DNP; a toxic choice for slimming/ body building. Beware!

GPs have recently received notice from Public Health England advising us about patients using a chemical known as DNP (2,4-Dinitrophenol) to supposedly aid with loss of weight, or body building. There has been a sharp increase in the number of cases since 2013.

Use of this chemical, sold as ‘fat burners’ or food supplements, has led to fatal outcomes in several cases. Most of those affected are teenagers or young adults.

DNP is not a licensed drug. It is an industrial chemical and is illegal for use in foodstuffs. It is NOT fit for human consumption.

Use of the chemical can cause multiple horrible side effects, from fever and vomiting, to headaches and irregular heart rate. Even with medical intervention it can lead to coma and death.

Please do not touch this chemical and discourage your friends from using it if they mention it, or consider it.

We are happy to talk to anyone who is worried about their weight, or wants help with weight loss. We have special services to help with eating issues, and weight loss if you are overweight.

Don’t suffer in silence. Dont use this chemical, it could be a fatal choice.



World Mental Health Day 10th October 2015

Every year the WHO leads a day of awareness on mental health related topics, and the theme this year is ‘Dignity in Mental Health’.
The aim is to campaign against discrimination and marginalisation, as well as stigmatisation, and to educate people as to what can be done to preserve the dignity of those with mental health conditions.
Here at Students’ Health Service we are proud to have recently been awarded a grading of ‘Outstanding’ by the Care Quality Commission (CQC) for our care of students with mental health conditions.
The whole team has worked really hard over the years to create a safe and welcoming environment for students who are struggling with emotional and psychological health conditions, and we have built up a solid network of services within the practice, which will support our students through their academic careers.
We provide a weekly visiting psychiatrist clinic, in-house Cognitive Behavioural Therapy (psychological support) for a variety of conditions, self hypnosis for anxiety, eating disorders referrals to a specialised local clinic, and we are soon to have our own team psychotherapist, to support our students with the most complex mental health needs.
We really believe that mental health is as important as physical health, and we will see a person with a mental health crisis for an appointment the same day, as we would see a person with chest pain, or difficulty breathing.
We work closely with the Student Counselling Service, and liaise with them, with patient consent, if it will help improve the student’s care.
We want our students to know that if they are worried about their mental health they can book an appointment to see a GP, and we will be non-judgmental, supportive and caring, will listen to their worries and discuss the situation, and we will do our best to help move things forwards, including liaising with academic departments, if requested by the student.
Don’t suffer in silence. Please talk to us.

The following links may also be of interst on World Mental Health day 2015.



Back Care awareness week 7-11 October 2015.

“The lack of physical activity is one of the top 4 leading causes of preventable death”. World Health Organisation statement.

So have you heard about the campaign to Get Britain Standing? And the ‘Active Working’ principles?
Nor had I till I read the Back Care info at
Active working is definitely a possibility for students! There are a few basic principles which I know some of the uni staff already practise, so why couldn’t you?!

Active Working Tips:
1. Keep moving around. Take frequent breaks
2. Take phone calls standing up, this also boosts confidence and voice quality
3. Try removing tables and chairs from meeting rooms. This leads to shorter meetings
4. Take the stairs instead of the elevator
5. Walk to a colleague’s desk, instead of emailing
6. Stand during presentations or speeches
Another popular move has been to have a sit-stand desk.
A height adjustable work station using it for between 15mins to 2 hours is seemingly a great way to stay fitter and keep those muscles working.
Apparently Winston Churchill did this, so you’d be following in some pretty impressive footsteps (or standing in them, at least!)
And you burn 40% more calories by standing at your desk.

Don’t forget that to prevent back problems in the first place you need to keep active, work your core muscles (yoga/ pilates), take care with lifting and carrying heavy items, and have a great posture when sitting eg in lectures/ in the library. Check out the link for exercises to help back health.

Finally, if you have severe back pain, with pain radiating down your leg, or from neck to arm, then please see the GP. We rarely x-ray backs anymore but we need to see you for assessment if you seem to be having nerve symptoms, like tingling/ numbness/ shooting pains or weakness of hand grip/ leg strength.
Physio clinics are a brilliant place to start for more mild to moderate back pain without nerve symptoms.

