WEAK AT THE KNEES
Q. I am 62. For years I have been plagued by a problem which seems to be related to balance. I have long had a rather bad sense of balance, but the specific problem which bothers me is an inability to walk more than a mile or so without finding it harder and harder to stay upright, accompanied by considerable fatigue in the lower back and legs, which gets harder and harder to control. If I don't sit down I become quite distressed, but recover after a rest. I am generally quite healthy otherwise.
A. These symptoms suggest that there is a problem in your lower spine, and I think you may well be suffering from spinal stenosis.
The spinal cord sits in a narrow canal inside the vertebral bones that make up the spine. Spinal stenosis is a condition that occurs when the spinal canal becomes too narrow, which puts pressure on the spinal cord and the nerves that come out of it. The symptoms of spinal stenosis develop extremely slowly, usually over many years, and the problems are often put down to "getting old", "arthritis" or "a bad back".
The typical symptoms are low back and leg pain, which get worse with activity and exercise. As the pressure on the spinal cord increases, you can lose the ability to control your legs, which seems like a loss of balance. Standing upright tends to make the spinal canal even narrower.
People with spinal stenosis often stoop over as an unconscious way of relieving pressure on the spinal cord. Spinal stenosis is usually caused by degeneration of the bones and tissues of the spine. Occasionally it is caused by a tumour or some other unusual injury, but this is quite rare. An examination by a doctor may not show anything wrong, but a CT or MRI scan of the spine will show a narrowed spinal canal.
Don't ignore your symptoms - see a neurologist before the problem gets too bad. If you do ignore the problem, it may eventually affect your bladder and bowel control. You may end up needing surgery, to relieve spinal-cord pressure.
UNDER THE WEATHER
Q. I am acutely sensitive to cold air. The effects are immediate and the colder the air the worse things are. I flinch on exposure to the cold at this time of year as if sniffing smelling salts. This is followed by a thumping headache and painful soreness in the eyes and nostrils. Further exposure can result in heavy nasal congestion and pain spreading all around my eyes, jaws and teeth. I am confined to the house from October to June and even in summer have to be wary of air-conditioning. The problem started after a spell in hospital due to pneumonia and a pulmonary embolism. Can you offer any help as to what it might be, what has caused it and what can be done?
A. Inhaling cold air is sometimes a trigger that sets off asthma in young children. Occasionally it is the first indication that a child is going to get asthma later in life. And some people who have very sensitive teeth notice pain in the teeth if they inhale cold air. Your symptoms suggest a condition called cold air-induced rhinitis, or non-infectious, non-allergic rhinitis (Ninar).
In people who suffer from this problem, the lining of the nose produces an excess of certain chemical substances when it is exposed to cold, dry air. The reaction is similar to an allergic reaction to dust or pollen, but it occurs in response to cold air, rather than to something that you are allergic to. The symptoms tend to be like sinus problems, with pain around the nose and eyes.
There have been some experiments treating this with a nasal spray that contains capsaicin (one of the substances that makes peppers hot). This seems to help the problem, but unfortunately the spray is not commercially available. You might get some help from an allergy specialist, if you can find one.
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 firstname.lastname@example.org. Dr Kavalier regrets that he is unable to respond personally to questions.
SJ, a GP, thinks there is a link between bald legs and bald heads: Many years ago there was an article in the British Medical Journal linking hair loss on the legs with the onset of male-pattern scalp baldness. I was interested as it mirrored my own experience and I subsequently observed it in a number of my patients in general practice.Reuse content