Why does my pee smell so foul? It's the worst smell ever!
On a weekend trip with friends, after a swim in the sea, I noticed my heart rate was really fast.
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It eased a little for a few hours before another attack in the evening, and I was taken to A&E.
For the first time in my life, I thought I could die.
My heart rate reached 300 beats per minute (compared to a normal of 60 to 100) due to something called atrial flutter, which can lead to a stroke or heart attack.
I was just unlucky because my heart is healthy.
But it gave me a new perspective on what matters and I'm even kinder to my body.
We think of heart issues as a male problem, but it's a leading killer of women.
It's important to be vigilant about your health.
Make sure you take the free NHS health check offered every five years from the age of 40, which can spot risky conditions.
Meanwhile, here's a selection of what readers asked me this week . . .
WHY DOES MY PEE STINK?
Life-saving NHS health checks to spot killer diseases will be carried out at work
Q: I'M a 73-year-old man and my urine must be the worst smell ever. It's so foul.
I have a dodgy kidney that works at only half the rate it's meant to and I've suffered with numerous urine infections.
They clear up with antibiotics but, after a few weeks, come back along with the foul smell.
I've also been clear of prostate cancer for five years.
A: It sounds like you've really been through a lot, health-wise.
I'm glad to hear that your prostate cancer is now in remission, but I do understand how frustrating and worrying these ongoing urinary issues must be.
A very foul-smelling urine can be an indicator of an underlying health issue.
It can be caused by infection, kidney problems or issues with waste product build-up in the body.
Your history of a dodgy kidney that functions at half its capacity is a key piece of information.
Some types of kidney problems can increase the risk of UTIs, especially those that interrupt the normal flow of urine from the kidney to the bladder, such as kidney stones which can lead to stagnant urine in the system, where bacteria is more able to grow.
Have you had a recent scan to assess your kidneys, and have you been assessed by either a urologist or nephrologist (kidney specialist)?
This is important, as it is crucial to find out if there are any potential blockages.
An enlarged prostate gland can also stagnate the flow of urine as it leaves the bladder, and some of the treatments for prostate cancer can also cause issues.
It's important to keep treating each infection, and to stay well hydrated and not delay passing urine when you get the urge (as much as possible).
But if these measures alone are not working, then there are also treatments to prevent further infections that you should explore with your specialist team.
Prophylactic antibiotics are a daily low dose of medication that can reduce UTIs.
Methenamine hippurate is an alternative to daily antibiotic prophylaxis for recurrent UTI in men, which has quite recently been added to the NICE guidelines.
I hope this helps to guide your conversations with your healthcare team – and please do let me know how you get on.
IS PREDIABETES CAUSE OF FOOT PAIN?
Q: CAN you tell me what is causing the pain in the soles of my feet after walking for about two hours?
Could it be because I was diagnosed with prediabetes?
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A: This could be caused by several factors and, while prediabetes can be related, it's not the most likely cause in this scenario – when pain comes on after a significant amount of walking.
Higher up the list would be footwear issues, plantar fasciitis or muscle fatigue.
Worn-out or unsupportive shoes can lead to poor shock absorption and pressure on foot muscles and ligaments, so opt for shoes or trainers that are well-cushioned and supportive.
Flat feet or high arches can exacerbate the issue.
So if you have either of these you may benefit from being assessed by a podiatrist, for orthopaedic insoles for long walks.
Plantar fasciitis typically causes sharp heel or arch pain that is made worse by prolonged standing or walking.
It's caused by overuse or strain of the plantar fascia (a ligament on the sole of the foot).
Walking for more than two hours, especially on hard surfaces, can cause muscular fatigue in the feet, particularly if you're not used to that level of activity.
So if the walking is a new activity for you, you may need to scale back initially.
But I hate advising people to do less activity, so try to increase the pace of the walking you do.
Essentially, a shorter but faster walk, and then build distance gradually as the muscles in your feet get stronger.
Do some stretching and strengthening exercises for your feet – there are good NHS videos on YouTube for this.
It is possible to get nerve damage with prediabetes – this is called 'impaired glucose tolerance neuropathy', which is damage that can begin even before full-blown diabetes.
But this would typically be described as tingling, burning, numbness or pins-and-needles.
Also, it is often worse at night-time, rather than after activity.
BOOK A MIDWIFE ONLINE
PREGNANT women can now see a midwife 'at the touch of a button', it was announced today.
They can book their first midwifery appointment via nhs.uk, bypassing the GP.
Traditionally, expectant mothers would see their GP to tell them they are pregnant before a referral to midwifery services.
But only 62 per cent of the first 'vital' appointments happen within the first ten weeks of pregnancy, health officials say.
NHS England said it is estimated the new service could lead to 180,000 fewer calls to GPs and up to 30,000 fewer GP appointments each year.
Officials stressed that women can still go in to see a doctor if they would like, for example, to discuss management of a long-term health condition.
Kate Brintworth, NHS chief midwife, said: 'Making this process simpler at the touch of a button is a vital step in empowering women to take control of their pregnancy journey right from the very start and improving access to timely, personalised care.'
