I’m overweight with type 2 diabetes and erectile dysfunction. My GP says I need to lose about 4 st (25 kg). Try as I might, I am unable to get my weight down, so I’m considering liposuction. Would this help?
Name and address supplied.
There is no doubt that you are facing significant health problems and, equally, there is no question that there’s one solution that will improve your current and future wellbeing immeasurably: weight loss.
You have type 2 diabetes because being overweight makes the body resistant to the effects of the hormone insulin, which normally moves sugar out of the blood and into cells.
Erectile dysfunction can be a complication as the high blood sugar levels can damage the nerve supply to the blood vessels supplying the penis.
I know that people can struggle to lose the kind of weight needed to reverse type 2. But I’m afraid liposuction, where small areas of unwanted body fat are sucked out with a vacuum-like device, is not going to make enough of a difference. That’s because it is a cosmetic procedure used to re-sculpt areas of the body, and isn’t going to lead to the significant weight loss needed.
However, from what you say in your longer letter, I think you would be eligible for semaglutide – one of the so-called weight-loss wonder jabs that you may have read about (under the brand name Ozempic).
The drug mimics the effect of a hormone, GLP-1, that plays key roles in both appetite and the control of blood sugar.
It slows the emptying of your stomach, which increases the extent to which you feel full, even after relatively small amounts of food.
Erectile dysfunction can be a complication of type 2 diabetes as the high blood sugar levels can damage the nerve supply to the blood vessels supplying the penis, writes Dr Martin Scurr
The medication is given by once-weekly injection (at home, using a pen-like device) and for the best outcome should be used alongside a switch to a reduced-calorie diet. To qualify for these jabs on the NHS your body mass index needs to be over 30 and you need to have type 2 diabetes (or pre-diabetes, its precursor).
I suggest you discuss it with your GP. If you are accepted for the prescription, it will revolutionise your life.
I’ve had both knees replaced and, over the years, the area around the scars on the front of my knees has become very sore. Massaging with a massage gun helps, but I worry it could do damage over time.
Rob Everitt, Essex.
Let me reassure you that you’ll not come to any harm from using the massage gun, provided you follow the instructions that came with it. More concerning to me is that you are in chronic pain.
Pain in the front of the knee below the patella, or kneecap, is not uncommon following total knee replacement, even years after the operation.
This could be because your kneecap isn’t tracking properly but slides slightly out of place when you bend your leg. This can be painful and can also put strain on the patellar tendon, the cord of tissue that joins your kneecap to your shin bone.
Another possibility is the surface of your kneecap is worn, leading to arthritic pain when it rubs against your thigh bone.
Finally, the pain could be coming from inflammation of the fat pad below the kneecap – or from a bursa, one of the jelly-like sacs that sit near the knee joint.
An X-ray will determine if it’s osteoarthritis, while an ultrasound will pick up damage to the soft tissue.
The good news is that, once diagnosed, these conditions can be treated. To get the ball rolling, ask your GP for a referral to the orthopaedic unit that oversaw your operations.
As you note, the massage gun has proved quite effective. So I’d suggest not using it for two weeks before your appointment to allow the specialist to get a full picture of your symptoms.
