Dr Le Fanu"s on-line wellness clinic, Friday 28th February 2014

It seems the hearing loss is permanent.

Dear Anon,

Thanks for being in touch and my sympathies for this serious, if rare, side effect of Erythromycin of which I must confess I was unaware. Your experience is a cautionary reminder of the potential hazards of even commonly prescribed drugs.

ALAMY

Dear Dr Le Fanu

I’m a widow of 80 years with severe back pain due to a very damaged spine, (scans).

My pain consultant is going to try more injections, but a new condition has been disturbing my sleep for the last week. It is only at night, when I have a continuous mild headache, back of the head. When I get up in the morning and move around it disappears. I’ve tried different number of pillows, warm or cold bed, nothing works. Could there be any connection between my other problem, irritable throat, which makes me sneeze and sometime gag? (My GP advised stopping Ramipril, but not enough time yet to see whether that works.)

At the moment he can’t suggest anything to help the headaches. Please Help!

Florence S

Dear Mrs S,

Thanks for your query. The location of these nocturnal headaches at the back of the skull would suggest they might be due to muscle spasm from pressure on the nerve of the neck which speculatively might be related to jarring of the vertebrae from the coughing and sneezing associated with the Ramipril. If so then a small dose (2mg) of the muscle relaxant Diazepam might be a useful preventive measure.

Dear Dr Le Fanu

Re your medical query in last Saturday’s Telegraph re Mr & Mrs HM from Bolton, I suffered with exactly those symptoms, plus a fear of being near large expanses of water, notably walking along the canal towpath. I suffered for over a year before going to my doctor. She promptly performed the Epley Manoeuvre, and I was fully recovered by the next morning.

Wikipedia describes it thus:

The Epley maneuver or repositioning maneuver is a maneuver used to treat benign paroxysmal positional vertigo (BPPV) of the posterior or anterior canals. Free floating particles from the affected semicircular canal are relocated, using gravity, back into the utricle, where they can no longer stimulate the cupula, therefore relieving the patient of bothersome vertigo.

And it is demonstrated on UTube via the following link:

http://www.youtube.com/watch?v=hq-IQWSrAtM

It will change their lives!

Best wishes

Trish M

Dear Trish M,

Thanks for being in touch and your personal experience of the benefits of the Epley Manoeuvre in countering your symptoms of vertigo. There has been a lot of correspondence on this matter which I will be summarising in the column of the 10th March.

REUTERS

Dr. Le Fanu,

I have two grandchildren (ages 11 and 8) who will visit Japan this coming summer for about 5 weeks. I am very concerned about radiation exposure data. Both the Abe government and Tepco have been caught at manipulating the data, so, finding accurate numbers has become problematic. I operate under the assumption that there is no safe level of exposure, even more so for children than adults. Yet, there are record levels of ionized hydrogen, cesium 134, 137, strontium 90 being released and now spread across the globe. Would you send children to that nation when there has been three core meltdowns, nearly three years of continual emissions and continuing dangers for an explosion at reactor #4? Would you allow your children/grandchildren to go?

Thanks for your time,

R J M

California, USA

Dear R J M,

Thanks for your query and I appreciate your concerns though I would not concur that there is ‘no safe level of exposure’ – as we are all exposed to background levels of natural radiation of around 2m/sev a year without it causing any harm. This, I gather, is on a par with the additional exposure of those in close proximity of Fukushima incident in 2011 but is well within the limit established for those in the radiation industry of 50m/sev a year. This is clearly reassuring and I would not have thought there is any reason why your grandchildren should not travel to Japan this summer.

In your last column there were three patients with what sounds very like Meniere Spectrum Disorder, a very common but widely misunderstood complaint. For a start, MSD is an otological disorder, not a neurological or psychiatric one. Thus the young woman with hearing problems and vertigo almost certainly had endolymphatic hydrops, a known otological side-effect from quinine-like drugs. While her facial numbness could have been of neurological origin, a quick check on Google confirms that this is also not uncommon among patients with Meniere’s disease. In the husband and wife with nausea and vertigo, either of these are of inner ear origin unless proven otherwise, and MSD is the likeliest diagnosis. Here vestibular function and balance fluctuate widely, probably as a result of a changing inner ear pressure, from dehydration for example. This lack of body and space stability can usually be compensated for by use of the eyes, except in the circumstances described where visual fixation is impossible — on cliff tops; descending a staircase with a central void; large cathedrals; and open spaces in general, which is likely to cause agoraphobia.

