Dr Le Fanu's online health clinic, Friday 14 September 2012 I'm having big problems with swallowing wind which causes problems especially at night when I cannot sleep. I have tried many solutions with no success. It is made worse during the summer when I have hayfever which blocks my nose so I have to breathe through my mouth. Trying "Wind eze" tablets but they do not seem to help. Had a cup of fennel tea before bed time this week which upset my stomach considerably. Any suggestions would be welcomed. Regards, Sandy Dear Sandy, The swallowing of air with food and saliva can indeed be an important contributory factor to excess wind - but is almost always invariably compounded by the internal production of gas. Specifically the stomach breaks down the bicarbonate in saliva to produce carbon dioxide, while the fermentation of food residues by bacteria in in the colon releases hydrogen and methane. Thus while the swallowing of air can be minimised by a change in eating habits - eating slowly in small mouthfuls, avoiding large meals, chewing gum and sucking on pen tops,- this gas generation must also be attended to. This is best addressed by cutting down on wind generating food such as beans, apples and fruit juice . You should inquire of your doctor whether you might have a mild degree of lactose intolerance and chew gas absorbing charcoal tablets four times a day. Dear Dr LeFanu I am having attacks of vertigo in bed at night. I am in my late fifties and did have an ear infection some years ago that had to be treated by a consultant and also one hospital visit where my ear had to be scraped by a machine. So far I have not had any attacks during the day. Please could you advise me what treatments would help and also if the exercises that are recommended for vertigo would help. Is vertigo an ongoing condition? I enjoy all your articles very much and find hem very informative. Hoping that you will be able to help me. Kathleen Dear Kathleen, There are two reasons why you might be having vertigo at night. First you may have some mild disturbance of the balance mechanism of the middle ear that is not apparent during the day, as it is compensated for by visual cues and the sense of position of the limbs. Alternatively this could be Benign Paroxysmal Positional Vertigo due to the presence of small crystals in the middle ear and which is brought on by sudden head movements but also rolling over in bed at night. The former can be alleviated by exercises to improve the balance and a small dose of the drug Stemetil . BPPV is best treated by either the Epley manoeuvre or Brandt - Daroff exercises, details of which are readily available on the internet. I read your column regularly and often find useful items of interest. However, I am puzzled by your response on Monday 3 September regarding a gentleman's enquiry about passing wind and urination. You quote a 13th century poem illustrating the benefits of passing water whilst breaking wind. But you then go on to say that passing water and wind together might indicate a health hazard requiring a major operation. This appears to be a contradiction. I don't understand. Ms Jones Dear Ms Jones The column you referred to had to be shortened for space reasons and so was not as clear as it should have been. Put simply the passing of urine while breaking wind may indeed be healthy but the situation is very different in those in whom there are bubbles of air in the urine. This indicates there is a connection between the bowel and bladder - known as a Vesico Colic Fistula that needs to be repaired. I am an 81 year old widow with 2 replacement hips and arthritis of the spine.In the last few months my feet have been misbehaving.They are alternately painful then very cold and then burning hot. Now they are also tender and a little swollen. This condition often keeps me awake at night. I would be so relieved to know the cause and how to deal with it. I always enjoy your articles. I do hope you can advise me. June Dear June, Thanks for being in touch and my great sympathy for these distressing symptoms in your legs. These are likely to be due to either pressure on the nerves in the lower spine or the disturbance of function of the sensory nerves to the legs known as a peripheral neuropathy. The former may be alleviated by an anti inflammatory drugs and manipulation though regrettably the treatment options for the latter are limited with some people being helped by the drug Gabapentin. The further possibility to be considered if your legs are red and warm to the touch as well as tender and swollen is the infection known as cellulitis that requires treatment with antibiotics. I am 77years old and have in the past 6months had tests for thyroid,lung,heart,etc. (a complete M.O.T.) all of which have proved fine.I have also been