Dr Le Fanu's online health clinic, Friday 17th January 2014 Can you suggest anything that might help this condition. It would seem sensible in the first instance to establish whether this rash is indeed "late onset" psoriasis - though this is certainly the most likely diagnosis. It is best treated, at least initially, with the drug Dovobet but also responds well to ultraviolet light treatment that would require referral to a skin specialist. I had a mild stroke on the 4th Nov 2013 but had no lasting problems. I was diagnosed with Atrial fibrillation and am taking Warfarin and Bisoprolol. I was told I could I fly in 3 months but as I am 81yrs old and the flight would be 4 hours to the Canaries, is this wise? I would appreciate your opinion. I read your article each Monday with interest. Thank you, yours sincerely Joyce R Dear Joyce R, Thanks for being in touch and I appreciate your concerns. Still the current advice would be that flying poses no additional hazards to those with Atrial Fibrillation so long as it is well controlled and you are taking Warfarin as a preventive measure. You will no doubt know of the CoaguChek device for self monitoring the drug thinning effects of Warfarin. Have fun in the Canaries! I am female, 76 years old and in good health. I take a lot of exercise. About a year ago, I had an MRI scan of the heart, because I was very tired and had a tight uncomfortable feeling in my chest. The scan found nothing wrong. But I am getting palpitations, particularly lying on my left hand side. I can feel extra beats and a faster heart-rate. This is very uncomfortable. Do you have any suggestions, please? Jean S Dear Jean S, It is very reassuring that the MRI heart scan "found nothing wrong" still the recent onset of these palpitations and the discomfort they cause would seem to warrant investigation to clarify whether you have some disturbance of heart rhythm that needs treating. I am a 68 year old male (12 stone 4lb ,Height 5ft 10, Waist 36) who's always had good health. I swim 1000m once a week, walk regularly, cycle occasionally and tend a 10 perch allotment. I started having health MOT's with my GP when I was 65. I was put (reluctantly) on Lisinopril for blood pressure 2 years ago. I take 5mg , they had no adverse effect but reduced incidence and severity of occasional headaches. They reduced my BP typically from 150/90 to 130/80 I was advised also to take Statins because my risk of a stroke was around 20% (ratios of good and bad cholesterol). Total cholesterol is 5.7 I eventually succumbed late 2013 (10mg Atorvastatin) and since then I have noticed the following: 1) Pains in the soles of my feet, especially the heels and most noticeable after sleep or sitting 2) Aching across the shoulders which seems to run into the neck and lead to cluster headaches that do not respond to analgesics / sleep (different to my "normal" headaches) 3) The consumption of even a modest amount of alcohol (eg a pint of shandy) seems to lead to a headache. 4) My blood pressure is raised to 150/90 -its to be checked in a fortnight and they may raise the Lisinopril to counteract. I have just had a blood test to see how the Statins have acted (results awaited). The practice nurse suggested I take the Statin in the morning instead of a night (which I'm trying) and depending on the result of the blood test might take alternate days. My doctor says without the pills we'd all be dead and regards alcohol just to cut out-not that a drink more than 2-3 units / week anyway. Given the risk factors above what is your view on my continuing with the Statin? I know headaches and general aches can be side effects but are painful soles a recognised affect? Are there any reports of the effect of alcohol? Can statins adversely affect blood pressure? For me it is the headaches that are of most concern. Regards Reg D Dear Reg D, Thanks for your query which reflects the experience of many. Where to start! The benefits of taking statins for someone of your age with cholesterol of 5.7 and no history of heart disease range somewhere between the scarcely detectable and the non existent. Meanwhile their adverse side effects of aches and pains in feet and shoulders compromise your enjoyment of all those activities which keep you healthy! You doctor's insistence that you take them (as in the absurd observation that without them "you would be dead") could be sincere (if misguided) but it is more likely to be due to his being financially rewarded for prescribing them. As for your specific queries: 1 and 2 are most certainly statin side effects. No 3: I have not come across statins causing an alcohol induced headache. No 4: statins do not raise blood pressure but can cause diabetes. You should give them a (permanent) rest. Dear Dr James, About 8 years ago I had a mucous cyst/ganglion surgically removed from my right index finger (I am right handed). It was resting on the nail bed and had stopped the nail growing. At the time I had been using an ultrasonic electric toothbrush and as it seemed to irritate the finger I went back to using a normal toothbrush. Last year, I changed dentists and the new one was nagging me