Dr Rosemary: What can cause a persistent cough?

The last visit to the doctor was disappointing as the bottom line seemed to be that she was stuck with it. She’s been given strong antacids (esomeprazole) on the basis that it could be acid reflux but it doesn’t seem to have helped. She had pneumonia in the past but according to her X-rays this has now cleared. What else could be causing the cough and why can’t something be done about it?

A

A PERSISTENT cough can be caused by either irritation in the throat or a problem in the lungs. Reflux of acid from the stomach back towards the throat is a common cause and sometimes it is necessary to try several different drugs that reduce acid secretion in order to find one that is effective.

Another potential cause is a post-nasal drip of mucus from the back of the nose to the throat, often due to allergic inflammation. Lung problems that can cause a cough include: infections, inflammation from smoking (either past or present) and also asthma.

Although a recent chest X-ray can be useful for ruling out an infection, it does not help with the diagnosis of either asthma or chronic obstructive pulmonary disease (COPD).

If your wife’s GP cannot sort out the problem and her cough remains troublesome, it is reasonable to ask for a referral to a specialist, who can arrange appropriate investigations to sort out the underlying cause.

Q

I’M 51 and haven’t had a period for just over a year. I had a Mirena coil fitted in March 2012 because of fibroids and heavy periods. It’s due to be removed this year but should I have it replaced? 

A

THE Mirena coil lasts for five years, so yes, it is due to be removed this year. The hormones it contains thin the womb lining which is why it can be such an effective treatment for heavy periods. Many women with one find they have hardly any periods at all and this can mean it is difficult to know when you are menopausal.

Knowing whether your ovaries are still working or not, and whether you need another coil, is really only important if you are using it for contraception as well as for controlling heavy bleeding.

A blood test for your FSH (follicle-stimulating hormone) level may be helpful, as this rises as the ovaries produce less oestrogen at the time of the change. However levels can vary a lot from day to day which can make the results difficult to interpret. If the level is very high – greater than 50 – then it is likely you are menopausal, but if it is much less than this then your ovaries may still be functioning.

One option is to have the coil removed and just wait and see what happens, but it’s important to use alternative contraception for several months afterwards. If your periods return, then you can always get another coil fitted – it doesn’t have to be done at the same time as the old one is removed. 

Q

LAST year I had a terrible attack of shingles, which has left me with post-herpetic neuralgia. I understood that when I turned 70 in January this year I would be entitled to a shingles vaccination. But when I contacted my surgery I was told they hadn’t been notified that I am entitled to the jab. I checked on the NHS website and couldn’t see any restrictions, so I am rather confused. The last thing I want is to go through another attack of shingles. Can you advise me who is and is not entitled to have the jab?

A

THE shingles vaccination boosts the body’s immunity to the varicella zoster virus that causes the illness. Following an attack of chickenpox (which usually occurs in childhood) the virus lies dormant in the nerve cells of the spinal cord. At a later date the virus can become active again and travel down the nerve to the skin it supplies, causing the characteristic rash of shingles.

Because the nerve can become inflamed, pain afterwards – post-herpetic neuralgia – is quite common. Shingles can occur more than once, so even if you have had an attack it is sensible to have the jab as soon as you are entitled to it. Shingles is more common in older people, whose immunity to the virus has decreased. The vaccine is expensive and because of that it has been introduced slowly in the UK.

Currently people aged between 70 and 73, and also those who were 70 or 79 on September 1, 2016, are entitled to have it free on the NHS. Currently those aged 74 to 77 have to wait until they are 78 but this may change in the next few years.

People aged 80 or over are not offered the vaccine as it has not been proved to be effective in this age group. So I reckon you are eligible. You don’t say who you spoke to at your surgery but I wonder if was a member of the junior reception staff who was unsure of his or her facts.

The surgery isn’t notified by anyone on these matters – it is a case of checking a patient’s date of birth and following official guidelines. Some surgeries do notify patients automatically when they become eligible but not all do this and many just tell patients when they next visit the surgery.

I suggest that you make an appointment to see either your GP or the practice nurse, who will be able to check properly if you are eligible and if so, can give you the jab.

If you have a health question for Dr Rosemary please write to her in confidence at The Northern & Shell Building, 10 Lower Thames Street, London EC3R 6EN or email health@express.co.uk Dr Rosemary’s reply will appear in this column. She regrets that she cannot enter into personal correspondence and that, due to the volume of letters, she cannot reply to everyone. Find out more about Dr Rosemary at drrosemaryleonard.co.uk