Leg cramps after exercise

Leg cramps are common, and although can be quite painful, are generally not a serious condition. They tend to increase as we get older.

Prevention

Some people complain of leg cramps after exercise. This may be partly due to inadequate stretching before exercise and muscle fatigue due to exercise. If you aim to become fitter with likes of extra walking or swimming, your muscles will become more accustomed to the increased exercise and you should find leg cramps reducing. To help prevent cramps, it is important to do warm ups including stretches before and after exercise.

Dehydration plays a major role in cramps after exercise. When you exercise you lose fluid, which can upset calcium and phosphorous levels in the body and can trigger cramps. Make sure you drink plenty of fluid before, during and after exercise.

Heavy or tight bed clothes can force the toes downwards, stretching the leg muscles. Sleeping under a light, loose duvet may help.

Other treatments

If the above advice does not work, you may like to try Crampex^® tablets. It is an over the counter treatment available in pharmacies, it works by improving circulation. Quinine can be used to prevent leg cramps, especially at night. Quinine should only be considered if all other efforts fail and is only available with a doctor’s prescription. Quinine can cause dizziness and blurred vision occasionally so caution is advised. Tonic water contains very small amounts quinine, so it may be enough to relieve night cramps.  

Can there be another cause?

On rare occasions, leg cramps can be a sign of arteriosclerosis, also known as hardening of the arteries. In this condition, the arteries become clogged by fatty deposits such as cholesterol, limiting the supply of blood to the muscles. As blood supply is limited, the muscles can’t get enough oxygen during activities like walking resulting in cramps. In mild cases, you may notice your legs are cold and your skin is dry. In more severe cases, the leg may become blue and ulcerated. Smoking, diabetes, high cholesterol and high blood pressure are all risk factors for atherosclerosis. Get checked by your GP if arteriosclerosis is a possibly.

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

More detailed information on leg cramps is available at www.whelehans.ie or ask in Whelehans.

Disclaimer: Please ensure you consult with your healthcare professional before making any changes recommended

Get the flu vaccine...not the flu

Influenza (flu) is a highly infectious acute respiratory illness caused by the influenza virus. It can affect people of any age. You can now get the flu vaccination from Whelehan’s pharmacy for €15.

Those considered “at-risk” from flu

There are certain groups of at-risk people who are more at risk of serious complications or even death if they get flu. In Ireland, the National Immunisation Advisory Committee has recommended that certain groups of at-risk people need to be vaccinated for seasonal influenza. This includes everyone aged 65 and older, children and adults with long-term illnesses such as asthma, diabetes and heart problems or any condition which weakens the immune system, people who attend schools or day centres for people with disabilities and pregnant women. Health care staff and carers are also advised get the flu vaccine. You can get the flu the vaccine through your GP surgery or pharmacy. Flu vaccination in pharmacy is free of charge for some groups including those with certain long term illness and medical card holders and GP visit card holders.

Symptoms of Flu

Symptoms of flu include sudden fever, chills, headache, muscle pain, sore throat, non-productive dry cough, exhaustion and weakness. Flu characteristically causes a temperature of 38 to 40° C that lasts 3-4 days.

The difference between cold and flu

A cold will develop slowly over a few days with symptoms like a sore throat and a blocked or runny nose. The symptom of flu hits you suddenly and severely with symptoms like fever and muscle aches. Flu hits you like a brick. Often people suffering from a bad cold wrongly believe they have flu. Flu causes extreme exhaustion, muscle aches, severe sweats and leaves you so weak you will not be able to get out of bed. Work and other normal routines are not possible with flu.

Complications of flu

Most people recover from flu in 2-7 days, but in some people it can last for up to two or three weeks. However, flu can be severe and can cause serious illness and death, especially in the very young and in the elderly. Serious respiratory complications can develop, including pneumonia and bronchitis. Older people and those with certain chronic medical conditions are at particular risk of these complications. Pregnant women and women up to six weeks after giving birth have also been found to be at increased risk of the complications of flu. Hospital treatment is needed in some cases, usually in the elderly or people with or serious long term conditions. Complications of flu are a common cause of death every winter. 80 to 90% of reported deaths from influenza occur in the elderly, mainly from bacterial pneumonia (200 deaths per year in Ireland), but also from the underlying disease. Other serious complications of flu are rare and may include ear infection, tonsillitis, septic shock (infection of the blood that causes a severe drop in blood pressure), meningitis (infection in the brain and spinal cord) and encephalitis (inflammation of the brain).

 How do you catch flu?

Flu is a highly infectious illness. Influenza is spread from person to person by direct contact, by droplet infection or by contact with materials recently contaminated by nasal or oral secretions. Airborne spread can also occur. For example, a person carrying the virus can spread the illness by coughing or sneezing. It is highly contagious, especially in close contact environments such as homes for the elderly. A person can spread the virus from 1-2 days before they develop symptoms and for up to a week after symptoms develop. 

