DR ELLIE CANNON: My back pain is so severe I’m scared it will stop me walking

I was diagnosed with spinal stenosis three years ago and am in constant pain. My painkillers are useless but my doctors won’t give me anything stronger. I even had injections in my spine but they didn’t work. I saw a neurosurgeon a few months ago but I haven’t heard anything since. My back is getting worse, and I am afraid that one day I won’t be able to walk. Can you advise me?

Spinal stenosis is a condition that causes back pain because the nerves are squashed by a narrowing of the spinal bones.

It can be horribly debilitating and hard to manage. Pain clinics, GPs or a practice pharmacist should be able to offer options in terms of the tablets you can take.

Often this is about combining treatments and can include things such as antidepressants, which can have a painkiller action. Doctors try to avoid strong painkillers for a chronic pain condition, due to the risk of addiction if taken long term, or side effects such as falls in the elderly.

But when someone’s quality of life is reduced by pain, it is worth having a discussion where the patient is allowed to weigh up the risks and the benefits of at least trying a stronger medication.

Tablets are not the only way to treat pain. In fact, when pain is a chronic issue, it is wise to look at other options. Cognitive behavioural therapy can be good and may help with changing the way you respond to pain.

Pilates and other low-impact exercise may also help because of the movements themselves and the endorphins released by exercising. Pain clinics may also recommend alternative measures for pain, such as acupuncture.

If a doctor has promised treatment but not followed through, you are entitled to go back to ask what has happened. If the doctor is uncontactable, the patient advice and liaison service at the hospital can help.

Surgery may be an option but setting realistic expectations is vital. An operation can offer false hope of relief, so honest discussions are necessary.

I have a condition called immune thrombocytopenia, where my blood has low levels of platelets. It started four years ago after what I thought was flu but now think was Covid. I’ve been in hospital three times in the past year. I had bad side effects from injections I was prescribed so I’m now taking a drug called avatrombopag. Can I do anything else to increase my platelet count?

Thrombocytopenia describes a low level of platelets – the component of blood that helps it clot. Really low levels can lead to easy bruising and serious bleeding because the blood can’t clot when it needs to.

It happens when the immune system mistakenly targets platelets and breaks them down.

We don’t know exactly why but it is known to occur after a viral infection such as flu or Covid.

Managing platelets can vary from monitoring people with mildly low levels to treatment from a haematologist in more serious cases. The aim is to raise the number of platelets in the blood and maintain a normal level – but this can be tricky to achieve by yourself.

There are no known foods to raise platelet count and you should avoid taking supplements as they can interfere with treatment or the condition.

Avatrombopag is a new drug for immune thrombocytopenia that increases platelet production.

Low platelets can be caused by other conditions, such as cancer, liver disease and pregnancy. Immune thrombocytopenia would be diagnosed by a haematologist after tests to rule out these things.

I have had four urinary tract infections (UTIs) in eight months. In each case I was prescribed antibiotics and the symptoms disappeared, only to return after a few weeks. Later I was offered topical HRT used vaginally, which seems to have helped, plus D-mannose tablets, cranberry tablets and oral probiotics. But I’m worried the problem will keep coming back. What should I do?

Post-menopausal  women can often experience urinary problems. Some specialists will recommend a trial of D-mannose or cranberry tablets, which may help to prevent bladder infections, although the scientific evidence for them is not solid.

Otherwise a nightly low-dose antibiotic is often used.

With a first infection, it is fine to prescribe antibiotics without a test.

For recurring symptoms, lab testing is essential to find out which type of bacteria is causing the infection and make sure the right antibiotic is being offered.

If the same bacteria is picked up in subsequent tests, the infection may be chronic, so some women are advised to take a low dose of antibiotics every day, long term. Other conditions can mimic an infection, so it’s common for antibiotics to be wrongly prescribed. The drop in oestrogen at menopause affects the genital and bladder systems, causing dryness or a change in function such as poor urine control – which can be mistaken for a UTI.

A trial of topical HRT, an oestrogen cream applied to the vaginal area, is the correct option to treat these symptoms.

This replenishes the hormones only in this region of the body and improves how the bladder and urethra feel. If it works, a low dose of the treatment can be used long term.

It is important for women to be aware that urine symptoms after the menopause can, in rare cases, be a sign of ovarian cancer and a pelvic ultrasound may be ordered to check the ovaries.

A boost for vaccines demand

Last week I called for the roll-out of a vaccination programme to guard against respiratory syncytial virus (RSV). My hope is that countless babies will avoid being admitted into hospital, but why stop there?

As we saw with Covid – and each year with the flu, too – respiratory viruses can become serious problems in very young and old patients.

While most adults who catch RSV will experience only mild cold-like symptoms, it can turn into a nasty chest infection called bronchiolitis that hospitalises thousands of elderly people every year, especially in the winter.

So it’s good the group advising the Government on vaccines is also all for jabbing over-75s – depending, of course, on the cost.

Let’s hope a scheme balancing protection of the public with pinching the pennies wins out.

You’re never too old to benefit from statins 

Do statins work in older patients? One reader has asked me this, believing they are meant to be avoided in over-75s.

There have been questions raised in the past about the effectiveness of the cholesterol-lowering drugs within this age group, particularly for something that doctors call primary prevention – when the pills are prescribed to reduce the risk of a first heart attack or a stroke rather than after one.

As a result, many older patients were previously either not offered statins or simply told they weren’t needed.

However, updated research has proven you can never be too old to benefit from the drugs, so we’ll prescribe them routinely up to the age of 85, and after that if we feel they’ll be of benefit.

It’s important to know that when calculating the risks of heart attacks and strokes, your cholesterol level isn’t the sole factor.

Old age does increase the chance of heart disease striking, so taking statins later in life can only be a good thing.