Anticipating trouble does not always pay dividends
‘A damaged heart valve proved no impediment to an active military career’
The paradox, often remarked on, is why, despite a marked increase in the number of family doctors, it can take so much longer to get an appointment than in the past. Among the several reasons could be that, in recent years, they have extended their remit beyond dealing with the sick to seeking out illness in the healthy majority – known as “anticipatory medicine”, because it promises to “anticipate” medical problems.
This can be very time-consuming and of marginal benefit as, even when something is found to be amiss, it does not necessarily need to be corrected. This is well-illustrated by the experience of war veteran Richard Morrell who, as a young man, contracted rheumatic fever, damaging his mitral valve and leaving him with a heart murmur. This was picked up during his FFI (fit and free from infection) examination on joining the Army, and he was duly referred for a specialist opinion – along with the other recruits who had also failed their medical.
“We were all in a queue in alphabetical order,” he writes in a leading medical journal. “Just behind me was Private Newman, who was down to see the ENT specialist.” Fortuitously, as it turned out, the orderly in charge got their notes mixed up. Mr Morrell was sent in to see the ENT surgeon, while the cardiologist could find no evidence of a murmur in Pte Newman’s heart.
And so, come the beginning of the war, he was – as far as the Army was concerned – a perfectly fit recruit ready for battle. He started as a tank commander in Egypt, was badly wounded and invalided home, but back in action for D-Day. With the end of hostilities, he opted to stay on in the Army and saw further active service in Korea and against Communist insurgents in Malaysia.
His heart murmur is a cautionary reminder that what is “medically abnormal” is not necessarily functionally abnormal, as his damaged valve was no impediment to an active military career.
Yawning gap
The curiosity, recently featured in this column, of a gentleman troubled by excessive yawning (a dozen very loud yawns over a five-minute period), causing his ribs to ache, has prompted several similar accounts.
A Reading reader reports that his episodes of prolonged yawning were the first indication of his hyperventilation syndrome – usually presumed to be psychological, but in his case probably due to disturbed functioning of the respiratory centre in the brain. The sense of breathlessness was very distressing, persisting for three months before recurring intermittently in a milder form.
He declined to take the SSRI antidepressants recommended by his doctor and now manages to control his symptoms by consciously regulating his breathing (counting the number of breaths in and out), and distracting himself by doing sudoku.
Alternatively, and intriguingly, for another reader, her tendency to excess yawning started with a serious car accident 20 years ago, which resulted in a whiplash injury and fracture of the neck of the first rib. Since then, she finds that bending her neck backwards invariably induces a spell of deep yawns. “When sightseeing in a cathedral, for instance, I have to ask my husband to stand behind me and support my neck so that I can lean back to inspect the ceiling,” she writes. Her family doctor suggested this might be due to irritation of the vagus nerves, whose many functions include control of the respiratory muscles.
Spice it up
Finally, a dedicated squash player for 40 years (now in his early seventies) writes to tell me that, when a painful right knee began to compromise his game, his partner on the court – a retired pharmacist – recommended the culinary spice turmeric (two grams daily) as being more effective than the antiinflammatory drug ibuprofen. To his amazement, he reports, within a couple of weeks his knee had so much improved that he is now back to playing squash twice a week.