Heartburn

Hints on Dealing With the DiscomfortWhat is heartburn?Despite its name, heartburn doesn't affect the heart. Heartburn is a burning feeling in the lower chest, along with a sour or bitter taste in the throat and mouth. It usually occurs after eating a big meal or while lying down. The feeling can last for a few minutes or a few hours.What causes heartburn?When you eat, food passes from your mouth down a tube (about 10 inches long in most people) called the esophagus. To enter the stomach, the food must pass through an opening between the esophagus and stomach. This opening acts like a gate to allow food to pass into the stomach.Usually, this opening closes as soon as food passes through. But if it doesn't close, acid from your stomach can get through the opening and into your esophagus. This is called reflux. Stomach acid can irritate the esophagus and cause heartburn.What is hiatal hernia?Hiatal hernia is a condition in which part of the stomach is pushed up through the diaphragm (the muscle wall between the stomach and chest) and into the chest. Sometimes this causes heartburn.What factors add to heartburn?Many things can make heartburn worse. Heartburn is most common after overeating, when bending over or when lying down. Pregnancy, clothing that's so tight it puts pressure on your stomach, stress and certain foods can also make heartburn worse. The box below lists other things that can aggravate heartburn symptoms.Things that can make heartburn worse
Cigarette smoking
Coffee (both regular and decaffeinated) and other drinks that contain caffeine
Alcohol
Citrus fruits
Tomato products
Chocolate, mints or peppermints
Fatty foods or spicy foods (pizza, chili, curry)
Onions
Excess weight
Aspirin or ibuprofen (one brand name: Motrin)
Some other medicines (check with your doctor)
Can heartburn be serious?If you only have heartburn now and then, it's probably not serious. However, if you have heartburn frequently, it can lead to esophagitis (an inflamed lining of the esophagus). If esophagitis becomes severe, your esophagus might narrow and you might have bleeding or trouble swallowing.If you get more than occasional heartburn, it may be a symptom of acid reflux disease, gastroesophageal reflux disease (GERD), an inflamed stomach lining (gastritis), hiatal hernia or peptic ulcer.What can I do to feel better?You might be able to avoid heartburn by making some changes in your lifestyle. The box below lists some tips on how to prevent heartburn.Tips on preventing heartburn
Place 4- to 6-inch blocks under the legs at the head of your bed to raise it.
Try to eat at least 2 to 3 hours before lying down. If you take naps, try sleeping in a chair.
Lose weight if you're overweight.
Don't overeat.
Eat high-protein, low-fat meals.
Avoid tight clothes and tight belts.
Avoid foods and other things that give you heartburn.
Will antacids take care of heartburn?Antacids neutralize the acid that your stomach makes. For most people, antacids that you can get without a prescription (over-the-counter) give fast, short-term relief.However, antacids can cause diarrhea or constipation. Look for antacids that contain both magnesium hydroxide and aluminum hydroxide. (One causes constipation while the other causes diarrhea so they counteract each other.) Some brands of antacids include Maalox, Mylanta and Riopan. Follow the directions on the package.What if my symptoms get worse?If lifestyle changes and antacids don't help your symptoms, talk with your doctor. Your doctor may want you to take medicine or schedule you for some tests.Tests might include x-rays to check for ulcers, a pH test to check for acid in the esophagus, or an endoscopy to check for other conditions. During an endoscopy, your doctor looks into your stomach through a long, thin tube which is inserted down your esophagus. Your doctor may also check for H. pylori, a bacteria that can cause ulcers.What about medicines for heartburn?Several kinds of medicine can be used to treat heartburn. H2 blockers (some brand names: Pepcid, Tagamet, Zantac) reduce the amount of acid your stomach makes. Several are available without a prescription.Other medicines, such as omeprazole (brand name: Prilosec) and lansoprazole (brand name: Prevacid), also reduce how much acid the stomach makes. Metoclopramide (brand name: Reglan) reduces acid reflux. To find out what medicine is right for you, talk with your doctor.Call your doctor if:
You have trouble swallowing or pain when swallowing.
You're vomiting blood.
Your stools are bloody or black.
You're short of breath.
You're dizzy or lightheaded.
You have pain going into your neck and shoulder.
You break out in a sweat when you have pain in your chest.
You have heartburn often (more than 3 times a week) for more than 2 weeks.
Is heartburn associated with heart attacks?No. But sometimes pain in the chest may be mistaken for heartburn when it's really a sign of heart disease. If you have any of the symptoms in the box below, call your doctor.

