Your Health
Monday, 30 November -0001

YOUR HEALTH Dr James Le Fanu: 5 October

Should saving a life come at any price, unpleasant spasms when swallowing and simple ways to handle an itchy problem

Written by Dr James Le Fanu
The flip side of the lifesustaining marvels of modern medicine is that they can prolong the misfortune of those for whom there is no realistic chance of recovery. The rich and famous are especially vulnerable to what is euphemistically known as Potentially Ineffective Care (PIC), as their doctors are under pressure to 'leave no stone unturned'.

General Franco's final illness in 1975 – as described in a bulletin at the time – was a classic early example of PIC: 'A defibrillator shocks his heart back to normal when it slows, a pump-like device pushes blood through his body when it weakens, a respirator helps him breathe and a kidney machine cleans his blood.' The same bulletin goes on to describe several tubes down his throat, in his chest and abdomen before noting how, despite the doctors' best efforts, 'his lungs are congested, his kidneys are giving out and his liver is weak'.

Since then, this has become a familiar ritual in hospitals in the western world – it is estimated that the United States spends almost a third of its intensive care costs on PIC. One might suppose doctors would by now be more hesitant – but no. Six years ago, Israeli surgeons performed an heroic seven-hour operation to control a catastrophic haemorrhage into Prime Minister Ariel Sharon's brain. It was certainly successful as he survived, but the damage to his brain was so extensive it is no surprise that though he is still alive, he has never regained consciousness.

Here a comparison with Nelson's death at Trafalgar is instructive. It is possible that with modern surgery he would have survived the impact of that fateful 20g bullet from a French musket – but the damage to his spinal cord would have left him paralysed and incontinent. Following his funeral, King George III remarked to Nelson's brother, 'He died a death he would have wished'.

This week's medical problem comes courtesy of a lady in Suffolk who reports how recently when starting to eat she develops what seems to be a blockage in the throat.

'It is difficult to swallow my food and when I do my mouth fills up with what seems like mucus.' There is no warning as to when this will happen but it seems to be sparked by food that requires a bit of chewing. Her family doctor has tried the drug domperidone, which improves the motility of the stomach, but the sudden and episodic nature of her symptoms makes them hard to treat.

This difficulty in swallowing is due to spasm of the muscles around the oesophagus, and the clear, slightly salty fluid that fills the mouth (known as waterbrash) is secreted by the salivary glands. This was described by Dr Alan Birch writing in The Practitioner's Handbook: 'The saliva passes down the oesophagus and collects above the sphincter, separating it from the stomach. Then, without nausea or active vomiting, it is shot up into the mouth and spat out or swallowed.' Both the spasm and the waterbrash are commonly related to acid reflux and can usually be prevented by taking an acidsuppressant drug such as Omeprazole.

drjames@lady.co.uk

An age-old itch

Generalised itching associated with ageing (known as senile pruritus) can be exacerbated by regular hot baths as they reduce the natural oils secreted by the skin. It would thus seem wise to bathe in lukewarm water, which is less likely to dry the skin. Or, for those who get itchy legs after a bath, spray them with cold water from the shower before drying. Further, as dry rubbing with a towel can exacerbate itchiness, particularly 'down below', it would be preferable to dry these areas with a hairdryer.


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