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You may have seen reference to something called COPD in the news or in promotional material at your local GP surgery, because there has been a huge awareness campaign about the condition recently. But what is it?

COPD stands for Chronic obstructive pulmonary disease and it is the term now used to cover emphysema, chronic bronchitis or both (it’s quit common to suffer both together). Both illnesses involve the airways in the lungs becoming obstructed (so that the airflow is reduced). The main symptoms are ‘productive’ coughing (over a long period, sometimes painfully, where phlegm is produced) and feeling breathless. Frequent chest infections and blood in the sputum are common in people with COPD. COPD can be fatal.

An estimated three million people in the UK suffer from COPD and a further 500,000 may have the condition but be unaware that they do. It’s most common amongst people over 40 and the risk of developing the disease increases with age.

The main cause of COPD is smoking – the smoke inflames the airways and damages them over time. Three out of every twenty smokers who have 20-a-day go on to develop COPD, whilst a quarter of smokers who smoke 40-a-day develop CPPD. But even if you don’t smoke heavily, there is a significant risk of developing COPD. Smoking doesn’t cause all cases – it can be through anything that irritates and damages the airways, such as breathing in heavily-polluted air, or it can be genetic (though this accounts for fewer than one percent of cases).

To test whether a person has COPD, a doctor would normally examine your chest with the stethoscope but this examination can appear normal in early or mild cases of COPD. Another test is a spirometry test, which measures your lung capacity by seeing how much air your can blow into a machine (a similar test is often used to diagnose asthma). Those results are compared with results that would be expected to be seen amongst other people of your age, gender and general level of health. It may also be necessary to have a chest x-ray to exclude other possible causes of the symptoms (like lung cancer).

Once a person begins to experience the symptoms of COPD it is vital that they stop smoking if they are to have any chance of survival. Damage that has already been done to the lungs cannot be repaired, but it will stop getting worse. If smoking continues, the symptoms gradually worsen over several years and eventually quality of life is impaired. Eventually, heart failure can occur, meaning that the heart no longer pumps blood efficiently. Ultimately, the lungs become so damaged that not enough oxygen is taken in and carbon dioxide (the gas you normally breathe out) builds up in the blood. This is known as ‘end-stage COPD’ and death follows.

Around 25,000 people in the UK die from COPD each year, usually following years of ill health and poor quality of life. If you do manage to stop smoking, you will probably notice a worsening of your cough at first – that is normal, it happens as your airways start to recover, so don’t resume smoking just to ease the cough, it will get better quickly.

Next week, we will look at treatments for COPD.

Many people, including health professionals and sufferers, do not recognise the symptoms of post-traumatic stress disorder (PTSD) and consequently potentially thousands of people are not getting the treatment they need.

PTSD is believed to affect hundreds of thousands of people each year in the UK alone (approximately 1.5% of the population) – and whilst many people believe that PTSD is something that only soldiers get after being in a war-zone, it can occur whenever a person has felt that their life is in danger.

A leading psychiatrist in this field, Dr Jennifer Wild, who is based at King’s College London’s Institute of Psychiatry says that PTSD is not being adequately recognised, addressed or treated despite its prevalence.

People with PTSD can suffer appalling symptoms (including flashbacks, irrational fears, loss of control of emotions, intense anger, inability to concentrate and being scared, like being in a state of threat all the time) for years without treatment. Many people don’t seek treatment, either because they’re ashamed (mental health problems still carry a huge stigma) or because they fear that they will be locked away or have their children removed if they admit to the problems they are suffering (neither of these things will typically happen, of course).

But those who do seek treatment often find that their GPs don’t recognise the symptoms for what they are and fail to provide adequate care. They may simply provide anti-depressants or drugs to aid sleep. That’s because many of the symptoms of PTSD overlap with those of depression (which often features sleep problems like insomnia).

For PTSD to be properly tackled, though, a combination of the right type of anti-depressant (such as paroxetine, which can have side-effects and must be reduced gradually if a person wants to stop taking them) with talking therapy to address the original trauma and put it firmly in the past rather than have it affect the present to such a degree.

