Dr Le Fanu"s on-line overall health clinic, Friday 31st January 2014

Dear Doctor,

I have had the same problem as the query on Monday Jan 20th and will try to keep this as brief as possible.

12 years ago pain in one ear started – I was at first able to cup my ear but that didn’t last long. It felt as if something pointed but not sharp was pressing on my ear. Over the subsequent years I have had dental work done, years on anti-inflammatory medication including antidepressants, and an operation on my nose and I have lost track of the antibiotic courses. I have seen Audio-mandible consultants, ear, nose and throat consultants all to no avail. I was shouted at by one ENT chap “There is nothing wrong with your ear.”

I have a very sympathetic GP who keeps referring to new consultants, recently for a sinus problem for which I was given Clarithromycin for one month, then for three months. Halfway through this last course my ear became distressingly painful and it occurred to me that the only thing not tried was for a fungal infection. I got a cream containing Clotrimazole 1% which became gritty so I thought something was working and bought some drops that I used for 5 days. The drops made me deaf (muffled sound). I continue to use the cream when I need to e.g. after washing my hair when it starts to return – I can sleep on that ear. It seems to me that the problem was in the neck of the ear and the shell and so out of sight of any scope inserted into the ear.

Do hope this helps.

Best wishes, Pauline D

Dear Pauline D,

Thanks for your comments on the puzzle of the painful ear. There has been much correspondence on this matter that features in the forthcoming Monday column (3rd Feb). The general gist is that the best way of dealing with it is by alleviating pressure on the ear but yours is the only suggestion that a fungal infection might be implicated.

Dr Le Fanu,

I am 62, male and fairly fit. Every winter I have the same problem and every winter it gets worse. Unfortunately it is something which other people don’t take seriously. I have a problem with my voice. When winter starts and the central heating comes on I just need to speak for 10 minutes and I start to get hoarse. Continuing to speak leads to a sort of sore throat and a headache at the back of my neck. I read once about nodules on the larynx and went to see a specialist at the end of 2011. He did a something-oscopy, inserting a camera through my nose and proclaimed that there was nothing to report. He said, “Face it, you are getting old and you just don’t produce enough mucous to lubricate your larynx. You’ll just have to talk less.”

Since then I have followed internet advice: installed a humidifier in the kitchen, cut out diuretic drinks like wine and coffee, stopped eating spicy foods and stopped speaking unless I have something really important to say. Every night we sleep with the window open (a humidifier in the bedroom is too noisy). The result is that I feel OK on wet, damp days and much worse on dry, cold days. I have almost stopped talking to my wife and at breakfast and dinner have a pile of scrap paper on the table for me to write notes. On some days I have to stay in the kitchen to be in the more humid atmosphere. Earlier today I drove to town (15 minutes) and even after that short space of time I could feel my throat drying badly. For a long drive in the car I have to chew gum to force myself to swallow frequently. I have always hated the idea of chewing gum. Finally, I am now trying to train myself to speak whilst exhaling and this produces a strange effect in normal conversation.

Will this ever get better?

Best regards,

Chris W

Dear Chris W,

Thanks for being in touch. I would concur with the ENT specialist that this hoarseness is due to an age related loss of lubrication of the vocal chords exacerbated by dry environment. It is very disappointing that it should persist despite the several steps you describe though it might be worthwhile discussing with your doctor a trial of the acid suppressant drug Losec as acid reflux can be an exacerbating factor.

Beyond that there is an interesting list of ‘folk remedies’ on the website health911.com including various teas and ginger. I note that you dislike chewing gum but its effect in increasing the amount of salivary secretions can be simulated by placing a raisin (or rolled up piece of paper or string) between gum and cheek.

Perhaps a somewhat trivial enquiry, but a tiresome problem for me. Suffering from Sjogren’s Syndrome my mouth is very dry and sleeping with an open mouth I wake several times during the night, because my tongue is like a board and most uncomfortable I use a saliva spray to try to alleviate this.

Arthritis in my neck means that it is not possible to sleep completely on my side. How can one learn to keep a closed mouth whilst asleep? This is affecting the surface of my tongue and making eating most disagreeable.

Mrs M.E.H

Dear Mrs M E H,

Thanks for your query. The simple remedy for this nocturnal dry mouth, recommended for those who snore loudly, is to tape the lips together with Micropore. I hope this does the trick!

