Dear doctor

Growing pains

Q I have a recurring problem of ingrowing toenails on my right big toe. It often hurts, digging into the soft flesh at the side of the nail. My GP advised that I see a podiatrist - what I gather chiropodists are called now. He said I'd have to have the nail removed. I have to admit I couldn't face the thought and never went back. Is there nothing else I can do?

A Ingrowing toenails don't seem to attract the sympathy they deserve. And yet, as you say, that little shard of nail that grows into the soft flesh can be exquisitely painful. Sweat softens the nails and flesh around the nail which exacerbates the problem. So cotton socks, leather shoes, careful washing and drying of feet can lessen the problem. Cutting the nail straight across and resisting the urge to dig into the crevices with scissors can also help prevent recurrence. If all else fails though, you may need to have some minor surgery on the nail. This may range from removal of just the spike of nail, to having the whole nail pulled out and phenol applied to the nail bed to prevent nail regrowth. Removal of the whole nail is statistically more likely to work though even removing part of the nail works in 90% of cases.

Bowel trouble

Q I was diagnosed with ulcerative proctitis in my second year at university. It cleared up on its own and I took no medication. Then two years later it recurred quite severely and one year on shows no signs of clearing up. I now have to take six mesalazine tablets everyday. Even with this treatment the bleeding has not stopped entirely and when I stop taking them it comes back worse than before. I feel tired, have indigestion often and dry itchy skin. I am finding it hard to get any advice about diet, alternative treatments etc. Do you have any suggestions?

A You have ulcerative colitis which is inflammation of the lining of the bowel. In your case, it is limited to the last bit of the large bowel (rectum) which is called ulcerative proctitis. The typical symptoms of this condition are bloody diarrhoea, though proctitis, which you have, can cause constipation and bleeding from the back passage. Urgent, crampy abdominal pains before opening your bowels and feeling ill and tired are also common. No one knows what causes it. It is probably an inherited predisposition triggered by some unknown factor. There is no consistent evidence that diet either causes or helps ulcerative colitis. The drug you are on is one of a group which reduces the risk of further attacks from 80% to 20% in the first year after diagnosis, so is almost certainly worth staying on. For further information, call National Association for Colitis and Crohn's Disease, tel 01727 844 296.

His noise annoys

Q My partner snores loudly, waking me up maybe 10 times per night. Is there a cure?

A Being overweight, excess alcohol, sedative drugs like sleeping pills and enlarged tonsils (rare in adults) all contribute to a tendency to snore. Sewing a tennis ball into the back of a tight fitting top so he can't roll onto his back at night can also help. Nasal drops that relieve nasal congestion sometimes help especially if snoring is worse in hayfever season so allergy may be playing a part. Referral to an ENT surgeon for consideration of surgery to the palate is an option, but it can be uncomfortable after the operation and snoring does sometimes restart after a few months. If snoring is causing daytime sleepiness, a CPAP machine, costing £5-600 and not available on the NHS, can help. It involves sleeping with a mask over your nose while a machine pumps a steady stream of air in. Details of sleep clinics throughout the UK from British Sleep Society, tel 01846 622266.

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