The different kinds of hair loss

The hair follicle

We have approximately a hundred thousand hair follicles on our head, divided into 3 parts:

• The hair bulb (the "root") , in the scalp
• The epidermic shealth, the opening of the scalp's skin, that forms a canal allowing the hair stem to appear from the scalp
• The hair stem composed of keratin

Each hair follicle has several hair cycles each composed of 3 phases

• The anagene phase (an active phase of growing lasting from 3 to 7 years)
• The catagene phase: a phase lasting for 1 to 2 weeks where growth stops, the root shrinks and results in death of the hair follicle
• The telogene phase: the resting phase where the hair follicle remains attached to the scalpfor 3 months before falling

The hair cycle consists therefore in a physiological loss of 50 to 100 hair follicles per day 

Pathological loss

When the loss exceeds 60 to 100 follicles a day, it is considered to be pathological and furtherinvestigation may be necessary. It can result from disturbances of the various phases of the hair cycle:

• Anagene phase: defect in the production of hair follicles because of hormonal and genetic factors (male and female pattern baldness), metabolic (iron deficiency, thyroid gland problems) and chemotherapy....
• Telogene phase: telogene effluvium most common after pregnancy and severe illness, where considerable hair loss is shed. During pregnancy hair loss stops so after giving birth you loose the hair that you would have lost during that period. Hair loss (alopecia) is thought to be an auto immune disease, hair follicles can also present with structural anomalies of the stem or be destroyed by an infection such as ringworm (tinea), or trauma (burn) ...

The loss can generate some localised loss or balding patches, known as alopecia zones 
We can distinguish two different alopecia types:

• Scarring alopecia (the scalp is abnormal, scarred, hair follicles damaged and hair loss is permanent)
• Non scarring alopecia (the scalp is normal in texture and appearance, hair follicles are not damaged and hair loss can resolve)

Fever in an infant - Infant Fever

Temperature above 38 degrees

Greater than 38 degrees body temperature means that a baby or a child is in a feverish state. 

The child is tired, in a state of agitation and crying. When the temperature exceeds 39 degrees,convulsions may occur: it is a case requiring the advice of a doctor urgently. 

Right actions to take

First, we must uncover the baby or child, then apply a wet towel on his forehead. 
If necessary, make him take a warm bath several times a day, at a lower temperature of two degrees as its own temperature. Thus, for a fever of 40 degrees for example, the bath should have a temperature of 38 degrees. 

Check the temperature in his bedroom and that it does not exceed 19 or 20 degrees. Give him to drink enough, to avoid dehydration. 

Give him only one type of drug designed to lower the temperature, observing the dosagerecommended by the doctor. Do not give other medicines (antibiotics , etc.), unless directed by medical. 

Consult your doctor in case of persistent fever or further symptoms apparition: vomiting, nausea,diarrhea, abdominal pain, rash, etc.. 

If the infant is just a few days old, it is recommended to consult your doctor immediately, especially if it is the first baby.

Consequences of tobacco on health

The effects of smoking are insidious and become apparent on the body after many years.. 

A smoker is a smoker regardless of the amount or type of cigarette they smoke. People who smoke in moderation do not necessarily avoid the same smoking-related fatal consequences as heavy smokers. The duration of time a person smokes for is one the principal factors. People who smoke 5 to 10 cigarettes per day over 20 years take as much risk as heavy smokers over the same period. 

Cancer: figures worth remembering

• Tobacco smoking increases the risks of developing a cancer.
• Tobacco smoking is the number one risk factor for developing cancer, and more than a quarter of all UK cancer deaths are caused from smoking.
• The carcinogenic smoke and the by-products of smoking settle in most of the body organs, via inhalation through the lungs and or saliva.
• In particular, the digestive tract, bladder, lungs, tongue, and throat are affected.
• 50% of cancers of the bladder are tobacco-related.
• Smoking has caused cancer and killed approximately 6 million people over the last 50 years.
• Smoking causes around 90% of lung cancer deaths in men and 80% in women in the UK.
• Important risk factors mainly depend on the number of years a person has smoked for, the amount of cigarettes and how deeply and how long the tobacco smoke is inhaled for..
• Smoke from the "mild" or "light"-type cigarettes reach the small airways more deeply causing more severe forms of cancer.

