Whelehans Health News

    This Is the first of three articles in the Topic on addiction. Addiction is a strong and uncontrollable urge to take substances like drugs or alcohol or carry out activities like gambling or sex. The urge to use or carry out an activity often takes precedent over other areas of the person’s life despite causing harm physically, emotionally or socially.  Common addiction is to alcohol or drugs, but can be anything from gambling to “less harmful” products such as fizzy drinks or addiction to the likes of work or the internet. Thus addiction can be substance dependence (e.g. alcohol or drug addiction) or behavioural addiction (e.g. gambling, sex, work, and video game addiction). 

     Addictions develop due to a complex web of factors including genetic, social, personality, brain response to pleasure, past experience and many other factors. Addiction causes feelings of guilt, shame, hopelessness, despair, failure, rejection, anxiety and humiliation.

What causes Addiction?

     Causes of addiction are varied and complex and due to a combination of mental, physical, circumstantial (eg. being introduced to a drug when young and prone to peer pressure) and emotional factors. Repeated use of an addictive substance is thought to change the way the brain experiences pleasure. The substance or activity (drug, alcohol, gambling etc) leads to changes in certain nerve cells (neurons) in the brain leading to feelings of euphoria, known as a “buzz” or a “high” which can lead to the urge for further and more frequent use

Tolerance increases

  With time, regular and frequent use or participation leads to the person not experiencing the same pleasure they initially would have experienced and the person needs to keep increasing the dose as the body will develop tolerance to the effects of the addictive substance.  To give an example of something as (deceptively) simple as coffee; those that consume large quantities of coffee have an increased tolerance to the effects of caffeine, whilst someone who rarely drinks it would get a huge kick from an espresso. Eventually, the addict will not experience “highs” from using and simply takes the substance to feel “normal” by preventing withdrawal symptoms. It is the tolerance to the substance or activity that increases the risk of addiction. Tolerance means the addicted person requires increasing amounts of addicted to in order to gain the same effect or to prevent unpleasant withdrawal symptoms. 

Difference between habits and addictions

A habit is something has a choice over meaning a person can when choose to stop and can successfully stop if they want to (eg) having a few sociable drinks at the weekend. With an addiction there is a psychological/physical compulsion to continue using/doing the substance/activity; the person is no longer able to control the addiction without help because of the mental or physical components.

What are the risk factors for Addiction?

Anybody, no matter what age, sex or social status can potentially become an addict; there are certain factors which may increase the risk:

• Genetics(family history) – those with a close relative with an addiction problem has a higher risk of eventually developing one themselves.  For example, alcoholics are six times more likely than non-alcoholics to have blood relatives who are alcohol dependent. Some of this is down to “normalization” of a certain activity (eg) copying what your parents do such as drinking heavily
• Family life– Young people who do not have a strong attachment to their parents and siblings have a higher risk of developing addiction problems compared to people with deep family attachments. (ie) do not have the guidance they need to follow the right path and more susceptible to the “desire” to belong to a group so can get more easily drawn into gangs or “wrong crowd”.
• Gender– Men suffer from addictions more than women. Statistics indicate males are twice as likely as females to experience drug addiction problems.
• Link with mental health problems– those with mental health problems like depression, bi-polar disorder, ADHD (attention-deficit hyperactivity disorder) and other mental disorders suffer from higher rate of addiction to the likes of drugs, alcohol or nicotine. In some cases the mental health disorder leads to addiction but in others it is the addiction that causes the mental health problem (alcohol or drugs)
• Peer pressure– Sometimes considered the biggest cause of addiction especially in younger people, especially addictions (and many addictions start young). The use of harmful substances is a way of conforming and gaining acceptance with peers.
• Loneliness- can lead to increased use of the likes of alcohol and nicotine as a means of coping leading to addiction.
• The nature of the substance- some substances, such as heroin or cocaine can bring about addiction more rapidly than others.
• Age when substance was first consumed- studies of alcoholism have shown that people who start consuming drugs, alcohol and nicotine earlier in life have a higher risk of eventually becoming addicted, than those who started later.
• Stress– evidence indicate certain stress hormones are among the causes of alcoholism. High stress levels make a person more prone to use the likes of alcohol to attempt blank out problems and relieve stress.
• How the body metabolises (processes) the substance- with alcohol, those who require a higher dose to achieve an effect have higher rates addiction. Some populations have a lower tolerance to alcohol (due to lower levels of the enzyme that breaks down alcohol) and this is blamed for higher alcohol addiction rates in these populations (eg) native Indian population in America and Aborigines in Australia.

