Dr MARTIN SCURR answers readers’ health questions
I am 68 years old and diabetic, but I have avoided the flu jab since 2014, when, exactly two weeks after having the vaccination, I developed Bell’s palsy. It was terrifying — could it happen again?
J. Fairhead, Tonbridge, Kent.
Bell’s palsy is when the nerve that controls facial movement becomes suddenly paralysed. It affects one side of the face, causing the eyebrow to sag and the mouth to droop.
Named after Sir Charles Bell, who identified this nerve in the early 1800s, the effect is dramatic and disfiguring and, as you found, it can be a terrifying experience. Much of the anxiety is driven by the fact that not all people recover fully, which can be devastating.
While Bell’s palsy is responsible for more than half of all cases of facial paralysis, other causes include shingles, where the same virus that causes chicken pox affects the nerves, and otitis media, a middle-ear infection which can press on the facial nerve as it passes through the middle ear to the brain, as well as Lyme disease, tumour and stroke.
People with diabetes are advised to have the annual flu jab because you are more at risk, and flu might affect you more severely, as well as affecting blood sugar levels
Between 15 and 30 in every 100,000 people develop Bell’s palsy each year and, while the exact mechanism is unknown, it tends to happen when people are ‘run down’ or under stress. Indeed, research has found that the herpes simplex virus — which causes cold sores and which reactivates when the immune system is overloaded — often affects the facial nerve.
People with diabetes are advised to have the annual flu jab because you are more at risk, and flu might affect you more severely, as well as affecting blood sugar levels.
As for whether the vaccine is linked to Bell’s, there was a report in 2004 describing a series of 46 cases of Bell’s palsy following the use of a certain flu vaccine delivered nasally and used only in Switzerland. But there are no reports of any association between Bell’s palsy and the flu jabs used here in the UK, and it is most likely that the onset in your case was coincidental.
Given the lack of evidence of any link, and the well proven benefits of the flu vaccine, particularly in people of your age and with a known diagnosis of diabetes, I urge you to have one when the jabs become available this month.
I have had erectile problems over the past six months, but numerous blood tests have come back OK. I have also noticed that my penis has a bend in it on erection. I am 57.
Billy, via email.
It sounds like you have Peyronie’s disease, a disorder of the tough membrane that surrounds the spongy tissue of the penis. It occurs when fibrous plaques — like spontaneous scar tissue — form within the membrane.
This scar tissue is rigid and inelastic, affecting erectile function and causing the distortion you have experienced. It’s not known why it happens, but there is suspicion that micro-injury sets up uncontrolled inflammation, which escalates into this spontaneous scarring.
A survey of 8,000 suggested 3 per cent of men have Peyronie’s disease and 20 to 50 per cent of those also have erectile dysfunction
Pain can occur in the early stages, but ceases after a year or two when the acute inflammatory phase ends. After this, the deformity gets no worse, but usually no better, either — the condition resolves itself in only 12 per cent of men.
A survey of 8,000 suggested 3 per cent of men have this condition and 20 to 50 per cent of those also have erectile dysfunction.
I would ask your GP to refer you to a urologist. The first line of treatment is the drug pentoxifylline, with a dose of 400mg taken three times daily. This acts on a growth factor involved in scar tissue forming — studies show that pentoxifylline slows the rate at which the curvature progresses, but early treatment (and it sounds like you are just in time) gives better outcomes.
Vitamin E, a powerful antioxidant, may also be prescribed. It’s thought to reduce collagen deposits, the material that creates the plaques.
The specialist may also suggest injecting collagenase, an enzyme that, in theory, softens collagen and so reduces plaque formation. One study has shown this produced an average 34 per cent improvement in the curvature.
If the deformity persists, there are surgical options to correct it — a surgeon will recommend the best.
Long term outcomes are good, with return to sexual activity for more than 80 per cent of people who have surgery.
In my view… A good GP can inspire better habits
One of the greatest difficulties doctors face nowadays is how to persuade patients to change their lifestyles.
Whether it’s dietary advice or the dangers of smoking, many people seem hell-bent on ignoring what we tell them.
When someone does want to change, however, it can save their life. Stelios, a friend of mine who lives in Athens, recently told me how he had stopped his 60-a-day smoking habit.
He was having a coffee with one of my friends from work, a cardiologist, when my colleague commented on the fact that Stelios had smoked three cigarettes over the course of one espresso. He said this was dangerous, asked Stelios his age — 42 — and told him he’d be lucky to reach 50.
One of the greatest difficulties doctors face nowadays is how to persuade patients to change their lifestyles, writes DR MARTIN SCURR
Stelios had just had his first child, a baby girl, and the combination of being proud parent and having his early demise predicted by a complete stranger — albeit a respected cardiologist — triggered ‘a magic moment’, and Stelios stopped smoking that day.
But he started snacking instead, and when he gained 21 kg (more than 3 st) over the next year, colleagues encouraged him to start jogging.
He began with just five minutes, and then ten.
Within a year, he had lost all that weight and now he runs a marathon every month in less than three hours — highly respectable for a man in his mid-40s.
Yes, change is possible, but patients can’t wait for serendipitous encounters, like Stelios’s, for that to happen.
They need their doctors taking the time to get to know them; it’s the sort of relationship that comes from long-term continuity of care — not health apps and online GP services — that unearths such ‘magic moments’.