Diversity, devolution, innovation: building an NHS fit for the 21st century

It was “the can-do crowd”, according to the NHS England chief executive, Simon Stevens. Those who gathered at the Health and Care Innovation Expo 2016 in Manchester were certainly hungry for the latest cutting-edge practice and the hottest technology on show.

But Brexit uncertainty, funding anxieties and the unresolved junior doctors’ dispute added a sharp edge to debate on how the health and care system can be transformed into one fit for 21st century purpose. And scarcely a session passed without warnings from patients’ and service-users’ representatives that people were feeling left out of the loop on plans for change.

Paul Baumann, NHS England’s chief financial officer and, as he said, “chief devolutionist” responsible for regional autonomy on health and care spending, set the tone for the reformers when he warned that the latest drugs and technologies would be unaffordable for the NHS unless it did “everything else differently”. This would require “bold innovation and bold leadership”.

But David Cartwright, a patients’ representative from Oldham, summed up the frustration of the opposing camp when he asked Baumann and leaders of the Greater Manchester devolution project: “When are you going to tell our communities what we are going to get and what we are not going to get?”

Public consultation on STPs assured

Stevens picked up on the mood and used his keynote speech to try to offer reassurance, particularly with respect to the 44 sustainability and transformation plans (STPs) being developed by local care leaders to transform systems across the whole of England.

He said he would be issuing a notice stressing the need for formal public consultation on the changes proposed by the STPs, which may include closure of hospital services. But he added: “I hope that people will give NHS and local government leaders the respect that what they are trying to do is incredibly difficult, but incredibly important.”

Matthew Swindells, NHS England’s national director for commissioning, said the aim was to get all plans for STPs “assured” by the end of December so that they could be aligned with operational plans effective from April 2017. Challenged on the tightness of the timescale, he said: “We don’t have time to take longer. Every day we decide to have another committee meeting rather than getting on with making hard decisions, we are not making optimal use of health and social care from the money available.”

Technology is the key

The health secretary, Jeremy Hunt, announced plans to create an “ivy league” of global exemplar hospitals to fast-track digital excellence.

Naming the initial 12 trusts each to receive up to £10m in funding, Hunt said the idea would be to “buddy up” each one with a leading US hospital such as the Cleveland or Mayo clinics to bring them up to the standard of the best in the world. Less tech-ready trusts would be prepared in subsequent waves. Hunt also promised “instant access” to personal online health records. He said: “This puts power back into the hands of the patients.”

These announcements came on the back of publication at Expo of the final report of the Wachter review of NHS digital readiness, highlighting the need for clinical input in achieving digital transformation.

The review’s author and professor at the University of California, Dr Robert Wachter, stressed the need to “reimagine tasks” rather then superimpose technology on old working methods. He said: “That is why we need to involve young people in this process. They need to look at workstreams and question why we do it that way, with fresh eyes.”

The digital revolution is, however, raising concerns about appropriate use of personal information. Dame Fiona Caldicott, the national data guardian, speaking about her review of public trust in the use of health and social care data, warned: “People no longer accept things being done to them without their knowledge.” Her review sets out 10 standards for data use, informing individuals and conditions for opting out.

Innovation needs to be implemented faster

There is no shortage of medical and health innovations to transform what NHS England’s medical director, Sir Bruce Keogh, described as the “biggest semi-integrated health system in the world”. But he pointed out that “ideas are only as good as their uptake”.

Discussing the challenge of achieving innovation at scale, Keogh outlined the NHS innovation accelerator programme (NIA) – the brain child of a junior doctor, Dr Mahiben Maruthappu. In its first year, the NIA funded 17 fellows whose ideas and processes were accessed by 3 million patients in six months, Maruthappu said, with a further cohort of fellows due to be announced in October, focusing on disease prevention, early identification and long-term conditions.

Devolution

Devolution plans are now being developed in areas covering some 55% of England, following Greater Manchester’s lead in setting up the NHS’s first devolved health and social care partnership, which came into being in April.

Jon Rouse, chief officer of the partnership, making his first speech after just 20 days in post, said no one should be under the illusion that devolution was “magic dust”. Although there was already satisfaction in the development of dementia-friendly pharmacies and Pride in Practice, a new standard of excellence in healthcare for gay, lesbian and bisexual patients, the biggest achievement so far was the bringing together of a strategic partnership of 37 NHS, local government and social organisations.

Rouse said: “Judge us later down the line by how we make progress on patient experience and clinical experience. Devolution is complex, it’s dynamic and difficult, but it’s worthwhile.”

People come first

Jane Cummings, chief nursing officer for NHS England, issued a call to arms to recognise and promote the diversity of the workforce. It was, she said, “frankly appalling” that there were so few black and minority ethnic directors of nursing. Making special mention of health workers from the rest of Europe, worried by Brexit, Cummings said: “Diversity makes us a better service.”

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Diversity, devolution, innovation: building an NHS fit for the 21st century

The "Sex Talk" For 21st Century Mother and father

“Would you rather have your very first kiss on YouTube?” My 9 year old son asked, “Or a transcript of everything you explained on your very first date offered on Google?” It was like he had just entered some new 21st Century iteration of Lacan’s “Mirror Phase.” He was abruptly conscious that what he does on the Net is public.

The “Mirror Phase” is a way of describing how the ego develops as an observer of the self. Imagine that second when a youngster encounters and comprehends his personal reflection in a mirror. Put basically, French psychoanalyst Jacques Lacan’s used this picture to describe the developmental second when a kid 1st experiences and embodies the stress in between internal and external identity.

My son’s query produced me wonder if, in the recent planet, psychoanalysts might require to add yet another encounter of the self: the 1st experience with the public nature of digital networked life. After all, a substantial portion of identity is presently caught up in how a single participates in social media and the manifestation of a character “brand.” Probably people who believe Facebook is narcissistic are complicated psychological theories that borrow reflection imagery.

It was about a week just before my son’s ninth birthday and he had been thinking a great deal about dating, eros, and romance lately. I could inform because he stored making passing remarks about it. YouTube, Google, Kissing. This was new territory for me. I sat for a minute with a bit of anxiety about the conversation that was coming and then I answered his query, “I select my very first kiss on YouTube. No matter how awkward that seems to be, it is not as negative as the clumsy methods we consider to express puzzling feelings to individuals before we genuinely know how.”

It was a hint I was fishing. I hoped he’d ask me to elaborate and I could launch into a total scale sex talk. I desired him to start off the discussion.

Each and every time I’ve experimented with to have similar conversations it has been clumsy. I did an anatomy lesson last 12 months, opening with, “come right here, there’s one thing I want to talk to you about.” That didn’t perform. Also hefty. It infused the discussion with unnecessary stress. I wished it to feel standard, like an daily conversation. Providing youngsters normalized and dignified vocabulary to talk about private elements is known to be one particular of the best preventative measures we can take against abuse. The sex taboo is problematic. It can create a culture of concern where children are as well scared to talk with their mothers and fathers as they understand to make sense of their quickly shifting bodies and desires. Producing little ones really feel safe about talking openly to their mothers and fathers about sex is essential.

