I’m 75, and since I had a tumour removed from my prostate in 2021 I’ve suffered with erectile dysfunction and incontinence. Nothing has helped. I have now heard about a treatment called electromagnetic wave therapy. What do you think of it?
Dr Ellie replies: Unfortunately, incontinence and erectile dysfunction are common risks associated with radical prostate surgery.
While this can often be a life-saving surgery, it is still distressing to suffer these side effects. Usually the NHS will offer tablets such as Viagra for erectile dysfunction. Patients are sometimes offered a vacuum pump, a device that helps sustain an erection.
Unfortunately, incontinence and erectile dysfunction are common risks associated with radical prostate surgery, Dr Ellie writes
Electromagnetic low-intensity shockwave therapy is a relatively new form of treatment. It involves directing waves of energy at the penis over a number of sessions.
The treatment has long been used for kidney stones, but there is growing evidence that it helps increase blood flow to the penis and may even improve some nerve function.
This is encouraging because – unlike Viagra or a vacuum pump – it actually treats the underlying issues rather than temporarily creating an erection. There is also some evidence that it helps with incontinence, too.
However, it is still considered an experimental treatment and so is not yet offered on the NHS for erectile dysfunction.
It is possible that patients could join an NHS research trial – it would be worth speaking to a urologist about this possibility. Some private clinics also offer it, but at high prices and with no guarantee of success.
My daughter is in terrible pain from the skin condition folliculitis on her neck and scalp. She’s been given antibiotics, steroids and pain drugs but nothing has worked for long. What should she do?
When normally effective treatments do nothing to combat a condition, then it’s possible that the diagnosis is incorrect, Dr Ellie writes
Dr Ellie replies: When normally effective treatments do nothing to combat a condition, then it’s possible that the diagnosis is incorrect.
Folliculitis is an infection of the hair follicles which then become inflamed and can form into hard spots which are extremely sore. In some cases these spots can clump together, creating a large and painful mass called a carbuncle. However, even the most severe cases of folliculitis usually respond to antibiotics.
If the infection doesn’t respond to the medicines, then a swab of the area should be taken and tested to ensure that the correct antibiotic is being used.
This swab would also pick up another potential trigger of these symptoms – a bacterial infection called PVL staph. It tends not to respond to normal antibiotics and would require specialist care from a microbiologist.
Another cause may be that the skin has too much bacteria on it in general, known as staph colonisation, which means infections keep coming back.
If suspected, a doctor can prescribe a longer-term treatment called decolonisation, which involves regularly applying antiseptic body wash and shampoo to remove bacteria from the skin.
Another possible cause of the rash is the inflammatory condition psoriasis, which leads to itchy, red raised patches on the skin – the scalp is one of the most common areas for it to occur. Treatment includes steroid cream and immune-system suppressing injections.
My mother, 94, has a lot of excess phlegm which makes eating difficult. She was prescribed carbocisteine but it hasn’t had much effect. She now appears to be losing weight. The problem started after she was hospitalised with pneumonia earlier this year. What do you think could be the cause?
Dr Ellie replies: Weight loss in an elderly person should always be investigated by a doctor, because it can be triggered by cancer. A small amount of weight loss is expected later in life, due to a reduction in muscle mass, but if it is noticeable or ongoing then this needs to be flagged with a clinician.
Overproduction of phlegm can be caused by chronic bronchitis – an inflammation of the airways. This can be caused by smoking, as well as inhaling fumes or pollution. A bout of pneumonia can also make it worse.
Carbocisteine is an effective treatment for reducing phlegm, but if the underlying cause is bronchitis then this would usually be given in combination with inhalers to combat inflammation in the lungs.
A less common cause of excess phlegm is a condition called bronchiectasis, which occurs when the airways of the lungs become widened, making them more vulnerable to infection. This can occur following a bout of pneumonia, but bronchiectasis would only be picked up through a CT scan in hospital.
Excess phlegm can also be down to heartburn, also known as acid reflux. This is when acid is regurgitated from the stomach, inflaming the throat.
One way to find out whether this is the trigger would be to try buying a simple over-the-counter heartburn medicine such as Gaviscon.
At my surgery it seems like we’re facing a near-endless shortage of drugs, Dr Ellie writes, particularly eye drops, diabetes medicines, anti-fungal drugs and ADHD tablets
Drugs shortage that’s being ignored
Are you struggling to get prescription medicines that you vitally need? You wouldn’t be alone.
At my surgery it seems like we’re facing a near-endless shortage of drugs. Most recently we’ve noticed a lack of eye drops, diabetes medicines, anti-fungal drugs and ADHD tablets.
It’s incredibly frustrating for patients, and takes up valuable GP appointment time as we have to find alternative options for patients.
So I am shocked that the Government is still yet to announce any solution to fixing this nationwide problem. It’s as though ministers don’t believe it’s really an issue.
Have you had difficulty getting your medication? Has this affected your health? Please write and let me know using the email address below.
When weight-loss jab is no help
It feels like every week we hear of an amazing new way that weight-loss jabs will improve the nation’s health.
Last week it was the Government’s ambitious plan to use the jabs – Ozempic and Wegovy – to help obese people get back to work.
However, I’m struck by the fact that there is one patient group who don’t seem to gain any benefit from these drugs – those with the weight-related condition lipoedema. It leads to an abnormal build-up of fat in the legs and arms, it can be painful and makes day-to-day activities difficult. It’s also more common in women.
However, so far, there are no drugs which can effectively treat lipoedema. And we are still unsure what causes it.
I recently saw a patient who was really struggling and was shocked to find out that these weight-loss drugs, for all their benefits, could not help her.
Have you been affected by a lack of lipoedema treatments? Please let me know.
