Tuberculosis (TB)

Tuberculosis (TB) is caused by a type of bacterium called Mycobacterium tuberculosis.

The condition is spread when a person with an active TB infection in their lungs coughs or sneezes and someone else inhales the expelled droplets, which contain TB bacteria.

Although it is spread in a similar way to a cold or the flu. TB is not as contagious. You would usually have to spend prolonged periods in close contact with an infected person to catch the infection yourself.

For example, TB infections usually spread between family members who live in the same house. It would be highly unlikely to become infected by sitting next to an infected person on a bus or train.

Not everyone with TB is infectious. Generally, children with TB or people with TB that occurs outside the lungs (extrapulmonary TB) do not spread the infection.

Latent or active TB

In most healthy people the immune system is able to destroy the bacteria that cause TB. However, in some cases the bacteria infect the body but don't cause any symptoms (latent TB), or the infection begins to cause symptoms within weeks or months (active TB).

Up to 10% of people with latent TB eventually develop active TB years after the initial infection. This usually happens when the immune system is weakened – for example, during chemotherapy.

Who's most at risk?

Anyone can catch TB, but people particularly at risk include those:

• who live in, come from, or have spent time in a country or area with high levels of TB – around three in every four TB cases in the UK affect people born outside the UK 
• in prolonged close contact with someone who is infected 
• living in crowded conditions 
• with a condition that weakens their immune system, such as HIV.
• having treatments that weaken the immune system, such as corticosteroids, chemotherapy or tumour necrosis factor (TNF) inhibitors (used to treat some types of arthritis and certain gut conditions) 
• who are very young or very old – the immune systems of people who are young or elderly tend to be weaker than those of healthy adults 
• in poor health or with a poor diet because of lifestyle and other problems, such as drug misuse, alcohol misuse or homelessness

Diagnosing Tuberculosis 

Several tests are used to diagnose tuberculosis (TB), depending on the type of TB suspected. 

Your GP may refer you to a TB specialist for testing and treatment if they think you have TB.

Pulmonary TB

A diagnosis of pulmonary TB (TB that affects the lungs) can be difficult and several tests are usually needed.

This will include a chest X-ray to look for changes in the appearance of your lungs that are suggestive of TB. Samples of phlegm will also often be taken and checked for the presence of TB bacteria.

These tests are important in helping to decide on the most effective treatment for you.

Extrapulmonary TB

If you have suspected extrapulmonary TB (TB that occurs outside the lungs), several tests can be used to confirm a diagnosis. These may include:

• a CT scan, MRI scan  or ultrasound scan of the affected part of the body 
• urine and blood tests
• a biopsy – a small sample of tissue or fluid is taken from the affected area and tested for TB bacteria 

You may also have a lumbar puncture.This involves taking a small sample of cerebrospinal fluid (CSF) from the base of your spine. CSF is fluid that surrounds the brain. It can be checked to see whether TB has infected your central nervous system (brain and spinal cord).

Screening for latent TB

In some circumstances, you may need to be tested to check for latent TB (when you have been infected with TB bacteria but do not have any symptoms).

For example, you may need to be screened if you have been in close contact with someone known to have an active TB infection (an infection that causes symptoms), or if you have recently spent time in a country where TB levels are high. 

If you have just moved to the UK from a country where TB is common, you may be screened when you arrive or your GP may suggest screening when you register as a patient. 

Mantoux test

The Mantoux test is a widely used test for latent TB. It involves injecting a substance called PPD tuberculin into the skin of your forearm. It's also called the tuberculin skin test (TST).

If you have a latent TB infection, your skin will be sensitive to PPD tuberculin and a hard red bump will develop at the site of the injection, usually within 48 to 72 hours of having the test. If you have a very strong skin reaction, you may need a chest X-ray to confirm whether you have an active TB infection. 

If you do not have a latent infection, your skin will not react to the Mantoux test. However, as TB can take a long time to develop, you may need to be screened again at a later stage. 

