From vaginismus to worrying lumps, Dr Zoe Williams answers your health queries
CONFUSED about Covid? Fed up with those niggling aches and pains?
I’ve been a GP for the past nine years and the best part of the job is seeing patients walk out of my clinic feeling better.
It’s not easy at the moment because the NHS is under extreme pressure as staff tackle the Covid backlog.
And for many, getting an appointment to see your GP face-to-face is even harder than before the pandemic.
But there’s no need to suffer in silence — help is out there. Local pharmacists are on hand to help with minor illnesses, you can call NHS 111 and it’s often worth asking to speak to the practice nurse at your GP surgery as well.
I’m here to help too. Since giving my column a revamp I’ve been inundated with questions from readers, covering all aspects of health.
So if you’re worried about any medical issues, however big or small, send me your questions and I will do my best to answer as many as I can each week.
Don’t be shy, no topic is off limits — as you can see from this week’s selection of queries.
Why does a headache wake me at night?
DR ZOE says: There are many types of headache and many causes. The most common types are tension, migraine, hormone headaches and medication overuse headaches.
While they can all cause suffering and distress, we doctors don’t usually think of them as particularly dangerous.
But there is a list of red-flag symptoms that would cause some concern, and in these cases it is important to see your doctor.
One is waking during the night with a headache, or having one first thing in the morning. Tell your GP if you have this symptom. If you can’t get a face-to-face appointment, it’s worth taking a phone appointment, or an eConsult, which is an online consultation form.
Other red flags include having had a head injury in the past three months, worsening headaches accompanied by fever or problems with speech and balance. Also, if they start very suddenly, if your memory or personality has changed with the headache, or if you’re confused.
Also seek advice if your headache starts when you cough, sneeze or strain, if it’s worse when you sit or stand, if it’s accompanied by red or painful eyes, if it is accompanied by vomiting, if you have low immunity or are taking immune-suppressing drugs, or if you have or have had cancer.
I'm a man, 60, with a pea-sized lump in my public area. Should I be worried?
DR ZOE says: I understand from your email it has been there – at the base of your penis – for about a year and hasn’t grown or changed.
That is a very reassuring sign that this lump isn’t likely to be anything serious.
However, if a new lump is growing rapidly or changing or is red and inflamed and painful, then it should be checked out by a GP.
When it comes to lumps and bumps, there are a number of different factors to take into account.
If the lump is very smooth and mobile under the skin and is not changing, it’s a reassuring sign.
But if the lump is growing, feels stuck down and not smooth but more like a jagged stone, this may be some cause for concern.
Location is also important. Any new lump in the breast or testicle should be reviewed by your GP within a couple of weeks.
And lumps or swellings in your neck, armpit or groin that do not go down after two or three weeks should also be checked out.
One tip to monitor the size of a lump is to take a photograph of it if it’s visible, next to a ruler on the skin.
This way you can accurately see over time if the lump is growing or changing in appearance.
I have bleeding between my periods. What could it be?
DR ZOE says: There are many different reasons for intermenstrual bleeding. You say you have had blood tests and swabs that found nothing.
It could be polycystic ovary syndrome, which affects around one in ten women in the UK, or cervical polyps or your contraceptive, if using one.
It could also be cervical ectropion, where cells from the inside of the cervix grow on the outside, causing harmless bleeding.
While all these things are towards the top of the differential diagnosis list, there are rare conditions which could be causing it too, including cancer of the lining of the womb or cervical cancer.
If you have this symptom, it requires examination and investigation, at least to rule out anything serious.
I'm trying to come off sertraline but I feel dreadful. What should I do?
DR ZOE says: Sertraline is a type of antidepressant medication which belongs to a group called SSRIs, or selective serotonin reuptake inhibitors.
Antidepressants, while being a very important option for treating depression, do come with possible side-effects and potential withdrawal symptoms.
