I’ve had trouble sleeping for years, but taking an antihistamine (cetirizine) a couple of nights a week really helps. However, the pills leave me a bit groggy, could they do any harm?
Tina Vowles, Gloucestershire.
Not all antihistamines are created equal. There are two types: sedating and non-sedating.
Dr Martin Scurr answers: Antihistamines act on histamine receptors. Histamine is a chemical that the body produces in response to a perceived threat (in the case of an allergy, the mistaken perception of a harmless substance as a threat). Symptoms are the body’s way of getting rid of it (such as sneezing).
But histamine also plays a role in wakefulness, so an antihistamine can make you feel sleepy.
However, not all antihistamines are created equal. There are two types: sedating and non-sedating.
The former have a greater capacity to reach the brain (thanks to the way they are transported by the blood); among them is chlorphenamine (trade name Piriton).
The cetirizine you are taking is not sedating, although some people find it makes them sleepy and you seem to be one of them.
Long-term use of antihistamines has been linked to dementia. It is important to note that this is not a proven cause, but the risk appears to be due to the fact that some antihistamines are anticholinergic.
Long-term use of antihistamines has been linked to dementia. It is important to note that this is not a proven cause, but the risk appears to be due to some antihistamines being anticholinergic, says Dr Martin Scurr.
This means that they act on the brain receptors that respond to the chemical messenger acetylcholine: low levels of acetylcholine are characteristic of dementia.
Long-term use of other medications that block these receptors, including antipsychotics and some antidepressants, is also linked to an increased risk of dementia.
In fact, cetirizine is a weak anticholinergic, so twice-weekly dosing is not a problem, although it is not good to feel light-headed.
My advice would be: limit pills, only go to bed when you are sleepy, get up if you can’t sleep, don’t read or watch TV in bed – it’s only for sleeping, get up at the same time every morning and don’t take naps during the day.
I was diagnosed with a heel spur after an x-ray. My GP referred me to a podiatrist. I am waiting for an appointment but I am in very bad pain. I use podiatry felt and heel supports in my shoes but that does not help the discomfort.
Owen Rees, Devon.
Dr Martin Scurr answers: Heel spurs are bony growths on the calcaneus, the heel bone. They may be asymptomatic and are often detected during an X-ray performed for other reasons. They can also be very painful and even disabling.
They develop as a result of prolonged stress on the ligaments of the foot; for example, as a result of gait abnormalities, ill-fitting shoes, excess weight, osteoarthritis or plantar fasciitis (inflammation of the tissue that connects the heel bone to the ball of the foot).
This causes inflammation, to which the body responds by forming bone as a protective mechanism. Treatments include the use of padding; heel supports may not help much, but a podiatrist will be able to offer a superior version, in the form of orthotics.
Your GP may also prescribe a non-steroidal anti-inflammatory drug (NSAID), such as diclofenac. You should persevere with this treatment for at least six weeks. The next stage is a corticosteroid injection, which is usually administered using ultrasound to precisely localise the problem area. But be aware that this is given to suppress inflammation, rather than remove the spur itself.
An orthopedic specialist may suggest Botox injections to “paralyze” the muscles on the sole of the foot, taking pressure off the swollen area so it can heal.
In extreme cases, patients may be offered surgery to remove the spur, although most find their pain resolves with more conservative methods and the need for surgical intervention is not yet proven.
I would caution against other experimental treatments, including shockwave therapy and ultrasound, which are widely advertised for this type of problem, but which in my opinion are a waste of money.