I am 78 and have been suffering from nosebleeds every day for the past two weeks. It can happen at any time, even in the middle of the night. I don’t want to bother my doctor about it, my pharmacist said it wasn’t serious. What do you think?
Dr. Ellie Cannon replies: Nosebleeds that occur regularly should be evaluated by a doctor. More often than not, the bleeding comes from a delicate area in the nose where blood vessels are easily damaged.
This can occur as a result of an injury, the use of nasal sprays, or an infection such as a bad cold. Rarely, it can be caused by a tumor or blood clotting problem. Nosebleeds are also more common in people taking blood thinners or in people who often come into contact with dust or cigarette smoke.
A GP can assess the cause and there are blood tests to detect clotting problems.
Once underlying serious conditions have been ruled out, a GP may be able to prescribe the nasal cream Naseptin, an antiseptic.
Patients may also be referred to a specialist for a minor procedure called a nasal cautery, which can close off the bleeding area and stop further episodes.
Whatever the condition, it is important that patients inform their doctor of any medical problems that are serious or long-lasting.
Delaying addressing a problem can sometimes make it worse.
In rare cases, regular nosebleeds can be caused by a tumor or blood clotting problem
I am 54 and have never had menopausal symptoms. I live with polycystic ovary syndrome and until a few years ago was taking the hormonal birth control pill to combat the symptoms. Do you think this could be the reason I haven’t gone through menopause?
Dr. Ellie answers: The average age of onset of menopause in Britain is between 47 and 53 years, but this can happen later.
It is caused by declining levels of the female sex hormone estrogen and the impact of this change affects women in different ways.
Although most people associate menopause with hot flashes, mood swings and sleep problems, some women never experience any of these problems.
That is why doctors usually define menopause as an absence of menstruation for more than a year. When this happens it is affected by each woman’s health, ethnicity and any medications she is taking.
Polycystic ovarian syndrome, or PCOS, is caused by a hormonal imbalance and typically causes irregular periods, acne, facial hair, and difficulty conceiving.
Some symptoms mimic perimenopause – the early stages of menopause – such as irregular periods and heavy bleeding.
Because PCOS is a hormonal condition, it is entirely possible that this could affect the age at which a woman experiences menopause and the nature of her symptoms.
Some data suggests that women with PCOS reach menopause an average of two years later than those who do not have it.
My husband recently developed a serious respiratory infection after getting a flu shot. He has Crohn’s disease and is prescribed azathioprine. Could the vaccine have given him the infection?
Dr. Ellie answers: It is impossible for the flu vaccine given to people over 65 to cause an infection because it does not contain a live version of the virus.
Instead, it contains only part of the virus to trick the immune system into producing protective antibodies to fight future flu infections.
I often hear about people getting an infection shortly after getting the flu shot, and there are a number of reasons why this would happen.
Firstly, the NHS offers the vaccine in autumn and winter, when infections are more common. Statistically speaking, it is simply more likely that someone will develop a respiratory infection around the time they receive a vaccine.
Secondly, it is not unusual to get a flu shot in a healthcare setting, such as a doctor’s office or pharmacy, where there are other sick people present who could pass on an infection.
This means that, ironically, getting a vaccine may increase the risk of infection, although the chance is small.
Finally, people who take immunosuppressive medications such as azathioprine, which are designed to calm the immune system, are more likely to develop infections than those who do not take these medications.
It is therefore crucial that anyone taking any of these medicines takes up the offer of a vaccine to reduce the risk of serious symptoms.
Patients with suppressed immune systems may also want to take some simple steps to lower their risk of infection, such as avoiding large crowds indoors or wearing a face mask.
GPs need to know how to diet
Last week I attended a conference exploring how social media has influenced nutrition advice – and I was shocked by what we saw.
Researchers have shown us that most online diet tips are not backed by scientific evidence. This is especially true of the wellness products advertised on social media: the gummies and powders that are supposed to provide a health boost, but turn out to have little to no benefits.
However, this event at the Royal Society of Medicine in London impressed me for another reason: it made me realize how absurd it is that doctors are not trained to give dietary advice. It may sound unbelievable, but at no point in our years in medical school were we taught about nutrition. This is especially crazy considering that so many diseases are linked to diet, such as type 2 diabetes.
If we want to combat misinformation online, perhaps it’s time we started educating medical students about nutrition.
- Do you have a question for Dr. Ellie Cannon? Email DrEllie@mailonsunday.co.uk