My husband is suffering from terribly bad breath and he worries people think he is unhygienic

HAPPY Christmas! I hope you all enjoy some well-earned time off for the festivities.

While we all look forward to the indulgence to come, as a GP, I often see the fallout in the final week of December.

It’s peak indigestion and bloating season, but a lesser-known condition can also spike at this time of year.

Dubbed “holiday heart” syndrome, an irregular heartbeat can be triggered by eating and drinking too much.

Those aged over 65 and men are at greater risk, as are people with high blood pressure, diabetes, obesity, sleep apnoea and other heart conditions.

But, in rare cases, it can strike otherwise healthy people, too.

I myself have experienced an episode of a heart arrhythmia AFib.

So my advice to you over Christmas is have fun, but take a break now and again.

Be mindful about whether the extra chocolate, mince pie or cocktail is necessary.

Here’s a selection of what readers have asked me this week.

HUBBY’S BREATH STINKS

Q) MY poor husband is suffering from terribly bad breath and he worries people will think that he isn’t clean.

He brushes his teeth twice a day, goes to the dentist every six months and uses mouthwash and mouth sprays.

He is 78, has had prostate cancer and is on tablets for his type 2 diabetes, as well as cholesterol and hypertension.

Could it be a side-effect of his medication?

A) I’m really sorry this is causing him (and you) distress.

Persistent bad breath despite excellent hygiene is frustrating, but it is rarely a sign of poor cleanliness.

The most common non-dental cause of halitosis is dry mouth (xerostomia).

Saliva naturally cleanses the mouth. When it is reduced, bacteria flourish and cause odours.

Salivary glands often become less efficient with age, and several of your husband’s medications – including those for blood pressure (diuretics or ACE inhibitors), statins, and prostate treatments – can cause dryness of the mouth.

Some alcohol-based mouthwashes can even worsen the condition. And, if blood sugar levels fluctuate, bacteria can grow more easily in the mouth.

It is also possible the odour originates elsewhere – chronic sinus inflammation, post-nasal drip or acid reflux are common culprits.

Occasionally, small pouches in the throat can trap food particles and liquids which then ferment.

Other symptoms of this include regurgitating food, difficulty swallowing and coughing.

There are several steps you can take to try to improve the situation, including using a tongue scraper.

This can be more effective than a toothbrush alone to pick up any bacteria sitting at the back of the tongue.

Increase saliva naturally by taking frequent small sips of water and using sugar-free chewing gum or lozenges (xylitol-based) and avoid drinking caffeine and alcohol – including mouthwash – as much as possible.

Ask his GP if any prescriptions could be to blame, and adjusted.

You could also suggest a trial of acid-reducing medication to rule out reflux.

Aim for optimal diabetes control, and the next time your husband sees the dentist, tell them he is worried about halitosis.

---

Q) AS soon as I lie in my bed at night, my legs are on fire and I sleep poorly.

I am quite a fit 84-year-old lady. I take pregabalin 50mg twice a day.

Also, I have lichen sclerosus.

The doctor just prescribed duloxetine 30mg. Reading about them, I have not taken them yet.

I have had tests on the nerves on my legs, and the veins are not blocked.

A) A burning sensation that occurs specifically when lying down strongly suggests small fibre neuropathy.

This affects tiny nerve endings that don’t always show up on standard nerve-conduction tests.

It causes burning, heat, stinging, or electricity-type pain, is common in older adults and typically flares up at night.

Both pregabalin and duloxetine are standard treatments for nerve pain.

Pregabalin 50mg twice daily is quite a low dose. Many people need 75 to 150mg at night for burning pain and it works best when the larger dose is taken in the evening.

Duloxetine 30mg (a starting dose) is very effective for burning nerve pain and it has the added benefit of aiding better sleep.

While it is also classified as an antidepressant, it is used here specifically for its ability to interrupt pain signals.

You shouldn’t let this put you off. If it concerns you, discuss it with your GP. Taking them both together is safe as they work via different mechanisms.

It is possible to experience side effects at first. These can include mild nausea, slight dizziness and a dry mouth – but they mostly settle within seven to ten days.

Discuss increasing your pregabalin dose before starting the duloxetine, if you are hesitant.

Other non-drug approaches that can help neuropathic burning include keeping the legs cool (but not cold), e.g. with a fan, avoiding hot showers and some light stretching.

