My doctor says I’m too old for HRT at 68. What can I do? DR ELLIE CANNON answers your health questions –

I am 68 years old and have been suffering from hot flashes since I went through menopause at 54. HRT helped, but my doctor switched me to a drug called clonidine last year because I’m not a good fit for hormone therapy because of my age. My hot flashes have gotten worse, especially at night it’s annoying. What should I do?

Clonidine is a treatment for hypertension and is also a drug we offer some women as it helps to control hot flashes during menopause. Studies show that it improves quality of life, although about half of patients experience sleep problems while taking it.

As with any new drug, the first thing to ask is whether you’re taking the right amount. We usually start and increase women with a low dose of clonidine. I would say it won’t work if the maximum dose has been tried or the side effects are intolerable.

Other things that can help reduce the severity of hot flashes include avoiding triggers such as spicy foods, caffeine and alcohol, and sleeping in a cool room with a fan. Antidepressants and the pain reliever gabapentin may also help.

Other than that, I question the decision to stop HRT due to age.

There is no limit to how long a woman can take HRT, but other factors, such as risk of breast cancer or blood clots, may be a factor in her decision to switch to non-hormonal therapy.

Have an open and candid discussion with your doctor about the risks and benefits of HRT.

Instead of continuing a treatment that is not working, it may be worth considering HRT patches rather than tablets or lower doses, which may not carry the same risks.

My wife had cataract surgery late last year and she was almost blind in that eye. His doctors have been consulting for months and now they say he needs another surgery. We are clearly concerned.

Cataract surgeries are considered routine and in England alone, around 330,000 of these are performed by the NHS each year.

The reason we operate is because cataracts, which are clouding of the lens at the front of the eye, usually worsen over time, causing vision loss. In reality, there is no other treatment or surgery, the lens is replaced with an artificial lens, the success rate is quite high.

But as with any medical procedure, there are risks and potential complications. About one in 50 patients who have cataract surgery will have blurred vision, vision loss, or retinal detachment when the light-sensitive cells in the back of the eye are damaged.

Cataract surgeries are considered routine and in England alone, around 330,000 of these are performed by the NHS each year. The reason we operate is because cataracts — a clouding of the lens at the front of the eye — often worsen over time, causing vision loss. (Image file)

The risk of permanent vision loss in the eye is one in 1000.

Rarely, a complication called intraocular lens luxation occurs where the newly inserted lens falls into place. It needs to be in the right place, directly behind the student, for it to work properly.

A second surgery to correct the lens dislocation is really the only option. The surgeon may move the same lens or start over with a new lens.

It is important to raise your concerns and make sure all your questions are answered, preferably well before the day of surgery.

I am 76 years old, living with stage 3 chronic kidney disease and have recently been told that I have high cholesterol. My doctor has prescribed atorvastatin, but reading the leaflet says “talk to your doctor” if you have kidney problems or are over 70 years old. I did, hoping to have a discussion about the pros and cons, but the answer I got was ‘it’s up to you’. Not helpful. What should I do?

Statins are cholesterol-lowering drugs and are one of the most commonly prescribed drugs to prevent heart attacks and strokes. We gave it to anyone with high cholesterol, but that has changed.

Today we calculate the risk of heart attack based on a number of factors: age and cholesterol levels would be one, but it also depends on what other diseases the patient has, lifestyle, family history, etc. we are looking. Anyone with a ten percent or greater risk of heart attack within ten years will be given statins.

One of the things that increase the risk is chronic kidney disease.

Age, heart disease, and high blood pressure can all contribute to the gradual decline in kidney function, and when it drops below a certain level, we call it chronic kidney disease.

This causes few symptoms in the early stages, but problems are often found during routine blood and urine tests.

As the problem worsens (there are six stages), patients may experience a range of problems, from weight loss, fatigue and ankles, swollen feet and hands to nausea, headaches and extremely itchy skin, all due to toxin buildup. . The kidneys normally filter the blood.

Once we know that a patient has a chronic disease, we can monitor him and try to prevent it from getting worse, but special care must be taken as drugs are processed by the kidneys – for example, we can adjust the dose or switch to medication. Which is the best.

Statins usually work well until later stages of chronic kidney disease where a lower dose may be needed. However, many patients with total kidney failure take statins.

In fact, a recent analysis of patients taking atorvastatin showed that kidney function improved over time, probably due to the good effect of statins on blood vessels.

How to clarify last wishes

Last week, I responded to a reader with terminal cancer who asked me if and when he could say “no more” to the life-prolonging treatment.

I wrote that this is the right of every patient and that he can eventually turn to palliative care to make himself as comfortable as possible. In response, I received letters from readers pointing out that it is also possible to express your wishes if you are in good health.

Documentation is a prior decision to refuse treatment (ADRT). If you cannot communicate your wishes on your own, you can specify how you would like to be treated here. You can also make a life and advance statement. You can forward it to your family doctor or other people involved in your care.

There are more details on the Dying Mercy website (compassieindying.org.uk †

Dude, with mental health issues? We’re just talking

Psychiatrist Dr. Andres Fonseca said last week that 60% of people do not share their mental health concerns with their family doctor. He’s not quite right.

In my experience, many patients tell me about their mental health, but they are almost always women.

Men, especially middle-aged men, are still not good at opening up to their doctors. And this is one of the highest suicide risk groups.

Dr. Fonseca said one of the reasons men find it difficult to talk about their mental health is that it’s often difficult to express symptoms, which are often just emotions.

My best advice is not to inflate everything. talk to someone. Even if we ask you to come to us, it doesn’t have to be a family doctor. Don’t make a bold face at him. If you feel bad, gloomy, or sad, tell a friend or colleague. Simply giving up is often the first step towards a solution.

Men, especially middle-aged men, are still not good at opening up to their doctors. And this is one of the highest suicide risk groups.