I get a burning sensation around my right breast when I go for a walk – should I be worried?

AROUND 1.2billion prescriptions are dispensed here yearly.

Almost half of the calls to pharmacies are from patients asking if their medicine is ready.

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But it has just got a lot easier to find this information via the NHS app.

Millions can now track if their prescription is ready to collect or has been dispatched.

It is a new feature that NHS England says nearly 1,500 high street chemists are offering.

The NHS app, which now has 37.4million users has made ordering prescriptions streamlined.

About 5.5million repeat prescriptions are ordered through the app each month.

These are sent electronically to your nominated pharmacy.

Digital prescription barcodes are created for those who do not have a nominated pharmacy.

Scotland is developing its own app, Digital Front Door, which is expected by the end of this year.

These apps help free up time for both GPs and pharmacists so they can see more patients.

Here’s a selection of what readers asked me this week.

Q: FOR the past two and a half years, my nine-year-old daughter has struggled with increasing her iron levels.

She has been on iron supplements, increased vitamin C and iron-rich foods.

Although her iron levels have gone from eight to 33, at the highest, it has recently taken another dip.

She is often tired but has ten hours of sleep each night and she has very little stamina for any physical activity.

She is not overweight or inactive, though.

We are frustrated at getting no real answers or solutions.

What more can we do?

A: It sounds as though you are taking some sensible steps to try to help your daughter overcome her iron deficiency, but the problem keeps coming back.

My assumption is that the numbers you have shown are a measurement of her ferritin levels, an indication of iron stores and the most reliable initial blood test for iron deficiency.

In general, a ferritin level of less than 15 micrograms/L indicates there is very little iron available for use in the body, while levels of less than 30 micrograms/L means there is less iron available for various functions, including red blood cell production.

If left untreated, this can lead to iron deficiency anaemia, so it is important to get to the bottom of this.

An inadequate diet is the commonest cause of iron deficiency, but it sounds as though your daughter is eating plenty of iron-rich foods and taking vitamin C, which helps the body to absorb iron.

Some conditions of the gut lead to poor absorption of nutrients, for example, coeliac disease. Has she been tested for this?

Also conditions which cause the body to lose small amounts of blood can cause iron deficiency.

Periods are an obvious cause, but your daughter is too young (but this could exacerbate the problem in the future).

Inflammatory bowel disease (Crohn’s and colitis) and even taking anti-inflammatory medicines (ibuprofen) frequently can cause small but persistent blood loss.

It sounds as though your daughter will need to restart some oral iron medication again while these are investigated.

When the blood level is back to normal, the iron treatment should continue for at least three months to build up iron in the body.

If the problem persists with no clear answers, then she may need to be referred to a paediatrician for further investigations.

Q: I AM a male, 73, and I get a burning sensation around my right breast to my right shoulder blade when I go for a walk.

This can stay a few minutes, then go. It doesn’t normally return until the next time I go for a walk.

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I have had scans and tests, which found nothing.

It’s been like this for a few years and is very uncomfortable.

A: Any pain in the chest area or back which is brought on by physical exertion and alleviated by rest should be considered to be angina until proven otherwise.

Angina is a symptom of heart disease.

Because the arteries are narrowed by plaque build-up, not enough oxygen-rich blood can get to the heart muscle when it is working hard.

Angina can feel like pain, pressure, squeezing, or tightness in the chest, and it may also radiate to the arms, back, neck, or jaw.

It is triggered by activities that increase the workload of the heart, such as walking, climbing stairs, or even emotional stress.

You mention having had tests, but were you referred to a specialist chest pain service?

In a patient with suspected angina, you would typically have blood tests and an ECG and usually a coronary angiogram or a myocardial perfusion scan.

Sometimes a GP can rule out angina based on their thorough history-taking and examination, for example, they can tell that the pain is musculoskeletal in origin.

Other times it is very clear that angina is the diagnosis and medication can be started immediately.

Other potential causes include pain originating from muscles and joints or compression of nerves.

Q: I HAVE had pain in my lower abdomen for approximately two months.

I have very little pain, if any, when lying down or slouching.

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The pain starts almost immediately when I am sitting upright or standing.

It can be severe.

I am 72 and otherwise reasonably healthy.

When I walk, I feel that I have to press/hold my abdomen in.

A CT scan and blood/poo tests have come back clear.

I have asked my GP if there is any referral he could make, and he says no.

I am desperate and willing to pay privately if absolutely necessary, but don’t know which type of specialist I should see.

Could the problem be muscular somehow? I do also get lower back pain sometimes when bending.

A: It sounds as though you definitely need some help from somewhere.

As your abdominal pain is made worse by standing or sitting upright and alleviated by lying down or slouching, it suggests that either posture or the pressure within the abdominal cavity plays a role in causing the pain.

It’s worth checking that your GP is confident that they have ruled out any serious disease with the CT scan and other tests, including hernias, inflammatory bowel disease, ovarian or bowel cancer.

If you have an inkling that the pain might be muscular, it might be worth seeing a physiotherapist who would be able to assess this issue.

It is possible to have abdominal pain from a herniated disc or nerves being trapped around the spine, too, which a physio can also assess for.

If the physio does not believe this to be the cause of the pain, then a gastroenterologist or general surgeon might be the next best step.

It is also possible for nerves in the abdominal wall to become entrapped and this can be made worse by certain movements or postures.

Finally, if you have had abdominal surgery in the past, then it is possible to have developed adhesions from scar tissue that causes pain

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