Food Intolerance: Just fussy eating?? Fad, friend or foe?

We are what we eat and it will affect how we feel. I recently attended a dinner party where each of the 12 guests had at least 1 dietary requirement. This is a relatively new normal, but food intolerance, to some degree, is thought to affect more than half of us.

There can be a lot of confusion surrounding this topic, with labels such as food hypersensitivity, food allergy and food intolerance often being freely interchanged. It is important to make the distinction between a food allergy and a food intolerance because the management can be quite different.

A true food allergy is relatively rare. It affects approximately 1% of the adult population and common allergies include nuts and shellfish. Here, the body sees the proteins found in the culprit food as a threat, and tries to attack it – this is called an immune response.

Symptoms of an allergic reaction usually start immediately (although sometimes a delay of a few hours can occur) and can include tingling in the back of the throat and lips, a rash and vomiting and/or diarrhoea. In more severe cases, it can lead to swelling of the face and breathing difficulties. This is called anaphylaxis and is a medical emergency. The treatment is adrenaline injected in to a muscle as soon as possible, and so once diagnosed, you may be asked to carry an EpiPen with you at all times. You need to avoid this food for the rest of your life.

This attack (or immune response) usually releases an immunoglobulin called IgE and this is what we check for when performing an allergy test. The 2 most common allergy tests are a skin prick test or a blood test known as a radioallergosorbent (RAST) test. Non IgE mediated allergies do exist, but these are more common in children. Speak to your doctor for more information.

An intolerance is different. Your body finds it difficult to break down and digest certain substances in foods but no allergic reaction place. Common intolerances include:

  • Dairy
  • Gluten
  • Wheat
  • Yeast 
  • Alcohol

 

Gluten free

 

It can take quite a long time to diagnose an intolerance or identify a trigger food, and there are many reasons behind this. Sometimes your body can tolerate a small amount of the food, but when eaten in larger quantities it can be troublesome. Often, you might just notice that you don’t feel quite right but you can’t quite explain why. You can feel tired and sluggish or notice problems with your skin. You may become constipated or have diarrhoea or a mixture of the two. Commonly, you can feel very bloated and you may find yourself passing more wind, which can be embarrassing.

It is not uncommon for your symptoms to change from day to day, or get worse over time. They can start to have a negative impact on day to day life and overall make you feel quite miserable!

the best place to think

If you are having any of these symptoms, book an appointment with your GP. They will take a full history, and ask questions such as: Have you had any change in your bowel habit? Have you noticed any blood in your stool? Have you had any weight loss? Your GP may also carry out basic investigations such as blood tests and possibly a stool sample to rule out things like coeliac disease, inflammatory bowel disease and even bowel cancer.

If you are given the ‘all clear’ for any specific cause by your doctor, it can take a while to accept there is no magic solution to the very real symptoms that you are having. They will probably advise you to make changes to your diet, and although it may feel like a bit of a cop out, this really is the management.

Your GP may mention the FODMAP diet to you, it stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols. Foods containing these short chain carbohydrates are difficult to digest because they attract water and feed gas-generating bacteria inside the intestine, which leads to bloating, flatulence and loose stools. This reaction affects some people more than others. The list of foods to avoid on the FODMAP diet can appear endless, but when done properly, it can make you feel a lot better.

iStock_000020778541_Large copy

Your doctor may make other suggestions about what to avoid in your exclusion diet and most often they will recommend a referral to a dietician or nutritionist for support and guidance. It is essential that we ensure you are still getting all the nutrients you need, despite making quite significant changes to your diet. The aim is to exclude a food for a period of time and then re-introduce it slowly and monitor for return of any symptoms.

Can’t I have blood test to check what I am intolerant to?

To be honest, there is no scientific date supporting the accuracy of this test. The most common commercially available tests look at the level of Immunoglobulin G in response to hundreds of different foods and report whether you have a reaction to them. I would advise caution when thinking about getting one, and don’t get one done without consulting a doctor.

