I have trouble putting weight on to my feet when getting out of bed due to painful heels. The right one in particular stays sore until I get going. Why might this be?

Alan Weir, Waterlooville, Hampshire

Dr Martin Scurr replies: Severe heel pain when putting weight on your feet is a classic sign of plantar fasciitis – or inflammation of the plantar fascia, a band of tissue that runs along the bottom of the foot from the heel to the toes.

Typically the pain is worse first thing in the morning as the tissue tightens overnight and then stretches when you stand up. This gradually eases over the next few minutes.

Plantar fasciitis is most common from middle-age, simply as a result of tissue ageing, and is typically triggered by unsupportive footwear or a sudden increase in exercise – such as a long walk. Or both.

It’s diagnosed by pressing on a point on the underside of the heel, called the medial calcaneal tubercle, which will cause acute pain if the fascia is inflamed.

If there is any doubt, you may be offered an X-ray – there might be a spur of new bone extending into the fascia from the heel bone, which is a result of inflammation and repair mechanisms. Damage to the Achilles tendon can also cause heel pain, though at the back of the heel rather than under it. Also pain tends to occur throughout the day as the tendon comes under load.

I suggest you see a physiotherapist or a podiatrist who will confirm the diagnosis and show you stretches that can improve flexibility and pain.

Typically foot pain is worse first thing in the morning as the tissue tightens overnight and then stretches when you stand up, says Dr Martin Scurr

An orthotic insole under the heel can help as it takes the strain off the inflamed tissue. You can buy these online or on the High Street, but your healthcare professional can best help you find the type you need.

In some cases, this treatment doesn’t relieve the pain and you may need to be referred to an orthopaedic specialist for a corticosteroid injection – though this is a last resort (not least because it is painful and risks include rupture of the plantar fascia).

On a recent morning flight to Portugal I fainted in my seat for 30 seconds before take-off. I was taken by ambulance to hospital, but all checks were clear. Should I worry about flying? I’m 81.

Alex Jones, Manchester

Dr Martin Scurr replies: A faint – known as a vasovagal episode – is a brief loss of consciousness and can be brought on by anything that causes a drop in blood pressure significant enough to temporarily cut normal blood flow to the brain.

All manner of things could do this – from the early travel, perhaps after a sleepless night (a lack of sleep reduces the body’s ability to regulate blood pressure) or anxiety about missing the flight.

In addition, standing in queues at security or at the gate can allow blood to pool in the legs, reducing flow to the brain.

In your longer letter you mention you ate breakfast before boarding and this may have contributed. Digestion requires extra blood flow to the stomach, so if your heart rate and blood vessels fail to adjust, blood pressure drops throughout your body, depriving the brain of blood which could have made you feel faint.

In older adults this is not uncommon, especially in those with blood pressure problems (you mention you are on ramipril, a drug for high blood pressure). Usually it occurs within an hour of a meal.

Mild dehydration, especially if you deliberately reduced fluid intake prior to travelling to avoid needing the loo during the flight, can also be implicated.

I am trusting that the doctor who examined you in A&E listened to your heart carefully and presumably an electrocardiogram (ECG) was carried out to rule out any abnormalities.

Some heart rhythm disorders, such as atrial fibrillation, can come and go and may not be detected by an emergency ECG or with a stethoscope. I’d ask your GP for a 24-hour ECG (you wear a monitor at home and it sends the results to your doctor).

If all is well in respect of your heart, there is no reason why you should not fly in future – though perhaps seeking assistance to reduce stress and the time spent standing might be a sensible precaution.

In my view… meningitis vaccine roll-out is vital

Infection with meningococcal group B (MenB) bacteria overwhelms the body so quickly that anyone who contracts it can become ill at breakfast time and die by teatime. The bacteria cause the lining of the brain to swell and spread to the blood, swiftly leading to deadly sepsis.

Time is so much of the essence that GPs always carry injectable antibiotics to be given the moment it is believed that a patient has the infection – before even calling for an ambulance.

It is a matter of pride that in 2015 we were the first country in the world to offer a vaccine, Bexsero, which protects against all strains of MenB. Before this, children received the ACWY vaccine – which protects against other meningococcal bacteria strains.

But recent outbreaks of MenB (which led to the death of sixth‑form student Lewis Walters last month) have caused great public anxiety. That’s why I welcome the news of a catch-up programme, to offer teenagers too old to have had the Bexsero vaccine, from July.

This will ensure all those at highest risk of this lethal disease can be protected. For to lose teenagers from MenB when it is preventable is both shocking and little short of unethical.

