The classification of obesity (in adults) is usually based on the measurement of body mass index (BMI).
BMI = weight (KG) divided by height (M) squared.
< 20 = underweight
>20-25 =  healthy weight
>25-30 =  overweight
> 30 = obese

Obesity and being overweight are the most common nutritional problems in the developed world and are increasing. More the half the Irish population are now either overweight or obese.

Human beings abide by the laws of conservation of mass and energy, and when energy intake and energy expenditure are equal, body weight is maintained. Excess intake over expenditure results in weight gain, so either or both must be altered in order to address any imbalance.

The consequences of obesity include increased risk of coronary heart disease, stroke, hypertension, non-insulin dependent diabetes, arthritis and back pain, breathlessness and respiratory disease.

The management of obesity is complex involving not just dietary and exercise advice but also cognitive and behavioural techniques are important too. Realistic goals must be set. Obese patients may aim to lose 1 KG per week, reducing calorie intake by 1000 kcal a day, below normal, should achieve this level of weight loss. Keeping a balanced diet is important, so aim to reduce fat intake, consume low calorie nutrient dense foods (e.g. fruits and vegetables), increase fibre rich foods contributes to satiety and helps prevent constipation, increase consumption of low calorie drinks. Increased exercise is a useful part of any weight management plan. If you have not exercised for some time or have any illness the level of increased activity should be discussed with your doctor.

Cognitive therapy involves recognising the reasons for the eating patterns that have led to weight gain. Binge eating after alcohol consumption for example can add significantly to calorie intake. It is helpful to understand possible reasons for weight gain before embarking on a weight loss programme.

Healthy eating and a gradual increase in daily activity will help to create the right balance between energy intake and energy expenditure.

John Duffy M.P.S.I.

What are leg cramps?
Leg cramps are common. The cause is not known in most cases. However, some drugs and diseases sometimes cause leg cramps. Regular calf stretching exercises may prevent leg cramps. Quinine tablets may be advised as a last resort if you have cramps regularly.
A leg cramp is a pain that comes from a leg muscle. It is due to a muscle spasm which is when a muscle contracts too hard. It usually occurs in a calf muscle, below and behind a knee. The small muscles of the feet are sometimes affected.

A cramp pain typically lasts a few minutes. In some cases it lasts just seconds, but in some cases it lasts up to 10 minutes. The severity of the pain varies. The muscle may remain tender for up to 24 hours after a leg cramp. Leg cramps usually occur when you are resting – most commonly at night when in bed. (They are often called night cramps.) They may wake you. It can become a distressing condition if your sleep is regularly disturbed.

Who gets leg cramps?

Many people have an occasional leg cramp. However, they occur frequently in some people. They are more common in older people. About 1 in 3 people over the age of 60, and about half of people over the age of 80, have regular leg cramps. About 4 in 10 people who have leg cramps have at least three per week. They occur every day in some people.

What causes leg cramps?

Unknown cause (idiopathic leg cramps)
In most cases the cause is not known. One theory is that cramps occur when a muscle that is already in a shortened position is stimulated to contract. As the muscle is already shortened, to contract further may cause the muscle to go into spasm. This commonly happens at night in bed as the natural position we lie in is with the knees slightly bent (flexed), and with feet pointing slightly downwards. In this position the calf muscle is relatively shortened and may be prone to cramps. This theory explains why stretching exercises may cure the problem.

Secondary causes
In some cases, the cramps may be a symptom of another condition or problem. For example:

• Some drugs can cause cramps as a side-effect, or make cramps occur more often. These include: diuretics (‘water tablets’), nifedipine, cimetidine, salbutamol, statins, terbutaline, lithium, clofibrate, penicillamine, phenothiazines, and nicotinic acid.
• Over-exertion of muscles.
• Dehydration.
• Conditions that cause alterations in the balance of salts in the bloodstream (such as a high or low sodium or potassium level).
• Some people who have renal (kidney) dialysis get leg cramps.
• Pregnancy – usually in the later stages.
• An untreated under-active thyroid gland.
• Peripheral vascular disease (narrowing of the leg arteries which causes poor circulation).
• Excess alcohol.
• Some uncommon disorders of nerves.
• Rare causes include: cirrhosis of the liver; lead poisoning; sarcoidosis.

With the above conditions the cramps would just be one of various other symptoms. Therefore, if you are otherwise well, and have no other unexplained symptoms, then the leg cramps are likely to be idiopathic (unknown cause) and not due to a secondary cause.

Note: leg cramps are different to a condition called restless legs syndrome. In this condition the legs can be uncomfortable, you feel creeping sensations in the legs, and it is relieved by walking about.

What is the treatment for a leg cramp?

Stretching and massaging the affected muscle can usually relieve an attack of cramp. Most cramps soon ease off. Painkillers are not usually helpful as they do not act quickly enough. However, a painkiller such as paracetamol may help to ease muscle discomfort and tenderness that sometimes persists for up to 24 hours after a cramp has gone.

