Sore Throats

Most likely you have an uncomplicated throat infection which can be very sore but hardly ever leads onto anything more serious.  Your body will normally fight the infection effectively and heal itself in the very great majority of cases over the next 4 to 7 days.

9 in 10 sore throats nowadays are caused by viruses which we cannot treat effectively .

Antibiotics do not kill viruses (only bacteria) and that's why sore throats are not usually helped by taking antibiotics.

Antibiotics also can have side effects.  These are usually mild (allergy, skin rashes and diarrhoea). Occasionally the side effects can be severe. (For women on the oral contraceptive pill they will also reduce the effectiveness of the pill)

Thus, unless there is an additional specific reason, antibiotics are often not recommended for most sore throats since they may do more harm than good.

Management of your sore throat

If your throat is hurting you should gargle with soluble aspirin every 4 hours and then swallow it. Alternatively or additionally you can gargle (but not swallow) diluted TCP. Children under 16 can take paracetamol and suck soothing throat pastilles.

Please take up to the maximum dose recommended on the packet.  This will help keep your throat more comfortable.  If at work and you feel very unwell, you may need to take some time of work until you feel able to work again.  You can ‘self certificate’ for up to 7 days.

However if in 3-4 days things are not improving or are much worse particularly if you have persistent fever please make an appointment to see a doctor.  

Flu and 'Chesty Coughs'

What causes flu and coughs?

Almost all coughs of all degree in children and adults are caused by virus infection. There are many different viruses that can infect the nose and throat. Coughing and sneezing the virus into the air pass them on. An average primary school child has 6 to 8 coughs or colds per year. A child may have several coughs or colds one after the other, particularly during winter. A child who lives with smokers has an increased risk of developing coughs and colds.

What are the symptoms of coughs and colds?

The common symptoms are a cough and a runny/stuffy nose. The cough is often worse at night. Coughing does not damage the lungs. A coughing child will not choke or stop breathing however bad it sounds.  In addition adults and children may have: a raised temperature (fever), a sore throat, headache, tiredness, and be off their food. Sometimes children will vomit after a bout of coughing. 

What are the treatments for coughs?

There is no magic cure for the majority of coughs, however bad they sound.! The symptoms tend to be worse in the first 4-5 days, and then usually ease gradually over the next few days.  In general I find a most coughs have 4 phases

1.     1st week feeling unwell plus cough

2.     2^nd week feel better but still coughing a lot

3.     3^rd week of gradually declining cough

4.     child catches another cold and the cycle repeats!!

An irritating cough may linger for up to 2-4 weeks after other symptoms have gone. Antibiotics do not kill viruses, so are of no use for common coughs and colds. Treatment aims simply to ease symptoms until they go. The most useful treatments are:

·       Give yourself (or your child) plenty to drink.

·       Give paracetamol (Calpol, Disprol, Tixymol, etc)

to ease aches and pains, headaches, and fever. Ibuprofen is a useful alternative.  You can also buy various other 'cold remedies' and 'cough mixtures' from pharmacies. There is little evidence that they do much good, but some people do find them useful.

See below for a natural soothing honey and lemon drink.

Note : Some contain paracetamol, so be careful not to give more than the maximum dose of paracetamol if you are already giving yourself/your child paracetamol in a different form.

Another useful treatment for a bunged-up nose in a baby is to put a few drops of saline (salt water) into the nose just before feeds. This helps to clear the nose to make feeding easier. You can buy saline drops from pharmacies.

What symptoms should I look out for?

Most coughs and colds get better without complications after 1 to 2 weeks. Sometimes a more serious 'secondary' bacterial infection develops subsequent to the initial virus infection. For example, an ear infection, chest infection, etc. Symptoms to look out for include: wheeziness, persistent earache, faster breathing, difficulty breathing, persistent high temperatures, drowsiness, chest pains.

See the doctor if symptoms become worse or you have a concern about your child. They may not be able to prescribe anything more effective for a common cough or cold, but a further check-over can be reassuring.

Sickness and Diarrhoea (Gastroenteritis) in Children

What is gastroenteritis?

Gastroenteritis is an infection of the guts (intestines). Many bacteria, viruses, and other microbes (bugs) can cause gastroenteritis. It can range from a mild stomach upset for a day or two with some mild diarrhoea, to severe vomiting and diarrhoea for several days or longer.

What are the symptoms of gastroenteritis?

The main symptom is diarrhoea, often with vomiting as well.  Crampy pains in the abdomen (tummy) are common. Pains may ease for a while each time some diarrhoea is passed.  High temperatures (fever) and headaches are common.

If vomiting does occur, it typically lasts 24 –48 hours. Diarrhoea often lasts for several days or more after the vomiting stops. Loose stools (motions or faeces) can persist for a week or so before a normal pattern returns. Sometimes the symptoms last longer.

What causes gastroenteritis?

A virus is a common cause in the UK. Sometimes it is just 'one of those bugs going about'. Viruses are easily spread from one person to another by close contact, or when an infected person prepares food for others.

Sometimes it is caused from infected food (food poisoning). There are many types of bacteria that can cause food poisoning. For example, campylobacter and salmonella.   Water contaminated by bacteria or other 'bugs' is a common cause, particularly in countries with poor sanitation.

Can gastroenteritis be prevented?

Good hygiene helps to prevent gastroenteritis. Always wash your hands, and teach children to wash theirs:

·       After going to the toilet (and after changing nappies).

·       Before touching food.

·       After gardening.

·       After playing with pets (healthy animals can carry certain harmful bacteria).

·       Between handling raw meat and food ready to be eaten. (There may be some bacteria on raw meat.)

