A word from our friendly local addiction specialist dr

Hello there, a brief update from my world as an Addiction Psychiatrist.


There have been big changes to how NHS services are providing support to people with alcohol and drug problems in Bristol over the last year. We are now providing services as part of ROADS (Recovery Orientated Alcohol and Drugs Service). This is a partnership between organisations in Bristol and aims to provide a seamless service so that when a person contacts ROADS they should not notice that the element of support they need can be provided by one of 5 different organisations. The aim being that all providers focus on the care provided rather than being passed between different organisations.


One of the big aims for ROADS was to improving the numbers of people receiving treatment for alcohol problems. Alcohol is the substance that causes the most harm in the UK but it has not had equivalent resources as traditional services focused on illicit drug treatment. There is no distinction between alcohol and drug services now in terms of funding and where people are seen. This is particularly important for young people as many more young people die or come to harm as a result of alcohol problems than for all other substances put together. We have seen a massive increase in the numbers of people referred for alcohol problems, in fact this has been such a success we are struggling to meet the extra demand which has exceeded our expectations.


We are still closely monitoring changes in patterns of substance use locally and nationally. An important area is Novel Psychoactive Substances (NPS), sometimes called ‘club drugs’ or ‘legal highs’. Although these substances are often less harmful than alcohol or other more traditional drugs, there are new substances emerging to exploit legal loop-holes which are often more harmful that substances that have just been made illegal. Also we are seeing problems as drugs are not being sold correctly. For example we have several people running into problems, and some deaths nationally, with substances sold as MDMA/ecstasy which in fact contain other more harmful substances such as PMA or PMMA. This is particularly a problem as people take a substance they think is MDMA but think it’s week so take more and then overdose on these more harmful substances.


Best wishes for Christmas and the New Year, stay safe, and be respectful of any substances that you put into your body,


Dr Tim

Why Mo? The stats, the stigma and the human side

  • Average life expectancy for men in the UK is almost 4 years less than for women
  • Men have 14% higher risk of developing cancer than women and 37% higher risk of dying from it
  • Every hour one man dies from prostate cancer in the UK (accounts for 13% of all male cancer deaths)
  • Testicular cancer is the most common cancer in young men aged 25-49 years old
  • 1/8 men are diagnosed with a mental disorder
  • 75% of deaths by suicide, are men
  • Highest suicide rate is among men aged 30-44

… and some key barriers to doing something about these issues…

  • Lack of awareness and understanding of the health issues men face
  • Men not openly discussing their health and how they’re feeling
  • Reluctance to take action when men don’t feel physical or mentally well
  • Men engaging in risky activities that threaten their health
  • Stigmas surrounding mental health

…so Movember aims to do something about these by raising awareness and encouraging open discussion and taking action, in addition to raising considerable funds for research and treatment.

The response from all walks of life is impressive and within the University there is some great involvement, MOtivated by many things…

Amber Bartlett is a second year French & German student and will be running in the Movember 10k in Bristol on 15th November:

  • How did you first hear about Movember?

I first heard about Movember while in Goldney Hall in my first year at University. A few of the guys from different blocks decided to enter as a team for Movember and grow some impressive tashes. One of my flatmates also started it but he looked so creepy with his tash he caved and shaved it off before the end of the month!

  • Why did you get involved this year?

I had been wanted to move on from 5ks runs to a 10k for a while and considered doing one whilst on my Year Abroad last year but chickened out due to too much eating and too little exercise! Sadly towards the end of my Year Abroad my Dad’s uncle passed away after a long battle with prostate cancer so when I was researching 10ks in Bristol I thought this would be a good way to commemorate his fight.

  • What can Mo Sistas do to help out this Movember?

Just because we lack the physical ability to grow a moustache doesn’t mean we can’t support the cause. Whether that means signing up for a run, sponsoring a Mo Bro or Mo Sista or just talking to people about Movember it’s all important in raising the profile of this fantastic cause.

Check out Amber’s progress at http://uk.movember.com/mospace/9684121


Seb Rodrigues, a first year Economics & Management student, has got involved in Movember for the first time and is currently the leading fundraiser in the University:

  • How did you first hear about Movember?

Through word of mouth really, quite a long time ago. I think it was in Year 8, when I wondered why my schoolteachers all started looking like they were from the 70s.

  • Why did you get involved this year?

I went to a boarding school where they didn’t take too kindly to any form of facial hair. People had asked about Movember but we were never able to do it – so thought I’d start straight away in my first year of ‘freedom’.

  • Any fundraising tips for your fellow Movember participants?

