SPENDING more time outdoors now the weather’s nice?
If so, you’ll not just be contending with potential sun damage (wear SPF30), but also critters that may bite.
Dr Zoe Williams answers some health questions sent in by readers
Getting a nip – whether from a bee, wasp or mosquito – is never nice, but usually the redness and itchiness clears up on its own.
You can also speak to your pharmacist for advice on at-home treatments to relieve swelling.
But if symptoms persist, the site of the bite continues to be sore and tender, or it’s near your eyes, mouth or throat, the pharmacist may advise to speak to your GP to assess it further.
Here’s what readers have asked me this week . . .
Q: I HAVE inflammation around my rectum that has been there for around 18 months.
So far I have used Trimovate, and Miconazole but to no effect. I always wash myself after using the toilet, but it refuses to clear up.
Can you give me any advice? My doctor doesn’t seem very interested.
A: You really need to be seen and examined by a doctor to figure out what is going on.
Is the inflammation definitely in the rectum, which is the internal organ that connects the final part of the large intestine (colon) to the anus, or is the inflammation actually around the anus, which is the opening where you poo from?
There could be several causes of inflammation to the perianal area (skin around the anus) from haemorrhoids (piles) to a skin condition such as eczema, to something more serious like Crohn’s disease.
It sounds as though the treatment you have tried so far was prescribed to treat any bacterial or fungal infection of the skin, but this clearly hasn’t worked so re-assessment with a clinical examination is required.
If these symptoms are more internal, then this could be proctitis — which is inflammation of the lining of the rectum. Proctitis may be acute or chronic.
Symptoms may also include pain, cramping or spasms during bowel movements, and the feeling that you haven’t completely emptied your bowels after you’ve finished a poo. We call this “tenesmus”.
Causes include Crohn’s disease, ulcerative colitis and some sexually transmitted infections.
Some people get it as a side-effect after radiation therapy that has been given to treat cancers in the pelvic area.
An examination is still required, which may include a finger inserted into the rectum, and some stool samples to check for traces of blood (FIT test) and evidence of inflammation with a “calprotectin” test.
Q: HAVING read The Sun’s article on atrial fibrillation increasing the risk of a stroke five-fold – could you please answer the following query?
I am a 59-year-old man with known atrial fibrillation. I don’t take medication for it.
I also have high blood pressure and take doxazosin and losartan 100mg. I have type 2 diabetes, self-controlled – no medication.
With the risk of a stroke so high, should I be taking something to combat the risk of a stroke occurring, such as statins?
A: You’re correct that atrial fibrilation increases the risk of stroke five-fold.
And research also shows when people with AF have a stroke, it can be more serious, with more damage to the brain and a potentially worse long-term impact. Around 1.4million people in the UK have AF and around 20 per cent of strokes are caused by it.
When you were diagnosed with it, your GP or specialist should have had a conversation with you about treatments to reduce your risk given your pre-existing conditions.
Doctors use a scoring system called CHA2DS2-VASc to assess the stroke risk in people who have AF.
If the score is above a certain number, it is usually advised to take medication to thin the blood. This is called anticoagulation. Modern medicines for this include apixaban, dabigatran, edoxaban and rivaroxaban.
Warfarin used to be the main drug for anticoagulation, but it is used much less often these days.
There are times when anticoagulation medication may not be prescribed, if the heart rhythm has reverted back to normal for example, or if the person is under 65 and has no chronic health conditions apart from AF, meaning their overall stroke risk remains low, or if a person is deemed to be at increased risk of bleeding, so the medicine has additional risk.
You are young, but with a background of hyper-tension and type 2 diabetes, I would usually expect anticoagulation medication to be prescribed.
You actually asked about statins, which are cholesterol-lowering drugs, and these are usually advised if it’s considered that your ten-year risk of having a heart attack or stroke is greater than ten per cent.
This is calculated using a different scoring system called QRISK2.
You can check your score online, but based on what you have told me, it is highly likely that a statin would be advisable in your case.
Help me heal my sore heel
Q: EVERY morning when I wake up, I experience pain on the heels of both feet. Please advise what this could be.
A: It sounds to me like you could have one of two conditions.
The first is called plantar fasciitis and this occurs when the plantar fascia, a strong band of tissue that supports the arch of your foot, becomes irritated and inflamed.
It affects millions of people every year.
Sudden damage (ie. from running or jumping) or damage that occurs over many months or years (standing for long periods of time for your job, or if you have a larger body or wear very flat-soled shoes such as sandals), can cause tiny tears to develop inside the tissue of the plantar fascia, leading to heel pain.
The second condition is achilles tendonitis which occurs when the achilles tendon – which goes down the back of your calf – gets overused.
Both conditions cause stiffness and pain, which tends to be worse after a period of rest.
The risk of achilles tendonitis increases as you get older. The way you walk – especially if you have flat feet – and higher body weight can also be a factor.
It’s not clear how the conditions are linked, but those with psoriasis and high blood pressure are more at risk of achilles tendonitis.
Search “video exercises for foot pain” at csp.org.uk. You might also be able to access a physiotherapist without a GP referral – it depends on your local area.
It’s worth checking with your GP practice.