Dr James Le Fanu: 6 September
Adults tend not to be much troubled by recurrent nightmares, for which there are two main culprits. They may be the side e ect of medication – beta blockers and the cholesterollowering statins being prime o enders. Alternatively, they are a common feature of post-traumatic stress disorder (PTSD) following a dreadful experience. The former are easy enough to deal with by discontinuing the medication, but the latter are more problematic.
Perhaps surprisingly, simply recounting the nightmares to a sympathetic listener may abolish them. A Worcester family doctor describes the case of an 80-year-old patient who had fought in the trenches in the First World War. ‘He recalled having to bayonet a dummy and how horrifying it was to perform this in real life on a German, who shouted mutter (mother) as he plunged the blade in and then had to stamp on his victim’s chest to extract it. Next, he passed a wounded comrade imploring his help, but kept on running for fear of being shot. The guilt has never left him and he “relived” this experience most nights.’ But, having described the details of his nightmare on separate occasions, they never recurred.
Some people may be helped by taking a small dose of the antidepressant amitriptyline, or a drug originally developed to treat prostate problems. The veterans of the Vietnam War are now moving into the age range where their prostates are starting to ‘play up’, impeding the flow of urine. The standard treatment is an operation – but before this, specialists advise a trial of the drug prazosin, which relaxes the neck of the bladder.
The veterans take their pills, their urine ow improves, but unexpectedly those with PTSD report their nightmares to be much less intense. Thus a veteran who defended the Marine Headquarters in Khe Sanh against communist insurgents had recurrent nightmares that were ‘like being in a horror videotape I could not turn off’. Within a few days of taking prazosin the emotional e ect of his dreams changed, ‘as if I was observing it all from some distance away’.
These recurrent nightmares are the crux of the psychological problems associated with combat neurosis. Prazosin may not be the answer for all, but this accidentally discovered benefit will stimulate the search for, hopefully, yet more e ective drugs.
This week’s medical query comes courtesy of a lady from Brighton writing on behalf of her husband, now aged 71, who for the last few years has found that parts of his body swell whenever the temperature rises above 80F. His ankles, hands and wrists are usually a ected, but sometimes his knees and stomach as well. This is particularly inconvenient as he ‘really enjoys’ warm weather.
This swelling is caused by dilation of blood vessels under the skin as part of the thermoregulatory response to hot weather – with a consequent exudation of uid into the surrounding tissues. The standard advice is to reduce the amount of salt consumed – but this is not likely to be very e ective. The better option is for him to discuss with his GP taking a small dose of a water tablet (or diuretic) in hot weather to eliminate the excess fluid.
Email drjames@lady.co.uk
Perhaps surprisingly, simply recounting the nightmares to a sympathetic listener may abolish them. A Worcester family doctor describes the case of an 80-year-old patient who had fought in the trenches in the First World War. ‘He recalled having to bayonet a dummy and how horrifying it was to perform this in real life on a German, who shouted mutter (mother) as he plunged the blade in and then had to stamp on his victim’s chest to extract it. Next, he passed a wounded comrade imploring his help, but kept on running for fear of being shot. The guilt has never left him and he “relived” this experience most nights.’ But, having described the details of his nightmare on separate occasions, they never recurred.
Some people may be helped by taking a small dose of the antidepressant amitriptyline, or a drug originally developed to treat prostate problems. The veterans of the Vietnam War are now moving into the age range where their prostates are starting to ‘play up’, impeding the flow of urine. The standard treatment is an operation – but before this, specialists advise a trial of the drug prazosin, which relaxes the neck of the bladder.
The veterans take their pills, their urine ow improves, but unexpectedly those with PTSD report their nightmares to be much less intense. Thus a veteran who defended the Marine Headquarters in Khe Sanh against communist insurgents had recurrent nightmares that were ‘like being in a horror videotape I could not turn off’. Within a few days of taking prazosin the emotional e ect of his dreams changed, ‘as if I was observing it all from some distance away’.
These recurrent nightmares are the crux of the psychological problems associated with combat neurosis. Prazosin may not be the answer for all, but this accidentally discovered benefit will stimulate the search for, hopefully, yet more e ective drugs.
This week’s medical query comes courtesy of a lady from Brighton writing on behalf of her husband, now aged 71, who for the last few years has found that parts of his body swell whenever the temperature rises above 80F. His ankles, hands and wrists are usually a ected, but sometimes his knees and stomach as well. This is particularly inconvenient as he ‘really enjoys’ warm weather.
This swelling is caused by dilation of blood vessels under the skin as part of the thermoregulatory response to hot weather – with a consequent exudation of uid into the surrounding tissues. The standard advice is to reduce the amount of salt consumed – but this is not likely to be very e ective. The better option is for him to discuss with his GP taking a small dose of a water tablet (or diuretic) in hot weather to eliminate the excess fluid.
Email drjames@lady.co.uk