I have suffered with a itchy skin problem for years, but recently it has got much worse on my buttocks and torso.
A few years ago I was diagnosed with papular urticaria and given various creams and tablets, but with no success. Could the fact I smoke be to blame?
Dr Ellie replies: Urticaria is a rash that can be very distressing to live with. The symptoms are similar to hives – the itchy skin reaction. But while hives, which are typically triggered by a food allergy or an insect bite, will fade within a few days at most, people with urticaria suffer for months, even years.
In most cases the cause is unclear, though it is thought to be linked to the immune system mistakenly going into overdrive.
Anti-allergy medicines – called antihistamines – are usually prescribed, as well as steroid tablets. Both can reduce the itchy sensation and calm the red rash, but cannot cure it.
Urticaria is a rash that can be very distressing to live with, Dr Ellie Cannon writes
Steroids can be taken in short bursts only, as long-term use can raise the risk of severe conditions such as the bone-thinning disease osteoporosis. However, in severe cases a dermatologist may decide the benefit of a low-dose daily steroid tablet outweighs the associated risks.
Another urticaria medicine is montelukast. This tablet is usually given to asthma patients to calm their immune system, but studies show it is also effective for urticaria. There is also an anti-itching salve called menthol aqueous cream which many urticaria patients swear by.
Smoking is not believed to be a trigger for the condition. However, along with caffeine and alcohol, it can make the symptoms worse.
I’m 82 and recently had a mini-stroke. A scan showed the arteries in my neck had thickened so very little blood was getting through to my brain. However, I was told an operation was too risky. Now I’m worried I could soon have a full-blown stroke. What should I do?
Dr Ellie replies: A mini-stroke is where the blood supply to the brain is temporarily blocked. In contrast to a stroke, which causes brain damage, most people who experience a mini-stroke will not suffer any lasting issues.
One common cause of both a stroke and mini-stroke is when arteries in the neck, the carotids, become blocked. Patients are usually given a percentage of how blocked they are – anything over 50 per cent is significant.
The blockage can build up over time, as the lining of the arteries thickens, but is also hastened by high levels of cholesterol.
In most cases the best way to combat this problem is medication, such as blood-thinning tablets to prevent clots, blood pressure medicine and statins to reduce cholesterol.
In some cases, surgery to open up the carotid arteries may be considered if the blood vessels are dangerously blocked.
This might involve removing the inner lining – known as a carotid endarterectomy – or widening the artery by inserting a tube, called a stent.
However, this will be carried out only if the surgeon believes it is more likely to benefit the patient than harm them. Life-threatening complications become more likely the older and sicker the patient is.
It’s important anyone who has been told they are not eligible for surgery speaks as soon as possible to a GP or cardiologist about what medicines they should be taking instead.
For nearly a year I’ve had severe neck and back pain. I’m told I have cervical spondylosis and apparently the only thing to treat it is physiotherapy – and this hasn’t helped one bit. What would you recommend?
Dr Ellie replies: Cervical spondylosis is a painful arthritis condition caused by inflammation of the spine in the neck. It can be agonising and patients may also find it difficult to move their neck.
All the evidence suggests that physiotherapy is important in treating this condition – it cannot be cured, but regular exercise can lessen the pain and improve mobility in the region.
While it is normal to feel that physiotherapy is having no effect, I would urge anyone who feels like this to stick with it, as its benefits are measured in months, not weeks.
And there is no reason why patients should not take pain relief to lessen their suffering. Doctors will usually start by prescribing a strong dose of paracetamol or ibuprofen. In some cases, codeine, a mild opioid, might be offered, but this should be taken sparingly as it can be addictive.
Other treatment options include prescription anti-inflammatory drugs such as naproxen or etoricoxib. Antidepressants, including amitriptyline and nortriptyline, can also be prescribed at low doses to help relieve pain and improve sleep.
Patients may also want to try non-pharmaceutical options such as heat pads.
These are all options that can be discussed with a GP.
Should assisted dying be for the ‘tired-of-life’?
Journalist Dame Esther Rantzen has been a prominent campaigner for legalising assisted dying
In the debate over legalising assisted dying, I feel there is a group of people who have not been heard – those who are just tired of life.
And last week, on the academic site The Conversation, a particularly bleak research paper was published which highlighted some of the reasons a significant number of elderly people do not want to go on, including chronic pain, lack of mobility and loneliness.
I see these patients often in my surgery. They are not suicidal or depressed, but believe life is burdensome and would give it up if offered an easy, painless way out.
However, the Bill currently in Parliament, and backed by journalist Esther Rantzen (pictured), would apply only to people who have less than six months to live.
Should we not also consider offering people in their twilight years the chance to die at a time and place of their choosing? Is this something you would consider?
Please write to me at DrEllie@mailonsunday.co.uk and let me know your thoughts.
