Brief overview of my encounters with depression

NOTE: this post is just my own personal experiences with encountering people with depression, and my views on depression. May not be that helpful if you actually have depression, but might help people who don't have depression gain a little insight on the topic. 

Everyone will experience a measure of depression at some point in their lives, but clinical depression is diagnosed based on whether the degree of depression and the duration of it is such that it is affecting your daily life. For example, is it preventing you from eating, or sleeping, or going to work, is it making you have suicidal thoughts. It is classified as a mental health disorder. It is extremely common, and is a difficult topic to discuss with people if you have it, or vice versa.

A lot of people don't consider depression to be a serious illness and think it is something you can just snap out of. They are confusing clinical depression with mild 'ordinary' depression caused by an external factor such as not getting a job. When there is prolonged depression even though there is no obvious external factor (for example several months later after losing a job) this is more clinical level and medical advise should be sought.

I can tell you about my own encounters with depression. For the longest time living in the UK I had seasonal affective disorder (self-diagnosis), giving me a degree of depression which I struggled with for the longest time. It might have been considered to be sub-clinical, but there were times I felt like I'd plummeted to the depths of despair. I felt I could only be happy if I had some sort of validation from a certain person or people (very typical for the teen years), even though it was completely irrational. It felt like there was nothing I could do to bring me out of it, life felt meaningless, an endless desert wasteland stretching out into eternity. But then very often the following day, I would be fine. Total 180. Even though nothing in my life had changed. That could be a subject for a whole other post.

I had a friend who has depression. The interesting thing is, when you first meet her, she seems like a very happy, bubbly character. This kind of contradiction is not uncommon (Robin Williams). At the beginning I would suggest all kinds of things she could try out or do. For example: getting work, volunteer work, finding a hobby, looking at inspirational You Tube videos, meditation, that kind of thing. She kind of looked into these options, but... The YouTube video I told her to watch, she didn't, telling me her illness made her uninterested in anything. She worked part time teaching English to children, barely 2-3 hours a week, refusing to travel further distances from her home to get more work. Even though being at home alone made her feel worse. You get the picture. 

She was a patient at her local government hospital in Hong Kong, and told me she would see a mental health doctor once every few months. Generally these meetings were not very helpful, and she had tried several different anti-depressants. The last anti-depressant she had been given to try was Mianserin, meaning she had gone through SSRIs, tricyclics, and St John's Wort. None of them worked mostly because it seemed she had not tried them for long enough, and also she was resistant to taking them. The Mianserin for example, the minimum dose is 10mg a day, but the doctor told her she could start on 5 mg a day. My friend automatically said, well I know it's not going to work then, so only tried taking it for a week before stopping them. On one hand her attitude towards anti-depressant medication taking (and everything else for that matter) was pretty annoying, but then again there are a couple of things to be said about anti-depressants. A) In many cases anti-depressants do not help even when they have been taken correctly for an appropriate length of time. B)Anti-depressants have side effects (as do many other drugs). Having said this most people on anti-depressants are on SSRIs, whose most common side effects are mild and not serious. 

Psychological therapy should always be considered first before drugs. For example group therapy, or seeing a counsellor. The problem was that she didn't have any money, and couldn't afford any treatment that required paying for. Her clinic ran workshops for mental health patients, such as basket weaving, flower arranging and meditation. All of which she attended, and they helped a little, but when they ended that would be it and she would still be left feeling awful. She wouldn't get a full time job, but would try and drag me out during the week and get me to hang out with her aimlessly wandering around shops and restaurants for hours in a day. After indulging her a couple of times at the beginning I eventually had to stop. I had my own life to live, and she was hardly the most stimulating company for me to spend hours of my time away from my family with. I knew that her lack of motivation was a symptom of the disease, but it was still frustrating to see her being exactly the same as she always was, complaining about being depressed, years later. I started avoiding her or restricting our meetup times to a couple of hours. Even two hours seemed arduous, but she would take offence if I wanted to head out earlier. She had been so positive and bubbly at the beginning of our relationship, and at the end she was emotionally draining me every time I went near her. 

I am a healthcare professional, and she was a friend I really wanted to help. But in the end I couldn't help and didn't even want to be around her anymore. It is also hard to tell where the disease ends and the person begins. People are just naturally messy and willfull and difficult to manage. Plus depressed people are depressing to be around - sorry to cause offense. But this is just to say... Where do you draw the line between trying to help and trying to preserve your own sanity? 

