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GP
June 2008: Q and As with the GP
Saga's online GP, Dr Margaret answers readers' questions on arthritis, menopause and medication
Arthritis ankle options
Q: I have an arthritic ankle diagnosed as bone to bone, no cartilage. My doctor has offered to fuse the ankle fused and also (but not very enthusiastically), to do ankle replacement. I have had this trouble for at least five years and it is getting worse. Are there any alternatives, please, or any new treatment that can be used?
A: I am afraid that the only options for severe ankle arthritis at present are either fusion or ankle replacement. There have been problems with ankle replacements in the past and, even now with improved designs, there is still a failure rate of just over 10% in the best hands. So it is not surprising that your consultant seems to prefer the option of fusion. This has the advantage of giving a pain-free ankle, but with the problem that it is fixed in one position. I wonder if your consultant or GP could put you in touch with a patient who has had this operation who might be able to help with advice.
Dyspepsia medication
Q: I am an 85-year-old female in reasonable health taking Amlodipine 10 mg and Levothyroxine 100 micrograms each day, also multivitamins, cod liver oil and glucosamine. I have been suffering from digestive troubles causing bloating, wind and abdominal discomfort for some time. My doctor has given me ranitidine 300 mg with instructions to take one at night when required. I find these do give me relief and wondered if it would do any harm to take them continuously.
A: Ranitidine works by blocking the production of acid in the stomach and can be very helpful for dyspeptic symptoms. It is a pretty safe medication and I think you could take it in the long term with little risk of problems.
Poor circulation
Q: My 88-year-old mother has poor circulation in her feet; can you suggest any exercise or activity, or element of diet that could help?
A: When you say 'poor circulation' I wonder if you mean a narrowing of the arteries supplying the feet, or just that your mother's feet tend to feel cold. If there is any doubt it might be sensible to get her to see her GP who would be able to arrange for investigations to check on her circulation if her foot pulses do not feel normal. Either way, regular exercise is helpful, and so is looking after your feet - not walking barefoot, watching out for and treating and any minor injuries, and wearing warm, comfortable footwear, especially in winter. In the unlikely event that your mother is a smoker, it is really important to give up, since cigarettes have a very bad effect on the circulation.
Pain control for arthritis
Q: I was prescribed 100mg of diclofenac per day as I have arthritis in my knee. I also take 30mg lansoprazole each day to protect my stomach. For how long can I safely take diclofenac?
A: Occasionally diclofenac can cause dangerous stomach bleeding, so it is sensible of your GP to prescribe it together with the protective medication, lansoprazole. Even so there is no absolute guarantee that you will not have a problem - although it is very unlikely. So it is sensible to take only as much as you need to control the pain, perhaps combining the diclofenac with paracetamol.
Pain in peri-menopause
Q: I'm 55 years old. My periods are becoming more erratic and further apart - lighter than they were and only lasting a few days, but I have more pain than I used to. I get occasional spotting, but what is worrying me is that I am having period-type pains for at least an hour nearly every day. Is this normal during peri-menopause? I am also a bit overweight but, over the last few months, my stomach has ballooned and I look pregnant.
A: The menopause is not usually associated with pain and, because of this and your other symptoms I think it is important for you to see your doctor so that he or she can examine you and arrange any necessary investigations. One very useful test that may be suggested is an ultrasound which is quick and easy and gives a good image of the ovaries and uterus.
Discoloration of facial tissues
Q: I am 67 and, over the last few years, I have developed a darkening of the facial tissues. It is like a form of bruising and was first noticed on my forehead. I have tried massage and constantly apply a cream to my forehead. It sometimes is lighter and then darker and moves around my features to the sideburns but always some discolouration on the forehead is visible. I am constantly being asked what is wrong.
A: I am afraid it is not possible to suggest a diagnosis from the details you give, but I am sure a visit to your GP could help. If he is not able to diagnose the discoloration himself, he would be able to refer you to a dermatologist for advice and treatment.
More from our GP
- Stiff shoulder; bunion surgery; thigh tremors
- Arteritis; abdominal pain; seeing spots
- Dr Margaret's Q&A archive
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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.
