Shoulder Pain Problem

Painful shoulder conditions that limit movement are common, and are caused by problems with the shoulder joint and its surrounding structures. The shoulder is more prone to injuries than other joints because of its wide range of movement.

Common causes of shoulder pain

There are several conditions that cause pain and limit movement of the shoulder joint, including the following.The rotator cuff is a group of muscles and tendons that help to move the shoulder and hold the joint in place. Rotator cuff disorders result from inflammation or damage to the rotator cuff muscles or tendons, or inflammation of the subacromial bursa (which is a fluid-filled pad that sits under the highest part of the shoulder). The inflammation can be caused by general wear and tear that occurs with age, activities that require constant or repetitive shoulder motion (especially above shoulder level), heavy lifting, trauma, or poor posture. Serious rotator cuff injury and untreated inflammation of the tendons can cause the rotator cuff to tear.

Treatment

In addition to relieving pain, treatment is aimed at restoring mobility in your shoulder joint. The choice of treatment depends on the shoulder problem.

Pain relievers such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) are often used as an initial treatment for shoulder pain. Another simple way of easing shoulder pain is by applying a cold pack to your shoulder. Cold packs can reduce inflammation, and are most helpful when applied for the first few days following a shoulder injury. After that, you can switch to using a heat pack; intermittent applications of heat can help relax the shoulder muscles.

You should also rest the shoulder for a couple of days after most injuries, and if you have dislocated your shoulder, you may need to rest your arm in a sling or splint for several weeks after the joint has been manipulated back into place. However, with most shoulder problems it isn't a good idea to rest for too long. While you should avoid strenuous activities and lifting heavy objects, you should still move your shoulder to help make sure that you regain full use of the joint. By returning to your normal activities as soon as possible (within the limits of disability and pain), you can help prevent the shoulder joint from stiffening up.

·         Physiotherapy: Physiotherapy can help improve shoulder strength and flexibility as well as relieve the pain associated with most shoulder problems. Physiotherapists use a variety of different therapies, including massage, ultrasound therapy, laser therapy and transcutaneous electrical nerve stimulation (TENS) — a therapy that uses mild electrical currents to treat pain. Taping the joint can also help stabilise it and reduce pain during activities.Physiotherapists can also teach special rehabilitation exercises to stretch and strengthen the rotator cuff muscles of the shoulder. Exercises that improve your shoulder's range of movement help reduce the stiffness that occurs after a period of immobility. Range of motion exercises may be followed by resistance exercises and weight training to strengthen the muscles.

·         Steroid injections: Depending on the cause of your shoulder problem, corticosteroid injections may be given to relieve the pain in the short term. The corticosteroid, which is often mixed with a local anaesthetic, reduces inflammation and allows you to move the shoulder more comfortably.

·         Surgery: Because most people improve with the above treatments, only about 10 per cent of people with shoulder problems will need to be treated with surgery. People with shoulder instability or rotator cuff problems that are not responding to less invasive treatments may benefit from an operation, and shoulder joint replacement may be considered for people with arthritis.

Abdominal pain in children

Children often complain of stomach pain. It is one of the most common reasons parents take children to their doctor or the hospital emergency department. Stomach pain can be hard to diagnose. The doctor will ask you questions then examine your child. Sometimes a problem may be quite obvious, so no tests are needed. 

Many children with stomach pain get better in hours or days without special treatment and often no cause can be found. Sometimes the cause becomes more obvious with time and treatment can be started. If pain or other problems persist, see your doctor.

Causes of abdominal pain in children

There are many health problems that can cause stomach pain for children, including:

·         bowel (gut) problems – constipation, colic or irritable bowel

·         infections – gastroenteritis, kidney or bladder infections, or infections in other parts of the body like the ear or chest

·         food-related problems – too much food, food poisoning or food allergies

·         problems outside the abdomen – muscle strain or migraine

·         surgical problems – appendicitis, bowel obstruction or intussusception (telescoping of part of the gut)

·         period pain – some girls can have pain before their periods start

·         poisoning – such as spider bites, eating soap or smoking.

Repeat attacks of stomach pain

Some children suffer repeat attacks of stomach pain, which can be worrying for parents. Often, no health problem can be found.

Children may feel stomach pain when they are worried about themselves or people around them. Think about whether there is anything that is upsetting your child at home, school or kindergarten, or with friends. See your local doctor for advice. A referral may be needed to a paediatrician (a doctor who specialises in children).

Treatment for abdominal pain in children

Your child’s treatment will depend on what the doctor thinks is causing their pain. Treatment may be as simple as sending your child home with advice to rest, take fluids and eat a bland diet. Other treatment options include hospital admission and surgery.