Depression is a difficult and complex illness to treat, and requires a professionally trained person to help. You can make suggestions, such as acupuncture, or meditation, but just leave it at that. In the end she moved back to the UK, and the last I heard she was doing temping work. Sometimes a change in scenery and circumstance can help. I hope it is helping her.   

Geek alert - Monoclonal antibody suffixes

This is a very specialised post so I don't expect anyone to really appreciate this but... I came across this figure in my internet travels and found it quite illuminating. These are the different types of monoclonal antibodies, ranging from fully human to fully not human. I knew that they all ended in '-mab', which means 'mono-clonal antibody' but I didn't realise that the couple of letter before the 'mab' also had further meaning. I just found that fascinating.

A psychotic episode

This is more of a personal blog post, and no it wasn't me who had the psychotic episode.

I was at the old Town Hall in Central (in Hong Kong), waiting for the lift. There was a lady there, possibly mid 40s, maybe older, who looked perfectly normal, apart from the fact she was standing by the doorway and shouting at someone. I thought she was shouting at someone behind me, so I didn't think too much of it at first. But when it looked like she was shouting at me, I checked behind me only to see that in fact there was nobody there, and it was now clear this woman was having an episode. As the minutes ticked by I became a bit more nervous as she seemed to get more agitated, and there was a rush of relief when the lift finally arrived and we filed in. Until I saw the shouting lady getting into the lift queue and into the lift as well!

She carried on shouting, and although she wasn't standing next to me, her outbursts were definitely becoming more and more aimed in my direction, especially as the lift became more and more empty the further up it went and passengers stepped out. Finally when it came to my floor there were only 4 of us in the lift. With a second rush of relief I left the lift, only to see that shouty lady decided to follow me out as well. I was there to attend choir practise, so I walked quickly to the room, the ladies were already singing, and shut the door firmly behind me. I was seriously worried crazy lady was going to come into the room and carry on shouting at me in front of all the choir ladies.

She didn't, actually she went quiet as soon as I left the lift. She wasn't there when I left two hours later either, so I don't know what happened to her. I was pretty shaken, I couldn't help thinking what if? What if she'd decided shouting wasn't enough and decided to attack me? What if she'd had a knife or some object like that? What should I have done? What could I have done?

As a pharmacist who taught a little on anti-psychotics I know a minimal amount on the actual condition of psychosis, and the drugs used to treat it. And for some reason this makes me feel like I should be in a position to have done something a bit more helpful other than running away. I believe when someone is psychotic there is not much point in trying to reason with them because they are at that moment divorced from reality. The only thing I possibly might have been able to do was to contact the local Mental Health centre or team and ask if they knew who she was and whether they ought to send someone over to take her away. But phone numbers of such teams are not really common knowledge, and in reality who is likely to bother? I wouldn't have known how to find out her name and whatnot either, I can't imagine I would have been able to extract that sort of information from her easily.

And what happened to her in the end? Did one of the town hall people sort her out after all, or did she come out of her psychosis and find her way home, wherever home for her might be?

The other thing was, even though I was shaken, I didn't feel I could tell anyone at the choir. Because I knew that a) it was a bit of a heavy topic, and b) they would not have known what to say. That's the thing about mental health stuff, people don't really want to talk about it, or don't understand it. I couldn't tell my husband about it either.

It's not the first time something like that has happened to me. The first time I was working in a hospital and I was passing by the mental health wing, where someone who was clearly a patient decided to verbally attack me. That was a bit different, I kind of knew the patient then.
Another time a mental health guy decided to fixate on my husband whilst we were sitting on the Underground in London. That was pretty scary actually, this guy looked kind of dangerous you know? And he followed us off the Tube, and even carried on following us out the station where fortunately there was a group of police officers hanging around, and they stopped him. I don't know what we would have done if they hadn't been there, probably run off and hid. No doubt my husband has completely forgotten about it by now.

And I have seen others, not directed at me, but at other random strangers.

• So clashes with psychotic patients may not be a common occurrence, but in my experience it happens often enough. I just want to know, is there a better way of dealing with it? What would you have done?

Ulcers in my throat

This week I was struck down with ulcers in my throat. 