If you have had the BOG vaccination,  you may have a mild skin reaction to the Mantoux test. This does not necessarily mean you have latent TB.

Interferon gamma release assay (IGRA) 

The interferon gamma release assay (IGRA) is a newer type of blood test for TB that is becoming more widely available.

The IGRA may be used to help diagnose latent TB:

• if you have a positive Mantoux test 
• if you previously had the BCG vaccination (as the Mantoux test may not be reliable in these cases) 
• as part of your TB screening if you have just moved to the UK from a country where TB is common 
• as part of a health check when you register with a GP 
• if you are about to have treatment that will suppress your immune system 
• if you are a healthcare worker

Treating tuberculosis 

Treatment for tuberculosis (TB) will usually involve a long course of antibiotics lasting several months.

While TB is a serious condition that can be fatal if left untreated, deaths are rare if treatment is completed.

For most people, a hospital admission during treatment is not necessary.

Pulmonary TB

If you are diagnosed with active pulmonary TB (TB that affects your lungs and causes symptoms), you will be given a six-month course of a combination of antibiotics. The usual course of treatment is:

• two antibiotics (isoniazid and rifampicin) every day for six months 
• two additional antibiotics (pyrazinamide and ethambutol) every day for the first two months 

It may be several weeks or months before you start to feel better. The exact length of time will depend on your overall health and the severity of your TB. 

After taking the medicine for two weeks, most people are no longer infectious and feel better. However, it is important to continue taking your medicine exactly as prescribed and to complete the whole course of antibiotics. 

Taking medication for six months is the most effective method of ensuring the TB bacteria are killed. If you stop taking your antibiotics before you complete the course, or you skip a dose, the TB infection may become resistant to the antibiotics. This is potentially serious as it can be difficult to treat and will require a longer course of treatment.

If you find it difficult to take your medication every day, your treatment team can work with you to find a solution. This may include having regular contact with your treatment team at home, the treatment clinic, or somewhere else more convenient.

If treatment is completed correctly, you should not need any further checks by a TB specialist afterwards. However, you may be given advice about spotting signs that the illness has returned, although this is rare.

In rare cases TB can be fatal, even with treatment. Death can occur if the lungs become too damaged to work properly.

Extrapulmonary TB

Extrapulmonary TB (TB that occurs outside the lungs) can be treated using the same combination of antibiotics as those used to treat pulmonary TB. However, you may need to take them for 12 months.

If you have TB in areas such as your brain, you may also be prescribed a corticosteroid such as prednisolone for several weeks to take at the same time as your antibiotics. This will help reduce any swelling in the affected areas. 

As with pulmonary TB, it's important to take your medicines exactly as prescribed and to finish the whole course.

Latent TB

Latent TB is when you have been infected with the TB bacteria but do not have any symptoms of active disease. Treatment for latent TB is usually recommended for:

• people aged 35 years or under  
• people with HIV, regardless of their age 
• healthcare workers, regardless of their age  
• people with evidence of scarring caused by TB, as shown on a chest X-ray, but who never received treatment  

Treatment is not recommended for people who have latent tuberculosis and are over the age of 35, do not have HIV and are not healthcare workers. This is because the risk of liver damage caused by antibiotic treatment increases with age, and the risks of treatment may outweigh the benefits.

Latent TB is also not always treated if it's suspected to be drug resistant. If this is the case, you may be regularly monitored to check the infection does not become active.

In some cases, testing and treatment for latent TB may be recommended for people who require treatment that will weaken their immune system, such as long-term corticosteroids, chemotherapy or TNF inhibitors. This is because there is a risk of the infection becoming active.

Treatment for latent TB generally involves either taking a combination of rifampicin and isoniazid for three months, or isoniazid on its own for six months.

Side effects of treatment

Rifampicin can reduce the effectiveness of some types of contraception, such as the combined contraceptive pill. Use an alternative method of contraception, such as condoms, while taking rifampicin. 

In rare cases the antibiotics used to treat TB can cause damage to the liver or eyes, which can be serious. Your liver function therefore may be tested before you begin treatment. 