Taking care of your child with abdominal pain

General suggestions on easing the pain include:

·         Make sure your child gets plenty of rest.

·         Help your child drink plenty of clear fluids such as cooled boiled water or juice.

·         Do not push your child to eat if they feel unwell.

·         If your child is hungry, offer bland food such as crackers, rice, bananas or toast.

·         Place a hot water bottle or wheat bag on your child’s tummy or run a warm bath for them. Take care not to scald yourself or your child.

·         Give paracetamol if your child is in pain or is miserable. Remember that doses for children are often different to those for adults, so check the packet carefully for the right dose. Avoid giving aspirin.

Fatty Liver Problem

Fatty liver is the buildup of fats within the cells of the liver to the point that more than 5-10% of the liver is fat. There are 2 types of fatty liver disease: alcoholic liver disease and non-alcoholic fatty liver disease (NAFLD). Fatty liver disease can progress to serious complications, such as cirrhosis of the liver.

Fatty liver symptoms: Fatty liver disease usually does not cause any symptoms. Occasionally, people with the condition will complain of feeling tired or generally unwell, but this varies between individuals, and the degree of symptoms does not usually equate to the severity of the disease. Sometimes, a person may feel pain in the upper right abdomen and have weight loss

.

Diagnosis of fatty liver disease: Fatty liver disease is often diagnosed by chance, after finding an abnormality on liver function tests, which are often done as part of standard blood tests, or when a person is having an abdominal ultrasound. The changes noticed in liver function tests are often raised concentrations of ALT (alanine aminotransferase) and AST (aspartate aminotransferase). Alternatively, your doctor may detect an enlarged liver while examining your abdomen.

A biopsy of your liver is the only test that can definitively diagnose fatty liver disease, but this is not usually necessary, as other tests such as ultrasound can be sufficiently suggestive to warrant treatment.

Treatment of fatty liver disease

There is no specific treatment for fatty liver disease, but lifestyle changes can significantly improve the condition and perhaps even reverse it in the early stages. These changes include:

• Avoiding alcohol. If you have alcoholic liver disease, then giving up alcohol is the most important thing you can do. Continuing to drink may result in you getting cirrhosis or alcoholic hepatitis. Giving up alcohol is also good for people with NAFLD.
• Losing weight. This is not easy for many people with fatty liver disease, so having a well-designed management plan designed by a doctor or dietitian can be beneficial. Gradual weight loss is the key, as sudden, severe weight loss can actually make the condition worse. Weight loss surgery may be recommended for some people.
• Exercising. Even if this does not directly result in weight loss, it is very worthwhile as exercise has been shown to reduce insulin resistance, a key factor in fatty liver disease. Both aerobic exercise and resistance training, such as low impact weight training, will help.
• Controlling your blood sugar levels.
• Reducing or avoiding soft drinks and juices and processed foods rich in sugar.
• Treating high cholesterol. Your doctor may suggest medicines to lower your cholesterol levels, in addition to dietary and lifestyle changes.
• Avoiding medicines that may affect your liver, such as some steroids. Do not take medicines that have not been prescribed by your doctor.
• Quit smoking. You will also be advised to quit smoking, to reduce your risk of heart disease.

There are a number of medicines that have been suggested for the treatment of fatty liver disease, although research into these is continuing. These are sometimes prescribed by doctors in particular cases.

By focusing on factors associated with fatty liver disease that can be modified, it may be possible to prevent progression of the disease.

Headaches problem

A headache can happen on one or both sides of your head, or in the front or back of your head. The pain can start in one place and move to another. Headaches can be triggered or aggravated by many things, including lack of fresh air, lack of food, eye strain, stress, too much alcohol, high blood pressure and caffeine withdrawal.
 
Tension headache is the most common type of headache. It is usually a mild, aching pain on both sides of your head that tends to worsen during the day, or if you are stressed. It can feel like a tight band across your forehead, or a weight pressing on your head.

Other types of headaches include sinusitis and medication overuse headaches. Sinusitis usually starts as a dull pain on one side of your head, and can spread to both sides. Bending, coughing or sneezing can make it worse. Blocked sinuses are usually what cause the pain, so it is important to seek treatment.

Medication overuse headache (previously called rebound headache) can develop from taking pain relief medicines (analgesics) for long periods, such as those containing codeine or caffeine. These headaches are worse in the morning, feel like a tension headache and require increasingly more pain relief to treat them. You should consult a doctor for treatment of medication overuse headaches.

