The Well Women Clinic at the Sunshine Clinic provides a full health screening
service, which consists of tests and screening in the following areas:
- Joint Examination
- Thyroid Function
- Drug Dependency
- Sexual History
The Well Woman Clinic
With today's busy lifestyles, finding time to visit the doctor can often
be difficult but it is important not to forget about our health.
Health checks don't take long and they needn't be expensive. However,
they have proved to be highly effective and in many cases early screening has literally
saved lives. More and more women recognise the importance of an annual health check
to pick up indications of any problems at the earliest opportunity. Discuss your
general health and have urine, weight, cholesterol and blood pressure checked together
with advice on gynaecological problems, family planning (often including IUD fitting),
cervical smears, breast disease, menopause. Osteoporosis, emergency contraception.
The ending of menstruation average age for a woman to reach the menopause is
52, when periods have stopped for one year post-menopausal. The peroid leading up to
the menopause is known as the peri-menopause, during the peri-menopause, is when
hormonal and biological changes are associated with the menopause begin. As a result
of these hormonal changes, many women experience both physical and emotional symptoms.
If the menopause occurs under 45 years, known as premature menopause. estimated
it affects 1% of women under the age of 40 and 0.1% under the age of 30.
Treatments available can ease menopausal symptoms which can be severe or distressing.
Hormone replacement therapy HRT is prescribed depending on symptoms and medical
history,HRT works by replacing oestrogen, which begin to fall in the approach to
the menopause.Taking either oestrogen-only or combined HRT may reduce your the symptoms.
Symptoms - Menopause
- hot flushes
- vaginal dryness
- loss of sex drive
- mood changes
- stress incontinence (leaking urine when you cough or sneeze)
- night sweats
- thinning of the bone, which can lead to brittle bones (osteoporosis)
Most of these symptoms pass within two to five years, though vaginal dryness
is likely to worsen if it is not treated. The risk of osteoporosis also increases
Caring about your health means keeping an eye on your cholesterol levels.About
two in three adults have a cholesterol level that is higher than recommended.
Types of cholesterol
Cholesterol is transported around your body attached to a protein in your blood.
This combination of fat and protein is called a lipoprotein. There are different
types of lipoprotein, depending on how much fat there is in relation to protein
- HDL (high-density lipoprotein)
- LDL (low-density lipoprotein)
Symptoms of high cholesterol
A high cholesterol level may only be revealed if you develop symptoms of heart
disease. Sometimes, yellow patches (known as xanthomas) may develop around your
eyes or elsewhere on your skin - these are cholesterol deposits and indicate that
you have high cholesterol levels in your blood.
Causes of high cholesterol
- diet high in saturated fat and cholesterol a lack of exercise being overweight
- drinking more than the recommended daily amount of alcohol
Diagnosis of high cholesterol
- Measuring cholesterol involves a blood test
- Treatment of high cholesterol
There are two ways to help lower high cholesterol. First lifestyle changes including
changing your diet, managing your weight and increasing exercise. Second is to combine
lifestyle changes with cholesterol-lowering medicines.
Cervical smear test
It's estimated that screening for cervical cancer using the smear test saves
up to 6,000 lives a year in the UK. But what does it involve and what can it tell
you? Women are now invited for their first test at 25. They're then invited
every three years until the age of 49, and every five years from 50 to 64. From
65, those who've had recent abnormal tests are offered another test. or on request
following the doctors advice. Screening is one of the best defences against cervical
Results of your smear will be available test within weeks.
- Lowering blood pressure helps prevent stroke & heart attack.
- High blood pressure can be successfully treated & prevented.
What is blood pressure ? When your heart beats, it pumps blood
round your body to give it the energy and oxygen it needs. If your blood pressure
is too high, it puts extra strain on your arteries (and your heart) and this may
lead to heart attacks and strokes. Having high blood pressure (hypertension) is
not usually something that you feel or notice
Vision & Hearing
A regular eye test can help detect eye conditions before you notice the effect
on your sight. Early treatment can often prevent your sight from getting worse.
Discuss any specific problems with your eyes and vision, any special demands
on your eyes created by work and hobbies may also need to be addressed. The doctor
may also want to know about your general health and health of your family, including
if someone in your family has an eye condition.
