Dr Le Fanu's online health clinic, Friday 30 March 2012 Jane Carmichael Dear Jane, Family doctors hand out quinine tablets like Smarties for these very common nocturnal cramps so I agree, it seems perplexing that your health authority should be seeking to restrict their use. The situation is essentially as follows. Back in 2006 the Food and Drug Administration in the United States sought to curtail the use of quinine for this indication on the grounds that it had been associated with approximately 100 fatalities, attributed to its effect on disrupting the conducting mechanism of the heart. This sounds serious, but then, a year ago, the very authoritative Cochrane Collaboration in Britain reviewed the 23 studies investigating the efficacy of quinine in cramps and found just a single report of a major adverse event and that was a drop in the number of platelets. This is, of course, reassuring, and I would not have thought the " dropped beats" you describe having experienced for the last 40 years are any significant additional hazard. The alternative way of taking quinine, as you may know, is in the form of tonic water. This might I suppose, be one of the secret ingredients of Diet Coke, thus accounting for its preventative effects as recently mentioned in my column. Dr Le Fanu. Seizures Dr. Le Fanu My wife, then aged 70 and a retired teacher, had a sub-arachnoid haemorrhage in 2002 affecting 4 veins. 3 were clipped , the 4th causing a severe stroke. After teaching herself to speak, walk, read and write she had a second stroke in Spain 6 months later.This was undetected by the hospital and was confused by the first epileptic seizure. The epilepsy is now well controlled by 1 g leviteracetam and 200 mg Lamotrigine daily. However she has some 4-5 non-epileptic seizures daily on 6-7 days each week. She rarely recovers from these until the following day. She has had all the usual scans etc including a 26 hr scan with simultaneous dual video recording which showed up no epileptic seizures but several non-epileptic ones. She has had psychiatric help to promote diversion techniques which has not improved things. Over the last 6 weeks she has had one clear day on which she was very sprightly, stable and fun.She has had all the usual epileptic drugs, including some very new ones. None seem to assist. Her current medication list is attached.We both realise and accept that this condition is not curable but there must be something to give some respite. Just one clear day per week would bring considerable relief. Have you any ideas what can be done to assist please? Thank you for reading this John H Humphreys Dear Mr Humphreys Thanks for being in touch and my enormous sympathies for your wife's current medical problems. I note that her epileptic seizures are well-controlled on medication but that she still has these "non-epileptic" episodes without evidence of abnormal electrical activity in the brain. These are very baffling and indeed, as you will know, their failure to respond to anti-epileptic drugs has led them to be labelled "psychogenic." I would have thought it more likely that there is indeed an underlying physical cause which, for the moment, remains unknown. My only two suggestions are that first, you might discuss with her specialist a trial of the SSRI antidepressant Sertraline, as there is apparently one study claiming it is of value for this condition. Beyond that you might consider being in touch with the NEAD Trust (Non-Epileptic Attack Disorder) that offers information, advice and support. Dear Dr. Le Fanu Nose bleeds A year or so ago I read your article on red wine causing nose bleeds and stopped drinking it that very day. Remarkably the nose bleeds did indeed stop and no more problems ensued - that is until I started taking Saw Palmetto a few days ago to ease night visits to the loo. Quite unexpectedly my nose bleeds returned (over breakfast) and rightly or wrongly I suspected the Saw Palmetto. I have now suspended taking them. Could the berry extract contain the same constituents as red wine and therefore have the same consequences on susceptible noses? Yours faithfully Rodney Parker Dear Mr Parker Thanks for being in touch and I am, of course, intrigued to learn that your abstaining from red wine has cured your nose bleeds. I would have thought it likely, in view of your experience, that the Saw Palmetto taken for your prostate problems must, like red wine, also contain some blood thinning chemicals though it might be difficult to pinpoint which one in particular. Above-normal alcohol levels My teetotal wife (half of Guiness once a year maybe) has just had a routine blood test which indicates above normal alcohol level in her liver. She has an ear infection but that apart enjoys good health. Any suggestions? Her problem is that she thinks people will think she is not being truthful! Julian MacKerracher Dear Mr MacKerracher I presume the blood test to which you refer is the Gamma GT which can be elevated (usually markedly) in those who drink considerably more than is good for them. It can, however, also be raised in those who are a bit overweight, or have diabetes or other illnesses. If none of this applies, and the results of her other liver function tests are unexceptional, I would suggest perhaps repeating the test in a few months by when it may well have returned to normal. Abdominal Nerve Entrapment Syndrome I have just been diagnosed with Abdominal Nerve Entrapment Syndrome after two years of trying to get a diagnosis and being subjected to a hysterectomy too, which has caused another set of problems in itself (I'm 41, by the way). I'm on a course of medication which in affect rules my life (Amitriptyline & Clonazepam) due to the side effects, and I'm now waiting for a steroidal pain block. How effective will this pain block be? Lisa Hunter Dear Lisa, Thanks for your query and my sympathies for the (not unusual) delay in the diagnosis of Abdominal Nerve Entrapment Syndrome as the cause of your pain. This is due to pressure on the nerves by the powerful rectus muscle, the definitive treatment for which is a steroid injection. This should allow you to dispense with the medication that is currently causing those side effects. Support for HIV sufferer Dear Doctor James, This may not be a typical question, but may answer a question that others may have. I know someone who has recently been diagnosed as HIV positive. Her husband died as a result of it, so she is quite depressed. I was wondering what kind of support I could offer this person. I do hope this is within your remit to answer on. Nancy Noder Dear Nancy This is a most grievous situation and your friend obviously needs specialist psychiatric help to deal with her understandable depression caused by her bereavement and learning that she too is now HIV positive. You can support her by offering to sort out her practical everyday problems and accompanying her when attending her hospital appointments. She might appreciate you arranging a short holiday together. Unsexy shingle scars Will my shingles scars on my tummy ever disappear. They seem to be going nowhere after two months. I'm only 28 and so slightly self conscious. Lovers wonder what the scarring is and it makes me feel SO unsexy. Thanks:) Mr Trimble Dear Mr Trimble Have no fear that your scars will fade away in a few months time - but meanwhile it is good to hear that you are enjoying such an active sex life. Dr James's online clinic will return next Froday morning. Do you have a medical query? Email drjames@telegraph.co.uk by Thursday morning to take part in next week's clinic.