Most   ankle injuries are soft tissue damage diagnosed at clinical examination.

X-Ray / Ultrasound/MRI   are only required if a fracture joint disruption or arthritis is suspected.

Initial treatment – usually for the first 8 hours

R est

I ce  – icepacks (wrap in cloth) 20 minutes 2 hourly during waking hours

C ompression firmly bandage the injured part

E legate the injured part

Avoid the following HARM in the first few days after injury

No Heat, No Alcohol, No Running No Massage

Reported pharmacological interactions of common herbal preparations with prescription medication from Medical Journal of Australia Feb 2017

St John’s Wort

• interferes with cyclosporine used to maintain transplants leading to rejection
• causes intermenstrual bleeding  for women using the oral contraceptive
• reduces effectiveness of warfarin
• reduces bioavailability of theophylline , amitriptyline,, methadone, digoxin
• potentiates side effects of tricyclic and SSRI antidepressants

Asian Ginseng

• reduces effectiveness of immunosuppressive drugs
• increases effects of oral hypoglycaemic ( diabetes ) drugs
• increases side effects of MAOI antidepressants
• has accumulative effect on benzodiazepines ( Valium, Serepax)

Garlic

• increases liver toxicity of paracetamol
• increases effects of oral hypoglycaemic ( diabetes ) drugs
• increases incidence of bleeding in users of anticoagulant medication

Evening Primrose  Oil

• lowers the seizure threshold  for  epileptics
• interferes with the action of  some anticonvulsants  including phenytoin ( Dilantin)

Dong Quai

• potentiates   warfarin

Dry mouth may present  as  mucous  surface  discomfort in the mouth  , burning sensation or pain on the lips  or mouth, “ bad “ taste , halitosis, denture discomfort and  eating  discomfort.

Sufferers may have  a higher  risk of dental caries , dental erosion oral infection and  loss of teeth. Causes can be  medication side effects form including  some  prescription medications, anti- cholinergics , antihistamines and  sedatives . Age , diabetes  and  underlying auto immune  diseases may also be a cause of dry mouth.

Treatment is  to review for  underlying  dental disease , illness and  medication side effects. Adequate  hydration.. Regular  and  frequent  oral  hygiene  including  brushing  /flossing / interdental brushing.

Encourage   sugar free  chewing (eg  chewing gum)  between meals , artificial saliva lubricants.

Scientific  studies  over 7 years  extending from pre – menopause to  4  years  post  menopause  confirm the  tendency to modest  weight gain in association with   hormonal  changes..  Subsequent trials  have demonstrated  that   modest  lifestyle  intervention can   contain  or   reduce the  weight gain to a minimum  over  5  year trials post onset of menopause. This could be achieved by maintaining a diet of 1300 kcal/day and an increase in energy expenditure 1000-1500 kcal/week more than their usual energy expenditure. Diets with an emphasis on increased protein and   lower carbohydrate and fats were useful.

Women who were already overweight prior to menopause were more likely to have menopausal weight gain.

A common  recessively inherited   blood disorder resulting  in excess  iron in the  body due to increased  absorbtion from the  intestine. An incidence of about  1 in 200.

May be  manifested   by the  following  symptoms –

• Fatigue and lethargy
• Cirrhosis of liver
• Liver cancer
• Arthritis
• Skin pigmentation
• Cardiomyopathy
• Testicular failure
• Diabetes mellitus

Diagnosis  is usually  by a  combination of  blood film  , iron studies and  gene testing.

Treatment  is  usually by venesection  – draining  off  excess blood