Persistent heartburn? Get it checked out...

Many people treat heartburn with over-the-counter remedies from a pharmacy, without visiting their GP for advice.  A new survey by Public Health England has revealed that only one in two people would visit their doctor if they had heartburn most days for three weeks or more. Yet persistent heartburn could be a sign of oesophageal or stomach cancer (collectively called oesophago-gastric cancers). Nearly 60 percent of people surveyed didn't know that heartburn could be a sign of cancer, with just 15 percent saying they were certain that it's a symptom.

Public Health England (PHE) launched its national 'Be Clear on Cancer' campaign today. Around 12,900 people in England are diagnosed with oesophago-gastric cancers each year, with approximately 10,200 people dying from these diseases annually. This equates to 28 people dying from either oesophageal or stomach cancer every day. Oesophago-gastric cancers are the fourth and fifth most common causes of cancer death in men and women respectively.

The PHE survey also highlighted that difficulty swallowing food is another possible symptom - 70 percent of respondents didn't know food sticking in the throat could be a sign of cancer, and just 13 percent said they were sure it's a symptom.

An early diagnosis of oesophageal or stomach cancer is crucial and means treatment is more likely to be successful. Around 67 percent of people diagnosed with these cancers at the earliest stage survive at least five years. This figure drops to around three percent for those diagnosed at a late stage.

According to Dr Richard Roope, Cancer Research UK's GP expert: "The advice we give is: if in doubt, check it out - this would not be wasting your GP's time. Often your symptoms won't be caused by cancer, but if they are, the quicker the diagnosis, the better the outcome. Seeking prompt advice from your GP about symptoms, either on the phone or during an appointment, could be a life-saver, whatever your age. And the good news is that more than half of all patients diagnosed with cancer now survive for more than 10 years."

Heartburn tips
If you are prone to heartburn, try the following self-help measures to reduce your symptoms:

• Keep your weight within the normal range for your height.
• Give up smoking.
• Eat smaller, more frequent meals during the day, rather than three large meals.
• Make sure you have your evening meal three or four hours before bedtime. 
• Limit, or avoid, alcohol, coffee, chocolate, tomatoes and/or fatty/spicy foods.
• Raise the head of your bed by around 20 cm (8 in) by placing a piece of wood or blocks under it. However, don't use extra pillows, as this may increase pressure on your abdomen.

Over-the-counter treatments

Many effective heartburn remedies are available over the counter, but these are not suitable for everyone. 

Antacids neutralise excess stomach acid and are ideal for occasional indigestion. These shouldn't be taken with certain other medicines, as they can affect their absorption, so check the label carefully or ask the pharmacist for advice. If you suffer from heartburn as well as indigestion, you can buy antacids combined with alginates, which produce a protective coating over the top of your stomach contents to stop stomach acid rising up into your oesophagus.

If antacids (with or without alginates) fail to work, you may be able to try a short course of an over-the-counter proton pump inhibitor (PPI), which reduces stomach acid production. Another option is an H2 antagonist, which also blocks acid production. However, don't use these over-the-counter heartburn medicines for longer than seven days without speaking to your pharmacist or consulting your GP.  Before buying any medicines, it's important to tell the pharmacist your age and if you are pregnant, suffer from any chronic medical conditions (e.g. high blood pressure) or take any other medicines or dietary supplements.

If your symptoms persist, always get them checked out. PHE highlights the following warning signs to look for:

• Heartburn most days for three weeks or more
• Food feels like it's sticking in your throat when you swallow
• Indigestion on and off for three weeks or more
• Losing weight for no obvious reason
• Trapped wind and frequent burping
• Feeling full very quickly when eating
• Feeling bloated after eating
• Nausea or vomiting
• Pain or discomfort in your upper tummy area.

Remember though, it's important not to panic or worry. Persistent heartburn often isn't a sign of cancer or any other serious medical problem. It may simply be caused by lifestyle factors (see heartburn tips above) or pregnancy or by a treatable problem, such as hiatus hernia. That's why it's important to seek medical advice from your GP for a proper diagnosis.

On diclofenac tablets? What should you do?

