Ask the doctor - aches and pains

Exercise hurts my face

After 30 minutes' walking, I get a severe pain spreading from under my ears to my gums, teeth and cheeks. How can I prevent this?

Facial pain can have a number of causes, and it's important to have a full check-up with your doctor. It may, for example, be a variant of migraine, due to inflammation of an artery or irritation of a nerve. A form of facial pain sometimes triggered by cold wind is trigeminal neuralgia - a condition of unknown cause that produces severe knife-like or electric shock-like pains in the upper and lower jaw before spreading to the cheeks. A drug known as carbamazepine can reduce the severity of attacks, although sometimes injections or surgery are needed to kill the nerve root. Don't ignore it - go and see your doctor.
Dr Sarah Brewer, Prima

Foot pain

I’m 45 years old, 5ft tall and a bit overweight. Recently, I’ve been getting pains in my feet and sometimes in my thighs, too. What’s the problem likely to be and will it need treatment?

There are several possible causes for these pains, including arthritis and circulation problems. Unfortunately, being overweight also makes you more prone to osteoarthritis (a disease that causes wear and tear in your joints). Losing some weight would be a good idea, so start taking regular exercise to help shift the extra pounds and improve your mobility. As the pain is also in your thigh, however, the underlying cause could be a problem with wear and tear of your spine. The nerves in the spine become trapped, causing pain that travels down the leg from the lower back or buttocks. Talk to your GP, because the right treatment will depend on which of these conditions is causing the symptoms. He'll also be able to give you advice as to the best type of exercise for you.
Dr Sarah Jarvis, Good Housekeeping
 

Whats causing my stomach pains? 

I'm a 35-year-old woman, and relatively fit. Recently however, I've been getting terrible stomach aches and diarrhoea, which occasionally is stained with blood. I also feel exhausted all the time. I am so busy at work that I haven't had time to go to my GP. Ten years ago I had a bout of Crohn's disease. Could it have returned?

Yes, Crohn's is a condition that can come back, and you are describing classic symptoms of the disease, which is caused by an inflammation of the gut. However, it's very important that you see your doctor so you can be diagnosed correctly as occasionally these symptoms can be a sign of bowel cancer. Statistically about one in 1,500 people are affected by Crohn's disease. It can develop at any age but often starts between the years 15 to 40. It affects women more often than men, no-one is quite sure why.

I suspect you're feeling so exhausted because you are anaemic. There are two reasons for this: firstly, you may be losing a significant amount of blood in your motions, and secondly, Crohn's can affect the ileum – the part of the gut that absorbs the vitamins and iron essential for making red blood cells. While awaiting a diagnosis I would suggest you start taking a multivitamin that contains vitamin B12, folate and iron. These are the three essential building blocks needed to combat anaemia. If you're diagnosed with Crohn's your doctor will discuss the various treatments that are available. The common treatment to control symptoms when Crohn's first develops is either a steroid or a 5-aminosalicylate medicine. Both treatments reduce inflammation, but work in different ways. Medication is taken for a few weeks until symptoms clear and then are usually prescribed again each time symptoms flare up. If you are a smoker, giving up cigarettes can reduce the number of flare-ups. Stress is also a trigger for Crohn's so think about trying some relaxation exercises. Also, try taking a probiotic such as Yakult yoghurt or Multibionta. Recent research suggests that probiotics may compete for space in the gut with harmful bacteria, helping to dampen down inflammatory responses.
For further information contact the National Association for Colitis and Crohn's Disease (NACC) on 0845 130 2233; www.nacc.org.uk
Dr Louise Selby, SHE
 

Severe heel pain

I love running and train regularly. I ran a marathon a few weeks ago and since then I've been experiencing severe pain under my heel. I can hardly walk now, let alone run. What can I do to get back on the track? 

I suspect you have developed plantar fasciitis from the repetitive strain put on your heel. This is an inflammation of the tendon that covers the sole of the foot. I'm afraid you'll have to avoid running until it settles, which may take several months. Try an anti-inflammatory, such as ibuprofen 400mg, three times a day. Wear shoes with a good arch support and cushioned heel and buy an orthotic insole (www.yoursole.co.uk , from £35 or www.physiosupplies.com, from £10.99) or have one tailor-made by a podiatrist. If it doesn't settle after eight weeks, visit a physiotherapist who can advise you on stretching exercises or give ultrasound treatment.

You also could try a new stretch developed in the US, which has been shown to be very effective in the treatment of plantar fasciitis. The exercise involves sitting with one leg crossed over the other and stretching the arch of the foot by pulling back the toes for a count of 10. Repeat the exercise 10 times, and perform it at least three times a day, including first thing in the morning and after periods of sitting.
Steroid injections are used to treat more persistent cases, and surgery may be considered as a last resort, but there is a risk of complications.
The Society of Chiropodists and Podiatrists, www.feetforlife.org
Dr Louise Selby, SHE

What will ease the pain in my wrists? 

