Treatment ideas for Prince Andrew

From Dr Maurice Gueret

There is a plenty of medical knowledge to be gained by looking at the way you walk, writes Maurice Gueret, who has some treatment ideas for Prince Andrew.

Gait spotting

This year sees the 50th anniversary of one of the great comedy sketches of all time — Monty Python’s Ministry of Silly Walks. But for medics, there is often nothing funny about a bizarre walk. One of the early skills imparted in medical schools is clinical observation of the gait. Doctors who lift their heads from screens can learn much from patients as they approach and depart. We were advised never to let a coffee in Bewley’s go to waste by leaving the premises without procuring at least one diagnosis of an unusual walk. Children are adept at spotting and nicknaming unusual gaits, but the skill gets lost as they enter politer society. There was once a brilliant, yet unqualified vet in the Liberties of Dublin who was known to local youngsters as No-Toes, because in his peculiar walk, only the balls of his feet touched the ground. The ideal gait study is conducted in bare feet with the legs fully exposed. The room needs to be long enough for the patient to walk a fair distance and then turn around and return to the examiner. Which rules out many medical premises for this examination.

Duck waddle

The first thing to notice about a gait is whether it is in a straight line. Does the patient veer to one side rather than the other? Any tendency to fall, and if so, to what side? Is there shuffling? High-stepping or prancing like a trained pony? Waddling like a duck? Perhaps the patient very suddenly raises the leading foot high and then stamps the foot quickly to the ground. Does the patient watch the ground as they walk? How do they do with eyes closed? Are they bent forward in a manner suggesting they are always trying to catch up with their centre of gravity? An ancestor of mine had Meniere’s disease of the inner ear which causes hearing loss, tinnitus, poor balance and dizzy spells.

It also caused funny walks. During flare-ups, his gait could become like that of a drunken man, and I believe that on at least one occasion, he had to explain the medical origins of his walk to a passing policeman. It may be a natural part of the human condition to giggle at silly walks, but not all strange gaits brought to the attention of doctors prove to be laughing matters.

Cockroach cuisine

The HSE deserves praise for jobs it does well. One is inspection of food premises, where brave environmental health officers get down and dirty in the lavatories, kitchens and pantries of some very dodgy establishments. I have been studying recent typed and handwritten inspection reports on the Food Safety Authority website (fsai.ie), and they wouldn’t stimulate your appetite. Dirty freezers; rat droppings beside the deep-fat-frier; old food residue in microwave ovens; mouldy loos with pools of raw sewage; upside-down bait boxes; dead mice left in traps; live rodents; woodlice; cockroaches among the cashew nuts; coliform bacteria in the ice, pigeon faeces on the wash basin; no soap in the staff toilet. I could go on. Last November saw the highest number of enforcements in a single month seen in any of the last 20 years. The Taoiseach wants us all to know that Ireland is the third best place in the world for quality of life. A billion culinary pathogenic bacteria are clapping their little flagella and with him all the way.

Dry Duke

Prince Andrew boxed himself into a corner before Christmas with bizarre comments about an inability to sweat. He responded to accusations that he sweated profusely while dancing in a nightclub with the following: “There is a slight problem with the sweating, because I have a peculiar medical condition which is that I don’t sweat, or I didn’t sweat at the time, and that was, oh actually, yes, I didn’t sweat at the time, because I, em, had suffered what I would describe as an overdose of adrenaline in the Falklands War when I was shot at, and I simply, it was, it was almost impossible for me to sweat.’ The press found it rather difficult to find any sweating medic who could rationalise or make sense of the Prince’s mysterious dry skin. Most of us thought back to our textbooks which insist that acetylcholine is the chemical messenger of sweating, and not adrenaline. Oversweating or hyperhidrosis is the more likely scenario to confront doctors. Anhidrosis is a condition more familiar to equine vets on the look-out for panting racehorses with thin dry coats and dandruff. It requires sponging, cool mist sprays, fanning and being kept in the shade as much as possible. Perfect treatment for a dry old Duke of York.