For the last two years I have had constant urine infections.
I have tried four different antibiotics, but as soon as I stop one treatment, the problem returns. Should I just learn to live with it or are there other options? I’m a man, by the way.
Dr. Ellie Cannon responds: Urinary tract infections (UTIs) are a common problem in women, but are much less common in men. So, if a man has recurrent UTIs, it warrants further investigation.
One cause may be an obstruction that interrupts the flow of urine from the bladder. This allows urine to build up and stagnate in the tubes, increasing the risk of infection. The cause may be constipation, which puts pressure on the bladder, or an enlarged prostate that prevents proper outflow from the bladder.
Treatment for recurrent urinary tract infections in a man might be a low dose of an antibiotic every night.
Stopped urine flow can also be caused by stones inside the bladder or a narrowing of the urethra itself, known as urethral stricture. UTIs are also more common in men who have diabetes or are immunocompromised, for example as a result of medication.
A GP should investigate this before seeking specialist opinion using blood tests and an ultrasound of the kidneys and bladder.
Treatment for recurrent urinary tract infections in a man may consist of a regular nightly low dose of an antibiotic.
Specialists may prescribe a treatment called hippurate, an antiseptic that prevents infection by keeping urine acidic.
Lately my knees are swollen and stiff and I find it difficult to walk. Although I have had breast cancer and suffer from osteoporosis, I am otherwise fit and not overweight. What could be the cause?
Dr. Ellie answers: Swollen and stiff knees and pain when walking.
like osteoarthritis. Although lack of physical fitness and being overweight increase the risk, it is mostly related to age.
Depending on how arthritis has affected the joint, discomfort may also occur when using stairs or sitting for too long. Osteoarthritis can also cause weakness: legs that give out, locking of the knees, and difficulty bending and extending the joints. Additionally, the joints may also feel warm and tender to the touch.
Too much rest can increase stiffness and difficulty walking, so we recommend patients keep moving. To make this easier, doctors recommend taking a pain reliever such as acetaminophen before activity.
For knee pain, pain-relieving creams or gels such as ibuprofen or diclofenac can also work very well; You can buy them without a prescription at the pharmacy. For stronger pain relief, a prescription from your GP would be necessary.
If things get really bad, they may also consider a referral for a steroid injection for pain.
I have suffered from chronic back pain for years. I was recently prescribed a medication called nortriptyline. It seems to work: my pain is about 50 percent. less bad However, I have developed horrible itching all over my body. There are no rashes or marks anywhere. Could the pills be to blame?
Dr. Ellie answers: The spinal cord, located within the spine, is a column of nerves that runs from the brain to the lower back and connects to the rest of the nerves in the body.
When there are problems with the spine, such as herniated discs or crumbling bones, pressure is put on these nerves.
And that can cause severe and prolonged back pain.
Patients with back pain often try many different types of pain relievers, sometimes to no effect. Finding a medication that reduces pain by half is extremely positive.
Nortriptyline is a medication used specifically to treat nerve pain and is usually taken at night as it can cause drowsiness. Other side effects include digestive problems such as constipation, dizziness, and headaches.
It is also possible to have a very serious allergic reaction to the medication. This would cause swelling of the throat and mouth, hives, and difficulty breathing.
Typically, the medication is started at a low dose and only increased very slowly to reduce possible side effects.
Itching is a common side effect of many medications and could certainly be a result of taking nortriptyline.
It is disappointing to have to deal with a distressing side effect from a medication that is working very well. Under the supervision of a doctor, it may be advisable to reduce the dose. This can stop the itching without reducing the positive effect of the medication.
Another option would be to continue with the same dose but take more tablets, such as an antihistamine, to control the itching.
Rarely, itching may be the result of liver problems, and since it may be caused by nortriptyline, it needs to be monitored with a blood test.
Don’t Underestimate How Bad The Flu Can Feel
Some people have asked me if the flu is particularly bad this year. One, in his 50s, told me, “I’ve never been so sick in my life.” He even suggested there might be “something different” this year.
But I don’t think so, it’s just that people don’t realize how bad (and dangerous) the flu can be.
While some people can get the flu fairly mildly, it’s not just a bad cold. Symptoms include very severe muscle pain that may prevent you from getting out of bed, along with high fever, difficulty breathing, and headaches. These can last a week or more.
It all depends on your health, the amount of virus you have been exposed to, and other factors.
The reason we offer flu vaccines is because it is a virus that can kill. Don’t underestimate it.
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.