Why do I bruise so easily from the slightest bump? ASK DR. MARTIN SCURR

Q: Over the past ten years I have had frequent bruises on my arms, often from the slightest bump. I’m 74; Is this something that can be cured, or will I just have to live with it?

Stephen Young, by email.

Dr. Martin Scurr replies: A bruise occurs when blood leaks from small blood vessels called capillaries and collects under the skin.

If there has been no obvious injury or if the extent of bruising is disproportionate to the trauma, we use the term ‘easy bruising’.

Age is an important factor because, as we age, the fatty layer under the skin, which acts as a cushion against bumps and blows, thins, leaving blood vessels less protected and more easily injured.

This type of ‘easily bruised’ is more common on the arms and legs, simply because these are the most exposed areas and most likely to be bumped, even if you are not aware of it.

The head, face and torso are not as exposed to impact from day to day – so any spontaneous bruising in these areas would be a greater concern.

Some medications, including aspirin, ibuprofen, and anticoagulants such as warfarin, can disrupt blood clotting mechanisms and make bruising more likely after minor impact.

Other medications such as corticosteroids (such as prednisolone) cause thinning and increased fragility of the skin, which can increase the risk of widespread bruising, again usually affecting the extremities.

Some natural remedies, for example ginkgo biloba and ginseng, are believed to be linked to easy bruising, and although not much research has been done on this, it may be a potential risk factor to consider.

Your best strategy is probably protection – this means wearing long sleeves during your daily activities.

Q: I woke up one morning about six months ago with a pain in my hip that has never gone away. An x-ray showed it was bursitis. I’m doing the exercises I was given, but the pain is getting worse.

During a visit to my GP I was told that a steroid shot could help, but no one at the practice could give me this. The pain wakes me up at night.

Heddy Bell, Fife.

Dr. Martin Scurr replies: I’m sorry to hear about your pain, and my feeling is that you should seek a referral for the steroid injection your practice mentioned.

In hip bursitis, the fluid-filled sac (‘bursa’) that protects the hip joint becomes inflamed and swollen, causing pain. This affects the prominent point you can feel when you slide your hand down the outside of your thigh from your pelvis.

Lying on the affected side can be painful, as can carrying weights and sitting with your legs crossed for long periods of time.

Bursitis of the hip can be caused by overuse (for example, when overweight people exercise) and trauma (I have often seen this condition in patients after a fall). But sometimes there is no clear trigger.

When it first occurs, using an ice pack for 20 minutes, two or three times a day, along with a pain reliever such as ibuprofen may provide relief (although this medication should not be taken long-term – up to one to two weeks).

It is also important to avoid activities that worsen the pain, such as sleeping on that side.

The good news is that the problem can usually be ‘cured’ with a steroid injection, a powerful anti-inflammatory administered on the spot – but only a radiologist can do this, using ultrasound to accurately locate the bursa.

Since the pain is disrupting your sleep, I suggest that now is the time for a referral.

• Write to Dr. Scurr from Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email drmartin@dailymail.co.uk
• Dr. Scurr cannot enter into personal correspondence. Answers should be taken in a general context. If you have health problems, consult your own doctor.

I think we need to pay attention to our medical watchdogs

In the wake of the Cass Review into gender identity services for children, the question that concerns me is: why didn’t the regulators identify the issues that led to this review at an earlier stage?

After all, healthcare regulation took a virtual leap after Harold Shipman’s murderous activities.

With the Care Quality Commission finally emerging after a protracted birth, I fear the regulator has been too busy dealing with the big evolutionary changes and learning on the job, just as referrals to gender identity services increased.

Dr. Hilary Cass at the publication of her Independent Review of Gender Identity Services for Children and Young People (the Cass Review) last month

Their eyes weren’t on the ball. In my experience they seemed overly concerned about what kind of soap was in the doctor’s office sink and where the staff vacation request files were stored. Inspections were irrelevant in terms of the protection and welfare of patients.

And let’s not forget that the General Medical Council, another regulatory body, failed to realize the implications of Dr. Harold Shipman’s drug addiction (he was arrested in the late 1970s when he took pethidine, a morphine-like drug, for first used). Despite police involvement, a trial, a sentence and some minimal rehabilitation, he was never followed up by the regulator.

If he had been, 200 murders could have been prevented.

Who controls the regulators?