Dr Martin Scurr answers questions on ganglions

Q. I’ve had a ganglion on my wrist for some time. The traditional method — bashing it with a book — hasn’t worked and in the past two weeks it has increased notably in size. Can I get this removed, and if so, what are the chances of it recurring?

Jacqui Shankland, Kilbarchan, Renfrewshire.

A ganglion is a firm, fluid-filled swelling over a joint or tendon, ranging in size from a chickpea (1cm) to a golfball (4 to 5cm). Occasionally, ganglions can be painful, but patients generally seek help for them because they’re worried about their appearance or that the lump could be something sinister.

They’re thought to be linked to mild damage or breach in the connective tissue around the tendons (which connect muscle to bone), ligaments (which connect bones or cartilage), and joint capsules (the tough fibrous wrapping around joints). Lubricating fluid then fills this breach.

Ganglions are small fluid-filled swellings thought to be linked to mild damage in the connective tissue around the tendons, and are most commonly found around the wrist or hand

It’s not clear what causes the initial damage. Interestingly, while repetitive movement doesn’t seem to be the problem, it can make a ganglion larger.

Ganglions can occur anywhere but typically they’re found around the wrist or hand — you also see them on the foot, and sometimes the knee or shoulder. They are most common between the ages of 20 and 40, and occur rather more frequently in women, although no one knows why.

Bashing a ganglion with a book is a popular, but ineffective, treatment. The cyst usually refills, and in any event, around half spontaneously resolve within a year or so.

Your doctor could drain the cyst using a needle after anaesthetising the skin with a tiny injection of local anaesthetic: around half of drained ganglions will recur within a year, but it is a simple treatment without complications so may be worth trying.

If the problem persists or recurs, another option is surgery, usually under a general anaesthetic. However, even then there is a small recurrence rate and many would consider this an unnecessary operation because of the cost — and the fact that a ganglion is otherwise harmless.

END PROSTATE SHAME 

It’s a scenario too many doctors face all too often. Sitting opposite a man talking to him about his prostate cancer diagnosis, and having to explain why a disease he’d read was treatable was incurable.

The truth is that men put off going to see their doctors when they first get symptoms, and as yet, the options for advanced prostate cancer treatment are limited.

Talking to men in this preventable situation is a deeply upsetting job for any doctor. Which is why I wholeheartedly support this paper’s campaign to try to stop men literally dying from embarrassment.

Q. My grandson, who is 14, has asthma and other severe allergies: he’s always sneezing or congested. He’s tried every anti-histamine with no relief.

He is extremely overweight (with breasts) which my daughter blames on his asthma steroids. Could they affect his hormones?

He still looks young among six-footers his age, and is being viciously bullied about his size and the constant sneezing and sniffling (he’s just had a second operation to remove nasal polyps).

He often coughs until he vomits, so doesn’t get a consistent night’s sleep. All in all, his life is pretty miserable.

Name and address supplied.

My heart goes out to your grandson, with his asthma and related nasal symptoms being complicated by the delay in puberty, obesity and bullying. I wonder, too, if his sleep problems are affecting his schooling.

Let me start with his asthma. This is a disease that affects the length of the respiratory tract, from the nose to the lungs, causing inflammation that leads to the airways narrowing and the production of excess sticky mucus.

At the same time, muscle cells in the airways contract — patients describe it as like trying to breathe through a straw.

Treating asthma involves identifying and controlling any triggers, writes Dr Martin Scurr (photo for representation only)

Treating asthma involves identifying and controlling any triggers, writes Dr Martin Scurr (photo for representation only)

As well as the characteristic cough and wheeze, symptoms include breathlessness, chest tightness and sometimes pain.

The other symptoms you describe — the sneezing and snuffling — are due to your grandson’s allergic rhinitis (nasal allergy), which affects the nose and sinuses: in severe cases patients also develop polyps, bulky gel-like swellings of the nasal lining. Allergic rhinitis is part and parcel of asthma, although not all patients have both to the same degree.

Treating asthma involves identifying and controlling any triggers, tailoring the medication to the individual, and ensuring they know how to self-manage the condition.

When it comes to triggers, typically for both asthma and allergic rhinitis these include respiratory infections, including flu, exercise (90 per cent of children with asthma find exercise is a trigger for airways to spasm), tobacco smoke, and allergy-including pollens, moulds and exposure to various domestic animals.

