DR ELLIE CANNON answers 50 questions we all want to ask a GP

Whatever happened to the Family Health Encyclopaedia – that doorstep-sized tome everyone had on their bookshelves that listed just about every ailment you and your kids were ever likely to have, and how to treat them?

They were written by teams of doctors, and put out by the Royal College of GPs, the British Medical Association, and other trusted organisations. And they were a resource you could really rely on.

But today most are out of print and instead we go online when we get a new symptom, be it a rash, lump or bump, a horrible infection or have an accident, to ask Dr Google.

In fact, eight in ten people now get health information via internet search engines, and almost half of us use them to look for specific treatment advice.

I fear there will be some with serious conditions going undiagnosed, and others falling into that Dr Google trap, and misdiagnosing, or mistreating their ailments, writes Dr Ellie Cannon

I fear there will be some with serious conditions going undiagnosed, and others falling into that Dr Google trap, and misdiagnosing, or mistreating their ailments, writes Dr Ellie Cannon

Despite worries about cyberchondria (the name given to the anxiety caused by self-diagnosing problems via search engines) and fake health news, I think the internet has on the whole had an astonishingly positive impact on public health.

With a few strokes of a keyboard, patients can arm themselves with up-to-date health advice, and the latest medical research. This can be empowering – and liberating. But there are pitfalls, too. A study published earlier this month found that search engines give an ‘inaccurate diagnosis’ about a third of the time.

And that’s unfortunate, given that easy access to reputable health advice is more important than ever right now.

As I wrote last week, GP services are very much open for business, and have been throughout the crisis.

Of course, things are different. The majority of our appointments are now via video calls, and prescriptions are filled out online.

I have been among the first to criticise the relentless march to ‘digitising’ healthcare, as I feared it would leave many of my older, or more vulnerable patients behind.

But in fact, they’ve been the most avid adopters of these changes – and are delighted that they can now get appointments the next day, on the comfort of their own sofa, rather than wait weeks to then sit for hours in a crowded waiting room.

Specialist services such as skin clinics and physiotherapy are suspended, and there is a pause on screenings for cervical, breast and prostate cancer.

GP services are very much open for business, and have been throughout the crisis (file photo of a doctor working in the office and listening to a patient)

GP services are very much open for business, and have been throughout the crisis (file photo of a doctor working in the office and listening to a patient)

However, we are still monitoring patients on the blood-thinning drug warfarin, reviewing sick children and seeing patients with extreme stomach pains.

And we’re still providing face- to-face appointments for those who cannot access video consultations or with urgent complaints.

Despite this, though, numbers contacting GPs are down across the UK. Surveys suggest that many people are reluctant to ‘bother’ their doctor and use up valuable NHS resources.

This is, of course, a worry, as I fear there will be some with serious conditions going undiagnosed, and also others falling into that Dr Google trap, and misdiagnosing, or mistreating their ailments.

And, with this mind – if you won’t, or can’t, go to the GP – I’ll bring the GP to you.

Over the following eight pages, you’ll find my vital guide to coping with all of your family’s health problems at home.

Routine health checks aren¿t happening right now, making it more important than ever to ensure that you¿re in good health (file photo of an elderly woman checking her blood pressure)

Routine health checks aren’t happening right now, making it more important than ever to ensure that you’re in good health (file photo of an elderly woman checking her blood pressure)

This includes answers to 50 questions I’m most often asked in clinic – from how to handle bad backs and sore knees, to spotting the symptoms of a chest infection, treatments for painful headaches and eye problems.

In case you are faced with an emergency, we’ve included an easy-to-follow basic First Aid guide, which includes up-to-date advice for minimising Covid-19 risk, should it be someone outside of your family that you’re attending to.

And, as routine health checks aren’t happening right now, making it more important than ever to ensure that you’re in good health, we’ve provided a guide to giving yourself a full-body MOT.

Consider this package your very own Family Health Encyclopaedia – an invaluable resource that’ll safeguard your health, and the health of your loved ones.

At a time when NHS provisions may seem sporadic, it’s vital for every patient to know what they can do to help themselves – and of course, when it’s time to seek help…

HEADACHES AND OTHER PAINFUL PROBLEMS

It¿s worth knowing that dehydration and stress are both very common headache triggers (pictured: illustration of a person with a headache)

It’s worth knowing that dehydration and stress are both very common headache triggers (pictured: illustration of a person with a headache)

1. Is it safe to take painkillers every day for a headache – and what’s the best type?

Headaches have many causes – and often they’re surprising. Headaches in the morning can be a result of jaw-clenching and tooth-grinding while we sleep. Both of these are a result of stress.

Dehydration is another culprit, and if the headache is worse when bending forwards, it may indicate a sinus infection.