That being said, I sympathise fully with sufferers, and being one myself, as a desperate last resort, I paid to have one done. I found my results very interesting (and a little depressing – I couldn’t eat anything I loved!!) Here are my results:

FIResult

R = Reactive and I should eliminate B = Borderline reaction (may or may not be helpful to eliminate)

There are also lots of other commercially available tests claiming to diagnose food intolerances. Novak Djokovic has famously used kinesiology which uses muscle testing to detect imbalances in the body and he has since cut out gluten amongst other things from his diet. Please speak to your doctor before paying lots of money to get any of these tests done, as the scientific evidence backing these methods is limited.

Food intolerance is real, and it can have a significant effect on people’s lives. If you are having symptoms then the first port of call should be your doctor to rule out any serious illness. Food intolerance tests are expensive, and not entirely backed by science, but some do find the results helpful as a guide. Usually, I find this is because it gives them focus and motivation to control their diet, which really is the key. Make use of a dietician or nutritionist to ensure you stay healthy.

Good luck with anything you are advised to try – its not easy but it will be worth it!

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Sunshine Pills… Yes Please! Why Is Vitamin D So Important?

This week I had my Vitamin D tested. My level was 24nmol/L, which is very low and I am now classed as being Vitamin D deficient. I join approximately half of the UK population, who are also thought to be lacking in this important vitamin. It is essential for good health and healthy, strong bones.

When sunlight hits our skin, Vitamin D is made in the outer layer of our skin called the epidermis. In order for our body to be able to use it, it has to be changed in to an active form by our liver and then our kidneys. The active form of vitamin D is called calcitrol and it has one main role – to help us absorb the right amount of calcium. If we have low levels of Vitamin D, our gut has to work harder to absorb the calcium we need for our bones and this can lead to problems.

Sunlight is the main source of vitamin D. Dietary sources are limited, but small amounts can be found in eggs and oily fish such as salmon, sardines and mackerel. Fortified cereals and margarines also offer part of your recommended daily dose. In some countries, milk is fortified with Vitamin D, but this is not the case in the UK.

Hand with pen drawing the chemical formula of vitamin d

Sunshine is important for Vitamin D, but don’t forget that you need to enjoy your time in the sun safely. Try and avoid the sun during the hottest part of the day (between 11am – 3pm) or maximise your time to 20-30 minutes once or twice a week. Take care to wear a hat and sunglasses, and always use sun protection with a minimum SPF 15 and 4 stars.

In most of Western Europe, especially in the Winter months, the amount of sunshine we get falls far below the levels needed for the body to produce adequate amounts of Vitamin D. This means you are at risk if:

  1. You have darker coloured skin because the body finds it more difficult to make Vitamin D
  2. Your job means you are inside all the time
  3. You are under 5 or over 65 years old
  4. Culturally you have to cover up
  5. You are overweight
  6. You have other health problems, e.g. with your gut, liver or kidney which might affect your body’s ability to make or use the Vitamin D
  7. You are pregnant or breast feeding

With that list – it is not entirely surprising that most of us are low in vitamin D!

In adults, a prolonged low vitamin D level can lead to osteomalacia or ‘soft bones.’ You may feel tired, and develop bone pain especially in the lower back and hips. You might also notice muscle aches and pains or muscle weakness, especially when climbing the stairs or getting up from sitting on the floor. Your joints can also become painful. In extreme cases, it can lead to a change in the shape of your spine and fractures of your bones.

In children, a low Vitamin D can cause rickets, thankfully this is rare. Rickets is a painful condition that affects how bones grow and can cause ‘bow legs’ or ‘knock knees’ to develop. These children are at increased risk of fractures and tend to have poor growth and development.

Bones

All children aged between 6 months and 5 years should take a daily supplement of Vitamin D unless they are having more than 500mls of formula milk per day (which is fortified with vitamin D). Pregnant and breast feeding women are also at high risk of deficiency and must take daily supplements. Speak to your doctor or midwife if you have any questions.

Speak To Your Doctor

If you have noticed you are having any of the symptoms of vitamin D deficiency, or you feel you are one of the people at risk, speak to your doctor. They will ask about the symptoms you are having and they may examine you. It is likely they will carry out a blood test checking your Vitamin D level, along with your bone profile and they may also request other tests depending on what you have told them.

