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Dr Mark Porter answers your health questions

Ask Dr Mark Porter

Dr Mark Porter

16 November 2021

Our health columnist, Dr Mark Porter, is one of the country’s best-known GPs.

Our expert on unusual swelling, the flu jab, antidepressants, and prescription savings.

Q.  I have an embarrassing problem that I have put off seeing my own GP about. Around four months ago, I noticed a swelling in the left side of my scrotum. It feels like it is around the testicle but it’s hard to be sure. I know you will tell me to book an appointment with a doctor, but I am hoping you can reassure me it’s unlikely to be serious.

A.  You need to get this checked. And there is no alternative to being examined by a doctor. In the meantime, this may help allay some of your concerns. Most lumps, swellings and aches in this area are not serious. The most common cause I see is swelling/inflammation of the epididymis, a soft coiled tubular structure that sits behind and above the testicle. Most cases of epididymitis settle on their own although some may require antibiotics and/or further investigation if persistent.

Engorged veins (a varicocele), particularly on the left side in taller men, are another cause of anxiety. They are most noticeable when standing up after a warm bath or shower, and often disappear when lying flat in bed. Varicoceles feel like a bag of worms and typically first appear during early adult life(so unlikely in your case). Most don’t need treatment and will never cause problems.

Fluid can also collect around one or both testes (a hydrocele) causing pronounced swelling and discomfort. Many of these hydroceles are nothing to worry about, but occasionally a new one can be a sign of underlying testicular disease, ranging from infection to cancer, so it pays to be wary. And, in some men, hernias of the groin can extend down into the scrotum too, but this is less common these days thanks to earlier surgery.

Last, but not least, there is testicular cancer. The classic sign of an early cancer is a painless hard lump felt on the otherwise smooth surface of the testicle. However, it can sometimes also cause pain without an obvious lump. On the plus side, cancer of the testicle is comparatively rare (lifetime risk: one in 215). Make that appointment, please.

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Q.  Can I ask my GP to give me longer than a month’s worth of medicine at a time? I am 58, have osteoarthritis of the hip and am waiting to see an orthopaedic surgeon about a replacement. In the meantime, I’m taking the anti-inflammatory naproxen to help the pain, as well as omeprazole to protect my stomach from the naproxen, and it’s costing me £18.70 every month. Given my operation is likely to be a year away due to current waiting times it’s going to cost me well over £200 if I only get a month’s worth at a time, money I can ill afford.

A.  England is the only country in the UK where prescription charges (currently £9.35 per item) still apply. The NHS favours monthly issues, not least because they improve cash flow and reduce wastage, but you end up footing the bill.

One option is to buy a prepayment certificate (PPC), which entitles you to ‘free’ prescriptions for a three or 12-month period. A 12-month one is better value. It costs £108.10 and would save you at least £116 if you stay on your current drugs.

If money is tight, four three-month ones at £30.25 each would still save you £103.40 over the year. You will find more details here:, or ask your pharmacist.

If funding a PPC is a struggle, your GP can make an exception where there is hardship, but we are expected to adhere to the NHS guidelines wherever possible. On the upside, your prescriptions will be free when you hit 60 (not that you will need them then – hopefully).

Q.  I have never had a flu jab, but our local surgery is offering one to everyone over 50. I declined last time, but am reconsidering this year. Do you think we are in for a bad season?

A.  We hardly saw any flu last year, but that was due to a combination of anti-Covid measures like lockdowns and social distancing, which impeded spread. There was a similar drop-off in rates of childhood respiratory infections like RSV too, but these have bounced back with a vengeance as natural immunity in children has waned and restrictions have eased. And there is growing concern that flu will follow suit. If it does, then this could be a very bad year. And it will be even worse if Covid does the same.

Bottom line? I will have had my flu jab by the time you read this, and I strongly advise you to do the same.

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Q.  I have been taking citalopram 20mg for depression for nearly two years and, now that I am feeling better, I am keen to stop it. I have tried a couple of times, but within a week or so I can feel my mood changing. I start to feel anxious and irritable, so I restart the drugs. Is citalopram addictive?

A.  Antidepressants are not addictive in the same way as members of the Valium family (diazepam, temazepam etc) can be, but it is not unusual to experience some withdrawal effects when you stop them, particularly if you do so abruptly. Citalopram is one of the better antidepressants in this respect, but it can still cause problems.

Most people need to take antidepressants for a minimum of nine months to get the best result and it is important not to stop therapy suddenly after this length of time. Practices vary, and you should discuss this with your own GP, but I like to wean people off by halving the dose every four weeks to reduce the likelihood of the type of discontinuation symptoms which may include tearfulness, irritability and disturbed sleep. So, in your case, your GP may suggest dropping down to 10mg every day for a month, and then 10mg every other day for two to four weeks after that.

If you still struggle despite slow weaning it may be a sign that you are not quite ready to stop treatment.

Email He can’t reply individually but will respond to queries in Saga Magazine. Always talk to your own GP.

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Article first published in Saga Magazine November 2021.

The opinions expressed are those of the author and are not held by Saga unless specifically stated. The material is for general information only and does not constitute investment, tax, legal, medical or other form of advice. You should not rely on this information to make (or refrain from making) any decisions. Always obtain independent, professional advice for your own particular situation.