So, try Active Working, and keep your back healthy!

Who should help me when I’m ill?

You may have noticed that when you call to book an appointment our receptionist will ask you if the health concern you have is ‘Something the nurse could help with?’.

The reason for this is to try and ensure that our patients are seen by the correct professional from first contact with us. The receptionist will try to find out the ‘nature of the problem’, with the aim of helping you to waste minimal time in getting to the right appointment.

If you or the receptionist are unsure about who can help, then they will ask the GP who is with them in recpetion every morning, so that an expert opinion advises you immediately. The GPs won’t give medical advice over the phone at this point or do a consultation, but they will guide you to an appropriate clinician, which might also include a pharmacist or dentist, as many people phone to book a GP appointment for toothache, or conjunctivitis, when these can best be dealt with elsewhere.

An alternative to booking by phone is to book online of course, and if you are interested in this option just apply for the PIN number required, via our website. It is much more convenient than sitting in a queue of people waiting for us to get to your call.

Our phones ring constantly in the morning, so it helps us a lot if you can be brief and tell us the nature of the problem immediately eg ‘pill check up’, or ‘mental health’, and can be flexible around appointment timing options please, as we have a very large list size of patients, and not enough NHS funding for more staff (despite campaigning constantly for better funding for young people’s healthcare).

We always do our best to get you to the right appointment first time, it doesn’t always work, but our intentions are good, and your support is appreciated.

If your problem is a medically urgent one, then please state this and why and we will always see you the same day.

If you need a certificate, then please speak to our office team first, Option 2. You may not need an appointment.

Please don’t use A&E unless it really is an emergency eg broken bone, collapse etc, as the Out of Hours GP is available 24/7, just phone our usual number. A&E is under strain nationally, and we should try to keep it for what it is designed for please.

Thank you for taking the time to read this and understand our system. We are here to help!


FODMAPS; not a catchy name but a very important food group!

FODMAPS; what’s that about then?!

  • Fermentable
  • Oligo
  • Di
  • Mono-saccharides
  • And
  • Polyols

These are foods that have been found to make the symptoms of Irritable Bowel Syndrome worse.

Therefore people diagnosed with, or who think they might have IBS, should follow a low FODMAP diet. FODMAPS don’t get digested easily, they ferment and create gas (wind) in the bowel, and this leads to bloating, cramps and diarrhoea.

There are many other ways to also manage your symptoms, such as taking a daily probiotic capsule, and avoiding certain types of fibre (insoluble); found in wheat, bran, corn and wholegrains.

Most people find that decreasing fizzy drinks, caffeine and alcohol helps, as they can all increase the speed at which food passes through the gut, and so make IBS worse.

If you would like to discuss your IBS then do book a routine appointment with one of our GPs. You can also check out the FODMAP apps available online to help you plan your diet, and see which lovely foods you can eat in peace.

Sun; sometimes it’s good and sometimes it’s bad!

Feeling pale and pasty? Feel like a quick visit to the tanning salon to use the sun bed? Think again….

Research published in the British Medical Journal has shown evidence that the increase in use of artificial sources of ultraviolet radiation such as indoor tanning devices like sun beds is associated with an increase in risk  of the 3 main skin cancers including malignant melanoma, an aggressive form. This risk is increased if the first exposure to artificial UV radiation is before the age of 35 yrs.

The authors of the study estimated that 3438 cases of malignant melanoma could be prevented each year in Western Europe by avoiding exposure to indoor tanning. The World Health Organisation has now classified tanning beds as a group 1 carcinogen alongside tobacco smoking and asbestos.

Still feeling pale and pasty? Feel like planning a holiday somewhere hot and sunny? Think again…..

It has long been recognised that excessive exposure of the skin to the direct UVA and UVB rays of direct sunlight increases the risk of developing skin cancers of all types. Episodes of sunburn greatly increase this risk as skin cells that are damaged are at greater risk of becoming abnormal and cancerous.

Take measures to be ‘sun safe’

Avoid the sun when the sun is strongest in the middle of the day.

Cover up when you are out in direct sunshine for a prolonged time.

