Tuesday, 27 May 2014

Reputable health information sources

Today, a US study reveals that 90% of Wikipedia medical entries are inaccurate. The researchers stress that people shouldn't be using the online encyclopaedia to diagnose their symptoms.

This comes as no surprise - and it's certainly not news. Many surveys over the years have revealed that too many people get inaccurate health information from the internet, family and friends, rather than go to their GP or another healthcare professional.

Wikipedia is hugely popular but it lets users create, delete and edit entries, without having any specialist knowledge themselves. This applies to all subjects, from finance to building materials, but it's particularly worrying when someone is relying on this knowledge to diagnose (and possible manage) a health condition.

So where should you get your health information from?

1. Your GP
There's no doubt that if you are experiencing severe or worsening symptoms, your first port of call should be your GP. There's nothing better than a proper physical examination to check for underlying causes or the chance to be referred for further tests or a hospital consultation. If you can't get an appointment with your GP straight away, try the practice nurse.

2. Your pharmacist
If your symptoms are relatively minor, you could ask a pharmacist for advice. You may be recommended some over-the-counter medicines, given practical suggestions or referred to your GP, optometrist, dentist etc, depending on the nature of the problem. Most pharmacies have a confidential area or consultation room if you want to speak in private.

3. The internet
You shouldn't use the internet for diagnosis, but heading to the right online sources can give you accurate information once you have already been diagnosed. NHS Choices and charities such as Diabetes UK, British Heart Foundation and Cancer Research UK have a wealth of information on their websites. There aren't many medical conditions or symptoms that won't be covered by one of the UK charities. If you require nutrition advice, check out the British Nutrition Foundation. Visit the National Pharmacy Associations' Ask the Pharmacist section for information on medicines and pharmacies. Make sure you use UK websites, as information about diagnosis and treatments varies from country to country. And always check the dates of publication on the websites to make sure the information is up to date.

4. Self-help groups
If you have been diagnosed with a medical condition like arthritis, diabetes or heart disease, you may find there is a support group in your local area. Generally these gatherings are for practical support and advice, but sometimes they hold talks by healthcare professionals or promote workshops to help you manage your symptoms more effectively. Call your GP surgery to check whether there is a support group in your local area, or try the website of the charity that is most relevant to your symptoms.

5. Family & friends
Let's face it, most of us have asked advice from those closest to us when we are struggling with symptoms. We shouldn't rely on family and friends for a diagnosis or health information (unless they are medically qualified). But there's nothing like practical support and self-help tips from people who share, or have shared, our experiences (just as with local self-help groups). It's important to be open about your symptoms and medical conditions as much as possible, as you may find that a friend of a friend or a relative of a relative knows exactly what you are going through and can provide the support you need.

6. Magazines and books
As a journalist and author, I should tell everyone to read as many health books and magazines as possible when researching their symptoms. But that wouldn't be a very responsible attitude. Many health books are thoroughly researched, but books tend to be written around a year in advance of publication and medical advice and information often changes during this time. Magazines tend to be more up-to-date, but certainly shouldn't be used for diagnosis. However, they may offer useful tips and background information (although you are relying on the fact that the journalist has thoroughly researched the articles before these are published).

Monday, 19 May 2014

Drinkable sunscreen? Whatever next!

Summer must be on its way, as the health media has been inundated with stories about sun protection products over the last few days. Or maybe it's pure chance that this coincides with the first hot weather of the year.

New Which? research (published on Friday May 16th)  into the effectiveness of sun creams has revealed products from three popular brands failed to provide the protection they claim.  Piz Buin Ultra Light Dry Touch Sun Fluid SPF 30 150ml, Malibu Protective Lotion SPF30 200ml and Hawaiian Tropic Satin Protection Ultra Radiance Sun Lotion SPF30 200ml all had results lower than SPF 25, despite claiming an SPF of 30. The Which? research also noted that spending more money doesn't guarantee effectiveness. Calypso Sun Lotion SPF30 250ml was the cheapest sun cream on test, costing just £1.20 per 100ml, and passed both British Standard tests.