A few days soon after the initial awkward conversation, I downloaded the sex ed app “Birdees” to the iPad mini and informed my son I essential him to assist me review an app for an report. It was tricky but it worked. I discovered that there was a lot he did not know about his very own anatomy, words like “scrotum,” “testicle,” and “anus.” When it came to female anatomy, he only knew the phrases “vagina” and “boobies.” Utilizing the app permitted us to have an ordinarily awkward conversation with out the trouble. The illustrations in the app had been modest and completely age proper. Regrettably, Birdeesapp is temporarily unavailable We downloaded it months ago. Even now, there is a whole lot of information on the Birdees web site and hopefully they’ll release an up to date model of the app quickly.

There are a lot of wonderful books that assist to teach reproductive anatomy to primary age kids. You actually do not want an app. Despite the fact that there are new strategies of content material delivery, human anatomy hasn’t changed.

Nevertheless, it is curious that a discussion of YouTube and Google inspired the conversation in my home. It raises familiar queries about the modifying nature of socialization and about how public and private existence are knowledgeable in the 21st Century.

Unfortunately, so much of our discussion about the new digital actuality of kids’ expertise misses the important points. We tend to get misplaced in irrelevant moral debates, worrying about what’s great or negative, resisting against adjustments that seem to be inevitable. Digital technological innovation is here to remain, we need to have to fear about how we interact with it–and how we teach our kids to interact with it.

The problems is that even though we’re occupied judging the encounter, labelling it as ‘bad,’ ‘distracting,’ or ‘narcissistic,’ our kids learn not to talk to us about it at all. Would you speak to somebody about anything they are certainly judgmental about? Probably not. Neither will you youngsters. They’ll just sneak into the social internet when nobody’s searching and figure out how to behave by themselves. It is like learning the rules of the playground with out adult supervision. Cyberbullies will prevail. Quickly, you may possibly be surprised to learn that your children have an total virtual lifestyle that is designed without mature guidance.

danah boyd (she does not use capital letters), is author of It’s Complicated: The Social Lives Of Networked Teenagers. She place it nicely in her March 2014 interview with the NY Occasions, “My son is going to develop up seeing his mothers and fathers making use of devices and so I’m much more interested in figuring out approaches to help him enjoy these resources than I am in instantiating restrictions that I couldn’t model.” She’s talking about her really youthful son in this quote, but danah boyd is an specialist on the methods teens use the web. Her research shows that teenagers are “desperate for the chance to leave their properties to collect with pals.” Teenagers with no the freedom to do so turn “to social media to produce and inhabit networked publics” (p. 201).

When my son asks me whether it is greater to have a 1st kiss on YouTube or a initial date on Google, he’s unconsciously asking me to assist him perform out the guidelines of a networked public. He’s asking me for advice as he experiments with early sexual feelings inside of the social realities of this new globe. I’m glad he feels secure enough to request me. Probabilities are, your kids are asking for the exact same guidance, are you existing adequate to hear the query?

Jordan Shapiro is author of FREEPLAY: A Video Game Manual to Optimum Euphoric Bliss, and MindShift’s Guidebook To Games And Learning For info on Jordan’s upcoming books and events click right here.

The "Sex Talk" For 21st Century Mother and father

Dr Le Fanu"s on-line wellness clinic, Friday 21st March 2014

Reading with interest your column, and recent letters to the editor, about side effects of statins, I bring to your attention an on-going localised reaction I am still having to a Shingles vaccination which I had in the middle of October last. You may/may not be aware that the NHS is offering this new vaccine to all 70 year olds, which age I attained last July: hence when offered it by my GP I took it up, although I’ve never suffered from Shingles. A few days after the vaccination I developed a localised reaction around the site of it which is still ongoing and which my GP has now referred me twice to hospital for tests.

The reaction ranges from a stinging sensation to an ache: not disabling in any way but certainly irritating! I first was referred to the local musculoskeletal clinic who thought I might have water on the site: an MRI scan showed this was not so. I’ve now been referred to a Neurologist next month. My GP has reported this to the Yellow Card Scheme, but I do wonder whether others have had this side effect from what is a new vaccine?

I don’t expect a reply but thought you might like to know!

Andrew M

Dear Andrew M,

Thanks for drawing attention to the side-effects of the shingles vaccine. This can, as you will know, cause an inflammatory reaction with pain and redness at the site of the injection – and yours seems to be a more serious variant of this. Perhaps a short course of ibuprofen may be of value.

ALAMY

Migril availability

Hello

For years I have found migril to be the only thing that worked for my migraines. Have been unable to obtain it for the last month and chemist just saying there is a manufacturing problem. Do you know if it has been withdrawn? Thank you for your help.

Regards Mrs M I

Dear Mrs I,

Thanks for your query to which I do not know the answer but I notice a similar preparation to Migril, Cafergot, was discontinued in 2012. It is possible this might be a marketing ploy by the drug companies to promote the sale of newer more expensive anti-migraine drugs.

Dear James

I have an unusual conundrum for you. I am a physiotherapist and a patient of mine, BS, a lady in her early 70s gets a bitter ‘metallic’ taste in her mouth on effort-usually involved with large arm movements, but it can also occur following more strenuous body activity.

She has a history of cerebral haemorrhage secondary to cerebral cavernous malformation, and right hemiparesis. She has reduced use of her right arm and has balance problems , but she can walk distances reasonably well with some assistance.

None of her medical consultants have been able to explain this.

(Ms) Gill S MCSP

Dear Ms S,

Thanks for your most interesting query. I would suspect this bitter taste in the mouth might be exertion induced acid reflux. This can be prevented with an acid-suppressant drug such as Omeprazole.

ALAMY

Dear Dr Le Fanu,

I would like to ask your advice on my lower back pain please. I am 35 years old. I have had very bad lower back pain since about spring 2008. It is on my lower central and right hand side and the nerve that goes from this region into my leg and foot is also affected (sciatica). It gets very bad at times and I can barely move without pain. It then will ease off for a while and I can manage again but then return.

I used to be very active – running and swimming and cycling a lot. I did run a marathon just before the pain started and fear I may have damaged my back permanently from this. I can do no sport now. I find just sitting at my work desk very painful and have to stand a lot of the time rather than sit. I have had a lying down mri scan. Which uncovered two bulging discs. Also an xray I had when I was 16 said I had marked lumbar scoliosis.

I have been doing core stability exercises religiously since the pain began, but this does not seem to help much.

I have seen various consultants but with no way forward. Do you think I should try and get a weight bearing mri scan as I have heard these can reveal the back and any issues more clearly. Also would you recommend a consultant or specialist I can see to help me with a way forward to try and reduce the pain? I have heard of caudal epidurals but I am very scared of injections as I have heard these have risks of paralysis and nerve damage and may only just mask the pain for a while.

Any advice would be greatly appreciated, many thanks

Dear Anon,

Thanks for your query and my sympathies for this severe chronic back pain that has so impaired your mobility and is, I gather, related to a series of problems in your lumbar spine . I would not have thought that a weight bearing MRI scan is likely to clarify matters further. I would suggest you contact Dr Clifford Harley (07810620058) who is an orthopaedic physician based in London with a lot of experience in dealing with this type of problem. Alternatively Mr Jeremy Hucker (01895 628891) specialises in the sort of minimally invasive procedures such as facet joint injections and caudal epidurals than can be very helpful.