I had no idea what was going on, I was like, wtf is my throat hurting? Why? WHY? 

Normally when I have a sore throat it only lasts for maybe 1-2 days, before transforming into a cough or cold. Neither of which happened, and my throat still hurt like heck. Normally I would take paracetamol, have a long nap, or go to bed early, and that would help a lot. But this time, those methods didn't help. Normally, with a sore throat usually (unless I ate something spicy) anything I ate would soothe it, which was great. But this time, it hurt every time I swallowed, and that was pretty horrible, cos I love my food. Even bananas and broccoli, foods which were soft and I thought bland actually felt like they were burning my throat. I started taking ibuprofen 400mg with my paracetamol (acetominophen), but that was hardly doing anything. So I cancelled a dinner with my family and father in law and went to see the doctor.

She had a look down my throat with a flash light, "Ah hah! I see... you have an ulcer! One, on your right tonsil."

"What?? But... but why??"

"Sometimes these things happen. Maybe you caught a virus, or your immune system is low. Just wait a few days and see if it heals by itself." That's when I recalled a few days prior I'd had this headache that had come on out of nowhere and lasted the whole day, which was when my throat started hurting. That was a definite "huh" moment.

Then she stuck an extra long ear bud (Q-tip) soaked with iodine down there and swabbed over the ulcer. That didn't hurt, surprisingly.

She told me she only saw one, but when I went home and had another swallow, I'm certain I had atleast one other on the left hand side because boy did it hurt. I couldn't sleep for ages that night, I could feel the little wounds throbbing in my throat. The inflammation was spreading into my mouth and making my tongue and gums sore as well.

I sprayed my throat with Corsodyl spray that I happened to have at home, aiming for where I could feel the wounds. That helped so much. Its soothing tingling spray sensation  counteracted that awful raw wound throbbing. The spray itself is cooling, as well as antiseptic.

The doctor had given me ibuprofen with famotidine (to counteract ibuprofen induced stomach irritation), vitamin B complex, and herbal drops.

I took the vitamin B complex, which I'd always considered to be a placebo type thing - it's an old fashioned remedy doctors give out to patients who they think might be a bit run down and could do with a bit of a tonic of some sort.
But this time I thought it was a good idea, because I'd decided to go vegan a couple of weeks ago. Vegans need to self supplement with vitamin B12, and I hadn't been. I don't know if this episode has anything do with being a bit low in vitamin B12, I don't think so, but no doubt my mum and other sceptics would disagree.

I was dubious about the herbal drops too, but turned out they really really helped, wow, as I was so ready to give a shot of morphine a go by then.

I stayed at home and napped as much as I could. I want to say I slept 12 hours, but really it was broken up sleep as I had to wake up through out the night to tend to my 8 month old baby. I felt pretty crap those few days. Corsodyl is normally a magic solution when it comes to mouth ulcers, I swear by it, a couple of sprays and the ulcer immediately goes on the retreat. I was spraying the heck out of my throat the whole of the next couple of days, and not eating very much. The only things I was eating was cups of soy or oat milk with shots of espresso, cold soba noodles and cold congee. I tried a bit of banana puree which I'd made for the baby, and wow, did that sting. Funnily enough plain toast with margarine seemed to be okay. After eating these foods my throat would be stinging and I'd have to drink cold water which I'd refridgerated which really helped.

This lasted for almost a week. Food in the fridge that I'd normally eat up went off and had to be thrown out. I was feeling a bit queasy from the amount of Corsodyl and throat sweets I was ingesting. I finished the herbal drops and bought some Dequasin Extra throat sweets, and wow that really helped too. Dequasin Extra contains hexylresorcinol and benzalkonium, both which are antiseptics, and hexa in addition is also a mild anaesthetic. The paracetamol and ibuprofen did not touch the pain, and although Corsodyl definitely helped, that did not take the pain away either. That night I went to sleep with a lozenge in my mouth and it was like bliss, being able to escape from that pain for a short while. Undoubtedly terrible for my teeth, but I didn't care.

I went to see the doctor on Monday, and it is Saturday today. Today I started eating more normal food, so yay. I don't know what brought those ulcers on, but thankfully they seem to be on their way out.