Once the results are back, they will discuss them with you. They will review your medical history and any other medications you are on, because in certain circumstances it isn’t safe to take higher doses. Rarely, there can be other reasons why you might have a low Vitamin D level or a low calcium level and if your doctor suspects this they may carry out further investigations.

As a guide a Vitamin D blood level of <30nmol/L is classed as deficient, a level of 30-50nmol/L is insufficient and 50-70nmol/L is considered adequate but ideally levels should be above 70nmol/L.

The most common treatment for a low Vitamin D level is high dose Vitamin D3 tablets – the dose can vary depending on your levels, but I tend to prescribe 50,000 IU once a week for 6 weeks. After ‘topping up’, it is important that you continue taking a maintenance of between 800 IU and 1000 IU otherwise your levels may fall again and any symptoms you had may return.

It is very rare that you can take too much vitamin D, so as long as you are taking your prescribed amounts I wouldn’t worry about overloading yourself.

Other Health Benefits?

There has been a lot in the media suggesting that Vitamin D can help to protect against developing breast and bowel cancer, or high blood pressure and heart disease. It has also been linked to being beneficial in diabetes, multiple sclerosis, dementia and depression. These have all been relatively small studies and no conclusive evidence has been found. It is likely that Vitamin D is protective to a certain degree, but there are many other factors that contribute. It is a small piece of a much larger puzzle.

Vitamin D is extremely important to our general health. Winter is almost upon us, and so my advice would be to speak to your doctor as soon as possible about getting your levels tested. You can then discuss with them the right dose of Vitamin D for you.

Today I March For You…

MarchPicWhat’s all the fuss about I hear you asking? Why did 20,000 doctors take to the streets of London on Saturday? Isn’t it all just about money? Is it because we don’t want to work weekends? Isn’t Jeremy Hunt promising us a 7 day NHS which can only be a good thing? Why aren’t doctors supporting that?

A lot has been said in the press over the past few weeks, and I feel compelled to offer my thoughts.

#SaveOurNHS

The NHS was founded in 1948. Its core principles are that it meets the needs of everyone, that it is free at the point of delivery and that it is based on clinical need regardless of a person’s ability to pay. Of course, a lot has changed since 1948… The UK population is growing year on year and so there are an ever increasing number of patients using the service. People are living longer, and their needs and demands on the system have become increasingly more complex. Advancements in technology mean we are diagnosing more diseases and much earlier, and treating them with more expensive drugs.

The Problem

Some argue that the NHS was never meant to offer the level of care that it does currently. It is no secret money is tight with many NHS trusts running at a loss. Over the past few years, since the change in the Health and Social Care Act in  2012 the NHS has undergone huge privatisation, with traditionally NHS contracts being offered to private companies. It is this fragmentation and privatisation of the NHS that worries doctors.

Why Attack Junior Doctors? What Have They Ever Done To Anyone?

Under the new contract, a normal working day will be from 7am-10pm Monday to Saturday. Currently junior doctors get a basic salary, around £23,000 in their first year of working, plus additional increments called banding depending on how many antisocial hours they work.  If the new contract goes ahead, it is likely junior doctors will take a pay cut of up to 30% for working the same, if not more hours. The government are also proposing to remove safeguards in place that exist to help prevent doctors working over their contracted hours by removing the financial penalties trusts have to pay.  It also penalizes doctors who want to carry out research, which is vital for finding new treatments and cures for cancer and other diseases.

Scotland and Wales are refusing to impose the new contract, and rightly so.

Why Does It Matter To Me?

Junior doctors need to be protected. They are ‘junior’ from the first day they qualify, up until the day before they become a consultant. This can take anywhere between 5-12 years, if not longer. They are not only our present, but our future. Your lives really are in their hands. Even if you are among the privileged few able to afford private health care, it is still your concern because even the most experienced of doctor, was still an NHS junior doctor at one time.

Isn’t It Still All About Money?

Most, myself included, view being a doctor as a huge privilege. We did not go in to this for money. Certainly, the level of debt, and hours we have to work wouldn’t make it worth our while if we were just doing it for the money. We fund all of our exams post qualification, we can miss Christmas’, our loved ones birthdays and sometimes even weddings because of the on-call rota, and we do it because we care about our patients.

