DR. ELLIE CANNON: Could my 24-hour flu bout really have been a mini-stroke?

Q: A few weeks ago I felt like I had flu got up and decided to put myself to bed. I managed to get upstairs, then collapsed and had to crawl to the bedroom. After about four hours I woke up and felt like I had about 50 percent of my strength – but when I woke up the next morning I felt absolutely fine. What could cause such a sudden loss of strength and yet recover so quickly?

It can be difficult to know what is causing sudden and temporary symptoms like these, which we all experience from time to time, often because the problem has passed by the time someone gets to my office.

However, the first thing that comes to mind in a case like this – especially if the patient is elderly – is a transient ischemic attack (TIA), often called a mini-stroke.

If someone has a stroke, the symptoms persist. But with a TIA, the symptoms usually only last a few hours and disappear completely after 24 hours.

A stroke occurs when the blood supply to the brain is blocked by a clot or bleeding, but a TIA occurs because this disruption is only temporary.

Weakness in a limb is a classic sign of a TIA or stroke, but this usually only happens on one side rather than losing all the strength in both arms and legs at once. Anyone at risk for heart disease or stroke is also at risk for TIAs, and this is something to discuss with a primary care physician about continued prevention. For example, this may include controlling high blood pressure or high cholesterol.

Viruses such as influenza or Covid typically cause muscle pain, especially in the arms and legs, and both sides of the body are affected equally. This can be a very significant symptom of a virus, causing profound and temporary weakness.

While it would be unusual for this to happen so suddenly and go away so quickly, it could still happen.

Q: I’ve been told I need surgery – a thyroidectomy – because a lump is growing on my thyroid. Besides feeling lethargic, I have trouble swallowing. But I’m terrified of surgery and worried about having to take a hormone drug called thyroxine for the rest of my life. I’ve heard it causes weight gain, hair loss and a general ill feeling. My advisor didn’t seem to take my fears seriously. What do you think?

Taking thyroxine does not cause people to gain weight, experience hair loss or generally feel unwell. In fact, these are the symptoms of hypothyroidism, also known as an underactive thyroid gland, for which the treatment consists of the use of thyroxine.

These symptoms would only become apparent if the dose of thyroxine was too low.

Many people use thyroxine for life with minimal side effects. It is certainly a better option than avoiding surgery that doctors have recommended.

Difficulty swallowing can be a symptom of an enlarged thyroid gland. This alone is a dire problem that certainly needs to be addressed.

The thyroid is a butterfly-shaped gland located at the front of the neck. A growth in the thyroid may be visible as a lump, but can also put pressure on underlying structures, including the trachea and esophagus. Thyroid nodules are diagnosed on an ultrasound, which can show the nodule in more detail. Typically, doctors will then perform a biopsy and possibly surgery to remove the lump, if there is any suspicion that it could be cancerous.

It is possible that people may experience short-term problems with their voice or calcium levels after thyroid surgery, so it is worth discussing this with the surgical team.

Question: I suffer from eczema and extremely itchy skin. The doctor prescribed a cream, but it doesn’t help, in fact, the itching is getting worse. I have also had swollen arms and legs, for which I have been given antibiotics. What can I do to stop all this?

Swelling and extreme itching are not normally a symptom of eczema, but could indicate that something else is going on and certainly require continued GP treatment.

There could be two possible causes. First, if the scratching causes damaged skin, an infection can easily occur. This would cause swelling and tightness.

Antibiotic tablets would be a first-line treatment, but if these don’t work you may need intravenous antibiotics in hospital.

Another possible cause is urticaria or nettle rash. These appear as noticeable bumps and swellings on the skin and can affect any part of the body.

Just like with eczema, this can be due to an allergy, but it can also simply be caused by an overactive immune system. Treatment consists of antihistamines and even steroid tablets, and avoidance of known triggers such as caffeine and high temperatures.

Getting the eczema under control should be a priority as it makes other problems, such as infection, less likely. A good eczema regimen includes avoiding irritants such as scented skin products. An emollient cream should be used to wash the skin and as a body moisturizer.

If the skin is red and sore, try a steroid or treatment cream that will calm the inflammation of the skin. If over-the-counter one percent hydrocortisone doesn’t work, ask the doctor for a prescription for a stronger steroid.

It is crucial that we listen to parents

Before becoming a general practitioner, I worked in pediatrics, where I learned an invaluable lesson: in addition to monitoring the child, it is crucial to monitor how concerned the parents are.

They are the ones who know their child best. If they say something is wrong, it should warrant investigation. This lesson has been proven correct time and time again. When a father or mother calls into my clinic to say they are just not happy with something with their child, we always assess them.

I thought about this when it was announced that Martha’s Rule would go into effect in April. Families and patients can request a second option if they are not satisfied with their care. It comes after the sad death of Martha Mills at the age of 13, whose parents felt their concerns were not listened to as she became sicker, before dying of sepsis.

The parental instinct is powerful. We must listen to it.

Is Honey Enough to Treat Cough?

The cough medicine codeine linctus is prohibited for sale without a prescription and is now only available with a prescription.

It follows an ongoing problem of people abusing it.

Codeine is sedating when taken in large amounts, and some people abuse it for this reason. And it can also be addictive, so pharmacists have faced aggressive demand for bottles.

I obviously support the ban, but I’m afraid we no longer have anything to offer people with coughs. Many cough syrups are actually just sugar, and honey and lemon often don’t cut it.

What should you do if you need to treat a cough? Are you relying on codeine linctus and feeling like you haven’t had treatment, or do you have a home remedy you’d like to share? Please write to me at the email address below and let me know.

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.