Is sharp needle-type itch in my upper arm arthritis? Dr Zoe Williams answers your health questions

VEGANUARY is in full force – with people encouraged to go meat-free in January.

So when it comes to health, does being vegan have any benefits?

It’s not a straightforward answer.

Eating plant-based has been linked with weight loss, a reduction in diabetes and heart-disease risk and lower blood pressure and cholesterol.

It depends on what vegan foods replace meat, eggs and dairy products a person has removed, and whether these are healthier or not.

It’s important to replace certain nutrients – such as vitamin B12, iron, iodine, and selenium – which people would otherwise get from eating animal products – to prevent deficiencies.

What is clear is that reducing the amount of meat, especially red and processed meat, can be beneficial for many people.

For example, try beans on toast instead of a bacon sandwich.

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

Q: I’M diabetic and have developed a tight foreskin.

Is there any cure other than circumcision?

A: Phimosis is when the foreskin of the penis is tight and cannot be retracted.

It is common and not usually of concern in babies.

If this is a new symptom in adulthood, then it is referred to as acquired phimosis, and it is more common in men who have diabetes.

In fact, diabetes can be associated with acquired phimosis in almost a third of cases.

Sometimes, phimosis is the clue that leads to a diagnosis of diabetes in the first place.

A 2006 study, which investigated 100 men who presented to a hospital urology department with phimosis, found that 12 per cent could be diagnosed with a disorder of blood glucose management.

The tightness of the foreskin is caused by scarring and may cause no symptoms, but can be troublesome when the penis becomes erect or during sex.

If you are not experiencing any major problems then it is possible to try conservative treatment, such as steroid cream, which can soften the skin and allow it to eventually be retracted.

However, it is quite common for any problems to return when you stop using the cream.

Do not stretch the skin though, as this has not been shown to help and can make the scarring worse.

Using a condom can make sexual intercourse more comfortable, and always be assessed if signs of infection develop.

For persistent issues, circumcision is often advised to resolve the issue permanently.

Q: I’M a 70-year-old man and about six months ago I started to experience an intense needle-type itch to my upper forearms.

My GP thinks I may have arthritis in my neck which is causing some sort of nerve damage.

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I was prescribed 100mg of gabapentin three times a day and although it seems to have eased, it has not gone away.

Is there any alternative treatment I could explore as this is affecting my sleep and is very depressing?

A: It sounds like your GP was describing cervical radiculopathy, a neck condition that puts direct pressure on a nerve or causes irritation.

The nerves of the upper limb leave the spinal cord in the neck and travel to the shoulder then down the arm, sometimes to the fingers.

The symptoms can be felt at any point along the route.

Symptoms can include pain, pins and needles, numbness, itch and sometimes muscle weakness.

It commonly affects one side but, rarely, nerves can be irritated on both sides of the spine at the same time.

In older people, it is most commonly caused by “wear and tear” of the spine (osteoarthritis) whereas in younger people it is more likely caused by an injury which causes the disc between the spinal bones to bulge, and irritate a nerve.

Most people who have this condition see improvement of symptoms over time with physiotherapy and medications such as gabapentin.

If you haven’t seen a physiotherapist, then I would recommend this as a next step.

Sometimes these symptoms are caused by a nerve being compressed at a different location, so not the neck, but from tight muscles in the shoulder, for example.

A physiotherapist could assess you and advise you on this.

In some areas you can self-refer to a physio, otherwise ask your GP.

If problems persist after three to six months of treatment, you may require an MRI.

Q: I HAVE pain under my rib cage on my right side and sometimes just underneath at the front.

It has been like this since I had Covid at the end of September.

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The pain feels like I have pulled a muscle.

I try to get on with my day but I can feel it if I do too much lifting or bending and when I reach out.

A doctor examined me two months ago and said, “Wait for your period”.

I know it’s not my period, I have had them since I was 12 and am 50 years old.

Any idea what it could be?

A: As doctors, we often consider what organs and tissues are in the area where a patient has pain.

The area of the upper abdomen, below the ribcage, is described as the “right upper quadrant”.

The organs within the right upper quadrant are your liver, gallbladder, part of the pancreas, part of your intestines and large bowel, the right kidney (at the back), the base of the right lung, as well as lower ribs, muscles, skin and nerves.

There is an important clue in your description, in that the pain is directly linked to movement and especially stretching or lifting.

This makes a musculoskeletal cause much more likely.

However, it is still important to think about the other possible causes and rule them out.

Let’s take gallstones as an example; pain related to gallstones has a particular pattern in that it tends to flare after a fatty meal and is “colicky” in nature, meaning the intensity of pain comes and goes in waves.

Shingles is another potential cause but you would expect there to be a history of a rash.

A rib injury usually has a history of trauma and tends to be extremely tender when pressed.

You see, what I’m getting at is that a full medical history is always the most important part of any medical assessment, so seeing your GP if it’s not resolving on its own would be the next step for detailed history, examination and consideration of investigations.

For example, a suspected problem with your liver or pancreas could be ruled out with a blood test, whereas possible gallstones could be looked for with an ultrasound scan.