From low blood pressure to high cholesterol, your problems solved

THEY are some of the most common questions fielded by GPs every day — and here, in this ground-breaking series, we present the answers from top experts. Today, we focus on circulation, gut health and memory. It’s essential reading for the whole family.

CIRCULATION 63 Why do I need a statin?

STATINS are a group of medicines that can help lower the level of low-density lipoprotein (LDL) or ‘bad’ cholesterol. Cholesterol can build up in the artery walls, causing them to become narrowed and hardened, leading to coronary heart disease.

For people who have already had a heart attack or stroke, statins could be important to prevent a recurrence, says Dr Sanjay Prasad, a consultant cardiologist at the Royal Brompton Hospital in London.

‘For other people whether you need a statin will ultimately depend on your doctor’s assessment of your risk of heart disease — it’s important to look at the overall picture.

‘Your GP will make an assessment using the QRISK2 cardiovascular risk calculator: this online questionnaire calculates your risk of developing cardiovascular disease over the next ten years.’

Statins have become a controversial area, with some experts questioning their increasing use in otherwise healthy people, not least as they carry the risk of side-effects, although just how serious and how common these are is also contested. But Dr Prasad is emphatic: ‘The overwhelming evidence is they are beneficial in the right patient.’

64 Can I cut my cholesterol without statins?

‘IF YOU eat a healthy diet and exercise then that can sometimes improve your cholesterol numbers — unless you have a genetic high cholesterol, or familial hypercholesterolemia,’ says Dr Glyn Thomas, a consultant cardiologist at the Bristol Heart Institute.

A plant-based diet can help: a major review of 50 studies published last year in the journal Nutrition Reviews found that vegetarian diets were associated with significantly lower levels of total cholesterol.

Some high-fibre foods, such as oats, are known to actively lower cholesterol. ‘When it comes to diet, the most important things which influence cholesterol are sugar and refined carbohydrates,’ says Dr Thomas.

‘You should stop snacking on processed foods, reduce refined carbohydrates and increase fibre and then go back three weeks later for a blood test. If there is no change your GP may then have to consider medication.’

For more information go to bda. uk.com/foodfacts/cholesterol.

66 Why do I feel faint when I standup?

THIS is known as postural hypotension, says cardiologist Dr Glyn Thomas. ‘ It happens because of a sudden fall in blood pressure that occurs when you stand up quickly.

‘Normally there is an almost undetectable change in blood pressure so if you are dizzy on standing, something is wrong.’

It can be a common experience — and often it’s simply a sign you haven’t been drinking enough fluid. This causes the blood to lose volume and blood pressure drops.

But it could also mean your blood pressure medication needs adjusting or you have postural orthostatic tachycardia syndrome (POTS), where the autonomic nervous system that controls functions such as blood pressure doesn’t work properly.

‘ If it is just a few random episodes then the GP should suggest you try drinking more fluid — lots of people don’t realise they are dehydrated,’ says Dr Thomas. ‘If you’re having other symptoms such as palpitations and headaches your GP should refer you to a cardiologist for further tests.

‘Some heart conditions such as an extremely low heart rate (bradycardia) and heart valve problems can lead to low blood pressure so it’s important to rule out potential issues.’

67 My wife says I need my bloodpressure checked. Is there any point— I feel fine?

‘SHE is absolutely right to nag — especially if you’re over the age of 40,’ says consultant cardiologist Dr Sanjay Prasad. High blood pressure or hypertension is known as the silent killer because you can have it but otherwise appear completely well, and all the while over time it’s causing

the arteries and blood vessels in your body to narrow. This can lead to damage to the brain or heart, such as a stroke or heart attack.

Heart attacks tend to occur more commonly in the over 40s — the average age for a first heart attack is 66 for men and 70 for women. Dr Prasad explains: ‘ If you treat borderline high blood pressure in your 40s it can help prevent a heart attack in your 60s and 70s.’

High blood pressure is also a risk factor for kidney disease, dementia and some eye conditions.

‘ It doesn’t necessarily mean having to take medication,’ he says. ‘It might just require a change of lifestyle such as cutting back on salt. I would suggest anyone over 45 should have their blood pressure checked a couple of times a year.’

68 Why are my ankles swollen?

SWOLLEN, puffy ankles are a common complaint at the end of a long day spent standing or sitting, caused by a build-up of fluid, mainly due to gravity.

This is known as peripheral oedema. Putting your feet up for an hour or so to relieve pressure usually does the trick in these cases. But swollen ankles can also be a sign of an underlying health condition says Tahir Bhatti, a consultant vascular surgeon at West Herts Hospitals NHS Trust in Watford.

‘In older people, swollen ankles may be a symptom of heart failure and liver and kidney disease, but they will have other symptoms as well, so it will be obvious that swollen ankles area symptom of their underlying condition.

‘In heart failure, the heart is not pumping blood around the body as efficiently, in kidney disease there is a build-up of fluids and salts, and in liver disease there is a lack of protein.’

Swollen ankles caused by these conditions can be treated with drugs including diuretics.

Some medicines, such as those for high blood pressure, heart problems and chemotherapy drugs — and ironically even some diuretics — can also cause fluid retention and swollen ankles.

Another common cause is lymphoedema, where the lymphatic system, which drains waste from tissues, becomes damaged, explains Mr Bhatti.

