Health: Dear Doctor

Disease on the farm

I live in a village in Herefordshire. We don't live on a farm but are surrounded by farmland. Is there any danger to my family from foot and mouth disease?

Foot and mouth is caused by a virus that affects all cloven-hoofed animals and spreads like wildfire between them. Humans can catch it but usually only after very close contact with affected animals. There hasn't been a human case reported since the last outbreak in 1967. You can't catch it from the milk or meat of diseased animals. Even in the unlikely event of infection, it causes a mild illness in humans with tingly blisters on hands, fever, sore throat and occasionally blisters on the feet and tongue. There is an unrelated viral illness that often affects young children and also causes blisters on the hands, feet and mouth. It's called hand, foot and mouth disease but it has nothing to do with cloven-hoofed animals and everything to do with other kids who infect one another.

Taking vitamin E

Should I take vitamin E supplements to prevent the ravages of ageing and reduce my risk of heart attacks?

Would that life were so simple. Vitamin E is an antioxidant which is, in general, a good thing. It's found naturally in fruit and veg. It's hard to be deficient in vitamin E unless you have cystic fibrosis, long-standing jaundice or severe bowel problems. Two recent studies have shown conflicting evidence about the role of vitamin E in reducing heart disease. On the other hand, it's unlikely that a supplement will do you harm.

Breakthrough bleeding

I have always had irregular periods but last year I had breakthrough bleeding between periods. I was put on the pill, which I hated, but it seemed to clear it up. Now I am bleeding again between periods. Is there anything that I can do apart from go back on the pill?

If all potentially dangerous/treatable conditions have been ruled out (ie blood test for thyroid, scan of ovaries and womb and cervical smear, etc), you can put your bleeding down to hormonal fluctuations - usually not enough progesterone to keep the womb lining in place except during periods. The combined pill is the best way of stabilising things. Alternatively, you can have a coil fitted which releases a tiny amount of progesterone into the womb. If you decide just to live with it, have a blood test now and again to check you are not becoming anaemic.

Anaemic after birth

I had a baby by caesarean section three months ago and following the procedure was told I was anaemic. I declined a transfusion and a follow up blood test showed that my iron/haemoglobin count was a respectable 12. However, six weeks ago at the gym I experienced a sensation of losing my balance. I thought this was a one off as it was my first gym visit in almost a year. However, this feeling of imbalance has not gone away since. My GP took my blood pressure which he said was low and attributed my loss of balance to low iron and low blood pressure so he has prescribed me more iron tablets. I am also experiencing a tingling feeling in my lower legs. What advice can you give me on this matter as it is disconcerting?

You can tell whether you are low in iron by asking whether the full blood count showed small and pale cells or normal looking ones. If there is any doubt, a further blood test specifically to measure your iron stores may be a good idea. I agree that both rushing into a transfusion and taking iron tablets orally are to be avoided unless necessary - and with a haemoglobin of 12, as you say, it seems unlikely that you are anaemic enough to make you dizzy.

Having low blood pressure is a good thing from a long-term health point of view but makes you prone to dizzy spells, especially if you are on your feet a long time or get very hot. There is no specific treatment in the UK and most people learn to avoid the dizzy spells by not overheating and sitting or even lying down if they feel dizzy.

You may also have a mild inner ear virus making you dizzy. This virus passes on its own within a few weeks. If it persists ask for further tests.

• These answers are intended to be as accurate 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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