A to Z of Medical Conditions

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Giardiasis – what are the signs and symptoms of Giardiasis?

Giardiasis

Giardiasis

Giardiasis is an infection of the digestive system caused by tiny parasites called Giardia intestinalis (also known as Giardia lamblia, or Giardia duodenalis).

Diarrhoea is the most common symptom of giardiasis.

Other symptoms can include:

abdominal cramps

foul-smelling flatulence and belching

nausea (feeling sick)

bloating

indigestion

fatigue (extreme tiredness)

dehydration

loss of appetite

weight loss caused by malnutrition

You may also experience vomiting and a mild fever of 37-38C (98.6-100.4F) but these symptoms are less common.

Although these symptoms are often unpleasant, giardiasis doesn’t usually pose a serious threat to health and can be easily treated.

When to see a doctor

See your GP if you have symptoms of diarrhoea, cramps, bloating and nausea that last for more than a week, particularly if you’ve recently travelled abroad.

If your baby or child has diarrhoea lasting for more than two or three days, or they’ve had six or more episodes of diarrhoea in the last 24 hours, take them to see your GP.

Your GP may have to send stool samples to be tested in a laboratory to diagnose giardiasis. Up to three samples may need to be taken over a number of days to confirm giardiasis.

Treating giardiasis

Giardiasis is usually treated successfully with antibiotic medicine that kills the giardia parasite. In most cases, medicines called metronidazole or tinidazole are used.

Nausea is the most common side effect of metronidazole. On rare occasions, some people may also feel dizzy or sleepy. If this happens to you, avoid driving or using power tools or machinery.

Don’t drink alcohol while taking metronidazole or tinidazole, or for 48 hours after finishing your dose. Mixing alcohol with these types of medication can make the side effects worse.

If you’re diagnosed with giardiasis, other members of your household may be advised to have treatment. This may be recommended as a precautionary measure in case they’ve also been infected. Your GP will be able to tell you if treatment is necessary.

How is giardiasis spread?

Most people become infected with giardiasis by drinking water contaminated with the Giardia parasite, or through direct contact with an infected person.

The giardiasis infection can also be passed on if an infected person doesn’t wash their hands properly after using the toilet, then handles food eaten by others. Food can also be contaminated if it is washed with infected water.

Practising good hygiene – such as regularly washing your hands with soap and water – and taking care when drinking water in countries with poor levels of sanitation can help to reduce your risk of developing giardiasis.

Read more about the causes of giardiasis and preventing giardiasis.

Who is affected?

Giardiasis occurs almost everywhere in the world, but is particularly widespread where access to clean water is limited and sanitation is poor.

It can affect people of all ages but is most common in young children and their parents. This is because things like nappy changing increase the risk of infection.

There are more than 3,500 cases of giardiasis reported in England and Wales each year, although the true number is likely to be higher as many cases go undiagnosed. Around one quarter of these cases are thought to be contracted abroad, but many people don’t develop the symptoms until they return home.

Most cases of giardiasis are one-offs, but small outbreaks can occur in households, among family members, or at nurseries. Larger outbreaks are usually traced to contaminated water sources, such as drinking wells or water parks.

Risk areas for giardiasis

Places where giardiasis is widespread include:

sub-Saharan Africa – all the countries south of the Sahara desert, such as South Africa, Gambia and Kenya

south and southeast Asia, particularly India and Nepal

Central America

South America

Russia

Turkey

Romania

Bulgaria

the countries of the former Yugoslavia (Croatia, Serbia, Montenegro, Slovenia, Macedonia, and Bosnia and Herzegovina)

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Essential tremor – what it is and why you need to know

Essential tremor

Essential tremor

Essential tremor is a type of uncontrollable shake or tremble of part of the body.

Most people with essential tremor experience a trembling, up-and-down movement of the hands.

The arms, head, eyelids, lips and other muscles can also be affected. A tremor in the voice box (larynx) may cause a shaky voice.

Essential tremor is usually more noticeable when you’re trying to hold a position or do something with your hands, such as write. It doesn’t always affect both sides of the body equally.

Essential tremor is a common movement disorder affecting around four out of 100 adults over 40 years of age. Some people only have a mild tremor at first, which usually gets more severe over time.

‘Normal’ tremor

Everyone has a very minor tremor when carrying out daily activities. For example, your hands will shake slightly when you hold them out in front of you. This is normal.

Sometimes, the everyday level of tremor can become more noticeable, particularly in older people. Noticeable tremor is also normal and it’s often caused by a raised level of adrenaline in the body, which can happen when a person is stressed, anxious or angry.

When does a tremor become a problem?

Essential tremor is more severe than normal tremor and it gradually gets worse over time. Eventually, the tremor may become so severe that carrying out normal, everyday activities can become difficult.

Certain things may temporarily increase any tremor, including:

tiredness caused by strenuous activity or lack of sleep

smoking

caffeine – from tea, coffee and some fizzy drinks

being very hot or cold

taking certain medicines – including some antidepressants and treatments for asthma

When to see your GP

It’s important to visit your GP if you experience frequent or severe tremors.

