Why’s my referral taking so long? DR ROSEMARY answers your health questions

Q - For the past 12 months I have had heart palpitations which have got progressively worse. My blood tests were all clear and a 24-hour ECG was normal. Last week I collapsed and was taken to A&E where I was resuscitated and told I had atrial fibrillation (AF). I was given emergency tablets until I could see my GP and told I would be referred to an AF clinic. I rang my GP only to be told by a receptionist that they had no letter from the hospital and I could only be offered an appointment two weeks later. I was also told it was not her job to follow up the letter and I should do this myself. Surely this cannot be right?

A - It sounds as if you have had an intermittent problem with your heart rate and the diagnosis can be easy to miss if it behaves itself at the time you are having a test done.

If a 24-hour ECG does not pick up a cause for palpitations then it is possible to do an ECG recording for eight days but there can be long waits for this.

I understand your frustration with the lack of communication between the hospital and your GP surgery which doctors and surgery staff find just as infuriating as patients.

Unfortunately due to a lack of hospital secretarial staff, it can mean that letters can take weeks to get to GPs and busy surgery staff find it really difficult to find the time to get the information.

My surgery staff often tell me they have to wait for 10 minutes or more to be put through to the correct extension, only to then have to wait a further 10 minutes before they are told that the letter has not yet been typed up. Your story is, I'm afraid, all too familiar to me - the whole NHS is stretched and despite the best efforts of staff the service being provided is not what everyone would like it to be.

Q - My friend had radiotherapy and chemotherapy last autumn for throat cancer. He has been given the all-clear but seven months on he still has an extremely dry mouth and cannot eat properly without drinking a lot of fluids and having food puréed. He has tried different things suggested by the speech therapist but nothing seems to work. Also, he has not put back the 3st he lost after treatment. It would appear that his salivary glands need to be stimulated. How can this be done?

A - I suspect the radiotherapy is to blame for the problems with his mouth, rather than the chemotherapy. The aim of radiotherapy is to destroy cancer cells with high-energy beams of radiation but unfortunately, even with highly-targeted beams, it is very difficult not to damage normal tissues surrounding the cancerous cells. This means that it is common for patients undergoing radiotherapy to their throat to experience inflammation and ulceration of the lining of the mouth and throat and for the cells that produce saliva to be damaged as well.

This damage is often permanent so the salivary glands no longer work and cannot be stimulated back into action. Artificial saliva in the form of gels or sprays can be helpful, along with drinking sips of fluid while eating. Scarring in the throat can also mean that swallowing solid foods is impossible without discomfort.

If your friend's weight loss means he is now underweight he should see his GP about having liquid nutritional supplements.

If he is managing to maintain his weight, albeit at a lower level, and eat a reasonably balanced diet via sloppy foods, then try not to be too concerned.

Q - Do you have any suggestions to ease the pulsatile tinnitus I've had for more than a year? I suffer with it all the time and cannot sleep. It's making me so depressed. I've had many tests and been told I've just got to live with it.

A - Pulsatile tinnitus is a rhythmical noise inside the ear that appears to have the same rate as the heart. It is thought to be due to a change in the blood near the ear. This can occur naturally during pregnancy or exercise and with an overactive thyroid.

It can also develop when there is fluid in the middle ear cavity or if the arteries around the ear are narrowed by fatty deposits. But in many cases no underlying cause can be found. If this is the case then there are methods that can help you manage and cope with the noise. These include sound therapy, relaxation therapy, cognitive behaviour therapy and tinnitus retraining therapy.

These are designed to help block out the noise coming from your ear so you are less aware of it.

For details call the British Tinnitus Association on 0800 018 0527 or visit tinnitus.org.uk.

If you have a health question for Dr Rosemary please write to her in confidence at The Northern & Shell Building, 10 Lower Thames Street, London EC3R 6EN or email health@express.co.uk Dr Rosemary's reply will appear in this column. She regrets that she cannot enter into personal correspondence and that due to the volume of letters she cannot reply to everyone. Find out more about Dr Rosemary at drrosemaryleonard.co.uk.