I am a 70 year old woman and last year when the weather was hot my ankles and feet swelled up. Since then the swelling has not gone down. I take amlodipine, a blood pressure medication, but I only started taking it after the swelling started. Can you offer me any advice?
Dr. Ellie answers: Swelling is a worrying condition and should not be ignored.
While it can occur after a long flight or in hot weather, it usually goes away. Swelling that persists for a long time can sometimes be a sign of heart failure, a dangerous condition in which the heart pumps less efficiently than before.
It can also be a symptom of kidney or liver problems, as well as poor circulation.
However, one of the most common causes of ankle swelling is blood pressure medications, such as amlodipine. While it is an effective medication for lowering blood pressure, this is a side effect that GPs see all the time.
Ankle swelling that continues for a long time can sometimes be a sign of heart failure.
A patient who already had swollen ankles due to heat, and then started taking amlodipine, may find that the problem continues.
The good news is that there are many other medications that can effectively treat high blood pressure and may not cause this uncomfortable side effect.
These are medications that can be prescribed by a family doctor. If a patient changes blood pressure treatment and the swelling decreases, this is a positive finding.
If the swelling continues after the change, further tests will be needed to find the source of the problem.
Regardless of the cause, it is important to consult a primary care physician about ankle swelling.
At the beginning of the year I had a horrible cough that lasted for two months. After a course The cough has gone away with antibiotics, but I still have difficulty breathing. I am 80 years old and quite active. What can I do? What do I do to improve my breathing?
Dr. Ellie answers: Shortness of breath is not only caused by lung problems, and it is important to determine the cause because it can be a sign of a life-threatening condition.
An infection may cause difficulty breathing, as it can cause scarring of the lungs. A recent infection can also worsen the symptoms of asthma, the lung condition that causes difficulty breathing.
However, shortness of breath can sometimes be a sign of lung cancer, so tests such as a chest X-ray are needed.
It can also be caused by heart problems that become more common after age 75.
These include heart rhythm problems, including a condition called atrial fibrillation, which can be easily diagnosed by a GP as it causes an abnormal pulse.
A particular heart problem that causes breathing difficulties during exercise is a valve condition called aortic stenosis.
This happens when one of the heart valves becomes stiff and doesn’t work as well as it should. A GP who suspects aortic stenosis will likely ask the patient to have an echocardiogram, a scan of the heart.
Another cause may be anaemia, which is caused by a lack of iron in the blood. Your GP can perform a blood test to detect this condition and prescribe iron pills to combat it.
A few years ago I was prescribed a low-dose antidepressant for chronic back pain. However, when I tried to stop taking it several months later, I suffered withdrawal symptoms. It took me years to stop taking it completely, but now nothing works for my back pain. What should I do?
Dr. Ellie answers: Dealing with pain can be incredibly complicated, and often treatment involves much more than just popping a pill.
Antidepressants are a tool used by GPs to treat chronic pain, such as back problems, as studies show they can reduce the feeling of agony. However, pills cannot eradicate pain completely.
Additionally, they may have side effects, including, in some cases, withdrawal symptoms.
Instead, research shows that the best way to combat back pain is movement and low-intensity exercise, such as walking, swimming, or even taking dance classes.
Pain relievers can be used in combination with movement.
For example, many people with pain problems might take a daily anti-inflammatory medication like naproxen and also acetaminophen if their pain is particularly severe that day.
I would recommend anyone living with chronic pain to ask their GP for a referral for physiotherapy sessions.
In many parts of the country it is possible to book an NHS physiotherapy appointment without needing to visit your GP first.
A physical therapist should be able to provide some specific exercises to help improve mobility and hopefully reduce pain levels.
RSV is not a cold: get vaccinated
There’s a new vaccine that many of you will be able to get this fall, but you may not have even heard of the infection it protects against.
Respiratory syncytial virus (RSV) is a very common illness in winter and for several months each year, thousands of hospital beds are occupied by people, often elderly, suffering from this serious lung infection. It can be so widespread that it can lead to delays and cancellations of routine treatments.
RSV is often mistaken for a cold, with mild symptoms such as runny nose, sore throat, cough and headache that go away on their own within a few days.
But it can also be deadly. If it gets worse, it can cause a horrible cough, shortness of breath, wheezing and a high fever. Up to 5,000 adults die from RSV each year, most of them over the age of 75.
That’s why it’s great news that, for the first time, everyone over 75 will be offered the RSV vaccine in September. So if you get the call for a dose, take it.
Antonya Cooper, who, after 40 years, admitted last week to giving her terminally ill son a large dose of morphine to end his life.
Is assisted dying the way forward?
I was struck by the extraordinary story of Antonya Cooper, who, after 40 years, last week admitted to giving her terminally ill son a large dose of morphine to “quietly end his life”.
Hamish, who was just seven years old in 1981, had stage 4 cancer and was, Mrs Cooper said, “going through horrendous suffering”.
Now facing her own battle with terminal cancer, Ms Cooper, from Oxfordshire, decided to speak out about her decision just as campaigners are fighting to change the law on the issue.
Assisted dying, also known as euthanasia, is illegal in the UK, so Ms Cooper, pictured above with Hamish, could be the subject of a police investigation. It is an incredibly complex and emotive topic, but the issue of assisted dying is changing and many more people, including our new Prime Minister, are calling for a change in the law.
