DR. ELLIE CANNON: Why do I get pain in my armpit during a strenuous bike ride?

I often have pain in my left armpit, especially when I walk uphill or cycle fast. My GP thought it might be angina and I had tests and my heart and blood vessels were found to be fine. Any ideas?

Pain that occurs during exertion reminds us of a heart problem. But once this has been ruled out, I would look at musculoskeletal causes – especially if there is discomfort due to extra movement or stress on the shoulder, chest wall or arm, from cycling and strenuous walking.

This could be muscle pain or a problem in the shoulder joint itself. The left armpit contains lymph nodes, or glands, which may swell, as well as sebaceous cysts – small infected lumps, or lipomas, which are small lumps of fat.

It is important that a doctor perform an examination to ensure that swelling in this area is not causing the problem.

More general swelling can result from exertion, and this could be why the pain worsens with these movements. One treatment option would be to try an anti-inflammatory gel or cream, which would only be effective if it was a local musculoskeletal problem, and not something deeper.

As an aside, I am often reassured that it is nothing sinister if the discomfort has been the same for a long time and has not worsened.

I have suffered from diverticulosis for more years than I can remember. I have no pain, but some days I have to empty my bowels more than ten times. Always having to be near a toilet defines my life. Do you have any advice?

Bowel symptoms, especially loss of control, are distressing and difficult to live with. Patients are often forced into isolation and stay at home so they don’t risk falling short.

Diverticulosis causes small pouches in the lower intestine, which can become inflamed. Pain and diarrhea, bloating and constipation may be common.

As far as diet goes, eating the right amount of fiber and drinking plenty of water are crucial. Both help keep things moving. But increasing fiber can also cause bloating, flatulence, and urgency in some patients, in which case doctors suggest trying a low-fiber diet (but not without fiber).

That means limiting things that are harder to digest, like onions, nuts and seeds, peels of fruits and vegetables, whole-grain breads and cereals, for a few weeks, and then gradually adding them back in.

People who simply cannot tolerate fiber-rich foods may benefit from a fiber supplement. Pharmacists can advise on this.

Loperamide can be used for diarrhea, but only as an occasional treatment.

An antispasmodic tablet can also be prescribed for diverticulosis. It can help the intestine relax and not squeeze as much, and may result in fewer bowel movements.

Urgently running to the toilet after eating may not be related to diverticulosis, but could be a symptom of another problem, such as lactose intolerance.

It might be worth keeping a food diary for a week to see if certain foods worsen the urgency. And apply for a Just Can’t Wait card from Bladder and Bowel UK to help you get quick access to toilets in cafes, restaurants and shops when you’re away (bbuk.org.uk).

I was recently prescribed melatonin to help with sleepless nights. It helped, but the doctor told me I could only get a three-month supply. Why?

Melatonin is a sleeping aid that is prescribed for short-term insomnia in people over 55. We cannot prescribe it for longer than twelve weeks because research shows that short-term use is safe for most adults, but more research is needed to confirm its longer-term safety.

Insomnia is a huge problem in Britain, affecting millions of people. Although doctors distributed sleeping tablets for decades, we now know that this was ineffective. The tablets do not work for many people and cause addiction in a large number of people. Younger people do not get melatonin for insomnia.

The best way to deal with sleep problems is to undergo sleep therapy, including cognitive behavioral therapy. It is available on the NHS through GPs in group and individual settings, or online or via an app.

Sleep restriction therapy is also worth investigating with your doctor. This initially involves going to bed as late as possible to get the average amount of sleep you currently get.

So if you normally only sleep four hours and have to wake up at 7am, you go to bed at 3am. After a few days, set your bedtime for five hours of sleep, and so on. It takes commitment, but it works.

Sleep therapy should not be confused with sleep hygiene – something everyone with sleep problems should do – but it is not a treatment in itself.

This involves creating the best sleeping environment using measures such as earplugs, avoiding phones and a quiet, cool bedroom to sleep in.

Are you honest about how much you drink?

Over the past week, a stream of worrying research has been published about the harm caused by alcohol. Even just one glass of wine a day puts us at greater risk for cancer and liver damage.

I sometimes wonder if my patients are completely honest with me when I ask them how much they drink.

Therefore, I would like you to write to me and let me know. Do you or someone you know rarely go a day without alcohol? Do you often find yourself drinking more than you intended?

Send me an email – in confidence – at the address below.

We are best placed for sick notes

Much has been said by my GP colleagues about sick notes since the Prime Minister announced a plan to stop us handing them out.

Many applaud the move and say they don’t have time for it anyway. But I don’t agree with that.

I think GPs are the right people to offer this service. Leave is an important part of treatment, and I prefer my patients to recover well rather than continue to struggle.

In my experience, few ask for notes they don’t need. In fact, I often encounter resistance when I suggest taking time off.

I’m not saying the system isn’t being abused – I’m not naive – but a one-size-fits-all approach is not the answer. If the practice functions well, general practitioners can ensure that people do not go on long-term leave. Well-equipped physio, psychology and pain clinics would also ensure patients no longer need notes.

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.