I have suffered from an itchy skin problem for years, but recently it has gotten much worse on my buttocks and torso.
A few years ago I was diagnosed with papular urticaria and was given several creams and pills, but without success. Could the fact that I smoke be the culprit?
Dr. Ellie answers: Hives are a rash that can be very distressing to live with. The symptoms are similar to those of hives: the itchy skin reaction. But while hives, which are usually caused by a food allergy or an insect bite, go away in a few days at most, people with hives suffer from them for months, even years.
In most cases, the cause is unclear, although it is thought to be related to the immune system being mistakenly revved up.
Anti-allergy medications, called antihistamines, are usually prescribed, as well as steroid tablets. Both can reduce the itchy sensation and soothe the red rash, but they cannot cure it.
Hives are a rash that can be very distressing to live with, writes Dr Ellie Cannon
Steroids can only be taken in short doses, as prolonged use can increase the risk of serious diseases such as osteoporosis, a bone-thinning disease. However, in severe cases, a dermatologist may decide that the benefit of a daily low-dose steroid tablet outweighs the associated risks.
Another medication for hives is montelukast. This tablet is usually given to asthma patients to calm their immune system, but studies show that it is also effective for hives. There is also an anti-itch ointment called menthol aqueous cream that many hives patients swear by.
Smoking is not thought to be a trigger for the condition. However, along with caffeine and alcohol, it can worsen symptoms.
I am 82 years old and recently had a mini stroke. A scan showed that the arteries in my neck had thickened, so very little blood was reaching my brain. However, I was told that the operation was too risky. Now I’m worried that I may soon have a full-blown stroke. What do I have to do?
Dr. Ellie answers: A mini stroke is when the blood supply to the brain is temporarily blocked. Unlike a stroke, which causes brain damage, most people who experience a mini-stroke will not suffer any lasting problems.
A common cause of both a stroke and a mini-stroke is when the arteries in the neck, the carotids, become blocked. Patients are usually given a percentage of how blocked they are; anything greater than 50 percent is significant.
The blockage can build up over time as the lining of the arteries thickens, but it is also accelerated by high cholesterol levels.
In most cases, the best way to combat this problem is medications, such as anticoagulant tablets to prevent clots, blood pressure medications, and statins to lower cholesterol.
In some cases, surgery may be considered to open the carotid arteries if the blood vessels are dangerously blocked.
This could involve removing the inner lining (known as a carotid endarterectomy) or widening the artery by inserting a tube, called a stent.
However, this will be carried out only if the surgeon believes that it is more likely to benefit the patient than harm him. Life-threatening complications are more likely the older and sicker the patient is.
It is important that anyone who has been told they are not eligible for surgery speaks to a GP or cardiologist as soon as possible about what medicines they should take instead.
For almost a year I have had severe neck and back pain. I was told I have cervical spondylosis and apparently the only thing I can treat is physical therapy, and this hasn’t helped me at all. What would you recommend?
Dr. Ellie answers: Cervical spondylosis is a painful arthritic condition caused by inflammation of the spine in the neck. It can be distressing and patients may also find it difficult to move their neck.
All evidence suggests that physical therapy is important in the treatment of this condition; It cannot be cured, but regular exercise can decrease pain and improve mobility in the region.
While it is normal to feel like physical therapy has no effect, I urge anyone who feels this way to pursue it as its benefits are measured in months, not weeks.
And there is no reason why patients should not take pain relievers to reduce their suffering. Doctors usually start by prescribing a strong dose of acetaminophen or ibuprofen. In some cases, codeine, a mild opioid, may be offered, but it should be taken in moderation as it can be addictive.
Other treatment options include prescription anti-inflammatory medications such as naproxen or etoricoxib. Antidepressants, including amitriptyline and nortriptyline, may also be prescribed in low doses to help relieve pain and improve sleep.
Patients may also want to try non-pharmaceutical options, such as heating pads.
These are all options that can be discussed with a GP.
Should assisted dying be for the “tired of life”?
The journalist Dame Esther Rantzen has been a prominent activist in favor of the legalization of assisted dying.
In the debate over legalizing assisted dying, I feel there is a group of people who have not been heard: those who are simply tired of life.
And last week on the academic site The Conversation, a particularly bleak research paper was published that highlighted some of the reasons why a significant number of older people don’t want to move on, including chronic pain, lack of mobility and loneliness
I see these patients often in my surgery. They are not suicidal or depressed, but they believe that life is a burden and would abandon it if they were offered an easy, painless way out.
However, the bill currently before Parliament, and backed by journalist Esther Rantzen (pictured), would apply only to people who have less than six months to live.
Shouldn’t we also consider offering people in their later years the opportunity to die at a time and place of their choosing? Is this something you would consider?
Please write to me at DrEllie@mailonsunday.co.uk and let me know your opinion.