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- General health - with Dr Hopcroft - Part 3
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General health - with Dr Hopcroft - Part 3
Dr Keith, a full time GP, drops in to answer your health queries on rashes, lack of sleep, depression and more.
Jo7: Hi everyone, we're going to kick off with a question from someone that couldn't make it tonight.
Anon: I have been diagnosed with post natal depression and I am wondering how long it could take to get back to 'normal' and what I could do to help myself feel like a real person and a good mum again. I don't feel I have bonded with my child and want to try and fix that.
Dr Keith: Post natal depression is really common. Nearly one in ten women get this and nearly everyone gets better, usually within a few months.
The fact that you are even saying 'How can I bond better with my child?' shows that there is unlikely to be a problem long term. This is a positive sign, that you are even worried about it and recognise this as an issue.
There are also some self-help things you can do. Try to stay positive and keep up some sort of a social life - bring in the cavalry as it were - accept help from relatives and friends so you can also get a bit of time to yourself. Make sure you find time to rest, relax, maybe even some physical exercise if you feel up to it. Trying to think positive in terms of remembering that you will get better and are on the way already by realising what might be wrong.
If you feel despite self-help that things are spiralling out of control then do seek further help as it is available. This could be talking treatments such as counselling or, if severe, anti-depressants. If you have been advised to take these already then do make sure you keep your appointments and medication as advised.
Hellfire: For about four years now I've had a rash on my feet, never itchy, never bothered me and hence, I've never been to a doctor to see what it is. I thought maybe it was a circulation issue but I have warm feet so kind of dismissed that.
Dr Keith: Hi Hellfire, thanks for your question. It's always difficult to be certain with skin rashes without actually examining it but from the photo you sent I would say you have nothing to worry about, nothing serious, and it's certainly not a circulation thing.
There are three main possibilities as to what it could be. One is a type of eczema (very common on the feet). The second is a type of fungal infection (also very common on the feet). The third one is the pressure effect of tight shoes.
If it's not bothering you, I would recommend just leaving it. You're certainly not neglecting yourself by doing this. If it is bothering you, make a trip to your GP and they will recommend you some creams.
Hellfire: Thank you, I thought so.
Dr Keith: No worries.
Angel: Over the last few days I've been really struggling to sleep, I'm unsure why.
Dr Keith: Hi Angel, how long has it been going on?
Angel: A few months or so.
Dr Keith: Is the problem getting off to sleep or waking up too soon?
Angel: Both, pretty much. I get at least 1 or 2 hours sleep.
Dr Keith: What do you, yourself think the causes might be?
Angel: I'm not sure. I always have so much on my mind so I'm always moving around in bed.
Dr Keith: I see. Are you on any medication at all, for sleep or anything else?
Angel: No, I used to be but the medication started affecting me more so my doctor told me to go into counselling.
Dr Keith: Thanks Angel. The usual reasons that people have trouble sleeping are, either they are suffering a lot of stress - this can tend to stop people falling asleep because their worries are going round in their head and they can't switch off.
Or, the other psychological issue that can affect sleep is depression. That tends to wake people earlier in the morning.
Angel: I wake up at the perfect time, ready for school, which tends to be about 5 or 6am. But then I start falling asleep in my lessons so I cut myself to stay awake.
Dr Keith: From what you're saying it sounds more like stress. Often it's a combination of things that are worrying people. You may well find it useful to sit down and list all the things that are worrying you. You could talk these through with someone you trust who can try and help you think straight so when you go to bed all these things aren't running round in your head.
Angel: So like my CAMHS worker?
Dr Keith: That could be a good person, yes. If you're feeling that it might be depression that is affecting your sleep then it's important to speak to someone about it. By treating the depression, the sleep will get better.
The other big issue with sleep is what we call poor sleep hygiene.
Angel: What's that?
Dr Keith: A lot of it comes down to common sense things, but these are easy to forget. It's all about having a set routine when you are sleeping. For example, it's best to avoid lying in to catch up or having naps to catch up. It might be tempting to have a nap but that messes up your sleep for the next night. These kind of things are poor sleep hygiene.
"The cause of M.E. is very uncertain and complex. I wouldn't say that what we know about M.E means that there isn't a role for anti-depressants/psychotics. These do have their place, they might not be right for every patient but in selected cases they can be a good idea."
You may want to try to take more physical exercise if you can as well. Cutting down on caffeine in the evening, things like coffee but also coke and red bull have a lot of caffeine in.
Angel: I don't drink any of those so that's good.