Symptoms of hearing loss
If you have hearing loss:
- you may be finding it difficult to hear and understand people when you're
in a noisy place
- you may have earache and/or a continual ringing in your ears
Hearing is measured by behavioral tests using an audiometer. Hearing loss can
be temporary or permanent and can affect all age groups. Ageing, ear infections
and loud noises all cause hearing loss, and hearing aids or cochlear implants may
be needed to restore it.
Causes of hearing loss
There are many possible causes of hearing loss. These can be divided into two
basic types, called conductive and sensorineural hearing loss.
Conductive hearing loss
This is caused by anything that stops sound moving from your outer ear to your
inner ear. The following are possible causes of conductive hearing loss.
Middle ear infections (acute otitis media) - collection of fluid in the
middle ear - 'glue ear' (otitis media with effusion). Blockage of the outer
ear, usually by wax.
Otosclerosis, a condition where the ossicles of the middle ear harden
and become less able to vibrate.
Damage to the ossicles, for example by serious infection or head injury.
Perforated (pierced) eardrum, which can be caused by an untreated ear infection
(chronic suppurative otitis media), head injury or a blow to the ear, or from poking
something in your ear.
Sensorineural hearing loss
This is caused by damage to the pathway between the inner ear and the brain.
It affects sound intensity and makes it more difficult for you to recognise complex
sounds. The following are some possible causes.
Age-related hearing loss (presbyacusis). This is a natural decline in your hearing.
Many people get this as they get older because of damage to the hair cells in the
Damage to the hair cells by loud noises (acoustic trauma). This is more likely
to happen if you work in a noisy place.
Certain infections such as measles, mumps or meningitis.
Ménière's disease, which causes hearing loss, dizziness and tinnitus (a persistent
ringing in the ears).
Certain medicines, such as some powerful antibiotics, can cause permanent hearing
loss. At high doses, aspirin is thought to cause temporary hearing loss and tinnitus.
Certain cancer treatments, such as chemotherapy and radiation therapy, can cause
Acoustic neuroma. This is a benign (non-cancerous) tumour affecting the auditory
nerve causing deafness and tinnitus.
Cholesteatoma (benign skin growth) in the middle ear, causing deafness and vertigo
(sensation of movement when you're standing still).
Mixed hearing loss is a combination of conductive and sensorineural hearing loss.
Diagnosis of hearing loss
Adults, hearing loss may be very gradual, as in age-related hearing loss, or
it can be very sudden, as in some viral infections of the inner ear. If you, your
friends or your family think that your hearing is getting worse, you should see
a doctor. If you have sudden hearing loss in one or both ears, you should seek immediate
The doctor will assess your symptoms carry-out an examination. also ask you about
your medical history how your hearing loss has developed, and what sort of problems
it causes. perform a hearing test, or refer you to either an otolaryngologist (a
doctor who specialises in ear, nose and throat disorders); an audiologist (a specialist
in hearing) or an audiovestibular physician (a doctor who specialises in hearing,
balance and communication problems).
You may have the following tests.
- Whispered speech test. The Doctor may whisper a combination of numbers and
letters behind you and check if you can hear anything by asking you to repeat
the combination. or will probably move further away from you each time to test
the range of your hearing.
- Tuning fork test. Different tuning forks can be used to test your hearing
at a variety of frequencies. They can also help determine the type of hearing
- Pure tone audiometry. An audiometer produces sounds of different volumes
and frequencies. During the test, you're asked to indicate when you hear
a sound in the headphones. The level at which you can't hear a sound of
a certain frequency is known as your threshold.
- If your hearing loss has a sensorineural cause, a number of tests can be
performed to pinpoint where the problem lies.
- Otoacoustic emissions. This is used to measure your cochlear function by
recording signals produced by the hair cells.
- Auditory brainstem response. This measures the activity of the cochlea,
auditory nerve and brain when a sound is heard.
- If the Doctor thinks your hearing loss is due to an acoustic neuroma or
cholesteatoma, a magnetic resonance imaging (MRI) scan of your head may be recommended.
