My wife is losing her voice. Her GP says that it’s silent reflux but the prescription medicines aren’t helping. Could there be another cause?
Dr Ellie Cannon replies: When voice changes are worsening despite treatment, a referral to a specialist is essential.
Silent reflux refers to acid travelling upward from the stomach into the oesophagus – the gullet – causing throat symptoms but without the heartburn many people associate with acid problems.
The term is something of a misnomer when symptoms are as pronounced as these. Silent reflux is typically treated with the tablet omeprazole, which reduces acid levels in the stomach.
Lifestyle changes can also make a meaningful difference.
Avoiding trigger foods such as caffeine, alcohol, fatty meals and citrus, eating smaller portions and not lying down within two to three hours of eating can all help reduce acid travelling upward.
However, anyone with persistent or worsening voice changes should be referred to an ear, nose and throat specialist – known as ENT – who can examine the larynx, or voice box, directly. This is done via a procedure called a laryngoscopy.
Voice hoarseness that does not resolve warrants this examination, as in rare cases it can indicate laryngeal cancer, particularly in those with a history of smoking.
Silent reflux refers to acid travelling upward from the stomach into the oesophagus – the gullet – causing throat symptoms but without the heartburn many people associate with acid problems (picture posed by model)
A diagnosis of silent reflux should be confirmed only once a specialist has been able to assess the throat properly.
For patients with severe symptoms, an endoscopy – where a camera is passed into the oesophagus and stomach – is also important to rule out other causes.
I have stopped taking the antidepressant venlafaxine after nearly 20 years, and now I can’t sleep. This has been going on for five months. What should I do?
Dr Ellie Cannon replies: Stopping venlafaxine after two decades is a significant achievement, and there are options to help with the sleep difficulties that have followed.
Venlafaxine is used to treat both depression and anxiety. After such a long period of use, the body takes time to adjust, and insomnia is a recognised withdrawal effect that can persist for several months.
It is also worth noting that poor sleep can be a symptom of the anxiety or depression the venlafaxine was originally prescribed to treat.
In most cases it is difficult to know which is the cause, but either way, the sleeplessness needs addressing.
Restarting the antidepressant is unlikely to be the recommended route. There are better options a GP can offer.
Melatonin – the chemical the brain produces in darkness to trigger sleep – is available on prescription on the NHS for patients over 55 and is used for short-term sleep problems.
A newer medication called daridorexant is also available, and is designed to avoid dependency issues associated with older sleeping tablets.
Both are typically offered alongside talking therapy. Cognitive behavioural therapy, known as CBT, is considered the first-line approach for insomnia and works by changing the thought patterns and behaviours that prevent sleep.
This is always preferable to medication alone – though it can take longer to have an effect.
I broke one of my toes and now it has curled, which makes wearing shoes uncomfortable. What can I do?
Dr Ellie Cannon replies: A significantly misshapen toe is cause to see an orthopaedic surgeon.
Hammer toe is a condition in which one or more toes become fixed in a bent position, usually after repeated injury. When toes heal this way, they no longer lie flat, causing pain and pressure when wearing shoes.
Surgery is a well-established treatment for this condition.
The most common procedure involves straightening the toe by removing a small section of bone and, in some cases, then inserting a pin or implant to hold the toe in the correct position.
Most patients are able to walk on the foot shortly after the operation, though full recovery takes several weeks.
The risks of surgery are worth understanding clearly.
There is a possibility of reduced sensation in the toe afterwards, which can affect balance and stability. General surgical risks, including infection and anaesthetic complications, also apply. For patients not yet ready for surgery, there are measures worth trying first. Specially designed wide-fitting shoes can reduce pressure significantly. Padded insoles and toe splints or straps – available from a podiatrist – can help realign the toe and ease discomfort.
PSA tests for black men is genetics, not racism
Former England footballer John Barnes revealed his prostate cancer diagnosis last week
Don’t listen to what some people say: it’s great news that black men will now be invited for prostate cancer screening.
The move was announced last week for all black men aged between 45 and 74. Some, like Zia Yusuf, Reform UK’s home affairs spokesman, have claimed that this decision is unfair because it disadvantages white men.
This is simply not the case. Health officials came to the decision not to offer prostate cancer screening to most men because the test used to catch it – the PSA blood test – is unreliable, meaning that it can trigger false positives, where patients are wrongly told they have the disease. This can lead to unnecessary and potentially harmful treatment.
But black men, such as former England footballer John Barnes who revealed his diagnosis last week, are twice as likely to develop the cancer than white men. This means the benefits of undergoing a PSA test are higher and the risks of unnecessary treatment are lower.
This isn’t about identity politics, it’s about genetics. And any man over 50 who is concerned about prostate cancer – regardless of their race – can request a PSA test from their GP.
Do you have a question for Dr Ellie Cannon? Email [email protected]
