I am 94 and in the past year have developed sensitive fingertips. They constantly feel cold and I need to wear gloves all the time. What could be wrong with me?
Dr Ellie Cannon replies: Sensitive fingertips may be due to peripheral neuropathy, a condition where the nerves don’t function as they should.
The senses of pain, touch and temperature may go awry. This can result in hyper-sensitivity, pain or, conversely, numbness.
Some causes of peripheral neuropathy include vitamin B12 deficiency, chronic alcohol use, or as a long-term consequence of chemotherapy or diabetes.
A GP can assess for these with blood tests and possibly refer patients to hospital for a nerve conduction study.
If it is a nerve problem, there are specific painkillers that focus on treating them.
While we are quite cautious about using these in the elderly, due to increased risk of some side effects, a very low dose may help.
Cold fingertips may also be an issue related to the circulation.
Raynaud’s is a problem with the blood vessels at the end of the fingers going into spasm. This typically causes colour changes, with the fingers going white and even purple.
Raynaud’s can be related to other conditions, such as arthritis or blood disorders, but it also occurs alone.
If you have Raynaud’s it is vital to keep the whole body warm, not just the hands in gloves. So using layered clothing, warm footwear and even a hat is important. You can also get hand-warming devices specifically for sufferers.
My partner, who is 69, is terrified of hospitals, having had a terrible experience at one, but she recently had a fall – twisting her leg – and is now struggling to walk due to pain at the top of her thigh. Should I persuade her to go to A&E to get an X-ray?
After this type of fall, and those symptoms, my main worry would be a broken hip.
There would also be difficulty moving the hip joint and you might even notice that the leg is twisted or maybe looks shorter than normal.
It is important not to leave a fracture untreated for too long, since it can start to heal in the wrong way or may cause other complications, such as an infection.
The best way of identifying a broken hip is with an X-ray.
An assessment by the GP would help to decide the likelihood of a hip fracture and whether an X-ray is necessary. We offer this to patients who can no longer bear their weight after a fall.
The GP may be able to help manage hospital appointments, too. Going to a different hospital may feel less traumatic.
Or, rather than attending A&E or a walk-in clinic, it might be possible to make a specific appointment. That way, as little time as possible is spent in hospital.
For some patients it can be appropriate for a doctor to prescribe an anti-anxiety medication to take before an appointment.
For somebody with a potential hip fracture, I would say the benefits of this outweigh the risks.
In October I started suffering from severe sickness and other digestive symptoms. Since then the vomiting hasn’t stopped, and I’ve been admitted to hospital four times – the last time for ten nights. No one can work out what it is, but I just can’t carry on like this. Do you have any advice?
Dr Ellie replies: Ongoing nausea and vomiting is really distressing.
New vomiting or nausea can be a sign of cancer, particularly when associated with weight loss.
Pancreatic cancer, stomach cancer or a brain tumour, while rare, would need to be ruled out.
Signs of these should have been picked up on multiple blood tests and scans, but only if the correct ones have been done.
For example, a pancreatic tumour can really only be seen on an abdominal CT, and may not cause any abnormal blood results.
Likewise, to properly look at the brain you would need an MRI. A colonoscopy, where a camera goes up into the bowel, may be helpful, but an endoscopy, where the camera goes down into the stomach, would be important too.
Sometimes lots of tests are done and patients are relieved, thinking that they have ‘been tested’, when actually they have not had the right ones.
There’s also a condition called cyclical vomiting syndrome, which responds to migraine medication sumatriptan – especially used as a nose spray.
Ondansetron and cyclizine are both anti-vomiting drugs, which may work. If they don’t, two alternatives are metoclopramide or prochlorperazine. The antidepressant amitriptyline may also ease chronic vomiting – the bonus is that it can help patients cope with the horrible psychological burden of the constant nausea.
Do you have an answer to a burning mouth?
Have you heard of burning mouth syndrome? It’s something GPs like myself see not uncommonly, but I don’t think many people have heard of it.
The distressing condition typically causes a hot sensation on the lips, tongue and all over the mouth. It is usual for it to get worse after eating hot or spicy foods, with a lot of talking and during periods of stress.
As well as being very uncomfortable, this can affect eating, mood, sleep and talking.
Unfortunately, it’s very poorly understood – although we know that it affects more women than men. It’s particularly an issue around the menopause. And, sadly, without knowing what is causing it, it is difficult to treat.
I’d like to know from those among my readers who suffer from it: Have YOU had any success tackling burning mouth syndrome? What has worked and what have you tried that hasn’t helped? Write to me at the address below and let me know. We plan to report on this issue in the coming weeks.
Get busy on what makes us dizzy
I’ve been struck down myself this week – but not with the usual Christmas coughs and colds. I’m suffering dizziness.
It’s a really horrible and disarming sensation when you feel dizzy. I think mine has come from an inner ear infection called labyrinthitis. And, thankfully, it is passing as quickly as it came. I know from seeing so many patients with dizziness how disabling it can be when it’s longer term: stopping people driving, walking safely and even just leaving the house.
For many people dizziness comes with nausea as well.
It’s not always easy to treat because there are so many different causes.
Have you suffered from dizziness? Write and let me know what caused it – if one was found – and how, if at all, you found relief.