This can be the result of an infection or cancer surgery to remove lymph nodes. This can lead to a build-up of lymph fluid, leading to swelling. Limbs affected can also feel heavy and ache.

There are at least 240,000 people in the UK living with lymphoedema (although the true figure is in fact believed to be much higher) and the main treatment is compression stockings.

‘Another common cause of ankle swelling is venous insufficiency, a condition that occurs when the vein wall and/or valves in the leg vein are not working effectively, making it difficult for blood to return to the heart,’ says Mr Bhatti.

This can happen in the superficial veins, when it’s known as varicose veins. It can also happen in the deep veins after a deep vein thrombosis (DVT). This post-thrombotic syndrome can cause heavy swollen legs. Treatments include elevating your legs, wearing compression hosiery, and regular exercise. ‘Some patients with deep venous disease will need surgery,’ says Mr Bhatti. ‘A relatively new technique for this is the insertion of venous stents — or thin tubes — to support the vein walls.’

‘This is becoming much more widely available both privately and on the NHS.’

69 I keep getting numbness and tingling in my fingers and toes. Could it be MS?

ONE of the most common causes of tingling and numbness is peripheral neuropathy, which is a form of nerve damage in the extremities, including the hands, feet and arms. This affects one in ten people over 55 and is commonly caused by diabetes, as high sugar levels can damage nerves. Other symptoms include burning and stabbing pains in the affected areas, muscle weakness and balance problems. The tingling and pain is usually constant but can come and go. Peripheral neuropathy can also be caused by the shingles virus, physical injury, side- effects of medication, low levels of vitamin B12 and excessive long- term alcohol consumption. Tingling and numbness in multiple sclerosis may start in the toes and feet and spread to surrounding areas such as the ankles and then the calf and thigh. This can then start in another part of the body independently, says Dr Anupam Bhattacharjee, who is a neurologist at the NHS Royal Free Hospital in London. Other symptoms of this neurodegenerative condition (where the body’s immune system attacks the protective sheath around nerves) can include muscle stiffness and spasms, balance and coordination problems, loss of bladder control, fatigue and sight problems such as blurred vision. ‘ Drugs to help prevent the immune system from attacking itself can help control the disease,’ says Dr Bhattacharjee.

70 Why does my handshake?

TREMOR is an involuntary muscle contraction that leads to shaking movements in one or more parts of the body.

The most common type is familial or essential tremor, which leads to uncontrollable shaking of any part of the body, including the hands and head, says neurologist Dr Anupam Bhattacharjee of One Stop Doctors Clinic in Hemel Hempstead, Hertfordshire. It can make holding a cup of tea difficult, for instance. ‘ Your head can shake in a “no-no” movement from side to side or a “yes-yes” nod,’ he says.

‘It can start at any age and is usually inherited from a parent or grandparent. We don’t know what the cause is, but we can lessen the severity of the symptoms by prescribing beta blockers and epilepsy drugs.’ Beta blockers are thought to help by dampening down nerve firing.

Another cause of tremor is Parkinson’s disease, a degenerative condition caused by a loss of nerve cells in an area of the brain called the substantia nigra.

It leads to a fall in a chemical messenger called dopamine, needed to regulate movement. As well as tremors this can cause rigid muscles and stiffness and a short shuffling gait.

While tremor is one of the main symptoms of Parkinson’s, it is not normally an early symptom, says David Dexter, deputy director of research at Parkinson’s UK.

‘Early symptoms can include loss of smell, small changes in handwriting and voice, changes in sleep, anxiety levels and memory.’ However, he stresses:

‘There are other conditions that can cause tremor, such as essential tremor, so it would not necessarily point towards Parkinson’s. If people are worried about a tremor they should speak to their GP.’

72I amreally thirsty all the time—could it be diabetes?

‘IT COULD be, but there are many reasons behind feeling thirsty,’ says Dr Dushyant Sharma, a consultant diabetologist at the Royal Liverpool University Hospital. ‘ It could be dehydration, food you are eating, or your medication — antihistamines or antidepressants can cause this as a side-effect.

‘But being thirsty all the time can also be a sign of a kidney or water infection.’ But being thirsty all the time despite drinking lots can be a sign of diabetes and should always be investigated.

‘If it is diabetes, by the time you’re thirsty the condition is well-established and could be more difficult to control,’ he says. Diabetes makes you thirsty as high levels of blood sugar mean your kidneys need to produce more urine to help clear the glucose from your body.

‘You therefore need to drink more to make up for the fluids you lose.

As a starting point, the GP might ask you to do a urine test. Urine doesn’t normally contain glucose, but glucose can overflow through the kidneys and into your urine if you have diabetes.

A urine test alone is not a completely accurate way to diagnose diabetes though, so if your sample contains glucose, your GP can do a specialised blood test, a glycated haemoglobin (HbA1c) test, to confirm the diagnosis.

73 Mymum/ dad was diagnosed with type2 diabetes at my age, should I get checked?

‘YES’, says diabetes expert Dr Dushyant Sharmal.

‘You should get checked for diabetes from around 40 if you have a family history.’

Type 2 diabetes tends to cluster in families: people with it in the family are two to six times more likely to have diabetes.

Your GP can do urine and blood tests to check for it. If there isn’t any sign of it, your doctor should still talk to you about lifestyle issues which raise the risk of type 2 diabetes, such as weight gain, and point out the need to watch for symptoms such as excessive thirst and trips to the loo. The key thing is to remain vigilant.’