Dr Le Fanu's online health clinic, Friday 18 October 2013 6 years ago my G.P. said that he could give me medication for my enlarged prostate, if it caused problems, but there would be some side effects. I am 88 but do not take any medication. I can cope with the slow urine discharge and getting up 2 - 3 times a night but would it be better to take something to reduce the size of the prostate? Would the cancer be affecting other parts of the body? Your advice would be much appreciated. Gordon H Dear Gordon H, I'm impressed that at 88 you are not on any medication and I can understand your reluctance to change this. Your symptoms are most likely due to the condition known as BPH or Benign Prostatic Hyperplasia which as its name suggests is due to a benign enlargement of the prostate rather than the cancer you mention. The prostate shrinking drug Finasteride would certainly improve your symptoms though it can take up to six months to have any noticeable effect. I would have thought it sensible to discuss this further with your doctor. Hi Dr Le Fanu, I enjoy your column and was wondering what you make of this? Saw my doc.last week about an urgency to wee lately (I'm in my early 60's). No prostrate or infection found so she said 'just to keep an eye on it' and if it persists to make a return appt. What do you make of it please as I intend to travel abroad soon and don't want any surprises on lengthy trips! This urgency you describe (in the absence of any evidence of infection) is most likely due to an "overactive" bladder otherwise known as Detrusor Instability - that is spontaneous contractions of the detrusor muscle that controls the emptying of the bladder. It is reasonable to "keep an eye on things" if you are not too inconvenienced (as it were) but it might be sensible to take a supply of the drug Oxybutynin when travelling abroad- the standard treatment for the condition. Shingles Vaccination Dear Dr. Le Fanu My brother and I heard about the above vaccination for those aged 70 plus. His date of birth is 18/9/1943 and mine 4/12/1934. Having had both friends and family suffer from shingles in later life it seemed an excellent idea to acquire a little protection against it. And then we hit the proverbial brick wall! After my brother was told in no uncertain terms that he was the wrong age when he enquired at his GP practice, we went online and discovered a leaflet published by the government on 16 July 2013 which states: people eligible are those born between 2 September 1942 and 1 September 1943 (so that excludes him) and all those born between 2 September 1933 and 1 September 1934 will also be offered the vaccine in a catch up programme (that's me excluded too). This smacks of a cost cutting exercise to us! Incidentally we tried our local Nuffield Hospital which has a private GP service and were told that the only nurse who administers the vaccine is based in Bath. Not much use to us in West Sussex. We would happily pay for the vaccine. Are you able to throw any light on this conundrum? Jan & Chris R Dear Jan and Chris R, The rationale for this shingles vaccination schedule (I presume) is that "the system" could not cope with immunising everyone over the age of 70. Thus , as you have discovered, it has been staggered with every year only those aged 70 and 79 being offered the jab. The only way round this is to have it down privately - though it is not cheap. The Queen Anne Street Medical Centre in London (020 7034 3301) charges £200 (!) though they are currently out of stock, and expecting further supplies in December. Dear Dr Le Fanu, My daughter from early childhood has suffered from asthma. One of her symptoms from the start was a very harsh cough from the throat it would occur as part of a cold and be very regular every few minutes and would continue for days. She is now 37 and although the asthma seems to be of little impact these days the cough still arises with a cold or other nose/chest infection. If she tries to go to work, it so unsettles other colleagues that she has to go home. There appears to be no option for her to endure many sleepless nights until this cough breaks but now with 3 young children this is even more difficult and tiring than ever. Perhaps your readers might have some suggestions as to what might prevent or relieve this malaise. Her General Practitioners over the years have not been able to help. Many thanks. Dear Anon Thanks for your query on behalf of your daughter. I note she has "grown out" of her asthma but this persistent cough you describe suggests she still has some irritability of the bronchial muscles around the airways brought on by a chest infection. This is best prevented by taking a course of antibiotics and a reducing schedule of steroids at the first sign of an infection and using a Salbutamol inhaler three times daily. She might also take the bronchodilator drug Aminophylline at night. To avoid any delay in initiating treatment it would be sensible to obtain a prescription for these medicines from her doctor in advance. Can you reassure me, please? I have occasionally dreamed that I am choking, and wake up to find that I am! I have a feeling of something stuck in my throat and the subsequent coughing gives me severe pain across my upper chest. As I am on my own, widowed, I feel vulnerable. What causes this and is there anything that I can do? Thank you , Avril W Dear Avril W, Thanks for being in touch and my sympathies for these frightening episodes you describe. The most likely cause is acid reflux where acid from the stomach refluxes up into the throat at night and tips over into the larynx causing it to go into spasm. There is a useful article available on the internet that explains this more fully - R Thurnheer "Sleep related laryngospasm" European Respiratory Journal 1997, vol 10 , pp 2084 -6 . This can be prevented by taking the acid suppressant drug Omeprazole at night. There are several other possible causes including post nasal drip associated with an infection of the sinuses (see my response