I am a 70 year old woman and last year when the weather was hot my ankles and feet swelled up. Since then the swelling has not gone down. I am on blood pressure medication, amlodipine, but I only started taking it when the swelling started. Can you give me some advice?
Dr. Ellie responds: Swelling is an annoying condition and should not be ignored.
Although it can happen after a long flight or in hot weather, it will usually subside. Swelling that lasts for a long time can sometimes be a sign of heart failure – a dangerous condition in which the heart pumps less efficiently than before.
It can also be a symptom of kidney or liver problems, or poor circulation.
However, one of the most common causes of swollen ankles is blood pressure medication such as amlodipine. Although it is an effective medication for lowering blood pressure, this is a side effect that GPs see all the time.
Long-term swelling of the ankle can sometimes be a sign of heart failure
It is possible that a patient who already has swollen ankles due to hot weather and then starts using amlodipine will have persistent problems.
The good news is that there are plenty of other medications that can effectively treat high blood pressure and may not cause this nasty side effect.
These are medications that a GP can prescribe. If a patient changes blood pressure treatment and the swelling goes down, that is a welcome finding.
If the swelling persists after changing, further testing will be required to determine the cause of the problem.
Regardless of the cause, it is important to consult a doctor if you have a swollen ankle.
Earlier this year I had a terrible cough that lasted for two months. After a course antibiotics have cleared up my cough but I still have shortness of breath. I am 80 and fairly active. What can What do I do to improve my breathing?
Dr. Ellie responds: Shortness of breath is not only caused by lung problems. It is important to find out the cause, because it can indicate a life-threatening condition.
It is possible that an infection is causing shortness of breath because it can cause scarring of the lungs. A recent infection can also worsen the symptoms of asthma – the lung disease that causes breathing problems.
Sometimes, however, shortness of breath can be a sign of lung cancer, in which case scans, such as a chest x-ray, are needed.
It can also be caused by heart problems, which are more common over the age of 75.
Examples of these are heart rhythm disorders, including a condition called atrial fibrillation. This condition can be easily diagnosed by a GP because it causes an abnormal pulse.
One specific heart problem that causes breathing problems during exercise is a valve disease called aortic stenosis.
This is when one of the heart valves becomes stiff and doesn’t work as well as it should. A GP who suspects aortic valve stenosis would likely refer a patient for an echocardiogram, a scan of the heart.
Another cause could be anemia, which is a result of a lack of iron in the blood. A GP can perform a blood test to detect this condition and prescribe iron tablets to combat it.
A few years ago I was prescribed a low dose of antidepressants for my chronic back pain. However, when I tried to stop taking them a few months later, I started having withdrawal symptoms. It took years before I was able to stop taking them completely, but now nothing else works for my back pain. What should I do?
Dr. Ellie responds: Pain management can be incredibly complicated and often involves much more than just taking a pill.
Antidepressants are a tool that GPs use to treat chronic pain, such as back pain, as studies show that they can reduce the painful sensation. However, the tablets cannot take the pain away completely.
In addition, they can have side effects, including withdrawal symptoms in some cases.
Research shows, however, that the best way to combat back pain is movement and low-intensity exercise. This could be walking, swimming, or even taking a dance class.
Painkillers can be used in combination with exercise.
For example, many people with pain complaints take an anti-inflammatory drug such as naproxen every day and, if the pain is particularly severe that day, also paracetamol.
I would recommend anyone living with chronic pain to ask their GP for a referral for physical therapy.
In many parts of the country it is possible to make an NHS physiotherapy appointment without having to visit your GP first.
A physical therapist should be able to provide some targeted exercises to improve mobility and hopefully reduce pain.
RSV is not a cold – get vaccinated
There is a new vaccine that many of you can get this fall, but you may never have heard of the infection it protects against.
Respiratory syncytial virus – known as RSV – is a common winter illness and for several months each year thousands of hospital beds are occupied by people, often elderly, who are severely affected by this lung infection. It can be so widespread that it can lead to delays and cancellations of routine treatments.
RS virus is often mistaken for a cold, with mild symptoms such as a runny nose, sore throat, cough and headache that go away on their own within a few days.
But it can also be deadly. If it gets worse, it can cause a terrible cough, shortness of breath, wheezing and high fever. About 5,000 adults die from RSV each year, most of them over the age of 75.
So it’s great news that all over 75s will be offered the RSV vaccine for the first time in September. So if you’re called up for a dose, take it.
Antonya Cooper who last week admitted after 40 years to giving her terminally ill son a large dose of morphine to end his life
Is Euthanasia the Right Path for Us?
I was moved by the extraordinary story of Antonya Cooper, who last week admitted after 40 years that she had given her terminally ill son a large dose of morphine to ‘quietly end his life’.
Hamish, just seven years old in 1981, had stage four cancer and was suffering ‘in the most appalling conditions’, according to Mrs Cooper.
Mrs Cooper, from Oxfordshire, is also battling terminal cancer and has decided to speak out about her decision as campaigners campaign to change the law on the issue.
Euthanasia – also known as euthanasia – is illegal in the UK, so Ms Cooper, pictured above with Hamish, could be open to a police investigation. It’s an incredibly complex, emotive issue, but the tone of euthanasia has been set, with many more people – including our new Prime Minister – calling for a change in the law.