Health chat with Dr Keith Hopcroft - Part 2
Dr Keith Hopcroft made his second visit to TheSite.org chat to answer your questions on sciatica, sex after pregnancy and skin tags.
Jim_V: Hi everyone, welcome to the chat. I'm going to start with a question from briggi.
briggi: What method of pain relief is most effective for sciatica? I've been on several anti-inflammatories for it over the last two years. The most recent being Fenactol which I believe is from the same family as Nurofen and has not been helpful at all. I'd just be interested to hear a second opinion, if you've got one. Also do you have any advice on alternative therapies for it, if that phrase is not a mortal insult? I know to stay away from stimulants like caffeine and I have tried all kinds of pillow origami but any other tips (medicinal or otherwise) are always welcome!
Dr_Keith: Assuming it is actually sciatica, it sounds like it has gone on for a long time. There are two things to look at and one is to try and relieve the pain. There's no one magic bullet and if you've tried several anti-inflammatories then it's worth asking your doctor to try a few more. On top of that you can try pain killers like paracetomal. There's no evidence that alternative therapies are of any use whatsoever so I wouldn't go down that line.
Secondly, even though sciatica can be prolonged, when someone has problems for many months it is a worry and we'd consider referring them to a specialist to have their spine scanned to find out if specialist treatments are required. If it definitely is sciatica then physiotherapy can help and surgery might also be an option.
rach: I want to ask about loss of appetite. I'm not avoiding eating, I'm just not hungry.
Dr_Keith: Can you tell me how long this has been going on for, if you're losing any weight and if you have any stomach pains or are under any stress or worry.
rach: I've been missing meals for a few weeks but it's more just a casual realisation at the end of the day that I haven't eaten. It's because of depression.
Dr_Keith: Loss of appetite isn't just treated using appetite stimulants as it's important to get the root of the problem. Stress and worry are the most common problems. There are several methods for dealing with depression such as talking treatments, self-help or seeing your GP for antidepressants if it's really severe.
rach: Thanks, I think it's the result of CBT because it's quite intense.
Dr_Keith: Generally if you have a poor appetite it's important to eat even a little regularly, especially for breakfast. If you leave your tummy empty for long periods then the acid has nothing to work on so it works on the stomach lining giving you an acidic sicky feeling which will reduce your appetite. It will become a vicious cycle if you're not careful. Hope that helps rach.
rach: Yes thanks, it does.
Hellfire: Since my girlfriend gave birth to our son seven months ago, sex has been really hard. We've managed it a few times but it hurts a lot for her. Her vagina isn't too tight; it seems to be just sore.
Dr_Keith: Did she have any trouble with the delivery, for example did she have stitches, and is the trouble on the outside or deep inside?
Hellfire: She had an episiotomy and some stitches. The trouble is inside, but not deep inside.
Dr_Keith: The likelihood is that her soreness is probably linked to scarring from the surgery. As sex is painful she is probably getting tense and when her muscles tighten the soreness will get worse. She needs to see her GP, preferably when she's not having a period, knowing she will need to be examined. She might like to ask specifically to see a woman. There are various things that can be done to help this problem.
Hellfire: Thank you Dr_Keith.
xsazx: What can you suggest as methods of self-help for dealing with depression?
Dr_Keith: The key methods of self-help include looking at healthy diets, taking plenty of exercise as it can release chemicals in the brain that are very much like antidepressants, having a regular routine, getting adequate sleep and going to bed at sensible times.
It's also worth having a look at things that may be causing or keeping the depression going such as family problems, money worries, alcohol or drugs. Making a list on a piece of paper of things that are getting you down, alongside strategies that can help sort them out, can also help.
If you're bottling things up then it's worth talking things through - not necessarily to get advice, but as a release. It may not solve problems but it can be therapeutic.
It's also important to keep a social network going and motivate yourself so you don't become isolated. Having said all that, if you feel you're spiralling then it is important to seek help, starting with your GP.
xsazx: I don't smoke, drink or take drugs so that's OK. My diet is appalling as I was anorexic a few years back and I'm on the verge again apparently. My GP is useless when I complain that I'm throwing up blood and acid and can't eat without feeling sick and dizzy for hours after. I haven't eaten in three days now and I'm still not feeling hungry. Although I'm not sure if that's more down to the fact I no longer want to live and I'm considering overdosing and have started self harming again.
Dr_Keith: If you feel there's a risk of you doing this straight away then you do need help right now. Perhaps turn to a family member or other help service. If there's really nowhere else to turn then you can always go to casualty. If you have these thoughts often, but don't always act on them straight away, then you should go to see another doctor in your practice very soon.
Hellfire: I'm having an operation to have my tonsils removed really soon. I'm 19 years-old but have had many problems with them. I work in a reception for a large hotel and talk to guests a lot. Roughly how long would I be off work for? I enjoy my job but would like to give my throat a chance to heal.
