I am 78 years old and have had daily nosebleeds for the last fortnight. It can happen at any time, even in the middle of the night. I don’t want to bother my GP because my pharmacist said it wasn’t serious. What do you think?
Dr. Ellie Cannon responds: A doctor should evaluate nosebleeds that occur regularly. Most of the time, the bleeding comes from a fragile area inside the nose where blood vessels are easily damaged.
This can occur due to an injury, the use of nasal sprays, or an infection such as a bad cold. In rare cases, it could be caused by a tumor or a blood clotting problem. Nosebleeds are also more common in people who take blood thinners or those who often come into contact with dust or cigarette smoke.
A GP can assess the cause and there are blood tests to look for clotting problems.
Once any serious underlying conditions have been ruled out, a GP may prescribe Naseptin nasal cream, which is an antiseptic.
Patients may also be referred to a specialist for a minor procedure called nasal cautery, which can seal the bleeding area and stop further episodes.
Whatever the ailment, it is important that patients inform their GP of any medical problems that are serious or long-lasting.
Sometimes putting off solving a problem can make it worse.
In rare cases, regular nosebleeds may be caused by a tumor or a blood clotting problem.
I am 54 years old and have never had any symptoms of menopause. I live with polycystic ovary syndrome and, until a few years ago, I took the hormonal birth control pill to combat the symptoms. Do you think that could be why I haven’t gone through menopause?
Dr. Ellie answers: The average age of onset of menopause in the UK is between 47 and 53, but it can occur later.
It is caused by falling levels of the female sex hormone estrogen and the impact of this change affects women in different ways.
While most people associate menopause with hot flashes, mood swings, and difficulty sleeping, some women never experience any of these problems.
That’s why doctors usually define menopause as the absence of menstruation for more than a year. When this occurs depends on each woman’s health, her ethnicity, and the medications she is taking.
Polycystic ovary syndrome, or PCOS, is caused by a hormonal imbalance and typically causes irregular periods, acne, facial hair, and difficulty getting pregnant.
Some of the symptoms mimic perimenopause (the early stages of menopause), such as irregular periods and heavy bleeding.
Since PCOS is a hormonal condition, it is likely to affect the age at which a woman experiences menopause and the nature of her symptoms.
Some data suggest that women with PCOS reach menopause, on average, two years later than those without PCOS.
My husband recently got a serious chest infection after getting a flu shot. He has Crohn’s disease and is prescribed azathioprine. Could the vaccine have given you the infection?
Dr. Ellie answers: It is impossible for the flu vaccine administered to people over 65 years of age to trigger 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 any future flu infection.
I often hear about people getting infections shortly after receiving the flu vaccine, and there are several reasons why this would happen.
Firstly, the NHS offers the vaccine in autumn and winter, which is when infections are most common. So statistically, someone is simply more likely to get a chest infection at the time they get the vaccine.
Secondly, it is not unusual to receive a flu vaccine in a healthcare setting, such as a GP surgery or pharmacy, where there are other sick people present who could transmit an infection.
This means that, ironically, getting a vaccine can increase your risk of getting an infection, even though the chances are low.
Finally, people who take immunosuppressive medications, such as azathioprine, which are designed to calm the immune system, are more likely to get infections than those who do not take these medications.
That’s why it’s crucial that anyone taking one of these medications accept the offer of a vaccine, to limit the risk of serious symptoms.
Immunocompromised patients may also want to take some simple steps to reduce the risk of infection, such as avoiding large crowds indoors or wearing a mask.
Is registering more APs the right decision for the NHS?
I am not surprised that the Government is launching a review of the NHS deployment of healthcare workers known as physician associates (PAs).
PAs have two years of training (not a medical degree) and the NHS is in the process of recruiting thousands of them to help doctors carry out basic medical tasks to cover serious staff shortages.
When used correctly, personal assistants can be invaluable members of the staff. I have been working with a personal assistant in my practice for a while now and she is a great help.
But, as The Mail on Sunday has repeatedly highlighted, personal assistants are being asked to cover for doctors in specialist wards and carry out complex medical procedures. It’s not fair to PAs and puts patients in danger – this is the unacceptable situation that led directly to the death of Emily Chesterton, pictured below.
I’d love to know what you think of it. Have you had a bad experience with a PA, or perhaps just the opposite? Send an email to the address at the bottom of the page and let me know.
Personal assistants are asked to cover for doctors in specialist rooms and carry out complex medical procedures, which led to the death of Emily Chesterton.
GPs need to know how to diet
Last week I attended a conference exploring how social media has affected nutritional advice and I was surprised by what we saw.
Researchers showed us that most online dietary advice is not backed by scientific evidence. This is particularly true of wellness products advertised on social media: gummies and powders that are supposed to improve health but turn out to have little to no benefits.
However, this event, at the Royal Society of Medicine in London, left an impression on me for a different reason: it made me realize how absurd it is that doctors are not trained to give dietary advice. It may seem incredible, but at no point in our years in medical school were we taught about nutrition. This is particularly crazy given that so many diseases are diet-related, such as type 2 diabetes.
If we want to counter misinformation online, perhaps it’s time we start teaching medical students about diet.
- Do you have any questions for Dr. Ellie Cannon? Email DrEllie@mailonsunday.co.uk