Ask Dr Ellie! This week: Asprin, crumbly nails and lymphoma

Ask Dr Ellie! This week: Asprin, crumbly nails and lymphoma

Our resident GP Ellie Cannon answers your burning medical questions...


Q   My elderly mum has been on aspirin for the past 10 years for an irregular heartbeat. As I understand it, this is to prevent strokes, but the GP says she needs to be on something better. We don’t understand why, as I thought aspirin was a blood thinner? 

You are describing what is a really common scenario for me in practice and a lot of people are in your mum’s position. Many people have a condition called atrial fibrillation (AF) which, as you say, is an irregular heartbeat. We know this can be a cause of strokes, just like smoking and high blood pressure.

In order to protect people from that stroke risk, we have used aspirin or warfarin to thin the blood, so blood clots, which are the cause of strokes, cannot occur.

Following research in the past few years, experts now believe aspirin is pretty useless at doing this; they actually stopped prescribing it years ago in Europe.

It is a blood thinner indeed, but just not good enough to prevent the clots that cause strokes.

As a result, NICE, the national body that advises doctors on treatment of medical problems, states that patients with AF are no longer to be given aspirin, as it does not work.

So the GP is right to offer warfarin or one of the newer blood-thinners. Take the advice as it sounds like the right thing to prevent your mum having a stroke.

It will be a change, but a good one.

Q  Can you tell me why my nails are so horrible? I have had three crumbly nails on my left foot for the past few months and now the right foot is affected. I thought this was shoe-related, but someone has said it is an infection. Is that correct?

Dr Ellie Cannon
Dr Ellie Cannon

It certainly could be, as fungal infections of the toenails are pretty common in all ages. A fungal infection will cause crumbly nails, perhaps discoloured and affects more and more nails gradually as time goes on. This is nothing to worry about, as it is not a sign of anything serious; it is similar to athlete’s foot, but it only affects the nails.

Starting with one or two nails, then spreading to all of them is typically what happens. You need to start treatment now, in order to get on top of the infection before it spreads anymore and becomes very hard to treat. You can get the right treatment from the pharmacist – buy an anti-fungal nail paint that you can use on your nails to kill the infection.

You have to be conscientious about applying this weekly, after filing your nails, and it normally takes six months to treat, but it can take even longer.

This will take some patience as it is not a quick process. Take the opportunity of the good weather to wear sandals and give your feet air. It’s worth taking good care of your feet not just to look nice, but to also prevent infections.

Q  I’m terribly worried about my nephew, who is only 21 and has lymphoma. His mum said he just has to have chemotherapy, but will be fine. Are they hiding something from me and the rest of the family?

I don’t think they are hiding anything from you, although of course I don’t know the exact diagnosis and type of lymphoma.

Lymphoma is one of the blood cancers: It can be very aggressive, but in a number of cases is very treatable and curable, “just” with chemotherapy. I say “just” chemotherapy, because chemotherapy is a hugely gruelling undertaking for anyone: he may have a year of difficult and distressing treatment.

However, often with lymphoma, patients are given very good chances of success with treatment and are cured after this. It is therefore possible your nephew was given very good odds when they were discussing treatment with their oncologist and this is why, quite rightly, they are optimistic.

Lymphoma is a cancer within the lymph nodes, which are what we commonly refer to as glands: they are present in your neck, tummy, groin and armpits. They get enlarged when we have an infection and shrink afterwards.  The first sign of lymphoma can be an enlarged gland that may be particularly big and does not shrink: it can also cause night sweats, as well as weight loss.

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