Other potential irritants include aerosol cleaning sprays, room deodorisers and traffic pollutants. You’ve listed your grandson’s medications and it’s clear he is using all the available mainstream inhalers for his nasal and lung symptoms.

He’s also taking antihistamine tablets for his nasal allergy. His nasal spray and inhalers contain steroids, which are essential to suppress the inflammation.

WHY I’M WORRIED ABOUT 

 The very notion that anyone should die in this country from malnutrition is disturbing; that it should be happening daily on NHS wards is appalling.

Yet the Office For National Statistics reports that one hospital patient a day dies with a basic lack of essential nutrients as an underlying cause or contributory factor.

NHS England responds saying that good nutrition will be made a clear priority. Excellent news.

Yet what about that other group of people who are arguably now most prone to malnutrition — the obese? Their diets, while calorie rich, are often nutrient poor, yet NHS England is not so quick to tackle that particular thorn.

Research has shown that inhaled steroids do slow the rate of growth in children — however, they don’t prevent them reaching their ultimate predicted height, and they don’t cause obesity or delayed puberty.

Your grandson’s excess weight may be caused by an inability to exercise because of the asthma itself. The most important thing to do first is ensure your grandson’s asthma is well controlled — that his general practice has a management plan in place, and that treatment is structured to include regular monitoring which can take into account any exacerbations due to infection or other triggers.

Second, his inhaler technique needs to be checked to ensure he inhales the medication fully down into the airway — it’s all too easy to end up merely coating the back of the throat. Your grandson’s practice nurse will be able to check his technique.

Increasingly, research has shown that the better the control of the upper respiratory tract allergy —and the congestion this causes — the greater relief patients get from their lung inhalers.

Your grandson’s recent nasal polyp surgery shows that an ENT specialist is involved, which is good news on that front.

It might help to add another nasal steroid spray (drug name beclomethasone) to his medication, as well as swapping from the oral antihistamine your grandson is currently taking (cetirizine) to a nasal antihistamine spray — this is known to be more effective than antihistamine tablets.

The nasal antihistamine spray, called azelastine, also avoids the sedating effect caused by oral antihistamines. This could be a change that your grandson’s GP might consider (he will need a prescription). My other contribution concerns his mental state.

The combination of being chronically unwell, excess weight, delayed puberty and bullying at school, commands the greatest sympathy.

I feel this, too, must be covered in conversation with the family doctor or the practice nurse — with the idea of referral for professional psychological support.

This must be handled with the utmost sensitivity by family and professionals alike when explaining it to your grandson. Please let me know how you get on. 

IN MY VIEW . . . blame red tape for GP exodus

Last week it was reported that GPs are retiring earlier — at an average age of 58 — to avoid paying the punitive taxes that apply when pension pots reach £1 million.

A lot of GPs are in that fortunate position as they’ve been the beneficiaries of healthy pension arrangements.

But I don’t think their early retirement is simply down to the lure of gold: I speak as someone who recently retired from the independent sector with no attached pension, and what pushed me finally to give up was over-regulation.

Last week it was reported that GPs are retiring earlier to avoid punitive taxes

Last week it was reported that GPs are retiring earlier to avoid punitive taxes

I’d always intended to work past three score years and ten, but at age 65 I abandoned my practice because I just couldn’t face any more ridiculous inspections about the type of soap we use or the rigour of yet another annual appraisal.

This testing process lacks any evidence base to support the hoops through which we’re expected to jump.

I had to prove my probity, that my conscience was clear (i.e. i’d not behaved in an inappropriate manner), as well as producing proof of endless sessions of retraining in political correctness, including child protection, CPR (resuscitation techniques — in classes aimed at the non-medical lay person) and various equally simplistic, but patronising, enforced charades. I am not against regulation per se, but this was not the way to ensure quality medical care.

Most senior experienced GPs, interested in the welfare of their patients and fascinated by the application of scientific progress to medical care, are leaving not to capitalise financially, but because they are exhausted and dispirited by the perfect storm of escalating workloads, an over-regulated environment and no time to care.

The generous pensions and tax penalties have made early departure possible. Who could blame them?

Write to Dr Scurr at Good Health, Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk – include your contact details. Dr Scurr cannot enter into personal correspondence. Replies should be taken in a general context and always consult your GP with any health worries. 

 



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