My cancer is terminal …so when can I tell doctors I’m ready to go?

I WAS recently diagnosed with a very rare, very aggressive incurable cancer. I’ve been referred to palliative care, but I’m often in so much pain I end up in A&E and have to be injected with morphine. I’m 67 and retired but used to run two very successful catering businesses. Now I struggle to open a bottle of water. At what point can I say I’ve had enough?

THIS is a very difficult and very important question – although it’s not for any doctor to decide when a patient has ‘had enough’.

End-of-life plans must be made by a patient and those closest to them. With incurable cancer, the aim of treatment is usually to prolong life. But the point may come when this might not be what’s wanted.

It’s perfectly acceptable to say it’s all become too much, and that you want to discuss other options. But that doesn’t mean having no treatment at all – far from it.

The aim of palliative care is not to treat the illness itself, but rather any symptoms that are uncomfortable or distressing.

Pain and weakness, along with immobility, bleeding and difficulties with normal bodily functions, are all horrible symptoms which ruin quality of life. Palliative care teams try to find ways to control or alleviate the worst of these problems.

If symptoms are adequately tackled then life can become a bit more bearable, and that feeling of just wanting it all to end may dissipate somewhat. Of course this doesn’t change any ultimate outcome, but it helps make the best of what time we have left.

Palliative care can be offered in the home or in the hospital, and it can also involve a hospice.

A palliative care team can also offer emotional and practical support around death and dying.

It may be worth having a conversation with Marie Curie Cancer Care. Their nurses care for all people diagnosed with terminal illness, and can offer support in the home and overnight. Call them on 0800 090 2309 as well as asking your GP or palliative care team for a referral for their services. They can also work alongside others involved in your care.

I RECENTLY visited my GP to ask about the pneumonia vaccine, as I had reached 65. They refused to give it to me, saying because I’d had a pneumonia travel jab privately in 2019 – before a holiday in India – I wasn’t eligible. What should I now do?

WE GIVE a pneumococcal vaccination, known as the pneumonia vaccine, to babies, adults aged 65 or over, and certain adults with long-term health conditions that put them at higher risk such as heart disease or kidney disease.

The standard guidelines are that people aged 65 and over need only a single pneumococcal vaccination rather than a repeat one as with the flu jab.

Some people with underlying chronic health conditions do have to have the pneumonia vaccine repeated every five years, and your GP should tell you if you fall into this category.

Private clinics sometimes offer younger patients a type of pneumococcal vaccination called Prevenar 13 vaccination.

A different type is given on the NHS for adults over 65, the pneumococcal polysaccharide vaccine, or PPV.

There are actually a lot of different strains of bacteria that cause pneumonia: Prevenar 13 protects against 13 strains of the bug whereas PPV protects against 23.

An adult who has had Prevenar 13 is not protected from all of the strains which PPV protects against, so should still have PPV at 65, as is standard.

Anyone over 65 who hasn’t had the PPV should do so.

This, to me, sounds like an administrative error. Have a conversation with the practice nurse or GP to sort it out.

I AM 29 and get dreadful neck acne and ingrown hairs after shaving. This has been going on for at least two years. I’ve tried so many products, but nothing works. Can you help?

THIS actually sounds like folliculitis, an inflammation of the hair follicles. It can happen anywhere on the skin, but the beard area is particularly prone.

Our skin is covered in bacteria which are usually harmless and even protective. But shaving can damage the skin, and the bacteria can grow and invade the follicles, causing infection.

Folliculitis looks a lot like acne, with itchy, sore areas of red and pus-filled spots.

Unlike normal acne, however, it has a tendency to spread, worsening day by day, with the area feeling swollen and hot, too.

Shaving can also cause ingrown hairs – where the hair shaft regrows at the wrong angle, pushing into the skin. What you see are red, irritated spots.

Of course it could also be acne which may require a prescription from the doctor to treat.

The GP or pharmacist can determine which condition it is, and recommend treatment.

For folliculitis, a short course of an antibiotic cream or lotion is used, and possibly a mild steroid cream, to reduce inflammation.

Depending how severe it is, it may be recommended to use a tablet antibiotic in a similar way to when we treat acne.

Sometimes the infection with folliculitis persists because razors can become contaminated, so make sure to change disposables regularly, or sterilise the metal parts with boiling water or an antiseptic solution.

It may also be helpful to shave less often, or not as closely, which would cause less trauma to the skin.