Dr Keith: One of the most important things is trying to be relaxed about it otherwise, it immediately becomes a self fulfilling prophecy; you get all tense and then you can't sleep again. Try and stay positive and stick to a routine if you can.
Angel: Thanks :)
nutter: Do you think it is a good idea for someone with M.E. to be taking anti-depressants and antipsychotics? I feel very messed up. I am lucky in that my psychiatrist understands about the fatigue (I often read that people with this condition are disbelieved by doctors and especially psychiatrists). I guess I just want to hear your opinion?
Dr Keith: Fair enough, it's good to get a range of opinions. These are not a treatment for M.E. (chronic fatigue syndrome) specifically but a lot of people with M.E., completely understandably, are depressed. The debate goes on and on about whether it's the depression causing the ME or vice versa. My view would be that it doesn't matter. If a person with M.E. is depressed, whether it is the cause or the effect, anti-depressants can be a good idea.
If someone is depressed, it's clearly not going to help their M.E. There are so few specific treatments for M.E. anyway so it would certainly make sense, if someone is depressed with M.E., to give them a try.
nutter: Yes, thanks. But do you think that these meds can mess up a person's system? I have read theories about the cause being a virus or a build up of toxins in the lymphatic system. If that were true, more bombardments of medications aren't going to help.
Dr Keith: I wouldn't recommend any medication, whatever it is, unless there was a good reason to give it. There are always side effects but you have to manage the benefit versus the risk. If the benefits are better, then it's worth it.
nutter: I see. Thanks for your answers.
Dr Keith: The cause of M.E. is very uncertain and complex. I wouldn't say that what we know about M.E means that there isn't a role for anti-depressants/psychotics. These do have their place, they might not be right for every patient but in selected cases they can be a good idea.
Jo7: Thanks Keith, I think we're going to have to move on to the next question now.
Anon: OK, here goes then. I have depression and have had it for years but recently things have got worse than ever. I'm on anti-depressants but it's not just the bad feelings and the self harm now. I am losing the ability to distinguish between whether a dream really happened or not. They're not very pleasant dreams. I'm quite scared and I'm seeing things and its really starting to mess with my head. What should I do?
Dr Keith: This is either a sign that the depression is getting worse, that whatever is feeding the depression (social circumstances or other stresses) are getting worse, or it might be side effects of the treatment you're on.
Dr Keith: Would you mind letting me know what medication you're taking and how long you've been on them?
Anon: I've been on 40mg a day of fluoxetine for about two years.
Dr Keith: OK thanks for that. It's unlikely in your case that it is based on side effects of the medication. That would only be a possibility if you'd started it recently, the dose had been changed, or you'd been given some additional medication. Either way, you should try and get reassessed fairly soon, either by your mental health worked or by your GP so they can decide what changes to make. Do you think this is something you would be able to do?
Anon: I will try. Will they put me on more medication or different ones because I don't think I could stop taking them.
Dr Keith: The honest answer is I don't know. They certainly won't be thinking of taking you off your treatment as, in your case, I doubt it is a side effect of the medication. They may want to talk about your dose, an additional treatment or an alternative one, whatever you and they decide would be best for you. It may be less about the drugs and more about talking about what in your life is making matters worse at the moment.
Well done for deciding to try and go. I know it can be a difficult step sometimes. Does that all make sense?
Anon: Yes, thank you.
Annaarrr: Not sure how to word this but what makes a relationship an abusive one?
Jo7: Hi Annaarrr, that's not strictly a general health question and may not be Keith's area of expertise but we do have some info on TheSite that you may find useful and there are other places you can go for support.
You can always post on the discussion boards or ask a question to askTheSite where we have relationships advisors on hand to answer your questions.
Annaarrr: OK, thank you.
Jo7: You may also want to have a look at this article about domestic violence although abusive relationships aren't always violent, there can be emotional abuse too. If you feel like your partner is very controlling for example. We will be running more expert relationships chats soon too.
Anon: I was recently pregnant in June until August but I lost the baby. Ever since then I've not been able to go to the toilet properly, has anyone else had this?
Dr Keith: This isn't a common knock on effect of having a miscarriage. The only connection I can see is that if you had to take anything like codeine to relieve any pain then this can cause constipation. Another alternative is that you've just become more generally run down as a result of the miscarriage.
In terms of treatment, increasing fruit and fibre is really useful, as is increasing fluid intake and doing more exercise. Assuming you are talking about bowel trouble rather than your waterworks, then a mild over the counter laxative will help. If this doesn't sort you out then you should go and talk to your GP.
Jo7: Thanks for coming everyone.
Dr Keith: Bye everyone, it's been good talking to you.