To scan or not to scan?
Q I suffer from headaches practically every day. They are quite incapacitating and last up to two hours. My GP takes my blood pressure, says it's OK and advises paracetamol. I feel I need a CT scan because I have a lingering fear that I may have a brain tumour. Should I insist on one?
A Headaches are universal, brain tumours rare. But that doesn't stop us worrying that we have one. And the fact is that tumours often go unrecognised in their early stages, so we're right to worry. Warning signs include pain that's worst in mornings, early-morning vomiting, neurological problems such as visual loss and headaches that begin soon after age 50. If you have warning signs, ask your GP to refer you for a CT or MRI scan to set your mind at rest.
Counselling dilemma
Q I've been a bit low and saw my GP, hoping for some antidepressants while I get my head round some personal problems. The GP was loath to prescribe anything but keen that I see the practice counsellor. Do I really have to see a counsellor? I'm not good at talking about myself and am not sure I believe in the whole process.
A Counselling within general practice has become widespread and most people say they feel better for it. That doesn't make it a panacea, and success depends on how depressed you are and why, the skill of the counsellor and your attitude to counselling. The majority of people with mild depression get better whether they have treatment or not, but there is evidence that seeing a practice-based counsellor helps people improve more than GP care alone. Counselling also seems to result in fewer referrals to psychiatrists, less prescribing of antidepressants and greater levels of client satisfaction. So it probably does help but you still shouldn't do it if you don't want to.
Frantic with worry
Q I'm 12 weeks pregnant and had an ultrasound scan to check the baby. They told me the back of the baby's neck is too thick, which can be a sign of Down's syndrome. The blood test I had to check for Down's was normal. I've an appointment with the specialist later this week but am so upset I don't know how to cope until then.
A Scans and blood tests can provide cues, but they're not definitive. The nuchal fold scan, which you have had, can indicate a suspicion of Down's syndrome or other chromosomal abnormalities but you won't know for certain until you have a test to sample the baby's cells (CVS or amniocentesis). This is what you'll be offered when you see the doctor or midwife later this week. A patient of mine recently had your experience and went ahead with CVS which proved that her baby had normal chromosomes. Doctors call abnormal results that turn out OK "false positives". Those of us who have experienced them think of them as an awful fright over nothing.
I lose my self-control
Q I wet myself when I cough, sneeze, run or jump too quickly. I've tried everything to strengthen my pelvic-floor muscles from physio to vaginal weights. My gynaecologist recommends a major operation but I'm scared.
A Think before you do. On the one hand you're going to get wetter as the years go by, you may find it harder to recover after an operation when you're older, and surgeons claim an 85% success rate after the procedure known as colposuspension. On the other, although two-thirds of women say the operation results in some improvement, a recent survey found that only 28% of women were totally continent one year after surgery. It depends how bad it is; you may be willing to put up with a few drops, but unable to tolerate a downpour.
• 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.