But doctors also have families, bills and mortgages. If the contact is imposed, many simply won’t be able to afford to continue working as a doctor. A large number have already left seeking greener pastures abroad, with many others exploring their options. These are some of the brightest individuals the UK and it is a travesty they are being driven away. It isn’t about a 10% pay rise like the MP’s had, its about not giving them a 30% PAY CUT. So yes, maybe it is a little about the money, but I’m alright with that! But please remember, overall, what doctors are actually fighting for is patient safety #NotSafeNotFair.  We need a realistic service that works for everyone – not just the government.

I Want A 7 Day NHS?

There already is a 7 day NHS and doctors already work 24 hours a day, 7 days a week. We offer an on-call service at weekends, which means anyone that needs to see a doctor will be able to see one. Doctors are in full support of increased provisions at weekends, as long as they are properly staffed and properly funded. We aren’t entirely sure how this is going to happen safely within the time limits the Jeremy Hunt is proposing as there is already not enough money, hospital doctors and GPs to fully staff a 5 day service.

What Does It Mean For The Future?

Demoralised and devalued staff are not good for anyone. Under the new contract doctors will be spread even more thinly, working more hours and for less pay. Tired doctors make mistakes and it is our duty to protect them and ourselves.

The worry is that making the NHS unsafe in this way gives the government even more reason to further push private health care, by showing the public that it isn’t working in its current form. Don’t forget, private companies are already cherry picking the most lucrative NHS services, affording their shareholders huge profits.

Why All The Fuss?

If this continues doctors will leave the profession or move abroad. There won’t be enough doctors and other allied health professionals to staff the service and the NHS will become unsafe for patients. This means, in a few years sadly, you may have to pay to see your GP, pay for your life saving care and pay for all your medication. As will your grandparents and your children. As a doctor working in the private sector, I would likely get paid more, work less hours and have better working conditions. The 20,000 doctors who protested on Saturday are wholly aware of this, but they still marched for you! We need to protect them and our NHS.

Staying Well: Stress… How it affects my body and how can I best manage it?

PriLakhani1Stress is a part of everyday life. A little bit of pressure can be a good thing to keep us motivated to get things done; too much however, and it can be a different story entirely. Stress is the feeling you get from being under too much mental or emotional pressure. Common causes include work, family, relationships, financial difficulties, unemployment and illness.

The stress response causes physical changes within our body as it releases hormones such as adrenaline and cortisol, triggering the ‘fight or flight’ response. This makes your heart beat faster, raises your blood pressure, makes you breathe faster and deeper so that you have an increase supply of oxygen, makes your muscles tighten up and causes a release of sugar into the bloodstream to give you a boost of energy.

All of this is excellent in the short term to help you up your game, but problems can arise when you are constantly stressed due to the continuous release of hormones. You can end up feeling tired all the time, not sleeping well, develop muscle aches and pains (usually back and neck) and suffer with headaches. You might also find that you have symptoms of acid reflux (heartburn) or get an upset stomach. Longer term, it can increase your risk of developing high blood pressure and heart disease.

You might notice that you keep getting ill, this is because cortisol and other hormones released over a continuous period of time can weaken your immune system. You also probably haven’t had enough time to rest. If you are feeling like this, listen to your body as it is trying to tell you something.

Being stressed can affect your mental health too. Emotionally you might find yourself withdrawing or feeling like you are walking around in a bit of a daze. Feeling like you are unable to cope is common, and you might even feel very anxious or depressed. It is important that you speak to your doctor if you are feeling like this, as they will be able to help.

The best way to deal with stress is to identify it early and make long term changes to the way you do things. Lets face it, you probably won’t be able to take away most of the things that make you stressed but you can ALWAYS deal with things in a better way.

First and foremost, try and avoid picking up (or returning to) bad habits like smoking, drinking excessive amounts of alcohol or using other recreational drugs. It might be tempting but it’s just not worth it, and in the long run you will end up feeling worse.

