Thursday, 14 June 2012

YOUR HEALTH Dr James Le Fanu: 15 June

Problems with a deviant upper and lower jaw, the downside of exercise in the gym and a remedy for constipation

Written by Dr James Le Fanu
The great wonder of the human body is how the most insignificant of its parts are indispensable to the proper functioning of the whole. The smallest of all joints, that connecting the jaw to the skull – the temporomandibular – is a case in point. Small it may be but no joint works harder, opening and closing a thousand times a day as we chew and talk.

The joint is so important in this and other aspects of our lives that not surprisingly its malfunction causes a lot of distress. The symptoms may vary in severity but most of those with TM dysfunction (as it is inelegantly called) experience pain, clicking, 'sticking' and are unable to open the mouth fully so the jaw deviates to the affected side. As is so often the case, the question of how best to treat it varies depending on what type of specialist is consulted.

The dentist predictably tends to locate the problem in the alignment of the upper and lower jaw – that can be corrected with a splint repositioning them in closer proximity. By contrast, orthopaedic surgeons take the view that the problem lies in the joint itself, whose internal structure can now, amazingly, be scrutinised by inserting a minuscule arthroscope and taking a look around. This may identify structural derangement or adhesions that can be improved by irrigating the joint with a suitable solution. Finally there are those who maintain the painful limitation of movement is due to stress-induced spasm of the surrounding muscles that may be relieved with a low dose of the antidepressant Amitriptyline.

This week's medical problem comes courtesy of a lady from Leeds who works out a couple of times a week at her local gym. She finds, however, that this causes her to produce excess phlegm – certainly compared to her fellow gym users. She is a non-smoker and wonders what the explanation might be.

This symptom of exertion-induced phlegm is not unusual and is presumed to be due to the influx of dry, cool air into the lungs, causing irritation. This is particularly notable in those with asthma, who may also experience wheeziness and tightness of the chest. Further, when the phlegm is yellow or green, this indicates the presence of a lowgrade infection. The sensible course of action here would be to take a couple of puffs of the bronchodilator salbutamol prior to a session in the gym and a course of antibiotics if the phlegm is discoloured.

Finally, my thanks to a lady from West Glamorgan for passing on her fortuitously discovered remedy for constipation to which she has been a martyr all her life. 'At a rather boring cocktail party I sat near a table on which there was a saucer of cashew nuts. With nothing better to do I absent-mindedly nibbled a few. The following morning I had a really easy motion. This was such a luxurious surprise I tried to pin down the cause and decided it must have been the cashew nuts. I now take a small handful a day just before lunch and have never looked back.'



The symptoms of poor circulation in the hands with cold white and painful fingers, most commonly attributed to Raynaud's phenomenon, are readily recognisable – though reputedly difficult to treat. Dr Beth Goundry of Leicester Royal Infirmary, writing recently in the British Medical Journal, draws attention to two recent developments. First it appears that the GTN spray used to treat anginal attacks can, if applied to the fingers, dilate the blood vessels, markedly improving the circulation. Secondly, this is yet another situation where the wonder drug Viagra can be of value – a recent study shows that, taken regularly, it reduces the frequency and severity of Raynaud's.



JamesLeFanu-Jun15-Remedy-02-176In May's hot weather I was foolish enough to get sunburnt on my back while gardening – at my age I should know better. The next day it was still tight and sore, so in true 'home remedy' fashion I decided to do a scientific test – on one shoulder I put aloe vera and on the other, vinegar – you can see I leave no stone unturned to bring you the latest research.

Aloe vera is well known for its soothing properties for burns and skin complaints, whereas vinegar has no such history. I read that someone used it for sunburn – I assume its astringent nature would help by tightening the skin.

Well, the result was interesting – the aloe vera gel was cooling and eased the sense of dryness after it had sunk in. The vinegar was instantly cooling and brought relief to the burning sensation, and although I expected this to wear off, it didn't and several hours later the 'vinegar' shoulder was more comfortable than the aloe vera one.

So if you can bear to smell like a bag of chips (the smell doesn't last), then I suggest giving vinegar a go – but on minor sunburn only, please.

Sof McVeigh:

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