Student Health Service
Common Health Issues
The title of this section is of course
a misnomer as there are many different healthy diets to choose from but they
all share certain basic nutritional principles.
The carnivorous New Zealander, that is to say, most of us, has two main defects in diet. Too many calories are consumed as fat, particularly saturated animal fats, and too much of the food intake is in the evening, at a time lf low physical activity. Enthusiasts might add to this that there is too much protein and salt and not enough fibre. By reducing meat intake (I am not recommending abolition), by trimming fat off meat, and grilling it rather than frying or roasting it, you can deal with the problems of fat and protein together. Since you have to get your calories from somewhere, usually in the form of complex carbohydrates like bread, pastas and root vegetables, you get your fibre at the same time. Quite a modest reduction in animal fat intake may have more effect at reducing future heart attacks and strokes than all the high technology medicine put together. By spreading out your food intake during the day, making sure of a substantial breakfast and not missing lunch, so that you can have a small evening; meal, you are much less likely to become obese with all the problems that obesity brings.
When food is plentiful, as it is in New Zealand, even on a student's income, and when a person eats more or less what he/she fancies it is unlikely in the extreme that he/she will run into any problems of deficiency. As a group, those most likely to run into deficiency problems are those following a very restricted diet eg. the strict vegetarian who eats neither milk products nor eggs (such people, called vegans, can run into difficulties with iron, vitamin B12 and calcium deficiency ordinary vegetarians are only at risk of iron deficiency.)
It is worth also making a few points about vitamins for everyone else. The only people to benefit from all those vitamin pills you take are the people who sell them to you. Vitamin C neither prevents nor cures colds, Vitamin B Complex will not give you extra energy nor do you need it for increased athletic activity. Vitamins A and D in overdose are dangerous and you get more than enough from your diet anyway and Vitamin E deficiency is practically unknown in New Zealand.
What are the facts about exercise in relation to health? First of all the benefits. These are mostly to the heart and blood vessels. In a number of studies, exercise has been shown to lower the incidence of heart attacks. The first of these studies was done in 1949 and showed that London bus drivers sitting on their backsides all day had a higher death rate than their more active conductors. Many subsequent studies have shown a positive benefit for regular exercise. Related benefits are weight and blood pressure reduction. The other major benefit claimed by adherents of exercise is of course the feeling of wellbeing, alertness, and relaxation which must be a plus in terms of general health.
And what are the risks of exercise? A very small number of people, usually with a pre-existing, medical problem die suddenly in the course of vigorous exercise, but the risk is extremely slight especially in the younger age group. A very large number of people will, however, injure themselves during exercise and this is the most obvious negative consequence of the activity. In general, swimming and cycling seem to cause far fewer problems than running which seems to cause a lot of lower limb problems.
Overall we can give a definite thumbs up for exercise even of the moderate variety. If you are serious about actually improving your cardiovascular fitness you need to be quite committed, because many studies have revealed a need for at least three sessions per week, exercising to at least 60 percent of maximum capacity, for at least 20 minutes per session. Most of us are not that ambitious but whatever your actual aim with exercise, there are some principles which will always apply:-
(a) Use good quality footwear designed for the chosen exercise many injuries result from the excessive foot and leg stresses created by the wrong footwear.
(b) Choose the right conditions for exercise avoid the heat of the day and wet, cold, windy weather.
(c) Prepare yourself by not eating for at least two hours before exercise, not drinking alcohol for six hours before exercise, and warming up for a few minutes before starting the really vigorous stuff. It is important to warm up and this should include stretching exercises of all the various muscle groups to help avoid the muscle strains which so often accompany sudden vigorous effort.
(d) Take it gradually - increase your duration and intensity of exercise slowly over successive sessions.
More specific and detailed advice is obviously needed for individual forms of exercise especially the more gruelling and prolonged varieties such as marathon running.
'Smoking or Health' is the correct title for this section as in the long term a choice does have to be made between the two. The evidence supporting the harmful effects of tobacco smoking is overwhelming and the frequency with which such consequences occur makes a healthy long term smoker almost a contradiction in terms. The attempts by tobacco companies to cast doubt on these scientific findings is a cynical act of self preservation. Their obvious vested interest minimises their credibility to all but those people who want to allay their anxieties about continuing with the habit.