Giving-up smoking decreases the risk of lung cancer. After 10 years of quitting the risk drops to a level that is almost half the risk of a smoker. It is crucial that ex-smokers always remain vigilant about their health and condition of their lungs and any persisting symptoms or problems should immediately see their GP.

Cardiovascular diseases

• Smoking is one of the main risk factors of cardiovascular diseases such as : heart attacks, high blood pressure, narrowing the arteries and blood supply to the legs, stroke, blood clots and impotence. This are much more likely in a smoker.
• Smoking contributes to the formation of atheromatous plaques which settle on the walls of the arteries. This can partially, and sometimes completely, block them.
• This narrowing of the arteries can cause a pain in the chest, called angina pectoris which can lead to a heart attack if one or more of the arteries supplying the heart is completely blocked.
• Under the age 45 years, 80% of heart attack victims are smokers.
• Smoking can result in poor circulation (peripheral artery disease) and cause pain in the legs when walking. This is called Intermittent Claudication .
• Cerebral Vascular Accidents, more commonly called "strokes", are more common in smokers causing weakness down one side of the body, loss of vision, inability to speak and sometimes even death.
• Impotence occurs due to the narrowing and sometimes obstruction by atheroma plaques, of the arteries that supply the penis with blood.
• A deep vein thrombosis (DVT), is a blood clot that blocks a vein can damage the leg but also cause smaller clots to break off and lodge in the lungs, brain or eye. The risk of a DVT is increased for those that smoke, but especially for women that smoke and take the oral contraceptive pill or HRT, anyone over the age of 40 and smoke, overweight and smoke those inactive or immobile and smoke.

The risk of thrombosis is not in direct proportion to the number of cigarettes smoked . 

Allergies

• Tobacco increases the risk of rhinitis and allergic conjunctivitis because it is an irritant and for those people being in the presence of smokers will worsen their symptoms
• Tobacco smoke does not cause allergies , except rarely in some people working in tobacco factories. However, it does often magnify the allergic reactions of susceptible people.

Asthma and chronic bronchitis

• Smoking is the main cause of many respiratory illnesses such as chronic bronchitis, emphysema, chromic obstructive pulmonary disease (COPD) and asthma.
• Tar coming from the cigarette smoke deteriorates the tiny hairs that line the lungs.

Asthma

• Tobacco plays a role in the onset of an asthma attack.
• It aggravates the frequency, rate and intensityof asthma attacks.
• Many asthmatics feel uncomfortable and sometimes symptomatic in a smoking environment.

Chronic bronchitis, COPD and Emphysema

• Chronic bronchitis, COPD and Emphysema are primarily related to smoking.
• It causes: breathlessness for even walking short distances and as the state of the disease advances, this breathlessness become much more severe. For some a thick cough occurs principally on first thing on waking in the morning and frequent repetitive exacerbations and infections occurs.
• COPD, chronic bronchitis and emphysema accounts for 25,000 deaths in the UK each year and over 8 out of 10 are directly linked to smoking.
• The heavier the smoker, this increased likelhood of respiratory failure is more likely causing increasing breathlessness especially with any effort, and a need for oxygen therapy at home, help at home and frequent hospital admissions.

Skin damage from tobacco

Smoking causes:

• The appearance of wrinkles due to degeneration of the skin's elasticity.
• The appearance of a, waxy and slightly greyish complexion which can be reversible after stopping smoking.
• Bad breath - all smokers have unpleasant breath .
• Discoloured, yellowing teeth
• Poor wound healing and poor formation of scars.

