A Question of Health: Do I have Parkinson's?

Is there a definitive test for Parkinson's disease? I am in my early fifties, and have developed a slight tremor in both hands over the past nine months. Over a longer period, my handwriting has become very small and cramped. I am otherwise healthy and active. My father was diagnosed with Parkinson's disease at a similar age.

There is no definitive test for Parkinson's Disease. It is normally diagnosed on the basis of symptoms. Tremor is a common symptom, but it is important to remember that about a quarter of people with the disease do not have a significant tremor. And not everyone who develops a tremor has Parkinson's. One common cause of the symptom is called Essential Tremor, which is five times more common than Parkinson's and is completely unrelated to it. People who are developing Parkinson's may also find that their movements are restricted. Fine movements, such as handwriting, become more difficult. Another symptom is poor balance.

The underlying cause of the disease is unknown. There is clearly a genetic component in some families – about 15 per cent of people with the disease have a least one close relative who is also affected. But there are environmental factors that also contribute to causing the disease.

Brain scans can sometimes confirm a diagnosis, but often they are done simply to make sure that nothing else – such as a stroke or a brain tumour – is causing a patient's symptoms. The American National Parkinson Foundation has a 12-point questionnaire to assess the likelihood that symptoms are due to Parkinson's Disease. You can find it on their website at www.parkinson.org

WHEN X GOES MISSING

Can you give me any information on the impact of Turner Syndrome on a child's lifestyle? I already know what it is, but would like to find out how society treats girls with Turner Syndrome.

Turner Syndrome is a condition that is caused by a missing X chromosome. Girls usually have two X chromosomes (boys have one X and one Y chromosome). A girl who has only one X chromosome will tend to be shorter than average, and may have other characteristic physical problems. These include a wide neck, puffy hands and feet at birth, and heart problems. Girls with Turner Syndrome do not usually have functioning ovaries, so they do not naturally go into puberty and it is rare for them to be able to fall pregnant. The puberty problems can be solved by taking extra hormones, but the fertility problems can be very difficult to overcome.

Many girls with Turner Syndrome are not diagnosed until their periods fail to begin, although some are diagnosed at the time of birth or even before they are born if their mother has a chromosome test during pregnancy. Short stature is the main reason why girls with Turner Syndrome may be treated by their peers as "different". Later in life, problems with fertility may affect how society views women with Turner Syndrome. It is important to realise that the condition is relatively common – it affects about 1 in 2,000 girls, and the vast majority of them lead healthy and normal lives. A good source of information and support is the Turner Syndrome Support Society (UK), 1/8 Irving Court, Hardgate, Clydebank G81 6BA (www.tss.org.uk)

TOO MUCH WAX

I have a problem with excessive ear wax. I have it syringed from time to time, but it is always back in about three days. This might seem an insignificant problem, but it is a huge irritant, and causes problems such as depression and tinnitis. Is there any means of inhibiting the production of the wax?

Human ears normally produce small amounts of wax. The wax comes from tiny glands, similar to sweat glands, that line the ear canal. The wax protects the delicate skin that lines the ear canal. If everything is working properly, the wax looks after itself and doesn't need much care or attention. Sometimes, as in your case, the wax doesn't clear itself, and begins to build up. Some people have very narrow ear canals and this is one of the causes of wax build-up. Another is ear canals that are positioned at a slightly unusual angle. The normal angle of the canal allows wax to flow outwards, but if the angle is wrong, the wax tends to stay put or even flow inwards. A final cause is hairy ear canals. The wax gets caught in the hairs and can't clear itself. I do not know of any way of inhibiting wax production. Ear drops of various kinds are quite effective in softening and dispersing wax, but at the end of the day it is sometimes necessary to physically remove the wax.

Syringing the ears involves squirting warm water into the ear canals and literally washing them out. Cotton buds are useful to remove wax from the outer part of the ear. But I think it is a bad idea to stick them into the ear canal as they have a tendency to push the wax up against the eardrum. The cheapest and simplest ear drops are sodium bicarbonate ear drops.

HAVE YOUR SAY

Advice for Raynaud's disease sufferers, from BT of London:

Like the 26-year-old woman who wrote in, I also suffered constantly from cold hands and feet, to the point where they'd become numb and colourless. I was eventually diagnosed with Raynaud's disease. It sounds obvious, but I found the best way of preventing attacks was to protect myself from the cold at all times, even wearing gloves to take food out of the fridge and wristlets outdoors in winter to close the gap between my gloves and sleeves. As a result, my symptoms have all but disappeared.

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