens, but research suggests its caused by a problem with the immune system. Your body produces new skin cells in the deepest layer of skin. These skin cells gradually move up through the layers of skin until they reach the outermost level. Then they die and flake off. This whole process normally takes around 3to 4weeks. In people with psoriasis, this process only takes about 3to 7days. As a result, cells that arent fully mature build up rapidly on the surface of the skin, causing red, flaky, crusty patches covered with silvery scales. Problems with the immune system Your immune system is your bodys defence against disease and it helps fight infection. One of the main types of cell used by the immune system is called a T-cell. T-cells normally travel through the body to detect and fight invading germs such as bacteria, but in people with psoriasis they start to attack healthy skin cells by mistake. This causes the deepest layer of skin to produce new skin cells more quickly than usual, which in turn triggers the immune system to produce more T-cells. Its not known what exactly causes this problem with the immune system, although certain genes and environmental triggers mayplay a role. Genetics Psoriasis runs in families. 1in 3people with psoriasis has a close relative with the condition. However, the exact role that genetics plays in causing psoriasis is unclear. Research studies have shown many different genes are linked to the development of psoriasis. Its likely that different combinations of genes may make people more vulnerable to the condition. However, having these genes doesnt necessarily mean youll develop it. Psoriasis triggers Many peoples psoriasis symptoms start or become worse because of a certain event, known as a trigger. Knowing your triggers mayhelp you toavoid a flare-up. Common triggers include: an injury to your skin, such as a cut, scrape, insect bite or sunburn (this is known as the Koebner response) drinking excessive amounts of alcohol smoking stress hormonal changes, particularly in women (for example, duringpuberty and the menopause ) certain medicinessuch aslithium, some antimalarial medicines, anti-inflammatory medicines including ibuprofen , ACE inhibitors (used to treat high blood pressure) and beta blockers (used to treat congestive heart failure) throat infections in some people, usually children and young adults, a form of psoriasis called guttate psoriasis develops after a streptococcal throat infection (although most people who have streptococcal throat infections dont develop psoriasis) other immune disorders, such as HIV ,which cause psoriasis to flare up or to appear for the first time Psoriasis isnt contagious, so it cant be spread from person to person. Treating psoriasis Treatment overview Treatments are determined by the type and severity of your psoriasis and the area of skin affected. Yourdoctor will probably start with a mild treatment, such as topical creams (which are applied to the skin), and then move on to stronger treatments if necessary. Awide range of treatmentsare availablefor psoriasis, but identifying which treatment is most effective can be difficult. Talk to yourdoctor if you feel a treatment isnt working or you have uncomfortable side effects. Treatments fall into 3categories: topical creams and ointments thatare applied to your skin phototherapy your skin is exposed to certain types of ultravioletlight systemic oral and injected medications that work throughout the entire body Often, different types of treatment are used in combination. Your treatment for psoriasis may need to be reviewed regularly. You may want to make a care plan (an agreement between you and your health professional)as this can help you manage your day-to-day health. The various treatments forpsoriasis are outlined below. You can also read a summary of the pros and cons of the treatments for psoriasis, allowing you to compare your treatment options. Topical treatments Topical treatments are usually the first treatments used for mild to moderatepsoriasis. These are creams and ointments you apply to affected areas. Some people find that topical treatmentsare alltheyneed to control their condition, althoughit may take up to 6weeks beforetheres a noticeable effect. If youhave scalp psoriasis, a combination of shampoo and ointment may be recommended. Emollients Emollients are moisturising treatments applied directly to the skin to reduce water loss and cover it with a protective film. If you have mild psoriasis, an emollient is probably the first treatment your GP will suggest. The main benefit of emollients is to reduce itching and scaling. Some topical treatments are thought to work better on moisturised skin. Its important to wait at least half an hour before applying a topical treatment after an emollient. Emollients are availableas a widevariety of products and can be bought over the counter from a pharmacyor prescribed by your GP, nurse or health visitor. Steroid creams or ointments Steroid creams or ointments (topical corticosteroids) are commonly used to treat mild to moderate psoriasis inmost areas of the body. The treatment works by reducing inflammation. This slows the production of skin cells and reduces itching. Topical corticosteroids range in strength from mild to very strong. Only use topical corticosteroids when recommended by your doctor. Stronger topical corticosteroids can be prescribed by your doctor and should only be used on small areas ofskin or on particularly thick patches. Overusing topical corticosteroids can lead to skin thinning. Vitamin D analogues Vitamin D analogue creams are commonly used along with or instead ofsteroid creamsfor mild to moderate psoriasis affecting areas such as the limbs, trunk or scalp. They work by slowing the production of skin cells. They also have an anti-inflammatory effect. Examples of vitamin D analogues are calcipotriol, calcitriol and tacalcitol. There are very few side effects, as long as you dontuse more than the recommended amount. Calcineurin inhibitors Calcineurin inhibitors,such astacrolimus and pimecrolimus,are ointments or creams that reduce the activity of the immune system and help to reduce inflammation. Theyre sometimes used to treat psoriasis affecting sensitive areas (such as the scalp, the genitals and folds in the skin) ifsteroid creamsarent effective. These medications can cause skin irritation or a burning and itching sensation when theyre started, but this usually improves within a week. Coal tar Coal tar is a thick, heavy oil and is probably the oldest treatment for psoriasis. How it works isnt exactly known, but it can reduce scales, inflammation and itchiness. It may be used to treat psoriasisaffecting the limbs, trunk or scalp if other topical treatments arent effective. Coal tar can stain clothes and bedding, and has a strong smell. It can be used in combination with phototherapy (see below). Dithranol Dithranol has been used for over 50 years to treat psoriasis. It has been shown to be effective in suppressing the production of skin cells and has few side effects. However, itcan burn if too concentrated. Its typically used as a short-term treatment for psoriasis affecting the limbs or trunk under hospital supervision, as it stains everything it comes into contact with, including skin, clothes and bathroom fittings. Its applied to your skin (while wearing gloves) and left for 10to 60 minutes before being washed off. Dithranol can be used in combination with phototherapy (see below). Phototherapy Phototherapy uses natural and artificial light to treat psoriasis. Artificial light therapy can be given in hospitals and some specialist centres, usually under the care of a dermatologist. These treatments arent the same as using a sunbed. UVB phototherapy Ultraviolet B (UVB) phototherapy uses a wavelength of light that is invisible to human eyes. The light slows down the production of skin cells and is an effective treatment for some types of psoriasis that havent responded to topical treatments. Each session only takes a few minutes, but you may need to go to hospital 2or 3times a week for 6to 8weeks. Psoralen plus ultraviolet A (PUVA) For this treatment, youll first be given a tablet containing compounds called psoralens, or psoralen may be applied directly to the skin. This makes your skin more sensitive to light. Your skin is then exposed to a wavelength of light called ultraviolet A (UVA). This light penetrates your skin more deeply than ultraviolet B light. This treatment may be used if you have severe psoriasis that hasnt responded to other treatment. Side effects of the treatment include nausea, headaches, burning and itchiness. You may need to wear special glasses for 24 hours after taking the tablet to prevent the development of cataracts. Long-term use of this treatment isnt encouraged, as it can increase your risk of developing skin cancer. Combination light therapy Combining phototherapy with other treatments often increases its effectiveness. Some doctors use UVB phototherapy in combination with coal tar, as the coal tar makes the skin more receptive to light. Combining UVB phototherapy with dithranol cream may also be effective (this is known as Ingram treatment). Systemic treatments If your psoriasis is severeor other treatments havent worked, you may be prescribed systemic treatments by a specialist. Systemic treatments aretreatments that work throughout the entire body. These medications can be very effective in treating psoriasis, but they all have potentially serious side effects. All the systemic treatments for psoriasis have benefits and risks. Before starting treatment, talk to your doctor about your treatment options and any risks associated with them. There are 2main types of systemic treatment, called non-biological (usually given as tablets or capsules) and biological (usually given as injections). These are described in more detail below. Non-biological medications Methotrexate Methotrexatecan help to control psoriasis by slowing downthe production of skin cells and suppressing inflammation. Its usually taken once a week. Methotrexate can cause nausea andmay affect the production of blood cells. Long-term use can cause liver damage. People who have liver disease shouldnt take methotrexate, and you shouldnt drink alcohol when taking it. Methotrexate can be very harmful to a developing baby, so itsimportant that women use contraception and dont become pregnant while they take this drug and for 3months after they stop. Methotrexate can also affect the development of sperm cells, so men shouldnt father a child during treatment and for 3weeks afterwards. Ciclosporin Ciclosporin is a medicine that suppresses your immune system (immunosuppressant). It was originally used to prevent transplant rejection, but has proved effective in treating all types of psoriasis. Its usually taken daily. Ciclosporin increases your chances of kidney disease and high blood pressure, which will need to be monitored. Acitretin Acitretin is an oral retinoid that reduces the production of skin cells. Its used to treat severe psoriasis that hasnt responded to other non-biological systemic treatments. Its usually taken daily. Acitretinhas a wide range of side effects, including dryness and cracking of the lips, dryness of the nasal passagesand, in rarer cases, hepatitis . Acitretin can be very harmful to a developing baby, so its important that women use contraception and dont become pregnant while they take this drug, and for 2years after they stop taking it. However, its safe for a man taking acitretinto fathera baby. Biological treatments Biological treatments reduce inflammation by targeting overactive cells in the immune system.These treatments are usually used if youhave severe psoriasis that hasnt responded to other treatments, or if you cant use other treatments. Etanercept Etanercept is injected twice a week and youll be shown how to do this. If theres no improvement in your psoriasis after 12 weeks, the treatment will be stopped. The main side effect of etanercept is a rash where the injection is given. However, as etanercept affects the whole immune system, theres a risk of serious side effects, including severe infection. If you had tuberculosis in the past, theres a riskit may return. Youll be monitored for side effects during your treatment. Adalimumab Adalimumab is injected once every 2weeks and youll be shown how to do this. If theres no improvement in your psoriasis after 16 weeks, the treatment will be stopped. Adalimumab can be harmful to a developing baby, so its important that women use contraception and dont become pregnant while they take this drug, and for 5months after the treatment finishes. The main side effects of adalimumab include headaches, a rash at the injection site and nausea. However, as adalimumab affects the whole immune system, theres a risk of serious side effects, including severe infections. Youll be monitored for side effects during your treatment. Infliximab Infliximab is given as a drip (infusion) into your vein at the hospital. Youll have 3infusions in the first 6weeks, then 1infusion every 8weeks. If theres no improvement in your psoriasis after 10 weeks, the treatment will be stopped. The main side effect of infliximab is a headache. However, as infliximab affects the whole immune system, theres a risk of serious side effects, including severe infections. Youll be monitored for side effects during your treatment. Ustekinumab Ustekinumab is injected at the beginning of treatment, then again 4weeks later. After this, injections are every 12 weeks. If theres no improvement in your psoriasis after 16 weeks, the treatment will be stopped. The main side effects of ustekinumab are a throat infection and a rash at the injection site. However, as ustekinumab affects the whole immune system, theres a risk of serious side effects, including severe infections. Youll be monitored for side effects during your treatment. Living with psoriasis Although psoriasis is just a minor irritation for some people, it can have a significant impact on quality of life for those more severely affected. If you have psoriasis, you may find the following advice helpful. Self care Self care is anessential part of your daily life.It involves taking responsibility for your own health and wellbeing with support from those involved in your care. Self care includesstaying fit and maintaining good physical and mental health, preventing illness or accidents, and caring more effectively for minor illnesses and long-term conditions. People with long-term conditions can benefit enormously from self care. They can live longer, have less pain, anxiety, depression and fatigue,a better quality of life, and be more active and independent. Having a care plan will help you manage your treatment so that it fits your lifestyle. Keep up your treatment Its important to use your treatment as prescribed, even if your psoriasis improves. Continuous treatment can help to prevent flare-ups. If you have any questions or concerns about your treatment or any side effects, talk to your GP or healthcare team. Regular reviews Because psoriasisis usuallya long-term condition, you may be in regular contact with your healthcare team. Discuss your symptoms or concerns with them, asthe more the team knows, the morethey can help you. Healthy eating and exercise People with psoriasishave aslightly higher risk of developing diabetes and cardiovascular disease than the general population, althoughits not known why. Regular exercise and a healthy diet are recommended for everyone, not just people with psoriasis, because they can help to prevent many health problems. Eating a healthy, balanced diet and exercising regularly can also relieve stress, which may improve your psoriasis. Emotional impact of psoriasis Because ofthe effect that psoriasis can have on physical appearance, low self-esteem and anxiety are common among people withthe condition. This canlead to depression , especially if the psoriasis gets worse. Your GP or dermatologist will understand the psychological and emotional impact ofpsoriasis, so talk to them about your concerns or anxieties. Psoriatic arthritis Somepeople with psoriasis develop psoriatic arthritis. This causes tenderness, pain and swelling in the joints and connective tissue, as well as stiffness. It commonly affects the ends of the fingers and toes. In some people, it affects the lower back, neck and knees. Most people develop psoriatic arthritis after psoriasis,but about20%develop itbefore theyre diagnosed with psoriasis. Theres no single test for psoriatic arthritis. Its normally diagnosed using a combination of methods, includinglooking at your medical history, physical examinations, blood tests, X-rays and MRI scans. If you have psoriasis, youll usually have an annual assessment to look for signs of psoriatic arthritis. Ifyour doctorthinks you have psoriatic arthritis, youll usually be referred to a specialist called a rheumatologist, so you can be treated with anti-inflammatory or anti-rheumatic medicines. Pregnancy Psoriasis doesnt affect fertility, and women with psoriasis can have a normal pregnancy and a healthy baby. Some women find their psoriasis improves during pregnancy,but for othersit gets worse. Talk to your healthcare team if youre thinking of having a baby. Some treatments for psoriasis can be harmful to a developing baby, so use contraception while taking them.This can apply to both men and women, depending on the medication. Your healthcare team can suggest the bestways tocontrol your psoriasis before you start trying for a family. Talk to others Many people with psoriasis have found that getting involved in support groups helps them. Support groups can increase your self-confidence, reducefeelings of isolation,and give youpractical advice about living with the condition. Further information and support for psoriasis is available from the charity Changing Faces . Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Depression Other health sites British Association of Dermatologists PAPAA: psoriasis support Psoriasis: young people Psoriasis Association Changing Faces NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Psoriatic arthritis | Psoriatic arthritis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Muscle, bone and joints Conditions Psoriatic arthritis Psoriatic arthritis About psoriatic arthritis About psoriatic arthritis Psoriatic arthritis is a type of arthritis that develops in some people with the skin condition psoriasis . It typically causes affected joints to become inflamed (swollen), stiff and painful. Between 20-40% of people with psoriasis will develop psoriatic arthritis. Psoriasis affecting the skin affects around 3% of people. In most cases, people will experience problems with their skin before they notice any symptoms affecting their joints. In a minority of cases, skin problems may develop after or at the same time as joint problems. Like psoriasis, psoriatic arthritis is thought to be a result of the immune system mistakenly attacking healthy tissue. Its not clear why some people with psoriasis develop psoriatic arthritis and others dont. Signs and symptoms The pain, swelling and stiffness associated with psoriatic arthritis can affect any joint in the body, but the condition often affects particular areas including the hands feet knees elbows neck and spine Tendons can also be involved in some people they may be the major problem. Symptoms usually develop slowly meaning that many people are unaware that they are developing psoriatic arthritis. In rarer cases, symptoms can develop suddenly and without warning. The severity of the condition can vary considerably from person to person. Some people may have severe problems affecting many joints, whereas others may only notice mild symptoms in one or two joints. There may be times when your symptoms improve and periods when they get worse (known as flare-ups or relapses). Some people may reach a point where they have no symptoms at all (known as remission). Relapses can be very difficult to predict, but can often be managed with medication when they happen. When to seek medical advice You should speak to your GP if you experience constant pain, swelling or stiffness in your joints even if you havent been diagnosed with psoriasis. If you have been diagnosed with psoriasis, you should have check-ups at least once a year to monitor your condition. Make sure you let your doctor know if youre experiencing any problems with your joints. Diagnosing psoriatic arthritis If your doctor thinks you may have arthritis, they should refer you to a rheumatologist (a specialist in joint conditions) for an assessment. A rheumatologist will usually be able to diagnose psoriatic arthritis if you have psoriasis and problems with your joints, and other types of arthritis such as rheumatoid arthritis and osteoarthritis have been ruled out. A number of tests may be carried out to help confirm a diagnosis, including blood tests to check for signs of inflammation in your body and the presence of certain antibodies found in other types of arthritis, as well as X-rays or scans of your joints. Treating psoriatic arthritis The main aims of treatment will be to relieve your symptoms, slow the progression of the condition and improve your quality of life. For most people, this will involve trying a number of different medications, some of which can also treat the psoriasis. Ideally, you should take one medication to treat both your psoriasis and psoriatic arthritis whenever possible. The main medications used to treat psoriatic arthritis are summarised below. Non-steroidal anti-inflammatory drugs (NSAIDs) Your GP may first prescribe non-steroidal anti-inflammatory drugs (NSAIDs) to see if they help relieve pain and reduce inflammation. There are two types of NSAIDs and they work in slightly different ways: traditional NSAIDs, such as ibuprofen , naproxen or diclofenac COX-2 inhibitors (often called coxibs), such as celecoxib or etoricoxib Like all medications, NSAIDs can have side-effects, but your doctor will take precautions to reduce the risk of these, such as prescribing the lowest dose necessary to control your symptoms for the shortest time possible. If side-effects do happen, they usually affect the stomach and intestines, and can include indigestion and stomach ulcers . A medication called a proton pump inhibitor (PPI) that helps protect your stomach by reducing the amount of acid it produces will therefore often be prescribed alongside NSAIDs. If NSAIDs alone are not helpful, some of the medications below may be recommended. Steroid medication (corticosteroids) Like NSAIDs, corticosteroids can help reduce pain and swelling. If you have a single inflamed or swollen joint, your doctor may inject the medication directly into the joint. This can offer rapid relief with minimal side effects, and the effect can last from a few weeks to several months. Corticosteroids can also be taken as a tablet, or as an injection into the muscle, to help when lots of joints are inflamed. However, doctors are generally cautious about this because the medication can cause significant side effects if used in the long term, and psoriasis can flare up when you stop using it. Disease-modifying anti-rheumatic drugs (DMARDs) Disease-modifying anti-rheumatic drugs (DMARDs) are medications that work by tackling the underlying causes of the inflammation in your joints. They can help to ease your symptoms and slow the progression of psoriatic arthritis. The earlier you start taking a DMARD, the more effective it will be. Psoriatic arthritis can be treated with a variety of DMARDs including: Methotrexate Sulphasalazine Leflunomide Cyclosporin Antimalarials (such as hydroxychloroquine) Azathioprine Apremilast Your rheumatologist will discuss the most appropriate choice of DMARD for you. It can take several weeks or months to notice a DMARD working. Therefore, its important to keep taking the medication, even if it doesnt seem to be working at first. DMARD therapy is monitored according to guidelines such as British Society for Rheumatology (BSR). Biological treatments Biological treatments are a newer form of treatment for psoriatic arthritis. You may be offered one of these treatments if: your psoriatic arthritis has not responded to at least two different types of DMARD you are not able to be treated with at least two different types of DMARD because of other problems e.g. other diseases. Biological drugs work by directly blocking the chemicals in the blood, skin and joints that switch the immune system on, leading it to attack the lining of your joints and your skin. Some of the biological medicines you may be offered are adalimumab, certolizumab, etanercept, infliximab and golimumab injections. See our page on treating psoriasis for more information about these medications. Newer biological drugs include ustekinumab. The most common side-effect of biological treatments is a reaction in the area of skin where the medication is injected, such as redness, swelling or pain, although these reactions arent usually serious. However, biological treatments can sometimes cause other side-effects, including problems with your liver, kidneys or blood count, so youll usually need to have regular blood or urine tests to check for these. Biological treatments can make you more likely to develop infections, so you should tell your doctor as soon as possible if you develop symptoms of an infection, such as a sore throat , a high temperature (fever), urinary problems or diarrhoea . Biological treatments usually take between 2 and 6 months to take effect. If its effective, the medication can be continued. Otherwise, your doctor may suggest stopping the medication or swapping to an alternative biological treatment. Complementary therapies There isnt enough scientific research evidence to say that complementary therapies, such as balneotherapy (bathing in water containing minerals), works in treating psoriatic arthritis. There is also not enough evidence to support taking any kind of food supplement as treatment. Complementary therapies can sometimes react with other treatments, so you should talk to your GP, specialist or pharmacist if youre thinking of using any. Managing related conditions As with psoriasis and other types of inflammatory arthritis, you may be more likely to get some other conditions such as cardiovascular disease (CVD) if you have psoriatic arthritis. CVD is the term for conditions of the heart or blood vessels, such as heart disease and stroke . Your doctor should carry out tests each year (such as blood pressure and cholesterol tests) so they can check whether you have CVD and offer additional treatment, if necessary. You can also help yourself by: having a good balance between rest and regular physical activity losing weight, if youre overweight not smoking only drinking moderate amounts of alcohol Read more about living with psoriasis and preventing CVD . Psoriatic arthritis can also cause inflammation of the eyes, such as Conjunctivitis and Iritis. If psoriatic arthritis affects your skin and joints, you may notice changes in your nails such as: dents pits discolouration loosening from the nail bed This is less common if only your skin is affected. Your care team As well as your GP and a rheumatologist, you may also be cared for by: a specialist nurse who will often be your first point of contact with your specialist care team a dermatologist (skin specialist) who will be responsible for treating your psoriasis symptoms a physiotherapist who can devise an exercise plan to keep your joints mobile an occupational therapist who can identify any problems you have in everyday activities and find ways to overcome or manage these a psychologist who can offer psychological support if you need it a podiatrist who can offer assessment and advice on foot problems if affected during the course of PSA. Outlook Like psoriasis, psoriatic arthritis is a long-term condition that can get progressively worse. In severe cases, there is a risk of the joints becoming permanently damaged or deformed, which may require surgical treatment. However, with an early diagnosis and appropriate treatment, its possible to slow down the progression of the condition and minimise or prevent permanent damage to the joints. Source: MSK Expert Panel - Opens in new browser window Last updated: 13 June 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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Psychosis | Psychosis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mental health Psychosis Psychosis Introduction Symptoms Causes Diagnosis Treatment Complications Introduction Psychosis is a mental health problem that causes people to perceive or interpret things differently from those around them. This might involve hallucinations or delusions. The two main symptoms of psychosis are: hallucinationswhere a person hears, sees and, in some cases, feels, smells or tastes things that arent there; a common hallucination is hearing voices delusions where a person believes things that, when examined rationally, are obviously untruefor example,thinking your next door neighbour is planning to kill you The combination of hallucinations and delusional thinking can often severely disrupt perception, thinking, emotion, and behaviour. Experiencing the symptoms of psychosis is often referred to as having a psychotic episode. What causes psychosis? Psychosis isnt a condition in itselfits triggered byother conditions. Itssometimes possible to identify the cause of psychosis as a specific mental health condition, such as: schizophrenia a condition that causes a range of psychological symptoms, including hallucinations and delusions bipolar disorder a mental health condition that affects mood; a person with bipolar disorder can have episodes of depression (lows) and mania (highs) severe depression some people with depression also have symptoms of psychosis when theyre very depressed Psychosis can also be triggered by traumatic experiences, stress, or physical conditions, such as Parkinsons disease , a brain tumour , or asa result ofdrugmisuse or alcohol misuse . How often a psychotic episode occurs and how long it lasts can depend on the underlying cause. For example, schizophrenia can be long term, but most people can make a good recovery and about a quarter only have a single psychotic episode. Episodes related to bipolar disorder usually resolve, but may recur. Read more about the causes of psychosis . Diagnosing psychosis You should see your GP immediately if youre experiencing psychotic episodes. Its important psychosis is treated as soon as possible as early treatment usually has better long-term outcomes. Your GP will look at your symptoms and rule out short-term causes, such as drug misuse. They may ask you some questions to help determine whats causing your psychosis. For example, they may ask you: whether youre taking any medication whether youve been taking illegal substances how your mood has beenfor example, whether youve been depressed how youve been functioning day-to-dayfor example, whether youre still working whether you have a family history of mental health conditions such as schizophrenia about your hallucinations such as whether youve heard voices about your delusionssuch as whether you feel people are controlling you whether you have any other symptoms Your GP should refer you to a mental health specialist for further assessment and treatment. Read more about diagnosing psychosis . Treating psychosis Treatment for psychosis involves using a combination of: antipsychotic medication which can help relieve the symptoms of psychosis psychological therapies the one-to-one talking therapy cognitive behavioural therapy (CBT)has proved successful in helping people with schizophrenia;in appropriate cases, family therapy has been shown to reduce the need for hospital treatment in people with psychosis social support support with social needs, such as education, employment, or accommodation Most people with psychosis who get better with medication need to continue taking it for at least a year. Some people need to take medication long term to prevent symptoms recurring. If a persons psychotic episodes are severe, they may need to be admitted to a psychiatric hospital. Read more about the treatment of psychosis . Getting help for others People with psychosis often have a lack of insight. Theyre unaware that theyre thinking and acting strangely. Because oftheir lack of insight,its often down to the friends, relatives, or carers of a person affected by psychosis to seek help for them. If youre concerned about someone you know and think they may have psychosis, you could contact their social worker or community mental health nurse if theyve previously been diagnosed with a mental health condition. If you think the persons symptoms are placing them at possible risk of harm, you can: take them to the nearestaccident and emergency (A&E) department, if they agree call their GP orlocal out-of-hours GP call 999 and ask for an ambulance Complications People with a history of psychosis are much more likely to have drug or alcohol misuse problems, or both. This may be because thesesubstances can provide short-term symptom relief, although they usually make symptoms worse in the long term. People with psychosis also have a higher than average risk of suicide . Its estimated1 in 5 people with psychosis will attempt to commit suicide at some point in their life, and1 in 25 people with psychosis will kill themselves. Side effects can also occur if someone istaking antipsychotics on a long-term basis. Weight gain is a common side effect. In rare cases,a person with psychosis mayalso develop type 2 diabetes . Read more about the complications of psychosis . Symptoms Someone who develops psychosis will have their own unique set of symptoms and experiences, according to their particular circumstances. However, four main symptomsare associated with a psychotic episode. They are: hallucinations delusions confused and disturbed thoughts lack of insight and self-awareness These are outlined in more detail below. Hallucinations Hallucinationsare where a person perceives something that doesnt exist in reality. They can occur in all five of the senses: sight someone with psychosis may see colours and shapes, or people or animals that arent there sounds someone with psychosis may hear voices that are angry, unpleasant or sarcastic touch a common psychotic hallucination is that you are being touched when there is nobody there smell usually a strange or unpleasant odour taste some people with psychosis have complained of having a constant unpleasant taste in their mouth Delusions A delusion is where a person has an unshakeable belief in something implausible, bizarre, or obviously untrue. Paranoid delusion and delusions of grandeur are two examples of psychotic delusions. A person with psychosis will often believe an individual or organisation is making plans to hurt or kill them. This can lead to unusual behaviour. For example, a person with psychosis may refuse to be in the same room as a mobile phone because they believe they are mind control devices. Someone with psychosis may also have delusions of grandeur. This is where they believe they have some imaginary power or authority. For example, they may think theyre the president of a country or they have the power to bring people back from the dead. Confused and disturbed thoughts People with psychosis often have disturbed, confused, and disrupted patterns of thought. Signs of this include: rapid and constant speech random speechfor example, they may switch from one topic to another mid-sentence a sudden lossin their train of thought, resulting in an abrupt pause in conversation or activity Lack of insight People who have psychotic episodes are often totally unaware their behaviour is in any way strange or that their delusions or hallucinations are not real. They may recognise delusional or bizarre behaviour in others, but lack the self-awareness to recognise it in themselves. For example, a person with psychosis being treated in a psychiatric ward may complain that their fellow patients are mentally unwell, while theyre perfectly normal. Postnatal psychosis Postnatal psychosis, also called puerperal psychosis, is a severe form of postnatal depression , a type of depression some women experience after having a baby. Its estimated postnatal psychosis affects around 1 in every 1,000 women who give birth. It most commonly occurs during the firstfew weeksafter having a baby. Postnatal psychosis is more likelyto affect women who already have a mental health condition, such as bipolar disorder or schizophrenia . As well as the symptoms of psychosis, symptoms of postnatal psychosis can also include: a high mood (mania) for example, talking and thinkingtoo much or too quickly a low mood for example, depression , lack of energy,loss ofappetite, and trouble sleeping Postnatal psychosis is regarded as a medical emergency. Contact your GP immediately if you think someone you know may have developed postnatal psychosis. If this isnt possible, call theNHS 24 111 serviceor your localout-of-hours service. If you think theres an imminent danger ofharm, call 999 and ask for an ambulance. Causes The causes of psychosis have three main classifications. They are psychosis caused by: mental (psychological)conditions general medical conditions substances, such as alcohol or drugs The three classifications are described in more detail below. Psychological causes The following conditions have been known to trigger psychotic episodes in some people: schizophrenia a long-term (chronic) mental health condition that causes hallucinations and delusions bipolar disorder a condition that affects a persons moods, which can swing from one extreme to another (highs and lows) severe stress or anxiety severe depression feelings of persistent sadness that last for morethan six weeks, including postnatal depression ,which some women experience after having a baby lack of sleep The underlying psychological cause will often influence the type of psychotic episode someone experiences. For example, a person with bipolar disorder is more likely to have delusions of grandeur, whereas someone with depression or schizophrenia is more likely to develop paranoid delusions . General medical conditions The following medical conditions have been known to trigger psychotic episodes in some people: HIV and AIDS a virus that attacks the bodys natural defence against illness and infection (the immune system) malaria a tropical disease spread by infected mosquitoes syphilisa bacterial infection usually passed on through sexual contact Alzheimers disease the most common form ofdementia, which causes a decline in mental abilities like memory and reasoning Parkinsons disease a long-term condition that affects the way the brain co-ordinates body movements, including walking, talking, and writing hypoglycaemia an abnormally low level of sugar (glucose) in the blood lupus a condition where the immune system attacks healthy tissue Lyme disease a bacterial infection spread to humans by infected ticks multiple sclerosis a condition that affects the nerves in the brain and spinal cord, causing problems with muscle movement, balance, and vision brain tumour a growth of cells in the brain that multiply in an abnormal and uncontrollable way Substances Alcohol misuse anddrug misuse can trigger a psychotic episode. A person can also experience a psychotic episode if they suddenly stop drinkingalcohol ortaking drugs after using them for a long time. This is known as withdrawal. Its also possible to experience psychosis after drinking large amounts of alcohol or if youre high on drugs. Drugs known to trigger psychotic episodes include: cocaine amphetamine (speed) methamphetamine (crystal meth) mephedrone (MCAT or miaow) MDMA (ecstasy) cannabis LSD (acid) psilocybins (magic mushrooms) ketamine In rare situations, psychosis can also occur as a side effect of some types of medication or as a result of an overdose of that medication. For example, levodopa, a medication used to treat Parkinsons disease , can sometimes cause psychotic episodes. However, any medicine that acts on the brain can cause psychosis with an overdose. Never stop taking a prescribed medication unless advised to do so by your GP or another qualified healthcare professionalresponsible for your care. See your GP if youre experiencing psychotic side effectscaused bymedication. The brain Theres been a great deal of research into how psychosis affects the brain and how changes in the brain can trigger symptoms of psychosis . Grey matter Research has revealed several physical and biological changes occur in the brainduring a psychotic episode. Grey matter is the part of the brain responsible for processing thoughts. The results of magnetic resonance imaging (MRI) scans have shown some people with a history of psychosis have less grey matter than most other people. However, its not yet fully understood why this is. Dopamine Researchers also believe dopamine plays an important role in psychosis. Dopamine is a neurotransmitter,one of many chemicals the brain uses to transmit information from one brain cell to another.It is associated with how we feel whether something is significant, important, or interesting. Its thoughtlevels of dopamine in the brain become too highin people with psychosis. The excess dopamine interrupts specific pathways in the brain that are responsible for some of its most important functions, such as: memory emotion social behaviour self-awareness Disruption to these important brain functions may explain the symptoms of psychosis. Evidence for the role of dopamine in psychosis comes from several sources, including brain scans andthe fact medicationsknown to reduce the effects of dopamine in the brain also reduce thesymptoms of psychosis. However, illegal drugsknown to increaselevels of dopamine in the brainsuch as cannabis, cocaine and amphetaminescan trigger psychosis. Diagnosis You should visit your GP if youre experiencing psychotic episodes. Its important to speak to your GP as soon as possible as the early treatment of psychosis usually has better long-term outcomes. Initial assessment Theres no test to positively diagnose psychosis. However, your GP will look at your symptoms and rule out short-term causes, such as drug misuse. Your GP may ask questions to determine the cause of your psychosis. For example, they may askyou: whether youre taking any medication whether youve been takingillegal substances how your moods have beenfor example, whether youve been depressed how youve been functioning day-to-dayfor example, whether youre still working whether you have a family history of mental health conditions, such as schizophrenia about the details of your hallucinations, such as whether youve heard voices about the details of your delusions, such as whether you feel people are controlling you about any other symptoms you have Referral The evidence supporting the early treatment of psychosis means youre likely to be referred to a specialist urgently. This will either be during or after your first episode of psychosis. Who youre referred to will depend on the services available in your area. You may be referred to: a community mental health team a team of different mental health professionals who provide support to people with complex mental health conditions a crisis resolution team a team of different mental health professionals who treat people currently experiencing a psychotic episode who would otherwise require hospitalisation an early intervention team a team of mental health professionals who work with people who have experienced their first episode of psychosis These teams are likely to include some or all of the following healthcare professionals: a psychologist a healthcare professional who specialises in the assessment and treatment of mental health conditions a psychiatrist a qualified medical doctor who has received further training in treating mental health conditions a community mental health nurse a nurse with specialist training in mental health conditions Your psychiatrist will carry out a full assessment to help identify and diagnose any underlying mental health condition that could be causing your symptoms. This will helpwhen planning your treatment for psychosis . Helping others The lack of insight associated with psychosis means people experiencingit arent always able to recognise their strange behaviour. They may be reluctant to visit their GP if they believe theres nothing wrong with them, and you may need to get help for them. Someone who has had psychotic episodes in the past may have been assigned a mental health worker, who works in social services,so try to contact them to express your concerns. Someone who is having a psychotic episode for the first time may need a friend, relative or someone else close to them to persuade them to visit their GP. If theyre having a psychotic episode thats rapidly getting worse, you should contact their crisis team or,if the team isnt available,the duty psychiatrist at their nearest accident and emergency (A&E) department. If a person who is having a psychotic episode refuses to seek help andis believed to present a risk to themselves or others, their nearest relative can request a psychological assessment. Your local mental health trust can advise you about this. If someone has very severe psychosis, they can be compulsorily detained at hospital for assessment and treatmentunder the Mental Health (Scotland) Act 2015 . Treatment Treatment for psychosis involves a combination of antipsychotic medicines, psychological therapies, and social support. Your care team Your treatment is likely to be co-ordinated by a team of mental health professionals working together. If this is your first psychotic episode, you may be referred to an early intervention team. Early intervention teams An early intervention team is ateam of healthcare professionals set up specifically to work with people who have experienced their first episode of psychosis. Some early intervention teams only focus on a certain age range, such as people who are 14 to 35 years old. Depending on your care needs, early intervention teams aim to provide: a full assessment of your symptoms prescriptions for medications psychological services social, occupational, and educational interventions Treatment for psychosis will vary, depending on the underlying cause. Youll receive specific treatment if youve been diagnosed with an underlying mental health condition as well. For example, treatment for bipolar disorder uses a variety of medications, which could include antipsychotics to treat symptoms of mania, lithium and anticonvulsants to help stabilise mood, as well as psychological therapy, such as cognitive behavioural therapy (CBT). Treatment for schizophrenia usually involves a combination of antipsychotic medication and social support. CBT or another type of psychotherapy called family therapyare also often used. Psychosis related to drug or alcohol intoxication or withdrawal may only require a short course of antipsychotics or tranquillisers, which have a calming effect. Referral to an addiction counsellor may then be recommended. Antipsychotics Antipsychotic medicines, also known as neuroleptics, are usually recommended as the first treatment for psychosis. Theywork by blocking the effect of dopamine, a chemical that transmits messages in the brain. However, theyre not suitable or effective for everyone, as side effects can affect people differently. In particular, antipsychotics will be monitored closely in people who also have epilepsy , a condition that causes seizures or fits. People who have cardiovascular disease conditions that affect the heart, blood vessels, or circulation, such as heart disease will also be closely monitored. Antipsychotics can usually reduce feelings of anxiety or aggression within a few hours of use, but they may take several days or weeks to reduce other psychotic symptoms, such as hallucinations or delusional thoughts. Antipsychotics can be taken by mouth (orally) or given as an injection. There are several slow-release antipsychotics, where you only need one injection every two to six weeks. Depending on the underlying cause of your psychosis, you may only need to take antipsychotics until your psychosis subsides. However, if you have a condition like schizophrenia or bipolar disorder, you may need to take antipsychotics on a long-term basis to prevent further episodes of psychosis. Side effects Antipsychotics can have side effects, although not everyone will experience them and their severity will differ from person to person. Side effectscan include: drowsiness this may affect your ability to drive shaking and trembling restlessness muscle twitches and spasms where your muscles shorten tightly and painfully blurred vision dizziness constipation loss of sex drive (libido) dry mouth See