AS July gets off to a sunny start, many of us are out and about enjoying the weather at festivals, village fetes and garden parties.
Brits are notorious for letting loose once the mercury rises, but it’s important to remember the risks to our health.
There were almost 3,000 deaths associated with the heat in the summer of 2022, the most recent statistics show. Groups such as young children, the elderly and those with pre-existing health conditions need to be more wary.
Hot weather can lead to dehydration, heat exhaustion and even heatstroke (which follows heat exhaustion) if precautions are not taken.
Prolonged exposure to high temperatures can strain the body, which is important if you have a heart condition.
Remember the warning signs of heat-related illnesses, including dizziness, excessive sweating, vomiting and headache.
Call NHS 111, but call 999 if the person doesn’t improve within 30 minutes or has fast breathing, a fast heartbeat, a very high temperature, has a seizure or loses consciousness.
Here’s a selection of what readers have asked this week . . .
SHINGLES IS CRIPPLING
Q: I AM a 70-year-old woman recovering from a painful bout of shingles. When the shingles rash appeared, a pharmacist prescribed 800mg acyclovir five times daily and the rash went.
I am now suffering from nerve pain and managed to see a GP who prescribed gabapentin daily.
I can’t say that the medication has helped much as I am still experiencing pain and intense tingling.
I am not keen on taking it as I have heard different reports about its side-effects, so I wondered if there is any other way to deal with this nerve pain?
A: It sounds like you are experiencing post-herpetic neuralgia (PHN), a common complication after shingles where nerve pain persists even after the rash has healed.
This pain can be severe and is often described as burning, aching or feeling like barbed wire, especially when the skin is touched or irritated.
Paracetamol or paracetamol with codeine can help, but often does not provide complete relief.
Prescribed medications for nerve pain are the next step and include gabapentin, but also amitriptyline, duloxetine or pregabalin.
The thing to note about these is that they can take several weeks to become fully effective, so persisting with the gabapentin or trying an alternative would be an option for you.
If you are going to get side-effects from gabapentin (common ones include dizziness, drowsiness, dry mouth, blurred vision and weight gain) then you are most likely to get them when you first start it, or increase the dose.
Lidocaine plasters and capsaicin cream can help too.
In some cases, opioids such as tramadol or morphine may be prescribed short-term.
Non-medication strategies include loose, cotton or silk clothing (to minimise irritation) and avoiding a bra.
If you are keen to wear your bra then try using a protective layer of soft bandage underneath or a plastic wound dressing under your clothes.
Apply a cold pack (in a tea towel) for 20 minutes every two to three hours, take cool baths or showers to soothe the skin and try relaxation techniques.
If your pain is severe, not improving or affecting your daily activities, see your GP who may refer you to a pain clinic or a specialist in nerve conditions for advanced treatments, such as stronger patches, injections or cognitive behavioural therapy.
Why am I always feeling unbalanced?
Q: I’M 81 years old and quite fit. But for the past two months, when walking, I feel jittery and unbalanced.
I take medicine for anxiety and sometimes I suffer from occipital neuralgia. Could any of this affect my walking?
A: While occipital neuralgia primarily causes pain at the back of the head, it is possible to have associated feelings of unsteadiness, especially if the pain is severe and distracting.
I’m interested to know what medicines you take for anxiety and when you started them or increased the dose?
Many medications used for anxiety are known to cause side-effects, including dizziness, unsteadiness, impaired co- ordination and balance problems, particularly in older adults, as the body’s ability to metabolise medications changes with age.
This is especially true for benzodiazepines, which aren’t used as regular treatment any more, but can be prescribed for occasional use – to manage panic attacks, for example.
In the first instance, I’d advise requesting a medication review in the context of these symptoms that you have described.
If medication isn’t the cause, your GP may want to investigate further.
This could involve blood tests to check for deficiencies, such as vitamin B12 or iron, which can affect balance, as well as an ECG to ensure your heart rhythm is regular.
You could also check your own pulse – either on your wrist or one side of your neck. Tap out the rhythm of the beat with your foot and see if it seems regular.
If not or in doubt, then get this checked.
Additionally, it may be worth discussing whether your anxiety itself could be exacerbating the issue. Anxiety can sometimes manifest physically, leading to sensations of unsteadiness or jitteriness.
Practising relaxation techniques, such as deep breathing or mindfulness, could help reduce these feelings.
HIDDEN PAIN IN BACK
Q: I AM a 72-year-old man who has had a hidden pain just below my left shoulder in my back.
You cannot see anything and sometimes it’s not too painful, but I reel with pain when it’s touched.
Have you any idea what this could be? It is impossible to get a doctor’s appointment.
I have had the problem for about ten years, maybe more.
A: Your symptoms certainly warrant an assessment with a trained healthcare professional and an examination.
Whilst the ten-year length of the history reassures that the cause is not sinister, being in chronic pain can impact our physical and mental health and it may well be that there is a solution to help with your pain.
To share my thoughts, I’m wondering whether you might have myofascial pain syndrome (MPS).
This is a chronic pain condition where pain is localised to specific muscles due to the presence of sensitive knots called trigger points.
People often describe the pain as “reeling”, just like you have.
It could also be a trapped nerve or something else, though.
A pinched nerve could be due to spinal issues, such as degenerative disc changes or arthritis, which are common with age. So I have three suggestions for you to choose from.
Firstly, you could attend a walk-in-centre or urgent care centre on a day that you are not working.
Secondly, you could contact NHS 111 online who may be able to provide you with appropriate advice, which may include attending an urgent treatment centre.
The third option is to see a physiotherapist or osteopath, either privately or you may be able to self-refer to physio on the NHS. This means you don’t need a GP referral to see a physio – though this isn’t available everywhere.
Some practices have an in-house physio. When you next make an appointment with your GP practice, request to see them. Or search your local hospital or musculoskeletal unit and see if it takes self-referrals.
The most likely cause is musculoskeletal in some way and a physio or osteopath would be able to assess you and determine the likely cause and offer a guide with treatment.
