I'm a 70-year-old woman, and last year when the weather was hot my ankles and feet swelled up. Since then the swelling has not gone down. I take blood pressure medicine, amlodipine, but I only started on this after the swelling began. Can you offer any advice?
Dr Ellie replies:Swelling is a worrying ailment and shouldn’t be ignored.
While it can happen after a long flight or in hot weather, this will usually subside. Swelling which continues for a long time can sometimes be a sign of heart failure – a dangerous condition where the heart pumps less efficiently than before.
It can also be a symptom of kidney or liver problems, as well as poor circulation.
However, one of the most common causes of swollen ankles is blood pressure medication such as amlodipine. While it is an effective drug for reducing blood pressure, this is a side-effect GPs see all the time.
Ankle swelling which continues for a long time can sometimes be a sign of heart failure
It is possible that a patient who already had swollen ankles caused by hot weather, and then began taking amlodipine, would see the problem continue.
The good news is that there are plenty of other drugs which can effectively treat high blood pressure and might not trigger this uncomfortable side effect.
These are medicines a GP can prescribe. If a patient switches blood pressure treatment and the swelling goes down, then that’s a welcome finding.
If the swelling continues after the switch, then more tests need to be carried out to find the source of the problem.
Regardless of the cause, it is important to see a GP about ankle swelling.
At the beginning of the year, I had a horrible cough which lasted for two months. After a course of antibiotics the cough has gone but I am still experiencing breathlessness. I’m 80 and reasonably active. What can I do to improve my breathing?
Dr Ellie replies: Breathlessness is not just caused by lung issues, and it is important to work out the cause because it can be a sign of a life-threatening condition.
It is possible for an infection to cause breathlessness, as it can lead to scarring in the lungs. A recent infection can also worsen the symptoms of asthma – the lung condition which causes breathing difficulties.
However, breathlessness can sometimes be a sign of lung cancer, which is why scans, such as a chest X-ray, are needed.
It can also be caused by heart issues that become more common over the age of 75.
These include heart rhythm problems, including a condition called atrial fibrillation, which can be easily diagnosed by a GP as it causes an abnormal pulse.
One particular heart problem that causes breathing issues during exercise is a valve condition called aortic stenosis.
This is when one of the valves in the heart becomes rigid and doesn’t work as well as it should. A GP who suspects aortic stenosis would likely send a patient for an echocardiogram, a scan of the heart.
One other cause could be anaemia, which results from a lack of iron in the blood. A GP can carry out a blood test to spot this condition and provide iron tablets to combat it.
I was prescribed a low-dose antidepressant drug for my chronic back pain a few years ago. However, when I tried to come off it several months later, I struggled with withdrawal symptoms. It took me years to fully stop taking it, but now nothing else works for my back pain. What should I do?
Dr Ellie replies: Combating pain can be incredibly complicated, and often the treatment involves far more than just taking a tablet.
Antidepressants are one tool GPs use to manage chronic pain, such as back issues, as studies show that they can lower the agonising sensation. However, the tablets cannot eradicate pain altogether.
Moreover, they can have side-effects, including, in some cases, withdrawal symptoms.
Instead, research shows that the best way to combat back pain is movement and low-intensity exercise. This might include walking, swimming or even taking a dance class.
Painkillers can be used in combination with movement.
For example, many people with pain issues might take a daily anti-inflammatory drug such as naproxen and also paracetamol if their pain is particularly bad that day.
I would recommend anyone living with chronic pain to ask their GP for a referral for physiotherapy sessions.
In many parts of the country it is possible to book an NHS physiotherapy appointment without seeing your GP first.
A physiotherapist should be able to provide some focused exercises to help improve mobility – and hopefully reduce pain levels.
RSV isn’t a cold – get the vaccine
There's a new vaccine which many of you will be able to get this autumn – but it’s possible you may not have even heard of the infection it guards against.
Respiratory syncytial virus – known as RSV – is a very common winter bug, and for several months every year thousands of hospital beds are taken up by people, often elderly, suffering severely with this lung infection. It can be so widespread it can lead to delays and cancellations for routine treatments.
RSV is often mistaken for a cold, with mild symptoms such as runny nose, sore throat, cough and headache that clear up on their own in a few days.
But it can also be deadly. As it gets worse it can cause a horrible cough, shortness of breath, wheezing and a high fever. As many as 5,000 adults die from RSV every year – the majority of whom are over 75.
So it’s great news that all over-75s will, for the first time, be offered an RSV vaccine in September. So if you’re called in for a dose, please accept it.
Antonya Cooper who, after 40 years, last week admitted giving her terminally ill son a large dose of morphine to end his life
Is assisted dying the way we should go?
I was struck by the extraordinary story of Antonya Cooper who, after 40 years, last week admitted giving her terminally ill son a large dose of morphine to ‘quietly end his life’.
Hamish, just seven in 1981, had stage 4 cancer and, Mrs Cooper said, was ‘facing the most horrendous suffering’.
Now facing her own battle with terminal cancer, Mrs Cooper, from Oxfordshire, has chosen to speak about her decision just as campaigners are fighting to change the law on the issue.
Assisted dying – also known as euthanasia – is illegal in the UK, so Mrs Cooper, pictured above with Hamish, could be open to a police investigation. It’s an incredibly complex, emotional issue, but the dial on assisted dying is moving, with many more people – including our new Prime Minister – calling for a change in the law.