Exercise  – This might be difficult to fit in to your busy schedule, but try to get moving wherever and however you can. Exercise itself is known to relieve stress and it releases natural endorphins to make you feel more positive. It can help you to feel more focused, self confident and motivated and help improve your quality of sleep.

Eat well –  you are what you eat and it will affect how you feel. Try and avoid refined sugars, which are found in processed foods, as these can cause energy crashes that might leave you feeling unnecessarily tired and irritable. Opt instead for a handful of nuts, some dark chocolate or a banana. Avoid comfort eating – easier said than done I know! Try also cutting down your caffeine intake (although you might feel you need more of it) because it is a stimulant and can make your feeling of stress worse.

Take a step back and take control – When you can’t see the wood from the trees, stop for a moment and reassess. Make a list of what needs to be done and prioritise it in order of importance. Delegate where possible and set realistic goals. There’s no point in making yourself feel worse – so be true to yourself with what you can realistically achieve with the time that you have.

Work smarter not harder – keep this as your mantra – look at ways you can improve the way you do things to make you more efficient. Learn how to say ‘no’ tactfully – this may be difficult at first, but it will help to minimise situations where you agree to take on new roles or responsibilities when you already have too much to do and too little time to do it in.

Relax and / or Meditate – ok, it’s not for everyone, but whatever you want to call it, try and spend a few minutes a day reflecting inwards. This might be practicing a few breathing exercises or trying to focus your mind on clearing away any negative energy. Mindfulness really can help you a great deal in your day to day life.

Make time for your hobbies and friends – I really can’t stress this enough! Doing things that you enjoy will naturally make you feel better and offer a welcome distraction from everything else that might be going on. Just remember what I said about those bad habits – everything in moderation!

TALK ABOUT IT – a problem shared is definitely a problem halved. Talking to friends or family might be all you need to regroup and get going again. Sometimes though, you might feel totally overwhelmed or have found that talking to your support network hasn’t quite done the trick. Speak to your GP – they can help. They can offer support, and if needed, refer you for talking therapy such as cognitive behavioural therapy. This can help in identifying your stress triggers and give you techniques to deal with them in a better way. If needed, they can prescribe medication to help your symptoms.

Finally, remember life is short! Try and look on the bright side – stop worrying about the things you can’t control and focus on the positives, once you start looking, you will find them!

Surviving Hay Fever Season!!

The Great British Summer is upon us! For most, this means picnics in the park, evening strolls and enjoying the great outdoors. But for some, it is a time of great misery.

Hay fever affects approximately 20% of the population at one time or another. It is caused by an allergic reaction to pollen. The body’s natural defence system reacts to the pollen as if it were harmful (even though it isn’t) and tries to fight it off, by releasing a substance called histamine.

Symptoms Include:

  1. Sneezing
  2. Runny nose
  3. Itchy, watery eyes
  4. Itchy throat
  5. Cough
  6. Lethargy

The pollen count is the number of grains of pollen in one cubic metre of air. Symptoms will usually be worse when the pollen count is high. I have compiled a few top tips to get you through those days!

Medication

  • Use a daily non-drowsy antihistamine – the most common ones you can buy over the counter are loratadine and cetirizine. If one stops working then switch to the other.
  • If these antihistamines don’t help then see your GP, they can prescribe a stronger antihistamine such as desloratadine or fexofenadine.
  • If your symptoms aren’t controlled with tablets, your GP might prescribe a nasal spray that has a steroid in it – this reduces the inflammation in the nose and helps with sneezing, itching and congestion.
  • Use sodium cromoglicate eye drops – four times a day

Reducing pollen exposure

  1. Use Vaseline around the nose to act as a barrier to the pollen entering your nose
  1. Wear sunglasses (ideally wrap arounds) to keep the pollen out of your eyes
  1. Change your clothes when you get in from being outside, and wash your hair if you can – this will reduce the transfer of pollen to furniture and your pillow
  1. Keep your windows closed – especially early in the morning and late evening when the pollen count is thought to be highest
  1. Avoid hanging your clothes outside to dry – they can collect pollen
  1. Keep your car windows closed when driving and use the ‘re-circulate’ button if there is one
  1. Don’t let your pets get too close to your face – they carry pollen in their fur. You can wipe them down after a walk.

