Health: Dear doctor

In a sweat

Q I am a 50-year-old man and slightly overweight. I suffer from excessive sweating in the forehead/temple/neck regions and have done for several years, ever since spending a year travelling in tropical climates. It troubles me night and day, winter and summer (although less in summer, ironically, as the sweat evaporates more readily), and can be triggered by the least exertion, or none at all. My GP has not shown much interest, and his treatment has been limited to referring me to the endocrinology department of my local hospital, where I tested as having slightly lowered testosterone levels. I was prescribed this hormone for some 10 months but there was no change. I also saw a Chinese herbalist, and took her remedy for four weeks without relief. I have now been told that nothing else can be done medically, and that all that remains is a surgical procedure, sympathectomy.

A Excess sweating is a problem if it bothers and embarrasses you. Anxiety, an overactive thyroid or hormonal imbalances such as the female (and male?) menopause may all contribute, so a thyroid blood test is worthwhile. Avoiding situations that make you sweat is a good idea, such as very spicy foods, overheated offices, anxiety-inducing presentations and alcohol. Dress as you did in the tropics, with layers of cool, natural fibres in light colours. The lighter you are, the lower your metabolic rate, so losing weight will help. Antiperspirants containing 20% aluminium chloride (eg Perspirex, Driclor) are good under the arms or on feet, but not for the face. Herbal and homeopathic remedies are not proven to help sweating. Drugs that reduce sweating (eg propantheline) are available on prescription but can cause dry mouth, constipation and blurred vision. Botox injections into sweat glands work for underarms, but effects are temporary. Sympathectomy is a major operation that often doesn't work and is very much a last resort.

Orange alert

Q I have just been abroad. I had some stomach pains before I left and felt sick. Since my return, my urine is a strong orange colour, though the pain has largely gone.

A You could have gallstones or hepatitis or something less likely and more esoteric. Go straight to your GP for tests on your urine and blood; ask for an ultrasound scan of your gall bladder and liver. You may be referred to hospital. The urine may show bile products in your urine which would turn it orange. The most likely problem is a gallstone. If there is just one, you may have passed it by now and you should have no further problems. But if you've got loads, you'll want to consider the pros and cons of having the gallbladder out. If your liver is under strain, avoid alcohol. If you have gallstones, fatty foods trigger the release of bile from the gall bladder, causing pain and nausea.

Ovarian fears

Q My great-grandmother died of ovarian cancer, aged 43. I am 32, with three young children, and worry that I may get it too. I have annual scans and a blood test, but am considering having my ovaries removed in case. Can you advise?

A Many of us think we have a family history of a disease but the illness of one family member, especially if it is not a first-degree relative, is likely to be due to chance. You can only make your decision once you know whether your risk of developing ovarian cancer is significantly higher than that of the rest of the population. To do this, you need to accurately chart your family tree with as many details as possible and see a genetic counsellor.

I understand your concern because there is currently no truly reliable screening method to detect ovarian cancer and no effective means of preventing it. It's a horrible disease that is the main cause of death from gynaecological cancers, but less common than the more successfully treatable breast and cervical cancers. It's also rare in the under 45s. Removing your ovaries (and possibly breasts as breast and ovarian cancers are linked) is a drastic step which means a major operation that would cause early menopause. You probably won't want to take HRT if you are at increased risk of breast cancer, so your options for dealing with the menopause will be limited.

Some of us have higher risk for specific cancers or illnesses. Not smoking, eating fruit and veg, keeping fit and checking blood pressure and cholesterol levels all reduce risk of early death.

· 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 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.

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