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Heart Attack

As many as one in three people will be dead within 24 hours of having a heart attack. But most people who survive the first month will still be alive five years later. So prompt treatment is essential, as is prevention.What causes a heart attack?The heart is a large muscular pump. It beats 70 times a minute to push blood around the body. Like any busy muscle, the heart tissues need a good supply of blood from their blood vessels, which are called the coronary arteries.Diseases that narrow the coronary arteries can cause a shortage of oxygen and essential nutrients in the heart muscle.This triggers chest pain known as angina, especially when the heart is made to work extra hard, for example during exercise. If someone has angina, the more severe the narrowing of the arteries, the less they can do before they experience pain.If the shortage is severe and prolonged, some of the heart muscle will die, resulting in permanent damage. This is a heart attack, more technically known as a myocardial infarction or MI.Blocked coronary arteriesThe most common underlying disease for heart attacks is atherosclerosis, where fatty plaques build up on the lining of the coronary arteries. This is known as coronary artery disease, and is a gradual process that slowly limits the blood supply to the heart muscle.How do heart attacks happen?What usually happens in a heart attack is that one of the fatty plaques cracks and a blood clot forms on top of it. It is this clot that finally blocks the artery completely.There are other, rarer causes of a heart attack, such as a dissection or splitting of the wall of the coronary artery.How many people are affected?The UK has one of the worst heart attack rates in the world. It's estimated that someone has a heart attack every two minutes in the UK. More than 1.4 million people have angina and each year about 275,000 people have a heart attack. Of these, more than 120,000 are fatal.Heart attacks are responsible for one in four deaths in men and one in six deaths in women. They are more common among older people.Risk factorsThe biggest single risk factor for heart attack is smoking. Other causes include high cholesterol, high blood pressure, diabetes and a family history of heart disease.There are many steps you can take to change your lifestyle and reduce your risk.Different types of heart attackWhen someone goes into hospital with pain or other symptoms suggesting coronary heart disease, a diagnosis of acute coronary syndrome (ACS) is made.The next step is to work out which part of the heart is affected, and how badly. This is done by studying an electrocardiogram (ECG) and other tests, in particular a blood test that measures levels of a chemical called troponin, which is released from damaged heart muscle cells.There are several different types of heart attack. The area of the heart that's affected has important implications for what sort of complications there may be, how well the patient will recover and the treatment they should be given.For example, if a heart attack affects the inferior (underneath) surface of the heart, which sits against the diaphragm, there is a greater risk of abnormal heart rhythms, because the electrical conducting system of the heart is disrupted.If the heart attack affects the anterior (front wall) of the heart, there is more likely to be damage to the left ventricle, which is responsible for pumping blood around the body, leading to low blood pressure and heart failure.Sometimes a heart attack doesn't affect the full thickness of the heart muscle and may not produce typical changes on an ECG. This sort of heart attack may require different treatment.Rapid treatment saves livesAbout half of those who have a heart attack die within 28 days. Most people who survive the first month will still be alive five years later, but many are left with long-term heart problems.One in three people dies within 24 hours. Most of these deaths are sudden, occurring within one hour of onset of symptoms and before reaching hospital, and are often due to dangerous heart rhythms.Heart attacks must be recognised and treated as quickly as possible because once a coronary artery is blocked, the heart muscle will die within four to six hours. Rapid treatment reduces the risk of sudden death and prevents long-term complications. Don't wait to call for help - this could make treatment less effective.
If you suspect a heart attack, get medical help immediately
Everyone's experience is different but common symptoms include:
chest pain, usually a central, crushing pain, which may travel into the left arm or up into the neck or jaw, and persists for more than a few minutes
sometimes the pain doesn't fit this pattern, or is confused with indigestion
some people having a heart attack don't have any pain
shortness of breath
nausea or vomiting
sweating
feeling light-headed or dizzy
palpitations or an abnormal heart rate
TreatmentWhen a heart attack is suspected, drugs such as aspirin may be given immediately to improve blood flow through the coronary arteries. Pain relief, oxygen and other treatments may also be given.When a heart attack has been diagnosed, one of two methods may be used to try to reopen the blocked artery.Drugs that dissolve the blood clots blocking the artery have greatly improved the treatment of heart attacks. These drugs, known as thrombolytics or 'clot busters', can restore blood flow in about 60 per cent of cases, although sometimes the artery blocks again later on.These drugs aren't suitable for everyone and there is a risk of bleeding. As many as two per cent of those treated will have a dangerous brain haemorrhage as a result. Thrombolytics must be given as soon as possible after symptoms start and certainly within 12 hours.The other method is an operation called percutaneous transluminal coronary angioplasty or PCI. It involves inserting a tube into the coronary arteries. The tube carries a deflated balloon that can be inflated in the blocked area to push against the artery walls and open the vessel. In general, PCI produces slightly better long-term results than thrombolytic drugs but it must be carried out in a specialised centre.Recovering from a heart attackNot so long ago, a heart attack meant weeks of bed rest. Nowadays, people may spend just a few days in hospital, but a much longer process of rehabilitation is important to help the person recover fully, deal with common problems such as depression and reduce the risk of a second attack.

