Social media and bullying: how to keep young people safe online

For all the benefits to mental health a digital world can bring, such as a sense of belonging and information and support for those with problems, there are also myriad dangers associated with online activity. In the very worst cases, people have live-streamed their suicide and had people cheer them on in the comments section.

Meanwhile, cyberbullying and trolling, along with communities and groups on social media that foster, glamorise or even encourage self-harm are pervasive. Stephen Buckley, head of information at the charity Mind, acknowledges these risks: “It is vital to recognise the huge danger created by any site or social media trend that promotes self-harm, suicide or eating disorders. They can be hugely damaging and possibly dangerous to someone in a crisis.”

This has come to the forefront over the past decade as more and more children use smartphones and tablets. A Young Minds report, Resilience For the Digital World, says half of Europe’s nine- to 16-year-olds now own a smartphone; the vast majority go online at least once a week, and most daily.

Buckley says that people are now used to following their friends on social media and sharing news of a new job, relationship, or a holiday presented in the best possible light. But this can have an impact on individual self-esteem. “While low self-esteem is not a mental health problem in itself, the two are closely linked. If lots of things are affecting your self-esteem for a long time, this may lead to depression or anxiety,” says Buckley.

Pressure on young people may also come from situations where they are being bullied in daily life that then cross over into their digital lives, says Marc Bush, chief policy adviser at Young Minds. “For instance, victimisation in the school playground is replicated on their Facebook pages or their WhatsApp or Snapchat groups, so they relive the distress they’re experiencing in real life on the digital platform.”

So, what’s to be done? Bush says industry has an important role to play. Today, if you search certain hashtags on Instagram, for example, a helpline pops up. He also cites the report from the House of Lords communication committee, Growing Up With the Internet, which calls for a national digital champion who can look at the rights of young people online, educate parents and teachers on how to look out for warning signs, and support young people to understand the consequences of bullying someone online.

The greater part of the solution, though, lies with young people themselves. “Ultimately,” says Bush, “young people are active in the creation, consumption and distribution of these images or forms of behaviour, so they have to be part of the solution.”

Tamanna Miah: ‘I developed severe anxiety after being bullied online.’

Tamanna Miah is now a prominent anti-bullying activist

Tamanna Miah, 23, is a campaigner and public speaker from Kent. She describes how she coped with being bullied on social media and what it has been like to grow up in a digital world.

“I grew up in Sevenoaks, Kent, which is a very conservative, middle-class area. I suffered from severe bullying and racism from primary school to my all-girls secondary school until university. When I went home, the abuse continued online. It happened on my social media networks – Facebook, Bebo and MSN. People would comment on photos, status updates, anything that I was doing. Sometimes it was racist or Islamophobic, or attacking my appearance or the way I acted – anything. People would find a fault and take advantage of the situation.

I was a very shy, quiet child, I couldn’t stand up for myself, or look people in the eye. I would be bullied at school, come home and log on to the laptop and it would continue. You wake up in the morning to check again and it’s never-ending torment and hate. I couldn’t escape. I hated school and my time in education. I was never happy.

I developed severe anxiety and depression as a result. I tried to get support from my school and was unsuccessful. I visited my GP and they dismissed me and didn’t take me seriously. They said nothing was wrong and told me to do some exercise. It wasn’t until university that I was diagnosed.

Now I try and be careful when using social media, but I also use it for networking and meeting people. I’ve been through bullying online and offline, but I’ve also had a wealth of opportunities through social media.

I make sure that my personal activity, photos and comments are restricted, to avoid anyone attacking me publicly or harassing me. I don’t want to experience more abuse so I’d rather keep personal things private. I’d say to others in similar situations to always be careful about what you post and where.

Your online life is always going to be present. Google yourself to see what’s out there so you can check your settings and change them if needed. If someone is bullying you, always tell a responsible person as soon as possible. Make sure you have evidence of everything. Take screenshots or make audio recordings.

Whatever happens, don’t give up – just keep going. We absolutely need to speak about these issues, because if we don’t, who will?”

Social media and bullying: how to keep young people safe online

CQC warns online doctor services may pose risk to public

Patients could be at risk from online companies offering doctors’ services, the Care Quality Commission has said.

The warning comes after investigators found two firms were putting patients at risk by failing to examine their medical history before prescribing medicines. There were also questions over whether clinicians had the relevant skills or qualifications to prescribe or diagnose illnesses.

The inspectors found there were no processes for contacting a patient’s GP, including when medication was prescribed that required monitoring or a follow-up. The medics failed to check patient identity before prescribing online and there was no way of checking if people lacked the capacity to consent to treatments.

The two online firms were MD Direct (which had traded through the website assetchemist.co.uk) and HR Healthcare Ltd (treated.com). The CQC said its inspection of HR Healthcare was influenced by an investigation by BBC Radio 5 Live, which looked at the site’s online sale of antibiotics.

Following this, the CQC suspended the registration of HR Healthcare Ltd. MD Direct voluntarily cancelled its registration; the site assetchemist.co.uk now uses a different online GP provider for its prescription service.

As well as these two inspections, a review of all 43 online services registered with the CQC revealed others were potentially posing a risk to patients.

The CQC has now brought forward a programme of inspections. It is particularly concerned about sites where patients can choose their own drug and select their symptoms or diagnosis from a drop-down menu. The prescription is then reviewed by a medic and passed to a pharmacist who processes it.

Steve Field, the chief inspector of general practice at the CQC, said: “The growth in online technology presents a real opportunity to improve people’s access to medical advice and treatment. It is important that healthcare services continue to innovate. However, in some cases we have found websites which in effect allow people to select their own medication, including medicines restricted as prescription-only, with little or limited clinical oversight.

“Patients can go online, self-diagnose their condition, order their own medicine and obtain a prescription from the online doctor service, with minimal checks on [their identity] and whether the medication is safe or appropriate for them, often within a matter of seconds. We know there are often inadequate identity checks, no checks on patient history or suitability, no checks with patients’ GPs and no follow-ups or monitoring.

“Following our review of all online services registered with CQC, we will now visit each provider, working closely in partnership with the relevant regulators and checking that providers are following the appropriate professional guidance. We will take action to cancel or suspend the registration of providers who are putting their patients at risk.”

Field said that, as with conventional GP surgeries, online companies and pharmacies were required to provide safe, high-quality and compassionate care. “They must not cut corners,” he said.

A further joint statement from four regulatory bodies – the CQC, the General Medical Council, the General Pharmaceutical Council and the Medicines and Healthcare products Regulatory Agency (MHRA) – reminds firms and their medics that they must provide safe and effective care, and follow professional guidelines.

Lord O’Shaughnessy, the health minister, said: “We have empowered the CQC to run a tough and comprehensive inspection regime and commend their work to uncover failings in digital care provision. Online providers can be a convenient option, but patient safety must always be the priority and we urge the public to follow CQC’s advice when buying medicines online.”

Gerald Heddell, the director of inspection, enforcement and standards at the MHRA, said: “Prescription-only medicines are prescription only for a reason and should only be taken under the supervision of a healthcare professional. A proper consultation with a medical professional is essential to ensure that an appropriate diagnosis of your condition can be made, your medical history can be reviewed, your recovery can be monitored and any adverse reactions can be dealt with.”

CQC warns online doctor services may pose risk to public

Good vibes: selling sex toys online to fund sexual health programs

As an engineer, Jak Haines never expected to find herself in the sex business – she was just looking for an opportunity to practise conscious capitalism.

“I looked at different sectors … but I decided the sex industry was ripe for change,” she says.

Haines launched her website, Vävven, in November to sell sex toys and accessories that are “body safe”, ethically sourced and are marketed without objectification.

As a social enterprise, Vävven will donate 30% of its profits to causes for sexual and reproductive health and rights.

Haines had a 20-year career in heavy industry (turnaround management) before she closed down her business last year and decided to put her ideals to work. Conscious capitalism aims to use ethical business practices to elevate humanity. “Business can change society,” she says.

Launching a business in the sex industry appealed to her because of its challenges of managing standards (sex toys are required to meet lower safety standards because they are usually sold as novelty items), stigma and objectification in marketing. “There are a whole lot of things you could change within the industry without even linking it to a cause,” she says.

But she enjoys the irony of using the sex industry to fund the cause of sexual and reproductive health and rights. “It is also a bit of ‘stuff you’ to society,” she laughs.

Once it turns a profit, the organisations Vävven will support include Marie Stopes International (family planning, sexual health and abortion) and Oxfam and its gender justice program.

The founder of Vävven, Jak Haines, aims to use the profits of the sex industry to fund reproductive health and rights. Photograph: Sarah Candlin

Vävven will also donate to Women on Waves – the Dutch non-profit that offers a floating sexual health and abortion clinic to women in countries where abortions are illegal. Last year Women on Waves used a drone to deliver abortion pills to two women in Northern Ireland.

There are few social enterprises that operate in this area but two are the UK Family Planning Association’s “pleasure shop” and the Denver-based online sex toy shop Vibrant, which donates all profits to Planned Parenthood.

