I’m 78 and have been having daily nose bleeds for the past fortnight. It can happen at any time, including the middle of the night. I don’t want to bother my GP about it as my pharmacist said it wasn’t serious. What do you think?
Dr Ellie Cannon replies: Nose bleeds that occur regularly should be assessed by a doctor. More often than not, the bleeding comes from a fragile area inside the nose where the blood vessels are easily damaged.
This can occur due to an injury, using nasal sprays or an infection such as a bad cold. In rare cases, it could be triggered by a tumour or a blood-clotting problem. Nose bleeds are also more common in people on blood-thinners or those who often come into contact with dust or cigarette smoke.
A GP can assess the cause, and there are blood tests to look for clotting problems.
Once any underlying serious conditions have been ruled out, a GP might be able to prescribe the nose cream Naseptin, which is an antiseptic.
Patients can also be referred to a specialist for a minor procedure called a nasal cautery, which can seal the bleeding area and may stop further episodes.
Whatever the ailment, it is important that patients tell their GP about any medical problems that are severe or long-lasting.
Putting off tackling an issue can sometimes make it worse.
In rare cases, regular nose bleeds could be triggered by a tumour or a blood-clotting problem
I’m 54 and have never had any menopause symptoms. I live with polycystic ovarian syndrome and, until a few years ago, was taking the hormonal contraception tablet to combat the symptoms. Do you think this could be why I haven’t gone through the menopause?
Dr Ellie replies: The average age to begin the menopause in the UK is between 47 and 53, but it can occur later.
It’s caused by falling levels of the female sex hormone oestrogen and the impact of this change affects women in different ways.
While most people associate the menopause with hot flushes, mood changes and difficulty sleeping, some women never experience any of these issues.
That’s why doctors usually define the menopause as an absence of periods for more than one year. When this occurs is influenced by each woman’s health, ethnicity and any medicines they are taking.
Polycystic ovarian syndrome, or PCOS, is caused by a hormonal imbalance and typically triggers irregular periods, acne, facial hair and difficulty getting pregnant.
Some of the symptoms do mimic the perimenopause – the early stages of the menopause – such as irregular periods and heavy bleedings.
Since PCOS is a hormonal condition, it is very possible that it could affect the age a woman experiences the menopause and the nature of her symptoms.
Some data suggests women with PCOS reach menopause, on average, two years later than those who do not have it.
My husband recently came down with a bad chest infection after getting a flu jab. He has Crohn’s disease and is prescribed azathioprine. Could the vaccine have given him the infection?
Dr Ellie replies: It is impossible for the flu vaccine given to the over-65s to trigger an infection, because it does not contain a live version of the virus.
Instead it contains only part of the virus in order to trick the immune system into making protective antibodies to fight off any future flu infection.
I often hear about people who get infections shortly after getting their flu jab, and there are a number of reasons why this would happen.
Firstly, the NHS offers the vaccine in autumn and winter, which is when infections are more prevalent. So statistically it is simply more likely that someone will get a chest infection around the time that they have a vaccine.
Secondly, it is not uncommon to have a flu jab in a healthcare setting such as a GP surgery or pharmacy where there are other sick people present, who could pass on an infection.
This means that, ironically, getting a vaccine can raise the risk of getting an infection, though the chances are low.
Finally, people who are on immunosuppressant drugs, such as azathioprine, which are designed to calm the immune system, are more likely to get infections than those who are not on these medicines.
That’s why it’s crucial that anyone taking one of these medicines takes up the offer of a vaccine, in order to limit the risk of severe symptoms.
Immunosuppressed patients may also want to take some simple steps to lower their risk of infection, such as avoiding large indoor crowds or wearing a face mask.
Is signing up more PAs the right move for NHS?
I am not surprised that the Government is launching a review into the NHS rollout of healthcare workers known as physician associates (PAs).
PAs have two years’ training – not a medical degree – and the NHS is in the process of recruiting thousands of them to help doctors carry out basic medical tasks in order to plug severe staff shortages.
When used correctly, PAs can be invaluable members of staff. I’ve been working with a PA at my surgery for a while now, and she is a massive help.
But as The Mail on Sunday has repeatedly highlighted, PAs are being asked to cover for doctors on specialist wards and to carry out complex medical procedures. It’s not fair on PAs and it places patients in danger – this is the unacceptable situation that directly led to the death of Emily Chesterton, pictured below.
I’d love to know what you make of it. Have you had a bad experience with a PA, or perhaps the opposite? Please email the address at the bottom of the page and let me know.
PAs are being asked to cover for doctors on specialist wards and to carry out complex medical procedures, which led to the death of Emily Chesterton
GPs need to know how to diet
Last week I attended a conference exploring how social media has affected nutrition advice – and I was shocked at what we saw.
Researchers showed us that the majority of diet tips online are not backed by scientific evidence. This is particularly true for the wellness products advertised via social media – the gummies and powders which are supposed to provide a health boost but, it turns out, have little-to-no benefits.
However, this event, at the Royal Society of Medicine in London, has left an impression on me for a different reason – it made me realise how absurd it is that doctors are not trained to provide diet advice. It might sound unbelievable, but at no point in our years at medical school are we taught about nutrition. This is particularly crazy given that so many diseases are linked to diet, such as type 2 diabetes.
If we want to counter online misinformation, perhaps it’s time we started teaching medical students about diet.
- Do you have a question for Dr Ellie Cannon? Email [email protected]