Dr_Keith: Your throat will be incredibly sore and people often underestimate how long it takes to heal after having tonsils out. Providing there are no complications or issues then you're probably looking at taking two to four weeks off work. If you smoke then it's a really good time to kick the habit as it will really affect the healing process.
rach: I'm depressed and about to start university. I've signed up with the medical surgery there but are there any steps that I should take to keep myself from going down?
"People who have recently smoked or still smoke are at high risk of gingivitis which will cause your gums to become sore and bleed."
Dr_Keith: First of all it's really important to engage in uni life straight away and develop a good strong social network. It's a good idea to join as many clubs as you reasonably can as there's a tendency for introverted people to retreat into their shell.
Secondly, if you're on treatment then make sure you have an adequate supply for when you start, in case you have to wait for appointments at the surgery. It's important not to have gaps in your treatment. All of the self-help tips that I talked about earlier are also relevant. There will also be uni-based support such as counselling available to you as depression is more common than you might think.
Sofie: I'm 18 and in full-time education. Do I need to pay for prescriptions yet or not?
Dr_Keith: No, not if you're in full time education. Box b on the prescription will be ticked to show you're exempt. If you choose to take the contraceptive pill, you're exempt from paying for that forever.
BritJamez: Can having bleeding gums be a healthy side effect of giving up smoking? As toxic chemicals are no longer passing over the gums is it actually a sign that the gums are healing?
Dr_Keith: Nice try. People who have recently smoked or still smoke are at high risk of gingivitis which will cause your gums to become sore and bleed. In order to combat the condition I'd recommend an antiseptic mouthwash such as Corsodyl or a similar brand. Regular brushing is also important but if the bleeding continues then you need to see your dentist.
Jim_V: On the ball as ever, Doc.
Hannah: What's the current situation with doctor patient confidentiality for under-16s? Also is it determined by different treatments - e.g. sexual health treatments or general treatments? Are there any plans for changes in the law?
Dr_Keith: I don't know of any proposals to change the law. The common scenario that's used to explain doctor patient confidentiality relates to prescribing the contraceptive pill. Provided the girl is 'Gillick' or 'Fraser' competent - i.e. you feel she's able to make an informed decision, and you can't persuade her to tell her parents, and it's in her best interests to have the treatment, you would go ahead and prescribe the pill. Those principles pretty much apply across the board when dealing with a minor aged under 16 years-old. There are only very rare circumstances when legal issues would override that confidentiality. For example, if a patient turned out to be minor who was subject to sexual abuse then the legal duty to inform social services would override the confidentiality issue.
aiden: How long do I have to abstain from alcohol after approximately two weeks of drinking before I'm detoxed?
Dr_Keith: Can you tell me a bit more - what are you worried about?
aiden: I feel agitated as fuck and I'm busting for a drink. I'm just wondering how long these symptoms generally last.
Dr_Keith: It's impossible to say for certain as it depends on so many factors such as how much you drink and how big you are.
aiden: I'm about 12 stone and drink about 10 alcoholic drinks in a night.
Dr_Keith: It's a worry as it sounds like you have an alcohol dependency issue. If you keep having these problems then you should go and see your doctor or a local community alcohol service.
aiden: Yes I definitely worry as my father and uncle both have pretty serious alcohol problems. My uncle was told he has cirrhosis of the liver a few months back so it's not sounding good.
Dr_Keith: Alcohol related problems certainly can run in the family both through influences and genetic factors. So it's important for you to nip it in the bud while you're young and seek help.
Jim_V: Thanks for that Dr_Keith, and Aiden you might want to use askTheSite to ask more about drinking and support.
aiden: OK, cheers for the answer, I think I will.
Jim_V: I've got a skin tag. It doesn't cause any discomfort but it ain't exactly the nicest thing in the world. I hate hospitals though so can a GP remove it or is it a hospital job?
Dr_Keith: A skin tag is a little excess tag of skin usually attached by a stalk commonly under the armpit, in the neck or in the groin area. They never cause harm but if they bug you they're easy to remove and a GP can remove it.
If it's got a narrow stalk then it's possible to tie a loop in something like a thread to put over the tag and then tie it tight which strangles it and cuts off the blood vessel. It will be sore, but it will be fine and the tag will drop off in a day or two. You could potentially do this yourself but you may well be more comfortable letting the GP do it.
If the tag is too big for that then the other way of getting rid of it is with a very cold spray called liquid nitrogen, which is like the dry ice they use at concerts. Again it can be sore but it will drop off in a few days.
Jim_V: Cheers for that Dr_Keith, nice to know and I think I'll ask the GP rather than DIY it.
That's the last question so thanks for participating everyone.
