I’m plagued by agonising mouth ulcers all the time – I can’t eat and they’re taking their toll mentally

WITH Christmas around the corner, don’t let a nasty bug ruin your festive fun. If you are eligible, get winter vaccines as soon as possible.

There are just two days left to book appointments online or via NHS 119 . . . Thursday is the last day of the autumn vaccination programme.

From Friday, you can only visit a Covid-19 walk-in vaccination site or find a pharmacy offering the flu vaccine.

In a bid to make it easier for people, the NHS is offering jabs at some football grounds, supermarkets, Christmas markets and fire stations.

It comes as fears grow of a “quad-demic”, with flu, RSV, Covid and norovirus cases all now reaching record levels.

Visit the NHS website to check if you are eligible.

Meanwhile, here’s a selection of what readers have asked me this week.

MOUTH ULCER MISERY

Q) I’M a 72-year-old man and have suffered with mouth ulcers since I was a child. I have exhausted every avenue, and currently use Anbesol.

My oral hygiene is good – regular dentist visits, flossing, mouthwash etc. But my last ulcers were debilitating.

They were on the side of my tongue, and mucked up my nervous system. I’ve had severe headaches, painful ears and a blocked nose.

It’s next to impossible to eat and drink, and it brings me down mentally. My daughter suffers the same pain but not my son.

Can it be genetic? I would appreciate advice on what food and drink to avoid, and a decent tincture if there is one?

A) What you describe is recurrent aphthous stomatitis. Aphthous ulcers tend to appear in crops of up to five ulcers, last ten to 14 days and heal without scarring.

It’s important that any single ulcer that is not healing after three weeks is examined by a doctor or dentist, who may refer you for an urgent biopsy to rule out cancer.

The cause of RAS is unknown and there are likely multiple factors, one of which is thought to be abnormal functioning of the immune system.

Sometimes there is an underlying cause that can be treated – anaemia, nutritional deficiency or stress, for example.

There is believed to be a hereditary link – nearly half of people who suffer also have a close relative who does.

Good dental hygiene is vital, as sharp or broken teeth can damage the soft tissues of the mouth and this can cause ulcers.

There are also some diseases that can cause mouth ulcers, such as Crohn’s, coeliac, lupus and Behcet’s.

There is no cure for RAS, and treatment aims just to alleviate the pain and support healing. Spicy, acidic, abrasive or salty foods and fizzy, caffeinated or very hot drinks can trigger ulcers.

Some studies have found tomatoes, oranges, lemons, and pineapple can trigger an inflammatory process, leading to RAS.

Topical corticosteroids, anaesthetics and antiseptics come as gels, mouthwashes, sprays or lozenges and I’m sure you’ve tried many of them.

There are pastes, too, that create a protective barrier layer over the ulcer.

In very severe cases, a short course of oral steroid tablets can be used, or other medicines which alter the immune system’s function, but there can be long-term side-effects.

Finally, use a toothpaste that does not contain SLS – an additive to make it foam – because this can cause ulcers too.

Q) I’M a very active, 54-year-old woman and for the last 12 months have been suffering from agonising lower back pain.

After several requests to my GP to send me for an MRI scan, I finally got one and the results revealed L4 and L5 slipped vertebrae – known as spondylolisthesis.

My back consultant suggested a medial branch block to ascertain whether the pain was coming from the facet joint.

This worked for six days, confirming the latter.

I was then referred to the pain management team for RF ablation, which I had done.

I am four weeks post-procedure and the pain is still as intense as ever. It would appear that the treatment has not been successful.

I am still taking strong medication just to go about my daily activity.

My consultant has suggested the RF ablation procedure once more, but this time with a higher frequency.

Is this likely to work? And is there a more guaranteed option to end the misery of my pain?

A) I’M so sorry to hear that you’ve been in such pain for so long.

I can empathise as I have experienced back issues myself over the past year and a half and have also had all the procedures that you have described here.

Spondylolisthesis is when one of the spinal bones (vertebrae) has slipped forward from its correct position.

It is different to a herniated disc – or slipped disc – but can cause similar symptoms.

The radiofrequency ablation (RF) ­procedure uses electrical heat to block nerves that carry the pain signals from the affected area – in your case the facet joints. It is much less invasive than surgery.

It sounds as though you may benefit from a discussion with your back consultant to better understand why a further ablation is being recommended and the chances of it working.

You could also ask about the pros and cons of this versus surgery.

Types of surgery sometimes carried out for spondylolisthesis include fusing the slipped bone to the bone below, or lumbar decompression to alleviate pressure if nerves are being compressed.

Legs keep cramping, often in bed

Q) I GET occasional cramps, mostly in my legs, usually at the back of my thigh and often when I am in bed. I am a man of 76.

The other morning I got up to feel a pain in my left knee and noticed quite a large swelling.

I didn’t twist my knee or anything but it was quite painful, and I found it difficult to get in and out of my car.

The following night I was in bed and I got a cramp in my right leg, again in the rear of my thigh.

I got out of bed quickly and walked around for about ten minutes, rubbing the affected area. It eased the cramp and I went back to bed. Could the cramps have caused the swelling in my knee?

I would appreciate any thoughts that you might have.

A) AN acutely swollen knee would usually indicate a build-up of fluid in the knee joint and I can’t really see why a short bout of cramp would cause that to happen.

It may well be that the cramps you ­experience, and this sudden swelling of the knee joint are unrelated.

However, it’s important to see your GP to rule out something serious like a DVT, and to find out what the underlying cause of the swelling might be.

There are a number of conditions that can cause the knee to swell up, ranging from gout to rheumatoid arthritis or osteoarthritis or bursitis, which is inflammation of the fluid-filled cushions in the knee.

There are lots of other causes of cramp – straining or overusing a muscle can cause it, as can dehydration and low electrolyte levels which can be caused by excessive sweating.

Nerve compression and even certain medications can cause cramps, so it’s definitely worth chatting with your GP.

You’re right to move about more, as ­exercise can be a treatment for cramps.

When you feel it coming on or if you’re woken by it, moving around is one of the best things you can do.