Doctor Q&A: Should I start preparing for a new pandemic? Dr Renée Hoenderkamp answers your burning health questions

Hi Dr Renée, I could really use your help. I suffer really badly from sweating all over. My face and body get drenched in sweat during the summer months mainly or after a little bit of exercise. But just generally too. I sweat all over. Could it be hormones? I suspect not as I have suffered from sweaty episodes since I was young and the menopause is behind me now (I think!). any help on what to do and what could be causing it would be welcome. Thank you

In a way you have answered your own question: you have always been prone to sweaty episodes and have made it post-menopause. So this is likely normal for you, but that doesn’t make it any easier to cope with and or more generally normal.

It sounds to me like you have what we medical types call hyperhidrosis, which is excessive sweating, not always related to heat or exercise. Some sufferers will sweat so much that it soaks through clothes and drips off the face, feet or hands and makes everyday life difficult at times. For example, some people can’t even hold a pen for even a short period of time and this level of sweating can cause social anxiety and embarrassment, and this can in turn make it worse.

Whilst unlikely, sweating can signal a more serious underlying condition and you must always seek medical help immediately if you have heavy sweating with dizziness, pain in the chest, throat, arms jaw, or throat, cold skin and/or feel that your heart is beating fast or irregularly.

But day to day, if your sweating disrupts your daily routine, causes emotional distress, is new or you start to get night sweats for no apparent reason then please see a doctor who can help and rule out any underlying medical cause.

There are treatments that can help and these are usually approached in a step-like fashion:

• Antiperspirants that contain aluminium chloride applied before bed and washed off in the morning.

• Nerve blocking medications propantheline bromide (Pro-Banthine tablets, which are licensed for hyperhidrosis), glycopyrronium bromide (unlicensed), oxybutynin (off-label) may help reduce sweating. (all medications have side effects of course)
• Lontophoresis which is tap water or glycopyrronium bromide (robinul powder) added to the water, which is licensed for hands and feet hyperhidrosis

A treatment that I have seen work very well for specific areas is Botulinum toxin type A (botox injections) which is licensed for the armpits but can be used off licence by a skilled practitioner on the feet and face. This works for around nine months and does the job well. It is of course expensive and hard to get on the NHS (but not impossible).

Overall, treating any anxiety which makes the problem worse can also help and CBT might help.

I hope that is useful.

Hi Doctor, last December I woke to find I could not rotate my wrist for the pain. I saw a practical nurse who decided this was carpal tunnel syndrome and was given exercises. But then over the next two months I started to knuckles stiffening up and the other wrist going the same way.  X-rays indicated osteoarthritis. Eventually I saw a doctor and the results of the blood test and thyroid came back normal. My worry is that I have rheumatoid arthritis as I am having flare-ups where everything will be worse for 24 hours and is accompanied by flu-like symptoms and fatigue. Are these symptoms not a type of rheumatoid arthritis? I would really appreciate your clarity on this.  

You do appear to be describing osteoarthritis (OA) and it may have been the case that you had underlying OA that you were not overtly aware of and then a trauma (even if you didn’t notice it) has caused it to flare and now you are of course only too well aware of it.

Just to explain to all that osteoarthritis is wear and tear to the joints that almost everyone will suffer as they age, to a greater or lesser extent. It is defined as degeneration of joint cartilage and the underlying bone, most common from middle age onward. It causes pain and stiffness, especially in the hip, knee, and thumb joints but can affect all joints and if you have it in one joint you can reasonably expect other joint involvement at some point.

In terms of being worried about rheumatoid arthritis (RA), I would hope that this was ruled out with the blood test you had, as you can check for blood markers usually present in RA. It is true that some RA is called ‘serum negative’ meaning that you have the signs (on X-ray etc) of RA but the blood markers are not present. For you, the X-ray should have shown the classic signs of OA (joint space narrowing, osteophytes, sclerosis and/or cysts). These are used to diagnose OA and rule out RA. Having said this, early rheumatoid may not show on X-ray and an ultrasound scan can be better. To this end, it wouldn’t be unreasonable to ask your doctor for new blood tests and an ultrasound scan or repeat X-ray.

When you have any joint disease, you can find, as do I, that any viral illness, such as flu, will cause your joint pain and stiffness to flare. This is due to your body trying to fight the illness via an inflammatory response and so inflaming the joints which are already inflamed. This can last for weeks and sometimes months and is known as a viral arthralgia and is not a particular feature of rheumatoid arthritis. So I would say, no, this does not make it more like RA and I would suggest having a look back at some of the articles I have done covering anti-inflammatory foods on here and Instagram (@DrReneeHoenderkamp) on anti-inflammatory diets.

In a nutshell, cut out all sugar and processed food, cook from raw ingredients, add polyphenols rich foods and have a good range of nuts, all different colours of fresh fruit. You could also try Turmeric which is good as an anti inflammatory treatment and I use one from FutureHealth with gold. There is some good information here.

I hope this helps and good luck!

Hey Dr Renee, are there any general tips you'd recommend for reducing your risk of infection? I keep reading headlines about different infectious diseases doing the rounds and I am terrified we might be facing another pandemic! Should I start preparing a new one? I have comorbidities  (diabetes and high cholesterol)  so I took extra precautions during Covid so looking for any guidance. Thank you 

I am really sad that you are so worried about the next pandemic, should it come. Of course, I understand why you are worried but it is very difficult to assuage your fear when you feel vulnerable due to your co-morbidities.

There is no magic answer to this but the general advice is really down to lifestyle and diet. So I would say that you should look to make sure your diet is totally clean and by that I mean, unprocessed. Cook from scratch, or eat mainly raw if that appeals, and include a wide range of fruit, vegetable and protein. When thinking about fruit, go for small portions of different colours, so blueberries, strawberry, orange, red berries, cranberries, kiwi for example. Add different nuts every day, so hazelnut, cashews, walnuts and brazils. Have mixed seeds with yoghurt every day (I do this for lunch). Add good quality, line caught fish, pasture fed meat and you are ensuring that your diet is containing all of the nutrients your body and gut need to protect you as required.

Thinking about your gut, I add what I think is the best probiotic available and analysis from UCL support this, showing it is the only one to actually reach your gut, and this is Symprove.

Thereafter, make sure your BMI is under 25 and that you exercise to include;

• At least 150 minutes moderate intensity activity, 75 minutes' vigorous activity, or a mixture of both.
• Strengthening activities on two days.
• Reducing extended periods of sitting.
• Reduce alcohol (this will help cholesterol and sleep) and don’t smoke.

Obviously, normal infection precautions such as handwashing, not touching your mouth when out and about and touching surfaces, sneezing into a tissue etc, but I can’t stress enough that isolating completely from all infection doesn’t challenge the immune system constantly which would happen if you were out and about normally and so it then becomes less well prepared to meet and fight an infection. In covid for example, teachers were not at increased risk of infection despite meeting children with covid constantly and there is a school of thought that suggests that constant low level exposure gave them an immunity.

It is also important to remember that stress and anxiety lowers immunity as does isolation and loneliness. So, as hard as I know it is, I would encourage you to stop worrying, attack your lifestyle because you will be better all round for it and at the same time will lower the risk of many diseases and enjoy life because it’s the only one we have and I saw too many people in the pandemic stop living until they died naturally.