||Abdominal aortic aneurysm
||Learn about abdominal aortic aneurysm symptoms and treatments
An abdominal aortic aneurysm (AAA) is a swelling (aneurysm) of the aorta – the main blood vessel that leads away from the heart, down through the abdomen to the rest of the body. The abdominal aorta is the largest blood vessel in the body and is usually around 2cm wide – roughly the width of a garden hose. However, it can swell to over 5.5cm – what doctors class as a large AAA. Large aneurysms are rare, but can be very serious. If a large aneurysm bursts, it causes huge internal bleeding and is usually fatal. The bulging occurs when the wall of the aorta weakens. Although what causes this weakness is unclear, smoking and high blood pressure are thought to increase the risk of an aneurysm. AAAs are most common in men aged over 65. A rupture accounts for more than 1 in 50 of all deaths in this group. This is why all men are invited for a screening test when they turn 65. The test involves a simple ultrasound scan, which takes around 10-15 minutes. Symptoms of an AAA In most cases, an AAA causes no noticeable symptoms. However, if it becomes large, some people may develop a pain or a pulsating feeling in their abdomen (tummy) or persistent back pain. An AAA doesn’t usually pose a serious threat to health, but there’s a risk that a larger aneurysm could burst (rupture). A ruptured aneurysm can cause massive internal bleeding, which is usually fatal. Around 8 out of 10 people with a rupture either die before they reach hospital or don’t survive surgery. The most common symptom of a ruptured aortic aneurysm is sudden and severe pain in the abdomen. If you suspect that you or someone else has had a ruptured aneurysm, call 999 immediately and ask for an ambulance. Read more about the symptoms of an AAA. Causes of an AAA It's not known exactly what causes the aortic wall to weaken, although increasing age and being male are known to be the biggest risk factors. There are other risk factors you can do something about, including smoking and having high blood pressure and cholesterol level. Having a family history of aortic aneurysms also means that you have an increased risk of developing one yourself. Read more about the causes of an AAA. Diagnosing an AAA Because AAAs usually cause no symptoms, they tend to be diagnosed either as a result of screening or during a routine examination – for example, if a GP notices a pulsating sensation in your abdomen. The screening test is an ultrasound scan, which allows the size of your abdominal aorta to be measured on a monitor. This is also how an aneurysm will be diagnosed if your doctor suspects you have one. Read more about diagnosing an AAA. Treating an AAA If a large AAA is detected before it ruptures, most people will be advised to have treatment, to prevent it rupturing. This is usually done with surgery to replace the weakened section of the blood vessel with a piece of synthetic tubing. If surgery is not advisable – or if you decide not to have it – there are a number of non-surgical treatments that can reduce the risk of an aneurysm rupturing. They include medications to lower your cholesterol and blood pressure, and quitting smoking. You will also have the size of your aneurysm checked regularly with ultrasound scanning. Read more about treating AAAs. Prevention The best way to prevent getting an aneurysm – or reduce the risk of an aneurysm growing bigger and possibly rupturing – is to avoid anything that could damage your blood vessels, such as: smoking eating a high-fat diet not exercising regularly being overweight or obese Read more about preventing aneurysms. Screening Read more about screening for an AAA. Symptoms In most cases, an unruptured abdominal aortic aneurysm (AAA) will cause no symptoms, unless it becomes particularly large. Symptoms of an unruptured AAA may include: a pulsating feeling in your stomach (abdomen), usually near your belly button, that's usually only noticeable when you touch it persistent back pain persistent abdominal pain If you have any of the symptoms above, you should see your GP as soon as possible. Ruptured AAA If your aortic aneurysm ruptures, you will feel a sudden and severe pain in the middle or side of your abdomen. In men, the pain can also radiate down into the scrotum. Other symptoms include: dizziness sweaty and clammy skin rapid heartbeat (tachycardia) shortness of breath feeling faint loss of consciousness Medical emergency A ruptured aortic aneurysm is a medical emergency, and it’s important to get to hospital as soon as possible. Around 80% of people with a rupture die before they reach hospital or don’t survive emergency surgery. This is why the NHS AAA Screening Programme was introduced, so dangerously large aneurysms can be treated before they burst. If you suspect that you or someone in your care has had a ruptured aneurysm, call 999 immediately and ask for an ambulance. Causes The aorta is the largest blood vessel in the body. It transports oxygen-rich blood away from the heart to the rest of the body. An abdominal aortic aneurysm (AAA) occurs when part of the aorta wall becomes weakened and the large amount of blood that passes through it puts pressure on the weak spot, causing it to bulge outwards to form an aneurysm. The abdominal aorta is usually around 2cm wide – about the width of a garden hosepipe – but can swell to over 5.5cm, which is what doctors classify as a large aneurysm. Risk factors for an AAA It's not known exactly what causes the aortic wall to weaken, although increasing age and being male are known to be the biggest risk factors. One study found that people aged over 75 are seven times more likely to be diagnosed with an AAA than people under 55 years old. Men are around six times more likely to be diagnosed with an AAA than women. However, there are other risk factors that you can do something about – described below – the most important of which is smoking. Smoking Research has found that smokers are seven times more likely to develop an AAA than people who have never smoked. The more you smoke, the greater your risk of developing an AAA. People who regularly smoke more than 20 cigarettes a day may have more than 10 times the risk of non-smokers. The risk may increase because tobacco smoke contains harmful substances that can damage and weaken the wall of the aorta. Atherosclerosis Atherosclerosis is a potentially serious condition where arteries become clogged up by fatty deposits, such as cholesterol. An AAA is thought to develop because these deposits (called plaques) cause the aorta to widen in an attempt to keep blood flowing through it. As it widens, it also gets weaker. Smoking, eating a high-fat diet and high blood pressure all increase your risk of developing atherosclerosis. High blood pressure As well as contributing to atherosclerosis, high blood pressure (hypertension) can place increased pressure on the aorta's wall. Family history Having a family history of AAAs means that you have an increased risk of developing one. One study found that people who had a brother or sister with an AAA were eight times more likely to develop one than people whose siblings were unaffected. This suggests that certain genes you inherit from your parents may make you more vulnerable to developing an AAA. However, no specific genes have yet been identified. Read about how to reduce your risk of developing an AAA. Diagnosis An abdominal aortic aneurysm (AAA) usually causes no symptoms. Therefore, they tend to be diagnosed as a result of screening, or during a routine physical examination when a GP notices a distinctive pulsating sensation in your abdomen. A diagnosis can be confirmed using an ultrasound scan. Ultrasound can also determine the size of the aneurysm, which is an important factor in deciding on a course of treatment. Screening All men in the UK who are 65 or over are offered an ultrasound scan to check for AAAs. All men should receive an invitation in the year they turn 65 years old. Men who are older than 65 can refer themselves for screening by contacting their local NHS AAA screening service. For more information, visit our page on AAA screening. Treatment Treatment for an abdominal aortic aneurysm (AAA) depends on several factors, including the aneurysm's size, your age and general health. In general, if you have a large aneurysm (5.5cm or larger) you will be advised to have surgery, either to strengthen the swollen section of the aorta or to replace it with a piece of synthetic tubing. This is because the risk of the aneurysm rupturing is usually greater than the risk of having it repaired. If you have a small (3.0-4.4cm) or medium (4.5-5.4cm) aneurysm, you will be offered regular scans to check its size. You will also be given advice on how to slow its growth and reduce the risk of it rupturing – for example, stopping smoking – and perhaps medications to reduce your blood pressure and cholesterol level. If you have a large AAA If you are diagnosed with an AAA that is 5.5cm or larger, you will be referred to a vascular surgeon (a surgeon who specialises in diseases of the blood vessels), who may recommend an operation. The surgeon will discuss treatment options with you, taking into account your general health and fitness, as well as the size of your aneurysm. If it's decided that surgery isn’t suitable for you, it’s still possible to reduce the risk of the aneurysm bursting, and you will have regular scans to check its size – in the same way people with small or medium aneurysms are treated. See below for more information on treating small and medium aneurysms. There are two surgical techniques used to treat a large aneurysm: endovascular surgery open surgery Although both techniques are equally effective at reducing the risk of the aneurysm bursting, each has its own advantages and disadvantages. The surgeon will discuss with you which is most suitable. Endovascular surgery Endovascular surgery is a type of "keyhole" surgery where the surgeon makes small cuts in your groin. A small piece of tubing called a graft– made of metal mesh lined with fabric – is then guided up through the leg artery, into the swollen section of aorta, and sealed to the wall of the aorta at both ends. This reinforces the aorta, reducing the risk of it bursting. This is the safest of the two types of surgery available. Around 98-99% of patients make a full recovery, and recovery time from the operation is shorter than if you have open surgery. There are also fewer major complications, such as wound infection or deep vein thrombosis (DVT). However, the way the graft is attached is not as secure as open surgery. You’ll need regular scans to make sure the graft hasn’t slipped, and in some patients, the seal at each end of the graft starts to leak and will need to be resealed. You will need to have surgery again if either of these occurs. Open surgery In open surgery, the surgeon cuts into your stomach (abdomen) to reach the abdominal aorta and replaces the enlarged section with a graft. This type of graft is a tube made of a synthetic material. Because the graft is stitched (sutured) into place by the surgeon, it’s more likely to stay in place, and will usually work well for the rest of your life. The risk of complications linked to the graft after surgery is lower than in people who have endovascular surgery. Open surgery isn’t usually recommended for people who are in poor health as it is a major operation. It is slightly more risky than endovascular surgery, with 93-97% of patients making a full recovery. The main risk of open surgery is death or heart attack, and recovery time is longer than with endovascular surgery. There is also a greater risk of complications, such as wound infection, chest infection and DVT. Making a decision about treatment for a large aneurysm If you or a relative is faced with making a decision about treatment for a large AAA, the AAA repair decision aid may help you weigh up the pros and cons of each option. If you have a small or medium AAA If you are diagnosed with a small (3.0-4.4cm) or medium (4.5-5.4cm) aneurysm, you won’t be referred to see a vascular surgeon, as it’s unlikely you’d benefit from surgery. You’ll be invited back for regular scans to check the size of the aneurysm, in case it gets bigger – every year if you have a small aneurysm and every three months if you have a medium aneurysm. You will also be given advice on how to prevent the aneurysm from getting bigger, including: stopping smoking eating a balanced diet ensuring you maintain a healthy weight taking regular exercise If you smoke, the most important change you can make is to quit. Aneurysms have been shown to grow faster in smokers than in non-smokers. Read more about stopping smoking and nicotine replacement therapies (NRTs) that can make it easier to stop smoking. Your GP will be sent your test result and may decide to change your current medication or start you on a new one, especially if you have: high blood pressure – which you will probably be treated for with a medication called an angiotensin-converting enzyme (ACE) inhibitor high cholesterol – which you will probably be treated for with a medication called a statin Treating a ruptured AAA Emergency treatment for a ruptured AAA is based on the same principle as preventative treatment. Grafts are used to repair the ruptured aneurysm. The decision on whether to perform open or endovascular surgery is made on a case-by-case basis by the surgeon carrying out the operation. Prevention The best way to prevent getting an aneurysm, or reduce the risk of an aneurysm growing bigger and possibly rupturing, is to avoid anything that could damage your blood vessels. This includes: smoking eating a high-fat diet not exercising regularly being overweight or obese If your GP finds out you have high blood pressure or a high cholesterol level, you may be prescribed medication for both. This will reduce the risk of developing an abdominal aortic aneurysm (AAA). Smoking Smoking is a major risk factor for aneurysms because it causes atherosclerosis (hardening of the arteries) and raises your blood pressure. Tobacco smoke contains substances that can damage the walls of the arteries. It is known that smokers are seven times more likely than non-smokers to develop an AAA. The more you smoke, the greater your risk. People who regularly smoke more than 20 cigarettes a day may have more than 10 times the risk of non-smokers. If you want to stop smoking, your GP will be able to refer you to an NHS Stop Smoking Service, which will give you dedicated help and advice about the best ways to quit. You can also call or chat online with Quit Your Way Scotland. The specially trained helpline staff can offer you free expert advice and encouragement. Read more about stopping smoking and nicotine replacement therapies (NRTs), which can make it easier to quit. Diet Eating a high-fat diet increases your risk of atherosclerosis. It’s especially important to limit the amount of foods you eat that are high in saturated fat, such as biscuits, cakes, butter, sausages and bacon. This is because eating too much saturated fat can lead to high cholesterol, which can build up in the artery walls. Read more about high cholesterol. Find out more about healthy eating and how to reduce the amount of saturated fat you eat. Exercise Being active and doing regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. Regular exercise can also help you lose weight, which will also help lower your blood pressure. Adults should do at least 150 minutes (two hours and 30 minutes) of moderate-intensity aerobic activity every week. Examples of moderate intensity activity include cycling or fast walking. For it to count, the activity should make you feel warm and slightly out of breath. Someone who is overweight may only have to walk up a slope to get this feeling. Physical activity can include anything from sport to walking and gardening. Get more ideas on being active. Weight Being overweight forces your heart to work harder to pump blood around your body. This can raise your blood pressure, which in turn puts pressure on your arteries. Use a BMI healthy weight calculator to find out if you need to lose weight. If you need to shed some weight, it's worth remembering that losing just a few pounds will make a big difference to your blood pressure and overall health. Get tips on losing weight safely and read more about preventing high blood pressure.
||Learn about acne symptoms and treatments
Acne is a common skin condition that affects most people at some point. It causes spots, oily skin and sometimes skin that's hot or painful to touch. Acne most commonly develops on the: face – this affects almost everyone with acne back – this affects more than half of people with acne chest – this affects about 15% of people with acne Types of spots There are 6 main types of spot caused by acne: blackheads – small black or yellowish bumps that develop on the skin; they're not filled with dirt, but are black because the inner lining of the hair follicle produces pigmentation (colouring) whiteheads – have a similar appearance to blackheads, but may be firmer and won't empty when squeezed papules – small red bumps that may feel tender or sore pustules – similar to papules, but have a white tip in the centre, caused by a build-up of pus nodules – large hard lumps that build up beneath the surface of the skin and can be painful cysts – the most severe type of spot caused by acne; they're large pus-filled lumps that look similar to boils and carry the greatest risk of causing permanent scarring What can I do if I have acne? The self-help techniques below may be useful: Don't wash affected areas of skin more than twice a day. Frequent washing can irritate the skin and make symptoms worse Wash the affected area with a mild soap or cleanser and lukewarm water. Very hot or cold water can make acne worse Don't try to "clean out" blackheads or squeeze spots. This can make them worse and cause permanent scarring Avoid using too much make-up and cosmetics. Use water-based products that are described as non-comedogenic (this means the product is less likely to block the pores in your skin) Completely remove make-up before going to bed If dry skin is a problem, use a fragrance-free, water-based emollient Regular exercise can't improve your acne, but it can boost your mood and improve your self-esteem. Shower as soon as possible once you finish exercising, as sweat can irritate your acne Wash your hair regularly and try to avoid letting your hair fall across your face Although acne can't be cured, it can be controlled with treatment. Several creams, lotions and gels for treating spots are available at pharmacies. If you develop acne, it's a good idea to speak to your pharmacist for advice. Products containing a low concentration of benzoyl peroxide may be recommended – but be careful, as this can bleach clothing. If your acne is severe or appears on your chest and back, it may need to be treated with antibiotics or stronger creams that are only available on prescription. When to seek medical advice Even mild cases of acne can cause distress. If your acne is making you feel very unhappy or you can't control your spots with over-the-counter medication, see your GP. Also see your GP if you develop nodules or cysts, as they need to be treated properly to avoid scarring. Try to resist the temptation to pick or squeeze the spots, as this can lead to permanent scarring. Treatments can take up to 3 months to work, so don't expect results overnight. Once they do start to work, the results are usually good. Read more about: diagnosing acne treating acne complications of acne Why do I have acne? Acne is most commonly linked to the changes in hormone levels during puberty, but can start at any age. Certain hormones cause the grease-producing glands next to hair follicles in the skin to produce larger amounts of oil (abnormal sebum). This abnormal sebum changes the activity of a usually harmless skin bacterium called P. acnes, which becomes more aggressive and causes inflammation and pus. The hormones also thicken the inner lining of the hair follicle, causing blockage of the pores (opening of the hair follicles). Cleaning the skin doesn't help to remove this blockage. Other possible causes Acne is known to run in families. If both your mother and father had acne, it's likely that you'll also have acne. Hormonal changes, such as those that occur during the menstrual cycle or pregnancy, can also lead to episodes of acne in women. There's no evidence that diet, poor hygiene or sexual activity play a role in acne. Read more about the causes of acne, including some common acne myths. Who's affected? Acne is very common in teenagers and younger adults. About 80% of people aged 11 to 30 are affected by acne. Acne is most common in girls from the ages of 14 to 17, and in boys from the ages of 16 to 19. Most people have acne on and off for several years before their symptoms start to improve as they get older. Acne often disappears when a person is in their mid-twenties. In some cases, acne can continue into adult life. About 5% of women and 1% of men have acne over the age of 25. Causes Acne is caused when tiny holes in the skin, known as hair follicles, become blocked. Sebaceous glands are tiny glands found near the surface of your skin. The glands are attached to hair follicles, which are small holes in your skin that an individual hair grows out of. Sebaceous glands lubricate the hair and the skin to stop it drying out. They do this by producing an oily substance called sebum. In acne, the glands begin to produce too much sebum. The excess sebum mixes with dead skin cells and both substances form a plug in the follicle. If the plugged follicle is close to the surface of the skin, it bulges outwards, creating a whitehead. Alternatively, the plugged follicle can be open to the skin, creating a blackhead. Normally harmless bacteria that live on the skin can then contaminate and infect the plugged follicles, causing papules, pustules, nodules or cysts. Testosterone Teenage acne is thought to be triggered by increased levels of a hormone called testosterone, which occurs during puberty. The hormone plays an important role in stimulating the growth and development of the penis and testicles in boys, and maintaining muscle and bone strength in girls. The sebaceous glands are particularly sensitive to hormones. It's thought that increased levels of testosterone cause the glands to produce much more sebum than the skin needs. Acne in families Acne can run in families. If your parents had acne, it's likely that you'll also develop it. One study has found that if both your parents had acne, you're more likely to get more severe acne at an early age. It also found that if one or both of your parents had adult acne, you're more likely to get adult acne too. Acne in women More than 80% of cases of adult acne occur in women. It's thought that many cases of adult acne are caused by the changes in hormone levels that many women have at certain times. These times include: periods – some women have a flare-up of acne just before their period pregnancy – many women have symptoms of acne at this time, usually during the first 3 months of their pregnancy polycystic ovary syndrome – a common condition that can cause acne, weight gain and the formation of small cysts inside the ovary Other triggers Other possible triggers of an acne flare-up include: some cosmetic products – however, this is less common as most products are now tested, so they don't cause spots (non-comedogenic) certain medications – such as steroid medications, lithium (used to treat depression and bipolar disorder) and some anti-epileptic drugs (used to treat epilepsy) regularly wearing items that place pressure on an affected area of skin, such as a headband or backpack smoking – which can contribute to acne in older people Acne myths Despite being one of the most widespread skin conditions, acne is also one of the most poorly understood. There are many myths and misconceptions about it: "Acne is caused by a poor diet" So far, research hasn't found any foods that cause acne. Eating a healthy, balanced diet is recommended because it's good for your heart and your health in general. "Acne is caused by having dirty skin and poor hygiene" Most of the biological reactions that trigger acne occur beneath the skin, not on the surface, so the cleanliness of your skin has no effect on your acne. Washing your face more than twice a day could just aggravate your skin. "Squeezing blackheads, whiteheads and spots is the best way to get rid of acne" This could actually make symptoms worse and may leave you with scarring. "Sexual activity can influence acne" Having sex or masturbating won't make acne any better or worse. "Sunbathing, sunbeds and sunlamps help improve the symptoms of acne" There's no conclusive evidence that prolonged exposure to sunlight or using sunbeds or sunlamps can improve acne. Many medications used to treat acne can make your skin more sensitive to light, so exposure could cause painful damage to your skin, and also increase your risk of skin cancer. "Acne is infectious" You can't pass acne on to other people. Diagnosis Your GP can diagnose acne by looking at your skin. This involves examining your face, chest and back for the different types of spot, such as blackheads or sore, red nodules. How many spots you have and how painful and inflamed they are will help determine how severe your acne is. This is important in planning your treatment. 4 grades can be used to measure the severity of acne: grade 1 (mild) – acne is mostly confined to whiteheads and blackheads, with just a few papules and pustules grade 2 (moderate) – there are multiple papules and pustules, which are mostly confined to the face grade 3 (moderately severe) – there's a large number of papules and pustules, as well as the occasional inflamed nodule, and the back and chest are also affected by acne grade 4 (severe) – there's a large number of large, painful pustules and nodules Acne in women If acne suddenly starts in adult women, it can be a sign of a hormonal imbalance, especially if it's accompanied by other symptoms such as: excessive body hair (hirsutism) irregular or light periods The most common cause of hormonal imbalances in women is polycystic ovary syndrome (PCOS). PCOS can be diagnosed using a combination of ultrasound scans and blood tests. Read more about diagnosing PCOS. Treatment Treatment for acne depends on how severe it is. It can take several months of treatment before acne symptoms improve. The various treatments for acne are outlined below. If you just have a few blackheads, whiteheads and spots, you should be able to treat them successfully with over-the-counter gels or creams (topical treatments) that contain benzoyl peroxide. Treatments from your GP See your GP if your acne is more widespread, as you probably need prescription medication. For example, if: you have a large number of papules and pustules over-the-counter medication hasn't worked Prescription medications that can be used to treat acne include: topical retinoids topical antibiotics azelaic acid antibiotic tablets in women, the combined oral contraceptive pill isotretinoin tablets If you have severe acne, your GP can refer you to an expert in treating skin conditions (dermatologist). For example, if you have: a large number of papules and pustules on your chest and back, as well as your face painful nodules A combination of antibiotic tablets and topical treatments is usually the first treatment option for severe acne. If this doesn't work, a medication called isotretinoin may be prescribed. Hormonal therapies or the combined oral contraceptive pill can also be effective in women who have acne. However, the progestogen-only pill or contraceptive implant can sometimes make acne worse. Many of these treatments can take 2 to 3 months before they start to work. It's important to be patient and persist with a recommended treatment, even if there's no immediate effect. Topical treatments (gels, creams and lotions) Benzoyl peroxide Benzoyl peroxide works as an antiseptic to reduce the number of bacteria on the surface of the skin. It also helps to reduce the number of whiteheads and blackheads, and has an anti-inflammatory effect. Benzoyl peroxide is usually available as a cream or gel. It's used either once or twice a day. It should be applied 20 minutes after washing to all of the parts of your face affected by acne. It should be used sparingly, as too much can irritate your skin. It also makes your face more sensitive to sunlight, so avoid too much sun and ultraviolet (UV) light, or wear sun cream. Benzoyl peroxide can have a bleaching effect, so avoid getting it on your hair or clothes. Common side effects of benzoyl peroxide include: dry and tense skin a burning, itching or stinging sensation some redness and peeling of the skin Side effects are usually mild and should pass once the treatment has finished. Most people need a 6 week course of treatment to clear most or all of their acne. You may be advised to continue treatment less frequently to prevent acne returning. Topical retinoids Topical retinoids work by removing dead skin cells from the surface of the skin (exfoliating) which helps to prevent them building up within hair follicles. Tretinoin and adapalene are topical retinoids used to treat acne. They're available in a gel or cream and are usually applied once a day before you go to bed. Apply to all the parts of your face affected by acne 20 minutes after washing your face. It's important to apply topical retinoids sparingly and avoid excessive exposure to sunlight and UV. Topical retinoids aren't suitable for use during pregnancy, as there's a risk they might cause birth defects. The most common side effects of topical retinoids are mild irritation and stinging of the skin. A 6 week course is usually required, but you may be advised to continue using the medication less frequently after this. Topical antibiotics Topical antibiotics help kill the bacteria on the skin that can infect plugged hair follicles. They're available as a lotion or gel that is applied once or twice a day. A 6 to 8 week course is usually recommended. After this, treatment is usually stopped, as there's a risk that the bacteria on your face could become resistant to the antibiotics. This could make your acne worse and cause additional infections. Side effects are uncommon, but can include: minor irritation of the skin redness and burning of the skin peeling of the skin Azelaic acid Azelaic acid is often used as an alternative treatment for acne if the side effects of benzoyl peroxide or topical retinoids are particularly irritating or painful. Azelaic acid works by getting rid of dead skin and killing bacteria. It's available as a cream or gel and is usually applied twice a day (or once a day if your skin is particularly sensitive). The medication doesn't make your skin sensitive to sunlight, so you don't have to avoid exposure to the sun. You'll usually need to use azelaic acid for a month before your acne improves. The side effects of azelaic acid are usually mild and include: burning or stinging skin itchiness dry skin redness of the skin Antibiotic tablets Antibiotic tablets (oral antibiotics) are usually used in combination with a topical treatment to treat more severe acne. In most cases, a class of antibiotics called tetracyclines is prescribed, unless you're pregnant or breastfeeding. Pregnant or breastfeeding women are usually advised to take an antibiotic called erythromycin, which is known to be safer to use. It usually takes about 6 weeks before you notice an improvement in your acne. Depending on how well you react to the treatment, a course of oral antibiotics can last 4 to 6 months. Tetracyclines can make your skin sensitive to sunlight and UV light, and can also make the oral contraceptive pill less effective during the first few weeks of treatment. You'll need to use an alternative method of contraception, such as condoms, during this time. Hormonal therapies Hormonal therapies can often benefit women with acne, especially if the acne flares up around periods or is associated with hormonal conditions such as polycystic ovary syndrome. If you don't already use it, your GP may recommend the combined oral contraceptive pill, even if you're not sexually active. This combined pill can often help improve acne in women, but may take up to a year before the full benefits are seen. Co-cyprindiol Co-cyprindiol is a hormonal treatment that can be used for more severe acne that doesn't respond to antibiotics. It helps to reduce the production of sebum. You'll probably have to use co-cyprindiol for 2 to 6 months before you notice a significant improvement in your acne. There's a small risk that women taking co-cyprindiol may develop breast cancer in later life. For example, out of a group of 10,000 women who haven't taken co-cyprindiol, you would expect 16 of them to develop breast cancer by the time they were 35. This figure rises to 17 or 18 for women who were treated with co-cyprindiol for at least 5 years in their early twenties. There's also a very small chance of co-cyprindiol causing a blood clot. The risk is estimated to be around 1 in 2,500 in any given year. It's not thought to be safe to take co-cyprindiol if you're pregnant or breastfeeding. Women may need to have a pregnancy test before treatment can begin. Other side effects of co-cyprindiol include: bleeding and spotting between your periods, which can sometimes occur for the first few months headaches sore breasts mood changes loss of interest in sex weight gain or weight loss Isotretinoin Isotretinoin has a number of beneficial effects: it helps to normalise sebum and reduce how much is produced it helps to prevent follicles becoming clogged it decreases the amount of bacteria on the skin it reduces redness and swelling in and around spots However, the drug can also cause a wide range of side effects. It's only recommended for severe cases of acne that haven't responded to other treatments. Because of the risk of side effects, isotretinoin can only be prescribed by a specially trained GP or a dermatologist. Isotretinoin is taken as a tablet. Most people take a 4 to 6 month course. Your acne may get worse during the first 7 to 10 days of treatment. However, this is normal and soon settles. Common side effects of isotretinoin include: inflammation, dryness and cracking of the skin, lips and nostrils changes in your blood sugar levels inflammation of your eyelids (blepharitis) inflammation and irritation of your eyes (conjunctivitis) blood in your urine Rarer side effects of isotretinoin include: inflammation of the liver (hepatitis) inflammation of the pancreas (pancreatitis) kidney disease Because of the risk of these rarer side effects, you'll need a blood test before and during treatment. Isotretinoin and birth defects Isotretinoin will damage an unborn baby. If you're a woman of childbearing age: don't use isotretinoin if you're pregnant or you think you're pregnant use 1, or ideally 2, methods of contraception for 1 month before treatment begins, during treatment and for 1 month after treatment has finished have a pregnancy test before, during and after treatment You'll be asked to sign a form confirming that you understand the risk of birth defects and are willing to use contraceptives to prevent this risk, even if you're not currently sexually active. If you think you may have become pregnant when taking isotretinoin, contact your dermatologist immediately. Isotretinoin is also not suitable if you're breastfeeding. Isotretinoin and mood changes There have been reports of people experiencing mood changes while taking isotretinoin. There's no evidence that these mood changes were the result of the medication. However, as a precaution, contact your doctor immediately if you feel depressed or anxious, have feelings of aggression or suicidal thoughts. Non-pharmaceutical treatments Several treatments for acne don't involve medication. These include: comedone extractor – a small pen-shaped instrument that can be used to clean out blackheads and whiteheads chemical peels – where a chemical solution is applied to the face, causing the skin to peel off and new skin to replace it photodynamic therapy – where light is applied to the skin in an attempt to improve symptoms of acne However, these treatments may not work and can't be routinely recommended. Complications Acne scarring can sometimes develop as a complication of acne. Any type of acne spot can lead to scarring, but it's more common when the most serious types of spots (nodules and cysts) burst and damage nearby skin. Scarring can also occur if you pick or squeeze your spots, so it's important not to do this. There are 3 main types of acne scars: ice pick scars – small, deep holes in the surface of your skin that look like the skin has been punctured with a sharp object rolling scars – caused by bands of scar tissue that form under the skin, giving the surface of the skin a rolling and uneven appearance boxcar scars – round or oval depressions, or craters, in the skin Treating acne scarring Treatments for acne scarring are regarded as a type of cosmetic surgery, which isn't usually available on the NHS. However, in the past, exceptions have been made when it's been shown that acne scarring has caused serious psychological distress. See your GP if you're considering having cosmetic surgery. They'll be able to discuss your options with you and advise you about the likelihood of having the procedure carried out on the NHS. Many private clinics offer treatment for acne scarring. Prices can vary widely (from £500 to more than £10,000) depending on the type of treatment needed. The British Association of Plastic, Reconstructive and Aesthetic Surgeons website has more information about private treatment available in your area. It's important to have realistic expectations about what cosmetic treatment can achieve. While treatment can certainly improve the appearance of your scars, it can't get rid of them completely. After treatment for acne scarring, most people notice a 50-75% improvement in their appearance. Some of the available treatments for acne scarring are explained below. Dermabrasion Dermabrasion involves removing the top layer of skin, either using lasers or a specially made wire brush. After the procedure, your skin will look red and sore for several months, but as it heals you should notice an improvement in the appearance of your scars. Laser treatment Laser treatment can be used to treat mild to moderate acne scarring. There are 2 types of laser treatment: ablative laser treatment – where lasers are used to remove a small patch of skin around the scar to produce a new, smooth-looking area of skin non-ablative laser treatment – where lasers are used to stimulate the growth of new collagen (a type of protein found in skin), which helps to repair some of the damage caused by scarring, and improves the appearance Punch techniques Punch techniques are used to treat ice pick scars and boxcar scars. There are 3 types of punch technique: punch excision – used to treat mild ice pick scars. The scar is surgically removed and the remaining wound is sealed. After the wound heals, it leaves a smoother and more even area of skin. punch elevation – used to treat boxcar scars. The base of the scar is surgically removed, leaving the sides of the scar in place. The base is then reattached to the sides, but lifted up so it's level with the surface of the skin. This makes the scar much less noticeable. punch grafting – used to treat very deep ice pick scars. As with a punch excision, the scar is removed, but the wound is "plugged" with a sample of skin taken from elsewhere on the body (usually from the back of the ear). Subcision Subcision is a surgical treatment that can be used to treat rolling scars. During surgery, the upper layer of the skin is removed from the underlying scar tissue. This allows blood to pool under the affected area. The blood clot helps form connective tissue, which pushes up the rolling scar so it's level with the rest of the surface of the skin. Once subscision has been completed, additional treatment, such as laser treatment and dermabrasion, can be used to further improve the appearance of the scar. Depression Acne can often cause intense feelings of anxiety and stress, which can sometimes make people with the condition become socially withdrawn. This combination of factors can lead to people with acne becoming depressed. You may be depressed if during the last month you've often felt down, depressed or hopeless, and have little interest or pleasure in doing things. If you think that you or your child may have depression, it's important to speak to your GP. Treatments for depression include: talking therapies such as cognitive behavioural therapy (CBT) a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs) Read more about treatment for depression.