As of today, you can no longer buy diclofenac tablets (for pain and inflammation) over the counter from a pharmacy. The Medicines and Healthcare Products Regulatory Agency (MHRA) has made this decision based on the fact that diclofenac carries a 'small' risk of serious cardiac side effects, especially if taken in high doses or for the long-term treatment of chronic pain. Pharmacists are being told to take any diclofenac tablets off their shelves and return any stock.

What is diclofenac?
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID), in the same class of medicines as ibuprofen. It combats pain and inflammation and has commonly been used for arthritis symptoms.

Why is the availability of diclofenac tablets changing?
In 2013, the MHRA warned that diclofenac tablets shouldn't be taken by people with an underlying heart condition or a history of a heart attack or stroke. This evidence has now been looked at by the Commission on Human Medicines, which concluded that the side effects can't be ruled out, even when the medicine is taken for a short time or at a lower dose. Therefore, diclofenac tablets are being reclassified as a prescription-only medicine (POM).

What about diclofenac gels?
Diclofenac topical gel is still available to buy over the counter as Voltarol Pain-eze, Voltarol Emulgel and Voltarol 12-hour Emulgel. You rub these gently into your skin for local pain relief. The gels are suitable for rheumatic or muscular pain, sprains, strains and bruises (e.g. due to sports injuries). To buy certain Voltarol gel products over the counter, you need to have a discussion with the pharmacist first, as these are pharmacy-only (P) medicines.

What should you do?
Firstly don't panic!

If you have been prescribed diclofenac by your GP, continue taking your medicines as instructed, as your GP will have already assessed your medical history and individual risks. If you are concerned, speak to your GP at your next visit.

If you have bought diclofenac tablets over the counter, stop taking them and speak to your pharmacist about suitable alternatives. If you want to continue taking diclofenac tablets, you will need to make an appointment with your GP, who can assess the risks and will prescribe diclofenac if it's appropriate for you.

What else is available from your pharmacy?
There are many pain relief options available over the counter.
These include:

• Ibuprofen and/or paracetamol tablets or capsules: you can buy these painkillers separately or take them together in one product (Nuromol).
• Topical analgesic gels, containing either diclofenac or ibuprofen in various strengths.
• Hot and cold treatments (in the form of patches, rubs and sprays).
• Non-drug treatments (e.g. those using acupressure, electromagnetic pulse therapy, TENS etc.)

Before buying any pain relief products, always check with the pharmacist that these are suitable for you - disclose whether you have any underlying medical conditions or take any other medicines. Even non-drug treatments aren't suitable for everyone.

Before using a product, read the instructions carefully, checking how to use it safely and the correct dosage. If your pain is severe or persistent, you should always get it checked out by your GP.

Vaginal dryness - break the taboo

Most women don't like to talk about vaginal dryness. Let's face it, it's not a sexy topic. It's highly embarrassing and doesn't usually feature in daily conversations. Many women therefore suffer in silence.

Yet there's no reason for the subject to be such a big taboo. Vaginal dryness is a common problem in the UK. And, because it has a major impact on sex and relationships, needs to be discussed more openly.

According to Dr Diana Mansour, consultant in community gynaecology and reproductive healthcare, vaginal dryness is not just a menopause-related problem. "Pregnancy, hormonal treatments and even stress or tiredness may also lead to dryness in the intimate vaginal area," she says. "As you age, hormonal changes can cause vaginal dryness, which can be uncomfortable, leaving you more vulnerable to irritation or causing pain and discomfort during sex. If your dryness is persistent, contact your doctor or other healthcare professional for advice or more information."

Various moisturisers for vaginal dryness are available over the counter from pharmacies. These include Replens MD, Balance Activ Menopause, Sylk Natural Intimate Moisturiser and new Canesintima Intimate Moisturiser from Bayer Healthcare, which makes Canesten. Your GP can also prescribe some of these products on prescription.

Dr Mansour stresses the importance of using an intimate moisturiser specifically for vaginal areas. "Using an intimate moisturiser may help keep the external vaginal area hydrated and lubricated, therefore easing the discomfort and further irritation," she says. "These products should be free from parabens, soap and preservatives, as well as dermatologically tested, making them suitable for the vagina's delicate environment."

If you want to discuss intimate health issues with your pharmacist, ask if you can go into their private consultation room.