Tobacco smoking is a relatively recent innovation in the western world having been popularised in Europe as recently as the nineteenth century. There was a steady increase in smoking during the first half of the twentieth century with surges in popularity during the two world wars. From 1950, medical evidence began to accumulate linking smoking to ill-health and since 1960 there has been a gradual decline in male smoking and a leveling out in female smoking.
What then are the health problems related to smoking? A reasonably comprehensive list would include:-
- Effects on the lungs.
Lung cancer - the most common fatal cancer.
(b) Chronic bronchitis and emphysema - disabling chronic diseases which produce increasing breathing difficulties over may years.
- Effects on the heart.
(a) Coronary heart disease.
- Effects on other arteries.
(a) Peripheral vascular disease - narrowing of arteries supplying blood to the legs often necessitating surgery, even amputation.
- Effects on mouth, throat, and gullet.
(a) Cancer of all these areas.
- Effects on genitor-urinary system.
(a) Bladder cancer (b) Cancer of the cervix.
- Effects on the unborn child (maternal smoking).
(a) Increased incidence of miscarriage, still birth, and death soon after birth.
(b) Reduced birth weight.
- Effects on the young child (parental smoking).
(a) Increased incidence of serious chest infections.
(b) Increased incidence of cot death.
- Effects on non-smokers of a smoky environment (passive smoking).
(a) Increased incidence of many of the smoking related diseases.
In some of the above smoking is almost the exclusive factor, in others it is one of a number of equally significant risk factors. In some the relationship is based purely on a statistical association, in others the casual relationship is proven.
The overall picture of smoking hazard is well summed up in this World Health Organisation statement: "smoking related diseases are such important causes of disability in developed countries that the control of cigarette smoking will do more to improve health and prolong life in these countries than any other single action in the whole field of preventative medicine."
Alcohol abuse has had often disastrous consequences for individuals both on campus and in the community. Studies of drinking patterns among university students consistently demonstrates that a significant problem exists. The problem is often excused as a temporary aberration and it is undeniable that social norms promote and allow a pattern of drinking at university that would be socially and professionally unacceptable later in life. Nevertheless, there are casualties both in alcohol related accidents and in those who establish a life-long pattern of alcohol abuse while at university."
What then are the negative consequences of alcohol
First of all it is worth making the point that we are talking about abuse not use. Abuse arises when alcohol use becomes a medical, social, or economic problem for the user or other affected persons. The negative consequences can be divided into acute and chronic.
The acute effects are those of a nervous system depressant although its initial disinhibiting effect can make it appear a stimulant. Moderate blood levels diminish judgement, coordination, and self control, predisposing people to accidents, violence, antisocial behavior, and suicide. At higher blood levels severe brain depression can occur with coma and death. The chronic effects of alcohol abuse are many and include dementia, liver cirrhosis, gullet cancer, and pancreas inflammation. Between 10 percent and 20 percent of hospital admissions are alcohol related.
The decision to use alcohol responsibly is part of the more fundamental decision to use life responsibly. We owe it to ourselves to make an informed choice about alcohol use - a choice which expresses our individuality not our pliability.
Cannabis, also known among other things as marijuana, grass and pot, is the subject of much uninformed or biased comment. On the one hand are those who say that using cannabis is no danger at all even when abused, and on the other hand are those who would like to see users in prison with hard labour.
Much is now known about Cannabis and it is unlikely to be considered to be a 'harmless' drug at any time in the future nor is it likely to be decriminalised as New Zealand has ratified two major international agreements committing the country to cooperating in controlling its production, distribution and sale.
It is now recognized that even low doses of cannabis adversely affect driving performance, increasing reaction times and impairing judgment. In some users, a dose of cannabis produces reactions ranging from mild anxiety to severe mental derangement, with detachment from the real world, hallucinations and bizarre behavior. These reactions occur most commonly in people who are under stress, depressed or borderline schizophrenics; and in normal users who take much more than their usual dose. Heavy or long term use can lead to lasting behavioural changes such as apathy, lack of concern for the future and loss of motivation.
The active constituent of Cannabis can be detected in the body for many days after consumption has ceased. There is reason to believe that at least some of the undesirable effects of cannabis are similarly prolonged.
Cannabis contains more tar and cancer producing chemicals than tobacco and, in the long term, heavy smoking causes chronic bronchitis and pre-cancerous changes in the air passages similar to those caused by tobacco smoke. Since many users of Cannabis also smoke tobacco they increase their risks.
