A question of health

Can severe knee pains be treated? And where is there good immunisation advice?

KNEE TROUBLES

KNEE TROUBLES

For almost a year I have been suffering sharp, sporadic pain in my right leg, mainly at night. This radiates from my knee down to my ankle and sometimes into my foot and wakes me at least five times each night. It occurs occasionally during the daytime, and always if I lie on the sofa to read for a few minutes. Sometimes I have pins and needles in my foot and a slight feeling of heaviness. The pain is usually very severe for a few minutes after I get out of bed in the morning. Pain killers and anti-inflammatory drugs don't make much difference. X-ray result shows, "spondylosis at L5/S1 and to much lesser extent at L4/L5. No focal bone lesion." I am very active and not overweight. One of my hobbies is walking and the pain doesn't interfere with this; I can walk 10 miles carrying a rucksack with no adverse effect. I would like advice as to what can be done about this, if anything, particularly as to whether osteopathy would be advisable. If I could get relief after a limited number of treatments, I would try this. But, as it is such an expensive form of therapy, it would be difficult if the osteopath recommended that I needed weeks or even months of treatment with an uncertain outcome.

Your symptoms and the results of the X-ray all point to some pressure on a nerve as the cause of your pain. Spondylosis is a term that means the discs between the vertebral bones are deteriorating. As this happens, the bones of the spine are subjected to physical stresses which encourage the development of new bone. The new bone impinges on the narrow passages through which nerves exit the spinal cord. The nerves that are travelling from your lower spine down to your right leg are suffering from this pressure, and this is the cause of your symptoms of pain, pins and needles and heaviness. The fact that you can walk 10 miles, but you get pain after you have been lying down is an important clue. Before you sign up for an expensive course of osteopathic treatment, I think you should think about your bed and your mattress. Remember that you spend many hours lying on your mattress, and if it is holding your spine in an unnatural position you may be making things worse simply by lying down. If your mattress is old and deformed, consider replacing it with one that will give you firm support at night. Even a rigid wooden board under an old mattress sometimes helps. An osteopath may be able to help you, but no honest osteopath will offer a guarantee of success. Some hospital physiotherapy departments run "back schools" that teach people how to look after their spines. A local physiotherapist would be willing to see you for free if your GP will refer you.

PERSISTENT COUGHING

My daughter has suffered from very severe bouts of coughing every day for the last eight months. She is 18 months old. The coughing is often enough to make her sick, will wake her from a deep sleep, and in the daytime causes her face to go a deep red because she cannot catch her breath. She has also had a cold for the same period and will sometimes put her fingers down her throat. Doctors (three so far) have pointed out that in every other way she is very healthy, her growth patterns and development are good, as is her eating. We have tried switching from cow's to goat's milk, but this has made no difference. We have been told not to worry, that it could be teething, cold, some form of asthma. We are not overly alarmed, but would really appreciate any advice.

This sounds suspiciously like the after effects of whooping cough, and my first question is whether your daughter was immunised against this as a baby. It is a standard part of the DPT triple vaccine that babies are given in the first six months of life ("P" is for pertussis, aka whooping cough). Babies who have had whooping cough can go on coughing for many months. Your description of a cough that causes her to turn red and not be able to catch her breath is very typical of whooping cough. If I am right, it will get better as she gets older, but she may be someone who always develops a cough easily from the slightest provocation. I think she should have a chest X-ray. Occasionally little children can get small objects such as beads and bits of plastic in their lungs which can also cause persistent coughs.

WWW.JABS

Where can I get reliable on-line advice about travel immunisations. My GP is reluctant to commit himself, and I don't want to pay good money to a commercial travel clinic.

Visit www.doh.gov.uk/traveladvice, the Department of Health's website. It contains a comprehensive table with immunisation suggestions for every country in the world. If you are willing to pay £3.49 you can get a personalised travel health plan from Masta (Medical Advisory Services for Travellers Abroad) at www.masta.org.

HAVE YOUR SAY: READERS WRITE

Advice from PM, a nurse in a genito-urinary medicine clinic:

May I suggest that the parents of the three-year-old suffering from vulval inflammation should stop using talcum powder. In my work as a nurse, I discovered that a very high percentage of patients complaining of "thrush" were able to cure their symptoms by not using talcum powder.

Send questions and suggestions to: A Question of Health, 'The Independent', Independent House, 191 Marsh Wall, London E14 9RS; fax 020-7005 2182; or e-mail health@independent.co.uk. Dr Kavalier regrets that he is unable to respond personally to questions