It is safe to take painkillers for a few days, but if you need them every day for a week or longer, you should speak to your doctor and try to work out what’s behind the problem.

Painkillers every day can actually worsen the problem – a condition called medication-overuse headache.

Alternate between paracetamol, ibuprofen and aspirin, and try resting without any painkillers, to avoid making things worse.

Ibuprofen and aspirin can irritate the stomach, so if you are taking them regularly, ensure it is with meals.

It’s worth knowing that dehydration and stress are both very common headache triggers.

2. Can I take ibuprofen and paracetamol together for my arthritis pain?

Paracetamol and ibuprofen can be safely taken together.

The usual daily dose for paracetamol is 1g (two tablets) four times a day. For ibuprofen, it is 400mg (usually two tablets) three times a day with food for an otherwise healthy adult.

Paracetamol and ibuprofen can be safely taken together. The usual dose for paracetamol is 1g (two tablets) four times a day (pictured: file photo of paracetamol tablets)

Paracetamol and ibuprofen can be safely taken together. The usual dose for paracetamol is 1g (two tablets) four times a day (pictured: file photo of paracetamol tablets)

Combining medications is a sensible way to control pain, and taking them regularly when you have a flare-up is a good way to keep moving, which is also vital.

Alongside painkillers, applying ice to joints is a great way to ease the pain, particularly if they are swollen as well, as is using rub-in treatments from the chemist.

3. I have awful toothache, but the dentist is closed. What should I do?

Toothache will usually go within a few days with no treatment. Take regular painkillers for a few days and ensure strict dental hygiene with chlorhexidine mouthwash and regular brushing. Ibuprofen or aspirin are good for dental pain.

At the moment, dental services are available via 111: the dentist can consult on the phone or via video. They may be able to prescribe and treat you remotely.

4. I keep getting random nosebleeds. What’s the best way to stop them?

Most nosebleeds are not a sign of anything serious and can be treated at home. Sit down, and pinch your nose, just above the nostrils and hold for ten minutes. Try to lean forward while doing this, to stop the blood draining back into your throat.

Once the bleeding has stopped, stay upright – don’t lie down, as this will increase the blood pressure inside your nose – and put a bag of frozen peas on the bridge of your nose. This causes the blood vessels in the nose to contract, preventing another bleed.

The lining of the centre of the nose is fragile and can break and bleed, particularly with nose-blowing, dry rooms or if you take blood-thinners. Often new nosebleeds are caused by an infection in the lining of the nose. An antibiotic cream on prescription is needed to treat that. If they are happening regularly, talk to your doctor. It is rare, but they can be a result of high blood pressure, so it is worth taking your blood pressure at home.

5. What cream should I put on a painful burn?

None. If your burn is mild enough to be treated at home, you shouldn’t need to use a cream, as they can cause your skin to become irritated – not what you want in addition to the burn.

Just run the burn under cool water for 20 minutes, then cover with clingfilm to keep it clean. Don’t wrap it, as this can constrict the burn and that’ll hurt more.

Run the burn under cool water for 20 minutes, then cover with clingfilm to keep it clean

Run the burn under cool water for 20 minutes, then cover with clingfilm to keep it clean

You can keep the clingfilm in place with a bandage.

To deal with any pain, you can take paracetamol or ibuprofen.

Most minor burns heal with minimal scarring within one to two weeks. Do not burst any blisters.

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COUGHS, COLDS AND HOW TO TACKLE A FEVER

6. How long does it take to recover from a cough or cold, and when do you need antibiotics?

At the moment, any new cough, high temperature or loss of sense of smell should be treated as a warning sign for coronavirus, and the advice is to self-isolate for seven days, or longer if symptoms persist.

Patients should also go to the NHS 111 website, as a Covid-19 test might be indicated. But in general, one of the most (if not the most) common thing I see in clinic is someone concerned that a cough, runny nose and excess phlegm have not cleared up after two weeks. A bad upper respiratory tract infection will often take two weeks or more to clear, and for a patient to feel back to normal.

In any case, antibiotics are rarely prescribed. These drugs kill off bacterial infections, not the viral ones responsible for most coughs and colds.

Instead, ask your pharmacist for advice about effective cough medicine – detailing whether your cough is dry or mucus-heavy. Otherwise, the best remedies are boring but effective: ample rest and plenty of fluids. But if you begin to have difficulty breathing, call your doctor. Very occasionally a lingering cough indicates an underlying condition or secondary infection, so call the GP if you’re still coughing after three weeks, just in case.

7. What colour is your mucus if you have a chest infection?

Forget the widely held belief that green phlegm means you need antibiotics. A change in mucus colour tells you nothing about your infection – unless you have chronic lung disease. It simply means the immune system is fighting the infection by deploying plenty of fighter cells, which range in colour.

