Q: For the past ten years or so, I’ve suffered frequent bruising to my arms — often from the slightest knock. I’m 74; is this something that can be cured, or will I simply have to live with it? 

Stephen Young, by email.

Dr Martin Scurr replies: A bruise occurs when blood leaks from tiny blood vessels called capillaries, and collects under the skin.

When there has been no ­obvious injury or when the extent of bruising is out of ­proportion to the trauma, we use the term ‘easy bruising’.

Age is a major factor because, as we get older, the layer of fat beneath the skin that acts as a cushion against knocks and blows starts to thin, leaving the blood vessels less protected and more easily injured.

Age is a major factor in 'easy bruising' because, as we get older, the layer of fat beneath the skin that acts as a cushion against knocks and blows starts to thin

This kind of ‘easy bruising’ shows up more on the arms and legs simply because they are the most exposed parts and most likely to be knocked, even below your level of awareness.

The head, face and trunk aren’t so exposed to knocks from day to day — so any spontaneous bruising in these areas would be more of a concern.

Some medications, including aspirin, ibuprofen and anti­coagulants such as warfarin can interfere with blood-clotting mechanisms and make bruises after minor impact more likely.

Other medication like corticosteroids (such as ­prednisolone) cause thinning and increased fragility of the skin which can increase the risk of widespread bruising, again most commonly affecting the limbs.

Some natural remedies, for example ginkgo biloba and ­ginseng, are thought to be linked to easy bruising, and while there’s not a huge amount of research of this, it may be a potential risk factor for you to consider.

Your best strategy is probably protection — this means ­wearing long sleeves as you go about your daily activities.

Q: I woke up one morning about six months ago with a pain in my hip which has never gone away. An X-ray showed this to be bursitis. I do the exercises I was given — but the pain is getting worse.

On a visit to my GP I was told a steroid jab may help, but no one at the practice could give me this. The pain wakes me up at night.

Heddy Bell, Fife.

Dr Martin Scurr replies: I am sorry to hear about your pain, and my feeling is that you should seek a ­referral for the steroid injection your practice mentioned.

Hip bursitis is where the fluid-filled sac (‘bursa’) that cushions the hip joint becomes inflamed and swollen, causing pain — this affects the prominent point you can feel if you slide your hand down the outside of your upper leg from the pelvis.

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Lying on the affected side can be painful, as can weight-­bearing activities, and sitting for long periods with legs crossed.

Hip bursitis can be caused by overuse (for instance, when overweight individuals take up exercise) and trauma (I’ve often seen this condition in patients following a fall). But sometimes there is no obvious trigger.

When it first occurs, using an ice pack for 20 minutes, two or three times daily, along with a painkiller such as ibuprofen can provide relief (though this ­medication should not be taken long-term — a maximum of one to two weeks).

It’s also important to avoid activities that worsen the pain such as sleeping on that side.

The good news is that the problem can usually be ‘cured’ with a steroid injection, a potent anti-inflammatory delivered right at the spot — but only a radiologist can perform this, using ultrasound to locate the bursa accurately.

As the pain is interrupting your sleep, I suggest the time has now come for a referral.

• Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email [email protected] 
•  Dr Scurr cannot enter into personal correspondence. Replies should be taken in a ­general context. Consult your own GP with any health worries.

 

 In my view... we need to watch our medical watchdogs

In the wake of the Cass Review on gender identity services for children, the question that concerns me is why didn’t the regulators identify the ­problems that resulted in this review at an earlier stage?

After all, regulation in ­healthcare did a virtual hyper leap following the murderous activities of Harold Shipman.

With the Care Quality ­Commission finally emerging after a protracted birth, I fear the regulator was too busy with its major evolutionary changes and learning on the job, just as the referrals to gender ­identity services rose.

Dr Hilary Cass at the publication of her Independent Review of Gender Identity Services for Children and Young People (the Cass Review) last month

Their eye was not on the ball. In my experience they seemed overly concerned about what type of soap was in the wash basin in the consulting room and where the files on staff holiday applications were stored. Inspections were ­irrelevant in terms of the ­protection and well-being of patients.

And let’s not forget that the General Medical Council, another regulatory body, failed to realise the ­implications of Dr Harold ­Shipman’s narcotics addiction (he was arrested in the late 1970s when mainlining ­pethidine, a morphine type drug). Despite the ­involvement of the police, a court case, a ­sentence and some minimal rehabilitation, he was never followed further by the regulator.

If he had been, around 200 murders could have been prevented.

Who checks on the regulators?