It seems that it’s the anti-oxidants in Blueberry Punch that provide the positive effects that have shown up in those university tests.

Blueberry Punch is made from ingredients that include turmeric, citrus and olive and the formula for Blueberry Punch combines those extracts with blueberry, red grape, white grape, elderberry, raspberry and other ingredients that are concentrated into a syrup

Now that may sound like a rather strange taste combination but the end result is a very pleasant tasting drink when diluted at a ratio of 1:6 with water, soda water or other mixer drink of your choice.

Blueberry Punch is available from both Beachside and Kawungan Pharmacies and our staff can provide you with more information about the full range of Dr Red products that can help you maintain your health.

The good news is there are treatments and steps that can be taken to help prevent and control problem dandruff. Understanding what dandruff is and the factors that cause it are the first steps in self care treatment and prevention - talk to your pharmacist about which treatments are best for you.

What is dandruff
A normal scalp skin sheds old cells in a cycle once every month. These old cells usually go unnoticed as there are very few of them at any one time. In dandruff the shedding of the dead skin cells from the scalp occurs at an excessive rate. The skin cells cycle every week, or even every three to four days.

Dandruff can happen at any age, but is more common from 12 years of age, peaking at 20 years of age. A form of dandruff known as cradle cap can occur in newborn babies and infants. Dandruff tends to be seasonal. It is most severe during winter and mildest during the summer.

Dandruff can cause either an overly dry scalp with small, round white to grey scales (flakes) on top of the head, which itch. Sometimes the flakes may appear yellow in colour and are waxy or greasy. Scales can occur anywhere on the scalp, in the hair, on the eyebrows, in the beard, and can spread to the neck and shoulders.

Dandruff is not dangerous, does not cause balding and is not contagious. Dandruff is a natural process and it can not be eliminated or cured. However dandruff can be effectively managed and controlled with the right treatment and self care.

Causes   
Dandruff and the fungus theory
The exact cause of dandruff is unknown. However, today most skin specialists agree that dandruff is linked with the overgrowth of a tiny fungus present on the scalp called  Pityrosporutn ovale, P. ovale for short.

This fungus lives on our bodies and scalp all the time, usually without causing any problems. Unfortunately, for some people, it can increase in number, leading to dandruff.

Another possible cause may be overactive oil glands on the scalp which cause an increase of the natural skin shedding process. Clogged oil glands on the scalp are also another possible cause. These clogged pores can lead to over-drying and flaking of the skin.

It is thought that there may be other factors that cause dandruff. Some of these factors are:
*    Hormonal changes
*    Hereditary
*    Bad hygienic habits
*    Excessive perspiration
*    Bad diet
*    Excessive use of hairsprays and gels
*    Too frequent hair-colouring or excessive use of electric curlers
*    Cold weather and dry indoor heating
*    Tight fitting hats and scarves
*    Infrequent shampooing, the use of wrong conditioners or improper rinsing of the hair
*    Long term stress, anxiety and tension
*    Allergic or hypersensitivity

Symptoms
Unsightly flakes or scales are typically present on the scalp and trapped in the hair. Whether or not these flakes are ‘oily’ or ‘dry’ may hint to the underlying cause of the dandruff. The most common symptom of dandruff is scaling with occasional itching.

Treatment and prevention of dandruff
Dandruff can disappear suddenly without treatment or may take many weeks of treatment to improve. There are steps you can take to prevent and effectively treat dandruff.

Important
Talk to a doctor if:
*    Your scalp is red, itches, bleeds or burns or if any of these conditions migrate onto your face.
*    The flaking skin is isolated in one area or in multiple areas as the condition may be a skin problem other than dandruff.
*    There are patches of hair loss.

Self care
*    Prevention of dandruff may be achieved by shampooing on a daily basis with a mild, non-medicated shampoo.
*    The scalp should be massaged gently to loosen flakes and the hair and scalp rinsed thoroughly.
*    Stronger anti-dandruff shampoos and lotions are also available - talk to your pharmacist.
*    Since dandruff shampoos and products tend to be harsh, it is important to carefully follow label directions. Doing so will ensure the safest, most effective use of the product.
*    Use shampoos containing tar if the hair starts becoming too dry.
*    Talk to your pharmacist about shampoos which contain antifungal agents.
*    Save your daily hair washing until after your exercise workout.
*    Use a conditioner. Try a ‘leave-in’ conditioner; it acts as a moisturiser for your scalp.
*    Try to avoid using hair gels and other products that contain alcohol, which tend to dry out the scalp.

Contact:
A doctor - listed under ‘medical practitioners’ in the yellow pages of the phone book

A Self Care pharmacy - to locate telephone 1300 369 772 and ask for the Pharmacy Self Care Field Officer.

In case of poisoning, phone the Poisons Information Centre on 13 11 26 from anywhere in Australia.

Pharmacists are medicines experts. Ask a pharmacist for advice when choosing a medicine.

The two main types of drugs involved in over - dose are depressant drugs and stimulant drugs.

Depressant drugs - reduce activity in the nervous system examples include:
*    Heroin
*    Morphine
*    Methadone
*    Sleeping pills
*    Benzodiazepines e.g. Valium, Serepax 
*    Alcohol.

