Many pathology tests are ordered unnecessarily in primary care and this can include testing for inflammatory markers. The most common examples of tests typically ordered are for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, with occasional requests for plasma viscosity (PV) too. Although such tests can be useful in giving some information as to a patient’s inflammatory response in certain conditions, their lack of specificity means that they are not perfect tests and interpretation is not always straightforward. In this podcast, Dr Roger Henderson looks at how inflammatory markers work, what may or may not constitute a normal reading and what to do with abnormal results.

Sweating is a crucial way to reduce our body temperature, such as when doing strenuous physical activity or when in a hot environment. Hyperhidrosis is defined as excessive sweating beyond what is physiologically required or normal. It can be categorised as primary (idiopathic), secondary to other conditions, or as a side effect of some medications. Primary hyperhidrosis can affect people at any age, but often starts in early life. The diagnosis of hyperhidrosis is typically made initially on the clinical history, and this can also determine between primary or secondary hyperhidrosis. It is usually diagnosed where there is visible sweating, which interferes with daily activities and which has lasted for at least 6 months. In this podcast, Dr Roger Henderson discusses what to look for when making the diagnosis, what investigations to undertake and the range of treatments currently available.

Testosterone deficiency (TD) is an increasingly common problem with significant health implications, but the diagnosis and management of this condition may present problems in primary care. Low levels of testosterone in men are associated with increased risk of incident type 2 diabetes mellitus, worse outcomes in chronic kidney disease and COVID-19 infection (with increased all-cause mortality), along with significant implications in the areas of mental health and relationships. In this podcast, Dr Roger Henderson provides a reminder of how to diagnose TD — including from the patient’s history as well as clinical findings — and current guidelines on its management.

Dry skin is an extremely common condition that occurs in all skin colours and ethnic groups; however, differences in skin colour can cause significant differences in the incidence, presentation and treatment of different skin conditions. Although dry skin may cause similar symptoms among different skin tones, the appearance may make it more challenging to easily recognise – a fact highlighted by hospital admissions linked to eczema being up to six times more likely in people of colour than in people with light skin.In this podcast, Dr Roger Henderson looks at the reasons for this, what impact skin of colour can have on both diagnosing and managing dry skin conditions and how best to manage dry skin in people with skin of colour.

Although pityriasis capitis (dandruff) is not a serious medical condition, it causes significant embarrassment and self-esteem issues in many people who suffer from it. It is extremely common, affecting up to half the global adult population, and its recurring nature is often a source of frustration. It can impact on primary care workload and can also be mistaken for other scalp conditions such as scalp psoriasis, seborrheic dermatitis or atopic eczema. In this podcast Dr Roger Henderson looks at how to distinguish dandruff from these conditions as well as how to effectively treat dandruff to stop patients from needing repeated consultations.

Lyme disease can present a number of particular difficulties in primary care, and these are often linked to clinical findings and the availability and timing of testing. In this podcast, Dr Roger Henderson discusses those and looks at Lyme disease’s three stages — early, disseminated and late — and whether it can be diagnosed clinically if erythema migrans is or is not present. He also looks at diagnostic difficulties and whether acute or convalescent serological testing is helpful. Treatment with antibiotics is also discussed along with prognostic indicators.

With tourism having now rebounded from the declines during and after the coronavirus pandemic, our patients are once again travelling globally. But what happens when their destination is 5000 metres above sea level? Many GPs will have been faced with a “travel consultation”, but it can be a daunting prospect when carried out infrequently. What are the risks of high altitude? What medication might be needed? And why might beer taste funny at high altitude? In this episode, Dr James Waldron asks Dr Rashbal Ghattaora about his experiences working at high altitude in Tibet. They discuss how to approach a travel consultation, relevant medications, counselling and much more.

The number of young people struggling with anxiety and depression seems to be on the rise and resources to help these young people are increasingly stretched. In this episode, Dr Kate Chesterman and Dr Dave Ledward (GP with an interest in mental health) discuss the growing problem of managing the mental health of children. They focus on the vital role that parents and caregivers play in supporting young people through emotional turmoil and discuss the educational sessions that Dave has run for the families of young people with mental health issues. Dave discusses some of the pitfalls and traps that caregivers can fall into when trying to support their young people and shares his top tips for parents and professionals to help manage an emotional crisis.

In this episode, Dr Hannah Rosa is joined by Dr Shan, a GP colleague and father to Oscar, an 8-week-old baby. Together, they go through the 6-week baby check, while discussing the recently updated guidance from Public Health England. They also explore the key role that the examination plays in screening for a variety of physical conditions, which, if picked up early, can make a huge difference to the future health of a child.

In this podcast, Dr Kate Chesterman discusses recurrent urinary tract infection (UTI). She covers the pathophysiology, some risk factors for UTI recurrence and treatment options including lifestyle changes and the use of antimicrobials. She also focuses on non-antimicrobial management, including the current advice regarding the use of probiotics, cranberry products, D-mannose and methenamine hippurate.