Friday Q&A: Ask A GP with Dr Raj

0:00Hi, this is Monica Reinagle of Nutrition Diva. Today's show is sponsored by Nature Raised Farms. Grocery shopping can be a little overwhelming, especially if you're reading labels. And in my opinion, chicken shouldn't be complicated, which is why I appreciate Nature Raised Farms. It's chicken that's just chicken, and their lightly breaded chicken nuggets are free from gluten, dairy, and soy. Look for Nature Raised Farms on your next grocery trip and feel more confident about your choices. Cha-ching! That's the sound of Lowe's Labor Day Savings. Get up to 45 % off select major appliances and save up to an additional$100 on select laundry pairs.

0:43Plus, get three bags of Miracle-Gro 0.75 cubic foot garden soil for just$10. Labor Day deals are on now at Lowe's. In-store and online. Valid through 9-9. While supplies last. Selection varies by location. See Lowe's.com for more details. Soil Offer excludes Alaska and Hawaii. Hello and welcome to Made by Mamas, the podcast. I'm Zoe Hardman. And I'm Georgia Dayton. And this is your parenting safe space where no conversation is off limits. With five kids between G and I, we have seen a lot. We really have. Each week, we'll be joined by some famous faces and experts, and we'll chat about the brands and products that have saved us along the way.

1:23In short, we're the parenting podcast for you. Before we get started, hit subscribe or follow so you're the first to know when each episode lands. And they're on Tuesdays and Fridays. And it really helps if you leave a rating and a review. You can also find us on Instagram. We're on at Made by Mummers. But for now, George, should we get into it? Hello and welcome to Friday's episode of the podcast. It's just me today. Zoe is, she's been off a lot actually as I'm saying this. My God. She's actually having a very active holiday in Greece. She's doing all sorts of things like cycling and running.

1:56I know. And we've got a guest today who has been on the podcast before and a very popular topic. Whenever we do these Ask a GP Anythings, we get inundated with questions. So welcome, Dr. Rajaroura. How are you? I'm good. Thank you. Thank you for having me again. It's been wonderful to connect. I think you're right. Whenever we get the ask of GP, it's always a great, you know, inundated with questions. But I think particularly now, like over the summer, I feel like even in clinic, we're seeing so many patients coming in with so many questions. People, you know, parents have a full time and it's just one of those busy times.

2:35I'm really happy to be here. Yeah. What sort of things, actually? What like what are people coming in with? Because I always think of like the winter months, people coming in with like coughs and colds and flus and all that kind of stuff. What would you see in the summer? Lots of skin stuff, you know. You see people coming with rushes, like heat rushes. They've been on holiday, they've come back, they might have discolouration on the skin with the children as well. Adults, we're seeing all of that. If the parents are off with the kids, because obviously it's summer holidays, most parents take a week off where they can.

3:05They'll just bunch up their appointments. You're actually seeing patients in one fall because they've got time off to have their GP appointments as well. So, yeah, it's a mixture of things. It's been really nice and busy, actually. oh um well as i mentioned before we've had loads of questions so i'm gonna kick us off we've got a mixture actually of um questions you know for adults and then questions to do with the kids so let's start with this one why are gps so reluctant to to give or try hrt before 45 this would be a good question um i think they're reluctant and i say this as in we're saying on the whole okay so obviously there's a lot of awareness around menopause has been fantastic it's been in the public eye a lot more we know a lot more about hrt from doctors healthcare freshmen are sharing information online um unfortunately though that doesn't always translate into doctors having their training updated or having information given to them.