the patient information leaflet that comes with your medicine for a full list of possible side effects. In addition,long-term use of antipsychotics can lead to complicationslikeweight gain and diabetes . Read more aboutthe complicationsof psychosis . Tell your GP if you haveside effects that are becoming particularly troublesome. There may be an alternative antipsychotic medicine you can take. Never stop taking medication prescribed for you unlessadvised to do so by a qualified healthcare professionalresponsible for your care. Suddenly stopping prescription medication could trigger a returnof your symptoms (relapse). When its time for you to stop taking your medication, it will be done gradually and under close observation. Psychological treatment Psychological treatment can help reduce the intensity and anxiety caused by psychosis. Some possible psychological treatments are discussed below. Cognitive behavioural therapy Cognitive behavioural therapy (CBT) for psychosis is based on an understanding of how people make sense of their experiences and why some people become distressed by them. The aim of CBT is to identify unhelpful thinking patterns and emotions that may be causing your unwanted feelings and behaviours. Its then possible to learn to replace this thinking with more realistic and balanced thoughts. A CBT therapist may encourage you to consider different ways of understanding whats happening to you. The aim is to help you achieve goals that are meaningful and important to you, such as reducing your distress, returning to work or university, or regaining a sense of control. Family therapy Family therapy is known to be an effective form of treatment for people with psychosis. Its a way of helping both you and your family cope with your condition. After having an episode of psychosis, you may rely on your family members forcare and support. While most family members are happy to help, the stress of caring for somebody can place a strain on any family. Family therapy involves a series of informal meetings that take place over a period of six months. Meetings may include: discussing your conditionand how it might progress, plus the available treatments exploring ways of supporting someone with psychosis deciding how to solve practical problems caused by psychosis, such asplanning how to manage future psychotic episodes Self-help groups If youre experiencing episodes of psychosis, you may benefit from being around other people whove had similar experiences. Complications Someone experiencing a psychotic episode may self-harm. Suicidal thoughts and an increased risk of suicide are also common. Self-harm Self-harming behaviour is a relatively common complication in people with psychosis. A study found 1 in 10 people with psychosis also had a history of self-harm. The risk of self-harm is thought to be highest in people who are experiencing their first episode of psychosis butarent receiving treatment. See your GPif youre self-harming. You can also call the Samaritans on 08457 90 90 90 for support. If you think a friend or relative is self-harming, look out for signs of unexplained cuts, bruises or cigarette burns, usually on the wrists, arms, thighs, and chest. People who self-harm may keep themselves covered upat all times, even in hot weather. A personwhos self-harming may feel deep shame and guilt, or they may feel confused and worried by their own behaviour. Its important to approach them with care and understanding. They may not want to discuss their self-harming behaviourwith you, but you could suggest they speak totheir GP ora counsellor ona support helpline. Suicide People with psychosis also have an increased risk of suicide . Its estimated 1 in 5 people with psychosis will attempt suicide at some point in their life, and 1 in 25 people with psychosis will kill themselves. If youre feeling suicidal, you can: callthe Samaritans support service on 08457 90 90 90 go to your nearest accident and emergency (A&E) department and tell the staff how youre feeling contactthe NHS 24 111 service speak toa friend, family member, or someone you trust make an urgent appointment to see your GP,psychiatrist, or care team Read more about getting helpif youre feeling suicidal . If youre worried that someone you know may be considering suicide, recommend that they contact one or more of the organisations above and encourage them, in a non-judgemental way, to talk about how theyre feeling. If the person has previously been diagnosed with a mental health condition, such as depression , you can speak to a member of their care team for help and advice. Read more about the warning signs of suicide and supporting someone whos feelingsuicidal . Antipsychotics Using antipsychotics on a medium- to long-term basis can cause a number of complications. Some of the more commoncomplications are discussed below. Weight gain Weight gain is a complication of many commonly used antipsychotics. There are two main reasons why weight gain is thought to occur. Antipsychotics can: lead to an increase in appetite make you less active Youll probably be advised to take more exercise tohelp burn off the excess fat. Read about getting started with exercise and how to lose weight safely . Metabolic syndrome Metabolic syndrome is a term describing a number of related conditions linked to weight gain, such as: high blood sugar (hyperglycaemia) high cholesterol high blood pressure (hypertension) obesity These health conditions can also increase your risk of developing type 2 diabetes , heart disease and, most seriously, heart attack or stroke . Because ofthe risk of metabolic syndrome, youll usually need to haveregular blood tests and blood pressure tests while taking antipsychotics. If your test resultsshow you have an increased risk of developing a condition such as heart disease, a number of preventative treatments, such as statins ,are available to help lower cholesterol levels. Tardive dyskinesia (TD) Tardive dyskinesia (TD) is another common complication of long-term antipsychotic use. TD is a movement disorder where a person experiences involuntary movements, such as twitching, tics, grimaces, tremors, and spasms. It usually starts in the face and mouth before spreading to the rest of the body. In some cases, stopping taking an antipsychotic will provide relief from TD symptoms, but in other cases it makes the symptoms worse. However, stopping medication isnt always safe andhastobe balanced against the risk of having a relapse. In some cases, TD can be a permanent condition. There are also a number of treatments that can sometimes improve thesymptoms of TD, including: clonazepam a medication used to treat epilepsy , a condition that affects the brain and causes seizures or fits vitamin E supplements check with the doctor in charge of your care before taking vitamin supplementsas theyre not safe or suitable for everyone Source: NHS 24 - Opens in new browser window Last updated: 27 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Schizophrenia Counselling and psychotherapy Bipolar disorder Psychosis (BSL) Other health sites YoungMinds Turning Point: Mental health support Mental Health Foundation: Psychosis Choice and Medication: Psychosis SIGN: Managing schizophrenia NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Pubic lice | Pubic lice | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Sexual and reproductive Pubic lice Pubic lice British Sign Language (BSL) | | Polski | Romn | slovenina Pubic lice, also known as crabs, are tiny insects that live on coarse human body hair, such as pubic hair around the penis or vagina. Pubic lice are not linked to poor personal hygiene. Symptoms of pubic lice It can take up to 3 weeks after coming into contact with pubic lice before you notice any symptoms. The most common symptom of pubic lice is itchy red spots. The itching is caused by an allergy to the lice saliva or poo. It can take 1 to 3 weeks for itching to develop after the first infestation, and itll usually be worse at night. Public lice are very small (2mm long) and grey-brown in colour. Theyre hard to spot, but sometimes you may be able to see them in your hair. They live mostly on pubic hair, but can also be found in hair on the chest, armpits, face and eyelashes. They do not affect hair on your head. You may also notice the following symptoms: small red or blue spots on your skin (lice bites) white or yellow dots attached to your hair (lice eggs) dark red or brown spots in your underwear (lice poo) crusty or sticky eyelashes, if theyre infected When to get medical advice Speak to your GP practice, local pharmacy or local sexual health clinic if: you think you might have pubic lice Testing for pubic lice If you think you might have pubic lice, get checked for free by: booking an appointment at your local sexual health service contacting your GP practice for an appointment What does a pubic lice test involve? There is no test for pubic lice. Your doctor or nurse will check your hair for lice. They may check your pubic hair around your penis or vagina and any other areas that could be affected. To help spot any pubic lice, your doctor or nurse may use a comb and a magnifying lens. You can also buy treatment over the counter at your local pharmacy although they will not be able to diagnose the infestation. Treatment for pubic lice Pubic lice are treated with medicated creams or shampoos that kill the lice. Youll usually need to use treatment on your whole body and leave it on for a few hours before washing it off. Youll need to repeat this a week later to make sure all the lice have been killed. You may be asked to come back to your GP practice or sexual health clinic once youve finished treatment to check the treatment has worked. Your partner(s) should also be treated, even if they do not have symptoms. Resistance Some pubic lice can be resistant to treatment. Resistance means that the lice will not be affected by a particular treatment. If your symptoms dont settle, you may need to try more than one type of treatment. Speak to your GP practice or local sexual health clinic if your first treatment hasnt worked. Treatment of lice in the eye area Treatment of lice in the eye area is usually different from elsewhere. Certain creams and lotions are not safe for use near the eye area. Lice here can be removed with tweezers or Vaseline can be used to suffocate the lice before removal. Things you can do While youre being treated for pubic lice, there are some things you can do to help stop the lice from spreading. Do wash your clothes and bedding on a hot wash (50 degrees or higher), have them dry cleaned or put them in a plastic bag for at least a week this will help kill any lice hoover your mattress to remove any lice Dont do not share clothes, bedding or hygiene products (including razors) do not have any close body contact (including sexual contact) with anyone during treatment How pubic lice are passed on Pubic lice are spread through close body contact with someone who has them, most commonly sexual contact. The lice crawl from hair to hair but cant fly or jump. They need human blood to survive, so generally only leave the body to move from one person to another. Pubic lice dont live on other animals such as cats or dogs. If you or your partner has pubic lice, you should avoid having sex (vaginal, anal or oral). You should also avoid close bodily contact. Do this until youve both finished treatment, including any follow-up treatment. How to prevent pubic lice Pubic lice are easily spread, and condoms dont protect against them. To reduce the risk of getting pubic lice, you should limit the number of people you have intimate or sexual contact with. Other STIs If you have been diagnosed with pubic lice you should get tested for other STIs including: gonorrhoea chlamydia syphilis Find your local sexual health clinic Source: Scottish Government - Opens in new browser window Last updated: 26 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Other languages and formats British Sign Language (BSL) | | Polski | Romn | slovenina British Sign Language (BSL) | | Polski | Romn | slovenina Add this page to\n Info For Me Also on NHS inform Book a sexual health appointment online Pubic lice (BSL) Pubic lice (Chinese) Pubic lice (Polish) Pubic lice (Romanian) Pubic lice (Slovak) Other health sites Sexual Health Scotland BASHH: sexual health Sexual Health Scotland: Contraception NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Rare tumours | "Rare tumours in children | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in children Rare tumours Rare tumours More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Its devastating to hear that your child has cancer, and at times it can feel overwhelming, but there are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your childs specialist will give you more detailed information, and if you have any questions its important to ask the specialist doctor or nurse who knows your childs individual situation. Types of rare cancers in children Rare cancers in children make up fewer than 1 in 30 of all childhood cancers and can broadly be grouped as: rare cancers that only affect children, such as pancreatoblastoma, malignant rhabdoid tumours and melanotic neuroectodermal tumours of infancy cancers that usually only affect adults, such as cancers of the digestive system, the thyroid and the adrenal gland rare cancers in the head and neck area, such as nasopharyngeal cancer rare hormonal/endocrine cancers, such as phaeochromocytoma rare brain tumours, such as meningioma rare skin cancers, such as melanomas Causes The causes of most rare childhood cancers are unknown. But if other family members have had particular types of cancer, this may sometimes suggest that there is an inherited faulty gene in the family. If this is a possibility, your childs specialist will talk to you about it. Treatment Rare cancers are treated with the same treatments used for other childhood cancers. This includes surgery, radiotherapy and chemotherapy. Your child may need a combination of these treatments. Surgery Usually an operation is done to remove all or as much of the cancer as possible. Other treatments, such as radiotherapy or chemotherapy, may be given after or sometimes before surgery. They may also be used if an operation is not possible. Radiotherapy Radiotherapy uses high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells. It can be used to treat any cancer cells that may be left behind after surgery, or to shrink a cancer. Chemotherapy Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It is usually given as injections and drips (infusions) into a vein. Chemotherapy may be used to lower the risk of the cancer coming back or to treat cancer that has spread to other parts of the body. Research Clinical trials are usually not available as the number of children with rare cancers is so small. The Childrens Cancer and Leukaemia Group (CCLG) aims to improve the care and treatment of children with cancer and it develops guidelines on the best ways of treating and managing those with rare tumours. Doctors communicate with specialist colleagues in other countries to promote research in rare tumours and develop new forms of treatment. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Its not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young Peoples Cancer; A Parents Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience of cancer. The Parents Guide discusses these further and talks about how you can support your child. Source: Children's Cancer and Leukaemia Group - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852" | null | null | null | null | null | null | null | null | null | null | null | null | null |
Raynauds phenomenon | "Raynaud's phenomenon - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Heart and blood vessels Conditions Raynauds phenomenon Raynauds phenomenon About Raynauds phenomenon Causes of Raynauds phenomenon Diagnosing Raynauds phenomenon Treating Raynauds phenomenon Complications of Raynauds phenomenon About Raynauds phenomenon Raynauds phenomenon is a common condition that affects the blood supply to certain parts of the body usually the fingers and toes. Its often referred to as Raynauds syndrome, Raynaudsdisease or just Raynauds. Why does it happen? Raynauds is usually triggered by cold temperatures, anxiety or stress. The condition occurs because your blood vessels go into a temporary spasm, which blocks the flow of blood. This causes the affected area to change colour to white, then blue and then red, as the bloodflow returns.You may also experience numbness, pain, and pins and needles. Symptoms of Raynauds can lastfrom a few minutes to several hours. IIts nota serious threat to your health, but can be painful and difficult to live with. If can affect your ability to move your fingers and hands.People with Raynauds often go for long periods without any symptoms, and sometimes the condition goes away altogether. Other parts of the body that can be affected by Raynauds include the ears, nose, nipples and lips. Treating Raynauds In many cases, it may be possible to control the symptoms of Raynauds yourself by avoiding the cold, wearing gloves and using relaxation techniques when feeling stressed. Stopping smoking can also improve symptoms, as smoking can affect your circulation. If youre unable to control your symptoms yourself, then a medication called nifedipine may be recommended. Read more about treating Raynauds . Types of Raynauds There are two types of Raynauds: primary when the condition develops by itself (this is the most common type) secondary when its caused byanother health condition Most cases of secondary Raynauds are associated with conditions that cause the immune system to attack healthy tissue (autoimmune conditions), such as sclerodermaand lupus . The causes of primary Raynaudsare unclear. However1 in 10 people with primary Raynauds goes on to develop a condition associated with secondary Raynauds, such as lupus. Your GP can help to determine whether you have primary or secondary Raynaudsby examining your symptoms and carrying out blood tests . Read more about what causes Raynauds and diagnosing Raynauds . Possible complications Secondary Raynauds can severely restrict theblood supply, so it carries a higher risk of complications, such as ulcers, scarring and eventissue death (gangrene) in the most serious cases. However, severe complications are rare. Read more about the complications of Raynauds . Who gets Raynauds? Raynauds phenomenon is a common condition. It affects up to 20% of the adult population worldwide. There may be as many as 10 million people with the condition in the UK. Primary Raynauds usually begins in your 20s or 30s. Secondary Raynauds can develop at any age, depending on the cause. Raynauds is slightly more common in women than men. Causes of Raynauds phenomenon Raynauds phenomenon is the result of over-sensitive blood vessels in the bodys extremities. In many cases, no cause is identified, although its sometimes linked to other health conditions. When your body is exposed to cold temperatures, the extremities, such as your fingers and toes, lose heat. This is because the small blood vessels under the skin spasm, slowing down the blood supply that is helping to preserve your bodys core temperature. In people with Raynauds, the sensitive blood vessels overreact to cold temperatures and become narrower than usual, significantly restricting the blood flow. Symptoms can be triggered by mildly cool weather, getting something out of the freezer, or running your hands under a cold tap. Strong emotions such as stress or anxiety may also trigger symptoms. Primary Raynauds The most common form of Raynauds is primary Raynauds phenomenon. This means the condition occurs by itself, without being associated with another health condition. It seems thatprimary Raynauds is caused by disruptions in how the nervous system controls blood vessels. Exactly what causes these disruptions is unclear. Theres some evidence that primary Raynauds may be an inherited condition, as cases have been known to run in families. Secondary Raynauds In some cases, an underlyinghealth condition couldbe causing the blood vessels to overreact. This is called secondary Raynauds. Autoimmune conditions The majority of cases of secondary Raynauds are associated with autoimmune conditions, which cause the immune system to attack healthy tissue. Autoimmune conditions known to be associated with secondary Raynauds include: scleroderma a condition that causes hardening and thickening of the skin rheumatoid arthritis which causes joint pain and swelling Sjogrens syndrome where the immune system attacks the bodys sweat and tear glands lupus which causes tiredness, joint pain and skin rashes Around1 in 10 people with primary Raynauds go on to develop an autoimmune condition. Infections Blood-born viral infections, hepatitis B and hepatitis C , can occasionally trigger Raynauds in some people. Cancer Some types of cancer can cause secondary Raynauds. These areusually cancers that develop inside the blood, bone marrow or immune system, such as: acute lymphoblastic leukaemia a cancer of the white blood cells that mainly affects children lymphoma a cancer that develops inside one or more of the glands that are part of the immune system multiple myeloma a cancer that develops inside bone marrow Medicines Secondary Raynauds can also be a side effect of taking certain medicines, including: some types of anti- migraine medication such as sumatriptan and ergotamine beta-blockers which are used to treat high blood pressure and heart disease some chemotherapy medicines decongestants the contraceptive pill medicines used in hormone replacement therapy some types of medicines usedto treathigh blood pressure Illegal drugs, such as cocaine and amphetamines, can also cause secondary Raynauds. Injury and overuse Raynauds sometimes results from a physical injury. It can also affect musicians, people who type a lot, or other people who use their fingers and hands more than usual. Skin and tissue damage caused byfrostbite can also lead to Raynauds. Smoking Smoking cigarettes also increases your risk of developing Raynauds. Readabout the support available to help you quit smoking . Vibration white finger Vibration white finger is a term used when secondary Raynauds has been caused by vibration. This typically happens to people who regularly use certain types of vibrating tools, such as: sanders, grinders and disc cutters hammer drills chainsaws, hedge trimmers and power mowers Any vibrating tool that causes tingling or numbness in your fingers could lead to vibration white finger. Your employer has a responsibility to protect you from vibration white finger. If the job cant be done without vibrating tools: ask to use suitable low-vibration tools make sure youre using the right tool for the job check tools are properly maintained keepcutting tools sharp reduce the amount of time you use the tool in one go by doing other jobs in between keep warm at work wear anti-vibration gloves store toolsindoors, so they dont have cold handles when next used encourage your blood circulation by keeping warm, stopping smoking and massaging and exercising your fingers during your breaks If youre diagnosed with the condition, tell your employer as soon as possible. If you stop using vibrating tools at an early stage, you may recover fully. By law, your employer must contact the Health and Safety Executive about your condition. You may be entitled to an Industrial Injuries Disablement Benefit, which is a payment given to people who have become ill or injured as a result of their work. See the GOV.UK website for more information about the Industrial Injuries Disablement Benefit . Diagnosing Raynauds phenomenon Raynauds phenomenon can usually be diagnosed after an examination of your symptoms and some blood tests. Your GP may place your hands in cold water or cool air to see if you show symptoms of Raynauds. Further testing is usually recommended to find out whether you have primary or secondary Raynauds. Secondary Raynauds may require more treatment and, in some cases, referral to a specialist. Secondary Raynauds may be suspected if: your symptoms only started when you were over 30 years of age most cases of primary Raynauds begin between the ages of 20 to 30 youre experiencing severe pain during an attack of Raynauds only one side of your body is affected Your GP may also check the tiny blood vessels, known as capillaries, found where your nail meets the finger. These capillaries are oftenlarger in people with secondary Raynauds, and look like red pen marks. Blood tests Your GP may also refer you for blood tests to check for other health conditionsthat could be causing your symptoms. These tests may include: a full blood count to check forinfection or, much less commonly, a cancer of the blood, such as leukaemia an antinuclear antibodies (ANA) test tocheck for anoveractive immune system, which is common in people with autoimmune conditions such as sclerodermaand lupus erythrocyte sedimentation rate to check for an autoimmune disorder Scleroderma & Raynauds UK (SRUK) If youve been diagnosed with Raynauds, Scleroderma & Raynauds UK (SRUK) may be helpful. It is the UKs leading charity for people affected by the condition. Treating Raynauds phenomenon You can usually treat Raynauds phenomenon yourself, although medication is sometimes necessary. If youve been diagnosed with secondary Raynauds, you may be referred to a specialist in the treatment of the underlying condition. If your secondary Raynauds may be a side effect of a medication, you may be asked to stop taking it, to see if your symptoms improve. Self-help The following advice is recommended forboth primary and secondary Raynauds. Keep your whole body warm, especially your hands and feet. Wear gloves and warm footwear in cold weather. If you smoke, stop. Quitting smoking will improve your circulation, which should help to improve symptoms. Exercise regularly, as this helps to improve your circulation and reduce stress levels (see below). For most people, 150 minutes of vigorous exercise a week is recommended. Read more about exercise . Try to minimise your stress levels. Regular exercise, eating a healthy diet , and relaxation techniques , such as deep breathing or activities such as yoga , can help. You may find it useful to avoid stimulants such as coffee, tea and cola. If you find it difficult to control feelings of stress, you may require additional treatment, such as counselling. Read more about therapies for stress . Medication Nifedipine If your symptoms fail to improve, you may be prescribed nifedipine. This is the only medicine licensed to treat Raynauds phenomenon in the UK. It doesnt cure Raynauds, but can help to relieve the symptoms. Nifedipine is a calcium channel blocker a type of medication that encourages the blood vessels to widen. Depending on the pattern of your symptoms and how well you respond to treatment, you may be asked to take your medication every day. Alternatively, you may only need to take it as prevention; for example, duringa sudden snap of cold weather. Side effects are common and include: oedema swelling of certain parts of the body, such as your hands and feet, due to a build-up of fluid headaches heart palpitations dizziness constipation Dont drink grapefruit juice when taking nifedipine, as this could make side effects worse. The side effects should improve as your body gets used to the medicine, but tell your GP if you find them particularly troublesome. There are alternative calcium channel blockers that may suit you better. Other medications Other medications have been used to treat Raynauds, but their use is controversial, as there is limited evidence to show theyre effective in most people. However, some people have claimed to benefit from treatment. These medications include: fluoxetine which was widely used in the treatment of depression sildenafil which is used to treat erectile dysfunction (inability to get or maintain an erection) These medicines are not licensed for the treatment of Raynauds in the UK, but you may be prescribed them if its thought the potential benefit outweighs the possible risks. Surgery Surgery for Raynauds is rare. Its usually only recommended if your symptoms are so severe that theres a risk the affected body part, such as your fingers, could lose their blood supply and begin to die. Read more about the complications of Raynauds phenomenon. A type of surgery called sympathectomy is sometimes used. It involves cutting the nerves causing the affected blood vessels to spasm. The results of a sympathectomy are often only temporary and further treatment and possibly more surgery may be required after a few years. Complications of Raynauds phenomenon People with Raynauds phenomenon have an increased risk of developing other problems, such as scleroderma. Scleroderma Around1 in 16 women and1 in 50 men with Raynauds develop a condition called scleroderma, usually between the ages of 25 and 55. Scleroderma is when the body produces excessively high levels of collagen. Scleroderma is a Greek word meaning hard skin, but it can affect other areas of the body, such as the kidneys, heart and lungs. Symptoms of scleroderma include: puffy and itchy skin tight and uncomfortable joints small calcium spots and red spots under the skin trouble swallowing, known as dysphagia diarrhoea , bloating or constipation Theres no cure for scleroderma, but there are ways of overcoming problems it may cause. For example, medicines can reverse or slow down the processes that cause damage around the body. For more information, visit Scleroderma & Raynauds UK (SRUK) , a UK charity dedicated to improving the lives of people affected by Scleroderma and Raynauds. Ulcers and gangrene In severe cases of Raynauds, the blood supply to an affected body part can become severely diminished. Without a constant supply of blood, the tissue in the body part will begin to die. This problem is rare and normally only occurs in secondary Raynauds. The initial sign is an open sore, known as an ulcer, which develops on the surface of the body part. If you suspect a skin ulcer, contact your GP for advice. Left untreated, the tissue can die, which is known as gangrene (specifically, dry gangrene). The symptoms of dry gangrene normally begin with a red line on the skin that marks the edges of the affected tissue. The tissue becomes cold and numb, and can be painful as the tissue dies. However, many people, particularly the elderly, experience no sensations. The affected area changes colour from red, to brown, to black. The dead tissue will then shrivel up, separate from the healthy tissue and fall off. These complications normally require admission to hospital, where youll be given medication designed to thin your blood, which should help to restore blood flow. If you fail to respond to treatment, you may need surgery to unblock or repair damaged blood vessels. Source: Chest Heart & Stroke Scotland - Opens in new browser window Last updated: 05 May 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852" | null | null | null | null | null | null | null | null | null | null | null | null | null |
Reactive arthritis | Reactive arthritis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Muscle, bone and joints Conditions Reactive arthritis Reactive arthritis About reactive arthritis Symptoms of reactive arthritis Causes of reactive arthritis Treating reactive arthritis About reactive arthritis Reactive arthritis, formerly known as Reiters syndrome, is a condition that causes inflammation (redness and swelling) in various places in the body. It usually develops following an infection, and in most cases clears up in a few months withoutcausing long-term problems. The three most common placesaffected by reactive arthritisare: the joints ( arthritis ), which can causepain, stiffness and swelling the eyes ( conjunctivitis ), which can causeeye pain and redness the urethra(non-gonococcal urethritis), which can cause pain when urinating (the urethrais the tube that carries urine out of the body) However,most people will not experience all of these problems. Read more about the symptoms of reactive arthritis . What causes reactive arthritis? Reactive arthritis usually develops within four weeks of an infection, typically after a sexually transmitted infection (STI)such as chlamydia, or an infection of the bowel. For reasons that are still unclear, the immune system (the bodys defence against infection) appears to malfunction in response to the infection and starts attacking healthy tissue, causing it to become inflamed. Read more about the causes of reactive arthritis . Seeking medical advice Seeyour GP ifyou haveswollen and painful joints, especially if you have recently hadsymptoms of an infection such as diarrhoea or pain when passing urine. There is no single test for reactive arthritis, although blood and urine tests, genital swabsand X-rays may be used to check forinfection and rule out other causes of your symptoms. Your GP will also want to know about your recent medical history,such as whether you may have recently had abowel infection or an STI. How reactive arthritis is treated There is currently no cure for reactive arthritis, but most people get better in around six months. Meanwhile, treatment can help to relieve symptoms such as pain and stiffness. Symptoms canoften be controlled using non-steroidal anti-inflammatory drugs (NSAIDs) and painkillers such as ibuprofen . Severe symptomsmayrequire more powerful steroid medication ( corticosteroids ) or disease-modifying anti-rheumatic drugs (DMARDs). Read more about treating reactive arthritis . Who is affected Reactive arthritis can occur at any age, but it most commonly affects young adults aged 20-40. Men are generally affected more than woman particularly in cases linked to STIs, which are estimated to be about 10 times more common in men. People who have a certain gene called HLA-B27, which is found in around one in every 10 people in theUK,are about thought to be around 50 times more likely to develop reactive arthritis than those who dont have this gene. Preventing reactive arthritis The most effective way to reduce your risk of reactive arthritis is to avoid the STIs andbowel infections that most commonlycause the condition. The most effective way of preventing STIs is to always use a barrier method of contraception , such as a condom , during sex with a new partner. Read adviceon contraception and sexual health . Symptoms of reactive arthritis The symptoms of reactive arthritis usually develop within four weeks of an infection. In most cases, reactive arthritis follows a sexually transmitted infection (STI)such as chlamydia, or abowel infection such as food poisoning . The three parts of the body most commonly affected by reactive arthritisare the: joints andtendons urinary system eyes However, most people wont experience problems inall of these areas. Joints and tendons Reactive arthritis usually involves inflammation of the joints ( arthritis ) and tendons, which can cause: joint pain, tenderness and swelling usually in weight-bearing joints such as your knees, feet and ankles lower back and buttock pain swelling of your fingers and toes joint stiffness particularly in the morning See your GP if you have any swollen and painful joints, especially if you have recently had diarrhoea or problems passing urine. The urinary system Reactive arthritis can sometimes alsoinvolve inflammation of the urethra (non-gonococcal urethritis), which is the tube that carries urine out of the body. Symptoms of urethritis caninclude: pain or a burning sensation when you pee urinating more often than usual having a sudden urge topee a discharge of fluid from the penis or vagina blood in your urine (less commonly) The eyes Reactive arthritis may occasionallyinvolve inflammation of the eyes ( conjunctivitis ). Symptoms of conjunctivitis caninclude: red eyes watery eyes eye pain swollen eye lids In rare cases, a type ofuveitis called iritis can develop.Iritis can cause the eyes to becomepainful, red and sensitive to light.See your doctor or an eye specialist as soon as possible if you have these symptoms. Other symptoms Reactive arthritis can also cause symptoms, including: feeling unusually tired ahightemperature(fever) weight loss mouth ulcers painless whitepatchesinside your mouth a rash thick and crumbly nails abdominal (tummy) pain bouts ofdiarrhoea Causes of reactive arthritis Its not known exactly what causes reactive arthritis, but its thought to be the result of the immune system reacting to an infection. The immune system Your immune system is your bodys defence against illness and infection. When it senses a virus or bacteria, itsends antibodies and cells to fight the infection. This causes tissues to swell, known as inflammation, which makesit harder for theinfection to spread. In cases of reactive arthritis, something goes wrong with the immune system and it causes inflammation in parts of the body that were not infected, often after the infection has already passed. Infection The two most common types of infection linked to reactive arthritis are: sexually transmitted infections (STIs) such as chlamydia or gonorrhoea , although many casesoccur afternon-gonococcal urethritis infections of thebowel and digestive system (gastrointestinal infections) usuallycaused by either campylobacter or salmonella bacteria, both of which can cause food poisoning Genetic factors Research has shown that people with a specific gene known as HLA-B27 have a significantlyincreased chance of developing reactive arthritis, as well as related conditions such as ankylosing spondylitis (a type of arthritis that affects the spine) . In the UK, its estimated thataround1 in every 10 people have the HLA-B27 gene. Around3out of every4 cases of reactive arthritis develop in people with the gene. People withthe HLA-B27 gene also tend to have more severe and longer-lasting symptoms, with a greater risk of their symptoms recurring. Exactly how the gene contributes to the development of reactive arthritis is unclear. Treating reactive arthritis Theres no cure for reactive arthritis, but the condition is usually temporary and treatment can help to relieve your symptoms. Most people will make a full recovery in about six months, although around one in five cases lasts a year or more, and a small number of people experience long-term joint problems. There is also a risk you could develop the condition again after another infection. Self-care In the initial stages of reactive arthritis, its recommendedthat you get plenty of rest and avoid using affected joints. As your symptoms improve, you should begin a gradual programme of exercisedesigned to strengthen affected muscles and improve the range of movement in your affected joints. Your GP or specialist may recommend a suitable exercise programme for your arthritis . Alternatively, you may be referred to a physiotherapist for physical therapy. You might also find ice packs and heat pads useful in reducing joint pain and swelling, although these should not be directly placed on yourskin. Antibiotics Antibiotics may not help to treat reactive arthritis itself, but they are sometimes prescribed if you have an ongoing infection particularly if you have asexually transmitted infection (STI). Your recent sexual partner(s) may also need treatment. Non-steroidal anti-inflammatory drugs (NSAIDs) Non-steroidal anti-inflammatory drugs (NSAIDs) , such as ibuprofen ,are the main medication used for reactive arthritis, as they can help to reduce inflammation and relieve pain. However, taking a regular dose of a NSAID on a long-term basis can increase your risk of problems such as stomach ulcers . If you are at an increased risk of developing stomach ulcers, your GP may recommend an additional medication known as a proton pump inhibitor (PPI), which can protect your stomach by reducing the production of stomach acid. Rarely, long-term use of NSAIDscan also slightly increase your risk of having a heart attack or stroke . Read more about the side effects of NSAIDs . Steroid medication Steroid medication ( corticosteroids ) may be recommended if your symptoms dont respond to NSAIDs, or youre unable to use NSAIDs. Steroids work by blocking the effects of many of the chemicals the body uses to trigger inflammation. A corticosteroid called prednisolone is usually the preferred choice. Prednisolone can be given as an injection into a joint or as a tablet. Eye drops are also available if you have inflamed eyes ( conjunctivitis ). Around1 in 20 people who take prednisolone will experience changes in their mental state, such as depression or hallucinations. Contact your GP as soon as possible if you notice any changes in your thoughts or behaviour. Other side effects can include weight gain, acne , stomach ulcers and osteoporosis ,although these should improve as your dose is decreased. Read more about the side effects of corticosteroids . Disease-modifying anti-rheumatic drugs (DMARDs) If your symptoms persist despite treatment with NSAIDs and/or corticosteroids, you may be prescribed a medication known as a disease-modifying anti-rheumatic drug (DMARD). Like corticosteroids, DMARDs work byblocking the effects of some of the chemicals your immune system uses to trigger inflammation. It can take a few months before you notice a DMARD working, so its important to keep taking medication even if you dont see immediate results. A DMARD called sulfasalazine is usually the preferred option. Common side effects of sulfasalazine include feeling sick, loss of appetite and headaches , although these usually improve once your body gets used to the medication. DMARDs may alsocause changes inyour blood or liver, so its important to have regular bloodtests while taking these medicines. Source: MSK Expert Panel - Opens in new browser window Last updated: 20 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Arthritis Other health sites The Pain Toolkit Pain Concern Versus Arthritis: reactive arthritis NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Restless legs syndrome | "Restless legs syndrome - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Restless legs syndrome Restless legs syndrome About restless legs syndrome Symptoms of restless legs syndrome Causes of restless legs syndrome Diagnosing restless legs syndrome Treating restless legs syndrome About restless legs syndrome Restless legs syndrome, also known as Willis-Ekbom disease, is a common condition of the nervous system that causes an overwhelming, irresistible urge to move the legs. It can also cause an unpleasant crawling or creeping sensationin the feet, calves and thighs. The sensation is often worse in the eveningor at night. Occasionally, the arms are affected too. Restless legs syndrome is also associated with involuntary jerking of the legs and arms, known as periodic limb movements in sleep (PLMS). Some people havethe symptoms of restless legs syndrome occasionally, while others have them every day. The symptoms can vary from mild to severe. In severe cases, restless legs syndrome can be very distressing and disrupt a persons daily activities. What causes restless legs syndrome? In the majority of cases, theres no obvious cause ofrestless legs syndrome. This known as idiopathic or primary restless legs syndrome, and it can run in families. Some neurologists (specialists in treating conditions that affect the nervous system) believe the symptoms of restless legs syndrome may have something to do with how the body handlesa chemical called dopamine. Dopamine is involved in controlling muscle movement andmaybe responsible forthe involuntary leg movements associated withrestless legs syndrome. In some cases, restless legs syndrome is caused by an underlying health condition,such as iron deficiency anaemia or kidney failure. This is known as secondaryrestless legs syndrome. Theres also a link betweenrestless legs syndrome and pregnancy. About 1 in5 pregnant women will experience symptoms in the last three months of their pregnancy, although its not clear exactly why this is. In such cases,restless legs syndrome usually disappears after the woman has given birth. Read more about the causes of restless legs syndrome Treating restless legs syndrome Mild cases ofrestless legs syndrome that arent linked to an underlying health condition may not require any treatment, other than making a few lifestyle changes, such as: adoptinggood sleep habits for example, following a regular bedtime ritual, sleeping regular hours, and avoiding alcohol and caffeine late at night quitting smoking if yousmoke exercising regularly during the daytime If your symptomsare more severe, you may need medication to regulate the levels of dopamine and ironin your body. Ifrestless legs syndrome is caused by iron deficiency anaemia, iron supplements may be all thats needed to treat the symptoms. Read more about treating restless legs syndrome Whos affected by restless legs syndrome? As many as 1 in 10 people are affected byrestless legs syndrome at some point in their life. Women are twice as likely to developrestless legs syndrome than men. Its also more common in middle age, although the symptoms can develop at any age, including childhood. Outlook Thesymptomsofrestless legs syndrome will usually disappear if its possible to address an underlying cause. However, if the causeis unknown, the symptoms can sometimes get worse with time and severely affect the persons life. Restless legs syndrome isnt life threatening, but severe cases can severely disrupt sleep (causing insomnia )and trigger anxiety and depression . Symptoms of restless legs syndrome Restless legs syndrome typically causes an overwhelming urge to move your legs and an uncomfortable sensation in your legs. The sensation may also affect your arms, chest and face, too. It has been described as: tingling, burning, itching or throbbing a creepy-crawly feeling feeling like fizzy water is inside the blood vessels in the legs a painful, cramping sensation in the legs, particularly in the calves These unpleasant sensationscan range from mild to unbearable, and are usually worse in the evening and during the night. They can often be relieved by moving or rubbing your legs. Some people experience symptoms occasionally,while others have them every day. You may find it difficult tosit for long periods of time for example, ona long train journey. Just over half of people withrestless legs syndrome also experience episodes of lowerback pain. Periodic limb movements in sleep (PLMS) Up to 80% of people withrestless legs syndrome also have periodic limb movements in sleep (PLMS). If you have PLMS, your leg will jerk or twitch uncontrollably,usuallyat night while youre asleep. The movements are brief and repetitive, and usually occur every 10 to 60 seconds. PLMS can be severe enough to wake up both you and your partner. The involuntary leg movementscan also occur when youre awake and resting. Causes of restless legs syndrome In many cases, the exact cause of restless legs syndrome is unknown. When no cause can be found, itsknown as idiopathic or primary restless legs syndrome. Research has identified specific genes related to restless legs syndrome, andit can run in families. In these cases, symptoms usually occur before the age of 40. Dopamine Theres evidence to suggest restless legs syndrome is related to a problem with part of the brain called the basal ganglia. The basal ganglia uses a chemical (neurotransmitter) called dopamine to help control muscle activity andmovement. Dopamine acts as a messenger between the brain and nervous system to help the brain regulate and co-ordinate movement. Ifnerve cells become damaged, the amount of dopamine in the brain is reduced, which causes muscle spasms andinvoluntary movements. Dopamine levels naturally fall towards the end of the day, which may explain why the symptoms of restless legs syndrome are often worse in the evening and during the night. Underlying health condition Restless legs syndrome can sometimes occuras a complication of another health condition, or it can be the result of another health-related factor. This is known as secondaryrestless legs syndrome. You candevelop secondaryrestless legs syndrome if you: have iron deficiency anaemia low levels of iron in the blood can lead to a fall in dopamine, triggeringrestless legs syndrome have a long-term health condition such as chronic kidney disease , diabetes , Parkinsons disease , rheumatoid arthritis , an underactive thyroid gland , or fibromyalgia are pregnant particularly from week 27until birth; in most cases the symptoms disappear within four weeks of giving birth Triggers There are a number of triggers that dont causerestless legs syndrome, but can make symptoms worse. These include medications such as: some antidepressants antipsychotics lithium used in the treatment of bipolar disorder calcium channel blockers used in the treatment of high blood pressure some antihistamines metoclopramide used to relieve nausea Other possible triggers include: excessive smoking , caffeine or alcohol being overweight or obese stress lack of exercise Diagnosing restless legs syndrome Theres no single test for diagnosing restless legs syndrome. A diagnosis will be based on your symptoms, your medical and family history, a physical examination, and your test results. Your GP should be able to diagnose restless legs syndrome, but they may refer you to a neurologist if theres any uncertainty. There are four main criteria your GP or specialist will look for to confirm a diagnosis. These are: an overwhelming urge to move your legs, usually with an uncomfortable sensation such asitching or tingling your symptoms occur or get worse when youre resting or inactive your symptoms are relieved by moving your legs or rubbing them your symptoms are worse during the evening or at night Assessing your symptoms Your GP or specialist will ask you about the pattern of your symptoms to help assess their severity. For example, they may ask you: how often you have symptoms how unpleasant you find your symptoms whether your symptoms cause significant distress whether your sleep is disrupted, making you tired during the day Keeping asleep diary may help your doctor assess your symptoms. You can use the diary to record your daily sleeping habits, such as the time you go to bed, how long it takes you to fall asleep, how often you wake during thenight, and episodes of tiredness during the day. Mild symptoms of restless legs syndrome can usually be treated by making lifestyle changes for example, establishing a regular sleeping pattern and avoiding stimulants, such as caffeine, alcohol or tobacco, in the evening. If your symptoms are more severe, you may need medication to bring them under control. Read more about treating restless leg syndrome Blood tests Your GP may refer you for blood tests to confirm or rule out possible underlying causes of restless legs syndrome.For example, you may have blood tests to rule out conditions such as anaemia , diabetes and kidney function problems. Its particularly important to find out the levels of iron in your blood because low iron levels can sometimes cause secondary restless legs syndrome. Low iron levels can be treated withiron tablets. Sleep tests If you haverestless legs syndrome and your sleep is being severely disrupted, sleep testssuch as asuggested immobilisation test may be recommended. The test involveslyingon a bed for a set period of time without moving your legs while anyinvoluntary leg movements are monitored. Occasionally, polysomnography may be recommended. This is a test that measures your breathing rate, brain waves and heartbeat throughout the course of a night. The results will confirm whether you have periodic limb movements in sleep (PLMS). Treating restless legs syndrome Mild restless legs syndrome that isnt linked to an underlying health condition can be managed with just a few lifestyle changes. If symptoms are more severe, medication may be needed. Restless legs syndrome caused by an underlying health conditioncan often be cured bytreating that condition. For example, iron deficiency anaemia can be treated by taking iron supplements. If its associated with pregnancy, itusually disappears on its own within four weeks of the birth. Lifestyle changes Anumber of lifestyle changes may be enough to ease the symptoms of restless legs syndrome, including: avoiding stimulants in the evening such as caffeine, tobacco and alcohol not smoking read more about quitting smoking taking regular daily exercise but avoid exercising near bedtime practising good sleep habits for example, going to bed and getting up at the same time every day, not napping during the day, taking time to relax before going to bed, and avoiding caffeine close to bedtime avoiding medicines that trigger the symptoms or make them worse if you think medication is causing your symptoms, continue to take it and make an appointment to see your GP During an episode ofrestless legs syndrome, the following measures may help relieve yoursymptoms: massaging your legs taking a hot bath in the evening applying a hot or cold compress to your leg muscles doing activities that distract your mind, such as reading or watching television relaxation exercises, such as yoga ortai chi walking and stretching Asmall medical trial carried out in 2011 found a type of osteopathic exercise technique called positional release manipulation could be of benefit to people withrestless legs syndrome. It involves holding different parts of the body in positions found to reduce feelings of pain and discomfort. Medication Dopamine agonists Dopamine agonists may be recommended if youre experiencing frequent symptoms of restless legs syndrome. They work by increasing dopamine levels, which are often low. Dopamine agonists that may be recommendedinclude: ropinirole pramipexole rotigotineskin patch These medications can occasionally make you feel sleepy, so you should be cautious whendriving or using tools or machinery after taking them. Other possible side effectscan include nausea, dizziness and headaches . If you experience nausea while taking a dopamine agonist, you may be given medication to help with this (antiemitic medication). Impulse control disorder (ICD) is a less common side effect sometimes associated with dopamine agonists. People with ICD are unable to resist the urge to do something harmful to themselves or others. For example, this could be anaddiciton to alcohol , drugs, gambling, shopping, or sex(hypersexuality). However, the urges associated with ICD will subside once treatment with the dopamine agonist is stopped. Painkillers A mild opiate-based painkiller, such as codeine or tramadol, may be prescribed to relieve pain associated withrestless legs syndrome. Gabapentin and pregabalin are also sometimes prescribed to help relieve painful symptoms of restless legs syndrome. Side effects of these medicationsinclude dizziness, tiredness and headaches. Aiding sleep Ifrestless legs syndromeis disrupting your sleep, a short-term course of medication may be recommended to help you sleep. These types of medication are known as hypnotics, and include temazepam and loprazolam. Hypnotics are usually only recommended for short-term use (typically no longer than a week). You may find you still feel sleepy or hungover the morning after taking your medication. Levodopa Levodopa may be recommended if you only have occasional symptoms of restless legs syndrome. This is because if you took levodopa every day, theres a high risk it would actually make your symptoms worse. Levodopa is available in tablet or liquid form, and you should take it once you feel the symptoms ofrestless legs syndrome coming on. The medication will make you feel very sleepy (often suddenly), so you should never drive or use tools or machinery after taking levodopa. Source: NHS 24 - Opens in new browser window Last updated: 23 October 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Iron deficiency anaemia Parkinson's disease Insomnia Other health sites NICE: Restless legs syndrome NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852" | null | null | null | null | null | null | null | null | null | null | null | null | null |
