Breast Cancer

The NHS Breast Screening Programme provides free breast screening (mammograms), every three years, for women in England who are aged 50-70. To receive an automatic invitation, you need to be registered with your local GP surgery, and ensure that they have your current contact details. Women aged over 70 are also entitled to screening every three years, by making their own appointment at their local screening unit.

Self-examination and regular screening

Having regular checks will help detect any potential cancer long before symptoms appear. Therefore, self-examination is really important. In most cases, the earlier cancer is diagnosed, the greater the chance of successful treatment. Men should regularly check their testicles for lumps, and women should become breast aware, so that they can notice any changes to what is normal for them.

The NHS screens for some, but not all cancers, in age groups that are considered to be at risk:

Health and safety

Make sure you follow all the relevant the health and safety guidelines if you work around hazardous chemicals, such as gas or radiation - for example, nuclear industry workers, scientists, medical staff or students.

Sunlight

The best way to prevent skin cancer is to avoid over-exposure to the sun. Cover up and use a high factor sunscreen of SPF 15 or above (children and those with fair skin will need to use a sunscreen with a higher protection factor) and avoid going out in the sun between the hours of 11am and 3pm.

This is not to say that you should avoid sunlight all together. Sunlight promotes the production of Vitamin D, which is needed by the body to produce calcium. Also, recent research has shown that Vitamin D can prevent other types of cancer, and cardiovascular diseases (conditions that affect the blood flow), such as strokes.

When spending time in the sun, you should do so in moderation. You do not need to get a suntan to enjoy the benefits of Vitamin D.

Obesity

Obesity is known to be a risk factor for some types of cancer, such as bowel, breast and colon cancer. You should try to maintain a healthy body weight by taking regular exercise in addition to eating a healthy diet. Take a look at our body mass index (BMI) calculator to find out if you are over your 'ideal' weight, and to get tips on how to lose weight safely. See the 'further information' section for more information. If you are overweight and want to lose weight safely, your GP will also be able to provide advice.

Exercise

All available information shows that rates of cancer are a lot lower in people who take regular exercise. Regular exercise will also reduce the risk of other serious conditions such as heart disease and strokes. For most people, thirty minutes of vigorous exercise a day, at least five times a week, is recommended. The exercise should be strenuous enough to leave your heart beating faster, and you should feel slightly out of breath afterwards. Examples of vigorous exercise include going for a brisk walk, or walking up a hill.

Alcohol

Reducing your alcohol intake will help prevent cancer. The recommended safe limit for units of alcohol per day is two for women and three for men (one unit = half a pint of beer, or a small glass of wine). For positive benefits to your health and general well-being, it is best to have a few alcohol-free days each week

Diet

It is recommended that you eat a healthy diet that is low in fat, with plenty of fresh fruit and vegetables, starchy carbohydrates (bread, potatoes, pasta and wholegrain cereals) and protein rich foods, such as chicken, fish and eggs. Eat plenty of fibre too, such as wholemeal bread and cereals like oats or muesli.

You should aim to aim to eat at least five portions of fruit and vegetables every day as fruit and vegetables contain special chemicals known as antioxidants, which are thought to help protect cells from damage. Leafy vegetables such as lettuce, spinach and cabbage are thought to provide the most protection against cancer.

It is recommended that you limit your consumption of red and processed meat to no more than 90 g (3oz). Examples of red and processed meat include beef, lamb, sausages, burgers and pork. Excessive salt consumption has also been linked to an increase risk of cancer, as well as heart disease and stroke. Do not eat more than 6g (0.2oz) of salt per day. 6g of salt is about one teaspoon.

Smoking

If you are a smoker, the best way to prevent cancer is to quit. Smoking is responsible for 29% of all cancer deaths. Even if you have been smoking for many years, your risk of getting lung cancer will start to decrease as soon as you stop.

Can I reduce the chance of cancer?

Cancer is the common name used to describe many different conditions caused by the body's cells dividing uncontrollably. Some cancers have no obvious cause, making them very difficult to prevent. Others are inherited and are more likely to affect people who have a close family member with the same condition. Fortunately, the high risk cancer gene faults that run in some families are quite rare.

Sometimes, there is no clear reason why cancer develops. However, the risk of getting some cancers is increased by certain lifestyle factors, such as smoking and poor diet.

According to Cancer Research UK, half of all cancers could be prevented by making lifestyle changes such as taking regular exercise or eating a healthier diet. Eating five portions of fruit and vegetables a day can reduce the chances of you developing certain types of cancer by as much as 80%. Taking regular exercise can reduce the chances of you developing cancer by 25%.

Why given a PSA test?

A PSA test is a blood test that measures the amount of prostate specific antigen (PSA) in the blood. In men, PSA is made by the prostate and is found naturally in small amounts in their blood. However, a raised PSA level can sometimes be a sign of prostate cancer and other conditions.

Prostate cancer is common in older men. Unlike many cancers, you can have prostate cancer for many years without any symptoms. This is because most prostate cancers grow very slowly and don't spread to other parts of the body. Therefore it may never need treatment. By the age of 80, half of all men will have some cancer cells in their prostate, but only 1 in 30 will die from it.

