Dr. Martin Scurr responds to readers’ health inquiries, providing medical guidance on conditions ranging from unexplained goosebumps to the prolonged use of omeprazole.

Mysterious Goosebumps

Andy McCormack from Manchester has experienced unusual symptoms for the past year, including frequent goosebumps starting at the head and spreading down his body, even during simple activities like reading. He also reports exceptionally tender skin, making even gentle touch intensely uncomfortable.

Diagnosis and Potential Causes

Despite extensive testing – including blood tests, hormone tests, and heart monitoring – no underlying medical condition has been identified. Dr. Scurr suggests this could be cutaneous allodynia, a condition characterized by hypersensitivity of skin nerves.

He explains that goosebumps are a natural reflex, the pilomotor reflex, triggered by cold or strong emotions. However, the described sensitivity could be linked to conditions like shingles, diabetes, migraine, or, rarely, temporal lobe epilepsy, potentially manifesting as pilomotor seizures.

Recommended Action

Dr. Scurr recommends a referral to a neurologist and suggests that anticonvulsant medication might provide relief.

Long-Term Omeprazole Use

Margaret Baker from Grangemouth has been taking 10mg of omeprazole daily for over 25 years to manage a hiatus hernia. She is concerned about potential long-term side effects, especially after reading negative reports.

Weighing the Risks and Benefits

Margaret has found that discontinuing omeprazole leads to a return of her hernia symptoms and has recently developed arthritis, questioning a potential link to the medication. Dr. Scurr acknowledges omeprazole’s widespread use and generally good safety profile as a proton pump inhibitor.

He stresses the importance of annual reassessment to ensure the benefits continue to outweigh the risks. Long-term PPI use can potentially affect the absorption of vitamin B12, magnesium, and calcium, potentially leading to deficiencies.

Reassurance and Monitoring

Dr. Scurr recommends annual blood tests to monitor vitamin and mineral levels and acknowledges a theoretical risk of gastrointestinal infections. However, he reassures Margaret that there is no evidence linking long-term omeprazole use to arthritis and advises continuing the medication while discussing concerns with her doctor annually.

The Role of Predictive Coding

Dr. Scurr concludes by discussing the challenges of treating patients with persistent, unexplained symptoms. He highlights the role of predictive coding, a brain phenomenon where expectations can influence the experience of symptoms.

He recounts a case of a patient with widespread itching driven by anxiety, where all physical causes were ruled out. The itching began as a result of predictive coding, fueled by fears of an underlying health condition.

He emphasizes that symptoms are real, even without a clear medical explanation, and that counseling can be beneficial for anxiety-driven conditions. The article highlights the need for a holistic approach to patient care, recognizing the interplay between physical and psychological factors.