Physical dependency can occur although this is less common than with narcotics. There is reason to believe that there are chronic effects on ovulation, sperm production, sex hormones and immunity; and research into all these effects is continuing. Some chemicals in Cannabis do have beneficial effects in asthma and nausea but they have side effects and they are no better than medicines available.
Experienced workers in the field of drug dependence are in no doubt of the dangers of Cannabis use. Certainly many of us are aware of the subtly persuasive misinformation being put about by those who would legalise their potentially dangerous habit.
This section aims to give an outline of contraceptive methods available with comment on effectiveness, benefits, risks and costs. It obviously cannot be comprehensive in the space available but should help you to narrow down your choices. While there is an enormous amount known about the various methods, there are also areas of uncertainty too, because the possibilities for well-controlled experiments using consenting human subjects are obviously limited.
First, a few facts to help in the understanding of what follows. The beginning of the menstrual cycle is timed from the first day of bleeding. In the first half of a typical cycle of 28 to 30 days, the lining of the womb increases in thickness and an egg matures in the ovary to be released at about day 14. For about 72 hours after this, fertilisation of the egg by a male sperm is possible. If this occurs, the fertilised egg implants itself in the mature lining of the womb at about day 20, hormone changes take place and a pregnancy begins. If no fertilisation or implantation occurs, different hormone changes take place, the lining of the womb is cast off with some bleeding and a period begins.
In general, the egg is released (ovulation) about 14 days before the onset of the next period, so that if someone normally has a 34 instead of a 28 day cycle, ovulation occurs at about day 20 with implantation at about day 26. All these figures are very approximate, but we can say that intercourse without contraception at about the time of ovulation gives a one in five chance of pregnancy as opposed to a chance of 2% to 4% for a single intercourse at any time in the cycle. About half of all couples having intercourse with average frequency will have conceived in five months and well over 70% in a year.
Conception can be prevented or hindered by either stopping sperm and egg from meeting, or stopping ovulation or stopping implantation or by choosing to have intercourse at a time when ovulation is less likely to occur or a combination of these. In assessing how effective a method is at preventing pregnancy, we count the number of pregnancies that occur in a hundred women in a year and express the rate as 'per hundred women years'.
This is a sheath of latex rubber about 0.03 mm thick, about 20 cm long and 4 cm wide which is unrolled onto the erect penis before there is any contact between the penis and vagina. Its elasticity holds it in place and prevents any semen from leaking out. Condoms are very strong and breakage of those made to America or UK standards should be a rare event.
Most problems are due to insufficient lubrication leading to breakage or to the condom slipping off because it was not completely unrolled onto the penis. Some brands of condom are coated with a spermicide which also kills the AIDS virus, but it is likely that the quantity is too little to be very effective for either purpose.
Condoms may be bought from supermarkets and chemists in packets of three, six or twelve. The Student Health Service can prescribe condoms and you can get a prescription through the nurses.
Condoms used alone have a failure rate of about five per hundred women years and I suspect that most pregnancies result from non-use rather than from failure of the condom itself.
Condoms give a lot of protection against most sexually transmitted diseases including AIDS, are reasonably cheap, need little skill to use and have no unwanted side-effects except in the occasional person who is allergic to rubber. On the other hand they can be inhibiting, especially if you're already a bit nervous and many men do not like the inevitable reduction in sensation. For others, this can be an advantage.
In view of the AIDS risk I would advise you to use a condom whether or not you need contraception unless and until you are absolutely sure your new partner's sexual history has been free of risky activity.
This is a soft and flexible dome of thin rubber about 75 mm diameter and about 25mm high with a springy rim. It is put into the vagina before intercourse so that it coves the neck of the womb (cervix) and prevents any sperms entering and swimming on to fertilise an egg. Its springiness and suction hold it in place and neither partner should be aware of it if it is properly fitted. It is removed a minimum of six hours after intercourse. It is only a little more difficult to put in and remove than a tampon and most people find it easy to use though it does need a trained doctor or nurse to fit the correct size and explain its use. It should always be used with a spermicide and this is usually placed inside the diaphragm before putting it into the vagina. If you have intercourse again before removing it you should insert more spemicide with an applicator.
A diaphragm can be bought over the counter at a chemist, but is more commonly obtained with a prescription after fitting by a trained person. Its fitting should be checked after any substantial weight gain, after pregnancy and in any case every two years.
