DR ELLIE CANNON: Why is my cholesterol on the rise even when I’m taking my statins?

I’ve been taking statins for a year to treat high cholesterol, but a recent blood test showed that it has continued to rise – as has something called bilirubin. I am a 72-year-old woman. Is the medication not working for me?

Bilirubin develops naturally in the bloodstream from the breakdown of old red blood cells. It can be checked during liver blood tests.

Doctors can use bilirubin levels – alongside other proteins and enzymes – as an indicator of how well the liver is working. High levels can suggest a problem with the liver, especially if other markers are raised. But some people have naturally high levels of bilirubin, and this isn’t usually an issue or a sign of any problem.

Statins are drugs used to reduce cholesterol levels. They are not exclusively offered to people with high cholesterol, though, nor those with an increased risk of stroke or heart attack within a decade. Those with angina and diabetes may be offered them, too.

We regularly perform liver function tests on people who take statins, but high levels of bilirubin are not a known side effect. It is usually other enzyme levels that are increased.

It is abnormal for both cholesterol and bilirubin to go up in a patient taking statins, so this needs further investigation. The statin should not be continued if it is not reducing cholesterol.

Further liver tests, such as an ultrasound scan, may be necessary, and alternative cholesterol-reducing medicines are also an option. The GP can offer advice about how essential a statin may be.

Some people who have high cholesterol may not have other heart disease risks, such as high blood pressure. In these cases, a statin isn’t always essential.

I have recently developed small bumps behind my ear that are very red and painful. I often wear glasses and think it could be a result of them rubbing, but I’ve been wearing them for years and this is new. Can you help?

People who wear glasses often develop a skin problem called dermatitis. This is where the skin is inflamed, similarly to eczema, but the cause is contact with a material that has caused irritation.

You may not notice the problem the first time the skin has contact with the material, but it can happen after repeated touch. The skin may not only look red and bumpy, but also dry and cracked.

The best way to test for an irritant dermatitis is to spend some time without the irritant to see if the problem goes away. But that can be difficult with glasses.

Using a barrier cream, such as nappy cream, between the glasses and skin would prevent contact and should soon clear up the problem. This type of skin condition would also respond well to an over-the-counter steroid cream, which a pharmacist can advise on.

Behind the ear is a common place for certain rashes, such as seborrheic dermatitis. It is a red rash that appears flaky and can scab over. It is thought to be a yeast infection, and an anti-fungal treatment would be used to calm it down, such as a cream or an anti-fungal shampoo.

Rashes that are painful, rather than itchy or sore, warrant investigation by a healthcare professional. Shingles, for example, is one such serious cause of a painful rash. Pharmacists are very good at assessing and treating such rashes and can advise on a treatment or whether it’s worth seeing a GP.

You can also submit photos to your GP via an online form which enables them to assess the problem and even offer treatment over the phone.

My 92-year-old mother has angina but is in otherwise generally good health. Yet a few weeks ago she became short of breath, finding it hard to even walk small distances. Last week she said she had a funny feeling in her chest, so we went to A&E, but were sent home after tests – doctors said it was just her angina. Should I have pushed for more tests, and is there anything that can be done to improve her condition?

While it might seem sensible to ask emergency doctors to do more for a loved-one, A&E is not the best place for supporting a person with a long-term condition.

The job of emergency doctors is to diagnose and treat a patient there and then. But once someone is discharged and back in the community, different types of doctors are responsible for monitoring and further testing.

An elderly person with worsening angina or heart symptoms should be cared for by a GP, who will use the results of tests done in hospital to work out what to do next. They can also arrange urgent appointments at a local chest pain clinic.

It’s crucial to be under the care of a GP because we can also spot other problems that may go hand-in-hand with the heart condition. This includes limited mobility, anxiety caused by symptoms and also potential side effects.

Angina can be treated with a range of different medications. Various types treat the pain itself, while some are specifically designed to prevent a heart attack.

Other healthcare professionals may be involved in the care of an elderly patient, too. For instance, occupational therapists can help patients overcome challenges of daily tasks, such as walking, dressing and washing, by suggesting equipment to use.

A local exercise class may also help the elderly to build strength and maintain confidence.

Are physician associates putting patients at risk? 

I’ve heard a worrying story of a 79-year-old man who visited his GP complaining of a month-long headache, and is now fighting for his life after being misdiagnosed by a physician associate (PA).

These workers are healthcare professionals and increasingly work alongside GPs like myself. They don’t go to medical school but have plenty of clinical training. Crucially, they should be supervised by a doctor – but this particular PA wasn’t, and told the man he was simply stressed. He was later rushed to hospital after suffering a brain haemorrhage.

This isn’t a one-off. Last year, 30-year-old actress Emily Chesterton died of a pulmonary embolism – a blood clot that blocks a blood vessel in the lungs – after a PA misdiagnosed her with long Covid and anxiety.

Our practice PA is a vital part of the team and patients’ feedback is very positive. But I’m concerned that elsewhere, PAs may be taking on complex medical work without support due to a lack of GP staff. Have you had a bad experience with a PA? If so, email me at the address below.

Jabs that missed a generation

A few weeks ago I wrote that it was never too late to have your MMR vaccine – the jab that protects against measles, mumps and rubella.

The main concern is ‘the Wakefield cohort’ – children who weren’t vaccinated in the 1990s after scare stories about the jab causing autism circulated widely. The false claims by disgraced academic Andrew Wakefield – which later saw him found guilty of serious professional misconduct and struck off the medical register – led to a huge, temporary fall in MMR uptake.

But is there another at-risk population: older Britons?

Although individual measles vaccines were introduced in the 1960s, uptake was pretty low until the MMR became routine in the 1980s, so it means there might also be a cohort of older adults who weren’t vaccinated.

I’d like to know, did you miss out on a measles jab and still avoid measles? Please write to me using my email address.