Community Alcohol and Drug Service (CADS)

The HSE Community Alcohol and Drug Service offer counselling and treatment services for adults suffering from addiction to alcohol, drugs and gambling. CADS have centres in Mullingar, Athlone and Longford. CADS provides counselling and treatment to help people get over their addiction. You can contact them at 04493 41630.

To be continued….next week

For comprehensive and free health advice and information call in to Whelehans, log on to www.whelehans.ie or dial 04493 34591.

Erectile dysfunction (ED) is the inability to get and maintain an erection that is sufficient for satisfactory sexual intercourse. Over the last two weeks I discussed causes. This week i discuss diagnosis and treatment.

Diagnosis

If ED has persisted for more than a couple of weeks, an appointment with the GP is the first step. ED that happens all the time may indicate an underlying physical cause, whereas, if it occurs only when attempting to have sex, this might suggest the problem is more psychological.

With evidence of a direct link between Cardiovascular Health and ED, your GP will likely assess this during the consultation. Even in cases of men with mild ED, indications are that they may be 25% more likely to experience heart disease. Furthermore, severity of ED is being increasingly taken as a more positive indicator of potential heart disease than traditional flags such as family history, smoking or high cholesterol.

Treatment

Once ED has been diagnosed, the course of action taken thereafter will depend on the cause. If ED is caused by one of the underlying health conditions already discussed, the priority will be to treat that first.  

Positive changes include: -Quitting smoking; Losing Weight; Starting and maintaining an exercise plan; Stress reduction strategies; Reduction in alcohol intake

Medication

If appropriate, the GP may prescribe medication to treat the ED directly. There are a number of ED drugs available. Known as Phosphodiesterase-5 inhibitors (PDE-5), they came on the market in the last 20 years (Viagra^® being the first and most famous) and they work by temporarily increasing flow of blood to the penis, enabling an erection to be achieved. To work, PDE-5’s are triggered by sexual stimulation and arousal and in general take 30 – 60 minutes to work. Thus, despite common perception in the general public, they will not cause erection without sexual stimulation.

In Ireland, there are three main types of PDE-5:

The first two types work “on demand” with the patient able to have sex for 1 -10 hours after taking the drug. They are: Sildenafil (Viagra^® and other generic equivalents)) and Vardenafil (Levitra^®)

The third PDE-5 class works differently from the others, with the effect of a single dose lasting up to 36 hours. This drug is Tadalafil (Cialis^®). Tadalafil is more suitable if treatment is required for a longer period of time, (eg) over a weekend.

In general, at least 66% of men have improved erections after taking a PDE-5. PDE-5 inhibitor Side effects: Nausea and / or Vomiting; Flushing; Blocked or runny nose; Visual Disturbances (blue tinge to vision or increased light sensitivity); Back and/or Muscle pain; Headaches. They must be used in caution in those with heart disease.

Psychological Help

If the cause of ED is related to depression or anxiety, counselling in the form of Cognitive Behavioural Therapy (CBT) may prove beneficial. If issues like low self esteem, sexuality and / or personal relationships are the cause of ED, sessions with an experienced CBT therapist may help change the patient’s mindset and view on those issues. Relationship therapy with an experienced Psychosexual therapist for individuals and couples may help if the cause of ED is relationship based.

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

Erectile Dysfunction (ED) is the inability to get and maintain an erection that is sufficient for satisfactory sexual intercourse.

Causes

Causes of ED can be either physical or psychological, or a combination of both. Certain medications, prescribed to treat other conditions can, in some cases, cause ED.

Physical causes

Physical problems leading to ED can be categorised in four ways: -

• Vasculogenic (vascular caused by reduced blood flow))
• Neurogenic (nerve related)
• Hormonal (eg) lack of tesosterone
• Anatomical (eg) due to shape of penis

1. Vasculogenic (ie) reduced blood flow

Conditions of this type affect the blood flow to the penis (70% of physical related causes). Causes include:

Cardiovascular Disease (CVD) –As the blood vessels in the penis are a lot smaller than the blood vessels elsewhere in the body, they are often affected first. Having ED is often considered an early warning sign for cardiovascular disease.