Shamelessly abuse your contacts and keep doing so – post a pleading Facebook status to your friends, ask your parents, ask your friends’ parents; and, obviously, ask them all to ask their friends. Most of us are on student budgets, but donating a pint’s value won’t be too much hardship; for us though, it massively adds up.

See how Seb is MO-ing at http://uk.movember.com/mospace/9864181

Psoriasis week 1-8 November 2014.

Psoriasis is a skin condition which can flare up at certain times, and tends to be life long, but can be improved and controlled. It happens because the skin cell turnover is faster in some areas of the skin than others, causing patches and ‘plaques’.

It can take several forms or distributions, large ‘plaques’, small ‘guttate’ patches (like raindrop splatter pattern), ‘flexural’ creases, nail indentations, like pin pricks, and ‘pustular’, often on the soles of the feet, and palms of the hands.

About 1 in 50 people get psoriasis at some point in their lives.

It most commonly starts between ages 15-30, or after 40. It is more common in white people, and in smokers.

It tends to get worse with stress, sore throat streptococcal infections, skin trauma/ scratching, certain medications, hormonal changes, sunburn (though a little sunlight can be helpful),  and alcohol.

Addressing these factors will help with controlling flare ups, and the condition can be treated with a variety of prescribed creams and ointments. These need to be used with care and by following instructions about application carefully.

Moisturising is vital, and should be a lifelong habit. Certain creams can also be used as soap substitutes. Check with your GP.

Vitamin D based treatments are the cornerstone of treatment, aiming to decrease the rate of skin cell turnover, and smooth the skin.

Specific scalp treatments are also available.

Steroid treatment creams also work, but should not be used for >4 weeks at a time.

Dithranol is a specific topical treatment for plaques, but can stain fabric, and skin!

Severe psoriasis can be referred to a dermatologist, and more potent treatments used, including light or ‘photo’- therapy.

In some cases people can develop joint problems associated with psoriasis.


Here at SHS we are very keen to help address these issues, and understand just how frustrating and challenging dealing with a chronic skin condition can be, so please book a routine appointment with a GP to discuss any worries you may have about your psoriasis.


Here are some helpful resources too;



http://www.psoteen.org.uk/  (under 21s)






Movember is all about bringing back the moustache or ‘Mo’ for the month of November.

It’s about having a bit of fun and putting a spotlight on men’s health, which doesn’t always get the attention it deserves.

It is for awareness of men’s health in general, but in  particular; prostate cancer, testicular cancer and mental health.

The appearance of new hair on a gentleman’s or ‘Mo Bro’s’ face will be like a walking-talking billboard, promoting the health message. The moustache is a way of generating conversations, awareness and of raising funds for men’s health.


The rules of Movember:-

1)      Sign up at Movember.com. Each ‘Mo Bro’ must begin on 1st November with a fresh, clean shaven face.

2)      Grow and groom a moustache for the 30 days of November

3)      NO fake moustache NO beards NO goatees. That’s cheating!

4)      Use the facial hair to stimulate conversation and raise funds for men’s health

5)      You must conduct yourself like a true gentleman!


It is well known that men visit GP’s and other health professionals less frequently than women, and the average life expectancy for men is on average 4 years less than for women. The reasons for this are numerous and complex but include:-

  • Men being unwilling to discuss their health, or how they feel.
  • Stigma around mental health in particular
  • Men feeling they ‘need to be tough and get on with it’
  • Reluctance to ask for help unless feeling unwell physically
  • Lack of understanding and awareness of men’s health issues.


Movember facts:-

  • Started in Australia in 2003
  • Over 100 million people have grown a moustache worldwide due to Movember
  • Raises in excess of 75 Million US Dollars equivalent each year, worldwide
  • Facial hair grows at around ½ inch a month
  • The world’s longest moustache is over 14 feet long
  • Over 99% of testicular cancers and most prostate cancers can be cured if caught early

Together we can make a difference as well as having some fun over the month of Movember. Please think about joining in and encouraging others.

Bring on facial hair cultivation and create a dodgy Mo!



International Students; blog Autumn 2014.

Almost 20% of the 2.34 million students in the UK are from overseas. At the Students’ Health Service, we and the NHS are here to help you with your health concerns, and worries.  Whether you are feeling physically or emotionally unwell, we will try to improve your situation, and allow you to continue with your academic work.