There is no evidence that a PSA screening programme for all men would cut deaths from prostate cancer. This is because around one fifth of men who have prostate cancer don't have a raised PSA level. Also, around two in three men who have a raised PSA level don't have prostate cancer. A slightly raised PSA level can also be a sign of a prostate infection, or enlargement of the prostate.

Therefore, your GP won't suggest that you have a PSA test unless you have other symptoms of prostate cancer such as urgent or very frequent need to urinate, or difficulty starting and stopping urination.

If a test reveals high levels of PSA in your blood, a biopsy (a small sample of tissue) will need to be taken to confirm if you have prostate cancer, and if it is likely to grow and spread to other parts of the body.

How to check my breasts correctly?

• Most of us know that an early sign of breast cancer can be a lump in the breast, but it can be difficult to know what you are looking for.

Being 'breast aware' can help you to recognise changes in your breasts that are not normal for you.

What's normal?

The first thing to remember is that every woman's breasts are different.

Get to know how your breasts normally look and feel - but remember that they may change at different stages of your menstrual cycle (before the menopause). This is because the milk-producing tissue in your breast is active for a few days before you get your period. During this time some women notice that their breasts feel tender and lumpy.

Getting to know what is normal for you will help you spot any changes.

How they look

Just by looking at your breasts you will be able to see if the outline or shape of them has changed, especially when you raise your arms or the breasts themselves. Keep an eye out for any dimpling or puckering of the skin.

How they feel

Get used to how your breasts feel at different times of the month. Do this whenever it suits you, but it does not have to be in a particular way or at a particular time.

Feel for any lumps, thickening or bumpy areas in the breast and armpit that are different from the same area on the other side.

Any discomfort or pain in one breast that is new and persistent also counts as a significant change.

Your nipples

Keep an eye out for any nipple discharge that is new but not milky. Also take note of bleeding or moist red areas, rash on or around the nipple, or changes in the position.

What do I do if I notice a change?

There are many reasons for changes like these and most of them are not serious.

In fact, 9 out of 10 breast lumps are benign, which means they are not cancerous. However, you should always visit your GP as soon as possible to be on the safe side. If there is a breast cancer present, the sooner it is diagnosed, the better the chance of successful treatment.

If you are over 50, it is also recommended that you have a regular mammogram, which is an x-ray procedure that detects early breast changes. Your GP will be able to tell you about the NHS Breast Screening Programme, which provides free screening every three years for all women over 50 in the UK. Women aged between 50 and 70 are routinely invited to attend a breast screening appointment.

Women over the age of 70 are not routinely invited for screening, but are encouraged to contact their local screening unit and request screening every three years.

If you have a family history of breast cancer (for example, your mother or sister have been affected by the disease), you may be at increased risk yourself. Your GP will be able to give you more information on family history of breast cancer, and advise whether you may be a candidate for monitoring on a more frequent basis.

Alcohol and drugs

Drinking alcohol can be harmful when combined with certain cancer treatments and antidepressant medications, so you will need to check with your GP or specialist. If it is safe for you to drink, continuing to socialise can be a positive thing when you are going through cancer treatment, a welcome distraction, and a way of not feeling different from everyone else.

However, remember that too much alcohol can actually cause problems. It can be damaging to relationships, reduce the quality of your sleep making you feel more tired, and have a depressant effect making you feel even more low. So keep alcohol to a minimum.

Recreational drugs can make you feel better short-term, but long-term they may be very damaging to your health, and should be avoided altogether.

Exercise

Regular exercise really can help you to feel better because it makes your body produce mood-enhancing chemicals. Speak to your GP or cancer specialist first though, and don't push yourself beyond what feels comfortable. Even just going for a walk every day, or taking a yoga class, could help you to feel more positive.

Talking to someone

Everybody is different, and while some find it easy to be open with a partner, close friend or family member, some find those closest to them the hardest to open up to. This is often due to worry about how those feelings will affect them.

There is no right or wrong way, but for your emotional well-being, it is usually a good idea to express your feelings to at least one person. That person might be your GP, specialist, nurse, counsellor, friend, partner, another person who has cancer, or even your whole support group.

Some people find that it is easier to manage emotions such as anger, frustration and sadness if they learn relaxation techniques, such as visualisation, meditation or progressive muscle relaxation. Your cancer nurse will be able to tell you more about these techniques, and also about complementary therapies such as acupuncture, aromatherapy, massage, homeopathy and reflexology.

There are many health professionals involved in cancer care, such as the Macmillan nurses, who will be happy to help you get through the emotional side of having cancer, as well as the physical side. Counsellors, clinical psychologists, psychiatrists and community psychiatric nurses (CPNs) are specifically trained to help people with conditions such as depression. Your GP or cancer specialist will be able to talk to you about referring you to the most appropriate health professional, should you need them.

Sleep problems

Many people with cancer have problems sleeping at some point. This may be due to feeling unwell because of the cancer, or the cancer treatment, or because of anxiety or finding it hard to relax. Speak to your GP, specialist or nurse if you have trouble sleeping. These bedtime tips may also help:

• Before bed, have a bath with a few drops of lavender oil (lavender-scented pillow spray can also help).
• Have a warm milky drink before bed.
• Cut down on caffeine, especially in the evenings.
• Avoid alcohol - it may make you feel sleepy at first, but it actually disrupts your sleep.
• Get some regular gentle exercise, if possible.
• Try to get used to a regular bedtime routine; go to bed at the same time every night.
• Try a relaxation tape.
• If you wake up in the night, try not to worry about it. Get up and do something for a while until you feel sleepy again, and then go back to bed. Don't lie in bed tossing and turning; it can make you feel anxious.

