Dear doctor

Suck it and see

Q My child fell off her bike this week and cut the inside of her lip. It bled for ages and her lip started to swell up afer a few minutes. My husband thought I should have taken her to casualty for stitches, but she became hysterical at the idea, so I gave her some ice to suck and let her be. Did I do the right thing?

A The proof of the pudding will be in the healing, which should have occurred by the time you read this. In general, the mouth has a great blood supply which means that cuts heal quickly. If the edges of the cut are lying edge-to-edge and the bleeding stops after a few minutes, you can often get away with leaving cuts in the mouth alone, as you did. If in doubt, run to casualty. Kids up to 15 or so are covered against tetanus by their routine childhood jabs, but if you didn't immunise them, forgot their pre-school booster at age 4-5 or they're over 15, you may want to ask for a booster, especially if the cut was on a dirty surface.

Turned off by sex

Q My sex drive is zero. I've just gone off the whole idea. Could there be any physical cause, or is it all psychological?

A Is it just sex you've gone off, or life in general; in other words, are you depressed? If you're sad, negative, can't enjoy anything, not sleeping, not eating and tired all the time, you need help for depression. If you're not depressed but very sluggish, you could have an underactive thyroid which can be checked with a blood test. Loss of libido can be hormonal, especially if you're in the run-up to the menopause - are you having night sweats, hot flushes, suffering from a dry vagina and mood swings? If so, you may want to consider HRT. Many drugs, including alcohol, can cause loss of libido as a side effect so try cutting out the booze for a while, and checking the information leaflets of any prescription drugs you're on to see whether they're possible culprits. If they are, you can discuss stopping or switching them with your GP.

How do I tell my girl?

Q I've just been told that my nine-year old daughter's dry, scaly rash is psoriasis. I don't know what to expect or how to explain it to my child. Can you help?

A Before you broach the subject with your daughter, find out as much as you can about this common, non- infectious skin condition in which the cells of the top layer of skin (epidermis) reproduce themselves too quickly, which causes heaped up cells and inflammation. You need to speak to a paediatric dermatologist if possible, and also to contact the excellent self-help group, the Psoriasis Association, on 01604 711129. Your daughter's psoriasis may burn itself out entirely, fade and only flare up at times of stress or illness, or prove more stubborn to treat. I would be upbeat, though you can't promise her that it will disappear forever. She needs to know that there are good creams and other treatments which will help, but you may need to try a few before finding the best one. I would find a specialist you can all trust, and stick with him or her, rather than shopping round the conventional, complementary and commercial sectors. Be very wary of promises of instant cures.

Fat-buster

Q I'm very fat. Should I try this new fat-busting drug, Xenical?

A It depends on how fat is "fat" and what else you've tried. If you calculate your body mass index (body weight in kg, divided by your height in metres squared) to be over 30, then you may be fat. If you've tried at least three months of a sensible diet, exercise, and sought some help from a GP, dietician or slimming group, all to no avail, then orlistat (Xenical) may be a good idea. This drug stops you absorbing some of the fat you eat and makes it pass straight through your gut. Your GP isn't supposed to prescribe it unless you can show commitment by losing 2.5kgs over four weeks, without drugs. The flip-side of orlistat is that it may cause bloating, a very strong urge to defecate, and oily stools that won't flush away. Most disappointingly, not everyone loses weight. I've seen a few people who found it a very useful kickstart to their weight loss. But the acid test is whether you manage to adapt your lifestyle so any weight you lose stays off.

Get an X-ray - fast

Q My mother-in-law told me she had a clear discharge from one of her nipples that recently had a bit of blood in it. She can't feel a lump. She's 73. Does she need to do anything about it?

A Emphatically, yes. Without wanting to alarm her, discharge from one nipple can be a sign of a blocked milk duct, a harmless growth or an underlying cancer. She needs urgent referral to a specialist breast unit by her GP. They will do a mammogram (breast x-ray) and see whether she needs further tests.

Itch for swimming

Q I swim a lot and get a very itchy right ear. Any tips?

A Keep your ears as dry as possible: use well-fitting earplugs, a swimming cap or keep your face out of the water. Don't be tempted to stick earbuds, fingers or Biros into your ear. Thrush is a common cause, so you could try some Canesten eardrops, available over the counter. If you have any discharge from the ear, hearing loss, or the Canesten drops don't do the trick, see your GP.

Soothe that rash

Q I've got a pimply rash round my bikini-line that is sore. I can't wear my new high-leg swimsuit and I'm going on holiday next week. What can I do?

A I wonder whether you shaved or waxed your bikini line, in honour of that new swimsuit? If so, that's a highly likely cause of the rash. If you have little red pimples, but no yellow, pus-filled spots, you may get away with a mild steroid cream eg Hc45, available over the counter. If you have any yellow pustules, it implies that the spots are infected and you need an antibacterial cream, only available on prescription eg Fucidin. If shaving or waxing is the culprit, try a hair-removing cream, or go for the Julia Roberts look and let that hair wave about. Thrush in the groin creases can also cause itchy, red rashes and will respond best to an antifungal cream, like Canesten. If in doubt, ask your doc.

Gut reaction

Q I'm a healthy and fit 80-year-old man and I exercise, swim and cycle regularly. Six months ago, I was diagnosed as having diverticulitis. I eat muesli, natural bran, fruit etc. Any suggestions?

A Diverticula are small pouches that develop in the wall of the large bowel. Bits of faeces can get stuck in them, which causes inflammation, known as "diverticulitis" which you experience as a sudden onset of pain and tenderness on the lower left abdomen. You may feel feverish and unwell. These flare-ups are usually treated with strong antibiotics, so visit your GP. The trick is to keep the stool flowing smoothly, so a comfortable amount of fibre (although in some people raw bran actally aggravates the problem), plenty of fluids and exercise are ideal. You can use antispasmodic drugs if you get gripey pain (eg mebeverine); suck peppermints if you feel bloated; and anti-diarrhoeal drugs (eg loperamide) if the stool gets too loose which sometimes happens. Above all, see your GP if you get any bleeding from the backpassage or the pattern of your stool changes, as you can't assume that all bowel problems are necessarily to do with your diverticulitis.

Thanks to guardian.co.uk who have provided this article. View the original here.