Dear Doctor

I have been suffering with Interstitial Cystitis for nearly five years (although it was only diagnosed in the last eighteen months). It is extremely painful having a chronically inflamed bladder and my life is ruled by how I can manage the daily pain. I have given up alcohol, caffeine, smoking, chocolate and many other foods and am trying a wheat/gluten free diet, I have also had to retire from work as a Teaching Assistant.

The pain can be relieved for a short time if I urinate (this in itself can be painful), because my bladder is so small now. I am not incontinent but have to

empty my bladder quite frequently (I am 57), particularly during the night (between 10pm and 6am) it can be up to 13 times. Constipation also adds to the

discomfort. Sitting and walking are most uncomfortable although I am trying to get to a yoga class twice a week as exercise is supposed to be good.

I have had cystate installations which I believe have helped slightly and am still taking anti acid…is Milk of Magnesia any good? I and many others need help

our lives are dominated by this condition and the constant pain for which no one seems to be able to offer any suggestions or relief. I dream of having one pain free normal day a week. I believe recently there was a Health drink mentioned in one of your articles perhaps I could try it! Any suggestions please.

Very best Regards

Dear Anon,

Thanks for being in touch and your account of the distressing symptoms caused by your interstitial cystitis. I note you have consulted a urologist who has organised some appropriate treatment. My only suggestion, if you have not tried it already, is you should discuss with your doctor a trial of the acid-suppressant drug Cimetidine which, it is claimed, can be of considerable value in some patients.

ALAMY

Dear Doctor LeFanu,

Having read a recent DT headline and your frequent comments on statins and their effects I can no longer resist reporting the following experience which may interest you.

Some years ago I was prescribed Atorvastatin, 40 mg. to be taken once a day, which from time to time I would forget to take.

As it happens I also play chess competitively to at least average club standard. When I forgot to take the tablets I gained the impression that I could see things over the board more clearly. Now chess players are graded by a process which, while not perfect, gives a pretty good idea of a player’s strength so it naturally occurred to me to wonder if stopping the tablets altogether would bring about an improvement in my playing standard.

A consultant cardiologist who I see regularly assured me that not taking Atorvastatin for a couple of months would be unlikely to have any harmful effects. I accepted his advice when within a year my grading shot up be nearly thirty points to a standard I was last at about thirty years ago, some way above the average of club players in the UK. I also came equal first or second in three successive tournament, an achievement which I have never before managed to accomplish.

It would clearly be rash to draw the obvious conclusion. For a start I had been at the lower standard for some years before I began taking Atorvastatin. Also there is no obvious explanation for the improvement. Clearly I did not become brainier but I did notice that my opponents for some reason reason would often not take advantage of clearly superior positions, clearly won games in one or two cases. That could be because I was evaluating positions more clearly than I had before though I do have two explanations of my own, one of them rather odd and relating to opponents not taking advantage of superior positions..

None the less the experience does seem suggestive and naturally one wonders if chess players could contribute to an assessment of the effects of statins on cognitive achievement.

Anon

Dear Anon,

Thanks for your fascinating account of the subtle cognitive effect of statins on your chess playing. I will mention this in the column of the 31st March.

Good Afternoon

About 5½ years ago I had a parathyroid gland removed. A biopsy of the gland revealed that it was malignant. As a result, half of my thyroid was removed as a precaution. Although I have had no further problems with my remaining parathyroid glands, I am increasingly getting erratic heartbeats, tremors in my hands and upper torso, and severe tiredness. Various GPs and the Consultant Endocrinologist have requested T4 blood tests from time to time. All the blood tests have come back more or less normal, and generally with a request that they be repeated 6 months later.

The question that I have, and which the Consultant seems to unwilling to answer, is whether the remaining part of my thyroid is struggling to maintain my thyroxin levels, thereby causing the symptoms that I am getting. Would a low dose of thyroxine relieve the thyroid and remove the symptoms?

I would be interested to know if any of your readers have experienced similar problems following removal of part of the thyroid.

Best Regards

John G

Dear John G,

Thanks for your most interesting query. The symptoms you describe are certainly suggestive of an overactive thyroid – though I do not think this is related, in the way you propose, to the operation on your parathyroid gland. You should discuss further with your doctor the significance of those ‘more or less’ normal thyroid function tests as a low normal TSH is still compatible with an overactive thyroid.

Dear Dr. James,

I’m 71 years old, reasonably fit & active for my age. I take Amlodipine 5mg & Valsartan 80mg, for high blood pressure. Also, I take Qvar 100, twice a day for my asthma. I enjoy a few pints of beer, two/three times a week at the local pub. Last week, I had four pints of beer one evening & walked home. On the way home, I called to visit a friend, for a cup of tea & a chat. Shortly after arriving, whilst sitting down in the chair, I got a fit of coughing. Next thing I slumped back in the chair, with my eyes closed. My friend rushed over to me, calling my name & was preparing to ring for an ambulance. After about four seconds, I opened my eyes & was OK. I had clearly “blacked-out” for some reason?

What could be the cause of this?

Do I need any tests?

Thanks.

Mike

Dear Mike,

Thanks for your query. This fainting episode you describe is known as Cough Syncope and is due to the fall in blood pressure caused by pressure changes within the chest cavity brought on by a severe bout of coughing. It is a benign condition and does not warrant further investigation.

My partner is a 58 male and has just started on warfarin a week ago as he has irregular heartbeat he has started to get hot sweats fluttering in his chest, giddiness, headache please can you advise on what to do many thanks

Theresa

Dear Theresa,

Thanks for your query. The symptoms you describe are certainly not typical of the side effects of Warfarin so there could be some other explanation such a viral illness. Still their onset so soon after starting the medication is clearly suspicious and were these symptoms to persist you might need to take a different form of blood thinning drug.

Dear Dr Le Fanu

I do hope that you or your readers can explain my medical query.

Having always had cold feet at night I now have the opposite but the right foot, above the instep, is worse and heats up until it feels as if is burning yet it is just normal temperature to the touch. The right foot feels swollen but it isn’t and it burns with heat all day and going to bed the leg gets hot with it and often keeps me from getting to sleep. During the evening I can sit with my feet up and right shoe off which helps and I often sit with a cold pack on it but I can’t do that at night in bed.

I am 77 years old and have walking difficulties due to osteoarthritis. I take paracetamol and occasional ibuprofen for the pain but it doesn’t seem to make much difference. I have been to my doctor about this but she says it must be my age. Is it just poor circulation?

Yours sincerely

V. H

Dear V H,

Thanks for your query. It sounds from the description of your symptoms that they are due to ‘burning foot syndrome’ caused by the disturbed functioning of the sensory nerves to the leg known as a Peripheral Neuropathy. There is regrettably no specific treatment but the drug Gabapentin is said to be of value.

I refer to the recent comments in your column.

I have had excess mucus since Nov 2012 but since March last year this has resulted in a mucous drip which seems to go down my Trachea and causes a wheeze which requires repeated coughs to release. This is usually 3-4 periods each day, there has not been a free mucous cough day in one year now.

I have had chest x-ray and recent nose scope which saw no polyps etc.

I am on steroid nose spray which has improved my breathing and the mucous a little the wheeze/cough remains.

I am told in my area (East Grinstead) 1 in 4 people suffer from rhinitis?! But I know of no other person that has coughed for a full year.

Is this usual?

