Q I have had three unpleasant bouts of cystitis in the past year. Each time, I've had to take antibiotics and now my GP has suggested that I stay on antibiotics for up to a year. She says that the cystitis may damage my kidneys and has shown me the test results that show that I have bacteria in my urine. I am really unhappy about taking antibiotics for so long.
A It is received medical wisdom that once you find bacteria in a urine sample, it must be treated with antibiotics to avoid the risk of the infection spreading. Kidney infection is even nastier than cystitis, causing fever, pain in the flank, nausea and vomiting, and the possibility of long-term damage. But the evidence suggests that untreated cystitis rarely causes kidney infection, and almost always gets better on its own though the symptoms may persist for some months. It's true that taking antibiotics for six to 12 months does reduce the number of attacks, but I can understand your reluctance to take tablets for that long.
Another option is for you to keep a single one-off dose of antibiotic at home (eg trimethoprim 200mgs) which you can take as soon as you start to get symptoms. You could see a specialist but there's no real need for further tests. Cranberry juice has had a good press and is worth a try. It's also worth drinking plenty of fluids, passing urine immediately after sex even if you can't be bothered, avoiding spermicide and taking care to wipe your bottom from the front backwards.
Into the dark
Q My father, now in his 80s, has lost almost all his sight because of a condition called senile macular degeneration. We have been told that nothing more can be done for him, and he has totally lost the will to live. Apart from worrying about him, I fear that I will inherit this condition.
A This condition is now called age-related macular degeneration (AMD). Would that treating it were as easy as renaming it. It is the commonest cause of blindness in the developed world and around 18 people in every 100 over 85 have little or no sight as a result. The usual cause is gradual drying out of the part of the retina that deals with what we see when we look straight ahead (macula). This leads to progressive, patchy loss of central vision while peripheral vision remains relatively intact.
Your dad now needs practical help; the RNIB is an excellent starting point. He may want to think about taking antidepressants for a while. For yourself, you may be at slightly increased risk of developing AMD, but it remains true that the passage of years is a far stronger risk factor than heredity. The other risk factors that you can control are smoking and high blood pressure. I'd also advise you to see an eye specialist (a high-street optician will do) to examine the back of your eyes (retina).
Q I'm a 43-year-old man and I've been told that my blood pressure is a bit high and that if I may need to take medication for life. I don't smoke, drink the odd beer or glass of wine and try to watch what I eat though my weight has crept up over the past few years. I work for myself in IT and do get a bit stressed at times though no more so than everyone else I know. I really don't want to take pills when I don't feel ill. What else can I do?
A Change your lifestyle to avoid pills. It will lower your blood pressure though whether you'll actually live longer as a result is debatable. Your risk of developing heart disease, stroke or Alzheimers as a result of your high blood pressure depends on several risk factors, not just your blood pressure. So it's great that you don't smoke, you should get your cholesterol checked and can afford to relax a bit if you come from a long line of octagenarians.
Any increased risk of stroke and heart disease as a result of high blood pressure, increases significantly as you get older. So you need to keep having your blood pressure checked at least once a year and whereas you may decide to try lifestyle options or just live with a highish blood pressure now, you may want to start medication if it remains high when you're in your 60s. If you can get your blood presure down to 140/80 or below, that's probably fine for now.
Avoiding stress is probably impossible, and being too laid back in the commercial sector may not be in your best interests anyway. Manageable levels of stress probably do you no harm. Increasing your potassium's a good idea (eat five small bananas a day or take supplements equivalent to 2g or 60mmol/day) so long as you don't have kidney problems or take other medication. Also, cutting down on salt at mealtimes is usually advised.
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 firstname.lastname@example.org 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.