• Vitamin D

    Vitamin D is an essential nutrient for all of us… but who is at risk of Vitamin D deficiency?

    It’s now no secret, as many as 90% of people living in our modern world are critically low in vitamin D and are suffering from many unexplainable aches, pains and illnesses because of it. Luckily this is an ailment we can address ourselves, improving our health and quality of life by simply taking a safe and inexpensive daily dose of vitamin D3.

    Why is Vitamin D important?

    Vitamin D plays an important role in maintaining good bone health

    A significant proportion of the population worldwide has low Vitamin D levels. Children are one of the groups especially at risk of deficiency.

    Low Vitamin D levels are a particular issue for all pregnant and breastfeeding women, infants and children under 5 years of age, all people aged 65 years and over, black and other darker-skinned minority ethnic or mixed-race groups, and those with limited exposure to sunlight. Pregnant women need to ensure that not only their own requirement for Vitamin D is met, but that they also build up adequate stores in the developing fetus for early infancy. It is essential that those most at risk are aware of the implications of Vitamin D deficiency and, more importantly, what can be done to prevent it.

    How do we get Vitamin D?

    The main source of Vitamin D (90%) is made in the skin with the help of sunlight (UVB rays). Unlike other vitamins, only a small amount (10%) comes from the food we eat, even if we have a healthy diet. UVB sunlight is available approximately between 10 am – 3pm

    10–15 minutes of unprotected sun exposure is safe for all; however, the exposure needs to be consistent. Groups at risk of Vitamin D deficiency, particularly people with darker skin and older people, may require far longer exposure than this. One thing to remember is that once sunscreen is correctly applied, Vitamin D synthesis is blocked. Remember – staying in the sun for prolonged periods without the protection of sunscreen increases the risk of skin cancer. The aim during the summer months is to achieve enough exposure to sunlight for Vitamin D synthesis, whilst minimizing the risk of skin cancer. Care should always be taken to cover up or apply sunscreen well before any exposed skin becomes red or begins to burn. Sunbeds are not a recommended source of Vitamin D.

    From dietary sources

    Certain foods can contribute to Vitamin D levels. However, there are relatively few foods that contain significant amounts of Vitamin D, making it almost impossible to meet Vitamin D needs from diet alone. Average daily intakes of Vitamin D from diet range from 2–4 µg/day, compared with a recommended intake for adults in at-risk groups of 10 µg/day. Vitamin D is found naturally in small amounts in oily fish (such as salmon, trout, mackerel, herring and sardines), eggs and meat.

    Vitamin D is also voluntarily added to some breakfast cereals, soya and dairy products, powdered milks and low-fat spreads. However, amounts in these products vary and are often quite small. Breastfed babies up to the age of 6 months get their Vitamin D from their mother’s breast milk, which is one reason why it is so important for pregnant and breastfeeding mothers to maintain adequate vitamin D levels of their own. Infant formula milk is fortified with Vitamin D, so formula-fed infants acquire their Vitamin D in this way.

    What causes Vitamin D deficiency?

    A low level of Vitamin D in the body is caused mainly by the lack of adequate exposure to sunlight. Adults and children with dark skin and those who cover up their body fully with clothing are more prone to Vitamin D deficiency.

    Who is at risk of Vitamin D deficiency?

    • All pregnant and breastfeeding women, especially teenagers and young women.
    • Children under 5 years of age.
    • All people aged 65 years and over.
    • People who are not exposed to much sunlight, for example those who cover their skin for cultural reasons, are housebound or who stay indoors for long periods.
    • People who have darker skin, such as people of African, African–Caribbean and South Asian origin, are also at risk of Vitamin D deficiency because it takes their skin a longer time to produce as much vitamin D as it does for someone with lighter skin
    • Patients who have been previously diagnosed with skin cancer are particularly at risk of developing Vitamin D deficiency because they are advised to avoid sunlight and wear sunscreen
    • Sunscreens greater than factor 8 will prevent the skin making Vitamin D.

    If you are in one of these at-risk groups, you can make a positive difference to your health by taking a daily Vitamin D supplement.

    It is recommended that:

    • Children aged between 6 months and 5 years take between 7 and 8.5 micrograms (µg) of Vitamin D a day
    • Adults should take 10 micrograms (µg) of Vitamin D a day

    What happens if you don’t have enough Vitamin D?

    Vitamin D deficiency is very common. Most people have no symptoms, or only vague ones such as tiredness or aches. Severe Vitamin D deficiency can cause soft bones, known as rickets in children and osteomalacia in adults. Symptoms include bone pains (often in the legs), weak muscles and bowing of the leg bones in children. Very rarely in severe Vitamin D deficiency when calcium is also very low, symptoms of muscle spasms (cramps) and seizures can happen. Long term Vitamin D deficiency increases the risk of developing weak bones (osteoporosis).

