“Pain so severe you just want to die” –and yet affecting approximately as many people in the UK as the widely known condition multiple sclerosis (MS) (1),  any mention of cluster headaches will likely draw blank looks from most of the general population. Given this, it’s hardly surprising that many sufferers feel alone in their battle with the condition. (1)

What are cluster headaches?

Cluster headaches (CH) differ vastly from a regular (tension) headache. Attacks (individual headaches) come on very suddenly. During an attack, sufferers experience a sharp, burning pain of excruciating intensity on one side of the head. (2) In fact, women who have both given birth and have CH have branded the latter as worse. (3) The pain is typically centred around the eye, but may affect other parts of the head or neck. The side affected may change between attacks, or less commonly, in the same attack. (4) Other symptoms occurring alongside the headache can include a red, watering eye, a congested or runny nostril, facial sweating, a droopy eyelid and a constricted pupil. (2)

Unlike migraine sufferers who usually want to lie down and rest during an attack, those with CH may pace around, rock their head or even resort to banging their head against a wall due to the severity of the pain. (2)

Attacks normally take place in bouts, or ‘clusters’, which persist on average for a period of four to twelve weeks. Within a cluster, attacks normally happen every day at the same time of day, and may occur multiple times a day, beyond eight in some cases. (2)

The period in between clusters is known as remission, which may last years before attacks return. However, many sufferers find they experience clusters around the same time every year.

In some particularly unfortunate instances, sufferers experience attacks on a chronic (ongoing) basis. This means they have experienced attacks every day for a year or more with no remission period, or a very short one. (3)

The excruciating pain of CH, along with the relentless nature, has led to the condition being dubbed “suicide headache”. (5)

What is the cause?

As of yet, there is no known definitive cause of CH, however, it is believed that malfunctioning of the hypothalamus, a part of the brain responsible for many vital bodily functions and processes, is the most likely basis. Additionally, CH is sometimes found to run in families, indicating a genetic link. (6)

How is it treated?

There are treatments available both to stop an attack from progressing and to prevent attacks from happening in the first place.

The following are abortive medications, used to treat individual attacks:

• Sumatriptan, when used at the beginning of an attack, can bring the headache to a halt. It comes in either injection form, which can be self-administered once or twice a day, or as nasal spray if preferred.

• Zolmitriptan is a similar medicine to sumatriptan and is available in a nasal spray form.

• Pure oxygen can be breathed through a mask to provide relief from an attack.

• Lignocaine is an anaesthetic administered in nasal drop or spray form. It is usually not sufficient to stop an attack completely, but can be helpful when used alongside other medicines.

• A gammacore device is a handheld appliance that can be held to the neck to generate a pulse which stimulates the vagal nerve, which is believed to play a role in CH. This can stop an attack in its tracks. (2, 7)

The following medications are preventative:

• Verapamil is the most common medicine used to prevent attacks. It may cause heart problems, so it is important to have regular electrocardiogram (ECG) tests during treatment.

• Local anaesthetic injections to the back of the head, corticosteroids or lithium are alternatives if verapamil is ineffective or unsuitable. (2)

It is thought that certain triggers can bring on attacks in some people. The smell of pungent chemicals, such as perfume or petrol, has been known to be a trigger. Also, avoidance of alcohol and smoking cessation is recommended. (2)

If these symptoms sound all too familiar and you think you may have cluster headaches, make an appointment with your GP as soon as you can. They will rule out other causes and assess your condition. Once you have a formal diagnosis, you should then be referred to a specialist who will discuss a treatment plan with you and help you to regain control over your life! (2)

For further support and information, visit ouchuk.org.

References

1. OUCH UK. Organisation for the Understanding of Cluster Headache [cited 3 September 2017]. Available from: https://ouchuk.org/

2. National Health Service. Cluster headaches [cited 3 September 2017]. Available from: http://www.nhs.uk/conditions/cluster-headaches/Pages/Introduction.aspx

3. OUCH UK. What is Cluster Headache? [cited 3 September 2017]. Available from: https://ouchuk.org/what-is-cluster-headache

4. OUCH UK. Cluster Attack [cited 3 September 2017]. Available from: https://ouchuk.org/cluster-attack

5. Medscape (2015). Hope for 'Suicide Headache'. [online] Available from: http://www.medscape.com/viewarticle/844217 [Accessed 3 Sep. 2017].

6. OUCH UK. Causes [cited 3 September 2017]. Available from: https://ouchuk.org/causes

7. OUCH UK. Abortive Medication [cited 3 September 2017]. Available from: https://ouchuk.org/abortive-medication

   Author: Gabby Gallagher MPharm

   Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 04/09/17

Polycystic ovary syndrome (PCOS) is a condition of which there is still little awareness in society, despite it affecting up to one in five women. (1) Many of these women remain undiagnosed due to simply not visiting their doctor because of lack of knowledge of the condition and its symptoms. Some may have consulted healthcare professionals, but have been misdiagnosed. Others may be reluctant to discuss their symptoms due to the long standing societal issue of ‘women’s problems’ not being taken seriously.

What is PCOS?