4:08Imagine there's so many GPs out there, so many, you know, and normal GPs who are not women's health specialists and then you've got women's health specialist GPs as well. And they've all got to kind of get up to date with guidelines. They've all got to learn anything that's new in the training programs. And I think it's really hard when you don't have those resources that you can just roll out an entire cohort of GPs so that they can all understand not what the new guidelines are but what are we you know what are patients wanting to know and how do we um not minimize risk like slain risk in a way that's really easy for patients to understand the thing is i think there's a real big awareness of actually perimenopausal symptoms and menopause that comes before the age of 45 so look i'm salvation typically i will go through perimenopausal symptoms at least five years before my Caucasian counterpart and if we don't have that understanding as gps and we don't know that's happening we're not aware of our cultural changes and fmrg background changes or whatever it might be we're not able to opish that conversation we're not going to be able to understand um or offer treatment in the form of hrt so i think that's one side of it that we're maybe not quite capturing and able to um keep our gp up to speed because they're busy they've got crazy for next they're running around we don't always have time for that and second is the narrative in the conversation around it changed so much in the media that our patients are really well informed so they're coming in a lot earlier with their symptoms and saying you know i need hrt can't have a discussion and maybe that's not within traditionally the way that gps have seen patients patients normally do attend a bit later on you know the the gp might be one that tells them about hrt for the first time and now that's the top of your head and got patients coming in asking for it a lot sooner so i don't know the exact answers to why GPs are reluctant because actually if you fit the criteria if there are no contra indications and if the risk versus benefit has been discussed clearly with a patient then I don't see any reason why a patient can't have HRT it's I think the question mark is whether doctors are feeling comfortable with that whether patients are eligible if there are contra indications on this case by case so that's what I would say although having said that I am seeing patients a lot younger and I'm treating them a lot younger a lot of them are having HRT um so that that's fine I think yeah um well so what's the average age like across the board for someone to be getting perimenopause or symptoms so we've always typically said like from 45 on haven't we but like you said I am seeing patients a lot younger than that so you know I've got patients are coming in a 40 you know a 41 42 with clear perimenopause symptoms like you know sweater say mood swings brain fog um physical symptoms as well so i think it's it's that it has been more change and that's maybe because now there's more awareness but i do also think that that sort of median age is around 45 i would say okay which is why you know we're kind of seeing as below 45 as young though though it's not it is just when that physiology starts to change yeah and so if you're having symptoms and you you know real symptoms then you should just push you know go to the GP tell them everything and push for it absolutely and it might not be that HRT is for you because you know it's case by case you have to rug door the medicals risk but the conversations really important so coming and understanding so when somebody comes into my clinic I will go through their options I will normally give them some homeworks and some paper if they don't know all the risks and all the benefits and all the things I'll give them something to read and do a follow-up with them so they'll either come back up a phone call conversation with me and we'll run through everything again so i give them something to read and to understand and to absorb but most times when somebody comes in they have already explored it they have got information on it and it's a case of running through that their past that is going through their contraindications or not whether it worked for them and sometimes it's trial and erroring when i start somebody on it they might do really well on it they might really be happy with it some people might find it makes a difference to them and actually want to try something else so it is very much um you want to give options but if you're having symptoms that are perimenopausal menopausal go and see or GP don't suffer in silence.

8:09Okay great and someone here has put I've got an increase in migraines in my mid-30s is this hormonal and what can I do about it? It can be hormonal I'm always really mindful and to not always just put everything down to hormones as well because migraines can be caused by other things and it's really important to treat any headache from the beginning so i think the other the other risks we have with menopause because it's got so much awareness and because in the media and because there are so many symptoms of menopause everything kind but kind of goes down to well it must be hormonal and it's become a bit of a trend almost and i worry about that because obviously many other conditions that can be happening in the background so i always say if you've got a headache it's new and it's might it feels like a migraine you know presenting as a migraine go and see your doctor go through everything with the doctor what could it be how is it presenting how long have you had it what the typical or as on you know you might you may or may not have an aura but what's around what the symptoms around that and then take it from there going back to the hormonal part of it yes hormones can trigger migraines so if there's somebody who already has migraines you might find that as your hormones change that you're getting more frequent migraines and that might require optimizing your medication to kind of tweak that you might find that you never had a migraine before that you've around that time and moment of changing, you trigger and start having migraines.

