text: Q: I have been suffering from mouth ulcers for the past five months and feel I'm living on Bonjela and mouthwash. I get them all around my mouth and on my tongue. I've been referred to hospital but the appointment isn't for three months. Although I'm otherwise in good health, I'm quite worried. A: Mouth ulcers may seem like a minor ailment but can actually be incredibly distressing. The pain can severely impact on quality of life, as eating and drinking are significantly affected. As many as 20 per cent of people suffer with the occasional single mouth ulcer and these are of no consequence. They are usually shallow and occur on the tongue or inside the lip or cheek. These small painful ulcers usually last no more than ten days and require no treatment. Mouth ulcers may seem like a minor ailment but can actually be incredibly distressing. The pain can severely impact on quality of life, as eating and drinking are significantly affected . We have a rule in medicine that any single mouth ulcer lasting longer than three weeks should be investigated in order to rule out a cancer of the mouth, but this would usually be an isolated ulcer that does not heal, rather than multiple lesions. Multiple ongoing mouth ulcers are quite a different issue and certainly warrant further investigation. Initially it is worth taking blood tests to establish deficiencies of iron, B12 or folic acid that could be a root cause of significant tongue and mouth problems. It is equally important to consider multiple chronic mouth ulcers as a symptom of bowel disease, as both coeliac disease and Crohn's disease can first present as mouth ulcers. Coeliac can be identified on specific blood tests and Crohn's on a thorough history, examination and specialist opinion. A sudden-onset chronic issue in a previously healthy person does need proper assessment, and referral to a specialist certainly seems appropriate. While waiting to see a specialist, always make another GP appointment if something has changed or you feel that perhaps an important symptom has been missed. Q: Three years ago I had an operation to remove my prostate because of cancer. This seems to have been a success so far because my prostate-specific antigen (PSA) levels are zero. However, I now have a urine infection which has resisted five courses of antibiotics. At a recent hospital visit a registrar suggested that I drink at least three litres of water daily. I am not sure I'll manage this. What can I do? Surgery to remove the prostate for cancer can lead to urinary problems in about one in five cases, as well as erectile dysfunction for almost two-thirds of men. The former may manifest as incontinence or leakage of urine rather than recurrent infections. These are more likely when the bladder cannot empty properly, as urine is able to stagnate and bacteria can multiply. This typically occurs in men with an enlarged prostate, which puts pressure on the bladder, but would not seem likely if a prostate has been removed. A urologist's opinion would be warranted to assess whether a complication such as scar tissue could be preventing the bladder from emptying properly. After cancer, it is easy to assume all subsequent conditions are related. In fact, recurrent urine infections may be secondary to another urinary-system problem such as kidney stones or bladder disease, which need to be ruled out. It is unlikely that three litres of water a day will help. Brave Claudia deserves her Bafta nod . I was thrilled to see Claudia Winkleman nominated for a Bafta – she has breathed new life into Strictly. And what a lovely boost for her given the horrendous six months she's had after her eight-year-old daughter Matilda was hospitalised with burns following a freak Halloween accident. Whoever wins the British Academy gong, Claudia Winkleman's an absolute champ in my book . The scars from such injuries are physically and psychologically traumatic, and Claudia has remained fiercely private about her daughter's recovery. Good for her. Yet she has thrown her considerable celebrity status behind a St John Ambulance scheme for free lifesaving lessons for 50,000 children, echoing The Mail on Sunday's campaign to add first aid to the school curriculum. Whoever wins the British Academy gong, Claudia's an absolute champ in my book. Pop star Avril Lavigne set tongues wagging when she disappeared from the public eye for months. It has now been revealed that the 30-year-old singer had Lyme disease, a bacterial infection passed to humans from a tiny tick bite. Avril, who likened her illness to 'having the life sucked out of you', is thankfully on the road to recovery. The 'Complicated' singer had Lyme disease, a bacterial infection passed to humans from a tiny tick bite . Up to 3,000 cases of Lyme disease are reported in England and Wales every year. It sounds harmless enough but, if left untreated, it can cause joint pain and inflammation, facial nerve palsies and even inflammation of the heart. It is treatable with antibiotics, but diagnosis can be difficult as many don't realise they have been bitten. There is a story doing the rounds on science blogs at the moment warning those who buy breast milk via the internet that it's highly likely to be contaminated with either harmful bugs or cow's milk. Or both. I am not sure what is stranger: that people choose to buy breast milk or that the sellers are artificially topping it up. If women who can't produce enough of their own opt to source donor milk, it is only safe to do it from bona fide regulated milk banks or within hospitals that are verified safe sources. The worry for vulnerable babies is that donor milk obtained via sharing websites is infected or non-hygienic. I would have thought a random website is the last place a concerned mother should be buying her baby milk. It's good news on meningitis, despite a scare for my son . One evening last week my eight-year-old son started complaining that he had a headache. He told me the lights seemed too bright, and when I checked him, he was running quite a temperature. He said his legs were cold, too. I instantly recognised these to be red-flag symptoms of meningitis and rushed with him to our local A&E, where it was confirmed he had the viral form of the disease, which is thankfully less severe – but no less serious – than the bacterial kind. Once the dust had settled (he's absolutely fine now) I couldn't help thinking it was quite a coincidence: I wrote on these very pages just a few weeks ago about the worrying rise of a rarer form of the disease, Meningitis W. And all of this happened in the week that Health Secretary Jeremy Hunt finally announced he will make the Meningitis B vaccine part of the routine UK vaccination schedule. Shame it wasn't sooner. But it's been good news all round, in the end. Do you have a question for Dr Ellie? Email DrEllie@mailonsunday.co.uk or write to Health, The Mail on Sunday, 2 Derry Street, London, W8 5TT. Dr Ellie can only answer in a general context and cannot respond to individual cases, or give personal replies. If you have a health concern, always consult your own GP.
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