Treatment Tips

• you can sometimes prevent headaches if you recognise the triggers and avoid them; keeping a headache diary may help you spot triggers
• pain relief medicines may be effective but rest is also helpful
• drink plenty of water and eat a healthy diet
• sinus headaches may require special medicines; check with your pharmacist
• if your headache is part of a cold and you take multiple medicines containing paracetamol, be careful not to exceed the safe daily dose of paracetamol
• have your eyes checked if you do a lot of computer work
• check your posture if you have a desk job, especially if you have shoulder aches and pains

Treatment Options

• it is important to know what type of headache you have and if you need to see a doctor
• some pain relievers are not suitable for everyone; check with your pharmacist

Oral pain relief medicines (analgesics)

[GENERAL SALE]
e.g. paracetamol, packets of 24 or fewer (Panadol range); aspirin (Aspro range, Disprin range); ibuprofen, packets of 24 or fewer (Advil, Nurofen range)
[PHARMACY ONLY]
e.g. paracetamol, ibuprofen: larger pack sizes; paracetamol liquid preparations (Panadol (Children) Liquid Formulations, Dymadon Suspension 1 Month to 2 Years, Dymadon Suspension 2 to 12 Years); ibuprofen liquid preparations (Nurofen for Children, Dimetapp Children's Ibuprofen Pain & Fever Relief Suspension, Dimetapp Infant's Pain & Fever Relief Ibuprofen Colour Free Suspension); diclofenac (Voltaren Rapid 12.5); naproxen (Naprogesic)

[PHARMACIST ONLY]
paracetamol, aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) (which include ibuprofen, diclofenac and naproxen) relieve pain and reduce fever

• paracetamol is a safe choice for most people but it is important not to take more than recommended. It is an ingredient in many cold and flu remedies so be careful not to double dose
• the maximum daily dose of paracetamol for an adult is 4 g (4000 mg), and no more than 1 g (1000 mg) every four hours
• Aspirin and NSAIDs are not suitable for everyone. Children under 12 years old must not take aspirin because it can cause Reye’s syndrome, a serious condition. It should also be avoided by adolescents under 16 years old who have a viral illness
• check with your pharmacist before taking aspirin or NSAIDs if you:
• have a history of stomach problems, such as ulcers or indigestion
• have asthma; some people with asthma find their condition is made worse by these types of medicines
• have kidney problems or a heart condition
• take other medications
• have an allergy to aspirin or NSAIDs
• are pregnant or breastfeeding
• are elderly; you may be at more risk of side effects
• are dehydrated
• Sometimes aspirin and NSAIDs can cause side effects. If you develop indigestion, or unusual or increased bleeding or bruising, stop taking them and talk to your pharmacist

Hiatus Hernia Symptoms

A hernia is when part of the body bulges or protrudes into another part of the body that would not normally contain it. In the case of a hiatus hernia, a part of the stomach, normally in the abdomen, slides or protrudes into the chest cavity.

Normal anatomy

The chest and abdomen are normally separated by the diaphragm, a thin sheet of muscle that aids in breathing. The oesophagus (the tube that food passes down from the mouth to the stomach) goes down through the chest, passing through a small opening (called a hiatus) in the diaphragm and entering the abdominal cavity to join the stomach.

Hiatus hernia

When a hiatus hernia occurs, a portion of the stomach is able to slide upwards through the opening in the diaphragm, beside the oesophagus, into the chest.

There are 2 main types of hiatus hernia.

• Sliding hiatus hernia: this is the most common type of hiatus hernia, accounting for about 90 per cent of cases. It occurs when the junction between the oesophagus and the upper part of the stomach protrude up through the oesophageal opening in the diaphragm into the chest cavity. The herniated portion of the stomach can slide back and forth, into and out of the chest.
• Rolling hiatus hernia: this is sometimes called a para-oesophageal hiatus hernia. In this case, the junction of the oesophagus and stomach stays down within the abdomen, and the top part of the stomach (the fundus) bulges up into the chest cavity. This type of hernia normally remains in one place, sitting next to the oesophagus, and does not move in or out when you swallow.

Common symptoms

The most common symptoms of hiatus hernia are those arising from gastro-oesophageal reflux, which can occur as a result of the hernia.

These symptoms include:

• heartburn, which is a painful burning sensation felt in the lower front chest area behind the breastbone and upper abdomen, often after eating or when lying down; and
• regurgitation of sour or bitter-tasting acid fluid into the mouth, particularly at night, which occurs with more severe reflux.

These symptoms are often worse when you bend over, lie down or strain to lift heavy objects.

Depending on the type of hiatus hernia, other symptoms can include:

• belching or burping;
• difficulty in swallowing; and
• pain on swallowing (especially hot drinks).

