DR ELLIE CANNON: I wake up with night sweats… could it be a sign of blood cancer?  

Most nights I wake up suffering terrible sweats. Sometimes my night clothes are damp and I have to put a towel down to protect the bedding. My doctor said it could be a sign of blood cancer and has ordered tests. Should I be worried?

It’s important to see a GP if you’re suffering night sweats. They are a common symptom that a lot of people struggle with from time to time, such as during the summer or when you have an infection. But if there is no clear reason for the problem, a check-up is vital.

Night sweats can be a sign of something serious – including a type of blood cancer called myeloma. But most commonly, they are caused by something non-sinister, such as menopause, an infection, the side effects of medication or heavy alcohol use.

If the sweats come with weight loss, it is a cause for concern. Together, these symptoms can point to the cancers myeloma and lymphoma, or even the bacterial infection tuberculosis.

Patients will always undergo investigations, usually beginning with blood and urine tests and a chest X-ray. It is possible that more hospital-based tests, such as an MRI scan and/or a bone biopsy, may be needed.

Myeloma is a cancer of one of the types of blood cells that affects the immune system, bones and kidneys. It may be more common in people with a family background of the disease, but the biggest risk factors are old age, black ethnicity and, in some cases, obesity.

Thankfully, the prognosis for myeloma is often very good. Treatments have also vastly improved in the past couple of decades. More than half of patients survive for at least five years after diagnosis, according to Cancer Research UK.

I’m very interested in your articles about depression and anxiety. My GP recently recommended that I start taking antidepressants. Can you tell me which of citalopram and escitalopram is better to take? She also thinks I should start therapy. I am 72 years old.

There are many different types of antidepressant medication. The family of drugs prescribed most often are called selective serotonin reuptake inhibitors, or SSRIs. They also treat anxiety, eating disorders, OCD and even irritable bowel syndrome.

Citalopram and escitalopram are two of the eight SSRIs available. These medications increase levels of the hormone serotonin in the brain, which is thought to have some effect on our emotions and mood.

But they are not effective for everyone. Some people find that they get greater benefits from therapy when they are taking medication.

Citalopram is recommended for use in depression and panic. Escitalopram, however, has a wider scope of use. It can also be prescribed for OCD, panic and social anxiety. They are slightly chemically different. This means you need higher doses of citalopram than you would escitalopram to treat depression.

Effectiveness and side effects may also be different. It is impossible to say if one antidepressant is better than another. Studies show it is very difficult to predict how a person will react to an antidepressant. It is worth remembering that a proportion of the population won’t find them helpful at all.

A GP should recommend you trial one type for about six weeks before considering switching to another or changing the dose.

Shortly after a Covid booster in December 2021, I developed a chesty cough that won’t shift. My lungs often feel sore and irritated and I produce mucus. Doctors have tried everything – antihistamines, acid reflux medication and inhalers – but nothing works. What can I do?

It can be very difficult when there is no simple explanation for a patient’s problem. The uncertainty brings a level of distress which can make symptoms worse. Ongoing, ‘wet’ coughs are an example of this.

It is certainly worth pursuing a referral to a respiratory-health specialist at the local hospital. This overproduction of mucus is referred to by doctors as catarrh, which can result from a number of lung conditions.

GPs have recently seen a lot of patients with this symptom, mostly as a result of a previous Covid infection. Chronic production of mucus can also be related to acid reflux and post nasal drip – when mucus from your nose or sinuses drips down the back of your throat. But both these problems would resolve quickly with treatment.

A reader is concerned about a cough they developed after receiving the Covid booster jab

Doctors may want to test a sample of mucus to see what type of infection may be present in the lungs. These symptoms are often seen in the long-term lung disease chronic bronchitis, commonly present in smokers.

Another important diagnosis to consider is bronchiectasis – a range of lung conditions which involve patients producing mucus and coughing persistently. Inflammation in the lungs causes damage to the airways, leading to a variety of problems.

In adults, bronchiectasis is often a result of a childhood infection such as tuberculosis or pneumonia, but it can also be triggered by autoimmune conditions and fungal allergies.

Bronchiectasis can also develop because of a Covid infection – respiratory experts at a hospital would be able to identify this.

Do not ignore your bowel test kit – it could save your life 

Please don’t forget to do your bowel cancer screening test, if you’ve been sent one.

In England, adults aged 60 to 74 are sent a kit, pictured left, in the post every two years. It’s now also sent to 56- and 58-year-olds as the programme is expanded. I’m backing NHS England’s drive to get people to actually do the test, sparked by research showing that a third of those eligible don’t bother.

There is no doubt that the tests are life-saving. Treatment is nine times more likely to be successful if the disease is caught early. 

I saw this for myself with a patient a few weeks ago – she had no symptoms but the cancer was picked up at a very early stage, thanks to her screening test.

It couldn’t be simpler to do: use the stick to take a sample of your business, put it in the pot and send it back. 

An analysis can spot traces of blood you wouldn’t see, which can indicate cancer.

My top tip is to put it next to the loo when it arrives – that way you can’t forget about it.

There is no doubt that the tests are life-saving. Treatment is nine times more likely to be successful if the disease is caught early. I saw this for myself with a patient a few weeks ago – she had no symptoms but the cancer was picked up at a very early stage, thanks to her screening test

Minimal respect for Covid study 

The impact of the pandemic on mental health was ‘minimal’, according to a study published last week.

I’ll admit, I was surprised to read this, but looking into the findings, I discovered they simply backed up what GPs have been saying all along: that adults in high-income countries, such as the UK, experienced only a minor deterioration in mental health. Women, older people and minorities were worse affected, though.

You were more likely to be fine if you were well off and working, which makes sense. But the study excluded those we know were most affected by the pandemic: children, young people and anyone with existing mental health problems. 

I’m taking this study with a pinch of salt, as those whose policies made our children’s lives hellish still have a lot to answer for.