Haines says the taboo nature of the sex industry means she has faced difficulties in getting her new business going. Firstly, it has been hard to find products that are safe to use and made by people who work in fair conditions. “If you are purchasing something for love, you shouldn’t be causing harm to others,” she says.

Although she sources her products from all over the world, most sex toys are made in China, where manufacturers are not accustomed to being asked to provide products at a higher safety standard. As a very small business, her requests are often swept to one side.

Haines has managed to find ethical manufacturers who “tick all boxes”, except for the stipulation that they must have freedom of association (the ability to join independent unions, for instance), which is not available in China.

Advertising her website also presents some trials. For a start, consumers are used to seeing sex products advertised with objectifying images of women and men, so catching their eyes without those images can be difficult, says Haines.

“You are attempting to change the way society thinks at the same time as you are marketing to them – and that is a ludicrously hard line to walk,” she says. “A woman can still look sensual, that is fine, but if they are just there just as a sexual object, that is not fine.”

She quotes feminist erotic filmmaker, Erika Lust: “Sex can stay dirty but the values have to be clean”.

Haines has also come up against what she describes as an unwritten moral code, which means that some businesses and banks are unwilling to deal with her because she is considered part of the sex industry.

Facebook, for instance, will allow Vävven to have a page,but will not allow it to “boost” its posts as paid advertising. “Selling of an intimacy product is considered immoral,” she says.

Dealing with a bank or getting access to PayPal can also take an “extraordinarily” long time. “There are a number of the big four [banks] that won’t even touch you because you sell sex toys. They say there is high risk with them – what that actually means, I am not sure.”

Building mutually beneficial relationships with other businesses is also a very slow process. “One of the things I discovered about the industry is that it is cagey, they are not necessarily interested in collaboration, which is a big problem. They need to learn how to collaborate”.

The Australian condom manufacturer Glyde Health is an exception with the managing director, Clive Woodworth, keen to join forces around the issue of sexual health.

Glyde Health supplies condoms and lubricants in bulk to brothels, male sex premises, the Aids councils and clinics for sexual health and family planning.

Woodworth started the business 27 years ago when he saw an opportunity to supply higher quality condoms than those that were being imported into Australia.

The company sells between 8m to 10m Malaysian-made condoms per year (Australia imports close to 60m per year).

Woodworth says it is still rare to find businesses in the sex industry that are mindful of objectification and operate under ethical lines.

He would like to see uniform legislation across all the states and territories to protect sex workers and says the stigma around the industry means that issues such as this are not properly dealt with.

He says there is room in the sex industry for businesses such as Vävven: “an operation that allows people to enjoy their sex life but not objectifying women as sex objects”.

Glyde Health also does not use objectifying images, marketing itself as a supplier of “sexual health products”. Like Haines, Woodworth’s entry into the sex industry was a business decision, rather than a personal interest. Before starting Glyde Health, he imported perfume.

“I went from French perfume to French letters in one fell swoop,” he says.

Good vibes: selling sex toys online to fund sexual health programs

Mother of teenager who killed himself appeals for kindness online

A mother whose teenage son took his own life after being the victim of bullying that began over a computer game has said everyone has a collective responsibility to prevent other young lives being lost.

In an open letter, Lucy Alexander said her son Felix, 17, was so damaged by the abuse, isolation and unkindness he had experienced before his death that he did not realise anyone at his school cared about him.

The sixth-form student, from Worcester, was pronounced dead after being hit by a train near the city on 27 April.

An inquest heard the “kind and caring” teenager with a bright future had moved to Pershore high school after experiencing difficulties at a previous school. Three weeks after his death, hundreds attended his funeral and there was standing room only because the church was so full.

In her letter published in the Worcester News, Alexander, who also has a daughter Charlotte, 22, and a son Ben, 21, said she was not writing for sympathy but for the other children like Felix who were also being bullied.

The bullying had begun, she told the Sun, when her son was just 10 and classmates at the fee-paying King’s school where he had previously been a pupil teased him because he was not allowed to play the video game Call of Duty: Modern Warfare 2. It spiralled from there and he later became the victim of online abuse.

She said of her son in her letter: “His confidence and self-esteem had been eroded over a long period of time by the bullying behaviour he experienced in secondary education.

“It began with unkindness and social isolation and over the years, with the advent of social media, it became cruel and overwhelming. People who had never even met Felix were abusing him over social media and he found that he was unable to make and keep friends as it was difficult to befriend the most ‘hated’ boy in the school.

Felix’s family have been fundraising for Place2Be, a children’s mental health charity which provides in-school support and training for emotional wellbeing. Photograph: Family handout/PA

“He did make friends at his new school and the teaching staff found him to be bright, kind and caring. He was however so badly damaged by the abuse, isolation and unkindness he had experienced, that he was unable to see just how many people truly cared for him.”

The letter urged children to be kind always and to report bullying if they saw it. It said: “Be that one person prepared to stand up to unkindness. You will never regret being a good friend. I have been told that ‘everyone says things they don’t mean on social media’. Unkindness is dismissed as ‘banter’ and because they cannot see the effect of their words they do not believe there is one.”

She also said that teachers should be looking out for the signs of children struggling, especially if they were always sitting alone during lunch. Her final appeal was to parents. She said: “Please take an interest in what your children do online. We don’t like to think that our children could be responsible for being cruel to another child, but I have been shocked by the ‘nice’ kids who were responsible in part for Felix’s anguish. Even if they only say something horrible once, that will not be the only person who will have said something that week.”

Parents should encourage their children to self-edit and to use social media for kindness, she said. “On several occasions we removed all form of social media from Felix as it was causing so much distress, but that just isolated him further,” she said.

“Our lives have been irrevocably damaged by the loss of our wonderful son; please don’t let it happen to any other family.”

The family have been fundraising for Place2Be, a children’s mental health charity which provides in-school support and training for emotional wellbeing.

The charity’s director of communications, Jennie Meadows, said: “We are inspired by Lucy Alexander’s commitment to bringing about positive change from such a tragic and heartbreaking situation.”

She said the money raised following the death of Felix would help the charity reach more young people. She said: “The support that we have received as an organisation in memory of Felix is both overwhelming and unprecedented.”

• In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here

Mother of teenager who killed himself appeals for kindness online

Virtual fracture clinics enable patients to receive care online

A physiotherapist and orthopaedic surgeon are transforming the way patients with fractures are treated and saving the NHS more than half a million pounds in an initiative which could become a national model.

Physio Lucy Cassidy and consultant James Gibbs have established a virtual follow-up clinic for patients with simple fractures or soft tissue injuries. In the past these patients would have come through A&E and have to return for a follow up appointment at a consultant-led fracture clinic. But today these patients receive all their post A&E care online.

The patient’s x-ray and injury is assessed within 24 hours by a physiotherapist and an orthopaedic consultant to decide if they can self-manage their recovery remotely. Patients are then phoned by the physio and offered a virtual clinic referral.

Virtual clinic patients are emailed a video message from the consultant talking through the injury and the prognosis and a link to an individual rehabilitation video – one of 27 which have been produced – with a six-week exercise plan to follow. Patients can phone a specialist physiotherapist if they have any problems; the option to come into a traditional face-to-face consultant outpatient clinic remains open.

Cassidy, an extended scope practitioner says: “This is a no brainer – it works for the patient, it works for the consultants and physios and it’s cost-efficient. Patients absolutely love the virtual clinic they say ‘What, I don’t have to come in?’ They really appreciate the service and they have a safety net.”

Some 12,000 patients have been referred to the virtual clinic run by Brighton and Sussex University hospitals NHS trust since it began three years ago. Fifty seven per cent of those patients are discharged without ever having to return to hospital; 37% have a follow up appointment at a consultant out-patient clinic and 6% are seen by a specialist physio. The service has already saved the NHS around £500,000 as the cost of a virtual referral is £67 – half the price of a traditional clinic appointment. Those savings are expected to double in the next year because since May the service has expanded to include wrist and hand injuries which account for almost half of all fracture clinic referrals.

Under the virtual system patients who require a face-to-face appointment are now booked in with the most appropriate specialist consultant at an outpatient clinic. Cassidy explains: “Under the old system it was a bit of a lottery who you saw. The patient would come to the fracture clinic and if it was run by the shoulder consultant on that day, but you had broken your ankle, you would still be seen by the shoulder consultant. One of the complaints I get from the consultants now is that ‘all my clinics are now full with people that need to be seen.’ ”

Gibbs first had the idea of a virtual fracture clinic when he was a junior doctor: “I would sit in the fracture clinic and feel exasperated for me, and for the patients, because the majority of injuries you see heal on their own with the passage of time and we were seeing people in clinic unnecessarily.”

He admits his consultant colleagues were sceptical at first about the changes but there would be a “hue and cry” now if the trust reverted to the old system: “It’s standardised treatment for specific injuries, it’s freed up consultants’ time and we are working smarter.”

