OUR resident specialist and NHS GP, Dr Zoe Williams, shares her expert advice.
Today, Dr Zoe helps a reader who has recently been diagnosed with osteoarthritis in their feet and hips.
SMALL but mighty, the kidneys play a huge role in the body. So looking after them is crucial.
Chronic kidney disease affects around one in ten people in the UK, and most do not have symptoms until it’s advanced.
Your kidneys are like the body’s master chemists, filtering 180 litres of blood a day.
When they are diseased, they may not filter waste properly – and this means by-products can build in the bloodstream, instead of being flushed out in your wee.
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Symptoms can include swollen ankles, feet or hands, a puffy face in the morning, fatigue, headaches, blood in urine and an increased need to wee, particularly at night.
There are 40-45,000 premature deaths every year due to chronic kidney disease, according to Kidney Care UK.
Most cases are caused by diabetes and high blood pressure, so staying on top of conditions like these – and routine check-ups – is vital.
Here’s a selection of what readers have asked this week . . .
CAN’T DIET WITH TYPE 1
Q: DO you think there may be weight-loss jabs/tablets for type 1 diabetics in the future?
I am insulin dependent and grossly overweight, but I can’t lose weight.
Cutting down food intake can cause very low sugar levels. I only see a consultant once a year for about a 15-minute appointment.
I’ve asked for help with my diet, but they don’t offer me any for some reason.
I joined a slimming club, but it said to fill up on pasta and rice if I was hungry, but these are too high in carbs for me.
A: Managing weight with type 1 diabetes can be particularly challenging, so you’re certainly not alone in feeling stuck.
Insulin is essential for controlling blood sugar, but it also encourages the body to store energy, which can make weight loss harder.
Additionally, reducing food intake may cause your blood glucose to drop (unless insulin doses are adjusted), meaning you need to eat to correct the low.
This can feel like it undermines your efforts.
At the moment, most of the newer weight-loss medications and jabs, such as GLP-1 receptor agonists, are licensed for people with type 2 diabetes or severe obesity, but not routinely for type 1 diabetes.
Research is ongoing, and studies have shown that adding GLP-1 medication for those with type 1 diabetes and who are overweight or obese reduces HbA1C (the measure of average blood glucose levels), body weight and daily insulin requirements.
So that is a positive start.
In the meantime, weight management with type 1 diabetes usually works best with individualised dietary guidance alongside careful adjustment of insulin.
Rather than very low-calorie diets or large amounts of high-carbohydrate foods like pasta and rice, many people benefit from balanced meals that include protein, fibre and slower-release carbohydrates, which help maintain steadier blood glucose levels.
You shouldn’t have to navigate this alone.
Ask your diabetes team for a referral to a diabetes specialist dietitian.
If access through your clinic is difficult, organisations such as Diabetes UK also provide reliable information and resources.
Q: I HAVE recently been diagnosed with osteoarthritis in my feet and hips.
It is extremely painful and, due to a stroke three years ago, I can only take 500 milligrams of co-codamol.
I would appreciate advice on how to manage an extremely painful condition.
A: I’m sorry to hear how much pain you’re dealing with.
Having had a stroke can limit the types of pain medication that are considered safe for osteoarthritis.
Although pain relief is important, osteoarthritis management usually involves several approaches working together.
Taking simple painkillers such as paracetamol can help.
Topical anti-inflammatory gels (ibuprofen or diclofenac) applied directly over painful joints deliver medication locally and these tend to have fewer effects on the rest of the body.
They work best for places like the feet, where the joints are close to the skin.
Footwear with good cushioning and support, or orthotic insoles recommended by a podiatrist, can reduce the pressure on painful joints in the feet.
For hip arthritis, physiotherapy exercises that strengthen the muscles around the joint often help improve stability and reduce pain over time.
Even some gentle, low-impact activities – such as swimming or cycling on an indoor bike – can keep the joints moving without overloading them.
Heat – warm baths, heated pads or wheat bags – can be surprisingly effective too, by relaxing the surrounding muscles and easing stiffness.
Because your pain is severe and the medication options are limited, it would be reasonable to ask your GP for a review of your overall pain management plan.
They may consider referral to a physiotherapist, podiatrist or orthopaedic surgeon.
While osteoarthritis can’t be reversed, many people do find that a combination of the right pain relief, physical support and tailored exercise significantly improves comfort and mobility over time.
