I’ve recently been getting pins and needles in my left hand. Often my fingers are so numb I can press them together and not feel anything. I also get elbow pain at the same time. What might this be? I am 66.
Michael O’Donnell, by email
The fact that the tingling and numbness in your fingers coincides with elbow pain suggests the cause is a problem with the ulnar nerve.
This nerve, which travels in a groove close to the elbow, helps you to move your forearm, hand and certain fingers (the little and ring finger primarily, but also the middle). It also sends information about touch, temperature and pain to your brain.
When people ‘bang their funny bone’, which can be both excruciating and strangely numb, they’ve actually knocked the ulnar nerve in its channel at that site.
A typical cause of tingling and numbness in your little and ring fingers is prolonged elbow flexion. Sometimes I see this in patients who sleep on one side with the elbow flexed. However, this is usually quickly relieved within minutes by straightening the arm.
Tingling and numbness in your fingers can be as a result of knocking the sensitive ulnar nerve out of its groove along the arm
Another — though much less likely — cause is arthritis of the elbow, which is rare and, in any event, doesn’t normally impinge on the ulnar nerve.
I wonder if you’ve had a previous injury to your elbow, and if gradual scar tissue could be causing irritation in this area of the ulnar groove. I’d suggest asking your GP for a thorough examination of this area.
I recently had a blood test at my GP surgery, and was told my kidney function is 27 — which, after looking at Dr Google, seems very severe. How can I manage this issue? And is it a precursor to dialysis or a kidney transplant? I’m 67, eat a balanced diet, walk two to four miles every day and do not over-indulge on food or drink.
Barry Cooper, Woking
Our kidney function is typically assessed by measuring our estimated glomerular filtration rate, or eGFR.
It’s literally a measure of how well your kidneys are filtering out waste products and extra fluid from your body, which is reflected in blood tests. The normal eGFR in a healthy young adult is 80 to 120. And while our GFR declines with age, a reading of 27 suggests the problem here is chronic kidney disease (CKD).
This is an increasingly common condition, affecting more than seven million people in the UK, but can often go undiagnosed for too long as patients tend not to experience symptoms initially.
As the disease progresses, it can lead to shortness of breath and fluid retention (causing swollen ankles, feet or hands and high blood pressure) as well as fatigue. Common causes include long-standing diabetes or a history of high blood pressure (both can damage the small blood vessels in the kidneys) — as are risk factors for cardiovascular disease, such as high cholesterol and smoking (again, because of damage these can cause to the blood vessels).
Other potential triggers include heart failure, obesity and recurrent urinary infections.
Chronic kidney disease is a common condition that affects more than seven million Britons, but can often go undiagnosed as patients tend not to experience symptoms initially
In my view, you must be referred to a nephrologist, undergo a kidney ultrasound scan, and it is possible that you will be investigated further, potentially undergoing a kidney biopsy.
While the discovery of your low eGFR is concerning, whether you will need kidney dialysis depends on several factors, and it may be that there are other treatment options that halt any decline in function.
Please do write again once you have undergone investigation, and do press your GP for a prompt referral.
In my view… Serious risks from online prescriptions
As a doctor, I’m not allowed to prescribe medication for my own family. I say ‘not allowed’ but actually it’s not illegal — it’s just severely frowned upon, and could end with some kind of rap across the knuckles from the regulatory body, the General Medical Council.
The reason for all this is that, however well motivated, my judgment might not be impartial where my nearest and dearest are concerned, and this might inadvertently threaten their health. Plus, I might not be privy to things in their private health history that are relevant to their condition. So why are doctors allowed to prescribe to patients they’ve never seen on the basis of an online or phone consultation? Details of past medical history are all too easily omitted, either because the patient doesn’t recognise their relevance or to hide something.
We know, for instance, that young women with lethal eating disorders are obtaining supplies of the revolutionary weight-loss drug semaglutide in this way.
I once came across a young student who was addicted to the sleeping tablet zopiclone, which he’d been obtaining for years by a variety of online consultations. My worry is the regulatory bodies are letting this slip through the net – until something awful wakes them up about it.