An overdose of a depressant drug slows the nervous system down to a dangerous level. This can stop a person’s breathing.

Stimulant drugs - speed up the nervous system, examples include:
*    Amphetamines
*    Designer drugs (e.g. ecstasy)
*    Caffeine
*    Nicotine.

An overdose of a stimulant drug speeds up the body, sometimes to a dangerous level. This can cause high blood pressure, a rapid heart rate and increased body temperature.

Important
If a drug overdose has been taken or you suspect someone has taken an overdose:
*     Try to stay calm.
*     Dial 000 and tell them you need the ambulance service.
*     Tell the ambulance service where the person is.
*     Tell the ambulance operator the person’s condition -are they breathing? Do they have a pulse? This will determine priority.
*     Tell the operator a drug overdose has occurred.
*     Tell the operator if you know what drugs have been taken and if possible how many.
*     Stay with the person until an ambulance arrives. You may have valuable information for the ambulance officers which could save time. This could be the difference between life and death.

If you are worried someone might have overdosed, but you don’t think they need an ambulance, watch them very closely and check on them every few minutes. Call an ambulance if you have any concerns.

Who is at risk of overdose?
An overdose can happen just as easily to an experienced drug user or an inexperienced user. In most cases of fatal overdose with drugs such as heroin, other drugs are found in the blood stream at the same time. While too much heroin can cause death, a mixture of drugs (a drug ‘cocktail’) is often more dangerous and its effects are unpredictable.

How a drug affects one person may be different to how it affects someone else. It can depend upon:
*    The tolerance of the user i.e. how sensitive their body is to the drug, and how often they’ve been using.
*    The quantity of the drug taken.
*    The mix of drugs i.e. what other drugs they have taken which would still be in their system.
*    The way the drugs are taken e.g. injected, swallowed or inhaled.

Treating heroin/opiate overdose
If a person has overdosed with heroin or other opiates, the drug Narcan can reverse the effects of the drug immediately. Once the Narcan wears off, it is possible to slip back to the original overdose condition, especially if heroin is used again soon after.

Narcan is the brand name for naloxone.

Self care and caring for others
The best way to prevent a drug overdose is to take only legally manufactured and distributed drugs, as directed and/or prescribed.
*    Avoid drug cocktails.
*    Purchase from the same supplier.
*    Try small or ’short’ tastes first to check the strength of the drug.
*    Use in a secure place or with other people so that help is near if needed.
*    If you are injecting for the first time or have had a break from injecting, always use a lower dose.
*    If you take stimulant drugs such as ‘ecstasy’ and are dancing, do not drink too much too quickly (this has proven fatal in the past due to rapid dilution of the blood). It is best to sip drinks slowly and regularly.
*    Learn relevant first aid skills e.g. Cardio Pulmonary Resusciation (CPR). This may help if others overdose in your company.
*    If somebody who has used drugs is asleep and you can not wake them up, they may have overdosed and their life may be in danger - dial 000.
*    If a person is unconscious but still has a pulse and is breathing, roll them onto their side - dial 000.
*    If a person is not breathing but they have a pulse, check their airway, and when this is clear, give them mouth-to-mouth resuscitation - get somebody else to dial 000.
•    If a person is not breathing and has no pulse, start CPR - get somebody else to dial 000.
•    If you have overdosed you are strongly advised to talk to a counsellor or doctor. Some states have Overdose Response Support Workers who are there to listen and assist you.

WARNING!
The following will not help to stop or reverse the effects when a person has taken a drug overdose:
*    Putting them under a shower
*    Injecting them with salty water or speed
*    Walking them around
*    Making them vomit
*    Slapping or yelling at them.

These actions can be dangerous and should not be attempted.

Remember - Check with your state/ territory user organisation so you know what the laws and procedures are in your state regarding police attendance. Even if you live in a state where the police are called, a person’s life may be at stake - the worst thing that can happen is that someone dies.

Contact numbers
A doctor - listed under Medical Practitioners in the yellow pages of the phone book

Further information and counselling service contact telephone numbers:

Ambulance Service tel. 000

Poisons Information Centre on 13 11 26 from anywhere in Australia.

The body can lose a lot of fluid through vomiting and diarrhoea, causing dehydration. Dehydration can cause serious, even life-threatening illness, especially in the very young or very old. Ask a pharmacist about suitable treatments for the family.

Causes
Viral infections of the gut - Viruses are common causes of gastroenteritis (’gastro’). The infection starts with sudden onset and often vomiting occurs before any diarrhoea. Often the first symptoms are those of a cold and perhaps a cough. In most cases the infection is short-lived, lasting 2-3 days, although diarrhoea may last a little longer.

Bacterial infections of the gut - these infections are the cause of food poisoning. Symptoms usually occur 12-48 hours after eating infected food. There is a sudden onset of frequent diarrhoea, stomach pains (often described as a ‘colicky7 pain) and vomiting.