Hello

I am a 67 years old male living in the Midlands. I retired from full time work at 50 and have spent time since involved in hobbies and travel as well as voluntary work. We have a large garden which is our joy and an extended family meaning life is full and busy. No worries re pensions and other than the following – a healthy lifestyle!

Some 7 years ago following a cruise we came home with a horrible virus infection that had been circulating the ship during our time at sea – despite our best efforts to avoid it the wife initially went down with it before passing it on to me. It was a coughing virus (cabin cough) in my wife’s case it left her on the verge of bronchial pneumonia. She has since recovered fully.

In my case it left me with constant tiredness which I call TATT – tired all the time! I get what I think is a good? nights sleep 8 hours but on waking can still be tired and every day have to go back to bed in the afternoon to get through the rest of the day. I have no problem sleeping albeit one of the tests undertaken revealed I may be bordering on sleep apnoea – my wife says that is not the case as I do not snore nor stop breathing at night! All tests undertaken have shown everything is ‘normal’ i.e. diabetes, thyroid, etc etc (too lengthy to list) although they did show up ‘para proteins’ in my system which are now monitored annually.

Blood pressure is normal but for 20 years I have suffered with high cholesterol and controlled same with statins. I stopped these over 12 months ago to see if they might be a cause.

The only other medication I take is for Nasal polyps which I have stopped at times for several months without any change in my TATT.

I have seen specialists including Endocrinologists who have tested various theories but nothing so far helps.

I try to keep fit at the Gym, am not overweight, maintain my interests in hobbies etc but the recent arrival of grandchildren means I am missing out more and on many things. None of my many friends and former colleagues – some younger – many older – can understand the situation and none of them have to go back to bed in the afternoon albeit they will all admit to 40 winks in the chair some days!

Any help or advice would be greatly appreciated as I think my GP has or is reaching the stage of exhaustion as well!!

Many thanks in anticipation and – Keep well

Dear Anon,

Thanks for being in touch and my sympathies for your TATT which has clearly been thoroughly investigated by your doctors regrettably to no avail. It could be I suppose related to your otherwise asymptomatic raised para proteins. Beyond that the onset following that viral infection is obviously suggestive of post viral ‘chronic fatigue syndrome’. This may improve with the SSRI Sertraline starting initially at a very low dose and slowly building upwards. You can find further details Google ‘Le Fanu Sertraline chronic fatigue’.

Dear Dr James,

I am a recent but now regular reader of your excellent advice column.

I would be sad to see people discouraged from taking Glucosamine/Chondroitin as it has done me so much good over the past eighteen years (I am now mid-sixties). I have three joint problems. One needs specific exercises (a knee), another needs rest and careful use (a shoulder) and the third, a hip, needs the supplement which I started without any other changes to my regime which could explain the benefit. If I become too complacent about it, and leave off the Glucosamine for a while, I soon find myself having to start again on the maximum dosage for a week or so. The only negative side effect is the cost but I certainly would not pay for something that I didn’t think was worth it. On the other hand, there is no point in taking it for a joint problem for which it is not suitable.

Regarding the young woman back from West Africa with a one-sided headache, blocked ear and vertigo perhaps I could mention that these were the first acute symptom one of my own family had of severe hypothyroidism (though without the numbness mentioned) following swine flu? It sounds as if the young lady has been thoroughly checked over but diagnosis and treatment of thyroid issues is so far from ideal that I thought it worth suggesting. And, of course, we have personal and anecdotal evidence of the difficulty of identifying tropical illnesses and parasites.

With my best wishes and thanks again for all the problems and advice shared,

Marion D

Dear Mrs M D,

Thanks for being in touch and your kind comments about the column. The jury on glucosamine is divided with some, like yourself, convinced of its merits while others (surprisingly) maintaining it exacerbates their symptoms. This may be related to the type of glucosamine with the suggestion that the hydrochloride form is superior to the sulphate. Thanks too for your comments about this week’s medical conundrum.

My damaged spleen was removed 20 years ago after a road accident. Following advice, I take penicillin V twice daily and Pneumovax booster every 5 years. I have also received Hib and meningococcal C vaccines. Do these vaccines require 5 yearly boosters? I have not received meningococcal A vaccine. Should I also ask for this? My immunity is also compromised because I have rheumatoid arthritis and receive Abatacept monthly by infusion.