examined by a general consultant who could find nothing wrong. About 2years ago I started to sweat excessively on my back,chest,and the back of my head, whenever I get warm or when exercising, even walking. Any suggestions to alleviate this embarassing condition will be greatly appreciated as all else has failed. Colin. Dear Colin, The problem of excess sweating is usually confined to the armpits, hands and feet but can also - as in your case, affect the head , back and chest. The treatment however is much the same, the regular use of the aluminium hydrochloride anti perspirant Anhydrol that blocks the sweat ducts and the drug Oxybutynin in small doses. Two weeks ago I came out in a rash on my legs and arms.Two days later it had cleared up but since then I have had a burning sensation in my knees and some times in my legs. Can you please help? John Smith I confess I have not encountered this problem of a post rash burning sensation but I suspect it will, almost certainly, resolve spontaneously in due course. Dear Dr. LeFanu I have for some years suffered lower back pain which in 2011, following an MRI scan. was diagnosed as stenosis of the spine. In March 2012 I underwent surgery to alleviate the problems caused by this complaint but six months later I find that my condition is worse in that I have difficulty walking. My lower legs have no feeling in them whatsoever, a condition a pjhysioterapist was unable to explain, and my right thigh is very painful. (I woke two days after the operation with severe pain in this thigh which had not been there previously and it has now become and annoying ache with occasional sharp pain which will not go away.) I have followed instructions as to exercise and try to walk as much as possible daily with the help of a walking stick which I cannot do without. My GP has little sympathy and states that I have not given sufficient time for the operation to take effect. I am concerned that after 6 months there is no sign of any improvement and shoul;d the deterioration continue, I will be confined in a wheelchair. I have been refused referral to the surgeon who performed the operation and would be very greatful for any advice you could give me. Michael Higgens Dear Mr Higgens, My great sympathies for your troubles. There are several reasons for the persistence or exacerbations of your symptoms following the operation including the possibility that it did not effectively decompress the nerves or that they might have been damaged during the procedure. Whatever it may be your case clearly needs to be reviewed by the surgeon and you should inform your GP accordingly. Dear Mr Le Fanu, Reading your comments about Cod Liver Oil reminded me of whilst attending School in Islington in 1942 during the war we used to queue outside the Headmasters study every morning for a tablespoon of Radio Malt Cod liver oil. There were 3 spoons, and one had to be quick and lick the spoon clean before passing it to the fourth boy and so on down the line. Considering the time we children spent underground in air raid shelters I cannot recall having a cold or other infections. To this day at over 80 years of age I still have my Cod liver oil and Malt (although my wife refuses to kiss me after taking it). I walk between 2 & 4 miles every morning, play golf twice a week, maintain a large garden growing all my own Veg. cut lawns for a couple of elderly widows on the estate and enjoy driving my Classic Morgan around the countryside. Yesterday I drove 250 miles back from holiday on the Isles of Scilly. I think that this is mainly due to Cod liver oil and malt, plus drinking full cream milk, or am I just lucky? Thankyou for your interesting articles. L. Alexander Dear Mr Alexander, Thanks for the interesting comments. The merits or otherwise of malt and cod liver oil have generated much interest and even made it into the correspondence column. I will be returning to it again next week. Dear Dr Fanu, I have a condition which has so far puzzled my GP and a specialist who I saw about 12 month ago. At intervals, when I start to eat, I get what I can only describe as a blockage in my throat. It is difficult to swallow the food and when it does go my mouth fills up with mucus. For anything from 15 mins to 4 hour hours my mouth continues to fill up. On one recent occasion i got up more than a pint over three hours. There is no warning as to when this will happen and the clear periods have varied from a week to a couple of months. The spark seems to be food which requires a bit of chewing and it is usually the first mouthful. My GP tried Domperidome but not very hopefully, and the specialist I saw tried a Barium swallow, though when not chewing there appears to nothing wrong so it produced negative results. Neither of these doctors have been able to progress