Your health: embarassing wind
Thursday, 01 November 2012

YOUR HEALTH: 2 November

The problems of diagnosing medical conditions according to age; how to deal with embarrassing wind and an old-fashioned, but effective, remedy for toothache

Written by Dr James Le Fanu
The doctor’s task of diagnosing what is amiss is considerably simplified by the way in which the likelihood of medical conditions varies with age. Thus the common childhood infections such as measles and chickenpox are rarely seen in adult life. Similarly, those conditions that may develop in the middle years, such as multiple sclerosis or diabetes are different again from the chronic degenerative diseases of ageing: cataracts, arthritis, prostate problems and so on.

So, when confronted by a patient with, say, chest pain, the doctor can focus on the most likely possibility on the criteria of age alone – in a young man it is more likely to be a collapsed lung; in someone in their 50s, angina; and in the over 70s, angina again or arthritis of the spine.

This ranking of diagnostic probabilities is obviously very useful but creates problems, as can be imagined, when people have diseases inappropriate to their age group. This is a particular hazard for those in their 30s or 40s with potentially serious illnesses, such as heart trouble. Their chest pain is misinterpreted as being due to indigestion, or their breathlessness misattributed to asthma. Then suddenly they have a heart attack, at which point the true significance of their symptoms becomes clear.

In the older age group the reverse situation may occur, where a ‘chronic degenerative’ illness is mistaken for one that is eminently treatable. Thus, a smoker in his 60s with a cough and a wheezy chest may be told he is suffering from emphysema and that, regrettably, there is little to be done for his damaged lungs. But he may in fact have late onset asthma – the distinction being made by prescribing a course of steroids that will both markedly improve his symptoms and make his airways more sensitive to bronchodilator drugs such as salbutamol.

So when told you are either ‘too young’ or ‘too old’ to suffer from some illness or other, it seems only sensible to enquire of the doctor how he can be so certain. Most of the time he will be absolutely right, but occasionally he may not be – and that can make a lot of difference.

This week’s medical problem comes courtesy of a lady from south London, who for many months has been troubled with excessive flatulence. She also has constipation caused by the strong painkillers she takes for her arthritis and which responds to the well-known laxative Movicol. She has tried to control the flatulence with medicinal charcoal tablets with some relief, but wonders what else can she do.

This lady’s excessive flatulence is almost certainly due to the Movicol. This sugar-based compound works by keeping the stool loose and moist but can also, in some cases, encourage the proliferation of bacteria in the lower gut that produce large amounts of gas. Switching to some other form of laxative might cure her problem.

Toothy Spin

There was a time when people could not afford to see a dentist and had to treat themselves – as a lady from Canterbury recalls.

‘When we had toothache as children my mother would fill a saucer with vinegar and pepper in which she would soak a square of brown paper. She then slapped the wet square on the cheek near the offending tooth and tied it with a large handkerchief. I think it helped as we always slept quite well, though it did not pay to wriggle one’s face in the pillow as the brown paper felt like sandpaper.’ This same remedy features as a cure for another ailment – Jack’s headache after ‘breaking his crown’ in the wellknown children’s nursery rhyme.

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