Diabetes – Over 50% of men with diabetes will suffer from erection problems. This is due to circulation problems caused by diabetes thus reducing blood flow in the penis and nerve damage from prolonged incontrolled high blood glucose which disrupts nerve signals between the brain and penis.

High blood pressure – both treated and untreated high blood pressure can be a cause of ED

2. Neurogenic (nerve related)

Conditions of this type relate to the brain and nervous system.

Examples include:

Multiple Sclerosis (MS) – a condition of the central nervous system that affects movement. ED is an often an overlooked common complication for MS sufferers.

Parkinson’s disease –like MS, sexual and erectile dysfunction is common in men with Parkinson’s. It is a symptom which may appear long before more recognised symptoms of the disease appear (eg.) Tremor, slowdown in movement.

Stroke – Whilst stroke in itself is rarely a cause of ED, stress and worry about resuming an active sex life post stroke is more likely to be the cause.

3. Hormonal

The primary hormone related to ED is Testosterone. As men get older, typically, testosterone levels drop. Reduced levels can reduce libido (sex drive), which in turn can have a direct effect on a man’s ability to achieve an erection.

Additionally, too much Cortisol produced by stress will also have a diminishing affect of Testosterone levels. Other related examples include thyroid hormone where either too much (hyperthyroidism) or too little (hypothyroidism) is produced. Other ED related hormone imbalances can come from Liver or Kidney disease. Simple blood tests by your GP can diagnose any of these hormone deficientcies and excesses and once diagnosed are easily treated.

4. Anatomical

Referring to the structure and function of the penis itself there are several conditions which can result in ED, two of which include Hypospadias (relates to the abnormal development of the male urethra which is duct where urine and semen is transferred) and Peyronie’s disease (a hard lump develops within the penile tissue due to injury leading to scarring. For more information on these two conditions check out my full ED article at www.whelehans.ie

To be continued....next week I discuss diagnosis and treatment

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

Erectile Dysfunction (ED) is a common condition which mostly affects older men. ED is age related, with estimates showing that up to 50% of men in the 40 – 70 age range will experience ED to some degree.  Erectile dysfunction (ED) is the inability to get and maintain an erection that is sufficient for satisfactory sexual intercourse. The inability to achieve and maintain an erection caused by an insufficient blood flow to the penis due to narrowing or restriction of blood vessels or damage to nerves that help stimulate blood flow.

If it persists for more than a couple of weeks, a visit to the GP for assessment is essential as the condition can be an indicator of perhaps a more serious underlying health problem (eg. heart disease, diabetes).

Causes

Causes of ED can be either physical or psychological, or a combination of both (as is the case with Diabetes). Certain medications, prescribed to treat other conditions can, in some cases, cause ED.

Psychological Causes

Even men that are “physically healthy” can suffer from ED. When this is the case it is most likely related to a range of negative feelings and emotional issues that are preventing the “trigger” message being sent from the brain when needed. At a higher emotional level, those suffering with depression or anxiety are increasingly likely to experience ED.

An erection starts with a message from the brain, however with psychological disorders and general emotional issues, the chemicals in the brain are unbalanced, so, if the right levels of chemicals are not there when the message comes, the result is erectile failure.

The causes could include:

• Self esteem issues
• Sexual Performance issues
• Relationship problems or perhaps a new relationship
• Condition related stress (eg. Diabetes)
• Past sexual history or relationships,
• Negative feelings of guilt.

Medication related ED

Certain medicines prescribed for a variety of conditions, may cause ED. If concerned or have experienced ED since starting a new medication, check with your GP or pharmacist whether it is a possible cause. In most cases there will be suitable alternatives. Do not stop taking prescribed medication unless your GP or other doctor advises to do so.

Medicines types that can cause ED include: -

• Diuretics (to reduce fluid in heart conditions and reduce high blood pressure)
• Anti- Hypertensives (to reduce blood pressure)
• Fibrates (for cholesterol; statins are more commonly used nowadays)
• Anti-psychotics (used to treat mental health conditions, such as schizophrenia and bi-polar disorder (eg. Risperidone)
• Anti-depressants (more common with the older types less commonly used nowadays)
• Corticosteroids (used to control inflammatory conditions such as rheumatoid arthritis, bronchitis)
• H2 – Antagonists (reduces stomach acid for likes of heartburn; newer PPIs types are used more nowadays)
• Anti- Convulsants (for epilepsy)
• Anti – Histamines (for allergies)
• Anti-Androgens (for hormone disorders)
• Cytotoxics (chemotherapy medication used to kill cancer cells)

It is important to note the ED is a rare side effect with most of these medicines.

