Consultant says I need fourth jab, GP says I don’t.Who do I believe?

I AM aged 73 and have rheumatoid arthritis, which is controlled with a drug, Rituximab, which I’m given via an injection once a year.

I was also treated for breast cancer ten years ago, and have had no recurrence.

My hospital consultant has told me that I need a second Covid booster – it’ll be my fourth jab – and that while waiting, I should isolate, to be on the safe side.

My GP, however, says I don’t need another jab yet and I don’t need to worry. Who do I believe?

THROUGHOUT the coronavirus pandemic, the rules and regulations have been made at a high level within the Department of Health or NHS England, and GPs are merely implementing their instructions. This is the case when we offer people vaccinations and when we offer treatment for Covid, as we can now, for instance.

Computer searches alert us to who is or isn’t eligible for these things.

The same process was used for shielding advice. If a patient’s records contained details of a condition that put them at high risk, they were automatically sent a letter, texts or emails advising them to isolate.

Along with all over-75s, anyone who is considered severely immunosuppressed should be eligible for a second booster, at least three months on from their last dose. This would include people having treatments for rheumatoid arthritis known as biologics, or steroids, both of which suppress the immune system.

Hospital consultants who oversee this kind of treatment are supposed to write to the GP on behalf of their patient and let them know the situation. But this doesn’t always happen. It means that GP records may not be fully up to date with the correct keywords that should instigate the vaccination invitation.

Usually, in each surgery there is someone within the administrative team who would look into this, and it would be worth trying to speak to them.

Another option would be to call 119, where advice is available on specific vaccination options.

I WENT through the menopause at least ten years ago without taking HRT. I’m now 61. Would it be beneficial for me to start taking it now, to give my bones some protection?

NO ONE has to go on HRT – some types of which are in short supply at the moment.

The choice to take medication depends on what a woman wants, and her symptoms.

HRT can be prescribed at any age from the perimenopause on, with no upper age limit. It is used to control problems such as hot flushes, vaginal dryness and the mental health changes associated with the menopause.

It is also used to protect against the bone-thinning disease osteoporosis, particularly in women who have had an early menopause. Oestrogen helps to maintain bone strength and density and prevent fractures.

There are many factors that can raise the risk of osteoporosis, including being a low weight, smoking, alcoholism and use of steroid medicines. Having a mother who has had a hip fracture or osteoporosis also raises the risk.

Doctors can determine whether bone protection is needed using a DEXA bone scan, which looks at the hip bones and spine to diagnose osteoporosis or the stage before it, known as osteopenia.

If a problem is seen, we have specific medications. For milder issues we would use calcium and Vitamin D supplements.

Weight-bearing exercise such as dancing or walking is important to protect bones for post-menopausal women, too.

I’M WAITING to have my gallbladder removed due to gallstones. The hospital cancelled my surgery appointments twice, and then I caught Covid and had to cancel. The hospital says I have to wait seven weeks before it will even book me back in, and then it’ll probably be weeks or even months before the op. I’m in so much discomfort that I can barely eat. What can I do?

MANY of my patients are waiting for operations at the moment. Covid has caused a backlog, and now it’s just delay upon delay with no end in sight.

Gallstones are solid lumps of cholesterol that can form in the gallbladder – a little pouch within the liver which contains bile, a substance that helps digest fats.

The stones can cause the gallbladder to become inflamed, or they can get stuck in the small tube exiting the gallbladder known as the bile duct, causing tremendous pain.

They can also trigger infections requiring hospitalisation.

If gallstones are a persistent problem, the gallbladder has to be removed. This can be done with keyhole surgery and it’s usually very successful.

But some people don’t want an operation and instead try to control their symptoms by losing weight and maintaining a low-fat diet. Both these measures prevent gallstones from forming.

Avoiding fat means that bile is not needed for digestion, and it basically helps to give the gallbladder a rest.

Fasting should be avoided for anyone with gallstones, since it is known to make the situation worse.

Pain relief, while waiting for the op, is also important. Your GP should be able to offer something quite strong.