I’m dizzy and slur my words, but I still can’t get a diagnosis

I have been suffering from dizziness – sometimes extreme – and blurry vision. I also find I’m slurring my words. The GP ordered blood tests last year but I have heard nothing more since. Having done my own research I think I have ataxia, which seems to be getting worse by the day. What do I need to do to get an official diagnosis?

Ataxia is the name for a range of serious brain conditions affecting balance, speech and co-ordination. It can be a long process to get a diagnosis with a neurologist, who will need to undertake many tests, including MRI scans.

Certain types run in families, so genetic testing is also important.

Some tests are not common and are offered only by certain major hospitals around the country, which also requires a referral.

The most common type of genetic ataxia is called Friedreich’s ataxia, which is inherited from parents. Usually people notice their symptoms developing very slowly over time before the age of 25, although not always. People can also develop ataxia as a result of other conditions, such as multiple sclerosis, or after a stroke.

It is usually not possible to treat ataxia but it may be possible to relieve the symptoms. This could include speech and language therapy, physiotherapy and occupational therapy. Medications are also available to help with muscle spasms and pain.

Since ataxia is a rare condition and difficult to treat, the charity Ataxia UK has accredited Specialist Ataxia Centres for treatment and research. You can ask your GP or neurologist for a referral to one of them.

Ataxia UK is an excellent source of support (ataxia.org.uk).

I had my baby in March and then a smear test in June, which showed I had the HPV virus – but the doctor said I had no abnormal cells. I have to return in June for another smear to check the situation. My problem is we would like to try for baby number two. I am in my late 30s so time is pressing on. Is it safe to do so before my next test?

There are many different types of HPV – more than 100. It’s a very common virus that doesn’t cause problems in most people, but some types can cause genital warts or cervical cancer.

While HPV affects up to 80 per cent of adults at some point, this will undoubtedly drop over the years as teenagers are now vaccinated against it.

But because of its association with cervical cancer, smear tests looks for HPV. People who don’t have it are very unlikely to develop the disease.

If someone does have the virus, the cells on the cervix – the entrance to the womb – are examined for abnormal changes. It is reassuring if none are found, and then women are kept under a closer surveillance with annual screening, rather than every three years. For most people the virus will go away and not cause cancer: nine in ten HPV infections clear within two years.

Weighing this up with the desire to try for another baby is a very personal decision, looking at the risks and benefits. I would advise patients to see through the HPV process as a priority, both for practical and emotional reasons.

There are excellent charities offering advice. The Eve Appeal offers an Ask Eve service, which provides nurse-led expert information online or on the phone, on 0808 802 0019.

My right big toe joint is very painful and I’m often unable to move it. I was told years ago that I had hallux limitus that would eventually become hallux rigidus. I was also advised that the only treatment other than surgery, which I’m reluctant to have, was painkillers. Is there anything else out there I am not aware of you could suggest?

Surgery can seem daunting, but when weighed up against not being able to walk or put shoes on, it could be worth undertaking.

Hallux limitus is osteoarthritis of the big toe, caused by wear and tear. The surfaces of the bones become damaged and rub against each other, restricting movement until the toe can’t move at all. Some people claim that alternative remedies, including turmeric, chondroitin and glucosamine, can help. However, these are not recognised treatments so I wouldn’t recommend them.

Anti-inflammatory tablets or gels such as ibuprofen, as well as other painkillers, are useful. It is recommended to wear stiff-soled shoes or those with a rocker bottom during activities.

It may be possible to be referred for podiatry or orthotics – specially made shoe insoles. Doctors may also offer a steroid injection into the joint – this would reduce the inflammation in the joint and can provide months of relief.

There is a range of operations, and an orthopaedic surgeon would advise which is the most suitable, as it depends on the condition of the joint. The operations either preserve the joints or leave them unable to move, which can sound rather frightening. 

But in all cases the aim is to reduce pain – studies show that weight-bearing on the foot improves with surgery, even if the joint is fused.This can be a price worth paying to allow pain-free activity and walking.

Sometimes a GP needs to see you – please don’t say no!

One might think it hardly needs saying, but if your doctor asks you to come in for an appointment, please say yes.

Data published last week in the British Medical Journal looked at the safety of remote consultations and, contrary to some reports, highlighted how safe they can be. However, researchers suggested that in some situations, such as when dealing with rashes, or for elderly people, they’re not the right choice. In these cases, doctors actually need to see patients in the flesh to properly assess them, just in case it’s serious.

I am aware that, in some areas, people are still struggling to get in-person consultations, but I’m encountering a different issue. Fairly often I’ll ask a patient to come in for an exam and they insist they’d rather be dealt with remotely.

There are some things we just can’t treat over the phone, and this sort of resistance worries me.

My question is, now that the dust has settled on the big shift brought in during Covid, how do you feel about telephone consultation versus face-to-face? Please write and let me know.

Will your A&E survive winter?

As we head into winter there’s understandable trepidation in the health service about the coming onslaught of viral infections, bugs, coughs, colds and other lurgys.

Most of us brush them off or spend a few days feeling rotten. But vulnerable people – babies, pregnant women, the elderly and frail, those who have cancer treatment or with conditions that affect the immune system – can end up being rushed to A&E. What will they find when they arrive?

A Care Quality Commission analysis published last week suggested that half of England’s A&E departments were failing to reach basic standards.

I’d like to know, how is your local unit coping? Have you struggled to get treatment, been left waiting for an ambulance or left in limbo without a care package? Write and let me know.