FDA proposes rule to prevent food contamination during transport

Fri Jan 31, 2014 12:21pm EST

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A view shows the U.S. Food and Drug Administration (FDA) headquarters in Silver Spring, Maryland August 14, 2012.

Credit: Reuters/Jason Reed

(Reuters) - Food transportation companies will be required to adhere to certain sanitation standards to prevent food from becoming contaminated during transit under a new rule proposed by the U.S. Food and Drug Administration.

The rule would require shippers and carriers to properly refrigerate food, clean vehicles between loads and protect food during transportation.

The rule is the seventh and final plank of the 2011 Food Safety Modernization Act, a sweeping initiative designed to reduce food-borne illnesses by giving the FDA greater powers to intervene before an outbreak occurs.

It would establish standards for vehicles and transportation equipment, transportation operations, information exchange, training and records.

"This proposed rule will help reduce the likelihood of conditions during transportation that can lead to human or animal illness or injury," said Michael Taylor, the FDA's deputy commissioner for foods and veterinary medicine.

Excluded from coverage will be shippers, receivers or carriers whose operations generate less than $500,000 in annual sales. The rule also excludes food that is fully packaged and stable, and live food animals and raw agricultural commodities transported by farms.

The FDA proposes staggering the implementation of the rule based on the size of a business, ranging from one to two years after publication of the final rule. The proposed rule is open for public comment through May 31.

(Reporting by Toni Clarke in Washington; Editing by Stephen Powell)

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Source : http://feeds.reuters.com/~r/reuters/healthNews/~3/Uo8Y5Ns1nyA/story01.htm

Sanofi sues Lilly over challenge to top diabetes drug Lantus

By Bill Berkrot and Natalie Huet

NEW YORK/PARIS Fri Jan 31, 2014 5:41am EST

NEW YORK/PARIS (Reuters) - French drugmaker Sanofi is suing Eli Lilly and Co for alleged patent infringements concerning its top-selling Lantus diabetes treatment, delaying the U.S. firm's plans to produce a copycat version of Lantus.

Lantus is the world's most prescribed insulin product, with annual worldwide sales of about $7 billion, but is set to lose patent protection in the United States, the world's largest pharmaceutical market, in February 2015.

Sanofi's lawsuit, filed on Thursday, triggers an automatic 30-month stay of approval by the U.S. Food and Drug Administration (FDA), keeping Lilly's biosimilar drug off the U.S. market until mid-2016, more than a year later than its previously expected launch date.

Sanofi's shares were up 0.7 percent at 73.87 euros by 0947 GMT. Shares in Denmark's Novo Nordisk, whose own rival to Lantus, called Levemir, accounts for 15 percent of group sales, were 3 percent higher at 217.60 Danish crowns.

"Any delay provides Sanofi and Novo increased pricing power in the $6bn U.S. basal insulin market," Citigroup analysts wrote.

Deutsche Bank analysts said the move also raised the possibility of a further, multi-year extension of exclusivity for Lantus if, in the end, the court found that Sanofi's patents had indeed been infringed.

The lawsuit, filed in the U.S. District Court for the District of Delaware, comes a month after Eli Lilly applied to the FDA for permission to sell a biosimilar version of Lantus, known chemically as insulin glargine.

Indianapolis-based Lilly, in its submission, challenged the validity of several patents on Lantus. But it also said it would not launch its product before Sanofi's patent on the active ingredient in Lantus expires in February 2015.

Sanofi hit back on Thursday, alleging in its lawsuit that Lilly had infringed on four of its patents.

EARNINGS BOOST

Lantus accounts for close to a fifth of Sanofi's total sales and over a third of its operating profit. Analysts estimate U.S. sales of the drug grew by 22 percent in 2013 to 3.8 billion euros ($5.15 billion).

Sanofi, which publishes full-year results next Thursday, is striving to return to growth after a difficult 2013 that featured problems in Brazil and several product setbacks.

Chief Executive Chris Viehbacher told Reuters last month he was confident its diabetes business could grow beyond 2015.

Sanford Bernstein analyst Tim Anderson said in a research note that the 30-month delay would raise Sanofi's earnings per share (EPS) from 2015 through 2020 by about 6 percent and reduce Lilly's EPS for the period by about 3 percent.

Deutsche Bank analysts said the delay would likely increase forecast EPS by close to 10 percent in 2016.

The delayed launch of Eli Lilly's biosimilar drug will also give Sanofi more time, before cheap competition for Lantus hits the market, to switch patients to a new long-acting follow-up product known as U300, which is expected to get FDA approval in 2015.

"Time is important in any switching strategy, so any delay would be supportive to the franchise's long-term growth," Jefferies analysts wrote.

(This refiled version of the story removed extraneous text characters in headline)

(Editing by Amanda Kwan and Greg Mahlich)

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Source : http://feeds.reuters.com/~r/reuters/healthNews/~3/uPavGPt49DQ/story01.htm

China reports second case of new bird flu strain

BEIJING Sat Jan 25, 2014 8:26pm EST

BEIJING (Reuters) - Chinese authorities have confirmed the second human case of the new H10N8 strain of bird flu, contracted by a woman who is in critical condition in hospital in the east of the country, state news agency Xinhua has reported.

The 55-year-old woman was admitted to hospital in Nanchang, the capital of Jiangxi province, on January 15, complaining of a sore throat and dizziness, Xinhua said late on Saturday.

"An investigation showed that she once had exposure to an agricultural market," the report said.

In December, China confirmed its first death from the H10N8 strain, also in Nanchang.

China is in the middle of its traditional flu season and has long had a problem with bird flu.

Another strain of bird flu, H7N9, emerged in China last year and so far has infected more than 200 people in China, Taiwan and Hong Kong, killing at least 52.

(Reporting by Ben Blanchard; Editing by Paul Tait)

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Source : http://feeds.reuters.com/~r/reuters/healthNews/~3/JEzKrqNZlj0/story01.htm

Michel Roux Sr makes smoked salmon gateau with poached egg and lemon

250g fromage blanc

freshly ground black pepper, for seasoning

8 pancakes, pre-cooked

200g oak smoked salmon, sliced

1 tbsp white wine vinegar

4 fresh eggs

¼ bunch dill

INSTRUCTIONS

1.Dry the lemon zest in the airing cupboard, until it is granular like salt, this should take an hour or so.

2.In a bowl, season the fromage blanc with lemon juice and freshly ground pepper. Lay a pancake onto a plate and spoon 2 tablespoons of the fromage blanc and with the back of the spoon spread it around evenly. Lay a single layer of the smoked salmon from edge to edge, careful not to overlap it.

3.Repeat until you have layered all the salmon and used all the pancakes, leaving the final one with nothing on the top. Cover with cling film and place a similar sized weight on top (I suggest a pot with the same circumference with a bag of sugar). Press for an hour or until you need it.

4.When you're ready to serve, bring a small pan of water to the boil, add a splash of white wine vinegar, stir the water and crack in the eggs one by one. Poach until soft, take out and drain,

5.To serve, cut a wedge of the salmon gateau and place on a plate. Place an egg next to the gateau and season with the dried lemon zest and picked dill leaves.

Source : http://telegraph.feedsportal.com/c/32726/f/564649/s/365b761b/sc/26/l/0L0Stelegraph0O0Cfoodanddrink0Cfoodanddrinkvideo0C10A5649680CMichel0ERoux0ESr0Emakes0Esmoked0Esalmon0Egateau0Ewith0Epoached0Eegg0Eand0Elemon0Bhtml/story01.htm

Recipes that make the most of mushrooms

When I was cooking the pie recipe below I got waylaid. On the hob was a pan full of sliced chestnut mushrooms fried in olive oil – briskly, so they'd get a good colour – with a knob of unsalted butter and seasoning added towards the end. No parsley, no garlic, just mushrooms. They were supposed to be the filling for the pie, but I ate the lot (it was lunchtime). And I found myself disagreeing with Jane Grigson (a rare occurrence), who, in her excellent book The Mushroom Feast (1975), lamented how the ubiquity of cultivated mushrooms had devalued wild ones. She's right that we should continue to value wild mushrooms, but wrong to view cultivated ones as poor relations.

Mushrooms are often described as tasting like meat, but they have a more deeply umami flavour than many steaks. Wild mushrooms have that to an extreme, and their flavour is more complex than that of cultivated ones. I recently had trouble finishing a plate of trompettes de la mort (I'm not spoilt – they were abundant and free). Their flavour was earthy, almost Bovril-like, and, served generously, almost too much. But I scoffed that panful of cultivated chestnut mushrooms without pause and thought how much flavour they give relatively cheaply. Of course the flavour of mushrooms varies in intensity. Those of the button variety are mild. Left to grow, they develop into closed-cups and then open-flats. The bigger they get, the deeper their flavour. Chestnut mushrooms are a cultivated strain, pale brown and nutty; meaty portobellos are their mature form.

I choose mushrooms according to what I want to make. The deep flavour of wide-flats is great in soup. Portobellos become even more woody and rich when roasted (splashed with balsamic and olive oil). Buttons – which many decry – are perfect raw in a salad of spinach and pecorino. Cooking mushrooms the right way is crucial. I used to fry them in butter only, but Antonio Carluccio taught me to sauté them in olive oil over a high heat first, to get a good colour (colour = flavour), then turn down the heat and add unsalted butter to enrich them.

The other key thing is to drive off the moisture mushrooms exude – very important if you are going to add them to an omelette or a pie – by whacking up the heat. And while you peruse these recipes don't forget how good a pan of fried chestnut mushrooms can be on its own. So good I had to buy another batch to finish the pie.

