Q: My granddaughter, who’s three, was diagnosed with hypermobility from birth. It affected her progress to walking but she caught up.
The problem now is she slightly soils herself several times a day. We wonder if the hypermobility is to blame.
Name and address supplied
A: I’m grateful to you for writing – hypermobility is a common problem but the medical world’s understanding of it is minimal. As a result, many people are left in some distress because of their symptoms, which can include excessively stretchy skin, dislocated joints, pain and gut problems.
Essentially, hypermobility is a problem affecting the connective tissues – including cartilage and collagen – that act as the glue to bind the body together. In some people, the proteins in these connective tissues are faulty.
The most common form is Ehlers-Danlos syndrome – which has 13 different subtypes, affecting connective tissue supporting the skin, tendons, ligaments, blood vessels and bones.
Most children are hypermobile to some degree, thanks to the flexible nature of their tissues, but some have symptoms of the disorder, such as joint and muscle pains, low muscle tone and weakness that affects their motor skills (e.g. sitting, crawling and walking – walking in those children can be as late as 20 months). Flat feet can also be a sign.
‘Bladder and bowel problems are not uncommon in children with hypermobility. This may be the result of a weakened anal sphincter, which controls the exit of stools, as part of a general weakness in pelvic floor muscle’
In recent years, it’s become clear that bladder and bowel problems are also not uncommon. This may be the result of a weakened anal sphincter, which controls the exit of stools, as part of a general weakness in pelvic floor muscles.
Muscles and other tissues in the gut may be affected, possibly helping explain the abdominal pain, bloating, constipation, even heartburn and vomiting that hypermobile people experience.
Many children improve as they mature. However, given your granddaughter’s early diagnosis and her current bowel-related problems it is essential she is regularly reviewed by a paediatrician familiar with the condition.
Q: I’m 79 and three years ago I suffered an attack of shingles. It cleared up, but the skin around the infected area became sensitive and seems to be getting worse.
Brian Walker, Stockport
A: You have post-herpetic neuralgia, a complication of shingles (also known as herpes zoster) – the pain is the result of nerve damage.
Although shingles viral infection clears up (usually within six weeks but quicker if you’re prescribed an antiviral drug such as acyclovir), residual pain is a common complication in older patients, affecting one in five over 70.
This is because the inflammation caused by shingles can lead to fibrosis (scar-like damage) in the nerves affected by the virus, even after inflammation from the infection has settled.
Pain lasting for three months or more is defined as post-herpetic neuralgia. As well as pain, it can cause a burning, itching and prickling sensation which can be intermittent or constant. Many sufferers complain of searing pain from the slightest touch.
The most effective medications are gabapentin, pregabalin, and tricyclic antidepressants, which work on nerve pain.
Key to success is starting at a low dose and gradually working up to higher doses.
I prescribe gabapentin or pregabalin and see patients weekly, increasing their dose from 75mg daily to 150mg, and then to 300mg.
If there’s no change after a month or six weeks, I move to amitriptyline – an antidepressant, prescribing 10mg, increasing the dose monthly.
The drug is almost invariably effective at about 70mg daily, although a dry mouth and drowsiness are common side-effects.
If your GP isn’t prepared to oversee such a regimen, ask to be referred to a pain clinic.
IN MY VIEW… Some good news for older women
While I sometimes lament how patient care is changing, at times it works to the advantage of all.
Take the way patients can buy previously prescription-only medications from over the counter. This now includes Ovesse cream, an effective treatment for vaginal dryness caused by the tissue thinning in menopause.
There are many other invaluable treatments that pharmacies can supply without prescription, such as eye drops for conjunctivitis (chloramphenicol) and fluconazole capsules for thrush, increasing convenience for the customer and reducing GPs’ workload.
But I worry about recent changes making antibiotics available in this way.
Although the medicines that pharmacists can provide is strictly limited (including the number of days of treatment issued), they can’t do a blood test to check if infected tonsils are an early sign of glandular fever, for instance.
Instead, it’s guesswork, which can only lead to the pills being over-prescribed, fuelling the rise of antibiotic resistance. This policy shouldn’t expand further.
- Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email drmartin@ dailymail.co.uk – include your contact details. Dr Scurr cannot enter into personal correspondence. Always consult your own GP with any health concerns