If you are resting a lot during the day, and not sleeping at night, it might be worth a change to your routine. If you feel up to it, stay out of bed during the day, but without overdoing it. Perhaps just have one short sleep during the day if you feel you need it.

Anxiety and panic attacks

Feeling very worried about something, such as having cancer or cancer treatment, can sometimes turn into anxiety and panic attacks. Feelings of anxiety may come and go, or be present all of the time.

Symptoms of anxiety and panic attacks can include:

• shaking,
• over-breathing (hyperventilating),
• breathlessness,
• palpitations,
• tense muscles,
• dizziness,
• sweating,
• dry mouth, and
• chest pain.

If you're experiencing any of the symptoms, speak to your GP as soon as possible. They will be able to help you control the panic and anxiety. They may refer you to a counsellor, as talking therapy can often be an effective treatment.

Emotional effects of having cancer?

When you are first told you have cancer, it may be difficult to take in. The first emotions that you go through may be shock and confusion. If it is difficult to take in what the doctor is telling you, try to keep asking questions until you feel satisfied that you understand. If necessary, make another appointment for another day and ask the questions again.

Hearing your diagnosis, and facing treatment, can make you feel a wide range of strong emotions. Many people feel a combination of anger, fear and sadness. Over time, these feelings can become easier to deal with, but if that is not the case for you, don't worry - there is help available and there are ways of coping.

Will cancer affect my sex life?

Some aspects of cancer and cancer treatments such as radiotherapy and chemotherapy may make you feel less interested in sex.

Feeling anxious, tired, depressed or nauseous can often reduce your desire for sex. Losing your hair, having a long-term tube (line) inserted, or having body-changing surgery such as a mastectomy (breast removal) or an orchidectomy (testicle removal) can also make you feel less desirable.

Talk to your partner about how you're feeling. It might help to explain that your lack of interest in sex is not personal, and to let them know what you are feeling. In turn, they may be able to reassure you about your concerns. Working through the issues together can help to bring you closer.

Talk to your GP or cancer specialist about your concerns as well, as some cancer treatments and antidepressants can affect your sexual desire. It may be possible to alter your medication.

Chemotherapy can sometimes bring on an early menopause in women, which itself can cause dryness of the vagina and lowered libido (sexual desire). HRT (hormone replacement therapy) can be prescribed for women with most types of cancer. Your GP will be able to advise you about your individual case. Creams and ointments that ease the problem of vaginal dryness are available from pharmacies.

If you have chronic pain that makes sex difficult or uncomfortable, you may find these suggestions helpful:

• Plan sex for the time of day that you know you are usually in the least amount of pain. This may be shortly after you take your painkillers, or when you are least tired. Plan some time with your partner for that time of the day, and try to make sure you'll have no interruptions.
  
  
• If heat helps soothe your pain, try using an electric blanket to warm the bed for a while before you have sex, or have a warm bath or shower with your partner. A gentle massage may also help.
  
  
• Remember that penetrative sex is not the only way to have a healthy sex life. Use masturbation, oral sex, erotic literature or sex toys if you and your partner find them stimulating.
  
  
• Talk to your partner. Be open with each other so that you both know what feels good and what feels uncomfortable. If you're in a lot of pain, it may be difficult for your partner to know. So be honest, and make suggestions.

Will I lose my hair if I have chemotherapy?

Hair loss, or alopecia, is one of the more well known side effects of chemotherapy. Whether or not you lose your hair depends on the type of chemotherapy drug that you are given.

Chemotherapy drugs attack the cancer cells in your body. However this may also affect healthy cells. This can include the cells of hair follicles. This may result in hair loss.

Some chemotherapy drugs cause no loss, or a very small amount of hair loss. Other drugs can cause a temporary loss of hair. This could be partial or a complete loss of hair.

Hair loss also depends on other factors. For example:

• The type of drug, or combination you are taking.
• The dose of drug you are taking.
• Your individual reaction to the drug.
• Your drug treatment in the past.

Ask your doctor about the hair loss you may encounter on the drugs you are being given. If the thought of losing your hair is causing you distress, ask your doctor if there is an alternative drug you can have that could make hair loss less likely. Sometimes, although not in all cases, there is a choice of drug treatments that you can have.

Treating your cancer must be your doctor's first priority. But, if you are having chemotherapy to make you feel better rather than to cure your cancer, then your doctor will want what is best for you. Discuss your options with your doctor.

Hair loss

You could lose other body hair such as hair on your arms and legs, chest hair and pubic hair. In some cases you could lose your eyebrows and eyelashes.

Remember that this is temporary, and after the treatment your hair will grow back.

Hair loss usually starts about 2 -3 weeks after you begin your treatment. However, this can vary.

Some patients can minimise the amount of hair they lose by using a cold cap. This treatment temporarily reduces the amount of blood flow in the scalp, so it limits the amount of drug that reaches your scalp.

