Dr Le Fanu"s on the web wellness clinic, Friday 20th June 2014

Every single Paludrine tablet is made up of Proguanil Hydrochloride 100mg.

I can’t bear in mind which drug I was taking when I realised that they have been effective for prickly heat or which pharmaceutical firm I contacted.

Very best wishes Ros W

Dear Ros W,

Thanks for clarifying that stage I appear forward to mentioning it in the column for the advantage of other individuals.

I have had dual bowel movements for some years. At a fairly current colonoscopy the technician/nurse carrying it out explained, when I gave a bit of a jerk, “which is as far as I can go. You have a right angle bend and I can not get previous it”.

I have assumed ever since that my initial motion consists of matter which has been in a position to negotiate the ‘bend’, and the 2nd motion the remainder which was waiting for the bypass to be cleared!!!!Is this so unlikely?

Christopher D

Dear Christopher D,

Thanks for being in touch and that fascinating suggestion which surely sounds plausible enough.

Dear Medical doctor

I have for more than an yr knowledgeable ‘vibrations’ all around my heart which are more pronounced when I am even now ie at bedtimes. ECG reviews show practically nothing out of the ordinary. Nonetheless to me they feel like a constant ‘electrical energy’ within my nervous technique.

A fortnight in the past I am feeling the sort of vibrations in my scalp which also accompanies a headache.

I suffer from depression for which I consider citalopram.

Can you please make clear what is going on.

Thanks

Dee S

Dear Dee S,

Thanks for your query. I note there are numerous anecdotal accounts on the world wide web of these ‘vibrations around the heart’ – attributed to becoming a side effect of Citalopram. This is most likely to be the explanation in your case.

Anal cancer?

Dear Dr James,

20 years in the past when I was 45 I developed a little lump on the anus. Above the many years this was joined by about 9 a lot more small anal lumps. They are not agonizing &amp really don’t bleed. I haven’t had any other signs and symptoms. I’m as well afraid to go to the GP in situation it’s anal cancer, as I really don’t think I could cope with tests, tubes or operations. Is there something else less severe it could be please?

Thank you extremely significantly.

Very best wishes,

A.

Dear A,

Thanks for your query. The modest lumps you describe are practically certainly anal warts known technically as Condylomata Acuminata. They can be frozen off but in your case most likely ideal eliminated surgically below local or spinal anesthesia.

Dear Dr Le Fanu,

I’ve just lately been provided conflicting data as to the viability of PSA screening for prostate cancer &amp would enjoy your suggestions.

I’m a healthy 67 year previous, 6ft 3ins tall, weighing 12st 8lbs. I workout day-to-day with a 3-4 mile brisk stroll &amp will not smoke. As RAF aircrew I attended an annual health-related examine up, a practice which I continued at my GP practice soon after I left the RAF in 1993. That is until final week when I went to book my annual blood check, followed by a chat with a practice nurse to acquire the final results. I was advised that this is no longer accessible, I suspect due to spending budget cuts. I asked for a cellphone contact with my GP to examine the matter.

Throughout the subsequent conversation he informed me that now that I was in excess of 60 &amp in excellent overall health prostate cancer is no longer a difficulty &amp screening isn’t needed. Getting study quite a lot about the disease I was somewhat shocked to say the least.

The following day, possessing study all of the material on the excellent prostate cancer United kingdom site, I gave them a call. The practice nurse, Lara, gave me a lot of information &amp stressed that there is a definite chance of the cancer establishing in between the ages of 70-74 &amp that yearly PSA screening is strongly advisable, albeit with the caveat that a raised PSA doesn’t always indicate cancer.

As you can picture I am now relatively baffled. I have a great relationship with my GP &amp find it hard to feel that he is wrong. Nevertheless, possibly he is. I would actually enjoy your tips.

Variety regards,

Nick J

Dear Nick J,

Thanks for becoming in touch and like you I am a bit amazed by your loved ones doctor’s feedback. The present consensus is that PSA testing need to not be accomplished right after the age of 75. For individuals like by yourself that are younger than this it may possibly be proper to have a test every three to five many years or a lot more frequently at the patient’s request. Even though the proof of whether it ‘saves lives’ is surprising equivocal. Most would feel a yearly PSA check to be a bit extreme no doubt that the aggressive probably unsafe prostate cancers can arise rapidly and therefore may presently be advanced if testing is limited to a 3 or five yr cycle.