A G G

Dear A G G ,

Thanks for being in touch and drawing attention to Meniere Spectrum Disorder as a possible cause of vertigo. This, as you say, is an otological problem that is usually associated with other hearing related symptoms such as tinnitus or deafness. I will mention this in the column in the near future.

ALAMY

Hi doctor I hope you can help me I read in the telegraph a letter to you about the trouble a lady was having with taking lansoprazole tablets as I am having the same problem I wondered if the lady said what she was taking in place of them if not could you recommend another i’m 76 years of age thank you very much . Len H

Dear Len H,

Thanks for being in touch and it is interesting to learn that, like the lady featured in this column recently, your restless leg syndrome resolved after discontinuing Lansoprazole. I would advise that you take instead an acid neutralising medication such as Gaviscon.

I am 71 and eighteen years ago I was diagnosed with eczema on my lower legs. This was never a great problem, controlled by diprobase and betnovate, until last 0ctober when it spread all over my body almost driving me crazy with constant itching, especially at night, when excessive scratching caused cellulitis. No treatment, including steroids and antibiotics, has made the slightest difference to the eczema and the various creams only give a very temporary relief. An appointment with a dermatologist takes. Four months though my g.p. is trying to hasten things. No one seems to have any idea what has caused this sudden flare up nor what can effectively relieve the symptoms let alone cure it. Any ideas? R.G.M

Dear R G M,

Thanks for being in touch and my sympathies for this sudden severe exacerbation of your eczema. There are, as you will know, several recognised trigger factors such as infection, a viral illness and stress – but given that for most the underlying cause of eczema is not known the same probably applies to the fluctuations in its severity. I am sure the skin specialist can advise further but in the meantime you might discuss with your doctor taking a low dose of oral steroids to bring it under control.

ALAMY

Dear Dr. James, I have been meaning to write to you for years but have only now got round to doing so. I was first prescribed anti-depressants forty-four years ago for a chronic depressive illness and noticed some unusual side effects with different types of antidepressant drugs. They all made me thirsty and some produced unusual sexual effects: Clomipramine prevented me from ejaculating-an effect that is put to useful effect in its being prescribed for young men with premature ejaculation problems, I understand. Mianserin markedly enhanced the intensity of sexual orgasm when I was on this drug and this interesting side-effect occurred even when I was prescribed low doses of 20mg per day. More recently I have been prescribed Dosulepin at 150 mg per day and this produces considerably delayed orgasm. I think the most interesting side-effect was that of Mianserin and I wonder whether this has any useful role in treating sexual dysfunction. I never drew any of these side-effects to the attention of my GP as I had other things on my mind-my illness. Jeffrey J

Dear Jeffrey J,

Thanks for being in touch and your fascinating personal account of the diverse effects of antidepressant drugs on your sex life. The value of drugs such as Clomipramine for those with premature ejaculation is well recognised but I had not previously come across the orgasm intensifying effect of Mianserin – which I gather has been used to counter the reduced libido associated with SSRIs (see D Aizenberg, Clinical Neuropharmacology 1997 vol 20 pp 210 – 4).

Dear Dr Le Fanu,

I have been very interested to read in your column of others who have facial paralysis hearing problems and one eye closing when one is looking down – there must be a lot of us about! Mine arrived suddenly just over three years ago and was diagnosed as Ramsay Hunt Syndrome. Whilst I am lots better it is the synkinesis which makes my eye flutter. I seem to be winking when I talk, especially when I get animated, which I feel is the most tiresome. I had physiotherapy with the Lindens Clinic in Sale for some time.

My balance is not very good either, which I attribute to the lack of nerve activity in my left ear. Do you have any recommendations or helpful advice to offer? I would love to feel like myself again.

Yours hopefully,

Jillian C

Dear Jillian C,

Thanks for being in touch and it is good to hear that those unusual symptoms you describe seem to be improving. This winking while talking must be most disconcerting for yourself and others. As for the balance problems, several hospitals (such as St Thomas’ in London, Addenbrooke’s in Cambridge) now run special clinics offering ‘vestibular rehabilitation’ for those with chronic vertigo and it might be worthwhile discussing with your doctor whether a referral might be appropriate.

Dear Dr James

I hope you can help me with a very distressing problem that has cropped up about 5-6 years back. Every few months I suddenly wake in the night and find I have voided my bladder. It is so random and I have not been able to find a trigger. I have very good bladder control at all other times, no leakage nothing. I am 63 years old, active, slim, had a hysterectomy around 16 years back. I was told that following the menopause one can get low grade urinary tract infections, and if I feel at all like I might be getting one ( any change in frequency, odour) I take cranberry concentrate for a few days.

This problem is causing me such distress that I am worried to go on holiday, to stay with friends and almost to fall asleep! Please suggest something to help?

Thank you.

Kind regards

S V

Dear S V,

Thanks for being in touch. The random episodic nature of your nocturnal enuresis, as it known, without any other urinary symptoms would suggest this is likely to be due to spontaneous contraction of the detrusor muscle that empties the bladder. This is probably related to the altered state of consciousness and brain activity when asleep. It is, for example, of interest that enuresis is also a feature of epileptic attacks and may be a side effect of some psychiatric drugs. The fact that this occurs only every few months would rule out any preventive drug treatment – and the only option would seem to be to wear some sort of waterproof pants when visiting friends or on holiday.

Your correspondent Carol G might be interested in the (rather ancient) Dr. Hay diet, which actually enabled me to give up Omeprazole for my constant reflux problems.

Since the problems of acidity and reflux are a constant in your columns, may I also warn nut eaters of my own experience: following an attempt to peel some almonds by boiling them briefly, the whole house became permeated with the smell of bleach – thus identifying yet another cause of acid reflux! Since raw cashew nuts had a similar effect, I assume that some sort of acid bath is used to ensure there is no fungal/bacterial growth before packing. I now only buy nuts in their shells.

Kind regards (and keep up the good work!)

Dear Anon,

Thanks for being in touch and it is interesting, as several readers have observed over the years, that The Hay Diet has cured your reflux problems. Thanks too for the nut warning!

Please, please help! We are desperate! Eight months after lithotripsy for a 7 mm kidney stone my daughter (32) is still in severe pain, for which she is taking large amounts of temgesic and diclofenac prescribed by her GP.

All investigations by the kidney consultant – ct scans, blood tests for infection, etc. have proved negative, and no other cause has been suggested: could it be nerve damage, and if so, what can be done? We wonder if you, or your readers have any suggestions.

Thanks for taking the time to read this and hope you can help.

Dear Anon,

Thanks for your query. I am not sure when you say your daughter is ‘still’ in severe pain whether this is the same or a different pain from that associated with the kidney stone. If it is the same this would suggest that the original diagnosis attributing the pain to the kidney stone must have been in error – now that the stone is no longer present. There is, for example, a condition known as Loin pain/Haematuria Syndrome that can cause the symptoms of severe pain and bleeding similar to those caused by a kidney stone. If, on the other hand, the pain is different then this might suggest the Lithotripsy procedure itself might be responsible, by for example causing soft tissue damage to the kidney or other organs in close proximity such as the pancreas. I hope these comments are helpful.

Dear Dr Le Fanu

I would like to say how grateful my daughter and I are to your readers for the many kind and helpful replies to my letter to the online health clinic of 17 Jan 2014. Also thank you for featuring the letter (wrongly attributed, I think, to Mrs S D of York) in your column of 10 February. We will be investigating some of the suggestions made and will let you know the outcome when we have any news.

