ASK DR ZOE
When numb chin and weird tingles could be a sign of killer cancer – and when to get help
Dr Zoe helps a runner with a shooting pain in their knee
TODAY is World Stroke Day – and if you don’t know the symptoms, it is time to learn.
A stroke is a medical emergency, so it is vital to call 999 – the quicker someone gets treatment, the less likely it is they will suffer long-term damage.
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It happens when either a blood clot or brain bleed stops blood flowing to part of the brain.
Symptoms can strike very suddenly and the easiest way to remember them is recalling the acronym FAST:
- Face – has their face fallen on one side? Can they smile?
- Arms – can they raise both arms and keep them there?
- Speech – is their speech slurred? Can they speak clearly and understand what you say?
- Time – it is time to call 999 if you spot any of these signs.
Symptoms of a stroke can disappear as quickly as they appeared, so you might think you are OK.
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Even if this is the case, it is important to get medical help and get checked over.
Here’s what readers have asked me this week . . .
NO LET UP IN KNEE PAIN
Q) I’M a 75-year-old man and I enjoy running and cycling.
I ran the second London Marathon in 1982 and have completed many more.
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I was out for a run in July and after about 1,500m, I got a terrible pain in my left knee.
How to check your pulse, for risk of stroke
I went to the doctors and he said that it was my medial collateral ligament.
Although it has improved, I still get shooting pains in my knee when I’m lying in bed and I can’t see myself running anytime soon.
I’ve tried various exercises such as squats and wall sits but there does not seem to be much improvement.
Can you advise me on any other course of action?
I appreciate my problem isn’t life-threatening but it’s reducing my quality of life.
A) If you stood up and squeezed your knees together, the bits that touch each other are roughly where the medial collateral ligaments are.
They connect the bottom of the thigh bone (femur) to the top of the shin bone (tibia) and so stabilise the inner (medial) side of the knee joint.
Injury usually occurs when excessive force is put on the knee in a way that stresses the ligament, causing it to tear.
MCL tears are the most common knee ligament injury and can affect anyone at any age, but we commonly see this injury in athletes – especially footballers, rugby players or skiers where twisting, falling or collision injuries are common.
However, running can cause MCL tears too.
Most patients do not require surgery and the recovery time is typically 12 weeks, but there are factors that influence recovery and healing time.
We heal more slowly as we get older.
Smoking also delays healing.
Eating a highly nutritious diet with a wide variety of fruit, vegetables and wholegrains alongside good quality and sufficient protein can support the healing process.
I commend you on living such a wonderful active lifestyle but taking time to rest while we heal is important too, as frustrating as that can be.
I’d advise you to seek some support from a physio.
One or two sessions may be enough to give you a rehabilitation plan.
This will incorporate the correct exercises for you to rebuild strength while not interfering with the healing process.
When you resume running it will be important to maintain strength-based exercises to reduce the risk of further injury.
Good luck with it, and please send a picture when you are running again in a few months’ time.
Tip of the week
AS you adjust to the clocks going back, you may feel more tired.
Try to get natural daylight either in the morning or during your lunch break – it can make a big difference to energy levels and how well you sleep.
Avoid caffeine late in the afternoon, large meals and screen use close to bedtime to get consistent sleep again
Q) l AM a man, aged 73.
Six years ago I was diagnosed with prostate cancer.
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I had surgery to remove it which was successful.
The problem l have now is l still need the toilet at least three times a night.
Also, l have to wear a pad 24/7. I’ve been doing pelvic floor exercises which haven’t helped.
During the day if I’m doing any kind of activity I tend to wet myself.
It’s got to the stage where I don’t want to leave my house.
Is there any surgery to rectify this?
A) You are describing a condition known as post-prostatectomy incontinence, sadly a well-recognised and devastating complication, especially in men who had their prostate removed for the treatment of prostate cancer.
For the majority of those affected it recovers after six months to two years, but for a minority, which unfortunately includes you, it can persist beyond then.
The good news is that there are a number of highly effective treatments.
Pelvic floor exercises are essential so it is good to hear that you are doing these and there’s no harm in having a session with a pelvic health physiotherapist to check that you are doing them optimally.
Other lifestyle factors, such as a healthy body weight, not smoking and avoiding caffeine, alcohol and constipation can help depending on the type or types of urinary incontinence that you have.
It sounds as though you are experiencing an element of stress incontinence, as you say that activity causes you to pass urine.
There may also be symptoms of urge incontinence which is when you have a strong, sudden need to urinate that is difficult to delay – this can also make you need to urinate more in the night.
Functional and overflow incontinence are other types and, in reality, individuals often have a combination of these, which is called mixed urinary incontinence.
Some types are amenable to medication, while for others surgery works best.
An example of one surgical technique is an artificial urinary sphincter.
My advice would be to ask your GP for a referral to a urologist who can fully assess you and explore what treatment options might work best
DOCTOR STUMPED BY MY NUMB CHIN
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Q) SINCE January, the right side of my chin has been numb.
It tingles on and off, usually in the early evening, and feels like I’ve been stung by a stinging nettle.
When I relax in bed the pain goes away and I’m just left with numbness.
I went to the doctor after three months and he just said he didn’t know why it’s numb, and basically said “bye”.
I am 59 and, apart from that, I have no other problems.
I work on building sites all week and play golf at the weekend, so I’m very fit.
In 2010 I did have a five-hour op to remove a cancerous tumour on my right tonsil and that left the left side of my neck numb.
I hope you can help.
A) The fact that you have a previous history of right-sided tonsillar cancer, which comes under the heading of head and neck cancer, is very relevant.
Your chin symptoms sound as though there could either be a damaged nerve or pressure on a nerve which is causing altered sensation messages, such as numbness, tingling or stinging to be sent to the brain.
In someone like yourself who has had head and neck cancer in the past, any new symptoms must be taken seriously and ruling out recurrence of cancer should be the number one priority.
I don’t mean to alarm you by saying this, and with your cancer being 14 years ago, it’s not likely that you would have a recurrence (most recurrences occur in the first two years) but it’s still important that ANY new symptoms be taken seriously, especially if the symptoms are progressing.
The numbness on the right of your neck, which has been there since the surgery, is less concerning because it is not new.
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It may be that a nerve was damaged during the operation to remove the cancer.
Nerve damage is always a risk of surgery and something that you would have been made aware of when you completed your consent form for surgery.
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