January 31, 2023


Dr. Zoe Williams answers some common questions submitted by readers.

At the start of a new year, it’s natural to think about what we can change, what we can give up, and what we can start doing more.

January is still dark, cold, and rather unhappy, so making decisions can feel like another burden.


But if you’re planning to work on your diet in 2023, you don’t have to jump right into a vegan or dry January. Fancy diets are not a sustainable way to maintain a healthy weight.

Instead, reading the NHS Eatwell Handbook is a good start. It explains what a healthy balanced diet looks like and how to achieve it.

In the meantime, here are just a few of the questions I’ve been asked by readers this week. . .

C) I am constantly exhausted and my joints hurt. It doesn’t matter what I eat or how much I rest. What is wrong with me?


AND) There are many different causes for the symptoms you describe. If this continues for more than a few weeks, it’s important to see a doctor so they can take a complete medical history, examine your joints, and do some blood tests.

At one end of the spectrum, a combination of stress, lack of physical activity, poor posture, and burnout can be the cause.

On the other hand, serious illnesses, including some types of cancer, can also present with fatigue and joint or bone pain.


There are several autoimmune conditions that can cause both joint pain and fatigue.

These include rheumatoid arthritis, lupus, and other unusual conditions such as systemic scleroderma and polymyalgia rheumatica.

Poor mental health can also be a reason, so it’s important to contact your GP even if you have to wait for an appointment.


C) Streptococcus A walks around my daughter’s school. How much do I need to worry about this?

AND) It’s good that you’ve been warned, and it’s important for parents to be aware of some of the illnesses that strep A bacteria can cause, but there’s nothing to worry about.

If your daughter gets strep A, it will most likely cause a mild illness, such as a sore throat or skin infection, or no illness at all.

It is important to be able to spot the signs of scarlet fever, as this condition requires antibiotic treatment and should also be reported to the local health safety agency.

There are two important reasons why antibiotics are needed. One of them is to reduce the further spread of bacteria. The other is to prevent the extremely rare occurrence of invasive group A streptococcus, which, unfortunately, was the cause of death in children, which was recently reported in the news.

Typical signs of scarlet fever are fever, sore throat, a sandpaper-like rash, and a “strawberry tongue” that is red and lumpy.

Your healthcare provider will also consider antibiotics for children with tonsillitis, especially if the child does not have a cough or runny nose and has pus on the tonsils or very swollen cervical glands.

The most likely cause of tonsillitis is a virus, but as general practitioners we have temporarily lowered the threshold at which we prescribe antibiotics due to the outbreak.

So, the bottom line is that if your child has symptoms of a viral illness, you should treat his symptoms in the usual way. If you suspect he may have bacterial tonsillitis or scarlet fever, call your GP.

And if you feel like your child is seriously ill or has an infection and is getting worse, seek emergency medical attention.

C) I SUFFER from premenstrual dysphoric disorder. Do you have any advice on how I can make this easier?

AND) PMDD is a severe PMS that is thought to affect between three and eight percent of women of reproductive age.

To confirm a diagnosis of PMDD, a woman must have at least five of the following symptoms in the week before her period during most months of the previous year: depressed mood, emotional instability, irritability and anger, poor concentration, tension and anxiety, bereavement. interest in normal activities, changes in eating habits or food cravings, sleep disturbance, fatigue, feeling overwhelmed or out of control, and finally, physical symptoms such as headache, breast tenderness, weight gain and bloating.

Treatment includes vitamin B6, antidepressants, combination pills, talk therapy, and counseling.

Sometimes hormone replacement therapy may be used, with or without drugs called GnRH analogs, which interfere with the body’s ability to produce its own estrogen.

An extreme option is a total hysterectomy with the removal of the ovaries, too, then HRT.

The most important thing you can do if you think you have PMDD is to keep a very detailed diary, writing down all of your symptoms and trying to identify any triggers, such as foods, that are making your symptoms worse.

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Start taking a vitamin B6 supplement as there is evidence that this may help.

Aromatherapy can help with some streptomas. Exercise, including yoga, also helps in some cases.


C) MY nose is stuffed up all the time. What should I do? It doesn’t seem important enough to justify a GP appointment, but it upsets me.

AND) A stuffy nose, or nasal congestion as it’s medically known, can be extremely annoying and frustrating, especially if it affects daily life and sleep.

This may be caused by the shape of the internal septum that separates each side of the nose. Or it could be huge adenoids, which are small patches of tissue that prevent foreign particles from entering your body through your nasal cavity.

The mucous membrane lining the nose has small folds called turbinates.

These folds tend to swell when we have a cold or a virus, which is what gives us a stuffy nose.

The medical term for swelling of the nasal mucosa is rhinitis, which can also be caused by a bacterial infection or an allergy.

Sometimes people get nasal polyps, which are painless growths that can keep growing if left untreated. They can be removed with a simple outpatient surgery.

You can start with decongestants, antihistamines, and steroid nasal sprays that are available over the counter. If this does not help, please contact your therapist.

If it affects your quality of life, then it matters, and that’s what GPs are for. Don’t suffer in silence.

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