Other infections - In some patients, especially infants and small children, diarrhoea and/ or vomiting can be a sign of serious illness, such as blood poisoning. If a child appears very unwell, or is not taking fluids orally, or there is any cause for concern, see a doctor immediately.

Chronic diarrhoea - Recurring or persistent diarrhoea may be as a result of an irritable bowel or inflammation of the bowel. See a doctor if there are frequent bouts of diarrhoea or if diarrhoea persists longer than 2-3 days. In rare cases in adults, a chronic change in bowel habit can be a sign of cancer of the gut. If this sort of change occurs, see a doctor straight away.
 
Medicines - Some medicines may cause diarrhoea and vomiting. Stopping some medicines may also cause diarrhoea. Those who suspect any medicines may be causing vomiting or diarrhoea should talk to a pharmacist.
Other causes - Excess alcohol and anxiety are other possible causes of diarrhoea.

IMPORTANT  
See a doctor if you have diarrhoea when:  
*    Bowel motions contain blood.  
*    You are losing weight.  
*    It is severe with dehydration.  
*    It persists longer than 2-3 days - - earlier for the elderly and the very young (under two years of age).  
*    You have severe abdominal pain or a high fever (greater than 38°C).  

Risks
*    Babies, young children, the elderly and people who have chronic illnesses can become dehydrated very quickly as a result of vomiting and diarrhoea. Urgent rehydration is required, as serious or even life-threatening dehydration illness can result.
*    Diarrhoea can cause some temporary damage to the bowel lining. This may make the bowel unable to cope with lactose (found in dairy products) for a short time. If dairy products make the diarrhoea worse, they should be avoided until it subsides.

Dehydration: warning signs
*    More than eight runny bowel motions in 24 hours.
*    Vomiting (can not keep anything down).
*    Going for 10 hours or more without passing urine (2-3 hours in children).
*    When the skin is pinched it stays up for a second or two.
*    Irritable, sleepy or ‘floppy’ child.
*    Sunken eyes or shadows under the eyes.
*    ‘Soft spot’ in top of baby’s head is sunken more than usual.
*    Changed breathing - either quick, or slow and deep.
*    Skin feels cold and clammy.
*    Dry mouth, tongue and lips, or no tears.

Rehydration
*    Make up the rehydration solution exactly as listed on the packet - ask a pharmacist if unsure.
*    Sip the solution whenever vomiting or a runny bowel motion occurs.
*    Adults need to drink 2-3 litres of solution in 24 hours to keep hydrated. Ask a pharmacist how much to give children.
*    Make up new solution every 24 hours and keep it in the fridge.

Medicines
Medicines (e.g. loperamide, diphenoxylate) are available in pharmacies for adults and children greater than 12 years of age to stop diarrhoea. Ask your pharmacist if these medicines are suitable for you. It is still important to follow the self care recommendations as well.

Self care
Babies
*    Keep breastfeeding the baby, offer the breast more often, and offer rehydration solution between feeds.
*    Replace other milk or formula with oral rehydration solution for 24 hours.
*    Give half-strength formula for the next 24 hours, or try a lactose-free formula if necessary - ask a pharmacist.
*    Sterilise babies’ bottles and dummies as well as items used to measure, mix or store made-up formula, juice or water.
*    Put made-up and sterilised formula back in the fridge as quickly as possible.
*    Throw away any leftover formula or milk.

Children and adults
*    Use rehydration solution to replace fluids.
*    After vomiting stops keep sipping fluids and eat if hungry. Avoid sweet foods. Try starchy foods e.g. rice, potatoes, bread or dry biscuits, cooked cereals, yoghurt.
*    Avoid undiluted sweet/sugary drinks -they can make diarrhoea worse.

Preventing gastro
Gastro bugs can get into food (especially milk) from unwashed hands, kitchen surfaces and eating utensils. They also grow in food kept warm. Keep cooked food hot, or put it in the fridge. Insist on everyone washing their hands after going to the toilet, changing nappies, handling animals and before touching food. Other precautions should be taken when travelling (see Travel Health Fact Card).

Contact
A doctor - listed under ‘Medical Practitioners’ in the yellow pages of the phone book

Internet sites: Gastroenterological Society of Australia - www.gesa.org.au

The Gut Foundation - www.gut.nsw.edu.au

A Self Care pharmacy - to locate telephone 1300 369 772 and ask for the Pharmacy Self Care Field Officer.

In case of poisoning, phone the Poisons Information Centre on 131 126 from anywhere in Australia.

Pharmacists are medicines experts. Ask your pharmacist
for advice when choosing a medicine.

When companies develop a new medicine, the active ingredient is named (often referred to as the ‘generic drug’ name), and it is also given an original brand name. As an example, amoxycillin is an active ingredient (generic drug) name; Amoxil is one brand name.

The first company to make the new medicine has exclusive rights to market its product (a patent or copyright) for a number of years. Other companies cannot market a copy of the original brand medicine until the patent expires.

Generic brand medicines - contain the same active ingredients, are of the same dosage form (e.g. tablets or liquid) and are the same strength as the original brand medicine. This means that different brands work in the same way in the body, with potentially the same risks and benefits.