Today, the Daily Mail reported that a US company claims to have invented the first drinkable sunscreen. Osmosis Skincare claim their product, Harmonised H20 UV protection, can provide sun protection up to SPF 30. Apparently, once ingested, the product's liquid molecules vibrate on the skin, cancelling out 97% of UVA and UVB rays. According to the company's website, you drink 2ml of the liquid every four hours while in the sun (preferably with water) to achieve the full protection. However, anyone exercising vigorously outdoors or taking sun-sensitising medicines should use alternate protection after 30 to 40 minutes.

This news story has great timing, considering the Which? report three days earlier that may have cast doubt into the minds of consumers about the sun lotions they are currently using to protect themselves. Yet, as it happens, even SPF 25 provides good protection from the sun; Cancer Research UK's Sun Smart website currently recommends using sunscreens with at least SPF 15 and a high star rating.

So would you want to drink sunscreen out of a bottle instead of slapping it on your skin? And, more importantly, would this be putting you at the risk of sunburn or, even worse, skin cancer? 

Bear in mind that both of these news stories come nearly a month after Cancer Research UK revealed that the incidence of malignant melanoma - the most serious form of skin cancer - is now five times higher than it was in the 1970s. Malignant melanoma is now the 5th most common cancer in the UK, with more than 2000 dying from it each year.

So far, the trend on twitter has been a resounding 'no', with terms 'irresponsible', 'stupid' and 'dubious'! In fact, the British Skin Foundation (BSF) posted on its twitter feed this morning: "For anyone who has read about drinkable sunscreen, we would advise extreme caution."

The BSF also posted its sun safety tips:
1. Protect your skin with clothing and don't forget to wear a hat that protects your face, neck and ears.
2. Spend time in the shade between 11am and 3pm when it's sunny.
3. When choosing a sunscreen, look for a high protection SPF (SPF 30 or more) to protect against UVB, and the UVA circle logo and/or 4 or 5 UVA stars to protect against UVA.
4. Apply plenty of sunscreen 15 to 30 minutes before going out in the sun, and reapply every two hours and straight after swimming and towel-drying.
5. Keep babies and young children out of direct sunlight.

Funnily enough, there was no mention of drinking sunscreen.

Thursday, 15 May 2014

Are you using your medicines properly?

A new report by the Royal Pharmaceutical Society (RPS), published last week, highlights the fact that pharmacists need to improve patients' use of medicines. Apparently, between 30 and 50 percent of patients taking medicines for chronic conditions don't take them as directed, leading to ill-health and extra costs for the NHS.

Ensuring the best use of medicines, reducing the risks of side effects and making sure people are taking medicines properly and safely are core activities of all pharmacy services. A report in May 2013, also by the RPS, revealed that 'only 16 percent of patients who are prescribed a new medicine take it as prescribed, experience no problems and receive as much information as they need.'

But we can't put all the responsibility onto pharmacists. It's also up to us as patients to make sure we are taking prescribed medicines correctly (where possible). And while the reports focus on prescription medicines, this also apply to anything we buy over the pharmacy counter.

So how can you make sure you are using your medicines properly?

1. Speak out
The National Pharmacy Association's Ask your Pharmacist campaign stresses that you should always let your pharmacist know if you are:

  • allergic to anything
  • taking prescribed medicines from another pharmacist or hospital pharmacy
  • taking over-the-counter (OTC) medicines or vitamin, mineral or herbal supplements
  • pregnant or breastfeeding
  • buying or collecting the medicines for someone else.

