Q: My granddaughter, who is three years old, was diagnosed with hypermobility since birth. It affected his walking progress, but he got there.
The problem now is that it gets a little dirty several times a day. We wonder if hypermobility is to blame.
Name and address provided
TO: I appreciate you writing to me: hypermobility is a common problem, but the medical world’s understanding of it is minimal. As a result, many people suffer some distress due to their symptoms, which can include excessively elastic skin, joint dislocations, pain, and intestinal problems.
Basically, hypermobility is a problem that affects the connective tissues (including cartilage and collagen) that act like glue to hold the body together. In some people, the proteins in these connective tissues are defective.
The most common form is Ehlers-Danlos syndrome, which has 13 different subtypes and affects the connective tissue that supports the skin, tendons, ligaments, blood vessels and bones.
Most children are hypermobile to some degree, thanks to the flexible nature of their tissues, but some have symptoms of the disorder, such as joint and muscle pain, low muscle tone, and weakness that affects their motor skills (for example, sitting up, crawling and walk). walking in such children can take up to 20 months). Flat feet can also be a sign.
‘Bladder and bowel problems are not uncommon in children with hypermobility. This may be the result of a weakening of the anal sphincter, which controls the release of stool, as part of a general weakness in the pelvic floor muscles.
In recent years, it has become clear that bladder and bowel problems are not uncommon either. This may be the result of a weakening of the anal sphincter, which controls the release of stool, as part of a general weakness of the pelvic floor muscles.
The muscles and other tissues of the intestine may be affected, possibly helping to explain the abdominal pain, bloating, constipation, and even heartburn and vomiting experienced by hypermobile people.
Many children improve as they mature. However, given your granddaughter’s early diagnosis and her current intestinal problems, it is essential that she be reviewed periodically by a pediatrician familiar with the condition.
Q: I am 79 years old and three years ago I suffered an attack of shingles. It cleared up, but the skin around the infected area became tender and seems to be getting worse.
Brian Walker, Stockport
TO: You have postherpetic neuralgia, a complication of shingles (also known as shingles); The pain is the result of damage to the nerves.
Although the shingles viral infection clears up (usually within six weeks, but faster if you are prescribed an antiviral medication such as acyclovir), residual pain is a common complication in older patients, affecting one in five over 70 years.
This is because the inflammation caused by shingles can cause fibrosis (scar-like damage) to the nerves affected by the virus, even after the inflammation from the infection has gone away.
Pain that lasts three months or more is defined as postherpetic neuralgia. In addition to pain, it can cause a burning, itching, and tingling sensation that may be intermittent or constant. Many patients complain of stabbing pain at the slightest touch.
The most effective medications are gabapentin, pregabalin and tricyclic antidepressants, which act on nerve pain.
The key to success is to start with a low dose and gradually increase to higher doses.
I prescribe gabapentin or pregabalin and see patients weekly, increasing their dose from 75 mg daily to 150 mg and then to 300 mg.
If there is no change after a month or six weeks, I move on to amitriptyline, an antidepressant, which I prescribe 10 mg and increase the dose monthly.
The drug is almost invariably effective at approximately 70 mg per day, although dry mouth and drowsiness are common side effects.
If your GP is not prepared to supervise such a regimen, ask for a referral to a pain clinic.
IN MY OPINION… Some good news for older women
While I sometimes lament how patient care is changing, sometimes it works to everyone’s benefit.
Take for example the way patients can purchase over-the-counter medications that were previously only available by prescription. This now includes Ovesse cream, an effective treatment for vaginal dryness caused by thinning tissue in menopause.
There are many other high-value treatments that pharmacies can supply without a prescription, such as eye drops for conjunctivitis (chloramphenicol) and fluconazole capsules for candidiasis, increasing convenience for the customer and reducing the workload for doctors. family doctors.
But I am concerned about recent changes that make antibiotics available this way.
Although the medications pharmacists can provide are strictly limited (including the number of days of treatment), they cannot perform a blood test to check whether infected tonsils are an early sign of glandular fever, for example.
Rather, it’s guesswork, which can only lead to pills being overprescribed, fueling the rise of antibiotic resistance. This policy should not be expanded further.
- Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email drmartin@dailymail.co.uk; include your contact information. Dr. Scurr cannot correspond personally. Always consult your primary doctor with any health problem.