Advice, what's the advice for people who do test positive for COVID, um, even if you're healthy? Like, we do need to be in the office, but is there changes to the current protocol, or what is protocol?

Yeah, so the, I looked at the protocol about two months ago, so it's not absolutely fresh in my head.

But I think if you test positive, I think that you do have to isolate still for at least two or three days.

Um, to be fair, the HSE have a really excellent resource, because it depends on your age, and it depends on a few other things as to what exactly you should do.

And if you go to that, it'll tell you.

I mean, yeah, if, if you think you have COVID, then you probably should test really.

And if you test positive, then look up the guidance, and you really do need to isolate for a couple of days.

Nine months of 350 mils, yeah.

The doctor gave them cream, which did help, but, did help a little bit, but they keep coming back, so, "I'm wondering, is there anything I can do to get them removed?"

removed?"Yeah, so, so generally, piles actually shouldn't cause that much pain.

Um, and what actually causes pain is a thing called, um, a perianal hematoma.

So this is where somebody is constipated or they strain or they're, they're always coughing or something, um, and they can get a bit of a collection, just a little collection of a little blood bubble around the back passage, and it's really, really sore.

Um, and I suppose making sure that you're passing a stool regularly, uh, certainly helps.

Um, if it's very recurrent, if somebody's getting a lot of these, it may be worth considering going along to your own doctor and making sure that you're getting a thing called a digital rectal exam.

Now, people, again-

Don't say, actually.

So is there anything I can do?

[lips smack] Uh, yeah, there are a few things you can do.

Definitely making sure that they're covered for pain relief, uh, is, is the most important thing, and I assume that they're doing that.

One thing that's quite good to do at nighttime is actually, uh, give a suppository.

So that's, um, a little tablet that you put into the, in- insert into the back passage, really, and that's really, really good.

It's absorbed quickly.

If they vomit, if they're spitting up, it'll, like, they don't lose any of it, and it's really, really effective for that.

Very debilitating, isn't it, for people?

Please help.

Well, I mean, things like this, weather related, I've just been, we've had so many of them lately.

Something like that.

You'd wonder, I suppose, generally, I would advise somebody it's no harm getting a baseline set of blood tests taken.

You should be able to get that done with your own GP, checking for things like thyroid and their blood count and just the very basics to make sure they're all normal.

If they're all normal and you find that perspiration is really, really upsetting or it's really, really debilitating or embarrassing, there are procedures that you can get done.

And there are clinics, I know of one in Dublin anyway, that will see people in relation to that.

Is there anything you'd suggest?

Is there an alternative? Is there side effects if taken without a break?

So it's a good question.

So Prolia is an injection people get every six months if they have osteoporosis.

And there are loads of alternatives, mainly oral medication.

The only issue with the oral medication really is it's once a week.

So it is one that people occasionally forget.

It also in very, very rare cases with the oral medication, there can be dental side effects.

one pill to a different pill?

Any thoughts on what it might be?

Sometimes people will get that because if they bite their nails, sometimes people will get that who are using a lot of different nail treatments and glues and shellacs and things like that.

If it's there since they're a child...

Look, it's probably no harm to get a baseline set of blood tests done.

It's the kind of thing that if they Google it, it'll probably throw up a whole load of very frightening but extremely rare things.

We do see people with nail issues from time to time.

The one big thing you'd want to make sure it's not is a fungal thing.

A listener who's 67 years of age says, I'm wondering what's the best treatment for ED?

God love them I have psoriasis and I've noticed that it's getting worse it used to be just in my scalp a few dots around my stomach as well but now it seems to be in my ankles and elbows little pieces of plaque is this arthritis could it be related is there anything I can do my dermatologist says that it's not a skin issue but an immune system issue

Yeah, well, psoriasis is a pretty unfortunate condition.

And if this person has a dermatologist, it sounds like they're doing a lot of the right stuff already.

I think the problem I often see with dermatology or excuse me, with psoriasis over time is that people often get a bit fed up dealing with it because it's a chronic condition to moisturise three, four times every day.

You can get flares through stress, through alcohol, things like that.

So it can be a very frustrating condition.

So when I see somebody like this, I usually go back to first principles, making sure that they're doing all the right things.

Is there something that I can do? I do take two sleeping tablets every night and have been doing so for a good while.

okay my daughter has started having migraines she's 22 now in college and is in agony with them they can last for days at a time any advice for this listener

Yeah, well, I think studies show that migraines can often be underdiagnosed and about one in seven people suffer with migraines.

And absolutely, I would get in there with pain relief.

Just make sure there's no coding in it.

So no, nothing like, say, salpidine or Nurofen Plus, because that can give a rebound headache.

People are a bit reticent to take things like paracetamol regularly.

You can take two paracetamol every six hours unless you've been told by a doctor not to.

Things

Can I continue to exercise or will it make it worse?

So this is very common.

So the meniscus is sort of like a lining of fat that's in the knee.

