Q: I had a mini-stroke three years ago and was given some tablets, including lansoprazole. After experiencing pain in my legs and hips, a scan revealed that I have early stage osteoporosis. I have read that lansoprazole may be a cause. Should I stop taking it?
Dr. Ellie answers: Lansoprazole is a type of medication known as a proton pump inhibitor or PPI. These work by reducing the amount of acid produced in the stomach, and for this reason they are given to people with acid reflux, stomach ulcers and gastritis.
They can also be prescribed preventively to people who take other medications that can irritate the stomach, for example if someone regularly uses an anti-inflammatory.
But all medications come with side effects and risks, which must be balanced with their necessity.
According to official guidelines, PPIs should be prescribed with caution to people at risk of the bone-thinning disease osteoporosis. Patients should be educated about the use of the medications and offered calcium and vitamin D supplements – and sometimes other treatments – to prevent problems from developing.
An x-ray showing osteoporosis resulting in hip replacement
Osteoporosis makes people susceptible to bone fractures. Studies published more than a decade ago showed that older adults who took PPIs, especially for more than a year, were at increased risk of breaking their hip, wrist, or spine. These effects were more likely at high doses and the longer people took them.
Contrary to popular belief, the symptoms of osteoporosis are not stiffness or nighttime pain. In fact, there are usually no signs until a rupture occurs and the disease is diagnosed with a scan.
An older person on a PPI who has been diagnosed with osteopenia – a warning sign of osteoporosis – can request a scan to assess the situation. If bone thinning continues to be a problem, it may be possible to switch to other medications.
Question: I often wake up at night with extreme pain under the arch of my foot. I went to a pedicure and tried different creams. Can you suggest something? I should point out that five years ago I had a brain tumor removed and had a brain hemorrhage.
Dr. Ellie answers: Severe heel pain is usually caused by a condition called plantar fasciitis. However, this causes pain during the day when walking and should get better with rest. Foot pain can be a side effect of cancer treatment, especially chemotherapy, which can damage the nerves.
The pain may be worse at night due to the higher temperature of the feet, some swelling from lying still and also because there is no distraction. It is unlikely that creams or paracetamol would help with this.
To diagnose a neurological cause of pain – especially peripheral neuropathy, which is a form of nerve damage – tests called nerve conduction studies may be performed in the hospital. A GP should be able to refer for this.
If nerves are the problem, this pain will not respond to normal painkillers, but will require a neuropathic painkiller such as gabapentin or pregabalin.
We also use an old-fashioned antidepressant called amitriptyline, which can also help with sleep.
Question: In 2018, at the age of 67, I was diagnosed with breast cancer and successfully treated. Now I’m 72 and at my last appointment I was told I would have a mammogram once every three years, and that was it. Is this really safe? I would much rather continue having one every year as I always have.
Dr. Ellie answers: Mammograms are a type of X-ray that we use to screen for breast cancer. The idea is to pick up lumps when they are still small, before they can be felt.
In Britain, women aged between 50 and 70 are screened once every three years. After the age of 70, women can apply every three years.
This is thought to be the best time frame because offering mammograms too often increases the risk of false positives and all the anxiety that comes with them. It also offers no benefit in terms of better protection or longer lifespan.
Screening is only for people who are healthy. The situation is of course different for women who have had breast cancer. Initially, annual mammograms are the normal procedure for five years, usually in addition to tablet treatment.
At this stage, women re-enter the usual screening program. This system mirrors treatment for other cancers. The five-year milestone is usually the point at which we consider a patient cured. If most cancers come back, they come back before then.
Five years after diagnosis, women who have had breast cancer are treated the same as other women their age who have not had it. This can feel quite difficult, although many patients are happy to return to their normal lives and not be reminded of their diagnosis.
However, it is important that women understand that if they have symptoms such as a lump, pain or changes in the breast, the screening program is not relevant. If you have complaints, go to your doctor. This controls tests completely separately from the program.
Lady Gaga posted a video about the migraine treatment rimegepant on Instagram. She says the drug has changed her life.
Lady Gaga got help for her migraines… but do you?
Big migraine news as the NHS spending watchdog has approved atogepant, a daily tablet that helps prevent the debilitating attacks.
Meanwhile, in America, Lady Gaga is promoting a similar new migraine treatment, rimegepant, which she says has changed her life.
But patients in Britain will have to try three other drugs before receiving atogepant – also known by the brand name Aquipta – and it can only be prescribed by a specialist, not a GP. Then in some areas there is a wait of up to a year before you can see a neurologist, and that is if your NHS provider funds the £500 per month treatment.
Reports suggest there is a postcode lottery when it comes to migraine treatments. Have you had any problems accessing it? Please write it and let me know.
A stoma without baggage
I’d never heard of Louise Thompson until last week, when the Made In Chelsea star announced that after years of suffering from the painful bowel problem ulcerative colitis, she had had a colostomy bag fitted.
In a video posted to Instagram, the 34-year-old said she “didn’t want to hide” her condition and that the bag “may have saved my life.” I applaud her honesty.
Having a stoma is a big problem. There are around 100,000 people in Britain who have one – usually due to Crohn’s disease, bowel cancer or infections – but there is still a stigma surrounding it. Some people become very isolated and stop doing things they used to enjoy for fear that they will hurt themselves, make a mess, or have people see the bag.
But life with a stoma does not have to change. Colostomy UK is a good source of advice and can refer you to support groups (colostomyuk.org).
Do you have a question for Dr. Ellie Cannon? Email DrEllie@mailonsunday.co.uk
Dr. Cannon cannot enter into personal correspondence and her responses must be placed in a general context.