Is there anything that can be done for my 80-year-old sister, whose life is so miserable from tinnitus?
Name and address provided.
Anyone who has had tinnitus – when you hear a sound such as a ringing or buzzing sound, without an obvious external source – will know what a profound impact it can have on quality of life, including mood. Some people may find it extremely exhausting.
Most tinnitus is associated with age-related hearing loss and damage to nerve cells that help transmit messages to the parts of the brain that process noise.
One theory is that in the absence of real sound, the brain “compensates” for it with its own sound. For this reason, simply using a hearing aid can often improve tinnitus.
Understandably, some people with tinnitus are in a bad mood and use antidepressants such as SSRIs (selective serotonin reuptake inhibitors).
Most tinnitus is associated with age-related hearing loss and nerve cell damage that help transmit messages to the parts of the brain that process noise.
For example, the SSRI escitalopram has been shown to be effective. These medications can also help suppress tinnitus itself for reasons we don’t yet fully understand.
Similarly, insomnia may be associated with tinnitus – and managing chronic insomnia has been shown to reduce the severity of tinnitus.
Although there are no quick fixes for insomnia, there are a number of ways to help improve sleep, such as sleep hygiene (meaning not watching TV or other electronic devices in the bedroom, for example) and restructuring the way you watch sleep (a form of sleep deprivation). treatment known as cognitive-behavioral therapy for insomnia or CBTi) – there are many good tips on the Internet to help with this.
Your nurse’s GP may also refer her to ear noise retraining at a specialist center, where approaches such as speech therapies (eg CBT) are used to help the patient learn not to focus on tinnitus.
This has been shown to improve symptoms in up to 80% of people who try it – the time it can take to help varies from weeks to months, depending on the patient.
Another option offered at these centers is biofeedback, which teaches relaxation techniques to help the patient change their response to tinnitus.
I get abdominal pain about every four weeks, which leaves me unable to breathe or talk, even though lying on my left side clears it. This has been happening for the last three or four years, but my doctor says he can’t offer a solution unless he’s present when I have an episode. I’m 77 and otherwise I’m very fit.
Maurice Watkins, Radford, Coventry.
There are a number of common causes of abdominal pain, and the fact that you have no symptoms between each episode may help rule out some of these possible diagnoses, such as kidney stones and gallstones.
In both cases, the pain would usually be much more common than what you are experiencing.
Based on the fact that you do not have these conditions, I would suggest that sporadic small bowel obstruction can cause the intense pain you have experienced, and explain why it is relieved by changing position as you describe.
This type of short-term obstruction can be associated with adhesions – they form when surfaces inside the body stick together, usually due to previous abdominal surgery – or an undiagnosed femoral hernia (where part of the bowel is pushed down into the groin).
Another possibility is a condition called volvulus, in which a loop of the intestine twists, causing physical obstruction, and then is released.
This is usually due to a muscle defect present at birth.
One of my patients discovered, at the age of 50, that he was born with an abnormality in part of his small intestine, which causes attacks of obstruction. This was soon corrected by surgery.
Ideally, you will be reviewed during an attack, but the short nature of your episodes means that this is not possible. It may help to undergo an X-ray with barium nutrition (where you ingest fluid that is seen on the X-ray) to check the progress of the small intestine.
I suggest you ask your GP for a referral for an abdominal surgeon.
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In my opinion: patients deserve to see the same doctor every time
Continuity of care – visiting the same doctor every time – is essential for good general practice. It has been shown to reduce mortality and hospital admissions and lower the referral rate.
Just last month a study in the UK added to this list of benefits.
The study, which included 9,000 patients with dementia, found that those examined by the same doctor had fewer complications – 35% lower risk of delirium and 58% lower risk of suffering. of incontinence – and are less likely to be accepted. hospital, according to the British Journal of General Practice.
Continuity of care – visiting the same doctor every time – is essential for good treatment in general practice
However, there is a decline in patients ‘ability to see their GP, a trend accelerated by the major NHS reforms introduced in the early 2000s, which, among other things, removed GPs’ responsibility to provide “care outside working hours ”, and the right to have a personal doctor – now patients have just been registered in practice.
But what is lost with this is the detailed knowledge of the patient, his history and needs.
And as the great William Osler, a Canadian physician and teacher who spent much of his career as a professor of medicine at Oxford University in the late 19th century, said: “It is much more important to know what kind of patient has a disease than what kind of disease the patient.
Good GP practice – an example of a patient being examined 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.