# GP Cover Letter: New Thirst and Urination Symptoms, Hand-Skin Review, and Separate Appointment Requests Date: Monday 13 July 2026 Type: Cover Letter ## Current concerns The matters below are arranged broadly from those requiring the most immediate attention to wider matters that may need to be addressed later. The main matter for assessment during this consultation is item 1. Item 2 may also be reviewed if there is still enough visible or palpable abnormality at the time of the appointment. Otherwise, the photographs and supporting record provide the clearest evidence, and a further appointment may be needed when the condition recurs. Items 3 and 4 are limited requests concerning the suspected medicine reaction record and the reissue of two questionnaires. Items 5 and 6 are included as wider clinical background that may be relevant to assessment, prescribing decisions, referrals, or future care. I am not requesting detailed assessment of either matter during this consultation. 1. New excessive thirst, increased urination, profound fatigue, and a perceived need for salted water. 2. Recurrent raised and itchy skin changes affecting the back of the right hand (advice requested on the safe use of Elocon, including when to start and stop treatment and how long each course should last). 3. Review and appropriate documentation of the previous suspected naproxen-related itchy rash. 4. Reissue of the ADHD questionnaire and AQ-10. 5. Possible dyslexia or another specific learning difficulty, included as background only; no GP or NHS action is currently requested. 6. DSD-related matters, included as background before a future referral request. ## Details ### 1. New excessive thirst, increased urination, fatigue, and perceived need for salted water Since around Monday 6 July 2026, I have experienced: - markedly increased thirst; - increased water intake; - increased urinary frequency and urine volume; - profound fatigue and sleepiness; - strong resistance to drinking plain tap water; and - a continued preference or perceived need for water with added salt. Before Friday 10 July, I had not expected the symptoms to continue and had not kept a formal fluid record. I retrospectively estimated that tap-water intake, including salted tap water, had increased to approximately 2 litres per day, around 1 litre more than usual. I began keeping a more detailed fluid and symptom record on Friday 10 July 2026. Oral rehydration solution was used: - once on Friday 10 July; - twice on Saturday 11 July; - twice on Sunday 12 July; and - once by the morning of Monday 13 July. The oral rehydration solution replaced some occasions on which I would otherwise have consumed water with added salt. I attempted to drink plain tap water between oral rehydration solution drinks. However, plain water continued to produce a strong resistance to drinking, and I therefore continued adding salt to most of the remaining water. There may have been slight subjective improvement, and daily water intake may have reduced by approximately one cup. However, the quantities were not formally measured, and there was no clear objective improvement in: - thirst; - urination; - fatigue; - resistance to plain water; or - the overall drinking pattern. Because my recent intake of water, added salt, and oral rehydration solution may be relevant to blood or urine tests, I would appreciate advice on: - whether further assessment or investigation is required; - whether I should change anything before testing; - whether continuing salted water or oral rehydration solution is appropriate; and - what I should do while awaiting further assessment. I am not assuming that these symptoms were caused by the revised exercise programme started after the Musculoskeletal Services appointment on Thursday 2 July 2026. However, the timing is recorded because the symptoms began approximately four days later. Related document(s): - **Excessive Thirst, Increased Urination and Salt Craving Record** - **Long-Term Health Summary** ### 2. Recurrent raised and itchy skin changes affecting the back of the right hand The recurrent skin changes became more noticeable again around Saturday 4 July 2026. Because the appointment had already been arranged, I applied Elocon 0.1% w/w ointment: - on one occasion only; and - to only part of the affected area. The intention was to reduce symptoms while preserving part of the untreated appearance for clinical examination. By Friday 10 July, the appearance had changed and no longer fully represented the untreated recurrence. The remaining abnormality was easier to detect by touch than by sight. After Friday 10 July: - small raised spots became noticeable again; - the affected area became itchy; and - by Monday 13 July, the raised and itchy changes were more pronounced than they had been on Friday. The itching remains tolerable. I have not started another Elocon course because similar changes have repeatedly returned after approximately three previous short courses. I would appreciate advice on: - what the recurrent skin changes may represent; - whether the diagnosis or treatment approach should be reviewed; - when Elocon should be started during a recurrence; - how many days each course should last; - whether it should continue after the visible spots or itching improve; - when treatment should be stopped; - whether there is a maximum recommended duration for each course; and - when further clinical assessment is required. Photographs taken before the partial Elocon application provide the clearest record of the untreated appearance. Related document(s): - **Recurrent Hand Skin Changes and Suspected Naproxen Medicine Reaction Record** - **Long-Term Health Summary** ### 3. Previous suspected naproxen medicine reaction During the February 2026 acute episode, I developed numerous itchy red spots extending from the wrist towards the elbow while taking naproxen and flucloxacillin concurrently. The rash improved after naproxen was discontinued while flucloxacillin continued. This timing makes naproxen my main suspected trigger. However: - causation has not been clinically confirmed; - flucloxacillin cannot be completely excluded; and - no medicine-allergy diagnosis has been made. As of Monday 13 July 2026, this suspected reaction has not been formally reviewed or added to my medical record. I would appreciate advice on: - whether and how the suspected reaction should be recorded; - whether future naproxen use should be avoided; - whether precautions are required with other NSAIDs; and - whether any further medicine-allergy assessment is needed. Related document(s): - **Recurrent Hand Skin Changes and Suspected Naproxen Medicine Reaction Record** ### 4. ADHD questionnaire and AQ-10 - Please could the ADHD questionnaire be reissued, as I was unable to complete it within seven days. - Please could the AQ-10 questionnaire also be reissued. ### 5. Possible dyslexia or another specific learning difficulty I may have dyslexia or another specific learning difficulty, although this has not been formally assessed and I cannot be certain. I have noticed similar difficulties when studying English, French, and Japanese. The most significant current impact is on compulsory English-language study. I am not currently requesting assessment or other action through the GP or NHS. As any formal assessment would mainly be used for educational support, I intend to raise this directly with my future university. I am including this as wider background information only. ### 6. DSD-related matters I also have DSD-related matters that I would like to discuss separately when I have more capacity. This is a substantial topic and is not expected to be addressed fully during this consultation. I am including it as wider clinical background because it may be relevant to assessment, prescribing decisions, referrals, or future care. After my usual GP returns from leave and I have completed the relevant supporting documents, I intend to request an appropriate referral. ## Notes Plain-text versions of the related documents are available at: **https://gp123.pages.dev/** The principal related documents for this consultation are: - **Long-Term Health Summary** - **Excessive Thirst, Increased Urination and Salt Craving Record** - **Recurrent Hand Skin Changes and Suspected Naproxen Medicine Reaction Record** - **Knee and Lower-Limb History** The **Long-Term Health Summary** provides an overview of the timing and overlap between the different health events. The condition-specific records contain the detailed observations, medicine histories, symptom estimates, photographs, and questions. The website contains patient-prepared plain-text documents only. Original NHS records, prescription labels, photographs, and other clinical records remain the primary supporting evidence where applicable. These documents record the observations that appeared relevant at the time of writing. They may not contain every detail that would be clinically useful. Please ask me about any additional history or information that may assist the assessment. Please feel free to copy, adapt, or retain any relevant information for clinical documentation or referral writing. As I am not a healthcare professional, please verify any clinical information before relying on it. Thank you for reviewing this information.