THE DOCTOR WILL SEE YOU NOW

The pandemic has caused a fall in hospital and GP visits, but if you have serious symptoms, it’s vital to seek help, says Dr Sarah Jarvis

Dr Sarah Jarvis on post-lockdown health

For months we’ve been hearing about the risks of Covid-19 and how we must all do our bit to avoid overwhelming the NHS. It seems we have listened. English A&E attendances were 39% lower in April 2020 than those in April 2019. Some of this might be explained by people taking more responsibility for their own health, self-caring or visiting a pharmacist for minor ailments. But behind the headlines are some very worrying health trends.

Heart attack horrors

In Northern Italy in the first month of the global pandemic, admission rates for heart attack were 30% down on the same time the previous year. In the US, the first months saw a 48% reduction in admissions for heart attacks compared with the months leading up to it. Some of the US drop might have been due to ‘seasonal variation’ (heart attack deaths are higher in winter) but with a 50% drop in 999 calls for chest pain in the UK in April, the British Heart Foundation believes patients may be dying as a result of not seeking help.

There are two main types of heart attacks, known medically as MIS (myocardial infarctions) and one is more serious than the other, depending on whether the artery supplying blood to the heart is totally or partially blocked.

Dr Sukhjinder Nijjer, consultant cardiologist at Chelsea & Westminster Foundation NHS Trust, has seen at first hand the worrying drop in people seeking help. He says: ‘Before Covid, we had lots of patients coming in with the less serious type of MI. Although we’ve seen fewer of these, many of them had fairly minor damage to the heart muscle and many might have survived anyway. However, we’ve also seen a big reduction in more serious MIS, where there is a long interruption to the blood supply and a large part of heart muscle can die. If these patients aren’t seen immediately, many of them will die.’

He adds: ‘There may have been fewer heart attacks in lockdown because people aren’t exerting themselves as much, pollution has been lower and they may be less stressed. But I don’t believe it’s biologically plausible that this accounts for all of the drop.’

‘In fact, since the relaxation of lockdown, I’ve seen a significant increase

in people coming in with chest pain. Some have had symptoms for more than a week, before their family have coerced them into coming into hospital.’

For chest pain, the message is clear: unless it’s a mild twinge that only happens when you cough, twist or press on the muscles between your ribs, and isn’t associated with breathlessness, light-headedness, nausea or other symptoms, get it checked.

Missed cancers

While the potentially life-threatening effects of cancer may not develop quite as quickly as a heart attack, seeking help early is equally crucial.

Cancer Research UK reported a 75% reduction in urgent suspected cancer referral rates in April 2020 in England, and estimated these referrals were over 60% lower in Northern Ireland. In Scotland, referral rates dropped by 72% in the first few weeks of lockdown. The charity highlighted two main causes:

 2,300 people a week not being diagnosed through urgent referral: a mix of those not seeing a GP about symptoms for fear of being referred to hospital and delays in hospital referral pathways.

 400 fewer cases a week identified invitations for cancer screening were paused or delayed.

As the peak of the Covid-19 pandemic passed, both GP and hospital services were advised to start up screening and non-urgent care again. If you were expecting a screening invitation and haven’t received it, contact your GP.

Red flags

There are certain key symptoms of possible cancer you should never ignore. There will often be a far less concerning explanation – but even if you get the worst news, long-term survival rates are dramatically improved by early diagnosis and treatment. Here are just some of the ‘red flag’ symptoms:

 Breathlessness or coughing up blood. These symptoms, as well as chest or shoulder pain, could signal lung cancer. Shortness of breath on lying flat as well as exertion, often with swollen ankles, can be caused by heart failure.

 Postmenopausal bleeding. While a reassuring 90% of women with postmenopausal bleeding don’t have cancer of the endometrium (womb lining) it should never be ignored. Your GP may not even need to see you – if they arrange an ultrasound and it shows the thickness of the endometrium is below 4mm (and certainly if it’s below 2mm) you could be discharged without the need for further tests.

 New or irregular bleeding between periods. See your GP – it may be as simple as missing contraceptive pills.

 Persistent hoarse or croaky voice. While usually a viral infection, persistent hoarseness, particularly in smokers or ex-smokers, could be a sign of cancer of the larynx (voice box) or lungs.

 Non-healing mouth ulcer. Either a dentist (if available) or doctor can refer you for a biopsy if you have an ulcer that doesn’t heal in two to three weeks. They can also be a symptom of gut disorders, such as Crohn’s or coeliac disease, or iron/vitamin B12 deficiencies.  Persistent bloating. Bloating that doesn’t come and go, along with feeling full quickly, loss of appetite, stomach or pelvic discomfort or needing to pass water more often or more urgently may indicate ovarian cancer. Your doctor will arrange a blood test (called a CA-125) and an ultrasound scan if indicated.

 Loss of appetite and weight loss.

Several cancers can lead to loss of appetite or unexplained weight loss. Overactive thyroid can also lead to weight loss and diarrhoea.

 Persistent change in bowel habit.

Most tummy bugs settle within days. A persistent change in bowel habit, especially if accompanied by blood in your stools, could signal bowel cancer or inflammatory bowel disease (Crohn’s or ulcerative colitis). Blood from higher in the gut can lead to black, tarry stools or vomiting blood or dark ‘coffee grounds’.  Abnormal bleeding. Blood in your urine, even if not persistent, always needs checking – while often due to a urine infection, it could be bladder cancer. Bruising without an obvious cause, or bleeding under the skin can be down to blood cancer.

 Breast changes. A breast lump is the ‘classic’ symptom of breast cancer, but never ignore new nipple discharge, change in the size, shape or feel of a breast, any skin changes, redness or pain.