||Learn about acute cholecystitis symptoms and treatments
Acute cholecystitis is swelling (inflammation) of the gallbladder. It is a potentially serious condition that usually needs to be treated in hospital. The main symptom of acute cholecystitis is a sudden sharp pain in the upper right side of your tummy (abdomen) that spreads towards your right shoulder. The affected part of the abdomen is usually extremely tender, and breathing deeply can make the pain worse. Unlike some others types of abdominal pain, the pain associated with acute cholecystitis is usually persistent, and doesn't go away within a few hours. Some people may additional symptoms, such as: a high temperature (fever) nausea and vomiting sweating loss of appetite yellowing of the skin and the whites of the eyes (jaundice) a bulge in the abdomen When to seek medical advice You should see your GP as soon as possible if you develop sudden and severe abdominal pain, particularly if the pain lasts longer than a few hours or is accompanied by other symptoms, such as jaundice and a fever. If it's not possible to contact your GP immediately, phone your local out-of-hours service or call the NHS 24 111 service for advice. It's important for acute cholecystitis to be diagnosed as soon as possible, because there is a risk that serious complications could develop if the condition is not treated promptly (see below). What causes acute cholecystitis? The causes of acute cholecystitis can be grouped into 2 main categories: calculous cholecystitis and acalculous cholecystitis. Calculous cholecystitis Calculous cholecystitis is the most common, and usually less serious, type of acute cholecystitis. It accounts for around 95% of all cases. Calculous cholecystitis develops when the main opening to the gallbladder, called the cystic duct, gets blocked by a gallstone or by a substance known as biliary sludge. Biliary sludge is a mixture of bile (a liquid produced by the liver that helps digest fats) and small crystals of cholesterol and salt. The blockage in the cystic duct results in a build-up of bile in the gallbladder, increasing the pressure inside it and causing it to become inflamed. In around 1 in every 5 cases, the inflamed gallbladder also becomes infected by bacteria. Acalculous cholecystitis Acalculous cholecystitis is a less common, but usually more serious, type of acute cholecystitis. It usually develops as a complication of a serious illness, infection or injury that damages the gallbladder. Acalculous cholecystitis is often associated with problems such as accidental damage to the gallbladder during major surgery, serious injuries or burns, blood poisoning (sepsis), severe malnutrition or AIDS. Who is affected Acute cholecystitis is a relatively common complication of gallstones. It is estimated that around 10-15% of adults in the UK have gallstones. These don't usually cause any symptoms, but in a small proportion of people they can cause infrequent episodes of pain (known as biliary colic) or acute cholecystitis. Diagnosing cholecystitis To diagnose acute cholecystitis, your GP will examine your abdomen. They will probably carry out a simple test called Murphy’s sign. You will be asked to breathe in deeply with your GP's hand pressed on your tummy, just below your rib cage. Your gallbladder will move downwards as your breathe in and, if you have cholecystitis, you will experience sudden pain as your gallbladder reaches your doctor’s hand. If your symptoms suggest you have acute cholecystitis, your GP will refer you to hospital immediately for further tests and treatment. Tests you may have in hospital include: blood tests to check for signs of inflammation in your body an ultrasound scan of your abdomen to check for gallstones or other signs of a problem with your gallbladder Other scans – such as an X-ray, a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan – may also be carried out to examine your gallbladder in more detail if there is any uncertainty about your diagnosis. Treating acute cholecystitis If you are diagnosed with acute cholecystitis, you will probably need to be admitted to hospital for treatment. Initial treatment Initial treatment will usually involve: fasting (not eating or drinking) to take the strain off your gallbladder receiving fluids through a drip directly into a vein (intravenously) to prevent dehydration taking medication to relieve your pain If you have a suspected infection, you will also be given antibiotics. These often need to be continued for up to a week, during which time you may need to stay in hospital or you may be able to go home. With this initial treatment, any gallstones that may have caused the condition usually fall back into the gallbladder and the inflammation often settles down. Surgery In order to prevent acute cholecystitis recurring, and reduce your risk of developing potentially serious complications, the removal of your gallbladder will often be recommended at some point after the initial treatment. This type of surgery is known as a cholecystectomy. Although uncommon, an alternative procedure called a percutaneous cholecystostomy may be carried out if you are too unwell to have surgery. This is where a needle is inserted through your abdomen to drain away the fluid that has built up in the gallbladder. If you are fit enough to have surgery, your doctors will need to decide when the best time to remove your gallbladder may be. In some cases, you may need to have surgery immediately or in the next day or 2, while in other cases you may be advised to wait for the inflammation to fully resolve over the next few weeks. Surgery can be carried out in two main ways: laparoscopic cholecystectomy – a type of keyhole surgery where the gallbladder is removed using special surgical instruments inserted through a number of small cuts (incisions) in your abdomen open cholecystectomy – where the gallbladder is removed through a single, larger incision in your abdomen Although some people who have had their gallbladder removed have reported symptoms of bloating and diarrhoea after eating certain foods, you can lead a perfectly normal life without a gallbladder. The organ can be useful but it's not essential, as your liver will still produce bile to digest food. Possible complications Without appropriate treatment, acute cholecystitis can sometimes lead to potentially life-threatening complications. The main complications of acute cholecystitis are: the death of the tissue of the gallbladder, called gangrenous cholecystitis, which can cause a serious infection that could spread throughout the body the gallbladder splitting open, known as a perforated gallbladder, which can spread the infection within your abdomen (peritonitis) or lead to a build-up of pus (abscess) In about 1 in every 5 cases of acute cholecystitis, emergency surgery to remove the gallbladder is needed to treat these complications. Preventing acute cholecystitis It's not always possible to prevent acute cholecystitis, but you can reduce your risk of developing the condition by cutting your risk of gallstones. One of the main steps you can take to help lower your chances of developing gallstones is adopting a healthy, balanced diet and reducing the number of high-cholesterol foods you eat, as cholesterol is thought to contribute to the formation of gallstones. Being overweight, particularly being obese, also increases your risk of developing gallstones. You should therefore control your weight by eating a healthy diet and exercising regularly. However, low-calorie, rapid weight loss diets should be avoided, because there is evidence they can disrupt your bile chemistry and actually increase your risk of developing gallstones. A more gradual weight loss plan is best. Read more about preventing gallstones.
||Acute lymphoblastic leukaemia
||Learn about acute lymphoblastic leukaemia, a cancer of the white blood cells
Leukaemia is cancer of the white blood cells. Acute leukaemia means the condition progresses rapidly and aggressively and requires immediate treatment. Acute leukaemia is classified according to the type of white blood cells affected by cancer. There are two main types: lymphocytes, which are mostly used to fight viral infections neutrophils, which perform several functions, such as fighting bacterial infections, defending the body against parasites and preventing the spread of tissue damage These pages focus on acute lymphoblastic leukaemia, which is cancer of the lymphocytes. The following other types of leukaemia are covered elsewhere: chronic lymphocytic leukaemia chronic myeloid leukaemia acute myeloid leukaemia Warning signs of acute leukaemia Symptoms of acute lymphoblastic leukaemia usually begin slowly before rapidly getting severe as the number of immature white blood cells in your blood increases (see below for an explanation of this). Symptoms include: pale skin tiredness breathlessness having repeated infections over a short space of time unusual and frequent bleeding Read more about the symptoms of acute lymphoblastic leukaemia What happens in acute leukaemia All of the blood cells in the body are produced by bone marrow – a spongy material found inside bones. Bone marrow produces specialised cells called stem cells which have the ability to develop into three important types of blood cells: red blood cells, which carry oxygen around the body white blood cells, which help fight infection platelets, which help stop bleeding Usually the bone marrow produces stem cells which are allowed to fully develop before being released into the blood. But in acute leukaemia, bone marrow starts releasing large numbers of immature white blood cells known as blast cells. As the number of blast cells increases there is a drop in the number of red blood cells and platelet cells. This drop causes the symptoms of anaemia, such as tiredness, and increases the risk of excessive bleeding. Also, blast cells are less effective than mature white blood cells at fighting bacteria and viruses, making you more vulnerable to infection. Around 8,600 people are diagnosed with leukaemia each year in the UK. In 2011, 654 people were diagnosed with acute lymphoblastic leukaemia. Despite being uncommon overall, acute lymphoblastic leukaemia is the most common type of cancer to affect children. Approximately one in every 2,000 children will develop it. About 85% of cases occur in children aged under 15, mostly between the ages of two and five years old. The cause or causes of acute leukaemia are uncertain, but known risk factors include: exposure to high levels of radiation exposure to benzene, a chemical used in manufacturing that is also found in cigarettes Read more information about the causes of acute lymphoblastic leukaemia Outlook The outlook for children with acute lymphoblastic leukaemia is usually good. Almost all children will achieve a remission (a period of time where they are free from symptoms) from their symptoms, and 85% will be completely cured. The outlook for adults with acute lymphoblastic leukaemia is less promising as only 40% of people with the condition will be completely cured. Treatments for acute lymphoblastic leukaemia usually involve a combination of chemotherapy and radiotherapy. In some cases, a bone marrow transplant may also be needed to achieve a cure. Read more about the treatment of acute lymphoblastic leukaemia If a cure is not possible, there is a risk that the lack of healthy blood cells can make the person extremely vulnerable to life-threatening infections (due to the lack of white blood cells) or uncontrolled and serious bleeding (due to the lack of platelets). Symptoms Symptoms of acute lymphoblastic leukaemia usually begin slowly before rapidly getting severe as the number of blast cells (immature white blood cells) in your blood increases. Most of the symptoms are caused by the lack of healthy blood cells in your blood supply. Symptoms of acute lymphoblastic leukaemia include: pale skin feeling tired and breathless having repeated infections over a short space of time unusual and frequent bleeding, such as bleeding gums or nose bleeds high temperature (fever) of 38C (100.4F) or above night sweats bone and joint pain easily bruised skin swollen lymph nodes (glands) abdominal pain – caused by a swollen liver or spleen unexplained weight loss a purple skin rash (purpura) In some cases of acute lymphoblastic leukaemia, the affected cells can spread from your bloodstream into your central nervous system. This can cause a series of neurological symptoms (related to the brain and nervous system), including: headaches seizures (fits) vomiting blurred vision dizziness When to seek medical advice If you or your child has some or even all of the symptoms listed above, it is still highly unlikely that acute leukaemia is the cause. However, see your GP as soon as possible because any condition that causes these symptoms needs to be promptly investigated and treated. Causes Acute lymphoblastic leukaemia is caused by a DNA mutation in the stem cells causing too many white blood cells to be produced. The white blood cells are also released from the bone marrow before they are mature and able to fight infection like fully developed white blood cells. As the number of immature cells increases, the number of healthy red blood cells and platelets fall, and it's this fall which causes many of the symptoms of leukaemia. It is not known exactly what causes this DNA mutation to occur, but there are a few factors which may increase the risk of developing acute lymphoblastic leukaemia. Risk factors Genetic disorders A small number of childhood acute lymphoblastic leukaemia cases are thought to be caused by related genetic disorders. For example, rates of leukaemia tend to be higher in children with Down’s syndrome. Radiation exposure Exposure to very high levels of radiation, either before birth or afterwards, is a known risk factor. However, it would require a significant level of radiation, such as the amount released during the nuclear reactor accident at Chernobyl. Due to the potential risk of radiation to unborn babies, medical techniques and equipment that use radiation, such as X-rays, are rarely used on pregnant women. Most cases of childhood leukaemia occur in children with no history of genetic disorders or exposure to radiation. Possible environmental factors Experts have also carried out extensive research to determine whether the following environmental factors could be a trigger for leukaemia: living near a nuclear power station living near a power line living near a building or facility that releases electro-magnetic radiation, such as a mobile phone mast At the moment there is no evidence to confirm that any of these environmental factors increases the risk of developing leukaemia. Benzene Exposure to the chemical benzene is a known risk factor for adult acute leukaemia. Benzene is found in petrol and is also used in the rubber industry. However, there are strict controls to protect people from prolonged exposure. Benzene is also found in cigarettes, which could explain why smokers are three times more likely to develop acute leukaemia than non-smokers. People who have had chemotherapy and radiotherapy to treat earlier, unrelated cancers also have an increased risk of developing acute leukaemia. Other risk factors There is some evidence to show an increased risk of acute lymphoblastic leukaemia in people who: are obese have a weakened immune system – due to HIV or AIDS or taking immunosuppressants after an organ transplant Diagnosis The first step in diagnosing acute lymphoblastic leukaemia is for your GP to check for physical signs of the condition, such as swollen glands, and to take a blood sample. A high number of abnormal white blood cells in the blood sample could indicate the presence of acute leukaemia and you will then be referred to a haematologist (a specialist in treating blood conditions). Bone marrow biopsy To confirm a diagnosis of acute leukaemia, the haematologist will take a small sample of your bone marrow to examine under a microscope. The haematologist will use a local anaesthetic to numb the skin over a bone – usually the hip bone – and then use a needle to remove a sample of bone marrow. You may experience some pain once the anaesthetic wears off and some bruising and discomfort for a few days afterwards. The procedure takes around 15 minutes to complete and you shouldn't have to stay in hospital overnight. The bone marrow will be checked for cancerous cells and – if found – the type of acute leaukaemia will be determined at the same time. Further tests There are various additional tests that can be used to help reveal more information about the progress and extent of the leukaemia. They can also provide an insight into how the leukaemia should be treated. These tests are described below. Cytogenetic testing Cytogenetic testing involves identifying the genetic make-up of the cancerous cells. There are specific genetic variations that can occur during leukaemia, and knowing what these variations are can have an important impact on treatment. Immunophenotyping Immunophenotyping is a test to help identify the exact type of acute lymphoblastic leukaemia. A sample of blood, bone marrow or another type of fluid is studied. This testing is important as the treatment needed may be slightly different for each type. Polymerase chain reaction (PCR) A polymerase chain reaction (PCR) test can be done on a blood sample. This is an important test to diagnose and monitor the response to treatment. The blood test is repeated every three months for at least two years after starting treatment, then less often once remission is achieved. Lymph node biopsy If you have been diagnosed with acute leukaemia, further biopsies may be carried out on any enlarged lymph nodes that you have. These will be able to establish how far the leukaemia has spread. CT scans If you have acute leukaemia, a computerised tomography scan (CT scan) may be used to check that your organs, such as your heart and lungs, are healthy. Chest X-ray An X-ray may be performed to examine the chest for any swollen lymph nodes. Lumbar puncture If it is felt that there is a risk that acute leukaemia has spread to your nervous system, a lumbar puncture may be carried out. A lumbar puncture is a test where a needle is used under local anaesthetic to extract a sample of cerebrospinal fluid (fluid that surrounds and protects your spine) from your back. The fluid is tested to determine whether leukaemia has reached your nervous system. Treatment Treatment for acute lymphoblastic leukaemia usually begins a few days after diagnosis as it's an aggressive condition that develops rapidly. Stages of treatment Treatment for acute lymphoblastic leukaemia is carried out in stages: induction – the aim of the initial stage of treatment is to kill the leukaemia cells in your bone marrow, restore the balance of cells in your blood and resolve any symptoms you may have consolidation – this stage aims to kill any remaining leukaemia cells in your central nervous system maintenance – the final stage involves taking regular doses of chemotherapy tablets to prevent the leukaemia returning Maintenance only seems to be effective in treating acute lymphoblastic leukaemia; it's not usually used in the treatment of acute myeloid leukaemia. Induction The induction stage of treatment is carried out in hospital or in a specialist centre. This is because you will probably need to have regular blood transfusions as it's likely that your blood will not contain enough healthy blood cells. You will also be vulnerable to infection, so it is important that you are in a sterile environment where your health can be carefully monitored and any infection that you have can be promptly treated. You may also be prescribed antibiotics to help prevent further infection. Chemotherapy You will be given chemotherapy to kill the leukaemia cells in your bone marrow. Although some medications may be given as pills, you will need more than one medication given as an injection. To make things easier and avoid repeated injections, they can all be given via one flexible tube into a vein in your chest (called a central line). Some chemotherapy medication may also be directly administered into your cerebrospinal fluid to kill any leukaemia cells that may have spread to your nervous system. This is given using a needle that is placed into your spine, in a similar way to a lumbar puncture. Side effects that occur following chemotherapy are common. They can include: nausea vomiting diarrhoea loss of appetite mouth ulcers tiredness skin rashes infertility hair loss The side effects should resolve once treatment has finished. Your hair will usually take between three to six months to grow back. Steroid therapy You may also be given corticosteroid injections or tablets to help improve the effectiveness of chemotherapy. Imatinib If you have a type of leukaemia known as Philadelphia chromosome-positive acute lymphoblastic leukaemia, you will also be given a medicine called imatinib. Imatinib works by blocking the signals in the cancerous cells that cause them to grow and reproduce. This kills the cancerous cells. Imatinib is taken orally (as a tablet). The side effects of imatinib are usually mild and should improve over time. They include: nausea vomiting swelling in the face and lower legs muscle cramps rash diarrhoea Depending on how well you respond to treatment, the induction phase can last from two weeks to several months. In some cases, you or your child may be able to leave hospital and receive treatment on an outpatient basis if your symptoms improve. Consolidation Leukaemia can return if just one cancerous cell remains in your body. Therefore the aim of consolidation treatment is to ensure that any remaining leukaemia cells are killed. Treatment involves receiving regular injections of chemotherapy medication. This is usually done on an outpatient basis, which means you will not have to stay in hospital overnight. However, you may require some short stays in hospital if your symptoms suddenly get worse or if you develop an infection. The consolidation phase of treatment lasts several months. Maintenance The maintenance phase is designed to act as further insurance against the possibility of the leukaemia returning. It involves taking regular doses of chemotherapy tablets while undergoing regular check-ups to monitor how effective your treatment is proving. The maintenance phase can often last for two years. Other treatments As well as chemotherapy and imatinib, other treatments are used in some circumstances. These are described below. Dasatinib Dasatinib is a new type of medication used to treat Philadelphia chromosome-positive acute lymphoblastic leukaemia, when all other treatments have proved unsuccessful. Dasatinib blocks a protein called tyrosine kinase that helps stimulate the growth of cancer cells. Dasatinib cannot cure acute leukaemia but it can slow its growth, helping to relieve symptoms and prolong life. The National Institute for Health and Care Excellence (NICE) has not yet made a decision about whether the NHS should provide treatment with dasatinib for people with acute lymphoblastic leukaemia. This means it will be at the discretion of your local clinical commissioning group as to whether you will be offered the drug. Radiotherapy Radiotherapy involves using high doses of controlled radiation to kill cancerous cells. There are two main reasons why radiotherapy is usually used to treat acute leukaemia: to sometimes treat advanced cases of acute lymphoblastic leukaemia that have spread to the nervous system or brain to prepare the body for a bone marrow transplant (see below) Side effects of both types of radiotherapy include: hair loss nausea fatigue The side effects should pass once your course of radiotherapy has been completed. However, your skin may be very sensitive to the effects of light for several months after the treatment has finished. If this is the case, avoid sunbathing or exposure to sources of artificial light, such as sunbeds, for several months. Many younger children treated with radiotherapy will go on to have restricted physical growth during puberty. A small number of people develop cataracts several years after radiotherapy. Cataracts are cloudy patches in the lens (the transparent structure at the front of the eye) that can make your vision blurred or misty. Cataracts can usually be successfully treated using surgery. Read more about cataracts and cataract surgery Bone marrow and stem cell transplants If you or your child do not respond to chemotherapy, a possible alternative treatment option is bone marrow or stem cell transplantation. Transplantations are more successful if the donor has the same tissue type as you, so the ideal donor is usually a brother or sister. Before transplantation can take place, the person receiving the transplant will need to have aggressive high-dose chemotherapy and radiotherapy to destroy any cancerous cells in their body. This can put a big strain on the body so transplantations are usually only successful when they are carried out in children and young people, or older people who are in good health, and when there is a suitable donor, such as a brother or sister. Read about bone marrow transplantation for more information Complications Being immunocompromised (having a weakened immune system) is a possible complication for some patients with acute leukaemia. There are two reasons for this: the lack of healthy white blood cells means that your immune system is less able to fight infection many of the medicines used to treat acute leukaemia can weaken the immune system This means that you are more vulnerable to developing an infection, and that any infection you have has an increased potential to cause serious complications. You may be advised to take regular doses of antibiotics to prevent infections occurring. You should immediately report any possible symptoms of an infection to your GP or care team because prompt treatment may be required to prevent serious complications. Symptoms of infection include: high temperature (fever) of 38C (101.4F) or above headache aching muscles diarrhoea tiredness Avoid contact with anyone who is known to have an infection, even if it is a type of infection that you were previously immune to, such as chickenpox or measles. This is because your previous immunity to these conditions will probably be lower. While it is important to go outside on a regular basis, both for exercise and for your psychological wellbeing, avoid visiting crowded places and using public transport during rush hour. Also ensure that all of your vaccinations are up-to-date. Your GP or care team will be able to advise you about this. You will be unable to have any vaccine containing activated particles of viruses of bacteria such as: the mumps, measles and rubella (MMR) vaccine the polio vaccine the oral typhoid vaccine the BCG vaccine (used to vaccinate against tuberculosis) the yellow fever vaccine Bleeding If you have acute leukaemia, you will bleed and bruise more easily due to the low levels of platelets (clot-forming cells) in your blood. Bleeding may also be excessive when it does occur. Bleeding can occur: inside the skull (intracranial haemorrhage) inside the lungs (pulmonary haemorrhage) inside the stomach (gastrointestinal haemorrhage) The symptoms of an intracranial haemorrhage include: severe headache stiff neck vomiting change in mental state, such as confusion The most common symptoms of a pulmonary haemorrhage are: coughing up blood from your nose and mouth breathing difficulties a bluish skin tone (cyanosis) The two most common symptoms of a gastrointestinal haemorrhage are: vomiting blood passing stools (faeces) that are very dark or tar-like All three types of haemorrhages should be regarded as medical emergencies. Dial 999 to request an ambulance if you suspect that you or your child is experiencing a haemorrhage. Infertility Many of the treatments that are used to treat acute leukaemia can cause infertility. Infertility is often temporary, although in some cases it may be permanent. People who are particularly at risk of becoming infertile are those who have received high doses of chemotherapy and radiotherapy in preparation for bone marrow or stem cell transplantation. It may be possible to guard against any risk of infertility before you begin your treatment. For example, men can have samples of their sperm stored. Similarly, women can have fertilised embryos stored, which can then be placed back into their womb following treatment. Read more about infertility Psychological effects of leukaemia Receiving a diagnosis of leukaemia can be very distressing, particularly if it is unlikely that your condition can be cured. At first, the news may be difficult to take in. The situation can be made worse if you are confronted with the knowledge that even though your leukaemia may not currently be causing any symptoms, it could be a serious problem in later life. Having to wait many years to see how the leukaemia develops can be immensely stressful and can trigger feelings of stress, anxiety and depression. If you have been diagnosed with leukaemia, talking to a counsellor or psychiatrist (a doctor who specialises in treating mental health conditions) may help you to combat feelings of depression and anxiety. Antidepressants or medicines that help to reduce feelings of anxiety may also help you cope better with the condition. You may find it useful to talk to other people who are living with leukaemia. Your GP or multidisciplinary team may be able to provide you with details of local support groups. Another excellent resource is Macmillan Cancer Support. Their helpline number is 0808 808 00 00 and is open Monday to Friday, 9am–8pm. Further information You can read more information on all aspects of living and coping with cancer at the following links: living with cancer – including information on treatment, support and personal experiences of cancer living with acute lymphoblastic leukaemia – Cancer Research UK
||Acute lymphoblastic leukaemia: Children
||Around three out of four childhood leukaemia cases are acute lymphoblastic
Acute lymphoblastic leukaemia (ALL) is a type of blood cancer. One-third of all childhood cancers are leukaemia, with approximately 400 new cases in the UK each year. Approximately, three out of four of these cases are acute lymphoblastic (ALL). ALL can affect children of any age but is more common in children aged 1-4 years old. More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. It is devastating to hear that your child has cancer, and at times it can feel overwhelming but there are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. We hope you find the information here helpful. Your child’s specialist will give you more detailed information, and if you have any questions it is important to ask the specialist doctor or nurse who knows your child’s individual situation. Leukaemia Leukaemia is a cancer of the white blood cells. All blood cells are made in the bone marrow, the spongy substance at the core of some bones in the body. Bone marrow contains: red blood cells, which carry oxygen around the body platelets, which help the blood to clot and control bleeding white blood cells, which help fight infection There are two different types of white blood cells; lymphocytes and myeloid cells (including neutrophils). These white blood cells work together to fight infection. Normally, white blood cells develop, repair and reproduce themselves in an orderly and controlled way. In leukaemia, however, the process gets out of control and the cells continue to divide in the bone marrow, but do not mature. These immature dividing cells fill up the bone marrow and stop it from making healthy blood cells. As the leukaemia cells are not mature, they cannot work properly. This leads to an increased risk of infection. There are four main types of leukaemia: acute lymphoblastic (ALL) acute myeloid (AML) chronic lymphocyte (CLL) chronic myeloid (CML) Chronic leukaemias usually affect adults and each type of leukaemia has its own characteristics and treatment. ALL is a cancer of immature lymphocytes, called lymphoblasts or blast cells. There are two different types of lymphocytes; T-cells and B-cells. Often, leukaemia occurs at a very early stage in the immature lymphocytes, before they have developed into either T-cells or B-cells. However, if the cells have developed this far before becoming leukaemic, the type of leukaemia may be known as T-cell or B-cell leukaemia. This is about acute lymphoblastic leukemia (ALL). Causes The exact cause of ALL is unknown. Research is going on all the time into possible causes of this disease. Children with certain genetic disorders, such as Down’s syndrome, are known to have a higher risk of developing leukaemia. Brothers and sisters of a child with ALL (particularly identical twins) have a slightly increased risk of developing ALL themselves, although this risk is still small. Like all cancers, ALL is not infectious and cannot be passed on to other people. Signs and symptoms As the leukaemia cells multiply in the bone marrow, the production of normal blood cells is reduced. Children may therefore become tired and lethargic because of anaemia, which is caused by a lack of red blood cells. Children may develop bruises, and bleeding may take longer to stop because of the low number of platelets present in their blood (which help blood to clot). Sometimes, children suffer from infections because of low numbers of normal white blood cells. A child is likely to feel generally unwell and may complain of aches and pains in the limbs or may have swollen lymph glands. At first, the symptoms are just like those of a viral infection, but when they continue for more than a week or two, the diagnosis usually becomes clear. How ALL is diagnosed A blood test usually shows low numbers of normal white blood cells and the presence of the abnormal leukaemia cells. A sample of bone marrow is usually needed to confirm the diagnosis. A sample is also sent to the genetics department to look for any abnormal chromosomes, and for a test called MRD (minimal residual disease) analysis. A test called a lumbar puncture is done to see if the spinal fluid contains any leukaemia cells. A chest x-ray is also done, which will show if there are any enlarged glands in the chest. Other tests may be necessary, depending on your child’s symptoms. These tests will help to identify the precise type of leukaemia and help doctors decide on the best treatment. Treatment The aim of treatment for ALL is to destroy the leukaemia cells and enable the bone marrow to work normally again. Chemotherapy is the main treatment for ALL and is given according to a treatment plan (often called a protocol or regimen). The treatment is given in several phases, or ‘blocks’, which are explained below. Induction This phase involves intensive treatment, aimed at destroying as many leukaemia cells as possible and is usually started within days of being diagnosed. The induction phase lasts 4-6 weeks. A bone marrow test is taken at the end of induction treatment to confirm whether or not the child still has leukaemia. The sample that is taken is looked at under a microscope and when there is no evidence of leukaemia, the child’s condition is referred to as being in ‘remission’. Consolidation and central nervous system (CNS) treatment The next phase of treatment is aimed at maintaining the remission and preventing the spread of leukaemia cells into the brain and spinal cord (the central nervous system, or CNS). CNS treatment involves injecting a drug, usually methotrexate lumbar puncture. After this consolidation treatment there is a recovery period which is called interim maintenance. This is when more drugs will be given to try to keep the leukaemia in remission. The exact details will depend on which arm of treatment your child follows and will be discussed in detail by your child’s doctor as it depends on your child’s response to treatment so far. Further doses of chemotherapy treatment, called ‘delayed intensification’, are given to kill off any remaining leukaemia cells. Maintenance treatment This phase of treatment lasts for two years from the start of interim maintenance for girls and three years from the start of interim maintenance for boys. It involves the child taking daily and weekly tablets, some children also have monthly injections of chemotherapy and oral pulses of steroids and three-monthly intrathecal treatment. Children will be able to take part in their normal daily activities as soon as they feel able to. Most children return to school before beginning maintenance treatment. Bone marrow transplantation Bone marrow treatment is only needed by a minority of patients and is used for children with ALL that is likely to come back following standard chemotherapy. Testicular radiotherapy In some situations it may be necessary for boys to have radiotherapy to their testicles. This is because leukaemia cells can survive in the testicles despite chemotherapy. Central nervous system (CNS) radiotherapy Children who have leukaemia cells in their CNS when they are first diagnosed with ALL need more frequent lumbar punctures with intrathecal chemotherapy. Your child’s specialist will discuss with you which treatment and how much of it your child needs, and will answer any questions you have. Side effects of treatment Many cancer treatments will cause side effects. This is because while the treatments are killing the cancer cells, they can also damage some normal cells. Some of the main side effects of chemotherapy are: hair loss reduction in the number of blood cells produced by the bone marrow, which can cause anaemia (an increased risk of bruising, bleeding and infection loss of appetite feeling sick (nausea) and being sick (vomiting) Steroid medicines can also cause side effects such as: increased appetite mood changes and irritability weight gain muscle weakness (especially in the legs) Most side effects are temporary, and there are ways of reducing them and supporting your child through them. Your child’s doctor or nurse will talk to you about any possible side effects. It is important to discuss any side effects your child is having with the team treating them, so that they know how your child is feeling. Late side effects of treatment A small number of children may develop late side effects, sometimes many years later. These include possible problems with puberty and fertility, a change in the way their heart works and a small increase in the risk of developing another cancer later in life. Your child’s doctor or nurse will talk to you about any possible late side effects. Clinical trials Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for ALL. If appropriate, your child’s medical team will talk to you about taking part in a clinical trial and will answer any questions you have. Written information is provided to help explain things. Taking part in a research trial is completely voluntary, and you’ll be given enough time to decide if it is right for your child. Treatment guidelines Sometimes, clinical trials are not available for your child. This may be because a recent trial has just finished, or because the condition is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the UK. The Children’s Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care Most children with ALL are cured. If the leukaemia recurs after initial treatment, it usually does so within the first three years. Further treatment can then be given. Long-term side effects (late side effects) are rare, and most children with ALL grow and develop normally. If you have specific concerns about your child’s condition and treatment, it’s best to discuss them with your child’s doctor, who knows the situation in detail. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. It’s not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young People’s Cancer; A Parent’s Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience of cancer. The Parent’s Guide discusses these further and talks about how you can support your child.
