IT’S common for people to put off seeing a doctor because they’re embarrassed.
But, let me reassure you, as GPs we’ve seen and heard most things before.
Talking about your bowel habits, bodily functions and nether regions honestly doesn’t faze us. However, it can impact the patient.
Delaying seeking help can mean we don’t pick up serious conditions like cancer in the earliest stages, which can mean the difference between a good and bad outcome.
So, whatever your problem, wherever your symptoms, please don’t worry or feel ashamed about talking to your GP.
It’s our job and we’re here to help. Here are this week’s reader questions . . .
Q) I’M nearly 60 and don’t remember the last time I burped.
My tummy gurgles after I’ve eaten and I get a lot of indigestion, which eases if I avoid gluten. I get really uncomfortable to the point of not being able to eat or drink a tiny amount.
My stomach is rock hard and I need to make myself sick – I stick a toothbrush down my throat to retch and release the gas from my stomach.
My GP laughed and said he’d never heard of it. It’s so embarrassing if I eat out, I have to find a toilet before I can make it home.
A) I’m so sorry you’re experiencing this. I can only imagine how awful you must feel.
But please don’t ever feel embarrassed to speak to your GP about things.
If you feel things weren’t taken seriously the first time, you should always go back or ask to speak to somebody else.
Sometimes it’s only when a patient returns that we really understand how much the problem is affecting them.
It makes total sense that you would feel self-conscious about this problem.
It sounds as though the upper part of your gastrointestinal tract isn’t functioning quite as it should.
It’s certainly not normal to need to perform the practices that you describe, in order to release gas from the stomach.
Inability to burp could be caused by dysfunction of a circular, elastic-like muscle called a sphincter at the top of the food pipe known as the oesophagus.
The cricopharyngeal sphincter is contracted most of the time apart from when it relaxes to allow food to pass down or gas to come up.
If this muscle fails to relax it can cause an inability to burp.
This wouldn’t necessarily explain your intolerance to gluten, though, which I think should be considered as a separate issue.
My suggestion would be to return to your GP and ask for referral to a gastroenterologist.
Q) WHY are my hot flushes starting again at the age of 78, after 15 years of not having any?
My periods stopped when I was 51, and I was on HRT – the combined pill – for ten years.
Over the next few months, I did have hot flushes now and again, but they were mild.
Now, along with insomnia for six years and brain fog, they’ve returned and are quite debilitating. Can I have HRT at 78?
A) Firstly it’s important to see your GP, who can fully assess your individual case.
They will consider the diagnosis of menopause alongside some other potential causes of your symptoms.
If menopause is the cause, then the next step is to weigh up the risks versus the benefits of HRT for you as an individual, which will take your age and other factors into consideration.
Your GP may feel less comfortable prescribing HRT for you, partly because there is very little evidence regarding starting HRT for older women.
More research is desperately required in this area. If you decide you want to take HRT and your GP has concerns about prescribing, then I would advise asking to speak to a doctor or nurse who has a special interest in menopause.
Though you took tablets previously, we now know the safest way to take oestrogen is through a patch or gel.
Often in older women lower doses of oestrogen are effective.
If you still have your womb you will also be prescribed progesterone to protect its lining.
Q) I’M a 55-year-old man and I’ve had a dull pain in my left testicle in the last few months, which is getting worse. What do you suggest?
A) Sudden testicular pain is always considered a medical emergency because one potential cause is testicular torsion.
This is where the testicle has twisted on itself, which can cause a loss of blood supply to the testicle.
If this happens, the tissues can die and can lead to the testicle having to be removed.
However you explain your symptoms have been going on for months, so this is much less likely in your case.
There are several other conditions that can cause the symptoms you describe.
One of the most common is epididymitis, where a tube at the back of your testicle becomes swollen and painful.
This is most commonly caused by sexually transmitted infections and can be treated with antibiotics.
Pain can also be caused by an inguinal hernia, or a build-up of fluid in the testicle — this is called a hydrocele — or a swollen vein, which is called a varicocele.
Other causes include mumps, or injury to the testicle.
My advice is to make an appointment with your GP. But for anyone reading this, if you experience sudden and severe testicular pain you must call 999 or go to A&E immediately.
A lump should always be assessed urgently too as it could be a sign of testicular cancer.
Q) I WAS diagnosed with type 1 diabetes 38 years ago.
I get itchy lower legs and incredibly dry skin despite having used various moisturising creams. What do you suggest?
A) Dry itchy skin on the legs is very common and tends to affect us more as we get older, partly because the glands in your skin that release oils that naturally protect and nourish may not function quite as well.
Diabetes, particularly if your blood sugars tend to be high, can also cause itchy skin.
Various factors can contribute, such as if nerves or blood vessels that supply the skin have been damaged by excess sugar in the blood.
There are a few things you can do to manage this yourself. Firstly you should use a particular type of moisturiser called an emollient.
These are sometimes greasy, although you can get them in a gel form.
They work by leaving a protective layer on top of the skin, which helps to hydrate it.
You can also use emollients as a soap substitute because soap can have a drying effect on the skin.
If this isn’t working and your skin is still dry and itchy then it’s worth explaining this to your GP or diabetes team and getting it assessed.
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