However this does not work for everyone and can be uncomfortable to wear. It cannot be used for some types of cancer, (for example, leukaemia) as there is a risk that cancer cells could survive in your scalp. Talk to your doctor if you want to discuss the possibility of using a cold cap.

After your treatment

Hair usually starts growing back about 2-3 weeks after treatment finishes. Only in very rare cases does it not grow back. You may find that it grows back a different colour or texture.

When your hair starts to grow back, your scalp can be very scaly because of dryness. Washing your hair with aqueous cream when your hair is very short will help to moisturise your scalp. You can get aqueous cream from your doctors or from a pharmacy (chemist).

Hair usually grows back very fine at first but many people have a full head of hair after 4 - 6 months. You may find it looks different than it did before your treatment. Talk to your friends and family, or a hairdresser about how to make the most of your hair.

Coping emotionally

Losing your hair can be very difficult and can cause strong emotions such as fear, anger and depression. Also, hair loss means that your cancer is more visible, and is a constant reminder of your illness.

Remember that your reaction to hair loss is completely individual. Different people cope with it in different ways. Some people find it upsetting, some are not affected at all, whilst others find it is not as bad as they expected.

You may find other people's reaction to your hair loss difficult to deal with. They might seem uncomfortable and unsure of what to say. It may be helpful to raise the subject first. If you are comfortable talking about it, show it. This will help people to relax and they may be able to offer you help and advice.

Many people worry about a child's reaction to hair loss. Children are often very accepting. You could find a way to explain your hair loss to them in a way that suits you and the child.

Teenagers with hair loss can meet other children of the same age at the Teenage Cancer Trust. Ask at your hospital for more information. Often meeting others who are in a similar position can make you feel better as you can share experiences and swap advice and help.

There may be other people at your hospital that you can talk to. Other patients and staff may be able to offer advice and personal hints on how you can cope. You could attend a support group where you will meet others in a similar situation.

If you feel you need help, talk to your doctor. Talk to a family member or friend, someone who you trust and who will help you get through this time.

Your appearance

Losing your hair may make you feel as though you look very different. There are ways in which you can increase your confidence in the way you look, and feel comfortable with the situation.

Women can make the most of facial features by putting on make-up, wearing pretty jewellery, or wearing bright colours to divert attention away from wigs or headwear.

Men could also wear bright colours, or find a style of hat or cap that suits them. These could all help enhance your appearance and confidence.

If you lose hair on your eyebrows, you could visit a beauty salon or beauty counter for tips on how to draw eyebrows in with an eyebrow pencil. Eyebrow pencils are available from chemists or beauty shops. If you lose your eyelashes, you could use false ones if you so wish. These are available from most department stores. Ask staff to show you how to use them.

It may take a while to get used to how you look. Some people find that, at first, they don't feel as confident as they did before in social situations. However, try not to hide away. Continuing with your social life as much as possible will mean that you grow more confident as you spend time with others.

Wigs

There are many different styles of wig to choose from, many of them look and feel natural. You can have an acrylic wig, or a wig made from real hair. Real hair wigs look more natural but are more expensive and harder to look after. All wigs come with care instructions. Follow these carefully to make the most of your wig.

The nurses on the ward can arrange for a wig fitter to come and help you. It might help to have a family member or friend with you at this time. Together you can choose what colour and style will suit you. You may find it hard to make the decision as the thought of wearing a wig may seem strange. Take your time, talk to your loved ones and ask a trusted hairdresser for advice.

If you have your treatment as an inpatient, you will be entitled to an acrylic wig provided by the NHS. If you don't qualify for a free wig, you may be able to receive financial help to cover the cost.

Making the most of your appearance after hair loss

The loss of hair caused by chemotherapy does not mean that you cannot look attractive or natural. Take your time to find out what will suit you and make the most of your appearance. Some people find that they enjoy experimenting with new looks and styles.

Some people feel that they are comfortable with being bald. Others may prefer to wear wigs, hats, scarves or other headwear. Always do what feels best for you. If you wish to disguise your hair loss, there are a variety of ways you can do this.

Before and during hair loss

There are some practical tips on how you can cope with hair loss:

• Ask your doctor or nurse if your drugs are likely to cause hair loss.
• If your drugs can cause hair loss, think about cutting your hair shorter before treatment starts. This could help to minimise hair loss as it reduces the amount of hair pulling on your scalp.
• Ask your doctor about wigs before you start your treatment. This means that if you want to, you can match the colour and texture of your hair as closely as possible.
• Some hospitals have staff that can show you different types of headwear and give you ideas and tips. Some hospitals run hair and beauty programmes. Ask your hospital or doctor for information.
• Talk to your friends and family for ideas on which wigs or headpieces would suit you.

The first thing you may notice is your hair starts to come out when you wash, brush or comb it. You could wake up to find hair on your pillow.

Some tips on looking after your hair during this phase:

• Use gentle hair products, such as baby shampoos.
• Use a soft baby brush to brush your hair, and try not to comb or pull too hard.
• Don't dye your hair as it may weaken your hair.
• Perms involve pulling on the hair so it may be best to avoid them.
• Try not to use hairdryers, straighteners or curlers on your hair. Try gently patting your hair dry instead. Talk to your hairdresser about other ways you can style your hair.
• Wear a hair net at night so you won't wake up with hair all over your pillow as this can be upsetting.
• Some people find that cutting off their hair or shaving their heads before treatment starts can help them keep a sense of control. You may prefer this to waiting for your hair to fall out. Think about what is best for you.