Use high factor sunscreen with UVA and UVB protection and reapply it regularly.

Still feeling pale and pasty? There is an answer……

Opt for a spray tan and take a walk, quite literally, on the sunny side of the street. Exposure to a moderate amount of direct sunlight is actually beneficial.

Vitamin D is vital for good health, growth and strong bones and is made in the skin with the help of sunlight. We also get a small amount from the foods we eat (oily fish, egg yolk and fortified foods eg. some breakfast cereals).

To prevent deficiency of Vitamin D it is estimated that we need 2 to 3 sun exposures per week in the summer months (April to September), lasting 20-30 mins, to bare arms and face. This needs to be in direct sunlight and not through a window. This is not the same as suntanning and sunburn should be avoided at all costs.

How can we help?

If you have any new or changing skin lesions, and particularly if you have been a heavy user of indoor tanning and sun beds, or have a history of multiple episodes of sunburn, the doctors at the Students’ Health Service

would be very keen to take a look at them. The earlier any skin cancer is caught, the better the outcome of treatment.

Further information:


Sun Awareness Fact sheet-

Sun and Health-


BMJ 6 October 2012 Volume 345.

Editorial p7, Research p14/15, Personal View p31

Eating Disorder Awareness Week 23rd Feb- 1st March 2015

This week is national charity B-eat’s Eating Disorders Awareness Week. B-eat aims to challenge stereotypes and increase understanding for the 6.4% of the adult population who show signs of an eating disorder, as well as their friends and families.

When attempts to diet get out of hand, and the pattern with food impacts on other areas of life, such as friendships, relationships, health, work or study, people are often thought to have an eating disorder. Usually people with eating disorders worry a lot about the physical appearance of their bodies.

Many of those experiencing eating disorders are students. In fact, First Step (Bristol’s primary care eating disorder service) receives more referrals from the Students’ Health Service than any other surgery in the city.

First Step is a free specialist service for people with eating disorders, including anorexia and bulimia. We offer advice and Cognitive Behavioural Therapy (CBT) sessions at Hampton House.

‘Over-evaluation of weight or shape, and their control’

Eating disorders have been characterised by Christopher Fairburn as an over-evaluation of weight or shape and their control. This state of mind is maintained by behaviours such as dieting, bingeing, exercise, purgeing, body checking and avoidance. The associated consequences of these behaviours, such as weight changes, preoccupation and social withdrawal tend to further increase the degree of importance given to body image and the need to control it.

One of the early challenges for people with eating disorders who are doing CBT is to experiment with eating three balanced meals and snacks per day. As other behaviours are reduced and consequences change, body weight and shape usually begin to feel less important. Body image dissatisfaction is also directly addressed in CBT.

So, we must love our bodies…?

One of my early lessons when training as a therapist was not to expect anyone to do anything that I wouldn’t be willing to do myself. I have endeavoured to carry on this ethos throughout my practice.

Last year, on a workshop with about 200 therapists, we were asked to raise our hands if we loved our bodies. One person raised their hand. It wasn’t me. This highlighted to me the danger of thinking of body dissatisfaction as a ‘symptom’ confined only to those with a diagnosable eating disorder.

‘Over-evaluation of weight or shape and their control’ is also not about vanity or a personal failing. It is a reflection of the culture that we live in, where the media links ever changing and increasingly unrealistic ideas of beauty to our fundamental human need for connection and acceptance from others. If everyone believed that they looked fine, and would be loved regardless of appearance, the diet and fashion industry would go under and the economy would take a serious hit.

So, you weren’t designed with an inbuilt immunity to the messages around you? Try not to beat yourself up about it. Neither was I. Feeling displeased with aspects of our appearance is a pretty normal reaction to our current times. People with eating disorders have often had these messages reinforced either subtly or explicitly by events in their lives.


Think you might have an eating disorder?

You can talk with your doctor at the Students’ Health Service about your situation and about referral to First Step. Choosing to do treatment is rarely easy, but it might be one of the most important things that you ever do.



Love is in the air………

It’s Valentine’s Day on the 14th February and many people will be thinking about the L word.