Retinoblastoma: Children | "Retinoblastoma in children | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in children Retinoblastoma: Children Retinoblastoma: Children Retinoblastoma is an uncommon eye cancer that usually affects children under 5, although it can affect children of any age. Treatment is very effective and nearly all children with retinoblastoma are cured. More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Its devastating to hear that your child has cancer, and at times it can feel overwhelming. There are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your childs specialist will give you more detailed information and if you have any questions its important to ask the specialist doctor or nurse who knows your childs individual situation. Retinoblastoma develops in the light-sensitive lining of the eye (called the retina). There are 2 forms of retinoblastoma: aheritable form this is genetic or inherited; there are often tumours in both eyes (bilateral) or sometimes only in 1 eye anon-heritable form this is not passed on in the family; theres 1 tumour in only 1 eye (unilateral) Causes The heritable form of retinoblastoma, which accounts for about 2 in every 5 cases, is caused by a genetic abnormality. This means that an abnormal gene allows the tumour to develop. This abnormal gene may either be inherited from a parent or happen for the first time at an early stage of development in the womb. Genetic counselling and support is available for families in which a member has retinoblastoma. Not all children of a parent with retinoblastoma will inherit this gene, but children born into families with a history of retinoblastoma are offered blood testing. They are also usually checked (screened) soon after birth for signs of retinoblastoma. This means that treatment can be started early if a tumour does develop. Screening usually starts shortly after birth and is repeated every few months for 5 years. An eye specialist examines the eye, while shining a light into it with an ophthalmoscope. In younger children, this may need to be done under a general anaesthetic . The genetic abnormality in the heritable form of retinoblastoma is now well-understood. But we dont know what causes non-heritable retinoblastoma. Signs and symptoms Some children with a family history of retinoblastoma are picked up by screening before they have any symptoms. If theres no family history of retinoblastoma, the first sign of the condition is often a white pupil that does not reflect light (leukocoria). This may be picked up when a picture of your child is taken using flash photography. The pupil of the affected eye may look white in the photograph. Some children may have a squint or, if the tumour is large, they may have a painful red eye. How retinoblastoma is diagnosed Tests are likely to involve an examination under anaesthetic (EUA) where an eye specialist (ophthalmologist) examines your childs eye while theyre asleep. Unlike nearly all other types of cancer, retinoblastomas can be diagnosed just by their appearance. So its not usually necessary to take a sample of tissue (a biopsy ). Your child will have several more EUAs to check how treatment is progressing. When retinoblastoma is diagnosed, your child may have some other tests to check the exact position and size of the tumour, and whether it has begun to spread into surrounding structures. This is known as staging. They may have some of the following tests: an ultrasoundscan this is a painless scan that uses sound waves to examine the eye and the surrounding area an MRI (magnetic resonance imaging) scan this uses magnetism to build up a detailed picture of the eye and the head alumbar puncture the doctor inserts a fine needle between the bones in the lower spine to remove a sample of the fluid from around the brain and spinal cord (cerebrospinal fluid)then the fluid is examined under a microscope to check whether there are any cancer cells present abone marrow sample this may be taken to check whether there are any cancer cells in the bone marrow (where our blood cells are made); the doctor inserts a needle into the hip bone and draws some of the bone marrow out with a syringe so that it can be checked for any cancer cells abone scan this involves taking a series of X-rays to check for signs of any spread to the bones ablood test this may be taken for genetic testing for the Rb gene; the results of this test can take some months The doctor or a specialist nurse will explain more about the tests that your child needs. Staging The stage of a cancer is a term used to describe its size and whether it has spread from where it first started. Knowing the stage of your childs retinoblastoma helps the doctors to decide on the most appropriate treatment. The following staging system is commonly used for retinoblastoma. Intraocular retinoblastoma There is cancer in 1 or both eyes, but it has not spread to other parts of the eye or the tissues surrounding the eye. This stage may be sub-divided into 5 grades (AE), depending on the size and position of the cancer and on whether theres any damage to the eye. Extraocular retinoblastoma The cancer has spread outside the eye into surrounding tissue, or to other parts of the body. Treatment Treatment depends on the number, position and size of the tumours in the eye. The aim of treatment is to first get rid of the cancer, and secondly to try to keep the sight in the eye. Some treatments may cause changes to the vision in the affected eye. Your childs specialist will talk to you about the possible risks as well as the advantages of the treatment. Smaller tumours For smaller tumours, treatment is given to the eye itself (called local therapy), while your child is asleep and under anaesthetic. Cryotherapy This is used to freeze the tumours. More than 1 session may be necessary, in which case they are usually done at monthly intervals. Laser therapy A laser is used to heat the tumour. Your child may need a number of sessions at intervals of 3to 4 weeks. Plaque A small radioactive disc is stitched over the tumour on the outside of the eye. The disc needs to stay in place for up to 4 days while the radiation destroys the cancer cells. This is done for slightly larger tumours, or tumours that have not been successfully treated with other methods. Thermotherapy This process uses heat to destroy the cancer cells and may be combined with chemotherapy or radiotherapy, as heat can improve the effectiveness of these treatments. The heat is produced by a laser, which is directed at the tumour. Larger tumours Chemotherapy This is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It may be given before the local treatments mentioned above, to help shrink the tumour and make treatment more successful. Chemotherapy can also be used if the cancer has spread to other parts of the body, or if theres a risk that it may spread. The chemotherapy drugs most commonly used to treat retinoblastoma are carboplatin, etoposide, and vincristine. Newer techniques include giving chemotherapy directly into the artery (the blood vessel) that supplies the eye (intra-arterial chemotherapy) or injecting chemotherapy into the central gelatinous part of the eye (intra-vitreal chemotherapy). Surgery If the tumour is very large and the vision in the eye is lost, your child is likely to need an operation to remove the eye. The specialist will only do this if it is absolutely necessary. An artificial eye is then fitted. Radiotherapy Radiotherapy treats cancer by using high energy rays from a machine to destroy the cancer cells, while doing as little harm as possible to normal cells. It can be given to the whole eye but does have some effect on the surrounding tissue. Radiotherapy for retinoblastoma is normally only used when other treatments have not worked well. Side effects of treatment The side effects will depend on the treatment your child is having. The immediate side effects will usually improve when treatment finishes. But unfortunately, some treatments may cause side effects that develop many years later. The specialist will explain all of this to you before treatment starts. Your childs follow-up will include checking for any long-term effects of treatment. Clinical trials Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for childrens cancers. If appropriate, your childs medical team will talk to you about taking part in a clinical trial, and will answer any questions you have. Written information is provided to help explain things. Taking part in a research trial is completely voluntary, and youll be given plenty of time to decide whether its right for your child. Treatment guidelines Sometimes, clinical trials are not available for your childs tumour. This may be because a recent trial has just finished, or because the tumour is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Childrens Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care At least 9 out of every 10 children with retinoblastoma are cured. Following treatment, the eye specialist will frequently examine your childs eye under anaesthetic to check that the retina is healthy, the cancer has not come back, and no new tumours have developed. Follow-up is usually in a clinic for childhood cancers, called a paediatric oncology clinic. Children with heritable retinoblastoma will be given genetic counselling when they are old enough to understand it. Having the heritable form of retinoblastoma means an increased risk of developing other types of cancer later in life. Your child will be followed up closely into adulthood. They will be encouraged to get any new symptoms, such as a lump, checked early, and to have a healthy lifestyle to help to reduce cancer risk. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Its not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young Peoples Cancer; A Parents Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience with cancer. The Parents Guide discusses these further and talks about how you can support your child. Source: Children's Cancer and Leukaemia Group - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852" | null | null | null | null | null | null | null | null | null | null | null | null | null |
Rhabdomyosarcoma | "Rhabdomyosarcoma | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in children Rhabdomyosarcoma Rhabdomyosarcoma Rhabdomyosarcoma is a type of soft tissue sarcoma (tumour). Most children with rhabdomyosarcoma areyounger than 10 years old. Its more common in boys than girls. More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Its devastating to hear that your child has cancer, and at times it can feel overwhelming. There are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your childs specialist will give you more detailed information and if you have any questions it is important to ask the specialist doctor or nurse who knows your childs individual situation. Sarcomas are rare types of tumour that develop in the supporting tissues of the body, such as bone, muscle or cartilage. There are 2 main types of sarcomas: soft tissue sarcomas can develop in muscle, fat, blood vessels, or in any of the other tissues that support, surround and protect the organs of the body bone sarcomas can develop in any of the bones of the skeleton Rhabdomyosarcoma is the most common of soft tissue sarcomas in children. These tumours develop from muscle or fibrous tissue and can grow in any part of the body. The most common areas of the body to be affected are around the head and neck, bladder, testes, womb, or vagina. Sometimes tumours are also found in a muscle or a limb, in the chest or in the abdominal wall. If the tumour is in the head or neck area, it can occasionally spread into the brain or the fluid around the spinal cord. Causes The causes of rhabdomyosarcoma are unknown but research is going on all the time. Children with certain rare genetic disorders, such as Li-Fraumeni syndrome, have a higher risk of developing rhabdomyosarcoma. Symptoms The most common symptom is a lump or swelling. Other symptoms will depend on the part of the body thats affected by the rhabdomyosarcoma: atumour in the head or neck area can sometimes cause a blockage (obstruction) and discharge from the nose or throat; occasionally, an eye may appear swollen and protruding atumour in the abdomen (tummy) can cause pain or discomfort in the abdomen and difficulty going to the toilet (constipation) atumour in the bladder may cause symptoms such as blood in the urine and difficulty passing urine (peeing) How rhabdomyosarcoma is diagnosed Different tests are usually needed to diagnose a rhabdomyosarcoma. Your child may need a small operation to remove a sample from the tumour (a biopsy ) so that it can be examined under a microscope. This is usually done under a general anaesthetic. Tests may be done to check the exact size of the tumour and to find out if it has spread to any other part of the body. These may include: a chest X-ray to check the lungs an ultrasound CT or MRI scans blood tests and bone marrow Any tests and investigations that your child needs will be explained to you Staging The stage of a cancer is a term used to describe its size and whether it has spread from where it first started. Knowing the stage helps the doctors decide on the most effective treatment for your child. The staging system for rhabdomyosarcoma is based on: where in the body the tumour started if it is in only one part of the body (localised disease), or if it has spread to another part of the body (metastatic disease). There are different ways of staging rhabdomyosarcoma, and your childs specialist doctor will explain more about the system they are using. Treatment Rhabdomyosarcomas are rare tumours and should be treated at specialist centres. Treatment will depend on the size of the tumour, its position in the body and whether it has spread. The 3 main types of treatment for soft tissue sarcomas are chemotherapy, surgery and radiotherapy. Your child may have a combination of treatments. Chemotherapy Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It can be given: to shrink the tumour before surgery after surgery to reduce the risk of rhabdomyosarcoma coming back The drugs used and the length of treatment depends on the type and stage of the rhabdomyosarcoma. Surgery If it is possible, your child will have an operation to remove all or as much as possible of the tumour, without damaging surrounding tissue or organs. The operation will depend on the size of the tumour and where it is in your body. The surgeon will explain what is involved. Chemotherapy is usually given before surgery to shrink the tumour and make it easier to remove with surgery. If an operation isnt possible, both chemotherapy and radiotherapy are given. Radiotherapy Radiotherapy treats cancer by using high energy rays, which destroy the cancer cells while doing as little harm as possible to normal cells. It may be given after surgery to the area where the rhabdomyosarcoma started. Side effects of treatment The side effects will depend on the treatment being given and the part of the body that is being treated. Your childs doctor will discuss this with you before treatment starts. Most side effects are short-term (temporary) and gradually disappear once treatment stops. Chemotherapy may cause side effects such as feeling sick, hair loss , tiredness , and an increased risk of infection. But it can also make your child feel better by relieving any symptoms the tumour is causing. Radiotherapy can make your child feel tired, and the skin in the area thats being treated may go red or get darker. Other side effects will depend on the area of the body that is being treated. Your childs specialist doctor or nurse will explain this. Late side effects A small number of children may develop long-term side effects many years after treatment for rhabdomyosarcoma. This depends on the type of treatment your child had. Your childs doctor or nurse will talk to you about any possible risk of late side effects. Follow-up for children whove had cancer includes close monitoring for any signs of any late effects. Late effects may include a possible reduction in bone growth, infertility, a change in the way the heart and the kidneys work, and a slight increase in the risk of developing another cancer in later life. Clinical trials Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for childrens cancer. If appropriate, your childs medical team will talk to you about taking part in a clinical trial, and will answer any questions you have. Written information is provided to help explain things. Taking part in a research trial is completely voluntary, and youll be given plenty of time to decide if its right for your child. Before any trial is allowed to take place, it must be approved by an ethics committee, which protects the interests of the patients taking part. If you decide to take part in a trial, your doctor or a research nurse must discuss the treatment with you so that you understand the trial and what it means for your child to take part. You may decide not to take part, or you can withdraw from a trial at any stage. You will then receive the best standard treatment available. Treatment guidelines Sometimes, clinical trials are not available for your childs tumour. This may be because a recent trial has just finished, or because the tumour is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Childrens Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care After treatment, the doctors will regularly check your child to be sure that the cancer has not come back and there are no complications. After a while, you will not need to visit the clinic so often. If you have specific concerns about your childs condition and treatment, its best to discuss them with your childs doctor, who knows their situation in detail. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Its not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young Peoples Cancer; A Parents Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience with cancer. The Parents Guide discusses these further and talks about how you can support your child. Source: Children's Cancer and Leukaemia Group - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Search for cancer support services near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852" | null | null | null | null | null | null | null | null | null | null | null | null | null |
Rheumatoid arthritis | Rheumatoid arthritis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Muscle, bone and joints Conditions Rheumatoid arthritis Rheumatoid arthritis About rheumatoid arthritis Symptoms of rheumatoid arthritis Causes of rheumatoid arthritis Diagnosing rheumatoid arthritis Treating rheumatoid arthritis Living with rheumatoid arthritis Complications of rheumatoid arthritis About rheumatoid arthritis Rheumatoid arthritis is a long-term condition that causes pain, swelling and stiffness in the joints. The hands, feet and wrists are commonly affected, but it can also cause problems in other parts of the body. There may be periods where your symptoms become worse, known as a flare-up or flare. A flare can be difficult to predict, but with treatment it is possible to decrease the number of flares and minimise or prevent long-term damage to the joints. Read more about the symptoms of rheumatoid arthritis and living with rheumatoid arthritis . When to seek medical advice You should see your GP if you think you have symptoms of rheumatoid arthritis, so your GP can try to identify the underlying cause. Diagnosing rheumatoid arthritis quickly is important because early treatment can help stop the condition getting worse and reduce the risk of further problems such as joint damage. Read more about diagnosing rheumatoid arthritis . What causes rheumatoid arthritis? Rheumatoid arthritis is an autoimmune disease. This means that your immune system which usually fights infection attacks the cells that line your joints by mistake, making them swollen, stiff and painful. Over time, this can damage the joint itself, the cartilage and nearby bone. Its not clear what triggers this problem with the immune system, although you are at an increased risk if you are a woman, you have a family history of rheumatoid arthritis, or you smoke. Read more about the causes of rheumatoid arthritis . Who is affected Rheumatoid arthritis affects around 400,000 people in the UK. It can affect adults at any age, but most commonly starts between the ages of 40 and 50. About three times as many women as men are affected. Howrheumatoid arthritis is treated There is no cure for rheumatoid arthritis, but early diagnosis and appropriate treatment enables many people with rheumatoid arthritis to have periods of months or even years between flares and to be able to lead full lives and continue regular employment. The main treatment options include: medication that is taken in the long-term to relieve symptoms and slow the progress of the condition supportive treatments, such as physiotherapyand occupational therapy, to help keep you mobile and find ways around any problems you have with daily activities surgery to correct any joint problems that develop Read more about treating rheumatoid arthritis . Possible complications Having rheumatoid arthritis can lead to several other conditions that may cause additional symptoms and can sometimes be life-threatening. Possible complications include carpal tunnel syndrome, inflammation of other areas of the body (such as the lungs, heart and eyes), and an increased risk of heart attacks and strokes . Ensuring that rheumatoid arthritis is well controlled helps reduce your risk of complications such as these. Read more about the complications of rheumatoid arthritis . Symptoms of rheumatoid arthritis Rheumatoid arthritis mainly affects the joints, although it can cause problems in other parts of the body too. The symptoms of rheumatoid arthritis often develop gradually over several weeks, but some cases can progress quickly over a number of days. The symptoms vary from person to person. They can come and go, and may change over time. Youmay occasionally experience flares when your condition deteriorates and your symptoms become more severe. Symptoms affecting the joints Rheumatoid arthritis is primarily a condition that affects the joints. It can cause problems in any joint in the body, although the small joints in the hands and feet are often the first to be affected. Rheumatoid arthritis typically affects the joints symmetrically (both sides of the body at the same time and to the same extent), but this is not always the case. The main symptoms of rheumatoid arthritis affecting the joints are outlined below. Pain Thejoint pain associated with rheumatoid arthritisis usually a throbbing andaching pain. It is often worse in the mornings and after a period of inactivity. Stiffness Joints affected by rheumatoid arthritis can feel stiff. For example, if your hands are affected, you may not be able to fully bend your fingers or form a fist. Like joint pain, the stiffnessis oftenmore severe in the morning or after a period of inactivity. Morning stiffness associated with another type of arthritis called osteoarthritis usually wears off within 30 minutes of getting up, but rheumatoid arthritis morning stiffness oftenlasts longer than this. Swelling, warmth and redness The lining ofjoints affected by rheumatoid arthritis become inflamed, which can cause the joints to swell, and become hot and tender to touch. In some people, firm swellings called rheumatoid nodules can also develop under the skin around affected joints. Additional symptoms As well as problems affecting the joints, some people with rheumatoid arthritis experience a range of more general symptoms, such as: tiredness and a lack of energy a high temperature (fever) sweating a poor appetite weight loss The inflammation associated with rheumatoid arthritis can also sometimes cause problems affecting other areas of the body, includingdry eyes if the eyes are affected andchest pain if the heart or lungs are affected. Read more about the complications of rheumatoid arthritis . When to seek medical advice You should see your GP if you think you have symptoms of rheumatoid arthritis. There are a number of conditions that can cause problems such as joint pain and stiffness, so its important to get a proper diagnosis. Diagnosing rheumatoid arthritis as soon as possible is particularly important because early treatment can helpstop the condition getting worse and reduce the risk offurther problems such as joint damage. Read more about diagnosing rheumatoid arthritis . Causes of rheumatoid arthritis Rheumatoid arthritis is an autoimmune condition, which means it is caused by the bodys immune system attacking itself. However, it is not yet known what triggers this. Normally, your immune system makes antibodies that attack bacteria and viruses, helping fight infection.But if you have rheumatoid arthritis, your immune system mistakenly sends antibodies to the lining of your joints, where they attack the tissue surrounding the joint. This causes the thin layer of cells (synovium) covering your joints to become sore and inflamed. This inflammation in turn causes chemicals to be released that thicken the synovium and damage nearby: bones cartilage the stretchy connective tissue between bones tendons the tissue that connects bone to muscle ligaments the tissue that connects bone and cartilage If the condition is not treated, these chemicals gradually cause the joint to lose its shape and alignment and, eventually, can destroy the joint completely. Various theories of why the immune system starts to attack the joints have been suggested, including that an infection orvirus may trigger this, but none of these theories has been proven. Possible risk factors There are a number of things that may increase your risk of developing rheumatoid arthritis, including: your genes there is some evidence that rheumatoid arthritis can run in families, although the risk of inheriting the condition is thought to be low as genes are only thought to play a small role in the condition hormones rheumatoid arthritis is more common in women than men, which may be due to the effects of a hormone called oestrogen that is found at higher levels in women, although this has not been conclusively proven smoking some evidence suggests that people who smoke are at an increased risk of developing rheumatoid arthritis Want to know more? National Rheumatoid Arthritis Society (NRAS): Possible causes and risk factors Diagnosing rheumatoid arthritis Rheumatoid arthritis can be difficult to diagnose because many conditions cause joint stiffness and inflammation and there is no definitive test for the condition. You should see your GP if you have these symptoms so they can try to determine the cause. Seeing your GP Your GP willcarry out a physical examination, checking your joints for any swelling and to assess how easily they move. Your GP will also ask you about your symptoms. It is important to tell your GP about allyour symptoms, not just ones you think are important, as this will helpthe doctor make the correct diagnosis. If your GP thinks you have rheumatoid arthritis,they will refer you to a specialist (rheumatologist). Your GP may arrange blood tests to help confirm the diagnosis after conducting a physical examination and consulting your medical history, or they may refer you at the same time as requesting tests. Blood tests Noblood test candefinitively prove or rule out a diagnosis ofrheumatoid arthritis, buta number of tests can show possible indications of the condition. Some of the main tests usedare outlined below. Erythrocyte sedimentation rate (ESR) In an ESR test, a sample of your red blood cellsis placed into a test tube of liquid. The cells are then timed to see how fast they fall to the bottom of the tube (measured in millimetres per hour). If they are sinking faster than usual, you may have an inflammatory condition, such as rheumatoid arthritis. C-reactive protein (CRP) A CRP test can indicate if there is inflammation anywhere in the body by checking how much CRP is present in your blood. CRP is produced by the liver. If there is more CRP than usual, there is inflammation in your body. Full blood count The full blood count will measure your red cells to rule out anaemia. Anaemia is a condition where the blood is unable to carry enough oxygen, due to a lack of blood cells. Anaemia is common in people withrheumatoid arthritis, althoughthe problem canhave many causes, so having anaemiadoes not prove that you have rheumatoid arthritis. Rheumatoid factor and anti-CCP antibodies Specific blood tests can help to diagnosis rheumatoid arthritis, but are not accurate in every person. About half of all people with rheumatoid arthritis have a positive rheumatoid factor present in their blood when the disease starts, but about one in every 20 people without rheumatoid arthritis also tests positive for this. Another antibody test known as anti-CCP (anti-cyclic citrullinated peptide) is also available. People who test positive for anti-CCP are very likely to develop rheumatoid arthritis, but not everybody found to have rheumatoid arthritis has this antibody. Those who test positive for both rheumatoid factor and anti-CCP may be more likely to have severe rheumatoid arthritis requiring higher levels of treatment. Joint imaging A number of different scans may also be carried out to check for joint inflammation and damage. These can help differentiate between different types of arthritis and can be used to monitor howyour condition is progressing over time. Scans that may be carried out to diagnose and monitor rheumatoid arthritis include: X-rays where radiation is passed through your body to examine your bones and joints ultrasound scans where high frequency sound waves are used to create an image of joints magnetic resonance imaging (MRI) scans where strong magnetic fields and radio waves are used to produce detailed images of your joints Treating rheumatoid arthritis Stopping the condition progressing There are a number of medications available that can be used to help stop rheumatoid arthritis getting worse and reduce your risk of further problems. These are often divided into two types of medication: disease-modifying anti-rheumatic drugs (DMARDs) and biological treatments. Disease-modifying anti-rheumatic drugs (DMARDs) If you have been diagnosed with rheumatoid arthritis, you will normally be offered a combination of DMARD tablets as part of your initial treatment, asthese medications are particularly effective ineasing symptoms of the condition and slowing down its progression. DMARDs work byblocking the effects of the chemicals released when the immune system attacks the joints, which could otherwisecause further damage to nearby bones, tendons, ligaments and cartilage. There are many different DMARDs that can be used, including methotrexate, leflunomide, hydroxychloroquine and sulfasalazine. Methotrexate isnormally the firstmedicine given for rheumatoid arthritis, often alongside another DMARD anda short-course of corticosteroids to relieve anypain (seebelow). It may also be combined with the biological treatments mentionedbelow. Common side effects of methotrexate include feeling sick, loss of appetite, a sore mouth, diarrhoea , headaches and hair loss.The medicationcan also sometimes have an effect on your blood count and your liver,so you will have regular blood tests to monitor this. Less commonly, methotrexate can affect the lungs, so you will usually have a chest X-ray and possibly breathing tests when you start taking methotrexate, to provide a comparison if you develop shortness of breath or a persistent dry cough while taking it. However, most people tolerate methotrexate well. It can take a few months to notice a DMARD working. It is important to keep taking the medication, even if you do not notice it working at first. You may have to try two or three types of DMARD before you find the one that is most suitable for you. Once you and your doctor work out the most suitable DMARD, you will usually have to take the medicine in the long term. Biological treatments Biological treatments are a newer form of treatment for rheumatoid arthritis. They include etanercept, infliximab, adalimumab, certolizumab, golimumab, rituximab, abatacept and tocilizumab. They are usually taken in combination with methotrexate or another DMARD and are normally only used if these medications alone have not been effective. Biological medications are given by injection and they work by stopping particular chemicals in the blood from activating your immune system to attack your joints. Side effects from biological treatments are usually mild and include skin reactions at the site of the injections, infections, feeling sick, a high temperature (fever) and headaches. Some people may alsobe at risk of getting more serious problems, including the reactivation of infections such as tuberculosis (TB) in people who have had them in the past. Relieving pain In addition to the medications used to control the progression of rheumatoid arthritis, you may also need to take medication specifically to relieve pain. Some of the different medicines thatmay be used to relieve painare outlined below. Painkillers In some cases, you may be advised to use painkillers such as paracetamol , or a combination of paracetamol and codeine (co-codamol) to relieve the pain associated with rheumatoid arthritis. These medications dont help treat the underlying inflammation of your joints, but they can sometimes be helpful in relieving pain. For example, they may be recommended while you are waiting to see a specialist or during periods where your symptoms are particularly bad (flare-ups). Non-steroidal anti-inflammatory drugs (NSAIDs) In addition to or instead of the painkillers mentioned above, your doctor may prescribe a non-steroidal anti-inflammatory drug (NSAID) . This may be a traditional NSAID (such as ibuprofen , naproxen or diclofenac) or an alternative type called a COX-2 inhibitor (such as celecoxib or etoricoxib). These medications can help relieve pain while also reducing inflammation in the joints, although they will not stop rheumatoid arthritis getting worse over time. Your doctor will discuss with you what type of NSAID you should take and the benefits and risks associated with each of them. Although uncommon, taking an NSAID tablet can increase the risk of serious stomach problems such as internal bleeding because the medications can break down the lining that protects the stomach against damage from stomach acids. If you are prescribed an NSAID tablet, you will often have to take another medicine, such as a proton pump inhibitor (PPI), as well. Taking a PPI reduces the amount of acid in your stomach, which greatly reduces the risk of damage to your stomach lining. Corticosteroids Corticosteroids are powerful medications that can help reduce pain, stiffness and inflammation. They can be used as a tablet (for example, prednisolone), as an injection directly into a painful joint, or as an injection into the muscle (to help lots of joints). They are usually used to provide short-term pain relief for example, while you are waiting for DMARD medication to take effect or during a flare-up. Corticosteroids are normally only used in this way because long-term use of corticosteroids can have serious side effects, such as weight gain, osteoporosis (thinning of the bones), easy bruising, muscle weakness and thinning of the skin. Supportive treatments Your doctor may also refer you to other services that might be able to help you with your rheumatoid arthritis symptoms. Physiotherapy A physiotherapistmay help you improve your fitness and muscle strength, and make your joints more flexible. They may also be able to help with pain relief using heat or ice packs, or transcutaneous electrical nerve stimulation (TENS). A TENS machine applies a small pulse of electricity to the affected joint, whichnumbs the nerve endings and can help ease the pain of rheumatoid arthritis. Occupational therapy If rheumatoid arthritis causes youproblems with everyday tasks, occupational therapy may help. An occupational therapist can provide training and advice that will help you to protect your joints, both while you are at home and at work. Some type of support for your joints, such as a splint, may also be recommended, or devices that can helpopen jars or turn on taps. Podiatry If you have problems with your feet, a podiatrist may be able to help. You may also be offered some type of support for your joints or shoe insoles that can ease pain. Surgery Sometimes, despite medication, damage to your joints may occur. In such cases, you may need surgery to help restore your ability to use your joint. Surgery may also be recommended to reduce painor correct deformities. Finger, hand and wrist surgery There are different types of surgery to correct joint problems in the hand. Examples include: carpal tunnel release (cutting a ligament in the wrist to relieve pressure on a nerve) release of tendons in the fingers to treat abnormal bending removal of inflamed tissue that lines the finger joints Arthroscopy Arthroscopy is a procedure to remove inflamed joint tissue. During the operation, a thin tube with a light source and camera (arthroscope) is inserted into the joint through a small cut in the skin so that the surgeon can see the affected joint. Special surgical instruments are inserted through other small cuts in the skin to remove the damaged tissue. You usually do not have to stay overnight in hospital for this kind of surgery, but the joint will need to be rested at home for several days. Joint replacement Some people with rheumatoid arthritis will need surgery toreplace part or all of a joint, such as the hip, knee or shoulder joint. This is known as a joint replacement or arthroplasty. Replacement of these joints is a major operation that involves several days in hospital followed by months of rehabilitation. Thelatest joints have a limited lifespan of 10-20 years. They are not perfect and some function may not be restored after the damaged joint is replaced by a new one. Read more about knee replacement and hip replacement . Complementary and alternative therapies Many people with rheumatoid arthritis try complementary therapies, such as: massage acupuncture osteopathy chiropractic In most cases, there is little or no evidence these are effective in the long-term, although some people may experience a short-term benefit from them. Nutritional supplements and dietary changes There is no strong evidence to suggest that specific dietary changes can help improve rheumatoid arthritis, although some people with rheumatoid arthritis feel that their symptoms get worse after they have eaten certain foods. If you think this may be the case for you, it may be useful to try avoiding problematic foods for a few weeks to see if your symptoms improve. However, it is important to ensure your overall diet is still healthy and balanced. There is also little evidence supporting the use of supplements in rheumatoid arthritis, although some can be useful in preventing side effects of medications you may be taking. For example,calciumandvitamin Dsupplements may help prevent osteoporosis if you are taking steroids andfolic acid supplements may help prevent some of the side effects of methotrexate. However, there is some evidence to suggest that taking fish oil supplements may help reduce joint pain and stiffness caused by rheumatoid arthritis. Living with rheumatoid arthritis Self-management Taking control of rheumatoid arthritis will help you cope with its impact on your lifestyle. Arthritis Care offers self-management training courses to teach techniques for living positively with arthritis. Techniques include relaxation and breathing exercises to help pain control, goal-setting exercises and positive thinking to help give you some control over your condition. A self-management programme specifically for people with rheumatoid arthritis has been developed by the National Rheumatoid Arthritis Society (NRAS). The course helps people learn more about their condition and provides practical tips on how to manage everyday life. Talk to others Many people find it helpful to talk to others in a similar position, and you may find support from an individual or group of people with rheumatoid arthritis. Patient organisations have local support groups where you can meet others diagnosed with the same condition. Call theNRAS helpline freeon0800 298 7650 to speak to a trained rheumatoid arthritis adviser. NRAS also has a team of medical advisers. You can also call Arthritis Cares free, confidential helpline on 0808 800 4050 (Monday-Friday,10am-4pm). Your feelings It can be hard to deal with the unpredictable nature of rheumatoid arthritis. Some days, the pain and stiffness will be much worse than others, and there is no way of knowing when a flare-up will occur. The difficult nature of rheumatoid arthritis can mean that some people develop depression or feelings of stress and anxiety. Sometimes, these feelings can be related to poorly controlled pain or fatigue. Living with any long-term condition makes you more likely to have a range of emotions such as frustration, fear, pain, anger and resentment. Speak to your healthcare team if you are struggling to deal with your condition emotionally. They may be able to offer medication or psychological interventions to help. Starting and raising a family If you are taking medicines for rheumatoid arthritis, let your healthcare team know if you want to start a family or ifyou are worried about becoming pregnant while on medication. Some medications, such as methotrexate, leflunomide and biological treatments, should not be taken by men or women while they are trying for a baby. The doctors and nurses will work with you to ensure your rheumatoid arthritis is controlled while you are trying to get pregnant. Babies and young children are physically and mentally demanding for any parent, but particularly so if you have rheumatoid arthritis. If you are struggling to cope, it may help to talk to other people in the same situation as you. You may also be able to get additional support from your health visitor or occupational therapist to help you manage your young family. Sex and relationships Pain, discomfort and changes in the way you feel can affect your sex life. Your self-esteem or thoughts about how you look may affect your confidence. Although many people find it difficult to talk about such private issues, there are resources that might help you. Talking to your partner or GP about the impact of rheumatoid arthritis on your sexuality and sexual relationships may help. Money and benefits If you have to stop work or work part time because of your rheumatoid arthritis, you may find it hard to cope financially. You may be entitled to one or more of the following types of financial support: If you have a job, but cannot work because of your illness, you are entitled to Statutory Sick Pay from your employer. If you do not have a job and cannot work because of your illness, you may be entitled to Employment and Support Allowance . If you are aged 64 or under and need help with personal care or have walking difficulties, you may be eligible for a Personal Independence Payment . If you are aged 65 or over, you may be able to get Attendance Allowance . If you are caring for someone with rheumatoid arthritis, you may be entitled to Carers Allowance . You may also be eligible for other benefits if you have children living at home or if you have a low household income. Telecare Self-Check online tool Visit the Telecare Self-Check online tool to find the right support for you in your area. This easy to use online tool allows you to find helpful information on telecare services that could help you live independently at home for longer. Complications of rheumatoid arthritis Having rheumatoid arthritis can put you at a higher risk of developing other conditions, particularly if it isnt well controlled. Carpal tunnel syndrome C arpal tunnel syndrome isa common condition in people with rheumatoid arthritis. It is the result of compression of the nerve that controls sensation and movement in the hands (median nerve) and can cause symptoms such as aching, numbness and tingling in your thumb, fingers and part of the hand. Symptoms of carpal tunnel syndrome can sometimes be controlled with wrist splints or corticosteroid injections, although surgery to release the pressure on the median nerve may beneeded in severe cases. Widespread inflammation Asrheumatoid arthritis is an inflammatory condition, it can cause inflammation to develop in other parts of your body, such as the: Lungs inflammation of the lungs or lung lining can lead to pleurisy or pulmonary fibrosis , which can cause chest pain , a persistent cough and shortness of breath . Heart inflammation of the tissue around the heart can lead to pericarditis, which causes chest pain. Eyes inflammation of the eyes can lead to scleritis or Sjogrens syndrome . Scleritis can cause eye redness and pain, whereas Sjogrens syndrome can cause dry eyes. Blood vessels inflammation of the blood vessels is known as vasculitis. This can lead to the thickening, weakening, narrowing and scarring of blood vessel walls. In serious cases, it can affect blood flow to your bodys organs and tissues and can be life-threatening. However, thanks to early treatment, inflammation due to rheumatoid arthritis affecting other parts of the body is becoming less common. Joint damage If rheumatoid arthritis is not treated early or is not well controlled, the inflammation in your joints could lead to significant and permanent damage. Problems that can affect the joints include: damage to nearby bone and cartilage (a tough, flexible tissue that covers the surface of joints) damage to nearby tendons (flexible tissue that attach muscle to bone), which could cause them to break (rupture) joint deformities These problems will sometimes need to be treated with surgery to prevent loss of function in the affected joints. Cardiovascular disease If you have rheumatoid arthritis, you are at a higher risk of developing cardiovascular disease (CVD) than the population at large. CVD isa general term that describes conditions affecting the heart or blood vessels, and it includes life-threatening problems such as heart attacks and strokes . Its not clear exactly why people with rheumatoid arthritis are at an increased risk of these problems, but you can reduce your risk by ensuring your arthritis is well controlled and by reducing the impact of other factors that contribute to CVD, such as by stopping smoking, eating healthily and exercising regularly. Read more about preventing CVD . Cervical myelopathy If you have had rheumatoid arthritis for some time, you are at increased risk of developing cervical myelopathy and you may need a special assessment of your neck before any operation where you are put to sleep. This condition is caused by dislocation of joints at the top of the spine, which put pressure on the spinal cord. Although relatively uncommon, it is a serious condition that can greatly affect your mobility and can lead to permanent spinal cord damage if not treated promptly with surgery. Source: MSK Expert Panel - Opens in new browser window Last updated: 13 June 2023 How can we improve this page? 