Women with PCOS often present with at least two of three predominant symptoms: irregular periods, excessive androgens (‘male hormones’) in the blood, and polycystic ovaries. The former two usually manifest as identifiable symptoms - affected women may experience erratic periods or none at all, and may exhibit male pattern hair growth (thick, dark hair in unwanted areas including the face, chest, abdomen, back and buttocks) as well as stubborn acne. (1, 2) The latter can only be confirmed by having an ultrasound scan, and a positive result will show oversized ovaries with a rugged, bumpy appearance which is caused by many fluid-filled sacs, or follicles, inside the ovaries. When eggs are not released, follicles continue to enlarge. (1, 3)

Other symptoms include tendency to gain weight, heavy periods, tiredness, hair thinning and difficulty conceiving. (1)

What causes PCOS?

A concrete cause of PCOS has not been found, but it is believed that hormone imbalance plays a major role. PCOS sufferers experience resistance to the effects of insulin, the hormone enabling the body to absorb glucose (sugar) after meals for energy stores. Therefore, more insulin is produced to make up for this, which in turn stimulates the ovaries to produce excessive amounts of the male hormones responsible for PCOS symptoms. (1)

Persistent insulin resistance can also increase the risk of type 2 diabetes later in life for those with PCOS. (1)

Is there a cure?

Unfortunately there is no cure for PCOS, but the symptoms can often be controlled through diet and lifestyle changes and medication.

Being overweight can worsen insulin resistance, so maintaining a healthy weight will help to ease symptoms. (1) Aim for 30 minutes of moderate intensity exercise 5 days a week and a diet high in vegetables, fruit, fibre and lean protein and lower in fat and sugar.

Various medicines can also be used to help alleviate PCOS symptoms.

• The combined oral contraceptive pill reduces the release and effects of male hormones and associated symptoms (excessive hair growth and acne) as well as regulating periods.

• Spironolactone is another medicine that works against male hormones.

• Metformin can help combat insulin resistance, reducing symptoms and promoting weight loss and fertility.

• Clomifene is used for women who are struggling to get pregnant. It helps the ovaries to release eggs on a monthly basis. (1)

In a procedure known as laparoscopic ovarian drilling, the ovarian follicles are treated with a laser or heat, stopping production of the male hormones to improve symptoms and fertility. (1)

With a variety of options available to control the symptoms of PCOS, and the opportunity to vastly increase awareness of the condition, the prognosis should not be seen as bleak. If you are a woman experiencing some of the symptoms listed above and think you may have PCOS, speak to your GP.

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 30/08/17

References

[1] National Health Service. Polycystic ovary syndrome [cited 25 August 2017]. Available from: http://www.nhs.uk/Conditions/Polycystic-ovarian-syndrome/Pages/Introduction.aspx

[2] PCOS UK. Polycystic ovaries and polycystic ovary syndrome [cited 25 August 2017]. Available from: http://www.pcos-uk.org.uk/about-pcos.html

What is PrEP?

PrEP (Pre- exposure prophylaxis) can be taken by people who are negative for HIV before sex to prevent them from contracting HIV (Human Immunodeficiency Virus). (1)

The results of clinical trials have been very successful, reporting that PrEP significantly lowers the risk of becoming HIV positive. (2)(3)

The medication used for PrEP is a tablet called Truvada which contains tenofovir and emtricitabine. These are drugs commonly used to treat HIV in the UK.

PrEP has been shown to be highly effective at preventing HIV as long as it’s taken as directed but it is important to note that it will not protect you from other STIs (sexually transmitted infections) and so it’s still vital to practise safe sex by using a condom. It is also important to go for regular STI screening every three months so you can get tested and treated if necessary.

Before PrEP

It is essential to have an HIV test before you start taking PrEP as it can only be used if you are HIV negative. If you take PrEP without being tested and find out later that you are HIV positive then you could develop resistance to the drugs that you will need for successful treatment.

You should also be tested for the Hepatitis B virus before you start PrEP, as although you can still take the medication, its use needs to be monitored more carefully and medical advice is needed, particularly if you decide to stop taking it at any point.

It is also important to check your kidney function both before starting the medication and every 3 months thereafter. Initially to assess your kidney function, a blood test is used to measure the level of creatinine in the blood as this is an indicator of how well your kidneys are working. If the kidneys become impaired for any reason, the creatinine level in the blood rises due to poor clearance of creatinine by the kidneys. Doctors routinely use creatinine levels to check kidney function and this is one of the most accurate ways of monitoring them.

During PrEP

Whilst taking PrEP, you should have a HIV test and a urine protein dipstick test every 3-4 months to reaffirm that you are still HIV negative and to ensure that the PrEP medication is not having an adverse effect on your kidney function. The urine test is an alternate way to measuring kidney function that is not as specific as the creatinine blood test needed before starting the medication, however it is a reliable and simple way to quickly determine if there are signs of kidney injury. 

If the dipstick test detects any protein in your urine then it’s a sign that your kidneys might be affected by taking PrEP and you should make an appointment with your GP or other healthcare provider or attend a local sexual health clinic. They will perform further tests that are able to determine the exact cause of the result and can inform you as to whether the medication is still safe to take. You can buy a urine protein dipstick test kit at your local pharmacy.

Also, every 12 months you should repeat the HIV test along with the creatinine blood test for accurate kidney function levels to ensure that there has been no change since commencing the medication.