GPs should be trained to ask anyone suffering from depression-symptoms or insomnia whether they have been through any kind of traumatic event. They need to ask if they’re suffering any of the typical symptoms of PTSD including intrusive memories or flashbacks, nightmares, avoiding triggers that remind them of the event (e.g. many women are traumatised by the delivery of their child and may avoid pregnant friends or watching programmes on TV about pregnancy or birth).

If you are suffering from PTSD, you can ask your GP to refer you to the IAPT team (Improving Access to Psychological Therapies) or you can refer yourself.

Prostate cancer is very common, with more than 35,000 cases diagnosed each year and many more passing undetected. Fortunately, prostate cancer tumours are generally slow-growing, so once symptoms are detected treatment is usually highly effective (around 70% of sufferers of cancer restricted to the prostate gland live beyond five years of diagnosis).

Its slow-growing nature can be bad news for some, though, since many men don’t experience any symptoms until the cancer is at an advanced stage. If it reaches an advanced state, spreading to other parts of the body, it is much harder to treat and more likely to be fatal. Such cancer cannot usually be treated, though it can be kept at bay for many years.

So if the symptoms are not often present until it reaches an advanced state, how can you tell if you have it and take steps to have it treated?

The prostate gland secretes a substance called PSA (prostate-specific antigen). If there are high levels of this PSA in the bloodstream, it could indicate prostate cancer, or it could indicate something else like prostatitis, or an enlarged prostate gland (neither of which are cancerous). A blood test can therefore give a good indication of whether there is a problem or not. A doctor who carries out such a test will also look at how quickly the PSA levels increase over what period of time, so further blood tests may be necessary if an initial result seems ominous.

It is important to remember that low levels of PSA will not always mean that there is no cancer – it is possible to have prostate cancer without elevated levels of PSA. As the test is normally combined with a rectal examination, though, they give a good chance of spotting anything developing.

In order to decide whether to test for PSA, doctors generally bear in mind different risk factors. These are:

Family history: you have almost double the risk of contracting the disease if a close male relative has had it.

Ethnicity: prostate cancer is much more common in black men, and in South Asian men who live in the UK.

Diet: obesity plays a role in the development of prostate cancer, so maintaining a controlled, balanced diet can reduce the risks of developing the disease. A high fat diet may contribute to the development of the cancer. Eating a diet rich in lycopenes (which are found in things like tomatoes, beans, blueberries, red oranges, spinach and watermelon) can reduce the risk of developing prostate cancer.

Sedentary lifestyle: it may be possible to reduce the risk of developing prostate cancer by taking regular exercise.

Age: the risk of prostate cancer increases year on year after the age of about 50.

At present, there isn’t a standard screening programme in the UK like there is for several other common diseases. Early detection equates to better prospects of successful treatment, though, so there is much pressure from organisations like Cancer Research UK for a routine screening programme to be undertaken. It is possible to request a PSA test on the NHS and you may want to ask for one if you have any of the above risk factors (from about age 50, or 40 if you are black or of South Asian heritage) or if you have a family history of prostate cancer.

Prostate cancer is something that affects many men, particularly as they reach fifty and over (though it is entirely possible to develop it at a younger age, too). It’s believed that most men over the age of fifty have it to some degree (though usually it causes no symptoms or problems). The prostate is a gland in men’s reproductive system. It makes the fluid part of semen. It’s located just under the bladder, and is regulated by testosterone (the male sex hormone).

Prostate cancer is the most common type of cancer to affect men in the UK, with one in 14 developing it at some point in their lives. However, the survival rate is very good, with about 70% surviving for at least five years.

It’s cause is not known exactly, though it is thought to be related to genetics (it is more common for men with prostate cancer to die if they have a family history of the disease), and diet contributes to the risk of death from the disease: men who eat lots of fat (especially animal, saturated fat) are more likely to develop the disease to an advanced stage and/or die from it. The disease is more common in countries that typically consume meat and dairy staples than in countries that have a diet rich in vegetables, rice and soya beans. It’s also linked to age, with around 60% of cases being found in men over 70.

