DR ELLIE CANNON: I’m off my anti-clot pills after aorta stent – so why do I still bruise so easily?

A few years back, I had a stent put into my aorta after a scan showed an aneurysm. I was also prescribed an anti-clotting pill, clopidogrel, and noticed soon after that whenever I had a knock, no matter how small, I would immediately bruise, badly. In January, I was taken off the tablets but I’m still bruising easily. Is this normal?

A stent is a surgical implant – a mesh tube placed inside a blood vessel where it acts as a scaffold, keeping it open and ensuring that blood can flow.

They’re often put into the heart’s arteries, if blocked, to prevent heart attacks. In the case of an aortic aneurysm, which is a weakness in the wall of the body’s main artery, a large stent is used to take the pressure off the vessel and stop it from rupturing.

After any stent is fitted, it’s standard to give anti-clot medication, stopping blood clots forming around the stent which can cause further blockages and trigger heart attacks and strokes.

When prescribing anti-clotting tablets such as clopidogrel, we warn patients they are likely to bleed more easily – for example, from the gums after brushing your teeth.

Bruises are little bleeds under the skin from a knock which causes damage to small, superficial blood vessels – and these are seen more often, too.

When the anti-clotting drug is discontinued, these side effects should stop. But it’s important to note that these things are seen with most of these medicines – so if there’s been a switch to a new one the problems may continue.

Bruising or a little more bleeding are not life-threatening, so we’d usually say the benefits of the drug – in terms of preventing fatal things such as heart attacks – far outweigh these small risks.

If it is not from medication, blood tests can be taken to check if the levels of clotting proteins and platelets are normal, alongside other checks such as liver function, which is also a key part of the blood-clotting system.

It is also common to bruise more easily as you age, as the skin is thinner and the blood vessels are more fragile.

Earlier this year I had shingles on my neck and shoulder blade. It was incredibly painful, I lost my appetite, couldn’t sleep and was extremely tired. It lasted a few months and even now, six months later, I get twinges of pain in my neck. I’m worried I’ll never feel back to my old self. Any advice?

Shingles is the reactivation of an old chickenpox infection. After the first infection, the virus that causes the chickenpox – which most of us get as children – remains dormant in the body.

But as you get older, or if you are rundown or weak, immunity to the virus – varicella-zoster virus (VZV), part of the herpes virus group – can wane, allowing it to become active again.

VZV lives in the nerves – that’s why, when it becomes active, the rash it causes appears in a band or patch along a nerve line.

It’s also the reason it’s very painful, causing burning, soreness and something called neuropathic pain – nerve pain that feels like electricity or prickling.

Shingles can also cause a long-term condition called neuralgia – when the pain continues, causing twinges. For some people shingles neuralgia does become long-term, requiring treatment.

After a bad bout of shingles, it’s worth checking in with your GP. There could be underlying problems, from stress to insomnia or even depression, that are making the discomfort worse.

We also vaccinate everyone over 70, and if you’ve not had a jab it’s worth it to prevent you getting the condition again.

In January, I went to the GP as I was suffering soreness in my vulva, and was told probably I had a skin cancer called basal cell carcinoma. This obviously worried me a lot, but the doctor didn’t seem too fussed and said I could have a biopsy if I really wanted. Should I bother, if it’s going to be painful?

This does seem quite confusing. A basal cell carcinoma is a slow-growing cancer that is usually found in sun-exposed areas of skin such as the face.

It is considered very rare in the vulva – the external part of the female genitals – so it would be unusual to diagnose it simply on an examination.

Most skin cancers of the vulva are of a type known as squamous cell carcinoma and these usually grow on the labia at the opening of the vagina.

Vulval cancers are rare, affecting 1,400 women a year in the UK, but are more common in women who are over 65.

Worrying symptoms that could indicate cancer would be a persistent sore, bleeding or pain, raised or thickened patches of skin, a lump or constant itching that doesn’t clear.

Persistent vulval changes are one of the criteria for GPs to organise what is known as a target referral for cancer, where patients should be able to get an appointment with a gynaecologist within two weeks. At this appointment, the specialist is able to take a much closer look and take a biopsy.

This does involve taking a small tissue sample, after an injection of local anaesthetic, but it is incredibly important if there is a suspicion of cancer.

Talk to the Ask Eve information service, which provides advice to any woman worried about the gynaecological cancers.

Its helpline is on 0808 802 0019 or visit eveappeal.org.uk.

Calorie counts on menus are harmful, not helpful 

A major suspicion of mine was confirmed last week: calorie counts on menus won’t help the obesity crisis

A major suspicion of mine was confirmed last week: calorie counts on menus won’t help the obesity crisis.

That was the conclusion of a major study presented at one of the biggest obesity conferences in the world – the European Congress on Obesity. The researchers concluded that the impact of calorie labelling will be ‘small or zero’.

I’m hardly surprised. There has always been a question mark over the quality of the evidence supporting the initiative, which came into force last spring.

And the policy is not risk-free. Eating disorder charities have raised serious concerns about the harm to the thousands of people with these life-threatening mental illnesses.

Some of my eating disorder patients avoid dining out because they are terrified that being faced with the calories will scupper their recovery.

The sooner we scrap the stupid scheme, the better.

Know the tell-tale dementia signs

This week I am supporting a campaign to help people know the difference between normal, age-related memory loss and dementia.

I often hear people speak about elderly relatives who ask the same question over and over again. This is not a normal sign of ageing. It is, in fact, one of the tell-tale signs of dementia.

Walking into rooms and forgetting what you are looking for is normal – we all do it. But with dementia, people forget words and lose track of time and dates. There is also a host of other, lesser-known symptoms such as insomnia and restlessness. The quicker someone gets a diagnosis, the earlier they can access drugs to help their symptoms.

If you’re worried about a loved-one, visit the Alzheimer’s Society (alzheimers.co.uk) or speak to your GP.