Health and Social Care Secretary Wes Streeting said: 'Early pregnancy should be about joy and excitement – not wrestling with NHS bureaucracy to book a midwife appointment.
'That's why we've overhauled the online referral system.
"No more endless phone calls or form-filling.
"Just a simple online service that lets you book those crucial first appointments with a few clicks.'
SOUNDS LIKE CANCER…
THE early signs of cancer could be detected from your voice, scientists say.
Using AI, subtle changes in vocal acoustics helped pick up lesions in people diagnosed with voice box cancer.
Researchers believe AI could be trained to hear these changes within a 'couple of years'.
There are around 2,000 new cases of voice box (laryngeal) cancer in the UK each year.
A hoarse voice for more than three weeks can be a key symptom, and should be investigated by a GP.
Using AI for diagnosis could spell the end of uncomfortable tests, such as a biopsy or nasendoscopy, in which a thin tube with a camera is passed through the nose down the back of the throat.
The US team, part of the Bridge2AI-Voice project, gathered voice recordings of 300 patients, some of whom had voice box cancer.
They study, published in the journal Frontiers In Digital Health, found 'marked' differences between men with and without cancer or a voice box disorder, such as nodules or polyps, specifically with the harmonic-to-noise ratio.
It's possible the same will be found for women, with a larger data set.
Dr Philip Jenkins, of Oregon Health & Science University, co-authored the study.
He said: 'Voice-based health tools are already being piloted.
'I estimate that with larger data sets and clinical validation, similar tools to detect vocal fold lesions might enter pilot testing in the next couple of years.'
Q: HAD a total knee replacement nearly seven years ago and have been in constant pain since.
At my last consultant appointment, it was suggested that I have steroid injections in my knee.
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But as I had a complete knee replacement, what would they inject into?
I feel like I'm just being messed around.
A: I'm really sorry to hear you're still in pain.
It's understandable to feel frustrated and even suspicious when treatments don't make sense.
When you have a total knee replacement, the joint surfaces are replaced with metal and plastic components, so there's technically no longer any cartilage or traditional joint space like in a natural knee.
There are still soft tissues which can be inflamed, but you are right to question the approach of steroid injections as they are not standard practice when a knee joint has been replaced with an implant.
This is partly due to a higher rate of complications, such as infection.
If you haven't had recent imaging (such as X-rays, a bone scan or MRI with metal artifact reduction), that should come first, looking for any evidence the pain is due to the implant failing or being loose, infected or malpositioned.
Some of the other common causes of pain following a total knee replacement include scar tissue, soft-tissue inflammation, nerve entrapment or complex reg-ional pain syndrome.
I'd advise you to ask some specific questions before having a steroid injection, such as, 'What is the specific diagnosis for my pain?' or, 'Is this pain mechanical, inflammatory, neuropathic or possibly related to implant failure?' and, 'What exactly are you injecting, and into what structure?'.
Don't accept vague answers, such as talk of generalised inflammation.
I'd advise asking to be referred back to the team who did your operation, or consider getting a second opinion from a revision knee specialist (an orthopaedic surgeon who focuses on failed joint replacements).
There may well be long wait times, but this does not mean you shouldn't get referred.
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For someone who has used a tanning bed for the first time before the age of 35, there is a 59% greater chance of developing melanoma. Despite this stark reality, having a tan is still presented to many young people as aspirational – whether it's faux tan-lines appearing on catwalks or bronzed influencers on holidays in Dubai. Many sunbed shop owners sell tanning as a form of 'self-care', while influencers post 'come for a sunbed with me' videos. Perhaps most perniciously, some sunbed shops even make light of the known risk associated with them. One meme shared on Instagram by a tanning salon overlays the text: 'When someone tells you sunbeds are bad for you' with a clip from the sitcom Benidorm, in which the character Madge Harvey says: 'I spy with my little eye something beginning with AB: absolute bollocks.' Emily Harris, 23, from Leeds, uses sunbeds. Her parents both work for the NHS and have warned her about the risks. But she says that having spent most of her teenage years in the midst of the Covid-19 pandemic, followed by various global conflicts and the ever-looming presence of climate breakdown, the dangers of a sunbed seem small by comparison. 'You can die of anything – do you know what I mean?' she says. While Harris, who works in sales, can't afford to use sunbeds all the time, she uses them whenever she has 'a bit of spare money', making use of the deals that salons offer. Before a recent holiday, she bought a package that gave her unlimited minutes, with a daily limit, for four weeks. 'I was going every day,' Harris says, which she admits 'is a bit silly', but adds: 'I was trying to make the most of the package.' As well as using tanning beds, Harris is 'obsessed with tracking the UV', and has the index on the lock-screen of her phone. She and her colleagues plan their breaks around times when the UV index is highest, so they can maximise their exposure to the dangerous radiation. A number of her friends also use nasal tanning sprays, which were the subject of a Trading Standards warning issued earlier this year that stated: 'These products can cause nausea, vomiting, high blood pressure, and even changes in mole shape and size … studies have shown a potential link to melanoma, a type of skin cancer.' Harris tried one when her friend had a spare bottle, but 'didn't see a result' so hasn't used one again. Was she worried about what might have been in it? 