For this survey, which is part of the wider Deaf Health Challenge project funded by the Scottish Government, BDA Scotland has gathered information from BSL users across Scotland about their experiences of using health services. 189 people were consulted in 13 different groups.

Findings 

1. Most participants were unsure about which services were part of primary healthcare and which were secondary. Overall, they found communication better in primary care settings, such as with a GP, because staff usually know them better and know about their communication needs. Secondary care was considered more problematic: participants reported that they had often turned up to appointments only to realise that no BSL/English interpreter had been booked, or that they did not know the BSL/ English interpreter who had been booked (this was especially problematic when the BSL/English interpreter was the wrong gender e.g. woman patient with male BSL/English interpreter.

2. NHS staffs were generally found to be easier to communicate with when they were part of a local service that Deaf patients used regularly, although staff rotation sometimes caused problems. Some participants said they took family members or friends to all appointments in case no BSL/English interpreters were provided. Staff with BSL / Deaf awareness and some BSL knowledge were considered very helpful.

3. While participants usually received a letter telling them about a referral to a hospital or clinic, they often did not understand why. This is because the letters were difficult to understand or did not include enough information, or because the GP did not explain the referral. This made Deaf patients very worried; they did not understand why they had to go to hospital and only found out at their appointment that there were no serious problems.

4. Most Deaf patients said they preferred to contact their local health services via text, email or Text Relay. When this is not possible, they preferred to make appointments face-to-face. Most participants had never heard of or used the online interpreting service contactSCOTLAND-BSL. Those who had tried it reported technical problems, such as unreliable connections.

5. Overall, participants said they were more comfortable in the familiar environments of their primary care services. Secondary care services can be faster, even though more complicated as they involve more staff and different departments.

6. While some respondents said they would recommend their local NHS services if they were used regularly and staff had good BSL/Deaf awareness, many would not recommend their local services. Services were said to vary in BSL/Deaf awareness and many did not provide BSL/English interpreters or did not know how to book them.

7. Many participants used public transport to get to hospital appointments. Only a few used Ambulance Patient Transport Services (PTS) because they could not use public transport. They were unhappy because PTS was found to be very inflexible and uncomfortable, as respondents could not communicate with other patients during a trip. One worry is that the first members of staff that Deaf people meet are usually paramedics (ambulance), who are not trained at all in BSL/Deaf awareness.

8. Those who had attended A&E stated that they communicated via a writing pad, a family member or a friend. They would like NHS staff to be more aware of the different communication methods that can be used with BSL users, such as online interpreting via iPads, written plain English and the BSL/English interpreter booking system.

9. It was highlighted that, unlike in England, there is no residential mental health service available in Scotland that specifically caters for Deaf people. Those who had used mental health services before did not receive enough support. Some participants knew a mental health professional socially and were therefore concerned about using their services. They felt that mental health support could be improved if more professionals learnt BSL and were more BSL/Deaf aware.

10. Most participants did not know about Pathway Support (diagnose health problem from start to end) for long term illness, or what it does, but were interested in finding out more.

Overall, it became clear that Deaf patients were usually more successful accessing services they were familiar with, but struggled upon referral to secondary care. A major issue was the lack of BSL/Deaf awareness among NHS staff and the failure to book BSL/English interpreters. Writing letters was not thought to be useful, as Deaf patients often did not understand the content and got confused, which sometimes led to them being treated without giving consent. BSL/English online interpreting services were rarely used because of technical problems. The short notice availability of BSL/English interpreters is a problem, particularly in A&E, so that a compromise may have to be found while waiting for the preferred BSL/English interpreter to arrive. The lack of residential mental health services and community support initiatives that are suitable for Deaf BSL users remains problematic.

 

Plan for this year: 

• Gather more information from Deaf community (from whole of Scotland) through surveys/consultations.

• Spread more information across NHS boards and voluntary organisations (Chest, Heart and Stroke Scotland – CHSS, Action on Depression, Dementia, COPD, and Multiple Sclerosis - MS) in Scotland, including problems and areas for improvement.

• Research other health related topics relevant to the Deaf community, e.g. Chronic Obstructive Pulmonary Disease (COPD) and stroke.

• Continue to work with the NHS, voluntary organisations and health promotion agencies to provide a presentation about BSL/Deaf Awareness training and BDA’s report “Access & Inclusion (Health) Review: Deaf British Sign Language users’ engagement with health care in Scotland”.

• Deliver presentations to health boards and health providers to raise awareness of the Deaf community and their experiences.

• Deliver BSL/Deaf awareness presentations to trainers for health service providers.

• Contribute to the BSL national plan regarding Deaf people’s health, as part of the BSL (Scotland) Act (2015).

• Work with BSL Health Champions (NHSGGC), Deaf & Mental Health Working group, Voluntary organisations (MS, Action on Depression, CHSS, Dementia) and contactSCOTLAND-BSL (advisory group), and support their service development, based on the information gathered in this survey.

• Work with the NHS and voluntary organisations to establish the BDA’s BSL (Scotland) Charter.

 

Recommendations: 

1. Communication between primary and secondary health care providers should be improved so that patients’ communication needs can be shared between all relevant departments. Procedures for booking BSL/English interpreters should also be improved.

2. Staff should be given the opportunity to attend BSL/Deaf awareness training.

3. Appointment confirmation should be possible by means other than telephone; e.g. by text messaging.

4. A cautious approach should be taken in the development of BSL/English online interpreting services. The issues affecting patients’ face-to-face access to health service information should be remedied prior to BSL/English online interpreting services being rolled out. A more productive short term aim would perhaps be to address weaknesses such as booking systems; the availability of BSL/English interpreters at short notice in other areas affects the consistent provision of face-to-face interpreters across departments.

5. Consider provision of basic BSL/Deaf awareness training for paramedics and ambulance staff, to help them to communicate with Deaf patients. Or, if practicable, they could be provided with BSL/English online interpreting equipment (ipads/mobile phone) such as Deaf people rather to use it because it is easier to access, to help to address existing communication issues.

6. A&E staff need to understand the importance of booking a face-to-face BSL/English interpreter in emergency situations and should also be aware of other communication strategies, such as online interpreting or written materials where this is suitable.

7. It is worth considering setting up a mental health service for Deaf people in Scotland, perhaps borrowing from successful initiatives established in other NHS Board areas throughout the UK such as the National Deaf Services e.g. John Denmark Unit (JDU) and others, in England. Deaf people may prefer a Deaf mental health service; this would be Deaf aware, and BSL will be used in it; in mainstream mental health services, BSL/English interpreters will be required.

8. Create BSL videos on specific health topics, together with the Pathway Service, and promote these amongst Deaf community.

What is Bipolar Disorder?

Bipolar disorder is mental illness which affects around 2% to 3% of the population. It affects both men and women equally.  It is characterised by people experiencing severe mood swings ranging from depression to mania.  However, people will often have long periods of stability in between episodes of illness.

Onset of the illness is often in adolescence or early adulthood, although diagnosis in late life is also common.

Bipolar disorder is often split into two diagnostic groups; bipolar 1 and bipolar 2.

It can take on average 10 years to be diagnosed from onset of symptoms for those affected by bipolar 2.

With bipolar 1 - the person will experience the full range of symptoms of mania and depression.

With bipolar 2 - the more extreme symptoms of mania are absent although the less severe symptoms know as hypomania will occur, as will the full range of depressive symptoms.

Moods are best viewed as a spectrum, with severe depression at one end and extreme elation at the other end. Within that spectrum most people will find themselves within the middle range at any given time.

In a manic phase (also known as a high phase), someone with bipolar disorder may have huge amounts of energy and feel little need for sleep. You may think and talk faster than usual, and your thoughts may jump rapidly from one subject to another, making conversation difficult. You may also have what are called 'grandiose' ideas or delusions about your abilities and powers, and a loss of judgement. People in a manic phase can get themselves into all sorts of difficulties that they would normally avoid – they may leave their job, spend money they don’t have, or give away all their possessions.

In a low (or depressive) phase, people feel hopeless, despairing and lethargic, become full of self-blame and self-doubt and have difficulty concentrating. This can make it difficult to cope with everyday life. You may want to withdraw from friends and social contacts, and may feel suicidal.

 

Prevention

There are also some things you can do that can help stop you going high:-

• Take control. Be aware of how you are feeling and when you are heading towards mania or hypomania so that you can plan for and reduce the worst effects.
• Sleeping tablets and tranquillisers may help if taken early on, but be careful not to overdo this.
• Get plenty of rest, even if you don’t really feel like it.
• Cancel most of your plans for the next few weeks. The less you have to think about the better.
• Avoid stimulants, like alcohol, coffee and any kind of recreational drugs.

There are a number of things you can do to help manage depressive phases:-

• Take control. Some people find it helps if they have some control over what happens to them. This helps to guard against the hopelessness associated with depression.
• Set small and manageable goals - this can give you a sense of achievement and make you feel better.
• Keep in touch with your friends. If you are already depressed you may find it very difficult to be sociable, and this can make you feel more depressed.
• Keep active. Exercise can be very helpful in counteracting depression.
• Review your diet. People who are depressed may have low levels of certain essential fatty acids that are found in fish oils.
• Try self-help techniques - for example, meditation and listening to music.

Treatments

Depressive episodes, if untreated, last for about six months to one year. On average, someone with bipolar will have five or six episodes over a 20-year period. With treatment, most depressive episodes clear in about three months, but if treatment is stopped before six months of full recovery, the risk of relapse is doubled. The depression may also be treated with anti-depressants and talking treatments, such as cognitive behavioural therapy or counselling.

The most common treatment during high phases is lithium carbonate, a mood stabilising drug. It is also sometimes prescribed to people with severe depression. High levels of lithium in the blood are dangerous, so anyone taking lithium must have regular blood tests.
What can I do to help myself?

There are various things you can do to minimise the effect of the illness which broadly come under the heading of “self-management”. These are techniques which have proved to be effective and which many people practice. You can take control of your illness to the best of your ability and live a more stable, fulfilling life as a result. Some advice for good mental and physical health is to eat a balanced diet, exercise regularly and get a good night’s sleep. There is a lot of evidence to show that these are the fundamentals to achieving better mental health. In addition try to maintain a good life routine, balanced in work, leisure and relationships.

Bowel cancer is a general term for cancer that begins in the large bowel. Depending on where the cancer starts, bowel cancer is sometimes called colon or rectal cancer.

Cancer can sometimes start in the small bowel (small intestine), but small bowel cancer is much rarer than large bowel cancer.

Bowel cancer is one of the most common types of cancer diagnosed in the UK, with around 40,000 new cases diagnosed every year.

About one in every 20 people in the UK will develop bowel cancer during their lifetime.

Signs and symptoms

The three main symptoms of bowel cancer are blood in the stools (faeces), changes in bowel habit (such as to more frequent, looser stools) and abdominal (tummy) pain. However, these symptoms are very common and most people with them do not have bowel cancer.

For example, blood in the stools is more often caused by haemorrhoids (piles), and a change in bowel habit or abdominal pain is usually due to something you have eaten.

As almost nine out of 10 people with bowel cancer are over 60 years old, these symptoms are more important as people get older. They are also more significant when they persist despite simple treatments.

Most people who are eventually diagnosed with bowel cancer have one of the following symptom combinations:

a persistent change in bowel habit causing them to go to the toilet more often and pass looser stools, usually together with blood on or in their stools a persistent change in bowel habit without blood in their stools, but with abdominal pain blood in the stools without other haemorrhoid symptoms such as soreness, discomfort, pain, itching or a lump hanging down outside the back passage abdominal pain, discomfort or bloating always provoked by eating, sometimes resulting in a reduction in the amount of food eaten and weight loss

The symptoms of bowel cancer can be subtle and don’t necessarily make you feel ill.

Read more about the symptoms of bowel cancer.

When to seek medical advice

Try the bowel cancer symptom checker for advice on treatments you can try to see if your symptoms get better and when you should see your GP to discuss whether any tests are necessary.

Your doctor will probably carry out a simple examination of your tummy and bottom to make sure you have no lumps, and they may arrange a simple blood test to check for iron deficiency anaemia (as this can indicate whether there is any bleeding from your bowel that you haven’t been aware of).

In some cases, your doctor may decide it is best for you to have a simple test in hospital to make sure there is no serious cause for your symptoms.

Make sure you return to your doctor if your symptoms persist or keep coming back after stopping treatment, regardless of their severity or your age.