If you are going to be treated with ethambutol, your vision should also be tested at the beginning of the course of treatment. 

Contact your TB treatment team if you develop any worrying symptoms during treatment, such as:

• being sick  
• yellowing of your skin and whites of your eyes (jaundice)
• an unexplained high temperature (fever) 
• tingling or numbness in your hands or feet 
• a rash or itchy skin 
• changes to your vision, such as blurred vision

Preventing the spread of infection

If you are diagnosed with pulmonary TB, you will be contagious up to about two to three weeks into your course of treatment.

You will not normally need to be isolated during this time, but it's important to take some basic precautions to stop TB spreading to your family and friends. You should:

• stay away from work, school or college until your TB treatment team advises you it is safe to return  
• always cover your mouth – preferably with a disposable tissue – when coughing, sneezing or laughing 
• carefully dispose of any used tissues in a sealed plastic bag  
• open windows when possible to ensure a good supply of fresh air in the areas where you spend time 
• do not sleep in the same room as other people as you could cough or sneeze in your sleep without realising it 

What if someone I know has TB? 

When someone is diagnosed with TB, their treatment team will assess whether other people are at risk of infection. This may include close contacts, such as people living with the person who has TB, as well as casual contacts, such as work colleagues and social contacts.

Anyone who is assessed to be at risk will be asked to go for testing, and will be given advice and any necessary treatment after their results. 

Living With Leukaemia

Leukaemia is cancer of the white blood cells. Chronic leukaemia tends to progress slowly over the course of many years.

Chronic leukaemia is classified according to the type of white blood cells affected by cancer.

This topic focuses on chronic lymphocytic leukaemia, which affects types of white blood cells called lymphocytes.

Symptoms of chronic lymphocytic leukaemia

In its early stages, chronic lymphocytic leukaemia doesn't usually cause any noticeable symptoms. As the condition develops, symptoms can include:

• repeated infections that occur over a short space of time 
• tiredness due to a lack of red blood cells (anaemia) 
• unusual bleeding and bruising 
• fever 
• night sweats 
• bone pain 
• weight loss 
• swollen spleen 
• swollen lymph nodes (glands) 

What happens in chronic leukaemia

Bone marrow – the spongy material found inside bones – contains a specialised type of cell called stem cells. 

These stem cells can develop into any of the three types of blood cell:

• red blood cells – which carry oxygen around the body 
• white blood cells – which help fight infection 
• platelets – which help stop bleeding 

In leukaemia, the stem cells start overproducing white blood cells that aren't fully developed. In chronic lymphocytic leukaemia, these are lymphocytes. 

This overproduction of lymphocytes is at the expense of the other blood cells, and it's this lack of red blood cells and platelets that can cause symptoms of anaemia such as tiredness, as well as increasing the likelihood of excessive bleeding.

In some people with chronic lymphocytic leukaemia, the body’s immune system can start attacking red bloods and cause a different type of anaemia called haemolytic anaemia. This may require different treatment.

The white blood cells are also not properly formed, and these immature lymphocytes are much less effective at fighting bacteria and viruses, making you more vulnerable to infection.

Causes of chronic lymphocytic leukaemia

In most cases, it's not known what causes leukaemia. However, there are some risk factors that may increase your chances of developing chronic leukaemia.

Known risk factors for chronic leukaemia include:

• having a family history of the condition 
• being of European, American or Australian origin (it's rare in people from China, Japan and South East Asia) 
• having certain medical conditions, such as pnenomia (chest infection) sinusitis or shingles.
• being male  

Diagnosing chronic lymphocytic leukaemia

Most cases of chronic lymphocytic leukaemia are discovered during unrelated routine blood tests.

However, visit your GP if you have the typical signs and symptoms of leukaemia (see above). They will ask you about your symptoms and your medical and family history.

Your GP will also carry out a physical examination to check for swollen glands, a swollen spleen and any signs of abnormal bleeding. You may also be asked to have a blood test.