Ears, Nose and Throat (ENT) problems

• Infections concerning the ears, nose, throat are more frequent among smokers and their children.
• Smokers are more liable to sore throats, colds, laryngitis and ear infections.
• Heavy smokers can have a typical throaty, rasping voice is easily recognisable in most heavy smokers.

Allergies to tobacco

Allergies to tobacco are exceptional but can sometimes be found in people working in tobacco factories.

Medical problems encountered during pregnancy

Pregnancy encounters many minor problems, sometimes annoying and rarely ever serious.It is therefore possible to reduce their intensity and in some cases completely avoid them. 

Back pain

During the second trimester of pregnancy, weight gain and swelling of the womb affects the spine. Your ligaments become soft and stretchy, helping prepare you for labour. This also affects your joints including your spine.

• Avoid standing on your feet for too long
• Avoid high heels
• Do not carry heavy loads
• Bend your knees keeping your back straight when lifting up objects or picking items up off the floor.
• Sit up straight and keep your back well supported
• Keep active: swimming, walking and yoga

Nausea and morning sickness

• Occurs in early pregnancy and usually continues until the third month, sometimes longer.
• It can happen at anytime, most commonly in the morning upon waking.
• It is aggravated by long gaps between meals, therefore eat little and often.

Tips for reducing the feeling of nausea

• Have 3 lighter meals each day and a snack around 5pm.
• Have a snack in the evening after your last meal to reduce the interval of fasting time until breakfast.
• Reduce the amount of food at each meal
• Avoid having your breakfast too late in the morning.
• If the morning is your worse time avoid rushing about. Feeling tired can make it worse - get plenty of rest.
• Keep busy to distract yourself from feeling sick.
• Some women find foods and drinks containing ginger help.

Haemorrhoids

• Hemorrhoids (Piles) are dilated veins around the back passage. Small grape like balls can form inside or outside the anus causing itching, soreness and can bleed after having your bowels opened. They are very common in pregnancy.
• They often occur after a prolonged constipation over several days a common problems especially towards the end of pregnancy.
• During pregnancy, veins relax under the influence of pregnancy hormones, the uterus becomes larger, compresses the abdominal veins, disrupting blood flow at the origin of varicose veins and hemorrhoids.
• Hemorrhoids do not cause any harm to your baby.

Tips

• Avoid becoming constipated which can cause hemorrhoids
• Avoid spicy foods
  • Avoid carbohydrates
  • Drink plenty of fluids especially water
  • Eat plenty of fresh vegetables, fruit, high fibre foods - in particular prunes are known to help.
  • Keep active, such as swimming or walking.

Medication is generally contraindicated during pregnancy, check with your pharmacist or midwife.
If symptoms persist, consult a doctor. 

Tiredness

Tiredness is felt during the first 3 months, sometimes requiring a sleep during the day. It tends to decrease during the fourth month. 

Tips to fight tiredness :

• Rest frequently
• Reduce your workload, especially with everyday tasks.
• Get help around the house
• Go to bed earlier
• Take a nap in the afternoon
• Do not overeat at night
• Do not overheat your bedroom: a temperature of 19-degrees during the night is recommended.

Permanent tiredness may indicate a deficiency in vitamins or iron. In this case, see your doctor or midwife. 

Varicose veins

Varicose veins mostly occur in late pregnancy . 
They disappear in most cases after delivery.

• Do not stand for too long.
• Avoid crossing your legs when sitting.
• Do not wear high heels.
• Elevate your legs at night and during the day if possible.
• Massage your legs from top to bottom.
• Wear compression stockings - you can buy them at most pharmacies or on prescription from your doctor

Cramps

Cramps tend to occur in late pregnancy. They are sudden sharp pains in the calf muscles of your legs and thighs. They appear at night. Their cause is unknown, but gentle massage helps throughout pregnancy. 
If the cramps persist and are frequent and disabling see your doctor. 