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Check your moles monthly

The British Skin Foundation is urging people to check their loved ones' moles - as Valentine's Day fast approaches.

According to Dr Bav Shergill, consultant dermatologist and British Skin Foundation trustee, most skin cancers can be cured if detected early. "The best way to detect skin cancer is to check your skin regularly, about once a month," he says. "You should examine the skin all over your body from top to toe. Ask a friend or member of your family to look at areas you can't see, such as your scalp, ears and back."

Things to look for

• Moles that are growing or changing shape
• Moles that are developing new colours
• Moles that are inflamed, bleeding or red around the edges
• Moles that are particularly itchy or behaving unusually
• A new growth or sore that won't heal
• A spot or sore that itches or hurts
• A mole or growth that bleeds, crusts or scabs.

According to Cancer Research UK, it's generally a good idea to be aware of how your skin normally looks so that you are more likely to notice any changes. Following Cancer Research UK's ABCD rules can help you identify specific changes in moles:

• Asymmetry: The two halves of the moles don't look the same.
• Border: The edges of the mole are irregular, blurred or jagged. 
• Colour: The colour of the mole is uneven with more than one shade.
• Diameter: The mole is wider than 6mm in diameter (the size of a pencil eraser).

The devastating facts

• Seven people die from skin cancer every day in the UK.
• Over 100,000 new cases of skin cancer are diagnosed in the UK each year.
• Rates of malignant melanoma are rising faster than any other type of common cancer.
• On average, someone who dies from skin cancer typically loses 20 years of their life.
• At least two 15-34 year olds are being diagnosed with malignant melanoma every day in the UK.

Tell your doctor about any changes to a mole or patch of skin. This is particularly important if you are at an increased risk of skin cancer (e.g. fair skin, lots of moles or freckles, red or fair hair, a history of sunburn and/or a personal or family history of skin cancer).

Most skin changes turn out to be nothing to worry about - but it's better to be safe and remain vigilant. If in doubt, get it checked straight away.

Medicine technique - get it checked

Following on from my post on 6th May 2014 about asthma inhaler technique…

In the last week, a new US report had revealed that a significant number of people with asthma don't receive adequate training on how best to use an inhaler and allergy sufferers don't know how to use their adrenaline pens (Epipen or Jext) properly. Asthma UK and Allergy UK are calling for improved training.

The research is due to be published in January 2015 in the Annals of Allergy, Asthma and Immunology. The researchers found that common problems with adrenaline pens were not pressing them hard enough or letting go too early (before the required 10 seconds had passed). With inhalers, most people received a less powerful dose than they needed, potentially meaning their breathing would continue to worsen.

If you suffer from any medical condition (either regularly or intermittently), it's essential that you make sure you know how to use your medicines properly - whether it's an asthma inhaler, adrenaline pen or even eye drops for glaucoma. Ask your pharmacist for advice or, even better, a practical demonstration.

Visit Asthma UK's website (click here) for essential demonstrations on inhaler technique, click here for advice on using Epipens and here for Jext advice.

Keeping allergic teens (and pre-teens) safe

Most people take eating out for granted. But for food allergy sufferers, a seemingly simple restaurant meal or takeaway can be a game of Russian roulette. It's not surprising that the fear of having a severe allergic reaction leads many people with a food allergy to eat only home-cooked meals. Hopefully though, this is set to change.

Since 13th December 2014, new EU regulations mean that food outlets have to provide allergen information on menus, chalkboards or information packs - and staff must be able to supply details about the ingredients in the foods they sell.  Fourteen allergens now have to be listed within the ingredients section and must be highlighted in some way (e.g. in bold), rather than having a separate allergen warning box.

Understandable this is causing some concern within the catering industry, as supplying the allergen information and, most importantly, keeping it up to date is no straightforward task. Suppliers change and menus vary, not to mention the extra staff training required.

As the mother of an 11 year old with nut allergy, I am hoping these new regulations will give me some peace of mind as my son steps out on his own. He is at an age where he wants to go out and about with the same freedom as his friends. However, there is always a nagging 'what if' feeling at the back of my mind. 

