Q My cholesterol is 5.6, which my GP says is too high, but I don’t need statins. I don’t understand why everyone else seems to be on them.
The obligatory prescription of statins for anyone with a high cholesterol is rather old-fashioned now.
When statins first came on the market, they certainly did seem like a must-have for everyone with even a slightly high cholesterol.
The rationale for that was simple: cholesterol is one of the risk factors for heart attacks and strokes, and so removing it reduces an individual’s risks. This was backed up by trials that came out at the time, so GPs dutifully stuck everyone on them. More and more trials have gone on since then looking at disease prevention and actually it appears not quite as straightforward as that.
If you have already had a heart attack or a stroke, then yes it is absolutely still worth being on a statin to prevent another one – we call this secondary prevention of disease.
But looking at people who have not had a heart attack or a stroke is now a bit different: the growing body of scientific evidence shows the benefits of taking a statin aren’t actually so significant and may not be worth the risks of side effects.
So it is better in your situation to concentrate on your diet to lower your total cholesterol and improve your levels of good cholesterol.
Eat oats, almonds, soya and olive oil and take plenty of exercise.
Q My mother is 84 and has been told she has cataracts, which we expected, as her sight is getting poorer. Otherwise she is independent and very healthy for her age. Is an operation worth it?
An estimated 2.5 million people aged over 65 in England and Wales have some sight impairment from cataracts, so your mum has a very common issue, particularly given our growing elderly population.
The natural lens in the eye is clear to allow light to travel through to create clear vision: cataracts cause a clouding of the lens, which makes the vision gradually go misty or blurry in parts, then eventually throughout the whole field of vision. Cataracts worsen over time and the only option is surgery. Nowadays, cataract surgery is pretty routine both on the NHS and privately, and even for an elderly person is performed as day case surgery.
Usually people go home the same day after having the procedure on one eye, then a second date is planned for the second eye. Given how healthy she is, the operation would certainly be considered worth it.
Firstly, it makes sense to have the operation now, while she is fit and well, rather than delaying it until a time when she may be less strong.
Secondly, a loss of vision, even if not significant, puts her at risk of falling: falls are a significant cause of illness and mortality in the elderly population. A fall could severely alter her quality of life and so is a risk worth avoiding.
Q How can there still be nits in primary schools? It seems like such a Victorian illness: surely we are all too clean for this in 2016?
Sadly not, I’m afraid. Head lice or nits are rife in primary schools because children play and work in very close circumstances, so the infestation spreads very easily.
Nits are a very common childhood infection, but they are a nuisance and parents spend a huge amount of time and money on treatments.
Head lice actually have no preference for clean or dirty hair, and since they cannot be washed out with normal shampoo they are not at all related to hygiene.
Over the past 30 years, the widespread use of pesticides has caused the lice to develop resistance. Most head lice now are resistant to permethrin, so it is no longer used. Our continued use of other insecticides just perpetuates this problem, which is why doctors now recommend wet-combing as the best treatment method.
Products containing dimeticone, which suffocates the lice, are also useful because resistance cannot develop.
Parents need to get into the habit of checking for nits weekly before symptoms develop – then nits will be detected very early on in the infestation and there will be fewer to clear, so treatment is more likely to be successful.
Waiting for the symptoms of scratching could mean there are three to four times as many insects or eggs. Proper wet-combing is a cheap, harm-free method if you use a huge amount of conditioner to make detangling less painful and let your child watch TV or read for distraction.