By LUKE ANDREWS, U.S. SENIOR HEALTH CORRESPONDENT

Published: 20:51 BST, 15 June 2026 | Updated: 20:52 BST, 15 June 2026

[noscript_1]

Hundreds of thousands of bottles of a hugely popular antidepressant have been recalled over fears that they could contain a cancer-causing chemical.

More than 370,000 bottles of duloxetine delayed-release capsules, sold by New Jersey-based Breckenridge Pharmaceuticals and commonly known as Cymbalta, were subject to the warning.

The FDA raised the alarm after tests found the capsules contained higher than permitted levels of N-nitroso-duloxetine, which is considered to be a probable carcinogen to humans.

No illnesses have been reported to date, but the agency warned this was a Class II recall, meaning exposure to the product could cause temporary or medically reversible events.

The recall includes 360,000 bottles of 60 milligram (mg) capsules, sold in bottles containing 90 or 1,000 capsules.

It also includes 14,000 bottles of 30mg capsules, sold in bottles containing 1,000 capsules. 

The prescription-only drugs were sold nationwide and have best-before dates up to May next year.

No advice has been issued by officials on what to do if you have the recalled drugs at home, but, typically, people are advised to contact their doctors to seek alternatives.

More than 370,000 bottles of duloxetine delayed-release capsules have been recalled

Physicians warn online that abruptly stopping the drug can lead to depression, fatigue, headaches and insomnia, or difficulty falling asleep.

Duloxetine, also sold as Irenka, is one of the most popular antidepressants in the US and has about 18 million prescriptions written every year.

Doctors use it to treat depression, anxiety or pain caused by nerve damage associated with diabetes. It may also be prescribed to treat fibromyalgia.

The recall was revealed as two notices on the FDA’s website. No press release has been issued as yet.

The drug was manufactured by Towa Pharmaceuticals Europe, based in Spain, and distributed in the US by Breckenridge Pharmaceuticals. 

N-nitroso-duloxetine is a byproduct that can accidentally form during the manufacturing process.

A list of the lot numbers in the recall is available in the first notice and second notice issued on the FDA website. 

People are exposed to trace levels of this chemical from the environment daily, but the FDA has safe limits for it in medications, at 26.5 nanograms per day.

Shown above are the 90-capsule and 1,000-capsule bottles from Breckenridge that have been recalled

Shown above is the 1,000-capsule 30mg duloxetine that has been recalled 

Experts say that prolonged exposure to higher levels of this chemical may raise the risk of developing cancer. 

Previous research in animals has linked nitrosamines, the group of chemicals that includes N-nitroso-duloxetine, to cancer in the colon and liver. 

The alert is at least the second recall of Breckenridge Pharmaceuticals-distributed antidepressants this year. 

In April, 165,000 bottles of its 60mg duloxetine delayed-release capsules were recalled over the presence of the same potentially cancer-causing chemical. These were all in 90-count bottles.

In 2024, Breckenridge recalled 7,100 bottles of its 20mg duloxetine delayed-release capsules that were sold in 500-count bottles.

By LUKE ANDREWS, U.S. SENIOR HEALTH CORRESPONDENT

Published: 20:51 BST, 15 June 2026 | Updated: 20:52 BST, 15 June 2026

[noscript_1]

Hundreds of thousands of bottles of a hugely popular antidepressant have been recalled over fears that they could contain a cancer-causing chemical.

More than 370,000 bottles of duloxetine delayed-release capsules, sold by New Jersey-based Breckenridge Pharmaceuticals and commonly known as Cymbalta, were subject to the warning.

The FDA raised the alarm after tests found the capsules contained higher than permitted levels of N-nitroso-duloxetine, which is considered to be a probable carcinogen to humans.

No illnesses have been reported to date, but the agency warned this was a Class II recall, meaning exposure to the product could cause temporary or medically reversible events.

The recall includes 360,000 bottles of 60 milligram (mg) capsules, sold in bottles containing 90 or 1,000 capsules.

It also includes 14,000 bottles of 30mg capsules, sold in bottles containing 1,000 capsules. 

The prescription-only drugs were sold nationwide and have best-before dates up to May next year.

No advice has been issued by officials on what to do if you have the recalled drugs at home, but, typically, people are advised to contact their doctors to seek alternatives.

More than 370,000 bottles of duloxetine delayed-release capsules have been recalled

Physicians warn online that abruptly stopping the drug can lead to depression, fatigue, headaches and insomnia, or difficulty falling asleep.

Duloxetine, also sold as Irenka, is one of the most popular antidepressants in the US and has about 18 million prescriptions written every year.

