Heath: your questions answered

Q: I have been enjoying the lovely autumnal weather as I suffer very badly from Sad (Seasonal affective disorder). I have had no help from my GP and when I insisted on referral, I was sent to a psychiatrist who gave me short shrift and no solutions. Can you be more helpful?

A: Your GP and psychiatrist share their scepticism with the World Health Organisation which doesn't recognise Sad as a condition. To be officially Sad, you have to be bad in winter, so-so in autumn and better in summer. If not, you're depressed - not Sad. You also need to improve when exposed to bright light treatment, contained in a privately marketed light box and not available in most NHS psychiatry departments. You also need to be not just a bit sluggish, but show signs of a psychiatric disorder that stops you functioning normally.

Many Sad sufferers lose their symptoms after a few years and, although it stops some people functioning well at work, it rarely causes extreme reactions or suicide. Evidence for light-box effectiveness is not very convincing. I'm probably not being very helpful either, although I do feel sympathetic. It looks as though there is no good solution yet to being Sad in winter other than sitting it out and waiting for spring.

Q: I suffer from painful and ugly spots in my beard area. I have tried growing a beard which disguised the spots to an extent but made me feel itchy and uncomfortable. I must have been given every antibiotic under the sun, yet nothing has worked. Can you suggest anything?

A: You've got bugs in your hair follicles (folliculitis). It glories in the name sycosis barbae and can certainly send both you and your barber psychotic. Bacteria called Staph. aureus that live on the skin, up your nose and round your bottom get into the skin openings through which hairs emerge. You need to use courses of both antibiotic cream (eg Bactroban) and oral antibiotics (eg Erythromycin) in tandem for about three months. Folliculitis can affect any hair-bearing part of the body.

Q: I thought that the BCG vaccination I had in my early teens gave me lifelong protection from tuberculosis, but someone told me that I am more likely to catch it now. I've heard that the disease has reappeared in England and am concerned I may be at risk. Is this right - and if so, what should I do about it?

A: TB incidence reached its lowest level in England and Wales in 1987 and there has been an increase in reported rates since then. You still have a less than one in 10,000 chance of catching it in this country. The risk is highest in inner-city areas and among people who have come from countries where TB rates are high. Anyone with a cough lasting more than three weeks, fever, night sweats and weight loss should ask their GP for tests including a chest X-ray or sputum examination. The BCG usually protects for life against the most serious forms of TB, though not always against the commonest type which affects the lungs. BCG boosters are not recommended. You are less at risk than if you have never had a BCG. Trials on a new jab are starting in Oxford so a more effective alternative to BCG may emerge. Another reader has asked whether, having had TB as a child, he was now immune for ever. Unfortunately, he is not.

Thanks to guardian.co.uk who have provided this article. View the original here.


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