Posts tagged Men's Health

There are a number of things to consider when deciding on a treatment for erectile dysfunction (ED) - how long will the effect last, how often do I need to take it, how much does it cost? But did you know that tadalafil, once only available as the Cialis brand, is now available to buy online as a generic (unbranded) version?

What is Generic Cialis (Tadalafil)?

Generic forms of any medication are medically identical to the branded originals and are quality controlled to the same standards as the brand name versions; they are just as safe and effective but generally cost much less.

Generic tadalafil contains exactly the same active ingredient as Cialis, but at a fraction of the price. This may be of benefit if you’ve thought about trying Cialis in the past but were put off by the cost. However, cost isn’t the only factor to take into account, and the information below aims to help you decide on the best erectile dysfunction (ED) treatment for you.

Which erectile dysfunction (ED) treatment should I choose: Sildenafil or Tadalafil?

Sildenafil and tadalafil are the two most popular treatments for erectile dysfunction (ED), with sildenafil, brand name Viagra, being the oldest and most well known of the two. But which is better?

Sildenafil is taken an hour before sexual activity, and it will help you get an erection up to at least four hours after taking it, sometimes up to six hours (this doesn’t mean you’ll have an erection that lasts for this length of time - just that you’ll have the potential to have an erection if sexually aroused within the four to six hours after taking). Tadalafil, on the other hand, can be taken 30 minutes before sexual activity and will help you to get an erection up to 36 hours later, so it allows for more sexual spontaneity and has been dubbed “The weekend pill”. Both sildenafil and tadalafil should not be taken more frequently than once a day.

The effect of sildenafil can be impaired if taken with or after food, but tadalafil works just as well taken after a meal as it does on an empty stomach.

Which erectile dysfunction (ED) treatment is best for lactose intolerant people?

If you are lactose intolerant, sildenafil may be the best option as it is available as a lactose free formulation. You can buy the Mylan brand of sildenafil at Webmed, which is lactose free.

Tadalafil can also be taken as a daily dose if you are sexually active at least twice a week. This means you don’t need to worry at all about waiting for the effects to kick in - you’ll be ready for sexual activity at any time.

Other erectile dysfunction (ED) medicines are available besides sildenafil and tadalafil - avanafil, available only as the brand Spedra, is the fastest acting, taking effect in just 15 minutes. Vardenafil, marketed as Levitra, may work more quickly and last slightly longer than sildenafil and tadalafil and may be the most suitable ED medication for people with diabetes.

What’s the best erectile dysfunction (ED) treatment?

Overall, it appears that tadalafil comes out on top when compared with sildenafil, with the notably longer duration of action, slightly faster onset of effectiveness, compatibility with food and the option to take it as a once daily dose. But everyone has different needs, and what works for one person may not work for the next. Hopefully, this information will have helped you to decide on which erectile dysfunction (ED) treatment will be best for you.

To see the full list of erectile disfunction (ED) medication available from Webmed, click here.

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 24/08/18

Despite there being a dramatic increase in bowel cancer cases above the age of 50, the screening programme in England is currently only offered to those aged 60 and over. However, Public Health England have recently announced that it plans to bring the starting age for screening down to 50, a move which will mean countless more cases are spotted in the earlier, more easily treatable stages. (1)

What is bowel cancer?

Bowel cancer is cancer of the large intestine, and depending on the area affected, may be referred to as colon cancer or rectal cancer. It is the fourth most commonly diagnosed cancer in the UK, responsible for 42,000 cases and over 16,000 deaths each year. (1, 2)

What are the symptoms?

One of the most common symptoms is blood in your poo. This may be noticed as red streaks on the surface of your poo or the poo being discoloured (red, very dark red/brown or black), toilet water being stained red or pink, or blood visible on toilet paper. Often, blood in poo has other, less serious causes, such as haemorrhoids or anal fissures (cuts). But if you’ve had any of the above symptoms for three weeks or longer, visit your GP. (2, 3)

A change in bowel habit can also be a sign of bowel cancer. One off changes in bowel habit can be caused by eating certain foods or stressful situations, but if this occurs persistently don’t ignore it. If you find you are needing to poo more frequently than what’s usual for you, and the poo is softer and thinner than usual for three weeks or more, see your GP. (2,3)

Another common symptom is lower abdominal pain, discomfort or bloating. This tends to worsen after eating and may therefore put you off eating, leading to weight loss. See your GP if you experience any of the above symptoms. (2, 3)

Other symptoms may include tiredness from anaemia caused by persistent blood loss from the bowel, slime in your poo and feeling like you can’t fully empty your bowel when you poo. (2, 3)

Bowel cancer screening

Currently, the bowel cancer screening programme in England involves inviting everyone aged between 60 and 74 to have a faecal occult blood (FOB) test every two years. This is a simple home testing kit which allows a small stool sample to be collected. When sent to the laboratory, this sample is tested for traces of blood, which could indicate bowel cancer. (1, 2)

A new, more accurate bowel screening kit is due to replace the FOB test this autumn, known as the faecal immunochemical test (FIT). It is the FIT that will be in use when bowel screening is introduced to people aged 50 and over in England. (1)

In some parts of England, a different test is also offered to 55 year olds, called bowel scope screening. During this screening, a healthcare professional will inspect the lower bowel for polyps (small growths that can be an early sign of cancer) using a gentle instrument. (2)

What causes bowel cancer?

