Dr Le Fanu's online health clinic, Friday 23 March 2012 May I ask your advice please? With many thanks, Trevor Brugger Dear Mr Brugger, Thanks for your query which I am sure reflects the concerns of many men of your age. I have two comments. First while the TURP procedure might sound a bit daunting it is relatively straightforward without,in general,any adverse consequences. It certainly has a long track record going back over 30 years and is highly effective in dealing with the sort of symptoms you describe. Secondly, from what you say, those symptoms at the moment do not overly interfere with your life so there is certainly no hurry in dealing with them - except for the fact that you have so high a PSA measurement which would suggest the presence of cancerous cells in the gland. Certainly if your specialist feels this is an appropriate operation I would have thought it sensible to take his advice. Misery of itching Dear Dr James Is there anyone out there can give an explanation for server itching all over the body? Some 13th months ago my husband went to the doctors and was told he had high blood pressure and was given ACE Inibitor tablets to reduce it bearing in mind he never suffered from it before (he's 77 years old and has annually gone for a check up) after 3 months he came out in a red rash and itched, not all the time but some of the time. I took him to see a dermatologist who told us it was atypical eczema possibly caused by the drugs (he has tried other types of blood pressure tablets). He then told us to use bendrofluazide on the red patches and gave him a strong dose of predisolone of which we have had several course, while on the steroids the itching was bearable but didn't go away. After trying for over a year and without any type of blood pressure tablet being taken since January this year he is still constantly in pain have you any suggestions it seems that when his body overheats it goes red like a raspberry the itching gets worse. It seems to stem from around his shoulder blades and the centre of his back. Hoping you can help a very desperate lady, J Morris Dear Mrs Morris, My sympathies for your husband's problems - a salutary reminder that even commonly prescribed drugs can have serious and ongoing side effects. The standard treatment for drug induced "atopic eczema" are immune suppressant drugs such as steroids and I note that they do seem to have improved matters. There are rather more potent forms including the drug Tacrolimus and as clearly this rash continues to have a significant adverse effect on your husband's life he might discuss with his specialist whether this might be an option. A persistent cough Sir, For years I have had a persistent and productive cough which several local GPs have been unsuccessful in clearing. Pathological analysis show excessive Moxilla Catarhalis, and non-infective, so no antibiotics have been tried. Actually I don't feel to bad in myself but the cough is distressing both to me and to my wife. Fortunately when the need arises to cough the mucus is fairly loose and when cleared I am able to have a cough free night which lasts until late in the morning. Nasal douche does not help. Steam inhaling only enable any firmer mucus to be more easily expelled. Any help you can offer would be much appreciated. Richard Stinton Dear Mr Stinton, Thanks for your query. This problem of a persistent cough is quite common for which there are, predictably, a range of possible explanations. I would have thought in the first instance you should have a course of antibiotics such as Clarithromycin as though the presence of the bacterium Moxilla is usually "benign" ,it can cause chronic respiratory infections. I would suspect that this might well stop your problem but if not the next logical step is a course of steroids that suppress the persistent inflammation of the airways that is usually a feature of chronic cough. The other possible explanations, which no doubt your doctor has considered are acid reflux, and side effect of drugs particularly the blood pressure lowering ACE inhibitors. Pain following a hip replacement Dear Dr Le Fanu I had a hip replacement 8 years ago. I am now suffering from very severe pain in my groin which lasts about an hour but I may go a few weeks without any trouble. My doctor , after seeing x rays , says that hip shows no sign ot deterioration and is at a loss to understand what is causing the periodical bouts ofpain. I am 96 so a further operation is out of the question and he has prescribed Zydol 50 mg tablets to take when required. Your views would be welcome, Dear F Laugharne, I think it most unlikely that this chronic pain is anything to do with your hip replacement. But it is certainly puzzling that the pain though severe is so intermittent which should rather be against it being due to pressure on the nerves at the bottom of the spine. Still it might be worth considering whether regular stretching exercises or physiotherapy might be of help. Pre Syncope Episodes Dear Dr James le Fanu. I have been having Pre Syncope Episodes for over 2 years now. After many consultations with my GP and a cardiologist, I was fitted with a pacemaker in November 2011, thinking that would solve the problem. The Pacemaker was fitted as it was found that I have a "Heartblock." However, I continue to have drops in blood pressure which I find debilitating - the GP has prescribed pills which have all given me dreadful side-effects, dizziness, headaches, nightmares etc. I have been prescribed beta blockers, Fludrocortisone. It was suggested that there is some other medication which isn't yet licensed, so I won't take that. He also informs me that the pacemaker won't stop Presyncope episodes. I am feeling quite desperate to get an answer as I seem to have drawn a blank with my