Mushroom and leek pie recipe

Source : http://telegraph.feedsportal.com/c/32726/f/564649/s/365d11ec/sc/26/l/0L0Stelegraph0O0Cfoodanddrink0Crecipes0C10A5863950CRecipes0Ethat0Emake0Ethe0Emost0Eof0Emushrooms0Bhtml/story01.htm

French President Hollande announces separation from Trierweiler

Valerie Trierweiler, companion of France's President Francois Hollande (C), attends a welcoming ceremony at the Planalto Palace in Brasilia, December 12, 2013 file photo.

Credit: Reuters / Ueslei Marcelino

Source : http://feeds.reuters.com/~r/reuters/lifestyle/~3/4-6k7XMBiV8/story01.htm

Pope urges apparent mafia killers of 3-year old to repent

Pope Francis waves before releasing doves during the Angelus prayer in Saint Peter's square at the Vatican January 26, 2014.

Credit: Reuters/Alessandro Bianchi

Source : http://feeds.reuters.com/~r/reuters/lifestyle/~3/Z4SNFywxJbo/story01.htm

Analysis: Replay of energetic deal-making seen for drugmakers in 2014

By Deena Beasley and Ransdell Pierson

Sun Jan 26, 2014 12:21pm EST

(Reuters) - The torrid pace of deals in the pharmaceutical and biotechnology sectors through 2013 is not expected to let up this year, thanks to new technologies to address unmet medical needs.

Between 2011 and 2016, patents in developed markets will expire on brand-name drugs that would otherwise have generated sales of $127 billion, according to data firm IMS Health. To replace some of the lost revenue, larger drugmakers are looking to bring in new products, often in areas of significant scientific advancement such as treatments for cancer, rare diseases and drugs designed to turn off the activity of rogue genes. Much of the breakthrough science is coming from biotechnology, meaning drugs derived from living cells.

There were 10 major M&A deals involving publicly traded biotech companies last year, led by Amgen Inc's $10 billion buyout of Onyx Pharmaceuticals. That was up from nine the previous year and six in 2011, according to JP Morgan.

"I think deal making this year will be even better because there was a lot of validation last year," said Joseph Gulfo, chief executive officer at Breakthrough Medical Innovations LLC, a consulting company to drug and medical device companies. "The new discoveries and data have sparked a tremendous amount of interest from the bigger companies."

Rather than the mega-mergers typically done to achieve big cost savings through layoffs and factory closings, most drugmakers are aiming for deals that increase sales. Many of them detailed their strategies this month at the annual JP Morgan Healthcare Conferenceare.

Those strategies included acquisitions of smaller companies as well as risk-sharing through product licensing and drug development partnerships.

AbbVie Inc, maker of top-selling arthritis drug Humira, is interested in a "gradual buildup" of its pipeline of experimental drugs, having forged a dozen collaborations with other drugmakers in the past three years, most involving drugs in mid-stage trials, said Chief Financial Officer Bill Chase.

"We don't have the need to go out and do a big deal. Large synergy deals are not overly attractive," he said.

HIGH VALUATIONS

With the 65 percent run-up in the Nasdaq Biotechnology Index last year, valuations of companies have gotten so high that licensing and partnership deals are becoming a more popular way to share financial risk.

"Biotech companies realize that developing a drug these days is economically and mathematically different than 20 years ago," said James Sabry, global head of partnering at Roche unit Genentech. "Most don't have that level of sophistication. Partnering with a pharma company is the only way to create long-term value."

Companies like Amgen and Roche performed well last year and don't really need to acquire new assets, beyond companion diagnostics to complement their products, said Anne O'Riordan, global managing director of Accenture Life Sciences.

According to Accenture's analysis, drugmakers that rank in the mid-tier in terms of growth prospects from new drugs and geographic expansion would include GlaxoSmithKline, Novartis and Sanofi.

A third clump of companies have relatively weak late-stage drug development pipelines and are still in the midst of dealing with expiring patents on top-selling drugs.

But most still have high profit margins and generate robust cash flows. "A lot of them can afford to buy something," O'Riordan said.

AstraZeneca, which recently paid $4 billion to buy Bristol-Myers Squibb's share of the two companies' diabetes joint venture, probably falls into that third camp, O'Riordan said.

Israel-based drugmaker Teva Pharmaceutical Industries, recently named turnaround specialist Erez Vigodman as its CEO and agreed to buy NuPathe Inc to expand its portfolio of medicines to treat conditions affecting the central nervous system.

Israel Makov, chairman of Biolight Israeli Life Sciences Investments Ltd, and a former CEO of Teva, said he believes deal flow among healthcare companies will be just as robust in 2014 as last year: "Why? Because there is a lot of money in the system and few places to invest it."

He predicted "more and more Big Pharma buying biotech because the problem with Big Pharma is the pipeline, and biotech can provide them the pipeline. Its even more expensive to develop a drug on your own and fail."

Companies like Teva, Merck & Co, Eli Lilly and Pfizer are avidly on the lookout for deals to supplement the flow of drugs from their own laboratories.

Eli Lilly CEO John Lechleiter said his company is "very active in the animal health space; we're gonna be buyers not sellers there."

He also said Lilly will look for ways to bolster its existing strengths in therapeutic areas such as neuroscience, diabetes, oncology, autoimmune diseases, or to widen its geographic presence.

"Growth is a challenge ... we have to take risk," Merck CEO Kenneth Frazier said in comments at the conference, while noting that the company still needs to build shareholder value and protect its capital.

Roger Perlmutter, head of research at Merck, said there are no longer many undervalued late-stage pharmaceutical product candidates. "There are earlier-stage products and we intend to exploit that opportunity," he said.

(Reporting by Deena Beasley and Ransdell Pierson; Editing by David Gregorio)

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Source : http://feeds.reuters.com/~r/reuters/healthNews/~3/iDpQVnUIx28/story01.htm

Obamacare coverage enrollment hits three million: official

Jaime Corona, patient care coordinator at AltaMed, speaks to a woman during a community outreach on Obamacare in Los Angeles, California November 6, 2013.

Credit: Reuters/Mario Anzuoni

Source : http://feeds.reuters.com/~r/reuters/healthNews/~3/vx15vZkpCf0/story01.htm

Detailed exams might benefit older cancer patients

By Kathleen Raven

NEW YORK Fri Jan 24, 2014 4:16pm EST

NEW YORK (Reuters Health) - Older people with cancer who seem to be coping well with the disease might still earn poor health scores when examined by a geriatrician, according to a new analysis of past studies.

The review focused on older people with leukemia and lymphoma. The findings suggest detailed examinations of those patients provide a better, more nuanced picture of their health for oncologists making treatment decisions, researchers said.

"Most of what we know about treating cancer comes from research that was done in young, fit patients," Dr. Marije Hamaker wrote in an email to Reuters Health.

Hamaker, a geriatrician at Diakonessenhuis, a hospital in Utrecht, The Netherlands, led the new review.

"It is incorrect to assume that what is best for a younger person will also be best for someone who is older," Hamaker said.

She and her team reviewed 18 published studies that looked at geriatric assessments among people with blood and bone marrow cancers. Those patients were 73 years old, on average.

The researchers found that patients who scored well on a simple health scale tied to daily activities were actually struggling in other areas especially relevant to the elderly, like cognitive function, depression, social environment, nutrition, medication interactions and frailty.

Ten of the studies examined relationships between geriatric assessment scores and death. They showed poor physical performance measured at a clinic and worse nutrition were consistently linked to a higher chance of dying early.

In the past, an older person's mental and physical decline, as well as declining social networks, were "written off as part of the aging process," said Dr. Heidi Klepin. "And yet all of those things have a major impact on how a person handles a disease."

Klepin, who was not part of the study, is an oncologist trained in geriatric care at the Comprehensive Cancer Center at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina.

"We don't have a lot of knowledge on older patients because they are rarely included in clinical trials," she said. That's because those trials often leave out people who have other health complications.

But, "there's an ever-increasing number of older patients being diagnosed with cancer," she said, and older patients require more complex care than younger ones.

Nearly one third of new blood and bone marrow cancers occur in adults over age 75, the researchers write in the journal Leukemia Research.

They stressed that there is not enough information to make cancer treatment decisions based on geriatric assessment scores. It's also not clear if the assessments benefit patients going forward.

"Do geriatric assessments result in a better quality of life or a different outcome with cancer? No one has done a randomized clinical trial to answer that question yet because it is very complicated," Klepin said.

The researchers suggest that geriatric assessments can play a role in cancer patient care and well being, but more research on the subject is needed.

"Geriatric assessments are a way of taking into account social, cognitive and physical function, as well as pharmacological concerns. (They) assess multiple health issues all at once," Klepin said.

"There is no question that as a doctor, I will be better prepared to help my patient the more I know about them."

SOURCE: bit.ly/1dc4iqJ Leukemia Research, online January 16, 2014.

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Source : http://feeds.reuters.com/~r/reuters/healthNews/~3/8LymZwSDcq4/story01.htm

Dr Le Fanu's online health clinic, Friday 24th January 2014

Dear Doctor James

I have been having this problem since last September, that is, I suffer badly with itchiness and sometimes accompanied by discharge and the feeling of not being able to pass urine. I feel as if I want to pass water, but sometimes there is nothing there, or when there is at the end of it is quite painful.

I was given so far 4 course of different antibiotics and I have also used 12 Canesten pessaries and 3 tubes of Canesten Cream. I am also using the HRT Vagifem. Nothing has worked so far. It has been hell, particularly for the past 2 weeks, I haven't been one day free of this terrible itchiness.

I feel I would like to find out the reason why the problem goes away, but keep on returning again and again.

My GP keeps on doing urine test which have showed to have an infection, hence all the different types of antibiotics I have taken so far, but it does not work.