What to you if you get flu?

There is no cure for the flu once you get it. Treatment consists of treating symptoms like high temperature and ensuring you are warm and comfortable to prevent complications like pneumonia. The flu will usually run its course within 7 days but it can take up to 3 weeks to recover depending on the strain of flu and the general health of the sufferer. If you are otherwise fit and healthy, there is usually no need to see a doctor if you have flu-like symptoms. The best remedy is to rest at home, keep warm and drink plenty of water to avoid dehydration. You can take paracetamol or ibuprofen to lower a high temperature and relieve aches and pains.

However you should see a doctor if you have flu-like symptoms and you are 65 or over, are pregnant, have a long-term medical condition such as diabetes, heart disease, lung disease, kidney or neurological disease or have a weakened immune system. This is because flu can be more serious for you, and your doctor may want to prescribe antiviral medication to prevent complications.

Antiviral medicines such as Tamiflu^® can reduce the symptoms of flu and shorten its duration, but treatment needs to start soon after flu symptoms have begun in order to be effective. Anti-viral medicines are only available on prescription from your GP and they will only be prescribed if the doctor feels you are at high risk of flu complications. Antibiotics are of no use in the treatment of flu because it is caused by a virus and not bacteria. However, they may me required if you develop complications from flu like a bacterial chest infection.

How can flu be prevented?

The only way flu can be prevented is with vaccination. Vaccinations can be done at your local GP surgery or at some pharmacies. It costs €15 to get the flu vaccine at Whelehans. Call us at 04493 34591 to book your vaccine.

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

This article is shortened for this Health Blog. More detailed information and leaflets are available in Whelehans or check www.whelehans.ie

Haemochromatosis

Haemochromatosis is a hereditary condition caused by the body’s iron levels building up excessively. It can also be referred to as “iron overload disorder”. Our body uses iron to transfer oxygen in the blood to essential organs. However, too much iron can lead to symptoms such as excessive tiredness, joint pain and more serious health problems if not treated.

Causes

Haemochromatosis is a hereditary condition due to a faulty gene called HFE meaning too much iron is absorbed from our diet. Without the condition, the body only takes in as much as is needed; however haemochromatosis causes more iron to be absorbed than is needed thus causing excess iron to build up in the body eventually leading to symptoms and organ damage. Iron levels increase over years and is deposited in organs including the liver, pancreas, joints, heart and endocrine glands (glands that produce the body’s important hormones) where damage can occur. This can cause numerous severe complications with examples including liver scarring (cirrhosis), liver cancer, heart failure (heart cannot pump properly) and arthritis.

Living with haemochromatosis

Haemochromatosis symptoms can be prevented with adequate treatment, but for people who are at risk or are diagnosed there are some preventative measures that a person can take to reduce iron levels.

A strict low iron diet is not necessary but ways to reduce iron levels include reducing red meat intake (eg. beef, lamb). It is probably best to avoid animal organ meat (eg. liver, kidney and heart) altogether as it is very high in iron. While vegetables, beans and cereals also contain iron, it is more rapidly absorbed from meat. Avoid foods fortified with iron (will be marked on the packaging, for example some breakfast cereals are fortified in iron). Do not take iron supplements. Your intake of vitamin C should be reduced as vitamin C increases iron absorption. Reduce alcohol intake especially with meals as alcohol increases iron absorption and can cause further damage to the liver. A cup of tea or milk (or other dairy products) with meals help reduce iron absorption.

Who it affects?

Haemochromatosis is called the “Celtic Curse” as it is more common in Ireland than any other country in the world. Approximately one in 83 people in Ireland are affected whereas frequency in other northern European countries varies from one in 200 to one in 400. About one in ten people are carriers of the faulty HFE gene in Northern European countries but this rises to one in five people in Ireland. The exact reason it is more common in Ireland is not fully understood. Symptoms usually do not start until the person is over 30. (usually between 30 and 50 but can start earlier). Iron levels are usually building up for years before symptoms appear. Symptoms for women can be delayed as iron levels reduce monthly due to the monthly menstrual discharge.

Symptoms

For many with haemochromatosis, it is symptomless and the condition is only discovered during a general blood test or after being called for screening because a blood relative (eg. parent, brother, sister) has been diagnosed.

