Thursday, 23 August 2012

YOUR HEALTH Dr James Le Fanu: 24 August

Avoiding the perils of glaucoma, how to cope with feeling chilly, and a simple way to boost fertility

Written by Dr James Le Fanu
My most recent visit to the optician ended, as is now customary, with a puff of air to the eyeballs which, by ingeniously measuring the pressure within, identifies those at risk of glaucoma. It is difficult to imagine a more useful test whose apparent rationale could not be more straightforward.

The watery fluid (aqueous humour) within the eye keeps it round and bouncy (like air in a football) and provides a clear medium through which the external world is focused on to the lightsensitive retina. And, just as a continuous stream of water prevents a pond from becoming stagnant so, too, is the aqueous humour constantly renewed, circulating within the eyeball before draining out through minute channels in the corner of the eye.

This ever-flowing fountain works brilliantly for 50 years, until the plumbing starts to go awry; the channels no longer provide adequate drainage and the volume of fluid within the eyeball rises, causing pressure on the optic nerve at the back. The resulting visual loss is insidious, as it starts at the periphery before gradually 'closing in'.

That, at least, is the theory, but simple mechanical analogies can be deceptive and fail to account for several observations. Why, for example, does the eyesight continue to deteriorate in about a third of patients, despite adequate treatment? And why do others with normal pressure in the eyeball develop the characteristic visual loss associated with glaucoma?

There are several other observations that do not quite 'fit', suggesting that glaucoma is likely to be rather more complex than can be accounted for by prevailing theories. Nonetheless, for the moment, the mainstay of treatment involves the use of drugs to boost the flow of the aqueous humour, and if that does not work, a small operation to improve the 'plumbing'. In addition, and for reasons quite unknown, it seems that regular exercise can reduce pressure within the eye; to the extent that those who walk briskly four times a week for 40 minutes or more are often able to stop their medication.

This week's medical problem comes courtesy of a lady in Rutland who has trouble keeping warm. 'I am freezing in winter and often cold in the other three seasons,' she writes. Her thyroid levels are always low-normal, she adds, but a course of thyroxine medication prescribed by her family doctor has not improved matters.

It is not unusual for people, especially in the older age group, to feel constantly chilly. As recognised causes, such as low body weight and an under-active thyroid, do not seem to apply in this case, it is important to test for anaemia and Addison's disease (a rare disorder of the adrenal glands). In some women, feeling the cold is hormonally related, which can be improved with a course of hormone replacement therapy. Beyond that, her symptoms are most likely to be due to some defect in the (complex) thermoregulatory mechanisms of the body for which, regrettably, there is no remedy other than to turn up the central heating and wrap up well.

Counting culture

Those couples having difficulty conceiving owing to the husband's low sperm count, should be aware that keeping the testes cool may be of help.

'My husband was told he was almost completely infertile,' writes a lady from Bristol. 'His sperm count at 2.5 million per millilitre was described as "grossly abnormal... fertility must be low if present at all" and he was advised to spray his testicles for 10 minutes with cold water morning and evening and to wear loose underpants.' Within three months his sperm count had risen to 56 million and, she says, 'I subsequently had three pregnancies in five years – two at the first attempt.'

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