Products mentioned:

Corsodyl spray: this contains chlorhexidine, a potent antiseptic agent. I swear by Corsodyl (or chlorhexidine) for mouth ulcers. As well as helping with would healing, it also provides a bit of pain relief by swamping the area with a tingly numbing sensation, which is partly to do with chlorhexidine, and partly to do with the spray action, which naturally has a cooling effect. It is not as such an anaesthetic though. Corsodyl is also available as a mouth wash, but in this case as my ulcers were down my throat the spray was more useful.

Dequasin Extra: I am not sure, but when I did a Google, it looked like this was a Hong Kong product? But in anycase I'm sure any throat lozenge containing hexylresorcinol, or some other anaesthetic agent would have worked as well. Some examples of other similar products: Strepsils Extra strength, Cepacol.

Vitamin B12 can be found in any multivitamin product, but also in vitamins which contain only vitamin Bs, such as Vitamin B complex, and Berocca.

Heartburn and gastritis

You know hydrochloric acid? The stuff you played around with in chemistry class, and if it was really concentrated you had to be really careful with it lest it burned your clothes or skin off? 

Well, your stomach produces it naturally, in large amounts, in order to break down the food you eat. I think that is pretty amazing.

But... surely it can’t be that concentrated, right? 

It might interest you to know that the pH of stomach acid can go down as low as 1.5. Which is fairly powerful:
- with the help of enzymes, it breaks down the food we eat.
- can kill swallowed micro-organisms, including the stuff in our phlegm! Thus forming part of the body's defence system.

Amazing. 

So what stops acid from digesting us from the inside out? The lining of the stomach produces a layer of  acid-neutralising mucous.

Incredible.

However there are times when the mucous barrier is overcome; imagine then the damage which can occur. Perhaps you have experienced it, stomach complaints are one of the most common of the minor ailments which afflict us.

Heart burn (or reflux) and gastritis are two very common ailments caused by hyperacidity (states of too much acid) in the stomach. (Indigestion is a general term for feelings of discomfort felt in the stomach area associated with eating).


Heartburn (Reflux):

Stomach acid is prevented from coming out the stomach back up (reflux) into the oesophagus via a valve called a sphincter. If the sphincter is overcome and reflux occurs, this causes the sensation of a burning discomfort located in the middle of the chest, because the oesophagus is not designed to withstand acid. It can also irritate further up and manifest as coughing. 

Possible causes of sphincter failure - overeating, pregnancy (where the stomach is squeezed). Less commonly, some people for unknown reasons just produce more stomach acid than normal.

Personal experience: Coughing and throat clearing after eating were symptoms I suffered with a lot and for a long time. It would get worse after a prolonged cough caused by a respiratory tract infection, so I always thought it was just due to that, and I did nothing about it because I simply had no idea. 


Gastritis:

Inflammation of the stomach. The acid-neutralizing mucous barrier is overcome and acid manages to irritate the stomach lining. 

Personal experience: I initially assumed I had heartburn, because the discomfort I felt was so localized. Then my sister pointed out that it was possible for the discomfort to be gastritis, as I was basically indicating where my stomach was. (Note, a lot of people don’t realise how high up their body their stomach is, it is practically up in your chest. Where the bulge of your ‘tummy’ is where the bulk of your intestines lie.) The discomfort at the time was also persistent, although in the past I definitely went through spells of clearing my throat and coughing a lot after eating which is a definite symptom of reflux. So probably I had both conditions.

Stomach Ulcers:
Although this post is about heartburn and gastritis, stomach ulcers are related. The causes of stomach ulcers may also cause gastritis and heartburn.

Ulcers occur when acid destroys parts of the stomach lining. How can this happen, why do some people get ulcers? Here are the major culprits:

Helicobactor pylori - a bacteria which lives in the stomach. These shield themselves from the acid by hiding out in the mucous layer, and also the stomach lining. This triggers inflammation, which then causes excess acid secretion, and then causes ulcers if not sorted. If the inflammation is very prolonged, then this may lead to stomach cancer.

NSAIDs - Non-steroidal Anti-inflammatory Drugs. These include the pain killers aspirin, ibuprofen (Nurofen), mefenamic acid and diclofenac (Voltaren) to name a few. Although these are valuable in pain management, stomach ulcers are one of their most common side effect, so beware if you take an NSAID on a prolonged, regular basis. They must be taken with food, and if taken often, should be taken with a stomach acid protectant such as a PPI or an H2 antagonist (see below).

