My husband’s gambling addiction is driving us apart

GETTING TO THE HEART OF MEDICAL MATTERS

Q I’m worried my husband is addicted to gambling. What started as having an occasional flutter on the horses now seems to have taken over his spare time – and we’re also in debt. We’ve had so many rows about it and he keeps promising me he will stop, but after a couple of days I find him glued to his phone again. I’m having to work extra hours to try to pay the bills and wondering whether the best thing to do is leave him. Is there anywhere I can get some help?

A Gambling is often seen as part of everyday life in the UK and can take many forms, from buying scratch cards to an occasional sporting bet. Many people appear to do this without any serious consequences, apart from losing a bit of money, but in others it can develop into an addiction.

In the UK it is estimated around 430,000 people are compulsive gamblers, a number that is increasing year on year, especially as it is now possible to gamble 24 hours a day.

As you have discovered, it can lead to debt and family breakdown. Like other addictions, only your husband can stop himself gambling. You can’t do it for him, but you could encourage him to get help.

You should also take care to look after yourself, not only your mental and physical health, but by keeping your money safe and taking control of your finances as much as possible.

The National Gambling Helpline (0808 8020 133) can provide free, confidential and personalised support for anyone who is experiencing problems, which includes people like you who are affected by someone else’s gambling, so please give them a call.

Your GP will also be able to direct you to local services that can help both you and your husband.

Q Recently I’ve had a lot of pain when passing a motion and my doctor has diagnosed an anal fissure. I’ve been applying the cream he prescribed for more than two weeks now but it doesn’t seem to have done anything other than give me a headache. Is there anything else I could try?

A An anal fissure is a tear in the lining of the lower bowel, just inside the anal opening. They are often linked with constipation, when a hard large stool tears the lining as it is passed. They are also associated with increased tone in the muscles around the anus.

Symptoms include pain when passing a motion, which can last for an hour or so afterwards, and some people also have some bleeding at the same time.

The muscle around the anus can put pressure on the small blood vessels in the area, which reduces the blood supply to the torn tissue and can delay healing. For this reason, the most commonly used treatment for a fissure is glyceryl trinitrate (GTN) ointment, which relaxes the muscle around the anus and dilates the tiny arteries in the area, increasing the blood flow to the damaged tissue.

This both eases pain and allows the fissure to heal more quickly. Unfortunately, headaches are a common side effect.

Most fissures heal in a couple of weeks, but in some it can take longer. It is important to make sure your stools are very soft, so increase the fibre in your diet. GTN ointment unfortunately does not work for everyone and if the fissure persists, then drugs known as calcium channel blockers, such as diltiazem, may help.

For a persistent fissure, a Botox injection to relax the anal muscles, can be very effective, but for this you will need a referral to your local hospital’s rectal clinic.

Q I’m 46 and have been having really bad night sweats. My periods have also become a bit erratic, and my GP has said I’m perimenopausal. But I’ve been doing some Googling, and it seems that night sweats can be a sign of blood cancer, so surely my GP should do some tests for that rather than just offer me HRT?

A If you Google “causes of night sweats” you are likely to find a very long list of 20 or more conditions, often in alphabetical order, plus a list of medications that can have side effects, including night sweats, too.

What most websites don’t tell you is which of these conditions are common causes (anxiety, the menopause, drinking too much alcohol, diabetes, an overactive thyroid), which are uncommon (lymphoma and leukaemia, for example) and which are incredibly rare (valley fever, which most doctors will never have heard of and will never encounter).

So the job for a GP, when a patient says they have night sweats, is to try to find out the cause, bearing in mind that checking for everything on that list is impossible. This involves taking into account the patient’s age and weight, asking questions about their lifestyle and, very importantly, if they have any other symptoms.

In a woman of your age, whose periods have become erratic and who is showing no other symptoms, menopause is by far the most likely cause.

Therefore offering HRT is an appropriate treatment option.

However, if there are other symptoms, such as palpitations, unexplained weight loss or tiredness, then it would be appropriate to do a physical examination to check for possible anaemia, a fast pulse, or enlarged lymph nodes. Basic blood tests may also be carried out, and any other tests the examination might suggest are appropriate.

The effect of treatment is important too. If you start HRT and your night sweats stop, then you can be reassured that they were caused by falling oestrogen levels.

However, if HRT makes no difference and your sweats continue, then you should go back and see your GP for investigations.