Q: My three-year-old granddaughter was diagnosed with hypermobility since birth. It affected her walking momentum but she was caught.
The problem is that she now breaks down several times a day. We wonder if the hypermobility is to blame.
Name and address provided
A: Thanks for writing – hypermobility is a common problem but the medical world has little understanding of it. As a result, many people are left with some stress due to their symptoms, which include overstretched skin, stiff joints, pain and intestinal problems.
Basically, hypermobility is a problem with sensitive tissues – including cartilage and collagen – that act as glue to hold the body together. In some people, the proteins in these connective tissues are faulty.
The most common form is Ehlers-Danlos syndrome – which has 13 different subtypes and affects the skin, ligaments, tendons, blood vessels and connective tissue that supports bones.
Most children are hypermobile to some degree thanks to the flexible nature of the tissues, but some have symptoms of the disease such as joint and muscle pain, low muscle tone and weakness that affects their motor skills (eg sitting, crawling and walking). ). Flat feet can also be a symptom.
Bladder and bowel problems are not uncommon in children with hypermobility. This may be the result of a weakened rectal tube that controls the passage of stool, which is part of the general weakness of the pelvic floor muscles.
In recent years, it has become clear that bladder and bowel problems are not so common. This may be the result of a weakened anal canal, which controls the passage of stool, which is part of the general weakness of the pelvic floor muscles.
Muscles and other tissues in the gut can be damaged, possibly helping to explain the abdominal pain, bloating, constipation, heartburn and vomiting experienced by hyperactive people.
Many children improve as they grow. However, given your granddaughter’s early diagnosis and current bowel problems, it’s important to have regular checkups with a pediatrician who knows her condition.
Q: I am 79 years old and had an attack of shingles three years ago. It cleared up, but the skin around the infected area became sensitive and seemed to be getting worse.
Brian Walker, Stockport
A: You have post-herpetic neuralgia, a complication of shingles (also known as herpes zoster) – the pain is the result of nerve damage.
Even if the shingles viral infection clears up (usually within six weeks, but sooner if antiviral drugs such as acyclovir are prescribed), residual pain is a common problem in elderly patients, affecting one in five of 70 people.
Because the inflammation caused by shingles can cause fibrosis (scar-like damage) of the nerves affected by the virus, even after the inflammation of the infection has stopped.
Pain that lasts for three months or more is defined as post-herpetic neuralgia. It can also cause pain, burning, itching and stinging which can be constant or non-stop. Many sufferers complain of pain at the slightest touch.
The most effective drugs are gabapentin, pregabalin and tricyclic antidepressants that work on nerve pain.
The key to success is to start with a low dose and gradually work your way up to a higher dose.
I take gabapentin or pregabalin and see patients every week, from 75mg to 150mg daily, and then to 300mg.
If there is no change after a month or six weeks, I go to amitriptyline – an antidepressant, order 10mg, increase the dose every month.
Although dry mouth and insomnia are common side effects, the drug is effective at about 70mg daily.
If your GP is not prepared to manage this type of treatment, ask for a referral to a pain clinic.
In my view… some good news for older women
While sometimes lamenting how patient care is changing, sometimes it works for the good of all.
Take the way patients could previously buy prescription drugs from a pharmacy. This now includes Ovesse cream, an effective treatment for vaginal dryness due to menopausal tissue thinning.
There are many other invaluable treatments that pharmacies can offer over the counter, such as eye drops for conjunctivitis (chloramphenicol) and fluconazole tablets for constipation, increasing the client’s comfort and reducing the GP’s workload.
But I worry that recent changes will make antibiotics available this way.
Although pharmacists are very limited in the medications they offer (including prescribed treatment days), they cannot, for example, perform a blood test to confirm that an infected tonsil is the first sign of glandular fever.
Instead, it’s guesswork that causes the pills to be over-prescribed, increasing antibiotic resistance. This policy should not be extended further.
- Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email drmartin@ dailymail.co.uk – include your address details. Dr Scurr cannot access personal correspondence. Always consult your own GP for any health issues
