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Dr Rosemary: Could lung cancer run in the family?

Q – My grandfather was a smoker and died of lung cancer but my mother only smoked occasionally when she was younger, however, she was also diagnosed with the same disease last year and we have recently lost her. Could there be a genetic link? Should I be tested? 

A – Smoking tobacco is the number one risk factor for lung cancer, with around 86 per cent of lung cancers linked to smoking – 83 per cent due to active smoking and three per cent due to environmental smoke in non-smokers. So it is possible that smoking is the only thing to blame here.

Your mother would have been at increased risk from her exposure to her father’s smoke as well as the smoking in her youth. But, that said, genetics may predispose some people to lung cancer and those with a first degree relative who has had lung cancer may be more at risk, although this seems to apply mainly to lung cancer in those who have never smoked.

There is no screening programme for lung cancer but if you develop a persistent cough that lasts for more than three weeks, you should see your GP. You can help keep your risk of lung cancer as low as possible by avoiding tobacco smoke as much as possible, along with environmental pollutants such as diesel exhaust fumes, and eating plenty of fresh fruit and vegetables.

Q – I have been lacking energy for the past few months and have had a constant cough for the past three weeks. Blood tests have revealed my vitamin D levels are low. Is this why I’ve got the cough? My GP prescribed tablets to boost my vitamin D. Can I boost my levels naturally? I am a 62-year-old female. 

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A – Most foods naturally contain very little vitamin D and the main source of the vitamin is the skin where it is made by exposure to sunlight. It is possible to make enough vitamin D if you go outside for 20 minutes a day in the summer in the UK but in the winter months there isn’t enough strong sunlight to suffice.

A lack of vitamin D is very common in the UK, affecting at least one in five people and it’s recommended that everyone over the age of one takes a 10 micrograms daily supplement. A lack of vitamin D can cause tiredness though I doubt it’s connected to your cough.

More importantly vitamin D is needed to get calcium into your bones and a lack of this can increase your risk of osteoporosis. The best food sources of vitamin D are oily fish and those that have been fortified with added vitamin D, such as margarine and some cereals. Now that we’re in the winter months, it will be nigh on impossible for you to get your vitamin D levels back up to normal through diet alone, so I suggest you take the supplement your GP has prescribed.

Next spring have your levels checked and, if they are normal, you could try to maintain them with a combination of eating oily fish and some daily exposure to the sun but be careful not to overdo it. You can also ask your GP about a DEXA scan, to check on the state of your bones.

Q – What is the best treatment for plantar fasciitis? Can I keep exercising? 

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A – In plantar fasciitis, the thick band of fibrous tissue that runs under the sole of the foot between the heel bone and the base of the toes becomes thickened and inflamed. The most common symptom of this is pain, usually under and just in front of the heel bone. The cause often isn’t clear but in many cases this is thought to be due to tiny tears developing in the fascia over months or years.

The condition is more common in people who spend a lot of time walking, such as those who deliver post or police officers and in runners, especially if you wear shoes with poor arch support.

Treatment of plantar fasciitis should start with resting the affected foot, avoiding anything that stretches the sole of the foot such as walking or running.

Exercise where the foot is stable, such as cycling, is fine. You should gently stretch your Achilles tendon on a regular basis, as this is often tight and can make plantar fasciitis worse. Don’t walk barefoot on hard surfaces, don’t wear flip-flops and use arch supports in your shoes all the time.

Taking anti-inflammatory painkillers can also be helpful. Plantar fasciitis can be very slow to improve and you do need to be patient but if after several months there is no sign of any improvement, it may be worth considering having a steroid injection into the affected area. Shockwave therapy can also be used although the availability of this on the NHS is patchy.

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