Read more about diagnosing bowel cancer.

Who's at risk?

It's not known exactly what causes bowel cancer, but there are a number of things that can increase your risk. These include:

Age – almost nine in 10 cases of bowel cancer occur in people aged 60 or over

Diet – a diet high in red or processed meats and low in fibre can increase your risk

Weight – bowel cancer is more common in people who are overweight or obese

Exercise – being inactive increases the risk of getting bowel cancer

Alcohol and smoking – a high alcohol intake and smoking may increase your chances of getting bowel cancer

Family history – having a close relative (mother or father, brother or sister) who developed bowel cancer below 50 years of age puts you at a greater lifetime risk of developing the condition

 

Some people are also at an increased risk of bowel cancer because they have another condition that affects their bowel, such as severe ulcerative colitis or Crohn's disease over a long period of time.

Read more about the causes of bowel cancer and preventing bowel cancer.

Bowel cancer screening

To detect cases of bowel cancer sooner, the NHS offers two types of bowel cancer screening to adults registered with a GP in England:

All men and women aged 60-74 are invited to carry out an FOB (faecal occult blood) test at home. They're sent the home test kit every two years through the post, until they reach the age of 74. The FOB test checks for the presence of blood in a stool sample, which could be an early sign of bowel cancer.

An additional one-off test called bowel scope screening is gradually being introduced in England. This is offered to men and women at the age of 55. As of March 2015, about two thirds of screening centres were beginning to offer this test to 55 year olds. It involves a doctor or nurse using a thin flexible instrument to look inside the lower part of the bowel and remove any small growths, called polyps, that could eventually turn into cancer.

 

Screening plays an important part in the fight against bowel cancer because it can help detect bowel cancer before it causes obvious symptoms, which increases the chances of surviving the condition.

Read more about screening for bowel cancer.

Treatment and outlook

Bowel cancer can be treated using a combination of different treatments, depending on where the cancer is in your bowel and how far it has spread.

The main treatments are:

surgery to remove the cancerous section of bowel, this is the most effective way of curing bowel cancer and is all that many people need

chemotherapy – where medication is used to kill cancer cells

radiotherapy – where radiation is used to kill cancer cells

biological treatments – a newer type of medication that increase the effectiveness of chemotherapy and prevent the cancer from spreading

As with most types of cancer, the chance of a complete cure depends on how far the cancer has advanced by the time it is diagnosed. If the cancer is confined to the bowel then surgery will usually be able to completely remove it.

Overall, between seven and eight in every 10 people with bowel cancer will live at least one year after diagnosis and more than half of those diagnosed will live at least another 10 years.

Every year, around 16,000 people die as a result of bowel cancer.

Cholesterol is a fatty substance known as a lipid and is vital for the normal functioning of the body. It is mainly made by the liver but can also be found in some foods.

Having an excessively high level of lipids in your blood (hyperlipidemia) can have an effect on your health. High cholesterol itself does not cause any symptoms, but it increases your risk of serious health conditions.

 

About cholesterol

Cholesterol is carried in your blood by proteins, and when the two combine they are called lipoproteins. There are harmful and protective lipoproteins known as LDL and HDL, or 'bad' and 'good' cholesterol.

Low-density lipoprotein (LDL): LDL carries cholesterol from your liver to the cells that need it. If there is too much cholesterol for the cells to use, it can build up in the artery walls, leading to disease of the arteries. For this reason, LDL cholesterol is known as "bad cholesterol".

High-density lipoprotein (HDL): HDL carries cholesterol away from the cells and back to the liver, where it is either broken down or passed out of the body as a waste product. For this reason, it is referred to as "good cholesterol" and higher levels are better.

The amount of cholesterol in the blood (both LDL and HDL) can be measured with a blood test. The recommended cholesterol levels in the blood vary between those with a higher or lower risk of developing arterial disease.

 

Why should I lower my cholesterol?

Evidence strongly indicates that high cholesterol can increase the risk of:

• narrowing of the arteries (atherosclerosis)
• heart attack
• stroke
• mini-stroke (TIA)

This is because cholesterol can build up in the artery wall, restricting the flow of blood to your heart, brain and the rest of your body. It also increases the chance of a blood clot developing somewhere.

Your risk of coronary heart disease (when your heart's blood supply is blocked or disrupted) also rises as your blood's cholesterol level increases and this can cause pain in the front of the chest or arm (angina) during stress or physical activity.

 

What causes high cholesterol?

There are many factors that can increase your chance of having heart problems or stroke if you have high cholesterol, including the following:

• an unhealthy diet: some foods already contain cholesterol (known as dietary cholesterol) but it is the amount of saturated fat in your diet which is more important
• smoking: a chemical found in cigarettes called acrolein stops HDL transporting fatty deposits to the liver, leading to narrowing of the arteries (atherosclerosis)
• having diabetes or high blood pressure (hypertension)
• having a family history of stroke or heart disease

There is also an inherited condition known as familial hypercholesterolaemia (FH). This can cause high cholesterol even in someone who eats healthily.

 

When should I test my cholesterol levels?

Your GP may recommend that you have your blood cholesterol levels tested if you:

• have been diagnosed with coronary heart disease, stroke or mini-stroke (TIA) or peripheral arterial disease (PAD)
• have a family history of early cardiovascular disease
• have a close family member who has a cholesterol-related condition
• are overweight
• have high blood pressure, diabetes or a health condition that can increase cholesterol levels
• Read more about how high cholesterol is tested.

 

How can I lower my cholesterol levels?

The first step in reducing cholesterol is to maintain a healthy, balanced diet. It is important to keep your diet low in fatty food. Try to swap food containing saturated fat for fruit, vegetables and wholegrain cereals. This will also help to prevent high cholesterol from returning.

Other lifestyle changes can also make a big difference. It will help to lower your cholesterol if you:

• do regular exercise – read tips on improving your health and fitness
• quit smoking – read information about how to stop smoking

If these measures don't reduce your cholesterol and you continue to be at a high risk of heart disease, your GP may prescribe a cholesterol-lowering medication such as statins. Your GP will take into account the risk of any side effects from statins and the benefit of lowering your cholesterol must outweigh any risks.

 

What is COPD?

Chronic Obstructive Pulmonary Disease, shortened to COPD, is an umbrella term for a group of conditions which cause long-term damage to the airways. COPD includes:

• Chronic bronchitis
• Emphysema
• Lung damage which is caused by chronic asthma

COPD causes the airways to narrow so air cannot flow freely in and out of your lungs.

There is no cure for COPD but there are many things that you can do to manage your condition.

 

Typical symptoms of COPD

COPD tends to creep up on you. You may have put up with symptoms for many years before going to your doctor, like when a chest infection won’t go away or gets worse. So when a diagnosis of COPD is made it can sometimes seem sudden.

The 4 main symptoms of COPD are:

• Coughing
• Producing sputum (phlegm)
• Breathlessness
• Wheezing

You may have noticed other symptoms such as repeated chest infections, weight loss and tiredness. Your doctor will ask about your smoking history as this is often (but not always) the cause of COPD.

 

What tests will be needed?

Your doctor will examine you by looking and listening to your chest. In addition your doctor will check other parts of your body (such as your fingers and ankles) to exclude any other conditions that may be causing your symptoms.

You may need some of the following tests and investigations:

• Sputum specimens
• Chest x-ray
• Heart tests (e.g. ECG, Echocardiogram)
• Lung function or breathing tests
• Blood tests
• CT scan

 

What causes COPD?

In COPD your airways are damaged, usually through constant irritation.

For example:

• Smoking
• Working in an occupation that creates dust
• Unhealthy living conditions and / or poor air quality
• Chronic asthma
• Genetic factors

 

What is the treatment for COPD?

The most common way to treat COPD is by using inhalers. Inhalers allow drugs to be delivered directly to your lungs.

You may already be using inhalers.

The three main groups of inhalers used for COPD are:

• Relievers – these are called bronchodilators, they open up the airways in your lungs to make breathing easier. Relievers act quickly and can be used during an episode of breathlessness.

• Long-acting relievers – these are also bronchodilators. These should be used regularly to give longer lasting relief. They do not act as quickly as relievers.

• Preventers – these contain a bronchodilator and a steroid. The steroid reduces inflammation in your airways. You should use your preventer regularly even if you do not feel unwell.

 

Other drug treatment

You may need steroids and/or antibiotics if you have a flare up.

 

What can I do to help myself?

Know how to take your inhaler correctly.

• Stop smoking
• Be physically active
• Monitor your symptoms and know when to see the doctor
• Protect yourself from getting ill

  

Are you taking your inhalers correctly?

Having the correct medication is only half of the battle. The other half is making sure you are using the device correctly so that medication gets into your lungs. Ask your nurse or other healthcare professional to check your inhaler technique.

 

Where can I get help to stop smoking?

If you smoke, stopping smoking is the most important thing you can do to help yourself. The damage caused by smoking is irreversible. However, the moment you stop smoking the risks to your health start to go down.

Options to help you stop smoking are:

• Internet, phone, text, one-to-one or group support
• Nicotine replacement therapy
• Other medication to help control cravings
• Ask your doctor or pharmacy about what support is available in your area and /or contact Smokeline.
• Smokeline will tell you about your nearest free stop smoking service, can provide access to specialist counsellors, and provide further information.
• Smokeline 0800 84 84 84: Free helpline 9am–9pm
• On-line information and support, text phone support and live on-line chat with a Smokeline advisor: canstopsmoking.com

You are four times more likely to quit smoking with professional support and nicotine replacement therapy than on your own.

 

What does ‘being active’ mean?

Some people think that being active is the same as being fit, but it’s not. There are many types of physical activity:

• Walking,
• Housework,
• Gardening,
• Sport,
• Play and dance

There are many benefits of being active. It can help your heart, circulation, bones, muscle, your mood and much more. People with COPD can improve their breathing by being active.

 

What is pulmonary rehabilitation?

Pulmonary rehabilitation (PR) is a structured programme of exercise, information and emotional support for people with chronic chest conditions It also allows you to ask questions and get more information about living with COPD.

• PR can lead to significant improvements in your quality of life and ability to exercise as well as improving symptoms such as breathlessness.

• Individual programmes may differ, e.g. what exercises are used, duration of programme, amount of home exercise.

• Some programmes are run in hospitals but many are based in the community, where it may be easier for you to attend, such as community and leisure centres or church halls.
• If there is a class in your area ask your GP, nurse, physiotherapist or hospital consultant to refer you.

 

When do I need to see the doctor?

Sometimes in COPD your condition can worsen quite quickly. This is called a flare up or exacerbation.

• It is important that you report any sudden changes in your symptoms to your doctor or nurse.

• Early treatment with antibiotics and/or steroids can often prevent you going into hospital.

• Ask your healthcare professional how you can help yourself.
• For example a ‘self-management plan’ and CHSS’s ‘COPD Traffic Lights’ can help you with this.
• You should also have a review with your doctor at least once a year to discuss how you are managing your COPD.

  

How can I protect myself from getting ill?

• Ask your GP for yearly flu injection to reduce the risk of infection and avoid a hospital stay/hospital admission.

• Ask your GP for a pneumonia vaccine. You will only need this once.

• Learn what triggers your breathlessness such as the weather, air quality or smoky environments.

• Join the CHSS free Air Quality and Weather Text Service. The Advice Line nurses will send free text alerts when poor air quality or bad weather are likely to affect you.

• Eat a healthy, balanced diet. A good diet helps you to keep strong, fit and healthy. You will be better at avoiding and fighting infections

• Keeping your lungs clear to help avoid infections. This can also help you to breath more easily. Ask a physiotherapist to show you how to do this.

COPD Pathway

1) PUBLIC AWARENESS

QUALITY ACCESSIBLE INFORMATION, SIGNPOST TO GP, FAMILY, FRIENDS AND CARERS, SCREENING

Raising awareness of COPD is vital if the vast numbers of people who are undiagnosed are to get the help and assistance they need. Patients, their family, friends and carers need access to quality-assured information so that they can make informed choices and for professionals, screening and case-finding needs greater priority. Throughout this pathway there are links like the ones below to information and guidance that may assist you with your journey with COPD.