Many thanks. Kieran C

Dear Kieran C,

Thanks for being in touch. Both meningococcal vaccines are recommended for those who have had a splenectomy though the schedule might need to be modified in view of your taking Abatacept. You should obviously see specialist advice on this.

Dear Dr James Le Fanu,

About 12 months ago my wife (84) was told she might have Senile Tremor as she was suffering shaking in the trunk. There is no shaking of the limbs. This gradually got worse and eventually our GP arranged for a consultant to see her. His report in October 2013 thought it was this or the start of Parkinson’s Disease and arranged for a Brain scan. He is satisfied it is not Parkinsons. He wanted to see her again in “a few months time” to see how it was progressing. It got very much worse making it difficult to stand without support but could walk slowly with a stick. Eventually the shaking got so bad that sometimes it was a very heavy shudder at about 1 second intervals. It has weakened her and other troubles not related has made her almost housebound if I were not fortunate to be fit enough for 86 to help her. It seems that our GP isn’t in the same NHS Trust as the consultants Hospital which seems to keep him out of the picture unless we keep him up to date and we don’t get the backup I think we might expect at our age. What happened to “Well Women’s Clinics” The nearest we’ve been offered seems to be a meeting of various old sufferers who compare their problems with each other which is no help at all. The consultant has suggested an appointment at his Clinic in May !!! The tablets prescribed this month have reacted so badly with my wife’s stomach that she is not taking them and although we have reported this to his secretary we have had no reaction.

Is there some organisation dedicated to this frightening disease or some particular expert who could help us find some relief or treatment. The Internet doesn’t appear to help in this case.

Regards

Dear Anon,

Thanks for being in touch and my sincere sympathies for your wife’s current problems. I note the consultant has excluded Parkinsons but you do not mention the findings of the CT which I presume did not identify any obvious cause of her symptoms. The shaking of the trunk is certainly suggestive of some disturbance of the coordinating centre at the back of the brain known as the Cerebellum. I would agree that the deterioration in her symptoms would warrant an earlier follow up appointment with her neurologist with a view to obtaining a specific diagnosis and prognosis.

Dear Dr James

I’m wondering if you are in a position to assist with an ongoing problem.

Back in August last year I experienced a chip seemingly getting stuck in my throat and remaining there for several days despite my attempts to dislodge it. Eating and swallowing caused discomfort and I had an associated pain in my chest. Since then I’ve had episodes of the same sensations, accompanied by a lot of belching.

My GP prescribed Lansoprazole which has helped reduce the burning feeling of reflux. A consultant found my larynx a little red and the results of a barium swallow revealed slow transit of food through the oesophagus. There is no known treatment.

I tend to eat bland and relatively smooth foods in a bid to alleviate these symptoms but I’m wondering if there are other strategies I could adopt or any remedies that have helped others to overcome a sluggish oesophagus.

Any advice will be gratefully received.

With many thanks

Sue B

Dear Sue B,

Thanks for your query. This impaired motility or ‘sluggishness’ of the oesophagus predisposes to acid reflux and muscle spasm – hence the discomfort and improvement with acid suppressant drugs. There is some evidence that the drug Nifedipine can be of value or more drastically an operation or botox injection to alter the dynamics of the valve between oesophagus and stomach. Further details can be found on the patient.co.uk website (search oesophageal spasm) which you may wish to discuss further with your doctor.

Dear Dr Le Fanu

Would it be possible for you to highlight the dangers of the possibility of zinc poisoning through over use of denture fixatives. I am afraid we are not careful enough of reading the small print, especially of something that can be bought easily and cheaply from many outlets. Some manufacturers have woken up to the problem and advertise their produce as “zinc free”, but not all. Just a look on line will show what a large problem this is. I am so grateful to have found out the cause of my malaise early.

I am one of your “awkward squad” of Polymyalgia Rheumatica sufferers who rejected steroid treatment and I relied on disprins much against my doctor’s advice. It took several months of gently reducing the quantity taken but I was off them altogether within nine months and thus far have suffered no recurrence.

Thank you so much for your column. We never miss it.

Dear Anon,

Thanks for bringing to my attention the problem of zinc toxicity associated with the use of denture fixatives – of which I confess I was not aware. I look forward to mentioning this in an upcoming column. It is good to hear you managed to control your PMR without having to resort to steroids.

