Am I an alcoholic?
Q: I work in software, and drinking's part of my work culture. I never feel drunk and, as far as I'm aware, I'm not dependent on alcohol although, to be fair, I never go for more than a day or two without a few drinks. How do I know if I'm drinking too much?
A: If you're asking that question, you're probably drinking too much. Ask yourself whether, on any single occasion in the past three months, you've had more than five alcoholic drinks, eg five pints. Then ask yourself how many days a week you usually have a drink, and how many units you have each time (where a unit is half a pint of beer, a glass of wine or a short). If you're drinking fewer than 21 units a week and haven't had more than 5 units at one sitting, you're probably fine. The other way to do it is to ask yourself the CAGE questionnaire:
Have you ever felt you should Cut down on drinking?
Have people Annoyed you by criticising your drinking?
Have you ever felt Guilty about your drinking?
Have you ever had an Eye-opener - a drink first thing to steady your nerves?
One "yes" means you should probably cut down, more than one "yes" means you may be more dependent than you realise and should seek help.
Bone of contention
Q: I've got a very stiff elbow, which is particularly painful on the outer bony bit. My GP said it's tennis elbow, which is odd because I don't play, and has offered me a steroid injection. I'm a bit wary. What do you think?
A: Tennis elbow can be caused by any repeated movement, such as cleaning windows or scrubbing floors and is due to inflammation at the point where the tendon of one of the muscles of the forearm fits into the outer bony bit (lateral epicondyle) of your elbow. You should rest the elbow for a couple of days and take an anti-inflammatory tablet such as Brufen if the pain's bad. You can rub on an anti-inflammatory gel or cream, such as Ibuleve, which won't cause side effects, but may not do much.
Once the pain has settled, physiotherapy can help to reduce any stiffness and help prevent a recurrence in the future. A steroid injection into the painful part will probably give you the fastest relief, but it may hurt, may not work and the pain may recur. Other side effects from steroid injections are relatively rare, but include infection and damage to overlying skin. If I had tennis elbow that wasn't too bad, I'd probably take some Brufen and leave the injection; but then, I'm a coward.
Q: There's a lot of cancer in my family, and I wonder whether I should ask my GP for a referral to a specialist. Is it likely to be worthwhile?
A: Your concern is understandable, but don't forget that most people die of either heart disease or cancer, and that although there's a lot we still don't know about the genetics of cancers, most are not linked and probably not inherited. You should certainly ask to be referred if you have a close relative who was under 40 when diagnosed with a common cancer such as breast, ovarian, bowel, stomach or prostate; or if you have two close relatives with any of those cancers diagnosed under the age of 50. If you don't fall into those categories but are still concerned, why not ask to be referred to a genetics clinic. Before you go, try to glean as much information from relatives as to who had what and at what ages they were diagnosed and died.
Q: My mouth gets very dry, especially when I wake up in the morning. I often have a nasty bitter taste in my mouth too. I sip water constantly, even though I'm not thirsty, but it still bothers me.
A: The two commonest causes of your problem are either a side effect of medication, or acid refluxing up from your stomach and into your mouth. If you're taking medication, check whether a dry mouth is a possible side effect - likely culprits are amitriptyline, an antidepressant, and hyoscine (Buscopan) used for irritable bowel syndrome. Acid refluxing up from your stomach may cause burping, indigestion and heartburn as well as a dry, bitter-tasting mouth. Try raising the head of your bed, cutting out acid foods, and try a swig of gaviscon or another antacid which neutralises acid. If that works, you've got your answer. If not, see your GP.
Time for a change
Q: My GP, who used to be a very nice man, has become very curt and offhand. How do I go about changing to another one?
A: It might be worth having a word with your GP - you'll be doing a service to other patients even if you do decide to move. And you may find that you can smooth things over - GPs are human. Perhaps he's been going through a difficult patch in his life. But if you do decide to move on, get a list of local GPs from your library or by phoning your local health authority. Ring around until you find one that is accepting new patients, then just walk in and register - you'll be asked to sign forms and have a health check. Your medical records will be transferred automatically.
Before taking the plunge, ask if you can meet the new doctors to ask any specific questions you may have about the way their practice is organised (on-call, repeat prescriptions, appointments, other services offered etc). Above all, make sure you like them - no point moving from one curt doctor to another.
These answers are intended to be as accurate and as 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 DRANN@dircon.co.uk or write to her c/o Health Editor, The Guardian, 119 Farringdon Road, London EC1R 3ER. She regrets she cannot enter into personal correspondence.