ASK DR ZOE
From persistent varicose veins to a ‘tired brain’ – Dr Zoe Williams answers your health questions
Dr Zoe also helps a reader with a burning pain in one of their ears
WE have made it to spring, after what felt like a never-ending, grey winter.
But many will be dreading the upcoming hay-fever season, which has technically already begun.
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Check out the NeilMed sinus-rinse device, which many allergy doctors advise using.
Available at most high-street pharmacies, it contains pre-mixed sachets that dissolve in water to make a pH-neutral solution, which is squeezed into the nasal passages with a bottle.
Also known as nasal irrigation, it can offer relief for stuffiness and congestion associated with hay fever.
You can make your own saline solution by dissolving one teaspoon of non-iodised salt and half a teaspoon of bicarbonate soda in a pint of boiled water that has been allowed to cool.
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I also would recommend a visit to the pharmacy before grass pollen season picks up – this is the most common cause of hay fever, and it’s best to start treatment a few weeks before symptoms start.
Here’s a selection of what readers have asked me this week.
MY LITERACY STRUGGLE
Q: I THINK I have a medical condition affecting my brain.
I find it difficult to read and writing is very difficult.
Most read in Health
When I try to force myself to read, I feel like my brain is getting tired and I can’t concentrate.
Sometimes it takes me a long time to learn things like when people tell me their names or places, or it feels like my brain is really tired.
Therapist challenges people to read text showing what it's like to have dyslexia
I don’t know if that makes sense.
I am 58 and have had this for at least 30 years. I also have high blood pressure. I have never spoken about this to anybody.
A: Thank you for being so brave and open about this.
Given your age and medical history of high blood pressure, when I initially read your email my first consideration was that you may have had a stroke, affecting the part of your brain that is responsible for writing.
So I followed up with you to clarify and you explained that this was not a sudden change, but more a problem you have always had.
I am now considering dyslexia, which primarily affects reading, and dysgraphia, which mainly affects writing.
It is estimated one in 10 people in the UK may be dyslexic, so you are not alone in this and should not be ashamed or embarrassed about it.
Unlike a learning disability, intelligence isn’t affected.
It’s more that the brain works in a slightly different way, so the correct way to think of it is as a “learning difference”.
When you were growing up, the education system did not properly recognise, understand or cater for children with dyslexia, and there was a lot of stigma attached.
The correct way to think of [dyslexia] is as a “learning difference”
Dr Zoe Williams
The good news is that things are changing for the better, and while the world is still mostly designed to support neurotypical people to thrive, much more is understood to support people who are neurodiverse to do well too.
To find out more I’d advise taking a look at the British Dyslexia Association website (bdadyslexia.org.uk).
There are several cheap screening tests you can do yourself.
These won’t give you a diagnosis but can help identify the likelihood of having a specific learning difference, like dyslexia, and also identify where some of your specific strengths and weaknesses may lie.
There is also information about how to get a formal diagnosis, but unfortunately for adults, this usually has to be self-funded.
Burning pain in my ear for months
Q: ONE of my ears is painful with a burning sensation off and on all day.
l have had this problem for months, but the doctor couldn’t solve it.
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He is sending me to the hospital but the way things are, l might never get there. I am an 80-year-old man.
A: The medical term for ear pain is otalgia and there are many potential causes.
Two of the most common causes are ear infection and fluid build-up behind the ear drum which can happen with or following a cold or flu, due to blockage of the eustachian tube which should drain fluid from the middle ear.
However, in your case, your GP has seen you and I assume examined you, which would likely rule out these conditions.
You shared some important clues, including that there is a burning sensation “off and on”, accompanying the pain.
This sways me more towards considering nerve-type pain.
It’s important to let your GP know if things are getting worse or changing while you await the specialist appointment
Dr Zoe Williams
The tricky thing here is that many different nerves could cause pain in the ear, some of which are nerves that directly supply the ear.
But at least 50 per cent of ear pain is referred pain, meaning it comes from a different area.
Referred ear pain can be caused by, for example, temporomandibular disorder – a condition affecting the jaw bone – tonsillitis, dental problems or sinusitis.
More rarely, tumours can be the cause.
