Why gardening gloves can help weed out sepsis

WE’RE constantly warned to look out for — and recognise the signs of — sepsis, which can develop from a tiny scratch or abrasion. What we are never told is how to prevent it in the first place. What is your advice?

SEPSIS is the consequence of an extreme response to an infection — the immune system is either overwhelmed by or overreacts to this infection.

The infections that trigger this could be quite literally anything — from an infected ingrown toenail, to a bout of pneumonia to quinsy — a complication of tonsillitis.

The over-reaction begins with the immune system triggering the release of chemicals called cytokines that encourage the blood vessels to widen, which can result in a dramatic drop in blood pressure. This can then lead to the most severe element of sepsis — septic shock, when organs start to fail due to the lack of blood supply.

The risk factors include anything that may impair how well the immune system works. For example, advanced age (being over 65), a compromised immune system (as a result of, say, necessary treatment for some illnesses such as cancer), previous hospitalisation (particularly if time was spent in intensive care), and pneumonia, diabetes, and obesity.

Although, as you say, sepsis can develop from a small scratch or abrasion, the type of organisms that might be introduced and the risk factors that I have detailed above are of relevance; gashing your finger on a clean kitchen knife is unlikely to lead to sepsis, but a cut from a mud-encrusted tool in the garden might.

In terms of protection, wearing gloves when gardening or working with tools, and general measures that enhance immunity — a healthy and nutritious diet, some regular exercise, enough sleep, maintaining a normal body weight and avoiding smoking or excessive alcohol intake — may all be beneficial.

And if any minor injury or skin infection appears to be worsening or spreading rather than resolving after a normal expected period of time, then seek medical advice.

For more than 20 years I have had headaches lasting two or three days, but recently they’ve lasted two months. The pain is dull and accompanied by tinnitus and is just about bearable, although there are days I have to take painkillers. My doctor said they couldn’t be serious and gave me gabapentin. I had sideeffects, so weaned myself off.

ISHARE the view of your GP: the headache, despite persistence over two months, is unlikely to be sinister. Nevertheless, a question remains

about the exact diagnosis. You say that you have previously had migraines but I question your criteria for dismissing that diagnosis this time.

Migraine is divided into two broad categories: migraine with aura and migraine without aura. In the former, there is a headache in addition to other neurological symptoms.

These may include visual disturbances (such as a partial loss of vision or seeing bright spots with geometric shapes), sensory changes including tingling or numbness of part of the face or arm, and mood changes. These typically start an hour before a headache begins.

In migraine without aura there is a moderate or severe headache, which may last a few hours or a few days, often with nausea or vomiting (which may also occur during migraine with aura) and pain, which may be confined to one side.

My experience of patients with migraine over many years is that it is possible for someone to experience either form of migraine from time to time, and I think this is

what you are experiencing.

I suspect the few episodes that you describe as migraine in your past may have been migraine with aura that had accompanying dramatic or alarming visual disturbances which is what led you to make the diagnosis. I suspect your more frequent headaches are migraine without aura.

The current two-month headache may fall into another category, called chronic migraine (also known as chronic daily headache. This is a headache occurring for 15 days or more in any given month and which may vary in intensity from day to day.

The eyeball ache you describe in your longer letter can be part of migraine; in some patients, migraine pain is in the eye only.

Treatments for chronic migraine have not been as well studied as those for the other, ‘episodic’ migraine. It is disappointing that gabapentin caused unacceptable side-effects as that medication is one good option.

Other treatments include the anticonvulsant drugs topiramate, valproate and pregabalin, and the antidepressant amitriptyline —

these can reduce the incidence of migraine headaches (possibly by dampening down pain nerve signals), so I would discuss these options further with your doctor. An alternative is to buy coenzyme Q10 capsules, a natural substance already present within the cells of the body.

Take 100mg once or twice daily, and also take riboflavin (vitamin B2), 200mg, daily. There is ample research that both can be of value in migraine prevention.

Note it will be at least a couple of months before you will see any effect, and as these are non-prescription supplements, there is an expense to bear.

THE last time I flew on a commercial airline, I returned with a cold — I’d tried Vicks First Defence Nasal Spray, as I understand the infection is caused by the air being recycled on the plane.

As I have chronic obstructive pulmonary disease (COPD), could you recommend anything that might stop me getting colds?

IT’S an interesting question, but let me first point out that it’s not the aircraft or recycled air that’s the problem — it’s the close confinement with a lot of people. Indeed, I suspect that merely being in an airport, where multitudes

of people from all over are closely gathered together, is an equal contributor — as is travelling by bus during rush hour, with passengers packed like sardines.

It’s also why cases of the common cold peak around Christmas, at a time when so many of us congregate inside together.

When I was a practising GP, I got a cold so rarely I could never remember when I’d had my last one. Even now, I probably have one only every two or three years.

When I do, the acute phase (where I feel under the weather, with a cough and sore throat) may last five to seven days, but the sequel of runny nose, congested sinuses and a cough will last only a week or so; for most, this can last longer, particularly if it descends on to the chest.

From which I think we can read that my immune response is very strong. I have a sense that my apparent immunity to colds comes from years of frequent exposure to the viruses that cause them.

This theory is, I think, underlined by the fact that I do not recall my father, a hospital doctor, ever having a cold until after he retired.

Within a few years of doing so, he seemed constantly to be ill with colds and, once in his 70s, he had endless infections.

That will partly have been because our immunity declines as we age.

But he was also heavily exposed, as my siblings and I constantly visited with children who imported respiratory viruses to which he would succumb.

Obviously, it’s not advisable for someone with chronic obstructive pulmonary disease (COPD) to try to acquire immunity to colds by seeking exposure to them.

COPD is the umbrella term for a variety of illnesses that stem from some degree of lung damage and inflammation in the airways. A cold can be a real problem, as it can lead to chest infection and deterioration in the ability to breathe freely.

So what should someone in your position do? More than 100 viruses can cause sore throats or colds. Minimising exposure to these is important for you so, if possible, avoid public transport and caution others to steer clear when they are unwell with a respiratory infection.

As to other measures, I have heard of many strategies thought to be effective — from high doses of vitamin C to zinc losenges, none of these have really stood up to scrutiny.

Apart from inhaling potentially infecting viruses that are in the air exhaled by those who are infected or incubating, viruses may be transferred via your eyes, nose or mouth from your hands.

That’s why I’m a stickler for hand washing with soap and water after touching door handles, rails or any surfaces others have used — before allowing hands to go near the face. Antiseptic gels are no substitute.

Obsessive, yes, but it is a protection and something to remember after using keyboards, screens or any surface touched by others who may be less particular.