18:23 EST, 26 May 2014
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18:23 EST, 26 May 2014
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Recently I have seen my GP about inflammation, irritation and a burning
sensation around my ankles and calves. He diagnosed vasculitis and said
it was age-related (I am 74), but did not prescribe any medication. I
had blood tests, including one that showed my cholesterol level was
slightly high (7.1). I am now on simvastatin. Is there any connection
between vasculitis and raised cholesterol, and what is vasculitis?
Name and address withheld.
A patient went to see their GP about inflammation, irritation and a burning sensation around the ankles and calves
VASCULITIS
is the medical term for inflamed blood vessels – it occurs as a result
of some underlying medical condition, such as lupus, an autoimmune
condition that causes inflammation throughout the body, or rheumatoid
arthritis.
The symptoms vary depending on which blood vessels are
affected, and the organs they supply. So they can range from
discolouration of the skin, to fatigue, breathlessness, and muscle or
joint pains.
However, I am not convinced that you have vasculitis, as
if this was the case, you would almost certainly have been referred on
to a specialist and would have been given some form of treatment.
So, you must ask, why have I been given this diagnosis?
On
occasions the word vasculitis is used rather loosely, as an imprecise
diagnosis for a problem such as that you described to your doctor.
I
would suggest that as the symptoms you describe – redness, irritation
and burning – are not sinister, and are very localised, the problem is
possibly varicose eczema, although I must be cautious about giving such a
diagnosis without having physically examined you.
This condition is
unrelated to your slightly raised cholesterol and is caused by varicose
veins, which affect one in three of the adult population at some point.
Varicose veins occur when the valves in the blood vessels in the
legs, which are meant to keep blood pumping towards the heart, become
faulty.
As a result, blood can pool in the legs. This in turn puts
pressure on the blood vessels, causing fluid and chemicals to leak into
the surrounding tissues, irritating them and drying out the skin,
especially around the ankles as there is little flesh there.
The
skin can scale and crack, turning red or brown – caused by red blood
cells leaking into the tissue. The skin may even ulcerate. I think you
need to talk to your doctor and ask if varicose veins could be the
source of the burning sensation and irritation.
It may be that the advice of a vascular surgeon is called for.
If
underlying varicose veins are confirmed by ultrasound scanning, then an
operation to improve the flow of the blood in this area might be
suggested.
Once the flow in the veins is improved, then the skin appearance will improve as the eczema resolves.
Maureen Birch has experienced a very rapid heartbeat
For
a few months I have experienced a very rapid heartbeat, accompanied by
discomfort on the left side of my chest. Sometimes it makes me cough a
little. This doesn’t happen all the time but comes and goes, and usually
occurs when I’m lying down or relaxing. I have seen my doctor twice. My
blood pressure is satisfactory and I have been told that my heart and
lungs are clear. However, my doctor has arranged for me to have a
monitor on my heart for 24 hours. I am waiting for an appointment. Have
you any idea what this could be?
Maureen Birch, London.
HOW very
worrying for you. The problem with a heart rhythm abnormality that comes
and goes is that it never seems to happen when you are at the doctor’s
surgery or in the hospital.
Yet pinning down the exact type of
abnormal rhythm you are having is important in making an exact
diagnosis. The good thing is that your GP has organised exactly the
right test for you.
A 24-hour ECG monitor, previously known as
Holter monitoring, tracks the electrical activity of the heart while you
go about your everyday life, so it will record the abnormal rhythms as
and when they occur.
There is nothing painful about this – two small
adhesive electrodes are applied to your chest. These electrodes are
connected by leads to a recording device that detects the electrical
signals that make your heart beat.
The device itself is small enough to sit in a pocket or can be attached to your waistband.
The data collected by the recorder is run through a computer and any abnormal rhythms are identified.
There
are now apps for smartphones to measure heartbeat – if you feel an
abnormal heartbeat, you press the phone against the skin of the chest
and it will record the electrical abnormality immediately.
Write to Dr Scurr
TO CONTACT Dr Scurr with a health query, write to him at Good Health
Daily Mail, 2 Derry Street, London W8 5TT or emailÂ
[email protected] – including contact details.
Dr Scurr cannot
enter into personal correspondence. His replies cannot apply to
individual cases and should be taken in a general context. Always
consult your own GP with any health worries.
This can
be looked at on the screen or even emailed as a file to the
cardiologist or GP. I learned about this from one of my patients, who
had got fed up with waiting for her appointment at the hospital. This
could be useful, as only once there is a precise understanding of the
disordered rhythm can the correct treatment begin.
There are a number of different causes of abnormal heartbeat – and each requires different treatment.
Probably the most common is atrial fibrillation, an abnormally fast heart rhythm.
It is common in older people and affects almost 10?per cent of people over the age of 80.
If this is identified, it can often be easily treated with medication such as beta-blockers to help regulate the rhythm.
But until you have the results of the ECG there is not enough information to even speculate about the cause of your episodes.
You
should be reassured, however, that your blood pressure is normal and
that no abnormalities were noted on examination of your heart and lungs.
Please do write back to me and let me know the outcome of your 24-hour ECG recording.
By the way?…?Homeopathy and meddling Mr Hunt
Medicine
should not be prey to personal whimsy, though I am not sure how much
Jeremy Hunt, the Health Secretary, understands this.
It’s recently
been revealed that he asked the Chief Medical Officer to review three
studies which have found in favour of homeopathy.
Until now,
independent scientific studies have been unable to prove homeopathy
offers a medical benefit, apart from the value conferred by the placebo
response.
After looking at the three studies, the Chief Medical
Officer responded that it was ‘difficult to draw useful conclusions’
from two – the third had problems with its methodology.
It’s since
been claimed that Mr Hunt only ‘passed on’ the reports given to him by
another MP. Though it is perhaps worth noting that Mr Hunt has
previously suggested that as homeopathic treatment is ‘valued by
thousands’ of people, it should continue to be offered as part of the
free service of the NHS.
Many doctors argue against this given current financial constraints.
What should be funded is what’s been shown to work – and, yes, some drugs, like homeopathy, may fail this hurdle.
But what has been shown to work is continuity of care – being regularly under the care of one informed and committed GP.
Not only is it valued by millions, there is evidence to prove that this confers better health outcomes.
Despite
this, there are no plans to ensure restoration of full continuity for
all patients, though lip service is being paid by the promise of a named
doctor for those over the age of 75.
So is healthcare being ruled by a politician who merely picks and chooses the options that appeal?
We
as doctors are under pressure from guidelines from the National
Institute for Health and Care Excellence to engage in evidence-based
healthcare – so why is it that our leaders are not, in some measure
evidence based?
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