What could you recommend as I don't know what else to take to alleviate this problem? It is so uncomfortable and distressing.

Kindest Regards

Yours sincerely

Maria

Dear Maria,

Thank you for being in touch and my sympathies for the distressing condition you describe. My impression would be that this due to a combination of factors where the Atrophic Vaginitis and the chronic vaginal thrush has resulted (I presume) in inflammation/infection around the urethra which then tracks up to the bladder resulting in cystitis. The situation is further complicated by the antibiotics taken for the cystitis predisposing to the vaginal thrush causing a sort of vicious circle. It might be sensitivity to either the pessaries or the Vagifem may be compounding matters. I would suggest discussing with your doctor switching from the Vagifem to oral hormone replacement therapy which together with the antifungal drug Diflucan should control the vaginal thrush. It can also help to take a longer course of antibiotics (for a month) to 'sterilise' the bladder and prevent recurrence of the cystitis.

Glucosamine "holiday"

Dear Dr Le Fanu

With reference to "feeling much fitter after discontinuing Glucosamine tablets", I'm curious to know what type of Glucosamine these people were taking. High dose Glucosamine Sulphate introduces a lot of Sulphates into the body and doesn't do your bones much good. (No one with Osteoporosis should take the Sulphate version). Glucosamine Hydrochloride is a much safer version in that respect supplying a much higher percentage of actual Glucosamine which as you know is used in practically every cell in the body. Can you please find out for me which version they were taking.

(Information taken from Dr Paul Clayton's book Health Defence)

Kind regards

Patrick C

Dear Patrick C,

Thanks for drawing attention to these two formulations of glucosamine. They are, I gather, claimed to be similarly effective - but it could be that those who have benefitted from discontinuing them were, as you suggest, taking the sulphate form. I will mention this in the column.

Osteoarthritis and osteopenia

Dear Dr Le Fanu,

I feel to be in a Catch 22 situation: having seemingly inherited a back condition and having issues as young as !7 with back and knees, and repeated prolonged episodes of pain throughout life, I was recently diagnosed as being moderately hyper mobile. My lifetime ( 72 years) of misuse flashed before me! Always interested in self help I sought the remedy in extreme yoga, ballet and other energetic forms of dance. At the same time as the repeated over? stretching, I have been passionate about hill walking, fast fitness classes and cycling. I am now told that I am doing too much weight bearing exercise which could cause further wear and tear on the right hip (it is not too bad as yet) whilst I had been counting on this for preventing osteoporosis. I take plentiful fish oil, Algaecal and use many herbs and spices. Other supplements I take intermittently. I have only just started on Rosehip extract said to prevent destruction of cartilage. Most of the above forms of exercise I have been forced to give up. I will not give up the walking as I need what little VitD is available (it is in the Algaecal also) and it is my form of antidepressant. Indoor cycling or crosstrainer indoors would depress me. Swimming O.K. My swimming pool not ideal. Have you any experience of Power Plate? I feel that this would be a short sharp session, minimising that couped up feeling. Or any other suggestions for appropriate exercise? I find the Alexander Technique brilliant, but cannot always afford to indulge.

Gratefully, Mary C

Dear Mary C,

Thanks for being in touch. You must be badly affected by your back pain to have to give up these outdoor pursuits that have kept you healthy for so long. I am sure you would benefit from a visit to the pain clinic at your local hospital with a view to a pain killing injection into the facet joint of the spine or something similar. Beyond that I don't have any suggestions about 'appropriate' exercise but would have thought that a physiotherapist or experienced trainer would be able to advise you further.

ALAMY

Dr Le Fanu,

I am aged 60 and several years ago suffered a vitreous humor detachment in my left eye. The right eye went the same way less than a year later leaving me with a large amount of "floaters" directly in my visual field.

I understand they are not in themselves harmless although one has to be cautious of complications involving possible retina detachment later in life.

The biggest problem is that, although I was told these floaters will generally disperse out of the field of vision in time, there is no sign of this happening.

I cannot emphasise how extreme they are - I liken it to seeing everything through a pond full of tadpoles and it has sadly affected my ability to enjoy reading - I have to constantly flick my eyes to move the floaters to enable me to read a few words before they drift back into view, effectively obscuring the words on the page.

I understand there is an operation involving removal of the gel in the eye but I have heard of many instances reporting a poor outcome.

I wondered if you have any comment that could give me hope I might improve my ability to read properly!

Many thanks

Peter G

Dear Peter G,

Thanks for being in touch and my sympathies for this serious floater problem. This is a difficult situation because, as your will know, there is no treatment other than surgical removal which is not widely practiced and described as 'risky'. Nonetheless I would have thought it appropriate to discuss with your doctor referral to a specialist in treating vitreous problems in the eye - perhaps at Moorfields Hospital - for an opinion as to whether this might be an option in your case.

Dear Dr James

Regarding the lady with ear pain. You do not mention whether she sleeps on feather or foam/fibre pillows. I always travel with a small feather pillow as I get what I call "hot ear"- painful ears, when I sleep on artificial filled pillows. One of my daughters is the same, though she has had to get used to, and cope with the problem as her husband is allergic to feathers!

Sincerely

Valerie T

Dear Valerie T,

Thanks for that useful hint and I will mention in next week's column (3rd Feb).

Dr James,

Regarding the lady who has had to sleep on her back for 20 years due to pain when her ears contact the pillow, I have seen pillows marketed in Canada and the United States which have a void in the middle to enable the ear not to touch the pillow surface. I believe they are available through various suppliers online.

I used to have a problem with pain in my right ear which prevented me from sleeping on my right side for several months. I believe the problem was caused by my excessive movement during the night which resulted in my ear unknowingly becoming folded back. Since I have stopped drinking caffeine in the evenings, and have reduced my alcohol intake which was not particularly excessive, I have had no recurrences for over a year.

Hope this may be of some interest to your correspondent.

Regards,

John F

Dear John F,

Thanks for those useful comments and see above.

Dear Dr. Le Fanu,

With reference to Mrs. D's "very itchy area around my anus", I was reminded of the same problem that my son had many years ago - in his case, however, it was caused by enterobiasis (oxyuriasis), which is a possibility that she might consider.

With kind regards (and my thanks for your ever-interesting column),

Ian G

Dear Ian G,

Thanks for that important reminder that worms can be an eminently treatable cause of itchy bottom.

Dear Dr Le Fanu,

I read with huge interest your article ref Mr. NA from Bath.

I have a life long friend who at the age of 81 has been suffering serious discomfort with a skin problem for many years. The last two he has been under a specialist and all sorts of topical and oral avenues have been tried, all being unsuccessful. He has constant irritation resulting in bleeding both at night and during the day to the extent that he has become housebound as is embarrassed in company.

I would be most interested to hear the feedback from your article and will you please advise me how I can arrange that.

Your articles are always interesting and informative and I am sure you give huge comfort to many.

All good wishes and I hope to hear from you.

Anne Q

Dear Anne Q,

Thanks for being in touch and my great sympathies for your friend's misfortune. There are, as you know, a lengthy list of causes of itchiness in your friend's age group which presumably the skin specialist has considered. Still it is a bit surprising that none of the several treatments he has tried have been of value and I wonder if this may have included a course of steroids that can sometimes work quite dramatically. The further possibility readily overlooked is that the itchiness can be a side effect of commonly prescribed drugs such as statins.

Dear Dr

In the last few weeks I seem to have developed a strange signal of a need to open my bowels.

I have had a difficult relationship with my bowels for many years on and off, I take 2 Senna tablets on prescription every night. If I try to "go" when not quite ready it usually ends in a struggle.

Recently I have noticed a strange feeling down the back of my left hand on the left side towards my little finger, It's not painful just enough to catch my attention, I respond by going to the lavatory successfully.

At first I thought it was my imagination but it happens daily. I would be interested to know if this is common. Presumably other people experience this, but it's not talked about.

Regards

Jan B

Dear Jan B,

Thanks for being in touch and your account of this unusual (and fascinating) symptom that I have encountered before associated with urination - but not with the bowels! The suggested explanation is that this is due to pressure on the nerves in the neck from the position adopted when sitting on the toilet - leaning forward with elbows on knees and then looking upwards. This should improve with a visit to the osteopath for some gentle manipulation of the neck.

ALAMY

Dear Dr. Le Fanu,

I have had several episodes of Ocular migraine in the last month. (About 8). No accompanying migraine, and no other symptoms. I consulted an Ophthalmic Surgeon, who said my eyes were fine, and that the cause of Ocular Migraine is not currently understood. He said - that he also had them! My GP send me off for various blood tests, and the cholesterol count was 7.2. I am nearly 69 yrs old, take no meds, and I am fit. BP 130/78. This is elevated, as my BP is usually 120/70 I am 5' 3.5" tall, and 1 stone heavier than usual, at 10 stone.

My questions to you are:

1) Is Ocular Migraine a vascular disease?

2) Am I at a significantly higher risk of a stroke?

3) What is the best preventative action that I can take? (Pref without meds)

Many thanks

Dear Anon,

Thanks for being in touch. Ocular migraine is indeed vascular being caused by spasm of the blood vessels to the retina at the back of the eye. It does not, to my knowledge, increase the risk of stroke. The cause, as your GP notes, is not known but it can be triggered by stress, exercise and bending over though not (or rarely) by caffeine, alcohol and other foods that may be implicated in the classic forms of migraine. I would have thought that were these episodes to become more frequent (and eight in a single month is quite a lot) you should discuss with your doctor taking some simple preventive medication such as aspirin or Atenolol.

