Dear doctor

Swollen breasts

Q My breasts get very swollen and tender for the week before my period. My GP offered me various drugs but said they all have potential side effects that sound even worse than the breast pain. Is there a good option?

A It may be a comfort for you to know that there's absolutely no link between the sort of pre-period breast pain and lumpiness and breast cancer. And although your breasts are obviously sensitive to the hormone shifts that occur just before a period, it doesn't mean there's anything unusual or abnormal about your hormone levels. You can try wearing a well-fitting bra day and night, cutting down on caffeine and taking regular exercise. Gamolenic acid (evening primrose oil) may help and is very unlikely to cause side effects. You need to take 6-8 40mg capsules a day for up to six months. Although expensive, it's available over the counter, and you may be able to get it on prescription. After six months, the breast pain may not recur at all or be much milder.

Dogged by spots

Q I've got an extremely itchy, round, crusty spot on my forearm, about the size of a 10p piece. My wife said I might have caught something from our new puppy, but I think it looks a bit like the eczema I used to have as a child. What do you think?

A It is hard to be sure without seeing it, but I'd put my money on your wife being right. Ringworm is a fungal infection that you catch from direct contact with infected animals. Eczema usually causes several patches and is symmetrical so you'd expect to have a similar spot on your other arm. The outer edge of a patch of eczema tends to merge into the surrounding skin, whereas fungal patches such as ringworm have a heaped-up, raised edge with a clear area in the middle. You can try Canesten or Daktarin anti-fungal creams available over the counter. If in doubt, ask your GP to take scrapings of the patch and have it tested.

Pain in the back

Q I get low back pain from time to time, usually after lugging the children around all weekend. So I take a couple of paracetamol and have a hot bath, and it tends to clear up after a couple of days. My friend, who gets much worse backache, told me to see his osteopath, whom he says works wonders. Is it safe or could I do more harm than good?

AThe point is that you're talking about your back, not your friend's. It seems that if you could lug the kids around less, you may not even get backache at all. And if it clears up on its own after a couple of days, how will you know what added benefit you're getting from the osteopath? I'm not anti-osteopathy - we have a wonderful one in my practice and I've seen what great results he can achieve. But it must be said that there is still no conclusive proof that it either works or is safe, nor proof that it doesn't work or isn't safe.

Too much fat?

Q I had a cholesterol test as part of a health check-up at work. They said it was a bit high and that I should try to alter my diet, but I don't eat much of the foods, such as cakes or fried food, they said to cut out. What should I do?

ACholesterol is only one part of the picture - smoking, blood pressure and genetics all play a part in whether you're at increased risk of heart disease. So a slightly high level of cholesterol, in an otherwise low-risk person, may not mean much. One tip is that eating 25g of soya protein a day lowers cholesterol and helps to protect against heart disease. You can get soya milk, yoghurts, desserts, burgers and tofu for cooking. Use unsaturated oils rather than saturated fats, and eat lots of starchy foods such as bread, rice and pasta as well as fruit and veg.

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