healthmedicinet

My husband had heart surgery last year for angina. He is on blood thinners, statins, and high blood pressure medications. But he also drinks a lot, most days, and I’m afraid he has a problem. Should I try to get him to stop?

This is a problem I often hear in my clinic. Alcohol is a huge health risk, especially if one drinks to excess.

On the other hand, not everyone who drinks a lot becomes unwell – it all has to do with one’s constitution and genetics.

People often worry about alcohol-related liver disease, but this is by no means the only problem booze can cause. High blood pressure, heart disease and cancer, not to mention brain diseases such as dementia and depression, are all linked to alcohol consumption. And it’s very addictive – I often see people who can’t cut back, much less stop, for an extended period of time.

My concern for someone who drinks while taking blood thinners and other heart medications is the effect of alcohol on those medications. There is also the chance of falling if you are drunk and then have severe bleeding from an injury due to bleeding much more than normal when taking blood thinners. A head injury would be a particular concern.

Safe drinking for men and women is considered less than 14 units per week — that’s about six pints or glasses of wine.

Sometimes there are very clear signs that someone is drinking too much: choosing drinking over other activities, being unable to say no, or even hiding the habit. It can be difficult to broach the subject with a loved one without being judgmental or confrontational.

Talking about your concern and being supportive – when sober – is the best way, rather than using accusatory words like alcoholic.

Drinkaware.co.uk has more advice on what to do if you’re concerned about someone’s drinking, including tips on what you should and shouldn’t say.

I suffer from a dragging and pushing feeling in my pelvis, a swollen abdomen and discomfort around my buttocks. My GP checked for prolapse, but she said that wasn’t the problem. I then got an ultrasound and was told they could see ‘congestion’ – which I’m not sure I understood. Could the doctor have missed something?

Dragging and shoving are classic features of a prolapse — when one of the organs in the pelvis, such as the uterus, falls into the vagina. It is normally caused by a problem with a weakened pelvic floor and is common after menopause.

What the ultrasound revealed may be a condition called pelvic congestion syndrome. This can be identified on a scan if the blood vessels around the ovaries are wider and different than normal.

It is usually seen in women before menopause and causes pelvic pain because the blood vessels are not working as efficiently as they should. It can cause a dull ache, a lingering pain and hemorrhoids that can cause discomfort in the anus. For a correct diagnosis, you need a scan of the pelvic veins.

In the absence of a clear answer, it would be reasonable to ask for further discussion with the doctor, another examination and even a referral to gynecology. These are not symptoms to be ignored.

I am on a medication called levothyroxine for my underactive thyroid. But when I take it, I get a tingling sensation in my face and my ears feel clogged like I’m on a plane. It takes a few hours to wear off. The specialist I’ve seen says it’s not the drug, I’ve been taking it for 22 years and I’ve never had a problem until this year. What do you think it could be?

An underactive thyroid gland, known as hypothyroidism, is where the thyroid gland, which is located in the neck, does not produce enough hormones. These are important for maintaining energy levels and symptoms of insufficient amounts include fatigue, weight gain and feelings of depression.

Levothyroxine is a hormone tablet prescribed to treat these problems. It’s common for people with an underactive thyroid to also experience nasal congestion, stuffiness, sinus problems, and even hearing loss — but these aren’t side effects of levothyroxine.

It is quite possible that these symptoms have nothing to do with the drug, but that they come on first, before breakfast, which happens to be when you take your tablets – so you are wrongly associating the two.

It wouldn’t be unusual for your sinus and ear congestion symptoms to show up first thing in the morning. When we get up from lying down, it causes fluid to move in the ear or sinuses, which can cause these symptoms. If a drug has been taken for a long time – in this case 22 years – it is possible that these problems are due to the condition not being well controlled and that a dose adjustment may be required.

It’s also possible that the sinus problems are related to an allergy, and a two-week trial of antihistamine tablets may be worth considering to see if it has any impact.

Tackling the nightmare of sleeping pill addiction

British health chiefs have launched a brilliant initiative that I want everyone to know about: a guide for patients taking sleeping tablets but wanting to reduce or stop their dose.

Dependence on sleeping pills is a huge problem in the UK. About a million people take the pills – so-called z-drugs such as zopiclone and benzodiazepines – to help them sleep better or to deal with severe anxiety.

But they are not a long-term solution. They carry a serious risk of addiction – over time you need to take more and more to get the same effect.

UK health chiefs have launched a brilliant initiative I want everyone to know: a guide for patients taking sleeping tablets but wanting to reduce or stop their dose

And after just a few weeks of use, my patients tell me they experience brain fog, difficulty concentrating, and feel emotionally numb.

As a doctor, you worry that patients have not taken the risks of these drugs because they are often prescribed in times of crisis. But now they have a simple guide to weigh their pros and cons. It also offers advice for those concerned about cold turkey.

I will point this out to my patients, and other GPs should do the same.

I was right about beta blocker

Earlier this month, I answered a reader’s question about her husband’s heart condition, atrial fibrillation.

He was on a drug called bisoprolol and I said it wasn’t commonly prescribed for the condition – it’s not what GPs would call first-line treatment. I suggested her husband ask the doctor why he was taking it.

I have since received emails from other readers saying they have atrial fibrillation and have been taking bisoprolol for years with no problems.

Bisoprolol is a beta blocker – it slows the heart rate – but is only recommended for atrial fibrillation if the patient also has another medical condition, such as diabetes.

I suspect that the readers who say they take bisoprolol for atrial fibrillation will also have an additional problem.