ALAMY

An itchy embarrassing subject

Dear Dr Le Fanu

Thank you for your answer in the confidential health clinic. Your answer is very interesting, because in the week since I wrote to you an interesting thing has happened. I remembered that when the itchy problem was very bad before, I was trying to lose a few pounds in weight, as I am at the moment. I always eat lots of fruit, but more so if I'm on a diet, eating 1-3 satsumas daily. To put this theory to the test, this week I have stopped eating any citrus fruit, and the itching is greatly improved, to the extent that I've stopped using any cream. So your reply was very interesting, especially the comments about food and drink that might have a role to play. Why would this be - is there a scientific reason, or is it just an observation?

Thank you so much for your answer - just writing to you made me realize how miserable the condition is, and spurred me to think of a possible cause myself. As it turns out, it wasn't such an unlikely idea after all! I shall avoid the satsumas and let you know if my relief is temporary or permanent.

Many thanks

Mrs D

Dear Mrs D,

Thanks for that follow up and how interesting to learn that satsumas seem to be the culprit in your case.

Hello

My wife,aged 85 has over the past year, developed the irritating problem of getting an attack of hiccups after eating something sweet particularly at meal times. The attacks can last up to 10 minutes. Can any of your readers suggest a way to avoid this happening.

D A C

Dear D A C,

Thanks for your query on your wife's behalf. Some foods and drinks can indeed bring on the hiccups particularly the hot and spicy, carbonated drinks and alcohol. It is however difficult to see why 'something sweet' might be responsible - especially, as you probably know, one of the many cures include taking a spoonful of sugar!

Dear Dr James

I have been having an HRT implant since I had a full hysterectomy in 1986. I am now 73 and although I have the lowest level 25 (g?) once a year I have been told that it can cause strokes in the over 70s. I have CLL and am not on any medication and wonder if the HRT is contributing to my good fortune in this respect. I am in a real quandary as I now feel my energy levels are becoming depleted. Do you have an opinion on this subject?

Mrs L

Dear Mrs L,

Thanks for being in touch. The Medicines Adverse Research Committee has advised there is a small increased risk of stroke associated with HRT and perhaps it might be sensible having taken it for 25 years to consider discontinuing it. It is, of course, important to ensure there is not some other treatable cause of these low energy levels such as anaemia (perhaps associated with the CLL) or an underactive thyroid.

Dear Dr Le Fanu,

Much attention, rightly, is given to failing sight and hearing, but I (aged 64) suffer from another and, as far as I can tell, scarcely noticed failing.

Whilst both parents and my sister had/have normal perception of smell, and my wife has a very acute one, my nose has always been less sensitive. Neither is it entirely satisfactory as a breathing channel due to its narrowness and consequent tendency to act as a self-closing valve. My sense of taste may not be the finest but it has worked perfectly well, and continues to do so.

I have long suffered from fairly mild chronic catarrh, which my GP has suggested may be caused by urban air pollution or by dairy products, which I tried giving up for 3 months with no improvement.

However, in recent years my sense of smell has declined markedly and it requires quite a strong odour for me to be aware of it. Whilst this is hardly a life-threatening condition, I suppose I could fail to smell the smoke if the house caught fire. I have mentioned this to my GP who was not interested, and have tried to research my condition via the internet, but there seems very little research or advice on the subject of either hyposmia, which is where I think I am, or anosmia, which is where it seems I am going.

Any assistance or information that you might be able to point me to would be very welcome.

James M

Dear James M,

Thanks for being in touch. I would have thought your reduced sense of smell (Hyposmia) is probably due to the nasal problems you describe that are strongly suggestive of chronic Rhinosinusitis. There is impressive evidence that this responds to prolonged treatment (three months) with antibiotics such as Clarithromycin (see Anders Cervin, Rhinology 2007, vol 45, pp 259-67 that can be downloaded from the internet) You should discuss this with your doctor. I would be more than interested to learn whether this does improve matters.

Dear Dr. James,

I was interested to read your piece about glucosamine and how some people find it actually makes their joints stiffer and more painful.

I am 76 years old, female and was diagnosed with osteo in the knees 30 years ago. I exercise a lot. About 10 years ago I began to take glucosamine and rarely have pain unless I walk a long distance. If I do get twinges, I stop for a while.I do not need any pain relief. I am convinced that the glucosamine has held off the deterioration, though of course, it is difficult to be sure about this.

I find your column really interesting and informative.

Many thanks,

Dear Anon,

Thanks for those interesting comments. It is good to hear you are not too much troubled by the arthritis of the knees - though as you say, it is difficult to know whether this is due to the glucosamine!

Hello Dr Le Fanu

My husband (who's a dentist) wakes every few weeks with marks on his forehead, as in the attached photo. There's usually just one (hence my decision to ask you for ideas!), slap bang in the middle above his nose.

He keeps his nails short and smooth so can't see how it could be scratches (and the marks don't look like scratches); he's not aware of any discomfort or skin irritation in that area in the morning.

No obvious irritants in the bed or pillows....we have no explanation!

Do you have any suggestions, please?

Thank you

Billy-Anne

Dear Billy-Anne,

Thanks for being in touch and the photograph of your husband's red patch on the forehead. This is of particular interest as I too have had this intermittently over the years. It certainly looks as if it is due to bleeding from the small blood vessel under the skin - but why it should occur and in just the one place I have no idea!

Dear Dr Le Fanu

I am a 74 year old woman and would like your opinion of my problem.

It started 3 years ago when I was woken in the night with pain in my jaw and teeth. My pulse was racing ,and this lasted for about an hour with no after effects.

This used to happen at long intervals - 2-3 months , and was always in the night .

I was seen by a cardiologist who did not give me a diagnosis and said I would need to be seen while having an attack. I did go to hospital once , but by the time I was monitored the attack had passed.

In 2013 it only happened once , in January and I thought it had stopped , until January this year. The pain in my neck and teeth was the same but my heart rate was irregular and fast.This time it lasted for 6 hours. Just over a week later it happened again , this time about 4 hours.

I would like to know what causes this and whether it is likely to get worse..

Yours faithfully

Dear Anon,

Thanks for your query. These episodes of palpitations certainly sound as if they are due to the disturbance of heart rhythm known as Paroxysmal Supraventricular Tachycardia. It is possible that the pain in the neck and teeth is angina as the rapid heart rate increases the heart muscle's need for oxygen. These episodes can be terminated by vigorously massaging the artery in the side of the neck just beneath the jaw line - known as Carotid Sinus Massage. I would have thought that with the two recent longish episodes within a fortnight you should really discuss with your doctor being referred back to the cardiologist.

Dear Dr Le Fanu,

I have a milder problem than Mrs HN from Reading as it is only my right ear that is affected. It is nevertheless painful. I also have a problem with that ear if I am out in the cold and wet as the ear flap and area below are extremely sensitive to even a light touch. My Doctor has no explanation. Do hope your readers will come up with some suggestions.

Yours faithfully

Celia T

Dear Celia T,

Thanks for your comments. See Valerie T above.

So the dilemma of golf and diabetes rumbles on in a very lighthearted way by the sounds of things but in fact one can be put in a very serious situation, not just because of the havoc of these blood sugar swings, but one's playing partners can be quite alarmed by the rather bizarre golfing actions that can take place.

I regularly go to the gym with no problems whatsoever and when younger played squash on a regular basis at a competitive level but for some reason golf seems so much more difficult and to be quite honest I've yet to speak to a doctor, diabetic nurse or dietician who understands the situation, probably partly because they don't play golf and are totally unaware of what actually is involved in playing the game. We see the game on television and all the professionals are strolling along the fairway looking relaxed - well no wonder they have a caddy and are looked after hand and foot.

In all the years I've been diabetic not one doctor has come up with a sensible suggestion. Tomorrow I'll be playing just after nine and due to the course conditions will be carrying my clubs so I'll have to be extra careful.

Regards

Denise W (frustrated golfer)

Dear Denise W,

Thanks for being in touch and I quite appreciate why, as you say, enthusiastic golfers like yourself should find this exacerbation of their diabetes so frustrating. It must somehow be related to the nature of the exercise involved in the sport but precisely what is not clear.

Dear Dr. Le Fanu,

My partner had an operation on his left ear, and because of a neck complaint, he cannot lie on his right side.

He found a piece of pillow sized sorbo rubber, and cut a large hole in the middle, and covered it with muslin.

He hopes this might help Mrs. HN from Reading.

Yours sincerely,

Deirdre L

Dear Deirdre L,

Thanks for your comments see Valerie T above.

Re Mrs. HN from Reading.

Dear Dr. Le Fanu,

I had similar symptoms to Mrs. HN for 25 years from the age of 14years. They were cured by visits to an Osteopath who treated me for a partially dislocated jaw and by cranial osteopathy.

The cause was thought to be either an earlier blow on the head or, more likely, the forcing open of my jaw during removal of my tonsils about 18 months before onset of severe symptoms.

Hope this helps. Regards, MT

Dear MT,

Thanks for your comments see Valerie T above

Re the problem of the lady from Reading.

I also have this problem and have to make a hole in my pillow to protect my ear before sleeping on either side.

There are pillows which have a triangular piece removed so you can support the head with the ear in the space.

I know not where you can buy these, but I am sure Amazon will provide!

Regards,

B. G

Dear B G,

Thanks for your comments see Valerie T above.

Dear Dr Le Fanu,

I am a 67 year old male with the following statistics: BMI 26.0, Ht 1.85m, Wt 89kg, BFI 17, Blood Pressure 135/75 average, Cholesterol TC 5.0 & LDL 1.25. I am a non-smoker. My BMI is slightly high but I believe my Body Fat Index (BFI) balances this out.