The virtual clinic – which is being showcased at the NHS Health and Care Innovation Expo 2016 in Manchester next month (September) – is already being adopted by others. Virtual clinics are now run at Western Sussex hospitals NHS foundation trust and Maidstone and Tonbridge Wells NHS trust in Kent; others in Hastings and Eastbourne are due to launch in January.

A free “plug and play” package – an electronic virtual clinic blue print – is available for trusts to use as a starting point. Computer software which will allow hospitals to run their own branded virtual clinic on their own system – to be sold under license – is due to be launched next February.

Cassidy and Gibbs believe the virtual clinic – which was recognised in the NHS Innovations Challenge awards this year – could become a national model. That ambition is shared by the Chartered Society of Physiotherapists. Society professional advisor Priya Dasoju says: “We would like to see this model rolled out but it’s key that it is a physio-led service because it’s physios who can provide the rehabilitation service. It’s such a simple concept but makes such a massive difference.”

Virtual fracture clinics are new to the UK but others already exist worldwide – particularly in rural areas of Scandinavia, according to orthopaedic surgeon Stephen Cannon, vice-president of the Royal College of Surgeons.

He says: “It does require resources in terms of time from the physio and the consultant and is a huge change for patients. But it is patient-centred, it works in other parts of the world – it’s a great idea.”

Health and Care Innovation Expo in Manchester on 7 and 8 September will explore the Five Year Forward View in action. High profile health leaders will speak across two stages, while feature zones will explore digital health, personalised medicine and new models of care. NHS colleagues can attend free-of-charge. Click here to register.

Do you work in the NHS? Please take our survey and tell us whether bullying is a problem and how it affects your work.

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Virtual fracture clinics enable patients to receive care online

The online tool that helps the public decode health research

Health concerns every one of us. We all have questions about the impact of factors such as lifestyle and diet on our wellbeing. Yet for all our collective curiosity, it is immensely difficult to sift through the mountain of claims and counter-claims we’re exposed to each day. We are bombarded with declarations about our health and wellbeing, and frequently these assertions are conflicting. Sorting the signal from the noise is no small task.

Traditionally, part of the problem has been access to information. Scientific journals charge for access to research papers, and the cost can be prohibitive to anyone – including researchers – bar institutional libraries . This has improved rapidly over recent years, with many research councils and funding bodies pushing towards open-access publishing, encouraging researchers to ensure their findings are made freely accessible to the public. This is hugely beneficial, but access is only half the battle. The vital issue of appraising medical findings still remains rather daunting for most of us.

The reality is that studies can be notoriously difficult to decode in isolation. The mere fact a study exists showing a particular result is not in itself evidence that result is robust or true. It is crucial to be aware that not all studies are created equal, and some are much higher quality than others. This is a particular concern in the medical field, where confounding factors frequently skew conclusions. For example, studies with only a small number of participants are often statistically underpowered, and results from these might give a misleading picture of reality .

Even with an adequate sample size, it can be difficult to distinguish causal relationships from mere correlation, and lurking variables or poor study design can throw out an entire analysis. Apparently conflicting findings can also occur, rendering a study’s conclusions ambiguous to a general audience, and making it difficult to draw inference with any certainty.

Addressing the difficulties in interpreting research results has therefore been a driving motivation for a project undertaken by the Medical Research Council/Central Statistics Office Social and Public Health Sciences Unit (MRC/CSO SPHSU) at University of Glasgow. The result is Understanding Health Research (UHR), a free service created with the intention of helping people better understand health research in context.

Essentially, UHR it functions as an interactive field-guide to evaluating the strengths and weaknesses of any given health paper. In addition, it gives clear and understandable explanations of important considerations like sampling, bias, uncertainty and replicability. This has the potential to be invaluable for improving public understanding of science and ultimately to improving our collective well-being. After all, as Dr Shona Hilton, deputy director of MRC/CSO SPHSU says “without the tools to assess contradictory health messages and claims about new discoveries and treatments, the public are vulnerable to false hope, emotional distress, financial exploitation and serious health risks.”

This is all too true. As Shakespeare pointed out “the devil can cite Scripture for his purpose”, and this remains especially true in health science, where misguided or unscrupulous operators can hide behind a veneer of science disguising dubious ideas or therapies. It is hoped that tools such as UHR will help the general public differentiate between high and low quality evidence.

A dark example of the need for UHR is the panic over the MMR vaccine, which was partly based on what turned out to be a weak study published in the Lancet. The ensuing panic lowered vaccination rates and fuelled a persistent on-going crusade against vaccines. Over a decade later we are still haunted by the spectre of frequent measles outbreaks worldwide, many of which trace their lineage back to this debacle.

Of course, science is inherently complex and findings often shaded with nuance, so no one tool can ever be expected to serve as a surrogate for expertise. Rather, UHR serves as an excellent place to start an investigation, giving people the ability to roughly assess how much stock they might place in a health finding or media story. In this era of rapidly perpetuating misinformation, useful and considered tools like this are a welcome antidote to unabated hyperbole, and a crucial vanguard in the campaign for better understanding of science and health.

The online tool that helps the public decode health research

Online Dining And Tele-Restaurants Obtain Acceptance

Ken Gordon, a 26 12 months old personnel recruiter, works in a large mid-western city and his three very best friends are scattered across each coasts. But, thanks to the rapidly maturing Tele-Restaurant market, never currently being in the identical place doesn’t stop them from possessing dinner together at least as soon as a week.

“It’s distinct, for sure. I imply there is no foods, just a bunch of pixels that appear like food. But I like it far better sometime,” he mentioned. He and his 3 close friends book reservations via Table 4-four 4U, a foremost on the internet restaurant portal. When it is time to “eat” their on-line maître d’ calls or texts every single of them to allow them know their “table is prepared.” Then all four, wherever they are, gather close to their personal screen for a unique culinary expertise.

“We’re very proud of the operate we’re doing. A person working in Florida can nevertheless share that special Brooklyn gastro-pub encounter with family in Seatlle,” mentioned Chet Brewer, founder of Table four-four 4U.

Display shot of a table for 4 from Table 4-four 4U

You can decide on every thing in between a substantial-end Michelin star-rated 9-course tasting menu and a fast meals buffet where you and your dinner companions can share the enjoyable of going through the line with each other.

It should be no shock to discover there is a enormous demand for Tele-Restaurant reservations. Gloria Juarez, spokesperson for the American Tele-Restaurant Association, reported 700% growth in the very first year,

“Of course,” she mentioned, “a Tele-Restaurant is not the ideal option if you are actually hungry and need to eat something.” But that is not stopping big numbers of talented chefs from opening an on the web place. As on-line chef Jeff Whisk explained, “Eating actual meals is only a tiny element of the restaurant encounter. We can give you the rest.”

And there is no arguing with accomplishment. “It was like, omg, we truly loved the meal. It was the very best ever” explained Ashley Jones, a 34 yr old lawyer who travels usually but continues to build her adore of shared high-finish dining with law college buddies scattered across the nation. And she extra, “it assists us lose excess weight as well … speak about win-win!”

As Ms. Juarez described, “Why need to so numerous therapists develop rewarding online practices and depart all the chefs behind? The American Tele-Restaurant Association is going to make certain that doesn’t come about.”

For updates on “Managing Mental Wealth” and connected news and links follow me on Twitter. To make contact with me click the mail icon over.

Online Dining And Tele-Restaurants Obtain Acceptance

Dr Le Fanu"s online health clinic, Friday 4th July 2014

I thought it really worth mentioning in situation you desired to inform your readers that there is an different supply. I understand it it also offered in Spain.

I discover your column really useful without a doubt.

Greatest wishes

Dear Anon,

Thanks for that most useful and indeed critical observation. This trouble in obtaining Cholestyramine is typically attributed to ‘production problems’ which can scarcely be the case if it is obtainable in France and Spain. This would recommend its non-availability in Britain is a marketing and advertising ploy to advertise the income of much more costly variants. I will mention this in the column.

ALAMY

Concerning Monica O’B"s leg pains, I am a woman now aged 71 who has suffered for many many years with excruciating nighttime pains/cramps in my feet, ankles, calves and thighs (which are the worst). It appears that practically each other lady I meet has this same dilemma, specifically females more than the age of forty.

Anyway, in my personal situation I have finally traced this to sugar, and if I never eat something with sugar in it after my evening meal, this dilemma doesn’t normally happen. If I have e.g. some chocolate or biscuits in front of the Tv, it does. Drinking lots of water before going to bed also helps.

Just believed I’d let you know.

LW

Dear LW,

Thanks for getting in touch and that most intriguing observation about the prospective causative part of sugar in nocturnal cramps. I was unaware of this and search forward to mentioning in in the column in the near long term.

Dear Dr Le Fanu,

My daily life is becoming significantly compromised by my osteoarthritis, especially in my knees, and most mornings I can hardly move for the very first hour or so. I consider not to take discomfort medication as fairly honestly, it just isn’t going to work. I go through and meant to tear out a reference to a treatment that can be helpful and of course lost it! It was a handful of weeks ago in your column and I would be quite grateful to have it once more.

