Stroke

Let’s begin with a potentially vital first aid tip from the Retired & Senior Volunteer Programme (RSVP - see our First Resources section). Is It A Stroke? - Sometimes the symptoms of a stroke are difficult to identify. The person suffering the stroke may be saved from unnecessary brain damage if those nearby recognise what’s happening. Ask the person to perform 3 simple tasks: <ul type="disc"> <li>Smile</li> <li>Raise both arms</li> <li>Speak a simple sentence</li> </ul> <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/stroke_1.png" /></div> We remember this as S-A-S (smile - arms - speak). If a person has any difficulty with any of these tests call 999 immediately. Prompt treatment can prevent brain damage. Do not wait to see if things improve. Minutes count. If you or someone you are with experiences: <ul type="disc"> <li>Sudden numbness or weakness of the face, arm or leg (especially on one side of the body) </li> <li>Sudden confusion, trouble speaking or understanding speech </li> <li>Sudden trouble seeing in one or both eyes </li> <li>Sudden trouble walking, dizziness, loss of balance or coordination </li> <li>Sudden severe headache with no known cause</li> </ul> ACT FAST. Do not hesitate. Call 999. THE BASICS: BBC Health says that Stroke is the greatest single cause of severe disability in the country. From BBC Health, Medline Plus, The Mayo Clinic and other sites we learn that: A STROKE is when an area of the brain is deprived of its blood supply - usually because of a blockage or burst blood vessel - for long enough to cause vital brain tissue to die. It's essentially the same as what happens in the arteries leading to the heart when someone has a heart attack, which is why a stroke is sometimes described as a 'brain attack'. The brain is the most complex organ in the body. It regulates absolutely everything the rest of your body does. To do so it must have a constant supply of blood to deliver oxygen and nutrients to the brain cells. If the blood supply fails, as in a stroke, the brain cells become damaged or die within a very short space of time. Unlike other cells in the body, once brain cells have died they cannot re-grow. If brain cells lose their supply of oxygen from the blood, they will be irreversibly damaged within minutes. This is so sudden that there is little that medical science can do to prevent it. But surrounding these dead cells is an area of tissue where the blood supply is poor but not completely lost, so the nerve cells are receiving barely enough oxygen to stay alive. One of the main aims of treating a stroke is to act fast enough to save this threatened brain tissue by restoring blood flow to the area, and minimising the damage. Medline Plus takes us to information estimating that roughly 10 percent of stroke survivors recover almost completely, approximately 25 percent recover with minor impairments, 40 percent experience moderate-to-severe impairments, 10 percent require care in a nursing home or other long-term care facility, and 15 percent die shortly after the stroke. THERE ARE TWO MAIN TYPES OF STROKE: ISCHAEMIC STROKE In this, the most common type of stroke, the artery is blocked by a blood clot, which interrupts the brain's blood supply (ischaemia means to restrain blood in Greek). This may be due to a cerebral thrombosis (sometimes called a thrombotic stroke) where a blood clot forms in one of the main arteries leading to the brain, or to a cerebral embolism (sometimes called an embolic stroke) in which a blood clot forms elsewhere in the body and is swept into the arteries serving the brain. Fatty tissue or air bubbles may also form emboli which cause stroke, especially after major trauma. A blood clot within an artery is known as an arterial thrombosis. Arterial thrombosis usually affects individuals who already have atherosclerosis, or narrowing of the arteries. Another type of thrombotic ischaemic stroke, known as lacunar stroke, may occur. In lacunar stroke one of the tiny blood vessels deep inside the brain tissue becomes blocked, leading to the death of the small area of tissue that it supplies. Lacunar strokes are usually less severe. HAEMORRHAGIC STROKE In this type of stroke a blood vessel in or around the brain ruptures causing bleeding, or a haemorrhage. The build up of blood presses on the brain damaging its delicate tissue, while other brain cells in the area are starved of blood and damaged. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/stroke_2.bmp" /></div In an intra-cerebral haemorrhage the bleeding occurs inside the brain itself. In a subarachnoid haemorrhage the burst blood vessel bleeds into the space surrounding the brain. Subarachnoid haemorrhage is more common in the 25-50 age group than in older people. Warning signs include severe headache, facial pain, double vision or other visual problems, brief loss of consciousness followed by feeling confused and sleepy. Intra-cerebral haemorrhage accounts for about 10% of all strokes but for a much higher percentage of deaths due to stroke. Among people older than 60, intra-cerebral haemorrhage is far more common than subarachnoid haemorrhage. Causes of intra-cerebral haemorrhage include high blood pressure and, in older people, fragile blood vessels. An intra-cerebral haemorrhage begins abruptly. In about half of the people, it begins with a severe headache. Neurological symptoms develop and steadily worsen. They include weakness, paralysis, numbness, loss of speech or vision, and confusion. Symptoms worsen as the haemorrhage expands. Nausea, vomiting, seizures, and loss of consciousness are common and may occur within seconds to minutes. Stroke due to intra-cerebral haemorrhage is more dangerous than ischemic stroke. The stroke is usually large and catastrophic, especially in people who have chronic high blood pressure. More than half of the people who have large haemorrhages die within a few days. Those who survive usually recover consciousness and some brain function as the body absorbs the leaked blood. Even after surgery, many people continue to have some neurological symptoms. Symptoms may include weakness, paralysis, loss of sensation on one side of the body, or difficulty understanding and using language (aphasia). However, people with small haemorrhages recover to a remarkable degree. TRANSIENT ISCHAEMIC ATTACK (TIA) A transient ischaemic attack, often known as a mini-stroke, is a brief episode where some brain function is temporarily lost because of a very short-lived disruption of the blood supply. Symptoms (such as weakness of a limb) last for just minutes (typically 2-15 minutes) before the blood supply returns and everything returns to normal, because the brain cells have not suffered permanent damage. Traditionally it has been said that if symptoms last less than 24 hours then it is a TIA, but when symptoms persist for more than 24 hours then a stroke has occurred. But with more powerful and sophisticated brain scanning techniques it has become possible to show that permanent damage ( the real hallmark of a stroke) can usually be detected when symptoms last more than an hour or so. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/stroke_3.jpg" /></div TIAs are an important warning sign that all is not well with the blood supply to the brain. As many as 1 in 10 people with TIAs will have a stroke within 7 days, and 1 in 5 will have a stroke within a month. Heed the warning from a “mini-stroke”. Work with your doctor. IMMEDIATE CAUSES OF STROKES Each of the different types of stroke has different causes. They include: Diseased arteries - Blockage of the arteries is usually the result of atherosclerosis, furring and narrowing of the artery walls with a sludgy mixture of cholesterol and other debris, known as atheroma. Aneurysm - This is a weakened spot on an artery wall that causes it to stretch a bit like a balloon. The vessel wall may become so thin and stretched it bursts causing bleeding into the brain - a haemmorhagic stroke. Atrial fibrillation - This is a kind of irregular heartbeat (arrhythmia). It can cause a blood clot to form in the heart which can shear off and travel to the brain. EFFECTS OF STROKE The physical damage stroke causes to the brain can have a wide range of effects that will depend on the type of stroke and its severity, the part of the brain affected, the extent of brain damage and how quickly other brain cells take over the function of those that are damaged or dead. Effects may include: Weakness or paralysis - these can lead to difficulties in walking, movement or coordination. These often affect one side of the body – known as hemiparesis or hemiplegia. Lack of feeling - or loss of awareness of objects on one side of the body, known as left- or right-sided neglect, depending on the side affected. Swallowing difficulties - these can cause trouble with eating or drinking which, if not managed, can result in chest infections including pneumonia as food or liquid passes into the windpipe and lungs instead of the gullet. Dehydration or constipation may also result . Speech or language difficulties - including difficulties in understanding (dysphasia), speaking (aphasia), reading, writing and calculation. Speech and language problems are usually a result of damage to the brain's left hemisphere. Aphasia is a partial or complete loss of the ability to express or understand spoken or written language because of damage to the language areas of the brain. There are a number of different kinds and severities of aphasia. Speech Therapists can help people who develop aphasia after brain damage due to such disorders as a stroke or head injury. Treatment is usually started as soon as the person is able to participate. Problems of perception - these can include trouble recognising or being able to use everyday objects such as a kettle or teapot, difficulties telling the time, and problems interpreting what the eyes see, even where vision is not affected. Cognitive difficulties - these include problems caused by damage to areas of the brain controlling mental processes such as thinking clearly and logically, learning, paying attention, memory, decision-making and forward planning. Among these problems are: Apraxia - loss of the ability to perform tasks that require remembering patterns or sequences of movements. Occupational Therapy can help some people with apraxia learn to compensate for their losses. Agnosia - loss of the ability to associate objects with their usual role or function (relatively rare). Some people with agnosia improve or recover spontaneously; others must learn to cope with their disability. Amnesia - total or partial loss of the ability to recall experiences or events that happened in the preceding few seconds (immediate memory), in the preceding few seconds to few days (intermediate memory), or further back in time (remote or long-term memory). The causes of amnesia are only partly understood. Damage to the brain can produce memory loss of events that occurred just before (retrograde amnesia) or just after (posttraumatic amnesia) the damage occurred. Depending on the severity of the damage, most amnesias last for only minutes or hours and disappear without treatment. However, with severe brain damage, amnesia can be permanent. Behaviour changes - these may include being slower to react than before the stroke, excessive caution, disorganisation, finding it difficult to adjust to change and becoming confused or irritated. Difficulties with bowel or bladder control (urinary or faecal incontinence) - these may be caused by a variety of different problems following stroke. These can often be considerably improved or overcome with medical help and physiotherapy. Fatigue - although a recognised phenomenon, the reason for fatigue is not fully understood. There may be sleep disturbance caused by damage to areas of the brain controlling the body's sleep-wake cycle and it could also be linked to depression.   Mood changes - these include mood swings, irritability, laughing or crying even when you do not feel particularly happy or sad. Depression is extremely common following a stroke, with symptoms such as loss of appetite, insomnia, crying, low self-esteem and anxiety that can all be signs of depression. Post-stroke pain - a small number of people develop a burning, shooting, throbbing pain that does not respond to painkillers following a stroke. Epilepsy - 7-20 per cent of people who have strokes develop epilepsy. This can usually be treated with anti-epileptic drugs. BBC Health reminds that: Although this list of problems may seem long and daunting, it's important to bear in mind that most people who have strokes do not experience all of them. Moreover, with time, patience, and the help of a number of different specialists many of them can be treated, overcome or reduced. Short-term effects disappear with time as any swelling in the brain goes down and the damaged cells surrounding the dead brain cells are repaired. Long-term effects are caused by the death of brain tissue, and although they will not go away, they can often be modified with rehabilitation.

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DIAGNOSIS A number of tests may be performed to pinpoint the type of stroke and help the professionals decide on the most appropriate treatment. They may include: blood pressure measurement blood sampling x-rays electrocardiogram (ECG) to assess the heart's rhythm echocardiogram, to look at the heart's structure and ability to function brain scans such as magnetic resonance imaging (MRI), computed tomography (CT) to check the kind of stroke and view the extent of damage carotid ultrasound scanning or transcranial doppler ultrasonography (a type of ultrasound scan) to assess blood flow to the brain. TREATMENT Acute stroke therapies try to stop a stroke while it is happening. These treatments try to dissolve the blood clot causing an ischemic stroke or to stop the bleeding of a hemorrhagic stroke. These therapies are most effective when given very soon after the onset of a stroke. Treatment of a hemorrhagic stroke is very different from that of an ischemic stroke. Anticoagulants, thrombolytic drugs, and antiplatelet drugs (including aspirin) given to dissolve the clot in an ischaemic stroke would increase bleeding and make a haemorrhagic stroke much worse. With a haemorrhagic stroke, surgery may be life saving. The goal of surgery is to stop and remove blood accumulating in the brain and to relieve the resulting increased pressure. Post–stroke treatment and rehabilitation are used to lower the risk of another stroke and to help patients overcome disabilities that result from stroke. People who have had a stroke can do things to lower their risk of having another stroke. These include controlling their underlying risk factors. BBC HEALTH says that: Although between 20 and 40 per cent of people who have had strokes are treated at home, research has now conclusively proved that organised stroke care in a dedicated stroke unit saves lives and reduces disability. LONG-TERM TREATMENT OF STROKE Long-term treatment after a stroke consists of a variety of therapies, and aims to help you get back as much independence as possible. This process of rehabilitation will be specific to you, depending on your symptoms, and their severity. A team of specialists can be expected to help, including physiotherapists, psychologists, occupational therapists, speech therapists and specialist nurses and doctors. An essential part of rehabilitation is exercise. The type and amount of exercise depends upon the severity of the stroke, and the parts of the body that have been affected. A common effect of a stroke is weakness in an arm or leg, and without exercise and physiotherapy this can lead to a loss of muscle strength. If the muscles lose strength they begin to contract (shorten), pulling your arm or leg into a curled position, which would make day-to-day tasks difficult. Exercise is also important for your overall health, and reduces the chances of developing heart disease, osteoporosis or another stroke. Your GP and physiotherapist can talk with you about ways of exercising that will suit you and your lifestyle. Occupational and Speech Therapists have critical roles to play in helping to overcome and work around the effects of a stroke. Physiotherapy, Speech Therapy and Occupational therapy are three pillars of post-stroke progress. DRUG TREATMENTS The NHS website explains that: If you have had an ischaemic stroke, a 300mg dose of aspirin will be given as soon as possible. Aspirin prevents the clot from getting bigger and if taken within 2 days of the stroke, improves your chances of making a good recovery. A “thrombolytic” medication to dissolve the blood clot may also be attempted, but this is only currently a possibility in the first three hours after an ischaemic stroke. If you have had a haemorrhagic stroke, you will not be given aspirin because it can cause further bleeding and make the stroke worse. Drugs to lower blood pressure and prevent further damage are being used experimentally in the case of haemorrhagic strokes. We note: DO NOT USE ASPIRIN AS FIRST-AID for a stroke. It could be a haemorrhagic stroke and you could be making matters much worse. Drug treatments are designed to tackle the effects of stroke, prevent complications and help treat risk factors in the hope of preventing a further stroke occurring. There are hundreds of drugs that may be used. They may include: anti-platelet drugs (such as aspirin) that make the blood less sticky and help reduce its tendency to clot (only if and as advised by your doctor); anti-coagulant drugs that reduce clotting factors in the blood so it is less likely to clot. Heparin is a fast-acting anti-coagulant used in hospital. Warfarin is a commonly prescribed anti-coagulant; cholesterol-lowering drugs to reduce high cholesterol levels; anti-hypertensive drugs that lower the blood pressure; drugs designed to limit the extent of damage to the brain tissue. The risk of ischaemic stroke can be significantly reduced with anticoagulant medicines including warfarin, phenindione and acenocoumarol. If you have had an ischaemic stroke, you may be advised to take anti-platelet or anti-coagulant medicines to help prevent another stroke occurring. Aspirin is the anti-platelet medication most commonly prescribed. The dose of aspirin may vary, the usual dose is 75mg daily (sometimes called a “junior aspirin”). This should be taken after food. Once aspirin is started, it is likely that you will take it for the rest of your life. Dipyridamole is used in combination with aspirin in certain people after a stroke. Aspirin and dipyridamole are not normally used together for more than 2 years after the last stroke. After 2 years, you would continue on aspirin alone. Anti-platelet medications may not be useable if you have certain allergies, and it is very important to follow your doctor’s instructions and cautionary advice when using them. Regardless of whether you've had a haemorrhagic or ischaemic stroke, medicines may also be prescribed to reduce the risk factors of having further strokes. These may include medicines to control high blood pressure, high cholesterol, diabetes (high blood sugar) or atrial fibrillation (fast and irregular heart beat). People with atrial fibrillation require full anticoagulation to stop the blood from clotting. Atrial fibrillation causes blood clots to form on the heart valves. If a blood clot breaks off and is carried in the bloodstream to the brain, it may cause an ischaemic stroke. The Cochrane Reviews (see our First Resources section) tell us that: Stroke is the third most common cause of death and the most common cause of disability in the western world. Thedevelopment of drugs to limit the effects of brain damage caused by stroke continues, but no routine effective treatment has yet been identified. There are a large number of treatments being tried. Searching “Stroke” on the Cochrane website will give you most of them, with high level reviews. WE NOTE again: There seems to be a general awareness that a daily dose of Aspirin can reduce the likelihood of stroke. DON’T DO IT without carefully consulting your doctor. For certain heart, venous and other conditions it might be the right medication, and if it could help you your doctor will tell you. It might also cause a haemorrhagic stroke or other problems. A study published on 1 May 2007 in The Lancet Neurological emphasises this danger. Don’t self-medicate with Aspirin for stroke prevention. SURGERY Surgery for a haemorrhagic stroke can be absolutely life saving and improve the outlook for healing immensely. The goal of surgery is to remove blood that has accumulated in the brain and to relieve the resulting increased pressure. Surgery may also deal with an aneurysm, and may prevent recurrence of some haemorrhagic strokes, but it does carry risks and may or may not be suitable. Some people who have had a transient ischaemic attack (TIA) or minor stroke that has been caused by blockage in the carotid artery in the neck may benefit from an operation called carotid endartectomy to remove the blockage, or insertion of a stent (a short stainless steel mesh tube) into the artery to help keep the artery open. This may significantly reduce the risk of having a full-blown stroke. REHABILITATION Many people who survive a stroke are left with some significant disability. Having said that, the brain is remarkably adaptable, and in the months or years after a stroke many cells that have sustained damage recover some of their function. At the same time other areas of the brain take over the functions performed by the cells that have died. The time it takes to recover is extremely variable. However, commonly people have a surge of recovery in the weeks following a stroke followed by a slower recovery over the next year to 18 months or so. The aim of rehabilitation is to encourage and enhance this process. Rehabilitation helps stroke victims relearn skills that may be lost when the brain is damaged. Rehabilitation is likely to include: PHYSIOTHERAPY - Physical therapy to help restore movement, balance, and coordination. OCCUPATIONAL THERAPY to help the patient relearn everyday activities such as eating, drinking, dressing, bathing, cooking, reading and writing. SPEECH THERAPY to help stroke patients relearn language and speaking skills, including swallowing, or to learn other forms of communication. PSYCHOLOGICAL OR PSYCHIATRIC HELP. Psychological problems, such as depression, anxiety, frustration, and anger, can be common after a stroke. In general the objectives of rehabilitation and medical follow-up are to help aid physical recovery, manage the physical, emotional and social effects of stroke, encourage you become as independent as possible, prevent potential medical or psychological complications, and reduce the likelihood of further strokes. Starting rehabilitation as early as possible can substantially improve recovery and reduce the effects of disability. In addition to the Useful Organisations we list for Stroke, look at our First Resources section for any information or self-help advice you need. The Mayo Clinic website is very good on this subject. Medline Plus says that says high blood pressure is perhaps the biggest risk factor for stroke. High blood pressure can be prevented and treated with behaviour changes and your doctor’s help. If you have had a stroke, your doctor and medical team will help you control the risk factors which can lead to further crises. If you haven’t had a stroke, controlling the risk factors can prevent you from having one. Stroke can run in families. Genes play a role in stroke risk factors such as high blood pressure, heart disease, diabetes, and vascular conditions. With or without a family history of strokes, however, these risk factors increase your vulnerability. STROKE PREVENTION Everyone can and should take steps to lower their risk for stroke, whether they have had a stroke or not. Get your doctor’s help with these as required, and see our Useful Organisations. Don’t play Russian Roulette with stroke. Lower your risk. Important things you can do include: Prevent and control high blood pressure: Blood pressure is easily checked and monitored. It can be controlled with lifestyle changes and with medicines when needed. You can work with your doctor to treat high blood pressure and bring it down. Lifestyle actions such as healthy diet, regular physical activity, stopping smoking, and maintaining a healthy weight will also help you to keep normal blood pressure levels. All adults should have their blood pressure checked on a regular basis. Prevent and control diabetes: People with diabetes have a higher risk of stroke, but they can also work to reduce their risk. Further, recent studies suggest that all people can take steps to reduce their risk of diabetes. These include weight loss and regular physical activity. Stop smoking: Yes, we’ve said this before, but it’s worth saying again. Stopping smoking is one of the best things a person can do to lower their risk of stroke. Treat Atrial Fibrillation: Atrial fibrillation is an irregular beating of the heart. It can cause clots that can lead to stroke. Your doctor can prescribe medicines to help reduce the chance of clots. Prevent and control high blood cholesterol: High blood cholesterol is a major risk factor for heart disease, which can increase the risk for stroke. Preventing and treating high blood cholesterol includes eating a diet low in saturated fat and cholesterol and higher in fibre, maintaining a healthy weight, and getting regular exercise. A lipoprotein profile can be done to measure several kinds of cholesterol as well as triglycerides (another kind of fat found in the blood). All adults should have their cholesterol levels checked once every five years, and more often if it is found to be high. If it is high, your doctor may prescribe medicines to help lower it. Moderate alcohol use: Excessive alcohol use can increase the risk of high blood pressure.   Regular Physical Activity: We keep coming back to exercise, don’t we? Walking, Yoga, Pilates, swimming, Tai Chi, gardening… calm, regular physical activity may not be the Fountain of Youth but it’s a big step in the right direction. If you haven’t found a satisfying and enjoyable way to get the exercise you need, look at our Useful Organisations or contact the Senior Alliance editor for suggestions. “Hairdresser Stroke”: This is a strange one, but we thought we’d better mention it. BBC Health reports stroke apparently caused by laying the head back in an extreme position for hair washing at a beauty parlour. They refer to a 1997 report published in The Lancet by two British doctors about a woman who suffered a stroke after having her hair washed. The doctors recommended that hairdressers use a cushion and that the neck is not overextended. We think the point to take from this is that having the head thrown back at an extreme angle for any length of time, for any purpose, should be avoided. SUPPLEMENTS, SNAKE-OILS AND DIETS Ginkgo Biloba: , The Cochrane Reviews tell us Ginko Biloba is widely used in the treatment of acute ischaemic stroke in China and is also used occasionally in Europe, but its efficacy is uncertain. There is limited experimental support for the use of Ginkgo Biloba extract in ischaemic stroke. …it has been shown that Ginkgo Biloba extract leads to a significant increase in cerebral blood flow and glucose uptake into brain tissue. The Cochrane Reviews advise that high-quality and large-scale randomised controlled trials are needed to test its efficacy in promoting recovery after an ischaemic stroke. Dan Shen, a herbal medicine, is widely used in the treatment of acute ischaemic stroke in China. Having studied a number of trials, Cochrane advises that reliable conclusions could not be drawn from the present data. Vinpocetine (reference The Mayo Clinic) is a synthetic derivative of a compound found in the periwinkle plant (Vinca minor). Vinpocetine is available as a prescription drug in Europe and Japan, and sometimes as a dietary supplement. Some preliminary research suggests that vinpocetine may reduce some of the long-term cognitive impairment after an acute ischemic stroke — supposedly by improving blood flow to the brain. However, there have been few clinical studies that have examined the use of vinpocetine for stroke. More research is needed to determine what, if any, role vinpocetine may play in the prevention and treatment of stroke. Side effects of vinpocetine may include upset stomach, vertigo, anxiety, nausea, facial flushing, sleep problems and headache. DIET Along with healthy weight and regular physical activity, an overall healthy diet can help to lower blood pressure and cholesterol levels. This includes eating lots of fresh fruits and vegetables, lowering or cutting out salt or sodium if you have any tendency to high blood pressure, and eating less saturated fat and cholesterol to lower the risk of high blood pressure and heart disease which can lead to stroke. Nutrition After a Stroke - in hospital and beyond: The Cochrane reviews tell us that strokes can produce a wide range of effects with potential to impact on ability to eat. These include difficulty maintaining upright posture; loss of upper limb motor control/sensation; problems with chewing and swallowing; communication, visual, perceptual, psychological, emotional and attention problems. They say that even minor difficulties may result in inadequate dietary intake. The gist of their information is that adequate nutrition is fundamental for recovery and rehabilitation, with potentially devastating effects associated with protein-energy malnutrition (PEM). It appears that far too many patients become malnourished from 48 hours to 7 days after admission to hospital. They tell us that nutritional support for acute stroke patients represents an important element of rehabilitation. Nutrition support for hospital patients is an area of particular concern with reports repeatedly flagging problems. They say that in recent years the nursing role in nutritional support has been under-recognised; that has now changed, with nutrition identified as one of the eight core nursing activity topics (Dept of Health 2001). We repeat this information as important if you are trying to help someone hospitalised with a stroke. COMPLEMENTARY THERAPIES / ALTERNATIVE MEDICINE The Stroke Association says that: Complementary therapies may sometimes help after a stroke but there is not much research to support their use. They acknowledge, however, that some people find the addition of complementary therapies helpful in aiding rehabilitation. The severity of the stroke may limit what can be usefully undertaken. The usefulness of complementay therapies for stroke will vary enormously depending on your specific conditions and needs. We can at least say that for some symptoms in some cases, and for dealing with feelings of depression, loss, looking for ongoing purpose and meaning and questioning the value of carrying on living, complementary therapies can make a great difference for some patients and for carers. We briefly describe some of the main complementary techniques and therapies below. Their usefulness will depend in many cases on the severity of the stroke. Look in our Useful Organisations section for guidance to learn more and find providers.   Acupuncture - Well known Chinese therapy using fine needles to change energy flows. Evidence of effectiveness in dealing with pain and other problems, at least short term. High level qualified practitioner essential. Acupressure - Same principles as acupuncture, using pressure instead of needles. You can learn to do some acupressure yourself. Alexander Technique - Technique for learning how to efficiently and effortlessly use your body. Simple but profound approach to letting go of harmful tensions in posture and breathing. A safe and effective learning and therapy technique. It doesn’t sound like much but it’s a physically liberating and undemanding technique. Aromatherapy - The art of applying essential oils to suit individual needs. The oils work directly on the chemistry of the body, via the skin and bloodstream. May seem unlikely, but a number of medical sites assure us that it can be surprisingly effective and safe. Often mentioned for stroke. Art Therapy - Use of art for emotional therapy. Early evidence of effectiveness was with survivors returning from World War 2. Pain and healing are strongly affected by emotion, so makes sense. Ayurveda - The most important form of medicine in India. An ancient tradition, but most practitioners are also doctors or otherwise medically qualified. Ayurveda seeks to balance the body and mind, find health problems before they occur or stop them doing unnecessary harm. Obviously requires a qualified practitioner and is complementary to, not a replacement for conventional medical treatment. Biofeedback - Machines give you feedback about how your body is working, allowing you to learn to regulate reactions causing problems. Evidence of usefulness for therapy and self-education for many conditions. Bowen Technique - soft and non-invasive holistic treatment that aims to restore balance to the body by using small, gentle moves to specific areas of the body. Because the therapy is so gentle, it is considered to be suitable for all ages and most conditions. Chiropractic - Manipulation of spine and muscles for good balancing and health functioning. A powerful technique and NOT to be used for many conditions. Check with your doctor, and see Useful Organisations for help finding a qualified and registered practitioner. Cognitive and Behaviour Therapies - Put crudely: It’s not what happens that causes the problems, it’s how you understand it and what you do with it. Less crudely, these have medical and government recognition for a wide variety of problems and can be startlingly effective in many cases. Many of us who they have helped consider them to be most remarkable life tools. Feldenkrais Method - Not a therapy as such, but a well established method for learning greater ease of physical movement and increasing vitality and well-being. Guided Imagery - The use of imagination as potent healer. Pleasant and powerful. See “Holistic Online” in Useful Organisations to learn more. Healing - comes in many forms, from spiritual or religious to using energy flow as understood in martial arts. Whether the effectiveness is due to a placebo effect, energy flows or spirit, many people have been helped by healings throughout history. Herbal medicine - Herbal medicines can be very powerful, and are the basis of many conventional drugs. A good herbal practitioner looks at the whole person and health, not just the disease or condition. Because they can be very strong and conflict with prescribed medications, you absolutely need to tell your doctor what you’re going to be taking. A herbal remedy can destroy your therapy and health if it’s the wrong one for you. Homoeopathy - famous and controversial. Vanishingly small amounts of a substance in water are given. Many in medical science consider this to be absurd. No conclusive proof either way, but many people have found help and relief. Hard to argue with happy patients, and it has the great virtue of being harmless. That said, neglecting medical treatment to depend on homeopathy is an enormous mistake, as your qualified homeopath will agree. Hypnotherapy - not in any way a frightening experience or loss of consciousness or control, safe in qualified hands, and considered very effective in helping with chronic pain, anxiety, depression and other condition related problems. Louise Hay techniques - based on the use of positive affirmations - highly recommended by many people for effectively changing your mindset and health. A place to start is the Louise Hay book “You Can Change Your Life” and audio tapes from Amazon. As we keep saying throughout this website, mindset can profoundly affect healing. Massage Therapy - There are many forms of massage, and they can be a great help in stress reduction, release of chronic muscle tensions around arthritis, and can have many other therapeutic effects depending on the technique used. Having your body cared for like this is great, but: be aware that deep or powerful massage pressure can be dangerous for some conditions. Check with your doctor or physio about what to avoid. It is important that your therapist asks what your medical / physical situation is. If they are not qualified, or you are not comfortable with them as a patient or carer for a patient, you are in the wrong hands. Don’t risk damage. Move on. Medau Movement - Enjoyable exercise to music for improving body use and posture, and good for stress reduction. Meditation - A truly profound way to deal with stress and the human condition. Good meditation teaching is simple, and the result should be access to peace and stillness whatever is happening and wherever you are - at home, on the street, at work… We give contacts for meditation in Useful Organisations. We’ve recommended the approach of the Shollond Trust as it’s fast, free, and a good starting place for appreciating all forms of meditation. We also like BBC Health and the H2G2 recommendations about meditation. Naturopathy - Technique for helping the body to heal itself, and often incorporates a number of the other techniques discussed here. Interesting to have one technique using the strengths of others. In capable hands this can be very effective for some people. NLP (Neuro-linguistic Programming) - A fascinating form of therapy, looking at how you do what you do, and how to change. We like this sentence from a practitioner: “If you always do what you've always done, you'll always get what you've always got. If what you're doing isn't working, do something else". Far more to it than that of course, and worth learning about if severity of stroke allows this level of rehabilitation work. Osteopathy - Certainly among the best known physical therapies and very well accepted as a complementary therapy. Osteopathy is highly regulated. Physical manipulation and massage techniques are used to help correct problems with the muscles, bones, and joints and influence many of the body’s systems. A good practitioner will ask in detail about your condition to not do harm with inappropriate manipulations. Practitioner be qualified, registered, and take a medical history to understand what your condition is. Pilates - Exercise method to method to strengthen the core postural muscles and develop balanced alignment through the use of slow, controlled movements and breathing. Often recommended by doctors, physiotherapists, and used by everyone from top professional athletes and dancers to people who have never done much exercise or thought they were unable to due to physical limitations. Teacher must understand your condition. Psychology of Mind - The book “Slowing Down to the Speed of Life” from Amazon is the well known place to start. POM techniques and understandings are simple and can be life changing. A way to use your problems to vastly improve your life. For the anxieties associated with illness (not to mention life) this is something special.  Psychotherapy - Many forms, and a vital and immensely beneficial approach for many people. The idea that psychotherapy is for crazies couldn’t be more wrong. It’s one of the best learning and healing tools and most interesting things you could choose to do. Practitioners must be qualified, and you have to find one you feel comfortable with and helped by. Reiki Healing - A Japanese form of healing through energy flow and which, interestingly, is also concerned with living in harmony with others, taking responsibility for one's own health and happiness, helping others, and being positive about all things. Shiatsu - Traditional Japanese physical therapy, using a range of techniques from gentle touch to more dynamic work to improve specific conditions and general health. A qualified practitioner will take a detailed history from you and avoid more dynamic techniques where they might be contra-indicated for your condition. Check with your doctor or physiotherapist before trying. Tai Chi - A soft, gentle and very powerful Chinese martial art, movement meditation, and way of healing through movement. Tai Chi works very well for older and ill people. It helps to free and balance the body, breathing and movement, and to find calm, stability, peace and deep security. If you have serious problems with feet, knees or walking it may not work for you. If that’s the case the exercises of Qigong (or Chi Kung) use the same principles but can be done sitting as well as standing. Tai Chi is a way to contact deep reserves of strength and ease. Trager Work - A form of bodywork and movement which utilises gentle, rhythmic movements to facilitate the release of stress patterns - physical, mental, and emotional. Created by a doctor and physiotherapist working with his own chronic pain since childhood, this method also has a meditation aspect. Yoga - The ancient Indian system of postures, exercises, breathing, and body and mind development and control. Popular and widely available these days. The basic exercises of Hatha Yoga, taught with careful respect for your physical problems and limitations, are a good place to start, along with pranayam breathing exercises. There are also some extremely challenging physical styles of yoga which may not be not at all appropriate. BE SURE your teacher knows what your physical problems are, and that your doctor has no problem with your doing yoga. That said, it is a wonderful combination of calm body, mind and spirit training and self-help therapy. GENERAL HELP WITH STROKE RELATED PROBLEMS The Stroke Association keeps it simple and has a TELEPHONE HELPLINE: 08453033100. For overview information and Complementary / Self-Help options, BBC HEALTH is easy to understand and helpful as always. As usual you can simplify your search by starting with the contacts in our FIRST RESOURCES section. The Age Concern and Help the Aged telephone help-lines can usually offer immediate guidance and assistance. Our selected Useful Organisations should help with any remaining needs. Stroke

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THE STROKE ASSOCIATION <a href="http://www.stroke.org.uk/">www.stroke.org.uk</a> Telephone HELPLINE 08453033100 BRAIN AND SPINAL INJURY CHARITY (BASIC) <a href="http://www.basiccharity.org.uk/">www.basiccharity.org.uk</a> National Help Line 0800 750 0000 Counselling, information and support services for patients and their families Email: <a href="mailto:Enquries@basiccharity.org.uk">Enquries@basiccharity.org.uk</a> HEADWAY (THE BRAIN INJURY ASSOCIATION) <a href="http://www.headway.org.uk/">www.headway.org.uk</a> The Headway UK Helpline provides information, advises on sources of support, finds local rehabilitation services and offers a listening ear to those experiencing problems. HELPLINE: 0808 800 2244 NATIONAL STROKE ASSOCIATION (USA) <a href="http://www.stroke.org">www.stroke.org</a> THE AMERICAN STROKE ASSOCIATION <a href="http://www.strokeasscociation.org/">www.strokeasscociation.org</a> ARCOS <a href="http://www.arcos.org.uk/">www.arcos.org.uk</a> The Association for Rehabilitation of Communication and Oral skills ARCOS is a national charity for people with communication and eating (swallowing) difficulties, their families, carers and others involved. ARCOS provides information, advice, practical help, specialist therapy training and other services not readily available elsewhere. BRAIN AND SPINE FOUNDATION <a href="http://www.brianandspine.org.uk/">www.brianandspine.org.uk</a> The Brain and Spine Helpline is a free and confidential service, open from Monday – Friday 9am-1pm - phone 0808 808 1000 BRAIN INJURY REHABILITATION TRUST (BIRT) <a href="http://www.birt.co.uk/">www.birt.co.uk</a> Tel 01924 896100 The Brain Injury Rehabilitation Trust (BIRT) helps people regain the skills lost as a result of brain injury – including strokes or illness. BRAIN TREE TRAINING <a href="http://www.braintreetraining.co.uk/">www.braintreetraining.co.uk</a> Tel: 01276 472 369 Email: <a href="mailto:enquiries@braintreetraining.co.uk">enquiries@braintreetraining.co.uk</a> Brain Tree produce home-based rehabilitation courses for those with acquired neurological injuries like stroke, and for anyone living with or helping a stroke patient. ROYAL COLLEGE OF SPEECH AND LANGUAGE THERAPISTS <a href="http://www.rcslt.org/">www.rcslt.org</a> Telephone 020 7378 1200 Email <a href="mailto:info@rcslt.org">info@rcslt.org</a> APHASIA NOW <a href="http://www.aphasianow.org/">www.aphasianow.org</a> 'Aphasia Now' is a website started by an aphasia sufferer who wanted to get in touch with like minded and other sufferers to learn more about the invisible disability. ASSOCIATION OF SPEECH AND LANGUAGE THERAPISTS IN INDEPENDENT PRACTICE <a href="http://www.asltip.co.uk/">www.asltip.co.uk</a> Telephone 0870 241 3357 (answerphone service) <a href="mailto:asltip@awdry.demon.co.uk">asltip@awdry.demon.co.uk</a> Can supply details of therapists by region or specific condition. LIFEBLOOD <a href="http://www.thrombosis-charity.org.uk/">www.thrombosis-charity.org.uk</a> For causes, effects, treatment and prevention of thrombosis BRITISH HEART FOUNDATION <a href="http://www.bhf.org.uk/">www.bhf.org.uk</a> Telephone 0845 070870 BRITISH LUNG FOUNDATION <a href="http://www.lunguk.org/">www.lunguk.org</a> Telephone 020 7688 5555 CHEST, HEART AND STROKE SCOTLAND <a href="http://www.chss.org.uk/">www.chss.org.uk</a> Telephone 0845 077 6000 CONNECT - THE COMMUNICATION DISABILITY NETWORK help with aphasia and communication problems <a href="http://www.ukconnect.org/">www.ukconnect.org</a> Telephone 020 7367 0840. <a href="mailto:info@ukconnect.org">info@ukconnect.org</a> SPEAKABILITY <a href="http://www.speakability.org.uk/">www.speakability.org.uk</a> Tel: 020 7261 9572 Helpline: 0808 808 9572 Advice line for people with dysphasia (loss of language following stroke or head injury), their families and professionals. Advice on accessing services, benefits, holidays, equipment and computer technology. Also gives advice on self-help groups and speech therapy. FOR IMMEDIATE HELP WITH HEALTH QUESTIONS and GENERAL MEDICAL INFORMATION: See our FIRST RESOURCES section - especially MedlinePlus ( <a href="http://medlineplus.gov/">http://medlineplus.gov</a> ) BBC Health ( <a href="http://www.bbc.co.uk/health">www.bbc.co.uk/health</a> ), the Mayo Clinic (<a href="http://www.mayoclinic.com/">www.mayoclinic.com</a> ) and: MEDICINENET.COM <a href="http://www.medicinenet.com/">www.medicinenet.com</a> For a general guide and information base on any subject this is an excellent resource. NETDOCTOR <a href="http://www.netdoctor.co.uk/">www.netdoctor.co.uk</a> Attempts to break down the "medical language barrier" between the doctor and the patient. Critical medical information presented in a clear and understandable language so that the patient fully understands his or her choices and decisions. THE COCHRANE REVIEWS (<a href="http://www.cochrane.org/">www.cochrane.org</a>) The Cochrane Collaboration assesses most areas of health care. To do this, it is divided into Cochrane Review Groups, each of which concentrates on a specific healthcare area, including a Consumer Network that represents the interests of healthcare consumers. Type any condition into their website and get pretty comprehensive information. If you want clear scientific analysis of any health issue or practice, you’ll usually find it here. BANDOLIER: THE OXFORD MEDICAL SITE <a href="http://www.jr2.ox.ac.uk/bandolier/index.html">http://www.jr2.ox.ac.uk/bandolier/index.html</a> Bandolier is a journal of evidence-based medicine. Look up any subject for links and knowledge. Their “Healthy Livig Zone” is a bit of a goldmine on the subject. MERCK MEDICUS <a href="http://www.merckmedicus.com/">www.merckmedicus.com</a> Easy to use and the US doctor’s reference tool. See MERCK GERIATRIC for age related information.   FOR ANCILLARY MEDICAL THERAPIES (Physiotherapy etc): HEALTH PROFESSIONS COUNCIL <a href="http://www.hpcuk.org/">www.hpc-uk.org</a> Telephone 020 7582 0866 The HPC is a statutory regulator that works to protect the health and well-being of people using the services of health professionals. Find therapists and be sure they are approved / regulated practitioners. CHARTERED SOCIETY OF PHYSIOTHERAPY <a href="http://www.csp.org.uk/">www.csp.org.uk</a> Tel: 020 7306 6218 / 6666 Information on physiotherpaists, physiotherapy and how it can help with pain. THE ORGANISATION OF CHARTERED PHYSIOTHERAPISTS IN PRIVATE PRACTICE <a href="http://www.physiofirst.org.uk/">www.physiofirst.org.uk</a> Tel: 01327 354441 Details of private chartered physiotherapists in your area. OCCUPATIONAL THERAPISTS IN INDEPENDENT PRACTICE (OTIP) <a href="http://www.otipp.co.uk/">www.otipp.co.uk</a> Tel: 0800 389 4873 Information and find an occupational therapist FOR COMPLEMENTARY AND ALTERNATIVE THERAPIES: THE COMPLIMENTARY HEALTHCARE INFORMATION SERVICE <a href="http://www.chisuk.org.uk/">www.chisuk.org.uk</a> Easy reference to learn about any and (just about all) complementary techniques. A truly excellent way to learn what the main comlementary techniques are, how they might work for you, and to explore the subject THE NETDOCTOR DR FOSTER COMPLEMENTARY PRACTITIONER DIRECTORY <a href="http://netdoctorcomplementarytherapistguide.drfoster.co.uk/">http://netdoctorcomplementarytherapistguide.drfoster.co.uk</a> If you are looking to find a reliable complementary therapy practitioner in your area, this directory is an essential resource. It can help you find a practitioner who meets your needs. This might be someone who has a particular interest in your condition, or who works at a practice near to your home, at hours that suit your needs. THE BRITISH COMPLEMENTARY MEDICINE ASSOCIATION <a href="http://www.bcma.co.uk/">www.bcma.co.uk</a> Tel 0845 345 5977 Find qualified practitioners of most therapies, learn about therapies, get recognised guidance through the therapy minefield and find a therapist near you. WHOLE HEALTH MD <a href="http://www.wholehealthmd.com/">www.wholehealthmd.com</a> American WholeHealth Networks' Complementary and Alternative Medicine (CAM) education website. The site is dedicated to providing integrative health and wellness solutions by combining the resources of both scientific health research and CAM. Click on specific health issues for information on conventional medicine, alternative therapies, supplements, diet, lifestyle options, and much more. HOLISTIC ONLINE <a href="http://www.holisticonline.com/">www.holisticonline.com</a> Comprehensive site for Alternative and Integrative Medicine. Learn about conditions and treatments. INSTITUTE FOR COMPLEMENTARY MEDICINE www.i-c-m.org.uk The ICM is a UK registered charity providing information on all aspects of the safe and best practice of Complementary Medicine. THE NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE <a href="http://nccim.nch.gov/">http://nccim.nch.gov</a> Vital and reputable information for the States. A treasure for understanding what’s what. THE ALTERNATIVE MEDICINE FOUNDATION <a href="http://www.amfoundation.org/">www.amfoundation.org</a> Excellent US site, good clear information. They also recommend: ALTERNATIVE MEDICINE RESOURCE <a href="http://www.altmedresource.com/">www.altmedresource.com</a> comprehensive and searchable catalog of all alternative medicine studies. Easy search by looking up your condition(s) or a key word.   FOR COMPLEMENTARY PRACTICTIONERS’ ASSOCIATIONS GENERAL OSTEOPATHIC COUNCIL www.osteopathy.org.uk Tel: 020 7357 6655 Provides details of qualified local osteopaths. BRITISH CHIROPRACTIC ASSOCIATION www.chiropractic-uk.co.uk Tel: 0118 950 5950 Information on chiropractic and details of local chiropractors. GENERAL CHIROPRACTIC COUNCIL <a href="http://www.gcc-uk.org/">www.gcc-uk.org</a> Tel: 020 7713 5155 Provides details of local chiropractors and information on what to expect when you see a chiropractor. It can also help if you've experienced a problem with a chiropractor. THE SOCIETY OF CHIROPODISTS AND PODIATRISTS <a href="http://www.feetforlife.org/">www.feetforlife.org</a> Telephone 020 7234 8620 GENERAL COUNCIL FOR MASSAGE THERAPY <a href="http://www.gcmt-uk.org/">www.gcmt-uk.org</a> Telephone 01992 537637 New voluntary regulation body for practitioners of massage. INTERNATIONAL FEDERATION OF AROMATHERAPISTS <a href="http://www.ifaroma.org/">www.ifaroma.org</a> Telephone 020 8992 9605 MUSIC THERAPY: see HEALTH PROFESSIONS COUNCIL above - <a href="http://www.hpcuk.org/">www.hpcuk.org</a> Telephone 020 7582 0866 THE BRITISH MEDICAL ACUPUNCTURE SOCIETY <a href="http://www.medical-acupuncture.co.uk/">www.medical-acupuncture.co.uk</a> Telephone 01925 730727 Medical doctors who practice acupuncture. Encourages the use and scientific understanding of acupuncture within medicine for the public benefit. ACUPUNCTURE ASSOCIATION OF CHARTERED PHYSIOTHERAPISTS <a href="http://www.longbo.demon.co.uk/aacp.html">www.longbo.demon.co.uk/aacp.html</a> Tel 01747 861151 Contact the AACP Secretariat for a register of members - qualified phyisos working with acupuncture. BRITISH ACUPUNCTURE COUNCIL <a href="http://www.acupuncture.org.uk/">www.acupuncture.org.uk</a> Tel: 020 8735 0400 Provides information on acupuncture and details of qualified traditional acupuncturists in your area. Phone or enclose an SAE for more information. NATIONAL INSTITUTE OF MEDICAL HERBALISTS <a href="http://www.nimh.org.uk/">www.nimh.org.uk</a> Telephone 01392 426022 Email nimh@ukexeter.freeserve.co.uk Professional body - offers a service for you to find a trained and qualified herbalist.   FOR DIET ADVICE: BRITISH NUTRITION FOUNDATION <a href="http://www.nutrition.org.uk/">www.nutrition.org.uk</a> Telephone 0207 404 6504 Includes advice on finding a dietician BRITISH DIETETIC ASSOCIATION <a href="http://www.bda.uk.com/">www.bda.uk.com</a> FOOD STANDARDS AGENCY <a href="http://www.eatwell.gov.uk/">www.eatwell.gov.uk</a> BBC HEALTH <a href="http://www.bbc.co.uk/health/healthy_living/nutrition">www.bbc.co.uk/health/healthy_living/nutrition</a> NHS DIRECT <a href="http://www.nhsdirect.nhs.uk/encyclopaedia">www.nhsdirect.nhs.uk/encyclopaedia</a>    FOR MEDITATION: THE SHOLLOND TRUST <a href="http://www.headless.org/">www.headless.org</a> tel. 020 8806 3710 - Richard Lang, Trust Co-ordinator The Trust offers a form of meditation you can do any time, any place, in any circumstances. It’s astoundingly easy to do, and it’s free. It’s also a great way to get the best out of and appreciate all other meditation and complementary techniques. THE BBC <a href="http://www.bbc.co.uk/">www.bbc.co.uk</a> and search “meditation”. A wide range of options. THE HITCHHIKER’S GUIDE TO THE GALAXY <a href="http://www.bbc.co.uk/dna/h2g2">www.bbc.co.uk/dna/h2g2</a> Ask the guide about meditation. In fact ask it about any question you have.   FOR COUNSELLING: BRITISH ASSOCIATION FOR COUNSELLING AND PSYCHOTHERAPY (BACP) <a href="http://www.bacp.co.uk/">www.bacp.co.uk</a> Telephone 0870 443 5252 Email bacp@bacp.co.uk A fisrt reference for anyone seeking information on counselling and psychotherapy in the United Kingdom. They have a helpful and easy to use search tool to find a therapist. THE SAMARITANS <a href="http://www.samaritans.org/">www.samaritans.org</a> Telephone 08457 90 90 90 (24 hours, seven days a week) Email <a href="mailto:jo@samaritans.org">jo@samaritans.org</a> Confidential non-judgemental support, 24 hours a day for people experiencing feelings of distress or despair. MIND <a href="http://www.mind.org.uk/">www.mind.org.uk</a> Telephone 020 8519 2122 Mind Infoline 0845 766 0163 (Monday-Friday 9:15-5:15) Email <a href="mailto:contact@mind.org.uk">contact@mind.org.uk</a> The MindinfoLine offers confidential help on a range of mental health issues from anywhere in the UK for the price of a local call. Local MIND associations offer supported housing, crisis helplines, drop-in centres, counselling, befriending, advocacy, employment and training schemes and other services. RELATE <a href="http://www.relate.org.uk/">www.relate.org.uk</a> Tel. 0845 456 1310 or 01788 573241 Relate is the UK's largest provider of relationship counselling and sex therapy. They also offer a range of other relationship support services. CRUSE BEREAVEMENT CARE <a href="http://www.crusebereavementcare.org.uk/">www.crusebereavementcare.org.uk</a> Day-to-day helpline: 0870 167 1677 Help for bereaved people, whatever their age, nationality or beliefs, including a free counselling service.   FOR CARE SERVICES: COUNSEL AND CARE <a href="http://www.counselandcare.org.uk/">www.counselandcare.org.uk</a> Advice line 0845 300 7585 (weekdays 10am-12.30pm and 2pm-4pm) A national charity getting the best care and support for older people, their families and carers SUE RYDER CARE <a href="http://www.suerydercare.org/">www.suerydercare.org</a> 020 7400 0440 Cares for people with life-shortening illnesses through specialist hospice care services. THE PRINCESS ROYAL TRUST FOR CARERS <a href="http://www.carers.org/">www.carers.org</a> Telephone 020 7480 7788 Email help@carers.org The trust is the largest provider of comprehensive carers support services in the UK. CARERS UK <a href="http://www.carersuk.org/">www.carersuk.org</a> Free Carers Line 0808 808 7777 (weekdays 10am-12pm and 2pm-4pm) Email info@ukcarers.org Carers UK is the voice of carers and the leading campaigning, policy and information organisation for carers. Provides information and advice on topics relating to caring. CARERS NATIONAL ASSOCIATION <a href="http://www.carersuk.org/">www.carersuk.org</a> Provides information and advice for carers and works for carers rights. CROSSROADS (The Association of Crossroads Care Attendant Schemes) <a href="http://www.crossroads.org.uk/">www.crossroads.org.uk</a> Tel: 0845 450 0350 Practical support for carers; respite care at home. Provides trained care support workers to allow carers the breaks and time off they need. CARE CHOICES LTD <a href="http://www.careselect.co.uk/">www.careselect.co.uk</a> Tel: 0800 389 2077 Care Choices Ltd offers a free residential/care home search service. The company has a database of care homes, nursing homes, elderly accommodation and similar establishments throughout the UK. HOSPICE INFORMATION <a href="http://www.hospiceinformation.info/">www.hospiceinformation.info</a> Tel: 0870 903 3903 Publishes a directory of hospice and palliative care services. FOR GENERAL UK HEALTH HELP, ISSUES and the NHS: NHS DIRECT ( <a href="http://www.nhsdirect.nhs.uk/">www.nhsdirect.nhs.uk</a> ) - see First Resources PATIENTS ASSOCIATION <a href="http://www.patients-association.com/">www.patients-association.com</a> Helpline: 0845 608 4455 Represents the views and interests of patients and campaigns for improved health services. Provides advice, factsheets and self-help guides. DR FOSTER <a href="http://www.drfoster.co.uk/">www.drfoster.co.uk/</a> Telephone 0207 332 8800 Works with the NHS to make it easier for professionals and the public to access health and social care information. Hospitals, consultants, complementary therapies and much more. PALS - PATIENT ADVICE AND LIAISON SERVICE (<a href="http://www.dh.gov.uk/">www.dh.gov.uk</a>) This web address will take you to the Department of Health website. Click on Patient Advice and Liaison Service to find your local PAL. Information and help with any questions or problems you have about your GP service, NHS hospital or other NHS service. EQUIP - ELECTRONIC QUALITY INFORMATION FOR PATIENTS <a href="http://www.equip.nhs.uk/">www.equip.nhs.uk</a> NHS search website for patient information on a very wide variety of conditions. RSVP - RETIRED AND SENIOR VOLUNTEER PROGRAMME <a href="http://www.csv-rsvp.org.uk/">www.csv-rsvp.org.uk</a> Advice and help for over 50’s by over 50’s: Transport for medical care, practical and domestic help, avoiding isolation, help for over 50’s in GP surgeries. LTCA - LONG TERM CONDITIONS ALLIANCE <a href="http://www.ltca.org.uk/">www.ltca.org.uk</a> An umbrella body for voluntary organisations. Promotes access to services, support, and knowledge for self-help. Includes an “Expert Patients” programme with the NHS. Look at the directory of member organisations on their website for the help you need, or RING THEM on 02078153637. PATIENT CONCERN <a href="http://www.patientconcern.org.uk/">www.patientconcern.org.uk</a> Helpful advice on how to survive medical treatment and the NHS, how to assess medical websites and more.   FOR EXERCISE: There are many possibilities to choose from, and you may be surprised what you can do and what you’ll enjoy. Just be sure to get your doctor’s and/or physiotherapist’s advice on any medical limitations and what to avoid. SIMPLE WAYS to look at the possibilities are with the help of: THE BBC - Go to <a href="http://www.bbc.co.uk/health">www.bbc.co.uk/health</a> BANDOLIER - go to <a href="http://www.jr2.ox.ac.uk/bandolier">www.jr2.ox.ac.uk/bandolier</a> and see Exercise in their healthy living section THE NHS Health encyclopaedia: <a href="http://www.nhsdirect.nhs.uk/">www.nhsdirect.nhs.uk</a> in our FIRST RESOURCES section has good information. THE COMPLIMENTARY HEALTHCARE INFORMATION SERVICE <a href="http://www.chisuk.org.uk/">www.chisuk.org.uk</a> links to all the main movement therapy exercise techniques. A one-stop convenience shop. And specifically for: TAI CHI - local adult education courses, local gym, fitness centre, library listing or the TAI CHI UNION OF GREAT BRITAIN - <a href="http://www.taichiunion.com/">www.taichiunion.com</a> PILATES <a href="http://www.pilatesfoundation.com/">www.pilatesfoundation.com</a> YOGA <a href="http://www.bwy.org.uk/">www.bwy.org.uk</a> DANCING - ballroom, tap, folk, flamenco, modern, social, jazz… too many styles to list. Once again the easy place to start is THE BBC. Go to <a href="http://www.bbc.co.uk/health">www.bbc.co.uk/health</a> and look under dance. Also many classes locally in many styles. GYMS / CIRCUIT TRAINING / SPORT - Infinite options. BBC Health provides guidance.   <a name="compalt2" id="compalt2"></a>EXERCISE IN WATER: AQUA-CHI <a href="http://www.taichiunion.com/">www.taichiunion.com</a> AQUA-GYM <a href="http://www.aquagym.co.uk/">www.aquagym.co.uk</a> POOLATES <a href="http://www.poolates.co.uk/">www.poolates.co.uk</a> Pilates in water. AQUA-DANCE classes at local pools or <a href="http://www.virginactive.co.uk/">www.virginactive.co.uk</a> for classes at their gyms   FOR GENERAL SELF-HELP ON MOST SUBJECTS: DIRECTORY OF UK SELF-HELP GROUPS www.ukselfhelp.info/ This is a remarkably complete A-Z of self-help organisations on just about any health subject you can think of and life problems of most kinds. FOR PRACTICAL GENERAL INFORMATION ON MOST SUBJECTS: <a href="http://www.about.com/">www.about.com</a> <a href="http://www.bbc.co.uk/">www.bbc.co.uk</a> <a href="http://www.bbc.co.uk/dna/h2g2">www.bbc.co.uk/dna/h2g2</a> <a href="http://www.wikipedia.org/">www.wikipedia.org </a>   FOR PHYSICAL AIDS AND EQUIPMENT - ACCESS, MOBILITY AND PRACTICAL HELP: DISABLED LIVING FOUNDATION (DLF) <a href="http://www.dlf.org.uk/">www.dlf.org.uk</a> Tel: 020 7289 6111 Helpline: 0845 130 9177 Text phone: 020 7432 8009 DLF are the leading source of information on disability equipment - free, impartial advice about all types of equipment and mobility products INDEPENDENT LIVING FUNDS <a href="http://www.ilf.org.uk/">www.ilf.org.uk</a> Tel: 0845 601 8815 Email: client.service@ilf.org.uk The funds were set up as a national resource dedicated to the financial support of disabled people enabling them to choose to live in the community rather than residential care. DISCOUNT MOBILITY PLUS LTD For scooters, wheelchairs, bathlifts, stairlifts, chairs <a href="http://www.discountmobilityplus.co.uk/">www.discountmobilityplus.co.uk</a> Tel: 0808 178 4151 DISABILITY ALLIANCE www.disabilityalliance.org The leading authority on social security benefits for disabled people Tel: 020 7247 8776 MOBILISE - THE DISABLED DRIVERS’ ASSOCIATION <a href="http://www.justwebs.co.uk/mobilise/">www.justwebs.co.uk/mobilise/</a> Tel: 01508 489449 (Representation, information and advice on mobility issues) DISABILITY RIGHTS COMMISSION <a href="http://www.drc-gb.org/">www.drc-gb.org</a> DRC Helpline Tel: 08457 622 633 Textphone: 08457 622 644 The Disability Rights Commission (DRC) is an independent body established in April 2000 by Act of Parliament to stop discrimination and promote equality of opportunity for disabled people. RELATIVES AND RESIDENTS ASSOCIATION www.relres.org Tel: 020 7359 8136 Provides information and support about carehomes. ROYAL ASSOCIATION FOR DISABILITY AND REHABILITATION (RADAR) www.radar.org.uk Tel: 020 7250 3222 Minicom: 0207 250 4119 RADAR is concerned with every aspect of disability, but is particularly involved with access, education, employment, holidays, housing, mobility and social services. CITIZENS ADVICE BUREAUX (CABx) <a href="http://www.nacab.org.uk/">www.nacab.org.uk</a> The website gives local offices, opening times and specialist services.   AGE CONCERN AID CALL <a href="http://www.aidcall-alarms.co.uk/">www.aidcall-alarms.co.uk</a> T: 0800 77 22 66 Emergency alarms to stay independent but summon help if needed MEDIC ALERT FOUNDATION <a href="http://www.medicalert.co.uk/">www.medicalert.co.uk</a> tel 02078333034 Medical identification, cards, bracelets, necklaces etc with information on call for emergency treatment. Knowing your chronic problems and what medications you’re on can make a critical difference for any doctor or emergency worker treating you in any situation. <a name="working" id="working"></a>  FOR FIRST AID TRAINING - and we always recommend this as part of learning to take care of ourselves and each other: RED CROSS <a href="http://www.redcross.org.uk/">www.redcross.org.uk</a> ST JOHN’S AMBULANCE <a href="http://www.sja.org.uk/">www.sja.org.uk</a> ST ANDREW’S AMBULANCE (Scotland) <a href="http://www.firstaid.org.uk/">www.firstaid.org.uk</a>   ALZHEIMER'S DISEASE (AD) is the most common form of dementia among older people. It is very rare among people under 60, more common in those over 85. It’s a brain disorder which seriously and increasingly affects a person's ability to function and carry out daily activities. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/al_1.jpg" /></div> There are a number of conditions producing some of the symptoms of Alzheimer’s. If you have such symptoms obviously see your doctor first and right away. You may have something else entirely which may be curable. Alzheimer’s is not currently curable. There are exciting recent prospects, but at this time all strategies are about slowing the progress of the condition and coping with all the related problems. You will find that there are a remarkable number of ways for both sufferers and carers to get help and support which can make a huge difference. In Alzheimer's disease, the ability to remember, think, understand, communicate, and control behaviour progressively declines because brain tissue degenerates. The symptoms of Alzheimer's disease are similar to those of other dementias and some totally unrelated conditions. They include memory loss, changes in personality, problems using language, disorientation, difficulty doing daily activities, and disruptive behaviour. A person with Alzheimer's disease may not have all the symptoms. Symptoms usually begin subtly. People may not notice any changes at first, depending on what activities they are involved in. At some point, people with Alzheimer's disease may notice they are not doing their job or activities quite as well as in the past. In most people with Alzheimer's disease, the first sign is forgetting recent events. In some people it may begin with changes in personality. Changes can include becoming emotionally unresponsive, depressed, or unusually fearful or anxious. Emotions may rapidly and unpredictably change from one extreme to another. Early in the disease, people have difficulty using language. They may use a general word or many words rather than a specific word, use words incorrectly, or be unable to find the right word. They become less able to use good judgment and think abstractly. Please note that there are a number of other problems and conditions which can produce some or all of these early symptoms. Disruptive or inappropriate behaviour is common with Alzheimer’s. People with the disease may become agitated, irritable, hostile, and physically aggressive. Many of them wander. Many people with Alzheimer's disease have insomnia. They have trouble falling or staying asleep. Some people become confused about day and night. Thinking it is day, they may get up and get dressed in the middle of the night. As Alzheimer's disease progresses, some people have psychotic symptoms, such as hallucinations, delusions, or paranoia. The progress of the disease is unpredictable. After symptoms begin, people live, on average, 8 to 10 years. During a good part of this time, many people continue to enjoy much of what they enjoyed before developing Alzheimer's disease. Eventually memory is completely lost, and people with Alzheimer's disease become totally dependent on others. Once people can no longer walk, they live, on average, about 6 months (although some bed-bound people can live much longer). Even at these late and dependent stages, techniques in our Self Help and Complimentary Therapies sections can be of real benefit. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/al_2.jpg" /></div> WHAT CAUSES DEGENERATION of brain tissue in Alzheimer's disease is unknown, although the mechanism involves proteins combining. For most people, the cause seems to be a combination of genes and environment. While there is evidence that there may be environmental factors involved, what they are is not yet clear. For some people, genes appear to be a deciding factor. The disease seems to run in some families, particularly when it develops at an early age, but: Note that having close family members with Alzheimer’s does not mean you will get the disease. While the cause is presently unknown, it is clear that In Alzheimer's disease brain tissue degenerates in a particular way. Nerve cells are lost. Tangles (neurofibrillary tangles) form in nerve cells, and clumps (senile or amyloid plaques) form between nerve cells. People with Alzheimer's disease also have a low level of acetylcholine in the brain. Acetylcholine is a chemical that helps nerve cells communicate with one another. DIAGNOSIS: If dementia is diagnosed in an older person and the person's memory has gradually deteriorated, doctors suspect Alzheimer's disease. The diagnosis is based partly on symptoms, which are identified by asking the person and family members or other caregivers questions. The diagnosis is also based on a physical examination and the results of tests, such as mental status tests, blood and urine tests, and computed tomography (CT) or magnetic resonance imaging (MRI). This information helps doctors exclude other types and causes of dementia. Such a diagnosis is correct most of the time. Some people with Alzheimer's disease also have atherosclerosis. Atherosclerosis can lead to strokes, which sometimes result in vascular dementia. Thus, such people may have two types of dementia at once. YOUR GP SHOULD BE CONSULTED FIRST if you are concerned that you or someone you are caring for may have Alzheimer’s or another dementia. DON’T DELAY TALKING TO YOUR GP. Alzheimer’s-like symptoms can be the result of something else. Health problems producing such worrying symptoms can include certain heart conditions, chest and urinary infections, sight - hearing and emotional problems, the side-effects of some drugs, severe constipation (strange but true), vitamin and thyroid deficiencies and brain tumours and other conditions - all of which may be treatable. IF THE DIAGNOSIS IS PROBABLE ALZHEIMER’S, getting it early will help in terms of possible early stage medications (see out “Therapies” section). A FULL MEDICAL ASSESSMENT will mean that both patient and carers get much needed help from extended medical teams and social services. COMMUNITY CARE ASSESSMENT is a vital next step after diagnosis and medical assessment for treatment. If a person is confused or has dementia and needs support, their local authority social services department should be asked to carry out a community care assessment. If this assessment shows that the person needs certain services, the local authority has a duty to ensure that these services are provided. SEE OUR GENERAL HELP WITH ALZHEIMER’S RELATED PROBLEMS section for more on community care assessment.