Therefore, before taking PrEP, you should be tested for HIV and Hepatitis B (HBV) and have your kidney function checked.

Click for: PrEP pre treatment test kit

While taking PrEP, you should have a HIV test and a urine protein dipstick test every 3-4 months.

Click for: HIV lab or home self-check test kit

Every 12 months, a HIV test and a kidney function check should be carried out again to ensure that there has been no change since commencing the medication.

Click for: PrEP Annual test kit 

Since these health checks are of such importance both before taking PrEP and while you are taking it, we at WebMed Pharmacy have introduced the following three tests;

Medically reviewed by: Super intendent pharmacist Margaret Hudson BSc(Hons)MRPharmS

1) PrEP pre-treatment test kit :- tests for HIV, Hepatitis B (HBV) and measures your baseline kidney function.

2) HIV test kit :- to be used every 3-4 months. 

3) Annual PrEP test kit :- this will check that you are still negative for HIV and measures your level of kidney function.

References;
(1) Terrence Higgins Trust. PrEP (Pre-exposure Prophylaxis) Terrence Higgins Trust [Internet]. Tht.org.uk. 2017 [cited 23 April 2017].
Available from: http://www.tht.org.uk/sexual-health/About-HIV/Pre-exposure-Prophylaxis

(2) Aids Map. PROUD PrEP study results published [Internet]. Aidsmap.com. 2017 [cited 23 April 2017].
 Available from: http://www.aidsmap.com/PROUD-PrEP-study-results-published/page/2998033/

(3)  BASHH. Updated BHIVA-BASHH Position Statement on PrEP in the UK [Internet]. 2017 [cited 23 April 2017]. Available from: https://www.bashh.org/documents/PreP_BHIVA_BASHH_Update_14June15_for%20consultation.pdf

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 23/04/17

Erectile dysfunction, or impotence as it’s sometimes called, is a very common condition that distresses men of all ages. It’s the inability to achieve or maintain an erection that is sufficient for satisfactory sexual activity.

Listen to our Superintendent Pharmacist, Margaret Hudson, discuss ED in a recent radio interview

In the UK erectile dysfunction, or ED, is thought to affect more than 50% of men over 40 years of age.¹

Most men are unaware that ED could be a symptom of a more serious underlying medical condition, and so if you suffer from ED you should get a health check from your GP. The most common of these conditions are high blood pressure, high cholesterol and diabetes.

ED can have a range of causes but the main culprits are physical problems, psychological factors and the side-effects of certain medications.

Physical problems include narrowing of the blood vessels going to the penis; commonly associated with high blood pressure (hypertension), high cholesterol or diabetes. Hormonal problems such as an over or under active thyroid gland and surgery or injury to the penis, pelvis or surrounding area can also cause it.

Some examples of causative neurological conditions are Parkinson’s disease and multiple sclerosis while the psychological causes of ED include stress, anxiety, depression and relationship problems.

Lifestyle can also cause ED and so if you’re overweight, smoke, drink excessively or take recreational drugs, you are more likely to suffer from these symptoms.

In younger men, it may be caused by anxiety, nervousness about having sex, inexperience in using a condom or even fear of causing an unwanted pregnancy.

The most common health conditions causing ED are cardiovascular disease and diabetes but the medications for high blood pressure, prostate problems, high cholesterol, depression and anxiety can also cause ED and therefore compound the situation. For example, you might have high blood pressure which causes ED, then you take a medication for your blood pressure which also causes ED making your symptoms even worse! ²

In fact, there is a long list of medications that may cause ED, including:

• Diuretics - “Water tablets”
• Beta-blockers - used to treat high blood pressure
• H2-antagonists - used to treat stomach ulcers
• Antihistamines - used to treat allergic health conditions, such as hay fever
• Antipsychotics - used to treat some mental health conditions, such as schizophrenia
• Anticonvulsants - used to treat epilepsy
• Corticosteroids - medication that contains steroids, which are a type of hormone

Speak to your GP if you are concerned that a prescribed medicine is causing erectile dysfunction as alternative medication may be available. However, it is important never to stop taking a prescribed medicine unless you are advised to do so by a qualified healthcare professional who is responsible for your care.

Most men blame themselves for having ED as they think it’s a reflection of their masculinity and don’t realise that it’s caused by a health problem that they may or may not be aware of.

It is believed that if more men were aware of this fact then they would be much more willing to go to their GP for a health check. Not only would the individual find out if they have an important health condition but they would also be more confident about seeking a solution to their ED.

Most men don’t talk about ED when they meet up with their friends for a drink or for any other social activity. It’s a topic that they would rather avoid at all costs!

In fact, most men even find it difficult to speak to their partner about it and it’s thought that ED causes the breakdown of about 20% of all relationships. ³ It seriously impacts on all aspects of a man’s quality of life and his self esteem. It can also affect how a man interacts with his friends and co-workers as it may cause him to lose confidence, reduce his morale and enjoyment of life generally. Furthermore, since ED is not openly discussed, a man may feel isolated and alone as he struggles with these symptoms.