Although there’s no specific test to diagnose essential tremor, your GP can carry out a physical examination and may request further tests to rule out other conditions (see causes, below).

They’ll also ask about your personal and family medical history as part of their assessment.

Treating essential tremor

There’s no cure for essential tremor, but medicines can be used to help improve the symptoms in at least half of people with the condition.

In rare cases, a severe tremor may be treated with surgery if it doesn’t respond to medication.

Read more about treating essential tremor.

Inherited essential tremor

Essential tremor can run in families and research suggests it’s passed on by a faulty gene. At least half of people with the condition have a family member who also has it.

However, the age at which a tremor develops and its severity can vary greatly between different family members. Some people may also develop the faulty gene without inheriting it from either parent.

Other causes of tremor

There are a number of conditions which may cause tremor, including:

overactive thyroid (hyperthyroidism)

Parkinson’s disease, a long-term condition affecting the way the brain co-ordinates body movements

multiple sclerosis, a condition of the central nervous system (brain and spinal cord) affecting the senses and the body’s actions

dystonia, a range of movement disorders which cause involuntary muscle spasms

stroke, which very rarely may result in tremor with few other symptoms

peripheral neuropathy, where the peripheral nervous system is damaged

A tremor can also be one of the withdrawal symptoms for people who are dependant on alcohol and have stopped or reduced their alcohol intake.

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Zach Anner: “Top 10 Things I Wish People Knew About Cerebral Palsy”

Zach Anner: "Top 10 Things I Wish People Knew About Cerebral Palsy"

Zach Anner: “Top 10 Things I Wish People Knew About Cerebral Palsy”

Zach Anner: “Top 10 Things I Wish People Knew About Cerebral Palsy”

This is brilliant – just brilliant!

That is all!

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Polymorphic light eruption – what is it?

Polymorphic light eruption

Polymorphic light eruption

Introduction

Polymorphic light eruption is a fairly common skin rash triggered by exposure to sunlight or artificial ultraviolet (UV) light.

An itchy or burning rash appears within hours, or up to two to three days after exposure to sunlight. It lasts for up to two weeks, healing without scarring.

The rash usually appears on the parts of the skin exposed to sunlight – typically the head and neck, chest and arms (the face isn’t always affected).

Polymorphic light eruption is thought to affect about 10-15% of the UK population.

What does the rash look like?

The rash can take many different forms (known as being “polymorphic”):

most people get crops of 2-5mm pink or red raised spots

some people get blisters that turn into larger, dry red patches (looks a bit like eczema)

less commonly, the skin patches look like targets or bulls-eyes, a bit like the skin rash erythema multiforme

It can be easy to mistake polymorphic light eruption for prickly heat. Prickly heat is caused by warm weather or overheating, rather than sunlight or UV light. The skin in prickly heat doesn’t “harden” or desensitise, as it can do in polymorphic light eruption (see information on desensitisation below).

How big a problem is it?

The skin rash may be a rare occurrence, or may happen every time the skin is exposed to sunlight. It ranges from mild to severe.

Sometimes, as little as 30 minutes of sun exposure is enough to cause the problem, and it can develop even through window glass or thin clothing.

However, for most people with polymorphic light eruption, the rash develops after several hours outside on a sunny day. If further sun is avoided, the rash may settle and go without a trace within a couple of weeks. It may or may not return when skin is re-exposed to sunlight.

If the skin is exposed to more sunlight before the rash has cleared up, it will probably get much worse and spread.

For many affected people, the skin rash appears every spring and remains a problem throughout summer, settling by autumn.

Who’s affected?

Polymorphic light eruption is more common in women than men. It particularly affects those who are fair, although it can affect those with dark skin.

It usually starts from the ages of 20 to 40, although it sometimes affects children.

What is the cause?

Polymorphic light eruption is thought to be caused by UV light altering a substance in the skin, which the immune system then reacts to, resulting in the skin becoming inflamed.

Polymorphic light eruption can run in families and about a fifth of affected people will have an affected relative.

It’s not infectious – there’s no risk of catching polymorphic light eruption from another person.

How is it treated?

There’s no cure for polymorphic light eruption, but careful avoidance of the sun and using sunscreens will help you manage the rash.

Generally, avoid the sun between 11am and 3pm, and wear protective clothing when outdoors (unless you’re hardening your skin; see below). Introduce your skin to sunlight gradually in the spring.

Sunscreen

You may be prescribed sunscreens, which may prevent the rash developing.

Use a sunscreen that is SPF 30 or above with a good UVA rating. Apply it thickly and evenly, reapplying often. Watch a video on how to apply sunscreen.

Steroid creams and ointments

Your GP can prescribe corticosteroid (steroid) cream or ointment, to be applied only when the rash appears. You should apply this sparingly, as often as your GP advises, and never when there’s no rash.

