Dr James Le Fanu: 18 January
‘My daughter says her ears are clicking,’ a bemused mother informed me on one occasion. ‘They seem fine to me,’ I responded, having inspected them closely, to which she replied, ‘But if you listen closely you can hear it!’
And so, very unusually, I found myself placing my stethoscope over her ear and there, sure enough, was a quite deafening ‘click’ about every five seconds – which turned out to be a rare but luckily self-limiting condition caused by the rhythmic oscillations of the minute bones in the middle ear.
On another occasion, a young man reported that his wrist ‘creaked so badly it must need oiling’. He wiggled it up and down quite cheerfully and I was about to comment ‘seems OK to me’ when he said ‘Go on, feel it’. To my surprise, placing my hand on his wrist elicited a sensation just like a rusty hinge – otherwise known as crepitating tenosynovitis.
Or there was the case of a gentleman, recently described in a medical journal, who reported intense itchiness of his nose after sexual relations with his partner.
He was initially fobbed off with ‘reassurance and tranquillisers’, only to return when his itchiness came on after carrying the shopping. Only then did the penny drop that this had to be a variant of angina – and sure enough, X-rays of the arteries to the heart revealed them to be seriously narrowed. His nasal itchiness duly vanished following a bypass operation. The moral of these stories would seem to be that no matter how unusual symptoms appear to be – if they are real for the patient, they are real.
THIS WEEK’S MEDICAL QUERY comes courtesy of a lady from Nottingham who, for the last 10 years, has been troubled by a deepseated and painful itch in the feet, which affects her sleep. ‘It can affect one or both feet, usually the soles but sometimes the side – it is painful enough to waken me.’
There are many possible causes of itchy feet, notably the fungal infection athlete’s foot, but here its persistence and the fact of it being painful and worse at night is strongly suggestive of some disturbance of the sensory nerves known as a peripheral neuropathy. It is, however, important to note that this can also be a presenting sign of Hodgkin’s lymphoma.
It is possible that massaging the feet with moisturising lavender foot cream or horse chestnut might be helpful. One or other of the drugs used for neuropathic pain, such as amitriptyline or gabapentin, might also be of value. drjames@lady.co.uk