    How is vitamin D deficiency diagnosed?

    If there are symptoms of deficiency and risk factors for deficiency, a blood test will be done to check the Vitamin D level. Vitamin D deficiency is diagnosed if the level is low.

    What is the treatment for Vitamin D deficiency?

    The treatment is to take Vitamin D supplements. They are available as tablets, capsules, liquid, or injection. Depending on your Vitamin D level, your Family doctor will prescribe you the appropriate dosage.

    After a treatment course with Vitamin D supplements, it is very important to maintain an adequate Vitamin D level in the blood by taking the lower dose of Vitamin D supplement advised by your Family doctor.


    If you want any more information on Vitamin D or have any risk factors, please do not hesitate to contact us at INTERCARE HEALTH CENTER.

    Dr Rahat Ghazanafar

  • Generalized Anxiety Disorder (GAD)

    Do you suffer from anxiety and depression?

    If you have these symptoms you may do:

    • You don’t have interest or pleasure in doing things you used to do
    • You feel helpless, down and low most of times without any clear reason
    • Your sleep is disturbed, either you sleep too much or you struggle to start sleep or maintain sleep. You get up early in the morning without a reason
    • Your appetite is different from what you normally used to, either you lack of appetite or you eat a lot
    • You feel bad about yourself, you feel like a failure…as if you let your family down or let yourself down
    • You Move or speak so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual
    • You have thoughts that you would be better off dead or of hurting yourself in some way
      All these affecting your life, work and enjoyment for more than several weeks (6-8 ws)

    Is it common?

    One in four has a mental health illness according to WHO 2001. Globally, more than 350 million people of all ages suffer from depression.

    You are not alone!!!

    The first step in treatment of anxiety and depression disorder is to accept it!!…”well I have it, so what should do about it?” Is there any way out?

    You have to realize that this illness has a course, and like any other illness it has to run its course

    We don’t know exactly how depression happens but we have some idea about the chemical changes in the body responsible for it. We know for sure that there are some chemicals (medications) which can help in the recovery of depression.

    More importantly, there are many people who have learned very well how to live with depression and have used it as a driving factor for success in many aspects of life.  It is well known that depression is more common in sensitive people, intellectual or deep thinkers
    In fewer numbers of people with GAD, the disease goes in remission for longer periods, could be for years.

    So what to do?

    Speak it up!!! Don’t hide it; being open and honest about it is the first step of treatment especially if early

    Writing your thoughts can help some people. Some people will write a thought diary others draw their thoughts and others log few words….but overall writing about it makes you see your thoughts and be able to deal with them in a more appropriate way. It makes you feel you back on control

    Exercise is proven to help controlling GAD “ NICE-UK 2009”…walking is a good exercise or cycling, or swimming…etc. but the most important thing is to keep consistency. Remember this is a treatment…so if you feel low don’t stop exercising but work your feeling out!

    Try to exercise at least three times a week, for at least 45 minutes.  Group exercise is very helpful…so join a pelate or salsa or spinning class and keep going

    Eating a balanced healthy diet is so important in certain specific times during the day; this gives the day a good structure that you build your time around. Fresh fruits and vegetables are so important to include in your diet

    Cognitive Behavioral Therapy” with either through therapist or through a computer based program. It makes the person understand about himself in a constructive way and about his disease then he will be able to develop modalities and tricks to beat the disease and manage his life accordingly

    Some benefit of starting little hobbies…such as reading, drawing, or learning music these can help to control the disease

    Reading about the disease is important and learning from others’ experiences

    Getting a proper medical advice is crucial, there are some depression with certain degrees necessitates medications and patients should be under medical supervision Your doctor will need to rule out other organic diseases which can lead to depression such as anaemia or thyroid disease…etc.

    WHO has launched a Multilanguage 5 minutes video regarding Depression. I  really recommend watching this video, It is called the “big black dog” – here is the link shown above:


    If you want a further medical advice re General Anxiety and Depression Disorder please come and see our Consultant Family Medicine at INTERCARE HEALTH CENTER.

  • Fever in children

    Fever is defined as a temperature of 37.5c (99.5F) and above, and can be caused by a number of different things.  When your child has a fever, it can be an anxious and worrying time, however it is very common and, in many cases, clears up itself without any specific treatment.