 

2) SYMPTOM RECOGNITION

The symptoms of COPD vary depending on how severe it is, and how people have adapted to their problems. Symptoms include:

• long-term, chesty cough
• wheeze
• phlegm
• breathlessness
• anxiety and sometimes depression

In mild cases, symptoms like a cough, phlegm and shortness of breath may only be present during the winter or after a cold. In more severe cases, you may be short of breath every day. With more severe COPD, because of breathlessness, normal activities can become more difficult.

 

3) PNEUMONIA & FLU VACCINE 

The flu vaccine is strongly recommended for people of all ages with COPD and especially for older people. This is because you are particularly at risk of getting more serious problems if you catch flu. You can get a free flu vaccine from your GP and it advisable to have it before the flu season starts, usually in November.

Pneumonia is an inflammation of the lungs usually caused by an infection, which can make it harder for the lungs to pass oxygen into the bloodstream. This can be serious for people with COPD. It is therefore important to know about the causes of pneumonia, its symptoms, treatment and prevention.

 

4) DIAGNOSIS

GP, nurses and clinical will assess and discuss / how to diagnosis.

a) SMOKING CESSATION

For patients: everyone knows that smoking isn’t good for you, especially if you have COPD, but we also know how incredibly difficult it is to give up smoking.  Most people who successfully give up smoking have had help and support and the good news is there’s lots of help and support available. Just ask your GP, nurse or your pharmacist.

People with COPD: if you smoke regularly you will be encouraged to stop and offered support to stop smoking.

b) DIAGNOSIS CONFIRMED 

For patients:  if you have symptoms of COPD you should have your diagnosis confirmed by a spirometry test (blowing into a special machine). This is carried out by a health care professional, usually a nurse, who is trained in the use of the machine and understanding the results of the test.

People with COPD: you may have COPD if you have at least one of the symptoms, for example breathlessness, long-lasting cough or often coughing up phlegm. However the diagnosis will need to be confirmed by a trained health care professional using specialist equipment to test how well your lungs work.

c) TIMELY, SENSITIVE

DIAGNOSTIC COMPETENCIES, UNDERSTANDING SEVERITY

As a person living with COPD the sooner you are diagnosed and treatment begins, the less chance of severe damage to your lungs. Therefore it makes sense from your point of view and that of your doctors to try and get a diagnosis as early as possible.

 

5) SIGNPOSTING

Whether you are a patient or carer, if you don’t know who to turn to – professional people like qualified nurses and specialist advisers who can help you with a range of both clinical and social issues.

a) SUPPORT IN THE COMMUNITY

Different organisations do have support groups to support everyone with lung disease and have COPD.  Groups provide mutual support often over tea or coffee as well as information in the form of talks from health care professionals and access to our leaflet library.

b) SELF-HELP OPPORTUNITIES 

Complementary therapies as the name suggests, are treatments which complement or work together with more mainstream therapies. They do not replace mainstream therapies. If you are thinking about using a complementary therapy you should always discuss it with your doctor or nurse first and keep taking your prescribed medication.

c) SIGNPOSTING OUTSIDE THE NHS 

There are a range of organisations outside the NHS that can help you if you are a patient or a professional with a wide variety of problems.  We know health problems are often accompanied by a range of other issues associated with things like housing, employment or family relationship problems.

 

6) ANXIETY AND DEPRESSION

Living with COPD can affect many aspects of your life. As well as physical symptoms it can also affect how you feel and how you cope so it is no surprise that many people feel anxious.

Having COPD can also affect your confidence. Whilst it is normal to feel sad or upset about how your life has been affected by COPD, it is important to try not to let yourself feel trapped by negative feelings because this can make it more difficult to cope with your illness.

 

7) PSYCHOLOGICAL ISSUES

Health care professionals need to recognise that patients with COPD and particularly those with co-morbidities require emotional and psychological support. Any effective COPD respiratory care pathway should allow for patients to be referred to appropriate psychological support services.

 

8) SELF-MANAGEMENT

For patients: it’s important to be able to manage your condition yourself and everyone is different, so your self-management plan needs to be individual to you. You should have the best information and educational materials about your condition available. Of course this needs to be relevant to the symptoms you are trying to manage, the medication you are using and the health and social care services you are accessing.

People with COPD: you should have an up-to-date, individually tailored care plan, which includes information and advice about your condition and how it will be managed, relevant to your stage of the disease.

 

9) KNOW YOUR NORMALS

Patients with COPD are usually best placed to know how they are feeling and when they are beginning to feel unwell. Patients who have previously suffered an exacerbation (or flare-up) are particularly likely to know when the onset of symptoms for a chest infection as a precursor to a flare-up occurs.  This is referred to by some of our patients as ‘knowing your normals’ or more importantly knowing when your ‘normal’ significantly changes.

Talk to your doctor about a prescription of ‘rescue medication’ and how best to use this as part of your self-management plan.

 

More BSL and subtitle videos are available at:

NHS Scotland - YouTube - Click here

Alzheimer’s Scotland (Action on Dementia)

What causes depression?

The exact cause of depression is unknown. For some people it can occur for no apparent reason. Others can pinpoint a trigger such as a difficult life event, a bad time in their past or some sort of trauma. It can sometimes run in families. Whatever the cause, it is important to remember that depression can be as debilitating an illness as cancer or diabetes.

 

Half of all people affected don't seek help

Estimates suggest nearly 1 in 5 of us will experience depression at some point in our lives. This means 1,250,000 people living in Scotland will be affected. Potentially 500,000 Scots are currently experiencing varying symptoms of depression and half of these will not have any help or support.

The World Health Organization predicts that depression will soon be the second biggest cause of ill health world-wide.

 

How can I tell I have depression?

Your doctor can professionally diagnose depression. They will talk to you about the signs and symptoms and they may also ask you further questions about your life and mood and how you are coping.

If you think you are affected, why not find out about the symptoms of depression and how depression can affect you on our website? If you notice some of these changes to your body, moods, emotions, or thoughts have been affecting you for longer than two weeks with no easily identifiable reason, It's a good idea to get help. The website will also help you find out more about how depression can be treated.

 

Depression affects each person in different ways but there are some common symptoms:

Do you recognise any of these symptoms in yourself or others?

• Feelings of hopelessness
  • Inadequacy
  • Anxiety
  • Self-hatred
  • Negativity
  • An inability to enjoy things which were once pleasurable in life
  • Guilt
  • Agitation
  • Weight loss or weight gain
  • Loss of energy or motivation
  • Loss of sex-drive
  • Disturbed sleep
  • Poor concentration, indecisiveness
  • Irritability, anger
  • Social withdrawal
  • Unexplained aches and pains
  • Self-harm
  • Recurring thoughts of death or suicide

 

Diagnosing depression

Everyone may experience some of the symptoms listed above from time to time. Doctors diagnose depression by looking at the persistence of symptoms and the extent to which they affect your daily life.

1. Are these feelings persistent, meaning that they never seem to go away and don’t change much from day to day, even when there isn’t any particular reason for feeling that way?

2. Do they interfere with your life, leaving you unable to enjoy things you normally like doing? In severe cases, depression can make normal everyday tasks like getting dressed or doing the shopping feel impossible?

 

Do you think you have depression?

If you notice that you have been experiencing some of these symptoms for over two weeks, that they are persistent and are interfering your work, study or home life, and you do not have any identifiable reason for feeling this way it is a good idea to see your GP.

 

Treating depression

The majority of people do recover from depression with support.

To recover from depression you need help and support that is going to work for you. There are a variety of different treatments and therapies for depression, and often people find that a combination of these works best.

There is no “golden rule” or “one size fits all” so what helps one person may not be the best treatment option for another. This is as true of medication as well as other therapies.

Do not give up if the first thing doesn’t work for you. Even if you think that your situation is hopeless, depression is treatable. There are many roads to get to the place of recovery.

In fact visiting this website is an important step in getting help for depression. Finding out what is available can help you make an informed choice about what might be best for you.

 

Treatment and support options for depression

These are some of the options available

• Talking to your GP
• Talking therapy
• Antidepressants
• Lifestyle changes
• Self-help
• Complementary therapies

Introduction

Glaucoma is a condition which can affect sight, usually due to build up of pressure within the eye.

Glaucoma often affects both eyes, usually to varying degrees. One eye may develop glaucoma quicker than the other.

The eyeball contains a fluid called aqueous humour which is constantly produced by the eye, with any excess drained though tubes.

Glaucoma develops when the fluid cannot drain properly and pressure builds up, known as the intraocular pressure.

This can damage the optic nerve (which connects the eye to the brain) and the nerve fibres from the retina (the light-sensitive nerve tissue that lines the back of the eye).

 

Types of glaucoma

There are four main types of glaucoma:

1. chronic open-angle glaucoma – this is the most common type of glaucoma and develops very slowly
2. primary angle-closure glaucoma – this is rare and can occur slowly (chronic) or may develop rapidly (acute) with a sudden, painful build-up of pressure in the eye
3. secondary glaucoma – this mainly occurs as a result of an eye injury or another eye condition, such as uveitis (inflammation of the middle layer of the eye)
4. developmental glaucoma (congenital glaucoma) – a rare but sometimes serious type of glaucoma which occurs in very young children, caused by an abnormality of the eye

 

Treating glaucoma

Glaucoma can be treated with eye drops, laser treatment or surgery. But early diagnosis is important because any damage to the eyes cannot be reversed. Treatment aims to control the condition and minimise future damage.

If left untreated, glaucoma can cause visual impairment. But if it's diagnosed and treated early enough, further damage to vision can be prevented.

 

Preventing glaucoma

Attending regular optician appointments will help to ensure any signs of glaucoma can be detected early and allow treatment to begin.

You are entitled to a free NHS eye test if you are over 40 years old and have a first-degree relative (mother, father, sister or brother) with glaucoma.

You may also be entitled to a free NHS eye test if:

• an ophthalmologist (eye specialist) thinks you are at risk of developing glaucoma
• you are over 60 years old

 

How common is glaucoma?

In England and Wales, it's estimated more than 500,000 people have glaucoma but many more people may not know they have the condition.

Chronic open-angle glaucoma affects up to two in every 100 people over 40 years old and around five in every 100 people over 80 years old.

You are also at increased risk of developing open-angle glaucoma if you are of black-African or black-Caribbean origin.

Some types of glaucoma, such as acute angle-closure glaucoma, are much less common. However, people of Asian origin are more at risk of getting this type of glaucoma compared with those from other ethnic groups.

High blood pressure (hypertension) means that your blood pressure is continually higher than the recommended level. It rarely has noticeable symptoms.

Around 30% of people in England have high blood pressure but many don't know it. If left untreated, high blood pressure increases your risk of a heart attack or stroke. It is often referred to as a "silent killer".

The only way of knowing there is a problem is to have your blood pressure measured.

All adults should have their blood pressure checked at least every five years. If you haven’t had yours measured, or you don’t know what your blood pressure reading is, ask your GP to check it for you.

What is high blood pressure?

Blood pressure is measured in millimetres of mercury (mmHg) and is recorded as two figures:

systolic pressure – the pressure of the blood when your heart beats to pump blood out

diastolic pressure – the pressure of the blood when your heart rests in between beats, which reflects how strongly your arteries are resisting blood flow

For example, if your GP says your blood pressure is "140 over 90", or 140/90mmHg, it means you have a systolic pressure of 140mmHg and a diastolic pressure of 90mmHg.

You are said to have high blood pressure (medically known as hypertension) if readings on separate occasions consistently show your blood pressure to be 140/90mmHg or higher.

A blood pressure reading below 130/80mmHg is considered to be normal.

Who is most at risk?

Your chances of having high blood pressure increase as you get older. There is often no clear cause of high blood pressure but you are at increased risk if you:

• are overweight
• have a relative with high blood pressure
• smoke
• are of African or Caribbean descent
• eat too much salt
• don't eat enough fruit and vegetables
• don't do enough exercise
• drink too much coffee (or other caffeine-based drinks)
• drink too much alcohol
• are aged over 65

If you fall into any of the groups listed above, consider making changes to your lifestyle to lower your risk of high blood pressure. Also consider having your blood pressure checked more often, ideally about once a year.

Prevention and treatment

You can take steps to prevent high blood pressure by:

• losing weight if you need to
• reducing the amount of salt you eat
• exercising regularly
• eating a healthy diet
• cutting back if you drink too much alcohol
• stopping smoking
• cutting down on caffeine

Find out more about how to prevent high blood pressure

If your blood pressure is found to be high, it will need to be closely monitored until it is brought under control. Your doctor will usually suggest changes to your lifestyle and, sometimes, medication to achieve this. Find out more about how blood pressure is treated.