I assume the Erythromycin is for the non-allergic and the other antihistamine for the allergic rhinitis ? How do I find out which I am? And is there any hope for the cough or is that it for the rest of my life (I am 63)

Yours

John W

Dear John W,

Thanks for your query. It is possible you may have become sensitive to, for example, the house dust mite or other allergens to account for your symptoms. This is best clarified by patch testing at an allergy clinic I would have thought it probable you would benefit from a course of Erythromycin as described in the column.

Hello,

I am sure you must have been inundated with emails on this subject but I would like to briefly tell you of my experience. I was prescribed these when all GP s were trawling through their patients and blanket prescribing.

I too suffered horrendous muscular pain, could hardly get out of a chair, had CT scans and full body MRI. All showed nothing. I read your article of a few years ago and immediately stopped taking them. However I still experience numbness in my feet and I have learned to live with this. I can still play golf and walk 18 holes,but I am sure as I get older this will get worse.C’est la vie!!

You are so right to warn people,

Thank you

Sincerely

Jenny H

Dear Jenny H,

Thanks for being in touch. Regrettably – as in your situation – the statins can have long term adverse side-effects. It is encouraging that you are still managing to get round the golf course!

ALAMY

I am 70 years old and have for many many years taken Statins as I have a raised familial cholesterol level. I too have all the aches and pains; however recently I was found to have a very low vitamin D levels and at the moment I am taking 20,000 bio Vitamin D3 capsules – 3 once a week for 14 weeks. The aches and pain are greatly reduced.

Janet D

Dear Janet D,

Thanks for that most interesting observation and drawing attention to the causes other than statins for these muscular aches and pains.

Dear Dr. Lefanu,

Regarding the report on adverse reactions to statins, have you thought that the reason the people on placebos had the same side effects was because it is the constituents put in tablets that cause the problems. I take thyroxine and had to change brands because of the ingredients. Eltroxin was mysteriously removed and I had taken it for some time with some energy sapping side effects.

Yours sincerely

Priscilla C

Dear Priscilla C,

Thanks for your query. It is certainly the case that the relative effectiveness of different brands of the same drug can be influenced by their formulation. This is not however the explanation for the supposedly low level of statin side effects which is due rather to under-reporting by the pharmaceutical companies.

I have been following the statins thread with interest if only because I do NOT take them. However, as I am on the border for type 2 diabetes I have been told quite often that I should have high cholesterol but do not.

Many years ago I had bouts of constipation but before I got to the GP I realised, courtesy of the Reader’s Digest, that I had probably been eating too much Raisin Bran in hotel for breakfast. A blood test showed elevated blood sugar and off I was sent. My GP told ne to make sure that WHEN I collapse in the street I must tell people I am diabetic. 10 years later and I am still waiting for that collapse. My diet is low in all the things that are supposed to be bad though I still imbibe.

I also have raised BP and for 5 years I was given a string of tablets none of which did any good. The contraries I could get but not reduced BP. In May 2013, I was allowed onto the ‘expensive’ list and now take Valsartan. It has already started to stop working leaving with only the one cure. 2 glasses of Red Wine!!!! That drops my BP 25 sys in about 20 minutes and keeps it there for hours. I have resveratrol tablets but at the suggested 250mg I do not think they are as good as the wine. I am a regular booze cruiser but even so the cost is quite high albeit rather pleasant. Bitter is nearly as good, lager is middling as is rose but white wine, of which I have 2 favourites, is useless.

The question in this is why if BP so important that I was allowed to have high BP for 5 years before being given proper treatment? Personally, I much more favour Pulse as that better indicates how the pump is actually working. In Florida last December I was running 250 sys while calmly sending emails. I never worked out out who was the real patient as the nurses could not understand why I was not having a heart attack! [My BP rarely got above 140/90 which the US has now suggested is OK!]

Which now takes me back to the Diabetes and drug reactions.

June 2012, I climbed out of a canyon in the Languedoc and then walked over a mile to get the car because I felt my grandchildren would be tired. My daughter has said that she, my son and their families only did the climb because ‘granddad had done it’!

June 2012, one week later, I started on Metformin.

Late August 2012, I was taking antibiotics and corticosteroids for a severely blocked nose and had 3 further courses that year.

February 2013, I was diagnosed with Nasal Polyps.

April 2013, I spent 2 days in a Florida hospital with breathing problems that I feel may have been a panic attack. I had a number when I returned home starting the day after my insurers tried to avoid payment of my $ 24,000 bill for 2 nights in hospital; plus ambulance services!!!!! The agreement to pay the bill and no more attacks!!!

July 2013, I became aware that I had been taking Metformin since my blockage had started, or from 1 week before. I stopped the drug and to date my diabetic status has not changed above the 7.2 level.

October 2013, December 2013 and February 2014, I have had 3 chronic breathing attacks that lead to 2 short hospital stays. Each has treated me for Asthma though in Florida in December that was quickly dismissed.

March 2014, I had a consultant here insist I am asthmatic. He insists that I am an asthmatic whose polyps come from that and would not understand the timeline above. He actually dismissed my evidence as irrelevant which begs the question as to where the asthma came from and why so suddenly. I will try for another opinion with a Consultant who is more scientifically minded! I await my operation and a return to see this man with relish.

On the other hand I suggest I am having asthma type symptoms brought on by the blockage dripping from the polyps ‘gumming’ up my airways and hence my lungs that started soon after I first took Metformin. When my nose is ‘clearish’ then what I blow out is not unlike what I cough up when blocked. And very nasty and thick it is, too! I have only one thing to keep even partially free and that is an OTC spray Oxymetazoline Hydrochloride which has a regular 2 day failure every few weeks. And very oddly the improved and sunny weather!!!!!!

A Google search last week – why did I never do that earlier? – supplied FDA evidence of a small number of people with polyps who took Metformin, and I mean small. But like the statin ‘conclusion’ it requires cause and effect to be seen. How many statin sufferers have had their reactions logged officially? And in my defence I cite the peculiar fact that Metformin helps deal with Polycystic Ovary Syndrome. As a man that worries me on a number of levels!! It also makes me question drug testing standards when drugs created for one reason help totally different ones. Are we being pushed drugs that actually no-one really knows about? After all Metformin could just as easily have killed women with that syndrome and would any one have noticed quickly?

I hope my GP will check his records as his Metformin patients come in to see whether there is even 1 extra sufferer. If even one more patient has it in a small surgery that would have amazing and far reaching consequences. My ENT consultant who will ‘do’ my polyps, if my lungs even get clear enough for an anaesthetic, I hope to also get checking. In the meanwhile ……… ?

Richard F,

Dear Richard F,

Thanks for being in touch. I would have thought it most unlikely that the Metformin you are taking for your diabetes is implicated in causing your nasal polyps.

Dr Le Fanu"s on-line wellness clinic, Friday 21st March 2014

Dr Le Fanu"s on the web wellness clinic, Friday 21st February 2014

Best wishes. Barbara C

Dear Barbara C,

Thanks for that further useful tip on how to ensure the bladder is properly emptied. I will be mentioning this in the Monday column on the 3rd March for the benefit of others. Best wishes.

A simpler and very effective answer to emptying one’s bladder, thus preventing frequent nightly trips to the loo, and, more importantly, avoiding infection, is to rock one’s pelvis back and forth whilst sitting on the lavatory. Just 1/2 dozen of these movements then a pause and repeat as necessary, has worked perfectly for me these last 10 years or so.

