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My GP says I'm too old for HRT at 68. What can I do? DR ELLIE CANNON answers your health queries


I’m 68 and have suffered scorching flushes since going by the menopause at 54. Hormone substitute remedy helped, however final yr my GP switched me to a drug known as clonidine, saying I am not appropriate for hormone therapy as a result of my age. My flushes have worsened – night-times are notably surprising. What ought to I do?

Clonidine is a hypertension therapy – and likewise a drug we provide some girls through the menopause, as a result of it helps management scorching flushes. Research present it improves high quality of life, though nearly half of sufferers have issues sleeping when utilizing it.

As with all new treatment, the very first thing to query is whether or not or not you’re taking the correct amount. Usually, we begin girls on a low dose of clonidine and construct up. I might solely say it is not working as soon as the utmost dose has been tried – or the uncomfortable side effects are insupportable.

Reasonably than proceed with a therapy that is not working, it could be value contemplating HRT patches somewhat than tablets, or decrease doses, each of which could not have the identical dangers

Different issues that may assist cut back the severity of scorching flushes embrace avoiding triggers comparable to spicy meals, caffeine and alcohol in addition to sleeping in a cool room with a fan. Antidepressants and the painkiller gabapentin may assist.

Except for this, I might query a choice to cease HRT as a result of age.

There isn’t any restrict for the way lengthy a girl can take HRT – nonetheless different components, comparable to threat of breast most cancers or blood clots, is likely to be a consider deciding to change to a non-hormone possibility.

Have an open and frank dialogue along with your GP in regards to the dangers and advantages of HRT.

Reasonably than proceed with a therapy that is not working, it could be value contemplating HRT patches somewhat than tablets, or decrease doses, each of which could not have the identical dangers.

My spouse had cataract surgical procedure and the top of final yr – and it left her nearly blind in that eye. Her docs have deliberated for months, and now say she’ll want one other operation. We’re clearly apprehensive.

Cataract operations are thought-about routine, with roughly 330,000 of them executed on the NHS yearly in England alone.

The explanation we function is as a result of cataracts – clouding of the lens, on the entrance of the attention – often worsen over time, inflicting imaginative and prescient loss. There’s actually no different therapy, and surgical procedure, which entails changing the lens with a synthetic one, has a really excessive success charge.

However as with all medical intervention there are dangers and potential problems. Round one in 50 sufferers who’ve a cataract operation endure blurred imaginative and prescient, lack of imaginative and prescient or a indifferent retina – when the light-sensitive cells behind the attention change into broken.

Cataract operations are considered routine, with roughly 330,000 of them done on the NHS every year in England alone. The reason we operate is because cataracts ¿ clouding of the lens, at the front of the eye ¿ usually worsen over time, causing vision loss. (File image)

Cataract operations are thought-about routine, with roughly 330,000 of them executed on the NHS yearly in England alone. The explanation we function is as a result of cataracts – clouding of the lens, on the entrance of the attention – often worsen over time, inflicting imaginative and prescient loss. (File picture)

There’s a one in 1,000 threat of everlasting sight loss within the eye.

Not often, a complication known as intraocular lens dislocation happens, the place the newly inserted lens drops misplaced. It must be in the fitting place, straight behind the pupil, to work correctly.

A second operation to appropriate the lens dislocation is basically the one possibility. The surgeon might reposition the identical lens or begin once more with a brand new one.

It is necessary to flag up any considerations, and ensure any questions you will have are answered, ideally in good time earlier than the day of surgical procedure.

I’m 76, stay with persistent kidney illness stage 3 and was not too long ago advised I even have excessive ldl cholesterol. My GP prescribed atorvastatin, however on studying the leaflet, it says ‘converse to your physician’ in case you have kidney issues, or are over 70. I did, hoping to have a dialogue in regards to the professionals and cons, however the response I acquired was ‘it is as much as you.’ Not useful. What do I do?

Statins are medicine that decrease ldl cholesterol – and they’re one of the crucial generally prescribed drugs to forestall coronary heart assaults and strokes. We used to present them to anybody with a raised ldl cholesterol, however this has modified.

DO YOU HAVE A QUESTION FOR DR ELLIE?

E-mail [email protected] or write to Well being, The Mail on Sunday, 2 Derry Road, London, W8 5TT.

Dr Ellie can solely reply in a basic context and can’t reply to particular person circumstances, or give private replies.

When you have a well being concern, all the time seek the advice of your personal GP.

At the moment, we calculate coronary heart assault threat utilizing a complete host of things: age and ldl cholesterol stage could be one, however we additionally take a look at what different sicknesses a affected person has, their life-style, household historical past and so forth. Anybody discovered to have a ten per cent or extra threat of a coronary heart assault inside the subsequent ten years is obtainable statins.

One of many issues that raises the chance is persistent kidney illness.

Age, coronary heart illness and hypertension can all contribute to progressively declining kidney perform – and if this dips under a sure stage, we name it persistent kidney illness.

This causes few signs within the earlier levels, however issues are sometimes picked up throughout routine blood and urine exams.

If the issue worsens (there are six levels) sufferers can endure a complete vary of issues, from weight reduction, fatigue and swollen ankles, toes and palms, to nausea, complications and very itchy pores and skin – all as a result of a construct up of poisons the kidneys usually filter out of the blood.

As soon as we all know a affected person has persistent illness, we will monitor them and attempt to cease it worsening however as a result of medicines are processed by the kidneys, particular care must be taken – as an example, we might regulate doses or swap to medicine which are higher tolerated.

Statins, on the whole, are high quality till the later levels of persistent kidney illness, when a decrease dose is likely to be wanted. Nevertheless, many sufferers with complete kidney failure take statins.

A latest evaluation of sufferers on atorvastatin truly confirmed that on the drug, kidney perform improves over time, probably because of the good impact of statins on the blood vessels.

Find out how to make final needs clear 

Final week I responded to a reader with terminal most cancers, who requested me if and when he might say ‘no extra’ to life-extending therapy.

I wrote that that is the fitting of any affected person, they usually can flip to palliative care which goals to make issues as snug as attainable on the finish. In response, I acquired letters from readers who identified that it is attainable to make your needs recognized even if you find yourself properly.

One doc is an Advance Resolution to Refuse Therapy (ADRT). This allows you to set out the way you need to be handled in case you are unable to speak your needs your self. You too can create a Dwelling Will and Advance Assertion. These could be given to your GP or others concerned in your care.

The Compassion In Dying web site has additional particulars (compassionindying.org.uk).

Male, with psychological well being worries? Let’s simply discuss 

Psychiatrist Dr Andres Fonseca claimed final week that 60 per cent of individuals don’t share psychological well being considerations with their GP. He is not completely off the mark.

In my very own expertise, many sufferers do discuss to me about their psychological wellbeing – however they’re nearly all the time girls.

Males, and notably middle-aged males, are nonetheless no good at opening as much as their physician. And this is likely one of the highest threat teams for suicide.

Dr Fonseca stated one of many causes males discovered it troublesome to speak about psychological well being was as a result of it was usually laborious to place signs – that are often simply emotions – into phrases.

My finest recommendation is, do not bottle issues up. Discuss to somebody. It does not should be a GP – though we do need you to return to us. Do not put a courageous face on it. Inform a good friend or a colleague – anybody – for those who really feel garbage or low or unhappy. Simply admitting it’s usually step one to discovering a decision.

Men, and particularly middle-aged men, are still no good at opening up to their doctor. And this is one of the highest risk groups for suicide

Males, and notably middle-aged males, are nonetheless no good at opening as much as their physician. And this is likely one of the highest threat teams for suicide



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