to use an electric brush so I purchased another. Now I have another cyst, this time on the middle finger of the right hand which is also disrupting the nail growth on that finger. A dermatologist has attempted to freeze off the cyst but so far without success, so I may have to have surgery again. Have you ever heard of high frequency vibration being the cause of these cysts or is this just a coincidence? I would be interested if you know of any similar cases. Thank you for your column, it is always interesting and challenges a lot of conventional medical thinking. Best regards, Janet H Dear Janet H, Thanks for your query the cause of these mucous cysts of the finger remain obscure - but whatever it might be, having one increases the likelihood of having another. That is all. Your electric toothbrush is exonerated. Firstly I would like to say what a first class column you have and I look forward to reading it each week. My questions are as follows I suffer from Bronchiectasis and chest infections from time to time. Sometimes I am unable to distinguish whether the coughing is from my Bronchiectasis or a chest infection. Is there an easy way to note the difference? What are the best antibiotics for a chest infection? Should steroids be taken together with the antibiotics? My consultant recommended to my GP that for a chest infection to take antibiotics and a course of steroids. My GP will not give me the steroids. Is there a good reason for this? Thanks for being in touch and your kind comments about the column. The structural damage to the lungs known as Bronchiectasis can become a focus for recurring chest infections best controlled with a judicious combination of antibiotics and chest physiotherapy. When very severe it can warrant removal of the damaged part of the lung. Steroids are not necessary unless you also have the wheezing and tightness of the chest characteristic of asthma. My grand-daughter Emma, nearly 8, has been troubled by skin problems since birth, eczema on body and dry patches on cheeks. She just does not like the feeling of aqueous cream on her body etc and I wonder if you or any of your Readers have any suggestions for alternatives. Aqueous cream is fine as a soap substitute but contains the chemical Sodium Lauryl Sulphate (SLS) that when used as a moisturiser can exacerbate the symptoms of eczema. Your granddaughter would probably benefit from switching to another type of moisturising agent such as Diprobase. I wonder if you can offer any suggestions regarding my daughter's symptoms. She is 25 and had no previous health problems before suddenly becoming ill. She has learned to live with them, but would love to feel healthy again. The symptoms began December 2011, one week after returning from backpacking in West Africa. She felt numb down her left side and was taken to hospital with a suspected stroke. Initially the numbness was accompanied by a high temperature and very painful headache (headache was constant for 5 months, but slowly decreased). Admitted at the time to hospital for 6 days, received a MRI scan, CT scan, ultrasound scan on left side of neck, lumbar puncture and blood tests- all clear. Vertigo- constant slow feeling of boat-like movement, walls breathing etc. Feeling increases when lying horizontal and in the dark, at its worse after just waking and getting up. Feeling decreases when on moving transport. Headache- apparent every morning after getting up, left side of the head, goes away usually within 30 minutes to 1 hour. Pin prick burning sensations of the scalp, last for a few seconds, sometimes 20 times a day, sometimes days without it at all. Pressing the left side of the head, behind left ear (particular spot, very painful). Numbness- loss of sensation on left side of face, can go days without noticing it, other days very apparent (prickling, tingly etc). Facial movement restricted such as raising eyebrows. Ear- constant fullness in left ear, clicking every time on swallowing. She has seen a neurologist, an ENT specialist, a cranial osteopath, a dentist (for possible TMJ) and a physiotherapist. None can find a solution, I would be very grateful if you could suggest anything we have not tried. Yours sincerely Barbara S Dear Barbara S, Thanks for your query and my greatest sympathies for your daughter's misfortunes. The pattern of symptoms you describe does not "ring any bells" but I will feature it in the column in the near future in the optimistic hope it will elicit some useful suggestions. Dear Dr. Le Fanu, My husband has experienced the terrible symptoms you describe, although I think probably not on the scale of your unfortunate correspondent. He has been helped by taking 200mg of Carbamazepine, twice a day, and although much improved the symptoms have not disappeared entirely but he is finding them much more liveable with. I hope this helps. Best regards, Jean S I am glad to hear that Carbamazepine seems to have improved your husband's distressing symptoms. Several readers have commented on this unusual syndrome which will feature in the column next week (27 Jan). For a long time now I've had a very itchy area around my anus. Two