Dr James Le Fanu: 2 August
There can be a long delay, as many of you will know, between the onset of symptoms and the initiation of the correct treatment – though luckily rarely as long as the 50 years reported by a reader from North Yorkshire. Since developing, in her late teens, an itchy red rash under both arms, over the years she has been prescribed ‘many kinds of cream’. Later, a similar rash would come and go under her breasts and in her genital area.
There are no prizes for guessing what the cause might be, but it was not until she was in her seventies that someone remarked it looked ‘fungal’. With distant memories of babies’ nappy rashes, she bought herself a tub of zinc and castor oil and ‘within a fortnight every vestige of the rash had gone’.
This tale might seem so extraordinary as to be of no general significance, but the staggeringly obvious can be overlooked for months or years. Thus, a retired chartered surveyor from Norfolk describes being troubled by recurrent exacerbations of his chronic lung disease, requiring admission to hospital for treatment with steroids, oxygen and antibiotics. Following his most recent admission, he was still not quite right – short of breath at rest and with swollen ankles. His family doctor was pessimistic. ‘There is nothing I can do. Your lungs are shot,’ he said, attributing the swollen ankles to a side e ffect of the steroid treatment.
This went on for a couple of months until a locum doctor visited him at home. He felt his pulse and was able to make the, in retrospect, obvious diagnosis of heart failure caused by the abnormally fast heart rhythm known as atrial brillation. Following a couple of days of digoxin and water tablets, his heart slowed, his ankle swelling vanished – and ‘I could breathe freely again’.
It is difficult to o ffer any general advice on how to avoid nding oneself in such a situation. It certainly helps when there are several partners in a local practice, making it easier to obtain a second opinion. More often than not, a new perspective and a simple physical examination will reveal what is amiss.
This week’s medical query comes courtesy of a woman from Sussex afflicted since last December with the sensation of a lump in the throat and tightening of the throat muscles. Her family doctor referred her to an ENT specialist, who inspected the inner lining of her throat with an endoscope and reassured her there was no physical cause for her symptoms, such as a tumour. Rather, he suggested, she has the condition known as globus pharyngeus, caused by a spasm of the throat muscles known to be brought on by stress. This is all very tiresome, and she wonders whether there might be some remedy or other that her specialist might have overlooked.
These symptoms certainly can be psychological, warranting treatment with anti-anxiety or antidepressant medication. However, this is unlikely to be the situation here. They may also be induced by acid reflux, and it is claimed that the suppressant drug omeprazole can be of value in almost two-thirds of cases.
Email drjames@lady.co.uk
There are no prizes for guessing what the cause might be, but it was not until she was in her seventies that someone remarked it looked ‘fungal’. With distant memories of babies’ nappy rashes, she bought herself a tub of zinc and castor oil and ‘within a fortnight every vestige of the rash had gone’.
This tale might seem so extraordinary as to be of no general significance, but the staggeringly obvious can be overlooked for months or years. Thus, a retired chartered surveyor from Norfolk describes being troubled by recurrent exacerbations of his chronic lung disease, requiring admission to hospital for treatment with steroids, oxygen and antibiotics. Following his most recent admission, he was still not quite right – short of breath at rest and with swollen ankles. His family doctor was pessimistic. ‘There is nothing I can do. Your lungs are shot,’ he said, attributing the swollen ankles to a side e ffect of the steroid treatment.
This went on for a couple of months until a locum doctor visited him at home. He felt his pulse and was able to make the, in retrospect, obvious diagnosis of heart failure caused by the abnormally fast heart rhythm known as atrial brillation. Following a couple of days of digoxin and water tablets, his heart slowed, his ankle swelling vanished – and ‘I could breathe freely again’.
It is difficult to o ffer any general advice on how to avoid nding oneself in such a situation. It certainly helps when there are several partners in a local practice, making it easier to obtain a second opinion. More often than not, a new perspective and a simple physical examination will reveal what is amiss.
This week’s medical query comes courtesy of a woman from Sussex afflicted since last December with the sensation of a lump in the throat and tightening of the throat muscles. Her family doctor referred her to an ENT specialist, who inspected the inner lining of her throat with an endoscope and reassured her there was no physical cause for her symptoms, such as a tumour. Rather, he suggested, she has the condition known as globus pharyngeus, caused by a spasm of the throat muscles known to be brought on by stress. This is all very tiresome, and she wonders whether there might be some remedy or other that her specialist might have overlooked.
These symptoms certainly can be psychological, warranting treatment with anti-anxiety or antidepressant medication. However, this is unlikely to be the situation here. They may also be induced by acid reflux, and it is claimed that the suppressant drug omeprazole can be of value in almost two-thirds of cases.
Email drjames@lady.co.uk