To be continued.. causes and diagnosis next week

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

For comprehensive and free health advice and information call in to Whelehans, log on to www.whelehans.ie or dial 04493 34591.

 More than 70 people took the positive step of attending the “Rheumatoid Arthritis” (RA) talk, hosted by Whelehans Pharmacy, Mullingar in conjunction with the Westmeath Branch of the Arthritis Ireland on Wednesday 12^th Oct at the Greville Arms Mullingar. There was an impressive line-up of 4 speakers.

The main speaker was Dr Killian O’Rourke, Consultant Rheumatologist at Midlands Regional Hospital, Tullamore. Dr O’Rourke delivered an excellent presentation which focused on two main areas:-

• Update on Midlands Rheumatology Services to Oct 2016
• Advances in RA treatment

Dr O’Rourke gave an overview of the extensive range of facilities now available at the service in Tullamore. One other really positive development within the unit was the extensive training programme for Midlands GP’s, hosted by Dr O’Rourke. On completion, each GP will have had around 400 hours of Rheumatology related training, which is then immediately relevant at point of first contact for most people (ie) the GP Surgery. This greatly assists with early diagnosis and subsequent quick referral.

New National Electronic Referral Form

To support the many recognised benefits of very early diagnosis, Dr O’Rourke outlined a new referral system of suspected IJD (Inflammatory Joint Disease) for GP’s using the new extremely detailed National Early Inflammatory Arthritis Referral form, developed in association with the charity Irish Society of Rheumatology and the HSE, full patient details along with supporting information (x-rays, pictures, history etc) can be sent electronically to rheumatology departments like Tullamore with a commitment to see referrals within six weeks.

Waiting list for Tullamore Rheumatology Department

Dr O’Rourke gave an update on the current waiting list position for new RA patients with recent improvements now sits at 15 months (down from 30 months), with those awaiting DEXA / MRI now at 12 months. In addition, whilst there has been recent positive progress in staffing levels, he outlined those shortfall areas that still exist to reduce the “waiting list” issue. The rheumatology department have a triage system which allows them to see more urgent cases quickly (eg) newly diagnosed early RA which needs early and aggressive treatment to prevent joint damage.

Risk factors for RA

Dr O’Rourke went on to discuss RA Risk factors. At the top of the group are two primary genetic factors followed by a list of over 12 “Higher Risk” factors….. of note here were:- Female Gender also Pregnancy and 12 months after giving birth; Occupational risks related to dust (mining, oil, woodwork, electrical, asbestos); Lifestyle factors (Smoking, High BMI, Coffee Consumption). Some developing evidence show that there may be a link between gum disease and development of RA.

Dr O’Rourke then gave an insight as to how RA is classified and the various systems that are used to evaluate severity. Two main organisations ACR (American College Rheumatology) and EULAR (European League against Rheumatism) have combined resources to produce a harmonised scoring system that provides some common classification criteria against which presenting symptoms can be measured, scored and which treatment pathway to take based on the outcome. The newly simplified scoring system aims: - Initially to REDUCE Disease activity, which through time PREVENTS structural damage, which then through remission, DECREASES disability. These factors are then translated into the recognised DAS28 scoring system which when used to indicate exactly where an individual lies within the goals above which dictate / prioritise immediacy and type of treatment.

Future of RA treatment

Looking to the future of RA treatment, the audience learned of a variety of current scientific initiatives and advancements that aim to help and assist with the earliest diagnosis of RA, perhaps even long before physical symptoms have appeared.

Gene screening to maximise treatment

Gene screening, currently in use in America, could help predict which drugs would be most effective for a given patient, which then enables the most effective treatment to be used right from the start.  Leading on from this, Dr O’Rourke suggested that at some time in the future, everyone could have their complete genome screened with the result showing what diseases or ailments they may be predisposed to. This is more likely to be reality in the coming years, something that would have been the realms of science fiction 25 years ago.

An RA vaccine?