Stress - Stress is often linked to causing ulcers, and hyperacidic symptoms such as heartburn and gastritis. Not sure why that is. But it is worth trying to destress to see if this helps. Try yoga, meditation, cutting out caffeine, sleeping 7-8 hours at night, etc.

Drugs which tackle stomach acid:

There are three classes of drugs in this category:

Antacids:
Literally, these are bases which react with acid and neutralize it. They are chalky type tablets or liquids. Products such as Rennies and Tums. Sodium Bicarbonate (Bicarbonate of soda) is a traditional one, which can be found in Gaviscon and Alka-Seltzer.
These are safe, providing you don’t over do them - for example sodium bicarbonate contains sodium, something to think about especially if you don’t want too much salt in your diet.
I don't recommend Alka-Seltzer, as it contains aspirin (NSAID, see above), which can irritate the stomach and contradicts its use for hangover management.

Often you will see antacid preparations containing Aluminium and Magnesium Hydroxide. In case you're wondering why - magnesium causes diarrhoea and aluminium causes constipation, so putting them together should cancel out any bowel related side-effects.

Gaviscon also contains alginate, this is a gel type substance obtained from sea algae. This forms a gel-foam barrier on the top of the stomach acid to hold acid down, and is good for reflux.

Antacids are good first line drugs to try out. But don’t take these for weeks on end without checking it out with a doctor first. H2 antags and PPIs are stronger, and may be worth trying in this case as well. 


H2 antagonists: 

These include Ranitidine (Zantac), famotidine (Pepcid) and cimetidine (Tagamet) - mostly drugs which end with -idine. These reduce the secretion of acid in the stomach, and are stronger than antacids.

These are available from the pharmacy, more pricey than antacids but worth trying to see if they help.

Proton pump inhibitors (PPIs):
Includes omeprazole (Losec), lansoprazole, pantoprazole, esomeprazole. These are considered to be ‘stronger’ still than H2 antags, and also suppress acid secretion. These are also available from pharmacies, typically in smaller packets and at more expensive prices.

You can combine drugs from different classes, for example you could take an antacid with a proton pump inhibitor. Take them at different times however, as antacids can reduce the effectiveness of PPIs. Also, if your stomach is bothering you so much that you are having to take combinations of these drugs, you really should get a doctor to check you out.

Digestive aids which contain enzymes

Digestive enzymes (amylase, protease and lipase - collectively known as 'pancreatin') are proteins naturally produced in the stomach and pancreas which help speed up the breakdown of food by acid. Examples of products which contain digestive enzymes are Combizym, Creon and Enzyplex, and can be found in pharmacies or healthfood stores. In the UK Creon is often given out on prescription, typically for patients with a problem with their pancreas such as cystic fibrosis. In theory it can also be used as a digestive aid, the composition of Creon 10000 is not far off from Combizym. Combizym is often given out or sold in HK as a digestive aid, and not only contains 'pancreatin' but also plant based digestive enzymes.

Whilst these do not directly reduce acid secretion, they help with the breakdown of food thus probably taking the strain off your stomach reduce the need for it over secrete acid.

Motility stimulants

Metoclopramide (Maxalon) and domperidone (Motilium) are relatively new to the scene. These speed up the digestive system, making the stomach empty quicker so there is less acid inducing strain on the stomach. Whether there is any detrimental effect due to having food move through the stomach quicker is not certain, but these drugs have been used for some time and been tolerated well.
They were initially used to prevent vomiting, and then found to work in indigestion and heartburn as well.
These are available in small quantities from the pharmacy, again worth a try for occasional use.

Non-druggy treatment

Heartburn and other indigestion symptoms can be alleviated somewhat by watching what you eat.
Eat smaller portions, but more frequently if required so you don’t feel like you’re starving yourself. If you get a sandwich, try eating half now, and half 1-2 hours later.

Avoid spicy, fatty, or oily food, these bog the stomach down or stimulate acid production.

Try mints or mint/peppermint tea. Peppermint or mint have a natural cooling refreshing effect, that’s why they are seen in so many stomach remedies. Try preparing a jug of mint tea and then cooling it and refrigerating it, so that it’s extra cooling when you drink it.