If your GP suspects leukaemia, they'll refer you to a haematologist (a doctor who specialises in conditions that affect the blood). You'll have a full blood count, where the number of different types of blood cell in a sample are counted.

You may also need to have some other tests, such as a chest X-ray, to rule out other possible causes of your symptoms, and an ultrasound scan or a computerised tomography (CT) scan to check your organs.

Treating chronic lymphocytic leukaemia

As most people diagnosed with chronic lymphocytic leukaemia don't have symptoms, immediate treatment isn't usually recommended.

Some people can live for years or decades with chronic lymphocytic leukaemia without developing symptoms or needing treatment.

This is because most treatment programmes involve chemotherapy, which has associated side effects. In such cases, a policy of  "watchful waiting" is usually recommended, which involves regular visits to your doctor and blood tests so that your condition can be closely monitored.

If treatment is required, chemotherapy will usually be recommended. Radiotherapy may also be needed to shrink swollen lymph nodes.

Treatment can't cure chronic lymphocytic leukaemia completely, but it can slow its progression and lead to remission (periods where there are no signs or symptoms).

Complications of chronic lymphocytic leukaemia

One of the main complications of chronic lymphocytic leukaemia is increased vulnerability to infection. 

This is because your immune system will be weakened due to a reduced number of healthy, infection-fighting white blood cells. Having chemotherapy treatment will also weaken your immune system.

Due to the risk of infection, you should have a flu vaccination and a pneumococcal vaccination. Regular doses of antibiotics may also be recommended.

Around 10% of people with chronic lymphocytic leukaemia will develop anaemia due to the breakdown of red blood cells. This form of anaemia is called autoimmune haemolytic anaemia and can be severe, causing fatigue and breathlessness. Steroids are often used to treat autoimmune haemolysis.

Living with chronic lymphocytic leukaemia

Being diagnosed with chronic lymphocytic leukaemia can be difficult to come to terms with. It can affect you both physically and emotionally.

In the early stages, you may not have any symptoms and your quality of life may be unaffected.

If the condition is more advanced, or if you need treatment, you may lack energy and feel very tired all the time, particularly after treatment.

Your treatment programme may also cause side effects. For example, some types of chemotherapy may make your skin more sensitive to light, which means you'll need to take extra care in the sun.

If you're diagnosed with cancer, you may experience a range of emotions. You may feel shocked, angry, confused, upset or frightened.

There's no right or wrong way to deal with a cancer diagnosis, but it's very important to talk about how you're feeling with a loved one or a healthcare professional, such as your specialist or a trained counsellor.

The Cancer UK website also has some useful information and advice about coping with chronic lymphocytic leukaemia and emotions and cancer.

Warning signs of acute leukaemia

Symptoms of acute lymphoblastic leukaemia usually begin slowly before rapidly getting severe as the number of immature white blood cells in your blood increases (see below for an explanation of this). Symptoms include:

• pale skin 
• tiredness 
• breathlessness 
• having repeated infections over a short space of time 
• unusual and frequent bleeding 

What happens in acute leukaemia

All of the blood cells in the body are produced by bone marrow – a spongy material found inside bones. 

Bone marrow produces specialised cells called stem cells which have the ability to develop into three important types of blood cells:

• red blood cells, which carry oxygen around the body 
• white blood cells, which help fight infection 
• platelets, which help stop bleeding 

Usually the bone marrow produces stem cells which are allowed to fully develop before being released into the blood. But in acute leukaemia, bone marrow starts releasing large numbers of immature white blood cells known as blast cells.

As the number of blast cells increases there is a drop in the number of red blood cells and platelet cells. This drop causes the symptoms of anaemia, such as tiredness, and increases the risk of excessive bleeding.

Also, blast cells are less effective than mature white blood cells at fighting bacteria and viruses, making you more vulnerable to infection.

How common is acute lymphoblastic leukaemia?

Around 8,600 people are diagnosed with leukaemia each year in the UK. In 2011, 654 people were diagnosed with acute lymphoblastic leukaemia.