Your ethnicity is likely to influence the likelihood of whether or not you develop the disease: it is most common in black men of African and African-Caribbean heritage, and least common in Asian men.

It is probable that hormonal changes trigger the cancer, and that diet triggers the hormonal changes. This is because fats stimulate a greater production of testosterone, which in turn encourages the growth of prostate cancer. Further, if you eat meat that has been cooked at high temperatures, carcinogens present in the meat as a result of the cooking process can affect the prostate.

Another risk factor is exposure to a metal called cadmium seem to be abnormally vulnerable to prostate cancer.

Next week we will examine how prostate cancer is detected.

The risks associated with exposure to ultraviolet (UV) rays are well documented: too much UVA and your skin loses its elasticity and you get wrinkles (think ‘UV Age); too much UVB and you burn and risk skin cancer (UV Burn).

However, some exposure to UV light can be therapeutic. Research by the University of London has found that the chickenpox virus may be contained (less likely to spread) if it is exposed to UV light. They found that in areas with high UV levels, there was less occurrence of chickenpox compared to the level of outbreaks seen in places with lower levels of UV light.

The findings may suggest that you’re more likely to get chickenpox if you live in an area with a cooler climate, and also may suggest how the virus can be avoided – as could shingles.

Chickenpox is normally only contracted once in a lifetime (usually during childhood) but if a person who has had chickenpox is exposed to the virus again (and is run down or has low levels of immunity at the time) they can develop shingles. The virus that causes chickenpox and shingles is called the varicella zoster virus. Shingles is a very unpleasant illness and if the research into UV rays could lead to a way of preventing the spread of that infection then it could help many thousands of people every year.

The virus is very infectious and is dangerous to the foetus if contracted during pregnancy. It is normally caught through close contact (skin-to-skin) when the blisters caused by the virus are still ‘wet’.

One of the researchers, Dr Phil Rice, believes that UV light exposure could kill the virus whilst it is on the skin, preventing it from infecting others.

The findings are consistent with anecdotal evidence that chickenpox is less common in tropical regions, and is more common in cooler climates during the Autumn and Winter seasons, when UV levels are low.

Previously, it had been assumed that the lower incidence of chickenpox in tropical climates was due to lower population density and other sociological factors. Dr Rice said, “No one had considered UV as a factor before, but when I looked at the epidemiological studies they showed a good correlation between global latitude and the presence of the virus.”

It’s not even Christmas Day yet, but before you know it it will be New Year’s Eve and once again you’ll be making promises you can’t keep about how you’re going to change your life in the new year. Top of many people’s list of resolutions they want to keep is to stop smoking.

Unless they’ve been living under a rock, everyone knows about the risks and dangers of smoking. The government has seemingly reduced the number of smokers in the UK (and for the first time, the number of young smokers has declined), by making it socially unacceptable to smoke in public. Smoking has become the social equivalent of passing wind.

If you want to stop smoking and are aiming to quit for New Year, here are some tips on how best to manage it:

1. Get motivated. A New Year’s Resolution isn’t going to help much in the long-run (you might have lit up on 1st January in a hung-over daze before you’ve even remembered that you’d promised to quit). You need something bigger to aim for: perhaps you want to make sure you’re there for your grandchild’s graduation. Or maybe you want to decorate the lounge but there’s no point doing so if you’re just going to turn it yellow again by February.

2. Get advice and support. You could go ‘cold-turkey’ but it doesn’t work for most people, the craving is just too hard. Cigarette addiction is a chemical addiction in your brain, it’s not something you can easily will-away. Look into nicotine-replacement therapy, which can help reduce the withdrawal symptoms of depression, anxiety and irritability. Gum, patches and lozenges are all available, as are fake cigarettes that also give you the sensation of smoking, and these can make you twice as likely to successfully quit as if you were trying on your own.

3. Tell people. Tell your friends, work colleagues, family, that you are trying to quit. They’ll be more understanding if you bite their head off for not holding a door open for you or breathing too loudly. Support groups are available if you need to vent or want to talk to others going through the same thing. Or you can try cognitive-behavioural therapy plus nicotine-replacement therapy, which will offer the best chance of success.

