Monday, 30 November -0001

Your Health Dr James Le Fanu: 3 August

Heeding the symptoms of an underactive thyroid, effective treatments for asthma, and eating chocolate for a healthy heart

Written by Dr James Le Fanu
Even if your doctor only requests a blood test to give the appearance of doing something, the result is likely to be accurate. Indeed, modern chemical analysis is so sensitive it is possible to detect hundreds of different hormones and enzymes in the blood, even in the smallest concentrations.

However, technology is never faultless and it would not be surprising if some tests suggest there is something amiss when there is not – or, conversely, that the tests are 'normal' even when there are strong reasons for believing there is something seriously wrong.

Several factors, such as exposure to infections or vaccinations, can stimulate the production of antibody chemicals in the blood, that mimic the substance being measured – so its level will seem to be much higher than it really is. This may, for example, happen with patients presenting to hospital with chest pain, whose blood tests, measuring the enzyme released by the injured heart muscle, are markedly raised. This is clear evidence of a substantial heart attack, warranting appropriate treatment and further investigations. But when the arteries to the heart are X-rayed, there is no evidence of blockage.

The reverse situation of the 'false negative' blood test has become a major source of contention in recent years. This is a particular difficulty in those who have all the symptoms of an underactive thyroid, such as weight gain, poor concentration, sensitivity to the cold, and fatigue.

Perplexingly, however, the relevant blood test for thyroid function is often normal. This situation, seemingly, is not unusual and there are numerous accounts of people battling for years with intransigent doctors only to have their lives miraculously transformed when someone finally agrees to prescribe the appropriate thyroxine supplements. In a further twist, some (whose underactive thyroid is being treated) believe their dose should be higher than prescribed, as symptoms still persist, albeit in a milder form. But this, too, is refused as the tests are apparently 'back to normal'. The sensible situation would seem to be to place one's trust in the patient's description of their symptoms rather than the results of the blood tests.

This week's medical problem comes courtesy of a 23-year-old woman from Leeds troubled with asthma for the last 10 years, but now even a flight of stairs causes her to be out of breath and slightly dizzy. 'I am not overweight and I am otherwise healthy,' she writes.

Breathlessness after such modest exertion would suggest there is something seriously inadequate about her asthma treatment. It is customary to start off with a short course of high-dose steroids, reducing slowly over a period of a fortnight. This reduces the chronic inflammation in the airways that is impeding the flow of air in and out of the lungs – and is combined with the regular use of a bronchodilator such as Ventolin. If this is not quite sufficient, the drug Phyllocontin (also to dilate the airways) can be added to the regime. Modern treatments for asthma are so effective that the goal of treatment should be effectively to abolish the symptoms of wheezing and breathlessness.



Chocolate FIX

The considerable benefits of dark chocolate should perhaps be better appreciated – specifically, its ability to lower blood pressure and cholesterol level. Recently, Dr Ella Zomer of the Royal Melbourne Hospital in Australia worked out the practical implications this could have in reducing the risk of cardiovascular problems. She estimates that, over a period of 10 years, eating a modest £25-worth of dark chocolate per person per year could prevent 700 non-fatal heart attacks and 150 fatal attacks and strokes. 'This represents a useful and cost-effective strategy,' comments Dr Zomer.

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