DR. ELLIE: I’m afraid this personal habit of mine might cause a terrible itch on my buttocks…

I have been suffering from itchy skin problems for years, but recently it has become much worse on my buttocks and torso.

A few years ago I was diagnosed with papular urticaria and was given various creams and tablets, but without success. Could the fact that I smoke be to blame?

Dr. Ellie answers: Urticaria is a skin rash that can be very painful to live with. The symptoms are similar to hives: the itchy skin reaction. But while hives, which are usually caused by a food allergy or an insect bite, will go away in a few days, people with urticaria suffer for months, even years.

In most cases, the cause is unclear, although it is thought to be related to the immune system mistakenly going into overdrive.

Allergy medicines – called antihistamines – are commonly prescribed, as are steroid tablets. Both can reduce the itching sensation and soothe the red rash, but cannot cure it.

Steroids can only be taken for short periods of time because long-term use can increase the risk of serious conditions such as the bone-thinning disease osteoporosis. However, in severe cases, a dermatologist may decide that the benefit of a daily dose of low-dose steroids outweighs the associated risks.

Another medicine for urticaria is montelukast. This tablet is usually given to asthmatics to calm their immune system, but research shows that it is also effective for urticaria. There is also an anti-itch ointment called menthol aqueous cream, which many urticaria sufferers swear by.

Smoking is not believed to be a trigger for the condition. However, together with caffeine and alcohol, it can worsen symptoms.

I’m 82 and recently had a mini-stroke. A scan showed that the arteries in my neck had thickened, causing very little blood to reach my brain. However, I was told that surgery was too risky. Now I’m afraid I might have a full blown stroke soon. What should I do?

Dr. Ellie answers: In a mini-stroke, the blood supply to the brain is temporarily blocked. Unlike a stroke, which causes brain damage, most people who experience a mini-stroke will not experience any lasting problems.

A common cause of both a stroke and a mini-stroke is when the arteries in the neck, the carotid artery, become blocked. Patients usually get a percentage of how blocked they are; anything above 50 percent is significant.

The blockage can build up over time as the lining of the arteries thickens, but is also accelerated by high cholesterol.

In most cases, the best way to combat this problem is medication, such as blood-thinning tablets to prevent blood clots, blood pressure medications, and statins to lower cholesterol.

In some cases, surgery to open the carotid arteries may be considered if the blood vessels are dangerously blocked.

This may involve removing the lining – known as a carotid endarterectomy – or widening the artery by inserting a tube called a stent.

However, this will only be performed if the surgeon believes it will benefit rather than harm the patient. Life-threatening complications become more likely as the patient becomes older and sicker.

It is important that anyone who has been told they are not suitable for surgery speaks to a GP or cardiologist as soon as possible about what medicines they should take instead.

I have been suffering from severe neck and back pain for almost a year. I’ve been told I have cervical spondylosis and apparently physiotherapy is the only thing I can treat – and this hasn’t helped at all. What would you recommend?

Dr. Ellie answers: Cervical spondylosis is a painful arthritis condition caused by inflammation of the spine in the neck. It can be painful and patients may also find it difficult to move their neck.

All evidence suggests that physical therapy is important in the treatment of this condition. It cannot be cured, but regular exercise can reduce pain and improve mobility in the region.

While it is normal to feel that physiotherapy is not having any effect, I would urge anyone who feels this way to continue with it as its benefits are measured in months not weeks.

And there is no reason why patients shouldn’t take pain relief to reduce their suffering. Doctors will usually start by prescribing a strong dose of paracetamol or ibuprofen. In some cases, codeine, a mild opioid, may be offered, but this should be used sparingly as it can be addictive.

Other treatment options include prescription anti-inflammatory drugs such as naproxen or etoricoxib. Antidepressants, including amitriptyline and nortriptyline, may also be prescribed in low doses to relieve pain and improve sleep.

Patients may also want to try non-pharmaceutical options, such as heating pads.

These are all options that can be discussed with a doctor.

Should assisted dying be something for people who are ‘tired of life’?

In the debate over legalizing assisted dying, I feel like there is a group of people who haven’t been heard: those who are just tired of living.

And last week, a particularly bleak research article was published on the academic site The Conversation highlighting some of the reasons why a significant number of older people don’t want to move on, including chronic pain, lack of mobility and loneliness.

I often see these patients in my practice. They are not suicidal or depressed, but believe that life is a burden and would give up if given an easy, painless way out.

However, the bill currently in parliament and supported by journalist Esther Rantzen (photo) would only apply to people who have less than six months to live.

Shouldn’t we also consider offering people in their final years the opportunity to die at a time and place of their choice? Is this something you would consider?

Please write to me DrEllie@mailonsunday.co.uk and let me know your thoughts.