or three years ago it became very troublesome, so I went to the doctor, who did not examine me, but prescribed Betnovate cream for when it got bad. I have used this over the years for when it was very itchy, but have been told recently by a friend that it's not a good idea to use this cream regularly. I have therefore been trying to use nappy rash cream or Sudafed cream instead, but at times the itching can be bad, particularly at night when I suppose I get hot, or when I wipe myself after using the toilet. If I don't cream the area it can feel dry and sore. Can you recommend a treatment I should use please Mrs D Dear Mrs D, Thanks for being in touch and my sympathies for these distressing symptoms of "Pruritus Ani." This is, as you will appreciate, a particularly sensitive part of the body and thus prone to this type of complaint. The standard treatment is a steroid cream as your family doctor prescribed together with measures to keep the area clean and dry - as outlined in the pamphlet on this condition published by The British Association of Dermatologists that can be downloaded from the internet. It is also claimed that certain foods exacerbate the itching - particularly tomatoes but also tea and coffee and some nuts and cheeses. Four years ago aged 50 I asked for a PSA test. I had no recognisable symptoms, no family history of the disease and being Caucasian, no other risk factors. The first result was 4.8 - well above normal for a man of my age. Sadly my GP filed it without telling me, but an unrelated trip to another doctor at the same surgery revealed the missing test and I had another scored at 6.0, five months after the first. And here's the first useful bit of data - the rate of change, which annualises at over 50%. Given that I had no sign of prostatitis it's significant. A DRE at the hospital was unremarkable, but clearly the PSA rise gave cause for concern, so I had a biopsy. The results were truly remarkable - nine of ten samples taken were 65%-70% tumour cells. Prostate biopsies are often referred to as looking for cherries in the fruit cake, so either the registrar who did the biopsies was a very lucky man or I had a large, bilateral tumour. Radical surgery was the only way forwards. The post-op pathology revealed a tumour 20 mm long by 6 mm in diameter, in an organ that's the size of a walnut when healthy. I was continent from the day the catheter was removed. I have ED, but I also have a PSA that is now less than 0.003. Over-treated? Clearly not. Saved by the PSA test, most certainly. My surgeon reckons I'd be facing metastatic cancer about now. Based on an average man with metastatic prostate cancer I'd be dead by 65, perhaps much sooner. I buried a friend aged 51 whose metastatic prostate cancer was diagnosed aged 48. Until there is a better test then urologists will have to use the PSA test. I hope GPs are like mine and agree that while imperfect, it's all we have. It saved my life. With best wishes Thanks for being in touch and your most informative account of your experience with the PSA test. I will be discussing this further in next week's column - but concur with your substantial point. The PSA is indeed a very useful test in identifying those with prostate cancer and certainly saves the lives of those like yourself with a large and growing tumour. The difficulty rather lies in the fact that currently 60% of those undergoing major surgery and other radical treatments have only "low risk" cancers where the chances of it causing harm are minimal. Further to the recent observations in your column, you may like to know that last year I went on holiday for a few weeks and forgot to take my glucosamine tabs with me. My achy legs and shoulders gave me very little trouble while away, so I decided to see if I would still feel OK if I took no more of them. Sure enough, I continued to be less achy, but the other benefit was I stopped having 2 or 3 evening episodes of diarrhoea each week. I had put this down to old age and put up with it , after never being able to find a common dietary reason for it. I can think of no other changes in my routines that would account for this very welcome outcome. I am so grateful for your sensible column and greatly benefited from learning to stop agonising thigh cramps by pinching between nose and lip, which by the way, also works for cramp in my feet at night. Many thanks, Sheila J Dear Sheila J, Thanks for your interesting comments about glucosamine and the possibility it might cause "unexplained" diarrhoea. I will be mentioning this in the column for the benefit of others. I am, of course, delighted to hear the "pinching" treatment for nocturnal cramps has proved so effective for you. I am in my late seventies and have a long history of intermittent Depression although I am now very well. For nearly seventeen years now I have been prescribed Venlafaxine and I have found it impossible to come off the drug because of the terrible side effects namely 'electrical shocks' in my head and generally feeling very unwell. I haven't really had any helpful advice from GP's or Psychiatrists as to how to wean myself off the drug but