GCXZ

Have you met this condition before? Can you suggest anything I can take or do to alleviate this problem

I am 83 years old and have been on blood pressure tablets for more than 10 years (lisinopril and amlodipine)

Yours sincerely Keith B

Dear Keith B,

Thanks for your query. I presume there is nothing abnormal about the appearance of the tongue - if so it may be this discomfort is caused by food or chemical sensitivity. The two main culprits are likely to be the preservative known as Benzoate present in processed food with E numbers E210 - 19, and the chemical Sodium lauryl sulphate (SLA) found in toothpaste.

Dear Dr Le Fanu,

I wonder if you can help solve a mystery?

I have a heart problem, an ectopic heartbeat, that only occurs when I eat wheat/gluten. My problem is to convince the medical profession that this is a real effect. I cannot get anyone to believe me. I have ended up in A&E several times when it has been really bad - they take a trace, increase my Beta blockers and send me home. Nothing goes on record to explain why it has happened, even though I explain it to everyone - my explanation of the cause goes unbelieved and unrecorded.

Does anyone else have this problem?

I had been ill with endless symptoms for several years, no tests showed up anything . My GP was starting to give me that ' Oh no, not again! ' look. Then I read a magazine article about wheat intolerance, and realised that I had all those symptoms and a few more. It was worth a try. Within days of giving up wheat, I started to feel better. When I told my GP, she gave me a test for coeliac disease, which was negative, as I had been wheat free for a while. As I refuse to make myself ill by eating wheat/gluten to take another test, her comment was that 'I remain undiagnosed'. Consequently, there is nothing on my medical records.

If I accidently eat wheat or gluten, I find that about twelve hours later my heart starts to jump around. This ectopic heartbeat can continue for hours before settling . It then continues to occur about twenty minutes after starting to eat. This effect can last for up to five weeks.

How can I get this problem recognised? I would be grateful for your advice.

Yours hopefully,

Jane R

Dear Jane R,

Thanks for being in touch and my sympathies for the frustration you must feel that you doctor does not acknowledge you have wheat/gluten allergy. The important thing however is that obviously excluding it from your diet has proved so beneficial. I was not aware that it could cause arrhythmias of the heart but note this is mentioned on the website of the Mayo Clinic.

Dear Dr. le Fanu.

A while back, acting on your advice, I bought a pump action "Ear Clear" irrigation device which has had intermittent use.

More recently, in need of replacement hearing aids, my wife was told by the audiologist that a plug of the ear could not be taken because of wax build up. After a week of nightly treatment with olive oil, she went to the practice nurse at our GP to be told that some wax remained and keep up the treatment as it was coming away nicely. She refused to flush out the ear on the grounds it might cause an ear infection.

Later, the audiologist called again only to find ear wax still present and therefore still unable to take impressions. So it is continue the treatment and back to the surgery to get someone to peer into her ear and report on the position.

I gather from another source that flushing out ears is bad this week. Whatever, it is a frustrating business and you get the feeling that you are being pushed from pillar to post and no end in view.

Were the condition on the surface, its state could easily be seen but a special instrument is needed view into the ear canal that only professionals seem permitted to use. How can one tell if there is ear wax build up? And how much? None seems to be the requirement for taking ear impressions for obvious reasons.

Self administering ear wax removal potions might help and use of the "Ear Clear" pump might flush it out but, it seems this might now be out of favour, possibly dangerous for fear of causing an ear infection and the GP reaching for yet more anti-biotics.

What is the common sense answer?

Best regards, M J M

Dear M J M,

Thanks for being in touch and I am sorry for the difficulties your wife has encountered. This claim that syringing the ears does not work/causes an infection is quite baffling. It is one of the most simplest and most dramatic of procedures. It is particularly necessary for those who need hearing aids as these can cause the ear canal to produce considerable quantities of wax. It looks as if this can be an ongoing problem so you might consider purchasing an Auroscope which is easy to use and which combined with the Ear Clear pump will ensure her ears remain wax free.

Dear Dr Le Fanu

Regarding your article in Monday 29 July's paper, I cannot comment on Prozac, but I have by chance found a similar effect from Healthspan's Over-70s Mulivitamins.

I now have osteoarthritis in my thumbs and right wrist resulting from several minor skiing injuries, which was very painful, to the extent that I could not lift a pan or do the ironing with my right hand, and sore to the touch. My husband bought some Over-70s vitamins but could not use them due to the presence of Vitamin K. I started taking them to use them up and found after a couple of weeks that the pain and inflammation had gone. Last month I purposely stopped taking them when on holiday for a week and found that the pain was returning when I got home. I started taking them again and the pain has now gone.