Bowel cancer, like all cancers, doesn’t have a definite cause, but there are several risk factors:

• Regularly eating red or processed meat
• Not eating enough fibre
• Being overweight or obese
• Sedentary lifestyle
• Excessive alcohol consumption
• Smoking
• Being 60 years of age or older
• Having a parent or sibling who had bowel cancer under 50 years of age
• Having had ulcerative colitis or Crohn’s disease for over 10 years

As you can see, some factors are unavoidable, but others can be changed. A diet high in fibre, fruit and vegetables and low in red and processed meat will help protect against bowel cancer, as will stopping smoking (if applicable), drinking alcohol in moderation or not at all, getting moderate exercise regularly and maintaining or attaining a healthy weight. (2)

For more information and support, visit Bowel Cancer UK here.

References

1. BBC News (2018). Bowel cancer screening to start earlier at age 50 in England [cited 13 August 2018]. Available at: https://www.bbc.co.uk/news/health-45143895

2. NHS Choices. Overview: Bowel cancer [cited 13 August 2018]. Available at: https://www.nhs.uk/conditions/bowel-cancer/

3. NHS Choices. Bleeding from the bottom (rectal bleeding) [cited 13 August 2018]. Available at: https://www.nhs.uk/conditions/bleeding-from-the-bottom-rectal-bleeding/

   Author: Gabby Gallagher MPharm

   Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 15/08/18

Viagra Connect is available to buy NOW!

Around 50% of men over the age of 40 suffer some form of erectile dysfunction.

This widespread condition can cause embarrassment, frustration and even depression for those affected. Some men are so ashamed about having erectile dysfunction that they choose not to seek help from their GP. They just continue to put up with the condition or more worryingly, opt to purchase treatment from illegal vendors online.

Purchasing any medicines in this way poses risks as there is no guarantee that they have been produced following the stringent quality and safety procedures and testing that medicines from UK registered and regulated online pharmacies undergo.

The good news is that this has impelled the Medicines and Healthcare products Regulatory Agency (MHRA) to reclassify Viagra Connect (sildenafil 50mg) from a prescription-only medicine (POM) to a pharmacy (P) medicine, meaning that it is available to purchase over the counter without a prescription in the UK from the spring of 2018. (1, 2)

Viagra Connect should be taken around one hour before sexual activity, ideally on an empty stomach as food can slow absorption. No more than a single tablet per day should be taken. Although the majority of men will be successful first time, it may take a few doses (therefore a few separate attempts) to reach the desired effect of a penile erection sufficient for satisfactory sexual activity. If this fails, you will need to see your GP. (3)

Men wishing to purchase Viagra Connect over the counter in a pharmacy will need to have a quick discussion surrounding symptoms, medical conditions and other medicines with the pharmacist, so that it can be determined whether the medicine is suitable or safe to take.

If buying from an online pharmacy, a short medical questionnaire will need to be completed to assess suitability. Certain medical conditions, such as cardiovascular diseases, high cardiovascular risk, and liver or kidney failure, may mean that the medicine cannot be sold and a GP appointment is needed. (2)

Viagra Connect is available to order from Webmed Pharmacy by selecting the medicine after clicking the ‘Treatments’ tab on the homepage. You will need to complete a short confidential online consultation, and then, like in any other pharmacy, the pharmacist will review the information you’ve given and assess whether the medicine is safe for you to take.

This regulatory change will benefit millions of UK men. For many, a trip to the pharmacy seems much more informal and is often more convenient than an appointment with the GP. The patient can even visit a pharmacy they don’t usually go to or use a General Pharmaceutical Council (GPhC) registered online pharmacy such as Webmed if they fear embarrassment. The danger to health of obtaining medicine from illegal, unregulated and unregistered websites will also be reduced. It may even help other underlying conditions to be diagnosed, since pharmacists will inform men buying Viagra Connect that they should make a follow-up appointment with their GP within 6 months so that such conditions can be tested for. (1)

Other options include:-

Viagra is the most well-known treatment for erectile dysfunction, often referred to as “the blue pill”.
The active ingredient in Viagra is sildenafil which dilates the blood vessels leading to the penis to enable a firm, long lasting erection when a man is sexually aroused or stimulated.

Viagra and Sildenafil both contain exactly the same active ingredient. They are both equally effective, but sildenafil is much cheaper.

Tadalafil, the generic form of Cialis, became available in November 2017 when the patent expired and has become very popular.

Tadalafil on demand is known as “the weekend pill” as, due to it's 36 hour duration of action, it can be taken on a Friday night and still be active on Sunday morning.

There is also a low dose tadalafil option taken on a daily basis, called Tadalafil daily, so you don’t have to plan ahead and can be ready for action “anytime, anyplace, anywhere”.