Sleep disorders

They vary depending on the stage of pregnancy 

In early pregnancy

Tiredness is very common and persists during the first 3 months. Going to bed early in the evening, rest and taking naps help enormously. 

In the Second Trimester

Sleeping is much easier during this period, and your energy levels are much better. 

In the Third Trimester

Insomnia can be a problem in late pregnancy.: The baby can be more active at night time, kicking more frequently and then getting up to go to the toilet. Some women have strange dreams and nightmares about the baby and birth - this is normal, but talking about them can help. 

Tips for a better nights sleep

• Avoid coffee and tea
• Eat lighter meals, especially at super time.
• Do relaxation exercises before bed
• Read rather than watch TV
• Go to bed at regular times in a well ventilated room and not too warm.
• It is recommended that you sleep on your left side: this position avoids compression of the vena cava (major vein taking de-oxygenated blood from the lower half of the body).

Urinary disorders

A frequent need to urinate

Compression of the bladder by the uterus, especially in late pregnancy. As the baby grows, it presses on the bladder, thus causing the need to pass urine frequently. 

Urinary infections

They are common in pregnant women and must be treated as soon as possible. Signs of infection are: a burning sensation on passing urine, blood in the urine, urgency and the need to urinate frequently. 

Stretch Marks

• Pinkish lines that appear on the belly, breasts, buttocks, hips and thighs
• They are more common and prominent in the third trimester
• Hydration of the skin regularly helps to decrease their intensity
• Some women get them some don't. They become pale and fade after giving birth.

Constipation

• Episodes of constipation are very common during pregnancy
• Keeping active helps - 30 minutes per day such as swimming, walking and yoga.
• Eat foods rich in fibre such as cereals, wholemeal bread or bran, pasta, rice, fruits and vegetables for example.
• Drink 1.5 liters of water per day.
• Do not use laxatives without consulting a doctor

Skin Changes in pregnancy

• Hormonal changes can make the skin go darker all over or in patches. The nipples and skin around them become darker and skin changes on face can occur such as brown spots or freckles on the forehead and cheekbones. You may also notice a brown line develop down your stomach which should fade after delivery.
• Sun exposure makes these skin changes worse.
• They fade and disappear after delivery
• Facial pigment changes can reappear when taking a contraceptive pill

Protect your face during sun exposure. 

Heartburn

Heartburn and indigestion can be very uncomfortable during pregnancy. It is caused by hormonal changes and as the baby grows it pushes up on the mothers stomach causing acid to spill into the food pipe.

• Avoid large meals and eat more slowly
• Avoid going to bed immediately after dinner
• Avoid foods which are spicy, sour, and fried.
• Try sleeping with several pillows to prop yourself up with.
• See your midwife or GP for antacids treatments that are safe during pregnancy.

Acne

Acne can suddenly appear during pregnancy and be distressing if you do not normally suffer with spots. Hormonal changes are responsible for it, however, most treatments are contraindicated during pregnancy. 

Take care of your skin washing and cleansing daily. 

Tooth decay and gingivitis

Tooth decay and infection, can occur more frequently during pregnancy

As with any infection during pregnancy they can be dangerous. Therefore brush your teeth morning and evening, with a soft brush, seek medical help if you suspect any infection 

The onset of gingivitis, gum disease, causes frequent bleeding

Monitoring by your dentist is therefore recommended throughout your pregnancy. 

Page written in collaboration with Claire Gabillat

Appendicitis

Appendicitis

Appendicitis can quickly develop into peritonitis: this is an acute abdominal infection causing severe abdominal pains and a very hard abdomen. Peritonitis is a very serious illness. 

Symptoms

Pain

Sudden and severe pain on the right side and the lower abdomen, the localisation of the appendix. The pain radiates down to the leg. It worsens when walking and coughing. 

Appendicitis is an emergency

Contact a doctor urgently or dial 999, or 911 depending on your local emergency number. 

Atypical symptoms

Abdominal pain is not always on the right it can be diffuse and occur on the left because of the atypical position of the appendix. The symptoms of nausea and vomiting for are not always present. 