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DRUG TREATMENTS The symptoms of Alzheimer’s worsen as brain cells die and the connections between cells are lost. Although current drugs cannot alter the progressive loss of cells, they may help minimize or stabilize symptoms. These medications may also delay the need for residential care. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/al_3.jpg" /></div> The Senior Alliance notes its gratitude to The Alzheimer’s Society for fighting a high court battle against NICE (National Institute of Clinical Excellence) for refusing advanced Alzheimer’s drugs to early and late stage NHS patients on the basis that they are too expensive at a cost of £2.50 a day and not cost effective. As you’ll see from their website: “The Alzheimer’s Society continues to campaign for drugs to be made freely available to anyone who may benefit from them”. If and as allowed by NICE, doctor’s have access to a number of drug treatments which can temporarily slow down the progression of Alzheimer’s symptoms in some people. Aricept, Exelon and Reminyl all work in a similar way and are known as acetylcholinesterase inhibitors. There is also a newer drug, Ebixa, which works in a different way to the other three. ARICEPT, EXELON AND REMINYL Research has shown that there is not enough of the chemical ‘acetylcholine’ in the brains of people with Alzheimer's disease. Acetylcholine is one of the chemicals that nerve cells use to communicate. Aricept, Exelon and Reminyl prevent an enzyme known as acetylcholinesterase from breaking down acetylcholine in the brain. Increased acetylcholine lead to increased communication between nerve cells, which may in turn temporarily improve or stabilise the symptoms of Alzheimer's disease. Aricept, Exelon and Reminyl work in similar ways. However, Reminyl also appears to act on the nicotinic neuronal receptors in the body, making them release more acetylcholine. As well as stopping acetylcholine breaking down, Reminyl can help more of it to be produced. It is possible that one of these drugs might suit an individual better than another. EBIXA (MEMANTINE) The action of Ebixa is quite different to, and more complex than, that of Aricept, Exelon and Reminyl. Ebixa blocks a messenger chemical, known as a neurotransmitter glutamate. Glutamate is released in excessive amounts when brain cells are damaged by Alzheimer's disease, which causes the brain cells to be damaged further. Ebixa can protect brain cells by blocking this release of excess glutamate. Medline Plus says “US research has suggested that a combination of Aricept and Ebixa is more effective than Aricept alone. Although this research is not conclusive, there is little evidence to support a contrary view. Ebixa works in a completely different way from the acetylcholinesterase inhibitors.” Whether doctors will be allowed to prescribe both drugs together on the NHS, is unclear. At present Aricept, Exelon and Reminyl are only used in people with mild to moderate Alzheimer's disease. They are not effective for everyone and may only temporarily improve memory or delay memory loss. Research is ongoing to find out whether any of these drugs may be effective in the later stages of Alzheimer's disease. Ebixa, however, can temporarily slow down the progression of symptoms in people in the middle and later stages of the disease. This is the first time a drug has been available for this group of people. There is also a suggestion that Ebixa may slow down the disease process itself. There are side-effects to be considered with all the drugs used for Alzheimer’s. Side-effects of Ebixa include hallucinations, confusion, dizziness, headaches and tiredness. Caution is also recommended for people with epilepsy and heart problems. Researchers continue to study drugs that may prevent or slow the progression of Alzheimer's disease. Nonsteroidal anti-inflammatory drugs (NSAIDs), commonly used to treat arthritis, are an example. Very exciting progress has been shown in a study published in the journal Molecular and Cellular Neuroscience and reported in the Guardian on 24 July 2007. This deals with a two-protein mechanism for plaque formation. Most encouragingly, it shows how a third protein may be used to disrupt this mechanism at an early stage. This indicates a way in which Alzheimer’s may be stopped at an early stage and even reversed. So far it looks good in mice, and the years of development seeking to create a viable drug are underway. OBTAINING EXISTING ALZHEIMER’S DRUGS NICE has recommended that Aricept, Exelon and Reminyl should be available on NHS prescription for anyone with a diagnosis of Alzheimer's disease who could benefit from the drug treatment. In the first instance, these drugs can only be prescribed by a consultant. A GP will need to refer the person to a hospital for a specialist assessment. A consultant will carry out a series of tests to assess whether the person is suitable for treatment and will write the first prescription if appropriate. Subsequent prescriptions may be written by the GP or the consultant. Private prescriptions can be obtained either through a consultant, a GP or a private hospital. Private prescriptions are subject to consultation fees, prescription charges and dispensing fees, which vary. The current cost of these drugs to the NHS ranges from £800 to £1,000 per patient per annum. COMMUNITY CARE is available for Alzheimer’s. GETTING AN ASSESSMENT for this and getting all the many forms of help it provides is extremely important. You can speak to your doctor about getting this ongoing support, and be sure to see our section on GENERAL HELP WITH ALZHEIMER’S RELATED PROBLEMS to learn more. You can contact the ALZHEIMEIR’S SOCIETY, see the BBC HEALTH website, or go to any of the Useful Organisations we list to start learning about and accessing these options. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/al_4.jpg" /></div> COMPLEMENTARY THERAPIES / ALTERNATIVE MEDICINE Both patients and carers can benefit from alternative approaches to life and complimentary therapies from the moment of diagnosis onward. This is one of the conditions where supplements and alternative therapies have shown very worthwhile results. In terms of how we see and make sense of life, the challenge of Alzheimer’s couldn’t be more profound. How do you deal with the prospect of losing past memories and facing a distressing future? As a carer, how do you deal with the thought of all the challenges and loss to come? Having done a great deal of research on this, we will make a basic suggestion: LIVE NOW. The past is gone. The future doesn’t exist. An asteroid could blow us all up tomorrow. This is actually good advice for any condition, and for life in general. Worrying about the past and the future rather than living now is something we all tend to do. This is easier to say than to do, but you will find help under Meditation in this section, or contact the Senior Alliance editor through Contact Us on this website Complimentary and alternative therapies and techniquescan give you practical ways to let go of the imaginary future, be calmed and connected to the present, and improve your condition in a number of ways. The following may help: AROMATHERAPY Aromatherapy is the therapeutic use of essential oils derived from plants. The oils can usually be: Applied directly to the skin, often accompanied by massage Heated in an oil burner to produce a pleasant odour Placed in a bath. The oils are concentrated and should be used according to instructions - they must be diluted, for example, before being applied to the skin. An aromatherapist can work with the patient and help carers to use this technique. Research funded by the Mental Health Foundation in 2000 highlighted the potential benefits of aromatherapy, specifically the use of melissa officinalis, or lemon balm, in the treatment of Alzheimer's disease. Researchers at Newcastle University's Medicinal Plant Research Centre believe that lemon balm may help prevent the loss of the key brain chemical acetylcholine. Lemon balm may then work in the same way as the first generation of drugs for Alzheimer's disease, Aricept and Exelon. This research suggests that aromatherapy may have a more specific role in the treatment of Alzheimer's than aiding relaxation. In 2002, a paper by Alistair Burns in the British Medical Journal added weight to the potential benefits of aromatherapy for people with dementia, used as an alternative to neuroleptic drugs. MASSAGE There is some evidence that massage - either alone or in combination with aromatherapy - is effective in helping people with dementia to relax. A number of studies have shown such benefits from massage and touch therapies. Massage with lavender oil has shown a reduction in agitated behaviour. MUSIC THERAPY Music therapy is the creative use of musical improvisation by both client and practitioner to create a relationship in which healing can take place. A review of music therapy for dementia concluded that, based on the available evidence, it may be beneficial in treating symptoms and improving the quality of life of people with dementia and their carers. ACUPUNCTURE A number of studies have addressed the use of acupuncture for treating Alzheimer's disease, the decline in mental functioning, and associated mental problems (anxiety and depression). Although these studies all report positive effects they are apparently considered to be limited and preliminary findings. MEDITATION Recommended for most conditions (see BBC Health in First Resources). Some meditation techniques can be learned in moments and be effective for both early-stage patients and for carers. See the website of the Shollond Trust in our Useful Organisations section for one of these. If you are a religious person, your religion or place of worship may offer help with meditation. MELATONIN AND BRIGHT LIGHT THERAPY The hormone melatonin, released by the pineal gland and considered important in regulating sleeping behaviour, has been cited as a beneficial supplement for patients with sleep disturbances. Sleep disorders and disruptive nocturnal behaviour associated with dementia present a significant clinical problem. A characteristic pattern of sleep disturbance referred to as 'sundowning' has been described. This shows itself in increased arousal and activity, usually in the late afternoon, evening or night and is a cause of increased stress for carers. There is considerable theoretical evidence to support the use of melatonin as a treatment for sleep disturbance associated with dementia. Melatonin is a hormone implicated in the control of the sleep-wake cycle. It is stimulated during darkness and suppressed by light. While the effects of melatonin have been extensively studied in animals, there is growing evidence that melatonin is also involved in the regulation and control of sleep and waking patterns in humans. Dementia appears to disturb these patterns. Bright light therapy may also be useful, but possibly not in combination with melatonin. Consult the Alzheimer’s Society and talk to your doctor about the availability, appropriateness and use of these therapies. <a name="Supp" id="Supp"></a>BASIC DESCRIPTIONS OF COMPLEMENTARY TECHNIQUES AND THERAPIES FOLLOW. These are among the better known. They may be useful at earlier stages, some even as the disease progresses, and have value for carers throughout: Acupuncture - Well known Chinese therapy using fine needles to change energy flows. Evidence of effectiveness in dealing with pain and other problems, at least short term. High level qualified practitioner essential. Acupressure - Same principles as acupuncture, using pressure instead of needles. You can learn to do some acupressure yourself. Alexander Technique - Technique for learning how to efficiently and effortlessly use your body. Simple but profound approach to letting go of harmful tensions in posture and breathing. A safe and effective learning and therapy technique. It doesn’t sound like much but it’s a physically liberating and undemanding technique. Aromatherapy - The art of applying essential oils to suit individual needs. The oils work directly on the chemistry of the body, via the skin and bloodstream. May seem unlikely, but a number of medical sites assure us that it can be surprisingly effective and safe. Art Therapy - Use of art for emotional therapy. Early evidence of effectiveness was with survivors returning from World War 2. Pain and healing are strongly affected by emotion, so makes sense. Ayurveda - The most important form of medicine in India. An ancient tradition, but most practitioners are also doctors or otherwise medically qualified. Ayurveda seeks to balance the body and mind, find health problems before they occur or stop them doing unnecessary harm. Obviously requires a qualified practitioner and is complementary to, not a replacement for conventional medical treatment. Biofeedback - Machines give you feedback about how your body is working, allowing you to learn to regulate reactions causing problems. Evidence of usefulness for therapy and self-education for many conditions. Bowen Technique - soft and non-invasive holistic treatment that aims to restore balance to the body by using small, gentle moves to specific areas of the body. Because the therapy is so gentle, it is considered to be suitable for all ages and most conditions. Chiropractic - Manipulation of spine and muscles for good balancing and health functioning. A powerful technique and NOT to be used for many conditions. Check with your doctor, and see Useful Organisations for help finding a qualified and registered practitioner. Cognitive and Behaviour Therapies - Put crudely: It’s not what happens that causes the problems, it’s how you understand it and what you do with it. Less crudely, these have medical and government recognition for a wide variety of problems and can be startlingly effective in many cases. Many of us who they have helped consider them to be most remarkable life tools. Feldenkrais Method - Not a therapy as such, but a well established method for learning greater ease of physical movement and increasing vitality and well-being. Guided Imagery - The use of imagination as potent healer. Pleasant and powerful. See “Holistic Online” in Useful Organisations to learn more. Healing - comes in many forms, from spiritual or religious to using energy flow as understood in martial arts. Whether the effectiveness is due to a placebo effect, energy flows or spirit, many people have been helped by healings throughout history. Herbal medicine - Herbal medicines can be very powerful, and are the basis of many conventional drugs. A good herbal practitioner looks at the whole person and health, not just the disease or condition. Because they can be very strong and conflict with prescribed medications, you absolutely need to tell your doctor what you’re going to be taking. A herbal remedy can destroy your therapy and health if it’s the wrong one for you. Homoeopathy - famous and controversial. Vanishingly small amounts of a substance in water are given. Many in medical science consider this to be absurd. No conclusive proof either way, but many people have found help and relief. Hard to argue with happy patients, and it has the great virtue of being harmless. That said, neglecting medical treatment to depend on homeopathy is an enormous mistake, as your qualified homeopath will agree. Hypnotherapy - not in any way a frightening experience or loss of consciousness or control, safe in qualified hands, and considered very effective in helping with chronic pain, anxiety, depression and other condition related problems. Louise Hay techniques - based on the use of positive affirmations - highly recommended by many people for effectively changing your mindset and health. A place to start is the Louise Hay book “You Can Change Your Life” and audio tapes from Amazon. As we keep saying throughout this website, mindset can profoundly affect healing. Massage Therapy - There are many forms of massage, and they can be a great help in stress reduction, release of chronic muscle tensions around arthritis, and can have many other therapeutic effects depending on the technique used. Having your body cared for like this is great, but: be aware that deep or powerful massage pressure can be dangerous for some conditions. Check with your doctor or physio about what to avoid. It is important that your therapist asks what your medical / physical situation is. If they are not qualified, or you are not comfortable with them as a patient or carer for a patient, you are in the wrong hands. Don’t risk damage. Move on. Medau Movement - Enjoyable exercise to music for improving body use and posture, and good for stress reduction. Meditation - A truly profound way to deal with stress and the human condition. Good meditation teaching is simple, and the result should be access to peace and stillness whatever is happening and wherever you are - at home, on the street, at work… We give contacts for meditation in Useful Organisations. We’ve recommended the approach of the Shollond Trust as it’s fast, free, and a good starting place for appreciating all forms of meditation. We also like BBC Health and the H2G2 recommendations about meditation. Naturopathy - Technique for helping the body to heal itself, and often incorporates a number of the other techniques discussed here. Interesting to have one technique using the strengths of others. In capable hands this can be very effective for some people. NLP (Neuro-linguistic Programming) - A fascinating form of therapy, looking at how you do what you do, and how to change. We like this sentence from a practitioner: “If you always do what you've always done, you'll always get what you've always got. If what you're doing isn't working, do something else". Far more to it than that of course, and worth learning about - especially for carers. Osteopathy - Certainly among the best known physical therapies and very well accepted as a complementary therapy. Osteopathy is highly regulated. Physical manipulation and massage techniques are used to help correct problems with the muscles, bones, and joints and influence many of the body’s systems. A good practitioner will ask in detail about your condition to not do harm with inappropriate manipulations. Practitioner be qualified, registered, and take a medical history to understand what your condition is. Pilates - Exercise method to method to strengthen the core postural muscles and develop balanced alignment through the use of slow, controlled movements and breathing. Often recommended by doctors, physiotherapists, and used by everyone from top professional athletes and dancers to people who have never done much exercise or thought they were unable to due to physical limitations. Teacher must understand your condition. Psychology of Mind - The book “Slowing Down to the Speed of Life” from Amazon is the well known place to start. POM techniques and understandings are simple and can be life changing. A way to use your problems to vastly improve your life. For the anxieties associated with illness (not to mention life) this is something special. Psychotherapy - Many forms, and a vital and immensely beneficial approach for many people. The idea that psychotherapy is for crazies couldn’t be more wrong. It’s one of the best learning and healing tools and most interesting things you could choose to do. Practitioners must be qualified, and you have to find one you feel comfortable with and helped by. Reiki Healing - A Japanese form of healing through energy flow and which, interestingly, is also concerned with living in harmony with others, taking responsibility for one's own health and happiness, helping others, and being positive about all things. Shiatsu - Traditional Japanese physical therapy, using a range of techniques from gentle touch to more dynamic work to improve specific conditions and general health. A qualified practitioner will take a detailed history from you and avoid more dynamic techniques where they might be contra-indicated for your condition. Check with your doctor or physiotherapist before trying. Tai Chi - A soft, gentle and very powerful Chinese martial art, movement meditation, and way of healing through movement. Tai Chi works very well for older and ill people. It helps to free and balance the body, breathing and movement, and to find calm, stability, peace and deep security. If you have serious problems with feet, knees or walking it may not work for you. If that’s the case the exercises of Qigong (or Chi Kung) use the same principles but can be done sitting as well as standing. Tai Chi is a way to contact deep reserves of strength and ease. Trager Work - A form of bodywork and movement which utilises gentle, rhythmic movements to facilitate the release of stress patterns - physical, mental, and emotional. Created by a doctor and physiotherapist working with his own chronic pain since childhood, this method also has a meditation aspect. Yoga - The ancient Indian system of postures, exercises, breathing, and body and mind development and control. Popular and widely available these days. The basic exercises of Hatha Yoga, taught with careful respect for your physical problems and limitations, are a good place to start, along with pranayam breathing exercises. There are also some extremely challenging physical styles of yoga which may not be not at all appropriate. BE SURE your teacher knows what your physical problems are, and that your doctor has no problem with your doing yoga. That said, it is a wonderful combination of calm body, mind and spirit training and self-help therapy.   SUPPLEMENTS, SNAKE-OILS AND DIETS VITAMIN E supplements are often prescribed as a treatment for Alzheimer’s disease, because they may help brain cells defend themselves from “attacks.” Normal cell functions create a byproduct called a free radical, a kind of oxygen molecule that can damage cell structures and genetic material. This damage, called oxidative stress, may play a role in Alzheimer’s disease. Cells have natural defences against this damage, including the antioxidants vitamins C and E, but with age some of these natural defences decline. Research has shown that taking vitamin E supplements may offer some benefit to people with Alzheimer’s. Most people can take vitamin E without side effects. However, any change in medications should first be discussed with a primary care physician because all medication can cause side effects or interactions with other medications. A person taking “blood-thinners,” for example, may not be able to take Vitamin E or will need to be monitored closely by a physician. Dosage must be controlled. Vitamin E is harmful in excessive doses. GINKGO BILOBA Ginkgo biloba is a plant extract containing several compounds that may have positive effects on cells within the brain and the body. Ginkgo biloba is thought to have both antioxidant and anti-inflammatory properties, to protect cell membranes, and to regulate neurotransmitter function. Ginkgo has been used for centuries in traditional Chinese medicine and currently is being used in Europe to alleviate cognitive symptoms associated with a number of neurological conditions. In a study of Alzheimer’s patients published in the Journal of the American Medical Association (October 22/29, 1997), Pierre L. Le Bars, MD, PhD, of the New York Institute for Medical Research, and his colleagues observed in some participants a modest improvement in cognition, activities of daily living (such as eating and dressing), and social behaviour. Results from this study show that ginkgo may help some individuals with Alzheimer’s disease, but further research is needed to determine the exact mechanisms by which Ginkgo works in the body. Also, results from this study are considered preliminary because of the low number of participants, about 200 people. Few side effects are associated with the use of Ginkgo, but it is known to reduce the ability of blood to clot, potentially leading to more serious conditions, such as internal bleeding. This risk may increase if Ginkgo biloba is taken in combination with other blood-thinning drugs, such as aspirin and warfarin. Currently, multicenter trial with about 3,000 participants is investigating whether Ginkgo may help prevent or delay the onset of Alzheimer’s disease or vascular dementia.   HUPERZINE A Huperzine A (pronounced HOOP-ur-zeen) is a moss extract that has been used in traditional Chinese medicine for centuries. Because it has properties similar to those of U.S. Food and Drug Administration approved Alzheimer medications, it has been promoted as a treatment for Alzheimer’s disease. Evidence from small studies shows that the effectiveness of huperzine A may be comparable to that of the approved drugs. Large-scale trials are needed to better understand the effectiveness of this supplement. In Spring 2004, the National Institute on Aging (NIA) launched the first U.S. clinical trial of huperzine A as a treatment for mild to moderate Alzheimer’s disease. Because huperzine A is a dietary supplement, it is unregulated and manufactured with no uniform standards. If used in combination with approved Alzheimer drugs, an individual could increase the risks of serious side effects.   OMEGA-3 FATTY ACIDS Omega-3s are a type of polyunsaturated fatty acid (PUFA). Research has linked certain types of omega-3s to a reduced risk of heart disease and stroke. Research has also linked high intake of omega-3s to a possible reduction in risk of dementia or cognitive decline. The chief omega-3 in the brain is DHA, which is found in the fatty membranes that surround nerve cells, especially at the microscopic junctions where cells connect to one another. A Jan. 25, 2006, literature review by the Cochrane Collaboration found that published research does not currently include any clinical trials large enough to recommend omega-3 supplements to prevent cognitive decline or dementia. But the reviewers found enough laboratory and epidemiological studies to conclude this should be a priority area for further research. According to the review, results of at least two larger clinical trials are expected in 2008. The Cochrane Collaboration is an independent, nonprofit organization that makes objective assessments of available evidence on a variety of issues in treatment and health care. Theories about why omega-3s might influence dementia risk include their benefit for the heart and blood vessels; anti-inflammatory effects; and support and protection of nerve cell membranes. A report in the April 2006 Nature described the first direct evidence for how omega-3s might have a helpful effect on nerve cells (neurons). Working with laboratory cell cultures, the researchers found that omega-3s stimulate growth of the branches that connect one cell to another. Rich branching creates a dense “neuron forest,” which provides the basis of the brain’s capacity to process, store and retrieve information.   SILYMARIN Silymarin is an extract of milk thistle (silybum marianum L), a tall herb with prickly leaves and a milky sap. Silymarin is alleged to help the functioning of the liver. It may reduce the side-effect of liver problems associated with some prescribed drugs. One study found that 420mg of Silymarin a day seemed to reduce the number of cases of liver toxicity in those taking it and found that the drug was well tolerated.   KANPO preparations 'Kanpo' is a Japanese variant of Chinese traditional medicine. Kanpo preparations using medicinal herbs have shown some benefits for patiuents with dementia. Contact the National Institute of Medical Herbalists (see Useful Organisations in this section) to learn more about Kanpo, traditional Chinese and other herbal treatments.   CORAL CALCIUM This would appear to qualify as a “snake oil”, or product we would warn against. Coral calcium supplements have been heavily marketed as a cure for Alzheimer’s disease, cancer, and other serious illnesses. Coral calcium is a form of calcium carbonate claimed to be derived from the shells of formerly living organisms that once made up coral reefs. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/al_5.jpg" /></div> In June 2003, the United States Federal Trade Commission (FTC) and the Food and Drug Administration (FDA) filed a formal complaint against the promoters and distributors of coral calcium. The agencies state that they are aware of no competent and reliable scientific evidence supporting the exaggerated health claims and that such unsupported claims are unlawful.   COENZYME Q10 Possibly another “snake oil”. Coenzyme Q10, or ubiquinone, is an antioxidant that occurs naturally in the body and is needed for normal cell reactions to occur. This compound has not been studied for its effectiveness in treating Alzheimer’s. A synthetic version of this compound, called idebenone, was tested for Alzheimer’s disease but did not show favourable results. Little is known about what dosage of coenzyme Q10 is considered safe, and there could be harmful effects if too much is taken.   PHOSPHATIDYLSERINE Phosphatidylserine is a kind of lipid, or fat, that is the primary component of cell membranes of neurons. In Alzheimer’s disease and similar disorders, neurons degenerate for reasons that are not yet understood. The strategy behind the possible treatment with phosphatidylserine is to shore up the cell membrane and possibly protect cells from degenerating. The first clinical trials with phosphatidylserine were conducted with a form derived from the brain cells of cows. Some of these trials had promising results. However, most trials were with small samples of participants. This line of investigation came to an end in the 1990s over concerns about mad cow disease. There have been some animals studies since then to see whether phosphatidylserine derived from soy may be a potential treatment. A report was published in 2000 about a clinical trial with 18 participants with age-associated memory impairment who were treated with hosphatidylserine. The authors concluded that the results were encouraging but that there would need to be large carefully controlled trials to determine if this could be a viable treatment. DIET See our Supplements section for the potential benefits of Omega-3 fatty acids in the diet. Recent studies indicate that eating a "Mediterranean-style" healthy diet significantly reduces the risk of developing Alzheimer's disease. Researchers in the USA looked at the diet and health of 2,200 people over four years. The more people kept to a Mediterranean diet, the less likely they were to develop Alzheimer's, according to the Annals of Neurology study. It increasingly appears that such a healthy diet could have a protective effect. MEDLINE PLUS says: “The Mediterranean diet - rich in fruit, vegetables and cereals with some fish and alcohol and little dairy and meat - has been cited as being generally good for health for some time. The researchers from the Columbia University Medical Center assessed participants' neurological health [in a study], and noted their dietary habits. Their food intake was given a "Mediterranean Diet score" of between zero and nine. During the course of the study [of 2,200 people], 262 people were diagnosed with Alzheimer's disease. The researchers found that, for each additional point on the Mediterranean diet scale, the risk of Alzheimer's dropped by almost 10%. Compared to the third of people who scored worst on the Mediterranean diet scores, those in the mid-ranking group had a 15% to 21% lower risk of developing Alzheimer's disease, and those with the highest score had a 39% to 40% lower risk. The association remained significant even after the researchers adjusted their findings for age, gender, ethnicity, education, caloric intake, weight, smoking and other conditions. Dr Nicholas Scarmeas, who led the research, said: "Higher adherence to the Mediterranean diet is associated with a reduction in risk for Alzheimer's disease." Professor Clive Ballard, director of research at the UK's Alzheimer's Society, said: This large study in a leading journal adds to the growing weight of evidence that diet and lifestyle are very important risk factors for Alzheimer's disease. It makes an important contribution by suggesting that a strong adherence to a healthy diet can reduce the risk of developing Alzheimer's disease by as much as 40%, emphasising the importance of healthy eating. As we get older, eating a healthy diet including fresh fruit and vegetables, getting our blood pressure and cholesterol checked regularly, taking exercise and watching our weight may all turn out to be important ways of reducing our risk of developing dementia in later life [the Alliance adds italics here for emphasis].   GENERAL HELP WITH ALZHEIMER’S RELATED PROBLEMS THE ALZHEIMER’S SOCIETY website (<a href="http://www.alzheimers.org.uk/">http://www.alzheimers.org.uk/</a>) is probably your best single UK resource. THEY HAVE A TELEPHONE HELPLINE open from 8.30am to 6.30pm Monday to Friday. The Helpline number is 0845 300 0336. For both people with this condition and their carers, THIS IS AN ESSENTIAL RESOURCE. If you’re struggling to cope in any way or to get information or help, CALL THEM. THE GUIDEPOSTS TRUST is less well known but a growing and vital resource for people with dementias, their families and carers. For their Dementia Information Service (DISC) call 0845 120 4048 - website <a href="http://www.disc.org.uk/">www.disc.org.uk</a> . For their full range of services call 01993 772886 or go to <a href="http://www.guidepoststrust.org.uk/">www.guidepoststrust.org.uk</a>. BBC HEALTH (see our First Resources section) is very good for telling you what you need to know about Alzheimer’s. Just search “Alzheimer” on their site. Also as always refer to Age Concern, Help the Aged and the other resources we recommend in First Resources. The information here is taken from researching these and other sources (see our list of Useful Organisations for Alzheimer’s). COMMUNITY CARE HELP - GETTING AN ASSESSMENT: We quote from the Alzheimer’s Society, with our emphasis in bold letters: “If a person is confused or has dementia and needs support, their local authority social services department should carry out a community care assessment. If this assessment shows that the person needs certain services, the local authority has a duty to ensure that these services are provided. Under the NHS and Community Care Act 1990, local authority social services departments are responsible for assessing the needs of people who may need care services to enable them to carry on living at home. Services can also include care in a care home if that seems to be the best option. The social services department must arrange any services that the assessment concludes are needed. It is not necessary to wait for a diagnosis of dementia before requesting a community care assessment. What matters is that the person needs certain types of care or support. The community care assessment enables social services to find out what the person’s care needs are and to decide which services could help to meet these needs. The social services department will work closely with other services, such as health services and voluntary organisations, when assessing the person’s needs. The local authority cannot arrange services unless an assessment has taken place. An assessment may involve: talking to the person concerned and their carer, where appropriate, to find out what their needs and views are - assessing the person’s health and disabilities and considering what they can and cannot do - considering the person’s present living arrangements and arrangements for care. A community care assessment may also be referred to as a ‘care assessment’ or a ‘needs assessment’. … Some services, such as community nursing, are arranged through the GP, either directly or after discussion with social services. A GP, a consultant or another professional can refer the person to social services for assessment. The person concerned can also contact social services directly and ask for an assessment or another person, such as a friend or relative, can do so on their behalf. … The local authority cannot refuse to assess a person on the grounds that they have a high enough income or sufficient savings to pay for their own care services.” Be sure to go to the Alzheimer’s Society website to learn more about assessment, or ring thie Helpline.   COUNSELLING Getting help from a COUNSELLOR or THERAPIST can make a big difference. One of the Alzheimer’s Society’s information sheets describes counselling as: giving people the chance to talk in confidence to a trained professional counsellor about problems or issues that are causing them concern. This can be very helpful and important for patients, their carers, and for former carers. There are many different types of counselling available. Counselling consists of an agreed number of regular sessions between a counsellor or therapist and the person seeking support. The counsellor listens to the person’s concerns in a non-judgmental and supportive manner. Together, the counsellor and the client try to find ways for the client to cope and/or feel better about themselves and their situation. This may result in a more satisfying and manageable life. It is important that people work with a counsellor whose style and way of working they feel comfortable with. Qualified professional counselling is expected to be absolutely confidential. No one else will know what you talk about. Some of the issues that the client might bring to the session may be distressing; this is normal. Sharing these feelings and thoughts in a supportive, safe and confidential setting is often helpful and can be life changing. Counselling can increase feelings of self-worth, well-being and capability, and help ease feelings of depression, anxiety, loss of control and sleeplessness. Living with dementia can raise many difficult feelings and thoughts as the person attempts to make sense of what is happening to them and how their life is changing. Some people with dementia feel angry, confused, frightened or anxious. Their family and friends may be tied up in how they themselves are feeling, and it may be difficult for the person with dementia to discuss their feelings with them frankly. Counselling might provide the person with dementia with the opportunity to speak honestly about their feelings and work out ways to live with their condition. Traditional counselling expects clients to have full use of their cognitive abilities. However, experience has shown that people with significant changes in their cognition (memory, speech, thought processes) still respond well to the emotional content of the counselling sessions. Living with dementia as a carer or a concerned relative, friend, neighbour or careworker can feel overwhelming and lonely. Carers often have very little time to themselves and it is easy to get run down and exhausted. Many carers experience feelings of sadness, grief, guilt or anger; counselling may help them to explore these feelings, as well as providing extra support outside their network of friends and family. A former carer or careworker may feel lost or sad when the person they have cared for moves away or dies. After the caring relationship ends it may be difficult to move on, to recover from the loss and to accept a new and different role. This is a normal reaction. Counselling may help a former carer to accept the past and look ahead to the future. There are many ways to find a counsellor. A recommendation from someone else who has had counselling can be very helpful. The GP should also be able to provide details of local counsellors and there may even be a counselling service run through the GP’s clinic. The social services department or local Citizens Advice Bureau may also have information – the number will be in the phone book. Most private counselling services operate a sliding scale for fees. Counselling services accessed through NHS referrals are usually free of charge. The British Association for Counselling and Psychotherapy (BACP) can provide more information about counselling and local counselling services. For them and other options see ‘Counselling’ under Useful Organisations in this section. OTHER VERY IMPORTANT RESOURCES which can be extremely important in terms of the care the NHS, community care or other organisations can provide include: Health visitors, GP practice, community and specialist NURSES - the front line in giving and teaching care. The Alzheimer’s Society lists: PHYSIOTHERAPISTS can advise on exercise for people at all stages of dementia. They can also advise carers on safe ways of helping someone to move. Home visits can be arranged. The GP or consultant can refer you to the community physiotherapy service or the hospital physiotherapy department. Some physiotherapists are in private practice. Look for the letters MCSP and/or SRP after their name to ensure that they are professionally qualified (see The Chartered Society of Physiotherapists under Useful Organisations). AUDIOLOGISTS can check for hearing problems and can fit a hearing aid, if appropriate. Once fitted, hearing aids should be checked regularly. Hearing tests, equipment and equipment checks are free on the NHS. Ask the GP for a referral to the nearest NHS hearing centre, preferably while the dementia is at an early stage. DENTIST’S advice should be obtained as soon as dementia is diagnosed. If any major treatment is needed it should be carried out as soon as possible, as dental treatment may become more difficult as dementia progresses. Regular dental care is important to ensure that teeth and gums are healthy and that dentures, if worn, are comfortable. If you are caring for someone in the later stages of dementia you may need advice on how to clean their teeth. Ask the dentist or dental hygienist. If the person with dementia already has a dentist whom they know and trust, they should continue to see that dentist for as long as possible. Your dentist may be able to arrange home visits, if they are needed. If not, contact your community dental service (CDS), which can cater for people who need treatment at home. NHS home visits are free but the normal charges for treatment may apply, depending on income. Details of local NHS dentists and your local CDS can be obtained from your local primary care trust (address in the phone book) or ask at your doctor’s surgery. If you wish to consult a dentist privately check first on fees and the cost of home visits. Many NHS dental practices also do private work. It is often a good idea to have a recommendation from a friend or neighbour.   OPTOMETRISTS are important, since problems with sight can add to confusion. Sight should be regularly checked by an optometrist, who will also examine the eyes for signs of glaucoma, cataract and other eye and medical conditions. If you do not have an optometrist, ask your GP or a friend or neighbour for a recommendation. You will need someone who understands what examining someone with dementia may involve. Some optometrists will carry out a home visit. Ask about fees. People over 60 are entitled to a free NHS eye examination and some people under 60 with dementia may also be entitled to a free NHS eye examination. SPEECH AND LANGUAGE THERAPISTS can advise someone with dementia and their carer on ways of communicating more effectively and on swallowing difficulties. Your GP may be able to refer you or you can refer yourself. For details of your local speech and language therapy department, contact the Royal College of Speech and Language Therapists. CHARTERED CLINICAL PSYCHOLOGISTS assess memory, learning abilities and other skills and offer support. They often work with consultants in memory clinics as part of a team. CONTINENCE ADVISERS advise on problems associated with incontinence. They can also give information on useful equipment ranging from commodes to incontinence pads. Your GP may refer you or you can get in touch direct. To find the address of your local continence adviser contact The Continence Foundation. DIETITIANS - If you have any concerns about a person with dementia eating or drinking, help is available. A dietitian can provide advice and guidance about food, nutrition and issues such as a poor appetite, weight loss, weight gain, vitamins and food supplements. A professionally qualified dietitian will have SRD after their name. Your GP or consultant can arrange for a referral to a dietitian. Some dietitians may be able to offer a domiciliary visit to people who are housebound; others may be based at a local health centre, GP practice or hospital. OCCUPATIONAL THERAPISTS (OTS) OTs can advise on adaptations and equipment and on ways of maintaining independence for as long as possible. Some OTs work for the health service and some for social services. Ask your GP, consultant or social services if you think an OT might be helpful. Some OTs work privately. To find an OT privately contact Occupational Therapists Independent Practice. SOCIAL WORKERS have specific professional training and qualifications. They may be involved in assessing needs for services and in planning, co-ordinating and advising on services. They can also offer support if you need to talk things through. Social workers are based in a wide variety of settings. These include social services departments, hospitals and care homes. To talk to a social worker, contact your social services department (the address will be in the phone book under the name of your local authority) or ask a nurse at your GP practice or hospital. SOCIAL CARE WORKERS work in a wide variety of settings and are known by a variety of names. Some work as home care workers or care attendants in the person’s home or as residential care workers in care homes, for example. They may help with personal care such as getting the person up, washed and dressed, changing bedding and emptying commodes, doing laundry, supervising meals to make sure the person eats properly and putting them to bed at night. The brief information here about these practitioners is derived primarily from the Alzheimer’s Society website. For more complete information, see the Alzheimer Society’s information sheets or contact the Society. Alzheimers Disease

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THE ALZHEIMER'S SOCIETY <a href="http://www.alzheimers.org.uk/">www.alzheimers.org.uk/</a> Telephone Helpline 0845 300 0336 - open from 8.30am to 6.30pm Monday to Friday. The UK resource for most of what you need in one place. THE GUIDEPOSTS TRUST <a href="http://www.guidepoststrust.org.uk/">www.guidepoststrust.org.uk</a>. Tel. 01993 772886 and the Trust’s Dementia Information Service (DISC) <a href="http://www.disc.org.uk/">www.disc.org.uk</a> and <a href="http://www.dementiaweb.org.uk/">www.dementiaweb.org.uk</a> Tel. 0845 120 4048 DISC offers advice and information before and after the person with dementia has moved into residential or nursing home care. A very special and user-friendly service. See the Trust’s website for other and regional services. ALZHEIMER'S FORUM <a href="http://www.alzheimersforum.org/">www.alzheimersforum.org</a> - a website produced by and for people with dementia ALZHEIMER EUROPE <a href="http://www.alzheimer-europe.org/">www.alzheimer-europe.org</a> Large database of information, tips for carers, links to other organisations. Recommended by BBC Health. ALZHEIMER'S RESEARCH TRUST <a href="http://www.alzheimers-research.org.uk/">www.alzheimers-research.org.uk</a> Telephone: 01223 843899 Email: enquiries@alzheimers-research.org.uk ALZHEIMER'S DISEASE INTERNATIONAL <a href="http://www.alz.co.uk/">www.alz.co.uk</a> An umbrella organisation of national Alzheimer Associations around the world. THE CONTINENCE FOUNDATION <a href="http://www.continence-foundation.org.uk/">www.continence-foundation.org.uk</a> Helpline 0845 345 0165 (weekdays 9.30am-1pm) Email continence-help@dial.pipex.com   FOR IMMEDIATE HELP WITH HEALTH QUESTIONS and GENERAL MEDICAL INFORMATION: See our FIRST RESOURCES section - especially MedlinePlus ( <a href="http://medlineplus.gov/">http://medlineplus.gov</a> ) BBC Health ( <a href="http://www.bbc.co.uk/health">www.bbc.co.uk/health</a> ), the Mayo Clinic (<a href="http://www.mayoclinic.com/">www.mayoclinic.com</a> ) and: MEDICINENET.COM <a href="http://www.medicinenet.com/">www.medicinenet.com</a> For a general guide and information base on any subject this is an excellent resource. NETDOCTOR <a href="http://www.netdoctor.co.uk/">www.netdoctor.co.uk</a> Attempts to break down the "medical language barrier" between the doctor and the patient. Critical medical information presented in a clear and understandable language so that the patient fully understands his or her choices and decisions. THE COCHRANE REVIEWS (<a href="http://www.cochrane.org/">www.cochrane.org</a>) The Cochrane Collaboration assesses most areas of health care. To do this, it is divided into Cochrane Review Groups, each of which concentrates on a specific healthcare area, including a Consumer Network that represents the interests of healthcare consumers. Type any condition into their website and get pretty comprehensive information. If you want clear scientific analysis of any health issue or practice, you’ll usually find it here. BANDOLIER: THE OXFORD MEDICAL SITE <a href="http://www.jr2.ox.ac.uk/bandolier/index.html">http://www.jr2.ox.ac.uk/bandolier/index.html</a> Bandolier is a journal of evidence-based medicine. Look up any subject for links and knowledge. Their “Healthy Livig Zone” is a bit of a goldmine on the subject. MERCK MEDICUS <a href="http://www.merckmedicus.com/">www.merckmedicus.com</a> Easy to use and the US doctor’s reference tool. See MERCK GERIATRIC for age related information.   FOR ANCILLARY MEDICAL THERAPIES (Physiotherapy etc): HEALTH PROFESSIONS COUNCIL <a href="http://www.hpcuk.org/">www.hpc-uk.org</a> Telephone 020 7582 0866 The HPC is a statutory regulator that works to protect the health and well-being of people using the services of health professionals. Find therapists and be sure they are approved / regulated practitioners.   CHARTERED SOCIETY OF PHYSIOTHERAPY <a href="http://www.csp.org.uk/">www.csp.org.uk</a> Tel: 020 7306 6218 / 6666 Information on physiotherpaists, physiotherapy and how it can help with pain. THE ORGANISATION OF CHARTERED PHYSIOTHERAPISTS IN PRIVATE PRACTICE <a href="http://www.physiofirst.org.uk/">www.physiofirst.org.uk</a> Tel: 01327 354441 Details of private chartered physiotherapists in your area. OCCUPATIONAL THERAPISTS IN INDEPENDENT PRACTICE (OTIP) <a href="http://www.otipp.co.uk/">www.otipp.co.uk</a> Tel: 0800 389 4873 Information and find an occupational therapist ROYAL COLLEGE OF SPEECH AND LANGUAGE THERAPISTS <a href="http://www.rcslt.org/">www.rcslt.org</a> Telephone 020 7378 1200 Email info@rcslt.org   FOR COMPLEMENTARY AND ALTERNATIVE THERAPIES: THE COMPLIMENTARY HEALTHCARE INFORMATION SERVICE <a href="http://www.chisuk.org.uk/">www.chisuk.org.uk</a> Easy reference to learn about any and (just about all) complementary techniques. A truly excellent way to learn what the main comlementary techniques are, how they might work for you, and to explore the subject THE NETDOCTOR DR FOSTER COMPLEMENTARY PRACTITIONER DIRECTORY <a href="http://netdoctorcomplementarytherapistguide.drfoster.co.uk/">http://netdoctorcomplementarytherapistguide.drfoster.co.uk</a> If you are looking to find a reliable complementary therapy practitioner in your area, this directory is an essential resource. It can help you find a practitioner who meets your needs. This might be someone who has a particular interest in your condition, or who works at a practice near to your home, at hours that suit your needs. THE BRITISH COMPLEMENTARY MEDICINE ASSOCIATION <a href="http://www.bcma.co.uk/">www.bcma.co.uk</a> Tel 0845 345 5977 Find qualified practitioners of most therapies, learn about therapies, get recognised guidance through the therapy minefield and find a therapist near you. WHOLE HEALTH MD <a href="http://www.wholehealthmd.com/">www.wholehealthmd.com</a> American WholeHealth Networks' Complementary and Alternative Medicine (CAM) education website. The site is dedicated to providing integrative health and wellness solutions by combining the resources of both scientific health research and CAM. Click on specific health issues for information on conventional medicine, alternative therapies, supplements, diet, lifestyle options, and much more. HOLISTIC ONLINE <a href="http://www.holisticonline.com/">www.holisticonline.com</a> Comprehensive site for Alternative and Integrative Medicine. Learn about conditions and treatments. INSTITUTE FOR COMPLEMENTARY MEDICINE www.i-c-m.org.uk The ICM is a UK registered charity providing information on all aspects of the safe and best practice of Complementary Medicine. THE NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE <a href="http://nccim.nch.gov/">http://nccim.nch.gov</a> Vital and reputable information for the States. A treasure for understanding what’s what. THE ALTERNATIVE MEDICINE FOUNDATION <a href="http://www.amfoundation.org/">www.amfoundation.org</a> Excellent US site, good clear information. They also recommend: ALTERNATIVE MEDICINE RESOURCE <a href="http://www.altmedresource.com/">www.altmedresource.com</a> comprehensive and searchable catalog of all alternative medicine studies. Easy search by looking up your condition(s) or a key word.   FOR COMPLEMENTARY PRACTICTIONERS’ ASSOCIATIONS GENERAL OSTEOPATHIC COUNCIL www.osteopathy.org.uk Tel: 020 7357 6655 Provides details of qualified local osteopaths. BRITISH CHIROPRACTIC ASSOCIATION www.chiropractic-uk.co.uk Tel: 0118 950 5950 Information on chiropractic and details of local chiropractors. GENERAL CHIROPRACTIC COUNCIL <a href="http://www.gcc-uk.org/">www.gcc-uk.org</a> Tel: 020 7713 5155 Provides details of local chiropractors and information on what to expect when you see a chiropractor. It can also help if you've experienced a problem with a chiropractor. THE SOCIETY OF CHIROPODISTS AND PODIATRISTS <a href="http://www.feetforlife.org/">www.feetforlife.org</a> Telephone 020 7234 8620 GENERAL COUNCIL FOR MASSAGE THERAPY <a href="http://www.gcmt-uk.org/">www.gcmt-uk.org</a> Telephone 01992 537637 New voluntary regulation body for practitioners of massage. INTERNATIONAL FEDERATION OF AROMATHERAPISTS <a href="http://www.ifaroma.org/">www.ifaroma.org</a> Telephone 020 8992 9605 MUSIC THERAPY: see HEALTH PROFESSIONS COUNCIL above - <a href="http://www.hpcuk.org/">www.hpcuk.org</a> Telephone 020 7582 0866 THE BRITISH MEDICAL ACUPUNCTURE SOCIETY <a href="http://www.medical-acupuncture.co.uk/">www.medical-acupuncture.co.uk</a> Telephone 01925 730727 Medical doctors who practice acupuncture. Encourages the use and scientific understanding of acupuncture within medicine for the public benefit. ACUPUNCTURE ASSOCIATION OF CHARTERED PHYSIOTHERAPISTS <a href="http://www.longbo.demon.co.uk/aacp.html">www.longbo.demon.co.uk/aacp.html</a> Tel 01747 861151 Contact the AACP Secretariat for a register of members - qualified phyisos working with acupuncture. BRITISH ACUPUNCTURE COUNCIL <a href="http://www.acupuncture.org.uk/">www.acupuncture.org.uk</a> Tel: 020 8735 0400 Provides information on acupuncture and details of qualified traditional acupuncturists in your area. Phone or enclose an SAE for more information. NATIONAL INSTITUTE OF MEDICAL HERBALISTS <a href="http://www.nimh.org.uk/">www.nimh.org.uk</a> Telephone 01392 426022 Email nimh@ukexeter.freeserve.co.uk Professional body - offers a service for you to find a trained and qualified herbalist.   FOR DIET ADVICE: BRITISH NUTRITION FOUNDATION <a href="http://www.nutrition.org.uk/">www.nutrition.org.uk</a> Telephone 0207 404 6504 Includes advice on finding a dietician BRITISH DIETETIC ASSOCIATION <a href="http://www.bda.uk.com/">www.bda.uk.com</a> FOOD STANDARDS AGENCY <a href="http://www.eatwell.gov.uk/">www.eatwell.gov.uk</a> BBC HEALTH <a href="http://www.bbc.co.uk/health/healthy_living/nutrition">www.bbc.co.uk/health/healthy_living/nutrition</a> NHS DIRECT <a href="http://www.nhsdirect.nhs.uk/encyclopaedia">www.nhsdirect.nhs.uk/encyclopaedia</a>   FOR MEDITATION: THE SHOLLOND TRUST <a href="http://www.headless.org/">www.headless.org</a> tel. 020 8806 3710 - Richard Lang, Trust Co-ordinator The Trust offers a form of meditation you can do any time, any place, in any circumstances. It’s astoundingly easy to do, and it’s free. It’s also a great way to get the best out of and appreciate all other meditation and complementary techniques. THE BBC <a href="http://www.bbc.co.uk/">www.bbc.co.uk</a> and search “meditation”. A wide range of options. THE HITCHHIKER’S GUIDE TO THE GALAXY <a href="http://www.bbc.co.uk/dna/h2g2">www.bbc.co.uk/dna/h2g2</a> Ask the guide about meditation. In fact ask it about any question you have.   FOR COUNSELLING: BRITISH ASSOCIATION FOR COUNSELLING AND PSYCHOTHERAPY (BACP) <a href="http://www.bacp.co.uk/">www.bacp.co.uk</a> Telephone 0870 443 5252 Email bacp@bacp.co.uk A fisrt reference for anyone seeking information on counselling and psychotherapy in the United Kingdom. They have a helpful and easy to use search tool to find a therapist.   THE SAMARITANS <a href="http://www.samaritans.org/">www.samaritans.org</a> Telephone 08457 90 90 90 (24 hours, seven days a week) Email <a href="mailto:jo@samaritans.org">jo@samaritans.org</a> Confidential non-judgemental support, 24 hours a day for people experiencing feelings of distress or despair. MIND <a href="http://www.mind.org.uk/">www.mind.org.uk</a> Telephone 020 8519 2122 Mind Infoline 0845 766 0163 (Monday-Friday 9:15-5:15) Email <a href="mailto:contact@mind.org.uk">contact@mind.org.uk</a> The MindinfoLine offers confidential help on a range of mental health issues from anywhere in the UK for the price of a local call. Local MIND associations offer supported housing, crisis helplines, drop-in centres, counselling, befriending, advocacy, employment and training schemes and other services. RELATE <a href="http://www.relate.org.uk/">www.relate.org.uk</a> Tel. 0845 456 1310 or 01788 573241 Relate is the UK's largest provider of relationship counselling and sex therapy. They also offer a range of other relationship support services. CRUSE BEREAVEMENT CARE <a href="http://www.crusebereavementcare.org.uk/">www.crusebereavementcare.org.uk</a> Day-to-day helpline: 0870 167 1677 Help for bereaved people, whatever their age, nationality or beliefs, including a free counselling service.   FOR CARE SERVICES: COUNSEL AND CARE <a href="http://www.counselandcare.org.uk/">www.counselandcare.org.uk</a> Advice line 0845 300 7585 (weekdays 10am-12.30pm and 2pm-4pm) A national charity getting the best care and support for older people, their families and carers SUE RYDER CARE <a href="http://www.suerydercare.org/">www.suerydercare.org</a> 020 7400 0440 Cares for people with life-shortening illnesses through specialist hospice care services. THE PRINCESS ROYAL TRUST FOR CARERS <a href="http://www.carers.org/">www.carers.org</a> Telephone 020 7480 7788 Email help@carers.org The trust is the largest provider of comprehensive carers support services in the UK. CARERS UK <a href="http://www.carersuk.org/">www.carersuk.org</a> Free Carers Line 0808 808 7777 (weekdays 10am-12pm and 2pm-4pm) Email info@ukcarers.org Carers UK is the voice of carers and the leading campaigning, policy and information organisation for carers. Provides information and advice on topics relating to caring. CARERS NATIONAL ASSOCIATION <a href="http://www.carersuk.org/">www.carersuk.org</a> Provides information and advice for carers and works for carers rights. CROSSROADS (The Association of Crossroads Care Attendant Schemes) <a href="http://www.crossroads.org.uk/">www.crossroads.org.uk</a> Tel: 0845 450 0350 Practical support for carers; respite care at home. Provides trained care support workers to allow carers the breaks and time off they need. CARE CHOICES LTD <a href="http://www.careselect.co.uk/">www.careselect.co.uk</a> Tel: 0800 389 2077 Care Choices Ltd offers a free residential/care home search service. The company has a database of care homes, nursing homes, elderly accommodation and similar establishments throughout the UK. HOSPICE INFORMATION <a href="http://www.hospiceinformation.info/">www.hospiceinformation.info</a> Tel: 0870 903 3903 Publishes a directory of hospice and palliative care services.   FOR GENERAL UK HEALTH HELP, ISSUES and the NHS: NHS DIRECT ( <a href="http://www.nhsdirect.nhs.uk/">www.nhsdirect.nhs.uk</a> ) - see First Resources PATIENTS ASSOCIATION <a href="http://www.patients-association.com/">www.patients-association.com</a> Helpline: 0845 608 4455 Represents the views and interests of patients and campaigns for improved health services. Provides advice, factsheets and self-help guides. DR FOSTER <a href="http://www.drfoster.co.uk/">www.drfoster.co.uk/</a> Telephone 0207 332 8800 Works with the NHS to make it easier for professionals and the public to access health and social care information. Hospitals, consultants, complementary therapies and much more. PALS - PATIENT ADVICE AND LIAISON SERVICE (<a href="http://www.dh.gov.uk/">www.dh.gov.uk</a>) This web address will take you to the Department of Health website. Click on Patient Advice and Liaison Service to find your local PAL. Information and help with any questions or problems you have about your GP service, NHS hospital or other NHS service. EQUIP - ELECTRONIC QUALITY INFORMATION FOR PATIENTS <a href="http://www.equip.nhs.uk/">www.equip.nhs.uk</a> NHS search website for patient information on a very wide variety of conditions. RSVP - RETIRED AND SENIOR VOLUNTEER PROGRAMME <a href="http://www.csv-rsvp.org.uk/">www.csv-rsvp.org.uk</a> Advice and help for over 50’s by over 50’s: Transport for medical care, practical and domestic help, avoiding isolation, help for over 50’s in GP surgeries. LTCA - LONG TERM CONDITIONS ALLIANCE <a href="http://www.ltca.org.uk/">www.ltca.org.uk</a> An umbrella body for voluntary organisations. Promotes access to services, support, and knowledge for self-help. Includes an “Expert Patients” programme with the NHS. Look at the directory of member organisations on their website for the help you need, or RING THEM on 02078153637. PATIENT CONCERN <a href="http://www.patientconcern.org.uk/">www.patientconcern.org.uk</a> Helpful advice on how to survive medical treatment and the NHS, how to assess medical websites and more.   FOR EXERCISE: There are many possibilities to choose from, and you may be surprised what you can do and what you’ll enjoy. Just be sure to get your doctor’s and/or physiotherapist’s advice on any medical limitations and what to avoid. SIMPLE WAYS to look at the possibilities are with the help of: THE BBC - Go to <a href="http://www.bbc.co.uk/health">www.bbc.co.uk/health</a> BANDOLIER - go to <a href="http://www.jr2.ox.ac.uk/bandolier">www.jr2.ox.ac.uk/bandolier</a> and see Exercise in their healthy living section THE NHS Health encyclopaedia: <a href="http://www.nhsdirect.nhs.uk/">www.nhsdirect.nhs.uk</a> in our FIRST RESOURCES section has good information. THE COMPLIMENTARY HEALTHCARE INFORMATION SERVICE <a href="http://www.chisuk.org.uk/">www.chisuk.org.uk</a> links to all the main movement therapy exercise techniques. A one-stop convenience shop. And specifically for: TAI CHI - local adult education courses, local gym, fitness centre, library listing or the TAI CHI UNION OF GREAT BRITAIN - <a href="http://www.taichiunion.com/">www.taichiunion.com</a> PILATES <a href="http://www.pilatesfoundation.com/">www.pilatesfoundation.com</a> YOGA <a href="http://www.bwy.org.uk/">www.bwy.org.uk</a> DANCING - ballroom, tap, folk, flamenco, modern, social, jazz… too many styles to list. Once again the easy place to start is THE BBC. Go to <a href="http://www.bbc.co.uk/health">www.bbc.co.uk/health</a> and look under dance. Also many classes locally in many styles. GYMS / CIRCUIT TRAINING / SPORT - Infinite options. BBC Health provides guidance. <a name="compalt2" id="compalt2"></a>  EXERCISE IN WATER: AQUA-CHI <a href="http://www.taichiunion.com/">www.taichiunion.com</a> AQUA-GYM <a href="http://www.aquagym.co.uk/">www.aquagym.co.uk</a> POOLATES <a href="http://www.poolates.co.uk/">www.poolates.co.uk</a> Pilates in water. AQUA-DANCE classes at local pools or <a href="http://www.virginactive.co.uk/">www.virginactive.co.uk</a> for classes at their gyms  FOR GENERAL SELF-HELP ON MOST SUBJECTS: DIRECTORY OF UK SELF-HELP GROUPS www.ukselfhelp.info/ This is a remarkably complete A-Z of self-help organisations on just about any health subject you can think of and life problems of most kinds.   FOR PRACTICAL GENERAL INFORMATION ON MOST SUBJECTS: <a href="http://www.about.com/">www.about.com</a> <a href="http://www.bbc.co.uk/">www.bbc.co.uk</a> <a href="http://www.bbc.co.uk/dna/h2g2">www.bbc.co.uk/dna/h2g2</a> <a href="http://www.wikipedia.org/">www.wikipedia.org </a> <a name="Heart" id="Heart"></a>  FOR PHYSICAL AIDS AND EQUIPMENT - ACCESS, MOBILITY AND PRACTICAL HELP: DISABLED LIVING FOUNDATION (DLF) <a href="http://www.dlf.org.uk/">www.dlf.org.uk</a> Tel: 020 7289 6111 Helpline: 0845 130 9177 Text phone: 020 7432 8009 DLF are the leading source of information on disability equipment - free, impartial advice about all types of equipment and mobility products DISCOUNT MOBILITY PLUS LTD For scooters, wheelchairs, bathlifts, stairlifts, chairs <a href="http://www.discountmobilityplus.co.uk/">www.discountmobilityplus.co.uk</a> Tel: 0808 178 4151 INDEPENDENT LIVING FUNDS <a href="http://www.ilf.org.uk/">www.ilf.org.uk</a> Tel: 0845 601 8815 Email: client.service@ilf.org.uk The funds were set up as a national resource dedicated to the financial support of disabled people enabling them to choose to live in the community rather than residential care. DISABILITY ALLIANCE www.disabilityalliance.org The leading authority on social security benefits for disabled people Tel: 020 7247 8776   MOBILISE - THE DISABLED DRIVERS’ ASSOCIATION <a href="http://www.justwebs.co.uk/mobilise/">www.justwebs.co.uk/mobilise/</a> Tel: 01508 489449 (Representation, information and advice on mobility issues) DISABILITY RIGHTS COMMISSION <a href="http://www.drc-gb.org/">www.drc-gb.org</a> DRC Helpline Tel: 08457 622 633 Textphone: 08457 622 644 The Disability Rights Commission (DRC) is an independent body established in April 2000 by Act of Parliament to stop discrimination and promote equality of opportunity for disabled people. RELATIVES AND RESIDENTS ASSOCIATION www.relres.org Tel: 020 7359 8136 Provides information and support about carehomes. ROYAL ASSOCIATION FOR DISABILITY AND REHABILITATION (RADAR) www.radar.org.uk Tel: 020 7250 3222 Minicom: 0207 250 4119 RADAR is concerned with every aspect of disability, but is particularly involved with access, education, employment, holidays, housing, mobility and social services. CITIZENS ADVICE BUREAUX (CABx) <a href="http://www.nacab.org.uk/">www.nacab.org.uk</a> The website gives local offices, opening times and specialist services. AGE CONCERN AID CALL <a href="http://www.aidcall-alarms.co.uk/">www.aidcall-alarms.co.uk</a> T: 0800 77 22 66 Emergency alarms to stay independent but summon help if needed MEDIC ALERT FOUNDATION <a href="http://www.medicalert.co.uk/">www.medicalert.co.uk</a> tel 02078333034 Medical identification, cards, bracelets, necklaces etc with information on call for emergency treatment. Knowing your chronic problems and what medications you’re on can make a critical difference for any doctor or emergency worker treating you in any situation. <a name="working" id="working"></a>    FOR FIRST AID TRAINING - and we always recommend this as part of learning to take care of ourselves and each other: RED CROSS <a href="http://www.redcross.org.uk/">www.redcross.org.uk</a> ST JOHN’S AMBULANCE <a href="http://www.sja.org.uk/">www.sja.org.uk</a> ST ANDREW’S AMBULANCE (Scotland) <a href="http://www.firstaid.org.uk/">www.firstaid.org.uk</a> The Alliance notes with concern the patchy attention to pain, and especially chronic pain, from the NHS, many charities for older people and other usually good sources of information. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/cp1.jpg" /></div> Anyone can have chronic pain, but it is suffered disproportionately by older people. All too often it is dealt with by giving us condescending advice and insufficient help and treatment. Chronic pain can be devastating and debilitating. It can’t be measured accurately like blood pressure or temperature, so it’s easier to assume that in many cases it’s perhaps not really that big a deal. Chronic pain is actually a very big deal indeed. The brutal willingness to minimise and under-treat it is starting to change, but there is still a long way to go. The Chronic Pain Policy Coalition is an encouraging move in the right direction. They make it clear that the way we as a nation deal with chronic pain is inadequate and must be improved. The Coalition is a newly established forum for patients, professionals and parliamentarians to develop an improved strategy for the prevention, treatment and management of chronic pain. Their website says that: “two recent independent reports support a government commissioned survey that identified pain services in the UK as ‘variable and patchy. When poorly managed, conditions associated with pain can have a devastating impact on the quality of life of individuals and their families… The failure to implement an effective prevention and treatment strategy for chronic pain not only imposes an unnecessary burden on patients, but also represents an inefficient allocation of time, money and professional expertise. The coalition believes that all people living with chronic pain in the UK must expect and ask for: Active involvement in the management of their pain Timely assessment of their pain Access to appropriate management and support Relevant information Early access to adequate resources and facilities The following, from a recent article on the Age Concern website, make it clear how far we are from getting this right: “Despite the levels of pain reported, the study revealed found that 85 per cent of people said a doctor or nurse had never spoken to them about how their constant pain could be treated… ‘It is unacceptable for healthcare and nursing staff not to be actively relieving chronic pain. There is a desperate need for a more proactive approach to the management and treatment of pain by healthcare and nursing home staff’.” It really is unacceptable that people in this country are not given appropriate help with and relief from pain as early, completely, and effectively as possible. Let’s make this completely clear by quoting the Chronic Pain Policy Coalition once again: "If pain were routinely assessed with the same priority as the other vital signs, then a great deal of unnecessary suffering, stress and anxiety could be avoided." "It is not unusual for people living with chronic pain to fall into a vicious circle of repeat doctor appointments, deteriorating physical and mental health, job loss, relationship breakdowns and depression before they receive the help they need." "Chronic pain has consistently failed to attract the attention it deserves. A renewed focus on early assessment of pain is long overdue and could bring about significant benefits for individuals as well as their families, friends, employers and the wider economy." The Coalition are working to change this on the policy level. Through the work of Pain Support, Action on Pain and others, chronic pain sufferers are improving things dramatically by and for themselves. Under Useful Organisations you’ll find that an encouraging number of people and practitioners are getting on with doing right in this area. Many of our usually helpful web resources don’t do so well when it comes to chronic pain. Pain Support, MedicineNet.com, Action on Pain, the Chronic Pain Mission and dailystrength.org (all in Useful Organisations) are among those which do perform. Much of our information here derives from them. For quick reference about any specific conditions which can lead to chronic pain, <a name="working" id="working"></a>Our Chronic Pain Mission is a first reference. We’ve taken care that our Useful Organisations section, combined with our First Resources, will deal with pretty much any information or help you may need. You can empower yourself and anyone you care for in dealing with chronic pain. The basics here may help for a start. Later sections will draw on some of the best guidance about pain issues, treatments, and ways to improve your quality of life.   THE BASICS: Chronic pain is defined as pain that persists longer than the normal course of time associated with a particular type of injury. This constant or intermittent pain has often outlived its purpose, as it does not help the body to prevent injury. There’s no shortage of pain in life. Much of it serves an important and necessary function. It’s a vital early warning system to say that something is causing trauma to the body. Get your finger out of that fire, get that baby born, deal with that heart attack, etc. Anything that damages or stresses us is likely to trigger the useful pain warning system. When we’ve done what we can and the warning system won’t turn off, however, it stops being useful and starts causing rather than preventing harm. We may experience pain in a number of forms. The physical mechanism begins with an electrical impulse travelling from the affected site(s) to the spinal cord. The spinal cord acts as a sort of relay centre where the pain signal can be blocked, enhanced, or otherwise modified before it is relayed to the brain. One area of the spinal cord in particular, called the dorsal horn, is important in the reception of pain signals. The most common destination in the brain for pain signals is the thalamus and from there to the cortex, the headquarters for complex thoughts. The thalamus also serves as the brain's storage area for images of the body and plays a key role in relaying messages between the brain and various parts of the body. Pain is a complicated process that involves an intricate interplay between a number of important chemicals found naturally in the brain and spinal cord. In general, these chemicals, called neurotransmitters, transmit nerve impulses from one cell to another. There are many different neurotransmitters in the human body; some play a role in human disease and, in the case of pain, act in various combinations to produce painful sensations in the body. Some chemicals govern mild pain sensations; others control intense or severe pain. The body's chemicals act in the transmission of pain messages by stimulating neurotransmitter receptors found on the surface of cells; each receptor has a corresponding neurotransmitter. Receptors function much like gates or ports and enable pain messages to pass through and on to neighbouring cells. One brain chemical of special interest to neuroscientists is glutamate. During experiments, mice with blocked glutamate receptors show a reduction in their responses to pain. Other important receptors in pain transmission are opiate-like receptors. Morphine and other opioid drugs work by locking on to these opioid receptors, switching on pain-inhibiting pathways or circuits, and thereby blocking pain. Another type of receptor that responds to painful stimuli is called a nociceptor. Nociceptors are thin nerve fibers in the skin, muscle, and other body tissues, that, when stimulated, carry pain signals to the spinal cord and brain. Normally, nociceptors only respond to strong stimuli such as a pinch. However, when tissues become injured or inflamed, as with a sunburn or infection, they release chemicals that make nociceptors much more sensitive and cause them to transmit pain signals in response to even gentle stimuli such as breeze or a caress. That receptors function like gateways has implied the possibility of closing the gates against pain. GATE CONTROL: The Action on Pain website tells us the "gate control theory" proposes that a "gating system" exists in the central nervous system that opens and closes to allow pain messages through to the brain or block them. Basically: the spinal cord is made up of two types of nerve fibres: the small diameter nerve fibres which carry pain stimuli through the 'gate mechanism' and larger diameter nerve fibres which go through the same gate but which can inhibit the transmission activity of the smaller nerves carrying the pain signal. Chemicals released as a response to the pain stimuli also influence whether the gate opens or closes for the brain to receive additional pain signals. An aspect of the gate control theory of pain is that the emotions, beliefs and thoughts that exist may influence the amount of pain felt from a given physical sensation. This is based on the principle that both psychological and physical factors influence how the brain receives and interprets pain signals, and how it responds to them. Many pain sufferers find that their pain is worst if they feel sad and despondent - and there is a clear mechanism whereby such feelings may open the pain gate - yet if they focus on doing something that requires attention or they find enjoyable the perception of the pain is dramatically different. As nerve signal reaches the brain, the sensory information is handled in the context of the individual's existing mood, state of attention, and previous experience. The combination of all this information affects the way the pain is perceived and experienced and these dictate what response takes place. The brain’s interpretation of this information determines whether a message is sent back down the large diameter nerve fibres to “close” the gate so that the pain signals are blocked and lower pain is experienced . If the brain orders the pain gates to “open” wider then the pain signals continue to pass through and the pain intensifies. Closing or narrowing the pain gate can be approached physically in terms of brain chemistry and circuitry, and also mentally. NB: Let’s stop here to make an important point: mental/psychological and emotional approaches to chronic pain are not flaky side issues. They should not be used or seen as backhanded ways of telling you to pull your socks up and get over yourself. These approaches, which we’ll look at under Self-Help, are extremely practical in terms of the mechanisms of pain and the Pain Gate model. We’ll look at what science can do in terms of both mechanics and mind under “Treatment”. Our abilities to work with and control our own pain through complementary / self-help techniques, and even use pain to improve our lives, will also be approached as being at least equally important. DIAGNOSING PAIN - There is no way to tell how much pain a person has. No test can measure the intensity of pain, no imaging device can show pain, and no instrument can locate pain precisely. Your description of what you’re experiencing is pretty much all your doctor has to start with. The point here, of course, is that some problem (or combination of problems) is causing you pain. Diagnosing the problem(s) as well as possible is obviously step one in dealing with your pain. Doctors do have some useful tests and technologies to help find the cause of pain. Among the most common are: Electrodiagnostic procedures include electromyography (EMG), nerve conduction studies, and evoked potential (EP) studies. Information from EMG can help physicians tell precisely which muscles or nerves are affected by weakness or pain. Thin needles are inserted in muscles and a physician can see or listen to electrical signals displayed on an EMG machine. With nerve conduction studies the doctor uses two sets of electrodes (similar to those used during an electrocardiogram) that are placed on the skin over the muscles. The first set gives the patient a mild shock that stimulates the nerve that runs to that muscle. The second set of electrodes is used to make a recording of the nerve's electrical signals, and from this information the doctor can determine if there is nerve damage. EP tests also involve two sets of electrodes-one set for stimulating a nerve (these electrodes are attached to a limb) and another set on the scalp for recording the speed of nerve signal transmission to the brain. Imaging techniques, including ultrasound and CT scanning and magnetic resonance imaging or MRI, provide pictures of the body's structures and tissues. MRI uses magnetic fields and radio waves to differentiate between healthy and diseased tissue. Neurological examination, in which the physician tests movement, reflexes, sensation, balance, and coordination. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/cp2.jpg" /></div> X-rays to look for physical / structural problems causing pain. The Action on Pain website reminds us that knowing what’s causing your pain may not mean that your doctors can stop it. Still, this is step one: is your pain necessarily chronic, or is it a sign of something which can and should be healed? If it’s a warning to act, and if acting can heal you and stop the pain, the pain needn’t be chronic. This is pain doing its job of saying that something needs healing, and it should be relieved. If the cause of your pain cannot be definitively healed however, or dealing with the cause doesn’t end the pain, then your pain is chronic and must be managed to increase your comfort and improve your quality of life as much as possible. AGE ,GENDER AND PAIN MedicineNet tells us: It is now widely believed that pain affects men and women differently. While the sex hormones estrogen and testosterone certainly play a role in this phenomenon, psychology and culture, too, may account at least in part for differences in how men and women receive pain signals. Many investigators are turning their attention to the study of gender differences and pain. Women, many experts now agree, recover more quickly from pain, seek help more quickly for their pain, and are less likely to allow pain to control their lives. They also are more likely to marshal a variety of resources-coping skills, support, and distraction-with which to deal with their pain. Interestingly, Merck Medicus tells us that older people tend to tolerate and handle pain better than the young. They speculate that this may be because changes in the body decrease the sensation of pain. On the other hand, older people may simply be more stoic than younger people. THE EVALUATION OF PAIN, as there is no actual way to test for or measure it, isn’t easy. Merck Medicus tell us that the usual approach is for doctors to ask about the history and characteristics of pain. To evaluate the severity of pain, they sometimes use a scale of 0 (none) to 10 (severe) or ask the person to describe the pain as mild, moderate, severe, or excruciating. As well as being impossible to measure, the pain you feel may not be where the problem is. Pain felt in one part of the body can be referred pain from a problem actually happening somewhere else. Pain can be referred because signals from several areas of the body often travel through the same nerve pathways going to the spinal cord and brain. For example, pain from a heart attack may be felt in the neck, jaws, arms, or abdomen. Pain from a gallbladder attack may be felt in the back of the shoulder. ACUTE OR CHRONIC: Acute pain begins suddenly and usually does not last long. When severe, it may cause anxiety, a rapid heartbeat, an increased breathing rate, elevated blood pressure, sweating, and dilated pupils. Chronic pain persists for weeks, months or more. Merck’s definition of the term Chronic Pain is that it usually describes pain that persists for more than 1 month beyond the usual course of an illness or injury, pain that recurs off and on for months or years, or pain that is associated with a chronic disorder such as cancer. Often chronic pain does not affect the heartbeat, breathing rate, blood pressure, or pupils, but it may result in other problems, such as depression, disturbed sleep, decreased energy, loss of appetite, weight loss, and loss of interest in sexual activity. Many people who are being treated for chronic pain may experience a brief, often severe FLARE-UPof pain [our emphasis]. This is called breakthrough pain because it breaks through the regularly scheduled pain treatment. Typically, breakthrough pain begins suddenly, lasts up to 1 hour, and feels much like the person's chronic pain except it is more severe. Breakthrough pain may differ from person to person and is often unpredictable. TYPES OF PAIN Nociceptive pain is caused by an injury to body tissues. The injury may be a cut, bruise, bone fracture, crush injury, burn, or anything that damages tissues. This type of pain is typically aching, sharp, or throbbing. Most pain is nociceptive pain. Pain receptors for tissue injury (nociceptors) are located mostly in the skin or in the internal organs. Most of the pain due to cancer is nociceptive. When a tumor invades bones and organs, it may cause mild discomfort or severe, unrelenting pain. Some cancer treatments, such as surgery and radiation therapy, can also cause nociceptive pain. Neuropathic pain is caused by abnormalities in the nerves, spinal cord, or brain. Neuropathic pain may be felt as a burning or tingling sensation or as hypersensitivity to touch or cold. Syndromes include phantom limb pain, postherpetic neuralgia from herpes zoster (shingles), and chronic pain conditions usually occurring after an injury, like reflex sympathetic dystrophy and causalgia. Sometimes this kind of pain is made worse by activity of the sympathetic nervous system, which normally prepares the body for stressful or emergency situations—for fight or flight. Psychogenic pain is entirely or mostly related to a psychological cause. Pain that is purely psychogenic is rare, and there are psychological factors at work in all pain. Good pain management pays great attention to the psychological as well as physical factors in dealing with chronic pain. TOOLS FOR OBSERVING AND REPORTING ON YOUR PAIN To get the right help with chronic pain both you and the people helping you need as clear a picture as possible of what you’re dealing with. Action On Pain is very good on this subject. We edit their advice below, but do go to them for the original and all the materials they supply to help. Assessment Tools: Proficient pain management starts with a detailed and systematic assessment which permits the health care provider to characterize the pain, clarify its impact, and consider other medical and psychosocial problems. Pain is very subjective so only you can adequately describe what it is like and the effects that it has on your life. To enable health care providers to understand your pain better, they need to ask about the duration and location of the pain, its severity and quality, and what factors that make it better or worse. It also helps for them to comprehend what changes have occurred in your life as a result of the pain, what impact there has been on your family, social and working life. As part of the assessment a physical examination [will] be required, and it is important to discuss and evaluate all the pain treatments that have been tried, whether they are conventional, complementary or alternative treatments [our emphasis]. A detailed pain assessment will: Determine whether the description corresponds to a well-known pain syndrome; Establish [any] structural disease of the body that may help explain the pain; Try to understand the mechanisms (tissue damage, nerve injury, psychological processes) that maintain the pain; Illustrate the negative effects on physical and psychosocial functioning resulting from the pain; Understand the medical and emotional problems that co-exist with the pain and might need treatment at the same time.   Pain Assessment Charts: Often there are few tangible or obvious indications which enable a health practitioner to judge the severity of pain. If you have no obvious handicap you may feel that your problems are ill-understood or even that you are disbelieved. Pain Assessment Charts provide healthcare professionals with a structured and distinguishable way of gathering a clear history of your pain and appraising the nature and severity of the pain, as well as the impact that it has on daily life for you, your family and friends. Action on Pain suggest that you may find it useful to complete an assessment chart yourself before you see your doctor so that you can clearly explain your pain and the effects that it is having on you. You can get a chart from their website in Useful Organisations. Their assessment charts and Pain Management Log are useful tools. They allow you and your healthcare providers to see clearly how things are progressing. Action on Pain also provide Pain Rating Charts and a Verbal Pain Scale to track how your pain changes and to see if treatment is having the intended effect. Pain Diaries - It is very common for people with chronic pain to feel tense and apprehensive when faced with trying to tell their doctor about the discomfort they feel and they can forget how hard some days can get. If you are one of these people it is useful to keep a diary to help you recall and describe what happened to you whilst the pain is so bad. When telling your doctor about times when the pain was really bad, it is very helpful for them to know how it started, how it made you feel, what made it better, what made it worse. Useful Tips for what to include in your diary include: 1. Where is the pain? · does the pain move? · does the pain vary in different places? 2. How does the pain feel? · e.g. stabbing, burning, tingling 3. When did the pain start? · when you woke up? · later in the day? 4. Does the pain change during the day? · becomes sharper, duller, piercing etc 5. Does anything make it better/ worse? · icepack, heat pad, tens machine. 6. What medications do you take? · do they help? 7. Do you use other non-drug based treatments? · e.g. acupuncture, massage, meditation 8. How well do you sleep? · wake in the night, can’t get off to sleep 9. Have you stopped spending time with family & friends? 10. Is you appetite affected? 11. How has the pain changed your life and what you enjoy? Key points about Pain Diaries A pain diary only requires you to note down words that sum up the pain and how you felt at the time. You do not need to complete the diary every day, as you will not want to be focusing on your discomfort all the time- go back when you feel ready and make brief notes. If you find it difficult ask a member of the family or a friend to make a record of what you want to say. You may like to keep a small notebook or tape recorder close at hand so that if necessary you can make notes about how you feel. You may like to use a specially designed form which provides a guide as to what to record. [Action on Pain supplies sample form]