4. Avoid triggers. If you normally smoke when you have a drink, then give drinking a rest socially for a while, just until your cravings have gone. Or if you smoke when stressed, manage your stress-levels better.

5. When you’ve quit, decorate the house. You’ll be less likely to want to wreck your beautiful, clean-smelling walls, ceilings and soft furnishings if you’ve spent days working on them. Get rid of your smoking paraphernalia too (ashtrays and the like) so you have fewer reminders around the house of your habit.

Whatever motivates you, however many attempts it takes to kick the habit, you will manage it in the end and you will feel so much better for it.

Since the human genome was mapped in 2000, genetic causes for all sorts of things have been found. One of these is a genetic variation that means that some people find it harder to get out of bed in a morning than others. They need at least an extra thirty minutes in bed than others. Of course, in these dark winter months most people would probably say they could do with an extra half an hour in bed, but most of them will be just trying it on.

The genuine cases, who really do need more sleep, have a variation on gene ABCC9. The variation is found in as many as one in five Europeans.

Researchers from Ludwig Maximilians University and Edinburgh University studied around 10,000 Europeans from various member states, and questioned them about how many hours’ sleep they got each night (on nights when they didn’t have something in particular to get up for the next day). They then took samples of their blood and analysed their DNA.

Those with the variation on ABCC9 needed more than the average, which is eight hours’ sleep per night.

A possible reason for the effect of the variation is that the normal function of gene ABCC9 is to detect energy levels in the body. Perhaps in the variation of the gene, it detects too little energy and makes the body want to sleep more to recover.

One of the researchers, Dr Jim Wilson from the University of Edinburgh’s Centre for Population Health Sciences said: “Humans sleep for approximately one-third of their lifetime. A tendency to sleep for longer or shorter periods often runs in families despite the fact that the amount of sleep people need can be influenced by age, latitude, season and circadian rhythms. These insights into the biology of sleep will be important in unravelling the health effects of sleep behaviour.”

Strokes occur when the blood to the brain is interrupted, either because of a clot in one of the vessels (‘ischaemic stroke’) or because of a burst vessel within the brain (‘haemorrhagic stroke’). They are experienced by roughly 150,000 people each year in the UK and about a third of those people die from the stroke, because of insufficient oxygen reaching the brain. Those who do not die are often left with significant disabilities.
Stroke charities and the NHS have done a good job of using awareness campaigns to help people to spot the signs of stroke early enough for them to get help quickly. The ‘Get Help FAST’ slogan has been used, with FAST being an acronym for ‘Face’ (a weakness in their facial muscles, drooping of the eye or mouth and inability to smile may warn of an impending stroke) ‘Arm’ (weakness in the arm or inability to raise one or both arms) ‘Speech’ (slurred speech) and ‘Time’ (if the other symptoms are present, it’s time to dial 999).
Now, though, researchers in the UK have identified two other signs that can indicate that a person is suffering or is about to suffer a stroke, and they are trying to raise awareness that these other signs should be added to the FAST ones. The researchers, based at the University Hospital in Leicester, say that leg weakness and loss of vision can be warning signs of a stroke and should be acted upon immediately.
Professor Ross Naylor of the University said, “The FAST campaign was very successful, but it’s important that people know leg weakness and loss of vision are also signs to look out for.
“It’s my fear are that many people may not be aware that anyone experiencing one or both of these additional signs, on their own or with one of the already recognised symptoms may be an indicator that they or a loved one is having a stroke and should also seek urgent medical advice.
“It’s really important that people are aware of all five of the signs and they shouldn’t be fooled into thinking that they must be having all five of them at the same time to be experiencing a stroke.
“You might be having a stroke and only suffering one of the five symptoms, however it’s more likely that you will experience one or two signs at the same time. Whilst the public appear aware of FAST and the three symptoms it highlights, we’ll be working to raise awareness with the public, health professionals and health services locally and nationally to make sure that those people showing any of these five signs get the medical assistance they need promptly.”