Some men find counselling helpful as a means of exploring psychological causes for ED. Some sexual health clinics (also known as GUM clinics) offer this service or your GP may be able to direct you to someone who can help. ⁴

If someone was too embarrassed to go to their GP about ED, there are other options. The first line treatment for ED is a group of drugs called phosphodiesterase -5 inhibitors (PDE-5 inhibitors) that dilate the blood vessels leading to the penis and, with sexual stimulation, give a much firmer and longer lasting erection.

In the UK there are four PDE-5 inhibitors available for treating erectile dysfunction.

They are:

• Sildenafil – sold under the brand name Viagra or generic name sildenafil
• Tadalafil – sold under the brand name Cialis
• Vardenafil – sold under the brand name Levitra
• Avanafil – sold under the brand name Spedra

There are differences between the various products available. They differ in the time it takes for them to act and how long they act for. This is due to the different pharmacokinetics* of the active ingredient. The pharmacokinetics, which include the half-life** of a medication, dictates how long it stays in the blood.

* Pharmacokinetics – How the drug moves through the body

**Half-life – The time taken for the levels of medicine in your blood to fall by half. This directly relates to how long the medicine acts for.

Sildenafil (Viagra) has a half-life of 4 hours and vardenafil (Levitra) has a half-life of 4-6 hours while tadalafil (Cialis) has a half-life of 17.5 hours and is active for up to 36 hours.

This means that vardenafil (Levitra) should act longer than sildenafil (Viagra) but the clinical significance is not known although some studies have shown that vardenafil (Levitra) is more suitable for diabetics. Tadalafil (Cialis) has the longest half-life and duration of action and so allows you to take the medication and not relate the sexual activity to its immediate use. It’s been called the “week-end pill” because of its long duration of action and in lower doses can be taken continuously each day, for those who are more sexually active and struggle to plan ahead.

The most recently introduced Avanafil (Spedra) has the quickest onset of action and only takes about 15 minutes but its effects last about the same time as vardenafil and sildenafil.  

ED drugs: How soon they start working and how long they last

It’s very important that men realise that they don’t have to suffer in silence as ED is a very common condition that’s easily treated, in most cases, with oral medication that can dramatically improve their performance and general well-being. 

References

1 NHS. Choices. Department of Health. Erectile dysfunction (impotence); 2016 Jun 21 [cited 2016 Sep 21]. Available from: http://www.nhs.uk/Conditions/Erectile-dysfunction/Pages/Introduction.aspx

2 Miller S. Medline Plus. Drugs that may cause impotence: MedlinePlus medical encyclopedia; 2015 Jan 21 [cited 2016 Sep 21].
Available from: https://medlineplus.gov/ency/article/004024.htm

3 Health Centre. Access to health & medical information on Internet; 2016 [cited 2016 Sep 21]. Available from: http://www.healthcentre.org.uk

4 Charitable Company. Sexual Advice Association. Sexual Advice Association. Factsheets [cited 2016 Sep 21].
Available from: http://sexualadviceassociation.co.uk/factsheets/

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 23/09/16

There has been a lot in the news recently about the increasing incidence of Type II Diabetes. So, what’s it all about?

Diabetes is a lifelong condition which is caused by a person’s body either producing less of, or becoming resistant to, the hormone insulin. This causes the blood sugar level to become dangerously high, leading to various ailments of the eyes, heart, kidneys, nerves and blood vessels to name a few.

The high levels of sugar in your blood make you tired all the time, thirstier than usual and also causes you to go to the toilet more frequently, especially at night.

The symptoms of this type of diabetes are usually quite mild and so aren’t typically obvious, meaning some may be living life with diabetes for years before it is actually diagnosed.

Type II diabetes has now reached epidemic levels in many places and this is thought to be mainly due to changes in lifestyle but is also partly due to improved diagnosis and treatment of the disease.

It's far more common than type I diabetes and it is estimated that more than 1 in 16 people in the UK has diabetes (diagnosed or undiagnosed), with this figure rising rapidly, and 90% of these cases being type II. (1)

There are some things which make a person more likely to develop type II diabetes, such as;

• Your age
  Most cases are seen in those over the age of 40, but there are now an increasing number of teenagers being diagnosed with the disease.
• Your ethnicity
  Being of Asian or African decent puts you at higher risk.
• Your genes
  If you have a close member of your family diagnosed (mother, father, brother or sister) than again you are at a higher risk. There is also an increased incidence in males.
• Your weight
  Being overweight or obese makes your change of having diabetes much more likely.
  Click here to calculate your Body Mass Index (BMI) to see if your weight puts you at risk. (2)

The majority of these things, we unfortunately cannot change. However, we are able to reduce our weight. It’s been said by the NHS that reducing your body weight by even just 5% could reduce your risk of getting diabetes by more than 50%. (3) This can be achieved by making a few simple lifestyle changes.

We have all heard it before and now you’re going to hear it again. The best way to avoid type II diabetes is to;

• Eat better! Eating a　healthy, balanced diet, not forgetting the fruit and veg.
• Bin the cigarettes! (if you smoke)
• Drink alcohol in moderation! You don’t need to ditch it all together.
• Get on the move! Take plenty of regular exercise, ideally 30 minutes a day.

If you are diagnosed with diabetes, it’s not the end of the world. There are many treatment options available to keep your blood sugar under control and, when managed well, should have no side effects or complications.

Having said that, prevention is most definitely better than cure!