Cardiologist. Can you please offer further advice Thank you, Christine Dunn (Mrs) Dear Mrs Dunn, Thank you for your query and my sympathy for the symptoms which, as you have discovered, can be very difficult to deal with. It is unfortunate that the pacemaker has not improved matters which focuses attention rather on a more generalised disturbance of the autonomic nervous system involved in maintaining a constant blood pressure. The leading expert in this field is Prof Christopher Mathias of St Mary's Hospital/Imperial College and it might be worth discussing with your doctor whether it would be appropriate to seek his opinion. Nuisance of heartbeat sound I have recently been hearing my heartbeat in my left ear. Sometimes there seems to be an almost squeaky sound too. My GP has checked my blood pressure and heart and says all sounds OK. Is this another inconvenience of getting older? I turned seventy in January. Have you come across this symptom before? No one I know has experienced this nuisance. Regards, Val M Dear Val M, This heartbeat in the ear is known as Pulsatile Tinnitus due to changes in the blood flow in the vessels near the ear or changes in awareness of that blood flow as occurs with conditions such as Glue Ear. When however the ears and hearing are normal then some form of imaging (CT or MRI scan) is usually advised to scrutinise the blood vessels and other structures that might be responsible. This of course, will require a referral to an ENT surgeon. Grinding teeth during sleep I have never done anything like this before, and probably won't again, but I was moved to write because Mrs WM of Leeds is suffering much as I am at present. I have identified my problem in that I am grinding me teeth quite badly during my sleep, and I now have a soft mouth guard which my dentist made for me, but I still get headaches. I never used to get headaches so I was naturally worried when I started waking with them, but they coincided with losing my job and money worries which has led to stress related grinding. In my opinion, the probable reason she doesn't have it when she has a cold is that she will be breathing through her mouth when her nose is blocked, and therefore not closing her mouth to grind her teeth. Many thanks, Dear A, Thank you for your comments on the conundrum of the early morning headache. Several readers, like yourself, attribute this to the nocturnal teeth grinding known as Bruxism for which, as you say, a soft mouth guard is usually an effective preventative measure. I would agree too with your explanation for why this lady did not get her headache from suffering from a cold or flu. Mystery fatigue Dear Dr James Le Fanu, Firstly my history. I am 70 years old, but am fairly active ie aerobics and gym twice a week/walk for 30 to 60 minutes every day/golf for 5 to 6 hours a week. My diet is good plenty of fruit & veg etc.I had triple bypass in 2001 ,no heart attack, but diagnosed with partially blocked arteries. Have been fairly fit ever since . My mystery medical problem started about 2 years ago following visits to gym and if I tended to overdo activity there wasn't any pain or acute shortage of breath at the time (my gym sessions are always first thing in a morning) but come night time my whole body seems to be dithery and am unable to sleep.This strange feeling used to last well into the next day, my trainer in gym thought it may be something to do with electrolytes and suggested I try drinking a 50/50 mix of orange juice and water + a teaspoon of sea salt mixed in. This drink taken whilst I am exercising seemed to help for a period of time but for the last 6 weeks or so the problem has been getting much worse and now can occur even if I do any fairly heavy gardening, problem now is that this strange feeling can last for 2 or 3 days. It seems to me that my body is reacting to exercise and is producing something strange which is giving me this odd sensation . Other symptoms are my legs feel tired and I don't have much spring in my step, also my legs are a bit tingly. Hoping you are able to follow the above and can suggest what the problem may be. Best regards Robert James Dear Mr James, Thank you for your most interesting query. As you may know this problem of exhaustion after modest exertion is a prominent feature of the poorly understood condition known as Chronic Fatigue Syndrome/ME . The causes in general are unknown but it may follow a viral illness ,hence its other name Post Viral Fatigue Syndrome. This might be a situation in which the treatment of "graded exercises" might be of value - the principle being that you gradually build up a tolerance to whatever is causing the fatiguability of the muscles. The further possibility in view of your comments about the legs feeling a bit "tingly" without much spring in the step is that you have some form of peripheral neuropathy-a disturbance of the function of the nerves to the legs. Either way I would have thought a referral for a specialist neurological opinion would be appropriate. Runny eye Dear Dr LeFanu I am 73, in good health apart from taking blood pressure tablets, but have the annoying "runny eye" that so many older people develop. It is an all-the-time thing, not just in cold or windy weather. Have you any suggestions for relieving this problem, please? Yours sincerely Carol Burke Dear Ms Burke, This "runny eye" is caused by a disturbance in the quality of the tear film as a result of which the lacrimal glands go into overdrive. The solution paradoxically, is to instill artificial tears (known as viscotears) several times a day and wear "wrap around" glasses when out in windy weather. Aching legs Six weeks ago I took an uneventful flight to holiday in Grand Canaria. Two days later on taking I short walk I was aware of dull tired aches in my buttox, thighs