ECG & TFTs
Electrocardiography (ECG or EKG) is the recording of the electrical activity
of the heart over time via skin electrodes. It is a noninvasive recording produced
by an electrocardiographic device. The etymology of the word is derived from electro,
because it is related to electrical activity, cardio, Greek for heart, graph, a
Greek root meaning "to write".
Its a simple and useful test which records the rhythm and electrical activity
of your heart.Small sticky patches called electrodes applied to your arms, legs
and chest. These are connected to an ECG recording machine, which picks up the electrical
signals that make your heart beat. The machine records a few beats from each set
of the electrodes onto paper. The test will only take a few minutes and is painless.
An ECG can detect problems you may have with your heart rhythm. It can help to
tell if someone is having a heart attack or if they’ve had a heart attack in the
past. Sometimes an ECG can indicate if the heart is enlarged or thickened.
The doctor may require exercise ECG?
This as an exercise stress test or an exercise tolerance test. It’s when an ECG
that is recorded while you are walking on a treadmill or cycling on an exercise
bike. The idea of this test is to see how your heart works when you are more active.
Your heart needs more blood and oxygen when you are active and the exercise ECG
can show if your heart is not getting enough blood from the coronary arteries during
physical activity. This can help doctors find out if coronary heart disease is present
or how severe it may be. An exercise ECG is also helpful for looking at how well
the heart is working after angioplasty or bypass.
Thyroid Function Tests (TFTs)
Thyroid disease is common in approximately 1% of the population. The test which
is a blood test, is used for the diagnosis in people with signs or symptoms of possible
thyroid disease, or people with suspected goitre or thyroid nodules , TFTs may also
be taken in women who have type 1 diabetes
Dietary & Drugs
Part of Dr Sood's well man/women check is finding out your BMI (body mass
index) this is the best way to see if you are the right weight for your height.
If your BMI shows that you are overweight for your height, you should seriously
think about losing weight to avoid the risk of health problems such as heart disease,
stroke and diabetes. Good health is fundamental to leading a full and active life.
The right nutrition is an important step towards good health.
The word diet is often used to describe an eating plan intended to aid weight
loss. However, diet really refers to the foods a person eats in the course of a
day, or week. The more balanced and nutritious the diet, the healthier the person
can expect to be. A balanced diet means eating the right amount of foods from all
The benefits of a balanced diet are numerous. No single food contains everything
the body needs so it is important to eat a wide variety. The right amount of vitamins
and nutrients can increase life expectancy by keeping the heart and body healthy,
and preventing many long-term illnesses.
Body weight can be kept to an acceptable level through healthy eating, leading
to a fitter, more active lifestyle.Most people are either apple shaped or pear shaped.
This means that when they put on weight, the fat is stored around the hips (pear-shaped)
or the middle (apple-shaped). If you're overweight and apple-shaped you are
at higher risk of health problems than if you're overweight and pear-shaped.
If you're apple-shaped and overweight the best way to lose weight is to do more
regular exercise. You should do at least 30 minutes on most days of the week, and
increase this to about 60 minutes for better results. This will also improve your
general health and increase your life expectancy.
Two out of 10 women aged between 16 and 24 and three out of 10 men in the same
age bracket have taken illegal drugs in the past year.
Drug addiction is when you become dependent on a drug and it forms a central
part of your life. The misuse of drugs can lead to physical dependency or psychological
Physical dependency means that your body has become so used to a drug that you
get physical withdrawal symptoms if you stop taking it. This means that you have
to keep taking the drug to stop yourself feeling ill.
Psychological dependency means that you take the drug because it has formed a
large part of your life, and you take it to make yourself feel good. You may feel
that you cannot stop taking the drug, even though you are not physically dependant.
Some drugs can make you both physically and psychologically dependent.
As you take more of a drug, your body becomes tolerant to it so it does not have
such a strong effect. This means that you need to take larger amounts to get the
same effect as when you started taking it.
Drug misuse is when you take illegal drugs, or when you take medicines in a way
not recommended a doctor, or the manufacturer. Taking medicines in very large quantities
that are dangerous to your health is also an example of drug misuse.
