OTC Patient Advice

Sleep and Relaxation Techniques

"Fall asleep in 60 seconds. Breathing technique based on pranayam, an ancient Indian practice Uses the ratio 4-7-8. First exhale completely through mouth making a whooshing sound. Close mouth and breathe in through nose for four seconds. Hold breath for a count of seven. Then exhale for eight seconds making another whooshing sound. Repeat at least three times. Progressive muscle relaxation Involves progressive tensing and relaxation of muscles starting from the toes and working up to the facial muscles. Hold each tension for about five seconds and relax for 10 seconds Visualisation With closed eyes, imagine a place or activity that is both calming and peaceful. Concentrate on how relaxed this place or activity makes you feel."

Hay Fever

"• Start preventive treatment for hay fever early in the season and take it regularly, especially if triggers that set off hay fever are unavoidable. •Eye symptoms generally reduce once nasal symptoms are controlled. •Corticosteroid nasal sprays must be used regularly since maximum relief may not be obtained for several days. •Wear sunglasses and possibly a mask or scarf outside and wash hands and face on returning. Avoid parks and pollen-abundant areas (especially if just mowed). Stay indoors if pollen counts are high (see www. metservice.com) •Wipe pets down with a damp cloth to remove pallen collected on their fur."

Contraception, Oral and Emergency

"•Advise customers that the ECP: If not 100% effective. The woman should carry out a pregnancy test if her next period is late. Does not protect the woman from STIs. Is not recommended as an ongoing method of contraception. •Women seeking multiple dispensing of the ECP should be referred to a doctor or family planning clinic for other methods of regular contraception."

Gout

"•Advise people predisposed to high uric acid levels, or who have a history of gout attacks to: Avoid HFCS-sweetened drinks, fruit juice and limit intake of fruit. Drink at least five glasses of water each day. Eat only small amounts of red meat or seafood. Eat mainly chicken or white fish. Keep active and keep weight down. Restrict alcohol intake, (especially beer, lager, port and RTDs). Take all medicines as prescribed and see a doctor as early as possible if another gout attack occurs."

Women's Health

"•Be sexually responsible. Always use condoms unless you are in a mutually monogamous relationship with a partner who is free from sexually transmitted infections (STIs). •Keep up-to-date with vaccinations. The human papillomavirus (HPV) vaccine is available free to all females and males aged nine to 26 (see Childhood Diseases and Immunisations). The hepatitis B vaccine also helps to prevent sexual transmission of hepatitis B. •Keep pelvic floor muscles toned and limit exercises that are likely to place strain on pelvic floor muscles. •Wear loese cotton underwear and avoid tight-fitting synthetic clothing. Avoid perfumed soap, vaginal deodorants, douches, or bath salts or foam. •After urinating wipe from front (vagina) to back (anus). •Women prone to recurring episodes of thrush should consider using a water based lubricant during intercourse and when inserting tampons if the vagina is dry, using a vaginal gel to regulate vaginal pH which can alter during the menstrual cycle, and showering straight after exercise. •Oral probiotics may be useful to recolonise bacterial flora within the vagina"

Allergies

"•Advise people with allergies to wear a medical alert bracelet or necklace (such as Mediband, Medic Alert) that states details of their allergy(ies) and to inform all health professionals of their allergic status before starting any new treatment, including complementary medicines. •Caregivers of children with serious allergies should consider providing a poster that clearly outlines their child's condition and treatment to their school or daycare. Training for staff on how to use auto-injector devices may also be needed. •Animal dander - keep pets out of your bedroom and off carpet and furniture. •Dust mites - Use allergen-proof bed covers and wash bedding weekly. Keep humidity low and ensure good house ventilation. Dust with a wet rag, was stuffed toys regularly and vacuum with a double-layered microfilter bag or HEPA filter. Replace carpet with wood or vinyl flooring. Remove clutter. •Food allergies - Keed a diary of what you eat and subsequent reaction to help identify food allergies. Experts no longer recommend delaying the introduction of allergenic foods in babies. Seek further advice from a doctor or allergy specialist. •Insect bites and stings - Wear footwear outdoors and cover body with clothes. Be alert for the presence of wasps around camp-sites or bins. Wear gloves and insect repellent when gardening. •Pollen - Keep the garden free of highly allergenic plants. Stay indoors when pollen count is high (eg, hot or windy days) and shut windows. Get someone else to mow your lawn, or wear a good mask and wrap-around sunglasses. Shower and wash hair at night to wash away any pollen. •Skin allergies - Avoid strong soaps, perfumes and products that may irritate."

Dental Pain - Caring for Children's Teeth

"•Always supervise and assist children aged less than 8 to brush their teeth. •Begin caring for your child's teeth as soon as they have erupted. •Use just a smear of normal-strength fluoride toothpast either on a cloth (very young children) or a child-size toothbrush, up until age six. •For children older than six years, use a pea-sized amount of toothpaste. •Brush twice a day, morning and last thing before going to bed, for two minutes. Spit out extra toothpaste, but avoid rinsing with large amounts of water as this will wash away protective fluoride. •Help children to floss their teeth when two teeth touch (usually when the back teeth appear). •Replace a toothbrush when worn, or at least every three months. •Breast milk is best for babies. Never give infants sweet drinks in their bottle and never dip dummies in sweetened substances. •Use a training cup insteead of a bottle as soon as the child can drink from one. •Parents should avoid sharing spoons with their children or putting their child's dummy in their own outh to avoid the transfer of dental caries-causing bacteria."

Influenza

"•Annual flu vaccination is recommended because, most years, the major prevailing viruses change. •If you contract the flu, rest in a quiet, darkened room, increase fluid intake and consider symptom control using analgesics or other treatments (see Treatment options, over page). Keep contact with other people to a minimum. Do not go to work while you have the flu and avoid public places where possible for up to five days. •See your doctor if symptoms worsen or persist for longer than a week. •Many cold and flu remedies contain paracetamol, a decongestant and/or a cough suppressant. Watch for double-dosing with these products."

Osteoporosis

"•Ask your pharmacist to check if any of the medicines you take inadvertently increase your risk of falls. Talk to your doctor about these medicines. •Lessen the risk of falls around your home by improving furniture placement and removing rugs. •Consider t'ai chi, which research shows can improve balance and prevent falls. •Book in a comprehensive eye examination with an optometrist to check both your vision and eye health. Good eyesight is needed to avoid tripping over or bumping into objects. •Wear shoes with non-slip soles and women should avoid high heels. •Partake in regular weight-bearing exercise to improve muscle strength and balance. •Consider a walking stick to help improve balance if falling remains a problem. •Consider an alarm/alert system, worn around their neck ar wrist, which could be a easily activated if a person has fallen and cannot move. •Ensure you expose your face and ams to the sun without sunscreen in the early moming or late aftemoon every day in order to maintain adequate vitamin D levels. Just five minutes of exposure in summer is considered sufficient. Supplements may be more suitable for some people (such as rest home residents)."

Fungal Infections: Skin and Scalp - Jock Itch, Ringwoom

"•Avoid sharing towels •Check pets for evidence of ringworm and get pets treated by a vet."