Always ask questions
Sometimes the instructions on the medicine label or in the supplied leaflet aren't clear (or in layperson's terms). So when picking up a prescription medicine or buying any OTC product for the first time, always ask:
  • What is this medicine for? [Make sure you know which medicines are helping which symptoms or medical conditions,]
  • How long does it take to work and will I notice the effects? [You may not notice blood pressure medicines doing anything, yet they will still be working in the background.]
  • Why do I need to take or use it? [It's important to understand why you need to take a medicine and what will happen if you don't.]
  • When should I take or use it? [How many times a day, morning or night etc.]
  • How do I take or use it? [Make sure you know, for example, how to put eye drops in.]
  • How long should I take it for? [Do you need to finish a specific course or do you need to keep getting new prescriptions each month?]
  • What do I do if I forget a dose? [Do I take the next one, take it as soon as I remember etc?]
  • Does it have any side effects? [What are the side effects? What do you do if you think you are experiencing any?]
  • Are there any possible risks I should be aware of? [Some medicines can affect your liver, for example, so your doctor may advise that you have regular liver function tests.]
  • Could it interact with any other medicines I am taking? [This includes over-the-counter medicines and vitamin, mineral and herbal supplements.]
  • Will it still work if I have a stomach upset? [If you use oral contraceptives, for example, you will need to use condoms if you have a stomach bug as the contraceptive won't be as effective.]
  • Can I take it with/without food or drink? [Some medicines, for example, interact with grapefruit juice.] 
  • Do I need to store it any particular way? [e.g. in the fridge].

3. Find ways to remind yourself
If you don't always remember to take your medicines, what can you do to jog your memory?
  • Get into a routine and stick with it.
  • Fill up a dossette box with medicines for a week. So you will be able to tell if you forget a dose. 
  • Link taking medicines with specific activities (e.g. the evening news, the morning paper TV programmes). 
  • Set multiple alarms or reminders on your mobile phone. 
  • Keep a diary or planner and tick off a dose once you have taken it.
  • Ask your friends or family to remind you.

3. Access pharmacy services
If you are prescribed a new medicine for the first time for asthma, chronic obstructive pulmonary disease, type-2 diabetes or high blood pressure, ask your pharmacist about The New Medicines Services (NMS), which is free across England. If you are eligible, the pharmacist will answer many of the questions above to help you get the most out of your medicines and stay well.

If you are taking two or more prescribed medicines for a chronic conditions, you can have a free NHS Medicines Use Review (MUR). This service is available throughout England and Wales ('Managing your Medicines' is offered in Ireland and a 'Chronic Medication Service' is available in Scotland). During this personal consultation, your pharmacist can discuss the medicines you are prescribed, whether you are experiencing any problems or side effects and whether there could be a more effective way of taking them.

Tuesday, 13 May 2014

Vitamin D boosters

Today has been sunnier than I expected. But unfortunately, thanks to work deadlines, I haven't had a chance to enjoy the sunshine and get a much-needed vitamin D boost.

Unlike many other vitamins, vitamin D isn't readily available from food, with sunlight being the best source. Thanks to our usually dreary skies, millions of people in Britain are not getting enough vitamin D, putting children at risk of rickets (soft bones) and leaving adults with osteoporosis (brittle bones) and other health problems. According to draft guidelines by the National Institute of Health and Care Excellence (NICE), currently undergoing consultation until 24th June, councils should consider making supplements available to the one in five adults at risk of deficiency, in particular older people and those with darker skin and pharmacies should be encouraged to stock low-cost vitamin D supplements.

Most people don't need to take vitamin D supplements - so don't take them unless your GP advises you to do so.

I was diagnosed as vitamin D deficient several years ago. When my vitamin D levels are low, I experience joint pains and fatigue, so I am supposed to take supplements every day to keep these symptoms at bay. Unfortunately, I have a dreadful habit of forgetting to take supplements (or medicines in general).

Recently, I have been trying out a vitamin D mouth spray, BetterYou's DLux 1000iu oral spray. This is much more convenient than taking a tablet, as I keep the spray at the side of my bed and grab it when I wake up. I simply spray once under my tongue and the vitamin is (apparently) absorbed directly into my bloodstream.  This particular product supplies 1000iu (25 mg) of vitamin D in every spray, but there is also a 3000iu version and 400iu version, depending on the dose you require.  

Many people worry about topping up their vitamin D levels through exposure to sunshine because of the risk of sunburn and skin cancer. The amount of time you need to be out in the sun will depend on many things - your skin type, time of day, time of year or where you are in the world. Generally, according to Cancer Research UK, you only need 10 to 15 minutes in the summer sun in the middle of day without sun protection to ensure you get enough vitamin D. Cancer Research UK stresses that your skin must not redden or burn.

