Living with a long-term condition

At any one time in the UK, as many as 17.5 million adults may be living with a chronic disease.
There are thousands of chronic conditions which affect people from mid-life onwards, including:

• Heart disease.
• High blood pressure.
• Arthritis.
• Diabetes.
• Depression.
• Asthma.
• Irritable bowel syndrome.

Although many of these diseases can be serious or even potentially fatal, modern medicine has meant that most people can control their condition with close supervision, medication, surgery and other treatments, living with it for decades.
The older you are, the more likely it is that you have to manage some sort of chronic health problem. Almost three-quarters of people aged over 75 suffer from one or more longstanding illnesses. But even among 16- to 24-year-olds, one in four will be living with a long-term condition.

Day-to-day problems

Once someone is diagnosed with a chronic lifelong condition, they face problems such as:

• Ongoing physical symptoms, which may be controlled by medication, slowly progress or come and go.
• The need to take medication regularly, managing any side effects, or have other therapies or interventions.
• Managing work and sustaining an income despite their condition, which can cause financial difficulties.
• Psychological problems resulting from stress and anxiety.

All these factors can contribute to a reduced quality of life and sometimes a sense of social exclusion. Those who get involved in managing their condition by learning about the issues and working with their doctors, nurses and therapists, tend to cope better and gain more control over their bodies and lives.

Learning about your condition

Learning about your condition is the key to recognising what is happening to you. There are plenty of good information sources such as:

• Your GP practice.
• The local pharmacist.
• Your local library (they may be able to help you search online for reliable information).
• Patient support groups (most have some sort of national self help group which can provide information and even local meetings - try searching online for your condition if you haven't already).
• If you're worried then your GP (or sometimes specialist nurse) should be able to help check you out.

Recognising symptoms

You can help yourself by knowing what to do when symptoms get worse, or how to recognise significant new symptoms.

Using medicines

Learn how to use your medicines effectively (remembering which ones to take at the right times) and recognise any side effects:

• When prescribing a medicine, the pharmacist should always check that you understand how to use it. If you have any questions, go back and ask them.
• Read the information that comes with the medicine. It's good to know the possible complications or side effects (but try not to let these prey on your mind as most are usually rare or minor).
• Always keep a written note of what medicines you are on. This may be useful if you're suddenly taken ill, lose your medicines while out or need to check for side effects.
• Most medicines are recommended to be given at a specific time of day. In some conditions timings may be critical (such as in Parkinson's disease) so always make sure you understand when you should be taking them and why.
• If you have lots of medicines or problems remembering what to take, talk to your pharmacist about the many devices that people can use to help, such as dosette boxes (to carry your daily/hourly tablets) or even call services. Maybe just setting a timer at home or on your mobile phone will help.
• If you live in England and are being prescribed a new medicine for certain existing or newly diagnosed long-term conditions (asthma, chronic obstructive pulmonary disease, type 2 diabetes, high blood pressure, or if you have been given a new blood-thinning medicine) you may be able to get extra help and advice from your local pharmacist. Under a new free NHS service, you will be given a series of private appointments with the pharmacist to check how you are getting on with the medicines. Ask your pharmacist about this new medicine service.

Employment issues

You may find you have to deal with work issues such as negotiating flexible hours or time off:

• If you feel able to do so, talk to your employers, about your condition. However, you're not obliged to, and some people prefer to keep health issues private. If you can talk to someone, even if it's a supportive colleague rather than the boss, you may feel better for having someone who understands what you are dealing with, and who may be able to offer support over specific issues in the workplace.
• If you can, get advice about illness-related issues from your union.
• Find out what your entitlements are, regarding sick leave or flexible working.
• If things are getting difficult, your employers may be able to consider part-time work, different hours, a work-break or some sort of flexible working arrangement.

Staying positive

Coping with the psychological consequences of the illness can be tough, but staying positive can really help your outlook:

• It can be difficult with a chronic condition to stay optimistic, especially if you're continually battling unpleasant symptoms, but trying to spot what gives you particular stress or depression and finding strategies to deal with them will really help.
• Deal with practical or emotional issues as they develop, rather than letting them fester or weigh you down. If you take steps to take control, no matter how small, this empowerment alone will start to make you feel better.
• Following a regular lifestyle with a balanced diet, daily exercise (if possible) and plenty of rest and sleep is vital to coping with stress.
• Take time out regularly to relax or do something you enjoy.
• Most people benefit from having someone they can offload their feelings to - a family member, friend or maybe a professional.

Talk to your GP if you feel you need support from a counsellor, or you can't seem to get on top of things.

Help is available

There is a lot of help available for people living with a chronic condition:

• You can access help from social services or other voluntary and governmental sources or support agencies, including claiming benefits but local help can vary from area to area. It can be difficult finding out what is available locally and how to access it - talk to your surgery or local support groups for your condition.
• Your local social services department may be able to help, guiding you to claiming benefits or by appointing you a case manager if appropriate. Your GPs surgery may also be able to offer some advice.
• Check with relevant agencies - for example your bank, your employer or your faith organisation, to see if they have anything which could help your situation.
• Many charities offer help relevant to chronic conditions. The Red Cross hires out wheelchairs and other equipment for example, while Age UK can offer all sorts of advice for the elderly from claiming benefits to finding carers or a care home.