If a child has gastroenteritis, they should stay off school, nursery, etc until symptoms have gone.

What is the treatment for gastroenteritis in children?   Symptoms often settle within a week or so as the immune system usually clears the infection. The following are commonly advised until symptoms ease.

Give the child lots to drink. The aim is to avoid dehydration (low body fluid). Even if the child vomits or feels sick, you should still give frequent sips as some fluid will still be absorbed. Ideally, give water as the main drink, but also give some fruit juice as this contains some sugar. However, any drink is better than none. If the child will only drink their favourite drink then that is fine. Ice-lollies are another useful extra source of fluid.

Rehydration drinks may be advised by a doctor or nurse if they are concerned that the child is at risk of dehydration (eg dioralyte). You can give these instead of, or in addition to, normal drinks. Rehydration drinks are made from sachets that you can buy from pharmacies. You add the contents of the sachet to water. Rehydration drinks provide a perfect balance of water, salt, and sugar. They are better than just drinking water alone. The small amount of sugar and salt helps the water to be absorbed better from the gut into the body. They do not stop or reduce diarrhoea, but are the best drinks to prevent or treat dehydration.

A sugar containing cola diluted to ‘half strength’ with water can be a useful ‘rehydration drink’ for children over 1 year old. (ie not diet coke). Another useful alternative nowadays is SPORT Lucozade.

The child can eat as normally as possible. There is no need to 'starve' a child with gastroenteritis. This used to be advised but is now known to be unhelpful. However, if he or she does not want to eat, then that is fine.  Drinks are the most important need and food can wait until their appetite returns. A useful ‘rule of thumb’ is to not offer food until 4-6 hours after the child last vomits. Offer some food every now and then. Soups and food high in carbohydrate such as bread, pasta, rice and potatoes are best to start with.

Do keep feeding babies

Breast fed babies should continue to breast feed if they will take it. This is in addition to extra rehydration drinks which may be advised. Bottle fed babies should be fed with their normal full strength feeds if they will take it. Again, this is in addition to extra rehydration drinks which may be advised.
 

Do not give medicines to stop diarrhoea to young children except on the advice of a doctor. 

Give paracetamol or ibuprofen to ease a high temperature or headache.

If symptoms are severe, or persist more than 4-5 days, a doctor may ask for a sample of the diarrhoea. This is sent to the lab to look for infecting bugs (bacteria, parasites, etc). Occasionally an antibiotic or other treatments are needed.

Are there any complications from gastroenteritis?

Complications are very uncommon in the UK. See a doctor if any of the following develop, or if other symptoms occur that you are concerned about.

·       Dehydration. Symptoms include: passing little urine, a dry mouth and tongue, drowsiness.

·       Blood in the diarrhoea.

·       Vomiting for more than 1 day, or diarrhoea that does not start to settle after 4-  5 days.

·       Pains that are getting worse.

·       Drowsiness or confusion.

·       Infections caught abroad.

Admission to hospital is sometimes needed if symptoms are severe, or if complications develop.

Toothache or other problems with your teeth?

You need to see a dentist. Doctors do not have dental training.

This is what doctors can and cannot do.

We can:

• Advise when you should see a dentist rather than a doctor.
• Provide Pain relief but not specific treatments.
• Inform you of the Primary Care Trust (PCT) dental helpline number to enquire about availability of a dentist:  The Surrey Dental Helpline : Tel’:   0845 271 2040

Your dentist should make day time and out of hours arrangements for emergencies and your dental practice should be phoned first.

Alternatively please contact

The Woking Dental Access Centre on 01483 721546.

This is an NHS centre for urgent dental problems based at WokingCommunityHospital, Heathside Road, Woking, Surrey, GU22 7HS

or

The Epsom Clinic, Dental Access Centre.

Church Street , Epsom, Surrey, KT17 4PH.  Telephone: 0845 2712040 or 01372 745349

or

The Guildford Dental Access Centre, Buryfields Dental Clinic ,61 Buryfields, Guildford, Surrey, GU2 4AX. Telephone: 01483 783378

In an emergency, if you have not been able to contact a dentist, we can prescribe medication for the short-term relief of pain only.  This will only be to last until such time as you are able to see a dentist We will NOT normally prescribe antibiotics without prior dental assessment.

You should not delay seeking help from a dentist as the problem may get worse and you may risk losing teeth as a result.

We cannot:
• Make decisions about what treatment is needed for dental conditions.

• Provide specific treatment for dental conditions except appropriate pain relief.  This applies both to operative treatment (fillings, extractions and other operations) and prescribing drugs such as antibiotics when the need is dental.

• These are things we are not trained, qualified or otherwise equipped to do.
• Dentistry does not feature in doctors’ training. Other than a small number of specialists, it is rare for a doctor to also hold a qualification in dentistry.
• Dentistry is also protected by law. It is an offence under the 1984 Dentists Act for anyone other than a qualified dentist to provide dental services.
• Only registered dental (not medical) practitioners are allowed to practise dentistry.

Please also note:

• Dentists can prescribe drugs needed in the treatment of dental problems.

• This includes antibiotics when necessary, and pain relief.

• The responsibility for such prescriptions rests with the dentist who initiated the treatment.

• If you have private dental treatment, you will have to pay privately for any prescription drugs that may be required as part of your dental treatment.

• You should inform your dentist if you are taking any medicines prescribed by your doctor.

• You should inform your doctor if you are taking any medicines prescribed by your dentist.

There are reports of shortages of dentists in many parts of the country. We are very sorry if this is causing a problem for you, but it does not suddenly mean that your doctor is adequately equipped and able to diagnose and treat dental problems.  This could potentially be dangerous and could be an offence.