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COMING NEXT: the doctor's next topic is about over-active and under-active thyroids. Read his article, The telltale loss of power and e-mail your question for answer online on Wednesday or read other recent topics here
For some years now I have become more and more allergic to firstly asprin, then NSAIDs, ibuprofen and anti-inflammatory drugs and have to, therefore, avoid these drugs. I also react strongly to Immodium although I used to be able to take it - my doctor thinks it is probably the blue colouring in the capsule coating. However, I have arthritis, particularly in my feet and back, and walking around and even doing everyday chores is becoming increasingly painful and tiring. One of my great loves is gardening and I can only do this in short bursts and am very stiff and in pain afterwards.
I read with interest your article in the Times when you talked about Pycnogenol (Zinopin) and wonder if this can be of any help to me as an anti-inflammatory I would not react to. I shall also be taking a long-haul flight in September and, again, can I take Pycnogenol? Any help and advise would be much appeciated. Pauline Austin (Mrs)
It is important if you have any suggestion of an aspirin allergy that you should avoid it and other drugs that have an allied hypersensitivity. I don't understand why you should be sensitive to Immodium but your doctor's suggestion that it is the blue colouring is a likely one. To confirm this you would have to find out from the manufacturers what dye is used in the production of the capsules. This knowledge could be useful to you as then you would be able to avoid foodstuffs that have it or a similar dye. It is known for example that patients who have a hypersensitivity to aspirin and other anti-inflammatory non-steroidal drugs may also be sensitive to some food dyes including, very often, those that are based on tartrazine.
In some people the hypersensitivity to aspirin and other NSAIDs (the non-steroidal anti-inflammatory drugs) is dose-related but if somebody gets a serious reaction then testing for it by using a challenging dose of aspirin is considered by many doctors (including me) to be too dangerous except under well-controlled situations. A classic sign of mild chronic aspirin sensitivity is revealed by the association of aspirin-taking with asthma and nasal polyps. This should be excluded always when this triad of symptoms has been noted.
I should discuss with your doctor the possibility of using such natural substances as rosehip extract. Two recent studies, one from Denmark and one from Norway, have been published on the anti-inflammatory properties of rosehip powder sold as a capsule known as LitoZin. It takes time for its action to take effect, little or no change for around three weeks is to be expected. By all means try pcynogenol (Zinopin), provided that your doctor agrees.
Specially bred green lipped mussels from New Zealand are also helpful to some patients with arthritis but their anti-inflammatory action is likely to be through the same inhibition of the prostaglandin synthesis as exists after taking aspirin and NSAIDs, and this will have to be taken into account by your doctor.
Fish oil helps osteoarthritis, my mother swore by it. It might be worthwhile trying any pleasant Omega 3 supplement, cod liver oil in which the vitamin A content has been reduced or fish oil. This can be obtained in capsules or in forms that no longer are necessarily nauseous.
Can you take anti-inflammatories if you are anaemic? Are there any forms of NSAID that don't make you gain weight? Helen Lamb, Dagenham
Yes, provided that you can be quite certain the anaemia is not the result of a slow, gradual bleed from the gastro intestinal tract. Many cases of anaemia result from bleeding, usually from the stomach or small intestine but the NSAIDs may also occasionally also cause bleeding from the colon.
A history of oesophageal reflux, chronic indigestion, or any form of peptic ulceration whether in the stomach or the duodenum or even inflammation of the stomach or duodenum (gastritis or duodenitis) is an absolute contradiction to taking NSAIDS. Likewise if there is colonic bleeding from the large bowel it would be unwise to take an NSAID.
The complication rate with NSAIDs is much greater in the over 65s. Unfortunately these are the very people that need them most. It is a matter of discussion with your doctor and together you will need to weigh up the benefits you would receive from taking these very useful drugs, including the ability to have a night sleep free of pain and to undertake such pleasures as walking and gardening, against the dangers, however small, that all NSAIDs pose. The likelihood of suffering gastrointestinal troubles from NSAIDs does vary from one to another and some include an additional substance that lessens the chance of causing gastro intestinal inflammation. Unfortunately the additional constituent may, in occasional people, induce mild degrees of diarrhoea.
The literature doesn't include any evidence that NSAIDs have a direct effect on weight. This is of course very different to any steroid based anti-inflammatory agent that does always cause weight problems. Many patients with arthritis have weight problems because the pain in the joints restricts their activity rather than from the NSAIDs they are taking.
