Question: What are cold sores? I get one every few months, and I hate them, because they look so ugly.
Cold sores are caused by a virus.
About a quarter of the population is susceptible to this condition, while the rest of us are immune. Once the virus is contracted, it settles in the tissue around the lips, nostrils and other areas of sensitive skin. At times when the body’s resistance is lowered, the virus will start rapidly reproducing and an itchy, painful, blistery and later weeping sore will develop. Eventually this dries out and heals, but while in the blistery stage, the virus can be spread to other people in the community.
There are ointments that can be used (eg. Zovirax) in the very early stages of a cold sore to prevent it from developing further. Once the sore is established, only soothing and drying preparations can assist in healing the sore. Tablets are available to prevent cold sores, but these are very expensive, available only on prescription, and must be taken all the time.

Question: What causes a venous lake to appear on the lip? Can it be removed without leaving a scar?
An injury from a blow, bite or burn may damage the lip tissue and allow blood to accumulate under the fine skin on the lip, or any other part of the body. They are caused by the rupture of a very small vein near the surface of the skin, while the skin over it remains intact. Blood leaks out of the vein and accumulates as a dark blue blob under the skin.
They are easily removed by bursting the venous lake with the tip of a needle that has been sterilized by holding it in a flame or soaking in antiseptic. The blood will rapidly come out through the hole made, and healing will occur very quickly, with no scarring, particularly on the lip, which is probably the best healing part of the whole body.

Question: I am in my fifties and would like to know the pros and cons of hormone replacement therapy. How should I take them and how safe are they? What do you think of vaginal oestrogen creams?
I personally recommend HRT to all my patients, unless there are specific reasons that they should not take hormones. Generally speaking, HRT has E’en a major advance in the health of women, who now outlive men by an average of more than seven years.
The points for and against hormone replacement therapy (HRT) sre outlined as simply as possible in the following points.
PROS:
• Prevents osteoporosis (thinning of bones) and fracture.
• Slows the development of wrinkles and keeps the skin moist and more elastic.
• Lubricates the vagina and enhances sexual pleasure.
• Slows the sagging of breasts by maintaining breast tissue.
• Relieves the hot flushes, depression, bloating and othei symptoms of menopause.
• Regulates irregular periods to make them milder and less painful.
CONS:
• Menstrual periods may restart, or continue, for a year after HRT
commenced.
• May cause breast tenderness if dosage too high.
• Nausea and belly cramps may occur.
• Migraines may be aggravated.

Except under special circumstances, HRT should not be used in women who have had:
• Cancer of the breast, uterus or cervix.
• Hormonal mastitis (breast pain).
• Endometriosis.
• Blood clots (thromboses), liver disease or strokes.

Question: Why can’t all women who have troubles with the menopause have hormone replacement therapy with oestrogen? Why can’t they stay on treatment until they are 60, 70 or indefinitely?
The vast majority of women can take hormone replacement therapy with both an oestrogen and progestogen to overcome their problems. It is necessary to take both hormones to prevent some of the long-term complications of constant oestrogen use. Women who have had a hysterectomy need only take oestrogen.
There are a small number of women who should not use hormone replacement therapy, including those who have had breast or gynaecological cancer, blood clots or liver disease.
Most GPs are sympathetic to these women, who may suffer flooding, cramps, depression, flushes, headaches, irritability etc. etc. etc.!!!
There are a number of different types of oestrogen, and vaning dosage regimes, and it sometimes takes a little trial and error to get the dosage just right for an individual woman. Oestrogens also protect against osteoporosis, heart disease, and dementia, skin ageing and improve the libido (sex drive) of older women.
There is a great deal of controversy about how long this treatment should continue, but there is no reason why they should not be continued beyond 70 years of age. Oestrogens are not a long term ‘youth pill’, but cm certainly help women through a difficult period in their lives and prevent l lot of the complications of ageing.