The Therapeutic Goods Administration (TGA) - is responsible for assessing and registering all medicines in Australia. This is important for public health and safety.

Before a prescription medicine can be put on the market in Australia or listed on the Pharmaceutical Benefits Scheme (PBS), an expert team of doctors, scientists and pharmacists make sure that it is:
*    Of good quality
*    Safe
*    Effective, including cost effective
*    Correctly labelled and packaged.

Companies which produce generic medicines must adhere to the same quality standardsand have the same tight manufacturing controls as companies making original brand medicines. In fact, original and generic brand medicines are sometimes made by the same company.

Different brands - of a medicine may contain different inactive ingredients. They may be a different colour, shape, or size, or may taste different. The type of container or packaging may be different, for example, a bottle or blister foil pack. Differences in formulation or outer packaging do not affect how the medicine works.

Medicines also contain other inactive ingredients such as preservatives, flavourings, colourings or fillers, and there is a rare possibility that an allergic reaction could occur to one of these inactive ingredients.

Important
*    Consumer Medicine Information leaflets provide helpful information on the ingredients in a medicine. It is important to read the leaflet carefully when starting a new medicine or using a different brand.
*    If you know you are allergic to a particular inactive ingredient, for example lactose or gluten, check with the pharmacist before using a new medicine.

Advantages of different brands
The competition that results from more brands can mean lower prices overall and differences in prices for PBS medicines for consumers. Because generic medicines are copies of an original brand medicine, the generic companies do not have to repeat all of the early research, development and marketing costs of the original company.

The competition that results from more brands can mean lower prices overall and differences in prices for PBS medicines for consumers.

Knowing about the availability of different brands may help you save money and exercise choice about which medicine you use. Lower cost does not mean lower quality - original and generic brands are equally as good and work equally well.

Just as with any other product, you may have particular preferences about your medicines, for example:
*    Types of packaging for ease of opening or storage
*    Shape or size for ease of swallowing or administering to children
*    The company that manufactures it
*    Price.

The difference in price between different brands may vary. The amount may or may not be important to you or your family. You can ask about any differences in price before you make a decision about brand choice.

Self Care
*    If you change to a different brand, check the active ingredient (generic drug name) on the label carefully to make sure you do not take the same medicine twice (double dose) or that you do not replace the wrong medicine.
*    Show your Medicare/Repatriation and/or concession card every time you have a prescription filled.
*    Ask the pharmacist about the PBS Safety Net, and keep a prescription record form so you will know when you qualify for the PBS Safety Net.
*    Always store medicine(s) according to the instructions in the product leaflet or on the packaging and keep all medicines safely out of reach of children.

Remember
*    For prescription medicines - less expensive does not mean lower quality.
*    All brands of a medicine meet the same safety standards and are just as effective.
*    Your pharmacist can dispense a different brand at your request in most cases; however, it can be a good idea to check with your doctor.
*    You have the choice. If you want a particular brand for any reason - ask your pharmacist. If you are offered the choice of a different brand, but do not want it - It is okay to say ‘No’.
*    If you choose or are prescribed a more expensive brand, you will need to pay the difference between your brand and the lowest priced brand - this amount does not count towards the Safety Net.
*    Talk to your pharmacist or doctor if you have any concerns.

Contact:
PBS Infoline 1800 020 613

A doctor - listed under ‘Medical Practitioners’ in the yellow pages of the phone book

A Self Care pharmacy - to locate telephone 1300 369 772 and ask for the Pharmacy Self Care Field Officer

In case of poisoning, phone the Poisons Information Centre on 131 126 from anywhere in Australia.

Pharmacists are medicines experts. Ask a pharmacist for advice when choosing a medicine.

The danger is you may not notice the effect a medicine has until it is too late. When starting a new medicine, always ask your pharmacist if it is safe to drive, cycle or use machinery and what the warning signs are to look for.

If it is not safe, DO NOT DRIVE.

Reactions to medicines
Some medicines can make you:
*    Drowsy or tired
*    Dizzy, light-headed or faint
*    Not think clearly
*    Shaky, unsteady
*    Angry, aggressive
*    Feel sick
*    Have blurred or double vision.

This can make it unsafe to drive, cycle or use machinery.

Risks
If you drive when affected by medicines you may cause an accident. You risk:
*    Killing, injuring or disabling other people or yourself
*    Damaging property
*    Losing your licence
*    Losing your insurance cover.

The effect of a medicine on your driving may be greater:
*    If you drink alcohol at the same time
*    If you take two (or more) medicines that have similar effects on driving
*    When you start using a new medicine
*    If you take more than the prescribed dose of your medicine
*    As you get older
*    If you are tired.

Important
*    If your medicine affects your driving, stop your driving, not your medicine, and talk to your doctor or pharmacist.
*    Ask your pharmacist or doctor if the medicine you are taking (prescription or non-prescription) may affect your driving. Some medicines may affect your driving only until your body gets used to them. Other medicines may affect your driving all the time you are taking them.
*    Read the labels on ALL medicines you take. Check with your pharmacist when your medicines have the following labels:

This medicine may cause drowsiness and may increase the effects of alcohol.

