How can I overcome my terror of the MRI chamber?

I AM due to have an MRI scan but I get very claustrophobic, so much so that I walked out of the last one. Would you recommend a mild sedative to help me cope?

BEFORE doctors prescribe a medicine, they weigh up the risks and benefits to the patient. The same applies to investigations such as scans and tests.

If a patient is reluctant to have a particular scan, doctors should first ask: do they really need it, and would it make any difference to their course of treatment? Other types of scan may do the job just as well.

An MRI, which uses radio waves to take detailed pictures of the organs and is often used to diagnose breast and prostate cancers, involves a patient lying inside a tube for at least 15 minutes but often longer. Although MRI scans are painless and safe, they are very noisy and claustrophobic. For this reason, people sometimes opt out.

For those who are claustrophobic, if the MRI is deemed essential a doctor may offer a sedative. Usually this is a drug called lorazepam. It can also help with keeping the body still – essential for good MRI pictures.

But doctors often need patients to be responsive while having the scan – asking them to move certain body parts, for example. This is why strong sedation isn’t really possible.

A sedative would be prescribed on an individual basis by a GP or consultant. It would depend on the patient’s medical history and any other medications they might be taking. And it’s worth noting that those who take sedatives shouldn’t drive after the scan.

I AM 64 and for the past year, haven’t been able to swallow food properly. It’s as if there is something stuck in my throat. Internal scans found no obvious cause. What can it be?

LOTS of people go through periods where they find it difficult to swallow food and drink. It’s a problem doctors refer to as dysphagia. It affects people in different ways: some find it makes them cough or choke, while others have a feeling of their food coming back up to their throat, or even into their nose. However it presents, dysphagia should always be discussed with a doctor.

Doctors might try a number of tests to look for the underlying cause. An endoscopy, where a thin camera is passed down the throat and into the food pipe, can help to spot problems in the oesophagus and stomach.

This is an important first port of call to rule out throat and oesophageal cancer. Another test can tell doctors what happens inside the body when you swallow different types of food. This is called videofluoroscopy. Similar swallowing tests can also be done with a speech and language therapist.

One test is often not enough to identify the problem – sometimes patients need a combination of many. A common cause of dysphagia is inflammation in the lining of the food pipe, and conditions such as acid reflux or oesophagitis. As the act of swallowing is controlled by nerves, a neurological disease may be the root cause. This would include Parkinson’s, multiple sclerosis and perhaps the complications of a stroke.

A condition called pharyngeal pouch, where a bulge develops in the food pipe, affecting the ability to swallow, might be to blame, but this is seen only in older people. Doctors might also consider a problem with the muscles, such as a condition called achalasia, which stops muscles being able to effectively push food into the stomach.

In most cases, acid reflux disease will be the culprit, although it won’t necessarily show up on scans. A range of effective treatments for this are available via prescription and over the counter, such as drugs that limit the amount of acid in the stomach, called proton pump inhibitors (PPIs). Sometimes, if there’s no obvious cause, doctors may prescribe a course of PPIs to see if that helps.

I HAVE an embarrassing problem with dryness in my groin – but I am only in my early 40s and not yet menopausal. Could this be early menopause? I have no other symptoms. It is making intimacy with my partner agonising.

IT IS extremely common for women to experience vaginal dryness at some stage in their life. But women all too often suffer needlessly because the problem can be easily resolved.

Menopause is one cause of dryness. Typically, it begins between the ages of 47 and 53, but some peri-menopausal changes may occur earlier.

If a doctor suspects early menopause, they may offer a blood test to check a woman’s level of a sex hormone called FSH which rises as reproductive cycles begin to tail off.

The female hormone oestrogen is responsible for maintaining the lubrication of the vaginal and vulval area. But during the menopause, oestrogen drops dramatically, causing the dryness. Some women find the same happens when they breastfeed, as post-pregnancy fluctuations in hormones cause oestrogen to drop too.

This type of dryness responds well to oestrogen creams and vaginal moisturisers, both of which can be prescribed by a GP.

Vaginal dryness can also happen as a side effect of medications such as contraceptives and cancer treatments. Perfumed soaps or body washes are another common culprit.

The yeast infection thrush can cause irritation, soreness and stinging during sex. It is very simple to treat using over-thecounter products.

It is worth trying a lubricant or vaginal moisturiser to ease pain during sex. I recommend a brand called Sylk, available at most high-street pharmacies.

As for washing, stick to plain water or a soap substitute called aqueous cream.

If there’s no obvious cause of the dryness, and over-the-counter treatments aren’t working, you should see your GP.