My mother, 85, has had constant mouth ulcers for the past three years. She was prescribed steroids, but they didn’t help. The pain is so bad that she now struggles to eat solid food or drink without a straw. What else can she do?
Dr Ellie Cannon replies: Mouth ulcers are painful lesions that come and go.
For some they can be a frequent occurrence – and are more common in women. People often believe they are caused by stress or anxiety, but there are many other triggers, too.
Those who have poorly fitted dentures, gum disease, severe tooth infections or sharp, chipped or misaligned teeth are more at risk of developing them.
It’s vital that anyone suffering sees a dentist. Some people discover that their ulcers are triggered by certain foods such as chocolate, coffee or gluten. They can also be worse in those with an allergy to sodium lauryl sulfate (SLS), a detergent often found in toothpastes.
For this reason there are SLS-free products available from most pharmacists.
In the elderly, deficiencies can also be to blame. This includes a lack of Vitamin B, D, folic acid, zinc and iron.
Mouth ulcers with no obvious cause may point towards an underlying disease. Inflammatory bowel diseases such as Crohn’s and ulcerative colitis, for example, can lead to ulcers, but these would normally be accompanied by uncomfortable stomach pain, bloating and changes in bowel habits.
Mouth ulcers are painful lesions that come and go and are more common in women
A GP can order tests to look for signs of deficiencies or inflammatory bowel disease, if they deem this route necessary.
In the meantime, pain relief can be helpful to counter ulcers. There are anaesthetic gels as well as mouth washes available over-the-counter.
Some people recommend probiotics – ‘friendly’ bacteria for your gut – as there is evidence these can reduce the pain of ulcers. And some studies suggest that taking Vitamin B12 tablets can reduce the frequency of ulcers, regardless of whether the patient has a deficiency or not.
I suffer from nasal congestion and, at times, can’t breathe through my nose at all. Decongestants, nasal washes and steam inhalation have not worked, so what could be behind my problem?
Dr Ellie Cannon replies: Nasal congestion is often related to allergies.
It is typically a symptom of rhinitis – inflammation of the nasal passages. This causes the feeling of blocked sinuses, sneezing and a runny nose. As a consequence, breathing through the nose becomes difficult, so people resort to breathing through their mouth, which in turn leads to a dry, sore throat.
However, rhinitis swelling is never severe enough to stop anyone from breathing.
One of the most common triggers of rhinitis is an allergy to pollen. Also known as hay fever, this tends to be seasonal, meaning that the congestion will occur only at certain times of the year – most often during spring.
If the symptoms occur all year round, however, then it’s more likely to be a household allergen to dust or mould, for instance. Other, less common triggers are household detergents such as laundry products. Nasal congestion can sometimes be triggered by chemicals or fumes at work, too.
Pinpointing the exact cause can be quite hard, as it involves removing each suspected allergen for two weeks to see if there is a noticeable difference.
Antihistamines may help clear the problem, if the cause remains elusive. These can be bought as over-the-counter tablets from supermarkets and pharmacists. Many people with persistent allergies take these every day to manage their symptoms.
While in hospital recently I was given a tablet called mirtazapine, which I was told would help me sleep. Since being discharged I’ve kept taking them and feel much more rested. Is it safe for me to take mirtazapine indefinitely?
Dr Ellie Cannon replies: Mirtazapine is not a sleeping tablet – it is a mental health medication most often used to treat depression, anxiety or obsessive compulsive disorder (OCD).
Drowsiness is one of its main side effects, so it can be very helpful for people whose mental health conditions trigger insomnia – as is common among those with depression.
Anyone who starts on a new drug – be it in hospital or at a GP practice – should be told exactly why they are taking it and what it is designed to treat.
The good news is that mirtazapine has few severe side effects and is generally safe to take long-term.
Anyone who feels like they are benefiting from a drug should talk to their GP about extending their prescription.
However, it is important that patients do not suddenly stop taking mirtazapine, as this can trigger withdrawal symptoms such as worsened anxiety, low moods and disrupted sleep.
Instead, under the supervision of a GP, the dose can be slowly reduced over time.
- Do you have a question for Dr Ellie Cannon? Email [email protected]
- Dr Cannon cannot enter into personal correspondence and her replies should be taken in a general context
Is there a secret to good care?
A viral video on TikTok has claimed there are certain phrases that patients should use in order to get better care from their doctor.
Actor Robyn Holdaway, a star of Netflix teen drama Sex Education, suggests 15 ways to increase the chances of a GP taking illnesses seriously or referring patients on to a specialist, including: ‘This is having a significant impact on my quality of life.’
While it may sound fanciful, it’s actually true – to an extent.
For example, if someone says pain wakes them in the night or stops them going to work, it’s a red flag that requires further examination. So be very specific with your GP about how a medical issue is affecting your life. It may even help to write a list to take into your appointment.
Do you think your GP failed to take your problems seriously? Please write in using the email on the right and let me know.
Jennifer’s workout is a menopause miracle
Jennifer Aniston, 55, follows an at-home programme called Pvolve made up of low-impact workouts using exercise bands rather than weights
I am usually no fan of celebrity exercise regimes, but I might make an exception for Jennifer Aniston.
The Friends star, 55, follows an at-home programme called Pvolve made up of low-impact workouts using exercise bands rather than weights.
Last week, a UK study concluded that Pvolve was more effective at improving muscle strength and reducing body fat than the exercise routines the NHS recommends for menopausal women.
I feel like I am constantly telling my female patients about the importance of exercise after the menopause, because they are more at risk of thinning bones as well as muscle loss that can lead to dangerous bone fractures – particularly in the hips.
So whether it’s Pvolve or some other exercise routine, it’s never too late to get started.
