Ask the Doctor - June columns

Sunday 27th June - Chest pains

My father suffers from chest pains and is waiting for exploratory tests, what will they do? Kevin, Edinburgh

Dr Neal Uren is a Consultant Cardiologist at the Spire Shawfair Park Hospital.

With the presentation of chest pain, a Consultant will establish whether the symptoms are due to the development of coronary artery disease. A Cardiologist will take a clinical history to determine whether or not the symptoms are typical for ischaemic-sounding chest pain (ischaemia is the condition where an organ does not get a sufficient blood supply for normal function). An assessment of cardiovascular risk factors will be made at the same time. Following examination, the patient will perform an exercise test to see whether there is evidence of ischaemia. If so, one would normally perform an invasive coronary angiogram. This is done under a local anaesthetic and involves passing thin plastic catheters to the coronary arteries above the heart. Dye can be injected into the arteries to determine the presence or absence of coronary atheroma (thickening) in the wall of the artery contributing to the restriction of blood flow.  In some cases, the narrowing is stretched and a thin metal stent placed in the area to restore blood flow to normal.  The patient can usually go home within a few hours.

Sunday 20th June - Pain management

Why do I still have burning and stabbing pain in my wound several months after my operation? Gilly, Edinburgh

Dr Craig Grice a Consultant in Pain Medicine and Anaesthesia at the Spire Murrayfield Hospital.

In most circumstances pain following surgery will resolve after several days. Occasionally, pain, discomfort or altered sensation can occur for several months, this is chronic post surgical pain (CPSP). The presence of CPSP does not necessarily indicate a complication and can be an unavoidable problem following surgery.

The mechanisms of CPSP are complex but involve damage to the nerves and subsequent changes in the peripheral and central nervous system. These changes “amplify” sensations making normal touch, movement and heat/cold unpleasant or painful. There are also changes in the brain that may affect mood and produce sleep disturbance.

CPSP may not be responsive to the usual types of analgesics.  Additional drugs and treatments  that “turn down” the amplified pain response and restore normal functioning of the nervous systems pain matrix can help this condition.

In the first instance this could be discussed with your GP who may be able to prescribe suitable medication. In some cases your GP may recommend a referral to a specialist in Pain Management.

Sunday 13th June - Ankle injury

I sprained my ankle badly last summer and it is still painful – I have not been able to get back to playing football. Is there anything that can be done? Gary, Edinburgh

Mr John McKinley is Consultant Orthopaedic Surgeon with Spire Edinburgh Hospitals.

A sprain generally causes a tear in one or more of the ligaments on the outside of the ankle. In more severe sprains other structures can be damaged, which may cause ongoing pain. The majority of patients will get better after a course of physiotherapy, which should be aimed at regaining movement, strengthening the muscles and improving balance.

If the ligaments do not heal properly then instability can occur, with patients ‘going over’ on the ankle frequently. In these cases the ligaments can be reconstructed surgically. Another cause of ongoing pain and swelling is damage to the cartilage of the ankle or loose fragments of bone – these can usually be fixed with an arthroscopy or key-hole surgery.  Some more minor problems can be addressed with a steroid injection.

With MRI scans, most of these problems can be visualised, allowing surgery to be planned with a very high likelihood of success.

Sunday 6th June - Dust mite allergy

I suffer from allergy more when I’m in the house than when I’m outside. What could it be? Lisa, Haymarket

Linda Stuart is an Allergy Nurse at Spire Murrayfield Hospital.

The most significant indoor inhaled allergen affecting us in the UK is the house dust mite.
These little mites feed on human skin scales and digest this by producing highly allergenic digestive enzymes. These enzymes, present in the mites' faeces, become easily airborne and are then inhaled by us. Mites, having no access to a water supply, rely on absorbing moisture from us.
Warm, damp environments containing lots of human skin scales are ideal conditions for them to accumulate like mattresses, pillows, bedclothes, carpets, sofas, soft toys and clothing.
The patients, who are allergic to the faeces of the mite, have blocked or runny noses, asthma or eczema and hay fever type symptoms which are persistent throughout the year.

A skin prick test will diagnose house dust mite allergy within 15 minutes at my allergy clinic.
De-cluttering our homes and favouring wooden floors over carpets will help to reduce the problem.
Well ventilated homes and low humidity levels will also help.