Should I tell my travel insurer about my op?

I HAD my whole prostate gland removed (a radical prostatectomy) in October 2013, and fortunately all my PSA tests have been good since then.

But when it comes to buying travel insurance, the firms significantly load the premiums because of my history. This annoys me. Surely if the prostate has been removed there should no reason for this?

Therefore, I have avoided mentioning my operation when buying insurance — am I safe to do this?

Name and address withheld.

For other readers, I will first explain that a radical prostatectomy is a treatment carried out to cure prostate cancer. A urologist will not perform this procedure until investigations and scans have confirmed the tumour is confined to the prostate, with no sign of spread outside the gland. This means the operation will remove the cancer in its entirety.

For an insurance company to load your travel insurance premium seems, on the face of it, to be wrong.

However, I would argue that in the immediate few months after the surgery there may be concerns about post- operative complications, such as urinary tract infection.

But it’s some years since your operation and it may be that the insurers are being lazy and not prepared to conduct the relevant research: the outcomes of a radical prostatectomy, particularly the complications in each patient, are fully documented.

Their view is that as you have had major surgery for cancer, you are at risk of possible subsequent problems.

THERE are specialised brokers with a particular interest in travel cover for clients who have suffered illness — Access to Healthcare is but one — and they can arrange specialised products on your behalf, which potentially might work out cheaper for you.

I think it unwise to withhold any information when it comes to buying insurance.

The company will use any excuse to decline payment, even if you suffer from an emergency that is not related to your prostate cancer surgery, and they may well invoke the conditions detailed in the small print.

Bear in mind that insurance companies do not exist to do you and me any favours. They are in business to return profits to their shareholders. COULD you advise me on the condition familial tremor? My father had it and so do I— undiagnosed, I may add.

When I’m stressed, my hands and legs shake. When nervous I also have facial and lip movements that I cannot control.

I’m outgoing and have a loving family, but underneath I’m shy and under-confident. What are your views?

Andrea Heron, by e-mail. Tremor is a repetitive, involuntary shaking. We all experience some degree of it from time to time; this is known as a physiological tremor.

What you have, I suspect, is often referred to as essential tremor, which is also known as familial tremor when there’s a history of it in the family. It is the most common of all the movement disorders and affects about 5 per cent of the population.

It can vary considerably, but it most often affects the hands and arms. It may also, as you have experienced, involve the head, face, trunk or legs.

In people with tremor, the nerve cells in an area of the thalamus, the part of the brain that controls movement, are firing in an abnormal pattern.

The drugs most often prescribed for it are beta blockers, typically propranolol, which has been shown to be effective at a number of clinical trials.

It blocks the action of the hormones adrenaline and noradrenaline on muscle fibres, stopping the tremor from getting worse with anxiety.

It is available in a long-acting capsule, which has to be taken twice daily.

The only disadvantage is that beta blockers are not given to people with asthma, because of concerns they may trigger asthma attacks; certain heart conditions, because they slow down the heart; and type 1 diabetes, because they may block the signs of low blood sugar, such as a rapid heartbeat.

Anticonvulsants such as primidone, gabapentin and topiramate are also known to be effective in reducing the tremor, possibly because they have a calming effect on the nerve supply to muscles as well as an action in the brain.

But because of this effect on the brain, they have the potential for greater side- effects than beta blockers, such as dizziness.

You may have found that small amounts of alcohol reduce or abolish your tremor. However, this is not a suitable regular treatment, not least as over time increasingly larger amounts are needed to achieve the same effect.

This raises the risk of addiction and liver damage, as well as interfering with work and the ability to drive safely.

Tranquillisers, such as diazepam, alprazolam and clonazepam, have been prescribed in the past on the basis the tremor is caused by anxiety, but this view is erroneous.

The drugs may help reduce tremor, but they also have a sedating effect and cause sleepiness, as well as the potential for addiction. At this point, I would mention that although anxiety is not the cause of essential tremor, it does make it worse.

I would also suggest that the tremor can cause anxiety, because patients may find it embarrassing. For that reason, in addition to medication, I would advise that you ask your GP for referral to a clinical psychologist.

Anxiety management strategies can be beneficial in helping you cope with your lack of confidence.