When will the pain stop?
Q I am a 44-year-old man and I broke my right patella in 1980. It now seems that the posterior cruciate ligament was also ripped free, tearing a chunk of bone off the tibia. This fragment caused no problems for 11 years, until it started to rub on a nerve, causing unbearable pain when I bent my knee. It was removed three months ago and I can bend my knee now. The problem is, I'm in so much pain that I can't follow the physio exercises I was given. How long will the pain go on?
A You may have arthritis in the joint which may have flared up after the operation. It may be that time, drugs and supervision by a physiotherapist will help reduce the pain. However, you should see the surgeon who did the op as soon as possible. There may be some infection in the joint. A fragment of bone may have been left behind or the nerve may be trapped or inflamed. The surgeon may advise an MRI scan or look inside the joint. If the nerve is damaged, a pain specialist can give injectionsto relieve pain.
Early-morning aches
Q Every morning I wake up with a dull pain in my lower abdomen. Covering it with my warm hands keeps the pain at bay until I get up. I usually find I have blood in my mouth. This occurs regardless of what I eat the night before. The problem always disappears within a short while of getting up, and my doctor says there is nothing wrong. What do you think is causing the problem?
A Lower abdominal pain is usually bowel or bladder-related. If it's a bowel problem, you may have constipation, diarrhoea, wind, weight loss, and blood or slime in the stool. Early-morning pain that improves once you open your bowels or pass wind may be due to mild constipation. A laxative at night (eg Lactulose syrup) may ease the early-morning pain. If the pain is due to a bladder infection, passing urine will be frequent and painful. Antibiotics usually solve the problem. If you're a man, your prostate could be inflamed causing painful urination and ejaculation. If you're a woman, it could be a gynaecological infection causing vaginal discharge, erratic vaginal bleeding and pain during sex. The reason your GP doesn't seem to be engaging much is that any problem that's better by breakfast is unlikely to be due to a progressive, dangerous disease. But you need to be thoroughly examined. A few tests may be worthwhile - urine, stool and blood tests and possibly an ultrasound and abdominal x-ray. Having narrowed the problem down, you could ask for referral to a specialist to look inside your bladder/bowel/uterus.
Hormone concerns
Q I am using a substance called Minoxidil 5% + Medroxy-Progesterone 0.0125%, which is used to counteract hair loss. My concern is with side effects, and particularly the progesterone hormone content. I recently read about suspected risks for women who are having IVF or HRT, and possible links with cancer.
A Minoxidil was developed as a drug to lower blood pressure and found to have the side effect of making people hairy. The drug is now marketed as a topical lotion (such as Regaine) which is rubbed onto the scalp. It can work well, though you usually have to keep using it or the hair falls out again. It's not available on prescription because male pattern baldness is not considered to be a health issue. You don't need to worry about the Minoxidil or progesterone; neither will be absorbed into your bloodstream to a significant extent if you use them as directed. And it's oestrogen rather than progesterone that has been implicated in breast cancer scares.
· These answers should never be used as a substitute for 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.