Thank you,

Lisa RR

Dear Lisa RR,

Thanks for your query. I am not really positive which is the reference you allude to – maybe how the (very) well-known Glucosamine could paradoxically exacerbate the pain of knee arthritis – which improves when it is discontinued. As your signs and symptoms are worse in the morning I did wonder no matter whether it may be advantageous to get a prolonged acting anti-inflammatory (this kind of as 50mg Diclofenac) prior to retiring.

ALAMY

Reading about the magnet remedy this morning reminded me that a handful of years ago I study in your column of an individual who kept a bar of soap in their bed for the identical explanation. I reasoned that “never knock it prior to you consider it” was a good dictum, and have never ever had cramp in bed since I have had a tiny white companion close to my feet! If it’s all in the mind, that Ok? It still operates!

A lot of thanks Dr James

Rev Barbara S-P

Dear Rev S-P,

Thanks for becoming in touch and delighted to hear you benefitted from the soap bar remedy.

Dear Dr. Le Fanu,

I was interested to read the part on Ghostly Goings On. I bear in mind my Mom, on more than a single occasion telling me about how she had a dream (details of which I can’t recall getting told) about her 19 yr outdated elder brother being killed in France. The up coming day the telegram arrived. My Mother was 16 at the time.

(Some years ago when you had been investigating folks seeing spots as they have been in the previous, I lent you my guide(because returned!) on the Moberley sisters seeing Versailles in the 18th Century. I was disappointed that you did not adhere to up on these paranormal experiences, or probably I missed it.

For very good measure it was your write-up a lot of years in the past on a patient on statins going on vacation in the West Indies with a wheelchair who forgot his statins and returned property without any want for the wheelchair which encouraged me to stand up to my GP in obtaining him to alter my medication when I located myself with severe muscle fatigue. Some twenty many years on, at 82, I am nevertheless ready to stroll miles.

Thank you for your lengthy series of intriguing content articles.

Regards

Dear Anon,

Thanks for getting in touch and your account of your mother’s premonition of her brother’s death – presumably, I suppose, on the battlefields of France. It is extremely hard to imagine her feelings on obtaining the telegram. I am delighted of program that you, like so a lot of other people, have been inspired to discontinue their statins by that item in the column you mention and twenty many years on are still going powerful.

I read that someone had a ache following urinating at night for no apparent cause. I had the very same, and had the typical tests etc. In the end I took a pint glass and filled it with cold water and “dangled” my bits in for 4/five minutes. It has worked a deal with.

Good luck

Richard W

Dear Richard W,

Thanks for getting in touch however I am a bit puzzled as to why the uncommon manoeuvre you describe ought to have alleviated your bladder ache.

Dear Medical professional

When individuals ask me how I am I reply that I am fine from the knees up.That is since ,despite the fact that I do not seem to have any respiratory,heart,blood and so forth issues, I do endure from neuropathy in my reduced legs and feet.

I have gone from getting a match and lively 71 year previous in 2009/10 to a badly disabled 75 yr previous now. I was advised that the problem is down to a stenosis of the spine and in 2010 a laminectomy was carried out aimed at preventing additional deterioration. As I have received older nonetheless my mobility has worsened. My stability is negative and I can stroll only quite brief distances with the support of sticks or arm crutches. The only issue recommended for me has been occasional physiotherapy but I do admit to getting not very disciplined in which exercise routines are concerned.

I ask as a result for your views please on this situation all round and whether you are mindful of any kind of medicine or remedy which you have heard of which may supply some succour? I must say that I do not, fortunately, have significantly soreness – it is the lack of mobility and seeming inevitability of becoming confined to a wheelchair before long which frustrates me.

I thank you in advance for your observations.

Sincerely

Geoffrey L

Dear Geoffrey L,

Thanks for being in touch and my sympathies for this severe mobility difficulty which you describe. It surely sounds that your lumbar stenosis has critically damaged the working of both the motor and sensory nerves to the legs. There is no medical therapy for this even though I wonder clearly whether a couple of sessions with an osteopath might have some modest result in bettering the mobility of the reduce spine. I would advise, if you reside in the south east, contacting Dr Clifford Harley who is quite knowledgeable in these issues. HIs phone quantity is (Tel 07810 620058)

In the winter of twelve-13 I acquired chilblains on the index &amp middle fingers of my left hand just behind the nail.

Right after they cleared up the nails began to deteriorate and have never ever recovered. The index finger is the worse, with an very thin nail which keeps cracking &amp has vertical splits. It is not feasible to let this nail grow to its total length due to the fact it cracks or bends in excess of &amp breaks off. This is inconvenient as it can make items this kind of as choosing up small objects, carrying out up buttons and so forth. difficult (I’m left handed).

I don’t know whether this is just an age issue (I’m 80). My GP says he doesn’t feel something can be completed about it.

If you’ve any concepts I’d be really grateful.

Derek B

Dear Derek B,

Thanks for your query it certainly sounds as if your chilblains have broken the growth bed of the nails – for which to my information there is regrettably no specific remedy. It may with luck improve with time. I would advise against making use of the formaldehyde primarily based nail strengthening preparations – although reputedly typical moisturising of the nail with a lanolin primarily based cream (this kind of as Cutemol) can be of value.

On the subject of night cramps may I supply yet another remedy. I have had agonising night cramps for many years and while in South Africa in January somebody suggested I consider corks beneath my pillow! I will not drink so had to collect corks from other sources! It is like a miracle! No far more pain, thank goodness. My husband has also stopped suffering from the same issue.

Mrs. J. G

Dear Mrs J G,

Thanks for being in touch and your more affidavit for the cork treatment.

Dear Dr Le Fanu

I wonder if you can assist me. I am struggling from eczema and am so itchy regardless of applying tons of moisturisers, sporting only cotton or wool and sleeping in dream silk sheets. I will not have a rash. I consider warfarin tablets,Digoxin,Bisoprol,Esomeprazole. Citirizine Hydrochloride. The only thing that assists is a cold, moist flannel. Yours Sarah G-S

Dear Sarah G-S,

Thanks for your query to which I will reply in my next column at the beginning of August.

Good afternoon, I have been diagnosed with moist amd but my vision is too excellent to qualify for NHS treatment. I have had my first injection of avastin. It is an costly business and I am asking yourself if I can appeal in anyway. I am 65 and will run out of funds prior to lengthy. Exactly where can I get actually good information about the potential for my eyesight ? Thank you so significantly Mary P

Dear Mary P,

Thanks for your query. The rationale for prompt treatment of moist AMD in its early phases will be that it may well stop, or at least slow its fee of progression. There is however (to my information) no evidence that this is the situation – consequently the Nice suggestions to which you allude. I would have considered it wise to adhere to them on health care and financial grounds.

Dr Le Fanu"s online health clinic, Friday 4th July 2014

Dr Le Fanu"s on-line well being clinic, Friday 23rd Could 2014

I would appreciate it if I could have your observations and suggestions as I am getting to the end of my tether and attach a rather long History.. Forgive me taking the liberty of approaching you directly, but I am at a loss as to where I can get information; my GP suggests I may have slight depression, but I refuse to go down that route as I feel that if only I could see properly – I am told I am not visually impaired, ha, ha, – I would be able to manage perfectly well, coping with the deafness and finding ways of getting round the immobility. I gather it is the movement of the eyes which is causing this.

I apologise for my verbosity, but I have tried to give you as much information as possible and maybe added to what you already know my comments perhaps are of interest. Also I sound full of woe, but I feel as though I am fighting a losing battle and I will not give up if anything can be done; I do not feel depressed and have been motivated but unable to do so much during the last twelve months. I am known for my perseverance and for finding alternative ways to get around problems.

One hears so much about stem cells these days and what is being achieved, is there nothing that can be done to alleviate the situation and so give me back some quality of life? I may be 80+, but I feel there is so much more I could/can be doing without the loss of ‘equilibrium’ which has affected my independence.

Thank you very much for your time and I hope, interest, and if there are further points, please let me know.

Charmian K

Dear Charmian K,

Thanks for being in touch and your comprehensive account of your medical history. It certainly sounds as if your doctors have been most assiduous in sorting out your several medical problems and though I appreciate that the loss of this equilibrium must be very trying, there is regrettably no treatment that can repair this ischaemic damage to the brainstem. I am very sorry not to be of more help in this matter.

PA

Dear Dr Le Fanu,

I have, over recent years, experienced quite severe sneezing after orgasm. My age is 71 and I am in good health. The sneezing is extensive, the duration being around 12 -15 sneezes. I am happily married and the “habit” does not cause any personal problem for my wife, but I find it extremely inconvenient. Only very, very occasionally does it not happen after orgasm, but we have been unable to pin-point any specific cause or circumstances, either physical or psychological. The environmental surroundings do not appear to make any difference There were no particular changes to my life during the initial onset period.

Any help in identifying a possible cause would be much appreciated.