Worried about buying fake medicines online?  Then read our blog on what to look for to prove that it is a fully approved and Regulated pharmacy only supplying genuine UK sourced medication.

1. You’ll be able to buy Viagra for the first time ever- in the UK [cited 20 February 2018]. Viagra Connect to be available over the counter from Spring 2018. Available at: http://fortune.com/2017/11/28/viagra-over-the-counter-uk/

2. GOV.UK. MHRA reclassifies Viagra Connect tablets to a Pharmacy medicine [cited 20 February 2018]. Available at: https://www.gov.uk/government/news/mhra-reclassifies-viagra-connect-tablets-to-a-pharmacy-medicine

3. emc. Viagra Connect [cited 20 February 2018]. Available at: https://www.medicines.org.uk/emc/product/8725

   Author: Gabby Gallagher MPharm

   Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 09/07/18

The current heatwave in the UK has provided perfect conditions for a wide range of biting and stinging insects to thrive – and this has been demonstrated by the huge increase in medical help being sought for insect bites and their complications. Twice the usual number of calls to NHS Direct (111) have been made recently regarding this issue, and there has been a spike in hospital admissions to treat infected bites, particularly horsefly bites. (1)

In light of this news, this blog explores some of the most common insect bites and stings in the UK, highlighting what to look out for and how to manage them.

Horseflies are common in the UK, and as the name suggests they do bite horses, but also other mammals including humans. If you’ve been bitten by a horsefly you’ll know about it! That’s because not only do horseflies tend to ‘hone in’ on their targets by buzzing round them before finally finding a place on their body to land and bite, but their razor sharp mouthparts dig in to the skin, tearing rather than piercing it to extract as much blood as possible. This will be particularly painful and leave a nasty looking raised red bite which takes longer to heal than most other insect bites. Because of this, the bite can become infected. Look out for pus appearing in or from the bite, worsening pain, fever, or redness and swelling spreading from the bite to the surrounding areas – see your GP if you notice any of these symptoms as you may need treatment with antibiotics. (1, 2)

Mosquitoes are also abundant and particularly favour areas with standing water, such as those near lakes and ponds, but they can be found in other areas too. Generally, people do not realise they have been bitten by a mosquito until a rash develops, as their bite is painless. The bites appear as small red lumps which may contain fluid-filled sacs and can be intensely itchy. (1, 2)

Bees tend to keep themselves to themselves as they travel between flowers collecting pollen. They will usually only sting if they feel threatened. A sharp, piercing pain is felt and a small red mark may be left which often contains the bee sting. It is important that the sting is removed as soon as possible as it is venomous. Scrape the sting out using an object with a thin, hard edge, such as a bank card, or your fingernail. Do this in a sideways motion to draw the sting out of the wound. Don’t try to pluck or squeeze it out as this may release more venom into the surrounding tissue. (2, 3)

Wasps and hornets can be more bothersome, attacking people who are just keeping themselves to themselves! Also, they may sting more than once at a time. The sensation will be similar to a bee sting, but there is no sting left in the wound. Within hours, a red, painful and itchy lump can form around the sting wound, and in some cases the irritation and swelling can cover a considerable area for up to a week as part of a mild allergic reaction. (2)

Bee, wasp or hornet stings can occasionally cause serious allergic reactions (anaphylaxis). If you or someone around you begins to struggle breathing, experiences severe swelling on the face (mainly around the eyes and lips), or dizziness after being stung, call 999 immediately. (2)

Ticks are tiny spider-like creatures which can leave a small red, itchy bite and sometimes a blistered or bruised surrounding area. The bite doesn’t tend to cause any pain, so you may not notice you’ve been bitten. In the UK, ticks are generally harmless unless they carry Lyme disease (covered in more detail in an earlier blog), in which case a characteristic ‘bullseye’ rash may develop. See your GP if this happens.

To ease itching, apply calamine lotion or crotamiton cream to the bites or stings. You can also purchase hydrocortisone cream and antihistamines such as chlorphenamine or loratadine over the counter. Painkillers such as paracetamol can be taken to ease pain associated with stings or bites. Applying a cold compress to the affected area can help to reduce swelling. (3)

Continual scratching of the stung or bitten area can break the skin, which makes infection more likely. Signs of infection include pus or yellow crusting, spreading of the red and swollen area, worsening pain and fever. Don’t hesitate to contact your GP if this develops as you may need antibiotics to clear the infection.