Avoid caffeinated drinks, such as tea, coffee and coke. Stomach problems are associated with stress. Drink water instead which has a neutral, refreshing effect on the stomach and will also rehydrate you.

Personal experience: I'd had heartburn on and off for years, but there was one period when it was particularly prolonged, in recent times. It was just this constant nagging burning sensation in my chest that just wouldn't let up. I remember I went away with my family for a 3 week holiday to the US, when I got there I bought a bottle of something like 50 tablets of famotidine and started taking it. when we came back from holiday, I was still taking it, and then I started taking things like omeprazole from my own stash of drugs, some of my Dad's esomeprazole, my brother's pantoprazole. I went to see a doctor, who gave me more pantoprazole and antacids. On bad days I would take one tablet in the morning, and then a different tablet in the evening, and various combinations of PPIs, H2 antags and antacids (don't try this out at home! I'm a qualified pharmacist!)

I'm pretty sure that this particular bout of gastritis/heartburn was brought on by a stint of me trying to work on my flabby abs post pregnancy. I did sit ups and push-ups, as well as a little arm action with some mild weight lifting. Sit ups and push ups obviously work out your abdominals, which in turn puts pressure on the stomach (squeezes it). I have since stopped doing these. My stomach is flabby, but I do still do regular exercise, such as swimming, and using the skiing machine in the gym, which is all the WHO require. I might consider looking into pilates or something at a later date to see if that will help with my stomach measurements.

And then this is not for everybody, but I tried acupuncture which in my case seemed to be what brought this episode to an end. After the acupuncture session I was given three days worth of Chinese medicine to take as well, so I don’t know if it was the acupuncture or the Chinese medicine, or both which did the trick. Or perhaps it was just a complete coincidence, but in any case I would totally go back to give it another go if I were ever to have a repeat incident. The gastritis did make a brief come back later on after which I went to see a different doctor, this time she gave me ranitidine. And after a few days of this it went away and I have been okay since then (2 years). 

Nowadays as soon I start finding myself having to clear my throat after eating, I take something like an H2 antag, so far that has sorted me out. Which to me is pretty revolutionary, I had never realised I could actually stop this particular symptom. 

Bleeding gums? Smelly breath?

Remember this ad? 

You wouldn't ignore it if this happens to any other part of your body, so why do you ignore it when it happens to your gums?

This was an ad for Corsodyl mouthwash, and I thought was brilliant. Even though my gums were bleeding at the time, and I still didn't do anything about it. 

People fuss about hair or make up, take a wash every day, etc. etc.

But many don’t think about their teeth when they think about their appearance. Probably because they are a bit of a fiddle and a chore to clean. 

We all know it’s important to brush our teeth, but how many of us really think about what happens if you don’t clean them properly? How many of us only clean our teeth just to avoid making people cringe when you open your mouth?

What is the big deal with having to clean them every single day anyway?

Bacteria!!! Bacteria own us. From the moment we are born till we die every part of our body is waging a war to keep bacterial growth in check.

* One of the most important ways it does this is by shedding cells, e.g. our skin is constantly shedding and regenerating.* However teeth surfaces are not able to shed and regenerate, as they are made of bone. So bacteria accumulate on teeth in a way they are simply unable to do anywhere else on the body.

What does accumulated bacteria look like?

They form a biofilm (plaque) covering your teeth (even between your teeth, even under your gum line!). When the biofilm becomes dense enough (only a matter of days), it becomes hard. Eeek! Hardened plaque is called tartar (calculus). Biofilm can be removed by brushing. Tartar can not. Think of cement, after its set. It has to be scraped off by a dentist/hygienist. The bacteria within the hard tartar are dead. If it is not removed, the tartar will continue to grow and thicken, imagine what that will do to your poor gums over time.  

Here the tartar (calculus) is practically pushing the gums back

What do bacteria do to your teeth?

They secrete enzymes and acid which corrode your teeth, when exposed to food and especially sugar. The only natural defence teeth have against the acids is saliva. Saliva contains water which dilutes and neutralizes acids. It is also antiseptic.

Corrosion of teeth/bone causes:

• Cavities (caries) 
• Detachment from the gums - The surface of the teeth (enamel) needs to be intact in order to attach to your gums the way they were intended to.

What do bacteria do to your gums?