||Acute lymphoblastic leukaemia: Teenagers and young adults
||Learn more about acute lymphoblastic leukaemia in young people
This section is for teenagers and young adults and is about a type of cancer called acute lymphoblastic leukaemia (ALL). The other main type of leukaemia that can affect teenagers and young adults is acute myeloid leukaemia. If you’re looking for information about ALL in people of all ages, please see our general ALL section. Leukaemia is a cancer of the white blood cells. In leukaemia, the process for making new white blood cells gets out of control. Immature white blood cells (called blasts) keep being made and build up in the bone marrow until there isn’t enough room for the bone marrow to make healthy white blood cells, red blood cells and platelets. The body needs these cells to: help us fight infection (white cells) carry oxygen from the lungs around our body (red blood cells) stop us bleeding when we cut ourselves by clotting our blood (platelets) Symptoms Many of the symptoms of ALL are caused by having fewer than normal healthy blood cells in the body. Symptoms can include: looking paler than usual and feeling tired - because of too few red blood cells (anaemia) bruises - you may bruise more easily and it could take longer for bleeding to stop, if you have less blood clotting cells (platelets) than normal infections - because there are too few mature white blood cells to fight infection aches and pains in your bones swollen glands (lymph nodes) in your neck, under your arm or in your groin feeling unwell and run down fever and sweats - you may have a high temperature without any obvious cause, such as an infection headaches and visual disturbance There can be other reasons you may have these symptoms. But if you are worried that you may have ALL, you should see your family doctor (GP). They will examine you and refer you to a hospital if they think you need to see a specialist doctor. Causes We don't know exactly what causes ALL, but research is going on to try to find out. Young people with some genetic conditions, such as Down's syndrome or Li-Fraumeni syndrome, are at an increased risk of developing ALL. A genetic condition is something you are born with. If you're worried about ALL If you think you have some of the symptoms of ALL you should go to your GP. They can talk to you about your symptoms and arrange any tests they think you might need. Leukaemia, blood tests and bone marrow To help you understand leukaemia, it can help to know a little about the blood and bone marrow. Leukaemia is a cancer of the white blood cells. Knowing a bit about how blood cells are made in the body can help you to understand leukaemia and how it’s treated. All blood cells are made in the bone marrow, which is like a blood cell factory inside our bones. A type of cell in the bone marrow, called a stem cell, can make any kind of blood cell your body needs. There are three main types of blood cells: white blood cells – which help us fight infection red blood cells – which carry oxygen from the lungs around our body platelets – which clot our blood to stop us bleeding when we cut ourselves The bone marrow normally makes millions of blood cells every day. To begin with, these new blood cells, called blasts, are not fully developed (they’re immature). The main job of blast cells is to make more blood cells like themselves. They can’t do any of the jobs that mature blood cells can do, like carrying oxygen or fighting infection. Blast cells normally stay inside the bone marrow until they’ve matured into fully-developed blood cells. Once blood cells are mature, they’re ready to do their jobs. They leave the bone marrow and go into the bloodstream, where they can be carried to wherever they’re needed. How leukaemia develops In leukaemia, the process for making new white blood cells gets out of control and immature white blood cells (blasts) keep being made. They build up in the bone marrow until there isn’t enough room for the bone maow to make healthy white cells, red cells and platelets. Types of leukaemia Leukaemia is a cancer of the white blood cells. Healthy white blood cells are made from two types of blood cells: lymphoblasts that make lymphocytes myeloid cells (myeloblasts) that make other types of white blood cells such as neutrophils. Leukaemias are named after the type of white blood cell that has become abnormal and started growing out of control. . The most common types in teenagers and young adults are AML and ALL: Leukaemia that starts from abnormal myeloid cells is called acute myeloid leukaemia - or AML for short. Leukaemia that starts from abnormal lymphoblasts is called acute lymphoblastic leukaemia (ALL). There are other types of leukaemia that are more common in older people. The information in this section is about ALL, but if you have a different type of leukaemia and want to know more, contact Macmillan. We also have more info about: symptoms and causes of ALL having tests for ALL being treated for ALL If you're looking for information about ALL in people of all ages, please see our general ALL section. Tests for ALL It’s important to remember that the symptoms of ALL can be caused by lots of different things.But you should go to your GP if you’re worried. They can talk to you about your symptoms and arrange any tests they think you might need. Visiting your GP Your GP (family doctor) will examine you and arrange for you to have blood tests. There can be different reasons for your symptoms, so you’ll need a blood test to help diagnose acute lymphoblastic leukaemia (ALL). If you have ALL, a blood test will usually find leukaemia cells and you'll be referred to a specialist at the hospital. This specialist is called a haematologist and is a doctor who treats people with blood problems. At the hospital The haematologist will examine you and ask you about your symptoms and any recent illnesses. They will also arrange for you to have some more tests. These may include: Blood tests - you’ve probably already had blood tests but you’ll need more when you have seen the haematologist. These tests look at the changes in the leukaemia cells. This helps the doctors decide on the best treatment for you. You might hear the doctors calling one of these tests immunophenotyping or flow cytometry. Bone marrow test - you’ll have samples taken from your bone marrow. The doctors will count the numbers of leukaemia cells in the bone marrow. They will also send samples for cytogenetic and immunophenotyping testing. Lumbar puncture - a small sample of the fluid that surrounds your brain and spinal cord is taken to check for leukaemia cells. Chest X-ray - this may also be done to see if there are any swollen lymph nodes (glands) in your chest. Macmillan has more information on these and other tests. If you have ALL, you might need a few more tests to check how your body is working in general. These could be blood tests, or an ultrasound scan of the tummy (abdomen) to look at your liver, spleen and kidneys, and an echocardiogram (an ultrasound of the heart). This may seem like a lot of tests, but they give the doctors important information that will help them give you the right treatment. Waiting for test results can be a scary time, but understanding a little about them - what will happen, how you'll feel and when you'll get the results - can help you cope. Thinking about how you feel and getting support from family, friends or your specialist nurse and doctor can also make it a bit easier. You could also talk to a Macmillan cancer support specialist on their free helpline. We also have more info about: symptoms of ALL being treated for ALL leukaemia, blood cells and bone marrow If you're looking for information about ALL in people of all ages, please see our general ALL section. Treating ALL The main treatment for acute lymphoblastic leukaemia (ALL) is chemotherapy (chemo). This means having anti-cancer drugs to destroy the leukaemia cells. You’ll also have drugs called steroids, which help the chemo to work. The treatment for ALL is pretty intensive at times and can cause unpleasant side effects. But you'll be in close contact with the hospital when you’re most likely to feel unwell and the staff will be able to help if things get tough. Don’t feel you have to be brave. Be honest about how you are feeling with your doctors and nurses and they can give you medicines that can help you feel better. ALL is treated in three phases: getting rid of the leukaemia - remission induction keeping the leukaemia away - consolidation and delayed intensification therapy keeping the leukaemia away long-term - continuing or maintenance therapy You usually start chemo pretty quickly after finding out that you have ALL. You'll be in hospital for your treatment to begin with. If you're 18 or younger, you'll be treated in a specialist Principal Treatment Centre (PTC) for teenagers and young adults (TYA). If you're 19 or older, you'll be offered the choice of having treatment at the PTC or another hospital closer to home called a TYA designated hospital. "I wouldn't want to go through it again and anyone who is going through it, then I know how you feel. It's very difficult but there is a light at the end of the tunnel because I've got through it and you can get through it as well." You’ll be given chemo as tablets, by injection and into your bloodstream (intravenously). You’ll also be given chemo into the fluid around the spinal cord to make sure the leukaemia cells can’t hide there. This is called central nervous system (CNS) therapy. It is also known as intrathecal therapy. You’ll have a ‘line’ put in to one of your main veins to make it easier for you to have intravenous treatment. Your nurses and doctors can also use the line to take blood samples for blood tests. There are different kinds of lines. You might have a central line (Hickman® or Groshong®), an implantable port (portacath), or a PICC line. Having chemo can be hard. But the staff looking after you will give you medicines to help you cope with any side effects so you can stay strong enough to have treatment. And you’ll be given medicines to stop you feeling sick and antibiotics to help prevent infections. There will probably be times when you feel rough and other times when you’ll feel better. You might also feel upset, down or irritable. Talking to someone you trust can help you cope with these feelings. Being in hospital or coming up to hospital for clinics and treatment can be frustrating, especially when you miss out on stuff happening at school, college, university or work, or on things your friends are doing. You could try talking to your friends and family about this and see what they can do to help you. It can also help to talk to any new friends you’ve made who are going through similar experiences to you. We have more information about chemotherapy that has been written for people of all ages, not just teens and young adults. Getting rid of the leukaemia (remission induction) The first phase of your treatment is about getting rid of the leukaemia. You’ll be given chemo to kill as many leukaemia cells as possible. Remission means there is no sign of leukaemia cells in your blood or bone marrow. This type of treatment involves: chemo to kill the leukaemia cells (including CNS therapy) steroids to help the chemo work drugs (allopurinol or rasburicase) to help protect your kidneys from problems that can happen when lots of leukaemia cells are destroyed at once another tablet (for example ranitidine or lansoprazole) to stop indigestion or ulcers You need to stay in hospital during this phase of your treatment so the doctors can check how things are going. Treatment to get you into remission takes about five weeks, sometimes a bit longer. Being in hospital that long can be really difficult at times. If you're struggling to cope, try and talk to your friends, family, doctors and nurses. It’s important not to bottle up your feelings otherwise your might end up finding it hard to cope. Drugs you may be given include: vincristine asparaginase daunorubicin mercaptopurine methotrexate Side effects Different chemo can cause different side effects. There is information about the specific ones in Macmillan's chemotherapy section. Central nervous system therapy Chemo given as tablets or into the blood can reach most places in your body. But it isn’t good at getting into the brain or spinal cord (called the central nervous system or CNS). So you’ll be given treatment into the fluid that goes around the CNS to target any leukaemia cells that might be hiding there. This is called CNS therapy. CNS therapy is given during remission induction treatment (to get rid of the leukaemia) and continues right until the end of maintenance therapy. Chemo is given into the fluid, called cerebrospinal fluid or CSF, around your spinal cord. Drug treatment given into the CSF is called intrathecal therapy. It’s a bit like having a lumbar puncture but with chemo added. A doctor puts a needle into the space between two small bones (vertebrae) near the bottom of your spine. Then they inject chemo into the CSF. The CSF will carry the chemo around your CNS so it can reach any leukaemia cells that might be there. The chemo drug used for CNS therapy is called methotrexate. Side effects Most people don’t have side effects after having intrathecal methotrexate. But occasionally it can cause headaches, dizziness, tiredness or blurry vision for a few hours. Rarely other side effects like seizures (fits), weakness of your arms or legs and changes in how awake you are can happen. But these almost always go away completely and you can still have the intrathecal injections in the future. Keeping leukaemia away This treatment is called consolidation and delayed intensification therapy. When you’re in remission, it means the doctors can’t see any leukaemia cells in your blood or bone marrow samples when they check them under the microscope. But there may still be leukaemia cells hiding in your body, so you need further treatment to get rid of these cells. You’ll be given different types of chemo drugs. This is so the leukaemia cells don't have a chance to get used to them (which is called drug resistance). This phase of treatment takes about 5-6 months. Most of the treatment can be given as an outpatient but you might need to stay in hospital for some parts of it. Drugs you may be given include: cyclophosphamide cytarabine (ara-C) mercaptopurine methotrexate vincristine asparaginase doxorubicin Side effects Chemo does cause side effects. There is information about the specific ones in Macmillan's chemotherapy section. Keeping the leukaemia away long term (maintenance therapy) This treatment is given to prevent the leukaemia from returning (known as relapse). The chemo is given in low doses. You have it as an outpatient so you can keep doing all your normal, everyday activities when you’re having maintenance therapy. Maintenance therapy is given in 12-week cycles. You’ll have: mercaptopurine tablets each day methotrexate tablets once a week steroid tablets for five days every four weeks vincristine chemo every four weeks methotrexate chemo into your cerebrospinal fluid (CSF) every 12 weeks At the moment, boys have just over three years of maintenance therapy and girls have just over two years. This is because it takes a bit longer in boys to get rid of any remaining leukaemia cells. During this time, you'll have regular check-ups - usually every week or two - to check if your drug doses need to be adjusted and to make sure you're OK. Very often, things like blood tests can be done at your GP's surgery or at home by a district nurse. Ask your doctor or nurse about arranging this.
||Acute myeloid leukaemia
||Learn about acute myeloid leukaemia, a cancer of the white blood cells
Leukaemia is cancer of the white blood cells. Acute leukaemia means it progresses rapidly and aggressively, and usually requires immediate treatment. Acute leukaemia is classified according to the type of white blood cells affected. The two main types of white blood cells are: lymphocytes – mostly used to fight viral infections myeloid cells – which perform a number of different functions, such as fighting bacterial infections, defending the body against parasites and preventing the spread of tissue damage This topic focuses on acute myeloid leukaemia (AML), which is an aggressive cancer of the myeloid cells. The following types of leukaemia are covered separately: acute lymphoblastic leukaemia chronic myeloid leukaemia chronic lymphocytic leukaemia Signs and symptoms of AML The symptoms of AML usually develop over a few weeks and become increasingly more severe. Symptoms can include: pale skin tiredness breathlessness frequent infections unusual and frequent bleeding, such as bleeding gums or nosebleeds In more advanced cases, AML can make you extremely vulnerable to life-threatening infections or serious internal bleeding. Read more about the complications of AML Seeking medical advice You should see your GP if you or your child have possible symptoms of AML. Although it's highly unlikely that leukaemia is the cause, these symptoms should be investigated. If your GP thinks you may have leukaemia, they'll arrange blood tests to check your blood cell production. If the tests suggest there's a problem, you'll be urgently referred to a haematologist (a specialist in treating blood conditions) for further tests and any necessary treatment. Read more about diagnosing AML What causes AML? AML occurs when specialised cells called stem cells, which are found in the bone marrow (a spongy material inside the bones), produce too many immature white blood cells. These immature cells are known as blast cells. Blast cells don't have the infection-fighting properties of healthy white blood cells, and producing too many can lead to a decrease in the number of red blood cells (which carry oxygen in the blood) and platelets (cells that help the blood to clot). It's not clear exactly why this happens and, in most cases, there's no identifiable cause. However, a number of factors that can increase your risk of developing AML have been identified. These include: previous chemotherapy or radiotherapy exposure to very high levels of radiation (including previous radiotherapy treatment) exposure to benzene – a chemical used in manufacturing that's also found in cigarette smoke having an underlying blood disorder or genetic disorder, such as Down's syndrome Read more about the causes of AML Who's affected AML is a rare type of cancer, with around 2,600 people diagnosed with it each year in the UK. The risk of developing AML increases with age. It's most common in people over 65. How AML is treated AML is an aggressive type of cancer that can develop rapidly, so treatment usually needs to begin soon after a diagnosis is confirmed. Chemotherapy is the main treatment for AML. It's used to kill as many leukaemia cells in your body as possible and reduce the risk of the condition coming back (relapsing). In some cases, intensive chemotherapy and radiotherapy may be needed, in combination with a bone marrow or stem cell transplant, to achieve a cure. Read more about treating AML Outlook The outlook for AML largely depends on the specific type of AML you have, as well as your age and general health. There are many subtypes of AML, which are classified according to various features – such as the specific genetic changes in the leukaemia cells. Some types of AML are more challenging to treat than others. Even if treatment is initially successful, there's still a significant risk that the condition will return at some point during the next few years. If this happens, treatment may need to be repeated. A number of medical trials have suggested that almost half of those aged under 60 diagnosed with AML will live for at least five years, and in some types of AML, such as acute promyeloid leukaemia (APML), around 85% will live for at least five years. In general, the outlook for children with AML tends to be better than that of adults diagnosed with the condition. Symptoms The symptoms of acute myeloid leukaemia (AML) usually develop over a few weeks, becoming more severe as the number of immature white blood cells (blast cells) in your blood increases. Symptoms of AML can include: pale skin tiredness breathlessness a high temperature (fever) excessive sweating weight loss frequent infections unusual and frequent bleeding, such as bleeding gums or nosebleeds easily bruised skin flat red or purple spots on the skin (petechiae) bone and joint pain a feeling of fullness or discomfort in your tummy (abdomen), caused by swelling of the liver or spleen In rare cases of AML, the affected cells can spread into the central nervous system. This can cause symptoms such as headaches, fits (seizures), vomiting, blurred vision and dizziness. When to seek medical advice See your GP if you or your child have the symptoms listed above. Although it's highly unlikely that AML is the cause, these symptoms need to be investigated and treated promptly. Causes Acute myeloid leukaemia (AML) is caused by a DNA mutation in the stem cells in your bone marrow that produce red blood cells, platelets and infection-fighting white blood cells. The mutation causes the stem cells to produce many more white blood cells than are needed. The white blood cells produced are still immature, so they don't have the infection-fighting properties of fully developed white blood cells. These immature cells are known as "blast cells". As the number of immature cells increases, the amount of healthy red blood cells and platelets decrease, and it's this fall that causes many of the symptoms of leukaemia. Increased risk It's not known what triggers the genetic mutation in AML, although a number of different factors that can increase your risk of developing the condition have been identified. The main risk factors for AML are outlined below. Radiation exposure Being exposed to a significant level of radiation can increase your chances of developing AML, although this usually requires exposure at very high levels. For example, rates of AML are higher in people who survived the atomic bomb explosions in Japan in 1945. In the UK, most people are unlikely to be exposed to levels of radiation high enough to cause AML. However, some people who have had radiotherapy as part of their treatment for previous cancer (see below) can be the exception. Benzene and smoking Exposure to the chemical benzene is a known risk factor for AML in adults. Benzene is found in petrol, and it's also used in the rubber industry, although there are strict controls to protect people from prolonged exposure. Benzene is also found in cigarette smoke, which could explain why people who smoke have an increased risk of developing AML. Previous cancer treatment Treatment with radiotherapy and certain chemotherapy medications for an earlier, unrelated cancer can increase your risk of developing AML many years later. Leukaemia that develops as a result of previous cancer treatment is called "secondary leukaemia" or "treatment-related leukaemia". Blood disorders People with certain blood disorders – such as myelodysplasia, myelofibrosis or polycythaemia vera (PCV) – have an increased risk of developing AML. Genetic disorders People with certain genetic disorders, including Down’s syndrome and Fanconi’s anaemia, have an increased risk of developing leukaemia. Other suggested triggers A number of other environmental factors that could trigger AML have also been suggested, including childhood vaccinations and living near a nuclear power station or a high-voltage power line. However, there's no clear evidence to suggest that these can increase your risk of developing AML. Diagnosis In the initial stages of diagnosing acute myeloid leukaemia (AML), your GP will check for physical signs of the condition and arrange for you to have blood tests. A high number of abnormal white blood cells, or a very low blood count in the test sample, could indicate the presence of leukaemia. If this is the case, you'll be urgently referred to a haematologist (a specialist in treating blood conditions). A haematologist may carry out further blood tests, in addition to some of the tests outlined below. Bone marrow biopsy To confirm a diagnosis of AML, the haematologist will take a small sample of your bone marrow to examine under a microscope. This procedure is known as a bone marrow biopsy, which is usually carried out under a local anaesthetic. The haematologist will numb an area of skin at the back of your hip bone, before using a thin needle to remove a sample of liquid bone marrow. In some cases, a larger needle may also be used to remove a small amount of bone and bone marrow together. You won't feel any pain during the procedure, but you may experience some bruising and discomfort for a few days afterwards. The procedure takes around 15 minutes to complete, and you shouldn't have to stay in hospital overnight. The bone marrow sample will be checked for cancerous cells. If cancerous cells are present, the biopsy can also be used to determine the type of leukaemia you have. Further tests Additional tests can be used to reveal more information about the progress and extent of your AML. They can also provide an insight into how the condition should be treated. These tests are described below. Genetic testing Genetic tests can be carried out on blood and bone marrow samples to identify the genetic makeup of the cancerous cells. There are many specific genetic variations that can occur in AML, and knowing the exact type of AML you have can help doctors make decisions about the most appropriate treatment. For example, people who have a type of AML known as acute promyelocytic leukaemia (APML) are known to respond well to a medicine called All Trans-Retinoic Acid (ATRA). Scans If you have AML, a computerised tomography (CT) scan, X-ray or echocardiogram (an ultrasound scan of the heart) may be used to check that your organs, such as your heart and lungs, are healthy. These tests are carried out because it's important for doctors to assess your general health before they can decide on the most appropriate treatment for you. Lumbar puncture In rare situations where it's thought there's a risk that AML has spread to your nervous system, a lumbar puncture may be carried out. In this procedure, a needle is used to extract a sample of cerebrospinal fluid (which surrounds and protects your spine) from your back, so it can be checked for cancerous cells. If cancerous cells are found in your nervous system, you may need to have injections of chemotherapy medication directly into your cerebrospinal fluid as part of your treatment. Treatment Acute myeloid leukaemia (AML) is an aggressive condition that develops rapidly, so treatment will usually begin a few days after a diagnosis has been confirmed. As AML is a complex condition, it's usually treated by a multidisciplinary team (MDT) – a group of different specialists working together (see below). Your treatment plan Treatment for AML is often carried out in two stages: Induction – the aim of this initial stage of treatment is to kill as many leukaemia cells in your blood and bone marrow as possible, restore your blood to proper working order and treat any symptoms you may have. Consolidation – this stage aims to prevent the cancer returning (relapsing), by killing any remaining leukaemia cells that may be present in your body. The induction stage of treatment isn't always successful and sometimes needs to be repeated before consolidation can begin. If you have a relapse after treatment, both re-induction and consolidation may need to be carried out. This may be the same as your first treatment, although it's likely to involve different medications or a stem cell transplant (see below). If you're thought to have a high risk of experiencing complications of AML treatment – for example, if you're over 75 years of age or have another underlying health condition – less intensive chemotherapy treatment may be carried out. This is less likely to successfully kill all of the cancerous cells in your body, but it can help control your condition. Induction The initial treatment you have for AML will largely depend on whether you're fit enough to have intensive chemotherapy, or whether treatment at a lower dosage is recommended. Intensive chemotherapy If you can have intensive induction chemotherapy, you'll usually be given a combination of chemotherapy medication at a high dose to kill the cancerous cells in your blood and bone marrow. This stage of treatment will be carried out in hospital or in a specialist centre, as you'll need very close medical and nursing supervision. You'll have regular blood transfusions because your blood won't contain enough healthy blood cells. You'll also be vulnerable to infection, so it's important that you're in a clean and stable environment where your health can be carefully monitored and any infection you have can be promptly treated. You may also be prescribed antibiotics to help prevent further infection. Depending on how well you respond to treatment, the induction phase can last from four weeks to a couple of months. You may be able to leave hospital and receive treatment on an outpatient basis if your symptoms improve. For intensive treatment, the chemotherapy medications will be injected into a thin tube that's inserted either into a blood vessel near your heart (central line) or into your arm (a peripherally inserted central catheter, or PICC). In very rare cases, chemotherapy medication may also be directly administered into your cerebrospinal fluid to kill any leukaemia cells that may have spread to your nervous system. This is done using a needle that's placed into your spine, in a similar way to a lumbar puncture. Side effects of intensive chemotherapy for AML are common. They can include: nausea vomiting diarrhoea loss of appetite sore mouth and mouth ulcers (mucositis) tiredness skin rashes hair loss infertility – which may be temporary or permanent (see complications of AML for more information) Most side effects should resolve once treatment has finished. Tell a member of your care team if side effects become particularly troublesome, as there are medicines that can help you cope better with certain side effects. Read more about the side effects of chemotherapy Non-intensive chemotherapy If your doctors don’t think you're fit enough to withstand the effects of intensive chemotherapy, they may recommend non-intensive treatment. This involves using an alternative type of chemotherapy to the standard intensive therapy, which is designed more to control leukaemia rather than cure it. The main aim of this treatment is to control the level of cancerous cells in your body and limit any symptoms you have, while reducing your risk of experiencing significant side effects of treatment. The medications used during non-intensive chemotherapy may be given through a drip into a vein, by mouth or by injection under the skin, and can often be given on an outpatient basis. All Trans-Retinoic Acid (ATRA) If you have the sub-type of AML known as acute promyelocytic leukaemia, you'll usually be given capsules of a medicine called ATRA, in addition to chemotherapy. ATRA works by changing the immature white blood cells (blast cells) into mature healthy cells, and can reduce symptoms very quickly. Side effects of ATRA can include headaches, nausea, bone pain, and dry mouth, skin and eyes. Consolidation If induction is successful, the next stage of treatment will be consolidation. This often involves receiving regular injections of chemotherapy medication that are usually given on an outpatient basis, which means that you won't have to stay in hospital overnight. However, you may need some short stays in hospital if your symptoms suddenly get worse or if you develop an infection. The consolidation phase of treatment lasts several months. Other treatments Many other treatments are used for AML, as described below. Radiotherapy Radiotherapy involves using high doses of controlled radiation to kill cancerous cells. There are two main reasons why radiotherapy is usually used to treat AML: to prepare the body for a bone marrow or stem cell transplant (see below) to treat advanced cases that have spread to the nervous system and/or brain, although this is uncommon Side effects of radiotherapy can include hair loss, nausea and fatigue. The side effects should pass once your course of radiotherapy has been completed. Bone marrow and stem cell transplants If chemotherapy doesn't work, a possible alternative treatment option is a bone marrow or stem cell transplant. Before transplantation can take place, the person receiving the transplant will need to have intensive high-dose chemotherapy and possibly radiotherapy to destroy the cells in their bone marrow. The donated stem cells are given through a tube into a blood vessel, in a similar way to chemotherapy medication. This process can put an enormous amount of strain on the body and cause significant side effects and potential complications, so you'll usually need to stay in hospital for a few weeks. Transplantations have better outcomes if the donor has the same tissue type as the person receiving the donation. The best candidate to provide a donation is usually a brother or sister with the same tissue type. Transplantations are most successful when they're carried out on children and young people, or older people who are otherwise in good health, and when there's a suitable donor, such as a brother or sister. Read about bone marrow donation Azacitidine Azacitidine is a possible alternative treatment for adults with AML who can't have a stem cell transplant. It's recommended by the National Institute for Health and Care Excellence (NICE) for use in certain circumstances – for example, depending on the characteristics of the person's blood and bone marrow. Azacitidine is a chemotherapy medication that's given by injection under the skin. It interferes with the growth of cancer cells and destroys them, and also helps bone marrow to produce normal blood cells. NICE has more information about azacitidine for the treatment of AML Clinical trials and newer unlicensed treatments In the UK, a number of clinical trials are currently underway that aim to find the best way of treating AML. Clinical trials are studies that use new and experimental techniques to see how well they work in treating, and possibly curing, AML. As part of your treatment, your care team may suggest taking part in a clinical trial to help researchers learn more about the best way to treat your AML, and AML in general. Search for clinical trials for AML. If you take part in a clinical trial, you may be offered medication that isn't licensed for use in the UK and isn't normally available. However, there's no guarantee that the techniques being studied in the clinical trial will work better than current treatments. Your care team can tell you whether there are any clinical trials available in your area, and can explain the benefits and risks involved. Macmillan has more information about unlicensed treatments for AML Complications If you have acute myeloid leukaemia (AML), you may experience a number of complications. These can be caused by the condition itself, although they can also occur as a side effect of treatment. Some of the main complications associated with AML are outlined below. Weakened immune system Having a weakened immune system – being immunocompromised – is a common complication of AML. Even if your blood is restored to normal working order with treatment, many of the medications that are used to treat AML can temporarily weaken your immune system. This means you're more vulnerable to developing an infection, and any infection you develop could be more serious than usual. Complications arising from infection are the leading cause of death in people with AML. However, if treated early, nearly all infections respond to appropriate treatment. Therefore, you may be advised to: take regular doses of antibiotics to prevent bacterial infections maintain good personal and dental hygiene avoid contact with anyone who's known to have an infection – even if it's a type of infection that you were previously immune to, such as chickenpox or measles check with your GP to ensure that all of your vaccinations are up to date, although you won't be able to have any vaccine that contains "live" viruses or bacteria, such as the shingles vaccine and MMR vaccine (against measles, mumps and rubella) Report any possible symptoms of an infection to your treatment unit immediately because prompt treatment may be needed to prevent complications. Symptoms of an infection can include: a high temperature (fever) a headache aching muscles diarrhoea tiredness Bleeding If you have AML, you'll bleed and bruise more easily due to the low levels of platelets (clot-forming cells) in your blood. Bleeding may also be excessive. People with advanced AML are more vulnerable to excessive bleeding inside their body, which is the second most common cause of death in people with the condition. Serious bleeding can occur: inside the skull (intracranial haemorrhage) – causing symptoms such as a severe headache, stiff neck, vomiting and confusion inside the lungs (pulmonary haemorrhage) – causing symptoms such as coughing up blood, breathing difficulties and a bluish skin tone (cyanosis) inside the stomach (gastrointestinal haemorrhage) – causing symptoms such as vomiting blood and passing stools (faeces) that are very dark or tar-like in colour All these types of haemorrhage should be regarded as medical emergencies. Dial 999 immediately and ask for an ambulance if you think a haemorrhage is occurring. Infertility Many of the treatments that are used to treat AML can cause infertility. This is often temporary, but in some cases can be permanent. People particularly at risk of permanent infertility are those who have received high doses of chemotherapy and radiotherapy in preparation for a bone marrow or stem cell transplant. Your treatment team can give a good estimation of the risk of infertility in your specific circumstances. It may be possible to guard against any risk of infertility before you begin your treatment. For example, men can have their sperm samples stored. Similarly, women can have eggs or fertilised embryos stored, which can then be placed back into their womb, following treatment. However, as AML is an aggressive condition that develops rapidly, there may not always be time to do this before treatment needs to start.
||Acute myeloid leukaemia: Children
||Learn more about acute myeloid leukaemia, an overproduction of myeloid white blood cells
Acute myeloid leukaemia (AML) is a type of blood cancer. A third of all childhood cancers are leukaemia, with approximately 400 new cases occurring each year in the UK. Less than a quarter of these are acute myeloid leukaemia (AML). AML can affect children of any age; girls and boys are equally affected. More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. It is devastating to hear that your child has cancer, and at times it can feel overwhelming but there are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. We hope you find the information here helpful. Your child’s specialist will give you more detailed information and if you have any questions it is important to ask the specialist doctor or nurse who knows your child’s individual situation. Leukaemia Leukaemia is a cancer of the white blood cells. All blood cells are produced in the bone marrow, the spongy substance at the core of some of the bones in the body. Bone marrow contains: red blood cells, which carry oxygen around the body platelets, which help the blood to clot and control bleeding white blood cells, which help to fight infection There are two different types of white blood cells: lymphocytes and myeloid cells (including neutrophils). These white blood cells work together to fight infection. Normally, white blood cells develop, repair and reproduce themselves in an orderly and controlled way. In leukaemia, however, the process gets out of control and the cells continue to divide in the bone marrow, but do not mature. These immature dividing cells fill up the bone marrow and stop it from making healthy blood cells. As the leukaemia cells are not mature, they cannot work properly. This leads to an increased risk of infection. There are four main types of leukaemia: acute lymphoblastic (ALL) acute myeloid (AML) chronic lymphocytic (CLL) chronic myeloid (CML) Chronic leukaemias occur mostly in adults. CLL is exclusively an adult condition, whereas CML does occur rarely in children and young people. Each type of leukaemia has its own characteristics and treatment. This is about acute myeloid leukaemia (AML). Acute myeloid leukaemia (AML) Acute myeloid leukaemia is an overproduction of immature myeloid white blood cells (blast cells). Cells that have started to show some of the features of myeloid cells are said to show differentiation. Cells that do not show signs of becoming a particular type of white blood cell are known as undifferentiated. There are different sub-types of AML, depending upon exactly which type of cell has become leukaemic, the stage of development (maturation) the cells are at and whether the cells are differentiated. Knowing the sub-type of AML is important, as it helps doctors decide on the best treatment. There are several classification systems for the sub-types of AML. The most commonly used system in the UK is the French-American-British (FAB) system. FAB classification of AML M0 - AML with minimal evidence of myeloid differentiation M1 - AML without maturation M2 - AML with maturation M3 - Acute promyelocytic leukaemia (APL) M4 - Acute myelomonocytic leukaemia M5 - Acute monocytic/monoblastic leukaemia M6 - Acute erythroleukaemia M7 - Acute megakaryoblastic leukaemia A newer system known as the WHO (World Health Organization) classification system is also sometimes used. Causes The exact cause of AML is unknown. Research into possible causes of this disease is ongoing. Children with certain genetic disorders, such as Down’s syndrome or Li-Fraumeni syndrome, are known to have a higher risk of developing leukaemia. Brothers and sisters of a child with AML have a slightly increased risk of developing it, although this risk is still small. Other non-cancerous conditions, such as aplastic anaemia or the myelodysplastic syndromes (MDS), may increase a child’s risk of developing AML. AML, like all types of cancer, is not infectious and cannot be passed on to other people. Signs and symptoms As the leukaemia cells multiply in the bone marrow, the production of normal blood cells is reduced. Children may therefore become tired and lethargic because of anaemia, which is caused by a lack of red blood cells. Children may develop bruises, and bleeding may take longer to stop because of the low number of platelets present in their blood. Sometimes they may suffer from infections because of low numbers of normal white blood cells. A child is likely to feel generally unwell and may complain of aches and pains in the limbs or may have swollen lymph glands. At first, the symptoms are just like those of a viral infection, but when they continue for more than a week or two, the diagnosis usually becomes clear. How AML is diagnosed A blood test usually shows low numbers of normal white blood cells and the presence of abnormal leukaemia cells. A sample of bone marrow is needed to confirm the diagnosis. The bone marrow sample is also examined to check for any abnormalities in the chromosomes of the leukaemia cells. A test called a lumbar puncture is done to see if the spinal fluid contains any leukaemia cells. A chest x-ray is also done, which will show if there are any enlarged glands in the chest. Other tests may be necessary, depending on your child’s symptoms. These tests will help to identify the precise type of leukaemia, and help doctors to decide on the best treatment. Treatment The aim of treatment for AML is to destroy the leukaemia cells and enable the bone marrow to work normally again. Chemotherapy is the main treatment for AML. Usually a combination of chemotherapy drugs is given, according to a treatment plan (often called a protocol or regimen). The treatment usually has different phases, explained below: Induction This phase involves intensive treatment, aimed at destroying as many leukaemia cells as possible. It usually involves two courses (cycles) of a combination of chemotherapy drugs. A bone marrow test is taken at the end of induction treatment to confirm whether or not the child still has leukaemia. When there is no evidence of leukaemia, the child’s condition is referred to as being in remission. Post-remission treatment When there are no signs of the leukaemia in the blood or bone marrow, further treatment is often given. This phase of the treatment aims to destroy any leukaemia cells that may be left and to help stop the AML from coming back. This treatment usually involves two more courses of chemotherapy. Bone marrow transplant This treatment is usually only used for children with AML that is likely to come back or has come back (recurred) following standard chemotherapy. Central nervous system (CNS) treatment AML may sometimes develop in the brain and spinal cord. This can be prevented by injecting chemotherapy drugs directly into the spinal fluid during a lumbar puncture (intrathecal chemotherapy). Intrathecal chemotherapy is usually given after each of the first two courses of chemotherapy. Sometimes a more intensive treatment is needed, and the intrathecal drugs are given more frequently until all the regular chemotherapy has been completed. Occasionally, radiotherapy to the brain is also necessary. Side effects of treatment Many cancer treatments will cause side effects. This is because while the treatments are killing the cancer cells, they can also damage some normal cells. Some of the main side effects are: hair loss reduction in the number of blood cells produced by the bone marrow, which can cause anaemia (an increased risk of bruising, bleeding and infection) loss of appetite and weight feeling sick (nausea) and being sick (vomiting) Most side effects are temporary, and there are ways of reducing them and supporting your child through them. Your child’s doctor or nurse will talk to you about side effects. Late side effects of treatment A small number of children may develop late side effects, sometimes many years later. These include possible problems with puberty and fertility, a change in the way the heart works, and a small increase in the risk of developing a second cancer in later life. Your child’s doctor or nurse will talk to you about any possible late side effects. Clinical trials Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for AML. If appropriate, your child’s medical team will talk to you about taking part in a clinical trial and will answer any questions you have. Written information is often provided to help explain things. Taking part in a research trial is completely voluntary, and you’ll be given plenty of time to decide if it’s right for your child. Treatment guidelines Sometimes, clinical trials are not available for your child’s cancer. This may be because a recent trial has just finished, or because the cancer is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Children’s Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care Many children with AML are cured. If the leukaemia comes back after initial treatment, it usually does so within the first three years. Most children with AML grow and develop normally. If you have specific concerns about your child’s condition and treatment, it’s best to discuss them with your child’s doctor, who knows the situation in detail. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. It’s not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young People’s Cancer; A Parent’s Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience of cancer. The Parent’s Guide discusses these further and talks about how you can support your child.
