Thursday, 07 June 2012

Your Health Dr James Le Fanu: 8 June

Does a surgeon’s age affect surgical success, how corns are caused by bulimia and prayer, and treating fibroids…

Written by Dr James Le Fanu
The considerable interest of medicine is that the most mundane of complaints turn out to have the most fascinating ramifications. Who would have thought, for example, that the humble corn would be linked with Shi'ite Muslims at prayer and the eating disorder bulimia.

The origin of a corn (or callus as it is more scientifically known) lies in the capacity of the skin of the foot to become thickened and hardened, thus protecting the joints from the damage of heavy downward pressure of the body. This phenomenon can, however, be elicited by any repetitive trauma.  Thus the presence of a callus on the forehead of those practising the Muslim faith is a sign of great religiosity – the 'prayer nodules' as they are known, are caused by the practice of bending forward, so the forehead touches the ground, up to 40 times a day, while chanting 'I extol the perfection of the Lord'.

Then the presence of calluses on the back of the first joint of the index finger in adolescent girls with bulimia is a sign of the very different practice of induced vomiting: the callus developing at the place where the finger is in contact with the teeth when it is pushed to the back of the throat to induce vomiting by stimulating the gag reflex.

This remarkable capacity of the skin on any part of the body to become hardened in this way as a protection against repetitive trauma is not, however, without its drawbacks – as illustrated by the painful corn where the dead and hardened skin on the upper surface of the toes presses on a nerve. The most obvious way of preventing this is by wearing sensible shoes, but the definitive treatment requires the hardened skin to be pared away by a sharp scalpel. This time-consuming procedure can apparently be made easier by the regular application of extract of marigold.

This week's medical problem comes courtesy of a lady from Norfolk, who is in her early 40s and has three children – she is now troubled with heavy periods of such severity as to cause her to be anaemic, resulting in chronic tiredness and shortness of breath.

This problem is exacerbated by fibroids in her womb and she has been advised that this is best treated by having a Mirena intrauterine coil fitted. But is this the best option, she wonders.

The Mirena coil is indeed the treatment of choice for women in this age group with heavy bleeding associated with fibroids. It differs from other types of coil in secreting a small amount of the female hormone progesterone that thins the lining of the womb so bleeding is lighter – thus keeping the heavy bleeding under control until the onset of the menopause, when the problem will cease.

The main alternative if this does not 'do the trick' is to have a hysterectomy.




James-LeFanu-Remedy-June08-176The many factors contributing to a successful operation include the stamina, skill and experience of the surgeon – and also, it would appear, his (or her) age, with the best results achieved in those between the ages of 30 and 52. This emerges quite clearly from a recent study published in the British Medical Journal where researchers in France investigated the outcome of 3,500 operations on the thyroid gland performed by 28 surgeons over a period of a year. They found, thankfully, a very low rate of complications but, perhaps surprisingly, these occurred most frequently in those with the most experience, aged 50 and over. This would suggest a modest decline in manual dexterity but also, it is suggested, a slight reduction in visual acuity that can make it difficult to distinguish between the tissues that need to be removed from those that need to be retained.

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