Falls are the biggest killer
Q My mother-in-law is in her 80s and is very independent in her own flat. My husband and I are very worried about her though because she has had some nasty falls recently. Last week, she fell in the flat and bruised her ribs and face. She was very shaken and has lost a lot of confidence but refuses to consider going into a home or even having a carer move in with her. Her GP sent a district nurse to visit but hasn't arranged any tests. Is there anything we can do?
A I'm sure your mother-in-law cherishes her independence and her wishes must obviously be respected. There's no doubt that she's at risk of further falls and you are right to be concerned for her. Without wishing to be alarmist, falls are actually the single most common cause of death among elderly people. Many factors make us more vulnerable to falling as we age, but in most cases elderly people fall because they trip. So you can do your mother-in-law a favour by scouring her flat for loose bits of carpet or lino. You may need to improve the lighting or move bits of furniture. Her GP can organise an occupational therapist to offer expert advice and organise hand rails, walking aids, a high chair that's easy to get out of and an alarm system in case of further falls.
Prescribed drugs are another common contributor to falls especially those that lower blood pressure and sedatives. A detailed discussion with her GP about her medication is a good idea and she may be pleased to have you with her during the consultation. She may also want to take a daily calcium with vitamin D supplement; it helps keep bones strong and may help to prevent falls. There's useful advice at www.helptheaged.org.uk/adviceinfo/slips+trips.htm
Hair is in your hormones
Q I went to my GP because I wanted to do something about the facial hair that grows on my upper lip. She asked about my periods which have always been very few and far between. She thought I might have polycystic ovaries and referred me to a specialist who has recommended metformin, a drug used for diabetics. I am very confused because I really just wanted help with my facial hair and they have said I'm definitely not diabetic. Can you explain?
A Years ago, women could be a bit hairy and spotty and only have a period every few months without being classified into a "syndrome". But we are more sophisticated nowadays and apparently up to one fifth of all women have some form of polycystic ovarian syndrome (PCOS). Losing excess weight can correct the underlying problem which is hormonal. The key problem seems to be overproduction of insulin which is the hormone that allows us to use up glucose. Insulin also stimulates the ovaries to produce androgens, which are hormones that don't suit girls. They makes us hairy, greasy, acne-ridden and poor ovulators. Metformin is a drug used to treat diabetes, which is confusing because diabetics typically need insulin and people with PCOS often have high insulin levels. But the reason you make too much insulin with PCOS is because the body doesn't respond properly to insulin, which "tells" the cells to deal with glucose. You keep making more and more insulin but the cells aren't listening and doing their job. Metformin makes the cells sit up and listen so glucose is dealt with efficiently and you don't keep churning out the excess insulin. Metformin doesn't work for everyone but it's worth a try. You'll want a firm diagnosis and some expert help now that your GP has broached the subject so ask for referral to an endocrinologist (hormone expert) who is interested in PCOS.
A car allergy? Maybe...
Q Is it possible that I have an allergy to exhaust fumes? I work as a traffic warden and constantly have itching and hearing problems. I'm now on my third lot of antibiotic ear drops from my GP and nothing seems to work. After a few days, the itching and soreness comes back. Any ideas?
A Irritation and inflammation of the outer part of the ear (otitis externa) is very common even among people who have little contact with traffic fumes. Continuous use of antibiotic eardrops isn't a good idea - you may be allergic to the drops themselves or develop an infection with antibiotic-resistant bacteria or thrush. I'd stop the drops for a couple of weeks. Then ask your GP to take a swab from the ear canal to see which bugs are festering there and the best treatment to polish them off. If your problem clears up while you're away from the traffic, it will add weight to your theory though there's no test to prove it. If it persists or your hearing remains affected, see an ENT surgeon.
· 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.
