Dr James Le Fanu: 8 February
Many people know of some relative or friend of a friend – the proverbial ‘black sheep’ of the family – who, despite everyone’s best efforts, never really got his (or less commonly, her) act together. He/ she might be bright enough but underachieved at school, never settled into a job and may even have drifted into drug abuse or petty criminality. Psychiatrists tend to attribute this pattern of behaviour to ‘personality disorder’ for which, regrettably, there is not a lot that can be done. But might it be that some have an underlying treatable brain condition?
It is now generally accepted that many children who would in the past have been dismissed as ‘diffi cult’ because they are always on the move and unable to concentrate on a task, turn out to have ADHD (attention defi cit hyperactivity disorder) which, to the great relief of parents and teachers, frequently improves with the stimulant drug Ritalin.
There is no logical reason, argues Professor Phillip Asherson of the Institute of Psychiatry, why those ‘black sheep’ might not have ADHD too. Further, the beneficial effects of medical treatment with Ritalin in adults are, he claims, similar to those in children.
American Psychiatrist Martin Wetzel concurs. Writing recently in the British Medical Journal, he notes how ‘adult ADHD seems clinically true and responds to treatment.’ Many of his colleagues predictably are unconvinced, insisting rather that this is the latest psychiatric diagnostic fad fabricated by the pharmaceutical industry to promote the prescription of its costly drugs. For the moment the dispute remains unresolved – but it is certainly a new angle on what can be a very diffi cult problem.
THIS WEEK’S MEDICAL QUERY comes courtesy of a lady from Sandhurst who notes a marked discrepancy in the temperature and colour of her two hands – one very cold, the other pink and warm – especially after exercise. The contrast is extreme and she notes that ‘it is my party trick to get my friends to feel the difference’.
Something here is compressing the blood fl ow to the ‘icy cold’ arm – the likeliest explanation being that this is Thoracic Outlet Syndrome. The thoracic outlet is a space behind and below the collarbone through which the nerves and blood vessels travel to the arm. Those in whom it is narrowed may experience a range of symptoms depending on which structure is compressed; if it is the nerves – pain, numbness and tingling – the veins – swelling and bluish discoloration – or, as with this lady, the arteries – resulting in a pale, cold hand. Whichever, an operation to widen the outlet is usually curative.
drjames@lady.co.uk
For those with tennis elbow, an ice pack placed on the elbow for 10 minutes, twice a day, brings relief. Also, ice can stop a cold sore if put on at the first sign of an eruption. As a (former) sufferer says, ‘It used to mean a week of pain and unsightly sores. Now I apply the ice for a couple of hours and by morning the blisters have gone.’ And those troubled by piles fi nd relief by sitting naked on a chair on which has been placed ice cubes wrapped in a clean towel. The coldness reduces pain while constricting the prolapsed veins, thus reducing rectal bleeding.
It is now generally accepted that many children who would in the past have been dismissed as ‘diffi cult’ because they are always on the move and unable to concentrate on a task, turn out to have ADHD (attention defi cit hyperactivity disorder) which, to the great relief of parents and teachers, frequently improves with the stimulant drug Ritalin.
There is no logical reason, argues Professor Phillip Asherson of the Institute of Psychiatry, why those ‘black sheep’ might not have ADHD too. Further, the beneficial effects of medical treatment with Ritalin in adults are, he claims, similar to those in children.
American Psychiatrist Martin Wetzel concurs. Writing recently in the British Medical Journal, he notes how ‘adult ADHD seems clinically true and responds to treatment.’ Many of his colleagues predictably are unconvinced, insisting rather that this is the latest psychiatric diagnostic fad fabricated by the pharmaceutical industry to promote the prescription of its costly drugs. For the moment the dispute remains unresolved – but it is certainly a new angle on what can be a very diffi cult problem.
Something here is compressing the blood fl ow to the ‘icy cold’ arm – the likeliest explanation being that this is Thoracic Outlet Syndrome. The thoracic outlet is a space behind and below the collarbone through which the nerves and blood vessels travel to the arm. Those in whom it is narrowed may experience a range of symptoms depending on which structure is compressed; if it is the nerves – pain, numbness and tingling – the veins – swelling and bluish discoloration – or, as with this lady, the arteries – resulting in a pale, cold hand. Whichever, an operation to widen the outlet is usually curative.
drjames@lady.co.uk
VERSATILE ICE
The pain-relieving, blood-vessel contracting properties of ice makes it a versatile remedy – despite the recent implausible claims by ‘researchers’ in the US that when applied to a sprained ankle it might retard healing.For those with tennis elbow, an ice pack placed on the elbow for 10 minutes, twice a day, brings relief. Also, ice can stop a cold sore if put on at the first sign of an eruption. As a (former) sufferer says, ‘It used to mean a week of pain and unsightly sores. Now I apply the ice for a couple of hours and by morning the blisters have gone.’ And those troubled by piles fi nd relief by sitting naked on a chair on which has been placed ice cubes wrapped in a clean towel. The coldness reduces pain while constricting the prolapsed veins, thus reducing rectal bleeding.