||Acute myeloid leukaemia: Teenagers and young adults
||Information about acute myeloid leukaemia, a type of blood cancer that can affect young people
This section is for teenagers and young adults and is about a type of cancer called acute myeloid leukaemia (AML). The other main type of leukaemia that can affect teenagers and young adults is acute lymphoblastic leukaemia. For information about AML in people of all ages, please see our general AML section. Leukaemia is a cancer of the white blood cells. In leukaemia, the process for making new white blood cells gets out of control. Immature white blood cells (called blasts) keep being made and build up in the bone marrow until there isn’t enough room for the bone marrow to make healthy white blood cells, red blood cells and platelets. The body needs these cells to: help us fight infection (white cells) carry oxygen from the lungs around our body (red blood cells) stop us bleeding when we cut ourselves by clotting our blood (platelets). Symptoms Many of the symptoms of AML are caused by having fewer than normal healthy blood cells in the body. Symptoms can include: looking paler than usual and feeling tired - because of too few red blood cells (anaemia) bruises or bleeding - you may bruise more easily and it could take longer for bleeding to stop, if you have less blood clotting cells (platelets) than normal infections - because there are too few mature white blood cells to fight infection aches and pains in your bones swollen glands (lymph nodes) in your neck, under your arm or in your groin feeling unwell and run down fever and sweats - you may have a high temperature without any obvious cause, such as an infection headaches and blurred vision - because of too many white blood cells breathlessness - because of too many white blood cells. Causes We don't know exactly what causes AML, but research is going on to try to find out. We do know some things might increase the risk of AML: Some genetic conditions, like Down's Syndrome. A genetic condition is something you are born with. Some non-cancerous conditions of the bone marrow, such as aplastic anaemia or myelodysplastic syndromes. If you're worried about AML If you think you might have any of the symptoms of AML, you should go to your GP. They'll talk to you about your symptoms, examine you and can arrange tests or refer you to see a specialist. Remember that the symptoms can be caused by other things, but it’s important to go and get checked if you are worried. Leukaemia, blood tests and bone marrow To help you understand leukaemia, it can help to know a little about the blood and bone marrow. Leukaemia is a cancer of the white blood cells. Knowing a bit about how blood cells are made in the body can help you to understand leukaemia and how it’s treated. All blood cells are made in the bone marrow, which is like a blood cell factory inside our bones. A type of cell in the bone marrow, called a stem cell, can make any kind of blood cell your body needs. There are three main types of blood cells: white blood cells – which help us fight infection red blood cells – which carry oxygen from the lungs around our body platelets – which clot our blood to stop us bleeding when we cut ourselves The bone marrow normally makes millions of blood cells every day. To begin with, these new blood cells, called blasts, are not fully developed (they’re immature). The main job of blast cells is to make more blood cells like themselves. They can’t do any of the jobs that mature blood cells can do, like carrying oxygen or fighting infection. Blast cells normally stay inside the bone marrow until they’ve matured into fully-developed blood cells. Once blood cells are mature, they’re ready to do their jobs. They leave the bone marrow and go into the bloodstream, where they can be carried to wherever they’re needed. How leukaemia develops In leukaemia, the process for making new white blood cells gets out of control and immature white blood cells (blasts) keep being made. They build up in the bone marrow until there isn’t enough room for the bone maow to make healthy white cells, red cells and platelets. Types of leukaemia Leukaemia is a cancer of the white blood cells. Healthy white blood cells are made from two types of blood cells: lymphoblasts that make lymphocytes myeloid cells (myeloblasts) that make other types of white blood cells such as neutrophils. Leukaemias are named after the type of white blood cell that has become abnormal and started growing out of control. The most common types in teenagers and young adults are AML and ALL: leukaemia that starts from abnormal myeloid cells is called acute myeloid leukaemia - or AML for short. leukaemia that starts from abnormal lymphoblasts is called acute lymphoblastic leukaemia (ALL). There are other types of leukaemia that are more common in older people. The information in this section is about ALL, but if you have a different type of leukaemia and want to know more, contact Macmillan. We also have more info about: symptoms and causes of AML having tests for AML being treated for AML If you're looking for information about ALL in people of all ages, please see our general AML section. Tests for AML You should see your GP as soon as possible if you think you have some of the symptoms of AML. But remember that the symptoms of AML can be caused by other things. Visiting your GP Your GP (family doctor) will examine you and arrange for you to have blood tests. There can be different reasons for your symptoms, so you’ll need to have a blood test to help diagnose acute myeloid leukaemia (AML). If you have AML, a blood test will usually find leukaemia cells and you'll be referred to a specialist at the hospital. This specialist is called a haematologist and is a doctor who treats people with blood disorders. At the hospital The haematologist will examine you and ask you about your symptoms and any recent illnesses. They will also arrange for you to have some more tests. These may include: blood tests - you’ll need more blood tests even if you’ve had some already. These tests look at the changes in the leukaemia cells. This helps the doctors decide on the best treatment for you. You might hear the doctors calling these tests cytogenetics and immunophenotyping. bone marrow test - you’ll have samples taken from your bone marrow. The doctors will count the numbers of leukaemia cells in the bone marrow. They will also send samples for cytogenetic and immunophenotyping testing. lumbar puncture - a small sample of the fluid that surrounds your brain and spinal cord is taken to check for leukaemia cells. chest X-ray – this may also be done to see if there are any swollen lymph nodes (glands) in your chest. Macmillan has more information on these and other tests. If you have AML, you might need a few more tests to check how your body is working in general. These could be blood tests, an ultrasound scan of the tummy (abdomen) to look at your liver, spleen and kidneys, or an echocardiogram (which is an ultrasound of the heart). This may seem like a lot of tests, but they give the doctors important information that will help them give you the right treatment. Waiting for test results can be a scary time, but understanding a little about them - what will happen, how you'll feel and when you'll get the results - can help you cope. Thinking about how you feel and getting support from family, friends or your specialist nurse and doctor can also make it a bit easier. You could also talk to a cancer support specialist on Macmillan's free helpline. We also have more info about: symptoms and causes of AML being treated for AML leukaemia, blood cells and bone marrow If you're looking for information about AML in people of all ages, please see our general AML section. Treating AML The main treatment for acute myeloid leukaemia (AML) is chemotherapy (chemo). This means having anti-cancer drugs to destroy the leukaemia cells. You’ll also have drugs called steroids, which help the chemo to work. The treatment for AML is pretty intensive at times and can cause unpleasant side effects. But you'll be in hospital when you’re most likely to feel unwell, and the staff can help if things get tough. Don’t feel you have to be brave. Be honest about how you're feeling with your doctors and nurses, and they can give you medicines to help you feel better. There are different phases of treatment for AML: getting rid of the leukaemia - remission induction keeping the leukaemia away - consolidation and delayed intensification therapy central nervous system (CNS) therapy (mainly for teenagers under 16) Very often, treatment is given as part of a clinical trial or research study, but it will be your decision whether to take part in the trial or not. Clinical trials help doctors to keep improving treatment for leukaemia. You usually start chemo pretty quickly after finding out that you have AML. You'll be in hospital for your treatment to begin with. If you're 18 or younger, you'll be treated in a specialist Principal Treatment Centre (PTC) for teenage and young adults (TYA). If you're 19 or older, you'll be offered the choice of having treatment at the PTC or another hospital closer to home called a TYA designated hospital. Most chemo for AML is given into the bloodstream (intravenously). So you’ll have a ‘line’ put into one of your main veins to make it easier for you to have intravenous chemo. There are different kinds of lines. You might have a central line (Hickman® or Groshong®), an implantable port (portacath), or a PICC line. You’ll also be given chemo into the fluid around your spinal cord and brain. This is to get rid of any leukaemia cells that might be hiding there. This type of treatment is called central nervous system (CNS) therapy. Having chemo can be hard, but the staff looking after you will give you medicines to help you cope with any side effects so you can stay strong enough to have treatment. And you’ll be given medicines to help you feel less sick and antibiotics to help prevent infections. There will probably be times when you feel rough and other times when you’ll feel better. You might also feel upset, down or irritable. Talking to someone you trust can help you cope with these feelings. Being in hospital for long periods can be frustrating, especially when you miss out on stuff happening at school, college, university or work or on things your friends are doing. You could try talking to your friends and family about this and see what they can do to help you. Getting rid of the leukaemia (remission induction) The first phase of your treatment is about getting rid of the leukaemia. You’ll be given chemo to kill as many leukaemia cells as possible. Remission means there is no sign of leukaemia cells in your blood or bone marrow. You have chemo over a few days, then you have a few weeks off so that your body can recover from any side effects. The days you have the chemo and the rest period afterwards is called a cycle. You’ll usually have four cycles of chemotherapy overall with two courses in the induction phase. Some people might also need to have a bone marrow transplant. This normally happens after 2 cycles of chemotherapy. You'll probably need to stay in hospital most of the time that you’re having remission induction. This is so that the doctors can check how things are going. Chemo drugs Drugs you may have include: cytarabine (Ara-C) daunorubicin, doxorubicin or idarubicin etoposide thioguanine Side effects Different chemo can cause different side effects. There is information about the specific ones in Macmillan's chemotherapy section. As well as the chemo drugs, you’ll be given other drugs to: Help prevent you from feeling sick or being sick. Help prevent infections. Protect your kidneys. Sometimes, when lots of leukaemia cells are destroyed at once, it can cause kidney problems. You may have a drug called allopurinol or one called rasburicase. You’ll probably also need blood and platelet transfusions to top up the numbers of red cells and platelets in your blood. Chemo can cause side effects. Most of them are short-term (temporary) and gradually disappear once treatment stops. The most common side effects are: being more at risk of infections feeling sick hair loss a sore mouth Sometimes side effects can be long-term. For example, some chemo treatments can affect fertility (your ability to have a baby). If you are a young man, you will be offered the chance to store sperm before chemotherapy is started. There may be other late effects of treatment and your specialist can talk to you about this. Remission induction is pretty intense treatment and you’ll probably feel a bit wiped out sometimes. You’ll need to stay in hospital for most of the time and you might not have the energy to do much. You might feel fed up, tearful or irritable. It’s normal to feel like this. It's hard to be in hospital and you might worry about losing touch with your friends or falling behind at school or college. It can help to talk about this with a friend, doctor, nurse or counsellor. Keeping the leukaemia away (post-remission treatment) This phase of treatment is sometimes also called consolidation or intensification treatment. It’s given to prevent the leukaemia from returning (known as a relapse). When you’re in remission, it means the doctors can’t see any leukaemia cells in your blood or bone marrow samples under the microscope. But there may still be leukaemia cells hiding in your body, so further treatment is needed to get rid of these cells. You start post-remission treatment soon after you complete remission induction. You’ll usually have two courses of treatment. You might be given the same chemo drugs you’ve had before (perhaps at similar or higher doses) or you might be given different chemo drugs. When your doctors decide what chemotherapy treatment plan to give you, they will take into account: how well your leukaemia responded to the first lot of treatment (remission induction) the results of the tests that were done when you were diagnosed The following drugs may be used to treat you: cytarabine (ara-C) methotrexate Central nervous system therapy (CNS) You usually won’t need this treatment if you’re 16 or over. But if you’re under 16, you’ll probably have it. CNS therapy is given to get rid of any leukaemia cells that might be in the brain or spinal cord. (The CNS or central nervous system is the name for the brain and spinal cord.) CNS therapy involves giving chemotherapy into the fluid, called cerebrospinal fluid or CSF, around the spinal cord and brain. It’s a bit like having a lumbar puncture but with chemo added. A doctor puts a needle into the space between two small bones (vertebrae) near the bottom of your spine. Then they inject chemo into the CSF. The CSF will carry the chemo around your CNS so it can reach any leukaemia cells that might be there. You’ll have a lumbar puncture before you start treatment to check for leukaemia cells in the CSF. If there is no sign of leukaemia cells, you’ll have two lots of CNS therapy, one after each cycle of remission induction therapy. If there are leukaemia cells in the CSF, you’ll have CNS therapy twice a week until all traces of leukaemia cells in your CSF have gone. You’ll then have two more lots of CNS therapy just to make sure. For CNS therapy for AML, you’ll have chemo drugs called methotrexate and cytarabine and a steroid called hydrocortisone. Side effects The most common side effect is feeling sick but you can be given anti-sickness treatment to help this. Rarer side effects include a headache, dizziness, tiredness or blurry vision for a few hours afterwards. We also have more info about: symptoms and causes of AML having tests for AML leukaemia, blood cells and bone marrow If you're looking for information about AML in people of all ages, please see our general AML section.
||Learn about acute pancreatitis symptoms and treatments
Acute pancreatitis is a serious condition where the pancreas becomes inflamed over a short period of time. The pancreas is a small organ located behind the stomach and below the ribcage. Most people with acute pancreatitis improve within a week and experience no further problems, but severe cases can have serious complications and can even be fatal. Acute pancreatitis is different to chronic pancreatitis, where the inflammation of the pancreas persists for many years. The most common symptoms of acute pancreatitis include: suddenly getting severe pain in the centre of your abdomen (tummy) feeling or being sick diarrhoea Read more about the symptoms of acute pancreatitis and diagnosing acute pancreatitis. When to seek medical help Contact your GP immediately if you suddenly develop severe abdominal pain. If this isn't possible, contact NHS 24 111 Service or your local out-of-hours service for advice. Why it happens It's thought that acute pancreatitis occurs when a problem develops with some of the enzymes (chemicals) in the pancreas, which causes them to try to digest the organ. Acute pancreatitis is most often linked to: gallstones – which accounts for around half of all cases alcohol consumption – which accounts for about a quarter of all cases By reducing your alcohol intake and altering your diet to make gallstones less likely, you can help to reduce your chances of developing acute pancreatitis. Read more about the causes of acute pancreatitis and preventing acute pancreatitis. Who is affected? Acute pancreatitis is more common in middle-aged and elderly people, but it can affect people of any age. Men are more likely to develop alcohol-related pancreatitis, while women are more likely to develop it as a result of gallstones. In England, more than 25,000 people were admitted to hospital with acute pancreatitis between 2013 and 2014. How it's treated Treatment for acute pancreatitis focuses on supporting the functions of the body until the inflammation has passed. This usually involves admission to hospital so you can be given fluids into a vein (intravenous fluids), as well as pain relief, nutritional support and oxygen through tubes into your nose. Most people with acute pancreatitis improve within a week and are well enough to leave hospital after 5-10 days. However, recovery takes longer in severe cases, as complications that require additional treatment may develop. Read more about treating acute pancreatitis. Complications About 4 out of 5 cases of acute pancreatitis improve quickly and don't cause any serious further problems. However, 1 in 5 cases are severe and can result in life-threatening complications, such as multiple organ failure. In severe cases where complications develop, there's a high risk of the condition being fatal. In England, just over 1,000 people die from acute pancreatitis every year. If a person survives the effects of severe acute pancreatitis, it's likely to be several weeks or months before they're well enough to leave hospital. Read more about the possible complications of acute pancreatitis. Symptoms The main symptom of acute pancreatitis is a severe, dull pain around the top of your stomach that develops suddenly. This aching pain often gets steadily worse and can travel along your back or below your left shoulder blade. Eating or drinking may also make you feel worse very quickly, especially fatty foods. Leaning forward or curling into a ball may help to relieve the pain, but lying flat on your back often increases the pain. Acute pancreatitis caused by gallstones usually develops after eating a large meal. If the condition is caused by alcohol, the pain often develops 6-12 hours after drinking a significant amount of alcohol. Other symptoms Other symptoms of acute pancreatitis can include: nausea (feeling sick) or vomiting diarrhoea indigestion a high temperature (fever) of 38C (100.4F) or above jaundice – yellowing of the skin and the whites of the eyes tenderness or swelling of the abdomen (tummy) When to seek medical advice Contact your GP immediately if you suddenly develop severe abdominal pain. If this isn't possible, contact NHS 24 111 Service or your local out-of-hours service for advice. Causes Most cases of acute pancreatitis are closely linked to gallstones or to alcohol consumption, although the exact cause isn't always clear. Gallstones Gallstones are hard pieces of stone-like material that form in your gallbladder. They can trigger acute pancreatitis if they move out of the gallbladder and block the opening of the pancreas. The blockage can disrupt some of the enzymes (chemicals) produced by the pancreas. These enzymes are normally used to help digest food in your intestines, but they can start to digest the pancreas instead if the opening is blocked. However, not everyone with gallstones will develop acute pancreatitis. Most gallstones don't cause any problems. Alcohol consumption It's not fully understood how alcohol causes the pancreas to become inflamed. One theory is that it interferes with the normal workings of the pancreas, causing the enzymes to start digesting it. Whatever the cause, there is a clear link between alcohol use and acute pancreatitis. A very large study found that people who regularly drank more than 35 units of alcohol a week were 4 times more likely to develop acute pancreatitis than people who never drank alcohol (35 units is the equivalent of drinking around 16 cans of strong lager or 4 bottles of wine a week). Binge drinking, which is drinking a lot of alcohol in a short period of time, is also thought to increase your risk of developing acute pancreatitis. Other causes Less common causes of acute pancreatitis include: accidental damage or injury to the pancreas – for example, during a procedure to remove gallstones or examine the pancreas certain types of medication, such as some antibiotics or chemotherapy medication – acute pancreatitis can be an unexpected side effect of these in a small number of people a viral infection – such as mumps or measles a complication of cystic fibrosis certain rare conditions – including hyperparathyroidism, Reye's syndrome and Kawasaki disease Severe pancreatitis Little is known about why some people develop severe acute pancreatitis. Factors thought to increase your risk include: being 70 years of age or over being obese (a person is considered obese if they have a body mass index (BMI) of 30 or above) having 2 or more alcoholic drinks a day smoking Researchers have also discovered that people with a specific genetic mutation, known as the MCP-1 mutation, are 8 times more likely to develop severe acute pancreatitis than the general population. A genetic mutation is where the instructions (DNA) found in all living cells become scrambled, resulting in a genetic disorder or a change in characteristics. Diagnosis Most cases of acute pancreatitis are diagnosed in hospital because of the risk of serious complications. The doctor in charge of your care will ask you about the history of your symptoms. They may also carry out a physical examination. If you have acute pancreatitis, certain areas of your abdomen will be very tender to touch. A blood test will be carried out to help confirm a diagnosis. This can detect signs of acute pancreatitis, such as a high level of 2 chemicals called lipase and amylase. At first, it can be difficult to tell whether your acute pancreatitis is mild or severe. You'll be monitored closely for signs of serious problems, such as organ failure. People with mild acute pancreatitis tend to improve within a week and experience either no further problems or problems that resolve within 48 hours. People with severe acute pancreatitis develop persistent serious problems. Further testing Several tests may be used to help determine the severity of your condition and assess your risk of developing more serious complications. You may have any of the following tests: a computerised tomography (CT) scan – where a series of X-rays are taken to build up a more detailed, three-dimensional image of your pancreas a magnetic resonance imaging (MRI) scan – where strong magnetic fields and radio waves are used to produce a detailed image of the inside of your body an ultrasound scan – where high-frequency sound waves are used to create an image of part of the inside of the body endoscopic retrograde cholangiopancreatography (ERCP) An ERCP uses a narrow, flexible tube known as an endoscope, which has a camera on one end. The endoscope will be passed through your mouth and towards your stomach. A special dye that shows up on X-rays is then injected through the endoscope into your bile and pancreatic ducts. After the dye has been injected, X-rays will be taken. This test can be useful in cases of gallbladder-associated acute pancreatitis, because it can pinpoint exactly where the gallstone is located. In some cases, it may be possible to pass surgical instruments down the endoscope, so the gallstone can be removed. Treatment Acute pancreatitis is treated in hospital, where you'll be closely monitored for signs of serious problems and given supportive treatment, such as fluids and oxygen. Many people are well enough to leave hospital after 5-10 days. In severe cases, complications can develop that require specific additional treatment and you'll need to be admitted to a high dependency unit or intensive care unit (ICU). In these cases, recovery may take much longer, and the condition can be fatal. Read about the potential complications of acute pancreatitis for more information on severe cases. Fluids Your body can become dehydrated during an episode of acute pancreatitis, so fluids are provided through a tube connected to one of your veins (this is known as intravenous, or IV, fluid). In severe cases of acute pancreatitis, IV fluids can help to prevent a serious problem called hypovolemic shock, which occurs when a drop in your fluid levels lowers the amount of blood in your body. Nutritional support Although the diet of many people with mild acute pancreatitis isn't restricted, some people are advised not to eat. This is because trying to digest solid food could place too much strain on your pancreas. Depending on the severity of the condition, you may not be able to eat solid foods for a few days or longer. If you need to avoid solid food, a feeding tube may be used to provide your body with nutrients. This is known as enteral feeding and often involves using a tube inserted into your stomach through your nose (nasogastric tube). Oxygen To ensure your vital organs have enough oxygen, it will usually be supplied through tubes into your nose. The tubes can be removed after a few days, once your condition is improving. In severe cases, ventilation equipment may also be used to assist with your breathing. Painkillers Acute pancreatitis often causes severe abdominal (tummy) pain, so strong painkilling medication will probably be required, such as morphine. Some of the painkillers used can make you feel very drowsy. If you're visiting someone who is in hospital with acute pancreatitis, don't be alarmed or concerned if they appear drowsy or unresponsive. Treating the underlying cause Once the condition is under control, the underlying cause may need to be treated. Treatments for the most common causes of acute pancreatitis – gallstones and alcohol consumption – are outlined below. Gallstones If a gallstone is responsible for the pancreatitis, you may need a procedure called endoscopic retrograde cholangiopancreatography (ERCP), or your gallbladder may need to be removed. Gallbladder removal surgery may be done while you're in hospital, or it may be planned for several weeks' time. Having your gallbladder removed should have no significant effect on your health, other than making it more difficult to digest certain foods, such as fatty or spicy foods. An ERCP procedure is an alternative treatment for gallstones. It involves using a narrow, flexible tube known as an endoscope, which has a camera on one end. X-rays guide the endoscope into your digestive system, and surgical instruments are passed down the endoscope to remove the gallstones. Alcohol consumption After recovering from acute pancreatitis, alcohol should be completely avoided if this was the cause of the condition. If you find this difficult, you'll probably need additional treatment. Treatment options for alcohol dependence include: one-to-one counselling self-help groups – such as Alcoholics Anonymous a medication called acamprosate – which helps to reduce your alcohol cravings Read more about treating alcohol misuse. Complications Although most people with acute pancreatitis recover without experiencing further problems, severe cases can have serious complications. Pseudocysts Pseudocysts are sacs of fluid that can develop on the surface of the pancreas. They're a common complication of acute pancreatitis, thought to affect around 1 in 20 people with the condition. Pseudocysts usually develop four weeks after the symptoms of acute pancreatitis start. In many cases, they don't cause any symptoms and are only detected during a computerised tomography (CT) scan. However, in some people, pseudocysts can cause bloating, indigestion and a dull abdominal (tummy) pain. If the pseudocysts are small and not causing any symptoms, there may be no need for further treatment, as they usually go away on their own. Treatment is usually recommended if you're experiencing symptoms or if the pseudocysts are large. Larger pseudocysts are at risk of bursting, which could cause internal bleeding or trigger an infection. Pseudocysts can be treated by draining the fluid out of the cyst by inserting a needle into it through your skin. This can also be done by carrying out an endoscopy, where a thin, flexible tube called an endoscope is passed down your throat, and tiny tools are used to drain away the fluid. Infected pancreatic necrosis In around 1 in 3 severe cases of acute pancreatitis, a serious complication called infected pancreatic necrosis occurs. In infected pancreatic necrosis, high levels of inflammation cause an interruption to the blood supply of your pancreas. Without a consistent supply of blood, some of the tissue of your pancreas will die. Necrosis is the medical term for the death of tissue. The dead tissue is extremely vulnerable to infection from bacteria. Once an infection has occurred, it can quickly spread into the blood (blood poisoning) and cause multiple organ failure. If left untreated, infected pancreatic necrosis is almost always fatal. Infected pancreatic necrosis usually develops 2 to 6 weeks after the symptoms of acute pancreatitis starts. Symptoms include increased abdominal pain and a high temperature. The infection is treated with injections of antibiotics, and the dead tissue needs to be removed to prevent the infection returning. In some cases, it may be possible to drain away the dead tissue using a thin tube called a catheter, which is placed through the skin. Alternatively, laparoscopic surgery (keyhole surgery) can be used. A small cut is made in your back and an endoscope is inserted to wash away any dead tissue. If laparoscopic surgery isn't possible, a cut can be made in your abdomen to allow the dead tissue to be removed. Infected pancreatic necrosis is a very serious complication. Even with the highest standards of medical care, the risk of dying from organ failure is estimated to be around 1 in 5. Systemic inflammatory response syndrome (SIRS) Another common complication of severe acute pancreatitis is systemic inflammatory response syndrome (SIRS). SIRS develops in an estimated 1 in 10 severe cases of acute pancreatitis. In SIRS, the inflammation affecting the pancreas spreads throughout the body, which can cause one or more organs to fail. It usually develops during the first week after the symptoms start, with most cases developing on the same day. Symptoms of SIRS include: a rise in body temperature to above 38C (100.4F) or a fall in body temperature to below 36C (96.8F) a rapid heartbeat of more than 90 beats a minute an unusually fast breathing rate (more than 20 breaths a minute) There's currently no cure for SIRS, so treatment involves trying to support the body's functions until the inflammation has passed. The outcome depends on how many organs fail. The higher the number of organs affected, the greater the risk of death. Chronic pancreatitis If you have repeated episodes of acute pancreatitis, the damage to your pancreas may lead to chronic pancreatitis. Chronic pancreatitis is a long-term condition that can have a serious impact on your quality of life. Prevention As acute pancreatitis is often caused by gallstones or excessive alcohol consumption, a healthy lifestyle can reduce your chances of developing the condition. Gallstones The most effective way of preventing gallstones is eating a healthy, balanced diet that includes plenty of fresh fruit and vegetables (at least 5 portions a day). Your diet should also include wholegrains, found in wholemeal bread, oats and brown rice. This helps lower the amount of cholesterol in your body. There is also evidence that regularly eating nuts, such as peanuts or cashews, can help reduce your risk of developing gallstones. Because of the role cholesterol appears to play in the formation of gallstones, it's advisable to avoid eating too many fatty foods with a high cholesterol content. Foods high in cholesterol include: meat pies sausages and fatty cuts of meat butter and lard cakes and biscuits Being overweight also increases your chances of developing gallstones, so maintaining a healthy weight by eating a balanced diet and taking plenty of regular exercise can also help reduce your risk of developing the condition. See exercise, healthy eating and losing weight for more information and advice. Alcohol Limiting the amount of alcohol you drink can help prevent your pancreas being damaged, and reduce your risk of developing acute pancreatitis. It can also lower your chances of developing other serious conditions, such as liver cancer. men and women are advised not to regularly drink more than 14 units a week spread your drinking over 3 days or more if you drink as much as 14 units a week A unit of alcohol is equal to about half a pint of normal-strength lager or a pub measure (25ml) of spirits. A small glass of wine or an alcopop is 1.5 units. Read the pages on drinking and alcohol for more information and advice.
