Christmas means coping with the hangover from hell

Nagging about diet and exercise is all well and good but I do sometimes feel we doctors could give a little more useful advice from time to time. At this time of year an obvious theme jumps out at me: how to avoid hangovers.I hear so many myths circulating on this subject and most are complete nonsense. So whilst I cannot possibly condone heavy drinking, even to celebrate so auspicious an event as the arrival of the baby Jesus, I can at least advise you on how to get through your Christmas parties with the minimal of damage and pain afterwards.The first mistakes people make occur before they have even left the house. Number one error is not eating before a night on the booze. Drinking on an empty stomach can lead to a rate of absorption of alcohol that is similar to being given it via an IV drip. This leads to disaster very quickly, and while the liver is in overdrive dealing with the booze it is not able to metabolise glucose very well. This causes blood sugar levels to drop, causing shakes and sweats. The heart pumps harder as well, causing blood pressure to rise, thought to be the reason why some drinkers suffer heart attacks the next morning. Wolfing down a dodgy kebab on your way home is too little too late, and will probably only make your hangover nausea worse. The reason some people get completely sloshed very quickly and others take much longer is partly to do with food, but it’s also partly due to genetics. The quantity of stomach enzymes that break alcohol down differs: women get drunk more quickly than men because they have more fat, less muscle and fewer enzymes. The good news for women is that as they get older women almost catch up with men. Brains shrink a little with age too, making them less prone to headaches the morning after.Whilst out, be aware of the need to avoid dehydration. The kidneys will produce more urine than normal, in response to the diuretic properties of alcohol, and this will dehydrate and deplete the blood's levels of sodium, potassium, calcium and magnesium. Although your brain may seem to tell you otherwise the next morning, alcohol doesn’t actually dehydrate the brain; it causes it to swell, creating pressures on the surrounding membranes and causing the infamous headache. Avoid this by alternating one alcoholic drink with one soft drink, to keep up your hydration levels, and the advice of drinking a pint of water before you go to bed is sound, provided you are not so pissed that you pee yourself in the night.
Despite what you have heard, all alcohol is the same, whether you are drinking the finest champagne or the roughest of alcopops. All drinks contain ethanol which your liver and brain deal with it in exactly the same way whatever the source. It's a myth that mixing your drinks makes a hangover worse. Beer before wine, or wine before beer, both will make you feel rough if you drink enough of them. What does make a big difference is what is mixed with the alcohol. Different drinks will affect you in different ways, and at different times, so choosing what you drink will help you the next day. Generally speaking the browner the drink, the worse the hangover it causes. Rum, whiskey, brandy and port can all be cruel. Vodka is least likely to give you a hangover as it is repeatedly filtered to remove as many impurities as possible. Beer is probably the least dangerous to drink but it's the most calorie rich - one pint contains between 170 and 200 calories.Lastly, I should warn you that knocking back painkillers can be dangerous. Aspirin is popular but can irritate the stomach, and even causing bleeding with alcohol. Paracetamol, too, is not ideal as it can promote further liver damage when combined with alcohol –this makes it a popular although slow acting suicide choice. Taking some before you go to sleep will not help –their effects will have worn off in about 4 hours and probably long before you wake up.And for our herbal and ‘complementary’ friends researchers have reviewed all the available studies on hangover pills, such as yeast and artichoke extract and concluded that there is no compelling evidence of any effective treatment. The only proven cure is time, and getting it right the night before.

