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Health Q&As with our GP
Our online GP responds to readers' concerns about unexplained weight loss, severe headaches and hormone treatment for prostate cancer
Weight loss
Q: 1 How can I lose weight? I have been a diabetic for 49 years, I stopped smoking 18 years ago and I’ve gone from 11.5 stone to 15.5 stone. I eat a well-balanced, low fat diet and exercise as much as I can with arthritis and a below knee prosthetic limb.
A: You do not give details of your medication but as you have been diabetic for so long I suspect you are on insulin. If so, you will be gearing your insulin to keep you around the normal range of glucose on your present diet. But if you have put on so much weight you must be taking in too many calories so you will need both to reduce your diet and your insulin dose. Although your diet is well-balanced and low fat it is important to cut back on quantity - and reducing carbohydrate intake is generally the easiest way to do this. It might be helpful for you to do this with the help of a dietician and perhaps your GP or your consultant could arrange this.
Hormone treatment for prostate cancer
Q: I have prostate cancer which has spread to my bladder, top of spine and hip. I am having hormone treatment. The weight gain plus the tiredness along with the slightly impaired mental agility has decided me to give up the treatment and take my chances of a shorter life in exchange for an improved quality of life. My consultant says this will cut my life expectancy from 10 to six years. How many of these years will be of acceptable quality before I start to go downhill?
A: It is very difficult to answer your question since the progress of prostate cancer is very variable. However, it is clear that it must be quite advanced if it is affecting your spine and hip, and I hope that your consultant is considering whether you need radiotherapy to control this spread. It is true that hormonal treatments can affect your weight and cause fatigue, but I wonder if you are sure that you feel better now that you have stopped taking them, because the general effects of the cancer spreading can also cause similar symptoms, though admittedly not the weight gain. I expect you have discussed with your consultant whether it might be helpful to try another type of hormone treatment (there are several types now available) in case you find it more tolerable. If not, perhaps you could raise this possibility at your next appointment.
Are statins causing my weight loss?
Q: Last October I was diagnosed as having high cholesterol, despite having a fit and healthy lifestyle. After two months on a low fat diet there was no improvement and I started taking Lipitor. After three months my cholesterol levels had halved and I had lost 7lbs in weight. Three months on I am still losing weight and am now down to 7st 3lbs. I am 5ft 1in tall, aged 65 and look positively skeletal. I eat well. Could the statins be causing this loss or should I be worried that I may have other problems?
A: It is good that the Lipitor has brought down your cholesterol, but it is not likely to be associated with your weight loss and you should certainly consult your doctor about this. If you are eating well with a good appetite one possible cause is an overactive thyroid, and you will probably have blood tests to investigate this and other possibilities.
Transfusion troubles
Q: I have just had the latest of a lot of blood transfusions. This one was after an operation for piles. I have been told I have developed antibodies to my red blood cells. I have to carry a card with me. What does this mean? I am having another operation in two weeks’ time: what if I need another transfusion?
A: It is bad luck that you have developed antibodies to some types of red blood cells, and this means that the doctors will take great care to avoid transfusions in future. One option would be to salvage blood during any operation and return it to your circulation. However, it is unusual to need a transfusion for most types of surgery so, although you do not mention what type of operation you are having, it is likely you will be able to avoid it. If it were to be necessary the doctors would know to order the type of blood least likely to cause any problem.
Severe headaches
Q: I’m male aged 44, a heavy smoker and coffee drinker. I’m experiencing very severe, agonising and intense headaches of four to five hours’ duration. They always start behind my left ear and rises up into the head – my head feels like head a blown up balloon that is about to explode. I get excruciating pain pulses approx three minutes on and three minutes off; my eyes blur after twp or three hours during an attack. I’ve had three attacks like this spaced four months apart over past year. I was recently admitted to A&E but a CT scan and lumbar puncture test were negative.
A: This is certainly a very odd and unusual form of headache and, although it is reassuring to have had a normal CT scan and lumbar puncture, I feel it would be sensible to investigate further. Most neurology departments do now have a headache specialist who runs regular clinics and your GP could refer you. If you are in London or the south east, there is an excellent headache clinic at the national neurology hospital in Queen Square, although there may be a shorter wait locally.
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Information on this site is for interest only and is not a substitute for professional medical advice. You should consult your own doctor about any specific health concerns.