Thank you again

Barbara S

Dear Barbara S,

Thanks for being in touch again. I would be more than interested to hear the outcome of investigating the various suggestions made by readers.

Dear Sir,

I am recently experiencing cold numbness to right hand side of face and in right arm, it is as though the dentist has given me a minor injection to carry out a filling.

On Friday went to Neville Hall Hospital Abergavenny, had a head scan, throat scan (TIA) and everything appeared to be normal. 9 blood tests taken, all ok, except still waiting on the cholesterol result to come back. Brilliant service.

Have been put onto Aspirin and Statins would rather not be dependant on either. The cold experience seems to last a few minutes to 10 minutes.

The only “big” change in my lifestyle, is that I decided in mid January not to drink anymore at home, used to have a few glasses of wine most evenings, (cost and to lose weight), only drink now, when out socially, not to open up a bottle when I get home, to continue the partying. The first experience was, I had a steroid injection in my knee for a cartilage pain, then had the face numbness in the evening may not be connected in any way, although at the time of injection my blood pressure was extremely high.

I do keep fit and next Saturday have booked to go skiing, it was mentioned that they would prefer me to drive rather than fly? The flight is a very short one Bristol to Geneva at a low altitude, but of course skiing will be at high altitude. Any suggestions, or other avenues help or advice would be much appreciated.

Bye for now Patricia W

Dear Patricia W,

Thanks for being in touch. This numbness in the face and arm would certainly fit with a TIA or stroke – so it is reassuring (if a bit surprising) that the various tests and brain scans have all been reported as normal,. This pattern of symptoms can sometimes be due to migraine but beyond that it is difficult to know what might be responsible I would not have thought that either your changing drinking habits or the knee injection are implicated. It would certainly be sensible to be cautious about flying until this is sorted out.

Good afternoon, Doctor

In 2011 I experienced a sudden total deafness in my left ear

The condition was explored extensively after the usual suspects were eliminated

Eventually, from extensive blood tests, it was established that I had a gene mutation affecting the MTHFR gene, resulting in an excess of Homocysteine (HC) in my bloodstream. This was diagnosed to be the cause of a mini stroke on the nerves taking sound signals to the brain

Folic Acid and Aspirin were prescribed, but after four months the (HC) level had risen further to 16.

The consultant recommended a change to Megafolinic Acid from folic acid but this did nothing to the HC level.

My wife searched the Internet for any information related to the problem and uncovered a report by The Life Extension Foundation in the USA which recommended high levels of Tri Methyl Glycine (TMG) to counteract the HC level

This report was also insistent that the HC level should be below 7 whereas our local Path laboratory is saying that 5 to 15 is “normal”

The Life Extension Foundation report also insists that anything above 7 significantly increases the risk of heart attack and strokes

For three months I took 4.5 grammes of TMG and my HC level fell to 8. I then reduced the TMG to 0.5 g (a suggested ‘maintenance dose’) and my most recent HC reading is 10

Should I be happy to keep my HC level below 15 or should I be aiming for below 7?

Is The Life Extension Foundation a respected authority or just another pseudo-scientific commercial organisation?

Finally I would add that while seeking a local supplier of TMG, our Health Food Shop commented that we (Britain) were way behind the Americans on this topic – which itself gave me cause for concern

Should you require more info I would be very happy to provide a copy of my Consultant’s letters together with a copy of the Life Extension Foundation report

I would be grateful for your thoughts on this matter

Regards

Ian B

Dear Ian B,

Thanks for being in touch. There is, it would appear, an increased risk of stroke and circulatory disorders in those with an elevated level of homocysteine- where any reading above 13 is considered to be ‘raised’ But the benefits of lowering it to within the normal range appears equivocal. I am sure you are best guided by the advice of your specialist about this. There is a most useful summary of the condition by Elizabeth Varga ‘Homocysteine and MTHFR mutations’( Circulation 2005 vol 111 pp 289-293) that can be downloaded from the internet.

Dr Le Fanu"s on-line wellness clinic, Friday 28th February 2014