Dear Doctor Le Fanu

Further to your article in this Monday’s Telegraph regarding Primary Hyperhidrosis:

My daughter has suffered with hyperhidrosis in hands and feet for over twenty years. Examinations, school and university work was a nightmare. She decided to undergo a sympathectomy operation when 21 as a last resort when nothing else seemed to help. Fortunately this was cancelled. I say fortunately as we discovered doing further research that although this would have reduced the sweating in the hands it would have caused extra sweating in other parts of the body.

I was interested to read in your article of the drug Oxybutynin as an alternative.

However, for someone wishing to use a drug free and very effective method to reduce this embarrassing condition my daughter discovered Iontophoresis Therapy. Briefly, this is a machine which resembles the size of a laptop. It opens into two trays into which a small amount of water is put and a very small electric current is passed through whilst placing hands and then feet on electrode plates in the tray for about 5 minutes. She does this once a week and has no sweating for the remainder of the week. She has used this successfully for 4 years and it has just become part of her routine.

Needless to say this has been a life changing treatment.

The machine can also be used on other parts of the body using sponge attachments. (For more detail see IontoCentre.com)

The drug would have been a useful alternative on a recent trip of 6 months through Africa where of course she was unable to plug in a machine !

Do hope this information can be of use to other sufferers.

Yours sincerely

Dear Anon,

Thanks so much for being in touch and your interesting account of your daughter’s hyperhidrosis. It is very gratifying that it should have responded so well to the Iontophoresis treatment that I look forward to mentioning in the column for the benefit of others.

Dear Dr Le Fanu,

Both my mother and her father ( neither of whom smoked or drank alcohol), suffered from hand tremors / shaking which became just about noticeable in their 40s and got progressively worse with age. So much so that in their late 60s and 70s one had to half fill a cup to avoid spillage. Both lived into their late 80s and were in good health. In the last years of his life my grandfather had to drink his tea through a straw.

When my mother was in her 70s the shaking became very noticeable, but if she fell asleep it stopped completely. My mother had 5 children – 3 boys & 2 girls and all of the males have shaking hands.

I have suffered from it all my adult life and now that I am in my late 60s and now, just as with my mother I have to half fill a cup as in the past few years the continual shaking is getting progressively worse. I do not smoke, but do drink (socially) but I have noticed that if I have 2/3 pints the shaking stops ! but next morning is back to what it was.

I mentioned this to my doctor, who does not think anything can be done. My 2 younger brothers suffer from shaking, but not as severe as mine – yet. Also my 2 sons, 40 and 38, also are showing signs of having inherited the condition.

Do you have any advice. Many thanks

Dear Anon,

Thanks for being in touch and your classic account of the symptoms of Essential Tremor that clearly runs strongly in your family. This is best treated with a small dose of a beta blocker such as Atenolol (see T A Larson, Acta Neurol Scand, 1982 vol 66, pp 547 – 554) You should discuss this with your doctor.

Firstly, I had four episodes of vertigo from February to December last year. The last one was the worst and we had to get our GP to come to the house because I could not move out of the chair. He prescribed Buccastem 3mg tablets for the sickness. I took one tablet twice a day for two days and felt much better. My question is – should I be worried about setting off the vertigo again when I fly to Singapore to see our daughter later this year? It has been suggested that I could take travel sickness tablets for such a long flight. Is this a good idea ?

Secondly, I have read with interest pieces in your column about Multivitality 70+ tablets alleviating the swelling and joint pain of arthritis. I am 72 and have had swelling to my hands and finger joints for several years. My GP suggested that I take glucosamine, which I have done for the last ten years at least. I am prescribed 25mg Atenolol and Lanzoprazole first thing in the morning every day. My question is, is the Multivitality 70+ compatible with my prescription drugs and am I right in thinking I should stop the glucosamine if I start taking the Multivitality ?

I apologise for using your time to ask two questions, and thank you in advance for your kind attention to my queries.

Ruth J

Dear Mrs J,

Thanks for your queries. The episodes of vertigo are presumably due to the condition known as Benign Paroxysmal Positional Vertigo and it is certainly encouraging that they respond so well to the Buccastem. They could, of course, recur so you need to take a supply of medication when travelling to Singapore. Iin the meantime you should discuss with your doctor whether the Epley manoeuvre (details on the internet) might be appropriate for preventing further episodes in the future. As for the Multivitality 70+ there is no reason you should not take them with your current medication. I have the impression that the glucosamine has not been particularly very helpful so perhaps, in view of recent comments in the Monday column,you should give them a rest.