||Learn about Addison's disease symptoms and treatments
Addison’s disease (also known as primary adrenal insufficiency or hypoadrenalism) is a rare disorder of the adrenal glands. The adrenal glands are two small glands that sit on top of the kidneys. They produce two essential hormones: cortisol and aldosterone. In Addison's disease, the adrenal gland is damaged, and not enough cortisol and aldosterone are produced. About 8,400 people in the UK have Addison's disease. It can affect people of any age, although it's most common between the ages of 30 and 50. It's also more common in women than men. Early-stage symptoms of Addison’s disease are similar to other more common health conditions, such as depression or flu. You may experience: fatigue (lack of energy or motivation) muscle weakness low mood loss of appetite and unintentional weight loss increased thirst Over time, these problems may become more severe and you may experience further symptoms, such as dizziness, fainting, cramps and exhaustion. You may also develop small areas of darkened skin, or darkened lips or gums. Although these symptoms aren’t always caused by Addison’s disease, you should see your GP, so they can be investigated. Read more about the symptoms of Addison’s disease and diagnosing Addison’s disease Why it happens The condition is usually the result of a problem with the immune system, which causes it to attack the outer layer of the adrenal gland (the adrenal cortex), disrupting the production of steroid hormones aldosterone and cortisol. It's not clear why this happens, but it's responsible for 70-90% of cases in the UK. Other potential causes include conditions that can damage the adrenal glands, such as tuberculosis (TB), although this is uncommon in the UK. Read more about the causes of Addison’s disease Treating Addison's disease Addison’s disease is treated with medication to replace the missing hormones. You'll need to take the medication for the rest of your life. With treatment, symptoms of Addison's disease can largely be controlled. Most people with the condition live a normal lifespan and are able to live an active life, with few limitations. However, many people with Addison's disease also find they must learn to manage bouts of fatigue and there may be associated health conditions, such as diabetes or an underactive thyroid. People with Addison's disease must be constantly aware of the risk of a sudden worsening of symptoms, called an adrenal crisis. This can happen when the levels of cortisol in your body fall significantly. An adrenal crisis is a medical emergency. If left untreated, it can be fatal. If you or someone you know has Addison’s disease and is experiencing severe symptoms, dial 999 for an ambulance. Read more about treating Addison's disease Information about you If you have Addison's disease, your clinical team will pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the register Symptoms Addison's disease can be difficult to detect at first, because early symptoms are similar to symptoms of many other health conditions. Initial symptoms of Addison's disease can include: fatigue (lack of energy or motivation) lethargy (abnormal drowsiness or tiredness) muscle weakness low mood (mild depression) or irritability loss of appetite and unintentional weight loss the need to urinate frequently increased thirst craving for salty foods Dehydration can also be an early sign of Addison’s disease. It's caused by lack of the hormone aldosterone in your body, which is used to regulate the balance of salt and water. Later symptoms Further symptoms of Addison’s disease tend to develop gradually over months or years. However, additional strees, caused by another illness or an accident, for example, may cause your symptoms to suddenly get worse. You may go on to develop: low blood pressure when you stand up, which can cause dizziness and fainting feeling sick (nausea) vomiting diarrhoea abdominal, joint or back pain muscle cramps chronic exhaustion, which may cause depression brownish discolouration of the skin, lips and gums (hyperpigmentation), particularly in the creases on your palms, on scars or on pressure points, such as your knuckles or knees a reduced libido (lack of interest in sex), particularly in women Some women may also have irregular periods or miss some periods completely. Children with Addison's disease may experience puberty later than usual. Some people with Addison's disease also develop low blood sugar (hypoglycaemia). This can cause symptoms such as difficulty concentrating, confusion, anxiety and even unconsciousness (particularly in children). If you're experiencing symptoms of Addison's disease, see your GP so they can diagnose or rule out the condition. These symptoms will usually improve with appropriate treatment. Read more about diagnosing Addison's disease and treating Addison's disease Adrenal crisis If Addison’s disease is left untreated, the levels of hormones produced by the adrenal gland gradually decrease in the body. This causes your symptoms to get progressively worse and eventually lead to a life-threatening situation called an adrenal or Addisonian crisis. During an adrenal crisis, the symptoms of Addison’s disease appear quickly and severely. This could happen when you're already experiencing initial symptoms or without any symptoms at all. Signs of an adrenal crisis include: severe dehydration pale, cold, clammy skin sweating rapid, shallow breathing dizziness severe vomiting and diarrhoea severe muscle weakness headache severe drowsiness or loss of consciousness An adrenal crisis is a medical emergency. If left untreated, it can be fatal. If you think you or someone you know with Addison’s disease is having an adrenal crisis, dial 999 for an ambulance. If an adrenal crisis isn't treated, it can lead to a coma and death. There's also a risk your brain won't get enough oxygen if treatment is delayed, which can cause permanent disability. Causes Addison's disease develops when the outer layer of your adrenal glands (your adrenal cortex) is damaged, reducing the levels of hormones it produces. Problems with the immune system In the UK, a problem with the immune system is the most common cause of Addison's disease, accounting for 70-90% of cases. The immune system is your body’s defence against infection and disease. If you're ill, your immune system produces antibodies (a special type of protein that destroys disease-carrying organisms and toxins). These antibodies attack the cause of the illness. However, if you develop a problem with your immune system, it can start to attack your own healthy tissues and organs. This is known as an autoimmune disorder. Addison’s disease can develop if your immune system attacks your adrenal glands and severely damages your adrenal cortex. When 90% of the adrenal cortex is destroyed, your adrenal glands won't be able to produce enough of the steroid hormones cortisol and aldosterone. Once levels of these start decreasing, you'll experience symptoms of Addison’s disease. It's not clear why some people develop this problem with their immune system, although it can run in families (see below). Genetics Research has shown that some people with certain genes are more likely to develop autoimmune disorders. It's not clear how these genes lead to Addison's disease and similar conditions, but it does mean your risk of developing Addison's disease is increased if you or a close family member have another autoimmune condition, such as: vitiligo– a chronic (long-term) condition that causes pale, white patches to develop on the skin type 1 diabetes – a chronic condition caused by too much glucose in the blood underactive thyroid gland (hypothyroidism) Other causes Tuberculosis (TB) is the most common cause of Addison's disease worldwide, but is rare in the UK. TB is a bacterial infection that mostly affects the lungs, but can also spread to other parts of your body. It can cause Addison’s disease if it damages your adrenal glands. Other possible causes of Addison’s disease include: infections – such as those linked to AIDS, or fungal infections a haemorrhage – very heavy bleeding into the adrenal glands, sometimes associated with meningitis or other types of severe sepsis cancer – if cancer cells from elsewhere in your body spread to your adrenal glands amyloidosis – a disease where amyloid, a protein produced by your bone marrow cells, builds up in your adrenal glands and damages them surgical removal of both adrenal glands (adrenalectomy) – for example, to remove a tumour adrenoleukodystrophy (ALD) – a rare, life-limiting, inherited condition affecting the adrenal glands and nerve cells in the brain that most often affects young boys certain treatments needed for Cushing's syndrome – a collection of symptoms caused by very high levels of cortisol in the body Diagnosis To help diagnose Addison’s disease, your GP will first ask about your symptoms and review your medical history. They're also likely to ask if anyone in your family has an autoimmune disorder (a condition caused by a problem with their immune system). Your GP will examine your skin for any evidence of brownish discolouration (hyperpigmentation), particularly in certain areas, such as: where skin creases on your palm in your elbow crease on any scars your lips and gums However, hyperpigmentation doesn't occur in all cases of Addison’s disease. You'll also be tested for low blood pressure (hypotension) while you're lying down and again shortly after you stand up. This is to see whether you have postural or orthostatic hypotension (low blood pressure when you change position). Blood tests If Addison’s disease is suspected, blood tests will be carried out to measure the levels of sodium, potassium and cortisol in your body. A low sodium, high potassium or low cortisol level may indicate Addison’s disease. You may need to see a hospital hormone specialist (endocrinologist) for your blood to be tested for the following: a low level of the hormone aldosterone a high level of adrenocorticotrophic hormone (ACTH) a low level of glucose (sugar used for energy) positive adrenal antibodies (antibodies designed to attack the adrenal gland) Any of the above could be a sign of Addison’s disease. Synacthen stimulation test If cortisol in your blood is low, or your symptoms strongly suggest Addison’s disease, you'll need to have a synacthen stimulation test to confirm the diagnosis. Your GP may refer you to an endocrinology unit (a unit that specialises in the study of hormones) for the test. How urgently you're referred depends on how severe your symptoms are. Synacthen is a man-made (synthetic) copy of the adrenocorticotrophic hormone (ACTH). ACTH is naturally produced by the pituitary gland (a pea-sized gland below the brain) to encourage the adrenal glands to release the hormones cortisol and aldosterone. When synacthen is administered, the adrenal glands should respond in the same way as they would to ACTH, and release cortisol and other steroid hormones into the blood. A blood sample will be taken and tested for cortisol, before an injection of synacthen is given into your arm. After 30 and 60 minutes, a further blood sample will be taken for cortisol measurement. If the ACTH level is high, but the cortisol and aldosterone levels are low, it's usually confirmation of Addison’s disease. Thyroid function test As well as a synacthen stimulation test, your thyroid gland may also be tested to see if it's working properly. Your thyroid gland is found in your neck. It produces hormones that control your body's growth and metabolism. People with Addison’s disease often have an underactive thyroid gland (hypothyroidism), where the thyroid gland does not produce enough hormones. By testing the levels of certain hormones in your blood, your endocrinologist (a specialist in hormone conditions) can determine whether you have hypothyroidism. Scans In some cases, your specialist may refer you for a scan of your adrenal glands – this could be a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan. Diagnosis during an adrenal crisis If Addison’s disease is left untreated, it eventually leads to an adrenal crisis. This is where the symptoms of Addison’s disease appear quickly and severely. During an adrenal crisis, there's not enough time to perform a synacthen stimulation test to confirm Addison’s disease. If possible, blood will be taken and tested for any of the abnormalities listed above. While you're waiting for the results, treatment may be started with steroid injections, and fluids containing salt and glucose. Read more about treating Addison’s disease Driving If you're diagnosed with Addison's disease and have a bus, coach or lorry licence, it's your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA). Read about driving and Addison's disease on the GOV.UK website. Treatment If you have Addison’s disease, you'll need to take daily medication to replace the lost hormones. This should help you to live an active life, although many people find they still need to manage their fatigue. In some cases, the underlying causes of Addison’s disease can be treated. For example, tuberculosis (TB) is treated with a course of antibiotics over a period of at least six months. However, most cases are caused by a problem with the immune system that can't be cured. Medication for Addison’s disease Treatment usually involves corticosteroid (steroid) replacement therapy for life. Corticosteroid medication is used to replace the hormones cortisol and aldosterone that your body no longer produces. It's usually taken in tablet form two or three times a day. In most cases, a medication called hydrocortisone is used to replace the cortisol. Other possible medicines are prednisolone or dexamethasone, though these are less commonly used. Aldosterone is replaced with a medication called fludrocortisone. Your GP may also ask you to add extra salt to your daily diet, although if you're taking enough fludrocortisone medicine this may not be necessary. Unlike most people, if you feel the urge to eat something salty, then you should eat it. In general, the medications used for Addison's disease don't have side effects, unless your dose is too high. If you take a higher dose than necessary for a long time, there's a risk of problems such as weakened bones (osteoporosis), mood swings and difficulty sleeping (insomnia). Living with Addison’s disease Many people with Addison’s disease find that taking their medication enables them to continue with their normal diet and exercise routines. However, bouts of fatigue are also common, and it can take some time to learn how to manage these periods of low energy. Some people find that needing to take regular doses of medication is restrictive and affects their daily life or emotional health. Missing a dose of medication, or taking it late, can also lead to exhaustion or insomnia. Some people can develop associated health conditions, such as diabetes or an underactive thyroid, which require extra treatment and management. You'll usually need to have appointments with an endocrinologist every 6-12 months, so they can review your progress and adjust your medication dose, if necessary. Your GP can provide support and repeat prescriptions in between these visits. Failing to take your medication could lead to a serious condition called an adrenal crisis, so you must: remember to collect your repeat prescriptions keep spare medication as necessary – for example, in the car or at work, and always carry some spare medication with you take your medication every day at the right time pack extra medication if you are going away – usually double what you would normally need, plus your injection kit (see below) carry your medication in your hand luggage if you are travelling by plane, with a note from your doctor explaining why it is necessary You could also inform close friends or colleagues of your condition. Tell them about the signs of adrenal crisis and what they should do if you experience one. Medical alert bracelets It's also a good idea to wear a medical alert bracelet or necklace that informs people you have Addison’s disease. After a serious accident, such as a car crash, a healthy person produces more cortisol. This helps you cope with the stressful situation and additional strain on your body that results from serious injury. As your body cannot produce cortisol, you'll need a hydrocortisone injection to replace it and prevent an adrenal crisis. Wearing a medical alert bracelet will inform any medical staff treating you about your condition, and what medication you require. Medical alert bracelets or necklaces are pieces of jewellery engraved with your medical condition and an emergency contact number. They are available from a number of retailers. Ask your GP if there's one they recommend, or go to the MedicAlert website. If you need to stay in hospital, the healthcare professionals responsible for your care will also need to know you need steroid replacement medication throughout your stay. It's important to note that this advice still applies if you're not supposed to eat or drink (nil by mouth) for any reason. Adjusting your medication At certain times, your medication may need to be adjusted to take into account any additional strain on your body. For example, you may need to increase the dosage of your medication if you experience any of the following: an illness or infection – particularly if you have a high temperature of 37.5C (99.5F) an accident, such as a car crash an operation, dental or medical procedure (such as a tooth filling or endoscopy) you're taking part in strenuous exercise not usually part of your daily life This will help your body cope with the additional stress. Your endocrinologist will monitor your dosage and advise about any changes. Over time, as you get used to the condition and learn what can trigger your symptoms, you may learn how to adjust your medication yourself. However, always consult your GP or specialist if you're unsure. Emergency treatment You and a partner or family member may be trained to administer an injection of hydrocortisone in an emergency. This could be necessary if you go into shock after an injury, or if you experience vomiting or diarrhoea and are unable to keep down oral medication. This may occur if you're pregnant and have morning sickness. Your endocrinologist will discuss with you when an injection might be necessary. If you need to administer emergency hydrocortisone, always call your GP immediately afterwards. Check what out-of-hours services are available in your local area, in case the emergency is outside normal working hours. You can also register yourself with your local ambulance service, so they have a record of your requirement for a steroid injection or tablets, if you need their assistance. Treating adrenal crisis Adrenal crisis, or Addisonian crisis, needs urgent medical attention. Dial 999 for an ambulance if you or someone you know are experiencing adrenal crisis. Signs of an adrenal crisis include: severe dehydration pale, cold, clammy skin sweating rapid, shallow breathing dizziness severe vomiting and diarrhoea severe muscle weakness headache severe drowsiness or loss of consciousness In hospital, you'll be given lots of fluid through a vein in your arm to rehydrate you. This will contain a mixture of salts and sugars (sodium, glucose and dextrose) to replace those that your body is lacking. You'll also be injected with hydrocortisone to replace the missing cortisol hormone. Any underlying causes of the adrenal crisis, such as an infection, will also be treated.
||Learn more about the risks of alcohol misuse
Alcohol misuse means drinking excessively – more than the lower-risk limits of alcohol consumption. Alcohol consumption is measured in units. A unit of alcohol is 10ml of pure alcohol, which is about: half a pint of normal-strength lager a single measure (25ml) of spirits A small glass (125ml) of wine contains about 1.5 units of alcohol. Lower-risk limits To keep your risk of alcohol-related harm low, the NHS recommends: not regularly drinking more than 14 units of alcohol a week if you drink as much as 14 units a week, it's best to spread this evenly over three or more days if you're trying to reduce the amount of alcohol you drink, it's a good idea to have several alcohol-free days each week Regular or frequent drinking means drinking alcohol most weeks. The risk to your health is increased by drinking any amount of alcohol on a regular basis. Risks of alcohol misuse Short-term The short-term risks of alcohol misuse include: accidents and injuries requiring hospital treatment, such as a head injury violent behaviour and being a victim of violence unprotected sex that could potentially lead to unplanned pregnancy or sexually transmitted infections (STIs) loss of personal possessions, such as wallets, keys or mobile phones alcohol poisoning – this may lead to vomiting, seizures (fits) and falling unconscious People who binge drink (drink heavily over a short period of time) are more likely to behave recklessly and are at greater risk of being in an accident. Long-term Persistent alcohol misuse increases your risk of serious health conditions, including: heart disease stroke liver disease liver cancer and bowel cancer mouth cancer pancreatitis As well as causing serious health problems, long-term alcohol misuse can lead to social problems, such as unemployment, divorce, domestic abuse and homelessness. If someone loses control over their drinking and has an excessive desire to drink, it's known as dependent drinking (alcoholism). Dependent drinking usually affects a person's quality of life and relationships, but they may not always find it easy to see or accept this. Severely dependent drinkers are often able to tolerate very high levels of alcohol in amounts that would dangerously affect or even kill some people. A dependent drinker usually experiences physical and psychological withdrawal symptoms if they suddenly cut down or stop drinking, including: hand tremors – "the shakes" sweating seeing things that aren't real (visual hallucinations) depression anxiety difficulty sleeping (insomnia) This often leads to "relief drinking" to avoid withdrawal symptoms. Read more about the risks of alcohol misuse Am I drinking too much alcohol? You could be misusing alcohol if: you feel you should cut down on your drinking other people have been criticising your drinking you feel guilty or bad about your drinking you need a drink first thing in the morning to steady your nerves or get rid of a hangover Someone you know may be misusing alcohol if: they regularly exceed the lower-risk daily limit for alcohol they're sometimes unable to remember what happened the night before because of their drinking they fail to do what was expected of them as a result of their drinking – for example, missing an appointment or work because of being drunk or hungover Getting help If you're concerned about your drinking or someone else's, a good first step is to visit your GP. They'll be able to discuss the services and treatments available. Your alcohol intake may be assessed using tests, such as: the Alcohol Use Disorders Identification Test (PDF, 224kb) – a widely used screening test that can help determine whether you need to change your drinking habits the Fast Alcohol Screening Test – a simpler test to check whether your drinking has reached dangerous levels the Severity of Alcohol Dependence Questionnaire – this helps identify how severely dependent on alcohol you may be As well as the NHS, there are a number of charities and support groups across the UK that provide support and advice for people with an alcohol misuse problem. For example, you may want to contact: Alcohol Concern – runs the national drink helpline, Drinkline on 0300 123 1110 Alcoholics Anonymous – helpline 0845 769 7555 Al-Anon Family Groups – helpline 020 7403 0888 For a full list of charities and support groups, see our page on alcohol support Treating alcohol misuse How alcohol misuse is treated depends on how much alcohol a person is drinking. Treatment options include: counselling – including self-help groups and talking therapies, such as cognitive behavioural therapy (CBT) medication detoxification – this involves a nurse or doctor supporting you to safely stop drinking; this can be done by helping you slowly cut down over time or by giving you medicines to prevent withdrawal symptoms There are two main types of medicines to help people stop drinking. The first is to help stop withdrawal symptoms, and is given in reducing doses over a short period of time. The most common of these medicines is chlordiazapoxide (Librium). The second is a medication to reduce any urge you may have to drink. The most common medications used for this are acamprosate and naltrexone. These are both given at a fixed dose, and you'll usually be on them for 6 to 12 months. Read more about the treatment options for alcohol misuse Further reading alcohol units caring for an alcoholic social drinking: the hidden risks the risks of drinking too much tips for cutting down on your drinking Alcohol and pregnancy Drinking in pregnancy can lead to long-term harm to the baby, and the risk increases the more you drink. The Chief Medical Officers for the UK recommend that if you're pregnant, or planning to become pregnant, the safest approach is not to drink alcohol at all to keep the risk to your baby to a minimum. If you're trying to conceive, your partner should drink no more than 14 units of alcohol a week, which should be spread evenly over three days or more. Drinking alcohol excessively can affect the quality of his sperm. Risks Alcohol is a powerful chemical that can have a wide range of adverse effects on almost every part of your body, including your brain, bones and heart. Alcohol and its associated risks can have both short-term and long-term effects. Short-term effects of alcohol consumption The short-term effects of alcohol consumption are outlined below. This information is based on the assumption that you have a normal tolerance to alcohol. Dependent drinkers with a higher tolerance to alcohol can often drink much more without experiencing any noticeable effects. 1-2 units After drinking 1-2 units of alcohol, your heart rate speeds up and your blood vessels expand, giving you the warm, sociable and talkative feeling associated with moderate drinking. 4-6 units After drinking 4-6 units of alcohol, your brain and nervous system starts to be affected. It begins to affect the part of your brain associated with judgement and decision making, causing you to be more reckless and uninhibited. The alcohol also impairs the cells in your nervous system, making you feel light-headed and adversely affecting your reaction time and co-ordination. 8-9 units After drinking 8-9 units of alcohol, your reaction times will be much slower, your speech will begin to slur and your vision will begin to lose focus. Your liver, which filters alcohol out of your body, will be unable to remove all of the alcohol overnight, so it's likely you'll wake with a hangover. 10-12 units After drinking 10-12 units of alcohol, your co-ordination will be highly impaired, placing you at serious risk of having an accident. The high level of alcohol has a depressant effect on both your mind and body, which makes you drowsy. This amount of alcohol will begin to reach toxic (poisonous) levels. Your body attempts to quickly pass out the alcohol in your urine. This will leave you feeling badly dehydrated in the morning, which may cause a severe headache. The excess amount of alcohol in your system can also upset your digestion, leading to symptoms of nausea, vomiting, diarrhoea and indigestion. More than 12 units If you drink more than 12 units of alcohol, you're at considerable risk of developing alcohol poisoning, particularly if you're drinking many units over a short period of time. It usually takes the liver about an hour to remove one unit of alcohol from the body. Alcohol poisoning occurs when excessive amounts of alcohol start to interfere with the body's automatic functions, such as: breathing heart rate gag reflex, which prevents you choking Alcohol poisoning can cause a person to fall into a coma and could lead to their death. Other risks Some of the other risks associated with alcohol misuse include: accidents and injury – more than 1 in 10 visits to accident and emergency (A&E) departments are because of alcohol-related illnesses unsafe sex – this can lead to unplanned pregnancies and sexually transmitted infections (STIs) loss of personal possessions – many people lose personal possessions, such as their wallet or mobile phone, when they're drunk unplanned time off work or college – this could put your job or education at risk Long-term effects of alcohol misuse Drinking large amounts of alcohol for many years will take its toll on many of the body's organs and may cause organ damage. Organs known to be damaged by long-term alcohol misuse include the brain and nervous system, heart, liver and pancreas. Heavy drinking can also increase your blood pressure and blood cholesterol levels, both of which are major risk factors for heart attacks and strokes. Long-term alcohol misuse can weaken your immune system, making you more vulnerable to serious infections. It can also weaken your bones, placing you at greater risk of fracturing or breaking them. There are many long-term health risks associated with alcohol misuse. They include: high blood pressure stroke pancreatitis liver disease liver cancer mouth cancer head and neck cancer breast cancer bowel cancer depression dementia sexual problems, such as impotence or premature ejaculation infertility As well as having a significant impact on your health, alcohol misuse can also have long-term social implications. For example, it can lead to: family break-up and divorce domestic abuse unemployment homelessness financial problems Kindling Kindling is a problem that can occur following a number of episodes of withdrawal from alcohol. The severity of a person's withdrawal symptoms may get worse each time they stop drinking, and can cause symptoms such as tremors, agitation and convulsions (seizures). Alcohol has a suppressing effect on the brain and central nervous system. Research has shown that when alcohol is removed from the body, it activates brain and nerve cells, resulting in excessive excitability (hyperexcitability). This can lead to behavioural symptoms such as seizures. With each alcohol withdrawal episode, the brain and nervous system becomes more sensitised and the resulting side effects become more pronounced. This kindling effect can also occur after chemical stimulus to the brain or body, such as anti-convulsant medication. This means a person's alcohol withdrawal programme needs to be carefully planned, with close monitoring of its effects. Read more about kindling in alcohol withdrawal (PDF, 163kb). Alcohol poisoning: what to do Signs of alcohol poisoning include: confusion vomiting seizures (fits) slow breathing pale or bluish skin cold and clammy skin unconsciousness Dial 999 for an ambulance if you suspect alcohol poisoning and you're worried. Don't try to make the person vomit because they could choke on it. To prevent choking, turn them on to their side and put a cushion under their head. If a person loses consciousness, don't leave them to "sleep it off". Levels of alcohol in the blood can continue rising for 30-40 minutes after the last drink, and symptoms can worsen. Treatment The treatment options for alcohol misuse depend on the extent of your drinking and whether you're trying to drink less (moderation) or give up drinking completely (abstinence). This page covers: brief intervention moderation vs abstinence detox and withdrawal symptoms medication for alcohol dependency therapy for alcohol dependency Alcohol Brief Intervention (ABI) An Alcohol Brief Intervention (ABI) is a short, evidence-based, structured conversation about alcohol consumption with a patient that’s seeks in a non-confrontational way to motivate and support an individual to think about and/or plan a change in their drinking behaviour in order to reduce their consumption and/or their risk of harm’. Moderation vs abstinence Moderation or abstinence are treatment options if you're: regularly drinking more than the lower-risk daily levels of alcohol – 14 units a week experiencing health problems directly related to alcohol unable to function without alcohol (alcohol dependency) Cutting alcohol out completely will have a greater health benefit. However, moderation is often a more realistic goal, or at least a first step on the way to abstinence. Ultimately, the choice is yours, but there are circumstances where abstinence is strongly recommended, including if you: have liver damage, such as liver disease or cirrhosis have other medical problems, such as heart disease, that can be made worse by drinking are taking medication that can react badly with alcohol, such as antipsychotics are pregnant or planning to become pregnant Abstinence may also be recommended if you've previously been unsuccessful with moderation. If you choose moderation, you'll probably be asked to attend further counselling sessions so your progress can be assessed, and further treatment and advice can be provided if needed. You may also have regular blood tests so the health of your liver can be carefully monitored. Detox and withdrawal symptoms If you're dependent on alcohol to function, it's recommended you seek medical advice to manage your withdrawal. Some people may be prescribed medication to help achieve abstinence. You may also choose to attend self-help groups, receive extended counselling, or use a talking therapy such as cognitive behavioural therapy (CBT). Where detox is carried out How and where you attempt detoxification will be determined by your level of alcohol dependency. In mild cases, you should be able to detox at home without the use of medication as your withdrawal symptoms should also be mild. If your consumption of alcohol is high (more than 20 units a day) or you've previously experienced withdrawal symptoms, you may also be able to detox at home with medication to help ease withdrawal symptoms. A tranquiliser called chlordiazepoxide is usually used for this purpose. If your dependency is severe, you may need to go to a hospital or clinic to detox. This is because the withdrawal symptoms will also be severe and are likely to need specialist treatment. Withdrawal symptoms Your withdrawal symptoms will be at their worst for the first 48 hours. They should gradually start to improve as your body begins to adjust to being without alcohol. This usually takes three to seven days from the time of your last drink. You'll also find your sleep is disturbed. You may wake up several times during the night or have problems getting to sleep. This is to be expected, and your sleep patterns should return to normal within a month. During detox, make sure you drink plenty of fluids (about three litres a day). However, avoid drinking large amounts of caffeinated drinks, including tea and coffee, because they can make your sleep problems worse and cause feelings of anxiety. Water, squash or fruit juice are better choices. Try to eat regular meals, even if you're not feeling hungry. Your appetite will return gradually. Avoid driving or operating heavy machinery if you're taking medication to help ease your withdrawal symptoms. It's likely the medication will make you feel drowsy. Only take your medication as directed. Detox can be a stressful time. Ways you can try to relieve stress include reading, listening to music, going for a walk, and taking a bath. If you're detoxing at home, you'll regularly see a nurse or another healthcare professional. This might be at home, your GP practice, or a specialist NHS service. You'll also be given the relevant contact details for other support services should you need additional support. Withdrawal from alcohol is an important first step to overcoming your alcohol-related problems. However, withdrawal isn't an effective treatment by itself. You'll need further treatment and support to help you in the long term. Medication for alcohol dependency The following medicines are licensed for the treatment of alcohol dependence and are available on NHS prescription in Scotland: acamprosate disulfiram naltrexone nalmefene These medications are discussed in more detail below. Acamprosate Acamprosate (brand name Campral) is used to help prevent a relapse in people who have successfully achieved abstinence from alcohol. It's usually used in combination with counselling to reduce alcohol craving. Acamprosate works by affecting levels of a chemical in the brain called gamma-amino-butyric acid (GABA). GABA is thought to be partly responsible for inducing a craving for alcohol. If you're prescribed acamprosate, the course usually starts as soon as you begin withdrawal from alcohol and can last for up to six months. Disulfiram Disulfiram (brand name Antabuse) can be used if you're trying to achieve abstinence but are concerned you may relapse, or if you've had previous relapses. Disulfiram works by deterring you from drinking by causing unpleasant physical reactions if you drink alcohol. These can include: nausea chest pain vomiting dizziness In addition to alcoholic drinks, it's important to avoid all sources of alcohol as they could also induce an unpleasant reaction. Products that may contain alcohol include: aftershave mouthwash some types of vinegar perfume You should also try to avoid substances that give off alcoholic fumes, such as paint thinners and solvents. You'll continue to experience unpleasant reactions if you come into contact with alcohol for a week after you finish taking disulfiram, so it's important to maintain your abstinence during this time. When taking disulfiram, you'll be seen by your healthcare team about once every two weeks for the first two months, and then every month for the following four months. Naltrexone Naltrexone can be used to prevent a relapse or limit the amount of alcohol someone drinks. It works by blocking opioid receptors in the body, stopping the effects of alcohol. It's usually used in combination with other medicine or counselling. If naltrexone is recommended, you should be made aware it also stops painkillers that contain opioids working, including morphine and codeine. If you feel unwell while taking naltrexone, stop taking it immediately and seek advice from your GP or care team. A course of naltrexone can last up to six months, although it may sometimes be longer. Before being prescribed any of these medications, you'll have a full medical assessment. Nalmefene Nalmefene (brand name Selincro) may be used to prevent a relapse or limit the amount of alcohol someone drinks. It works by blocking opioid receptors in the brain, which reduces cravings for alcohol. Nalmefene may be recommended as a possible treatment for alcohol dependence if you've had an initial assessment and: you're still drinking more than 7.5 units a day (for men) or more than 5 units a day (for women) you don't have any physical withdrawal symptoms you don't need to stop drinking immediately or achieve total abstinence Nalmefene should only be taken if you're receiving support to help you reduce your alcohol intake and continue treatment. Therapy for alcohol dependency Self-help groups Many people who have alcohol dependency problems find it useful to attend self-help groups, such as Alcoholics Anonymous (AA). One of the main beliefs behind AA is that alcoholic dependence is a long-term, progressive illness and total abstinence is the only solution. The treatment plan promoted by AA is based on a 12-step programme designed to help you overcome your addiction. The steps include admitting you're powerless over alcohol and your life has become unmanageable, admitting you've acted wrongly and, where possible, making amends with people you've harmed. Read more about the 12 steps of Alcoholics Anonymous and alcohol support Twelve-step facilitation therapy Twelve-step facilitation therapy is based on the programme devised by AA. The difference is you work through the stages on a one-to-one basis with a counsellor, rather than in a group. The therapy may be your preferred treatment option if you feel uneasy or unwilling to discuss your problems in a group setting. Cognitive behavioural therapy (CBT) Cognitive behavioural therapy (CBT) is a talking therapy that uses a problem-solving approach to alcohol dependence. The approach involves identifying unhelpful, unrealistic thoughts and beliefs that may be contributing towards your alcohol dependence, such as: "I can't relax without alcohol" "My friends would find me boring if I was sober" "Just drinking one pint can't hurt" Once these thoughts and beliefs are identified, you'll be encouraged to base your behaviour on more realistic and helpful thoughts, such as: "Lots of people have a good time without alcohol, and I can be one of them" "My friends like me for my personality, not for my drinking" "I know I can't stop drinking once I start" CBT also helps you identify triggers that can cause you to drink, such as: stress social anxiety being in "high-risk" environments, such as pubs, clubs and restaurants Your CBT therapist will teach you how to avoid certain triggers and cope effectively with those that are unavoidable. Family therapy Alcohol dependence doesn't just impact on an individual – it can also affect a whole family. Family therapy provides family members with the opportunity to: learn about the nature of alcohol dependence support the member of the family who is trying to abstain from alcohol Support is also available for family members in their own right. Living with someone who misuses alcohol can be stressful, so receiving support can often be very helpful. There are a number of specialist alcohol services that provide help and support for the relatives and friends of people with a dependence on alcohol. For example, Al-Anon is an organisation affiliated with AA that provides relatives and friends with help and support. Its confidential helpline number is 020 7403 0888 (10am to 10pm, 365 days a year). Drinking diary If you're aiming to moderate your drinking, you may be asked to keep a "drinking diary". On a daily basis, make a note of: all the alcoholic drinks you've had what time you had them where you were how many units you drank – you can use the Alcohol Concern unit calculator to work this out This will give you a good idea of how much alcohol you're drinking, the situations in which you drink, and how you could start to cut down.