Once in bed, keep your legs uncovered, try a pillow under the calves and use cotton sheets.

The supplement magnesium glycinate at night may help – ask your GP first – and your vitamin B12 level should be checked, if not already.

How can I stop ringing in my ears?

Q) I HAVE tinnitus and it seems to have got louder recently.

I realised this on holiday when I climbed to the top of a hill where there was complete silence, except for the screaming in my ears.

What causes it? I read somewhere that blueberries can be a problem for ­people with tinnitus, and I do eat them.

I also got vertigo in 2012, which I still take betahistine for. A consultant said I’d had an inner ear infection.

My vertigo seems to be worse when my neck is more painful, due to osteoarthritis and osteophytes.

I am 74 and have just got used to putting up with it all, but I wonder if these issues are connected?

A) Tinnitus is a symptom, not a disease, that mostly comes from changes in the hearing and balance system. It is usually linked to age-related hearing loss.

When the delicate hair cells in the inner ear wear out, the brain “turns up the volume” to compensate, which we perceive as ringing or hissing. This is why your tinnitus sounded louder in the silence of the hills.

The inner ear infection you experienced in 2012 could have caused permanent inflammation, worsening the sound.

Another common cause is inner ear damage that can be caused by past noise exposure, even from decades earlier.

While neck arthritis and muscle tension can alter the pitch or volume of tinnitus, they are rarely the primary cause. And there is no medical evidence that blueberries cause tinnitus, so do keep enjoying them.

Unfortunately, there is no cure for tinnitus unless an underlying cause is found, but there are ways to help it.

A hearing test is extremely important, as hearing aids often reduce tinnitus by restoring external sound input.

Use sound therapy, such as a radio or sound machine at night and have a read about tinnitus retraining therapy, which helps the brain stop reacting to the noise.

Also, try not to worry about it and sleep well, as tinnitus feeds on stress and fatigue.

SIGNS YOUR LOVED ONE HAS A DRINK PROBLEM

IT can prove the best cover up, Christmas is a time when alcoholics can hide in plain sight.

It’s easy to write their behaviour off over the festive period – after all, isn’t it normal to have one too many drinks?

But Elizabeth Walker, a recovery coach, says the difference is knowing when to stop.

She says: “If you notice someone is unable to stop drinking once they have started, and just one drink can start the compulsion to drink, this is a real red flag that their relationship with alcohol is unhealthy.” Other key signs your loved one is a problem drinker are:

1. THE PRIORITY: Work, family, friends and even personal hygiene can end up coming second to drink if a person has a problem. “It seems that alcohol has become more important in their lives than anything else, even you,” says Elizabeth.
2. ‘NEED’ NOT WANT: “You notice they need to drink every day and maybe even need a ‘hair of the dog’ in the morning to settle the stomach, nerves or to stop the shaky hands,” says Elizabeth. “Not every ‘alcoholic’ is a daily drinker though.”
3. LIMITLESS: It’s never just a wine with dinner, or after-work beer. “They seem to ‘have’ to continue drinking, even when they said that they will only be having the one,” says Elizabeth.
4. ALL IN: “Their drinking patterns have changed, perhaps gradually increasing over the years,” says Elizabeth. “They will promise or declare they are going to do Dry January, Stoptober or stop completely, only to give up prematurely and/or return to their old habits and patterns.”
5. JEKYLL & HYDE: “It may feel a bit like you are living with a Jekyll and Hyde character,” says Elizabeth. “Things to look out for are irritability during the hours when they aren’t drinking, to instantly relaxed when they have a drink.”
6. DANGER ZONE: “They regularly drink to the point where they pass out or become physically sick,” says Elizabeth.
7. SECRET SQUIRREL: “For example, finding reasons to go out to the shop for groceries when it’s not needed, being out longer than they have said when nipping out on an errand,” says Elizabeth.
8. CREATIVE FLAIR: “There is nothing more creative and manipulative than someone who has become dependent upon alcohol when it comes to finding a way or reason to drink,” says Elizabeth. “Christmas may not be the best time to talk to your loved one about their drinking,” says Elizabeth, who recommends trying in the new year. Approach a conversation with empathy, not judgement. If they are prepared to admit they have a problem, you can help guide them to their GP, or suggest researching together on websites like Alcohol Change UK.

• Always take medical advice if stopping cold turkey, as it can be dangerous.