ASK THE GP: Dr Martin Scurr answers your health questions

ASK THE GP: Why gardening gloves can help weed out sepsis! Dr Martin Scurr answers your health questions

We’re constantly warned to look out for — and recognise the signs of — sepsis, which can develop from a tiny scratch or abrasion. What we are never told is how to prevent it in the first place. What is your advice?

Ian Charles, Shrewsbury.

Sepsis is the consequence of an extreme response to an infection — the immune system is either overwhelmed by or overreacts to this infection.

The infections that trigger this could be quite literally anything — from an infected ingrown toenail, to a bout of pneumonia to quinsy — a complication of tonsillitis.

The over-reaction begins with the immune system triggering the release of chemicals called cytokines that encourage the blood vessels to widen, which can result in a dramatic drop in blood pressure. 

Sepsis warning: Gashing your finger on a clean kitchen knife is unlikely to lead to sepsis, but a cut from a mud-encrusted tool in the garden might

This can then lead to the most severe element of sepsis — septic shock, when organs start to fail due to the lack of blood supply.

The risk factors include anything that may impair how well the immune system works. For example, advanced age (being over 65), a compromised immune system (as a result of, say, necessary treatment for some illnesses such as cancer), previous hospitalisation (particularly if time was spent in intensive care), and pneumonia, diabetes, and obesity.

Although, as you say, sepsis can develop from a small scratch or abrasion, the type of organisms that might be introduced and the risk factors that I have detailed above are of relevance; gashing your finger on a clean kitchen knife is unlikely to lead to sepsis, but a cut from a mud-encrusted tool in the garden might.

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In terms of protection, wearing gloves when gardening or working with tools, and general measures that enhance immunity — a healthy and nutritious diet, some regular exercise, enough sleep, maintaining a normal body weight and avoiding smoking or excessive alcohol intake — may all be beneficial.

And if any minor injury or skin infection appears to be worsening or spreading rather than resolving after a normal expected period of time, then seek medical advice.

For more than 20 years I have experienced headaches lasting two or three days, but recently they’ve lasted two months. The pain is dull and accompanied by tinnitus and is just about bearable, although there are days I have to take painkillers.

It is not migraine, which I’ve had in the past. My doctor said they couldn’t be serious and gave me gabapentin. But I had side-effects, so weaned myself off. I also have aching eyeballs.

Peter Ormsby, Hereford.

I share the view of your GP: the headache, despite persistence over two months, is unlikely to be sinister.

Nevertheless, a question remains about the exact diagnosis. You say that you have previously had migraines but I question your criteria for dismissing that diagnosis this time.

Migraine is divided into two broad categories: migraine with aura and migraine without aura

Migraine is divided into two broad categories: migraine with aura and migraine without aura. In the former, there is a headache in addition to other neurological symptoms.

These may include visual disturbances (such as a partial loss of vision or seeing bright spots with geometric shapes), sensory changes including tingling or numbness of part of the face or arm, and mood changes. These typically start an hour before a headache begins.

In migraine without aura there is a moderate or severe headache, which may last a few hours or a few days, often with nausea or vomiting (which may also occur during migraine with aura) and pain, which may be confined to one side.

My experience of patients with migraine over many years is that it is possible for someone to experience either form of migraine from time to time, and I think this is what you are experiencing.

Write to Dr Scurr 

To contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email [email protected] — including contact details. 

Dr Scurr cannot enter into personal correspondence.

His replies cannot apply to individual cases and should be taken in a general context.

Always consult your own GP with any health worries.

I suspect the few episodes that you describe as migraine in your past may have been migraine with aura that had accompanying dramatic or alarming visual disturbances which is what led you to make the diagnosis. I suspect your more frequent headaches are migraine without aura.

The current two-month headache may fall into another category, called chronic migraine (also known as chronic daily headache. This is a headache occurring for 15 days or more in any given month and which may vary in intensity from day to day.

The eyeball ache you describe can be part of migraine; in some patients, migraine pain is in the eye only.

Treatments for chronic migraine have not been as well studied as those for the other, ‘episodic’ migraine.

It is disappointing that gabapentin caused unacceptable side-effects as that medication is one good option.

Other treatments include the anticonvulsant drugs topiramate, valproate and pregabalin, and the antidepressant amitriptyline — these can reduce the incidence of migraine headaches (possibly by dampening down pain nerve signals), so I would discuss these options further with your doctor. An alternative is to buy coenzyme Q10 capsules, a natural substance already present within the cells of the body.

Take 100mg once or twice daily, and also take riboflavin (vitamin B2), 200mg, daily. There is ample research that both can be of value in migraine prevention.

Note it will be at least a couple of months before you will see any effect, and as these are non-prescription supplements, there is an expense to bear.

IN MY VIEW: Volunteers can provide the vital human touch 

Thirty years ago, I became medical director of a hospice. Many of our patients were elderly, all were in the last days of their lives and a proportion had few or no visitors.

We wanted to ensure our patients spent their final days pain-free, but also comforted. However, the nurses and doctors would not always have the time to sit and talk, so I encouraged the formation of a group of volunteers to do this. It worked very well, and the volunteers and patients formed significant bonds that, at that time in the patient’s life, meant so much.

Our volunteers became a vital cog of the function of the hospice and were greatly valued in that charitably-funded organisation.

Surely now volunteers are more important to the NHS than ever. In my early days as a hospital doctor, we didn’t have ultrasound, CT, MRI scanning and other technologies now considered routine. But what we had then — but don’t have now — is time. Most junior doctors were constantly in the building (we lived in), and we had the time to see everyone under our care at least once or twice daily. There were more nurses on each ward, too. Patients rarely lacked attention — clinical or social.

While technological and other advances have transformed medicine over the past 20 years, what is missing is the human touch which cannot be provided by overwhelmed medical teams.

And that is why I rejoice at the launch of the Mail’s Hospital Helpforce campaign, working with the charity Helpforce, to encourage more people to pledge to volunteer in the NHS.

Volunteers will bring new skills, emotion, warmth and communication — a breath of fresh air to the health service. It is an exciting innovation. We need this.

 

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