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Ask the doctor: Why do my wife's hands bruise so easily?

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Recently my wife has started to develop bruises on her arms and the back of her hands, but on no other part of her body. She is 73, and although she is a vegetarian her diet is good. The bruises appear and disappear in different spots with no apparent cause. Why does this happen?

Patrick Berrill, by email.

The forearms and hands are most likely to be damaged during everyday activities, causing blood vessels to weaken

Please do not be concerned, for although these bruises can look alarming, they do not indicate any illness. You were kind enough to send me photographs of the bruises, and examining these suggests senile purpura, also known as actinic purpura.

These are common in elderly individuals and are the result of a lifetime of wear and tear on blood vessels in the skin. These become weakened and are prone to rupture, causing blood to leak out into the surrounding area, triggering a painless bruise.

Years of sun damage can also weaken the blood vessels, which is why they commonly appear on the forearms and hands.

These are also the areas of the body that are most likely to be knocked or damaged during everyday activities — even the slightest of trauma can lead to the vessels leaking.

It is usually easy to distinguish purpura — which your wife appears to have — from another condition we call ‘easy bruising’.

The bruises in purpura are a bright purple colour and  painless. This is because the bruise forms in the very top levels of skin, away from the nerve endings. The leaking blood is very close to the skin, which is why the colour is so vivid.

‘Easy bruising’, however, is a condition seen in younger patients, and is, as the name suggests, when bruises form easily on the skin. These bruises are often much darker, and because they can form at deeper layers in the skin, are more painful.

CONTACT DR SCURR

To contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk — including contact details.Dr Scurr cannot enter into personal correspondence.His replies cannot apply to individual cases and should be taken in a general context.

There are a number of possible causes. One possibility is a vitamin deficiency, such as a severe lack of vitamin C (scurvy), which can weaken blood vessels, leading to rupture and bruising. Vitamin K (usually obtained from green leafy vegetables and cereals) is crucial for blood clotting, and so a significant deficiency of this could also lead to bruising.

In some cases, too much of a certain nutrient (usually as a result of taking too many supplements) can also cause bruising because of the effect on blood vessels — this includes vitamin E, ginger and gingko.

Another possible cause is a disorder that prevents the blood from clotting properly, such as haemophilia and the liver disease cirrhosis.Generally, it is a good idea to book an appointment with a GP if you notice that you are bruising more easily.

However, I am pleased to say that the condition affecting your wife is not sinister and does not need further investigation. While she might think it unsightly, it is not a sign of ill health.

In January last year, I had a large kidney stone blasted by laser, but then six months later another stone was found. Until last year I never suffered any problems. How can I stop getting them?

Eva Gahan, by email.

The formation of stones in the kidneys is a common problem. Around one in ten men and one in 20 women have had at least one by the age of 70.

They are formed when two waste substances, calcium oxalate and calcium phosphate, start to crystallise in the kidneys, and eventually harden to form stones.

Those that are smaller than 4mm in diameter will usually be passed spontaneously, but  10 per cent or more have to be removed, either because they are causing so much pain or because the stone is blocking the ureter, which is the pipe connecting the kidney to the bladder.

Removal usually involves breaking up the stone with laser, ultrasound or high-energy sound waves, and then either taking out the fragments under a general anaesthetic, or allowing them to pass out naturally.

We are still unsure why some people develop them while others don’t, but they are linked to chronic urinary tract infections, some cancers, gout and chronic dehydration.

In terms of prevention, there are various factors that interact to cause the formation of stones, and hence stopping them involves a number of steps.

Broadly, these are all aimed at reducing calcium and oxalate in the urine, or increasing the levels of citrate, which prevents stones forming.

The most important factor in prevention is to drink a lot of water. This increases the flow of fluid through the kidneys, as well as reducing the concentration of any stone-forming substances.

Water is ideal, though any fluid will help — with the one exception of grapefruit juice, which has been shown to increase the risk of stones, though we are unclear why this is the case.

Overall, the advice is to drink sufficient amounts so that you produce at least two litres of urine per day — so you should be visiting the loo around four to five times a day.

From the point of view of foods, the key points are as follows.  First, limit your intake of animal protein, which is a risk factor as it contains sulphur and generates more acid, which both seem to increase stone formation. (This risk factor applies particularly to men, less so to women.)

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Next, increase vegetable and fruit intake, as these are rich in potassium, which reduces stone formation, and reduce salt intake, as this increases the risk of stones.

We also know that limiting sucrose (table sugar) and fructose (also known as fruit sugar) reduces the risks. But do not avoid fruit — instead, just try to limit juice.

Paradoxically, restricting calcium is not recommended as evidence suggests it makes  no difference.

However, in patients with stones who need calcium supplements — such as for the treatment of osteoporosis — it can help to also take thiazide diuretic (a prescription drug), which helps the body to retain calcium, so that less of it is excreted and it doesn’t travel through the kidneys.

Kidney stones can prove to be quite a nightmare. Prevention needs a long-term determined approach — but getting that habit of two to three litres of water per day is the key.

By the way . . . 

This care watchdog just looks after itself

So what are we to make of the latest news about the incompetent Care Quality Commission (CQC)? Just in case you needed reminding, this is the health watchdog that is meant to ensure that healthcare providers are up to scratch.

Recently, Kay Sheldon, a non-executive director of the organisation, blew the whistle on it. The CQC’s duty is to check that hospitals are safe and compliant, but Ms Sheldon said it had actually suppressed findings of serious problems in hospitals such as Furness General (part of Morecambe Bay NHS Trust).

The trust was given a clean bill of health by the CQC, but distressing reports of infant deaths at the hospital have now led to a public inquiry. This news came in the very same week that we learned that GPs are spending millions attempting to prepare for compulsory CQC registration and inspection. 

There has been continuing concerns regarding the quality of patient care (picture posed by models)

This money is being spent at a time of serious cutbacks in a rapidly changing Health Service; a time when patient care and clinical services are subject to enormous financial pressure; and a time when doctors themselves are already subject to the process of revalidation and relicensing by the General Medical Council.

The independent non-NHS sector has been subject to inspection by the Care Quality Commission for some years: it’s where these jokers cut their teeth. The officials have been learning the job on the job — how else do the new recruits learn their craft?

However, they have mostly spent their time endlessly reorganising. The CQC was originally hatched in 2000 as the National Care Standards Commission, re-formed as the Commission for Health Audit and Inspection, then converted into the Healthcare Commission, and is now parading around under its current name.

Is it not time to abandon this farcical, time-consuming and expensive failure? The Home Secretary has seen the light with the UK Border Agency and closed it. The same should happen here.

This organisation merely distracts from the real task — taking care of sick patients.

These organisations seem to function solely for the employment benefit and pension arrangements of a bunch of civil servants. It’s time to use the ‘new broom’ they’ve been waffling about, and sweep them all away.


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