Myalgia means muscle pain and encephalomyelitis means inflammation of the brain and spinal cord.

Chronic fatigue syndrome (CFS) causes persistent fatigue (exhaustion) that affects everyday life and doesn't go away with sleep or rest.

Both CFS and ME are commonly used terms.

Sometimes the term 'myalgic encephalopathy' is used. Encephalopathy means a condition that affects brain function.

CFS is a serious condition that can cause long-term illness and disability, but many people – particularly children and young people – improve over time.
What is M.E.?

M.E. is a long-term (chronic) fluctuating illness that causes symptoms affecting many body systems, more commonly the nervous and immune systems. Many people will seek medical advice at some time because they experience persistent fatigue or pain. However, M.E. is characterised by a range of additional symptoms which can significantly affect your ability to live a normal life.
What are the symptoms?

Symptoms vary but may include persistent exhaustion (‘fatigue’), muscle and/or joint pain, sleep disturbance, ‘flu-like symptoms such as headache, sore throat, painful lymph nodes, dizziness and/or nausea and problems with memory and concentration.
Who does M.E. affect?

Men, women and children of all ages and of all social and ethnic backgrounds can develop M.E., although it is most common in women aged 25-50. It is thought that around 250,000 people in the UK have the illness.
What causes M.E?

We don’t fully understand what causes the illness. There are likely to be a number of factors involved. It sometimes affects more than one family member. The reasons are being studied but it seems your genetic make-up can play a part, as can the influence of your environment. There is evidence that certain infections can trigger M.E. Many are viruses but M.E. can be triggered by other types of infection. Many of the infections which trigger M.E. seem to be ordinary flu-like infections, from which some people don’t recover in the normal way.
How is M.E. diagnosed?

There is no medical laboratory test currently available to detect M.E. Doctors diagnose the illness by assessing your medical history, recognising the typical symptom pattern of M.E. and conducting basic tests, for example on blood or urine samples, to rule out other conditions. Many illnesses can sound quite similar in their symptoms and excluding other conditions is a usual part of the process of reaching a diagnosis.

You may need to make several visits to your doctor before a final diagnosis is made. A provisional diagnosis should be made as early as possible.

NHS guidelines say a diagnosis should be made in adults if symptoms have lasted four months and other diagnoses have been excluded. In children or young people, diagnosis should be made (or confirmed by a paediatrician) after three months.

The earlier that your illness is recognised, the sooner you can begin to manage and treat your symptoms.
How is M.E. treated and managed?

There are no wonder drugs or treatments that can cure M.E. but there are many approaches open to you and your doctor that can make a difference to how you feel and give you back control over your situation.

In 2007, the National Institute for Health and Clinical Excellence (NICE) published a clinical guideline on the diagnosis and management of CFS/M.E. for NHS healthcare professionals in England and Wales. The guideline is available via links on our Online M.E. Centre at www.actionforme.org.uk or directly from NICE at www.nice.org.uk

In Scotland, NHS Scotland has produced a Good Practice Statement for healthcare professionals, Quick Reference Guide for GPs and leaflet for patients, facilitated by Action for M.E. These documents are available on the NHS Scotland website www.show.scot.nhs.uk and via our Online M.E. Centre at www.actionforme.org.uk

It is important to establish a relationship with your doctor so that you can discuss all the management approaches available and ‘problem solve’ any issues together.

People with M.E. respond to treatment in different ways and what works for someone else may not be helpful for you, even if you share the same symptoms.

It is important to adopt one approach or make one change at a time, to find out what works for you.

If left untreated, symptoms such as pain, sleep difficulties and mood problems can take over your life and get in the way of recovery.

Your doctor and other healthcare professionals can treat and prevent symptoms by prescribing medication and perhaps suggesting changes in your lifestyle. NHS guidelines highlight cognitive behaviour therapy (CBT) and graded exercise therapy (GET), which were recently studied in the PACE trial.

You will also discover tactics for yourself as you understand more about how M.E. is affecting your body.

You are the best judge of how you feel, so don’t be afraid to discuss your treatment with your doctor, especially if you think it isn’t working. Each different approach takes time to work, so be patient and don’t expect results immediately.

It may take some time to find the regime that suits you best, particularly as people with M.E. are thought to be more prone to side effects. It is advisable that drugs are started at lower doses than would normally be prescribed, to minimise side effects.

Our booklet, All about M.E., contains detailed information about what is available, including chapters for people who have particular difficulties with pain, sleep disruption or mood problems such as anxiety or depression.
When will I get better?

People with M.E. can vary enormously in their experience of the illness, and also how long their symptoms last.

Many people make good progress quite quickly, while others can remain ill for a number of years. Most people improve over time, especially with treatment. For many, the illness fluctuates, with periods of remission and relapse. A small minority are severely affected (bedbound or housebound) for a long time.

People often find that they don’t go back completely to the way they felt before they became ill – but they do recover sufficiently and/or learn to manage their symptoms well enough to lead happy and fulfilling lives. This is similar to many other chronic illnesses.

Treatment (symptom management) can help by reducing symptoms and making the experience of illness much less unpleasant in the short term. More importantly, rehabilitative approaches that are suited to your level of severity can maximise the chances of recovery and the rate at which it happens, as well as reducing the risk of setbacks and relapses.

Hold on to hope, but be prepared in case the illness does last a long time.

Factors that can hold back recovery M.E. can be an extremely frustrating illness, particularly as the intensity of the different symptoms can fluctuate. Managing M.E. requires patience and self-control.

On good days, you will naturally want to do more – but do too much and 24 hours or more later, you may find yourself in a relapse from which recovery will seem painfully slow. This pattern is called ‘boom and bust.’ If it becomes the norm it can be very distressing and it can undermine your confidence.

There are also strong indications that this pattern can prolong the illness.

It is important to get to know your limits and to set yourself small, realistic goals for getting better. This may mean that initially you have to reduce your overall activity levels so that you can achieve a routine that you can sustain. You will achieve more by working within your limits and increasing activities very gradually, than by pushing the boundaries all the time. There are many small changes you can make on a daily basis that will improve your health in the long term.

The key to managing your illness is to ‘pace’ your physical and mental (including emotional) activity – to strike a balance between activity and rest and to make any changes in your routine small and gradual.

In the early stages of the illness in particular, or during a relapse, adequate rest may be necessary and helpful. It is important to think about the quality of your rest, not just the quantity. Many people with M.E. find it difficult to relax and therefore do not get the full benefit from their rest periods.

However, while rest is very important, doing too little or being totally inactive can be harmful. Prolonged inactivity can cause muscle wasting and weakness, making it even harder for you to perform everyday tasks. Some gentle activity, according to your limits, is important.

Find out about pacing in our Online M.E. Centre at www.actionforme.org.uk or request a copy of our booklet, Pacing for people with M.E.
Relapses and setbacks

During your illness you may experience periods of better health or well-being, but there may also be times when your health deteriorates.

Having a relapse or setback is not uncommon at some stage. Relapses can be mild or severe and can happen for many reasons, but often because of trying to do too much.

You will need to make changes in your daily routine to manage any setbacks.

Most importantly, you need to understand what is happening and to have a plan of what to do. Don’t be disheartened by these hiccups in your progress. Some people say that they experience relapses throughout their recovery but that over time they get shorter or less severe through learning ways to manage them better.

Just as a small step forward in your health doesn’t guarantee that you will immediately get better, a relapse doesn’t have to mean that the course of your illness is on a downward curve. It could be just a blip!
M.E. checklist

1. Learn to manage your energy and physical, mental and emotional activities. Become an expert at managing your illness and stay in control.
2. Deal with the major symptoms that can take over your life, such as pain, sleep disturbance and low mood. Uncontrolled symptoms can get in the way of recovery. Your doctor can help you to manage these with medication. Other strategies can also be helpful, such as pacing your activities, relaxation techniques and complementary therapies.
3. Establish a relationship with your GP. This can take time and in some cases may be difficult, but the partnership between you and your GP can be crucial to stabilising your illness and enabling recovery.
4. Remember that people do recover from M.E. Learn to recognise and accept your illness and recovery is more likely to follow in time.
5. You are not alone. An estimated 250,000 people in the UK have this illness.

To get information and support join Action for M.E. online at: www.actionforme.org.uk or by calling 0845 123 2380.
Useful contacts

Action for M.E.:
Information and support for people with M.E. and their careers
General enquiries: 0845 123 2380 or 0117 927 9551 (Mon-Fri 9am-5pm)
Enquiries email: admin@actionforme.org.uk

Welfare Rights Line: 0845 122 8648 (times vary)

Online M.E. Centre: www.actionforme.org.uk

Association of Young People with M.E. (AYME):
Information, advice and support for people with M.E. under 26 and their families
Helpline: 08451 232389 (Mon-Fri 10am-2pm)
Website: www.ayme.org.uk

Carers UK:
A charity for carers, led by carers
Advice line: 0808 808 7777
E-mail: adviceline@carersuk.org
Website: www.carersuk.org

Carers Direct:
Information, advice and support for carers via the NHS
Helpline 0808 802 0202
Website: www.nhs.uk/Carersdirect

If you have found the information in this factsheet helpful, please consider making a donation to Action for M.E. at www.actionforme.org.uk or by calling 0845 123 2380 or 0117 927 9551.

Thank you.

Introduction

Motor Neurone Disease (MND) is a rare condition that progressively damages parts of the nervous system. This leads to muscle weakness, often with visible wasting.

Motor neurone disease, also known as amyotrophic lateral sclerosis (ALS), occurs when specialist nerve cells in the brain and spinal cord called motor neurones stop working properly. This is known as neurodegeneration.

Motor neurones control important muscle activity, such as:

• gripping
• walking
• speaking
• swallowing
• breathing

As the condition progresses, people with motor neurone disease will find some or all of these activities increasingly difficult. Eventually, they may become impossible.

It's not clear what causes motor neurones to stop working properly. In about 5% of cases there's a family history of either motor neurone disease or a related condition called front temporal dementia. This is known as familial motor neurone disease. In most of these cases, faulty genes have been identified as making a major contribution to the development of the condition.

There's no single test to diagnose motor neurone disease and diagnosis is based mainly on the opinion of a brain and nervous system specialist (a neurologist). The diagnosis of motor neurone disease is usually clear to an experienced neurologist, but sometimes specialised tests are needed to rule out other conditions with similar features.

Read more about the causes of motor neurone disease and diagnosing motor neurone disease.

 

Progression of symptoms

The symptoms of motor neurone disease begin gradually over weeks and months, usually on one side of the body initially, and get progressively worse.

Common early symptoms include:

• a weakened grip, which can cause difficulty picking up or holding objects
• weakness at the shoulder that makes lifting the arm difficult
• a "foot drop" caused by weak ankle muscles dragging of the leg
• slurred speech (dysarthria)

The condition isn't usually painful.

As damage progresses, symptoms spread to other parts of the body and the condition becomes more debilitating.

Eventually, a person with motor neurone disease may be unable to move. Communicating, swallowing and breathing may also become very difficult.

In up to 15% of cases, motor neurone disease is associated with a type of dementia that can affect personality and behaviour. This is called front temporal dementia, and is often an early feature when it occurs in motor neurone disease. The affected person may not realise that their personality or behaviour is different.

 

Who's affected by motor neurone disease?

Motor neurone disease is a rare condition that affects around two in every 100,000 people in the UK each year. There are about 5,000 people living with the condition in the UK at any one time.

The condition can affect adults of all ages, including teenagers, although this is extremely rare. It's usually diagnosed in people over 40, but most people with the condition first develop symptoms in their 60s. It affects slightly more men than women.

 

Treating motor neurone disease

There's currently no cure for motor neurone disease. Treatment aims to:

• Make the person feel comfortable and have the best quality of life possible
• Compensate for the progressive loss of bodily functions such as mobility, communication, swallowing and breathing
• For example, a breathing mask can greatly help the symptoms of breathing and weakness, and a feeding tube (called a gastrostomy) helps maintain nutrition and overall comfort. If necessary, medication can be used to help control excessive drooling.
• A medication called riluzole has shown a very small improvement in patients' overall survival, but it isn't a cure and doesn't stop the condition progressing.

 

Survival rates

Motor neurone disease is a severely life-shortening condition for most people. Life expectancy for about half of those with the condition is three years from the start of symptoms. However, some people may live for up to 10 years, and in rarer circumstances even longer.

