I’ve been in remission for blood cancer but still have aches all over my body – please help?

MENINGITIS is inflammation of the membranes surrounding the brain and spinal cord and can be devastating. Many of us became more familiar with it in March, when an outbreak in Kent took the lives of two young people. Dr Zoe Williams helps Sun readers with their health concerns A reader who is now in remission for Burkitt lymphoma blood cancer is suffering from terrible aches and pains all over Credit: Getty Now, as students – perhaps your children or grandchildren – go to university, school, sixth form or college, it’s important they know the signs. Meningitis can develop rapidly, sometimes starting with flu-like symptoms before escalating into severe headache, neck stiffness, light sensitivity, vomiting, drowsiness or confusion. Sepsis can also develop. Sign up for the Health newsletter Thank you! Teenagers and young adults are at increased risk, partly because close contact with others makes it easier for the bacteria to spread. NHS England is reminding students born on or after July 21, 2001, to claim their free NHS meningitis B (MenB) vaccine. Remind young people in your family of the symptoms and to seek urgent medical help if meningitis is suspected. Here’s a selection of what readers have asked me about this week . . . CAN’T SHAKE MY ACHES Q) I’M 59 and, after five months in hospital with Burkitt lymphoma blood cancer in 2023, I’m now in remission. But my bones, from my jaw to the back of my skull, and all my joints, are really stiff. Most read in Health My doctor prescribed gabapentin but I haven’t taken any yet. Is this the right medication? A) Five months in hospital and intensive cancer treatment is an enormous ordeal, and it is very common for people to expect they will feel “back to normal” much sooner than their body is able. Stiffness and reduced flexibility after cancer treatment can have several causes. Long periods in hospital can lead to muscle loss, deconditioning and joint stiffness. Chemotherapy, steroids, reduced activity, weight change and inflammation, vitamin deficiencies and menopause-related changes can all affect muscles, joints and bones. Some lymphoma treatments can also have longer-term effects. For example, vincristine can cause peripheral neuropathy – which may feel like burning, tingling, shooting pain, numbness or altered sensation. Gabapentin is usually prescribed for this type of nerve pain, not for ordinary joint stiffness. Steroids, which are often used during lymphoma treatment, can contribute to muscle weakness and, rarely, bone problems such as avascular necrosis, where blood supply to part of a bone is reduced. This usually affects joints such as the hip, knee or shoulder. But new severe or persistent bone pain after cancer treatment should be assessed.Jaw pain or stiffness may be dental, jaw-joint or neck-related. Osteonecrosis of the jaw – a serious condition where part of the jawbone loses blood supply and dies, leading to exposed bone in the mouth – is not usually caused by standard chemo alone, but may be more associated with medicines such as bisphosphonates or denosumab, radiotherapy to the jaw, dental extractions or infection. If you have exposed bone, loose teeth, swelling, non-healing mouth ulcers, numbness or pain if chewing, you should have a dental or maxillofacial review. Ask your doctor what they think gabapentin is treating, and contact your haematology team about the possible late effects of treatment. You may benefit from cancer rehabilitation physiotherapy and blood tests.You survived something huge. You deserve support with recovery. Dr Zoe also helps a reader who has suspected seronegative psoriatic arthritis Credit: Getty Q) I AM 66 years old and have suspected seronegative psoriatic arthritis. I was diagnosed with inflammatory arthritis in May 2022. I stopped taking methotrexate due to bad stomach issues. My rheumatologist is away so I recently saw two different consultants who gave different advice. One proposed leflunomide or sulfasalazine after an ultrasound suggested extensor tendon inflammation. Another is suggesting methotrexate injection to bypass the stomach. My latest bloods (ESR and CRP2) show low inflammation and I have pain on and off in my feet, hands, wrists and elbows. I am so confused as to what treatment I need. As a regular reader, I would value your advice greatly. A) Psoriatic arthritis can often be difficult to assess because the symptoms do not always match blood results. Your inflammation markers are reassuringly low, but some people can still have tendon or joint inflammation despite normal blood tests. The ultrasound result is important. Extensor tendon inflammation suggests inflammation around the tendons on the back of the hands or wrists, which can fit with psoriatic arthritis. It often affects tendons and the points where tendons attach to bone, as well as joints. The medications being discussed are all disease-modifying anti-rheumatic drugs, or DMARDs. Their aim is not just pain relief, but reducing inflammation and preventing damage over time. Leflunomide and sulfasalazine are commonly used alternatives when methotrexate is not tolerated. Injectable methotrexate is also a sensible option to discuss, because it can reduce side-effects for some people by bypassing the gut. The two opinions are not necessarily contradictory – one consultant is suggesting moving to a different DMARD; the other is suggesting trying methotrexate by a different route. I would contact the rheumatology department, explain the situation and ask for a clear explanation of the pros and cons of each option in your case: likely benefits, side-effects and how long to try it before judging response. A specialist rheumatology nurse may be able to help you make a shared plan. Shingles has left me in terrible pain Dr Zoe helps a reader who had a bad case of shingles a few years ago Credit: Getty Q) A FEW years ago, I had a bad case of shingles on the right side of my chest, underarm and to the back. Ever since, I’ve suffered excruciating pain. Even the touch of clothes is unbearable. I’m a 74-year-old male. Paracetamol doesn’t help and my doctor said there’s not really much else that can be done as it has damaged my nerve endings. Is this something I just have to put up with? I don’t want to go anywhere, which is frustrating my wife. A) I’m sorry to hear you have been living with this. Pain after shingles is very real and can become socially limiting, so I understand why it is having such a big impact on both you and your wife. What you describe sounds very typical of post-herpetic neuralgia. This is long-lasting nerve pain after shingles. Shingles affects a nerve and the strip of skin supplied by that nerve, which is why the original rash can appear as a band around one side of the chest, underarm or back. After it clears, the nerve can remain irritated or damaged. The pain may feel burning, stabbing, electric, raw or exquisitely sensitive to touch. Even light clothing can feel painful, as you know. This is called allodynia.Paracetamol often does very little for nerve pain so please don’t assume because that hasn’t worked, nothing will. There are medications specifically aimed at nerve pain, such as amitriptyline, gabapentin or pregabalin. These are not ordinary painkillers and need to be started carefully, especially at 74, because they can cause drowsiness, dizziness or unsteadiness. There are also topical options, such as lidocaine patches or capsaicin treatments, which may help some people with localised nerve pain. So no, I wouldn’t say this is something you simply have to put up with.It may not disappear completely, but it can likely be improved. TIP OF THE WEEK GOT high blood pressure? Eating pulses (beans, peas, chickpeas and lentils) can help. They may contribute to modest reductions in blood pressure, as part of an overall healthy diet. They’re also a source of fibre and plant protein – and cheap and easy to add to meals.