'To be honest, not really. I know it's bad, but at the time, I was more bothered about getting a tan.' Nasals, as they are known, usually contain a lab-made substance called melanotan II, a chemical that darkens skin pigmentation. Though it is illegal to sell medicinal products containing melanotan II in the UK, cosmetic products fall outside that remit and are easily available on social media. 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Being on the show made Feldman realise how much potential damage she could be doing. She hasn't used a tanning injection for four months, and has reduced her use of a nasal spray to a couple of times over the past month, when previously it would have been four inhalations a day. 'I do still use sunbeds,' she says. 'But I have cut down. There was a time when I was going on them four, five, six times a week and now I only go on them once or twice.' Data from the UK and Ireland's Sunbed Association suggests that tanning beds are most popular among 25- to 45-year-olds, and more women than men use them. But that's not to say gen Z men are free from the pressure to sport a tan. Craig Hopkins, a 29-year-old dance teacher based in Harpenden, Hertfordshire, says he uses sunbeds to 'look like I've just come back from holiday'. He prefers the look of a 'real' tan to a fake tan, which ties in to existing social media trends such as 'looking expensive' and 'quiet luxury'. 'On Instagram especially, everyone is always on holiday, always super brown. So it's probably just trying to keep up,' Harris says. Like Harris, Hopkins also tried a nasal spray once, via a friend who used to sell them, but it made him 'feel really sick'. Despite the known risks and side-effects, most of the young people I spoke to for this article were still willing to give nasal sprays a try. Megan Urbaniak, a 23-year-old nail technician from Rotherham, says: 'I feel as if I know a million people who use them and everyone seems to have been fine. It does kind of weird me out that they don't tell you what's in them, but I'm sure there's worse in the world.' Urbaniak is a regular sunbed user – and has even encouraged friends to use them before going on holiday 'because it stops you from burning immediately when going in the sun'. Venables is quick to debunk claims such as this, saying that all it does is put your skin through even more 'excess UV exposure'. She points to another type of common skin cancer, squamous cell carcinoma, which is thought to be due to cumulative UV exposure. While Urbaniak does not seem to be put off by any safety concerns, she is keen to stress that there is a 'cultural line that you probably shouldn't cross' when it comes to tanning as a white person. 'I don't think that my body is capable of going that colour, but if it was, I'd like to think someone would tell me to stop.' That said, it isn't just white people who like to tan. Melissa Jones, 19, from Chester, says she has 'seen way more people of colour – including south-east Asian girls like me – getting into tanning. For me, it's not about being darker – it's about adding that warm, radiant glow and evening out my tone'. Like Feldman, Jones uses the word 'addictive' in relation to her tanning habit, and thinks it helps her in her job as a content creator. Tanned skin 'looks amazing on camera and in content', she says. However, she has recently switched from using tanning beds to using only fake tan. 'I became more aware of the risks, like ageing, skin cancer, all of that.' The WHO has urged countries to consider banning sunbeds: Australia banned all commercial sunbeds 10 years ago and Brazil banned them in 2009. Kukadia and Venables both say they would like them banned in the UK. Jak Howell, a 26-year-old content creator from Swansea, has been urging his followers to stop using sunbeds since he was diagnosed with stage three advanced melanoma when he was 21, which his doctors were surprised to see in someone so young, and said was probably due to his use of sunbeds. Howell had been using sunbeds regularly since he was 15 (it has been illegal for under-18s to use tanning beds since 2010, but the ones Howell used weren't staffed. Customers bought tokens from a machine and slotted them into the beds). When a mole appeared on his back that 'kept bleeding and scabbing over but never healing', he sent a photograph of it to his GP and was immediately referred to hospital. He underwent radiotherapy and surgeries to remove his lymph nodes, but these failed to remove the cancer. Eventually, after a year of immunotherapy, which 'completely knocks you for six', he went into remission. Howell now wants to see sunbeds banned. He tells young users: 'OK, it hasn't happened yet, but it could happen. And when it does happen, it is far, far worse than anything I could ever describe and you could ever imagine.' For many young people, though, the allure of the sunbed's 'instant fix' is too great to resist. And it's not as if this is the first time young people have put themselves at risk. As Kukadia points out: 'If alcohol was discovered or invented now, it would be illegal.' But tanning does feel different from other classic rebellious pursuits such as binge drinking, cigarettes and drugs because people don't do it for fun, but to achieve a certain aesthetic – a symptom, perhaps, of our screen-filtered lives. 'If I wasn't on social media, I probably wouldn't use sunbeds,' Feldman admits, but because her job requires social media use, she can't see herself stopping. A few years ago, Clark noticed a dark, 'pretty scary-looking' lesion on her leg, and was referred to a dermatologist. Though it didn't turn out to be skin cancer-related, she had to have it removed, and the experience has stopped her being so 'frivolous' with tanning beds. Urbaniak can't see herself giving up either. 'If something were to go wrong, then maybe I'd reconsider,' she says. 'But I feel as if I'm in that generation where we all just live in denial until something happens.' Do you have an opinion on the issues raised in this article? 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