Nobody thinks about their gums. Your gums are delicate soft tissue which hold your teeth in place. Continuous build up of tartar can physically rub against and irritate the gums, and push them back.

Bacterial assault causes inflammation. Inflammation means redness, swelling, soreness, and in the case of your gums, bleeding. And your mouth will smell. 

If this is happening to you, your gums are infected - you have gum disease. Go see a dentist.

There are two stages of gum disease: gingivitis and periodontitis. When gingivitis becomes advanced this leads to periodontitis, where there is bone loss and serious detachment going on.

What happens when gums detach from teeth?

Gums only detach from parts of the teeth which have been permanently damaged by plaque acids or aggressive brushing.

Detachment caused by aggressive brushing leads to receding gums.

Detachment caused by plaque acids can lead to pockets, gaps between the gum and the tooth where there shouldn’t be, as well as receding gums. And of course in extreme cases loss of the tooth.

Gums have receded, exposing the lower part of the tooth making it look longer

Gum has detached from tooth, forming a pocket

Receded gums and pockets are irreversible. You can stop them from getting worse, but you can’t make them rejoin the tooth again (apart from with surgery).

You end up having more teeth surfaces to clean, and (for example in the case of pockets,) more difficult to clean as well.

Your teeth become sensitive. Only the bottom part of the tooth which is normally supposed to be covered by your gums is sensitive.

When your gums recede, cosmetically your teeth will look longer. This is actually very aging. And not very attractive!

Tooth loss is very common in the older generations, dental hygiene awareness is more advanced now.

Tips for effective dental hygiene

• Brush AND FLOSS your teeth every single day. Twice a day is the gold standard, but your teeth will still fly by on once a day cleaning. Dentists will accept once a day, they won’t want to hear it, but they accept it. Once a day is enough to break up bacterial colonies to slow down the creep of tartar.
• If you clean only once a day, then do it at night before bed time. Saliva provides your teeth with some protection against bacterial assault, but dries up when you are asleep.
• Flossing is just as, if not even more so, important as brushing. No brush is going to be able to between the teeth. Leaving those parts uncleaned is basically not cleaning half your teeth. Imagine kind of just brushing half your mouth, doesn’t make sense.Also with floss you are able to partially clean underneath the gum line, which is pretty cool. A lot of people will brush but don't floss, previous me included. So I'm going to go into flossing again at the end. 
• Get your teeth cleaned professionally at least twice a year. Even if you brush and floss religiously twice a day every day, there is just no way you are going to clean completely beneath the gum line, not without the professional tools. And please don’t try either, you might end up damaging your gums. They can also remove stains, which you can’t do with just brushing. Stains on the teeth really age you. 
• From personal experience, a hygienist will give you more help with your brushing and flossing technique than a dentist will. 
• Use an electric toothbrush. They are more efficient at removing bacteria from your teeth than a conventional toothbrush. Use a mirror, make sure you are covering all the surfaces properly.
• Don’t brush your teeth too hard. You’ll damage your teeth enamel and make your gums recede permanently. You’ll know if you’re brushing too hard if your tooth brush is splaying within 3 months of use. I used to make my brush splay within a week, crazy.
• It is worth spending the money and time on your teeth. Think of how much money you spend on a haircut, or shoes. People notice your teeth, nice teeth make a huge difference to your appearance. Nice smelling breath is practically priceless.

More tips! Love it

• Floss before brushing, so that the good stuff in your toothpaste is more able to go between your teeth.
• You can brush partially between each tooth with interdental brushes, which may be worth doing if you have large gaps between your teeth. Maybe wait and ask a dentist or hygienist to show you how to use them though. Some gaps are too tight to use brushes and can only be flossed. Interdental brushes can’t really replace flossing however, floss is able to clean partially below the gum line. You’d need to do both. 