||Learn about alcohol poisoning symptoms and treatments
Alcohol poisoning occurs when a person drinks a toxic amount of alcohol, usually over a short period of time (binge drinking). Being poisoned by alcohol can damage your health or even put your life in danger. It's important to avoid misusing alcohol and to be aware of how much you're drinking and the effect this could have on your body. This topic covers: Signs and symptoms When to seek medical help Treatment in hospital Dangers of alcohol poisoning How alcohol poisoning occurs The effects of alcohol Recommended alcohol limits Signs and symptoms of alcohol poisoning The signs and symptoms of alcohol poisoning include: confusion severely slurred speech loss of co-ordination vomiting irregular or slow breathing hypothermia (pale or blue-tinged skin caused by low body temperature) stupor (being conscious but unresponsive) passing out and being unconscious In the most severe cases, alcohol poisoning can lead to coma, brain damage and death. When to seek medical help If you suspect alcohol poisoning, dial 999 immediately to request an ambulance. While you're waiting: try to keep them sitting up and awake give them water if they can drink it if they've passed out, lie them on their side in the recovery position and check they're breathing properly keep them warm stay with them and monitor their symptoms Never leave a person alone to 'sleep it off'. The level of alcohol in a person's blood can continue to rise for up to 30-40 minutes after their last drink. This can cause their symptoms to suddenly become much more severe. You also shouldn't give them coffee or any more alcohol, put them under a cold shower or walk them around. These won't help someone 'sober up' and may even be dangerous. How alcohol poisoning is treated in hospital In hospital, the person will be carefully monitored until the alcohol has left their system. If treatment is required, this may include: inserting a tube into their mouth and windpipe (intubation) – to open the airway, remove any blockages and help with breathing fitting an intravenous drip, which goes directly into a vein – to top up their water, blood sugar and vitamin levels fitting a catheter (thin tube) to their bladder – to drain urine straight into a bag so they don't wet themselves Dangers of alcohol poisoning If a person is poisoned by alcohol they could: choke on their vomit stop breathing have a heart attack inhale vomit, leading to fatal lung damage become severely dehydrated, which can cause permanent brain damage in extreme cases develop more severe hypothermia have seizures (fits) as a result of lowered blood sugar levels Repeated vomiting and retching can lead to the vomiting of blood as a result of a torn blood vessel (Mallory-Weiss tear) at the junction of the stomach and gullet. Other related risks Drinking too much alcohol can affect a person's judgement and put them in situations where their health and safety are at risk. For example, they may: have an accident or get injured become involved in violent or antisocial behaviour have unsafe sex, which can lead to an unplanned pregnancy or a sexually transmitted infection (STI) lose personal possessions How alcohol poisoning occurs Every time you drink alcohol, your liver has to filter it out of your blood. Alcohol is absorbed quickly into your body (much quicker than food), but the body can only process around one unit of alcohol an hour. If you drink a lot of alcohol over a short space of time, such as on a night out, your body won't have time to process it all. Alcohol poisoning can also occur if a person drinks household products that contain alcohol – children sometimes drink these by accident. The amount of alcohol in your bloodstream – known as your blood alcohol concentration (BAC) – will rise. The effects of alcohol Around 1-2 units your heart rate will speed up and your blood vessels will expand you get the warm, sociable feeling associated with moderate drinking Around 4-6 units your decision making and judgement will start to be affected, making you lose your inhibitions and become more reckless the cells in your nervous system will start to be affected, making you feel lightheaded your co-ordination will be affected and your reaction time may be slower Around 8-9 units your reaction times will be much slower your speech will be slurred your vision will begin to lose focus your liver won't be able to remove all of the alcohol overnight, so it's likely you'll wake up with a hangover At this stage you should seriously consider not drinking any more alcohol. If you do: Around 10-12 units your co-ordination will be seriously impaired, placing you at high risk of having an accident you may stagger around or feel unstable on your feet you'll feel drowsy or dizzy the amount of alcohol in your body will begin to reach toxic (poisonous) levels you may need to go to the toilet more often as your body attempts to quickly pass the alcohol out of your body in your urine you'll be dehydrated in the morning, and probably have a severe headache the excess alcohol in your system may upset your digestive system, leading to nausea, vomiting, diarrhoea or indigestion More than 12 units you're at high risk of developing alcohol poisoning, particularly if you're drinking lots of units in a short space of time the alcohol can begin to interfere with the automatic functions of your body, such as your breathing, heart rate and gag reflex you're at risk of losing consciousness Recommended alcohol limits If you drink most weeks, to reduce your risk of harming your health: men and women are advised not to regularly drink more than 14 units a week spread your drinking over three days or more if you drink as much as 14 units a week One unit of alcohol is equivalent to: half a pint of lower-strength lager, beer or cider (ABV 3.6%) a single small shot of spirits (25ml, ABV 40%) You should also avoid binge drinking as it's dangerous and puts you at risk of alcohol poisoning. Read more about alcohol units and drinking and alcohol including tips on cutting down on your drinking
||Alcohol-related liver disease
||Learn about alcohol-related liver disease symptoms and treatments
Alcohol-related liver disease (ARLD) refers to liver damage caused by excess alcohol intake. There are several stages of severity and a range of associated symptoms. ARLD doesn't usually cause any symptoms until the liver has been severely damaged. When this happens, symptoms can include: feeling sick weight loss loss of appetite yellowing of the eyes and skin (jaundice) swelling in the ankles and tummy confusion or drowsiness vomiting blood or passing blood in your stools This means ARLD is frequently diagnosed during tests for other conditions, or at a stage of advanced liver damage. If you regularly drink alcohol to excess, tell your GP so they can check if your liver is damaged. Read more about: symptoms of ARLD diagnosing ARLD Alcohol and the liver With the exception of the brain, the liver is the most complex organ in the body. Its functions include: filtering toxins from the blood aiding digestion of food regulating blood sugar and cholesterol levels helping fight infection and disease The liver is very resilient and capable of regenerating itself. Each time your liver filters alcohol, some of the liver cells die. The liver can develop new cells, but prolonged alcohol misuse (drinking too much) over many years can reduce its ability to regenerate. This can result in serious and permanent damage to your liver. ARLD is very common in the UK – the number of people with the condition has been increasing over the last few decades as a result of increasing levels of alcohol misuse. Read more about the causes of ARLD. Stages of ARLD There are 3 main stages of ARLD, although there's often an overlap between each stage. These stages are explained below. Alcoholic fatty liver disease Drinking a large amount of alcohol, even for just a few days, can lead to a build-up of fats in the liver. This is called alcoholic fatty liver disease, and is the first stage of ARLD. Fatty liver disease rarely causes any symptoms, but it's an important warning sign that you're drinking at a harmful level. Fatty liver disease is reversible. If you stop drinking alcohol for 2 weeks, your liver should return to normal. Alcoholic hepatitis Alcoholic hepatitis – which is unrelated to infectious hepatitis – is a potentially serious condition that can be caused by alcohol misuse over a longer period. When this develops, it may be the first time a person is aware they're damaging their liver through alcohol. Less commonly, alcoholic hepatitis can occur if you drink a large amount of alcohol in a short period of time (binge drinking). The liver damage associated with mild alcoholic hepatitis is usually reversible if you stop drinking permanently. Severe alcoholic hepatitis, however, is a serious and life-threatening illness. Many people die from the condition each year in the UK, and some people only find out they have liver damage when their condition reaches this stage. Cirrhosis Cirrhosis is a stage of ARLD where the liver has become significantly scarred. Even at this stage, there may not be any obvious symptoms. It's generally not reversible, but stopping drinking alcohol immediately can prevent further damage and significantly increase your life expectancy. A person who has alcohol-related cirrhosis and doesn't stop drinking has a less than 50% chance of living for at least 5 more years. How ARLD is treated There's currently no specific medical treatment for ARLD. The main treatment is to stop drinking, preferably for the rest of your life. This reduces the risk of further damage to your liver and gives it the best chance of recovering. If a person is dependent on alcohol, stopping drinking can be very difficult. However, support, advice and medical treatment may be available through local alcohol support services. A liver transplant may be required in severe cases where the liver has stopped functioning and doesn't improve when you stop drinking alcohol. You'll only be considered for a liver transplant if you've developed complications of cirrhosis, despite having stopped drinking. All liver transplant units require a person to not drink alcohol while awaiting the transplant, and for the rest of their life. Read more about treating ARLD. Complications Death rates linked to ARLD have risen considerably over the last few decades. Alcohol is now one of the most common causes of death in the UK, along with smoking and high blood pressure. Life-threatening complications of ARLD include: internal (variceal) bleeding build-up of toxins in the brain (encephalopathy) fluid accumulation in the abdomen (ascites) with associated kidney failure liver cancer Read more about the complications of ARLD. Preventing ARLD The most effective way to prevent ARLD is to stop drinking alcohol or stick to the recommended limits: men and women are advised not to regularly drink more than 14 units a week spread your drinking over 3 days or more if you drink as much as 14 units a week A unit of alcohol is equal to about half a pint of normal-strength lager or a pub measure (25ml) of spirits. Even if you've been a heavy drinker for many years, reducing or stopping your alcohol intake will have important short- and long-term benefits for your liver and overall health. See our drinking and alcohol pages for more information and advice. Symptoms In many cases, people with alcohol-related liver disease (ARLD) don't have any noticeable symptoms until their liver is badly damaged. Early symptoms If you do experience early symptoms of ARLD, these are often quite vague, such as: abdominal (tummy) pain loss of appetite fatigue feeling sick diarrhoea feeling generally unwell Advanced symptoms As the liver becomes more severely damaged, more obvious and serious symptoms can develop, such as: yellowing of the skin and whites of the eyes (jaundice) swelling in the legs, ankles and feet, due to a build-up of fluid (oedema) swelling in your abdomen, due to a build-up of fluid known as ascites a high temperature (fever) and shivering attacks very itchy skin hair loss unusually curved fingertips and nails (clubbed fingers) blotchy red palms significant weight loss weakness and muscle wasting confusion and memory problems, trouble sleeping (insomnia) and changes in your personality due to a build-up of toxins in the brain vomiting blood and black, tarry stools due to internal bleeding a tendency to bleed and bruise more easily, such as frequent nosebleeds and bleeding gums increased sensitivity to alcohol and drugs (because the liver can't process them) When to seek medical advice ARLD doesn't often cause symptoms until it's reached an advanced stage. If you misuse alcohol, you may have liver damage, even though you have none of the symptoms above. Read about alcohol misuse (drinking too much). Contact your GP for advice if you have a history of regular alcohol misuse. A good way to assess your history and pattern of drinking is to use a short test known as the CAGE test, which consists of 4 questions: Have you ever thought you should cut down on your drinking? Have people annoyed you by criticising your drinking? Have you ever felt guilty about your drinking? Have you ever drunk an "eye-opener", which means: have you ever drunk alcohol first thing in the morning to get over a hangover and steady your nerves? If you answer "yes" to 1 or more of the questions above, you may have an alcohol problem and are advised to see your GP. See your GP as soon as possible if you have symptoms of advanced ARLD. Read more about how ARLD is diagnosed. Causes Alcohol-related liver disease (ARLD) is caused by drinking too much alcohol. The more you drink above the recommended limits, the higher your risk of developing ARLD. There are 2 ways alcohol misuse (drinking too much) can cause ARLD. These are: drinking a large amount of alcohol in a short amount of time (binge drinking) can cause fatty liver disease and, less commonly, alcoholic hepatitis drinking more than the recommended limits of alcohol over many years can cause hepatitis and cirrhosis, the more serious types of ARLD Evidence suggests people who regularly drink more than the recommended maximum amounts are most at risk of developing ARLD: men and women are advised not to regularly drink more than 14 units a week spread your drinking over 3 days or more if you drink as much as 14 units a week Read more about alcohol units and how to calculate them. Additional factors As well as drinking excessive amounts of alcohol, other factors can increase your chances of developing ARLD. These include: being overweight or obese being female – women appear to be more vulnerable than men to the harmful effects of alcohol having a pre-existing liver condition, such as hepatitis C genetics – alcohol dependence and problems processing alcohol often run in families Diagnosis Alcohol-related liver disease (ARLD) is often first suspected when tests for other medical conditions show a damaged liver. This is because the condition causes few obvious symptoms in the early stages. If a doctor suspects ARLD, they'll usually arrange a blood test to check how well your liver is working. They may also ask about your alcohol consumption. It's important to be totally honest about how much and how often you drink alcohol to avoid further unnecessary testing. This could lead to a delay in the treatment you need. Blood tests Blood tests used to assess the liver are known as liver function tests. However, liver function tests can be normal at many stages of liver disease. Blood tests can also detect if you have low levels of certain substances, such as a protein called serum albumin, which is made by the liver. A low level of serum albumin suggests your liver isn't functioning properly. A blood test may also look for signs of abnormal blood clotting, which can indicate significant liver damage. Lab Tests Online has more information on liver function tests. Further testing If your symptoms or liver function test suggest an advanced form of ARLD – either alcoholic hepatitis or cirrhosis – you may need further tests. These are described below. Imaging tests Scans may be needed to produce detailed images of your liver. This may include: an ultrasound scan a computerised tomography (CT) scan a magnetic resonance imaging (MRI) scan Some scans may also measure the stiffness of the liver, which is a good indication of whether your liver is scarred. Liver biopsy During a liver biopsy, a fine needle is inserted into your body (usually between your ribs). A small sample of liver cells is taken and sent to a laboratory to be examined under a microscope. The biopsy is usually carried out under local anaesthetic, either as a day case or with an overnight stay in hospital. Specialist doctors will examine the liver biopsy tissue under the microscope to determine the degree of scarring in the liver and the cause of the damage. Endoscopy An endoscope is a long, thin, flexible tube with a light and a video camera at one end. During an endoscopy, the instrument is passed down your oesophagus (the long tube that carries food from the throat to the stomach) and into your stomach. Pictures of your oesophagus and stomach are transmitted to an external screen. The doctor will be looking for swollen veins (varices), which are a sign of cirrhosis. Treatment Successful treatment for alcohol-related liver disease (ARLD) often depends on whether someone is willing to stop drinking alcohol and make changes to their lifestyle. Stopping drinking alcohol Treatment for ARLD involves stopping drinking alcohol. This is known as abstinence, which can be vital, depending on what stage the condition is at. If you have fatty liver disease, the damage may be reversed if you abstain from alcohol for at least 2 weeks. After this point, it's usually safe to start drinking again if you stick to the NHS guidelines on alcohol consumption. If you have a more serious form of ARLD – alcoholic hepatitis or cirrhosis – life-long abstinence is recommended. This is because stopping drinking is the only way to prevent your liver damage getting worse and potentially stop you dying of liver disease. Stopping drinking isn't easy, especially as an estimated 70% of people with ARLD have an alcohol dependency problem. Nevertheless, if you have alcohol-related cirrhosis or alcoholic hepatitis and don't stop drinking, no medical or surgical treatment can prevent liver failure. Withdrawal symptoms If you're abstaining from alcohol, you may suffer withdrawal symptoms. These will be at their worst for the first 48 hours, but should start to improve as your body adjusts to being without alcohol. This usually takes 3 to 7 days from the time of your last drink. Many people initially experience disturbed sleep when abstaining from alcohol, but in most cases their sleep pattern returns to normal within a month. In some cases, you may be advised to reduce your alcohol intake in a gradual and planned way to help avoid withdrawal problems. You may also be offered a medication called a benzodiazepine and psychological therapy, such as cognitive behavioural therapy (CBT), to help you through the withdrawal process. Some people need to stay in hospital or a specialist rehabilitation clinic during the initial withdrawal phases, so their progress can be closely monitored. If you're staying at home, you'll regularly see a nurse or other health professional. You might see them at home, at your GP surgery or at a specialist NHS service. Preventing relapses Once you've stopped drinking, you may need further treatment to help ensure you don't start drinking again. The first treatment usually offered is psychological therapy. This involves seeing a therapist to talk about your thoughts and feelings, and how these affect your behaviour and wellbeing. If psychological therapy alone isn't effective, you may also need medication to help you abstain from alcohol, such as: acamprosate naltrexone disulfiram Read our page on treating alcohol misuse for more information on the treatments offered. Self-help groups Many people with alcohol dependence find it useful to attend self-help groups to help them stop drinking. One of the most well-known is Alcoholics Anonymous, but there are many other groups that can help. See alcohol support for more information about the help available. Diet and nutrition Malnutrition is common in people with ARLD, so it's important to eat a balanced diet to help ensure you get all the nutrients you need. Avoiding salty foods and not adding salt to foods you eat can reduce your risk of developing swelling in your legs, feet and abdomen (tummy) caused by a build-up of fluid. The damage to your liver can also mean it's unable to store glycogen – a carbohydrate that provides short-term energy. When this happens, the body uses its own muscle tissue to provide energy between meals, which leads to muscle wasting and weakness. Therefore, you may need extra energy and protein in your diet. Healthy snacking between meals can top up your calories and protein. It may also be helpful to eat 3 or 4 small meals a day, rather than 1 or 2 large meals. Your GP can advise you on a suitable diet or, in some cases, refer you to a dietitian. In the most serious cases of malnutrition, nutrients may need to be provided through a feeding tube inserted through the nose and into the stomach. Medication for symptoms The use of medication to directly treat ARLD is controversial. Many experts have argued there's limited evidence for its effectiveness. For people with severe alcoholic hepatitis, treatment in hospital may be necessary. Specific treatment with corticosteroids or pentoxifylline medication may be used to reduce inflammation of the liver in some people with this condition. Nutritional support (see above) is also an important part of treatment in these cases. Other medications that have been used to treat liver damage include: anabolic steroids (a more powerful type of steroid medication) ropylthiouracil (a type of medicine originally designed to treat overactive thyroid glands) However, there's a lack of good evidence that these help and they're no longer used for severe alcoholic hepatitis. Liver transplants In the most serious cases of ARLD, the liver loses its ability to function, leading to liver failure. A liver transplant is currently the only way to cure irreversible liver failure. A liver transplant may be considered if: you develop progressive liver failure, despite not drinking alcohol you're otherwise well enough to survive such an operation you commit to not drinking alcohol for the rest of your life Complications A number of serious complications can develop if you have alcohol-related liver disease (ARLD). Some of the main complications associated with the condition are described below. Portal hypertension and varices Portal hypertension is a common complication of cirrhosis and, less commonly, alcoholic hepatitis. It occurs when the blood pressure inside your liver has risen to a potentially serious level. When the liver becomes severely scarred, it's harder for blood to move through it. This leads to an increase in the pressure of blood around the intestines. The blood must also find a new way to return to your heart. It does this by opening up new blood vessels, usually along the lining of your stomach or oesophagus (the long tube that carries food from the throat to the stomach). These new blood vessels are known as varices. If the blood pressure rises to a certain level, it can become too high for the varices to cope with, causing the walls of the varices to split and bleed. This can cause long-term bleeding, which can lead to anaemia. Alternatively, the bleeding can be rapid and massive, causing you to vomit blood and pass stools that are very dark or tar-like. Split varices can be treated by using an endoscope to locate the varices. A tiny band can then be used to seal the base of the varices. Ascites A person with portal hypertension may also develop a build-up of fluid in their abdomen (tummy) and around the intestines. This fluid is known as ascites. Initially, this can be treated with water tablets (diuretics). If the problem progresses, many litres of fluid can build up, which needs to be drained. This is a procedure known as paracentesis and involves a long, thin tube being placed into the fluid through the skin under local anaesthetic. One of the problems associated with the development of ascites is the risk of infection in the fluid (spontaneous bacterial peritonitis). This is a potentially very serious complication and is linked to an increased risk of kidney failure and death. Hepatic encephalopathy One of the most important functions of the liver is to remove toxins from your blood. If the liver is unable to do this due to hepatitis or cirrhosis, the levels of toxins in the blood increase. A high level of toxins in the blood due to liver damage is known as hepatic encephalopathy. Symptoms of hepatic encephalopathy include: agitation confusion disorientation muscle stiffness muscle tremors difficulty speaking in very serious cases, a coma Hepatic encephalopathy may require hospital admission. In hospital, body functions are supported and medication is used to remove toxins from the blood. Liver cancer Liver damage due to heavy drinking over many years can also increase your risk of developing liver cancer. Over the past few decades, rates of liver cancer in the UK have risen sharply due to increased levels of alcohol misuse. It's estimated that, every year, 3-5% of people with cirrhosis will develop liver cancer.
||Learn about allergic rhinitis symptoms and treatment
Allergic rhinitis is inflammation of the inside of the nose caused by an allergen, such as pollen, dust, mould, or flakes of skin from certain animals. It's a very common condition, estimated to affect around one in every five people in the UK. Signs and symptoms Allergic rhinitis typically causes cold-like symptoms, such as sneezing, itchiness and a blocked or runny nose. These symptoms usually start soon after being exposed to an allergen. Some people only get allergic rhinitis for a few months at a time because they're sensitive to seasonal allergens, such as tree or grass pollen. Other people get allergic rhinitis all year round. Most people with allergic rhinitis have mild symptoms that can be easily and effectively treated. But for some symptoms can be severe and persistent, causing sleep problems and interfering with everyday life. The symptoms of allergic rhinitis occasionally improve with time, but this can take many years and it's unlikely that the condition will disappear completely. When to see your GP Visit your GP if the symptoms of allergic rhinitis are disrupting your sleep, preventing you carrying out everyday activities, or adversely affecting your performance at work or school. A diagnosis of allergic rhinitis will usually be based on your symptoms and any possible triggers you may have noticed. If the cause of your condition is uncertain, you may be referred for allergy testing. Read more about diagnosing allergic rhinitis What causes allergic rhinitis? Allergic rhinitis is caused by the immune system reacting to an allergen as if it were harmful. This results in cells releasing a number of chemicals that cause the inside layer of your nose (the mucous membrane) to become swollen and excessive levels of mucus to be produced. Common allergens that cause allergic rhinitis include pollen – this type of allergic rhinitis is known as hay fever – as well as mould spores, house dust mites, and flakes of skin or droplets of urine or saliva from certain animals. Read more about the causes of allergic rhinitis Treating and preventing allergic rhinitis It's difficult to completely avoid potential allergens, but you can take steps to reduce exposure to a particular allergen you know or suspect is triggering your allergic rhinitis. This will help improve your symptoms. If your condition is mild, you can also help reduce the symptoms by taking over-the-counter medications, such as non-sedating antihistamines, and by regularly rinsing your nasal passages with a salt water solution to keep your nose free of irritants. See your GP for advice if you've tried taking these steps and they haven't helped. They may prescribe a stronger medication, such as a nasal spray containing corticosteroids. Read more about treating allergic rhinitis and preventing allergic rhinitis Further problems Allergic rhinitis can lead to complications in some cases. These include: nasal polyps – abnormal but non-cancerous (benign) sacs of fluid that grow inside the nasal passages and sinuses sinusitis – an infection caused by nasal inflammation and swelling that prevents mucus draining from the sinuses middle ear infections – infection of part of the ear located directly behind the eardrum These problems can often be treated with medication, although surgery is sometimes needed in severe or long-term cases. Read more about the complications of allergic rhinitis Causes Allergic rhinitis is caused by an allergic reaction to an allergen, such as pollen, dust and certain animals. Oversensitive immune system If you have allergic rhinitis, your immune system – your natural defence against infection and illness – will react to an allergen as if it were harmful. If your immune system is oversensitive, it will react to allergens by producing antibodies to fight them off. Antibodies are special proteins in the blood that are usually produced to fight viruses and infections. Allergic reactions don't occur the first time you come into contact with an allergen. The immune system has to recognise and "memorise" it before producing antibodies to fight it. This process is known as sensitisation. After you develop sensitivity to an allergen, it will be detected by antibodies called immunoglobulin E (IgE) whenever it comes into contact with the inside of your nose and throat. These antibodies cause cells to release a number of chemicals, including histamine, which can cause the inside layer of your nose (the mucous membrane) to become inflamed and produce excess mucus. This is what causes the typical symptoms of sneezing and a blocked or runny nose. Common allergens Allergic rhinitis is triggered by breathing in tiny particles of allergens. The most common airborne allergens that cause rhinitis are described below. House dust mites House dust mites are tiny insects that feed on the dead flakes of human skin. They can be found in mattresses, carpets, soft furniture, pillows and beds. Rhinitis isn't caused by the dust mites themselves, but by a chemical found in their excrement. Dust mites are present all year round, although their numbers tend to peak during the winter. Pollen and spores Tiny particles of pollen produced by trees and grasses can sometimes cause allergic rhinitis. Most trees pollinate from early to mid-spring, whereas grasses pollinate at the end of spring and beginning of summer. Rhinitis can also be caused by spores produced by mould and fungi. Animals Many people are allergic to animals, such as cats and dogs. The allergic reaction isn't caused by animal fur, but flakes of dead animal skin and their urine and saliva. Dogs and cats are the most common culprits, although some people are affected by horses, cattle, rabbits and rodents, such as guinea pigs and hamsters. However, being around dogs from an early age can help protect against allergies, and there's some evidence to suggest that this might also be the case with cats. Work-related allergens Some people are affected by allergens found in their work environment, such as wood dust, flour dust or latex. Who's most at risk? It isn't fully understood why some people become oversensitive to allergens, although you're more likely to develop an allergy if there's a history of allergies in your family. If this is the case, you're said to be "atopic", or to have "atopy". People who are atopic have a genetic tendency to develop allergic conditions. Their increased immune response to allergens results in increased production of IgE antibodies. Environmental factors may also play a part. Studies have shown certain things may increase the chance of a child developing allergies, such as growing up in a house where people smoke and being exposed to dust mites at a young age. Diagnosis Your GP will often be able to diagnose allergic rhinitis from your symptoms and your personal and family medical history. They'll ask you whether you've noticed any triggers that seem to cause a reaction, and whether it happens at a particular place or time. Your GP may examine the inside of your nose to check for nasal polyps. Nasal polyps are fleshy swellings that grow from the lining of your nose or your sinuses, the small cavities inside your nose. They can be caused by the inflammation that occurs as a result of allergic rhinitis. Allergic rhinitis is usually confirmed when medical treatment starts. If you respond well to antihistamines, it's almost certain that your symptoms are caused by an allergy. Allergy testing If the exact cause of allergic rhinitis is uncertain, your GP may refer you to a hospital allergy clinic for allergy testing. The two main allergy tests are: skin prick test – where the allergen is placed on your arm and the surface of the skin is pricked with a needle to introduce the allergen to your immune system; if you're allergic to the substance, a small itchy spot (welt) will appear blood test – to check for the immunoglobulin E (IgE) antibody in your blood; your immune system produces this antibody in response to a suspected allergen Commercial allergy testing kits aren't recommended because the testing is often of a lower standard than that provided by the NHS or an accredited private clinic. It's also important that the test results are interpreted by a qualified healthcare professional with detailed knowledge of your symptoms and medical history. Further tests In some cases further hospital tests may be needed to check for complications, such as nasal polyps or sinusitis. For example, you may need: a nasal endoscopy – where a thin tube with a light source and video camera at one end (endoscope) is inserted up your nose so your doctor can see inside your nose a nasal inspiratory flow test – where a small device is placed over your mouth and nose to measure the air flow when you inhale through your nose a computerised tomography (CT) scan – a scan that uses X-rays and a computer to create detailed images of the inside of the body Treatment Treatment for allergic rhinitis depends on how severe your symptoms are and how much they're affecting your everyday activities. In most cases treatment aims to relieve symptoms such as sneezing and a blocked or runny nose. If you have mild allergic rhinitis, you can often treat the symptoms yourself. You should visit your GP if your symptoms are more severe and affecting your quality of life, or if self-help measures haven't been effective. Self-help It's possible to treat the symptoms of mild allergic rhinitis with over-the-counter medications, such as long-acting, non-sedating antihistamines. If possible, try to reduce exposure to the allergen that triggers the condition. See preventing allergic rhinitis for more information and advice about this. Cleaning your nasal passages Regularly cleaning your nasal passages with a salt water solution – known as nasal douching or irrigation – can also help by keeping your nose free of irritants. You can do this either by using a homemade solution or a solution made with sachets of ingredients bought from a pharmacy. Small syringes or pots that often look like small horns or teapots are also available to help flush the solution around the inside of your nose. To make the solution at home, mix half a teaspoon of salt and half a teaspoon of bicarbonate of soda (baking powder) into a pint (568ml) of boiled water that's been left to cool to around body temperature – do not attempt to rinse your nose while the water is still hot. To rinse your nose: stand over a sink, cup the palm of one hand and pour a small amount of the solution into it sniff the water into one nostril at a time repeat this until your nose feels comfortable – you may not need to use all of the solution While you do this, some solution may pass into your throat through the back of your nose. The solution is harmless if swallowed, but try to spit out as much of it as possible. Nasal irrigation can be carried out as often as necessary, but a fresh solution should be made each time. Medication Medication won't cure your allergy, but it can be used to treat the common symptoms. If your symptoms are caused by seasonal allergens, such as pollen, you should be able to stop taking your medication after the risk of exposure has passed. Visit your GP if your symptoms don't respond to medication after two weeks. Antihistamines Antihistamines relieve symptoms of allergic rhinitis by blocking the action of a chemical called histamine, which the body releases when it thinks it's under attack from an allergen. You can buy antihistamine tablets over the counter from your pharmacist without a prescription, but antihistamine nasal sprays are only available with a prescription. Antihistamines can sometimes cause drowsiness. If you're taking them for the first time, see how you react to them before driving or operating heavy machinery. In particular, antihistamines can cause drowsiness if you drink alcohol while taking them. Corticosteroids If you have frequent or persistent symptoms and you have a nasal blockage or nasal polyps, your GP may recommend a nasal spray or drops containing corticosteroids. Corticosteroids help reduce inflammation and swelling. They take longer to work than antihistamines, but their effects last longer. Side effects from inhaled corticosteroids are rare, but can include nasal dryness, irritation and nosebleeds. If you have a particularly severe bout of symptoms and need rapid relief, your GP may prescribe a short course of corticosteroid tablets lasting 5 to 10 days. Add-on treatments If allergic rhinitis doesn't respond to treatment, your GP may choose to add to your original treatment. They may suggest: increasing the dose of your corticosteroid nasal spray using a short-term course of a decongestant nasal spray to take with your other medication combining antihistamine tablets with corticosteroid nasal sprays, and possibly decongestants using a nasal spray that contains a medicine called ipratropium, which will help reduce excessive nasal discharge using a leukotriene receptor antagonist medication – medication that blocks the effects of chemicals called leukotrienes, which are released during an allergic reaction If you don't respond to the add-on treatments, you may be referred to a specialist for further assessment and treatment. Immunotherapy Immunotherapy, also known as hyposensitisation or desensitisation, is another type of treatment used for some allergies. It's only suitable for people with certain types of allergies, such as hay fever, and is usually only considered if your symptoms are severe. Immunotherapy involves gradually introducing more and more of the allergen into your body to make your immune system less sensitive to it. The allergen is often injected under the skin of your upper arm. Injections are given at weekly intervals, with a slightly increased dose each time. Immunotherapy can also be carried out using tablets that contain an allergen, such as grass pollen, which are placed under your tongue. When a dose is reached that's effective in reducing your allergic reaction (the maintenance dose), you'll need to continue with the injections or tablets for up to three years. Immunotherapy should only be carried out under the close supervision of a specially trained doctor as there's a risk it may cause a serious allergic reaction. Complications If you have allergic rhinitis, there's a risk you could develop further problems. A blocked or runny nose can result in difficulty sleeping, drowsiness during the daytime, irritability and problems concentrating. Allergic rhinitis can also make symptoms of asthma worse. The inflammation associated with allergic rhinitis can also sometimes lead to other conditions, such as nasal polyps, sinusitis and middle ear infections. These are described below. Nasal polyps Nasal polyps are swellings that grow in the lining inside your nose or sinuses, the small cavities above and behind your nose. They're caused by inflammation of the membranes of the nose and sometimes develop as a result of rhinitis. Nasal polyps are shaped like teardrops when they're growing and look like a grape on a stem when fully grown. They vary in size and can be yellow, grey or pink. They can grow on their own or in clusters, and usually affect both nostrils. If nasal polyps grow large enough, or in clusters, they can interfere with your breathing, reduce your sense of smell and block your sinuses, which can lead to sinusitis. Small nasal polyps can be shrunk using steroid nasal sprays so they don't cause an obstruction in your nose. Large polyps may need to be surgically removed. Sinusitis Sinusitis is a common complication of rhinitis. It's where the sinuses become inflamed or infected. The sinuses naturally produce mucus, which usually drains into your nose through small channels. However, if the drainage channels are inflamed or blocked – for example, because of rhinitis or nasal polyps – the mucus can't drain away and it may become infected. Common symptoms of sinusitis include: a blocked nose, making it difficult to breathe through your nose a runny nose mucus that drips from the back of your nose down your throat (post-nasal drip) a reduced sense of smell or taste a feeling of fullness, pressure or pain in the face snoring obstructive sleep apnoea (OSA) – your airways become temporarily blocked while you're asleep, which can disturb your sleep Over-the-counter painkillers, such as paracetamol, ibuprofen or aspirin, can be used to help reduce any pain and discomfort in your face. However, these medications aren't suitable for everyone, so check the leaflet that comes with them before using them. For example, children under the age of 16 shouldn't take aspirin, and ibuprofen isn't recommended for people with asthma or a history of stomach ulcers. Speak to your GP or pharmacist if you're unsure. Antibiotics may also be recommended if your sinuses become infected with bacteria. If you have long-term (chronic) sinusitis, surgery may be needed to improve the drainage of your sinuses. Read more about treating sinusitis Middle ear infections Middle ear infections (otitis media) can also develop as a complication of nasal problems, including allergic rhinitis. These infections can occur if rhinitis causes a problem with the Eustachian tube, which connects the back of the nose and middle ear, at the back of the nose. If this tube doesn't function properly, fluid can build up in the middle ear behind the ear drum and can become infected. There's also the possibility of infection at the back of the nose spreading to the ear through the Eustachian tube. The main symptoms of a middle ear infection include: earache a high temperature (fever) being sick a lack of energy slight hearing loss Ear infections often clear up within a couple of days, but paracetamol or ibuprofen can be used to help relieve fever and pain. Antibiotics may also be prescribed if the symptoms persist or are particularly severe. Read more about treating middle ear infections Prevention The best way to prevent allergic rhinitis is to avoid the allergen that causes it. But this isn't always easy. Allergens, such as dust mites, aren't always easy to spot and can breed in even the cleanest house. It can also be difficult to avoid coming into contact with pets, particularly if they belong to friends and family. Below is some advice to help you avoid the most common allergens. House dust mites Dust mites are one of the biggest causes of allergies. They're microscopic insects that breed in household dust. To help limit the number of mites in your house, you should: consider buying an air-permeable occlusive mattress and bedding covers – this type of bedding acts as a barrier to dust mites and their droppings choose wood or hard vinyl floor coverings instead of carpet fit roller blinds that can be easily wiped clean regularly clean cushions, soft toys, curtains and upholstered furniture, either by washing or vacuuming them use synthetic pillows and acrylic duvets instead of woollen blankets or feather bedding use a vacuum cleaner fitted with a high efficiency particulate air (HEPA) filter – it can remove more dust than ordinary vacuum cleaners use a clean damp cloth to wipe surfaces – dry dusting can spread allergens further Concentrate your efforts on controlling dust mites in the areas of your home where you spend most time, such as the bedroom and living room. Pets It isn't pet fur that causes an allergic reaction, but exposure to flakes of their dead skin, saliva and dried urine. If you can't permanently remove a pet from the house, you may find the following tips useful: keep pets outside as much as possible or limit them to one room, preferably one without carpet don't allow pets in bedrooms wash pets at least once a fortnight groom dogs regularly outside regularly wash bedding and soft furnishings your pet has been on If you're visiting a friend or relative with a pet, ask them not to dust or vacuum on the day you're visiting because it will disturb allergens into the air. Taking an antihistamine medicine one hour before you enter a house with a pet can help reduce your symptoms. Pollen Different plants and trees pollinate at different times of the year, so when you get allergic rhinitis will depend on what sort of pollen(s) you're allergic to. Most people are affected during the spring and summer months because this is when most trees and plants pollinate. To avoid exposure to pollen, you may find the following tips useful: check weather reports for the pollen count and stay indoors when it's high avoid line-drying clothes and bedding when the pollen count is high wear wraparound sunglasses to protect your eyes from pollen keep doors and windows shut during mid-morning and early evening, when there's most pollen in the air shower, wash your hair and change your clothes after being outside avoid grassy areas, such as parks and fields, when possible if you have a lawn, consider asking someone else to cut the grass for you Mould spores Moulds can grow on any decaying matter, both in and outside the house. The moulds themselves aren't allergens, but the spores they release are. Spores are released when there's a sudden rise in temperature in a moist environment, such as when central heating is turned on in a damp house or wet clothes are dried next to a fireplace. To help prevent mould spores, you should: keep your home dry and well ventilated when showering or cooking, open windows but keep internal doors closed to prevent damp air spreading through the house, and use extractor fans avoid drying clothes indoors, storing clothes in damp cupboards and packing clothes too tightly in wardrobes deal with any damp and condensation in your home
