From hyperventilating attacks to how safe is HRT – Dr Zoe Williams answers YOUR questions
IT’S time to start thinking about booking your flu jab.
Autumn and early winter are the best time to get the vaccine, so you’re covered before flu season really kicks in.
The jab is free for all over-65s, as well as if you have certain health conditions, are pregnant, or live/work with someone who is high risk.
At-risk groups get theirs first, but then from mid-October, people aged 50 and over (including anyone who’ll turn 50 by March 31) can get theirs too.
Check with your GP surgery or local pharmacy to find out when they have flu vaccine slots available, and get booked in.
In the meantime, here are this week’s reader questions . . .
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Q: I HAVE just been diagnosed with neuropathic nerve damage. I have seen a specialist at my hospital and was told there is no cure.
I’ve had three falls, my legs and feet are very cold and I have pins and needles. I have physiotherapy but it doesn’t seem to help.
Is there anything that you could suggest for me please? I am 73 and I am on blood pressure tablets as well as propranolol for anxiety and I have balance issues.
A: Although this can’t be cured, there are likely further treatments that can be tried to alleviate or lessen your symptoms.
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The treatments for neuropathy vary, depending on the underlying cause, the symptoms and which nerves have been damaged.
Sometimes the main focus is supporting the person to be able to have a good quality of life despite the symptoms.
Nerve pain may be treated with prescribed medicines called neuropathic pain agents, such as gabapentin, amitriptyline and pregabalin.
If these have been tried and are not helping then you may benefit from referral to the local pain specialist clinic who may consider other medications, and therapies such as acupuncture or talking therapy.
However, I must warn that waiting times can be quite long for pain specialist services. The British Pain Society has helpful information on their website .
Q: I THINK I am suffering from hyperventilating attacks – should I tell my GP about it?
A: Yes, 100 per cent you should tell your GP. It might be worth keeping a diary of when you get the episodes of hyperventilation or you may already be aware of what some of the triggers are.
When we breathe we inhale oxygen and exhale carbon dioxide. When we hyperventilate, which means that we breathe too rapidly, we actually get rid of too much carbon dioxide, which can cause unpleasant symptoms such as light-headedness or tingling in the fingers.
This is the reason that breathing into a paper bag can help, as it means you inhale some of the carbon dioxide back in. You can also breathe into cupped hands or through pursed lips.
You can also try alternate nostril breathing. This involves covering your mouth and alternating breathing through each nostril.
With your mouth covered, close the right nostril and breathe in through the left. Then alternate by closing the left nostril and breathing in through the right.
Repeat this pattern until breathing has returned to normal.
Hyperventilation most commonly results from anxiety, panic, nervousness, or stress, and your GP would be a great person to advise you on how you could get some support for these.
You can also self-refer if you prefer, by going to the NHS talking therapies webpage.
Q: I THINK I’m having menopausal symptoms. I feel like I should ask for HRT but I have a history of breast cancer in my family – does that mean I can’t take HRT?
My symptoms are getting worse each month, I’m gaining weight and my periods are all over the place. I’m really struggling.
A: Having a family history of breast cancer does not mean that it’s unsafe for you to take HRT but talk to your GP if you have concerns.
There is no strong evidence that, when compared to women who do not have a family history of breast cancer, taking HRT would put you at any higher risk. This includes those women with a BRCA gene (which greatly increases a woman’s chance of developing breast cancer and ovarian cancer), who can usually take HRT safely.
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When it comes to whether or not to take HRT, base that decision on the benefits to you versus any risk. There is a very small increased risk of breast cancer with some types of HRT (see above), but other things also increase risk, such as obesity, lack of exercise and drinking too much alcohol.
A healthy, active lifestyle is usually easier to achieve for people who are taking HRT to combat their menopausal symptoms, so this is worth factoring into the equation.
HRT + breast cancer: How safe is it?
THE increase in breast cancer risk from HRT is small.
According to the British Menopause Society, if you take 1,000 women aged 50-60 who do not take HRT, over a five-year period, 23 will develop breast cancer, because breast cancer is quite common.
This is called the background risk.
Take a similar group of 1,000 women who take combined HRT, so that’s oestrogen and progesterone (the latter protects the lining of the womb), then an additional four would get breast cancer over the five-year period (so 27 in total).
Women who have had a hysterectomy can take oestrogen-only HRT (no need for progesterone), in 1,000 women, four fewer would get breast cancer (so 19 in total).
And for topical oestrogen tablets (or gels applied directly to the vagina) to alleviate vaginal dryness or soreness and UTIs associated with menopause, there is no change to breast cancer risk.
Compare this to some other risk factors for breast cancer: Two extra units of alcohol a day will add five women (total 28). A BMI over 40 will add 24 women (a total of 47)
Two hours of exercise each week reduces the risk, and seven fewer women would get breast cancer (total 16).
HRT is largely safe for women with a family history of breast cancer, but do speak to your GP about any concerns.