What are the options for preventing leg cramps?

If cramps do not occur often, then no particular treatment is usually needed. However, if you have frequent cramps, you may wish to consider ways of preventing them.

Consider your medication (where appropriate) or other conditions
Tell your doctor if you take any of the drugs listed earlier. It may be causing the leg cramps, or making them recur more often. Alternative drugs may be available. Also, if you have other symptoms apart from cramps, see your doctor who may examine you or do some checks to rule out a secondary cause for the cramps.

Stretching exercises
Stretching exercises are commonly advised. However, there is a lack of good research evidence to prove that they work. One research study concluded that stretching exercises did reduce the number and severity of cramps, but another study did not confirm this. However, many doctors feel that regular calf stretching does help. So, as it may help, it is worth trying if you are able to do the exercises. If it works, you will not need any tablets to prevent the cramps.

At first, do stretching exercises of affected muscles for about five minutes, three times a day. Do the last exercise shortly before bedtime. If the cramps ease off, you may then only need to do the exercise once or twice a day to keep the cramps away.

To stretch calf muscles, stand about 60-90 cm from a wall. Then, keeping the soles of your feet flat on the floor, bend forward and lean on the wall. You will feel your calf muscles stretch. Do this several times, each time for as long as you can manage. It may take a week or so of exercises before you notice an improvement. So, it is worth giving yourself a 2-4 week trial of regular calf stretching exercises to see if your cramps ease off. The cramps may not go completely, but their frequency and/or severity may reduce.

Posture of the legs when resting in bed
Positions which prevent the calf muscle from shortening when you are asleep may help. The following are not proven treatments (from research studies), but some experts believe that they help to prevent cramps.

• Using a pillow to prop the feet up in bed while sleeping on your back.
• Hanging the feet over the end of the bed while sleeping on your front.
• Keeping blankets loose at the foot of the bed to prevent toes and feet from pointing downwards during sleep.

Quinine is used as a last resort – and you need to be aware of the risks
If you take quinine you have a good chance of reducing the number and/or severity of leg cramps, but it may not stop them altogether. One tablet at bedtime is the normal dose. Most people can take quinine, but do not take it if you are pregnant or may become pregnant. There are also some rare conditions where you should not take quinine. These include: a previous reaction to quinine; a previous haemolytic anaemia; optic neuritis; glucose 6- phosphate dehydrogenase deficiency.

Side-effects are uncommon at the low dose used to treat leg cramps. However, serious side-effects do sometimes occur. For example, a serious blood disorder which is potentially fatal is a known rare side-effect. Also, a small number of people who take quinine long-term develop a condition called cinchonism (a complex of nausea, vomiting, dizziness, visual disturbance, and hearing impairment). Read the drug packet leaflet for a full list of possible side-effects. Note: quinine is dangerous in overdose, particularly in children. Keep tablets away from children.

Therefore, quinine is only used as a ‘last resort’ when other treatments have not worked, and leg cramps are frequent and are affecting your quality of life.

When quinine is first prescribed it may be done on a trail basis for 4–6 weeks you should be aware of the small risk of serious side effects. Also, it is best to objectively assess how well the quinine works. For example, by keeping a sleep and cramp diary. Ideally, this should be for a few weeks before and after the start of treatment so as to gauge its effect. If quinine is found to help then you may be advised to continue with it for a few months. You should consider stopping quinine every three months or so to see if it is still needed. This is because in some people the cramps go away and so the treatment may no longer be needed. If the cramps return, you can always re-start the tablets.

Other treatments
Other drugs have been suggested as possible treatments for leg cramps. These include: magnesium, diltiazem, vitamin B complex, vitamin E, naftidrofuryl, orphenadrine, and verapamil. In general, these are not currently recommended as most studies involving them found that they do not work very well in most people. Quinine remains the main treatment. However, your doctor may suggest a trial of one of these drugs if quinine has not worked or has caused troublesome side-effects.

Head Lice:
Infestation with head lice is common and affects schoolchildren usually at ages 5 to 11 years. Girls are more likely to be affected than boys. Transmission is by head to head contact, as the lice cannot fly or jump but can crawl quickly. Sharing of personal items such as brushes, combs or hats can possibly spread the head louse. Shaven heads and hair gels act as a physical deterrent. Itching is the most common symptom, the louse feeds by sucking blood and injecting saliva, thus causing an itch. The head louse is a pale reddish-brown insect; most infestations consist of less than 10 lice. A fine-toothed comb should be used to aid detection of live lice. Special attention should be paid to the area near the ears and nape of the neck where most of the eggs are laid.