We have a lot of experience dealing with students from all over the world, and are familiar with a wide variety of health and cultural issues that may arise. We are open minded and non judgmental. We want you to feel able to talk to our doctors and nurses if you are worried. We know that English may not be your first language, or that your symptoms may be treated differently in your home country, or that certain conditions are not discussed openly in some places, but we will do our very best to support you and help you to feel better. Sometimes we have to refer you to other teams for help and treatment, ranging from hospital specialists, to psychiatrists, to the Students’ Counselling Service. All of these people are there to support you to, and most are free of charge.

For more details of any possible costs at hospital treatment level, please see our information on the website http://www.bristol.ac.uk/students-health/docs/overseas-guide.pdf


It may be helpful to understand a little more about how our service works, so here are the basics;

  • Everyone in the UK should see a Primary Care professional (General Practitioner/ GP or nurse) before deciding whether or not to refer to a specialist. We have a ‘gate keeper’ role.
  • Therefore when you have a health problem, the first team you will deal with will be us, and our receptionists will ask you the ‘nature’ of the problem (no need for details), just to ensure you see the right person in our team
  • Primary Care in the UK deals with 90% of health problems, with only the rare few requiring a hospital team at all.
  • Many of our nurses can prescribe, eg for contraception, sexual health, travel, asthma, minor infections etc.
  • Only use Accident and Emergency departments for EMERGENCIES please!
  • If we are closed then phone ‘111’ to get advice about the nearest Primary Care (walk in) centre, or other options, eg dentists
  • Phoning ‘999’ is for life and death emergencies only
  • We are not dentists, and we cannot prescribe for dental infections etc
  • We are not opticians, and so if you need help with glasses/ eyesight issues, please find a local optician
  • We can refer for psychological support, but you can self refer at our Office for physiotherapy/ podiatry/ LIFT psychology  (all free of charge)
  • For Student Counselling Service go straight to their website http://www.bristol.ac.uk/student-counselling/
  • For blood tests you must see a GP first, to arrange and order the correct tests.


We hope this will help you to access health care as and when you need it, but if you are not sure then please do ask our reception team, and they can advise you of what we do and don’t do, or check our website. http://www.bristol.ac.uk/students-health/


We look forward to meeting you and helping to make your stay in Bristol as successful and healthy as possible!


Health Advice for the Returning Traveller; When to see the GP?

It’s the time of year again when all our backpacking students return from the four corners of the world. Some will be arriving for the first time in Bristol, as international students of course, and many of you will have been traipsing through the jungles/ beaches and villages of the world’s most remote places, possibly even to Coca-cola free zones!

Unfortunately, even if you did everything right, had every last jab, and took all your malaria pills, you may still be at risk of post-travelling illness, so here is a quick summary of what to watch for and what to act on;

  • Tell the nurse/ doctor exactly where you have been, and dates
  • Tell them if you worked in ‘at risk’ environments, eg in a hospital/ clinic
  • Most illnesses will be common conditions like pneumonia/ fungal skin rashes
  • Be honest about malaria tablet history and compliance
  • Report any treatment tried or taken overseas
  • Fever is a common symptom requiring medical attention in returning travellers, especially if it is accompanied by; rash/ jaundice/ breathing difficulties/ bruising/ persistent vomiting/ altered conscious level or paralysis (the latter are extremely rare with only 0.3% of unwell travellers ever requiring hospital admission).
  • Malaria commonly presents with fever, chills, sweats, headaches, muscle pains, nausea and vomiting.
  • Jaundice (yellowing of the skin, and whites of the eyes) can indicate Hepatitis, most commonly type A, from infected food and water.
  • Arbovirus infections (Dengue, West Nile and Chikungunya fevers) are the main cause of viral fevers in returning travellers, and tend to have short incubation periods, typically less than two weeks .ie you will show symptoms within 2 weeks of being infected.
  • Diarrhoea is extremely common in travellers, and those who develop three or more loose stools in an eight-hour period, especially if associated with nausea, vomiting, abdominal cramps, fever, or blood in stools, may benefit from antibiotics.
  • Prolonged, severe diarrhoea with blood should be reviewed by a GP.
  • Skin rashes are very common, and should be reviewed by your GP if not settling, or if associated with fever.
  • The vast majority of travellers’ infections have a short incubation period, meaning that symptoms will start within 10 days or less from infection. The notable exceptions are schistosomiasis (bilharzia)/ malaria/ TB/yellow fever, and Q fever.



Therefore, if you continue to feel unwell despite being home, and eating and drinking normally for you, then please come and see one of the GPs. You may also find it useful to look at the following;






Cough it up! When your cough needs a doctor…

It’s the beginning of the new academic year and all you can hear is coughing. Lecture theatres full of students hacking away, and the same in your flatmate’s room, or the shared lounge. Well don’t worry it’s common, and rarely anything to worry about.

