DR ELLIE CANNON: I’m dizzy and slur my words, but I still can’t get a diagnosis

I have suffer from dizziness – sometimes extreme – and blurred vision. I also notice that I slur my words. The GP had blood tests done last year, but I haven't heard anything since. After doing my own research, I think I have ataxia, which seems to be getting worse every day. What do I need to do to get an official diagnosis?

Ataxia is the name for a series of serious brain disorders that affect balance, speech and coordination. It can be a long process to get a diagnosis from a neurologist, who will need to perform many tests, including MRI scans.

Certain species run in families, so genetic testing is also important.

Some tests are not common and are only offered by certain major hospitals across the country, which also require a referral.

The most common type of genetic ataxia is called Friedreich's ataxia, which is inherited from the parents. Typically, before age 25, people notice that their symptoms develop very slowly over time, although not always. People can also develop ataxia as a result of other conditions, such as multiple sclerosis or after a stroke.

It is usually not possible to treat ataxia, but it may be possible to relieve symptoms. This includes speech therapy, physiotherapy and occupational therapy. Medications are also available to help with muscle spasms and pain.

Because ataxia is a rare condition and difficult to treat, the charity Ataxia UK has accredited specialist ataxia centers for treatment and research. You can ask your GP or neurologist for a referral to one of them.

Ataxia UK is an excellent source of support (ataxia.org.uk).

I had my baby in March and then had a smear test in June, which showed I had the HPV virus – but the doctor said I had no abnormal cells. I have to come back in June for another swab test to check the situation. My problem is that we would like to try for baby number two. I'm in my late thirties, so time is running out. Is it safe to do this before my next test?

There are many different types of HPV – more than 100. It is a common virus that does not cause any problems in most people, but some types can cause genital warts or cervical cancer.

Although HPV affects as many as 80 percent of adults at some point, this will undoubtedly decline over the years as teens are now vaccinated against it.

But because of its association with cervical cancer, Pap smears look for HPV. It is very unlikely that people who do not have it will develop the disease.

If someone does have the virus, the cells on the cervix – the entrance to the uterus – are examined for abnormal changes. It is reassuring if none is found, and women are then kept under closer surveillance with annual screening, rather than every three years. For most people, the virus will clear up and not cause cancer: nine in ten HPV infections clear up within two years.

Weighing this against the desire to try for another baby is a very personal decision where we consider the risks and benefits. I would advise patients to go through the HPV process as a priority, for both practical and emotional reasons.

There are excellent charities that provide advice. The Eve Appeal offers an Ask Eve service, providing nurse-led expert information online or by telephone, on 0808 802 0019.

My right big toe joint is very painful and I often cannot move it. Years ago I was diagnosed with hallux limitus that would eventually become hallux rigidus. I was also told that painkillers were the only treatment, short of surgery, which I was reluctant to undergo. Is there anything else I don't know that you could suggest?

Surgery can seem intimidating, but considering you won't be able to walk or put on shoes, it may be worth undertaking.

Hallux limitus is osteoarthritis of the big toe, caused by wear and tear. The surfaces of the bones become damaged and rub against each other, limiting movement until the toe can no longer move at all. Some people claim that alternative medicine, including turmeric, chondroitin and glucosamine, can help. Howeverthese are not recognized treatments so I would not recommend them.

Anti-inflammatory tablets or gels such as ibuprofen, as well as other painkillers, are helpful. It is recommended to wear stiff-soled shoes or shoes with a rocker bottom during activities.

You may be referred for podiatry or arch supports – specially made insoles. Doctors may also offer a steroid injection into the joint – this is said to reduce inflammation in the joint and provide relief for months.

There are a range of operations and an orthopedic surgeon can advise you which is most suitable as this depends on the condition of the joint. The surgeries preserve the joints or make them unable to move, which can sound quite scary.

But in all cases the goal is to reduce pain. Research shows that the load on the foot improves with surgery, even if the joint has fused. This may be a price worth paying to be able to move and walk without pain.

Sometimes a GP needs to see you – please don't say no!

You might think this is hardly necessary, but if your doctor asks you to come in for an appointment, please say yes.

Data published in the British Medical Journal last week looked at the safety of remote consultations and, contrary to some reports, highlighted how safe they can be. However, researchers suggested that in some situations, such as skin rashes or in the elderly, they are not the right choice. In these cases, doctors need to actually see patients in person to properly assess them, in case it is serious.

I am aware that in some areas people are still struggling to get personalized advice, but I am running into another problem. It often happens that I ask a patient to come in for an examination, but he/she insists that he/she would prefer to be treated remotely.

There are some things we just can't address over the phone, and this kind of resistance worries me.

My question is: Now that the dust has settled on the major shift brought about during Covid, what are your thoughts on phone consultations versus face-to-face? Please write it and let me know.

Will your emergency room survive the winter?

As we enter winter, there is understandably concern within the healthcare community about the coming onslaught of viral infections, insects, coughs, colds and other ailments.

Most of us brush them off or feel bad for a few days. But vulnerable people – babies, pregnant women, the elderly and frail, people undergoing cancer treatment or with conditions that affect the immune system – may end up being rushed to A&E. What will they find when they arrive?

An analysis by the Care Quality Commission published last week found that half of England's emergency departments were failing to meet basic standards.

I would like to know: how is your local unit doing? Have you struggled to get treatment, had to wait for an ambulance or been left in limbo without a care package? Write and let me know.