ASK DR ZOE
My husband had a sudden pain in his calf – doctors have been no help. He’s 80 and time is running out
Dr Zoe also helps a reader with essential tremor
MERRY Christmas one and all!
It’s been my pleasure to help Sun readers get to the bottom of their health queries this year, answering 190 questions in 2024 so far.
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The feedback I’ve had from you following my responses is even more rewarding.
Some have gone on to receive life-changing diagnoses and treatment.
One reader ended up having an emergency double heart valve bypass after I prompted her to seek urgent attention for chest pain when exerting herself.
She said: “I’m not sure where I would be today if it was not for your kind advice.”
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Thankfully, most readers’ ailments can be managed by themselves, but often people need reassurance that their problem is worth contacting their GP for.
Please continue to send your health queries in the new year, for which I wish you all HEALTH, wealth, and happiness in 2025.
Here’s a selection of what you have asked me this week…
Q) MY 80-year-old husband has had problems since August, which began with a sudden pain in his calf.
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He saw a nurse practitioner who ruled out a blood clot.
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A Doppler test showed good circulation but five months later he is still in pain, limping, and has no push-off on walking.
What is Parkinson's and what are the main symptoms?
He has twice seen a physiotherapist but the exercises greatly increased the pain in his heel.
He used to play golf three times a week and was very fit. It is depressing him.
He has only once seen a doctor who was no help, and was told a scan wouldn’t help.
I realise that these things can take time but at 80 his time is limited enough.
A) As doctors and nurses we often consider the worst-case scenario first.
So a sudden pain in the calf always makes us think about DVT, because if left untreated it has the potential to be life-threatening.
It therefore makes sense that the nurse your husband saw initially ensured he was checked for this first.
Once reassured of no blood clot we can then consider other causes.
Calf pain can be caused by a problem with the calf muscle, Achilles tendon, knee or it can be a symptom of sciatica, where the actual problem is in the lower back, even though pain is felt in the calf.
Sciatica pain tends to have a more “nerve irritation” quality, such as shooting, sharp, searing, pins and needles, or electric shocks.
A thorough assessment from a physiotherapist would be the best way to determine the most likely cause and also determine if he would benefit from any X-rays or scans.
I know he’s seen a physio, but it may be that he needs a referral to MCATs – most hospitals have this department where advanced diagnosing physios work alongside orthopaedic doctors and rheumatologists.
It’s different to seeing a physio who has been asked to “treat” a specific issue.
Q) I HAVE essential tremor – my hands shake but my stomach feels like it’s shaking as well.
I suffer with it all the time and I’m a nervous wreck when I used to be the calmest of people. I’m on Bisoprolol tablets.
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I’m 76 and I exercise – yoga, Pilates, swimming, walking.
I would like something to calm the shaking, but doctors tell me that it’s not possible.
I’ve heard about focused ultrasound. I have asked my doctor for an appointment with a neurologist.
A) Essential tremor (ET) is a movement disorder that originates in the brain and causes uncontrollable shaking movements.
The word “essential” means that there is no associated disease causing the tremor.
Sometimes when people develop ET they are initially concerned that it might be Parkinson’s disease (PD) as tremors are often an early sign.
The tremors do have some differences, though, mainly that PD tremor tends to be worse when relaxed, “a resting tremor”, while an ET tremor tends to be worse when using the hands, “an action tremor”.
While ET does most commonly affect the hands and arms, more rarely it can also affect the trunk, lower limbs, head, tongue and voice – so it is possible that your ET is causing the shaking feeling in the abdomen area.
First-line treatments for ET include beta blockers, like you are taking, and primidone, a type of anti-epilepsy medicine, but they’re not effective for everyone.
Sometimes sedatives or even Botox injections are used, but you’re right that the latest breakthrough is a surgical one, where ultrasound pulses are used to permanently ablate the cells of the brain responsible for the tremor.
It’s not suitable for all types of tremor, though, and is only given to one side of the body, so tremor remains on the other side.
A neurologist would be able to talk you through what is suitable for you, so do persist in trying to see one.
However, you do also mention symptoms that could be anxiety and the two conditions can co-exist and even exacerbate each other.
You should ask your doctor to assess your mental health, as treating anxiety, if you have it, could be key to you feeling much better all-round.
Fears after heart op
Q) IN September 2022, I underwent heart surgery for constrictive pericarditis, which I might add was horrendous.
After the operation, my surgeon told me he had never seen a case so bad.
To cut a long story short, on leaving the hospital, the surgeon told me he had cut away all the pericardium and I thought that was that.
But after a consultation phone call with the registrar, he told me: “They could not get to the back of the heart so they have removed what they can see.”
I have asked what happens to the pericardium that is left behind, but nobody seems to know.
After several echocardiograms, I still have constrictions of the heart but they do not seem to be of any concern to doctors.
Please can you throw some light on my concerns as I have looked on Google (which I know I shouldn’t have).
Will I have much life expectancy after an op like this?
A) The pericardium is a protective, fluid-filled sac which encompasses the heart muscle.
It's flexible and can stretch as the heart expands and constricts.
Think of it like a tied balloon with the heart inside, instead of air.
Constrictive pericarditis is when that balloon stops being as flexible for some reason (inflammation, infection, radiotherapy) so starts to constrict the heart’s movement and ability to pump properly which, as you experienced first-hand, can be very serious indeed.
Now imagine that a surgeon cut the balloon, peeled back the layers and removed most of the balloon, but couldn’t remove the bits behind the heart without risking damaging the heart.
It’s easy to now imagine that while these bits remain, the balloon can no longer constrict the heart because it only covers a small section.
Even if it impacts the back of the heart, the heart can compensate for this.
Echocardiograms show the pumping action of the heart, how the blood flows through the heart and measure how much blood it pumps with each beat – something called an ejection fraction.
It sounds as though your tests have been very reassuring.
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I can’t comment for certain on your exact case, and I’d advise you to seek an individualised explanation from your own specialist team, but
I hope this has helped.
Tip of the week
IF you’re reading this, it means you’ve managed to get some time for a breather on Christmas Eve – congratulations!
Make sure to grab moments of peace for yourself in the next couple of days – including outdoors – to sustain wellbeing over what is a busy and often loud period.
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