If you have gallstones, you really know about it. They’re incredibly painful, small stones that are formed in the gallbladder. They’re made of cholesterol and whilst tiny ones don’t cause any symptoms normally, the bigger ones can get trapped in the ducts leading in or out of the gallbladder or even move out of the gallbladder altogether. These are the ones that cause the problems, namely:
sudden, hugely intense pain in the abdomen (either in the centre, between sternum and belly button, or in the upper right);
nausea
vomiting
jaundice (yellowish appearance of the skin and whites of the eye)
So what is the gallbladder, why do we need it, how do we avoid gallstones and what do we do if we get them?
The gallbladder is a rather small internal organ that lives just beneath the liver. Its job is to store bile, which is concentrates by extracting the other liquids from it. Bile is what the liver produces to help to break down food, and the liver passes the bile down various ducts to the gallbladder. The more concentrated the bile becomes there, the better it is at digesting fats, which it does when the gallbladder releases it into the digestive tract when food needs breaking down.
For all that, it is not a vital organ and can be removed without any long-term, ill effects.
Gallstone disease (when the gallstones cause a problem) comes in two forms:
1. Uncomplicated gallstone disease – when the gallstones block the duct that leads into the gallbladder. Causes occasional bouts of pain in the abdomen lasting a few hours at a time. Episodes can be weeks or even months apart.
2. Complicated gallstone disease – the gallbladder becomes inflamed and more serious complications and symptoms are experienced, like high temperature, jaundice, constant, intense pain in the abdomen.
If you develop gallstone disease you’re not alone: it’s estimated that around 10 – 15 percent of adults develop it, though most have no symptoms. You’re more likely to develop them if you’re female (women develop them three times as often as men do) and as you get older. Obesity is a major risk factor, mainly because obese people tend to have high levels of cholesterol. So losing weight can help you to reduce your risk of developing the disease.
The good news is that gallstones are easily treated, with surgery to remove the gallbladder (usually by keyhole method, meaning shorter recovery time and less traumatic surgery). If you have uncomplicated gallstone disease, surgery may not be necessary. If your symtoms last longer than eight hours, and/or you have a fever, then you may have complicated gallstones disease and should seek immediate medical advice.

In the news this week was the sad story of Robert McIndoe, 52, who committed suicide following just a few months of suffering from tinnitus. Tinnitus is a condition suffered by approximately ten percent of the population, with one percent being so badly affected by it that their quality of life is severely affected. It is usually experienced as a ringing sound in one or both ears but can also be heard as many different sorts of sounds. The sounds are auditory illusions in that they don’t come from any outside source, but to the sufferer they are very real indeed and interrupt sleep and make it hard to hear or concentrate during the day.

It’s usually caused when the nerves in the inner ear are damaged. The nerves send information to the brain that doesn’t relate to real sounds and the brain doesn’t understand what it’s being told, perceiving ringing or other sounds. It can also be caused by some medical conditions and can be a side effect of certain drugs, so if you are suffering it is worth getting the cause checked out. For poor Robert McIndoe, his problem started after he went to a rock concert this summer. According to his wife at the inquest, he was angry with himself for not having worn earplugs, which could have easily prevented the problem. His wife said, “When it first happened he wasn’t too bothered about it because he thought it would subside, and the friend he had been with also had ringing in his ears that day. But it was a constant irritation. He didn’t get a night of sleep after that. He was very distressed saying he couldn’t go on. It was awful, he looked terrible, and he just felt so bad all the time. He was desperate that it was never going to change – he didn’t know if he could live like this.”

There’s limited treatment available unless there’s a medical/medicine-related cause that can be addressed. Mostly, it is a question of managing the condition. There are devices available that mask the sound by creating other, real sounds (usually white noise); relaxation techniques might be effective in that stress tends to make the symptoms worse. Limiting caffeine and alcohol is also thought to help. Tinnitus can lead to depression, which is a condition that really must be addressed properly through therapy and medication. Robert McIndoe’s wife told his inquest that he had had inadequate support from professionals in managing his tinnitus.