Dr Le Fanu’s on the web health clinic, Friday 7th March 2014

In addition to paralysis, l have chronic pain, due to the severe nerve damage and or a stroke during the surgery. l now take Tramadol 100SR x 2, Oxycontin 20mg x 2 and OxyNorm for breakthrough pain management, l also take a Statin, Omeprazole and Zomig. Is this dangerous?

Rob S

Dear Rob S,

Thanks for being in touch and your account of the devastating effect of this illness and the heroic surgical procedure to correct it. I would have not have that the medicines you are taking to minimise the pain due to nerve damage are ‘dangerous’. I do, however, wonder whether the statins that are well known to cause musculoskeletal pains are necessary.


Dear Dr Le Fanu,

I should be grateful for any advice on curing (not simply relieving) flatulence, from which I’ve suffered for nearly two years, after (successful) radiotherapy for prostate cancer.

I was also left with bleeding blood vessels (radiation proctitis) which have not been totally eliminated. The combination is unpleasant!

No nurse, doctor or specialist has been able to suggest a cure for my flatulence. Can you or any reader help?

Thank you,


Dear G H J,

Thanks for your query. I note from an excellent review of the gut symptoms following radiotherapy for prostate cancer that ‘distressing’ flatulence in surprisingly frequent (J Andreyev, Lancet Oncology 2007, vol 8, pp 1007-17) -though why this should be so is not clear. You will know no doubt that so called ‘healthy’ foods (beans, pulses etc etc) are an exacerbating factor and best avoided. Dr Andreyev also notes that antibiotics ‘might help’ presumably through their effects on the composition of the gas producing bacteria in the colon. Several readers over the years have commented on how a course has markedly reduced the amount of flatus. You may wish to discuss this with your doctor.

Dear Dr James

I had an echocardiogram last March which showed mild aortic regurgitation which is a central jet and trivial mitral regurgitation. I am sure it is due to my hypertension. I started on 2.5mg Ramipril, last March and for the past 8 months the dosage has increased to 10mg Ramipril plus 5mg amlodipine.

Almost every night when in bed I experience a sensation of pulsation in the neck and chest. I can also feel the heartbeat in my left ear. My doctor referred me to the ENT doctor, but she could not find anything and said that the noise I can hear could be related to the blood pressure.

Fortunately my blood pressure is under control it varies 135/78 to 146/88.

I also had a ultrasound of carotid and vertebral vessels with no evidence of atheroma or stenosis.

My questions are:

Can the regurgitation of the valve return to normal if blood pressure is controlled?

What can I do to get rid of the noise in my left ear, as it is not a ringing or whistling noise like tinnitus, so it must be to do with heart/blood pressure.

If the blood pressure is normal, why do I still from time to time feel the pulsation on the neck and sometimes in the chest?

I would very much appreciate your good advice.

many Thanks

Mrs N

Dear Mrs N,

Thanks for your query. This is a tricky one. Hypertension can (if severe) cause aortic regurgitation through its effects in dilating the musculature of the heart – but both conditions are common and can thus occur independently of each other. Hence treatment of hypertension may indeed improve AR – but clearly if they are ‘independent’ it will not.

Next the pulsating sensation in the neck can indeed be due to the increased haemodynamic flow associated with AR – but again only when severe which I gather is not the case. Put another way your symptoms do not really ‘fit’ – but I would favour the positive that your blood pressure is now well controlled and your AR is ‘mild’ – and thus unlikely to cause any serious problems in the future.


Dear Dr Le Fanu

May I report what appears to be a fairly simple treatment for heartburn and acid reflux? These had been giving me some problems for a number of months, but I noticed the problems were less in the summer. One difference in my lifestyle in the summer is that I go swimming most days, breaststroke. This of course exercises certain muscles which would not normally be used much. Since Christmas (when this idea occurred to me), I have been doing (dry) the sort of arm exercises that roughly simulate the breast stroke action (such as I recall from school PT), and since I started I have not been troubled by heartburn or acid reflux. I can only imagine the exercises strengthen the diaphragm, giving it a stronger grip on the gullet. I don’t do much, maybe three or four minutes a day at most. Worth a try.



