Is there another way to prevent a stroke? Can I treat my ear wax at home? And how can I find out if I have coeliac disease?

RASH REACTION

Q. After I had a mini-stroke last autumn my doctor prescribed statins, and emphasised the importance of taking them. But within a very few days I had a most unpleasant skin rash, which was much worse than the eczema I have had for most of my life. My doctor said that I was obviously allergic to statins and so I was no longer to take them. Is there anything else I can do to prevent another, possibly more damaging, stroke?

A. Stroke prevention is far, far better than stroke treatment. Once a stroke has occurred, then a portion of the brain is damaged, and the damage is usually permanent.

Sometimes another part of the brain can learn to take over the function of the damaged area, but many stroke survivors are left with permanent disability.

There is some evidence that statins - the family of drugs used to lower cholesterol - are able to lower the risk of having a stroke.

For people who have already had one stroke, they may be effective in preventing a recurrence. It is less certain if they can help to prevent a first stroke occurring.

A small dose of aspirin seems to reduce the risk of having a first stroke in women, but for some reason which is not understood, aspirin does not seem to prevent first strokes in men.

For all people who have already had a stroke - men and women - a small dose of aspirin reduces the risk of further strokes.

Statins also seem to reduce the risk of further strokes, but if you get a rash when you take them, the treatment may be worse than the disease it is trying to prevent.

It is also vitally important that your blood pressure is kept under good control. High blood pressure is a powerful risk factor for strokes, and people with normal blood pressure are much less likely to have strokes than people with high blood pressure.

WATER CURE

Q. I'm 52 years old and keep having to go to the doctor to get my ears syringed, as I keep going slightly deaf because of wax. One of my friends suggested I try Audiclean instead, which she saw advertised. I thought you weren't supposed to put things in your ears. Is this true? I'd just like to find an alternative to visiting my surgery all the time.

A. Audiclean is a commercial product made from salt water. In the words of its manufacturers: "It is created from seawater taken from the crystal clear waters of St. Malo. The tides here are among the strongest in the world, constantly enriching the pure waters with natural mineral salts."

It comes is a bottle with a nozzle that fits into the ear.

Although it is certainly a bad idea to put cotton buds into your ears, I doubt if you will do much harm by squirting salt water into your ears.

If Audiclean works - and I do not know if it does - I would expect tap water with a pinch of salt in it to work equally well.

The main problem with Audiclean is the cost. A 60 ml bottle (the equivalent to four tablespoons) costs £5.99.

This works out at £100 per litre. Why not get a small plastic dropper from the pharmacy, and try using home-made salt water, made by adding a good pinch of salt to a glass of water?

A TRICKY TEST

Q. I recently had a blood test for coeliac disease. I have not had the results yet but my dietician informed me that the result would be flawed as I had already started to cut the obvious sources of wheat from my diet (bread and pasta, for example). However, the consultant advised me that this should not be a problem since I had not eliminated wheat completely from my diet. Which advice is correct?

A. The blood test that is usually used to test for coeliac disease detects antibodies called antigliadin antibodies and antiendomysial antibodies. If these antibodies are detected in the blood, it means that the immune system is reacting against gluten, which is found in wheat and some other grains and cereals.

The blood tests are not perfect, however, and occasionally someone will have a negative blood test even though they really do have coeliac disease.

They may even have a positive blood test when they do not have coeliac disease. A "false" negative blood test can occur if gluten has already been removed from the diet at the time of the blood test. A "false" positive test occurs if the antibodies are being caused by another auto-immune condition.

Both the dietician and the consultant are probably right. The result may be flawed if you have cut down your exposure to gluten before having the test.

But, as the consultant said, this may not be a problem, because you were still being exposed to small amounts of gluten from non-wheat sources.

If the test result is positive and you have symptoms typical of coeliac disease, it is likely that you do have coeliac disease. If the test result if only weakly positive, or equivocal, you may need to reintroduce wheat into your diet before performing another test.

Another option is to have a biopsy of the small intestine. The lining of the small intestine in people with coeliac disease looks very flat and "worn-down".

If the intestine is abnormal when you are eating gluten, and if it returns to looking normal when you cut gluten out of your diet completely, the diagnosis of coeliac disease is positively confirmed.

Have your say: Readers write

RH of London bought some Tamiflu on the internet

"I ordered a course of Tamiflu from an online chemist. When the tablets arrived they had an expiry date of December 2005. I only hope that the flu epidemic arrives soon. Buyer beware!"

Send your questions and suggestions to: A Question of Health, 'The Independent', 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

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