Urticaria (Hives)

"•Avoid triggers for urticaria if known and if possible. •Dietary changes may help. Some urticaria is aggravated by salicylates in certain fruits, or additives including amines, tartrazine (102), benzoates (210-220) and other food chemicals. •Seek medical advice if certain medications appear to precipitate urticaria. Similar classes of medications may do the same thing. •Customers with urticaria should: avoid alcohol (it causes the surface blood vessels to dilate). avoid tight clothes as sweating and pressure may worsen symptoms cool the affected area with a fan, cold flannel, ice pack, or cream containing menthol; alternatively a tepid or cold shower may be soothing treat any pain with paracetamol see a doctor if the urticaria does not respond to an antihistamine, or persists more than a few days."

Fever

"•Be alert for symptoms that may indicate meningitis and seek urgent medical attention if any worrying signs are present or if you are unsure. Classic signs include a fever, stiff neck, headache, sensitivity to light and nausea or vomiting. A rash may or may not be present. •A luke-warm bath or cool compress may provide comfort. •Dress the person in light clothing and keep bedding light. •Drink plenty of water and/or electrolyte relpacement fluids since fever can cause dehydration. •When using a mercury thermometer, always shake before use. Wait 10 minutes after eating anything hot or cold before taking the temperature. Tympanic thermometers measure the temperature of the eardrum, but may underestimate temperature if not used properly. Digital thermometers are preferred in children as there is a risk children may bite the glass bulb of a mercury thermometer, releasing its contents."

Foot Care - Athlete's Foot, Infected Nails and Warts

"•Bleach the shower/bath area regularly to kill fungi and viruses. •Wash socks and towels in hot water and allow to dry in the sun. •Wear jandals in communal changing areas (ie, at public pools)."

Fungal Infections: Skin and Scalp - Athlete's Foot, Infected Nails

"•Bleach the shower/bath area regularly to kill fungi and viruses. •Wash socks and towels in hot water and allow to dry in the sun. •Wear jandals in communal changing areas (ie, at public pools)."

Baby Care

"•Change resuable or disposable nappies as soon as possible when wet or soiled. Consider changing the nappy at least once in the night. •Clean the skin gently to remove any urine or faeces from the area. If the baby's nappy was wet, use warm water to clean. If the baby's nappy was dirty, use a mild soap-free cleanser. Baby wipes may sting if the skin is sore (use muslin cloths instead.) •Have frequent nappy-free times where the skin is exposed to air and filtered sunlight. Use a barrier cream or ointment at each nappy change to prevent urine or faeces from coming into contact with skin. •Barrier creams can be used over the top of anti fungal or antibacterial creams. •Talculm powder is no longer recommended for use. It won't protect against nappy rash, can cause friction and irritate a baby's skin, and may be associated with breathing problems and other conditions. •Sterilise and rinse reusable nappies meticulously, removing all traces of detergent, and dry in direct sunlight, rather than in a clothes dryer. •If possible, avoid giving any foods that appear to aggravate the condition until the baby is older."

Men's Health

"•Condoms should always be used to protect against unintended pregnancies and sexually transmitted infections. •Condoms should be stored away from heat and sunlight (ie, not in a car glove box), and should not be used passed their expiry date. •Latex condoms should only be used with water-based lubricants to decrease the risk of breakage. •Men should check their testicles every month for pea-shaped areas of hardness (and see a doctor if any are found). • All men aged 35 and alder with risk factors for cardiovascular disease, or aged 45 and older with no risk factors should see a doctor for a cardiovascular risk assessment."

Ear Conditions

"•Cotton buds or other devices should not be used for cleaning ears since they can result in ear wax becoming more deeply impacted and damage the lining of the external ear canal. •For people prone to earwax impaction, regular earwax removal by a doctor every six to 12 months is recommended. •Check any suspected hearing loss, especially in children. •Free ear checks are available for preschool children up until the age of five. •Children aged five to 16 with suspected hearing loss may be entitled to a free hearing assessment through a hospital audiology clinic. •Free hearing checks are available for New Zealanders over the age of 16 through Life Unlimited Hearing Therapy Services. •Constant low noise, eg, lawn mowing, may impair hearing long term. Use ear protectors if working in a noisy environment, including the home environment. •Ensure correct nose-blowing technique. Regularly blowing (instead of sniffing) may help prevent glue ear incidence in children."

Coughs: Dry

"•Cough and cold preparations are not recommended for children under the age of six, and pharmacist advice should be sought before using in children under the age of 12. •Avoid dry environments and drink plenty of water. •Always cover your mouth when you cough, preferably with a tissue, or cough into the crook of your arm. •Wash your hands after coughing, before preparing food, and before touching othre people if the cough is from an infectious source. •One to two teaspoonfuls of honey taken at night is effective at relieving cough, but not give to children aged less than one year. Hot lemon drinks and glycerol mixtures also have a soothing effect."

Bites and Stings

"•Customers with severe reactions to a bite or sting should carry adrenaline at al times and wear medical alert jewellery that states what they react to and what happens. •Avoid scratching the area (this also reduces the risk of infections. •Cover-up and take extra precautions if travelling to an area at risk of tick or mosquito-borne illnesses. Tips to avoid getting bitten. •Use insect repellents and cover arms and legs if in an area prone to insects. •Avoid perfume or wearing bright-coloured clothing around bees; mosquitoes like dark clothing. •Cover food and rubbish and try to minimise odours at picnics. Destroy hives or nests. •Drain pools of stagnating water or add houshold cleach to them to eliminate mosquito larvae. •Repel mosquitoes with electrical insect-repelling devices or citronella products when outside. •De-flea cats, dogs and other houshold pets regularly."

Warts

"•Do not pick or scratch warts. Warts are easily spread to other parts of the body this way. Never share razors. Avoid going barefoot in public places like showers, gyms, and changing rooms. Wear jandals or pool shoes in public showers, locker rooms and pool areas. •Avoid touching another person's wart. •Change shoes and socks daily and keep foot warts dry, as moisture tends to allow the warts to spread. •Stop treatment for a few days if the skin becomes sore, then recommence, paying particular attention to not getting the paint on unaffected areas of skin."

Menopause

"•Dress in light clothing and in layers to help with hot flushes. •Eat a balanced, healthy diet. •Be conscious of your weight and be aware that some women are prone to weight gain after menopause. Begin weight control before it becomes a problem. •Falling oestrogen levels shift fat storage from your hips to your waist (truncal obesity) which increases your risk of cardiovascular disease. •Eating frequent, smaller meals throughout the day may satisfy appetite better than eating three large meals. • Partake in regular weight-bearing exercise (eg, walking, dancing, tennis, aerobics, golf) on most days of the week. •Exercise is also beneficial for reducing the risk of cardiovascular disease, preventing osteoporosis, and aiding sleep. •Avoid foods which exacerbate menopausal symptoms or decrease sleep (eg. caffeine, fatty or spicy foods and alcohol) •Practise pelvic floor strengthening exercises (Kegel exercises) to help with urinary incontinence. •Use vaginal lubricants or moisturisers to help with vaginal dryness. •Some women find yoga, massage, acupuncture or meditation beneficial. •Stop smoking (see Smoking Cessation). •Women going through early menopause may like to consider joining a local support group [ree www.earlymenopause.org.nz)"

Shingles

"•Early treatment from a doctor will reduce the severity and duration of shingles. •Rest and take pain relief, such as paracetamol. •Apply a bland, protective cream to the rash, and wear loose clothing. •If the pain persists following treatment, return to your doctor. •Warn customers that they are highly contagious until the rash crusts over."

