Dr. ELLIE CANNON: Will there be serious side effects from the steroids I’m taking?

I have diagnosed with a blood disorder called giant cell arteritis. My GP prescribed 50mg of steroids while I wait for a specialist, but I am concerned about the side effects. This dose seems high. Is it normal?

Giant cell arteritis occurs when arteries, usually those on the side of the head, become inflamed and cause severe headaches and vision problems.

Prompt treatment is vital to prevent further loss of vision or spread of pain to the neck and shoulders, which occurs in about half of patients.

A primary care physician will initially diagnose the condition through a blood test for signs of inflammation. A referral to a rheumatologist can be made, but there is usually no need to confirm a diagnosis before starting treatment, and in severe cases, a concerned primary care physician can immediately prescribe high doses of a steroid called prednisone.

Many patients find the side effects of steroids difficult to tolerate – constipation is very common, as is indigestion and excessive sweating. Long-term steroids can suppress the immune system and increase the risk of osteoporosis.

But the high dose of prednisone for patients with giant cell arteritis is short-lived – usually just a few weeks to get symptoms under control. A doctor will reduce this to a much lower dose, which reduces the risk of side effects.

A small number of people may need to use steroids in the near future and will be monitored closely. At this point, a rheumatologist can suggest other medications and treatments to counter the side effects of steroids, or explore nonsteroidal options. Very serious side effects – notably upper back weight gain, a swollen, round face, severe abdominal pain, or feeling faint – are uncommon but require an urgent call to NHS 111.

I have polymyalgia in my right shoulder and the pain often prevents me from sleeping. I have read that cannabis oil can help reduce discomfort and put me to sleep. Will it help?

Cannabis-based medicinal products are made from chemicals derived from the cannabis plant and have no psychoactive effects. They are available in oral solution or nasal spray form, and there are only three situations in which a doctor would recommend them – otherwise, doctors don’t prescribe them.

The first is to treat epilepsy that cannot be controlled with other drugs, as some studies have shown that it can be effective in reducing the frequency of seizures. It can also be prescribed for vomiting caused by chemotherapy, or to relieve multiple sclerosis spasms.

Polymyalgia is a condition in which an overreaction of the immune system causes inflammation in the muscles and connective tissue. Cannabis-based medications are not recommended.

Talk to your doctor as steroids are usually the first way to control symptoms. Sleep problems are common with polymyalgia, because of the painful muscle pain.

One thing to try is a strong pain reliever, such as co-codamol, that will make you sleepy. Again, only include this under medical advice. It can also help improve your bedtime routine – keep phones out of the bedroom and try some deep breathing exercises.

There are over-the-counter tinctures that contain cannabidiol (CBD), a cannabis-derived chemical. There is little evidence that it does anything, despite what is being claimed online. That said, you could try it as it probably won’t do any damage. However, consult a local pharmacist first.

About 20 years ago I had surgery to remove nasal polyps, but they came back after seven years. Now I am often dumbfounded. I’ve used sprays that should rinse your nose and other decongestants. Nothing works, and I am regularly prescribed steroid tablets, which help, but not for long. Can you give any advice?

Nasal polyps are painless little fleshy growths in the nose. You usually can’t see or feel them, and they’re not often a cause for concern, but if they get too big, they can start to cause problems.

A constantly stuffy or runny nose, the feeling of having to swallow all the time – a condition called post-nasal drip – and a decreased sense of smell and taste are all signs of nasal polyps. Problems breathing through the nose, snoring, and nosebleeds are also common symptoms.

It’s not fully understood why people develop them, but they are sometimes seen alongside asthma and aspirin sensitivity – a response to the pain reliever that causes wheezing and itchy rash or hives.

Polyps can be quickly diagnosed by a doctor who looks up the nose with a flashlight to see what is going on.

Initially, many people try over-the-counter medicines to relieve congestion, while nasal drops containing steroids or a prescription spray can help reduce them.

If this doesn’t work, or if the polyps are large, steroid tablets may be prescribed.

If things don’t improve after ten weeks, a referral to an ENT (ear, nose and throat specialist) may be necessary.

They can recommend surgery – a polypectomy. It’s done through the nostrils so there are no incisions, but it does require a general anesthetic. It usually takes a few months for any difference to be noticed. While the surgery is effective, polyps often grow back, but using a steroid spray after surgery can help prevent or delay recurrence.

However, if symptoms start or change again, it is important to get a new ENT referral.

Just because the problem was polyps last time, doesn’t mean it’s again. Although rare, certain types of cancer in the nose can look the same. Cancer is more common as you get older, so it’s always important to rule it out. Currently, surgeries for simple polyps can be delayed because of Covid, but not completely canceled. It is important to continue with your primary care physician.

Missed your over 50s flu shot?

Despite the government’s commitment to vaccinate all over 50s against the flu this winter, it seems many of you won’t be able to get your hands on one.

I am shocked to receive several letters from vulnerable elderly readers telling me that they have yet to be invited for an injection or are victims of a local shortage.

Vaccination would be rolled out from last month in an effort to save the NHS from the double burden of Covid-19 and flu disease.

Yet many are still waiting.

I want to find out how widespread the problem is – and I need your help for that.

If you’ve been having trouble getting your flu shot, write me and tell me what happened.

My GP probe has just started …

Last week I asked you to inform me about general practice closures for Covid-related reasons. And you did – hundreds of you.

In fact, I’ve never had such a large mail bag. It seems that many of you have made telephone appointments, when you actually want an extensive one-to-one conversation with your trusted doctor.

Others are frustrated with the assumption that everyone has access to the Internet. Online forms used by some practices are a challenge for many.

For those who have written, I have not forgotten this. I’ll cover the matter in the coming weeks, but I’m going to read each letter first and find out what’s really going on.