Dr Le Fanu"s online wellness clinic, Friday 20th December 2013

I’d be grateful for info. on the following: the current advice on the daily intake of Vit. B 6, B12 & Folic Acid for people with existing cognitive problems. Many thanks.

Dear Anon,

Thanks for your query. There is no ‘current advice’ on the merits of high dose vitamin B in those with ‘mild cognitive impairment’ though a study published this year (G Douaud in the Proceedings of the National Academy of Sciences, May 2013) found that the combination of a daily dose of 0.8mgs folic acid, 20mgs of vitamin B6 and 500mgs of vitamin B12 had a ’significant effect’ in inhibiting the loss of neurons from the brain.

Good morning

As an 85 year old I suffer from paper-thin skin on the back of my hands, probably worsened by anticoagulants I need to take. This means that even the slightest knocks will cut and bruise my hands and I wonder whether you can suggest any treatment to reduce this risk?

Your advice would be much appreciated.

Yours sincerely

Ron C

Dear Ron C,

Thanks for being in touch. This thinning of the skin, as you will know, is not unusual in the older age groups due to the loss of the supportive collagen fibres and the associated bruising is exacerbated in those taking blood thinning drugs. There is very regrettably no treatment of which I am aware that will correct or prevent this process.

Dear Dr Le Fanu.

Can medication cause nasal congestion?

Currently I am taking Ramipril 10mg and Bendroflumethiazide 2.5mg daily for hypertension. For several years I have suffered with blocked sinus in the winter months.The blockage goes away in the summer with days at the seaside etc.

I have been on the above medication for 5 years and I now no longer am free of the blocked nasal passages. On several nights recently I have resorted to a chest rub to get a few hours sleep.

Am I just getting old at 66 years of age, or is it possible that the medication is causing my condition.

interestedly yours,

James S

Dear James S,

Thanks for your query. This nasal congestion (or chronic rhinitis) is indeed a recognised side effect of Ramipril. I would suggest you discuss with your doctor switching to some other medication.

Dear Dr Le Fanu,

A few weeks ago I read with interest an article in the Telegraph by Hazel Blearsabout how she discovered her mother was suffering from Alzheimer’s disease after “…she saw a psychologist”. What Hazel did not say was what happened to cause her mother to see her GP in the first place and subsequently be referred to a psychologist.

I and my children are most concerned about my wife’s increasing loss of memory and have all tried to persuade her to see our GP about it. In spite of all of us regularly quoting recent examples the reply is always “There is nothing wrong with my memory” and she refuses to raise the subject. She is otherwise healthy and leads a normal life for an 81 year old..

I have discussed this with our GP and he understandably says that he will not call her in to test her for loss of memory as it would destroy the doctor to patient relationship. She will have to seek his help.

As Alzheimer’s has been in the news lately it occurs to me you might like to cover this problem in your column and perhaps seek suggestions from readers who have met and solved it.

It seems likely a visit to her GP about this will have to wait until there is an incident that even she recognises as requiring treatment. That could be a very long time. I and our family would welcome any suggestions as to how that day can be brought forward, as I understand that, although there is as yet no cure for memory loss, the earlier treatment is begun the more successful it is in prolonging the development of this sad disease. We are due to celebrate our Diamond Wedding on 1st January 2015. I hope she will not have deteriorated so much by then she is unable to enjoy it.

I shall read your future columns with even more interest than usual.

Yours sincerely,

Richard N

Dear Richard N,

Thanks for your query and my sympathies for the predicament you describe. Your wife’s reluctance to acknowledge her memory impairment is both understandable and a reasonable protective mechanism against the fearfulness and anxiety that can result from being diagnosed with Alzheimers and which would more than outweigh the modest benefits of treatment.

Dear Sir

Please can you help with my problem?