Treatment:
It is appropriate to start treatment as soon as possible after the diagnosis has been made. There are two basic treatment options for which there is some scientific evidence of efficacy: (1) topical insecticides, e.g. Malathion, permethrin and phenothrin, and (2) wet combing. Herbal products containing tea tree oil, battery powered combs and other shampoos are also used to help treat and prevent infestation.

Wet combing used in addition to insecticides provides the best attack on an infestation. The rationale behind wet combing is that lice do not move to another host within 7 days of hatching and do not reproduce within 10 days of hatching. Therefore, if all young lice are combed out within a few days the infestation can be eradicated. It is done with wet hair and added lubricant (e.g. hair conditioner) and continued until no lice are found. Combing is repeated every three days and should be continued for two weeks after initial infestation is detected.

John Duffy MPSI. Claregalway pharmacy. 091-799754
Open late Monday to Friday 9am to 8pm.Sat.9am to 7pm.

Eat plenty of starchy foods (complex carbohydrates)
The main part of most meals should be starchy foods such as bread, cereals, potatoes, rice, and pasta, together with fruit and vegetables. Some people wrongly think that starchy foods are ‘fattening’. In fact, they contain about half the calories than the same weight of fat.

Eat at least five portions of a variety of fruit and vegetables each day
One portion is: one large fruit such as an apple, pear, banana, orange, or a large slice of melon or pineapple, or two smaller fruits such as plums, satsumas, etc., or one cup of small fruits such as grapes, strawberries, raspberries, cherries, etc, or two large tablespoons of fruit salad, stewed or canned fruit, or one tablespoon of dried fruit, or one glass of fresh fruit juice (150ml),
or a normal portion of any vegetable (about two tablespoons), or one dessert bowl of salad.

Eat protein foods in moderation
Meat, fish, nuts, pulses, chicken, and similar foods are high in protein. You need some protein to keep healthy. However, most people eat more protein than is needed. Choose poultry such as
chicken, or lean meat. Oily fish is thought to help protect against heart disease. For example, herring, sardines, mackerel, salmon, kippers, pilchards, and fresh tuna (not tinned tuna). Aim to eat at least two portions of fish per week, at least one of which should be oily.

Don’t eat too much fat
Try not to fry much food. It is better to grill, bake, poach, barbecue, or boil food. If you do fry, use unsaturated oil such as corn, sunflower or  olive oil. Drain off the oil before eating.Choose lean cuts of meat, and cut off any excess fat.Try not to add unnecessary fat to food. For example, use low fat spreads, spread less butter or margarine on bread, measure out small portions of oil for cooking, etc. Watch out for hidden fats that are in pastries, chocolate, cakes, and biscuits. Have low-fat milk, cheeses, yoghurts, and other dairy foods rather than full-fat varieties. Avoid cream. Use low fat salad cream, or low-fat yoghurt as a cream substitute.

Don’t have too many sugary foods and drinks
These are high in calories, and too much may cause weight gain (and they are bad for your teeth).

Try not to eat too much salt
Use small amounts of salt with cooking, and don’t add more salt at the table.

Don’t drink too much alcohol
A small amount of alcohol (1-2 units per day) may help to protect you from heart disease. One unit is about half a pint of normal strength beer, or two thirds of a glass of wine, or one pub measure of spirits. However, too much can be harmful. Men should drink no more than 21 units per week (and no more than four units in any one day). Women should drink no more than 14 units per week (and no more than three units in any one day).

Chickenpox mainly affects children; more than 90% of people have had it by the age of 15. Most children catch chickenpox in pre-school or early school years, there are outbreaks most years especially in winter and early spring. Once the symptoms have cleared up, the virus remains in the body and is kept at bay by the immune system. At any time later in life the virus can be reactivated, causing shingles. You can’t get shingles from someone that has chickenpox.

Symptoms of chickenpox can include headache, fever, sore throat, backache and a general feeling of being unwell, this is normally the pre-rash phase, then small itchy reddish spots form on the skin surface, normally on the face and scalp first and then spread to the chest, arms and legs. The time from catching the virus to the rash forming is known as the incubation period, it usually takes between 5 and 20 days. The spots go on to form raised papules and can develop into small blisters called vesicles. These then form into pustules which crust over and heal, usually taking a little over 2 weeks.

The spots are usually very itchy. Generally the illness is milder in children than adults. The virus is spread by direct contact with a person who has broken chickenpox blisters, indirect contact with clothes etc. which are infected with fluid leaks from the vesicles, saliva or nasal discharge, and small airborne droplets of infected mucus or fluid. People incubating chickenpox are not infectious immediately and only become so from about 2 days before the rash appears until five days later.

Treatments include eurax or calamine lotion or cream to relieve the itch, antihistamine tablets or liquid help to reduce the skin reaction caused by the virus, paracetamol for fever and headache and sometimes for at-risk groups, antiviral drugs, like acyclovir, are used.

John Duffy MPSI. Claregalway Pharmacy. 091 799 754.