Dermatitis/Eczema

"•Improve overall skin hydration. Have showers instead of baths and use lukewarm water. Keep shower-time to under five minutes and use a soap-free cleanser. Wear gloves or use barrier creams to protcect hands from exposure to detergents or solvents. Moisturise the skin at least twice daily with a fragrance-free emollient and always after bathing. •Wear clothes that are cool and comfortable. Avoid scratchy fabrics or coarse fibres such as wool or synthetics. •Protect the skin as much as possible from dust, harsh chemicals or water and avoid excessive sun exposure. •Stress can also aggravate eczema. Limit exposure to stress and have some good stress-relieving techniques on hand."

Sore Throat

"•Eat cool, soft food such as smoothies and drink cool or warm liquids such as chicken soup. Avoid cruncy or spicy foods with severe sore throats. Increase water and fluid intake to offset dehydration. •Rest as much as you can. Talk to a doctor if your sore throat does not get better wihing a few days. •Regular sucking of lozenges or pastilles stimulates saliva, which will lubricate and soothe sore throats. Do not exceed the recommended dosage. •Avoid smoking-it can make a sore throat feel worse. •Strep throats are highly infectious and all members of a household should be tested for the presence of bacteria. Cough into the crook of your elbow or cover your mouth with a tissue when you sneeze or cough. Wash your hands or use a sanitising hand gel immediately if you cough on your hands. •Wash hands thoroughly before preparing food, and before and after tending to small children."

Asthma and COPD

"•Ensure customers know what each inhaler is for and how to use them. •Advise people with asthma to use paracetamol instead of NSAIDs because NSAIDs may precipitate an asthma attack in some people. •Ensure they have talked with their doctor about what to do if their asthma worsensand they have an Asthma Self-Management Plan. •Treat allergies and avoid known asthma triggers wherever possible. •People with exercise-induced asthma should warm up and use a reliever before exercising."

Diabetes

"•Ensure customers: Know how to use their blood glucose meter and to contact a pharmacist or diabetes educator if the equipment is not working correctly. Wear a personalised medical bracelet (eg, Bupa, Mediband, MedicAlert) stating that they have diabetes and their usual treatment."

Urinary Incontinence

"•Ensure the customer has discussed an incontinence management plan with their doctor which usually consists of several of the following options: Ensuring an adequate, but moderate fluid intake (ef, 1000 - 1500 mL/day) A pelvic floor muscle retraining and toileting programme. Medicines for incontinence Incontinence aids (eg, pads, condom drainage, catheters) Advice about toileting outside of the home situation. •Some exercise regimens are not pelvic floor friendly. See pelvicfloor.co.nz for pelvic floor safe exercises. •Customer with incontinence of recent onset should keep a bladder diary before seeing their doctor. Record when and how much leakage occurs, how strong the urge is to urinate, what activity was being done when the urge to urinate occurred, medicines taken (prescription, over the counter) and daily fluid intake. •Avoid foods and drinks that can irritate the bladder, eg, spicy foods, caffeine, alcohol, fizzy drinks, chocolate, citrus fruits and juices. •Weight loss may help people who are overweight. •Community incontinence nurse educators are available to provide education and advice."

Head Lice

"•Ensure the hair is free of conditioner and completely dry before applying treatment products. Rewash hair with just shampoo if conditioner has been used on the hair in the preceding two days and dry thoroughly before applying the treatment product. •Use all products with a fine-toothed nit comb to improve success. Combing (or regular brushing) damaged their legs and other body parts which prevents them from gripping onto the hair shaft to lay their eggs. •Wash bed linen, head coverings and clothes in a hot wash; soak combs and grooming aids in hot water for 10-15 minutes and vacuum furniture and floors. •Avoid washing the hair or using a hairdryer for 24-48 hours after applying chemical treatment products. •Note that some products are flammable and treated hair should be kept away from heat sources such as hair dryers and straightening irons. •Never use fly spray or pet treatment products to treat head lice. •Parents or caregivers should inform their child's teacher and friends that their child has head lice so that other close contacts can be checked at the same time. Prevention •Hair should be kept short, if possible, or tied back and plaited if long. •Regular brushing can help prevent head lice since they have no defence against disease or injury, and can be damaged by combing or brushing. Encourage children not to share hats and combs, although the chances of catching head lice from objects is remote. A couple of drops of tea-tree or lavender oil added to conditioner or on a hair brush before brushing may deter lice from settling on the hair."

Sleep Problemts and Snoring

"•Exercise daily, but not within four hours of going to bed. •Set a bedtime that is not too early or late and stick to that time every night. •Start preparing for bed 30-60 minutes before bedtime. Turn off electronic devices shower and brush teeth, and do something relaxing but not stimulating. •Try to keep your bedroom temperature around 18°C Make sure your bed is supportive and comfortable, and use your bedroom only for sleeping in. The bedroom should be dark once the lights are cut (use blackout curtains to prevent any street lighting from shining in). Set your alarm clock and wake up at the same time each morning. Ensure you expose your face to some natural sunlight as soon as you can, because this helps maintain a healthy sleep-wake cycle. • Avoid napping during the day, taking stimulants such as caffeine, nicotine and alcohol too close to bedtime, eating a meal or large snack just before going to bed, or going to bed too early (unless you need to wake early). •See www.tuck.com for more information about sleep and sleeping"

Constipation

"•Fibre is important for our health, and a high-fibre diet should be recommended for most people, although it may not be appropriate for the very yound or very old. Whole grain breads and cereals, nuts, beans, lentils, fresh and dried fruits (not fruit juices) and vegetables are high in fibre. Men should aim for around 38g/day of fibre and women 28g/day. Children aged between four and 18 need only slightly less than adults (about 18-28g a day). Increase fibre intake once the current constipation problem has resolved. •Don't put off going to the toilet if you feel the urge as this can lead to constipation or make it worse. •Regular exercise and sufficient fluid intake - at least six glasses of water a day - also prevents constipation. •Remind the customer that not everyone has a daily bowel motion and offer advice about haemorrhoids if these are also present. •Avoid long-term use of stimulant laxatives unless under medical advice. •Seek medical advice if problems with bowel motios persist."

