Dr James Le Fanu: 28 June
The natural history of many medical conditions is for them to progress slowly and tolerably over many years without necessarily requiring intrusive investigations or treatments. The point is well made by the experience of a retired engineer from Berkshire, now in his mid-70s, who vouches for the merits of ‘watching and waiting to see what happens’.
It all started when, aged 50, he found he had to rise at night to pass urine. He knew enough to realise this was probably due to an enlarged prostate gland, but did not feel it warranted action. In the subsequent 27 years, his symptoms have gradually worsened, so he now sometimes has difficulty in ‘getting going’ and maintaining a steady stream but has never felt it necessary to consult his GP.
Then, 15 years ago, by now in his early 60s, he developed the classic symptom of angina when walking up the hill to his home – a tight pain in the chest that vanished when he rested. After three years, he consulted his doctor but declined the offer of further investigations. He still finds he can do two or three miles on the straight at his usual pace, while a couple of squirts of the anti-anginal GTN spray under his tongue can get him up the most moderate of inclines.
Then last year, a routine blood test revealed the rare disorder of bone marrow myelodysplastic syndrome, which impairs production of the white and red blood cells and platelets. This causes no symptoms, however, and he’s happy to go along with the advice to wait and see what happens.
The health service would save a lot of money if more people shared this gentleman’s aversion to bothering a GP. Still, there are a few points worth pondering. First, it’s only in retrospect that his decision not to seek medical advice can be seen to have had no untoward consequences. If, for example, his initial prostate symptoms had been caused by a tumour, or had his chest pain been a prelude to a heart attack, he would have had a different tale to tell.
Second, while ‘doing nothing’ protects against the hazards of over investigation and over treatment, there seems little virtue in stoically tolerating one’s symptoms.
THIS WEEK'S MEDICAL QUERY comes courtesy of a woman in her late 60s who, for the past two years, has had pain and stiffness in her feet and ankles, which her podiatrist attributes to loose ligaments causing wear and tear. The discomfort has grown worse over time and now makes it difficult for her to pursue her favourite activity of ballroom dancing several times a week. Might there be, she wonders, something that would keep her on the dance floor?
This is clearly a difficult situation. The only two options would seem to be: first, to take a regular dose of an anti-inflammatory drug (such as Voltarol) in the hope this will reduce the pain and stiffness. Beyond that, it would seem advisable to find an alternative to ballroom dancing that might be less traumatising to those particular bones and ligaments.
drjames@lady.co.uk
‘The recognised palliative for a chronic cough was to find an area where street resurfacing was taking place. I have clear memories of being walked, every day, past the roadside brazier where a cauldron of tar was being prepared, and being required to deeply inhale the coal-tar fumes.’
It all started when, aged 50, he found he had to rise at night to pass urine. He knew enough to realise this was probably due to an enlarged prostate gland, but did not feel it warranted action. In the subsequent 27 years, his symptoms have gradually worsened, so he now sometimes has difficulty in ‘getting going’ and maintaining a steady stream but has never felt it necessary to consult his GP.
Then, 15 years ago, by now in his early 60s, he developed the classic symptom of angina when walking up the hill to his home – a tight pain in the chest that vanished when he rested. After three years, he consulted his doctor but declined the offer of further investigations. He still finds he can do two or three miles on the straight at his usual pace, while a couple of squirts of the anti-anginal GTN spray under his tongue can get him up the most moderate of inclines.
Then last year, a routine blood test revealed the rare disorder of bone marrow myelodysplastic syndrome, which impairs production of the white and red blood cells and platelets. This causes no symptoms, however, and he’s happy to go along with the advice to wait and see what happens.
The health service would save a lot of money if more people shared this gentleman’s aversion to bothering a GP. Still, there are a few points worth pondering. First, it’s only in retrospect that his decision not to seek medical advice can be seen to have had no untoward consequences. If, for example, his initial prostate symptoms had been caused by a tumour, or had his chest pain been a prelude to a heart attack, he would have had a different tale to tell.
Second, while ‘doing nothing’ protects against the hazards of over investigation and over treatment, there seems little virtue in stoically tolerating one’s symptoms.
THIS WEEK'S MEDICAL QUERY comes courtesy of a woman in her late 60s who, for the past two years, has had pain and stiffness in her feet and ankles, which her podiatrist attributes to loose ligaments causing wear and tear. The discomfort has grown worse over time and now makes it difficult for her to pursue her favourite activity of ballroom dancing several times a week. Might there be, she wonders, something that would keep her on the dance floor?
This is clearly a difficult situation. The only two options would seem to be: first, to take a regular dose of an anti-inflammatory drug (such as Voltarol) in the hope this will reduce the pain and stiffness. Beyond that, it would seem advisable to find an alternative to ballroom dancing that might be less traumatising to those particular bones and ligaments.
drjames@lady.co.uk
Coal-tar for coughs
The recent resurgence in the number of reported cases of whooping cough could promote renewed interest in the simpler remedies of earlier times, such as that recalled by a reader when growing up in north London in the 1930s.‘The recognised palliative for a chronic cough was to find an area where street resurfacing was taking place. I have clear memories of being walked, every day, past the roadside brazier where a cauldron of tar was being prepared, and being required to deeply inhale the coal-tar fumes.’