DR ELLIE CANNON: Why do I get pain in my armpit during a strenuous bike ride?

I often suffer symptom successful my near armpit, peculiarly erstwhile I locomotion uphill aliases rhythm hard. My GP thought it mightiness beryllium angina and I’ve had tests, and my bosom and arteries person been fixed a cleanable measure of health. Any ideas?

Pain which occurs connected exertion does make america deliberation of a bosom problem. But erstwhile this is ruled out, I’d look astatine musculoskeletal causes – peculiarly if location is discomfort resulting from other activity aliases strain connected nan shoulder, thorax wall aliases arm, connected cycling and strenuous walking.

This whitethorn beryllium a musculus symptom aliases a problem wrong nan enarthrosis associated itself. The near armpit contains lymph nodes aliases glands, which tin swell, arsenic tin sebaceous cysts – mini infected lumps, aliases lipomas, which are small lumps of fat.

It is important a expert carries retired an introspection to guarantee that a swelling successful this area is not causing nan problem.

More wide swelling tin consequence from exercise, and this could beryllium why nan symptom worsens connected these movements. One curen action would beryllium to effort an anti-inflammatory gel aliases cream, which would beryllium effective only if it was a section musculoskeletal rumor alternatively than thing deeper.

As an aside, I’m often reassured it’s not thing sinister if nan discomfort has been nan aforesaid for a agelong clip and has not worsened.

For much years than I attraction to retrieve I’ve suffered from diverticulosis. I don’t person immoderate symptom but immoderate days I request to quiet my bowels much than 10 times. Always having to beryllium adjacent to a loo dictates my life. Do you person immoderate advice?

Bowel symptoms, peculiarly nonaccomplishment of control, are distressing and difficult to unrecorded with. Sufferers are often forced into isolation, staying astatine location alternatively than risking being caught short.

Diverticulosis causes small pouches successful nan little bowel, which tin go inflamed. Pain and diarrhoea, bloating and constipation tin beryllium common.

In position of diet, eating nan correct magnitude of fibre and drinking plentifulness of h2o are key. Both thief to support things moving. But expanding fibre tin besides trigger bloating, upwind and urgency successful immoderate patients, successful which lawsuit doctors propose trying a low-fibre (not no-fibre, though) diet.

That intends limiting things that are harder to digest, specified arsenic onions, nuts and seeds, consequence and veg skins, wholegrain breadstuff and cereals for a fewer weeks, past gradually adding those backmost in.

People who are simply incapable to tolerate fibrous foods mightiness use from a fibre supplement. Pharmacists tin counsel connected this.

Loperamide tin beryllium utilized for nan diarrhoea but only arsenic an occasional treatment.

An anti-spasmodic tablet tin besides beryllium prescribed for diverticulosis. It tin thief nan bowel to relax and not compression truthful much, and whitethorn consequence successful less bowel movements.

Urgently rushing to nan toilet aft eating whitethorn not beryllium related to diverticulosis but beryllium a denotation of different issue, specified arsenic lactose intolerance.

It would beryllium worthy keeping a nutrient diary for a week to spot if immoderate foods make nan urgency worse. And use for a Just Can’t Wait paper from Bladder and Bowel UK to thief you swiftly entree toilets successful cafes, restaurants and shops erstwhile you are retired (bbuk.org.uk).

 I was precocious prescribed melatonin to thief pinch sleepless nights. It helped but I was told by nan GP that I could person only a three-month supply. Why?

Melatonin is simply a slumber assistance prescribed for short-term insomnia successful nan over-55s. We cannot prescribe it for longer than 12 weeks because while studies person recovered short-term usage is safe for astir adults, much investigation is needed to corroborate its longer-term safety.

Insomnia is an tremendous rumor successful nan UK pinch millions affected. Although doctors handed retired sleeping tablets for decades we cognize now that this was not effective. The tablets do not activity for galore group and successful a ample number origin addiction. Younger group are not fixed melatonin for sleeplessness.

The champion measurement of dealing pinch sleeping problems is to acquisition slumber therapy, including cognitive behavioural therapy. It is disposable connected nan NHS via nan GP successful group and individual settings, aliases online aliases via an app.

Sleep regularisation therapy is besides worthy exploring pinch nan GP. This astatine first involves getting into furniture astatine nan latest imaginable clip to get nan mean magnitude of slumber you presently get.

So if you usually get only 4 hours’ slumber and person to aftermath up astatine 7am, you would spell to furniture astatine 3am. After a fewer days you group your bedtime to get 5 hours’ sleep, and truthful on. It takes committedness but does work.

Sleep therapy should not beryllium confused pinch slumber hygiene –something everyone pinch slumber problems should undertake – but unsocial it is not treatment.

This involves creating nan champion situation for slumber utilizing measures specified arsenic receptor plugs, telephone avoidance and a calm, cool chamber to slumber in.

Are you honorable astir really overmuch you drink?  

Over nan past week location has been a flurry of worrying investigation published connected nan harm caused by intoxicant – pinch moreover conscionable 1 solid of vino a time putting america astatine higher consequence of crab and liver damage.

I wonderment sometimes whether my patients are wholly honorable pinch maine erstwhile I inquire them really overmuch they drink.

So I’d for illustration you to constitute to maine and fto maine know. Do you, aliases personification you know, seldom spell a time without alcohol? Do you often find yourself drinking much than intended?

Please email maine – successful assurance – connected nan reside provided below.

We’re champion placed connected sick notes

Much has been said by my GP colleagues astir sick notes since nan PM announced a scheme to extremity america handing them out.

Many invited nan move, saying they don’t person nan clip anyway. But I disagree.

I deliberation GPs are nan correct group to connection this service. Time disconnected activity is simply a valid portion of treatment, and I’d alternatively my patients recuperate decently than effort to struggle on.

In my experience, fewer inquire for notes they don’t need. In fact, I often meet guidance erstwhile I propose taking clip off.

I’m not saying nan strategy isn’t abused – I’m not naive – but a one-size-fits-all attack is not nan answer. When practices usability well, GPs tin guarantee group don’t extremity up connected semipermanent leave. Properly resourced physio, psychology and symptom clinics would besides extremity patients needing notes.

Do you person a mobility for Dr Ellie Cannon? Email DrEllie@mailonsunday.co.uk

Dr Cannon cannot participate into individual correspondence and her replies should beryllium taken successful a wide context.