Could Viagra help my cold, painful fingers and toes?

QAI have suffered from Raynaud’s syndrome for many years – especially in my feet. It always really starts to become bothersome at this time of year. A friend mentioned that Viagra is now being used as a treatment for this, but is it suitable for women? In Raynaud’s, the small blood vessels in the extremities of the body go into spasm whenever there is a fall in temperature. The most commonly affected parts are the fingers and toes, and sometimes the nose and ears.

The skin first goes white, then blue and feels extremely painful. Though it can occur with temperature change in the summer, it’s always worse with the low temperatures that occur in autumn and winter, and it can make life a misery.

It’s a common condition, with up to 20 per cent of the population affected to some degree, especially women. The most effective treatment is probably nifedipine, which is more commonly used to treat high blood pressure, as it relaxes and widens blood vessels. Unfortunately, side effects can include headaches and swollen ankles, which means many people can’t tolerate it.

Other possible medical treatments include ACE inhibitors and SSRI antidepressants.

Sildenafil (originally marketed as Viagra) also relaxes blood vessels and can be used to treat Raynaud’s, although generally only after other treatments haven’t worked or are unsuitable, as side effects can include flushes, headaches and a runny, blocked nose. It is suitable for both men and women.

All of these are available on prescription from your GP. Lifestyle measures can make a big difference – wear thick socks and make sure your footwear is warm, sturdy and big enough to give your toes room to wiggle. Well-lined boots are essential for really cold winter weather too. Q

I have developed several bruises on my legs for no obvious reason. A blood test by my GP has shown that I have slightly low platelet levels. She doesn’t seem concerned and just said I should repeat the test in a month’s time. But I’m a bit worried – what could be causing this?

A

Platelets are small colourless blood cells that help with blood clotting and live in the bloodstream for about 10 days. Having a slightly low platelet count is quite common and can be due to slightly decreased production of them in the bone marrow, caused by a viral infection or drinking too much alcohol. Increased breakdown of platelets can also be to blame, either caused by medications such as quinine or, less commonly, by the body’s immune system attacking and destroying them. This can occur either in isolation or alongside other auto-immune diseases such as rheumatoid arthritis or lupus.

Normally, the platelets count is between 150,000 and 450,000 per microlitre of blood and symptoms, such as easy bruising do not usually occur until the level is lower than 50,000. So if your count is only slightly low it may be that your leg bruises are not related to your platelet count.

Unfortunately, the skin does become thinner and more fragile with age and just a tiny knock, which you may not even notice, can cause a bruise – and it will take longer to heal than in younger people.

If your GP was not concerned, then you almost certainly have no need to worry and it may well be that in a month’s time the level is back up to normal. If not, then you can discuss with your GP whether you need further investigations.

I twisted my ankle badly a couple of weeks ago and it swelled up so much my GP sent me for an X-ray. This ruled out a fracture but apparently it has shown that my bones “look a bit thin”. My GP is now sending me for a DEXA scan, which she told me was in the nuclear medicine department at the hospital. Will I be exposed to radiation and is it dangerous?

Standard X-rays produce high-quality images of bones and other parts of the body. Although they can give an idea if a bone is a little thinner than normal, it cannot give an accurate measurement of bone density, which is required to assess osteoporosis.

Dual X-ray absorptiometry, aka DEXA scans, aim to produce information about the density of a body tissue, especially bones. But they do not produce a high-quality picture so, unlike standard X-rays, they cannot be used to assess whether a bone is broken or affected by arthritis.

A DEXA scan is, however, very useful for showing whether you have, or are at risk of, osteoporosis. If so, early treatment can help prevent it getting worse and hopefully stop you breaking a bone.

Both use X-ray energy, or radiation, which we are all exposed to naturally, at low levels.

A standard X-ray uses a single focused beam, while a chest X-ray, for example, exposes the body to the equivalent of the natural radiation the body receives over 10 days.

A DEXA scan uses a fan beam for a shorter length of time. This means the body is exposed to much less radiation, equivalent to the amount the body receives naturally in a three-hour period.

Neither are dangerous, but it is important that X-rays especially are only done when there is a very good reason to do so, to avoid exposing the body to unnecessary radiation.

DEXA machines are bulkier than those used for standard X-rays and it is for this reason they’re often placed in hospital basements, alongside other big machines, like those used for MRI scans and radiotherapy.

If you have a health question for Dr Leonard, email her in confidence at yourhealth@express.co.uk. Dr Leonard regrets she cannot enter into personal correspondence or reply to everyone.