I gave up my (long-term) nightly large glass of red wine in mid-February after realising it was a ridiculous habit that needed breaking. I had previously attributed my sluggishness and low mood to old age – but after six weeks I suddenly had my old spark back. My brain has become totally fired up again.
Carole Goodman, East Grinstead.
Dr Martin Scurr replies: A large glass of wine (250ml) counts as three units of alcohol, so you were consuming around 21 units a week – well above the recommended limit.
Many who see drinking as convivial and cheering don’t realise there is a well-established link between alcohol intake and depression. It’s a dose-response relationship – which means that the more you drink, the greater its effect on mood.
Although alcohol initially can improve mood, thereafter it acts as a depressant, interfering with levels of the ‘feel-good’ chemical serotonin, and promoting low-grade inflammation in the brain.
I believe that over the long term, your intake caused a mild form of depression, resulting in low energy and sluggishness – compounded by the effect of alcohol on the quality of your sleep, disrupting your sleep cycle – so you would have had less deep, restorative sleep.
Even ‘just’ one large glass a night can have this effect, which may be news to some readers.
But your weeks of abstinence have reversed this. How gratifying for you to recognise what was happening – and thank you for telling us your story.
Many who see drinking as convivial and cheering don’t realise there is a well-established link between alcohol intake and depression. It’s a dose-response relationship – which means that the more you drink, the greater its effect on mood (picture posed by model)
I am a 74-year-old man in generally good health, but I have suffered from lower back and upper thigh pain for several years. After an MRI I was diagnosed with severe osteoarthritis in my left hip and a trapped nerve in my lower back. I had a hip replacement in January. However, the back and thigh pain in the right leg has got noticeably worse. What do you advise?
Steve Miller, Oxfordshire.
Dr Martin Scurr replies: I suspect the issue here is your right thigh – with your recent left hip replacement and the diagnosis of a trapped nerve in your lower back, clouding this issue.
In your longer letter you mention Googling your symptoms and coming up with meralgia paraesthetica – a common condition involving a nerve that passes from the lower back into the leg just under a tough fibrous band of tissue (the inguinal ligament) in the crease of the groin.
This vulnerable position means the nerve can easily become stretched or compressed – being overweight or even wearing tight clothing can trigger this – producing a burning pain or electric shock-like sensations in an area a little larger than the palm of your hand on the outer right thigh.
In some cases, it can also reduce feeling in that area (which we can test using cotton wool or light pin-pricks).
The problem is that a trapped nerve in the lower back can cause very similar symptoms, so re-examining your previous MRI scan may be helpful in pinpointing whether the trapped nerve was actually on the right side of your body rather than the back.
If meralgia paraesthetica is confirmed, injections of a corticosteroid – combined with a local anaesthetic – may help.
The anaesthetic brings immediate relief, followed by a longer-lasting effect from the reduction in swelling around the nerve from the corticosteroid. You would need to be referred to a neurologist or a pain-control anaesthetist for this. In some cases, a minor procedure, carried out by a neurosurgeon, can free the trapped nerve.
I’d suggest asking your GP to refer you to a specialist. The correct diagnosis should be straightforward once you come under specialist care.
In my view… Taking statins is like winning the lottery
Statins are proven to protect against dying prematurely from heart attack and stroke. Yet doctors can find it difficult to persuade people to take them.
It’s not so much an issue with patients who have had a cardiovascular ‘event’ who want to avoid another – but trying to convince someone in apparently good health to commit to long-term medication that could be life-saving, but which they fear causes side-effects, can be hard.
In a recent survey published in JAMA Internal Medicine, people were asked whether they’d take a statin if their risk of a heart attack or stroke over the next ten years was deemed low (2.5 per cent) – 70 per cent said they wouldn’t, but if the risk was high (20 per cent), 70 per cent would.
I think the key is to show each patient their individual risk – which GPs calculate using a tool such as QRISK3 – and taking the time to discuss it.
We normally offer statins if the risk is 10 per cent. Patients often say this isn’t much – but I then point out that if they had a 10 per cent chance of winning the lottery in the next ten years, they would take a ticket.