The failure rate of the diaphragm when used with a spermicide is about three to five pregnancies per hundred women years.
Diaphragm users tend to have more urinary infections and fewer yeast infections than users of other methods. It does not seem to have other unwanted effects. While it needs a little practice to learn how to use it, it can be put in an hour or two before intercourse and forgotten about until due for removal.
The standard contraceptive pill is a mixture of two synthetic female hormones which prevent eggs being released from the ovaries. The pills come pre-packed with the day on which you should take each pill clearly marked. You take hormone pills for 21 days and then dummy pills or no pills for a further seven days after which you start the next pack. During the time that you take the dummy pills you have a period which is usually shorter and lighter than usual. People who have period pain and premenstrual tension often find that these problems are much improved.
The pill can be obtained only with a doctor's prescription. Taken correctly, the pill has a failure rate of less than three to four pregnancies per thousand women years, i.e. about 10 times better than the diaphragm or condom. If taken late or not at all, or vomited up or lost through a prolonged, severe attack of diarrhea, it may fail. Two sorts of antibiotics, neither in very common use, and some anti-epilepsy medication definitely reduce the effectiveness of the pill. The chance of other antibiotics doing the same thing is less, but has to be considered possible. The pill is an extremely effective method of contraception, but some women may not be able to use it because of other medical conditions and other women may have side-effects. This is discussed in detail in a later section.
This contains only a progestogen hormone and is taken continuously. It works mainly by making the mucus in the neck of the womb (cervix) hostile to the passage of sperm. Whereas the standard pill has to be taken within 12 hours of the same time each day, timing has to be much more precise with the mini-pill and even then it has a failure rate of one to two per hundred women years. Women who have had unacceptable minor side effects on the standard pill are often happier on the mini-pill and some women with medical conditions which would prevent them using the standard pill may use the mini pill without problems. The mini pill has no serious side effects.
This is an injection of a progestogen hormone, MPA, which is given in a form that releases the hormone over three to six months. Its main advantages are that it requires thought about contraception only once every three months and has an effectiveness even greater than that of the standard pill.
The commonest side effect is that periods stop altogether while some women get irregular spotting and bleeding which is sometimes prolonged. Overall, this method suits many women very well and has no serious side effects.
This means intra-uterine contraceptive device and is a device nowadays made of plastic and copper shaped to fit in the cavity of the womb (uterus). It works by making the lining of the womb unsuitable for implantation of the fertilised egg. A doctor has to insert it and, when it is no longer required, remove it. Its main advantage is that once inserted it can be left for two years before replacement and that the woman does not have to remember to do anything to remain contraceptively safe.
However, for most students it is not a method of choice because of the difficulties of inserting an IUCD in someone who has never had a child.
There is also a slightly greater risk of infection especially if women change partners often. Many women in a stable, long term relationship find it an excellent method to use once they have completed their families although sterilization operations are now the preferred method for men and women in New Zealand. The IUCD has a failure rate of around one pregnancy per hundred women per year.
These rely on attempts to estimate when ovulation occurs. You then avoids intercourse for a few days either side of ovulation time to give a margin of safety. If a women has very regular periods, she can make a very good estimate of ovulation time simply by using a calendar to count back 14 days from the estimated time of onset of her next period. Unfortunately for the method, ovulation can also occur at other times.
During the first half of the menstrual cycle, a woman's body temperature is relatively low. At ovulation, it takes a slight dip and then rises to a new plateau for the remainder of the cycle. By measuring the temperature very carefully at rest first thing in the morning and plotting it on a chart she can, provided she has no colds, flu's emotional upsets etc., often estimate when ovulation has occurred. Many women unfortunately do not show the typical pattern of temperature change.
As the time of ovulation approaches, the mucus in the vagina becomes clear, slippery and can be drawn out into strings. Ovulation occurs within 24 hours of the last day on which this occurs.
For women who for religious or other reasons cannot use any other method of contraception, a combination of these 'natural' methods is very much better than nothing at all, but is likely to have a substantial failure rate. This can be improved upon with excellent instruction and the best instructors are those who are using the method themselves.
