I’ve been losing a lot of hair daily. I took alendronic acid for osteopenia for about 18 months and then my hair started falling out, so I stopped taking it. I was worried about osteoporosis and was given an alternative, but reacted badly. I started taking alendronic acid again and my hair fell out again, so I’ve stopped completely.
Name and address supplied.
Dr Martin Scurr replies: How very distressing for you and I do hope that we identify a way forward.
Alendronic acid is a drug known as a bisphosphonate: alopecia (widespread hair loss) is not reported as a side-effect, but I have seen other people report this.
It’s always difficult to be certain that a drug has caused a particular effect, but you’ve obeyed the golden rule, to re-challenge yourself. And the conclusion is the hair loss seems to be a response to the drug.
Osteopenia is the precursor condition to osteoporosis, but the other treatments you mention in your longer letter that you’re taking – calcium, vitamin D, HRT (patches) – will stand you in good stead in terms of preserving bone strength. And on the basis of my experience with many patients who’ve lost a lot of hair post menopausally, for it to be restored by HRT, I wouldn’t be in too much of a hurry to stop your twice-weekly oestrogen patches.
Alopecia (widespread hair loss) is not reported as a side-effect of the pills, but I have seen other people report this, says Dr Scurr
The key is what your most recent DEXA bone scan showed: if your bone strength has further declined into osteoporosis, there are alternatives to bisphosphonates.
My suggestion is denosumab, a drug shown in studies to improve bone mineral density, reducing the risk of fractures.
The drug works by inhibiting the cells that break down bone and is given by injection every six months. The problem is that while effective, once you come off this drug it can result in rapid bone loss and fractures, unless you’re put on another drug (a bisphosphonate). However, there is no reason why you shouldn’t be on denosumab long-term, though you would need to accept that it’s a lengthy treatment.
I think I’ve developed an irregular heartbeat but I have a long-standing fear of medical and dental appointments and don’t want to see a GP. Is an irregular heartbeat dangerous?
Ann Wills, London.
Dr Martin Scurr replies: An irregular heartbeat may come and go. The irregularity may be due to ectopic beats, or ‘extra’ heartbeats. These can make it feel as if your heart is skipping a beat, but are harmless.
At your age (you’re say you’re in your 70s or 80s), it might also be due to atrial fibrillation.
The most common heart rhythm problem, this causes the heart to beat quickly and erratically. Left untreated, it can lead to blood pooling in the heart and forming clots, and raises the risk of a stroke.
It is diagnosed with an electrocardiogram (ECG), checking the heart’s electrical activity as you lie down for five or ten minutes. Fortunately blood-thinning medication can significantly cut the risk of blood clots and stroke.
It may be that first you see a psychologist or a psychotherapist to help you tackle your fears about seeing the doctor.
There are different techniques to achieve this, including hypnosis or EMDR (eye movement desensitisation and reprocessing, which helps you to process negative emotions, such as your anxiety at seeing a doctor).
Perhaps you could confide in a friend and ask them to help you research the options? While I understand how debilitating this fear can be, it’s vital for your overall health that you overcome it and seek a diagnosis.
In my view… Doctors know the right words to use
I come to work smartly dressed, usually in a three-piece suit. It’s about respect for my patients.
Is that an attitude that can be forced on to healthcare professionals? The National Institute for Health and Care Excellence (NICE) seems to think so – it’s published a ‘language guide’, based on the questionable assumption that changing the words used will benefit patients.
Out, for instance, go terms such as ‘smoker’ (for ‘people who smoke’) and even ‘obese’.
But I should be the judge of language not NICE – as the trained professional, nobody’s better placed to understand the needs and reactions of the patient before me. These recommendations are patronising. And where’s the evidence that giving them the information straight isn’t in their best interest?
The fact is, your doctor’s not your friend. If we give information that alarms or causes a reaction, that might be unwelcome – but also very necessary.
Softening the doctor’s role by twisting language to reduce its impact won’t provide quality care. Yes, we need to be respectful and inclusive but ‘person-centred’ language, as NICE puts it, is just political correctness.
What a waste of NHS resources.
Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London W8 5HY or email [email protected] — include your contact details. Dr Scurr cannot enter into personal correspondence. Replies should be taken in a general context and always consult your own GP with any health worries.
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