If you’ve been stung or bitten in a sensitive area, such as inside the mouth or near the eyes, or if you experience worsening symptoms or see no improvement after a few days, see your GP or call NHS 111. (3)

To learn more, there is a great article called Bug Bite Identification - The 10 most common bug bites and how to identify them. It starts by explaining why bugs bite and then how to identify if you really have a bug bite. It goes on to venomous versus non venomous bites and when to seek medical attention. (4) 

References

1. Ives L (2018).Heatwave causes spike in insect bite calls to NHS [cited 18 July 2018]. Available at: https://www.bbc.co.uk/news/health-44823286

2. NHS Choices. Insect bites and stings – Symptoms [cited 18 July 2018]. Available at: https://www.nhs.uk/conditions/insect-bites-and-stings/symptoms

3. NHS Choices. Insect bites and stings – Treatment [cited 18 July 2018]. Available at: https://www.nhs.uk/conditions/insect-bites-and-stings/treatment

   4. Bug Bite Identification - The 10 most common bug bites and how to identify them. [cited 26 July 2020]. https://howigetridof.com/bug-bite-identification/

   Author: Gabby Gallagher MPharm

   Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 08/07/18

   Update: 21/11/20 by Margaret Hudson

We’re well into hay fever season which, for a fifth of the UK population, means relentless cold-like symptoms, headaches and general exhaustion. If this sounds all too familiar, it’s the perfect time to review the steps you can take to help reduce the intensity of your symptoms and make your day to day life easier! (1)

What is hay fever?

Hay fever, also known as seasonal allergic rhinitis, is a condition caused by the immune system’s reaction to pollen. Pollen is a fine powder produced by plants for the purpose of reproduction, and is easily carried by the air and therefore breathed in and deposited on hair, skin and clothes. (1)

Symptoms include sneezing, coughing, nasal congestion and running, reduced sense of smell, itching of the eyes, nose, throat and ears, headache and temple pain, earache and a lack of energy. Hay fever may also worsen asthma symptoms. (2)

Symptoms tend to be present for the whole hay fever season (March to September), particularly when the pollen count is high. This usually happens on hot and humid days with a breeze or wind. (2)

How is hay fever treated?

Antihistamines are the most common medical treatment for hay fever symptoms and can be purchased over the counter in pharmacies. They work by antagonising the effects of histamine, a chemical produced by the immune system in response to allergens. This will help with all symptoms. Over-the-counter antihistamines include chlorphenamine, acrivastine, cetirizine and loratadine and are available as tablets and oral solution. Chlorphenamine is a ‘drowsy’ antihistamine, so is useful for people who have trouble sleeping due to their symptoms, whereas acrivastine, cetirizine and loratadine are considered ‘non-drowsy’ and may be more suitable for daytime use, driving, working, school and exam time.

Other treatments that can be bought over the counter include steroid nasal sprays (beclometasone or fluticasone), decongestant nasal sprays (xylometazoline), and saline nasal sprays, which can help with stubborn congestion not relieved by antihistamines, and sodium cromoglicate eye drops to help specifically with itchy eyes.

If your symptoms still persist after trying medicines from the pharmacy, your GP can help. Other antihistamines unavailable over the counter, such as fexofenadine, can be prescribed, as can a wider range of stronger steroids in tablet or nasal spray form.

If this also fails, your GP may consider referring you to a specialist for immunotherapy treatment. This involves administering injections of low doses of pollen at regular intervals, usually starting around December time, to gradually build your immunity to pollen. Once hay fever season comes around, your body should have had enough exposure to no longer treat pollen as an allergen, therefore symptoms should not develop. Unfortunately, this is not a cure - you’ll need to have this done every year. (2)

What else can I do to help ease my hay fever symptoms?

Try to avoid going outside whenever possible, and particularly early in the morning and late in the afternoon/early evening. This is when pollen counts are highest. Also, avoid opening windows and doors in the house, and don’t allow outdoor pets in if possible. Vacuum daily if you can - consider investing in a vacuum incorporating a HEPA filter - and dust surfaces each day with a damp cloth. And although it seems obvious, don’t bring flowers into your house. (1, 2)

If you must go outside, create as many barriers as you can between you and the pollen! Protect your eyes with wraparound sunglasses, protect your airways by applying petroleum jelly around your nostrils, and stop pollen from getting into your car by attaching pollen filters to the air vents. Washing clothes, showering or bathing and washing hair after going outside will wash away any pollen stuck to you or your clothes. And don’t proceed to dry your clothes on the line - they’ll only become covered in pollen again! (2)

Stick to paths and pavements where possible, as walking on grass can release pollen into the air. Cutting grass also has this effect, so let someone else mow the lawn! (2)

Smoking and breathing in other people’s smoke can worsen hay fever symptoms, so avoid this at all costs. (2)

Click here for further information and support from Allergy UK.

References

1. BBC News. Tips for reducing hay fever symptoms [cited 12 June 2018]. Available at: https://www.bbc.co.uk/news/health-44381799
2. NHS Choices. Hay fever [cited 12 June 2018]. Available at: https://www.nhs.uk/conditions/hay-fever/

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 13/06/18

Although rare in the UK, botulism can have serious consequences if caught. Up to one in ten people affected with botulism die as a result of the condition, but this risk is greatly reduced if treatment is started as soon as possible, so it is important to know the signs to look out for. (1)

What is botulism?

