I’ve suffered from sleep problems for years and taking an antihistamine (cetirizine) a few nights a week really helps, but the medicine leaves me feeling a bit sleepy, so is it doing any harm?
Tina Vowles, Gloucestershire.
Not all antihistamines are the same. There are two types: sedating and non-sedating.
Dr Martin Scarr responds: Antihistamines target histamine receptors. Histamine is a chemical produced in response to what the body perceives as a threat (or, in the case of allergies, a harmless substance mistakenly perceived as a threat). Symptoms are the body’s way of trying to get rid of the histamine (such as sneezing).
However, histamine is also involved in wakefulness, so antihistamines can make you feel drowsy.
However, not all antihistamines are the same. There are two types: sedating and non-sedating.
The former are more likely to reach the brain (because they are carried in the blood) and include chlorphenamine (brand name Piriton).
The cetirizine you are taking does not have a sedative effect, but some people find it makes them drowsy. You may be one of those people.
Long-term use of antihistamines has been linked to dementia. It is important to point out that this is not a proven cause, but since some antihistamines are anticholinergics, there may be a risk.
Long-term use of antihistamines has been linked to dementia, and although this is not a proven cause, it does seem to pose a risk because some antihistamines have anticholinergic effects, says Dr Martin Scarr.
This means that it acts on receptors in the brain that respond to the chemical messenger acetylcholine, low levels of which are a hallmark of dementia.
Long-term use of other drugs that block these receptors, such as antipsychotics and some antidepressants, also increases the risk of dementia.
In fact, cetirizine is a weak anticholinergic, so taking it twice a week is fine, but making you feel drowsy is not a good thing.
My advice would be to limit the amount of medication, only go to sleep when you feel sleepy, get up when you can’t sleep, don’t read or watch TV in bed (that’s just for sleep), get up at the same time every morning, and don’t take naps during the day.
I have been diagnosed with a heel spur after an x-ray. My GP has referred me to a podiatrist. I am waiting to see him but the pain is terrible. I am using podiatric felt and heel supports in my shoes but the pain is not relieving.
Owen Rees, Devon.
Dr Martin Scarr responds: Heel spurs are bone tumours that form on the heel bone (calcaneus). They may have no symptoms, are often found on an x-ray taken for another reason, and can be extremely painful and disabling.
They develop as a result of long-term stress on the ligaments in the foot, for example due to an abnormal gait, ill-fitting shoes, excess weight, osteoarthritis or plantar fasciitis (inflammation of the tissue that connects the heel bone to the ball of the foot).
This causes inflammation, and the body responds by building up bone as a defense mechanism. Treatment includes wearing pads. Heel supports may not be very effective, but a podiatrist can provide a better version called orthotics.
Your doctor may also prescribe a non-steroidal anti-inflammatory drug (NSAID) such as diclofenac. This treatment should be continued for at least six weeks. The next step is a corticosteroid injection, usually using an ultrasound to pinpoint the problem area. However, it’s important to note that this is given to reduce inflammation, not to remove the bone spurs themselves.
Your orthopedic specialist may suggest Botox injections to “numb” the muscles in the bottom of your foot, relieving pressure in the inflamed area and encouraging healing.
Although surgery to remove bone spurs may be recommended in extreme cases, the majority of patients find that their pain is relieved by more conservative methods, and the need for surgical intervention remains unproven.
There are many widely advertised treatments for this type of problem, such as shock wave therapy and ultrasound therapy, but I would be wary of other experimental treatments, as I think they are a waste of money.