To further your understanding, take a look at this great list of myths and frequently asked questions on type II diabetes here. (4)

1. Choices N.: Department of Health. Type 2 diabetes; 2016 Jul 28 [cited 2016 Apr 20]. Available from: http://www.nhs.uk/Conditions/Diabetes-type2/Pages/Introduction.aspx
2. Diet throughout life; 2014 Nov 10 [cited 2016 Apr 20].
   Available from: https://www.bupa.co.uk/health-information/tools-calculators/bmi-calculator
3. Choices N.: Department of Health. Type 2 diabetes - causes; 2016 Jul 12 [cited 2016 April 20].
   Available from: http://www.nhs.uk/Conditions/Diabetes-type2/Pages/Causes.aspx
4. Myths, questions frequently asked. Myths and frequently asked questions - diabetes UK [cited 2016 Apr 20].
   Available from: https://www.diabetes.org.uk/Guide-to-diabetes/What-is-diabetes/Myths-and-FAQs/

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 10/08/16

Nutritional or dietary advice changes like the weather and we are never sure if today’s meat is tomorrows poison!

Remember the days when it was "Go to work on an egg", then it was no more than 3 eggs a week and now the advice we’re given is eat as many eggs as you like as although they have cholesterol, its apparently "good" cholesterol.

Then there’s the new superfoods; nutrient-rich foods considered to be especially beneficial for health and well-being. It’s a list that’s constantly gaining additions, with a few of those being beetroot juice, blueberries, walnuts, edamame beans, pomegranates, coconut oil, oily fish and avocados.

For years we’ve been told that for good health we should eat a low fat diet with plenty of fruit and vegetables. The general consensus was that low fat foods were better than full fat foods. Now we’re being told that the diet industry that produces a lot of these low fat foods supplement them with sugar to improve the flavour lost by reducing the fat content. We all thought that to lose weight we had only to count the calories and that fat was higher in calories than sugar and therefore to be avoided at all costs.

Now the nutritionists are saying that fat doesn’t make you fat but sugar does and is responsible for the increasing obesity crisis in the UK.

This debate has been going on for a long time and while there is really no good sugar that you can eat, fat can be good or bad for you, depending of what kind you choose.

Sugar comes in many guises on food labels, including:

corn sugar, dextrose, fructose, glucose, high-fructose glucose syrup, honey, maple syrup, agave syrup, isoglucose, levulose, maltose, molasses, sucrose, invert sugar
Table 1. (1)

The government recommends that free or added　sugars shouldn't make up more than 5% of the energy (calories) you get from food and drink each day. That's a maximum of 30g of added sugar a day for adults, which is roughly seven sugar cubes. (2)

Added sugars are found in foods such as sweets, cakes, biscuits, chocolate, and some fizzy drinks and juice drinks – these are the sugary foods we should cut down on. For example, a 500ml bottle of cola contains the equivalent of 17 cubes of sugar!

If you want to lose weight, you need to find a diet plan that avoids refined sugars and uses only healthy fats. These are monounsaturated fats such as olive oil, sunflower oil and rapeseed oil instead of saturated fats like butter and dairy products. There is good evidence to show that there is a link between saturated fat and raised cholesterol levels.

Bad fats increase cholesterol and your risk of certain diseases, while good fats protect your heart and support overall health. In fact, good fats - such as omega-3 fats - are essential to physical and emotional health.

Therefore, a healthy diet shouldn’t cut out the fat but replace bad fats with the good ones that promote health and well-being.

Eating foods rich in monounsaturated and polyunsaturated fat can improve blood cholesterol levels and lower your risk of heart disease. These fats may also benefit insulin levels and control blood sugar, which can be especially helpful if you have type 2 diabetes. These good fats are found in fish, nuts, seeds, and cold-pressed vegetable oils. (3)

Trans fats raise your LDL or "bad" cholesterol and lower your HDL "good" cholesterol and increases your risk of heart disease, stroke, and diabetes. Any amount of trans fats is unhealthy. They are found in commercially baked goods such as biscuits, cakes, and pastry. Any product with "partially hydrogenated oil" in the ingredients contains trans fats.

When trying to lose weight, eating a balanced diet and being more active will help you lose weight steadily and gradually which is better for keeping weight off long term.

The traditional Mediterranean diet naturally includes most of the key diet changes that will help to lose weight and keep your heart healthy. This means that your meals should contain carbohydrates such as wholegrain bread and pasta and plenty of fruit and vegetables. (4)

Protein should be obtained by having more fish in your diet and less meat as well as including beans and pulses. You should also cut down on the foods that provide a lot of saturated fat in your diet such as dairy products and butter.

The healthiest diet is to cut out processed foods that are high in sugar　and salt and cook from scratch as often as possible.