Most students will probably elect to see a doctor at the Student Health Service and if you prefer, you may see a female doctor. I hope that this section will give you at least a basis for discussing your choice though in practice we find that most people have made up their minds by the time they visit the Service. Others may prefer to see their family doctors, visit a Family Planning Clinic or make contact with the Natural Family Planning Association. Telephone numbers may be found for all these in the telephone directory.
Most people want to know "is it effective and is it safe?" and it should be clear from what I have written that both safety and effectiveness are relative terms. You may have to balance one against the other, bearing in mind that if a method fails you, abortion carries a risk to life and health and that about one out of 3500 pregnant women die during their pregnancy (more if accidental death is included).
The standard pill is still the most popular choice among students because of its convenience, effectiveness and relative safety. Mini-pill use and injection use is preferred by a smaller number (or they may have to choose these methods because of particular risks for them from the standard pill).
The rise of the AIDS spectre should make one think about condom use. The only ones who do not need to do so are those who have and intend ever to have only one sexual partner and whose partner is of a like mind. AIDS has found its way into the heterosexual community in New Zealand and is likely to increase. There are about 1500 known people who have HIV infection in New Zealand (2000 figures) and certainly many times that number who are antibody positive and can pass the disease to others. My advice is clear: if you or your partner have had other sexual partners you should use condoms irrespective of whether you are using any other method of contraception.
The diaphragm used to be a very popular method of contraception until the pill arrived on the scene and a minority of students still sue it, often combined with another method like the calendar method or condoms. A very few elect to use IUCD but this is not generally an ideal method for younger people. Many times a year, often when judgment has been affected by alcohol, students forget to use any method. If planning and good intentions both fail then the morning after pill should be considered (see next section).
This involves taking two pills, 12 hours apart as soon as possible after sex. It may have an anti-ovulation effect, but it probably works in most cases by making the lining of the womb unsuitable for implantation of a fertilised egg. It is important to take it as soon as possible after intercourse and in any case well within 72 hours.
This is obviously a method of occasional rather than regular or often repeated use. It has a failure rate per single use of between 0.2 and 2%. There are no long or short-term risks to the user.
Contraceptives Benefits and Risks
From time to time articles appear in the press about risks of oral contraception but rarely is emphasis given to the benefits of using this method of contraception. Oral contraceptives have been in use now well over thirty years but unfortunately much of the information we have about risks relates to older types of pills in which the dose of hormones was relatively high. In some areas, risk is impossible at this stage to assess with any accuracy and we have to make do with the information that we have.
The first and most obvious benefit is very effective contraception so that the pregnancy rate is around about one pregnancy per three hundred women users per year. The costs of an unwanted pregnancy are high in both health and emotional terms and the effectiveness of the oral contraceptive must be regarded as a major medical and social benefit. Obviously, since pregnancies are very uncommon when using the pill, it follows that complications of pregnancy are also extremely rare.
There is clear evidence that the use of the pill reduces pelvic inflammatory disease by fifty percent and as this condition has a high rate of subsequent infertility, this must be regarded as a major benefit. Cancer of the womb and of the ovaries are also much reduced in incidence by the pill. One of the major causes of illness and days lost from work in modern society is period paid and premenstrual tension. In most pill users, both these conditions are greatly improved.
Although a great deal is now known about pill-related risks of heart attacks, strokes and raised blood pressure, this can be summarised for the purposes of the student population at least by saying that users aged under 30 years who smoke and non-smoking users under the age of 35 years do not appear to face any increased risk. However for smokers, particularly overweight smokers over the age of 30, risks rise quite sharply. About one in twenty users show some rise in blood pressure and it is for this reason that blood pressure checks every six months are advisable.
The risk of blood clotting in veins of the legs with pieces breaking off and damaging the lungs is small for most women, but the consequences are serious. The risk of deep vein clot (DVT) is about 2 per 10,000 women per year on the pills that are most often used now. Some previously popular pills (3rd generation pills) have twice the risk (4 per 10,000 per year) but are still preferred by some women.
The pill is not a factor in causing cervical cancer (this is now known to be caused by certain strains of genital wart virus). The risk of breast cancer is also not significantly increased by pill use.
After stopping the pill, there is a delay in return to normal fertility of about thee months on average. In about eight percent of users the delay may be as long as two years, especially in women who have never been pregnant. There is however no permanent effect on fertility.