ALAMY

HIP Substitute DEATHS everyday telegraph 17-6-14

Dear Dr Le Fanu

Re the article described over:-

I had a complete hip joint substitute in Jan 2013 – is there any probability I could be impacted or is it just partial hip replacements – I am 67 yrs old

Very best Wishes – Ken G

Dear Ken G,

Thanks for your query. I note the evidence for this scary headline is disputed and would be reassured by the letter from the foremost orthopaedic surgeons in the correspondence columns of the 20th June.

Dear Dr. Le Fanu

I was really interested to read your correspondent’s letter concerning his dual bowel movements. I am 72 and have been afflicted with this syndrome above the past couple of months, at random intervals, and it was a relief to find I’m not alone! Nevertheless, reading by way of the different responses, I have a variant form from individuals who endure in the mornings. I am a ‘morning person’ by nature, and this seems unaffected. It strikes me about two hours (approximately) right after eating my major, evening meal. I have a definite get in touch with to go to the lavatory, with normal consequence. Then, right after about 10-15 minutes, my abdomen ‘boils up’ (like it does with a tummy bug) and then it is a definite rush to get there. The result is, as described by other folks, like diarrhoea. This is typically the finish of what I have come to get in touch with ‘my spectaculars’ !! I would just mention that I have comparatively just lately been individually diagnosed, right after ultrasound, with a massive oval gallstone – but that have to have been about for longer than my current symptoms I envision. (My GP recommended elimination of the gallbladder, but I am reluctant to do so unless of course it gets a nuisance).

Kind regards

Mrs. DF

Dear Mrs DF,

Thanks for your more account of a variation on the dual motion conundrum. As per the gallstones I would concur that there is no hurry to have them eliminated.

Dear Dr, I hope that you can support me with this issue, occasionally I perspire all over my body and occasionally I come to feel really cold even in the course of this scorching spell. The problem started in march 2014. I have to adjust bedding and day outfits numerous instances . My hair never looks to dry. Your tips sought.

Dear Anon,

Thanks for your query. I presume you need to have observed your loved ones medical doctor about this distressing symptom and that he will have done all the required tests to exclude some potentially critical underlying trigger – this kind of as the menopause or hidden infection. If so the most very likely probability is that it is due to the disturbance of the temperature handle technique in the physique for which regrettably there is no distinct therapy. The intensity of the sweating even so can sometimes be reduced by taking a tiny dose of a drug such as Amitriptyline.

ALAMY

I wonder if you or your readers could support with recurring signs for which my GP/Hospital have been unable to locate a purpose? I’m a 66 year old Chartered Surveyor who’s been a regular health club attendee for 18 years.I have for the past ten months, off and on, been going through intervals of considerable fatigue, lacking power, light-headedness, occasional nausea, headaches and normally just not feeling nicely. These signs and symptoms come on quickly and I have at times observed a pattern of them commencing right after eating or consuming tea/coffee, but as it lasts for about 2 days it doesn’t make significantly sense.

My GP took it significantly adequate for me to have substantial checks around the possibility of heart problems such as blood exams, BP, scans and a pressure echo check all of which has pointed to me getting extremely healthier in that respect. What appears to make me feel a lot greater is a number of days of Iron/Vitamin C (14mg/60mg) and the occasional Vitamin B-complicated tablets. However, within a additional week of stopping the Iron tablets the above signs and symptoms come back and re-taking the tablets does not instantly decrease the signs and symptoms.

This helps make me wonder if they are curing the signs and symptoms or whether or not it is a coincidence and something else is taking area. We eat a great balanced diet which includes fresh veggies.

I’m creating this on a Monday afternoon soon after a couple of great weeks broken on Saturday evening right after a Lasagne/Salad/fresh fruit (no alcohol) dinner. The symptoms got progressively worse into Sunday.

This morning I woke up feeling the very best I have felt for months – total of energy and feeling actually good. It lasted 2hrs right up until right after breakfast of Shredded Wheat/Milk and two cups of tea. The signs, which includes a nausea/headache returned to the earlier day’s worst. It’s as if my blood composition levels are being disruptive but all the exams for diabetes, etc present no issues.

