DR ELLIE CANNON: Will my husband’s drinking worsen his heart problem?

My husband had an operation on his heart last year due to angina. He takes blood thinners, statins, and high blood pressure medications. But he also drinks a lot, most days, and he worries me that he has a problem. Should I try to make it stop?

This is a problem I often hear about in my clinic. Alcohol is a huge health risk, especially if a person drinks to excess.

On the other hand, not all heavy drinkers end badly; it all has to do with the constitution and genetics of an individual.

People often worry about liver disease from alcohol, but this isn’t the only problem that drinking can cause. High blood pressure, heart disease, and cancer, not to mention brain diseases like dementia and depression, are linked to alcohol use. And it’s very addictive – I often see people who can’t slow down for an extended period of time, let alone stop.

My concern for someone who drinks while taking blood thinners and other heart drugs is the effect of alcohol on those medications. There is also the possibility of falling if you are drunk and then having a serious bleed from an injury because you bleed much more than normal when you are on blood thinners. A head injury would be a particular concern.

The safe consumption of alcohol for men and women is considered to be less than 14 units per week, that is, approximately six pints or glasses of wine.

Sometimes there are very clear signs that someone is drinking too much: choosing to drink over other activities, not being able to say no, or even hiding the habit. It can be difficult to bring up the topic with a loved one without judging or confronting them.

Talking about your concern and being supportive, when sober, is the best way, rather than using accusatory words like alcoholic.

Drinkaware.co.uk has more advice on what to do if you’re worried someone is drinking, including advice on what to say and what not to say.

I suffer from a pulling and pushing sensation in my pelvis, a swollen tummy and discomfort around my buttocks. My GP checked for a prolapse but said that was not the problem. Then they did an ultrasound and said they could see ‘congestion’ which I’m not sure I understood. Could the doctor be missing something?

Dragging and pushing are classic features of a prolapse, when one of the organs within the pelvis, such as the womb, falls into the vagina. It is normally caused by a problem with a weakened pelvic floor and often occurs after menopause.

What the ultrasound revealed may be a condition called pelvic congestion syndrome. This can be identified on a scan as the blood vessels around the ovaries being wider and different than normal.

It is usually seen in women before menopause and causes pelvic pain because the blood vessels do not work as efficiently as they should. It can cause a dull ache, a type of dragging pain, and piles that would cause discomfort in the anus. For a proper diagnosis, you need a scan of the pelvic veins.

Without a clear answer, it would be reasonable to ask for another conversation with the doctor, another exam, and even a referral to a gynecologist. These are not symptoms to be ignored.

I am taking a medication called levothyroxine for my underactive thyroid. But when I take it, I get a tingling sensation on my face and I feel like my ears get clogged, like I’m on a plane. It takes a few hours to disappear. The specialist I saw says that it is not the medication, that I have been taking it for 22 years, and until this year I have never had a problem. What do you think it could be?

An underactive thyroid gland, known as hypothyroidism, is when the thyroid, which is located in the neck, does not produce enough hormones. These are important for maintaining energy levels, and symptoms of having insufficient amounts include tiredness, weight gain, and depression.

Levothyroxine is a hormone tablet prescribed to treat these problems. It is common for people with an underactive thyroid to also experience nasal congestion, stuffiness, sinus problems, and even hearing problems, but these are not side effects of levothyroxine.

It is perfectly possible that these symptoms have nothing to do with the drug but that they appear first thing in the morning, before breakfast, which happens to be when you take the tablets, so you are associating them wrongly.

It would not be uncommon for symptoms of sinus and ear congestion to appear first thing in the morning. When we get up from lying down, fluid moves around inside the ear or sinuses, which can cause these symptoms. If you have taken a medication long term, in this case 22 years, these problems may be because the condition has not been controlled as well and a dose adjustment may be necessary.

It’s also possible that your sinus problems are related to an allergy, and it might be worth considering a two-week trial with antihistamine tablets to see if this has any impact.

Tackling the nightmare of sleeping pill addiction

UK chief health officers have come up with a brilliant initiative that I want everyone to know about: a guide for patients who take sleeping pills but want to reduce or stop taking the dose.

Dependence on sleeping pills is a big problem in the UK. About a million people take the pills, called z drugs, such as zopiclone and benzodiazepines, to help them sleep or combat severe anxiety.

But they are not a long-term solution. They come with a serious risk of addiction: over time, you have to keep taking more to get the same effect.

UK chief health officers have come up with a brilliant initiative that I want everyone to know about: a guide for patients who take sleeping pills but want to reduce or stop their dose.

And after just a few weeks of use, my patients tell me they get brain fog, struggle to focus, and feel emotionally numb.

As a doctor, he worries that patients have not assumed the risks of these drugs, because they are often prescribed in times of crisis. But now they will have a simple guide to help them weigh their pros and cons. It will also offer advice for those concerned about quitting.

I will tell my patients and other doctors should do the same.

I was right about the beta blocker

Earlier this month, I answered a reader’s question about her husband’s heart condition, atrial fibrillation.

I was taking a medication called bisoprolol and I mentioned that it was not often prescribed for the condition; it is not what GPs would call first line treatment. I suggested to her husband that she ask the doctor why she was taking it.

Since then I have received emails from other readers saying they have atrial fibrillation and have been taking bisoprolol for years with no problems.

Bisoprolol is a beta blocker (slows the heartbeat), but it is only recommended for atrial fibrillation if the patient also has another medical condition, such as diabetes.

I suspect that readers who say they are taking bisoprolol for atrial fibrillation will also be suffering from a co-occurring problem.