DR ELLIE CANNON: I’m dizzy and slurring my words but still can’t get a diagnosis.

Have been suffering from dizziness, sometimes extreme, and blurred vision. I also find that I am slurring my words. The GP ordered blood tests last year, but I haven’t heard anything since. Having done my own research, I believe I have ataxia, which seems to get worse by the day. What do I need to do to get an official diagnosis?

Ataxia is the name for a variety of serious brain conditions that affect balance, speech, and coordination. It can be a long process to get a diagnosis from a neurologist, who will need to perform many tests, including MRIs.

Certain types run in families, so genetic testing is also important.

Some tests are not common and are only offered by certain major hospitals in the country, which also requires a referral.

The most common type of genetic ataxia is called Friedreich’s ataxia and is inherited from parents. People usually notice that their symptoms develop very slowly over time before age 25, although not always. People can also develop ataxia as a result of other conditions, such as multiple sclerosis, or after a stroke.

Ataxia usually cannot be treated, but symptoms can be relieved. This could include speech and language therapy, physical therapy, and occupational therapy. There are also medications available to help with muscle spasms and pain.

As ataxia is a rare and difficult disease to treat, the charity Ataxia UK has accredited specialist ataxia centers for its treatment and research. You can ask your GP or neurologist to refer you to one of them.

Ataxia UK is an excellent source of support (ataxia.org.uk).

I had my baby in March and then had a smear test in June, which showed I had the HPV virus, but the doctor said I had no abnormal cells. I have to return in June to have another cytology to check the situation. My problem is that we would like to try for baby number two. I’m almost 30 years old and time is of the essence. Is it safe to do it before my next test?

There are many different types of HPV: more than 100. It is a very common virus that does not cause problems in most people, but some types can cause genital warts or cervical cancer.

While HPV affects up to 80 percent of adults at some point, this number will undoubtedly decrease over the years as adolescents are vaccinated against it.

But because of its association with cervical cancer, swab tests look for HPV. People who do not have it have a very low chance of developing the disease.

If someone has the virus, the cells of the cervix (the entrance to the uterus) are checked for abnormal changes. Reassuringly, none are found and women are then kept under closer surveillance with annual screenings, rather than every three years. For most people, the virus will go away and will not cause cancer: nine out of ten HPV infections clear up within two years.

Weighing this against the desire to try for another baby is a very personal decision, taking into account the risks and benefits. I would advise patients to consider the HPV process as a priority, both for practical and emotional reasons.

There are excellent charities that offer advice. Eve Appeal offers an Ask Eve service, providing expert nurse-led information online or by phone on 0808 802 0019.

My big toe joint on my right foot hurts a lot and I often can’t move it. Years ago I was told I had hallux limitus which would eventually become hallux rigidus. I was also told that the only treatment other than surgery, which I am reluctant to receive, was painkillers. Is there anything else I don’t know that you can suggest?

Surgery may seem daunting, but compared to not being able to walk or put on shoes, it might be worth it.

Hallux limitus is osteoarthritis of the big toe, caused by wear and tear. The bone surfaces become damaged and rub against each other, restricting movement until the finger can no longer move at all. Some people claim that alternative remedies, such as turmeric, chondroitin, and glucosamine, can help. HoweverThese are not recognized treatments so I would not recommend them.

Anti-inflammatory pills or gels such as ibuprofen, as well as other pain relievers, are useful. It is recommended to wear shoes with rigid soles or rocker soles during activities.

You may be referred to podiatrists or orthopedics (specially made shoe inserts). Doctors may also offer a steroid injection into the joint; This would reduce inflammation in the joint and can provide months of relief.

There are various operations and an orthopedic surgeon will advise which is the most appropriate, since it depends on the condition of the joint. The operations preserve the joints or leave them unable to move, which can seem quite scary.

But in all cases the goal is to reduce pain: Studies show that weight bearing on the foot improves with surgery, even if the joint is fused. This may be a price worth paying to allow activity and pain-free walking.

Sometimes a GP needs to see you. Do not say no!

You might think it goes without saying, but if your doctor asks you to keep an appointment, say yes.

Data published last week in the British Medical Journal looked at the security of remote consultations and, contrary to some reports, highlighted how safe they can be. However, researchers suggested that in some situations, such as when dealing with skin rashes or in older people, they are not the right choice. In these cases, doctors need to see patients in person to properly evaluate them, in case it is serious.

I’m aware that in some areas people still have difficulty getting in-person consultations, but I’m running into a different problem. Quite often I ask a patient to come in for an exam and he insists that he prefers to be seen remotely.

There are some things we just can’t discuss over the phone and this kind of resistance worries me.

My question is, now that the dust has settled after the big change caused by Covid, what do you think of the telephone consultation versus the in-person one? Please write to me and let me know.

Will your A&E survive the winter?

As we approach winter, there is understandable concern in the health service about the imminent onslaught of viral infections, bed bugs, coughs, colds and other illnesses.

Most of us ignore them or spend a few days feeling terrible. But vulnerable people – babies, pregnant women, the elderly and frail, those receiving cancer treatment or suffering from conditions that affect the immune system – can end up being rushed to A&E. What will they find when they arrive?

An analysis by the Care Quality Commission published last week suggested that half of emergency departments in England were not meeting basic standards.

I would like to know how your local drive copes. Have you struggled to receive treatment, been left waiting for an ambulance, or been left in limbo without a care package? Write to me and let me know.