I have tried numerous ways of slowly reducing over a long period of time only to find a couple of days after stopping the drug completely all the horrible side effects begin. If it had been explained what the drug can do I would never have consented to take it. I understand it is possible I might never be able to get the drug out of my system after such a long period of time. I would greatly appreciate any advice or comments you have to make as I always find your Diary so interesting and helpful. I currently take 1x 75mg tablet a day in the morning. Dear AC, It would, be surprising if you did not have these disturbing withdrawal effects you describe having taken Venlafaxine for so long. There is, as you will know, a lot about this on the internet (see, for example, the website of The Royal College of Psychiatrists on "Withdrawing from Venlafaxine"). There is no way I am aware of of coming off this drug other than the slow weaning method you have obviously tried on several occasions. The only other option would be to stay on the drug indefinitely which might seem undesirable but there is no reason in principle why you should not do so. Dear Sir, As a 68 year old man whose first PSA test last year revealed a level of 158 I read your item in Monday's Telegraph with interest and not a little dismay. Without a PSA blood test how is it possible to know that a man has "low risk" prostate cancer? How many untested men are walking around with symptom free prostate cancer? It is impossible to know. My own case shows that early testing is essential. I have locally advanced grade 8 tumours outside the prostate and my oncologist estimates that I may have had prostate cancer for as long as 15 years to have reached this condition. Initially my tumours were too large to be treated by radiotherapy and only after 6 months of hormone treatment was I accepted for radiotherapy. I moved to a new surgery in 2003 and was enrolled in their "Well Man Clinic" where I was checked annually for cholesterol, Body Mass Index etc. There was no mention of PSA testing at this surgery; the reason given is "too many false positives." My counter argument as stated above is that there is such a thing a symptom free prostate cancer. If PSA testing (which costs only pennies when combined with other tests) had been included in my "Well Man Clinic" I would be in a much better situation than I am now. I have micro disease in my body, and although no medic will commit themselves to estimating my life expectancy my research leads me to believe it to be about 5 years give or take a year or two. Jim P P.S. Here in Wales everyone over the age of 60 receives a bowel cancer testing kit through the post every 2 years. If bowel cancer can be screened why not prostate cancer? Dear Jim P, Thanks for being in touch and your interesting comments. See my reply to "Anon" above on the same subject. It is encouraging that your cancer is currently being held at bay with the hormonal treatment - long may it continue. Re your column 13th January on the subject of prostate cancer this is not so much a question as an observation based on my own experience. In 1995 at the age of 60, I was diagnosed with prostate cancer and treated with radiotherapy at Nottingham City Hospital. In the intervening period I have had Bone Density and CT scans and latterly both Zoladex and Prostap hormone injections at 12 weekly intervals administered and results monitored by my GP. My Oncologist has effectively signed me off and now wishes to see me only if my PSA level rises above 4.0. Over the past 3 years this has stabilised between 0.1 and 0.5. Apart from impotency since the onset of radiotherapy and hot flushes in the early years I do not experience any adverse side effects. I suspect Prostap has superseded Zoladex for cost reasons but I have to admit that it is less painful and would appear to be equally effective in achieving its" objective. I am, however, concerned at the long term effects of this drug. Meanwhile, 3 years ago, following a bone marrow biopsy, I was diagnosed with myelodysplasia and I am now receiving blood transfusions at 6 weekly intervals at my local hospital to relieve the symptoms of anaemia. I mention this because I suspect there is a link to the radiotherapy treatment and radiation poisoning following the number of bone scans, X rays. CT scans etc., over the past 18 years. My Haematologist is, however, non-committal and says there is no evidence to support my theory. Without wishing to sound ungrateful I do sometimes wonder whether it was necessary to undergo the course of treatments prescribed by the professionals in charge of my case although I understand it is still the preferred option if diagnosed in the early stages of prostate cancer. I do hope this will be of interest to you. I gather that around 10% of cases of Myelodysplasia follow cancer chemotherapy or radiotherapy and you presumably fall into this category. Your cancer certainly warranted treatment of some sort and radiotherapy obviously has considerable advantages over radical surgery. There has recently been a lot of articles on the subject of aspirin, which leaves