    Mechanism of fever

    Fever is usually caused by an infection or illness, and it is the body’s response to try and make it more difficult for the bacteria or virus causing this infection to survive. When the body is attacked by these bacteria or viruses, specific chemicals called “cytokines” and “mediators” are produced in response, in addition to special cells called “macrophages” which try and “eat up” the invading organism.  Many types of bacteria are also enclosed in a membrane, which, when disrupted or broken, can be toxic to the body and stimulate the brain to increase the temperature further.

    The body does however react, by being busy and producing natural antibodies, which try and remember the infection and recognise it the next time the infection tries to invade.

    Causes of fever

    Common conditions that can cause fevers include viruses, such as those which cause “Upper Respiratory Tract Infections” (a group of conditions which includes coughs and colds like the “common cold”, sore throats and earaches) and viruses which cause the “flu”, diarrhea and vomiting and viral rashes.

    Fever can also be caused by other common (often viral) childhood conditions such as chickenpox and whooping cough, but also bacterial conditions such as ear infections, tonsillitis, kidney or urinary tract infections. Another cause – which often parents worry about and understandably so – is meningitis, and although this condition is very rare, if there is ever any suspicion of this (such as a high fever, headache, confusion, stiff neck, inability to look at lights and a non-blanching rash – a rash which doesn’t disappear when a glass is rolled over it), urgent medication attention is crucial.

    On another note, children can have raised temperatures during teething, following vaccinations or if they overheat due to too much clothing or bedding – all of these are common causes too, and often need no medical intervention.


    Diagnosing a fever

    You may be able to tell your child has a fever if they feel hotter than usual when you touch them, if they feel sweaty or clammy, or if they have flushed cheeks.  If you then suspect a fever, the next thing to do would be to check their temperature using a digital thermometer.

    The most accurate way of checking a baby’s temperature is using a rectal thermometer (especially if they are less than six months old), although in reality this is not usually practical and not commonly done. For younger babies (especially those less than 1 month old) and for smaller babies, the best method is likely to be an axillary (underarm) thermometer – these often have to be held in position for at least 15 seconds (or until a “beep” is heard), and are easy to use and inexpensive. However, as the baby becomes older and larger, and for children of all other ages, the tympanic (“in-ear”) thermometer is the best device to use, and as long as it is correctly inserted into ear, this is a very quick and accurate method.

    Forehead thermometers and oral thermometers are not recommended for checking the temperature however, due to inaccurate results, and the risk associated with glass and mercury in oral thermometers.


    When to seek medical advice

    If your child is under three months old and has a temperature of over 38c (101F) or is between three and six months and has a temperature of over 39c (102F), always seek urgent medical advice from a Family Medicine doctor.

    In addition, if your child has other signs of being unwell – such as refusal to feed, appearing floppy or drowsy, signs of dehydration (for example, a dry mouth, no tears, less wet nappies, sunken eyes or a sunken fontanelle – the soft spot on a baby’s head), having a fit (convulsion), persistent vomiting, persistent or high pitched crying, breathlessness, a productive cough or signs of meningitis (as mentioned earlier), contact a Family Medicine doctor urgently.

    If you have tried simple measures of treating the fever (as below), yet it still persists for more than 3-4 days, your child’s health is getting worse, or you have any other concerns, again contact a Family Medicine doctor.

    If your child has a slightly raised temperature, but is otherwise appearing well, e.g. playing, attentive, eating and drinking as normal, then it is less likely they are seriously ill. If in doubt though, or you just need advice, it’s best to get in touch with a healthcare provider.

    Treating a fever

    If your child has a fever, there are a number of things you can do to help before speaking to a doctor.  Firstly, it is really important to keep your child well hydrated by giving them plenty of fluids -either cool water for infants or children, or breast milk/formula milk for babies.  Try and get your child to drink small amounts but often, to keep their fluid levels up – even if they are not thirsty. In terms of food, only offer them food if they want it, and don’t be too alarmed if they have gone a day without eating much (as long as they have been drinking).

    Keeping your child cool if the environment is warm is also very important, for example by covering them with lightweight clothes or a thin sheet (but ensuring they are appropriately dressed for their surroundings), as well as keeping the room cool (18c/65F is a good guide temperature). Sponging your child with cool water or a cool flannel however is not recommended, nor is completely undressing your child.