Living with motor neurone disease is extremely challenging and often a terrifying possibility before the diagnosis is made. However, it's not necessarily as bleak as people imagine.

With strong community and specialist support, many people can maintain some independence for a significant part of the condition's course, and experience a quality of life they may not have imagined was possible at the time of their diagnosis.

The end of life for someone with motor neurone disease isn't usually distressing and is most often in their own home. In most cases, a person with the condition will die in their sleep as the end stage of gradual weakness in their breathing muscles. Although some people with the condition will have swallowing problems, they won't choke to death.

 

Advice and support

The Motor Neurone Disease Association (MNDA) is the leading UK charity for people affected by the condition.

The MNDA can give you information, practical advice and support about living with motor neurone disease and coping with the emotional impact of being diagnosed.

Multiple sclerosis (MS) affects nerves in the brain and spinal cord, causing a wide range of symptoms including problems with muscle movement, balance and vision.

Each nerve fibre in the brain and spinal cord is surrounded by a layer of protein called myelin, which protects the nerve and helps electrical signals from the brain travel to the rest of the body. In MS, the myelin becomes damaged.

This disrupts the transfer of these nerve signals, causing a wide range of potential symptoms, such as:

• loss of vision – usually only in one eye
• spasticity – muscle stiffness that can lead to uncontrolled muscle movements
• ataxia – difficulties with balance and co-ordination
• fatigue – feeling very tired during the day

Types of multiple sclerosis

Around eight out of 10 people with MS are diagnosed with the relapsing remitting type of MS.

Someone with relapsing remitting MS will have flare-ups of symptoms, known as relapses. These can last from a few days to a few months.

These will be followed by periods where symptoms are mild or disappear altogether. This is known as remission and can last for days, weeks or sometimes months.

Usually after around 15 years, around half of people with relapsing remitting MS will go on to develop secondary progressive MS.

In secondary progressive MS, symptoms gradually worsen over time. Some people may still have relapses, but without full recovery from symptoms.

The least common form of MS is primary progressive MS. In this type, symptoms gradually get worse over time and there are no periods of remission.
Treatment

There is currently no cure for MS but there are a number of treatments that can help.

Relapsing remitting MS can be treated with disease-modifying drugs. These are designed to reduce the number of relapses someone has. They may also be able to slow the progression of MS. But they are not suitable for all people with MS.

Some of these drugs can also be used for treating secondary progressive MS, if someone is still experiencing relapses.

At the moment, there is no treatment that can slow the progress of primary progressive MS.

There are also a wide range of treatments, including physiotherapy, that can help relieve symptoms and make day-to-day living easier. Steroids can also be used to speed up recovery from relapses.
Causes

MS is known as an autoimmune condition. This is where something goes wrong with the immune system (the body’s defence against infection) and it mistakenly attacks healthy body tissue – in this case, the myelin covering of nerves.

This can cause multiple sections of the brain and spinal column to become damaged and hardened (sclerosis), which can disrupt the nerve signals passing through these areas.

Exactly what causes the immune system to act in this way is unclear, but most experts think a combination of genetic and environmental factors are involved.
Who is affected

It is estimated that there are currently around 100,000 people with MS in the UK.

MS is most commonly diagnosed in people aged 20-40, although it can happen at any age. Children can also get MS, although this is rare.

For reasons that are unclear, MS is three times as common in women than men, and more common in white people than black and Asian people.
Outlook

MS can be a challenging and frustrating condition to live with but new treatments over the past 20 years have considerably improved the quality of life of people with the condition.

MS is not fatal, but some complications that can arise from severe MS, such as pneumonia, can be.

As a result, the average life expectancy for people with MS is around five to 10 years lower than the population at large. This gap appears to be getting smaller, perhaps because of improved medical care.
Symptoms of multiple sclerosis 

The central nervous system (brain and spinal cord) controls all of your body's actions. When MS damages the myelin coating around the nerve fibres that carry messages to and from your brain, symptoms can occur in any part of your body.

There are many different symptoms of MS and they affect each person differently. Some of the most common symptoms include:

• extreme tiredness (fatigue)
• numbness and tingling
• blurring of vision
• problems with mobility and balance
• muscle weakness and tightness

Most people with MS only have a few of these symptoms and it is unlikely someone would develop all possible symptoms.

The symptoms are unpredictable. Some people's MS symptoms develop and increase steadily over time, while for others, they come and go periodically.

These periods when symptoms get worse are known as relapses. Periods when symptoms improve or disappear are known as remissions.
Visual problems

In around one in five cases of MS, the first noticeable symptom is problems with one of your eyes. You may experience:

• some loss of vision in the affected eye – this can range from mild to severe (total loss of vision occurs in one in 35 cases)
• colour blindness
• eye pain; usually made worse when moving the eye
• flashes of light when moving the eye

These symptoms are the result of optic neuritis, which is inflammation (swelling) of the optic nerve that transmits visual information to the brain. This normally only affects one eye.

Other visual problems that can occur in MS include:

• double vision
• eye pain in both eyes
• involuntary eye movements (usually from side to side), known as nystagmus

Abnormal sensations

Abnormal sensations can also be a common initial symptom of MS. This can take the form of numbness or tingling in different parts of your body.

Muscles in your arms and legs may also feel unusually weak.
Muscle spasms and spasticity

If messages between your brain and muscles are disrupted, this can cause problems with muscle movements. It can cause muscles to contract tightly and painfully (spasm) or your muscles may also become stiff and resistant to movement, known as spasticity.
Pain

Around half of people with MS experience pain, which can take two forms:

• Neuropathic pain – caused by damage to the nerve fibres in the brain and spinal cord. It can be a stabbing pain, extreme skin sensitivity, or a burning sensation.
• Musculoskeletal pain – this is not caused directly by MS, but can occur if there is excess pressure on muscles or joints as a result of spasms and spasticity.

Mobility problems

MS can affect balance and co-ordination. It can make walking and moving around difficult, particularly if you also have muscle weakness and spasticity. You may experience:

• ataxia – difficulty with co-ordination
• tremor – shaking of the limbs, which is rare, but can be severe
• dizziness and vertigo can happen late on and can make you feel as if your surroundings are spinning

Extreme tiredness (fatigue)

Feeling extremely tired (fatigue) is a common symptom of MS that many people describe as one of the most troublesome.

It is estimated that as many as nine out of 10 people with MS will experience episodes of fatigue.

People with MS have reported feeling an overwhelming sense of weariness where even the most simple physical or mental activity seems to be a tremendous struggle to carry out.

Fatigue may be worse in hot weather, after exercising, or during illness.
Problems with thinking, learning and planning

Around half of people with MS have problems with thinking, learning and planning (known as cognitive dysfunction). They may experience:

• problems understanding and using language
• a shortened attention span
• problems learning and remembering new things (long-term memory is usually unaffected)
• problems understanding and processing visual information, such as reading a map
• difficulty with planning and problem solving – people often report that they know what they want to do, but can’t grasp the method of how to do it
• problems with reasoning, such as mathematical laws or solving puzzles

Mental health issues

Around half of all people with MS experience at least one episode of depression at some point in their life.

It is unclear whether the depression arises from the damage to the brain caused by MS, or due to the stress of having to live with a long-term condition, or both.

Anxiety can also be a problem for people with MS, possibly due to the unpredictable nature of the condition.

Some people with MS can sometimes experience rapid and severe mood swings, suddenly bursting into tears, laughing or shouting angrily for no apparent reason.
Sexual problems

MS can have an effect on sexual function.

Men with MS often find it hard to obtain or maintain an erection (erectile dysfunction). They may also find it takes a lot longer to ejaculate when having sex or masturbating, and may even lose the ability to ejaculate altogether.

For women, problems include difficulty reaching orgasm as well as decreased vaginal lubrication and sensation.

Both men and women with MS may find they are less interested in sex than they were before. This could be directly related to the MS, or it could be the result of living with the condition.

Bladder problems

Bladder problems are common in MS.

They may include:

• difficulty emptying the bladder completely
• having to urinate more frequently
• having a sudden, urgent need to urinate which can lead to unintentionally passing urine (urge incontinence)
• having to get up frequently during the night to pass urine (nocturia)

Bowel problems

Many people with MS have problems with their bowel.

Constipation is the most common problem, affecting around half of people with MS. They may pass stools much less frequently than normal, and find this difficult.

Bowel incontinence is less common but is often linked to constipation. If a stool becomes stuck, it can irritate the wall of the bowel, causing it to produce more fluid and mucus that can leak out of the anus (back passage).
Speech and swallowing difficulties

Around a third of people with MS experience difficulty chewing or swallowing (dysphagia) at some point. In some cases, speech may also become slurred, or difficult to understand.

However, for most people with MS, speech and swallowing symptoms are mild and only last for a few minutes at a time. They are often at their worst during a relapse.
Causes of multiple sclerosis 

The exact reason why someone develops multiple sclerosis (MS) is not known. What is known so far suggests it is caused by a combination of environmental and genetic factors.
Autoimmune condition

MS is an autoimmune condition. This means your immune system mistakes the myelin for a foreign substance and attacks it. The myelin becomes inflamed in small patches (called plaques or lesions), which can be seen on an MRI scan.

This can disrupt the messages travelling along nerve fibres. It can slow them down, jumble them, send them down a different nerve fibre, or stop them from getting through completely.

When the inflammation goes away, it can leave behind scarring of the myelin sheath (known as sclerosis). These attacks can eventually start to destroy the myelin sheath (demyelination), which can damage the underlying nerve fibre.
Why do people develop multiple sclerosis?

It is not understood what causes the immune system to attack myelin, although there are several theories. Most experts agree that MS is probably caused by a combination of genetic and environmental factors. This means it's partly caused by genes you inherit from your parents and partly caused by outside factors that may trigger the condition.
Genetic factors

MS is not defined as a genetic condition because there is no single gene that causes it. It's not directly inherited, although research has shown people who are related to someone with MS are more likely to develop it.

Researchers have found that if one twin develops MS then the second twin has around a one in four chance of also developing MS.

The chance of a brother, sister or child of a person with MS also developing MS themselves is less than one in 30.

It's possible that different combinations of genes make developing MS more likely, and research into this is continuing. However, genetic theories cannot explain the wide variation in occurrences of MS throughout the world.
Sunlight and vitamin D

Research into MS around the world has shown that it's more likely to occur in countries far from the equator. For example, MS is relatively common in the UK, North America and Scandinavia, but rare in Malaysia or Ecuador.

It’s possible that people living further from the equator are exposed to less sunlight and, therefore, have less vitamin D in their bodies. Some studies have found a link between lower levels of vitamin D and incidence of MS.

Some researchers have suggested that vitamin D supplements may reduce the risk of MS. However, this has not been proven.
Smoking

Smoking is another factor that appears to increase someone’s risk of developing MS. It is not yet clear exactly why this is, although one theory is that the chemicals in the cigarette smoke affect the immune system.
Viral infection

Another theory is that a virus may be involved in the development of MS. The Epstein-Barr virus (EBV) has been the subject of most of the current studies.

MS is thought to be an autoimmune condition, where the body's own immune system attacks healthy tissue. One possible explanation is that a virus might cause a strong response from the immune system, which leads it to target healthy parts as well as the virus.

More research is needed to further understand how EBV may increase the risk of developing MS.
Diagnosing multiple sclerosis 

If you have unexplained symptoms that are similar to those of multiple sclerosis (MS), see your GP. If your GP suspects MS, they will ask you for a detailed medical history, including past signs and symptoms as well as the current state of your health.

Your GP can refer you to a neurologist (a specialist in conditions of the central nervous system).

If your GP suspects MS, you should see a neurologist within six weeks.

Read more about waiting times in the NHS.
Diagnostic tests

Diagnosing MS is complicated because no single laboratory test can positively diagnose it.

Several conditions have symptoms similar to those of MS, so your neurologist may rule them out first.

It may also not be possible to confirm a diagnosis if you have had only one ‘attack’ of MS-like symptoms. A diagnosis can usually only be made with confidence once there is evidence of at least two separate attacks.

To confirm MS, your neurologist may carry out a number of tests.
Neurological examination

Your neurologist will look for changes or weakness in your eye movements, leg or hand co-ordination, balance, speech and reflexes. This will show whether your nerve pathways are damaged.
Magnetic resonance imaging (MRI) scan

An MRI scan creates a detailed image of your brain and spinal cord.

