ASK THE DOCTOR: My insomnia pills worked, why can't I still have them??

I を煩う insomnia. Earlier this year I was in India where I was 定める／命ずるd Lorazepam. It worked wonderfully with no 味方する-影響s. But when I （機の）カム 支援する home my GP said this 薬／医学 is banned here because of its harmful 影響s and is used only for dementia. I am 81 and have high 血 圧力 and type 2 糖尿病.

Mr J. Patel, Wembley, London.

Most doctors' first steps in 扱う／治療するing a person who is having difficulty sleeping is to 定める／命ずる a sedative - this will 供給する almost instant 救済, 明らかに without any 味方する-影響 or 刑罰，罰則.

But there will 必然的に be problems その上の 負かす／撃墜する the line, typically in the form of dependency or even 中毒.

Mr Patel's?GP said Lorazepam is banned here because of its harmful 影響s

Dependency means that it becomes ますます difficult to do without the tablet; 中毒 暗示するs that if 奪うd of the tablet, the 患者 will experience 重要な and unpleasant （麻薬中毒の）禁断症状s.

For this 推論する／理由, doctors are 堅固に encouraged to 避ける 定める／命ずるing sleeping tablets of almost any type for more than 14 doses. Lorazepam is 特に troublesome for its 傾向 to induce dependency.

I was a GP when it was introduced in the Seventies (when it was known by the brand 指名する Ativan).

Lorazepam is one of a family of tranquillisers known as benzo-diazepines and the 麻薬 reps 促進するing it 主張するd it was superior to a 前任者, diazepam (sold as Valium), as it was far いっそう少なく likely to 原因（となる） 中毒.

Experience soon showed that the opposite was the 事例／患者. While not 現実に banned, Lorazepam is used only with 警告を与える, for example, a 選び出す／独身 dose as a pre?med 事前の to 外科, but not as a tablet to be taken night after night for insomnia.

取り組むing sleep problems 伴う／関わるs not just 定める／命ずるing an 即座の 解答, but trying to 明らかにする the 原因（となる）: ie, what has changed? What has 混乱に陥れる／中断させるd the previous reasonable sleep pattern?

Most doctors' first steps in 扱う／治療するing difficulty sleeping is to 定める／命ずる a sedative [とじ込み／提出する photo]

Such an evaluation is more time?消費するing than 令状ing a prescription, but the way 今後 can only be through a careful 分析 of the 原因（となる）.

Often the origins of the insomnia - whether it be bereavement, life 強調する／ストレスs or chronic health problems - are all too obvious and not amenable to change. That doesn't mean, however, that insomnia is another problem to put up with.

I 勧める you to look up the 支配するs of 'sleep hygiene' on the internet (easily 設立する with any search engine; 捜し出す the 援助 of a computer- literate friend if you need help), as it is a 井戸／弁護士席 known regimen, and follow these closely.

At the same time, 本気で consider taking up a 正規の／正選手 form of meditation: a good start is to read the わずかな／ほっそりした 容積／容量 Get Some Headspace by Andy Puddicombe, which will give you straight- 今後 指導／手引.

You could be sleeping 井戸／弁護士席 in six months. This may seem a long time to get 支援する to what should come 自然に, but it is a worthwhile goal.

My 13-year-old son 苦しむs from dreadful hay fever, 特に when he's 近づく 削減（する） grass.?He's been 定める／命ずるd antihistamines, steroid nose sprays and 注目する，もくろむ 減少（する）s, but as he's coming up to GCSEs in the next couple o f years, I wondered about a more 永久の 治療.?I asked my GP about steroid 注射s, but he said these are banned for children.?We've tried all the other suggestions - wearing sunglasses, Vaseline in the nose and eating 地元の honey - but 非，不，無 has made much difference.?One of the mums at school said her son is having a tablet every day for three years and then he'll be immunised from pollen. Is this 利用できる on the NHS?

M. Maguire, Holywood, Co. 負かす／撃墜する.

Though the grass pollen season is almost over, this is a very good moment to talk about this as your son should start preventative 治療 with hyposensitisation tablets as 早期に as January.

治療s such as ナトリウム cromoglicate 注目する，もくろむ 減少（する）s (sold over the 反対する under the brand 指名する Opticrom or, better still, the prescription-only Rapitil) along with steroid nasal sprays and perhaps even antihistamine nasal sprays can be remarkably 効果的な when used 定期的に and 正確に／まさに as 定める／命ずるd, 特に if done so as soon as symptoms begin.