Difficulty breathing

Sometimes with large hiatus hernias there is so much of the stomach protruding up through the oesophageal gap in the diaphragm that it presses on your lungs and can make breathing more difficult. See your doctor if you are having difficulty breathing.

The outlook

In most cases, symptoms from a hiatus hernia can be kept under control with medicines and lifestyle and dietary changes to treat gastro-oesophageal reflux — your doctor can help you with these.

Other treatment, such as surgery, is normally only required if your symptoms become worse and more constant. Rolling, or para-oesophageal, hernias are more likely to require surgery than sliding hiatus hernias.

Common Cold Problems

The common cold is an infection, mainly of the nose and throat, which is caused by a virus. It usually lasts about a week and should not cause serious illness in otherwise healthy people.

How do you get a cold?

A number of different viruses cause the common cold, but the rhinovirus is the most common cause. The virus, which is very infectious, can be spread from person to person by the fine spray shot from the nose and mouth when you cough or sneeze. It can also be spread by close contact (e.g. shaking hands) with someone who has a cold.

The virus can survive on indoor surfaces (such as door handles, light switches and taps) for days and can infect someone when they rub their eyes or nose after touching a contaminated surface.

Symptoms

Cold symptoms usually appear 1-3 days after exposure to the virus and include:

·          nasal congestion (blocked nose);

·          nasal discharge (runny nose);

·          sneezing;

·          sore throat;

·          coughing;

·          mild fever;

·          headache; and

·          red, watery eyes.

Relief for cold symptoms

There is no cure for the common cold, but treatments can relieve some of the unpleasant symptoms.

Antibiotics do not work against viruses and there are currently no antivirals available to treat colds. Antibiotics may occasionally be used to treat some bacterial infections that develop following a cold.

The following tips may help you to relieve some common cold symptoms.

·          Drink plenty of fluids. This replenishes the moisture lost during mucus production and makes mucus looser and easier to expel. Warm soup or warm water with lemon may also help soothe a sore throat and relieve congestion.

·          Adults and children older than 12 months of age can try honey to relieve a cough, especially at night time.

·          Rest is recommended to help your body fight off the cold. Staying at home will also limit the spread of your cold to other people.

·          Saline (salt water) nasal sprays or washes can help unblock the nose and clear the back of the throat. Nasal drops may be needed if a baby has a blocked nose and can't suck or feed. Your doctor or pharmacist will tell you what's best and how to use it.

·          Salt water gargle. Dissolve some salt in a glass of water and gargle to relieve a sore throat.

·          Sucking on ice can help relieve the pain of a sore throat. Adults and children older than 6 years may also want to try sore throat lozenges or sprays.

·          Vapour rubs may help a blocked or runny nose.

·          Antihistamines may improve runny noses and sneezing.

·          Decongestants, available as tablets and nasal sprays, may be helpful for some adults. Decongestants can provide short-term relief of congestion (blocked nose), but don’t use decongestants for more than a few days, otherwise you may suffer from rebound congestion (return of the symptoms). Children younger than 6 years should not use decongestants at any time, and those aged under 12 should take these medicines only if advised by a doctor or pharmacist. Decongestants should not be used if you have certain conditions (such as heart problems) - again, check with your doctor or pharmacist.

·          Painkillers, including paracetamol and NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen, can relieve aches and pains and reduce fever. Aspirin should not be given to children or teenagers. Paracetamol is included in many cold and flu preparations, so be careful to read labels and keep track of how much paracetamol you are taking.

·          Cough suppressants are not usually recommended, as coughing is the body's way of getting rid of mucus. Some mixtures may help in the short term if your cough is dry and annoying, but they are not recommended at all for young children. Follow directions carefully.

·          Use soft tissues for blowing the nose as the area around the nose tends to become sore and irritated. Barrier cream may help protect the skin around the nose.

·          Vitamin C may help reduce the duration of a cold when taken before symptoms start. So taking vitamin C might be a good idea if you are frequently exposed to cold germs.

·          Zinc lozenges, when taken at the onset of cold symptoms, may reduce the length and severity of colds. Zinc can be associated with potentially harmful side effects, so check with your doctor before taking it.

·          Echinacea is of unknown effectiveness. Further studies are needed to work out if it helps relieve or prevent colds.

Stop the spread of germs

Take some time off and stay at home to rest when you have a cold. It will help you feel better and help stop the cold virus infecting others.

When you are around others, sneeze and cough into a tissue. If you don’t have a tissue, cover your mouth with your upper sleeve or inner part of your elbow rather than your hands. This can help stop the spread of germs from your hands to doorknobs and other surfaces.

Remember to throw any used tissues straight into the bin and to wash your hands frequently when you have a cold.