Despite being uncommon overall, acute lymphoblastic leukaemia is the most common type of cancer to affect children. Approximately one in every 2,000 children will develop it. About 85% of cases occur in children aged under 15, mostly between the ages of two and five years old. 

The cause or causes of acute leukaemia are uncertain, but known risk factors include:

• exposure to high levels of radiation 
• exposure to benzene, a chemical used in manufacturing that is also found in cigarettes 

Outlook

The outlook for children with acute lymphoblastic leukaemia is usually good. Almost all children will achieve a remission (a period of time where they are free from symptoms) from their symptoms, and 85% will be completely cured. 

The outlook for adults with acute lymphoblastic leukaemia is less promising as only 40% of people with the condition will be completely cured.

Treatments for acute lymphoblastic leukaemia usually involve a combination of chemotherapy and radiotherapy. In some cases, a bone marrow transplant may also be needed to achieve a cure.

If a cure is not possible, there is a risk that the lack of healthy blood cells can make the person extremely vulnerable to life-threatening infections (due to the lack of white blood cells) or uncontrolled and serious bleeding (due to the lack of platelets).

                 

Having And Living With A Brain Tumour

A malignant brain tumour is a fast-growing cancer that spreads to other areas of the brain and spine.

Most malignant brain tumours are secondary cancers, which means they started in another part of the body and spread to the brain. Primary brain tumours are those that started in the brain. 

There are different types of primary malignant brain tumour, depending on the type of brain cells they have grown from. The most common type is a glioma, which accounts for more than half of all primary brain tumours.

Generally, brain tumours are graded from 1 to 4 according to their behaviour, such as how fast they grow and how likely they are to spread. A malignant brain tumour will be either grade 3 or 4, whereas grade 1 or 2 tumours are usually classed as benign or non-cancerous brain tumours.

What are the symptoms 

The symptoms of a malignant brain tumour depend on how big it is and where it is in the brain. 

The tumour can put pressure on the brain and may cause headaches and seizures (fits). It can also prevent an area of the brain from functioning properly.

Who is affected

Brain tumours can affect people of any age, including children. 

There are about 5,000 new cases of malignant (cancerous) brain tumours in the UK each year. Most are caused by cancer that starts somewhere else in the body.

The exact cause of primary malignant brain tumours, which start in the brain, is unknown. However, an underlying genetic disease, such as neurofibromatosis, can increase your risk of developing one.

Treatment

Primary tumours

A primary malignant brain tumour needs to be treated as soon as possible because it can spread and damage other parts of the brain and spinal cord. 

The tumour is usually operated on and as much of it as possible is removed. This may be followed with radiotherapy, chemotherapy or a combination of both. However, malignant tumours will often return.

The outcome for malignant primary brain tumours depends on a number of things, such as the type and location of the tumour and how ill you were when diagnosed.

Secondary tumours

Secondary brain tumours are serious as they have already spread throughout the body. Treatment aims to improve symptoms and prolong life.

Recovery

After treatment, several types of therapy will be available to help you recover. 

Your doctor can refer you to a counsellor if you want to talk about the emotional aspects of diagnosis and treatment. There are also many organisations and helplines, such as Brain Tumour UK, that provide information and support.

Living with a brain tumour 

Living with a brain tumour is not easy. The future can look very unpredictable and the unknown can be frightening.

As well as medical worries about tests, treatments and side effects, it is also common for patients to worry about life’s practicalities. For example, patients may worry about who will care for their family when they feel too ill to do so.

This panic and anxiety is a natural response and one that will affect everyone concerned. Changes in daily routines and responsibilities are often necessary and this is something that involves the whole family. Try to ensure that everyone knows what is happening and has an idea of what to expect.  