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Avoiding allergens

There are plenty of steps you can take to cut down on allergens in your home. Time to open the windows and get cleaning... Some basic rulesTake the following immediate actions to cut down on allergens in your home:
Keep your home dry and well ventilated.
Open windows regularly and keep vents open, particularly in kitchens and bathrooms. A useful guide is to open windows for at least one hour, twice a day.
However, if you suffer from hay fever, you should keep the windows closed as much as possible during the peak of the pollen season.
Don't dry clothes indoors, especially in your bedroom or living room.
If you have central heating, turn it down by a few degrees.
Increase the ventilation if your home is very humid - a dehumidifier might help.
House dust mitesHousehold dust is a great breeding ground for house dust mites and may also contain animal dander and mould or mildew spores. There are various ways to keep a lid on house dust mites:
Choose wooden or other hard vinyl floorings instead of carpets, and fit roller blinds, which can be wiped clean, rather than curtains.
Remove cushions, soft toys and other fabric accessories.
Avoid indoor houseplants, as they are also dust traps.
Don't use woollen blankets or feather bedding in your home. Try synthetic pillows and acrylic duvets instead.
If you can, buy a high-filtration vacuum cleaner. Most standard cleaners stir up dust as you clean and release most of the dust back into the air in your home.
Always wipe surfaces with a clean, damp cloth, as dusting will just spread the allergens further.
The most beneficial action you can take is to buy barrier covers for your beddingThe most beneficial action you can take is to buy barrier covers for your bedding. These are designed to prevent house dust mites and their tiny droppings escaping from your pillows, mattresses and duvets. They are made from a soft micro-porous material, which is comfortable to sleep on. And wash your sheets, duvet covers and pillowcases once a week in a hot wash (60°C), then iron your sheets and bedclothes with a hot iron, which will help to kill mites.If your child is unhappy about giving up soft toys, machine wash them instead in a hot wash once a fortnight. Then place the toys in the freezer for 24 hours after which they should be thoroughly dried.On a final note, acarosides are chemicals that kill house dust mites. They are expensive and only offer temporary benefit, and the dead mites still have to be removed from carpets and furnishings by intensive vacuuming.Pets in the homeAnother priority is to remove pets from the home. If this is too traumatic, then try the following:Keep pets outside as much as possible or limit them to one room only, preferably one without carpeting.Don't allow pets into bedrooms, as dander can remain airborne for long periods. The cat dander allergen can also be carried on clothing to school or work. Wash your pets regularly - fortnightly if possible.
Female animals produce less allergen and castration will reduce the production of allergen by male cats and dogs.If you are allergic to cats and are visiting the home of a cat owner, ask them not to dust, sweep or vacuum on the day you arrive. Disturbing the dust could make your allergy worse as stirred-up cat allergen can remain in the air for over 24 hours. You might want to take anti-histamine medication if entering a cat-inhabited home.