Regards,

Mr R A

Dear Mr R A,

Thanks for your query and you account of this interesting phenomenon of orgasm induced sneezing. This was first described in 1897 by the eminent ENT specialist Sir John Mackenzie in an article ‘The Physiological relations between the nose and the sexual apparatus of man’. It is claimed that the lining of the nose contains the same type of tissue as in the penis which becomes engorged during sexual arousal thus triggering the sneezing. It can apparently be prevented with nasal decongestants.

hi dr james can statins cause constipation, thanks tony

Dear Tony,

Yes! Best wishes.

Dear Dr James,

I was catching up on your column today (having been unable to read it for some weeks) and came across the following query:

‘Can you make any suggestions for a rather silly problem I have? My feet feel as if I am wearing socks when I’m not. My GP has done various blood test that all come back OK…and there is no loss of sensitivity when he touches my feet. This has been with me for a year or more …sometimes my feet will go red hot suddenly but only now and then. Could the problem be in the skin do you think? It really is a strange feeling.’

This immediately reminded me of a friend who had gone to his doctor some years ago with a similar “phantom sock” sensation. Having undergone various tests, he was given a brain-scan which showed the presence of a (benign) tumour. This was removed and he recovered well. The phantom sock sensation disappeared following the operation.

I don’t wish to scaremonger, but I thought I would let you know just in case it helps.

Yours sincerely,

Mrs C. L.

Dear Mrs C L,

Thanks for being in touch and that most interesting observation. This sock (or stocking) sensation in both legs is characteristic of some defect in the sensory nerve as I described. It is however possible that were this sensation to affect just one foot it could be induced by a benign tumour in the sensory cortex of the brain – which would indeed improve following its removal.

I was treated for tonsillar cancer last year with radiochemotherapy. Apart form a reaction in the form of acute sepsis (three weeks in ICU) I have been given the all clear.

However I now suffer from acutely dry mouth and am largely unable to eat. Do you know of any trials to remedy this? I have tried Salogen for months but it just causes excessive sweating.

Any ideas would be gratefully received

Sue McK

Dear Sue McK,

Thanks for your query and my great sympathies for this most distressing complication of your cancer treatment. You will no doubt have experimented with the various methods for moistening the mouth as described in (for example) the Macmillan Cancer Support document on Xerostomia. My only further suggestion would be that several readers over the years have mentioned that keeping a raisin (or small piece of string) between the gum and cheek helps stimulate salivary secretions. Best wishes.

Dear Dr Le Fanu.

Having read your article a few weeks ago re sensory nerve damage, I have the exact symptoms.

I had keyhole surgery for colon cancer 21/2 years ago and one entry was through my navel, but only in the last 3 months has this neuropathic pain emerged. It has been getting gradually worse and when I have an attack, which comes for no reason about 3 times a day and can last for anything up to 20 minutes to all day. If I sit down it usually calms down.It can also wake me up in the night.Most painkillers don’t touch it. I am going back to see the surgeon when I can get an appointment. This stabbing pain only covers a small area over my navel, it is so debilitating and wearing when it is active.

I would be grateful for any suggestions you might suggest to alleviate this problem.

Yours sincerely Shirley L

Dear Shirley L,

Thanks for being in touch. It is very puzzling that this stabbing neuropathic pain around the navel should have developed so long after your keyhole surgery. It is possible I suppose it might be due to an adhesion where the gut is being pinched by fibrous tissue at the site of the incision. I would be more than interested to learn what your surgeon makes of it.

ALAMY

Dear Doctor Le Fanu

There has been more press about statins and my doctor wants me to take them as I have a genetic propensity to have high cholesterol.

I wonder what effect statins may have on neurons, axons and other neurological signalling devices in the brain and body? My husband’s Parkinson’s disease first became apparent when he was prescribed statins. There seem to be more and more people with Parkinson’s and I just wondered if there could be a link with the introduction of the prescription of statins. I have read there are fats in the myelin sheath surrounding nerves and nerve junctions. Do the statins break down that necessary fat too?

Marion V

Dear Marion V,

Thanks for your query. Statins as you will know adversely affect the functioning of the brain in several ways resulting in depression, poor concentration and dementia – but the evidence implicating it in Parkinsons is contradictory. There are certainly anecdotal accounts of the situation you describe where the first symptoms become apparent soon after starting statins and Dr Duane Graveline (see below) on his website cites evidence of reduced levels of the enzyme COQ10 – that is lowered by statins – in the parts of the brain affected by Parkinsons. But a recent study (B. Friedman, American Journal of Managed Care, 2013, vol 19, pp 626 – 632) suggests the contrary that statins might have a protective effect, reducing the risk of Parkinsons.

Dear Dr Le Fanu

I am writing in respect of the very recent articles in the Press concerning Statins. It appears to me that the recent report in the BMJ has resulted in what seems to be an hysterical outburst to ensure that any challenges against the “wonder drug” should be completely suppressed. You yourself have been writing cautionary critical articles in the Press since at least 2004 and I would like to ask what your current views are on this subject.

In my earlier life I was a practising fundamental research biochemist and have continued to retain my interest in the fascinating field of body chemistry. In this context I wonder if you have read any of Dr Duane Graveline’s books on the subject of the chemical interactions of Statins ? He is an American family doctor, a former astronaut and aerospace medical research scientist, who suffered serious side effects from Statins. As a result he has been pursuing in some considerable depth their biochemical involvement in the human body since well before 2006.

His most recent publication “The Statin Damage Crisis” (in 2012) makes for very interesting reading and provides further clarification as to which specific chemical pathways are particularly affected in the human body. In particular, he shows :-

a) the point where this group of drugs interferes with the body’s systems damaging, in addition to Cholesterol production, a number of other critical synthetic pathways – resulting in a range of adverse impacts on human health (pages 172 – 174);

b) the main benefit of Statins as being actually anti-inflammatory and immunomodulatory;

c) that Cholesterol levels in the body are not the main danger.

I would certainly appreciate your comments.

Yours sincerely,

Barry D

Dear Barry D,

Thanks for being in touch. Dr Graveline’s critique is most persuasive on the three counts you mention. The complexity of those cholesterol synthesis pathways make it highly probable that statins must have adverse effects. Next the claims of benefit from the statin trials cannot be accounted for by their cholesterol lowering effect – suggesting they must work through some other mechanism. Thirdly the striking pattern of a sharp rise and subsequent precipitous fall in the incidence of heart disease over the past 60 years cannot be accounted for by changes in dietary patterns or cholesterol levels.

ALAMY

Dear Dr Le Fanu,

I thought you might like to know of my experience of the side effects of statins, in particular Simvastatin.

In 2000 at the age of 38 I experienced a minor MI. Tests later showed I had 6 of the 7 factors for heart disease including high cholesterol. I was put on statins, initially 80mg, and subsequently reduced to 40mg daily. In early 2011 I took up target archery, a sport that requires muscle control and some strength. By the summer of 2012 I was regularly drawing a weight of 37lbs per arrow (a little above average for a male) and shooting 70-100 arrows in a session without problem.

In the summer of 2012 after a flare up of a previously slipped lumbar disk I received a cortisone injection adjacent to my spine which did alleviate much of the back pain. However over the following 18 months the muscle tone in my shoulders gradually deteriorated and I struggled to draw the bow to full weight and, more importantly, was unable to hold it steady while shooting. The result was a dramatic reduction in the quality of my archery and the scores I achieved. I was also experiencing regular painful cramps in my calves and pains in both forearms.

This spring, with the agreement of my doctor I stopped taking statins. At the end of two months the effect was dramatic. I am back to a full weight draw, able to shoot 70 arrows again without effort and my scores are recovering. I just need to forget the bad habits I developed to cope with the muscle weakness. My cholesterol went up to 7.8 and as a heart disease ‘victim’ I probably should be on statins. I’m now on 20mg Atorvastatin with fingers crossed that the cholesterol decreases without any muscle tone loss. I would hate to have to choose between archery and my health.

Apologies if this is a long letter but I thought it may be informative.

Mike S

Dear Mike S,

Thanks for being in touch and that most interesting account of your statin experience – similar to that of the champion chess player who observed the adverse effects on his prowess at the chessboard. It certainly sounds as if you might belong to the minority who actually benefit from these drugs and I wonder whether you have investigated the possible benefits of taking the enzyme supplement COQ10 that minimises their effects on muscle function.

Dear Dr James,

I am 66 years old and some 9 months ago I had a large molar extracted following an infection in the root. The gum was slow to heal and even now it has not knitted together fully. My dentist doesn’t seem overly concerned but I was wondering whether there could be an underlying healing issue with increasing age. My general health is good.

Am I right to be concerned?

Yours sincerely,

Mrs Valerie F,

Dear Mrs Valerie F,

Thanks for your query. I would agree that nine months does seem rather a long time for the gums to heal – but as you rightly infer this is an age related phenomenon. There are a whole host of nutritional factors involved in healing (vitamins A, C and E, magnesium and copper etc) and it might be that a generous intake of fruit juice daily may speed things along.

Sir,

Being in the middle of a series operations for Aneurysms, and having had a stent of some ilk inserted to reside somewhere around my Aortic Artery, I am now awaiting some more surgery on two which are at each Knee. I am taking the liberty of writing to you as I think an article of yours would be helpful.