I have no idea which ingredient is responsible as there are so many. I would not normally have started taking vitamins as I feel that we get sufficient vitamins from fresh home-cooked food with a balanced diet and have not found any other discernable advantage. However, under the circumstances, I shall carry on taking them, and would recommend anyone to give them a try if they are suffering.

Thank you for a very common-sense attitude to health care, which makes a pleasant change from the current fashion of trying to treat every situation that is recorded as "above normal". Don't they realise that we are individuals and everyone's "normal" is different. I would personally reject treatment unless it could be shown that it was "dangerously high". Is this reasonable?

Yours sincerely

Dear Anon,

Thanks for that most interesting account of your serendipitous arthritis cure I look forward to mentioning in the column for the benefit of others.

I remember my uncle, wounded in WW1, told me he was taken to an hospital In Paris and fed on oysters and champagne !

Dear Anon,

Thanks for that - I am sure he deserved it. Others have recounted similar experiences.

Dear Dr le Fanu, your column in the Telegraph welcomes queries. I have a presumed prostate problem which doesn't fit with my Dr's "normal" view of the difficulty.

About 4 weeks ago she had the results of the urine test [and was OK] and the PSA at 0.4. "Very smooth and slightly enlarged she said, at 9am.

Symptoms vary consistently during the day, if they vary at all, and I wondered if there was an explanation?

3am-ish less than perfect flow.

8am—usually best flow of the day.

9am after breakfast—bowel movement.

Mid morning usually normal flow.

2pm possible slight deterioration.

5pm possibly more degraded.

8pm and bedtime, sometimes as bad as half max. flow, but not always that bad.

Could the state of the bowel in terms of gas or unremoved water, have an effect on the prostate as, after all, this is where you Doctors get the "Hands on" knowledge.

I was also wondering if diet or presence or not of some minor virus caused the gland to swell or contract?

Thanks

Leslie D

Dear Leslie D,

Thanks for being in touch with your interesting query. The problem you describe is, I suspect, quite common though I could not find any mention of it in the medical literature. A 'full' colon can press on the angle of the bladder and cause urinary obstruction so it could be that the variability of your symptoms is a variation of this - though surprising that your 'best' urinary flow should be just prior to opening the bowels. The other possibility might be positional where the effect of gravity from walking around all day might alter the position of the organs in the pelvis, and thus the angle of the bladder, which is then reversed by lying flat in bed at night. I hope to mention this in the column in the hope that it might elicit further possible suggestions.

Dear Dr. Le Fanu,

My sister, who lives in the South East told me recently that her doctor offered her some "lipid like" tablets to treat "borderline high" cholesterol.

She asked him directly "are they statins?" and he said yes, they were.

I now know of someone else (who lives in the North West) who I understand has been offered "lipid tablets" by her doctor - although I do not yet know if they are simply "as described" or if (as I suspect) they are in fact the same things which my sister was offered.

The first situation suggests to me that the G.P. in question was avoiding mentioning the "statin". Further, if both stories are the same - "lipid/lipid like = statin" - then this further suggests that a single source was encouraging both G.P.s to describe the treatment thus?

I wonder if it would be of interest for your Telegraph column to see if there are other, similar stories?

Regards

Stephen B

Dear Stephen B,

Thanks for being in touch. I suspect you are right about this euphemistic change in terminology and the reasons for it. I will mention it in the column to alert others to this covert method of prescribing statins.

THE RESULTS OF LETTING MEDICAL SCIENCE HELP ME !!!

The result of a blood test in 2012 showed that I have a vitamin D deficiency. I was prescribed a course of calcium carbonate and vitamin D3, chewable tablets, 400 I.U.twice daily and was advised to sit out in the sun for 20min per day. I have an underactive thyroid and am intolerant of the sun's rays. However, using a prescribed suntan lotion, I did that in mid afternoon whenever possible.The combination enabled me to get through the winter of 2012/13 without suffering the usual frightening depression.The annual blood test in Spring 2013 showed my vitamin D3 level although improved was still below the satisfactory level and my G.P. prescribed a capsule of 800 I.U. twice daily. I took one capsule as prescribed. I had the most violent reaction. It lasted for several minutes during which I thought I was dying.The local pharmacist recognized the reaction as I described it to him and said that the drug company was having problems with the coating of the capsule. He was not surprised by my reaction to it. My doctor however did not at first believe me. She said that the Practice had innumerable patients taking it. Now I am taking the chewable tablets again!! Am I the 1 in ten thousand ?