Dear Dr James,

I have a chronic medical condition which started in around 2007, and which leaves me unable to work or drive, due to unrelenting headaches, dizziness, vertigo, and a host of other symptoms besides.

Getting a formal diagnosis has proved impossible, but it’s become obvious to me that I am suffering from electro-hypersensitivity (or any of the variant names by which the condition goes).

It’s quite simple – the more exposed I am throughout the day to artificial radiofrequency/wireless radiation from technology such as mobile phone masts, cordless phones, mobiles (especially smart phones) and so on, the worse I become. And now I have the imminent rollout of smart meter technology threatening to add to my daily doses of non-ionizing radiation poisoning.

We appear to be in a situation as a society (and as a species) whereby we are rolling out layer upon layer of wireless radiation, to which we are all exposed on a 24/7 basis, with absolutely no idea of the cumulative health effects of this – although a few brave scientists, researchers and medics are starting to raise urgent concerns, and the International Agency for research on Cancer has said that “Radiofrequency electromagnetic fields are possibly carcinogenic to humans (Group 2B).”

I read the article in the Telegraph on 24th January 2014, about a French village that is desperately trying to remain a mobile-free zone, with great interest (“French village in ‘Asterix-style battle’ to be mobile network-free zone”).

What reassurance, if any, can you give electro-hypersensitivity sufferers such as me that things are ever going to improve, when in this country, the NHS seems to be constitutionally incapable of recognising the condition in the first place, and we all seem to be absolutely wedded to our wireless gadgets?

Kind regards,

Dear Anon,

Thanks for being in touch and my sympathies for these debilitating symptoms you attribute to electro-hypersensitivity. You might be interested in attending a conference on this organised by the British Society for Ecological Medicine in London on Friday 7th March.Further details can be found on the website www.bsem.org.uk .

Dear Dr,

My husband and I enjoy cruise holidays. Unfortunately every time recently he has suffered badly with swollen legs. I am attaching a photograph of them on our last cruise. He can’t get shoes on by the evening they are so swollen but, come morning, they are their normal rather skinny self! He did have a DVT in his left leg about four years ago whilst we were at home and was treated with Warfarin for a few months. He hasn’t had any trouble since. He has also had a couple of squamous cell carcinomas removed from his legs over the past five years.

Our GP isn’t very interested and just tells him to stop going on cruises. We are both in our eighties and enjoy our holidays.

I hope that you may come up with an answer!!

E G

Dear E G,

Thanks for your query and those rather alarming looking photos of your husband’s swollen legs. This problem is usually (though probably incorrectly) attributed to the allegedly high salt content of the meals served on cruise ships. I suspect, however, that as with the swollen feet associated with flying this is more likely to be a gravitational effect. The simple (and indeed only remedy) is to take a daily dose of the diuretic or water tablet Frusemide.

Dear Doctor Le Fanu,

I am 89 years old. In January 2013 I was diagnosed with prostate cancer. I was prescribed 3-monthly injections of Leuprorelin which are proving successful.

Very recently there was an article in the Telegraph about a new drug for prostate cancer which would extend the life of Leuprorelin injections and perhaps even halt the progress of the cancer. I meant to cut the article out but forgot to do it. Can you suggest a way of finding this article and printing it out.

I greatly enjoy your column each week and wish you continued success in the weeks ahead.

Yours sincerely,

Dear Anon,

Thanks for being in touch and it is good to hear these injections are controlling your prostate cancer. I was unable to find any reference to the article you mentioned and to my knowledge there is no adjunctive treatment that prolongs its effects.

Dear Dr James Le Fanu,

I write in connection with the letter from ‘Mr N A from Bath, concerning extreme skin pains.

For the last several months I have suffered these pains: Itching, stinging, burning and stabbing. They started at least a year ago, as painful itching and have developed over time, into the most painful condition. As with Mr N A there is no sign on the skin.

Like Mr N A, I have tried many forms of relief and the only respite I can get, is to apply an Hydrocortisone cream (Betnovate). This mostly relieves but, because the pains are ‘all over’, the cream has to be applied to most of the body.

Unlike Mr N A, I also get the symptoms in the neck and hair.

I have seen two consultants as well as my GP, a dermatologist and a cardiologist (this latter because I have a ‘loop recorder’ implanted and I feared an allergic reaction. I am waiting for this to be removed but, all the doctors doubt this is the cause!).