Doctors use it to treat depression, anxiety or pain caused by nerve damage associated with diabetes. It may also be prescribed to treat fibromyalgia.

The recall was revealed as two notices on the FDA’s website. No press release has been issued as yet.

The drug was manufactured by Towa Pharmaceuticals Europe, based in Spain, and distributed in the US by Breckenridge Pharmaceuticals. 

N-nitroso-duloxetine is a byproduct that can accidentally form during the manufacturing process.

A list of the lot numbers in the recall is available in the first notice and second notice issued on the FDA website. 

People are exposed to trace levels of this chemical from the environment daily, but the FDA has safe limits for it in medications, at 26.5 nanograms per day.

Shown above are the 90-capsule and 1,000-capsule bottles from Breckenridge that have been recalled

Shown above is the 1,000-capsule 30mg duloxetine that has been recalled 

Experts say that prolonged exposure to higher levels of this chemical may raise the risk of developing cancer. 

Previous research in animals has linked nitrosamines, the group of chemicals that includes N-nitroso-duloxetine, to cancer in the colon and liver. 

The alert is at least the second recall of Breckenridge Pharmaceuticals-distributed antidepressants this year. 

In April, 165,000 bottles of its 60mg duloxetine delayed-release capsules were recalled over the presence of the same potentially cancer-causing chemical. These were all in 90-count bottles.

In 2024, Breckenridge recalled 7,100 bottles of its 20mg duloxetine delayed-release capsules that were sold in 500-count bottles.

One of the most common questions that I receive from the patients on GLP-1 weight-loss medication is: ‘When should I stop taking them?’

My answer often surprises them: I don’t recommend stopping at all.

The biggest mistake many GLP-1 users make is assuming that they’ll reach their goal weight and return to their ordinary lifestyles. But the number on the scale doesn’t mark the finish line.

Obesity and weight regulation don’t work that way.

I know that firsthand.

After losing 13lbs on GLP-1s, I stopped taking the medication for approximately two months and during that time, I gained all the weight back.

Then, when I restarted treatment I found that I needed a higher dose than before to achieve the same effect. The medication simply didn’t ‘hit the same’ as it had before. I cannot say why this occurs, studies of this phenomena have yet to be undertaken. But I have seen this effect both in myself and my patients.

As a board-certified plastic surgeon and physician who routinely prescribes GLP-1s to patients through my practice Physique26, I have seen this phenomenon repeated again and again.

The biggest mistake many GLP-1 users make is assuming that they’ll reach their goal weight and return to their ordinary lifestyles

This cycle of stopping and restarting can be frustrating, emotionally draining and ultimately more expensive than maintaining a lower dose.

That’s why I developed a different strategy at my practice.

We call it ‘microdosing.’

Once patients reach their desired weight, I gradually reduce them to the lowest dose that allows them to maintain their results.

The goal isn’t continued weight loss. The goal is weight stability. I’ve been microdosing for roughly 18 months and the number on my scale has remained the same.

This approach allows many patients to preserve the health benefits they’ve achieved from GLP-1s while minimizing medication exposure and cost.

Of course, there are exceptions.

Occasionally, I recommend stopping treatment if a patient is becoming excessively thin (one extreme user was down to barely 100lbs), losing too much muscle mass, experiencing negative side effects or chasing a goal weight that is no longer healthy nor even achievable.

As a physician, my responsibility is not to help patients become the thinnest version of themselves. My responsibility is to help them become the healthiest version of themselves.

But, as a doctor, I must also recognize that not everyone wants to use GLP-1s in a rational way.

Dr Sheila Nazarian is the founder of Nazarian Plastic Surgery and NazarianSkin

The recent trend toward ‘Ozempic skinny,’ for instance, has created unrealistic expectations. But being underweight is not healthier than being overweight.

Extreme weight loss can carry its own risks, including nutritional deficiencies and reduced bone density. Anecdotal evidence has also linked some GLP-1s to manifestations of eating disorders such as anorexia.

But even with all of these potential risks, I believe that when GLP-1s are prescribed responsibly and patients are treated appropriately, the drugs can be lifesavers and life-changing.

Emerging research suggests GLP-1s may reduce the risk of certain obesity-related cancers. Studies have also demonstrated significant cardiovascular benefits, including reductions in heart attack and stroke risk. Researchers are actively investigating potential protective effects against neurodegenerative diseases, such as Alzheimer’s disease, as well.

So, when patients ask me when they should stop their GLP-1 medication, my answer is often another question: ‘Why would you stop something that’s working?’