The NHS now runs self-management programmes (known as 'Expert patient programmes') designed to:

• Help people reduce the severity of their symptoms in chronic illness.
• Work more closely with NHS professionals.
• Improve their confidence and resourcefulness.

These may be general, with people attending who have a range of different conditions, or specific to one condition (such as arthritis, diabetes or stroke). The sorts of topics covered include:

• Setting goals and making action plans.
• Problem solving skills.
• Developing communication skills.
• Managing emotions.
• How to pace daily activities.
• Managing relationships with family, friends and work colleagues.
• Communicating with health and social care professionals.
• Finding other health care resources in the local community.
• Understanding the importance of exercise, keeping active and healthy eating.
• Managing fatigue, sleep, pain, anger and depression.

READMORE:http://www.bbc.co.uk/health

Dyspareunia (painful intercourse)

Causes of dyspareunia

Lack of sexual arousal is by far the most common cause of painful intercourse. When a women's body is ready for sex, the vagina expands both lengthways and widthways. While this is happening, it becomes moist and lubricated to avoid any friction. The vagina wasn't designed to be penetrated in its unaroused state.
If you're sure you're fully aroused but still experiencing pain, check with your GP that you aren't suffering from an underlying condition. These can include:

• Childbirth - it's quite common for women to suffer some discomfort after childbirth, particularly if there was an episiotomy (a cut to make delivery easier).
• Menopause - intercourse may be more painful during the menopause as lower oestrogen levels cause a thinning of the vaginal wall. Ask your GP or local menopause clinic about oestrogen cream, which usually resolves the problem quite quickly.
• Urinary infections - cystitis or vaginal irritations such as thrush, vaginitis and genital warts are also likely to cause soreness. Once the underlying condition has been diagnosed, a course of treatment should solve the problem.
• Sensitivity to condoms - you may be irritated by certain makes of condoms, contraceptive creams or lubricants. Experiment with different brands.

The problem with pain is that it blocks sexual arousal, which causes further pain. Many women find that they're caught up in a pain cycle - having experienced painful intercourse before, they fear more pain which blocks arousal, causing more pain and so the cycle continues.
If the pain is in your lower abdomen or to one side, you should see your GP to rule out any gynaecological disorder such as:

• Endometriosis
• Prolapse
• Ovarian cysts
• Fibroids
• Pelvic inflammatory disease

Another possible cause is uterine retroversion, a natural condition where the womb tilts towards the back of the pelvis. In all these conditions, you may find that a different position, where thrusting is not so deep, is more comfortable.
If you experience ongoing vulval discomfort then you should check with your GP to see whether you're experiencing vulvodynia or vulval vestibulitus. You can get more information on these conditions from the Vulval Pain Society.

Treatments for dyspareunia

There are a number of self-help techniques wich may help:

• Relax. This is the most important thing you can do. Have a bath, use deep-breathing techniques or buy a relaxation tape from your local health shop.
• Work on relationship issues. You need to be sure that your head and heart are in the mood for sex as well as your body. If you're unhappy about something with your partner then sort it out first.
• Exercise your pelvic floor. This will increase the blood flow to your genital area and make you more conscious of any sensations of physical arousal.
• Use lubrication to speed up the process; keep a tube by the bed.
• Stimulate your sympathetic nervous system with exercise, or anything that will speed up your heart rate. Research suggests that your body will be more sexually responsive 15 to 30 minutes later.

Don't worry if none of the self-help techniques work for you, it's likely that whatever is causing the pain is treatable once appropriate help has been found.
If you've been suffering from painful intercourse for a while, it's essential to check that you're not suffering from an underlying condition.
READMORE:http://www.bbc.co.uk/health

Sterilisation

What is sterilisation?

Sterilisation is a permanent method of contraception, suitable for women or men who are sure they never want children or don't want more children. Male sterilisation is called vasectomy.

How does it work?

Sterilisation works by stopping the egg and the sperm meeting. This is done by blocking the fallopian tubes (which carry the egg from the ovary to the womb) in women or the vas deferens (the tube that carries sperm from the testicles to the penis) in men.
Myths about sterilisation:

• It can easily be reversed. Not true - vasectomy and female sterilisation are difficult to reverse, involving major surgery that isn't available on the NHS.
• Vasectomy is like castration. Not true - vasectomy only involves cutting the tubes that carry sperm to the penis, nothing else is touched.

Male sterilisation

Usually under local anaesthetic, a small cut is made in the skin of the scrotum. The vas deferens are cut and tied or sealed with heat. The operation takes about 15 minutes and can be carried out in a clinic, hospital outpatient department or some general practice settings.
Vasectomy is very effective - about one in 2,000 male sterilisations fails.