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Ringworm and other fungal infections | Ringworm | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Ringworm and other fungal infections Ringworm and other fungal infections About ringworm and other fungal infections Symptoms of ringworm and other fungal infections Causes of ringworm and other fungal infections Diagnosing ringworm and other fungal infections Treating ringworm and other fungal infections Preventing ringworm and other fungal infections About ringworm and other fungal infections Ringworm is a common fungal infection that can cause a red or silvery ring-like rash on the skin. Ringworm commonly affects arms and legs, but it can appear almost anywhere on the body. Despite its name, ringworm doesnt have anything to do with worms. Other similar fungal infections can affect the scalp, feet, groin and nails. These fungal infections, medically known as tinea, are not serious and are usually easily treated. However,they arecontagious and easily spread. Tinea fungal infections There are different types of tinea fungal infection, based on the affected area of the body: ringworm(tinea corporis) affecting the body fungal nail infection (onychomycosis) affecting the nails athletes foot (tinea pedis) affecting the feet jock itch (tinea cruris) affecting the groin tinea capitis affecting the scalp Ringworm usually looks like a round, red or silvery patch of skin that may be scaly, inflamed and itchy, but other fungal infections may present themselves slightly differently. Read more about the symptoms of ringworm and other tinea fungal infections . When to see a doctor See your GP if you or your child has a fungal scalp infection, as its treated with antifungal tablets, which are only available on prescription. Symptoms of a fungal scalp infection include small patches of scaly scalp skin (which may be sore), patchy hair loss and itchiness. Other types of fungal infections (including ringworm) are generally treated with antifungal cream from the pharmacy, and you dont need to see a doctor unless it persists. However, pharmacists often prefer children to see a GP to confirm a diagnosis. Whats the cause? Fungal spores are passed between people through direct skin contact and by sharing objects such as towels, hairbrushes and bedding. Athletes foot is commonly spread in gym and swimming pool changing rooms. Pets, such as dogs and cats, can have ringworm, and you can catch it by stroking them. Read more about the causes of ringworm . Who is affected? Its estimated that 10% to 20% of people will haveringworm in their lifetime. Although children are more likely to get this, people of all ages can be affected. Groin infections are more common in young men. Fungal scalp infections (tinea capitis) are most common in children who have not reached puberty, particularly African-Caribbean children and those who live in urban areas. Treatment Most ringworm infections are mild and can be treated using a pharmacy antifungal cream. Scalp infections can be treated with antifungal tablets, sometimes combined with antifungal shampoo. If the skin is irritated or broken, it can lead to other bacterial infections, which may need treatment with antibiotics . Read more about how to treat fungal infections . Stopping it spreading Its important to prevent the infection spreading. You should avoid sharing towels, bedding or clothes with someone with a fungal infection. If you think your pet has ringworm, take it to the vet. If your pet is treated quickly, youll be less likely to catch it. If your child has a fungal infection, they can go to school, but you should inform their teacher. In addition to treatment, your child should maintain a good level of personal hygiene to prevent the infection spreading. Read more about how to stop the spread of fungal infections . Symptoms of ringworm and other fungal infections The symptoms of a tinea fungal infection depend on where the infection is. Ringworm (on the skin) The symptoms of ringworm include: a ring-like red or silvery rash on your skin your skin will look red and irritated around the ring, but healthy inside scaly, itchy and inflamed skin In more severe cases: the rings may multiply, grow in size and merge together the rings may feel slightly raised and the skin underneath may be itchy blisters and pus-filled sores may form around the rings The ring spreads outwards as it progresses. You can have one patch or several patches of ringworm, and in more serious cases, your skin may become raised and blistered. Face and neck ringworm Ringwormon the face and neck may not appear ring-shaped, but may be itchy and swollen, and it can become dry and crusted. If you have a beard, you may notice patches of hair breaking away. Hand ringworm Ringworm on the hand often causes the skin to become thicker on the palm and in between the fingers. It may affect one hand or both and normally only appears on one side. Fungal scalp infection (tinea capitis) The symptoms of a fungal scalp infection include: small patches of scaly skin on the scalp, which may be sore patchy hair loss an itchy scalp In more severe cases: small, pus-filled sores on the scalp crusting on the scalp bald patches (if your hair is affected) In very severe cases, a large inflamed sore called a kerion may form on your scalp. This can ooze pus, and you may also have a fever and swollen lymph glands. Athletes foot (tinea pedis) The main symptom of athletes foot is an itchy, dry, red and flaky rash, usually in the spaces between your toes. In more severe cases, you may have: cracked skin in the affected area blisters , which may ooze or crust swelling of the skin a burning or stinging sensation in your skin scaling patterns around your sole, between your toes and on the side of your foot Jock itch (tinea cruris) The symptoms of jock itch include: red-brown sores, which may have blisters or pus-filled sores around the edge itchiness and redness around your groin area, such as your inner thighs and bottom (the genitals are not usually affected) scaly, flaky skin on your inner thighs Exercising, walking and wearing tight clothing or underwear can make the symptoms of a groin infection worse. Fungal nail infection (onychomycosis) The symptoms of a fungal nail infection include: a whitish thickening of the nail discolouration (the nail can turn white, black, yellow or green) the nail can become brittle and start to fall off the skin around the nail may be sore and irritated Read more about fungal nail infection When to seek medical advice Make an appointment to see your GP if you: or your child develop the symptoms of a fungal scalp infection have ringworm that has not improved after two weeks of treatment with antifungal cream have another medical condition, or youre having medical treatment that is known to weaken your immune system, such as chemotherapy or steroid tablets Read more about how fungal infections are diagnosed . Causes of ringworm and other fungal infections Tinea fungal infections are caused by a particular type of fungi, called dermatophytes, which live off keratin. Keratin is a tough, waterproof tissue found in many parts of your body, including your skin, hair and nails. This explains why fungal infections mostly affect your skin, scalp or nails. How it spreads The fungi are tiny spores tough enough to survive for months on your skin, in soil or on household objects, such as combs or towels. They thrive in heat and moisture, which helps them to grow and explains why they are often spread in swimming pool changing rooms and communal showers. The spores can be spread in four different ways: human-to-human contact human-to-animal contact for example, by stroking an infected dog or cat human-to-object contact both animals and humans can leave traces of fungi spores on objects and surfaces, such as towels, clothing, bed linen, combs or brushes human-to-soil contact less commonly, it can develop after lengthy exposure to infected soil As an adult, you can become a carrier of a scalp infection without developing any symptoms. This is because your body has usually developed a defence against the infection by the time you reach adulthood. If youre a carrier of a fungal infection, you can unknowingly pass the condition on to children, who may then go on to develop symptoms. Risk groups You are more likely to develop a fungal infection if you: are very young or very old are African-Caribbean (in the case of scalp infections) have type 1 diabetes are very overweight ( obese ) have a medical condition that weakens your immune system, such as HIV or AIDS are receiving medical treatment that weakens your immune system, such as chemotherapy or steroid tablets have had fungal infections in the past have hardened arteries (atherosclerosis) have poor circulation (specifically, a condition called venous insufficiency, where the veins in your legs have trouble moving blood back to your heart) Diagnosing ringworm and other fungal infections Ringworm and other tinea fungal infections are usually easy to diagnose from their appearance and location. Fungal scalp infections Your GP will usually be able to diagnose a scalp infection after examining your scalp. Knowing exactly which fungus is causing the infection is useful, because some antifungal medications are better at treating certain types. Your GP will take a small scraping of skin from your scalp to test in a laboratory. You may be given an antifungal medication before you receive your test results. If the tests show that a different antifungal medication would work better, you will be prescribed that instead. Ringworm and other fungal infections Most fungal infections can be diagnosed by your GP after examining your skin and asking whether you have other related symptoms. Further tests will usually only be needed if your symptoms are severe or if they fail to respond to antifungal treatment. If this happens, your GP may take a small scraping of affected skin for analysis in a laboratory. Microscopic analysis will show if fungi are present and the specific type that is causing your infection. Read about how to treat ringworm and other fungal infections . Treating ringworm and other fungal infections Most tinea fungal infections, including ringworm, are easily treated by using antifungal creams, tablets or shampoo. You can also help to get rid of fungal infections and stop them from spreading by: washing areas of affected skin daily and drying thoroughly, paying particular attention to skin folds and between your toes in the case of a groin or foot infection, changing your underwear or socks daily, because fungi can persist in flakes of skin with a scalp infection, not sharing combs, hairbrushes or hats washing clothes, towels and bed linen frequently wearing loose-fitting clothes, preferably made of cotton or other natural materials Read more about preventing ringworm . Ringworm, groin infections and athletes foot Most cases of ringworm, groin infections and athletes foot can be treated using an over-the-counter antifungal cream, gel or spray. There are lots of different types, so ask your pharmacist to help you choose the right one for you. You usually apply antifungal creams, gels and sprays daily to the affected areas of skin for 2 weeks. The cream, gel or spray should be applied over the rash and to one inch of skin beyond the edge of the rash. Read the manufacturers instructions first. You may be advised to use the treatment for a further 2 weeks, to reduce the risk of re-infection. See your GP if your symptoms have not improved after 2 weeks of treatment, because you may need to take antifungal tablets. Both terbinafine and griseofulvin tablets can be used to treat ringworm infections, as well as another antifungal medicine called itraconazole. Treat groin and feet together Groin infections can sometimes occur at the same time as athletes foot. Its vital to treat both infections at the same time to avoid being re-infected with either condition. Fungal scalp infections Scalp infections are usually treated using antifungal tablets, often alongside an antifungal shampoo. There are 2 main types of antifungal tablet: terbinafine griseofulvin The antifungal medicine that your GP prescribes will depend on the type of fungi causing the infection. Terbinafine tablets Most people with fungal scalp infections are prescribed terbinafine tablets to take once a day for 4 weeks. Its an effective treatment for most cases. Side effects of terbinafine can include: nausea diarrhoea indigestion rashes These side effects are usually mild and short-lived. Some people have also reported that terbinafine temporarily affected their sense of taste. Terbinafine is not suitable for people with a history of liver disease or lupus (where the immune system attacks healthy tissue). Griseofulvin Griseofulvin is a type of antifungal medicine that prevents fungi from growing and multiplying. Its available in the form of a spray and is usually taken daily for 8 to 10 weeks. Side effects of griseofulvin can include: nausea vomiting mild diarrhoea headache indigestion However, these side effects should improve as your body gets used to the medicine. Griseofulvin can cause birth defects, so it shouldnt be taken during pregnancy, or if you intend to become pregnant soon after stopping treatment. Men shouldnt father a child within 6 months of stopping treatment. Griseofulvin is also not suitable for women who are breastfeeding, and those with severe liver disease or lupus. Griseofulvin can interfere with both the combined contraceptive pill and the progestogen-only pill, so women need to use an alternative barrier form of contraception, such as a condom , while taking it. Griseofulvin may also affect your ability to drive and can enhance the effects of alcohol. Antifungal shampoo Antifungal shampoo cannot cure scalp infections, but it can help to prevent the infection spreading and may speed up recovery. Antifungal shampoos, such as selenium sulphide and ketoconazole shampoo, are available from your pharmacist. Ideally, antifungal shampoo should be used twice a week during the first 2 weeks of treatment. There is no evidence that shaving a childs head will reduce the risk of an infection or speed up recovery. Itraconazole Itraconazole is usually prescribed in the form of capsules for 7 or 15 days. It is not recommended for use in children, elderly people or those with severe liver disease. Side effects of itraconazole can include: nausea vomiting indigestion diarrhoea headache Read about how to stop ringworm spreading or coming back . Fungal nail infections Fungal nail infections can be treated with antifungal nail paint, but it also often requires antifungal tablets. These tend to work better than nail paints, although they can cause side effects, such as headache, nausea and diarrhoea. Read more about treating fungal nail infections . Preventing ringworm and other fungal infections The following advice will help to stop fungal infections from spreading. The fungi that cause tinea infections can survive on items such as furniture, hairbrushes, clothing and towels, and can be spread through contact with these items. Therefore, if someone in your household has a fungal infection, you should: avoid sharing personal items such as combs, hairbrushes, towels, clothing and bed linen avoid scratching the affected areas of your skin or scalp, because it could spread the infection to other parts of your body Its important that other household members check themselves for signs of infection and get treatment if necessary. If you suspect that your pet is the source of the infection, take them to your vet for treatment. Patches of missing fur is a sign that an animal has ringworm. Always wash your hands after touching a pet with the infection. If someone in your family has a fungal infection, there is no need for them to stay off work or school. However, treatment should be started as soon as possible. Good personal hygiene should also be followed to stop it spreading to other children. Wearing something on your feet in gym and swimming pool changing rooms will reduce your chances of getting athletes foot. Find out how to treat fungal infections . Source: NHS 24 - Opens in new browser window Last updated: 04 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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Rosacea | Rosacea | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Rosacea Rosacea About rosacea Symptoms of rosacea Causes of rosacea Treating rosacea Preventing rosacea About rosacea Rosacea is a common but poorly understood long-term skin condition that mainly affects the face. It can be controlled tosome degree with long-term treatment, but sometimes the changes inphysical appearance can havea significant psychological impact. Symptoms of rosacea Symptoms often begin with episodes of flushing,where the skin turns red for a short period, but other symptoms can develop as the condition progresses, such as: burning and stinging sensations permanent redness spots (papules and pustules) small blood vessels in the skin becoming visible Rosacea is a relapsing condition, which means there are periods when symptoms are particularly bad, but less severe at others. Read about the symptoms of rosacea Rosacea symptoms include redness and flushing, as well as stinging and spots. Source: https://dermnetnz.org/ When to see your GP See your GP if you have persistent symptoms that could be caused by rosacea. Early diagnosis andtreatment can help stop the condition getting worse. Theres no specific test for rosacea, but your GP will often be able to diagnose the condition by: examining your skin asking about your symptoms asking about possible triggers you may have In some circumstances your GP may arrange further teststo rule out other conditions with similar symptoms, such as lupus or the menopause . For example, these could be a blood test orskin biopsy, where a small scraping of skin is removed and examined. Causes of rosacea The exactcause of rosacea is unknown, although a number of possible factors have been suggested, including abnormalities in the blood vessels of the face and a reaction to microscopic mites commonly found on the face. Although theyre not thought to be direct causes of the condition, several triggers have been identified that may make rosacea worse. These include: exposure to sunlight stress strenuous exercise hot or cold weather hot drinks alcohol and caffeine certain foods, such as spicy foods Read about causes of rosacea Treating rosacea Theres currently no cure for rosacea, but treatment can help control the symptoms. Long-term treatmentis usually necessary, although there may be periods when your symptoms improve and you can stop treatment temporarily. For most people, treatment involves a combination of self-help measures and medication, such as: avoiding known triggers for example, avoiding drinks containing alcohol or caffeine creams and gels medications applied directly to the skin to reduce spots and redness oral medications tablets or capsules that canhelp clear up more severe spots, such as oral antibiotics In some cases procedures such as laser and intense pulsed light (IPL) treatment may be helpful.These involvebeams of lightbeing aimed at the visible blood vessels in the skin to shrink them and make them less visible. Read about more about treating rosacea and self-help measures for rosacea Living with rosacea Any long-term (chronic) condition can have an adverse psychological effect, but rosacea can be particularly troublesomeas it affects your appearance. This can change how you feel about yourself and how you interact with others. Many people with rosacea have reported feelings of low self-esteem, embarrassment and frustration. Its important to try to come to terms with the fact you have a chronic condition that, although incurable, is controllable. Persevering with your treatment plan and avoiding your individual triggers are the best ways of controlling your symptoms. As your physical symptoms improve, youmay start to feel better psychologically and emotionally. If you have rosacea, take comfort in knowing youre not alone. There are millions of people living with the conditionin the UK and across the world. You can find support and information from organisations like: Changing Faces a charity for people with a visible difference or facial disfigurement, who can be contacted on0300 012 0275 for counselling and advice Speak to your GP if youre feeling depressed as a result of your condition. They may recommend further treatment if necessary. Ocular rosacea Rosacea that affects your eyes (ocular rosacea) can lead to a number of eye problems, some of which can be serious. Symptoms of ocular rosacea can include: feeling like there is something in your eyes dry eyes irritated and bloodshot eyes inflammation of the eyelids (blepharitis) Rosacea can sometimes cause the cornea, the transparent layer at the front of the eyeball, to become inflamed and damaged. This is known as keratitis. This damage can make the cornea vulnerable to ulceration and infection, which could potentially threaten your sight. Symptoms of serious problems with your corneas include: eye pain sensitivity to light (photophobia) deterioration in your vision Contact your GP immediately if you think you may have a problem with your corneas. If this isnt possible, visit your nearest accident and emergency (A&E) department . If keratitis isnt treated promptly by an ophthalmologist, a doctor who specialises in treating eye conditions, theres a risk of permanent vision loss. Symptoms of rosacea Rosacea causes a range of symptoms, although not everyone will experience them all. Most people with rosacea have periods when their symptoms are particularly troublesome, followed by periodswhen their symptoms are less so. The main symptoms of rosacea include: flushing persistent facial redness visible blood vessels papules and pustules thickened skin These are discussed in more detail below. Other symptoms associated with rosacea include: sensitive skin burning, itching, stinging andpain dry, rough skin raised red patches (plaques) on your skin facial swelling (lymphoedema) Rosacea can cause different symptoms, including facial redness and flushing. Source: https://dermnetnz.org/ Permanent damage to the face (scarring) almost never occurs in rosacea. Flushing Flushingis when your skin turns red for a short period usually a few minutes. It tends to mainly affect the face, although it can spread to your neck and chest. In some cases the redness may be accompanied by an unpleasant feeling of heat. In rosacea flushingis often caused by a certain trigger, such as sun exposure, hot drinks or exercise. See causes of rosacea for more information about possible triggers. Persistent facial redness Persistent facial redness (erythema) islikea blush or a patch of sunburn that doesnt go away, or the sort of blotchy skin often associated with drinking too much alcohol. This can be upsetting for those with rosacea as people can mistakenly assume they are heavy drinkers. The redness usually affects the cheeks, nose and chin, but may spread to other areas, such as the forehead, neck and chest. Visible blood vessels Over time the blood vessels in the skin may become permanently widened(dilated) and visible. The medical name for visible blood vessels is telangiectasia. Papules and pustules If you have rosacea, you may develop round red bumps that rise from your skin (papules) and pus-filled swellings(pustules). These spots appear on your face and are similar to acne . Rosacea used to be called acne rosacea, but the 2conditions are quite different. In rosacea there are no blackheadsandthe skin is not greasy, but dry and peeling. Rosacea spots also dont cause scarring. Thickened skin In the most serious cases of rosacea the skin can thicken and form excess tissue, usually around the nose. This causes the nose to take on a large, bulbous appearance (rhinophyma). Rhinophyma is an uncommon,severesymptom of rosacea and takes several years to develop. Italmost exclusively affects men. Causes of rosacea The exact cause of rosacea is unknown, although a number of potential factors have been suggested. Its possible a combination of these factors may be responsible for the condition, although there isnt enough evidence to say this for certain. Some of the main factors that have been suggested are outlined below. Blood vessel abnormalities Some experts believe abnormalities in the blood vessels of the face may be a major contributing factor for rosacea. This may explain symptoms of flushing, persistent redness and visible blood vessels. Its not known what causes these abnormalities. But sun damage may be responsible for degeneration of the elastic tissue of the skin and the dilation of blood vessels. Skin peptides Recent research has shown external triggers such as ultraviolet (UV) light, spicy food, alcohol (particularly red wine), exercise, stress, heat and cold can lead to theactivation of certain molecules within the skin called peptides. Increased levels of these peptides may in turn affect the immune system ornerves and blood vessels(neurovascular system) of the skin. Activation of these systems can cause dilation of blood vessels, redness and inflammation. Microscopic mites Microscopic mites called demodex folliculorum usually live harmlessly on human skin, but people with rosacea have particularly large numbers, which may play a role in the condition. It is currently uncertain whether the mite is a cause or an effect of rosacea, although someresearchers have suggested the symptoms may be caused by the skin reacting tobacteria in the mites faeces. Helicobacter pylori bacteria Helicobacter pylori bacteria are bacteriafound in the digestive system. Its been suggested these bacteria may be a possible cause of rosacea, althougha linkhasnt been proven. One theory is the bacteria may stimulate the production of a protein called bradykinin, which is known to cause blood vessels to expand. Genetics Rosacea seems to be more common in families, although its not clear which genes if any are involved or how theyre passed on. Triggers of rosacea Although theyre not thought to be direct causes ofthe condition, many people with rosacea find certain triggers make their symptoms worse. Different people can have different triggers, but triggers that have been commonly reported include: exposure to sunlight stress hot or cold weather strongwinds strenuous exercise alcohol hot baths spicy foods hot drinks humidity caffeine found in tea, coffee and cola the menopause dairy products othermedical conditions certain medicines such as amiodarone, corticosteroids and high doses of vitamins B6 and B12 Treating rosacea Although rosacea cant be cured, treatment can help keep the symptoms under control. Long-term treatment is usually necessary, although there may be periods where your symptoms improve and you can stop treatment temporarily. Treatment choices depend onwhich type of symptom is most troublesome, but usually involves a combination ofself-help measures and medication, and areoutlined below. Self-help measures There are a number ofthings you can do yourself to help keep the symptoms of rosacea under control, including: avoiding things that trigger your symptoms for example, by using sun cream and covering yourself up if direct sunlight makes your symptoms worse taking good care of your skin for example, byusingproducts suitable for sensitive skin using make-up patches of persistent red skin can be disguised using specially designed camouflage make-up keeping your eyelids clean if rosacea is causing your eyelids to become inflamed (blepharitis) Treating papules and pustules If you haveround red bumps that rise from your skin (papules) and pus-filled swellings (pustules) caused by rosacea, there are a number of different medications that can be effective. These can be divided into topical treatments that are applied to the skin, or oral treatments, which are taken by mouth. Topical treatments Topical medications are usually prescribed first. These include: metronidazole cream or gel azelaic acid cream or gel ivermectin cream Ivermectin is a relatively new medicine. Theres some evidence to suggest it may be more effective and perhaps less irritating to the skin than metronidazole, although its not currently available on the NHS everywhere and may only be recommended if the other treatments dont work. Youll usually need to apply these topical treatments once or twice a day, taking care not to get them in your eyes or mouth. It may be several weeks before you notice any significant improvement in your symptoms. Side effects of these treatments can include a burning or stinging sensation, itchiness and dry skin. Oral antibiotics If your symptoms are more severe, an oral antibiotic medication may be recommended as these can help reduceinflammation of the skin. Antibiotics often used to treat rosacea include tetracycline, oxytetracycline, doxycycline and erythromycin. These medications are usually taken for 4to 6weeks, but longer courses may be necessary if the spots are persistent. For example, a low-dose doxycycline capsule is available if oral antibiotics need to be taken long term. Common side effects of these medications include: feeling and being sick diarrhoea bloating and indigestion tummy (abdominal)pain loss of appetite Some of the medications used can alsomake your skin sensitive to sunlight and artificial sources of light, such as sun lamps and sunbeds. As with the topical treatments mentioned above, these medications usually need to be takenonce or twice a day and you may not notice a significant improvement in your symptoms for several weeks. Oralisotretinoin Isotretinoin is a medicine often used to treat severe acne ,but at lower doses its also occasionally used to treat rosacea. As isotretinoin is a strong medication that can cause a range of side effects, it can only be prescribed by aspecialistin treating skin conditions (dermatologist) and not your GP. Common side effects of isotretinoin include: dryness and cracking of the skin, lips and nostrils inflammation of your eyelids (blepharitis) oreyes (conjunctivitis) headaches muscle orjoint pain back pain blood in your urine (haematuria) mood changes Isotretinion can also cause birth defects if taken during pregnancy. Treating facial redness Treatingfacial redness andflushing caused by rosaceais generally more difficult than treating papules and pustules caused by the condition. But as well asthe self-help measures mentioned above, there are some medications that can help. Brimonidine tartrate Brimonidine tartrate is a relatively new medication for facial redness caused by rosacea. It comes in the form of agel thats applied to the face once a day. The medication works by restricting the widening (dilation) of the blood vessels in your face. Researchhas shown it can start to have an effect about 30 minutes after its first used, and this can last for around 12 hours. Common side effects ofbrimonidine tartrate include itchiness and a burning sensation where the gel is applied. Less common side effects can include: a dry mouth headaches pins and needles dry skin A rebound effect, where flushing becomes worse, has also been reported with this medication. Oral treatments Alternatively, there are a number of oral medications that may help improve redness caused by rosacea. These include: clonidine a medication that relaxes the blood vessels beta-blockers medications that decrease the activity of the heart anxiety medications medications sometimes used to help calm the person and reduce blushing Its not clear how effective these medications are at treating redness caused by rosacea, but they may sometimes be prescribed under the supervision of a dermatologist. Laser and intense pulsed light (IPL) treatment Redness and visible blood vessels (telangiectasia) can also sometimes be successfully improved with vascular laser or intense pulsed light (IPL) treatment. These treatments may also improve flushing. A referral to a dermatologist is usually required before having these treatments and theyre not usually available on the NHS, so you may need to pay for them privately. Around 2to 4treatments may be needed, so the overall cost may be significant. Laser and IPL machines produce narrow beams of light that are aimed at the visible blood vessels in the skin. The heat from the lasers damages the dilated veins and causes them to shrink so theyre no longer visible, with minimal scarring or damage to thesurrounding area. Laser treatment can cause pain, but most people dont need an anaesthetic. Side effects of laser treatment are usually mild and can include: bruising crusting of the skin swelling and redness of the skin blisters (in rare cases) infection (in very rare cases) These side effects usually only last a few days and are rarely permanent. Treating thickened skin In some people with rosacea the skin of the nose can become thickened. This is known asrhinophyma. If you have severe rhinophyma, your GP may refer you to a dermatologist or plastic surgeon todiscussways the appearance of your skin can be improved. A number of surgical treatments are available to remove any excess tissue and remodel the nose into a more pleasing shape. This may be done with alaser, a scalpel or specially designed abrasive instruments using a technique called dermabrasion. Treating eye problems If rosaceais affecting your eyes (ocular rosacea), you may require further treatment. For example, you may need to use lubricating eye drops or ointment if you have dry eyes, or oral antibiotics if you have blepharitis. Ifinitial treatment isnteffective or you develop any further problems with your eyes, youll need to be referred to an eye specialist called an ophthalmologist for further assessment and treatment. Preventing rosacea If you have rosacea, there are a number of things you can do to help keep the condition under control. Avoid triggers Many people with rosacea notice certain triggers make their symptoms worse. Although its not always practical or possible, takingstepsto avoid these triggers canhelp reduce the severity and frequency of your symptoms. If youre not sure whether your symptoms have a specific trigger, it may be useful to keep a diary to identify whether your symptoms get worse depending on thingslike the activities you do and foods or drinks you have. Advice about how to avoid some common triggers can be foundbelow. Sunlight As sunlight is the most commonly reported trigger of rosacea, you should use sun cream whenever possible, even when its overcast. A sun cream with a sun protection factor (SPF) of at least 30 is recommended. A broad-spectrum sun cream that protects against UVA and UVB light should be used. Using sun creams specifically designed for children may help reduce skin irritation. Covering exposed skin with clothes or a sun hat may also help. Try to minimise your exposure to the sun during the summer months, particularly in the middle of the day when the sun is at its hottest. But remember, sun can also be strong in the morning and evening, so take adequate precautions at these times as well. Stress Stress is also a commonlyreported trigger of rosacea. Successfully managing your stress levels can help control your symptoms. Ways you can reduce stress include: learning relaxation techniques, such asdeep breathing exercises, meditation and yoga taking regular exercise As strenuous exercise can sometimes make rosacea symptoms worse, a low-intensity exercise programme, such as walking or swimming, may be better than high-intensity activities, such as running or aerobics. Readabout stress management . Food and drink Some of the mostcommonly reported food- and drink-related triggers are alcohol and spicy foods. You may want to try completely removing these from your diet to see if your rosacea improves. Butthere are many other dietary triggers that can also affect some people with rosacea. Its a good idea to include information about how your diet affects your rosacea symptoms inyour rosacea diary. Cold weather Covering your face and nose with a scarf can help protect your skin from cold temperatures and wind. If you need to spend considerable time outside during cold weather, protect your facewith a balaclava. Skincare techniques The advice below about skincare techniques may also help control your rosacea symptoms. Clean your skin every morning and evening using a gentle, non-abrasive cleanser. Use soap-free cleansers with non-alkaline or neutral pH. Avoid scented soaps and alcohol-based skin cleansers Rinse your face with lukewarm water and allow skin to dry thoroughly before you apply medication or make-up Look for products suitable for sensitive skin. These are usually described as mild, hypoallergenic, fragrance-free and non-comedogenic (will not block pores) Use a moisturiser to soothe skin if it feels sore Avoid oil-based or waterproof cosmetics requiring solvents for removal. Use water-based make-up and skin productsinstead Avoid astringents, toners and other facial or hair products that contain ingredients that might irritate your skin, such as fragrances, alcohol, menthol, witch hazel,eucalyptus oil, camphor, clove oil, peppermint, sodium lauryl sulphate and lanolin You may want to avoid using anything on your skin that you arent sure of. You can then graduallyreintroduce products once your symptoms have been treated and cleared to see if you can use them again without any problems Men may find that using an electric razor, rather than a blade, helps reduce skin irritation Some people find regular gentle facial massage reduces swelling (lymphoedema) Dont use steroid cream unless youre specifically instructed to by your GP, as it may make your symptoms worse Skin camouflage It may be possible to disguise patches of persistent red skin using specially designed camouflage make-up. The charity Changing Faces offers a skin camouflage service , available nationally and free of charge, to help with the use of these creams. Your GP or dermatologist can refer you to the skin camouflage service and prescribe skin camouflage make-up. Eyelid hygiene If your eyelids are inflamed as a result of rosacea (blepharitis), cleaning your eyelids every day withwarm water and a small amount of cleaning solution can help ease your symptoms. Avoidingeye make-up can also help reduce your symptoms, but if you do choose towear eye make-up, make sure it is a type that washes off easily so you can still clean your eyelids. Source: NHS 24 - Opens in new browser window Last updated: 10 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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Scabies | Scabies | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Scabies Scabies About scabies Symptoms of scabies Causes of scabies Diagnosing scabies Treating scabies Complications of scabies About scabies Scabies is a contagious skin condition caused by tiny mites that burrow into the skin. The main symptom of scabies is intense itching thats worse at night. It also causes askin rash on areas where the mites have burrowed. Read more about the symptoms of scabies . Scabies mites Scabies mites are called Sarcoptes scabiei. They feed using their mouths and front legs to burrow into the outer layer of skin (epidermis), where they lay eggs. After 3to 4days, the baby mites (larvae) hatch and move to the surface of the skin, where they mature into adults. Scabies like warm places, such as skin folds, between the fingers, under fingernails, or around the buttock or breast creases. They can also hide under watch straps, bracelets or rings. Read more about the life cycle of the scabies mite . How scabies is spread Scabies is usually spread through prolonged periods of skin-to-skin contact with an infected person, or through sexual contact. Its also possible but rare for scabies to be passed on by sharing clothing, towels and bedding with someone whos infected. It can take up to 8weeks for the symptoms of scabies to appear after the initial infection. This is known as the incubation period. Read more about the causes of scabies . Scabies outbreaks Scabies is widespread in densely populatedareas with limited access to medical care, and is most common in the following tropical and subtropical areas: Africa Central and South America northern and central Australia Caribbean Islands India southeast Asia In developed countries, scabies outbreaks can sometimes occur in places where there are lots of people, such as schools, nurseries andcare homes. In the UK, most outbreaks of scabies occur in the winter. This may be because people tend to spend more time indoors and closer to each other at this time of year. Its difficult to know exactly how many cases of scabies there are in the UK. This is because many people dont visit their GP and treat the condition with non-prescription medicines. Treating scabies Visityour GP if you thinkyou have scabies.Its not usually a serious condition, but it does need to be treated. The 2most widely used treatments for scabies are permethrin cream andmalathion lotion.Both medications contain insecticides that kill the scabies mite. Permethrin 5% cream is usually recommended as the first treatment. Malathion 0.5% lotion is used if permethrinis ineffective. If your partnerhas been diagnosed with genital scabies, to avoid reinfection you should visit your nearest sexual health clinic so you can be checkedand, if necessary, treated. Avoid having sex and other forms of close bodilycontact until both you and your partner have completed the full course of treatment. Read more about diagnosing scabies and treating scabies . Complications of scabies Scabies can sometimes lead to a secondary skin infection if your skin becomes irritated and inflamed through excessive itching. Crusted scabies is arare but more severe form of scabies, wherea large number ofmites are in the skin. This can develop inolder people and those with a lowered immunity. Read more about complicationsof scabies . Symptoms of scabies The main symptoms of scabies are intense itching and a rash in areas of the body where the mites have burrowed. The itching is often worse at night, when your skin is warmer.It may take 4to 6weeks before the itching starts because this is how long it takes for the body to react to mite droppings. Symptoms will start within 1to 2days if youve had a scabiesinfection in the past. This is because your immune system will have learned to respond to a scabies infection. What does a scabies rash look like? The scabiesrash consists of tiny redspots. Scratching the rash may cause crusty sores to develop. Burrow marks can be found anywhere on the body. Theyre short (1cm or less), wavy, silver-coloured lines on the skin, with a black dot at one end that can be seen with a magnifying glass. Scabies cause burrow marks of short, wavy and silver-coloured lines. Source: https://dermnetnz.org/ A scabies rash often appears on the palms of the hands. Source: https://dermnetnz.org/ Where does a scabies rash develop? In adults, burrow marks often appear in the following areas: the folds of skin betweenfingers and toes the palms of the hands the soles and sides of the feet the wrists the elbows around thenipples (in