Add on treatments

  • Sodium cromoglicate nasal spray – may help with a runny / itchy nose symptoms
  • Ipratropium bromide nasal spray – may help with a runny nose but not sneezing or congestion
  • Decongestant nasal sprays – can give immediate relief for a blocked nose, but shouldn’t be used for more than a few days
  • Nasal saline washouts – to help wash out any pollen in the nostrils

In severe cases

A short course of steroid tablets can be prescribed to help settle the inflammation in special circumstances – for example if you have an exam coming up. Immunotherapy treatment which aims to desensitise the body to pollen over a period of time may also be offered in rare cases.

Don’t Despair!

Usually, once you find the right combination that works for you – your symptoms can be controlled! Speak to your GP if you have any questions.

Cervical Screening: Why it is so important

Cervical SmearBooking your smear test can stay on the ‘to do list forever (I know the feeling)!! Managing time off work, getting an appointment and making sure it isn’t that ‘time of the month’ makes it one of those things you just keep meaning to do…. But ladies it is FINALLY time, and here are the reasons why…

Cervical cancer is the number one cancer in women under the age of 35. In 2011 there were 3,064 new cases diagnosed in the UK making it the 12th most common cancer affecting women.

By going for your smear tests regularly, the majority of new cases can be prevented. Between the ages of 25-49 you will be invited for a smear test every 3 years and between 50 and 65 every 5 years.

The cervical screening test is not a test for cancer, it is looking for abnormal cells which can range from being mildly abnormal all the way through to cancerous The idea of screening is that we catch any abnormal cells early, and treat them, so we can prevent them from going on to develop in to cancer.

It works, the number of people diagnosed with cervical cancer has almost halved in the last 20 years since screening was introduced in 1988. But 22% of women in the UK still don’t go for their smears.

It is an intimate examination, but don’t let this put you off. It is a routine examination that we do all the time. Your doctor or nurse will use a speculum to visualize the cervix, this can be a little bit uncomfortable, but shouldn’t be painful. We then use a brush to sweep off cells from the area and send them to the lab for analysis. The whole procedure shouldn’t take more than 10-15 minutes.

If you are all clear, you will be asked to come back in 3 years, If abnormal cells are found, don’t panic, it doesn’t always mean the worst! You might be referred for a colposcopy so that we can look at these cells more closely. These abnormal cells can either be monitored (sometimes they change back by themselves) or removed depending on what stage they are at.

The Human Papilloma Virus (HPV) significantly increases your risk of getting cervical cancer. HPV is transmitted by sexual contact, and having multiple sexual partners can increase your risk. A vaccination against certain strains of HPV has been developed and is now being given routinely as part of the childhood immunization schedule at 12-13 years of age.

Whether you have had a smear or not – I have listed the important symptoms to look out for below and if you have any of them you must see your doctor immediately:

  • Abnormal vaginal bleeding – either in between periods or bleeding after sex 
  • Bleeding after you have been through the menopause
  • Smelly or blood stained vaginal discharge
  • Pain during sex

If caught early, the chances of survival are excellent. So pick up the phone and book that smear…!

Men: Why you don’t go to the doctor but probably should!

PriLakhani1

Men are notoriously bad at visiting the doctor. Yes, you slumping down in your chair, you know who you are! This week is Men’s Health week, a week dedicated to raising awareness of common conditions that are specific to men, helping them to understand when and why it is important to seek help.

I’ve outlined a few of the commonest problems men face, which are often the ones they talk about the least.

An Enlarging Prostate

Your prostate is a small walnut size gland that sits at the base of the penis. As you get older, your prostate naturally enlarges. This can lead to urinary problems. Sometimes they can start by just being a bit irritating and annoying, but often, left untreated they become worse over time. Signs and symptoms your prostate might be enlarging include:

  1. Getting up more often at night time to pass urine
  2. It takes you a bit longer than usual to get going
  3. Your stream isn’t as strong as it used to be
  4. You have a bit of dribbling at the end
  5. When you need to go, you need to go!

