DR ELLIE CANNON: Why can’t anything help shift the cough I’ve had for years?

I’ve had a cough for years. It’s there almost every day to some degree. Most of the time it’s dry, but occasionally it’s so intense that it feels like I’m choking and bringing up bile. I’ve had numerous scans, blood tests, and even had a camera put in to look around. I have been given nasal sprays, antihistamine tablets and an inhaler. My GP has more or less said that there is nothing that can be done about it now. Can you help?

Getting to the bottom of a chronic cough can be very tricky. It is also a distressing symptom that you have to endure every day, especially since you don’t know what causes it.

The first places doctors often examine are the upper respiratory tract, or lungs, for conditions such as allergies, asthma, nasal problems, and even lung cancer, but when these are fully examined and nothing is found, things can get tricky.

Medications can cause a cough, for example an ACE inhibitor for blood pressure, such as lisinopril or ramipril. Discuss with your doctor whether it can be a side effect and whether switching to another drug can help.

A chronic cough may also be related to acid reflux, where small amounts of stomach acid leak up into the esophagus and irritate the throat. If this is a problem, people often find themselves waking up coughing in the middle of the night because the acid can more easily go the wrong way when they’re lying down.

Acid reflux may not be seen on an endoscopy — when a camera is passed down the throat and into the stomach — but can still cause symptoms. It is worth trying an over the counter two week acid suppressant medication such as omeprazole to see if the cough lessens.

It’s also worth checking with your GP about medications that have been tried before, such as antihistamines, as people often don’t take them for long enough or at a high enough dose to have a significant effect.

I suffer from mild rosacea on and around my nose. I’ve been able to keep it under control with various gels, creams and antibiotics, but over the last three months it’s gotten really bad. My nose is sore, swollen and red and looks horrible. Is there anything you can suggest that might help?

People with rosacea experience redness or flushing of their face, in addition to blemishes, broken blood vessels, and inflamed skin that can resemble acne. Other symptoms include burning or stinging skin and sore eyes.

Patients often find that there are triggers that make it worse, including sunlight, wind or heat waves, and spicy foods.

Alcohol, stress, and exercise can also make rosacea worse. As well as medications, especially calcium channel blockers, used to treat high blood pressure, and steroid creams.

Some people find that using a high SPF sunscreen helps, and sunglasses can relieve sore eyes.

There are also green-tinted moisturizers available at many well-known drugstores that can help reduce the visibility of the redness to some extent. A dermatologist may prescribe brimonidine, also known as Mirvaso, for redness, but this should be used with care as it has been reported that once it wears off, the redness can come back with a vengeance in some people.

Ivermectin cream is used to treat the spots.

Doxycycline is the first-line antibiotic used for the condition. If it stops working or if the skin is particularly swollen, switching to another antibiotic may be indicated.

I’ve always been a good sleeper, but lately I keep waking up at about 4am with terrible panic and anxiety, and then I have trouble getting back to sleep. My mind feels like it won’t settle down. The strange thing is that I rarely feel anxious or worried during the day. Do I need sleeping pills?

I’ve always been a good sleeper, but lately I keep waking up at about 4am with terrible panic and anxiety, and then I have trouble getting back to sleep. Do I need sleeping pills?

Sleeping pills are rarely the answer to insomnia, except in the very short term.

Waking up this way can certainly indicate an anxiety or stress problem, but it can also be a sign of other problems.

People can wake up early this way due to menopause, which causes body temperature fluctuating, and depression. Or it could be something in the environment that’s triggering it, like sunrise in the summer around 5am or earlier – if the curtains can’t keep out the light, it can wake some people up.

An eye mask and earplugs are worth trying. Also, make sure the hours before going to bed are as relaxing as possible – so no exercise, social media, or checking emails.

If your mind is racing about something specific in the wee hours, you might try a method of using some “worry time” earlier in the day. This is a technique used for anxiety where you set aside time during the day to think about your concerns and write them down. This gives them air time so you don’t suddenly think of them later.

It’s also an option to keep a pen and notepad by your bedside, so if you wake up in the middle of the night and find yourself worrying, you can write down your worries to acknowledge them.

Lost for words after a stroke

Take a moment this week to watch a powerful documentary from the Stroke Association – When The Words Away Went.

It follows three stroke survivors who developed aphasia – loss of speech and difficulty writing and understanding language – as they try to rebuild their lives. Aphasia can also be caused by other conditions that damage the brain.

For example, Hollywood star Bruce Willis quit acting last year because he said he had aphasia, and in February revealed he had been diagnosed with dementia.

It’s a very annoying problem. Sufferers say people often assume they are drunk, and the impact the inability to speak has on socialization and interaction is also significant.

The documentary is now streaming on Channel 4 (channel4.com) and on the Stroke Association website (battle.org.uk).

Your vacation is not a reason to make an urgent drug application

Take repeat prescriptions. In most practices, you can order them in person, online, or from the pharmacist

It feels like there is always some new strategy or idea being floated by ministers as a solution to the NHS waiting list crisis. Last week we were told we could get around the never-ending queues by ‘shopping around’ – using the NHS app to choose a hospital with the shortest waiting time for that vital operation.

But there’s another problem that I doubt politicians will do, so I will. Patients – not all, but some – are an overlooked part of the problem. Take repeat prescriptions. In most practices, you can order them in person, online, or from the pharmacist. It’s done electronically and couldn’t be easier. Why then am I regularly asked for urgent prescriptions because people are going on vacation the next day?

Of course, doctors will do it for them. But urgent requests mean others have to wait. It’s thoughtless behavior. If you’re organized enough to book a vacation, you certainly can be with your medications.