MRI scans can show whether there is any damage or scarring of the myelin in your central nervous system. The results of the MRI scan confirm a diagnosis in over nine out of 10 people who have MS.

The procedure is painless and usually takes between 10 and 30 minutes. A standard MRI scanner is like a giant tube or tunnel. You may feel claustrophobic when going into the tunnel and the machine is noisy.

Tell your neurologist if you have any concerns about this experience.
Evoked potentials test

An evoked potentials test involves placing small electrodes on your head. These monitor how your brain waves respond to what you see and hear. It is painless and can show whether it takes your brain longer than normal to receive messages.
Lumbar puncture

A lumbar puncture is also sometimes called a spinal tap. A sample of your cerebrospinal fluid (the fluid that surrounds your brain and spinal cord) is taken using a needle inserted into the area around your spinal cord.

This is done under local anaesthetic, which means that you will be awake, but the area the needle goes into will be numbed. The sample is tested for antibodies, the presence of which means that your immune system has been fighting a disease in your central nervous system.

A lumbar puncture is usually only needed if other tests for MS are inconclusive.
Blood tests

Blood tests are usually performed to rule out other causes of your symptoms, such as vitamin deficiencies. In addition, antibody tests may be required, for example to rule out a very similar condition called neuromyelitis optica (NMO).
Diagnosing the different types of multiple sclerosis

Once a diagnosis of MS has been made, your neurologist may be able to identify which type of MS you have.

However, this often only becomes clear over time as the symptoms of MS are so varied and unpredictable.

A diagnosis of relapsing remitting multiple sclerosis (RRMS) may be made if:

• you have two relapses of your symptoms more than 30 days apart
• you have one relapse and an MRI scan shows new myelin damage or scarring three months later

A diagnosis of secondary progressive multiple sclerosis (SPMS) may be made if:

• you have had relapses of your symptoms in the past
• you have become steadily more disabled for at least six months, with or without relapses

MS never starts out as secondary progressive. However, it is possible for someone to be told they have this type if they have had unexplained symptoms for some time.

A diagnosis of primary progressive multiple sclerosis (PPMS) may be made if you have had no previous relapses of your symptoms, and:

• you have become steadily more disabled for at least one year
• an MRI scan shows damage and scarring to myelin
• a lumbar puncture shows antibodies in the fluid surrounding your brain and spinal cord

In rare cases, some people with primary progressive multiple sclerosis can have relapses. This can make it even harder to clearly identify what type of MS they have.
Treating multiple sclerosis 

The National Institute for Health and Care Excellence (NICE) has published a clinical guideline for MS.

The guideline provides comprehensive evidence-based information on the benefits and limitations of various methods of diagnosing, treating and caring for people with MS. This helps health professionals and patients decide on the most appropriate treatment.

The NICE guideline states that if you have MS, you should have access to a specialist neurological rehabilitation team. This is because MS is a complex disorder that can impact on many aspects of your life so you will need to receive treatments from a number of different health professionals working together.

Members of your care team may include:

• a neurologist (a specialist in treating conditions that affect the nervous system)
• a physiotherapist
• a speech and language therapist
• an occupational therapist
• a continence adviser
• a psychologist
• a social worker
• a pharmacist
• a specialist MS nurse who will often serve as a point of contact

You should have a way of contacting your team, for example by calling an MS specialist nurse. You should have someone who gives you reliable information about MS and its symptoms and treatments, and the wider issues that can affect people with MS and their family or carers.
Living with multiple sclerosis 

A diagnosis of MS is life changing. You may need long-term treatment to control your symptoms and you may have to adapt your daily life.
Self-care

Self-care is an integral part of daily life. It means you take responsibility for your own health and wellbeing, with support from people involved in your care. Self-care includes the things you do each day to stay fit, maintain good physical and mental health, prevent illness or accidents, and effectively deal with minor ailments and long-term conditions. People living with long-term conditions can benefit enormously if they receive support for self-care. They can live longer, have less pain, anxiety, depression and fatigue, have a better quality of life, and be more active and independent.
Regular reviews

Because MS is a long-term condition, you'll be in regular contact with your healthcare team. A good relationship with the team means you can easily discuss your symptoms or concerns. The more the team knows, the more they can help you.
Keeping well

Everyone with a long-term condition such as MS is encouraged to get a flu jab each autumn to protect against flu (influenza). It's also recommended that they get an anti-pneumoccocal vaccination. This is a one-off injection that protects against a specific serious chest infection called pneumococcal pneumonia.
Healthy eating and exercise

Regular exercise and a healthy diet are recommended for everyone, not just people with MS. They help prevent many conditions, including heart disease and many forms of cancer. Try to eat a balanced diet, containing all the food groups, to give your body the nutrition it needs. Exercising regularly can help relieve stress and reduce fatigue.

A migraine is usually a severe headache felt as a throbbing pain at the front or side of the head.

Some people also have other symptoms, such as nausea, vomiting and increased sensitivity to light or sound.

Migraine is a common health condition, affecting around one in every five women and around one in every 15 men. They usually begin in early adulthood.

There are several types of migraine, including:

• migraine with aura – where there are warning signs before the migraine begins, such as seeing flashing lights
• migraine without aura – where the migraine occurs without warning signs
• migraine aura without headache, also known as silent migraine – where an aura or other migraine symptoms are experienced, but a headache does not develop

Some people have migraines frequently, up to several times a week. Other people only have a migraine occasionally. It is possible for years to pass between migraine attacks.

 

When to seek medical advice

You should see your GP if you have frequent or severe migraine symptoms that cannot be controlled with over the counter painkillers.

You should also make an appointment to see your GP if you have frequent migraines (on more than five days a month), even if they can be controlled with medication, as you may benefit from preventative treatment.

You should call 999 for an ambulance immediately if you or someone you are with experiences:

• paralysis or weakness in one or both arms and/or one side of the face
• slurred or garbled speech
• a sudden agonising headache resulting in a blinding pain unlike anything experienced before
• headache along with a high temperature (fever), stiff neck, mental confusion, seizures, double vision and a rash

These symptoms may be a sign of a more serious condition, such as a stroke or meningitis, and should be assessed by a doctor as soon as possible.

 

What causes migraines?

The exact cause of migraines is unknown, although they are thought to be the result of temporary changes in the chemicals and blood vessels in the brain.

Around half of all people who experience migraines also have a close relative with the condition, suggesting that genes may play a role.

Some people find migraine attacks are associated with certain triggers, which can include starting their period, stress, tiredness and certain foods or drinks.

 

How migraines are treated

There is no cure for migraines, but there are a number of treatments available to help reduce the symptoms.

These include:

• painkillers – including over the counter medicationssuch as paracetamol and ibuprofen
• triptans – medications that can help reverse the changes in the brain that may cause migraines
• anti-emetics – medications often used to reduce nausea and vomiting
• During an attack, many people find that sleeping or lying in a darkened room can also help.

 

Preventing migraines

If you suspect a specific trigger is causing your migraines, such as stress or a certain type of food, avoiding this trigger may help reduce your risk of experiencing migraines.

It may also help to maintain a generally healthy lifestyle, including regular exercise, sleep and meals, as well as ensuring you stay well hydrated and limiting your intake of caffeine and alcohol.

If your migraines are severe or you have tried avoiding possible triggers and you are still experiencing symptoms, your GP may prescribe medication to help prevent further attacks.

Medications used to prevent migraines include the anti-seizure medication topiramate and a medication called propranolol that is usually used to treat high blood pressure.

Obsessive compulsive disorder (OCD) is a mental health condition where a person has obsessive thoughts and compulsive activity.

An obsession is an unwanted and unpleasant thought, image or urge that repeatedly enters a person's mind, causing feelings of anxiety, disgust or unease.

A compulsion is a repetitive behaviour or mental act that someone feels they need to carry out to try to temporarily relieve the unpleasant feelings brought on by the obsessive thought.

For example, someone with a fear of their house being burgled may feel they need to check all the windows and doors are locked several times before they can leave the house.

OCD symptoms can range from mild to severe. Some people with OCD may spend an hour or so a day engaged in obsessive-compulsive thinking and behaviour, but for others the condition can completely take over their life.

What causes OCD?

It's not clear exactly what causes OCD, although a number of factors have been suggested.

In some cases the condition may run in families, and may be linked to certain inherited genes that affect the brain's development.

Brain imaging studies have shown the brains of some people with OCD can be different from the brains of people who do not have the condition.

For example, there may be increased activity in certain areas of the brain, particularly those that deal with strong emotions and the responses to them.

Studies have also shown people with OCD have an imbalance of serotonin in their brain. Serotonin is a chemical the brain uses to transmit information from one brain cell to another.

Who is affected?

It's estimated around 12 in every 1,000 people in the UK are affected by the condition. This equates to almost 750,000 people.

OCD affects men, women and children. The condition typically first starts to significantly interfere with a person's life during early adulthood, although problems can develop at any age.

Getting help

People with OCD are often reluctant to seek help because they feel ashamed or embarrassed.

However, if you have OCD, there is nothing to feel ashamed or embarrassed about. It is a long-term health condition like diabetes or asthma, and it is not your fault you have it.

Seeking help is important because it is unlikely your symptoms will improve if left untreated, and they may get worse.

You should visit your GP if you think you may have OCD. Initially, they will probably ask a number of questions about your symptoms and how they affect you.

If your GP suspects OCD, you may need to be referred to a specialist for an assessment and appropriate treatment.

How OCD is treated

With treatment, the outlook for OCD is good. Many people will eventually be cured of their OCD, or their symptoms will at least be reduced enough that they can enjoy a good quality of life.

The main treatments for OCD are:

cognitive behavioural therapy (CBT) – involving a therapy known as graded exposure with response prevention (ERP), which encourages you to face your fear and let the obsessive thoughts occur without "neutralising" them with compulsions

selective serotonin reuptake inhibitors (SSRIs) – this medication can help reduce your symptoms by altering the balance of chemicals in your brain

If these treatments aren't effective or your condition is particularly severe, you may need to be referred to a specialist mental health service for treatment.

Around 8,800 people are diagnosed with pancreatic cancer in the UK each year, making it the 11th most common cancer.

Cancer of the pancreas is more common in older people, with about half of all new cases diagnosed in people who are aged 75 or over. It's uncommon in people under 40 years of age.

Pancreatic cancer affects men and women equally.

 

The pancreas

The pancreas is a large gland that's part of the digestive system. It's about 15cm (six inches) long, and is located high in the abdomen, behind the stomach, where the ribs meet at the bottom of the breastbone.

The pancreas produces:

• digestive enzymes – which break down food so it can be absorbed into the body
• hormones – including insulin, which helps keep your blood sugar levels stable

 

Pancreatic cancer

In the early stages, a tumour in the pancreas doesn't usually cause any symptoms, which can make it difficult to diagnose.

The first noticeable symptoms of pancreatic cancer are often:

• pain in the back or stomach area
• unexpected weight loss
• jaundice (yellowing of the skin and whites of the eyes)

It's important to remember that these symptoms can be caused by many different conditions, and aren't usually the result of cancer. However, you should contact your GP if you're concerned, or if these symptoms start suddenly.

Read more about the symptoms of pancreatic cancer.

 

Causes of pancreatic cancer

It's not fully understood what causes pancreatic cancer, but risk factors for developing the condition have been identified.

Risk factors for pancreatic cancer include:

• age – it mainly affects people who are 50-80 years of age
• smoking
• having a history of other health conditions – such as diabetes, chronic pancreatitis (long-term inflammation of the pancreas), stomach ulcer and Helicobacter pylori infection (a stomach infection)

Read more about the causes of pancreatic cancer.

Diagnosing pancreatic cancer

Your GP will ask about your general health and carry out a physical examination.

They will check your skin and eyes for signs of jaundice, and you may also have a urine and blood test.

Your GP may also examine your tummy (abdomen) for a lump and to see whether your liver is enlarged.

If your GP suspects pancreatic cancer, you may be referred to a specialist at a hospital for further investigation. You may have an ultrasound scan, computerised tomography (CT) scan, or a magnetic resonance imaging (MRI) scan.

Read more about diagnosing pancreatic cancer.

 

Treating pancreatic cancer

Cancer of the pancreas is difficult to treat. It rarely causes any symptoms in the early stages, so it's often not detected until the cancer is fairly advanced. If the tumour is large, treating the cancer will be more difficult.