My GP has now recommended that this is somehow connected to some type of nervousness or mild depression episodes. When it very first started out I admit I was sleeping poorly but that cured itself about three-four months in the past. As for depression, I suffer the typical irritation with our climate but I’ve been quite happily married for in excess of 40 years, solvent and couldn’t come to feel a lot more relaxed save for these irritating cycles.

Have you any tips, or other avenues to investigate?

Sort regards,

Colin R

Dear Colin R,

Thanks for getting in touch and your in depth account of your signs and symptoms which I note your medical doctor has diligently investigated but regrettably to no definite conclusion. The episodic nature of these attacks and the nausea and headache are suggestive of a variation of migraine – perhaps induced by ‘sensitive’ to caffeine (or other meals). Maybe it would be smart to examine with your medical professional the likelihood of a trial of a preventive remedy (such as a low dose of a beta blocker) or a particular anti migraine drug. I would be interested to hear the final result.

Dear Dr Le Fanu

I am reading through with interest your correspondence re ‘urgent’ calls to the loo. It is some consolation to know this, to me, recent symptom is not unusual. Lately it had a rather serious ‘domino’ result. Early morning, coming downstairs as quick as my arthritic limbs would enable, carrying a half filled commode pot, to my downstairs bathroom, I misplaced my footing virtually at the bottom. I fell heavily landing on my upper back/neck with my head crashed against the bottom of a door frame. The force of the blow triggered a tooth to fly out. I had significant general bruising and extreme inner bruising to my neck/shoulders. I had two extreme cuts on my head. While waiting to be stitched up in A&ampE due to the reduction of the tooth, a fitting on my denture ripped my tongue. I came residence in a pricey taxi wearing borrowed hospital nightwear and my dressing gown and slippers. My severely mentally unwell grownup son who can’t cope with stress, was left to clear up the substantial and embarrassing mess.All this happened 48 hours ahead of I was booked to go on vacation!

My Dr. says it is tough to deal with and talked about ‘firming items up’ He prescribed Loperamide but it is not truly proper as the outcome is not liquid. Any even more tips would be really welcome, are there workout routines? At almost 79 years old I truly feel I could not control the drastic dietary modifications some of your correspondents suggest.I practically feel I must invest the rest of my daily life, certainly in the mornings camped outdoors the loo! Seriously it has been most traumatic, as you can imagine. I nonetheless have to see my dentist and get my relatively squashed glasses sorted.

I really feel I have realized a lot from your column above the many years and appreciate any advice you can give me now

Greatest wishes

Rosemary C B

Dear Rosemary C B,

Thanks for getting in touch and my sincerest sympathies for this recent distressing incident you describe. Regrettably I do not know of any exercise routines that may possibly be of aid but it may possibly be really worth pursuing the Loperamide choice as advised by your medical professional – perhaps taking 1 at breakfast time to see whether or not this minimizes the frequency of people bowel movements.

In 2010 aged 83 I had an Angioplasty which was unsuccessful due to the density of the the blockage in my femoral arteries. The surgeon said that it would be unwise to carry out further surgical procedure as at my age a standard anaesthetic could nicely result in a heart attack or a stroke. I went property and place up with leg pains and problems in walking, but as time passed issues got worse and worse. I saw my GP not too long ago and asked if anything at all could be done. He thought it really doubtful , but prescribed Naftidrofuryl a hundred mg capsules, one 3 occasions a day. After 3 days I was entirely cured- no discomfort and strolling with out a stick. I can not inform you how wonderful this was – my existence was fully transformed. 7 days later I abruptly went back to square one, in spite of doubling the dose on instruction. I was unable to get any a lot more tablets as the neighborhood pharmacies could not get supplies, and they had been not working anyway. I now have fantastic problems strolling more than 25 yards (with a stick) and suffer a lot more or significantly less continual discomfort. Any suggestions tremendously appreciated – I am only 87 and have a great deal of function to do

Dear Anon,

Thanks for your query and I am sorry to hear that the angioplasty was not productive and Naftidrofuryl was of only short-term advantage. The further possibility may possibly be an operation recognized as a Chemical Sympathectomy that interferes with the nerves to the blood vessels creating them to dilate and therefore theoretically improve the blood movement to the legs. This kind of treatment has fallen out of favour in current years but nevertheless has its advocates. You may discuss with your household medical professional no matter whether it is carried out by a surgeon in your hospital in your region.