any further. I read somewhere recently that the throat produces about 2 litres per day of mucus to lubricate the digestive system. I wonder if in my case it is getting stuck and ultimately has to come up. I would be grateful of any help, Sincerely, William Dear William, The blockage you describe is due to spasm of the muscles around the esophagus and the clear slightly salty fluid that fills your mouth (known as waterbrash) is secreted by the salivary glands as part of a protective reflex against acid reflux. These problems are clearly related and can usually be prevented by taking an acid suppressant drug such as Omeprazole or Ranitidine. I have noticed that over the years that my husband, who is in his mid 50s, holds his head at an angle so that while looking forward the top of his head is over by about 10 degrees. Should we be worried? He says he has noticed that he does it while driving and now only holds his head straight if he thinks about it. Thank you for your help. Deborah Wilmington Dear Mrs Wilmington, I am not quite sure what accounts for this forward tilting of the head. It sounds as if it could be positional or perhaps due to weakness to the muscles at the back of the neck. I will mention it (anonymised of course) in the Monday column in the near future in anticipation that it might elicit useful suggestions as to what to do about it. Around 27 years ago I was involved in a car accident ultimately resulting in a cervical discetomy. Between the accident and the operation I had some very bad physiotherapy which made things worse and for quite a bit of time I had to wear a hard collar to get relief particularly when sitting or lying down. Before scans became available I had a myelogram to identify where the disc prolapsed was in my neck - it turned out to be C5. Over the years I developed serious muscle and connective tissue pain for which a specialist neurologist prescribed Amitryptaline. The pain extends to my face, arms, neck, shoulders back and legs. The Amitryptaline works fine (I currently take 12.5 mg per day but could take up to 25 mg) as I am very active 72 year old playing golf 3 times per week, walking at least 10-15miles per week and maintaining a large garden. Apart from the neck an muscle problem I am a very fit person However when that any activity done too much causes extreme muscle pain and spasms in my thoracic and lumber spine. A lot of the face & neck pains I had originally before the operation get worse as well. I can get relief from these pains by visiting a Cranial Osteopath and wearing a collar - this I have done on and off for many years now. Other forms of treatment like physiotherapy have an adverse effect on the muscle pain. Herein lies my problem - I cannot rest my head in a chair or lie down for long without activating activating the muscle pain to a level where it would keep me awake or I have to stand up! Lying down in any case is possible on my right side only. Wearing a soft collar at night helps but this is in itself hot and uncomfortable. I would be interested to know if anyone else has this type of problem and of any other solutions? Graham M Dear Graham M, My sympathies for this difficult problem, though I am very impressed how it does not prevent you from leading such an active life. With regrets I can't really suggest anything you are not doing already other than to ensure that you have a firm pillow and continue visiting the osteopath on a regular basis. I had surgery to remove a malignent colon tumour followed by chemotherapy to mop up which finished in November last year. A lasting side effect is numbness in the hands and feet and lower legs. It doesn't seem to improve and wonder if anything can be done to help the damaged nerve ends to repair. For example, is it better to rest or exercise the legs and hands? How long should I wait before accepting it is permanent? Philip Dear Philip Thanks for being in touch and it is good to hear of the successful treatment of your colon cancer. This numbness of the hands and legs, as you rightly infer, is a side effect of the chemotherapy, damaging the sensory nerves to the limbs - otherwise known as a peripheral neuropathy. Some people report their symptoms resolve in the few months following treatment but I suspect by now it is unlikely you will see much improvement. I would have not thought rest is particularly beneficial but you will have to take steps to prevent the consequences of the balance problems that may be a feature of this condition - ensuring you have adequate handrails and lighting around the house. It is reported the antidepressant Duloxetine may help alleviate some of the symptoms of chemotherapy induced neuropathy - and your might discuss with your doctor giving it a trial. Iam sorry not to be able to be of more help.With best wishes.