Examples of drugs that are commonly misused include:
- illegal drugs
- prescribed medicines including painkillers, sleeping tablets, and cold remedies
- khat (a leaf that is chewed over several hours)
- glues, aerosols, gases and solvents
Illegal drugs are drugs that have been banned, by law, for use in this country.
It is illegal to possess or supply banned drugs. Some illegal drugs have been categorised
as prescription-only, meaning that they may only be used legally if prescribed by
a doctor, but are illegal to use, possess, or supply, in any other circumstances.
Illegal drugs are categorised into three classes:
Class B drugs
Class B drugs are also considered to be dangerous, but less so than class A drugs.
- amphetamine (an ingredient of ecstasy; nicknamed speed, whizz, dexies)
- codeine (in concentrations above 2.5%)
- DF118 (dihydrocodeine)
Class C drugs
Class C drugs are considered to be the least harmful to health but they are still
illegal to possess and give or sell to other people. They include:
- cannabis resin
- cannabinol (marijuana, grass, pot, weed)
- anabolic steroids (nicknamed roids)
- ketamine (nicknamed special K, vitamin K, green)
- GHB (gammahydroxybutrate; nicknamed GBH, liquid ecstasy and sometimes referred
to as date-rape drugs)
- benzodiazepines including valium, and rohypnol (nicknamed roofies and sometimes
referred to as date-rape drugs)
Some of these drugs are legal when prescribed by a doctor and can be used for
pain relief or to relieve the symptoms of certain medical conditions.If you are
taking prescription medication, you should always follow the manufacturer's
advice about driving. Never drive after taking medication where the manufacturer
advises against driving and operating heavy machinery.
The more alcohol you drink the greater your risk of causing various kinds of
damage to your body.There is no guaranteed ‘safe’ level of drinking but there is
a lower risk level for which the risks of harm are in general relatively low.
Lower risk drinkers are men who don't regularly drink more than three to
four units of alcohol a day and women who do not regularly drink above two to three
units a day.
Increasing risk drinkers are men who regularly drink above three to four units
of alcohol a day and women who regularly drink above two to three units a day.
Higher risk drinkers are men who regularly drink more than eight units a day
or 50 units a week and women who regularly drink more than six units a day or 35
units a week. Liver problems, depression, reduced fertility, high blood pressure,
increased risk of various cancers and forgetfulness are some of the effects of long-term,
- Men should not regularly drink more than three to four units a day
- Women should not regularly drink more than two to three units a day
- No alcohol for 48 hours after a heavy drinking session
- Avoid alcohol completely if you're pregnant or trying to conceive. But
if you do drink, drink no more than one to two units once or twice a week
If you feel a regular need to drink, or you drink a fair amount every day, you
may be addicted to alcohol or on the way there. People with high alcohol tolerance
are especially vulnerable to alcohol dependency.
Drinking might cheer you up for a few hours but in the long term it is more likely
to make you feel depressed. Alcohol changes the chemistry of the brain, increasing
the risk of depression or contributing to making depression worse.
You may not normally drink enough to have a complete memory blackout, but alcohol
– even in more sensible amounts – can affect your day-to-day memory. And the more
you drink, the more you forget.
Inside your body
Mouth and throat
Regularly drinking more than the recommended amounts increases your risk of mouth
and throat cancers between two and fivefold. The risk of mouth cancer, if you also
smoke, is even greater. Stopping drinking will bring these risks down.
Drinking more than the sensible limits can lead to high blood pressure and to serious
heart problems. For example, drinking at higher risk levels increases the chances
of suffering high blood pressure two- to fourfold.
Fatty liver is the first stage of liver damage but it is reversible. More serious
conditions include alcohol hepatitis and liver cirrhosis. The risk of liver cirrhosis
is increased in those drinking above lower risk levels between twofold and 13-fold
(the latter figure is the risk for the higher risk drinkers).
Gastritis is a condition where the stomach lining is inflamed. The symptoms are
similar to the sick, nauseated feeling and stomach pains you get from a hangover.
Alcohol can lead to 'brewer’s droop' in men(loss of erection during sex)
and to reduced sexual performance. Intoxication can increase the risk of an unwanted
pregnancy or sexually transmitted diseases. Excessive drinking also affects female
fertility. Among other effects, it upsets vital hormones that affect reproductive
Drinking increases your chance of developing bowel cancer.