9:32If you're on a pill, if you're on HRC, it's important that you see your doctor and talk about, you know, this is happening because you may have street medication to make sure that you're safe. Migraines is such a funny one, aren't they? I don't suffer from migraines, but my husband does. And he will get like three really bad ones in a year where he has to come home and like lay down. there is no way and but we have we did he did find something that he can take that does take the edge off it I can't remember it must be from the doctor but um yeah I just I didn't realize how bad they were I mean they just can be they can be so debilitating can't they I think that's why I always like when we talk about headaches I'm always be mindful to to not try and minimize that because a migraine is not like a tension headache or like a mild headache no you know normally with a migraine you can have visual disturbances you can have you know lots of sensory disturbances you can have um olfactory so you can have like lots of smell you can have vomiting you can have so many other things that come with it you know aura you might have it and muscular aches after before this vestibular for example it might have dizziness so there's so many different layers to it and you're right you might not get them frequently but the one or two or three you might get in a year can be have a huge impact so yeah if you're getting that kind of a headache please don't just sit on it or think it's your hormones do go and get that checked.

10:51We'll be right back after this short break.

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12:30Welcome back to this episode of Made by Mamas. Now, where were we? Should kids 4 +, be taking vitamins? If so, which ones? Malty, vitamin D? What should we be looking for? So kids 4 +, if my children, well, one of my children, child, for this range i think it's important to make sure they have a holistic balanced diet they're getting enough calcium for their bone growth they're getting enough of a mixed diet if they do have a lack of something because they're not eating it then you might want to give them a supplement you could always talk to a gp about that so my children won't have a multigate um they have like a bit in the um supplement but that's because you know we know that this many levels can be low in the uk where there's no sun all year round so that's basically the only supplement i give them um but you know they don't need much else to be given to them they're lots of different multivitamins if you're worried about low iron levels they've been diagnosed with that doctor will tell you what to give them and how to give it to them but most things from four plus should come from their diets unless they're a fussy eater where they're really not taking the right amounts of milk or you know dairy products then yes you could you could think about that but generally i think there's a lot of culture around buying multivits and it's become again quite trendy um yeah but the most important ones of it's g i you want to make sure they're getting their vitamin d uh iron if it's low um and sometimes you might want to do vitamin c so i've got friends and patients who do swear by you know their immune drops or their vitamins um but again it's not the data's not strong it's not proven that's going to give them a stronger immune system um we know that the best way is to be healthy and to be having a getting nutrients from their diet yeah definitely um it's hard isn't it because sometimes i guess with kids mine definitely they'll have weeks where i think oh my gosh they're eating so well and this is all good and then we have weeks where that isn't the case and i guess having a multivitamin does kind of just give you that little peace of mind that okay right on the weeks where they're not so good it kind of covers you.

14:37Yeah, I must say like sometimes it's a bit for reassuring for the parent. Yeah, exactly. You feel like, well, look on their multivitamin. And look, I don't think giving them a little gummy multivitamin or like a pepper pig multivit is going to cause any harm to them. And, you know, I was ill, a lemon would give me one. And, you know, I think most children will have something of the kind. So I think the point is you're not doing anything harmful, but how much benefit are you really getting from it? Are they absorbing much from it? You know, really want to make sure you're getting those nutrients in the diet.

15:04trying to give them an all-rounded diet if it's not happening like my daughter's quite a fussy eater then yeah you know you can supplement that with whatever it might be that they need but i would always say speed if it's something in particular going to give them speed to a gp and see if it's worth it there's all sorts of magnesium and omega drops and everything out there if you look for it now online you'll find a reason to give something but i think just making sure it's safe is really important okay um oh this is interesting my child gets loads of nosebleeds is it normal or worth investigating really depends on what kind of nosebleeds so um oftentimes when it's hot so in the hotter you know the hot weather the summer nosebleeds come more frequent because your capillary smaller vessels in the nose dilate so just imagine that when you're sweaty those vessels are dilating sometimes they can believe you can get nosebleeds if you're someone who's prone to it you can get more recurrent than that nosebleeds during the hotter months I didn't know that or if they're running around whatever the children are doing but I think on the whole that's like a smaller nose bead or just a little bit when you're wiping tissue fine but if you're getting the current nose beads where they're heavy you want to go and see your jiggy you might need an ENT referral just make sure there's nothing else going on in the nose just to make sure and sometimes what I've seen is you know not to worry anybody and we're not scared normally but you've had patients you know bounce along with smaller nose beads and then they've had a really big one and we don't talk about this enough but having a wee and head and firm nose bead can be dangerous in some cases.