    In terms of medicines, paracetamol and ibuprofen are both antipyretics (fever-reducing medicines) as well as painkillers, so they can be given to try and reduce a fever. Please always follow the instructions and doses as mentioned on the bottle, and start off with one of these medications, and if it is not helping, try the other (and not both at the same time, but alternate both if needed, every 4-6 hours for paracetamol and a maximum four times in a day, and every 6-8 hours for ibuprofen, at a maximum three times a day).  Ibuprofen is best given with or after food, but seek advice if your child is asthmatic as they may not be able to tolerate the medication. Also, avoid aspirin in children due to the risk of a rare condition called Reye’s syndrome. The most important message though is that if your child has a mild fever, but is otherwise appearing very well and not distressed, you do not need to give any medications.


    Fever in children is a very common symptom, which can be caused by a number of different things, but may be a sign of a viral of bacterial infection.  In many cases, no medical input is required, but simple measures can be undertaken at home and if needed, paracetamol or ibuprofen (or both if necessary) can be given, alternating between them if required.  If however the fever is high, it persists, or there are any other symptoms, especially those which may be more concerning, it is always best to get your child assessed and seen by a Family Medicine doctor.
    If you have any further questions or would like your child assessed, please book an appointment with Dr Koyes Ahmed or one of the other Family Medicine doctors at INTERCARE HEALTH CENTER.

  • Hair loss and child birth

    Hair loss and child birth, is there a connection? Why am I losing hair ? I lose it on a daily basis, every morning in the shower, in my bed and during the day as well.

    Unlike men, the most common cause of hair loss for women is hormonal, rather than genetic. Changes in hormone levels, such as those seen with pregnancy, Child birth, thyroid Conditions, stopping or starting of birth control pills or hormone replacement therapy or Menopause can cause temporary hair loss in women.

    When certain hormones, like estrogen or testosterone, are produced more rapidly or their production is reduced, it can lead to hair loss. For example, after a woman gives birth to a baby there could be a temporary hormonal imbalance and women may notice an increase in hair loss, usually three to six months after delivery. The good news is that this hair loss is temporary and you do not have to do anything to remedy it. Most women see their hair return to its normal fullness by their child’s first birthday and some women may regain normal fullness even earlier.

    If hormonal changes are not responsible for your hair loss, the condition could be brought on by harmful hair care techniques, stress, illness, an unhealthy diet or in some cases it may be hereditary.

    Hair loss in women with poor diet is very common. Women who follow a strict diet and lose weight too rapidly can experience temporary hair loss, as can women who do not get enough protein, zinc, fatty acids, or iron through food consumption.

    If the hair loss bothers you, these tips can help until your hair regains its normal fullness.

    Avoid tight hairstyles

    Pulling on your hair, or styling it tightly, can cause hairs to be pulled out. Styling or playing with your hair too often may also contribute to hair loss.

    Avoid tight braids, using hair rollers, or tight hair clips and holders.

    Don’t use hot oil treatments on your hair either, as they can be damaging to the hair and scalp.

    Use a comb with widely spaced teeth

    Avoid playing with your hair often, twisting or pulling on it

    When brushing your hair, always brush gently.

    We Be careful with heat. Using any heated tool on your hair can cause damage and increase hair loss.

    Try to avoid frequent use of any device such as hair dryers or curling irons. If you must use a hair dryer, set it to the coolest setting you can. Hair is more fragile when wet than when it is dry. Be careful when combing or brushing wet hair.

    Use shampoo and conditioner that add volume.

    Use a volumizing shampoo. These shampoos tend to contain ingredients like protein that coat the hair, making the hair appear fuller.

    Avoid any shampoo labeled “conditioning shampoo.” These contain heavy conditioners that can weigh down the hair and make it look limp.

    Use a conditioner formulated for fine hair. These contain lighter formulas that will not weigh down hair.

    Use conditioner primarily on the ends of your hair. Applying conditioner to your scalp and all of your hair tends to weigh down hair.

    Avoid conditioners labeled “intensive conditioners.” These are too heavy.

    Finding the best shampoo and conditioner for thin hair is really a matter of trial and error. A single ingredient that makes a volumizing shampoo or conditioner for fine hair better than the rest does not exist.

     Try a new hairstyle.

    Some haircuts make hair look fuller. An experienced stylist can tell you what will work for you. Many new mothers prefer short hair. A short style can make hair look fuller. Short hair also can be easier to manage, which can save time. With a baby, anything that saves time can be a real boon.

    Avoid stress.

    Being under stress can increase hair loss. Stress may cause your hair follicles to go into a resting phase, resulting in thinner hair coverage. Hair loss caused by stress can be reversed by reducing that stress

    Watch your diet.

    Your diet can have an effect on the health of your hair. By eating certain foods you can help ensure that you have healthy hair. Try monitoring your diet for the following vitamins and minerals

    Hair consists of protein. Getting enough protein in your diet will help keep your hair strong.

