A recent ultrasound scan to monitor my fatty liver disease showed I also have gallstones. I have no symptoms, but I have been unable to get a face-to-face appointment with my GP to discuss what, if anything, needs to be done. I feel like I’m in limbo. I’m 74 and fit for my age.
Don Rae, Bridge of Allan, Stirlingshire.
Gallstones, known medically as cholelithiasis, are small stones, usually made up of cholesterol, which form in the gallbladder.
This pouch-like organ is tucked under the liver and stores bile, a fluid produced by the liver that helps break down fatty foods.
In most cases, these stones cause no symptoms and need no treatment, and often their presence is picked up by chance, as in your case, when someone undergoes a scan for another reason.
Gallstones are very common: around six per cent of men and nine per cent of women have them, and the possible causes are multiple — from age to obesity to sudden weight loss.
Gallstones, known medically as cholelithiasis, are small stones, usually made up of cholesterol, which form in the gallbladder
I can understand that not being offered any advice on what to do next is alarming, but the official guidance is not to treat them unless they do cause problems.
Surgery to remove them is only really considered if they cause complications, such as acute cholecystitis (an infection in the gallbladder), pancreatitis (acute inflammation of the pancreas) or biliary colic (when a stone migrates from the gallbladder and causes a blockage in one of the nearby channels that drain bile down into the intestine — this is extremely painful and requires urgent medical attention).
The surgery involves removing the gallbladder as well as the stones, and is performed under a general anaesthetic.
The symptoms that suggest complications typically come on suddenly and include an intense pain in your upper right abdomen, a high temperature and nausea — but as you don’t have these, there should be no need for any intervention or treatment.
But if you were to experience any of the complications set out above, you should immediately be listed for surgery to have your gallbladder removed, which is normally done during a keyhole procedure. Hopefully, an opportunity will arise when you can discuss the subject with a doctor at your practice.
For years, I’ve suffered with uncomfortable tiny cuts in the corner of my mouth. I’ve tried many remedies but no luck. Can you suggest anything?
Brian Gibson, by email.
This sounds like angular stomatitis, also known as angular cheilitis — a condition that is most common in older people, occurring when saliva collects at the corners of the mouth, leading to cracking.
The environment there — with a steady supply of moisture — encourages fungi and bacteria to flourish, causing inflammation.
Eczema, poorly fitting dentures and drooling during sleep can all make it worse.
There’s some evidence that a lack of certain nutrients may be implicated — specifically insufficient B vitamins, iron or protein.
Other risk factors include long-term smoking and the wrinkling we get with age. I suggest you buy a tube of two per cent clotrimazole cream (available from the chemist under the brand name Canesten) and apply using your little fingertip, sparingly, twice daily for at least two weeks.
This medication is both antifungal and antibacterial and should resolve the inflamed cracks.
After this, make it a habit to apply a small blob of Vaseline in the same way, twice daily, to stop the skin drying out.
This should almost certainly be effective.
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