If a patient is at a healthy weight, feeling great, maintaining muscle mass, tolerating the medication well and experiencing meaningful health benefits, I generally prefer microdosing rather than discontinuing treatment altogether.

The future of weight management may not be about getting off these medications but learning how to use them intelligently for the long haul.

Living a sedentary life could be even more dangerous than smoking, and outdated exercise guidelines may be partly to blame.

Very low cardiovascular fitness quadruples the risk of death compared to a high-fitness lifestyle, while low muscular strength more than doubles it.

Smoking, meanwhile, raises the risk by about half that. Still, 28 million Americans smoke combustible cigarettes.

A sedentary lifestyle fundamentally damages the heart, weakens muscles, and disrupts how the body processes sugar and fat. Over time, this drives up one’s risk of heart disease, stroke, diabetes and certain cancers. 

For most healthy adults, the CDC and federal guidelines recommend 150 to 300 minutes of moderate-intensity exercise or 75 to 150 minutes of vigorous activity per week and muscle-strengthening activities at least two days a week

While only about 20 percent of American adults meet these activity recommendations, Dr Chris MacDonald, a behavioral scientist at the University of Cambridge and author of a new report on the harms of an inactive lifestyle, says they aren’t ambitious enough.

He said current exercise standards are built around a ‘bare minimum’ mindset designed to prevent deficiency, not to help people actually thrive.

Poor cardiovascular fitness quadruples death risk while smoking raises it by roughly half that amount. And 28 million Americans still smoke (stock)

In his report published in the journal Frontiers in Nutrition, MacDonald cited a study that tracked over 122,000 adults for more than eight years. It found that low muscular strength is linked to roughly a 200 percent higher risk of early death compared to high strength. 

Very low cardiovascular fitness is associated with about a 400 percent higher risk. 

Researchers behind that report looked at patients who underwent exercise treadmill testing and grouped them by fitness level: low, below average, above average, high and elite.

People in the elite fitness group had about 80 percent lower risk of death compared to those in the lowest fitness group.

Being unfit carried a risk of death comparable to or even greater than having coronary artery disease, smoking, or diabetes. In fact, the increased mortality risk associated with low fitness was several times larger than the risk tied to smoking.

Smoking, a separate study found, raises mortality by about 50 percent by comparison. The statistic that MacDonald cited came from a 2017 meta-analysis of 12 studies regarding the risk of sudden death due to smoking.

The report found that current smokers have more than three times the risk of sudden cardiac death compared to never-smokers. Former smokers still carry an elevated risk — about 38 percent higher than never-smokers — but quitting lowers it.

Each additional 10 cigarettes per day raises the risk of sudden cardiac death by about 58 percent, according to the report.

Over 122,000 adults were tracked for more than eight years in a 2018 study. The least fit had roughly five times the death risk of the most fit, which is a 400 percent higher risk 

The study’s authors noted that because 80 percent of sudden cardiac deaths are caused by heart rhythm disturbances, smoking’s link to arrhythmias through nicotine’s effects on the heart’s electrical system may help explain the connection.

MacDonald did not specify the health risks tied to vaping. The statistic he cited referred to traditional cigarettes.

The harms of a sedentary lifestyle are also well-documented. 

In one study of older adults, those who were physically inactive had more than double the mortality risk of their more active peers.

When physical inactivity is combined with other risk factors like smoking or obesity, the effects compound dramatically. 

Adults who are inactive, smoke, and are obese face a mortality risk more than 230 percent higher than those without these risk factors.

Low fitness is associated with a two- to 2.5-fold increase in mortality risk regardless of body weight. This relationship holds across decades of follow-up, with low fitness consistently linked to higher death rates in both men and women.

The CDC recommends 30 minutes of moderate exercise daily, five days a week plus strength training twice weekly. Only 20 percent of Americans meet these goals (stock)

Muscular strength matters just as much. Low muscular strength is independently associated with higher all-cause mortality, even after accounting for physical activity levels and cardiorespiratory fitness.

Referring to the UK’s single-payer National Health Service’s recommendation to aim for at least 20 minutes of moderate exercise a day, MacDonald said guidelines are framed around ‘minimums’ that ‘are not supported by the best available data nor do they explain the broader benefits.’

‘The UK and other governments should be ambitious and aspire to have the healthiest populations possible. Limiting recommendations to casual strolling and encouraging people to sit less, and reducing success to the number of daily steps is unambitious and inadequate,’ MacDonald said.

‘In my opinion, we should instead promote a culture that values strength, fitness, and purposeful movement across the lifespan, enabling people not merely to live longer, but to remain capable, independent, and vibrant throughout their lives.’