Sleep’s hard on blood pressure meds
Q: I AM a 74-year-old woman recently diagnosed with high blood pressure (177/91).
I was prescribed Lercanidipine but it gave me shaky legs, and I could not sleep and felt anxious and agitated.
The GP then prescribed a different medication, Cardide SR, and although I feel better, I am still not sleeping much.
Is it safe for me to take sleep gummies that I purchased from Holland & Barrett?
My blood pressure is coming down slowly through trying to lose weight and watching my diet.
A: High blood pressure is very common as we get older, and a reading of 177/91 is certainly high enough that treatment is important.
It’s also quite normal to need a bit of trial and adjustment before finding medication that suits you best.
Lercanidipine is a type of calcium channel blocker.
Most people tolerate it well, but some do experience side-effects such as flushing, palpitations, anxiety or disturbed sleep.
It sounds sensible that your GP reviewed things and switched you to a different medication.
Cardide SR (a slow-release form of Propranolol) is a beta-blocker.
These medicines work in a different way to lower blood pressure and are often well- tolerated.
But in some people, they affect sleep or cause vivid dreams.
If your sleep problems continue, it would be worth mentioning this to your GP.
Night-time gummies may be OK for you.
They typically contain ingredients such as magnesium, zinc, B vitamins, amino acids and herbal extracts.
These are considered low-risk, but supplements aren’t regulated as strictly as prescription medicines, and their exact combinations can vary.
Because you’ve recently started new blood pressure medication, it would still be sensible to check with your pharmacist or GP before taking them, just to be sure.
Good sleep habits can help – keeping a regular bedtime, limiting caffeine and avoiding screens close to bedtime.
TIP
WHAT do a change in your sense of smell, suffering constipation and your handwriting becoming smaller have in common?
They are all early, but much less commonly known, symptoms of Parkinson’s.
See a GP if you have these persistently.
DADS NEED TO STEP UP
A DAD’S health may be as important to a baby’s development as the mum’s, researchers say.
Experts at the University of Southampton said the effect of boys’ and men’s physical and mental health on the next generation is “under-appreciated”.
Studies show that a man’s health might affect both the pregnant mother and the children before they are born.
How much he eats, drinks, smokes, or uses drugs could have a direct effect – for example, obesity and smoking can cause genetic damage that is passed on to a baby via sperm.
Studies suggest children of obese men are more likely to struggle with their weight.
And having a dad who smokes may increase a kid’s risk of asthma.
But the effect could also be indirect: Men may worsen the mum’s health if they are not supportive or do not help to cook, according to the report, published in the Lancet medical journal.
Professor Keith Godfrey, a human development expert at Southampton, said research in the area “has been neglected”.
“Now this is changing,” he said.
“Their own health and behaviours like their weight, whether they use substances, and their age can influence pregnancy and child outcomes – not just the pregnant person’s.
“For some aspects, the influence of the father is even stronger than that of the mother, with some of these fathers’ effects linked to experiences from their own childhood.”
TECHNIQUE PUT ON ICE
THE NHS will hook up donated organs to blood pumps instead of putting them on ice, to keep them alive longer.
The technique, called perfusion, could permit up to 750 more organ transplants every year, on top of the current 4,600, NHS Blood and Transplant estimates.
More than 8,000 people are on the NHS waiting list for transplants but the number of donors has fallen in recent years.
Hundreds of patients die waiting every year.
Typically, organs put on ice to preserve them after a donor dies last as little as three hours.
Medics often run out of time to carry out necessary tests.
Experts say hooking them up to a perfusion machine, which pumps oxygen-rich blood into the organ, can boost this to eight hours or more.
The shelf life of a donated liver could be doubled from 12 to 24 hours, they said.
Derek Manas, medical director at NHSBT, said: “You can keep organs on a machine until the theatre is available, until surgeons are available, until anaesthetic staff are available and so on.
“The length of time will depend on each organ.
“Putting organs on a machine also allows you to assess their function.
“We’re not sure exactly how long we can extend the time for, but it certainly will make a significant difference.”
Health minister Dr Zubir Ahmed said: “Every person waiting for a transplant deserves the best possible chance of receiving one.
“We are committed to funding this crucial programme.”
It will be soon be trialled in hospitals.