IT’S tick season so, if you spend any time outdoors, you should keep an eye out for bites.
The UK Health Security Agency has reminded us to #BeTickAware.
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If you are bitten, remove the tick carefully with good technique, ideally using a tick removal device, which you can get from pet stores, Boots or online. It’s important not to crush the tick or leave parts in the skin.
Check the bite for changes in the following weeks. A “bullseye” rash – circular with a red centre, or more bruise-like on brown or black skin – is a symptom of Lyme disease, which can be spread by ticks.
If you have a rash, flu-like symptoms, nerve pain or drooping of the face, call your GP or NHS 111.
Lyme disease is treatable with antibiotics and symptoms resolve within a few weeks. But if the disease has progressed, it may take longer to clear.
A rare few face lifelong symptoms, sometimes severe. Ticks that may cause Lyme disease are found UK-wide, particularly in grassy and wooded areas in southern and northern England and the Scottish Highlands.
Meanwhile, here’s some of what readers asked me this week . . .
Tests OK but I’m constantly peeing
Q: I’VE been peeing all the time, with a burning sensation, for more than two weeks now.
Two urine samples have come back clear, as has my PSA test. My prostate is a little bit large, but OK.
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I’ve got tablets to relax the prostate muscles but nothing is working yet.
I’m getting desperate now. I can’t really go anywhere because of the constant need to pee.
A: There are several potential reasons for increased urinary frequency, accompanied by a burning sensation, in a man.
Bladder-outlet obstruction can cause these types of symptoms.
This means that the urine is obstructed in some way, so it is unable to pass freely from the bladder through the urethra – which passes through the prostate – and then out of the penis.
An enlarged prostate is the most common cause, but bladder stones, narrowing of the urethra or tumours can also cause obstruction.
Do you have difficulty starting to pass urine, straining when you pee, or a weak or interrupted stream? Do you have a feeling your bladder isn’t fully empty after peeing? Or do you leak urine after you’ve finished?
These symptoms could all point towards an obstruction.
Prostatitis is another potential cause of your symptoms.
This is inflammation of the prostate gland, which can also be painful.
It can be acute, meaning that it comes on suddenly and severely – or chronic, meaning that it lasts for a long time and tends to come on more gradually or can come and go.
Finally, it is possible to have a urinary tract infection (UTI) with a normal urine test, especially if you have been taking antibiotics, as this can lower the bacterial count in the urine.
FIVE-YEAR-LONG COUGH
Q: I AM a 58-year-old male and have had a cough for about five years now. Is this just an age thing?
I don’t smoke, I gave up when I was 28, and I didn’t really smoke that much back then.
The first time I saw the doctor, I got some amoxicillin tablets, which didn’t help.
The second time, I got more antibiotics from the doctor, which also didn’t do anything.
Sometimes when I cough, I bring up thick, green phlegm.
I have not had any problems with my lungs, although I do have asthma.
Could you possibly give me any ideas? It’s driving me nuts.
A: This cough sounds very annoying for you, especially as it’s been going on for so long.
But the fact that it has been there for five years and you’re still well is a reassuring sign that the cause is not something sinister.
The fact you were a mild smoker over 30 years ago would not likely be the cause.
After stopping for ten years, a person’s risk of lung cancer is reduced to about half that of a person who continues to smoke.
And after 15 years, risk of coronary heart disease approaches that of someone who has never smoked.
While some form of lung infection or disease does present itself as the most obvious cause of a cough, there are other organs and systems in the body that can actually cause a long-term cough, too – for example, post-nasal drip, which is excess fluid production at the back of the nose, that drips down the throat and irritates the airways.
If this is the problem, you could try a three-month course of nasal steroid spray from the pharmacy.
Another example is gastric-reflux disease. This is when acid is not properly contained in the stomach and can make its way into the oesophagus and irritate the airways.
So, alternatively, you could try a two-week course of over-the-counter antacid tablets.
The diagnosis of a long-term cough is not always straightforward, and your GP will be able to ask lots of other questions to better help decide what is more likely and if further investigations are necessary.
A chest X-ray is important for anyone who has had a cough, which doesn’t have an obvious cause, for longer than three weeks.
Unbearable pain in cheek
Q: I’VE got osteonecrosis in my cheekbone. The pain is unbearable, constant and feels like a toothache.
I was taking oral morphine but the doctor took me off this – and tapentadol, which was morphine- based – because he said I was taking it for too long. I’ve now got no medication.
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I queue on the phone for the doctors every day and it’s always, “Call back tomorrow morning, nothing is available”.
This has been going on for weeks now.
Is there anything I could get from the chemist that is strong enough for my need?
A: I’m so sorry to hear that you have been going through all this. Osteonecrosis of the cheekbone (maxilla) is a rare condition where bone cells actually die, usually due to a lack of blood supply.
Risk factors include certain dental procedures as well as facial fractures from trauma to the face.
Biphosphonates are a type of medicine used to treat osteoporosis, and a rare side-effect can be osteo-necrosis of the upper or lower jawbone.
Other medicines include those used in cancer treatment, and long-term use of high-dose oral steroids. Sickle cell disease, diabetes and Gaucher disease can also increase risk of osteonecrosis.
The predominant symptom, as you described, tends to be pain, which can be severe.
Other complications can include increased risk of loose teeth, swelling of the mouth and gums and poorly healing oral wounds.
It certainly sounds like you do need to have your pain relief assessed, urgently.
While there are rightly significant concerns regarding taking opioid medication long-term, equally, in those who are taking it, it should not be stopped suddenly.
If you can’t get a GP appointment, it’s advised you contact NHS 111.
Explain your symptoms and situation to them so that they can ensure you at least receive some pain relief within a timely fashion.
When your GP is able to see you, please attend the appointment to start to figure out a longer-term plan for managing the pain.