References;

1. Dolson L. Verywell. How to spot hidden sugar in foods; 2016 Mar 6 [cited 2016 May 27].  Available from: https://www.verywell.com/sugars-many-disguises-2242526
2. Choices N. Department of Health. How does sugar in our diet affect our health?; 2016 May 24 [cited 2016 May 27].  Available from: http://www.nhs.uk/Livewell/Goodfood/Pages/sugars.aspx
3. Helpguide. Good fats, bad fats, and the power of Omega-3s [cited 2016 May 27]. Available from: http://www.helpguide.org/articles/healthy-eating/choosing-healthy-fats.htm
4. Choices N. Department of Health. What is a Mediterranean diet?; 2016 Mar 17 [cited 2016 May 27].  Available from: http://www.nhs.uk/Livewell/Goodfood/Pages/what-is-a-Mediterranean-diet.aspx

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 02/06/16

Gonorrhoea is the second-most common bacterial Sexually Transmitted Infection, STI, in the UK after chlamydia - and overall, there were almost 35,000 cases of gonorrhoea reported in England alone last year.[1]

In 2011 the British Association for Sexual Health and HIV, BASHH, gonorrhoea treatment guidelines were changed to an intra-muscular injection of 500mg of ceftriaxone in combination with a 1g oral dose of azithromycin as first-line therapy.[2] For those who find it difficult to access a sexual health clinic, choose not to visit their GP or do not want an injection we supply the alternative dual treatment of an oral dose of 400g cefixime and 1g of azithromycin taken together as a single dose. We also supply a free test of cure to make sure that the treatment has been effective.

An outbreak of a resistant strain of gonorrhoea began in Leeds six months ago and then spread to Scunthorpe, Macclesfield and Oldham and has now more recently been found in the West Midlands and the South-East of England.

Public Health England, PHE, said on Sunday there had been 34 confirmed cases since November 2014.[3] Since September 2015, 11 cases have been confirmed in the West Midlands and in the South East of England, five of which were in London.

This particular strain of gonorrhoea, known as HO41, is highly resistant to azithromycin, the drug most commonly used in dual therapy to treat the infection.[4] HO41 has so far proved resistant to current antibiotic treatment and so it has been placed in the superbug category. Instances of this particular strain were previously rare, according to the BASHH guidelines and they added: "PHE is concerned that the effectiveness of current frontline dual therapy for gonorrhoea will be threatened if this resistant strain continues to spread unchecked."

There are no other effective drugs to tackle the resistant strain, raising the prospect of it becoming untreatable if it builds further resistance.

About 50% of women and 10% of men are unaware that they’re infected as they don’t experience any obvious symptoms and this means that the infection can go untreated until the disease has progressed. This can lead to serious long term health problems and infertility.

PHE have urged people to use condoms with new or casual partners to cut the risk of catching the disease and anyone beginning a new relationship should get tested along with their partner.

There is more information on our website about the symptoms in both men and women and on testing and treatment.

Medically reviewed by: Super intendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 18/04/16

References

[1] Public Health England. Sexual and Reproductive Health Profiles [cited 2016 Apr 17]. Available from: http://fingertips.phe.org.uk/profile/sexualhealth/data#page/0

[2] BASHH. UK national guideline for the management of gonorrhoea in adults [cited 2016 Apr 17]. Available from: http://www.bashh.org/documents/3920.pdf

[3] Public Health England. GOV.UK. Safe sex reminder as antibiotic resistant gonorrhoea investigations continue; 2016 Apr 17 [cited 2016 Apr 17]. Available from: https://www.gov.uk/government/news/safe-sex-reminder-as-antibiotic-resistant-gonorrhoea-investigations-continue

[4] Science World Report. Science World Report. Gonorrhea HO41 Superbug may be ‘worse than AIDS’; 2013 May 6 [cited 2016 Apr 17]. Available from: http://www.scienceworldreport.com/articles/6672/20130506/gonorrhea-ho41-superbug-worse-aids.htm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 18/04/16

The World Health Organisation, WHO, is so concerned about the worldwide chronic health condition, diabetes that they have decided to focus on the problem for the Organisation’s World Health day on 7th April 2016.

World Health Day will be used to highlight the disease in order to promote strategies to help prevent diabetes and ensure optimal management for people living with one of the various forms of the condition. About 350 million people in the world have diabetes and as this chronic disease becomes more common the importance of learning how to prevent, detect, treat and manage it becomes more crucial.

What is Diabetes?

Diabetes is a chronic disease that occurs when the body has raised blood sugar - hyperglycamia, which can lead to serious damage, especially to the nerves and blood vessels. This is caused when either the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar, which gives us the energy we need to live. If the sugar is unable to get into the cells to be burned as energy, it can build up to harmful levels in the blood.

There are two main forms of the disease.

Type 1 diabetes is characterised by the lack of insulin production and requires daily insulin injections for survival. The cause is not known and is not preventable at the moment.

Type 2 diabetes results from the body not producing enough insulin or the body is resistant to any insulin produced. This form of diabetes comprises 90% of people with diabetes around the world and is largely due to excess body weight and lack of physical activity. Until recently, this type of diabetes was only seen in adults but now it’s found in children. In fact, in some parts of the world, type 2 diabetes has become the main type of diabetes in children and adolescents. This is thought to be due to the global rise of childhood obesity and physical inactivity.

Ultimately, high blood sugars can have devastating effects on every major organ in the body, leading to heart attacks, strokes, impotence, blindness, kidney failure and infections that can lead to amputations.

Other less common types

Gestational diabetes is hyperglycaemia with blood glucose values above normal but below those of diagnostic diabetes, when a woman is pregnant. These women are at an increased risk of complications during pregnancy and delivery as well as being at increased risk of type 2 diabetes in the future.