And I suppose it's a little bit like in the knee, if it's torn, if it falls over on itself, then it can be like sticking a pencil into a hinge joint.

It just blocks it and causes the knee to lock and sometimes to give way.

So if the person has been told that it's a meniscus issue, then there's a reasonable chance that they've had a scan or an MRI.

So as regards to whether they can continue to exercise, it's a hard question to answer.

I'm wondering would an LED face mask be any good or laser treatment?

I'm concerned that she could potentially make herself sick.

That's a really good question.

Yeah, the short answer is I don't really know, to be honest with you.

I get lots and lots of ads for this on my own Instagram, people saying that they only eat for certain parts of the day.

It's very possible that there is some evidence that...

There might be something behind it, but I'm always really wary about anything that seems unnatural or anything where you're fasting for long periods.

I think what people do is they only eat between certain times of the day, for example, between midday and 8 p.m., And they don't eat outside of that.

I'm worried about this.

Would the Mirena coil help in any way? I'm just curious.

Well, we sometimes...

For some people, the Mirena coil is helpful if they have a certain type of migraine.

Now, this person...

Why is that, mate? Some people get a thing called a menstrual migraine, where they get a...

I'd point it's that time of the month that they get severe headaches and migraines it's a recognised condition and somebody who has a history of migraines has to be very careful with their contraception because some of them you're not allowed to take so if that's what that person is getting at then I suppose if they're looking for a contraception or they're considering going on hormone replacement therapy or there's you know something along those lines then it might help them but migraine is I suppose an umbrella term for many conditions so Yeah, that's probably something that needs to be fleshed out a little

Any advice?

Well, I suppose the big thing I'd want to know about that person is, are they a smoker? So they specifically asked about COPD, which is where you have, it's an airway limitation where you have difficulty breathing that's partly reversible.

Should we take a calcium tablet when we reach the age of 50 or just even to check to see how much calcium if we have enough in our system?

Yeah, I think I know where that person's coming from.

A lot of people who have two conditions, either osteoporosis or osteopenia.

So both of those mean that your bones aren't mineralised properly and they do need to take a calcium supplement as part of that.

I don't think I would go on one myself empirically without reason to take it.

That person sounds like they're very busy, but if they can get themselves a window...

It's probably worth going along to your doctor to get a blood test.

Okay, listeners wondering how do I cut formula out of my baby's diet? He's 14 months, still has two bottles, seven ounces a day, doesn't eat much during the day, so I'm nervous about stopping the bottle.

Any advice or any tips?

Yeah, so whenever we start an antidepressant or an anxiety medication, I don't know which one that person has been started on, but the commonest prescribed one that we do, I'll usually advise patients within the first 10 days of starting it, you might see a very marginal uptick in symptoms of anxiety particularly.

But that should pass after about the first one to two weeks of And the best benefit from taking an antidepressant, whether it is for low mood or anxiety, is if you can take it for at least six months.

We know that people who stop taking it before then, the risk of relapse is a bit higher.

And we probably aren't brilliant at communicating that to people when we start prescribing them an antidepressant.

that you can have an uptick in anxiety that will be within the realm of normal, provided it's not intolerable.

The best course of action is to try and take it for at least six months.

I'm looking for any advice.

It's prescription and not even prescribed outside of the US.

Yeah.

So some medicines will be licensed in the US and won't be licensed here and vice versa.

So that medication, desoxan, I think they might call it Adderall as well.

I think it is a few names and it is a controlled medication.

So if you go along to your doctor, I would imagine he or she won't be that keen to prescribe it.

So I suppose it's usually specialist led.

Is there anything wrong with taking one every day when you don't have an outbreak?

Any other suggestions? Don't know if it's male or female actually.

Yeah, yeah.

And I'm assuming if they've run a half marathon within a couple of weeks that they're relatively young.

But, you know, it may be a dangerous assumption.

So I think if someone has a fairly intractable, persistent itch that isn't responding to medication within a relatively short period of time like that, I would probably consider going back to your doctor and get or getting a basic set of blood tests done immediately.

It doesn't really sound like any rash that I can recognise a very clear pattern from with little blisters.

And it seems that they more have what we call a generalised itch.

Now, I'm not sure how to fully pronounce this, but listener looking for advice on how to alleviate the strain of, is it caustic chondritis, apart from putting etophenamate on it?

Should K2 vitamin, should we be taking that with calcium tablets to try and prevent this? You're going to have to explain what that is, first of all.

Yeah, I'm not sure what they mean by K2 vitamin, but what causes a buildup in your arteries, basically, there's a few things.

So lack of exercise is one of them.

Diet is another that contains a lot of saturated fat.

But then there's probably a third element that is genetic, that some of us are just a bit more prone to it than others.

Smoking is particularly bad as well when it comes to kind of causing a buildup inside in your arteries.

In relation to certain vitamins and supplements that you can take to stop it, it's very difficult to advise people on that, really, because I'm not sure of anything that has a robust evidence that you should be taking.

Has four seven ounce bottles a day.