Warnings about iPods may fall on deaf ears

I come from a relatively small family but still find choosing Christmas presents one of the great headaches of the year.
Some small short-circuit occurs in my brain that prevents any form of sensible thought occurring any time I plan who should get what.
I thought I had it cracked this year, however. MP3 players are, according to consumer research, top of the list of most popular Christmas gifts. For Londoners, they provide some much-needed escape from the stress of Christmas shopping and the commute to work each day, so I thought I had my solution: iPods all round.
I'm sure even my mother would find some use for one, downloading Intermediate Spanish to practise on the bus, or listening to Eileen Atkins reading the latest Alan Bennett. But I've had to backtrack.
Increasingly shrill warnings are being issued by the various hearing protection organisations about how these gadgets, played at excessive volume, are setting us up for a future of hearing problems and deafness. Perhaps not the best present for a doctor to give after all —back to the drawing board.
Actually, come to think of it, I can't think of anything more irritating than sitting next to someone listening to their MP3 player too loudly. The tinny frenetic beat of their always utterly-unsuitable-for-the-time-of-day music is impossible to shut out.
It's the modern-day equivalent of the Chinese water torture. I have started asking people to turn theirs down.
But experts would say that I am doing these headbangers a favour. London commuters face the greatest risk of all as the noise on the Underground means that the devices have to be played at potentially damaging volume levels to be heard.
Hearing specialists are warning that for young people this is a huge problem and that prolonged listening could lead to permanent damage.
It's not an exaggeration. I have certainly seen an increase in young people coming to see me in clinic with ear problems, mainly tinnitus or dullness to their hearing, and on questioning they nearly all use MP3 players and go to concerts regularly.
Tinnitus can be an early sign of hearing damage due to noise, and occurs when the sensory hair cells in the cochlea are damaged by loud sounds. Some ear, nose and throat specialists explain the damaging effect of the noise exposure on the inner ear as being similar to the effect of a storm on a field of corn, flattening and damaging the stalks.
Proposals have been made to limit the maximum volume of a player to 100dB. As a rough guide to decibels, if you are listening to sound at 70dB it's possible to hold a conversation at normal volume; at 90dB one needs to talk loudly; at 100dB loud shouting is necessary, and from 105dB upwards it is no longer possible to hear speech at all.
Most MP3 players have a maximum volume of 125dB (equivalent to the sound of an aeroplane engine a few metres away, and more than 40dB more than generally permitted noise levels for a working environment), and according to a British study, 39 per cent of 18-24-year-olds listen to music for at least an hour a day at close to this upper volume limit.
This creates a serious danger of becoming deaf within about five years — and herein lies the problem. The damage can take a long time to show up and therefore is of no real concern to young people now.
One audiologist has even predicted that at current rates one third of young people using MP3 players today will need a hearing aid by the time they hit 50.

Sex and booze and the festive"spirit"

An advantage of the Virgin Birth was that it neatly bypassed the risk of catching STIs. Before you accuse me of blasphemy there were significant numbers of STIs around, even in Jesus’ day. Indeed his persecutor Herod was thought to have died of syphilis, a common disease of the time, his death following internal pains and burning sensations, swelling of the feet, convulsions, an ulcerated colon, putrefied and worm-eaten genitals, and very, very bad breath. Many biblical stories and particularly the list of rules offered in parts of the Old Testament merely give practical medical advice on how to stay fit and healthy during those times. Most is utterly outdated today of course but it’s interesting to read how circumcision, mandatory in biblical times, has now been shown to reduce infection rates of herpes, HPV and to a lesser extent HIV. As the world turns full circle and another Christmas approaches the threat of syphilis and other STIs remains ever present, but unfortunately for our STI and teen pregnancy stats virgin births seem few and far between. The NHS is launching a campaign warning Londoners about ‘Christmas Chlamydia’ as the party season approaches. This is inspired by research showing that a quarter of under 25 year olds admitted having unprotected sex during last year’s festive season, of which 60% were left unsure whether they had caught the sexually transmitted infection or not. The main culprit, of course, is alcohol. Sex and alcohol is a powerful combination that frequently leaves you with more than you bargained for. Alcohol based stats show that more than one in ten 18 – 34 year olds in London have had sex with someone they just met due to the influence of alcohol at a party over the festive season, more than one third admitted to having sex under the influence of alcohol that they wouldn’t have had if sober, nearly two in five have had sex that they regretted the morning after it happened and the majority have drunk to the point where they would describe themselves as ‘out of it’. Women are also more at risk of an unplanned pregnancy during Christmas and New Year than at any other time. Marie Stopes International is so aware of the problem that they have advised women to stock up on emergency contraception to cover this season. They have also put together festive family planning pack (containing two condoms, two luminous spikeys [to stop people spiking your drink], the Emergency Contraception pill Levonelle 1500, a pocket sized Christmas sexual health guide and even a festive chocolate) priced at £15 in an effort to reduce the incidence of unwanted pregnancies and infections. The excess of alcohol and the general over-excited atmosphere of the dreaded office party lead to fewer inhibitions and more casual hook ups, again upheld by the stats which reveal that almost one third of those surveyed claimed to have had sex with a colleague either during or after an office party. This then makes less surprising the news that in January and February of 2007, more women than ever before in MSI’s thirty year history, attended its nine UK centers for abortion services and official statistics show that the first quarter of every year always produces the highest numbers of women having abortions.But there is a darker side. Along with the increased alcohol and reduced inhibitions comes increased vulnerability. Sexual consent can be a confusing subject at the best of times. Add in buckets of alcohol and the pent up frustration of the past year spent flirting at the photocopier and things can get badly out of hand. But to the police there are no grey areas with regards to sex without consent: if there is doubt, it’s treated as rape.
If you have had unprotected sex over the festive period, a test for sexually transmitted infections is advisable, even if you don’t have symptoms, and if you are a woman and don’t want to be pregnant, visit your local pharmacy, doctor’s surgery or sexual health clinic for emergency contraception as soon after the unprotected sex as possible. All this can be avoided, however, by making sure you carry condoms with you; in AD2009 this is no longer seen as meretricious.

