Q: A few weeks ago I felt like I had flu It was getting closer and I decided to go to bed. I managed to get up the stairs, then I collapsed and had to crawl to the bedroom. After about four hours I woke up feeling at about 50 percent of my strength, but the next morning when I woke up I felt absolutely fine. What could cause such a sudden loss of strength and yet recover so quickly?
It can be difficult to know what causes sudden, temporary symptoms like these, which we all experience at one time or another, often because by the time someone comes to my office the problem has already passed.
However, the first thing that comes to mind in a case like this (especially if the patient was elderly) would be a transient ischemic attack (TIA), often called a mini-stroke.
If someone has a stroke, the symptoms persist. But with a TIA, symptoms usually last only a few hours and, within 24 hours, are completely gone.
A stroke occurs when the blood supply to the brain is blocked due to a clot or hemorrhage, but a TIA occurs because this interruption is only temporary.
Weakness in one limb is a classic sign of a TIA or stroke, but this usually occurs only on one side rather than losing all strength in both arms and legs at once. Anyone at risk of heart disease or stroke is also at risk of a TIA, and this is something that should be discussed with a primary care physician regarding ongoing prevention. This could include managing high blood pressure or high cholesterol, for example.
Viruses such as the flu or Covid usually cause muscle pain, especially in the arms and legs, and both sides of the body would be affected equally. This can be a very important symptom of a virus and cause deep and temporary weakness.
Although it would be unusual for it to occur so suddenly and be resolved so quickly, it could happen.
Q: I have been told I need surgery (thyroidectomy) because of a nodule growing on my thyroid. In addition to feeling lethargic, I have difficulty swallowing. But I’m terrified of surgery and worried that I’ll have to take a hormonal medication called thyroxine for the rest of my life. I have heard that it causes weight gain, hair loss and general discomfort. My consultant didn’t seem to take my fears seriously. What do you think?
Taking thyroxine does not make people gain weight, suffer from hair loss, or feel unwell in general. In fact, these are the symptoms of hypothyroidism, also known as underactive thyroid, the treatment of which is taking thyroxine.
These symptoms would be evident only if the thyroxine dose were too low.
Many people take thyroxine for life with minimal side effects. It is certainly a better option than avoiding an operation recommended by doctors.
Having difficulty swallowing may be a symptom of an enlarged thyroid. This alone is a worrying issue that certainly needs to be addressed.
The thyroid is a butterfly-shaped gland located in the front of the neck. A growth inside the thyroid may be visible as a lump, but it can also put pressure on the structures behind it, including the trachea and esophagus. Thyroid nodules are diagnosed using an ultrasound, which can show the lump in more detail. Doctors will usually perform a biopsy and possibly an operation to remove the nodule, if there is a suspicion that it might be cancerous.
After thyroid surgery people may have problems with their voice or calcium levels in the short term, so it is worth discussing this with the surgical team.
Q: I suffer from eczema and my skin is very itchy. The GP prescribed a cream, but it doesn’t help; in fact, the itching is getting worse. I also had swollen arms and legs, so I was prescribed antibiotics. What can I do to stop all this?
Swelling and extreme itching are not typically symptoms of eczema, but may imply that something else is going on and certainly warrants continued medical treatment.
There may be two potential causes. First of all, if scratching causes skin injuries, it is easy to cause infection. This would cause swelling and tightness.
Antibiotic tablets would be a first-line treatment, but if they don’t work you may need intravenous antibiotics in hospital.
Another possible cause is hives or hives. They appear as noticeable bumps and swelling on the skin and can affect any part of the body.
As with eczema, this can be related to an allergy, but it can also occur simply due to an overactive immune system. Treatment would consist of antihistamines and even steroid pills, as well as avoiding known triggers such as caffeine and high temperatures.
Controlling eczema should be a priority, as this will make other problems, such as infection, less likely. A good eczema regimen includes avoiding irritants like scented skin products. An emollient cream should be used to wash the skin and as a body moisturizer.
If the skin is red and sore, try a steroid or treatment cream that calms skin inflammation. If over-the-counter one percent hydrocortisone doesn’t work, ask your primary care doctor if he or she can prescribe a stronger steroid.
It is vital that we listen to parents.
Before becoming a GP, I worked in paediatrics, where I learned an invaluable lesson: in addition to monitoring the child, it is essential to monitor parental concern.
They are the ones who know their child best. If they say “something just isn’t right,” this should warrant an investigation. This lesson has been proven correct time and time again. At my clinic, if a mom or dad calls on the phone to say they’re just not happy with something about their child, we always evaluate them.
I thought about this when it was announced that Martha’s Rule will go into effect in April. Families and patients may request a second option if they are not satisfied with their care. It comes after the sad death of Martha Mills aged just 13, whose parents felt her concerns were not heard as she deteriorated, before dying from sepsis.
The paternal instinct is powerful. We must listen to it.
Is honey enough to treat cough?
The cough medicine codeine linctus has been banned from sale without a prescription and will now be available only with a prescription.
It is due to an ongoing problem with people misusing it.
Codeine is sedating when taken in large amounts and some people abuse it for this reason. And it can also be addictive, which is why pharmacists have had to deal with aggressive lawsuits for vials.
Many cough syrups are just sugar, and honey and lemon may not be enough to treat a cough.
I support the ban, of course, but I worry that we will have nothing left to offer people with coughs. Many cough syrups are basically sugar, and honey and lemon are often not enough.
What do you do when you need to treat a cough? Do you rely on codeine linctus and feel like you have been left untreated or do you have a home remedy you would like to share? Please write to me at the email address below and let me know.
Do you have any questions for Dr. Ellie Cannon? Email DrEllie@mailonsunday.co.uk
Dr. Cannon cannot engage in personal correspondence and her responses should be taken in a general context.