Before and during hair loss

There are some practical tips on how you can cope with hair loss:

• Ask your doctor or nurse if your drugs are likely to cause hair loss.
• If your drugs can cause hair loss, think about cutting your hair shorter before treatment starts. This could help to minimise hair loss as it reduces the amount of hair pulling on your scalp.
• Ask your doctor about wigs before you start your treatment. This means that if you want to, you can match the colour and texture of your hair as closely as possible.
• Some hospitals have staff that can show you different types of headwear and give you ideas and tips. Some hospitals run hair and beauty programmes. Ask your hospital or doctor for information.
• Talk to your friends and family for ideas on which wigs or headpieces would suit you.

The first thing you may notice is your hair starts to come out when you wash, brush or comb it. You could wake up to find hair on your pillow.

Some tips on looking after your hair during this phase:

• Use gentle hair products, such as baby shampoos.
• Use a soft baby brush to brush your hair, and try not to comb or pull too hard.
• Don't dye your hair as it may weaken your hair.
• Perms involve pulling on the hair so it may be best to avoid them.
• Try not to use hairdryers, straighteners or curlers on your hair. Try gently patting your hair dry instead. Talk to your hairdresser about other ways you can style your hair.
• Wear a hair net at night so you won't wake up with hair all over your pillow as this can be upsetting.
• Some people find that cutting off their hair or shaving their heads before treatment starts can help them keep a sense of control. You may prefer this to waiting for your hair to fall out. Think about what is best for you.

Hair loss caused by cancer treatments?

Many people feel that their hair is an important part of their appearance. The loss of hair can be distressing, during what is already a difficult time. It can be difficult to know what to do, both practically and emotionally.

When do I introduce solids to my child?

For the first six months, breast milk - and/or substitute milk - provides all the nutrients and fluids that your baby needs. The Department of Health recommends that solid food should not be introduced before a baby is six months of age. Also, that after six months, you should continue breastfeeding and/or giving your baby breast milk substitute, alongside solid food for up to two years of age, or beyond.

You should not give your baby cows' milk to drink before the age of 12 months.

Weaning
Introducing solid food is known as weaning. It is not recommended before your baby is six months of age because the infant digestive system, and kidneys, are not usually developed enough to deal with solid food.

Soft, runny foods should be given when weaning your baby because babies are not able to chew at this age. Start with baby rice, cooked and pureed vegetables, such as carrot, or butternut squash, avocado, or fruit, such as banana, or stewed eating apple. As your baby gets older, you can slowly introduce textured foods, such as lumpy purees, rice cakes, or breadsticks, which will teach them to chew.

Meat, fish, dairy products, and pulses, are all excellent sources of iron and protein, and are important for sustaining the rapid rates of growth and development in your baby.

Liquid drops containing vitamins A, C, and D are recommended for infants who are over the age of six months, and who are receiving breast milk as their main drink. They are available from your health visitor, or baby clinic. Formula milk is fortified with these vitamins, so infants who are drinking it, do not require the supplement, unless they were born prematurely.

Commercial baby foods
There are many brands of commercial baby foods that come in jars, ready to eat. Organic varieties, which are grown without pesticides and other chemicals, are also becoming more widely available.

Commercial baby food products can be convenient, and you may want to use them from time to time. However, you should not rely on them. Wherever possible, you should give your child fresh food; home cooked meals are inexpensive and you know exactly what has gone into them.

Cooking in batches for freezing is also a good idea, particularly for purees, which are only eaten in small amounts (and can be frozen in ice-cube trays for ease of use). Develop your child's senses by introducing a variety of tastes and textures.

Mealtime equipment
Buying a few pieces of useful equipment can make mealtimes easier, and a less stressful experience all-round. A rubber-tipped spoon will protect your baby's gums, and a plastic dish, with suction cups, can help keep your baby's meal in place.

It is best to feed your baby while they are seated in a highchair, or an eating chair, because handing food to a baby that is crawling, or rolling about, could result in choking.

You should never leave your baby alone when eating because of the risk of choking.

Foods to be avoided
There are a number of foods that should be avoided in the diet of a young infant. These are outlined below.

Gluten
Gluten is a protein that is found in certain cereals, such as wheat, rye, barley, and oats. You should avoid giving foods containing gluten to young infants, particularly those under six months of age. This will reduce the risk of your child developing a reaction to gluten called coeliac disease.

Salt
Do not add salt to your baby's food because their immature kidneys are unable to process it. Children between the ages of 1-3 years should have no more than 2g of salt (0.8g sodium) a day.

Sugar
You should restrict the amount, and frequency, of sugary foods and drinks, in your child's diet because they can damage their teeth and cause tooth decay.

Shellfish
Shellfish may cause an allergic reaction in young children. Some types of fish, such as shark, marlin, and swordfish, may contain relatively high levels of methylmercury, which can affect the nervous system. See the 'further information' section for more information.

Whole and chopped nuts
Whole and chopped nuts should not be given to children under five years of age due to the risk of choking. Peanuts have been linked to allergy in some families that have a tendency for inherited conditions, such as asthma, eczema, and hay fever.

