Dear doctor

Pinches of salt

Q I have intermittent hypertension and so have become very conscious of salt in foods. I've found out that a couple of bowls of breakfast cereal, six slices of bread or three veggie sausages contain more sodium than an adult's daily requirements, and that most of us are eating at least three times as much sodium as we should. How do manufacturers get away with it?

A Salt intake has a direct effect on blood pressure, and it's worth getting your blood pressure as low as possible to minimise any risk of heart attacks or strokes. Restricting your salt intake is one of several measures, such as losing excess weight, cutting down on alcohol, eating potassium-rich foods like fruit and taking regular exercise, that can help lower your blood pressure. Ideally, you should stick to less than a teaspoon of salt (2,000mgs) a day.

It's tricky to work out the salt content of foods - you need to tot up the sodium content, but quantities are hard to estimate and many foods don't list it at all. Sensible advice is to avoid extra salt at the table and cut out salty foods like sausages, salty bacon and salted peanuts. Takeaways and processed foods are usually high in salt. Salt substitutes that are high in potassium and low in sodium are worth a try, but excess potassium is dangerous, so go easy on that too.

Manufacturers are being urged to adopt clearer labelling - but if you want to restrict your salt, you have to watch what you put in your mouth.

Double trouble

Q For 18 months I have been troubled by a strange feeling in one ear, similar to the pressure build-up when taking off in a plane. Throughout the same period I've suffered from nausea that makes me retch but never fully vomit. It all started when I was in Asia during the toxic smog crisis in 1997; I was also stressed at the time. I am male, 24 years old and reasonably fit. I gave up smoking a year ago; this eased the nausea, but hasn't cured either problem.

A It's always tempting to look for one cause to account for several symptoms; but I think that in your case, we need to look at the problems separately. The toxic smog crisis may have made you wheezy and breathless at the time, but would be unlikely to cause long-term effects. The stress and smoking probably contributed to acid reflux from the stomach that would account for your nausea and gagging. And the pressure in your ear is most likely to be a blockage of the Eustachian tube that connects the middle ear to the back of the nose. If holding your nose while blowing out through closed lips makes your ear 'pop' and clears the stuffy feeling, it's almost certainly your Eustachian tube. Decongestant nose drops or nasal sprays such as Sudafed or Vicks Sinex, available over the counter, are worth a try.

Highly stressed

Q I am a generally happy, relaxed twentysomething woman who loves rock climbing. About a month ago I started suffering from panic attacks. I went to my GP, who thankfully did not instantly prescribe beta-blockers. However, he recommended avoiding situations that brought on stressful feelings - some of the attacks have occurred while I was climbing. He suggested a referral to an anxiety management group, which will take a month to arrange. As a climber himself, he seemed to feel that climbing was the root of the problem. However, I have been climbing for years, with the normal, healthy fears that keep one safe, and no previous irrational panic. I also mentioned to him that for some months previously I had been feeling rather tense, irritable and generally unhappy, but was unable to put my finger on the cause. Are there any positive steps I could take while waiting for this referral?

A I think that focusing on whether or not to avoid climbing is a diversion; clearly, you have become a bit depressed and anxious. The panic attacks are a sign of anxiety, and I agree with you that merely taking beta-blockers to stop the physical effects (such as palpitations) is no substitute for confronting the underlying problem. I would recommend a few sessions with a cognitive behavioural therapist who can help you explore your beliefs about what is happening to you and why, and show you how to plan a programme to control the panic attacks and regain your confidence in climbing. Your GP may be able to recommend a therapist.

Womb worry

Q I have just turned 40, and 18 months ago had an ultrasound scan to check an ovary which revealed that the lining of my uterus was very thick. A second scan three months later showed that it was still 18mm thick. My GP referred me to a consultant who said that in a woman my age this endometrial thickening can come and go, and it is only because of ultrasound that we are alerted to such changes. My periods are now nine to 10 weeks apart, and I remain worried. If the lining is still thickened, could it be indicative of something sinister? I have read about endometrial cancer and would like to see my GP again and request a scan, but fear she will feel that I am overreacting.

A I think you should stop worrying. Endometrial cancer (cancer of the lining of the womb) would be rare in a woman as young as you are. It usually causes vaginal bleeding in women who have passed the menopause, and tends to become continuous. Given your menstrual cycle, the chances of you having endometrial cancer are incredibly low. If you want further reassurance, get your GP to ask the consultant to clarify in writing that you don't require further scans.

How to fight flu

Q Is there anything I can do to avoid getting flu this winter? I'm in my early 40s, not in an at-risk group and otherwise well. Is it worth asking my GP for a flu jab?

A If you want to avoid flu, avoid people! All the common viruses are spread by tiny droplets from infected people's noses and mouths. Crowded trains, cinemas and poorly ventilated offices are your worst enemies. Keep immunity buoyant by adhering to all the maxims mum drummed into you; eat well, sleep well and consider vitamin C and zinc supplements. You can ask your GP for a flu jab - the government doesn't encourage GPs to vaccinate the fit and well, but some will do it. Some workplace occupational health departments give jabs too. There are anti-flu drugs, but as a young, fit person, there is no way you'll get an NHS prescription. Far better to avoid the crowds.

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