Q My husband returned from a long-haul business flight with a swollen leg and has now been told he has DVT. We thought he was healthy. Can you explain more about it please?
DVT is a deep vein thrombosis and a blood clot in the lower leg veins. The blood circulates around the body due to the action of the heart pumping, which pushes it round. When it gets to the extremities furthest away from the heart, the pressure pushing the blood is a bit lower and a bit slower.
For some added help, the blood is squeezed on its journey back to the heart, with the help of the leg muscles. When the leg muscles move – for example, when you are simply moving around – the veins are squeezed, encouraging the blood flow. If your legs aren’t moving much, for example, because you’re stuck in an airline seat, the blood becomes sluggish and moves much slower as it’s not being squeezed. When the blood is moving slowly or turbulently rather than in this normal way, a clot can develop.
This happens classically in people who are immobilised – after surgery for example, or long-term immobility or even from a long-haul flight. This is sometimes known as economy-class syndrome.
There are conditions that some people have called ‘clotting disorders’, which make this more likely, as well as diseases such as cancer or Lupus when, generally, the blood is more likely to clot.
The treatment will be blood thinners and a thorough investigation of why the clot happened. In this case, it could simply be just the flight.
Q Can I be tested for the menopause? I’m 49 and have noticed flushing as well as changes in my cycle. How do I know whether or not to get HRT?
There is no medical value in testing for the menopause, other than ‘knowing’, so the NHS doesn’t usually offer it anymore.
If you are experiencing changes in your cycle with flushing, then the likelihood is you are, particularly as you are the right age – the menopause usually occurs for most women between the ages of 47 and 52, and can also depend on the age your mother experienced it.
Other symptoms that are pretty classical are insomnia, mood changes, dryness and urinary discomfort, as well as thinning hair: not a fun group of symptoms for something that is a normal part of life for women.
The decision to take HRT is entirely personal. Nowadays menopausal women are busy, often working, often caring for young children, maybe in new relationships, travelling and living life to the full: no longer getting ready for retirement or grandparenthood. There is not really time to be burdened with symptoms. This is why many women choose HRT to replace their oestrogen and reduce their symptoms.
The most common reason I am asked for this is because of the mood and insomnia effects, which can be crippling.
All medications have risks and HRT is associated with a very small increase in breast cancer risk: this will be weighed up with you when it is prescribed.
Q Do you think children can get irritable bowel syndrome? My 10-year-old girl seems to get a lot of tummy aches and intermittent diarrhoea.
Children can get irritable bowel syndrome, but it is really important for your daughter to be checked out, given the symptoms you have mentioned.
Tummy aches are hugely common in children: they occur for a variety of reasons, including the common ‘psychosomatic’ tummy ache children get, associated with nerves or worry.
Tummy aches in children can also be caused by milk allergy or lactose intolerance, infections and urinary issues.
When that tummy pain is associated with diarrhoea, then there are two things that need to be looked at properly by a doctor: Could she have Crohn’s or coeliac disease? Both of these are bowel diseases and can appear at her age, also with symptoms of diarrhoea.
Crohn’s is an inflammatory bowel disease affecting the bowel the whole way through: this could also have caused her to stop growing – have you noticed what height she is compared to her peers? It is really important to start treatment really early for Crohn’s so her growth is as affected as little as possible.
Coeliac disease is another bowel disease specifically affecting the jejunum within the bowel – it is an allergy to gluten (the protein within wheat) and causes tummy aches, diarrhoea, bloating and tiredness. If she has this, she needs to be on a strict gluten-free diet long-term.
A doctor would only diagnose irritable bowel syndrome, or IBS, once these other things have been ruled out.