Heart Health

"•Follow the Ministry of Health's Eating and Activity Guidelines. Eat plenty of vegetables and fruit grain foods, some milk and milk products (mostly low or reduced fat); some legumes, nuts, seeds, fish, poultry and lean meat. Cut back on foods high in suger, salt, and trans fats. Make water your preferred drink. •Partake in at least 150 minutes of moderate or 75 minutes of vigorous intensity physical activity throughout the week. Do muscle strengthening exercises on at least two days per week. Break up long periods of sitting with activity. •Stop smoking, lose weight, keep alcohol intake low, and maintain good blood glucose control if you have diabetes"

Scabies

"•Follow the product instructions exactly and ensure product stays on for the recommended length of time before being washed off. The whole body needs to be treated, not just the itchy areas. Reapply product to the hands, if they are washed within the treatment time. •A second application is recommended after seven days. •Consider taking oral antihistamines or using topical crotamiton, moisturisers or hydrocortisone cream for help with the itch which may persist for up to four weeks after treatment. •Treat everyone in the house and at the same sime, even if they have no signs of scabies. Advise family members, friends and babysitters who have been in the house that they will also need to be treated. If multiple family members require treatment and cost is an issue, inform customers that some products are subsidised on a prescription from a doctor. •Wash in hot water any bedding clothing or soft toys that have come into contact with the infected person. Alternatively seal objects in plastic bag for one to two weeks, Hang other bedding outside in sun the for a day, and thoroughly vacuum carpets and furniture."

Fungal Nail Infections (Onychomycosis)

"•Fungal nail infections have a high recurrence rate. Lifelong preventive measures are recommended. Protective footwear should always be worn on hotel bedrooms, gyms, and changing rooms of public bathing facilities. Absorbent antifungal powders should be used regularly in shoes and on the feet. Nails should be kept as short as possible and nail clippers should not be shared with family members or friends. Always wear comfortable, well-fitting shoes to avoid trauma to the nail and discard hold and mouldy shoes to prevent reinfection. •Frequent manicures and pedicures predispose many people to a variety of nail problems and customers should be advised to only choose nail salons with good sterilisation techniques."

Smoking Cessation

"•Giving up smoking may take a number of attempts but this a normal. •Plan a quit attempt, rather than just stopping suddenly. Make a chart to identity your smoking trigers. A key factor in quitting is changing routines and habits. Register with Quitine (www.quit.org.nz) and discuss coping with cravings before quit. Review your previous quit attempts - what helped, what didn't and reasons for relapse. Consider a different type of treatment. Apply for subsidised replacement therapies - an eight week supply of nicotine patches costs around $5 compared with over $200 if bought. •Make your home and car smoke free and get rid of ashtrays. Wash all your smoky clothes and wash down furnishings. •Brush your teeth with fresh minty toothpaste and book into a dentist to have your teeth cleaned. •Carry a water bottle with you and practise saying ""I am a non-smoker"" or ""I don't smoke."" •The Nicorette inhalator should only be inhaled into the mouth, not the lungs. •The comect way to use nicotine gum is the ""chew and park"" method. Bite down slowly on a piece six to 10 times, enough to soften it and release the nicotine, which may tingle or taste spicy. Park the gum under the tongue or between the cheek and the gum, allowing the nicotine to be absorbed through the lining of the mouth into the bloodstream. Avoid over-chewing the gum or drinking while chewing as this can wash nicotine into the stomach, causing side effects such as heartburn, abdominal pain or hiccups. An occasional bite will expose a fresh surface of gum and release more nicotine. Repeat the process around five or six times in 30 minutes if needed, until the gum loses its effectiveness. Wrap up the gum and dispose of in a rubbish bin. Do not use oral NRT while eating or drinking or within 10 minutes of eating or drinking. •If using lozenges, follow the same process as for the gum, except the lozenge should be sucked, not bitten."

Hair Loss

"•Handle hair gently and avoid over-vigorous combing, brushing, tying up and any type of scalp massage. •Wash hair with a mild shampoo and avoid dyes and other chemicals. • Treat dandruff or psoriasis if present. •If using a hairdryer, use on a low setting to avoid damaging the hair shaft. •Relaxation techniques may help with hair loss caused by stress. •Eat a well-balanced diet and consider supplements with deficiencies. •Cooling caps or scalp cooling systems may allow some people to keep some of their hair during chemotherapy."

Weight Loss

"•Have a realistic weight-loss target. A weekly weight loss of 0.5 kg is healthy and achievable. •Research has shown that people who weight themselves daily are more successful at keeping weight off as they use it as an early warning systems for preventing weight regain. •Waist measurement is also important for fat loss. •Targeting weight loss from just one spot, eg, the hips generally does not work, but overall weight loss will eventually result in reduction of the size of the problem spot. •Beware of products which advertise ""no effort or exercise required"", ""burn fat"", and other fad diets. They rarely work. •A change in lifestyle is usually necessary to maintain weight loss - this involves increased activity and different eating habits. •Choose healthier foods and make use of wristband activity monitors, Download the FoodSwitch app to identify what's in packaged foods which allows you to make simple switches to healthier options. •Eat a bit less of most things (except vegetables and fruit). See Vitamins and Dietary Supplements: Eating and Activity Guidelines. •Take every opportunity to move and be active, eg, get rid of the TV remote, park on the far side of the supermarket car park, walk up and down stairs, get off the bus one stop early and do housework energetically. •Smoking should not be used to lose weight. Smoking increases the risk of heart and lung disease. It also reduces circulation and ages skin, increasing wrinkles. •Some medicines, eg for blood pressure and diabetes, may need adjusting as weight loss continues."

Eye Conditions - Applying Eye Ointment

"•Hold the tube between your thumb and index finger and rest your hand against the base of your noce to position the ointment tube tip. •Apply a small blob of ointment into the lower eyelid pocket. Do not touch the with tube tip. •Eye ointment may blur vision for a short time after use. Do not drive or operate machinery until vision is clear."

Headache

"•Identity and avoid factors that trigger the headache if possible. •Rest in a quiet, darkened room. •Reusable heat pads may provide relief. •Be careful not to overuse pain-relief medicines. •Drink plenty of water maintain regular exercise, and eat a healthy diet."

Poisonings

"•If a child or adult is unconscious or having difficulty breathing, call 111 for an ambulance. •For other suspected poisonings, call 0800 POISON 0800 764 766)-the National Poisons Centre Urgent Phoneline, open 24-hours a day, seven days a week. •Do NOT assume that first-aid information on the label is correct. •Do NOT induce vomiting unless told to do so by the Poisons Centre •Bring the product container or plant to the phone if you can, and remain calm. The poisons information officer will need to ask you some questions. •Save any vomit, containers and labels in case they are needed later to help identify the poison. •Always protect yourself from the poison."

Osteoarthritis

"•If pain worsens or continues longer than two to three days, see a doctor. •Supportive footwear will help protect joints. See an orthotics expert. •A walking stick for osteoarthritis of the knee and hip helps reduce stress on these joints. •Weight control reduces the load on joints (See Weight Loss). • Heat may be useful before exercise and ice packs after exercise. •Special aids to help with everyday life, eg, opening jars, turning on taps, putting on stockings and picking up objects, are available from some pharmacies and Arthritis New Zealand, see Support Groups, page 217. •Arthritits New Zealand also delivers regular exercise and information sessions in some main centres (see www.arthritis.org. nz for more details). • Medicines and their dosage should be reviewed every two to three months because pain severity can increase or diminish"

Sexual Health

"•If unprotected sex occurs or if a condom breaks, women should see a doctor as soon as possible. The ECP is available from accredited pharmacists and accredited nurses without prescription, but must be taken within 72 hours of unprotected sexual intercourse (see Contraception: Oral and Emergency). •Remind customers to store condoms away from heat and sunlight (ie, not in a car glove box), and to only use condoms that have not passed their expiry date. •Only use water-based lubricants with latex condoms to decrease the risk of breakage."