If you've been diagnosed with pancreatic cancer, your treatment will depend on the type and location of your cancer, and how far it's advanced. Your age, general health and personal preferences will also be taken into consideration.

The first aim will be to completely remove the tumour and any other cancerous cells. If this isn't possible, treatment will focus on preventing the tumour growing and causing further harm to your body.

The three main treatments for pancreatic cancer are:

• surgery
• chemotherapy
• radiotherapy

Some types of pancreatic cancer will only require one form of treatment, whereas others may require two types of treatment or a combination of all three.

Read more about treating pancreatic cancer.

 

Recovering from surgery

The recovery process after surgery to remove a cancerous tumour can take a long time.

Following surgery, you will probably have a six-month course of chemotherapy, which will greatly increase your chance of being cured.

Read more about recovering from pancreatic cancer surgery.

Parkinson's Disease Fact Sheet

If you have just been diagnosed or know somebody who has, you’ve probably got a lot of questions and perhaps some worries.

That’s where Parkinson’s UK can help.

We’re the UK’s Parkinson’s support and research charity. We’re committed to finding a cure and improving life for everyone affected by Parkinson’s. We provide a range of information and support through our 370 local groups, website and free, confidential helpline manned by expert staff and nurses.

The symptoms someone has and how quickly the condition develops will differ from one person to the next. Although there’s currently no cure, a range of medicines and treatments are available to manage many of the symptoms.

Parkinson’s is not infectious and doesn’t usually run in families. For most people, their life expectancy won’t change much because of Parkinson’s. We don’t yet know why people develop Parkinson’s.

Around one person in every 500 has has Parkinson’s. That’s about 127,000 people in the UK. Most people who get Parkinson’s are aged 50 or over, but younger people can get it too.

People get Parkinson’s because some of the nerve cells in their brains that produce a chemical called dopamine have died. Lack of dopamine means that people can have great difficulty controlling movement. Sometimes people can ‘freeze’ suddenly when moving.

Parkinson’s can also cause some people’s hands and bodies to shake. This can make everyday activities, such as eating, getting dressed, or using a phone or computer, difficult or frustrating.

As well as difficulties with movement, people with Parkinson’s might experience other symptoms such as tiredness, pain, depression, anxiety, problems with memory and constipation. These are often referred to as non-motor symptoms and can have an impact on people’s day-to-day lives.

Arrange of medicines are available to help manage the symptoms and your specialist or Parkinson’s nurse (if you have one) will help you find the best ones for you. While someone may be helped by one medicine, it may not work for others. Some people may need larger doses or a combination of medications – others may need to take smaller doses but more often.

As time goes on, people may need to change their medication. Physiotherapy, speech and language and occupational therapy can also help. Surgery may also be an option for some people whose symptoms have stopped responding to medication.

How Parkinson’s affects someone can change from day to day, and even from hour to hour – symptoms that may be noticeable one day may not be a problem the next. Although at times life can be difficult, many people with Parkinson’s continue to lead active, fulfilling lives.

You can find out more about Parkinson’s and the support Parkinson’s UK offers – including our UK-wide network of information and support workers and local groups – by visiting our website www.parkinsons.org.uk

You can also have a look at our booklets Parkinson’s and you, Living with Parkinson’s or The carer’s guide. The booklets are available to download as PDFs from our website or you can order a paper copy.

To order, visit www.parkinsons.org.uk/publications

Call 0845 121 2354 or email resources@parkinsons.org.uk
Every hour, someone in the UK is told they have Parkinson’s. Because we’re here, no one has to face Parkinson’s alone.

We bring people with Parkinson’s, their carers and families together via our network of local groups, website and free confidential helpline. Specialist nurses, our supporters and staff provide information and training on every aspect of Parkinson’s.

As the UK’s Parkinson’s support and research charity we’re leading the work to find a cure, and we’re closer than ever. We also campaign to change attitudes and demand better services.

Our work is totally dependent on donations.

Help us to find a cure and improve life for everyone affected by Parkinson’s.
Parkinson’s UK

Free* confidential helpline 0808 800 0303

Text Relay 18001 0808 800 0303

Monday to Friday 9am–8pm,
Saturday 10am–2pm. Interpreting available.

*calls are free from UK landlines and most mobile networks.

Website: www.parkinsons.org.uk

Email: hello@parkinsons.org.uk

Pneumonia is swelling (inflammation) of the tissue in one or both of your lungs. It's usually caused by an infection.

At the end of the breathing tubes in your lungs are clusters of tiny air sacs. If you have pneumonia, these tiny sacs become inflamed and swell up with fluid.

Terms such as bronchopneumonia, lobar pneumonia and double pneumonia are sometimes used, but refer to the same condition with the same causes and treatment.

Common symptoms of pneumonia include:

• a cough – which may produce thick mucus (phlegm) that is yellow, green, brownish or blood-stained
• fever
• difficulty breathing

 

When to see your GP

If you feel very unwell and experience any of the symptoms of pneumonia, see your GP.

You may need a chest X-ray or further tests to confirm the diagnosis.

If you are experiencing severe symptoms – such as rapid breathing, chest pain or confusion – seek urgent medical attention.

 

What causes pneumonia?

The most common cause of pneumonia is a pneumococcal infection, caused by bacteria called Streptococcus pneumoniae.

However, there are many different types of bacteria and viruses that can lead to pneumonia.

Good hygiene and a healthy lifestyle can help prevent pneumonia. Try to avoid smoking, as it damages your lungs and increases the chance of infection.

People at high risk of pneumonia should also be offered the pneumo jab and the flu jab.

Read more about the causes of pneumonia.

 

How is pneumonia treated?

Mild cases of pneumonia can usually be treated at home with antibiotics, rest and fluids. People who are otherwise healthy will normally recover well.

For people with other health conditions, pneumonia can sometimes be severe and may need to be treated in hospital.

This is because pneumonia can lead to complications, some of which can be fatal, depending on the health and age of the patient. These include:

• respiratory failure (when the lungs cannot take in enough oxygen) due to the air sacs filling with fluid
• lung abscesses
• blood poisoning (septicaemia)

 

Who is affected?

In the UK, pneumonia affects around 1 in 1000 adults each year. It is more common during autumn and winter.

Pneumonia can affect people of any age, although it is more common and can be more serious in groups such as:

• babies, young children and elderly people
• people who smoke
• people with other health conditions, such as a lung condition or a weakened immune system

People in these groups are more likely to need hospital treatment.

Prostate cancer is the most common cancer in men in the UK, with over 40,000 new cases diagnosed every year.

Prostate cancer usually develops slowly, so there may be no signs you have it for many years.

Symptoms often only become apparent when your prostate is large enough to affect the urethra (the tube that carries urine from the bladder to the penis).

When this happens, you may notice things like an increased need to urinate, straining while urinating and a feeling that your bladder has not fully emptied.

These symptoms shouldn’t be ignored, but they do not mean you definitely have prostate cancer. It is more likely that they are caused by something else, such as benign prostatic hyperplasia (also known as BPH or prostate enlargement).

 

What is the prostate?

The prostate is a small gland in the pelvis found only in men. About the size of a satsuma, it's located between the penis and the bladder and surrounds the urethra.

The main function of the prostate is to help in the production of semen. It produces a thick white fluid that is mixed with the sperm produced by the testicles, to create semen.

Why does prostate cancer happen?

The causes of prostate cancer are largely unknown. However, certain things can increase your risk of developing the condition.

The chances of developing prostate cancer increase as you get older. Most cases develop in men aged 50 or older.

For reasons not yet understood, prostate cancer is more common in men of African-Caribbean or African descent, and less common in men of Asian descent.

Men who have first degree male relatives (such as a father or brother) affected by prostate cancer are also at slightly increased risk.

 

Tests for prostate cancer

There is no single test for prostate cancer. All the tests used to help diagnose the condition have benefits and risks, which your doctor should discuss with you.

The most commonly used tests for prostate cancer are blood tests, a physical examination of your prostate (known as a digital rectal examination or DRE) and a biopsy.

The blood test, known as a prostate-specific antigen (PSA) test, measures the level of PSA and may help detect early prostate cancer. Men are not routinely offered PSA tests to screen for prostate cancer, as results can be unreliable.

This is because the PSA blood test is not specific to prostate cancer. PSA can be raised due to a large non-cancerous growth of the prostate (BPH), a urinary tract infection or inflammation of the prostate, as well as prostate cancer. Raised PSA levels also cannot tell a doctor whether a man has life-threatening prostate cancer or not. This means a raised PSA can lead to unnecessary tests and treatment.

However, you can ask to be tested for prostate cancer once the benefits and risks have been explained to you.

 

How is prostate cancer treated?

For many men with prostate cancer, treatment is not immediately necessary.

If the cancer is at an early stage and not causing symptoms, a policy of "watchful waiting" or "active surveillance" may be adopted. This involves carefully monitoring your condition.

Some cases of prostate cancer can be cured if treated in the early stages. Treatments include surgically removing the prostate, radiotherapy and hormone therapy.

Some cases are only diagnosed at a later stage when the cancer has spread. If the cancer spreads to other parts of the body, typically the bones, it cannot be cured and treatment is focused on prolonging life and relieving symptoms.

All treatment options carry the risk of significant side effects, including erectile and urinary incontinence. For this reason, many men choose to delay treatment until there is a risk the cancer might spread.

Newer treatments, such as high-intensity focused ultrasound (HIFU) or cryotherapy, aim to reduce these side effects. Some hospitals may offer them as an alternative to surgery, radiotherapy or hormone therapy. However, the long-term effectiveness of these treatments are not yet known.

 

Living with prostate cancer

As prostate cancer usually progresses very slowly, you can live for decades without symptoms or needing treatment.

Nevertheless, it can have an effect on your life. As well as causing physical problems such as erectile dysfunction and urinary incontinence, a diagnosis of prostate cancer can understandably make you feel anxious or depressed.

You may find it beneficial to talk about the condition with your family, friends, a family doctor and other men with prostate cancer.

Financial support is also available if prostate cancer reduces your ability to work.

 

Symptoms of prostate cancer 

Prostate cancer does not normally cause symptoms until the cancer has grown large enough to put pressure on the urethra.

This normally results in problems associated with urination. Symptoms can include:

• needing to urinate more frequently, often during the night
• needing to rush to the toilet
• difficulty in starting to pee (hesitancy)
• straining or taking a long time while urinating
• weak flow
• feeling that your bladder has not emptied fully

Many men's prostates get larger as they get older due to a non-cancerous condition known as prostate enlargement or benign prostatic hyperplasia.

Symptoms that the cancer may have spread include bone and back pain, a loss of appetite, pain in the testicles and unexplained weight loss.

 

Causes of prostate cancer 

It is not known exactly what causes prostate cancer, although a number of things can increase your risk of developing the condition.

These include:

• Age – risk rises as you get older and most cases are diagnosed in men over 50 years of age.
• Ethnic group – prostate cancer is more common among men of African-Caribbean and African descent than in men of Asian descent.
• Family history – having a brother or father who developed prostate cancer under the age of 60 seems to increase the risk of you developing it. Research also shows that having a close female relative who developed breast cancer may also increase your risk of developing prostate cancer.
• Obesity – recent research suggests that there may be a link between obesity and prostate cancer.
• Exercise – men who regularly exercise have also been found to be at lower risk of developing prostate cancer.
• Diet – research is ongoing into the links between diet and prostate cancer. There is evidence that a diet high in calcium is linked to an increased risk of developing prostate cancer.

In addition, some research has shown that prostate cancer rates appear to be lower in men who eat foods containing certain nutrients including lycopene, found in cooked tomatoes and other red fruit, and selenium, found in brazil nuts. However, more research is needed.

 

Diagnosing prostate cancer 

If you have symptoms that could be caused by prostate cancer, you should visit your GP.

There is no single, definitive test for prostate cancer, so your GP will discuss the pros and cons of the various tests with you to try to avoid unnecessary anxiety.

Your doctor is likely to:

• ask for a urine sample to check for infection
• take a blood sample to test your level of prostate-specific antigen (PSA)
• examine your prostate (digital rectal examination)

In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of prostate cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected prostate cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral.

 

PSA testing

PSA is a protein produced by the prostate gland. All men have a small amount of PSA in their blood, and it increases with age.

Prostate cancer can increase the production of PSA, and so a PSA test looks for raised levels of PSA in the blood that may be a sign of the condition in its early stages.