I have been regularly active for over six years with the following weekly activities: Half hour aerobics, two half hour general gym exercises/running, hour and a half badminton, half hour volleyball, golf.

I have varying degrees of Tinnitus in my right ear, which at present is hardly noticeable. This started in 1999 for which I had a brain scan (MRI). The result was that nothing could be identified to indicate any defect. In January 2012 I had a severe bout of echoing in my right ear for about a week. When this subsided my hearing was noticeable reduced in this ear. I did not go to a GP at this time as I needed to go to New Zealand! When I returned I saw the GP and had tests on the ear and the hearing loss was confirmed but not enough for a hearing aid as my left ear was strong enough to take over. (Prior to 1999 I had three infections in my right ear which occurred after flying to other countries and swimming straight away). I was referred by my GP for an MRI scan without contrast on the 15th August 2012. The report for this scan stated "It showed a focal area of abnormality in the left midbrain measuring 4 mm and they thought it was benign in nature".

I had another scan with contrast on the 20th February 2013. The following Consultant's report stated "He has had no previous symptoms of stroke. MRI scan of brain again shows a 4 mm well defined area of brain loss in the left midbrain. There is no surrounding oedema or contrast enhancement. Overall there does not appear to be any significant neurological condition, in particular the change in the scan is not an expanding lesion. Probably this is a small stroke experienced at some time, for which management includes general measures including management of any hypertension and not smoking".

I met with my GP on the 13th May and it was recommended that I take Statins based on the Cholesterol readings above. My ratio is 4.0 and my GP wanted to have it as 2.0. I asked whether I could try and bring it down to change the GP's mind. I had another Cholesterol test in November 2013. My GP's notes (via the receptionist) state "results are slightly lower - recommend Statins". I have an appointment with my GP in two weeks time.

My questions are: Could a 4 mm area of brain loss be caused by anything other than a stroke? If I have had a minor stroke prior to August 2012 would it be a low probability for another stroke to occur. I have heard that if there is no treatment after a mini stroke that another stroke would normally soon follow?

My annual travel insurance is due for renewal and with my screening questions I mentioned the "probable stroke" and that at present my GP recommends Statins, which I decided not to take. They would not insure me and I assume other companies would be the same. If my GP keeps that recommendation on file I assume I have no option but to take Statins!

A bit long winded but this is my last bid in trying to not take Statins unless really necessary.

Yours sincerely

Dear Anon,

Thanks for your challenging query. We have to presume that the first MRI scan in 1999 was correctly reported as being normal - in which case the 'benign' area of abnormality on the subsequent scan must be presumed to be a 'vascular event' such as a stroke. This might, I suppose, have caused the episode of echoing and loss of hearing in January 2012 (though I would not be certain of this).

You obviously have none of the risk factors for a stroke but it might be that a daily low dose aspirin might reduce the risk of having another. As for the cholesterol levels they would not warrant lowering but statins, like aspirin, have a blood thinning (or fibrinolytic) effect and this would be a reason for prescribing them in your case. I would have thought in view of the difficulties you are having in obtaining travel insurance the sensible compromise might be to take 10mg Atorvastatin (that is least likely to cause side effects).

Dear Dr. Le Fanu,

Thank you so much for your interesting and informative column.

I have been taking 500 mg Glucosamine Sulphate daily for about eight years. My osteopath suggested that it might help with lower back problems.

Now 65 years old, I did for the past 6-9 month have severe stiffness and cramps in both legs, to the extent that I sometimes had to hold onto the furniture to walk around.

When I read about Glucosamine in your column in December, I stopped taking it immediately. Within a few days I was much improved, and now, six weeks later, it is clear that the Glucosamine was causing all the problems. I can now go for a 2 mile walk again with ease.

My query is: why did it take years before these problems occurred?

Thank goodness you included the discussion in your column.

Many thanks

Best wishes,

Mrs Jo G

Dear Mrs Jo G,

Thanks for your interesting account of your glucosamine experience - and I am, of course, delighted to hear you have benefitted so much from reading something in the column!

Dear Doctor James

For the past 6 months I have had 5 urine tests and in four of them it showed I had an infection (white cells). It is quite painful when passing water, and it is accompanied by a very itch vagina.

My GP keeps on prescribing antibiotics, but it goes away and within 2 weeks it returns again. I was just given yet my fourth course this morning of Macrodantin antibiotics, the after that 1 capsule Fluconazole.

Can you advised what is the way to put an end to this suffering as it is so unconformable.

Many Thanks

Mrs N

Dear Mrs N,

Thanks for your query and my sympathies for this problem which is not dissimilar to that of Maria (see above) though I presume you do not have the complicating factor of menopause induced Atrophic Vaginitis. It is not clear why you should be having these recurrent episodes of cystitis - but it would be sensible to discuss with your doctor 'sterilising' the bladder with a month long course of antibiotics. This would, of course, exacerbate the vaginal thrush so you need to take a couple of doses of Diflucan weekly to keep this under control.

Dear Dr

My friend was hospitalised with chest pains he spent 10 days in hospital while in hospital he had an angiogram. When he left the hospital he was put on a repeat prescription of Aspirin, Atenolol, Clopidogrel, Isosorbide and last of all Simvastatins, he was on the statins for app 18mths then he was taken off the statins.abruptly. The family now know that statins can have some very serious side effects including (Hepatic) would this include HepC and B?

John

Dear John,

Thanks for being in touch. I presume the doctor has discontinued your friend's statins because they were causing inflammation of the liver - which should now improve. This is quite different from Hepatitis B and C which are viral infections of the liver.

Dear Dr. Le Fanu : Can you help me regarding my recent diagnosis of lymphoedematous rosacea of the bottom portion of my nose - I don't know what the best treatment options are ? a) I get up every day with a swollen nose since mid-july 2012 ; b) there is also enlargement of tissue on the tip of the nose - I feel as if I'm turning into a proboscis monkey ! c) pores on nose are very enlarged - like orange peel. The NHS say they can do no more for me , prescribing doxycycline - good for the skin problems - but does nothing for the nose ! It's a very depressing state of affairs as I am now socially withdrawn. I find this condition very distressing so I look forward to your advice. Yours sincerely Pat H

Dear Pat H,

Thanks for being in touch and my great sympathies for this disfiguring enlargement of the tip of the nose which I presume is what is known as a Rhinophyma. There are several techniques for improving the appearance including carbon dioxide laser and surgical shave. You should discuss this further with your doctor.

Dear D Le Fanu.

With reference to Mrs HN from Reading who can only sleep on her back because of pain in her ear.

Could it be a blocked eustachian tube which l have had and is very painful . It is cleared by holding the nose and blowing . This has helped me. Cate G

Dear Cate G,

Thanks for your comments see Valerie T above.

ALAMY

AUG. '12 Patient discharged from hospital with note to G.P. to follow-up management of high blood glucose level.

Patient/family not informed that Type2 Diabetes Mellitus had been diagnosed.

JAN. '13 Patient admitted to A. & E. with suspected T.I.A. Stroke team expressed surprise that monitoring had not been put in place by G.P. as blood glucose reading was quite high.

JUNE '13 Routine home-visit by Community Matron. Blood glucose reading was 30. Patient taken to A.& E. by ambulance. No treatment was given & patient was returned to the care of his G.P.

7 months later having tried & discontinued Metformin (unacceptable side-effects re overflowing stoma bags), Gliclazide (max. dose) + Sitagliptin have now been joined by a daily injection of insulin. The readings need to come down still further.

QUESTION Could this 79 year old, with complex health problems (including dementia}, have been spared any of the trauma he has had to endure during the last 18 months if the diabetes had been managed/monitored when first diagnosed rather than left until it became an emergency?

Thank you, M.V. H

Dear M V H,

Thanks for being in touch. It is very difficult to understand how it could be that this patient's obviously severe diabetes went untreated for 18 months. So the short answer to your question is certainly yes.

Source : http://telegraph.feedsportal.com/c/32726/f/568612/s/36501f6c/sc/14/l/0L0Stelegraph0O0Chealth0C10A5955620CDr0ELe0EFanus0Eonline0Ehealth0Eclinic0EFriday0E24th0EJanuary0E20A140Bhtml/story01.htm

Another pay rise for GPs is not the best medicine

At a time when politicians are arguing over whether average incomes are finally beginning to pick up after five years in decline, one group of workers appears to have no such worries. As we report today, the number of GPs earning six-figure salaries has increased fourfold to 16,000 in the past 10 years, since their new contract was agreed with the Labour government. More than 600 are on more than £200,000. The figures have been revealed by NHS England, which controls the budget, as part of its submission to the annual pay review. It says GPs have seen pay rises of 41 per cent in a decade, making them among the best paid in the world.

There is nothing inherently wrong with this. Family doctors are an integral part of our social fabric, highly trained and respected. They should be properly rewarded for their contribution to our wellbeing, provided, that is, their productivity improves. Yet the number of patients each family doctor cares for has dropped substantially in the past decade because the number of GPs has risen.

Not for the first time, blame for this state of affairs is laid at the door of the 2004 contract, which saw a massive jump in earnings, while doctors were allowed at the same time to give up responsibility for out-of-hours care. Although there were rumours last year that the Government wanted to reverse this, a compromise was agreed whereby doctors will monitor out-of-hours service in their area and report any concerns.

Clearly, the times when GPs would be on call for their own patients during the evenings or at weekends are not coming back, and perhaps nor should they. But the new model of primary out-of-hours care is still not working properly. Problems in A&E provision persist (a threatened crisis has probably only been averted by the mild winter) and the public remains suspicious of alternatives such as walk-in centres and remote diagnosis. It is unfortunate that the BMA could not agree a better deal for patients beyond "signing off" their satisfaction with out-of-hours provision. Even if in many areas the concept of the traditional "family doctor" has gone for ever, the issue of GP availability still needs to be satisfactorily resolved.