Even with the new rules in place, ultimately he still has to remember to read the menu carefully and/or ask whether the restaurant's chocolate ice cream, for example, contains peanut or pecan (the two nuts he is allergic to). And he also needs to carry his allergy medicines with him at all times (just in case).

As children reach the teenage years, there is a fine line between encouraging independence and keeping them safe. I don't want to be a neurotic mother or leave him feeling over-anxious. My son has been aware of the dangers since he was diagnosed at the age of four, and we have drummed into him the importance of checking the food he is about to eat. Fortunately, he hasn't had a food-related allergic reaction since he was diagnosed and has never had a severe reaction. But teenagers (and pre-teens) often feel under pressure to conform or take risks. I feel that he was safer at primary school, when I knew all of his friends and their mothers were aware of his allergy. When he went to parties, the food was always nut free. Now there's no guarantee.

So every so often, when he is about to leave the house, I remind him of the basic rules to follow:

1. Carry his medicines (anti-histamine and adrenaline pens) with him at all times - it doesn't matter whether he is out for the day or just popping to the park. It's not worth taking the risk. Rather than keeping his medicines loose in his pocket or school bag, he carries them in a medicine bag from YellowCross.

2. Practise using his adrenaline pens (I have a trainer dummy pen from the manufacturer).

3. Alert his friends and their parents to his allergy (without worrying them unnecessary). When he has a sleepover, for example, I would prefer it if the family doesn't have any peanut butter on the table at breakfast time.

4. Ensure he wears his allergy ID jewellery at all times, just in case we are not there in an emergency. My son wears his MedicAlert sports band on his wrist every day - even when he is swimming or playing sport. It's become a part of him and he even sleeps with it on. 

If you have a child with an allergy, you will want to keep them safe, healthy and independent. My book Allergies: A Parents' Guide (published by Need2Know Books) contains essential background information and practical advice. 

Our pill-popping nation

The latest Health Survey for England, published today, reveals that 50% of women and 43% of men in England take prescription medicines on a regular basis. In 2013, over one billion prescription items were dispensed by community pharmacists in England. That's an average of 2.7 million items every day and 18.7 prescription items per person in England in 2013. The cost to the NHS in 2013 exceeded £15 billion.

Twenty-two percent of men and 24% of women in the survey reported that they had taken at least three prescribed medicines in the last week. Cholesterol-lowering statins, blood pressure medicines, painkillers and anti-depressants were amongst the most commonly prescribed drugs.

In England, more than 15 million people currently have a long-term condition, which is placing a significant burden on health, welfare and social services. According to the Department of Health, this figure is set to increase over the next 10 years, with rising numbers of people suffering from three or more conditions at once. And as the population ages, the problem is likely to get worse.

If you look at some of the medicines being prescribed in large quantities - e.g. statins and blood pressure pills - these are for conditions that are often related to lifestyle choices. According to the Office for National Statistics, nearly one in four deaths - more than 100,000 every year - are potentially avoidable.

It's easy to blame the government, political leaders and healthcare system for the state of the nation's health. But should we also be doing more as individuals?

In November 2014, The Richmond Group of Charities (including the British Heart Foundation, Diabetes UK and Breakthrough Breast Cancer) highlighted that taking action to tackle common risk factors (e.g. smoking, inactivity, unhealthy diet and alcohol) would drastically reduce the number of people affected by conditions such as heart disease, cancer, lung disease and diabetes.

According to the Richmond Group of Charities, as individuals we can try to adopt healthy behaviours to protect and improve our wellbeing - and even if we are diagnosed with a health condition, we can still take steps to improve our quality of life and try to prevent our health spiralling downhill even further.

The facts gathered by The Richmond Group of Charities speak for themselves:

• 75% of cardiovascular disease is preventable
• 80% of strokes are preventable
• Up to 30% of Alzheimer's disease cases are attributable to modifiable risk factors
• If every woman in the UK was regularly physically active, 9,000 fewer women would develop breast cancer each year
• Up to half of all cancers could be prevented by changes in lifestyle behaviours.

So should we all be taking a more preventative approach? Should we be looking at keeping ourselves fitter and healthier to avoid taking medicines in the long-term? Or should we just accept that, at some point, we will join the rest of the pill-popping nation.