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Allergic rhinitis

Perennial allergic rhinitis is usually triggered by indoor allergens such as house dust mite and pet skin flakes. It's similar to hay fever - the allergen causes inflammation and irritation of the delicate linings in the nose and eyes. More and more people are developing allergic rhinitis. Some have symptoms all year round, while others have seasonal symptoms (such as hayfever). As with asthma and eczema, it can run in families.What causes it?Perennial allergic rhinitis starts in early childhood and occurs all year round. It's caused by allergy to the droppings of house dust mites or pet skin flakes. Occasionally, indoor mould spores and, in rare cases, food allergy can be causes.There is often a family predisposition to developing rhinitis and other allergies.What are the symptoms?The following symptoms can be observed:
Symptoms of a 'permanent cold'
Blocked stuffy nose
Headaches and earache
Constant sore throats and postnasal drip
Sleep disturbances and snoring
Loss of taste and smell
Poor concentration
What's the treatment?Low-dose steroid nasal sprays and nose drops are the most effective treatment, but need to be used continuously on a daily basis throughout the year.Decongestant tablets and sprays will help relieve a stuffy, blocked nose with catarrh, but should be used for short periods only.Antihistamine medication may helpAntihistamine medication may help, but it's more effective for hay fever. Anti-allergy nasal sprays and eye drops are ineffective in perennial allergic rhinitis. Ipratropium nasal sprays treat the constantly 'dripping' nose of rhinitis.Immunotherapy, when available, might be considered in severe house dust mite allergic rhinitis.Can I prevent it?The only way to prevent perennial allergic rhinitis is to avoid the allergen that causes it. Allergy testing is, therefore, important to identify the exact indoor allergen that provokes the allergy.

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Eye Allergies

Eye allergies can vary from mild irritation of the conjunctiva - the membrane that covers the eyeball and extends to the inside of the eyelids - to severe conjunctival inflammation with corneal scarring.'Hay fever eyes'Seasonal allergic conjunctivitis is the eye equivalent of hay fever and affects up to 25 per cent of the general population. The eyes become itchy, watery and red in the summer pollen season - usually from exposure to grass and tree pollen.The eyes are very sticky with a stringy dischargeA more severe form of this disease seen in children is vernal conjunctivitis where the symptoms are more intense. The eyes are very sticky with a stringy discharge and pain occurs especially when opening the eyes on waking. The eyelid inner membranes swell with the conjunctiva developing a cobblestone appearance, corneal damage may even occur if the condition is left untreated.Perennial allergic conjunctivitis tends to occur all year round with house dust mite and cat allergy. The symptoms are usually milder than those in seasonal allergic conjunctivitis.'Eczema eyes'Atopic keratoconjunctivitis although rare is the most severe manifestation of allergic eye disease occurring predominantly in adult males. It is the eye equivalent of severe eczema. This persistent condition results in constant itching, dry eyes, blurred vision and is associated with corneal swelling and scarring. Eyelid eczema and infection are common and lens cataracts may develop over time.Contact lens allergyContact lens wearers may develop giant papillary conjunctivitis triggered by the constant local irritation of the contact lenses on the conjunctival surfaces. The lining of the upper eyelid is usually most affected. Disposable contact lenses may help settle symptoms but occasionally contact lens wearing has to be suspended.Never use steroid eyedrops unless under the direct supervision of a doctor. Steroid eyedrops although very effective for treating eye allergies can lead to unwanted side effects such as glaucoma, cataract formation and encourage infections of the eye with resultant corneal scarring.What treatment can you get?The treatment for allergic conjunctivitis involves the regular use of eyedrops. Anti-allergy eyedrops such as sodium chromoglycate, nedocromil sodium, olopatidine and lodoxamide help treat mild seasonal disease. Anti-histamine solutions such as levocabastine work for mild to moderate disease.
The oral anti-histamines - cetirizine, loratadine, mizolastine and fexofenadine - also help, especially when there is associated nasal allergy. In more severe eye allergies corticosteroid eyedrops occasionally have to be used, but this should be for short periods only.

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Eating out - choosing healthier options