Of course, the income figures do not tell the complete story and many family doctors feel they are being unfairly traduced for doing less and earning more when they maintain they have taken on additional tasks with little extra funding. But they are not alone in this. With hospitals and other parts of the health service facing a £30 billion budget shortfall by 2020, the case for another pay increase for family doctors at this juncture is hard to justify.

Source : http://telegraph.feedsportal.com/c/32726/f/568612/s/3652d0d3/sc/21/l/0L0Stelegraph0O0Ccomment0Ctelegraph0Eview0C10A5949990CAnother0Epay0Erise0Efor0EGPs0Eis0Enot0Ethe0Ebest0Emedicine0Bhtml/story01.htm

Dr Le Fanu's online health clinic, Friday 24th January 2014

Dear Doctor James

I have been having this problem since last September, that is, I suffer badly with itchiness and sometimes accompanied by discharge and the feeling of not being able to pass urine. I feel as if I want to pass water, but sometimes there is nothing there, or when there is at the end of it is quite painful.

I was given so far 4 course of different antibiotics and I have also used 12 Canesten pessaries and 3 tubes of Canesten Cream. I am also using the HRT Vagifem. Nothing has worked so far. It has been hell, particularly for the past 2 weeks, I haven't been one day free of this terrible itchiness.

I feel I would like to find out the reason why the problem goes away, but keep on returning again and again.

My GP keeps on doing urine test which have showed to have an infection, hence all the different types of antibiotics I have taken so far, but it does not work.

What could you recommend as I don't know what else to take to alleviate this problem? It is so uncomfortable and distressing.

Kindest Regards

Yours sincerely

Maria

Dear Maria,

Thank you for being in touch and my sympathies for the distressing condition you describe. My impression would be that this due to a combination of factors where the Atrophic Vaginitis and the chronic vaginal thrush has resulted (I presume) in inflammation/infection around the urethra which then tracks up to the bladder resulting in cystitis. The situation is further complicated by the antibiotics taken for the cystitis predisposing to the vaginal thrush causing a sort of vicious circle. It might be sensitivity to either the pessaries or the Vagifem may be compounding matters. I would suggest discussing with your doctor switching from the Vagifem to oral hormone replacement therapy which together with the antifungal drug Diflucan should control the vaginal thrush. It can also help to take a longer course of antibiotics (for a month) to 'sterilise' the bladder and prevent recurrence of the cystitis.

Glucosamine "holiday"

Dear Dr Le Fanu

With reference to "feeling much fitter after discontinuing Glucosamine tablets", I'm curious to know what type of Glucosamine these people were taking. High dose Glucosamine Sulphate introduces a lot of Sulphates into the body and doesn't do your bones much good. (No one with Osteoporosis should take the Sulphate version). Glucosamine Hydrochloride is a much safer version in that respect supplying a much higher percentage of actual Glucosamine which as you know is used in practically every cell in the body. Can you please find out for me which version they were taking.

(Information taken from Dr Paul Clayton's book Health Defence)

Kind regards

Patrick C

Dear Patrick C,

Thanks for drawing attention to these two formulations of glucosamine. They are, I gather, claimed to be similarly effective - but it could be that those who have benefitted from discontinuing them were, as you suggest, taking the sulphate form. I will mention this in the column.

Osteoarthritis and osteopenia

Dear Dr Le Fanu,

I feel to be in a Catch 22 situation: having seemingly inherited a back condition and having issues as young as !7 with back and knees, and repeated prolonged episodes of pain throughout life, I was recently diagnosed as being moderately hyper mobile. My lifetime ( 72 years) of misuse flashed before me! Always interested in self help I sought the remedy in extreme yoga, ballet and other energetic forms of dance. At the same time as the repeated over? stretching, I have been passionate about hill walking, fast fitness classes and cycling. I am now told that I am doing too much weight bearing exercise which could cause further wear and tear on the right hip (it is not too bad as yet) whilst I had been counting on this for preventing osteoporosis. I take plentiful fish oil, Algaecal and use many herbs and spices. Other supplements I take intermittently. I have only just started on Rosehip extract said to prevent destruction of cartilage. Most of the above forms of exercise I have been forced to give up. I will not give up the walking as I need what little VitD is available (it is in the Algaecal also) and it is my form of antidepressant. Indoor cycling or crosstrainer indoors would depress me. Swimming O.K. My swimming pool not ideal. Have you any experience of Power Plate? I feel that this would be a short sharp session, minimising that couped up feeling. Or any other suggestions for appropriate exercise? I find the Alexander Technique brilliant, but cannot always afford to indulge.

Gratefully, Mary C

Dear Mary C,

Thanks for being in touch. You must be badly affected by your back pain to have to give up these outdoor pursuits that have kept you healthy for so long. I am sure you would benefit from a visit to the pain clinic at your local hospital with a view to a pain killing injection into the facet joint of the spine or something similar. Beyond that I don't have any suggestions about 'appropriate' exercise but would have thought that a physiotherapist or experienced trainer would be able to advise you further.

ALAMY

Dr Le Fanu,

I am aged 60 and several years ago suffered a vitreous humor detachment in my left eye. The right eye went the same way less than a year later leaving me with a large amount of "floaters" directly in my visual field.

I understand they are not in themselves harmless although one has to be cautious of complications involving possible retina detachment later in life.

The biggest problem is that, although I was told these floaters will generally disperse out of the field of vision in time, there is no sign of this happening.

I cannot emphasise how extreme they are - I liken it to seeing everything through a pond full of tadpoles and it has sadly affected my ability to enjoy reading - I have to constantly flick my eyes to move the floaters to enable me to read a few words before they drift back into view, effectively obscuring the words on the page.

I understand there is an operation involving removal of the gel in the eye but I have heard of many instances reporting a poor outcome.

I wondered if you have any comment that could give me hope I might improve my ability to read properly!

Many thanks

Peter G

Dear Peter G,

Thanks for being in touch and my sympathies for this serious floater problem. This is a difficult situation because, as your will know, there is no treatment other than surgical removal which is not widely practiced and described as 'risky'. Nonetheless I would have thought it appropriate to discuss with your doctor referral to a specialist in treating vitreous problems in the eye - perhaps at Moorfields Hospital - for an opinion as to whether this might be an option in your case.

Dear Dr James

Regarding the lady with ear pain. You do not mention whether she sleeps on feather or foam/fibre pillows. I always travel with a small feather pillow as I get what I call "hot ear"- painful ears, when I sleep on artificial filled pillows. One of my daughters is the same, though she has had to get used to, and cope with the problem as her husband is allergic to feathers!

Sincerely

Valerie T

Dear Valerie T,

Thanks for that useful hint and I will mention in next week's column (3rd Feb).

Dr James,

Regarding the lady who has had to sleep on her back for 20 years due to pain when her ears contact the pillow, I have seen pillows marketed in Canada and the United States which have a void in the middle to enable the ear not to touch the pillow surface. I believe they are available through various suppliers online.

I used to have a problem with pain in my right ear which prevented me from sleeping on my right side for several months. I believe the problem was caused by my excessive movement during the night which resulted in my ear unknowingly becoming folded back. Since I have stopped drinking caffeine in the evenings, and have reduced my alcohol intake which was not particularly excessive, I have had no recurrences for over a year.

Hope this may be of some interest to your correspondent.

Regards,

John F

Dear John F,

Thanks for those useful comments and see above.

Dear Dr. Le Fanu,

With reference to Mrs. D's "very itchy area around my anus", I was reminded of the same problem that my son had many years ago - in his case, however, it was caused by enterobiasis (oxyuriasis), which is a possibility that she might consider.

With kind regards (and my thanks for your ever-interesting column),

Ian G

Dear Ian G,

Thanks for that important reminder that worms can be an eminently treatable cause of itchy bottom.

Dear Dr Le Fanu,

I read with huge interest your article ref Mr. NA from Bath.

I have a life long friend who at the age of 81 has been suffering serious discomfort with a skin problem for many years. The last two he has been under a specialist and all sorts of topical and oral avenues have been tried, all being unsuccessful. He has constant irritation resulting in bleeding both at night and during the day to the extent that he has become housebound as is embarrassed in company.

I would be most interested to hear the feedback from your article and will you please advise me how I can arrange that.

Your articles are always interesting and informative and I am sure you give huge comfort to many.

All good wishes and I hope to hear from you.

Anne Q

Dear Anne Q,

Thanks for being in touch and my great sympathies for your friend's misfortune. There are, as you know, a lengthy list of causes of itchiness in your friend's age group which presumably the skin specialist has considered. Still it is a bit surprising that none of the several treatments he has tried have been of value and I wonder if this may have included a course of steroids that can sometimes work quite dramatically. The further possibility readily overlooked is that the itchiness can be a side effect of commonly prescribed drugs such as statins.

Dear Dr

In the last few weeks I seem to have developed a strange signal of a need to open my bowels.

I have had a difficult relationship with my bowels for many years on and off, I take 2 Senna tablets on prescription every night. If I try to "go" when not quite ready it usually ends in a struggle.

Recently I have noticed a strange feeling down the back of my left hand on the left side towards my little finger, It's not painful just enough to catch my attention, I respond by going to the lavatory successfully.

At first I thought it was my imagination but it happens daily. I would be interested to know if this is common. Presumably other people experience this, but it's not talked about.

Regards

Jan B

Dear Jan B,

Thanks for being in touch and your account of this unusual (and fascinating) symptom that I have encountered before associated with urination - but not with the bowels! The suggested explanation is that this is due to pressure on the nerves in the neck from the position adopted when sitting on the toilet - leaning forward with elbows on knees and then looking upwards. This should improve with a visit to the osteopath for some gentle manipulation of the neck.