women) around the genital area (in men) The rash usually affects the whole body, apart from the head.The following areas can be particularly affected: the underarm area around the waist the inside of the elbow the lower buttocks the lower legs the soles of the feet theknees the shoulder blades the female genital area the groin around the ankles Elderly people, young children and those with a low immune system (immunocompromised) may also develop a rash on their head and neck. Men usually have 1or more very itchy, lumpy, 3 to 10mm spots on the skin of the genitals (on the penisand scrotum). In infants and young children, burrow marks tend to appear in differentplaces on their body, including onthe: face head neck scalp palms of the hands soles of the feet Scabies mites leave small red blotches and silver-coloured lines on the skin. These marks are caused by the mites burrowing into the skin. In infants with scabies, blisters and pustules (small blisters that contain pus) may develop onthe soles of the feet and palms of the hands. Causes of scabies Scabies is a skin condition caused by the parasite Sarcoptes scabiei. The intense itching associated with scabies is thought to be caused by the immune system reacting to the mites and their saliva, eggs and faeces. The scabies mite life cycle A scabies infestation starts when a female mite burrows into your skin. Male mites move between different burrow sites looking to mate. After mating, the male mite dies and the female begins to lay eggs, whichhatch around 3to 4days later. After hatching, the young mites move to the surface of the skin, where they mature into adults after 10 to 15 days. Male mites stay on the surface of the skin, whilefemale mites burrow back into the skin to create a new burrow. The life cycle is then repeated. Without effective treatment, the life cycle of the scabies mite can continue indefinitely. Scabies mites are resistant to soap and hot water and cant be scrubbed out of the skin. How scabies is spread Scabies mites cant fly or jump, which means they can only move from one human body to another if 2people have direct and prolonged physical contact. For example, scabies mites can be transmitted by: holding hands with aninfected person for a prolonged period of time having sex with aninfected person sharingclothing, towels and bedding with an infected person (althoughthis is rare) Its unlikely that scabies will be transmitted through brief physical contact, such as shaking hands or hugging. Scabies mites can survive outside the human body for 24 to 36 hours, making infection by coming into contact with contaminated clothes, towelsor bed linen a possibility. However, itsrare for someone to be infected in this way. Scabies infestations can spread quickly because people are usually unawaretheyhave the condition until 2to 3weeks after the initial infection. Theres an increased risk of catching scabies in confined environments, such as schools and nursing homes, where people are in close proximity to one another. Diagnosing scabies Your GP should be able to diagnose scabies from the appearance of your skin, and by looking for the burrow marks of the Sarcoptes scabiei mite. However, as scabiesis spread very easily, its often possible to make a confident diagnosis if more than one family member has the same symptoms. Your GP will also want to rule out other skin conditions that may be causing your symptoms, such as eczema or impetigo (a highly contagious bacterial skin infection). Read more about the symptoms of scabies . Ink test The burrows of scabies mites can be identified by using an ink test. Ink is rubbed around an area of itchy skin before being wiped off with an alcohol pad. If scabies burrows are present, some of the ink will remain and will have tracked into the burrows, showing up as a dark line. To confirm the diagnosis, a skin sample may be gently scraped from the affected area soit can be examined under a microscope for evidence of scabies mites, their eggs and faeces (poo). Where to get help with scabies Visit your GP if you think you have scabies. If you think you have genital scabies or your partner has been diagnosed with it, visit your nearest sexual health clinic , where youll be examined and, if necessary, treated. If you decide to treat scabies yourself, youll need to have a full sexual health check to make sure you dont have any sexually transmitted infections (STIs) . To prevent reinfection, its important that all members of your household are treated, as well as any sexual partners youve had over the last 6weeks (in the case of genital scabies). If youve had genital scabies in the past, anyone youve had sex with in the previous 48 hours will need to be treated. If youre embarrassed about contacting previous sexual partners, your GP surgery or local sexual health clinic may be able to inform them that theyve been exposed to scabies on your behalf without disclosing your identity. Sexual health clinics Some sexual health clinics operate on a walk-in basis. Others work byappointment only. Its therefore a good idea to call first. When you attend a clinic, youll be asked for your name, date of birth and contact details. These details will be treated confidentially and wont be passed on to your GP without your agreement. Youll also be asked about your sexual history, including: when you last had sex whether you used condoms whether youve had an STI in the past whether youre taking any medication If youre attending a clinic for scabies, you may also be offered tests for STIs. Treating scabies See your GP immediately if you have scabies and you havent had a previous infection. Delaying treatment places other people at risk. As other more serious skin conditions can sometimes cause similar symptoms to the symptoms of scabies , your GP will need to rule these out. If you have scabies, your partner will also need to be treated regardless of whether or not they have any symptoms. This is because its highly likely that scabies will have been transmitted through close bodily contact, such as duringsex. To reduce the risk of reinfection, avoid having sex and other forms of prolonged close bodily contact, such as holding hands,until both you and your partner have completedthefull course of treatment. If youve been diagnosed with scabies, you may be advised to visit your nearest sexual health clinic to be checked and, if necessary, treated for other sexually transmitted infections (STIs) . Lotions and creams Lotions and creams are commonly used to treat scabies. Your GP, pharmacist or nurse will be able to advise you about which treatment to use. Applying the cream or lotion To prevent reinfection, all members of your household and any close contacts, including recent sexual partners, should betreated at the same time as you, even if they dont have any symptoms. The cream or lotion should be applied to theskin ofall of your body, except your head.Before you apply it, make sure your skin iscool and dry. Dont apply it after having a hot bath. If you apply it when your body is hot, it will quickly be absorbed into your skin and wont remain on the area where the scabies burrows are. When using a cream or lotion to treat scabies, you should also: read the patient leaflet that comes with the cream or lotion for details of where to apply it some products need to be applied to the whole body, including the scalp and face, whereas others must only be applied from the neck down pay particular attention to difficult-to-reach areas, like your back, the soles of your feet, in between your fingers and toes, under fingernails, and on your genitals use a cotton bud or old toothbrush to apply the treatment under fingernails and toenails put the cotton bud or toothbrush in a bag and throw it away afterwards leave the treatment on your skin for 8 to 24 hours (depending on the preparation used) before washing it off thoroughly follow the manufacturers instructions regarding how long to leave the cream or lotion on for reapply the cream or lotion immediately to any areas of skin that are washed during the period of application wash bed linen, nightwear and towels after the first application repeat the treatment process 7 days after the first application to ensure its successful the second application will ensure any mites hatched from existing eggs are killed It can take a month after treatment for the general itching to subside completely, and longer for the lumpy genital lesions to resolve. Your GP may recommend repeating thetreatment or they may prescribe a different lotion. Speak to your GP if: the itching hasnt improved after 2 weeks of treatment and you notice new burrows on your skin you experience any persistent side effects Managing a scabies infection On the day you first apply the cream or lotion, you shouldwash all bed linen, nightwearand towels ata temperature above 50C (122F). If youre unable to wash certain items,place them in a plastic bag for at least 72 hours. After this time, the scabiesmites will have died. In cases of crusted scabies, you should cleanthe floors in your house and thoroughly vacuum your carpetsand furniture, including the armchairs and sofa. If youve been diagnosed with scabies,avoid close and prolonged physical contact with others until youve applied the cream or lotion. You should alsoavoid close contact with other members of your household until their treatment has been completed. Children and adults can return to school or work after the first treatmenthas been completed. Treating the itch Your GP should be able to prescribe treatments, such as a mild steroid cream,to reduce the itchiness. Menthol cream or gel, availablefrom pharmacies without a prescription, may alsohelp relieve itchy skin. Oralsedative antihistamines are also available from your local pharmacy and can be used to control itching and help you get a better nights sleep. As this type of antihistamine can cause drowsiness, you should avoid driving or operating heavy machinery if youre affected in this way. Non-sedating antihistamines dont help relieve the itching of scabies.Check with your GP or pharmacistif youreunsure. You may continue to experience itchiness for a couple of weeks after your treatment has been completed. This is because your immune system will still be reacting to the presence of dead mites and their droppings. Visit your GP if youre still experiencing itchiness 6weeks after completingyour treatment. Complications of scabies A secondary infection and crusted scabies are 2possible complications of scabies. Secondary infection Repeatedly scratchingitchy skincaused byscabies may break the skins surface. This willmake youmore vulnerable to developing a bacterial skin infection, such as impetigo . Antibiotics may be recommended to control a secondary infection. Scabies has been known tomake some pre-existing skin conditions, such as eczema ,worse. However, other skin conditions should settle down afterthe scabies infection has been successfully treated. Crusted scabies Crusted scabies, also known as Norwegian scabies, is a more severe form of scabies. This means thousands or even millions of scabies mites are present. Normal scabies can develop into crusted scabiesafter a skin reaction. The condition affects all parts of the body, including your head, neck, nails and scalp. However, unlike normal scabies, the rash associated with crusted scabies usually doesnt itch. In crusted scabies, the increase in the number of mites causes thick, warty crusts to develop on the skin. Its often mistaken for psoriasis (a skin condition that causes red, flaky, crusty patches of skin covered with silvery scales). Crusted scabies affects people with a weakened immune system (the bodys natural defence against infection andillness). This includes: the very young people with brain disorders (neurological disorders, such as Parkinsons disease ) people with Downs syndrome pregnant women elderly people people with a condition that affects their immune system, such as HIV or AIDs people who are taking steroids to treat other medical conditions people who are having chemotherapy treatment Research has found a healthy immune system appears to interrupt the reproductive cycle of the scabies mite . For example, most people with scabies will only have 5 to 15 mites on their body at any one time. However, if you have a weakened immune system, the number of scabies mites can increase significantly. People with crusted scabies can have thousands or millions of scabies mites on their body at any one time. Because ofthe high number of scabies mites, crusted scabies is highly contagious. Even minimal physical contact with a person with crusted scabies, or with their bed linen or clothes, can lead to infection. However, contact withsomeone with crusted scabies willonly lead to the normal type of scabies in people with a healthy immune system. Crusted scabies can be treated using insecticide creams or a medicine called ivermectin, which is taken by swallowing a tablet. Ivermectin kills the mites by stopping their nervous system working. Source: NHS 24 - Opens in new browser window Last updated: 05 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Impetigo Self-help guide: Rash Other health sites BAD: scabies BAD: impetigo BASHH: sexual health Brook: advice for under 25s NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Scarlet fever | Scarlet fever | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Scarlet fever Scarlet fever Scarlet fever is a bacterial illness that mainly affects children. It causes a distinctive pink-red rash. The illness is caused by Streptococcus pyogenes bacteria, also known as Group A Streptococcus , which are found on the skin and in the throat. Scarlet fever symptoms Scarlet fever usually follows a sore throat or a skin infection, like impetigo , caused by particular strains of Streptococcus bacteria. The symptoms of scarlet fever usually develop 2 to 5 days after infection. However, the incubation period (the period between exposure to the infection and symptoms appearing) can be as short as one day or as long as 7 days. Speak to your GP if: You or your child: have symptoms of scarlet fever do not get better in a week (after seeing a GP) have scarlet fever and chickenpox at the same time are ill again weeks after scarlet fever got better this can be a sign of a complication like rheumatic fever are feeling unwell and have been in contact with someone who has scarlet fever Rash The distinctive rough pink-red rash caused by scarlet fever. https://dermnetnz.org/ The distinctive rough texture rash caused by scarlet fever. https://dermnetnz.org/ The distinctive pink-red rash caused by scarlet fever develops 12 to 48 hours after symptoms like a sore throat or headache. Red blotches are the first sign of the rash. These turn into a fine pink-red rash that feels like sandpaper to touch and looks like sunburn . It may also be itchy. On darker skin the rash may be more difficult to see although its rough texture should be apparent. The rash usually starts on the chest and stomach, but soon spreads to other parts of the body, like the: ears neck elbows inner thighs groin The rash doesnt usually spread to the face. However, the cheeks become flushed and the area just around the mouth stays quite pale. The rash will turn white if you press a glass on it. The rash usually fades after about a week, but the outer layers of skin, usually on the hands and feet, may peel for several weeks afterwards. In milder cases, sometimes called scarlatina, the rash may be the only symptom. Other symptoms of scarlet fever Other symptoms of scarlet fever may include: swollen neck glands loss of appetite nausea or vomiting red lines in the folds of the body, such as the armpit, which may last a couple of days after the rash has gone a white coating on the tongue, which peels a few days later leaving the tongue red and swollen (this is known as strawberry tongue) a general feeling of being unwell When to seek medical advice If you think you or your child may have scarlet fever, see your GP for a proper diagnosis and appropriate treatment. It usually clears up after about a week Your GP should be able to diagnose scarlet fever by examining the distinctive rash and asking about other symptoms. They may also decide to take a sample of saliva from the back of the throat so it can be tested in a laboratory to confirm the diagnosis. Theres no evidence to suggest that catching scarlet fever when pregnant will put your baby at risk. However, if youre heavily pregnant, tell the doctors and midwives in charge of your care if youve been in contact with someone who has scarlet fever. How scarlet fever spreads Scarlet fever is very infectious and can be caught by: breathing in bacteria in airborne droplets from an infected persons coughs and sneezes touching the skin of a person with a Streptococcal skin infection, such as impetigo sharing contaminated towels, baths, clothes or bed linen It can also be caught from people who have the bacteria in their throat or on their skin but dont have any symptoms. Whos affected by scarlet fever Most cases of scarlet fever occur in children under 10 (usually between 2 and 8 years of age). However, people of any age can get the illness. As its easily spread, scarlet fever is likely to affect someone in close contact with a person with a sore throat or skin infection caused by Streptococcus bacteria. Outbreaks can occur in nurseries and schools where children are in close contact with one another. The symptoms of scarlet fever will only develop in people susceptible to toxins produced by the Streptococcus bacteria. Most children over 10 years of age will have developed immunity to these toxins. Its possible to have scarlet fever more than once, but this is rare. Treating scarlet fever Most cases of scarlet fever clear up after about a week without treatment. However, your GP may recommend treatment as it: reduces the length of time youre infectious speeds up recovery lowers the risk of complications of scarlet fever With treatment, most people recover in about 4 to 5 days and can return to nursery, school or work 24 hours after starting antibiotic treatment. Without treatment, youll be infectious for 1 to 2 weeks after symptoms appear. Antibiotics Scarlet fever is usually treated with a 10-day course of antibiotics . This is often in the form of penicillin or amoxicillin tablets, although liquid may be used for young children. For people who are allergic to penicillin, alternative antibiotics like erythromycin can be used instead. The symptoms usually improve within 24 hours of starting antibiotics, with the other symptoms disappearing within a few days. However, its important that the whole course of treatment is completed to ensure the infection is fully cleared and reduce the potential for antibiotic resistance . Keep your child away from nursery or school for at least 24 hours after starting antibiotic treatment. Adults with scarlet fever should also stay off work for at least 24 hours after starting treatment. Self care Many of the symptoms of scarlet fever can be relieved using some simple self care measures. Do drink plenty of cool fluids eat soft foods (if your throat is painful) take paracetamol to bring down a high temperature use calamine lotion or antihistamines to relieve itching Complications of scarlet fever Most cases of scarlet fever dont cause complications, particularly if the condition is properly treated. However, theres a small risk of the infection spreading to other parts of the body and causing more serious infections, like: an ear infection a throat abscess (painful collection of pus) sinusitis (inflammation of the sinuses) pneumonia (inflammation of the lungs) Very rare complications that can occur at a later stage include: bacteraemia (an infection of the bloodstream) septic arthritis meningitis necrotising fasciitis (a severe infection involving death of areas of soft tissue below the skin) Streptococcal toxic shock syndrome (rapidly progressive symptoms with low blood pressure and multi-organ failure) Speak to your GP immediately if: You or child develop any of these symptoms in the first few weeks after the main infection has cleared up: feeling very unwell severe pain severe headaches vomiting diarrhoea If your GP is closed, phone the 111 service. Preventing scarlet fever from spreading Theres currently no vaccine for scarlet fever. If your child has scarlet fever, keep them away from nursery or school for at least 24 hours after starting treatment with antibiotics. Adults with the illness should also stay off work for at least 24 hours after starting treatment. GPs, schools and nurseries should be aware of the current high levels of scarlet fever and inform local health protection teams if they become aware of cases, particularly if more than one child is affected. Do cover your mouth and nose with a tissue when coughing or sneezing wash your hands with soap and water after using or disposing of tissues. Dont do not share contaminated utensils, cups and glasses, clothes, baths, bed linen or towels Source: NHS 24 - Opens in new browser window Last updated: 01 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Self-help guide: Sore throat Self-help guide: Fever in adults Self-help guide: Fever in babies Fever in adults Fever in children Streptococcus A (strep A) Other health sites Group A strep in Scotland NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Schizophrenia | Schizophrenia | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mental health Schizophrenia Schizophrenia Introduction Symptoms Causes Diagnosis Treatment Living with Introduction Schizophrenia is a long-term mental health condition that causes a range of different psychological symptoms, including: hallucinations hearing or seeing things that do not exist delusionsunusual beliefs not based on reality that often contradict the evidence muddled thoughts based on hallucinations or delusions changes in behaviour Doctors often describe schizophrenia as a psychotic illness.This means sometimes a person may not be able to distinguish their own thoughts and ideas from reality. Read more about the symptoms of schizophrenia . Why does schizophrenia happen? The exact cause of schizophrenia is unknown. However, most experts believethe condition is caused by a combination of genetic and environmental factors. It is thought certain things make you more vulnerable to developing schizophrenia, andcertain situations cantrigger the condition. Read more about the causes of schizophrenia . Who is affected? Schizophrenia is one of the most common serious mental health conditions. About1 in 100 people will experience schizophrenia in their lifetime, with many continuing to lead normal lives. Schizophrenia is most often diagnosed between the ages of 15 and 35. Men and women are affectedequally. There is no single test for schizophrenia. It is most often diagnosed after an assessment by a mental health care professional, such as a psychiatrist. It is important that schizophrenia is diagnosed as early as possible, as the chances of recovery improve the earlier it is treated. Read more about diagnosing schizophrenia . How is schizophrenia treated? Schizophrenia is usually treated with a combination of medication and therapyappropriate to each individual. In most cases, this will be antipsychoticmedicines and cognitive behavioural therapy (CBT). People with schizophrenia will usually receive help from a community mental health team (CMHT), which will offer day-to-day support and treatment. Many people recover from schizophrenia, although they may have periods when symptoms return (relapses). Support and treatment can helpreduce the impactthe condition hason your life. Read more about treating schizophrenia. Living with schizophrenia If schizophrenia is well managed, it is possible to reduce the chances of severe relapses. This can include: recognising the signs of an acute episode taking medication as prescribed talking to others about the condition There are many charities and support groups offering help and advice on living with schizophrenia. Most peoplefind it comfortingtalking to others with a similar condition. Read more about living with schizophrenia . Symptoms Changes in thinking and behaviour are the most obvious signs of schizophrenia, but people can experience symptoms in different ways. The symptoms of schizophrenia are usually classified into one of two categoriespositive or negative. positive symptoms represent a change in behaviour or thoughts, such as hallucinations or delusions negative symptoms represent a withdrawal or lack of function that you would usually expect to see in a healthy person; for example, people with schizophrenia often appear emotionless, flat and apathetic The conditionmay develop slowly. The first signs of schizophrenia, such as becoming socially withdrawn and unresponsive or experiencing changes in sleeping patterns, can be hard to identify. This is because the first symptoms often develop during adolescence and changes can be mistaken for an adolescent phase. People often have episodes of schizophrenia, during which their symptoms are particularly severe, followed by periods where they experience few or no positive symptoms. This is known as acute schizophrenia. If you are experiencing symptoms of schizophrenia, see your GP as soon as possible.The earlier schizophrenia is treated, the more successful the outcome tends to be. Read more information about how schizophrenia is diagnosed . Positive symptoms of schizophrenia Hallucinations A hallucination is when a person experiences a sensation but there isnothing ornobody there to account for it. It can involve any of the senses, but the most common is hearing voices. Hallucinations are very real to the person experiencing them, even though people around themcannot hear the voices or experience the sensations. Research using brain-scanning equipment shows changes in the speech area in the brains of peoplewith schizophreniawhen they hear voices. These studies show the experience of hearing voices as a real one, as if the brain mistakes thoughts for real voices. Some people describe the voices they hear as friendly and pleasant, but more often they are rude, critical, abusive orannoying. The voices might describe activities taking place, discuss the hearers thoughts and behaviour, give instructions, or talk directly to the person. Voices may come from different places orone place in particular, such as the television. Delusions A delusion is a beliefheld with complete conviction, even though it is based on a mistaken, strange or unrealistic view. It may affect the way people behave. Delusions can begin suddenly, or may develop over weeks or months. Some people develop a delusional idea to explain a hallucination they are having. For example, if they have heard voices describing their actions, they may have a delusion that someone is monitoring their actions. Someone experiencing a paranoid delusion may believethey are being harassed or persecuted. They may believe they are being chased, followed, watched, plotted against or poisoned, often by a family member or friend. Some people who experience delusions find different meanings in everyday events or occurrences. They may believepeople on TV or in newspaper articles are communicating messages to them alone, or that there are hidden messages in the colours of cars passing on the street. Confused thoughts (thought disorder) People experiencing psychosis often have trouble keeping track of their thoughts and conversations. Some people find it hard to concentrate and will drift from one idea to another. They may have trouble reading newspaper articles or watching a TV programme. People sometimes describe their thoughts as misty or hazy when this is happening to them. Thoughts and speech may become jumbled or confused, making conversation difficult and hard for other people to understand. Changes in behaviour and thoughts A persons behaviour may become more disorganised and unpredictable, and their appearance or dress may seem unusual to others. People with schizophrenia may behave inappropriately or become extremely agitated and shout or swear for no reason. Some people describe their thoughts as being controlled by someone else, that their thoughts are not their own, or that thoughts have been planted in their mind by someone else. Another recognised feeling is that thoughts are disappearing, as though someone is removing them from their mind. Some people feel their body is being taken over and someone else is directing their movements and actions. Negative symptoms of schizophrenia The negative symptoms of schizophrenia can oftenappear several years before somebody experiences their first acute schizophrenic episode. These initial negative symptoms are often referred to as the prodromal period of schizophrenia. Symptoms during the prodromal period usually appear gradually and slowly get worse. They include becoming more socially withdrawn and experiencing an increasing lack of care about your appearance and personal hygiene. It can be difficult to tell whether the symptoms are part of the development of schizophrenia or caused by something else. Negative symptoms experienced by people living with schizophrenia include: losing interest and motivation in life and activities, including relationships and sex lack of concentration, not wanting to leave the house, and changes in sleeping patterns being less likely to initiate conversations and feeling uncomfortable with people, or feeling there is nothing to say The negative symptoms of schizophrenia can often lead to relationship problems with friends and family because they can sometimes be mistaken for deliberate laziness or rudeness. Causes The exact causes of schizophrenia are unknown, but research suggests that a combination of physical, genetic, psychological and environmental factors can make people more likely to develop the condition. Current thinking is that some people may be prone to schizophrenia, and a stressful or emotional life event might trigger a psychotic episode. However, its not known why some people develop symptoms while others dont. Increased risk Things that increase the chances of schizophrenia developing include: Genetics Schizophrenia tends to run in families, but noone gene is thought to be responsible. Its more likelythat different combinations of genes make people more vulnerable to the condition. However, having these genes doesnt necessarily mean you will develop schizophrenia. Evidence the disorder is partly inherited comes from studies of twins. Identical twins share the same genes. Inidentical twins, if one twin develops schizophrenia, the other twin has a one in two chance of developing it too. This is true even if they are raised separately. In non-identical twins, who have different genetic make-ups, when one twin develops schizophrenia, the other only has a one in seven chance of developing the condition. While this is higher than in the general population (where the chance is about 1 in a 100), it suggests genes are not the only factor influencing the development of schizophrenia. Brain development Studies of people with schizophrenia have shown there are subtle differences in the structure of their brains. These changes arent seen in everyone with schizophrenia andcan occur in people who dont have a mental illness. But they suggestschizophrenia may partly be a disorder of the brain. Neurotransmitters These are chemicals that carry messages between brain cells. There is a connection between neurotransmitters and schizophrenia because drugs that alter the levels of neurotransmitters in the brain are known to relieve some of the symptoms of schizophrenia. Research suggestsschizophrenia may be caused by a change in the level of two neurotransmitters: dopamine and serotonin. Some studies indicatean imbalance between the two may be the basis of the problem. Others have found a change in the bodys sensitivity to the neurotransmitters is part of the cause of schizophrenia. Pregnancy and birth complications Research has shown that people who develop schizophrenia are more likely to have experienced complications before and during their birth, such as a low birth weight, premature labour, or a lack of oxygen (asphyxia) during birth. It may be that these things have a subtle effect on brain development. Triggers Triggers are things that can cause schizophrenia to develop in people who are at risk. These include: Stress The main psychological triggers of schizophrenia are stressful life events, such as a bereavement, losing your job or home, a divorce or the end of a relationship, or physical, sexual, emotional or racial abuse. These kinds of experiences, though stressful, do not cause schizophrenia, but can trigger its development in someone already vulnerable to it. Drug abuse Drugs do not directly cause schizophrenia, but studies have shown drug misuse increases the risk of developing schizophrenia or a similar illness. Certain drugs, particularly cannabis, cocaine, LSDor amphetamines, may trigger symptoms of schizophrenia in people who are susceptible. Using amphetamines or cocaine can lead to psychosis and can cause a relapse in people recovering from an earlier episode. Three major studies have shown teenagers under 15 who use cannabis regularly, especially skunk and other more potent forms of the drug, are up to four times more likely to develop schizophrenia by the age of 26. Want to know more? Mind: what causes schizophrenia? Rethink Mental Illness: Schizophrenia Royal College of Psychiatrists: cannabis and mental health Diagnosis There is no single test for schizophrenia. The condition is usually diagnosed after assessment by a specialist in mental health. If you are concernedyou may be developing symptoms of schizophrenia, see your GP as soon as possible. The earlier schizophrenia is treated, the more successful the outcome tends to be. Your GP will ask about your symptoms and check they are not the result of other causes, such as recreational drug use. Community mental health team (CMHT) If a diagnosis of schizophrenia is suspected, your GP should refer you promptly to your local community mental health team (CMHT). CMHTs are made up of different mental health professionals who support people with complex mental health conditions. A member of the CMHT team, usually a psychiatrist or a specialist nurse, will carry out a more detailed assessment of your symptoms. They will also want to know your personal history and current circumstances. To make a diagnosis, most mental healthcare professionals use a diagnostic checklist. Schizophrenia can usually be diagnosed if: you have experienced one or more of the following symptoms most of the time for a monthdelusions, hallucinations,hearing voices, incoherent speechor negative symptoms, such as a flattening of emotions your symptoms have had a significant impact on your ability to work, study or perform daily tasks all other possible causes, such as recreational drug use or bipolar disorder, have been ruled out Related illnesses Sometimes it might not be clear whether someone has schizophrenia. If you have other symptoms at the same time, a psychiatrist may have reason to believe you have a related mental illness. There are severalrelated mental illnesses similar to schizophrenia. Your psychiatrist will askhow your illness has affected you so they can confidently confirm you have schizophrenia and not another mental illness, such as: bipolar disorder (manic depression) people with bipolar disorder swing from periods of mania (elevated moods and extremely active, excited behaviour) to periods of deep depression; some people also hear voices or experience other kinds of hallucinations, or may have delusions schizoaffective disorder this is often described as a form of schizophrenia because its symptoms are similar to schizophrenia and bipolar disorder, but schizoaffective disorder is a mental illness in its own right; it may occur just once in a persons life orrecur intermittently, often when triggered by stress. You should also be assessed for post-traumatic stress disorder and other conditions,suchasdepression, anxiety and substance misuse. Getting help for someone else As a result oftheir delusional thought patterns, people with schizophrenia may be reluctant to visit their GP if they believe there is nothing wrong with them. It is likelysomeone who has had acute schizophrenic episodes in the past will have been assigned a care co-ordinator. If this is the case, contact the persons care co-ordinator to express your concerns. If someone is having an acute schizophrenic episode for the first time, it may be necessary for a friend, relative or other loved one to persuade them to visit their GP. In the case of a rapidly worsening schizophrenic episode, you may need to go to the accident and emergency (A&E) department, where a duty psychiatrist will be available. If a person who is having an acute schizophrenic episode refuses to seek help, their nearest relative can request that a mental health assessment is carried out. The social services department of your local authority can advisehow to do this. In severe cases of schizophrenia, people can be compulsorily detained in hospital for assessment and treatmentunder the Mental Health (Scotland) Act 2015 . After diagnosis If you or a friend or relative are diagnosed with schizophrenia, you may feel anxious about what will happen. You may be worried about the stigma attached to the condition, or feel frightened and withdrawn. It is important to remember that a diagnosis can be a positive step towards getting good, straightforward information about the illness and the kinds of treatment and services available. Treatment Community mental health teams Most people with schizophrenia are treated by community mental health teams (CMHTs). The goal of the CMHT is to provideday-to-day support and treatment while ensuring you have as much independence as possible. A CMHT can be made up of and provide access to: social workers community mental health nurses a nurse with specialist training in mental health conditions occupational therapists pharmacists counsellors and psychotherapists psychologists and psychiatrists the psychiatrist is usually the senior clinician in the team After your first episode of schizophrenia, you should initially be referred to an early intervention team.These specialist teams provide treatment and support, and are usually made up of psychiatrists, psychologists, mental health nurses, social workers and support workers. Care programme approach (CPA) People with complex mental health conditions, such as schizophrenia, are usually entered into a treatment process known as a care programme approach (CPA). A CPA is essentially a way of ensuring you receive the right treatment for your needs. There are four stages to a CPA: assessment your health and social needs are assessed care plan a care plan is created to meet your health and social needs care co-ordinatorappointed acare co-ordinator, sometimes known as a key worker, is usually a social worker or nurse, and is your first point of contact with other members of the CMHT reviews your treatment will be regularly reviewed and, if needed, changes to the care plan can be agreed Not everyone uses the CPA. Some people may be cared for by their GP, while others may be under the care of a specialist. You will work together with your healthcare team to develop a care plan. The care plan may involve an advance statement or crisis plan, which can be followed in an emergency. Your care plan should includea combined healthy eating and physical activity programme and, if you smoke,supportfor giving up. Your care co-ordinator will be responsible for making sure all members of your healthcare team, including your GP, have a copy of your care plan. Want to know more? Rethink Mental Illness: Care programme approach fact sheet (PDF, 483kb) Acute episodes People who have serious psychotic symptoms asthe result of an acute schizophrenic episode may require a more intensive level of care than a CMHT can provide. These episodes are usually dealt with by antipsychotic medication and special care. Crisis resolution teams (CRT) One treatment option is to contact a home treatment or crisis resolution team (CRT). CRTs treat people with serious mental health conditions who are currently experiencing an acute and severe psychiatric crisis. Without the involvement of the CRT, these people would require treatment in hospital. The CRT aims to treat people in the least restrictive environment possible, ideally in or near their home. This can be in your own home, in a dedicated crisis residential home or hostel, or in a day care centre. CRTs are also responsible for planning aftercare once the crisis has passed to prevent a further crisis from occurring. Your care co-ordinator should be able to provide you and your friends or family with contact information in the event of a crisis. Voluntary and compulsory detention More serious acute schizophrenic episodes may require admission to a psychiatric ward at a hospital or clinic. You can admit yourself voluntarily to hospital if your psychiatrist agrees it is necessary. People can also be compulsorily detained at a hospital under the Mental Health (Scotland) Act 2015 . It is only possible for someone to be compulsorily detained at a hospital if they have a severe mental disorder, such as schizophrenia, and if detention is necessary: in the interests of the persons own health and safety toprotect others People with schizophrenia who are compulsorily detained may need to be kept in locked wards. All people being treated in hospital will stay only as long as is absolutely necessaryfor them toreceive appropriate treatment and arrange aftercare. An independent panel will regularly review your case and progress. Once they feel you are no longer a danger to yourself and others, you will be discharged from hospital. However, your care team may recommendyou remain in hospital voluntarily. Advance statements If it is felt there is a significant risk of future acute schizophrenic episodes occurring, you may want to write an advance statement. An advance statement is a series of written instructions about what you would like your family or friends to do in case you experience another acute schizophrenic episode. You may also want to includecontact details for your care co-ordinator. If you want to make an advance statement, talk to your care co-ordinator, psychiatrist or GP. Antipsychotics Antipsychotics are usually recommended as the initial treatment forthe symptoms of an acute schizophrenic episode. They work by blocking the effectof the chemical dopamineon the brain. Antipsychotics can usually reduce feelings of anxiety or aggression within a few hours of use, butmay take several days or weeks to reduce other symptoms, such as hallucinations or delusional thoughts. Its important that your doctor gives you a thorough physical examination before you start taking antipsychotics, and that you work together to find the right one for you. Antipsychotics can be taken orally (as a pill) or given as an injection (known as a depot). Several slow-release antipsychotics are available.These require you to haveone injection every two to four weeks. You may only needantipsychotics until your acute schizophrenic episode has passed. However, most people take medication for one or two years after their first psychotic episode to prevent further acute schizophrenic episodes occurring, and for longer if the illness is recurrent. There are two main types of antipsychotics: typical antipsychotics the first generation of antipsychoticsdeveloped during the 1950s atypical antipsychotics newer-generation antipsychoticsdeveloped in the 1990s The choice of antipsychotic should be made following a discussion between you and your psychiatrist about the likely benefits and side effects. Both typical and atypical antipsychotics can cause side effects, although not everyone will experience them and the severity will differ from person to person. The side effects of typical antipsychotics include: shaking trembling muscle twitches muscle spasms Side effects of both typical and atypical antipsychotics include: drowsiness weight gain, particularly with some atypical antipsychotics blurred vision constipation lack of sex drive dry mouth Tell your care co-ordinator, psychiatristor GP if your side effects become severe. There may be an alternative antipsychotic you can take or additional medicinesthat will help you deal with the side effects. If you do not benefit from one antipsychotic medication after taking it regularly for several weeks, an alternative can be tried. It is important that you work with your treatment team to find the right one for you. Do not stop taking your antipsychotics without first consulting your care co-ordinator, psychiatrist or GP.If you stop taking them,you couldhave a relapse of symptoms. Your medication should be reviewed at least once a year. Want to know more? Mind: antipsychotics Royal College of Psychiatrists: depot medication Psychological treatment Psychological treatment can help people with schizophrenia cope with the symptoms of hallucinations or delusions better. They can also help treat some of the negative symptoms of schizophrenia, such as apathy or a lack of enjoyment. Psychological treatments for schizophrenia work best when they are combined with antipsychotic medication. Common psychological treatments include: Cognitive behavioural therapy (CBT) Cognitive behavioural therapy (CBT) aims to help you identify the thinking patterns that are causing you to have unwanted feelings and behaviour, and learn to replace this thinking with more realistic and useful thoughts. For example, you may be taught to recognise examples of delusional thinking. You may then receive help and advice about how to avoid acting on these thoughts. Most people will requirebetween 8 and 20 sessions of CBT over the space of6 to 12 months. CBT sessions usually last for about an hour. Your GP or care co-ordinator should be able to arrange a referral to a CBT therapist. Family therapy Many people with schizophrenia rely on family members for their care and support. While most family members are happy to help, caring for somebody with schizophrenia can place a strain on any family. Family therapy is a way of helping you and your family cope better with your condition. It involves a series of informal meetingsover a period of around six months. Meetings may include: discussing information about schizophrenia exploring ways of supporting somebody with schizophrenia deciding how to solve practical problems that can be caused by the symptoms of schizophrenia If you think you and your family could benefit from family therapy, speak toyour care co-ordinator or GP. Arts therapy Arts therapies are designed to promote creative expression. Working with an arts therapist in a small group or individually can allow you to express your experiences with schizophrenia. Some people find expressing things in a non-verbal way through the arts can provide a new experience of schizophrenia and help them develop new ways of relating to others. Arts therapies have been shown to alleviate the negative symptoms of schizophrenia in some people. NICE recommendsthat arts therapies are provided by an arts therapistregistered with the Health and Care Professions Council who has experience of working with people with schizophrenia. Want to know more? Mind: understanding talking treatments Living with As well as monitoring your mental health, your healthcare team and GP should monitor your physical health. A healthy lifestyle,including a balanced diet with lots of fruits and vegetables and regular exercise, is good for you and can reduce your risk of developing cardiovascular disease or diabetes . You should also try to avoid too much stress and get a proper amount of sleep. You should have a check-up with your GP at least once a year to monitor your risk of developing cardiovascular disease or diabetes. This will include recording your weight, checking your blood pressure, and any appropriate blood tests. Stop smoking Rates of smokingin people with schizophrenia are three times higher than in the general population. If you are a smoker, you are at a higher risk of developing cancer, heart disease and stroke. Stopping smoking has clear physical health benefits but it has also been shown to improve the mental health of people with schizophrenia. Research has shown you are up to four times more likely to quit smoking if you use NHS support as well as stop-smoking medicines, such as patches, gum or inhalators. Ask your doctor about this or phone Quit Your Way Scotland on 0800 84 84 84. If you take antipsychotic medicines and want to stop smoking its very important that you talk to your GP and/or psychiatrist before you stop as the dosage of your prescription drugs may need to be monitored and the amount you have to take could be reduced. Want to know more? Healthy eating Rethink Mental Illness: wellbeing and physical health Royal College of Psychiatrists: smoking and mental health Who is available to help me? In the course of your treatment for schizophrenia, you will be involved with many different services. Some are accessed through referral from your GP, others through your local authority. These services may include the following: community mental health teams (CMHTs) these provide the main part of local specialist mental health services, and offer assessment, treatment and social care to people living with schizophrenia and other mental illnesses trained peer support this involves the support of someone who has had schizophrenia themselvesand is now stable, andmay be availablethrough your CMHT early intervention teams these provide early identification and treatment for people with the first symptoms of psychosis; your GP may be able to refer you directly to an early intervention team crisis services specialist mental health teams that help with crises that occur outside normal office hours and allow people to be treated at home for an acute episode of illnessinstead of in hospital acute day hospitals an alternative to inpatient care in a hospital, where you can visit every day or as often as necessary assertive outreach teams deliver intensive treatment and rehabilitation in the community for people with severe mental health problems and provide rapid help in a crisis situation; staff often visit people at home, act as advocates, liaise with other services (such as your GP or social services), andcan also help with practical problems (such as helping to find housing and work), and daily tasks (such as shopping and cooking) advocates trained and experienced workers who help people communicate their needs or wishes, get impartial information, and represent their views to other people; they can be based in your hospital or mental health support groups, or you can find an independent advocate to act on your behalf Want to know more? Mind: Mind in your area Rethink Mental Illness: treatment and support Employment and financial support Avoid too much stress, including work-related stress. If you are employed, you may be able to work shorter hours or in a more flexible way. Under the Equality Act 2010 , all employers must make reasonable adjustments for people with disabilities, including people diagnosed with schizophrenia or other mental illnesses. Severalorganisations provide support, training and advice for people with schizophrenia who wish to continue working. Your community mental health team is a good first point of contact to find out what services and support are available for you. Mental health charities such as Mind or Rethink Mental Illness are also an excellent source of information on training and employment. If you are unable to work as a result of your mental illness, you are entitled to financial support, such as Incapacity Benefit. Want to know more? GOV.UK: disability and the Equality Act 2010 GOV.UK: Incapacity Benefit Money Advice Service Talk to others Many people find it helpful to meet other people with the same experiences for mutual support and to share ideas. It is also an important reminder that you are not alone. Charities and support groups allow individuals and families to share experiences and coping strategies, campaign for better services, and provide support. Useful charities, support groups and associations include: Hearing Voices Network Mind Rethink Mental Illness SANE There are also other places that offer support to people with schizophrenia and other mental illnesses. Day centres Even if you do not have a job or are unable to work, it is still important to go out and do everyday things andgive a structure to your week. Many people regularly go to a day hospital, day centre or community mental health centre. These offer a range of activities thatallow you to get active again and spend some time in the company of other people. Work projects These provide training to help you develop your work skills and support you back into work. They often have contacts with local employers. Supported accommodation This could be a bedsit or flat where there is someone around who is trained to support you and help you deal with day-to-day problems. Peer support You may be offeredthe chance tomeet regularlywith a trained peer support worker who has recovered from psychosis or schizophrenia themselves. Want to know more? Mind: housing and mental health What can family, friends and partners do to help? Friends, relatives and partners have a vital role in helping people with schizophrenia recover and make a relapse less likely. 