If affected, do not drive a motor vehicle or use machinery.
OR
This medicine may affect mental alertness and/or coordination.

If affected, do not drive a motor vehicle or operate machinery.

Medicines
Some prescription and non-prescription medicines used to treat the following conditions may affect your ability to drive, cycle or use machinery.
*    Sleeping problems
*    Epilepsy, convulsions
*    Heart conditions
*    High blood pressure
*    Fluid retention
*    Inflammation (e.g., arthritis)
*    Nausea and vomiting
*    Reflux, heartburn, indigestion
*    Nervous system diseases
*    Some infections
*    Anxiety, depression - ‘nerves’
*    Pain, headache
*    Migraine
*    Period pain
*    Travel/morning sickness
*    Coughs and colds
*    Allergies, hay fever
*    Stomach/duodenal ulcers
*    Eye conditions
*    Diabetes
*    Methadone.

Self care
*    If your medicine does affect you, ask if there is an alternative. For example, if you get hay fever, there are antihistamines that are less likely to make you drowsy.
*    Ask your pharmacist for a list of all your medicines (e.g., MediList) to remind you of the ones that may affect you.
*    Use public transport, take a taxi or ask a friend to drive if you are taking medicines that could affect your driving.
*    If you have missed a dose of your prescribed medicine, do not drive if your condition can make driving dangerous (e.g., epilepsy).
*    Manage medical conditions by taking medicines correctly - if you have any problems talk to your pharmacist or doctor.
*    If your medicine is affecting you, do not drink alcohol. Talk to your pharmacist or doctor before mixing alcohol with your medicines.
*    Do not drive when you are tired, particularly on longer trips.
*    Do not use other people’s medicine - it could have a different effect on you, possibly affecting your driving.

Most illegal drugs will affect your alertness or reaction times. Do not drive if you have used these substances.

Alcohol
Even a small amount of alcohol, especially if taken with some medicines, can affect your driving skills.
Think of yourself, think of others - do not drive if you have been drinking alcohol.

Contact
A doctor - listed under medical practitioners in the yellow pages or the phone book.

A Self Care pharmacy - to locate telephone 1300 369 772 and ask for the Pharmacy Self Care Field Officer.

In case of poisoning, phone the Poisons Information Centre on 13 11 26 from anywhere in Australia.

Pharmacists are medicines experts. Ask your pharmacist for advice when choosing a medicine.

Cause
Chickenpox is caused by a herpes virus, the Varicella zoster virus.
It is highly contagious, spread by droplets breathed out into the air or from the fluid of chickenpox blisters.

Signs and symptoms
*    Begin between one and three weeks after infection
*    First symptoms: mild headache, moderate fever, general unwell feeling
*    Most younger children (<10 years) do not get these early symptoms, and symptoms are worse in adults
*    Rash develops a day or so later: small flat red spots, developing quickly into itchy blisters which break down to form crusts
*    Rash first appears on back and chest then spreads to face, neck, arms and legs
*    New spots can continue to appear for up to five days
*    The various stages of spots, blistering and crusts may be present on different parts of the body as the rash progresses
*    Blisters vary from a few on the trunk, to covering the whole body. They can occur anywhere, including the scalp, eyelids and on mucous membranes in the mouth, throat, anus and vagina in severe cases
*    Crusts disappear within a few weeks
*    Blisters can be complicated by secondary bacterial infection and can leave scars
*    Other complications include pneumonia, encephalitis, serious bacterial infections of deep tissue or the bloodstream and a bleeding tendency Infections in the first half of pregnancy can cause damage to the foetus and infections late in pregnancy can cause severe chickenpox in the newborn infant.

Important
Most people recover from chickenpox without any problems. However, you should see your doctor if:
*    The blisters get very red and sore with pus
*    There is high fever, severe headaches or vomiting, particularly a week or so after the chickenpox began
*   Joint pain occurs
*   You have a condition or are taking medication that affects your immune system e.g. chemotherapy, radiotherapy, HIV infection.    

Preventing chickenpox
Vaccines are now available on prescription from doctors for immunisation of children over nine months of age and adults
*    Vaccination is suggested for child-care workers, non-immune parents of young children and contacts of patients with weakened immune systems
*    It is not known yet if booster doses of vaccine will be needed to ensure long-term protection. Protection after immunisation is long-lasting.

How contagious is chickenpox?
*    A person with chickenpox is contagious from when symptoms first appear until the last blisters have crusted
*    Children with chickenpox should not go to childcare or school until at least five days after the rash first appears
*    The chickenpox virus stays dormant in the nerve roots of the spine, so generally you can not catch chickenpox again. However, the virus can reactivate in later life to cause shingles.
*    Someone who has not had chickenpox or been immunised against it, can catch chickenpox following contact with a person with shingles.

