WE’VE all been enjoying the hot weather this summer.

But it is important to remember that the Met Office issues serious heat health alerts for good reason.

Dr Zoe gives you health advice

A reader’s partner coughs and has phlegm more than normal, worsening in the past six months Credit: Getty

They urge us to keep an eye on the vulnerable, including those over 65, people with chronic health conditions, pregnant women and young children.

Are they able to keep their home cool?

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Are they drinking plenty of water and avoiding the sunshine during the hottest part of the day (11am to 3pm)?

While rare, deaths can occur from dehydration, extra pressure on the heart and organ failure due to overheating.

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Drownings, mostly caused by cold-water shock, are another risk.

Please make sure you read about this on the RNLI website, especially if you are going to any water for a swim, and teach your kids, too.

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

Builder hubby has so much phlegm

Q) MY husband is 36 and coughs and has phlegm more than normal, worsening in the past six months.

I also notice a wheeze, sometimes.

A GP referred him for an X-ray after antibiotics for a chest infection, but it found nothing.

Could it be COPD?

He’s a builder and all he says is, “It must just be the way I am.” Is that possible?

A) I don’t think you are wrong to question this. Some people are naturally more “phlegmy” than others, especially after infections. But a cough that has noticeably increased deserves proper review.

A normal chest X-ray is reassuring because it makes some serious causes less likely, but it does not rule out all lung conditions.

Conditions such as asthma, COPD, chronic bronchitis, reflux, post-nasal drip and occupational lung irritation can all cause persistent cough and phlegm, even when an X-ray looks normal.

COPD is less common at 36 than in older adults. But it is not impossible, especially if there is a history of smoking and long-term exposure to dust, fumes or particles at work – so the building-site exposure is relevant if he has worked around cement, plaster, silica, wood dust or poor ventilation.

The wheeze you notice is also important. Wheeze can happen with asthma, irritated airways, smoking-related airway disease, infection, allergies or reflux.

It would be reasonable for him to go back to the GP and explain that the cough has persisted, has worsened over six months, and that there is occasional wheeze.

He may need spirometry or peak-flow monitoring to assess how well air moves in and out of the lungs.

Sometimes blood tests, sputum testing, inhaler trials or referral are considered depending on symptoms and examination.

It is also worth reducing anything that irritates the airways, and wearing proper respiratory protection at work.

So no, I wouldn’t simply accept, “This is just the way I am.” It still needs explanation.

Dr Zoe helps a reader with terrible feet pain Credit: stockphotodirectors

Q) I’M an 82-year-old man and get terrible pain in my feet, under the ankle bone and over the top of my foot.

It comes up on alternate weeks. I can hardly walk, and wear thick-sole trainers.

I’m quite fit and have been on blood pressure tablets and simvastatin for years.

A) I’m sorry you’re dealing with this. Pain that stops you walking, even if it comes and goes, deserves a proper assessment, especially when it is recurring in the same area.

Pain under the ankle bone spreading across the top of the foot could come from several places.

It may be a tendon problem, arthritis in the foot or ankle joints, irritation of a nerve, or inflammation around the soft tissues.

Sometimes footwear or changes in walking pattern can overload one part of the foot, and your thick-soled trainers may help because they reduce movement and impact.

Pain that affects walking can sometimes be linked to reduced blood flow to the legs or feet, particularly if it comes on with activity and improves with rest.

Your GP can check the pulses in your feet and may arrange a simple circulation test called an ankle-brachial pressure index. Nerve pain can also affect the feet and may feel like burning, shooting, tingling or electric.

Problems in the lower back can sometimes refer pain down into the foot, even if the back itself is not painful.

I would book a face-to-face GP or first-contact physiotherapy appointment.

You may need examination of the foot, ankle, pulses and sensation, and possibly blood tests or an X-ray, depending on what is found.

Seek urgent help if the foot becomes cold, pale or blue, very swollen, red and hot, or if you develop sudden severe pain or cannot bear weight.

You are clearly active, and the aim should be to keep it that way.

NAIL AND TOES BURNING

Q) I GOT a nail infection in my big toe.

I was given terbinafine but after a consultation with a podiatrist, they have now stated it looks like a trauma, and think the nail should be removed.

My toes and nails feel hot, like they are burning, and the skin is peeling around some of them. I’m confused – is it something underlying?

I have just been diagnosed with Crohn’s and am having blood tests for diabetes.

A) I can understand why you feel confused, as several things seem to be happening at once.

A damaged or discoloured big toenail can be caused by a fungal nail infection, but it can also be caused by trauma.

It might be an obvious cause, such as dropping something on the toe, or more subtle, such as repeated pressure from footwear.

Trauma can make the nail thicken, lift, change colour or become painful, and it can sometimes look very similar to fungal infection.

Terbinafine is not needed if the problem is not fungal.

Nail clippings can sometimes be sent to confirm fungus before or during treatment.

If the nail is very damaged, painful, repeatedly catching, or unlikely to recover, a podiatrist may suggest removing it.

The peeling may be a separate issue, perhaps athlete’s foot, which is a fungal infection of the skin rather than the nail.

Burning can also be linked to nerve irritation, circulation issues, inflammation, or diabetes, so checking for diabetes is sensible.

Deficiencies such as B12, folate or iron can sometimes contribute to nerve-type symptoms and Crohn’s can affect the absorption of these vitamins.

Some inflammatory conditions might also have effects beyond the gut.

I would ask your GP whether your blood tests include diabetes, B12, folate, ferritin/iron, thyroid function and inflammatory markers.

In the meantime, avoid tight shoes, keep your feet dry, do not pick peeling skin, and seek urgent advice if a toe becomes very red, swollen, increasingly painful, hot to touch, or you feel unwell.

This may still be straightforward, but the burning you describe in all toes means that it is worth looking beyond just the nail.

TIP OF THE WEEK

IF you like to get out into the garden and tend to your plants, remember that it’s important to take regular hydration breaks.

Also, always wear a hat, ideally one that covers the back of your neck, and make sure you use high-factor SPF – at least 30 – sun cream to protect skin from the harmful rays.