Margaret R

Dear Margaret R,

Thanks for being in touch. It certainly sounds as if you have had a severe allergic (anaphylactic) response probably due to the soya which is used as a 'carrier' for vitamin D in these capsules. You should stick to the chewable tablets.

Dear Doctor Le Fanu,

I was interested in the "filament" causing irritation in the foot.

My suggestion is a dog hair. Over the years I have extracted these from the feet of various family members - they are very difficult to see but removal, with tweezers, gives instant relief. It is my recollection that Labrador hair was particularly troublesome.

Dear Anon,

Thanks for your suggestion of the possible cause for those mystery white filaments - that feature in the column on Monday.

Dear Dr Le Fanu - a possible explanation of the 'white filament' which a reader extracted from his foot. My husband had a similar experience and the culprit proved to be part of the nylon plastic tag with which his new socks had been fastened together!

Best wishes

Dear Anon,

See above.

Dear Dr Le Fanu,

I assume that the body has a "thermostat" that controls how hot and cold we feel. My wife (aged 71) regularly fluctuates between feeling "hot" and "cold" regardless of the ambient temperature so I assume that her "thermostat" is faulty. Any ideas on the likely cause ?

Regards,

J E H

Dear JEH,

Thanks for being in touch. I suspect your wife must have some disturbance of the autonomic nervous system that controls the 'automatic' functions of the body such as the thermostat controlling the core temperature. There is, regrettably, no specific cure but a reader in the past has mentioned soya (in the form of the herb drink Bioforce Menosan) in controlling excess perspiration in the upper part of the body and which might also perhaps minimise the discomfort of those hot spells.

Dear Dr. Le Fanu

For the past week or so I have had recurring, maybe half a dozen a day, bouts of split second feelings of fainting followed by a lengthy neck and shoulder ache.

I have arthritis in my spine and take tablets for blood pressure and I also have difficulty sleeping.

I have made an appointment with my GP but as I didn't think it warranted an early visit I have over a week to wait

In the interim I wondered if you could possibly shed some light on this.

Thank you, best wishes.

George T

Dear George T,

Thanks for your query. This, I agree, is a puzzling set of symptoms for which I have no ready explanation. Perhaps you could be in touch again once you have seen your family doctor.

Dear Dr.James Le Fanu,

Prostate Cancer

I suffer from this form of cancer and have hormone injections.

Can you explain why on some nights I have to urinate nearly every hour whilst on others I can go through the night with never having to go .

I have tried to reconcile this with what I have eaten and drunk - I have a glass of wine or beer most nights - but to no avail. Hot weather seems to make a big difference with less trips. Any ideas?

Many thanks,

David B

Dear David B,

I presume you are receiving hormone treatment for a tumour on the prostate gland. This is rather different from Mr Leslie D's query above - but as they are both in the same territory, as it were, I will mention them in the column in the hope that some explanation might be forthcoming.

Dear Sir,

Re: the gentleman who found mysterious foreign bodies emerging from his foot. May I make one or two suggestions? Hairdressers frequently suffer from short, sharp hairs sticking in the soles of their feet. Not, I suppose, merely restricted to hairdressers. I have also suffered from short, sharp hairs in my feet from the many dogs over my lifetime. Also, a few years ago we mistakenly planted Rosa Rugosa for a hedge. The thorns from these are tiny, sharp, virtually colourless and only discovered some time later when they have festered.

Olga L

Dear Olga L,

Thanks for these further suggestions as to the possible explanations of these foreign bodies.

I am a retired male aged 71. For the last few years I have found that parts of my body swell in temperatures over approximately 25 degrees.

The areas affected are my feet, ankles, hands, wrists and my stomach. Sometimes my knees also swell.

I feel bloated and quite uncomfortable and it is often difficult to walk. Is this a known condition and do you know what treatment will cure it?

Thanks, TWB

Dear TWB,

Thanks for your query. This swelling is caused by dilation of the blood vessels under the skin as part of the thermoregulatory response to hot weather with the consequent exudation of fluid into the surrounding tissues. The normal advice is to reduce the amount of salt consumed but would not have thought this likely to be very effective (or a particularly good idea). This is obviously causing considerable discomfort and you might discuss with your doctor taking a small dose of a water tablet (or diuretic) in hot weather to disperse the excess fluids.