My advice would be to speak to your doctor, who may recommend a variety of different solutions for helping you come off sertraline.
Do not suddenly stop taking this medication without consulting your GP – you could increase the risk of withdrawal effects.
Some of the possible solutions include gradually reducing the dose over time, or maybe switching to a different type of SSRI.
How do I recover from breathlessness and fatigue after Covid?
DR ZOE says: Long Covid is when someone has not recovered from their Covid symptoms after 12 weeks.
If your symptoms are mild or moderate you should seek ongoing support from your GP, but it is unlikely you’ll be referred to a long Covid clinic as spaces are very limited.
It’s vital to take things slowly with Covid recovery, though. Don’t try too much too soon.
If you can only walk for a few minutes, stick with that for a while and maybe add on a minute or an extra 50 metres over time.
Build up slowly and increase the intensity or length of time gradually for the best recovery.
I'm struggling to sleep and have personal problems
DR ZOE says: Take a good look at your sleep environment and habits. It is likely a few small changes might help.
Turn off screens at least half an hour, or ideally an hour, before bed, as well as turning lights down and avoiding any caffeine.
The key is to make sure you do the same thing every night to create a sleep routine, whether it’s having a bath, sipping a milky drink, lighting candles, or reading a book.
This way your brain starts to identify that it is now time to go to sleep.
Our bedrooms should be used for two things only: sleep and sex.
If you’re struggling with personal problems and feel overwhelmed, you can self-refer on the NHS for talking therapies, or you can make an appointment to speak to your GP about how you feel.
My daughter is starving herself, then bingeing. What should I do?
DR ZOE says: Research suggests up to half of us demonstrate problematic or disordered relationships with food, body and exercise —yet rates of clinical eating disorders are estimated at a little under two per cent of the population.
It is important to realise it is not just about the food itself, it is about how a person feels.
Eating disorders are serious mental illnesses, they’re dangerous and can be fatal but they can be treated.
Avoid trying to talk about the issue around meal times. Try saying something like: “I wondered if you’d like to talk about how you’re feeling.”
Encourage her to write down how she feels, focusing on what she thinks affects her eating, how long it’s been going on for and what kind of support she thinks she would benefit from.
I've got perfect vision but have started having light sensitivity?
DR ZOE says: For several reasons it’s worth seeing your optician first.
They’ll have a shorter waiting time for appointments, but they will also have all the kit to properly check your eyes and see right to the back of them.
They can then treat you, refer you on or redirect you back to your GP if required.
While you wait for an appointment, though, it might be worth seeing the pharmacist for some eye drops.
Dry eyes can cause all sorts of symptoms, including light sensitivity, and it might be that your eyes need some lubrication.
How do you to tell if someone has irritable bowel syndrome?
DR ZOE says: IBS or irritable bowel syndrome is a common condition that affects the digestive system.
I wouldn’t advise trying to self-diagnose IBS because It is difficult and the symptoms could be many other things.
The most common symptoms are bloating, stomach cramps, diarrhoea, and constipation.
The symptoms usually come and go but last for a long time.
But there are many other conditions, including Crohn’s disease, ulcerative colitis, coeliac disease and some types of cancer, which can cause very similar symptoms, so it is important to see a doctor.
Your GP will probably do stool and blood tests before making what we call a diagnosis of exclusion if it is IBS.
What are the common treatments for vaginismus?
DR ZOE says: Vaginismus is when the vagina suddenly tightens up when you try to insert something into it.
This could be a tampon, or often it occurs when attempting penetrative sex.
If this is something you have been experiencing, don’t think you’re alone.
It’s a much more common issue than you’d think but people can be embarrassed to see their GP.
However, there are a range of treatments, so if you’ve been struggling with this, please don’t hesitate to get some support from your GP.
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Treatments include talking therapies, relaxation techniques, pelvic floor exercises and devices that help to train the vagina.
Don’t suffer in silence — it can be treated very effectively.