Botulism is a condition caused by exposure to a type of bacteria called Clostridium botulinum. These bacteria release a toxin called the botulinum toxin, which is one of the most potent toxins known. It is these toxins rather than the bacteria themselves which pose such a threat to health. The toxins attack the cells of the nervous system, leading to paralysis. In cases where the muscles controlling the respiratory (breathing) system are affected, this can prove fatal. (1)

The bacteria which release the toxin can be found in the soil, sea or river sediments, and even dust. Perhaps the best known source is home canning, pickling or other types of preserving involving food in closed containers. If guidelines on safe and hygienic preparation are not followed, the food may become contaminated with Clostridium botulinum, and the low oxygen environment inside the jar or can is perfect for botulinum toxin production. For food preserved in jars, cans and bottles sold in UK shops, the risk of botulism is minute as stringent hygiene practices must be adhered to during their preparation. Nevertheless, be wary of warped or damaged containers and preserved food that smells or tastes ‘off’. (1)

Botulism can also develop as a result of injecting illegal drugs contaminated with the bacteria into muscle. The reason why this risk applies to illegal drugs in particular is because they are not prepared in a sterile environment, unlike prescribed injectable drugs. Whilst the best advice is obviously to refrain from injecting illegal drugs altogether, it is safer to inject into a vein rather than a muscle. (1)

Babies aged one year or younger are also at risk of contracting botulism from ingesting spores (a dormant form) of the causative bacteria. The spores may be found in soil or food, but honey is a particularly risky source. For this reason, honey should not be given to babies until they are at least 12 months old. (1)

What are the symptoms?

Initially, symptoms may be similar to those of a ‘stomach bug’, including feeling and being sick, diarrhoea and abdominal cramps. This may occur hours or days after first exposure. (1)

Symptoms of paralysis include blurred vision, droopy eyelids, problems swallowing, difficulty speaking or making facial expressions, and eventually problems breathing. (1)

Babies may be quieter than normal, struggle to feed and their body may appear floppy. (1)

How is botulism treated?

The aim of treatment for botulism is to deactivate the toxins produced by the bacteria. This is achieved by administering post-exposure vaccines containing botulism antitoxins or antibodies, which work as toxin neutralisers, stopping any further damage from occurring. Additionally, help with breathing and other essential bodily functions should be given until patients recover. Paralysis that has already occurred can’t be undone by treatment, but it should eventually ease off over time regardless. (1)

If you suspect that you or someone else in your presence may have contracted botulism, it is essential to seek emergency medical attention and to begin treatment at the earliest opportunity, as the more time passes, the greater the damage that will be caused by the deadly toxins. In this instance, do not hesitate to call 999 for an ambulance or to visit A&E as soon as possible. (1)

References

1. NHS Choices. Botulism [cited 4 June 2018]. Available at: https://www.nhs.uk/conditions/botulism/

   Author: Gabby Gallagher MPharm

   Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 6/06/18

This time of year, many of us like to make the most of the warmer weather and lighter evenings. A nice long country walk is a great way to unwind - the exercise benefits the body and the sights, smells and sounds of nature help to clear the mind and promote mental wellbeing. Given this, it can be easy to overlook a growing risk posed by this seemingly harmless activity -  Lyme disease.

What is Lyme disease?

Lyme disease is a bacterial infection caused by the bacterial species Borrelia burgdorferi. It is transmitted via tick bites. Ticks are tiny arachnids (in the same class as spiders) which feed on the blood of several different animals, depending on the species of tick. In the UK, the species most likely to transmit Lyme disease to humans is the sheep tick - as the name suggests, this tick feeds primarily on sheep’s blood, but will feed on the blood of other animals and birds if it needs to. Ticks will wait on tall grass or other shrubs for an animal or human to brush past them, allowing the tick to attach itself to the skin of the animal or human. If the animal is infected with Lyme disease, this is transferred to the tick when it feeds, then the infection can be passed onto the next animal or human that the tick bites. (1, 2)

Usually, the earliest symptom of Lyme disease is a characteristic red rash with the appearance of a bull’s eye on a dartboard. At the centre of the rash is the tick bite. The edges may feel bumpy or raised to the touch. This rash most often develops within a month of being bitten, but it can take as long as three months, and in some cases it may not appear at all. Other symptoms of Lyme disease include flu-like illness (headache, bodily aches and pains, raised temperature, chills and lethargy). (3)

Occasionally, Lyme disease may cause symptoms which persist for years after infection and treatment. These symptoms include aches and pains, low energy and lethargy and are known as post-infectious Lyme disease. There is no known treatment for this post-infectious condition, but speak to your GP if you are still suffering with symptoms after treatment for Lyme disease, as they may be able to help you with arrangements to make your everyday or working life easier. (3)

If Lyme disease is left untreated or if treatment is unsuccessful, it may lead to arthritis and complications in several organs including the heart and brain. (1)

Figures released by Public Health England from 2017 demonstrated an increase in cases of over a third compared to the previous year. (4)

How do I know if I’ve been bitten?