Varicose Veins and Support Stockings

"•Measurements for support stocking are best taken early morning. Rest the legs horizontally before measuring. •Refer to label for laundry details. •Wear rubber gloves when putting on support stocking to prevent fingernails and jewellery snagging the stockings."

Childhood Diseases and Immunisations - General

"•Keep children at home until they are no longer infectious (see individual conditions for exclusion peroids) •Keep sick children away from pregnant women, newborn babies or any person who is immunocompromised (eg, with cancer, HIV, or organ transplant recipients), whenever possible. •Advise caregivers to obrserve their child frequently and to reek urgent medical advice if they are worried or the child seems in distress. •Fluids should be offered regularly in order to avoid dehydration in the sik child. If their child refuses even small sips, caregivers should seek medical advice urgently. •Caregivers should wash and dry their hands frequently, especially before and after tending to a sick child. •Dress children in light, loose-fitting clothing or pyjamas and encourage them to rest in a half-darkened room. •Only administer pain relief, such as paracetamol, occosionally if needed to relieve a child's discomfort. •Aspirin should not be given to children under 16 years (unless under medical advice) due to the risk of Reye's syndrome. •Trim children's findernails short to discourage scratching which may lead to infection. •Some diseases may require specific medicines prescribed by a doctor."

Travel (Motion) Sickness

"•Keep food light and avoid heavy, fatty or spicy meals and alcohol before travelling. •Peppermint or ginger taken before travel may help. •Take the recommended medicine at least one or two hours before travelling (or even the night before). •Reduce symptoms by choosing seats with the smoothest ride (eg, front seat of a car, front carriages of a train, seats between the wheels of a bus centre of a boat and seats over the aircraft wing). •Focus on distant objects or the horizon, do something distracting (eg, listen to music or keep eyes closed.) •Avoid activities, such as reading, that encourage looking down and require close visual concentration. •Minimise head movement with a head support, or try lying down. •Get plenty of fresh air (open personal air vents on planes). •If a person is feeling car sick, stop in a safe spot and allow them to get out and walk around a bit. •Keep a plastic bag in the car just in case!"

Cystitis (Bladder Infection)

"•Keep up your fluid intake, although there is no evidence that drinking more fluids than normal decreases the duration of a UTI. •Rest and a hot water bottle placed on the stomach may help relieve pain. Paracetamol or ibuprofen may be taken. Avoid Aspirin. •Vaginal lubricants may reduce the risk of ""Honeymood cystitis"", caused by repeated trauma in the genital area. •Bath products and vaginal deodorants may cause irritation. •Some medications may result in inefficient emptying of the bladdes. Talk to your doctor if the cystitis seems to have coincided with a recently started medicine. •Incorrect toileting may cause cystitis. Wipe ""front to back"", preferably using a ""blotting"" technique. Respond to the urge to urinate - do not ""hold on"" as this can cause urine to concentrate and give bacteria an opportunity to multiply. •Acidic drinks (eg fruit juices, fizzy drinks) and spicy foods may irritate the bladder in some people. •Weaar loose-fitting cotton underpants and trousers. Tight clothing may encourage bacterial growth. •If antibiotics are prescribes, explain the importance of compliance, especially the need to complete the course. Ensure the customer understands any drug interactions and how to avoid or minimise them, and can recognise common adverse effects. Once-daily doses are best taken before bed after emptying the bladder. •Evidence is conflicting regarding the benefits of cranberry juice at reducing the incidence of UTIs. Recent report suggest benefit is minor or non-existent. Evidence supporting D-mannose to reduce UTI symptoms such as dysuria, urinary urgency, supra-pubic pain and nocuria (excessive night-time urination) is more robust."

Coughs: Productive

"•Keep warm and rest. •Drink plenty of fluids such as water, diluted non-sweetened fruit juice and clear, warm soups. Liquids help thin the mucus in the throat and lungs and make it easier to cough up. •Gargle with plain water for one minute, three times a day - this can ease symptoms. •Humidity the air if it is dry. If a humidifier is not available, steam from a hot shower will also help break down mucus. •Combination cough suppressant/expectorant cough mixtures are not recommended for productive coughs; however may be soothing for unproductive coughs. •Always cover your mouth when you cough, preferably with a tissue, or cough into the crook of your arm. •Wash your hands after coughing, before preparing food, and before touching other people to reduce spread if the cough is from an infectious source. •Always use tissues (not handkerchiefs) and dispose of them hygenically following a single use."

Haemorrhoids

"•Keeping the stools soft helps prevent haemorrhoids from occurring. A diet high in fibre (fruit vegetables wholegrains). Maintain a reasonable fluid intake (six glasses of water a day). Treat any constipation if present and avoid straining when passing a bowel motion if possible. •Avoid foods and drinks that may make haemorrhoids worse, including spicy foods, nuts and seeds, and alcohol. •Get plenty of exercise and avoid sitting for long periods. •Do not ignore the urge to go to the toilet (""holding-on"" can lead to increase pressure inside the anus). •Use unfagranced wet wipes instead of toilet paper to clean the anal area. Avoid soap as this may further aggravate the problem. Ensure used wipes are discarded appropriately and not flushed as they can easily block sanitary systems. •Apply products only as directed and for the recommended time. If treatment fails to improve haemorrhoids, seek further medical advice. •A cold compress applied to the area may help with symptoms. Alternatively sitting in a warm bath for 15-20 minutes at a time (a sitz bath) after each bowel movement may provide relief. Gently pat the area to dry afterward, or alternatively use a hair dryer. • Wear cotton underwear to minimise discomfort. • Avoid scratching the anal area. • Sit on a cushion rather than a hard surface to reduce the swelling of existing haemorrhoids and prevent the formation of new ones"

Iron Deficiency

"•Lean red meat is the best source of easily- absorbed iron. Chicken, other poultry pork and fish also contain easy to-absorb iron. •Combine vitamin C-rich foods with sources of non-haem iron to incase absorption (eg kiwifruit and cereal, beans and tomatoes tufu and broccoli. •Combining haem foods with non-haem foods also increases iron absorption (eg meat and salad.) •Avoid thinking tea and coffee at metimes as they both reduce iron absorption. •Babies are born with sufficient iron supplies to last for approximately six months. After that time iron-rich foods should be gradually added to their diets to meet their iron requirements. •Ensure children and teenagers going through growth spurts are getting enough iron in their diet. •Iron stores in pregnant women have to serve the increased blood volume of the mother as well as the needs of the growing baby. Some pregnant women may be prescribed iron supplements by their doctor; however there is controvery regarding routine supplementation. • Supplemental iron may cause gastrointestinal side effects such as abdominal pain constipation, diarrhoea, nausea, and black, tarry stools."

