Dr James Le Fanu: 24 January
It may not be a lot of fun lying on your back in hospital unable to move a muscle below the neck but, as Laurence Knott reflected soon after being admitted to London’s Royal Free Hospital, things could be a lot worse. Certainly it was a nuisance being unable to feed himself and humiliating to require nursing assistance for his basic physical needs but his condition, Guillain-Barré syndrome, is one of the few catastrophic neurological illnesses that tend to resolve of their own accord.
His phlegmatic reasoning was helped by his being a GP in north London. The first sign of something being amiss came when visiting a patient after morning surgery. ‘By the time I got to her room, I was more breathless than she was,’ he recalls. ‘We made a sorry picture, with her wheezing on one side of the bed, me gasping on the other.’
As soon as he got home he made straight for his medical textbooks and found there seemed to be just one condition that fitted his symptoms of breathlessness, tingling in his hands and feet, and difficulty in walking.
Guillain and Barré were two French physicians who in 1916 described this syndrome of progressive ascending paralysis for the first time. The main life threatening complication, accounting for Dr Knott’s breathlessness, is involvement of the respiratory muscles of the ribcage – warranting mechanical ventilation – though gratefully most recover spontaneously over a period of a couple of months.
Dr Knott survived and after a short stay in the intensive care unit returned to the general ward. But after his brush with death his phlegmatic optimism had evaporated. ‘For the short period I thought I was going to die, I consoled myself with the thought that my life had not been too bad,’ he says.
‘But when the crisis was over I was overwhelmed by despair at the prospect of my continued dependency. I was assailed with morbid thoughts that perhaps I would be spending the rest of my life in a wheelchair.’
After six weeks came the first signs of recovery. ‘It happened in the physiotherapy department when in response to the command “move your legs” I looked down and saw the first flicker of movement in my feet.’
He graduated from the wheelchair to walking with sticks and ‘to this day will never forget when I was able to get around on my own two feet again’.
This week’s medical query comes courtesy of a woman from Bolton who for the last few years has been troubled by a blocked nose and sinuses in the winter – though this usually cleared in the summer with regular visits to the seaside.
More recently she finds her symptoms persist all year. ‘I am no longer free of the blocked nasal passages and have to use a chest rub at night to get a few hours sleep.’ She takes the drug Ramipril for raised blood pressure and wonders whether this is responsible.
Nasal congestion (or chronic rhinitis) is a side effect of Ramipril and it would seem sensible to discuss with her doctor switching to another drug to lower the blood pressure in anticipation this would improve matters.
Email drjames@lady.co.uk
His phlegmatic reasoning was helped by his being a GP in north London. The first sign of something being amiss came when visiting a patient after morning surgery. ‘By the time I got to her room, I was more breathless than she was,’ he recalls. ‘We made a sorry picture, with her wheezing on one side of the bed, me gasping on the other.’
As soon as he got home he made straight for his medical textbooks and found there seemed to be just one condition that fitted his symptoms of breathlessness, tingling in his hands and feet, and difficulty in walking.
Guillain and Barré were two French physicians who in 1916 described this syndrome of progressive ascending paralysis for the first time. The main life threatening complication, accounting for Dr Knott’s breathlessness, is involvement of the respiratory muscles of the ribcage – warranting mechanical ventilation – though gratefully most recover spontaneously over a period of a couple of months.
Dr Knott survived and after a short stay in the intensive care unit returned to the general ward. But after his brush with death his phlegmatic optimism had evaporated. ‘For the short period I thought I was going to die, I consoled myself with the thought that my life had not been too bad,’ he says.
‘But when the crisis was over I was overwhelmed by despair at the prospect of my continued dependency. I was assailed with morbid thoughts that perhaps I would be spending the rest of my life in a wheelchair.’
After six weeks came the first signs of recovery. ‘It happened in the physiotherapy department when in response to the command “move your legs” I looked down and saw the first flicker of movement in my feet.’
He graduated from the wheelchair to walking with sticks and ‘to this day will never forget when I was able to get around on my own two feet again’.
This week’s medical query comes courtesy of a woman from Bolton who for the last few years has been troubled by a blocked nose and sinuses in the winter – though this usually cleared in the summer with regular visits to the seaside.
More recently she finds her symptoms persist all year. ‘I am no longer free of the blocked nasal passages and have to use a chest rub at night to get a few hours sleep.’ She takes the drug Ramipril for raised blood pressure and wonders whether this is responsible.
Nasal congestion (or chronic rhinitis) is a side effect of Ramipril and it would seem sensible to discuss with her doctor switching to another drug to lower the blood pressure in anticipation this would improve matters.
Email drjames@lady.co.uk