Why did my lips feel like they were on fire? Ask the GP DR MARTIN SCURR

Some years ago my lips, tongue, throat and oesophagus felt like they were on fire. I saw a consultant who was very offhand and straight away said I had burning mouth syndrome, that it affected older women and nothing could be done. But when I cut soy products from my diet – I’d dramatically increased my intake, to ease hot flushes – it all went back to normal. Now if I inadvertently eat soy, my mouth flares up in minutes.

Angela Donnelly, Cambridge.

Your experience highlights a trap that medical professionals can fall into – reaching a diagnosis that seems to fit and not taking a step back to rethink the conclusion, so enamoured are we of our own brilliance!

You were very swiftly diagnosed with burning mouth syndrome, which causes symptoms like yours and is most common in middle-aged women, as you were told.

I suspect your negative experience (in your longer letter, you say you had to ask the consultant if he was going to examine your mouth which he very grudgingly glanced at) made you rightly and correctly sceptical.

So often when people exclude a particular food to get to the root of unexplained symptoms, it reveals nothing.

But gratifyingly this resulted in relief of your burning mouth sensations – then finding that when you again consumed foods containing soya, your symptoms rapidly returned.

Soya products are a popular remedy for hot flushes in menopause as they contain plant oestrogen – although the evidence for their benefits is mixed.

Soya beans and products such as soy sauce and tofu are one of the most common sources of food allergies in infants and children, though this occurs less frequently in adults (who tend to have more allergies to milk, fish and eggs).

Quite why you’d experience this allergy later in life is not clear, but essentially the membranes lining your mouth reacted to the soya molecules by producing an immune protein (or antibody), called IgE, which in turn triggered the release of histamine and other chemicals, resulting in the burning sensations. The only treatment is avoidance of all foods containing soya products.

Most of my contemporaries – I’m 83 – have had the shingles jab. When I asked at my surgery if I should have it, they said no because I’d not had chicken pox.

Lee Janogly, North London.

While you say you didn’t have chicken pox as a child, it’s not uncommon for it to be missed – I’ve seen children with as few as seven spots, which the mother took to be a few insect bites but it was unmistakably chicken pox.

Infection confers lifelong immunity although the virus remains in the body, locked down by the immune system close to the spinal cord. Later in life, factors such as age or ill health suppress the immune system, allowing the virus to escape and travel down a nerve, triggering herpes zoster (aka shingles) and a blistering and very painful rash and acute illness.

The only way you can know for sure if you didn’t have chicken pox earlier in life would be for your GP to send a blood sample to a lab to check for the antibodies. If you’ve never been infected, to catch chicken pox at your age (either from someone who has the virus or shingles) would be very serious, as in adults a common complication is viral pneumonia, which is potentially lethal.

One in four people over the age of 50 will develop shingles, and vaccination provides a high degree of protection. There are two vaccines: Zostavax, which works against the chicken pox virus and shingles, and a newer vaccine, Shingrix, which is more effective against shingles and is now the standard.

The question of whether you should receive Zostavax is controversial, because it’s a live virus and could, in theory, cause shingles, though this is highly unlikely. It’s a question to raise with your GP when you request the blood test — you do need to know, and until then, isolate from anybody who has shingles, at least until their rash has completely healed.

In my view… GP practices need better funding 

The NHS ‘is the closest thing the English have to a religion’, Tory chancellor Nigel Lawson famously said, ‘with those who practise in it regarding themselves as a priesthood’. So where does this leave the flock?

As long ago as 1984 a renowned healthcare economist, Alain Enthoven, recognised that the NHS relies on the dedication and idealism of its staff, but he noted that somehow the interests of the patients get lost. I think for many people trying to make an appointment to see their GP, this is all too true.

That loss is measurable; the Institute for Public Policy Research has calculated that there would have been 240,000 fewer deaths between 2010 and 2020 (prior to the pandemic) if the UK’s mortality data matched other comparable European nations.

A major factor is thought to be not accessing healthcare in a timely manner.

The answer is better funding of primary care over hospitals, as that, after all, is where up to 90 per cent of healthcare is delivered.

Write to Dr Scurr at Good Health, Scottish Daily Mail, 20 Waterloo Street, Glasgow G2 6DB or email: [email protected]. Dr Scurr cannot enter into personal correspondence. Replies should be taken in a general context. Consult your own GP with any health worries.