The first symptoms of haemochromatosis can include:

·         Excessive fatigue and tiredness

·         Joint pain

·         Weakness

·         Erectile dysfunction in men

·         Irregular or lack of periods in women

 

If the condition is not treated further symptoms can appear including:

·         Subtle skin colour change such as a more bronzed or tanned colour

·         Enlarged liver which can be sore when the upper abdominal area (area where liver is) is touched. This can also lead to jaundice (yellowing of eyes and skin)

·         Diabetes (initial symptoms are excessive thirst and loss of weight)

·         Arthritis (including severe joint pain and stiffness especially finger joints)

·         Damaged heart muscles which leads to chest pain, problems breathing and swelling of hands and feet

·         loss of sex drive (libido)

·        Neurological or psychiatric symptoms that can occur in later stage of haemochromatosis include memory problems, mood swings, irritability and depression

Inheriting the HFE gene

Everybody has two sets of HFE genes, one we receive from our father and one we receive from our mother. If you receive one set that includes one abnormal HFE gene and one normal HFE, you will not develop haemochromatosis but will be a carrier. If a couple who each have an abnormal HFE gene have a baby there is a chance the baby will receive two sets of abnormal HFE gene and hence develop haemochromatosis in later life.

The chances of passing it on

If both parents are carriers of the abnormal gene, here are the risks of passing on haemochromatosis. There is a one in four chance the child will receive two normal HFE genes so they cannot develop haemochromatosis. There is a one in two chance the baby receives one normal and one abnormal HFE gene which means they will not develop haemochromatosis but will be a carrier of the condition. There is a one in four chance that the baby receives two abnormal HFE genes meaning haemochromatosis is a risk in later life. However, even if the person inherits two abnormal genes (one from each parent), the good news is that there is still only less than a one in ten chance of developing haemochromotosis.

Diagnosis

Many of the usual symptoms of haemochromatosis are similar to other conditions meaning it can be tricky diagnosing. Haemochromatosis is often diagnosed during unrelated blood tests. Unless a person has a history of the condition in the family, getting a diagnosis can be slow.

Screening

There is no routine screening programme for haemochromatosis in Ireland. If you have a close blood relative (parent, sibling) diagnosed with haemochromatosis, your risk is higher so a haemochromatosis check is advised. There is a one in four chance of developing haemochromatosis if a close blood relative (parent, sibling) is diagnosed. It is important for other family members including your children to be tested if you are diagnosed. Children of haemochromatosis sufferers are normally not screened until they are at least in their late teens.

Blood tests

Blood tests are used to diagnose haemochromatosis and the two blood tests that can diagnose include:

·         Transferrin saturation: reveals how much iron is readily available to use by the body. Transferrin saturation levels of below 45% may indicate haemochromatosis.

·         Serum ferritin: determines the amount of iron in storage in the body

 Fasting transferrin saturation and serum ferritin are the first tests needing done for anyone suspected of haemochromatosis. If you have increased transferrin saturation the next step can be to take a sample of DNA to check for HFE gene mutation. Serum ferritin is the most commonly used blood test for haemochromatosis as it is a very sensitive test for excess iron and normal ferritin levels essentially rules out haemochromatosis.

A liver biopsy may be performed if tests show high enzymes that indicate liver damage; however thankfully most people are diagnosed early before liver damage is done so liver biopsy is rarely needed. A serum ferritin level of less than 1000mcgg/L means the risk of severe liver damage is less than 1%. Serum ferritin levels higher than 1000mcg/L means an increased risk of liver cirrhosis so a liver biopsy may be required. Alcohol abuse is another reason for ordering a liver biopsy. Raised ferritin levels can also result from other unrelated conditions including alcohol abuse, diabetes mellitus and other liver conditions.

Treatment

Treatment is quite simple. It involves regularly removing blood from the body which has the effect of reducing the body’s iron levels. Blood is removed in the same manner that we give a blood donation (technique is called a phlebotomy which involves taking blood from a vein). About 400 to 500ml of blood (200-250mg) is taken on each occasion which again is similar to a blood donation.

Phlebotomy therapy has two stages:

·         Induction: blood is taken frequently (usually weekly) until iron levels return to normal. Can take up to 12 months 

·         Maintenance: blood is removed less regularly (generally every two to four months) to maintain iron at normal levels

Some GP surgeries offer a phlebotomy service otherwise you will be referred to a hospital to undergo the service. Should a haemochromatosis sufferer wish to donate blood, the Irish Blood Transfusion Board currently runs a dedicated clinic one day per week especially for haemochromotosis patients who meet the criteria of donating blood. However, you must be referred by your GP to avail of this service.

On some rare occasions a person cannot undergo phlebotomy for medical reasons. When this happens, a treatment called chelation therapy using a tablet called deferasirox is an alternative treatment option. Deferasirox works by binding to iron in the body and then excreting it from the body via urine or stools. Side effects can include nausea and diarrhoea.

This article is shortened for this Health Blog.. More detailed information and leaflets is available in Whelehans or check www.whelehans.ie

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

Lower Back Pain

Lower back pain (LBP) is a very common condition, with most adults (60-80%) experiencing LBP at some point in their lives. The pain can originate from the muscles, nerves, bones, joints and other structures in the back.  Often pain in the back can be very intense and worrying. However, it is important to remember that the spine is a strong stable structure and in most cases the pain is not due to any serious damage.  The degree of pain felt depends on a number of factors such as the circumstance in which the pain occurred, previous experiences of back pain, mood, fear and stress levels, among others.

