Inside Health

Dr Mark Porter dispels myths about osteoarthritis. It is usually put down to ageing and the result of wear and tear with people told that the condition inevitably leads to surgery. Mark Porter investigates the latest research on the condition and discovers that a third of patients will get better through the natural repair process.

HIV testing The first over-the-counter DIY testing kit for HIV is expected to go on sale in America in the next month. It's said to allow people to screen potential sexual partners for HIV before deciding to have sex them - all in the comfort of their own home. But sexual health consultant from London's Chelsea and Westminster hospital Ann Sullivan believes that the idea is flawed as someone could be recently infected and still show a negative result. Her hospital offers an HIV test to all patients who are admitted to the Emergency Department. A positive result is picked up in around 4 people in every thousand tested. Glasgow GP Dr Margaret McCartney analyses the latest HIV figures for the UK - which are on the rise. She advises that safe sex should be practised even with a negative result to help protect people from all sexually transmitted infections. Vitamin D and TB As much of the UK enjoys the last of the summer sun, Vitamin D is back in the headlines. The body makes its own Vitamin D with sun exposure - but supplements in tablet form can be taken by anyone who's deficient. A dose of the Vitamin D was given to patients with tuberculosis - along with the regular antibiotics - and it helped to speed up their recovery. Dr Adrian Martineau, who's a Senior Lecturer in Respiratory Infection and Immunity at Queen Mary University, London, says that the Victorian idea of giving "consumptive" patients of sunshine was spot on. Vitamin B12 A growing number of people believe they're deficient in another Vitamin - B12. Sources of the vitamin include meat, fish and dairy products - so strict vegans can be at risk of deficiency. The vitamin is crucial in the production of red blood red cells and for the normal functioning of the brain and nervous tissue. Symptoms of low levels can include anaemia, tiredness, pins and needles, memory loss and confusion. If it's not addressed promptly the damage can be irreversible. John Hunter who's Professor of Medicine at Cranfield University sees many patients who can't absorb the vitamin because of problems with their gut like Crohn's or Coeliac disease. Another condition - pernicious anaemia - is caused by the lack of a protein required to make absorption possible. As many as 1 in 30 adults have B12 deficiency - rising to 1 in 16 in the over 65s. A blood test which is used to check levels is thought by many doctors and patients to be inaccurate. The top-up injections of B12 are usually given every 2 or 3 months, in spite of many patients saying that their symptoms return well before their next one is due. Martyn Hooper from the Pernicious Anaemia Society says that testing and treatments need to be improved - to stop patients resorting to their own drastic solutions outside mainstream medicine.Mouth Ulcers One in 5 of the UK population will get mouth ulcers at some stage of their lives. For some, they can recur every month or so - in painful crops that can take a fortnight to heal. Some are associated with underlying problems such as inflammatory bowel disease, or vitamin and mineral deficiencies, but in many cases no cause is found. Patients like Ruth have to avoid certain foods - like chocolate and fruit - to reduce the risk of recurrence. She's had ulcers since her teens and now takes immunosuppressant drugs to reduce their impact on her life. Tim Hodgson who's a consultant in oral medicine at the Eastman Dental Institute in London has had some success treating them with drugs like thalidomide. He says that some patients fear that their recurrent ulcers could develop into oral cancer - but that simply isn't the case.

As many as 2 million people in the UK may have been misdiagnosed with high blood pressure - getting treatment they don't need. But how many of them have so-called "white coat hypertension" - where their blood pressure shoots up at the very sight of their doctor or nurse? For patients with high readings in the surgery doctors can offer "ambulatory" machines for them to take home, which monitor blood pressure round-the-clock. Bryan Williams who's professor of medicine at University College, London, led the team which drew up the latest blood pressure guidelines for the National Institute for Health and Clinical Excellence, or NICE. He says that anyone considering monitoring their own blood pressure at home should take measurements both in the morning and evening whilst sitting down - and work out the average over four days. The British Hypertension Society has a list of approved home blood pressure monitors on their website.NICE has also just approved the use of Botox injections to help people with chronic migraine that hasn't responded to other treatments. But it's been a controversial decision - Botox is expensive, and no miracle cure. It was initially rejected and is still not endorsed by NICE's equivalent in Scotland. Consultant neurologist Dr Fayyaz Ahmad has had some success with patients at his private clinic outside Hull. One of them is Dawn Cook, who's just had her third round of injections. She's suffered from headaches since she was 7 years old.Would you like to read your medical notes? The Government has pledged that everyone will have online access to NHS records by October 2015. So will this change the way doctors write about their patients? Professor Steve Field - who's Chair of the NHS Future Forum and one of the driving forces behind the plan - hopes that it will mean more plain English that's easy to understand. His own surgery will give patients online access early next year.One in 4 women develop fibroids at some time - benign, non cancerous growths in the wall of the uterus which can cause heavy painful periods. Surgery might be suggested to help wtih the discomfort - using keyhole techniques via the abdomen or vagina - a procedure known as myomectomy. But in recent years some less invasive techniques have become available to help relieve symptoms.