As the condition is so distressing, I long for a diagnosis.

Yours sincerely, Terry S

Dear Terry S,

Thanks for being in touch and my sympathies for these distressing symptoms which I mentioned in the column last week may be the condition known as Migrating Sensory Neuritis. The cholesterol lowering statins have also been implicated and if you are taking them, a ‘statin holiday’ may bring relief.

Hello,

My dad has severe back pain and also has rheumatoid arthritis and has been on an anti-inflammatory for over 10 years. He recently had a blood clot in his calf muscle and was put on Coumadin.

He was told that he can’t take any anti-inflammatory medicine anymore. Would he be able to take a cox-2 inhibitor or do you know of any other medications he can take to help with the rheumatoid arthritis?

Thank you

Dear Anon,

Thanks for your query. The cox-2 inhibitors, as you suggest are less likely to cause complications in those taking anticoagulants such as Coumarin (see T C Cheetham, ANN Pharmacophore 2009 vol 43 pp1765 – 73). As for the severe back pain this would warrant a visit to an osteopath for manipulation or referral to the pain clinic at the local hospital with a view to an epidural injection. If your father lives in the London area he should contact orthopaedic physician Dr Clifford Harley (07810620058) who is very skilled in dealing with this sort of problem.

Dear James,

You may find the following medical conundrum interesting!

A little background:

Male, aged 69

Good health

Life-long non-meat eater, enjoying a basically Asian/Mediterranean diet.

Minimum of ready-prepared foods in diet

Normal/low blood pressure

No alcohol, tea, coffee or any other stimulants

Low sodium salt intake

Only current medication is Terbinafine for fungal nail infection.

I have developed a sensitivity (ranging from slight to extreme) to a range of foods and food flavourings which previously I tolerated: all produce the same reaction – marked diuretic effects leading to dehydration and lethargy. An unwitting combination of any of the following list can necessitate up to five trips to the bathroom overnight. The problem first arose about 10 years ago whilst living in Rome, affecting me only a couple of times a year. Over the past two years the incidence has risen slowly to more than once a week.

The dehydration can lead to a loss in weight overnight of 1kg from my normal weight of 64kg. My blood pressure falls typically to 99/62 with a pulse rate if 105 after climbing stairs. With either oral rehydration salts, drinking lots of water, and by eating salted peanuts in small quantities, the effects of dehydration normally wear off by early afternoon.

The following list contains the principal observed offending foods/ingredients:

Parsley, particularly flat-leaved variety (admittedly a well-known natural diuretic)

Asparagus (ditto)

Prepared Italian sauces containing “soffritto” herbal flavourings

Parmesan and Pecorino cheeses

Olives in brine with Lactic Acid as preservative

Certain types of Soy sauce

MSG and hydrolysed vegetable protein

Many of these ingredients feature in authentic dishes. Even trace quantities can trigger the sensitivity. There would appear to be some common elements running through the above:

firstly, well-known natural vegetable/herbal diuretics,

and secondly, natural fermentation by-products (dairy and vegetable).

Soy sauce apart, I tolerate most oriental spices very well. However, prepared spices and sauce concentrates do not always list the full ingredients!

I am now into the fifth month of the Terbinafine – is it possible that this is increasing my sensitivity? (I would be reluctant to abandon the anti-fungal treatment, as the response to the long-standing toe nail fungal infection looks promising).

My long-standing GP has recently retired, and locums have not considered my problem to be more than a curiosity. Any thoughts?

Kind regards,

Robert D

Dear Robert D,

Thanks for being in touch and your most interesting (if difficult to explain) account of the diuresis induced by this eclectic selection of foods – and its consequences. This is clearly quite different from the ‘normal’ diuretic properties of coffee and fresh vegetables. I would not have thought that Terbinafine is an exacerbating factor.

Hello

I wonder if you would be able to comment on my problem which is one of what you might call ‘projectile diarrhoea’. I have had this for probably 10 years now. 22 years ago my gall bladder was removed. I think my problem may be connected with that and probably with the possibility that I may not be able to digest fats as I should.

I plucked up courage to mention this to my doctor about 4 or 5 years ago and was referred to a specialist who prescribed codeine tablets up to four a day. As I had no wish to become constipated with the codeine nor to be too drowsy to drive I confine myself to taking Imodium now and again – certainly no more than once a day every few days.

