Q.A 69-year-old overseas friend was staying with us when she suddenly developed a rash of spots over her body. She saw a pharmacist who diagnosed shingles (which she'd had last year) and advised her to see a doctor. A description of her symptoms to NHS Direct elicited the same response. A doctor at a cottage-hospital also assumed this was the complaint, although he puzzled over the widespread nature of the spots - shingles normally appears in a concentrated area. Our GP, however, without seeing the patient, doubted this diagnosis and said that it sounded like chickenpox (which our friend had had as a child).
The last diagnosis was right - the affected area cleared up within days without treatment. So, how is it that someone can be diagnosed as having shingles, without chickenpox being recognised, and is it unusual to get the latter more than once? We suspect that ageism played a part.
A. Chickenpox is common in children and relatively unusual in adults. Both chickenpox and shingles are caused by the same virus, varicella-zoster, a member of the herpes family. After a child recovers from chickenpox, the virus can remain dormant in the body for decades. But at some stage, it can reactivate, particularly if an adult's immune system is less than perfect. This is why the rash of shingles, which looks very like chickenpox, tends to be linear, often along a rib.
So, why did your friend get chickenpox not shingles? Probably because her immune system was weak, so the virus spread. Why wasn't it diagnosed at first? Probably because you don't expect chickenpox in an adult.
SPRUNG A LEAK
Q. I have started to leak urine if I can't get to the loo quickly enough. This has never been a problem before. In fact, I have always thought of myself as someone with a strong bladder. Even after three difficult deliveries of good-sized babies, I never had bladder problems. I'm now 59, and expect the problem is caused by sagging, ageing tissues and bodily deterioration. Where is the best place to get help? I have a charming young male GP, but I don't feel that he is the right person with whom to discuss this.
A. Your bladder sounds as if it has become overactive - wanting to empty even if it is not very full. This is quite a common problem, affecting men and women. It probably has nothing to do with having babies, and may not be related to getting older. People of all ages can suffer from an overactive bladder. Usually, it is difficult to discover why a bladder becomes overactive. But there are a variety of treatments that help the problem. You are not alone in feeling embarrassed about talking about this with your GP. Many people with bladder and urine problems suffer in silence rather that admit that they need help. The Continence Foundation, a charitable organisation that helps people with bladder problems, has an excellent free leaflet on overactive bladders, available by calling the confidential helpline: 080845 345 0165. The helpline can also put you in touch with your local NHS continence clinic. You can usually refer yourself to these clinics, so your young doctor need never know. Copies of a booklet, The Overactive Bladder! are also available by post. Send an sae to: The Continence Foundation, 307 Hatton Square, 16 Baldwins Gardens, London EC1N 7RJ. The Foundation's website address is: www.continence-foundation.org.uk
AVIAN FLU ANXIETY
Q. I am thinking of buying Tamiflu online as a treatment for avian flu. Is there a way to avoid a counterfeit product? To be effective, we are told that antivirals must be taken within 48 hours of symptoms appearing. How would one know within this time whether one had basic flu, or something worse, and when to take the drugs? And will GPs treat everyone with flu-like symptoms with antivirals within 48 hours, just in case?
A. There are many unanswered questions about a potential avian-flu epidemic, including those you ask. Tamiflu is made by Roche. I'm sure there will be counterfeit drugs circulating via internet sales, so get the drug from a pharmacist. NHS guidelines do not allow Tamiflu to be prescribed for healthy adults under 65, except in "exceptional circumstances". Ideally, it should be started within a few hours of the first flu symptoms. It seems unrealistic to expect GPs to be able to achieve this.
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CJ, a massage therapist, reveals a trade secret:
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Send your queries to: A Question of Health, 'The Independent', Independent House, 191 Marsh Wall, London E14 9RS; fax 020-7005 2182; or e-mail to email@example.com. Dr Kavalier regrets that he cannot respond personallyReuse content