There seems to be a reluctance in my age group, I am 82, to go seek information on these problems and their consequences, if not accidentally detected.

Three full cousins of my late Father all had these.

One was a GP in Shipley and his burst, luckily he was with his son, also a Doctor, who got him to hospital and the life was saved, This mans Brother who was a Gynaecologist in the Leeds Bradford group ,on retirement, and on the suggestion of one of the surgeons of the team got checked, to be told that he had one too and it was fixed. their cousin, a Vet in Canada also had one and indeed I have discovered a distant cousin of mine died of his in Zimbabwe. There has to be a genetic connection

I have been treated at the Royal Victoria Hospital here in Belfast by marvelous people who deserve the highest praise which I give gladly.

Yours Ian M B

Dear Ian M B,

Thanks for being in touch. There are indeed several types of genetic disorder that predispose to aneurysms, the commonest being a condition known as TAAD (Familial Thoracic Aortic Aneurysm and Dissection). It is encouraging to hear that your two siblings have had theirs successfully repaired and I am sure you are in excellent hands at the Royal Victoria.

I have had ulcers on both legs for the past year and have been under the dermatology department at the Norfolk and Norwich University Hospital and have received treatment from them for the past year. I must have been given every dressing there is and in November had a biopsy and they said that I had a condition called calciphylaxis – which they had never seen before – and is usually found in end stage kidney cancer patients. In December I was in hospital for a week and they began iv treatment with sodium thiosulphate although I fortunately have no problem with my kidneys. However after eleven infusions – which incidentally made me feel completely wretched and it would take all week to recover only to be hit with the infusion again. The legs have shown only minimal improvement and I am finding it increasingly difficult to deal with this situation. My wife dresses the legs for me sometimes twice a day and I am bandaged from toe to knee. What is your view of the hyperbaric oxygen chamber as a form of treatment? I would be so grateful if you could email me. Regards Mike W

Dear Mark W,

Thanks for being in touch. I had not I must confess previously encountered Calciphylaxis. I could only find one study describing the benefits of hyperbaric oxygen therapy (M E Edsel in the Diving and Hyperbaric Medicine Journal). This apparently resulted in a remission in a third of patients which is certainly worth pursuing.

Dear Dr Le Fanu

All my adult life (and possibly before) I have occasionally (perhaps twice or three times a year) experienced a very sensitive patch on the surface of an arm or leg. These vary from two inches or so in diameter to five or six inches. Sometimes the patch begins small and gets larger through the day. It’s the skin that is affected, not the flesh or muscle beneath the skin. It usually becomes so sensitive to the touch (or rather, to movement across it) that I keep a hand on the patch to stop clothes moving on it. Heat helps, and at night I place a hot-water bottle against the patch. Most occurrences begin in the afternoon or the evening. By next morning all is well again.

These incidents occur randomly through the year. I have not been able to connect the occurrences with causes such as draughts, particular materials, toiletries, food, drink, etc.

I have never asked my GP about it because it is a minor discomfort at the time and nothing more.

I am 71 years old, male, fit and active, non-smoker, taking no medication, but since I’ve experienced these episodes all or most of my life, I assume these facts are irrelevant.

If you or your readers have any ideas what might be causing this I should be interested to hear.

Yours sincerely,

Roger D

Dear Roger D,

Thanks for being in touch. The symptoms you describe are strongly suggestive of Wartenberg’s Migratory Sensory Neuropathy first described by a neurologist of that name in 1958. Its cause is not known and can result in permanent sensory impairment – though this does not seems to be the situation in your case. It may be helped by drugs such as Amitriptyline and Gabapentin.

Dear Dr Le Fanu

I enjoy reading your column and wondered if I could ask you about my chalazion I have had it on my left lower eyelid for over two months now. My doctor initially gave me drops but they have not helped. He has now referred me to an eye hospital to have it scraped off and I am waiting for an appointment I wondered if you knew of any treatment in the meantime that might help. I have put warm compresses on and gently massaged the eyelid but alas my friend Mr chalazion wishes to stay attached to my lid !

Very best wishes to you

Dianne A (Mrs)

Dear Mrs Dianne A,

Thanks for being in touch. I am sure you are doing the right thing by applying those warm compresses though it certainly sounds as if your chalazion warrants surgical removal.

Dear Dr James,

Since the mid 1990’s I have had a cough that never goes and it is driving me insane. I have been diagnosed with asthma but now they say it is COPD. I take 2 puffs a day of Asmanex Twisthaler 400 micrograms inhaler and do not need to use the Bricanyl preventer as luckily I do not get breathless. I cough for several hours and it is really embarrassing, especially when I am out with friends. I have seen the lung specialist at hospital but she cannot think of anything to relieve this. Quite often I have to hold my diaphragm to ease the effort to cough. The mucus is never green.

All this coughing came about because for about a year my office was located on the floor above where the company garage was, where they serviced company cars which were started up virtually under my chair and I could smell fumes and would open my window wide. Later investigations found the builders had left something such as an air vent going directly into my office. No one else shared this office.

Anything you could suggest would be very welcome indeed.

Yours sincerely,

Ann W (Mrs)

Dear Mrs Ann W,

Thanks for being in touch and my great sympathies for this persistent cough. You mention the production of mucus that would suggest some form of bronchitis or post nasal drip which as recently commented on in the column can be ameliorated by a three month course of Erythromycin. The other causes of a chronic cough include acid reflux and a side effect of drugs such as the ace inhibitors. I presume these possibilities have been considered.

Dear Sir,

As a longstanding Telegraph reader I often read your column with interest for the common sense advice and unusual problems involved.

After the recent publicity over asthma diagnosis, I thought you might find my case of interest. I will try and be brief.

I am 66 years old, female and have been blessed with good health, only having been in hospital for the birth of my two children and one minor operation. I do now have a very low dose of indapamide for high blood pressure.

Just before Christmas 2011 I got a bad cold/chest infection which left a persistent cough. By March I was regularly coughing to clear my chest for about an hour at 2.00am. When I got to the point of sitting up, virtually sleepless all night I went to the doctor. I got an urgent appointment with Dr X, a member of the practice I had never found sympathetic. When asked if I had acid reflux at night, I decided to say yes as after an hour of coughing this did happen. He prescribed antacid tablets. I thought this was wrong and spoke to a friend, a retired nurse with a hiatus hernia. She said that she used this for her condition and advised me not to take it.

I got an appointment with my own doctor (meeting him for the first time – it must have been 10 years since I had darkened the doors of the surgery). He was very pleasant and prescribed antibiotics and dealt with the blood pressure issue. Over the next two years I had about 5 courses of antibiotics and two chest ex-rays. My symptoms improved but never disappeared. At one early morning appointment I could hardly speak because of the mucous in my throat (although I could breathe without difficulty). This induced a controlled concern and I was carefully shepherded to have an ECG. This was completed and produced no diagnosis, but at least they cared.

On 29th January 2013 a friend said my voice sounded as hers had done for 3 years before she was diagnosed with asthma. Several others (including the nurse) suggested this. I asked for an emergency appointment. The first available with my doctor was the 12th February. I accepted one with a locum for 5th February.

On 30th January (a cold wintry day) I went to the Manet exhibition in London, did some shopping and visited cousins. I must have walked about 5 miles, no really great distance, but I felt exhausted when I got home. After no supper (unheard of!) and just a mug of hot chocolate I went to bed about 8.00pm (also unheard of). Tired the next day and reflecting on old age (!!) I decided to phone my daughter, living in Germany, that evening. As I reached the phone my arms were tingling and I felt awful. I phoned a neighbour (another retired nurse). We agreed I should go to the doctor the next day.

On 1st February I went and asked for an emergency appointment. I was told they were booked for that day, I should go home and they would call me. I said I would wait. I eventually saw Dr X (him again!)

With the air of a man whose patience has been sorely tried he asked why I had come. I said I felt awful and had they thought of asthma. He instantly produced a flow meter – the reading was almost off the bottom.

At a rate of knots he went on about inhalers, steroids etc. Being relieved and a little shocked I could not take this all in and asked him to write it down. He started to do so and then said Oh go and sit in the waiting room the nurse will be free in 20 minutes.

The nurse was pleasant, but initially said Oh one of my friends has had a cough for three months. Not two years I suggested. After doing another flow-meter reading she grimaced and was silent. I began to feel that I was not a time-wasting fraud at last.

Asthma medication was prescribed and suitably adjusted over the next few months. I am learning to live with what for me, is a minor form of the condition. I did manage to get an apology from my doctor for this lack of relatively simply diagnosis, but only when I said I thought I deserved one. I have since changed the practice I attend and they are helpful and understanding.

I apologise for the length of this message, but it does raise a number of issues:

What a nonsense the appointments system has become (at least at this practice)

Is high tech relied on more than common sense – surely with the increasing incidence of asthma, they should have thought of this?

What if I had not been relatively intelligent and persistent? I live alone – could I have died? (this is an extreme scenario I admit)

Thank you for your patience in ploughing through this and if it adds to the evidence that changes are needed then it will have served some purpose.