||Learn more about allergies and their symptoms and treatments
An allergy is a reaction the body has to a particular food or substance. Allergies are very common. They're thought to affect more than 1 in 4 people in the UK at some point in their lives. They are particularly common in children. Some allergies go away as a child gets older, although many are lifelong. Adults can develop allergies to things they weren't previously allergic to. Having an allergy can be a nuisance and affect your everyday activities, but most allergic reactions are mild and can be largely kept under control. Severe reactions can occasionally occur, but these are uncommon. Common allergies Substances that cause allergic reactions are called allergens. The more common allergens include: grass and tree pollen – an allergy to these is known as hay fever (allergic rhinitis) dust mites animal dander (tiny flakes of skin or hair) food – particularly nuts, fruit, shellfish, eggs and cow's milk insect bites and stings medication – including ibuprofen, aspirin, and certain antibiotics latex – used to make some gloves and condoms mould – these can release small particles into the air that you can breathe in household chemicals – including those in detergents and hair dyes Most of these allergens are generally harmless to people who aren't allergic to them. Symptoms of an allergic reaction Allergic reactions usually happen quickly within a few minutes of exposure to an allergen. They can cause: sneezing a runny or blocked nose red, itchy, watery eyes wheezing and coughing a red, itchy rash worsening of asthma or eczema symptoms Most allergic reactions are mild, but occasionally a severe reaction called anaphylaxis or anaphylactic shock can occur. This is a medical emergency and needs urgent treatment. Read more about the symptoms of allergies. Getting help for allergies See your GP if you think you or your child might have had an allergic reaction to something. The symptoms of an allergic reaction can also be caused by other conditions. Your GP can help determine whether it's likely you have an allergy. If your GP thinks you might have a mild allergy, they can offer advice and treatment to help manage the condition. If your allergy is particularly severe or it's not clear what you're allergic to, your GP may refer you to an allergy specialist for testing and advice about treatment. Read more about allergy testing. How to manage an allergy In many cases, the most effective way of managing an allergy is to avoid the allergen that causes the reaction whenever possible. For example, if you have a food allergy, you should check a food's ingredients list for allergens before eating it. The Food Standards Agency has more information about food allergen labelling. There are also several medications available to help control symptoms of allergic reactions, including: antihistamines – these can be taken when you notice the symptoms of a reaction, or before being exposed to an allergen to stop a reaction occurring decongestants – tablets, capsules, nasal sprays or liquids that can be used as a short-term treatment for a blocked nose lotions and creams, such as moisturising creams (emollients) – these can reduce skin redness and itchiness steroid medication – sprays, drops, creams, inhalers and tablets that can help reduce redness and swelling caused by an allergic reaction For some people with very severe allergies, a treatment called immunotherapy may be recommended. This involves being exposed to the allergen in a controlled way over a number of years, so your body gets used to it and doesn't react to it so severely. Read more about treating an allergy and avoiding allergic reactions. What causes allergies? Allergies occur when the body's immune system reacts to a particular substance as though it's harmful. It's not clear why this happens, but most people affected have a family history of allergies or have closely related conditions such as asthma or eczema. The number of people with allergies is increasing every year. The reasons for this are not understood, but one of the main theories is it's the result of living in a cleaner, germ-free environment, which reduces the number of germs our immune system has to deal with. It's thought this may cause it to overreact when it comes into contact with harmless substances. Symptoms Symptoms of an allergic reaction usually develop within a few minutes of being exposed to something you're allergic to, although occasionally they can develop gradually over a few hours. Although allergic reactions can be a nuisance and hamper your normal activities, most are mild. Very occasionally, a severe reaction called anaphylaxis can occur. Main allergy symptoms Common symptoms of an allergic reaction include: sneezing and an itchy, runny or blocked nose (allergic rhinitis) itchy, red, watering eyes (conjunctivitis) wheezing, chest tightness, shortness of breath and a cough a raised, itchy, red rash (hives) swollen lips, tongue, eyes or face tummy pain, feeling sick, vomiting or diarrhoea dry, red and cracked skin The symptoms vary depending on what you're allergic to and how you come into contact with it. For example, you may have a runny nose if exposed to pollen, develop a rash if you have a skin allergy, or feel sick if you eat something you're allergic to. See your GP if you or your child might have had an allergic reaction to something. They can help determine whether the symptoms are caused by an allergy or another condition. Read more about diagnosing allergies. Severe allergic reaction (anaphylaxis) In rare cases, an allergy can lead to a severe allergic reaction, called anaphylaxis or anaphylactic shock, which can be life-threatening. This affects the whole body and usually develops within minutes of exposure to something you're allergic to. Signs of anaphylaxis include any of the symptoms above, as well as: swelling of the throat and mouth difficulty breathing lightheadedness confusion blue skin or lips collapsing and losing consciousness Anaphylaxis is a medical emergency that requires immediate treatment. Read more about anaphylaxis for information about what to do if it occurs. Testing If you think you have an allergy, tell your GP about the symptoms you're having, when they happen, how often they occur and if anything seems to trigger them. Your GP can offer advice and treatment for mild allergies with a clear cause. If your allergy is more severe or it's not obvious what you're allergic to, you may be referred for allergy testing at a specialist allergy clinic. The tests that may be carried out are described below. Skin prick testing Skin prick testing is one of the most common allergy tests. It involves putting a drop of liquid onto your forearm that contains a substance you may be allergic to. The skin under the drop is then gently pricked with a needle. If you are allergic to the substance, an itchy, red bump will appear within 15 minutes. Skin prick testing is painless and very safe. Make sure you don't take antihistamines before the test, as they can interfere with the results. Blood tests Blood tests may be used instead of, or alongside, skin prick tests to help diagnose common allergies. A sample of your blood is removed and analysed for specific antibodies produced by your immune system in response to an allergen. Patch tests Patch tests are used to investigate a type of eczema known as contact dermatitis, which can be caused by your skin being exposed to an allergen. A small amount of the suspected allergen is added to special metal discs, which are then taped to your skin for 48 hours and monitored for a reaction. Elimination diet If you have a suspected food allergy, you may be advised to avoid eating a particular food to see if your symptoms improve. After a few weeks, you may then be asked to eat the food again to check if you have another reaction. Don't attempt to do this yourself without discussing it with a qualified healthcare professional. Challenge testing In a few cases, a test called a food challenge may also be used to diagnose a food allergy. During the test, you're given the food you think you're allergic to in gradually increasing amounts, to see how you react under close supervision. This test is riskier than other forms of testing, as it could cause a severe reaction, but is the most accurate way to diagnose food allergies. And challenge testing is always carried out in a clinic where a severe reaction can be treated if it does develop. Treatment The treatment for an allergy depends on what you're allergic to. In many cases, your GP will be able to offer advice and treatment. They'll advise you about taking steps to avoid exposure to the substance you're allergic to, and can recommend medication to control your symptoms. Avoiding exposure to allergens The best way to keep your symptoms under control is often to avoid the things you're allergic to, although this isn't always practical. For example, you may be able to help manage: food allergies by being careful about what you eat animal allergies by keeping pets outside as much as possible and washing them regularly mould allergies by keeping your home dry and well-ventilated, and dealing with any damp and condensation hay fever by staying indoors and avoiding grassy areas when the pollen count is high dust mite allergies by using allergy-proof duvets and pillows, and fitting wooden floors rather than carpets Read more about preventing allergic reactions. Allergy medications Medications for mild allergies are available from pharmacies without a prescription, but always ask your pharmacist or GP for advice before starting any new medicine, as they're not suitable for everyone. Antihistamines Antihistamines are the main medicines for allergies. They can be used: as and when you notice the symptoms of an allergic reaction to prevent allergic reactions – for example, you may take them in the morning if you have hay fever and you know the pollen count is high that day Antihistamines can be taken as tablets, capsules, creams, liquids, eye drops or nasal sprays, depending on which part of your body is affected by your allergy. Decongestants Decongestants can be used as a short-term treatment for a blocked nose caused by an allergic reaction. They can be taken as tablets, capsules, nasal sprays or liquids. Don't use them for more than a week at a time, as using them for long periods can make your symptoms worse. Lotions and creams Red and itchy skin caused by an allergic reaction can sometimes be treated with over-the-counter creams and lotions, such as: emollients (moisturising creams) to keep the skin moist and protect it from allergens calamine lotion to reduce itchiness steroids to reduce inflammation (see below) Steroids Steroid medications can help reduce inflammation caused by an allergic reaction. They're available as: nasal sprays and eye drops for an inflamed nose and eyes creams for eczema and contact dermatitis inhalers for asthma tablets for hives (urticaria) Sprays, drops and weak steroid creams are available without a prescription. Stronger creams, inhalers and tablets are available on prescription from your GP. Immunotherapy (desensitisation) Immunotherapy may be an option for a small number of people with certain severe and persistent allergies who are unable to control their symptoms using the measures above. The treatment involves being given occasional small doses of the allergen – either as an injection, or as drops or tablets under the tongue – over the course of several years. The injection can only be performed in a specialist clinic under the supervision of a doctor, as there is a small risk of a severe reaction. The drops or tablets can usually be taken at home. The aim of treatment is to help your body get used to the allergen so it doesn't react to it so severely. This won't necessarily cure your allergy, but it will make it milder and mean you can take less medication. Treating severe allergic reactions (anaphylaxis) Some people with severe allergies may experience life-threatening reactions, known as anaphylaxis or anaphylactic shock. If you're at risk of this, you'll be given special injectors containing a medicine called adrenaline to use in an emergency. If you develop symptoms of anaphylaxis, such as difficulty breathing, you should inject yourself in the outer thigh before seeking emergency medical help. Read more about the treating anaphylaxis. Preventing a reaction The best way to prevent an allergic reaction is to avoid the substance that you're allergic to, although this isn't always easy or practical. Below is some practical advice that should help you avoid the most common allergens. House dust mites One of the biggest causes of allergies are dust mites, which are tiny insects found in household dust. You can limit the number of mites in your home by: choosing wood or hard vinyl floor coverings instead of a carpet fitting roller blinds that can be easily wiped clean choosing leather, plastic or vinyl furniture instead of upholstered furniture cleaning cushions, soft toys, curtains and upholstered furniture regularly, either by washing (at a high temperature) or vacuuming using tested allergy-proof covers on mattresses, duvets and pillows using a vacuum cleaner fitted with a HEPA (high efficiency particulate air) filter, because it can trap more dust mites than ordinary vacuum cleaners regularly wiping surfaces with a damp, clean cloth – avoid dry dusting, as this can spread dust into the air Concentrate your efforts of controlling dust mites in the areas of your home where you spend the most time, such as the bedroom and living room. You can find more information on allergies in the home on the Allergy UK website. Pets It's not the pet fur that causes an allergic reaction. Instead, it's flakes of their dead skin, saliva and dried urine. If you can't permanently remove a pet from the house, you could try: keeping pets outside as much as possible, or limiting them to a particular area of the house, preferably an area without carpet not allowing pets in bedrooms washing pets at least once a week regularly grooming pets outside regularly washing all bedding and soft furnishings on which a pet has lain using an air filter in rooms where you spend most of your time increase ventilation with fans, air-conditioning or by opening windows If you're visiting a friend or relative with a pet, ask them not to dust or vacuum on the day you're visiting, as this will stir up the allergens into the air. Taking an antihistamine medicine about an hour before entering a pet-inhabited house can also help reduce your symptoms. The Allergy UK website has more information about domestic pet allergies. Mould spores Tiny particles released by moulds can cause an allergic reaction in some people. You can help prevent this by: keeping your home dry and well-ventilated removing any indoor pot plants from your home not drying clothes indoors, store clothes in damp cupboards or packing clothes too tightly in wardrobes dealing with any damp and condensation in your home avoiding damp buildings, damp woods and rotten leaves, cut grass and compost heaps Food allergies By law, food manufacturers must clearly label any foods that contain something that's known to cause allergic reactions in some people. By carefully checking the label for the list of ingredients, you should be able to avoid an allergic reaction. People with food allergies most often experience an allergic reaction while eating out at a restaurant. You can avoid this by: not relying on the menu description alone (remember, many sauces or dressings could contain allergens) communicating clearly with the waiting staff and asking for their advice avoiding places where there's a chance that different types of food could come into contact with each other, such as buffets or bakeries let restaurant staff you know your dietary requirements, including how severe your food allergy or intolerance is always check what allergens are in the dish even if you have eaten it before, as recipes and ingredients can change Remember, simple dishes are less likely to contain "hidden" ingredients. If you're not sure about a dish, don’t risk it Read more about living with a food allergy and advice from the Food Standards Agency on food allergen labelling. Hay fever Pollen allergies – more commonly known as hay fever – are caused when trees and grasses release pollen into the air. Doctors often call hay fever allergic rhinitis. Different plants pollinate at different times of the year, so the months that you get hay fever will depend on what sort of pollen(s) you are allergic to. Typically, people are affected during spring (trees) and summer (grasses). To help keep your hay fever under control, you can: check weather reports for the pollen count and stay indoors when it's high, if possible avoid drying clothes and bedding outside when the pollen count is high wear wraparound sunglasses to protect your eyes keep doors and windows shut when possible shower and change your clothes after being outside avoid grassy areas, such as parks and fields – particularly in the early morning, evening or night, when the pollen count is highest if you have a lawn, try asking someone else to cut the grass for you Read more about preventing hay fever. Insect bites and stings If you've ever suffered a bad reaction to an insect bite or sting, it's important to take precautions to minimise your risk. When you're outdoors, particularly in the summer, you could: cover exposed skin wear shoes apply insect repellent avoid wearing strong perfumes or fragrances, as these can attract insects Read more about preventing insect bites and stings. Preventing severe allergies (anaphylaxis) If you're at risk of experiencing a severe allergic reaction (anaphylaxis), make sure you carry two adrenaline auto-injectors with you everywhere. Wearing a MedicAlert or Medi-Tag medallion or bracelet can make others aware of your allergy in an emergency. Consider telling your teachers, work colleagues and friends, so they can give you your adrenaline injection in an emergency, while waiting for an ambulance. Read more about preventing anaphylaxis.
||Learn about Alzheimer's disease symptoms and treatments
Alzheimer's disease is the most common type of dementia, affecting an estimated 850,000 people in the UK. Dementia is a progressive neurological disease which affects multiple brain functions, including memory. The exact cause of Alzheimer's disease is unknown, although a number of things are thought to increase your risk of developing the condition. These include: increasing age a family history of the condition previous severe head injuries lifestyle factors and conditions associated with cardiovascular disease It's becoming increasingly understood that it's very common to have both changes of Alzheimer's and vascular dementia together (mixed dementia). Read more about the causes of Alzheimer's disease Signs and symptoms of Alzheimer's disease Alzheimer's disease is a progressive condition, which means the symptoms develop gradually and become more severe over the course of several years. It affects multiple brain functions. The first sign of Alzheimer's disease is usually minor memory problems. For example, this could be forgetting about recent conversations or events, and forgetting the names of places and objects. As the condition develops, memory problems become more severe and further symptoms can develop, such as: confusion, disorientation and getting lost in familiar places difficulty planning or making decisions problems with speech and language problems moving around without assistance or performing self-care tasks personality changes, such as becoming aggressive, demanding and suspicious of others hallucinations (seeing or hearing things that aren't there) and delusions (believing things that are untrue) low mood or anxiety Read more about the symptoms of Alzheimer's disease Who is affected? Alzheimer's disease is most common in people over the age of 65, and affects slightly more women than men. The risk of Alzheimer's disease and other types of dementia increases with age, affecting an estimated 1 in 14 people over the age of 65 and 1 in every 6 people over the age of 80. However, around 1 in every 20 cases of Alzheimer's disease affects people aged 40 to 65. Receiving a diagnosis As the symptoms of Alzheimer's disease progress slowly, it can be difficult to recognise that there's a problem. Many people feel that memory problems are simply a part of getting older. However, a timely diagnosis of Alzheimer's disease can give you the best chance to prepare and plan for the future, as well as receive any treatment or support that may help. If you're worried about your memory or think you may have dementia, it's a good idea to see your GP. If you're worried about someone else, you should encourage them to make an appointment and perhaps suggest that you go along with them. There's no single test that can be used to diagnose Alzheimer's disease. Your GP will ask questions about any problems you are experiencing and may do some tests to rule out other conditions. If Alzheimer's disease is suspected, you may be referred to a specialist memory service to: discuss the process of making the diagnosis organise testing create a treatment plan Read more about diagnosing Alzheimer's disease How Alzheimer's disease is treated There's no cure for Alzheimer's disease, but medication is available that can help relieve some of the symptoms and slow down the progression of the condition in some people. Various other types of support are also available to help people with Alzheimer's live as independently as possible, such as making changes to your home environment so it's easier to move around and remember daily tasks. Psychological treatments such as cognitive stimulation therapy may also be offered to help support your memory, problem solving skills and language ability. Read more about treating Alzheimer's disease Outlook On average, people with Alzheimer's disease live for around 8 to 10 years after they start to develop symptoms. However, this can vary considerably from person to person. Some people with the condition will live longer than this, but others will not. Alzheimer's disease is a life-limiting illness, although many people diagnosed with the condition will die from another cause. As Alzheimer’s disease is a progressive neurological condition, it can cause problems with swallowing. This can lead to aspiration (food being inhaled into the lungs) which can cause frequent chest infections. It's also common for people with Alzheimer’s disease to eventually have difficulty eating and to have a reduced appetite. There's increasing awareness that people with Alzheimer’s disease need palliative care. This includes support for families, as well as the person with Alzheimer's. Can Alzheimer's disease be prevented? As the exact cause of Alzheimer's disease isn't clear, there's no known way to prevent the condition. However, there are things you can do that may reduce your risk or delay the onset of dementia, such as: stopping smoking and cutting down on alcohol eating a healthy, balanced diet and maintaining a healthy weight staying physically fit and mentally active These measures have other health benefits, such as lowering your risk of cardiovascular disease and improving your overall mental health. Read more about preventing Alzheimer's disease Symptoms The symptoms of Alzheimer's disease progress slowly over several years. Sometimes these symptoms are confused with other conditions and may initially be put down to old age. The rate at which the symptoms progress is different for each individual and it's not possible to predict exactly how quickly it will get worse. In some cases, infections, medications, strokes or delirium can be responsible for symptoms getting worse. Anyone with Alzheimer's disease whose symptoms are rapidly getting worse should be seen by a doctor, so these can be managed. Stages of Alzheimer's disease Generally, the symptoms of Alzheimer's disease are divided into three main stages. Early symptoms In the early stages, the main symptom of Alzheimer's disease is memory lapses. For example, someone with early Alzheimer's disease may: forget about recent conversations or events, or misplace items forget the names of places and objects, or have trouble thinking of the right word repeat themselves regularly, such as asking the same question several times show poor judgement or find it harder to make decisions become less flexible and more hesitant to try new things There are often signs of mood changes, such as increasing anxiety or agitation, or periods of confusion. Middle-stage symptoms As Alzheimer's disease develops, memory problems will get worse. Someone with the condition may find it increasingly difficult to remember the names of people they know and may struggle to recognise their family and friends. Other symptoms may also develop, such as: increasing confusion and disorientation – for example, getting lost, or wandering and not knowing what time of day it is obsessive, repetitive or impulsive behaviour delusions (believing things that are untrue) or feeling paranoid and suspicious about carers or family members problems with speech or language (aphasia) disturbed sleep changes in mood, such as frequent mood swings, depression and feeling increasingly anxious, frustrated or agitated difficulty performing spatial tasks, such as judging distances hallucinations By this stage, someone with Alzheimer's disease usually needs support to help them with their everyday living. For example, they may need help eating, washing, getting dressed and using the toilet. Later symptoms In the later stages of Alzheimer's disease, the symptoms become increasingly severe and distressing for the person with the condition, as well as their carers, friends and family. Hallucinations and delusions may come and go over the course of the illness, but can get worse as the condition progresses. Sometimes people with Alzheimer's disease can be violent, demanding and suspicious of those around them. A number of other symptoms may also develop as Alzheimer's disease progresses, such as: difficulty eating and swallowing (dysphagia) difficulty changing position or moving around without assistance considerable weight loss – although some people eat too much and put on weight unintentional passing of urine (urinary incontinence) or stools (bowel incontinence) gradual loss of speech significant problems with short- and long-term memory In the severe stages of Alzheimer's disease, people may need full-time care and assistance with eating, moving and using the toilet. Read more about how Alzheimer's disease is treated Seeking medical advice If you're worried about your memory or think you may have dementia, it's a good idea to see your GP. If you're worried about someone else, you should encourage them to make an appointment and perhaps suggest that you go along with them. Memory problems are not just caused by dementia – they can also be caused by depression, stress, medications or other health problems. Your GP can carry out some simple checks to try to find out what the cause may be, and they can refer you to a specialist for more tests, if necessary. Read more about diagnosing Alzheimer's disease Causes Alzheimer's disease is caused by parts of the brain shrinking (atrophy), which affects the structure and function of particular brain areas. It's not known exactly what causes this process to begin. However, in the brains of people with Alzheimer's disease, scientists have found amyloid plaques (abnormal deposits of protein), neurofibrillary tangles (containing tau) and imbalances in a chemical called acetylcholine. It's also common to have a degree of vascular damage in the brain. These reduce the effectiveness of healthy neurons (nerve cells that carry messages to and from the brain), gradually destroying them. Over time, this damage spreads to several areas of the brain. The first areas affected are responsible for memories. Increased risk Although it's still unknown what triggers Alzheimer's disease, several factors are known to increase your risk of developing the condition. Age Age is the single most significant factor in the development of Alzheimer's disease. The likelihood of developing the condition doubles every five years after you reach 65 years of age. However, it's not just older people who are at risk of developing Alzheimer's disease. Around 1 in 20 people with the condition are under 65. This is called early onset Alzheimer's disease and it can affect people from around the age of 40. Family history The genes you inherit from your parents can contribute to your risk of developing Alzheimer's disease, although the actual increase in risk is small if you have a close family member with the condition. However, in a few families, Alzheimer's disease is caused by the inheritance of a single gene, and the risks of the condition being passed on are much higher. If several of your family members have developed dementia over the generations, it may be appropriate to seek genetic counselling for information and advice about your chances of developing Alzheimer's disease when you are older. The Alzheimer's Society website has more information about the genetics of dementia. Down's syndrome People with Down's syndrome are at a higher risk of developing Alzheimer's disease. This is because the genetic fault that causes Down's syndrome can also cause amyloid plaques to build up in the brain over time, which can lead to Alzheimer's disease in some people. Head injuries People who have had a severe head injury have been found to be at higher risk of developing Alzheimer's disease. Cardiovascular disease Research shows that several lifestyle factors and conditions associated with cardiovascular disease can increase the risk of Alzheimer's disease. These include: smoking obesity diabetes high blood pressure high cholesterol You can help reduce your risk by: stopping smoking eating a healthy, balanced diet leading an active life, both physically and mentally losing weight if you need to drinking less alcohol having regular health checks as you get older Read more about reducing your risk of Alzheimer's disease Diagnosis It's best to see your GP if you're worried about your memory or think you may have dementia. If you're worried about someone else, encourage them to make an appointment and perhaps suggest going with them. It's often very helpful having a friend or family member there. A timely diagnosis gives you the best chance to adjust, prepare and plan for the future, as well as accessing treatments and support that may help. Seeing your GP Memory problems aren't just caused by dementia – they can also be caused by: depression or anxiety stress medications alcohol or drugs other health problems – such as hormonal disturbances or nutritional deficiencies Your GP can carry out some simple checks to try to find out what the cause may be. They can then refer you to a specialist for assessment, if necessary. Your GP will ask about your concerns and what you or your family have noticed. They'll also check other aspects of your health, and carry out a physical examination. They may also organise some blood tests and ask about any medication you're taking to rule out other possible causes of your symptoms. You'll usually be asked some questions and carry out some memory, thinking, and pen and paper tasks to check how different areas of your brain are functioning. This can help your GP decide if you need to be referred to a specialist for more assessments. Referral to a specialist Your GP may refer you to a specialist memory assessment service to help with your diagnosis. Memory clinics are staffed by professionals from multiple disciplines who are experts in diagnosing, caring for and advising people with dementia and their families. Memory clinic staff can include the following, depending on your local area: a nurse – usually a trained mental health nurse who specialises in diagnosing and caring for people with dementia a psychologist – a healthcare professional who specialises in the assessment and treatment of mental health conditions a psychiatrist – a qualified medical doctor who has training in treating mental health conditions a neurologist – a specialist in treating conditions that affect the nervous system (the brain and spinal cord) a geriatrician – a physician with specialist training in the care of older people a social worker – a trained member of staff able to advise and assist with accessing social services within the local area an occupational therapist – a member of staff with specialist skills in assessing and supporting people with dementia and their families with adjusting to disabilities There's no simple and reliable test for diagnosing Alzheimer's disease, but the staff will listen to the concerns of both you and your family about your memory or thinking. They will assess your skills and arrange more tests to rule out other conditions. Assessing your mental abilities A specialist will usually assess your mental abilities using a special series of questions. One widely used test is the mini mental state examination (MMSE). This involves being asked to carry out activities such as memorising a short list of objects correctly and identifying the current day of the week, month and year. Different memory clinics may also use other, longer tests. The MMSE isn't used to diagnose Alzheimer's disease, but it's useful to initially assess areas of difficulty that a person with the condition may have. This helps specialists to make decisions about treatment and whether more tests are necessary. Tests To rule out other possible causes of your symptoms and look for possible signs of damage caused by Alzheimer's disease, your specialist may recommend having a brain scan. This could be a: computerised tomography (CT) scan – where several X-rays of your brain are taken at slightly different angles and a computer is used to put the images together magnetic resonance imaging (MRI) scan – where a strong magnetic field and radio waves are used to produce detailed images of the inside of your brain Some specialist centres offer scans which look at brain function and particular protein deposits. However, at the moment, these are mostly experimental and only used if the diagnosis is unclear. After diagnosis It may take several appointments and tests over months, or even years, before a diagnosis of Alzheimer's disease can be confirmed. For some people, a diagnosis of Alzheimer's disease is a huge shock, especially as it's not unusual for people with dementia to have less awareness of their difficulties. For others, the diagnosis can be very important in helping them and their families to make sense of symptoms they've been concerned about for a long time. If you've just been given a diagnosis of dementia, you may be feeling numb, scared and unable to take everything in. It may be helpful to have the diagnosis explained again to help make sense of the idea over time. It might help to talk things through with family and friends. It takes time to adapt to a diagnosis of dementia, for both you and your family. Some people find it helpful to seek information and plan for the future, but others may need a longer period to process the news. However, as dementia is a progressive illness, the weeks to months after a diagnosis is often a good time to think about legal, financial and healthcare matters for the future. Read more about what to do if you've just been diagnosed with dementia Treatment There's currently no cure for Alzheimer's disease, although medication is available that can temporarily reduce some symptoms or slow down the progression of the condition in some people. Support is also available to help someone with the condition cope with everyday life. Care plan If you're diagnosed with Alzheimer's disease, it's helpful if your health and social care needs are assessed and plans made for the future. A care plan is a way of ensuring you receive the right treatment for your needs. It involves identifying areas where you may need some assistance, such as: what support you or your carer need for you to remain as independent as possible whether there are any changes that need to be made to your home to make it easier to live in whether you need any financial assistance Healthcare professionals (such as your GP or psychiatrist) and social care services (which is normally your local council working with the NHS), will usually both be involved in helping draw up and carry out care plans. Medication A number of medications may be prescribed for Alzheimer's disease to help temporarily improve some symptoms and slow down the progression of the condition. Donepezil, galantamine and rivastigmine (known as AChE inhibitors) can be prescribed for people with early to mid-stage Alzheimer's disease. Memantine may be prescribed for people with mid-stage disease who cannot take AChE inhibitors, or for those with late-stage disease. There's no difference in how well each of the three different AChE inhibitors work, although some people respond better to certain types or have fewer side effects. All of these medications can only be prescribed by specialists such as psychiatrists, neurologists and geriatricians. They may be prescribed by your GP on the advice of a specialist. If you're caring for someone with Alzheimer's disease, your views should be taken into account when prescribing medication, as well as at regular assessments. These assessments take place to ensure the medication is having a worthwhile effect and to identify and monitor side effects. Read guidance from the National Institute for Health and Care Excellence (NICE) on donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease. Side effects Donepezil, galantamine and rivastigmine can cause side effects such as: feeling and being sick dizziness diarrhoea headache agitation insomnia muscle cramps more rarely, slowing of the heartbeat – which can cause issues if you already have problems with your heart rhythm. These side effects are more likely to occur at the beginning of therapy or when the dose is increased. Your doctor should review your medical history and your other medications to check the suitability and risk of interactions. Common side effects of memantine include: dizziness headaches high blood pressure tiredness constipation shortness of breath more rarely, problems with walking or increased confusion very rarely, seizures For more information about the possible side effects of your specific medication, refer to the patient information leaflet that comes with it or speak to your doctor. Supportive measures and treatments In addition to medication, treatment for Alzheimer's disease involves a wide range of other measures and treatments to help people with dementia live as independently as possible. For example, an occupational therapist can identify problems or unsafe areas in your everyday life and help you to develop strategies or use alternative tools to manage these. They may suggest: ways of prompting and reminding yourself of important tasks – such as using diaries or calendars assistive technology – devices or systems to help maintain the independence and safety of people living with dementia adding grab bars and handrails to your home to help you move around safely other professionals visiting you at home and assisting with daily tasks to maintain your independence in the community Psychological treatments, such as cognitive stimulation, may be offered to help improve your memory, problem solving skills and language ability. Medication, other psychological therapies, such as cognitive behavioural therapy (CBT), music and art therapy, reminiscence and relaxation therapies may also be offered. These may help with managing depression, anxiety, agitation, hallucinations, delusions and challenging behaviour that can occur with Alzheimer's disease. Read more about how dementia is treated Practical tips for people with Alzheimer's If you have Alzheimer's disease, you may find it useful to: keep a diary and write down things you want to remember pin a weekly timetable to the wall put your keys in an obvious place, such as in a large bowl in your living room have a daily newspaper delivered to remind you of the day and date put labels on cupboards and drawers keep useful telephone numbers by the phone write yourself reminders – for example, put a note on the front door to remind you to take your keys with you if you go out programme people's names and numbers into your telephone set the alarm on your watch to act as a reminder install safety devices such as gas detectors and smoke alarms throughout your home It may also be helpful to get in touch with a local or national Alzheimer's or dementia support group, such as the Alzheimer's Society, for more information and advice about living with Alzheimer's disease. Read more about living well with dementia Advance care planning People with dementia often live for many years after their diagnosis. However, as it's a progressive condition, it can be helpful and reassuring for both you and your family if you make plans for the future. Advance care planning means considering, discussing and possibly recording your wishes and decisions for future care. It's about planning for a time when you may not be able to make some decisions for yourself. In the earlier stages of the disease, you should have the opportunity to discuss with health professionals and your family about the future. This may involve the use of: advance statements advance decisions to refuse treatment lasting power of attorney preferred priorities for care Palliative care Although the outlook is variable, dementia is a life-limiting illness and can begin to affect multiple body systems in the later stages. End of life care, or palliative care, provides support for people with an incurable illness, so they're able to live as well and as comfortably as possible until their death. It also involves support for family members. Care may be provided at home, a hospice, a care home or hospital. For people nearing the end of life, their care team should assess their needs, make them feel comfortable and allow them to die with dignity in a place of their choosing. Read more about palliative care Telecare Self-Check online tool Visit the Telecare Self-Check online tool to find the right support for you in your area. This easy to use online tool allows you to find helpful information on telecare services that could help you live independently at home for longer. Prevention As the exact cause of Alzheimer's disease is still unknown, there's no way to prevent the condition. However, there are steps you can take that may help to delay the onset of dementia. Reducing your risk of cardiovascular disease Cardiovascular disease has been linked with an increased risk of Alzheimer's disease and vascular dementia. You may be able to reduce your risk of developing these conditions – as well as other serious problems, such as strokes and heart attacks – by taking steps to improve your cardiovascular health, including: stopping smoking not drinking large amounts of alcohol eating a healthy, balanced diet, including at least five portions of fruit and vegetables every day exercising for at least 150 minutes (2 hours and 30 minutes) every week by doing moderate-intensity aerobic activity (such as cycling or fast walking) – this will improve both your physical and mental health make sure your blood pressure is checked and controlled through regular health tests if you have diabetes, make sure you keep to the diet and take your medication Read more about preventing dementia Staying mentally active There's some evidence to suggest that rates of dementia are lower in people who remain as mentally, physically and socially active as possible throughout their lives, as well as among those who enjoy a wide range of different activities and hobbies. It may be possible to reduce your risk of Alzheimer's disease and other types of dementia by: reading writing for pleasure learning foreign languages playing musical instruments taking part in adult education courses playing tennis playing golf swimming group sports, such as bowling walking Interventions such as "brain training" computer games have been shown to improve cognition over a short period, but research hasn't yet demonstrated whether this can prevent dementia. Future research Research into Alzheimer's disease is continuing. As more is revealed about the condition, other ways to treat or prevent it may be found. Participation in research is important and helps to improve dementia care and support for people with dementia, plus their carers and families. You can read about ongoing dementia research on the Alzheimer's Research UK website. You can also ask your local memory clinic about projects taking place. The National Institute for Health and Care Excellence (NICE) has advised that there isn't evidence to support the use of the following to prevent dementia: statins hormone replacement therapy – when chemicals are taken to replace those that your body no longer produces vitamin E – found in a variety of foods, such as olive oil, nuts and seeds non-steroidal anti-inflammatory drugs (NSAIDs)