16:32It's important, especially the flow's not stopping. So if you're somebody who's seen this pattern, you're wondering, oh, it's happened a few times and worrying about it. Go and see your GP, go and get them looked at. It's always a safer option, I think. Because smaller nose beads in the summer, we're wiping a nose, we've been bludding the nose, that can always cause a little bit of injury that can lead to bleeding. Right. Light bleeding. that is yeah that's interesting i never knew that um someone has put i've got various veins on the back of my knee they were worse after two pregnancies and can be painful hot and itchy and it means i don't want to wear shorts or want them on show can it be removed on the nhs okay so the guidelines around this have been quite that they change and they are actually dependent on your particular um sort of where your primary care practice is and whether they what they feed into the prime the pcns networks that decide um whether that you know whether you locally qualify for that if you refer to a vascular surgeon or vascular doctor if that's we looked at generally the answer is no you have to have this quite strict guidance about the symptoms you this lady in particular sounds like she got bite-free symptoms itchy visible causing pain so all of those things would qualify for her to be reviewed i think can be seen but she would have to ask her gp in that area of that something she'd qualify for otherwise obviously she can't go privately and see somebody um and treatments there's a there's a variety of treatments they can laser they can use remove the veins through surgeries or certain things you can do um inject to get rid of the veins as well so there's different treatments around this and if it's if it's causing debilitation in your daily life it's kind of stop you can do things so it's painful you're not wearing shorts these are all more reason to speak to gp because they come put together a case of the autopsy referring you but it is very much uh no gp surgery by gp surgery depending on whether you're gonna get a referral in the NHS or not fine okay but there are lots of options yes um someone here has put when should you worry about heart palpitations my son often complains about a sharp pain in his chest maybe once or twice a week um what should I okay so firstly i would obviously explore it see when is it happening is it happening normally in children um i hate to open down to anxiety but when it comes to the heart and cardiovascular it normally is um that's quite rare in children to be honest so it's important to try and find out what's going on around this time when it comes on is it muscular is it is he's 40 is he anxious about something i'd ask all those questions i wouldn't try and self-diagnose i won't just sit on it i would definitely go and see your gp because at minimum they can do like you know an ecg have a little look of a feel of his chest and listen to his chest to make sure there's nothing pathological going on or worrying going on and and you know i've worked the pediatric job quite a few times as a trainer with a gp and obviously you do see patients coming and children coming and you've had these kind of symptoms and you might do a little work cut for them so you might burn you know do more of a 24-hour take or just make sure the rhythm's okay make sure their heart's okay they might get a scan but these are all down the line the first thing would be to go and see your gp not don't panic because like i said it's quite rare for a child to have you know a cardiovascular yeah issue really um but but i would get looked at just to make sure it's once or twice a week to make sure there's nothing else going on in the background and they might need to work up for that okay there's actually so many questions about periods um wow okay i'll just ask a few and then we can round up into an answer so someone's put is it normal for periods to completely change in your 30s and 40s?