Dear MS,

Thanks for being in touch with that most interesting account of the value of breaststroke type exercises in reducing the symptoms of acid reflux. I will mentioning this in the column in the near future.

Dear Dr. James LeFanu

I have recently come out of hospital where I spent 8 days recovering from a condition called Guillain-Barre Syndrome, this unusual condition puzzled the doctors for a while because of its rarity. I have not been ill prior to this occurrence. My question is, is it likely to return or is it a ‘one-off’?


Neil G

Dear Neil G,

Thanks for being in touch – and it is good to hear you have recovered from Guillain-Barre Syndrome. This can indeed recur, but gratifyingly only very rarely, in around 1% of those affected which, by the laws of probability, is obviously very reassuring.


Dear Dr James,

Having read your column this week, due to the ‘editors pick’ recommendation, I would suggest that Primary (AL) Amyloidosis is a cause of changes in taste, along with an enlarged or inflexible tongue. If picked up early, Amyloidosis can be successfully treated, especially by the NAC (National Amyloidosis Centre) at the Royal Free Hosp. A rare but overlooked disease, due to the difficulty in diagnosing it.


With best wishes,


Jean R

Dear Jean R,

Thanks for being in touch and drawing attention to Primary Amyloidosis as a cause of taste disturbance. I hope to mention this and the NAC in the near future.

Dear Colleague,

Your column today touched on this subject. It reminded me of a previous writer who reported to you that “lifting his scrotum” helped empty his bladder and solved his tendency to recurrent UTIs. I wrote to you at that time pointing out that what he was probably doing was massaging, or milking, his spongeosus urethra. though I haven’t suffered UTIs myself, such a manoeuvre succeeds in preventing embarrassing leaks down ones trouser legs having put everything away and “adjusted one’s dress” in the mistaken impression that one had finished urinating! Perhaps you recall this correspondence?

Dear Anon,

Thanks for being in touch I do indeed recall that correspondence and will be mentioning it again in the Monday column in the near future.

Regarding the medical query from AN from Aberdeen who suffers a transient loss of taste after cooking the family supper.

I used to suffer a bad headache after cooking the Sunday dinner until I realised that this was caused by keeping my head bent forward as I prepared the food (more preparation that a weekday meal).

I also suffered headaches on holiday until it was suggested that this was caused by tilting my head backwards as I swam the breaststroke (to keep my glasses and hair dry!!!).

His head position may be a cause of the problem suffered by AN.

Also, regarding overlooking the rarer causes of common conditions, I suffered body and head itching and also a tremor in my leg which caused problems when driving. As I have a history of depression these problems were dismissed as being psychosomatic. Some time later I developed palpitations and by chance saw a different doctor to my regular one. Without the pre-knowledge of my mental illness (although it is in my notes) she immediately suspected an overactive thyroid and this subsequently proved to be the case. The previous symptoms were a precursor of hyperthyroidism.


Gillian C

Dear Gillian C,

Thanks for being in touch and your interesting account of this cooking related headache – an interesting phenomenon I had not previously encountered. I was intrigued too by the unusual presentation of your overactive thyroid and will mention this in the column shortly.

Maybe this is too late for inclusion, but I’ve found that pushing gently upwards on the perineum helps too. (Only works for 50% of the population, I suppose.)

Dear Anon,

Thanks for that further hint on promoting urine flow.

Dear Dr Le Fanu

In your piece in the DT on Monday 10th February you referred to a neurological condition that readers had experienced whilst being on holiday. Amongst the symptoms were; a severe sore throat, leading to deafness, loss of balance, difficulty in swallowing, facial palsy on the left side and the closing of the left eye.