Dr Mark Porter asks whether doctors can try too hard in the early detection of disease and investigates the overdiagnosis of hypertension. This week he discovers that as many as 3 million people who have been told they have high blood pressure may not actually have it - could you be one of them?

Dr Mark Porter finds out that some medical conditions are over-diagnosed and therefore over-treated, because of the results of certain tests.

Apart from a few cases that hit the headlines, the use of anabolic steroids is rare among the athletes in the Olympic village. But in the wider society abuse has exploded, according to an expert from Liverpool John Moores University. Jim McVeigh - who's Deputy Director at the Centre for Public Health - says that anabolic steroid abusers are the largest group using needle exchanges. Anabolic steroids are naturally occurring hormones, like testosterone, which influence growth, physical development and the workings of the reproductive system. Abuse allows athletes to train harder for longer so they become bigger, stronger and faster. But those effects will not be seen if you don't exercise or fail to eat and sleep properly. The injected steroids are often combined with tablets. There are a number of side effects like a growth in breast tissue, acne, baldness and shrinking testes - as well as longer-term health concerns for the heart and kidneys. Although they share the same umbrella term - steroids - anabolic steroids are not the same as drugs from the corticosteroid family - found in cortisone joint injections and some types of creams for eczema, sprays for hayfever and inhalers for asthma. For the best chance of good recovery from strokes patients need to be treated within a few hours. In the Lake District new technology is giving suspected stroke patients access to specialists - using high speed broadband and video cameras. Dr Paul Davies is Consultant Stroke physician at the Cumberland Infirmary in Carlisle. He can assess a patient's scans and other tests over a video connection - with the help of nurses and doctors treating them locally. Thrombolytic - or clotbusting treatment - can be given if the stroke is one of the 80% caused by a clot. It's important to get this diagnosis right as the other 20% are the result of a bleed - which could be potentially fatal if thrombolysis is given. It's has been dubbed the Killing Season by some sections of the media - but Dr Margaret McCartney believes that August isn't as risky a time to be in hospital as the headlines claim. One study compared the number of deaths at the end of July and the beginning of August - but the difference wasn't statistically significant and could have been down to chance rather than a real harmful effect of new doctors.Inside Health listener and keen pianist Roger emailed the programme about Dupuytren's contracture - where the fingers curve into the hand and can't be straightened. A new treatment is becoming available on the NHS for this common problem which affects 1 in 10 people's hands. The only option used to be surgery but Mike Hayton, who's a Consultant Orthopaedic Hand Surgeon at Wrightington Hospital in Lancashire, is now carrying out collagenase injections on some of his patients. Up to 60% of Dupuytrens patients can benefit from the treatment - which helps to break down the collagen-rich cords so they can then be snapped a day or two later.

If you believe recent headlines the growing increase in deaths from liver disease is entirely down to excessive alcohol consumption, but it's estimated that two thirds of liver related deaths are caused by other conditions. Dr Mark Porter investigates two liver conditions that do not hit the headlines but could be silently creeping up on millions of people in the UK.