2008-11-27T10:30:25-08:00

There are a number of causes contributing to most chronic pain. Once your doctor has done what’s possible in terms of treating the causes of pain, remaining chronic pain is not serving any useful purpose. It can be debilitating mentally, emotionally and physically, and the objective is to relieve it. Unfortunately current medical science can’t do this simply and effectively. Obvious. If they could it wouldn’t be chronic. There is good hope in current research (see below), but at present medical treatment is usually just part of the story. This is not to say that medical treatment can’t help. As we said under Basics for pain, you should seek and expect as much pain relief as medicine can offer. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/cp3.jpg" /></div> <a href="http://www.stoppain.org/">www.stoppain.org</a> emphasises that treating pain is important. It should not be minimised or neglected. Unrelieved pain can cause us to: <ul> <li>experience depression </li> <li>experience disruptions in activity, appetite and sleep </li> <li>feel helpless and anxious </li> <li>give up hope </li> <li>reject treatment programs </li> <li>stop participating in life to the fullest extent possible </li> </ul> They also remind us that: <ul type="disc"> <li>Pain usually can be controlled. </li> <li>There are many treatment options. </li> <li>To offer the best approaches for pain, doctors must recognize that pain is different in every person. </li> <li>All patients who experience pain deserve a detailed evaluation of the pain, the effect of the pain, and the conditions that may be causing the pain. </li> </ul> THERAPIES OVERVIEW: <a href="http://www.dailystrength.com/">www.dailystrength.com</a> provides a useful quick overview guide to a range of treatments, both medical and complimentary. The following is an edited summary, laying out territory we will then look at in more detail: Anti-inflammatory drugs, both over the counter and by prescription, are essential to treatment of many forms of chronic pain. See our information below on Non-Steroidal Anti-Inflammatories (NSAIDs), steroids etc. Analgesic refers to the class of drugs that includes most painkillers, such as aspirin, acetaminophen (paracetamol), and ibuprofen. The word analgesic is derived from ancient Greek and means to reduce or stop pain. Non-prescription or over-the-counter pain relievers are generally used for mild to moderate pain. Prescription pain relievers, sold through a pharmacy under the direction of a physician, are used for more moderate to severe pain. Anticonvulsants are used for the treatment of seizure disorders but are also sometimes prescribed for the treatment of pain. Carbamazepine in particular is used to treat a number of painful conditions, including trigeminal neuralgia. Another antiepileptic drug, gabapentin, is being studied for its pain-relieving properties, especially as a treatment for neuropathic pain. Antidepressants are sometimes used for the treatment of pain and, along with neuroleptics and lithium, belong to a category of drugs called psychotropic drugs. In addition, anti-anxiety drugs called benzodiazepines also act as muscle relaxants and are sometimes used as pain relievers. Physicians usually try to treat the condition with analgesics before prescribing these drugs. Antimigraine drugs include the triptans- sumatriptan (Imitrex), naratriptan (Amerge), and zolmitriptan (Zomig)-and are used specifically for migraine headaches. They can have serious side effects in some people and therefore, as with all prescription medicines, should be used only under a doctor's care. Chemonucleolysis is a treatment in which an enzyme, chymopapain, is injected directly into a herniated lumbar disc in an effort to dissolve material around the disc, thus reducing pressure and pain. The procedure's use is extremely limited, in part because some patients may have a life-threatening allergic reaction to chymopapain. COX-2 inhibitors are one result of the search to develop a drug that works as well as morphine but without its negative side effects. Nonsteroidal anti-inflammatory drugs (NSAIDs) work by blocking two enzymes, cyclooxygenase-1 and cyclooxygenase-2, both of which promote production of hormones called prostaglandins, which in turn cause inflammation, fever, and pain. The newer COX-2 inhibitors primarily block cyclooxygenase-2 (thus the name) and are less likely to have the gastrointestinal side effects sometimes produced by NSAIDs. They do increasingly appear to have other risks, however, as detailed below. Electrical stimulation can be simple transcutaneous electrical stimulation (TENS), implanted electric nerve stimulation, or deep brain or spinal cord stimulation. See our alternative and complimentary organisations below for more about TENS and other safe, surface techniques. The other forms of electrical stimulation involve major surgical procedures. They only work for some people and are not 100 percent effective. The following techniques each require specialized equipment and medical personnel trained in the specific procedure being used: <ul type="disc"> <li>Peripheral nerve stimulation uses electrodes placed surgically on a carefully selected area of the body. The patient is then able to deliver an electrical current as needed to the affected area, using an antenna and transmitter.</li> </ul> <ul type="disc"> <li>Spinal cord stimulation uses electrodes surgically inserted within the epidural space of the spinal cord. The patient is able to deliver a pulse of electricity to the spinal cord using a small box-like receiver and an antenna taped to the skin.</li> </ul> <ul type="disc"> <li>Deep brain or intracerebral stimulation is considered an extreme treatment and involves surgical stimulation of the brain, usually the thalamus. It is used for a limited number of conditions, including severe pain, central pain syndrome, cancer pain, phantom limb pain, and other neuropathic pains.</li> </ul>   Nerve blocks employ the use of drugs, chemical agents, or surgical techniques to interrupt the relay of pain messages between specific areas of the body and the brain. There are many different names for the procedure, depending on the technique or agent used. Types of surgical nerve blocks include neurectomy; spinal dorsal, cranial, and trigeminal rhizotomy; and sympathectomy, also called sympathetic blockade, in which a drug or an agent such as guanethidine is used to eliminate pain in a specific area (a limb, for example). Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed and sometimes called non-narcotic or non-opioid analgesics. They work by reducing inflammatory responses in tissues. They include such common drugs as aspirin and ibuprofen. Although paracetamol may have some anti-inflammatory effects, it is generally distinguished from the traditional NSAIDs. Opioids are derived from the poppy plant and are among the oldest drugs known to humankind. They include codeine and perhaps the most well-known narcotic of all, morphine. Physical therapy: Physiotherapy and many forms of body work can help many conditions (see our descriptions in Complementary and Alternative Therapies and Self Help). Steroids: Corticosteroids are powerful medicines to reduce inflammation and the pain it causes. Administration can be oral, injected (as into joints for arthritis or directly into nerves for sciatic pain) or topical. Steroids work on a wide variety of inflammatory conditions and symptoms. Among the best known is probably cortisone. Use of these powerful drugs must be carefully managed. They can have very serious side effects. How you use them and how you stop using them require medical supervision and care on your part. That said, they can be extremely effective and necessary.  Surgery, although not always an option, may be required to relieve pain, especially pain caused by back problems or serious musculoskeletal injuries. Surgery may take the form of a nerve block or it may involve an operation to relieve pain from a ruptured disc, deteriorated joint or some other causative factor. Surgical procedures for back problems include: discectomy or, when microsurgical techniques are used, microdiscectomy, in which the entire disc is removed; laminectomy, a procedure in which a surgeon removes only a disc fragment, gaining access by entering through the arched portion of a vertebra; and spinal fusion, a procedure where the entire disc is removed and replaced with a bone graft. In a spinal fusion, the two vertebrae are then fused together. Although the operation can cause the spine to stiffen, resulting in lost flexibility, the procedure serves one critical purpose: protection of the spinal cord. Other operations for pain include: neurectomy (including peripheral neurectomy) in which a damaged peripheral nerve is destroyed. rhizotomy, in which a nerve close to the spinal cord is cut. Other rhizotomy procedures include cranial rhizotomy and trigeminal rhizotomy, performed as a treatment for extreme facial pain or for the pain of cancer. cordotomy, where bundles of nerves within the spinal cord are severed. Cordotomy is generally used only for the pain of terminal cancer that does not respond to other therapies, and dorsal root entry zone operation, or DREZ, in which spinal neurons corresponding to the patient's pain are destroyed surgically. Occasionally, surgery is carried out with electrodes that selectively damage neurons in a targeted area of the brain. These procedures rarely result in long-term pain relief, but both physician and patient may decide that the surgical procedure will be effective enough that it justifies the expense and risk. In some cases, the results of an operation are remarkable. As one example, many individuals suffering from trigeminal neuralgia who are not responsive to drug treatment have had great success with a procedure called microvascular decompression, in which tiny blood vessels are surgically separated from surrounding nerves. Surgical blocks are performed on cranial, peripheral, or sympathetic nerves. They are most often done to relieve the pain of cancer and extreme facial pain, such as that experienced with trigeminal neuralgia. Nerve blocks and they are not without problems and complications. They can cause muscle paralysis and, in many cases, result in at least partial numbness. For that reason, the procedure should be reserved for a select group of patients and should only be performed by skilled surgeons. DRUG TREATMENTS Action on Pain is our source here, followed by Merck Geriatric. See their websites. When affected by chronic pain many factors induce and add to the stress of the situation and for many people, just gaining access to effective prescription medications can amplify that stress. As well as having understandable apprehensions about the side-affects of some medications, and concerns about becoming dependent or addicted to stronger prescription drugs, countless people face difficulties in receiving specific types of medicines due to postcode prescribing and NHS cutbacks. In the midst of all this it is easy to become overwhelmed and confused about what is safe and effective for treating pain. These misgiving are shared by numerous individuals and as a result many pharmaceutical companies are beginning to recognize that they need to address patient concerns and ensure that the information they provide is more patient friendly and unambiguous. Try to get your doctor and chemist to give you as much thoughtful advice as possible, and use Medline Plus and BBC Health to get unbiased and un-spun information. Drugs alone are not always the answer, as the usefulness of any drug must be balanced against the side effects. Educating yourself about the various treatment options available will enable you to be more confident when talking to your doctor about suitable medications. YOUR GP is likely to stick to traditional prescribing methods in finding a safe and effective drug for your pain. This can often seem to be a long drawn out and “by-the-book” exercise which may fuel your feelings of frustration and anxiety. In truth, it can take some time for the effective dose of drugs to build up in your body - and side effects are always a concern - so it may take a while to find the right drug, or combination of drugs, and doses for you. It is important during this process that you keep communicating your concerns and feelings to your doctor about the progress that is being made in finding a suitable resolution to your pain. Numerous authoritative sources tell us that there may be a tendency to under-prescribe for pain. It is difficult to balance the good and harm drugs may do, but do be clear when your pain is not being sufficiently relieved. Often your GP will aim to maintain an acceptable amount of pain control for you by prescribing painkillers at one of three levels. This may involve them steadily increasing the dosage of the medicines they prescribe which will become more powerful if the pain worsens and you move up to the next level of drug treatments. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/cp4.jpg" /></div> At the start you doctor is likely to prescribe relatively low doses of low-potency analgesic medications like paracetamol. It may be appropriate for them to also prescribe an anti-inflammatory like ibuprofen or another type of non-steroidal anti-inflammatory (NSAID). If the pain persists or becomes more severe, a stronger painkiller like codeine may be needed, and your GP will try different dosage levels with or without NSAIDs to control the pain. In the final stage, if the pain persists or increases to a moderate-to-severe level, then higher strength opioid analgesics (again with or without NSAIDs) can be prescribed. Psychotropic agents like antidepressants and anti-anxiety drugs may also be usefully prescribed. These tackle problems of depression and anxiety which are commonly experienced by people with chronic pain. Specialist Pain Consultants, Pain Consultants and Specialist Pain Nurse Practitioners have the experience and training to provide more specialist forms of treatment and they are therefore able to prescribe a wider range and combination of drug therapies. If you are not getting acceptable pain relief you can ask to be referred.   Action on Pain’s good advice on medications includes reminders that: Doctors appointments may be rushed and pressurized so it can be difficult to remember all the questions about your medication when you are there. Make a list of your questions and concerns before the appointment and ensure that you are satisfied with the answers you have received before you leave. Confident communication is central to ensuring you obtain the best medical care available, so it is to your advantage to generate clear responses to your concerns. It is important to know why the doctor has prescribed a particular drug; you should know how it should help or relieve your condition or symptoms; you must be clear when, how and how often you need to take the medication; whether it must be taken before or after meals; if it must be taken with water and whether you must avoid alcohol; and whether you must avoid taking any other prescription or over the counter medicines at the same time. You should ask how long it is likely to be before you start to feel or see the benefits of the medication. If your doctor does not have the time to answer all you questions or you remain unclear on some points, ask to see someone else in the practice who can answer your questions. Many health care providers now have nurse practitioners and Health Care assistants who are trained to help. Side effects: Although most doctors will tell you about the side affects of your medication if you ask them, nowadays your local chemist may be more helpful. Side-effects can be unpleasant and dangerous. Tell your doctor if you run into any problems which may be caused by your medication. Dependency on a medication is not the same as addiction (see the information from Merck Medicus below). Dependency arises when your body becomes accustomed to a medication and reacts negatively to its absence or any reduction in dosage. e.g. a diabetic will react negatively if they do not get their insulin but this does not mean that they are addicted to their medication. Addiction is a neurobiological disease distinguished by activities that include a lack of control over use of the drug, compulsive use, continued use despite harm, and craving. Tolerance is a situation in which the use of a drug brings about adaptive changes within the body that cause a reduction in one or more of the drug's effects over time. It is because of this that it is advisable to regularly review your medication with your doctor. LONG TERM MEDICATION can cause a number of problems. A drug can help chronic pain for years, and then start to cause difficulties. You need to be aware of this and discuss anything which might be a side effect with your doctor. Do not hesitate. Check whether you need to change medication before unnecessary damage is done. Action on Pain tells us that patients may often need the help of a pain clinic after taking various medications which are either simply not working on their pain or are giving them inadequate pain relief. There may be many reasons for this, but the simplest and probably most common one is non-compliance; that is they are not taking the drugs regularly as prescribed. Drugs are formulated to work in a particular way and therefore it is important to take the medication as prescribed. If the body has a constant, adequate level of a drug then it can fight the pain much more effectively. WHICH DRUG? As you already know if you have chronic pain like back pain, it can be very complex and difficult to accurately diagnose and treat. There can be many underlying factors causing chronic pain, and a wide range of potential treatments that may or may not work for the same condition. Different drugs are prescribed according to what sort of pain is being targeted. If the pain is from a chronic inflammation, for instance, an anti-inflammatory treatment is obvious - but it’s often not so easy to find the right one which you can tolerate in terms of side-effects, your general health and your lifestyle and needs. Nociceptive pain which is felt in the tissues and organs is likely to respond well to classic painkillers such as aspirin, paracetamol, codeine and in moderate to severe cases of pain opiods like morphine may be warranted. Neuropathic pain, felt from nerves, often responds poorly to the traditional analgesics like aspirin, codeine and morphine. Pain Specialists may often prescribe painkilling drugs which are usually used for treating other conditions like epilepsy and depression. e.g. Gabapentin and Tegretol (antiepileptics); Amitriptyline and Dothiepin.(antidepressants). If your specialist recommends you try such drugs, it is not because they think you have these other conditions, but rather because they can help to combat certain kinds of pain. These drugs work by preventing the random firing of nerve impulses from nerve cells, which is what causes the pain. The greatest problem with using these medications is that they may often give patients unpleasant side effects. The advent of aspirin-like analgesics such as Ibuprofen, Voltarol, Mefanamic Acid, Ketoprofen, has opened up several effective options for treating nociceptive pain. Known as non-steroidal anti-inflammatory drugs (NSAIDS), the downside of these newer analgesics drugs is they can cause severe side effects including gastric ulcers and kidney damage, so they need to be used with caution. Newer COX-2 NSAID’s like Celecoxib, and Parecoxib/ Valdecoxib have now also been found to have a significant incidence of causing cardiovascular problems in "at risk" groups. Obviously care needs to be taken by health professionals when prescribing these anti-inflammatory drugs and provided there are no medical reasons to preclude you from being prescribed these analgesics the benefits in pain relief may be most valuable. The MERCK MEDICUS website does a fairly extensive listing of pain medications which may be prescribed or suggested by your doctor. We edit below for your convenience, but see Merck in Useful Organisations to learn more. Merck is responsible as always in reminding us that for chronic pain whatever drugs may be used normally need to be supplemented by non-drug treatments (see our discussion of Self Help options).  ANALGESICS fall into three categories: opioid (narcotic) analgesics, nonopioid analgesics, and adjuvant analgesics (drugs that are usually given for reasons other than pain but that sometimes relieve pain). Opioid Analgesics Opioid analgesics (narcotics), the most powerful analgesics, are the mainstay for treatment of severe acute pain and chronic pain due to cancer and other serious disorders. Opioids are preferred because they are so effective in controlling pain. The use of opioids to treat chronic pain not due to cancer is becoming more accepted, but opioids are not appropriate for everyone. Opioids are all chemically related to morphine, a natural substance extracted from poppies. Some opioids are extracted from other plants, and some are synthesised in a laboratory. Opioids have many side effects. People who take opioids for acute pain often become drowsy. For some people, this drowsiness is welcome, but for others, it is not. Most people who take opioids become tolerant of this effect and do not continue to feel drowsy. Some people who continue to feel drowsy are given stimulant drugs, such as methylphenidate to keep them awake and alert. Opioids may also cause confusion, especially in older people. Opioids often cause constipation and retention of urine, especially in older people. Stimulant laxatives such as senna help prevent or relieve the constipation. Increasing intake of fluids can also help. Sometimes people with pain feel nauseated, and opioids can increase the nausea. Antiemetic drugs taken by mouth, suppository, or injection help prevent or relieve nausea. Taking too much of an opioid [overdose] can have serious side effects, including a dangerous slowing of breathing and even coma. These effects can be reversed with naloxone, an antidote given intravenously. Nurses and family members should watch for side effects of opioids. Doctors carefully weigh the benefits and side effects when they consider these drugs for the treatment of chronic pain. With repeated use of opioids over time, some people need higher doses because the body adapts to and thus responds less well to the drug; this phenomenon is called tolerance. For other people, the same dose remains effective for a long time. People who take opioids for a long time usually become dependent on them.. When opioids are stopped after long-term use, the dose must be gradually tapered to minimize the development of withdrawal symptoms. Dependence is not the same as addiction, which is the disruptive behaviour or activity associated with obtaining and using the drug. Although addiction is possible, it appears to be rare among people who take opioids to control pain. Too often, exaggerated concern about the addiction potential of opioids leads to undertreatment of pain and needless suffering. People with severe pain should not avoid opioids, and adequate doses should be taken as needed. - Note: this is Merck Geriatric’s published view, with which we agree. When possible, opioids are taken by mouth. Opioids are given by injection when people cannot take them by mouth. For people who are helped by an opioid but cannot tolerate its side effects, an opioid can be administered directly into the space around the spinal cord through a pump, thus providing high concentrations of the drug to the brain. One opioid, fentanyl, is available as a skin patch. It provides pain relief for up to 72 hours. Different opioid analgesics have different advantages and disadvantages. MORPHINE, the prototype of these drugs, can be taken by mouth (orally) or by injection. There are two oral forms: sustained-release and immediate-release. Different sustained-release forms provide relief for 8 to 24 hours. These drugs are widely used to treat chronic pain [again, we are quoting from Merck]. The immediate-release form provides short-lived relief, usually for less than 3 hours. In injected forms, 2 to 6 times less morphine is required than in oral forms, because when morphine is taken by mouth, much of the drug is chemically altered (metabolized) by the liver before it reaches the bloodstream. Usually, the difference in the amount needed for the different routes does not change the effects of the drug. Pain relief with injected forms is quicker than that with oral forms, but relief does not last as long. Morphine may be injected into a vein (intravenously), into a muscle (intramuscularly), or under the skin (subcutaneously). With the intravenous form of morphine pain relief is almost immediate but does not last very long. With the intramuscular form, pain relief is less rapid but lasts somewhat longer. With the subcutaneous form, pain relief is the least rapid but lasts the longest. Morphine starts to work quickly. The oral form can be very effective for chronic pain. CODEINE is a less potent opioid than morphine. It is often taken in combination with aspirin or paracetamol FENTANYL is available as a lozenge that is dissolved in the mouth; it is used to treat breakthrough pain. The patch is often used to treat chronic pain, and lasts for 72 hours MEPERIDINE is not preferred for long-term use because it causes side effects, such as psychosis, muscle spasms, tremors, and seizures METHADONE is a synthetic opioid. Although chemically unlike morphine or heroin, methadone also acts on the opioid receptors and thus produces many of the same effects. LEVORPHANOL is a strong alternative to morphine. HYDROMORPHONE begins to work quickly. It can be used instead of morphine and is useful for chronic pain. OXYCODONE can be used instead of morphine to treat chronic pain. The short-acting formulation is usually combined with aspirin or paracetamol. PENTAZOCINE can cause confusion and anxiety, especially in older people Nonopioid Analgesics A variety of nonopioid analgesics are available. Several, such as aspirin, ibuprofen, ketoprofen, naproxen and paracetamol (acetaminophen) are available in prescription and nonprescription (over-the-counter, or OTC) strengths. Prescription-strength formulations contain more active ingredient per dose than OTC formulations. OTC analgesics are reasonably safe to take for short periods of time, but their labels caution against taking them for more than 7 to 10 days to treat pain. If you’re going to use them long-term check with your doctor, and be careful not to overdose.  Nonsteroidal Anti-Inflammatory Drugs Most nonopioid analgesics are classified as nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are used to treat mild to moderate pain and may be combined with opioids to treat moderate to severe pain. How they work: NSAIDs work in two ways: They reduce the sensation of pain, and they reduce the inflammation that often accompanies and worsens pain. NSAIDs produce these effects because they reduce the production of hormone-like substances called prostaglandins. Different prostaglandins have different functions, such as sensitizing pain receptors to mechanical and chemical stimulation and causing blood vessels to dilate. NSAIDs tend to irritate the stomach's lining and cause digestive upset (such as heartburn, indigestion, nausea, bloating, diarrhea, and stomach pain), peptic ulcers, and bleeding in the digestive tract. Taking NSAIDs with food and using antacids may help prevent stomach irritation. The drug misoprostol can help prevent stomach irritation and ulcers, but it can cause other problems, including diarrhoea. Proton pump inhibitors (such as omeprazole or histamine-2 (H2) blockers such as famotidine, which are used to treat peptic ulcers, can also help prevent stomach problems due to NSAIDs. NSAIDs interfere with the clotting tendency of platelets (cell-like particles in the blood that help stop bleeding when blood vessels are injured). Consequently, NSAIDs increase the risk of bleeding, especially in the digestive tract if they also irritate the stomach's lining. NSAIDs cause fluid retention and swelling in 1 to 2% of people. Regular use of NSAIDs may also increase the risk of developing a kidney disorder, sometimes resulting in renal failure (a disorder called analgesic nephropathy). For older people, the risk of side effects due to NSAIDs is increased. For people who drink alcoholic beverages regularly and take NSAIDs, the risk of digestive upset, ulcers, and liver damage may be increased. People with heart failure, high blood pressure, or kidney or liver disorders require a doctor's supervision when they take NSAIDs. Some prescription heart and blood pressure drugs may not work as well when taken with these analgesics. NSAIDs vary in how quickly they work and how long they relieve pain. Different NSAIDs may be effective for different conditions, and individual people respond to them differently. It also seems that some people can take these medications long-term with no apparent problems, while others cannot. COMMON NSAIDs include Aspirin, Ibuprofen, Ketoprofen, Naproxen, and Diclofenac (Voltarol). These and other drugs in this class should not be taken with anticoagulants like warfarin (Coumadin) except under a doctor's close supervision. People who are allergic to or have difficulty coping with one of the conventional NSAIDs may also have trouble with the others. Coxibs (COX-2 Inhibitors) are a new alternative to conventional NSAIDs. Other NSAIDs block two enzymes: COX-1, which is involved in the production of the prostaglandins that protect the stomach and play a crucial role in blood clotting; and COX-2, which is involved in the production of the prostaglandins that promote inflammation. Coxibs tend to block only COX-2 enzymes. Thus, coxibs are as effective as other NSAIDs in the treatment of pain and inflammation - but are less likely to damage the stomach; to cause nausea, bloating, heartburn, bleeding, and peptic ulcers; and to interfere with clotting than are other NSAIDs. HOWEVER:   BBC HEALTH tells us that Rofecoxib and another Cox-2 inhibitor called valdecoxib have been withdrawn from use in the UK. Celecoxib has also been linked to an increased risk of heart attack. This drug hasn't yet been withdrawn from use because there's some debate about the research that identified this risk. The manufacturers plan to do more studies to look closely at the problem. These developments have left both doctors and patients unsure what to do for the best. New research means that safer COX-2 drugs should be forthcoming. Meanwhile people with arthritis who can’t take conventional NSAIDs may well get the help they need from their doctor’s careful choice of a COX-2 inhibitor. BBC Health reminds is that the aim is to find some sort of balance between relief of pain and improved function on the one hand, and the likelihood of serious adverse effects on the other. Finding this balance isn't easy, especially for older people who are more likely to suffer from side effects. Adjuvant Analgesics Adjuvant analgesics are drugs that are not usually used for pain relief but may relieve pain in certain circumstances and that, when used to relieve pain, are usually used with other analgesics or non-drug pain treatments. The adjuvant analgesics most commonly used for pain are antidepressants, anticonvulsants, and oral and topical local anaesthetics. Antidepressants can potentially relieve pain in people who do not have depression. There is some evidence that tricyclic antidepressants are more effective for this purpose than other antidepressants, but selective serotonin reuptake inhibitor (SSRI) antidepressants such as fluoxetine (Prozac) are tolerated better. People may respond to one antidepressant and not others. Anticonvulsants may be used to relieve neuropathic pain. As BBC Health tells us that this chronic nerve pain affects about 8% of older people in the UK, it is a big subject. Some anticonvulsants may also prevent migraine headaches. Local anaesthetics: Mexiletine is a local anaesthetic taken by mouth to treat abnormal heart rhythms, and can sometimes be used to treat neuropathic pain. Local anesthetics are more commonly placed directly on or near a sore area to help reduce pain. Doctors may inject a local anaesthetic, such as lidocaine into the skin to control pain due to an injury or a neuropathic pain syndrome. Local anesthetics are also used in nerve blocks. For example, a sympathetic nerve block involves injecting a local anaesthetic into a group of nerves near the spine—in the neck for pain in the upper body or in the lower back for pain in the lower body. Occasionally, pain related to nerve injury can be treated by injecting a caustic substance, such as phenol, into a nerve to destroy it, by freezing the nerve (in cryotherapy), or by burning the nerve with a radiofrequency probe. These techniques may be used to treat facial pain due to trigeminal neuralgia. Topical anaesthetics like lidocaine, applied as a lotion, ointment, or skin patch, can be used to control pain due to some conditions. These treatments are usually for short-term pain, but some people with chronic pain benefit from using topical anaesthetics for a long time. For example, a lidocaine patch can be used to relieve postherpetic neuralgia. A cream containing capsaicin, a substance found in hot peppers, sometimes helps reduce the pain caused by such disorders as herpes zoster and osteoarthritis. It is most often used by people with localized pain due to arthritis. This cream must be applied several times a day. <a name="future" id="future"></a>WHERE MEDICAL AND DRUG RESEARCH IS LEADING editing from <a href="http://www.dailystrength.com/">www.dailystrength.com</a> : In his research, the late John C. Liebeskind, a renowned pain expert and a professor of psychology at UCLA, found that pain can kill by delaying healing [our emphasis] and causing cancer to spread. He also found evidence that controlling pain and stress allowed the body to fight the disease more effectively. The link between the nervous and immune systems is an important one. Cytokines, a type of protein found in the nervous system, are also part of the body's immune system, the body's shield for fighting off disease. Cytokines can trigger pain by promoting inflammation, even in the absence of injury or damage. Certain types of cytokines have been linked to nervous system injury. After trauma, cytokine levels rise in the brain and spinal cord and at the site in the peripheral nervous system where the injury occurred. Improvements in our understanding of the precise role of cytokines in producing pain, especially pain resulting from injury, may lead to new classes of drugs that can block the action of these substances. Some pain medications dull the patient's perception of pain. Morphine is one such drug. It works through the body's natural pain-killing machinery, preventing pain messages from reaching the brain. Scientists are working toward the development of a morphine-like drug that will have the pain-deadening qualities of morphine but without the drug's negative side effects, such as sedation and the potential for addiction. Patients receiving morphine also face the problem of morphine tolerance, meaning that over time they require higher doses of the drug to achieve the same pain relief. Studies have identified factors that contribute to the development of tolerance; continued progress in this line of research should eventually allow patients to take lower doses of morphine. The body's natural painkillers may yet prove to be the most promising pain relievers, pointing to one of the most important new avenues in drug development. The brain may signal the release of painkillers found in the spinal cord, including serotonin, norepinephrine, and opioid-like chemicals. Many pharmaceutical companies are working to synthesize these substances in laboratories as future medications. Endorphins and enkephalins are other natural painkillers. Endorphins may be responsible for the "feel good" effects experienced by many people after vigorous exercise. This is one of the reasons why exercise is recommended for many forms of chronic pain. Similarly, peptides, compounds that make up proteins in the body, play a role in pain responses. Mice bred experimentally to lack a gene for two peptides called tachykinins-neurokinin A and substance P-have a reduced response to severe pain. When exposed to mild pain, these mice react in the same way as mice that carry the missing gene. But when exposed to more severe pain, the mice exhibit a reduced pain response. This suggests that the two peptides are involved in the production of pain sensations, especially moderate-to-severe pain. Continued research on tachykinins may pave the way for drugs tailored to treat different severities of pain. One objective of investigators working to develop the future generation of pain medications is to take full advantage of the body's pain "switching centre" by formulating compounds that will prevent pain signals from being amplified or stop them altogether. Blocking or interrupting pain signals, especially when there is no injury or trauma to tissue, is an important goal in the development of pain medications. An increased understanding of the basic mechanisms of pain will have profound implications for the development of future medicines. The following areas of research are bringing us closer to an ideal pain drug. Channels: The frontier in the search for new drug targets is represented by channels. Channels are gate-like passages found along the membranes of cells that allow electrically charged chemical particles called ions to pass into the cells. Ion channels are important for transmitting signals through the nerve's membrane. The possibility now exists for developing new classes of drugs, including pain cocktails that would act at the site of channel activity to block pain signals. Trophic Factors: A class of "rescuer" or "restorer" drugs may emerge from our growing knowledge of trophic factors, natural chemical substances found in the human body that affect the survival and function of cells. Trophic factors also promote cell death, but little is known about how something beneficial can become harmful. Investigators have observed that an over-accumulation of certain trophic factors in the nerve cells of animals results in heightened pain sensitivity, and that some receptors found on cells respond to trophic factors and interact with each other. These receptors may provide targets for new pain therapies. Plasticity: Following injury, the nervous system undergoes a tremendous reorganization. This phenomenon is known as plasticity. For example, the spinal cord is "rewired" following trauma as nerve cell axons make new contacts, a phenomenon known as "sprouting." This in turn disrupts the cells' supply of trophic factors. Scientists can now identify and study the changes that occur during the processing of pain. For example, using a technique called polymerase chain reaction, abbreviated PCR, scientists can study the genes that are involved in dealing with by injury and persistent pain. There is evidence that the proteins that are ultimately synthesized by these genes may be targets for new therapies. The dramatic changes that occur with injury and persistent pain underscore that chronic pain should be considered a disease of the nervous system, not just prolonged acute pain or a symptom of an injury. Thus, scientists hope that therapies directed at preventing the long-term changes that occur in the nervous system will prevent the development of chronic pain conditions. Neurotransmitters: Just as mutations in genes may affect behaviour, they may also affect a number of neurotransmitters involved in the control of pain. Using sophisticated imaging technologies, investigators can now visualize what is happening chemically in the spinal cord. From this work, new therapies may emerge, therapies that can help reduce or obliterate severe or chronic pain. Systems and Imaging: The idea of mapping cognitive functions to precise areas of the brain dates back to phrenology, the now archaic practice of studying bumps on the head. Positron emission tomography (PET), functional magnetic resonance imaging (fMRI), and other imaging technologies offer a vivid picture of what is happening in the brain as it processes pain. Using imaging, investigators can now see that pain activates at least three or four key areas of the brain's cortex - the outer layer of the brain. Interestingly, when patients undergo hypnosis so that the unpleasantness of a painful stimulus is not experienced, activity in some, but not all, brain areas is reduced. This emphasizes that the experience of pain involves a strong emotional component as well as the sensory experience… We emphasise that last sentence to come back to the present and underline the solid scientific basis for saying that, at this time: the prescribing of pain relieving drugs by Pain Practitioners is rarely the only aspect in the treatment and control of chronic pain. A holistic approach will be needed to help you start to take control over your pain, and this may involve attending Pain Management Programmes, seeing physiotherapists and Occupational Therapists, having hypnotherapy, counselling or sessions with a Pain Psychologist or taking advantage of some of the many other forms of help, skills you can learn and techniques you can use. Most doctors and pain organisations will be right behind us when we say that drugs and medical techniques are only part of the story when it comes to relieving pain, and that other treatments and your own practices are extremely important. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/cp5.jpg" /></div> The self-help and complimentary options for chronic pain can be absolutely life-changing. There are those of us who give thanks every day for the life-changing discoveries we made because of pain, and the richer lives we lead as a result. At the same time we stay emphatic that sufficient and appropriate pain medication should be available to chronic pain sufferers. Let’s not make a virtue of unnecessary suffering. It isn’t one or the other with Chronic Pain. It’s both. As much pain control as possible and as much enriching our lives and discovery as we can get from working with the pain. The importance of psychological support for people in pain should not be underestimated. We would add that spiritual support can also be most profound and effective. The often quoted “Man’s extremity is God’s opportunity” may be deeply relevant and important if you are that way inclined. Whether you are or not, you can also try the Shollond Trust (see our Useful Organisations) for a fast, simple but profound non-denominational meditation technique. In Useful Organisations you’ll find opportunities to help with pain from Activity to Zoology (alright, zoology is a bit of stretch, but there’s a lot to be said for pets and animals). painSupport ( <a href="http://www.painsupport.co.uk/">www.painsupport.co.uk</a> ) is a great organisation for helping you to combine medical help with Self Help. You’ll find others in our Useful Organisations section. We’ll concentrate on the advice from painSupport here because we really like their content and style. You’ll read on the painSupport website that they are often asked what the difference is between PAIN CLINICS AND PAIN MANAGEMENT PROGRAMMES. and what each can offer. They explain that: PAIN CLINICS offer a wide range of treatment including drug therapy, nerve blocks, manipulation, exercise, electrical methods, some complementary therapies and pain management programmes to teach you self-help skills to control and relieve your pain. Remember, it's your choice and your body, you don't have to have anything anyone suggests to you without finding out everything about it first of all. Discuss with the consultant what the treatment will involve, what the likely benefits will be and also whether there are any risks or side effects involved. On a PAIN MANAGEMENT PROGRAMME you will learn how to control your pain yourself, through careful pacing of activities, learning about correct breathing and relaxation, positive thinking skills, exercise and many of the other skills that can be found on the painSupport website. You could talk to your GP and ask what kinds of treatment you are likely to be offered at the Pain Clinic. You could also discuss with your doctor if it would be a good idea to ask your Consultant if you could be referred on to a PAIN MANAGEMENT COURSE as well as, or instead of, the Pain Clinic. painSupport has a really excellent menu on the left side of their home page to explore the techniques for pain relief which you can use to change your life. They are enormously encouraging that you can change your situation, and we know their techniques well enough to agree. Other sites will give you similar suggestions, and see Useful Organisations and our First Resources for other forms. We offer a digest of some of the painSupport information below. This is just to summarise and be sure that you catch their drift. Do go to the original source. They say the good news is that you already have the power within you to reduce your pain. Those of us who have tried know this to be true. Whether you go to painSupport or one of the other excellent organisations offering similar advice, you’ll find that Self Help techniques can be amazingly effective for pain control. What’s more they can make life far more interesting and quality of life far better than you may have thought possible. Our following summary of self-help from the painSupport website is digested (and sometimes italicised and occasionally butchered) by us. Once again, go to the source for the real thing. THE PAIN GATE Pain levels vary from time to time throughout each day. The Gate Control Theory of Pain does much to explain why this happens. The theory uses the idea of a gate, which can be open to allow pain messages through, or shut to stop pain messages being passed to the brain. The gate also opens and closes in response to messages sent from the brain. The following advice is about how to avoid opening the Pain Gate and to close it as much as possible. We are summarising, so let’s start by picking out a few tasty bits of overall gate-closing advice we really like, including: Feeling joyful [easier said than done, but true and look for opportunities] Good posture Being enthusiastic Rubbing the area that hurts Laughing painSupportgoes on with plenty more, and explains quite practically how and why pain management techniques work. We just liked the above for openers. The painSupport Pain Management approach includes, mostly in their words: A Daily Plan Pain Relief techniques will enable you to get back in control of your life, and encourage the body's natural healing processes to be maximised. All of the methods suggested can be used alongside conventional medicine. They will enhance the effect of any treatment you may be having. When you help yourself, you empower yourself. You feel that you’re in control of the situation, not the pain. You may not like it, but, for the moment, the pain is here and part of your life. Try to accept it as such and do what is best for it. Don't let the days just drift - by giving your days some shape you remain in control and you are more likely to keep pain levels down. Make a daily plan, so as to be sure that essentials, such as relaxation and pacing, are definitely included in your day's activities. PACING - Don't keep going until the pain forces you to stop. Make sure you space out activities, breaking them up into smaller sections, if necessary. Vary your activities and the posture needed for them. Plan your meal for the day, especially if you're the cook and the meal needs to be prepared in sections throughout the day. EXERCISE - Plan to take some exercise, whether it is walking, swimming or some other activity. Perform a set of exercises that are appropriate to you and your pain. Do them in a relaxed, meditative state. Take advice on which exercises are best for you from an expert, such as a physiotherapist, chiropractor or osteopath. [We note: see our Complementary and Alternative sections and Useful Organisations for exercise techniques and opportunities]. RELAXATION - Best taken after your exercise session. Let yourself go into a deep relaxation for about 15-20 minutes at least once a day. Sitting watching TV is not the equivalent of relaxation. You need to lie down and really let go so that you allow the production of endorphins, your natural pain relieving agents, to flow. The relaxation will leave you feeling peaceful, centred and with less, or no pain. SOCIAL CONTACT - Try to have close contact with at least one person during the day, family or close friend. painSupport acknowledges in their advice that this is not always possible, but - a hug a day helps keep the pain away! If you can't do this physically, contact a friend by phone, write a letter, use the painSupportContact Club [or Action on Pain (you can call their Pain Line), the Alliance Forum, any of the other support organisations we list, or write to the Alliance Editor. LEISURE ACTIVITY - First thing in the morning, before you get up, ask yourself, "What am I going to do to enjoy myself to-day?" Decide on at least one thing, then make sure you do it. WORK - It doesn't matter whether the work is voluntary, paid or studying, try to do some every day if you can. It improves your self-esteem and keeps you in touch with the 'real' world. Voluntary work can be most rewarding. Find some to do at home if you can't go out. FUN - Laugh and smile - the best therapy of all! Pain relieving endorphins are released with every smile. You will look and feel better for having some fun in your life. Not always easy, and if it doesn't come naturally, you need to plan to have laughter in your life. There are plenty of videos, books and tapes which are guaranteed to make you smile or even laugh out aloud. There is also a meditation/relaxation technique which combines breathing and smiling so that you keep a smile on your lips, which makes you feel calmer and happier - and, yes, it really does work! [see the painSupport website] FLARE-UP PLAN: At flare-up time you need a plan of action already in place so you will know what to do. If you haven't already started learning some Survival Skills, such as diaphragmatic breathing or relaxation, etc. - check them out and begin today [see painSupport and Self Help below]. DAILY REVIEW: This is vital. In the early evening, note any problem areas and unfinished tasks and write down the next action to be taken - there's no need to write everything down, just the next action to be taken. It is unfinished business like this that is the cause of most sleeplessness. Use this time as a dividing line between your day and your evening. If you start thinking about these items at night tell yourself you have dealt with them until tomorrow. Spend the last hour or so of the evening preparing for sleep. Keep all activities after the Daily Review very low key and undemanding so that you are in a relaxed and quiet mood when it is time for bed - but don't become so relaxed that you fall asleep on the sofa! [Our note: we define evening as whenever you choose to start winding down for bed. If you like to function late, it’s late].   We will not repeat in detail here all the excellent advice you can easily get from painSupport, Action on Pain, Pain Concern and others. We’ll just stay with painSupport’s advice that some of what you can learn includes: <ul type="disc"> <li>not to panic, and to control the situation</li> </ul> <ul type="disc"> <li>to stop negative thoughts and know how to cope</li> </ul> <ul type="disc"> <li>living with less tension, more confidence and more joy [which is more than lots of people who are not in chronic pain manage to do]</li> </ul> <ul type="disc"> <li>to acknowledge how hard things are and still turn negative thoughts into positive thoughts. </li> </ul> <ul type="disc"> <li>to be patient. Stop battling. Accept the situation and allow it to take its course. Work with it.</li> </ul> <ul type="disc"> <li>learning to live with bed-rest when you really need it but not a weakening habit of sleeping / giving up when you don’t. </li> </ul> <ul type="disc"> <li>the use of simple heat, cold and touch techniques to make a big difference to your pain.</li> </ul> <ul type="disc"> <li>staying involved in day to day household activities.</li> </ul> <ul type="disc"> <li>keeping your body mobilised for better healing, strength and better spirits no matter what your condition. painSupport recommends that each day you:</li> </ul> Make time for one or two relaxation sessions. Make time for your exercise programme. Make time for at least 20 minutes of an enjoyable leisure activity. <ul type="disc"> <li>to go on setting goals for yourself to improve your activity levels once you have your pain more under control.</li> </ul> <ul type="disc"> <li>cry or otherwise release sadness or anger effectively when you need to, while not spend too much time focused on your pain. </li> </ul> <ul type="disc"> <li>focusing on what you CAN do and not on what you can't do. </li> </ul> <ul type="disc"> <li>increasing your own cheerfulness and that of other people.</li> </ul> <ul type="disc"> <li>using posture, the way you move and the way you set up your physical life and surroundings to help relieve pain and increase your wellbeing.</li> </ul> <ul type="disc"> <li>sleeping better at night and reducing tension during the day. </li> </ul>   COMPLEMENTARY THERAPIES AND TECHNIQUES painSupportadvises that: Both medical and complementary therapies have their uses in reducing and coping with pain. It's a good idea to check with your doctor or medical expert before starting a course of any therapy. Also check out the therapists' qualifications with their professional associations. When seeking a therapist, ask the professional association for details of one nearest to you and/or ask in your local natural health centre. Personal recommendation is one of the best ways to find a good therapist. There are many complementary therapies available nowadays which can be used alongside conventional medicine. It's best to regard any therapy with the attitude, 'I'll try it for a few weeks and see what happens.' Not every therapy suits every person or their particular pain. So monitor your progress carefully and don't carry on unless, after a fair trial, you continue to make progress. FINDING THE ONE FOR YOU: We note that not all the techniques which could be helpful have professional associations regulating their teaching and practice. There are no absolutely clear dividing lines here, but: TECHNIQUES YOU LEARN TO DO AND PRACTICE YOURSELF, like Tai Chi, Yoga and Meditation, can’t really be regulated to great effect. That a teacher is a member of an organisation may well be a good thing, but the best teacher for you may well not have the seal of approval of any self-appointed group. You really do have to test, trust yourself, and move on if you’re not comfortable. TREATMENT TECHNIQUES, where you are being treated by a therapist, usually can be and are regulated. For treatments including osteopathy, physiotherapy, hypnotherapy, psychotherapy and anything else where a practitioner is giving you any kind of therapy, professional qualification and regulation does matter. In our Useful Organisations you’ll find professional bodies to help you be sure you’re in qualified hands. Practices like physiotherapy, occupational therapy, counselling, psychotherapy etc are really part of your extended medical treatment, and your doctor may help with referrals. Complementary techniques can help enormously with chronic pain. Which ones will be right for you will depend on the nature of your pain and what you feel you need. If badly done they can be worse than useless. Done well they can give absolutely direct help with causes of pain, help in closing the pain gate in a variety of ways, lift your spirits and improve your general health and sense of wellbeing. At best they can go far beyond helping with the pain and change your whole appreciation, enjoyment and quality of life. We can’t fully describe all the techniques available and what they can do for you, but we can refer you to The Complementary Healthcare Information Service in our Useful Organisations to learn about them and get links to explore the ones you’re interested in. We also have a section in Useful Organisations section devoted to Complementary and Alternative Therapies. This should help you find qualified practitioners and much more information. What we will do here is get you started with brief descriptions of some of the better known options. The list below draws from the Complementary Healthcare Information Service website, but with our comments and descriptions added in to help you get a quick overview of some of the very interesting options you could try:   TECHNIQUES AND THERAPIES INCLUDE: Acupuncture - Well known Chinese therapy using fine needles to change energy flows. Evidence of effectiveness in dealing with pain, at least short term. High level qualified practitioner essential. Acupressure - Same principles as acupuncture, using pressure instead of needles. You can learn to do some acupressure therapy on yourself. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/cp6.jpg" /></div> Alexander Technique - Technique for learning how to efficiently and effortlessly use your body. Simple but profound approach to letting go of harmful tensions in posture and breathing. A safe and effective learning and therapy technique. Aromatherapy - The art of applying essential oils to suit individual needs. The oils work directly on the chemistry of the body, via the skin and bloodstream. Sounds unlikely, but a number of medical sites assure us that it can be surprisingly effective and safe. Art Therapy - Use of art for emotional therapy. Early evidence of effectiveness was with survivors returning from World War 2. Pain is strongly affected by emotion, so makes sense (and can really help). Autogenic Training - A form of self-hypnosis, said to be effective for many conditions. In some areas it is available on the NHS. Ayurveda - The most important form of medicine in India. An ancient tradition, but most practitioners are also doctors or otherwise medically qualified. Ayurveda seeks to balance the body and mind, find health problems before they occur or stop them doing unnecessary harm. Obviously requires a qualified practitioner.  Bach Flower Remedies - Uses liquid preparations made from flowers. You can buy these over the counter. We can’t comment on effectiveness, but many people say they are helped by the Bach Rescue Remedy. Certainly worth learning about. Biofeedback - Machines give you feedback about how your body is working, allowing you to learn to regulate reactions causing problems. Evidence of usefulness for therapy and self-education for many conditions. Biofeedback is often referred to as a very helpful tool for working with chronic pain. Bowen Technique - soft and non-invasive holistic treatment that aims to restore balance to the body by using small, gentle moves to specific areas of the body. Because the therapy is so gentle, it is considered to be suitable for all ages. May be helpful for many pain and stress related problems. Chiropractic - Manipulation of spine and muscles for good balancing and health functioning. A powerful technique and NOT to be used for a number of complaints including osteoporosis, cancer and serious circulatory problems - so a qualified and registered practitioner essential. Cognitive and Behaviour Therapies - Put crudely: It’s not what happens that causes the problems, it’s how you understand it and what you do with it. Less crudely, these have medical and government recognition for a wide variety of problems and can be startlingly effective in many cases. Many of us who they have helped consider them to be most remarkable life tools. Cranio-sacral Therapy and Cranial Osteopathy - use touch to evaluate and affect the cranium (skull), the spinal column and the membranes and cerebrospinal fluid that surround and protect the brain and spinal cord. Said to be effective for many chronic pain conditions, registered and qualified practitioner essential. Feldenkrais Method - Not a therapy as such, but a well established method for learning greater ease of movement and increasing vitality and well-being. Guided Imagery - The use of imagination as potent healer. Pleasant and powerful. See Holistic Online to learn more.<a name="current" id="current"></a> Healing - comes in many forms, from spiritual or religious to energy use as understood in martial arts. Whether the effectiveness is due to a placebo effect, energy flows or spirit, many people have been helped by healings throughout history. Hellerwork - deep tissue massage that unblocks the body, movement education to correct postural alignment, and verbal dialogue to assess emotional holding patterns. Appropriate tools for many chronic pain syndromes. Caution for conditions where deep massage contraindicated. Check with your doctor before using any deep massage technique.   Herbal medicine - Herbal medicines can be very powerful, and are the basis of many conventional drugs. A good herbal practitioner looks at the whole person and health, not just the disease or condition. Because they can be very strong and conflict with prescribed medications, you need to tell your doctor or a trusted chemist what you’re going to be taking. Homoeopathy - famous and controversial. Vanishingly small amounts of a substance in water are given. Many in medical science consider this to be absurd. No conclusive proof either way, but many people have found help and relief. Hard to argue with happy patients, and it has the great virtue of being harmless. That said, neglecting prescribed medications to depend on homeopathy is an enormous mistake, as your qualified homeopath will doubtless agree. Hypnotherapy - not in any way a frightening experience or loss of consciousness or control, safe in qualified hands, and considered very effective in helping with chronic pain. Louise Hay techniques - based on the use of positive affirmations - highly recommended by many people for effectively changing your mindset and health. A place to start is the Louise Hay book “You Can Change Your Life” and audio tapes from Amazon. Massage Therapy - There are many forms of massage, and they can be a great help in stress reduction, release of muscle tensions and other therapeutic effects depending on the technique used. Having your body cared for like this is great, but: deep or powerful massage pressure can be dangerous for some conditions. It is important that your therapist asks what your medical / physical situation is. If they are not qualified or you are not comfortable you are in the wrong hands. Don’t risk damage. Move on. Medau Movement - Enjoyable exercise to music for correct body use and posture, and good for stress reduction. Meditation - A truly profound way to deal with stress and the human condition. Good meditation teaching is simple, and the result should be access to peace and stillness wherever you are and whatever is happening. We like the approach of the Shollond Trust, and the BBC Health and H2G2 recommendations (or contact the Alliance editor). Naturopathy - Technique for helping the body to heal itself, and often incorporates a number of the other techniques discussed here. Interesting to have one technique using the strengths of others. NLP (Neuro-linguistic Programming) - A fascinating form of therapy, looking at how you do what you do and how to change. We like this sentence from a practitioner: “If you always do what you've always done, you'll always get what you've always got. If what you're doing isn't working, do something else". Far more to it than that of course, and worth learning about. Nutritional therapy - a form of complementary medicine working on eliminating harmful substances from diet and introducing helpful ones. Some evidence of helping a number of conditions, but avoid extreme diets and check with your doctor. Osteopathy - Certainly among the best know physical therapies and very well accepted as a complementary therapy. Osteopathy is highly regulated. Physical manipulation and massage techniques are used to help correct problems with the muscles, bones, and joints and influence many of the body’s systems. A good practitioner will ask in detail about your condition to not do harm with inappropriate manipulations. Often helpful for chronic pain conditions. Pilates - Exercise method to method to strengthen the core postural muscles and develop balanced alignment through the use of slow, controlled movements and breathing. Often recommended by doctors, physiotherapists, and used by everyone from top professional athletes and dancers to people who have never done much exercise or thought they were unable to. Psychology of Mind - The book “Slowing Down to the Speed of Life” from Amazon is the well known place to start. POM techniques and understandings are simple and can be life changing. A way to use your problems to vastly improve your life. Easy and simple techniques for being okay now rather than in endless distress about the past and future. Psychotherapy - Many forms, and a vital and immensely beneficial approach for many people. The idea that psychotherapy is for crazies couldn’t be more wrong. It’s one of the best learning and healing tools and most interesting things you could choose to do. Practitioners must be qualified, and you have to find one you feel comfortable with and helped by. Often recommended and useful for chronic pain. Reiki Healing - A Japanese form of healing through energy flow and which, interestingly, is also concerned with living in harmony with others, taking responsibility for one's own health and happiness, helping others, and being positive about all things. Rolfing - Strong deep massage technique to bring harmony and alignment to the body through the loosening and balancing of the connective tissues. Deep pressure, can be painful and not for everyone, but some find it effective. Caution and can be dangerous for those with osteoporosis, other skeletal or joint conditions, some cancers, circulation problems. Check with your doctor if in any doubt. Shiatsu - Traditional Japanese physical therapy, using a range of techniques from gentle touch to more dynamic work to improve specific conditions and general health. A qualified practitioner will take a detailed history from you and avoid more dynamic techniques where they might be contra-indicated for your condition. T’ai Chi - A soft, gentle and very powerful Chinese martial art, movement meditation, and way of healing through movement. T’ai Chi works very well for older and ill people. It helps to free and balance the body, breathing and movement, and to find calm, stability, peace and deep security. If you have serious problems with feet, knees or walking it may not work for you. If that’s the case the exercises of Qigong (or Chi Kung) use the same principles but can be done sitting as well as standing. Trager Work - A form of bodywork and movement which utilises gentle, rhythmic movements to facilitate the release of stress patterns - physical, mental, and emotional. Created by a doctor and physiotherapist working with his own chronic pain since childhood, this method also has a meditation aspect. Created out of chronic pain and highly relevant. Yoga - The ancient Indian system of postures, exercises, breathing, and body and mind development and control. Popular and widely available these days. The basic exercises of Hatha Yoga, taught with careful respect for your physical problems and limitations, are a good place to start, along with pranayam breathing exercises. There are also some extremely challenging physical styles of yoga which may not be appropriate. Be sure your teacher knows what your physical problems are, and that your doctor has no problem with your doing yoga. That said, it is a wonderful combination of calm body, mind and spirit training and self-help therapy.   <a name="snakeoil" id="snakeoil"></a>SUPPLEMENTS, SNAKE-OILS AND DIETS Beware “miracle cures”. Check Medline Plus or BBC Health in our First Resourcessection to learn more about any supplement, alternative medicine or diet cure which interests you. They are not prejudiced against alternative options. You will get excellent information on whatever you’re considering, with no spin. From Merck Medicus (and others) we get some useful basic information on: Herbal Medicine, the oldest known form of health care, uses plants to treat disease and promote health. Either a single herb or a mixture of different herbs can be used. In the case of Chinese herbal medicine, mixtures can also contain minerals and animal parts. Unlike conventional drugs, in which the active substance is extracted from the herb, herbal medicine usually makes use of the herb in its natural form. Herbal medicines are available as extracts (solutions obtained by steeping or soaking a substance, usually in water), tinctures (usually alcohol-based preparations, with the alcohol acting as a natural preservative), infusions (the most common method of internal herbal preparation, usually referred to as a tea), decoctions (similar to an infusion), pills, and powders and even in a moistened cloth applied to the skin. We note: many herbal remedies can be powerful and surprisingly effective. Powerful also means handle with care. Obviously “natural” does not equal “safe”. Herbal remedies can interact very badly indeed with each other and with prescribed medications. ORTHOMOLECULAR MEDICINE: Orthomolecular medicine focuses on the use of nutritional supplements to maintain and restore health. It uses combinations of vitamins, minerals, and amino acids normally found in the body to treat specific conditions. Sometimes referred to as megavitamin therapy, orthomolecular therapy emphasizes supplementing the diet with large quantities of vitamins. Some of the more common orthomolecular treatments make use of shark cartilage to treat cancer, chelation therapy (removal of toxic materials from the bloodstream), and glucosamine or chondroitin (substances occurring naturally in the body) to treat osteoarthritis (for which there is good evidence of effectiveness). We note that: megavitamin therapy may be effective but again, handle with care. The body can react badly to higher than normal levels of vitamins. The BBC’s website caries a report about Which? magazine undercover research into 30 health food shops in five areas of the country, including London. They found that staff were recommending remedies which could be dangerous for people to combine with their prescription medications, offering remedies without knowing if people were seeing a doctor about their problem at all, even telling people they could stop taking their prescription and substitute a remedy. Obviously on the internet the information from people selling remedies can be even worse. As a principle, tell your doctor about any supplement or alternative remedy you are taking. This may sound fussy and unnecessary, but we have seen too many harmful consequences from alternative self-medication. If your doctor has a negative attitude to these things check what you plan to take with a sympathetic chemist or go to one of our First Resources. There are many alternative remedies offered for various types and causes of chronic pain. Some have good evidence of effectiveness, and a quick check with MedlinePlus or BBC Health in First Resources will tell you if there is good effectiveness and safety evidence for a remedy. Kava is an interesting example of “useful but…” It appears to be a potentially worthwhile alternative remedy for anxiety. You might find it helpful - but if you’re on tranquillisers it could be actively harmful. Things like Bach and Homeopathic remedies may be pretty benign, but Capsaicin (the fierceness in chilli peppers - used in a number of ways for rheumatic and other pain) and Cannabis demonstrate the power of plants and natural medicines. You can get good guidance on possible supplements and alternative remedies from our Useful Organisations and First Resources. They aren’t trying to make money from your pain, and can help you avoid remedies which are either just not right for you or outright snake-oils. DIET Unusual for us to keep quoting one organisation, but when someone’s got the spirit and the facts of a subject right, why re-invent the wheel? Once again we turn to painSupport. They supply quick and easy food that doesn't involve hours spent cutting, chopping, mixing, sitting or standing in the kitchen, recognising that you may need to be the cook, deal with flare-ups and not make the experience a lengthy ordeal. Their advice with regard to diet and pain includes: Always talk a special diet over with your doctor, dietician or nutritionist before you begin. It's easy to let your diet become unbalanced which could result in you missing out on essential minerals and vitamins, so it's best always to check with an expert. When you have pain and/or ill health your diet becomes even more important that normal. A healthy diet ensures your basic body functions operate well, including your immune and natural healing systems. People with longstanding pain often have digestive problems, sometimes due to the drugs they may have taken. Some foods are also suspected of triggering or aggravating pain. The best approach to this is to undergo a proper elimination diet and remove the foods you suspect may be causing you trouble and then reintroduce them one at a time, leaving 3-4 days in-between each new food. Notice anything that happens. Not every person with a food intolerance would be found to be intolerant of the same food, and so on no account restrict your diet unnecessarily [our emphasis]. If the problem is severe or longstanding it's best to seek the advice of an expert nutritionist [see our Useful Organisations or the painSupport website’s Therapies page] and always seek advice before undergoing an elimination diet. You may also find by trial and error that some foods actually help to reduce your pain (see the list below). BASIC RULES FOR HEALTHY EATING Eat a wide variety of foods. Eat from all four basic food groups (breads and cereals, fruits and vegetables, meats, and dairy) to obtain the nutrients you need to maintain good health. Eat mostly breads, cereals, fruit and vegetables, supplement with fish (including oily fish), meat and dairy food. The five portions of fruit and veg guideline is a pretty good one. Maintain your ideal weight for optimum function and least strain on your body For those with arthritis or other joint problems, less strain equals less pain. Avoid too much fat, saturated fat, cholesterol. Too much fat contributes to weight gain and to poorer health. Avoid too much sugar and salt. Sugar provides little nutrition and contributes to weight gain. Salt contributes to high blood pressure and water retention. [We comment that if you have low blood pressure and no water-retention issues salt may not necessarily be a problem. Salt substitutes using potassium rather than sodium can also be useful for some people]. Avoid alcohol. Alcohol is high in calories and can deplete the body of vitamins and minerals. It potentially interacts negatively with medications. [We add that there is no need to be extreme about this unless your condition or medications make alcohol dangerous. Moderate alcohol consumption within government guidelines has actually been shown to be beneficial in some studies and for certain conditions.] Avoid fad diets and unproven diet claims that may end up robbing your body of essential nutrients. [our emphasis]. WE NOTE that some of the diet advice above may vary for certain conditions, and it’s worth talking to your doctor about any special dietary considerations for your condition. Foods that POSSIBLY may Decrease Pain Remember to check out with your doctor or nutritionist before embarking on a restricting diet. Remember that experts disagree amongst themselves about the effect of food on the body and new discoveries are being made all the time. That said, it may be beneficial to eat plenty of these foods: Bananas Ginger Chilli peppers Brown rice Cooked green vegetables (e.g. broccoli and Swiss chard) Cooked orange vegetables (e.g. carrots, sweet potatoes) Cooked yellow vegetables (e.g. summer squash) Non-citrus fruits painSupport add the following supplements to this list: Flaxseed oil Starflower Evening Primrose Blackcurrant or Hemp oil   GENERAL HELP WITH CHRONIC PAIN AND RELATED PROBLEMS Action on Pain and Pain Concern (below) have telephone lines for immediate contact. PainSupport has a remarkably attractive and complete approach and programme. Our Chronic Pain Mission (in Useful Organisations) is an exciting and informative approach to “Pain Power”. Our First Resources section contains organisations you can ring with most problems. Specific forms of help, information and therapies are in categories under Useful Organisations below. Addresses of pain management clinics can be obtained from: The College of Health St Margaret's House 21 Old Ford Road London E2 1225 Tel: 0208 983 1225 or from NHS Direct: Tel: 0845 4647 Chronic Pain

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PAIN SUPPORT www.painsupport.co.uk We really like painSupport. Excellent attitude, information and help. Don’t miss it. Conventional medicine and complementary therapies working side by side. As they say, all the ideas and techniques on their website can be used to enhance any medical treatment you may be having. Useful Products / Books, CDs, Downloads, an e-mail newsletter and a Contact Club to help us all prevent pain from making us feel lonely and isolated. ACTION ON PAIN www.action-on-pain.co.uk Painline: 0845 603 1593 Tel: 01760 725993 Support and advice for by people with chronic pain for people with chronic pain. Good to see, an example of how to deal with our problems. People to talk to on the Painline who know from personal experience what you’re dealing with. Tested ways of coping and helpful information. PAIN CONCERN www.painconcern.org.uk Helpline: 01620 822572 Mon-Fri 9-5pm, Fri evening 6.30-7.30pm. Offers a Listening Ear helpline - the chance to talk to another pain sufferer about pain problems Information and support for pain sufferers, those who care for them and about them. Free Factsheet and leaflets to help you manage your pain, quarterly magazine and a list of other local members. CHRONIC PAIN MISSION www.cpmission.com This American site is quite an amazing collection of insights, information, what we might call “Pain Power” (the mobilising of people with chronic pain for better treatment) and EXTENSIVE LINKS for most pain issues and problems. A very cool, interesting and powerful site. THE BRITISH PAIN SOCIETY www.britishpainsociety.org Tel: 020 7631 8870 Representative body for healthcare professionals and scientists involved in the management and understanding of pain. THE PAIN RELIEF FOUNDATION www.painrelieffoundation.org.uk Tel: 0151 529 5820 Vital research and up to date Information on chronic pain conditions. THE CHRONIC PAIN COALITION www.paincoalition.org.uk Tel: 020 7202 8582 “The Chronic Pain Policy Coalition is a newly established forum for patients, professionals and parliamentarians who operate at policy level to develop an improved strategy for the prevention, treatment and management of chronic pain and its associated conditions.” [We note with great appreciation the importance of the Coalition] BANDOLIER: THE OXFORD PAIN INTERNET SITE www.jr2.ox.ac.uk/bandolier/booth/painpag/index2.html Bandolier is a journal of evidence-based medicine. This website focuses on systematic reviews with pain as an outcome, including downloadable articles and numerous links to other pain-specific topics. BATH PAIN MANAGEMENT UNIT www.bath.ac.uk Tel: 01225 473427 Residential and outpatient pain management programmes for adults and adolescents with persistent and disabling pain. Admission is subject to a referral by your consultant or GP. MEDICINENET.COM www.medicinenet.com Search “chronic pain” or any specific condition or therapy. For a general guide and information base on the subject this is a great place to start. See their Chronic Pain Centre. WIKIPEDIA for a chronic pain overview: www.wikipedia.org/wiki/Chronic_pain STOPPAIN.ORG www.stoppain.org The famous US Beth Israel Hospital’s site for patients and professionals seeking accurate, reliable information on treatment options. For information on complementary treatments go to their site www.HealingChronicPain.org DAILYSTRENGTH.ORG www.dailystrength.org Comprehensive health network of people sharing their advice, treatment experiences, and support. MAYDAY PAIN PROJECT www.painandhealth.org A listing of conventional and alternative medicine Internet resources for general and specific types of pain. Look up your specific problem. PAIN.COM www.pain.com This educational and informational Internet source for pain practitioners and patients, provides directories for support groups, pain clinics, and various other resources. Although this site is supported by pharmaceutical companies, there are several links to organizations and sites that are focused on alternative medicine. CHRONIC PAIN SUPPORT GROUP www.chronicpainsupport.org A forum for people living with chronic pain to seek support through chat rooms and message board. PAIN ASSOCIATION SCOTLAND www.painassociation.com Provides an information pack and details of about 20 groups in Scotland. Tel: 0800 783 6059   FOR IMMEDIATE HELP WITH HEALTH QUESTIONS and GENERAL MEDICAL INFORMATION: See our FIRST RESOURCES section - especially MedlinePlus ( http://medlineplus.gov ) BBC Health ( www.bbc.co.uk/health ), the Mayo Clinic (www.mayoclinic.com ) and: MEDICINENET.COM www.medicinenet.com For a general guide and information base on any subject this is an excellent resource. NETDOCTOR www.netdoctor.co.uk Attempts to break down the "medical language barrier" between the doctor and the patient. Critical medical information presented in a clear and understandable language so that the patient fully understands his or her choices and decisions. THE COCHRANE REVIEWS (www.cochrane.org) The Cochrane Collaboration assesses most areas of health care. To do this, it is divided into Cochrane Review Groups, each of which concentrates on a specific healthcare area, including a Consumer Network that represents the interests of healthcare consumers. Type any condition into their website and get pretty comprehensive information. If you want clear scientific analysis of any health issue or practice, you’ll usually find it here. BANDOLIER: THE OXFORD MEDICAL SITE http://www.jr2.ox.ac.uk/bandolier/index.html Refered to for chronic pain above, Bandolier is also excellent for links and knowledge on most subjects. Their “Healthy Living Zone” is a bit of a goldmine. MERCK MEDICUS www.merckmedicus.com Easy to use and the US doctor’s reference tool. See MERCK GERIATRIC for age related information. FOR ANCILLARY MEDICAL THERAPIES (Physiotherapy etc): HEALTH PROFESSIONS COUNCIL www.hpc-uk.org Telephone 020 7582 0866 The HPC is a statutory regulator that works to protect the health and well-being of people using the services of health professionals. Find therapists and be sure they are approved / regulated practitioners. CHARTERED SOCIETY OF PHYSIOTHERAPY www.csp.org.uk Tel: 020 7306 6218 / 6666 Information on physiotherapists, physiotherapy and how it can help with pain. THE ORGANISATION OF CHARTERED PHYSIOTHERAPISTS IN PRIVATE PRACTICE www.physiofirst.org.uk Tel: 01327 354441 Details of private chartered physiotherapists in your area. OCCUPATIONAL THERAPISTS IN INDEPENDENT PRACTICE (OTIP) www.otipp.co.uk Tel: 0800 389 4873 Information and find an occupational therapist FOR COMPLEMENTARY AND ALTERNATIVE THERAPIES: THE COMPLIMENTARY HEALTHCARE INFORMATION SERVICE www.chisuk.org.uk Easy reference to learn about any and (just about all) complementary techniques. A truly excellent way to learn what the main comlementary techniques are, how they might work for you, and to explore the subject THE NETDOCTOR DR FOSTER COMPLEMENTARY PRACTITIONER DIRECTORY http://netdoctorcomplementarytherapistguide.drfoster.co.uk If you are looking to find a reliable complementary therapy practitioner in your area, this directory is an essential resource. It can help you find a practitioner who meets your needs. This might be someone who has a particular interest in your condition, or who works at a practice near to your home, at hours that suit your needs. THE BRITISH COMPLEMENTARY MEDICINE ASSOCIATION www.bcma.co.uk Tel 0845 345 5977 Find qualified practitioners of most therapies, learn about therapies, get recognised guidance through the therapy minefield and find a therapist near you. WHOLE HEALTH MD www.wholehealthmd.com American WholeHealth Networks' Complementary and Alternative Medicine (CAM) education website. The site is dedicated to providing integrative health and wellness solutions by combining the resources of both scientific health research and CAM. Click on specific health issues for information on conventional medicine, alternative therapies, supplements, diet, lifestyle options, and much more. HOLISTIC ONLINE www.holisticonline.com Comprehensive site for Alternative and Integrative Medicine. Learn about conditions and treatments. INSTITUTE FOR COMPLEMENTARY MEDICINE www.i-c-m.org.uk The ICM is a UK registered charity providing information on all aspects of the safe and best practice of Complementary Medicine. THE NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE http://nccim.nch.gov Vital and reputable information for the States. A treasure for understanding what’s what. THE ALTERNATIVE MEDICINE FOUNDATION www.amfoundation.org Excellent US site, good clear information. They also recommend: ALTERNATIVE MEDICINE RESOURCE www.altmedresource.com comprehensive and searchable catalog of all alternative medicine studies. Easy search by looking up your condition(s) or a key word. FOR COMPLEMENTARY PRACTICTIONERS’ ASSOCIATIONS GENERAL OSTEOPATHIC COUNCIL www.osteopathy.org.uk Tel: 020 7357 6655 Provides details of qualified local osteopaths. BRITISH CHIROPRACTIC ASSOCIATION www.chiropractic-uk.co.uk Tel: 0118 950 5950 Information on chiropractic and details of local chiropractors. GENERAL CHIROPRACTIC COUNCIL www.gcc-uk.org Tel: 020 7713 5155 Provides details of local chiropractors and information on what to expect when you see a chiropractor. It can also help if you've experienced a problem with a chiropractor. THE SOCIETY OF CHIROPODISTS AND PODIATRISTS www.feetforlife.org Telephone 020 7234 8620 GENERAL COUNCIL FOR MASSAGE THERAPY www.gcmt-uk.org Telephone 01992 537637 New voluntary regulation body for practitioners of massage. INTERNATIONAL FEDERATION OF AROMATHERAPISTS www.ifaroma.org Telephone 020 8992 9605 MUSIC THERAPY: see HEALTH PROFESSIONS COUNCIL above - www.hpcuk.org Telephone 020 7582 0866 THE BRITISH MEDICAL ACUPUNCTURE SOCIETY www.medical-acupuncture.co.uk Telephone 01925 730727 Medical doctors who practice acupuncture. Encourages the use and scientific understanding of acupuncture within medicine for the public benefit. ACUPUNCTURE ASSOCIATION OF CHARTERED PHYSIOTHERAPISTS www.longbo.demon.co.uk/aacp.html Tel 01747 861151 Contact the AACP Secretariat for a register of members - qualified physios working with acupuncture. BRITISH ACUPUNCTURE COUNCIL www.acupuncture.org.uk Tel: 020 8735 0400 Provides information on acupuncture and details of qualified traditional acupuncturists in your area. Phone for more information. NATIONAL INSTITUTE OF MEDICAL HERBALISTS www.nimh.org.uk Telephone 01392 426022 Email nimh@ukexeter.freeserve.co.uk Professional body - offers a service for you to find a trained and qualified herbalist. FOR DIET ADVICE: BRITISH NUTRITION FOUNDATION www.nutrition.org.uk Telephone 0207 404 6504 Includes advice on finding a dietician BRITISH DIETETIC ASSOCIATION www.bda.uk.com FOOD STANDARDS AGENCY www.eatwell.gov.uk BBC HEALTH www.bbc.co.uk/health/healthy_living/nutrition NHS DIRECT www.nhsdirect.nhs.uk/encyclopaedia   FOR MEDITATION: THE SHOLLOND TRUST www.headless.org tel. 020 8806 3710 - Richard Lang, Trust Co-ordinator The Trust offers a form of meditation you can do any time, any place, in any circumstances. It’s astoundingly easy to do, and it’s free. It’s also a great way to get the best out of and appreciate all other meditation and complementary techniques. THE BBC www.bbc.co.uk and search “meditation”. A wide range of options.   THE HITCHHIKER’S GUIDE TO THE GALAXY www.bbc.co.uk/dna/h2g2 Ask the guide about meditation. In fact ask it about any question you have. FOR COUNSELLING: BRITISH ASSOCIATION FOR COUNSELLING AND PSYCHOTHERAPY (BACP) www.bacp.co.uk Telephone 0870 443 5252 Email bacp@bacp.co.uk A fisrt reference for anyone seeking information on counselling and psychotherapy in the United Kingdom. They have a helpful and easy to use search tool to find a therapist. THE SAMARITANS www.samaritans.org Telephone 08457 90 90 90 (24 hours, seven days a week) Email jo@samaritans.org Confidential non-judgemental support, 24 hours a day for people experiencing feelings of distress or despair. MIND www.mind.org.uk Telephone 020 8519 2122 Mind Infoline 0845 766 0163 (Monday-Friday 9:15-5:15) Email contact@mind.org.uk The MindinfoLine offers confidential help on a range of mental health issues from anywhere in the UK for the price of a local call. Local MIND associations offer supported housing, crisis helplines, drop-in centres, counselling, befriending, advocacy, employment and training schemes and other services. RELATE www.relate.org.uk Tel. 0845 456 1310 or 01788 573241 Relate is the UK's largest provider of relationship counselling and sex therapy. They also offer a range of other relationship support services. CRUSE BEREAVEMENT CARE www.crusebereavementcare.org.uk Day-to-day helpline: 0870 167 1677 Help for bereaved people, whatever their age, nationality or beliefs, including a free counselling service. FOR CARE SERVICES: COUNSEL AND CARE www.counselandcare.org.uk Advice line 0845 300 7585 (weekdays 10am-12.30pm and 2pm-4pm) A national charity getting the best care and support for older people, their families and carers SUE RYDER CARE www.suerydercare.org 020 7400 0440 Cares for people with life-shortening illnesses through specialist hospice care services. THE PRINCESS ROYAL TRUST FOR CARERS www.carers.org Telephone 020 7480 7788 Email help@carers.org The trust is the largest provider of comprehensive carers support services in the UK. CARERS UK www.carersuk.org Free Carers Line 0808 808 7777 (weekdays 10am-12pm and 2pm-4pm) Email info@ukcarers.org Carers UK is the voice of carers and the leading campaigning, policy and information organisation for carers. Provides information and advice on topics relating to caring. CARERS NATIONAL ASSOCIATION www.carersuk.org Provides information and advice for carers and works for carers rights. CROSSROADS (The Association of Crossroads Care Attendant Schemes) www.crossroads.org.uk Tel: 0845 450 0350 Practical support for carers; respite care at home. Provides trained care support workers to allow carers the breaks and time off they need. CARE CHOICES LTD www.careselect.co.uk Tel: 0800 389 2077 Care Choices Ltd offers a free residential/care home search service. The company has a database of care homes, nursing homes, elderly accommodation and similar establishments throughout the UK. HOSPICE INFORMATION www.hospiceinformation.info Tel: 0870 903 3903 Publishes a directory of hospice and palliative care services. FOR GENERAL UK HEALTH HELP, ISSUES and the NHS: NHS DIRECT ( www.nhsdirect.nhs.uk ) - see First Resources PATIENTS ASSOCIATION www.patients-association.com Helpline: 0845 608 4455 Represents the views and interests of patients and campaigns for improved health services. Provides advice, factsheets and self-help guides. DR FOSTER www.drfoster.co.uk/ Telephone 0207 332 8800 Works with the NHS to make it easier for professionals and the public to access health and social care information. Hospitals, consultants, complementary therapies and much more. PALS - PATIENT ADVICE AND LIAISON SERVICE (www.dh.gov.uk) This web address will take you to the Department of Health website. Click on Patient Advice and Liaison Service to find your local PAL. Information and help with any questions or problems you have about your GP service, NHS hospital or other NHS service. EQUIP - ELECTRONIC QUALITY INFORMATION FOR PATIENTS www.equip.nhs.uk NHS search website for patient information on a very wide variety of conditions. RSVP - RETIRED AND SENIOR VOLUNTEER PROGRAMME www.csv-rsvp.org.uk Advice and help for over 50’s by over 50’s: Transport for medical care, practical and domestic help, avoiding isolation, help for over 50’s in GP surgeries. LTCA - LONG TERM CONDITIONS ALLIANCE www.ltca.org.uk An umbrella body for voluntary organisations. Promotes access to services, support, and knowledge for self-help. Includes an “Expert Patients” programme with the NHS. Look at the directory of member organisations on their website for the help you need, or RING THEM on 02078153637.   PATIENT CONCERN www.patientconcern.org.uk Helpful advice on how to survive medical treatment and the NHS, how to assess medical websites and more. FOR EXERCISE: There are many possibilities to choose from, and you may be surprised what you can do and what you’ll enjoy. Just be sure to get your doctor’s and/or physiotherapist’s advice on any medical limitations and what to avoid. SIMPLE WAYS to look at the possibilities are with the help of: THE BBC - Go to www.bbc.co.uk/health BANDOLIER - go to www.jr2.ox.ac.uk/bandolier and see Exercise in their healthy living section THE NHS Health encyclopaedia: www.nhsdirect.nhs.uk in our FIRST RESOURCES section has good information. THE COMPLIMENTARY HEALTHCARE INFORMATION SERVICE www.chisuk.org.uk links to all the main movement therapy exercise techniques. A one-stop convenience shop. And specifically for: TAI CHI - local adult education courses, local gym, fitness centre, library listing or the TAI CHI UNION OF GREAT BRITAIN - www.taichiunion.com PILATES www.pilatesfoundation.com YOGA www.bwy.org.uk DANCING - ballroom, tap, folk, flamenco, modern, social, jazz… too many styles to list. Once again the easy place to start is THE BBC. Go to www.bbc.co.uk/health and look under dance. Also many classes locally in many styles. GYMS / CIRCUIT TRAINING / SPORT - Infinite options. BBC Health provides guidance.     EXERCISE IN WATER: AQUA-CHI www.taichiunion.com AQUA-GYM www.aquagym.co.uk POOLATES www.poolates.co.uk Pilates in water. AQUA-DANCE classes at local pools or www.virginactive.co.uk for classes at their gyms FOR GENERAL SELF-HELP ON MOST SUBJECTS: DIRECTORY OF UK SELF-HELP GROUPS www.ukselfhelp.info/ This is a remarkably complete A-Z of self-help organisations on just about any health subject you can think of and life problems of most kinds. FOR PRACTICAL GENERAL INFORMATION ON MOST SUBJECTS: www.about.com www.bbc.co.uk www.bbc.co.uk/dna/h2g2 www.wikipedia.org FOR PHYSICAL AIDS AND EQUIPMENT - ACCESS, MOBILITY AND PRACTICAL HELP: DISABLED LIVING FOUNDATION (DLF) www.dlf.org.uk Tel: 020 7289 6111 Helpline: 0845 130 9177 Text phone: 020 7432 8009 DLF are the leading source of information on disability equipment - free, impartial advice about all types of equipment and mobility products   INDEPENDENT LIVING FUNDS www.ilf.org.uk Tel: 0845 601 8815 Email: client.service@ilf.org.uk The funds were set up as a national resource dedicated to the financial support of disabled people enabling them to choose to live in the community rather than residential care. DISCOUNT MOBILITY PLUS LTD For scooters, wheelchairs, bathlifts, stairlifts, chairs www.discountmobilityplus.co.uk Tel: 0808 178 4151 DISABILITY ALLIANCE www.disabilityalliance.org The leading authority on social security benefits for disabled people Tel: 020 7247 8776 MOBILISE - THE DISABLED DRIVERS’ ASSOCIATION www.justwebs.co.uk/mobilise/ Tel: 01508 489449 (Representation, information and advice on mobility issues) DISABILITY RIGHTS COMMISSION www.drc-gb.org DRC Helpline Tel: 08457 622 633 Textphone: 08457 622 644 The Disability Rights Commission (DRC) is an independent body established in April 2000 by Act of Parliament to stop discrimination and promote equality of opportunity for disabled people. RELATIVES AND RESIDENTS ASSOCIATION www.relres.org Tel: 020 7359 8136 Provides information and support about carehomes. ROYAL ASSOCIATION FOR DISABILITY AND REHABILITATION (RADAR) www.radar.org.uk Tel: 020 7250 3222 RADAR is concerned with every aspect of disability, but is particularly involved with access, education, employment, holidays, housing, mobility and social services. CITIZENS ADVICE BUREAUX (CABx) www.nacab.org.uk The website gives local offices, opening times and specialist services.   AGE CONCERN AID CALL www.aidcall-alarms.co.uk T: 0800 77 22 66 Emergency alarms to stay independent but summon help if needed MEDIC ALERT FOUNDATION www.medicalert.co.uk tel 02078333034 Medical identification, cards, bracelets, necklaces etc with information on call for emergency treatment. Knowing your chronic problems and what medications you’re on can make a critical difference for any doctor or emergency worker treating you in any situation. FOR FIRST AID TRAINING - and we always recommend this as part of learning to take care of ourselves and each other: RED CROSS www.redcross.org.uk ST JOHN’S AMBULANCE www.sja.org.uk ST ANDREW’S AMBULANCE (Scotland) www.firstaid.org.uk Medline Plus describes diabetes as a disorder of metabolism—the way our bodies use digested food for growth and energy. Most of the food we eat is broken down into glucose, the form of sugar in the blood. Glucose is the main source of fuel for the body. After digestion, glucose passes into the bloodstream, where it is used by cells for growth and energy. For glucose to get into cells, insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/d1.jpg" /></div> When we eat, the pancreas automatically produces the right amount of insulin to move glucose from blood into our cells. In people with diabetes, however, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced. Glucose builds up in the blood, overflows into the urine, and passes out of the body in the urine. Thus, the body loses its main source of fuel even though the blood contains large amounts of glucose. There are two main types of diabetes: TYPE 1 Type 1 diabetes develops if the body is unable to produce any insulin. This type of diabetes usually (but not always) appears before the age of 40. Type 1 diabetes is the less common of the two main types and accounts for between 5 – 15% of all people with diabetes. Type 1 diabetes is an autoimmune disease. An autoimmune disease results when the body’s system for fighting infection (the immune system) turns against a part of the body. In diabetes, the immune system attacks and destroys the insulin-producing beta cells in the pancreas. The pancreas then produces little or no insulin. A person who has type 1 diabetes must take insulin daily to live. At present, scientists do not know exactly what causes the body’s immune system to attack the beta cells, but they believe that autoimmune, genetic, and environmental factors, possibly viruses, are involved. Symptoms of type 1 diabetes usually develop over a short period, although beta cell destruction can begin years earlier. Symptoms may include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue. If not diagnosed and treated with insulin, a person with type 1 diabetes can lapse into a life-threatening diabetic coma, also known as diabetic ketoacidosis. TYPE 2 DIABETES Type 2 diabetes develops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly (known as insulin resistance). In most cases this is linked with being overweight, and can also run in families. This type of diabetes most often appears in people over the age of 40. It is the most common of the two main types and accounts for between 85 - 95% of all people with diabetes. About 80 percent of people with type 2 diabetes are overweight. There are currently over 2 million people with diabetes in the UK and there are up to another 750,000 people with diabetes who have the condition and don’t know it. When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin, but for unknown reasons the body cannot use the insulin effectively, a condition called insulin resistance. After several years, insulin production decreases. The result is the same as for type 1 diabetes—glucose builds up in the blood and the body cannot make efficient use of its main source of fuel. This form of diabetes usually begins with insulin resistance, a condition in which fat, muscle, and liver cells do not use insulin properly. At first, the pancreas keeps up with the added demand by producing more insulin. In time, however, it loses the ability to secrete enough insulin in response to meals. The symptoms of type 2 diabetes develop gradually. Their onset is not as sudden as in type 1 diabetes. Symptoms may include fatigue, frequent urination, increased thirst and hunger, weight loss, blurred vision, and slow healing of wounds or sores. Some people have no symptoms. Approximately 15% of people older than 70 have type 2 diabetes. We also note that about 65 percent of deaths among those with diabetes are attributed to heart disease and stroke. Both kinds of diabetes can lead to a number of serious conditions, so it is extremely important that you manage it carefully to reduce the risks. Lifestyle changes, your own vigilance and medical help can make all the difference. PRE-DIABETES is a condition to be taken seriously. People with pre-diabetes have blood glucose levels that are higher than normal but not high enough for a diagnosis of diabetes. This condition raises the risk of developing type 2 diabetes, heart disease, and stroke. Pre-diabetes is also called impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), depending on the test used to diagnose it. Some people have both IFG and IGT. IFG is a condition in which the blood glucose level is high after an overnight fast, but is not high enough to be classified as diabetes. IGT is a condition in which the blood glucose level is high after a 2-hour oral glucose tolerance test, but is not high enough to be classified as diabetes. Many people with pre-diabetes go on to develop type 2 diabetes within 10 years. If your doctor finds you have a pre-diabetic condition, get to work on it. Medline Plus tells us the good news is that if you have pre-diabetes you can take effective steps to prevent or delay diabetes. Studies have clearly shown that you can lower your risk of developing diabetes by losing 5 to 7 percent of your body weight through diet and increased physical activity. A major study of more than 3,000 people with IGT, a form of pre-diabetes, found that diet and exercise resulting in a 5 to 7 percent weight loss—about 10 to 14 pounds in a person who weighs 200 pounds—lowered the incidence of type 2 diabetes by nearly 60 percent. Study participants lost weight by cutting fat and calories in their diet and by exercising (most chose walking) at least 30 minutes a day, 5 days a week. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/d2.jpg" /></div> Type 1 and Type 2 diabetes are classified as DIABETES MELLITUS. DIABETES INSIPIDUS The word diabetes is derived from Greek and means, “a syphoning of water through the body”. Insipidus is a Latin word meaning tasteless. The name Diabetes Mellitus implies that patients with this condition lose large amounts of urine which is sweet and full of sugar, whereas in the case of Diabetes Insipidus the urine, although passed in excess, does not contain sugar. Diabetes Insipidus is not related to Diabetes Mellitus except that patients with either condition are thirsty and pass a lot of urine. In the case of Diabetes Insipidus increased amounts of urine are passed because the body cannot retain water; the body has normal amounts of sugar and insulin. The inability to retain water is usually due to a shortage of a hormone called antidiuretic hormone (ADH, sometimes called vasopressin), which is made by the pituitary gland situated underneath the brain. Occasionally normal amounts of ADH are present, but the kidneys are not able to use it properly. Diabetes Insipidus is much less common than Diabetes Mellitus. In many cases there is no obvious cause for the inability of the pituitary gland to make ADH. In other people an inflammation, infection around the pituitary gland or a head injury may lead to the loss of ADH secretion. Operations on the pituitary gland may also lead to Diabetes Insipidus, but as in the case of a head injury, this is often temporary. Diabetes Insipidus (unlike Diabetes Mellitus) does not usually require treatment with diet, tablets or injections. Instead ADH or ADH-like substances are self administered by the patient in the form of a nasal spray, and this returns the urine flow to normal. Treatment will usually be life-long, and in many cases may require hospital clinic attendance. For help with diabetes insipidus contact The Pituitary Foundation in our Useful Organisations section. SIGNS AND SYMPTOMS The Diabetes UK website tells us that the signs and symptoms of diabetes can include: • Increased thirst • Going to the loo (for a wee) all the time – especially at night • Extreme tiredness • Weight loss • Blurred vision • Genital itching or regular episodes of thrush • Slow healing of wounds In Type 1 diabetes the signs and symptoms will usually be very obvious, developing quickly, usually over a few weeks. In people with Type 2 diabetes the signs and symptoms will not be so obvious or even non-existent. Older people may put the symptoms down to ‘getting on a bit’ - expected downsides of ageing. IF YOU HAVE SYMPTOMS, SEE YOUR DOCTOR. DO NOT DELAY. Taking early action is key so if any of the symptoms apply to you, ask your GP for a diabetes test. In both types of diabetes, the symptoms are quickly relieved once the diabetes is treated. Early treatment will also reduce the chances of developing serious health problems. You may well be right that you’re simply feeling your age, but find out, It can’t hurt, and it may save you from a great deal of suffering. CAUSES AND RISK FACTORS Merck Geriatric’s website tells us that people develop type 2 diabetes because the cells in the muscles, liver, and fat do not use insulin properly. Eventually, the pancreas cannot make enough insulin for the body’s needs. As a result, the amount of glucose in the blood increases while the cells are starved of energy. Over the years, high blood glucose damages nerves and blood vessels, leading to complications such as heart disease, stroke, blindness, kidney disease, nerve problems, gum infections, and amputation. Research has demonstrated that people at risk for type 2 diabetes can prevent or delay developing type 2 diabetes by losing a little weight. The results of the Diabetes Prevention Program (USA) showed that moderate diet changes and physical activity can delay and prevent type 2 diabetes. The DPP tested two approaches to preventing diabetes: lifestyle change—a program of healthy eating and exercise—and the diabetes drug metformin. People in the lifestyle change group exercised about 30 minutes a day 5 days a week, usually by walking, and lowered their intake of fat and calories. Those who took the diabetes drug metformin received information on exercise and diet. A third group only received information on exercise and diet. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/d3.jpg" /></div> The results showed that people in the lifestyle change group reduced their risk of getting type 2 diabetes by 58 percent. In the first year of the study, people lost an average of 15 pounds. Lifestyle change was even more effective in those aged 60 and older. They reduced their risk by71 percent. People receiving metformin reduced their risk by 31 percent. RISK FACTORS include: • A close member of your family has Type 2 diabetes (parent or brother or sister). • You are overweight. • You’ve been diagnosed with any problems with your circulation, had a heart attack or stroke, or have high blood pressure. • You’re a woman with polycystic ovary syndrome and you are overweight. • You’re a woman who has had gestational diabetes. • You have severe mental health problems. • You’re over 40 or you’re over 25 and black, Asian or from a minority ethnic group. The risk rises with age, so the older you get the more at risk you are. • You’ve been told you have either impaired fasting glycaemia (IFG) or impaired glucose tolerance (IGT) The more risk factors that apply to you, the greater your risk of having diabetes. Merck Geriatric tells us that Diabetes also may occur in people with excess production of growth hormone (acromegaly) and in people with certain hormone-secreting tumors. Severe or recurring pancreatitis and other diseases that directly damage the pancreas can lead to diabetes. COMPLICATIONS Merck Geriatric’s website describes the potential serious, long-term complications from diabetes. Some of these complications begin within months of the onset of diabetes, although most tend to develop after a few years. Most of the complications are progressive. The more tightly a person with diabetes is able to control the levels of sugar in the blood, the less likely it is that these complications will develop or become worse. High sugar levels cause narrowing of both the small and large blood vessels. Complex sugar-based substances build up in the walls of small blood vessels, causing them to thicken and leak. As they thicken, they supply less blood, especially to the skin and nerves. Poor control of blood sugar levels also tends to cause the levels of fatty substances in the blood to rise, resulting in atherosclerosis (see Atherosclerosis in our pages on Heart Conditions) and decreased blood flow in the larger blood vessels. Atherosclerosis is between 2 and 6 times more common in people with diabetes than in people who do not have the disease and tends to occur at younger ages. Over time, elevated levels of sugar in the blood and poor circulation can harm the heart, brain, legs, eyes, kidneys, nerves, and skin, resulting in angina, heart failure, strokes, leg cramps on walking (claudication), poor vision, renal failure, damage to nerves (neuropathy), and skin breakdown. Heart attacks and strokes are more common among people with diabetes. Poor circulation to the skin can lead to ulcers and infections, and all wounds heal slowly. People with diabetes are particularly likely to have ulcers and infections of the feet and legs. Too often, these wounds heal slowly or not at all, and amputation of the foot or part of the leg may be needed. People with diabetes often develop bacterial and fungal infections, typically of the skin. When the levels of sugar in the blood are high, white blood cells cannot effectively fight infections. Any infection that develops tends to be more severe. Damage to the blood vessels of the eye can cause loss of vision (diabetic retinopathy). Laser surgery can seal the leaking blood vessels of the eye and prevent permanent damage to the retina. Therefore, people with diabetes should have yearly eye examinations to check for damage. The kidneys can malfunction, resulting in kidney failure that may require dialysis or kidney transplantation. Doctors usually check the urine of people with diabetes for abnormally high levels of protein (albumin), which is an early sign of kidney damage. At the earliest sign of kidney complications, the person is often given angiotensin-converting enzyme (ACE) inhibitors, drugs that slow the progression of kidney disease. Damage to nerves can manifest in several ways. If a single nerve malfunctions, an arm or leg may suddenly become weak. If the nerves to the hands, legs, and feet become damaged (diabetic polyneuropathy), sensation may become abnormal, and tingling or burning pain and weakness in the arms and legs may develop. Damage to the nerves of the skin makes repeated injuries more likely because the person cannot sense changes in pressure or temperature. The Foot in Diabetes: Diabetes causes many changes in the body. The following changes in the feet are common and difficult to treat. Neuropathy (damage to the nerves) affects sensation to the feet, so that pain is not felt. Irritation and other forms of injury may go unnoticed; an injury may wear through the skin before any pain is felt. Other changes in sensation alter the way people with diabetes carry weight on their feet, concentrating weight in certain areas so that calluses form. Calluses (along with dry skin) increase the risk of skin breakdown. Diabetes can cause poor circulation in the feet, making it more likely that ulcers will form when the skin is damaged and making the ulcers slower to heal. In addition to the changes in the foot, diabetes can affect the body's ability to fight infections. Therefore, once an ulcer forms, it easily becomes infected; the infection may become serious and difficult to treat, leading to gangrene. People with diabetes are more than 30 times more likely to require an amputation of a foot or leg than are people without diabetes. Foot care is critical. The feet should be protected from injury, and the skin should be kept moist with a good skin moisturizer. Shoes should fit properly and not cause areas of irritation. Shoes should have appropriate cushioning to spread out the pressure caused by standing. Going barefoot is ill advised. Regular care from a podiatrist, such as having toenails cut and calluses removed, may also be helpful. Also, sensation and blood flow to the feet should be regularly evaluated by a doctor. From women with diabetes there may be additional complications regarding menopause, osteoporosis and menstrual irregularities. Given the impact of the long and incomplete list above, we’ll repeat Merck’s advice: The more tightly a person with diabetes is able to control the levels of sugar in the blood, the less likely it is that these complications will develop or become worse.<a name="current" id="current"></a> People with diabetes benefit enormously from learning about the disease, understanding how diet and exercise affect their blood sugar levels, and knowing how to avoid complications.

