THE DOC REPLIES

MY stomach muscles are flat in the morning, but I’m often bloated and have to loosen my belt in the evening. I’m a 50-year-old woman in reasonably good health.

I don’t think this is anything to be concerned about. The abdomen can swell for a number of reasons including gas, food, wind and muscle issues. If it is normal in the morning then you do not have anything serious going on. It is probably just the changes that happen as a result of your food and drink intake and daily activity.

I’M a 30-year-old woman who takes the contraceptive pill. Can other medications interfere with the pill?

There are many medicines which can affect the pill. This is because drugs are often broken down within the liver using the same pathway of enzyme. If this pathway is being used to deal with one drug, then it isn’t able to deal with a second. As a result, either or both drugs may not work as well as they should. This is the case for prescribed drugs as well as some herbal remedies such as St John’s Wort. Using antibiotics can also affect contraceptive use, as well as anti-epileptic drugs. It’s the responsibility of the prescriber to check that you are not taking anything else that might interfere with the pill. There is, however, an information leaflet in all medicine packs which will tell you a little bit about interactions.

MY husband is a 60-year-old man who is slightly overweight. I’ve noticed recently that when he gets stressed his lips turn slightly blue. Should I be concerned?

When the skin turns blue, it is sometime referred to as cyanosis. This can be a sign that there isn’t enough oxygen circulating in the blood. However, it can also happen as a result of cold temperatures. It is slightly more worrying if the lips and tongue are blue. If it comes and goes and is not affecting his activity then it probably isn’t anything serious to worry about.

RECENTLY I’ve begun to struggle hearing people if there’s a lot of background noise. I’m 70 and wondered if this is just a normal part of getting older, or if there is anything I could do?

The age of 70 is relatively young. If you are having difficulty hearing, you should ask your GP for an assessment. He or she will likely check your ears in the surgery and, if there is no obvious treatable cause for the deafness, should refer you to a hearing clinic for further assessment.

I’VE been told I have a hiatus hernia. Does that mean I have to avoid certain types of food?

The stomach sits below the diaphragm. There is a passageway through the diaphragm for the gullet to fit through and enter the stomach. A hiatus hernia occurs when a defect in the diaphragm allows some part or even all of the stomach to slip from its usual position beneath the diaphragm to above the diaphragm. As a result, food can regurgitate or reflux, while there are a variety of other stomach-related symptoms. Usually hiatus hernias are managed conservatively – advice is available about when and how much to eat, for example. Medications for acidity and reflux are also useful. In extreme situations

there are surgical options.

I’VE developed varicose veins. Is it down to me crossing my legs?

Varicose veins are found just below the surface of the skin, usually in the legs, and are visible. The veins contain valves which prevent the blood flowing in the wrong direction. As the veins enlarge, these valves burst and the veins subsequently become lumpy and at risk of inflammation and thrombosis. Most people with varicose veins have a family history of the problem. They are also aggravated by certain conditions such as pregnancy or standing for long periods. I don’t think crossing your legs caused them, however.