Tick bites are rarely painful, so the main way to tell whether you’ve been bitten by a tick is by seeing the tick attached to your skin. This is why it’s important to check your skin thoroughly after walking in rural or grassy areas - particularly after walking in tall grass. Ticks are very small - ranging from the size of a full stop on this page (a tick larva) to a small pea (an adult female tick after a large feed). (2, 3)

If you spot a tick on your skin, you should carefully remove it as soon as possible. Using clean pointed tweezers (not regular hair plucking tweezers) a tick removal tool or looped fine thread, get hold of the tick at the closest point to the skin as possible and slowly, carefully pull the tick upwards and outwards. Take care not to squeeze or crush the tick’s body, as this can cause the body to detach from the head, leaving the head attached to the skin, or cause the tick’s stomach contents to enter the bite, increasing the risk of infection. (3, 5)

Once you’ve removed the tick, throw it away and wash the bite and the tweezers or tool with soapy water or antiseptic. (3, 5)

You don’t need to visit your GP after removing a tick unless you develop a rash or illness. (3)

How is Lyme disease treated?

If you do feel ill or develop the characteristic bull’s eye rash, visit your GP who may arrange a diagnostic blood test. The usual treatment is a two to four week course of oral antibiotics, namely doxycycline, amoxicillin or cefuroxime. Other antibiotics may be used if the first choices are unsuitable for the patient, and antibiotic injections may be prescribed by a specialist for particularly severe cases. (3, 6)

How can I avoid tick bites?

The best way to prevent tick bites when out in the countryside, woods or in parks is to stop ticks from reaching your skin - by wearing long trousers tucked into your socks and long sleeved tops. Apply a DEET- based insect repellent to your skin and clothes. Avoid wearing dark clothing when out walking as this can make any ticks you’ve picked up harder to spot. Also, avoid walking through tall grass and shrubs and walk along paths where available. Remain responsible and vigilant and continue to enjoy our abundance of beautiful countryside and green spaces this summer! (3)

References

1. Lyme Disease Action. About Lyme [cited 24 May 2018]. Available at: http://www.lymediseaseaction.org.uk/about-lyme/
2. Lyme Disease Action. About Ticks [cited 24 May 2018]. Available at: http://www.lymediseaseaction.org.uk/about-ticks/
3. NHS Choices. Lyme disease [cited 27 April 2018]. Available at: https://www.nhs.uk/conditions/lyme-disease/
4. Lyme Disease Action. Significant rise in cases of Lyme disease [cited 24 May 2018]. Available at: http://www.lymediseaseaction.org.uk/press-releases/significant-rise-in-cases-of-lyme-disease/
5. Lyme Disease Action. Tick Removal [cited 25 October 2017]. Available at: http://www.lymediseaseaction.org.uk/about-ticks/tick-removal/
6. British National Formulary (version 2.0.2) [Mobile application software]. Retrieved from: www.bnf.org

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 30/05/18

The weather is getting warmer, the nights are getting longer and the summer months are fast approaching. This goes hand in hand with people wanting to spend more time outside in the sun. But did you know a single episode of sunburn every two years can increase your chances of developing skin cancer threefold? (1)

“I don’t burn, I tan, so I’m safe!” you might say. But it’s been proven that there’s no safe or healthy way to develop a suntan either. So take note of the advice in this blog to make sure you stay safe in the sun this summer! (2)

The link between sun exposure and skin cancer

Ultraviolet (UV) light is a type of radiation found in the sun’s rays and is invisible to the naked eye. It is the component of sunlight that causes sunburn, suntan and the damage to the DNA in your skin’s cells that can lead to skin cancer. The UV light that reaches our atmosphere comprises two varieties: UVA and UVB. UVA can reach the deeper layers of the skin, whereas UVB affects the superficial layers, therefore both varieties of UV light damage the skin in different ways. (1, 2)

Skin cancer can be categorised into melanoma and non-melanoma. Around 250,000 people in the UK are diagnosed with non-melanoma annually. It is generally less serious than melanoma but can leave those affected with disfigurements, since the main treatment is to remove the affected area of skin if possible. (2)

Melanoma kills approximately 2,000 UK people annually. (2)

How to stay safe in the sun

Overall, the best way to avoid overexposure to the sun is to avoid going out in it, particularly at times when sunlight is strongest, between 11am and 3pm from March through to October. In the summer months, UV rays can filter through cloud in the above hours. If you need to go out, cover as much of the skin with clothing as possible as long as it is not too warm (for example, long sleeved tops and full length trousers), apply sunscreen to bare skin, and seek shade whenever you have the chance. Sunglasses are also important as even eyes can be damaged by sun exposure, but they must bear the CE Marking and European Standard EN 1836:2005 - if they don’t, you run the risk of having less or no eye protection, and this can be very dangerous as looking through tinted glass allows the eyes to open more widely in sunlight, meaning more harmful UV rays reach the eyes. (2)

Your sunscreen needs to offer protection against both UVA and UVB light. You can identify this by looking on the container for the letters ‘UVA’ within a circle, as well as a four star UVA protection rating or above, and SPF15 or higher. Apply sunscreen generously - around eight teaspoons’ worth as a minimum for an adult of average size, half an hour before you’re due to go outside and again immediately before you go out. Remember to cover all areas that will be exposed to the sun, including ears, neck, and the scalp if you have thinning, little or no hair - but wide-brimmed hats are more reliable for this purpose. Sunscreen should be reapplied if the skin is wet, rubbed or sweating occurs. (2)