Now to the nitty gritty. I usually have a reasonable bowel motion up to half an hour after breakfast and that’s it for the day. this is fine, but every so often perhaps up to an hour after that I get this very urgent diarrhoea and I MUST find a toilet within a couple of minutes or otherwise I cannot stop it all from coming out wherever I happen to be. I have no way of knowing whether this is going to happen or not so I may be on the morning dog walk and nowhere to go or for instance staying with my daughter and walking the children to school.

I have wondered whether this is bile acid diarrhoea. Because (I think) I don’t ‘go’ like this more than once a day I feel that the doctors are not bothered and therefore I have stopped mentioning it.

I look forward to your response.

Dear Anon,

Thanks for being in touch and my sympathies for the long standing bowel problems which certainly could be due to Bile Acid Diarrhoea though the fact that these episodes only occur in the morning is, as you may know, a well-recognised form of Irritable Bowel Syndrome. It would certainly be sensible to discuss with your doctor a trial of the drug Cholestyramine that, as recently described in this column, can be quite dramatically effective.

Thank you

About nine months ago I read in your column a list of symptoms that fitted the condition I am suffering from – sadly I did not log on to see your reply and as I am still in the same position I wondered if you could trace it for me.

I have a pain that starts in my right buttock goes down the back of my thigh and then transfers to the side of my lower leg and finishes in pins and needles in my foot. Classic sciatica!- sadly this has stayed with me for nine months and is now wearing me down. As I remember the article it was one of your readers writing in with the symptoms and asking if there were fellow sufferers with an answer. Could you please let me know if a magic cure was found or at least the name of this vicious pain. In the beginning it was the sleepless nights that bothered me but now it is the daily pain only kept down with various pain killers.

I do hope that you can find the article and hopefully some magic cure!! Many thanks for a fine column – sadly the older I get the more interesting it becomes! Best wishes

Dear Anon,

Thanks for being in touch. It certainly sounds that you have the classic symptoms of sciatica for which my advice would be the same as that for the query from ‘Anon’ – three above.

Hello, I’m an 83 year old male who has suffered from fairly mild Psoriasis from my late teens. Inherited from my father and passed on, presumably, to my younger son who has it worse than me.

I have sought and tried many possible remedies from my doctor, online etc; Some have given slight relief but none cured it. Happily I have, I believe, cracked it and that is Medi-honey. For just over a week I have washed with Medi-honey body wash and applied, once a day, Medi-honey derma cream.

It is astonishing and almost unbelievable, my skin is now free from red sore patches, flaking and irritation.

I shall continue for the rest of my days of that there is no doubt. Do hope this may help others with this complaint.

Keep up your good work.

David C

Dear David C,

Thanks for being in touch and I am so glad to hear that your psoriasis has responded to the Medi-honey. It is not quite clear why it should have done so but I look forward to mentioning in the column for the benefit of others.

In November our 34 year old daughter approached us asking for help. She told us that she had an alcohol dependency problem and that she thought the only way to deal with it was to go into Rehab.(I have since learnt that her GP had also told her she needed to do this) She told us of a clinic near Cape Town, SA called Stepping Stones. Her work were very supportive and gave her 2 months off. Her extraordinarily generous, kind and understanding aunt paid the fee (very much cheaper than a clinic in the UK and with the ZAR rather low at the moment ….) as we are really not at all well off. There is a history of alcoholism in my husband’s family and, apparently, she had been suffering from depression since schooldays (she was at boarding school) when she was diagnosed and prescribed for depression in the 6th Form.

From a telephone conversation with her counsellor at Stepping Stones I was very much getting the message that ideally my husband and I should go out to Cape Town. Stepping Stones hold a family session once a fortnight and then a family counselling session. My husband has just suffered a stroke and so I was unable to consider going until he was passed fit to drive again. Once he was I flew out but unfortunately he was unable to accompany me due to his health.

At this clinic I attended the family session which, in just a day, tried to explain to us about alcoholism. It was a very intense and informative and I am still trying to process what I learnt. My daughter then told me that not only was her alcoholism very much more serious than we, her family, had realised (suffering black outs etc) but that also, 3 years ago, she had overdosed and been in hospital for 4 days. She had begged her (very supportive network of) friends and her brother not to tell us. Last year she overdosed again on Diclofenac which she had been prescribed for a very badly slipped disc (in old money, sorry not sure of modern terminology). This time, as I understand it, because Diclofenac is not so likely to cause such damage (to liver, kidneys?) she was in hospital for 24 hours.

