I've been left with excess fluid in my ankle and foot after bad bout of cellulitis – help!
Whether you're embracing the sunshine (and the vitamin D that comes with it), planning holidays (a boost to wellbeing), or exercising outdoors, I find this season filled with energy and opportunity.
This column is YOUR space to ask questions, so I can help you live as healthy a life as possible.
Whether it's understanding a new treatment, managing a long-term condition, or simply wondering about the best way to stay fit while living with a chronic condition.
Perhaps you or a loved one has been worried about a symptom you've been experiencing, and you need some reassurance, have been feeling down and unsure what to do, or you're curious about how to make healthier choices.
Or perhaps you are reconsidering the health goals you made at the start of the year, and whether you still have time to make changes.
I answer three questions a week on a Tuesday, and one on Sunday.
Email me at health@thesun.co.uk.
Here's a selection of what readers have asked this week . . .
Cellulitis legacy is causing concern
3
Q: I HAD a bad bout of cellulitis in my left leg four years ago.
Since then I have had a few recurrences but have managed to get antibiotics quickly and before the cellulitis gets as bad.
I have been left with a red mark on my lower left calf, almost like a bruise, which does get worse from time to time.
I also have excess fluid in my left ankle and foot, which swells during the day.
Can I do anything about either of these?
I try to be as active as I can and elevate my feet.
A: A severe case of cellulitis can cause persistent changes to the skin and tissue, even years later.
These can be permanent, but there may be ways to improve things, which I will explain.
Your swelling and red mark may be due to long-term damage or changes to the lymphatic and skin tissue caused by the infection and inflammation.
Cellulitis can damage the lymphatic vessels, which are responsible for draining fluid from tissues.
If these vessels are scarred or weakened the fluid may accumulate, causing chronic swelling, and the area can become more vulnerable to future infections.
It may improve slightly over time, but if the lymphatic damage is significant, some degree of chronic swelling may remain.
Compression therapy (e.g. compression stockings), leg elevation and physiotherapy can help manage it.
The red mark could be post-inflammatory hyperpigmentation, which is when skin is left darker or more red by the healing process or it could be scarring in the area where the infection was worst.
In some people, this never fully fades, though it may lighten slowly.
It is important to be vigilant about future infections.
Signs to look out for are any increase in redness, pain or warmth.
And also worsening swelling or hardening of the skin.
Look after the skin by moisturising with an emollient, treating fungal infections, avoiding cuts or other injuries to the skin.
In need of a diagnosis
Q: MY neurologist believes I may have AL amyloidosis due to my various medical issues.
I have peripheral neuropathy and was recently diagnosed with orthostatic hypotension, which my cardiac consultant has said is neurogenic.
I have been on fludrocortisone for five weeks with no improvement and my GP has said to stop them as they could also be affecting my Stage 3 CKD.
I also have NAFLD, laryngeal obstruction, gallstones and osteoarthritis.
My neurologist said getting a diagnosis will take some time and I'm worried about this disease requiring urgent diagnosis to facilitate treatment.
A: Amyloidosis is a general term for a group of diseases where abnormal proteins called amyloid build up in the body's tissues.
As you rightly pointed out, delays in diagnosing AL amyloidosis, a variant of the disease where the bone marrow is affected, can significantly affect prognosis, especially if the heart is involved.
NHS trusts should have mechanisms to expedite diagnosis, especially when organ damage is suspected, though it doesn't fall under a formal two-week cancer pathway.
AL amyloidosis, or primary amyloidosis, is caused by abnormal light chain proteins produced by plasma cells in the bone marrow.
These misfold into amyloid deposits, which can affect organs such as the kidneys, heart, nerves, liver and digestive system.
If a diagnosis is made, treatment typically involves multidisciplinary care led by haematology specialists and other teams depending on organ involvement.
Tests aiding diagnosis include blood and urine analysis, imaging like ECG, echocardiogram or MRI, biopsies to detect amyloid deposits, SAP scans to locate amyloid and genetic testing.
In England, patients suspected of having amyloidosis should be referred to the National Amyloidosis Centre, located at the Royal Free Hospital, London.
Referrals can be made by hospital consultants or your GP, with appointments often arranged within two weeks if cardiac involvement is suspected.
This is the NAC website – ucl.ac.uk/amyloidosis – which you can share with your GP.
Risk in recurring migraines
3
Q: I AM an 83 year old man and have recently started having occasional migraines which last for around 15 to 30 minutes.
It's been about 40 years since I had one.
I have little headache but vivid auras. Should I be concerned?
A: New or unusual headaches in people over 50 are always taken seriously.
While you've had migraines in the past, the recurrence after decades – particularly with changes in aura or frequency – should be treated as a 'new' headache and investigated as such.
Migraine auras can mimic other conditions, but in older adults, it's vital to rule out more serious causes.
Sudden visual disturbances such as zig-zags, flashing lights, or blind spots may be caused by migraine aura.
But they could also indicate a transient ischaemic attack (TIA) or mini-stroke, particularly if they come on quickly and resolve within an hour.
Other potential causes include retinal issues, certain types of seizures, vascular problems, or, in rare cases, brain tumours.
These possibilities make it essential to seek medical advice promptly.
I recommend booking an urgent GP appointment and keeping a detailed diary of your symptoms in the meantime.
Record the description of the aura, its duration, any accompanying headache or other symptoms, and whether you feel unwell afterwards.
Identifying patterns can be helpful for your doctor.
While your symptoms may indeed be benign migraine auras, their recurrence after 40 years – and at your age of 83 – necessitates thorough evaluation to rule out more serious conditions.
Early investigation is crucial, even if your symptoms turn out to be harmless.
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