My toenails have become hard and crusty. They don’t cause me any problems, but I don’t like how they look. What can I do?

It’s normal for the toenails to thicken with age, but sometimes the problem can be due to a medical issue.

Fungal nail infections affect all age groups. They can cause nails to break, thicken and change colour – usually yellow or brown.

A GP can take a sample of the nail and send it to a lab for testing. If a fungal infection is present, then the doctor would normally prescribe antifungal tablets, which need to be taken for a minimum of six months to clear the infection.

If only one or two toenails are affected, an antifungal colourless nail paint, called amorolfine, can be bought at most pharmacies.

If the nails are so thickened that they cannot be trimmed, this could be a condition called onychogryphosis. This is more common in people with diabetes or those who have suffered a severe foot injury.

The are no medicines which can combat onychogryphosis, but the NHS can surgically remove the nail. However, this means the nail will not grow back afterwards.

For any minor toenail issues it’s best to see a private podiatrist. This is because NHS podiatry is reserved for those with very severe issues or particularly vulnerable patients, such as the elderly or those with diabetes.

Dr Ellie Cannon says that nail problems can occur at any age, and your GP can take a sample of your nail and send it for lab testing

For any minor toenail issues it’s best to see a private podiatrist, as NHS podiatry is reserved for those with very severe issues or particularly vulnerable patients

Podiatrists use thinning tools and cutting equipment to improve nail appearance and reduce the thickness. They can even do minor surgery to remove problematic nails.

Most high street podiatrists charge about £40 to £75 for an initial appointment.

I’ve been taking sertraline for anxiety for six months. I started with a 50mg dose but now I’m on 100mg. The pills make me tired and queasy, and it’s usually worst in the morning. Can you help?

Anybody taking a medication that is making their life miserable should consider coming off it.

Sertraline is an antidepressant called a selective serotonin reuptake inhibitor (SSRI) that can be used to treat anxiety. One of the most common side effects is nausea, as the tablets can irritate the stomach.

If patients are dealing with debilitating SSRI side effects they should consider lowering their dose. Cutting a 100mg dose down to, say, 75mg, could alleviate some symptoms but still treat the anxiety.

Another option would be combining the SSRI with an anti-sickness tablet. This is something a GP should be able to prescribe if necessary.

Sertraline does not have be taken in the morning. Taking the tablets in the evening may make the side effects more tolerable as they might pass during sleep.

In rare cases, SSRIs can trigger a stomach inflammation issue called gastritis.

It’s important that anyone taking these drugs who develops stomach problems informs their GP as they may decide to do an endoscopy – where a thin camera is threaded down the throat into the stomach to look for signs of damage.

I suffer from hyperhidrosis and I sweat constantly. I tried medication but found the side effects intolerable. What would you suggest?

Hyperhidrosis is a condition where people sweat far more than normal.

Sometimes it affects only certain areas – such as the armpits – but for others it can impact the whole body.

Hyperhidrosis can be triggered by another medical problem, usually an overactive thyroid. In these cases, treating the underlying problem should reduce the sweating. Medicines such as antidepressants can also make it worse.

If there is no underlying cause, patients can take steps to mitigate the symptoms, such as wearing moisture-wicking clothing or sweat-absorbing pads – which can be stuck on extra-sweaty areas.

Stronger aluminium-based antiperspirant solutions are proven to reduce sweating and are best applied at night and washed off in the morning. These can be prescribed by a doctor, and are usually trialled for six weeks as they can irritate the skin.

There are also anti-sweating tablets that GPs can prescribe, the most commonly used being propantheline. For some, these can trigger side effects including dry mouth, dizziness and difficulty sleeping.

Stronger aluminium-based antiperspirant solutions are proven to reduce sweating

Specialists may offer Botox injections, which block the nerves that stimulate sweat glands. The effects are only temporary so injections are needed every few months.

Another procedure, called iontophoresis, involves passing a weak electric current through the skin of the affected area, blocking the nerve signals that trigger sweating.

GPs have to apply for special funding for hyperhidrosis treatment, as it’s not considered a medical priority. Many patients therefore go private in order to access speedy care.

Do you have dizzy spells like pop star Billie?

I’m concerned about the growing number of patients suffering with a debilitating dizziness condition that was once considered relatively rare.

Postural orthostatic tachycardia syndrome (POTS) occurs when the heart rate jumps significantly – usually after simply standing up – and side effects include heart palpitations, chest pain and shortness of breath.

Young women are most likely to develop POTS – 23-year-old pop star Billie Eilish, pictured above, last year revealed she has it – and cases have increased since the pandemic (researchers believe it can be triggered by an infection).

I now see patients with the tell-tale symptoms of POTS in my surgery most weeks, but diagnosis and treatment is lacking due to a shortage of specialist clinics.

Have you been diagnosed with POTS? If so, did you find a treatment that helped? Please write in and let me know.

Billie Eilish, 23, revealed last year that she has postural orthostatic tachycardia syndrome (POTS)

Bags, passports… prescriptions!

The same infuriating problem plagues GPs across the country every summer – patients who wait until the very last minute to request their vital prescriptions before jetting off on holiday.

It amazes me that so many people can meticulously plan these trips but forget to stock up on potentially life-saving medicine.

And then, when they finally remember, they expect their GP to put their prescription to the top of the pile – and blame them if it doesn’t arrive in time.

Recently a lady requested we refill her glaucoma eye drop prescription just a few hours before her flight. These are drops that are stopping her from going blind… Why on earth do people do this?

So, please, make your life – and your GP’s – easier and request your prescription at least a week in advance.