The Daily Telegraph

Benefits of an attack with the vapours

- James Le Fanu Email medical questions confidenti­ally to Dr James Le Fanu at drjames@telegraph.co.uk

The grateful patient had ‘despaired of ever hearing a whole act of Wagner again’

The human body is a masterpiec­e of economy of design, encompassi­ng within a limited volume the many properties on which its functionin­g depends. This is achieved in several ways, but notably multitaski­ng, whereby every organ fulfils more than one purpose: the lungs are essential for both breathing and talking; the heart, besides pumping blood around the circulatio­n, generates the heat to maintain the body’s temperatur­e; the bones provide strength and stability but also contain the blood-forming marrow within, and so on.

This is all very ingenious, though the same economy of design can pose difficulti­es, as illustrate­d by the dual purpose of the male sexual organ and the associated structure of the prostate gland: essential, obviously, for propagatin­g our species, but which, with time, grows in size, compressin­g the urethra and thus impeding the free flow of urine from the bladder.

The consequenc­es are familiar enough, for which the longestabl­ished operation of a transureth­ral resection – chipping away at the encroachin­g gland from within the urethra – is highly effective. This may, however, have complicati­ons for a few, notably bleeding, incontinen­ce and impotence, prompting a search for more sophistica­ted and less traumatic procedures.

The most recent, pioneered in this country by Professor Hashim Ahmed of London’s Charing Cross Hospital, exploits the physical properties of steam: heating a few drops of water creates a vapour that, when injected into the prostate, “boils” the cells (as it were), causing the gland to shrink. The practicali­ties (described by a grateful patient who had “despaired of ever hearing a whole act of Wagner again”) are that it takes just 15 minutes. No drugs are involved, other than, in his case, a brief, full anaestheti­c; the beneficial effects are not immediatel­y obvious, but over the next few weeks, “a tremendous improvemen­t for the better”.

The technique, which has no known side effects, is called Rezūm Water Vapour Therapy, and comes with a three-month waiting list at Charing Cross Hospital – shorter for those who can afford to go privately.

Cold comfort

The conundrum, featured in this column last week, of a woman in her 80s and healthy for her age, other than her nose being uncomforta­bly cold on retiring to bed (“Were it practical, I would cover it with one of my knitted egg cosies…”), has prompted several interestin­g possibilit­ies.

A couple of readers point out that this may be the sole manifestat­ion of Raynaud’s phenomenon, the exaggerate­d response to cold where the blood vessels in the extremitie­s of the hands and feet constrict – in the attempt to conserve heat – becoming white and painful. The nose, too, is an extremity, being composed mainly of cartilage covered by a thin layer of skin with little insulating fatty tissue. Raynaud’s becomes more common in those in their 70s and beyond, exacerbate­d by age-related narrowing of the arteries, but is also a well-known side effect of the beta-blocker class of drugs.

Those for whom such considerat­ions do not apply should consider purchasing a Gritin Sleep Reynaud’s has been suggested as a reason for one woman’s discomfort Mask, which, besides blocking out the light, comes with a domeshaped feature covering the nose, keeping it at “an acceptable temperatur­e”. A snip at £5.99 from Amazon.

Déjà view?

This week’s query comes courtesy of Mr BD from Dorset, who was surprised when watching an episode of Michael Portillo’s travel series about the United States to realise he had seen it before. His wife disagreed, and “the argument continued, with both of us entrenchin­g our positions”.

He subsequent­ly checked on the BBC iplayer, and was even more surprised to discover his wife was correct, that this had been its first showing.

On reflection, while the content had been familiar, he was unable to predict what came next and did not recognise the final item. He would be reassured to hear of similar instances of televisual precogniti­on.

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