I also had an ultrascan. The urologist told me to take a low dose of antibiotics permanently! Luckily a friend gave me this invaluable tip.

Ruth,

Dear Ruth,

See above

Sir

Rather than walking around the bathroom between “sessions” on the loo, the advice from a Nursing Sister in Lincoln, after my colposuspension op. about 25 years ago, may be of interest.

When I couldn’t produce the amount of urine required before I was discharged, she suggested I “tickle” the base of my spine until the bladder reopened and discharged the final stream.

It worked then – and has gone on working since – and doesn’t require moving from the loo between streams!

Yours

Jane K

Dear Jane K,

See above

I read your advice about how to cope with repeated attacks of Cystitis which I have found helps enormously. In addition I also ensure that there is no constipation which also adds to the build up of urine residue in the bladder. I eat bran for breakfast together with two prunes in juice and this works like magic. As a result I also have avoided repeated attacks which lasted on and off for several years. Yours sincerely, Sheila Z

Dear Sheila Z,

See above

Dear Dr Le Fanu,

I’m a 60-year-old female in good health except for the following. I have very painful leg cramps, which wake me up, beginning at about 6-6:30 AM, when either the furnace or the air-conditioning switch on. They run from the point of the hip down the outside of the leg to the knee. They never go below the knee and only occur in the right leg (the side I sleep on) and when I am in bed. The pain is excruciating and no amount of massage or stretching makes it go away. They last about 20 minutes. My doctor is baffled, although she wondered if a shift in air-pressure from the furnace could be triggering it. But what precisely is it triggering? I have had sciatica, but only in the left hip and this does not feel the same, as well as not extending to the calf and foot. Any suggestions?

Many thanks,

Chris W.

Dear Chris W,

Thanks for your query about these agonising muscle cramps which I too suffer from. From personal experience I find they are best relieved with a small dose (2mgs) of the muscle relaxant Diazepam. There is no obvious explanation for why they should wake you in the early morning though I would doubt it is related to the boiler/air conditioning.

Dear Dr James

I am 84, have very recently had a heart attack and have been diagnosed with severe aortic stenosis. My daughter is adamant that because I have now been put on statins, I should be taking CoQ10 to counteract the depletion of this from my body by the statins.

I have asked both my GP and the coronary nurse about CoQ10 and neither of them seem to know much about it. Do you think it will be beneficial for me?

I am taking the following medication and have reserves about taking any supplementation without knowing whether it may affect what I have been prescribed:

Amlodipine 5mg daily

Levothyroxine 125 micrograms daily.

Valsartan 80mg daily

Aspirin 75mg daily

Atorvastatin 80mg daily

Ticagrelor 90mg twice daily

Lansoprazole 15mg twice daily

Bisoprolol 3.75mg daily

Glyceryl trinitrate 400 microgram S/L spray (75-dose) as needed

Thank you advance for your advice.

Best regards

Jean T

Dear Jean T,

Thanks for being in touch my and sympathies for your recent heart problems. I note you are already taking a long list of medications and appreciate your reluctance to take yet another. Nonetheless there is an obvious rationale for those on statins to take CoQ10 as they block the production of this important enzyme in the liver. A recent review suggests this is likely to be of particular benefit for those like yourself over the age of 65.

Dear Dr Le Fanu

Thank you so much for your brilliant column and regular online clinic.

I have read that waist to height ratio is a better indicator than Body Mass Index for various serious future health problems.

Dr Michael Mosley’s Fast Diet book for one advises that your waist measurement should be no more than half your height. For the former he says to measure around your belly button.

I am 1m74 tall and weigh 66 kg. I am fit with good muscle tone and usually described as slim but if I don´t hold my stomach in and measure round my belly button, I am in the at risk category (92cm). However, my actual waist is a good 5cm above my belly button and if you measure this waist, I am well within the parameters of safety (79cm).

Should I be concerned?

Thank you

Dear Anon,

Thanks for your query. The appropriate measurement is ‘the smallest circumference of the natural waist’ – so you are indeed within the ‘safety parameters’.

Good Evening Doctor

I am a perfectly well 70 year old male with one strange and intermittent problem. I cook for the family every night and on average three times a week I lose 80% of my sense of taste during cooking. It only happens when I cook – never ever at any other time. And it doesn’t happen every time. And it returns to normal about an hour after I’ve cooked (and enjoyed the (tasteless) fruits of my labours.

Have you come across this before?

Dear Anon,

Thanks for that most puzzling query that I have never encountered before. I will mention it in the column for the 3rd March and it will be intriguing to find out whether others describe a similar experience.

Dear Dr. Le Fanu,

I am a 59 year old woman, who encountered during a snorkelling holiday in Minorca last October, the exact same pattern of neurological symptoms as the retired RAF Group Captain who had holidayed there (he replied to the back-packing lady on holiday in West Africa).

In the last few weeks my symptoms have been reduced to the ear-clicking deafness, a twitching of the left eye whenever a headache resumes and a red, spotty rash around my mouth.

My holiday was at Punta Prima on the south-east tip of Minorca and I would very much like to know if the RAF gentleman was on holiday in this part of the island, as perhaps the water quality was not as it should be for a Blue Flag quality area.

Best regards,

Linda B

Dear Linda B,

Thanks for being in touch and how fascinating that when on holiday in Minorca you should have experienced the same neurological syndrome as Group Captain G. If you want to get in touch we can pass on his email address.

ALAMY

Dear Dr Le Fanu,

I have been very interested in the recent debates about statins.

I have rheumatoid arthritis and my cholesterol readings have always been high at around 7.9.

I cannot tolerate statins have tried them all.

Recently I had to see a cardiologist on another matter took with me the results of a recent blood test,he looked at this and said you need not worry as you have lots of good cholesterol.

This made me think and wonder how many other people are like me without ever being told?

Yours sincerely Mrs Iona A

Dear Mrs Iona A,

Thanks for being in touch. I could not agree more that doctors prescribing statins should take into account the good/bad (HTL/LDL) cholesterol ratio. My impression is they rarely do.

Dear Dr Le Fanu,

A question to ask Mr H M and his wife might be: had they both contracted strep infections/sore throats before the emergence of these new fears? There is increasing evidence that the infections can cause anxiety and obsessive behaviours in children. Perhaps the same might occur in adults.

http://www.scientificamerican.com/article/from-throat-to-mind/

Many thanks for your excellent columns and online clinics.

Dear Anon,

Thanks for being in touch and for drawing my attention to that most interesting article in Scientific American. I do not know of this link between ‘throat and mind’ and will pass it on to Mr H M.

Dear Dr Le Fanu,

I was interested to read (in the Telegraph) of the lady who was given the dementia test. I had a similar experience a few weeks ago. I am 81. Completely out of the blue I had a phone call asking me to attend the surgery for a blood pressure test. I was rather bemused about it (even though within the last year I have had cancer operations and radiotherapy which has taken a bit of a toll), but I attended. After the BP test I was asked to draw a clock face in a circle on a sheet of paper. I asked if it were a dementia test and the doctor declined to reply. Other memory and cognitive tests followed e.g. a random name and address, reciting numbers backwards, etc. etc. I asked the doctor if she could recite the alphabet backwards (as I can at speed) but she declined. In retrospect I felt I should have walked out. The blood test was so blatantly a devious ruse to get me to the surgery to do the test. And when she refused to confirm what the test was for, that was so rude. I felt I was treated like an ignorant “specimen” to achieve the practice quota. If she had explained what she wanted I would have found the tests of some interest. Instead it got my back up and I shall feel suspicious of any further unsolicited requests from the practice.