Your weightExpert advice to help you maintain a healthy weightDissatisfied with your weight?We're bombarded with scare stories about weight, from size zero to the obesity 'epidemic'. But a healthy weight is determined by different factors for each of us. Our expert advice is designed to help you achieve and maintain a healthy, life-enhancing weight.Overweight or underweight?Being the right weight has a positive effect on wellbeing but also on our health, as being the wrong weight can cause a range of medical problems.
More and more of us are eating out on a regular basis, whether it's for a business lunch, a girls' get together, or for a family meal. The 2006 Family Food Survey found that households where the head of the household was under 30 years old were spending more than 40 per cent of their food budget on eating out. Eating out usually means that we have little control over how the food is prepared or how large the portion is. Foods eaten out tend to be higher in fat and research has shown that those who eat out regularly generally have higher intakes of fat, salt and calories. Studies have also shown that eating with friends can tempt us to overeat. Meals with multiple courses eaten over longer periods and with alcohol are all associated with overindulgence. Large serving bowls and spoons increase the likelihood of piling more food on your plate than you usually eat. Unlike packaged food, foods bought from cafes, restaurants etc don't have to carry nutritional information and so opting for the healthiest option might not always be obvious, or easy. However, with some knowledge and thought, eating out can be enjoyable and healthy!General tipsIf you're unsure as to what something is, or what it contains - ask! If the waiter/waitress doesn't know, then the chef will.Think ahead, if you know you're eating out later and it could be a lavish affair, choose wisely earlier in the day to keep calories, fat, sugar and salt intakes under control. Don't eat an extra course just to be polite. Only order a sweet after the main course, and only if still hungry. Opt for sorbets, or fruit dishes to balance out a heavy main course. Think about sharing a course with a companion if the portions look large. Speak up about how you'd like a dish prepared eg ask for no mayonnaise, dressing on the side. You're more likely to overeat at an 'all you can eat' style buffet. Choose side orders of salad or vegetables to fill up on. Cut off any visible fat from meat to keep saturated fat intake down. Look out for smaller portions ie a main meal option as a starter size. Opt for dishes which are grilled, baked, steamed, poached or cooked in own juice rather than fried. Check the menu for dressings on salads and ask for it to be served separately. An otherwise healthy and nutritious salad could be drowned in a high fat sauce, bumping up its calorie content. Avoid cheese, cream or butter-based sauces If you're a cheese lover, think about sharing the cheese board option to keep saturated fat, salt and calorie intakes in check.

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Choking - child

A choking child needs first aid to prevent them losing consciousness.First, encourage the child to dislodge the obstruction by coughing. If this does not clear it, apply the following techniques in sequence until the child is able to breathe freely again.First stage - back blowsBend child forwards and give up to five blows between shoulder blades with heel of your handCheck mouth for removable obstructionSecond stage - abdominal thrustsStand or kneel behind child, bend them forwards and put your arms around their upper abdomenPlace your fist against lower part of child's breastboneGrasping fist with your other hand, pull sharply upwards and inwards, trying with each thrust to clear the obstructionCheck mouth for obstructionRepeat up to five times, if necessaryThird stageIf the obstruction still hasn't cleared, continue a cycle of five back blows and five abdominal thrusts up to three times. Further actionsIf the child is still in difficulties, call for emergency help. If the child loses consciousness, begin resuscitation. See babies choking if the child is less than a year old.Choking - adultsChoking can result in the loss of consciousness but is often not as serious as this.What is it?A severe obstruction is when a person is unable to speak, cry, cough or breathe. A mild obstruction is when a person finds it difficult to breath, but is able to speak, cry, cough or breathe. They are able to clear the obstruction without help.First aid aimsRelieve the obstructionArrange for medical help if necessaryActionsIf the obstruction seems to be mild, get the casualty to continue coughing. If the obstruction is severe, follow this patternFirst stage - back blowsGive up to five blows between the shoulder blades with the heel of your handCheck the mouth quickly after each one and remove any obvious obstructionSecond stage - abdominal thrustsIf obstruction is still present, give up to five abdominal thrustsPlace a clenched fist above the casualty's navel, grasp your fist with your other hand and and pull inwards and upwardsCheck the mouth quickly after each oneThird stageIf obstruction does not clear after three cycles of back blows and abdominal thrusts, dial 999Continue until help arrives and resuscitate if necessaryIf casualty loses consciousnessBegin resuscitation and continue until help arrivesPanic attackA panic attack is distressing for the person experiencing it and difficult to respond to, but it isn't harmful. What is it?A panic attack is a sudden rush of overwhelming fear that often occurs without warning or any obvious reason.SymptomsHyperventilation and fast breathing result in lack of carbon dioxide in blood PalpitationsNervous behaviourDifficulty swallowing or breathingTremblingFirst aid aimsCalm the casualtyEncourage them to regain control and seek medical adviceActionsTake casualty to a quiet placeBe reassuring but firmRemain with casualty until panic attack is overAdvise casualty to see their GP.

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