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Medline Plus tells us that before the discovery of insulin in 1921, everyone with type 1 diabetes died within a few years after diagnosis. Although insulin is not considered a cure, its discovery was the first major breakthrough in diabetes treatment. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/d4.jpg" /></div> Today, healthy eating, physical activity, and taking insulin are the basic therapies for type 1 diabetes. The amount of insulin must be balanced with food intake and daily activities. Blood glucose levels must be closely monitored through frequent blood glucose checking. People with diabetes also monitor blood glucose levels several times a year with a laboratory test called the A1C. Results of the A1C test reflect average blood glucose over a 2- to 3-month period. Healthy eating, physical activity, and blood glucose testing are the basic management tools for type 2 diabetes. In addition, many people with type 2 diabetes require oral medication, insulin, or both to control their blood glucose levels. Adults with diabetes are at high risk for cardiovascular disease. Managing diabetes requires keeping blood glucose levels under control - and also managing blood pressure and cholesterol levels through healthy eating, physical activity, and use of medications (if needed). By doing so, those with diabetes can lower their otherwise increased risk of heart disease or stroke. Aspirin therapy, if recommended by the health care team, and smoking cessation can also help lower risk. People with diabetes must take responsibility for their day-to-day care. Much of the daily care involves keeping blood glucose levels from going too low or too high. Getting the sugar / insulin balance wrong can create a crisis condition. When blood glucose levels drop too low—a condition known as hypoglycemia—a person can become nervous, shaky, and confused. Judgment can be impaired, and if blood glucose falls too low, fainting can occur. A person can also become ill if blood glucose levels rise too high, a condition known as hyperglycemia. People with diabetes should see a health care provider who will help them learn to manage their diabetes and who will monitor their diabetes control. Most people with diabetes get their primary care from their GP. Often, having a team of providers can improve diabetes care. A care team can also include: an endocrinologist with special knowledge of diabetes a dietitian a nurse or nurse practitioner a physiotherapist a podiatrist (for foot care) an ophthalmologist or an optometrist (for eye care) and other health care providers, such as cardiologists and other specialists. The goal of diabetes management is to keep levels of blood glucose, blood pressure, and cholesterol as close to the normal range as safely possible. Medline Plus quotes strong evidence that keeping blood glucose levels close to normal reduces the risk of developing major complications of type 1 diabetes and keeps the risk reduced. The United Kingdom Prospective Diabetes Study, completed in 1998, showed that intensive control of blood glucose and blood pressure reduced the risk of blindness, kidney disease, stroke, and heart attack in people with type 2 diabetes. FIRST AID for hyper and hypoglycaemia: We have seen far too little mention in most information about diabetes concerning first aid. The authorised UK First Aid Manual advises that sugar should be given if a diabetic person is in crisis but still conscious and the cause is unclear. This will rapidly correct hypoglycaemia and will do little harm in hyperglycaemia. The next step is to dial 999 without delay. If the person in crisis knows what is needed and just needs help to use their kit - help them. Hyperglycaemia comes on gradually. Symptoms can include thirst, vomiting and excessive urination. Signs of the condition can include a fruity sweet odour on the breath, rapid breathing, rapid and weak pulse, warm dry skin and drowsiness. Hypoglycaemia happens rapidly. The person may feel hungry. The pulse is rapid and strong, the skin pale and cold with sweating. Seizures are common, and there is a rapid loss of consciousness. MEDICAL ESSENTIALS: BBC Health tells us that although diabetes can't be cured, it can be managed and kept under control. Anyone diagnosed with diabetes should seek treatment immediately to prevent associated illnesses. <a name="Diagnosis" id="Diagnosis"></a>DIAGNOSIS The fasting blood glucose test is the usual tool for diagnosis and most reliably done in the morning. This tests for a high level of glucose in the blood after an 8 hour fast. A diagnosis can also be made based on one of the following test results, confirmed by retesting on a different day: A high blood glucose level 2 hours after drinking a solution containing glucose dissolved in water. This test is called the oral glucose tolerance test (OGTT). A high random (taken at any time of day) blood glucose level along with the presence of diabetes symptoms. TREATMENT BBC Health tells us that the type of treatment depends on the type of diabetes. In both types, dietary measures play a crucial role. Specially trained dieticians can offer invaluable advice on suitable foods - see our section on diet. Treating type 1 diabetes: Type 1 is treated with insulin and by eating a healthy diet. Insulin can't be taken by mouth because the digestive juices in the stomach destroy it. This means that for most people it has to be given by injections. Most people find giving the injections simple and relatively painless, since the needle is so fine. How often someone needs to inject depends on what their diabetes specialist has recommended, and which type of insulin they're using. Treating type 2 diabetes: Type 2 may have been considered the 'milder' form of diabetes in the past, but this is no longer the case. For many people, type 2 diabetes can be controlled by diet alone. Medication in tablet form is used when diet doesn't provide adequate control. BBC Health reminds usagain that it is possible to minimise the risk of strokes, heart, vascular and kidney disease and other serious complications by keeping diabetes under tight control. They stress the vital importance of checking glucose levels at home regularly as instructed, and attending hospital check-ups where blood glucose, blood pressure, kidney function, eyes and feet will be examined. Any problems detected can then be treated early, rather than later when problems may be more difficult to treat. They also remind that while uncontrolled diabetes is a common cause of blindness, treatment can prevent blindness in 90 per cent of those at risk. DRUG TREATMENTS Staying with the information provided by BBC Health: FOR TYPE 1 DIABETES insulin is given at regular intervals throughout the day, usually two to four times. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/d5.jpg" /></div> Each injection may contain one, or a combination of different types of insulin, which act for a short, intermediate or longer period of time. Injections can be given using either a traditional needle and plastic syringe, or with an injection pen device, which many people find more convenient. An automatic insulin pump is available, which means that fewer injections are needed. The needle is sited under the skin, and connected to a small electrical pump that attaches to a belt or waistband and is about the size of a pager. Inside is a reservoir of fast-acting insulin which is delivered continuously at an adjustable rate. Inhaled insulin has recently become available for treating people with a proven needle phobia or people who have severe trouble injecting. Insulin was first used to treat diabetes in 1921. Under normal circumstances, it's made by beta cells that are part of a cluster of hormone-producing cells in the pancreas. The hormone regulates the level of glucose in the blood, preventing the level from going too high. Insulin enables cells to take up the amount of glucose they need to provide themselves with enough energy to function properly. It also allows any glucose left over to be stored in the liver. Most insulin used today is 'human insulin', although some people still use insulin from cows and pigs. 'Human insulin' is a product of genetic engineering, where bacteria bred in a laboratory are given a gene that allows them to produce insulin. FOR TYPE 2 DIABETES The different types of medication in tablet form work by one of these methods: <ul type="disc"> <li>helping the pancreas to make more insulin </li> <li>increasing the use of glucose and decreasing glucose production</li> <li>slowing down the absorption of glucose from the intestine</li> <li>stimulating insulin release from the pancreas</li> <li>enabling the body to use its natural insulin more effectively</li> </ul> Over time, if a careful diet combined with oral medication are not sufficient to keep the diabetes under control, insulin injections may be recommended. The Senior Alliance is grateful to Diabetes UK for its stance since 2003 against drug rationing by the National Institute of Clinical Excellence (NICE) which could compromise the care of people with diabetes. The Diabetes UK website tells us that restrictions direct doctors to deny glitazone drugs to some people with diabetes. Glitazones can provide an alternative to insulin injections for those with Type 2 diabetes who need to improve their blood glucose control. Suzanne Lucas, Director of Care at Diabetes UK is quoted as saying that “Diabetes is serious and if not well controlled can devastate lives. Doctors and patients need to have access to the treatments that are best for them. Today’s ruling will deny that. Diabetes is costing the NHS millions of pounds a day. Much of that is spent on treating the long-term effects of the condition, many of which could be prevented with early, effective treatment. NICE needs to look at the long-term picture rather than basing decisions on trying to make small financial savings today.” Diabetes UK would urge manufacturers and regulatory bodies to look more closely at the full range of treatment options for glitazones and make them available where they are safe and effective. The charity is also urging doctors to put their patients health first when interpreting the new guidelines. The ruling could also leave people with diabetes facing a choice between their health and their livelihood. Glitazones can provide an alternative to insulin injections for those with Type 2 diabetes who need to improve their blood glucose control. Denying access will limit their options and potentially open them to discrimination which could see people such as those who drive for a living or those who work offshore losing their jobs. ALTERNATIVE METHODS FOR USING INSULIN From the Diabetes Exercise and Sports Association website we get the following simple information: Injection has been the standard means of self-administering insulin, but alternative insulin–delivery methods have emerged. The various options provide an array of choices for people with diabetes, with each method appealing to different patients based on their preferences and the specific nature of their disease. These alternative delivery methods include: Insulin pumps: A lightweight device the size of a pager holds insulin that flows through a tube and needle inserted into the patient’s abdomen. The patient wears this device day and night, occasionally removing it for activities such as athletics or showering. Insulin pumps continuously deliver basal doses of insulin maintaining the proper glucose (blood sugar) level. The pump also allows the patient to release varied doses of insulin if the glucose becomes too high. Patients who use insulin pumps have to take an active role in managing their care. They must commit to glucose monitoring several times a day and keeping a close watch on carbohydrate consumption. Insulin pens: A device that resembles a pen and has a cartridge of insulin attached. Patients turn a dial to set the dosage amount and press a plunger to deliver the medicine, usually in the abdomen, upper arms, thighs or buttocks. It is extremely important that patients using insulin pens ensure that they properly mix the insulin before injecting the medication. Recent research indicates that many patients are not properly mixing their dosages, which results in insulin that is absorbed too quickly. This increases the chance of episodes of low glucose (hypoglycemia). Insulin jet injectors: A high-pressure mechanism that sends a fine spray of insulin through the skin. No needles are involved, but some patients find the high-pressure air to be painful. We note that others don’t. Inhaled insulin: An inhaler, similar to the device used by people with asthma, delivers powered insulin through the mouth. The medication travels to the lungs, where it is absorbed into the bloodstream. U.S. and European regulators approved the first brand of inhaled insulin in late January 2006. Find out if you can get this, and if it could work for you. Some people, especially those with type 1 diabetes, will still need to inject long-acting insulin. Whichever type you have, it may or may not be right for you. In general, the U.S. Food and Drug Administration described it as the biggest advance in insulin therapy since discovery of the hormone in the 1920s. glucose monitoring: The “Take Control of Your Diabetes website (see Useful Organisations) reports on the development of continuous glucose monitoring, a revolutionary technology they say will change the lives of people with diabetes on insulin. <a name="TARGET" id="TARGET"></a> NEW DRUG TREATMENTS Diabetes UK’s website tells us that: 1. A new treatment for Type 2 diabetes based on a hormone discovered in the Gila lizard is now available in the UK. Byetta (Exenatide) is a synthetic copy of the hormone found in the Gila lizard that can be used as an add-on treatment for people with Type 2 diabetes. It works in three different ways: It helps the body to produce more insulin when it is needed. It reduces the amount of glucose being produced by the liver when it is not needed. It reduces the rate at which the stomach digests foods and empties. This means that the rate at which glucose from food is released into the blood is reduced. “Managing blood glucose levels, along with blood pressure levels, is central to reducing the risk of heart attacks, blindness, strokes, kidney disease and amputations in people with Type 2 diabetes," said Cathy Moulton, Care Advisor at Diabetes UK. “This is an exciting time, as any new drug that helps people with Type 2 diabetes and is safe and effective is to be welcomed. New treatments provide more options to ensure the most effective treatment for any individual.” Byetta (Exenatide) is one of the first in a new class of drug to help people with Type 2 diabetes manage their blood glucose levels. Although it is injected, it is not an insulin. It must be injected twice daily and has been shown to shown to reduce blood glucose levels and may also help weight management. It is used in combination with metformin, and/or sulphonylurea tablets. 2. A new drug to treat Type 2 diabetes is now available in the UK. Januvia (Sitagliptin) is an add-on treatment for people with Type 2 diabetes. It is a DPP-4 inhibitor which works by increasing the levels of hormones in the body called incretins. These hormones are released throughout the day and levels are increased at meal times. They work in the body in two ways: Produce more insulin only when needed. Reduce the amount of glucose being produced by the liver when it is not needed. Diabetes UK welcomes any advances that help improve quality of life for people with diabetes, says Simon O’Neill, Director of Care, Information and Advocacy Services at Diabetes UK. “In some cases, Type 2 diabetes can be managed through lifestyle adjustments such as eating a healthy, balanced diet and taking regular physical activity. When managing the condition in this way is not possible, Diabetes UK recognises that a wide choice of treatment options, including Januvia (sitagliptin) in combination with metformin or glitazone tablets, can help. People with diabetes should have as wide a choice as possible of effective treatments for their condition. Good blood glucose control is essential for people with diabetes to improve wellbeing and protect against long-term damage to the eyes, kidneys, nerves, heart and major arteries.” Januvia (Sitagliptin) is taken in tablet form once a day with or without food. It is an add-on treatment suitable for use with either Metformin or a Glitazone. It is currently not licensed as mono-therapy, triple-therapy or as an add-on medicine with insulin. You should always have with you, and ideally wear a medical identification bracelet or tag to alert health care professionals to the presence of diabetes. This information allows health care professionals to start life-saving treatment quickly, especially in the case of injury or altered mental status. See the Medic Alert Foundation in Useful Organisations. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/d6.jpg" /></div> SUPPLEMENTS, SNAKE-OILS AND DIETS On the Take Control of Your Diabetes website Dr. Edelman has an article titled “False Promises and Marketing Scams -- Herbal Remedies and Vitamins”. It pretty much says what needs to be said. Read it if you can. A digest of what he’s saying is that: he has an open mind about any product that has been proven to help people with diabetes live healthier lives, but… he is concerned about an unregulated herbal and vitamin industry taking advantage of people with problems like diabetes. The Wall Street Journal’s report "The Case Against Vitamins" cited numerous studies showing that common supplements offered for diabetes, such as vitamins E, C, B, A and beta carotene, could have no purpose or even harmful affects in some. He says he’s not suggesting we all stop taking vitamins. He’s reminding people with diabetes about some of the blatant scams that over the counter supplement manufacturers have used, and encouraging you to look critically at the claims about these products before taking them. Dr Edelman refers to many outrageous, unsubstantiated and unproven claims, including actors pretending to be people who have benefited from these products. He refers to Pancreas Tonic, a product that was supposed to rejuvenate the insulin producing cells of the body and allow you to get off of insulin injections; Cortislim pretends to create beautiful men and women who lost tons of weight without even watching what they eat; Viagro (playing on Viagra?) is a silly supplement with an "unconditional money back guarantee". Dr Edelman reminds us that there are thousands of examples of quack remedies like these because, quite simply, it is all about money and greed. We comment that any product claiming to work wonders should be checked carefully. If it says it can do something the experts haven’t offered you, find out more before wasting your money or endangering your health. Medline Plus (see First Resources) will give you unbiased information on what it is and what it does - or simply ring the Diabetes UK Careline and ask. DIET Diet is so important for diabetes management that we would be wrong to say too much here. DIABETES UK will give you all the information and tips you need. Your doctor, medical carers and ideally a dietitian should advise you. You must have the best information you can get about diet with diabetes. You will find resources in Useful Organisations and our First Resources section, but Diabetes UK is your basic source. As a quick digest of advice we look at the Diabetes UK website, which freely admits that balancing your diet when you are diagnosed with diabetes can be challenging. On the up-side it says that although the food choices you make and your eating habits are important in helping you manage your diabetes, you should be able to continue enjoying a wide variety of foods as part of healthy eating. Eating a balanced diet, managing your weight, and following a healthy lifestyle, together with taking any prescribed medication and monitoring where appropriate will benefit your health enormously. Remember, in the long run it is better to make small changes that you feel you can stick to rather than completely altering your diet and not sticking to it. The objective in balancing your diet is to help you control your: • blood glucose levels • blood fats – cholesterol and triglycerides • blood pressure It will also help regulate your weight. If you are overweight losing weight will help you control your diabetes and will also reduce your risk of heart disease, high blood pressure and stroke. Diabetes UK recommends that everyone with diabetes should see a registered dietitian at diagnosis, and then have regular reviews for specific advice on their eating habits. Contact Diabetes UK or talk to your doctor about getting this help. Diet is too important to get wrong, so the following information is quoted pretty directly from the Diabetes UK website. We have added emphasis to some points. In general they recommend: 1. Eat three regular meals a day. Avoid skipping meals and spread your breakfast, lunch and evening meal over the day. This will not only help control your appetite but also help in controlling your blood glucose levels. 2. At each meal include starchy carbohydrate foods such as bread, pasta, chapattis, potatoes, yam, noodles, rice and cereals. The amount of carbohydrate you eat is important to control your blood glucose levels. All varieties are fine but try to include those that are more slowly absorbed (have a lower glycaemic index) as these won’t affect your blood glucose levels as much. Better choices include: • Pasta • Basmati or easy cook rice • Grainy breads such as granary, pumpernickel and rye • New potatoes, sweet potato and yam • Porridge oats, all bran and bran flakes. The high fibre varieties of starchy foods will also help to maintain the health of your digestive system and prevent problems such as constipation. 3. Cut down on the fat you eat, particularly saturated fats as this type of fat is linked to heart disease. Choose unsaturated fats or oils, especially monounsaturated fat (eg olive oil and rapeseed oil) as these types of fats are better for your heart. All fats contain calories. Fat is the greatest source of calories so eating less fat and fatty foods will help you to lose weight. Here are some tips to cutting the fat: • Use less saturated fat by having less butter, margarine, cheese and fatty meats. • Choose lower fat dairy foods such as skimmed or semi-skimmed milk, low fat or diet yogurts, reduced fat cheese and lower fat spreads. • Grill steam or oven bake instead of frying or cooking with oil or other fats. • Watch out for creamy sauces and dressings and swap for tomato based sauces instead. 4. Eat more fruit and vegetables. Aim for at least five servings in total a day to provide you with vitamins and fibre as well as to help you balance your overall diet. A portion is for example • a whole banana or apple • a slice of melon • two plums • a handful of grapes • a cereal bowl of salad • three heaped tablespoons of vegetables. 5. Include more beans and lentils such as kidney beans, butter beans, chickpeas, red and green lentils, as these can help to control your blood glucose levels and blood fats. Try adding them to stews, casseroles and soups, or to a salad. 6. Aim for at least two portions of oily fish a week. Oily fish contains a type of polyunsaturated fat called omega 3 which helps protect against heart disease. Eat oily fish such as mackerel, sardines, salmon and pilchards. 7. Limit sugar and sugary foods. This does not mean you need to eat a sugar-free diet. Sugar can be used in foods and in baking as part of a healthy diet. However, use sugar-free, no added sugar or diet squashes and fizzy drinks, as sugary drinks cause blood glucose levels to rise quickly. 8. Reduce salt in your diet to 6g or less a day – more than this can raise your blood pressure, which can lead to stroke and heart disease. Limit the amount of processed foods you eat and try flavouring foods with herbs and spices instead of salt. 9. Drink ALCOHOL in moderation only – that’s a maximum of two units of alcohol per day for a woman and three units per day for a man. For example, a pub measure (25ml) of spirit or half a pint of normal strength beer is about one unit. Over the years the alcohol content of most drinks has gone up. A drink can now contain more units that you think – a pint of premium lager can contain as much as 3 units, and a small glass of wine (175ml) around 2 units. Remember alcohol contains empty calories so think about cutting back further if you are trying to lose weight. Never drink on an empty stomach, as alcohol can make hypoglycaemia (low blood glucose levels) more likely to occur when taking certain diabetes medication. THE GOOD NEWS here, of course, is there is not necessarily any need to give up alcohol just because you have diabetes. Be aware, however, that: Alcohol makes hypoglycaemia (low blood glucose levels) more likely to occur. However, as long as your diabetes is well controlled, moderate amounts of alcohol in line with the above daily guidelines can be drunk before, during or soon after a meal without affecting short-term blood glucose control. As above: never drink on an empty stomach. If you are drinking throughout the evening snack on something starchy like crisps. Do not substitute alcoholic drinks for your usual meal or snacks as this may lead to a hypo (hypoglycaemia). Serious hypoglycaemia can occur with larger quantities of alcohol, particularly if you are treated with insulin and especially if too little carbohydrate is eaten. If this could apply to you, always make sure you take some carbohydrate before going to bed after drinking. Useful snacks include toast, cereal and sandwiches, although chips or pizza on the way home may be an easier, albeit unhealthier, option. The liver gets rid of alcohol at the rate of about 1 unit per hour but this can vary. If you drink more than a few units in the evening you will have an increased risk of hypos that may occur up to 16 hours after heavy drinking. It is vital you keep your blood glucose levels topped up with carbohydrate and always remember to take something at breakfast. Monitor your blood glucose levels closely. Remember you may be less aware of your hypo symptoms when you are drinking so always wear some form of diabetes identification. A hypo can be confused with drunkenness when there is the smell of alcohol on your breath Continuous heavy drinking can lead to raised blood pressure so again try to limit your intake. If you have neuropathy (nerve damage), drinking alcohol can make it worse and increase the pain, tingling, numbness and other symptoms associated with nerve damage. Drinking low carbohydrate beers and cider offer no benefit because of their higher alcohol content. Low alcohol drinks can be useful if you are driving, but few are alcohol free, so remember if you drink enough of them you may still be over the limit. Low alcohol wines are often higher in sugar than ordinary ones, so if you do choose these, just stick to a glass or two. Drinks with a high sugar content, eg sweet sherries, sweet wines and most liqueurs should be limited. Mixer drinks should be ‘diet’ or ‘sugar free’ such as diet tonic water and diet cola. Moderate alcohol consumption in line with recommended daily guidelines can be beneficial for your heart. Wine, especially red wine, may offer greater benefit than spirits or beer. However there is currently insufficient evidence to suggest that you take up drinking if you are currently ‘teetotal’. And again, for those of us watching our weight: all types of alcoholic drinks contain calories. Sad but true. 10. Don’t be tempted by diabetic foods or drinks. They offer no benefit to people with diabetes. They: • Are expensive • Contain just as much fat and calories as the ordinary versions • Can have a laxative effect • Will still affect your blood glucose levels. ASPARTAME: Aspartame (Nutrasweet) is one of the intense sweeteners used widely in foods, beverages and also as a tabletop sweetener. Like all intense sweeteners it is virtually calorie free and does not affect blood glucose levels. Recent media reports have questioned the safety of aspartame after an Italian study has linked it to cancer in rats. This has raised fears that the product could also cause a carcinogenic (cancer causing) risk for humans. In response, the European Food Safety Authority has declared that aspartame is safe but it is planning to review the full data from the Italian study conducted by the Ramazzini Foundation based in Bologna, Italy. Diabetes UK takes seriously any reports about the safety of products which may be relevant to people with diabetes and will continue to monitor this situation closely. Diabetes UK suggests that if you do use intense sweeteners or products sweetened with them, then you should make sure that you use a variety of brands so as to reduce the risk of exceeding the Acceptable Daily Intake (ADI) for each one. There are five types of sweeteners that are permitted for use in the UK: aspartame (Nutrasweet), saccharin, acesulfame potassium (acesulfame K), cyclamates and sucralose. People with the condition Phenylketonuria, a disorder caused by an enzyme deficiency, are unable to metabolise the amino acid phenylalanine that is found in aspartame. They should avoid aspartame for this reason. Diabetes UK has produced a Sweetener Guide, priced £2.00, which provides further information on the use of sugar and sweeteners. To order a copy call free on 0800 585088 and quote code 8009. FISH AND FISH OILS - Diabetes UK Position Statement: Fish is a good choice for the protein portion of a balanced diet and can offer positive health benefits. White fish such as cod, plaice and haddock are low in fat and therefore helps us to follow a low fat diet. Oily fish are higher in fat than white fish and contain a special type of polyunsaturated fat known as ‘omega 3’ fat. This type of fat has been shown to help protect against heart attacks. It also helps to lower a type of fat in your blood known as triglycerides which is also beneficial for the health of your heart. People with diabetes are all encouraged to try to eat oily fish twice a week (one portion is about 140g). Even though oily fish is higher in fat it is still a good choice if you are trying to lose weight. Oily fish are generally rich in vitamin D too, which is important to maintain calcium balance in the body. Most of us make our own vitamin D when our skin is exposed to sunlight, but eating foods that contain vitamin D is essential for people who are housebound or rarely expose their skin to sunlight. Examples of oily fish (fresh, frozen or tinned – either in brine, oil or tomato sauce) Salmon Trout Mackerel Herring Sardines Pilchards Kipper Eel Whitebait Tuna (fresh only. When tuna is canned the omega-3 is reduced to similar levels found in white fish) Sprats Fish Oil Supplements: Diabetes UK can only make general recommendations for all people with diabetes and because everyone’s needs are so different we cannot give individualised advice. Diabetes UK does not generally recommend that people with diabetes take any kind of supplements as there is not enough evidence available to support their use in diabetes care. Prescribed doses of fish oil supplements of more than 3g per day also have the potential to worsen blood cholesterol levels especially the LDL cholesterol (the bad type of cholesterol) although the potential benefits of taking the supplement could outweigh this effect. There is clinical evidence both for and against the use of fish oil supplements. People with diabetes should consult their doctor if they already take fish oils supplements or are thinking about taking them. People who are taking high doses of prescribed fish oil supplements (greater than 3g per day) should ask their doctor to monitor the effect on their cholesterol and triglycerides. NETDOCTOR emphasises the importance of diet in controlling BODY WEIGHT. Excess weight is associated with: <ul type="disc"> <li>high blood pressure</li> <li>Type 2 diabetes</li> <li>increased risk of cardiovascular disease eg heart attack, stroke, angina. </li> </ul> We’ve said this many times, but is a clear and recurring point to get and works with: Diabetes, particularly Type 2, is easier to control when your weight is normal. If you have Type 1 diabetes, controlling your weight through a healthy diet will help your blood pressure and reduce your risk of cardiovascular disease. Netdoctor suggests that a good rule of thumb is to burn an extra 250 calories a day through exercise, and eat 250 calories less per day by reducing the amount of fat and sugary foods in your diet. If you have diabetes, you should have access to a qualified dietician through your GP or diabetes clinic. Your dietician can help you work out your daily calorie needs, taking into account your age, lifestyle, work and activity levels. Your dietician will identify any problems with your diet and is there to help if you're having difficulties. Most of all, your dietician will help you understand the relationship between what you eat and what you need - once you understand this, the diet aspect of diabetes will fall into place. EXERCISE The Diabetes Exercise and Sports Association (see our Useful Organisations section) is a great resource for advice and inspiration. It is also a treasure with regard to a great deal of general information on living with diabetes. As always, Diabetes UK will have the answers to your questions and can advise. You’ll also find a number of alternatives in Useful Organisations. You may feel too weak or tired be overly enthusiastic about a programme of exercise. Don’t be. It really is important, as you’ll learn from the organisations above. The right choice of exercise for you can also make you feel a great deal less weak and tired, lift your spirits and energy, and help deal with negative emotion, as well as improving your condition. The most pleasant exercise is usually the best. Many people find that walking is ideal, but any physical activity can help. Check your choice of exercise with the experts, but this is one condition where your range of exercise possibilities is very wide. If you want to do it, chances are you can. The Cochrane Reviews (see our First Resources section) tell us that exercise for type 2 diabetes improves blood sugar control and decreases body fat content. Their review found that exercise improves blood sugar control and that this effect is evident even without weight loss. Furthermore, exercise decreases body fat content, thus the failure to lose weight with exercise programmes is probably explained by the conversion of fat to muscle. Exercise improved the body's reaction to insulin and decreased blood lipids. No adverse effects with exercise were reported. High blood glucose can make you feel tired and sluggish, so you don’t exercise. Want to feel better? Exercise. The American Diabetes Association highly recommends walking, and the use of a pedometer because: Walking is inexpensive, easy, and convenient. It’s a good way to get the recommended level of physical activity of 30 minutes 5 days a week. Inactive people take an average of 2,000 to 4,000 steps per day. Moderately active people take 5,000 to 7,000 steps per day. Active people take at least 10,000 steps per day. People who have diabetes are more likely to be inactive than other people. Studies have shown that a walking program can increase your insulin sensitivity for up to 72 hours, lowering blood glucose and giving you more energy. Pedometers can help you count (and increase) the number of steps you take each day. You can buy an inexpensive pedometer in most stores selling sport equipment. Slightly more expensive pedometers measure distance as well. You can estimate the distance from your number of steps. Walking 2,000 steps is about one mile. Awareness of the number of steps helps you think of creative ways to take more. You can even purchase a "talking" pedometer to boost your motivation while you walk. If there are physical reasons why you can’t walk for exercise, there are many other equally good options including gardening, housework, swimming or a standing in the swimming pool workout (look for aqua aerobics, tai chi or dance in water), a gym or home fitness programme, Pilates etc. See Useful Organisations. COMPLEMENTARY THERAPIES / ALTERNATIVE MEDICINE Reuters reports that older people who are depressed are more likely to develop type 2 diabetes than those who are not. A major study in the Archives of Internal Medicine said that people with a high number of symptoms of depression were about 60 percent more likely to develop type 2 diabetes than people who are not depressed. There could be any number of reasons for this finding, including less healthy lifestyles when one is depressed and/or higher levels of stress hormones. In any case the connection to depression suggests that counselling / therapy and complementary health disciplines could be more helpful than we might have thought. EXERCISE, PEACE OF MIND, FEELING MORE EMPOWERED these are all areas where alternative and complimentary approaches can excel. So long as you don’t neglect or work against the basics of controlling your condition, these approaches can be positive and even life-changing. If diabetes gets you into meditation, mind-body discovery, better physicality or any of the other possibilities in our Useful Organisations list, it may turn out to have been a power for good in your life. The following brief overview of some of the better known complementary techniques may help. You’ll find a section in our Useful Organisations dedicated to learning more and finding teachers or practitioners. Acupuncture - Well known Chinese therapy using fine needles to change energy flows. Evidence of effectiveness in dealing with pain and other problems, at least short term. High level qualified practitioner essential. Acupressure - Same principles as acupuncture, using pressure instead of needles. You can learn to do some acupressure therapy on yourself. Alexander Technique - Technique for learning how to efficiently and effortlessly use your body. Simple but profound approach to letting go of harmful tensions in posture and breathing. A safe and effective learning and therapy technique. It doesn’t sound like much but it’s a liberating technique. Aromatherapy - The art of applying essential oils to suit individual needs. The oils work directly on the chemistry of the body, via the skin and bloodstream. May seem unlikely, but a number of medical sites assure us that it can be surprisingly effective and safe. Art Therapy - Use of art for emotional therapy. Early evidence of effectiveness was with survivors returning from World War 2. Healing and health are strongly affected by emotion, so makes sense. Ayurveda - The most important form of medicine in India. An ancient tradition, but most practitioners are also doctors or otherwise medically qualified. Ayurveda seeks to balance the body and mind, find health problems before they occur or stop them doing unnecessary harm. Obviously requires a qualified practitioner and is complementary to, not a replacement for conventional medical treatment. Biofeedback - Machines give you feedback about how your body is working, allowing you to learn to regulate reactions causing problems. Evidence of usefulness for therapy and self-education for many conditions. Biofeedback is often referred to as a very helpful tool. Bowen Technique - soft and non-invasive holistic treatment that aims to restore balance to the body by using small, gentle moves to specific areas of the body. Because the therapy is so gentle, it is considered to be suitable for all ages. May be helpful for many pain, health and stress related problems. Chiropractic - Manipulation of spine and muscles for good balancing and health functioning. A powerful technique and NOT to be used for many conditions. Check with your doctor, and see Useful Organisations for help finding a qualified and registered practitioner. Cognitive and Behaviour Therapies - Put crudely: It’s not what happens that causes the problems, it’s how you understand it and what you do with it. Less crudely, these have medical and government recognition for a wide variety of problems and can be startlingly effective in many cases. Many of us who they have helped consider them to be most remarkable life tools. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/d7.jpg" /></div> Feldenkrais Method - Not a therapy as such, but a well established method for learning greater ease of physical movement and increasing vitality and well-being. Guided Imagery - The use of imagination as potent healer. Pleasant and powerful. See “Holistic Online” in Useful Organisations to learn more. Healing - comes in many forms, from spiritual or religious to using energy flow as understood in martial arts. Whether the effectiveness is due to a placebo effect, energy flows or spirit, many people have been helped by healings throughout history. Hellerwork - deep tissue massage that unblocks the body, movement education to correct postural alignment, and verbal dialogue to assess emotional holding patterns. Appropriate tools for many chronic syndromes. Caution for conditions where deep massage contraindicated. Check carefully with your doctor before using any deep massage technique. Herbal medicine - Herbal medicines can be very powerful, and are the basis of many conventional drugs. A good herbal practitioner looks at the whole person and health, not just the disease or condition. Because they can be very strong and conflict with prescribed medications, you absolutely need to tell your doctor what you’re going to be taking. A herbal remedy can destroy your therapy and health if it’s the wrong one for you. Homoeopathy - famous and controversial. Vanishingly small amounts of a substance in water are given. Many in medical science consider this to be absurd. No conclusive proof either way, but many people have found help and relief. Hard to argue with happy patients, and it has the great virtue of being harmless. That said, neglecting medical treatment to depend on homeopathy is an enormous mistake, as your qualified homeopath will agree. Hypnotherapy - not in any way a frightening experience or loss of consciousness or control, safe in qualified hands, and considered very effective in helping with chronic pain, anxiety, depression and other condition related problems. Louise Hay techniques - based on the use of positive affirmations - highly recommended by many people for effectively changing your mindset and health. A place to start is the Louise Hay book “You Can Change Your Life” and audio tapes from Amazon. As we keep saying throughout this website, mindset can profoundly affect healing. Massage Therapy - There are many forms of massage, and they can be a great help in stress reduction, release of chronic muscle tensions around arthritis, and can have many other therapeutic effects depending on the technique used. Having your body cared for like this is great, but: be aware that deep or powerful massage pressure can be dangerous for some conditions. Check with your doctor or physio about what to avoid. It is important that your therapist asks what your medical / physical situation is. If they are not qualified, or you are not comfortable, you are in the wrong hands. Don’t risk damage. Move on. Medau Movement - Enjoyable exercise to music for improving body use and posture, and good for stress reduction. Meditation - A truly profound way to deal with stress and the human condition. Good meditation teaching is simple, and the result should be access to peace and stillness whatever is happening and wherever you are - at home, on the street, at work… We give contacts for meditation in Useful Organisations. We’ve recommended the approach of the Shollond Trust as it’s fast, free, and a good starting place for appreciating all forms of meditation. We also like BBC Health and the H2G2 recommendations about meditation. Naturopathy - Technique for helping the body to heal itself, and often incorporates a number of the other techniques discussed here. Interesting to have one technique using the strengths of others. In capable hands this can be a very effective option. NLP (Neuro-linguistic Programming) - A fascinating form of therapy, looking at how you do what you do, and how to change. We like this sentence from a practitioner: “If you always do what you've always done, you'll always get what you've always got. If what you're doing isn't working, do something else". Far more to it than that of course, and worth learning about as a strong tool for living with any form of arthritis. Osteopathy - Certainly among the best known physical therapies and very well accepted as a complementary therapy. Osteopathy is highly regulated. Physical manipulation and massage techniques are used to help correct problems with the muscles, bones, and joints and influence many of the body’s systems. A good practitioner will ask in detail about your condition to not do harm with inappropriate manipulations. Practitioner must be qualified, registered, and take a medical history to understand what your condition is. Pilates - Exercise method to method to strengthen the core postural muscles and develop balanced alignment through the use of slow, controlled movements and breathing. Often recommended by doctors, physiotherapists, and used by everyone from top professional athletes and dancers to people who have never done much exercise or thought they were unable to due to physical limitations. Teacher must understand your condition. Psychology of Mind - The book “Slowing Down to the Speed of Life” from Amazon is the well known place to start. POM techniques and understandings are simple and can be life changing. A way to use your problems to vastly improve your life. For the anxieties associated with illness (not to mention life) this is something special. Psychotherapy - Many forms, and a vital and immensely beneficial approach for many people. The idea that psychotherapy is for crazies couldn’t be more wrong. It’s one of the best learning and healing tools and most interesting things you could choose to do. Practitioners must be qualified, and you have to find one you feel comfortable with and helped by. For most chronic conditions, for anxiety, and for life, a good one. Reiki Healing - A Japanese form of healing through energy flow and which, interestingly, is also concerned with living in harmony with others, taking responsibility for one's own health and happiness, helping others, and being positive about all things. Shiatsu - Traditional Japanese physical therapy, using a range of techniques from gentle touch to more dynamic work to improve specific conditions and general health. A qualified practitioner will take a detailed history from you and avoid more dynamic techniques where they might be contra-indicated for your condition. Check with your doctor or physiotherapist before trying. Tai Chi - A soft, gentle and very powerful Chinese martial art, movement meditation, and way of healing through movement. Tai Chi works very well for older and ill people. It helps to free and balance the body, breathing and movement, and to find calm, stability, peace and deep security. If you have serious problems with feet, knees or walking it may not work for you. If that’s the case the exercises of Qigong (or Chi Kung) use the same principles but can be done sitting as well as standing. Tai Chi is a way to contact deep reserves of strength and ease. Trager Work - A form of bodywork and movement which utilises gentle, rhythmic movements to facilitate the release of stress patterns - physical, mental, and emotional. Created by a doctor and physiotherapist working with his own chronic pain since childhood, this method also has a meditation aspect. Yoga - The ancient Indian system of postures, exercises, breathing, and body and mind development and control. Popular and widely available these days. The basic exercises of Hatha Yoga, taught with careful respect for your physical problems and limitations, are a good place to start, along with pranayam breathing exercises. There are also some extremely challenging physical styles of yoga which may not be not at all appropriate. BE SURE your teacher knows what your physical problems are, and that your doctor has no problem with your doing yoga. That said, it is a wonderful combination of calm body, mind and spirit training and self-help therapy. GENERAL HELP WITH DIABETES RELATED PROBLEMS: DIABETES UK is the place to start. A telephone Careline for a condition is a great thing to have, and they do much more. On the internet, “Take Control of Your Diabetes” and the “Diabetes Exercise and Sports Association” are worth early visits. Our First Resources section should provide or lead you to everything else you need. Diabetes