Dear Dr, I suggest that the white filaments your correspondent sometimes extrudes from his feet (Doctors Diary 05/08/2013) are in fact either animal hairs (dog probably) or carpet/matting fibres. As a registered podiatrist (chiropodist) I have often treated patients with mystery pricking lesions, from which I have extract dog hairs or other fibres. If he habitually walks around barefoot and has a dog or some stiff matting at home, this is the most likely explanation. The answer is to wear slippers.

With regards,

E V B

Dear EVB,

Thanks for your explanation that features in this week's column.

Dear Dr James,

My 26 year old daughter who has always been very slim but is increasingly suffering from prolonged painful cramps of the toes and soles of her feet. Never in the calf. She drinks plenty and keeps her feet warm and eats a good varied diet. Any ideas?

Mary G

Dear Mary G,

Thanks for your query on behalf of your daughter. It must be quite unusual for someone of her age to be troubled with cramps as you describe - which suggests they may be some underlying cause. The biomechanics of the foot can be a predisposing factor in those with flat feet or do insufficient stretching after exercise. I know your daughter has a healthy diet and there is no reason why she should be deficient in several minerals - potassium, calcium and magnesium - that have been implicated in causing cramps. She might however have a blood test just to ensure that the levels are in the normal range. Bananas are a potent source of both potassium and magnesium.

A few weeks ago my grandson was taken ill at school and taken to hospital where the initial diagnosis was appendicitis but further tests diagnosed a blood infection which thank goodness he has now fully recovered. The treatment given was daily intravenous antibiotics.

It has left us with more questions than answers for instance how did this happen as, blood results were inconclusive as to the cause. He had not been bitten, stung no open wounds whatsoever and ingested anything other than anyone else also not travelled anywhere where these infections are rife.

Our fear is that this illness may return if the cause cannot be found. I hope you can help us with our worries.

Kind regards

Dear Anon,

Thanks for being in touch and I am glad to hear your grandson has recovered so well from his septicemia. I am sure the hospital doctors would have investigated the possible sources of an infection - but as you will know it is not unusual for no cause to be identified in which case the chances of recurrence are near to zero. It might be sensible however for his parents to enquire why his original symptoms were attributed to appendicitis - and to ensure that, for example, the possibility of a 'grumbling appendix' has definitely been ruled out.

Would anyone have any suggestions to help with cramps in the lower legs and feet during the night. My doctor did not want to prescribe quinine because of side effects, she said it had been banned in America. I find if I get out of bed and stand or walk around then it usually goes but it means getting up sometimes a few times in the night.

Sincerely - Mrs L A

Dear Mrs L A,

Thanks for your query and see my reply to Mrs Mary G above. There is a long list of potential cramp remedies which I would be pleased to forward if you could let me have your postal address.

Dear Dr LeFanu, before going into my reason for contacting you, I would just like to thank you very much for the help and advice you give in your column which has been so very helpful to me over the years. You are my back-up GP many times!

Some years ago when the subject of cholesterol and statins was first in the headlines I was under some pressure from my GP to take statins, because of my blood pressure and a cholesterol reading of between 6 and 7. Which was stable in those parameters for many years. I was very reluctant and refrained from taking this advice. Then fresh pressure from the Government Health Watchdog, surgeries were encouraged with a monetary reward if they persuaded their patients, whom they deemed suitable candidates to take statins. To please my GP after all her care of me over the years I decided, reluctantly, to do so. I had been on them some months without any noticeable side effects, until one day in the duty free shop, prior to my flight I thought to buy some perfume. I had absolutely no sense of smell. Couldn't smell a thing then I realised I had also a very restricted sense of taste. The latter had at times niggled but I had not given it any real thought. So I stopped the statins. They were the only thing I could identify as being responsible. I had not been ill, no viral illness that might have caused this to happen and so I stopped the statins.Then sometime thereafter you gave your views on taking statins by older folk, I was 70 years old at that time. I subsequently read two research papers obtained by a doctor friend, and felt relieved at my decision. My cholesterol has remained the same. Thank you for that guidance, and now my reason for writing you is because I would like you to help me with my problems taking warfarin.