Treatment
Treatment for chickenpox aims to relieve itching, fever and discomfort.
*    Cold compresses
*    Baths - coal tar /pine tar or oatmeal bath additives
*    Hydrogels e.g. Solugel, Solosite
*    Calamine lotion/creams
*    Antihistamine tablets and syrups (one with a sedative action is especially useful for night-time scratching. Ask a pharmacist)
*    Oral paracetamol (e.g. Panadol) for fever
*    Aspirin should NOT be given to children or teenagers with chickenpox.
*    In addition, keeping up plenty of fluids is important, particularly if blisters/ulcers in the mouth and throat make swallowing painful.
*    In some circumstances, such as patients with complications, or in patients with compromised immune function, antiviral medication may be appropriate.

Self care
*    Get as much rest as possible, with plenty of fluids
*    Resist scratching - risk of infection is increased
*    Children can relieve their itch by patting or gently smacking their lesions
*    Keep nails short to reduce risk of infection
*    Avoid contact with people who have not had chickenpox or shingles while contagious.

Contact
A doctor - (listed under ‘Medical Practitioners’ in the yellow pages of the phone book).

A Self Care pharmacy - to locate telephone 1300 369 772 and ask for the Pharmacy Self Care Field Officer.

In case of poisoning, phone the Poisons Information Centre on 131 126 from anywhere in Australia.

Pharmacists are medicines experts. Ask the pharmacist for advice when choosing a medicine.

Type 1 diabetes
(Previously called insulin-dependent diabetes mellitus or juvenile diabetes.)
*    The body’s immune system destroys the insulin-producing cells in the pancreas.
*    It usually starts suddenly and the exact cause is unknown.
*    People with type 1 diabetes need insulin injections to survive.

Type 2 diabetes
(Previously called non-insulin-dependent diabetes mellitus or mature-onset diabetes.)
*    The most common form of diabetes.
*    People with type 2 diabetes are more likely to have high blood pressure and cholesterol and be overweight.
*    Develops gradually.
*    Can often be controlled with diet and exercise but sometimes tablets and then later, insulin may be required.

Signs and symptoms
These may include:
*    Passing more urine
*    Increased thirst and/or hunger
*    Tiredness - loss of energy
*    Weight loss (type 1)
*    Itching and skin infections (e.g., thrush)
*    Blurred vision
*    Slow-healing wounds
*    Tingling and numbness in the feet.

People with type 2 diabetes may only notice symptoms after their blood glucose levels have been high for many years.

If you are at risk of type 2 diabetes, don’t rely on the presence of symptoms to know if diabetes has developed. Be tested annually in order to detect diabetes early. You may have diabetes without feeling any symptoms.

Risk factors for diabetes
More than 500,000 Australians have type 2 diabetes and do not know it. Ask yourself these questions and if you answer ‘yes’to one or more of them then you are at risk of diabetes and you should see your doctor and ask to be tested.

Am I over 45 and have high blood pressure?
Am I over 45 and overweight?
Am I over 45 and have a family member with diabetes?
Am I over 55?
Do I have heart disease or have had a heart attack?
Did I have high blood sugar levels while I was pregnant?
Have I had a borderline high blood sugar test?
Do I have polycystic ovary syndrome and am overweight?
Am I over 35 and am an Aboriginal or Torres Strait Islander, a Pacific Islander, of Chinese cultural origin or from the Indian sub-continent?

Effects of diabetes
If diabetes is not well controlled, blood vessels, nerves and other body organs may be damaged. This may cause complications such as:
*    Loss of eyesight         
*    Kidney damage          
*    Heart disease, stroke 
*    Foot problems and leg ulcers.
*    Poor blood flow
*    Infections
*    Impotence in men

Managing diabetes
The aim of diabetes management is to maintain blood glucose levels as close to normal as possible (4-8mmol/L).

A good management plan is important. Your doctor, diabetes educator, dietitian and pharmacist will help you.
*    Regular testing of blood glucose levels at home can monitor diabetes control. There is a variety of blood glucose monitors available.
*    Home blood-ketone testing for type 1 diabetics during times of illness or stress can signal an impending ketoacidosis emergency. Blood testing is more accurate than urine testing.
*    Some medicines can affect control of blood glucose. Always check with a doctor or pharmacist before taking anything new.

Self care
*    Learn about diabetes and how to manage it.
*    Monitor blood-glucose levels regularly.
*    Follow your diet and medicine plan.
*    Eat regular, healthy meals.
*    Limit food high in fat or sugar.
*    Control weight.
*    Exercise regularly (at least 30 minutes on most days).
*    Limit alcohol intake.
*    Have blood pressure checked at each doctor’s visit.
*    Have regular long-term blood glucose, kidney, cholesterol and liver tests.
*    Always carry some jelly beans in case of hypoglycaemia.
*    Have feet examined regularly by a doctor or a podiatrist and wear shoes that fit well.
*    Have an eye examination every year.
*    Smokers should quit - ask a pharmacist.
*    Join Diabetes Australia for information and support.
*    Wear a MedicAlert bracelet.

Hypoglycaemia
People may experience hypoglycaemia if insulin or certain diabetes tablets cause the blood-glucose level to fall below about 3.5mmol/L. Symptoms include:
*    Sweating, chills
*    Shaking, weakness, dizziness
*    Racing heart
*    Tingling around the mouth
*    Hunger
*    Unusual behaviour (irritable, anxious, poor concentration)
*    Drowsiness.