Desensitisation or UV treatment

Sometimes you can increase the resistance of your skin to the sun. This involves visiting a hospital department three times a week for four to six weeks in the spring.

Your skin is gradually exposed to a little more UV light every visit, to try to build up your skin’s resistance. The effects of desensitisation are lost in the winter, so you’ll have to build up your resistance again in the spring.

Hardening or toughening

You may be able to increase the resistance of your skin at home, which is known as “hardening”. This involves going outside for short periods in the spring to build up your resistance.

You might find the time is as short as a few minutes at first, but you may be able to gradually build up to longer times. You’ll have to be careful not to overdo it, but as you understand more about how much light triggers your rash, you’ll be able to judge how long to stay out.

The effects of hardening are lost in the winter, so you’ll have to build up your resistance again in the spring.

Vitamin D

People with polymorphic light eruption are at greater risk of vitamin D deficiency, as a certain amount of sun exposure is needed to make your own vitamin D. Your GP will advise whether you need treatment with vitamin D supplements.

What’s the outlook?

Many people with polymorphic light eruption find the skin complaint improves over years – the skin may harden (become more resistant to sunlight) during the summer, which means more and more sun can be tolerated without the skin reacting. It may even eventually clear up on its own, although this is unusual.

However, hardening of the skin doesn’t always happen, and some people with very sensitive skin may even get the rash in the winter. For these people, it may be a long-term condition to manage with lifestyle changes and creams.

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Post-polio syndrome – Symptoms of post-polio syndrome

Post Polio Syndrome

Post Polio Syndrome

Post-polio syndrome can cause a wide range of symptoms that can severely affect everyday life.

They tend to develop gradually and get worse very slowly over time.

Common symptoms

Fatigue

Fatigue is the most common symptom of post-polio syndrome. It can take many forms, including:

muscle fatigue – where muscles feel very tired and heavy, particularly after physical activity

general fatigue – where you feel an overwhelming sense of physical exhaustion, as if you’ve not slept for days

mental fatigue – where you find it increasingly difficult to concentrate, have problems remembering things and make mistakes you would not usually make

Organising your activities so that you don’t over-exert yourself and taking regular rests will help to reduce your fatigue.

Muscle weakness

Increasing muscle weakness is another common symptom of post-polio syndrome. It can be easy to confuse muscle weakness with muscle fatigue, but they are different.

Muscle weakness means that you’re increasingly unable to use affected muscles, whether you feel tired or not. Weakness can occur in muscles that were previously affected by a polio infection, as well as in muscles that were not previously affected.

There may also be associated shrinking of affected muscles, known as atrophy.

Muscle and joint pain

Muscle and joint pain are also common in post-polio syndrome. Muscle pain is usually felt as a deep ache in the muscles or muscle cramps and spasms.

The pain is often worse after you’ve used the affected muscles. It can be particularly troublesome during the evening after a day’s activities.

Joint pain is similar to arthritis and consists of soreness, stiffness and a reduced range of movement.

Associated symptoms

As well as the common symptoms of post-polio syndrome, several associated symptoms can arise from the combination of fatigue, muscle weakness, and muscle and joint pain.

Weight gain

Because of the symptoms mentioned above, most people with post-polio syndrome become less physically active than they used to be.

This can often lead to weight gain and, in some cases, obesity. This in turn can make any fatigue, muscle weakness and pain worse.

Walking difficulties

As well as weight gain, the combination of fatigue, weakness and pain can lead to walking difficulties and increasing difficulty with mobility.

Many people with post-polio syndrome will require a walking aid such as crutches or a stick at some stage, and some people may eventually need to use a wheelchair.

Breathing difficulties

In some people with post-polio syndrome, breathing can be difficult because the breathing muscles become weaker.

This can cause problems such as shortness of breath, interrupted breathing while you sleep (sleep apnoea – see below), and an increased risk of chest infections.

If you have post-polio syndrome, it’s important to seek medical advice as soon as possible if you experience symptoms of a possible chest infection. These can include coughing up discoloured phlegm or blood, chest pain and wheezing.

Sleep apnoea

Sleep apnoea affects many people with post-polio syndrome. The walls of the throat relax and narrow during sleep, interrupting normal breathing.

This can cause problems such as feeling very sleepy during the day, headaches and increased fatigue.

Swallowing problems

Weakness in the muscles you use for chewing and swallowing may lead to problems swallowing (dysphagia), such as choking or gagging when you try to swallow.

You may experience changes in your voice and speech, such as hoarseness, low volume or a nasal-sounding voice, particularly after you’ve been speaking for a while or when you are tired.

Swallowing problems are usually mild and progress very slowly. A speech and language therapist may be able to help.

Sensitivity to cold

Some people with post-polio syndrome find they become very sensitive to cold temperatures or a sudden drop in temperature as a result of poor blood supply.

Because of this intolerance to cold, people with post-polio syndrome may need to wear extra layers of clothing to try to stay comfortable.