Q: I had a mini-stroke three years ago and was put on a bunch of tablets, including lansoprazole. After suffering pain in my legs and hips, a scan revealed I have early-stage osteoporosis. I’ve read that lansoprazole could be a cause. Should I stop taking it?

Dr Ellie replies: Lansoprazole is a type of medication known as a proton pump inhibitor, or PPI. These work by reducing the amount of acid produced in the stomach, and for this reason they are given to people with acid reflux, stomach ulcers and gastritis.

They can also be prescribed preventatively to people taking other drugs that may irritate the stomach – for example, if someone is taking a regular anti-inflammatory.

But all drugs come with side effects and risks which must be balanced with the need for them.

According to official guidance, PPIs should be prescribed with caution to people who are at risk of the bone-thinning disease osteoporosis. Patients should be advised about taking the drugs and offered calcium and vitamin D supplements – and sometimes other treatments – to prevent problems developing.

An X-ray showing osteoporosis resulting in a hip replacement

An X-ray showing osteoporosis resulting in a hip replacement

An X-ray showing osteoporosis resulting in a hip replacement

Osteoporosis makes people susceptible to fractures. Studies published more than a decade ago showed that elderly people taking PPIs, particularly for more than a year, were at an increased risk of breaking their hip, wrist or spine. These effects were more likely with high doses and the longer people took them.

Contrary to popular belief, the symptoms of osteoporosis are not stiffness or night pain. In fact, there are usually no signs until a fracture happens and the disease is diagnosed with a scan.

An elderly person taking a PPI who has been diagnosed with osteopenia – a warning sign of osteoporosis – can request a scan to assess the situation. If bone thinning remains an issue, it might be possible to switch to other medication.

Q: At night I often wake up with extreme pain under the arch of my foot. I’ve seen a chiropodist and tried various creams. Can you suggest anything? I should point out, five years ago I had a brain tumour removed and had a bleed on the brain.

Dr Ellie replies: Severe heel pain is usually caused by a condition called plantar fasciitis. However, this causes pain while walking during the day and would get better once resting. Foot pain can be a side effect of cancer treatment, particularly chemotherapy, which can damage the nerves.

The pain could be worse at night because of the higher temperature of the feet, some swelling from lying still, and also because there are no distractions. It is unlikely that creams or paracetamol would help with this.

To assess for a neurological cause of pain – specifically peripheral neuropathy, which is a form of nerve damage – tests called nerve conduction studies can be done in hospital. A GP should be able to refer for this.

If nerves are the problem, this pain will not respond to normal pain-relief drugs but will need a neuropathic painkiller, such as gabapentin or pregabalin.

We also use an old-fashioned antidepressant called amitriptyline, which can additionally help with sleep.

Q: I was diagnosed with, and successfully treated for, breast cancer in 2018, aged 67. Now I’m 72 and I was told at my last appointment that I would be given a mammogram once every three years, and that’s it. Is this really safe? I’d much rather continue having one every year, as I have been.

Dr Ellie replies: Mammograms are a type of X-ray we use to screen for breast cancer. The idea is to pick up lumps when they are tiny, before they can be felt.

In the UK, women aged 50 to 70 are screened once every three years. After the age of 70, women can request to have them every three years.

This is thought to be the best timeframe because offering mammograms too frequently increases the risk of false positives and all the anxiety of that. It also provides no benefit in terms of better protection or a longer life.

Screening is only for people who are well. For women who have had breast cancer, the situation, of course, is different. At first, annual mammograms are the normal procedure for five years, usually alongside tablet treatment.

At this stage, women then re-enter the usual screening programme. This system mirrors treatment for other cancers. The five-year milestone is usually the point at which we consider a patient to be cured. Most cancers, if they’re going to return, come back before this time.

Five years after diagnosis, women who have had breast cancer are treated the same as other women of their age who haven’t. This can feel quite difficult, although many patients are pleased to go back to their normal life and not be reminded of their diagnosis.

However, it is important that women understand if they have symptoms such as a lump, pain, or changes in the breast, the screening programme is irrelevant. If you have symptoms, go to your GP and they will arrange tests entirely separate to the programme.

Lady Gaga posted a video about the migraine treatment rimegepant on Instagram. She says the drug has changed her life.

Lady Gaga posted a video about the migraine treatment rimegepant on Instagram. She says the drug has changed her life.

Lady Gaga posted a video about the migraine treatment rimegepant on Instagram. She says the drug has changed her life.

Lady Gaga got help for her migraines… but did you? 

Big migraine news as the NHS spending watchdog has approved atogepant, a daily tablet that helps prevent the debilitating attacks.

Meanwhile, in America, Lady Gaga is advertising a similar new migraine treatment, rimegepant, which she says has changed her life.

But patients in the UK will have to try three other medications before they get atogepant – also known by the brand name Aquipta – and it can be prescribed only by a specialist, not a GP. Then there are waits of up to a year to see a neurologist in some areas, and that’s if your NHS provider will fund the £500-a-month treatment.

Reports suggest there’s a postcode lottery when it come to migraine treatments. Have you had difficulties accessing them? Please write and let me know.

A stoma without the baggage

I’d never heard of Louise Thompson until last week, when the Made In Chelsea star announced that after years of suffering from the painful gut problem ulcerative colitis she’d had a stoma bag fitted.

In a video she posted on Instagram the 34-year-old said she ‘didn’t want to hide’ her condition and that the bag ‘may well have saved my life’. I applaud her honesty.

Having a stoma is a big deal. There are roughly 100,000 people in Britain with one – usually as a result of Crohn’s, bowel cancer or infections – yet there is still a stigma around it. Some people become very isolated, not doing things they used to enjoy through fear they’ll hurt themselves, make a mess or that people will see the bag.

But life with a stoma need not change. Colostomy UK is a good source of advice and can direct you to support groups (colostomyuk.org).

Do you have a question for Dr Ellie Cannon? Email DrEllie@mailonsunday.co.uk

Dr Cannon cannot enter into personal correspondence and her replies should be taken in a general context.

Source: Mail Online

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