DR ELLIE CANNON: I’m off my anti-clot pills after aorta stent – so why do I still bruise so easily?

A few years ago I got a stent in my aorta after a scan showed an aneurysm. I was also prescribed an anticoagulant pill, clopidogrel, and I soon noticed that if I got a knock, no matter how small, I immediately bruised, badly. I was taken off the tablets in January, but I still bruise easily. Is this normal?

A stent is a surgical implant – a mesh tube that is placed in a blood vessel, where it acts as a scaffold, keeping it open and allowing blood to flow.

They are often placed in the heart arteries, if they are blocked, to prevent heart attacks. In the case of an aortic aneurysm, a weakness in the wall of the body’s main artery, a large stent is used to take pressure off the vessel and prevent it from rupturing.

After a stent has been placed, it is standard practice to administer anticoagulant medication, which stops blood clots from forming around the stent, which can cause further blockages and cause heart attacks and strokes.

When prescribing anticoagulant tablets such as clopidogrel, we warn patients that they bleed more easily, for example from the gums after brushing their teeth.

Bruises are small bleeds under the skin from a blow that damage small, superficial blood vessels – and are also more commonly seen.

When the anticoagulant is discontinued, these side effects should stop. But it’s important to note that these things are seen with most of these drugs – so once switched to a new one, the problems may persist.

Bruising or a little more bleeding isn’t life-threatening, so we’d usually say that the benefits of the drug – in terms of preventing deadly things like heart attacks – far outweigh these minor risks.

If not due to medication, blood tests may be done to check that levels of clotting proteins and platelets are normal, in addition to other checks such as liver function, which is also an important part of the blood clotting system.

It is also common to bruise more easily as you age because the skin is thinner and the blood vessels are more fragile.

At the beginning of this year I had shingles on my neck and shoulder blade. It was incredibly painful, I lost my appetite, couldn’t sleep and was extremely tired. It took a few months and even now, six months later, I get shooting pains in my neck. I’m afraid I’ll never feel the same again. Any advice?

Shingles is the reactivation of an old chickenpox infection. After the initial infection, the virus that causes the chickenpox – which most of us get as children – remains dormant in the body.

But as you get older, or if you’re decrepit or frail, immunity to the virus — varicella-zoster virus (VZV), part of the herpesvirus group — can decline, allowing it to become active again.

VZV lives in the nerves – that’s why the rash it causes, when it becomes active, appears in a band or patch along a nerve line.

It’s also why it’s very painful, causing burning, pain and something called neuropathic pain – nerve pain that feels like electricity or prickling.

Shingles can also cause a long-term condition called neuralgia — when the pain persists, causing stinging. For some people, shingles neuralgia becomes long-lasting and needs treatment.

After a severe attack of shingles, it is worth contacting your GP. There may be underlying issues, from stress to insomnia or even depression, that exacerbate the discomfort.

We also vaccinate everyone over 70, and if you haven’t had a shot it’s worth it to avoid getting the condition again.

In January I went to the doctor because I had pain in my vulva and was told I probably had a skin cancer called basal cell carcinoma. This naturally worried me a lot, but the doctor didn’t seem too preoccupied and said I could have a biopsy if I really wanted to. Should I bother, if it’s going to hurt?

This seems quite confusing. Basal cell carcinoma is a slow-growing cancer usually found in sun-exposed areas of the skin, such as the face.

It is considered very rare in the vulva – the external part of the female genitalia – so it would be unusual to diagnose it simply on an exam.

Most skin cancers of the vulva are of a type known as squamous cell carcinoma, and they usually grow on the labia near the opening of the vagina.

Vulval cancers are rare, affecting 1,400 women in the UK each year, but are more common in women over the age of 65.

Disturbing symptoms that may indicate cancer include a persistent ulcer, bleeding or pain, raised or thickened areas of skin, a lump, or constant itching that does not go away.

Persistent vulval changes are one of the criteria for GPs to organize a so-called cancer target referral, which requires patients to be able to get an appointment with a gynecologist within two weeks. At this appointment, the specialist can take a much closer look and take a biopsy.

A small sample of tissue is taken after an injection with local anaesthetic, but it is extremely important if there is a suspicion of cancer.

Talk to the Ask Eve information service, which offers advice to any woman concerned about gynecologic cancers.

The helpline is on 0808 802 0019 or visit eveappeal.org.uk.

Calorie counts on menus are harmful, not helpful

A big suspicion of mine was confirmed last week: calorie counts on menus are not helping the obesity crisis.

That was the conclusion of a major study presented at one of the largest obesity conferences in the world: the European Congress on Obesity. The researchers concluded that the impact of calorie labeling will be “little or zero.”

I’m hardly surprised. There has always been a question mark over the quality of the evidence supporting the initiative, which took effect last spring.

And the policy is not without risk. Eating disorder charities have expressed serious concern about the harm being done to thousands of people with these life-threatening mental illnesses.

Some of my eating disorder patients avoid eating out because they are terrified that confronting the calories will hinder their recovery.

The sooner we scrap the stupid plan, the better.

Know the telltale signs of dementia

This week I’m supporting a campaign to help people learn the difference between normal, age-related memory loss and dementia.

I often hear people talk about older relatives asking the same question over and over. This is not a normal sign of aging. In fact, it is one of the telltale signs of dementia.

Walking into rooms and forgetting what you’re looking for is normal – we all do it. But with dementia, people forget words and lose track of time and dates. There are also a host of other lesser-known symptoms such as insomnia and restlessness. The sooner someone gets a diagnosis, the sooner they can access medications to relieve their symptoms.

If you’re concerned about a loved one, visit the Alzheimer’s Society (alzheimers.nl) or contact your doctor.