FATIGUE is quite normal for this time of year, especially after the festive period.
But it can also be a sign that you are not eating enough nutrients or a sufficient amount of food, which can lead to malnutrition.
This can be the case even if you are carrying a bit of extra weight – you may not be eating enough of the right things.
There are many causes of undereating including the rising cost of food prices, mobility issues, old age and lack of appetite.
Other signs of undereating include low energy levels, hair loss, low mood, feeling cold all the time and constipation.
See a GP if you have unintentionally lost a lot of weight over the last three to six months or show signs of malnutrition.
They can give dietary advice, such as eating fortified foods and choosing high-calorie nutritional drinks.
They may also be able to suggest how to get more support.
Here’s a selection of what readers have asked me this week . . .
Q: MY legs from the knee down are swollen and discoloured. My BNP is above 100.
I have had scans on my kidney, liver and heart but all normal. I am 59.
I know it is heart failure but my GP did not tell me.
How long on average do I have left, online says three to ten years?
A: The first thing to say here is that a blood test alone cannot diagnose heart failure.
BNP stands for brain natriuretic peptide – a hormone produced in higher levels by the heart when it’s working harder than normal.
While heart failure is a common cause of elevated BNP in the blood, other conditions can cause elevated BNP levels.
Hence, a medical history is important for understanding the results and considering the need for further tests.
The NHS nowadays tends to measure NT-pro-BNP (which is a better test) to assess for suspected heart failure and NICE guidance states that an NT- pro-BNP level of below 400 means that heart failure is unlikely.
But if there remains suspicion of heart failure, the next tests are usually an ECG and an echocardiogram.
This assesses the heart’s structure, including heart valves and how much blood the heart can pump with each beat – this is called the ejection fraction.
The symptom you describe of swollen legs below the knee is a common symptom of heart failure, where fluid collects in the lower legs as the heart muscle gets less effective at pumping blood around the body.
But you can also have “dependent oedema” where this swelling is not at all associated with the heart’s function.
Or you can have swelling if the veins in the legs have become enlarged.
Other common symptoms of heart failure are shortness of breath, especially on exertion or when lying flat in bed at night, or a cough – sometimes with foamy sputum.
People may report using more pillows than before, gasping for air during the night, or describing wanting to stand by an open window.
Even if a diagnosis is made of heart failure, there is no set life expectancy.
There are so many factors ranging from age at diagnosis (under-65s have a better prognosis), gender, the reason you have heart failure, and the ejection fraction.
With lifestyle adjustments and the correct treatments, many people can live for decades with heart failure.
AFTER a GP appointment but fear there’s too long a wait?
Always tell the receptionist on the phone or fill in the online form fully about your symptoms.
It may be that they can book you in with a nurse, physio or paramedic at the practice who can help much sooner.
Q: FOR weeks, I’ve been experiencing pain in the neck.
I find it virtually impossible to turn my neck fully to the side and when I lie on my pillow the pain is also in my lower head.
I have tried sleeping on one, two and even three pillows in the hope that by sitting up the pain would go away.
But I constantly wake up with bad upper neck pain. I’m a male, aged 73.
A: I’m so sorry to hear that you’ve been experiencing neck pain which sounds very unpleasant and disabling.
I would be interested to know – did your neck pain start suddenly on waking up one morning or has it been coming on gradually over time?
Most of us will have experienced waking up with a “crick in the neck”; a very sore neck due to a poor sleeping position, meaning that we wake with our neck muscles locked and restricting movement or with a pinched nerve.
This can last for a few days before settling down and usually responds well to painkillers that can be bought over the counter.
However, noting your age and the fact that this has now been going on for several weeks, it’s important to be assessed as there may be another cause.
Arthritis of the spinal bones (vertebrae) of the neck is a common cause of neck pain, as is nerve compression caused by a herniated disk or bone spur in your neck.
It’s also important to consider more serious causes too, especially as the pain has been waking you at night, which is considered a red flag symptom.
Is it tender to press on the neck bones at all?
This is also classed as a red flag symptom and can indicate a bony lesion.
Please do make an appointment to get this assessed by your GP who can examine you and take a full history.
Other important things that you should tell your GP are if you have been feeling low in energy, lost weight unintentionally, had fevers, numbness, tingling or any pains radiating down your arms.
Do let me know how you get on.
Q: I’M a healthy 58-year-old female.
I am a good weight, my blood pressure is fine and I don’t drink or smoke.
My only medication is fluoxetine for anxiety.
I’m intrigued why, when I’m in bed, throughout the night, I need to keep stretching – a full body stretch.
It has been happening for a long time. Why?
A: What you are describing sounds like “pandiculation”, which most of us will experience from time to time upon waking up.
It’s that full-body stretch accompanied by a yawn that feels great.
Pandiculation is our nervous system’s brilliant way of waking up our body after rest and preparing us to get moving.
We will see cats do this often when they arch their backs after a nap.
So while this is normal on waking up, it’s a little unusual to be experiencing this through the night and it sounds like a natural bodily response which is supposed to feel good is causing a bit of a nuisance for you during the night.
Stress, anxiety, your medication or a lack of physical activity could all be partly responsible.
It’s also worth mentioning restless legs syndrome, which can cause a need to move the legs (sometimes stretching) but wouldn’t necessarily cause the whole body movement you describe.
It’s unlikely to be dangerous in any way but if it is affecting sleep or causing distress it is definitely worth chatting with your GP about it.