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DIABETES UK <a href="http://www.diabetes.org.uk/">www.diabetes.org.uk</a> DIABETES UK CARELINE: 0845 120 2960 Monday-Friday, 9am-5pm careline@diabetes.org.uk Helps people with diabetes and their families. Represents and campaigns for their interests, and funds research into the condition. First resource for help, information, advice. DIABETES EXERCISE AND SPORTS ASSOCIATION <a href="http://www.diabetes-exercise.org/">www.diabetes-exercise.org</a> Members include people with diabetes who participate in fitness activities at all levels, healthcare professionals, and everyone interested in the relationship between (or special problems of) diabetes for exercise/fitness/ sport. Also excellent general diabetes tips and links. TAKE CONTROL OF YOUR DIABETES <a href="http://www.tcoyd.com/">www.tcoyd.com</a> Very empowering American site. See Dr. Edelman’s corner and his Article Archive. THE DIABETES MONITOR <a href="http://www.diabetesmonitor.com/index.htm">www.diabetesmonitor.com/index.htm</a> Resource for patients to educate themselves about their role as active participants in care of their condition. Email: info@diabetesmonitor.com THE BRITISH DIETETIC ASSOCIATION <a href="http://www.bda.uk.com/">www.bda.uk.com</a> Intended for professional dieticians but has interesting features for the general public on diets and food for people with diabetes. EUROPEAN ASSOCIATION FOR THE STUDY OF DIABETES <a href="http://www.easd.org/">www.easd.org</a> Encourages and supports research into diabetes to disseminate knowledge and facilitate its application. AMERICAN DIABETES ASSOCIATION <a href="http://www.diabetes.org/">www.diabetes.org</a> THE NATIONAL DIABETES INFORMATION CLEARINGHOUSE (USA) <a href="http://www.diabetes.niddk.nih.gov/">www.diabetes.niddk.nih.gov</a> EUROPEAN ASSOCIATION FOR THE STUDY OF DIABETIC EYE COMPLICATIONS <a href="http://medweb.bham.ac.uk/easdec/index.html">http://medweb.bham.ac.uk/easdec/index.html</a> Information and advice on all the eye complications that diabetes may cause. FEET FOR LIFE <a href="http://www.feetforlife.org/">www.feetforlife.org</a> Information to help prevent common foot problems, injuries and long-term foot damage. Take a look at its guide to buying shoes, and learn how to get into a daily foot care routine. Tel: 020 7234 8620 GOOD HOPE HOSPITAL NHS TRUST: EYE DEPARTMENT <a href="http://www.goodhope.org.uk/Departments/eyedept/index.htm">www.goodhope.org.uk/Departments/eyedept/index.htm</a> A good resource on eye problems and conditions. Offers online leaflets that can be downloaded and printed. MOORFIELDS EYE HOSPITAL: RETINAL DISEASE <a href="http://www.moorfields.org.uk/">www.moorfields.org.uk/</a> This site covers most eye illnesses and conditions, including those caused by diabetes. Helpline: 020 7566 2345 Tel: 020 7253 3411 NATIONAL KIDNEY RESEARCH FUND <a href="http://www.nkrf.org.uk/">www.nkrf.org.uk</a> Supports medical research into kidney diseases and aims to improve patient care. NATIONAL KIDNEY FEDERATION <a href="http://www.kidney.org.uk/">www.kidney.org.uk</a> Helpline: 0845 601 0209 Run by kidney patients for kidney patients. Promotes the welfare of people with kidney disease or renal failure, and the relatives and friends who care for them. AMERICAN DIABETES ASSOCIATION www.diabetes.org THE PITUITARY FOUNDATION (diabetes insipidus) <a href="http://www.pituitary.org.uk/">www.pituitary.org.uk</a> Provides information and support to people with pituitary disorders, of which diabetes insipidus is one. BRITISH HEART FOUNDATION <a href="http://www.bhf.org.uk/">www.bhf.org.uk</a> Telephone 0845 070870 BRITISH LUNG FOUNDATION <a href="http://www.lunguk.org/">www.lunguk.org</a> Telephone 020 7688 5555 FOR IMMEDIATE HELP WITH HEALTH QUESTIONS and GENERAL MEDICAL INFORMATION: See our FIRST RESOURCES section - especially MedlinePlus ( <a href="http://medlineplus.gov/">http://medlineplus.gov</a> ) BBC Health ( <a href="http://www.bbc.co.uk/health">www.bbc.co.uk/health</a> ), the Mayo Clinic (<a href="http://www.mayoclinic.com/">www.mayoclinic.com</a> ) and: MEDICINENET.COM <a href="http://www.medicinenet.com/">www.medicinenet.com</a> For a general guide and information base on any subject this is an excellent resource. NETDOCTOR <a href="http://www.netdoctor.co.uk/">www.netdoctor.co.uk</a> Attempts to break down the "medical language barrier" between the doctor and the patient. Critical medical information presented in a clear and understandable language so that the patient fully understands his or her choices and decisions. THE COCHRANE REVIEWS (<a href="http://www.cochrane.org/">www.cochrane.org</a>) The Cochrane Collaboration assesses most areas of health care. To do this, it is divided into Cochrane Review Groups, each of which concentrates on a specific healthcare area, including a Consumer Network that represents the interests of healthcare consumers. Type any condition into their website and get pretty comprehensive information. If you want clear scientific analysis of any health issue or practice, you’ll usually find it here. BANDOLIER: THE OXFORD MEDICAL SITE <a href="http://www.jr2.ox.ac.uk/bandolier/index.html">http://www.jr2.ox.ac.uk/bandolier/index.html</a> Bandolier is a journal of evidence-based medicine. Look up any subject for links and knowledge. Their “Healthy Livig Zone” is a bit of a goldmine on the subject. MERCK MEDICUS <a href="http://www.merckmedicus.com/">www.merckmedicus.com</a> Easy to use and the US doctor’s reference tool. See MERCK GERIATRIC for age related information. FOR ANCILLARY MEDICAL THERAPIES (Physiotherapy etc): HEALTH PROFESSIONS COUNCIL <a href="http://www.hpcuk.org/">www.hpc-uk.org</a> Telephone 020 7582 0866 The HPC is a statutory regulator that works to protect the health and well-being of people using the services of health professionals. Find therapists and be sure they are approved / regulated practitioners. CHARTERED SOCIETY OF PHYSIOTHERAPY <a href="http://www.csp.org.uk/">www.csp.org.uk</a> Tel: 020 7306 6218 / 6666 Information on physiotherpaists, physiotherapy and how it can help with pain. THE ORGANISATION OF CHARTERED PHYSIOTHERAPISTS IN PRIVATE PRACTICE <a href="http://www.physiofirst.org.uk/">www.physiofirst.org.uk</a> Tel: 01327 354441 Details of private chartered physiotherapists in your area. OCCUPATIONAL THERAPISTS IN INDEPENDENT PRACTICE (OTIP) <a href="http://www.otipp.co.uk/">www.otipp.co.uk</a> Tel: 0800 389 4873 Information and find an occupational therapist FOR COMPLEMENTARY AND ALTERNATIVE THERAPIES: THE COMPLIMENTARY HEALTHCARE INFORMATION SERVICE <a href="http://www.chisuk.org.uk/">www.chisuk.org.uk</a> Easy reference to learn about any and (just about all) complementary techniques. A truly excellent way to learn what the main comlementary techniques are, how they might work for you, and to explore the subject THE NETDOCTOR DR FOSTER COMPLEMENTARY PRACTITIONER DIRECTORY <a href="http://netdoctorcomplementarytherapistguide.drfoster.co.uk/">http://netdoctorcomplementarytherapistguide.drfoster.co.uk</a> If you are looking to find a reliable complementary therapy practitioner in your area, this directory is an essential resource. It can help you find a practitioner who meets your needs. This might be someone who has a particular interest in your condition, or who works at a practice near to your home, at hours that suit your needs. THE BRITISH COMPLEMENTARY MEDICINE ASSOCIATION <a href="http://www.bcma.co.uk/">www.bcma.co.uk</a> Tel 0845 345 5977 Find qualified practitioners of most therapies, learn about therapies, get recognised guidance through the therapy minefield and find a therapist near you. WHOLE HEALTH MD <a href="http://www.wholehealthmd.com/">www.wholehealthmd.com</a> American WholeHealth Networks' Complementary and Alternative Medicine (CAM) education website. The site is dedicated to providing integrative health and wellness solutions by combining the resources of both scientific health research and CAM. Click on specific health issues for information on conventional medicine, alternative therapies, supplements, diet, lifestyle options, and much more. HOLISTIC ONLINE <a href="http://www.holisticonline.com/">www.holisticonline.com</a> Comprehensive site for Alternative and Integrative Medicine. Learn about conditions and treatments. INSTITUTE FOR COMPLEMENTARY MEDICINE www.i-c-m.org.uk The ICM is a UK registered charity providing information on all aspects of the safe and best practice of Complementary Medicine. THE NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE <a href="http://nccim.nch.gov/">http://nccim.nch.gov</a> Vital and reputable information for the States. A treasure for understanding what’s what. THE ALTERNATIVE MEDICINE FOUNDATION <a href="http://www.amfoundation.org/">www.amfoundation.org</a> Excellent US site, good clear information. They also recommend: ALTERNATIVE MEDICINE RESOURCE <a href="http://www.altmedresource.com/">www.altmedresource.com</a> comprehensive and searchable catalog of all alternative medicine studies. Easy search by looking up your condition(s) or a key word. FOR COMPLEMENTARY PRACTICTIONERS’ ASSOCIATIONS GENERAL OSTEOPATHIC COUNCIL www.osteopathy.org.uk Tel: 020 7357 6655 Provides details of qualified local osteopaths. BRITISH CHIROPRACTIC ASSOCIATION www.chiropractic-uk.co.uk Tel: 0118 950 5950 Information on chiropractic and details of local chiropractors. GENERAL CHIROPRACTIC COUNCIL <a href="http://www.gcc-uk.org/">www.gcc-uk.org</a> Tel: 020 7713 5155 Provides details of local chiropractors and information on what to expect when you see a chiropractor. It can also help if you've experienced a problem with a chiropractor. THE SOCIETY OF CHIROPODISTS AND PODIATRISTS <a href="http://www.feetforlife.org/">www.feetforlife.org</a> Telephone 020 7234 8620 GENERAL COUNCIL FOR MASSAGE THERAPY <a href="http://www.gcmt-uk.org/">www.gcmt-uk.org</a> Telephone 01992 537637 New voluntary regulation body for practitioners of massage. INTERNATIONAL FEDERATION OF AROMATHERAPISTS <a href="http://www.ifaroma.org/">www.ifaroma.org</a> Telephone 020 8992 9605 MUSIC THERAPY: see HEALTH PROFESSIONS COUNCIL above - <a href="http://www.hpcuk.org/">www.hpcuk.org</a> Telephone 020 7582 0866 THE BRITISH MEDICAL ACUPUNCTURE SOCIETY <a href="http://www.medical-acupuncture.co.uk/">www.medical-acupuncture.co.uk</a> Telephone 01925 730727 Medical doctors who practice acupuncture. Encourages the use and scientific understanding of acupuncture within medicine for the public benefit. ACUPUNCTURE ASSOCIATION OF CHARTERED PHYSIOTHERAPISTS <a href="http://www.longbo.demon.co.uk/aacp.html">www.longbo.demon.co.uk/aacp.html</a> Tel 01747 861151 Contact the AACP Secretariat for a register of members - qualified phyisos working with acupuncture. BRITISH ACUPUNCTURE COUNCIL <a href="http://www.acupuncture.org.uk/">www.acupuncture.org.uk</a> Tel: 020 8735 0400 Provides information on acupuncture and details of qualified traditional acupuncturists in your area. Phone or enclose an SAE for more information. NATIONAL INSTITUTE OF MEDICAL HERBALISTS <a href="http://www.nimh.org.uk/">www.nimh.org.uk</a> Telephone 01392 426022 Email nimh@ukexeter.freeserve.co.uk Professional body - offers a service for you to find a trained and qualified herbalist. FOR DIET ADVICE: BRITISH NUTRITION FOUNDATION <a href="http://www.nutrition.org.uk/">www.nutrition.org.uk</a> Telephone 0207 404 6504 Includes advice on finding a dietician BRITISH DIETETIC ASSOCIATION <a href="http://www.bda.uk.com/">www.bda.uk.com</a> FOOD STANDARDS AGENCY <a href="http://www.eatwell.gov.uk/">www.eatwell.gov.uk</a> BBC HEALTH <a href="http://www.bbc.co.uk/health/healthy_living/nutrition">www.bbc.co.uk/health/healthy_living/nutrition</a> NHS DIRECT <a href="http://www.nhsdirect.nhs.uk/encyclopaedia">www.nhsdirect.nhs.uk/encyclopaedia</a> FOR MEDITATION: THE SHOLLOND TRUST <a href="http://www.headless.org/">www.headless.org</a> tel. 020 8806 3710 - Richard Lang, Trust Co-ordinator The Trust offers a form of meditation you can do any time, any place, in any circumstances. It’s astoundingly easy to do, and it’s free. It’s also a great way to get the best out of and appreciate all other meditation and complementary techniques. THE BBC <a href="http://www.bbc.co.uk/">www.bbc.co.uk</a> and search “meditation”. A wide range of options. THE HITCHHIKER’S GUIDE TO THE GALAXY <a href="http://www.bbc.co.uk/dna/h2g2">www.bbc.co.uk/dna/h2g2</a> Ask the guide about meditation. In fact ask it about any question you have. FOR COUNSELLING: BRITISH ASSOCIATION FOR COUNSELLING AND PSYCHOTHERAPY (BACP) <a href="http://www.bacp.co.uk/">www.bacp.co.uk</a> Telephone 0870 443 5252 Email bacp@bacp.co.uk A fisrt reference for anyone seeking information on counselling and psychotherapy in the United Kingdom. They have a helpful and easy to use search tool to find a therapist. THE SAMARITANS <a href="http://www.samaritans.org/">www.samaritans.org</a> Telephone 08457 90 90 90 (24 hours, seven days a week) Email <a href="mailto:jo@samaritans.org">jo@samaritans.org</a> Confidential non-judgemental support, 24 hours a day for people experiencing feelings of distress or despair. MIND <a href="http://www.mind.org.uk/">www.mind.org.uk</a> Telephone 020 8519 2122 Mind Infoline 0845 766 0163 (Monday-Friday 9:15-5:15) Email <a href="mailto:contact@mind.org.uk">contact@mind.org.uk</a> The MindinfoLine offers confidential help on a range of mental health issues from anywhere in the UK for the price of a local call. Local MIND associations offer supported housing, crisis helplines, drop-in centres, counselling, befriending, advocacy, employment and training schemes and other services. RELATE <a href="http://www.relate.org.uk/">www.relate.org.uk</a> Tel. 0845 456 1310 or 01788 573241 Relate is the UK's largest provider of relationship counselling and sex therapy. They also offer a range of other relationship support services. CRUSE BEREAVEMENT CARE <a href="http://www.crusebereavementcare.org.uk/">www.crusebereavementcare.org.uk</a> Day-to-day helpline: 0870 167 1677 Help for bereaved people, whatever their age, nationality or beliefs, including a free counselling service. FOR CARE SERVICES: COUNSEL AND CARE <a href="http://www.counselandcare.org.uk/">www.counselandcare.org.uk</a> Advice line 0845 300 7585 (weekdays 10am-12.30pm and 2pm-4pm) A national charity getting the best care and support for older people, their families and carers SUE RYDER CARE <a href="http://www.suerydercare.org/">www.suerydercare.org</a> 020 7400 0440 Cares for people with life-shortening illnesses through specialist hospice care services. THE PRINCESS ROYAL TRUST FOR CARERS <a href="http://www.carers.org/">www.carers.org</a> Telephone 020 7480 7788 Email help@carers.org The trust is the largest provider of comprehensive carers support services in the UK. CARERS UK <a href="http://www.carersuk.org/">www.carersuk.org</a> Free Carers Line 0808 808 7777 (weekdays 10am-12pm and 2pm-4pm) Email info@ukcarers.org Carers UK is the voice of carers and the leading campaigning, policy and information organisation for carers. Provides information and advice on topics relating to caring. CARERS NATIONAL ASSOCIATION <a href="http://www.carersuk.org/">www.carersuk.org</a> Provides information and advice for carers and works for carers rights. CROSSROADS (The Association of Crossroads Care Attendant Schemes) <a href="http://www.crossroads.org.uk/">www.crossroads.org.uk</a> Tel: 0845 450 0350 Practical support for carers; respite care at home. Provides trained care support workers to allow carers the breaks and time off they need. CARE CHOICES LTD <a href="http://www.careselect.co.uk/">www.careselect.co.uk</a> Tel: 0800 389 2077 Care Choices Ltd offers a free residential/care home search service. The company has a database of care homes, nursing homes, elderly accommodation and similar establishments throughout the UK. HOSPICE INFORMATION <a href="http://www.hospiceinformation.info/">www.hospiceinformation.info</a> Tel: 0870 903 3903 Publishes a directory of hospice and palliative care services. FOR GENERAL UK HEALTH HELP, ISSUES and the NHS: NHS DIRECT ( <a href="http://www.nhsdirect.nhs.uk/">www.nhsdirect.nhs.uk</a> ) - see First Resources PATIENTS ASSOCIATION <a href="http://www.patients-association.com/">www.patients-association.com</a> Helpline: 0845 608 4455 Represents the views and interests of patients and campaigns for improved health services. Provides advice, factsheets and self-help guides. DR FOSTER <a href="http://www.drfoster.co.uk/">www.drfoster.co.uk/</a> Telephone 0207 332 8800 Works with the NHS to make it easier for professionals and the public to access health and social care information. Hospitals, consultants, complementary therapies and much more. PALS - PATIENT ADVICE AND LIAISON SERVICE (<a href="http://www.dh.gov.uk/">www.dh.gov.uk</a>) This web address will take you to the Department of Health website. Click on Patient Advice and Liaison Service to find your local PAL. Information and help with any questions or problems you have about your GP service, NHS hospital or other NHS service. EQUIP - ELECTRONIC QUALITY INFORMATION FOR PATIENTS <a href="http://www.equip.nhs.uk/">www.equip.nhs.uk</a> NHS search website for patient information on a very wide variety of conditions. RSVP - RETIRED AND SENIOR VOLUNTEER PROGRAMME <a href="http://www.csv-rsvp.org.uk/">www.csv-rsvp.org.uk</a> Advice and help for over 50’s by over 50’s: Transport for medical care, practical and domestic help, avoiding isolation, help for over 50’s in GP surgeries. LTCA - LONG TERM CONDITIONS ALLIANCE <a href="http://www.ltca.org.uk/">www.ltca.org.uk</a> An umbrella body for voluntary organisations. Promotes access to services, support, and knowledge for self-help. Includes an “Expert Patients” programme with the NHS. Look at the directory of member organisations on their website for the help you need, or RING THEM on 02078153637. PATIENT CONCERN <a href="http://www.patientconcern.org.uk/">www.patientconcern.org.uk</a> Helpful advice on how to survive medical treatment and the NHS, how to assess medical websites and more. FOR EXERCISE: There are many possibilities to choose from, and you may be surprised what you can do and what you’ll enjoy. Just be sure to get your doctor’s and/or physiotherapist’s advice on any medical limitations and what to avoid. SIMPLE WAYS to look at the possibilities are with the help of: THE BBC - Go to <a href="http://www.bbc.co.uk/health">www.bbc.co.uk/health</a> BANDOLIER - go to <a href="http://www.jr2.ox.ac.uk/bandolier">www.jr2.ox.ac.uk/bandolier</a> and see Exercise in their healthy living section THE NHS Health encyclopaedia: <a href="http://www.nhsdirect.nhs.uk/">www.nhsdirect.nhs.uk</a> in our FIRST RESOURCES section has good information. THE COMPLIMENTARY HEALTHCARE INFORMATION SERVICE <a href="http://www.chisuk.org.uk/">www.chisuk.org.uk</a> links to all the main movement therapy exercise techniques. A one-stop convenience shop. And specifically for: TAI CHI - local adult education courses, local gym, fitness centre, library listing or the TAI CHI UNION OF GREAT BRITAIN - <a href="http://www.taichiunion.com/">www.taichiunion.com</a> PILATES <a href="http://www.pilatesfoundation.com/">www.pilatesfoundation.com</a> YOGA <a href="http://www.bwy.org.uk/">www.bwy.org.uk</a> DANCING - ballroom, tap, folk, flamenco, modern, social, jazz… too many styles to list. Once again the easy place to start is THE BBC. Go to <a href="http://www.bbc.co.uk/health">www.bbc.co.uk/health</a> and look under dance. Also many classes locally in many styles. GYMS / CIRCUIT TRAINING / SPORT - Infinite options. BBC Health provides guidance. <a name="compalt2" id="compalt2"></a> EXERCISE IN WATER: AQUA-CHI <a href="http://www.taichiunion.com/">www.taichiunion.com</a> AQUA-GYM <a href="http://www.aquagym.co.uk/">www.aquagym.co.uk</a> POOLATES <a href="http://www.poolates.co.uk/">www.poolates.co.uk</a> Pilates in water. AQUA-DANCE classes at local pools or <a href="http://www.virginactive.co.uk/">www.virginactive.co.uk</a> for classes at their gyms FOR GENERAL SELF-HELP ON MOST SUBJECTS: DIRECTORY OF UK SELF-HELP GROUPS www.ukselfhelp.info/ This is a remarkably complete A-Z of self-help organisations on just about any health subject you can think of and life problems of most kinds. FOR PRACTICAL GENERAL INFORMATION ON MOST SUBJECTS: <a href="http://www.about.com/">www.about.com</a> <a href="http://www.bbc.co.uk/">www.bbc.co.uk</a> <a href="http://www.bbc.co.uk/dna/h2g2">www.bbc.co.uk/dna/h2g2</a> <a href="http://www.wikipedia.org/">www.wikipedia.org </a> <a name="Heart" id="Heart"></a> FOR PHYSICAL AIDS AND EQUIPMENT - ACCESS, MOBILITY AND PRACTICAL HELP: DISABLED LIVING FOUNDATION (DLF) <a href="http://www.dlf.org.uk/">www.dlf.org.uk</a> Tel: 020 7289 6111 Helpline: 0845 130 9177 Text phone: 020 7432 8009 DLF are the leading source of information on disability equipment - free, impartial advice about all types of equipment and mobility products INDEPENDENT LIVING FUNDS <a href="http://www.ilf.org.uk/">www.ilf.org.uk</a> Tel: 0845 601 8815 Email: client.service@ilf.org.uk The funds were set up as a national resource dedicated to the financial support of disabled people enabling them to choose to live in the community rather than residential care. DISCOUNT MOBILITY PLUS LTD For scooters, wheelchairs, bathlifts, stairlifts, chairs <a href="http://www.discountmobilityplus.co.uk/">www.discountmobilityplus.co.uk</a> Tel: 0808 178 4151 DISABILITY ALLIANCE www.disabilityalliance.org The leading authority on social security benefits for disabled people Tel: 020 7247 8776 MOBILISE - THE DISABLED DRIVERS’ ASSOCIATION <a href="http://www.justwebs.co.uk/mobilise/">www.justwebs.co.uk/mobilise/</a> Tel: 01508 489449 (Representation, information and advice on mobility issues) DISABILITY RIGHTS COMMISSION <a href="http://www.drc-gb.org/">www.drc-gb.org</a> DRC Helpline Tel: 08457 622 633 Textphone: 08457 622 644 The Disability Rights Commission (DRC) is an independent body established in April 2000 by Act of Parliament to stop discrimination and promote equality of opportunity for disabled people. RELATIVES AND RESIDENTS ASSOCIATION www.relres.org Tel: 020 7359 8136 Provides information and support about carehomes. ROYAL ASSOCIATION FOR DISABILITY AND REHABILITATION (RADAR) www.radar.org.uk Tel: 020 7250 3222 Minicom: 0207 250 4119 RADAR is concerned with every aspect of disability, but is particularly involved with access, education, employment, holidays, housing, mobility and social services. CITIZENS ADVICE BUREAUX (CABx) <a href="http://www.nacab.org.uk/">www.nacab.org.uk</a> The website gives local offices, opening times and specialist services. AGE CONCERN AID CALL <a href="http://www.aidcall-alarms.co.uk/">www.aidcall-alarms.co.uk</a> T: 0800 77 22 66 Emergency alarms to stay independent but summon help if needed MEDIC ALERT FOUNDATION <a href="http://www.medicalert.co.uk/">www.medicalert.co.uk</a> tel 02078333034 Medical identification, cards, bracelets, necklaces etc with information on call for emergency treatment. Knowing your chronic problems and what medications you’re on can make a critical difference for any doctor or emergency worker treating you in any situation. <a name="working" id="working"></a> FOR FIRST AID TRAINING - and we always recommend this as part of learning to take care of ourselves and each other: RED CROSS <a href="http://www.redcross.org.uk/">www.redcross.org.uk</a> ST JOHN’S AMBULANCE <a href="http://www.sja.org.uk/">www.sja.org.uk</a> ST ANDREW’S AMBULANCE (Scotland) <a href="http://www.firstaid.org.uk/">www.firstaid.org.uk</a> In discussing the basics of heart conditions and blood pressure we’ll start with some “how things happen” essentials and some emergency facts we should all have. This will lead us into dealing with both acute and chronic conditions. We’ll look at what they are, how they’re treated, the importance of blood pressure and other factors, and how you can improve your own condition and quality of life. If the basics and emergency facts are old news to you and you’re more interested in therapies and condition management, go straight to those sections. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/h1.jpg" /></div> THE HEART has three basic systems, much like the systems in a car engine. <ul type="disc"> <li>THE FUEL LINE is the blood flow </li> <li>THE ELECTRICAL SYSTEM is made up of special heart muscle cells carrying electrical impulses through the heart. </li> <li>THE MECHANICAL SYSTEM is primarily the heart muscle contracting to pump blood, and valves which open and close to keep blood flowing in the right direction.</li> </ul> If any one of these systems is damaged it can cause serious problems and affect the other systems. THE MOST COMMON ORIGINS OF HEART PROBLEMS involve the flow of blood. The blood in our bodies flows through a system of arteries and veins. Arteries carry blood away from the heart to the rest of the body. Veins return blood to the heart. The heart is the pump, driving the blood through the system. CARDIOVASCULAR DISEASE is the general name for diseases affecting the heart and the arteries supplying blood to the rest of the body. Arteries carry blood filled with oxygen to all the tissues of the body. When every part of our body has taken the oxygen it needs to function, the veins return the blood to the heart. This returning blood needs to be filled with oxygen again, so the heart pumps it to the lungs where it’s loaded with fresh oxygen. The heart than takes this oxygenated blood back and pumps it back out to deliver more oxygen to the body. The basic pattern then, is from the heart through the body, back to the heart to be sent to the lungs for fresh oxygen, and back out through the body again. It’s a nice simple pattern, but it only works if the heart pump is able to keep it flowing and the blood keeps flowing in the right direction. The heart muscle has to function well to pump, and a series of VALVES need to work properly and not leak so blood doesn’t seep backwards or leak out of the system. CORONARY ARTERY DISEASE In modern societies the most common of these conditions is ATHEROSCLEROSIS, or “hardening of the arteries”. This begins almost from birth. Atherosclerosis is a complex process started by injury to the lining of the arteries. Some forms of cholesterol, “free radicals” and many other things mounting up in our systems as we live are thought to play a part. Our bodies respond by sending white blood cells to fight off whatever is damaging us, but this activity creates scarring. Gradually over time the white blood cells, scar tissue and cholesterol form a plaque, narrowing the space for blood to flow through the artery. A lime scale deposit furring up and starting to block the pipes in your home’s plumbing is a good image of what’s going on here. THE MAJOR RISK FACTORS for coronary artery disease are: <ul type="disc"> <li>High blood pressure</li> <li>Smoking</li> <li>High cholesterol</li> <li>Diabetes</li> <li>Family history</li> </ul> STENOSIS is the medical term for the narrowing of the arteries. The result as the condition advances is that the heart muscle (myocardium) doesn’t get enough blood to work properly. This lack of blood is called myocardial ischaemia. It can cause CHEST PAIN (ANGINA). Angina may come with shortness of breath, and sometimes nausea, sweating or fainting. These are HEART ATTACK symptoms. A HEART ATTACK (or Myocardial infarction) usually happens when a blood clot in the coronary artery blocks the supply of blood and oxygen to the heart. Often this leads to an irregular heartbeat – called an ARRHYTHMIA - that causes a severe decrease in the pumping function of the heart. A blockage that is not treated in time causes the affected heart muscle to die. HEART ATTACK SYMPTOMS: A HEART ATTACK IS A CRITICAL EMERGENCY. MINUTES COUNT. Suspect a heart attack, and DIAL 999 WITHOUT HESITATION, if you or someone you’re with has any combination of:<div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/h2.jpg" /></div> <ul type="disc"> <li>Discomfort in the centre of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness/pressure or pain. </li> <li>Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach. </li> </ul>   <ul type="disc"> <li>Shortness of breath with or without chest discomfort. </li> <li>a cold sweat, nausea or light-headedness (this could be simple fainting, but take no chances)</li> <li>ashen skin and blueness in lips </li> <li>rapid then weakening pulse</li> </ul> HEART ATTACK FIRST AID: <ul type="disc"> <li>If the person is conscious and able to swallow, give one aspirin (ideally to be chewed slowly). Do not give fluids.</li> <li>If the person has tablets or an aerosol for angina, help to get to and use them</li> <li>The heart attack victim can try taking deep breaths and cough as long and hard as possible between breaths. </li> </ul> Deep breaths get oxygen into the lungs and really hard coughing squeezes the heart and keeps the blood circulating. The squeezing pressure can help the heart regain its normal rhythm. RSVP (see our First Resources section) posts this advice in GP surgeries. They advise that this coughing technique can be lifesaving while waiting to get help. <ul type="disc"> <li>If the person becomes unconscious, has no pulse/stops breathing, begin CPR immediately. If a defibrillator is available and you know how to use it, do so. If you don’t know how to do these things please consider taking a basic life saving course (see our Useful Organisations section). Courses with St. Johns, St. Andrews or the Red Cross can take as little as 3-4 hours to learn the basics. </li> </ul> ANGINA Angina is chest pain or discomfort you get when your heart muscle does not get enough blood. It may feel like pressure or a squeezing pain in your chest. It may feel like indigestion. When you exert yourself the heart needs more fuel. If the artery flow is restricted the heart may struggle, producing exertional angina. Angina in itself does not necessarily mean you are having a heart attack, but it does mean there is a serious blood supply problem. The chest pain of Angina may often also radiate into the arms, back, neck shoulders or jaw. There are other conditions which may cause these symptoms, but if you or someone you’re with has radiating pain with chest pain, CALL 999. THERE ARE TWO BASIC TYPES OF ANGINA: People who have had angina for a while may have STABLE ANGINA. They know pretty much what level of exertion they can take, and how to rest and let it subside. UNSTABLE ANGINA is angina with where the pattern changes: more or different pain, pain lasting longer or coming on with less exertion, or an unexpected angina. UNSTABLE ANGINA IS A MEDICAL EMERGENCY AND MAY BE A HEART ATTACK. CALL 999. Quite a high number of people can have what we might call “Silent Angina”: the heart isn’t getting enough blood flow but there is no chest pain. There may be other symptoms, or nothing very dramatic at all. This means that you could well have a heart attack and resulting damage without knowing it. A HEART ATTACK IS HEART MUSCLE DYING from lack of blood flow. This occurs most often when some plaque build-up in a coronary artery breaks, exposing substances which promote CLOT FORMATION in the blood. The resulting blood clot, or THROMBOSIS, stops blood from feeding the heart itself. The heart muscle, starved of blood, begins to die. This causes chest pain like severe Angina, but usually lasts longer and may be more severe. For the avoidance of doubt, let’s repeat: if you suspect a heart attack you are dealing with AN EXTREME MEDICAL EMERGENCY, AND MINUTES COUNT. To minimise damage and increase chances of survival the blood flow to the heart must be re-established as quickly as possible. DO NOT HESITATE if you suspect a heart attack. CALL 999. Use the first aid techniques above while waiting, if possible. SUDDEN CARDIAC DEATH Sudden death from cardiac arrest is a major health problem that has received much less publicity than heart attack. Sudden cardiac death occurs on average at about 60 years of age, claims many people during their most productive years, and devastates unprepared families. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/h3.jpg" /></div> Sudden cardiac death happens when the heart stops abruptly (cardiac arrest). The victim may or may not have diagnosed heart disease. Death can occur within minutes after symptoms appear, or there may be no symptoms before collapse. The most common underlying reason that patients die suddenly from cardiac arrest is coronary heart disease. In 90 percent of adult victims of sudden death, two or more major coronary arteries are narrowed by atherosclerosis. Scarring from a prior heart attack is found in two-thirds of victims. Adrenaline released during intense athletic or physical activity often triggers sudden death when these abnormalities are present. Under certain conditions, various heart medications and other drugs -- as well as illegal drug abuse -- can lead to abnormal heart rhythms that cause sudden death. Most known heart diseases can lead to cardiac arrest and sudden death. Most of the cardiac arrests that lead to sudden death occur when the electrical impulses in the heart become rapid (ventricular tachycardia) or chaotic (ventricular fibrillation) or both. This irregular heart rhythm causes the heart to suddenly stop beating. A small number of cardiac arrests are caused by extreme slowing of the heart (bradycardia). During cardiac arrest, a victim collapses suddenly, becomes unresponsive, stops normal breathing, and loses pulse or other signs of circulation. If this happens begin cardiopulmonary resuscitation (CPR) immediately. This will help keep the cardiac arrest victim alive until emergency help arrives. CPR keeps blood flowing to the heart and brain until defibrillation can be provided. Brain death and permanent death start to occur in just 4 to 6 minutes after someone experiences cardiac arrest. Cardiac arrest can be reversed in most victims if it's treated with immediate CPR and an electric shock to the heart within 7 to 10 minutes. Again, if you don’t know basic cardio-pulmonary resuscitation (CPR), do consider taking a short course. Immediate CPR and rapid defibrillation combined with early advanced care can produce high long-term survival rates for cardiac arrest. Needless to say, whatever else you do, call 999. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/h4.jpg" /></div> ATRIAL FIBRILLATION Atrial fibrillation causes a very irregular and, usually, rapid heart rate due to disorganized electrical activity in the upper heart chambers which are called the right and left atrium or atria. Electricity usually flows smoothly in the heart muscle but becomes irregular and disorganized in the atria during episodes of atrial fibrillation (AF). AF can occur in short episodes called paroxysmal AF or longer episodes called persistent AF. When AF is present for very long periods of months or years it is called permanent AF. To visualize what AF looks like, imagine a very still swimming pool with a smooth surface. If a pebble is dropped into the water a series of waves will spread out from the entry point of the pebble in smooth circles. When a normal electrical impulse forms in the right atrium, coming from the pacemaker cells, this impulse spreads through the heart in a smooth fashion. Now, imagine the swimming pool in a rain storm with waves everywhere. That is what the electrical activity in the atria looks like during atrial fibrillation. Atrial fibrillation is very common and becomes more common as we age. Up to 10% of people over the age of 70 may have AF. Atrial Fibrillation increases the risk of stroke. Because blood doesn’t flow as smoothly in the atria during AF small clots may form along the atrial walls and these can fall off and be carried to the brain where they obstruct blood flow and cause a stroke. This risk also increases with age and if other risk factors for stroke are present such as diabetes or high blood pressure. AF can cause a number of symptoms. The type of symptoms will depend on several factors including whether other types of heart problems are present. AF may cause congestive heart failure, chest pain, shortness of breath or fainting. The most common symptom is a sensation of rapid irregular heart beat or “palpitations”. In the presence of abnormal heart valves or reduced heart function, these symptoms may be more severe. Looking at <a href="http://www.about.com/">www.about.com</a> (a good site for most subjects - see Useful Organisations) we learn that: <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/h5.jpg" /></div> The cardiac electrical system regulates the frequency of the heart beat (i.e., it sets the heart rate), and it coordinates the contraction of the heart muscle, so that the heart beats efficiently. CARDIAC ARRHYTHMIAS are abnormal heart rhythms from problems in the heart’s electrical system. Abnormally slow arrhythmias are called the bradycardias, and abnormally rapid arrhythmias are called tachycardias. A PACEMAKER is a sophisticated electronic device to deal with many arrhythmias. It does two things: 1) It analyzes the function of the heart’s own electrical system. 2) When necessary, it sends tiny, precisely-timed electrical signals to the heart, to correct certain abnormalities in the heart’s electrical system. Most pacemakers are designed to correct the bradycardias (the slow arrhythmias.) Abnormally slow heart rhythms can cause weakness, fatigue, light-headedness, dizziness, loss of consciousness, or even death. Pacemakers, properly used, effectively eliminate all of these symptoms. HEART FAILURE Based on information from the BBC Health website: Heart failure is responsible for one in 20 admissions to hospital and is more deadly than many cancers. The good news for sufferers, however, is that it can be treated. We’ve described the heart as a muscular pump providing blood flow to the rest of the body. As with any piece of machinery, as it gets older or if it's damaged in any way, it won't work efficiently. When this happens, people notice they haven't as much energy as before, that they get tired more easily and out of breath more quickly. They may also notice their ankles swelling. THE MOST COMMON SYMPTOMS OF HEART FAILURE are severe breathlessness, tiredness and swelling of the ankles and feet. Because the symptoms of heart failure are common to other medical problems, certain tests are needed to confirm the diagnosis. These may include a chest x-ray to show whether the heart is enlarged, an electrocardiogram to detect any abnormal heart function and, probably most importantly, an echocardiogram. This is a special type of ultrasound that shows how well the heart and its valves are working. In addition, blood tests will be performed and blood pressure must be measured. These symptoms tend to develop gradually and usually go unnoticed for a long time. With heart failure the heart doesn't fail totally and stop; it struggles and is inefficient, and causes fluid to collect in the lungs and legs. Common causes of heart failure include: <ul type="disc"> <li>Angina </li> <li>Heart attack</li> <li>High blood pressure</li> <li>Heart valve damage (allowing blood to leak and to flow the wrong way) </li> <li>Excessive alcohol</li> <li>Inherited heart conditions, such as Cardiomyopathy (a group of diseases enlarging the heart or make it thicker and more rigid than normal).</li> <li>Some viruses and other infections (including dental abscess) can also affect the heart and cause damage quickly.</li> </ul> The most common cause of heart failure is another heart problem such as angina or a previous heart attack. A third of cases are caused by high blood pressure, which causes the heart's muscular wall to thicken, making it less flexible and unable to pump blood properly. DIAGNOSIS of heart failure begins with your doctor examining you and listening to you about your symptoms, doing an ECG (electrocardiogram) and arranging blood tests. You may than need an ECHOCARDIOGRAM. This procedure is similar to an ultrasound scan. No pain or discomfort involved and it shows an accurate picture of heart structure, valves and pumping action. It’s also a tool for looking specifically at heart valve disease. HEART VALVE DISEASE Heart valve disease usually develops over time, affecting people aged 60 or over, but it can be the result of an infection which damages the valve in a matter of days. The condition is often present at birth (congenital heart disease), the child being born with valves made of two parts rather than the usual three. Gradually the valve wears and becomes thicker to the point where it has to be replaced. Rheumatic fever used to be a common cause; the effect of bacteria is to damage the valve, preventing it opening or closing properly. Acute infection (endocarditis), sometimes as a result of an abscess of a tooth, is however still a common cause of valve disease. Bacteria can destroy the valve in as little as a week. If one or more of the four heart valves are diseased or damaged it can affect the flow of blood in two ways. If the valve does not open fully, it obstructs the flow of blood - known as valve stenosis. If the valve does not close properly, it will allow blood to leak backwards - called valve incompetence or valve regurgitation. Both put extra strain on the heart. Symptoms include tiredness or breathlessness when exercising, swelling of the ankles and legs, dizziness or fainting in extreme cases. Angina can occur. Treatment with drugs including diuretics, ACE inhibitors and digoxin may be used to control the problem, or in severe cases, surgery to replace a heart valve may be necessary (see our Treatment section). HIGH CHOLESTEROL LEVEL (hypercholesterolaemia) Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood. It is not a disease but a metabolic abnormality that can be secondary to many diseases and can contribute to many forms of disease. It can play a very big role in cardiovascular disease. A high level of cholesterol is one of the factors that can increase your risk of cardiovascular disease, angina, heart disease and stroke. High levels of cholesterol lead to fatty deposits that cause the arteries to narrow (atherosclerosis) and restrict blood flow to the heart, causing cardiovascular disease. Everyone should have their cholesterol level measured at least once before they are far past middle age. Cholesterol levels don't tend to fluctuate, so if you have a normal level it doesn't need to be repeated for many years. Have you’re your doctor check your cholesterol level if it hasn’t been done recently, and consult HEART UK (see our Useful Organisations section) for any and all the help you need.  HIGH BLOOD PRESSURE (Hypertension) Based on information from the netdoctor website: Every adult over 40 should have their blood pressure checked. Being a pump, our hearts push blood under pressure around our bodies. Too much blood pressure puts a strain on the arteries and on the heart itself. This can cause an artery to rupture or the heart to fail under the strain - in the worst case stopping altogether. Hypertension occurs when blood is forced through the arteries at an increased pressure. Blood pressure depends on a combination of two factors: <ul type="disc"> <li>how forcefully the heart pumps blood around the body</li> <li>how narrowed or relaxed your arteries are. </li> </ul> Around 10 million people in the UK have high blood pressure - that's one in five of us. BLOOD PRESSURE IS MEASURED using two numbers. An example of this could be '120 over 80', which is written as '120/80mmHg'. The first number is the systolic blood pressure - the maximum pressure in the arteries when the heart contracts (beats) and pumps blood out into the body. The second figure is the diastolic blood pressure. This is the minimum pressure in the arteries between beats when the heart relaxes to fill with blood. Because the height of a mercury column is used in blood pressure gauges, standard blood pressure readings are always written as so many ‘millimetres of mercury’, which is abbreviated to ‘mmHg’. The systolic pressure is always listed first, then the diastolic pressure. A typical normal blood pressure reading would be 120/80 mmHg. DETERMINING HIGH BLOOD PRESSURE There is a natural tendency for blood pressure to rise with age due to the reduced elasticity of the arterial system. Age is therefore one of the factors that needs to be taken into account in deciding whether a person's blood pressure is too high. In general terms, people with a systolic blood pressure consistently above 160mmHg and/or a diastolic pressure over 100mmHg need treatment to lower their blood pressure. People with slightly lower blood pressures (140-159mmHg systolic or 90-99mmHg diastolic) may also need treatment if they have a high risk of developing cardiovascular disease, eg stroke or angina (chest pains). SYMPTOMS may be invisible. One of the big problems with high blood pressure is that by itself it hardly ever causes symptoms. This means it may go unnoticed until it causes one of its later complications such as a stroke or heart attack. Severe hypertension can cause symptoms, including headache, sleepiness, confusion, and even coma. COMPLICATIONS caused by high blood pressure can come with dramatic symptoms. Complications can include: <ul type="disc"> <li>Atherosclerosis: narrowing of the arteries.</li> <li>Stroke: haemorrhage or blood clot in the brain.</li> <li>Aneurysm: dangerous expansion of the main artery either in the chest or the abdomen, which becomes weakened and may rupture.</li> <li>Heart attack.</li> <li>Heart failure: reduced pumping ability.</li> <li>Kidney failure. </li> <li>Eye damage. </li> </ul> In other words, if you have high blood pressure (hypertension), deal with it. With your doctor’s help and your own lifestyle changes you can. See our “Treatment” and “Self Help” sections. THE CAUSE of hypertension is hard to determine in most people. For more than 90 per cent of those with high blood pressure the cause is unknown. This is called 'primary' or 'essential hypertension'. In the remaining 10 per cent or so, there is an underlying cause. This is called 'secondary hypertension'. Some of the main causes for secondary hypertension are chronic kidney diseases, diseases in the arteries supplying the kidneys, chronic alcohol abuse, hormonal disturbances and endocrine tumours. If you have high blood pressure it is far more likely to be primary hypertension. Anyone can suffer from high blood pressure, but certain factors can seriously aggravate hypertension and increase the risk of complications: <ul type="disc"> <li>a tendency in the family to suffer hypertension</li> <li>obesity </li> <li>smoking </li> <li>diabetes Type 1 or Type 2 </li> <li>kidney diseases</li> <li>high alcohol intake</li> <li>excessive salt intake</li> <li>lack of exercise</li> <li>certain medicines, such as steroids. </li> </ul> This is not a complete list. Please do get your doctor’s help to keep an eye on your blood pressure. If it’s high, stick carefully to the regime and treatments your doctor gives you. Everyone over 50 should know their blood pressure and cholesterol levels. It makes all the difference to start treatment and lifestyle changes before any complications arise.

2008-11-27T10:35:56-08:00

CORONARY HEART DISEASE The H2G2 website describes medical essentials and treatments including: DIAGNOSTIC TESTS: An initial diagnosis can be made by having an ECG, (Electrocardiograph). This simply involves having a series of electrodes attached to the chest and lower legs. The electrodes pick up the electrical impulses from heart activity and from blood flow which then produces a printout showing the trace patterns. A normal trace pattern shows in the form of a graph with even peaks and troughs showing different impulses produced at each stage of the cardiac cycle. Any abnormalities can be seen fairly quickly by the doctor and further tests and treatment then arranged. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/h6.jpg" /></div> If an actual heart attack is suspected, as well as showing up on the ECG, blood tests are taken which measure certain enzymes that are released by the heart muscle during an attack. These are Troponin I and Troponin T tests. There should be little or no Troponin in the blood if there is no damage to the heart muscle itself. Troponin is released into the blood stream and is measured up to six hours after the initial onset of the attack. For heart attack one of the most useful tools is an ANGIOGRAM. This is normally done as a day patient and involves a tube being inserted into the main artery in the groin through which a fine wire/tube is fed up the artery to the heart. A dye is injected and this allows the arteries to show up clearly on a video/x-ray. The resulting pictures will show the cardiologist where and how severe the blockage of blood flow is, and will then lead on to whether a full by-pass operation is required or a procedure known as angioplasty with a stent (more on this under Surgery in our 'Treatments' section). An exercise stress test can also be carried out. This involves the patient being wired to a heart monitoring machine and a blood pressure monitor and then the patient starts by walking on a treadmill. The treadmill is adjusted for different levels of severity mimicking walking uphill and possibly jogging. The test can last for up to 20 minutes after which the printed results are studied to see what abnormalities, if any, are present. This test is carried out with qualified staff present in case it triggers an angina attack or worse. For patients unable to have either an angiogram or carry out a stress test, an echocardiogram can be used in a number of ways see how your heart is functioning. The angiogram is the only test that involves what medics term invasive diagnostics. All three of the above procedures are relatively safe and routine these days. Surgery, drug treatments and lifestyle changes can all be essentials in dealing with coronary heart disease.   HEART FAILURE The therapeutic goals are to: <ul type="disc"> <li>Treat the underlying cause of your heart failure </li> <li>Improve your symptoms (typically including poor energy, breathlessness and swollen ankles) and improve your quality of life </li> <li>Stop your heart failure from getting worse </li> <li>Prolong your life span</li> </ul> Your doctor will treat any identifiable diseases or conditions (such as coronary artery disease, high blood pressure, or diabetes) causing your heart failure. The treatments for heart failure include: Lifestyle changes (see our Self-Help section) Medications Specialized care for those in the most advanced stage of heart failure Lifestyle Changes: There are things that you can do to help with your treatment. Your doctor will recommend that you: Follow a diet low in salt. Salt can cause extra fluid to build up in your body, making your heart failure worse. Limit the amount of fluids that you drink. Weigh yourself every day, and let your doctor know right away if you have a sudden weight gain. This could mean you have extra fluid building up in your body. Exercise as directed to help build your fitness level and ability to be more active. Your doctor will also tell you to: Lose weight if you are overweight. Quit smoking if you smoke. Limit the amount of alcohol that you drink. Medicines: Your doctor will prescribe medicines to help improve your heart function and symptoms. The main medicines are: Diuretics (water or fluid pills) to help reduce fluid buildup in your lungs and swelling in your feet and ankles. ACE inhibitors to lower blood pressure and reduce the strain on your heart. These medicines also may reduce the risk of a future heart attack. Beta blockers to slow your heart rate and lower your blood pressure to decrease the workload on your heart. Digoxin to make the heart beat stronger and pump more blood. As heart failure progresses, lifestyle changes and regular medicines may not be enough to control worsening symptoms. Many people with severe heart failure must be treated in the hospital from time to time. In the hospital, your doctor may prescribe new or special medicines. You will continue to take your regular medicines during this treatment. Your doctor will also order extra oxygen if you continue to have trouble breathing. The extra oxygen can be given in the hospital and at home. Persons with very severe heart failure may be considered for a: <ul type="disc"> <li>Mechanical heart pump </li> <li>Heart transplant </li> </ul>   A mechanical heart pump is a special device placed inside the body to help pump blood to the rest of the body. There are different kinds of mechanical heart pumps. Some stay in the body for a short period of time, while others can stay in the body for a long time. Many people with a mechanical heart pump will also be considered for a heart transplant. A heart transplant is surgery to replace a heart failure patient’s heart with a healthy heart from someone who has recently died. A transplant is indicated in some people when all other treatments fail to control symptoms.   HIGH BLOOD PRESSURE (HYPERTENSION) Much of what you need to do can be found in our Self-Help section. If your blood pressure requires medical treatment, you will probably have to take medicine on a regular basis. If so, never stop taking it without consulting your GP, even if you feel fine. The result of doing so could be very bad indeed. Sometimes blood pressure control is not straightforward. Many people require more than one drug on a regular basis to get their blood pressure under good control. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/h7.jpg" /></div> Your GP may wish to seek the advice of an expert in hypertension if your blood pressure seems particularly difficult to control. By treating hypertension well, complications can be avoided and average life expectancy will remain almost normal. Without treatment, life expectancy may well be reduced due to the risk of developing complications such as heart failure or stroke.   ATRIAL FIBRILLATION increases the risk of stroke. Because blood doesn’t flow as smoothly in the atria during AF small clots may form along the atrial walls and these can fall off and be carried to the brain where they obstruct blood flow and cause a stroke. This risk also increases with age and if other risk factors for stroke are present such as diabetes or high blood pressure. For this reason, coumadin or warfarin is used as an anticoagulant, sometimes called a “blood thinner”. This greatly reduces the risk of stroke. There is a very small increased risk of bleeding as long as the coumadin level is carefully monitored. For people who can’t use coumadin, aspirin also reduces the risk of stroke but not as much as coumadin. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/h8.jpg" /></div> AF is caused by many factors, however in most people it seems to be initiated by muscle cells located in the veins which connect the lungs to the heart. The pulmonary veins bring the oxygen rich blood back to the heart to be pumped out to the body. (Trivia fans note: these are the only veins - as opposed to arteries - in the body to carry oxygenated blood!) . The four pulmonary veins attach to the back of the left atrium. Muscle cells in the pulmonary veins are electrically active cells and some may begin firing off electrical impulses very rapidly. These impulses go to the left atrium and may initiate atrial fibrillation. We earlier described the healthy electrics of the heart as being like an undisturbed swimming pool. The rapidly firing muscle cells in AF are like dropping one stone after another at speed into the water. The speed of firing causes a disorganized chaos of waves. This chaotic electrical activity disrupts the heart’s pumping and blood flow systems. Doctors have debated for years whether it is best to treat AF by controlling the heart rate with medications and using coumadin to prevent stroke, or to use medicines to try to convert the AF back to a normal rhythm. There is agreement that heart rate control is very important and that the use of coumadin is important for at least four to six weeks after the onset of AF. If AF has been present for less than 48 hours it is usually safe to try to convert the heart back to a normal rhythm. This is called a cardioversion and can be done using medication or by using an electric shock to convert the rhythm back to normal. Once AF has been present for 48 hours the risk of stroke with cardioversion goes up and coumadin must be used for three or four weeks first. Unfortunately, the drugs used to convert and prevent AF have a variety of possible side effects some of which may be serious. Also, AF will recur in about half of people with AF within two years despite being on drug therapy. Some people do well with AF as long as the heart rate is controlled and they take coumadin. They do not have symptoms and are able to function well with their normal activities. Other people do not tolerate AF well and have moderate or severe symptoms. For this group treatment can be difficult when the medications fail to maintain a normal rhythm. It is this group that may benefit from: Ablation Therapy - The first type of ablation therapy is called AV node ablation. A catheter is used to cauterize and eliminate the electrical connection (AV node) between the atria and the ventricles or bottom chambers of the heart. The ventricles are the main pumping chambers. A pacemaker is then implanted. After AV node ablation, the electrical impulses from the atria can no longer reach the ventricles and the ventricular rate is now controlled by the pacemaker. This therapy has worked well for many people. However, it doesn’t cure the atrial fibrillation or reduce the risk of stroke. Patients still need to take coumadin and many become “pacemaker dependent” so that they have a dangerously slow heart rate without the pacemaker. The newest type of ablation therapy involves making thin scars in the left atrium around the pulmonary veins where they attach to the back of the left atrium. Scars do no conduct electricity and act as insulators, electrically isolating the pulmonary veins from the left atrium. This prevents the rapidly firing cells in the pulmonary veins from exciting the atrial muscle and AF is prevented. If we refer back to our swimming pool example, this is about preventing the stones from hitting the water. This procedure can be done using several different approaches. Tools have been developed to perform atrial fibrillation ablation during open heart procedures for patients requiring other surgery such as coronary bypass. AF ablation can also be done surgically using a minimally invasive technique performed for AF alone. Finally AF ablation can be done using catheters introduced to the heart through veins in the leg. All of these procedures carry a small risk of serious side effects but are between 70% and 90% effective in curing AF. For patients who have very symptomatic AF and for whom drug therapy has failed, AFablation may be the right choice. See SURGERY AND OTHER PROCEDURES below to learn more about this in simple terms.   DRUG TREATMENTS Medication advice: Avoid confusion. Give your medication a chance to do its job for you. Take the right things at the right times. You’d be surprised how many people don’t and suffer the consequences. It helps to write down what you take and when you take it. You need to use heart and blood pressure medications properly. Consider buying a medication tray with sections for each day and time of day. Fill it with the right medications and you can be sure that you took what you should when you should. There are many different drugs for treating heart disease, but they all belong to a few main types/categories. Most heart drugs change how the heart or circulation works. Drugs can be used to treat: Angina Heart attack High blood pressure Disorders of heart rhythms Heart failure Some drugs can be used to treat more than one condition. Others are used to prevent coronary heart disease. We’ll start with a summary and then go into some detail: Angina - The main drugs used to prevent or treat angina are beta-blockers, calcium blockers, nitrates and potassium channel activators. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/h9.jpg" /></div> Heart Attack - Also known as myocardial infarction or coronary thrombosis. The drugs used are generally given in hospital and not self-administered. Aspirin is used to reduce the risk of blood clots, and hospitals will administer clot busting enzymes called thrombolytics. High Blood Pressure - A wide range of drugs are used including ACE inhibitors, beta blockers, calcium channel blockers and diuretics. ACE inhibitors stop the production of a hormone called angiotensin II that makes the blood vessels narrow. As a result, the vessels expand, improving blood flow. Tension in the circulation is also lowered by the kidneys filtering more fluid from the blood vessels into urine. This also helps reduce blood pressure. If your blood pressure is not easily controlled on simple medication, your doctor will probably use a medicine of this type. Angiotensin-II receptor antagonists work in a similar way to ACE inhibitors. But instead of stopping the production of angiotensin II, they block its action. This allows the blood vessels to expand, improving blood flow and reducing blood pressure. Beta-blockers block the effect of the hormone adrenaline and the sympathetic nervous system on the body. This relaxes the heart so that it beats more slowly, lowering the blood pressure. Alpha-blockers cause the blood vessels to relax and widen. Combining them with beta-blockers has a greater effect on the resistance in the circulation. Calcium-channel blockers reduce muscle tension in the arteries, expanding them and creating more room for the blood flow. In addition, they slightly relax the heart muscle so it beats more slowly, reducing blood pressure. Diuretics help the body get rid of excess salt and fluids via the kidneys. In certain cases, they relax blood vessels, reducing the strain on your circulation. FOR ALL HEART PROBLEMS, more information on the drugs in use and what's likely to be available can be found by contacting or looking at the website for the British Heart Foundation (see Useful Organisations) or through our First Resources organisations. We cannot possibly be comprehensive here, but the following begins to detail some of the main streams of drug treatment. Among the most common are: BETA-BLOCKERS (e.g. Atenonol) - These block the actions of hormones such as adrenaline that make the heart beat harder and faster. They are very effective in preventing angina but work too slowly in relieving chest pain from an angina attack. They are also very effective in lowering blood pressure therefore reducing the risk of further heart attacks. Some types of beta-blockers can help control abnormal heart rhythms and heart failure. Beta blockers are usually taken in small doses alongside ACE inhibitors (see below) and diuretics (drugs that help your body get rid of extra fluid). They are not suitable for people with respiratory problems such as asthma, or for people with diabetes. ACE (Angiotensin Converting Enzyme) INHIBITORS are commonly used to treat heart failure and high blood pressure. They block the activity of a hormone called angiotensin II, which narrows blood vessels. This stops the heart having to work so hard and improves the flow of blood around the body. Your blood pressure will be monitored while you are taking ACE inhibitors, and regular blood tests are needed to check the kidneys are working properly. Around one in ten people have kidney problems as a result of taking ACE inhibitors. You should not stop taking ACE inhibitors without consulting you doctor first. If you do, your symptoms are likely to get suddenly worse. The most common side effects of ACE inhibitors are a dry cough, dizziness and fainting.   ANGIOTENSIN II RECEPTOR ANTAGONISTS work in a similar way to ACE inhibitors. They are used to lower your blood pressure by limiting angiotensin, a hormone produced by the body that regulates blood pressure. Angiotensin II receptor antagonists have fewer side effects than ACE inhibitors – most commonly mild dizziness - so they may be prescribed for people who have a strong reaction to ACE inhibitors.   CARDIAC GLYCOSIDES (such as digoxin) strengthen and slow the heartbeat. By making the heart muscles contract (squeeze together) more strongly, blood is pushed around the body with more force. Cardiac glycosides are usually only taken in addition to other medication, such as ACE inhibitors and diuretics.   ANTI-ARRHYTHMIC DRUGS control the rhythm of your heart. They are most effective when exactly the right level is in your bloodstream, so it’s important to take them correctly.   CALCIUM CHANNEL BLOCKERS (e.g. Amlodopine) - These drugs reduce the amount of calcium entering the muscle cells of the arteries causing them to relax and widen resulting in a better blood flow to the heart and reducing the work the heart has to do. Calcium Channel Blockers are sometimes used to treat angina, often together with other drugs. They are also used to reduce high blood pressure.   NITRATES (e.g. Isosorbide Mononitrate) - Nitrates relax the muscles in the walls of arteries including the coronary arteries and make them wider. They are very useful in relieving angina pain and in preventing predictable attacks for example, prior to physical exertion. Isosorbide mononitrate is a slow release nitrate that works over a period of time but does not give immediate relief from angina pain. Glyceryl Trinitrate tablets or GTN spray is the normal method of relieving angina pain. The tablet is placed under the tongue and dissolves quickly. You do not swallow them as this makes them ineffective. The GTN spray is also sprayed under the tongue.   POTASSIUM CHANNEL ACTIVATORS (e.g. Nicorandil)- These have a similar effect to nitrates as they relax the walls of the arteries and so improve blood flow to the heart. Unlike Nitrates they do not appear to become less effective with continued use.   STATINS (e.g. Atorvastatin) - Blood Lipids is the name given to the fatty deposits in the blood including HDL and LDL Cholesterol. Statins are very effective in reducing these levels which if left lead to the furring up of the arteries. These are used if lifestyle and diet changes do not lower the cholesterol naturally.   ASPIRIN/ANTI-PLATELET/ANTI-COAGULANTS - These are used to prevent blood clots and reduces stickiness of blood platelets. Drugs include aspirin, clopidrogel, coumadin (warfarin) and several others. Anticoagulants stop the blood clotting. They may cause bleeding or make bleeding from cuts or during your period worse, so your GP may advise regular blood tests. It is a good idea to carry a card with you stating that you are taking anticoagulants. Warfarin is an import and often essential anti-coagulant that is in common use but has to be monitored with regular blood tests. Other medicines starting to be used may do the same job without the need for monitoring in the form of regular blood tests.   HORMONE REPLACEMENT THERAPY (HRT) was used for some years to prevent coronary heart disease and heart attack in women who had gone through menopause. Current evidence shows that HRT does not necessarily reduce the risk of heart attack and some women may have an increased risk of heart attack and stroke in the first year or two after starting treatment.   IN GENERAL: Coronary heart disease cannot be cured, but the condition can often be managed with medication and lifestyle changes to stop it getting worse. Regular use of appropriate drugs can improve the function of the heart and reduce the symptoms of coronary heart disease. It may take some time to get the right combination and amount of medication, as many of the drugs have side effects. Your GP or specialist will discuss this with you. We’ve said it before but we’ll say it again: Please remember to never stop taking any medication for your heart without first speaking to your doctor.   SURGERY AND OTHER PROCEDURES If the blood vessels are very narrow, or if symptoms cannot be controlled with drugs, then surgery may be needed to open up or replace blocked arteries. Taking our information mostly from about.com: A CORONARY ANGIOPLASTY operation is the most common treatment for coronary heart disease. An angioplasty opens up a blocked or narrowed coronary artery, allowing the blood supply to flow freely. A catheter (flexible tube) is inserted through the upper leg, groin or upper arm and threaded through to the coronary artery using a thin wire. A device like a small balloon is inserted into the artery and inflated until the artery is wide enough to allow a good blood supply. A STENT (a very fine wire gauze tube) is also inserted to keep the artery open. More than one stent can be used. The balloon is then deflated and taken out.   CORONARY ARTERY BYPASS This is the most common kind of heart surgery. You may also hear it called coronary artery bypass graft surgery (CABG), coronary artery bypass (CAB), coronary bypass, or bypass surgery. The surgery involves sewing a section of vein from the leg or arteries from the chest or another part of the body to bypass a part of a diseased coronary artery. This creates a new route for blood to flow, so that the heart muscle will get the oxygen-rich blood it needs to work properly. It may take 2-3 months or more to recover from, but can have extremely good (not to mention life-saving) results. During bypass surgery, the breastbone (sternum) is divided, the heart is stopped, and blood is sent through a heart-lung machine. Unlike other kinds of heart surgery, the chambers of the heart are not opened during bypass surgery. When you hear the words single bypass, double bypass, triple bypass, or quadruple bypass, it refers to the number of arteries that are bypassed. The number of bypasses does not necessarily indicate how severe the heart condition is.   VALVE REPAIR OR REPLACEMENT Blood is pumped through your heart in only one direction. Heart valves play key roles in this one-way blood flow, opening and closing with each heartbeat. Pressure changes behind and in front of the valves allow them to open their flap-like "doors" (called cusps or leaflets) at just the right time, then close them tightly to prevent a backflow of blood. Two of the most common kinds of valve problems that require surgery are: Stenosis, which means the leaflets do not open wide enough and only a small amount of blood can flow through the valve. Stenosis occurs when the leaflets thicken, stiffen, or fuse together. Surgery can either open the valve that is there or replace it with a new one. Regurgitation, which is also called insufficiency or incompetence, means that the valve does not close properly and blood leaks backward instead of moving   in the proper forward direction. Surgery is needed to either tighten or replace the valve. Surgical repair of a valve involves the surgeon rebuilding the valve so that it will work properly. Valve replacement means that the valve is replaced with a biological valve (made of animal or human tissue) or a mechanical valve (made from materials such as plastic, carbon, or metal).   ARRHYTHMIA SURGERY As we’ve discussed, any irregularity in your heart's natural rhythm is called an arrhythmia. Arrhythmias are usually treated first with medicines. Other treatments may include: <ul type="disc"> <li>Electrical cardioversion, where the cardiologist or surgeon uses paddles to "shock" the heart back into a normal rhythm. </li> </ul> <ul type="disc"> <li>Catheter ablation, where the cardiologist uses a special tool to destroy (ablate) the cells that are causing the arrhythmia. This is done in the cardiac catheterization laboratory (the cath lab). </li> </ul> <ul type="disc"> <li>Pacing and rhythm-control devices, including PACEMAKERS and implantable cardioverter defibrillators (ICDs).Patients can have these devices implanted while in the operating room or the cath lab.</li> </ul>   When these treatments do not work, surgery may be needed. One type of surgery is called MAZE SURGERY. In Maze surgery, surgeons create a "maze" of new electrical pathways to let electrical impulses travel easily through the heart. Maze surgery is used most often to treat Atrial fibrillation, the most common type of arrhythmia.   ANEURYSM REPAIR An aneurysm is a balloon-like bulge in a blood vessel or in the wall of the heart. An aneurysm occurs when the wall of a blood vessel or the heart becomes weakened. Pressure from the blood forces it to bulge outward, forming what you might think of as a blister. An aneurysm can often be repaired before it bursts. Surgery involves replacing the weakened section of blood vessel or heart with a patch or artificial tube (called a graft). Aneurysms in the wall of the heart occur most often in the lower-left chamber (called the left ventricle). These aneurysms are called left ventricular aneurysms, and they may develop after a heart attack. (A heart attack can weaken the wall of the left ventricle.) If a left ventricular aneurysm leads to an irregular heartbeat or to heart failure, the surgeon may perform open heart surgery to remove the damaged part of the wall.   TRANSMYOCARDIAL LASER REVASCULARIZATION (TMLR) Angina is the pain you feel when a diseased vessel in your heart (called a coronary artery) can no longer deliver enough blood to a part of the heart to meet its need for oxygen. Transmyocardial laser revascularization (TMLR) is a procedure that uses lasers to make channels in the heart muscle, in an attempt to allow blood to flow from a heart chamber directly into the heart muscle. If the blood flow is increased, more oxygen can reach the heart. This procedure is only done as a last resort. For example, TMLR may be done in patients who have had many coronary artery bypass operations and cannot have another bypass operation.   CAROTID ENDARTERECTOMY Carotid artery disease is a disease that affects the vessels leading to the head and brain. Like the heart, the brain's cells need a constant supply of oxygen-rich blood. This blood supply is delivered to the brain by the 2 large carotid arteries in the front of your neck and by 2 smaller vertebral arteries at the back of your neck. The right and left vertebral arteries come together at the base of the brain to form what is called the basilar artery. A stroke most often occurs when fatty plaque blocks the carotid arteries and the brain does not get enough oxygen. Carotid endarterectomy is the most common surgical treatment for carotid artery disease. Surgeons make an incision at the location of the blockage in the neck and a tube is inserted above and below the blockage to reroute blood flow. Surgeons can then remove the fatty plaque. A carotid endarterectomy can also be done by a technique that does not require blood flow to be rerouted. In this procedure, the surgeon stops the blood flow just long enough to peel the blockage away from the artery.   HEART TRANSPLANTATION The first heart transplants were performed in the late 1960s. With modern anti-rejection medicines it has become an established operation giving hope to a select group of patients who would otherwise die of heart failure. The need for a heart transplant can be traced to one of many heart problems, each of which causes damage to the heart muscle. The two most common heart problems are idiopathic cardiomyopathy (disease of the heart muscle without a known cause) and coronary artery disease (the buildup of plaque in the arteries of the heart). As the heart problem gets worse, the heart grows weaker and is less able to pump oxygen-rich blood to the rest of the body. Because the heart must work harder to pump blood through the body, it tries to make up for this extra work by becoming enlarged (hypertrophied). In time, the heart works so hard to pump blood that it may simply wear out, overcome by disease and unable to meet even the smallest pumping demands. Medicines, mechanical devices to assist the heart, and other therapies can sometimes help and even improve a patient's condition. But when those treatments fail, transplantation becomes the only option. Not all patients are suitable for a heart transplant, and there may be a long wait for a donor.   REHABILITATION Contact the British Heart Foundation, from whom we learn that: Cardiac rehabilitation programmes aim to restore confidence and benefit both heart patients and their families. These programmes feature three key areas - exercise, relaxation and information on lifestyle and treatment. The aim of a cardiac rehabilitation programme is to help you to recover and resume as full a life as quickly as possible after a cardiac event. It also aims to help promote your health and keep you well. Cardiac rehabilitation can be helpful if you have had a heart attack, a coronary angioplasty, or coronary artery bypass surgery. It can also be helpful if you have other conditions such as angina or heart failure. Ideally, cardiac rehabilitation should begin when you are admitted to hospital. In many hospitals a member of the cardiac rehabilitation team will see you on the ward to give you information about your condition and about the treatment you have had. Cardiac rehabilitation continues after you leave hospital. Some rehabilitation teams are able to telephone or visit you and can support you in the first few weeks at home. Cardiac rehabilitation programmes and services vary widely throughout the country. You can find details of the programmes that are available in the UK through the British Heart Foundation. You will need to be referred by your GP or cardiologist. We base much of our advice here on the American Heart Association’s website content. You’ll notice that almost all the information in this section, whatever the heart conditions, has some things in common. They’re mostly about lifestyle. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/h10.jpg" /></div> You may not want to change your lifestyle. It might not seem like an attractive or pleasant thing to do. You could be surprised. Those of us who have had to make drastic changes or suffer the consequences have in many cases had more fun as a result than we could ever have imagined. Yes, we do use the word FUN in talking about heart conditions and other serious problems. Much of what we’re dealing with is NOT FUN by any stretch of the imagination. Life and death are not, let us face it, usually a laugh a minute. The lifestyle changes you’ll need to make, however, can be challenging in the exciting sense and add unexpected enjoyment to your life. Lifestyle changes you’ll probably need to make include: EXERCISE - and let’s be clear that we mean the right forms of exercise for your specific condition. Your doctor or physiotherapist can advise. If you haven’t been exercising, are overweight, have a high risk of coronary heart disease or have some other chronic health problem, see your doctor for a medical evaluation before beginning a physical activity program. The American Heart Association advises that swimming, cycling, jogging, skiing, light aerobic workouts, dancing, walking (we highly recommend) or any of dozens of other activities can help your heart. These are appropriate when they cause you to feel warm, perspire and breathe heavily without being out of breath and without feeling any burning sensation in your muscles. We would add Tai Chi, Pilates Technique, Yoga, golf, or any of the other exercises available in our Useful Organisations sections. Choose something that is fun, something you enjoy and mostly look forward to, not a health-promoting chore. Try to make it a habit, but be flexible. If you miss an exercise opportunity, work activity into your day in another way. Don't overdo it. Do low to moderate-level activities, especially at first. Gradually increase the duration and intensity of your activities as you become more fit. Over time, work up to exercising on most days of the week for 30-60 minutes. STOP SMOKING - The American Heart Association’s Scientific Position advises that smoking is the most important preventable cause of premature death. Atherosclerosis (buildup of fatty substances in the arteries) is a chief contributor to the high number of deaths from smoking. Many studies detail the evidence that smoking is a major cause of coronary heart disease, which leads to heart attack. Smoking, high blood cholesterol, high blood pressure, physical inactivity, obesity and diabetes are the six major independent risk factors for coronary heart disease that you can modify or control. Smoking increases the risk of coronary heart disease by itself. When it acts with other factors, it greatly increases risk. Smoking increases blood pressure, decreases exercise tolerance and increases the tendency for blood to clot. Smoking also increases the risk of recurrent coronary heart disease after bypass surgery. Smoking decreases HDL (good) cholesterol. Smoking combined with a family history of heart disease seems to greatly increase risk. Smoking also creates a higher risk for peripheral arterial disease and aortic aneurysm.   DIET and CONTROLLING YOUR WEIGHT - A weight-loss diet can be a necessary kick-start, but for long term weight control a combination of exercise and a pleasantly healthy diet will deliver far more positive results for your heart and general health, The British Heart Foundation is our source for much of the following. They say that a healthy diet and keeping physically active can both reduce the risk of developing heart disease and increase chances of survival after a heart attack. What you eat and drink can protect you in many ways, including: reducing the strain on your heart from unhealthy body weight lowering your blood cholesterol level keeping your blood pressure down preventing atheroma (fatty buildup) inside your arteries preventing blood clots forming. The BHF advises that a healthy diet contains plenty of fruit and vegetables and starchy foods such as wholegrain bread, pasta and rice; and is low in fat (especially saturated fat), salt and sugar. There is good evidence that eating a diet that is rich in a range of vegetables and fruits lowers the risk of heart disease. As most of us know but not enough of us do, the idea is to eat at least 5 portions each day. They can be fresh, frozen, dried or tinned. Reducing the total amount of fat you eat can help to reduce your blood cholesterol level. Too much saturated fat from fatty meats, biscuits, cakes and full fat dairy products can clog up your arteries and put a strain on your heart. Eating oily fish regularly can help to reduce the risk of heart disease and improve the chances of survival after a heart attack. The omega 3 fatty acids found in oily fish may keep the heartbeat regular, reduce triglyceride levels (these are fatty substances found in the blood), and prevent blood clots from forming in the coronary arteries. Reducing the amount of salt you eat can be an important factor in keeping your blood pressure down. Some margarines claim to help lower cholesterol, and surprisingly enough this seems to be true to some degree.  Too much alcohol can damage the heart muscle, increase blood pressure and also lead to weight gain. The good news, however, is that moderate drinking (the BHF suggests between 1 and 2 units of alcohol a day) can help protect the heart in men aged over 40 and women who have gone through the menopause. Check the British Heart Foundation’s website and publications for more on healthy eating, or see our Helpful Organisations section. SEX AND HEART DISEASE - Sex? Good. You may have very legitimate concerns about possible limitations or problems if you have coronary heart disease, heart surgery or some other heart event. The British Heart Foundation can deal with your concerns. No need to feel embarrassed, as you can get their DVD’s and videos to give you the knowledge and security you need. HIGH BLOOD PRESSURE (hypertension) requires the very same lifestyle changes as for heart conditions above. These changes will help to reduce your risk of developing the condition in the first place or to treat hypertension. If your blood pressure requires medical treatment, you will probably have to take medicine on a regular basis. If so, never stop taking it without consulting your GP, even if you feel fine. Hypertension can lead to serious complications if left untreated. Without treatment, life expectancy may well be reduced due to the risk of developing complications such as heart failure or stroke. By treating hypertension well, complications can be avoided and average life expectancy will remain almost normal. WATCH OUT FOR HIGH CHOLESTEROL Cholesterol is an important and necessary substance. It's the starting point of manufacture for many of the body’s natural steroid hormones and for vitamin D, which controls calcium in the body. It is also an essential component of the membrane that forms the walls of individual cells in all tissues. Eighty per cent of the cholesterol we have is produced within our own body – mostly by the liver. It's then transported from the liver via the blood stream to other tissues. Cholesterol travels through the blood in minute packages mixed with large molecules called lipoproteins. Lipoproteins are themselves combinations of fats and proteins. High density lipoproteins (HDL) mop up excess cholesterol in the body and return it to the liver for re-processing. HDL is often called good cholesterol and raised amounts give protection against heart disease. Exercise raises HDL levels, as does modest alcohol intake. Low density lipoproteins (LDL) transport cholesterol from the liver to be deposited elsewhere in the body. LDL is known as bad cholesterol because it deposits cholesterol in the lining of your arteries. The more LDL you have, the more likely you are to develop heart disease. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/h11.jpg" /></div> Cholesterol levels don't tend to fluctuate, so if you have a normal level it doesn't need to be measured again for many years. If it is high, it may need quite frequent re-testing to gauge the effect of treatment. Measurements are done of your: <ul type="disc"> <li>Total cholesterol, which is all the subtypes combined. If this is high and you smoke, are overweight or have high blood pressure you will reduce your cardiovascular risk quite a lot by getting your cholesterol down. </li> </ul> <ul type="disc"> <li>HDL (good) cholesterol. If your HDL is high your risk is lowered.</li> </ul> <ul type="disc"> <li>LDL (bad) cholesterol. If this is high, and most especially if you have diabetes, it needs dealing with. A healthy diet can help, but most people will also need cholesterol-lowering drug treatment. </li> </ul>   SUPPLEMENTS, SNAKE-OILS AND DIETS Check Medline Plus or BBC Health in our First Resourcessectionto learn more about any supplement which interests you, and please tell your doctor what you are taking. Remember that even quite legitimate herbal or alternative medications/supplements can have very bad interactions with your medication or be dangerous for your particular circumstances.   OMEGA 3 fatty acids and FISH OILS Overall, a number of studies offer evidence to support the hypothesis that fish, fish oil, or ALA (alpha linolenic acid) supplement consumption reduces mortality from cardiovascular illness and various cardiovascular disease outcomes, although the evidence is strongest for fish or fish oil.   VITAMIN E A report published in the March 16, 2005 issue of the Journal of the American Medical Association showed that those taking vitamin E supplements had a 13 percent increased risk of heart failure.This report comes from a clinical trial called the Heart Outcomes Prevention Evaluation Study Extension   HAWTHORNE (Crataegus) An ancient remedy for heart conditions. The US National Center for Complementary and Alternative Medicine (NCCAM) website tells us that currently hawthorn leaf and flower are used for heart failure and for symptoms of coronary artery disease (such as angina). The leaf and flower are used to make liquid extracts, usually with water and alcohol. Dry extracts can be put into capsules and tablets. The NCCAM says there is scientific evidence that hawthorn leaf and flower are safe and effective for milder forms of heart failure. There is not enough scientific evidence to determine whether hawthorn works for other heart problems. In terms of Side Effects and Cautions, the NCCAM tell us that Hawthorn is considered safe for most adults when used for short periods of time. Side effects are usually mild and can include upset stomach, headache, and dizziness. Drug interactions with hawthorn have not been thoroughly studied. It was once thought that hawthorn interacted with the heart medicine digoxin. However, a very small study in people without heart conditions found no interaction, but evidence is limited.   FLAXSEED (FLAXSEED OIL, LINSEED) Again using the NCCAM as reference: Flaxseed is most commonly used as a laxative. It has also been used for hot flashes and breast pain, arthritis and other conditions. It’s available in powder liquid and capsule form. Both flaxseed and flaxseed oil have been used for high cholesterol level. Studies of flaxseed preparations to lower cholesterol levels report mixed results. Some studies suggest that alpha-linolenic acid (a substance found in flaxseed and flaxseed oil) may benefit people with heart disease. So far there is not enough reliable data available to determine whether flaxseed is effective for heart conditions. Side Effects and Cautions include possible digestive problems (it should always be taken with plenty of water. The fibre in flaxseed may lower the body's ability to absorb medications that are taken by mouth. Flaxseed should not be taken at the same time as any conventional oral medications or other dietary supplements.   GARLIC (Allium sativum) NCCAM says garlic's most common uses as a dietary supplement are for high cholesterol, heart disease, and high blood pressure. It can be eaten raw or cooked. It can also be dried or powdered and used in tablets and capsules. Raw garlic cloves can be used to make oils and liquid extracts. Preliminary research suggests that taking garlic may slow the development of atherosclerosis (hardening of the arteries) - [our emphasis], a condition that can lead to heart disease or stroke. Evidence is mixed on whether taking garlic can slightly lower blood pressure. Some evidence indicates that taking garlic can slightly lower blood cholesterol levels; studies have shown positive effects for short-term (1 to 3 months) use. However, an NCCAM-funded study on the safety and effectiveness of three garlic preparations (fresh garlic, dried powdered garlic tablets, and aged garlic extract tablets) for lowering blood cholesterol levels found no effect. Side Effects and Cautions: NCCAM says that garlic appears to be safe for most adults. Side effects include breath and body odor, heartburn, upset stomach, and allergic reactions. These side effects are more common with raw garlic.   Garlic can thin the blood (reduce the ability of blood to clot) in a manner similar to aspirin. This effect may be a problem during or after surgery. Use garlic with caution if you are planning to have surgery or dental work, or if you have a bleeding disorder [our emphasis]. A cautious approach is to avoid garlic in your diet or as a supplement for at least 1 week before surgery. ANTIOXIDANTS: The American Heart Association reviewed 20 separate clinical trials that examined whether taking antioxidant supplements (specifically, vitamin E, beta-carotene, antioxidant cocktails, or the combination of vitamins E and C) would reduce the risk of cardiovascular disease. They found no proven positive effect. Other studies have suggested that antioxidant supplements can actually be harmful to people with heart conditions. We’re talking here about antioxidants as vitamins/suppements you buy, not the naturally occurring ones in a healthy diet. Check any vitamins/supplements you’re using with your doctor, or at least with Medline Plus (see our First Resources section). Go carefully and don’t buy the promotional claims. CHELATION THERAPY - The American Heart Association has reviewed the available literature on using chelation (E.D.T.A. - ethylenediamine tetraacetic acid) to treat arteriosclerotic heart disease. They found no scientific evidence to demonstrate any benefit from this form of therapy. A very big study is underway to determine whether chelation therapy is safe and effective for people with coronary heart disease. See MedlinePlus in First Resources for more on what this is and how it is claimed to work. If people use chelation therapy and it doesn’t work, they may be deprived of the well-established benefits from the many other valuable methods of treating these diseases, such as lifestyle modifications, medications and surgical procedures. VIAGRA: the BBC website has a news story saying that Viagra could provide effective treatment for Pulmonary Hypertension, or high blood pressure in the arteries of the lungs. The research was published in Circulation, the journal of the American Heart Association. Needless to say you could harm yourself disastrously by self-medicating with Viagra for a circulation problem. We mention the research as interesting only. MIRACLE DIETS: There aren’t any, unless you consider a healthy, balanced Mediterranean style diet miraculous. Anyone who tell you that several weeks subsisting on brown rice or any other single food or wildly limited selection of foods should be treated with extreme caution. See our Useful Organisations section for sources of good dietary advice.   COMPLEMENTARY THERAPIES / ALTERNATIVE MEDICINE (CAM) The National Centre for Complementary and Alternative Medicine (NCCAM) in the USA is one of a few goldmines for learning about best practice in helping yourself with these therapies. You’ll find the ones we think most helpful in our Useful Organisations section. The following is some good and very necessary advice from the NCCAM about complementary and alternative medicine and heart conditions: Heart patients, do you tell your doctor you’re using alternative medicines? Doctors, do you ask your patients if they’re using alternative medicines? According to the Medical Dictionary Online, alternative therapies are practices which are not currently considered an integral part of conventional medical practice and are used instead of conventional treatment. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/h12.jpg" /></div> As the use of alternative medicines increases, physicians must be more active in determining what their heart patients should take and educating them on the risks, according to new research reported at the American Heart Association’s Scientific Sessions 2005. “Depending on the alternative medication, there can be life-threatening interactions with prescribed cardiac medications,” said Beth Abramson, M.D., F.R.C.P., F.A.C.C., lead author of the study and director of the Cardiac Prevention Center at St. Michael’s Hospital in Toronto. “What is striking is the number of heart patients taking these types of medications and not talking to their doctors about it,” she said. “Some of these patients are on multiple prescribed heart medications.” Abramson, an assistant professor of medicine at the University of Toronto, advises heart patients to give their doctors a list of the complementary or alternative medicines they are taking [our emphasis]. “There are specific interactions with cardiac drugs that could make alternative medicines dangerous,” Abramson said. “Patients are hearing about these alternative therapies from the lay press and friends. No doubt, in the time of instantaneous information on the Internet, patients must be cautious where they gather their information.” For example, certain herbal preparations interfere with cardiac drugs. Hawthorne berries may be dangerous to heart patients on prescribed drugs. Medications containing liquorice affect high blood pressure. St. John’s wart interferes with levels of heart drugs such as digoxin and warfarin. “Unfortunately many patients believe that if something is natural, then it’s safe. But many of these alternative medicines are not regulated, aren’t necessarily safe and many have not been proven effective.”   These cautions may seem obvious, but the Alliance would ask its members to please tell your doctors about any CAM you are trying. Having said this, we go on with the NCCAM to appreciate that there are many and very real benefits to be had from CAM. Their description of The Science of Mind-Body Medicine, only slightly edited by us, tells us that: These practices form a small part of a large domain (area of knowledge) of CAM: mind-body medicine, which involves the interaction of mind, brain, other body systems, behaviour, and, ultimately, health and disease. Some examples of other mind-body practices include prayer, relaxation techniques, hypnosis, various forms of meditation, yoga, and tai chi. Mind-body medicine is one of NCCAM's current research priorities. Through this research, the Center seeks to discover means for enhancing and accelerating the healing process beyond the effects of conventional medicine; preventing, treating, and slowing the progression of diseases and disorders; reducing the burden of stress-related chronic illnesses; and enhancing people's resilience and coping--all toward improving public health and well-being. Many mind-body techniques date back to ancient times. In recent years, science has found evidence that patients faced with chronic and even terminal illnesses--particularly conditions like heart disease and cancer--can learn and utilize a variety of mind-body practices to achieve symptom relief, a better quality of life, and, in some cases, improvements in health outcomes [our emphasis]. Techniques the NCCAM refer to include: TAI CHI: Chronic heart failure, a condition in which the heart cannot pump enough oxygen throughout the body, impairs the health of millions of adults. Studies show that low-intensity exercise can be helpful. Led by Harvard Medical School's Gloria Yeh, M.D., researchers there and at the New England School of Acupuncture carried out a randomized controlled trial of tai chi… in people with heart failure. The control group received standard care for heart failure. The tai chi group received both standard care and 12 weeks of tai chi training. The tai chi group had significant improvements in physical condition, heart function, and quality of life; the control group did not. The report (American Journal of Medicine, October 15, 2004) notes that tai chi may be a useful addition to standard heart failure treatment. MEDITATION - Meditation has been shown to be helpful in dealing with life in general and in particular to deal with health problems including: Anxiety Pain Depression Mood and self-esteem problems Insomnia Fear of death Stress   Stress Reduction as a general objective may almost seem to obvious to mention, but few of us do anything very effective about it. Stress is not doing your heart any good, it seriously needs taking down with regard to hypertension, and in general it’s not good for your health. Life is stressful, and there’s no avoiding it. What you can do is learn techniques to deal with and reduce stress, and to not create more stress in your life than you have to. Meditation, relaxation techniques, counselling/psychotherapy, prayer, dancing, exercise, massage, Tai Chi, yoga or other calming and controlled movement classes, any of the other complementary therapies and techniques, going for a walk in the park… look at our list of techniques below and see our Useful Organisations section for ideas and options. Your local authority, sports or community centre and library are also good resources to find things which might work and make sense for you.   COMPLEMENTARY TECHNIQUES, or “mind-body” techniques as the NCCAM very accurately calls them, offer a wide variety of options which may help improve your condition, and your quality and enjoyment of life. We list and describe some of the better known ones here for overview purposes. Look in Useful Organisations to get more on any of these or others. Acupuncture - Well known Chinese therapy using fine needles to change energy flows. Evidence of effectiveness in dealing with pain and other problems, at least short term. High level qualified practitioner essential. Acupressure - Same principles as acupuncture, using pressure instead of needles. You can learn to do some acupressure therapy on yourself. Alexander Technique - Technique for learning how to efficiently and effortlessly use your body. Simple but profound approach to letting go of harmful tensions in posture and breathing. A safe and effective learning and therapy technique. It doesn’t sound like much, but it’s a liberating technique on many levels and a good basis for all physical activity from sports to making a cup of tea. Aromatherapy - The art of applying essential oils to suit individual needs. The oils work directly on the chemistry of the body, via the skin and bloodstream. May seem unlikely, but a number of medical sites assure us that it can be surprisingly effective and safe. Art Therapy - Use of art for emotional therapy. Early evidence of effectiveness was with survivors returning from World War 2. Healing and health are strongly affected by emotion, so makes sense. Ayurveda - The most important form of medicine in India. An ancient tradition, but most practitioners are also doctors or otherwise medically qualified. Ayurveda seeks to balance the body and mind, find health problems before they occur or stop them doing unnecessary harm. Obviously requires a qualified practitioner and is complementary to, not a replacement for conventional medical treatment. Biofeedback - Machines give you feedback about how your body is working, allowing you to learn to regulate reactions causing problems. Evidence of usefulness for therapy and self-education for many conditions. Find out what your body’s up to, and work with it. Bowen Technique - soft and non-invasive holistic treatment that aims to restore balance to the body by using small, gentle moves to specific areas of the body. Because the therapy is so gentle, it is considered to be suitable for all ages. May be helpful for many pain and stress related problems. Chiropractic - Manipulation of spine and muscles for good balancing and health functioning. A powerful technique and NOT to be used for many conditions. Check with your doctor, and see Useful Organisations for help finding a qualified and registered practitioner. Cognitive and Behaviour Therapies - Put crudely: It’s not what happens that causes the problems, it’s how you understand it and what you do with it. Less crudely, these have medical and government recognition for a wide variety of problems and can be startlingly effective in many cases. Many of us who they have helped consider them to be most remarkable life tools. Feldenkrais Method - Not a therapy as such, but a well established method for learning greater ease of physical movement and increasing vitality and well-being. Guided Imagery - The use of imagination as potent healer. Pleasant and powerful. See “Holistic Online” in Useful Organisations to learn more. Healing - comes in many forms, from spiritual or religious to using energy flow as understood in martial arts. Whether the effectiveness is due to a placebo effect, energy flows or spirit, many people have been helped by healings throughout history. Hellerwork - deep tissue massage that unblocks the body, movement education to correct postural alignment, and verbal dialogue to assess emotional holding patterns. Caution for conditions where deep massage contraindicated. Check carefully with your doctor before using any deep massage technique. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/h13.jpg" /></div> Herbal medicine - Herbal medicines can be very powerful, and are the basis of many conventional drugs. A good herbal practitioner looks at the whole person and health, not just the disease or condition. Because they can be very strong and conflict with prescribed medications, you absolutely need to tell your doctor what you’re going to be taking. A herbal remedy can destroy your therapy and health if it’s the wrong one for you.  Homoeopathy - famous and controversial. Vanishingly small amounts of a substance in water are given. Many in medical science consider this to be absurd. No conclusive proof either way, but many people have found help and relief. Hard to argue with happy patients, and it has the great virtue of being harmless. That said, neglecting medical treatment to depend on homeopathy is an enormous mistake, as your qualified homeopath will agree. Hypnotherapy - not in any way a frightening experience or loss of consciousness or control, safe in qualified hands, and considered very effective in helping with anxiety, pain, depression, destructive life-style and other condition related problems. Louise Hay techniques - based on the use of positive affirmations - highly recommended by many people for effectively changing your mindset and health. A place to start is the Louise Hay book “You Can Change Your Life” and audio tapes from Amazon. As we keep saying throughout this website, mindset can profoundly affect healing. Massage Therapy - There are many forms of massage, and they can be a great help in stress reduction, release of chronic muscle tensions around arthritis, and can have many other therapeutic effects depending on the technique used. Having your body cared for like this is great, but: be aware that deep or powerful massage pressure can be dangerous for some conditions. Check with your doctor or physio about what to avoid. It is important that your therapist asks what your medical / physical situation is. If they are not qualified, or you are not comfortable, you are in the wrong hands. Don’t risk damage. Move on. Medau Movement - Enjoyable exercise to music for improving body use and posture, and good for stress reduction. Meditation - A truly profound way to deal with stress and the human condition. Good meditation teaching is simple, and the result should be access to peace and stillness whatever is happening and wherever you are - at home, on the street, at work… We give contacts for meditation in Useful Organisations. We’ve recommended the approach of the Shollond Trust as it’s fast, free, and a good starting place for appreciating all forms of meditation. We also like BBC Health and the H2G2 recommendations about meditation. Naturopathy - Technique for helping the body to heal itself, and often incorporates a number of the other techniques discussed here. Interesting to have one technique using the strengths of others. In capable hands this can be a very effective option. NLP (Neuro-linguistic Programming) - A fascinating form of therapy, looking at how you do what you do, and how to change. We like this sentence from a practitioner: “If you always do what you've always done, you'll always get what you've always got. If what you're doing isn't working, do something else". Far more to it than that of course, and worth learning about as a strong tool for problem solving. Osteopathy - Certainly among the best known physical therapies and very well accepted as a complementary therapy. Osteopathy is highly regulated. Physical manipulation and massage techniques are used to help correct problems with the muscles, bones, and joints and influence many of the body’s systems. A good practitioner will ask in detail about your condition to not do harm with inappropriate manipulations. Practitioner must be qualified, registered, and take a medical history to understand what your condition is. Pilates - Exercise method to method to strengthen the core postural muscles and develop balanced alignment through the use of slow, controlled movements and breathing. Often recommended by doctors, physiotherapists, and used by everyone from top professional athletes and dancers to people who have never done much exercise or thought they were unable to due to physical limitations. A great way to do exercise carefully and well. Teacher must understand your condition. Psychology of Mind - The book “Slowing Down to the Speed of Life” from Amazon is the well known place to start. POM techniques and understandings are simple and can be life changing. A way to use your problems to vastly improve your life. For the anxieties associated with illness (not to mention life) this is something special. Psychotherapy - Many forms, and a vital and immensely beneficial approach for many people. The idea that psychotherapy is for crazies couldn’t be more wrong. It’s one of the best learning and healing tools and most interesting things you could choose to do. Practitioners must be qualified, and you have to find one you feel comfortable with and helped by. For the anxiety and emotional problems of chronic conditions, including the chronic condition of being human, a good one. Reiki Healing - A Japanese form of healing through energy flow and which, interestingly, is also concerned with living in harmony with others, taking responsibility for one's own health and happiness, helping others, and being positive about all things. Shiatsu - Traditional Japanese physical therapy, using a range of techniques from gentle touch to more dynamic work to improve specific conditions and general health. A qualified practitioner will take a detailed history from you and avoid more dynamic techniques where they might be contra-indicated for your condition. Check with your doctor or physiotherapist before trying. Tai Chi - A soft, gentle and very powerful Chinese martial art, movement meditation, and way of healing through movement. Tai Chi works very well for older and ill people. It helps to free and balance the body, breathing and movement, and to find calm, stability, peace and deep security. If you have serious problems with feet, knees or walking it may not work for you. If that’s the case the exercises of Qigong (or Chi Kung) use the same principles but can be done sitting as well as standing. Tai Chi is a way to contact deep reserves of strength and ease. Trager Work - A form of bodywork and movement which utilises gentle, rhythmic movements to facilitate the release of stress patterns - physical, mental, and emotional. Created by a doctor and physiotherapist working with his own chronic pain since childhood, this method also has a meditation aspect. Yoga - The ancient Indian system of postures, exercises, breathing, and body and mind development and control. Popular and widely available these days. The basic exercises of Hatha Yoga, taught with careful respect for your physical problems and limitations, are a good place to start, along with pranayam breathing exercises. There are also some extremely challenging physical styles of yoga which may not be not at all appropriate. BE SURE your teacher knows what your physical problems are, and that your doctor has no problem with your doing yoga. That said, it is a wonderful combination of calm body, mind and spirit training and self-help therapy.   GENERAL HELP WITH HEART RELATED PROBLEMS If in doubt or unable to find the information you need, talk to the British Heart Foundation, Heart UK, and as always Help The Aged and Age Concern (see our First Resources section). You can speak to people at these organisations, not just read websites. Heart Conditions