It’s good that you have been referred and it’s important to let your GP know if things are getting worse or changing while you await the specialist appointment.
In the meantime, you could try some painkillers that work well for nerve pain, such as amitriptyline or gabapentin.
Q: WHEN I first had varicose veins in my early 20s, the initial treatment (in 1983) was a course of injections over three months.
Within five years they had returned.
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Eventually, in 2008, I was referred for surgery. Although successful for my left leg (between the groin and the knee), those in the right leg below the knee are still prominent, very lumpy and itchy.
After that, I recall the doctor saying they would never disappear.
According to my new GP, further treatment is now considered “cosmetic” so she won’t refer me to an NHS consultant. Is this correct?
Can they be “cut and tied” again?
A: It is correct that as a means to cut NHS costs, several procedures were restricted and classified as PoLCE, which stands for “Procedures of Limited Clinical Effectiveness”.
These are treatments that are not clinically effective for everyone and can now only be offered when specific clinical criteria are met.
Visible varicose veins in the legs are estimated to affect at least a third of the population and many people would like to have them removed because they don’t like the look of them, making it a cosmetic procedure.
However, a relatively small proportion have symptomatic varicose veins and these individuals should be assessed on a case-by-case basis.
GPs are no longer supposed to refer patients for treatment of varicose veins unless any of the following criteria apply:
- Symptomatic varicose veins.
- Lower‑limb skin changes, such as pigmentation or eczema, thought to be caused by chronic venous insufficiency.
- Superficial vein thrombosis (characterised by the appearance of hard, painful veins) and suspected venous incompetence.
- A venous leg ulcer (a break in the skin below the knee that has not healed within two weeks).
- A healed venous leg ulcer.
My advice would be to speak to your GP again and be very clear on any symptoms that you have related to your varicose veins.
It may be that in your case, you will qualify for a referral to the vascular surgery team.
Tip of the week
CASES of sexually transmitted infections are rising among the over 45s.
Safe sex is not just for youngsters. The only way to prevent disease is by using condoms.
You can get free condoms from sexual health clinics.
Also, get regular tests between sexual partners.
‘DON’T EXPOSE KIDS TO VAPE TOXINS’
PARENTS have been warned not to vape around their children over fears they could be putting them at harm.
Scientists say secondhand e-cigarette vapour could expose kids to dangerous chemicals.
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In a study of children aged four to 12, kids living in households where vapes were used daily had “significantly higher” levels of metabolites linked to the chemicals found in e-cigarette liquids.
These metabolites can cause inflammation and oxidative stress, which leads to cellular damage and is linked to diseases such as diabetes, heart disease and cancer.
Researchers at Emory University, Atlanta, said: “While the vapour from electronic cigarettes may be invisible after it disperses through the air, the effects on children are not.”
Lead author Jeannie Rodriguez, an associate professor at Emory’s School of Nursing, said: “Many people who smoke have switched to e-cigarettes thinking that it’s safer for them and others nearby.
However, there are chemicals in the liquids used in a vape that are hazardous for you and for those who are exposed to the vapours you exhale.”
When the researchers shared the results of their study with the parents, more than half were unaware of the risk of secondhand vapour from the devices.
“This alarming disconnect underscores the need for education on the subject,” said Prof Rodriguez.
“If you do vape and are ready to quit, talk to your health care provider and your family.”
PEOPLE with spinal cord injuries, including those paralysed, could regain movement after being injected with cells from their own fat.
Scientists at the Mayo Clinic took stem cells from patients’ fat stores and grew them in a lab.
Once the cells were injected into the spine, they moved toward areas of damage.
In the study of ten adults, seven demonstrated improvements, such as increased sensation when touched and strength in muscles.
Those who benefited included two patients with complete injuries of the thoracic spine, meaning they had no feeling or movement below their injury between the base of the neck and mid-back.
Dr Mohamad Bydon, neurosurgeon and first author of the study, published in Nature Communications, said: “In spinal cord injury, even a mild improvement can make a significant difference in that patient’s quality of life.”
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In the UK, an estimated 50,000 people are living with spinal cord injuries and around 2,500 new injuries occur every year.
Participants in this study had been injured in vehicle accidents and falls, for example, while other causes include sporting injuries or diseases related to ageing.
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