ASK THE DOC
Surgeon and lecturer Dr Sarah Rayne answers your questions. This month, they’re all about chest pains and debilitating skin conditions.
Q: Three months ago I was overcome by shortness of breath and crushing chest pain. I underwent an ECG and a chest X-ray, and the doctor put it down to heartburn and gave me a prescription – but the drugs have provided no relief. I’m beginning to think this is more serious.
A: Chest pain is a really scary thing to experience. As doctors, we’ve educated people about the signs of heart attacks (chest pain, tightness or heaviness, breathlessness, sweating and feeling sick) but there are lots of other reasons for chest pain. Getting immediate medical help was the right thing to do: an ECG and some blood tests can determine whether the heart is in trouble. The good news is that if the tests were properly done and the results were negative, studies show the risk of a heart attack is almost zero.
Although that’s a relief, it doesn’t help with your pain. Go back to your doctor to talk about it. If this is heartburn and the medicines aren’t working, you might benefit from a different type of medication or an investigative procedure like a gastroscopy (where a small camera is passed down the food pipe into the stomach) to see what the problem is. Sometimes it takes a little time to find the cause of pain, but you can help your doctor by keeping a diary of when you experience it, what it feels like and what you’re doing or eating when it happens. That way you’re well prepared and can work with your GP to find out why this is happening.
Q: This is weird, but I think I’m allergic to water. I can’t sweat, cry or take a shower without experiencing debilitating pain.
A: It is indeed possible to be allergic to water or to sweat (although extremely unlikely!). It’s part of a collection of conditions called urticaria, which results in an allergic reaction on the skin that causes red, raised, itchy patches. Lots of different things can cause urticaria, the most common being stings or heat rashes. But aquagenic urticaria (water-related) and cholinergic urticaria (sweat-related) are classified as genetic and very rare diseases. It’s a good idea to see your GP, who can check your symptoms.
Aquagenic and cholinergic urticarias are most common in young people, who develop an itchy rash after exposure to water (even their own tears) or sweating. It might be that there is a substance in water that causes an allergy, or that the water or tears dissolve something on the skin that causes a reaction. Either way, stopping the reaction helps – by trying anti-allergy medications that calm down the body’s response, or using barrier protections like petroleum jelly (not practical in this case!). Usually with an allergy, we’d tell you to avoid the cause, but in this case, that’s impossible. See your doctor, and if you do have this condition, consult an allergy specialist.
Q: The eczema on my hands has got to the point where my skin is so dry and cracked it starts to bleed. It’s horrible to look at and makes day-to-day life difficult. The usual moisturisers and remedies just aren’t working.
A: Most people with eczema find that it’s sometimes better, sometimes worse, and when it’s bad it can be really miserable, particularly when it’s on the hands or other visible areas. Severe eczema is often too hard or inflamed for creams, bath oils and some steroid creams to work alone. Where the skin is very dry, cracks develop and infections can take hold.
The good news is that there are more treatments available that work to calm the immune system and decrease inflammation. ‘Soak and smear’ is a technique the US National Eczema Association (nationaleczema. org) recommends; it involves deep moisturising overnight. Find a good GP or dermatologist who can work with you long-term to help you explore more complex treatments. ✤