2009-04-28T04:02:32-07:00

THE BRITISH HEART FOUNDATION www.bhf.org.uk main telephone number: 020 7935 0185 Heart Information Line: 08450 70 80 70 (open Mon, Tues, Fri 9am-5pm and Weds, Thurs 8am-6pm) A wide range of advice and information. The British Heart Foundation focuses on Investing in pioneering research and supporting and caring for heart patients. BHF Nurses visit heart patients with all types of heart conditions in their homes. BHF also provide defibrillators and echocardiograph machines for hospitals, emergency services and first-aiders. They provide vital information to help people reduce their own risk of dying prematurely from a heart or circulatory related illness HEART UK Tel: 0845 450 5988 Website: www.heartuk.org.uk National charity for patients and their families combining research science and the caring and knowledgeable attention of doctors, nurses and dieticians, in order to support all those at risk of inherited high cholesterol and cardiovascular disease. CHEST, HEART AND STROKE SCOTLAND www.chss.org.uk Telephone 0845 077 6000 THE AMERICAN HEART ASSOCIATION www.americanheart.org Comprehensive information to help understand your condition. THE NATIONAL HEART LUNG AND BLOOD INSTITUTE www.nhlbi.nih.gov Authoritative US government health information, written in plain language, on diseases, conditions, and procedures related to Heart diseases, Lung diseases, Blood diseases and Sleep disorders. Easy to find factual information. LIFEBLOOD www.thrombosis-charity.org.uk For causes, effects, treatment and prevention of thrombosis   FOR IMMEDIATE HELP WITH HEALTH QUESTIONS and GENERAL MEDICAL INFORMATION: See our FIRST RESOURCES section - especially MedlinePlus ( http://medlineplus.gov ) BBC Health ( www.bbc.co.uk/health ), the Mayo Clinic (www.mayoclinic.com ) and: MEDICINENET.COM www.medicinenet.com For a general guide and information base on any subject this is an excellent resource. NETDOCTOR www.netdoctor.co.uk Attempts to break down the "medical language barrier" between the doctor and the patient. Critical medical information presented in a clear and understandable language so that the patient fully understands his or her choices and decisions. THE COCHRANE REVIEWS (www.cochrane.org) The Cochrane Collaboration assesses most areas of health care. To do this, it is divided into Cochrane Review Groups, each of which concentrates on a specific healthcare area, including a Consumer Network that represents the interests of healthcare consumers. Type any condition into their website and get pretty comprehensive information. If you want clear scientific analysis of any health issue or practice, you’ll usually find it here. BANDOLIER: THE OXFORD MEDICAL SITE http://www.jr2.ox.ac.uk/bandolier/index.html Bandolier is a journal of evidence-based medicine. Look up any subject for links and knowledge. Their “Healthy Livig Zone” is a bit of a goldmine on the subject. MERCK MEDICUS www.merckmedicus.com Easy to use and the US doctor’s reference tool. See MERCK GERIATRIC for age related information. FOR ANCILLARY MEDICAL THERAPIES (Physiotherapy etc): HEALTH PROFESSIONS COUNCIL www.hpc-uk.org Telephone 020 7582 0866 The HPC is a statutory regulator that works to protect the health and well-being of people using the services of health professionals. Find therapists and be sure they are approved / regulated practitioners. CHARTERED SOCIETY OF PHYSIOTHERAPY www.csp.org.uk Tel: 020 7306 6218 / 6666 Information on physiotherpaists, physiotherapy and how it can help with pain. THE ORGANISATION OF CHARTERED PHYSIOTHERAPISTS IN PRIVATE PRACTICE www.physiofirst.org.uk Tel: 01327 354441 Details of private chartered physiotherapists in your area. OCCUPATIONAL THERAPISTS IN INDEPENDENT PRACTICE (OTIP) www.otipp.co.uk Tel: 0800 389 4873 Information and find an occupational therapist FOR COMPLEMENTARY AND ALTERNATIVE THERAPIES: THE COMPLIMENTARY HEALTHCARE INFORMATION SERVICE www.chisuk.org.uk Easy reference to learn about any and (just about all) complementary techniques. A truly excellent way to learn what the main comlementary techniques are, how they might work for you, and to explore the subject THE NETDOCTOR DR FOSTER COMPLEMENTARY PRACTITIONER DIRECTORY http://netdoctorcomplementarytherapistguide.drfoster.co.uk If you are looking to find a reliable complementary therapy practitioner in your area, this directory is an essential resource. It can help you find a practitioner who meets your needs. This might be someone who has a particular interest in your condition, or who works at a practice near to your home, at hours that suit your needs. THE BRITISH COMPLEMENTARY MEDICINE ASSOCIATION www.bcma.co.uk Tel 0845 345 5977 Find qualified practitioners of most therapies, learn about therapies, get recognised guidance through the therapy minefield and find a therapist near you. WHOLE HEALTH MD www.wholehealthmd.com American WholeHealth Networks' Complementary and Alternative Medicine (CAM) education website. The site is dedicated to providing integrative health and wellness solutions by combining the resources of both scientific health research and CAM. Click on specific health issues for information on conventional medicine, alternative therapies, supplements, diet, lifestyle options, and much more. HOLISTIC ONLINE www.holisticonline.com Comprehensive site for Alternative and Integrative Medicine. Learn about conditions and treatments. INSTITUTE FOR COMPLEMENTARY MEDICINE www.i-c-m.org.uk The ICM is a UK registered charity providing information on all aspects of the safe and best practice of Complementary Medicine. THE NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE http://nccim.nch.gov Vital and reputable information for the States. A treasure for understanding what’s what. THE ALTERNATIVE MEDICINE FOUNDATION www.amfoundation.org Excellent US site, good clear information. They also recommend: ALTERNATIVE MEDICINE RESOURCE www.altmedresource.com comprehensive and searchable catalog of all alternative medicine studies. Easy search by looking up your condition(s) or a key word.   FOR COMPLEMENTARY PRACTICTIONERS’ ASSOCIATIONS GENERAL OSTEOPATHIC COUNCIL www.osteopathy.org.uk Tel: 020 7357 6655 Provides details of qualified local osteopaths. BRITISH CHIROPRACTIC ASSOCIATION www.chiropractic-uk.co.uk Tel: 0118 950 5950 Information on chiropractic and details of local chiropractors. GENERAL CHIROPRACTIC COUNCIL www.gcc-uk.org Tel: 020 7713 5155 Provides details of local chiropractors and information on what to expect when you see a chiropractor. It can also help if you've experienced a problem with a chiropractor. THE SOCIETY OF CHIROPODISTS AND PODIATRISTS www.feetforlife.org Telephone 020 7234 8620 GENERAL COUNCIL FOR MASSAGE THERAPY www.gcmt-uk.org Telephone 01992 537637 New voluntary regulation body for practitioners of massage. INTERNATIONAL FEDERATION OF AROMATHERAPISTS www.ifaroma.org Telephone 020 8992 9605 MUSIC THERAPY: see HEALTH PROFESSIONS COUNCIL above - www.hpcuk.org Telephone 020 7582 0866 THE BRITISH MEDICAL ACUPUNCTURE SOCIETY www.medical-acupuncture.co.uk Telephone 01925 730727 Medical doctors who practice acupuncture. Encourages the use and scientific understanding of acupuncture within medicine for the public benefit. ACUPUNCTURE ASSOCIATION OF CHARTERED PHYSIOTHERAPISTS www.longbo.demon.co.uk/aacp.html Tel 01747 861151 Contact the AACP Secretariat for a register of members - qualified phyisos working with acupuncture. BRITISH ACUPUNCTURE COUNCIL www.acupuncture.org.uk Tel: 020 8735 0400 Provides information on acupuncture and details of qualified traditional acupuncturists in your area. Phone or enclose an SAE for more information. NATIONAL INSTITUTE OF MEDICAL HERBALISTS www.nimh.org.uk Telephone 01392 426022 Email nimh@ukexeter.freeserve.co.uk Professional body - offers a service for you to find a trained and qualified herbalist. FOR DIET ADVICE: BRITISH NUTRITION FOUNDATION www.nutrition.org.uk Telephone 0207 404 6504 Includes advice on finding a dietician BRITISH DIETETIC ASSOCIATION www.bda.uk.com FOOD STANDARDS AGENCY www.eatwell.gov.uk BBC HEALTH www.bbc.co.uk/health/healthy_living/nutrition NHS DIRECT www.nhsdirect.nhs.uk/encyclopaedia FOR MEDITATION: THE SHOLLOND TRUST www.headless.org tel. 020 8806 3710 - Richard Lang, Trust Co-ordinator The Trust offers a form of meditation you can do any time, any place, in any circumstances. It’s astoundingly easy to do, and it’s free. It’s also a great way to get the best out of and appreciate all other meditation and complementary techniques. THE BBC www.bbc.co.uk and search “meditation”. A wide range of options. THE HITCHHIKER’S GUIDE TO THE GALAXY www.bbc.co.uk/dna/h2g2 Ask the guide about meditation. In fact ask it about any question you have. FOR COUNSELLING: BRITISH ASSOCIATION FOR COUNSELLING AND PSYCHOTHERAPY (BACP) www.bacp.co.uk Telephone 0870 443 5252 Email bacp@bacp.co.uk A fisrt reference for anyone seeking information on counselling and psychotherapy in the United Kingdom. They have a helpful and easy to use search tool to find a therapist. THE SAMARITANS www.samaritans.org Telephone 08457 90 90 90 (24 hours, seven days a week) Email jo@samaritans.org Confidential non-judgemental support, 24 hours a day for people experiencing feelings of distress or despair. MIND www.mind.org.uk Telephone 020 8519 2122 Mind Infoline 0845 766 0163 (Monday-Friday 9:15-5:15) Email contact@mind.org.uk The MindinfoLine offers confidential help on a range of mental health issues from anywhere in the UK for the price of a local call. Local MIND associations offer supported housing, crisis helplines, drop-in centres, counselling, befriending, advocacy, employment and training schemes and other services. RELATE www.relate.org.uk Tel. 0845 456 1310 or 01788 573241 Relate is the UK's largest provider of relationship counselling and sex therapy. They also offer a range of other relationship support services. CRUSE BEREAVEMENT CARE www.crusebereavementcare.org.uk Day-to-day helpline: 0870 167 1677 Help for bereaved people, whatever their age, nationality or beliefs, including a free counselling service.   FOR CARE SERVICES: COUNSEL AND CARE www.counselandcare.org.uk Advice line 0845 300 7585 (weekdays 10am-12.30pm and 2pm-4pm) A national charity getting the best care and support for older people, their families and carers SUE RYDER CARE www.suerydercare.org 020 7400 0440 Cares for people with life-shortening illnesses through specialist hospice care services. THE PRINCESS ROYAL TRUST FOR CARERS www.carers.org Telephone 020 7480 7788 Email help@carers.org The trust is the largest provider of comprehensive carers support services in the UK. CARERS UK www.carersuk.org Free Carers Line 0808 808 7777 (weekdays 10am-12pm and 2pm-4pm) Email info@ukcarers.org Carers UK is the voice of carers and the leading campaigning, policy and information organisation for carers. Provides information and advice on topics relating to caring. CARERS NATIONAL ASSOCIATION www.carersuk.org Provides information and advice for carers and works for carers rights. CROSSROADS (The Association of Crossroads Care Attendant Schemes) www.crossroads.org.uk Tel: 0845 450 0350 Practical support for carers; respite care at home. Provides trained care support workers to allow carers the breaks and time off they need. CARE CHOICES LTD www.careselect.co.uk Tel: 0800 389 2077 Care Choices Ltd offers a free residential/care home search service. The company has a database of care homes, nursing homes, elderly accommodation and similar establishments throughout the UK. HOSPICE INFORMATION www.hospiceinformation.info Tel: 0870 903 3903 Publishes a directory of hospice and palliative care services.   FOR GENERAL UK HEALTH HELP, ISSUES and the NHS: NHS DIRECT ( www.nhsdirect.nhs.uk ) - see First Resources PATIENTS ASSOCIATION www.patients-association.com Helpline: 0845 608 4455 Represents the views and interests of patients and campaigns for improved health services. Provides advice, factsheets and self-help guides. DR FOSTER www.drfoster.co.uk/ Telephone 0207 332 8800 Works with the NHS to make it easier for professionals and the public to access health and social care information. Hospitals, consultants, complementary therapies and much more. PALS - PATIENT ADVICE AND LIAISON SERVICE (www.dh.gov.uk) This web address will take you to the Department of Health website. Click on Patient Advice and Liaison Service to find your local PAL. Information and help with any questions or problems you have about your GP service, NHS hospital or other NHS service. EQUIP - ELECTRONIC QUALITY INFORMATION FOR PATIENTS www.equip.nhs.uk NHS search website for patient information on a very wide variety of conditions. RSVP - RETIRED AND SENIOR VOLUNTEER PROGRAMME www.csv-rsvp.org.uk Advice and help for over 50’s by over 50’s: Transport for medical care, practical and domestic help, avoiding isolation, help for over 50’s in GP surgeries. LTCA - LONG TERM CONDITIONS ALLIANCE www.ltca.org.uk An umbrella body for voluntary organisations. Promotes access to services, support, and knowledge for self-help. Includes an “Expert Patients” programme with the NHS. Look at the directory of member organisations on their website for the help you need, or RING THEM on 02078153637. PATIENT CONCERN www.patientconcern.org.uk Helpful advice on how to survive medical treatment and the NHS, how to assess medical websites and more. FOR EXERCISE: There are many possibilities to choose from, and you may be surprised what you can do and what you’ll enjoy. Just be sure to get your doctor’s and/or physiotherapist’s advice on any medical limitations and what to avoid. SIMPLE WAYS to look at the possibilities are with the help of: THE BBC - Go to www.bbc.co.uk/health BANDOLIER - go to www.jr2.ox.ac.uk/bandolier and see Exercise in their healthy living section THE NHS Health encyclopaedia: www.nhsdirect.nhs.uk in our FIRST RESOURCES section has good information. THE COMPLIMENTARY HEALTHCARE INFORMATION SERVICE www.chisuk.org.uk links to all the main movement therapy exercise techniques. A one-stop convenience shop. And specifically for: TAI CHI - local adult education courses, local gym, fitness centre, library listing or the TAI CHI UNION OF GREAT BRITAIN - www.taichiunion.com PILATES www.pilatesfoundation.com YOGA www.bwy.org.uk DANCING - ballroom, tap, folk, flamenco, modern, social, jazz… too many styles to list. Once again the easy place to start is THE BBC. Go to www.bbc.co.uk/health and look under dance. Also many classes locally in many styles. GYMS / CIRCUIT TRAINING / SPORT - Infinite options. BBC Health provides guidance. EXERCISE IN WATER: AQUA-CHI www.taichiunion.com AQUA-GYM www.aquagym.co.uk POOLATES www.poolates.co.uk Pilates in water. AQUA-DANCE classes at local pools or www.virginactive.co.uk for classes at their gyms   FOR GENERAL SELF-HELP ON MOST SUBJECTS: DIRECTORY OF UK SELF-HELP GROUPS www.ukselfhelp.info/ This is a remarkably complete A-Z of self-help organisations on just about any health subject you can think of and life problems of most kinds. FOR PRACTICAL GENERAL INFORMATION ON MOST SUBJECTS: www.about.com www.bbc.co.uk www.bbc.co.uk/dna/h2g2 www.wikipedia.org   FOR PHYSICAL AIDS AND EQUIPMENT - ACCESS, MOBILITY AND PRACTICAL HELP: DISABLED LIVING FOUNDATION (DLF) www.dlf.org.uk Tel: 020 7289 6111 Helpline: 0845 130 9177 Text phone: 020 7432 8009 DLF are the leading source of information on disability equipment - free, impartial advice about all types of equipment and mobility products INDEPENDENT LIVING FUNDS www.ilf.org.uk Tel: 0845 601 8815 Email: client.service@ilf.org.uk The funds were set up as a national resource dedicated to the financial support of disabled people enabling them to choose to live in the community rather than residential care. DISCOUNT MOBILITY PLUS LTD For scooters, wheelchairs, bathlifts, stairlifts, chairs www.discountmobilityplus.co.uk Tel: 0808 178 4151 DISABILITY ALLIANCE www.disabilityalliance.org The leading authority on social security benefits for disabled people Tel: 020 7247 8776 MOBILISE - THE DISABLED DRIVERS’ ASSOCIATION www.justwebs.co.uk/mobilise/ Tel: 01508 489449 (Representation, information and advice on mobility issues) DISABILITY RIGHTS COMMISSION www.drc-gb.org DRC Helpline Tel: 08457 622 633 Textphone: 08457 622 644 The Disability Rights Commission (DRC) is an independent body established in April 2000 by Act of Parliament to stop discrimination and promote equality of opportunity for disabled people. RELATIVES AND RESIDENTS ASSOCIATION www.relres.org Tel: 020 7359 8136 Provides information and support about carehomes. ROYAL ASSOCIATION FOR DISABILITY AND REHABILITATION (RADAR) www.radar.org.uk Tel: 020 7250 3222 Minicom: 0207 250 4119 RADAR is concerned with every aspect of disability, but is particularly involved with access, education, employment, holidays, housing, mobility and social services. CITIZENS ADVICE BUREAUX (CABx) www.nacab.org.uk The website gives local offices, opening times and specialist services. AGE CONCERN AID CALL www.aidcall-alarms.co.uk T: 0800 77 22 66 Emergency alarms to stay independent but summon help if needed MEDIC ALERT FOUNDATION www.medicalert.co.uk tel 02078333034 Medical identification, cards, bracelets, necklaces etc with information on call for emergency treatment. Knowing your chronic problems and what medications you’re on can make a critical difference for any doctor or emergency worker treating you in any situation. FOR FIRST AID TRAINING - and we always recommend this as part of learning to take care of ourselves and each other: RED CROSS www.redcross.org.uk ST JOHN’S AMBULANCE www.sja.org.uk ST ANDREW’S AMBULANCE (Scotland) www.firstaid.org.uk We like Parkinson’s Health.com ( <a href="http://www.parkinsonshealth.com/">www.parkinsonshealth.com/</a> ) for its very positive and empowering attitude towards dealing with this condition. As is often the case, we also like Medline Plus (see our First Resources section) for just about any factual information you may need about this condition. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/pa1.jpg" /></div> Parkinson’s Health’s positive attitude doesn’t feel like whistling in the dark. It’s based on first-hand experience, and they have reason to be encouraging. When they say: “Managing Parkinson’s disease can be complicated, but it’s nothing you can’t handle”, they back it up with practical information and advice. The following derives from sources including their website, Medline Plus, and the Parkinson’s Disease Society website among others. PARKINSON'S DISEASE is a disorder that affects nerve cells (neurons) in a part of the brain that controls muscle movement. In Parkinson's there is a loss of nerve cells in the part of the brain known as the substantia nigra. Neurons that make a chemical called dopamine die or do not work properly. Dopamine normally sends signals that help coordinate your movements. No one knows what damages these cells. Symptoms of Parkinson's disease may include Trembling of hands, arms, legs, jaw and face Stiffness of the arms, legs and trunk Slowness of movement Poor balance and coordination <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/pa2.jpg" /></div> Fine movement control is affected. In severe cases with worsening symptoms, people may have trouble walking, talking or doing simple tasks. They may also have problems such as depression, sleep problems or trouble chewing, swallowing or speaking. The symptoms of Parkinson's usually begin slowly, develop gradually and in no particular order. It is important to remember that everyone with Parkinson's is very different and may have a different collection of symptoms and response to treatment. The nature and severity of symptoms and the rate at which the condition progresses will also be individual. The symptoms may take years to progress to a point where they cause major problems and when they do, many of these symptoms can be treated. DIAGNOSIS: Parkinson’s disease is a difficult disease to diagnose. Its symptoms vary from person to person and mimic symptoms of numerous other diseases, making an accurate diagnosis difficult in some people. Parkinson’s disease is usually diagnosed by a neurologist or a movement disorder specialist, who evaluates a person’s symptoms and may conduct a brain scan. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/pa3.jpg" /></div> If you are experiencing signs and symptoms associated with Parkinson's disease, or have other reasons to believe you may have Parkinson's disease, talk to your doctor without delay. Early testing and diagnosis can help you manage your symptoms very well. You may also find that your symptoms are due to some other condition entirely and get the help you need. THE SYMPTOMS of Parkinson's can be classified as motor and non-motor. Motor symptoms define Parkinson's, with three primary features: 1. Tremor - which usually begins in one hand. This is the first symptom for 70% of people with Parkinson's. 2. Slowness of movement (bradykinesia) - people with Parkinson's may find that they have difficulty initiating movements or that performing movements takes longer. 3. Stiffness or rigidity of muscles - problems with activities such as standing up from a chair or rolling over in bed may be experienced. Various non-motor symptoms may also be experienced, for example: sleep disturbances constipation urinary urgency depression When about 80% of dopamine production has been lost, the symptoms of Parkinson's appear and the level of dopamine will continue to fall slowly over many years. The reason why the loss of dopamine occurs in the brains of people with Parkinson's is currently unknown. Most researchers believe it is likely that many factors play a role in causing Parkinson's. Areas of research into the cause include genetics and environmental factors.

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There have been many advances in treatments for Parkinson's that can offer a much better quality of life to people with Parkinson's than was possible a few years ago. This trend is likely to continue. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/pa4.jpg" /></div> There is no cure for Parkinson's disease, but a variety of medicines sometimes help symptoms dramatically. The NICE Guideline for Parkinson's disease (which covers England and Wales) states that people with suspected Parkinson's should be referred quickly (within 6 weeks) and untreated to a specialist with expertise in the differential diagnosis of this condition. The Guideline also recommends that the diagnosis of Parkinson's should be reviewed regularly (every 6-12 months). Parkinson's itself is not a fatal condition. With the treatment that is now available, life expectancy for someone with Parkinson's is fairly normal and none of the drugs that are used for Parkinson's have any serious side effects that could cause death. That said, occasionally in people who are seriously disabled (usually those who have had Parkinson's for many years), their general physical and mental condition can either cause or exacerbate other illnesses and so contribute to the final cause of death. DRUG TREATMENTS People with Parkinson’s disease often take a variety of medications in different doses in order to manage the symptoms of the disease. These factors, combined with the frequency with which medications must be taken, can result in confusion. People with Parkinson’s and their caregivers should become familiar with their medications in order to use them most effectively and avoid possible interactions. Understanding a medication regime and sticking to it will provide the greatest benefit from the drug and avoid unpleasant “off” periods due to missed doses or confusion. We advise making a list of the medications to be taken in a day, and then making a written note on the list saying at what time you take each dose of each medicine. Although there are general guidelines that doctors use to choose a treatment regimen, each patient must be individually evaluated to determine which drug or combination of drugs is best for them. For some, a “first choice” drug might be one of the levodopa preparations, and for others, an initial prescription may be given for one of the agonists, an MAO inhibitor or an anticholinergic. The choice of drug treatment depends on many variables including symptom presentation, other concurrent health issues (and the medications being used to treat them) and a person’s age Drug treatments include: Levodopa / Carbidopa LEVODOPA is a substance that is converted into dopamine by an enzyme in the brain. It is then released by brain cells and activates dopamine receptors allowing for normal function of the movement control centres of the brain. Forty years after its discovery, levodopa remains the most effective medication for Parkinson’s disease. In fact, 70 to 80 percent of treated Parkinson’s patients are on levodopa therapy. Levodopa is the “gold standard” by which all treatments for Parkinson’s are measured. Levodopa combined with CARBIDOPA represented a significant improvement in the treatment of Parkinson's disease. The addition of carbidopa prevents levodopa from being converted into dopamine in the bloodstream, allowing more of it to get to the brain. Therefore, a smaller dose of levodopa is needed to treat symptoms. In addition, the nausea and vomiting often associated with levodopa treatment is greatly reduced by the presence of carbidopa. With increased dosing and prolonged use of levodopa, patients can experience other side-effects including dyskinesias (spontaneous, involuntary movements) and "on-off" periods when the medication will suddenly and unpredictably start or stop working. Carbidopa may be combined with levodopa and entacapone in a combination tablet for patients who experience end-of-dose "wearing-off". While carbidopa reduces the side effects of levodopa, entacapone extends the time levodopa is active in the brain (up to 10 percent longer). Check with a doctor before taking any of the following to avoid possible interactions: antacids, anti-seizure drugs, anti-hypertensives, anti-depressants and high protein food (see our section on Diet). Dopamine agonists are drugs that stimulate the parts of the human brain that receive dopamine. In effect, the brain "thinks" it is receiving dopamine, so these drugs help satisfy the brain's need for dopamine. Dopamine agonists can be taken alone or in combination with medications containing levodopa. Agonists may include bromocriptine, pramipexole and ropinirole. Consult your doctor before taking any of the following to avoid possible interactions: alcohol, anti-psychotics, medications that lower blood pressure, thiothixene, chlorprothixene, haloperidol), metoclopramide, phenothiazines, thiozanthenes, cimetidine, phenothiazines, butyrophenones, Ciprofloxacin and benzodiazepines. Some of these drugs may be sold under other commercial names, so be sure to check what else you can and cannot take if you are prescribed a dopamine agonist. Anticholinergics (trihexyphenidyl, benztropine mesylate, procyclidine, etc.) do not act directly on the dopaminergic system. Instead they decrease the activity of another neurotransmitter that controls movement, called acetylcholine, to balance out the production of dopamine and acetylcholine. In general, mild PD that consists of tremor at rest can often be treated initially with anticholinergic agents. Adverse effects of these drugs include blurred vision, dry mouth and urinary retention. Anticholinergics may be contraindicated in older patients because they could cause confusion and hallucination. Anticholinergics can interact badly with antihistamines, alcohol and a number of drugs. Be sure to check what else you can and cannot take with your doctor. MAO-B inhibitors such as selegiline or deprenyl are used to block an enzyme in the brain that breaks down levodopa. They have been shown to delay the need for levodopa/carbidopa when prescribed in the earliest stage of Parkinson’s, and can also be useful in later stages of the disease to boost the effects of levodopa/carbidopa. Possible interactions may include anti-depressants, narcotic pain killers and decongestants. Check with a doctor before taking any medications with these. COMT inhibitors such as entacapone represent a different class of Parkinson's medications and they must be taken with levodopa. COMT inhibitors prolong symptom relief by blocking the action of an enzyme which breaks down levodopa, allowing a larger amount of levodopa to reach the brain, which raises the dopamine level. This helps provide a more stable, constant supply of levodopa. MANAGING MEDICATIONS Taking medications for Parkinson's disease is straightforward for most people during the first several years of treatment. The effect of each dose usually lasts well into the period after the next dose, and delaying a dose even by an hour does not disrupt the effective coverage of symptoms. The situation is different for many people who have been taking Parkinson's medications for several years (usually five years or more). In these stages of the disease, effective relief from symptoms can depend on carefully following a regular schedule of medication doses. There are several ways for Parkinson's patients to achieve the greatest possible benefit from their medications. Since in the more advanced stages of Parkinson's disease the   symptoms are often unpredictable and can fluctuate daily, it is important to take an active role in finding a routine for yourself that makes the most of the medicine. Notice how long it takes for a pill to work and how long its positive effects remain. Note if the pills should be taken with food, between meals or on an empty stomach and how it feels when medication starts to wear off. The answers to these questions can help explain how the pill works and possibly increase "on" time. People with Parkinson's must know what medications they are taking, when and why. This can be achieved by working primarily with one pharmacist. A pharmacist will note all of the medications a person is taking in a computer, which safeguards them from any interactions. Another way to control this information is by constructing your own medication chart or list. As we’ve said before, it’s best to write down what you’re taking, when you should take it, and note down when you actually take it. Having this information in writing will make all the difference for you and will help your doctor and neurologist to monitor your treatment and its results. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/pa5.jpg" /></div> Organisation is a key factor in getting the most from Parkinson's medications. Since several medications will probably be taken at different times of the day, a timing device can be crucial in avoiding missed doses. Talking systems, beeping watches and multi-alarm timers are widely available. These systems can be both discreet and loud, with vibrating and sound features. In addition, pill dispensers organise pills by day and time to eliminate carrying several large prescription bottles. Interactions between other medications and Parkinson’s drugs can be dangerous and even life-threatening, so make sure your pharmacist (and ideally your doctor) knows of all medications and supplements you’re taking. SURGERY FOR PARKINSON’S Surgery for Parkinson's disease and other movement disorders has been available since the 1960s. Back then, surgery was used to destroy a small part of the brain called the globus pallidus. This type of surgery is still done today although less frequently because of the availability of deep brain stimulation. The surgery to destroy the globus pallidus is called a pallidotomy. It is thought that the globus pallidus becomes overactive in Parkinson's disease. This overactivity acts like a brake and slows or diminishes movement. Pallidotomy is a way to destroy the overactive globus pallidus to improve the symptoms of Parkinson's disease. This surgery is effective but carries significant risks. Pallidotomy requires purposeful destruction of the brain. If the surgeon is off by even a fraction of an inch, the surgery may not be effective and severe complications can result. Deep Brain Stimulation is a way to inactivate the globus pallidus without purposefully destroying part of the brain. Therefore, the risks are much less. In deep brain stimulation, an electrode is placed with the tip of the electrode in the globus pallidus. Introducing a small electric current through the electrode has the same effect as pallidotomy without actually destroying parts of the brain. The electrode for deep brain stimulation is left in the brain. It is connected by a wire to a pacemaker-like device that is implanted under the skin over the chest. Deep brain stimulation offers a number advantages. The electrical stimulation is adjustable, whereas surgical destruction is not. The electrode has four metal contacts that can be used in many different combinations. Even if one electrode contact is not in the exact location, it is likely that one of the others or some combination of electrical contacts will be closer to the proper target. As the patient's response to surgery changes over time, the stimulation can be adjusted without the necessity of repeat operation. Another significant advantage of deep brain stimulation relates to future treatments. Destructive surgery such as pallidotomy may reduce the patient's potential to benefit from future therapies. For example, future brain cell transplantation may be of great help to patients with Parkinson's disease. There is concern that a pallidotomy may prevent patients from benefiting from brain cell transplantation. This would not be the case with deep brain stimulation as the stimulator could be turned off. Because the right side of the brain controls the left side of the body and the left side of the brain controls the right side of the body, a stimulator will help only on the opposite side of the body. Most patients will have the stimulator placed in only one side of the brain; a few will have stimulators placed on both sides but not at the same time. The risks for complications increase when stimulators are place in both sides of the brain. In Parkinson's disease, the goals of deep brain stimulation are to (1) improve the speed and dexterity of the arm on the side opposite to the stimulator, (2) to reduce tremor, and (3) to block the involuntary movements (called dyskinesia) associated with the medications used to treat Parkinson's disease. Neither deep brain stimulation nor pallidotomy help problems related to walking or balance. Deep brains stimulation should not be considered if medication can give satisfactory control of your condition. However, surgery can be considered for people who do not achieve satisfactory control through medications. There is evidence that deep brain stimulation is as effective as or more effective than the older pallidotomy, which is a well established and accepted treatment. However, deep brain stimulation may be safer. Patients who fail to achieve satisfactory control with medications, by which is meant being able to do the things that make them happy, may consider deep brain stimulation. If you are considering or want to know more about deep brain stimulation, go to the Medline Plus website in our First Resources section. Search the term “Parkinson’s”, and look at the article “Deep Brain Stimulation for Movement Disorders (Cleveland Clinic Foundation)”.   OTHER THERAPIES OCCUPATIONAL THERAPY AND PHYSIOTHERAPY can help a great deal in managing Parkinson’s by assisting with movement and providing help and techniques to maintain independence in everyday life. Speech and Language Therapists can be very helpful with communication or swallowing difficulties. PARKINSON’S DISEASE NURSE SPECIALISTS (PDNS) work with patients to understand their requirements and take control of their condition from diagnosis onwards. For example, they provide clinical monitoring and medication adjustment, are a continuous point of contact for support and are a reliable source of information for patients and carers alike.   We refer again to Parkinson’s Health, and their statement that: “Managing Parkinson’s disease can be complicated, but it’s nothing you can’t handle”. Go to www.parkinsonshealth.com/TakeControl for more on self-help. We derive much of the following advice from them. Suggested highly-achievable goals for managing your condition include: <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/pa5.jpg" /></div> Reducing your Parkinson’s disease symptoms. Minimizing problematic side effects. Maintaining your activities of daily living. Ensuring your emotional well-being. Continuing your work or hobbies. Maintaining relationships with family and friends. Maximizing your independence. EXERCISE If you are not exercising regularly, start today. However, always consult your doctor before beginning any exercise program. Exercise can help make living with Parkinson’s disease easier by: • helping you feel more in control of your movements. • reducing gait problems and muscle/joint injuries. • improving flexibility. • increasing muscle strength and balance. • increasing energy, stamina and cardiovascular health. Your exercise program should be tailored to your personal abilities and any other health concerns, such as high blood pressure or arthritis. Your doctor and physiotherapist can advise about this. Tai Chi, Yoga and Pilates technique may be particularly effective. We also note that the Parkinson’s Disease Foundation offers an exercise program and workout video specifically designed for people with Parkinson’s disease. Many people with Parkinson's are involved in active sports and activities such as racquet sports, bowling, sailing, skiing, swimming and dancing. You may be surprised how much you can do. The Parkinson's Disease Society has produced “Keeping Moving”, an exercise video and booklet working with two physiotherapists, Bhanu Ramaswamy and Richard Webber. See the “how to order resources page” on their website or download their “Keep Moving” order form. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/pa6.jpg" /></div> SLEEP A good night’s sleep keeps your body and mind functioning properly, but Parkinson’s disease can include symptoms that interfere with your sleep – such as vivid dreams, sleeplessness, or restless legs. Try these tips to help you catch your rest: Avoid alcohol, caffeine, and other stimulants in the evening. Minimize fluid intake in the hours before bedtime. Establish a regular routine by going to bed and waking up at the same time each day Avoid oversleeping Create a comfortable, peaceful environment in your bedroom Exercise regularly. MEDITATION Meditation can allow you to discover and enjoy a profound stillness and peace. See the Parkinson’s Society and other references in our Complementary Therapies section, or try the Shollond Trust website under Useful Organisations. SUPPLEMENTS, SNAKE-OILS AND DIETS Although there is little conclusive scientific information on natural supplements, researchers are examining several substances to evaluate their effectiveness on slowing Parkinson's disease progression and managing its symptoms. Note that you should discuss using any supplements with your doctor or chemist before taking them to avoid potentially dangerous interactions. Since there is evidence relating oxidative damage of nerve cells to PD, some researchers are studying antioxidants. A 2002 study focused on the potential antioxidant Coenzyme Q10 (CoQ10), which is believed to play an important role in mitochondria health. Mitochondria are the "powerhouses" of a cell, and some scientists think that abnormalities of mitochondrial function may play a role in Parkinson's. A recent clinical trial found that high doses of CoQ10 (up to 1200 mg) showed a possible slowing of disease progression in a small number of subjects. These results are promising but researchers have not studied CoQ10 extensively enough to recommend it. Scientists have also examined Vitamin E, Vitamin C and health foods to evaluate their oxidative properties. Vitamin E can fight damage in the brain caused by free radicals, and has been suggested to lower the risk of PD. However, researchers conducted an extensive and thorough study over 10 years ago ( the DATATOP trial) and failed to find any evidence that Vitamin E slows the progression of Parkinson's or manages symptoms. Since Vitamin E has very few side-effects, many Parkinson's patients continue to take it in high doses of 400 IU or more. Researchers are also examining health foods, such as fermented papaya and blueberries, to determine their role in slowing nerve cell death. Scientists are optimistic about the research but do not have enough conclusive data yet to recommend these supplements. Creatine is another compound of scientific interest that increases levels of phosphocreatine (an energy source in muscle and the brain). Multi-center clinical trials are being conducted to determine if creatine protects against nerve cell damage. Researchers have also studied a compound called glutathione to determine its effect on nerve cell metabolism and its power as an antioxidant. Both compounds show promise, but the appropriate dosing is unclear, as are the most effective method of administration, side-effects and long-term dosing risks. Both the BBC and the Alzheimer’s Society report that Ecstasy and cannabis can have positive effects for people with Parkinson’s. In 2001 a BBC Horizon’s programme featured a young man whose symptoms disappeared when he took Ecstasy. The mechanisms by which both Ecstasy and cannabis may alleviate symptoms are being studied. Speaking of such ‘recreational’ drugs, The Alzheimer’s Society warns quite sternly against the use of any illegal recreational drug. Check Medline Plus or BBC Health in our First Resources section to learn more about any supplement which interests you. DIET Good nutrition is one of the important aspects of managing Parkinson’s. Four common reasons for hospitalization among people living with Parkinson’s disease (bone fracture, dehydration, bowel impaction, and weight loss) can be lessened by proper nutrition. Parkinson’s Health suggests making the following nutrition habits part of your game plan: Drink 6-8 glasses of water a day, even if you aren’t thirsty. Eat natural laxatives – prunes, vegetables, and foods high in fibre – to prevent or relieve constipation. Eat something cold and sour before a meal to help prevent dry mouth. Talk to your doctor about any food-specific issues related to your medications. For example, meals high in protein may interfere with the absorption of levodopa. So if you use levodopa, you may need to adjust the amount of protein in your diet. A balanced and nutritious diet including three meals a day (or four smaller meals) is recommended. You should aim to eat a mixture of: starchy foods - for example bread, rice, potatoes or pasta fruit and vegetables dairy products proteins - for example meat, fish or beans and pulses, but again we note that some people taking levodopa medication may find a large protein meal slows the effectiveness of the medication. Check with your specialist to find out if this is a consideration for you. COMPLEMENTARY THERAPIES / ALTERNATIVE MEDICINE THE PARKINSON’S DISEASE SOCIETY website has an alphabetical list of information sheets about a very wide range of alternative therapies and advice on most subjects to do with managing Parkinson’s. Go to www.parkinsons.org.uk, click on “Advice”, then on “Information Sheets” Also be sure to get the Parkinson’s Disease Society’s booklet: “Complementary Therapies and Parkinson's Disease” This booklet includes information on: Acupuncture/acupressure Alexander Technique Aromatherapy Art therapy Ayurveda Bowen technique Breathwork Conductive education Craniosacral therapy Diet Feldenkrais method Healing Herbal medicine Homeopathy Hydrotherapy Hypnotherapy Kinesiology Magnet therapy Massage Meditation and visualisation Music therapy Pilates Reflexology Reiki Shiatsu Spinal manipulation Tai chi Yoga Parkinson’s is a condition in which you really can empower yourself. All the above are worth considering for therapy or learning and self-management. From personal experience we can particularly recommend Tai Chi, Yoga, and Meditation for basic self-empowerment. These disciplines can help you use your condition to actually make life better, deeper, stronger, more whole and more satisfying. See our Useful Organisations sections for these and other references. In addition to the Parkinson’s Disease Society you can check BBC Health and the British Complementary Medicine Association to learn about complimentary activities like those listed above, and which might be right for you. Be aware that depression and anxiety are common in Parkinson's and can occur at any stage of the condition. This is not just you being unable to cope. Doctors generally believe that depression in Parkinson's is caused by the chemical changes in the brain that cause the condition. Depression in Parkinson's can also occur as a reaction to the effect that having the condition may have on a person's lifestyle. For most people with Parkinson's, both biological and psychological factors are likely to play a role. Symptoms of depression may include: low mood or self esteem lack of interest in or pleasure from usual activities or interests tiredness and difficulty sleeping   Your doctor may prescribe antidepressants, which can be very effective in treating depression in Parkinson's, as long as they are compatible with any medication you are taking. COUNSELLING or COGNITIVE THERAPY can be beneficial. To find a counsellor, contact British Association for Counselling and Psychotherapy. BRIEF DESCRIPTIONS FOLLOW for some of the better known COMPLEMENTARY TECHNIQUES: Acupuncture - Well known Chinese therapy using fine needles to change energy flows. Evidence of effectiveness in dealing with pain and other problems, at least short term. High level qualified practitioner essential. Acupressure - Same principles as acupuncture, using pressure instead of needles. You can learn to do some acupressure yourself. Alexander Technique - Technique for learning how to efficiently and effortlessly use your body. Simple but profound approach to letting go of harmful tensions in posture and breathing. A safe and effective learning and therapy technique. It doesn’t sound like much but it’s a physically liberating and undemanding technique. Aromatherapy - The art of applying essential oils to suit individual needs. The oils work directly on the chemistry of the body, via the skin and bloodstream. May seem unlikely, but a number of medical sites assure us that it can be surprisingly effective and safe. Art Therapy - Use of art for emotional therapy. Early evidence of effectiveness was with survivors returning from World War 2. Pain and healing are strongly affected by emotion, so makes sense. Ayurveda - The most important form of medicine in India. An ancient tradition, but most practitioners are also doctors or otherwise medically qualified. Ayurveda seeks to balance the body and mind, find health problems before they occur or stop them doing unnecessary harm. Obviously requires a qualified practitioner and is complementary to, not a replacement for conventional medical treatment. Biofeedback - Machines give you feedback about how your body is working, allowing you to learn to regulate reactions causing problems. Evidence of usefulness for therapy and self-education for many conditions. Bowen Technique - soft and non-invasive holistic treatment that aims to restore balance to the body by using small, gentle moves to specific areas of the body. Because the therapy is so gentle, it is considered to be suitable for all ages and most conditions. Chiropractic - Manipulation of spine and muscles for good balancing and health functioning. A powerful technique and NOT to be used for many conditions. Check with your doctor, and see Useful Organisations for help finding a qualified and registered practitioner. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/pa7.jpg" /></div> Cognitive and Behaviour Therapies - Put crudely: It’s not what happens that causes the problems, it’s how you understand it and what you do with it. Less crudely, these have medical and government recognition for a wide variety of problems and can be startlingly effective in many cases. Many of us who they have helped consider them to be most remarkable life tools. Feldenkrais Method - Not a therapy as such, but a well established method for learning greater ease of physical movement and increasing vitality and well-being. Guided Imagery - The use of imagination as potent healer. Pleasant and powerful. See “Holistic Online” in Useful Organisations to learn more. Healing - comes in many forms, from spiritual or religious to using energy flow as understood in martial arts. Whether the effectiveness is due to a placebo effect, energy flows or spirit, many people have been helped by healings throughout history. Herbal medicine - Herbal medicines can be very powerful, and are the basis of many conventional drugs. A good herbal practitioner looks at the whole person and health, not just the disease or condition. Because they can be very strong and conflict with prescribed medications, you absolutely need to tell your doctor what you’re going to be taking. A herbal remedy can destroy your therapy and health if it’s the wrong one for you. Homoeopathy - famous and controversial. Vanishingly small amounts of a substance in water are given. Many in medical science consider this to be absurd. No conclusive proof either way, but many people have found help and relief. Hard to argue with happy patients, and it has the great virtue of being harmless. That said, neglecting medical treatment to depend on homeopathy is an enormous mistake, as your qualified homeopath will agree. Hypnotherapy - not in any way a frightening experience or loss of consciousness or control, safe in qualified hands, and considered very effective in helping with chronic pain, anxiety, depression and other condition related problems. Louise Hay techniques - based on the use of positive affirmations - highly recommended by many people for effectively changing your mindset and health. A place to start is the Louise Hay book “You Can Change Your Life” and audio tapes from Amazon. As we keep saying throughout this website, mindset can profoundly affect healing. Massage Therapy - There are many forms of massage, and they can be a great help in stress reduction, release of chronic muscle tensions around arthritis, and can have many other therapeutic effects depending on the technique used. Having your body cared for like this is great, but: be aware that deep or powerful massage pressure can be dangerous for some conditions. Check with your doctor or physio about what to avoid. It is important that your therapist asks what your medical / physical situation is. If they are not qualified, or you are not comfortable with them as a patient or carer for a patient, you are in the wrong hands. Don’t risk damage. Move on. Medau Movement - Enjoyable exercise to music for improving body use and posture, and good for stress reduction. Meditation - A truly profound way to deal with stress and the human condition. Good meditation teaching is simple, and the result should be access to peace and stillness whatever is happening and wherever you are - at home, on the street, at work… We give contacts for meditation in Useful Organisations. We’ve recommended the approach of the Shollond Trust as it’s fast, free, and a good starting place for appreciating all forms of meditation. We also like BBC Health and the H2G2 recommendations about meditation. Naturopathy - Technique for helping the body to heal itself, and often incorporates a number of the other techniques discussed here. Interesting to have one technique using the strengths of others. In capable hands this can be very effective for some people. NLP (Neuro-linguistic Programming) - A fascinating form of therapy, looking at how you do what you do, and how to change. We like this sentence from a practitioner: “If you always do what you've always done, you'll always get what you've always got. If what you're doing isn't working, do something else". Far more to it than that of course, and worth learning about. Osteopathy - Certainly among the best known physical therapies and very well accepted as a complementary therapy. Osteopathy is highly regulated. Physical manipulation and massage techniques are used to help correct problems with the muscles, bones, and joints and influence many of the body’s systems. A good practitioner will ask in detail about your condition to not do harm with inappropriate manipulations. Practitioner be qualified, registered, and take a medical history to understand what your condition is. Pilates - Exercise method to method to strengthen the core postural muscles and develop balanced alignment through the use of slow, controlled movements and breathing. Often recommended by doctors, physiotherapists, and used by everyone from top professional athletes and dancers to people who have never done much exercise or thought they were unable to due to physical limitations. Teacher must understand your condition. Psychology of Mind - The book “Slowing Down to the Speed of Life” from Amazon is the well known place to start. POM techniques and understandings are simple and can be life changing. A way to use your problems to vastly improve your life. For the anxieties associated with illness (not to mention life) this is something special. Great for carers as well. Psychotherapy - Many forms, and a vital and immensely beneficial approach for many people. The idea that psychotherapy is for crazies couldn’t be more wrong. It’s one of the best learning and healing tools and most interesting things you could choose to do. Practitioners must be qualified, and you have to find one you feel comfortable with and helped by. Reiki Healing - A Japanese form of healing through energy flow and which, interestingly, is also concerned with living in harmony with others, taking responsibility for one's own health and happiness, helping others, and being positive about all things. Shiatsu - Traditional Japanese physical therapy, using a range of techniques from gentle touch to more dynamic work to improve specific conditions and general health. A qualified practitioner will take a detailed history from you and avoid more dynamic techniques where they might be contra-indicated for your condition. Check with your doctor or physiotherapist before trying. Tai Chi - A soft, gentle and very powerful Chinese martial art, movement meditation, and way of healing through movement. Tai Chi works very well for older and ill people. It helps to free and balance the body, breathing and movement, and to find calm, stability, peace and deep security. If you have serious problems with feet, knees or walking it may not work for you. If that’s the case the exercises of Qigong (or Chi Kung) use the same principles but can be done sitting as well as standing. Tai Chi is a way to contact deep reserves of strength and ease. Trager Work - A form of bodywork and movement which utilises gentle, rhythmic movements to facilitate the release of stress patterns - physical, mental, and emotional. Created by a doctor and physiotherapist working with his own chronic pain since childhood, this method also has a meditation aspect. Yoga - The ancient Indian system of postures, exercises, breathing, and body and mind development and control. Popular and widely available these days. The basic exercises of Hatha Yoga, taught with careful respect for your physical problems and limitations, are a good place to start, along with pranayam breathing exercises. There are also some extremely challenging physical styles of yoga which may not be not at all appropriate. BE SURE your teacher knows what your physical problems are, and that your doctor has no problem with your doing yoga. That said, it is a wonderful combination of calm body, mind and spirit training and self-help therapy.   GENERAL HELP WITH PARKINSON’S RELATED PROBLEMS For wide ranging help and advice in the UK, including telephone helpline 0808 800 0303, contact The Parkinson’s Disease Society (see our Useful Organisations section). As always you can usually get directed to any help you need by contacting Age Concern, Help the Aged or one of the other organisations we list in our “First Resources” section as needed. The Parkinson's Disease Society produces an information sheet to give advice on mobility and help with getting around. The sheet includes information on: The Blue Badge Scheme (BBS) Driving issues Motability Vehicle Exemption Duty National Toilet Key Scheme Transport Wheelchairs Travel and holiday information Be sure to see the Parkinson’s Society information sheet on Equipment. They advise that there are all kinds of aids and equipment available to help people who have difficulties carrying out daily living activities. These might include smaller aids to help with washing, bathing, reaching, eating and drinking, or larger adaptations such as stair lifts and wheelchairs. Consult the Society about requesting an assessment from a relevant therapist to help you to decide what equipment would be useful. The therapist will assess your needs and make recommendations accordingly. These recommendations may involve equipment but may also involve exercise, a change to the way you do things, or other kinds of treatments. If the therapist suggestions equipment, they should also be able advise you on suppliers and any funding that may be available. The Society advises that you may want to call their Helpline to find out about the Mali Jenkins Help Fund, which provides one-off grants to people with Parkinson's to help buy equipment, to make an adaptation to the home and purchase many other items to help improve your quality of life. You can see their website section on BENEFITS or ring them to learn what other financial help may be available to you. Parkinson's

