I am healthy and active but can't stop going to the toilet. Will the medication I take give me dementia? DR MARTIN SCURR replies
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I am a healthy, active 70-year-old but for the past three years I have been taking tolterodine daily to treat an overactive bladder. I read that it is linked to dementia. Should I worry?
Anne Birch, Oxfordshire.
Dr Martin Scurr replies: You are correct, there are concerns that a number of different types of drugs are what is known as anticholinergic, meaning they block the action of a chemical messenger in the brain, called acetylcholine.
This chemical is important for maintaining, for example, memory and attention span.
Any reduction in acetylcholine may affect the way nerve cells in the brain behave – hence the concern about whether long-term use of such drugs might increase your risk of dementia. As well as those prescribed for bladder problems and incontinence, some antihistamines have this anticholinergic action – as do certain antidepressants (such as amitriptyline).
The risks seem to occur with sustained use of these drugs – longer than three years, according to research.
For my female patients I recommend vaginal pessaries containing oestrogen (Vagifem) – even in patients who are past the menopause – as they’re effective in reducing urinary problems and I believe such an approach will also free you of symptoms, without further needing to take tolterodine.
Other medication can be used for bladder problems that has not raised concern
I have osteoarthritis in my left knee and will soon need a replacement joint. But I am allergic to the nickel and cobalt, which I know are used in implants. Is there an alternative?
Carol Lewis, Exeter.
Dr Martin Scurr replies: Patients with a confirmed nickel or cobalt allergy should indeed avoid standard cobalt-chromium orthopaedic implants, used for joint replacement.
These types of implant can release metal particles, or ions, into the body. In some people this can cause a delayed hyper-sensitive reaction, such as skin rashes or poor wound healing.
It’s not dissimilar to how certain jewellery containing these metals provoke an eczema-like response in some people.
But these metals don’t only provoke reactions on the skin – in joint replacements, they can trigger a deep tissue reaction in sensitive people.
For example, if a metal implant is used in the knee, the particles it releases can provoke immune responses which can cause swelling and tissue death. In turn, these reactions can lead to implant failure and the need for revision surgery.
Patients with a confirmed nickel or cobalt allergy should avoid standard cobalt-chromium orthopaedic implants
While it’s important to stress that standard implants made from these metals are well-tolerated in most patients, if there’s unexplained pain, swelling or loosening of the implant – and no infection or other explanation – then an allergic reaction may be considered as the cause.
Patients are routinely asked beforehand if they have an allergy to the metals used, and hypo-allergenic (or allergen-free) implants are available. They are usually made with titanium or ceramic materials.
I recommend discussing the matter with your specialist and possibly seeking an up-to-date reappraisal by an allergy expert before your orthopaedic consultant decides which joint to use in your case.
Your specialist may also be able to offer nitride-coated implants (metal, but with a special coating) or oxinium implants (a metal core but with a ceramic surface), which both reduce the release of metal ions.
Overall this is a matter for very careful consideration before you go ahead with a procedure. If allergy testing does reveal you are allergic to those metals, it is important that this is noted in your medical records.
Chronic back pain is one of the most common complaints that we see as GPs – but it’s a label, rather than a diagnosis, as long-term problems can be caused by a number of issues, from osteoarthritis to disc degeneration.
The range of treatments available include epidural injections of local anaesthetic to radiofrequency ablation of local nerves.
But a major study in the BMJ, which reviewed 132 trials and involved 13 procedures, has now concluded there’s no convincing evidence that any of these standard treatments consistently provided relief for chronic back pain.
This is alarming, given the money and time expended in trying to help patients live with the misery of this pain.
Meanwhile, the long-term use of non-steroidal anti-inflammatory drugs and other painkillers is fraught with the risk of side-effects, such as heartburn and nausea.
This means that our focus as GPs must now lie with alternative interventions, such as acupuncture, physiotherapy, osteopathy, tai chi or yoga – which not only help when pain strikes, but have the potential to stop it coming back.
Daily Mail