Diarrhoea and Vomiting

"•Most infectious causes of diarrhoea and vomiting are easily spread. Regular and thorough hand washing by all household members and close contacts of the infectious person helps reduce the risk of other people becoming ill. Alcohol-based hand gels are useful but use in addition to hand washing not as a substitute, unless hand washing facilities are not available. •Electrolyte solutions should be drunk to help prevent dehydration because water alone will not replace electrolytes lost through diarrhoea and vomiting. •Undiluted fruit juices, soft drinks (eg, flat lemonade), sports drinks and cordials can worsen dehydration due to their hugh sugar content. •Mothers with sick babies who are still breastfeeding should continue with feeds as normal. Any baby that is unable to keep fluids down (whether breastfed or bottle-fed) needs to referred to a doctor. •Food intake does not need to be restricted if the person feels like eating, although bland and dry foods may be preferred innitially. •Be particularly careful with food hygiene, especially during the summer months and when cooking barbecues - remember to Clean, Cook, Cover, Chill."

Period Pain and Endometriosis

"•Physical activity may reduce period pain by improving uterine blood flow. •Applying heat (eg, a hot water bottle or wheat pack) to the lower abdomen over clothing may provide some relief. • Eat a well-balanced diet, including plenty of fresh fruit and vegetables. •Drink at least six glasses of water a day (especially during menstruation). •Don't put up with severe pain. Talk to a sympathetic doctor who is willing to do further investigations"

Dandruff

"•Regular hair washing (at least twice weekly) with a mild cleansing shampoo will reduce flakes. However, treatment shampoos have a more dramatic effect on reducing flakes. Follow directions exactly as directed on the shampoo label. If the product irritates or burns your scalp, rinse it away thoroughly and do not use it again. Ask a pharmacist about alternative products. If one product does not appear to work, relief may be gained by using a different type of anti-dandruff product. Do not use dandruff products if your skin is broken, and avoid getting it into your eyes. •Dandruff is more visible on dark clothing compared to light clothing. •Stress may trigger dandruff or worsen existing symptoms. Take time out to relax and ry to manage stress. •Cut back on the use of styling products. Hair sprays, styling guls, mousses and hair waxes can all build up on the hair and scalp. Some may also cause an allergic reaction or irritate the scalp. •Eath a healthy, well-balanced diet. •A little bit of sun on the hair is good for dandruff but avoid overexposure. Wear a hat if outside for prolonged periods to avoid sunburn. •Daily shampooing with a tea-tree oil shampoo has been shown to reduce the incidence of dandruff. •Treatment reduced symptoms but does not cure the problem long term - customers may need to repeat treatment periodically."

Eye Products and Contact Lenses

"•Remove contact lenses before using eye drops or ointments, except when using lens-wetting agents or when directed by the optometrist to keep the lens in. •Soft lenses in particular may become stained when exposed to chemicals in diagnostic eye drops, some medicated eye drops and some medicines taken by mouth that are then secreted in tears (eg, rifampicin, sulfasalazine.)"

Migraine

"•Rest in a quiet, darkened room. Reusable heat pads may provide relief. •Keep a diary of when the migraines occur, paying particular attention to occurrence with food, stress or other events (eg menstrual cycle). •Analgesics or serotonin agonists, with or without antiemetics, should be taken at the first sign of an attack (once the attack has started gastric motility is slowed, which decreases absorption of the medicine). •Be careful not to overuse analgesics since medication overuse headache can coexist with migraine. • Drink plenty of water, maintain regular exercise and a healthy diet. •Consider acupuncture, hypnosis and relaxation training"

Eyes: Contact Lenses

"•See an optometrist for an eye check regularly (at least every 12 months). •Always wash, rinse and dry hands before handling lenses. •Do not use tap water or saliva on contact lenses. A naturally occurring amoeba found in water can cause an infection that can be difficult to treat and has the potential to lead to blindness. Dirty storage cases, incorrect cleaning of lenses and using tap water or saliva on lenses or lens cases are common sources of infection. Use an unused toothbrush to clean the lens case every week before rinsing with lens cleaner. Replace the case every month. Never touch lens solution bottle tips to any surface as they may become contaminated. Dry lenses may be rehydrated with saline, rewetting solution, or lubricant drops before reinsertion. Soft lenses become brittle if they dry out. Do not exceed the recommended wearing time of your lenses. Never shar contact lenses. •If contact lenses make eyes drier than normal, lubricant eye drops are available that are compatible with contact lenses. Considere using preservative-free products long term. •Insert lenses before applying make-up and remove them before removing make-up. Cream or gel eye shadows are less likely than powders to fall into the eye. Avoid mascara with lash-building fibres. •Do not use les-care products or eye products (especially make-up) past their expiry date. •If you lose or drop a lens: For a GP lens, use a vacuum cleaner with a pantyhose over the inlet to catch the lens. For a soft lens, turn out the light and shine a torch around the room (the light will reflect off the lens."

Childhood Pain

"•Seek urgen medical advice if the pain does not abate or the child is in distress. •Research has identified four ways needle-related pain can be reduced or eliminated. Numbing with topical anaesthesia. Giving an oral sucrose solution to children aged from birth to 12 months. Positioning the child for comfort. Distracting the child (includes the use of electronic devices.) •Chronic pain requires special management. •Pain relievers should not be used regularly or continuously, except on medical advice. •Watch for ""double-ups"" when using pain-relieving medicines (for example, paracetamol can be an active ingredient in combination pain-relief products and cough or cold remidies.)"

Advice for Smokers Ready to Quit

"•Set a quit date, preferably within two to four weeks. •Contact a local smoking cessation provider. •Infom friends, family, and co-workers and ask for support to quit if you are a heavy smoket start using NRT patches two weeks before your quit date. •If the urge to smoke is strong then Delay (acting on the urge to smoke), Deep breathe, Drink water, and Do something else. •Remove cigarettes from home, car and workplace and avoid smoking in these places. •Anticipate challenges, particularly during the first few weeks, including nicotine withdrawal. •Focus on the benefits and rewards of quitting. •On quit day, complete abstinence is preferable - not even a single puff. •Drinking alcohol is strongly associated with starting smoking again."

Sweating: Excessive (Hyperhidrosis)

"•Silver has antimicrobial properties and is suitable for sensitive skin and may enhance the effectiveness of antiperspirants. •Avoid clothes that show up sweat marks more easily. •Wear loose-fitting clothing, made of natural fibres (avoid Lycra or nylon). •Use a soap-free cleanser. •Dress shields also known as armpit or sweat shields) can help absorb excess sweat and protect delicate or expensive clothing. •Look up the International Hyperhidrosis Society's website for more information, support, or to purchase products (www. sweathelp.org). •See Foot Care for advice for people with excessively sweaty feet"

Eye Conditions - Useful Tips

"•Some eye products contain preservatives or ingredients that can affect contact lenses or may cause a sensitivity with continued use. Check compatibility with a pharmacist or an optometrist. Preservative-free eye drops may be more suitable. Discontinue products that make eyes red or even more irritated. •Damage to the eyes can easily occur if eye conditions are left untreated. •Without the protection of the tear film, the cornea can scratch easily which can result in infection, ulcers, scarring and potentially permanent vision loss. •Protect eyes from the wind and sun by wearing sunglasses. •Discard multi-use eye products one month after opening unless otherwise stated. •Single-use products are sterile until they are opened. Eye mist sprays are designed to keep the product sterile even when in use. Refer to their package instructions for the discard date. •Replace eye make-up frequently and do not share. •Contact lens wearers should always follow their optometrist's instructions with regards to lens hygiene (see Eye Conditions: Contact Lenses) •Consider visiting an optometrist every two years for an eye examination. Eye problems are more likely as people age. Eye diseases can be detected earlier, eg glaucoma is symptomless. Contact lens wearers should see an optometrist at least yearly."