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PARKINSON'S DISEASE SOCIETY <a href="http://www.parkinsons.org.uk/">www.parkinsons.org.uk</a> Helpline 0808 800 0303 Email: <a href="mailto:enquiries@parkinsons.org.uk">enquiries@parkinsons.org.uk</a> See their site map for great help and ease of use. The primary UK organisation. PARKINSON’S DISEASE FOUNDATION <a href="http://www.pdf.org/">www.pdf.org</a> PARKINSON’S HEALTH <a href="http://www.parkinsonshealth.com/">www.parkinsonshealth.com/</a> US site full of useful information THE PARKINSON'S COMMUNITY ON THE INTERNET <a href="http://james.parkinsons.org.uk/community.htm">http://james.parkinsons.org.uk/community.htm</a> ‘More and more people affected by Parkinson's Disease are gathering together on the Internet. The resulting "Virtual Community" is welcoming, helpful, and well informed.’ THE CURE PARKINSON’S TRUST <a href="http://www.cureparkinsons.org.uk/">www.cureparkinsons.org.uk</a> Sets out to do what the name says. The site also offers some helpful books.   ROYAL COLLEGE OF SPEECH AND LANGUAGE THERAPISTS <a href="http://www.rcslt.org/">www.rcslt.org</a> Telephone 020 7378 1200 Email <a href="mailto:info@rcslt.org">info@rcslt.org</a> <a name="orgs" id="orgs"></a>BRAIN AND SPINE HELPLINE <a href="http://www.brainandspine.org.uk/">www.brainandspine.org.uk</a> Tel: 0808 808 1000 (Information and support on neurological disorders for patients, carers and health professionals)      FOR IMMEDIATE HELP WITH HEALTH QUESTIONS and GENERAL MEDICAL INFORMATION: See our FIRST RESOURCES section - especially MedlinePlus ( <a href="http://medlineplus.gov/">http://medlineplus.gov</a> ) BBC Health ( <a href="http://www.bbc.co.uk/health">www.bbc.co.uk/health</a> ), the Mayo Clinic (<a href="http://www.mayoclinic.com/">www.mayoclinic.com</a> ) and: MEDICINENET.COM <a href="http://www.medicinenet.com/">www.medicinenet.com</a> For a general guide and information base on any subject this is an excellent resource. NETDOCTOR <a href="http://www.netdoctor.co.uk/">www.netdoctor.co.uk</a> Attempts to break down the "medical language barrier" between the doctor and the patient. Critical medical information presented in a clear and understandable language so that the patient fully understands his or her choices and decisions. THE COCHRANE REVIEWS (<a href="http://www.cochrane.org/">www.cochrane.org</a>) The Cochrane Collaboration assesses most areas of health care. To do this, it is divided into Cochrane Review Groups, each of which concentrates on a specific healthcare area, including a Consumer Network that represents the interests of healthcare consumers. Type any condition into their website and get pretty comprehensive information. If you want clear scientific analysis of any health issue or practice, you’ll usually find it here. BANDOLIER: THE OXFORD MEDICAL SITE <a href="http://www.jr2.ox.ac.uk/bandolier/index.html">http://www.jr2.ox.ac.uk/bandolier/index.html</a> Bandolier is a journal of evidence-based medicine. Look up any subject for links and knowledge. Their “Healthy Livig Zone” is a bit of a goldmine on the subject. MERCK MEDICUS <a href="http://www.merckmedicus.com/">www.merckmedicus.com</a> Easy to use and the US doctor’s reference tool. See MERCK GERIATRIC for age related information.   FOR ANCILLARY MEDICAL THERAPIES (Physiotherapy etc): HEALTH PROFESSIONS COUNCIL <a href="http://www.hpcuk.org/">www.hpc-uk.org</a> Telephone 020 7582 0866 The HPC is a statutory regulator that works to protect the health and well-being of people using the services of health professionals. Find therapists and be sure they are approved / regulated practitioners.   CHARTERED SOCIETY OF PHYSIOTHERAPY <a href="http://www.csp.org.uk/">www.csp.org.uk</a> Tel: 020 7306 6218 / 6666 Information on physiotherpaists, physiotherapy and how it can help with pain. THE ORGANISATION OF CHARTERED PHYSIOTHERAPISTS IN PRIVATE PRACTICE <a href="http://www.physiofirst.org.uk/">www.physiofirst.org.uk</a> Tel: 01327 354441 Details of private chartered physiotherapists in your area. OCCUPATIONAL THERAPISTS IN INDEPENDENT PRACTICE (OTIP) <a href="http://www.otipp.co.uk/">www.otipp.co.uk</a> Tel: 0800 389 4873 Information and find an occupational therapist   FOR COMPLEMENTARY AND ALTERNATIVE THERAPIES: THE COMPLIMENTARY HEALTHCARE INFORMATION SERVICE <a href="http://www.chisuk.org.uk/">www.chisuk.org.uk</a> Easy reference to learn about any and (just about all) complementary techniques. A truly excellent way to learn what the main comlementary techniques are, how they might work for you, and to explore the subject THE NETDOCTOR DR FOSTER COMPLEMENTARY PRACTITIONER DIRECTORY <a href="http://netdoctorcomplementarytherapistguide.drfoster.co.uk/">http://netdoctorcomplementarytherapistguide.drfoster.co.uk</a> If you are looking to find a reliable complementary therapy practitioner in your area, this directory is an essential resource. It can help you find a practitioner who meets your needs. This might be someone who has a particular interest in your condition, or who works at a practice near to your home, at hours that suit your needs. THE BRITISH COMPLEMENTARY MEDICINE ASSOCIATION <a href="http://www.bcma.co.uk/">www.bcma.co.uk</a> Tel 0845 345 5977 Find qualified practitioners of most therapies, learn about therapies, get recognised guidance through the therapy minefield and find a therapist near you. WHOLE HEALTH MD <a href="http://www.wholehealthmd.com/">www.wholehealthmd.com</a> American WholeHealth Networks' Complementary and Alternative Medicine (CAM) education website. The site is dedicated to providing integrative health and wellness solutions by combining the resources of both scientific health research and CAM. Click on specific health issues for information on conventional medicine, alternative therapies, supplements, diet, lifestyle options, and much more. HOLISTIC ONLINE <a href="http://www.holisticonline.com/">www.holisticonline.com</a> Comprehensive site for Alternative and Integrative Medicine. Learn about conditions and treatments. INSTITUTE FOR COMPLEMENTARY MEDICINE <a href="http://www.i-c-m.org.uk">www.i-c-m.org.uk</a> The ICM is a UK registered charity providing information on all aspects of the safe and best practice of Complementary Medicine. THE NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE <a href="http://nccim.nch.gov/">http://nccim.nch.gov</a> Vital and reputable information for the States. A treasure for understanding what’s what. THE ALTERNATIVE MEDICINE FOUNDATION <a href="http://www.amfoundation.org/">www.amfoundation.org</a> Excellent US site, good clear information. They also recommend: ALTERNATIVE MEDICINE RESOURCE <a href="http://www.altmedresource.com/">www.altmedresource.com</a> comprehensive and searchable catalog of all alternative medicine studies. Easy search by looking up your condition(s) or a key word.   FOR COMPLEMENTARY PRACTICTIONERS’ ASSOCIATIONS GENERAL OSTEOPATHIC COUNCIL <a href="http://www.osteopathy.org.uk">www.osteopathy.org.uk</a> Tel: 020 7357 6655 Provides details of qualified local osteopaths. BRITISH CHIROPRACTIC ASSOCIATION <a href="http://www.chiropractic-uk.co.uk">www.chiropractic-uk.co.uk</a> Tel: 0118 950 5950 Information on chiropractic and details of local chiropractors. GENERAL CHIROPRACTIC COUNCIL <a href="http://www.gcc-uk.org/">www.gcc-uk.org</a> Tel: 020 7713 5155 Provides details of local chiropractors and information on what to expect when you see a chiropractor. It can also help if you've experienced a problem with a chiropractor. THE SOCIETY OF CHIROPODISTS AND PODIATRISTS <a href="http://www.feetforlife.org/">www.feetforlife.org</a> Telephone 020 7234 8620 GENERAL COUNCIL FOR MASSAGE THERAPY <a href="http://www.gcmt-uk.org/">www.gcmt-uk.org</a> Telephone 01992 537637 New voluntary regulation body for practitioners of massage. INTERNATIONAL FEDERATION OF AROMATHERAPISTS <a href="http://www.ifaroma.org/">www.ifaroma.org</a> Telephone 020 8992 9605 MUSIC THERAPY: see HEALTH PROFESSIONS COUNCIL above - <a href="http://www.hpcuk.org/">www.hpcuk.org</a> Telephone 020 7582 0866 THE BRITISH MEDICAL ACUPUNCTURE SOCIETY <a href="http://www.medical-acupuncture.co.uk/">www.medical-acupuncture.co.uk</a> Telephone 01925 730727 Medical doctors who practice acupuncture. Encourages the use and scientific understanding of acupuncture within medicine for the public benefit. ACUPUNCTURE ASSOCIATION OF CHARTERED PHYSIOTHERAPISTS <a href="http://www.longbo.demon.co.uk/aacp.html">www.longbo.demon.co.uk/aacp.html</a> Tel 01747 861151 Contact the AACP Secretariat for a register of members - qualified phyisos working with acupuncture. BRITISH ACUPUNCTURE COUNCIL <a href="http://www.acupuncture.org.uk/">www.acupuncture.org.uk</a> Tel: 020 8735 0400 Provides information on acupuncture and details of qualified traditional acupuncturists in your area. Phone or enclose an SAE for more information. NATIONAL INSTITUTE OF MEDICAL HERBALISTS <a href="http://www.nimh.org.uk/">www.nimh.org.uk</a> Telephone 01392 426022 Email <a href="mailto:nimh@ukexeter.freeserve.co.uk">nimh@ukexeter.freeserve.co.uk</a> Professional body - offers a service for you to find a trained and qualified herbalist.   FOR DIET ADVICE: BRITISH NUTRITION FOUNDATION <a href="http://www.nutrition.org.uk/">www.nutrition.org.uk</a> Telephone 0207 404 6504 Includes advice on finding a dietician BRITISH DIETETIC ASSOCIATION <a href="http://www.bda.uk.com/">www.bda.uk.com</a> FOOD STANDARDS AGENCY <a href="http://www.eatwell.gov.uk/">www.eatwell.gov.uk</a> BBC HEALTH <a href="http://www.bbc.co.uk/health/healthy_living/nutrition">www.bbc.co.uk/health/healthy_living/nutrition</a> NHS DIRECT <a href="http://www.nhsdirect.nhs.uk/encyclopaedia">www.nhsdirect.nhs.uk/encyclopaedia</a>   FOR MEDITATION: THE SHOLLOND TRUST <a href="http://www.headless.org/">www.headless.org</a> tel. 020 8806 3710 - Richard Lang, Trust Co-ordinator The Trust offers a form of meditation you can do any time, any place, in any circumstances. It’s astoundingly easy to do, and it’s free. It’s also a great way to get the best out of and appreciate all other meditation and complementary techniques. THE BBC <a href="http://www.bbc.co.uk/">www.bbc.co.uk</a> and search “meditation”. A wide range of options. THE HITCHHIKER’S GUIDE TO THE GALAXY <a href="http://www.bbc.co.uk/dna/h2g2">www.bbc.co.uk/dna/h2g2</a> Ask the guide about meditation. In fact ask it about any question you have. FOR COUNSELLING: BRITISH ASSOCIATION FOR COUNSELLING AND PSYCHOTHERAPY (BACP) <a href="http://www.bacp.co.uk/">www.bacp.co.uk</a> Telephone 0870 443 5252 Email bacp@bacp.co.uk A fisrt reference for anyone seeking information on counselling and psychotherapy in the United Kingdom. They have a helpful and easy to use search tool to find a therapist. THE SAMARITANS <a href="http://www.samaritans.org/">www.samaritans.org</a> Telephone 08457 90 90 90 (24 hours, seven days a week) Email <a href="mailto:jo@samaritans.org">jo@samaritans.org</a> Confidential non-judgemental support, 24 hours a day for people experiencing feelings of distress or despair. MIND <a href="http://www.mind.org.uk/">www.mind.org.uk</a> Telephone 020 8519 2122 Mind Infoline 0845 766 0163 (Monday-Friday 9:15-5:15) Email <a href="mailto:contact@mind.org.uk">contact@mind.org.uk</a> The MindinfoLine offers confidential help on a range of mental health issues from anywhere in the UK for the price of a local call. Local MIND associations offer supported housing, crisis helplines, drop-in centres, counselling, befriending, advocacy, employment and training schemes and other services. RELATE <a href="http://www.relate.org.uk/">www.relate.org.uk</a> Tel. 0845 456 1310 or 01788 573241 Relate is the UK's largest provider of relationship counselling and sex therapy. They also offer a range of other relationship support services. CRUSE BEREAVEMENT CARE <a href="http://www.crusebereavementcare.org.uk/">www.crusebereavementcare.org.uk</a> Day-to-day helpline: 0870 167 1677 Help for bereaved people, whatever their age, nationality or beliefs, including a free counselling service. FOR CARE SERVICES: COUNSEL AND CARE <a href="http://www.counselandcare.org.uk/">www.counselandcare.org.uk</a> Advice line 0845 300 7585 (weekdays 10am-12.30pm and 2pm-4pm) A national charity getting the best care and support for older people, their families and carers SUE RYDER CARE <a href="http://www.suerydercare.org/">www.suerydercare.org</a> 020 7400 0440 Cares for people with life-shortening illnesses through specialist hospice care services. THE PRINCESS ROYAL TRUST FOR CARERS <a href="http://www.carers.org/">www.carers.org</a> Telephone 020 7480 7788 Email help@carers.org The trust is the largest provider of comprehensive carers support services in the UK CARERS UK <a href="http://www.carersuk.org/">www.carersuk.org</a> Free Carers Line 0808 808 7777 (weekdays 10am-12pm and 2pm-4pm) Email info@ukcarers.org Carers UK is the voice of carers and the leading campaigning, policy and information organisation for carers. Provides information and advice on topics relating to caring. CARERS NATIONAL ASSOCIATION <a href="http://www.carersuk.org/">www.carersuk.org</a> Provides information and advice for carers and works for carers rights. CROSSROADS (The Association of Crossroads Care Attendant Schemes) <a href="http://www.crossroads.org.uk/">www.crossroads.org.uk</a> Tel: 0845 450 0350 Practical support for carers; respite care at home. Provides trained care support workers to allow carers the breaks and time off they need. CARE CHOICES LTD <a href="http://www.careselect.co.uk/">www.careselect.co.uk</a> Tel: 0800 389 2077 Care Choices Ltd offers a free residential/care home search service. The company has a database of care homes, nursing homes, elderly accommodation and similar establishments throughout the UK. HOSPICE INFORMATION <a href="http://www.hospiceinformation.info/">www.hospiceinformation.info</a> Tel: 0870 903 3903 Publishes a directory of hospice and palliative care services.   FOR GENERAL UK HEALTH HELP, ISSUES and the NHS: NHS DIRECT ( <a href="http://www.nhsdirect.nhs.uk/">www.nhsdirect.nhs.uk</a> ) - see First Resources PATIENTS ASSOCIATION <a href="http://www.patients-association.com/">www.patients-association.com</a> Helpline: 0845 608 4455 Represents the views and interests of patients and campaigns for improved health services. Provides advice, factsheets and self-help guides. DR FOSTER <a href="http://www.drfoster.co.uk/">www.drfoster.co.uk/</a> Telephone 0207 332 8800 Works with the NHS to make it easier for professionals and the public to access health and social care information. Hospitals, consultants, complementary therapies and much more. PALS - PATIENT ADVICE AND LIAISON SERVICE (<a href="http://www.dh.gov.uk/">www.dh.gov.uk</a>) This web address will take you to the Department of Health website. Click on Patient Advice and Liaison Service to find your local PAL. Information and help with any questions or problems you have about your GP service, NHS hospital or other NHS service. EQUIP - ELECTRONIC QUALITY INFORMATION FOR PATIENTS <a href="http://www.equip.nhs.uk/">www.equip.nhs.uk</a> NHS search website for patient information on a very wide variety of conditions. RSVP - RETIRED AND SENIOR VOLUNTEER PROGRAMME <a href="http://www.csv-rsvp.org.uk/">www.csv-rsvp.org.uk</a> Advice and help for over 50’s by over 50’s: Transport for medical care, practical and domestic help, avoiding isolation, help for over 50’s in GP surgeries. LTCA - LONG TERM CONDITIONS ALLIANCE <a href="http://www.ltca.org.uk/">www.ltca.org.uk</a> An umbrella body for voluntary organisations. Promotes access to services, support, and knowledge for self-help. Includes an “Expert Patients” programme with the NHS. Look at the directory of member organisations on their website for the help you need, or RING THEM on 02078153637. PATIENT CONCERN <a href="http://www.patientconcern.org.uk/">www.patientconcern.org.uk</a> Helpful advice on how to survive medical treatment and the NHS, how to assess medical websites and more. FOR EXERCISE: There are many possibilities to choose from, and you may be surprised what you can do and what you’ll enjoy. Just be sure to get your doctor’s and/or physiotherapist’s advice on any medical limitations and what to avoid. SIMPLE WAYS to look at the possibilities are with the help of: THE BBC - Go to <a href="http://www.bbc.co.uk/health">www.bbc.co.uk/health</a> BANDOLIER - go to <a href="http://www.jr2.ox.ac.uk/bandolier">www.jr2.ox.ac.uk/bandolier</a> and see Exercise in their healthy living section THE NHS Health encyclopaedia: <a href="http://www.nhsdirect.nhs.uk/">www.nhsdirect.nhs.uk</a> in our FIRST RESOURCES section has good information. THE COMPLIMENTARY HEALTHCARE INFORMATION SERVICE <a href="http://www.chisuk.org.uk/">www.chisuk.org.uk</a> links to all the main movement therapy exercise techniques. A one-stop convenience shop. And specifically for: TAI CHI - local adult education courses, local gym, fitness centre, library listing or the TAI CHI UNION OF GREAT BRITAIN - <a href="http://www.taichiunion.com/">www.taichiunion.com</a> PILATES <a href="http://www.pilatesfoundation.com/">www.pilatesfoundation.com</a> YOGA <a href="http://www.bwy.org.uk/">www.bwy.org.uk</a> DANCING - ballroom, tap, folk, flamenco, modern, social, jazz… too many styles to list. Once again the easy place to start is THE BBC. Go to <a href="http://www.bbc.co.uk/health">www.bbc.co.uk/health</a> and look under dance. Also many classes locally in many styles. GYMS / CIRCUIT TRAINING / SPORT - Infinite options. BBC Health provides guidance. <a name="compalt2" id="compalt2"></a>  EXERCISE IN WATER: AQUA-CHI <a href="http://www.taichiunion.com/">www.taichiunion.com</a> AQUA-GYM <a href="http://www.aquagym.co.uk/">www.aquagym.co.uk</a> POOLATES <a href="http://www.poolates.co.uk/">www.poolates.co.uk</a> Pilates in water. AQUA-DANCE classes at local pools or <a href="http://www.virginactive.co.uk/">www.virginactive.co.uk</a> for classes at their gyms   FOR GENERAL SELF-HELP ON MOST SUBJECTS: DIRECTORY OF UK SELF-HELP GROUPS www.ukselfhelp.info/ This is a remarkably complete A-Z of self-help organisations on just about any health subject you can think of and life problems of most kinds. FOR PRACTICAL GENERAL INFORMATION ON MOST SUBJECTS: <a href="http://www.about.com/">www.about.com</a> <a href="http://www.bbc.co.uk/">www.bbc.co.uk</a> <a href="http://www.bbc.co.uk/dna/h2g2">www.bbc.co.uk/dna/h2g2</a> <a href="http://www.wikipedia.org/">www.wikipedia.org </a> <a name="Heart" id="Heart"></a>  FOR PHYSICAL AIDS AND EQUIPMENT - ACCESS, MOBILITY AND PRACTICAL HELP: DISABLED LIVING FOUNDATION (DLF) <a href="http://www.dlf.org.uk/">www.dlf.org.uk</a> Tel: 020 7289 6111 Helpline: 0845 130 9177 Text phone: 020 7432 8009 DLF are the leading source of information on disability equipment - free, impartial advice about all types of equipment and mobility products INDEPENDENT LIVING FUNDS <a href="http://www.ilf.org.uk/">www.ilf.org.uk</a> Tel: 0845 601 8815 Email: client.service@ilf.org.uk The funds were set up as a national resource dedicated to the financial support of disabled people enabling them to choose to live in the community rather than residential care. DISCOUNT MOBILITY PLUS LTD For scooters, wheelchairs, bathlifts, stairlifts, chairs <a href="http://www.discountmobilityplus.co.uk/">www.discountmobilityplus.co.uk</a> Tel: 0808 178 4151 DISABILITY ALLIANCE www.disabilityalliance.org The leading authority on social security benefits for disabled people Tel: 020 7247 8776 MOBILISE - THE DISABLED DRIVERS’ ASSOCIATION <a href="http://www.justwebs.co.uk/mobilise/">www.justwebs.co.uk/mobilise/</a> Tel: 01508 489449 (Representation, information and advice on mobility issues) DISABILITY RIGHTS COMMISSION <a href="http://www.drc-gb.org/">www.drc-gb.org</a> DRC Helpline Tel: 08457 622 633 Textphone: 08457 622 644 The Disability Rights Commission (DRC) is an independent body established in April 2000 by Act of Parliament to stop discrimination and promote equality of opportunity for disabled people. RELATIVES AND RESIDENTS ASSOCIATION www.relres.org Tel: 020 7359 8136 Provides information and support about carehomes. ROYAL ASSOCIATION FOR DISABILITY AND REHABILITATION (RADAR) www.radar.org.uk Tel: 020 7250 3222 Minicom: 0207 250 4119 RADAR is concerned with every aspect of disability, but is particularly involved with access, education, employment, holidays, housing, mobility and social services. CITIZENS ADVICE BUREAUX (CABx) <a href="http://www.nacab.org.uk/">www.nacab.org.uk</a> The website gives local offices, opening times and specialist services. AGE CONCERN AID CALL <a href="http://www.aidcall-alarms.co.uk/">www.aidcall-alarms.co.uk</a> T: 0800 77 22 66 Emergency alarms to stay independent but summon help if needed MEDIC ALERT FOUNDATION <a href="http://www.medicalert.co.uk/">www.medicalert.co.uk</a> tel 02078333034 Medical identification, cards, bracelets, necklaces etc with information on call for emergency treatment. Knowing your chronic problems and what medications you’re on can make a critical difference for any doctor or emergency worker treating you in any situation. <a name="working" id="working"></a>     FOR FIRST AID TRAINING - and we always recommend this as part of learning to take care of ourselves and each other: RED CROSS <a href="http://www.redcross.org.uk/">www.redcross.org.uk</a> ST JOHN’S AMBULANCE <a href="http://www.sja.org.uk/">www.sja.org.uk</a> ST ANDREW’S AMBULANCE (Scotland) <a href="http://www.firstaid.org.uk/">www.firstaid.org.uk</a> For those of us who have had a cancer diagnosed, it can often be overwhelming and frightening. We know from experience, however, that cancer is a journey which can have surprising results. The treatment and expectations for many cancers are far better now than they were even a few years ago, and continue to improve. There’s also an enormous amount of complementary help and things we can learn to do in our own lives to get more benefit and less damage from our treatment. In addition to its dark and sometimes awful aspects, the cancer journey can be enlightening, love enhancing and bring great depth to living. These pages are intended as a clear and simplified guide. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/c1.jpg" /></div> Combining advanced medical practice with supporting and complementary therapies makes it increasingly possible to do what the very excellent Penny Brohn Cancer Care (formerly Bristol Cancer Help Centre) describes as its goals: <ul type="disc"> <li>Have quality of life in the presence of illness </li> </ul> <ul type="disc"> <li>Live well with cancer </li> </ul> <ul type="disc"> <li>Have an impact on your own wellbeing and health</li> </ul> It’s because things have changed so much that we include cancer with the “chronic conditions” common to older people. The realism of the goals above mean that many cancer conditions are now effectively chronic in that we need to learn to live well and have quality of life with them. Let’s not pretend that most cancer has become a stroll in the park. It hasn’t. Sometimes, and for some forms, it can be an extremely hard journey. Our job here is to help you find your way as directly as we can to the knowledge, assistants, protection, and good discoveries you’ll need along the way. MEDICAL TREATMENT will of course play an absolutely central role in dealing with any cancer. It will seek to stop or at least limit the disease, help to overcome the sometimes damaging side-effects of treatment, and deal aggressively with pain. We emphasise this and will say more about it because there is no point to being, and no need to be, in unnecessary pain. It can and should be alleviated. Advanced medical treatment is the bottom line. That said, cancer specialists and caring organisations are clear that COMPLEMENTARY TECHNIQUES and self-help are not side issues when it comes to cancer. The professionals who deal with it know from experience that there is no such thing as a separate body and mind. What we can learn to do mentally, emotionally and spiritually can both change the course of our disease and completely transform the experience of living with cancer. We are not talking about the far reaches of alternative thinking or religion here. The Bristol Approach is just one demonstration of the fundamental and medically accepted importance of complementary approaches. HOW WE’LL DEAL WITH CANCER It’s important to have the factual basics, so we’ll start with a summary drawn from some of the sites and organisations we recommend. This will include information you may already have about what cancer is and the MEDICAL approach to it. What we offer is a broad medical overview of the cancer territory, and easy signposting to take you to any level of further detail or help you want about any specific area. Once we’ve laid out the medical territory, much of our focus will be on the COMPLEMENTARY aspects of dealing with cancer. By this we mean therapies, techniques, lifestyle changes and learning which support and help improve the outcome of medical treatment. Everything from unavoidable fear to physical weakness gets in the way of healing. These are not side issues. They’re important. Dealing with them can promote healing from cancer, and also healing, deepening and getting more from our lives than we ever thought possible. The sea of information about most chronic conditions is enormous, and can easily be confusing. The information available on living with cancer seems endless, often contradictory and of very variable quality. We will limit ourselves here to remarkably few sources. We really think that “less is more” with cancer information, and that the few organisations and sources we’re concentrating on can take you anywhere you need to go. In our Useful Organisations section we’ll stay very selective, while offering a wider range of help and information. If you think we’ve missed anything in focusing down like this, please let us know. <a name="Basics" id="Basics"></a>     THE BASICS: Merck Geriatric tells us that: although cancer occurs in people of every age, it is fundamentally a disease of ageing. Sixty percent of new cancer cases and two thirds of cancer deaths occur in people 65 and over. Incidence of many cancers levels off after age 80, however, suggesting the possibility of resistance to the development of cancer in late life. HELP THE AGED responds to the age factor, giving cancer and its treatment prominence. Their website is excellent on the subject, they work to protect the interests and right to the best medical help for older people, and we appreciate the fact that you can ring them for help and advice on cancer and all the related issues. Equally, advice from CANCER RESEARCH UK and CANCERBACKUP will strongly feature here. More later and in Useful Organisations about what they, Macmillan Cancer Support, Marie Curie Cancer Care and other excellent resources offer - and how they can help. For now we begin with our digest of factual essentials, drawing from their websites. OLDER PEOPLE AND CANCER It has been said that the only reason we don’t all get cancer in our later years is that most of us die of something else first. Half of all cancers appear in people aged 70 or over - so it pays to know your body and talk to your doctor about any unexplained symptoms, even if they only seem to be vague changes. Screening techniques can discover cancer developing at an early stage - when it can be far more easily and effectively dealt with. Cancerbackup (see our Useful Organisations) can make screening easy to access, understand and do. Breast and prostate cancer are two for which our age-group should particularly be screened. Health problems can be very intimidating and cancer is possibly the biggest taboo of all. It’s tempting to just not want to know. Life is tough enough without thinking about cancer. Big mistake. The earlier a cancer is diagnosed and treated, the more likely you are to be in a position of living very well with and overcoming it. Try not to put new symptoms or changes in your body down to 'just my age' and ignore them. Compared to the rest of Europe, people in the UK tend to have a more advanced stage of breast and bowel cancer by the time they are treated. There are a number of possible explanations for this (such as waiting times for hospital appointments) but one factor may be our national characteristic of being a bit reticent. In the case of cancer we need to start standing up for ourselves. We’re a durable and philosophical age group. We don’t need to be shy about this. We can save ourselves and the health service a lot of grief by telling our doctors about any unusual physical changes. See a doctor if you notice: a lump, or a sore which does not heal, including in the mouth a mole which changes in shape, size or colour any abnormal bleeding a persistent cough or hoarseness changes in your toilet routine any unexplained weight loss Speaking up and asking for clear information or a second opinion could be a very important first step to staying healthy. We’ve heard people in our age group say that they feel or have been told that there’s little point or hope in seeking advanced medical treatment for cancer because they’re too old. This is a point on which we must quote and add our own emphasis to Help the Aged: You are never too old to be treated for any condition and that includes treatment for cancer. More about this later under Self-Help.   WHAT CANCER IS Our bodies are made up of cells that regularly duplicate and renew themselves in a controlled and limited way to stay healthy. If this process of healthy renewal goes wrong, some cells can grow out of control and start to harm the healthy tissues around them. With the body unable to correct the mistake this uncontrolled growth becomes cancer. If cells in the bone marrow start to duplicate out of control it’s called leukaemia. In all other parts of the body, the extra duplicating cells develop into solid lumps called tumours. Pretty much any part of the body can be affected by cancer. A tumour is benign when it isn’t growing aggressively and affecting the healthy cells or tissues around it. The term malignant is used if a tumour is growing quickly and affecting other tissues. Cells can break off from a malignant tumour and start to grow in another part of the body, this is known as a secondary tumour. STAGES OF CANCER There are over 200 different kinds of cancer. Each kind is a separate condition with its own characteristics, but there are general terms like ‘staging’ used for most. The stages describe how advanced the progress of a cancer is. In many cancers there are four main stages: STAGE ONE: The tumour is very small and has not spread outside the original site. There are usually no symptoms and the tumour cannot be felt. Stage one tumours are normally detected by chance or during a routine medical examination. STAGE TWO: The tumour is still localised, but may be felt during examination or may show up on scans. STAGE THREE: A tumour which has spread to tissues immediately alongside the original site. STAGE FOUR: A tumour which has spread more widely to other, often distant, organs such as the liver, lungs and the lymphatic system. This is known as secondary cancer, or metastatic disease. The cancer has metastasised, or spread. <a name="CAUSES" id="CAUSES"></a>  CANCER RESEARCH UK has websites providing truly extensive information about the forms, diagnosis and medical treatment of cancer. Drawing from their information we can start to look at the crunch question: I HAVE CANCER. WHAT AM I DEALING WITH AND HOW CAN IT BE TREATED? Cancers start to develop because some of the information carried in the cell's DNA becomes altered in certain ways. This altered information can tell the cell to carry on and on growing and dividing instead of stopping. There are many different types of cells in the body and any of them can become cancerous, so there are many different types of cancer. Because cancer cells carry on dividing, cancerous tumours grow. As the cancer grows, it invades the body tissues surrounding it. This is harmful to the body because it damages these surrounding normal tissues. The ability of cancer to spread further increase the harm and can make the disease extremely difficult to deal with. The staging system we’ve described is a way of describing how advanced a cancer is and whether spreading (metastasising) is a factor. When cells become cancerous they don’t just keep multiplying out of control, they can also have a tendency not to hold together well. This means that they can spread and start to move around the body. Some cancers are more likely to spread than others. Doctors know where cancers are likely to spread - different cancer types are more likely to spread to particular parts of the body. Because doctors know where a cancer is likely to go next, they may often attempt to prevent it getting there. CAUSES of cancer may include genetic, environmental (sun, chemicals and other work environment hazards) diet, smoking, certain viruses and others. It seems likely that a number of different factors are often combined. Why did you get cancer and not someone else? Chance as much as anything. A combination of causes. A technical term Cancer Research UK uses is “ bad luck”, but… some things make it more likely that someone may be unlucky enough to get cancer. Some people have genes that make it more likely that they will get cancer. Some have genes that protect them. Things around us can also damage our genes and make a cell cancerous. This includes poisons in cigarette smoke and radiation. Age is a major additional factor. Genetic damage piles up over time, so just ageing can make cancer more likely. Genetic malfunctions and damage leading to cancer can come in many forms. Some genes encourage cells to multiply or 'double'. Normally, in adults, this would not happen very often. Cells would only multiply to repair damage, for example after a wound or operation. But if these genes become abnormal, they tell the cell to multiply all the time. These are referred to as oncogenes (meaning cancer genes). Tumour suppressor genes exist in cells specifically to stop the cell multiplying or doubling. They act as the brake to the oncogene's accelerator. If one of these 'tumour suppressor genes' becomes damaged and stops working, then the cell may carry on and on multiplying. In other words it becomes immortal, which is one of the properties of a cancer cell. The best known tumour suppressor gene is called p53. This gene normally stops cells with other damaged genes from reproducing and encourages them to commit suicide (apoptosis). p53 is damaged or missing in most human cancers. In addition, genes that normally repair other damaged genes can themselves be damaged. It can take a long time before enough mutations happen for a cell to become cancerous. This is why many cancers are more common in older people. There has been more time to be exposed to all kinds of damage, and for accidents when cells reproduce.   PRIMARY AND SECONDARY CANCER The place where a cancer begins is called the primary cancer. From there cancer cells can break away and be carried in the blood or lymphatic system to other parts of the body where they can start to grow new tumours. Cancers can also spread to nearby body tissues. For example, lung cancer can spread to the lining of the chest, the pleura. Ovarian cancer can spread to the lining of the abdomen (the peritoneum). Tumours from cancers that have spread are called secondary cancers. The areas of spread are called 'metastases', and a cancer that has spread has 'metastasised'. The various organs of the body are made up of different types of cells. Any of these cell types can grow into a primary cancer. Cancers from different cell types behave differently. They can: Grow at different speeds Have various effects on the body by releasing chemicals into the blood Be more or less likely to spread in the blood Respond differently to drugs or radiation treatments Cancers can cause different symptoms in different people because of where they are located. A cancer may press on a nerve, or another body organ that is nearby. They can also cause symptoms by releasing chemicals or hormones into the bloodstream. The place where the cancer starts also affects what treatment can be used, because doctors have to take into account the risk of damaging neighbouring organs. GRADE The grade of your cancer refers to how well developed or mature the cell looks under a microscope. The more the cancer cell looks like a normal cell, the more it will behave like one. The more normal a cancer cell looks, the lower its grade. Cancer cells are more primitive and less well developed than normal ones, and tend to get increasingly primitive. A cancer cell is assigned a higher grade the more primitive and abnormal it is. Differentiation refers to the grade of cancer cells. A well differentiated cell is close to normal, grade 1. A moderately differentiated cell is more primitive and abnormal, or grade 2. A poorly differentiated cell is primitive, very poorly developed and abnormal, or grade 3. Although there are several ways of talking about grade and differentiation, it all comes down to the same thing. A low grade cancer is likely to be less aggressive in its behaviour than a high grade one.   TYPES OF CELLS / TYPES OF CANCER Over 200 kinds of cancer. We will not waste time cataloguing them. Let’s just say that they have similarities. There’s one disease called cancer, not many diseases. That said, different cancers behave differently and have very different meanings in terms of your health and what you can expect. Cancer is one disease, but some forms once treated may have little impact on your ongoing health. Others may have a very big impact, and some may not be effectively treatable other than in terms of protection from pain and dealing with symptoms and quality of life.   Cancer Research UK, from whom we quote extensively here, can give you as much detail as you want about the form of cancer you’re dealing with. Between them, CancerBackup and our other featured organisations in Useful Organisations, you can quickly learn what you want to know about any cancer. Our recommended organisations also offer telephone help and personal advice and support, so you can needn’t trawl the internet if you just want someone to give you clear information about the type of cancer you’re dealing with.   Briefly and in the spirit of overview, cancer type is determined by the type of cell which has become cancerous. EPITHELIAL TISSUE is basically skin tissue that covers and lines the body. As well as covering the outside of the body, epithelial cells cover the inside too. They cover all the body organs, for example the organs of the digestive system and line the body cavities such as the inside of the chest cavity and the abdominal cavity. Most cancers are cancers of the epithelial cells. Cancers of the epithelial cells are called carcinomas. Carcinomas make up about 85% of all cancers. There are different types of epithelial cells and these can develop into different types of cancer. For example, epithelial cells can be: <ul type="disc"> <li>Flat surface covering cells called squamous cells</li> <li>Glandular cells called adenomatous cells</li> <li>Layers of stretchy cells called transitional cells</li> </ul>   So you can have: <ul type="disc"> <li>Squamous cell carcinoma </li> <li>Adenocarcinoma of glandular cells </li> <li>Transitional cell carcinoma </li> <li> </li> </ul> Squamous cells and adenomatous cells are found in most body organs. Cancers are named after the body organ they grow in as well as the type of cell. So a cancer of the squamous epithelial cells covering the lung would be 'squamous cell lung cancer'. CONNECTIVE TISSUE is the name for the supporting tissue of the body, the bones, cartilage, tendons and fibrous tissue that supports the body organs. Connective tissue cancers are called sarcomas. Sarcomas can develop from bone, cartilage and muscle. Sarcomas are much less common than carcinomas. They are usually grouped into two main types - bone sarcomas and soft tissue sarcomas. Altogether, these make up less than 1 in every 100 cancers diagnosed (less than 1%). BLOOD AND LYMPH TISSUE - There are many different types of blood and lymph tissue cells. These are really specialised connective tissue cells. The blood cells are made in the bone marrow in tissue called haematopoetic tissue. Blood and lymph tissue can develop into <ul type="disc"> <li>Cancers of the blood cells - leukaemias</li> <li>Cancers of the lymphatic system - lymphomas</li> </ul>   Leukaemias and lymphomas make up about 7% of all types of cancer. OTHER BODY TISSUE cells can become cancerous. But these types of cancer are very rare. The biggest group of these rare cancers are brain tumours. Brain tumours develop from the cells that support the nerve cells in the brain, called glial cells. These cancers also get their names from the cells they developed from. So cancers of the glial cells are called gliomas.     <a name="diagnosis" id="diagnosis"></a>  DIAGNOSIS Tests to diagnose cancer and to see how treatment is progressing can involve a number of extremely helpful procedures. You may well benefit from several of them. We’ll list them here and follow with a description of each. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/c2.jpg" /></div> Tests can include: <ul type="disc"> <li>A CT SCAN or computerised X-ray. </li> <li>An MRI SCAN picturing your tissues using magnetism. </li> <li>ULTRASOUND using sound waves to scan with, and used for particular parts of the body such as the liver. </li> <li>BONE SCANS using a tiny amount of radioactive tracer to show up 'hot spots' in the bones. </li> <li>PET scans - a newer type of scan. They can be useful for telling the difference between scar tissue and cancerous tissue. You may also have a combined PET-CT scan, which gives a more detailed picture. </li> <li>A MAMMOGRAM - a low-dose x-ray of the breasts for breast cancer.</li> <li>A BONE MARROW TEST to look for cancer cells in the bone marrow.</li> <li>BARIUM X-RAY AND ENDOSCOPY, which are used to diagnose cancers in the digestive system. </li> <li>UROGRAM OR PYELOGRAM, which is an X-ray examination of the kidneys and bladder. </li> <li>LUMBAR PUNCTURE, which looks for cancer cells or infection in the spinal fluid. </li> <li>CYSTOSCOPY - an internal bladder examination </li> <li>LYMPHANGIOGRAM in support of or instead of a scan to look at the lymph nodes.</li> </ul>   THE CT or CAT SCAN - The letters stand for Computerised (Axial) Tomography. This means that the scanner takes x-ray pictures from all around your body and uses a computer to put them together. Effectively the doctor is seeing a series of cross sections or 'slices' through the part of the body being scanned. A very detailed picture of the inside of the body can be built up in this way. It can show very accurately where a tumour is, how big it is, and how close major body organs are to the area that needs to be treated or operated on. The scan is painless, but you may want to say in advance if you have trouble being in an enclosed space for a short time. Calming medications can be given if you do. Sometimes drinks, injections or other means are required to get contrasting materials into you to help the scan. Nothing dreadful, and your doctor will tell you if anything of this sort will be needed.   THE MRI SCAN - MRI stands for Magnetic Resonance Imaging. This type of scan uses magnetism to build up a picture of the inside of the body instead of X-rays. Like an X-ray, MRI is completely painless. On the down-side it is surprisingly noisy. The MRI scanner can be used for very accurate cross section views of the body, like the CT scanner. The main advantages of MRI scans are that they use no X-ray radiation, they can show up soft tissues very clearly and a single scan can produce many pictures from angles all round the body. The can’t be used for all parts of the body, because they’re affected by movement. No good for a mouth tumour, for example, because of the movement involved in swallowing or coughing. As with the CT scan, if you have problems being in an enclosed space say so in advance. Calming medication can be organised. THE MAMMOGRAM - A mammogram is a low-dose x-ray of the breast tissue. It is a test to look for early breast cancers. You will need to take off the clothes from the top part of your body, including your bra. The radiographer will then position you so that each breast is placed in turn on the x-ray machine and gently but firmly compressed with a flat, clear, plastic plate. The breast tissue needs to be compressed (squashed) to keep the breast still and to get the clearest picture with the lowest amount of radiation possible. Most women find this uncomfortable and for some women it is painful for a short time while the breast is being compressed. You will need to stay still for less than a minute while the x-ray is taken. Usually two mammograms are taken of each breast from different angles. ULTRASOUND SCAN - A sort of medical Sonar. The scanner uses sound waves. A microphone is passed over your body. Sound waves bounce off the structures inside your body, and are picked up again by the microphone as they bounce back. The microphone is linked to a computer. This turns the reflected sound waves into a picture. Painless and easily done. Ultrasound can if necessary also be used internally in the anus, vagina etc. Weird, but not too awful. BONE SCAN - A bone scan, or radionuclide scan, or scintigram, is usually done in the medical physics or nuclear medicine department of a hospital. A bone scan can look at a particular joint or bone. In cancer diagnosis, it is more usual to scan the whole body. The scan involves one injection, and is painless. You do have to drink as much as you can of whatever you like, and go amuse yourself for a couple of hours while the injection moves around. The injection of a radionuclide travels through the blood and collects in your bones. More of it tends to collect in areas where there is a lot of activity in the bone. 'Activity' means the bone is breaking down, or repairing itself. These areas of activity are picked out by the camera. They are commonly called 'hot spots'. Having 'hot spots' doesn't necessarily mean that there is cancer in your bones. Bone can break down and repair for other reasons. If you have arthritis, for example, this will also show up on the scan. PET SCAN - PET stands for Positron Emission Tomography. This is a fairly new type of scan developed in the 1970s. It can show how body tissues are working, as well as what they look like. Again, a single injection is required. PET scanners are very expensive and only a few hospitals in the UK have one. This means that you may have to travel to another hospital for your scan if you need to have one. BONE MARROW TESTS - to see whether there are cancer cells in your bone marrow, the doctor removes a tiny sample of bone marrow cells to look at under the microscope. The bone marrow sample is usually taken from the hip bone. A local anaesthetic is injected, and then a needle or needles are used to take the sample. The needle going into the hip bone can be painful, but it doesn't last for too long. Don’t hesitate to ask for a sedative before the test if this sort of thing is not your idea of an interesting experience. If you do have a sedative you may need to stay for a while until it has worn off, and you’ll need someone to go home with you. After the test, your hip may ache for a couple of days, and you may want to ask for an appropriate painkiller. BARIUM X-RAY - a test to look at the outline of any part of your digestive system. A barium swallow is most often used to look at the inside of the foodpipe (gullet or oesophagus) or stomach. A barium enema is looks at the lower bowel (colon) and back passage (rectum). Barium is a white liquid that shows up clearly on an X-ray. Once it is inside you, it coats the inside of the gullet, stomach or bowel and shows up the outline of the organs on the X-ray. If there is a tumour, it will show up as an irregular outline extending out from the wall of the affected body organ. Barium does not do you any harm and passes through your digestive system. A barium swallow makes some people feel sick. Over the couple of days following the test, barium may cause mild constipation and white stools at first. You have a barium enema if your doctor wants to look at the inside of your bowel. Not necessarily everyone’s idea of fun, but it shouldn’t be too uncomfortable physically. Preparing for this involves taking a laxative beforehand to clear out your bowel, as well as strict eating and drinking instructions for the day before and day of the test. After the test you may be constipated and your first couple of stools will be white. Your doctor can supply a mild laxative to take home in case of need.   ENDOSCOPY - An endoscopy is a test that looks inside the body. The endoscope is a long flexible tube that can be swallowed or inserted through the anus. For possible gullet (oesophagus), stomach and colon cancers it’s the main diagnostic tool. Note however that patients who can not have an endoscopy because of other health issues may be able to have a “virtual endoscopy” using a scanner. The endoscope, however, does more than look - it can allow the doctor to take biopsy samples of abnormal looking tissues. If the endoscopy sounds even less attractive than the Barium test, remember that: <ul type="disc"> <li>these people have done this before, and will use local anaesthetics as required.</li> <li>you can ask for a sedative to make you drowsy and calm</li> <li>you can ask for an anaesthetic injection to miss as much of the experience as possible.</li> </ul> IVU (INTRAVENOUS UROGRAM) OR IVP (IV PYELOGRAM) - An IVU or IVP is a test that looks at the whole of your urinary system. It looks at the kidneys, bladder and the tubes that connect them (ureters) The test uses a dye, also called contrast medium. This shows up the soft tissues of the urinary system on a normal X-ray. It can show if cancer is growing in any part of your urinary system. The cancer will show up as a blockage or an irregular outline on the wall of the bladder or ureter, for example. A small injection of dye is required which may make you feel a bit hot for a few minutes, but no pain at all involved. The dye circulates through your blood stream and goes to your kidneys. The doctors can then watch the dye on an X-ray screen, as it goes through your kidneys and then through the ureters to the bladder. X-rays are taken as the dye passes through your system.   LUMBAR PUNCTURE - A lumbar puncture is a test to check the fluid that circulates round the brain and spinal cord (the cerebrospinal fluid or CSF). For cancer, this test is usually done to see if there are any cancer cells in this fluid. But it is also used to look for infection. Having a lumbar puncture is not necessarily as bad as it sounds. The doctor will inject a little local anaesthetic to numb the area. Once the anaesthetic has worked, the doctor will push the needle very carefully into the small of your back. The needle goes into the space around the spinal cord. Once it is in the right place, it only takes a couple of seconds for enough fluid to drip out into a sterile pot because only a few drops are needed. Not the height of comfort, but the local anaesthetic works. Still expect some soreness and discomfort. Your doctor will probably ask you to lie flat for a few hours after the test. This helps to prevent headache afterwards. You may still get a headache after this test, so make sure you have or get some appropriate painkillers to take at home.  CYSTOSCOPY - A cystoscope is a thin tube with a light and eyepiece attached to it. The tube has optic fibres inside it. Through the eyepiece, your doctor can see down the optic fibres and into the inside of your bladder. You can have a cystoscopy under local or general anaesthetic, depending on what the doctor needs to do. This is the most important test for diagnosing cancer of the bladder. You may also have a cystoscopy if you are having investigations for other types of cancer, to see if there is any spread to the bladder. Cystoscopy under local anaesthetic is fast, and yes you are having a fine tube stuck up your urinary tract, but it is anaesthetised and painless. If samples of tissue may need to be taken you’ll have this done in hospital under a general anaesthetic. Again, painless, except either way you may be a bit sore when you first urinate. If large tumours are found in a cytoscopy under general anaesthetic, you will obviously need to stay to recover and you may need a catheter (a tube into the bladder) for a few days after the operation.

2008-11-27T10:43:10-08:00

THE MEDICAL TREATMENT OPTIONS we’ll be looking at depend on the type of cancer you have and the stage (size and spread). It may be possible to have: <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/c3.jpg" /></div> <ul type="disc"> <li>SURGERY to remove the cancer, but this can’t necessarily guarantee that every cell is gone and it won’t come back. Surgery deals directly with cancer by removing the cancer cells as much as possible. This often means also taking out healthy tissue to be sure cancer cells have not spread or will not spread to it. Obviously surgery can cause other problems in attempting to remove the cancer. </li> </ul> <ul type="disc"> <li>RADIOTHERAPY to kill cancer cells with radiation, but this also harms healthy tissue and functioning. </li> </ul> <ul type="disc"> <li>CHEMOTHERAPY to kill cancer cells with drugs, but again the side effects again can be serious. </li> </ul> <ul type="disc"> <li>HORMONE THERAPY - Some types of cancer need hormones to grow. Hormone therapy treats the cancer by cutting off the hormone supply. These different types of treatment can be given on their own or together. For some types of cancer, you may have all of them - breast cancer, for example (very much a disease of our age group).</li> </ul> <ul type="disc"> <li>BIOLOGICAL THERAPIES - Research into cancer treatment is going on all the time, lead by innovators like the Cancer and Polio Research Fund, the other dedicated groups we list under Useful Organisations, and many others. One major result of this worldwide effort has been the emergence of Biological Therapies. These use natural body substances (or drugs developed to block them) to fight cancer. </li> </ul> In our discussion of medical therapies below we’ll also look at new areas of cancer treatment including GENE THERAPY and STEM CELL TRANSPLANTS. Despite the most intensive treatment, it’s possible for some cancer cells to survive and begin to grow into a new tumour in the future. ADJUVANT TREATMENTS are treatments given alongside main cancer treatment. They try to reduce the risk of your cancer coming back by killing off any stray cells that might be there. MEDICAL TREATMENTS used for cancer are outlined below, using some of the excellent information from the CancerBackup and Cancer Research UK’s sites, edited and digested with reference to the Help the Aged website.   SURGERY Surgery is one of the main treatments for cancer. If you have a cancer that is completely contained in one area and has not spread, surgery may cure it by removing it. Since all the cancer cells must be removed, surgery may also have to remove seemingly healthy tissues around or connecting to the site of the cancer in the hope of leaving none behind. Because it is a local treatment focused on one area, surgery may not be the right choice, or not enough by itself, for people whose cancer has spread or is likely to spread to another part of their body. They may be offered a systemic treatment such as radio or chemotherapy, biological therapy, or hormone therapy as well or instead. Obviously a cancer like leukaemia can’t be cured by surgery because the cancer cells could be anywhere in your body. If surgery is possible, it may well cure a cancer. This will depend on: <ul type="disc"> <li>Whether the cancer can be completely removed </li> <li>Whether a border or margin of healthy tissue, free of cancer cells, is removed with the cancer </li> <li>Whether the cancer has already spread before the surgery</li> </ul> Sometimes, although all the scans look clear, cancer cells have already broken away from the primary cancer and travelled to another part of the body. These secondary cancers may just be too small to see and are called micrometastases. Sometimes the surgeon may also find that the cancer may have spread further than first thought. This may mean the operation takes longer, be more extensive, or not be worthwhile. Usually, the surgeon will remove the main lymphatic vessels and lymph nodes that are nearest to the cancer, or the organ where the cancer is. This is because the main draining lymph nodes and vessels are the most likely place for cancer cells to have spread. [NB. this removal can cause other problems which we discuss below. Don’t hesitate to get second opinions about the possibility of using other techniques for the same purpose]. Because there may be cancer cells that have broken away from the primary cancer, your doctor may recommend that you have radiotherapy or chemotherapy after your surgery. This is called 'adjuvant' treatment. Sometimes radiotherapy or chemotherapy are given before surgery to help shrink the cancer and make it easier to remove. This is called 'neo-adjuvant' treatment. There are always short term problems after any surgery, including pain, potential for infection, blood clots etc. You should expect good pain management. There is no need to be excessively strong about enduring pain. The hospital will help you to be mobile as soon as possible and use standard procedures to deal with the standard down-sides to surgery. Longer term problems after surgery don’t happen to everyone, but two notable ones are: Chronic nerve pain - sometimes starting a couple of months after an operation. This is due to nerve endings that were damaged during the operation growing back. It can last for a few months or longer. Usually it goes away, but very occasionally, it can be permanent. Nerve pain can be dealt with or at least effectively managed in a number of ways. See the Alliance pages on Chronic Pain. Lymphoedema is fluid build up. It usually occurs in an arm or leg, but can happen elsewhere in the body where lymph nodes have been removed. Most people will not get lymphoedema. But if you notice swelling in your hands or feet, after surgery to the armpit or groin, you should tell your doctor. Once lymphoedema has happened it cannot be cured, but if caught early it can be treated and controlled. Check CancerHelp UK about this, particularly if you are going to have an operation for breast cancer. If you are, talk to one of our suggested breast cancer organisations. Learn about the advantages and problems associated with particular operations from any of our recommended short-list in Useful Organisations. CHEMOTHERAPY Chemotherapy is treatment with anti-cancer drugs. You may have chemotherapy: <ul type="disc"> <li>To shrink a cancer before surgery </li> <li>To reduce the risk of a cancer coming back after surgery </li> <li>Along with radiotherapy </li> <li>By itself to cure a cancer </li> <li>To control symptoms and improve quality of life when a cancer is too advanced to cure </li> </ul>   There are over 50 different kinds of chemotherapy drugs used to destroy cancer cells. If several drugs are given at once the treatment is called combination chemotherapy. Chemotherapy drugs specifically target and destroy cells that divide, such as cancer cells. The drugs travel through the bloodstream, affecting cancer cells all over the body. Unfortunately they also affect other cells, particularly those that divide regularly such as hair follicles and those in the lining of the mouth, digestive system and bone marrow. This results in side effects such as nausea, diarrhoea, hair loss and an increased chance of developing infections. Chemotherapy treatment is designed to destroy as many cancer cells as possible whilst doing as little damage as possible to healthy cells. The healthy cells that are affected will be able to repair themselves over time. Different chemotherapy drugs cause different side effects, and some people may have very few. Cancer treatments cause different reactions in different people and any reaction can vary from treatment to treatment. It may be helpful to remember that almost all side effects are only short-term and will gradually disappear once the treatment has stopped. You should of course tell your doctor or chemotherapy nurse if you find that the treatment or its side effects are making you unwell. They may want to change your treatment, and can help you deal with the side-effects. The benefits of treatment should hugely outweigh the problems over time.   RADIOTHERAPY Radiotherapy is the use of X-rays or similar rays to destroy cancer cells and tumours. It may be given before or after surgery or chemotherapy, or possibly at the same time as chemotherapy, if so this is called chemoradiotherapy. As well as for curative purposes, radiotherapy can be given to people with terminal cancer to reduce the size of a tumour and thus help to relieve any pain that they may be feeling. The aim is to give the maximum dose of radiation to the tumour and the minimum to the healthy tissue around it. You may have radiotherapy: <ul type="disc"> <li>To shrink a cancer before surgery </li> <li>To reduce the risk of a cancer coming back after surgery </li> <li>Along with chemotherapy </li> <li>By itself to cure a cancer </li> <li>To control symptoms and improve quality of life when a cancer is too advanced to cure </li> </ul> Radiotherapy can be external or internal. External radiotherapy is a bit like having an X ray, although you will usually have a course of treatments. In some situations, your doctor may suggest just one treatment, for example to treat lung cancer, or cancer that has spread to the bones. The high energy rays are produced by a large machine and are directed at the part of the body being treated. Internal radiotherapy is radiotherapy from inside the body. This can be targeted radiotherapy in the form of a drink or injection. Or it may be radioactive wires or pellets implanted into the area where there is a tumour. While external radiotherapy can destroy cancer cells, it can also have an effect on some of the surrounding normal cells. The side effects that may occur are described in this section. It is important to remember that no person will have more than a few of them, and for many people they may be very mild. As radiotherapy affects people in different ways, it is difficult to predict exactly how you will react to your treatment. Before you start your treatment, the staff will discuss with you any likely side effects of the particular treatment you are having. They can also give tips on how to deal with them and how they can be treated. Being aware of side effects in advance can help you to cope with any problems that occur. Most side effects of radiotherapy disappear gradually once the course of treatment is over. However, the side effects may continue for a few weeks.   STEM CELL and BONE MARROW TRANSPLANTS Stem cell or bone marrow or transplants are used to treat a variety of different cancers. They are sometimes called stem cell or bone marrow rescue. This is because the bone marrow or stem cells are used to replace the cells in your bone marrow that have been killed off by high dose chemotherapy or total body radiotherapy. Stem cells are of course much in the news these days, and this therapy involves very early and undeveloped forms of blood cells. Red cells, white cells and platelets can all develop from them. They are normally found in the bone marrow, but doctors have found ways of getting them into the bloodstream so they can be collected more easily. These transplants can form part of a cure for some types of cancer. You can be given a very high doses of chemotherapy, sometimes with radiotherapy. The stem cells can then be used to replace those that the cancer treatment has killed off. Because you have the stem cells replacing the healthy ones the treatment has damaged, your body can tolerate higher doses of treatment to cure the cancer. Side effects of bone marrow and stem cell transplants are mostly about the more intense chemo and radiation therapies they’re allowing. Basically you’re having higher doses of these therapies, so their side effects can be more severe. The main side effects of the chemo and radio-chemo therapies - increased through these higher doses - are: Risk of infection Drop in red blood cells (anaemia) Risk of bleeding Sickness and diarrhoea Sore mouth Difficulty eating and drinking Feeling tired and run down All these side effects are at their worst when you have just had your transplant / treatment, and for a couple of weeks afterwards. When your blood counts start to rise you will start to feel better. There’s a huge list of Do’s and Don’ts associated with these transplants, and many effects to watch out for. Search or ring CancerBackup, Macmillan or one of our other suggested cancer organisations for everything you need to know. CancerHelp UK suggests you may want to ask your doctor some of the following questions about having one of these transplant and high dose therapy combinations: What are the long term side effects? Will this transplant cure my cancer? Will I be able to go back to work after this treatment? BIOLOGICAL THERAPY Biological therapies are treatments that use natural body substances or drugs made from natural body substances. They can help to <ul type="disc"> <li>Treat a cancer </li> <li>Control side effects caused by other cancer treatments such as chemotherapy</li> </ul> Biological therapies are also sometimes called Biological Response Modifiers (BRM's), Biologic agents, or simply ‘biologics’. The names refer the fact that they stimulate the body to respond biologically (or naturally) to cancer. There are many different types of biological therapy including immunotherapy treatments. Biological therapies are quite a different approach from chemotherapy and radiotherapy. They all help kill cancer cells, but doing so with natural body substances, or treatments developed from a natural body substances, has some clear advantages in being less destructive or toxic to normal cells. Many types of biological therapies for cancer are still in their experimental stages. They are currently not suitable for treating all types of cancers - but for some cancers they could be the best choice of treatment. Some biological therapies may be given as part of a clinical trial when other treatments, such as chemotherapy, are no longer working. Your cancer doctor is of course your reference about whether or not biological therapy is going to help your type of cancer or not. People sometimes use the terms ‘biological therapy’ and ‘immunotherapy’ to mean the same thing, but not all biological therapies are immunotherapies. Immunotherapy is treatment using natural substances that the body uses to fight infection and disease. In other words, substances that are part of the body's immune system. Because it uses natural substances, immunotherapy is one form of biological therapy. In fact, the first biological therapies for cancer were all immunotherapies. Other types of biological therapy have now been developed which are not immunotherapies. They use substances that are still natural, but are not part of the immune system. Among the classes of biological therapies are: MONOCLONAL ANTIBODIES - There is a lot of research going on into the use of monoclonal antibodies (MABs) to treat cancer. MABs are proteins, made in the laboratory from a single copy of a human antibody. Monoclonal just means ‘all of one type’. MAB’s act in the same way as immune system proteins that seek out and kill foreign matter in your body, such as bacteria and viruses. MABs are designed to recognise abnormal proteins on the outside of cancer cells. They can then seek out and kill these cancer cells. Different antibodies have to be made for different types of cancer. Perhaps the best known is the extremely importent new breast cancer drug Herceptin (Trastuzumab), which recognises breast cancer cells that produce too much of the protein HER 2 (are 'HER 2 positive'). Rituximab recognises CD20 protein on the outside of non Hodgkin's lymphoma cells. ADEPT is a treatment using antibodies that recognise bowel (colon) cancer. Most monoclonal antibodies are still experimental and are only being tested for a few types of cancer, but they are increasingly coming into use. This is exciting research because it may be possible to kill cancer cells without damaging other body cells. Thanks to pioneering work by the CANCER AND POLIO RESEARCH FUND and others, this remarkable approach to cancer has survived initial cancer establishment cynicism and now is well supported and developing. Other forms of biological therapy in use or development include: Cancer vaccines - the idea is to get the body to mount its own immune response, rather than make the antibodies in the laboratory and give them to the patient. Many vaccine approaches are being tried, and one preventing the major cause of cervical cancer is much in the news having been found effective and licensed. It is, however, early days for most vaccine development. BCG vaccine for bladder cancer is a type of immunotherapy but not really a ‘cancer vaccine’. It’s a vaccine for tuberculosis. As it happens it’s just also very effective for helping to stop early bladder cancers growing back in the bladder  Growth factors - Growth factors are natural substances that stimulate the bone marrow to make blood cells. We can now make some of these substances artificially and use them to increase the number of white blood cells, red blood cells and stem cells in the blood. Erythropoietin or EPO is a famous one, having been abused by cycle racers and athletes. It encourages the body to make more red blood cells, so increases your haemoglobin levels and the levels of oxygen in your body tissues. Other growth factors are being developed which may boost platelets but these are not yet in routine use. Cancer growth blockers - This type of biological therapy uses the substances cells use to signal to one another. Many of these signalling chemicals control the growth and multiplication of cells. Scientists have been able to make drugs that block these signals and so may be able to stop cancers from growing and dividing. Anti angiogenesis treatment - 'Angiogenesis' means the growth of new blood vessels. Cancers need to grow their own blood vessels as they get bigger. Without its own blood supply, a cancer cannot continue to grow because, as it gets bigger, the cancer cells will be too far away from a supply of food and oxygen. Anti angiogenic drugs are a type of biological therapy that stops tumours from developing their own blood vessels. Two of the better known examples are: <ul type="disc"> <li>Thalidomide, mainly for treating myeloma but also in trials for other types of cancer. </li> <li>Avastin (Bevacizumab), a type of monoclonal antibody that has been investigated for bowel cancer.</li> </ul>   Interferon alpha - Interferon alpha was one of the first immunotherapies used to treat cancer. It is a natural substance produced in the body, in very small amounts, as part of the immune response. Now that it is possible to make it in the laboratory, doctors can use it in much larger quantities as a treatment to boost the immune system and help fight cancer. Interferon alpha can help to stop cancer cells growing. It may also boost the immune system and so help it attack the cancer, and it may affect the blood supply to the cancer cells. In cancer care, doctors use interferon most often to treat melanoma, kidney cancer and myeloma. Interleukin 2 (IL-2)- Interleukin 2 (IL-2) is a protein made naturally by the body as part of the immune system. When made artificially in the laboratory, it is called 'aldesleukin'. It may also be called IL2, interleukin 2, aldesleukin or Proleukin. In cancer care, it’s most often used to treat kidney cancer.   Gene Therapy - Gene therapy may be used to treat cancer in the following ways: <ul type="disc"> <li>specially made genes could be put into the cancer cells to make them more sensitive than normal cells to treatments such as chemotherapy </li> </ul> <ul type="disc"> <li>genes may be given into cancer cells and then activated to produce a poisonous substance (toxin) that kills the cell </li> </ul> <ul type="disc"> <li>genes could be introduced into cancer cells which make those cells more obvious to the body’s own defences (the immune system), so that they are destroyed 'naturally' by the cells of our immune system </li> </ul> <ul type="disc"> <li>damaged genes may be replaced by the correctly working version </li> </ul> <ul type="disc"> <li>new genes could be put into normal cells to make them more resistant to the side effects of treatment such as radiotherapy and chemotherapy. This protects the normal cells from the treatments so that higher doses can be given. At present the risk of damage to normal cells often limits the doses that can be used.</li> </ul>   This is new medicine, and mostly happening in research labs or clinical trials.   Hormone therapy - Hormone treatments are treatments using sex hormones, or drugs that work against these hormones to treat cancer. This type of treatment is only used for particular types of cancer that are called 'hormone sensitive' or 'hormone dependent'. These cancers are <ul type="disc"> <li>Breast cancer </li> <li>Prostate cancer </li> <li>Uterine (womb) cancer</li> </ul> Hormone treatments are also sometimes used for kidney cancer, thyroid cancer and melanoma. 'Blocking' sex hormones: This type of treatment is used for breast and prostate cancer. These cancers are hormone dependent. The cancer cells are stimulated to grow by oestrogen (breast cancer) or testosterone (prostate cancer). The drug Tamoxifen is taken by women with breast cancer to stop oestrogen from getting to the breast cancer cells. Drugs called aromatase inhibitors block oestrogen in women who have been through the menopause. There are also quite a few different hormone treatments used for prostate cancer to stop testosterone from getting to the cancer cells. Giving hormones as treatment - For some cancers, taking hormones can cause them to shrink. These treatments are often used for advanced cancers. But they can also be used to try to prevent recurrence in some cases. Progesterone is sometimes given to treat uterine cancer or kidney cancer.   PALLIATIVE CARE People who have been diagnosed with cancer may also be offered palliative care, especially if the cancer is at an advanced stage and other treatment is not possible. Palliative care is provided by a team of professionals and aims to improve quality of life. The idea is to prevent and relieve suffering by identifying, assessing and treating pain and other problems. Palliative care: <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/c4.jpg" /></div> <ul type="disc"> <li>intends neither to hasten or postpone death; </li> <li>affirms life and regards dying as a normal process; </li> <li>offers a support system to help patients live as actively as possible until death; </li> <li>offers a support system to help the family cope during the patients illness and in their own bereavement; </li> <li>uses a team approach to address the needs of patients and their families, including bereavement counselling, if needed; </li> <li>integrates the psychological and spiritual aspects of patient care.</li> </ul> A member of the palliative care team might offer advice on managing physical symptoms such as breathlessness, nausea and loss of appetite. Or they could help patients and family members to understand their feelings. They can also help with practicalities like arranging care at home. Palliative care services should be available to all patients, if and when they need them. Your doctor will supply help and information about this. Cancerbackup and Macmillan can tell more, and Marie Curie Cancer Care are the specialists for everything you need to know and the actual care you need. END OF LIFE issues come up here. We are inevitably facing fear, helplessness and loss at this stage. As far as we can see, Marie Curie Cancer Care is the go-to organisation at this time. Ask them about hospice care, respite breaks for those caring for someone at home, and expert free home nursing care. We’ve been in the position ourselves of not know which way to turn until we discovered that nursing and hospice care at home can be arranged. Cancerbackup and Macmillan can also help in this regard. Some of the Complementary Techniques we describe below can also help make end of life a powerful and even a wonder-full time. Hard to believe, but true. Complementary techniques and Self-Help are our next subjects. For living with and getting over both cancer and the side effects of treatment they are critically important. For terminal cancer we would suggest that some of them could also make a life-changing and death-changing difference. With regard to all the treatment options we’ve discussed above, it may be helpful to note the following, adapted from Merck Geriatric’s advice on cancer treatment for older people: Age per se is not usually the deciding factor as to whether aggressive treatment is warranted. Merck says all the forms of medical treatments for cancer can work for us. Advances in a number of areas have made the use of chemotherapy safer for older people, although other conditions of ageing may rule out - or make chemotherapy less well tolerated by - some elderly patients. Nausea and vomiting from chemotherapy, however, tend to be less intense in the elderly. Radiation therapy has also become more tolerable and safer with newer technologies and improved techniques. Older people have some special problems to watch out for, but even some seemingly frail elderly patients can tolerate modern radiation therapy. Pain control is especially important in the care of older cancer patients. Although pain control is often considered part of end-of-life care, persons with cancer may have chronic pain or intermittently painful complications of cancer during any stage of their disease and it may continue over the course of many years. The goal is to achieve an acceptable level of pain control with tolerable adverse effects. Merck strongly advises that comfort must be emphasized and the patient reassured that pain will be aggressively managed. Opioids are used to treat severe pain… Addiction should not be an issue for prescribers, and patients should be reassured that fear of addiction should not affect their use of these drugs. [See the Alliance pages on Chronic Pain on this website for more on this subject.] TRYING EXPERIMENTAL TREATMENTS - You may be given false hope by reading about all the splendid new approaches to cancer, including the disposable newspaper miracle cure stories. There are clinical trials of advanced and new treatments going on, and you can ask your cancer specialist if one might be appropriate for the condition you’re dealing with. Remember, however, that a trial could wind up giving you worse treatment as a control subject than if you had stayed out of it. The experiment itself could also be worse than the disease. This is not to say that a new treatment might not work wonders, but be very cautious.   CURE OR REMISSION? These days, some cancers have very high cure rates. Testicular cancer, for example, is usually cured even if it has spread. Other cancers can return many years after they have first been treated. So you may find your doctor very unwilling to use the word 'cure' even though there is no sign that you have any cancer left. Your cancer will be said to be in remission. This means there is no sign of cancer in your body. If there are any cancer cells left: There are too few to find There are too few to cause any symptoms They are in an inactive state and are not growing You may be on some form of long term treatment to try to keep any remaining cancer cells in an inactive state, for example, tamoxifen for breast cancer. Being on this type of long term treatment doesn't mean your cancer is definitely still there. You may have been cured, but the doctor cannot know this. The point is that however successful the treatment, there can be no certainty about if or when your cancer may return. This uncertainty is one of the things that makes a diagnosis of cancer so difficult to live with. On the other hand, there are no guarantees about anything in life other than that we will all die. In a sense learning to live with cancer is about learning to live, and to find peace and security here and now in a life full of future hazards and the certainty of death which we all have in common. Cancer is quite a strong motivation to learn more about this (see Complementary Techniques below). The medical treatment of cancer has changed and continues to change so much that we can now reasonably include cancer as a “chronic condition” on this website. Most of us are, as Penny Brohn Cancer Care says, living with, rather than dying from cancer. In fact learning to live well as a result of cancer can actually help to cure it. There are choices you can make to help yourself with cancer. Medical practitioners will suggest some of these to you. There are many truly and remarkably worthwhile self-help and complementary options for cancer. We will lay out a fairly wide variety of possibilities here. Cancerbackup, Macmillan and our other featured Useful Organisations can offer an even wider palette. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/c5.jpg" /></div> With medical therapies you have the expertise of your doctor and cancer specialists to determine the best course of treatment for you. With Self-Help, as the name implies, you are the expert. You test what works for you. Give things a chance, but if you’re not getting results - move on. Actually your doctors, cancer nurses and other practitioners will probably get you started by suggesting some of the approaches which follow. You can also get a great deal of help in being your own expert from our small but carefully chosen list of other recommended organisations. This is a vitally important aspect of your healing and living with cancer, so if you find any difficulties with it - or if we haven’t made everything you need to be your own expert simple and available, please let the Alliance Editor know.   COMPLEMENTARY THERAPIES / ALTERNATIVE MEDICINE One of the gold-standard organisations for the combining of medical and complementary approaches to cancer is Penny Brohn Cancer Care (formerly the Bristol Cancer Help Centre). Their way of working is called The Bristol Approach. We start with some of their description of the Approach because it may be everything you need in one place - and because it demonstrates clearly that many elements can be combined to improve the experience of cancer and the effectiveness of medical treatment. The Bristol Approach, developed by doctors, nurses, therapists and people with cancer, is a combination of complementary therapies and self-help techniques. It is designed to work alongside medical treatment and is supported by leading oncologists and others in the healthcare field. The Approach is a programme of lifestyle advice, information, complementary therapies and self-help techniques which: Provides support through your treatment and recovery Supports positive health, physical and psychological wellbeing The courses at Penny Brohn Cancer Care help people to: <ul type="disc"> <li>Cope with the emotional aspects of a cancer diagnosis</li> <li>Manage fear and anxiety</li> <li>Deal with the specific problems and challenges a cancer diagnosis brings</li> <li>Manage and reduce symptoms and treatment side-effects</li> <li>Improve health and energy</li> </ul> With all of this support we have seen that it is possible to change the way you live with cancer. Individual elements of the Bristol Approach include: Specialist support: Psychotherapy/counselling Doctor sessions Nutritional advice Group work <a name="BristolComp" id="BristolComp"></a>Self-help techniques: Relaxation Meditation Imagery Breathwork Natural pain management Gentle exercise Complementary therapies: Massage Shiatsu Healing Music therapy Art therapy The Bristol Approach helps you combine these elements to provide a complete programme of tailored support – whether you have had a cancer diagnosis or are supporting someone with cancer. The Alliance promotes the understanding that complementary and self-help techniques are an essential part of cancer therapy. Their highly respected use in the Bristol Approach may help to substantiate that these are not side issues. Many people living with cancer are getting life-changing benefits from complementary techniques with the help of practitioners, programmes other than Bristol, or through their own discoveries. You’ll have seen by now that the Alliance thinks highly of Cancerbackup as a resource. We particularly like their advice in this area, and we think it’s important to work with some of it here. Search “complementary” on their site for the whole story: CancerBackup says, and we know from experience how right they are, that people often speak of feeling that they have lost control of their life when they have cancer. It may be bewildering to spend time in hospitals, which can seem frightening and impersonal, and to meet so many different health professionals, as well as coping with the high-tech machinery and techniques used in cancer treatment. At the same time, it can be difficult to cope with the implications of the illness itself. Complementary therapists usually work with the person as a whole, not just the part of the body with the cancer. This is called a holistic approach and is something good medical practitioners also do. A complementary therapist who listens and cares may help you cope with some of those difficult feelings, which can be an effective way of getting back some control. Some hospitals and hospices provide complementary therapies as part of cancer care, alongside conventional cancer treatments such as chemotherapy or radiotherapy. Complementary therapies can: <ul type="disc"> <li>help you feel better and improve your quality of life </li> <li>Improve your general health</li> <li>give you a sense of control over what is happening to you</li> <li>reduce stress, tension, sleeplessness, anxiety, depression and make you feel more relaxed</li> <li>help to reduce the symptoms of cancer, such as pain, feeling sick, breathlessness, constipation, diarrhoea, tiredness and poor appetite </li> <li>help to reduce some of the side effects of cancer treatment.</li> </ul> There may be complementary therapies that are not suitable if you have a particular type of cancer or during a particular treatment. It is important to tell your hospital specialist if you are having some form of complementary therapy. It is also important to tell your complementary therapist that you have cancer. Putting the above in bold is our emphasis. This is the biggest caution with regard to complementary techniques. Take it seriously and you can safely develop you own expertise. We have several ways of finding complementary techniques and practitioners in Useful Organisations. You can go to any of our featured organisations to get a more complete view of what is available and how it may help you. Cancerbackup has information we like on choosing a therapist or teacher, including the good advice that it is important to choose a therapy that feels right for you. It is also important that you trust and feel comfortable with the therapist. You may need to try more than one therapist to find someone you feel confident with. Some people find it helpful to use a combination of therapies. It is a good idea to ask how much a therapy session will cost you before you book, and to get some idea of how often you may need to have the therapy. Some complementary therapies can be very expensive if used over a long period of time. Some hospitals and hospices offer therapies free of charge or you may be asked to make a small financial contribution. Some cancer support groups offer complementary therapies free or make a small charge. Some private practitioners offer a sliding scale of charges. It is important to choose a qualified practitioner. We draw from our own pages on Chronic Pain (which we recommend if we do say so ourselves) when we say that practitioner qualifications are important but: not all the techniques which could be helpful have professional associations regulating their teaching and practice. There are no absolutely clear dividing lines here, but basically: TECHNIQUES YOU LEARN TO DO AND PRACTICE YOURSELF, like Tai Chi and Meditation, can’t really be regulated to great effect. That a teacher is a member of an organisation may well be a good thing, but the best teacher for you may well not have the seal of approval of any self-appointed group. You really do have to test, trust yourself, and move on if you’re not comfortable. TREATMENT TECHNIQUES, where you are being treated by a therapist, usually can be and are regulated. For treatments including osteopathy, physiotherapy, hypnotherapy, psychotherapy and anything else where a practitioner is giving you any kind of therapy, professional qualification and regulation does absolutely matter. In our Useful Organisations you’ll find professional bodies to help you be sure you’re in qualified hands. Practices like physiotherapy, occupational therapy, counselling, dieticians, psychotherapy etc are really part of your extended medical treatment. While we give ways to find these for yourself, your doctor or medical team can be expected to help with referrals. We can’t fully describe all the techniques available and what they can do for you here, but in addition to the cancer organisations we can most highly recommend The Complementary Healthcare Information Service in our Useful Organisations. On their site you can learn about the range of complementary techniques, and get links to explore the ones you’re interested in. We also have a section in our Useful Organisations devoted to Complementary and Alternative Therapies. What we will do here is get you started with brief descriptions of some of the better known options. The list below draws from the Complementary Healthcare Information Service website, but with our comments and descriptions added in to help you get a quick overview of some options. This material is reproduced from our pages on Chronic Pain, adapted for this section. COMPLEMENTARY TECHNIQUES AND THERAPIES INCLUDE: Acupuncture - Well known Chinese therapy using fine needles to change energy flows. Evidence of effectiveness in dealing with pain and other problems, at least short term. High level qualified practitioner essential. Acupressure - Same principles as acupuncture, using pressure instead of needles. You can learn to do some acupressure therapy on yourself. Alexander Technique - Technique for learning how to efficiently and effortlessly use your body. Simple but profound approach to letting go of harmful tensions in posture and breathing. A safe and effective learning and therapy technique. It doesn’t sound like much but it’s a physically liberating technique no matter what your condition. Aromatherapy - The art of applying essential oils to suit individual needs. The oils work directly on the chemistry of the body, via the skin and bloodstream. Sounds unlikely, but a number of medical sites assure us that it can be surprisingly effective and safe. Art Therapy - Use of art for emotional therapy. Early evidence of effectiveness was with survivors returning from World War 2. Pain and healing are strongly affected by emotion, so makes sense (and is used as part of the Bristol Approach). Autogenic Training - A form of self-hypnosis, said to be effective for many conditions. In some areas it is available on the NHS. Ayurveda - The most important form of medicine in India. An ancient tradition, but most practitioners are also doctors or otherwise medically qualified. Ayurveda seeks to balance the body and mind, find health problems before they occur or stop them doing unnecessary harm. Obviously requires a qualified practitioner and is complementary to, not a replacement for cancer therapies. Bach Flower Remedies - Uses liquid preparations made from flowers. You can buy these over the counter. We can’t comment on effectiveness, but many people say they are calmed and helped by the Bach Rescue Remedy. Certainly worth learning about. Biofeedback - Machines give you feedback about how your body is working, allowing you to learn to regulate reactions causing problems. Evidence of usefulness for therapy and self-education for many conditions. Biofeedback is often referred to as a very helpful tool for working with the chronic pain which can come with some cancers and as a result of some aggressive treatments.   Bowen Technique - soft and non-invasive holistic treatment that aims to restore balance to the body by using small, gentle moves to specific areas of the body. Because the therapy is so gentle, it is considered to be suitable for all ages. May be helpful for many pain and stress related problems. Chiropractic - Manipulation of spine and muscles for good balancing and health functioning. A powerful technique and NOT to be used for many forms of cancer. Check carefully with your doctor and practitioner, and a qualified and registered practitioner essential. Cognitive and Behaviour Therapies - Put crudely: It’s not what happens that causes the problems, it’s how you understand it and what you do with it. Less crudely, these have medical and government recognition for a wide variety of problems and can be startlingly effective in many cases. Many of us who they have helped consider them to be most remarkable life tools. Feldenkrais Method - Not a therapy as such, but a well established method for learning greater ease of movement and increasing vitality and well-being. Guided Imagery - The use of imagination as potent healer. Pleasant and powerful. See Holistic Online in Useful Organisations to learn more. Healing - comes in many forms, from spiritual or religious to using energy flow as understood in martial arts. Whether the effectiveness is due to a placebo effect, energy flows or spirit, many people have been helped by healings throughout history. Hellerwork - deep tissue massage that unblocks the body, movement education to correct postural alignment, and verbal dialogue to assess emotional holding patterns. Appropriate tools for many chronic pain syndromes. Caution for conditions where deep massage contraindicated. Check carefully with your doctor before using any deep massage technique. Herbal medicine - Herbal medicines can be very powerful, and are the basis of many conventional drugs. A good herbal practitioner looks at the whole person and health, not just the disease or condition. Because they can be very strong and conflict with prescribed medications, you absolutely need to tell your doctor what you’re going to be taking. A herbal remedy can destroy your therapy and health if it’s the wrong one for you. Homoeopathy - famous and controversial. Vanishingly small amounts of a substance in water are given. Many in medical science consider this to be absurd. No conclusive proof either way, but many people have found help and relief. Hard to argue with happy patients, and it has the great virtue of being harmless. That said, neglecting medical treatment to depend on homeopathy is an enormous mistake, as your qualified homeopath will agree. Hypnotherapy - not in any way a frightening experience or loss of consciousness or control, safe in qualified hands, and considered very effective in helping with chronic pain, anxiety, depression and other condition related problems. Louise Hay techniques - based on the use of positive affirmations - highly recommended by many people for effectively changing your mindset and health. A place to start is the Louise Hay book “You Can Change Your Life” and audio tapes from Amazon. As we keep saying, mindset can profoundly affect healing. Massage Therapy - There are many forms of massage, and they can be a great help in stress reduction, release of muscle tensions and other therapeutic effects depending on the technique used. Having your body cared for like this is great, but: deep or powerful massage pressure can be dangerous for some cancer conditions. It is important that your therapist asks what your medical / physical situation is. If they are not qualified or you are not comfortable you are in the wrong hands. Don’t risk damage. Move on. Medau Movement - Enjoyable exercise to music for correct body use and posture, and good for stress reduction. Meditation - A truly profound way to deal with stress and the human condition. We’ve said that the uncertainty and fear of what will happen with a cancer, and the dismay about what is happening, can be destabilising and often overwhelming. Good meditation teaching is simple, and the result should be access to peace and stillness whatever is happening and wherever you are - in a hospital or hospice, at home, on the street, at work… We know that the approach of the Shollond Trust can do this fast and for free, and we like the BBC Health and H2G2 recommendations about meditation (or contact the Alliance editor). Naturopathy - Technique for helping the body to heal itself, and often incorporates a number of the other techniques discussed here. Interesting to have one technique using the strengths of others. In capable hands this can be a very effective option. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/c6.jpg" /></div> NLP (Neuro-linguistic Programming) - A fascinating form of therapy, looking at how you do what you do, and how to change. We like this sentence from a practitioner: “If you always do what you've always done, you'll always get what you've always got. If what you're doing isn't working, do something else". Far more to it than that of course, and worth learning about as a strong tool for living with cancer. Nutritional therapy - a form of complementary medicine working on eliminating harmful substances from diet and introducing helpful ones. Good statistics for helping a number of conditions, but check with your doctor as diet and supplements are such essential issues with regard to cancer. Osteopathy - Certainly among the best know physical therapies and very well accepted as a complementary therapy. Osteopathy is highly regulated. Physical manipulation and massage techniques are used to help correct problems with the muscles, bones, and joints and influence many of the body’s systems. A good practitioner will ask in detail about your condition to not do harm with inappropriate manipulations. Often helpful for chronic pain conditions and to help with treatment side-effects. Practitioner must know what your condition is, and doctor must approve the use of osteopathy. Pilates - Exercise method to method to strengthen the core postural muscles and develop balanced alignment through the use of slow, controlled movements and breathing. Often recommended by doctors, physiotherapists, and used by everyone from top professional athletes and dancers to people who have never done much exercise or thought they were unable to. Teacher must understand your condition, and doctor must be asked about any exercise limitations. Psychology of Mind - The book “Slowing Down to the Speed of Life” from Amazon is the well known place to start. POM techniques and understandings are simple and can be life changing. A way to use your problems to vastly improve your life. For the anxieties associated with cancer (not to mention life) this is something special. Psychotherapy - Many forms, and a vital and immensely beneficial approach for many people. The idea that psychotherapy is for crazies couldn’t be more wrong. It’s one of the best learning and healing tools and most interesting things you could choose to do. Practitioners must be qualified, and you have to find one you feel comfortable with and helped by. Often recommended and useful for cancer and related problems, and used as part of the Bristol Approach. Reiki Healing - A Japanese form of healing through energy flow and which, interestingly, is also concerned with living in harmony with others, taking responsibility for one's own health and happiness, helping others, and being positive about all things. Shiatsu - Traditional Japanese physical therapy, using a range of techniques from gentle touch to more dynamic work to improve specific conditions and general health. A qualified practitioner will take a detailed history from you and avoid more dynamic techniques where they might be contra-indicated for your condition. Check with your doctor or physiotherapist before trying.   Tai Chi - A soft, gentle and very powerful Chinese martial art, movement meditation, and way of healing through movement. Tai Chi works very well for older and ill people. It helps to free and balance the body, breathing and movement, and to find calm, stability, peace and deep security. If you have serious problems with feet, knees or walking it may not work for you. If that’s the case the exercises of Qigong (or Chi Kung) use the same principles but can be done sitting as well as standing. Tai Chi is a way to contact deep reserves of strength and ease. Trager Work - A form of bodywork and movement which utilises gentle, rhythmic movements to facilitate the release of stress patterns - physical, mental, and emotional. Created by a doctor and physiotherapist working with his own chronic pain since childhood, this method also has a mediation aspect. Obviously relevant to the mental, emotional and physical pain of cancer. Yoga - The ancient Indian system of postures, exercises, breathing, and body and mind development and control. Popular and widely available these days. The basic exercises of Hatha Yoga, taught with careful respect for your physical problems and limitations, are a good place to start, along with pranayam breathing exercises. There are also some extremely challenging physical styles of yoga which may not be not at all appropriate. Be sure your teacher knows what your physical problems are, and that your doctor has no problem with your doing yoga. That said, it is a wonderful combination of calm body, mind and spirit training and self-help therapy. The above list should give some idea of the complementary territory. It is in no way complete though, and combines both therapies and techniques you learn to practice yourself. See Useful Organisations for much more. Cancerbackup is one of the organisations which can advise further.   EXERCISE is an important aspect of self-help. The right kind in the right amount can be good for your physical resilience and great for your spirit. Some of the Complementary Techniques we have described are exercise techniques and are good possibilities. We also have exercise references in Useful Organisations, and the cancer organisations we list can also advise. Our favourite guide to what might work best for you is your PHYSIOTHERAPIST. Aside from giving you therapeutic exercises, your physio should be able to consider any exercise form with you in terms of do’s and don’ts. Your doctor can advise on the level of activity you might find beneficial. ALTERNATIVE THERAPIES Returning to more from Cancerbackup, we draw below from some of their advice on Alternative Therapies. These are unconventional treatments. As we use it, the term ‘Alternative Therapy’ means that it is used as an alternative to medical therapies. ‘Complementary Therapies’, on the other hand, work with and complement medical therapy. The line between Alternative and Complementary therapies is in fact often not that clear. There are alternative therapists who use their therapies with respect for conventional medical or complementary therapies. Other practitioners advise their patients to give up or make less use of conventional treatments. A bigger mistake is hard to imagine, and the suffering this can and has caused is inexcusable. Even if alternative therapies don’t try to replace the basic ones, they can cause severe side effects and make people extremely unwell. Some alternative therapies are very cleverly marketed so that when you read about them or are told about them, they seem to be very effective with proven results. The claims made about some therapies may give patients false hope. People with cancer can be very vulnerable, especially if they have been told that their cancer cannot be cured with conventional therapies. Don’t be misled and harmed by promises of a miracle cure. No reputable therapist would claim to be able to cure cancer. There are various reasons for wanting to try alternative therapies. Sometimes it is because people feel that conventional treatment cannot help them or is harmful. This is understandable, as many chemotherapy drugs are toxic and can cause unpleasant side effects. The idea of having radiotherapy can also be frightening. Medical treatments, however, can effectively deal with cancer and effectively cure many forms if caught in time. If a cancer is terminal, the wilder reaches of alternative therapies might be tempting. They offer hope, and some of the them may do no harm. Others could be very harmful, substituting huge unnecessary suffering for good palliative care. At the very least check any alternative therapy with MedlinePlus in our First Resources section, or with CancerBackup. <a name="snakeoil" id="snakeoil"></a>   SUPPLEMENTS, SNAKE-OILS AND DIETS <a name="SuppnSnake" id="SuppnSnake"></a>  NUTRITIONAL SUPPLEMENTS, in the sense of supplementary protein and other diet fortifiers, can be important for cancer. Cancerbackup lists them. Search “supplements”. Some vitamin or other dietary supplements may help some people in coping with their surgery, radiotherapy or chemotherapy. Diet, after all, really matters when dealing with cancer. We are talking here about conventional nutritional supplements in conventional amounts, which have been checked with your doctor. To find out which vitamins or supplements show good evidence of helping, check Medline Plus or BBC Health in our First Resourcessection. Cancerbackup is pretty blunt about the value of less conventional supplements. They don’t dismiss, but they are sharp and clear on the subject, saying that: A number of the drugs used by conventional Western medicine for cancer treatment come from plants originally. For example the vinca alkaloids are a group of drugs extracted from the periwinkle plant, vinca rosea.This group includes the chemotherapy drugs vincristine, vinblastine, vindesine and vinorelbine. Another group of chemotherapy drugs are the taxanes; Taxol and Taxotere which originate from the bark of the Pacific yew tree. So some chemotherapy drugs do actually have natural origins. As far as herbal medicines are concerned, there are no preparations that have been scientifically proven to help treat cancer. Despite this a recent survey in the UK has suggested that more than a third of people being treated for cancer are supplementing their conventional therapy with herbal treatments, the most commonly used being echinacea, evening primrose oil, milk thistle and essiac. Although there is no evidence that any of these compounds actually help in the treatment of cancer, it is usually the case that they won’t actually do any harm. However, this is not always true. Some herbal remedies do contain chemicals that can react with conventional drugs and may lead to harmful side-effects. For example echinacea can interfere with some conventional treatments for lymphoma, while evening primrose oil and ginkgo can react with drugs like warfarin (used to treat or prevent thrombosis and blood clots) and aspirin, increasing the risk of abnormal bleeding. If you feel that you would like to try supplementing your treatment with herbal preparations then do mention this to your doctors, so they can check that the remedies you are intending to use will not have harmful effects on any of the other medicines you are taking.   SNAKE OILS, as we use the term, are alternative remedies promising miracles, cures for cancer and other wonders. They can be remarkably convincing and believable, and have caused a great deal of confusion, distress and suffering. At best they may be harmless, other than in the way they drain your hope and money. At worst they can be fantastically dangerous. “Miracle cures” have added to the suffering of terminal patients who thought they had nothing to lose. They’ve also damaged people who could otherwise have lived well with cancer. If it claims to cure or change the course of your cancer, and if you want to believe it, look it up on Medline Plus or BBC Health in our First Resourcessection. They are not prejudiced against alternative options. You will get excellent information on whatever you’re considering, with no spin. Medline and BBC Health aren’t trying to make money from your pain, and can help you avoid remedies which are either just not right for you or outright snake-oils. Not all alternative remedies are snake-oils. We’ve mentioned some quite reasonable ones above. Chinese herbal medicine is another example where Cancerbackup sees potential for help with symptoms and treatment side-effects. Things like Bach Flower and homeopathic remedies will at least do no harm unless substituted for medical therapies. Ayurvedic remedies show some evidence of being beneficial if used in cooperation with your medical treatment. Lactoferrin is an example of the health food shop approach to cancer. It is sold claiming to help, and indeed studies have shown that it has effects on cancer cells and the immune system but… the supplements being sold contain cow rather than human lactoferrin, and there is absolutely no evidence that this has any effect on humans. Many such remedies have some basis in reasonable theory, but no evidence of any value in practice.   <a name="Diet" id="Diet"></a>DIET <a name="CAM" id="CAM"></a>A healthy diet is an essential part of dealing with cancer. For some cancer conditions where there are problems with eating this can require special help. Others may require “building up” or other very specific special diets. This is a big and vital subject. The kind of cancer you’re dealing with and the kinds of treatment you’re having can require different diet solutions. In general, however, be clear that diet is of central importance. For specific conditions, problems and diets you can get extensive advice from our suggested organisations, including Cancer Research’s CancerHelp website. By way of general information they advise that : Up to 4 out of 10 people (40%) have unintended weight loss when their cancer is diagnosed, or have problems with nutrition early on. A good diet can help your body to: Cope with treatment side effects Handle the most beneficial dose of certain treatments Recover and heal faster Fight off infections Feel stronger, healthier and have more energy If you are eating and drinking well, you will be able to cope better and recover faster. This could improve your chance of survival. You need a balanced diet, with plenty of calories, to keep your immune system working well. This can help you fight off infections, as well as helping your body fight the cancer. Balanced diet: It is important to include everything you need in your diet, including: Protein Carbohydrates Fat Vitamins and minerals Water Fibre Not eating enough protein and calories [our emphasis] is one of the main problems faced by people with cancer. You need extra protein for healing – after surgery for example. Even in good health, roughly a third of all the calories you eat are used up by your immune system. So if you aren't eating enough food, you might be more prone to infections and find it harder to fight them off once you get one. We will not try to say here what the right diet might be for each type and degree of cancer, but we will stress the importance of getting good dietary advice from your doctor, from Cancerbackup, CancerHelp, or any of our other recommended organisations. There’s just no point in going to all the trouble of everything involved in dealing with cancer if you don’t eat well. Diet and Anxiety - CancerHelp deals with the fact that: Problems with eating and drinking may cause you a lot of distress and anxiety if you, or someone close to you, has cancer. Naturally, if you are looking after someone who is ill, you want to feed them up - but people with cancer can find it very difficult to eat enough. They may have an overwhelming feeling that they are disappointing their relatives or friends or being too difficult. Everyone involved could need a great deal of emotional support to help them cope. There is a detailed section on emotions and diet problems on the CancerHelp website. There’s also more about what makes a good diet in general. With this as a basis they also remind us that there may be times when treatment side effects or your illness affect your appetite and you will lose weight. At these times, eat what you like when you feel like it to make sure that you take as many calories as possible. If you feel like a big bowl of ice cream with chocolate sauce, have one!   HOSPITAL FOOD, CancerHelp warns us, can make it very difficult to eat other than badly - the opposite of what cancer therapy requires. This is obviously an absurd situation, but in the NHS as it stands it is a serious problem. As CancerHelp says: Being a patient in hospital and having to fit in with set meal times is in any case not always easy. You may feel sick, be away from the ward having tests or be asleep at meal times. Reheating meals is not safe. Because of this, nurses and kitchen staff cannot do it. This means that you may end up with a cold meal or nothing at all. Added to this, nurses may not be available to help at meal times. If you are feeling very tired or unwell, or are tied up with drips, it can be difficult to cope alone. Recent research has shown that nurses are often too busy and unable to pay enough attention to whether patients actually eat their meals - whether they are able to cut food up and eat it by themselves, for example. People who feel ill because of cancer or treatment need encouragement to eat and drink as this may help them recover faster. Unfortunately, the quality of food in hospitals is not always good and there may be nothing you like, particularly if you really don't feel well. None of this helps if you are having problems with eating and weight. CancerHelp adds, and we are right with them on this, that improving food standards in hospitals will take time, but change may happen faster if more people let the hospital administration know that they are not happy with hospital food. If you can't eat it, you or your relatives really should complain. In an ideal world, you should be able to have meals when you like and have a wide choice of foods. In the meantime, get someone to help you by bringing in food to supplement your diet. Just check with your nurse about the suitability of foods if you are on any sort of special diet. <a name="current" id="current"></a>    PREVENTING CANCER These pages are about dealing with cancer as a chronic condition, but under “Self-Help” we should probably say a few words about prevention. In fact there really are only a few words to be said: <ul type="disc"> <li>STOP SMOKING</li> <li>Eat a healthy, Mediterranean-style diet (including the basic 5 portions of fruit and vegetables)</li> <li>Drink moderately</li> <li>Get regular exercise</li> <li>Don’t get sunburnt or overexposed to the sun </li> </ul>   Brief advice, but not bad. The various cancer organisations can tell you much more, and suggest very worthwhile lifestyle changes which can help reduce the risk of cancer and other chronic conditions.   GENERAL HELP WITH CANCER RELATED PROBLEMS The highlighted cancer organisations in Useful Organisations below can take you to most of the help and support available. Cancerbackup and Macmillan Cancer Support may be two of the easiest places to start for dealing with the practical and life issues arising from cancer. they offer just about everything you might need. Working from a Cancerbackup list of usual problems for which help is available, related problems include: <ul type="disc"> <li>Older People’s special needs </li> <li>Daily living - Disability, Appearance, getting Help and Care</li> <li>Pet care - If you have to go into hospital or otherwise need help with care for your pet</li> <li>Financial & legal issues </li> <li>Talking about cancer - It can be hard to talk about what’s going on with family, let alone friends and colleagues. Carers and friends can also get help learning to engage and talk constructively. Help with talking to children. </li> <li>Relationships - serious illness stresses them. Help is available. </li> <li>Life after cancer - finding the way forward</li> <li>Travel - help with travelling with or after cancer </li> <li>Work & cancer - help dealing with work issues </li> </ul>   Other areas of concern where support is needed and available include: <ul type="disc"> <li>Emotional effects </li> <li>Sexuality </li> <li>Counselling organisations </li> <li>Caring for someone </li> </ul> <ul type="disc"> <li>Resources for living with cancer </li> <li>Support organisations </li> <li>Coping with advanced cancer </li> <li>CPR for people with cancer </li> <li>Dying with cancer </li> <li>Death & bereavement </li> <li>Hospices </li> </ul>   This partial CancerBackup list is a pretty good precis of the issues. Go to them, Macmillan, Marie Curie and the rest of our very short list of cancer organisations in bold, and you basically have them covered. The other organisations we list below will also help with many of these and other issues, and of course Help the Aged, Age Concern and our other First Resources are always there in support.   TREATMENT PROBLEMS AGE DISCRIMINATION: Help the Aged has found that older people can be discriminated against in many different ways, including their access to health services. ‘Age discrimination is rife in the UK but often goes unnoticed and unchallenged, even though it is just as wrong as racism and sexism’. The Government's programme for the delivery of cancer services - NHS Cancer Plan - explains on its website: 'There are also inequalities in the treatment patients receive depending on their age. Not all patients are suitable for all treatments and it can be dangerous to give some very frail patients aggressive treatment with harmful side effects. But frailty and age are not the same thing and some 70 year olds are healthier than some 50 year olds. As within any other disease treated by the health service, ageism is unacceptable in NHS cancer services.' If you think you are being discriminated against because of your age, you should contact Help the Aged.   ACCESS TO NEW TREATMENTS: Age Concern reports a major international study of 25 countries showing that the UK is one of the worst countries for giving cancer patients access to new drugs. The report said that differences in the uptake of new drugs were having an impact on survival rates from the disease. Researchers said they had found "no evidence" that the UK's National Institute for Clinical Excellence (NICE) – the official body which approves drugs for use – had met its objective of avoiding significant delays in bringing new cancer treatments to the market. There is an abundance of help and good care available in the UK for people dealing with cancer. We flag these problems here simply because together we need to be aware of and address them. We are a capable age-group. We will see to it that they are addressed. As an Alliance our members can help focus the strength of our generation to improve conditions for everyone, not just people of our age.   Cancer