||Learn about anal cancer, a cancer that affects the end of the large bowel
Anal cancer is a rare type of cancer that affects the very end of the large bowel. Less than 1,200 people are diagnosed with cancer of the anus each year in the UK. Symptoms of anal cancer The symptoms of anal cancer are often similar to more common and less serious conditions affecting the anus, such as piles (haemorrhoids) and anal fissures (small tears or sores). Symptoms of anal cancer can include: bleeding from the bottom (rectal bleeding) itching and pain around the anus small lumps around the anus a discharge of mucus from the anus loss of bowel control (bowel incontinence) However, some people with anal cancer don't have any symptoms. See your GP if you develop any of the above symptoms. While they're unlikely to be caused by anal cancer, it's best to get them checked out. Diagnosing anal cancer Your GP will usually ask about your symptoms and carry out some examinations. They may feel your tummy and carry out a rectal examination. This involves your doctor inserting a gloved finger into your bottom so they can feel any abnormalities. Your GP will refer you to hospital if they think further tests are necessary. The National Institute for Health and Care Excellence (NICE) recommends in its 2015 guidelines that GPs should consider referring someone with an unexplained anal lump or anal ulcer. The person should receive an appointment within two weeks. If you're referred to hospital, a number of different tests may be carried out to check for anal cancer and rule out other conditions. Some of the tests you may have include a: sigmoidoscopy – where a thin, flexible tube with a small camera and light is inserted into your bottom to check for any abnormalities proctoscopy – where the inside of your rectum is examined using a hollow tube-like instrument (proctoscope) with a light on the end biopsy – where a small tissue sample is removed from your anus during a sigmoidoscopy or proctoscopy so it can be examined in a laboratory under a microscope If these tests suggest you have anal cancer, you may have some scans to check whether the cancer has spread. Once these are complete, your doctors will be able to "stage" the cancer. This means giving it a score to describe how large it is and how far it has spread. You can read more about the stages of anal cancer on the Cancer Research UK website. How anal cancer is treated If you're diagnosed with anal cancer, you'll be cared for by a multidisciplinary team. This is a team of different specialists who work together to provide the best treatment and care. The main treatments used for anal cancer are: chemoradiation – a combination of chemotherapy and radiotherapy surgery – to remove a tumour or a larger section of bowel In cases where the cancer has spread and can't be cured, chemotherapy alone may be considered to help relieve symptoms. This is known as palliative care. The main treatments are described in more detail below. Chemoradiation Chemoradiation is a treatment that combines chemotherapy (cancer-killing medication) and radiotherapy (where radiation is used to kill cancer cells). It's currently the most effective treatment for anal cancer. You don't usually need to stay in hospital when you're having chemoradiation. Chemotherapy for anal cancer is usually given in two cycles, each lasting four to five days, with a four-week gap between the cycles. In many cases, part of the chemotherapy is delivered through a small tube called a peripherally inserted central catheter (PICC) in your arm, which can stay in place until your treatment has finished. The tube means you don't need to stay in hospital during each of the cycles of chemotherapy. However, you'll be attached to a small plastic pump, which you take home with you. A few hospitals now offer tablet chemotherapy for anal cancer, which avoids the need for the pump and PICC. Read more about how chemotherapy is carried out Radiotherapy is usually given in short sessions, once a day from Monday to Friday, with a break at weekends. This is usually carried out for five to six weeks. To prepare for radiotherapy, additional scans will be required. Read more about how radiotherapy is carried out Both chemotherapy and radiotherapy often cause significant side effects, including: tiredness sore skin around the anus sore skin around the penis and scrotum in men or vulva in women hair loss – limited hair loss from the head, but total loss from the pubic area feeling sick diarrhoea These side effects are usually temporary, but there's also a risk of longer-term problems, such as infertility. If you're concerned about the potential side effects of treatment, you should discuss this with your care team before treatment begins. Other possible long-term side effects can include: bowel control problems long-term (chronic) diarrhoea erectile dysfunction vaginal pain when having sex dry and itchy skin around the groin and anus bleeding from the anus, rectum, vagina or bladder Tell your doctor if you develop any of these symptoms so they can be investigated and treated. Surgery Surgery is a less common treatment option for anal cancer. It's usually only considered if the tumour is small and can be easily removed, or if chemoradiation hasn't worked. If the tumour is very small and clearly defined, it may be cut out during a procedure called a local excision. This is a relatively simple procedure, carried out under general anaesthetic, that usually only requires a stay in hospital of a few days. If chemoradiation has been unsuccessful or the cancer has returned after treatment, a more complex operation called an abdominoperineal resection may be recommended. As with a local excision, this operation is carried out under general anaesthetic. An abdominoperineal resection involves removing your anus, rectum, part of the colon, some surrounding muscle tissue, and sometimes some of the surrounding lymph nodes (small glands that form part of the immune system) to reduce the risk of the cancer returning. You'll usually need to stay in hospital for up to 10 days after this type of surgery. During the operation, a permanent colostomy will also be formed to allow you to pass stools. This is where a section of the large intestine is diverted through an opening made in the abdomen called a stoma. The stoma is attached to a special pouch that will collect your stools after the operation. Before and after the operation, you'll see a specialist nurse who can offer support and advice to help you adapt to life with a colostomy. Adjusting to life with a colostomy can be challenging, but most people become accustomed to it over time. Read more about living with a colostomy Follow-up After your course of treatment ends, you'll need to have regular follow-up appointments to monitor your recovery and check for any signs of the cancer returning. To start with, these appointments will be every few weeks or months, but they'll gradually become less frequent over time. What causes anal cancer? The exact cause of anal cancer is unknown, although a number of factors can increase your risk of developing the condition. These include: infection with human papilloma virus (HPV) – a common and usually harmless group of viruses spread through sexual contact, which can affect the moist membranes lining your body having anal sex or lots of sexual partners – possibly because this increases your risk of developing HPV having a history of cervical, vaginal or vulval cancer smoking having a weakened immune system – for example, if you have HIV Your risk of developing anal cancer increases as you get older, with half of all cases diagnosed in people aged 65 or over. The condition is also slightly more common in women than men. Outlook The outlook for anal cancer depends on how advanced the condition is when it's diagnosed. The earlier it's diagnosed, the better the outlook. Compared with many other types of cancer, the outlook for anal cancer is generally better because treatment is often very effective. Around 66 out of 100 people (66%) with anal cancer will live at least five years after diagnosis, and many will live much longer than this. There are about 300 deaths from anal cancer each year in the UK. Further information about anal cancer Cancer Research UK: anal cancer Macmillan: anal cancer
||Learn about anaphylaxis symptoms and treatments
Anaphylaxis is a severe, potentially life-threatening allergic reaction that can develop rapidly. It is also known as anaphylactic shock. Signs of anaphylaxis include: itchy skin or a raised, red skin rash swollen eyes, lips, hands and feet feeling lightheaded or faint swelling of the mouth, throat or tongue, which can cause breathing and swallowing difficulties wheezing abdominal pain, nausea and vomiting collapse and unconsciousness What to do Anaphylaxis should always be treated as a medical emergency. If available, an injection of a medicine called adrenaline should be given as soon as possible. Some people with a previous history of anaphylaxis will have an auto-injector of adrenaline. This should be injected into their outer thigh muscle and held in place for 5 to 10 seconds. Instructions for how to use these auto-injectors can be found on the side of each device. You should call 999 for an ambulance whether adrenaline has been given or not. If after 5 to 10 minutes the person still feels unwell, a second injection should be given. This should be given in the opposite thigh. A second dose may also be needed if the person improves and then becomes unwell again. The person should lie flat, with their legs raised on a chair or a low table. If they are having difficulty breathing, they should sit up to make breathing easier. If the person is unconscious, you should move them to the recovery position – on their side, supported by one leg and one arm, with the head tilted back and the chin lifted. If the person's breathing or heart stops, cardiopulmonary resuscitation (CPR) should be performed. Further treatment will be carried out in hospital. Read more about treating anaphylaxis. Causes and triggers Anaphylaxis is the result of your body's immune system overreacting to a harmless substance, such as food. Substances that trigger allergic reactions are known as allergens. Anaphylaxis usually develops within minutes of contact with an allergen, but sometimes the reaction can happen up to 4 hours later. The most widely reported triggers of anaphylaxis are: insect stings – particularly wasp and bee stings peanuts and tree nuts other types of foods – such as milk and seafood certain medicines – such as antibiotics Read more about the causes of anaphylaxis. Preventing further episodes If you know what has triggered anaphylaxis, it's important to take steps to avoid exposure to similar triggers. You should be referred to a specialist allergy clinic to either find out your allergy triggers or, if you already know what causes it, for further assessment and advice about how to avoid allergens in the future. You may be given two adrenaline auto-injectors to use during any future episodes of anaphylaxis. Read more about preventing anaphylaxis. Who is affected? Anaphylaxis is not common, but people of all ages can be affected. People with other allergic conditions, such as asthma or the allergic skin condition atopic eczema, are most at risk of developing anaphylaxis. Although the condition is life threatening, deaths are rare. There are around 20 deaths in the UK each year. With prompt and proper treatment, most people make a full recovery. Causes Anaphylaxis is caused by a problem with the immune system, which is the body's natural defence against illness and infection. In the case of anaphylaxis, your immune system overreacts to a harmless substance and releases a number of different chemicals, such as histamine, to deal with the mistaken threat. Triggers Some of the more common triggers for anaphylaxis are shown below. Insect stings Most cases of anaphylaxis are caused by wasp and bee stings, although potentially any insect bite or sting can cause anaphylaxis. It's estimated around 1 in 100 people will experience an allergic reaction after a wasp or bee sting, but only a small number of these people will go on to develop severe anaphylaxis. Foods More than half of all cases of food-related anaphylaxis are caused by peanuts. Other foods known to trigger anaphylaxis include: nuts – such as walnuts, cashew nuts, almonds, brazil nuts and hazelnuts milk fish and shellfish eggs some types of fruit – such as bananas, kiwi fruit, grapes and strawberries Medicines Medicines known to trigger anaphylaxis in a small amount of people include: antibiotics – particularly penicillin-like antibiotics general anaesthetic – muscle-relaxant medicines used during surgery non-steroidal anti-inflammatory drugs (NSAIDs) – a type of painkiller that includes ibuprofen and aspirin People sensitive to these types of medicines will usually develop anaphylaxis as soon as they begin a course of treatment, although they may have safely received them in the past. The risk of anaphylaxis using these types of medicines is very small, so in most cases the benefits of treatment outweigh the potential risk. For example, the risk of developing anaphylaxis is around: 1 in 1,480 after taking a NSAID-type painkiller 1 in 5,000 after taking penicillin 1 in 10,000 after being given a general anaesthetic Contrast agents Contrast agents are a group of special dyes used in some medical tests to help certain areas of your body show up better on scans such as X-rays. For example, a contrast agent injected into a blood vessel will help show up any problems in the vessel, such as a blockage, on the X-ray. This is known as angiography. The risk of developing anaphylaxis after being injected with a contrast agent is thought to be less than 1 in 10,000. Rubber latex Less than 1 in 100 people in the population has a natural rubber latex allergy. Healthcare, hair, beauty, catering and motor industry workers are more likely to have a latex allergy. Those with a history of hayfever, asthma, eczema, and certain medical conditions, like spina bifida, are more likely to be affected. Idiopathic anaphylaxis Sometimes, despite extensive testing, no trigger can be found for anaphylaxis, and the cause remains unknown. This is known as idiopathic anaphylaxis. Treatment If you think somebody is experiencing symptoms of anaphylaxis, you should use an adrenaline injector if one is available. Dial 999 immediately afterwards. Call 999 straight away if an adrenaline injector is not available. If you can see a potential trigger, such as a wasp or bee sting stuck in their skin, carefully remove it. Adrenaline injections Adrenaline causes the blood vessels to become narrower, which raises your blood pressure and reduces swelling. It also causes the airways to open, relieving breathing difficulties. An adrenaline injection should be given as soon as a serious reaction is suspected. The signs of suspected anaphylaxis are: problems breathing feeling faint or dizzy loss of consciousness The injection can be done by the person with anaphylaxis, but sometimes – if it's a young child or someone who is unconscious, for example – another person may need to do it. Before attempting the injection, make sure you know what to do. You should read all of the instructions carefully when you, or the person you are responsible for, are first prescribed the injector. After injecting, the syringe should be held in place for 5 to 10 seconds. Injections can be given through clothing. After injecting the adrenaline, you should immediately dial 999 for an ambulance, even if the person is starting to feel better. Most people should experience a rapid improvement in symptoms once the adrenaline has been used. If there's no improvement after 5 to 10 minutes, you should inject a second dose of adrenaline, if one is available. This should be injected into the opposite thigh. Read Medicines and Healthcare products Regulatory Agency (MHRA) 2014 guidelines on how to use an adrenaline auto-injector (PDF, 188kb). Positioning and resuscitation In most cases, the person should lie flat, with their legs raised on a chair or a low table, to help maintain bloodflow to the head and heart. Pregnant women should lie down on their left side to avoid putting too much pressure on the large vein that leads to the heart. If the person is conscious but having trouble breathing, they should sit up to make breathing easier. If the person is unconscious, check that their airways are open and clear, and also check their breathing. Then put them in the recovery position to make sure they don't choke on their vomit. Place the person on their side, making sure they are supported by one leg and one arm. Open the airway by tilting the head and lifting the chin. If the person's breathing or heart stops, cardiopulmonary resuscitation (CPR) should be performed. Admission to hospital Even if adrenaline is given, the person will need to go to hospital for observation – usually for 6 to 12 hours – as symptoms can occasionally return during this period. While in hospital, an oxygen mask can be used to help breathing, and fluids given by an intravenous drip directly into a vein can help increase blood pressure. As well as adrenaline, additional medications such as antihistamines and corticosteroids can be used to help relieve symptoms. Blood tests may also be carried out while you're in hospital to confirm anaphylaxis. You should be able to leave hospital when the symptoms are under control and it's thought they will not return quickly. This may be after a few hours, but you may have to stay in hospital for a few days if the symptoms were severe. You may be asked to take antihistamines and corticosteroid tablets 2 to 3 days after leaving hospital to help stop your symptoms returning. You will probably be asked to attend a follow-up appointment so you can be given advice about how you can avoid further episodes of anaphylaxis. An adrenaline auto-injector may be given to you for emergency use between leaving hospital and attending the follow-up appointment. Read more about preventing anaphylaxis. Prevention If you have anaphylaxis, you should be offered advice and medication to help prevent further episodes. Allergy clinic You should be referred to a specialist allergy clinic for tests to find out what caused the anaphylaxis. Knowing what allergen triggered the allergic reaction can help you avoid further episodes of anaphylaxis. Some of the tests commonly used to determine allergies include: a skin prick test – your skin is pricked with a tiny amount of a suspected allergen to see if it reacts by becoming red, raised and itchy a blood test – a sample of your blood is taken to test its reaction to a suspected allergen Read more about diagnosing allergies. Adrenaline auto-injectors You may be prescribed an adrenaline auto-injector if you've had a previous episode of anaphylaxis and there's a risk of you having another episode in the future. There are 3 types of auto-injector: EpiPen Jext Emerade Each type is slightly different, and you should make sure you know how to use your auto-injector correctly. You can also ask for a "trainer" kit so you can practise giving yourself or your child injections. The following points are important: Carry your auto-injector(s) at all times – there should be no exceptions. It may also be recommended that you get an emergency card or bracelet with full details of your allergy and doctor's contact details to alert others. Extremes of heat can make adrenaline less effective, so don't leave your auto-injector in the fridge or your car's glove compartment. Check the expiry date regularly. An out-of-date injector will offer limited protection. The manufacturers offer a reminder service, where you can be contacted near the expiry date. Check the information leaflet that comes with your medicine for more information. If your child has an auto-injector, they will need to change over to an adult dose once they reach 30kg (approximately 4.5 stone). Don't delay injecting yourself if you think you may be experiencing the beginning of anaphylaxis, even if your initial symptoms are mild. It's better to use adrenaline early and then find out it was a false alarm than delay treatment until you're sure you are experiencing severe anaphylaxis. Avoid triggers If a trigger has been identified as causing your episode of anaphylaxis, you will need to take steps to avoid it in the future. Food You can reduce the chances of being exposed to a food allergen by: checking food labels letting staff at a restaurant know what you're allergic to, so it's not included in your meal remembering that some types of food may contain small traces of potential allergens – for example, some sauces contain wheat and peanuts See our page on living with a food allergy for more information. Insect stings You can reduce your risk of being stung by an insect by taking basic precautions, such as: moving away from wasps, hornets or bees slowly without panicking – don't wave your arms around or swat at them using an insect repellent if you spend time outdoors, particularly in the summer Some specialist allergy centres also offer special treatment to help desensitise you to insect stings if you are at a particularly high risk of a further sting – for example, if you are a beekeeper or gardener. Read more about preventing insect stings. Medicines If you're allergic to certain types of medicines, there are normally alternatives that can be safely used. For example, if you're allergic to: penicillin – you can normally safely take a different group of antibiotics known as macrolides non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin – you can normally safely take paracetamol, but read the ingredients of things like colds medicines carefully to make sure they don't contain NSAIDs one type of general anaesthetic – others are available, or it may be possible to perform surgery using a local anaesthetic or an epidural injection angiotensin-converting enzyme (ACE) inhibitors – alternative blood pressure medications, such as calcium channel blockers, can be used Always tell any healthcare professional about medicine allergies you have, as they may not be aware of them. Contrast agents There may be times when it's necessary to use contrast agents – for example, if you had bleeding inside your brain – even if this places you at risk of anaphylaxis. In such circumstances, you can be given injections of antihistamines and corticosteroids before the contrast agents, which may help prevent symptoms occurring or at least make them less severe.
||Learn about angioedema symptoms and treatments
Angioedema is the swelling of the deeper layers of the skin, caused by a build-up of fluid. The symptoms of angioedema can affect any part of the body, but swelling usually affects the: eyes lips genitals hands feet Many people with angioedema also experience urticaria (hives). This is a raised, red and itchy rash that appears on the skin. Read more about the symptoms of angioedema. Why does angioedema happen? The cause of angioedema depends on the type you have. There are 4 main types of angioedema: allergic angioedema – the swelling is caused by an allergic reaction, such as a reaction to peanuts, and sometimes occurs in combination with anaphylaxis idiopathic angioedema – there is no known cause for the swelling (although certain factors, such as stress or infection, may trigger the symptoms) drug-induced angioedema – the swelling is a side effect of certain medications, most often angiotensin-converting enzyme (ACE) inhibitors hereditary angioedema – the swelling is caused by "faulty" genes that are inherited from a person’s parents Read more about the causes of angioedema. Who is affected Angioedema is a common condition, affecting about 10-20% of people during their life, although some types are more common than others. Hereditary angioedema is rare, only affecting between 1 in 10,000 and 1 in 50,000 people worldwide. Diagnosis Your doctor can diagnose angioedema by examining the affected skin and discussing symptoms. However, further tests, such as blood tests or allergy tests, may be required to determine the type of angioedema. Idiopathic angioedema is only diagnosed if no cause can be found. Read more about diagnosing angioedema. How is angioedema treated? Although most cases of angioedema get better without treatment after a few days, medication is often used. For cases of allergic and idiopathic angioedema, antihistamines and oral steroids (steroid tablets) can be used to relieve the swelling. Drug-induced angioedema can usually be treated by using an alternative medication to treat whatever underlying condition you have. Although the condition cannot be cured, regular drug treatment can prevent attacks in people with hereditary angioedema. Read more about treating angioedema. Symptoms The main sign of angioedema is swelling that develops below the skin's surface. Swollen skin The swelling is caused by a collection of fluid in the deep layers of the skin. It most often affects the hands, feet, eyes, lips, or genitals. In severe cases, the inside lining of the throat and bowel can be affected (see below). The swelling usually appears suddenly, and is more severe than normal hives (nettle rash). It commonly lasts 1 to 3 days. There may be a prickling sensation in the affected area before swelling is visible. The swelling is not itchy and the skin may look a normal colour; however, many people with allergic or idiopathic angioedema also develop urticaria (hives), which is red and itchy. Other symptoms As well as visible swellings, angioedema can cause other symptoms, including: a hot or painful sensation in the swollen areas swelling of the inside of the throat, the windpipe and the tongue, making breathing difficult swelling of the conjunctiva (the transparent layer of cells that cover the white part of the eye), which affects vision People with hereditary angioedema may also experience: abdominal (stomach) pain caused by swelling in the stomach and bowel, which can cause nausea, vomiting and diarrhoea swelling of the bladder or urethra (the tube that connects the bladder to the genitals), which can cause bladder problems and difficulty passing urine When to seek medical advice Contact your GP if you have an episode of angioedema that does not affect your breathing and you have not previously been diagnosed with the condition. You will need to have tests to determine what type of angioedema you have. When to seek emergency medical advice Dial 999 to request an ambulance if you suspect that you, or someone you know, is experiencing anaphylaxis (a severe allergic reaction). Tell the operator that you suspect anaphylaxis. Initial symptoms of anaphylaxis include: a feeling of tightness in the chest that leads to breathing problems swelling of the tongue and throat If you, or the person in your care, has previously been prescribed an adrenaline auto-injector pen, you should use it while waiting for the ambulance to arrive. Causes Angioedema is often caused by a problem with the immune system, although there are many cases where no cause can be identified. Allergic angioedema Normally, your immune system protects your body from illness and infection by attacking germs in your body. In allergic angioedema, your immune system mistakenly attacks harmless substances in your blood. Your body produces the chemical histamine, which causes the blood vessels in the area to expand, leading to swelling of the skin. Substances known to trigger allergic angioedema include: certain types of food – particularly nuts, shellfish, milk and eggs some types of medication – such as penicillin, aspirin and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen insect bites and stings – particularly wasp and bee stings latex – a naturally occurring rubber used to make medical gloves, balloons and condoms Idiopathic angioedema Cases of angioedema without an identifiable cause are known as idiopathic angioedema. It may be that a problem with the immune system sometimes causes it to "misfire". In cases of idiopathic angioedema, certain triggers may lead to swelling, such as: anxiety or stress minor infections hot or cold temperatures exercise Avoiding these triggers whenever possible may improve your symptoms. Drug-induced angioedema Some medications can cause angioedema. Angiotensin-converting enzyme (ACE) inhibitors, which are used to treat high blood pressure (hypertension), are usually responsible. It's estimated that around 1-5% of people taking ACE inhibitors will develop drug-induced angioedema. Black people being treated with ACE inhibitors are 3 to 4 times more likely to develop this side effect than white people. Around 1 in 4 cases of drug-induced angioedema occurs during the first month of taking an ACE inhibitor. The remaining cases develop many months or even years after treatment begins. While they are useful in lowering blood pressure, ACE inhibitors can sometimes disrupt the "chemical balance" and trigger an episode of severe swelling. Less common causes of drug-induced angioedema include: bupropion – a medication that helps people to give up smoking vaccines selective serotonin reuptake inhibitors (SSRIs) – a type of antidepressant COX-II inhibitors – a type of painkiller used to treat chronic pain conditions such as arthritis NSAIDs – a type of painkiller, such as aspirin or ibuprofen angiotensin-2 receptor antagonists – another medication used to treat high blood pressure statins – used to treat people with high cholesterol levels proton pump inhibitors (PPIs) – used to treat stomach ulcers Hereditary angioedema Hereditary angioedema is caused by a genetic mutation (a change in the DNA) in the C1 esterase inhibitor (C1-inh) gene. Genes are single units of genetic material that code for characteristics such as eye and hair colour. As a result of the mutated C1-inh gene, the body does not make enough C1-inh protein. This protein plays an important role in regulating the immune system. Without enough C1-inh protein, the immune system can misfire and trigger the symptoms of angioedema. Certain things are thought to trigger hereditary angioedema, such as: trauma – including surgery or infection the oral contraceptive pill pregnancy The mutated C1-inh gene is passed down through families. If you have hereditary angioedema, you have a 50% chance of passing it on to your children. Diagnosis Angioedema is usually diagnosed by your doctor examining the affected skin and discussing your symptoms. It can be difficult to find the exact cause and identify which type of angioedema you have. There is no single test available, but you may have allergy tests or blood tests if a specific cause is suspected. Allergic angioedema You're likely to be asked if you have recently been exposed to any allergy-causing substances, such as nuts or latex. You may also be asked whether you have a history of other allergic conditions, such as urticaria (hives) or asthma. People with an allergic condition often develop other allergic conditions. Tell your doctor about any medications you are taking, including over-the-counter medication, such as painkillers, herbal supplements and vitamins. Your GP may recommend that you keep a diary of your exposure to possible irritants – or a food diary, if a food allergy is suspected. If allergic angioedema is suspected, you are likely to be referred to a specialist allergy or immunology clinic for further testing. Tests may include: a skin prick test – your skin is pricked with a tiny amount of the suspected allergen to see whether there is a reaction a blood test – a sample of your blood is tested to determine whether your immune system reacts to a suspected allergen Read more about diagnosing allergies. Drug-induced angioedema If you are taking a medication known to cause drug-induced angioedema, your GP will withdraw that medication and prescribe an alternative. You should not stop taking any prescribed medication without advice from a health professional. If you don't have any further episodes of angioedema, a diagnosis of drug-induced angioedema can be made. Hereditary angioedema Hereditary angioedema can be diagnosed using a blood test to check the level of proteins regulated by the C1-inh gene. A very low level would suggest hereditary angioedema. The diagnosis and management of hereditary angioedema is highly specialised and should be carried out in a specialist immunology clinic. Idiopathic angioedema Idiopathic angioedema is usually confirmed by a "diagnosis of exclusion". This means a diagnosis of idiopathic angioedema can only be made after all the above tests have been carried out and a cause has not been found. As angioedema can be associated with other medical problems – such as an iron deficiency, liver diseases and problems with the thyroid gland – your doctor or specialist will undertake some simple blood tests to check for these conditions. Treatment Medication is the main treatment for angioedema, although many cases get better after a few days without treatment. Allergic angioedema and idiopathic angioedema are usually treated in the same way, using a combination of antihistamines and corticosteroids to help relieve the swelling. Drug-induced angioedema can usually be treated by using an alternative medication to the one causing your symptoms. If you also had symptoms of anaphylaxis during an episode of angioedema, you will probably be given an adrenaline auto-injector pen in case your symptoms return. Read more about treating anaphylaxis. Hereditary angioedema cannot be cured and does not respond to adrenaline, antihistamines or steroids, so a preventative approach is taken. A number of different medications are used to stabilise the protein levels in your blood to help prevent symptoms developing. Antihistamines Antihistamines work by blocking the effects of a protein called histamine, which is one of the chemicals responsible for causing your skin to swell. A 2-week course of a non-sedating type of antihistamine (which does not cause drowsiness) is usually recommended – these include fexofenadine and cetirizine. Cetirizine can be bought over the counter in pharmacies and supermarkets without a prescription. Antihistamines can also be given by injection at hospital or your GP surgery. If you also have urticaria (hives) and are being kept awake at night by itchy skin, your GP may prescribe an older type of antihistamine to take before going to bed. These types cause drowsiness and should help you sleep. A minority of people will still experience drowsiness after taking the newer type of antihistamines. If you find yourself feeling drowsy, you should avoid: driving drinking alcohol operating complex or heavy machinery Other side effects of the newer antihistamines include: headache dry mouth dry nose These side effects are usually short-lived and should pass quickly. Corticosteroids Corticosteroids (steroids) work by blocking many of your immune system's actions. In most cases, a 3 to 5 day course of steroid tablets is recommended. A steroid called prednisolone is the preferred choice. Side effects of prednisolone include: nausea abdominal (stomach) pain tiredness oral thrush – a fungal infection inside your mouth dizziness If you feel dizzy after taking prednisolone, avoid driving and operating heavy machinery. These side effects should pass once you finish the course of treatment. Steroid injections may be needed for more severe cases of angioedema. These are usually administered in hospitals or at specialist clinics by an allergy specialist or immunologist (a doctor who specialises in treating conditions that affect the immune system). Medication for hereditary angioedema The medication used to treat hereditary angioedema falls into 1 of 2 categories: medication used to prevent angioedema medication used to relieve symptoms Danazol Danazol is a synthetic hormone that is effective in preventing the symptoms of angioedema because it helps boost levels of the C1-inh protein. However, danazol can cause a number of unpleasant side effects if used on a long-term basis. For example, it may cause: weight gain depression disruption to the menstrual cycle – such as irregular periods or absent periods high blood pressure in women, changes to the body that are usually associated with men – such as excessive body hair growth, flattening of the chest, deepening of the voice and an increase in muscle tone liver problems Due to these side effects, many people with hereditary angioedema are uneasy about using danazol on a long-term basis. Stanozolol is a similar medication that is slightly better tolerated. Tranexamic acid Tranexamic acid is also an alternative medication to danazol. It can be as effective as danazol, but does not cause as many side effects and is preferred for use in women. Icatibant Icatibant is a relatively new medication used to treat acute (short-lasting) episodes of swelling. It works by blocking the effects of some of the chemicals that are responsible for causing the swelling in cases of hereditary angioedema. Icatibant is given by injection under the skin, and a second injection is often required. Common side effects of icatibant include: adverse skin reactions at the site of the injection – such as pain, redness, swelling or itchiness itchiness in other areas of the skin dizziness C1-inhibitors Purified C1-inhibitor concentrate is widely used to replace the missing protein in the blood. It's needed for patients undergoing surgery, to prevent attacks caused by surgical trauma. It's used to treat acute attacks and is injected directly into the vein. Many patients will keep supplies of their concentrate at home for emergency use. Icatibant and C1-inhibitor concentrate will be prescribed by the specialist immunology unit caring for the patient with hereditary angioedema.