Ask Dr Ellie! This week: Gallstones, a vasectomy and hayfever

Q  I get quite a lot of tummy pain after eating and my GP has suggested I may have gallstones. I am 55. Is there anything I can do about it or is an operation to remove them always necessary?

Gallstones are really common and are little stones within the gallbladder, which is a sack next to the liver.  The gallbladder is a storage sack for something called bile, which is a substance involved in the digestion of fat that we eat.

Stones develop in the gallbladder in many people, but the majority do not know they have them because they don’t cause any pain.

It is important in cases of any tummy pain that a scan is done to confirm the diagnosis; in the case of gallstones, this would simply be a painless ultrasound scan.

Gallstones cause pain in the top right corner of the tummy when you eat fatty foods; this corresponds to the area where the gallbladder sits.

They are more common in ladies who are overweight or diabetic, and are always more troublesome after eating fatty food. If they are causing only occasional pain, adopt a low fat diet and lose any excess weight.

If this is not enough to ease your symptoms, you may need to discuss the operation to remove your gallbladder. This is done as keyhole surgery so is a relatively minor operation.

Pain after eating has other causes, such as ulcers or acid reflux, so it is important this is checked out properly
for you.

Q   My husband and I have three kids and, at 38, I’m sure our family is complete. We have discussed him having a vasectomy, but he is worried in case he changes his mind. What are our options?

If your husband is not 100 percent sure, then vasectomy is not for him.
It is a permanent form of contraception, so if there is even the tiniest chance he would change his mind, you shouldn’t consider it.

There is a reversal procedure available for vasectomy, but it is only reported to be successful in 50 percent of cases. Also, it is not usually available on the NHS.

That means the contraceptive choices are going to fall onto your shoulders: sterilisation is also available for women, of course, but, again, you have the issue of it being permanent.

Therefore you are most likely going to look at options we term as long-acting, reversible contraceptives. These are options where you don’t need to remember a pill every day for example, but you can change your mind, should you wish, and have them removed.

Many women I see in your situation opt for a coil or intra-uterine system, sometimes known by the brand name Mirena.

Both of these options are tiny devices that sit in the womb and act as a contraception for at least five years. The advantage of the coil is that it is hormone free, which many women want. The Mirena has small amounts of hormone, but is sometimes preferred as it makes periods very light.

Q  What is the best thing to take for hayfever? I’m determined not to suffer so badly this year!

You probably need to look at trialling different treatments to get the best results. A once a day, non-drowsy tablet available over the counter is a good start and there are many different ones available – cetirizine or loratadine.

Chlorphenamine (Piriton) is very effective, but it is a sedative, so not ideal for during the day.  If you are not finding these tablets useful, ask your GP about prescription antihistamines or an antihistamine nasal spray containing azelastine, which may help.

If a blocked nose is one of your predominant symptoms, you will probably not find antihistamines helpful; steroid sprays such as Beconase or Flixonase are better for blocked noses.

If you know the time of year you usually become affected, you can start with your steroid nasal spray a few weeks before to reduce the severity. Grass pollen causes hayfever from May to August, but tree pollen causes the problem from January to now.

Remember to look at the pollen count each day; normally hay fever symptoms start at a pollen count of 50 or more, so if that is predicted, you need to have your treatment with you.

Finally, don’t forget non-medical treatments. Salt water is useful to clean out the pollen, with specifically designed salt water aerosol cans to wash out the nasal passages on a daily basis. You can also use barrier creams, such as HayMax, to prevent the pollen getting in.