My cough isn’t Covid but people think it is. How can I stop it?

I HAVE had a chronic seasonal cough for more than ten years and it’s having an increasing impact on my personal and social life. In the current situation with Covid, it makes things embarrassing. The only medication that relieved it was codeine, but it came back as soon as I stopped taking it. Please help – it’s affecting my sleep.

A CONSTANT cough can be a nuisance – especially in the current climate when no one wants to be potentially infectious.

There are a number of causes of coughs. There’s the obvious ones such as respiratory infections, but a cough can also be a side effect of medication or triggered by acid reflux in the food pipe.

Uncovering the underlying cause involves lots of tests by lots of different specialists. Sometimes there is no obvious answer, but it is possible to find relief.

The painkiller codeine is a cough-suppressant and can be particularly helpful. For example, if a patient is elderly and the cough stops them going outside the house to see people, I’d see no harm in prescribing codeine to be used when the coughing is particularly bad.

Codeine is addictive, but I would not expect a problem in the case of seasonal coughs, where it would be used for only six months out of the year. It can also cause constipation, but this can easily be addressed with dietary changes or laxatives. Patients often find these kinds of symptoms follow a seasonal pattern.

Typically, this is due to weather and temperature changes, but also changes in our behaviour in the winter months. For instance, we’re more likely to be in a dry home with the heating on in the winter months, which irritates the throat.

Improving the humidity in the home, particularly at night, may provide a degree of relief and comfort.

I HAVE been diagnosed over the phone with carpal tunnel syndrome in my right wrist. The bone at the base of my thumb is raised and I get pain in the fleshy part of the thumb, extending to my palm. I lost my husband last year and live on my own, which is making completing jobs very difficult. I have a gel and a wrist wrap which helps, but it is taking a while to heal. When will the problem be resolved?

CARPAL tunnel syndrome happens when the nerve travelling through the wrist to the hand becomes squashed or trapped. This causes pain, numbness or tingling in the hand. Usually, the pain affects only three fingers and the thumb – and not the little finger, due to the pattern of the nerves controlling the hand. Symptoms also tend to be worse at night.

The causes are usually unknown. But it’s definitely more common in people who do repeated movements, such as gardening or repetitive hand movements at work.

It is also more common in people who are obese, pregnant, diabetic and arthritic.

For as many as a third of sufferers, the symptoms go away on their own within six months, according to some studies. This is especially likely if just one side is affected.

Wrist supports, pain relief and specific hand exercises, which aim to recover the use of the nerve, may help. A local physiotherapy or musculoskeletal service will be able to help with this. You can also find exercises online via the Chartered Society of Physiotherapy website.

If all else fails, steroid injections can reduce inflammation. In severe cases, doctors may recommend surgery – an operation to reduce the pressure on the nerve.

RECENTLY I’ve felt strange vibrations in my left breast – a sensation that feels like a mobile phone is in there.

They’re not painful but they are making me anxious. My last mammogram in September 2020 was clear. I’ve previously had a cyst removed. What’s going on?

IT IS very important that patients seek help for any changes in the breast as soon as possible. It’s not just lumps you

should watch out for: changes in sensation, look, size or feel are worth noting too. This includes dimpling of the skin, a rash, or changes to the nipple.

Abnormal feelings, such as tingling or numbness, could mean there is something the matter with the nerve.

When this happens in the breast, doctors might worry that it means a lump or swelling is pressing on the nerve, squashing it. It is possible that scar tissue from a previous cyst removal could be obstructing the nerve.

GPs should offer a breast exam to look for changes.

As the risk of breast cancer increases with age, a referral is often made to a breast clinic quickly in patients over 60.

These patients shouldn’t have to wait more than two weeks for a specialist appointment.

A recent positive mammogram

is reassuring – but a new symptom always warrants a further look.

Remember that breast symptoms do not always mean someone has cancer – in fact most lumps are not cancer.

Changes in sensation in the breast can be a side effect of hormone replacement therapy, and even antidepressants. Sometimes the problem lies with underlying muscles or joints between the ribs – not the breast.

Further investigations will be able to eliminate the worstcase scenario.