Impaired glucose intolerance (IGT) and impaired fasting glycaemia (IFG)

These are intermediate conditions in the transition between normality and diabetes but the progression is not inevitable and can be prevented by following a healthy diet and increasing physical activity.

Symptoms of Diabetes

• Urinating more frequently, especially at night
• Feeling very thirsty
• Feeling very tired
• Cuts or wounds that don’t heal properly or heal slowly
• Blurred vision
• Weight loss (more common with type 1 diabetes)
• Itching around the penis or vagina or frequent bouts of thrush
• Intense hunger which may lead to weight gain
• Irritability due to lack of energy
• Gum disease/infection
• Sexual  dysfunction
• Numbness or tingling in hands or feet

Type 1 diabetes symptoms usually present suddenly and may be accompanied by nausea, vomiting and stomach pains.

It’s possible to have very mild symptoms or no symptoms at all with type 2 diabetes. In fact, about half of all people with type 2 diabetes are unaware of their condition and are therefore undiagnosed. Also, the condition known as prediabetes, that often leads to type 2 diabetes, produces no symptoms. Usually, type 2 diabetes and its symptoms develop very slowly.

Diabetes Diagnosis

Excess glucose in the urine can be detected by a simple urine test.  This can be followed up by a blood test that measures blood glucose levels and can confirm a diagnosis of diabetes.

Therefore, if you have any of the symptoms described above you should visit your GP as soon as possible. It’s very important that diabetes is diagnosed as early as possible because it will get progressively worse if left untreated leading to serious health conditions.

If you are diagnosed with type 1 diabetes you will need insulin injections for the rest of your life. If you are diagnosed with type 2 diabetes you may be able to control your symptoms by following a healthy diet, exercising on a regular basis and careful monitoring of your blood glucose levels. However, you may eventually require medication in the form of tablets or insulin as type 2 diabetes is a progressive condition.

In the UK there are 3.9 million people living with diabetes, either diagnosed or undiagnosed, which is a staggering more than one in 16 people. This figure is constantly increasing and it’s estimated that by 2025 five million people in the UK alone will have diabetes. Furthermore, many more people are estimated to have blood sugar levels above the normal range but not high enough to be diagnosed as having diabetes. The health implications of this prediction and the cost to the NHS is frightening.

Overweight and obese people have a much higher risk of developing type 2 diabetes compared to those with a healthy body weight. Those with a lot of belly fat or abdominal obesity are especially at risk. That is why it’s recommended for males  to have a waist measurement of less than 94cm(37 inches) and females to measure less than 80cm(31.5 inches). Diabetes experts are asking world leaders at the G20 leaders summit in Turkey this weekend to use sugar taxes to fight obesity, arguing that it would save lives and slash health care budgets . A new report published in the journal Diabetic Medicine has projected that the NHS’s annual spending on diabetes in the UK will increase from £9.8 billion to £16.9 billion over the next 25 years, a rise that means the NHS would be spending 17% of its entire budget on the condition.

Many things can be done to reduce the impact of diabetes through embracing personal  responsibility by adopting a healthy lifestyle. This means achieving and maintaining a healthy body weight by being physically active for at least 30 minutes every day and walking has been advocated in the press recently as the best way to keep fit. Also, by eating a healthy diet that includes between 3 and 5 servings of fruit and vegetables daily and reducing our intake of sugar and saturated fats. Avoiding the use of tobacco is essential as smoking increases the risk of cardiovascular diseases.

Being overweight, physically inactive and eating the wrong foods all contribute to our risk of developing type 2 diabetes. Drinking just one can of (non-diet) soda per day can raise our risk of developing type 2 diabetes by 22%, researchers from Imperial College London reported in the journal Diabetologia. The scientists believe that the impact of sugary soft drinks on diabetes risk may be a direct one, rather than simply an influence on body weight.

There are many diseases which we have no power over but diabetes is not one of them. Properly treated and managed, the impact of diabetes can be minimised. Even people with type 1 diabetes can live long and healthy lives if they keep their blood sugar well controlled.

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 18/11/15

HAIR TODAY; GONE TOMORROW.
The distressing condition of men’s hair loss and the latest remedies

There are different types of hair loss or alopecia but androgenic alopecia, commonly known as male-pattern baldness accounts for more than 95% of hair loss in men. It’s a genetic hair loss condition and usually begins with a receding hairline followed by thinning of the hair on the crown and temples to form a horseshoe shape.

For more information about hair loss treatments for men, click here.

Alopecia may not be life threatening but it can be very distressing to those affected. People who haven’t experienced it may be inclined to see it as a purely cosmetic issue but for many sufferers it destroys their confidence which can lead to depression and create terrible stress.

About half of all men will be affected by male pattern baldness at some point in their lives.

Another type of alopecia that has become more prevalent recently is traction alopecia. It is caused by excessive pulling or tension on hair shafts as a result of certain types of hairstyle. It used to be seen more often in women, particularly those of East Indian and Afro-Caribbean origin, due to braiding their hair. However, there is a popular hairstyle for men that is trending at the moment , the “man-bun” or “top-knot”,  sported by celebrities such as Leonardo DiCaprio, Jared Leto and Harry Styles. Here the hair is tightly scraped back and if you wear it like that all day, every day then it puts long term stress on the hair, pulling the follicle and damaging the root, pulling it out. It's just like plucking an eyebrow hair where if you keep plucking it, it won't grow back. 