Thanks to The Sun for supplying the image.
Health chat with Dr Keith Hopcroft - Part 2
Dr Keith Hopcroft made his second visit to TheSite.org chat to answer your questions on sciatica, sex after pregnancy and skin tags.
Jim_V: Hi everyone, welcome to the chat. I'm going to start with a question from briggi.
briggi: What method of pain relief is most effective for sciatica? I've been on several anti-inflammatories for it over the last two years. The most recent being Fenactol which I believe is from the same family as Nurofen and has not been helpful at all. I'd just be interested to hear a second opinion, if you've got one. Also do you have any advice on alternative therapies for it, if that phrase is not a mortal insult? I know to stay away from stimulants like caffeine and I have tried all kinds of pillow origami but any other tips (medicinal or otherwise) are always welcome!
Dr_Keith: Assuming it is actually sciatica, it sounds like it has gone on for a long time. There are two things to look at and one is to try and relieve the pain. There's no one magic bullet and if you've tried several anti-inflammatories then it's worth asking your doctor to try a few more. On top of that you can try pain killers like paracetomal. There's no evidence that alternative therapies are of any use whatsoever so I wouldn't go down that line.
Secondly, even though sciatica can be prolonged, when someone has problems for many months it is a worry and we'd consider referring them to a specialist to have their spine scanned to find out if specialist treatments are required. If it definitely is sciatica then physiotherapy can help and surgery might also be an option.
rach: I want to ask about loss of appetite. I'm not avoiding eating, I'm just not hungry.
Dr_Keith: Can you tell me how long this has been going on for, if you're losing any weight and if you have any stomach pains or are under any stress or worry.
rach: I've been missing meals for a few weeks but it's more just a casual realisation at the end of the day that I haven't eaten. It's because of depression.
Dr_Keith: Loss of appetite isn't just treated using appetite stimulants as it's important to get the root of the problem. Stress and worry are the most common problems. There are several methods for dealing with depression such as talking treatments, self-help or seeing your GP for antidepressants if it's really severe.
rach: Thanks, I think it's the result of CBT because it's quite intense.
Dr_Keith: Generally if you have a poor appetite it's important to eat even a little regularly, especially for breakfast. If you leave your tummy empty for long periods then the acid has nothing to work on so it works on the stomach lining giving you an acidic sicky feeling which will reduce your appetite. It will become a vicious cycle if you're not careful. Hope that helps rach.
rach: Yes thanks, it does.
Hellfire: Since my girlfriend gave birth to our son seven months ago, sex has been really hard. We've managed it a few times but it hurts a lot for her. Her vagina isn't too tight; it seems to be just sore.
Dr_Keith: Did she have any trouble with the delivery, for example did she have stitches, and is the trouble on the outside or deep inside?
Hellfire: She had an episiotomy and some stitches. The trouble is inside, but not deep inside.
Dr_Keith: The likelihood is that her soreness is probably linked to scarring from the surgery. As sex is painful she is probably getting tense and when her muscles tighten the soreness will get worse. She needs to see her GP, preferably when she's not having a period, knowing she will need to be examined. She might like to ask specifically to see a woman. There are various things that can be done to help this problem.
Hellfire: Thank you Dr_Keith.
xsazx: What can you suggest as methods of self-help for dealing with depression?
Dr_Keith: The key methods of self-help include looking at healthy diets, taking plenty of exercise as it can release chemicals in the brain that are very much like antidepressants, having a regular routine, getting adequate sleep and going to bed at sensible times.
It's also worth having a look at things that may be causing or keeping the depression going such as family problems, money worries, alcohol or drugs. Making a list on a piece of paper of things that are getting you down, alongside strategies that can help sort them out, can also help.
If you're bottling things up then it's worth talking things through - not necessarily to get advice, but as a release. It may not solve problems but it can be therapeutic.
It's also important to keep a social network going and motivate yourself so you don't become isolated. Having said all that, if you feel you're spiralling then it is important to seek help, starting with your GP.
xsazx: I don't smoke, drink or take drugs so that's OK. My diet is appalling as I was anorexic a few years back and I'm on the verge again apparently. My GP is useless when I complain that I'm throwing up blood and acid and can't eat without feeling sick and dizzy for hours after. I haven't eaten in three days now and I'm still not feeling hungry. Although I'm not sure if that's more down to the fact I no longer want to live and I'm considering overdosing and have started self harming again.
Dr_Keith: If you feel there's a risk of you doing this straight away then you do need help right now. Perhaps turn to a family member or other help service. If there's really nowhere else to turn then you can always go to casualty. If you have these thoughts often, but don't always act on them straight away, then you should go to see another doctor in your practice very soon.