    Monitor your iron intake. If you eat meat, try consuming lean meat for a healthy source of iron. Vegetarian sources of iron include soybeans, lentils, and spinach.

    Vegetables and fruits can contain flavonoids and antioxidants, which can help with the maintenance of hair follicles.

    Start taking supplements.

    Some supplements are recommended to keep hair healthy and strong. While you wait for your hormone levels and hair growth to return to normal, you can maintain your hair with the following supplements

    Try taking vitamin B, C, E and zinc.

    Applying lavender oil mixed with thyme, rosemary and cedar wood oils, may help treat some forms of hair loss

    Also Honey, Olive Oil and Egg Yolk Hair Mask helps helps in revitalizing dry and dull hair

    If you would like further advice and tips on hair loss and prevention  come and see Dr Rahat Ghazanfar  at the INTERCARE HEALTH CENTER, open 7 days a week 8am-8pm.

  • Sensory Processing Disorder

    Sensory processing disorder (SPD) is a disorder that has just recently garnered public attention, having been called the next attention deficit disorder. However, it has been a part of Occupational Therapy for many years prior, because despite how many people know about it, SPD is a real and serious condition. And if your child has it, all you want to know are the facts—what exactly SPD means and how to help your child. The answers in exact detail can best be gotten from a medical professional, such as an occupational therapist, but here are a few of the basics:

    Sensory Processing:  To best understand sensory processing disorder, you must first understand sensory processing, also called sensory integration (SI). SI refers to how the nervous system senses and responds to various stimulation. For people without SPD, SI allows them to appropriately complete tasks and every-day activities, such as eating a meal, sitting calmly in a crowded, noisy room, or reading a book. For people with SPD, these activities are difficult. The stimulation is not properly processed and thus cannot be properly acted upon without a great deal of difficulty on the part of the individual.

    Those with SPD may have one of three processing problems:

    • [O] Over-processing;
    • [U] Under-processing;
    • [P] Processing with interference.

    Each presents its own unique set of challenges and will manifest differently depending on the type of sensory input and the individual.

    Symptoms of SPD: The signs and symptoms of SPD, again, vary with each individual, and it is important to remember that simply identifying a symptom in your child is not a sign of diagnosis. However, there are certain symptoms you may want to be aware of and/or mention to your child’s pediatrician, occupational therapists, and other medical professionals, as necessary. They have been divided below into types of sensory input.

    Vestibular (movement)

    • Hypersensitive to movement—is clingy, fears having his/her feet leave the ground, loses balance easily, startled if moved, etc.
    • Hyposensitive to movement—is constantly moving, loves thrills, rocks while sitting, etc.
    • Limited muscle tone.

    Proprioception (positioning)

    • Seeks out sensory behaviors such as stomping while walking, jumping from high places, falling on purpose, etc.
    • Has difficulty with force and stability—cannot distinguish between light and heavy, applies too much force in every-day activities, rips paper while writing/erasing, etc.


    • Hypersensitive to sound—easily bothered, frightened, or startled by noise;
    • Hyposensitive to sound—does not respond to verbal cues, enjoys loud music and television, talks to self throughout a task, etc.


    • Hypersensitivity to touch—bothered by rough fabrics, avoids or is negatively affected by others’ close proximity or touch, overly upset by minor cuts and bruises, etc.
    • Hyposensitivity to touch—continually needs to be touched, is self-abusive, repeatedly touches surfaces, etc.
    • Poor tactile perception.


    • Hypersensitive to smell—regularly comments on smell won’t eat certain foods because of their smell, makes decisions based on smell, etc.
    • Hyposensitive to smell—has difficulty discriminating odors, uses smell to interact, etc.


    • Hypersensitive to visual input—is easily distracted by visual stimuli, dislikes bright lights, avoids eye contact, etc.
    • Hyposensitive to visual input—has difficulty differentiating shapes, colors, etc., can’t distinguish objects from each other, writes at a slant, etc.


    • Hypersensitive to oral input—is a picky eater, only eats hot or cold foods, has difficulty sucking, etc.
    • Hyposensitive to oral input—likes foods with intense flavors, constantly seeking oral input, chews on hair, etc.

    These symptoms are merely examples of what your child may display and should not be taken as definite or the only signs of SPD.


    Treatment for SPD will vary depending on the needs of your child and the type of sensory input he/she needs. An Occupational Therapist and additional medical professionals in INTERCARE HEALTH CENTER, if necessary, will work with your child to both challenge him/her and enable his/her success. It is imperative that you take part in the treatment, learning from the therapists, helping your child, and integrating sensory integration into your routine at home.