2009-04-28T01:43:44-07:00

CANCERBACKUP www.cancerbackup.org.uk Freephone Helpline 0808 800 1234 “Europe's leading cancer information charity, with over 4,500 pages of up-to-date cancer information, practical advice and support for cancer patients, their families and carers.” If we were to suggest one place to go to for the widest and most accessible online help and information at this stage, Cancerbackup would be it. MACMILLAN CANCER SUPPORT www.macmillan.org.uk Freephone 0808 808 2020 Textphone 0808 808 0121 A source of pretty much any support you could possibly need. Covers the full range of treatment, lifestyle and practical problems, with drop-in centres and mobile centres throughout the country. Get help from people, not just websites. Macmillan works to improve the lives of people affected by cancer, provide practical, medical, emotional and financial support and push for better cancer care CANCERHELP UK www.cancerhelp.org.uk CancerHelp is the help and information site for: CANCER REASEARCH UK www.cancerresearchuk.org Cancer Research UK is “the UK's leading charity dedicated to cancer research”. Extremely full and wide ranging information also provided. For any questions about cancer you can ring CancerHelp’s team of Specialist Nurses on 020 7061 8355, or freephone 0800 226 237. Lines are open Monday to Friday, between 9am and 5pm. Excellent website information on 5 sites, covers a broad range of subjects. MARIE CURIE CANCER CARE www.mariecurie.org.uk Tel: 020 7599 7777 There are some wonderful people in the world. Marie Curie cancer nurses care for cancer patients in their own homes, for free. They also run 10 hospices across the UK and are at the forefront of cancer research. CALL - The CANCER AID AND LISTENING LINE www.canceraid.co.uk Tel: 0161 205 7780 Emotional support and home-based practical help for people living with cancer, their carers and families. PENNY BROHN CANCER CARE www.pennybrohncancercare.org Helpline 0845 123 2210 The UK's leading charity in complementary cancer care. Short retreats, non-resident +and starter course, individual appointments and group sessions using The Bristol Approach. Considered a gold-standard approach to combining medical and complementary therapies. BREAST CANCER HAVEN www.breastcancerhaven.org.uk Tel. 020 7384 0099 A very special and much needed initiative: Breast Cancer Haven is a UK charity supporting the physical and emotional needs of anyone affected by breast cancer. Havens are welcoming day centres which offer free support, information and complementary therapies to help you before, during and after medical treatment. Have we mentioned that there are some wonderful people in this world? BREAST CANCER CARE www.breastcancercare.org.uk Tel. 020 7384 2984 The UK's leading provider of information, practical assistance and emotional support for anyone affected by breast cancer. TENOVUS CANCER INFORMATION CENTRE www.tenovus.com Helpline: 0808 808 1010 General enquiries: 029 2048 2000 Funds support and counselling services for cancer patients and their families through a team of nurses, counsellors and social workers. CHAI CANCER CARE www.chaicancercare.org Helpline: 0808 808 4567 Physical, emotional and spiritual support to Jewish cancer patients, their families and friends. COUNSEL AND CARE www.counselandcare.org.uk Advice line 0845 300 7585 (weekdays 10am-12.30pm and 2pm-4pm) A national charity getting the best care and support for older people, their families and carers SUE RYDER CARE www.suerydercare.org 020 7400 0440 Cares for people with life-shortening illnesses through specialist hospice care services. NATIONAL CANCER ALLIANCE www.nationalcanceralliance.co.uk Tel: 01865 793566 Represents the interests of cancer patients and their carers, increasing awareness of cancer services, diagnosis, treatment and care. HOSPICE INFORMATION www.hospiceinformation.info Tel: 0870 903 3903 Publishes a directory of hospice and palliative care services. THE CANCER AND POLIO RESEARCH FUND www.cprf.org.uk Responsible for advances in cancer treatment, dragging the cancer establishment along behind them when necessary. £35 million of research investment to date, and some of the critical cancer issues being addressed. NATIONAL CANCER INSTITUTE - USA www.cancer.gov ALL, and we do mean ALL the facts about cancer. THE INSTITUTE OF CANCER RESEARCH www.icr.ac.uk/ieu/links/cancerlinks.htm Professional research site, but this page gives good internet links for the various types of cancer and treatment. CANCER SUPPORT www.cancersupporters.com Click on ‘alt.support.cancer’ for probably the most extensive worldwide and all-subject cancer links on the internet.   FOR ANCILLARY MEDICAL THERAPIES: HEALTH PROFESSIONS COUNCIL www.hpc-uk.org Telephone 020 7582 0866 The HPC is a statutory regulator that works to protect the health and well-being of people using the services of health professionals. Find therapists and be sure they are approved / regulated practitioners. CHARTERED SOCIETY OF PHYSIOTHERAPY www.csp.org.uk Tel: 020 7306 6218 / 6666 Information on physiotherpaists, physiotherapy and how it can help with pain. THE ORGANISATION OF CHARTERED PHYSIOTHERAPISTS IN PRIVATE PRACTICE www.physiofirst.org.uk Tel: 01327 354441 Details of private chartered physiotherapists in your area. OCCUPATIONAL THERAPISTS IN INDEPENDENT PRACTICE (OTIP) www.otipp.co.uk Tel: 0800 389 4873 Information and find an occupational therapist   FOR DIET ADVICE: BRITISH NUTRITION FOUNDATION www.nutrition.org.uk Telephone 0207 404 6504 BRITISH DIETETIC ASSOCIATION www.bda.uk.com FOR DEALING WITH CHRONIC PAIN PAIN SUPPORT www.painsupport.co.uk We really like painSupport. Excellent attitude, information and help. Don’t miss it. Conventional medicine and complementary therapies working side by side. As they say, all the ideas and techniques on their website can be used to enhance any medical treatment you may be having. Useful Products / Books, CDs, Downloads, an e-mail newsletter and a Contact Club to help us all prevent pain from making us feel lonely and isolated. ACTION ON PAIN www.action-on-pain.co.uk Painline: 0845 603 1593 Tel: 01760 725993 Support and advice for by people with chronic pain for people with chronic pain. Good to see, an example of how to deal with our problems. People to talk to on the Painline who know from personal experience what you’re dealing with. Tested ways of coping and helpful information. PAIN CONCERN www.painconcern.org.uk Helpline: 01620 822572 Mon-Fri 9-5pm, Fri evening 6.30-7.30pm. Offers a Listening Ear helpline - the chance to talk to another pain sufferer about pain problems Information and support for pain sufferers, those who care for them and about them. Free Factsheet and leaflets to help you manage your pain, quarterly magazine and a list of other local members. CHRONIC PAIN MISSION www.cpmission.com This American site is quite an amazing collection of insights, information, what we might call “Pain Power” (the mobilising of people with chronic pain for better treatment) and EXTENSIVE LINKS for most pain issues and problems. A very cool, interesting and powerful site. PAIN ASSOCIATION SCOTLAND www.painassociation.com Provides an information pack and details of about 20 groups in Scotland. Tel: 0800 783 6059 BATH PAIN MANAGEMENT UNIT www.bath.ac.uk Tel: 01225 473427 Residential and outpatient pain management programmes for adults and adolescents with persistent and disabling pain. Admission is subject to a referral by your consultant or GP.   FOR COMPLEMENTARY AND ALTERNATIVE THERAPIES: THE COMPLIMENTARY HEALTHCARE INFORMATION SERVICE www.chisuk.org.uk Easy reference to learn about any and (just about all) complementary techniques. A truly excellent way to learn what the main comlementary techniques are, how they might work for you, and to explore the subject   THE NETDOCTOR DR FOSTER COMPLEMENTARY PRACTITIONER DIRECTORY http://netdoctorcomplementarytherapistguide.drfoster.co.uk If you are looking to find a reliable complementary therapy practitioner in your area, this directory is an essential resource. It can help you find a practitioner who meets your needs. This might be someone who has a particular interest in your condition, or who works at a practice near to your home, at hours that suit your needs. NEW APPROACHES TO CANCER www.newapproaches.co.uk Tel: 0800 389 2662 Promotes the benefits of complementary therapies and holistic treatment for cancer patients and their carers. Provides an information and referral service. THE BRITISH COMPLEMENTARY MEDICINE ASSOCIATION www.bcma.co.uk Tel 0845 345 5977 Find qualified practitioners of most therapies, learn about therapies, get recognised guidance through the therapy minefield and find a therapist near you. WHOLE HEALTH MD www.wholehealthmd.com American WholeHealth Networks' Complementary and Alternative Medicine (CAM) education website. The site is dedicated to providing integrative health and wellness solutions by combining the resources of both scientific health research and CAM. Click on specific health issues for information on conventional medicine, alternative therapies, supplements, diet, lifestyle options, and much more. HOLISTIC ONLINE www.holisticonline.com Comprehensive site for Alternative and Integrative Medicine. Learn about conditions and treatments. INSTITUTE FOR COMPLEMENTARY MEDICINE www.i-c-m.org.uk The ICM is a UK registered charity providing information on all aspects of the safe and best practice of Complementary Medicine.   THE NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE http://nccim.nch.gov Vital and reputable information for the States. A treasure for understanding what’s what. THE ALTERNATIVE MEDICINE FOUNDATION www.amfoundation.org Excellent US site, good clear information. They also recommend: ALTERNATIVE MEDICINE RESOURCE www.altmedresource.com comprehensive and searchable catalog of all alternative medicine studies. Easy search by looking up your condition(s) or a key word.   FOR COMPLEMENTARY PRACTICE ASSOCIATIONS GENERAL OSTEOPATHIC COUNCIL www.osteopathy.org.uk Tel: 020 7357 6655 Provides details of qualified local osteopaths. BRITISH CHIROPRACTIC ASSOCIATION www.chiropractic-uk.co.uk Tel: 0118 950 5950 Information on chiropractic and details of local chiropractors. GENERAL CHIROPRACTIC COUNCIL www.gcc-uk.org Tel: 020 7713 5155 Provides details of local chiropractors and information on what to expect when you see a chiropractor. It can also help if you've experienced a problem with a chiropractor. GENERAL COUNCIL FOR MASSAGE THERAPY www.gcmt-uk.org Telephone 01992 537637 New voluntary regulation body for practitioners of massage. THE BRITISH MEDICAL ACUPUNCTURE SOCIETY www.medical-acupuncture.co.uk Telephone 01925 730727 Medical doctors who practice acupuncture. Encourages the use and scientific understanding of acupuncture within medicine for the public benefit.   ACUPUNCTURE ASSOCIATION OF CHARTERED PHYSIOTHERAPISTS www.longbo.demon.co.uk/aacp.html Tel 01747 861151 Contact the AACP Secretariat for a register of members - qualified phyisos working with acupuncture. BRITISH ACUPUNCTURE COUNCIL www.acupuncture.org.uk Tel: 020 8735 0400 Provides information on acupuncture and details of qualified traditional acupuncturists in your area. Phone or enclose an SAE for more information.   FOR MEDITATION: THE SHOLLOND TRUST www.headless.org tel. 020 8806 3710 - Richard Lang, Trust Co-ordinator The Trust offers a form of meditation you can do any time, any place, in any circumstances. It’s astoundingly easy to do, and it’s free. THE BBC www.bbc.co.uk and search “meditation”. A wide range of options. THE HITCHHIKER’S GUIDE TO THE GALAXY www.bbc.co.uk/dna/h2g2 Ask the guide about meditation. In fact ask it about any question you have.   FOR COUNSELLING: CANCER COUNSELLING TRUST www.cctrust.org.uk Tel: 020 7704 1137 Psychotherapists and counsellors with specialist training and experience of working with people affected by cancer. BRITISH ASSOCIATION FOR COUNSELLING AND PSYCHOTHERAPY (BACP) www.bacp.co.uk Telephone 0870 443 5252 Email bacp@bacp.co.uk THE SAMARITANS www.samaritans.org Telephone 08457 90 90 90 (24 hours, seven days a week) Email jo@samaritans.org MIND www.mind.org.uk Telephone 020 8519 2122 Mind Infoline 0845 766 0163 (Monday-Friday 9:15-5:15) Email contact@mind.org.uk RELATE www.relate.org.uk Tel. 0845 456 1310 or 01788 573241 Relate is the UK's largest provider of relationship counselling and sex therapy. They also offer a range of other relationship support services. CRUSE BEREAVEMENT CARE www.crusebereavementcare.org.uk Day-to-day helpline: 0870 167 1677 Help for bereaved people, whatever their age, nationality or beliefs, including a free counselling service.   FOR GENERAL UK HEALTH ISSUES and the NHS: PATIENTS ASSOCIATION www.patients-association.com Helpline: 0845 608 4455 Represents the views and interests of patients and campaigns for improved health services. Provides advice, factsheets and self-help guides. EQUIP - ELECTRONIC QUALITY INFORMATION FOR PATIENTS www.equip.nhs.uk NHS search website for patient information on a very wide variety of conditions including cancer   FOR IMMEDIATE HELP UNDERSTANDING HEALTH ISSUES: See our FIRST RESOURCES section - especially MedlinePlus and BBC Health, and: MEDICINENET.COM www.medicinenet.com For a general guide and information base on any subject this is a great place to start. NETDOCTOR www.netdoctor.co.uk Attempts to break down the "medical language barrier" between the doctor and the patient. Critical medical information presented in a clear and understandable language so that the patient fully understands his or her choices and decisions. BANDOLIER: THE OXFORD MEDICAL SITE http://www.jr2.ox.ac.uk/bandolier/index.html Bandolier is a journal of evidence-based medicine. Look up any subject for links and knowledge. MERCK MEDICUS www.merckmedicus.com Easy to use and the US doctor’s reference tool. See Merck Geriatric for age related information. THE MAYO CLINIC www.mayoclinic.com Search information on any medical or therapy subject from this world-famous clinic. FOR EXERCISE: There are many possibilities to choose from, and you may be surprised what you can do and what you’ll enjoy. Just be sure to get your doctor’s advice on any medical limitations and what to avoid. A SIMPLE WAY to look at possibilities is with the help of THE BBC. Go to www.bbc.co.uk/health THE COMPLIMENTARY HEALTHCARE INFORMATION SERVICE www.chisuk.org.uk links to all the main movement therapy exercise techniques. A one-stop convenience shop. A few additional sources we can mention are: TAI CHI - local adult education courses, local gym, fitness centre, library listing or the TAI CHI UNION OF GREAT BRITAIN - www.taichiunion.com PILATES www.pilatesfoundation.com YOGA www.bwy.org.uk FOR GENERAL SELF-HELP ON MOST SUBJECTS: DIRECTORY OF UK SELF-HELP GROUPS www.ukselfhelp.info/ ARTHRITIS is the general name for a number of conditions causing problems with the joints between bones. The affected joints get irritated, inflamed and often damaged. This causes pain, stiffness, and other symptoms depending on the kind of arthritis. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/ar1.jpg" /></div> There are many kinds of arthritis. Not all are serious. There is no cure for most forms, but they are manageable conditions. You can get a great deal of relief from symptoms. With the right help and information you can improve your quality of life to a remarkable degree. Don’t just accept arthritis pain and limitations as part of ageing. If you have any ongoing pain, stiffness or swelling in joints, talk to your doctor . Do not hesitate. It is absolutely essential to find out which arthritic condition you have. There are other conditions with similar symptoms, and some forms of arthritis must be treated medically without delay. See your doctor as a first step to prevent more serious and unnecessary damage to your joints, general health and happiness. All forms of arthritis are manageable once you know which one you’ve got. Arthritis can actually be an opportunity to improve many aspects of your life. Exercise and Increased fitness can become a relief and a pleasure, not a chore. Your mobility and functionality can be increased. Your pain can be controlled (be sure to see our section “Chronic Pain” for this). You can gain greater peace of mind. Almost every aspect of life can be improved by learning how to deal with arthritic conditions. We hope you’ll find it possible to do these things and more using this site. You may be surprised at how much better things can get.   THE DIFFERENT KINDS OF ARTHRITIS are mostly caused by <ul type="disc"> <li>damage, wear and tear of the joint. </li> <li>autoimmune disease (our own protective immune system becoming over-active) </li> <li>an infection</li> </ul>   OSTEOARTHRITIS is the “wear and tear” most common form of arthritis. Most of us will have it to some degree as we get older. Damaging wear, stress or injury to a joint is a principal cause, and there may also be hereditary and other factors. The joints most often affected are the knee, hip, great toe, fingers, lower back and neck. In osteoarthritis the cartilage padding where bones join is worn. There is less padding, space and lubrication for free movement between bones. Scraps of cartilage may break off and clog the joint. As the cartilage wears away the bones may start to change shape from the stress, and eventually bone can grate against bone. These changes all irritate and inflame the joint and prevent it from moving normally. The result can be pain, swelling, stiffness, deformed joints, and other symptoms if nerves or blood vessels are compressed or irritated - especially in the neck and spine. With osteoarthritis: <ul type="disc"> <li>joint pain increases as you get tired or when the joint is strained. </li> <li>joints stiffen up after a long rest or a night’s sleep. </li> <li>getting moving again loosens things up.</li> <li>pain and limited movement can make it difficult to function.</li> </ul>   Osteoarthritic joints respond very well to the right forms of exercise. Learning how to use them better and with less strain is important. Improving the muscles around the joints can make all the difference. You can do this whatever your age or state of health. Seeing a physiotherapist is an ideal way to start. Under “Self-Help” for Arthritis we provide information about exercise, including a wide variety of complementary movement techniques and physical therapies. There are many forms of inflammation and pain relief available for osteoarthritis. Medical treatments from symptom relief through to the replacement of severely damaged joints can be very effective and are always the place to start. That said, Self-Help options which complement the medical approach work extremely well. Under “Therapies” “Self-Help” and “Useful Organisations” in this section you’ll see that options for any problem related to osteoarthritis are not hard to find. Also see our pages on “Chronic Pain” for additional self-help. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/ar2.jpg" /></div> We must take care not to underplay the problems arising with this condition. The symptoms of severe osteoarthritis can be debilitating, chronically painful, and can make it difficult or impossible to carry on life as before. Medical help on the NHS may also not be as good in practice as it is in theory and as we describe it. Nevertheless this is a manageable condition, and we should not be shy about seeking all the help we need to deal with it. If you find that the help you need with pain and functioning is not easy to access through medical and social services, our First Resources and Useful Organisations should provide effective help.   RHEUMATOID ARTHRITIS Rheumatoid Arthritis (RA) is actually an illness, an autoimmune disease. Your immune system becomes overactive. It attacks the lining of joints, causing pain, swelling, and stiffness that lasts for hours. Many joints may be affected at once. Because RA is an illness, you may suffer from fever, tiredness and loss of appetite as well as difficulty in moving. RA can affect almost any joint. If the disease becomes severe it can also affect your eyes, skin, lungs and other organs. There is no cure yet, but there are very good drugs to keep the condition under control. The disease has periods of “flare-ups” and periods where symptoms ease off. Getting ill with something else can bring on a flare-up. So can stress. Proper medical treatment can control the flare-ups, and there can be very long periods with far less symptoms. The anti-inflammatory drugs and painkillers which help with osteoarthritis are also effective for RA symptoms. Steroids can be very effective. To control the actual disease there are “disease modifying anti-rheumatoid drugs” (DMARDS). Treatment of Rheumatoid Arthritis and the similarly autoimmune Sjögren's Syndrome has come a long way. With medical help, and using the information and resource links you’ll find on this site, you can stay independent and live a full life.   GOUT Gout is one of the most painful forms of arthritis. It is far more common in men than women, but can affect either sex. An attack can begin when crystals of uric acid form in a joint. Uric acid is produced by the natural breakdown of chemicals called purines which we all have in our cells. Gout sufferers have an inherited tendency to turn purines into a lot of uric acid. Gout attacks usually affect the great toe, but can sometimes also affect other joints, the kidneys and skin (white secreting lumps or ‘tophi’). An attack is extremely painful and anything touching the joint may be unbearable. The good news is that the attack will go away in a matter of a few days up to a week. There may be very long periods between attacks. Gout attacks are severe, so we probably won’t need to encourage you to see your doctor. You’ll want to know what’s going on. As with the other arthritic conditions, medical help is effective. Your doctor can supply anti-inflammatory drugs. An old-fashioned drug called Colchicine is also used. Your doctor has to balance treatment against side-effects, but these treatments work. Having them with you in case of an attack can make a big difference. If you have several attacks in a year your doctor may also prescribe a daily tablet to help control the condition. Diet may or may not be of some help for other arthritic conditions. For Gout, diet is vitally important. You need to drink lots of water and not get dehydrated. Be moderate with alcohol. Learn which foods have high purine levels and try to avoid them. These include red meat, shellfish, liver and kidneys, dried beans, peas, sardines, anchovies, gravy… Aspirin and some blood pressure medicines must also be avoided. Your doctor will give you clear advice about these things. Go to Useful Organisations in this section and find ARTHRITIS CARE for any other information you need.   OTHER FORMS OF ARTHRITIS There are over 200 conditions involving inflammation of the joints. Osteoarthritis, Rheumatoid Arthritis and Gout are by far the most common. Other forms of arthritis include: SPONDYLOSIS - arthritic changes in the spine. Almost all of us over 50 have some of this, and it will show on an x-ray. Causes and treatment are pretty much as for osteoarthritis.   ANKOLYSING SPONDYLITIS If you inherited an unusual tissue type called HLA-B27 you could well suffer from this condition. If you have a parent or sibling with Ankolysing Spondylitis you are in a high risk group. Main symptoms are pain and stiffness in the lower back and hips. Symptoms are worst in the morning. If not dealt with, the whole spine can become stiff. Eventually it can curve and lock up. Sometimes the eyes can also become inflamed. This can and must be treated by an ophthalmologist. Physiotherapy is the main treatment for AS. Physio is brilliant for all forms of Arthritis, but particularly vital for this one. The right daily exercise is vital. As with other forms of arthritis, drugs can also help with the pain and discomfort from stiffness.   PSORIATIC ARTHRITIS This can sometimes affect people with the skin condition psoriasis. It’s not a Rheumatoid Arthritis, but it has similar symptoms. An indicator in many people with PA is that their nails become pitted and chalky. Lower back pain can also be a symptom. Like with most forms of arthritis, anti-inflammatory drugs and exercise can make all the difference. If PA is severe it may be treated with many of the same drugs as Rheumatoid Arthritis.   POLYMYALGIA RHEUMATICA This is painful and not unusual for those of us over 50. It comes with very painful shoulders and hips, especially in the morning. Moving in bed can be difficult. You may feel depressed, unwell, lose weight, and possibly have a fever. Not nice, but diagnosis and treatment with steroids can stop these problems almost immediately.   REACTIVE ARTHRITIS AND OTHERS REITER’S SYNDROME: joints become painful and swollen in reaction to an infection. Can include eye inflammation and a rash on the soles of the feet. INFLAMMATORY BOWEL DISEASE can also cause joint inflammation. In these cases the disease itself must be treated. Symptoms may be controlled as with other arthritic conditions. There are a number of reactive conditions. Diseases like LUPUS, and bacterial, fungal and viral infections, can also cause arthritic symptom reactions. There are many other conditions causing joint pain and problems. Once again, never accept arthritic symptoms. Always go to your doctor to find our what’s causing them. You may have a condition which can and must be cured.   IN GENERAL, arthritic conditions are manageable. Your quality of life can be improved. The following texts, Useful Organisations, and our separate section on Chronic Pain should provide much of what you need to know.

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The absolutely essential first step is a medical diagnosis of which arthritic condition you are suffering from. If possible, treatment will then focus on eliminating the underlying cause of the arthritis. Osteoarthritis, Rheumatoid Arthritis and other chronic forms cannot be cured. Medical treatment for these is nevertheless vital and effective. Pain and discomfort can be much reduced. Unnecessary damage and disability can be prevented. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/ar3.jpg" /></div> DRUG TREATMENTS Medication advice: Always write down what you take and when you take it. This avoids confusion. Taking the wrong amounts or combinations of medications can be very dangerous. Pain is best controlled if you take painkillers before it gets too bad. Talk to your doctor or chemist about having enough of the right drugs to keep pain safely controlled. Most people with arthritis will be prescribed some kind of pain relieving or disease controlling drug. Drug treatments include: <ul type="disc"> <li>ANALGESIC PAINKILLERS like paracetamol, co-dydramol and codeine are for reducing pain. Stronger, sometimes narcotic painkillers may also be prescribed for for severe pain. The over-the-counter analgesics can be very effective for the milder forms of arthritis pain. Analgesics are specifically for pain, not for inflammation. </li> </ul>   <ul type="disc"> <li>NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs) to reduce pain, stiffness and swelling caused by inflammation. Common NSAIDs are aspirin, ibuprofen, paracetamol, naproxyn and diclofenac (Voltarol). NSAIDs can cause a number of side effects, especially stomach problems. The same mechanism that reducess inflammation also reduces your stomach’s ability to protect itself from its own digestive juices. Talk to your doctor and chemist about doing the best you can with these very helpful medications. It can be protective to take them with or just after food. </li> </ul> NB. Some NSAIDs are now sold in a gel form to rub into arthritic joints. BE CAREFUL about using these if you are also taking an oral NSAID. While not much of the medication gets through the skin into your system, it can actually be enough to cause an excessive dose reaction in some people.   <ul type="disc"> <li>STEROIDS (oral or injected) - Corticosteroids are powerful drugs to reduce inflammation and supress immune reactions. They can be very effective in severe cases of osteoarthritis. They are also used to treat </li> </ul> autoimmune forms like rheumatoid arthritis. They are avoided in treating infectious arthritis. Steroids can have many side effects if used for long periods of time. They require careful medical supervision. <ul type="disc"> <li>DISEASE MODIFYING ANTI-RHEUMATIC DRUGS (DMARDs) and anti-TNFs slow down the progress of rheumatic diseases like Rheumatoid Athritis. Studies show that they may even stop the diease progressing if given early. In any case they can be extremely effective. </li> </ul> See the Medline Plus website in our First Resources to learn all about them. Their side effects need to be considered carefully. Medline Plus describes these drugs as “including gold salts, penicillamine, sulfasalazine, and droxychloroquine. More recently, methotrexate has been shown to slow the progression of rheumatoid arthritis and improve your quality of life. Methotrexate can be highly toxic and requires frequent blood tests for patients on the medication”. <ul type="disc"> <li>CYCLO-OXYGENASE-2 (COX-2) INHIBITORS. These drugs block an inflammation-promoting enzyme called COX-2. Medline Plus reports that: “This class of drugs was initially believed to work as well as traditional NSAIDs, but with fewer stomach problems. However, </li> </ul> numerous reports of heart attacks and stroke have prompted the FDA to re-evaluate the risks and benefits of the COX-2s”. Rofecoxib (Vioxx) and valdecoxib (Bextra) have been withdrawn from the U.S. and UK markets following reports of heart attacks in patients taking the drugs. Celecoxib (Celebrex) is still available, but labelled with strong warnings and a recommendation that it be prescribed at the lowest possible dose for the shortest duration possible. Talk to your doctor about whether COX-2s are right for you. <ul type="disc"> <li>BIOLOGICS are the most recent breakthrough for the treatment of rheumatoid and other forms of arthritis. These medications may dramatically improve your quality of life. Biologic response modifiers – drugs that target specific products of the immune system – have very recently gained momentum as treatment for inflammatory arthritis. Much discussed in US sites. Availability in the UK is unclear. Ask your doctor about availability and appropriateness for you. </li> </ul>   <ul type="disc"> <li>MMUNOSUPPRESSANTS are drugs which can suppress the overactive immune system. They are used for serious cases of rheumatoid arthritis when other medications have failed. Side affects must be carefully monitored.</li> </ul>   See our section on “Chronic Pain” for more on potentially relevant drug treatments.   <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/ar4.jpg" /></div> PHYSIOTHERAPY Physiotherapy, physiotherapy, physiotherapy. For almost all forms of arthritis this cannot be emphasised often enough. Exercise, help with posture, learning to protect affected joints… Your physiotherapist will treat your painful joints, but physiotherapy is not just treatment. It’s also education. A physiotherapist will help you gain strength, become more functional and suffer less damage. By strengthening, stretching and learning good body mechanics you can improve many aspects of your life. It doesn’t matter what state you’re in, physiotherapy can help. The only downside with physiotherapy is there can be a dreadfully long wait for it on the NHS. See Useful Organisations for alternatives if or while you are waiting.   NURSE SPECIALISTS If you are referred for hospital outpatient treatment, you may have the good fortune to find you are being helped by a Rheumatology Nurse Specialist. The RNS should be the easy one to contact and talk to on your medical team. Problems from the various forms of arthritis can be hard to cope with. The RNS is there to help with anything from your medication to emotional counselling. You can get help with physical coping, relaxation techniques, a good physiotherapy programme, occupational therapy and ways to keep working… When you need to get help, advice, or just to talk, the RNS is likely to be there for you.   SURGERY AND OTHER APPROACHES In some cases, including advanced Osteoarthritis, surgery to replace the joint may help maintain a more normal lifestyle. The decision to perform joint replacement surgery is normally made when other alternatives, such as lifestyle changes and medications, are no longer effective. Knee and hip replacement surgery can be extremely effective. Other joint replacement procedures are currently less advanced and may be less durable or practical. Some joints do not need flexibility for ordinary daily life. The knuckle of the big toe or a single joint in the spine are examples. When joints like these degenerate beyond use they can be “fused”. The operation stops them from moving. Some flexibility is lost, but you can function again without pain. Normal joints contain a lubricant called "synovial fluid." In joints with arthritis, this fluid may not be produced in adequate amounts. Medline Plus advises that “another treatment approach is to inject arthritic joints with a manmade version of joint fluid such as hylan G-F 20 (Synvisc) or other hyaluronic acid preparations. This synthetic fluid may postpone the need for surgery at least temporarily and improve the quality of life for arthritis patients. Many studies are evaluating the effectiveness of this type of therapy”. Many of us have wished we could simply oil our joints like rusty hinges. Manmade joint fluids are an attempt to do just that. You can work with your arthritis to improve your whole life. Learn which form you have. Get the right medical help. Then be amazed how much you can do to improve things for yourself. Under Helpful Organisations in this section, you will find ARTHRITIS CARE. For detailed advice on any of the options here, or anything else to do with arthritis, click on the Arthritis Care link or ring their helpline. <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/ar5.jpg" /></div> EXERCISE makes all the difference for most forms of arthritis. The right exercise may be the single most important thing you can do for yourself. Your physiotherapist will get you started with therapeutic exercises. There are many forms of exercise you can really enjoy while enormously improving your condition. What you basically want are exercises to <ul type="disc"> <li>increase flexibility, </li> <li>strengthen muscles to strengthen and protect joints</li> <li>improve your posture and the way you use your body</li> <li>increase endurance </li> </ul>   It is important to choose low impact exercise. Avoid exercise which jars or puts sudden strains on your joints. The right daily exercise can increase your mobility, reduce pain, let you be more functional, lift your spirits, and increase your enjoyment of life. Always check with your physiotherapist that the exercise you’re choosing is a good one for your particular condition. Some good ones to consider include: <ul type="disc"> <li>walking</li> <li>swimming</li> <li>low-impact aerobics or dance</li> <li>Tai Chi</li> <li>yoga (if done carefully and without excess stretch or strain)</li> <li>bicycle riding</li> <li>light weight or resistance training - done carefully with an experienced instructor who understand your condition.</li> <li>Pilates Technique </li> </ul>   If you are not capable of any of these at this point, do not despair. There is no arthritic disability that will stop you from doing some form of exercise. Your physiotherapist can create a programme for you. Housework, gardening and other basic life activities can also be great exercise. Get some guidance from an Occupational Therapist or Physiotherapist to make these therapeutic exercises rather than damaging chores. For ways to find out more about exercise see the “Exercise” in our Useful Organisations. Many Complementary techniques are movement based and can provide therapeutic exercise. See Complementary Therapies below for an overview of well-known options. POSTURE Your physiotherapist will diagnose and give exercises for any posture problems relating to your condition. Particularly for Osteoarthritis and other forms of degenerative arthritis, posture improvement and better body mechanics can make a huge difference. To free and ease your posture and movement, Alexander technique, Tai Chi, yoga, Pilates classes and other complementary techniques can be very helpful. REST AND RELAXATION This can be as important as exercise. Sleeping 8 hours or more and taking rests when needed during the day can help. Learning relaxation and meditation techniques can make a difference. Many of these can help with letting go of unnecessary physical and mental tension. They can also help you get more enjoyment and satisfaction out of life. Again, complementary techniques as below and in our Useful Organisations can be life-changing in this regard. Also see our “Chronic Pain” pages. POSITIONS, FURNITURE, STICKS AND JOINT PROTECTION Finding good positions in which to rest and work can be difficult. The right kind of mattress and pillow on your bed can make a big difference. So can the right choice of chairs. We tend to be still in unhelpful positions when we sit. Walking sticks, the right shoes (talk to a Podiatrist), all the right tools for living more easily with arthritis can make a big difference. Once again, your physio can advise. Your doctor, hospital or social services can get you the help of an OCCUPATIONAL THERAPIST if you need help with these issues. They are experts in helping you to function as well as possible. You can also find pretty much any aid, equipment or adaptation you need by contacting Arthritis Care or the Disabled Living Foundation. Find their links and telephone helplines in Useful Organisations in this section. SUPPLEMENTS, SNAKE-OILS AND DIETS The internet is full of “cures” for arthritis. Beware anything claiming to cure your condition. There are supplements and dietary factors which may help, but “cures” are what we call “snake-oils”. In fact some of them have actually been snake venoms. Be careful about anything claiming to help all forms of arthritis. Some, like copper bracelets, are unproven but harmless. Most should be avoided. If you are considering using a supplement, herbal or other complimentary remedy for arthritis, check the Medline Plus or BBC Health website to learn more about it. You will find them in First Resources on this site. SUPPLEMENTS which show good scientific evidence of helping arthritis include GLUCOSAMINE AND CHONDROITIN. There is increasing evidence that the essential fatty acids in fish oils have an effect on inflammation, and some evidence for ginger and garlic among others. That a supplement is “natural”, doesn’t mean it is safe. Check Medline Plus to learn more about any supplement which interests you. WholehealthMD (see Useful Organisations) tells us that in a recent review of 14 studies from 19662006 data from higher quality studies suggested that the herb Devil’s Claw is effective in helping to relieve the inflammation and pain associated with arthritis. Devil’s Claw may be complementary to non-steroidal anti-inflammatories and reduce the amounts of them required. They also suggests that: <ul type="disc"> <li>In addition to using a glucosamine combination, try applying CAPSAICIN (cayenne cream) to painful joints. Capsaicin, the ingredient in cayenne peppers that makes them hot to the taste and can cause a burning sensation when the cream is applied to the skin, </li> </ul> also inhibits the production of substance P, a chemical involved in relaying pain signals to the brain. However, you must use an effective dose of capsaicin cream regularly (two or three times a day for over a week) to know if cayenne will help your arthritis. <ul type="disc"> <li>to relieve or reduce [joint] discomfort, it’s worth trying the herbs boswellia or white willow; both have anti-inflammatory effects. Although it is more frequently recommended by nutritionally oriented doctors for rheumatoid arthritis, some physicians find that bromelain, the natural anti-inflammatory derived from pineapple, can be effective in controlling the pain of osteoarthritis, especially when it's combined with other supplements like glucosamine and MSM. </li> </ul>   <ul type="disc"> <li>SAMe (S-adenosylmethionine), a cartilage-building form of the amino acid methionine, is claimed to have anti-inflammatory effects similar to ibuprofen's. WholehealthMD says studies have demonstrated that SAMe can be as effective as NSAIDs. MedlinePlus, however, considers this supplement to be unproven for effectiveness or safety. What both sources agree about is that it is expensive, especially when taken for any length of time. </li> </ul> DIET Diet is vitally important for Gout, and your doctor will give you clear advice on what to avoid. For other forms of arthritis the best advice is simply a nutritious, balanced diet. Keeping to a healthy weight, however, is important. WholehealthMD reminds that if you are overweight, losing excess pounds may slow or stop the damage to weight-bearing joints. A minority of arthritis sufferers also find that their joint pain is less when they stay away from certain foods. While no scientific studies have proven who can be helped or how, trying a food sensitivity diet over an eight-week period is an easy self-care experiment. Track your joint pains while off the suspect foods, and then see what happens during the week you start eating the foods again after the eight-week "holiday." There are many theories about diets for arthritis, Some may be right, but so far there is not much proof.   COMPLEMENTARY THERAPIES / ALTERNATIVE MEDICINE One or more complementary therapies may be a great help to you. They may help relieve symptoms. They may help you do more to take charge of your own condition and life. They may offer a level of support, empowerment and care which you aren’t finding in conventional medicine. If you find a complementary therapy which works for you, it can very much improve your whole quality of life. Never use a complementary therapy or medication instead of seeing your doctor. They are what they say they are; complementary. They are useful in addition to medical diagnosis and treatment, not instead of. Never stop taking a steroid or other prescription drug because you’re substituting an alternative therapy. Always check with your doctor first to be sure it’s safe to stop. Many complementary techniques and therapies have been found very helpful by arthritis sufferers. Look in our Useful Organisations section to find recommended guides to the techniques and ways to find qualified practitioners. We can’t say what will work for you, but some well known options include: Acupuncture - Well known Chinese therapy using fine needles to change energy flows. Evidence of effectiveness in dealing with pain and other problems, at least short term. High level qualified practitioner essential. Acupressure - Same principles as acupuncture, using pressure instead of needles. You can learn to do some acupressure therapy on yourself. Alexander Technique - Technique for learning how to efficiently and effortlessly use your body. Simple but profound approach to letting go of harmful tensions in posture and breathing. A safe and effective learning and therapy technique. It doesn’t sound like much but it’s a physically liberating technique and extremely relevant to arthritis. Aromatherapy - The art of applying essential oils to suit individual needs. The oils work directly on the chemistry of the body, via the skin and bloodstream. May seem unlikely, but a number of medical sites assure us that it can be surprisingly effective and safe. Art Therapy - Use of art for emotional therapy. Early evidence of effectiveness was with survivors returning from World War 2. Pain and healing are strongly affected by emotion, so makes sense. Ayurveda - The most important form of medicine in India. An ancient tradition, but most practitioners are also doctors or otherwise medically qualified. Ayurveda seeks to balance the body and mind, find health problems before they occur or stop them doing unnecessary harm. Obviously requires a qualified practitioner and is complementary to, not a replacement for conventional medical treatment. Biofeedback - Machines give you feedback about how your body is working, allowing you to learn to regulate reactions causing problems. Evidence of usefulness for therapy and self-education for many conditions. Biofeedback is often referred to as a very helpful tool for working with chronic pain. Bowen Technique - soft and non-invasive holistic treatment that aims to restore balance to the body by using small, gentle moves to specific areas of the body. Because the therapy is so gentle, it is considered to be suitable for all ages. May be helpful for many pain and stress related problems. Chiropractic - Manipulation of spine and muscles for good balancing and health functioning. A powerful technique and NOT to be used for many conditions. Check with your doctor, and see Useful Organisations for help finding a qualified and registered practitioner. Cognitive and Behaviour Therapies - Put crudely: It’s not what happens that causes the problems, it’s how you understand it and what you do with it. Less crudely, these have medical and government recognition for a wide variety of problems and can be startlingly effective in many cases. Many of us who they have helped consider them to be most remarkable life tools. Feldenkrais Method - Not a therapy as such, but a well established method for learning greater ease of physical movement and increasing vitality and well-being. Guided Imagery - The use of imagination as potent healer. Pleasant and powerful. See “Holistic Online” in Useful Organisations to learn more. Healing - comes in many forms, from spiritual or religious to using energy flow as understood in martial arts. Whether the effectiveness is due to a placebo effect, energy flows or spirit, many people have been helped by healings throughout history. Hellerwork - deep tissue massage that unblocks the body, movement education to correct postural alignment, and verbal dialogue to assess emotional holding patterns. Appropriate tools for many chronic pain syndromes. Caution for conditions where deep massage contraindicated. Check carefully with your doctor before using any deep massage technique. Herbal medicine - Herbal medicines can be very powerful, and are the basis of many conventional drugs. A good herbal practitioner looks at the whole person and health, not just the disease or condition. Because they can be very strong and conflict with prescribed medications, you absolutely need to tell your doctor what you’re going to be taking. A herbal remedy can destroy your therapy and health if it’s the wrong one for you. Homoeopathy - famous and controversial. Vanishingly small amounts of a substance in water are given. Many in medical science consider this to be absurd. No conclusive proof either way, but many people have found help and relief. Hard to argue with happy patients, and it has the great virtue of being harmless. That said, neglecting medical treatment to depend on homeopathy is an enormous mistake, as your qualified homeopath will agree. Hypnotherapy - not in any way a frightening experience or loss of consciousness or control, safe in qualified hands, and considered very effective in helping with chronic pain, anxiety, depression and other condition related problems. Louise Hay techniques - based on the use of positive affirmations - highly recommended by many people for effectively changing your mindset and health. A place to start is the Louise Hay book “You Can Change Your Life” and audio tapes from Amazon. As we keep saying throughout this website, mindset can profoundly affect healing. Massage Therapy - There are many forms of massage, and they can be a great help in stress reduction, release of chronic muscle tensions around arthritis, and can have many other therapeutic effects depending on the technique used. Having your body cared for like this is great, but: be aware that deep or powerful massage pressure can be dangerous for some conditions. Check with your doctor or physio about what to avoid. It is important that your therapist asks what your medical / physical situation is. If they are not qualified, or you are not comfortable, you are in the wrong hands. Don’t risk damage. Move on.  <div class="image2"> <img alt="Logo" src="http://www.spinstudios.co.uk/sa/ar6.jpg" /></div> Medau Movement - Enjoyable exercise to music for improving body use and posture, and good for stress reduction. Meditation - A truly profound way to deal with stress and the human condition. Good meditation teaching is simple, and the result should be access to peace and stillness whatever is happening and wherever you are - at home, on the street, at work… We give contacts for meditation in Useful Organisations. We’ve recommended the approach of the Shollond Trust as it’s fast, free, and a good starting place for appreciating all forms of meditation. We also like BBC Health and the H2G2 recommendations about meditation. Naturopathy - Technique for helping the body to heal itself, and often incorporates a number of the other techniques discussed here. Interesting to have one technique using the strengths of others. In capable hands this can be a very effective option. NLP (Neuro-linguistic Programming) - A fascinating form of therapy, looking at how you do what you do, and how to change. We like this sentence from a practitioner: “If you always do what you've always done, you'll always get what you've always got. If what you're doing isn't working, do something else". Far more to it than that of course, and worth learning about as a strong tool for living with any form of arthritis. Osteopathy - Certainly among the best known physical therapies and very well accepted as a complementary therapy. Osteopathy is highly regulated. Physical manipulation and massage techniques are used to help correct problems with the muscles, bones, and joints and influence many of the body’s systems. A good practitioner will ask in detail about your condition to not do harm with inappropriate manipulations. Often helpful for chronic pain conditions and arthritis related problems. Practitioner must be qualified, registered, and take a medical history to understand what your condition is. Pilates - Exercise method to method to strengthen the core postural muscles and develop balanced alignment through the use of slow, controlled movements and breathing. Often recommended by doctors, physiotherapists, and used by everyone from top professional athletes and dancers to people who have never done much exercise or thought they were unable to due to physical limitations. Teacher must understand your condition. Psychology of Mind - The book “Slowing Down to the Speed of Life” from Amazon is the well known place to start. POM techniques and understandings are simple and can be life changing. A way to use your problems to vastly improve your life. For the anxieties associated with illness (not to mention life) this is something special. Psychotherapy - Many forms, and a vital and immensely beneficial approach for many people. The idea that psychotherapy is for crazies couldn’t be more wrong. It’s one of the best learning and healing tools and most interesting things you could choose to do. Practitioners must be qualified, and you have to find one you feel comfortable with and helped by. For chronic pain and the anxiety, a good one. Reiki Healing - A Japanese form of healing through energy flow and which, interestingly, is also concerned with living in harmony with others, taking responsibility for one's own health and happiness, helping others, and being positive about all things. Shiatsu - Traditional Japanese physical therapy, using a range of techniques from gentle touch to more dynamic work to improve specific conditions and general health. A qualified practitioner will take a detailed history from you and avoid more dynamic techniques where they might be contra-indicated for your condition. Check with your doctor or physiotherapist before trying. Tai Chi - A soft, gentle and very powerful Chinese martial art, movement meditation, and way of healing through movement. Tai Chi works very well for older and ill people. It helps to free and balance the body, breathing and movement, and to find calm, stability, peace and deep security. If you have serious problems with feet, knees or walking it may not work for you. If that’s the case the exercises of Qigong (or Chi Kung) use the same principles but can be done sitting as well as standing. Tai Chi is a way to contact deep reserves of strength and ease. Trager Work - A form of bodywork and movement which utilises gentle, rhythmic movements to facilitate the release of stress patterns - physical, mental, and emotional. Created by a doctor and physiotherapist working with his own chronic pain since childhood, this method also has a meditation aspect. Yoga - The ancient Indian system of postures, exercises, breathing, and body and mind development and control. Popular and widely available these days. The basic exercises of Hatha Yoga, taught with careful respect for your physical problems and limitations, are a good place to start, along with pranayam breathing exercises. There are also some extremely challenging physical styles of yoga which may not be not at all appropriate. BE SURE your teacher knows what your physical problems are, and that your doctor has no problem with your doing yoga. That said, it is a wonderful combination of calm body, mind and spirit training and self-help therapy.   You can find practitioners and learn more about these and other techniques through our Useful Organisations. You may find that one of them is just what you need. Medline Plus and BBC Health in our First Resources are also useful for checking the possible advantages and dangers for any complimentary therapy. If in doubt about any complementery or alternative approach, check First Resources or ring the Arthritis Care Helpline.   SIMPLE THERAPIES you can do for yourself include: <ul type="disc"> <li>applying WARMTH: a warm bath, heating pad or a hot water bottle to ease joints and reduce stiffness. Bags of wheat can also be bought to heat in a microwave and shaped the contours of affected areas for superficial heating, and chemists sell gel packs to be heated and applied to small areas.</li> </ul>   <ul type="disc"> <li>A COLD pack, ice pack, frozen gel pack from a chemist (or a bag of frozen peas - very effective) or ice massage to reduce swelling.</li> </ul> <ul type="disc"> <li>massaging an affected joint to increase circulation. Many over the counter creams are sold to help increase circulation (rubifacients) and temporarily help ease pain. Rubbing one of these onto an affected joint can give short-term help. Creams with strongly cooling ingredients can also help.</li> </ul>   <ul type="disc"> <li>using a Tens (Transcutaneous Electrical Nerve Stimulation) machine, providing electrical impulses to block pain. </li> </ul> PLEASE BE SURE to check with your doctor, your physiotherapist, or get advice from the Arthritis Care Helpline before using any of these. Different arthritic problems require different handling. THE “CHRONIC PAIN” pages on this website give medical, self-help and lifestyle information in detail. For much more on dealing with the pain of arthritis, don’t miss them.   GENERAL HELP WITH ARTHRITIS RELATED PROBLEMS Arthritic conditions are manageable, but they can be incredibly challenging. The basics of life can become difficult, exhausting, a practical, emotional and financial strain. THE ARTHRITIS CARE website and telephone HELPLINE is probably the best one-stop shop to point you in the right direction and help deal with your needs. The Site Map on their website should help you find what you want quickly. Arthritis Care covers almost any arthritis problem or issue you can think of. Rather than searching the internet for everything from government benefits to counselling, walking sticks, travel, work, therapies, devices for easier living or the right furniture, you can simply start with them. Find them here under USEFUL ORGANISATIONS. You can also ring them and talk to an advisor on the Freephone number we’ve listed. Arthritis

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ARTHRITIS CARE <a href="http://www.arthritis.org.uk/">www.arthritis.org.uk</a> 18 Stephenson Way London NW1 2HD Telephone Helplines: Freephone 0808 800 4056 weekdays 10am - 4pm 020 7380 6555 weekdays noon - 4pm. Arthritis Care empowers people to take control of their arthritis and their lives. Arthritis self-help programme and much more. Look at the Site Map on their website. NATIONAL RHEUMATOID ARTHRITIS SOCIETY (NRAS) <a href="http://www.rheumatoid.org.uk/">www.rheumatoid.org.uk</a> Telephone Helpline: 0800 298 7650 UK patient-led charity helping people with rheumatoid arthritis, their families, carers and healthcare professionals. ARTHRITIS RESEARCH CAMPAIGN <a href="http://www.arc.org.uk/">www.arc.org.uk</a> Research and over 90 booklets and pamphlets of arthritis information for the public. FIBROMYALGIA ASSOCIATION <a href="http://www.fibromyalgia-associationuk.org/">www.fibromyalgia-associationuk.org</a> Telephone Helpline 0870 751 7389 weekdays 10am-12 noon NATIONAL ANKYLOSING SPONDYLITIS SOCIETY <a href="http://www.nass.co.uk/">www.nass.co.uk</a> Telephone 01435 873527 BRITISH SJÖGREN'S SYNDROME ASSOCIATION <a href="http://www.bssa.uk.net/">www.bssa.uk.net</a> Telephone Helpline: 0121 455 6549   FOR IMMEDIATE HELP WITH HEALTH QUESTIONS and GENERAL MEDICAL INFORMATION: See our FIRST RESOURCES section - especially MedlinePlus ( <a href="http://medlineplus.gov/">http://medlineplus.gov</a> ) BBC Health ( <a href="http://www.bbc.co.uk/health">www.bbc.co.uk/health</a> ), the Mayo Clinic (<a href="http://www.mayoclinic.com/">www.mayoclinic.com</a> ) and: MEDICINENET.COM <a href="http://www.medicinenet.com/">www.medicinenet.com</a> For a general guide and information base on any subject this is an excellent resource. NETDOCTOR <a href="http://www.netdoctor.co.uk/">www.netdoctor.co.uk</a> Attempts to break down the "medical language barrier" between the doctor and the patient. Critical medical information presented in a clear and understandable language so that the patient fully understands his or her choices and decisions. THE COCHRANE REVIEWS (<a href="http://www.cochrane.org/">www.cochrane.org</a>) The Cochrane Collaboration assesses most areas of health care. To do this, it is divided into Cochrane Review Groups, each of which concentrates on a specific healthcare area, including a Consumer Network that represents the interests of healthcare consumers. Type any condition into their website and get pretty comprehensive information. If you want clear scientific analysis of any health issue or practice, you’ll usually find it here. BANDOLIER: THE OXFORD MEDICAL SITE <a href="http://www.jr2.ox.ac.uk/bandolier/index.html">http://www.jr2.ox.ac.uk/bandolier/index.html</a> Bandolier is a journal of evidence-based medicine. Look up any subject for links and knowledge. Their “Healthy Livig Zone” is a bit of a goldmine on the subject. MERCK MEDICUS <a href="http://www.merckmedicus.com/">www.merckmedicus.com</a> Easy to use and the US doctor’s reference tool. See MERCK GERIATRIC for age related information.   FOR ANCILLARY MEDICAL THERAPIES (Physiotherapy etc): HEALTH PROFESSIONS COUNCIL <a href="http://www.hpcuk.org/">www.hpc-uk.org</a> Telephone 020 7582 0866 The HPC is a statutory regulator that works to protect the health and well-being of people using the services of health professionals. Find therapists and be sure they are approved / regulated practitioners. CHARTERED SOCIETY OF PHYSIOTHERAPY <a href="http://www.csp.org.uk/">www.csp.org.uk</a> Tel: 020 7306 6218 / 6666 Information on physiotherpaists, physiotherapy and how it can help with pain. THE ORGANISATION OF CHARTERED PHYSIOTHERAPISTS IN PRIVATE PRACTICE <a href="http://www.physiofirst.org.uk/">www.physiofirst.org.uk</a> Tel: 01327 354441 Details of private chartered physiotherapists in your area. OCCUPATIONAL THERAPISTS IN INDEPENDENT PRACTICE (OTIP) <a href="http://www.otipp.co.uk/">www.otipp.co.uk</a> Tel: 0800 389 4873 Information and find an occupational therapist   FOR COMPLEMENTARY AND ALTERNATIVE THERAPIES: THE COMPLIMENTARY HEALTHCARE INFORMATION SERVICE <a href="http://www.chisuk.org.uk/">www.chisuk.org.uk</a> Easy reference to learn about any and (just about all) complementary techniques. A truly excellent way to learn what the main comlementary techniques are, how they might work for you, and to explore the subject   THE NETDOCTOR DR FOSTER COMPLEMENTARY PRACTITIONER DIRECTORY <a href="http://netdoctorcomplementarytherapistguide.drfoster.co.uk/">http://netdoctorcomplementarytherapistguide.drfoster.co.uk</a> If you are looking to find a reliable complementary therapy practitioner in your area, this directory is an essential resource. It can help you find a practitioner who meets your needs. This might be someone who has a particular interest in your condition, or who works at a practice near to your home, at hours that suit your needs. THE BRITISH COMPLEMENTARY MEDICINE ASSOCIATION <a href="http://www.bcma.co.uk/">www.bcma.co.uk</a> Tel 0845 345 5977 Find qualified practitioners of most therapies, learn about therapies, get recognised guidance through the therapy minefield and find a therapist near you. WHOLE HEALTH MD <a href="http://www.wholehealthmd.com/">www.wholehealthmd.com</a> American WholeHealth Networks' Complementary and Alternative Medicine (CAM) education website. The site is dedicated to providing integrative health and wellness solutions by combining the resources of both scientific health research and CAM. Click on specific health issues for information on conventional medicine, alternative therapies, supplements, diet, lifestyle options, and much more. HOLISTIC ONLINE <a href="http://www.holisticonline.com/">www.holisticonline.com</a> Comprehensive site for Alternative and Integrative Medicine. Learn about conditions and treatments.   INSTITUTE FOR COMPLEMENTARY MEDICINE <a href="http://www.i-c-m.org.uk">www.i-c-m.org.uk</a> The ICM is a UK registered charity providing information on all aspects of the safe and best practice of Complementary Medicine. THE NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE <a href="http://nccim.nch.gov/">http://nccim.nch.gov</a> Vital and reputable information for the States. A treasure for understanding what’s what. THE ALTERNATIVE MEDICINE FOUNDATION <a href="http://www.amfoundation.org/">www.amfoundation.org</a> Excellent US site, good clear information. They also recommend: ALTERNATIVE MEDICINE RESOURCE <a href="http://www.altmedresource.com/">www.altmedresource.com</a> comprehensive and searchable catalog of all alternative medicine studies. Easy search by looking up your condition(s) or a key word.   FOR COMPLEMENTARY PRACTICTIONERS’ ASSOCIATIONS GENERAL OSTEOPATHIC COUNCIL <a href="http://www.osteopathy.org.uk">www.osteopathy.org.uk</a> Tel: 020 7357 6655 Provides details of qualified local osteopaths. BRITISH CHIROPRACTIC ASSOCIATION <a href="http://www.chiropractic-uk.co.uk">www.chiropractic-uk.co.uk</a> Tel: 0118 950 5950 Information on chiropractic and details of local chiropractors. GENERAL CHIROPRACTIC COUNCIL <a href="http://www.gcc-uk.org/">www.gcc-uk.org</a> Tel: 020 7713 5155 Provides details of local chiropractors and information on what to expect when you see a chiropractor. It can also help if you've experienced a problem with a chiropractor. THE SOCIETY OF CHIROPODISTS AND PODIATRISTS <a href="http://www.feetforlife.org/">www.feetforlife.org</a> Telephone 020 7234 8620 GENERAL COUNCIL FOR MASSAGE THERAPY <a href="http://www.gcmt-uk.org/">www.gcmt-uk.org</a> Telephone 01992 537637 New voluntary regulation body for practitioners of massage.   INTERNATIONAL FEDERATION OF AROMATHERAPISTS <a href="http://www.ifaroma.org/">www.ifaroma.org</a> Telephone 020 8992 9605   THE BRITISH MEDICAL ACUPUNCTURE SOCIETY <a href="http://www.medical-acupuncture.co.uk/">www.medical-acupuncture.co.uk</a> Telephone 01925 730727 Medical doctors who practice acupuncture. Encourages the use and scientific understanding of acupuncture within medicine for the public benefit. ACUPUNCTURE ASSOCIATION OF CHARTERED PHYSIOTHERAPISTS <a href="http://www.longbo.demon.co.uk/aacp.html">www.longbo.demon.co.uk/aacp.html</a> Tel 01747 861151 Contact the AACP Secretariat for a register of members - qualified phyisos working with acupuncture. BRITISH ACUPUNCTURE COUNCIL <a href="http://www.acupuncture.org.uk/">www.acupuncture.org.uk</a> Tel: 020 8735 0400 Provides information on acupuncture and details of qualified traditional acupuncturists in your area. Phone or enclose an SAE for more information. NATIONAL INSTITUTE OF MEDICAL HERBALISTS <a href="http://www.nimh.org.uk/">www.nimh.org.uk</a> Telephone 01392 426022 Email <a href="mailto:nimh@ukexeter.freeserve.co.uk">nimh@ukexeter.freeserve.co.uk</a> Professional body - offers a service for you to find a trained and qualified herbalist.   FOR DIET ADVICE: BRITISH NUTRITION FOUNDATION <a href="http://www.nutrition.org.uk/">www.nutrition.org.uk</a> Telephone 0207 404 6504 Includes advice on finding a dietician BRITISH DIETETIC ASSOCIATION <a href="http://www.bda.uk.com/">www.bda.uk.com</a> FOOD STANDARDS AGENCY <a href="http://www.eatwell.gov.uk/">www.eatwell.gov.uk</a> BBC HEALTH <a href="http://www.bbc.co.uk/health/healthy_living/nutrition">www.bbc.co.uk/health/healthy_living/nutrition</a> NHS DIRECT <a href="http://www.nhsdirect.nhs.uk/encyclopaedia">www.nhsdirect.nhs.uk/encyclopaedia</a> FOR MEDITATION: THE SHOLLOND TRUST <a href="http://www.headless.org/">www.headless.org</a> tel. 020 8806 3710 - Richard Lang, Trust Co-ordinator The Trust offers a form of meditation you can do any time, any place, in any circumstances. It’s astoundingly easy to do, and it’s free. It’s also a great way to get the best out of and appreciate all other meditation and complementary techniques. THE BBC <a href="http://www.bbc.co.uk/">www.bbc.co.uk</a> and search “meditation”. A wide range of options. THE HITCHHIKER’S GUIDE TO THE GALAXY <a href="http://www.bbc.co.uk/dna/h2g2">www.bbc.co.uk/dna/h2g2</a> Ask the guide about meditation. In fact ask it about any question you have.   FOR COUNSELLING: BRITISH ASSOCIATION FOR COUNSELLING AND PSYCHOTHERAPY (BACP) <a href="http://www.bacp.co.uk/">www.bacp.co.uk</a> Telephone 0870 443 5252 Email bacp@bacp.co.uk A fisrt reference for anyone seeking information on counselling and psychotherapy in the United Kingdom. They have a helpful and easy to use search tool to find a therapist. THE SAMARITANS <a href="http://www.samaritans.org/">www.samaritans.org</a> Telephone 08457 90 90 90 (24 hours, seven days a week) Email <a href="mailto:jo@samaritans.org">jo@samaritans.org</a> Confidential non-judgemental support, 24 hours a day for people experiencing feelings of distress or despair. MIND <a href="http://www.mind.org.uk/">www.mind.org.uk</a> Telephone 020 8519 2122 Mind Infoline 0845 766 0163 (Monday-Friday 9:15-5:15) Email <a href="mailto:contact@mind.org.uk">contact@mind.org.uk</a> The MindinfoLine offers confidential help on a range of mental health issues from anywhere in the UK for the price of a local call. Local MIND associations offer supported housing, crisis helplines, drop-in centres, counselling, befriending, advocacy, employment and training schemes and other services. RELATE <a href="http://www.relate.org.uk/">www.relate.org.uk</a> Tel. 0845 456 1310 or 01788 573241 Relate is the UK's largest provider of relationship counselling and sex therapy. They also offer a range of other relationship support services.   FOR CARE SERVICES: COUNSEL AND CARE <a href="http://www.counselandcare.org.uk/">www.counselandcare.org.uk</a> Advice line 0845 300 7585 (weekdays 10am-12.30pm and 2pm-4pm) A national charity getting the best care and support for older people, their families and carers SUE RYDER CARE <a href="http://www.suerydercare.org/">www.suerydercare.org</a> 020 7400 0440 Cares for people with life-shortening illnesses through specialist hospice care services. THE PRINCESS ROYAL TRUST FOR CARERS <a href="http://www.carers.org/">www.carers.org</a> Telephone 020 7480 7788 Email help@carers.org The trust is the largest provider of comprehensive carers support services in the UK. CARERS UK <a href="http://www.carersuk.org/">www.carersuk.org</a> Free Carers Line 0808 808 7777 (weekdays 10am-12pm and 2pm-4pm) Email info@ukcarers.org Carers UK is the voice of carers and the leading campaigning, policy and information organisation for carers. Provides information and advice on topics relating to caring. CARERS NATIONAL ASSOCIATION <a href="http://www.carersuk.org/">www.carersuk.org</a> Provides information and advice for carers and works for carers rights. CROSSROADS (The Association of Crossroads Care Attendant Schemes) <a href="http://www.crossroads.org.uk/">www.crossroads.org.uk</a> Tel: 0845 450 0350 Practical support for carers; respite care at home. Provides trained care support workers to allow carers the breaks and time off they need.   CARE CHOICES LTD <a href="http://www.careselect.co.uk/">www.careselect.co.uk</a> Tel: 0800 389 2077 Care Choices Ltd offers a free residential/care home search service. The company has a database of care homes, nursing homes, elderly accommodation and similar establishments throughout the UK.   FOR GENERAL UK HEALTH HELP, ISSUES and the NHS: NHS DIRECT ( <a href="http://www.nhsdirect.nhs.uk/">www.nhsdirect.nhs.uk</a> ) - see First Resources LTCA - LONG TERM CONDITIONS ALLIANCE <a href="http://www.ltca.org.uk/">www.ltca.org.uk</a> An umbrella body for voluntary organisations. Promotes access to services, support, and knowledge for self-help. Includes an “Expert Patients” programme with the NHS. Look at the directory of member organisations on their website for the help you need, or RING THEM on 02078153637. PATIENTS ASSOCIATION <a href="http://www.patients-association.com/">www.patients-association.com</a> Helpline: 0845 608 4455 Represents the views and interests of patients and campaigns for improved health services. Provides advice, factsheets and self-help guides. DR FOSTER <a href="http://www.drfoster.co.uk/">www.drfoster.co.uk/</a> Telephone 0207 332 8800 Works with the NHS to make it easier for professionals and the public to access health and social care information. Hospitals, consultants, complementary therapies and much more. PALS - PATIENT ADVICE AND LIAISON SERVICE (<a href="http://www.dh.gov.uk/">www.dh.gov.uk</a>) This web address will take you to the Department of Health website. Click on Patient Advice and Liaison Service to find your local PAL. Information and help with any questions or problems you have about your GP service, NHS hospital or other NHS service. EQUIP - ELECTRONIC QUALITY INFORMATION FOR PATIENTS <a href="http://www.equip.nhs.uk/">www.equip.nhs.uk</a> NHS search website for patient information on a very wide variety of conditions. RSVP - RETIRED AND SENIOR VOLUNTEER PROGRAMME <a href="http://www.csv-rsvp.org.uk/">www.csv-rsvp.org.uk</a> Advice and help for over 50’s by over 50’s: Transport for medical care, practical and domestic help, avoiding isolation, help for over 50’s in GP surgeries. PATIENT CONCERN <a href="http://www.patientconcern.org.uk/">www.patientconcern.org.uk</a> Helpful advice on how to survive medical treatment and the NHS, how to assess medical websites and more.   FOR EXERCISE: There are many possibilities to choose from, and you may be surprised what you can do and what you’ll enjoy. Just be sure to get your doctor’s and/or physiotherapist’s advice on any medical limitations and what to avoid. SIMPLE WAYS to look at the possibilities are with the help of: THE BBC - Go to <a href="http://www.bbc.co.uk/health">www.bbc.co.uk/health</a> BANDOLIER - go to <a href="http://www.jr2.ox.ac.uk/bandolier">www.jr2.ox.ac.uk/bandolier</a> and see Exercise in their healthy living section THE NHS Health encyclopaedia: <a href="http://www.nhsdirect.nhs.uk/">www.nhsdirect.nhs.uk</a> in our FIRST RESOURCES section has good information. THE COMPLIMENTARY HEALTHCARE INFORMATION SERVICE <a href="http://www.chisuk.org.uk/">www.chisuk.org.uk</a> links to all the main movement therapy exercise techniques. A one-stop convenience shop. And specifically for: TAI CHI - local adult education courses, local gym, fitness centre, library listing or the TAI CHI UNION OF GREAT BRITAIN - <a href="http://www.taichiunion.com/">www.taichiunion.com</a> PILATES <a href="http://www.pilatesfoundation.com/">www.pilatesfoundation.com</a> YOGA <a href="http://www.bwy.org.uk/">www.bwy.org.uk</a> DANCING - ballroom, tap, folk, flamenco, modern, social, jazz… too many styles to list. Once again the easy place to start is THE BBC. Go to <a href="http://www.bbc.co.uk/health">www.bbc.co.uk/health</a> and look under dance. Also many classes locally in many styles. GYMS / CIRCUIT TRAINING / SPORT - Infinite options. BBC Health provides guidance. EXERCISE IN WATER: AQUA-CHI <a href="http://www.taichiunion.com/">www.taichiunion.com</a> AQUA-GYM <a href="http://www.aquagym.co.uk/">www.aquagym.co.uk</a> POOLATES <a href="http://www.poolates.co.uk/">www.poolates.co.uk</a> Pilates in water. AQUA-DANCE classes at local pools or <a href="http://www.virginactive.co.uk/">www.virginactive.co.uk</a> for classes at their gyms   FOR GENERAL SELF-HELP ON MOST SUBJECTS: DIRECTORY OF UK SELF-HELP GROUPS www.ukselfhelp.info/ This is a remarkably complete A-Z of self-help organisations on just about any health subject you can think of and life problems of most kinds.   FOR PRACTICAL GENERAL INFORMATION ON MOST SUBJECTS: <a href="http://www.about.com/">www.about.com</a> <a href="http://www.bbc.co.uk/">www.bbc.co.uk</a> <a href="http://www.bbc.co.uk/dna/h2g2">www.bbc.co.uk/dna/h2g2</a> <a href="http://www.wikipedia.org/">www.wikipedia.org </a>   FOR PHYSICAL AIDS AND EQUIPMENT - ACCESS, MOBILITY AND PRACTICAL HELP: DISABLED LIVING FOUNDATION (DLF) <a href="http://www.dlf.org.uk/">www.dlf.org.uk</a> Tel: 020 7289 6111 Helpline: 0845 130 9177 Text phone: 020 7432 8009 DLF are the leading source of information on disability equipment - free, impartial advice about all types of equipment and mobility products   DISCOUNT MOBILITY PLUS LTD For scooters, wheelchairs, bathlifts, stairlifts, chairs <a href="http://www.discountmobilityplus.co.uk/">www.discountmobilityplus.co.uk</a> Tel: 0808 178 4151 DISABILITY ALLIANCE www.disabilityalliance.org The leading authority on social security benefits for disabled people Tel: 020 7247 8776 MOBILISE - THE DISABLED DRIVERS’ ASSOCIATION <a href="http://www.justwebs.co.uk/mobilise/">www.justwebs.co.uk/mobilise/</a> Tel: 01508 489449 (Representation, information and advice on mobility issues) DISABILITY RIGHTS COMMISSION <a href="http://www.drc-gb.org/">www.drc-gb.org</a> DRC Helpline Tel: 08457 622 633 Textphone: 08457 622 644 The Disability Rights Commission (DRC) is an independent body established in April 2000 by Act of Parliament to stop discrimination and promote equality of opportunity for disabled people. RELATIVES AND RESIDENTS ASSOCIATION www.relres.org Tel: 020 7359 8136 Provides information and support about carehomes. ROYAL ASSOCIATION FOR DISABILITY AND REHABILITATION (RADAR) www.radar.org.uk Tel: 020 7250 3222 Minicom: 0207 250 4119 RADAR is concerned with every aspect of disability, but is particularly involved with access, education, employment, holidays, housing, mobility and social services.   CITIZENS ADVICE BUREAUX (CABx) <a href="http://www.nacab.org.uk/">www.nacab.org.uk</a> The website gives local offices, opening times and specialist services.   AGE CONCERN AID CALL <a href="http://www.aidcall-alarms.co.uk/">www.aidcall-alarms.co.uk</a> T: 0800 77 22 66 Emergency alarms to stay independent but summon help if needed   MEDIC ALERT FOUNDATION <a href="http://www.medicalert.co.uk/">www.medicalert.co.uk</a> tel 02078333034 Medical identification, cards, bracelets, necklaces etc with information on call for emergency treatment. Knowing your chronic problems and what medications you’re on can make a critical difference for any doctor or emergency worker treating you in any situation. <a name="working" id="working"></a>  FOR FIRST AID TRAINING - and we always recommend this as part of learning to take care of ourselves and each other: RED CROSS <a href="http://www.redcross.org.uk/">www.redcross.org.uk</a> ST JOHN’S AMBULANCE <a href="http://www.sja.org.uk/">www.sja.org.uk</a> ST ANDREW’S AMBULANCE (Scotland) <a href="http://www.firstaid.org.uk/">www.firstaid.org.uk</a>