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From Strep A to blocked noses, Dr Zoe Williams answers your health questions

Dr Zoe Williams answers some common questions sent in by readers

AT the start of a new year, it’s natural to think about what we can change, what we can quit and what we can start doing more of.

January is still dark, cold and quite miserable, so making resolutions can feel like yet another burden.

But if you are planning to work on your diet in 2023, you don’t have to throw yourself straight into Veganuary or Dry January. Fad diets are not a sustainable route to maintaining a healthy weight. 

Instead, a good place to start is getting to know the NHS Eatwell Guide. It explains what a healthy, balanced diet looks like and how to achieve it. 

In the meantime, here are just some of the questions that readers asked me this week . . . 

Q) I AM permanently exhausted and have sore joints. It doesn’t matter what I eat or how much I rest. What’s wrong with me?

A) There are many different causes of the symptoms you describe. If this has been going on for more than a few weeks, it’s important to see your doctor so they can take a full history, examine your joints and do some blood tests.

At one end of the spectrum, a combination of stress, lack of physical activity, poor posture and burnout can be responsible.

At the other end, serious diseases, including some cancers, can present with fatigue and joint or bone pain, too.

There are several autoimmune conditions that can cause both joint pain and fatigue. 

These include rheumatoid arthritis, lupus, and other uncommon conditions too such as systemic scleroderma and polymyalgia rheumatica.

Poor mental health can be responsible too, so it is important to contact a GP, even if you have to wait for an appointment.

Q) Strep A is going round at my daughter’s school. How worried do I need to be about it?

A) It’s good that you’ve been alerted and it’s important for parents to have an awareness of some of the illnesses that Strep A bacteria can cause, but there is no reason to feel worried.

If your daughter does contract Strep A then most likely it would cause a mild illness, such as a sore throat or skin infection, or no illness at all.

It’s important to be able to spot the signs of scarlet fever as this disease requires antibiotic treatment and it also needs to be reported to the local health security agency. 

There are two important reasons why antibiotics are required. One is to reduce further spread of the bacteria. The other is to prevent the extremely rare occurrence of invasive group A Strep, which is what has sadly caused the deaths of the children that have been in the news recently.

The typical signs of scarlet fever are a temperature, sore throat, a rash that feels like sandpaper and a “strawberry tongue” — red and bumpy.

Your GP will also consider antibiotics in children who have tonsillitis, especially if the child does not have a cough or runny nose and they have pus on the tonsils or very swollen neck glands.

The most likely cause of tonsillitis is a virus, but as GPs we have temporarily lowered the threshold at which we prescribe antibiotics due to the outbreak.

So the bottom line is, if your child has symptoms of a viral illness then you should manage their symptoms in the usual way. If you suspect they may have bacterial tonsillitis or scarlet fever, call the GP.

And if you feel your child is seriously unwell or has an infection and is deteriorating, seek urgent medical help.

 Q) I SUFFER from premenstrual dysphoric disorder. Do you have any advice on how I can make it easier?

A) PMDD is severe PMS and is believed to affect around three to eight per cent of women of reproductive age. 

To fulfil the diagnosis of PMDD, a woman should have had at least five of the following symptoms in the week before menstruation for most months of the previous year: depressed mood, emotional instability, irritability and anger, poor concentration, tension and anxiety, loss of interest in usual activities, altered eating habits or food cravings, disturbed sleep, fatigue, feeling overwhelmed or out of control and, finally, physical symptoms such as headache, breast tenderness, weight gain and feeling bloated. 

Treatments include vitamin B6, antidepressants, the combined Pill, talking therapies and counselling. 

Sometimes hormone replacement therapy may be used, either with or without drugs called GnRH analogues, which affect the body’s ability to produce its own oestrogen.

The final option is a full hysterectomy with removal of the ovaries too, then HRT

The most important thing you can do if you think you have PMDD is to keep a very detailed diary, logging all symptoms and trying to identify any triggers, such as foods, that make your symptoms worse.

Start taking a vitamin B6 supplement as there is evidence that this can help. 

Aromatherapy can help with some strmptoms. Exercise, including yoga, has been found to help in some cases, too.

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