From chronic UTIs to a pain in your toe – Dr Zoe Williams answers your concerns

IT won’t be long before the leaves start turning brown and autumn begins.

And as the weather cools down, September is the best time to get your flu jab – in order to build up immunity before the virus starts spreading.

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The NHS is offering free jabs to those eligible, including anyone over the age of 65, pregnant women, carers and healthcare workers, and those with certain health conditions.

Find out if you are eligible at www. nhs.uk/conditions/vaccinations/flu-influenza-vaccine/.

The NHS will invite you to come to get your jab, and it’s important to do so because flu can be serious and even life-threatening

You can get it at your GP surgery or most local pharmacies, as well as big store chains including Boots and Superdrug.

A free nasal spray flu vaccine is offered to children aged between two and three at their GP surgery, while primary school kids will get theirs at school.

Meanwhile, the Covid autumn booster campaign has also begun for a select group of people, including those over the age of 65.

People who received an autumn booster last year were around 53 per cent less likely to go to hospital with Covid in the two to four weeks after getting vaccinated, compared to those who did not get a jab.

So it’s well worth getting your jab when invited, especially given the new Pirola variant is spreading.

Here’s a selection of what readers have asked me this week . . . 

Q: FOR more than two and a half years my daughter-in-law has suffered from a chronic UTI. This has been very debilitating, very painful and now she is becoming depressed.
I have found her crying a lot – she feels no help or support has been given. The problem started when she had an ectopic pregnancy and a catheter fitted. She has seen several NHS ­doctors with no help and finally went private.
She was prescribed long-term antibiotics after being diagnosed with an embedded chronic UTI, but this is very expensive to fund. She is now back in the NHS.
Her symptoms subsided but did not go away when she was pregnant. Now they are back with a vengeance. She is back on antibiotics, has chronic back pain and feels there is no end to this debilitating condition.
Her doctor has referred her to gynaecology/complex urogynaecology but she is still waiting to be seen. Please advise what, where and how we go about getting help, as all avenues and doors seem shut.

A: This sounds like an incredibly painful and distressing ordeal for your daughter-in-law and I’m sorry to hear that it’s now having such an effect on her mental health too.

When urinary catheters are inserted into the bladder, one of the possible risks is infection.

In fact, UTIs caused by using a catheter are one of the most common types of infection that affect people staying in hospital.

They are, however, only used when ­necessary and the benefits outweigh such risks.

Undergoing surgery for an ectopic pregnancy is a procedure where the placement of an indwelling catheter is considered standard.

On a side note, I am delighted to hear that your daughter-in-law subsequently went on to have a baby.

The complexity of her case requires assessment by either a urologist or a ­urogynaecologist, so it’s good to hear that this referral has been made.

Has your daughter-in-law called to see what the waiting time for an appointment might be?

Unfortunately, there are long waiting lists on the NHS at the moment, but as long as the phone call is polite and courteous, most medical secretaries do not mind being asked how long patients might have to wait.

In the meantime, let’s discuss this working diagnosis of an embedded chronic UTI.

UTIs become recurrent or chronic when bacteria in the urine embed themselves into the lining of the bladder wall where antibiotics and immune cells cannot easily reach them.

Assuming she’s had a normal ultrasound scan of the kidneys, ureters and bladder, then long-term preventative antibiotics are one of the main treatments.

However, these are usually only recommended for a duration of six months.

And, more importantly, it sounds as though this treatment method is not actually working.

So it would be advisable to either try an alternative type of antibiotic (if not done already) or non-antibiotic treatments.

D-Mannose is an over-the-counter treatment that can be used if the infection is caused by a bacteria called E.coli.

Research suggests success rates of this treatment can be as high as 45 per cent at six months.

Another non-antibiotic treatment is something called Methenamine hippurate (Hiprex), which is a urinary antiseptic.

A recent study published in the British Medical Journal concluded that Hiprex was as effective in preventing recurrent UTI as prophylactic antibiotics over a 12-month period.

This medication is prescription-only and is not yet in the NICE guidelines, and therefore not yet used all that commonly in primary care.

But it is worth your daughter-in-law discussing it with her GP.

How can I kick toe pain?

Q: I AM a man in my mid-seventies. For some time I have had pain in the big toe joint. The hospital diagnosis is arthritis.   The pain is quite uncomfortable, especially across the ball of my foot. Is there anything I can do for it?

A: This is an uncomfortable condition and unfortunately it can be fairly common.

Big toe arthritis is where the main joint of the big toe – the first metatarsophalangeal joint – has become worn and has damaged ­cartilage or extra bony growths called ­osteophytes.

Pain can occur when the joint is being used – which in the case of a foot is often, but it can also cause pain at rest.

It’s worth looking at the footwear you use as that can exacerbate or help.

A flat, stiff sole can mean the toe is restricted with less movement which might help, so try well-fitting walking shoes or boots.

A medical insole isn’t cheap but you can be referred for an opinion to an orthotist to see if it’s something you could benefit from.

Painkillers such as ibuprofen and paracetamol can help, as can ice packs.

You don’t mention your weight but even small amounts of weight loss can help with the pain experienced. Steroid injections are an option that may give pain relief for a while, but they do not fix the underlying issue.

Other options include surgery, which can be done in a few different ways.

But it’s often a last resort option, so your GP will be best placed to talk you through what that might look like in your case.