Your health questions answered

Can teething cause a fever? And how can I learn to swallow again?

TEETHING TROUBLES

Q. I have never believed the old wives' tale about a fever being a sign of teething, but yesterday my baby was miserable and developed a temperature of 38.5C. Our GP found no local signs of infection, so we thought she must have a non-specific viral infection. This morning, lo and behold, her first tooth arrived. Was this just a coincidence, or did the teething cause the fever?

A. I am always reluctant to say that a baby's fever is caused by "teething", not least because by doing so it is possible to miss an important cause of fever (such as an ear or urine infection) that might need specific treatment with antibiotics. But I am convinced that some babies do get a fever before a tooth erupts, probably the body's reaction to the trauma and inflammation caused by the tooth as it bursts through the surface of the gum.

The fever of teething is usually very short-lived - less than 24 hours - while a fever caused by a viral infection can go on for several days. I would be interested to hear from readers who are convinced that their babies developed fevers when they were teething.

I CAN'T SWALLOW

Q. I have had thyroid problems and lots of nodules on my thyroid gland for many years. Now that the nodules have been zapped, I have to take thyroid replacement therapy for life. The problem now is that I have trouble swallowing food and liquids, and as a result I am severely underweight. Can you recommend someone who could help me?

A. Although most of us swallow food and drinks without having to think about it, the physiological process of swallowing is incredibly complicated. Food has to be chewed and moistened in the mouth, before it is propelled backwards. At the back of the throat, the food has to be directed away from the windpipe and into the oesophagus. It then has to be moved downwards, on its way to the stomach and intestine. If the muscles of the mouth and throat act in an unco-ordinated way, or it there is any kind of mechanical obstruction, the swallowing mechanism doesn't work.

I strongly suspect that the treatment you have had for your thyroid nodules has damaged either the nerves or muscles that control swallowing. Your best hope is to see a speech and language therapist who specialises in swallowing. Although most people think speech therapists only help people with speech problems, they are also experts in swallowing. A therapist will be able to analyse where the problem lies and suggest techniques for overcoming it.

BED PAINS

Q. I am in my late fifties and am in reasonable health. I do aerobic exercises and enjoy quite strenuous walking holidays with no discomfort. However, over the past year or two I have noticed that I am often woken in the night by nagging pains in my hips (I tend to lie on my side). The pain disappears within a minute or two of getting up and moving around. As our mattress is quite old, we decided to invest in a new bed, but although we advised the salesman of my problem before we chose it, the bed we have bought is, if anything, causing more problems than the old one. What can I do?

A. If you can walk strenuously without any pain in your hips, the problem is very unlikely to be arthritis of the hip joints. Two clues to a possible cause are the facts that you lie on your side in bed, and that the pain seems worse with your new mattress. The bony point at the upper end of the thigh bone (you can feel it if you press on the upper, outer surface of the thigh) is called the greater trochanter. The surface of this bone is covered with a membrane called a bursa. If the bursa gets sore and inflamed, the condition is called greater trochanteric bursitis.

When you lie on your side in bed, you put pressure on the greater trochanter. Your new mattress is probably firmer than your old one, and this may increase the pressure. The same type of problem can occur over the tip of the elbow (olecranon bursitis) and the knee ("housemaid's knee"). First of all, you need a proper diagnosis, either from your GP or an orthopaedic specialist. If the problem isbursitis, a local steroid injection may be the solution.

Readers write

JS from London disputes my recent suggestion that fibromyalgia is not psychological:

I suffered from fibromyalgia, and was exhibiting all the symptoms you describe. I needed painkillers all the time, and I agree that they didn't really work. I consulted a psychotherapist who explained to me that fibromyalgia is a depressive illness, although he acknowledged that the medical profession seeks to deny this. During my fifth session under hypnosis I actually felt it go - although I simply cannot find words to describe the sensation this involved. You are wrong to say it is "misrepresented" as a psychological problem - the physical pain, tiredness and suffering are all completely real, but the origin is psychological and it does sufferers a terrible disservice to tell them otherwise.

Please send your 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 to health@independent.co.uk. Dr Kavalier regrets that he is unable to respond personally to questions