Do I need an MoT?
Q I am a man who has just turned 60 and do not visit my GP often. Should I have a medical "MoT", such as Bupa offers? Alternatively, should I ask my GP for any tests - for example, blood cholesterol, PSA, ECG?
A An annual MoT can be a mixed blessing. Most of us know by now that we shouldn't be smoking, drinking every night or grossly overweight. We've also picked up that fruit and veg are good, fat and sugar bad, and exercise is fabulous. You don't really need an MoT to tell you that. A blood pressure check is worthwhile but even the most hard-pressed GP's surgery will do that for you. If your cholesterol has been tested in the past and not been found to have particularly high levels, you probably don't need another test. A urine test can show diabetes, but if you have no symptoms or strong family history, you are unlikely to be diabetic. The blood test for prostate disease or enlargement (PSA) is still controversial as a screening test as it is not entirely clear whether early diagnosis of prostate cancer makes you live longer. Still, PSA is included in most private medicals for men of your age. An ECG of your heart is unlikely to tell you much if you can walk up a steep hill without chest pain.
All this is available on the NHS. What you pay for, and get, with a private medical is time. The outcome won't be different but the process is smoother.
Fungus
Q I suffer from recurrent thrush and athlete's foot. This has been diagnosed as an overgrowth of candida, and is apparently common. My GP has prescribed anti-fungal medication, but I have been told by alternative practitioners and have read that this suppression of symptoms will not have a lasting effect. I understand that candida can be controlled by diet but my doctor says nutritional advice is not available on the NHS. I find the supplements very expensive. I do not understand why I cannot get the most appropriate help from the health service I invest in through taxation. Any ideas?
A Candida is a humble yeast which, for some reason, arouses overwhelming passions. On one side there are practitioners who believe that an overgrowth of candida, which lives in the gut, can result in a host of symptoms and is best controlled by a diet that excludes sugar and yeast. Many - perhaps most - conventional medical practitioners, can't engage with this at all.
Candida is largely harmless except in people whose immune systems are clobbered, in which case it is highly dangerous and needs to be wiped out with heavy-duty antifungal drugs. If your immune system is OK, candida can gain a hold in hot, wet crevices, like the groin or vagina. But keeping the area dry and using a bit of anti-fungal cream (or a pessary) usually does the trick. Antibiotics wipe out helpful bacteria that keep candida at bay, so avoiding unnecessary antibiotics is wise. Helpful bacteria can also be replaced by eating live yoghurt or taking lactobacillus tablets, available from health food shops.
Athlete's foot is caused by a different fungus. Anti-fungal creams or a course of oral terbinafine (Lamisil) usually helps. Some people clear fungal infections more easily than others just as some people clear skin viruses such as verrucas and warts more easily and quickly than others. You are obviously prone to fungal skin infections, as are many others.
I reckon expensive diets are a waste of money and that there is not enough evidence to support their use within the NHS.
Tube problem
Q My six-year-old has glue ear and the doctors want to remove his tonsils and adenoids, but I am worried about it. What do you advise?
A Glue ear means fluid in the middle ear which affects the hearing and is extremely common. There is a device that your child can insert in his nostril and blow out through his nose to inflate a balloon. It sounds wacky but it can work wonders at clearing the tube between the nose and middle ear (Eustachian tube) and improves glue ear. Your pharmacist should be able to order you one. There is no good evidence that removing tonsils helps in glue ear. Putting grommets (small tubes through the eardrum) and/or removing adenoids may result in some short-term hearing improvement, though some studies have shown grommets to be of no use at all. Your child's adenoids are going to shrink by the age of seven anyway. Trust your instincts; if you aren't keen on the operation for your child, say no.
· These answers are intended to be as accurate and full as possible, but should never be used as a substitute for visiting a doctor and seeking medical help. If you have a question for Dr Robinson, email drann@dircon.co.uk or write to her c/o The Health Editor, The Guardian, 119 Farringdon Road, London EC1R 3ER. She regrets that she cannot enter into personal correspondence.