Doctors must stop refusing to confront Aids

Yesterday was World Aids Day. It's a hugely important event given that there are more than 33 million people living with HIV worldwide and it is the number one killer of women aged 15-44. It matters.
New research offers some hope that the number of new Aids cases is decreasing but fear and misunderstanding of HIV are still, even in 2009, hindering the introduction and implementation of more improvements.
HIV prevention programmes are having an impact but as in so many areas of sexual medicine shame, embarrassment and ignorance are our greatest opponents. And then comes stigma and taboo, which are still rampant.
As long as discrimination exists, people will be much less willing to get tested. My faith in human nature is sorely tested when I hear, even today, people stating that HIV and Aids is revenge from God for promiscuity.
Continental Europe is streets ahead of us, promoting greater openness and understanding in dealing with sexuality, including teen sexuality.
This has created wider and easier access to sexual health information and services for people of all ages.
Most important for me is that in Europe political and religious interest groups have little influence on public health policy.
This means that the stigma of sexually transmitted infections (STIs) is just not there - going for a check-up is seen as being cool and responsible.
How have they achieved all this? For a start, doctors make STI screening and HIV testing part of normal GP practice.
Ours, in many cases, do not. Ignorance and stigma apply not just to the public's attitude but also, I'm ashamed to say, to my colleagues too.
Many UK doctors still view HIV/Aids as a specialist subject and one that they do not feel confident or willing to get involved with.
HIV is now so prevalent, especially in a large city such as London, that it must now been seen as part of normal, everyday general medicine.
While I agree that the management of HIV-positive patients does indeed require expert care, basic advice and, in particular testing, does not. Any doctor should be able to do it.
There are still far too many GPs who refuse to do HIV tests and send their patients to GUM (genito-urinary medicine) clinics instead.
This sort of insensitive handling only adds to the stigma, and decreases the public's willingness to be tested.
It can take a lot of courage for some people to seek help and one callous comment - even if unintentional - from a stressed doctor can do untold damage.
GPs do an incredible job (for little thanks and many complaints) and are probably in the best possible position to make a difference.
All too often many of us allow personal prejudice, religious beliefs or even academic ambitions to affect the way we practice.
This must stop if doctors are ever going to improve medicine and come crawling from the 20th century into the 21st.
We alienate ourselves at the expense of our patient's health and I am sorry to say that I suspect we may compound the problem of worsening STI and HIV figures in many cases, instead of helping to lower them.