Are there any NSAIDs which do not contain ibuprofen? I have been told that ibuprofen may have triggered a chronic auto-immune skin problem so I have stopped taking it, but paracetamol is not as effective for joint pain. W. Hazel, Nuneaton
Yes. There are a legion of non-steroidal anti-inflammatory drugs (NSAIDS) that don't cause chronic auto immune skin problems. Some forms of arthritis are caused by an auto immune tendency that may be responsible for both the joint pain and the skin manifestations. These could therefore be the results of an auto immune response rather than an hypersensitivity caused by the NSAIDs. I would suggest that you discuss this with your doctor and or rheumatologist.
I suffer from mild IBS and am flying to the US next month. Is it still all right for me to take aspirin before the flight? Name and address supplied
Yes. it will be perfectly safe for you to take a small dose of aspirin. There is an association between gastritis and intestinal hurry, one of the symptoms of IBS, so don't take so much aspirin that there is a danger of developing gastritis. I would recommend that you take low dose aspirin tablets and that you start taking them for ten days before you fly, and after you reach your destination. Aspirin acts by reducing platelet stickiness. As these small particles don't adhere together the traveller is less likely to suffer from any thrombo-embolic troubles. The NSAIDs don't have the same action on platelets, or if they do it is rapidly reversible. The long action of aspirin is related to the ten day life of the normal platelet particle.
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i am a 62 year old woman who is experiencing hot flushes especially at night, my doctor will not prescribe HRT I was on it till I was 55 as I had a hysterectomy at 44 this last year I have been so uncomfortable at night especially in bed I tried alternative medicine to no avail can you help?
alison sproule, port glasgow, inverclyde
i am a 46 yr old male reasant this year after 4 yrs blood tests was diagnosed april 07 with pressure on the forehead which since sept 07 was a small dose thyroxin and as of today now subscribe full dose this problem is on the pituary gland to my forehead i suffer with short term memory loss and affects my work also caused me high blood pressure does this affect most people
chris vernall, crewe, uk
HI I AM A 35 YEAR OLD FEMALE WITH AN OVERACTIVE THYROID. ABOUT 4 YEARS AGO I WAS GIVEN RADIO ACTIVE IODIENE WHICH HAS COMPLETELY MESSED MY THYROID UP. I AM CURRENTLY ON 400MG OF THYROXINE A DAY AND HAVE BEEN FOR ALMOST A YEAR. (YES YOU READ RIGHT 400MG A DAY) AND IT STILL ISN'T WORKING. i AM ALSO HAVING TO GO THROUGH IVF AS I HAVE SEVERE ENDOMETRIOSIS AND AM WORRIED ABOUT WHAT WILL OR WONT HAPPEN IF I MANAGE TO BECOME PREGNANT WITH THE IVF. Please can you help.
wendy halliday, aberdeen, scotland
penis dysmorphobia? not me then! I have a small penis, but I love it when compared to bigger ones by girls, size queens, oh we are all freaks when it comes to sex, internet to blame??? sexual fantasies are a persons most hidden secrets!
Adam Webb, MK, UK
I cannot understand how women, just because they had a good birth experience at home can criticise hospital births. Forty years ago I had a son in hospital and was made to deliver on my back with feet in stirrups! We were both fine but a friend of that period had a difficult birth at home. I felt glad I had mine in hospital. My second delivery was still in hospital but the birth was so easy it could have happened at home. When I became pregnant for the 3rd time I had to almost beg to go into hosital. Thanks goodness I needed a lot of help and care afterwards. My point being - we can never predict how well a delivery may be. Please ladies forget about how wonderful you want the experience to be and concentrate on a safe healthy baby and a "rest" afterwards.
fran of norwich, norwich, norfolk
Re: Aspirin and flying. Some experts suggest that, as aspirin acts mainly on the arterial system and blood clots form in the veins, aspirin has no part in the prevention of clots.
Vivian, Hvar Island, Croatia
...another argument implying that childbirth is a disaster waiting to happen and is only safe in retrospect.