Fuzzy feelings and the glow created by cards and poetry can lead to other things, and it is very easy to get carried away and forget the C word – contraception. Or an accident may befall the wearer of a condom and it may tear or fall off at the wrong moment.

It is at this point that Emergency Contraception should be considered and we can provide it to you free of charge. If you are under 25 you can also get it free from pharmacies.

Emergency hormonal contraception (EHC), often called the ‘morning after pill’ comes in two forms:❤ The first must be taken within 72 hours of unprotected sex, and works best if taken within 24 hours. It consists of one tablet of a hormone called progestogen and can prevent ovulation (release of an egg) which will stop pregnancy occurring. It may also make the lining of the uterus (womb) unsuitable for pregnancy to develop. It is not an abortion, and will not affect your future fertility.

❤ The second is also a tablet, called ellaOne. It is licensed to be given 72-120 hours after unprotected sex. This one needs to be prescribed by a doctor.

There are many old wives tales about the morning after pill, but it can be taken more than once in a cycle if necessary, and will not stop you having a baby when you want one.

EHC is not 100% effective and its efficacy is dependent on where you are in your cycle. A copper coil (IUD) is the only sure method of preventing pregnancy. We can fit these at SHS and this will be discussed when you attend for your EHC.

Taking EHC is not as effective as using regular contraception such as the pill, the implant or the copper coil. We offer a wide range of contraception at Students’ Health Service. Please book in to see us and have a chat about the range of contraception that is available.

There is a lot of information on the internet, much of which is not true or causes anxiety. NHS sites will give you the correct information and enable you to make a decision about what would be best for you. The following site is very easy to use, gives information about emergency contraception and regular methods, and the leaflets are the same as we use at Students’ Health Service:


Antidepressants; a GP ponders the urban myths…

I’m writing this blog purely as a GP who, every day, sees patients who take antidepressants. So these are my thoughts, based on experience, as well as evidence.

I also see patients every day who should consider taking antidepressants, because they clearly have all the signs and symptoms of significant clinical depression, anxiety, obsessive compulsive disorder or social phobia. Up to one in three of my consultations is for a mental health problem, and I suspect most of these people have finally come to see a doctor because they have reached a crisis point, or no longer know how to cope. They do not come lightly, and I understand that. They will often have already tried sensible measures, though we usually discuss those anyway, such as minimising alcohol or drug use, better sleep and eating routines, and exercise.

I always suggest counselling or other talking therapies, though again, many have had unsuccessful experiences of these. I will probably mention giving them another go…a different approach or technique perhaps?

But finally we come to medication, always approaching the subject gently, knowing that everyone comes with preconceptions and concerns.

“But they’re addictive”

“I don’t want to feel like a failure, needing medication”

“They’ll make me fat”

“They’ll make my acne worse”

“My parents won’t approve”

“I’ll be on them forever”


I have heard all of these, and many more, hundreds of times in the 15 years I’ve been a GP.

And it takes time and patience to pick my way through the concerns, which are mainly based on hearsay/myth (especially because they are NOT addictive or dependency inducing, and only one specific antidepressant is classically associated with possible weight gain. They have no effect on acne!).


But it’s worth the time, and listening to the concerns, because often a patient will then agree that it might be worth ‘giving them a go’, and that there is little to lose by trying them. Side effects are usually minimal for most people, especially if started at a half or low dose, and we always like to review how things are going at 2-3 weeks. And then when they have given them a go, and they return 4-6 weeks later, I have lost count of the number of people, but it is the vast majority, who have noticed an improvement, and as time goes on, at 8-12 weeks, say “I wish I’d tried these sooner”.


So all I would say is this; if you’re struggling and unsure about medication, then talk to a GP, sooner rather than later, and discuss your concerns, so we can see if antidepressants might help you too. And if they’re not right for you, we will still support you, and meet with you, to discuss other options and therapies.

You are not alone, and we are here to help.


A&E in Crisis- what can I do?

We are all aware of recent reports in the media about Emergency Departments (previously called A&E) being overstretched. One of the many reasons that this is happening is due to the inappropriate use of the Emergency Departments by patients accessing healthcare. This is a timely reminder of what to do when you are unwell so that we can allow Emergency Departments to treat those people who need them most.