Children’s skin is generally much more sensitive than that of adults. Up to the age of 6 months, they should not be taken outside in strong sunlight, or if it cannot be avoided, they should be shaded. For older children, it is crucial to follow the advice stated above with regard to covering the skin, seeking shade and applying sunscreen, as childhood sunburn is a major risk factor for skin cancer in later life. (2)

A ‘healthy glow’ - a common misconception

In 2016, the National Institute for Health and Care Excellence (NICE) released new guidelines stating that, contrary to popular belief, there is no safe way to tan in the sun. It might make you look healthier, but that’s as far as it goes. A suntan, just like sunburn, is a sign that potentially harmful changes have occurred in the skin. And protection from the effects of further UV exposure offered by tanned skin is negligible. Even if you have naturally dark or black skin you can still be at risk of skin cancer from overexposure to UV light. (2)

Since sunbeds also utilise UV light, often at higher concentrations than in sunlight, they are equally unsafe. If you crave darker skin as summer approaches, fake tanning products exist as a safe alternative to the sun or sunbeds. Or ideally, we can embrace our skin just the way it is! (2)

References

1. Cancer Research UK. How the sun and UV cause cancer [cited 26 April 2018]. Available at: http://www.cancerresearchuk.org/about-cancer/causes-of-cancer/sun-uv-and-cancer/how-the-sun-and-uv-cause-cancer
2. NHS Choices. New NICE guidelines on sun exposure warn 'tanning is unsafe' [cited 26 April 2018]. Available at: https://www.nhs.uk/news/cancer/new-nice-guidelines-on-sun-exposure-warn-tanning-is-unsafe/

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 02/05/18

Pulmonary arterial hypertension is a rare but serious disease which affects smaller branches of the pulmonary arteries, which are the blood vessels which carry oxygen-poor blood from the heart to the lungs to be re-oxygenated, ready to be pumped back around the body. Currently, half of people with the condition die within five years of it first appearing, but will a new genetic discovery lead to earlier diagnoses and therefore a more positive outlook for those affected? (1, 2, 3)

What is pulmonary arterial hypertension?

Pulmonary arterial hypertension (PAH) is raised blood pressure in the smaller branches of the pulmonary arteries, caused by the arterial walls stiffening and thickening. It is difficult for blood to be pumped through stiff, thick arteries as there is less ‘give’, therefore the right side of the heart, which supplies the pulmonary arteries, is forced to pump harder to make sure enough blood reaches the lungs, and blood pressure rises. This increased workload can weaken the right side of the heart over time and eventually cause heart failure. (1, 3)

What causes PAH?

A number of pre-existing conditions can be linked to PAH, including scleroderma (a condition associated with thickened skin, which can occur in blood vessels), HIV, thyroid problems, sickle cell disease, and particular medication. However, a cause cannot be established in around 20% of cases. (1, 2)

What are the symptoms of PAH?

PAH can cause you to experience shortness of breath, feel tired, faint or dizzy, experience palpitations (unusually fast or erratic heartbeat), experience pain in the chest, and develop swelling in the ankles, feet, legs or abdominal area. Usually, exercise worsens these symptoms. Unfortunately, contrary to other types of pulmonary hypertension, symptoms often do not occur until the later stages of the disease, when a lot of the damage is already done. (1)

How is PAH treated?

If a pre-existing condition has led to PAH, the first step is to treat this condition if possible. (4)

To treat PAH itself, a range of medicines can be taken including anticoagulants (such as warfarin), diuretics, inhaled oxygen therapy, digoxin (encourages the heart to pump more forcefully whilst lowering heart rate). Sildenafil and tadalafil are primarily used to treat erectile dysfunction but can be prescribed by specialists to treat PAH. (4)

In severe cases, PAH which is not sufficiently controlled by medication may call for surgery or a lung transplant. (4)

Unfortunately, PAH cannot be cured, but the treatments may help to slow, halt or even reverse the progression of the disease to an extent. (4)

The latest news

An exciting discovery has been made by researchers working on the 100,000 Genomes Project - four new genetic mutations have been found that are responsible for causing PAH. Previously, experts knew of only one mutation linked to the disease. These mutations code for faulty proteins which are incorporated into tissues including the pulmonary arteries. Knowing about these mutations opens up the opportunity for more targeted treatments to be produced in future, and if people with a family history of PAH can be genetically screened for the condition, it enables earlier diagnosis and earlier interventions. (2)

References

• NHS Choices. Pulmonary hypertension: Overview [cited 14 March 2017]. Available at: https://www.nhs.uk/conditions/pulmonary-hypertension/
• Therrien A. Genes behind deadly heart condition found, scientists say [cited 17 April 2018]. Available at: http://www.bbc.co.uk/news/health-43727026
• NHS Choices. Pulmonary hypertension: Causes [cited 17 April 2018]. Available at: https://www.nhs.uk/conditions/pulmonary-hypertension/causes/#PAH
• NHS Choices. Pulmonary hypertension: Treatment [cited 17 April 2018]. Available at: https://www.nhs.uk/conditions/pulmonary-hypertension/treatment/

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 19/04/18

A recent review of prostate cancer diagnoses in the UK has led to the discovery that almost 40% of cases are diagnosed in the later stages of the disease.