20:12What period symptoms should we absolutely not just put up with? How much pain during your period is considered normal? I mean, there's loads like that. Basically, what's normal? What should you put up with? When should you go and see someone? So definitely period symptoms can change and your period can change per se and your cycle can change, obviously, as you get older. So when you're getting into your late 30s and your 40s, like I said, you might be entering perimenocles your estrogen level might be dropping you might be seeing those changes happening to your cycle cycle length might reduce it might get extended you might have a heavier period your periods might stuff all together they might look more regular so all these things can happen that's very normal moving on to pain during a period i always say this so from the moment your period starts to when it ends you can have discomfort during a period i.e oh that's not nice you know a little bit uncomfortable you can get on with things that's normal if you've got a pain that's stopping you from doing things so it's it's not allowing you to go to work it's not allowing you to go to school you are not able to get out of bed you're passing out with you're vomiting with it you're doubled over with it you know you're really finding it difficult to get on with your daily activities that's not normal that's not normal and that's really important because the longest time women have been told oh just get on with this fine it's just a period it's fine and it's not and now we've got this sort of time coming which i love where we're talking a lot more about women's health and we're actually breaking down what is acceptable and what's not when it comes to painful periods and actually pain itself i think is very very subjective we all take pain at different thresholds but i always say that if you are struggling with it and you're finding it hard to get on with things and be the best version of yourself during your period then you need to go and get some help that's not normal and also because you might have an underlying condition you might have you know like a fibroid you might have especially because they're heavy as well you might have NDB churches so you want to get in there early and get those things checked out and not sit on it yeah I do think people are talking more about periods yeah I definitely just even anecdotally like among friends and stuff like that I think we talk about it a lot more um and it's wild like how many of us sort of have just been putting up with stuff for so long and just thinking oh it's just the way it is I was saying to my sister we put up with it ourselves but then now we're seeing like say our daughters or nieces going through it and then we're like absolutely not but so weird we put up with it ourselves and now they're almost like having to see the next generations they'll be like this is not fair we don't want to see you go through this but we need to apply that same thing to ourselves and then we're going through changes and pain and putting up with things and just telling ourselves I don't be a wimp and then the bottom line is periods are physiological thing that happens to women you know allows us to have cycles have babies all these wonderful things um but I think it's important that it's not a hindrance it's not stopping us from doing what we need to do you know so i think then i always see that as sort of like the if that's happening just stopping you from even like i don't know i'm endometriosis and i was at school i would have really painful periods i would struggle with going to school and struggle through lessons i'd be like in awful pain like cramps if that is happening it's not normal please don't check down yeah no definitely I think that's what we've got time for um but you'll have to come back on come into the studio you'll have to get me back on I love these episodes come into the studio we can do more I always think in the winter there'll be you know loads more different questions will have come up as well so thank you so much you're so welcome and anyone who wants to find you where can they on instagram so you can find me on my instagram which is at dr underscore rajavora you can find And then my TikTok with lots of health content as well.

23:49And again, it's Aunt Dr. Rajavora. And you'll probably hear me on LBC on TV. I'm always doing health bites and information on health topics. I would love to come back in the winter and do some more of winter health topics. But thank you so much for having me. It's been great. Amazing. Thank you so much. And as always, we'd love you to rate, review and subscribe to the podcast. And if you've got any feedback on this episode or guests you'd like to hear from, please drop us a DM on Instagram. We're on app made by mummers. And we'll be back on Tuesday.

24:44We'll be right back. Great deals are on now at Lowe's. In-store and online. Vela through 9-7. While supplies last. Selection varies by location. Holland Paver's offer excludes Alaska and Hawaii. Hi, this is Monica Reinagle of Nutrition Diva. Today's show is sponsored by Nature Raised Farms. Grocery shopping can be a little overwhelming, especially if you're reading labels. And in my opinion, chicken shouldn't be complicated. Which is why I appreciate Nature Raised Farms. It's chicken that's just chicken. and their lightly breaded chicken nuggets are free from gluten, dairy and soy. Look for Nature Raised Farms on your next grocery trip and feel more confident about your choices.

25:26Help I Sex and My Boss is the podcast where manners meets mayhem. I'm William Hanson. I'm Jordan North. And together we take on the hilarious challenges of modern life. William's the arbiter of etiquette. And Jordan's the chaotic yin to my perfectly polished yang. So if you want laugh out loud stories and brutally honest moments, then you'll love Help I Sexted My Boss. Watch and listen every Tuesday and Friday. On YouTube and wherever you get your podcasts. Just search Sexted. Be warned, it's a bit rude.