Across the country, approximately 47 per cent of people attending an Emergency Departments could have received the same service via their GP, by telephoning NHS 111 or by calling in at an NHS walk-in centre, minor injuries unit or urgent care centre.

Be prepared

The best way to avoid falling ill is to stay healthy by eating a balanced diet, getting some exercise, drinking sensibly and knowing your limits


Self-care is perfect if your condition is something you will be able to treat at home – in fact, home is the best place for you. A big part of your recovery from these minor ailments is to rest and drink plenty of fluids. You can plan ahead by stocking up on some healthcare essentials – paracetamol, indigestion remedies and plasters for example. You can find all these at your local pharmacy.

Use the NHS symptom checker to help you identify your condition.

If you have sickness and diarrhoea don’t go to your GP surgery or hospital, as you may spread this to others. Drink plenty of fluids and call your GP practice if you have concerns. The best way to prevent this spreading is hand washing with soap and warm water.

NHS 111

NHS 111 has been introduced across England and Wales to make it easier for you to access local NHS healthcare services. It is open 24 hours a day, every day of the year and is free to call from your landline or mobile phone.

You should call 111 if

  • You need medical help fast but it’s not a 999 emergency.
  • You think you need to go to A&E or need another NHS urgent care service.
  • You don’t know who to call or you don’t have a GP to call.
  • You need health or medical information, or reassurance about what to do next.

For less urgent health needs, contact your GP or local pharmacist in the usual way.

GP surgeries

Your GP surgery should be your first port of call for non-urgent, on-going illnesses or injuries. Using a GP saves time as they know your medical history. Many GPs are open longer hours now – including early morning, late evenings and Saturdays and offer emergency appointments for urgent cases. You can also see a GP outside of usual opening hours. Just call your GP surgery as usual and a recorded message will tell you how to contact the out of hours GP service.


You can be treated by health professionals at your local pharmacy. Pharmacists can give advice on treating minor ailments like coughs and colds, give sexual health and contraception advice and provide treatments for minor ailments.

Walk-in Centres

NHS Walk-in Centres offer convenient access to health advice, information and first aid. You can walk in 7 days a week. Professional nurses run the centres which are available for all patients whether they are registered with a GP surgery or not.
The service is for the treatment of any minor illness or minor injury. This includes sexual health concerns, emergency contraception, wound management, travel health and smoking cessation. Procedures such as suturing and clip removals can also be performed.

Bristol City Walk-in Centre
Broadmead Medical Centre
59 Broadmead
Telephone: 0117 954 9828
Above Boots
More details about Broadmead Medical Centre

Minor Injuries Units

Your nearest minor injuries unit can help with a number of urgent minor injuries. You don’t need to make an appointment.

Southmead Minor Injuries Unit
Gate 35, Level 0
Brunel building
Southmead Hospital
Southmead Road
BS10 5NB

More details about Southmead Minor Injuries Unit

South Bristol Urgent Care Centre
South Bristol NHS Community Hospital
Hengrove Promenade, Hengrove, Whitchurch Lane Bristol BS14 0DE  
Sat nav postcode: BS14 0DB
Telephone: 0117 342 9692
Open 7 days a week, 8am to 8pm
More details about South Bristol Urgent Care Centre

Emergency Departments

Emergency departments provide urgent treatment for serious, life-threatening conditions. You should travel to A&E yourself if you can but if someone is too ill, for example if they have collapsed or can’t breathe, dial 999 for an ambulance. The most seriously ill patients will be seen before those with less urgent conditions. This means some people have to wait for several hours for treatment, or they may be redirected to a GP, walk-in centre or a minor injuries unit.

Bristol Royal Infirmary A&E Department
Upper Maudlin Street, Bristol BS2 8HW
More information about Bristol Royal Infirmary Emergency Department


Bristol Eye Hospital Emergency Department
Lower Maudlin Street, Bristol BS1 2LX Telephone: 0117 342 4613
Open 8.30am - 5pm seven days a week Call before you visit. They may be able to offer you advice over the telephone.

More information about Bristol Eye Hospital Emergency Department


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