The following are a few suggestions that may help you, your family and close friends deal with the changes in your lives:

• Seek accurate medical information about the disease and your treatment options. 
• Make sure you are involved in decisions about your care and treatment. This can help to dispel the fear of the unknown and the feeling that you do not have any control of what is happening to you. 
• Take a notepad with you if you find it difficult to remember questions and the answers, and write things down to refer to later.  
• Set your own limits according to how you feel. Do not push yourself to perform at the level you were before the diagnosis and think you have to carry on as usual. 

        

Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) causes persistent fatigue (exhaustion) that affects everyday life and doesn't go away with sleep or rest. 

CFS is also known as ME, which stands for myalgic encephalomyelitis. Myalgia means muscle pain and encephalomyelitis means inflammation of the brain and spinal cord. Both CFS and ME are commonly used terms (see box on this page).

Sometimes the term 'myalgic encephalopathy' is used. Encephalopathy means a condition that affects brain function.

CFS is a serious condition that can cause long-term illness and disability, but many people – particularly children and young people – improve over time.

Who is affected

It is estimated that around 250,000 people in the UK have CFS. 

Anyone can get CFS, although it is more common in women than in men. It usually develops in the early 20s to mid-40s. Children can also be affected, usually between the ages of 13 and 15. 

How it affects quality of life

Most cases of CFS are mild or moderate, but up to one in four people with CFS have severe symptoms. These are defined as follows: 

• Mild: you are able to care for yourself, but may need days off work to rest.  
• Moderate: you may have reduced mobility, and your symptoms can vary. You may also have disturbed sleep patterns, and need to sleep in the afternoon. 
• Severe: you are able to carry out minimal daily tasks, such as brushing your teeth, but you have significantly reduced mobility. You may also have difficulty concentrating.

Why it happens

It is not known exactly what causes CFS.

Various theories have been suggested, including:

• a viral infection 
• problems with the immune system 
• an imbalance of hormones 
• psychiatric problems, such as stress and emotional trauma 

Some people are thought to be more susceptible to the condition due to their genes, as the condition is more common in some families.

More research is needed to confirm exactly what causes the condition.

How it is diagnosed 

There are specific guidelines issued by the National Institute for Health and Care Excellence (NICE) about the diagnosis and management of CFS.

NICE says that a diagnosis of CFS should be considered if you meet specific criteria regarding your fatigue (for example, it can't be explained by other conditions) and if you have other symptoms too, such as sleeping problems or problems thinking and concentrating.

The diagnosis can then be confirmed if these symptoms are experienced for several months.

How it is treated 

There is no cure for CFS, so treatment aims to reduce the symptoms. Everyone with CFS responds to treatment differently, so your treatment plan will be tailored to you.

Some of the main treatments include:

• cognitive behavioural therapy (CBT)
• a structured exercise programme called graded exercise therapy 
• medication to control pain, nausea and sleeping problems 

Treatments such as these can help improve CFS in most cases, although some people do not make a full recovery. It is also likely there will be periods when symptoms get better or worse.

What Chronic Fatigue Feels Like 

Chronic fatigue symptoms differ between patients, but severe fatigue or chronic tiredness that interferes with work or daily activities is common. Patients may also complain of pain and achiness and a kind of brain fog that makes it hard to concentrate or remember recent events or details. 

If you've been exhausted for months, can't carry out your daily activities, and nothing you have tried makes you feel better, it's time to see a doctor. Studies suggest that close to 80 percent of people who are living with chronic fatigue syndrome have never been formally diagnosed and are not getting the treatment they need, but data also implies that getting a diagnosis early in the course of the disease — before you've had it for two years — gives you the best chance of improving your symptoms through treatment.

Blood Clots

Every year, many thousands of people in the UK develop a blood clot in a vein. It's known as venous thromboembolism (VTE) and is a serious, potentially fatal, medical condition.

 VTE is the collective name for deep vein thrombosis (DVT) and pulmonary embolism 

Although serious, most blood clots can be completely avoided. The key is to be aware if you're at risk and take some simple preventative steps.

This article concentrates on blood clots in a vein. If you want information on blood clots in an artery, which is a common cause of heart attack and stroke.

Who gets blood clots?