I have been insulin dependent type 1 diabetic since 1977. I also have ME and an under active thyroid (which is treated with thyroxine). I am about the right weight for my height. I am a keen golfer and play whenever I can. When I do any other exercise (such as walking or gardening) than golf my blood sugars fall as you would expect them to. When I play golf the blood sugars rise alarmingly high whether I eat or not. I end up having to take insulin on the course. I have looked on the internet and can only find blood sugars rising due to intensive exercise and I could not really describe my golf as that. Very occasionally I have terrible hypos when playing. I test regularly while playing and have excellent hypo awareness so the highs are not as a result of unknown hypos. I am reluctant to take extra insulin until the blood glucose is definitely going up – it goes up very quickly when it does. I am on the Dafne protocol and my background insulin and quick acting insulin seem to be fine except when I am playing golf. It does not matter how competitive the round is a friendly with a good friend with us barely counting the score seems just as likely to cause a high blood sugar as a more competitive round.

Nobody seems to know why this happens or how to keep things more even.

Margaret R

Dear Margaret R,

Thanks for your query. The situation you describe is most unusual for while the surge of adrenalin associated with intense exertion can certainly push up the blood sugar level, it is difficult to understand how playing a round of golf could have the same effect. I am not sure what you mean by ‘alarmingly high’ but would have thought that if the hyperglycemia is transient and not causing any symptoms it is probably best not to try and control it with additional doses of insulin – especially as this can result in the hypos you describe.

I am writing this as a warning to other readers.

I broke my ankle abroad and was given slow release morphine. I saw my gp as soon as I returned and asked to have something other than the morphine as I did not want to get dependent on it and he gave me dihydrocodeine which I took in good faith for just under 3 weeks, just two a day until I forgot one dose on Friday night.

I woke up a few hours after the due time feeling sick with stomach ache and loose stools (this has now subsided)

I checked the internet about these tablets and discovered that when stopped they gave withdrawal symptoms, I was shocked and felt I should have been warned about this as I am not a person that takes tablets for pain unless absolutely necessary.

It has also left me with an asthmatic cough if I lie down – I am an asthmatic but manage with the brown preventer inhaler and I use the ventolin very rarely until this. I am hoping this will go in time as well.

Mrs V A

Dear Mrs V A,

Thanks for being in touch and your account of those withdrawal symptoms from Dihydrocodeine. I suspect you must be particularly sensitive to this medication as I would not normally expect this to occur with the modest dosage you were taking. It is not clear how the exacerbation of your asthma fits into this but would advise taking a couple of puffs of the Ventolin inhaler before retiring as a preventative measure against nocturnal cough.

REX

Dear Dr Le Fanu

I was interested in your column this week regarding variable doses of medication. Perhaps you could consider writing something on the “cocktail” of meds that many people take. All medication is very carefully tested to ensure its safety etc. but, as far as I know, there are no tests about the effects of combinations and any interactions between them. While A or B might be perfectly safe individually, they might have unpredicted effects when taken in combination. This is, of course, made considerably worse by the fact that people rarely take just one or two but, often, a large number (I sit on a Disability Appeal Tribunal and I’m often astounded to see the very lengthy lists of medication that some appellants produce).

I seem to recall that one of the causes postulated for “Gulf War syndrome” was the number of different inoculations the soldiers had and their possible interactions.

Anyway, I thought that, in view of this week’s column, this is something you might like to comment on at some stage

Best wishes

Dear Anon,

Thanks for being in touch. I could not be in greater agreement about the hazards of drug interactions and have commented on this extensively in the past. Please see my article ‘The tablets that do more harm that good, Telegraph 19 November, 2012′.

Dear Sir,

Oh yes, I recognise the feelings experienced by your correspondent with jelly legs.

I set off each morning to walk to the paper shop. I often look longingly at the car. I steel myself and walk whatever the weather.

To start with I feel unwell, my hip hurts and my knees are wobbly. By the time I reach the front door on my return I am feeling so much better. The difference is quite noticeable. The pain is still in my hip but feels smoother. My knees feel as though they will hold my weight for another day.

I also have not worked out why this is so. I know it is a fact. My walk takes 30 minutes. I am female and over 80 years.

I have enjoyed your articles for years now. I hope to read them for many years to come.

