I am a 72-year-old man in good health and I exercise regularly. I recently started wearing a watch that tracks my heart rate, and noticed the figure is regularly falling below 40 beats per minute for up to ten minutes.
This seems to happen at night and in the early hours of the morning.
I have a history of low blood pressure and am not overweight. Should I be concerned?
DR ELLIE CANNON: Low blood pressure is only generally a concern in someone with naturally high blood pressure, who is taking tablets to lower it. (file photo)
Some people have naturally lower blood pressure than others and it is not usually a concern.
Low blood pressure is only generally a concern in someone with naturally high blood pressure, who is taking tablets to lower it.
These patients can find they suffer fainting, dizziness and falls if the blood pressure drops too low.
Heart rate should not be confused with blood pressure.
Heart rate or pulse is the rate at which the heart beats every minute. A normal rate would be 60 to 100 beats per minute (bpm) when you are resting.
It goes up when we exercise and falls when we sleep.
If it is lower than this, it is known medically as bradycardia.
It is not an uncommon finding in very athletic people.
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Often, these patients have a resting heart rate of about 50, and doctors wouldn’t be concerned about this.
There are many heart-rhythm problems that can cause episodes of an abnormally low heart rate.
Doctors might choose to check for this using a heart test called an ECG using a small device that’s worn for two to three days.
Many GPs like me are cautious about using fitness tech such as tracking watches to diagnose medical problems.
They are not likely to be accurate enough to spot dangerously low heart rates or rhythm problems.
Even so, it’s worth checking out all potential problems with a GP – even if they’re informed by results of a health tracker.
They might choose to follow up with investigations using a medical heart-rate monitor, to verify if there are any serious problems.
Roughly eight months ago I had a third-degree utero-vaginal prolapse, which was treated with a vaginal hysterectomy, pelvic-floor repair and vault fixation.
The operation was successful but I have had heavy discharge, which is sometimes bloody, ever since. Is this normal? I use oestrogen pessaries twice weekly.
A general rule of thumb is that any ongoing bleeding is not normal and should be checked out by a doctor.
A third-degree prolapse is a very significant problem and surgery to repair it – which includes removing the womb – is a large operation.
It is important doctors discuss possible risks before patients go in for surgery. This includes infection, bleeding and persistent pain.
But eight months after the op, we would expect any side effects to have settled if a patient is otherwise fit and well.
A doctor should examine a patient who has discharge and bleeding, and also take swabs.
It is possible that this symptom is the result of an ongoing vaginal infection or scar tissue.
Sexual activity or regular use of pessaries could be irritating the vaginal wall. It is worth stopping them for two to four weeks to see if this is the case.
While unlikely, bleeding can also be a sign of cancer. Gynaecological cancers can develop – even after a hysterectomy.
This is why an appointment with a GP or gynaecologist is crucial.
I suffer dreadful anxiety, feeling sick and sweating all the time, and drugs don’t seem to work. Most recently, the GP put me on citalopram but it made my panic attacks worse, and then diazepam.
I even went private and the doctor said I shouldn’t be taking citalopram, but amitriptyline or mirtazapine, even though I tried them in the past and they weren’t helpful.
Could it be that I’m not actually suffering anxiety – but something else?
Anxiety is an increasingly common mental health problem.
Extreme anxiety is known medically as generalised anxiety disorder and it is important to get a proper diagnosis from a psychologist or GP.
A medical professional should ask a range of questions to identify symptoms that indicate that this is the problem,
Medications will only help if patients are suffering genuine anxiety, and making lots of changes to the medication can be unhelpful, bringing with it withdrawal-related side effects – which add to the anxiety.
Anybody who has taken drugs for mental health problems will tell you it can take time to get used to them, and for them to become effective. This can take two to three months.
Tablets and therapy are as effective as each other.
More from Dr Ellie Cannon for The Mail on Sunday…
Cognitive behavioural therapy is the specific psychological tool that is thought to be useful for anxiety. This should be offered alongside or as an alternative to medication.
If symptoms persist despite treatment, it is important to check if the diagnosis of anxiety is correct, as sweating, feeling as though your heart is racing and a sense of panic can be related to other health problems.
This includes a heart condition, the menopause or a malfunctioning thyroid.
It would be sensible to undergo blood tests or a further examination with the GP to rule out these problems.
The cancer ops with no cancer
Last weekend I answered a question from a reader about a hysterectomy she was told she needed to remove cancer, but who was shocked to be told after the operation she didn’t have cancer – but cysts and fibroids.
And it seems to have struck a chord with a few readers.
Some have written to me and told of being forced into early menopause because of the operation, only to be told there was never any cancer to begin with.
As I explained in my column, it is a tricky balance and all the risks of benefits of the procedure should be explained to patients fully before the procedure.
But, from what some of you are saying, it seems as though this isn’t happening in some cases.
How many more women have been affected? If you’re one of them, write and tell me.
You don’t need a test if you just have a sniffle
Are you anxious about not being able to get a Covid test? Don’t be. Testing isn’t ‘stopping’.
If you’ve got major Covid symptoms – the cough, fever and anosmia (loss of smell) – you can still get a PCR test via the normal routes.
Hospitals will still be testing patients too, and certain employers might make their own rules.
DR ELLIE CANNON: For the overwhelming majority of us who have immunity, Omicron is mild, causing perhaps a few cold-like symptoms. (file photo)
But the ‘test twice a week even with no Covid symptoms’ rule for the rest of us is over.
It’s a good move, in my opinion, because mass Covid screening just isn’t good value any more.
For the overwhelming majority of us who have immunity, Omicron is mild, causing perhaps a few cold-like symptoms.
If you feel like this, then stay at home for a few days until you feel better.
You don’t need a phenomenally expensive testing programme to tell you that. It’s just common sense.