I thought you might be interested to hear that I have all of those symptoms but from a totally different set of circumstances.

Having been a Trigeminal Neuralgia sufferer for a very long time I underwent the Glycerol Injection procedure for the relief of that condition in January of 2011 at the Princess Elizabeth Hospital in Birmingham as a NHS patient. Following this procedure I immediately developed a severe sore throat which persists to this day and deafness in the left ear. Although the latter was a known possible side effect of the procedure all the other symptoms seem to have arisen from the procedure too. When I mentioned them at the subsequent check ups the Consultant’s ignored them.

Your mention of Dr John Boughey’s opinion on the likely cause, a herpes simplex virus, is most interesting and is something I would dearly like to discuss with my GP and the Consultant’s at Birmingham as I am also experiencing what seems to be a never ending cold, itching to the eye lids, headaches, migraines and sweating at present. But that is unlikely to happen as it is considered poor form by them when referring to another clinician’s views or experiences.

Incidentally, is Dr Boughey an American by any chance?.

In conclusion may I thank you for your most interesting column which you produce with great compassion and humour.

Thanks and regards.


Dear Peter,

Thanks for being in touch and your kind comments about the column. It would appear from the description of your symptoms that the treatment of your trigeminal neuralgia must have damaged the glossopharyngeal nerve in close proximity to cause this deafness and sore throat. I would not have thought the herpes simplex virus is implicated.


I was most interested in the final point in your print column this week suggesting gentle tickling of the base of the spine to encourage passing of the last drops during urination.

This has been a tip in my family for many years and I found it invaluable when caring for my adored mother in her final months, whilst supporting her on the commode. Avoiding that annoying feeling of not having finished is especially useful when getting out of bed is such a difficult enterprise.

I can also confirm from my own experience that it is equally useful when putting tinies on the pot last thing at night. It has probably helped to save me many disturbed nights, and my dear parents many a wet nappy!

Yours faithfully,

C.P. B

Dear C P B,

Thanks for being in touch and I am so interested to hear of your family tradition on the value of tickling the base of the spine – and particularly for the ‘tinies on the pot’. I will be mentioning this shortly.


I am 80 years old and I am having trouble sleeping. I go to sleep quickly but I then wake up between 2/3am and cannot get back to sleep. Any suggestions?

Regards Brian D

Dear Brian D,

Thanks for being in touch. This type of insomnia is, I suspect, not unusual for those in your age group for which there is no specific remedy other than perhaps a small dose of a sleeping pill such as Zopiclone.

I am male aged 85 and have taken 10mg amlodipine, 1mg doxazosin, 10mg enalapril & 2.5mg bendroflumethiazide daily for 18 years the water tablets instead of speeding up the excretion of water i.e a tin of beer taken mid-day Sunday would be removed 2am Monday. does this matter?


Dear Jack,

Thanks for being in touch I cannot begin to imagine why your medication should have the paradoxical effect you describe.

Dear Dr Le Fanu,

Further to your Doctor’s Diary in The Telegraph of March 3rd, I thought it might be helpful to remind you of the physiology behind Taste and Smell. The former responds to fluids only, is subdivided into 4 parts (sweet, sour, salt and bitter), and is appreciated by “buds” at the back of the tongue. The latter is activated only by gaseous substances drawn past olfactory receptors at the back of the nasal septum, and can be lost as the result of catarrh or a head cold. I suspect that your Mr AN from Aberdeen is suffering from chronic catarrh affecting his sense of smell, and this is aggravated by the heat of the kitchen cooker! But your oenophile may have a neurological problem involving his sense of taste, which might require a neurological second opinion. I am not an expert in such matters, but just happen to remember my Primary FRCS physiology from the distant past !!


Dear J B,

Thanks for your most interesting suggestions both as to the cause of the cooking related anosmia and the selective wine dysgeusia – that I will feature in next week’s column (Monday 10th March).

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>