Health

My GP says I’m too old for HRT at 68. What can I do? DR ELLIE CANNON answers your health questions


I’m 68 and have had hot flashes since going through menopause at 54. Hormone replacement therapy has helped, but last year my doctor switched me on a medication called clonidine, says that I am not suitable for hormone treatment due to my age. My hot flashes got worse – especially shocking at night. What should I do?

Clonidine is a medicine for high blood pressure – and also a medicine we give to some women during menopause, because it helps control hot flashes. Studies show it improves quality of life, although nearly half of patients experience sleep problems while using it.

For any new medication, the first thing to ask yourself is whether you’re taking the correct dose. Usually, women start off on a low dose of clonidine and increase it gradually. I’m just saying it doesn’t work when the maximum dose is tried – or the side effects are intolerable.

Instead of continuing with an ineffective treatment, it may be advisable to consider HRT patches instead of pills or a lower dose, both of which may not carry the same risks.

Instead of continuing with an ineffective treatment, it may be advisable to consider HRT patches instead of pills or a lower dose, both of which may not carry the same risks.

Instead of continuing with an ineffective treatment, it may be advisable to consider HRT patches instead of pills or a lower dose, both of which may not carry the same risks.

Other things that can help reduce the severity of hot flashes include avoiding triggers such as spicy foods, caffeine, and alcohol, and sleeping in a cool room with a fan. The antidepressant and pain reliever gabapentin may also be helpful.

Other than this, I doubt the decision to discontinue HRT is due to age.

There’s no limit to how long a woman can take HRT – however other factors, such as breast cancer risk or blood clots, can be a factor in deciding to switch to a hormone-free option .

Have an open and frank discussion with your GP about the risks and benefits of HRT.

Instead of continuing with an ineffective treatment, it may be advisable to consider HRT patches rather than pills or lower doses, both of which may not present the same risks.

My wife had cataract surgery late last year – and it left her almost blind in that eye. Her doctors have weighed in for months, and now say she will need another surgery. Obviously we are apprehensive.

Cataract surgeries are considered routine, with around 330,000 of them performed on the NHS each year in the UK alone.

The reason we have surgery is because cataracts – the covering of the lens, at the front of the eye – often deteriorates over time, causing vision loss. There is really no other treatment and surgery, which involves replacing the lens with an artificial lens, has a very high success rate.

But as with any medical intervention there are potential risks and complications. About one in 50 patients with cataracts experience blurred vision, loss of vision, or detachment of the retina – when the light-sensitive cells in the back of the eye are damaged.

Cataract surgeries are considered routine, with around 330,000 of them performed on the NHS each year in the UK alone.  The reason we have surgery is because cataracts - the covering of the lens, at the front of the eye - often deteriorates over time, causing vision loss.  (file image)

Cataract surgeries are considered routine, with around 330,000 of them performed on the NHS each year in the UK alone.  The reason we have surgery is because cataracts - the covering of the lens, at the front of the eye - often deteriorates over time, causing vision loss.  (file image)

Cataract surgeries are considered routine, with around 330,000 of them performed on the NHS each year in the UK alone. The reason we have surgery is because cataracts – the covering of the lens, at the front of the eye – often deteriorates over time, causing vision loss. (file image)

One in 1,000 people is at risk of permanent vision loss in the eye.

Rarely, a complication called an intraocular lens dislocation, where the newly inserted lens will fall out of place. It has to be in the right place, right behind the pupil, to work properly.

The second operation to correct lens aberration is really the only option. The surgeon can put back the same lens or start over with a new lens.

It is important to mark any concerns and to ensure that any questions you have are answered, preferably by the appropriate time before the day of surgery.

I am 76 years old, living with stage 3 chronic kidney disease and was recently told I also have high cholesterol. My GP prescribes atorvastatin, but when I read the leaflet it says ‘talk to your doctor’ if you have kidney problems or are over 70 years old. I did, hoping to discuss the pros and cons, but the response I got was ‘it’s up to you.’ Useless. What do I do?

Statins are cholesterol-lowering drugs — and they’re one of the most commonly prescribed medications to prevent heart attacks and strokes. We used to give them to anyone with high cholesterol, but this has changed.

DO YOU HAVE QUESTIONS FOR DR ELLIE?

Email [email protected] or write to Health, The Mail on Sunday, 2 Derry Street, London, W8 5TT.

Dr. Ellie can only respond in a general context and cannot respond to individual cases or respond individually.

If you have health concerns, always consult your own doctor.

Today, we calculate the risk of a heart attack using a series of factors: age and cholesterol levels would be one, but we also consider what other diseases the patient has, their lifestyle, money family history, etc. Anyone found to have a 10% or higher risk of heart attack within the next 10 years is offered a statin.

One of the things that increases the risk of the disease is chronic kidney disease.

Age, heart disease and high blood pressure can all contribute to a gradual decline in kidney function – and if this drops below a certain level, we call it chronic kidney disease.

This causes some symptoms in the early stages, but problems are often discovered with routine blood and urine tests.

If the problem becomes more severe (there are six stages), the patient can experience a variety of problems, from weight loss, fatigue and swelling of the ankles, feet and hands, to nausea, headaches and itchy skin – all due to the accumulation of toxins. The kidneys normally filter out of the blood.

When we know a patient has a chronic illness, we can monitor them and try to prevent the disease from getting worse, but because drugs are handled by the kidneys, special care is needed – for example, we can Dosage adjustments or switching to more tolerable drugs may be possible. .

In general, statins are fine until later stages of chronic kidney disease, when lower doses may be needed. However, many patients with total renal failure take statins.

A recent analysis of patients taking atorvastatin actually showed that with the drug, kidney function improved over time, possibly due to the beneficial effects of the statin on the blood vessels.

How to make the last wish clear

Last week, I responded to a reader with terminal cancer who asked me if and when he could say ‘no’ to life-prolonging treatment.

I wrote that this is the right of any patient and that they can turn to palliative care in order to make things as comfortable as possible in the end. In response, I have received letters from readers indicating that it is possible to publish your wishes even if you are well.

One document is an Advance Decision to Deny Treatment (ADRT). This allows you to set out how you’d like to be treated if you’re unable to articulate your wishes. You can also make a Living Will and a Statement of Progress. These may be given to your GP or others involved in your care.

The website Compassion In Dying has more details (compaionindying.org.uk).

Male, with mental health concerns? We often talk

Psychiatrist Andres Fonseca announced last week that 60% of people do not share mental health concerns with their GP. He’s not perfect.

In my own experience, many patients tell me about their mental state – but they are almost always women.

Men, and especially middle-aged men, have yet to open up to their doctors. And this is one of the groups most at risk of suicide.

Dr Fonseca says one of the reasons men find it difficult to talk about mental health is that it is often difficult to put symptoms – often just feelings – into words.

My best advice is, don’t call things out. Talk to someone. It doesn’t have to be a general practitioner – although we do want you to come to us. Don’t put a brave face on it. Tell a friend or colleague – anyone – if you feel trashy, low, or sad. Just acknowledging it is often the first step to finding a solution.

Men, and especially middle-aged men, have yet to open up to their doctors.  And this is one of the groups with the highest risk of suicide

Men, and especially middle-aged men, have yet to open up to their doctors.  And this is one of the groups with the highest risk of suicide

Men, and especially middle-aged men, have yet to open up to their doctors. And this is one of the groups with the highest risk of suicide

Source: | This article originally belonged to Dailymail.co.uk



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