I was woken up by hot flashes three months ago, but I’m not sweating. I had a blood test that came back normal. Last year I tested positive for Covid, just before the hot flashes started. Can this be long Covid? And what can I do about it? I’m 69.
Carole Woodcock, via email.
A hot flash feels like deep shame, with a tidal wave of heat washing over you. If it’s a symptom of menopause, you sweat too.
This is because decreasing levels of estrogen affect the hypothalamus, the part of the brain that regulates temperature.
As you begin to feel warmer, your body triggers cooling responses, which include widening blood vessels to release heat and sweat.
But sweating isn’t a problem in your case, so we need to look at other potential causes of hot flashes. These include stress, fever, alcohol and foods, such as curry, that contain spices that can activate a nerve receptor that responds to changes in body temperature.
A hot flash feels like deep shame, with a tidal wave of heat washing over you. If it’s a symptom of menopause, you sweat too [File photo]
An overactive thyroid can also cause hot flashes, but since your blood test was clear, this doesn’t apply.
A likely explanation for your hot flashes is the drug lercanidipine, which you mention in your longer letter.
This is a calcium channel blocker used for high blood pressure. Since it works by widening the arteries, it can also cause flushing as more blood is pumped to the small vessels. Other side effects include increased heart rate and headache.
That said, the tablet should normally be taken in the morning, and since your flushing occurs at night, this may not be the cause – unless you’ve been told to take the drug in the evening?
I suspect the hot flashes are not due to Covid-19. I recommend that you discuss your medication with your doctor.
I am a healthy 60 year old, but six months ago I woke up with an excruciating pain in my chest the day after lifting heavy suitcases. My GP diagnosed a problem with the chest wall.
I am still short of breath and coughing, and would appreciate some reassurance.
Richard Stokoe, Gateshead.
This sounds inconvenient and is understandably concerning to you. Based on your description, I agree with your GP that the chronic pain is probably due to a mechanical disorder of the chest wall, which affects the musculoskeletal structure.
Shifting the cases may have caused a minor injury to one or more of the costochondral joints — the points where your ribs meet your sternum (or sternum).
This can cause an inflammatory response and the pain can be so extreme that you have trouble breathing in completely. This can lead to coughing, which can also hurt, as it involves the chest wall.
Most patients with these symptoms have costochondritis, in which several joints are affected, causing multiple areas of tenderness. It can be caused by activities that are even less taxing than lifting a suitcase, such as light pressure on the joints when sitting. There is no visible swelling.
The symptoms may be associated with a more unusual condition called Tietze syndrome, but there will also be swelling of one or two costochondral joints and sometimes of the sternoclavicular joint, where the collarbone (collarbone) and sternum meet.
Shifting the cases may have caused a minor injury to one or more of the costochondral joints — the points where your ribs meet your sternum (or sternum)
There is no ideal treatment for either condition, although research suggests that physical therapy can relieve pain. Costochondritis usually clears up on its own after many months, but physical therapy can help speed recovery.
Certain treatments — such as therapeutic ultrasound that uses sound waves to stimulate blood flow and healing, as well as relieve pain — can help. This is offered by musculoskeletal physical therapists and may be worth trying in addition to the exercises your chiropractor recommends.
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In my opinion… we should allow assisted dying
We live in an age of social equality, with equal rights, freedom of expression and equal access to goods and services.
In turn, we can make our own decisions, except for the most important one we should ever make – those regarding our death. I am, of course, talking about assisted dying.
But there is light at the end of the tunnel. The Scottish Parliament is considering proposals for a bill to grant terminally ill people the right to help when dying. A similar debate will take place in England later this year.
As someone who has worked in palliative care, I know it’s not perfect, and I’ve seen too many patients suffer unnecessarily painful deaths.
Many doctors argue that prescribing drugs for death aid violates the Hippocratic oath to do no harm. But failure to eliminate terminal suffering is in itself harmful to the dying and their loved ones.
Too many times I’ve had to listen to patients’ desperate pleas to do something to put an end to it, but I’ve been unable to help. But we should not be bound by old or religious dogmas.
We want to alleviate and limit unbearable suffering when no other means are possible.