Monday, 12 May 2014

Don't forget gluten-free guests

This weekend, we invited a group of friends over for tea to celebrate my husband's birthday. One of our friends is gluten intolerant, so we wanted to make sure that she was well-catered for. We made her a flour-less chocolate almond cake and bought some Doves Farm gluten-free biscuits.

It is estimated that around one in 100 people in the UK has coeliac disease (gluten-intolerance). Symptoms include bloating, diarrhoea, wind, nausea, constipation, tiredness, headaches, sudden or unexpected weight loss (but not in all cases), hair loss and anaemia. Leading a gluten-free lifestyle can be a challenge, but it is essential to prevent the symptoms and reduce the risk of complications.

Sweet treats aside, according to Coeliac UK, many people who are gluten-intolerant encounter difficulties when searching for gluten-free staple items such as bread, crackers, cereals and rolls. They often have to travel from one supermarket to another simply to buy essential food items.

This year's Coeliac Awareness Week (12th to 18th May) focuses on the availability of gluten-free food in supermarkets. The charity's Gluten-free Guarantee is asking supermarkets to sign up to having eight core gluten-free items in store, so people can manage their condition more easily. The core items are: fresh white bread, fresh brown bread, bread rolls, breakfast cereals, pasta, flour, crackers and cereal bars. For more details, visit Coeliac Awareness Week 2014

If you have been diagnosed with coeliac disease by a doctor, did you know you are entitled to receive a reasonable quantity of gluten-free staple foods on prescription? You fill out a gluten-free prescription order form with your GP (or in some pharmacies) indicating which products you would like and the quantities. Your order will then be delivered to your chosen pharmacy for you to collect once it is ready. In England, you will have to pay prescription charges unless you are exempt (see my blog on 30th April 2014). For details, visit Coeliac UK's Prescriptions page.

Thursday, 8 May 2014

Ovarian cancer - make sure you know the signs

Today is World Ovarian Cancer Day. Many symptoms of this type of cancer are non-specific little niggles that could be caused by a whole host of less-serious health problems, such as irritable bowel syndrome or ovarian cysts. This is why many women ignore them and are diagnosed too late.

Remember, ovarian cancer is fairly rare
According to Ovarian Cancer Action, all women in the UK have a one in 54 chance of developing ovarian cancer. Women are most at risk if they have a family history of ovarian or breast cancer or they are aged over 50, although there are some other factors that will increase the risk slightly (e.g. being obese or starting menstrual periods before the age of 12).

Know for the signs
Watch out for these symptoms  (courtesy of Ovarian Cancer Action):

  • Persistent stomach pain
  • Persistent bloating
  • Finding it difficult to eat or feeling full quickly
  • Needing to wee more often.

If you are regularly experiencing these symptoms on most days, it's important to talk to your GP as soon as possible. Make a symptom diary including when they occur and if they appear to be getting worse. Also think about any triggers that could be setting them off (e.g. what you eat or drink, your stress levels etc).

Other symptoms you may notice include:

  • Back pain
  • Changes in your bowel habits (diarrhoea or constipation)
  • Feeling tired all the time.
Don't panic
Most people get the above symptoms from time to time. Usually these don't have a serious cause. However, they also shouldn't be ignored. According to Ovarian Cancer Action, ovarian cancer symptoms usually persistent and frequent (for more then 12 days a month), get progressively worse, will have started within the last 12 months and will be unusual for you. Your GP can arrange a number of tests and discuss any concerns.

Tuesday, 6 May 2014

How is your asthma inhaler technique?

Today's big health story (so far) is a new report - Why asthma still kills - published by the Royal College of Physicians (RCP) to coincide with World Asthma Day. According to the report, nearly three-quarters of asthma deaths could have been avoided with better care and better access to medical help. The RCP report recommends that everyone with asthma has their inhaler technique assessed formally once a year and whenever the pharmacist dispenses a new device.

So what should you be doing to make sure you are using your inhalers properly?