Another at-risk group is men who suffer baldness on the top of the head and so they pull the remainder back into a ponytail. This again causes tension on the root leading to even more hair loss.

Furthermore, Sikh men who tie their hair up tightly under their turban may cause traction alopecia.

However, the good news is that traction alopecia is relatively rare, even for men who regularly sport man buns. Therefore, I suggest that those who want to have a bun hairstyle, should style their hair into a looser bun. Also, it’s best to use a soft, snag-free elastic which is kinder to your hair, like a scrunchie.

The latest research into hair loss treatments involves hair cell cloning. The technique takes small amounts of a person's remaining hair cells, multiplying them, and injecting them into bald areas. Cloning is intended to treat both male- and female-pattern baldness. However, the science behind the technique is new and more trials are needed before it can be fully assessed.

Another potential treatment for male pattern baldness is a pioneering technique involving wound healing. The process involves creating a very minor “wound” on the scalp that subsequently allows the formation of new hair follicles.

However, at the moment, the two main treatments available for male-pattern baldness are minoxidil and finasteride.

Minoxidil is available over the counter from pharmacies without a prescription. It takes the form of a foam or solution that can be rubbed into the scalp on a daily basis. It comes in two strengths containing 5% or 2% of minoxidil. Women are recommended only to use the 2% solution and the evidence is mixed as to whether men benefit from using the higher strength. However, side-effects are more likely with the higher strength which involves scalp itchiness or dryness. Also, the treatment seems to be more effective for female pattern baldness. It takes a few months for signs of regrowth to appear  and the situation will revert back to the start if treatment is stopped.

Finasteride is a daily tablet treatment for only men with male pattern baldness. It prevents testosterone  from being converted to dihydrotestosterone(DHT). DHT is responsible for shrinking the hair follicles and therefore they return to their normal size, allowing natural re-growth. About  90% of men see either increased hair growth or prevention of further hair loss. It usually takes between 3-6 months before any effect is seen and hair loss will start again within a year if treatment is stopped. This treatment is recommended by many hair transplant surgeons as the most effective way to encourage hair regrowth.

For more information on Finasteride hair loss treatment for men click here. 

At Webmed Pharmacy we can supply finasteride treatment, after completing a short medical questionnaire that our doctor will review and it will be discreetly delivered the next day, in a 1 hour time slot , by dpd .

Webmed Pharmacy specialises in treatments where patients may feel embarrassed or awkward talking to their GP; or simply find it difficult to get an appointment; or aren't able to take time off from work.

If you would like to see what other treatments Webmed can provide, please click here.

Medically reviewed by: Super intendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 14/10/15

"Sexpression:UK is a network of student-led projects at over thirty universities across the UK. They deliver fun, informal workshops on sex and relationships to schools, youth clubs and sports clubs in their local areas.

They believe in empowering young people to make their own informed decisions about their sexual health and relationships. Sexpression:UK, their branches, and their volunteers, have won, and been shortlisted for, several awards for their outstanding commitment to volunteering and promoting sexual health."They are an entirely volunteer run and led organisation where schools and clubs are not charged any fee for their services.

Sexpression:UK  is involved in educating young people about Sexually Transmitted Infections, STIs, and safer sex.

It’s advisable that sexually active, under 25 year olds should be screened every year and on change of sexual partner.

Chlamydia is the most common STI in the UK and easily transferred during sex. There were approximately 440,000 STI diagnoses made in England alone in 2014. Genital chlamydial infection was the most common, accounting for 47% of diagnoses resulting in 206,774 cases. There were 138,000 chlamydia diagnoses among young people aged between 15 and 24 years old.

However, the actual number of infections is likely to be far higher as STIs, because they are symptomless in many cases, are often passed on unknowingly before someone realises they are infected. Also, younger adults are at greater risk as they are more likely to have unsafe sex with multiple sexual partners.

WebMed pharmacy can supply STI kits for both males and females, at a competitive price, to check if you are clear of the 7 most common STIs.

If treatment is required for either chlamydia or gonorrhea then WebMed pharmacy can deliver it, after a short medical questionnaire is completed and approved by our online doctor. There is a charge for this service. If ordered by 4p.m. it will be discreetly delivered the next day in a very convenient one hour time slot. This service is provided to all mainland UK except the Scottish Highlands where we use Royal Mail Special Delivery.

We use dpd as our preferred carrier with their industry-leading predict and follow my parcel service. You will receive a one hour delivery window via your chosen method, SMS or email from webmed-supplies.co.uk. This allows you to track the progress of your treatment on a map, counting down to a 15 minute window.

If for any reason this is not convenient, you will be offered other options; to leave with a neighbour, change the day or to be delivered to the nearest dpd pickup point.

STIs can be prevented through sexual health promotion and education and encouraging safer sexual behaviour. WebMed pharmacy simply provides you with more choice in accessing sexual health services.  

Our service is fast, discreet and confidential where you can be tested and receive treatment in the comfort of your own home.

https://webmedpharmacy.co.uk/gonorrhoea-symptoms-and-treatment