I felt like writing a strong letter of disapproval to the practice manager / senior doctor but desisted as I was afraid that if I rubbed them up the wrong way they could make things difficult for me when I need their help.

Yours sincerely,

David C

Dear David C,

Thanks for being in touch with your most disturbing account of your experience of dementia screening. I have summarised this in the medical column of the 3rd March to warn others of this devious (and unethical) ploy.

Dear Dr James,

I have read all the recent letters about prostate issues and feel my experience may help others. I am 69 years of age and was diagnosed with prostate cancer 5 years ago, (PSA 10.5) . The tumour was Gleason score 7. It was contained within the prostate although very close to the nerves likely to affect incontinence and impotence. I took the option of radiotherapy and it was the best solution without doubt. In the last 5 years I have not experienced any erectile dysfunction or incontinence. My 6 monthly PSA checks have constantly remained below 1.0. The radiotherapy treatment was high density modulated treatment spread over 38 sessions. Having read much about diet and prostate health I cut out all dairy products. Drink soya milk, avoid all red meat, eat lots of fruit and vegetables and take regular exercise. For many years before my diagnosis I ate 500g of natural yogurt every day and strongly suspect this contributed to my prostate cancer.

I now feel very positive about the future and intend to maintain my healthy lifestyle. I hope my experience help others.

Best regards

B. W

Dear B W,

Thanks for being in touch and I would certainly concur that for those with your type of prostate cancer, radiotherapy is a much better option than surgery.

Dear Dr Le Fanu,

I always enjoy your informative Friday column, and am wondering if you can offer any help to alleviate my embarrassing problem, namely, over-salivation. I am 84 and have no health problems other than an underactive thyroid. This is dealt with by 100mg thyroxine daily, and has never caused me any trouble. But as I have grown older my saliva flow seems to have increased. The problem is not helped by the deep creases that run from the corners of my mouth, providing channels down my chin! I have not had a stroke, and my teeth are well maintained. I wonder if there is something astringent I could suck?

Yours hopefully

Dear Anon,

Thanks for your query and my sympathies about this embarrassing drooling problem. This can certainly be due to over salivation but in your age group is more likely to be related to a defect in the mechanism for swallowing saliva. Hence the rationale for the (paradoxical) treatment of chewing gum that increases the volume of saliva which is then more readily swallowed. I would be more than interested to hear if this works for you.

Dear Dr Le Fanu

It was interest that I read your article in today’s DT about the effect of Omeprazole on iron levels. A couple of years ago I was diagnosed with the hereditary form of Hemochromatosis and after scans to ensure that iron hadn’t built up in my heart, liver, stomach and lungs and regular venesections, the iron levels are under control but are monitored.

As I have acid reflux due to a hiatus hernia, I take one Omeprazole before breakfast which solves the problem for the day. My consultant knows that I take Omeprazole. Does this medicine have any effects on my Hemochromatosis?

Yours sincerely

GW (aged 75)

Dear G W,

Thanks for your query. The reduced iron absorption with Omeprazole should theoretically be of value in patients with hemochromatosis though it is unlikely to confer any benefit over and above that of regular venesection.

I was 90 yrs.old last December and am in excellent health (apart from a few arthritic joints) but I have had a very tiresome tickly throat for at least 30 years – which I have not been able to ease or cure by cough mixtures etc – & which produces phlegm after taking food.

Have you any suggestions to help my tiresome & long-standing problem?

I do enjoy reading your very helpful advice on minor problems every Monday! Do hope to find some helpful suggestions in your Medical column on Mondays!

Regards from Mrs.Barbara C

Dear Mrs Barbara C,

Thanks for being in touch and my sympathies for this long standing tickly throat/chronic catarrh throat problem. It certainly sounds as if this could be due to chronic rhinosinusitis in which case it might respond to a three month course of low dose Erythromycin as mentioned in the column last week. Alternatively you might discuss with your doctor a trial with the nasal spray Rhinolast (see my response to Simon P below).

I have for some years developed quite severe muscle pain overnight. This does not happen every night but seems to go in phases.

Rather difficult to describe. It occurs mainly in my thighs and forearms but increasingly seems to affect other muscles. Around my neck and shoulders. Cumulatively it is extremely uncomfortable – possibly waking me and forcing me to get up in the night. It is more than just stiffness; possibly like extreme muscle tiredness. At times my muscles seem on the edge of cramp. Lately I feel as though I am vibrating when it is at its worst. There is no movement however; just an impression. I feel shattered in the mornings but it subsides within an hour or so.

I have the Rheumatoid factor and have attended clinics for quite a long time. I have been told that I do not fit into any pattern and have not received any treatment as such. I do have arthritis in wrists and hands but my strength is pretty good.

The nearest I have come to a diagnosis was from a neurologist who after electrical muscle tests tentatively suggested Myositis. This was dismissed by rheumatology but they did send me for an MRI of my muscles but I do not yet know the result of that.

I am 75 years old.

I do hope you may have some idea what is wrong. I cannot believe that it is all in my imagination.

Regards

Brian H

Dear Brian H,

Thanks for being in touch with your description of these unusual muscle symptoms at night. I have not encountered this before and will mention this in the column in the hope that someone will be able to clarify what is amiss.

Dear Dr James

Last year my 47 year old son-in-law fell ill with viral encephalitis, and after two months in hospital he is at home, slowly making a good recovery while suffering short term memory loss. A few years previously my other son-in-law, then aged 35, was suddenly taken seriously ill with a very high temperature and severe pain in his groin, which was diagnosed as a bacterial streptococcus infection and from which he thankfully recovered after five weeks in hospital.

Both were very fit, high achieving young men who took care of their health and exercised frequently. I have been wondering what could be the common denominator that caused them to be susceptible to these rare and life threatening illnesses. They had not been overseas in the preceding months. The only thing that comes to mind is that both had become weight conscious and were on an Atkins type diet, following the rules impeccably. Might it be that the sudden complete change to their diets, which excluded fruit, potatoes and bread, could result in a reaction affecting the immune system? Their families, who were eating as usual, did not show any signs of illness.

I would be interested to know if you have any views on the subject.

Kind regards

Anita

Dear Anita,

Thanks for being in touch and your account of those serious infectious illnesses experienced by both your sons in law. This is almost certainly one of those unfortunate consequences and I would not have thought there is likely to be a ‘common denominator’ of the sort you mention.

Fear of heights (Mr HM Bolton)

As a Clinical Hypnotherapist, I have helped very many people suffering with this problem. I strongly urge him and his wife to find a reputable Clinical Hypnotherapist.

Kind regards

Enid H

Clinical Hypnotherapist

Dear Enid H,

Thanks for being in touch. Several other readers have mentioned the value of hypnotherapy in this situation and I will mention it in the column shortly.