Regards Jo B [Mrs]

Dear Mrs B,

Thanks for being in touch and your kind comments about the column. There has been some interesting correspondence about this conundrum of the initial ‘wobbly legs’ sensation that improves with modest exertion – variously attributed (see below) to pressure on the nerves at the base of the spine and magnesium deficiency. I discuss this in this week’s (Monday 22nd) column.

Re: letter from Mrs.E.S./ Hertfordshire

Sir:

For several months I have experienced similar symptoms in both legs (“jelly sensation”/ “Woolly feeling”/ and sometimes “electric buzzing” to the point of temporary numbness) which gradually disappears with walking and exercise and the day’s routine.

An X-ray exam and subsequent MRI + EMG found moderate to severe spinal stenosis in four levels of the vertebrae and arthritis in the lower lumbar region. The narrowing nerve canal plus inflammation (and sometimes dehydration) contributed to a pinching of the primary nerves in the legs. I’ve learned to adjust activity & exercise but am told surgery will almost definitely be required one day. So far so good. I am grateful for the diagnosis, as the neuro-symptoms were bizarre; but they are no longer “un-nerving”.

Christopher F

Dear Christopher F,

Thanks for that most interesting observation which I mention in this week’s column.

Dear Dr Le Fanu.

I have a similar feeling in my legs as this lady. It started with bradycardia so I had a pacemaker inserted. Now I am in AF and this makes me feel most strange Like this lady I start walking and after a very short time the legs feel woolly, and feel as if they are going to give way (but they never have!!!) Could it be something to do with her heart??? All best wishes I love your column

Marion M

Dear Marion M,

Thanks for your kind comments about the column . I appreciate that AF can have the effects you describe but doubt if this is the explanation in this case.

Dear Dr Le Fanu,

I refer to the above comment received from Mrs ES and reported to you.

I, too, suffer from a similar syndrome. I am an 81 year old retired veterinary surgeon and upon rising in the morning my legs feel as if they will not support me – they feel weak and “wooley”. After breakfast I take our two dogs on a ½ – ¾ hour walk lose alongside the river Wye. As the walk progresses the legs feel stronger until we walk the last 100 yards uphill to our house – this becomes a bit of a struggle! My doctor has referred me to Hereford Hospital for a CT scan (tomorrow).

On a totally different (and personal) issue I have often wondered if you could be related to my first girl-friend! She was Adrienne Le Fanu, a lovely girl, daughter of Richard Brindley Sheridan LeFanu, a keen car rally driving enthusiast. They and her mother lived in Dundrum, a south Dublin superb. I have no wish to cause alarm as I have been happily married for 53 years (wife is also from Dundrum) with three adult children, but curiosity has just got the better of me.

Kind regards,

Alex A

Dear Alex A,

Thanks for your interesting observations, please see my reply to Mrs B above. I will pass on your best wishes to your erstwhile girlfriend.

Dear Dr Le Fanu

Why is it that I, a (well) 75-year-old but with stable CLL (chronic lymphocytic leukaemia) and therefore more likely to get shingles (I had it a few years ago – nasty, pain for 3 months), cannot have the shingles jab? Do I have to wait until I am 79? I contacted my surgery to enquire if I can have it, but no, I cannot. I am intending to try again in a few weeks.

Rosemary B (Mrs)

Dear Mrs B,

Thanks for your query. The shingles jab, being a live vaccine, is contraindicated in those like yourself with an impaired immune system due to CLL. Please see www.cllsupport.org.uk/shingles.htm

Regarding medical query from Mrs ES from Hertfordshire I had a similar problem. I had some bio-medical screening and screened on a Vegatest (I think) machine and as this lady thought my body was right down on magnesium. I therefore went on quite a high dose – she said this would take 6 weeks to get into the body and please don’t call her before that time was up to say it was not working! and practically to the day the problem was solved.

Now take a magnesium table every day and this problem has not reoccurred. Perhaps this could be helpful.

Dear Anon,

Thanks for your comments please see my reply to Mrs B.

Dr Le Fanu"s online wellness clinic, Friday 20th December 2013