The only way to diagnose a chest infection is via a GP examination or a chest X-ray. Blood or a brown stain in the mucus could indicate a serious infection, as well as other problems. If you have a stain this colour, call your GP.

8. I don't have a thermometer. How can I tell if I have a fever – and what should I do about it?

If your forehead is hot to the touch, or if you have rosy, flushed cheeks and a faster-than-normal pulse, these are signs that you have a high temperature. It’s your body’s response to common infections, including a flu, tonsillitis, urinary tract infections and, of course, coronavirus.

Obviously, these will also come alongside feeling generally unwell: fatigued and not yourself.

Having said that, it’s a really good idea to have a thermometer – especially now, as a persistent high temperature can be a warning sign that Covid-19 is not getting better. Choose a digital one, as these are more accurate. Most fevers – a temperature of more than 37C – subside after a few days. Rest, plenty of fluids and paracetamol or ibuprofen are the main treatments. Symptoms that worsen, or new ones developing, are signs you should seek help.

Child fevers and tummy troubles

9. What's the best way to deal with my toddler’s fevers?

Having a distressed child with a fever can be extremely worrying. But it is a common problem and, in most cases, it is not serious.

My first advice is: don’t panic. Most children will have high temperatures – over 37.5C – three times a year. And the fever may persist, even for a few days.

If the child seems happy and they are drinking enough fluid to keep hydrated, it’s likely they’ll be fine.

Most children will have high temperatures ¿ over 37.5C ¿ three times a year

Most children will have high temperatures – over 37.5C – three times a year

The main treatment would be a liquid paracetamol to bring the temperature down but that’s not essential.

So how do you know if it’s morphed into something more serious? Watch how often they drink and go to the toilet. If they’re not drinking or passing urine and are more drowsy or floppy, call NHS 111 – this could be more serious. Other red flags include headaches accompanied by pale, cold or mottled skin, a dislike of bright lights and irritability. These could indicate meningitis. 

Parents often think a rash that disappears if a glass is rolled over it is the main sign for meningitis – but by the time this occurs, the infection may already be quite advanced.

And what about dreaded stomach pains? Typically, the problem is constipation and related to diet. Add in plenty of water or fruit juice, lots of dried fruit and wholemeal bread to get them moving.

Less common are occasional bouts of diarrhoea, which you should keep an eye on.

Keep a food diary for a couple of weeks to watch for any triggers. Rarely, the stomach pain is paired with weight loss, a swollen belly, poor appetite or persistent diarrhoea – in these cases, call your GP.

If the pain is sudden and moves from the centre to the right, call NHS 111 – this is the telltale sign of appendicitis.

10. What is the best way to manage vomiting in adults?

The most common cause of vomiting in adults is a stomach bug, that will be either bacterial or viral.

It usually stops after one or two days. Drink small amounts of clear fluid, or rehydration fluids, which can be purchased from a pharmacist.

Once the vomiting has stopped, after about 12 hours, try some bland food such as a dry, plain biscuit or toast. Vomiting bugs can be infectious, so make sure you thoroughly clean all areas that have been in contact with vomit. 

11. What should I eat to settle nausea?

Ginger is a known anti-sickness remedy, so you could try sipping ginger tea and taking small bites of ginger biscuits.

Everyone in your household should also be extra-careful about hygiene and hand-washing. Vomiting can be a sign of something serious such as meningitis, and if a vomiting lasts for more than an hour, and doesn’t provide relief, or is accompanied by severe headache, call your GP.

12. What do I do about tonsillitis?

Tonsillitis, an infection in the throat, is pretty easy to spot – look for the telltale white spots on the two fleshy nodules at either side of the back of the throat. These nodules, the tonsils, are bright red when infected. It might be painful to swallow, and you’ll probably have a fever too.

Paracetamol or ibuprofen will help manage the pain, and gargling with salt water – a natural anti-inflammatory – will help.

Gargling for three to four minutes with soluble aspirin can also provide relief and can be used alongside other painkillers, but take care not to swallow it.

If tonsillitis persists, then the antibiotic penicillin may be prescribed.

13. How often should I update my asthma inhaler prescription?

Make sure you¿re using the inhaler properly ¿ helpful videos can be found on the Asthma UK website (file photo of a Ventolin inhaler)

Make sure you’re using the inhaler properly – helpful videos can be found on the Asthma UK website (file photo of a Ventolin inhaler)

Symptoms are the best guide to the strength of medication you need. If you’re using a blue inhaler every day – for immediate relief from symptoms – it’s probably time for an update. This is also true if you can’t exercise for as long as usual without getting breathless.