Mothers from these families may be advised to avoid peanuts while they are pregnant, and breastfeeding, and to remove peanuts from their child's diet until they are three years old. This reduces the risk of them developing an allergic sensitivity to nuts, although severe nut allergy is rare (affecting less than 1% of the population).

Honey
Honey should not be given to infants who are under one year of age because it may contain harmful bacteria.

Eggs
Do not give eggs to young infants, particularly those who are under six months of age. Eggs prepared for older infants and children should be thoroughly cooked (both the white and the yolk).

How can I tell if my baby is ill?

Parents are usually good at noticing when something is wrong with their baby. However, many parents worry that they won't recognise the signs that their baby is unwell.

Symptoms that require emergency medical attention

You should dial 999 immediately if you find your baby:

• is not breathing,
• is unconscious,
• seems breathless, or is breathing much faster than usual,
• looks very pale, or their skin is blue or dusky around the lips,
• is having a convulsion (fit),
• has cold hands or feet, but also has a fever (a temperature over 38C or 100.4F),
• feels floppy or limp (perhaps when cuddled), or
• has a raised, tense or bulging soft spot (fontanelle) on their head.

If your baby displays any of the above symptoms, it is very important that you dial 999 straight away. This is because these symptoms are often a sign that your baby requires urgent medical attention. If you seek attention promptly, then your baby can receive any necessary treatment as soon as possible.

How to take a young child to hospital

If you and your child need to go to hospital, reassure your child and explain that you're going together to see the doctor at the hospital to make things better:

• take a favourite toy with you,
• dress your child in a coat or a dressing gown over their nightclothes, or dress your child fully (it doesn't matter which - do what seems most sensible),
• arrange care for other children or, if this is not possible, take them as well (it is not wise to leave a child at home without an adult there to look after them),
• if your child takes regular medication, take it with you, and
• don't forget to leave a note, and take your keys, handbag or wallet with you.

Hair loss in alopecia

1.Alopecia: Various types of hair loss or balding.
2.Alopecia: baldness; absence of hair from skin areas where it is normally present.
Source - Diseases Database
3. Alopecia: loss of hair (especially on the head) or loss of wool or feathers; in humans it can result from heredity or hormonal imbalance or certain diseases or drugs and treatments (chemotherapy for cancer)

Causes, Symptoms and tratment of Abdominal Pain

Watch for These Symptoms
We will ask that you watch for the development of the possible symptoms listed and return or seek additional
medical attention if:
• The pain becomes worse or changes location.
• You have an increase in fever or develop shaking chills, or develop a fever.
• You vomit many times or your vomiting persists.
• You see blood in your urine, vomitus, or bowel movements
• You move your bowels many times or your bowel movements stop (become blocked), or you cannot pass
gas.
• Your skin or the whites of your eyes look yellow.
• Your abdomen (stomach) becomes swollen or seems larger.
• The pain is not completely gone in 24 hours.
• You develop any dizziness or bleeding.
• You develop chest pain or discomfort of any kind.
Remember that the cause of abdominal pain often cannot be determined from one clinician visit.
Please Read
You develop any new, prolonged, or more severe symptoms of your illness, call the advice consult your clinician.

Acne Vulgaris

Acne is a chronic inflammatory skin condition common in adolescence, but occasionally occurring intermittently
throughout life. It is characterized by skin eruptions on the face, chest and back and is more common in males than
in females.
Frequent Signs and Symptoms
• Blackheads (black spots the size of a pinhead).
• Whiteheads (white spots similar to blackheads).
• Pustules (small pus-filled lesions).
• Redness and inflammation around eruptions.
• If acne is severe, cysts (larger, firm swellings in the skin), and abscesses (swollen, inflamed, tender area of infection
containing pus).
Causes
Oil glands in the skin become plugged for unknown reasons, but sex-hormone changes during
adolescence play a role. When oil backs up, it becomes infected by bacteria normally present in
glands. Contrary to myth, acne is not caused by dirt, masturbation or foods. Cleanliness can lessen it, but sexual activity has no effect on it.
The risk increases with:
• Exposure to extremely hot or cold
temperatures
• Stress
• Oily skin
• Endocrine disorders
• Use of drugs, such as cortisone, male hormones, or some oral contraceptives.
• Family history of acne
• Some cosmetics
Preventive Measures
Cannot be prevented at present.
Expected outcomes
• Most cases respond well to treatment.
• Despite good treatment, acne will flare up
from time to time.
Possible Complications
• Poor self-image and psychological distress.
• Permanent facial scars or pitting of the skin.
Treatment
General Measures
• If your skin is oily, cleanse it as follows:
o Gently massage face with unscented soap for 3 to 5 minutes.
Don’t massage sorest places.
Cleanse skin gently (rough scrubbing spreads infection).
o Rinse soap off for 1 to 2 minutes.
Sometimes an antibacterial soap will help.
o After cleansing, use an astringent, such as alcohol, to remove oil.
o Use a fresh washcloth each day. Bacteria grow in damp wet cloths.
• Shampoo hair at least twice a week. Don’t
let hair hang over the face even at night. Hair spreads oil and bacteria. Use dandruff shampoo to treat or prevent dandruff. Avoid cream rinses.
• After vigorous exercise, wash the sweat and
oil off as soon as possible.
• Avoid the heavier oil-based cosmetics and
use the thinner, lotion-style, water-based
ones.
• Avoid moisturizers unless prescribed by
doctor.
• Don’t squeeze, scratch, pick or rub the skin.
Acne heals better without damage to the
skin. Removal of comedones (blackheads)
may be done by the doctor.
• Don’t rest your face on your hands while
reading, studying or watching TV.
• Exposure to ultraviolet light may be a
recommended treatment.
• Cosmetic surgery (dermabrasion) may be
recommended to remove unsightly scars
after acne heals.
Medications
Many treatments require several (4-8) weeks of
consistent use before improvement is noticed. It is
not uncommon to have some worsening of symptoms
before improvement occurs.
Over-the-counter
• Benzoyl peroxide, 2.5%, 5%, and 10%
Prescription
• Oral and topical antibiotics
• Retinoids (must avoid sun or use sunscreen)
• Accutane only for severe, cystic acne
(usually prescribed by a specialist)
• Cortisone injections
Activity
No restrictions
Diet
Foods don’t cause acne, but some foods may make it worse. Keep a record of the foods you eat. To discover any food sensitivities, eliminate foods from your diet that you suspect make your acne worse.
Then reintroduce them one at a time. If acne flares up 2 or 3 days after a food is eaten, leave it out of your diet. If not, you may eat it. Acne usually improves in the summer, so some foods that cannot be eaten in the winter may be tolerated in the summer.

