Dear doctor

A pain that spreads

Q At 79, I enjoy hillwalking and motorcycling. However, I began to have lower back pain in September 1998, with sciatica-type pain down the left leg, especially at night. Last March, the pain and stiffness extended to the right shoulder and knuckles of the right hand. Later the symptoms extended to the joint at the base of the neck, with grating of the joint, light-headedness and buzzing in the right ear. The diagnosis was degeneration of the spine with arthritis in the neck joint, and no cure but painkillers. Things have improved, but it has not cleared. I dislocated my right shoulder some years ago and fractured the upper arm; also, I have fractured my left ribs three times, but not recently. I've had slight curvature of the spine since 1945.

A First, can you alter anything in your life? Is the motorbike exacerbating the pain? Is your mattress giving good back support? Do you sit in a well-designed chair? Are you stooping while gardening?

Second, ensure there is no other underlying cause. Given your fractures, you should ask for x-rays, a blood test and a bone-density scan to check you don't have osteoporosis or other treatable conditions. Third, see an osteopath, chiropractor or physiotherapist for manipulation to relieve the pain. Ask your GP about this. Check that any osteopath or chiropractor you consult is registered by phoning the statutory bodies. (General Osteopathic Council: 0171-357 6655. General Chiropractic Council: 0171-713 5155.)

Breathe easy

Q My husband has had a blocked nose for almost two years; nasal sprays haven't worked. He has a stressful office job and suffered exhaustion a while ago. Could there be a connection?

A The commonest cause of a permanently blocked nose is nasal polyps - fleshy swellings which often develop when the lining inside is irritated by an allergy to something breathed in, such as cat fur, house dust mites or pollen. Sufferers often snore. The next step would be referral to an ear nose and throat specialist; large polyps can be removed surgically.

ME or not ME?

Q Tests have failed to pinpoint the cause of my illness and the conclusion is that I have ME. Can you provide a checklist of blood investigations my GP should do to rule out anything else?

A The criteria for diagnosis set out by the American Centre for Disease Control (CDC) have helped, but there is still no one diagnostic test for ME. The CDC states that to have ME you must have four or more of the following symptoms persisting or recurring over six months following the onset of abnormal fatigue. These are: loss of normal concentration or short-term memory to an extent that impairs your normal functioning, sore throat, tender glands in the neck or armpits, headaches of a type new to you, muscle pains, joint pains in several joints with no signs of redness or swelling, unrefreshing sleep and feeling ill for more than 24 hours after exertion. Your GP will run blood tests to check you haven't got anaemia, diabetes, underactive thyroid or a virus.

The ME Association has a list of consultants who are particularly interested in the condition- your GP can refer you. The number is 01375 642 466.

Avoiding ulcers

Q Below my left ankle, on the inner side, I have an unsightly area that my GP has diagnosed as varicose eczema. He said that nothing can be done, but my wife thinks it could ulcerate if banged.

A The key to preventing ulcers is to keep the skin well moisturised. Aqueous cream and E45 are fine as long as you're not allergic to lanolin; otherwise use Vaseline. If your skin is very flaky, avoid bubble bath and use a moisturiser as a soap substitute. Try a support bandage, which will reduce pressure on your veins.

Out, damned spot

Q For my 40th birthday I want to get the age spot on my cheek removed. It's a brown mark like a giant freckle, and I loathe it. How do I go about it, and is it safe?

A Removing any spot may result in a scar that you like even less. It can be lasered off or frozen with liquid nitrogen; either may result in a darker or paler spot than the rest of your skin. Ask your GP if he or she will give you a skin clinic referral.

• 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 any personal correspondence.

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