Do you have trouble getting an appointment to see your GP? If so, you are not alone. A Department of Health review from 2009 suggested that as many as 200,000 patients a day struggle to get a consultation with their doctor. And a quarter of those who want to book an appointment in advance simply can't. One Inside Health listener emailed us to ask why some surgeries seem to only release appointments on the day - a bit of a telephone lottery - and others do allow for some advance booking. Chair of the the Royal College of General Practitioners Dr Clare Gerada offers some insight. Monitoring patients in their own homes - telehealth - is one of the latest developments in general practice. The government hopes that the technology will help at least 2 million people over the next 5 years, saving the NHS more than a billion pounds. The £2,000 black boxes measure blood pressure, blood sugar levels and blood oxygen - information that's then sent over the internet to a medical professional. But the project to monitor patients with long term conditions like diabetes, heart failure and breathing difficulties hasn't got off to a good start and GP Margaret McCartney questions whether it will ever live up to the hype. The most seriously ill patients in hospital are looked after in Intensive Care - where they are given life-saving treatment and support with vital bodily functions like breathing. To help staff relieve anxiety - and enable staff to carry out procedures like inserting breathing tubes - patients are often sedated. Dr Chris Danbury from the Royal Berkshire hospital in Reading says it's important to get the level of sedation right - not too little and not too much. One consequence of the drugs and environment can be hallucinations and flashbacks - with some patients reporting dreams of being abducted by alien space ships. Specialist outreach nurses in Reading - like Sister Melanie Gager - are skilled at offering strategies to overcome this - including follow-up visits to the ICU for both patients and their families. Now that summer has finally arrived for most parts of the UK, if you are planning an outdoor swim then there may be hazards lurking in the water. Heavy downpours result in the release of sewage into the sea from overflow pipes - which can affect water quality for a couple of days. Inside Health reporter Anna Lacey met Pollution Control Manager Dr Robert Kierle on the banks of the river Axe in Weston-Super-Mare - and Surfers Against Sewage who are offering a free text service to alert would-be bathers about local measurements of any pollutants.

Whooping cough is on the rise - but the official figures could be the tip of the iceberg, according to one doctor. Retired GP from Nottinghamshire Dr Doug Jenkinson has spent most of his professional life researching the condition which is also known as pertussis. He says that instead of around 1,700 cases every year, there could be tens of thousands. He personally has seen around 700 cases and a blood test available for the last few years has helped to confirm cases. The key to diagnosis is a cough which almost causes choking - sometimes with the characteristic whooping sound - which then subsides for a few hours. The cough can last up to 3 months. The cough can be dangerous for infants under the age of one - who can catch it from parents and grandparents. Dr Jenkinson suggests a vaccine booster could be offered to parents-to-be.Following the recent high profile cases of elite sportspeople collapsing with undiagnosed heart conditions should screening be made available to amateurs? Since the collapse of footballer Fabrice Muamba on the pitch earlier this year the profile of so-called silent heart conditions has risen. Sanjay Sharma is Professor of Cardiology at St George's Hospital - he works closely with the charity Cardiac Risk in the Young or CRY - and supports screening. CRY believes that screening will pick up an abnormality in as many as 1 in 300 youngsters - although it freely admits that the vast majority of these would never have gone on to develop a serious problem. And it is the resulting disruption to these children's lives that puts some people off screening, not least because they far outnumber those likely to be saved by the tests. Dr Anne Mackie is the Director of Programmes for the UK National Screening Committee. She says that she wouldn't even opt for screening for her own children Following last week's feature on unfounded rumours that toys were to be banned from GP waiting rooms to reduce the risk of cross infection, an Inside Health listener emailed the programme to ask about the evidence behind products marketed as killing germs on the various surfaces we touch at home. So what's the science behind adding antibacterial agents to household products? Dr Kamran Abbasi, Editor of the Journal of the Royal Society of Medicine reveals that there is no evidence to show that products labelled 'antibacterial' reduce the number of infections in the home any more than 'regular' cleaning products. GP Margaret McCartney explains why she thinks the latest campaign to encourage more self-care for minor ailments is wrong to imply that people who consult their doctor about dandruff are wasting NHS resources. The NHS 'Choose Well Summer' campaign says 'self care is the best option if you have a summer health complaint' and it's supported by the National Association for Patient Participation, who say it's all about 'empowering individuals'. The campaign was launched with headlines about the 40,000 visits in a year to GPs which were for dandruff. But what was really behind those consultations? And how good are we at looking after our own health?Computer games are being used to help people recover from strokes and brain injury, thanks to experts in Reading. Products like Microsoft's Xbox Kinect - which can recognise a player's movements - are being adapted by Professor Malcolm Sperrin at the Royal Berkshire Hospital. The technology allows patients to select an activity - from dancing to golf or ten pin bowling - and monitor their progress as part of their recovery. The charity Headway - which supports people with brain injury - is using the technology in the community to help people to recover at home.

Dr Mark Porter debates whether the recent lung cancer awareness campaign on TV, radio and the internet, hits the spot or is scaremongering. He discovers new research suggesting some people with exercise induced asthma are being given the wrong diagnosis and treatment. And GP Margaret McCartney investigates rumours this week that children's toys are to be thrown out of the doctors surgery in the on going battle against infection.Producer: Erika Wright.