Upon reading your letter I was dismayed at the clear lack of support or reassurance you have received.
Your diagnosis sounds as if it has been delivered without explanation — and further inquiries have done little to ease your anxiety.
Your scan revealed that the carotid arteries in your neck, which carry blood to the brain, have become furred, and the arteries within the brain — the cerebral arteries — may also have showed signs of blockage.
This is restricting the flow of oxygen and nutrients to the brain, and the result has been balance problems (possibly because one of the furred cerebral arteries carries blood to the area of the brain that controls balance) and a mental fogginess.
This is called cerebrovascular disease, and it affects millions of people (an estimated one in every ten deaths is due to this condition).
The main risk, as you rightly fear, is that one of these fatty build-ups can trigger a blood clot, causing a stroke.
You tell me in your letter that you are waiting for an appointment at a specialist clinic — receiving expert attention is essential for helping you manage the condition and I hope this appointment comes through soon.
In the meantime, it is a good idea to be aware of the risk factors for cerebrovascular disease.
These are high cholesterol level, smoking, obesity, high blood pressure and diabetes.
If your cholesterol is more than the recommended 5mmol per litre, then measures must be put in place to lower this: these include reducing animal fat intake, losing weight if you’re overweight, and almost certainly being prescribed a statin.
Taking a statin is important as research published last year confirmed that the drugs don’t just prevent further accumulation of cholesterol in arteries, they can reduce the size of the cholesterol plaques, which may increase the blood flow in narrowed arteries.
CONTACT DR SCURRTo contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk — including contact details.Dr Scurr cannot enter into personal correspondence.His replies cannot apply to individual cases and should be taken in a general context.Always consult your own GP with any health worries.
You tell me in your longer letter that you’re already taking medication for an irregular heartbeat — most likely to be atrial fibrillation.
This occurs when the natural pacemaker of the heart becomes unreliable, and it can trigger the formation of clots in the upper chambers of the heart, which can travel to the brain and cause a stroke.
Accordingly, you have been placed on aspirin, which makes the blood less sticky, and the beta blocker bisoprolol, to help regulate the heart.
The aspirin will also help to reduce the risk of blood clots in the carotid arteries.
In the immediate short-term, if you’re a smoker you need to give up; you should also control your weight with vigour, take regular exercise — at least a walk every day — and take your medicines diligently.
These are simple instructions, but there is every prospect that you can improve your risk factors and have a better outcome than you were fearing.
For the past 50 years I have been taking testosterone. I was prescribed this when I was 19, but am unclear why.I recently requested a copy of my medical records and it mentions hypogonadism. I am concerned about the long-term effects of this condition and my treatment, as I was recently diagnosed with thinning bones. Mr L. Dodson, Dorset.
How frustrating for you that your diagnosis was not communicated to you at the time.
I suspect you were identified as having a delay in the onset of puberty and it was decided this was caused by hypogonadotropic hypogonadism, a condition that accounts for 10 per cent of boys who experience delayed puberty.
This is caused by faulty genes, and results in the body not releasing enough of the hormone testosterone to trigger puberty.
You were prescribed testosterone treatment to trigger puberty — and this was continued to this day.
About one in 4,000 men have this condition and more than 60 per cent of them also have a reduced or complete lack of sense of smell as an additional symptom.
More from Martin Scurr... How can I get this heavy feeling off my chest? 03/06/13 Ask the doctor: Bad breath is ruining my self-confidence 27/05/13 Ask the doctor: Will my shingles pain ever go away? 20/05/13 Ask the doctor: Is blood in my urine a reason to worry? 13/05/13 Ask the doctor: Why am I seeing stars in my eyes? 07/05/13 Ask the doctor: What has caused my unbearable leg pain? 29/04/13 Ask the doctor: Why are my teeth starting to crumble? 22/04/13 Ask the doctor: Simple steps for easing a hormone headache 08/04/13 Ask the doctor: Why do my wife's hands bruise so easily? 01/04/13 VIEW FULL ARCHIVEThis is because the gene that is affected in this condition also plays a role in the development of the nerves in the nose that detect smells.
The testosterone you were correctly given has hopefully resulted in a normal masculine appearance.
The aim was to keep your levels normal but it’s entirely possible that, at some stage in your life, your testosterone dosage was not strong enough, and this had a knock-on effect on your bones.
The hormone is crucial for strong bones, and too little can lead to osteoporosis.
And although testosterone therapy produces many positive results, such as an increase in libido and muscle strength, there are also potential side-effects.
Some men — especially those in your age group — experience a non-cancerous enlarged prostate, called benign prostatic hyperplasia, which can cause urinary flow problems.
But studies show there is no increased risk of prostate cancer or other health issues such as heart attack.
I can reassure you that there is no concern that men who rely on testosterone supplementation are more likely to develop diseases.
Please try to rest easy.
By the way...If only NHS staff were as well-looked after as MPsMost of us in healthcare are both angry and shamed by the appalling detail of the Francis Report.
We share, too, the handwringing over the disastrous performance of the management and the other professionals at Stafford Hospital.
But who should carry the can?
The Prime Minister himself pointed out how few professionals are accountable, as everybody in management has always moved on elsewhere — a bit like that Sir David Nicholson, then boss of the Mid Staffs health authority, but now elevated to chief executive of the NHS.
A junior hospital doctor I know was working 12-hour shifts in A&E, yet when he arrived at 8pm every night, the canteen was closingHe and others have conveniently and smoothly managed to distance themselves from any responsibility.
The clinical staff can be pinned down and identified. But what about those who weren’t directly involved, the ones who turned a blind eye — how much responsibility do they bear?
In truth, most of us see small failures here and there, yet feel impotent to wield any influence, particularly under the cosh of the vast cutbacks and management-rule.
The very poor morale in the health service is no doubt another factor.
A junior hospital doctor I know was working 12-hour shifts in A&E, yet when he arrived at 8pm every night, the canteen was closing and staff were expected to work full shifts on junk food from a vending machine.
He was not allowed to park in the hospital car park, as, not unreasonably, it was reserved for visitors.
But he didn’t have a locker in which to store his jacket, motorcycle helmet or bag during his shift. Nothing was provided.
Is that good employee relations?
But then rotten treatment of employees in the NHS is the usual routine these days.
When I was a house surgeon the junior doctors had their own dining room, and whatever time they arrived there was a chance of something to eat.
Egalitarianism closed such privileged facilities, so the doctors had to queue with the other staff, even if that meant having to go back to the end of the line after having run off to answer a bleep or attend to a crisis, of which there are always plenty.
Sisters and nurses have lost out in much the same way. But not so for our political masters.
On the occasions I’ve been to the House of Commons or the House of Lords I’ve been impressed with the quiet sense of luxury; the numerous bars, the delightful well-appointed dining areas. These ‘professionals’ are cared for. Aren’t they the lucky ones.
Perhaps any politicians reading this brief paragraph might pay attention to the fact that those working within the health services are not only profoundly stressed by what they do, but sometimes battered by the lack of care and support during the simple pursuit of their daily tasks.
The poor morale in the NHS that follows inevitably has consequences; that is why, at times, compassion is lacking.
There is no excuse for any of what happened at Mid Staffs, or what must be happening at times elsewhere.
But if you don’t take care of your most precious asset — your highly trained staff — they may not function very well, however much you regulate them.