Again, currently in progress is the possibility of a vaccine to prevent RA. Research in Australia is developing a vaccine to re-educate the immune system and the T-Cells (which currently attack in RA) to act in support of the immune system and prevent attack. Whilst an outcome may be a long way off and hugely expensive currently, it may be reality in within most of our lifetimes.

Cannabis based painkillers

To conclude, another therapy currently under evaluation (and common practice in many countries) is the use of Cannabis based Medicine (CBM) to treat and alleviate the symptoms of RA. Dr O’Rourke gave examples from USA and Israel of how CBM treatment has been proven to reduce and eliminate pain in RA. Medicine is administered primarily through tablets or sprays so that the purity and dosage can be guaranteed, CBM has been shown in clinical trials to reduce symptoms across a range of “traditional” RA measures. Cannabis based painkillers have been shown to have significantly less side effects than many traditional painkillers. Dr O’Rourke pointed out the CBM is not currently available in Ireland in any form.

Other health professionals

Next up was a presentation from Dr Siafullah Khan from Mullingar Dental Centre. Dr Khan is qualified in Special Care Dentistry. Dr Khan gave an overview of how Special Care dentistry can be of benefit to those with Mental or Physical challenges. He mentioned that something as simple as scheduling the “right” appointment time can be helpful for those that may, for instance, experience stiffness in the morning, making an afternoon appointment a better option.

Kevin Conneely, Chartered Physiotherapist from Health Step Physio based at Whelehans Pharmacy suggested that physiotherapy treatment can help maintain or increase range of movement for those with mobility issues. Physiotherapy can also help people understand the limitations that RA presents, which in itself can be a benefit in helping people help themselves.

To conclude, the final speaker of the evening was Eamonn Brady, MPSI, Pharmacist at Whelehans Pharmacy who gave an initial overview of medications used to manage RA. So, initially, looking at medication to reduce pain and then drugs aimed at slowing down the progression of the disease, pointing out that whilst there is no cure for RA, the correct and appropriate use of medication can have a significant positive effect on living with the condition. Supporting Dr O’Rourke earlier position that the earliest possible diagnosis is ideal and then the initial introduction of DMARD’s (Disease Modifying Anti-Rheumatic Drugs) to slow disease progression.

Eamonn highlighted that paracetamol is rarely effective against the pain of RA but may be used to augment other pain killers while waiting for longer term solutions like DMARDs to work. He cautioned however against the long term use of codeine based medications such as tramadol and Solpadeine^® and potential addiction risks.

Moving on to discuss NSAID’s (Non-Steroidal Anti-Inflammatory drugs), Eamonn indicated that whilst these offered relief, they would not affect the progression of RA and should not be used longer term. Giving examples such as diclofenac and etoricoxib, Eamonn stated that these should not be given to patients with heart problems or who had a high stroke risk.

Eamonn went on to discuss DMARD’s in more detail, giving an overview of how they work and, as they slow down the progress of the disease, the benefit of early referral. DMARD’s treatment can only be initiated by consultant, so, some of the initiatives mentioned earlier by Dr O’Rourke to speed the process of GP – Consultant referral will help massively.

Commonly used DMARDs include methotrexate, hydroxychloroquine and sulfasalazine. They can be slow to work, however Eamonn stressed the need to maintain the treatment as it can take some time to find the right one and for the benefit to materialise. A key point regarding Methotrexate was that it should only be taken weekly.

To conclude Eamonn discussed the various Biological treatment injections available. Traditionally, these would be a “last resort” for those with severe RA, however, with medical advances, these are now being promoted earlier to improve response to treatment overall. Mostly given by sub-cutaneous injection, can biologics can be used in conjunction with DMARD’s if needs be. In Ireland, Enbrel^® and Humira^® would be the most commonly used biological brands. More than 650 RA patients now take biological treatment at the Midlands RA Service.

Local Support

Westmeath Branch of Arthritis Ireland supports a vibrant community of 17,000 people living with Arthritis in the County.  The committee is made up of people living with arthritis so they understand the challenges that a chronic condition brings.  Your local committee are here to support you and offers a wide range of activities, information and training that will help you to live well with arthritis. If you have any further queries, Westmeath Branch contacts are: Margaret Egerton, Chairperson 0857587171 or Secretary 0871413225 (Branch Phone). You can follow the Westmeath Branch of Arthritis Ireland on Facebook.

Check www.arthritisireland.ie or Locall 1890 252 846 for more information