Antihistamine tablets are also often given in 合同 with these, though they can 原因（となる） drowsiness. However, in some people - as you are aware - even the above combinations aren't 効果的な enough.

An アレルギー is essentially a misplaced 免疫の 返答 to something the 団体／死体 should regard as 害のない.

A steroid 注射 - typically Kenalog, which 含む／封じ込めるs 40mg of triamcinolone, or Depo?Medrone, with 40mg methylprednisolone - can 供給する 早い and very 効果的な 救済 for several weeks.

It's given 深い into the buttock muscle and powerfully 抑えるs the 免疫の reaction. But the use of steroid 注射s has been discouraged in 最近の years because of a rare but real 危険 of 損失 to the hip 共同のs, where the artery 供給（する）ing the 最高の，を越す of the thigh bone develops clots and the bone dies.

Desensitisation 治療 (the tablets the boy at your son's school is taking) 伴う／関わるs giving tiny doses of the allergen to desensitise the 免疫の system and 減ずる its reaction to it.

初めは this was done with 注射s, but this approach was abandoned some years ago as the 可能性のある danger of 誘発する／引き起こすing a 大規模な and dangerous 最高の-allergic reaction far outweighed the 利益s.

But we now have a far safer 科学（工学）技術 - a tablet that 解散させるs under the tongue. In my so far 限られた／立憲的な experience, this has 証明するd 優れた.

Called Grazax, it's 利用できる only for grass アレルギー and is a chemically 修正するd form of grass pollen. It's taken daily, starting four months before the 開始／学位授与式 of the grass pollen season (which is why I am 示唆するing a January start) and continued for three years.

There may 井戸／弁護士席 be a startling 改良 even in the first season.

The 治療 is prescription-only, either by your GP or an アレルギー 顧問.

The 患者 must be under 観察 for 30 minutes after the first oral dose in 事例／患者 there are untoward 味方する-影響s, such as an allergic reaction, which is why some GPs may prefer 治療 to be 開始するd through a specialist アレルギー 部隊.

Its availability on the NHS is 限られた／立憲的な and patchy, 大部分は 予定 to the cost - £66 per month - and not everyone is 納得させるd about 有効性, though all the 患者s I have 扱う／治療するd with it have been impressed.

Having this desensitisation 治療 does not 妨げる the use of 注目する，もくろむ 減少（する）s and nasal sprays, but to get Grazax for your son, you will need the 受託 of your GP or a referral to an アレルギー clinic.

By the way... The Pill and a shocking cultural 転換

Few can have failed to be 関心d, or even shocked, by the 熟考する／考慮する published last month that 設立する one in 20 schoolgirls is 存在 定める／命ずるd the Pill - and not やむを得ず with the 同意 of her parents.

Time was when girls 捜し出すing contraception would see their family doctor in the company of their mothers. If they （機の）カム alone, then at the very least there would be a conversation with the young 患者 about whether her mother was aware of her 意向s.

Mostly, a girl requesting the Pill would be in a 安定した 関係 and would want contraception before she'd even engaged in intercourse; all very respons ible. But our culture has changed, and I had to alter my 態度 when, 15 years ago, a much younger 女性（の） GP joined my practice.

She made the point that even a girl under the age of 16 - the age of 同意 - should, in her 見解（をとる）, be permitted 完全にする confidentiality, and it was not 義務的な for the parents to be 伴う／関わるd without the 表明するd 許可 of the child.

This gives the GP 広大な／多数の／重要な 責任／義務. In 協議, care has to be given to 査定する／（税金などを）課すing the capacity of the 患者 for self-決意 (does she have 十分な understanding of all of the 関わりあい／含蓄s of 開始するing 性の activity?) 同様に as a 十分な discussion about the 危険s and 利益s, not least the hazards of sexually transmitted 感染s, with the now almost 全世界の／万国共通の 傾向 to change partners frequently.

A 患者 recently asked me what I thought would be the 普通の／平均（する） number of partners for a girl 老年の 21 - her daughter's age. Her own lifetime experience was three or maybe four, but her daughter, still an undergraduate, has had eight boyfriends.

But the fact remains, shocked though many of us are by the new 人物／姿／数字s, we have to 尊敬（する）・点 the 決定／判定勝ち（する） of the 患者. We can only guide them to what we believe is the safest, most appropriate course medically.

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