1. Check your technique
I suffer from mild asthma - my symptoms usually only strike at the peak of the hayfever season or when I have a respiratory infection such as a cold. I don't need new inhalers very often, because I don't use them very often, but I don't recall any pharmacist checking my inhaler technique when dispensing my prescriptions since I was first diagnosed over 30 years ago. I think the fact that I don't use inhalers on a regular basis could possibly make me more likely to forget the correct technique.

Even if your pharmacist doesn't mention it to you, make sure you ask them to check that you are using your inhaler properly. There's nothing like a one-to-one practical demonstration. However, for general guidance, you can also visit Asthma UK's Using your inhalers page.

2. Get the right products
If you are having problems using your inhaler (because of arthritis in your hands, for example), speak to your GP, who may be able to switch you to a different type of inhaler or suggest products that can help, such as the Haleraid or Turboaid - you can't get these on prescription, but your pharmacist should be able to order them in for you. Spacers, which are available on prescription, make aerosol inhalers more effective by trapping the medicine inside so you don't have to worry about pressing the inhaler and breathing in at the same time.

Use inhalers appropriately
Also speak to the pharmacist about when you use your inhalers. The RCP report found that asthma patients are relying too heavily on their reliever inhalers (usually blue) and not enough on their preventer inhalers (usually brown, red or orange). Nearly half of those who died from an asthma attack had not had an asthma review with their GP or nurse in the previous year.

3. Write an asthma action plan
According to the RCP report, better education is needed for doctors, nurses, patients and carers to make them more aware of the risks of asthma, to spot the warning signs of poor asthma control and to know what to do during an attack. All patients should be provided with a personal asthma action plan (PAAP), to help them identify if their asthma is worsening and tell them how and when to seek help. Asthma UK has a useful Asthma Action Plan that you can download from the charity's Personal action plan page and take to your GP or asthma nurse to discuss and fill in.

4. Have a Medicines Use Review
You can also ask your local pharmacist if they offer a Medicines Use Review (MUR) - this is a free NHS service in a private consultation room. You can discuss all your medicines with the pharmacist, to check they are all necessary, you are using them properly and to solve any problems you may have.

Licensed herbal medicines

As of the 1st of May 2014, all herbal medicines sold in pharmacies must have a traditional herbal registration (THR) or product licence (PL). So what does this mean for pharmacy customers?

According to Dr Linda Anderson from the Medicines and Healthcare products Regulatory Agency (MHRA), the THR scheme gives people access to traditional herbal medicines that are safe, of good quality and sold with information on how to use the product correctly.

What are THR products for?
You can use a THR product for minor self-limiting ailments like colds or hayfever. Beware of any unlicensed product claiming to cure, treat or prevent any illness.

The THR scheme doesn't mean the herbal remedy has been tested and proven to actually work. It just means the product is made to good-quality standards with appropriate labelling and a product information leaflet. It also means the herb has been used in traditional remedies for more than 30 years.

What to look for on the label:

  • Look for the THR number on the packaging of herbal products.
  • Most registered herbal products will have the THR logo (see right) too.
  • Licensed medicines have a nine-digit PL (product licence) number on their labels, just like conventional medicines.

Herbal medicine safety
Natural doesn't always mean safe. Some unlicensed herbal medicines can cause side effects or may interact with other medicines. It's always important to tell your GP or pharmacist whether you are taking any herbal remedies or dietary supplements. St John's Wort, for example, which can be taken for mild depression, may interact with a whole host of medicines including the contraceptive pill, hormone replacement therapy (HRT), thyroid hormones and some anti-depressants.

Always read the product information leaflet carefully before taking any herbal remedy. If you experience any possible side effects, stop taking the product and speak to the pharmacist.

If you have an adverse reaction to any medicine, including herbal remedies, your pharmacist (or GP) can report this to the MHRA under a system called the Yellow Card Scheme. Alternatively, you can report it yourself directly at the MHRA Yellow Card Scheme website.

Consulting a medical herbalist
If you wish to consult a herbalist to get tailor-made advice, make sure you choose a reputable practitioner. You can find a herbalist in your local area through the website of The National Institute of Medical Herbalists (NIMH).