If the blood glucose is low the patient needs to:
*    Take a ready source of glucose, e.g., fruit juice, jelly beans, honey
*    Eat a sandwich or dried fruit after the glucose
*    Check blood-glucose levels.
If the patient is unconscious do not give them anything by mouth. Turn them on their side and follow first-aid procedures. Get medical help.

Internet sites
International Diabetes Institute - www.diabetes.com.au

Diabetes Australia - www.diabetesaustralia.com.au (includes multilingual information)

Eyes on Diabetes - www.eyesondiabetes.org.au

Abbott Diabetes Care - www.medisense.com.au (information on blood-glucose meters).

Contact
A doctor - listed under ‘Medical Practitioners’ in the Yellow Pages.

Diabetes Australia - listed under ‘D’ in the White Pages.

A Self Care pharmacy - to locate telephone 1300 369 772 and ask for the Pharmacy Self Care Field Officer.

In case of poisoning, telephone the Poisons Information Centre on 131 126 from anywhere in Australia.

Pharmacists are medicines experts. Ask a pharmacist for advice when choosing a medicine.

The medical name for dry mouth is xerostomia and it is usually due to a reduction in saliva production.

Saliva
Saliva is the clear fluid secreted by the salivary glands of the mouth.

Saliva assists speech, taste and swallowing and prepares food for digestion. It washes away food and plaque from teeth, helps prevent tooth decay and protects against mouth and gum infections. Most healthy adults secrete about 1.5 litres of saliva per day. Saliva production commonly decreases with age, but it is also affected by illness and medicines.

Signs and Symptoms
Dry mouth has varying degrees of discomfort. Some people feel a dry or burning sensation in their mouth. Severe dry mouth may inhibit the ability to speak or swallow. Changes in saliva also can lead to deterioration of oral and dental health.

Other symptoms may include:
*  Cracked lips
*  Dry, tough tongue
*  Bleeding gums
*  Cavities
*  Thick, stringy saliva
*  Continual need for drinks
*  Sores and split skin at mouth corners
*  Bad breath
*  Difficulty speaking and swallowing
*  Burning or tingling tongue
*  Changes in taste
*  Increase in plaque and tooth decay
*  Mouth and gum infections - e.g. oral thrush
*  Dry and damaged mucosal lining inside the mouth.

Common causes of dry mouth include:
 *  Medicines - the most common cause of dry mouth. There are more than 400 commonly used drugs that can cause dry mouth - these include antidepressants, methadone, antihistamines, anti-inflammatories, analgesics, decongestants, diuretics, muscle relaxants, and medicines for Parkinson’s disease and urinary incontinence
*  Cancer chemotherapy
*  Radiotherapy - especially radiation to head and neck
*  Nerve damage to head and neck
*  Autoimmune disorders such as Sjogren’s syndrome, lupus and diabetes
*  Alzheimer’s disease
*  Stroke
*  Anxiety and depression
*  Dehydration - e.g. from fever, vomiting and diarrhoea, burns.

Other factors that may contribute to a dry mouth problem include:
*  Smoking - can reduce saliva production
*  Drinking alcohol
*  Snoring
*  Breathing through the mouth.

Management and treatment
Ideally the best way to treat dry mouth is to identify the underlying cause and take steps to minimise it. Unfortunately, for many causes, little can be done to correct it. But there are ways to help you feel more comfortable and have extra dental protection.

Dry mouth is a serious problem because it happens gradually and often goes unnoticed. Without the saliva’s natural protection, you could lose your oral health in a short time and hurt your ability to maintain necessary nutrition intake. As such the treatment for a dry mouth involves relieving symptoms, improving oral hygiene, preventing tooth decay and, if possible, increasing saliva flow.

A doctor or pharmacist can advise on the side effects of any medication you are taking.

A dentist can advise on oral hygiene and tooth and gum care and should be consulted regularly. It is best to brush with a soft brush and low-abrasive fluoride toothpaste and floss regularly. It will also be helpful to use a non-alcohol fluoride rinse and/or moisturising gel.

Saliva production may be increased by sucking on sugar-free hard candy or chewing sugar-free gum for dry-mouth sufferers. Sour flavours, especially, stimulate saliva flow.

Natural and artificial saliva sprays, mouth-wash solutions and gels are available from most pharmacies.
These preparations mimic natural saliva in content and action and can be used as a saliva substitute. They keep the mouth moist and are longer lasting than mouth rinses. They can be used ‘as often as needed’ and can be applied to dentures before insertion.

Self care
*  Stop smoking.
*  Limit alcohol and caffeine-containing drinks.
*  Protect lips with a moisturising lip balm or lubricant.
*  Sip water regularly throughout the day.
*  Suck on ice chips or sugar-free ice blocks.
*  Soft food may be easier to eat. Use gravies and sauces to make food easier to swallow. Pureed food may help.
*  Try smaller, more frequent meals.
*  Avoid salty, acidic or sugar-containing foods and drinks.
*  Mouth cleaning and care is vital. Use a soft toothbrush and a low-abrasive fluoride toothpaste.
*  Avoid toothpastes containing sodium lauryl sulphate.
*  Avoid mouthwashes and rinses containing alcohol or peroxide.
*  Breathe through nose, not mouth.
*  If air is dry, a humidifier or vaporiser may help, especially at night.