Strains and Sprains

"•Sprains, strains and other soft-tissue injuries are best treated by the PRICED regimen for the first 48 hours. Controlled mobilisation of the joint usually begins after 48 hours. Avoid HARMS (Heat, Alcohol, Running, Massage, Stretching) for 48-72 hours after a sprain or strain. Allow enough time for the injury to heal properly. If surgery is needed it may take at least six months before a person can return to sport. •Supports such as shoes with good ankle support, tape for ankle strapping, knee braces etc. are important once activity is resumed. •With more severe injuries, non-weight- bearing exercise may be preferred initially (eg swimming cycling). •Organise work areas to make them more comfortable and avoid awkward working postures. •Practise correct lifting techniques and use two-person lifts. •Incorporate strengthening exercises into your exercise programme. •Warm up, stretch and take regular breaks from intensive activities"

Colds

"•Stay hydrated. •Keep warm and rest. •Practice good hygiene to avoid spreading your cold to others: Wash your hands frequently, before eating, after toileting, before and after touching others. Sneeze or cough into a tissue. •See your doctor if symptoms worsen or persist for longer than a week."

Indigestion, Heartburn and Gastritis

"•Stop smoking if you smoke and try to lose weight if you are overweight. •Avoid tight waistbands, bending over or lying down soon after a meal. •Watch what you eat and how much you eat. Try to eat small meals slowly and avoid overfilling your stomach. Reduce alcohol and coffee intake. • Antacids and alginates may reduce the absorption of some medicines so need to be taken two hours apart from them-check with your pharmacist • Raise the head of the bed by 10cm and avoid eating two to three hours before lying down if you are prone to nocturnal symptoms • Avoid taking NSAIDs, Use paracetamol for pain relief."

Psoriasis

"•Stress is one of the main triggers of psoriasis. Find ways to relax, such as yoga or meditation Build a good support network. Contact a local psoriasis support group (see page 217 for contact details of support groups). •Follow a healthy diet, maintain an optimal weight and limit intake of alcohol, fried or processed foods. Do not smoke. •Try not to scratch or pick psoriatic lesions (it may make them more resistant to treatment and trigger new lesions). •Keep skin cool and moisturised to help reduce itching and scratching. Apply emollients frequently and regularly for relief. •Bathing with oils or coal tar solutions can help soften the psoriasis and lift the scale. Warn patients to be careful when getting out of the bath or when using bath additives that may make the bath slippery. •While some sun exposure is beneficial, avoid overexposure or getting burnt."

Sun Care

"•Sunscreen is considered safe to use on full-term babies over six months of age; however, it is still best to keep them out of the sun as much as possible. •Water-resistant sunscreens protect for at least 40 minutes in water. ALL sunscreens need to be reapplied after swimming or sweating. •Warn people taking phototoxic medications (eg, doxycycline) to limit sun exposure and use a broad-spectrum sunscreen when outside. •Avoid sunbeds since the risk of skin cancer is increased. Artificial tanning lotions may be used to create a tanned look without exposure to the sun. •Store sunscreen away from heat and discard once expired."

Traveller's Thrombosis

"•This term describes the formation of a blood clot soon after any form of travel (not just air travel). The risk is generally low but is more likely to occur in people aged over to or who: are immobile for longer than four hours are obese, pregnant, or have recently given birth are taking the contraceptive pill or hormone replacement therapy (HRT) are dehydrated (increases blood viscosity) have certain medical conditions or recent major surgery or trauma with a personal or family history of DVT. Symptoms •A cramping, aching pain that does not subside with rest is the most common symptom. Other symptoms include swelling or tenderness and a localised redness or warmth If a pulmonary embolism (PE) has occurred, there may be chest pain and breathlessness. •Sometimes, a DVT is symptomless. Recommendations: Maintain activity during long-distance travel-wiggle ankles up and down, stretch, or walk around every few hours. Avoid sedative medicines. Consider compression stockings and ask your doctor about taking aspirin or another blood thinner if you are at high risk. Maintain your fluid intake and avoid alcohol."

Worms

"•Treat the whole family, even if some family members have no symptoms. •To prevent re-infection: Wash hands thoroughly before eating food and after toileting (encourage use of gel hand-sanitisers and personal hand towels at school or work.) Scrub underneath fingernails and keep them short, as eggs may lodge under nails. While undergoing treatment for worms, shower at night and again the next morning to remove eggs. Undress children in the shower so eggs are washed away. Change underwear daily. Disinfect the toilet seat daily for one week after treatment. Wash bed linen and towels in hot water, separate from other washing, daily until worms have been eradicated. Do not shake before washing. Vacuum carpet and furniture to remove eggs. •If children scratch themselves in their sleep it may be necessary for them to wear cotton mitts and tight-fitting underpants at night. This prevents anus-to-mouth transfer. •Worm and de-flea dogs and cats monthly. •Dogs and cats of any age may get roundworms and hookworms but they are most vulnerable when they are very young. Most pets show no sign of infection, although heavy infestations may be fatal. Puppies are often born with a significant number of wams which are often passed to them from their mother before or shortly after birth Teach children to always wash their hands after coming into contact with animals. Keep play areas lawns and gardens free of animal waste. Cover sandpits when not in use."

Dry Skin

"•Try to identify and limit any contributing cause(s) if possible. •Avoid spending long periods of time int the sun and always use sun protection when outdoors during the day. •Bathe or shower less frequently - once a day is plenty - and use lukewarm water. Pat skin dry with a towel rather than vigorously rubbing. •Use a soap-free cleanser, even when the skin is in good condition - normal soap is very alkaline and can irritate or dry the skin. •Dress appropriately for the weather. •Frequently moisturise. •Keep hydrated by drinking plenty of fluids. •Wear gloves or use a barrier cream if your hands are frequently in water. •Hypoallergenic or unperfumed skin products may be less irritating."

Bruises

"•Use PRICED treatment (protect, rest, ice, compression, elevation and diagnosis) straight after the soft tissue injury. •Do not massage a bruise."

