DR ELLIE CANNON: My kidney disease is chronic

I found out that I had chronic kidney disease by chance when I was called to have a flu vaccine – I’m 64. The GP said that I was eligible for the jab due to my kidney problem – he called it CKD 3a – which had been picked up in routine blood tests a year before. I asked why I hadn’t been told earlier, to which he said he didn’t want to worry me. A nurse also said the same, but it has played on my mind. Is there anything I should be doing?

I imagine there are many people who are unaware they have been labelled with chronic kidney disease (CKD).

It’s important to note that despite the alarming name, the condition is not always significant. It is often thought of by doctors as a risk factor for other health problems, rather than a disease in its own right.

However, your GP definitely should have told you about the diagnosis.

CKD is essentially a reduced ability to filter blood in the kidneys that tends to occur with age. We also see it alongside conditions such as high blood pressure, type 2 diabetes, heart disease and obesity.

It is important to be aware of as CKD can worsen and lead to a greater chance of heart disease.

CKD 3a is the earliest stage and means someone has a consistently mild level of reduced kidney function. Stage 4 is severe while stage 5 indicates kidney failure.

Treatment for CKD 3a involves monitoring the kidneys to ensure things are not worsening, and regularly checking blood pressure to ensure other conditions are not damaging them.

This can be maintained through annual urine checks, monitoring for diabetes, treatment for any underlying high blood pressure and possibly offering a cholesterol-lowering statin due to the heart risk.

Healthy lifestyle advice applies, too: avoid smoking, eat a balanced diet, keep salt consumption low (the NHS suggests less than 6g a day) and regular exercise.

Someone with CKD also has to be careful about the use of anti-inflammatories such as ibuprofen, and avoid protein supplements and herbal remedies – all of which may harm the kidneys.

Sufferers are in the higher-risk groups for flu and Covid, so keeping on top of vaccines is key.

My 30-year-old daughter has always struggled with her mental health and has been on citalopram since her late teens. She and her partner are talking about trying for a baby, and I’m concerned that being on an antidepressant might be dangerous for a developing child. What would your advice be?

Taking medication is always about weighing up the risks and benefits, and this is especially true for pregnant women and those trying to conceive.

Before deciding to reduce or stop a treatment, you have to consider the effect on the woman’s overall health and how that might impact the pregnancy.

Citalopram is an antidepressant known as a selective serotonin reuptake inhibitor (SSRI), and these can be taken in pregnancy without any cause for concern.

Some studies have linked the use of these tablets with premature and low-birth weight babies, but doctors can’t say for certain whether this is truly from the pills or the mum’s circumstances. It was thought that SSRIs taken during early pregnancy may cause heart problems in a developing foetus, but recent research has proven this to be false.

Most women who take an SSRI while carrying a child will have a normal pregnancy without issue.

My mum died recently in her 90s of C. diff. Her last weeks were very traumatic, not least the dreadful and acute diarrhoea she suffered. Prior to this she had been on antibiotics for a leg infection and, when diagnosed with C. diff, she was prescribed even more. I’ve now read that this wasn’t appropriate. If she hadn’t been given these drugs, might she still be alive?

Clostridium difficile, also known as C. diff, is the name of a diarrhoea-causing bacterial infection of the gut.

For someone elderly and frail, it can be extremely serious – gut problems like this can rapidly lead to severe dehydration and kidney damage. This is far more likely to happen in a patient who has been on strong antibiotics – these drugs kill bacteria but also deplete the healthy ones found in the gut, which then allows C. diff to take hold. This is why we often see outbreaks in old people’s homes and on hospital wards.

There has been a huge drive within the NHS to prevent this through careful antibiotic prescribing as well as strict hygiene and isolation in hospitals.

Sadly, recent figures show that more than 13 per cent of people with C. diff die – most commonly in those over 85.

Treating C. diff involves using very specific antibiotics which should be provided by a hospital microbiology team. It is also important to take in plenty of fluids and stop other medications that can impact the gut or hydration levels.

This may mean stopping some high blood pressure treatments and stomach acid suppressants such as omeprazole.

It is also advised that no anti-diarrhoea medicines are used, including loperamide, sold over-the-counter under the brand name Imodium.

This drug tackles the Jolie gene, but I’m not risking it

Drug regulators have given the green light to a medicine called anastrozole for women with a high genetic risk of developing breast cancer.

On the face of it, this sounds like great news. But while anastrozole does help, by lowering the levels of oestrogen hormones in the body, there are some significant downsides – notably its serious side effects.

Due to my family history, I am one of the 250,000 women in the UK that this decision could help. Actress Angelina Jolie, pictured, found her risk from the ‘faulty’ gene, BRCA1, was so great she opted for a double mastectomy. But I’m not sure I’d opt to take a tablet that would put me into an early menopause and risk osteoporosis, just two of a significant list of side effects.

I want to know what you think. Would you take anastrozole to prevent breast cancer? Have you taken it and suffered?

Please write to me at the email address below.

Is physio all it’s cracked up to be?

Physiotherapy sessions can be prescribed to treat a whole host of afflictions.

There are physios who help with recovery from injuries, joint replacements and rehabilitation after a stroke.

Some might specialise in working with disabled people, and there even physios that tackle incontinence and other pelvic problems.

I believe this is a positive thing – but not everyone agrees.

I’ve come across some doctors on social media debating about how much measurable benefit physios provide, as well as the conflicting and confusing advice sometimes given by them on how to treat ailments.

I’m interested to know about your experiences. Was physiotherapy actually helpful, or just plain pointless?

Please send me an email to the address on the right.