Yeast Infection Diagnosis and Treatment

Yeast Infection

Yeast infections or Candida vulvovaginits are one of the most common gynecologic complaints women bring with them to the doctors office. A fungus called Candida albicans is responsible for most of your signs and symptoms of yeast infections.

Yeast infections affect 75 percent or more of women during their reproductive years. The diagnosis and treatment of yeast infections should be performed by your health care professional, to avoid a recurrent problem interfering with your health and well-being. Though yeast infections in adolescents are rare, at least 50% of women will have one yeast infection before they turn 25.

Biology and Risk Factors for Yeast Infection
While Candida albicans is to blame for almost all yeast infections, other candida strains may also result in recurrent yeast infections. The reasons for this may include use of over-the-counter drugs, antibiotics or short instead of long course use of antifungal drugs that combat the condition.

Here is a list of some of the most common causes for yeast infections or vulvovaginal candidasis:

• Frequent use of antibiotics: Some women are prone to yeast infections when they take antibiotics, because antibiotics often destroy both good and bad flora in the body. Supplementation with oral or vaginal lactobacillus tablets may help combat yeast infections associated with antibiotic use.
• Oral contraceptive pills: Some women are at higher risk for yeast infections when they take oral contraceptives that contain high levels of estrogen in them.
• Use of contraceptive devices: Certain contraceptives including vaginal sponges, intrauterine devices and diaphragms can irritate the lining of the vagina and contribute to yeast infections.
• Pregnancy: Women who are pregnant are more likely to develop yeast infections, secondary to the hormonal changes seen with pregnancy.
• Suppressed Immune System: Yeast infections are common in patients whose immune systems are suppressed, including women taking corticosteroid medications or women with HIV.

Yeast infections can occur in women who are not sexually active just as easily as women who are, thus it is important not to confuse yeast infections with sexually transmitted diseases though the two can exist at the same time. However, women do experience more yeast infections with regular sexual intercourse than when they are celibate.

People with weakened immune systems including patients with HIV, cancer or other serious illnesses may develop a yeast infection that spreads throughout the body. This condition can be life threatening, affecting the brain, eyes, kidneys and other major organs of the body.

Sometimes these patients may also develop a systemic yeast infection, where yeast enters the bloodstream through a cut or tear in the skin. Many people with HIV develop a yeast infection in the upper gastrointestinal system called esophagitis. This type of yeast infection is similar to oral candidiasis but spreads through the esophagus to the stomach. This can make eating and even swallowing liquids painful.

Signs and Symptoms of Yeast Infection
Most women are aware if they have a yeast infection because of the telltale symptoms that go with an infection.

• Vaginal discharge that is white. The discharge often has a cottage cheese like appearance.
• Itching or burning in the vagina and in the area surrounding the vagina.
• Swelling around the vulva and vagina.
• Pain or discomfort during intercourse.

Most women will have a yeast infection at least once during their lifetime, though many will have more than one.

Yeast infections can also occur in the mouth, a condition called oral candidiasis or thrush. This is most common in infants and babies. Oral thrush often comes with thick white patches in the mouth, usually on the tongue and sides of the cheeks. These white patches may look like milk curds, but usually can’t be wiped away. Oral candidiasis can be painful and make it difficult to eat.

Diagnosis and Treatment of Yeast Infection
It is important that you see a qualified doctor to diagnose a yeast infection before you begin treating it. There are many conditions that mimic yeast infections. If you use an over-the-counter remedy to treat a yeast infection that is something else, such as bacterial vaginosis, your condition will not improve and may get worse.

It is important that you do not douche or overly clean your vagina prior to your exam, so that your test results will be accurate. The actual test used for a yeast infection is quick and easy. Your healthcare provider will take a sample of your vaginal discharge and look at it under a microscope. The fungus can be easily identified with this technique.

