The truth about that nagging cough
The difficulty arises when the cough persists for several weeks in the absence of any cause
The purpose of coughing, obviously enough, is to dislodge some irritant from the airways – and very effective it is, too. The difficulty arises when the cough persists for several weeks in the absence of any readily identifiable cause. For adults, the checklist of possible explanations include post-infective inflammation of the airways (which usually responds to a course of steroids); acid reflux; or the blood pressure-lowering ACE inhibitors, such as Captopril.
The situation with children is rather different. Here, a persistent cough is usually attributed to asthma, though not necessarily correctly. If the standard inhaler treatment does not improve matters, then the alternative possibility, of Protracted Bacterial Bronchitis (PBB), needs to be considered.
This has become more prevalent in recent years due, in part, to doctors’ commendable reluctance to prescribe antibiotics, permitting bacteria (such as Haemophilus or
Streptococci) to infiltrate the lining of the airways. “Children with PBB may not appear unwell, but the impact on their general wellbeing can be significant,” says Prof Mark Everard of Sheffield Children’s Hospital. He commends a protracted course (6-8 weeks) of high-dose antibiotics to eradicate the bacteria and allow the lining of the airways to heal.
Magic magnesium
The possibility that several medical conditions – disturbances of heart rhythm, muscle weakness, cramps – may be due to (or exacerbated by) magnesium deficiency continues to elicit much interest. This deficiency, as noted, is a particular danger for those taking acid-suppressant drugs, such as Omeprazole, which inhibit absorption of the mineral from the gut; or diuretics, which increase the amount excreted in the urine.
The details for those who have requested further clarification are as follows. There is no reliable diagnostic test, as those with magnesium deficiency may none the less have normal levels in the blood. Thus, those at risk of deficiency and troubled with the conditions mentioned above should take a daily dose (200mg) to see whether this improves matters. The preparation, available on the NHS, is known as Magnaspartate, but there are several others (magnesium citrate and glycinate), as well as a spray.
MRI mystery
This week’s medical query comes courtesy of Prof WM from Surrey, much troubled with lower back pain over the years, warranting a fusion operation of the spine with the insertion of stainless steel rods a decade ago. Gratifyingly, this was successful in controlling his symptoms until recently, when, following a recurrence of his earlier problems, he had an MRI scan. Thirty minutes later, he experienced a jolt in his back – “as though I had been kicked by a very large horse” – and, three months on, he is still incapacitated by pain that is considerably worse (and qualitatively different) to that he was experiencing before.
The official response has been non-committal to his queries as to whether the powerful magnetic forces generated by the scan might be responsible, by, for example, interacting with the steel rod implants in his spine. He would be more than interested to hear from anyone who might have been similarly afflicted.
Falls by the wayside
Further to the recent comments on the 20-fold increase in the number of fall-induced head injuries in the elderly, my thanks for a couple of simple preventive measures. First, a reader from Norfolk describes how his father’s tendency to fall when negotiating kerbs, steps and slopes turned out to be due to his bifocal glasses. His physiotherapist advised two pairs – one for reading, one for walking – and, “as a consequence of no longer viewing uneven surfaces through lenses intended for reading, he has not had another fall”.
Next, a gentleman in his mid-70s reports he has had no bouts of dizziness since purchasing an exercise bike three years ago, on which he works out for just 15 minutes a day. “Age is not the issue,” he writes. “I am just surprised how little effort is needed to stay in shape.”