Your Questions Answered

I have lost the padding on the bottom of my feet. How can I minimise the pain associated with this ?

In scleroderma, there is often a loss of soft connective tissue, especially in established disease. This includes changes in the feet and this, together with tightening or contractures of the tendons, can give rise to severe discomfort, especially on weight bearing. Wearing well fitted supportive footwear with a padded sole can be helpful. A variety of in-soles or shoe inserts can be of great benefit as the pressure on tender areas can be reduced and the mechanical forces on the foot redistributed. It is important to obtain advice from a foot specialist for this and there may be specialist podiatry services available to you that can be accessed by your hospital consultant or family doctor.

The medical term "malabsorption" describes the inability of the bowel to extract nutrition from food despite an adequate diet. In scleroderma this can occur due to changes within the bowel wall; as a result of stagnation of bowel contents and breakdown of nutrients by gut bacteria (bacterial overgrowth) or due to a deficiency of digestive enzymes. Possible treatments include antibiotics to sterilize the bowel, enzyme supplements..., and strategies that increase the amount of nutrition available for absorption, such as liquid food supplements...

Barrett's Oesophagus develops in some cases of scleroderma due to long term inflammation in the oesophagus. It does not cause symptoms but is a concern as it may progress to dysplasia and eventually to cancer. For this reason it is often suggested that patients with this condition have regular endoscopy and biopsy, as you describe. In this way, any changes can be treated early before serious problems occur. Proton pump inhibitors such as lansoprazole are usually effective at treating symptoms of reflux, but can cause side-effects. In the first instance, I would suggest trying another member of the proton pump inhibitor drug family. Otherwise, alternative drugs such as ranitidine can be considered and treatments that improve contraction can be useful such as domperidone.

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Although calcium channel blockers can be helpful in Raynaud's Phenomenon, they often cause headaches. One approach is to try a different member of the drug family. There are a number to choose from and individual side- effects do vary. Alternatively, you could try another prescription drug such as an angiotensin receptor blocker. Seratonin inhibitors such as fluoexetine have been helpful to many patients and do not usually cause headaches. I suggest that you discuss these options with your doctor.

The mechanical work involved in swimming is quite different from that of climbing stairs or a hill. Lifting your body weight is a major exertion whereas this is partly supported by the water when swimming. Therefore, it is probably a reflection of the greater effort needed to climb. However, although breathlessness is common in scleroderma, it should not be ignored. If you are becoming more short of breath, or finding that you are doing less with the same degree of shortness of breath, this should be brought to your doctor's attention.