I’ve had a series of horrible falls since I started taking a blood pressure drug called bisoprolol that seems to make me dizzy and weak. I’m 87. Do you have any idea why that is?
Bisoprolol is known as a beta blocker and is used to treat high blood pressure, angina and heart failure.
Dizziness and fainting are side effects of all beta-blockers, and bisoprolol can sometimes cause a drop in blood pressure when standing up, which can lead to fainting.
When prescribing medication, we weigh the benefit to each patient against the known risks and side effects. There is no point in checking a person’s blood pressure, which is crucial to prevent strokes and heart attacks when treatment causes falls – a significant problem for the elderly that can lead to serious problems and a massive reduction in quality of life.
Today’s reader asked DR. ELLIE CANNON if her blood pressure treatment is causing her to fall over more often (Image provided by the model)
There are now entire medical teams dedicated to preventing falls in the elderly and infirm, and we would certainly want to avoid any medication that might contribute to them.
If a side effect like this is a problem, see a GP and ask about fall help and prevention. It may be possible to get a referral to a community falls team or clinic.
There are a number of blood pressure treatments you can have, but this depends on other health conditions and their severity.
The family doctor can assess your risk and decide which treatment is the best and safest.
I suffer from an intimate skin condition called lichen sclerosus. From the beginning my husband and I have tried to have intercourse but it has been an absolute agony. My doctor has prescribed steroids and lidocaine ointment but neither has helped. I’m done. Is there anything that takes away this pain?
Lichen sclerosus is an inflammatory skin disease that particularly affects the vulva and anal areas.
It is most common in women over 50 and causes pale patches on the skin that are very sensitive, as well as blisters and ulcers. The condition is incredibly itchy.
Scar tissue can also develop, which can be distressing and causes a feeling of tightness and dryness that can make sex difficult or even impossible.
A second reader has Dr. Ellie asked about possible treatments for an intimate skin condition that affects women in their 50s and can make sex painful
The NHS recommends women get treatment early and quickly to prevent this type of scarring. Women with lichen sclerosus also have a low cancer risk.
Lidocaine ointment is a local anesthetic designed to relieve pain and discomfort in this area, but it doesn’t treat the condition. Any woman with lichen sclerosus should be treated by a specialist dermatologist or gynecologist and the normal treatment would be strong steroid creams such as Dermovate or Clobetasol.
These will initially be used once a day for four weeks and patients should not use any other creams or moisturizers as they may reduce the effectiveness of the treatment. This then falls on alternate days for a month, then just twice a week.
This regimen should reduce symptoms and prevent scarring, but can be repeated if a flare-up occurs. Other creams may also be offered by specialists, including immunosuppressants such as tacrolimus.
Soaps should be avoided when washing, as they are often too aggressive for sensitive skin, or a soap substitute such as a cream should be used. A pharmacist can advise on this.
I am a fit 73 year old female. I run, take Zumba and Pilates classes, and do weights. However, for the past two years I have had a sebaceous cyst on the inside of my leg just below my knee. It is very delicate and rubs against my leggings when I jog. It also seems to be more painful in cold weather – sometimes enough to make me almost nauseous. Any suggestions?
Cysts are fluid-filled lumps that develop on the skin that most adults will have at some point in their lives.
Write to Dr. ellie
Do you have a question for Dr. Ellie Canon? Email [email protected]
dr Cannon cannot engage in personal correspondence and her responses should be viewed in a general context
There are many types found on the skin – some are more common in people who have had acne, for example, others are more common in middle-aged women due to hormonal fluctuations. Importantly, cysts do not usually cause pain or symptoms unless they are infected. When a cyst is infected, it will be very tender – possibly red and swollen. There may also be discharge.
A leg lump that has been very painful for two years doesn’t sound like a simple skin cyst, so the first thing you should do would be to get a second opinion. This could be at a family doctor or dermatologist.
A new NHS service called teledermatology, whereby GPs send photos of the lump to a dermatologist for a quick remote diagnosis, may also be helpful.
A good way to diagnose a cyst is to use an ultrasound scan, which will identify exactly what the lump’s contents are.
Sometimes they don’t need to be removed. But usually if there is pain, removal would be warranted – it’s not just a cosmetic issue. After excision, the lump is sent to a lab and examined to find out exactly what it is.
We need to talk about prostate
We still miss far too many cases of prostate cancer. A report last week found that in some parts of the country a third of men are diagnosed at a late stage – when the disease has spread and is incurable. A lot of this has to do with the same old problem: embarrassment. Men are notoriously reluctant to seek help for the first signs – trouble using the toilet and having sex. Some experts want a national screening program – blood tests on every man over a certain age to determine his level of PSA, a protein that cancer cells release. However, this test is not accurate and can reveal problems when none exist.
I prefer screening – but not with PSA testing. Instead, men over 60 should be interviewed about toilet habits and family history, and monitored if necessary.
We need to find a way to get men talking.
My radical alternative to statins, just in case
I was quite baffled by the recommendations from UK health chiefs that millions more people could be prescribed cholesterol-lowering statins.
The UK’s regulator of medicines spending, the National Institute for Health and Care Excellence (NICE), has released updated guidelines that allow GPs to prescribe the drug for patients who are even slightly more at risk of a heart attack. Previously, we could only offer statins to people at risk of 10 percent or more.
Instead of spending NHS cash on more statins, why not fund public gyms, swimming pools and smoking cessation services and even subsidies for nutritious food and community cooking classes?
But aren’t these just medical solutions to health problems mostly related to lifestyle? Instead of spending NHS cash on more statins, why not fund public gyms, swimming pools and smoking cessation services and even subsidies for nutritious food and community cooking classes?
For my part, I don’t want us to become like the US — where the majority of adults are prescribed a statin, just in case.
I would like to know what you think.
Would you take a statin even if your heart risk was low? Write and let me know at [email protected]