Dear Dr Le Fanu

Reading your column nowadays I see you mention cholestyramine as getting of possible advantage to individuals who have had their gallbladder removed. My wife has Crohn’s Disease and had part of her massive bowel removed, like her ileum. The resultant diarrhoea from failure to re soak up bile salts has been efficiently controlled with cholestyramine. Nonetheless, for some months now she has been unable to get cholestyramine, both as Questran or as one particular of the generic forms. A manufacturing dilemma has been cited as the trigger of its non-availability. Her gastroenterologist has recommended colestipol (Colestid) as the only substitute and she has been taking this with variable final results for some time. She finds it less palatable than cholestyramine and much less effective. Have you witnessed the exact same difficulty with the provide of cholestyramine? I have been unable to locate any data as to if or when it may possibly once again turn into obtainable.

Variety regards

Robert F

Dear Robert F,

Thanks for getting in touch . This non availability of Cholestyramine is all extremely puzzling as it is relatively inexpensive and easy to create. It may possibly of program be relevant to industrial concerns – an attempt by the manufacturers to shift prescribing in direction of the more expensive (and seemingly much less successful) options this kind of as Colestid. I note it can nonetheless be bought on the net – Canada Medication currently being a reputable supplier.

Dear Dr Le Fanu. Here is my experience of statins. As a teenager I contracted rheumatic fever which left me with two mildly broken heart valves and a resolve to safeguard my health for the rest of my daily life as best as I could.At 65 my cholesterol degree was more than twelve so my GP place me on 20mgs of Atorvastatin which was elevated to forty mgs and then 80mgs .On querying why there had to be this kind of a jump in medication,I was told “you are not the only 1″.this was 13 many years ago when there was the initial big push to prescribe statins.I am 5ft 3ins and weigh 50 kilos so now realise this was excessive for my entire body mass.I took Atorvastatin for four years in the course of which I did have some days of nausea.I did have ligament ache in numerous places,not the normal muscle ache so ignored it.?my age ?arthritis.Later I had days when I was breathless,again ignored it ?slight asthma soon after all the statin was supposed to be undertaking me good.Then soon after 4 many years I started to get soreness in my spine and ribs and when walking observed I couldn’t be confident in which the pavement was and where to place my feet.So I went back.to my GP had a blood check and was told I had Aplastic Anaemia.this reverted to normal very swiftly but then I had many years of lots of small infections,tooth abscess,eye infections,cystitis and sinus infection and generally feeling unwell.I had a sinus washout soon after having had a chest infection.At one particular stage I had a coronary angiogram which showed I had pristine arteries,so maybe I did not need statins after all.I am now 78 many years previous my wellness is on an even keel,but I have to be extremely careful not to get cystitis and my sinuses are nonetheless a problem.I wonder if my immune technique has been permanently broken.

Anne B

Dear Anne B,

Thanks for currently being in touch. It is certainly possible the Atorvastatin may possibly have been implicated in these muscular aches and pains. I note the Aplastic Anaemia that has gratifyingly recovered, but the persistent infections you describe would propose an ongoing defect in the immune method. The great news would be that at 78 you have pristine coronary arteries and your overall health usually to be on’ an even keel.’

ALAMY

Hello

Thanks for the Telegraph column.

An eminent heart surgeon, lately wrote of how he came down on the side of prescribing statins to all older individuals.

I am older.

I was advisable to start off statins numerous many years ago due to obtaining a six.5?? cholesterol degree + my dad and mom the two died of strokes at 63 &amp 72 many years.

I have superb blood pressure so think I am okay not taking statins.

The eminent heart surgeon (are not able to remember his name) has created me rethink my mindset to statins.

Do you think a GP can advise me of the danger variables I face?

Or is it pot luck whether or not or not statins are successful?

Thanks

Alex D

Dear Alex D,

Thanks for being in touch. I collect you do not have a historical past of heart problems your self in which case the advantages of taking statins would be miniscule – undoubtedly for a marginally raised cholesterol of 6.five. My common impression is that heart surgeons have a tendency to be rather over enthusiastic in their prescribing routines.

Dr Le Fanu"s on the web wellness clinic, Friday 20th June 2014