Hellfire: I'm having an operation to have my tonsils removed really soon. I'm 19 years-old but have had many problems with them. I work in a reception for a large hotel and talk to guests a lot. Roughly how long would I be off work for? I enjoy my job but would like to give my throat a chance to heal.
Dr_Keith: Your throat will be incredibly sore and people often underestimate how long it takes to heal after having tonsils out. Providing there are no complications or issues then you're probably looking at taking two to four weeks off work. If you smoke then it's a really good time to kick the habit as it will really affect the healing process.
rach: I'm depressed and about to start university. I've signed up with the medical surgery there but are there any steps that I should take to keep myself from going down?
Dr_Keith: First of all it's really important to engage in uni life straight away and develop a good strong social network. It's a good idea to join as many clubs as you reasonably can as there's a tendency for introverted people to retreat into their shell.
Secondly, if you're on treatment then make sure you have an adequate supply for when you start, in case you have to wait for appointments at the surgery. It's important not to have gaps in your treatment. All of the self-help tips that I talked about earlier are also relevant. There will also be uni-based support such as counselling available to you as depression is more common than you might think.
Sofie: I'm 18 and in full-time education. Do I need to pay for prescriptions yet or not?
Dr_Keith: No, not if you're in full time education. Box b on the prescription will be ticked to show you're exempt. If you choose to take the contraceptive pill, you're exempt from paying for that forever.
BritJamez: Can having bleeding gums be a healthy side effect of giving up smoking? As toxic chemicals are no longer passing over the gums is it actually a sign that the gums are healing?
Dr_Keith: Nice try. People who have recently smoked or still smoke are at high risk of gingivitis which will cause your gums to become sore and bleed. In order to combat the condition I'd recommend an antiseptic mouthwash such as Corsodyl or a similar brand. Regular brushing is also important but if the bleeding continues then you need to see your dentist.
Jim_V: On the ball as ever, Doc.
Hannah: What's the current situation with doctor patient confidentiality for under-16s? Also is it determined by different treatments - e.g. sexual health treatments or general treatments? Are there any plans for changes in the law?
Dr_Keith: I don't know of any proposals to change the law. The common scenario that's used to explain doctor patient confidentiality relates to prescribing the contraceptive pill. Provided the girl is 'Gillick' or 'Fraser' competent - i.e. you feel she's able to make an informed decision, and you can't persuade her to tell her parents, and it's in her best interests to have the treatment, you would go ahead and prescribe the pill. Those principles pretty much apply across the board when dealing with a minor aged under 16 years-old. There are only very rare circumstances when legal issues would override that confidentiality. For example, if a patient turned out to be minor who was subject to sexual abuse then the legal duty to inform social services would override the confidentiality issue.
aiden: How long do I have to abstain from alcohol after approximately two weeks of drinking before I'm detoxed?
Dr_Keith: Can you tell me a bit more - what are you worried about?
aiden: I feel agitated as fuck and I'm busting for a drink. I'm just wondering how long these symptoms generally last.
Dr_Keith: It's impossible to say for certain as it depends on so many factors such as how much you drink and how big you are.
aiden: I'm about 12 stone and drink about 10 alcoholic drinks in a night.
Dr_Keith: It's a worry as it sounds like you have an alcohol dependency issue. If you keep having these problems then you should go and see your doctor or a local community alcohol service.
aiden: Yes I definitely worry as my father and uncle both have pretty serious alcohol problems. My uncle was told he has cirrhosis of the liver a few months back so it's not sounding good.
Dr_Keith: Alcohol related problems certainly can run in the family both through influences and genetic factors. So it's important for you to nip it in the bud while you're young and seek help.
Jim_V: Thanks for that Dr_Keith, and Aiden you might want to use askTheSite to ask more about drinking and support.
aiden: OK, cheers for the answer, I think I will.
Jim_V: I've got a skin tag. It doesn't cause any discomfort but it ain't exactly the nicest thing in the world. I hate hospitals though so can a GP remove it or is it a hospital job?
Dr_Keith: A skin tag is a little excess tag of skin usually attached by a stalk commonly under the armpit, in the neck or in the groin area. They never cause harm but if they bug you they're easy to remove and a GP can remove it.
If it's got a narrow stalk then it's possible to tie a loop in something like a thread to put over the tag and then tie it tight which strangles it and cuts off the blood vessel. It will be sore, but it will be fine and the tag will drop off in a day or two. You could potentially do this yourself but you may well be more comfortable letting the GP do it.
If the tag is too big for that then the other way of getting rid of it is with a very cold spray called liquid nitrogen, which is like the dry ice they use at concerts. Again it can be sore but it will drop off in a few days.
Jim_V: Cheers for that Dr_Keith, nice to know and I think I'll ask the GP rather than DIY it.
That's the last question so thanks for participating everyone.
Thanks to The Sun for supplying the image.