It is normal for a cough to last up to 3 weeks, and 10-20% of the population have a chronic cough, ie one lasting more than 8 weeks.

Coughing is a reflex, clearing your throat of irritants and mucus, so asking your GP or nurse to ‘make it stop’ is fairly futile, but some things can dampen the reflex a little, such as honey and lemon juice in hot water. With a dry cough, pholcodine linctus can be helpful. But most cough medicines are a waste of money and therefore we never recommend them. Dextromethorphan is also a possible medication that can suppress the reflex, in certain ‘over the counter’ remedies, so ask your pharmacist for guidance.


When to see the nurse or doctor then (several Student Health nurses are trained to listen to chests, so can help you sort this out too)?

See us if your cough has lasted more than 3 weeks, or if you are short of breath, or coughing up blood. Also, if you have chest pain, recurrent fevers/ night sweats or unexplained weight loss.


Coughing up green mucus/ sputum is not in itself a reason to worry, as this can happen with viral and bacterial infections. Only bacterial ones may need antibiotics.The symptoms mentioned above are a more helpful guide as to when to get a check up.

Being a smoker or asthmatic may make you more prone to infections, so do mention this when you see us.

We can help you to quit smoking should you decide to take this fantastic step for your wellbeing, and we have a specialist asthma nurse for our asthma sufferers, so do book in with her for regular reviews.

Coughing is common, and in our student population rarely anything to worry about. Try the pharmacy first if you can, and see us if you are worried.



LGBT+ and your health; a student writes…

There are a lot of ways people like me – LGBT+ people – struggle in life due to society’s stigmatisation of us. Doctors and healthcare services, which exist to care for us, as for everyone, are invaluable and essential to the poor health that arises from these struggles, for complex reasons, so it is very important that healthcare challenges received ideas. The Student Health Service kindly invited me to write a blog on LGBT+ peoples’ issues relating to healthcare, which is definitely a really encouraging thing. I realised it was a difficult topic to be able to cover fully, but I’ve tried to bring together thoughts, evidence and memories that will hopefully be illuminating.

Firstly from my own life, I thought about the way being queer has affected me in terms of my health and the way I access healthcare. Lots of complicated thoughts came to my mind.

I’ve thought about the way, for example, in which fear of rejection for my orientation has prevented me from being ‘out’ to any therapist I’ve had. The effects of not being straight on my mental health have also been very strong, including the damaging shame and anxiety created by realising that I was not straight, as well as the issues it has created in my friendships and family relationships, including fear of rejection.

One time from my life also really stands out to me – I actually thought of when I was younger, of my experiences to do with gender expectations, and not fitting them. I am a woman, and someone who’s seen by others as a woman. However, as a teenager I developed facial hair- I didn’t realise that the feeling of shame about this supposed fault with me and my body, was actually a false shame put upon me from outside, and I didn’t realise I could push back with my own narrative and ideas about how my body should be – perhaps if the doctors I saw about this problem had questioned whether it was really something by necessity negative, I wouldn’t have been ashamed for so long. As I got older I realised that society has strict binary definitions of male and female that are so ingrained and hegemonic it’s easy for many of us to barely notice them. This dictates as wrong, and somehow lesser, those, for example, whose bodies don’t match these definitions. I am cisgender (I understand myself as a woman, and my body’s sex is considered as female), so it has been much easier for me that for those who are transgender, whom I know this gender binary affects very strongly.

How then can doctors help? How could my interactions with doctors have gone better? I’m not sure, and I think it’s a difficult task for doctors that want to help, to do so. I suppose two things to think of are the way in which our health is looked after specifically in relation to our gender, sex, sexuality etc, and of the way in which our general health is looked after, aside from these issues. I thought  that even if doctors simply take a stance of providing a respite from oppressive ideas, actively countering dominant ideas about LGBTQ+ people, that would be a very helpful thing.

I’ve only been able to speak about my own particular experiences here, so I’ve looked for examples and information to shed light on other ways in which LGBT+ affects people’s health. One thing that affects LGBTQ+ people disproportionately is mental ill health, and this was reflected in pretty much every piece of research I found.

The NUS research ‘Education Beyond the Straight and Narrow’ notes that Chakraborty “affirms that discrimination can be analysed as a predictor of mental disorders.”

The research also tells us that “42 per cent of LGBT respondents to the Youth Chances28 survey reported having experienced depression or anxiety, compared to 29 per cent of non-LGBT respondents”, and that this is linked to experiences of discrimination and harassment.