However, PSA testing is not a specific test for prostate cancer. Most men who have prostate cancer will not have a raised PSA level. More than 65% of men with a raised PSA level will not have cancer, as PSA levels rise in all men as they get older.

 

Digital rectal examination (DRE)

The next step is a DRE, which can be done by your GP.

During a DRE, your GP will insert a lubricated and gloved finger into your rectum. The rectum is close to your prostate gland, so your GP can check to feel if the surface of the gland has changed. This will feel a little uncomfortable, but should not be painful.

Prostate cancer can make the gland hard and bumpy. However, in most cases, the cancer causes no changes to the gland and a DRE may not be able to detect the cancer.

DRE is useful in ruling out prostate enlargement caused by benign prostatic hyperplasia, as this causes the gland to feel firm and smooth.

 

Biopsy

Your GP will assess your risk of having prostate cancer based on a number of factors, including your PSA levels, the results of your DRE, and your age, family history and ethnic group. If you are at risk, you should be referred to hospital to discuss the options of further tests.

The most commonly used test is a transrectal ultrasound-guided biopsy (TRUS). A biopsy may also be taken during a examination or through the skin behind the testicles (perineum).

During a TRUS biopsy, an ultrasound probe (a machine that uses sound waves to build a picture of the inside of your body) is inserted into your rectum. This allows the doctor or specialist nurse to see exactly where to pass a needle through the wall of your rectum to take small samples of tissue from your prostate.

The procedure can be uncomfortable and sometimes painful, so you may be given a local anaesthetic to minimise any discomfort. As with any procedure, there may be complications, including bleeding and infection.

Although it is more reliable than a PSA test, the TRUS biopsy can have problems. It can miss up to one in five cancers, because the location of the cancer is unknown when it is carried out. The doctors can see the prostate using the ultrasound scan, but not the tumour(s) if they are present.

You may need another biopsy if your symptoms persist, or your PSA level continues to rise. Your doctor may request an MRI scan of the prostate before another biopsy.

The TRUS biopsy can also find small low-risk cancers that do not need treatment, but may cause you anxiety. Many men often choose to undergo surgery or radiotherapy that may not benefit them but causes side effects, such as incontinence and erectile dysfunction.

The samples of tissue from the biopsy are studied in a laboratory. If cancerous cells are found, they can be studied further to see how quickly the cancer will spread. This process is known as "staging and grading" and helps doctors to decide which treatment is the most appropriate.

 

Further testing

If there is a significant chance the cancer has spread from your prostate to other parts of the body, further tests may be recommended.

These include:

• A magnetic resonance imaging (MRI) or computerised tomography (CT) scan – these scans build a detailed picture of the inside of your body.
• An isotope bone scan – this can tell if the cancer has spread to your bones. A small amount of radiation dye is injected into the vein and collects in parts of the bone where there are any abnormalities.

  

Testing for prostate cancer 

There is currently no screening programme for prostate cancer in the UK. This is because it has not been proved that the benefits would outweigh the risks.

 

PSA screening

Routinely screening all men to check their prostate-specific antigen (PSA) levels is a controversial subject in the international medical community.

There are several reasons for this:

• PSA tests are unreliable and can suggest prostate cancer when no cancer exists (a false-positive result). This means that many men often have invasive and sometimes painful biopsies for no reason. Also, up to 15% of men with prostate cancer have normal PSA levels (a false-negative result), so many cases may be missed.
• The PSA test can find aggressive prostate cancer that needs treatment, but it can also find slow-growing cancer that may never cause symptoms or shorten life. Some men may therefore face difficult decisions about treatment.
• Treating prostate cancer in its early stages can be beneficial in some cases. But the side effects of the various treatments are potentially so serious that men may choose to delay treatment until it is absolutely necessary.
• Although screening has been shown to reduce a man's chance of dying from prostate cancer, it would mean many men receive treatment unnecessarily.

More research is needed to determine whether a screening programme would provide men with more benefit than harm.

One European study showed deaths from prostate cancer could be reduced by 20% if there was a screening programme, but this needs to be balanced against the harms of:

• over diagnosis – people being diagnosed with a cancer that will never cause symptoms or death during their lifetime
• overtreatment – people being treated unnecessarily for tumours that would be unlikely to be harmful

To save one life from prostate cancer, 27 men would have to be diagnosed with it. A recent large study in America found no reduction in the number of deaths.

 

Improving the test

As there are many reasons why PSA levels may be high at any one time, researchers are trying to make the PSA test, or a variation of it, more accurate. This includes looking at how PSA levels change over time and comparing the PSA level to prostate size.

Researchers are also looking at whether new imaging tests, such as MRI scans, or other blood and urine tests, can be used to decide which men with an elevated PSA should have a biopsy.

Instead of a national screening programme, there is an informed choice programme called prostate cancer risk management for healthy men aged 50 or over who ask their GP about PSA testing. It aims to give men good information on the pros and cons of a PSA test.

If you're a man aged 50 or over and decide to have your PSA levels tested after talking to your GP, they will be able to arrange for it to be carried out for free on the NHS.

If results show you have a raised level of PSA, your GP may suggest further tests.

 

Should I have a PSA test?

Because the results of the PSA test are not as reliable as doctors would like, other tests and investigations are needed to diagnose prostate cancer.

A PSA test cannot identify prostate cancer on its own, and changes in PSA levels alone are not a good reason to start treatment.

If you are thinking about asking for a PSA test, it is important that you first discuss whether it is right for you with your GP so you understand what the results might mean.

The Prostate Cancer Risk Management Programme has information on the risks and benefits of the PSA test to help you decide whether or not to have it.

 

Treating prostate cancer  

Your treatment for prostate cancer will depend on your individual circumstances.

For many men with prostate cancer, no treatment will be necessary. Active surveillance or "watchful waiting" will mean keeping an eye on the cancer and starting treatment only if the cancer shows signs of getting worse or causing symptoms.

When treatment is necessary, the aim is to cure or control the disease so it doesn't shorten life expectancy and affects everyday life as little as possible. Sometimes, if the cancer has already spread, the aim is not to cure it, but to prolong life and delay symptoms.

 

Your cancer care team

People with cancer should be cared for by a multidisciplinary team (MDT). This is a team of specialists who work together to provide the best care and treatment.

The team often consists of a specialist cancer surgeon, an oncologist (a radiotherapy and chemotherapy specialist), a radiologist, pathologist, radiographer and a specialist nurse. Other members may include a physiotherapist, dietitian and occupational therapist. You may also have access to clinical psychology support.

When deciding what treatment is best for you, your doctors will consider:

• the type and size of the cancer
• what grade it is
• your general health
• whether the cancer has spread to other parts of your body

 

Good prostate cancer care

Your MDT will be able to recommend what they feel are the best treatment options, but ultimately the decision is yours.

Your MDT should also let you know about any clinical trials you may be eligible for. See prostate cancer clinical trials for a database of trials currently studying prostate cancer.

The National Institute for Health and Care Excellence (NICE) has made recommendations about treatments offered to men with the three main stages of prostate cancer:

• localised prostate cancer (cancer that is just in the prostate gland)
• locally advanced prostate cancer (cancer that has spread beyond the prostate capsule, but is still connected to the prostate gland)
• relapsed (cancer that has returned after treatment) and metastatic prostate cancer (cancer that has spread outside the prostate gland, with no remaining link to the original cancer in the prostate gland)

 

Living with prostate cancer

Depending of the type of prostate cancer you have, your life may be affected in different ways.

Unlike many other types, most prostate cancers get worse slowly. Men may have it for years without symptoms. During this time, men with low-risk prostate cancer (which has not spread beyond the prostate gland) may not need treatment.

About one in five men with prostate cancer have fast-growing cancer. Men whose cancer is more likely to spread may decide to have surgery or radiotherapy, which aims to cure the cancer. However, these treatments can have side effects.

Introduction

Osteoarthritis is a condition that causes the joints to become painful and stiff. It is the most common type of arthritis in the UK.

The severity of osteoarthritis symptoms can vary greatly from person to person, and between different affected joints. For some people, the symptoms may be mild and may come and go, whereas others can experience more continuous and severe problems.

Almost any joint can be affected by osteoarthritis, but the condition most often causes problems in the knees, hips, and small joints of the hands.

The pain and stiffness in the joints can make carrying out everyday activities difficult for some people with the condition.

 

When to seek medical advice

You should see your GP if you have persistent symptoms of osteoarthritis so they can try to identify the cause.

To help determine whether you have osteoarthritis, your GP will ask you about your symptoms and examine your joints.

 

What causes osteoarthritis?

Osteoarthritis occurs when there is damage in and around the joints that the body cannot fully repair.

It's not clear exactly why this happens in some people, although your chances of developing the condition can be influenced by a number of factors, such as your age and weight.

Osteoarthritis usually develops in people over 45 years of age, although younger people can also be affected.

It is commonly thought that osteoarthritis is an inevitable part of getting older, but this is not quite true. You may in fact be able to reduce your chances of developing the condition by doing regular, gentle exercises and maintaining a healthy weight.

 

Managing osteoarthritis

Osteoarthritis is a long-term condition and can't be cured, but it doesn't necessarily get any worse over time and it can sometimes gradually improve. A number of treatments are also available to reduce the symptoms.

Mild symptoms can sometimes be managed with simple measures including regular exercise, losing weight if you are overweight, wearing suitable footwear and using special devices to reduce the strain on your joints during your everyday activities.

If your symptoms are more severe, you may need additional treatments such as painkilling medication and a structured exercise plan carried out under the supervision of a physiotherapist.

In a small number of cases, where the above treatments haven't helped or the damage to the joints is particularly severe, surgery may be carried out to repair, strengthen or replace a damaged joint.

 

Living with osteoarthritis

As osteoarthritis is a long-term condition, it is important you get the right support to help you cope with any issues such as reduced mobility and advice on any necessary financial support.

As well as support from your healthcare team, it is important to look after your own health and wellbeing. This includes taking your medicine regularly and adopting as healthy a lifestyle as possible.

Some people may also find it helpful to talk to their GP or others who are living with the same condition as there may be questions or worries you want to share.

Seasonal affective disorder (SAD) is a type of depression that has a seasonal pattern.

The episodes of depression tend to occur at the same time each year, usually during the winter.

As with other types of depression, the two main symptoms of SAD are a low mood and a lack of interest in life. You may also be less active than normal and sleep more.

 

Winter depression

SAD is sometimes known as "winter depression" because the symptoms are more apparent and tend to be more severe at this time of the year.

The symptoms often begin in the autumn as the days start getting shorter. They're most severe during December, January and February.

In most cases the symptoms of SAD begin to improve in the spring before eventually disappearing.
What causes SAD?

The exact cause of SAD isn't fully understood, but it's thought to be linked to reduced exposure to sunlight during the shorter days of the year.

Sunlight can affect some of the brain's chemicals and hormones. However, it's not clear what this effect is. One theory is that light stimulates a part of the brain called the hypothalamus, which controls mood, appetite and sleep. These things can affect how you feel.

In people with SAD, a lack of sunlight and a problem with certain brain chemicals stops the hypothalamus working properly. The lack of light is thought to affect the:

• production of the hormone melatonin
• production of the hormone serotonin
• body's circadian rhythm (its internal clock, which regulates several biological processes during a 24-hour period)

 

Diagnosing SAD

You should visit your GP if you have the symptoms of SAD. They may carry out an assessment to check your mental health.

Your GP may ask you about your mood, lifestyle, eating habits and sleeping patterns, plus any seasonal changes in your thoughts and behaviour.

 

Treating SAD

As with any type of depression, SAD can be difficult to live with. It can make you feel tired, stressed and unhappy. However, it can usually be treated successfully.

Light therapy is often used to treat SAD. It involves sitting in front of or beneath a light box that produces a very bright light. Light boxes come in a variety of designs, including desk lamps and wall-mounted fixtures.

You should speak to your GP and read the manufacturer's instructions before using a light box to treat SAD.

Depending on the nature and severity of your symptoms, talking therapies such as cognitive behavioural therapy (CBT) or medication such as antidepressants may also be recommended.

Your GP will recommend the most suitable treatment programme for you, which may involve using a combination of treatments.

This video is to explaining what is stroke. Click play to find out more information about stroke and F.A.S.T.

If you want more information based on stroke, go to www.chss.org.uk