I have had Paroxysmal Atrial Fibrillation for about 12 years. Medication was verapamil 80 mgm o.d. also Aspirin 75mg o.d. After an initial Cardiac screen, Echocardiogram, Stress Test appropriate bloods this was the regime I was on for some years. The attacks were random and separated by months, until a prolong attack necessitated a trip to A&E. My blood pressure was then questioned and after monitoring I was give a hypertensive Candesartan 16 mgm b.d. The random attacks became a little more frequent and after referral to a Cardiac Consultant I was given in addition Bendroflumethiazide 2.5.mg l o.d. On this regime the A.F attacks returned to being infrequent, months apart and short lived. Until in 2011 I again had another prolonged attack and was sent to A&E. The outcome was, a very keen houseman, horrified that I was not on warfarin suggested I commence taking it with all the usual warnings if I did not. Within a month of taking warfarin it settled quickly and within 6 months I was having readings every 10 weeks. In April 2013 my reading was 2.0 and 8 weeks later it was l.8. with appropriate change to the warfarin dose. For the last 4 weeks the readings have remained at about this level and this week it was 1.5. and 6mg/5mgm alternate days. THE QUESTION if this level persists and I no longer stay in the desired therapeutic range of 2 - 3 which is the aim I want to know why this is happening with no change in my lifestyle. Are there any statistics or papers that mitigate against the efficacy of returning to taking aspirin and stopping the warfarin. I had been reluctant to commence it and am always undecided whether to continue it, when having had AF for so many years and treated with aspirin I should now have this 'sledge' hammer to prevent strokes etc., at the great age of 75 years.

I am looking forward to your advice. Thank you in anticipation Dr.Le Fanu. Mrs A S

Dear Mrs A S,

Thanks for your query and generous comments about the column. This is a tricky one. The combination of your age (75+) and raised blood pressure places you in the 'high risk' category of having a stroke for which Warfarin treatment is advised and a most effective preventative measure. I think it probably best to stick with these current recommendations despite the difficulties you are having in finding the right dose. Still it might be you could switch to just taking aspirin at some time in the future.

Dear Dr two or three weeks ago you printed a letter from a lady who had a bowel problem so much so that she could not go out, she had resolved the problem but for the life of me I cannot remember what that outcome was, my husband is now in that position and we would be most grateful if you could advise us what the lady did to resolve the problem, I wish I had kept the article, and I would not need to trouble you, many thanks in anticipation.

Pam

Dear Pam,

Thanks for your query. The drug is Cholestyramine, otherwise known as Questran. I do hope it helps your husband's problem.

Hi Dr James,

My friend in Spain has had bowel cancer surgery called an "Ileostomy" on 27th June.

She had a reaction but it has cleared up, but now she has mucus discharge.

If anyone has any information post op we would be very grateful.

Lin P

Dear Lin P,

Thanks for your query. I am sure this is best sorted out by the surgeons who performed the operation.

Dear Sir,

When I was on holiday in Spain in June I suffered from two consecutive morning occurrences where I struggled to breathe for approximately 5 - 15 minutes.

These took place as I got up from bed and the feeling was as if I had been winded. After my breathing had returned to normal, I was able to act as usual albeit at a slower pace.

I suffer from c.o.p.d. and am fully aware of the problems of bronchial problems, but this was unlike anything I have ever suffered before, or since.

On my return I saw my GP who prescribed antibiotics and steroids for a five day course, and my breathing and general well being was considerably better.

I also saw my lung specialist who sent me for a pulmonary scan which proved clear. However as my breathing levels had deteriorated he also prescribed a ten day reducing course of steroids.

I had been booked to see a heart specialist as an e.c.g I had taken before my holiday showed a change since the previous one three years ago. It showed a Bifascicular Block.

I explained what had happened and he sent me for an echocardiogram, a calcium scan and a twenty four hour holter ecg. These were all clear and he was unable to suggest a likely cause for my breathing problem.

I am 63 and as well as c.o.p.d. I have high blood pressure and some gastric problems which may or may not be associated with taking in too much air brought on by the c.o.p.d.

I would be most grateful to hear if anybody else has suffered anything similar and if so what was the cause.

Yours Sincerely,

Marcus P

Dear Marcus P,

Thanks for being in touch. These two acute episodes of breathlessness are suggestive of a cardiac problem - despite the normal findings of the cardiologists. They might perhaps have been brought on by a transient disturbance of heart rhythm - perhaps related to the bifascicular block you mention. I can only suggest that if there is a next time you should check the pulse and seek prompt medical attention.

Migraine,

I carry two sugar cubes with me wherever I go. At the first indication of an attack I take them (one at a time) the migraine doesn't then take effect. I should stress you need to act at the onset and not delay for any reason. I had suffered with this condition for many years and this is the only cure I have found.

I wish them luck

ASF

Dear ASF,

Thanks for that most useful and simple migraine cure.