Your faithfully,

Jane T

Dear Jane T,

Thanks for being in touch and the detailed account of the difficulty (and delay) in diagnosing your asthma. It is presumably the late onset variety that as in your case can indeed present with a chronic cough as its major symptom. It is possible it would have been identified more promptly had you been treated with a course of steroids.

ALAMY

Dear Dr Le Fanu,

My doctor suggested that I should write to you about relief for lower back pain. For some years I have suffered from back pain and I endeavour to avoid surgery, consequently I have spent a lot of money on physiotherapists without very much success. Last year I went to a NH physio and whilst she did not give me much massage or manipulation she did suggest that I might find some relief if I was to lie on a tennis ball and massage my back for five minutes every day. Whilst this is no panacea, it has provided more relief than all the expensive visits to private physios, all for the price of a tennis ball – not that really as my dog found the ball when out walking! This tip might help others with a similar affliction.

Yours sincerely

Michael D

Dear Michael D,

Thanks for that most useful tip about the tennis ball. I look forward to mentioning it in the column for the benefit of others.

Dr Le Fanu"s on-line well being clinic, Friday 23rd Could 2014

Dr Le Fanu"s online well being clinic, Friday 9th May 2014

I am interested in your additional mention in the Everyday Telegraph March 17 2014 for the remedy of excess catarrh and would be grateful to have to have sight of your unique article on this topic.

I have an curiosity in this subject as I have suffered given that about final Might 2013, though initial signs and symptoms feasible began months ahead of this. I initially approached my doctor with the difficulty of constant excess mucus, soreness inside the nostril and a nasty taste in my mouth. I ultimately received by means of 4 diverse prescriptions of antibiotic lasting seven/10 days each and every. My medical professional also advised I must use a Fluticasone Propionate nasal spray .

Though the unpleasant taste disappeared the other symptoms of blocked/runny sore nose still existed. I then attended a regional ENT Out Individuals in late December 2013. A Fluticasone spray was prescribed with an antihistamine element included – Dymista. I experimented with this for a handful of weeks despite the fact that by that time I was discovering steroid sprays have been even now generating the issue worse such as spots of blood.. I was then provided Betamethasone drops which had the identical adverse troubles. I have been offered an assurance that the situation is benign by my doctor.

I have experimented with lengthy intervals without making use of any treatment but nevertheless the signs and symptoms exist though to a lesser extent.

I would pleased for any comments and a copy of your articles so I can at least increase the matter with my following ENT appointment in early May.

Yours sincerely

Dear Anon,

Thanks for your query and my sympathies that these distressing catarrhal symptoms have not responded to the various therapies your mention. Please discover connected a hyperlink to the pertinent articles or blog posts.

http://www.telegraph.co.united kingdom/well being/10699687/Physicians-Diary-Statins-and-their-side-results.html

http://www.telegraph.co.united kingdom/wellness/elderhealth/10642395/Statins-Is-the-public-starting up-to-question-mass-medicalisation.html

You will find a comprehensive review of the pertinent evidence by Googling ‘Civers, macrolide, rhinosinusitis’.

Dear Dr.Le Fanu,

I have been following the comments about placebos with excellent curiosity, and it has reminded me about a tale which my late Father used to tell.

He was a pharmacist at The London Hospital in the 1920′s.

He used to make up a prescription of coloured water, and his was often red.

When my Father went on vacation, an additional pharmacist produced up this specific prescription, but his was yellow.

When the patient next saw the consultant, the patient told the advisor in basic English, that the yellow medication was no very good. !!

Regards,

P.H

Dear P H,

Thanks for being in touch – intriguing that teaching hospitals (not just family members medical professionals!) also dispense these coloured water treatments. It will be intriguing to know whether or not your father’s (favored) red tonic also contained some extra fortifying elements (this kind of as strychnine).

MATT

Vertigo signs Monday 5th May

Dear Dr. Le Fanu

I may possibly be ready to help with the intermittent vertigo dilemma. About 14 yrs ago I started to go deaf in my right ear and sought healthcare help. The ENT consultant eliminated a polyp from the nose and checked for a neuroma with a MRI scan. Over the subsequent 12 months or so the deafness worsened. Then I had an appalling assault of vertigo which was diagnosed as BPV and offered Buccastem. Luckily functioning in the School of Health care Sciences at Oxford I had entry to all the lit. I asked for the BPV check and treatment that had become offered the end result was that the diagnosis was transformed to Menieres. The ENT consultant had a repeat MRI and diagnosed that the right ear was damaged both hearing and balance. He explained that the ear was sending rubbish info to the brain in contrast to the left ear. The baffled signals in the brain caused the vertigo. He had me tightroping the lines in the vinyl flooring everyday as often as attainable to educate the brain to use the grid data from my eyes and left ear. Also I discovered that Beta-Histine (SERC) was used in the USA for Menieres and it undoubtedly assisted me. At some point soon after one more two many years the right ear died and the brain only used good info and the vertigo stopped and I never ever had one more attack.

I have just lately attempted an very strong hearing support in my dead ear, so that I could hear typically. After a week or so I experienced signs and symptoms like people reported in your column. These I attributed to the brain now obtaining very good audio info from the appropriate ear but rubbish stability info. In the dark there are no visual balance signals to correct the rubbish. I stopped employing the hearing aid and the issues stopped.

I suspect that your Telegraph patient has mild BPV or Menieres and it is the lack of the visual balance signals in the dark that leads to the problem. As for time of yr it could be explained by it being lighter at night as we go into Spring/Summer and then when it goes darker on the Autumn the brain is deprived of the visual balance.

If its BPV its effortlessly treatable if its Menieres she has my sympathy.

I am now 76 and retired,

Dr. Alan T, MSc(Oxon) PhD. FRSC. FRGS

Dear Dr Alan T,

Thanks for getting in touch and your comprehensive account of how (and why) a hearing aid should have exacerbated your Menieres induced vertigo. I hope to mention this in the column.

Dear Dr Le Fanu,

I read with interest the comment on Electro-Sensitivity dated 2nd May, which I think was in response to my letter to you on the subject which appeared in your column dated 31st January.

While I am mindful that this issue is contentious, and that not all scientists and researchers agree that it brought on by means of a physiological response to prolonged publicity to a variety of types of man-manufactured electro-magnetic fields (EMFs), it does seem to be an concern which is now being treated with an escalating degree of seriousness by researchers in the area, if not yet by governments and by corporations who, one particular may possibly argue, have a vested curiosity in denying any website link between EMF exposure (particularly wireless) and detrimental well being results.

Leaving aside that debate, I would like to thank you for allowing this issue to be covered in your Overall health Clinic, and performing what I contemplate to be a crucial public support.

Regarding my very own condition, it out of the blue worsened dramatically one evening a number of weeks ago, to the stage that my signs and symptoms have now turn into so severe and incapacitating that I have been forced to leave my personal home. Readings on my EMF meter demonstrate that the ambient level of radiofrequency/microwave radiation in and close to my property has elevated substantially, and so far I have been fully unable to shield it out.

It seems most likely that this has coincided with the installation of sensible meters in one or more close by houses, and I believe that my own situation could represent a taste of what is to come, as the deployment of wise meters gathers pace, as vulnerable people – for what ever explanation – are the 1st to manifest the variety of symptoms which have now come to dominate my daily life entirely.

Type Regards,

Dear Anon,

Thanks for your further observations about electro-sensitivity. I confess to not realizing about these ‘smart meters’ that you mention – could you perhaps clarify?

Dear Dr James

Mrs F D from Leeds need to be struggling from Benign paroxysmal positional vertigo ….induced by loose crystals in her ear canals. I too suffered from this earlier on this yr. It can be purchased on by a modify of air pressure, so yes, there could be a cosmic connection! I wait to see what September brings.

Jane E

Dear Jane E,

Thanks for that fascinating – and plausible suggstion – however I wonder about the proof for this change in atmospheric stress at the time of the equinox.

Hello,

I am a 71 yr old female in very good well being and the only medication I consider is 75mg of thyroxine for underactive thyroid. I have been on the very same dose for 10years now and its doing work well. A buddy was suggested by her GP to consider the supplement ubiquinol . I would also like to start off taking this but I am not sure if it would interact with the thyroxine. I have asked in the overall health foods shops but noone seems to be ready to give me an answer.

It seems as well trivial to bother the DR with. I would be grateful if you could give me some suggestions on this.

Sort regards

Angie.

Dear Angie,

Thanks for your query. To my information there is no explanation why taking Ubiquinol would interfere with your Thyroxine medication.

PAUL GROVER

NOT a health care query!

I thought you’d like to know what my husband (who did have dementia) answered when asked the Prime Minister query one particular time (I knew he didn’t approve of the then incumbent). “So who is the Prime Minister, Stephen?” Extremely, Quite extended pause although he studied his clasped hands on the table. He looked up. “Does it matter?” The research medical doctor &amp I laughed like drains &amp he joined in, searching really pleased for having amused us.