But before you make any changes, make sure you’re using the inhaler properly – helpful videos can be found on the Asthma UK website.

14. I take an antihistamine tablet every day for my hay fever. Is this safe?

Patients don’t believe me when I tell them they can take antihistamines every day of the year.

For those with severe hay fever and other allergies that are active all year round, these daily tablets can be a life-saver.

If one stops working, switch to another over-the-counter type – the pharmacist can help with this. I’d also recommend buying a saline nose spray from your local pharmacy, as it washes away pollen.

ACHY JOINTS, BAD BACKS AND BROKEN BONES

15. My knee is in agony! Is it because I’ve started jogging or could it be something serious?

Knee pain is common – and there are a range of causes. It can be related to an injury, including damage to the soft tissues within and around the joint, which is easy to do when throwing yourself into a new exercise regime.

This kind of pain is frequently one-sided.

Often, it’s minor. Rest and using a cool compress – an ice pack or bag of frozen peas wrapped in a tea towel – will help. Try to keep your bad knee elevated, as this means the circulation won’t have to work against gravity, meaning swelling will be minimised.

Intense pain on movement, or when resting, instability and swelling that doesn’t go away with a few days of rest might indicate a problem that needs medical attention.

Knee pain can also be a symptom of osteoarthritis, but this is more often in both knees, and will usually be worse in the morning.

This is also common, from middle age onwards, and can be tricky to treat – excess weight is a big exacerbating factor, so weight loss and, paradoxically, keeping as active as possible are the best ways to reduce pain.

16. I can't move my right shoulder, it’s too painful. What have I done?

This is what’s known as a frozen shoulder: it’ll be painful all the time and stiff, particularly if you try to reach up. It happens when the capsule around the joint becomes thickened, and tight, restricting movement.

We’re not sure why it happens, but it’s more common in those over 40 and two-thirds of patients are women.

Keep moving and use anti-inflammatory tablets and ice packs to relieve the pain. Learn how to sit properly, not slouching and with your shoulders gently back (file photo)

Keep moving and use anti-inflammatory tablets and ice packs to relieve the pain. Learn how to sit properly, not slouching and with your shoulders gently back (file photo)

Diabetics are more likely to suffer a frozen shoulder – again, we don’t know why – as are those who’ve had recent arm surgery, or suffered a fracture.

Physiotherapy is key. You can self-refer locally via the NHS, via your GP, or go private. You can also find correct exercises online – the charity versusarthritis.org has a comprehensive booklet on shoulder pain. Keep moving and use anti-inflammatory tablets and ice packs to relieve the pain. Learn how to sit properly, not slouching and with your shoulders gently back.

17. I’ve had lower back pain for two weeks now. Will it ever go away?

Lower back pain happens to almost everyone, and for most it resolves without medical help.

As with knee pain, and all other joint problems, it can come on after a single incident, twisting or lifting something, or just build over time.

The trick is to keep moving, so try using gentle exercises you can find online at versusarthritis.org. You have to stick at it, doing them every day for weeks, ideally even once your symptoms have gone.

If it’s bad, take painkillers regularly each day so you can move normally. Immobility or moving unnaturally – what we call compensating movements – to avoid pain can make matters worse. Combine that with heat packs or rubs on the area. Any leg weakness, numbness or changes in your bowel or bladder are an urgent reason to seek medical help. Simple back pain usually starts to improve within two to three weeks.

18. I’ve noticed my hearing is much worse in one of my ears. What’s the best way to clean them out, and could they need syringing?

Wax blocking the ear is a very common cause of hearing loss on one side – and can be quite annoying.

Never use cotton buds, which jam it in. Instead, try a wax-removing drop from the pharmacist – they contain oils or hydrogen peroxide, which both soften the wax, allowing it to pass out naturally.

If you've got a blocked ear, never stick anything into it.. however much you're longing to

If you've got a blocked ear, never stick anything into it.. however much you're longing to

A word of warning: it may take two weeks.

If it persists, the two options are ear irrigation, a newer, safer version of syringing, which involved a machine, or microsuction, which gently sucks out the wax. Not all GPs offer these, so you may have to go private.

19. I've twisted my ankle and can barely walk. What shall I do?

Twisting an ankle pulls the ligaments in the joint, damaging them, and resulting in pain and swelling.

The answer is rest, ice, compression and elevation.

Rest as much as you can with little or no weight being put on the joint. Ice the joint with frozen peas or an ice pack for 15 minutes four times a day. Compress it with a bandage from the pharmacy to support it. As much as you can, keep it elevated to reduce swelling.

Paracetamol is best for pain in the first few days after a twist.

20. Why am I getting leg cramps at night?

Leg cramps are normally

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