I have had a cough for years. It’s there, to some extent, nearly every day. Mostly it’s dry but occasionally it’s so severe it feels like I’m choking and bringing up bile. I’ve had numerous scans, blood tests and even had a camera inserted to have a look around. I’ve been given nose sprays, antihistamine tablets and an inhaler. My GP has more or less said that there is now nothing more that can be done. Can you help?
Getting to the bottom of a chronic cough can be very tricky. It is also a distressing symptom for you to have to endure every day, particularly as you don’t know what is causing it.
The first places doctors tend to investigate are the upper airways or lungs, for conditions such as allergies, asthma, nasal problems and even lung cancer, but if these are fully explored and nothing is found, things can get tricky.
Medications can cause a cough – for instance, an ACE inhibitor for blood pressure such as lisinopril or ramipril. Discuss with the GP whether it could be a side effect and if switching to another drug might help.
A chronic cough can also be related to acid reflux, where small amounts of stomach acid leak upward into the oesophagus, irritating the throat. If this is a problem, people often find they wake up coughing in the middle of the night, because it’s easier for the acid to travel the wrong way when lying down.
I have had a cough for years. It’s there, to some extent, nearly every day
Acid reflux may not be seen on an endoscopy – when a camera is passed down the throat and into the stomach – but may still cause symptoms. It’s worth a two-week trial of an over-the-counter medication to suppress the acid, such as omeprazole, to see if the cough reduces.
It is also worth discussing with your GP medications that have already been tried before, such as antihistamines, as often people do not take these for long enough or at a high enough dose to have a decent effect.
I suffer from mild rosacea on and around my nose. I’ve managed to keep it in check with various gels, creams and antibiotics, but for the past three months it’s become really bad. My nose is sore, swollen and red, and looks horrendous. Is there anything you can suggest that might help?
People with rosacea experience redness or flushing of their face, alongside spots, broken blood vessels and inflamed skin that may appear like acne. Other symptoms include burning or stinging skin and sore eyes.
Patients often find there are triggers that worsen it, including sunlight, wind or heat waves and spicy foods.
Alcohol, stress and exercise can also make rosacea worse. As can medications, particularly calcium channel blockers, which are used to treat high blood pressure, and steroid creams.
Some people find that using a high SPF sunscreen helps, and sunglasses can ease sore eyes.
There are also green-tinted moisturisers available in many high street chemists which can help to reduce the appearance of the redness somewhat. A dermatologist can prescribe brimonidine, also known as Mirvaso, for redness, but this should be used with care as it’s been reported that once it wears off, for some people the redness can come back with a vengeance.
Ivermectin cream is used to treat the spots.
Doxycycline is the first-line antibiotic used for the condition. If it is no longer working or the skin is particularly swollen, a switch to another antibiotic may be appropriate.
I’ve always been a good sleeper, but recently I keep waking up at about 4am with terrible panic and anxiety, and then struggling to go back to sleep. My mind feels like it won’t quieten. What’s odd is that I rarely feel anxious or worried about anything during the day. Do I need sleeping pills?
I’ve always been a good sleeper, but recently I keep waking up at about 4am with terrible panic and anxiety, and then struggling to go back to sleep. Do I need sleeping pills?
Sleeping pills are rarely the answer to insomnia, except in the very short term.
Waking up in this way could certainly indicate an anxiety or stress problem, but it may also be a sign of other issues.
People can wake up early in this way due to the menopause, which causes body temperature to fluctuate, and depression. Or it could be something in the environment causing it, such as sunrise during the summer at around 5am or before – if the curtains can’t keep out the light, this might wake some people.
An eye mask and ear plugs are worth trying. Also, making sure the hours before bed are as relaxing as possible – so no exercise, social media use or checking emails.
If your mind is racing about something specific in the small hours you could try a method of adopting some ‘worry time’ earlier in the day. This is a technique used for anxiety, where you set aside time in the day to consider and write down your concerns. This gives them air time, so you are not suddenly thinking about them later on.
It is also an option to leave a pen and notepad by your bed, so when you wake up in the middle of the night and find you feel worried, you can write down your concerns to acknowledge them.
Lost for words after a stroke
Take a moment this week to watch a powerful documentary from the Stroke Association – When The Words Away Went.
It follows three stroke survivors who developed aphasia – a loss of speech and difficulty with writing and understanding language – as they try to rebuild their lives. Aphasia can also be caused by other conditions that damage the brain.
For instance, Hollywood star Bruce Willis retired from acting last year saying he had aphasia, and in February revealed he had been diagnosed with dementia.
It is a very upsetting problem. Sufferers say that people often assume they are drunk, and the impact that the inability to speak has on socialising and interaction is also profound.
The documentary is streaming now on Channel 4 (channel4.com) and on the Stroke Association website (stroke.org.uk).
Your holiday isn’t a reason to make an urgent drug request
Take repeat prescriptions. In most practices you can order them in person, online or from the pharmacist
It feels like there’s always a new strategy or idea being floated by Ministers as a solution to the NHS waiting list crisis. Last week we were told we might be able to jump the never-ending queues by ‘shopping around’ – using the NHS app to choose a hospital with the shortest wait for that vital op.
But there’s another issue I doubt politicians will touch, so I will. Patients – not all, but some – are an overlooked part of the problem. Take repeat prescriptions. In most practices you can order them in person, online or from the pharmacist. It’s done electronically and couldn’t be simpler. So why am I being asked, regularly, for urgent prescriptions because people are travelling on holiday the next day?
Of course, doctors will do it for them. But urgent requests mean others then have to wait. It’s thoughtless behaviour. If you’re organised enough to book a holiday, surely you can be as organised with your medicine.