When asked to speak about Alzheimer’s at a Civic Dinner lately, that was how I wound up &amp it was just as productive.

Yours sincerely

Dear Anon,

Thanks for being in touch. You could know that for a even though Margaret Thatcher’s potent personality invalidated the use of the query ‘Who is the Prime Minister?’ as a dementia screening check – as virtually everyone (no matter how demented) knew the solution!

Dear Dr James

I have been on Tramadol, Lansoprazol, Gabapentin, Amatriptalin and more not too long ago, Fentanyl patches for the past 5 many years, due to persistent neuro pain from spinal cord damage.

I am at present waiting for SCS implant but am anxious about long phrase side effects of these medication. Any advice would be appreciated.

Regards, Chris C

Dear Chris C,

Thanks for your query. I would not have thought the medication you are at present taking would necessarily have any long term adverse results.

Dear Dr Le Fanu

My stepmother is 89 years of age and, apart from the “typical” frailty associated with most people at this age, she is usually in great overall health. For some months, even so, she has complained of itching/burning mainly on her back which makes her uncomfortable and spoils relatively her high quality of lifestyle.

She has experimented with most lotions and takes one particular tablet of Fenoxfenadine per day. She requires a single day-to-day tablet of Losartan and a single of Felodipine each for blood pressure.

By way of background, she has in the previous suffered anxiety episodes which have been diagnosed as the consequence of urinary infections and these have been eliminated with long lasting antibiotics. I do not know if this has any bearing on the circumstance.

Do you have any ideas as to what other action we may well take to deal with the itching/burning?

Yours sincerely.

Dear Anon,

Thanks for your query on behalf of your mom. I presume this itching/burning is not related with a rash of any type which would depart two primary prospects. 1st this could be the (regrettably named) issue Senile Pruritus brought on by age connected dryness of the skin – for which the treatment is to get a bath less usually and use generous quantities of moisturising lotions. 2nd – as talked about last week – a localised location of itching on the back might be brought on by pressure on the spinal nerves, – otherwise identified as Notalgia Paresthetica. This may be ameliorated by a tiny dose of a drug such as Amitriptyline.

Daily my feet give me little difficulty, but at night hell. On appropriate foot the minor toe is often excruciatingly tender &amp ditto to touch. Plus the huge toe really tender to strain on the best of the nail – when I arise all is properly for the day – weird.

Jon C

Dear Jon C,

Thanks for becoming in touch with that account of that most unusual symptom. It is hard to know what may be the explanation and I will mention it in the column in the hope of clarification from others who may well be similarly afflicted.

ALAMY

Dear Dr Le Fanu,

The lady you talked about on the 28th with sore eyes soon after going out walking etc isn’t going to mention how old she is. Even so, for two years or more I have had related problems, worse in the wind or vivid light and ultimately my eye professional stated my tears weren’t viscous enough to stick to and coat my eyes and this was probably a hormonal deficiency. He prescribed Viscotears which worked properly. At the identical time I commenced taking 1.5 tablespoons of coconut oil a day as I’d been told I was borderline hypothyroid and coconut oil stimulates the thyroid. Inside in six weeks of taking the coconut oil, I realised I was no longer employing the eye drops. When I ran out of the oil, inside 2 – 3 days I had to use the drops once more until I got back on the coconut when I again no longer essential the drops.

I wrote to Dr Bruce Fife,the ‘coconut ‘doctor about this, and he explained he’d had several people report related reactions and he believed that as the coconut stimulated the thyroid ( I’d monitored my basal entire body temperature every day for twelve months plus and never got over 36.1. Following taking the coconut oil daily it by no means goes beneath 36.6 and is typically 36.seven/8 ) which controls hormones, and thus the tears grew to become a lot more viscous as a consequence and the difficulty disappears. I mention the age as I’m publish menopausal which could be a element as well.

Yours sincerely,

Mrs C. S

Dear Mrs S,

Thanks for your account of the wonders of coconut oil that I had not previously encountered. I appear forward to mentioning it in the column for the advantage of other people.

I also suffer in early spring from difficulty in reading soon after waking which clears as the day progresses.Rinsing the eyes with water also assists.

As a former sufferer from hay fever and itchy eyes induced by some tree pollens I suspect in my case it is a certain pollen which is the culprit as the dilemma does not persist during the spring months.

Regards

Shirley K

Dear Shirley K,

Thanks for currently being in touch and your intriguing observation that this early morning problems in reading might be a symptom of hay fever. I have not come across this ahead of.

Dear Dr Le Fanu,

The above lady with trouble in reading initial hour soon after studying, enhanced by eye bathing in warm water and sore eyes at the finish of the day, sounds with out a doubt as though she has mild dry eyes.

Efficient remedy-use The Eyebag(www.eyebags.com) with the advised eye massage upon arising,then studying is no problem and no sore eyes at the end of the day!

Kind regards

Dear Anon,

Thanks for drawing my interest to The Eyebag that I will mention in the column shortly.

Hi there –

I consider I go through anything numerous years ago about memory loss induced by statins. Could you please forward any analysis final results there have been on this issue.

A lot of thanks,

Noreen C

Dear Noreen C,

Thanks for your query. There is, as you will find, a prodigious amount of information on the internet about the part of statins in creating memory reduction. I would recommend ‘Lipitor, – Thief of Memory’ by Dr Duane Graveline.

Could the lady with sore eyes have blepharitis? My signs are the exact same as your correspondent, diagnosed by my optician after several months of comparable symptoms. I also have no difficulty with prolonged distance vision but have blurred near vision which improves for the duration of the day. Warm compresses and eyelid washes have enhanced the signs substantially.

Dear Anon,

Thanks for becoming in touch. Several readers have advised blepharitis – as a attainable diagnosis that I will mention in the column shortly.

Dear Dr Le Fanu

My 93-year old mother has been scanning your column for as extended as I can keep in mind – she loves it in spite of the reality that she will take no medication and apart from “wobbly knees” is in rude wellness.

Have you ever discussed achievable remedies for blepharitis? I have had it for seven years and six-month to month journeys to the eye clinic just end result in the normal suggestions to clean lids and lashes, use hot compresses to try out and dissolve oil blocking ducts, and I have had two small “bungs” put it to attempt and stop moisture draining away. I use eye drops hourly during the day and gel at night. No one has actually advised me what the lead to is.

Absolutely nothing genuinely looks to operate and some days the eyes are so sore I can barely go through, other days they just feel as if I have been in a chlorine pool all day. I enjoy this is this kind of a trivial complaint compared to sight-threatening ailments and there is not much related study going on, so I believed I may well appeal to your wealthy supply of readers’ experiences for something which operates for them.

Ideal wishes

Dear Anon,

Thanks for becoming in touch and I am of course delighted to hear that your mom appreciates the column so a lot. I have without a doubt written about blepharitis in the past which can be identified by googling Telegraph On the web and seeking ‘Le Fanu, blepharitis, doctors diary’. It is, as you mention, a aggravating issue to treat. A number of readers over the years have commented how it would seem to improve with a typical daily dose of vitamin C – as in a glass of orange juice.

Dear Dr.

You mention Sarsaparilla what are the health-related positive aspects ?

Regards

Dear Anon,

Thanks for your query. Sarsaparilla, it is claimed can assist alleviate psoriasis and ‘other skin conditions’. It may also have anti inflammatory and diuretic properties with anecdotal reviews of its benefits in treating rheumatoid arthritis and fluid retention.

Mrs PB from Suffolk

Dear James

My wife has the exact same symptoms. They are due to the ‘dry eye’ syndrome which was confirmed by an ophthalmologist who prescribed a lubricant gel (Viscotears Liquid Gel) and Hypromellose eye drops which have helped a wonderful deal.

Yours sincerely

Paul P-J,

Dear Mr P-J,

Thanks for becoming in touch. I will be mentioning this in the column for the 20th May.

Persistent catarrh

Hi Dr Le Fanu.

Lately you have talked about the over with reference to a 3 month course of an antibiotic whose name I have forgotten (starts with E). Does this give a prolonged phrase or long lasting relief from the issue? A couple of months in the past I had a persistent cough and chest infection for which my GP prescribed this antibiotic with what I felt were good outcomes. The program was not the three month one particular you mentioned and did not have a everlasting impact. This is a dilemma which I have had most of my daily life and it would be wonderful to have what is left cost-free of the situation as I am nearly a pensioner!

Dear Anon,

Thanks for your query. The antibiotic is Erythromycin. You can uncover out more about the evidence for its efficacy in treating the signs and symptoms you describe by Googling ‘Anders Cervin, macrolide and rhinosinusitis’.

Itchy Nose

Dear Sir

Some time ago in your column you described an itchy nose as becoming a symptom of anything else. I would be grateful if you could remind me of what that is.

Yours faithfully

John R

Dear John R,

Thanks for your query. I did describe some time ago the situation of a man with physical exercise induced itchiness of the nose – that turned out to be due to angina.

Dr Le Fanu"s online well being clinic, Friday 9th May 2014