I simply cannot tell you how very, very angry I am that, presumably because of the data protection act – or whatever – her decision not to allow us to be told (and as she is unmarried we are presumably her next of kin) the first time she overdosed was not over-ruled. From what I learnt at Stepping Stones alcoholism is a mental illness – and she has a history of depression also – and would have been in no state to have made a rational decision. If she had suffered a diabetes hypo say, or had been run over then I am sure we would have been informed. The result of her being denied our help and support at that time has led to a further 3 years of anguish for her as had we been able to intervene and give her the support and help she needed in 2011 we might well have been able to prevent her further and continued decline into alcohol and depression. At the very least we would have been there as a support and help to her. As she is long past childhood, owning her own flat, holding down a responsible job we did not see very much of her sadly. We live in the country and she in London. There was never any rift but because she always seemed to be so busy and social (which she maintains she was although I think some of that social activity was with a bottle on her own in her flat) and we didn’t wish to appear to be “nosey”. We were, of course, sad that she didn’t seem to have a partner or be getting too close to marrying and having a family like most of her friends and didn’t want to appear to be putting any pressure on her in that respect.

On a practical note, although we are not at all well off, happily as I said above another member of the family has paid for her treatment in South Africa. But what about people (the vast majority I suspect) who could not afford to put their child through therapy? How can it be right that a mentally ill person’s family are denied the opportunity to intervene and help? Surely at the very least we should have been offered an interview with the psychiatrist who must have seen our daughter at the time of her first overdose.

I have telephoned MIND to ask them about this conundrum but they were too busy to take my call. I think that we, and other families like us, deserve an explanation as to why we were/are denied the opportunity to help any family member in this situation. Could you offer me some sort of reasonable explanation as to how this can be right which might give me some peace of mind. I am aware that it is necessary for my daughter’s recovery for us also, as her family, to “let go” of any anger and it may be that I am focussing all my anger on this particular point but I cannot emphasise enough how utterly furious I am. Could you advise me to whom I should address this? My MP? He, as it happens, a medical doctor but very young. (Daniel Poulter). Sometimes one can only think that the ‘State’/"Government’ has gone quite mad and all common sense thrown, like the baby, out with the bath water.

Yours very sincerely and with kind regards

Dear Anon,

Thanks for your details account of your daughter’s travails. It is good to hear the facilities in South Africa for sorting out these problems are not only of a high standard but also (relatively) cheap. The specific problem you raise is a difficult one for while sharing this type of information is permitted on a ‘need to know’ basis for health professionals, the patient’s consent is required for relatives like yourself to be informed. Your daughter not only declined to give that consent but also made deliberate efforts to ensure you were not made aware of what had happened. It is obviously clear in retrospect she would have benefitted enormously from your health and support at that time but it is difficult to see on what grounds her doctors could have overruled her decision.

Dear Dr Le Fanu

I am an elderly woman whose hair has suddenly started to fall out in alarming amounts and I hope that you can recommend a suitable remedy.

Thank you

Bettina M

Dear Bettina M,

Thanks for your query and my sympathies for this alarming hair loss without, I presume, any underlying scalp condition. The general recommendation is to wash the hair ‘with care’but the only specific remedy is a regular daily application of the drug Regaine –whose effectiveness is disputed and is not available on the NHS.

I have recently been diagnosed as having a grade1/11 Spondylolisthesis at L4/5 resulting from a fall. I am experiencing discomfort in the lower legs and feet. My consultant has given me the choice of an injection ( a temporary solution) or major back surgery with rods. I feel this is not the route I wish to take at the moment and was interested to read in one of your comments recently of a gentleman with similar problems and you said that this could be resolved by a small incision and micro surgery. Please could you give me information on this. I live in Gloucestershire.

Thank you

Mrs Hazel S

Dear Mrs S,

Thanks for being in touch. I obviously have no specialised knowledge in this field but while there are indeed reports of the benefits of microsurgery for the treatment of Spondylolisthesis I would favour your surgeon’s advice. These operations can be quite tricky and it would seem important to have a full rather than ‘keyhole’ view of what is going on.

Dr Le Fanu"s on-line overall health clinic, Friday 31st January 2014