What to do if faced with possible appendicitis

Do not offer food or drink... Consult urgently a doctor 

A complication of appendicitis is peritonitis

Peritonitis is inflammation of the entire abdominal wall, which encases the stomach, small and large intestine. It is usually an infection that causes peritonitis and the abdomen becomes hard and is diffusely tender. 

Peritonitis is life threatening and needs urgent medical attention. 

A generalised infectious peritonitis begins in general with a pain in a particular point of the abdomen and then diffuses secondarily. 

Symptoms of peritonitis

Pain can start in one area and then diffuses to all over. Rigid hard abdomen when palpated. Vomiting and the bowel stops working completely. 

Emergency hospitalisation

Emergency hospitalisation is necessary for intravenous antibiotics, rehydration and possible surgical intervention. 

Diagnosing appendicitis

Abdominal pain is usually located at the bottom right of the abdomen and is the most usual sign of appendicitis. Pain can also be differed to other areas of the abdomen. A rectal examination, carried out by a doctor, will reawaken this pain. 

Fever, when it is present, is in general around 38°-38°5, but seldom higher. Rapid pulse rate. Other symptoms like fever, constipation, nausea and vomiting for example can be symptoms of other pathology. 

Other examinations

A full blood count. An increase in the number of white cells indicates an infection of some kind.

• Appendicitis can occur despite of a normal blood count
• An increase in white cells can be caused by any type of infection
• A reduction in white cells can also be sometimes a sign of appendicitis
• An increase in CRP, is a sign of inflammation

A X-ray of the abdomen is a very useful examination which helps to exclude other pathologies and to confirm a diagnosis of appendicitis. 

An ultrasound scan is more better at examining soft tissue and can reveal inflammation around the appendix, it can also help differentiate appendicitis from a gynaecological or urinary anomaly. 

Children are always closely monitored and only proceed to surgery if appendicitis is suspected. 

Treatment

Removal of the appendix called appendectomy is essential to treat the problem. Rehydration and antibiotics are also given. 

The main risk is that an appendicitis goes undetected and then develops into peritonitis. 

A doctor should always assess a sudden onset of abdominal pain located on the lower right hand side of the abdomen so that appendicitis can be excluded.

Abuse, addiction and polyconsumption: how to identify them

• Polyconsumption of pyschoactive substances
• Identification
  • Intervening
  • Reminders
• Assessment of gravity factors

Polyconsumption of pyschoactive substances

Polyconsumption of pyschoactive substances is defined by "people consuming at least two, simultaneously or sequentially, with at least for one of these the notion of a harmful use or a dependence".

Identification

Intervening

Several health care professionals are concerned with identifying polyconsumption problems (attending physicians, school doctors, company doctors, pharmacists, etc). 
A commission reccomended the need for systematic screening of polyconsumption by health professionals. And among other issues, for doctors to draw the awareness of the general public on the dangers of polyconsumption (information campaigns, setting self-assessment tools, etc), or the development of computerised pharmaceutical files (the pharmacist thus can locate them more easily). 

Reminders

In order to better locate polyconsumption problems, the commission provided some reminders:

• A consumption can hide others (after the identification of a consumption, not to forget to systematically seek possible others)
• Association with possible purely behavioral addictions is possible
• Waiting for a care request is not enough: health professionals, in contact with the public, are incited to locate polyconsumption whatever the age or the socio-professional profile of the subjects,
• The identification and evaluation of the problematic consumption must be based on reliable, simple and validated tools (producing and validating these tools are a priority).

Assessment of gravity factors

The assessment of gravity factors, the damage and motivation of the patient to change is done during one or several clinical talks. 
A tool makes it possible "to systematise" the collection of information during these talks, it is theAddiction Severity Index (ASI). 

This very detailed questionnaire would help collect information on the medical state of the patient as well as on his resources, legal situation or family and social relations.