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Schizophrenia | to stay positive and supportive when dealing with a friend or loved ones mental illness. As well as supporting the person with schizophrenia you may want to get support to cope with your own feelings.Several voluntary organisations provide help and support for carers. Friends and family should tryto understand what schizophrenia is how it affects people and how they can help.You can provide emotional and practical support and encourage people to seek appropriate support and treatment. As part of someones treatment you may be offered family therapy. This can provide information and support for the person with schizophrenia and their family. Friends and family can play a major role by monitoring the persons mental state watching out for any signs of relapse and encouraging them to take their medication and attend medical appointments. If you are the nearest relative of a person who has schizophrenia you have certain rights that can be used to protect the patients interests. These include requesting that the local social services authority ask an approved mental health professional to consider whether the person with schizophrenia should be detained in hospital. Want to know more? Mind: how to cope as a carer Depression and suicide Many people with schizophrenia experience periods of depression . Do not ignore these symptoms.Ifdepression is not treated it can worsen and lead to suicidal thoughts. Studies have shown thatpeople with schizophrenia have a higher chance of committing suicide. If you have been feeling particularly down over the last month and no longer take pleasure in the things you used to enjoy you may be depressed. See your GP for advice and treatment. Immediately report any suicidal thoughts to your GP or care co-ordinator. The warning signs of suicide The warning signs that people with depression and schizophrenia may be considering suicide include: making final arrangementssuch as giving away possessions making a will or saying goodbye to friends talking about death or suicide this may be a direct statement such as I wish I was dead or indirect phrases such as I think that dead people must be happier than us or Wouldnt it be nice to go to sleep and never wake up? self-harmsuch as cutting their arms or legs or burning themselves with cigarettes asudden lifting of mood thiscould mean a person has decided to commit suicide and feels better because of their decision Helping a suicidal friend or relative If you see any of these warning signs: get professional help for the person such as from a crisis resolution team (CRT) or the duty psychiatrist at your local A&E department let them know they are not alone and you care about them offer your support in finding other solutions to their problems If you feel there is an immediate danger of the person committing suicide stay with them or have someone else stay with them. Remove allavailable means of suicide such as sharp objects and medication. | null | null | null | null | null | null | null | null | null | null | null | null | null |
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Scoliosis | Scoliosis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Muscle, bone and joints Conditions Scoliosis Scoliosis About scoliosis Causes of scoliosis Diagnosing scoliosis Treating scoliosis in children Treating scoliosis in adults Possible complications of scoliosis About scoliosis Scoliosis is the abnormal twisting and curvature of the spine. It is usually first noticed by a change in appearance of the back. Typical signs include: a visibly curved spine one shoulder being higher than the other one shoulder or hip being more prominent than the other clothes not hanging properly a prominent ribcage a difference in leg lengths Back painis common in adults with scoliosis. Young people with scoliosis may also experience some discomfort but its less likely to be severe. When to get professional help If you or your childhave signs of scoliosis, make an appointment to see your GP.They can examine your back and can refer you for an X-ray for confirmation. If you or your child are diagnosed with scoliosis, its important to see a scoliosis specialist to talk about treatment options. Read more about diagnosing scoliosis . Rarely scoliosis can cause a condition called cauda equina syndrome to develop. Cauda equina syndrome is a rare but serious back condition which can lead to permanent damage or disability. If you develop this condition youll need to be seen by an emergency specialist spinal team. Phone 111 if: there has been a new, significant trauma within the last 7 days, for example a fall from height or direct blow to the back Or you have experienced a new onset of the following symptoms: loss of feeling/pins and needles between your inner thighs or genitals numbness in or around your back passage or buttocks altered feeling when using toilet paper to wipe yourself increasing difficulty when you try to urinate increasing difficulty when you try to stop or control your flow of urine loss of sensation when you pass urine leaking urine or recent need to use pads not knowing when your bladder is either full or empty inability to stop a bowel movement or leaking loss of sensation when you pass a bowel motion change in ability to achieve an erection or ejaculate loss of sensation in genitals during sexual intercourse What causes scoliosis? In aroundeight out of every 10 cases, a cause for scoliosis is not found. This is known as idiopathic scoliosis. A small number of cases are caused by other medical conditions, including: cerebral palsya condition associated with brain damage muscular dystrophy a genetic condition that causes muscle weakness Marfan syndrome a disorder of the connective tissues Rarely, babies can be born with scoliosis,as a result ofa problem with the development of the spine in the womb. In adults, age related changes in the discs and joints of the spine and a reduction in bone density may cause scoliosis. Adults can also experience worsening over time of previously undiagnosed or untreated scoliosis. Read moreabout the causes of scoliosis . Who is affected It used to be thought that scoliosis was only a childhood condition, but its now increasingly recognised as a condition that affects older adults as well. It can developat any age, but is most common in children aged 10-15. In the UK, around three or four in every 1,000childrenneed treatment for scoliosis. Its more common in females than males. How scoliosis is treated Treatment for scoliosis depends on your age,how severe it is, and whether its thought it will worsen with time. In very young children, treatment is not always necessary because the curvature of the spine may improve naturally as they get older. If treatment is necessary, bracing or casting may be used to attempt to halt the curves progression. If the infant or younger childs curve continues to progress despite bracing or casting, an operation may be necessary. This will usually involve inserting metal rods into the back to stabilise the spine, which are lengthened at regular intervals as your child grows. In older children and adults, it is unlikely that scoliosis will improve with time, and in some it may progressively worsen. The main treatments for older children are: a back brace worn until they stop growing, to prevent the spine from curving further surgery to correct the curvature where the spine is straightened using rods attached to the spine by screws, hooks and/or wires In adults, treatment primarily aims to relieve any pain. Non-surgical options, such as painkillers and exercises are often tried first, with correctional surgery seen as a last resort. Read more about treating scoliosis in children and treating scoliosis in adults . Further problems Scoliosis can sometimes lead tofurther emotional and physical problems. Having a visibly curved spine or wearing a back brace can cause problems related to body image, self-esteem and overall quality of life. This is particularly the case for children and teenagers with scoliosis. If this is a problem for you or your child, you may find it useful to contact a scoliosis support group, such as Scoliosis Association UK . These groups are a good source ofinformation and support for people with scoliosis. In rare cases, scoliosis can lead to physical problems if its severe. For example, significant curvature of the spine can sometimes put increased pressure on the heart and lungs. Read more about the possible complications of scoliosis . Causes of scoliosis In most cases, the cause of scoliosis is unknown and it cannot usually be prevented. It is notthought to be linkedwith things such as bad posture, exercise or diet. If the cause of scoliosis is unknown,it is called idiopathic scoliosis. About eight out of every 10 cases of scoliosis are idiopathic. However, researchers have foundthere isa family history of the condition in someidiopathic cases,which suggestsa possible genetic link. Idiopathic scoliosis can affect adults and children.Some casesmay only become noticablein later life. Known causes In a small number of cases, a cause is identified. Other health conditions Some cases of scoliosis are caused by conditions that affect the nerves and muscles (neuromuscular conditions), such as: cerebral palsy a condition thataffects the brain and nervesand occurs during or shortly after birth muscular dystrophy a genetic condition that causes muscle weakness neurofibromatosisagenetic condition that causes benign tumours to grow along your nerves Scoliosis can also develop as part of a pattern of symptoms called a syndrome. This is known as syndromic scoliosis. Conditions that can cause syndromic scoliosis include: Marfan syndrome a disorder of the connective tissues inherited by a child from their parents Rett syndrome a genetic disorder, usually affecting females, which causes severe physical and mental disability These conditions are usually diagnosed at a young age and children with them are often monitored for problemssuch asscoliosis. Birth defects In rare cases, babies can be born with scoliosis. This is known as congenital scoliosis. Congenital scoliosis is caused by the bones in the spine developing abnormally in the womb. Long-term damage In adults, scoliosis can sometimes be caused by gradual deterioration to the parts of the spine. This is known as degenerative scoliosis. This can occur because some parts of the spine become narrower and weaker ( osteoporosis ) with age. Diagnosing scoliosis Scoliosis can usually be diagnosed after a physical examination of the spine, ribs, hips and shoulders. You may be asked to bendforward to see if any areas areparticularly prominent. For example, one of your shoulders may be higher than the other or there may be a bulge in your back. Initial examinations are usually carried out by a GP. If scoliosis is suspected, you should be referred to an orthopaedic specialist (a specialist in conditions that affect the skeleton) for further tests and to discuss treatment. Scans The orthopaedic specialist will take an X-ray to confirm the diagnosis of scoliosis. The X-ray images will also help determine the shape, direction, location and angle of the curve. The medical name for the anglethe spine curvesis known as the Cobb angle. In some cases,scans such as a magnetic resonance imaging (MRI) scan or a computerised tomography (CT) scan may also be recommended. Treating scoliosis in children If your child has scoliosis, their treatment will depend on their age and how severe it is. The main treatment options are: observation casting bracing surgery These are described below. There is a separatepageabout treating scoliosis in adults . Observation Treatment is not always necessary for very young children because their condition often corrects itself as they grow. However, if the curve does not correct itself, it can reduce the space for the internal organs to develop in, so careful monitoring by a specialist is important. Your specialist will usually recommend having regular X-rays to monitor the curvature to see if it improves, stays the same, or gets worse. Casting In some cases affecting young children, the spine may need to be guided during growth in an attempt to correct the curve. In a child aged under two years of age, this can sometimes be achieved by using a cast. A cast is an external brace to the trunk made out of a lightweight combination of plaster and modern casting materials. The cast is worn constantly and cannot be removed, but is changed regularly to allow for growth and remodelling. The cast will be changed under anaesthetic every two to three months with the aim of gradually straightening the spine. However, your child may still need to use a removable brace (see below) after treatment. Bracing If the curve of your childs spine is getting worse, your specialist may recommend they wear a back brace while they are growing. A brace cannot cure scoliosis or correct the curve, but it may stop the curve from getting worse. However, while there is some evidence bracing may be of benefit in certain cases, its not recommended by all scoliosis specialists. If a brace is used, it will need to be carefully fitted to your childs spine. To do this, a cast of your childs back may need to be taken. This can be done as an outpatient which means that your child will not have to stay overnight in hospital. Braces are often made of rigid plastic, although flexible braces are sometimes available. In general, modern back braces are designed so they are difficult to see under loose-fitting clothing. Its usually recommended that the brace is worn for 23 hours a day, and is only removed for baths and showers. The brace should not interfere with normal everyday activity and can be worn during most non-contact sports. However, it should be removed during contact sports and swimming. Regular exercise is important for children wearing a brace. This helps improve muscle tone and body strength, and will help make wearing the brace more comfortable. The brace will usually have to be worn for as long as your childs body is still growing. For most children, this will mean they can stop wearing it when they are around 16 or 17 years old. Surgery If your child has stopped growing and their scoliosis is severe, or other treatments have been unsuccessful, corrective surgery may be recommended. They type of surgery will depend on your childs age. Surgery in children For younger children, generally those under the age of ten, an operation may be carried out to insert growing rods. These rods aim to allow for continued controlled growth of the spine while partially correcting the scoliosis. After surgery to insert the rods, your child will need to return to their specialist every 4-6 months to have the rods lengthened to keep up with the childs growth. This procedure will be done through a small incision, and takes place often as a day case or an overnight stay. In some cases, rods that can be lengthened using external magnets during an outpatient appointment may be used. Many children will also have to wear a brace to protect the growth rods. When your child stops growing, the adjustable rods can be removed and a spinal fusion (see below) will be carried out. Surgery in teenagers and young adults In teenagers and young adults whose spine has stopped growing, an operation called a spinal fusion may be carried out. This is a major operation where the spine is straightened using metal rods attached with screws, hooks, and/or wires, and bone grafts are used to fuse the spine in place. This metalwork will usually be left in place permanently, unless they cause any problems. The surgery will take several hours. After surgery, your child will be transferred to an intensive care unit (ICU) or high dependency unit (HDU), where they will be given fluids through a vein (intravenously) and pain relief. Most children are well enough to leave intensive care after a day or two, although they will often need to spend another five to 10 days in hospital. After the operation, most children can return to school after a few weeks and can play sports after a few months. Contact sports should be avoided for 9-12 months. Occasionally a back brace may need to be worn to protect the metal rods after surgery. Risks of surgery Spinal fusion surgery is a major operation which, like any surgical procedure carries a risk of complications. It will not be recommended unless the surgeon feels the benefits outweigh these risks. Some of the main risks the spinal fusion procedure include: bleeding if this is severe your child may need ablood transfusion wound infection this can usually be treated with antibiotics the implants moving or the grafts failing to fuse properly additional surgery may be required to correct this in rare cases, damage to the nerves in the spine this can lead to permanent numbness in the legs, and can sometimes cause paralysis of the legs and loss of control of the bowels and bladder Its important that parents and children understand the risks of spinal fusion surgery so that they can make an informed decision about treatment. Make sure you discuss the potential complications with your childs surgeon. Additional therapies There is no reliable evidence to suggest that other therapies such as osteopathy and chiropractic can be used to correct the curvature of the spine or stop it progressing. The role of scoliosis specific exercises is currently under investigation. Physiotherapy may be beneficial when used in combination with a back brace. Exercise can help significantly with any muscular pain experienced with scoliosis, and back health in general. Treating scoliosis in adults Back painis one of the main problems caused by scoliosis in adults, so treatment is mainly aimed at pain relief. In some cases, surgery may be carried out to improve the shape of the spine as a way of helping with back and leg pains. Medication Painkilling medication is usually recommendedto help relieve the painthat can be associated with scoliosis. Over-the-counter painkillers, such as paracetamol and ibuprofen , are often recommended initially. See your GP if these dont work. They may prescribe stronger painkillers or refer you to a specialist pain management clinic. In some cases, corticosteroids or local anaesthetic may be injectedinto your back to relieve pain caused by the bones in your spinecompressing or irritating nearby nerves. However, these injections onlywork in theshort-term and are mostly useful in helping work out where your pain iscomingfrom. If its thought that osteoporosis of your spine is contributing to your symptoms, you may be given medication and supplements to strengthen your bones. Read more about treating osteoporosis . Exercise General strengthening and stretching exercises canimprove your general posture and flexibility,and may help control any back pain. Exercises can also help you maintain a healthy weight, which can reduce the strain on your back. Some people may benefit from physiotherapy, where they are taught specific exercises to carry out. Bracing Braces are not often used to treat scoliosis in adults, although they canprovide pain relief in some cases. A bracemay be considered as an alternative to surgery if you are not well enough to undergo an operation. Surgery Surgery for adults with scoliosis is usually only recommended if the curve in the spine is severe, if its getting significantly worse, for back pain related to standing in an abnormal posture, or if the nerves in the spine are being compressed. There are two types of surgery: decompressionsurgery if a disc or bone is pressing down on a nerve, it can be removed to reduce the pressure on the nerve spinal fusion surgery where the position of the spine isimproved using metal rods, plates and screws before being fused into place using bone grafts These are major operationsand it can take up to a year or more to fully recover from them. They also carry a risk of potentially serious complications, including: failureto reducepain surgery is generally better at relieving pain that radiates to the legs, rather than back pain theimplants becoming displaced, broken or loose infection blood clots rarely, damageto the nerves in the spine in severe cases this can result inpermanent leg numbness and the loss of bladder or bowel control Read more about lumbar decompression surgery . Possible complications of scoliosis Physical complications of scoliosis are rare, although serious problems can develop if its left untreated. Emotionalissues Having a visibly curved spine orwearing a back brace may cause problems related to body image, self-esteem and overall quality of life. This is particularly the case for children and teenagers with scoliosis. Modern back braces are designed to bedifficult to see under loose-fitting clothing, but your child may still worry that they look different or unusual. Encouraging your child to talk with other teenagers who have scoliosis can helpimprove their confidence and lessen any feelings they are alone with their condition. There are several support groups, such as the Scoliosis Association UK , that provide information and support for people with scoliosis. Some also host message boards soteenagers from across the world can compare experiences, share tips and exchange messages of encouragement. Lung and heart problems In particularly severe cases of scoliosis the ribcage can be pushed against the heart and lungs, causing breathing problems and making it difficult for the heart to pump blood around the body. This can also increase the chances of lung infections, such as pneumonia , and lead to problems such as heart failure . Nerve compression In some cases of scoliosis, particularly those affecting adults, the bones in the spine compress nearby nerves. In severe cases, this can cause problems such as: back and leg pain numbness or weakness in the legs When to get professional help Rarely scoliosis can cause a condition called cauda equina syndrome to develop. Cauda equina syndrome is a rare but serious back condition which can lead to permanent damage or disability. If you develop this condition youll need to be seen by an emergency specialist spinal team. Phone 111 if: there has been a new, significant trauma within the last 7 days, for example a fall from height or direct blow to the back Or you have experienced a new onset of the following symptoms: loss of feeling/pins and needles between your inner thighs or genitals numbness in or around your back passage or buttocks altered feeling when using toilet paper to wipe yourself increasing difficulty when you try to urinate increasing difficulty when you try to stop or control your flow of urine loss of sensation when you pass urine leaking urine or recent need to use pads not knowing when your bladder is either full or empty inability to stop a bowel movement or leaking loss of sensation when you pass a bowel motion change in ability to achieve an erection or ejaculate loss of sensation in genitals during sexual intercourse Source: MSK Expert Panel - Opens in new browser window Last updated: 20 December 2023 How can we improve this page? 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Septic shock | Septic shock | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Blood and lymph Septic shock Septic shock Septic shock is a life-threatening condition that happens when your blood pressure drops to a dangerously low level after an infection. Any type of bacteria can cause the infection. Fungi such as candida and viruses can also be a cause, although this is rare. At first the infection can lead to a reaction called sepsis. This begins with: weakness chills a rapid heart and breathing rate Left untreated, toxins produced by bacteria can damage the small blood vessels, causing them to leak fluid into the surrounding tissues. This can affect your hearts ability to pump blood to your organs, which lowers your blood pressure and means blood doesnt reach vital organs, such as the brain and liver. Phone 999 immediately if: You think that you or someone in your care has symptoms of septic shock like: low blood pressure (hypotension) that makes you feel dizzy when you stand up a change in your mental state, like confusion or disorientation diarrhoea nausea and vomiting cold, clammy and pale skin Who is more at risk of developing septic shock? People with a weakened immune system have an increased risk of developing septic shock. This includes: newborn babies elderly people pregnant women people with long-term health conditions, such as diabetes, cirrhosis or kidney failure people with lowered immune systems, such as those with HIV or AIDS or those receiving chemotherapy Treating septic shock Youll usually be admitted to an intensive care unit (ICU) so your bodys functions and organs can be supported while the infection is treated. In some cases treatment may start in the emergency department. Treatment may include: oxygen therapy fluids given directly through a vein (intravenously) medication to increase your blood flow antibiotics surgery (in some cases) Oxygen therapy To help you breathe more easily, youll be given oxygen through a face mask, a tube inserted into your nose, or an endotracheal tube inserted into your mouth. If you have severe shortness of breath , a mechanical ventilator may be used. Increasing blood flow Youll probably be given fluids directly into a vein. This will help raise your blood pressure by increasing the amount of fluid in your blood. To increase the blood flow to your vital organs, such as your brain, liver, kidneys and heart, you may be prescribed inotropic medicines or vasopressors. Inotropic medicines Inotropic medicines (inotropes), such as dobutamine, stimulate your heart. They increase the strength of your heartbeat, which helps get oxygen-rich blood to your tissues and organs, where its needed. Vasopressors Vasopressors include: dopamine adrenaline noradrenaline These medicines will cause your blood vessels to narrow, increasing your blood pressure and the flow of blood around your body. This will allow your vital organs to start functioning properly. Antibiotics Antibiotics are often used to treat the associated bacterial infection. The type of antibiotic used depends on the type of bacterial infection and where in the body the infection started. You may be started on antibiotics immediately to increase your chances of survival. Initially, two or three types of antibiotics may be used. The most effective type of antibiotic can be used once the bacterium responsible for the infection is identified. Surgery In severe cases of sepsis or septic shock, the large decrease in blood pressure and blood flow can kill organ tissue. If this happens, surgery may be required to remove the dead tissue. Complications of septic shock The chances of surviving septic shock will depend on: the cause of infection the number of organs that have failed how soon treatment is started Complications of septic shock can include: inability of the lungs to take in enough oxygen (respiratory failure) the heart not being able to pump enough blood around the body (heart failure) kidney failure or injury abnormal blood clotting These are serious health conditions that will need to be treated urgently. Septic shock can be fatal because of complications like these. Source: NHS 24 - Opens in new browser window Last updated: 18 January 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Sepsis Heart failure Other health sites Surviving Sepsis Campaign UK Sepsis Trust healthtalk.org: patient experiences British Heart Foundation: Heart failure Chest Heart & Stroke Scotland: Heart failure Intensive Care Society NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Shingles | Shingles | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Shingles Shingles Shingles, also known as herpes zoster, is an infection of a nerve and the skin around it. Its caused by the varicella-zoster virus, which also causes chickenpox. Symptoms of shingles The main symptom of shingles is pain, followed by a rash that develops into itchy blisters . These look like chickenpox . Sometimes shingles causes symptoms that develop a few days before the painful rash. This includes symptoms like: a headache burning, tingling, numbness or itchiness of the skin in the affected area a feeling of being generally unwell a high temperature (fever) Shingles rash The shingles rash usually appears on one side of your body. It develops on the area of skin related to the affected nerve. New blisters can appear for up to a week. A few days after appearing they become yellowish in colour, flatten and dry out. Scabs then form where the blisters were, which may leave some slight scarring. Examples of the shingles rash Shingles on the back Shingles on the chest Shingles on the face Shingles on back of neck Shingles pain Most people with shingles experience a localised band of pain in the affected area. The pain may be a constant, dull or burning sensation and its intensity can vary from mild to severe. You may have sharp stabbing pains from time to time, and the affected area of skin will usually be tender. Getting advice from a GP or pharmacist Contact your GP practice if: You havent had chickenpox before, youve been exposed to someone who has chickenpox or shingles and you: are pregnant have a weakened immune system (the bodys natural defence system) are under 18 years old If your GP is closed, phone 111. Speak to a pharmacist if: youre 18 years or over and have symptoms of shingles If the pharmacist cannot treat you they may recommend you see your GP. Find your nearest pharmacy Causes of shingles When you catch chickenpox the virus stays in your body. It can become active again later on if your immune system is lowered and cause shingles. Your immune system can be lowered by things like: stress other illnesses or conditions treatments like chemotherapy Its possible to have shingles more than once, but its very rare to get it more than twice. Treating shingles Theres no cure for shingles. But, there are ways to ease your symptoms until the condition improves. Shingles symptoms usually get better in 2 to 4 weeks. Speak to your GP or pharmacist as soon as you get symptoms of shingles. Early treatment may help to reduce the severity of the condition and complications. Treating symptoms at home Do keep the rash as clean and dry as possible wear loose-fitting clothing use a cool damp cloth to soothe the skin and keep blisters clean try calamine lotion to help relieve itching Dont do not let dressings or plasters stick to the rash do not use antibiotic cream this slows healing Other treatments for shingles Your GP or pharmacist may recommend painkillers to ease discomfort caused by shingles. This includes: paracetamol non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen opioids used for more severe pain antidepressants used for severe pain anticonvulsants used for severe pain Some people with shingles may also be prescribed antiviral tablets. Preventing the spread of shingles You cant give shingles to other people. But, other people can catch chickenpox from you if they havent had it before. If you have shingles, youre contagious until the last blister has dried and scabbed over. To help prevent the virus being passed on: Dont do not share towels or flannels do not go swimming do not play contact sports do not go work or school if your rash is weeping (oozing fluid) and cant be covered Chickenpox Chickenpox can be particularly dangerous for certain groups of people. If you have shingles, avoid: pregnant women who havent had chickenpox before people with a weak immune system, for example someone with HIV or AIDS babies less than 1 month old (unless its your own baby) Complications of shingles Complications can sometimes occur as a result of shingles. They are more likely if your immune system is low, (the bodys natural defence system), or are elderly. Shingles is rarely life threatening. Complications, though, can mean that around 1 in every 1,000 cases in adults over the age of 70 is fatal. Complications can include: postherpetic neuralgia eye problems Ramsay Hunt syndrome the rash becoming infected with bacteria white patches (a loss of pigment) or scarring in the area of the rash inflammation of the lungs (pneumonia) , liver (hepatitis), brain (encephalitis), spinal cord (transverse myelitis), or protective membranes that surround the brain and spinal cord (meningitis) these complications are rare. The shingles vaccine Read about the shingles vaccine and find out if youre eligible Source: NHS 24 - Opens in new browser window Last updated: 16 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Shingles vaccine Other health sites The Pain Toolkit Pain Concern British Pain Society: FAQs Age UK Find your nearest pharmacy Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Shortness of breath | Shortness of breath | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Lungs and airways Shortness of breath Shortness of breath Sudden shortness of breath, or breathing difficulty (dyspnoea), is the most common reason for visiting a hospital accident and emergency department. Its also one of the most common reasons people phone 999 for an ambulance. Its normal to get out of breath when youve overexerted yourself, but when breathlessness comes on suddenly and unexpectedly, its usually a warning sign of a medical condition. The information below outlines the most common reasons for: sudden shortness of breath long-term shortness of breath This guide shouldnt be used to self-diagnose your condition, but should give you an idea of whats causing your breathlessness. When to phone a doctor You should phone your GP immediately if you have sudden unexpected shortness of breath, as there may be a problem with your airways or heart. Your GP will assess you over the phone, and may either visit you at home or admit you to hospital. If your shortness of breath is mild or the result of anxiety, you may be asked to come to the surgery rather than a home visit. If youve struggled with your breathing for a while, dont ignore it. See your GP as its likely you have a long-term condition, such as obesity , asthma or chronic obstructive pulmonary disease (COPD) , which needs to be managed properly. Your doctor may ask you some questions, such as: Did the breathlessness come on suddenly or gradually? Did anything trigger it, such as exercise? How bad is it? Does it only happen when youve been active, or when youre not doing anything? Is there any pain when you breathe? Do you have a cough? Do certain positions make it worse for example, are you unable to lie down? Feeling like you cant get enough air can be terrifying, but doctors are well trained in managing this. You may be given extra oxygen to breathe if this is needed. Causes of sudden shortness of breath Sudden and unexpected breathlessness is most likely to be caused by one of the following health conditions. Click on the references at the end for more information about these conditions. A problem with your lungs or airways Sudden breathlessness could be an asthma attack. This means your airways have narrowed and youll produce more phlegm (sticky mucus), which causes you to wheeze and cough. Youll feel breathless because its difficult to move air in and out of your airways. Your GP may advise you to use a spacer device with your asthma inhaler. This delivers more medicine to your lungs, helping to relieve your breathlessness. Pneumonia (lung inflammation) may also cause shortness of breath and a cough. Its usually caused by an infection, so youll need to take antibiotics . If you have COPD, its likely your breathlessness is a sign this condition has suddenly got worse. A heart problem Its possible to have a silent heart attack without experiencing all the obvious symptoms, such as chest pain and overwhelming anxiety. In this case, shortness of breath may be the only warning sign youre having a heart attack. If you or your GP think this is the case, theyll give you aspirin and admit you to hospital straight away. Heart failure can also cause breathing difficulties. This life-threatening condition means your heart is having trouble pumping enough blood around your body, usually because the heart muscle has become too weak or stiff to work properly. It leads to a build-up of fluid inside the lungs, which makes breathing more difficult. A combination of lifestyle changes and medicines or surgery will help the heart pump better and relieve your breathlessness. Breathlessness could also relate to a problem with your heart rate or rhythm, such as atrial fibrillation (an irregular and fast heart rate) or supraventricular tachycardia (regular and fast heart rate). Panic attack or anxiety A panic attack or anxiety can cause you to take rapid or deep breaths, known as hyperventilating. Concentrating on slow breathing or breathing through a paper bag can bring your breathing back to normal but should only be done when you are certain anxiety is the cause of your breathlessness. More unusual causes These include: a severe allergic reaction (anaphylaxis) pneumothorax partial collapse of your lung caused by a small tear in the lung surface, which allows air to become trapped in the space around your lungs pulmonary embolism a blockage in one of the blood vessels in the lung idiopathic pulmonary fibrosis a rare and poorly understood lung condition that causes scarring of the lungs pleural effusion a collection of fluid next to the lung diabetic ketoacidosis a complication of diabetes where acids build up in your blood and urine Causes of long-term breathlessness Long-term breathlessness is usually caused by: obesity or being unfit poorly controlled asthma chronic obstructive pulmonary disease (COPD) permanent damage to the lungs usually caused by years of smoking anaemia a low level of oxygen in the blood caused by a lack of red blood cells or haemoglobin (the part of red blood cells that carries oxygen) heart failure when your heart is having trouble pumping enough blood around your body, usually because the heart muscle has become too weak or stiff to work properly a problem with your heart rate or rhythm, such as atrial fibrillation (an irregular and fast heart rate) or supraventricular tachycardia (regular and fast heart rate) More unusual causes of long-term breathlessness are: bronchiectasis a lung condition where the airways are abnormally widened and you have a persistent phlegmy cough pulmonary embolism a recurrent blockage in a blood vessel in the lung partial collapse of your lung caused by lung cancer pleural effusion a collection of fluid next to the lung narrowing of the main heart valve, restricting blood flow to the rest of the body frequent panic attacks , which can cause you to hyperventilate (take rapid or deep breaths) Source: NHS 24 - Opens in new browser window Last updated: 01 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Heart failure Shortness of breath Asthma Chronic obstructive pulmonary disease Home oxygen treatment Other health sites Asthma UK NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Sickle cell disease | Sickle cell disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Blood and lymph Sickle cell disease Sickle cell disease About sickle cell disease \u200bSymptoms and diagnosis \u200bTreating sickle cell disease \u200bLiving with sickle cell disease \u200bCauses of sickle cell disease \u200bSickle cell disease carriers and screening About sickle cell disease Sickle cell disease is the name for a group of blood disorders. The most severe is sickle cell anaemia. These disorders are inherited, meaning they are passed on through your genes. You can have a blood test at any time to find out if you carry the gene for sickle cell disease, or if you have sickle cell disease. Sickle cell disease affects how your body produces red blood cells. Normal red blood cells are round red blood cells affected by sickle cell disease harden and become sickle-shaped, like a crescent moon. This causes them to die too quickly and block blood vessels, leading to symptoms that are often painful. People from particular ethnic backgrounds are more likely to have sickle cell disease or carry the gene. You are more likely to have sickle cell disease if you are from one of these ethnic backgrounds: African Asian Caribbean Eastern Mediterranean Middle Eastern There are treatments to manage sickle cell disease, but no cure yet its a lifelong condition. Find out about symptoms and diagnosis Find out about treating sickle cell disease Find out about living with sickle cell disease Find out about screening to see if youre a sickle cell carrier \u200bSymptoms and diagnosis The main symptoms of sickle cell disease are sickle cell crises (very painful episodes affecting different parts of the body), infections, and anaemia. Getting immediate medical advice There are a number of serious problems that can appear suddenly as a result of sickle cell disease. If you experience any of the following symptoms, you should get medical advice immediately: high temperature (a fever) going to 38C (100.4F) or higher difficulty breathing drowsiness, confusion, or slurred speech a severe headache, stiff neck, or dizziness skin or lips that are very pale fits (seizures) serious pain that isnt responding to treatments at home sudden swelling in the tummy priapism a painful erection lasting two hours or more weakness on one or both sides of your body sudden vision loss, or changes in your vision If you develop any of the symptoms listed above, phone your GP or care team immediately. If you cant contact your GP or care team, go to your closest Accident and Emergency (A&E) department. Dial 999 for an ambulance if you arent able to travel yourself. Its important to make sure that the medical team looking after you know that you have sickle cell disease. Sickle cell crises Episodes of pain known as sickle cell crises happen when the blood vessels that go to one part of your body become blocked. The pain can be severe. Sickle cell crises are one of the most common symptoms of sickle cell disease and, on average, occur once a year and last up to seven days. Some people have sickle cell crises every few weeks others experience them less than once a year. A sickle cell crisis typically affects one part of the body at a time. The most common parts affected are: hands or feet (this is especially common in young children) ribs and breastbone spine pelvis tummy legs and arms Sickle cell crises have different causes. They can be triggered by cold, rainy or windy weather, stress, dehydration, or exercise that leaves you severely out of breath. Infection Sickle cell disease leaves people especially children extra vulnerable to infection because their bodies arent as effective at dealing with bacteria and viruses. This leaves them more vulnerable to viruses like the common cold, as well as severe and potentially life-threatening conditions like meningitis. As well as keeping up to date with their vaccinations, many people with sickle cell disease take daily doses of antibiotics in order to prevent infections. Anaemia Almost everyone with sickle cell disease has anaemia. Haemoglobin is found in red blood cells its the substance that transports oxygen around the body. People with anaemia have low levels of haemoglobin in their blood. Most of the time anaemia doesnt cause symptoms, but if youre infected with parvovirus, the virus that causes slapped cheek syndrome, the anaemia can get worse. When that happens, it causes: headaches a fast heartbeat fainting dizziness If these symptoms occur, the anaemia is usually treated with a blood transfusion. Sudden anaemia can happen in young children if they experience swelling of the spleen. This is also treated with a blood transfusion. Other sickle cell disease symptoms Theres a wide range of other issues that can be caused by sickle cell disease. These include: a serious lung condition called acute chest syndrome that can cause chest pain, a cough, breathing difficulties and fever pain in bones and joints delayed puberty delayed growth in childhood kidney or urinary problems, including bedwetting and blood in the urine gallstones these are stones in the gallbladder that can cause jaundice (yellow eyes and skin) and abdominal (tummy) pain ulcers on the lower legs (open sores that can be very painful) priapism a painful, persistent erection that can last for several hours high blood pressure (pulmonary hypertension) transient ischaemic attacks (TIAs) or strokes these happen when blood flow to the brain is interrupted or blocked enlarged spleen this can cause a fast heartbeat, worsening of anaemia, a swollen tummy, shortness of breath and abdominal pain vision problems like floaters, worsened night vision, blurred vision, patchy vision and, occasionally, sudden vision loss These symptoms can be treated see Treating sickle cell disease for more information. Diagnosing sickle cell disease You can have a blood test any time to find out if you have sickle cell disease, or find out if youre a carrier who could have a child with the condition. Sickle cell disease is usually diagnosed during pregnancy free screening to find out if a baby is at risk of having the condition is offered to every pregnant woman in Scotland. Even if your family background doesnt make it likely your child will have sickle cell disease, you can still request a test. If possible, screening should be done before the tenth week of pregnancy, so that theres time to think about further tests that can find out if your baby will be born with sickle cell disease. Newborn babies are screened for sickle cell disease as part of the newborn blood spot test the heel prick test. There are a few reasons for this: if a babys parents werent screened during pregnancy, this test identifies if the child has sickle cell disease if screening during pregnancy showed that the baby had a high risk of having sickle cell disease, but no more testing was done, the heel prick test will determine if the child has the condition or not this test shows if the baby is a carrier of sickle cell, and could one day have children of their own who have the condition (find out more about sickle cell carriers here ) the heel prick test identifies other inherited conditions, like cystic fibrosis Another blood test will be used to confirm the diagnosis if the heel prick test suggests that the baby could have sickle cell disease. Learn about being tested to see if you carry the sickle cell gene \u200bTreating sickle cell disease People of all ages with sickle cell disease are supported by a team of medical professionals in a specialist sickle cell centre. A specialised care plan will be developed with you that helps you to fully understand the condition and find the best way of managing it. Treating and preventing sickle cell crises Sickle cell crises can usually be managed at home. The following steps are recommended for adults or children experiencing a sickle cell crisis: over the counter painkillers like paracetamol and ibuprofen can help although aspirin should not be given to anyone under 16 and if needed, your GP may prescribe stronger painkillers heating pads or warm towels can be placed on the area and massaged to ease the pain pharmacies usually sell heating pads you can use for this drink plenty staying hydrated will help relaxing distractions like reading, videos, and computer games are a good way to distract your mind, or your childs mind, from the pain If none of the above measures help, or the pain is very severe, phone your GP. You or your child should go to the local accident and emergency (A&E) if its not possible to contact your GP. It may be necessary for you or your child to spend a few days in hospital being treated with stronger pain relief. The best way to prevent a sickle cell crisis is by being aware of potential triggers and avoiding them. Prevent dehydration by drinking plenty of fluids especially water. Avoid alcohol alcohol causes dehydration. Stay warm with enough layers of clothing to avoid getting cold, and avoid extreme temperatures. Dont expose yourself to sudden changes in temperature for example, avoid swimming in cold water. The lack of oxygen at high altitudes can trigger a sickle cell crisis, so be careful if youre at high altitude for any reason. However, plane travel shouldnt be an issue because planes maintain a consistent oxygen level due to being pressurised. Make sure to stay active, but avoid activities that leave you severely out of breath. Dont smoke smoking can trigger acute chest syndrome. Stay relaxed as much as you can sickle cell crises can be triggered by stress, so consider learning relaxation techniques like breathing exercises . Your care team may recommend a medication called hydroxycarbamide (hydroxyurea) if you keep experiencing sickle cell crises. This is a capsule that is taken once a day. It works by reducing how many other types of blood cell, like white blood cells and platelets (clotting cells) there are in the body. This means that youll need regular blood tests to make sure youre healthy. Treating and preventing infections Children who have sickle cell disease should be kept up to date on all of their routine vaccinations, and may also need additional vaccinations like the hepatitis B vaccine and the annual flu vaccine. If you have sickle cell disease, youll most likely need to take a dose of antibiotics every day, usually penicillin. This will not pose serious health risks. Reduce risk in day-to-day life by being careful about activities that can make you vulnerable to infection. Always follow good food hygiene measures , for example. If youre planning to go abroad, talk to your GP as far in advance as you can. You might need extra vaccinations or medication, such as anti-malarials if youre going to a place where malaria is a risk. It may also be a good idea to take extra precautions when it comes to food and water. Treating anaemia Most of the time, anaemia doesnt have any symptoms and you wont require any treatment for it. However, children with sickle cell anaemia who are also on a restricted diet (such as a vegan or vegetarian diet) may need folic acid supplements. Folic acid helps your body to create more red blood cells, so it can help to improve anaemia. Its important to be aware that this type of anaemia isnt the same as the anaemia caused by iron deficiency, so dont take iron supplements without talking to your care team first. Taking iron supplements with the anaemia caused by sickle cell disease can be dangerous. Blood transfusions or hydroxycarbamide may be necessary for serious or persistent anaemia. Treating other sickle cell disease-related issues There are a range of treatments for other problems that can be caused by sickle cell disease, depending on the type of symptom and how severe it is: people with acute chest syndrome need emergency treatment this involves oxygen, blood transfusions, antibiotics, and fluids given through a vein, as well as possibly hydroxycarbamide to prevent it happening again painkillers can treat joint and bone pain a short course of hormones can be given to children in order to trigger delayed puberty gallbladder removal surgery is used to treat gallstones for persistent priapism, medication can stimulate blood flow, or a needle can be used to drain blood from the penis regular blood transfusions or hydroxycarbamide are given to people who have had a stroke or who are at greater risk of having one In addition to the treatments above, chelation therapy involves taking medication to make the level of iron in your blood lower, bringing it to safe levels. This treatment is given to people who need a lot of blood transfusions. Learn more about living with sickle cell disease here \u200bLiving with sickle cell disease Sickle cell disease is a lifelong illness, which can be managed well with treatment and self-help. In addition to preventing symptoms and crises as much as possible, there are a few things you can do that will make it easier to live with the condition and stay in the best possible health. Getting surgery when you have sickle cell disease If youre due to have surgery, or youre brought in for surgery in an emergency, its very important you take some precautions. You should tell your care team about any surgeries you have planned that involve a general anaesthetic. Tell your surgeon on the day that you have sickle cell disease. General anaesthetic can cause a number of problems, including increasing the risk of a sickle cell crisis. Its important that youre monitored closely during the surgery, and are given plenty of fluids as well as being kept warm. It might be necessary to have a blood transfusion before the surgery to reduce the chances of complications. Pregnancy and birth with sickle cell disease You can have a healthy pregnancy if you have sickle cell disease, but its a good idea to talk to your care team before planning a pregnancy, for a number of reasons: theres a bigger chance of complications such as miscarriage, pre-eclampsia, anaemia and sickle cell pain while youre pregnant you may have to stop taking some of the medications for sickle cell disease, like hydroxycarbamide, before getting pregnant, as these can harm a foetus it may be a good idea to find out if your partner is a sickle cell carrier and talk with a counsellor about what this could mean extra monitoring during pregnancy, as well as extra treatment, might be necessary Its important to use a reliable form of contraception if you arent planning a pregnancy. Learn about pregnancy and newborn screening for sickle cell disease The outlook for people with sickle cell disease Most children with sickle cell disease lead normal, happy lives. However, sickle cell disease can be very different from person to person, and its still a serious condition. Sickle cell disease can have a big impact on someones life. It can lead to serious infections, strokes and transcient ischaemic attacks (TIAs), and lung problems, which can be fatal. The overall live expectancy for people with sickle cell disease is shorter than normal, but this changes depending on the type of sickle cell disease, what problems they experience, and how the condition is treated. Milder types of sickle cell disease may not impact life expectancy. People with sickle cell anaemia have a typical life expectancy of between 40 and 60 years of age. As newer treatments are developed, its hoped that the outlook will get better. \u200bCauses of sickle cell disease Sickle cell disease is caused by a gene problem that is inherited from your parents. It isnt something you can catch, and its not caused by anything the parents did during or before pregnancy. Inheriting sickle cell disease You inherit one set of genes from your mother, and one from your father. Genes always come in pairs. Children born with sickle cell disease inherit a copy of the sickle cell gene from both of their parents, so each one of the pair of genes is faulty. This happens when both parents are carriers they carry the faulty gene for sickle cell. This is also known as having the sickle cell trait. Carriers dont have sickle cell disease, but if their partner is a carrier too they may have a child with the condition. When both of a childs parents are sickle cell carriers: theres a 25% (one in four) chance that each of their children wont inherit any faulty genes they wont have sickle cell disease, and they wont be able to pass it on to their children theres a 50% (one in two) chance that each child will inherit a copy of the faulty gene from just one parent, and be a sickle cell carrier theres a 25% (one in four) chance that each child will inherit copies of the sickle cell gene from both of their parents, and have sickle cell disease when theyre born You can find more information about how sickle cell disease is inherited from the Sickle Cell Society . Learn more about sickle cell carriers and screening \u200bSickle cell disease carriers and screening Sickle cell disease carriers are people who carry the faulty gene that causes sickle cell disease, but do not have the disease. This is also called having the sickle cell trait. If you have the sickle cell trait, you wont develop sickle cell disease. However, theres a risk that youll have a child with the condition, or who is also a sickle cell disease carrier. Sickle cell disease carriers The sickle cell gene can be carried by anyone, but people from certain ethnic backgrounds are much more likely to be carriers. You are more likely to be a carrier if you have family from one of these areas : Africa Asia The Caribbean The Eastern Mediterranean The Middle East Most sickle cell carriers in the UK have an African or Caribbean family background its estimated around one in ten people with this background may be a sickle cell carrier. Finding out if you are a sickle cell carrier You can request a blood test from your GP at any time to find out if youre a sickle cell carrier. This is a particularly good idea if your family background makes it more likely that you have the gene. Both men and women are able to get the test. Every pregnant woman in Scotland is offered screening to check if their baby is at risk of being born with sickle cell disease. You can ask for a test even if your family background doesnt suggest your child will have sickle cell disease. Its a good idea to have your partner screened for the gene too. If possible, screening should be done before the tenth week of pregnancy, so that theres time to think about further tests that can find out if your baby will be born with sickle cell disease. Read more about diagnosis and screening for the sickle cell disease gene here Other health risks for sickle cell carriers Youre not at risk of developing sickle cell disease if you carry sickle cell. The only time you may be at risk of health problems is in rare cases where you might not get enough oxygen, such as: having surgery under general anaesthetic make sure your medical team knowyou carry sickle cell before your operation so they can ensure you get enough oxygen during extreme sports such as deep sea diving and climbing at high altitudes if you do sports like these, ensure youre never short of oxygen during regular, intensive physical activity make sure you drink plenty of fluids during training and avoid extreme exhaustion Theres also a very small risk of developing kidney problems associated with carrying sickle cell. Apart from these uncommon situations, you can lead a completely normal and healthy life if youre a sickle cell carrier. Other blood disorders Sickle cell carriers are also at risk of having a child with a blood disorder if their partner is a carrier of a different type of blood disorder. You can find more detailed information about some of the other types of carrier in the following pages: Your baby carries a gene for Sickle Cell Your baby carries a gene for unusual haemoglobin Source: NHS 24 - Opens in new browser window Last updated: 12 April 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Sinusitis | Sinusitis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Ears, nose and throat Sinusitis Sinusitis Sinusitis is inflammation (redness and swelling) of the sinuses. The sinuses are small, air-filled spaces in your cheekbones and forehead. Inflammation blocks the sinuses so mucus cannot drain into your nose as usual. Sinusitis is usually caused by a viral infection. Its common and usually gets better within 2 to 3 weeks. Symptoms of sinusitis Sinusitis usually occurs after an infection, such as a cold . Symptoms of sinusitis include: a green or yellow discharge from your nose a blocked nose pain and tenderness around your cheeks, eyes or forehead a high temperature (fever) of 38C (100.4F) or more toothache a reduced sense of smell bad breath (halitosis) Children with sinusitis may: be irritable breathe through their mouth have difficulty feeding sound nasal when they speak, as though they have a stuffy cold The symptoms of sinusitis often clear up within a few weeks (acute sinusitis). Occasionally they can last 3 months or more (chronic sinusitis). When to get medical advice If your symptoms are mild and getting better, you can often treat sinusitis without seeing a GP. Speak to your GP practice if: your symptoms are severe or getting worse your symptoms havent started to improve after around 7 to 10 days you keep getting sinusitis Diagnosing sinusitis Your GP will usually be able to diagnose sinusitis from your symptoms and by examining the inside of your nose. If you keep getting sinusitis, or its severe, they may refer you to an ear, nose and throat (ENT) specialist. Treatment for sinusitis Sinusitis usually gets better on its own within 2 or 3 weeks. Things you can do to help your symptoms Do get plenty of rest drink plenty of fluids take over-the-counter painkillers such as paracetamol or ibuprofen (do not give aspirin to children under 16) use nasal decongestants these shouldnt be used for more than a week, as this might make things worse hold warm packs to your face clean your nose with a salt water solution you can make yourself or buy sachets from a pharmacy Always read the leaflet that comes with your medicine before taking it. Follow the recommended dosage instructions. If youre not sure which treatments are suitable for you or your child, speak to a pharmacist for advice. How to clean your nose with a homemade salt water solution Boil a pint of water, then leave it to cool. Mix 1 teaspoon of salt and 1 teaspoon of bicarbonate of soda into the water. Wash your hands. Stand over a sink, cup the palm of 1 hand and pour a small amount of the solution into it. Sniff the water into 1 nostril at a time. Breathe through your mouth and allow the water to pour back into the sink. Try not to let the water go down the back of your throat. Repeat the first 5 steps up to 3 times a day until your nose feels more comfortable. You do not need to use all of the solution, but make a fresh solution each time you clean your nose. Treatments from your doctor If your symptoms arent improving or are getting worse, your GP may prescribe antibiotics tablets or corticosteroid spray or drops. If your symptoms still dont get better, you may be referred to an ENT specialist for surgery to improve the drainage of your sinuses. What causes sinusitis? Sinusitis is usually caused by a cold or flu virus spreading to the sinuses from the upper airways. Only a few cases are caused by bacteria infecting the sinuses. An infected tooth or fungal infection can also occasionally cause the sinuses to become inflamed. Chronic sinusitis Its not clear exactly what causes sinusitis to become chronic (long-lasting), but it may be related to: allergies and related conditions, including allergic rhinitis, asthma and hay fever nasal polyps (benign growths inside the nose) smoking a weakened immune system Controlling underlying conditions like allergies may improve the symptoms of chronic sinusitis. Source: ENT Scotland - Opens in new browser window Last updated: 05 March 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Flu Common cold Other health sites NICE: Balloon catheter dilation for chronic sinusitis NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Sjogrens syndrome | "Sjgren's syndrome - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Immune system Sjogrens syndrome Sjogrens syndrome About Sjogrens syndrome Symptoms of Sjogrens syndrome Causes of Sjogrens syndrome Diagnosing Sjogrens syndrome Treating Sjogrens syndrome Complications of Sjogrens syndrome About Sjogrens syndrome Sjgrens (pronounced Show-grins) syndrome is an autoimmune disorder. The bodys immune system attacks glands that secrete fluid, such as the tear and saliva glands. The effects ofSjgrens syndrome can be widespread. Certain glands become inflamed, which reduces the production of tears and saliva, causing the main symptoms of Sjgrens syndrome, which aredry eyes and dry mouth . In women (who are most commonly affected), the glands that keep the vagina moist can also be affected, leading to vaginal dryness. Readmore about the symptoms of Sjgrens syndrome What causes Sjgrens syndrome? Sjgrens syndrome is an autoimmune condition, which means that instead of protecting the body from infection or illness, the immune system reacts abnormally and starts attacking healthy cells and tissue. In Sjgrens syndrome, the immune system attacks the tear and saliva glands,and other secretory glands throughout the body. The reasons for this remains unknown, but research suggests that its triggered by a combination of genetic, environmental and, possibly, hormonal factors. Some people are thought to be more vulnerable to the syndrome when theyre born and that certain events, such an infection, can trigger the problems with the immune system. Read more about the causes of Sjgrens syndrome Healthcare professionals classify Sjgrens syndrome as being either: primary when the syndrome develops by itself and not as the result of another condition secondary when the syndrome develops in combination with another autoimmune disorder, such as lupus or rheumatoid arthritis DiagnosingSjgrens syndrome Sjgrens syndrome can be difficult to diagnose, becauseit has similar symptoms to other conditions and there is no single test for it. Your doctor will ask about your symptoms and carry out a test to see how dry your mouth and eyes are. Read more about diagnosing Sjgrens syndrome Treating Sjgrens syndrome There is no cure for Sjgrens syndrome, but treatments can help control symptoms. Dry eyes and mouth can usually behelped with artificial tears and saliva. Its important to maintain good eye and mouth hygiene, because your risk of developing an infection is greater. Taking care of your eyes and mouth can help prevent problems such ascorneal ulcers and tooth decay . In severe cases, medication or surgery may be recommended. Read more about treating Sjgrens syndrome Complications ofSjgrens syndrome Sjgrens syndrome can sometimes lead to complications. For example, your eyesight could be permanently damaged if the reduced tear production isnt treated. Sjgrens syndrome also increases your risk of developing non-Hodgkin lymphoma , which isa cancer of the lymph glands. However, the chancesare still low, at around 5%. Women with Sjgrens syndrome have an increased risk of having children with a temporary lupus rashor heart abnormalities. Any pregnancy will be closely monitored for potential problems. Read more about the complications of Sjgrens syndrome Whos affected bySjgrens syndrome? Sjgrens syndrome most commonly affects people aged 40-60, with women accounting for about 90% of cases. Its difficult to know exactly how many people are affected by the syndrome because many dont see their GP about their symptoms. Further information on Sjgrens syndrome Information about you If you have Sjgrens syndrome, your clinical team will pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the register Symptoms of Sjogrens syndrome The most commonly reported symptoms of Sjgrens syndrome are a dry mouth and eyes, which can lead to other associated symptoms. However, these symptoms can be common in old age, and most people withdry eyes or a dry mouth do not have Sjgrens syndrome. Many women also experience vaginal dryness, which can make sex painful. Associated symptoms of dry mouth A dry mouth can lead to: tooth decay and gum disease dry cough difficulty swallowing and chewing hoarse voice difficulty speaking swollen salivary glands (located between your jaw and ears) repeated fungal infections in the mouth ( oral thrush ) symptoms of which can include a coated or white tongue Associated symptoms of dry eyes Dry eyes can lead to: burning or stinging eyes itchy eyes a feeling that theres grit in your eyes irritated and swollen eyelids sensitivity to light (photophobia) tired eyes mucusdischarge from your eyes These symptoms can get worse when youre: in a windy or smoky environment in an air-conditioned building travelling on aeroplane Other symptoms of Sjgrens syndrome In more serious cases of Sjgrens syndrome, the immune system can attack other parts of the body, causing symptoms and conditions such as: dry skin tiredness and fatigue which are common and can lead to total exhaustion muscle pain joint pain, stiffness and swelling vasculitis(inflammation of blood vessels) difficulty concentrating, remembering and reasoning Causes of Sjogrens syndrome Its not known exactly what causes Sjgrens syndrome, but its thought to be linked to a problem with the immune system. The immune system Your immune system usually helps protect the body from infection and illness by making antibodies. Antibodies attack bacteria and viruses, which help stop you from becoming ill. An autoimmune condition causes your immune system to react abnormally. Instead of attacking foreign cells, such as bacteria, the antibodies start attacking your bodys healthy cells and tissue. In Sjgrens syndrome, the parts of the body usually affected are the tear, saliva and vaginal glands, which are collectively known as the exocrine glands. The antibodies damage the exocrine glands so they can no longer function normally. Theres some evidence that the immune system also damages the nerves that control these glands, which further reduces their effectiveness. The immune system can go on to damage other parts of the body, such as muscles, joints, blood vessels, nerves and, less commonly, organs. Possible triggers for Sjgrens syndrome Primary Sjgrens syndrome Most researchers believe that primary Sjgrens syndrome is triggered by a combination of genetic and environmental factors. Certain people are born with specific genes that make them more vulnerable to a faulty immune system. Then, many years later, an environmental factor, possibly a common virus, triggers the immune system to stop working properly. The female hormone oestrogen also seems to playa role. Sjgrens syndrome mostly occurs in women, and symptoms usually start around the time of the menopause , when oestrogen levels begin to fall. Falling oestrogen levels can contribute to dryness, and this drynesscould make thecondition more noticeable. Secondary Sjgrens syndrome Sjgrens syndrome can be associated with other autoimmune conditions, such as rheumatoid arthritis or lupus . This is known as secondary Sjgrens syndrome. The exocrine glands Your saliva and tear glands play a vital role in protecting your mouth and eyes, which is why the symptoms ofSjgrens syndrome can be widespread and troublesome. The importance of tears We usually only notice our tears when we cry, but our eyes are always covered by a thin layer of tears, known as a tear film. Tears are made up of a mix of water, proteins, fats, mucus and infection-fighting cells. Tears serve several important functions. They: lubricate the eye keep the eye clean and free of dust protect the eye against infection help stabilise your vision The importance of saliva Saliva also serves several important functions, including: keeping the mouth and throat naturally lubricated aiding digestion by moistening food and containing enzymes that can break down certain starches acting as a natural disinfectant (saliva contains antibodies, enzymes and proteins that protect against some common bacterial and fungal infections) Diagnosing Sjogrens syndrome Sjgrens syndrome can be difficult to diagnose because the symptoms are similar to those of other health conditions. You may see different health professionalsfor yourdifferent symptoms, such as a dentist for a dry mouth , an optician fordry eyes and a gynaecologist foradry vagina, which can sometimes make it difficult to reach a firm diagnosis. Seeyour GP if you experience any symptoms of dryness, particularly of your eyes and mouth. Screening questions Experts in the field have come up with a series of screening questions, which may be useful if youre worried you may have Sjgrens syndrome. If you answer yes to most of the questions below, you may have Sjgrens syndrome and will probably be advised to have further tests. Have you had daily, persistent, troublesome dry eyes for more than three months? Do you keep having a sensation of grit in your eye? Do you need to use eye drops containing tear substitutes more than three times a day? Have you had a daily feeling of dry mouth for more than three months? Do you keep getting swollen salivary glands (located between your jaw and your ears)? Do you frequently drink liquids to help you swallow food? Further testing Tests used to diagnoseSjgrens syndrome include: tear break-up time and Schirmer tests a lip biopsy blood tests salivary flow rate These are explained below. Tear break-up time and Schirmer tests Tear break-up time and Schirmer tests are usually carried out by an ophthalmologist (a doctor who specialises in treating eye conditions). The tear break-up time test measures how effective your tear glands are.A non-toxic dye is dropped onto the surface of your eye and thecolour of the dye allows the ophthalmologist to see how well your tear film is functioning and how long it takes for your tears to evaporate. This test is also carried outusing a slit lamp. A slit lamp is a low-power microscope with a high-intensity light source that can be focused to shine in anarrow beam. The specialist will use the slit lamp to examine your tear glands more closely. In the Schirmer test, small strips of blotting paper are placed into your lower eyelid. After five minutes, the strips are removed to see how much of the paper is soaked with tears. Lip biopsy During a lip biopsy , a small tissuesampleis removed from your inner lip and examined under a microscope. A local anaesthetic isinjected intothe inner surface of your lower lip to numb the area, before a small cut is made to remove a few of your minor salivary glands. Clusters of lymphocytes (a type of white blood cell) in the tissue can indicate Sjgrens syndrome. Blood tests Blood tests are carried out to look for antibodies known as anti-Ro and anti-La (or SS-A and SS-B), which are produced when the immune system has been affected by Sjgrens syndrome. These antibodies are only present in about 60% of people with Sjgrens syndrome, so its possible to have a negative blood test result and still have the condition. Salivary flow rate A salivary flow rate test measures how much saliva your glands produce. Youll usually be asked to spit as much saliva as you can into a cupover a five-minute period. The amount of saliva is then weighed or measured. An unusually low flow rate can indicate Sjgrens syndrome. Treating Sjogrens syndrome Theres no cure for Sjgrens syndrome, but treatments help relieve symptoms such as eye and mouth dryness. Sjgrens syndrome affects everyone in different ways, so your treatment plan will betailored to suit you. Eye care Artificial tears Mild to moderate cases of dry eye can usually be successfully treated with eye drops containing artificial tears a liquid that mimics tears. These eye drops are available from a pharmacist, without a prescription. There are many different types of eye drops, so you can try different brands to find the one that works best for you. If youre using eye drops regularly (more than three times a day), you should use one that doesnt containpreservatives. This is because theres evidence that over-exposure to preservatives can damage the surface of the eye. A short-term dose of eye drops containing corticosteroids may be recommended if your eyes become irritated. However,long-term corticosteroid use isnt recommended because they can cause serious side effects. To minimise the chance of experiencing side effects from corticosteroids, youll be prescribed the lowest effective dose for the shortest possible time. Moisture chamber spectacles Wearing glasses reduces tear evaporation by up to 30%, and this effect can be maximised by wearing specially-made glasses called moisture chamber spectacles. These wrap around your eyes like goggles and help retain moisture and protect the eyes from irritants. Some people used to be embarrassed towear them, but modern designs look like sports glasses. Punctal plugs Punctual occlusion is a widely-used technique that seals the tear ducts (into which the tears drain) with small plugs. This should help keepthe eye better protected by tears. Temporary plugs made of silicone are usually used first to see if they help. If it does, more permanent plugs can be used. Mouth care Looking after your mouth Anumber of techniques can be used to keep your mouth lubricated, including: maintaining good oral hygiene to prevent tooth decay and gum disease increasing your fluid intake using sugar-free chewing gum to stimulate saliva production sucking ice cubes to help lubricate your mouth and reduce dryness regularly using mouth rinses to sootheyour mouth and protect it against infection If you smoke, you should try to quit. Smoking irritates the mouth and increases the rate at which saliva evaporates. Read more about how to stop smoking Saliva substitutes There are a number of saliva substitute products that can help lubricate your mouth. However, they dont replicate the role ofsaliva in preventing infection, so youll still need to maintain excellent oral hygiene. Saliva substitutes are available as a spray, lozenge (medicated sweet), gel, or gum. Your GP or pharmacist can tell you which product is most suitable for you. Medication for Sjgrens syndrome Pilocarpine The medicine pilocarpine is often used to treat the symptoms of dry eyes and dry mouth . Pilocarpine stimulates the glands to produce more saliva and tears. Side effects of pilocarpine include: hyperhidrosis (excessive sweating) nausea diarrhoea heartburn abdominal (stomach) pain an increased need to go to the toilet For some people, the side effects of pilocarpine are mild. Others find that the side effects outweigh the benefits. Dont take pilocarpine if you have asthma or chronic obstructive pulmonary disease (COPD) , or if youre pregnant or breastfeeding. Hydroxychloroquine Hydroxychloroquine has been shown to slow down the immune systems attack on the tear and saliva glands. It can also help reduce any associated symptoms of muscle pain, joint pain and stiffness. Youll need to take hydroxychloroquine for several weeks before you notice any improvements, and it could be six months before you experience the full benefit of the treatment. Side effects are uncommon and usually mild. They include: nausea skin rash loss of appetite stomach cramps vomiting In very rare cases, hydroxychloroquine can damage the retina, affecting vision. Youll probably be asked to attend an eye examination so that your retina can be checked before you start treatment. Regular eye examinations (usually at least once a year) are also recommended after you begin treatment. Hydroxychloroquine shouldnt be used by breastfeeding women. Treating other symptoms of Sjgrens syndrome Dry skin Several soaps and creams are specifically designed for people with dry skin. Your pharmacist or GP can advise you. Vaginal dryness Vaginal dryness can be treated using a lubricant. Some women also use oestrogen creams or hormone replacement therapy (HRT) . Muscle and joint pains Muscle and joint pains can be treated with an over-the-counter non-steroidal anti-inflammatory drug (NSAID) , such as ibuprofen . If this doesnt work, see your GP, as stronger NSAIDs are available on prescription. NSAIDs can increase your risk of developing stomach ulcers and internal bleeding, particularly if theyre taken on a long-term basis. If you find swallowing NSAIDs difficult because of your dry mouth, you can try an NSAID cream thats rubbed into affected joints. NSAIDs arent recommended for pregnant or breastfeeding women, or for people with pre-existing risk factors for cardiovascular or kidney conditions. General advice Thesesimple tips can help prevent many of the problems associated with Sjgrens syndrome: have a dental check-up every six months practise good dental hygiene brushing, flossing and using mouthwash regularly avoid eating too many sweet foods avoid strong and perfumed soaps use special creams and soaps from your pharmacist avoid dry environments, such as air-conditioned offices, whenever possible avoid drinking too much alcohol Complications of Sjogrens syndrome Sjgrens syndrome isnt usually life-threatening, but it is linked to more seriousproblems. Non-Hodgkin lymphoma Its estimated that people with Sjgrens syndrome are 44 times more likely to develop non-Hodgkin lymphoma than people without the condition. Non-Hodgkin lymphoma is a cancer of the lymphatic system. The lymphatic system is a series of vessels and glands (lymph nodes) that are spread throughout your body, much like your blood vessels. While this increased risk may sound alarming, the chance of a person with Sjgrens syndrome developing non-Hodgkin lymphoma is still small, as it only affects around 5% of people with the syndrome. However, if you have Sjgrens syndrome, you should be aware of the main early symptom of non-Hodgkin lymphoma, which is a painless swelling in a lymph node (gland) usually in the neck, armpit or groin. Report any swollen lymph nodes to your GP. Eye damage If dry eyes arent treated, they canbecome inflamed and you can develop ulcers on the surface of youreyes (corneal ulcers). If left untreated, corneal ulcers can lead to loss of vision and permanent sight damage. Pregnancy If youre planning to become pregnant and have Sjgrens syndrome, ask your GP to test for certain antibodies that may be present in Sjgrens syndrome and are known to cause a temporary lupus rash in newborn babies. In very rare cases, the antibodies can also cause heart defects in babies. If these antibodies are found, there should be no reason why you cant continue with the pregnancy, but your child may need additional specialist care during pregnancy and after the birth. Read more about antenatal appointments Other conditions A number of other conditions have been linked to Sjgrens syndrome, including: peripheral neuropathy a condition that often involves loss of sensation in the hands and feet Raynauds phenomenon restricted blood flow to the hands, which can cause them to feel cold, numb and painful kidney problems such as inflammation or kidney stones an underactive thyroid gland (hypothyroidism) which can lead to tiredness and weight gain irritable bowel syndrome (IBS) which can cause abdominal pain and irregular bowel movements teeth cavities Source: NHS 24 - Opens in new browser window Last updated: 23 February 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Lupus Rheumatoid arthritis NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852" | null | null | null | null | null | null | null | null | null | null | null | null | null |
Skin cancer (melanoma) | Skin cancer (melanoma) - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Skin cancer (melanoma) Skin cancer (melanoma) About melanoma Symptoms of melanoma Causes of melanoma Diagnosing melanoma Treating melanoma About melanoma Melanoma is a type of skin cancer that can spread to other organs in the body. The most common sign of melanoma is the appearance of a newmole or a change in an existing mole. This can happen anywhere on the body, but the back, legs, arms and face are most commonly affected. In most cases, melanomas have an irregular shape and more than 1 colour. They may also be larger than normal moles and can sometimes be itchy or bleed. An ABCDE checklist has been developed for people to tell the difference between a normal mole and a melanoma. Read more about the symptoms of melanoma . These pages mainly cover a type of melanoma known as superficial spreading melanoma, which accounts for around 70% of all melanomas in the UK. Nodular melanoma Nodular melanoma is a fast-developing type of melanoma, most common in middle-aged people. It may not develop from an existing mole and can appear in areas of skin that arent regularly exposed to the sun. Lentigo maligna melanoma Lentigo maligna melanoma is most common in elderly people and those who have spent a lot of time outdoors. It is common on the face and tends to grow slowly over a number of years. Acral lentiginous melanoma Acral lentiginous melanomaisa rare type of melanoma that usually appears on the palms of the hands and the soles or big toenails of the feet. This is the most common type of melanoma in people with dark skin. Cancer Research UK has more information about the different types of melanoma . Why does melanoma happen? Melanoma happens when some cells in the skin begin to develop abnormally. Its thought that exposure to ultraviolet (UV) light from natural or artificial sources may be partly responsible. Certain things can increase your chances of developing melanoma, such as having: lots of moles or freckles pale skin that burns easily red or blonde hair a family member who has had melanoma Read more about the causes of melanoma . Diagnosing melanoma Speak to your GP if you notice any change to your moles. Your GP will refer you to a specialist clinic or hospital if they think you have melanoma. In most cases, a suspicious mole will be surgically removed and studied to see if it is cancerous. This is known as a biopsy . You may also have a test to check if the melanoma has spread elsewhere in your body. This is known as asentinel node biopsy. Read more about diagnosing melanoma . How is melanoma treated? The main treatment for melanoma is surgery, although your treatment will depend on your circumstances. If melanoma is diagnosed and treated at anearly stage, surgery is usually successful. If melanoma isnt diagnosed until an advanced stage, treatment is mainly used to slow the spread of the cancer and reduce symptoms. This usually involves medicines, such as chemotherapy . Read more about treating melanoma . Onceyouhave had melanoma, there is a chance it may return. This risk is increased if your cancer was widespread and severe. If your cancer team feels there is a significant risk of your melanoma returning, you will probably need regular check-ups to monitor your health. You will also be taught how to examine your skin and lymph nodes to help detect melanoma if it returns. Who is affected Melanoma is the 5th most common cancer in the UK. More than a quarter of cases are diagnosed in people under 50, which is unusual compared to most other types of cancer. Its also becoming more common in the UK over time, thought to be caused by increased exposure to UV light from the sun and sunbeds. Can melanoma be prevented? Melanoma is not always preventable, but you can reduce your chances of developing it by limiting your exposure to UV light. You can help protect yourself from sun damage by using sunscreen and dressing sensibly in the sun. Sunbeds and sunlamps should also be avoided. Regularly checking yourmoles and frecklescan help lead to early diagnosis and increase your chances of successful treatment. Symptoms of melanoma The first sign of a melanoma is often a new mole or a change in the appearance of an existing mole. Normalmoles are usually round or oval, with a smooth edge, andnobigger than 6mm (1/4 inch) in diameter. Speak to your GP as soon as possible if you notice changes in a mole, freckle or patch of skin, especially if the changes happen over a few weeks or months. Signs to look out for include a mole that is: getting bigger changing shape changing colour bleeding or becoming crusty itchy or painful Ahelpfulway to tell the difference between a normal mole and a melanoma is the ABCDE checklist: Asymmetrical melanomas have 2 very different halves and are an irregular shape Border melanomas have a notched or ragged border Colours melanomas will be a mix of 2 or more colours Diameter melanomas are larger than 6mm (1/4 inch) in diameter. Enlargement or elevation a mole that changes size over timeis more likely to be a melanoma Melanomas can appear anywhere on your body, but they most commonlyappear on theback, legs, arms and face. They may sometimes develop underneath a nail. In rare cases, melanoma can develop inthe eye. Noticing a dark spot or changes in vision can be signs, although it is more likely to bediagnosed during a routine eye examination. Read further information: Cancer Research UK: Melanoma symptoms Causes of melanoma Most skin cancer is caused by ultraviolet (UV) light damaging the DNA in skin cells. The main source of UV light is sunlight. Sunlight contains 3 types of UV light: ultraviolet A (UVA) ultraviolet B (UVB) ultraviolet C (UVC) UVC is filtered out by the Earths atmosphere, but UVA and UVB damage skin over time, making it more likely for skin cancers to develop. UVB is thought to be the main cause of skin cancer. Artificial sources of light, such as sunlamps and tanning beds, also increase your risk of developing skin cancer. Repeated sunburn , either by the sun or artificial sources of light, increases the risk of melanoma in people of all ages. Moles Youare at an increasedrisk of melanoma if you havelots ofmoleson your body, especially if they are large(over 5mm) or unusually shaped. Having just 1 unusually shaped or very large mole increases your risk of melanoma by 60%. For this reason, its important to monitor moles for changes and avoid exposing them to the sun. Family history Research suggests that if you have 2 or more close relatives who have had non-melanoma skin cancer, your chances of developing the condition may be increased. Increased risk Certainthingsare believed to increase your chances of developing all types of skin cancer, including: pale skin that does not tan easily red or blonde hair blue eyes older age a large number of freckles an area of skin previously damaged by burning or radiotherapy treatment a condition that suppresses your immune system such as HIV medicines that suppress your immune system (immunosuppressants) commonly used after organ transplants exposure to certain chemicals such as creosote and arsenic a previous diagnosis of skin cancer Read further information: Cancer Research UK: Melanoma risks and causes. Diagnosing melanoma A diagnosis of melanoma will usually begin with an examination of your skin. Your GP will refer you to a specialist if they suspect melanoma. Some GPs take digital photographs of suspected tumours so they can email them to a specialist for assessment. As melanoma is a relatively rare condition, many GPs will only see a case every few years. Its importantto monitor your moles and return to your GP if you notice any changes. Taking photos to document any changes will help with diagnosis. Seeing a specialist In 2015, the National Institute for Health and Care Excellence ( NICE ) published guidelines to help GPs recognise the signs and symptoms of malignant melanoma and refer people for the right tests faster. To find out if you should be referred for further tests for suspectedmalignant melanoma, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral . You will be referred to a dermatology clinic or hospitalfor further testing if melanoma is suspected. You should see a specialist within 2 weeks of seeing your GP. Thedermatologistor plastic surgeon will examine the mole and the rest of your skin. They mayalso remove the mole and send it for testing ( biopsy ) tocheck whether the mole is cancerous. A biopsy is usually carried out under local anaesthetic ,meaning the area around the mole will be numbed and you wont feel any pain. If cancer is confirmed, you will usually need a further operation, most often carried out by a plastic surgeon, to remove a wider areaof skin. Further tests Further tests will be carried out if there is a concern the cancer has spread into other organs, bones or your bloodstream. Sentinel lymph node biopsy If melanoma spreads, it will usually begin spreading through channels in the skin (called lymphatics) to the nearest group of glands (called lymph nodes).Lymph nodesare part of the bodys immune system, helping to remove unwanted bacteria and particles from the body. Sentinel lymph node biopsy is a test to determine whether microscopic amounts of melanoma (less than would show up on any X-ray or scan) might have spread to the lymph nodes. It is usually carried out by a specialist plastic surgeon, while you are under general anaesthetic . A combination of blue dye and a weak radioactive chemical is injected around your scar. This is usually done just before the widerareaof skin is removed. The solution follows the same channels in the skin as any melanoma. The first lymph node this reachesis known asthe sentinel lymph node. The surgeon canlocate and remove the sentinel node, leaving the others intact. The node is then examined for microscopic specks of melanoma(this process can take several weeks). If the sentinel lymph node is clear of melanoma, its extremely unlikely that any other lymph nodes are affected. This can be reassuringbecause if melanoma spreads to the lymph nodes, its more likely to spread elsewhere. If the sentinel lymph node contains melanoma, there is a risk that other lymph nodes in the same group will contain melanoma. Your surgeon should discuss the pros and cons of having a sentinel lymph node biopsy before you agree to the procedure. Sentinel lymph node biopsy does not cure melanoma, butis used to investigate the outlook of your condition. An operation to remove the remaining lymph nodes in the groupmay be recommended. This is known as a completion lymph node