On the outside
As alcohol is a diuretic, it dehydrates your body. It can also permanently enlarge
blood vessels in your skin, leading to a permanent flush. And it aggravates conditions
such as rosacea and psoriasis.
Alcohol is not the main cause of breast cancer, but drinking alcohol does increase
your risk of developing it. For those drinking above lower risk levels, the risk
increases 1.2 to 1.6-fold.
If you have a healthy appetite and drink above recommended lower risk levels, you’re
likely to become overweight because of the extra calories in the alcohol.
Cigarettes contain a substance called nicotine. Even though you may want to quit
smoking, you may find it difficult because you are addicted to the effects of nicotine.
Some research has suggested that nicotine can be even more addictive than the drug
Nicotine alters the balance of chemicals in your brain. The main chemicals it
affects are called dopamine and noradrenaline. Nicotine changes the levels of these
chemicals, which causes you to feel a change in mood and concentration levels, which
many smokers find enjoyable.
This happens very quickly, so when you inhale the nicotine it immediately rushes
to your brain where it takes affect. This is why many smokers enjoy the nicotine
rush and become dependent on it.
The more you smoke, the more your brain becomes used to the nicotine. This means
that you have to smoke more to get the same rush.
When you stop smoking, the loss of nicotine causes the levels of dopamine and
noraderenaline to be altered. This can cause you to feel anxious, depressed, and
irritable. Craving nicotine is normal at this time, as it provides an immediate
fix from these problems.
It is difficult to quit smoking using just your willpower as the nicotine cravings
can be very strong. There are quit smoking programmes that your GP can refer you
to. These provide counselling, support and advice, nicotine substitutes such as
patches and drug treatments if necessary.
Spirometry (meaning the measuring of breath) is the most common of the Pulmonary
Function Tests (PFTs), measuring lung function, specifically the measurement of
the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled,
breathing in and out. Spirometry is an important tool used for generating pneumotachographs
(airflow meter provide quantitative measurements of airflow and ventilation that
will improve the diagnosis and management of patients with sleep disordereded breathing
and respiratory disorders). which are helpful in assessing conditions such as asthma,
pulmonary fibrosis, cystic fibrosis, and COPD (chronic obstructive airways disease)
A chest xray may also be requied.
Peak Flow Meter
A peak flow meter is a small device that you can blow into. It measures the fastest
rate of air (airflow) that you can blow out of your lungs. It is important to do
this correctly; otherwise the readings will be misleading. Used to help diagnose
Asthma,and measuring the lung function of multiple patients in Hospitals/Clinic,
for over 20 years the peak flow meter has been used as an integral one-way valve
device that prevents patients from inhaling through the meter during use. Peak flow
meter monitoring remains an important tool in the diagnosis and monitoring of reversible
airway disease, ans this is a test Dr Sood may carry out during a wellman/women
Joint & Neurological
There are well over a hundred musculoskeletal related conditions. (This system
describes how bones are connected to other bones and muscle fibers via connective
tissue such as tendons and ligaments). the starting point is to determine the difference
between inflammatory and mechanical or degenerative process. Thereafter the doctor
can make an diagnosis of the precise structures involved and finally a pathological
A comprehensive history of the presenting complaint, the general medical and
systematic history is obtained. Past history and family history should be obtained,
as well as a list of medications and allergies.
Pain is the most common presenting complaint in musculoskeletal related conditions
Ongoing type pain, some aggravating factors provide clues to origin. These include
prior trauma like accidents, or previous infections causing reactive arthritis.
Pain can be acute/sudden, as in gout which is caused by the formation of small crystals
of uric acid forming in the joints,where the onset may be sudden or spread over
hours, compared to pseudogout, which is rare in young people, but increases in frequency
with age. It hardly ever occurs in people under the age of 40, but is the commonest
cause of acute arthritis in those aged over 70. It is a little more common in women
than in men. The knee is by far the commonest joint to be affected by attacks. The
wrist, shoulder, ankle and elbow are the other joints that are most likely to be
involved. Attacks are almost always confined to a single join
Palindromic Rheumatism consists of sudden and rapidly developing attacks of arthritis.
