YOUR HEALTH Dr James Le Fanu: 4 January
There is something apocalyptic about the recent storms and floods, retribution perhaps for forgetting ‘the old ways’. In the past, farmers dredged their ditches every year. Now the Environmental Agency sends a man in a JCB whose efforts clearing the main ditches block the minor ones flowing into them. Heavy rain then waterlogs the fields – and it’s floods all round.
An intimate knowledge of the land, once lost, may never be retrieved. So, too, with medicine’s fascination with modern imaging technology. Nowadays it is MRI scans all round, and while their pictures of our brains and joints are magnificent, they can short-circuit the more revealing diagnostic process of asking a few simple questions. Thus there were, at the last count, 150 types of headache – in only a handful of which (such as a stroke or tumour) a scan might clarify what’s going on. But these and all the others are more readily diagnosed by asking questions such as: where is the headache? What is its nature? What exacerbates or relieves it? These questions distinguish the ‘hot poker’ character of cluster headaches from the ‘buzzing and fluttering’ of tension headaches; the stabbing pain of cephalgia fugax from the diffuse pulsation of hypnic (sleeping) headaches and so on.
The point is well made by a consultant neurologist in the British Medical Journal, who reports the case of a 50-year-old woman who’d had several scans over the years for headaches she’d suffered from since adolescence. She described them as ‘excruciating, near continuous, always on the left side, never crossing the midline and unresponsive to all treatments.’ This is typical of a variant of migraine known as hemicrania continua – for which there’s only one effective drug: indomethacin. This did the trick. The moral is simple: the truth lies in the details, not the MRI scan.
This week’s medical query comes courtesy of a lady from Buckinghamshire. Often, having slept for an hour or so, she wakes feeling hungry, with hot and restless legs. ‘I get up, have tea with a slice of bread and honey and read my book,’ she writes. ‘I get back to sleep within an hour.’ This can occur two or three times a week, leaving her exhausted the next day. What, she wonders, can she do about it?
This link between heat and restless legs is well recognised and remedies include lying on the ground with the feet in the fridge before retiring, or (weather permitting) walking barefoot in the snow. A doctor from north London found that removing the bedding from his legs and letting them cool down diminished the restless legs sensation over a period of half an hour – after which he could cover them up and go back to sleep. Also, you could discuss with the family doctor a trial of the drug ropinirole which, in small doses, is effective. drjames@lady.co.uk
An intimate knowledge of the land, once lost, may never be retrieved. So, too, with medicine’s fascination with modern imaging technology. Nowadays it is MRI scans all round, and while their pictures of our brains and joints are magnificent, they can short-circuit the more revealing diagnostic process of asking a few simple questions. Thus there were, at the last count, 150 types of headache – in only a handful of which (such as a stroke or tumour) a scan might clarify what’s going on. But these and all the others are more readily diagnosed by asking questions such as: where is the headache? What is its nature? What exacerbates or relieves it? These questions distinguish the ‘hot poker’ character of cluster headaches from the ‘buzzing and fluttering’ of tension headaches; the stabbing pain of cephalgia fugax from the diffuse pulsation of hypnic (sleeping) headaches and so on.
The point is well made by a consultant neurologist in the British Medical Journal, who reports the case of a 50-year-old woman who’d had several scans over the years for headaches she’d suffered from since adolescence. She described them as ‘excruciating, near continuous, always on the left side, never crossing the midline and unresponsive to all treatments.’ This is typical of a variant of migraine known as hemicrania continua – for which there’s only one effective drug: indomethacin. This did the trick. The moral is simple: the truth lies in the details, not the MRI scan.
This week’s medical query comes courtesy of a lady from Buckinghamshire. Often, having slept for an hour or so, she wakes feeling hungry, with hot and restless legs. ‘I get up, have tea with a slice of bread and honey and read my book,’ she writes. ‘I get back to sleep within an hour.’ This can occur two or three times a week, leaving her exhausted the next day. What, she wonders, can she do about it?
This link between heat and restless legs is well recognised and remedies include lying on the ground with the feet in the fridge before retiring, or (weather permitting) walking barefoot in the snow. A doctor from north London found that removing the bedding from his legs and letting them cool down diminished the restless legs sensation over a period of half an hour – after which he could cover them up and go back to sleep. Also, you could discuss with the family doctor a trial of the drug ropinirole which, in small doses, is effective. drjames@lady.co.uk