ASK DR ELLIE: Covid left me feeling dizzy all the time… how do I end this nightmare?

After getting Covid a few years ago I now have terrible dizzy spells. It’s so bad that sometimes my legs give way. Do you have any advice?

Dr Ellie replies: Covid can, just like many other viruses, lead to a number of long-term health problems.

This is often called post-Covid syndrome, or long Covid. It’s very similar to post-viral fatigue, a collection of chronic symptoms, including fatigue, triggered by a viral infection such as a cold or flu.

Dizziness is a symptom of long Covid. One theory is that this occurs because the virus affects the inner ear, which plays a pivotal role in our sense of balance.

Unfortunately, for some, these symptoms can continue even after the virus has long gone.

Dizziness can also be a symptom of a cardiovascular problem caused by Covid called postural tachycardia syndrome, or PoTS, where the heart rate increases very quickly after getting up from sitting or lying down.

Some patients benefit from visiting specialist long Covid clinics, where tests can work out whether long Covid is the trigger.

They can also offer a range of treatments, including compression socks which can improve blood flow to and from the heart.

Increased water consumption – usually around two to three litres a day – as well as boosting salt intake also appears to help some.

There are also long Covid physiotherapists who can provide exercises designed to improve the balance of dizzy patients.

Specialists may also prescribe short courses of medicines such as ivabradine or fludrocortisone.

Any patient who believes they may have long Covid or PoTS should tell their GP, who can assess their symptoms and then, if necessary, refer them on to the nearest long Covid clinic.

My husband, who is 86, has inoperable cancer and seriously low iron levels. He’s extremely fatigued and struggles to eat.

He was given an iron infusion last month but has seen no improvement. What can we do?

Dr Ellie replies: Iron is needed to help red blood cells carry oxygen from the lungs to the rest of the body. Without enough of it, patients develop the condition anaemia, which leaves them very tired and unwell.

Often this can be treated with iron supplements but, in severe cases, an infusion given directly into the veins is warranted.

However, even with this it can take up to two months to see iron levels go up. Patients often need more than one infusion – particularly if they are unwell with a disease such as cancer.

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But for a patient with incurable cancer, iron levels are unlikely to be the only cause of fatigue.

Cancer patients often struggle to eat enough food, due to pain and discomfort, and this means they can be severely short of vital nutrients – not just iron.

When someone is off food, it is sometimes worth taking calorie-supplement drinks – shakes packed with nutrients and energy that are easier to digest.

It’s also not unusual for cancer patients to be fatigued due to the strong painkillers they are taking. In this situation there is a careful balancing act required to ensure they are not overwhelmed with pain but equally are not too dosed up to think or speak.

Caring for someone with terminal cancer is very hard, not just because of the emotional trauma but the struggle to arrange good care.

If somebody is being looked after at home, the GP should be co-ordinating the care alongside cancer doctors and, ideally, a palliative team. These are specialists in end-of-life care who manage the fatigue, pain and sickness caused by cancer and its treatments.

It is always worth making sure a referral to a palliative care team has been made, so that carers can be supported in these difficult times.

I have a constant ache in my right shoulder. My doctor has said this is likely just old age – I’m 87. Is there anything I can do to ease the pain?

Dr Ellie replies: It would be reasonable to assume that shoulder pain in later life is due to osteoarthritis. The condition is triggered by long-term wear-and-tear in the joints, meaning that older patients – usually those over 70 – are most at risk.

Anyone with suspected osteoarthritis should seek a diagnosis from their GP, because there are a number of treatment options we can offer.

The first step is usually painkillers to manage the aching. Physiotherapy to improve mobility and reduce pain in the affected area can also make a big difference.

Patients might be offered steroid injections, which can provide pain relief that lasts for several months, but they are not effective for everyone. Shoulder pain can also be caused by problems with the muscles that stabilise the shoulder, known as the rotator cuff. Problems in this area can be treated with physiotherapy, but surgery may be required if the damage is found to be particularly severe.

I have a question for my female readers: are you comfortable seeing a doctor about problems with your vagina or vulva?

Many people find these issues acutely embarrassing, and I understand why – another issue is that doctors can, I’m sad to say, be brusque, dismissive or fail to investigate women’s health problems adequately, which discourages patients from seeking help.

From lumps and bumps, to rashes and infections, lots of things can go wrong with female genitals. And it is so important that any new symptoms are properly checked out.

I can guarantee the longer something is left, the more complicated it can be to treat. Although its rare, you can even get cancer of the vagina or vulva – 1,350 cases of vulval cancer are diagnosed in the UK each year.

Have you put off going to your doctor with an intimate problem? Write and let me know.

Are you a fan of oat milk? I am not at all. There is a reason we give babies and children cows milk: it is full of good calories, carbohydrates and proteins not to mention vitamins and minerals.

The alternatives have never been as nutritious. It might be controversial but I also think many people avoid milk who don’t really need to. Of course I look after people with genuine cow’s milk protein allergy and lactose intolerance but most people can drink regular milk with no issue.

It has really become a commercial fad, and it isn’t a healthy option. Some oat milks contain a fair amount of sunflower oil, and many don’t even have added vitamins to make them vaguely nutritious. I would not recommend my patients drink it.

• Do you have a question for Dr Ellie Cannon? Email [email protected]

• Dr Cannon cannot enter into personal correspondence and her replies should be taken in a general context.