IT IS common for people to put off visiting the doctor because they are embarrassed.
But let me reassure you, as GPs, we’ve seen and heard most things before.
To be honest, we don’t mind talking about your bowel habits, bodily functions and sub-regions. However, it can affect the patient.
Delaying seeking help can mean we don’t recognize serious illnesses like cancer in the earliest stages, which can mean the difference between a good outcome and a bad one.
Whatever your problem, whatever your symptoms, please do not worry or be ashamed to speak to your GP.
It’s our job and we’re here to help. Here are this week’s reader questions. . .
Q) I’m almost 60 and can’t remember the last time I burped.
My tummy gurgles after eating and I get a lot of indigestion that gets better when I avoid gluten. I am so unwell that I am unable to eat or drink even a tiny amount.
My stomach is rock hard and I need to get sick – I stick a toothbrush down my throat to choke and clear the gases from my stomach.
My GP laughed and said he’d never heard of it. It’s so embarrassing when I eat out, I have to find a restroom before I can make it home.
A) I am so sorry that you are experiencing this. I can only imagine how awful you must feel.
But please never feel ashamed to talk things over with your GP.
If you feel like things weren’t taken seriously the first time, you should always go back or ask to speak to someone else.
Sometimes it’s not until a patient comes back that we really understand how much the problem affects them.
It makes perfect sense that you would feel insecure about this issue.
It sounds like the upper part of your GI tract isn’t working as it should.
It is certainly not normal that you have to perform the practices you describe to release gas from the stomach.
The inability to belch could be caused by a dysfunction of a circular, elastic muscle called the sphincter at the top of the esophagus known as the esophagus.
The cricopharyngeal sphincter is contracted most of the time, except when relaxing to allow food to pass down or gas to rise.
Failure to relax this muscle can result in an inability to belch.
However, that wouldn’t necessarily explain your gluten intolerance, which I think should be considered a separate issue.
My suggestion would be to go back to your GP and ask for a referral to a gastroenterologist.
Q) WHY are my hot flashes coming back at age 78 after not having had them for 15 years?
My periods stopped when I was 51 and I took HRT – the combination pill – for ten years.
I had intermittent hot flashes for the next few months, but they were mild.
Now they have returned along with six years of insomnia and brain fog and are quite debilitating. Can I have HRT at 78?
A) First of all, it is important to see your family doctor, who can comprehensively assess your individual case.
They will consider diagnosing menopause alongside some other possible causes of your symptoms.
If menopause is the cause, the next step is to weigh the risks versus benefits of HRT for you as an individual, taking into account your age and other factors.
Your GP may be less comfortable prescribing HRT for you, partly because there is very little evidence about starting HRT in older women.
More research is urgently needed in this area. If you decide to have hormone replacement therapy and your GP has concerns about the prescription, I would advise you to speak to a doctor or nurse who has a specific interest in menopause.
Although you’ve taken pills before, we now know that the safest way to take estrogen is through a patch or gel.
In older women, lower doses of estrogen are often effective.
If you still have your uterus, you will also be prescribed progesterone to protect the lining of the uterus.
Q) I am a 55 year old male and for the past few months I have had a dull ache in my left testicle that is getting progressively worse. What do you suggest?
A) Sudden testicular pain is always considered a medical emergency as a possible cause can be testicular torsion.
This is where the testicle has twisted, which can result in a loss of blood supply to the testicle.
When this happens, the tissue can die and result in the testicle having to be removed.
However you explain, your symptoms have been going on for months, so it’s a lot 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 a hernia or a buildup of fluid in the testicles—this is called a hydrocele—or a swollen vein called a varicocele.
Other causes include mumps or an injury to the testicle.
My advice is to make an appointment with your GP. But for everyone reading this, if you experience sudden and severe testicle pain, you must call 999 or go to the emergency room immediately.
A lump should also always be examined urgently 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 using different moisturizers. What do you suggest?
A)Dry itchy skin on the legs is very common and affects us more as we age, partly because the glands in your skin that release oils that naturally protect and nourish may not be working as well.
Diabetes, especially if your blood sugar tends to be high, can also cause itchy skin.
Various factors can contribute, for example if nerves or blood vessels that supply the skin have been damaged by too much sugar in the blood.
There are a few things you can do to manage this yourself. First, you should use a specific type of moisturizer called an emollient.
These are sometimes greasy, although you can get them in gel form.
They work by leaving a protective layer on the skin that helps keep it hydrated.
You can also use emollients as a soap substitute, as soap can have a drying effect on the skin.
If this doesn’t work and your skin is still dry and itchy, you should explain this to your GP or diabetes team and get it checked out.
https://www.the-sun.com/health/5603713/burping-testicle-pain-health-question-dr-zoe-williams/ I’m almost 60 and can’t remember the last time I burped – help me it’s agony