I have had trouble sleeping for years, but taking an antihistamine tablet (cetirizine) a couple of nights a week really helps. But the pills leave me a little foggy and could they be bad for me?
Tina Vowles, Gloucestershire.
Not all antihistamines are the same. There are two types: sedating and non-sedating
Dr. Martin Scurr answers: Antihistamines target histamine receptors. Histamine is a chemical produced by the body in response to a perceived threat (misperception of a harmless substance as a threat in the case of an allergy). Symptoms are the body’s way of getting rid of it (eg sneezing).
But histamine also plays a role in wakefulness, so an antihistamine can cause drowsiness.
But not all antihistamines are the same. There are two types: sedating and non-sedating.
The former have better access to the brain (due to the way they are carried in the blood) – these include chlorphenamine (brand name Piriton).
The cetirizine you are taking is not a sedative, although some people find it makes them drowsy and you seem to be among them.
Long-term use of antihistamines has been linked to dementia. It is important to note that this is not a proven cause, but the risk appears to be due to some antihistamines being anticholinergic.
Long-term use of antihistamines has been linked to dementia. It’s important to note that this isn’t a proven cause, but the risk appears to be because some antihistamines are anticholinergic, says Dr Martin Scurr.
This means they work on receptors in the brain that respond to the chemical messenger acetylcholine: low levels of acetylcholine are a hallmark of dementia.
Long-term use of other drugs that block these receptors (including antipsychotics and some antidepressants) is also associated with an increased risk of dementia.
In fact, cetirizine is a weak anticholinergic, so your twice-weekly doses are nothing to worry about, although it’s not good if you feel drowsy.
My advice would be to limit your pills, go to bed only sleepy, get up when you can’t sleep, don’t read or watch TV in bed – it’s only for sleeping, get up at the same time every morning and don’t sleep during the day.
I was diagnosed with a heel spur after an x-ray. My family doctor referred me to a podiatrist – I’m waiting for an appointment, but I’m in a lot of pain. I use chiropody felt and heel supports in my shoes but it doesn’t relieve the discomfort.
Owen Rees, Devon.
Dr. Martin Scurr answers: Calcane or heel spurs are bony growths on the calcaneus or heel bone. They can be asymptomatic and are often noticed during X-rays taken for other reasons. They can also be excruciatingly painful, even crippling.
They occur as a result of long-term stress on the ligaments of the foot – for example, abnormal gait, ill-fitting shoes, carrying too much weight, osteoarthritis or plantar fasciitis (inflammation of the tissue connecting the heel bone and foot). football).
This causes inflammation, to which the body responds by building bone as a defense mechanism. Treatments include cushioning – heel supports may not help much, but a podiatrist can provide a better version, in the form of orthotic insoles.
Your GP may also prescribe a non-steroidal anti-inflammatory drug (NSAID) such as diclofenac. You should continue this treatment for at least six weeks. The next step is a corticosteroid injection, usually administered using ultrasound to pinpoint the problem area. But note that it is used to suppress inflammation rather than eliminate the spurt itself.
An orthopedic specialist may recommend Botox injections to “paralyze” the plantar muscles, reducing pressure on the inflamed area to allow it to heal.
In extreme cases, patients may be offered surgery to remove the spur, although most find that their pain is resolved with more conservative methods and the case for surgical intervention remains unproven.
I caution against other experimental treatments, including shock wave therapy and ultrasound, which are widely touted for this type of problem, but are, in my opinion, a waste of money.
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