Our close friend was put on Statins by his doctor. Although he complained several times to his doctor about the side effects he was suffering he was not listened to. After talking his brother in America he was made aware of many complaints in the USA about some side effects. He gave statins up, started taking more exercise and had a better diet with a self regulating 2 days off things. After a few weeks he was free of the side effects felt better and his cholesterol was much lower. We noticed the difference while he was on statins to when he came off and it was quite noticeable.

A story about experts in WW1. Some experts stated that if the body went over 100 mph they would die. Other experts said rubbish. Pilots soon were over the 100 mph mark and survived.

Dear Anon,

Thanks for your account of your close friend’s statin experience. Might you perhaps have a reference for the claim about the dangers of travelling at 100 miles an hour?

Retracting penis

About 15 years ago when I was working and could afford private insurance I consulted a urinary specialist because I felt that something was wrong with my scrotum and testicles. He told me that fatty tissue had descended into my scrotum, no cause for alarm, not cancerous, an operation not necessary and would in fact do more harm than good.

Now many years later the old sensations have returned: one testicle is sore to touch and the scrotum has acquired a lot more fatty tissue which causes an unpleasant feeling of being over-filled.

It has wrapped itself around the shaft of the penis which, in turn, now looks as if it has virtually retracted into the abdomen. Its visible length is now around one inch which means that to urinate I have to push the fatty tissue out of the way as I tug it into the outside world. At home I just drop my trousers .. But this is not possible when using public, theatre or restaurant urinals. Inevitably there’s often a small amount of urine left which then trickles into my trousers, announcing the fact that I have “wet myself”.

I have tentatively sought some help and advice from the local hospital departments but whereas the private sector was helpful, the NHS seems to think it’s an hilarious situation and refuse to take me seriously – I’m the silly old fool who reckons he’s the real live Little Willie.

Must I accept it as simply being a good anecdote when doctors get together to swap funny patient stories ?

Dear Anon,

Thanks for being in touch. The problem you describe is known, for obvious reasons, as Buried Penis Syndrome. It certainly sounds as if you might benefit from some sort of surgical repair as described by Dr Miroslav Djordjevic on the informative website of the Belgrade Centre for Reconstructive Surgery. I am dismayed the urologists at your local hospital have been so unhelpful and you should discuss with your doctor being referred elsewhere.

ALAMY

Reading your item on catarrh, might I suggest another possible cause.

For probably 20 years I had a great supply of mucus, but because it increased so very gradually I did not even realise I had a problem. Only when I found that I could inhale through my left nostril but NOT exhale did I consult a specialist who said I had a large polyp there. It took 3 operations to get all of the thing out, but at last I now have a dry nose !

Hamish G

Dear Hamish G,

Thanks for being in touch. Nasal polyps, as you say, are an important and treatable cause of excess catarrh.

Dear Dr James,

I am emailing for advice on behalf of my mum.

In September 2011 she went into hospital to have a full knee replacement on her left leg and drastically my dad died suddenly at home on her first night in hospital. She just needed to be home and so came out of hospital the day after her operation. As well as the huge pain in her heart she started suffering with pain in the back of her legs (like sciatica) – being worse in her right leg. She has had this pain constantly since then. Her new left knee is working well and isn’t painful. In September 2012 she had a big operation to her lower back to release trapped nerves from collapsed discs to help with the pain in her legs. Unfortunately this has made no difference to the pain in her legs.

This January she had to have a full knee replacement on her right leg as it was bone on bone. The operation went well and she is doing well with it. However she is still In the same pain down the back of her leg.

She is continually using a tens machine to help with the pain and sleeps all night with a hot water bottle and an electric blanket. She has tried tablets that dull nerve pain and although they give her a small bit of relief the side effects far outweighed the benefits. She has also had trigger point injections in her thigh and buttocks.

A physiotherapist has told her that she finds it hard to believe it is sciatica as she can sit up ok with her legs out in front of her.

She is a young 70 year old and if her knees and legs hadn’t been bad she would be very active. She has two dogs and loves to go on long walks.

We are at our wits end as to what to do for the best. She hasn’t been able to move on since my dad died as she is continually in pain and can’t enjoy life like she would love to. She is naturally a very positive happy person but when it has got really bad she has said that she wants to end her life.

Back in 2008 she was diagnosed with non-Hodgkin’s lymphoma and underwent 6 months of chemotherapy. She was given the all clear and now goes for check ups every 8 months. Could the chemotherapy have affected her bones, joints, nerves etc? She has already been told that she will have to have new hips in the future.

Any advice would be gratefully received.

Many thanks

Dear Anon,

Thanks for being in touch and my sympathies for your mother’s persistent pain following her knee replacement which I would doubt is related to her past treatment for non-Hodgkin’s Lymphoma. It certainly sounds as if she has severe generalised arthritis and this pain could well be referred from the arthritis in her hips and will hopefully resolve once they are replaced.

ALAMY

I read Monday’s column about chronic catarrh and I will study the download.

When I was young at and for years I had chronic catarrh, and could never breath through my nose and always had my mouth open. When I was at prep school I was taken to an ENT specialist in London called Dr Robin. He numbed the bone at the back of my nose and then pushed a syringe needle through the bone into the sinus. He then attached the needle to a small vacuum machine and sucked out whatever was in the cavity; I remember ti tickled. The result was miraculous, and I was able to breath through that nostril for the first time in my life. a year later they did the other nostril, and I have not had trouble since.

What is this procedure called and is it still done as my son also has similar symptoms and seems to have a constant cold and I wonder if this technique would work for him.

I look forward to hearing from you.

Regards

Dear Anon,

Thanks for being in touch. My impression is that this method of draining the sinuses you describe has now been replaced by a procedure known as Endoscopic Sinus Surgery (ESS). I would suggest your son discuss with your doctor the possibility of being referred to an ENT specialist to consider whether this would be an appropriate treatment for his symptoms.

Dear Doctor

I am an 82 year old man in generally good health. I try to swim (very slowly!) two or three times a week. Before I enter the pool I empty my bladder as a matter of routine. Within 15/20 minutes I am “dying to go” again so I have to come out of the pool to go to the toilet again. At that stage the bladder seems to be full again. Two GPs cannot offer any advice on the cause or treatment of this condition. Can you please?

Dear Anon,

Thanks for your query. This excess urination following swimming is known as Immersion Diuresis, an interesting physiological phenomenon caused by the combined effects of the temperature and pressure of water in increasing the blood flow to the kidneys. It can be prevented with the drug Desmopressin – but I would not have thought this is indicated in your case.

ALAMY

Following your ‘doctor’s diary’ comments yesterday on statins you may find this useful for your file

I am a fit, 77, tall, lean, gentleman of a professional background

Two years ago, after a routine health check blood samples etc., it was told that clinically it had been shown that for persons of my age, regardless of the state of health, a, from then, lifetime intake of statins would be beneficial from the point of view of health protection

So I started taking them every day, within six months, little by little, decrepitude overtook me with muscle aches and pains and overall ennui

This was attributed to ‘old age’ it seemed and as it was so gradual there was no obvious link to the statins

I read an article referring to possible side effects and stopped toking the statins, within a week I was, and remain, in a state of vibrating high level wellness

I hope this is interesting and useful

James G

Dear James G,

Thanks for your interesting account of your statin induced decrepitude that I will mention in the column on 3rd March.