The onset of back pain can be variable. In some instances, the pain occurs suddenly as a direct result of an acute incident, such as bending over to pick something up from the ground. In other cases, the onset of pain can be more gradual, over a number of weeks or months and is often related to factors such as posture, work and home life activities and hobbies **.  Pain can be acute (up to 12 weeks) or develop into chronic pain (longer than three months).

Signs and symptoms of LBP can also differ between people. The pain may be constant or intermittent. It may stay in one place or it can radiate across the back or down into the legs and feet. Sensations such as pins and needles, numbness or weakness may be present. In more severe cases bladder and bowel function may be disturbed. ** LPB is associated with time away from work, limitation in everyday activity and difficulty playing sports.

 General Back Pain Management

Stay Active - Activities such as walking, swimming and pilates are excellent ways to keep your spine strong. If you are experiencing an episode of back pain, continue to keep active but remember to pace yourself – little and often. Too much activity can increase pain but remaining inactive will cause your back to stiffen up more.

Avoid prolonged bed Rest – During an acute episode of back pain it is important to avoid aggravating activities and short bouts of rest may help to relieve pain, similar to pain in any other part of the body, such as a sprained ankle. However, returning to small amounts of activity as soon as possible helps to facilitate recovery.

Continue Working – Evidence has shown that staying in work or returning to work as soon as possible aids recovery of back pain. When off work, there is a tendency to be inactive and as a result the back can stiffen up, thus elevating the level of pain. If your job is physical, try and return to lighter duties for the first few days.

Stay Positive – Most back pain resolves within 6-8 weeks. Physiotherapy can help to speed up healing and help prevent persisting or recurring pain. A positive attitude about your recovery goes a long way in aiding recovery.

Educate yourself – There is an abundance of evidence to suggest that knowing more about your back pain helps to ease fear and anxiety associated with this condition, which in turn helps promote a good recovery.

Use appropriate pain medication - Talk to your pharmacist or GP about the use of appropriate pain medication for the management of your pain in the initial phase. This won’t mask your pain, but will allow you to move better and get on with strengthening your back so it doesn’t become stiff and weak.

Wear good footwear – High heels can cause you to arch your back more which may aggravate back pain more. Try and stick to shoes with a small 1inch heel to give the back some support without over-extending it.  

Postural Awareness - A good chair can make all the difference to your pain in sitting. Sit to the back of the chair so the low back is supported, keeping feet flat on the ground and knees slightly below hip height.

Watch your weight - Extra weight, particularly around the mid-section can add extra strain to the muscles and ligaments of the back. Further-more, the spine can be stressed unevenly to compensate for the extra weight. If you feel your back pain is preventing you from exercising and losing weight, try doing small amounts of exercise, consistently.

Sleeping position – Lying flat on your back can arch your spine causing the joints in your back to move closer together, which can contribute to back pain. Try lying on your side with a pillow between your knees, which facilitates gapping the joints in your back slightly, thus allowing you a more comfortable night’s sleep.

Lifting/Carrying – avoid carrying heavy bags on back or laptops slung over one shoulder. Bend your knees when lifting an object and try not to bend and twist the back at the same time.

Symptom Control – Ice/heat, gentle massage, Jacuzzi baths, sauna and gentle back movements may help manage the early symptoms of low back pain.

Warning symptoms: Contact GP or Chartered Physiotherapist immediately if back pain is associated with: Accident/trauma; Abnormalities with bladder or bowel; Night sweats and weight loss; Gait disturbance and Pins and needles/numbness between your legs

Benefits of Pilates

Pilates is a form of body conditioning that focuses on developing a strong core by using the deep abdominal muscles to control movement and postures.  Pilates develops tone and flexibility throughout the body and is a great way to strengthen your back, prevent injury, improve sports performance and to help you look and feel great!

Talk on Lower Back Pain

Whelehans Pharmacy in conjunction with Chartered Physiotherapist Sinead Brogan of FlexPhysio (Physiotherapy Service at Whelehans Pharmacy) is holding a free talk on Lower Back Pain on Tuesday November 18^th at 7pm in the Greville Arms Hotel, Mullingar. Sinead will discuss pain relief, improving flexibility, restoring muscle strength and length, increasing your range of motion and suppleness, when to seek urgent medial treatment and beneficial exercises. Pharmacist Eamonn Brady will also speak. Book your free place by calling Whelehans at 04493 34591.
Thanks to Chartered Physiotherapist Sinead Brogan from Flexphyio for information for this article. Flexphysio is a chartered physiotherapy service based in Whelehans Pharmacy in Mullingar. Tel Sinead at 083 1722171

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie