NHS misses key targets in June as service faces increasing demand

The number of patients who were medically fit to leave hospital but could not be safely discharged reached a record high in June as NHS England continued to creak under the strain of increasing demand.

Targets to reach patients quickly enough after a 999 call and treat patients in A&E within four hours continued to be missed, and there were 3.63 million people on the waiting list for non-urgent care in hospital, usually elective operations.

The worrying figures emerged after the NHS had its busiest June on record, with more than 1.9 million A&E attendances, up by 2.1% on the same month last year, and more than 480,000 emergency admissions, 4.7% higher than in June 2015.

The NHS Confederation chief executive, Stephen Dalton, said: “These figures once again illustrate the strain the NHS is under to maintain timely access to high standards of care in the face of huge financial pressures.

“Our staff on the frontline are working flat out and deserve recognition for the dedication they display, day in, day out. But unless we break the cycle, performance results will continue to follow this downward trend.

“The recent and important relaxation of some targets, and of the penalties for missing them, will give many hospitals much-needed opportunity.

“We now need the government to incentivise greater coordination between local authorities and the NHS, and to invest more in out-of-hospital health and care.”

There were 6,105 patients delayed in hospital when medically fit to be discharged in June, often because social care support was not available, compared with 6,045 in May. The number of days lost to delayed transfers of care was 171,298, the second highest recorded, below only the total of 171,452 in May.

Hospital A&E departments admitted, transferred or discharged 85.8% of patients within the required four hours, well below the target of 95%. The number of patients waiting longer than four hours, 181,535, has almost doubled in the past year, from 96,663 in June 2015. Earlier this week, medics’ representatives warned that hospital emergency wards are in crisis as the supply of doctors fails to keep pace with demand for their services.

Nearly one-third of critically ill patients had to wait more than eight minutes for an ambulance to arrive in June. The national target is for no more than 25% of critically ill patients to wait this long.

The objective for non-urgent care was also not achieved, with 91.5% of patients waiting 18 weeks or less for treatment, below the 92% target.

The Labour leadership candidate Owen Smith said: “Waits for ambulances are going up, A&E departments are bursting at the seams and cuts to social care have left older people trapped on hospital wards for weeks or even months at a time.

“I won’t sit back and allow the Tories to destroy one of Labour’s greatest creations. That is why, if I am elected Labour leader and then prime minister, I would introduce a wealth tax on the richest 1% of people to fund a 4% annual increase in NHS funding.”

Matthew Swindells, NHS England’s national director for operations and information, said frontline services were improving in the face of intense pressure. “We continue to admit, treat or discharge more than nine out of 10 emergency patients within the four-hour target time,” he said.

A Department of Health spokesman said almost 60,000 people a day were seen in A&E within four hours and there were 1,250 extra doctors working in emergency departments compared with 2010.

“We are committed to delivering a safer, seven-day NHS, which is why we have invested £10bn to fund the NHS’s own plan to transform services in the future,” the spokesman said.

NHS misses key targets in June as service faces increasing demand

Dr Le Fanu"s on the internet health clinic, Friday 27th June 2014

Mrs Valerie C

Dear Mrs Valerie C,

Thanks for your query and my sympathies for this distressing problem you describe that is recognized technically as Craniofacial Hyperhidrosis. This is due to an age relevant disturbance of perform of the autonomic nerves that handle the sweat glands in the head and neck. There is regrettably no certain treatment but this sweating can surely be minimised by regular use of an aluminium based antiperspirant that blocks the sweat glands as does yet another Facade Facial antiperspirant that is obtainable on the internet. You may discuss with your physician a trial of the drug Oxybutynin typically used for the treatment of bladder problems which can reduce the volume of sweating. The topical remedy Glycopyrrolate is also reported to be powerful but is very pricey. There is an informative website at www.hyperhidrosisuk.org.

Dear Dr Le Fanu

I have just go through your column in today’s Day-to-day Telegraph and your piece on psychic unease notably struck a chord with me.

My mother had been unwell for some years although I had no specific cause to consider her death was imminent when a single night I woke abruptly to locate her standing at the foot of my bed. I acquired the telegram announcing her death the following morning and when, in due program, I saw her death certificate, I mentioned that the time of death coincided with that of her apparition in my bedroom. Coincidentally, she died on my 23rd birthday. I like to feel that might have had some thing to do with her look and have usually identified it comforting.

Kind regards

Jennifer H

Dear Jennifer H,

Thanks for that most intriguing account that I have pointed out in the column this week (30th June).

Dear Dr. le Fanu,

I enjoy and learn from your column quite significantly – my G.P. likes it as well!

Concerning the story of ‘psychic unease’ I will place right here my encounter, which I did not recognize or consider onboard at all, at the time.

In excess of a time period of a 12 months or two, when my youngest daughter was about 14, I often would feel really anxious, and would telephone my husband at work to ask, ‘Is everything alright?’ I told him that I considered anything terrible was about to happen. It wasn’t normal to mobile phone him at work, and I did not like to do so, but the urge was so great to seek reassurance. I am a fairly well-balanced particular person and rather sceptical, or logical. I certainly didn’t connect this feeling with both of my daughters, and was in a quite satisfied predicament with a happy marriage and moderately comfy way of life. I just felt a big fear which came into my mind. This carried on intermittently until finally…..

My daughter was harm in a car crash at the age of 16, and was paralysed. Now 45, she is nonetheless paralysed and has tremendous bodily issues – but lives a complete daily life in the hours left in her day right after care, and is wonderfully happily married.

When my husband came into the bedroom at 2.a.m. that morning, getting answered a mobile phone contact, saying, ‘There’s been an accident. She is all right but has broken her neck somewhat,’ I could only say, ‘ I can not inform you how much I knew this would happen.’ The hospital had informed him that she had a small damage in buy not to shock us till we knew much more.

Of course, no-a single can demonstrate that I had a premonition – I can only say that I felt this fear very strongly, at sudden moments, above a couple of many years. I haven’t had it given that.

Yours with extremely greatest wishes,

Janet R (Mrs.)

Dear Mrs Janet R,

Thanks for currently being in touch and your most intriguing account of your sense of prescient foreboding about your daughter’s injury. It is, as you say, particularly interesting that it need to have 1st started so extended just before the occasion itself.

My tall,slim,non-smoking twenty-five 12 months old son first seasoned his right lung collapse 7 years ago.Whilst chatting to buddies on line, laughing at a joke resulted in a pneumothorax without having any warning.He believed he was having a heart assault simply because the chest soreness was so excruciating.By the time we arrived at A&ampE his lung had begun to re-inflate.After several more episodes he had his lung cavity aspirated(drained).Three years later on,his left lung out of the blue collapsed as he walked property from college.This time,following many more episodes,aspiration and a series of chest drains failed,he at some point had to have surgical procedure.Since then,he has suffered from persistent chest pain and following numerous attempts has been forced to give up his studies at university.We believe he often has partial collapses which he manages by resting and slowing down his breathing and heartbeat.He has now been at property for almost eighteen months turning into more and more depressed and struggling from acute anxiety.Physiotherapy and Pilates have failed to support.A lot more lately,normal visits to a chiropractor and a cranial-sacral therapist have provided some limited relief.He has been obtaining some counselling for a even though and is awaiting an appointment at the Ache Clinic.He has been striving to manage his pain amounts with paracetamol and ibuprofen cream .He stays desperately unhappy and worries about the future.We have been unable to uncover a support group.Is there anything else we can try?

A extremely concerned mother.

Dear Anon,

Thanks for your query. This problem of persistent soreness following corrective surgical procedure for a pneumothorax is, as you will know, not unusual becoming reported in almost a third of patients. I would have imagined that in the first instance your son requirements to be taking significantly more powerful painkillers this kind of a Co-codamol and – as there is virtually undoubtedly a neuropathic element to the soreness – a drug this kind of as Gabapentin. I would hope the medical professionals at the ache management clinic need to advise on this. Your son has obviously grow to be, however scarcely remarkably, depressed by it all and would advantage I am sure from each some Cognitive behavioural treatment and an antidepressant such as Sertraline to enhance his spirits and restore his self confidence.

Hello Dr James

I have leg soreness considering that October final. It came on abruptly and has been with me ever considering that. I get serious discomfort in I feel my calf muscle in my left leg only. I had MRI scans completed but showed up nothing. What is leading to this pain. It improves when i raise my leg up and I find standing on it helps make it worse and then it will get extremely serious.

Hope you can help as I am a gardener and I need to have to get it sorted.

A lot of thanks.

Sincerely

Monica O’B

Dear Monica O’B,

Thanks for your query. There are, as you will know, numerous brings about of calf pain such as muscle strain and blood clots Still, it is difficult to envision – offered the regular MRI scan – what could account for its persistence above the last 9 months. I would talk about with your doctor the possibility of a referral for a specialist viewpoint – if he has not carried out so currently.

ALAMY

Response to Mr TS of Leeds Bladder pain (23 June)

It sounds as if I had the identical issue as the above gentleman, though I am a 53 year outdated female! I have at some point identified that I am struggling from candida. I had many programs of antibiotics following an operation and my bladder grew to become significantly worse as a result. I discovered with the yeast overgrowth that it was essential to cut out sugar as much as achievable as this absolutely aggravated the dilemma. I hope this may possibly be valuable to Mr TS of Leeds.

G K

Dear G K,

Thanks for that valuable suggestion. I hope to mention in the column this week.

The death of a near buddy far away

Dear Dr Le Fanu,

A dear and very near pal of mine had to move all of a sudden from her residence in Hull after the floods of 1977. She went to her daughters in Plymouth without a likelihood to say goodbye. Ringing her daughters a couple of weeks later I was shocked to find out that she had died of undiagnosed cervical cancer…..she had been taken care of for pain in her hip!

That night she appeared at the finish of my bed dressed in shimmering blue. She just mentioned, ‘Hello Tony’ and was gone….it had never ever took place before and has never happened considering that!

Variety Regards,

Tony C

Dear Tony C,

Thanks for your most intriguing account of your friend’s go to from ‘the other side’ – though your observation that she was sporting a shimmering blue dress raises the challenging query as to how a non sentient material object, such as a dress, can appear in spiritual type.

Dear Dr Le Fanu,

Like Mr T S of Leeds I have been unable to discover a remedy for bladder pain either by way of my GP or the urological division of my nearby hospital who performed a cystoscopy. I take a 400gr capsule of Tamsulosin everyday to offset benign prostate enlargement and the bladder soreness began some months soon after commencement. I am 78.

Yours genuinely

GM.

Dear GM,

Thanks for your query. I have summarised the responses in this week’s column.

Dual bowel movements

Dear Medical professional,

I have suffered similar problems to your correspondent, and have put it down to my every day intake of 1 Pantoprazole 40mg pill, which I take for Barratt’s Oesophagus.

My GP, and consultant at the Hammersmith, the two have a tendency to disagree, and items just wander on.

Yours sincerely,

Charles H

Dear Charles H,

Thanks for getting in touch. It is not apparent why Pantoprazole should result in this dual bowel motion. The only way to clarify the matter would be to temporarily discontinue it and see what transpires.

Dear Dr.Lefanu, really sympathise with this gentleman, obtaining typically suffered with a painful bladder (which my GP says is ‘irritable bladder’ not unusual in men and women like me who have IBS) I wonder if he has ever tried consuming pearl barley water? It’s rather gloopy and not to everyone’s taste but it constantly seems to assist me. Please pass on my ideal wishes to Mr.TS

Dear Anon,

Thanks for that suggestion talked about in the column this week.

Dear Dr

Concerning significant discomfort – lasting up to an hour – right after emptying the bladder.

I reduce out Polo sweets, Tea and all variety of cereal (they all have sugar) and my pain almost gone.

SA

Dear SA,

Thanks for that suggestion that I hope to mention in the column next week.

Dr Le Fanu"s on the internet health clinic, Friday 27th June 2014

Dwell Q&A, 26 June: generating well being programs perform in poor countries

How can we help well being techniques to deliver service outcomes? Photograph: Issouf Sanogo/AFP

On Tuesday 24 June the Global Growth Committee begins an inquiry into well being technique strengthening, and if the Globe Health Organisation (WHO) is to be believed, this couldn’t come soon enough.

According to WHO, the lack of powerful healthcare infrastructure in components of the developing planet is currently one particular of the most significant barriers to growing essential healthcare accessibility. Of the millennium improvement goals, the wellness-relevant goals are the least most likely to be met, and regardless of a increasing availability of medication, vaccines and overall health-relevant resources, there is a disconnect in between innovation and the power of worldwide overall health methods to provide them.

So how can we assist shut this gap? As all wellness programs are context-particular, there is no single set of rules that can be put forward to enhance efficiency. But analysis demonstrates that wellness methods with the highest well being outcomes have specified shared traits. To start, they have procurement and distribution techniques that really supply interventions to those in require. Their overall health staff have the correct skills and motivation, and they operate inside monetary processes that are sustainable, inclusive, and honest.

Partnership is also important as Frank Anderson, member of the Institute for Healthcare Policy and Innovation explains: “Worldwide academic partnerships have the potential to make monumental breakthroughs in the wellness of poorer countries. Nonetheless, issues like distance, communication and cultural dfferences usually turn into barriers that stop us from creating the best affect.”

Similarly the size of the job can be daunting. Strengthening health programs requires investments in accessibility, coverage, top quality, or efficiency – the place will minimal and middle revenue nations find the funds amid all the other pressures on the budget? As developing countries face the double burden of disease, quickly-developing populations that are both really young or more and more old, it is important that the backbone that supports overall health delivery is strengthened. Join our expert panel on Thursday 26 June from one-3pm BST to go over how this can be sustainably accomplished.

The live chat is not video or audio-enabled but will consider place in the comments section (under). Get in touch via globaldevpros@theguardian.com or @GuardianGDP on Twitter to advise someone for our expert panel. Follow the discussion employing the hashtag #globaldevlive.

Dwell Q&A, 26 June: generating well being programs perform in poor countries

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

Dr Le Fanu"s on the web well being clinic, Friday 13th June 2014

I am writing to you about the query that Mrs Barbara had about her friend’s daughter who is doing her GCSE.

My 17 year old son suffers from CVS – cyclical vomiting syndrome. I am told its the same thing as Abdominal migraine. He started getting stomach pains when he was about 6 years old. They gradually became worse with bouts of vomiting which we put down to food poisoning. Its only when we noticed a pattern which was cyclical that we started to ask for help. It took us 3 years but we finally got a diagnosis last year just before he took his GCSE.

He used to get his episodes every 6-8 weeks. They would consist of intense stomach pains and vomiting every 15 minutes for about 12-15 hours.The pains would last for 3 days. There was no medicine to help ease the pain or the vomiting. He used to lose 2- 3 kilos every time he had an episode. He had to be hospitalised a few times because of dehydration.

After a lot of research on the net, we contacted CVSA UK organisation who told us about Dr Sonny Chong. Our son is on Periactin and has been episode free for the past year.

I hope this will help the young girl. I am happy to talk to the parents if they wish.

Yours sincerely,

Mrs Bindu K

Dear Mrs Bindu K,

Thanks for being in touch and account of your son’s CVS that sounds in his case to have been particularly severe. The cause as you will know, is obscure and though it certainly shares some features with abdominal migraine it is a different clinical ‘entity’. It is encouraging that he has responded to treatment with Periactin.

Dear Dr Le Fanu

I thought the following would be of interest to lots of your readers who suffer from Restless Legs Syndrome.

Last November, fed up with continual broken nights due to severe restless legs, I decided to go back to my GP. I’d read about and heard from someone at a sleep clinic,that low iron could be a cause. Following blood tests which revealed I did have a low iron count, I have since been taking ferrous sulphate tablets daily. I haven’t had a single broken night since!

Worth a try!

Regards,

Sue T

Dear Sue T,

Thanks for being in touch and the important reminder that iron deficiency (for some mysterious reason) is an eminently treatable cause of RLS.

For the past few months, I have been experiencing considerable pain AFTER emptying my bladder. It can last at least an hour. Passing urine is quite painless.

I have seen a consultant urologist and have had an ultrasound scan, urine tests and a physical examination of the bladder, all of which proved negative. I am just completing a three month course of low-dose antibiotics which have been of no benefit.

I have cut out obvious irritants which means sacrificing a gin and tonic and other aerated drinks.

I have been taking painkillers when the discomfort is very severe.

Have you any experience of this problem? I am 86 years old which may mean the equipment is worn out!

Best regards,

Dear Anon,

Thanks for being in touch and my sympathies for this distressing problem you describe which I have not encountered before.I will mention this in the column in the hope of eliciting some useful suggestions.

I am a 78 year old man, 5ft11ins and 11stone 12lb. I sleep reasonably well, and eat well and regularly. I am fairly active, playing golf and walking.

Regularly around mid morning (but not everyday) I fell shacky, hungry,slightly off balance and my limbs feel like lead. I have been checked for diabetes and found to be clear. My blood pressure is pretty constant circa 140 over 80

Sometime in the past I have had a heart attack, but do not know when, but probably some 20 years ago,when I spent about 45mins in the north sea rescuing a suicide victim when the sea temp was about 5deg C This involved a swim of about 150Yds out and the same back towing the victim.

Regards

Richard B

Dear Richard B,

Thanks for being in touch and your account of these unusual symptoms which certainly sound as if they might be associated with a low blood sugar. Perhaps you could clarify how long these episodes last and what, if anything, relieves them. I could then mention this in the column in anticipation of further enlightenment.

Earlier this year you wrote about prostate operations and the dangers of. I am being pressurised by my consultant to have an operation to relieve pressure on the urethra and improve urine flow. The latter has been a problem for several years causing me to get up several times during the night. I would appreciate your comments on this operation or a copy of your previous article and where I can get hold of it.

Anon

Dear Anon,

Thanks for being in touch This problem you describe is due to overgrowth of the prostate gland pressing on the urethra. The standard operation (known as a TUR) is straightforward, effective and not associated with the complications of the ‘radical ‘ prostatectomy for cancer of the prostate.

ALAMY

Dear Doctor Le Fanu,

I am a 71yr. old male and my Doctor recommended Statins in January this year. I declined at the time and embarked on a strict regime of exercise and change of diet.

My Cholesterol level is now 4.73 (down from 5.73 5 months ago), height 5ft6, weight 9st8 (down from 10st6 5 months ago), a BMI of 21.8 and blood pressure 120/80. I now have a Joint British Societies adjusted Cardiovascular 10yr risk of 22% down from 25%.

My doctor still wants to put me on Statins because of the NICE recommendations. It seems my age and family history are the overwhelming factors in the calculation.

Have I no escape from Statins for the rest of my life and, if not, what is the point of taking care of my Cholesterol level, diet and weight?

David M

Dear David M,

Thanks for being in touch. You are obviously in good shape for your age and as the benefits in your case from taking statins would scarcely be detectable I would have thought it entirely reasonable to say ‘Thanks, but no thanks’.

Broken heart syndrome

I was very interested in your article in yesterday’s telegraph on the above. In February I was rushed into Papworth hospital with a suspected serious heart attack. In theatre the doctors were baffled by my pristine arteries and told me I was a mystery. A day later they could tell me more. The syndrome is called Tako-tsubo cardiomyopathy, after the discovery in Japan. There are, at least, three websites – BHF etc- with useful and encouraging information. It is rarely fatal (!) and will heal itself in time. Medication is needed, aspirin, for life I’m told, statins and blood pressure – Ramipril. I was recently recommended Ubiquinol (COQ10) for the side effects of statins, and my GP agreed. I had a second MRI at Papworth recently and my heart, apparently, is practically back to normal, with normal function,although scarred. I still tire easily and have become paranoic about chest pains! What they can’t tell me is, will it happen again? I write in case of others wondering what happened; my GP told me I was the first in his 30 years in practice, and Papworth itself said they had only 6 that they knew about!! Mrs M B

Dear Mrs M B,

Thanks for being in touch and your account of your experience with Tako-tsubo cardiomyopathy. I would be interested to know whether, in your case, this was prompted by some severe emotional stress. It is encouraging that the recent MRI shows the heart is recovering well. I would not have thought, given those ‘pristine’ arteries you need to be taking statins.

Dear Dr Le Fanu

I am aware that you are, or have been associated with, IBS Network. With this background I have been anticipating an item in your column on the low-fodmap diet. I have suffered pain and bloated abdomen for about 30 years. This came to an end in two stages – removal of a gallstone two years ago which took away the pain and recently Fodmap which has taken away the bloating. I feel that Fodmap would help other sufferers and would be helped by promotion in your column. Can you advise if a website is available that lists manufactured food products that are fodmap compliant – looking at ingredients is all very well but many are so incomprehensible!

Regards

Dr P J G (of science!)

Dear Dr P J G,

Thanks for being in touch. I am delighted to hear that the Low-Fodmap Diet has so relieved your long standing abdominal symptoms. I look forward to mentioning this in the column in the near future for the benefit of others. The Digestive Health Centre at Stanford University has a most informative website.

ALAMY

Dr Le Fanu,

I have read your column and your opinion on statins, but you do make an exception for those who have had a heart attack. My problem is that I had a heart attack over two years ago at the age of 67. I was told I was unlucky as I am a non smoker, have low blood pressure and no family history of heart trouble, I was, however lucky that my attack happened a ten minute ambulance ride from one of the major heart surgery centres in the country. My treatment was exceptional, within an hour I had a stent inserted in the artery that was partially blocked, because it didn’t close completely I was told damage would probably be minimal. My other arteries were all clear with negligible furring. Since then I have had no angina or any other heart problems.

Before my heart attack I did suffer with arthritis in some of my joints but with the help of a few pain killers managed golf, yoga, gardening and lived an active life. After starting to take statins ( 80 mg Atorvastatin) my legs became more and more painful. I had a blood test that my doctor said proved that the statins were not to blame so soldiered on until last month when, at the urging of my husband, I stopped taking them. My arthritis is still painful, I’m waiting for a hip replacement, but I have lost the feeling that someone has a tight grip on all my leg muscles, I had reached the stage of thinking that if this was life, was it worth living. I would like to know what statistical risk I am taking if I go against my doctors advice and discontinue statins completely. I personally feel that the inactivity the pain caused must be just as risky, I feel that I have just sat in a chair for the last six months. What would your advice be.

Dear Anon,

Thanks for being in touch. I am pleased to hear that you have made such a good recovery from your heart attack. As for the statins, the situation in your case is quite straightforward – they are obviously compounding the problems with your arthritis, adversely affecting your quality of life on a major scale. The benefits for women are miniscule hence you should not be taking them.

Dear Dr James Le Fanu

I woke up one morning with a spinning head and dizziness. It was so bad I could not walk anywhere without holding to something. The GP thought it was Vertigo. I have taken PROCHLORPERAZINE for 10 days without any improvement on my balance. GP changed to Beta- histamine which I am still taking 3 times per day for the past two weeks. GP also performed the Epley Manoeuvre but it didn’t make a lot of difference to the problem. Although the spinning has stopped but I still feel dizziness, but not as bad as before. Is there any other test you could recommend to be sure it is Vertigo? I also had been having physiotherapy on my neck as the cervical neck C 6 & 7 are pressing against each other, with some arthritis on the neck. Could this also be the cause for the dizziness and sometimes like a vacuum inside my head? I would appreciate your opinion.

Dear Anon,

Thanks for being in touch. This episode of acute dizziness is strongly suggestive of Vestibular Neuronitis – most commonly caused by a virus. This should with luck resolve of its own accord. It is indeed the case that neck manipulation can cause dizziness (probably due to restriction of blood flow to the brain) but the presentation (coming on during a session) is quite different.

Dear Dr James

I know this is not a nice subject but my husband seems to always be passing wind, that goes on and on and on that it is almost ridiculous the sound it makes. He doesn’t eat a lot of fibre, he has already taken a dose of charcoal tablets but it didn’t work. What could it be the cause and what he can do to stop farting so much, although I am glad to say it does not smell. Your opinion will be much appreciated.

Dear Anon,

Thanks for being in touch about your husband’s, not unusual, symptoms. He could consider trying the Low-Fodmap Diet (see above) that reduces the amount of fermentable sugars in the colon. I would be interested to learn whether this is of help.

Dear Dr. James.

I am writing to you in the hope that you will be able to help me.

I have been suffering with very debilitating pain in my lower left abdomen for about fourteen months. The pain has worsened in the last month or so and I have it constantly although there have been a couple of occasions where it has completely gone, only for it to return again. The relief was only for a couple of weeks on both occasions.

I have seen various consultants at East Surrey and Guildford hospital but none of them have come up with a diagnosis.

The procedures I have had so far, in approximate order are:

Ultra Sound Scan

Cystoscopy

Colonoscopy

Endoscopy

CT Scan

Endoscopic Ultra Sound

Ultra Sound Scan

Second Endoscopic Ultra Sound

Capsule Endoscopy

Also had urine, stool and blood tests. The first endoscopy showed helicobacter which was treated and cleared up. The Endoscopy Ultra Sounds showed some inflammation of the small bowel but not enough to cause this pain. I also get some bouts of vomiting but only bringing up clear fluid even when shortly after eating.

The pain is aggravated by any exertion no matter how minimal. I was taking Ibuprofen for a while and also Omeprazole to help with the inflammation. I now take just co-codamol when the pain is extreme but this does not work for long.

My consultant at East Surrey is unable to diagnose the problem and has requested CT Angiogram and has referred me to a Vascular Surgeon and also to St. Marks Hospital in Harrow although I have no appointments yet.

I would also mention that I was diagnosed with type 2 diabetes about eighteen months ago but am not taking any medication for this.

I am really struggling to cope with all this and would welcome your views/advice. I will be 70 in July and before this started I was in very good health and had not been to the GP for some years., apart from the diabetes visit.

Many thanks.

Dear Anon,

Thanks for being in touch and my sympathies for this intermittent abdominal pain that has defied the most thorough of investigations. It is perhaps significant that you also had these episodes of ‘bringing up clear fluid’ this is suggestive of a condition known as Water Brash and is associated with spasm of the muscles in the lower oesophagus. This might suggest the pain in the lower abdomen has a similar cause and I would be interested to know whether drinking alcohol (which relaxes the muscles) brings some relief. If so you might discuss with your specialist a trial of muscle relaxant drug such as Nifedipine.

Dear Dr Le Fanu,

I have read your column in the Telegraph for several years and always found it most interesting.

We have a daughter, Melissa, the brightest and bravest girl who could be relied upon to run the fastest, climb the most dangerous trees, ride the wildest horses and ski down the blackest slopes. She has however had in the background an awareness of Ehlers Danloss which is gradually increasing in severity. Her philosophy is that life is for living whilst she can, and that fitness may help to compensate the effects of her condition.

She is now taking very strong medications to combat her underlying back & joint pains but has recently experienced numbness / pins and needles which she had hoped were caused by a separate and treatable thyroid condition. The results of her blood test received today however show no abnormality so we are all disappointed to now believe that all of her problems relate to E D.

Dr Michael Shipley whose report I attached is a leading expert in this field, however I always believe that a 2nd opinion may be of value. In this connection I recall reading a “guest doctor” (of whom I think you did not entirely approve!), mentioning the value of genetic testing. I do hate to trouble you, but am wondering if you think that this could be appropriate for Melissa and if you might have any other thoughts.

Kind regards

CW

Dear CW,

Thanks for being in touch and my greatest sympathy for your daughter and these distressing symptoms you describe. Dr Michael Shipley (and Professor Rodney Grahame) are, as you will know, the ‘top’ experts in hypermobility syndrome and I would not have thought, with regrets, that there is anything to be gained from seeking a second opinion.

Dear Dr Le Fanu,

We hear so much about dieting, but how can one put on weight without risking Type II diabetes (lots of sugar) or clogged arteries (lots of saturated fat)?

I am 72, 56 Kg (8st 11lbs) and 1.68m (5′ 6”) in height. So my BMI is 19.

As far as I know, I am in good health, but my weight has slowly but steadily declined over the last 10 years and I don’t want it to fall much further.

I am quite fit (cycling) and watch what I eat.

Your advice would be welcome,

Morley H

Dear Morley H,

Thanks for being in touch. You will be pleased to hear that sugar does not cause diabetes, nor high fat meat and dairy goods clog up the arteries. I would commend a regime of steak and chips, chocolate pudding and a couple of glasses of wine – or whatever other foods you enjoy.

ALAMY

Abdominal pain in 12 year old boy. Interested in the the report on 6th June suggesting abdominal migraine in the above.

I occasionally suffer from migraine (I am 64 years old). Although the headache is hardly noticeable the stomach upset and nausea requires medication (I use paramol which my doctor agrees is suitable).

Despite many searches on the internet I have failed to find any mention of adult abdominal migraine. You receive much correspondence and I wonder if you have received any other notification of this condition from adults?

Best regards

Dear Anon,

Thanks for being in touch. This is an interesting question. My impression is that abdominal migraine in children tends to evolve into classical migraine in adulthood – which would account for its rarity in those over 20 (though it may of course occur).

Mr NA

Many thanks to all those who have contributed to clarifying the cause of Mr NA’s unusual bowel symptoms.

After trips to doctors, hospitals and A and E department, my 13 yr grandson, now 15, with identical problems to the 12yr old was taken to a physiotherapist as suggested by his 17yr brother who spotted the problem instantly. “He is growing and there is pressure on his internal organs and will certainly get severe pain – I can sort it out”. Two wonderful sessions later and my grandson was fine with no more pain. The NHS suggested it was psychological and that something was wrong at school or at home which was very upsetting and untrue. They do need to get their act together in some areas. Good luck to the lad. We hope to hear that all is well.

NR

Dear Dr. LeFanu,

I read your articles with great interest, thank you.

On June 3rd. the conundrum concerned a Mr. N. A. from Leeds. I have a similar symptoms and it is a very tricky problem to manage.

I had a year of expensive investigations which produced very little in the way of helpful results. I finally had proctogram. Although this was a somewhat undignified examination, it produced an immediate and helpful result showing that I had a full width rectal prolapse. Again, not great but somehow symptoms are easier to manage when the cause is known.

I was then referred to a consultant at Northwick Park Hospital (North London) to discuss having a ventral rectoplexy. I haven’t decided to go ahead with this yet but have certainly not ruled it out. I can provide further details.

If Mr. NA has not had a protogram done, I would advise that it was the most useful of all the investigations and I would have saved time and money if it had been the test of choice in the first instance.

Kind regards,

Elizabeth T

Dear Sir,

My problem started mid-January, 2014 and before the diabetic consultant decided to up my Metformin dose from 1000 mg per day to 2000 mg per day (1000mg with breakfast: 1000mg with the evening meal) so that she could “get you off that novo mix insulin” ). I was loathe to change the dosage as loose bowels are a noted Metformin side-effect and I was already experiencing difficulties although nowhere near as severe as they have become.

With my doctor’s agreement I yesterday (4 June ) lowered my Metformin dose back to 1000 mg per day.

Yours sincerely,

Keith N

ALAMY

Dear Dr James

Re. abnormal bowel movements, 2nd June 2014

A banana a day at breakfast helps. It makes a difference after a few days

My doctor suggested it, and it works

Dear Dr Le Fanu

I am writing about this week’s conundrum from Mr N A of Leeds. I have exactly the same problem.

I have a normal bowel movement within 15 minutes of finishing breakfast, sometimes immediately I’ve finished eating. I then have another urgent bowel movement about half-an-hour later, but this time it’s like water. I then frequently have to go a third time with ten minutes, again very watery.I then don’t have any more bowel action for the rest of the day.

I have suffered from Irritable Bowel Syndrome most of my adult life (I’m now 67) and assumed this was part of the IBS. I get round the problem, if I have to go out, by making sure I finish breakfast at least an hour before I leave the house. This does mean some very early rising at times! The biggest problem comes if I go on holiday and my eating habits change. I always carry some imodium tablets with me in case I need them.

This doesn’t give Mr N A a solution, but at least he will know he’s not alone.

Yours sincerely

Christine S (Miss)

mr.n.leeds bowel problem mon 2 june telegraph

Dear Dr

Would confirm I suffer from the same problem this has only happened in the last few months but it does not happen every day would welcome a cure !! aged 84

Mr T G B

Dear James,

I had a similar problem many years ago: I used to have a very thick layer of marmalade on my breakfast toast, and in an attempt to cut down on sugar, I bought a jar of diabetic marmalade. Still the greedy thick layer of marmalade, and I had to rush to the loo as soon as I arrived at work. Luckily I connected the change as being timed with the change of marmalade, so hastily gave it up, and returned to normal. What I don’t remember is what the sugar substitute in the diabetic marmalade was called – but it certainly was a laxative in large spoonfuls!

Hope this may help your correspondent.

I enjoy your Monday column, and your disapproval of statins!

Best wishes, Jan P

Re this week’s conundrum, my symptoms exactly. I just put it down to old age, but maybe someone will have an explanation!

I always look forward to your column.

Best wishes,

Chris H

Mr N A Leeds: I had very similar symptoms to Mr NA. I would go to the loo in the morning quite normally and then after around 30 minutes or so would feel the need to go again quite urgently. This second movement would be much looser. I didn’t think much of it but when I reached 60 I was sent a bowel cancer screening kit which I sent off and it was found to be abnormal and a colonoscopy revealed a Dukes C bowel cancer which was partially blocking the bowel.I think that overnight ‘poo’ manages to get past the tumour and firm up so the first visit to the loo is fairly normal, after that waste squeezes past the blockage and the need to go again is felt. I would strongly advise Mr N A to visit his doctor to investigate the possibility of a bowel cancer. I hope this is of benefit. John D

Bowel movement

To cut a l o n g story short, I call the first urgent, “air and bits” upon arising, movement of the day ‘The Unplugging’. Then 2 more urgent needs as per Mr NA from Leeds, mine during the next hour or two before I leave the house. This, tho with different textures 10 years ago, has always been the case.

Originated with IBS, and altho that was controlled by DIY when Dr’s stuff didn’t help 10 years ago, movements became more troublesome last 2-3 years, and now a homeopath is helping stem unwanted ‘tides’ – I’ve been better in last few months than for a l o n g time. It’s WONDERFUL. No more daytime leaks, far less desperate ‘needs’ for the lavatory (as a recent DT ‘classy’ article suggested we say instead of toilet)!

So can’t really help Mr NA except I was intrigued to see someone else with a similar other ‘upon arising’ condition. I hope he manages to sort it out, and it doesn’t take as long as mine did – tho’ it hasn’t stopped completely, it’s improved — and will even more, according to homeopath, tho’ I’m happier anyway where she’s got me so far!

Also forgot to say, YES, a tennis ball placed on floor and rolled on can help many sorts of stiffness, pain – an excellent remedy! (When you can do DIY!)

G G

Dear Dr. Le Fanu,

I spotted you mentioned the remedy I suggested for Mr. A.N. and I hope it will work for him. However, in the last paragraph of my earlier email I did say that I wondered what 21 – or on occasion a few more – Imodium might do to me – without saying PER WEEK! I thought I should put this right.

Your column is just so helpful and varied. I especially loved the tennis ball for the bad back one! Brilliant.

Best regards

Two stools

I did intend to reply to initial query but didn’t get round to it but saw today’s replies and felt I should offer another scenario as my husband had identical symptoms getting worse over a period of time -was referred for sigmoidoscopy and was found to have a large polyp in the upper rectum.Since this was removed no further problems,so perhaps further investigation re symptoms is needed?

Diane T

Dr Le Fanu"s on the web well being clinic, Friday 13th June 2014

Dr Le Fanu"s on the internet health clinic, Friday 6th June 2014

I wonder if you can offer me any advice please. I have locally aggressive prostate cancer which. had spread to the bladder by the time it was diagnosed. Since 2009 I have been given Prostrap injections. Because of the worsening side effects (sore and watery eyes combined with heavy flushing) the oncologist advised me through my doctor to stop treatment until my PSA reached 5 or above. After 15 months, in February this year, I resumed treatment. During the 15 months the severity of the effects diminished slightly but during the period I noticed that the smallest quantity of red wine (at 84 about the only pleasure left to me) and then any alcohol would trigger the flushing etc. but more seriously than usual. I am a widower and live alone. I would like to go back to my two glasses per night and the odd Scotch. Help!!

Sincerely

Steven R

Dear Steven R,

Thanks for being in touch, this flushing, as you will know, is a well recognised side effect of hormonal treatment caused by dilation of the blood vessels in the skin – though the precise mechanism is not clear. This is compounded by alcohol which has the same effect on the blood vessels. There is thus regrettably no solution to your dilemma – other than to experiment with some non alcoholic form of psychoactive stimulants!

Dear Dr James

I have type 1 diabetes together with hereditary spherocytosis. I have recently been diagnosed for the second time with an overactive thyroid.

When last I had a problem with my thyroid I was prescribed block and replace therapy, carbimazole and levothyroxine, for 18 months. During the whole period of treatment the doctors never once managed to raise my thyroxine levels to where they should have been, leaving me with the equivalent of an underactive thyroid. As a result I felt dreadful for the full 18 months and over the course of treatment put on 2 stone in weight.

I understand that for a second episode of overactive thyroid the usual treatment is radioactive iodine, designed to reduce the activity in the thyroid but more often than not killing it off entirely leaving the patient needing to take thyroxine daily for life. I am obviously not keen on spending the rest of my days (I am only in my 40s) feeling dreadful and getting fat!

Is it possible that the spherocytosis could be affecting the absorption of the thyroxine?

Similarly every time the doctor tests my HBA1c I am congratulated for keeping my sugar levels in the 4-6 range, results not borne out by my own testing at home.

Many thanks.

JW

Dear JW,

Thanks for your query. It certainly does seem that radioactive iodine is the next logical step though the lack of efficacy of those thyroxine supplements is puzzling, and I share your concern. I would not have thought that your spherocytosis is implicated. The two possible explanations might be that you are not absorbing the thyroxine perhaps because you have some degree of malabsorption caused for example, by celiac disease. Alternatively it could be due to some coexisting autoimmune disorder. I am sure you should discuss this with your specialist.

Hi,

Although I do not have diabetes I suffered with abdominal pain almost 50 years of my life, much as described. Having every test and scan imaginable it was not until I eradicated gluten and dairy from my diet, did the pain go entirely. I took an allergy test as a last resort. I imagine it will be difficult to sort his diet if this is the case for a 12 year old boy, being a Type 1 diabetes sufferer. If I stray from the diet, the pain returns. Worth a shot in any case and was life changing for me. I am now 58. I, too, when much younger was told it was “all in my head” and you cannot have stomach ache every day!

Heather T

Dear Heather T,

Many thanks for those comments

In response to the query on 26th May regarding the grandson with stomach pains, might it be undescended testicles? On occasion a growth spurt can mean undescended testicles move higher up causing pain.

Regards

R C

Dear R C,

Many thanks for those comments

ALAMY

Dear Dr James

Our daughter had a recurring abdominal pain. We eventually took her to a consultant who could see no reason for the pain. He said to go back in 4 months if no better and he would do exploratory operation. In meantime my daughter wondered if might be related to wheat. She then either cut out wheat or reduced it and pain disappeared, now if pain comes back she reduces wheat and it goes again.

yours sincerely

Judith B

Dear Judith B,

Many thanks for those comments

Re: your query about the 12 year old diabetic boy with unexplained abdominal pain. I wonder if the possibility of autonomic neuropathy has been considered. Rare in one so young but it is an exceedingly complex condition. Although traditionally diarrhoea is said to be the predominant symptom it can however cause bloating and symptoms similar to Irritable Bowel Syndrome. There is a good summary in the professional section of Patient.co.uk.

Dr. Robert W

Dear Dr Robert W,

Many thanks for those comments

ALAMY

Dear James

My son also has Type 1 diabetes and when he was around the same age as the subject in the article (he is now 20) also suffered from abdominal pains. He still does to some degree but as he has developed and understood the condition he seems to have some rationale for what is causing it. Very often he will say he is ‘hyper’ (high blood sugar) but sometimes if you insist on him testing he is in fact ‘hypo’ (low sugar – hence his reluctance to blood test – hypos cause huge obstinacy).

However, since being issued with an insulin pump 5 years ago his level of control and even temperedness has improved significantly. He is thriving and studying at Cambridge.

A major problem for which I would seek more advice is that of snoring and ‘chronic sleep apnoea’ which leaves him so tired and sleep pattern disturbed. He uses a CPAP pump but I have heard there are mouth guards that can be used effectively. Any experience? Or feedback?

Many thanks and I do hope I can be of help to the reader – I have had 10 years experience of being the ‘mum of a diabetic’

Best wishes

Rachel W

Dear Rachel W,

Thanks for being in touch. It is most interesting your son’s abdominal symptoms improved with the use of the insulin pump but my impression is that they are not related to the degree of control of blood sugar levels. As per the snoring if your son definitely has sleep apnoea then mouthguards are definitely not indicated and he should stick with the CPAP.

Dear Dr Le Fanu,

A possible cause could be sorbitol intolerance.

Sorbitol is used as an alternative sweetener in diabetic diets and can I believe, cause abdominal problems.

P.M.B

Dear P M B,

Many thanks for those comments

Dear Dr Le Fanu

Perhaps he has chronic pancreatitis? It would be certainly worth an MRCP (the scan not the qualification!)

As far as the bariatric vertigo is concerned, fluids don’t expand or contract in response to changes in atmospheric pressure, so I don’t think it is an inner ear problem, unless of course there are bubbles in the endolymph. It’s all in the middle ear. I get this slightly in blustery weather.

Keep up the good work, I enjoy your articles immensely.

Tom D

Dear Tom D,

Thanks for being in touch. I would agree that pancreatitis is a possible culprit. I stand corrected about the possible mechanism for that barometric vertigo.

I would suggest severe reflux as a probable cause for her grandson’s symptoms.

Since being unable to take PPIs (or Ranitadine or similar) and despite maintaining a strict low fat/anti-reflux diet, I am nevertheless all too familiar with these symptoms. Perhaps raising his bed at the head end and having nothing to eat for three hours before lying down would be a start. Perhaps. Hopefully!

Best wishes,

Mary

Dear Mary,

Many thanks for those comments

Forty years ago I became the victim of sudden onset excruciating abdominal pain, so intense it caused me to vomit. This could last from 20 minutes to well over an hour. Numerous tests were carried out for no results. I would be administered pethidine injections, which mostly relieved it.

Those were the days the doctor would immediately come out, night or day. Eventually it was diagnosed as abdominal migraine, they eventually stopped after ten years.

Dear Anon,

Many thanks for those comments

Dear Dr Le Fanu,

In response to your column in The Telegraph on Monday the 26th of May.

The section featuring the conundrum of the lady with mild vertigo when lying and turning in bed has had me thinking.

Firstly, I agree that allergic reactions in the Spring could contribute to a general feeling of mild unsteadiness, particularly as a result of eustachian tube dysfunction. I am rather amiss at the idea that mild fluctuations in atmospheric pressure could result in such sensations as a result of minor changes in middle ear pressure. I accept that this statement is open for debate. However, if these symptoms are only occurring when lying down and turning in bed I would be much more inclined to consider the movement evoked diagnosis of Benign Paroxysmal Positional Vertigo (BPPV).

I would be most interested to understand your reasoning for not including BPPV as a potential cause of this lady’s concern.

Amy J

BSc (Hons) Audiology

Dear Amy J,

Thanks for being in touch. I would agree that this lady almost certainly has BPPV – the conundrum was why it should be exacerbated at the time of the spring equinox.

Hi there, I am baffled as to why you exclude psychological causes for the boys chronic non-organic abdo pain. If anyone feels they can say ‘this clearly cannot be the case’ I think all the more likely to be the case. In paediatrics we used to talk about abdominal migraine. Just being a 12 year old boy is enough cause for anxiety and turbulence. And that can produce all sorts of strange symptoms. It will no doubt settle in time and he will go on to enjoy the migraines and IBS of modern adulthood.

Best wishes

Melanie C

Dear Melanie C,

Many thanks for those comments

ALAMY

Sir, May I suggest that the grandson of Mr. JH form Leeds is put on a gluten-free diet for a trial period. That, and perhaps dairy-free as well. It would certainly do him no harm.

Yours sincerely,

Dr. David R

(Retired Radiologist)

Dear Dr David R,

Many thanks for those comments

Sir,

Your last item regarding the 12 year old with type 1 diabetes refers. My own situation may be of some help.

I developed Type 2 20 months ago and when dietary control did not work my doctor prescribed Metformin three times day. I then developed considerable pain discomfort in the groin and lower stomach areas – sometimes reaching up to lower chest area. My doctor checked but could find no cause – muscle strain or other symptoms. My daughter suggested taking Yakult once a day as Metfomin prevents certain biological processes acting correctly. To my surprise and great relief the pains vanished within two days and have not returned. I am now able to do without Yakult for as many as 8 days without the pains returning.

For your information I am a 74 year old male and reasonably active.

I hope this is of use to your contact.

Regards

Chris O,

Dear Chris O,

Many thanks for those comments

Dear Dr Le Fanu,

My son is now 32 years old, and he has had Type 1 diabetes since the age of 7. He used to have awful stomach pains/cramps very regularly. They were very severe and he would have to have a hot bath, painkillers and a hot water bottle to try and ease the pain. Nothing really worked though, and sometimes the pain would make him sick. The attacks could last up to a day at a time and the diabetes paediatric consultant at the Royal Berkshire Hospital, Reading, called them TUMMY MIGRAINES. They lasted at least until the end of puberty. Apparently you could have these instead of the conventional migraines. He still can have trouble with his stomach at times.

I hope that this will help Mr HJ from Leeds.

Yours sincerely,

Heather L-B (Mrs.)

Dear Mrs L-B,

Many thanks for those comments

Dear Doctor,

Allow me to share our experience of teenage undiagnosable abdominal pain. This wasn’t constant pain, but occurred all too frequently, and for considerable periods of time. There was no involvement of diabetes.

Our daughter (now 27) suffered with such pains for 2 or 3 years during her mid-teenage years, like Mr HJ’s grandson this interrupted her education. When not in pain she was a fit and healthy teenager, who played football with a passion – it eventually took her to university in the USA via a sporting scholarship.

Treatment/diagnosis was via our excellent GP (many times), various other experts we were referred to, stays in hospital and attending a 3 week Pain Management Course at a hospital in Bath.

Our ‘eureka’ moment came one morning when I came across a small article in the Daily Telegraph which reported a girl in Swansea who seemed to have similarly suffered and had visited a cranial osteopath who had diagnosed teeth braces as the cause, by setting tension in various muscles from jaw/head through the neck and down to the abdomen. Removal of the braces had removed the pain.

My wife became detective, phoning the Telegraph who put her in contact with a local paper in Wales, who put her in touch with a pub who had been involved in fund-raising for the girl’s treatment. They got her family to make contact. From there we immediately got our daughter’s teeth braces removed – they had been on for some time, and their job was nearly done.

Just before this happened I had seen a Chiropractor for a neck problem (I had never used one before!). Before treating me we had discussed my health etc (and I ask everyone I see if thy have a ‘magic cure’ for migraine which is my personal bug-bare) and he asked about sources of stress in my life – so I mentioned my daughter’s medical problems. He asked if he could see her.

Timings meant the teeth braces had been removed before she saw the chiropractor, but he was in total agreement that setting un-natural tensions in the jaw could impact muscle groups in other parts of the body. He demonstrated this by testing knee reflexes with jaw relaxed and then again with teeth clenched – they are very different. Treatment proceeded working to relax and stretch out muscles and other soft tissues etc (I don’t pretend to understand all that Chiropractors do, I just know how well it returned movement to my neck – in reality I’m more of a skeptical biology graduate).

In a short space of time our daughter’s abdominal pains were gone, never to return.

I know that doing 2 things simultaneously is poor science as either, or the combination could have been the cure.

I hope this is of some use to Mr HJ’s grandson, or to any of your other patients.

I only ask for a cure for migraine in return!

Kind regards,

Steve P

Dear Steve P,

Many thanks for those comments

Dear Dr Le Fanu,

I was particularly interested to read, yesterday, your explanation for the problem of the patient with mild vertigo when lying down.

I have now been retired since 1998 but prior to that I was a specialist asthma nurse and for a long time before my retirement I was explaining just the points you make, but in respect of asthma mainly.

So many patients suffered increased symptoms and indeed, had acute attacks of asthma if they failed to read the signs and failed to adjust their medication appropriately. It was interesting that many doctors did not understand and dismissed patients anxiety when the symptoms were due to fall in barometric pressure – they did partially understand the hay fever-type allergy, though often it was difficult to convince them!!! I guess that the same level of knowledge still exists in general practice, which is criminal after so long. The figures for asthma deaths remains frightening.

Sincerely,

Maggie H (Mrs)

Dear Mrs H,

Thanks for being in touch and those interesting observations on the influence of changes in barometric pressure on asthmatic symptoms .

Dear Dr Fanu,

I am writing regarding a problem you featured in yesterday’s Daily Telegraph, Monday 26th, Doctor’s Diary.

On two occasions I have had bouts of dizziness when turning over in bed at night, the first started in early March, and the second last week. On the first occasion my GP diagnosed labyrinthitis, for which there is no cure, but a friend who had had a similar problem a few years ago, suggested I had BPPV. The Epley manoeuvre was recommended, and I instantly recovered. It was performed again yesterday with the same result. I was very interested to hear that some of your readers suggested the changes in pressure could be to blame. I, however believe it can occur at any time, and am skeptical that the weather can affect it, despite the timings of my episodes!

I would be very interested to hear your thoughts on BPPV, and the Epley manoeuvre.

Yours sincerely,

Amanda S

Dear Amanda S,

Thanks for being in touch. I am delighted of course to hear that your BPPV responded so well to the Epley manoeuvre.

Dear Dr Le Fanu,

My problems is that having gone to bed at 9pm feeling fit for my age (89) and in good spirits I wake at 7am after a good nights sleep (with one visit to the loo around 5am) feeling utterly exhausted and aching all over. This waking mood casts a shadow over the day but when I force myself to get up the symptoms gradually ease as I become active.

My GP says this is a mystery complaint.

The increasing lack of energy, which my GP attributes to old age, is frustrating but I visit a gym three times a week and enjoy light gardening when the sun shines. I eat a healthy diet and do not smoke.

I suffered a heart attack four years ago and at present I am on the following cocktail of drugs:

Eplerenone 50 mg 1daily

Furosemide 40mg 1daily

Rtidine 150mg 2 daily

Aspirin 75mg 1daily

Losartan 50mg 1daily

Bisoprolol 1.25mg 1daily

Omacor 1g 1daily

Levothyroxine 50mcg daily

Viscotears

Warfarin variable dose

With kind regards,

Richard M

Dear Richard M,

Thanks for being in touch. I agree this early morning exhaustion that improves during the day is very puzzling especially as you are generally so active. Several years ago a reader described a variation of this in the form of severe early morning gloominess and low spirits that similarly improved during the day. The general consensus was that this must be brought about by changes in the brain chemistry that occurred during sleep. There is regrettably no remedy but it can be reassuring to know of this straightforward explanation.

Dear Dr. Le Fanu

My mother is 87 and is generally very healthy. She is unsteady on her feet and always very tired, but otherwise is remarkably well, I think.

However, she is very distressed at not being able to sleep at night because of having to go to the bathroom many times and also because of sharp pains and tight sensations in her ankles and legs at night only.

The pain and peculiar sensations that she gets prevent her from sleeping and seem to disappear when she gets up. She has poor circulation in her lower legs.

She has been prescribed Neurontin (Gabapentin) by her GP, but is afraid to take it in case she cannot wake up in time to get to the toilet. She has seen several doctors and been to the local hospital and nobody seems to be able to tell her what the problem actually is. She has been given some exercises by the Physiotherapist at the hospital, and she is doing these as prescribed.

I would appreciate any further thoughts you may have, please?

Thank you so much,

Kind regards

Dear Anon,

Thanks for being in touch and my sympathies for your mother’s problems. It is possible these frequent trips to the toilet at night are due to the condition known as Benign Nocturnal Polyuria . This can be prevented or minimised by taking an anti inflammatory drug such as aspirin or nurofen before retiring. Your mother should be then be less apprehensive about taking the Gabapentin for her neuropathic pain.

Mr HJ from Leeds

I had similar problems with pain from childhood. At the age of mid-30s a doctor suggested we try for food allergies/intolerance. He said that if I had a very favourite food it could be the cause of such pain. He was right – it turned out that total (absolutely total) avoidance of any trace of ONIONS provided a cure for pain and often associated diarrhoea. If I am even slightly careless the trouble comes back.

Hence I suggest avoidance trials of successive foods and/or flavours. MAH

Dear MAH,

Thanks for your comments.

Dear Dr. LeFanu,

In your column on Monday, you asked for suggestions as to what might be amiss with the young boy with stomach pains.

I wonder if it could be the disease which dogs carry? I read a book about a similar case and all sorts of tests and even an operation to remove the appendix was performed but no answer could be found. Eventually some sort of test – possibly faeces, maybe blood, was sent to the Welcome laboratory and they found out that it was the disease which dogs carry.

Anyway, I do hope that a solution will be found for the poor boy.

yours

Thelma M (Mrs)

Dear Mrs M,

Thanks for your comments

Dear Dr Le Fanu

Re Mr HJ’s query on behalf of his grandson,

You may wish to forward the attached testimonial regarding a child of the same age I worked with (surrogately through his mother, by telephone only), with severe ulcerative colitis. I realize Mr. HJ’s grandson pain has no obvious physical cause, but I’m sure some investigation into his emotional state could reveal deeper causes. I specialize in the emotional context of chronic pain, and would be happy to have an initial chat with the child’s parents to find out more about the case.

I copy below my signature, the testimonial in case the google doc attachment cannot be opened. I should mention that in the year since this testimonial was written to me, the child is still in remission and now leading a normal life. As surgery to remove the colon had being considered, it is a relief to all concerned that such an option was no longer considered necessary!

Yours sincerely,

John-David B

thechronicpaindetective.com

Date Friday 19th April 2013

RE: L. Diagnosed Ulcerative Colitis July 2012. DOB 11/10/02

Current Medication

Prednisone 5mgs every alternate day

Imuran 75mgs daily

Salazopyrine 1mgm mane, 1.5mgs nocte

Homeopathic remedy

Probiotic

Calcium

Vit D

At L’s January 2013 review, the doctors showed particular concern regarding L’s progress since his diagnosis in July 2012. His condition was classified as severe. He was stooling up to 9 times a day including stooling at night with bleeds. He was also experiencing severe abdominal cramps.

L had been commenced on Imuran 25mgs in December and was tolerating it well. So the dosage was increased to 75mgs in January. He had been off prednisone but in light of his symptoms he was re-commenced on 30mgs daily and Colifoam enema at night and was maintained on salazopyrine. We were told if L remained unresponsive to medical treatment it was possible we may need to consider surgery to remove his entire colon as he was diagnosed with pancolitis.

At this point, we felt the need look further and include other possibilities in relation to his care, looking at a broader approach to support the medical side of treatment. A friend, who himself was diagnosed with ulcerative colitis, recommended a particular homeopath

who had experience working with this condition. This homeopath is a qualified doctor with a solid appreciation of the medical side while also providing a more holistic approach. We made an appointment with him and he advised us that L should have an OATS test and IgG test. The OATS test examines the urine for the functionality of the gut and gut dysbiosis. The IgG test examines the blood for food intolerance and allergies. We proceeded with the tests and subsequently results for L showed an imbalance of intergut flora and a complete depletion in Vit C. L was started on a homeopathic constitutional remedy.

At this time we also felt L would benefit from continued body work. We discontinued Osteopathy and instead opted for craniosacral therapy having a preference for a gentle and less intensive approach. We continued with the counselling for L which we had started the previous

November as we could see the benefits of it.

In addition, our family needed support. L’s condition was on going and all the family were experiencing significant stress. We knew it was vital to be positive and hold a relaxed approach within the family. However it was a very difficult time and we all felt the strain of the situation. I was the primary carer, so I had the most interaction with L each day. I felt my attitude with L was in need of strong attention as I had become very anxious and obsessive in observing and assessing his day to day toilet activity.

It was at this point that I had the opportunity to work with JD Biggs.

I had had a session with JD about a year previously and had felt enormous benefits gained from insights I got in the work together. I let go of a lot of emotional baggage that had stopped me from making progress in my life at that time. I knew his approach to illness and disease was different to the mainstream and conventional methods of thinking. There is a“freshness” in his approach thinking and creates new possibilities in approaching health and how we manage experiences of physical and emotional pain. I felt this would provide a fresh approach which would benefit L and the family.

A strong example of this took place between late January into February and early March. L was experiencing severe abdominal cramps throughout the last school term up to Christmas and they had continued into January. They came on in the morning and were persistent through school time. The cramping was a big issue for L. He was missing a significant amount of school and although his teacher and the staff in school were understanding and supportive of the situation, I was anxious about his level of absence. I was eager to try and help L find support at school so his attendance would improve. I hoped with the help of his teacher he could find ways to manage these periods during school. However L found it too difficult to manage at school and he began to get very distressed and expressed intense levels of anxiety about going to school, begging me to let him stay at home. I was struggling to cope with the intensity of the emotions that were coming up for myself and L.. I felt at a loss as to manage these episodes.

The sessions with JD were invaluable at this time. With his guidance and encouragement, I began to develop skills around opening up and accepting what was taking place for L when he was experiencing abdominal pain. Through our conversations together, JD gently and very patiently offered suggestions and guidance to create changes in my thinking. This change in thinking created changes in my interaction with L.

Slowly I began to open up my awareness, to implement strategies to help me remain calm, either by using my breath or simply looking around and fixing my gaze on what was in my direct field of vision to become very aware of what was present to me in the moment.

I slowly began to practice this method of awareness and found that as I maintained this practice I was more open and accepting to whatever was presented to me. By deliberately slowing down my thoughts and being intensely present to what was taking place within me emotionally and

mentally, I became more open to allowing L express his feelings so he could fully acknowledge approach but required effort and focus from both L and myself.

With JD’s continued encouragement and support I maintained this practice. I

began to notice a remarkable change taking place in L.

Slowly, L began to get calmer when he experienced cramps. He became more open to dialogue as he was experiencing the cramps, something he was resistant to before. He became more open to guidance in how to navigate his way through the pain. Over the next 2 to 3 weeks L began to learn how to relax his body by breathing and I learned the value of providing him the time and space to work his way through the cramps. He began to notice that the cramps came in a wave and he learned how to manage his way through it. He was getting more assured in how to deal with the pain. As this was occurring he also began to negotiate his way back into school without all the anxiety and distress displayed previously. It was an extraordinary process.

L is currently attending school every day. While he can still get occasional cramping it is not severe and does not last as long as previously.

On the medical side, L’s Prednisone is slowly being tapered down. He is now maintained on 5mgs every alternate day with the plan to stop in June. The enemas have been discontinued and L’s toilet activity has stabilised to 1 or 2 toilet trips daily. There has been no blood in the stools since February. Since January, L has gone from strength to strength and at his last medical review on the 12th of April the medical team confirmed that L had entered into remission.

We continue with the treatment of care from a multi skilled team of practitioners and remain open and grateful to the support it provides L and our family.

Dear John-David B,

Thanks for being in touch and that detailed testimonial on the value of your intervention. It is encouraging that L’s symptoms are now in remission.

Writing on behalf of my 85 year old father in response to the young man with the night time abdominal pains. He suffered for years and followed all of the conventional advice to no avail.. Atkins and Barry Groves gave the answer. Cut out the cereals and grains, eating only one slice of white bread a day has totally solved the problem.

We have benefitted from a number of things raised in your column, and would hope that this can help.

Thanks, Anne J

Dear Anne J,

Many thanks for those comments

Dear Dr Le Fanu

Re the grandson of Mr HJ from Leeds with bad stomach pains

My daughter had a similar experience 7 years ago when she was 12 too. She experienced agonising stomach pains for about 6 months, lost her appetite, was admitted to hospital 3 times and lost 2 kg in weight. All blood tests were clear. From our research on the internet, we were convinced that it was a grumbling appendix, but were told that there was no such thing. In the end, the doctors did operate as my daughter’s condition began to deteriorate. The problem turned out to be her appendix which was unusually long and tucked behind her bowel; the end of the appendix was impacted. Once removed, she immediately began to improve and made a full recovery.

I hope this may be of some use to Mr HJ’s grandson. It may prove difficult, however, to persuade the doctors to operate as everything is ruled by the blood test nowadays. We only got my daughter’s operation because she was visibly going downhill and the doctors proposed a barium meal – which would have meant that they could not then operate for 4 days. I got very distressed; a kindly ward Sister phoned the registrar on her own initiative and within an hour we were off to theatre.

I love reading your column; have you published a book of the home remedies featured?

Kind regards

Dear Anon,

Many thanks for those comments

Dear Dr. Le Fanu,

I always read your column with interest and I like your common-sense approach to a lot of problems. That is my approach to life also ( am 75 and take no medication, haven’t seen my doctor in more than 5 years)

Your article on Prozac etc. was very timely for us, as over the last 6 months we have experienced problems in our son with depression. He is 46 years old and has no history of this. But it started last December, caused we think by unemployment, the realisation that at his age he may never get another permanent full time job, after a series of temporary and part-time jobs.

He decided to start his own business, has no business knowledge, but opened 2 new bank accounts, one personal, one for business. After arranging an overdraft he went on a spending spree, bought a new television, computer, top of the range mobile phone, and iPod etc. “I need these for my business” was his argument when we queried this. He could not tell us what his business was going to be. Now he has realised of course that he has no means of paying back the overdraft and the credit card debt. He gets benefit payments of £72 per week, which is pathetic, out of that he has to pay his mortgage, insurances, fuel bills etc. He has survived with our financial help so far.

Because of the depression we asked him to go to the doctor, who prescribed Olanzapine 10 mg. tablets last January, which he has been taking since then. The last couple of months he has become completely incapable of doing anything, his movements are grotesque, his tongue is forever going in and out of his mouth, could not sleep at night, not our son at all. I took him to the doctor (who had not seen him for some time) and asked for his opinion. He said he would refer him to the mental-health clinic. This was followed up with a phone call from a nurse, who asked me to describe his symptoms and how he was. She commented that these could be side-effects from the medication. He then had a home visit from a nurse and trainee, she brought a subscription with her for a different medication, the name escapes me, (beginning with i or q), he now sleeps better, but does not want to come out of bed. He keeps holding his head and saying “I cannot cope with this, I cannot cope with the outside world”. When I rang him last night he said he had not eaten at all, also had not fed his cat. He had several phone calls but had not answered them. Missed appointments reminders I think.

I cannot help feeling that counselling would have been a much better option at the beginning, rather than put him on the tablet regime. After 5 months of this he is at last getting an appointment with a psychiatrist next week. Should I be optimistic or despairing about that I wonder? We do not know how to help him cope, should we relieve the pressure by paying his debts? That would give him free rein to spend some more probably. We have coped with most things during our lifetime, but feel helpless in this case.

I would welcome your comments and input into this if possible. It will be much appreciated.

Yours sincerely,

Joyce T (Mrs.)

Dear Mrs Joyce T,

Thanks for being in touch and my great sympathies for your son’s psychological problems and the side effects of Olanzapine. It certainly sounds as if he has bipolar disorder (what used to be called manic depression) and it is almost certain he would benefit considerably from treatment with Lithium. This must have been a most stressful time for you but I would be optimistic that he should respond to treatment.

ALAMY

my son has had type 1 diabetes since he was three he is now 15

For approximately the last seven years he has suffered with the same symptoms ie severe stomach pains

I have spoken to his diabetic nurse consultant and gp to no avail the only suggestion was to bring him to see him when he is suffering an attack as that only happens at night this has not been possible

The only reason we can think could explain the pain is that his blood sugars are dropping more quickly than usual other than that we cannot explain it

Dear Anon,

Many thanks for those comments

Dear Dr Le Fanu

My daughter, aged 43, fairly frequently wakes during the night and experiences a smell of burning for no apparent reason. I have an idea that there is an underlying health problem which causes this, and would be very grateful for your advice.

Kind regards

Diane T

Dear Diane T,

Thanks for being in touch. The crucial question is whether this smell of burning is real (that is can be independently confirmed by others) – and if so its source clearly needs to be identified. I suspect however that it is more likely to be a phantosmia (that is a form of hallucination) which may rarely be caused by pressure of a benign tumour on the olfactory nerve. She may need to have an MRI scan and should discuss this further with her doctor.

I have had very dry and sore eyes for a few years now and also dry claggy mouth overnight and dry vagina etc. Have seen doc about eyes but there is no infection says it is old age (74) and drying up of bodily juices. Optician says same about eyes and gave artificial tears like the GP. I reckon a small dose of female hormone like oestrogen in a vaginal cream or something like that might help . I have been trying to find one you can buy over the counter with no luck- you always need a prescription or was looking for a natural plant oestrogen from somewhere. Any ideas, what do you think? I suppose I just accept the diagnosis and live with the problems. Thanks for any help you give. Ps I do use a computer but not enough to give eye trouble.

Dear Anon,

Thanks for being in touch and my sympathies for your problems. This ‘drying up’ of bodily secretions is suggestive of a condition known as Sjogrens . There is regrettably no specific treatment other than to use artificial lubricants though the drug Hydroxychloroquine can reputedly prevent it from getting worse. You should discuss this with your doctor as well as the option of using oestrogen cream to control your vaginal symptoms.

Prickly Heat

Dear Dr Le Fanu

I would be delighted if my communication helped someone. I know doctors are not allowed to prescribe tablets for a purpose for which they are not intended. However, you can walk in and buy these over the counter!

I am in my early 60s and have since the age of ten suffered from prickly heat. This first came to light on a windy boating holiday on the Norfolk Broads and subsequently on family holidays in sunnier climes. The itchy and unsightly rash was most unpleasant – and being perpetually covered in calamine lotion was not a great look! However, one year we visited Kenya and I dutifully took malaria tablets and to my surprise I had no skin problems. We visit family in Greece each year and in a two week stay I probably take four low dosage old school malaria tablets and have not suffered since. Some years ago I told my GP of my discovery (she was interested) and I also phoned the drug manufacturer (who took no interest).

Best wishes Ros W

Dear Ros W,

Thanks for being in touch and I am intrigued that these malaria tablets should have cured your prickly heat. Perhaps you could clarify which they were.

I have suffered from this every day for the past few years.

I am 82 and in good health, apart from some osteoporosis, for which I take prescribed calcium tablets 4 times a day..

My quite violent bowel movements seem to be caused or activated by wind, which are a side-effect of my tablets. The wind, on its own, often persists throughout the day.

Needless to say, the condition makes travel difficult and embarrassing.

Sadly, I don`t know of a remedy.

Don P

Dear Don P,

Thanks for being in touch, perhaps you could let me know the tablets you are taking and which you think might be implicated in these severe abdominal symptoms.

Dear James

I have had similar problems and after a colonoscopy [8 biopses] and a gastroscopy [6 biopses] the diagnosis was coeliac disease lymphocytic colitis hope this observation is of help.

This came as a shock at age 78 but much better now I am slowly getting used to a gluten free diet [and encouraging restaurants to be helpful !!!]

regards

Barry

Dear Barry,

Many thanks for those comments

I have similar symptoms to Mr A N and a colonoscopy confirmed chron’s / colitis. Medication (Mezavant ) is helpful.

I am aware of 2 people who have sensitive bowel problems who have been helped considerably by taking a teaspoonful of Manuka honey, strength 10+, each day. In both cases their problems diminished within a few days of starting treatment and have not recurred whilst they have been taking it.

Dear Anon,

Many thanks for those comments

Dear Dr Le Fanu,

Your medical query in the Daily Telegraph of today concerning undiagnosed abdominal pain reminds me of my own experience.

In 1943 at the age of 12 , recurrent agonising tummy aches were finally diagnosed as due to a trapped gut, in what was described as a “muscular divarication”. Long before precision scanning, the discovery was made by Cambridge based surgeon Mr Riddiough, with deep manual probing of the abdomen above and below the navel.

The divergent muscles were successfully reunited with a surgical repair, resulting in a complete cure. My stay in Addenbrookes Hospital, tended by beautiful nurses, had the beneficial side effect of arousing my passionate admiration for the fair sex!

Kind regards,

Dear Anon,

Many thanks for those comments

Dear Sir

In response to your medical query of todays date, re the 12 year old with chronic abdominal pain: My daughter, spent most of her childhood suffering from “Tummy Aches” that were put down to school nerves etc….We spent endless nights cuddled up together waiting for Paracetamol to take effect. She was very small for her age, and is now only just 5′ tall. We were sent to London hospitals for tests and offered hormone growth treatment, which thankfully I declined! It wasn’t until I took her, aged 19, to see a Consultant who actually took time to examine her, that it was found that she had been, and is still, suffering with Crohns/Ulcerative Colitis. That will not show up on any Xray, and a colonoscopy is the only way sadly to really confirm it.

Looking back we now realise that my mother who died aged 60 of bowel cancer and related illnesses also had undiagnosed Crohns, and that my daughter probably inherited the disease. Her sister is borderline diabetic, as am I.

Please ask this family to get their son checked out as Crohns becomes very debilitating as one gets older.

Mrs. Sheila S

Dear Mrs Sheila S,

Many thanks for those comments

Dear Dr Le Fanu

I am responding to your query re the above with an experience of my son’s illness at the age of 14.

The local consultant could not find a cause for the pain he was having, especially at night, and the school was querying his frequent absences.

After many tests he was referred to Gt Ormond Street where, again after a lot of diagnostics which didn’t show anything, we had a ‘final’ appointment with one of the top surgeons. He was as baffled as everyone else and suggested that it might ‘right itself’ but, being a nurse as well as a mother, I said I believed it was something to do with his appendix (others had dismissed this). He very kindly listened to me and sent my son for another ultrasound which showed a tiny bit of ‘something’ on the appendix. He operated and found a benign tumour. Fortunately this had not spread to the liver as this type sometimes does, in spite of being benign. My son was playing badminton in the garden 2 days after coming out of hospital and has never looked back.

This, of course, may not be the answer for the boy you have mentioned but it might in some way help. If a solution to my son’s problem hadn’t been found he would have had to repeat the school year, never a good thing for a bright student.

Regards and thanks for your excellent column.

Dear Anon,

Many thanks for those comments

Dear Dr James

Two items

1. I too suffered from severe and disabling stomach pains when I was 9 – 10 years old. I ended up in University College Hospital (1957) in London where Mr Bonham Carter cut a 4 inch incision in my lower abdomen. He removed my appendix because it was there and diagnosed MESENTERIC ADONITIS. It went away without any further treatment that I can recall. Mind you I still have a damn great scar.

2. I also suffer occasionally from the problem explained this week regarding very loose motion on returning to the loo a short time after the first, normal motion. I too would love an explanation. It does seem to occur the day after highly spiced food for dinner.

I enjoy your articles – please keep them coming.

Regards

Christopher B

Dear Christopher B,

Many thanks for those comments

Re your article about the problem experienced by NrN A from Leeds:

I have been a registered coeliac for 5 years and had the same problem and after a considerable amount of trial and error have discovered a solution. I now make smoothies which include lettuce or mixed leaves and it may be that this neutralises and normalises excess acid in the digestive system. I do feel that this needs investigating and could be a real help for people with this type of problem. Eating more leafy uncooked greens would obviously be as effective.

Kind regards

Dear Anon,

Many thanks for those comments

Dear Dr Le Fanu,

In response to this week’s conundrum of Mr N A from Leeds:

Nine years ago, aged 50, I was diagnosed with (mild) diverticular disease and microscopic colitis. Leading up to diagnosis I had similar bowel movements to those described in your column but used to have to “rush” more than once—maybe up to four times in the first hour of getting up. The cause was speculated to be an adverse reaction to lanzoprazole. Although I stopped taking lanzoprazole at the time of diagnosis, my condition never improved but it is sometimes less bad than at others.

I was advised that the colitis was causing the acute diarrhoea and, regrettably, these days I rarely pass normal stools even at the start of the day and the evacuations are generally very liquid.

However, the diarrhoea is very well controlled by my taking 30mg of codeine phosphate after the first couple of movements in the morning and maybe with a further 15mg in the middle of the afternoon if necessary.

Regards,

Ruth H

Dear Ruth H,

Many thanks for those comments

Dear Dr. Le Fanu,

In response to your reader with the urgent bowel movement I have just been diagnosed with IBS and one of my symptoms was exactly as described. I was advised to take probiotics either as capsules or as yogurt drinks and to have a tablespoon of linseeds each day which I put on my morning cereal. This has definitely helped and is worth a try.

Dear Anon,

Many thanks for those comments

Dear Doctor Le Fanu,

Mr N.A of Leeds is suffering from what is almost certainly Diverticulosis.I suffer from this which is annoying but not life threatening apparently. It usually affects older people and is caused by pockets in the gut which trap food which in turn causes fermentation , leading to what I call flooding i.e. serious looseness of the bowels. One has to be alert, especially in the morning and has to put up with it unfortunately.

With regards . G.C

Dear G C,

Many thanks for those comments

PA

Dear Dr Le Fanu

Having suffered from similar symptoms to Mr N A of Leeds I was recommended by a hospital consultant to try golden linseed. It must be crushed to a powder and I use my coffee grinder for this. Since starting this regime about 6 months ago I have not been troubled.

Regards

Betty McD

Dear Betty McD.,

Many thanks for those comments

Dear Dr Le Fanu

In answer to the query of a person who has two bowel movements close together, has this person had a cholecystectomy? (Removal of gallbladder). I have had this operation and I suffer the same effects. I believe it is a known side effect as there is no control over the flow of bile into the intestinal tract. In the past I have been prescribed Questran to assist, but I found this to cause more problems with regards to constipation than it was worth.

Hope this assists,

Chas H

Dear Chas H,

Many thanks for those comments

Mr AN of Leeds (2 June)

Dear Dr Le Fanu,

I experience exactly the same problem as your correspondent. I wonder whether it can be related to the cocktail of heart-related pills that I take daily: Clopidogrel, Atorvastatin, Omprazole, Nicorandil, Atenolol and Amlodipine.

Any explanation would be greatly welcome.

MP

Dear MP,

Thank you for your query. I would doubt these symptoms are related to the medication.

Dear Dr Le Fanu,

Approximately three months ago i had a throat infection following a bad cold. I was given antibiotics for this and after the first day of taking them i had an allergic reaction to them and came out itching all over – so stopped taking them.

After this i had problems with itching and feeling very prickly on and off for the next two months. If any time i got warm it would bring the prickling out bad for several days.

I have been taking antihistamines to try and help and over the months the prickling has become less prominent. But i am still suffering with an aversion to heat (which if i get hot will bring out the itching/prickling) and more strangely a very acute sensitivity to anything that is mildly warm.

For example; if i am sitting within a couple of feet of a light bulb it will make me feel uncomfortably hot in the face. Likewise if i am near a computer screen i also get the same problem. Also sitting near a window where the sun has been several hours before makes me feel hot in the face as though the sun is still shining hot through the window.

Any ideas why i am getting this heat aversion so bad – and what i can do? Or is it a case of keep taking the antihistamines and wait for it to slowly go?

Thankyou,

M J

Dear M J,

Thanks for being in touch. These symptoms you describe are strongly suggestive of Physical Urticaria where the mast cells in the skin respond to changes in temperature by releasing histamine. There is regrettably no specfic treatment other than to take antihistamines.

Dear Dr Le Fanu,

Re: Abdominal Migraine

I meant to e-mail you last week concerning the above with further information.

From the age of six my youngest son was having the same symptoms – severe abdominal pain and vomiting to the point where he could not even keep down a few sips of water. Our GP at the time diagnosed AM. Over the years my son experienced intermittent attacks and during his late teens was X-rayed but nothing was found.

He is now 27 and a few months ago he had an extremely severe bout and, it being a Sunday, I took him to Winchester A & E. He was in such pain that he was unable to walk the few yards to the entrance and had to use a wheelchair. The doctor immediately put him on a paracetamol drip and called in a senior doctor.