Are there any alternatives to the steroid injections or surgery that my GP is offering for carpal tunnel syndrome (CTS)?

Chiropractic treatment can be effective for the pain and weakness in the wrist, hand, thumb and forefingers caused by CTS. To find an accredited chiropractor in your area, contact the British Chiropractic Association (www.chiropractic-uk.co.uk or 0118 950 5950). Some people with CTS have low vitamin B6 levels, and high-dose supplements, taken under the supervision of a doctor or nutritionist, may also help. Diuretic herbs such as dandelion can help where symptoms are linked with fluid retention. Follow a low-fat diet and try to lose any excess weight, which can worsen symptoms. Wearing neutral-angle wrist splints at night can be beneficial. Acupuncture is also worth considering.
Dr Sarah Brewer, Prima 

 

Mystery thigh pain

I love to run and keep fit and have been training for the London Marathon this year. But recently I have developed a pain on the outside of my upper thigh. It is excruciating and sometimes I can barely hobble, let alone run. Do I need some physio, or is this a more serious problem?
 
It sounds as if you may have hip bursitis, a condition commonly affecting runners. It occurs when a fluid-filled sac over the joints (a bursa) becomes inflamed due to continual strenuous activity, causing serious pain. Sufferers may also experience discomfort when they’re lying on the affected side. On rare occasions, the bursa becomes infected, leading to septic bursitis. A visit to your GP is essential to diagnose the problem and an X-ray may be needed to rule out other conditions, such as arthritis.

If it is hip bursitis and there is no infection, the treatment usually involves anti-inflammatory and pain medications, the use of ice packs and plenty of rest. So no London Marathon for you this year! Your doctor may also suggest a course of cortisone injections to reduce inflammation, while a sports physiotherapist will be able to show you stretching exercises that could help relieve your symptoms and provide advice on how to prevent your condition from returning.

Septic bursitis is generally treated with antibiotics. Your doctor can drain the bursa and send the fluid for analysis to discover the nature of the infection. Very occasionally, surgical drainage and the removal of the infected bursa sac are required.
Dr Louise Selby, SHE

Easing neck pain

I have a job that involves sitting at a desk using a computer for much of the day. Recently I've developed a neck ache and a burning pain runs down my arms, making my fingers tingle. Physiotherapy isn't helping. Is there anything else you can suggest?

Neck pain is mostly caused by minor injuries or bad posture - people who sit hunched over a desk for long periods are more at risk. It's important to sit with your back straight and walk around every 15 minutes or so. The problem often goes away on its own or with physiotherapy. But if the pain continues there may be more permanent damage. Sometimes the spinal vertebrae and the ‘discs' between become damaged and press on a nerve. This can be painful and is indicated by numbness, pins and needles and discomfort down the arm.

If the problem is mechanical and there's no lasting damage, gentle neck stretching exercises and improved posture should help. Anti-inflammatories, like ibuprofen (400mg three times a day), may free the neck up. Or painkillers, such as paracetamol, (two 500mg tablets four times a day) could help recovery; visit your doctor if there is no improvement after a week.
If there is damage to the vertebrae and discs you may have cervical spondylosis, where there's irreversible wear and tear to the bones in the neck. In some cases a nerve may become trapped, causing pain. It is important to visit your doctor to get the problem diagnosed properly. Rarely, surgery may be an option. 
Dr Louise Selby, SHE
 

My fingers hurt

In cold weather my fingers get red, swollen and very painful when I come in from the cold. Wearing gloves doesn’t seem to help. What’s happening and what can I do about it?

You may have Raynaud’s, which affects around 10 per cent of women in the UK. It’s much more common in women than men. Typically your fingers – and other extremities, including the toes and nose – turn white in nippy weather because the blood vessels to the fingers narrow, restricting circulation. It has no obvious cause, though it can be part of a larger problem such as rheumatoid arthritis or scleroderma. To reduce symptoms, keep your hands warm while outdoors and avoid things that reduce circulation, including smoking. Your doctor may also prescribe medication to help, such as nifedipine. In severe cases, surgery might improve or cure the problem by cutting some of the nerves that control the flow of blood to the fingers.

Gingko biloba is an effective alternative remedy, but check with your doctor before use if you are on any medication. (Boots Gingko Biloba 120mg, £14.05 for 28 capsules). For more information, contact the Raynaud’s and Scleroderma Association (www.raynauds.org.uk).

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The answers to specific problems may not apply to everyone and are not substitutes for professional medical advice. If you're worried, see your GP. For more information, visit www.netdoctor.co.uk