Will fish help aches?
Q My father is in his early 80s. He suffers from aches and pains in the joints, particularly in his wrists and ankles. I was wondering what dietary recommendations there may be to help with arthritis/rheumatism - I've read that oily fish may be beneficial.
A Your dad is most likely to be suffering from osteoarthritis, which is wear and tear of the joints that affects most of us as we get older. He should try to lose weight if he's overweight to take pressure off his knees, ankles and back. Unfortunately, there is no good evidence that oily fish or any other kind of dietary supplement really help in osteoarthritis, though they do in rheumatoid arthritis.
Paracetamol in quite high doses (up to eight tablets or 4g a day) is best for pain relief. If they aren't strong enough, non-steroidal anti-inflammatory drugs such as Brufen are worth a try but may cause side effects of indigestion, bruising, even stomach ulcers. If his joints swell up, fluid can be drained by the GP to give relief. Injection of steroids into the joint may help. There's hope that injections of hyaluronic acid into arthritic knees will protect the cartilage and relieve pain.
Only joint specialists or rheumatologists offer this treatment. Physiotherapists can help improve joint movements. An occupational therapist can visit to suggest aids and hoists that will help him cope better and avoid falls. Using a stick and replacing thin-soled shoes with cushioned trainers can make a huge difference. An appointment with an orthopaedic surgeon to discuss surgical options may also be useful.
Q About 10 years ago I was prescribed an antidepressant, amitriptyline, which I have been using ever since. When I enquired about side effects I was told there were none. A few days ago I was looking through a medical book and was horrified to discover that there was a list half a page long - including heart and blood problems and impotence. Are these effects reversible if I stop using the medicine?
A If you were to read the potential side effects, you'd probably flush any prescribed drug down the loo. Of course, you do need to take note of the warnings. A frank discussion with a pharmacist is a good way of getting an informed perspective.
Amitriptyline is effective and safe, so long as you don't overdose on it. Its side effects are largely predictable: it tends to make you tired, but that can be a good thing given that you usually take it at night and that sleep disturbance is often a feature of depression; if you suffer from heart disease, glaucoma or prostate trouble, you probably shouldn't be on it.
Baldness and hormones
Q For the last four years my hair has been thinning at the sides and top and my hairline has been receding. My blood tests have been normal, but my doctor refuses to check my hormone levels as my periods have been OK. However, I have read that female baldness/hair loss can be caused by an increase in the level of testosterone. Have you any advice?
A Your hair loss sounds like it is the type known as male pattern baldness. In men, this is linked to the male hormones, androgens. In women, it is unclear whether hormones play a part. It's often an inherited tendency. The most practical solution is to take the oral contraceptive pill, Dianette, which blocks the male hormones and so can help prevent further hair loss.
If you can't take the pill because you've had a thrombosis or you prefer not to, you could try Minoxidil lotion, marketed as Regaine, available over the counter. You have to keep using it or any hair regrowth tends to fall out again. If you are approaching the menopause then you may want to consider HRT which may restore hair thickness and halt the process. A blood test won't tell you much but can let you know whether you're approaching the menopause despite regular periods. I'd go for Dianette myself.
Q I'm in my late 20s, and I've begun to get fine thread veins on my cheeks. They're not too bad at the moment, but the probability that they are going to get worse is worrying. Is there anything I can do to stop them getting worse (and possibly remove the ones I already have)?
A Tiny thread veins in the cheeks come on with age and sunbathing makes them worse. Rosacea, a skin condition causing facial flushing and tiny pustules, can result in lots of thread veins, as can prolonged steroid treatment. But most of us just get a few tiny ones on the cheeks, starting in our late 20s, and increasing with age. You can get them treated with a pulsatile laser by a dermatologist or cosmetic surgeon. One treatment is usually enough. You'll never get it done on the NHS unless it's due to rosacea or steroids because it will be deemed a cosmetic procedure. Expect to pay at least £175 for consultation and one-off treatment.
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.