He decided to do an ultrasound scan and found the cause of the problem – kidney stones. They kept my son in overnight for further tests which confirmed the diagnosis. Having undergone treatment he has improved tremendously and at least is now aware of the problem and can take steps to alleviate the onset of any twinges. Incidentally, he is not diabetic.

The X-ray did not show anything amiss because he was not having a problem at the time so a scan has to be done during an episode.

I hope this helps

Kind regards

David S-C

Dear David S-C

Many thanks for those comments

Good Morning

I have a weird allergy for you.I am 60 fit and active. If I use milk in small cartons usually found in hotels and now peroni lager within the hour I suffer from diarrhea so violent that I cannot reach a loo!

Can you possibly tell me what I need to avoid as it is making life complicated?

Many thanks

Elissa M Mrs

Dear Mrs Elissa M,

Thanks for your query. It looks as if you need to avoid milk in cartons and peroni lager!

Hi

I was interested in the problem of Mr N A re bowel problem, as I intermittently have this too. Mine started after the removal of my gall-bladder 15 months ago and does not seem to be triggered by any particular foods.

Mr A did not say if he had a similar operation.

I hope someone has helpful advice on this

Thanks

Dear Anon,

Many thanks for those comments

Dear Dr Le Fanu,

Further to the readers enquiry in your diary of Sunday 1 June 2014 relating to his inconvenient bowel movement. I have a similar problem but this only occurs infrequently – approximately two or three times a month on average. I have not discovered a specific cure but my findings are such that I put the problem, in my case, to two possible causes.

One is that the normal first movement becomes separated from the second by a degree of fermentation occurring in the bowels, thus giving the effect of two distinct movements at different times. The fermentation may be caused by part of a meal consisting of fermentable fibre. I have consistently found that the second movement is invariably preceded by excessive flatulence. The second movement is invariably looser and of an irritated nature

The second possibility is that a digested meal that is following the first movement irritates the bowel (spicy?) and causes the passage through the bowel to be speedy and not fully absorbed. Thus it “catches up” and becomes ready for elimination to soon.

I have reason to think, for myself, that the first option is the most frequent, with occasional additions of the second.

I do however suffer from a surplus of stomach acid for which I take omeprazole, and from diverticular disease where I have been advised to reduce fermentable fibres.

These opinions are merely theories based on experience but I have found no permanent cure, only alleviation.

You may pass on any information you think appropriate.

Best wishes John

Dear John,

Many thanks for those comments

Dr.Le Fanu, Mr. N.A. of Leeds echoes exactly my own problems. Eighteen months ago I suffered a severe loss of blood and exudate from what I thought was my anus, it turned out to be a inter anal abscess which had formed a fistula through to my buttock. Nine months ago my surgeon suggested LOPERAMIDE to alleviate the twice in quick succession daily visit to the loo. This has not solved the problem. I have recently had the sixth full surgical operation on the original site brought about by the presence of Pre-cancerous cells, the surgeon now believes my wound will heal after removing a ‘tumour’. I gather my case has gone down in the history books? He says the ops have nothing to do with my ‘Toilet’ problems….but….I did have a TURPS and seven weeks of radiotherapy on my prostate some eight years ago and maybe this has some bearing on my present predicament. Meantime I hope to continue without having an accident and finding a cure sometime soon. PS I’m coming up to my 82 birthday. John Moore.

Dear John

Many thanks for those comments

I have instantly put down yesterday’s Telegraph on reading your column. This symptom is the same experienced by my late husband which we ignored for a while, but he mentioned it on a visit to his doctor, was tested, and was diagnosed with bowel cancer.

Please insist your reader seeks medical help immediately. It upsets me not to give a reassuring answer.

Lutena Y

Dear Lutena Y,

Thanks for being in touch and drawing attention to the possible serious underlying cause of these symptoms.

Your correspondent with the annoying bowel habit, which I also sometimes have, might try cutting out or minimising any butter or spread at breakfast.

This certainly seems to act as an aperient, usually occurring an hour or so after intake, and sometimes more than once. !

Many thanks for those comments

On several occasions I have had an excruciating stabbing pain coming from deep in my right ear but yesterday’s bout was not a good experience. – over about 3 hours I had this pain in separate occasions, not continuous, and very slight relief was if I pressed really hard in my ear with my thumb but still the pain was hardly bearable.

Your thoughts would be much appreciated.

Dear Anon,

Thank you for your query. Could you possibly let me have more details – including your age, how long you have had this complaint, whether you have seen any specialists etc.

Dear Dr. Le Fanu,

I think that Mr. A.N from Leeds could have Diverticular Disease. I had precisely this problem perhaps 2-3 years ago which made leaving the house even by 10am virtually impossible. After a colonoscopy and various other (horrid) procedures, it was discovered that I had ‘very severe Diverticular Disease’ for which, alas, there appears to be no permanent solution. Despite consulting a professor of gastroenterology, I really got no further, so I decided to try various ideas myself.

SO: I now take one Imodium before my Weetabix and one immediately afterwards, no matter how I feel my tummy is, even if I feel that all is well. This has made the entire difference to my life. I then need one more, perhaps after lunch or before dinner and my problem is now completely under control.

What does worry me somewhat is that I’ve no idea what 21 (or, on occasion a few more) Imodium will do to me as I will obviously be taking them for the rest of my life. Any ideas re this please?

Yours sincerely,

Dear Anon,

Many thanks for those comments

re Mr N A from Leeds

I have a similar problem at age 79.. It started when I was 78.9yrs . I have been on statins and Metformin since 77.6 yrs. I cannot attribute any change in health or circumstances to this new condition. It happens irregularly but the urgency for a second visit is such that I worry a bit.

I shall be interested in your readers opinions.

Thank you for your interesting columns.

Alan B

Dear Alan B,

Many thanks for those comments

Dear Dr Le Fanu

In your column published on 2 June, you refer to ‘the interesting condition known as abdominal migraine’.

A friend has a teenage daughter who is apparently suffering from this condition – and has done since she was about 7 years old, although it has become much worse recently. She has endured a painful lumbar puncture and numerous drugs have been tried by way of exploratory treatment, but to no effect.

She is now trying to take GCSEs while suffering from debilitating nausea and sickness, as well as a chronic headache which only abates slightly in the afternoons. She has been permitted to attend school on a part-time basis when she feels she can, but this is, of course, having a considerable negative impact on her education, and her confidence, at a very important time in her life.

Neither the local GP practice, nor hospital seem to have any idea what to do next. Are you, or your readers able to offer any help or advice, please?

Yours sincerely

Barbara M (Mrs)

Dear Mrs Barbara M,

Thanks for being in touch and my sympathies for the plight of your friend’s daughter. There are, as with classical migraine, a range of possible preventive treatments such as Pizotifen and Propanol, while some patients respond to the specific anti-migraine drug Sumatriptan.

In Mondays telegraph you passed on a query from Mr N A who was puzzled by his bowels. I frequently have a similar problem since having a pancreaticodoudectomy (excuse spelling). I guess having had gallbladder removed at the same time affects digestion. I try to eat small, regular meals but it only seems to work now and then. I look forward to one of your readers having a better solution.

Dear Anon,

Many thanks for those comments

Re this weeks conundrum June 2nd.

3 years ago I had pancreatitis and then my gallbladder removed and have since suffered this problem, sometimes after every meal. The pain is bad and motion “yellow water”….I presume this is bile, not controlled by the gall bladder. I tried and stopped various foods to no avail and my GP prescribed codeine phosphate which does help to a degree but has other side effects.

Could Mr N have a gall bladder full of stones? If someone has a miracle cure I would like to know as life is controlled by “where’s the nearest loo”! That’s when I manage to go out.

Hope this may help Janet D

Dear Janet D,

Many thanks for those comments

Interesting query from Mr N A of Leeds this week as I have the same pattern and have had for a number of years; I am now 58

Unfortunately, my second almost liquid evacuation is followed by similar movements through the day after drinking coffee which may be linked

I use lactose-free milk now which eases the situation as well as an immodium a day or its equivalent

In the past, my faeces have been tested and I have had a intestinal tube inserted to check, presumably for cancer, all to no avail

I look forward to the answers!

PS My two daughters follow you with great interest as they are both at medical school, King’s (and I was at the Royal Free)

Yours sincerely

Dear Anon,

Many thanks for those comments

The symptoms described in the conundrum of June 2nd are similar to mine. After being diagnosed as suffering from IBS (= don’t really know) I self diagnosed via the internet and later confirmed by my doctor as “bile salt diarrhoea”. This can arise after having your gallbladder removed resulting in excess bile in the gut which rejects it. A solution is a resin which captures the bile but it must be taken 2 hours before food and other medicines which may not be easy done. Hope this helps.

John

Dear John,

Many thanks for those comments

Dear Dr Le Fanu

In response to this week’s conundrum from Mr N A from Leeds, I had a similar experience a few years ago. After I reduced my milk intake significantly (including the milky drink at bedtime) my problems disappeared completely and I concluded that this may well have been lactose intolerance. I also experienced bloating and gas, which have similarly disappeared.

It might be worth considering.

Yours sincerely

Pat T (Mrs.)

Dear Mrs Pat T,

Many thanks for those comments

Dear Dr Le Fanu

For a number of years I have had trouble with irregular bowel movements as experienced by Mr N A of Leeds.

My doctors had thought that I had some form of Diverticulitis. However a month ago Dr Collyer who is treating me for Polymyalgia Rheumatica suggested I give up all caffeine. I was already drinking decaffeinated coffee but now after 4 weeks of going over to decaffeinated tea or drinking Red Bush I am 90-95% better.

Regards

Nick E

Dear Nick E,

Many thanks for those comments

I have had for several years the same problem as the gentleman who after having a normal bowel movement needed a short while later an urgent and loose return. The solution in my case was to stop using cow’s milk and use goat’s milk instead.

Even now after many months the problem returns if I use cow’s milk say when staying away from home. I also use goat butter and cheese although this is not essential.

It can be a very embarrassing problem.

JLMC

Dear JLMC,

Many thanks for those comments

Dear Dr Le Fanu

I read with interest the two articles on the above in Monday’s edition.

Relief may be obtained if the parties concerned revert to the squatting position for defecation as practiced in the East.

A useful website is www.naturesplatform. It is not necessary to purchase anything but a small bowl filled with water can be used. See the website for position etc.

The site also refers to other western diseases which may be the result of our use of the “throne” over the last 150 years or so. A very interesting and informative read and also concerning.

JT

Dear JT,

Many thanks for those comments

Dear Dr le Fanu

The item about someone who has a normal bowel movement & then diarrhoea.

I had something a bit similar, although with me the movements were all loose or diarrhoea. I eventually found Questran (cholestyramine), which apparently is used for bile acid malabsorption. This worked perfectly for me & may be worth trying on a suck it & see basis.

Derek

Dear Derek B,

Many thanks for those comments

Dr Le Fanu"s on the internet health clinic, Friday 6th June 2014