to Shirley D below) and "sleep apnoea." I'm sure you should discuss this further with your doctor. My laryngospasms are not related to acid reflux, but will often occur if the larynx detects phlegm in the throat resulting from a sore throat/chesty cough. Is there anything that would make the larynx less sensitive? May I also ask you what is the best medication to thin and reduce the mucous. These experiences are terrifying, and your help would be much appreciated. Shirley D Dear Shirley D, Thanks for our query. There is regrettably no way of reducing the sensitivity of the larynx. My impression is that your episodes of laryngospasms are associated with (or brought on by) an upper respiratory tract infection which should be treated promptly with antibiotics and the drug Mucodyne that thins the catarrhal secretions. Dear Dr. Lefanu, I read in The Daily Telegraph a few weeks ago that there is now an injection or something against shingles. Having had friends who have suffered from this, and taken so long to recover, I thought it was a brilliant idea, so I went to my Surgery to ask if I, and the man in my life, could have it. I am 72 and he is 82. Apparently it is only available at present for people aged 70 or 79. Every following year the age will go up and down as applicable. I am not good at maths, but I think it may be 2016 when I will be 75 before I can have it, (forget my man, who may be dead by whatever time). Trying to stay healthy, I am not happy. Very sincerely yours, Mrs. Deirdre L Dear Mrs Deirdre L, Please see my reply to Jan and Chris R above. During the winter months I am plagued by splits at the end of my fingers which are both painful and annoying. I alway use gloves to wash up and I go to bed wearing cotton gloves with my hands lathered in cream, plus I take a daily 1000mg dose of cod liver oil. Once I have developed a split I'm able to allow it to heal by filling the crack with superglue but I would prefer to prevent them in the first place, any suggestions? Sarah W Dear Sarah W, Thanks for your query and my sympathies for these recurrent splits. It does sound as if you are currently taking all the relevant preventive measures - and with regrets there is nothing further I can suggest. Last year I was diagnosed via sigmoidoscopy with severe diverticulitis. This year I underwent a virtual colonoscopy via CT Scan. This report states bowels normal. Q. Can diverticulitis be cured?? My understanding is no. Q. Could the initial diagnosis have been wrong. Even though the Consultant was pointing out the diverticula pouches? Q. Can the CT scan be wrong? Which one do I believe or should I subject myself to further camera investigations. Or do I live in the knowledge I have diverticulitis and ignore the second investigation. Diverticulitis means the sufferer has to be more dietary aware...be aware of possible infections of the bowel etc. I am very gluten sensitive. This change of diet with gluten exclusion has improved defecation dramatically with near normal stools I can now lead a normal life. I need to know ...do I have diverticulitis or not. I would be delighted not to have it of course, but feel its important to know as there are risks of bowel infection and possible peritonitis. Judith, with best wishes. Dear Judith, Thanks for your query and I fully understand why you should be a bit confused by all of this. The presence of these pouches in the gut is known as Diverticulosis that by themselves do not necessarily cause any symptoms unless they become inflamed or infected which is known as Diverticulitis. It is encouraging that your bowels now appear to be functioning normally though clearly you need to seek prompt medical attention if you develop symptoms suggestive of a recurrence of your Diverticulitis. Mrs DM's son. I get gout in my left big toe and the last few years during the summer months I have also experienced significant pain in joints and tendons throughout my body. Having put up with them for some weeks, this year, I cut out all red meat and offal and within two weeks the pain had reduced to mild discomfort. I suspect that it occurs in summer and not the winter maybe due to sweating and passing less water the cause of gout builds up in the body and affects other parts? I like a few beers and having cut out the meat they have no effect on the pain and I would value your opinion? Maybe a test for urates in the blood would be helpful? Thanks for your interesting suggestion as to the possible cause of those seasonal symptoms. As for your own , I would have thought it sensible to have a blood test to check out your urate levels which if raised (and I suspect they will be) warrant treatment with the drug Allopurinol that should, with luck, prevent these gouty episodes in future. My mother came down with Miller Fisher Syndrome 9 years ago and it has left her with numbness in her body (hand and feet and some part of body are asleep). She has visited many physiotherapists and neurologist who all told her that she will recover by own but it has been 9 years Doctor please advise is there any medicine or any thing which can help her recover. Regards, Rohit Dear Rohit, Thanks for your query and my sympathies for your mother's persistent symptoms caused by her Miller Fisher Syndrome. Though most patients do indeed recover fully some like your mother are left with a permanent disability from the nerve damage - for which regrettably there is no specific treatment. I am 84 years old and have been receiving flu jabs without any problems over many years. This year, five days after the jab, I developed pains over most of my body and had to succumb to a day in bed (the first time for over 30 years!) and am wondering whether it could be a reaction to the jab. For many years I have been taking medicines for High Blood Pressure, Cholesterol and Gout without any obvious side effects and also, more recently, Warfarin for an Atrial Fibrillation. This year my Statin was changed from Simvastatin to Atorvastatin and I was diagnosed as suffering from