• Avoid brushing straight away after eating. Plaque produces acid which softens the enamel of your teeth. If you brush at this point, you’ll damage the enamel. Wait an hour or so after, or brush before eating, for example before breakfast or lunch.
• If you have very sensitive teeth rub toothpaste for sensitive teeth onto the affected areas and leave.
• If you use mouth wash, don’t use straight away after brushing. This removes the beneficial layer of fluoride left on your teeth from the toothpaste. Recently not rinsing even with water has been suggested, just spit the excess toothpaste out and wipe your mouth.
• I don’t really bother with mouthwash, but I will use Corsodyl (Chlorhexidine) mouthwash if my gums are inflamed, or on ulcers. Chlorhexidine kills bacteria. I wouldn’t use it every day though, I don’t think I need it, plus it stains the teeth. Stains can be removed by a hygienist.  You can also get Corsodyl spray, which enables you to spray onto specific parts of the mouth, rather than sloshing mouthwash all over if you don’t need to.
• Change your toothbrush every 3 or so months, for hygiene reasons if nothing else. 

FLOSSING, and what happened with me

I was never the best with brushing my teeth, but I NEVER flossed. My gums started bleeding when I was young, I think in my teens. And I didn't think anything of it. Kids eh? This was years before that ad with the bleeding eye came out. I remember seeing that poster, and still not thinking anything of it because I'd had it for so long I thought it was normal. It wasn't until I got pregnant and my gums got even worse, and my dental hygienist really rammed the point home - pregnant women are more prone to gum disease and tooth loss. That was when I finally started brushing and flossing daily, for the first time in my life. I was 34.

I had started seeing the hygienist a couple of years earlier, after a particularly bad bout of gum inflammation. She removed all my tartar build up, and I improved my brushing technique and frequency but still only flossed every 2-3 days. Which to me was a big improvement from before. However my gums continued to bleed.

Getting myself to floss every day was a challenge, I seriously was like, can I really do this? It is about retraining yourself, and developing that habit. I would say it took about a month or so before it mentally became less of a chore. And the results were so, so worth it.

The first time my gums did NOT bleed when I brushed was after a couple of months of daily brushing and flossing. My goodness, when that happened, it was like a religious moment. My gums had bled when brushing for so long, I honestly had not realised that they were not supposed to do that. Parts still bled when I flossed, but after a further couple months later, that too stopped. 

As I said, I was 34. The result of years of insufficient dental hygiene and gingivitis: my gums are receded (more due to hard brushing, and not as bad as that photo above), and I have a couple of pockets between my two bottom back teeth on the left side of my mouth. 

The pockets get inflammed a lot, which makes it feel like there's food stuck there and drives me nuts. I have to try and clean them with an interdental brush which I pretty much poke around with and hope for the best. If I don't do this the pockets tends to bleed and smell. It's a hassle, and took a little while for me to realise that I was going to have to do this for the rest of my life. You might be interested to know I only found out about them and how to clean them through the hygienist, and not the dentist.

I have read that gingivitis can be hereditary, my mother had it and has lost several teeth, one of which was during her last pregnancy. Apparently some people are more prone to forming tartar than others, maybe something to do with the strains of bacteria in their mouths. 

My routine now is brushing twice a day and flossing once a day. I tend to floss when I'm watching TV or YouTube, then go into the bathroom in front of the mirror, clean again with an interdental brush, and then finally brush with an electric toothbrush. As I only floss once a day, I do this in the evening, roughly around 9 pm. I used to forget, and then go to sleep with out cleaning, and I went through a spell of setting an alarm clock to remind myself. Nowadays having a routine makes it easier to not forget.

I also have my teeth cleaned professionally every 6 months, or even more. They don't really have hygienists in HK, so I've been getting my teeth cleaned by dentists, and I don't really feel they do as good a job somehow. But for now it'll have to do.

My teeth have a lot of yellowing and stains from tea drinking, so I am now interested in whitening, but that would have to be saved for another post....

You Tube videos

This one is pretty good for showing you what the dentist/hygienist does, and what tartar (calculus) looks like:

This lady is a hygienist and she goes over teeth brushing technique. She has a couple other videos on cleaning between the teeth as well.

Here's the Corsodyl commercial with the powerful image of the girl with the bleeding eye:

That's the end of this post, I hope you found it helpful. 

To good dental health and hygiene!

My teeth now - haha I wish!

Book club....

This is kind of pharmacy related. If you're into 'chick lit' and have always struggled to remember what Guillain-Barré syndrome is, try reading Marian Keyes' "The Woman Who Stole My Life". It's funny, entertaining, and now I'll always remember what GBS is! Remembering how to spell it, however, that's a different matter.

What might cause GBS? It is a possible but extremely rare side effect of the flu vaccine. Any others? Leave me a comment below!