My 70 year old husband had an episode of complete confusion last week and had to lie down for ten minutes until he felt better. He’s doing well now, but I’m afraid he may have had a mini-stroke?
Dr. Ellie Cannon replies: A sudden, brief change in speech, vision, mental function, muscle function, or balance are all signs of a mini-stroke.
It is also called a transient ischemic attack and symptoms can last from a few minutes to 24 hours. Total confusion would certainly be considered a possible symptom.
In a mini-stroke, the affected part of the brain suddenly has no blood supply and therefore no longer works
A mini-stroke occurs due to a sudden interruption of blood flow to the brain. Often this happens because a blood clot is blocking the artery, but it can also happen if there is a small bleed in the brain.
The affected part of the brain suddenly has no blood supply and therefore stops working, which explains the sudden symptoms.
Unlike a full-blown stroke, this blood loss is temporary, usually because the clot breaks free and no longer blocks the artery. No matter how brief the symptoms, it is crucial that anyone who suspects they have had a mini-stroke is taken to hospital immediately.
This is partly because doctors must assess whether there is brain damage. They may also offer treatment if it appears that a clot is still blocking blood flow.
Even if it’s been more than a week since the episode – and the problem seems to have resolved itself – it’s still worth going to the hospital. This is because doctors can reduce the risk of another mini-stroke – or even a full-blown stroke.
This can be done by recommending exercise, suggesting quitting smoking or prescribing medications. A drug called clopidogrel is often used to prevent blood clots from forming.
High doses of statins can be given to lower cholesterol, reducing the chance of further fat deposits.
There are also other causes of sudden confusion in the elderly, such as low blood sugar in someone with diabetes. An infection can also cause this symptom, but it normally does not last for such a short time. A sudden change in level of consciousness and confusion can also be a sign of a certain type of seizure.
Whatever the cause, it is crucial that anyone with these symptoms see a doctor as soon as possible.
I was recently diagnosed with piriformis syndrome. I’m in so much pain. What should I do?
Dr. Ellie answers: Piriformis syndrome is a form of sciatica, but mainly causes pain in the buttocks, normally on one side. It is caused by the same defect as sciatica, in which the large nerve that runs from the spine to the lower extremities, the sciatic nerve, becomes crushed or damaged.
This causes pain, numbness or tingling in the buttocks and leg. However, people with piriformis syndrome feel it mainly in the buttock, especially when going upstairs or getting up from a chair.
The piriformis is a narrow muscle that runs from the lower back through the buttocks to the top of the thighs and is involved in every movement of the leg. Pain can be caused by a problem in the muscle, such as swelling or an injury, which then affects the sciatic nerve.
For most, symptoms should resolve within two weeks with simple exercise, rest, and anti-inflammatory pain relief such as ibuprofen or naproxen.
Unfortunately, in some people the pain persists and specialist physiotherapy and stretching exercises are required.
When pain has an impact on quality of life, it is essential to speak to a GP about its proper control.
A steroid injection into the area may be an option.
My husband has COPD and has used a number of different inhalers over the years. However, his condition continues to worsen. Is there any other medicine he can try?
Dr. Ellie answers: COPD – short for chronic obstructive pulmonary disease – is a lung condition often linked to a history of smoking. It is progressive, meaning it gets worse over time.
Moderate to severe COPD patients are likely to receive a dark gray inhaler called Trimbow. This has three medications to reduce inflammation and keep the airways open.
If Trimbow no longer works, it is important that you see your doctor. They will have to assess how exactly the condition is deteriorating. After this, a GP will probably refer you to a respiratory specialist.
One option is physical therapy, which can help improve lung function. Another is oxygen therapy, where you wear a nasal tube or face mask at home, which delivers extra oxygen into your bloodstream.
It is also important that anyone with COPD is up to date with their flu, Covid and pneumonia vaccines, as these infections can make the condition worse.
Trendy language doesn’t help anyone
I talk about obesity a lot with my patients and in the media, and I can honestly say that I have never heard the phrase “overweight people.”
This clumsy expression is now used in some NHS literature. I understand it’s part of a trend to stop referring to people as ‘having’ their disease – for example, you’re not a ‘diabetic’, you’re someone who ‘lives with diabetes’.
Well, that may be true, but in the case of ‘living with excess weight’ it makes no sense for me, and I think for most people too – which is a problem.
Decent healthcare communication and education depends on using sensible language that we all understand and that reflects the facts – not making up phrases to satisfy a box that the average patient won’t appreciate.
Creating this new expression has nothing to do with precise science – or grammar – and will not help patients.
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.