The age of entitlement
Q I am always surprised when you suggest that one of your correspondents asks for a referral. When one is over 80, the verdict is always: "It's your age. Nothing can be done." I told my doctor that my back pain, diagnosed 25 years ago as arthritis, had become much worse recently. He did not want to refer me to a rheumatologist and I paid more than £100 to consult one privately. She found that I have an arthritic hip that needs replacement.
A Yours is a salutary tale. Most doctors are not consciously ageist, but there is a lot of fobbing off along the lines of: "It's passage of the years/you can't expect to feel as you did at 20." Most of us only begin to experience health problems in our 70s, so a medical profession that dismisses the elderly is denying its own raison d' tre . You have paid for the NHS all your life. You are entitled to proper check-ups (blood pressure, diabetes, blood tests and screening for cancers or heart disease, and so on). If you have a condition that needs treating, such as osteoporosis (bone thinning), you should be offered the treatment, such as HRT. If you need a major operation, it should be available for you within a reasonable time. Long waiting times, cancellation of operations or appointments at hospital or any unsatisfactory service should be challenged for you by your GP. The best way to improve the service is to demand a high standard for yourself.
Sex has gone stale
Q Some time ago I had a highly sexual love affair. Four years on, I'm back with my husband but finding sex with him repellent. Would Viagra help me?
A I don't think it would help either of you. Clearly you had no problem enjoying sex during your affair. The implication is that it's sex with your husband that is less satisfactory and you need to explore that. I suggest you both go to Relate, which offers couples a psychosexual counselling service. Email Relate at firstname.lastname@example.org
Q Why has my hayfever been so bad this year? I've tried every antihistamine under the sun and still have stinging, watery eyes, bouts of sneezing, a constantly running nose and a scratchy feeling in my throat. I don't remember it ever being so awful. Help!
A Heavy rain is particularly bad news for hayfever sufferers as it means more grass and more pollen. Try not to go outdoors in the evening when counts are high. To prevent symptoms building up, start using a nasal steroid spray, such as Beconase, two weeks before you expect symptoms to start and use it regularly while pollen counts are high. This prevents the nasal lining becoming sensitised to the pollen. Delaying treatment makes the hayfever more difficult to treat and last longer. If even liberal use of nasal steroids isn't enough, take an oral antihistamine, too. They are all much of a muchness, but Clarityn and Zirtek are particularly fashionable this year. Telfast is the least sedating and probably best choice for drivers and exam-takers. Eye drops containing nedocromil (Rapitil, Tilade) are good for streaming, itchy eyes. Oral or intramuscular steroid injections are available for those in dire straits. Combining antihistamines and the anti-asthma drug montelukast is thought to be more effective than antihistamines on their own, but more trials are needed. Desensitising injections are considered a bit dodgy, and homeopathy works for some, but not all.
Q I've noticed reddish patches on the side of my face. It's more noticeable when I'm warm or drink alcohol. What is this condition called and is there a remedy?
A It sounds like rosacea, which causes a red face, pimples and broken blood vessels on cheeks and nose. The advice used to be to avoid alcohol and stick to a bland diet, but there's no evidence that it makes the slightest difference. We do know that using steroid creams makes rosacea worse, so avoid those. Antibiotics (oxytetracycline or metronidazole) as gels or creams, or taken as tablets by mouth, can be effecive. Laser treatment can help particularly unsightly areas.
Q I have two firm lumps under the skin of my forearm. They seem to be getting bigger and when I straighten my forearm, you can see their outline through my skin. They don't hurt or itch but my girlfriend says I should get them removed. What do you think?
A Diagnosing lumps via a newspaper column is asking for trouble, so you do need to get them checked out by a GP. Having said that, they do sound like fat lumps, or lipomas, which don't become cancerous and can be left alone. They do tend to grow and can occasionally cause discomfort - if they press on a nerve, for instance. If you want to have them removed, ask your GP; some GPs do it themselves, others will refer you to a local surgeon.
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 email@example.com 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.