Cold Sores

"•Use a lip balm containing sunscreen on your lips before going outside if you find sunlight tends to reactivate the virus. •Have treatment on hand, ready to use at the first ""tingle"". •Keep the cold sore moisturised to prevent the affected area drying out and cracking, and do not pick off the scab. •People who get repeat attacks of severe cold sores may need to see their doctor for a prescription medicine. •Cold sores are easily spread from person to person, especially when the sore is still weeping. Advise your customer that while they have the cold sore they should: Avoid kissing or other intimate contact. Avoid sharing towels, face flannels, or eating and drinking utensils. Take care not to touch the cold sore, then touch or rub their eyes. Extra care should be taken if they wear contact lenses. Wash their hand before and after applying cold sore products, before preparing food or eating, and before attending to other people. Avoid using the same finger when appling cold sore products as they may contaminate the cream. Not share their cold sore cream with other people. Not share cosmetics, especially lipsticks."

Acne

"•Use a mild cleansing lotion or wash twice a day to gently clense the skin. •Apply a thin smear of treatment product to the whole area of affected skin, not just to individual spots or pimples. This is because is can take two to three weeks for the blocked follicle to show on the surface of the skin, so it is important to treat those areas which are still in the process of developing. •Some treatments may cause tryness, particularly in the first month of use. The skin usually adjusts to this effect by an oil free moisturiser may be applied between treatments if the skin is obviously peeling. •Minimise the use of oily substances on the face. Use sunscreens that are non-acnegenic and if using foundations, choose an oil-free one specifi for acne-prone skin and apply it lightly. Apply sunscreen before going outside. •Do not pick or squeeze acne because this can aggravate inflammation and cause scarring. •Exposure to sunlight filtered throught window glass can help, but avoid sunburn. •High-glycaemic diets and dairy may exacerbate acne. Low-glycaemic, low-dairy diets that contain plenty of vegetables may improve acne. Avoid protein or amino acid supplements, particularly if they contain leucine. •Don't be discouraged if one treatment product doe not work - there are many different types available and more than one may need to be tried."

Oral Health

"•Use a soft toothbrush and brush teeth for two minutes twice a day. •Brush gently around the back and front of the teeth, including where the teeth meet the gums. •Change your toothbrush every threemmonths. •Spit out after toothbrushing and don't rinse. A small amount of fluoride toothpaste left around the teeth will help protect them. •Floss or use an interdental brush daily (minimum three times/week). •Fluoride mouth rinses may be used in adults and children aged older than six who are at high risk of dental caries (see Dental Pain). •Eat a healthy diet and limit sugar intake. •Avoid sipping sweet drinks for prolonged periods and discourage snacking and grazing throughout the day - teeth need a break! •Visit your dentist regularly (every six to 12 months) for check-ups. •Talk to your dentist about taking fluoride supplements or using topical fluoride products if your water supply is not fluoridated."

Scarring

"•Use moist wound dressings and, if necessary, would closure strips to help reduce scarring. •Continue until the wound heals then tape for at least three months. •Do not pick at wounds. •Minimise movement of the area while healing. •Do not expose new scars to the sun - cover or apply sunblock."

Eye Conditions - Eye Mist Sprays

"•Usually formulated to relieve dry eyes. •Spray directly onto closed eyelids moisturising particles are then swept into the eye with every blink. •Easier to use and last longer than regular eye drops; however may be more expensive."

Muscular Aches, Pains and Tightness

"•Warm up and stretch before and after exercise. •When you experience muscle pain, rest the area and apply ice as directed (see Strains and Sprains). •Avoid high-impact and weight-lifting sessions until after the muscle pain has resolved. •Low-impact exercises such as walking, cycling and swimming can help restore proper muscle tone. •Begin slowly and avoid high-impact activities initially."

Foot Care - Smelly Feet

"•Wash feet twice daily with an antibacterial soap and dry thoroughly, particularly between the toes. Use a clean towel. •Change socks daily and wear cotton, not synthetic socks. Wash socks and towels at a high temperature. •Wear leather shoes or open shoes, such as sandals, to reduce sweating. •Apply a foot antiperspirant daily if feed sweat a lot."

Eye Conditions - Applying Eye Drops

"•Wash your hands first. •Shake the container (if instructed to do so) to mix the eye drops, the open. •Pull the lower eyelid down gently with the to form a pocket. Tilt head slighty back and look up. •Hold the bottle between thumb and index finger and squeeze it gently to release the recommended number of drops into the pouch. •Do not touch the eye with the dropper tip. •Do not blink (this draws the eye drop into tear duct.) •Close and press gently over the corner of the eye for a few minutes to stop the drop draining through the tear duct. Remove drops with a clean tissue. •Wait 10 minutes before adding other eye products to the eyes. Put eye drops into the eye before putting in eye ointment "

Cuts and Abrasions

"•Watch for signs of infection (ef, redness spreading out from the wound or yellow drainage from the area) and seek medical advice if this occurs. •Do no pick scabs off as the wound heals - this can cause scarring. •Keep scabs moist with fil dressings."

Wound Care

"•Watch for signs of infection (eg, redness spreading out from the wound or yellow drainage from the area) and seek medical advice if this occurs. •Topical antibiotics are usually not necessary. Overuse of these medicines can lead to bacterial resistance and oral antibiotics are usually more effective if antibiotics are deemed necessary. •Do not pick scabs off as the wound heals - this can cause scarring. •Correct any nutritional deficiencies. Deficiencies of vitamins A, C, and zinc and poor dietary protein intake impair normal wound-healing mechanisms. •People with diabetes should seek medical advice with any wound, especially wounds on the lower extremities (ie, feet, lower leg). This is because people with diabetes have a reduced blood flow to their extremities (which delays healing) and commonly have peripheral neuropathy, a reduced sensation in the hands and feet, which means an injury may not be noticed straight away. For elderly people at risk of skin tears keep skin moisturised and use sheepskin boots and elbow pads to reduce friction. Self-adhesive bandages are less likely to damage the skin than adhesive tapes and dressings. Assist those at risk of falling and pad furniture and equipment to prevent bruising from collisions."

Blisters

"•Watch for signs of infection and seek medical advice if this occurs. •Wear proper fitting shoes to avoid blisters on the feet. •Ensure the heel does not slip during walking. Select socks that fit the foot without being too tight or loose. Choose ones made of soft wicking fabric. •Do not wear untested socks on a long walk and never wear unwashed socks. Follow the manufacturer's instructions for laundering. •Consider applying moleskin, hydrocolloid plasters or other types of protective plasters to areas prone to rubbing prior to long walks."

Ovulation and Pregnancy Testing

"•Women without regular menstrual cycles should test for pregnancy first thing in the morning when the HCG concentration is at its highest. Use a mid-stream urine sample. •Retesting in a few days is recommended if a women gets a negative result after using an early pregnancy test seven days post ovulation. •Alternatively, blood tests (from a doctor) are sensitive at detecting HCG six to eight days after ovulation. •For more information on medications that can be safely taken during pregnancy see Drugs in Pregnancy, page 215."

Sinus and Nasal Problems

None in my photos :(

Foot Care - Cracked Heels

•Inspect feet daily and apply a moisturising cream two to three times daily at the first signs of cracking.

Veins

•Wearing support hose, maintaining an ideal body weight, exercise and avoiding prolonged standing may help prevent spider veins.