If you have any of these symptoms is important you see your doctor who can examine your prostate. This is done by placing a gloved finger in to your back passage (through the anus) and feeling the back of the prostate gland. They will also test your urine and might carry out a blood test called the Prostate Specific Antigen (PSA). A quick note on this test – it is specific to the prostate, but not specific for cancer, so if it is raised, it can be raised for a number of reasons.

Depending on their examination findings, your GP might decide to watch and wait if symptoms are mild, and suggest things like reducing your caffeine intake. If your symptoms are more troublesome, they can start you on tablets to help slow the growth of the prostate. Sometimes, in more severe cases, they will refer you to a urologist who might consider removing the prostate.

Testicular Cancer

This is the most common cancer diagnosed in men aged between 20-35 years (although overall a relatively uncommon cancer). But, the good news is, if is found and treated early it has one of the highest cure rates of over 95%.

The most common symptom is a painless lump in one of the testicles, usually about the size of a pea, but you can also get symptoms such as a dull ache or a heavy feeling in the scrotum, or a generalised swelling of the testicle. If the cancer spreads before it is found you might get symptoms of tiredness, back pain or shortness of breath.

It is important to say that not all lumps in the testicles are cancerous, there are many other causes, but any changes need to be examined, and quickly. You should examine your testicles about once a month, if you do it too often you might not feel any changes. You are looking for:

  • A hard lump
  • Any swelling or enlargement
  • Any pain or discomfort when examining
  • Any unusual difference between one testicle and the other
  • A dull ache in the lower stomach, groin or scrotum.

See your GP straight away if you have any worries or concerns.

Erectile Dysfunction

This is the inability to attain or maintain an erection sufficient for satisfactory sexual performance. Research suggests that as many as 1 in 2 men above the age of 40 have been affected by this at some time. Which means… yes it happens, and yes it is ok to talk about.

There are many reasons why it can occur… It might be as simple as having had a few too many to drink, or sometimes, it can reflect a more prolonged unhealthy lifestyle. Stress, tiredness and relationship difficulties can all cause ED and can often be the first sign there is a problem. It is a sensitive ‘early warning signal’ in the development of cardiovascular disease, so it is important if this is happening to you then you visit your doctor.

Your GP will examine you, check your urine and blood pressure, and might carry out a blood test checking your cholesterol, sugar and testosterone levels. There are lots of treatments available, from simple to more complex. The commonest treatment is a tablet to help increase blood flow to the penis (the most well known being Viagra) along with diet and lifestyle changes.

There are other options such as injections, vacuum devices, urethral medication and even penile prosthesis. Sometimes, if the cause it thought to be psychological, you might be referred for counselling with or without your partner depending on what you feel most comfortable with.

Depression 

Everyone goes through times in their life when they feel down or depressed, and usually it is a natural reaction to something that has happened. But sometimes these feelings can last longer than expected and interfere with everyday life, and no matter how hard you try you can’t snap out of it.

Men are bad at talking about their feelings at the best of times, and to admit they have a problem, especially a mental health one, can be hard. I have to stress that asking for help is not a sign of weakness; depression is a common and serious problem, which without help will not go away. A few of the common signs and symptoms you might be depressed include:

  • Feeling low continuously
  • A loss of interest in things you usually enjoy doing
  • Feeling hopeless about the future
  • Finding it difficult to get to sleep and waking up early in the morning
  • Over or under eating
  • A loss of self confidence
  • Feeling tired all the time or unexplained aches and pains
  • Poor concentration and difficulty making decisions
  • Feeling like you can’t cope
  • Feelings of guilt, worthlessness or helplessness
  • Loss of sex drive
  • Thoughts about death, harming yourself, or committing suicide

The symptoms men experience compared to women can be slightly different. They can become more irritable, aggressive, or have sudden outbursts of anger. They might take more risks than they usually do, or feel like they are losing control. Often, they try and deal with their feelings by turning to alcohol or drugs.

If you are experiencing any of these symptoms then book an appointment with your doctor to discuss how you are feeling, or if you are worried about someone you know, then encourage them to do so.

If you have any of the symptoms I have talked about or have any other health concerns book an appointment with your GP to discuss these further. Please don’t be embarrassed; we really have heard it all before!