Although it can happen to anyone, you're more at risk of develping blood clots if you can't move around very much or if you're unwell.

You've probably heard of blood clots linked to long-haul plane journeys or the contraceptive pill, but you're much more likely to get a blood clot after going into hospital. In fact, about two-thirds of all blood clots occur during or just after a stay in hospital.

Hospital-acquired blood clots

In 2005, a House of Commons Health Committee report stated that every year in England an estimated 25,000 deaths occur as a result of hospital-acquired VTE.

The report also stated that the estimated number of deaths due to VTE, "is more than the combined total of deaths from breast cancer, AIDS and traffic accidents, and more than 25 times the number who die from MRSA

The government recognises that deaths from hospital blood clots are preventable and has recommended that all patients admitted to hospital should be assessed for their risk of developing blood clots and, if necessary, protection should be provided.

Following the government's recommendation, a national VTE Prevention Programme has been put in place to try to reduce the number of deaths caused by VTE acquired in hospitals. The programme includes an analysis of all hospital-associated blood clots to identify problems, assess outcomes and improve prevention.

The VTE prevention programme has already had some positive results. For example, at London’s Kings College Hospital where the programme has been implemented, there's been 20% less hospital-related blood clots and a 40% reduction in events associated with inadequate preventative treatment.

Am I at risk?

When you arrive at hospital, you should be checked for your risk of blood clots. Hospital staff will record your age and weight and ask you about your general health. The assessment will also take into account the reason for your hospital stay. 

Your risk of clots is likely to be higher, for instance, if you're having a major operation, if you're going to be confined to bed for long periods, or you're very overweight. 

Some people also have certain 'risk factors' that make them more likely to get a clot while in hospital. These include women who take the combined contraceptive pill or HRT, women who are pregnant or who have recently had a baby, if you're over 60, or if you've had a previous blood clot.

If the assessment shows that you're at risk of a blood clot, you should be offered preventative treatment. The options include blood-thinning drugs, compression stockings, or foot pumps to keep your blood circulating and help prevent any clots forming.

Hospital staff should check whether bleeding might be a problem before offering you a drug to help prevent a clot.

If you've been admitted to hospital and you haven't had your blood clot risk checked, it's important that you ask a doctor or nurse. Equally, if you've been told you're at risk of clots and have been given medicine, stockings or other devices, it's important that you understand how to use them properly.

Don't be afraid to ask hospital staff about reducing your risk of blood clots - it could save your life.

Questions you might like to ask your healthcare team about blood clots are:

• am I at risk of blood clots? 
• how likely am I to have bleeding problems? 
• what happens if I have problems with a drug or treatment I am having to help prevent clots? 

How can I help myself?

You can help yourself before coming into hospital by:

• losing any excess weight 
• stopping smoking 
• talking to your doctor if you take HRT or the combined contraceptive pill – you may need to stop them a few weeks before your operation 

While you're in hospital, you will reduce your chances of a blood clot if you:

• drink plenty of fluids to keep hydrated 
• wear your compression stockings day and night (except when you're washing) 
• wear any other compression devices you've been given 
• take any blood-thinning medicines you've been prescribed 
• get up and move around as soon as you're advised to 

How to tell if you have a blood clot

The term venous thromboembolism (VTE) covers two types of venous blood clots:

          : Deep Vein Thrombosis 

          : pulmonary embolism 

       

A DVT is a blood clot in a deep vein, usually in the leg. You may have no symptoms at all with a DVT, or you may get a cramping pain, redness or swelling in the leg. 

Occasionally, a clot in a vein dislodges and forms what is known as an embolus and moves to the lungs. This is a more dangerous condition, called pulmonary embolism (PE). Known as the 'sudden killer' because it can strike so quickly, PE can cause breathlessness, chest pain and sudden collapse. 

If, after you've left hospital, you develop any of the symptoms of a blood clot, or you suspect you may have a blood clot, see your GP or go to your nearest accident and emergency (A&E) department as soon as possible. Blood clots can be treated if they're spotted in time.