me a bit troubled. I am 83, but would emphasise that I am fairly fit and I am able to do a lot of what would be expected of a younger person. My blood pressure hovers around 140/70, I take it on roughly a weekly basis. About four years ago I had a scan for another problem, which has since been rectified. This scan showed that at some time I had a small stroke, they don't know when. I was put on one aspirin a day, however I find that I bruise very easily with often very large black marks forming. I realise that these marks are internal bleeding and as it happens so easily it is causing me concern. In the articles, which I referred to above, they were intimating that internal bleeding was a great danger. I also read, that anyone having a small stroke should take aspirin for up to a year as a precaution of a repeat stroke. As I have said my small stroke was over four years ago. I was wondering if you felt that with the internal bleeding possibility, it was necessary for me to continue taking aspirin. I am only asking for your personal opinion and would not consider putting your view to my own GP. The reason for this email is to help me make my mind up about continuing the dose with its implications before seeing him. I'm sorry that this is such a long email, but I felt that I had to give you the facts as I saw them. Thanking you in anticipation. Yours truly, Robert M Dear Robert M, It would seem sensible having had a small stroke in the past to take some form of medication to prevent it happening again I understand your concerns about aspirin especially if it is causing the bruising you describe. You might discuss with your doctor taking some alternative such as the anti-platelet drug Dipyridamole. I was interested in your report on glucosamine. A few years ago I read of the possible contra-indicativeness of this with Dupuytren's contracture of the fingers. This had been progressing in both hands. I immediately stopped taking the glucosamine/chondroitin and my fingers have got no worse and on one hand I have been able to straighten them through exercise. I am convinced that stopping taken the tablets was beneficial. At the time I could not find any modern research on this, but I see there are now other similar comments on the internet. Barbara T Dear Barbara T, Thanks for being in touch and your account of your glucosamine experience - though it is not clear why this might have been exacerbating your Dupuytren's contracture of the fingers. I suffer from Diffuse Cervical Spondylosis: Would acupuncture help? Tried Physiotherapy, but that seemed to make it worse: i.e. Neck pain. From Mrs.A.C Dear Mrs A C, I am sorry to hear that physiotherapy worsened your symptoms of Cervical Spondylosis. It is indeed possible that acupuncture might be of help. My husband, aged 76, underwent a small operation to relieve the symptoms of an enlarged prostate about 18 months or so ago (not found to be cancerous). Since then he has suffered intermittently from prostatitis. Currently the pain and discomfort is very severe and he has to urinate frequently to relieve pressure. Consequently his lifestyle is very much affected keeping him almost totally housebound and his mood is very low. His urologist prescribed an anti-depressant which I think was imipramine (now discontinued as it didn't seem to help). Currently he is on an antibiotic Cefalexin. He has been taking this for the past week with no noticeable improvement. He is on a great deal of medication with other problems - type 2 diabetes, therefore metformin, simvastatin, blood pressure tablets, aspirin,allopurinol for gout, and another antibiotic - erythromycin (permanently) following 2 prolonged outbreaks of cellulitis in his leg. Generally despite his medical problems my husband is usually busy, happy and pretty well and stable. However the prostatitis is really getting him down. We have tried barley water and cranberry juice - also my husband drinks whisky (too much in my opinion) but he says it makes him happier. Can you offer any other suggestions which would help? Thank you very much. - Winifred C Dear Winifred C, Thanks for being in touch and my great sympathies for your husband's current medical problems. My impression is that prostatitis is unusual following the sort of prostate operation you describe. It can, as you will know, be a difficult condition to treat though two possibilities might be, first, to take a small dose of Diazepam whose muscular relaxing effects are said to be beneficial, or secondly taking an anti-inflammatory drug such as Voltarol. I have been reading your article in yesterday's telegraph and in particular the query from Mr NA. I have had on a recurring basis identical symptoms to those he has had and my GP has given me all the medication mentioned and some others as well, all without any beneficial effect.The only thing that has calmed the various sensations with me is old-fashioned calamine lotion; the calming effect is fairly immediate and usually lasts for a number of hours. I hope this might help your correspondent. Thanks for that most helpful observation that I will be mentioning in the column on the 27th Jan.