dissection or completion lymphadenectomy. Other tests you may have include: a computerised tomography (CT) scan a magnetic resonance imaging(MRI) scan a positron emission tomography (PET) scan blood tests Read further information: Cancer Research UK: Melanoma tests Cancer Research UK: Further tests for melanoma Treating melanoma Melanoma stages Health professionals use a staging system to describe how far melanoma has grown into the skin (the thickness) and whether it has spread. The type of treatment you receive will depend on what stage the melanoma has reached. The melanoma stages can be described as: stage 0 the melanoma is on the surface of the skin stage 1A the melanoma is less than 1mm thick stage 1B the melanoma is 1 to 2mm thick, or the melanoma is less than 1mm thick and the surface of the skin is broken (ulcerated) or its cells are dividing faster than usual (mitotic activity) stage 2A the melanoma is 2 to 4mm thick, or the melanoma is 1 to 2mm thick and is ulcerated stage 2B the melanoma is thicker than 4mm, or the melanoma is 2 to 4mm thick and ulcerated stage 2C the melanoma is thicker than 4mm and ulcerated stage 3A the melanoma has spread into 1 to 3 nearby lymph nodes, but they are not enlarged; the melanoma is not ulcerated and has not spread further stage 3B the melanoma is ulcerated and has spread into 1to 3 nearby lymph nodes but they are not enlarged, or the melanoma is not ulcerated and has spread into 1 to 3 nearby lymph nodes and they are enlarged, or the melanoma has spread to small areas of skin or lymphatic channels, but not to nearby lymph nodes stage 3C the melanoma is ulcerated and has spread into 1 to 3 nearby lymph nodes and they are enlarged, orthe melanoma has spread into 4 or more lymph nodes nearby stage 4 the melanoma cells have spread to other areas of the body, such as the lungs, brain or other parts of the skin Read further information: Cancer Research UK: Treating melanoma Cancer Research UK: Stages of melanoma Macmillan: Melanoma Stage 1 melanoma Treating stage 1 melanoma will involve surgically removing the melanoma and a small area of skin around it this is known as surgical excision. Surgical excisionis usuallycarried outunder local anaesthetic . This means you will be awake but the area around the melanoma will be numbed, so you wont feel pain. In some cases, general anaesthetic is used, which means you will be asleep during the procedure. If a surgical excision is likely to leave a significant scar, it may be done in combination with a skin graft. A skin graft involves removing a patch of healthy skin, usuallytaken from a part of your body where scarring cannot be seen, such as your back. It is then connected, or grafted, to the affected area. Skin grafts or flaps are used when the area of skin being removed is too big to close using a direct method. Once the melanoma has been removed, there is little possibility it will return and no further treatment should be required. You will probably be asked to come for follow-up appointments before being discharged. Stage 2 and 3 melanoma As with stage1 melanomas, any affected areas of skin will be removed.The remaining skin iseither closed directly, or a skin graft or flap may becarried outif necessary. Sentinel node biopsy Sentinel node biopsy, which is not a mandatory procedure, will be discussed with you. If you decide to go aheadwith the procedureand the results show no spread to nearby lymph nodes, it is unlikely you will have further problems with this melanoma. If the test confirms melanoma has spread to nearby nodes, your specialist will discuss with you whether further surgery is required. Additional surgery involves removing the remaining nodes, known as a completion lymph nodedissection or completion lymphadenectomy. Lymph nodes If the melanoma has spread to nearby lymph nodes, you may need further surgery to remove them. Your doctor willhave felt a lump in your lymph nodes andthe diagnosis of melanoma is usually confirmed using a needle biopsy (fine needle aspiration).Removing the affected nodes requires a procedure called a block dissection, performed under general anaesthetic. While the surgeon will try to ensurethe rest of your lymphatic system can function normally, there is a risk that the removal of lymph nodes will disrupt the lymphatic system, leading to a build-up of fluids in your limbs. This is known as lymphoedema . Follow-up Once the melanoma has been removed, you will need follow-up appointments to see how you are recovering and to watch for any sign of the melanoma returning. You may be offered treatment to try to prevent the melanomareturning. This is called adjuvant treatment. There is not much evidence that adjuvant treatment helps prevent melanoma from coming back, so this is only offered as part of a clinical trial. Stage 4 melanoma It may not be possible to cure melanoma if it has: beendiagnosed at its most advanced stage spread to another part of your body (metastasis) come back in another part of your body after treatment (recurrent cancer) Treatment is available and given in the hope that it can slow the cancers growth, reduce any symptoms you may have and possibly extend your life expectancy. You may be able to have surgery to remove other melanomas that have occurred away from the original site. You may also be able to have other treatments to help with symptoms. These include: radiotherapy drug treatments Radiotherapy Radiotherapy may be used after an operation to remove your lymph nodes, and can also be used to help relieve the symptoms of advanced melanoma. Radiotherapy uses controlled doses of radiation to kill cancer cells. It is given at the hospital as a series of 10 to 15 minute daily sessions, with a rest period over the weekend. The side effects of radiotherapy include: tiredness nausea loss of appetite hair loss sore skin Many side effects can be prevented or controlled with medicines your doctor can prescribe, so let them know about any that you experience. After treatment has finished, the side effects of radiotherapy should gradually reduce. Read further information: Cancer Research UK: Radiotherapy for melanoma . Drug treatment In recent years there have been major advancements in treating melanoma. The medications used to treat melanoma are changing as new formulations are being introduced into clinics. The medications currently being used include: vemurafenib ipilimumab nivolumab However, not everyone is suitable for these drugs. Your specialist will discuss an appropriate treatment with you, and many people are entered into clinical trials. Chemotherapy Chemotherapy involves using anti-cancer (cytotoxic) drugs to kill the cancer.It is normally used to treat melanoma that has spread to parts of the body and is mainly given to help relieve symptoms of advanced melanoma. Several different chemotherapy drugs are used to treat melanoma and are occasionally given in combination. The drugs most commonly used for melanoma are dacarbazine and temozolomide. However, many different types of drugs can be used. Your specialist can discuss with you which drugs are the most suitable. Chemotherapy is usually given as an outpatient treatment, which means you will not have to stay in hospital overnight. Dacarbazine is given through a drip and temozolomide is given in tablet form. Chemotherapy sessions are usually given once every 3 to 4 weeks, with gaps between treatment intended to give your body and blood time to recover. The main side effects of chemotherapy are caused by their influence on the rest of the body. Side effects include infection, nausea and vomiting, tiredness and sore mouth. Many side effects can be prevented or controlled with medicines that your doctor can prescribe. Electrochemotherapy Electrochemotherapy is a possible treatment for melanoma. It may be considered if: surgery isnt suitable or hasnt worked radiotherapy and chemotherapy havent worked The procedure involves giving chemotherapy intravenously (directly into a vein).Short, powerful pulses of electricity are then directed to the tumour using electrodes. These electrical pulses allow the medicine to enter the tumour cells more effectively and cause more damage to the tumour.The procedureis usuallycarried out using general anaesthetic (where youre asleep) but some people maybe able to havelocal anaesthetic(where youre awake but the area is numbed). Depending on how many tumours need to be treated, the procedure can take up to an hour to complete. The main side effect is some pain where the electrode was used, which can last for a few days and may require painkillers. It usually takes around 6 weeks for results to appear and the procedure usually needs to be repeated. Your specialist can give you more detailed information about this treatment option. Read the NICE (2013) guidelines on Electrochemotherapy for metastases in the skin . Immunotherapy Immunotherapy uses drugs (often derived from substances that occur naturally in the body) that encourage your bodys immune system to work against the melanoma. Two such treatments in regular use for melanoma areinterferon-alpha and interleukin-2. Both are given as an injection (into the blood, under the skin, or into lumps of melanoma). Side effects include flu-like symptoms, such as chills, a high temperature, joint pain and fatigue. Vaccines There is ongoing researchinto producing a vaccine for melanoma, either to treat advanced melanoma or to be usedafter surgery in patients who have a high risk of the melanoma coming back. Vaccines are designed to focus the bodys immune system so it recognises the melanoma and can work against it. Vaccines are usually given as an injection under the skin every few weeks, often over a period of months. As more research is needed into vaccines, they are only given as part of a clinical trial. Monoclonal antibodies Our immune systems make antibodies all the time, usually as a way of controlling infections. They are substances that recognise something which doesnt belong in the body and help to destroy it. Antibodies can be produced in the laboratory and can be made to recognise and lock onto specific targets, either in the cancer or in specific parts of the body. Antibodies produced in the laboratory are usually called monoclonal antibodies. Ipilimumab Ipilimumab is a monoclonal antibody that has been licensed for use in the UK since 2011. It works like an accelerator for the immune system, allowing the body to work against all sorts of conditions, including cancer. In December 2012, NICE recommended ipilimumab as a possible treatment for people with previously treated advanced melanoma that has spread or cannot be surgically removed. Signalling inhibitors Signalling inhibitors are drugs that work by disrupting the messages (signals) a cancer uses to co-ordinate its growth. There are hundreds of these signals, and it is difficult to know which ones need to be blocked. Most of the signals have short, technical names. Two that are of current interest in relation to melanoma are BRAF and MEK. There are drugs available that can interfere with these signals, but most are currently only widely available as part of clinical trials. NICE recommends a signalling inhibitor called vemurafenib as a possible treatment for melanoma that has spread or cannot be surgically removed. Read further information: Cancer Research UK: Biological therapy for melanoma . Cancer Research UK: Chemotherapy for melanoma . Clinical trials All new treatment for cancer (and other diseases) is first given to patients in a clinical trial. A clinical trial or study is an extremely rigorous way of testing a drug on people. Patients are monitored for any effects of the drug on the cancer, as well as side effects. Many people with melanoma are offered entry into clinical trials, but some people are suspicious of the process. There are a few key things to know about clinical trials: overall, patients in clinical trials do better than those on routine treatment, even when receiving a drug that would be given routinely all clinical trials are highly regulated all new treatments will first become available through clinical trials even where a new drug fails to offer any benefits over existing treatment, the knowledge that we gain from the trial is valuable for future patients If you are asked to take part in a trial, you will be given an information sheet and, if you want to take part, you will be asked to sign a consent form. You can refuse or withdraw from a clinical trial without it affecting your care. Read further information: Cancer Research UK: Melanoma research . Deciding against treatment for stage 4 melanoma Many of the treatments described have unpleasant side effects that can affect your quality of life. You may decide against having treatment if it is unlikely to significantly extend your life expectancy, or if you do not have symptoms causing you pain or discomfort. This is entirely your decision and your healthcare team will respect it. If you decide not to receive treatment, pain relief and nursing care will be made available when you need it. This is called palliative care . Read further information: Accessing palliative care Cancer Research UK: Advanced melanoma (stage 4) Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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Skin cancer (non-melanoma) | "Skin cancer (non-melanoma) - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Skin cancer (non-melanoma) Skin cancer (non-melanoma) About non-melanoma skin cancer Symptoms of non-melanoma skin cancer Causes of non-melanoma skin cancer Diagnosing non-melanoma skin cancer Treating non-melanoma skin cancer About non-melanoma skin cancer Skin cancer is one of the most common cancers in the world. Non-melanoma skin cancer refers to a group of cancers that slowly develop in the upper layers of the skin. The term non-melanoma distinguishes these more common kinds of skin cancer from the less common skin cancer known as melanoma , which spreads faster in the body. The first sign of non-melanoma skin cancer is usually the appearance of a lump or patch on the skin that doesnt heal after a few weeks. In most cases, cancerous lumps are red and firm, while cancerous patches are often flat and scaly. Speak to your GP if you have any skin abnormality that hasnt healed after 4 weeks. Although it is unlikely to be skin cancer, it is best to be sure. Read more about the symptoms of non-melanoma skin cancer Types of non-melanoma skin cancer Non-melanoma skin cancers usually develop in the outermost layer of skin (epidermis) and are often named after the type of skin cell from which they develop. The 2 most common types of non-melanoma skin cancer are: basal cell carcinoma starts in the cells lining the bottom of the epidermis and accounts for about 75% of skin cancers squamous cell carcinoma starts in the cells lining the top of the epidermis and accounts for about 20% of skin cancers Although not classed as non-melanoma skin cancers, actinic keratosesand Bowens disease may sometimes develop into squamous cell carcinoma if left untreated. Why does it happen? Non-melanoma skin cancer is mainly caused by overexposure to ultraviolet (UV) light. UV light comes from the sun, as well as artificial sunbeds and sunlamps. In addition to UV light overexposure, there are certain things that can increase your chances of developing non-melanoma skin cancer, such as: a family history of the condition pale skin that burns easily a large number of moles or freckles Read more about the causes of non-melanoma skin cancer Who is affected? Non-melanoma skin cancer is one of the most common types of cancer in the world. It affects slightly more men than women. Diagnosis Your GP can examine your skin for signs of skin cancer. They may refer you to a skin specialist (dermatologist) or a specialist plastic surgeon if they are unsure or suspect skin cancer. Your GP may refer you urgently, within 2 weeks, for squamous cell skin cancer. Basal cell skin cancers usually dont need an urgent referral but you should still see a specialist within 18 weeks. The specialist will examine your skin again and will perform a biopsy to confirm a diagnosis of skin cancer. A biopsy is an operation that removes some affected skin so it can be studied under a microscope. Read more about diagnosing non-melanoma skin cancer Treating non-melanoma skin cancer Surgery is the main treatment for non-melanoma skin cancer. This involves removing the cancerous tumour and some of the surrounding skin. Other treatments for non-melanoma skin cancer include cryotherapy, creams, radiotherapy, chemotherapy and a treatment known as photodynamic therapy (PDT). Treatment for non-melanoma skin cancer is generally successful as, unlike most other types of cancer, there is a considerably lower risk that the cancer will spread to other parts of the body. It is estimated that basal cell carcinoma will spread to other parts of the body in less than 0.5% of cases. The risk is slightly higher in cases of squamous cell carcinoma, which spreads to other parts of the body in around 2 to 5% of cases. Treatment fornon-melanoma skin canceris completely successful in approximately 90% of cases. Read more about treating non-melanoma skin cancer Complications If you have had non-melanoma skin cancer in the past, there is a chance the condition may return. The chance of non-melanoma skin cancer returning is increased if your previous cancer was widespread and severe. If your cancer team feels there is a significant risk of your non-melanoma skin cancer returning, you will probably require regular check-ups to monitor your health. You will also be shown how to examine your skin to check for tumours. Prevention Non-melanoma skin cancer is not always preventable, but you can reduce your chances of developing the condition by avoiding overexposure to UV light. You can help protect yourself from sunburn by using sunscreen, dressing sensibly in the sun and limiting the time you spend in the sun during the hottest part of the day. Sunbeds and sunlamps should also be avoided. Regularly checking your skin for signs of skin cancer can help lead to an early diagnosis and increase your chances of successful treatment. Read more about sunscreen and sun safety Symptoms of non-melanoma skin cancer The main symptom of non-melanoma skin cancer is the appearance of a lump or discoloured patch on the skin that doesnt heal. The lump or discoloured patch is the cancer, sometimes referred to as a tumour. Non-melanoma skin cancer most often appears on areas of skin which are regularly exposed to the sun, such as the face, ears, hands andshoulders. Basal cell carcinoma Basal cell carcinoma (BCC) usuallyappears as a small red or pink lump, although it can be pearly-white or waxy looking.It can also look like a red, scaly patch. The lump slowly grows and may become crusty, bleed or develop into a painless ulcer. Squamous cell carcinoma Squamous cell carcinoma (SCC) appears as a firm pink lumpand may havea flat, scaly and crusted surface. The lump is often tender to touch, bleeds easily and may develop into an ulcer. Bowens disease Bowens disease is a very early form of skin cancer, sometimes referred to as squamous cell carcinoma in situ. It develops slowly and is easilytreated. The main sign is a red, scaly patch on the skin which may itch. It most commonly affects elderly women and is often found on the lower leg. However, it can appear on any area of the skin. When toseek medical advice If you develop a lump, lesion or skin discolouration that hasnt healed after 4 weeks, speak to your GP. While it is unlikely to be cancer, it is best to be sure. Read further information: Cancer Research UK: Skin cancer symptoms Macmillan: Symptoms of skin cancer Causes of non-melanoma skin cancer Most skin cancer is caused by ultraviolet (UV) light damaging the DNA in skin cells. The main source of UV light is sunlight. Sunlight contains 3 types of UV light: ultraviolet A (UVA) ultraviolet B (UVB) ultraviolet C (UVC) UVC is filtered out by the Earths atmosphere but UVA and UVB damage skin over time, making it more likely for skin cancers to develop. UVB is thought to be the main cause of non-melanoma skin cancer. Artificial sources of light, such as sunlamps and tanning beds, also increase your risk of developing skin cancer. Repeated sunburn , either by the sun or artificial sources of light, will make your skin more vulnerable to non-melanoma skin cancer. Family history Research suggests that if you have 2 or more close relatives who have had non-melanoma skin cancer, your chances of developing the condition may be increased. Increased risk Certain factors are believed to increase your chances of developing all types of skin cancer, including: pale skin that does not tan easily red or blonde hair blue eyes older age a large number of moles a large number of freckles an area of skin previously damaged by burning or radiotherapy treatment a condition that suppresses your immune system, such as HIV medicines that suppress your immune system (immunosuppressants), commonly used after organ transplants exposure to certain chemicals, such as creosote and arsenic a previous diagnosis of skin cancer Read further information: Cancer Research UK: Skin cancer risks and causes . Macmillan: Risk factors and causes of skin cancer . Diagnosing non-melanoma skin cancer A diagnosis of non-melanoma skin cancer will usually begin with a visit to your GP who will examine your skin and decide whether you need further assessment by a specialist. Some GPs take digital photographs of suspected tumours so they can email them to a specialist for assessment. In 2015, the National Institute for Health and Care Excellence ( NICE ) published guidelines to help GPs recognise the signs and symptoms ofskin cancerand refer people for the right tests faster. To find out if you should be referred for further tests for suspected skin cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral . Biopsy If skin cancer is suspected, you may be referred to a skin specialist (dermatologist) or specialist plastic surgeon. The specialist should be able to confirm the diagnosis by carrying out a physical examination. However, they will probably alsoperform a biopsy a surgical procedure where either a part or all of the tumour is removed and studied under a microscope. This is usually carried out under a local anaesthetic , meaning you will be awake, but the affected area will be numbed so you wont feel pain. This allows the dermatologist or plastic surgeon to determine what type of skin cancer you have and whether there is any chance the cancer could spread to other parts of your body. Sometimes, skin cancer can be diagnosed and treated at the same time. In other words, the tumour can be removed and tested and you may not need further treatment because the cancer is unlikely to spread. It may be several weeks before you receive the results of a biopsy. Further tests If you have basal cell carcinoma (BCC), then you usually wont require further tests, as the cancer is unlikely to spread. However, in rare cases of squamous cell carcinoma, further tests may be needed to make sure the cancer has not spread to another part of your body. These tests may include a physical examination of your lymph nodes (glands found throughout your body). If cancer has spread, it may cause your glands to swell. If the dermatologist or plastic surgeon thinks there is a high risk of the cancer spreading, it may be necessary to perform a biopsy on a lymph node. This is called a fine needle aspiration (FNA). During FNA, cells are removed using a needle and syringe so they can be examined. Finding cancerous cells in a nearby lymph node would suggest the squamous cell carcinoma has started to spread to other parts of your body. Treating non-melanoma skin cancer Surgery is the main treatment for non-melanoma skin cancer, although it may depend on your individual circumstances. Overall, treatment is successful for more than 90% of people with non-melanoma skin cancer. People with cancer should be cared for by a team of specialists that often includes a dermatologist, a plastic surgeon, an oncologist (a radiotherapy and chemotherapy specialist), a pathologist and a specialist nurse. If you have non-melanoma skin cancer, you may see several (or all) of these professionals as part of your treatment. When deciding what treatment is best for you, your doctors will consider: the type of cancer you have the stage of your cancer (how big it is and how far it has spread) your general health Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours. Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions you would like to ask the specialist. For example, you may want to find out what the advantages and disadvantages of particular treatments are. The National Institute for Health and Care Excellence (NICE) has produced healthcare guidelines about NHS skin cancer services. These outline NICEs main recommendations on how, over the coming years, people with skin cancer or melanoma should be treated. Read further information: NICE: improving outcomes for people with skin tumours including melanoma Surgical excision Surgical excision is anoperation tocut out the cancer along with surrounding healthy tissue to ensure the cancer is completely removed. It may be done in combination with a skin graft, ifits likely to leave significant scarring. A skin graft involves removing a patch of healthy skin, usually from a part of your body where any scarring cannot be seen, such as your back. It is then connected, or grafted, to the affected area. In many cases, this operation is enough to cure skin cancer. Curettage and electrocautery Curettage and electrocautery is a similar technique to surgical excision, but is only suitable for cases where the cancer is quite small. The surgeon will use a small, spoon-shaped blade to remove the cancer and an electric needle to remove the skin surrounding the wound. The procedure may need to be repeated two or three times to ensure the cancer is completely removed. Cryotherapy Cryotherapy uses cold treatment to destroy the cancer. It is sometimes used for non-melanoma skin cancers in their early stages. Liquid nitrogen is used to freeze the cancer, and this causes the area to scab over. After about a month, the scab containing the cancer will fall off your skin. Cryotherapy may leave a small white scar on your skin. Mohs micrographic surgery Mohs micrographic surgery (MMS) is used to treat non-melanoma skin cancers when: its felt there is a high risk of the cancer spreading or returning the cancer is in an area where it would be important to remove as little skin as possible, such as the nose or eyes It involves removing the tumour bit by bit, as well as a small area of skin surrounding it. This minimises the removal of healthy tissue and reduces scarring. Each time a piece of tissue is removed, it is checked for cancer. The procedure may need to be repeated 2 or 3 times to ensurethe cancer is completely removed. Chemotherapy Chemotherapy involves using medicines to kill cancerous cells. In the case of non-melanoma skin cancer, chemotherapy is only recommended when the tumour is contained within the top layer of the skin. This type of chemotherapy involves applying a cream containing cancer-killing medicines to the affected area. As only the surface of the skin is affected, you will not experience the side effects associated with other forms of chemotherapy, such as vomiting or hair loss. However, your skin may feel sore for several weeks afterwards. Photodynamic therapy (PDT) Photodynamic therapy (PDT) is used to treat basal cell carcinoma,Bowens disease and actinic keratoses. It involves using a cream which makes the skin highly sensitive to light. After the cream has been applied, a strong light source is shone onto the affected area of your skin, which kills the cancer. PDT may cause a burning sensation and around 2% of people who have this treatment will be left with some superficial scarring. Imiquimod cream Imiquimod cream is a treatment for basal cell carcinoma with a diameter of less than 2cm (0.8 inches). Its also used to treat actinic keratoses. Imiquimod encourages your immune system to attack the cancer in the skin. Common side effects of imiquimod include redness, flaking or peeling skinand itchiness. Less common and more serious side effects of imiquimod include blistering or ulceration of your skin. Wash the cream off and contact your GP if your skin blisters or you develop ulcers after using it. Radiotherapy Radiotherapy involves using low doses of radiation to destroy the cancer. The level of radiation involved is perfectly safe. However, your skin may feel sore for a few weeks after radiotherapy. Radiotherapy is sometimes used to treat basal cell and squamous cell carcinomas if: surgery would be unsuitable the cancer covers a large area the area is difficult to operate on Radiotherapy is sometimes used after surgical excision to try to prevent the cancer coming back. This is called adjuvant radiotherapy. Electrochemotherapy Electrochemotherapy is a possible treatment for non-melanoma skin cancer. It may be considered if: surgery isnt suitable or hasnt worked radiotherapy and chemotherapy havent worked The procedure involves giving chemotherapy intravenously (directly into a vein).Short, powerful pulses of electricity are then directed to the tumour using electrodes. These electrical pulses allow the medicine to enter the tumour cells more effectively and cause more damage to the tumour. The procedureis usuallycarried out using general anaesthetic (where youre asleep) but some people maybe able to havelocal anaesthetic(where youre awake but the area is numbed). Depending on how many tumours need to be treated, the procedure can take up to an hour to complete. The main side effect is some pain where the electrode was used, which can last for a few days and may require painkillers. It usually takes around 6 weeks for results to appearand the procedure usually needs to be repeated. Your specialist can give you more detailed information about this treatment option. Read the NICE (2013) guidelines on Electrochemotherapy for metastases in the skin . Read further information: Cancer Research UK: Treating skin cancer . Macmillan: Treatment for skin cancer . Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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Skin rashes in children | Skin rashes in children | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Skin rashes in children Skin rashes in children Skin rashes in children are common and are often nothing to worry about. Learn about some common skin rashes in children, what their symptoms are and how to treat them. What to do if a child has a rash Phone 999 or go to A&E now if: Your child is unwell with a rash and: has a stiff neck is bothered by light seems confused has a high temperature has difficulty breathing (you may notice grunting noises or their tummy sucking under their ribs), breathlessness, or theyre breathing very fast has a rash that looks like small bruises or bleeding under the skin and does not fade when you press a glass against it their skin, lips or tongue look pale, blue, grey or blotchy On brown and black skin, it may be easier to see the rash or colour changes on the soles of the feet, palms, lips, tongue and inside the eyelids. Ask for an urgent GP appointment or phone 111 if: youre worried about your childs rash and youre not sure what to do Cellulitis Image source: dermnetnz.org Cellulitis is an infection of the deeper layers of skin and underlying tissue. Moreabout cellulitis Symptoms and treatments Symptoms The affected area will be: red painful swollen hot It often affects the legs, but can occur anywhere on the body. Your child will probably also have a fever. See your GP immediately if an area of your childs skin suddenly turns red, hot and tender. If you cant see your GP on the same day, go to a walk-in centre or minor injuries unit. Treatment Cellulitis can usually be diagnosed by assessing the symptoms and examining the skin. It usually responds well to treatment with antibiotics. Chickenpox Image source: dermnetnz.org Chickenpox is a viral illness that most children catch. Its most likely to affect children under 10. Moreabout chickenpox Symptoms and treatment Symptoms An itchy, spotty rash is the main symptom of chickenpox. It can be anywhere on the body. Some children only have a few spots. Others have them all over their body. The spots turn into fluid-filled blisters. This can be very itchy and some may burst. These spots crust over to form scabs, which after a while drop off. Chickenpox on back Treatment Theres no treatment for chickenpox. But, you can get remedies from your pharmacy that can help symptoms. These include: paracetamol to help bring down a fever calamine lotion and cooling gels to ease itching Eczema Image source: dermnetnz.org The most common type of eczema is atopic eczema. This mostly affects children but can continue into adulthood. More about eczema Symptoms and treatments Symptoms Eczema is a long-term condition that causes the skin to become: itchy red dry cracked Atopic eczema often develops on the: backs of the knees elbows neck eyes ears Eczema isnt a serious condition. But, if your child becomes infected with the herpes simplex virus, it can cause the eczema to flare up into an outbreak of tiny blisters. This is called eczema herpeticum and will cause a fever. Treatment Creams and ointments can help eczema symptoms like itching and redness. You should speak to your GP if you think your child has eczema. Theyll be able to tell you whats the most suitable treatment. Erythema multiforme Image source: dermnetnz.org Erythema multiforme is a skin rash. Its caused by an allergic reaction to the herpes simplex virus and is usually mild. Symptoms and treatment Erythema multiforme causes spots. These look like targets with a dark red centre and paler ring around the outside. The hands or feet are usually affected first, followed by the limbs, upper body and face. Your child will probably feel unwell and may have a fever. In rare cases, erythema multiforme can be triggered by a reaction to certain medications. This can include antibiotics or anticonvulsants. This more severe form is called Stevens-Johnson syndrome and it can be life-threatening. Treatment You should speak to your GP if your child has a rash and seems unwell. Hand, foot and mouth disease Image source: dermnetnz.org Hand, foot and mouth disease is a common, contagious infection. Its most common in young children (particularly those under 10). But, it can also affect older children and adults. More about hand, foot and mouth disease Symptoms and treatments Symptoms Hand, foot and mouth disease causes: mouth ulcers spots and blisters on the palms of the hands and soles of the feet Treatment Theres no cure for hand, foot and mouth disease. Your childs immune system will fight the virus and it should clear up after about 7 to 10 days. Hand, foot and mouth disease spreads easily. This means you should keep your child away from school or nursery until theyre better. Make sure your child drinks plenty of fluid. If eating and swallowing is uncomfortable, give them soft foods like mashed potatoes, yoghurt and soup. Impetigo Image source: dermnetnz.org Impetigo is a common and highly contagious skin infection. More about impetigo Symptoms and treatment Symptoms Impetigo causes sores and blisters. There are 2 types of impetigo called: non-bullous bullous Non-bullous impetigo usually affects the skin around the nose and mouth. It causes sores that burst quickly to leave a yellow-brown crust. Bullous impetigo typically affects the trunk (the area of the body between the waist and neck). It causes fluid-filled blisters that burst after a few days to leave a yellow crust. Treatment Speak to your GP or pharmacist if you think your child has impetigo. An antibiotic cream or tablets will be prescribed. This should reduce the length of the illness to around 7 to 10 days. Impetigo isnt usually serious and often improves within a week of treatment. Hives (urticaria) Image source: dermnetnz.org Hives is a common skin reaction that often affects children. It can be known as: hives urticaria weals welts nettle rash More about hives Symptoms and treatments Symptoms Hives is a raised, itchy rash. It can affect one part of the body or be spread across large areas. It occurs when a trigger causes high levels of histamine and other chemicals to be released in the skin. These substances cause the blood vessels in the skin to open up, resulting in: redness or pinkness swelling itchiness There are many possible triggers of hives, including: allergens, like food or latex irritants, like nettles or medicines physical factors, like heat or exercise Sometimes a cause of hives cant be identified. Treatment A hives rash is usually short-lived and mild. It can often be controlled with antihistamines. Keratosis pilaris (chicken skin) Image source: dermnetnz.org Keratosis pilaris is a common and harmless skin condition. It usually begins in childhood and gets worse during puberty. Some people find it improves after this and may even disappear in adulthood. Symptoms and treatment Symptoms The skin on the back of the upper arms becomes rough and bumpy, as if its covered in permanent goose pimples. Sometimes other areas of the body can be affected like the: buttocks thighs forearms upper back Treatment Theres no cure for keratosis pilaris. It often gets better on its own without treatment. But, there are some things you can do that may improve your childs rash. You could use: non-soap cleansers rather than soap an emollient to moisturise their skin Your GP or pharmacist will be able to recommend a suitable cream. Measles Image source: dermnetnz.org Measles is a highly infectious illness that most often affects young children. Its now rare in the UK because of the effectiveness of the measles, mumps and rubella (MMR) vaccine . More about measles Symptoms and treatments Symptoms The measles rash is red-brown blotches. It usually starts on the head or upper neck and then spreads outwards to the rest of the body. Your child may also have a fever and cold-like symptoms. Treatment Phone your GP practice immediately if you think your child has measles. Its best to phone before visiting your GP practice as they may need to make special arrangements. Thisll help to reduce the risk of spreading the infection to others. Measles usually passes in about 7 to 10 days without causing further problems. Paracetamol or ibuprofen can be used to relieve fever, aches and pains. You should also make sure that your child drinks plenty of water to avoid dehydration . Molluscum contagiosum Image source: dermnetnz.org Molluscum contagiosum is a viral skin infection. It often affects young children aged between 1 to 5. They usually catch it after close physical contact with another infected child. Most adults are resistant to the virus. This means theyre unlikely to catch it if they come into contact with it. Symptoms and treatment Symptoms Molluscum contagiosum causes clusters of small, firm, raised spots on the skin. The condition is usually painless, although some children may experience some itchiness. Treatment Molluscum contagiosum usually goes away within 18 months without the need for treatment. Pityriasis rosea Image source: dermnetnz.org Pityriasis rosea is a relatively common skin condition. Most cases occur in older children and young adults (aged between 10 and 35). Symptoms and treatments Symptoms It causes a temporary rash of raised, red scaly patches. The rash can be very itchy. Treatment In most cases, pityriasis rosea clears up without treatment. It usually takes 2 to 12 weeks to clear. But, in rare cases it can last up to 5 months. Emollients, steroid creams and antihistamines can be used to help relieve the itchiness. The rash doesnt usually leave scars. But, the skin can sometimes be discoloured afterwards. Prickly heat (heat rash) Image source: dermnetnz.org Prickly heat (heat rash) is also known as miliaria. It occurs when the sweat ducts in the outer layer of skin (epidermis) are obstructed. Symptoms and treatment Symptoms Heat rash is an itchy rash of small, raised red spots. It causes a stinging or prickly sensation on the skin. You can get a heat rash anywhere on your body but it often affects the: face neck back chest thighs Infants can sometimes get a prickly heat rash if they sweat more than usual. For example, when its hot and humid or if theyre overdressed. Treatment Heat rash isnt a serious condition and rarely requires any specific treatment. Psoriasis Image source: dermnetnz.org Psoriasis is a long-lasting (chronic) skin condition. More about psoriasis Symptoms and treatments Symptoms Psoriasis causes red, flaky, crusty patches of skin covered with silvery scales. The severity of psoriasis varies from person to person. Treatment Theres no cure for psoriasis. But, there are treatments to help improve the symptoms and appearance of skin patches. This includes topical corticosteroids like creams and ointments. Ringworm Image source: dermnetnz.org Ringworm is a highly infectious fungal skin infection. More about ringworm Symptoms and treatment Symptoms Ringworm causes a ring-like red or silvery patch on the skin that can be scaly, inflamed or itchy. Ringworm often affects the arms and legs, but it can appear almost anywhere on the body. Other similar fungal infections can affect the scalp, feet, groin and nails. Treatment Ringworm can usually be easily treated with antifungal medicines. These are available from a pharmacy. Ringworm of the scalp can cause scaling and patches of hair loss. Its treated with antifungal tablets, often combined with antifungal shampoo. Scabies Image source: dermnetnz.org Scabies is a contagious skin condition. Its caused by tiny mites that burrow into the skin. In children, scabies is usually spread through long periods of skin-to-skin contact with an infected adult or child. For example, during play fighting or hugging. More about scabies Symptoms and treatments Symptoms Scabies mites leave small, red blotches. These are often found on the palms of the hands or the soles of the feet. In infants, blisters are often found on the soles of the feet. A scabies rash can be very itchy. Treatment Speak to your GP if you think your child has scabies. Its not usually a serious condition, but it does need to be treated. Your GP will prescribe a lotion or cream. Scarlet fever Image source: dermnetnz.org Scarlet fever is a highly contagious bacterial infection. It usually affects children between 2 and 8. More about scarlet fever Symptoms and treatment Symptoms Scarlet fever causes a distinctive pink-red rash. This feels like sandpaper to touch and may be itchy. Scarlet fever often starts with a sore throat, fever and headache . The rash then develops 2 to 5 days after infection. The rash usually occurs on the chest and stomach. It then spreads to other areas of the body, like the ears and neck. Treatment Speak to your GP if you think your child has scarlet fever. Antibiotics are used to treat scarlet fever. It usually clears up after about a week. Slapped cheek syndrome Image source: dermnetnz.org Slapped cheek syndrome is a viral infection thats common in children aged 6 to 10. Its also known as fifth disease or parvovirus B19. More about slapped cheek syndrome Symptoms and treatments Symptoms Slapped cheek syndrome causes a distinctive bright red rash on both cheeks. This can look alarming, but it usually clears up by itself in 1 to 3 weeks. Treatment Unless your child is feeling unwell, they dont need to stay away from school. Once the rash appears, the infection is no longer contagious. But, its a good idea to notify your childs school about the infection. NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
Slapped cheek syndrome | Slapped cheek syndrome | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Infections and poisoning Slapped cheek syndrome Slapped cheek syndrome Slapped cheek syndrome (also called fifth disease or parvovirus B19) is a viral infection. Its most common in children but it can affect people of any age. It usually causes a bright red rash on the cheeks. Slapped cheek syndrome is normally a mild infection that clears up by itself in 1 to 3 weeks. Once youve had the infection, youre usually immune to it for life. However, slapped cheek syndrome can be more serious for some people. If youre pregnant, have a blood disorder or a weakened immune system and have been exposed to the virus, you should get medical advice. Symptoms of slapped cheek syndrome Symptoms of slapped cheek syndrome usually develop 4 to 14 days after becoming infected. Sometimes, symptoms may not appear for up to 21 days. First symptoms Some people with slapped cheek syndrome wont notice any early symptoms, but most people will have the following symptoms for a few days: a slightly high temperature (fever) of around 38C (100.4F) a runny nose a sore throat a headache an upset stomach feeling generally unwell The infection is most contagious during this initial period. Adults may also feel joint pain and stiffness. This may continue for several weeks or even months after the other symptoms have passed. Slapped cheek rash Image source: dermnetnz.org After a few days, a distinctive bright red rash on both cheeks (slapped cheeks) normally appears. Adults may not get this. By the time this rash develops, the condition is no longer contagious. After another few days, a light pink rash may also appear on the chest, stomach, arms and thighs. This often has a raised, lace-like appearance and may be itchy. The rashes will normally fade within a week or two. Occasionally, the body rash may come and go for a few weeks after the infection has passed. This can be triggered by exercise, heat, anxiety or stress. When to get medical advice You dont usually need to see your GP if you think you or your child has slapped cheek syndrome as it normally gets better on its own. Speak to your GP practice if: Youve been exposed to anyone with slapped cheek syndrome or you have symptoms of the infection and: youre pregnant theres a very small risk of miscarriage or other complications you have a blood disorder, such as sickle cell anaemia or thalassaemia you have a weakened immune system ask for an urgent appointment if you have symptoms of severe anaemia, such as very pale skin, shortness of breath , extreme tiredness or fainting If your GP is closed, phone 111 . In these cases, a blood test may be carried out to see if youre immune to the infection. If youre not immune, youll be monitored carefully to check for any problems. If you develop severe anaemia, its likely that youll be sent to hospital for a blood transfusion . What to do if you or your child has slapped cheek syndrome Slapped cheek syndrome is usually mild and should clear up without specific treatment. If you or your child is feeling unwell, there are things you can do help ease the symptoms. Do rest drink plenty of fluids babies should continue their normal feeds take paracetamol or ibuprofen for a high temperature, headaches or joint pain children under 16 shouldnt take aspirin use an emollient (moisturising lotion) on itchy skin speak to a pharmacist about itchy skin they can recommend the best antihistamine for children Unless you or your child is feeling unwell, you do not have to stay away from work or school once the rash has developed. The infection is no longer contagious by this point. Let your childs school know if your child has slapped cheek syndrome. How do you get slapped cheek syndrome? Slapped cheek syndrome is caused by a virus called parvovirus B19. This is found in the droplets in the coughs and sneezes of someone with the infection. The virus is spread in a similar way to colds and flu . You can become infected by: inhaling droplets that are sneezed or coughed out by someone with the infection touching a contaminated surface or object and then touching your mouth or nose Someone with slapped cheek syndrome is infectious during the period before the rash develops. Once the rash appears, the condition can no longer be passed on. Preventing slapped cheek syndrome Its very difficult to prevent slapped cheek syndrome. This is because people who have the infection are most contagious before they develop any obvious symptoms. Make sure that everyone you live with washes their hands often to help stop the infection from spreading. Theres currently no vaccine available to protect you against the condition. Source: NHS 24 - Opens in new browser window Last updated: 04 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n Info For Me Also on NHS inform Self-help guide: Rash Skin rashes in children NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats 2023 NHS 24 v1.1.1.17852 | null | null | null | null | null | null | null | null | null | null | null | null | null |
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