and calves (both sides). The next day I took a longer walk and felt it neccessary to take frequent breaks. The next day even on a short walk I felt wobbly and returned post-haste to my hotel to rest. The problem has persisted ever since. I am aware directly on rising - although it is variable from day to day. I have never had these symptoms before, although I suffered from sciatica down one leg some years ago - the pain is quite different. I do not recall any strains when handling luggage, although I did endure two successive cold nights in bed (before obtaining extra blankets, one at the pre-holiday hotel and my first night at the hotel). My doctor is baffled and has confirmed I have good blood flow - she has ordered a blood test to check for inflammation and is arranging some physio. I have needed to take drugs to control hypertension for over one year with no apparent ill effects and am otherwise a reasonably fit 60 year old of normal weight. Can you suggest what might be amiss? David Sheppard Dear Mr Sheppard, The pattern of symptoms you describe of aches and pains in the legs with modest exercise is strongly suggestive of the condition known as Lumbar Spinal Stenosis where narrowing of the spinal canal impinges on the blood supply to the nerves to the legs (otherwise known as Neurogenic Claudication). This is readily diagnosed with an MRI scan and if confirmed would require a decompression operation. Itching following treatment for diabetes Dear James Further to your piece in Tuesday's Daily Telegraph, I have suffered from acute itching all over my body during treatment over the last 18 months for type 2 diabetes. My GP has prescribed several different types of ointment but none has been successful Are you able to suggest a suitable altermative? My current daily medication is: Allopurinol 100mg. Amlodipine 10mg, Gliciazide 80mg, Bisoprolol 7.5mg, Doxazosin 2mg, calcium carbonate 1.25g, Bumetanide 2mg. Look forward to hearing from you. Colin Bray Dear Mr Bray, If, as you suggest, the itching is related to the medication you are taking then there is no alternative other than to discontinue each in turn to try and find the culprit. The further common cause of generalised itching is the unfortunately named Senile Pruritus due to an age related drying of the skin that can be corrected by regular use of moisturising creams and oils. Lichen planus I am a 66 year old woman who has been diagnosed with lichen planus, which is always worse late winter /spring and more or less disappears in the summer. I have steroid cream which clears the patches up in 12 hours, but they "lurk" and re appear somewhere else, feet, legs and buttocks. My question is, can diet affect this condition.. and if so, what should I be avoiding? Many thanks SCHogg Dear Ms Hogg, I am glad to hear that steroids clear up these patches of lichen planus so promptly. There is , to my knowledge, no evidence that diet is involved. Migraines Dear Dr. LeFanu, In forty five years in medicine, most of them in general practice, I found that migraine attacks tended to become less frequent and less severe with advancing age, and often stopped completely. I was therefore rather surprised when at the age of sixty I began to have them. They have been recurring at intervals of a few days to several weeks for twenty two years. The attacks begin with a central scotoma which is replaced by a bright ring. Half of this then enlarges gradually and disappears when it reaches the periphery. A dull headache, usually right sided but occasionally on the left, comes on after about half an hour and will occasionally last all day. On rare occasions there is also slight nausea. The whole episode is uncomfortable but I have never needed to take any medication. I am writing this because I sometimes wake with a typical headache which then usually lasts all day. I have always assumed that this is a migraine headache and that I should have experienced the initial symptoms if I had been awake. Your column also refers to Sir Norman Brown, and I think this must be a misprint. Norman Browse was in the year below me at school, though I knew nothing about him apart from the fact that he played the oboe in the school orchestra. He went on to become Professor of vascular surgery at St Thomas's hospital and President of the Royal College of Surgeons. Geoffrey Cox Dear Mr Cox, Thanks so much for your most interesting observations. Several readers also report these early morning headaches to be a feature of their migraine. You are also quite correct about the regrettable misspelling of Professor Norman Browse's name in the column last week. A curious hunger Dear Dr Le Fanu, My problem is not one of discomfort or pain. I think it is just curious (and unique??) I am moderately hungry at breakfast,lunch and (hot) diner time. However,it is about one hour after the evening diner that I crave for something to eat and must have a biscuit or some fruit-whatever I can find. My wife is used to it now and knows it is no reflection on her cooking but I find it a strange and cannot explain it. Except that I seem to remember- as a small child- that my grandmother asked my mother-after a diner-whether she could have a "dry" slice of bread. Is it in the genes? I would be interested to find an answer. With kind regards and thanks for all the help you give us -readers John Pelle Dear Mr Pelle, Thank you for your interesting query. The supposed mechanism for this hunger after meals is that the presence of food in the stomach prompts the secretion of digestive enzymes and insulin from the pancreas to facilitate its absorption. It is thus possible to imagine how an overshoot in the amount of insulin secreted might cause a fall in blood sugar (hypoglycemia) that is then perceived as hunger - warranting a biscuit to correct it. .