DR ELLIE CANNON: Mum had a stroke in her 80s… will statins help me avoid one?

My doctor suggested I start taking statins, but he was quite non-committal and said it's up to me. I am 69, not overweight, eat a varied diet and drink about a bottle of wine a week. My father had a heart attack in his mid-70s and my mother had a mini-stroke in her 80s. My cholesterol levels fluctuate between about 5.5 and 6.5. What do you think I should do?

When we propose statins, which lower the risk of heart attack and stroke, we look at many factors – not just cholesterol levels – such as blood pressure, smoking, age, zip code (our environment affects our health) and family history.

In fact, there are more than twenty criteria that make up a heart attack risk score. Guidelines recommend statins if your risk score is higher than ten percent over the next ten years, although patients can also request them if they have a lower score.

Most people have to weigh the benefits of preventing a major health event such as a heart attack or stroke against the disadvantages of taking a pill, such as side effects and the need for regular monitoring or blood tests – although statins generally cause few problems.

There is always the option to try the medication to see if it is effective and does not cause any problems.

Age has a major influence on the risk score, so it will usually only increase. Alcohol is also a risk factor for high cholesterol – we consider it high if it's above five – because it can increase levels of triglycerides, a type of fat in the blood, and also lower levels of the beneficial cholesterol HDL. We used to think alcohol was good for the heart, but for women over 55 this is only if intake is less than five units per week – roughly two glasses of wine or two pints – and even then the benefits are small.

I hurt my ankle falling down some stairs. After days of bouncing around, I went to A&E and was told I had a hematoma but would be better in two months. Six months later, and with no improvement, a scan showed the hematoma was still there. My ankle hurts and wearing shoes is painful. Can you recommend anything to speed up recovery?

ANKLE injuries can take an irritatingly long time to heal because it is difficult to avoid weight bearing. I often see patients with persistent swelling after a year or more. But if things continue for that long, patients should seek further medical advice.

A hematoma is a type of bruise in which bleeding accumulates under the skin and forms a lump. These problems normally go away without additional help, but this may take some time.

If a hematoma persists for a year, you may need to have it surgically removed if possible. This may certainly be justified based on the pain and disruption of mobility, for which a GP can refer you.

Ankles are complex. Injuries to it can cause bone fractures, ligament sprains and instability of the joint as a whole. Add to this the swelling of the soft tissue and it is easy to see why problems can persist for a long time.

Physiotherapy can be very effective and you can ask your GP how best to make an appointment. The exercises that physiotherapists offer can strengthen the joints and ligaments.

Anti-inflammatory medications such as ibuprofen are good for pain relief and to aid mobility, but make sure they are safe to take with any other medications you are taking. Some medications and health conditions can also contribute to ankle swelling, so this is also worth evaluating.

About two hours after taking my heart pills, I seem to start sweating a lot. These include nebivolol, for blood pressure, and apixaban, a blood thinner. It's not when I'm doing something energetic and it lasts about an hour or so. However, my doctor suggests that I have a “sweat problem” called hyperhidrosis. Is he right?

Any side effects that may be due to a medicine should be reported to the Medicines and Healthcare Products Regulatory Agency. You can do this online by searching for 'Yellow Card Scheme'. Alternatively, a pharmacist or GP can do this on your behalf.

Sweating is an unknown side effect of nebivolol or apixaban, but that does not mean that it is absolutely not the cause; it may come from another drug or from the combination of medications a patient is taking.

It may also be a symptom of the condition being treated: blood thinners such as apixaban and beta blockers such as nebivolol may be used for heart conditions, such as heart failure, which in themselves can cause sweating.

Hyperhidrosis is the name we give to excessive sweating. It can be related to medications, medical conditions, anxiety, and even alcohol. In some people, sweating occurs all over the body, in others it can occur in specific places, such as the hands or armpits.

Treatment would depend greatly on how this symptom affects someone. If it really is a drug that is causing this, there may be room to change the drug, on the advice of a doctor, as long as it does not affect the stability of the heart condition.

This may not be possible if the benefits of the drug are significant and no alternative is available or would cause the same problem.

Another option would be to treat the sweating.

For hyperhidrosis, a specific deodorant lotion containing aluminum is initially used, which can be prescribed for use on specific areas such as the armpits.

Click into this week's Medical Minefield podcast to hear why doctors are going to war over a £45 cholesterol-lowering drug

Great test kits – but so what?

You can now get an HIV self-test kit from Tesco.

Launched late last month, it costs £18 and provides results in 15 minutes with a drop of blood.

Broadly speaking, I'm all for this. In the 1990s, when I was in medical school, HIV testing had to be performed in hospitals, which involved ominous consultations with nurses and doctors. The process was unpleasant and the recording wasn't great.

Fast forward to now, we have highly effective treatments and Prince Harry is performing these instant finger prick HIV tests for the world's media.

It goes a long way toward removing the stigma that prevents people from getting tested, diagnosed, and receiving medical care. I have one concern: as with all DIY tests, there needs to be some sort of quick support for those with positive results.

It is far from ideal to have a home test that produces worrying results if patients then have to wait days for a GP appointment for a proper diagnosis. I hope Tesco has thought about this.

Pills can't solve all your woes – I wish they could

A group of leading doctors have written an open letter to the British Medical Journal suggesting that GPs should prescribe fewer antidepressants. They say we should instead try to tackle the 'root causes' of suffering, such as loneliness, poverty and poor housing.

A group of leading doctors have written an open letter to the British Medical Journal suggesting that GPs should prescribe fewer antidepressants

I agree in principle. Many conditions we encounter every day, not just depression, are the result of loneliness, poor diet or lack of exercise. But in reality, the best thing we can do for a patient is often to offer medications that can alleviate at least some of the symptoms.

In an ideal world I could prescribe better housing, more money and better social support. But unfortunately I can't.