The fungi that cause yeast infections thrive on all surfaces of the body. Yeast infections may take many forms including thrush, diaper rash and other skin infections. Yeast infections are most common in areas of the body that are warm and moist.

You should see your doctor for treatment if you have recurring yeast infections or if you have symptoms of a yeast infection that last for one week or more.

Most yeast infections can be treated with over-the-counter topical antifungal creams. The most common of these include:

• Miconazole
• Tioconazole
• Butoconazole
• Clotrimazole

Miconazole Vaginal Cream
Miconazole vaginal cream is the generic name for the brand names: Femizole-M Vaginal Cream, Monistat 3 Vaginal Cream, Monistat 7 Vaginal Cream, and Monistat Vaginal Cream.

Miconazole or Monistat is an antifungal that is used as a vaginal cream or suppository. It is used to treat the most common type of yeast infection due to Candida. These products all relieve the itching and burning symptoms that are common with vaginal yeast infections. The products are available in a 1-day (prescription only), 3-day and 7-day treatment courses.

Miconazole vaginal tablets are use in the vagina only, where as the Miconazole vaginal cream maybe used around the vagina as well.

If you miss a dose, use it as soon as you remember and if it is almost time for the next dose use only that dose. Do not use double or extra doses.

Miconazole products should not be used with the blooding thinning drug, Warfarin. It will increase the thinning of blood and may increase bruising and cause bleeding.

It is better to abstain from sexual intercourse until you have finished your treatment. Do not rely on condoms, diaphragms, cervical caps or other barrier devices to prevent pregnancy while using Miconazole products. Miconazole will weaken these devices and can interfere with the proper action of spermicides. This may lead to unwanted pregnancy.

If your clothing gets soiled with the vaginal cream you can wear a sanitary napkin, but not tampons. The tampons will absorb the medication and decrease the efficacy of the medication and require a longer or repeated treatment.

Tioconazole Vaginal Ointment
Tioconazole (Vagistat-1) is an antifungal onitment that is used to treat monilia yeast infections of the vagina. Tioconzaole vaginal ointment should only be used in the vagina. Use the ointment at bedtime by gently inserting the applicator in to the vagina and push the plunger fully to release the ointment. Only one dose is needed for treatment of your yeast infection.

Butoconazole Vaginal Cream
Butoconazole Vaginal Cream is the gneric name for the brand names, Femstat, Gynazole 1, Myselex 3. Butoconzaole vaginal creams are antifungal agents that relieve the symptoms of yeast infections. They are available in 1-day or 3-day treatment approaches.

Clotrimzaole Vaginal Cream
Clotrimzaole Vaginal Cream is the generic name for the brand name antifungals Gyne-Lotrimin, Bynix, Mycelex-7, Myselex-G and Trivagizole. They all are antifungal agents that treat the symptoms of yeast infections. Both vaginal tablets and vaginal creams are available for Clotrimazole products.

Tell your health care professional if your symptoms do not improve after 3 days of use with Clotrimzaole products. Do not use for more than one week. If you are pregnant or think you might be pregnant, notify your physician prior to using non-prescription products.

Yeast infection Prevention
Fortunately there are several steps you can take to avoid recurring yeast infections.

Here are some tips for preventing yeast infections in the future:

• Avoid wearing tight clothing that may cause irritation of the vaginal and surrounding tissue.
• Wear cotton undergarments when possible.
• Avoid wearing synthetic fiber clothing.
• Avoid wearing panty hose or leotards for extended periods of time.
• Make sure your genital area is dried off completely before you get dressed.
• Don’t wear wet swimsuits or other damp clothing for long periods of time.
• Avoid douching or using feminine sprays regularly.
• Avoid scented tampons or performs.

Treating Recurrent Yeast Infections
Women who experience four or more yeast infections every year have a condition called recurrent vulvovaginal candidiasis. Up to 8 percent of women suffer from recurrent yeast infections.

Some women with weakened immune systems or those with unmanaged diabetes are more at risk for developing recurrent yeast infection.

Treating women with recurrent yeast infections is often more challenging than treating traditional yeast infections. One of the best ways to treat recurrent infections is to reduce the risk factors associated with infection.

Doctors usually proscribe longer antifungal therapy for women with recurring yeast infections. Reducing the sugar in the diet may also help reduce recurrent infections.

Occasionally your doctor may prescribe suppressive antifungal therapy that can be taken for six months. Typical drugs prescribed for recurrent infections include ketoconazole, intraconazole and clotrimazole.

Studies have also suggested use of a drug called fluconazole may help reduce recurrent vaginal yeast infections, however typically when therapy is discontinued yeast infections again develop.

If you suffer from recurrent yeast infections it is important you talk with your doctor about lifestyle factors that may contribute to your condition. It is possible that changes in your diet and personal habits may improve your condition dramatically. Following the prevention tips listed above may also help reduce the number of recurrences you experience every year.

Though yeast infections are an embarrassing and uncomfortable condition, they are also common. Be sure to talk with your doctor if you experience any of the symptoms of a yeast infection. Together you can come up with a treatment program that will help reduce your discomfort and improve your health and well-being.