This NUS research talked about the very high rates of ill health, depression and anxiety for Trans students in particular, and this was strongly related to high levels of transphobia, unacceptably long waits for provision of treatment to transition, and stress and discomfort about seeing medical professionals due to dismissive or phobic attitudes.

I have also read, although not in this research in particular, about asexual people’s (people who do not or experience little sexual attraction) experiences of healthcare, including asexual identities being seen as problems or illnesses.

LGB+(Lesbian, gay, bi+) and T+ (Trans+) students were all more likely to consider dropping out than straight and cisgender students, with T+ students being proportionally most likely to consider dropping out due to health concerns, while LGB+ students being proportionally most likely to consider dropping out due to feeling like they don’t fit in (although both overlap significantly). This data reflects the complex nature of reality even more in that black LGB+ students, for example, had a higher likelihood of considering dropping out, suggesting lower levels of wellbeing that need to be considered.

Research also noted that mental health has an evidenced effect on physical health. This must be compounded by the fact that LGBT+ people report attending doctors less, or feeling put off or distressed by negative reactions by doctors, and this can be anywhere, from GP surgeries, to hospital emergency care.

So, in the end it seems to me that healthcare services often fail LGBT+ people if they have taken in societal biases and left them unchallenged, but I think they could definitely help in our lives if they are positive –because they’re at that central, delicate position in which people are going for help.

If you’re LGBT+, and uncomfortable seeing a doctor about something or uncomfortable to talk about something because you’re scared of being looked down upon, it can be hard. I thought that this quote (from the NUS research mentioned previously) was illuminating, even if it’s not directly related to health:

“I’ve had negative experiences or responses to being trans in every university building I’ve been in, including the students’ union (SU), but only in the SU have I ever been listened to about them and those experiences dealt with. So that makes me feel safer there than anywhere else.”

For university support you can contact; lgbt.officer@ubu.org.uk

For medical students; Bristolmedicslgbt@gmail.com




Accessing health care over the holidays!

There are a number of ways to access health care in the UK during the vacation:

  1. If you are in or visiting Bristol, you can access care as usual from the Students’ Health Service.
  2. If you want advice about an ongoing issue for which we have seen you, please make a telephone appointment with a GP. Not all medical concerns can be resolved in this way.
  3. THINK AHEAD- if you are running low on a regular medication,  please send repeat prescription  requests by post, with a stamped addressed envelope.  There will be cases when this is not appropriate, e.g. you need up-to-date blood pressure or blood tests.

This useful link gives further advice,



  1. If you are away from Bristol and need medical care you can contact a local GP and sign on as a ‘temporary resident’. We advise our students not to sign on as a ‘permanent patient’ if they are returning to Bristol as a student after the vacation, as this causes problems with transfer of medical notes.  Please follow this link for information regarding accessing healthcare in this way



  1. Remember that other clinics may meet your needs e.g. local family planning service, STI clinic or minor injury services. Details of these can be found on the link above.


  1. Remember that ‘A+E/999 calls’ are for medical emergencies.  If your local GP is closed and you want medical advice for a problem that cannot wait until the surgery re-opens (but is not an emergency), please call 111 to get advice (as you would normally do in Bristol).

National Smile Month! 19th May- 19th June 2014

Each year the British Dental Health Foundation promotes dental health awareness with its National Smile Month, this year it will be May 19th – June 19th.




Further advice about looking after your teeth while you are a student can be found at




Students are vulnerable to tooth decay and the beginnings of gum disease – looking after your teeth between 18 and 25 will have long term positive effects as well as saving you a lot of money over your lifetime.


Seeing a dentist once a year will help to identify problems while they are small, therefore easier (and cheaper) to sort out. There are lots of preventive things that dentists can do to stop decay in its tracks. One of the simplest things is just having your teeth cleaned, which is enormously beneficial to your gums and helps prevent bad breath. If you haven’t had a snog for a while it could be your teeth need a scale and polish . . .


Unfortunately dentistry is no longer free for students but you can get help on grounds of low income by filling in an HC-1 form for NHS treatment. Always use your term time address so that other family income doesn’t have to be included.

See http://www.bristolstudentdentalpages.co.uk/finding-a-good-dentist/nhs-access  for further advice.


Looking after your teeth now is so important. As the Smile Month website says, most adults wish they had looked after their teeth more when they were younger. By being good to your teeth and gums as a student, you will have a healthier, trouble free mouth both now and in the future, and that will save you a lot of money.


David Obree


Redland Road Dental Practice



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