Mystery virus risk
Q I am due to travel to the Far East on business next week. I'm concerned about this mystery bug that I've heard causes a fatal pneumonia. Is it a real risk and can I avoid it?
A There is a nasty bug afoot that has killed at least 18 people in the world so far. It causes a flu-like illness with fever, aches, sore throat, a cough and headache. 96% of those who catch the illness make a complete recovery. It's possible that the culprit is a virulent mutation of a common cold virus known as Corona.You can probably catch it if an infected person sneezes or coughs on you. Experts don't think it's enough of a threat to advise cancelling trips to the Far East. Many people in Hong Kong now wear face masks if they develop a cold, to stop spreading their bugs to others. This is very public-spirited of them but probably does litle to stop the spread of this determined mutant virus. Realistically, the risk to you is infinitesimally small at the moment.
The bug won't budge
Q In early summer last year I had a number of acute indigestion attacks. I had not suffered with indigestion before (I am 57). Blood tests indicated that I had helicobacter pylori and I was treated with strong antibiotics. However, a blood test six months later showed that the bacteria were still present. I was then prescribed Zantac for indigestion, which I have been taking for a month. However, I still have (milder) indigestion and wondered if you could clarify for me what helicobacter is and what my future is likely to be. Will my symptoms disappear over time, or am I now to have regular bouts of indigestion?
A Helicobacter pylori is a ubiquitous and ancient bug. Many of us have it in our stomachs and many of us get indigestion. Whether or not the bug causes the indigestion remains a mystery. And whether treating the bug will get rid of you indigestion is also one of nature's unknowns. You've obviously had the anti-helicobacter treatment, which consists of two antibiotics and a drug that switches off stomach acid production (a proton pump inhibitor). That triple therapy eradicates the bug in over 90% of cases, even though the blood test may stay positive. Despite that, you've still got symptoms, which proves the point that treating the bug may not cure the problem. On a more prosaic note, anyone with indigestion is well advised to eat little and often, avoid acid foods like tomatoes, lose weight if overweight, stop smoking, chuck out your aspirin and other anti-inflammatory drugs, unless they are essential, and swig an antacid like Gaviscon to neutralise acid. Since you are 57 and have not had indigestion before, you really ought to be referred to a gastroenterologist, who can look inside your stomach with an instrument called an endoscope. You are still getting symptoms now despite taking a drug that blocks the effect of stomach acid. You need endoscopy to look for other causes of your indigestion such as an ulcer or even an early cancer.
Queasy pickings
QMy seven-year-old son gets nosebleeds every couple of weeks. I suspect he's a secret nose-picker. Should I do anything?
A There is a blood-rich area just inside each nostril called Little's area. It's mostly little people (three- to eight-year-olds) who suffer from recurrent nosebleeds, often after a cold, when you get crusts inside the nose. These crusts can be irresistible to little pickers, who pick off the crust, bleed, then crust over again in a glorious cycle of bogie-clearance. An antibacterial nasal cream called Naseptin is available on prescription, which will reduce your son's chance of having a nosebleed by nearly half. You should use the cream three times a day for two weeks. It's as effective as having his nose cauterised, which is done by holding a silver nitrate-tipped stick against the inside of his nose for a few seconds. Cautery will make his eyes water, may sting and make his nose feel blocked up. Most kids prefer the cream. Only kids with a serious peanut allergy should avoid the cream, as it contains peanut oil. If his nosebleeds continue or worsen, get a blood test done, as it can very occasionally be a sign of a clotting problem, and heavy blood loss can make a child anaemic.
I can't stop fretting
Q I have always been a very anxious person but as I have got older, it is becoming worse and worse. I am 56 and live on my own as my children have left home. I work part-time as a librarian but am barely able to cope with getting myself to work and back. I am overwhelmed with worry about everything; my children, the war, household bills, and items I hear on the news. My GP has prescribed Valium but I am reluctant to take it as I don't want to become dopey or more forgetful than I am. Have you any advice?
A We all worry, especially when it comes to those we care about. But the sort of pervasive, constant, debilitating anxiety that you are describing is a different ball game because it interferes with your ability to enjoy your life. You could benefit from a type of counselling called cognitive therapy or from drug treatment, or both. Cognitive therapy is a short-term talking therapy in which you focus on practical ways of overcoming your anxiety. You explore why you have such negative thoughts about yourself and the world, are shown by the therapist why these thoughts are unreasonable, and learn to replace negative thoughts with positive ones. You usually have one session a week for four months. It may take a couple of months until you notice an improvement. Half of people with anxiety who try cognitive therapy say their quality of life improves and their symptoms of anxiety are about halved. Whether or not it works forever and whether its more effective than drug treatment, we don't know but most of us would rather give it a go and avoid drugs if possible.
Effective drug treatments include an anti-anxiety drug called buspirone or an antidepressant such as paroxetine. Like cognitive therapy, about half of people who take the drugs feel better, but lots stop taking them because of side effects such as drowsiness. You can ask your GP to refer you for cognitive therapy, though it's thin on the ground on the NHS. More information on private therapists is available from the British Association for Behavioural and Cognitive Therapy (www.babcp.com).
· 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.
