The Well Women Clinic at the West Midlands Hospital provides a full health screening service, which consists of tests and screening in the following areas:

• Hearing
• Vision
• Joint Examination
• Thyroid Function
• Neurological
• ECG
• Dietary
• Drug Dependency
• Menopause
Cholesterol profile
• Urinary
Diabetes


• 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 menopause

The ending of menstruation average age for a woman to reach the menopause is 52. when periods have stopped for one year post-menopausal. 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.

Treatment

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 with age.

Cholesterol profile

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 cancer

Results of your smear will be available test within weeks.

Blood Pressure

• 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

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.

Hearing

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 cochlea.

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 hearing loss.

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 advice.

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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).

Hearing tests

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 loss.
• 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

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 History

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 food groups.

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.

Drugs

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 dependency.

Physical dependency

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

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

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
• alcohol
• tobacco
• 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:

• A
• B
• C

Class B drugs

Class B drugs are also considered to be dangerous, but less so than class A drugs. They include:

• amphetamine (an ingredient of ecstasy; nicknamed speed, whizz, dexies)
• codeine (in concentrations above 2.5%)
• DF118 (dihydrocodeine)
• ritalin
• barbiturates

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
• cannabis resin
• cannabinol (marijuana, grass, pot, weed)
• methaqualone
• 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.

Alcohol

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, excessive drinking.

Drinking guidelines

• 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

Addiction

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.

Depression

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.

Memory

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.

Heart
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.

Liver
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).

Stomach
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.

Fertility
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 function.

Bowel
Drinking increases your chance of developing bowel cancer.

On the outside

Skin
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.

Breasts
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.

Waist
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.

Smoking

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 heroin.

Chemicals

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.

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 check-up.

Joint Examination

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 diagnosis.

History

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

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.

Neurological

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
• epilepsy
• 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

Blood Cholesterol

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:

• smoke
• have high blood pressure
• have a high blood cholesterol level
• do not take regular exercise
• have a thrombosis
• have diabetes

Sexual History

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.