Dear doctor

Paying for a checkup

Q I'm coming up to my 40th birthday and feel I need a complete health checkup. I have private health cover through my work but was told that it doesn't cover a standard health checkup, for which I would have to pay nearly £200. Is it value for money or are there cheaper options?

A Your local GP surgery should do all the checkups that are relevant. This involves finding out details of any inherited conditions, such as heart disease or some cancers, and arranging appropriate screening tests. All of us should have our blood pressure measured at least once every five years, and there is a case for having a blood test every few years to check for anaemia, thyroid disorders, cholesterol and diabetes if you are at an increased risk. You can also check your weight and height to find out what your ideal weight is.The rest of what goes on during expensive health checkups is largely froth.

I'm getting more allergic

Q I have become very allergic as I have got older. I am now in my late 30s and come up in hives at least once a month. I take antihistamines for a few days, then it settles down. I suspect it is something I am eating because nothing else has changed. My GP has said it is often difficult to pinpoint the cause, but is there really no test I can have?

A It is worth keeping an obsessive diary of what you eat and drink each day, in the hope of identifying a trigger. If there doesn't seem to be any reason for your hives, your GP can take a blood test and send it to the local hospital-based lab. It can measure the antibody in your blood that rises in response to an allergic reaction, called IgE. Total IgE levels just tell you that you are having an allergic reaction, but specific IgE to different groups of common culprits can also be measured. There are well over 450 different tests, and if your local lab can't do them, they can be sent on to a specialist centre. The more information you can give about the foods you suspect, the better. Common culprits are peanuts, mixed nuts and mixed-food allergies including egg, milk, wheat, peanut, soya and cod. You and your GP can refer to a specialist website for more information and also refer you to a dermatologist or allergy specialist.

Is coffee really so bad?

Q I drink coffee all day. A colleague says it is very unhealthy and that when she drinks coffee, she gets extremely anxious. But when I switch to decaf, I get a stinking headache and can barely function.

A Just because she can't handle caffeine, doesn't mean you have to stop. Research suggests that a rare genetic variation means that some people feel very anxious when they drink even one cup of coffee. On the other hand, excess caffeine will make even the most genetically tolerant person feel twitchy, provoking a racing heart, sweating, anxiety and shaking hands. Coffee raises blood pressure a bit, and decaffeinated is no better than the real thing. The good news is that people become immune to the effects of coffee on blood pressure when drinking it regularly. Caffeine also has myriad qualities. According to an embryologist friend of mine, if you put sperm in caffeine, they go bonkers, though the exact effect on their ability to penetrate an egg is still uncertain. Yet another study has shown that drinking more than 350mg of caffeine a day can make you unproductive and stressed. The average cup of coffee contains 100mg so you are probably way over that level. Apparently, the reason it makes you unproductive is that caffeine is a diuretic which means you may become dehydrated and sluggish - plus you waste time going to the toilet. Suffice it to say that this research was commissioned by Volvic. Sensible advice is to limit yourself to three to four cups a day, drink water and tell your colleague to mind her own business.

Getting rid of wrinkles

Q I have promised myself that I will get rid of my wrinkles, but I don't even know where to start.

A Wrinkles are the price we pay for getting older, sunbathing, smoking and having wrinkly parents. The darker your skin, the less wrinkled you will be. Wherever "cures" abound, you can rest assured there is none. Facial exercises may be fun, but probably won't work. Sunblocking creams make sense, though sun avoidance is better. Vitamins C and E are anti-oxidants, available in creams or orally, which help cells repair themselves. Their anti-wrinkle powers are unclear but they are cheap. The oral tablets may prevent heart attacks if not wrinkles.

Collagen-containing creams can work well, at least in the short term. Oral versions are more variable in their effectiveness and more likely to cause side-effects.

Prescribable anti-acne cream Tretinoin used for six months can help fine wrinkles, although it can be a bit like paint stripper, often causing peeling, burning and redness. An even heavier-duty cream, Isotretinoin works on all types of wrinkles, if you can put up with the 5-10% risk of having a bright-red and sore face. Laser treatments are widely advertised and poorly researched though that doesn't mean they don't work. Dermabrasion, a technique similar to sandpapering the skin smooth, suffers from a similar lack of evidence and tendency to make the skin red. Botox blocks nervous impulses to tiny facial muscles controlling lines of facial expression so that the overlying skin becomes smooth and unlined. Botox lasts around four months, is usually effective but can occasionally make you look lopsided.

My head lice shame

Q I started work as a teacher earlier this year and am mortified to find that I have head lice. I would rather avoid chemicals if possible. Can you advise?

A Try tea-tree-oil shampoo to wash your hair, then shovel on some thick conditioner and comb through your hair with a nit comb (metal ones are a bit vicious but more lasting and effective than the plastic ones). Wash off the conditioner and comb through again.

Repeat every two to three days for a week or so. Go easy on the tea-tree oil - it may be natural but it's actually more toxic than the chemicals such as malathion contained in nit lotions and shampoos.

· 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 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.

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