Many other minor side effects have been reported for the oral contraceptive pill, as indeed are reported for any sort of medication. However, the incidence of such side effects is very low and it is generally possible to find a pill which will suit each particular individual. As knowledge of side effects improves, no doubt it will be possible further to lower the risks of pill taking by excluding people known to be at high risk. In the student population age group, such risks are very low in any case.
Smears and Breast Self Examination
Cancer of the cervix and cancer of the breast are two of the commonest female cancers. Both can occur in relatively young women especially cancer of the cervix, but in statistical terms most cases will still be in the 40+ age group. Both the cervix and the breast can be directly examined, unlike internal organs like liver or lung, so a lot of work has gone into methods of early detection.
The cervix is the neck of the uterus or womb and it protrudes into the top end of the vagina. It can easily be examined by a doctor or nurse using a device called a speculum. Cancer of the cervix is known to be triggered by a sexually transmitted genital wart virus. It only occurs in women who have been or are sexually active. The cell changes leading to cancer develop very slowly over a number of years in the surface cells of the cervix. It is these cells which are sampled by scraping the surface of the cervix with a special spatula or brush during a cervical smear test. The cells obtained are examined in the laboratory under a microscope and deviations from normal can be detected. Any cell changes can thus be detected well before actual cancer develops and the abnormal area of cervix can be easily and permanently treated using simply techniques such as freezing.
The most important things about cervical smear testing are firstly that it is a very simple procedure and secondly it does work in the prevention of cancer. If you have ever been sexually active, you should have your first smear by the age of 20. The smear test should be repeated one year later and if both these tests are normal then repeat tests every three years are sufficient, right through to age 65. The very disappointing fact of the matter is that at least half of those women diagnosed as having cervical cancer in New Zealand have never had a smear test.
Breast self-examination is the technique by which women examine all parts of their breasts each month to detect any lump which might represent an early cancer. It is worth making the point right at the start that the great majority of lumps detected are totally benign, but the idea is that the occasional cancer picked up will have been detected earlier than would otherwise have been the case. This is thus a method for early detection of cancer rather than prevention of cancer as is the case with cervical smears.
There is at present considerable controversy as to the true value of breast self-examination as there is evidence that early detection does not reduce the death rate from this disease. This is because by the time a cancer can be felt as a lump, spread may have occurred to other parts of the body. There are also other criticisms of the technique including the fact that the detection of a lump commits a woman to expensive and sometimes uncomfortable investigations when in the great majority of cases the lumps are not cancerous but just benign cysts or overgrowth of breast gland tissue. Also there is the risk that regular examinations of the breast will make women unnecessarily anxious about every little difference in the texture of what are normally slightly lumpy structures. On the other hand there are many doctors who believe that breast self-examination does save lives and certainly it may mean a less disfiguring operation for a woman if her cancer is detected early.
What then should we recommend about breast self-examination? Well there is general agreement that because breast cancer is almost unknown under the age of 25 and rate between 25 and 30 age group will get little value from the technique. Of course there is value in knowing the normal texture and anatomy of your breasts well before that age but regular examination is unnecessary. Over the age of 30 one would tend to recommend the practice still bearing in mind that most lumps detected are benign. The details of the technique are available in pamphlet form from the Student Health Service.
This is your own responsibility. We don't provide it or fund it, but we can recommend local dentists who offer reduced charges for students and we can refer to the hospital dentist. The level of dental health among New Zealand born students is very high indeed. It is quite rare for us to see cavities in teeth and very common to see perfect sets, so that it is unlikely that a dental service will ever be provided on campus, free or otherwise. (Overseas students often have poorer dental health and should consider having a dental check while here in New Zealand.) Unfortunately, the cost of this is not covered by health insurance.
An annual dental check-up can prevent you needing more expensive treatment later. Regular brushing, helps to keep costs down. In addition, regular use of dental floss will help to prevent decay between the teeth as well as keeping the gums healthy. If you don't know how to use dental floss ask your dentist to show you.
Wisdom teeth occasionally give trouble when they're breaking through the gums. Regular, full doses of Disprin or paracetamol helps relieve the discomfort. If you need anything other than emergency treatment to your wisdom teeth, it makes sense to have this done during a vacation rather than during term time and the person who arranges non-urgent treatment to coincide with exams won't be given much sympathy.
If you get severe toothache at the weekend, the Accident Service at the hospital holds a list of dentists prepared to see patients urgently, but be prepared for a hefty bill.Page Content: Bethea Weir