From chronic bad breath to struggling to poo – Dr Zoe Williams answers your health concerns

YOUR summer holiday may seem a long way off – but it’s time to slap on sunscreen.

The sun’s harmful UV rays can penetrate the clouds, so it’s important to be protected, whatever the weather.

That’s why the British Skin Foundation is telling us to wear SPF 50 “365 days a year”.

Doing so helps prevent the skin damage that can lead to cancer. It can also prevent wrinkles and other signs of ageing. So get a bottle of SPF 50 and place it by the bathroom cabinet, then apply it every morning.

Potential signs of skin cancer include a new or changing mole, skin patch or nodule that has changed, become itchy, waxy, shiny or pale, a sore that does not heal, or crusts and scabs for more than four weeks.

Cancerous moles may be raised, have a mix of colours and jagged edges.

Here’s a selection of what readers have asked me this week . . . 

LEG SWELLING WON’T GO

Q: MY husband has had swelling in his feet and legs for the past six months. Doctors just say to elevate his legs and it should go away.

He has had a blood test and was told everything is fine. One doctor said it was because he has arthritis in his knee and keeps falling over.

Is there anything else he can do to get the swelling down, as elevating them does not seem to work? I’m worried about it on our flight for an upcoming holiday.

A: Swelling in both feet and legs (peripheral oedema) has several potential causes such as lymphatic issues, heart failure, kidney and liver disease.

It is somewhat reassuring that your husband’s blood test results are ­normal. Some medications, such as ibuprofen, insulin and steroids, can cause oedema because they affect how the kidneys function, meaning fluid is retained.

One tip is to have the legs elevated on a pillow in bed at night.
Compression stockings, gentle exercise, leg massages, drinking enough water and a balanced diet low in sodium and high in potassium-rich foods can all help to reduce peripheral oedema.

See your GP again if the swelling is not improving or worsening.

On your flight, your husband can wear compression stockings.

Try to choose aisle seats so he can move around at least every half hour or so. Notify the airline staff in case they can make any further adjustments.

I don’t know where you’re going on holiday but be warned that exposure to extreme heat can worsen swelling.

Arthritis doesn’t typically cause peripheral oedema directly, but it can result in swelling through secondary mechanisms such as decreased mobility from pain and stiffness, joint instability and knee inflammation.

I often see patients who stop moving due to painful arthritis and this can be the start of a downward spiral.

It may spark a whole series of problems, including oedema, weight gain, and loss of strength and fitness. I don’t say this to frighten you or other Sun health readers, but to empower you to take action.

Encourage your husband not to accept arthritis and pain as a part of getting older, but to explore what help is available, such as appropriate pain relief, physiotherapy and exercise courses such as Escape-pain – see escape-pain.org.

HARD TIME HAVING A NUMBER TWO

Q: I AM 75 and have to take a laxative every morning to make me poo.

I try to drink plenty of water and eat plenty of fruit but my stools are very hard.

A: Constipation is defined as having a number two less than three times a week, straining or being in pain when you have a poo, a feeling of being blocked or not having fully emptied your bowels, and often having large and dry, hard or lumpy stools.

The first thing I want to clear up is that it is normal for some people to defecate less frequently than once a day. For some, three times a week is normal.

What matters is if you are feeling as though your bowels aren’t working as well as they should and this is causing discomfort or debilitation.

Constipation is very common, even more so as we age. There are lots of things you can do to prevent and manage it.

I often explain “the three Fs” to my patients – two of which you are already doing (fibre and fluid).

Fibre is found in all non-processed plant foods – fruit, veggies, nuts, seeds, beans, pulses and wholegrains, and it helps ­support gut health and add bulk to stools.

Increase fibre gradually to prevent excess wind. Fluid is required to help digest and manage all that fibre well.

I’d advise someone with constipation to aim for at least two litres of water per day. The third F, which is just as important as the first two, isn’t strictly an F but sounds like it – physical activity.

Food is pushed through the long tube that makes up our gut by muscular wave-like contractions called peristalsis.

If we move our bodies, be that walking, hoovering, gardening or doing some stretches, we increase peristalsis.

Food, and eventually its waste product, poo, moves more easily through the tube.

One final note: remember that any ­sudden change in bowel habit should be discussed with your GP as it is a potential sign of bowel cancer.

BAD BREATH WOES

Q: MY husband has had bad breath for several years, and it’s been getting worse in the past year. He has had numerous dental and hygienist appointments to no avail and an endoscopy found nothing.

The doctor has said he can’t do anything else, just change his diet. But it hasn’t made any difference.

He is at the end of his tether and I am finding it hard, too. It affects our relationship. He is 74, in good health and only takes statins.

A: Chronic bad breath, also known as halitosis, can sometimes be associated with underlying medical conditions, such as gastrointestinal or respiratory conditions or infections, such as tonsillitis.

Several dental issues can also be the culprit so well done for already seeking medical and dental help, though the lack of answers or improvement must be frustrating.

One potential cause could be dry mouth (xerostomia).

Saliva acts as a natural mouthwash that helps keep your mouth clean by washing away food particles and bacteria.

Reduced saliva ­production, which can be caused by ageing, some medications or underlying medical conditions, can result in bad breath.

Chewing sugar-free gum may freshen breath but importantly, it also stimulates glands to produce more saliva.

Another area to consider is the oral microbiome – the bacteria and other microbes that live in our mouth but do not cause infections.

No two people have the exact same makeup of microbiome.

There have been various studies on the alleviation of halitosis by use of probiotics that have reported satisfactory results.

It’s not totally conclusive but something that might be worth a try.

You can buy probiotic supplements or increase foods in the diet that are naturally probiotics – such as yoghurt, miso, sauerkraut, kefir, ­kimchi and tempeh.

My final tip is to use a tongue scraper – you’ll be amazed at what can be scraped away each day.

Trapped bacteria on the tongue’s surface can add to issues with halitosis.

Bad breath can knock your confidence. Remind your husband that he is loved for who he is, and that together you will find a solution to help him feel confident again.