ALAMY

Dear Dr. Le Fanu,

I have had several episodes of Ocular migraine in the last month. (About 8). No accompanying migraine, and no other symptoms. I consulted an Ophthalmic Surgeon, who said my eyes were fine, and that the cause of Ocular Migraine is not currently understood. He said - that he also had them! My GP send me off for various blood tests, and the cholesterol count was 7.2. I am nearly 69 yrs old, take no meds, and I am fit. BP 130/78. This is elevated, as my BP is usually 120/70 I am 5' 3.5" tall, and 1 stone heavier than usual, at 10 stone.

My questions to you are:

1) Is Ocular Migraine a vascular disease?

2) Am I at a significantly higher risk of a stroke?

3) What is the best preventative action that I can take? (Pref without meds)

Many thanks

Dear Anon,

Thanks for being in touch. Ocular migraine is indeed vascular being caused by spasm of the blood vessels to the retina at the back of the eye. It does not, to my knowledge, increase the risk of stroke. The cause, as your GP notes, is not known but it can be triggered by stress, exercise and bending over though not (or rarely) by caffeine, alcohol and other foods that may be implicated in the classic forms of migraine. I would have thought that were these episodes to become more frequent (and eight in a single month is quite a lot) you should discuss with your doctor taking some simple preventive medication such as aspirin or Atenolol.

ALAMY

An itchy embarrassing subject

Dear Dr Le Fanu

Thank you for your answer in the confidential health clinic. Your answer is very interesting, because in the week since I wrote to you an interesting thing has happened. I remembered that when the itchy problem was very bad before, I was trying to lose a few pounds in weight, as I am at the moment. I always eat lots of fruit, but more so if I'm on a diet, eating 1-3 satsumas daily. To put this theory to the test, this week I have stopped eating any citrus fruit, and the itching is greatly improved, to the extent that I've stopped using any cream. So your reply was very interesting, especially the comments about food and drink that might have a role to play. Why would this be - is there a scientific reason, or is it just an observation?

Thank you so much for your answer - just writing to you made me realize how miserable the condition is, and spurred me to think of a possible cause myself. As it turns out, it wasn't such an unlikely idea after all! I shall avoid the satsumas and let you know if my relief is temporary or permanent.

Many thanks

Mrs D

Dear Mrs D,

Thanks for that follow up and how interesting to learn that satsumas seem to be the culprit in your case.

Hello

My wife,aged 85 has over the past year, developed the irritating problem of getting an attack of hiccups after eating something sweet particularly at meal times. The attacks can last up to 10 minutes. Can any of your readers suggest a way to avoid this happening.

D A C

Dear D A C,

Thanks for your query on your wife's behalf. Some foods and drinks can indeed bring on the hiccups particularly the hot and spicy, carbonated drinks and alcohol. It is however difficult to see why 'something sweet' might be responsible - especially, as you probably know, one of the many cures include taking a spoonful of sugar!

Dear Dr James

I have been having an HRT implant since I had a full hysterectomy in 1986. I am now 73 and although I have the lowest level 25 (g?) once a year I have been told that it can cause strokes in the over 70s. I have CLL and am not on any medication and wonder if the HRT is contributing to my good fortune in this respect. I am in a real quandary as I now feel my energy levels are becoming depleted. Do you have an opinion on this subject?

Mrs L

Dear Mrs L,

Thanks for being in touch. The Medicines Adverse Research Committee has advised there is a small increased risk of stroke associated with HRT and perhaps it might be sensible having taken it for 25 years to consider discontinuing it. It is, of course, important to ensure there is not some other treatable cause of these low energy levels such as anaemia (perhaps associated with the CLL) or an underactive thyroid.

Dear Dr Le Fanu,

Much attention, rightly, is given to failing sight and hearing, but I (aged 64) suffer from another and, as far as I can tell, scarcely noticed failing.

Whilst both parents and my sister had/have normal perception of smell, and my wife has a very acute one, my nose has always been less sensitive. Neither is it entirely satisfactory as a breathing channel due to its narrowness and consequent tendency to act as a self-closing valve. My sense of taste may not be the finest but it has worked perfectly well, and continues to do so.

I have long suffered from fairly mild chronic catarrh, which my GP has suggested may be caused by urban air pollution or by dairy products, which I tried giving up for 3 months with no improvement.

However, in recent years my sense of smell has declined markedly and it requires quite a strong odour for me to be aware of it. Whilst this is hardly a life-threatening condition, I suppose I could fail to smell the smoke if the house caught fire. I have mentioned this to my GP who was not interested, and have tried to research my condition via the internet, but there seems very little research or advice on the subject of either hyposmia, which is where I think I am, or anosmia, which is where it seems I am going.

Any assistance or information that you might be able to point me to would be very welcome.

James M

Dear James M,

Thanks for being in touch. I would have thought your reduced sense of smell (Hyposmia) is probably due to the nasal problems you describe that are strongly suggestive of chronic Rhinosinusitis. There is impressive evidence that this responds to prolonged treatment (three months) with antibiotics such as Clarithromycin (see Anders Cervin, Rhinology 2007, vol 45, pp 259-67 that can be downloaded from the internet) You should discuss this with your doctor. I would be more than interested to learn whether this does improve matters.

Dear Dr. James,

I was interested to read your piece about glucosamine and how some people find it actually makes their joints stiffer and more painful.

I am 76 years old, female and was diagnosed with osteo in the knees 30 years ago. I exercise a lot. About 10 years ago I began to take glucosamine and rarely have pain unless I walk a long distance. If I do get twinges, I stop for a while.I do not need any pain relief. I am convinced that the glucosamine has held off the deterioration, though of course, it is difficult to be sure about this.

I find your column really interesting and informative.

Many thanks,

Dear Anon,

Thanks for those interesting comments. It is good to hear you are not too much troubled by the arthritis of the knees - though as you say, it is difficult to know whether this is due to the glucosamine!

Hello Dr Le Fanu

My husband (who's a dentist) wakes every few weeks with marks on his forehead, as in the attached photo. There's usually just one (hence my decision to ask you for ideas!), slap bang in the middle above his nose.

He keeps his nails short and smooth so can't see how it could be scratches (and the marks don't look like scratches); he's not aware of any discomfort or skin irritation in that area in the morning.

No obvious irritants in the bed or pillows....we have no explanation!

Do you have any suggestions, please?

Thank you

Billy-Anne

Dear Billy-Anne,

Thanks for being in touch and the photograph of your husband's red patch on the forehead. This is of particular interest as I too have had this intermittently over the years. It certainly looks as if it is due to bleeding from the small blood vessel under the skin - but why it should occur and in just the one place I have no idea!

Dear Dr Le Fanu

I am a 74 year old woman and would like your opinion of my problem.

It started 3 years ago when I was woken in the night with pain in my jaw and teeth. My pulse was racing ,and this lasted for about an hour with no after effects.

This used to happen at long intervals - 2-3 months , and was always in the night .

I was seen by a cardiologist who did not give me a diagnosis and said I would need to be seen while having an attack. I did go to hospital once , but by the time I was monitored the attack had passed.

In 2013 it only happened once , in January and I thought it had stopped , until January this year. The pain in my neck and teeth was the same but my heart rate was irregular and fast.This time it lasted for 6 hours. Just over a week later it happened again , this time about 4 hours.

I would like to know what causes this and whether it is likely to get worse..

Yours faithfully

Dear Anon,

Thanks for your query. These episodes of palpitations certainly sound as if they are due to the disturbance of heart rhythm known as Paroxysmal Supraventricular Tachycardia. It is possible that the pain in the neck and teeth is angina as the rapid heart rate increases the heart muscle's need for oxygen. These episodes can be terminated by vigorously massaging the artery in the side of the neck just beneath the jaw line - known as Carotid Sinus Massage. I would have thought that with the two recent longish episodes within a fortnight you should really discuss with your doctor being referred back to the cardiologist.

Dear Dr Le Fanu,

I have a milder problem than Mrs HN from Reading as it is only my right ear that is affected. It is nevertheless painful. I also have a problem with that ear if I am out in the cold and wet as the ear flap and area below are extremely sensitive to even a light touch. My Doctor has no explanation. Do hope your readers will come up with some suggestions.

Yours faithfully

Celia T

Dear Celia T,

Thanks for your comments. See Valerie T above.

So the dilemma of golf and diabetes rumbles on in a very lighthearted way by the sounds of things but in fact one can be put in a very serious situation, not just because of the havoc of these blood sugar swings, but one's playing partners can be quite alarmed by the rather bizarre golfing actions that can take place.

I regularly go to the gym with no problems whatsoever and when younger played squash on a regular basis at a competitive level but for some reason golf seems so much more difficult and to be quite honest I've yet to speak to a doctor, diabetic nurse or dietician who understands the situation, probably partly because they don't play golf and are totally unaware of what actually is involved in playing the game. We see the game on television and all the professionals are strolling along the fairway looking relaxed - well no wonder they have a caddy and are looked after hand and foot.

In all the years I've been diabetic not one doctor has come up with a sensible suggestion. Tomorrow I'll be playing just after nine and due to the course conditions will be carrying my clubs so I'll have to be extra careful.

Regards

Denise W (frustrated golfer)

Dear Denise W,

Thanks for being in touch and I quite appreciate why, as you say, enthusiastic golfers like yourself should find this exacerbation of their diabetes so frustrating. It must somehow be related to the nature of the exercise involved in the sport but precisely what is not clear.