There is acute pain, redness, swelling, and disability of one (usually) or multiple
joints. The interval between recurrent attacks is extremely variable and how long
the attack lasts is also variable. There is no joint damage after attacks, which
may occur over weeks and osteoarthritis, which can be gradual over years. Thirty
percent of rheumatoid patients present with acute onset. Pain may come and go over
days, or in cycles over months as in palindromic rheumatism.
Inflammatory pain is usually worse in the morning and increases again at the
end of the day. Mechanical pain is worse with use, and activity. Night pain and
rest pain may be frequently seen with bone diseases such as Pagets, but also is
seen with malignancy. Neuralgic pain is usually diffuse in a dermatomal distribution
worsened by specific activity, whereas referred pain is unaffected by local movement.
Diffuse unrelenting pain described as constant and "all over" is often
associated with Fibromyalgia. The description of pain may be very subjective. Joint
pain is often described as aching, whilst nerve entrapment is frequently associated
with shooting pain or like an electric shock.
Neurology deals with diagnosis and treatment of diseases of the brain, spinal
cord, nerves and muscles.
Major conditions include:
- headache disorders such as migraine, cluster headache and tension headache
- cerebrovascular disease, such as transient ischemic attack and stroke.
- neurodegenerative disorders, including Alzheimer's disease, Parkinson's
disease, Huntington's disease, and motor neuron disease.
- infections of the brain (encephalitis), brain meninges (meningitis), spinal
cord (myelitis) and infections of the peripheral nervous system
- neoplasms - tumors of the brain and its meninges (brain tumors), spinal
cord tumors, tumors of the peripheral nerves (neuroma)
- movement disorders such as Parkinson's disease, Huntington's disease,
tic disorder, and Gilles de la Tourette syndrome
- demyelinating diseases of the central nervous system, such as multiple sclerosis,
and of the peripheral nervous system, such as Guillain-Barré syndrome and chronic
inflammatory demyelinating polyneuropathy (CIDP)
- spinal cord disorders - tumors, infections, trauma, malformations
Cholesterol is a blood fat needed by the body in moderate amounts. However, high
cholesterol levels can lead to atherosclerosis and coronary artery disease (CAD)
and heart attack. Methods for increasing good cholesterol or lowering bad cholesterol
levels include cholesterol reducing drugs.
Coronary heart disease is the UK's biggest killer, with one in every four
men and one in every six women dying from the disease. In the UK, approximately
300,000 people have a heart attack each year.
Coronary heart disease (CHD) is usually caused by a build-up of fatty deposits
on the walls of the coronary arteries. The fatty deposits, called atheroma, are
made up of cholesterol and other waste substances.
The build up of atheroma on the walls of the coronary arteries makes the arteries
narrower and restricts the flow of blood to the heart. This process is called atherosclerosis.
Your risk of developing atherosclerosis is significantly increased if you:
- have high blood pressure
- have a high blood cholesterol level
- do not take regular exercise
- have a thrombosis
- have diabetes
As with other history taking, the doctor must consider how to put the patient
at ease, find out if there are any real problems. As a sexual health professional
Dr Sood has through educational practices- sexual history taking has been taught
separately, therefore is aware there may be great discomfort, trepidation and even
shame felt approaching a medical professional for help in sexual matters. There
are many reasons why its important to assess sexual history for example:-
- Earlier identification and treatment of STIs such as chlamydia or HIV.
- Increased opportunities for preventative care e.g. hepatitis B immunisation,
discussion regarding sexual risk-taking.
Identifying sexual dysfunction:
- High prevalence in the general population - most often undiagnosed and untreated.
- As a marker of organic or psychiatric disease e.g. erectile dysfunction
(ED) as a risk marker for cardiovascular disease.
- As an iatrogenic side-effect of medication or surgery
Sexuality and sexual function are integral aspects of an individual throughout
life. Sexual health is associated with happiness, longevity and well-being. We increasingly
recognise the importance of sex to many of our elderly patients2 and those with
chronic illness or disability, as well as the young and fit.