With reference to your correspondent who is concerned about osteoporosis medication, I also have fairly advanced osteoporosis and IBS. I have tried 3 kinds of tablets, all of which caused inflammation of the gullet, and then a powder taken in water, which caused severe IBS symptoms. There appears to be no alternative and I am now just taking the Vitamin A, C & D tablets and crossing my fingers that I don’t fall over.

Another correspondent mentioned restless leg and Esomeprazole, as result of which I left out my evening Esomeprazole tablet with a view to moving on to another antacid. However 10 hours later I was struck with agonising pains in the oesophagus which lasted for 4 hours, so I decided to try to live with the restless legs and take iron supplements instead!

J. W

Dear J W,

Thanks for being in touch and your account of the side effects caused by these treatments for osteoporosis which I suspect are not unusual.

Dear Dr. le Fanu,

I read the piece with interest. I have been plagued by catarrh, secondary to allergies since my chemotherapy with Pentostatin for Hairy Cell Leukaemia in 1996. My immune system is, to use a well known non medical term, shot! I have allergies to all sorts of things, but they are not even consistent. One day I will have rhinitis with conjunctivitis and within hours it might be just the one or the other. I have been using Rhinolast (as well as the other regimes you describe including saline nose washes – Sterimar) for the last 2 to 3 years. It keeps my catarrh under good control. Before that I had maxillary sinusitis at least once or twice a year, whereas I have not had it once since regular use. I have even had the long term erythromycin regime on a couple of occasions. It certainly works, but not forever, in contrast to the Rhinolast.

For your amusement I enclose a letter I wrote to the DT in 1996. At least it shows I am a consistent reader!

I hope this information about Rhinolast might be helpful to your readers. Keep up the good work on resistance to mass medicalisation.

Best wishes,

Simon P

Dear Simon P,

Thanks for being in touch and your account of the benefits of Rhinolast in controlling your symptoms of Rhinitis. I will mention this in the column in the near future for the benefit of the many troubled by this common complaint.

Hello Dr Le Fanu

I have been diagnosed with gastroesophageal reflux disease. My doctor has prescribed 20mg of omeprazole twice daily and gaviscon after my evening meal and at bedtime.

However I read in your column that omeprazole interferes with the absorption of iron.

Could you comment on whether it is appropriate to take omeprazole and if not what are the alternatives? I am retired and aged 65 years and in good health.

Regards

Carol G

Dear Carol G,

Thanks for being in touch and I am sure the benefits of taking Omeprazole for your severe acid reflux more than outweigh its effects in reducing iron absorption.

Dear Dr. Le Fanu,

My 90 year old father is now suffering from the debilitating condition lymphoedema, though is otherwise very well.

Though he has regular clinic appointments and daily performs his exercises, lymph drainage massage and wears his compression stockings, the condition does not appear to be improving.

Could Daily Telegraph readers come up with any suggestions that they have found relieves the symptoms of this very uncomfortable condition?

With best wishes and many thanks for your very interesting column.

Lesley W

Dear Lesley W,

Thanks for being in touch. It certainly sounds as if your father is receiving the best possible treatment for his lymphoedema. There is a most informative website about this condition run by Lymphoedema Support Network.

Dr Le Fanu"s on the web wellness clinic, Friday 21st February 2014

What 12 Many years a Slave tells us about 21st century black psychological health

twelve Years a Slave ‘reminds us of the current tension in between psychiatry and the black community’, writes Patrick Vernon. Photograph: Sportsphoto Ltd./Allstar

I had the privilege of attending the film preview of twelve Years A Slave organised by Damaris, a movie training charity, which made a totally free official neighborhood resources pack to assistance a debate on the key issues in the movie. The Oscar-nominated film’s narrative supplies a historical context of overall health inequalities and could be employed as a resource on cultural identify and diversity for any frontline worker, senior manager, commissioner and clinician delivering well being and social care solutions.

The film also reminds of us of the existing stress in between psychiatry and the black neighborhood which is further reinforced with deaths and inquiry processes, like those of Rocky Bennett and Sean Rigg.

Freedom is a clear theme in the film. The expression of freedom was frequently an anathema to plantation owners, the financial markets and politicians. In the 1850s, slaves working away or damaging white plantation owners’ property had been diagnosed with the developed psychological disorder drapetomania and dysaethesia aethiopis. The treatment was extreme beating, castration, a foot chopped off, or lynching.

These days, a quantity of support customers and campaigners see the diagnosis of schizophrenia as the modern equivalent, in which the therapies are medication with a range of side results and restricted talking therapies.

Jonathan M. Metzl’s book, The Protest Psychosis, provides an examination of the historical past of the diagnosis of schizophrenia. In the 1930s and 1940s in America, it was aimed at white middle class women even though in the 1960s it was redefined and racialised for black individuals associated with the Black Power Movement or linked to violent or criminal exercise.

The psychological well being charity Rethink published its report in 2012 referred to as Schizophrenia – The Abandoned Sickness that manufactured a variety of recommendations. An different commission was also established from a black, Asian and minority ethnic (BAME) point of view to challenge the notion of this label and its detrimental impact on black communities.

The situation of the legacy of enslavement, especially all around the crisis in the psychological health and criminal justice program dealing with the black community, is even now appropriate nowadays. The in excess of representation of black men and, increasingly ladies, in psychatriatic care and prisons is a single of the greatest indictments for 21st century Britain. Now, much more young children and teens are caught as victims or perpetrators of knife and/or gun crime. There needs to be a major rethink and policy growth with regards to racial inequalities exactly where mental overall health is one factor of the wider issues affecting BAME communities.

The suggestions made by the Centre for Psychological Well being report Breaking the Circle of Fear, 1st launched more than 10 years ago, contributed to the improvement of the Department of Overall health policy close to delivering race equality. The report also influenced the improvement and launch of Catchafiya, the 1st nationwide black services consumer led motion supported by the Afiya Believe in. The report’s suggestions along with other reports over the final number of many years is still relevant right now as the modifications inside of providers are still in suspended animation as the vitality and leadership for transformation modify feels light years away.

Because there is no consensus or collective method to tackling racial inequalities in mental well being services, politicians and policy makers are thus influenced by clinicians in offering answers.

The present mainstream discourse presented by psychiatrists and academics articulated in the AESOP study undertaking seeking at psychological illness inside the Caribbean community was that you can’t blame mental wellness solutions for the above representation of black men and women as they are responding to the signs from society.

In the meantime, new trends in psychosis and psychological sick health are emerging inside black, and other, communities which could be accelerated throughout this period of austerity as the marginalised are pushed to the extremes in all factors of their lives. We do need to have to generate space and a new agenda by exploring structural racism in society and its affect on companies by coming to terms with historical inequalities to develop the proper conditions around reconciliation and believe in that has the prospective to transform policy producing and services development.

The meaning of emancipation in the context of tackling mental wellness inequalities could be portion of the strategy about parity of esteem. This could be extended beyond physical and mental health to include race, gender and LGBT equality as a mantra to tackle more than representation in inpatient care, extend culturally relevant talking therapies, revisiting commissioning designs and empowering services end users, carers and the wider community close to leadership and accountability.

We also want a debate inside of the black community on the legacy of enslavement which influences our individual and loved ones relationships, and cultural identity. And, we have to counter the stigma, stereotypes and misunderstanding which existing black individuals as mad, negative and hazardous!

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What 12 Many years a Slave tells us about 21st century black psychological health