DR ELLIE CANNON: I’ve felt dizzy for over three years. Is it Lyme disease?

I have had severe balance problems for more than three years. I’ve read that it could be due to Lyme disease. Is that true?

Lyme disease is a bacterial infection caused by a bite from an infected tick, an insect in the spider family that normally lives on animals.

Usually, patients remember being bitten. It’s uncommon in the UK – only 3,000 people in England and Wales are affected every year. 

It is true it can cause neurological problems, including dizziness and feeling off-balance, but it’s rare for such symptoms to be the only complaint.

However balance problems are incredibly common, and feeling off-balance all the time can be debilitating, affecting every aspect of one’s daily routine.

It can be hard to find an answer, but often the problem lies with the area of the inner ear responsible for balance, called the labyrinth. 

Lyme disease is a bacterial infection caused by a bite from an infected tick (pictured), an insect in the spider family that normally lives on animals

It is true it can cause neurological problems, including dizziness and feeling off-balance, but it’s rare for such symptoms to be the only complaint [file image]

The most common conditions are benign paroxysmal positional vertigo (BPPV), chronic labyrinthitis, Meniere’s disease or vestibular neuronitis.

All of these problems affect specific balance mechanisms in the inner ear. In neuronitis, for instance, it’s the nerves that are malfunctioning.

It is important to obtain a diagnosis from a GP or specialist – a doctor can refer you to one. 

Some hospitals have balance departments, and a consultation with an ear, nose and throat specialist should get to the bottom of the issue.

Specialists also offer a type of treatment called vestibular rehabilitation, essentially a series of exercises you do while guided by a physiotherapist. 

The Brain & Spine Foundation (brainandspine.org.uk) has an excellent leaflet on this.

In less common cases, feeling off-balance is a sign of something serious such as heart problems or multiple sclerosis. It can also come hand-in-hand with migraines and some medications.

I was prescribed clopidogrel after suffering a minor heart attack in 2013. But in the past few weeks I’ve developed bloodshot eyes which look terrible. 

The doctor says I can’t stop taking it because I might die. Is there an alternative?

Clopidogrel is often given to patients who’ve had heart attacks, to stop them having another one. It is from a family of drugs known as anti-platelet medication, which means it prevents blood clots from forming in the arteries.

It’s these clots that cut off the blood supply to the heart and brain, resulting in heart attacks and strokes.

Medications that stop this are very important – a wealth of evidence shows that they work to stop future attacks. 

It is common for clopidogrel to cause bruising or bleeding, including bloodshot eyes, as a complication of the blood-clotting mechanism.

As with every drug, deciding whether to stop taking it depends on the balance of benefits and risks, including side effects.

It is common for clopidogrel to cause bruising or bleeding, including bloodshot eyes, as a complication of the blood-clotting mechanism. As with every drug, deciding whether to stop taking it depends on the balance of benefits and risks, including side effects. [File image]

Many patients taking clopidogrel experience bruising, but they choose to continue on it because they consider it a small price to pay for the benefit of the drug. 

If side effects become too difficult to handle, there are alternatives GPs can offer.

These include other anti-platelet drugs such as prasugrel or ticagrelor, which may or may not cause similar side effects.

Many patients taking clopidogrel experience bruising, but they choose to continue on it because they consider it a small price to pay for the benefit of the drug. If side effects become too difficult to handle, there are alternatives GPs can offer

It’s worth having a detailed discussion with the GP to talk through the side effects – what you might be able to handle, and what you cannot.

It may be the case that an expert opinion of a cardiologist is needed. Some people don’t spend a long time taking clopidogrel anyway. 

For example, those who’ve had a heart stent fitted rarely stay on it for longer than a year. Ask your doctor if it was ever supposed to be a long-term medication.

I am a fit 68-year-old and do not take any medication. The only problem is that my cholesterol is high, at 7.2.  

I exercise regularly and am a healthy weight, so this has never been a problem. 

I took atorvastatin but started getting itchy skin and muscle pain. I changed to pravastatin, but the side effects worsened. Should I try something else?

Most people assume that high cholesterol is always related to a poor diet. In fact, some people can inherit high cholesterol from their parents. 

But some dietary choices can make it worse.

It is possible to be a healthy weight and to exercise a great deal, but still have a high cholesterol level because of a diet rich in meat and cheese.

When assessing cholesterol, doctors never look at the figures in isolation. We consider a patient’s overall risk of heart disease and stroke, informed by a host of factors from age to smoking status, and even postcode. 

Rather than a total cholesterol score, we look at the ratio of the two different types of cholesterol. Only when a GP has all this information can they decide whether it’s worth treating the cholesterol itself.

If a patient’s risk score is over ten per cent, GPs usually offer a statin to lower cholesterol in the blood. But some patients suffer side effects. In this case, doctors can offer other cholesterol-lowering drugs.

GPs may also treat other problems that simultaneously raise heart disease risk, such as high blood pressure.

Eating some foods, such as almonds, soya-based products and oats, may reduce cholesterol levels naturally.

A compound called plant stanol is also clinically proven to reduce cholesterol and you can find yogurts and drinks containing it in supermarkets.

Don’t ignore the breast cancer in your family 

Last week US cancer experts suggested women with genes that put them at raised risk of breast cancer should be screened yearly for the disease from the age of 30.

Currently we offer all women, regardless of risk, a mammogram once every three years, from the age of 50 to the age of 70. 

There have long been concerns the current system is too blunt – with cers missed.

So any steps taken to better tailor screening to risk would be incredibly welcome.

Sarah Harding, pictured with her mother Marie in London in 2013, died of breast cancer last year at just 39

It’s important to point out that if you do have breast cancer in the family, even if you are younger than 50, you’re already eligible for enhanced surveillance. 

My maternal great-grandmother and grandmother both died of breast cancer, and my mum was diagnosed with it too, so since the age of 40 I’ve been recommended to have yearly mammograms.

I was interested to discover that pop star Sarah Harding, who died with breast cancer last year at just 39, had a similar family history to me. 

If you have family history of the disease, tell your GP and ask for referral to an NHS genetic clinic.

Take your statins… they work 

Statins – which lower cholesterol – have a reputation for causing a range of side effects. 

Critics have claimed – inaccurately – up to a third of patients suffer things like muscle aches and fatigue on the pills. 

But research which involved more than four million patients published this week showed that 90 per cent of people who take the pills suffer no side effects at all. 

Of course I have patients who genuinely have a hard time with the tablets. 

Usually, when we switch to a different brand, the problems resolve. 

And if they don’t, there are other cholesterol-lowering drugs to try.

Statins are remarkable medicines that play an important role in preventing heart attacks and strokes. 

If they’re recommended, it means you’re at risk, so don’t be put off by those scare stories.