What IS making my toes red, hot and tingly at night?

I SUFFER from burning-hot, tingly red toes which have got worse over this past year. It’s particularly bad at night. The only thing that helps is keeping the house very cold, which upsets everyone else I live with.

THESE are typical signs of what we call Grierson-Gopalan syndrome: a sensation of tingling and burning that might affect the soles of the feet, or the whole foot, ankles and even lower legs.

A feeling of heaviness in the lower legs is also common, and it’s usually worse at night. For many people the cause of Grierson-Gopalan syndrome is not known, but it may be linked to nerve damage, in particular something called peripheral neuropathy.

People who’ve had diabetes for a long time are at risk of developing peripheral neuropathy as raised blood sugar, over time, damages the tiny blood vessels that supply the nerves. It’s also seen in people with autoimmune diseases such as rheumatoid arthritis, in cancer patients who’ve had some kinds of chemo, and in those with kidney failure. It can also be triggered by Vitamin B12 deficiency. Burning feet may also be caused by skin conditions such as dermatitis and even athlete’s foot.

After a year, tests would be sensible. The GP can look for signs of a skin or nerve problem and give blood tests to check for deficiencies. There could be more tests at hospital, but it’s not always possible to find a cause.

Soaking the feet in cool, not icy, water for 15 minutes when symptoms occur can provide temporary relief. At night, raising your legs and feet is thought to be helpful and Capsaicin cream, derived from chillis, can also provide relief.

Some people do require painrelief tablets or antidepressants to deal with the problem.

AT NIGHT, I can feel a horrible burning sensation rising in my chest. I was referred for an endoscopy test to see if it was acid reflux, but it came back negative. What else could it be?

ACID reflux, or heartburn, is a very common problem which does cause this sort of burning in the middle of your chest. It’s usually worse after eating, and when in certain positions, for instance when bending over or when lying in bed.

Most of us suffer heartburn from time to time, when going to bed after a heavy meal or after eating spicy food, for instance, but for some it may be persistent.

This can be the case if a patient is overweight, smokes or takes medications that worsen the problem, like anti-inflammatories or antidepressants.

The best investigation to determine acid reflux is indeed an endoscopy, where a camera is passed down through the mouth into the oesophagus and stomach under sedation.

It’s an invasive (and not very pleasant) procedure, so we would normally offer this only if symptoms are particularly troubling or have been going on for a long time.

During the endoscopy, doctors are looking for signs of damage to the lower part of the oesophagus, caused by stomach acid leaking upwards out of the stomach. Interestingly, though, in up to two-thirds of people with acid reflux, the oesophagus will appear normal.

This does not mean there is not an acid problem – it just shows there is no damage.

Endoscopy can also show up oesophageal or stomach cancer or a hiatus hernia, in which a bit of the stomach pokes through a weakness in the diaphragm just above it, often causing reflux symptoms.

Other, more specialist investigations may also be necessary. These may include pressure testing, in which a fine, pressure-sensitive tube is passed down the throat and into the oesophagus to see if there are problems with the muscles and nerves involved in moving food down the gullet or with the valve at the top of the stomach.

There’s also pH monitoring. This involves a very fine tube being inserted into the oesophagus via the nose – it’s attached to a device, and worn for 24 hours, so we can see exactly what happens down there after meals and at night.

Treatment for reflux would include acid-suppression tablets such as omeprazole or lansoprazole, and there are some surgical options. It is also worth remembering that other diseases can mimic night-time reflux pain, such as gallstones, and these should be ruled out.

I AM a 78-year-old woman with a rather embarrassing problem. I’ve recently noticed an unpleasant, intimate body odour. I’ve also started to suffer slight incontinence and have to wear a light pad. I can’t bring myself to see a doctor.

AFTER the menopause, the lack of the female hormone oestrogen causes significant changes in the bladder and vagina area, leaving women with a higher chance of chronic infections.

It’s called atrophic vaginitis and it changes the pH in the vagina, making it more likely for bacteria and yeast infections to thrive. Urinary problems also become more likely.

GP tests can be helpful. Ideally this would include a urine sample as well as a vaginal swab – something a patient can do themselves. Infections can be treated very easily – and we can give treatments to prevent them coming back.

This includes specific moisturisers which can be prescribed or bought over the counter, or an oestrogen cream. Ongoing incontinence can be treated with physiotherapy, or medication if it is becoming troublesome.