Parkinsons for which I have been prescribed Sinemet. Before the flu jab I checked with my GP's surgery and was advised that Sinemet would not affect it but now I am wondering if this was correct since my symptoms, which are now clearing up after three days, are something which I have never experienced before. John L Dear John L, I have encountered before this problem you describe of being laid low for a day or so following a flu jab despite not having had any problems previously . There is usually no obvious reason for this but it may, as you suggest, be caused by an interaction with the Warfarin you are taking (see the article by P F D'Arcy, "Vaccine - drug interactions" that can be downloaded from the internet). You should discuss with your doctor whether it is advisable to have the flu jab next year. My daughter aged 42 is experiencing considerable problems and has had visits to a neurosurgeon, CT and MRI scans, eye tests and all appear clear. The problem arises when she is stirring upright and particularly when driving. She gets a numbness in the side of her face and upper lip, pulsating in the roof of the mouth and swooshing noises in her head. She also is intolerant of loud noises such as the banging of pots and pans but can take loud music. Has anyone else suffered similar problems? This has been ongoing for almost 2 years. Dear J L, Thanks for your query and my great sympathies for your daughter's most unusual problem which seems to have defied the best efforts of her doctors. This combination of numbness and sensitivity to noise is also a feature of Bell's Palsy due to inflammation of the seventh cranial nerve - which may be relevant. I hope to mention this in the column in the near future in the hope of eliciting some insights into what might be amiss. Dear Dr. James, I have woken up most mornings for over a year with a headache. Any time from 4a.m. onwards. I take 2 paracetamol plus and it goes after 30min. to 1 hour. I have been prescribed Amitriptyline for a year. Seems to work sometimes. Have had some physio which I have arranged. I feel my doctor has given up on me. Have you any advice please? Lynda T Dear Lydia T, This problem of early morning headaches featured recently in the column. The several suggestions are that this is brought on by the nocturnal grinding of the teeth known as Bruxism for which a soft mouth guard can be a preventive measure. Next, it can either be a feature of sleep induced migraine or a "tension type" occipital headache brought on by the relaxation of the muscles of the neck when asleep. Perhaps you should discuss these possibilities with your doctor. Dear Dr Le Fanu, I have recently been suffering from acute trigeminal neuralgia emanating from the lower jaw below the ear which strikes with no notice as an excruciating and terrifying shooting pain into my mouth. After dental treatment to remove an abscessed tooth I was told the pain would disappear. Three weeks later it recurred and I was given by my doctor a prescription for 28 x 100mg carbamazepine [carbagen] tablets to to be taken one at am and one at pm. The dosage has stopped the attacks but my question is; The attacks have now abated and on completion of the prescription, will the nerve be in remission enough for that be the end of the problem, or is it likely to recur? Many thanks, Tony E Dear Tony E, Thank you for your query and my great sympathies. It is encouraging that your TN has responded to Carbamazepine and I would hope with luck it will not recur. I have had infections of my toenails for two years. My doctor wont prescribe because I have too many pills already.! A man in your column a week or so ago, mentioned garlic as a cure, but how, do you swallow it, soak it, infuse it or what. Please could you help. I would have thought that as this fungal infection involves several toe nails - and your doctor is reluctant to prescribe the necessary treatment - the best option would be to apply Amorolfine Nail Lacquer - that can be purchased directly from the chemist. I read your weekly column in the Telegraph with interest; it's full of common-sense. I am a 76-year-old retired university academic. I am reasonably fit, lead a relatively stress-free life, swimming a leisurely 1km every other day and have never had a serious illness in my life. I have been taking 20mg Simvastatin for about 15 years now, which has reduced my cholesterol level from 6.2 to 3.6 mg/l. I have long believed that there is a link between chronic hypertension and loose bowels. Over the past thirty years I have noticed a very gradual, progressive loosening of my bowels. The symptoms are that I do not move my bowels any more often than previously, i.e. sometimes once a day, sometimes twice, sometimes not at all. However, in the mornings, my bowels are loose. The condition is distinct from diarrhoea, in that it does not go away. I have a BP reading that, of course, varies during the day. Late evening, relaxing watching Newsnight generally yields a value of about 125/70. I have had 24-hour ambulant BP monitoring on me about six times over the last decade and the overall average of that is around 138/85. I have had an AAA US scan, my abdominal aorta is about 1.4cm, which I am assured is normal, resting and stress-ECGs which are normal and also a Ba enema, which revealed some diverticulosis. Finally, I recently used a kit to measure fecal blood and that was negative. The GPs in our practice are very reasonable people who, following the Ba enema, diagnosed diverticulitis. However, I find that a bit difficult to believe. When I suggest a link between HT and loose bowels, they politely tell me that I am talking nonsense as they are unaware any such link. So, to cut a long story short, the question is: is there any link between HT and loose bowels, and if so, what is the name of the disease? Best wishes Qubus Dear Qubus, Like your doctors I am not aware of any link between chronic hypertension and bowel disorders - though Simvastatin as you may know can cause both diarrhoea and constipation.