Is there anything that can be done for my 80-year-old sister whose life is being made so miserable by tinnitus?
Name and address supplied.
Anyone who’s experienced tinnitus — where you hear a sound, such as ringing or buzzing, without an obvious external source — will know what a profound impact it can have on quality of life, including mood. Some people can find it extremely debilitating.
Most tinnitus is linked to age-related hearing loss and damage to the nerve cells that help relay messages to the parts of the brain that process noise.
One theory is that in the absence of true sound, the brain ‘makes up’ for it with its own sound. For this reason, simply using a hearing aid can often improve tinnitus.
Understandably, some people with tinnitus experience low mood and use antidepressant medication such as SSRIs (selective serotonin reuptake inhibitors).
Most tinnitus is linked to age-related hearing loss and damage to the nerve cells that help relay messages to the parts of the brain that process noise
For example, the SSRI escitalopram is proven to be effective with this. These drugs may also help suppress the tinnitus itself, for reasons that we don’t yet fully understand.
Similarly, insomnia may also be linked to tinnitus — and managing chronic sleeplessness is proven to reduce the severity of tinnitus.
Although there are no quick-fix solutions for insomnia, there are a number of ways to help improve sleep, such as sleep hygiene (this means not watching TV or other electronic devices in the bedroom, for instance) and reframing the way you look at sleep (a form of treatment known as cognitive behavioural therapy for insomnia, or CBTi) — there is a large body of good advice available on the internet to help with this.
Your sister’s GP may also refer her for tinnitus retraining therapy at a specialist centre, where approaches such as talking therapies (e.g. CBT) are used to help the patient learn not to focus on the tinnitus.
This has been shown to improve symptoms in up to 80 per cent of people who try it — the time it can take to help varies from weeks to months, depending upon the patient.
Another option offered at these centres is biofeedback, in which relaxation techniques to help the patient change their response to the tinnitus are taught.
I get an abdominal pain roughly every four weeks that leaves me unable to breathe or talk, although lying on my left side clears it. It’s been happening for the past three or four years but my doctor says he cannot offer a solution unless he’s present when I have an episode. I am 77 and very fit otherwise.
Maurice Watkins, Radford, Coventry.
There are a number of common causes for abdominal pain and the fact that you don’t have any symptoms inbetween each episode can help exclude some of these possible diagnoses — for instance, kidney stones and gallstones.
With both of these problems the pain would usually be much more frequent than what you are experiencing.
On the basis that you don’t have these conditions, I’d suggest that a sporadic small-bowel obstruction might be causing the intense pain you’ve experienced and explain why it settles by changing position as you describe.
This kind of short-term obstruction could be linked to adhesions — these form when surfaces inside the body stick together, typically due to previous abdominal surgery — or an undiagnosed femoral hernia (where part of the bowel pushes down into the groin).
Another possibility is a condition called volvulus, where a loop of the bowel twists, causing a physical obstruction, then releases.
This is usually due to a muscle defect present since birth.
One of my patients discovered, aged 50, that he’d been born with an abnormality in part of his small intestine which caused bouts of obstruction. This was soon corrected by surgery.
Ideally you’d be examined during an attack, but the brief nature of your episodes means this isn’t possible. It may help to undergo a barium meal X-ray (where you swallow a liquid that shows up on X-ray) to check the course of your small intestine.
I suggest you ask your GP for a referral to an abdominal surgeon.
Write to Dr Scurr
Write to Dr Scurr at Good Health, Daily Mail, 2 Derry Street, London W8 5TT or email [email protected] — include your contact details. Dr Scurr cannot enter into personal correspondence. Replies should be taken in a general context and always consult your own GP with any health worries.
In my view: Patients deserve to see the same GP every time
Continuity of care — seeing the same doctor every time — is central to good doctoring in general practice. It’s been shown to reduce mortality rates and hospital admissions and lower the rates of referral for specialist care.
Just last month, a UK study added to this list of benefits.
The research, which involved 9,000 dementia patients, showed those who were seen by the same doctor had fewer complications — with a 35 per cent lower risk of delirium and a 58 per cent lower risk of suffering incontinence — and were less likely to be admitted to hospital, reported the British Journal of General Practice.
Continuity of care — seeing the same doctor every time — is central to good doctoring in general practice
And yet there has been a decline in patients being able to see their preferred GP, a trend accelerated by the major NHS reforms introduced in the early 2000s, which, amongst other things, removed the responsibility for GPs to provide ‘out of hours care’, and the right to have a named GP — now patients are just registered with the practice.
But what is lost with this is the detailed knowledge of the patient, their history and their needs.
And, as the great William Osler, a Canadian physician and teacher who spent much of his career as a professor of medicine at the University of Oxford in the late 19th century, said: ‘It is much more important to know what sort of patient has a disease than what sort of disease a patient has.’
Good GP care — exemplified by a patient being seen by the same doctor — will only be possible once we have more GPs, and that will take time.
Until then we must accept that we have a second-class service.
Source: | This article originally belongs to Dailymail.co.uk