From chronic UTIs to a pain in your toe – Dr Zoe Williams answers your concerns

It won’t be long before the leaves turn brown and autumn begins.

And as the weather cools, September is the best time to get the flu shot – to build immunity before the virus spreads.

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The NHS is offering free vaccinations to everyone who is eligible, including everyone over the age of 65, pregnant women, carers and healthcare workers, and people with certain health problems.

Find out if you are eligible at www. nhs.uk/conditions/vaccinations/flu-influenza-vaccine/.

The NHS is inviting you to get a vaccination and this is important because flu can be serious and even life-threatening

You can get it from your GP or most local pharmacies, as well as major chains such as Boots and Superdrug.

A free nasal spray flu vaccination will be offered to children aged between two and three at their GP practice, while primary school children will receive their vaccination at school.

Meanwhile, the Covid Autumn Booster campaign has also started for a select group of people, including those over 65.

People who received a booster shot in the fall last year were about 53 percent less likely to go to hospital with Covid in the two to four weeks after vaccination than people who did not receive a vaccination.

So it’s definitely worth taking the invitation, especially given the increasing popularity of the new Pirola variant.

Here’s a selection of what readers asked me this week. . .

Q: My daughter-in-law has been suffering from a chronic urinary tract infection for more than two and a half years. It was very debilitating, very painful and now she is becoming depressed.
I noticed that she cried a lot – she felt like she wasn’t being given any help or support. The problem started when she had an ectopic pregnancy and a catheter was inserted. She saw several NHS doctors without help and eventually went into private practice.
After she was diagnosed with an embedded chronic urinary tract infection, she was prescribed long-term antibiotics, but they are very costly. She is now back on the NHS.
Her symptoms subsided but did not go away when she was pregnant. Now they are back with a vengeance. She’s back on antibiotics, suffering from chronic back pain, and feels like this debilitating condition is never ending.
Her doctor referred her to gynecology/complex urogynecology, but she is still waiting for an appointment. Please tell us what, where and how we can get help, as all avenues and doors seem to be closed.

A: This sounds like an incredibly painful and stressful ordeal for your daughter-in-law, and I’m sorry to hear that this is now having such a major impact on her mental health as well.

When inserting a urinary catheter into the bladder, there is a risk of infection, among other things.

In fact, urinary tract infections caused by catheter use are one of the most common types of infections affecting hospitalizations.

However, they are only used when necessary and the benefits outweigh the risks.

Surgery for an ectopic pregnancy is a procedure in which placement of an indwelling catheter is considered standard.

By the way, I am very pleased that your daughter-in-law subsequently had a child.

The complexity of her case requires evaluation by either a urologist or a urogynecologist. So it’s good to hear that this transfer has been made.

Has your daughter-in-law called to find out how long the wait might be for an appointment?

Unfortunately there are long waiting lists on the NHS at the moment, but as long as the phone call is polite and courteous, most medical assistants don’t mind being asked how long patients will have to wait.

In the meantime, let’s discuss this working diagnosis of embedded chronic urinary tract infection.

Urinary tract infections recur or become chronic when bacteria in urine become lodged in the lining of the bladder wall, where antibiotics and immune cells cannot easily reach them.

Provided she has had a normal ultrasound scan of the kidneys, ureters and bladder, long-term preventative antibiotics are one of the main treatments.

However, these are usually only recommended for a period of six months.

More importantly, it seems like this treatment method actually doesn’t work.

Therefore, it would be advisable to either try an alternative type of antibiotics (if not already done) or pursue non-antibiotic treatments.

D-mannose is an over-the-counter medication that can be used if the infection is caused by a bacteria called E. coli.

Research suggests that the success rate of this treatment can be as high as 45 percent after six months.

Another nonantibiotic treatment is methenamine hippurate (Hiprex), a urinary antiseptic.

A recent study published in the British Medical Journal concluded that Hiprex was as effective as prophylactic antibiotics in preventing recurrent urinary tract infections over a 12-month period.

This medication requires a prescription, is not yet in the NICE guidelines and is therefore not yet widely used in primary care.

But it’s worth your daughter-in-law talking to her doctor about it.

How can I relieve toe pain?

Q: I am a man in my mid-seventies. I’ve been having pain in my big toe joint for some time now. The hospital diagnosis is arthritis. The pain is quite unpleasant, especially in the ball of the foot. Is there anything I can do about it?

A: This is an unpleasant condition and unfortunately can be quite common.

In big toe osteoarthritis, the main joint of the big toe – the first metatarsophalangeal joint – is worn out and has caused cartilage damage or additional bony growths called osteophytes.

Pain can occur when the joint is stressed – which is often the case with the foot – but pain can also occur at rest.

It’s worth taking a look at the footwear you’re using, as this can make the discomfort worse or lessened.

A flat, stiff sole can cause the toe to be restricted and have less range of motion, which could be helpful. So try wearing well-fitting hiking shoes or boots.

A medical orthotic isn’t cheap, but you can consult a prosthetist to see if it might benefit you.

Painkillers such as ibuprofen and paracetamol can help, as can ice packs.

You don’t mention your weight, but even a small amount of weight loss can ease the pain. Steroid injections are an option that may provide pain relief for a while, but cannot resolve the underlying problem.

Other options include surgery, which can be performed in a variety of ways.

However, as this is often a last resort, your GP is best placed to discuss what this might look like in your case.