Furthermore, in February this year, the number of deaths from prostate cancer in men surpassed the number of deaths from breast cancer in women, which had never happened before in the UK. What is causing this startling rise in prostate cancer deaths and why isn’t the disease being picked up sooner? (1)

The key message is, that if your male and over the age of 50 you should get tested regularly.

Early diagnoses often means it can be treated successfully. 

Where can I buy a Self-Check Prostate PSA test kit? - click here.

What is the prostate?

The prostate gland is a crucial part of the male reproductive system. It is responsible for the production of the white fluid, which along with sperm, makes up semen. It is found within the pelvis, enveloping the upper part of the urethra, which is the tube through which urine from the bladder flows out of the body. Prostate cancer develops when mutations (changes) in the DNA of cells in the prostate cause cells to proliferate uncontrollably. It is unclear why this happens, but a genetic link has been found, with men whose father or brother has/has had prostate cancer more likely to be affected by it themselves. (2)

Why the increase in prostate cancer, and why the late diagnoses?

The main reason for the increase in cases and deaths is thought to be our aging population. Prostate cancer is more likely to develop in men over 50, and the risk increases further with age. With life expectancy continually rising in the UK, this means more chance for prostate cancer cases to arise, and consequently more related deaths. (1, 2)

Also, prostate cancer symptoms can be difficult to recognise. In the earlier stages, people with prostate cancer may show few or no symptoms. This may last for decades, until the prostate enlarges to such an extent that it puts pressure on the urethra. Once this has occurred, changes in the pattern and ease of urination may become apparent. You may find it difficult to begin urinating, and you may need to forcefully push to achieve a normal urinary flow. It might also feel as if you can’t get the last drops of urine out of your bladder. Prostate cancer can also cause sudden urges to urinate, and waking up to urinate several times in the night. Erectile dysfunction is another symptom that can occur as a result of prostate cancer. (1, 2)

It is important to note that the above symptoms are not always caused by prostate cancer - other conditions such as benign prostatic hyperplasia (BPH) also cause these symptoms. But any men experiencing such changes in urination must see their GP to rule it out. (2)

How can prostate cancer be identified in the early stages?

There are a number of tests that can be carried out to assess prostate health. The most common test is the prostate -specific antigen (PSA) blood test. 

To buy your Self-Check PSA home test kit - click here. 

PSA levels are increased in men with prostate cancer at any stage, but also in other conditions such as BPH, so raised PSA does not necessarily indicate presence of prostate cancer. Nevertheless, the PSA test is available free of charge on the NHS to men over the age of 50 if they ask their doctor for it. (1, 2)

A digital rectal examination (DRE) involves a doctor or nurse inserting a gloved, lubricated finger into the back passage to feel the shape and size of the prostate. It is not reliable enough to be used as a diagnostic test alone, but can be combined with a PSA test or biopsy. (3)

A biopsy involves taking a small sample of tissue from the prostate which is examined for any abnormalities. However, approximately 20% of cancerous samples are not identified, and the procedure can cause problems such as bleeding and infection of the prostate. (3)

What if I am diagnosed with prostate cancer?

Quite often, there is no urgent action required after a diagnosis, other than looking out for the aforementioned symptoms, sometimes called ‘watchful waiting’. If treatment is started in the early stages, it usually comprises hormone therapy, radiotherapy and possible surgery. In the latter stages, when the cancer has often spread to other areas of the body, treatment is supportive (prolonging life and easing pain and discomfort). (2)

Since the symptoms of urinary incontinence and erectile dysfunction can be embarrassing and debilitating, men with prostate cancer may develop depression or anxiety. Prostate Cancer UK has a wealth of information on living with prostate cancer as well as links to support groups, a helpline and advice from nurses specialising in the condition. (2)

As we said at the beginning of this blog - the key take away message is, that if you are male and over 50 you should get tested regularly.

Early diagnoses often means it can be treated successfully. 

Where can I buy a Self-Check Prostate PSA test kit? - click here.

References

1. BBC News. Prostate cancer: Four in 10 cases diagnosed late, charity says [cited 12 April 2018]. Available at: http://www.bbc.co.uk/news/health-43669439

2. NHS Choices. Prostate cancer [cited 12 April 2018]. Available at: https://www.nhs.uk/conditions/prostate-cancer/

3. NHS Choices. Should I have a PSA test? [cited 12 April 2018]. Available at: https://www.nhs.uk/Livewell/Prostatehealth/Pages/psa-test.aspx

   Author: Gabby Gallagher MPharm

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