Can someone in the media please do some research on the training of midwives (and the ongoing training once qualified)? It is mandatory that midwives train in neonatal resuscitation techniques every year, and are also trained to deal with most obstetric emergencies (be it at home, on the bus, in a yurt, or up a mountain). Midwives support and promote the normality of birth, but equally are also trained to recognize the parameters of normality so that when a deviation is seen, appropriate help is sought: and that includes transfer to hospital if attending a homebirth.
Planning for a home birth is not final and binding and not forced on women (despite what the media would have us think). Midwives offer 'informed choice': pros and cons (based on extensive research) are discussed and the woman makes up her own mind. Something the medics often fail to consider...
Hacked off student midwife, London,
With modern forensic, post-natal techniques paediatric neurologists can tell by acidosis in the cord blood precisely how minutes of oxygen deprivation a baby suffered during a delayed birth and how much additional brain-damage each successive minute caused. So, at least if something does go wrong during a home birth it should be possible to discover afterwards whether being 5 minutes away from emergency intervention or 15 would have made much of a difference. Not much comfort to the new mother of a disabled child of course, but it might reassure her that the home birth was not necessarily an enormous factor in her child's lifelong impairment as 5 minutes might have meant her child would someday walk and talk and 15 that they would do one or the other but not both. Imagine what it must be like for a healthy, full-term baby struggling to be born and to breathe with its cord failing but stuck helpless inside its mother. This is real life and its a life-sentence for parent and child.
Michelle, Chislehurst, UK
Hi as a midwife currently providing a homebirth service then the importance that should be placed on a womans instincts can not be underestimated. Midwifery practice is evidence based but also works "with woman" to ensure that where possible the pregnancy experience meets her wishes and expectations. In the case of homebirth I have looked after many women who "safely" deliver at home but conversely have transferred women into hospital due to them not feeling happy at home or complications arising (as can happen in hospital labour). It is unusual for complications to arise out of the blue and with watchful, competent midwives any problems can be pre-empted and acted on. It is also important as midwives that we listen to women as they are most aware of what is happening to their bodies. In this current climate it is important that womens choice is valued and supported where possible. For appropriately assessed women with straight forward pregnancies home birthshould always be an option.
Lucy , East Anglia,
With Dr Stuttafords response to Margaret in London, all is made clear: agree with him, and receive a pat on the back as a good girl. Disagree, and receive a reply that is patronising or verging on the rude reply. Little woman, know your place, and do as doctor tells you.
Incidentally, I was born in hospital in the mid-seventies to a mother of thirty, my younger sisters at home a few years later. Re. the long-term study Dr Stuttaford suggests, of the three of us only I have ever been hospitalised, and otherwise we are all healthy, intelligent, and and productive members of society. It's hardly a proper study, but it's just as good evidence as "I had to have a forceps delivery, thank goodness I was in hosptial", when hospitalized brith itself increases the likelihood in a low-risk birth of a forceps delivery.
Catherine, Oxford,
I suffered from severe joint pain and extremely painful feet for two years at the start of my menopause. I was referred to Arthritis Clinic which took around 9 months before being seen there (leaving me to suffer and deal with the side-effects of medication which did little if anything to help), until I read of an old remedy of two capfuls of cider vinegar added to cup of boiled hot water with two teaspoons of Manuka honey to taste. Take this twice to three times a day. Its not a cuppa you would want to take time over drinking, but a small cup of this taken as above over a period of three months, resulted in very little joint pain now and pain free feet for the first time in two years. The joy of walking now is something I never take for granted.
Try sea kelp supplements to help thicken hair.
Isovon (Soy Isoflavones) may be worth trying also.
I empathise with all you are experiencing but good luck.
Sylvia, Glasgow, Scotland
..I have been losing hair from fringe and temple area very slowly over last 2/3 years and deduct that it is probably male pattern baldness resulting from falling oestrogen levels.As I have an extremley high hairline anyway and have always used fringe to soften severe look it is very de
pressing to think that by the time my menopause is over I could lose a lot more(as Idid after birth of my 2 children).I'm 50,eat lots of fruit,veg,soya ,pulses and even red meat I have had negative tests for underactive thyroid ,anaemia and abnormal testosterone levels I.have taken all sorts of supplements to no avail and would willingly take H.R.T. if this slowed down hair loss.Is there really nothing I can do?My French GP won't even do a hormone test until I have been period free for at least 6 months,despite extreme fatigue,joint pain,bad temper and memory problems.
Thomas Julie, Le Mans, France