Contact
A doctor - listed under ‘Medical Practitioners’ in the yellow pages of the phone book.

A dentist - listed under ‘Dentists’ in the yellow pages of the phone book.

A Self Care pharmacy - to locate telephone 1300 369 772 and ask for the Pharmacy Self Care Field Officer.

In case of poisoning, phone the Poisons Information Centre on 131 126 from anywhere in Australia.

Pharmacists are medicines experts. Ask the pharmacist for advice when choosing a medicine.

Tinea is contagious, and is spread from person to person through skin-to-skin contact, or indirectly through towels, clothes and floors. It is also spread through animals such as cats, dogs, horses or cattle, or from soil, although this is rare.

Signs and symptoms

Warning
Some rashes look like tinea but are not. See a doctor if:
*       The rash is red, inflamed or starts to ooze, weep or smell
*        Nails become infected - look yellow, thick and crumbly
*        The rash does not get better with treatment
*        You also have diabetes or circulation problems
*        You are unsure if your rash is tinea
*        Hair is being lost from a tinea on the scalp.

A doctor may scrape some skin to check under a microscope. Do not put anything on the skin before the scraping is taken as this can make it hard for a doctor to find out what is causing the rash.

Tinea of the feet (athlete’s foot, tinea pedis)
*    Skin on feet appears soft and whitish, often with cracks and redness
*    Seen especially between the toes
*    Often itchy, and may burn and sting
*    May have an unpleasant smell
*    May have small fluid-filled blisters.

Tinea of the groin - jock itch
*    Itchy, red rash on the inner thighs, usually with scaly edges, clearing in the centre; sometimes occurs in the pubic area and between the buttocks
*    Small fluid filled blisters in rash area.

Tinea can also affect the other areas including the scalp, body and nails, particularly the toenails.
*   Slightly raised, itchy red patch on body, often round with a scaly edge and clearing centre
*    Small fluid-filled blisters in the patch
*    On the scalp, may appear as scaly patches with broken hairs.

Risks
Tinea is more likely to occur if you:
*    Live or work in hot, humid climates
*    Have diabetes
*    Have a health condition that affects your immune system or you are HIV positive
*    Work with animals
*    Are a child or spend time with children.

Tinea of the feet is more likely to occur if you;
*    Wear nylon or acrylic socks
*    Walk barefoot in public showers
*    Wear tightly fitting shoes or plastic or rubber shoes (gum boots/bushwalking shoes)
*    Have sweaty feet
*    Don’t wash and dry between your toes properly

Tinea of the feet can be picked up easily from infected scales of skin dropped on the floors of showers, change rooms and around swimming pools and spas.

Tinea of the groin is more likely if you:
*    Perspire a lot
*    Are overweight
*    Are male.

Medicines
*    Apply an antifungal product, as directed, and try not to miss any applications.
*    It usually takes 3-4 weeks of treatment to get rid of tinea. There is also a cream that may only require a week of treatment. Discuss which product is best for you with a pharmacist.
*    While the tinea may appear to clear up after a week or so, there may still be enough of the fungus in the skin for the tinea to come back. Continue to treat the area for two weeks after signs or symptoms of tinea have gone.
*    To help treat tinea pedis and prevent reinfection, dust lightly inside all shoes with anti-fungal powder. Ask a pharmacist.
*    You may need oral antifungal medicine if you have severe tinea or if your nails get infected. Ask a doctor.
*    Wash hands and scrub under nails thoroughly after treatments to stop infection spreading.

Self care*    Wash feet well every day. Gently rub the skin between the toes with a cotton bud to remove dead skin.
*    Use a separate, fresh towel to dry your feet and between your toes. Dry your feet last.
*    Go barefoot or wear sandals to air feet, especially in warm, humid weather.
*    Wear socks made of 100% cotton or wool — they soak up moisture. Change socks daily, or more regularly in hot weather.
*    Allow sweaty shoes to dry out before wearing again.
*    Clean the base of the shower or bath with bleach after use so you don’t reinfect yourself and others.
*    Wear sandals or thongs around the pool or in public showers.
*    Look at your feet every day and keep them clean and dry, especially between the toes.
*    Use an antiperspirant product if your feet sweat a lot. Products are also available to reduce chafing. Ask your pharmacist.
*    Do not borrow other people’s shoes.

Tinea of the feet

Tinea of the groin
*    Wear loose, cotton clothing - boxer shorts allow more airflow, and reduce chafing.
*    Dry skin carefully after showering.
*    Wash and dry skin after physical activity or if sweaty.

Contact
A doctor - listed under ‘medical practitioners’ in the yellow pages of the phone book

A Self Care pharmacist. To find: ph. (02) 6283 4777

In case of poisoning, phone the Poisons Information Centre on 131 126 from anywhere in Australia.

Pharmacists are medicines experts. Ask a pharmacist for advice when choosing a medicine.