Dear Dr. Le Fanu,

My partner had an operation on his left ear, and because of a neck complaint, he cannot lie on his right side.

He found a piece of pillow sized sorbo rubber, and cut a large hole in the middle, and covered it with muslin.

He hopes this might help Mrs. HN from Reading.

Yours sincerely,

Deirdre L

Dear Deirdre L,

Thanks for your comments see Valerie T above.

Re Mrs. HN from Reading.

Dear Dr. Le Fanu,

I had similar symptoms to Mrs. HN for 25 years from the age of 14years. They were cured by visits to an Osteopath who treated me for a partially dislocated jaw and by cranial osteopathy.

The cause was thought to be either an earlier blow on the head or, more likely, the forcing open of my jaw during removal of my tonsils about 18 months before onset of severe symptoms.

Hope this helps. Regards, MT

Dear MT,

Thanks for your comments see Valerie T above

Re the problem of the lady from Reading.

I also have this problem and have to make a hole in my pillow to protect my ear before sleeping on either side.

There are pillows which have a triangular piece removed so you can support the head with the ear in the space.

I know not where you can buy these, but I am sure Amazon will provide!

Regards,

B. G

Dear B G,

Thanks for your comments see Valerie T above.

Dear Dr Le Fanu,

I am a 67 year old male with the following statistics: BMI 26.0, Ht 1.85m, Wt 89kg, BFI 17, Blood Pressure 135/75 average, Cholesterol TC 5.0 & LDL 1.25. I am a non-smoker. My BMI is slightly high but I believe my Body Fat Index (BFI) balances this out.

I have been regularly active for over six years with the following weekly activities: Half hour aerobics, two half hour general gym exercises/running, hour and a half badminton, half hour volleyball, golf.

I have varying degrees of Tinnitus in my right ear, which at present is hardly noticeable. This started in 1999 for which I had a brain scan (MRI). The result was that nothing could be identified to indicate any defect. In January 2012 I had a severe bout of echoing in my right ear for about a week. When this subsided my hearing was noticeable reduced in this ear. I did not go to a GP at this time as I needed to go to New Zealand! When I returned I saw the GP and had tests on the ear and the hearing loss was confirmed but not enough for a hearing aid as my left ear was strong enough to take over. (Prior to 1999 I had three infections in my right ear which occurred after flying to other countries and swimming straight away). I was referred by my GP for an MRI scan without contrast on the 15th August 2012. The report for this scan stated "It showed a focal area of abnormality in the left midbrain measuring 4 mm and they thought it was benign in nature".

I had another scan with contrast on the 20th February 2013. The following Consultant's report stated "He has had no previous symptoms of stroke. MRI scan of brain again shows a 4 mm well defined area of brain loss in the left midbrain. There is no surrounding oedema or contrast enhancement. Overall there does not appear to be any significant neurological condition, in particular the change in the scan is not an expanding lesion. Probably this is a small stroke experienced at some time, for which management includes general measures including management of any hypertension and not smoking".

I met with my GP on the 13th May and it was recommended that I take Statins based on the Cholesterol readings above. My ratio is 4.0 and my GP wanted to have it as 2.0. I asked whether I could try and bring it down to change the GP's mind. I had another Cholesterol test in November 2013. My GP's notes (via the receptionist) state "results are slightly lower - recommend Statins". I have an appointment with my GP in two weeks time.

My questions are: Could a 4 mm area of brain loss be caused by anything other than a stroke? If I have had a minor stroke prior to August 2012 would it be a low probability for another stroke to occur. I have heard that if there is no treatment after a mini stroke that another stroke would normally soon follow?

My annual travel insurance is due for renewal and with my screening questions I mentioned the "probable stroke" and that at present my GP recommends Statins, which I decided not to take. They would not insure me and I assume other companies would be the same. If my GP keeps that recommendation on file I assume I have no option but to take Statins!

A bit long winded but this is my last bid in trying to not take Statins unless really necessary.

Yours sincerely

Dear Anon,

Thanks for your challenging query. We have to presume that the first MRI scan in 1999 was correctly reported as being normal - in which case the 'benign' area of abnormality on the subsequent scan must be presumed to be a 'vascular event' such as a stroke. This might, I suppose, have caused the episode of echoing and loss of hearing in January 2012 (though I would not be certain of this).

You obviously have none of the risk factors for a stroke but it might be that a daily low dose aspirin might reduce the risk of having another. As for the cholesterol levels they would not warrant lowering but statins, like aspirin, have a blood thinning (or fibrinolytic) effect and this would be a reason for prescribing them in your case. I would have thought in view of the difficulties you are having in obtaining travel insurance the sensible compromise might be to take 10mg Atorvastatin (that is least likely to cause side effects).

Dear Dr. Le Fanu,

Thank you so much for your interesting and informative column.

I have been taking 500 mg Glucosamine Sulphate daily for about eight years. My osteopath suggested that it might help with lower back problems.

Now 65 years old, I did for the past 6-9 month have severe stiffness and cramps in both legs, to the extent that I sometimes had to hold onto the furniture to walk around.

When I read about Glucosamine in your column in December, I stopped taking it immediately. Within a few days I was much improved, and now, six weeks later, it is clear that the Glucosamine was causing all the problems. I can now go for a 2 mile walk again with ease.

My query is: why did it take years before these problems occurred?

Thank goodness you included the discussion in your column.

Many thanks

Best wishes,

Mrs Jo G

Dear Mrs Jo G,

Thanks for your interesting account of your glucosamine experience - and I am, of course, delighted to hear you have benefitted so much from reading something in the column!

Dear Doctor James

For the past 6 months I have had 5 urine tests and in four of them it showed I had an infection (white cells). It is quite painful when passing water, and it is accompanied by a very itch vagina.

My GP keeps on prescribing antibiotics, but it goes away and within 2 weeks it returns again. I was just given yet my fourth course this morning of Macrodantin antibiotics, the after that 1 capsule Fluconazole.

Can you advised what is the way to put an end to this suffering as it is so unconformable.

Many Thanks

Mrs N

Dear Mrs N,

Thanks for your query and my sympathies for this problem which is not dissimilar to that of Maria (see above) though I presume you do not have the complicating factor of menopause induced Atrophic Vaginitis. It is not clear why you should be having these recurrent episodes of cystitis - but it would be sensible to discuss with your doctor 'sterilising' the bladder with a month long course of antibiotics. This would, of course, exacerbate the vaginal thrush so you need to take a couple of doses of Diflucan weekly to keep this under control.

Dear Dr

My friend was hospitalised with chest pains he spent 10 days in hospital while in hospital he had an angiogram. When he left the hospital he was put on a repeat prescription of Aspirin, Atenolol, Clopidogrel, Isosorbide and last of all Simvastatins, he was on the statins for app 18mths then he was taken off the statins.abruptly. The family now know that statins can have some very serious side effects including (Hepatic) would this include HepC and B?

John

Dear John,

Thanks for being in touch. I presume the doctor has discontinued your friend's statins because they were causing inflammation of the liver - which should now improve. This is quite different from Hepatitis B and C which are viral infections of the liver.

Dear Dr. Le Fanu : Can you help me regarding my recent diagnosis of lymphoedematous rosacea of the bottom portion of my nose - I don't know what the best treatment options are ? a) I get up every day with a swollen nose since mid-july 2012 ; b) there is also enlargement of tissue on the tip of the nose - I feel as if I'm turning into a proboscis monkey ! c) pores on nose are very enlarged - like orange peel. The NHS say they can do no more for me , prescribing doxycycline - good for the skin problems - but does nothing for the nose ! It's a very depressing state of affairs as I am now socially withdrawn. I find this condition very distressing so I look forward to your advice. Yours sincerely Pat H

Dear Pat H,

Thanks for being in touch and my great sympathies for this disfiguring enlargement of the tip of the nose which I presume is what is known as a Rhinophyma. There are several techniques for improving the appearance including carbon dioxide laser and surgical shave. You should discuss this further with your doctor.

Dear D Le Fanu.

With reference to Mrs HN from Reading who can only sleep on her back because of pain in her ear.

Could it be a blocked eustachian tube which l have had and is very painful . It is cleared by holding the nose and blowing . This has helped me. Cate G

Dear Cate G,

Thanks for your comments see Valerie T above.

ALAMY

AUG. '12 Patient discharged from hospital with note to G.P. to follow-up management of high blood glucose level.

Patient/family not informed that Type2 Diabetes Mellitus had been diagnosed.

JAN. '13 Patient admitted to A. & E. with suspected T.I.A. Stroke team expressed surprise that monitoring had not been put in place by G.P. as blood glucose reading was quite high.

JUNE '13 Routine home-visit by Community Matron. Blood glucose reading was 30. Patient taken to A.& E. by ambulance. No treatment was given & patient was returned to the care of his G.P.

7 months later having tried & discontinued Metformin (unacceptable side-effects re overflowing stoma bags), Gliclazide (max. dose) + Sitagliptin have now been joined by a daily injection of insulin. The readings need to come down still further.

QUESTION Could this 79 year old, with complex health problems (including dementia}, have been spared any of the trauma he has had to endure during the last 18 months if the diabetes had been managed/monitored when first diagnosed rather than left until it became an emergency?

Thank you, M.V. H

Dear M V H,

Thanks for being in touch. It is very difficult to understand how it could be that this patient's obviously severe diabetes went untreated for 18 months. So the short answer to your question is certainly yes.

Source : http://telegraph.feedsportal.com/c/32726/f/568612/s/36501f6c/sc/14/l/0L0Stelegraph0O0Chealth0C10A5955620CDr0ELe0EFanus0Eonline0Ehealth0Eclinic0EFriday0E24th0EJanuary0E20A140Bhtml/story01.htm