Female sterilisation

Under local or a light general anaesthetic, a small cut is made in the lower abdomen. The fallopian tubes are cut and tied, or sealed or blocked, usually with clips.
Around one in 200 females sterilisations fails. The clip method is more effective.
Women considering sterilisation should always be given information about long-acting reversible contraception as these methods are as effective, or more effective, than female sterilisation.

When can I stop using other contraception?

Women should use contraception up to the operation and for four weeks afterwards.
Men will need to use contraception after vasectomy until a semen test shows there are no sperm. This test is usually done around eight weeks after vasectomy.

Advantages and disadvantages

The advantages of sterilisation include:

• After sterilisation has worked you don’t need to think about contraception ever again.
• There are no known serious long-term health risks.

The disadvantages of sterilisation include:

• The tubes may rejoin and you will be fertile again - although this isn't common.
• It cannot be easily reversed.
• It takes at least two months for vasectomy to be effective.

Other things to consider include:

• Sterilisation doesn't protect you against sexually transmitted infections.
• After sterilisation your sex drive and enjoyment of sex should not be affected.

Can anyone be sterilised?

Sterilisation is only for women and men who are sure they don't want children or any more children. It is a permanent method.
Although sterilisation isn’t 100 per cent reliable, and also a reversal can be attempted (although not on the NHS), it should be considered permanent and irreversible for anyone undergoing it. You shouldn't consider sterilisation if you're unsure, under any stress (for example after birth, miscarriage or abortion) or have any family or relationship crisis.
Research shows that more women and men regret sterilisation if they were sterilised when they were under 30, had no children or were not in a relationship.

Where can I be sterilised?

Sterilisation is free on the NHS from contraception clinics, sexual health clinics or general practice.
READMORE:http://www.bbc.co.uk/health

Contraceptive injection

What is it?

The contraceptive injection contains the hormone progestogen. There are two types of injection:

• Depo-Provera provides contraception for three months (12 weeks)
• Noristerat provides contraception for two months (eight weeks)

Depo-Provera is the most used injectable method in the UK. Injectable contraception is a long-acting method of contraception.

How does it work?

The main way it works is by stopping the ovaries releasing an egg (ovulation) each month. It also:

• Thickens the mucus in the cervix, making it difficult for sperm to reach an egg
• Makes the lining of the womb thinner so it's less likely to accept a fertilised egg

Myths about the contraceptive injection:

• It makes you infertile. Not true - but normal fertility can take up to a year to return after using Depo-Provera
• You can only use it for two years. Not true - it can be used for longer providing you do not have any risk factors for osteoporosis (being over 45, poor diet, low exercise or family history of osteoporosis)

How reliable is it?

It's more than 99 per cent effective. This means that using this method, fewer than one woman in 100 will get pregnant in a year. All long-acting reversible methods are very effective because while they're being used you don't have to remember to take or use contraception.

How to use the contraceptive injection

The hormone is injected into a muscle, usually in your bottom. Depo-Provera can also sometimes be given in the leg or arm. The injection can be started up to and including the fifth day of your period. If started at any other time, additional contraception has to be used for seven days.

Advantages and disadvantages

The advantages of the contraceptive injection include:

• It's very effective
• It doesn’t interrupt sex
• You can use it if you can't use oestrogens or are breastfeeding
• It may reduce heavy painful periods and help with premenstrual symptoms for some women
• It may give you some protection against cancer of the womb
• It may give you some protection against pelvic inflammatory disease
• It isn't affected by other medicines

The disadvantages include:

• Your periods may change in a way that is not acceptable to you, or they may stop
• Irregular bleeding may continue for some months after you stop the injection
• You may put on weight when you use Depo-Provera
• Some women report having headaches, acne, mood changes and breast tenderness
• The injection lasts for eight or 12 weeks, so if you have side effects they will continue during this time and for some time afterwards
• Your periods and normal fertility may take some time to return - more than a year for some women
• The evidence about the risk of breast cancer in women using hormonal contraception is contradictory, but research suggests that women who use hormonal contraception may have a slightly increased risk of being diagnosed compared to women who don’t use it

Other things you may want to consider include:

• Once you've had the injection you don't need to think about it until it needs replacing
• You don't need a cervical screening test or internal examination to have the injection
• It doesn't protect you against sexually transmitted infections
• Depo-Provera affects your normal oestrogen level, which may cause thinning of the bones, but once you stop, any risk is reversed - women aged under 18 and over 45 will be carefully counselled about this

Can anyone use it?

Most women can have the contraception injection, but it may be unsuitable if you:

• Think you might already be pregnant
• Want a baby within the next year
• Don't want your periods to change
• Have thrombosis, heart or circulatory disease
• Have active liver disease
• Have breast cancer now or within the past five years
• Have migraines with aura
• Have diabetes with complications or have had diabetes for more than 20 years
• Have risk factors for osteoporosis

Where can I get it?

Injectable contraception is free on the NHS from contraception clinics, sexual health clinics and general practice.
READMORE:http://www.bbc.co.uk/health