Ask the Doctor - May Scotland on Sunday column

Sunday 29th May - Blocked Nose

Mr Ray Kelleher FRCS(ORL-HNS) is Consultant Rhinologist at Spire Murrayfield Hospital.

The main functions of the nose are for breathing, warming of inspired air and smell.

The nose has two passages, right and left “noses”, either or both of which can be blocked. Blockage can be due to anatomical or structural problems such as a bend in the dividing septum of the nose or collapse of the soft front part of the nose on breathing in. The causes of such blockage may be due to trauma or inappropriate or excessive surgery.

Seasonal blockage due to pollens, perennial allergies such as dust mites and a wide range of inflammations due to bacterial, viral and immunological conditions can cause swelling of the lining of the nose with consequent blockage.

Choice of management depends on the severity of the complaint and the cause.

Possible solutions include nasal douches, nasal steroid sprays and anti-histamines, with surgery reserved for non-responsive and severe symptoms.

Sunday 22nd May - IBS Treatment

Dr Ian Penman is a Consultant Gastroenterologist at Spire Edinburgh Hospitals.

Diet can help but the first step is to be certain you really have IBS and not other conditions
causing similar symptoms such a gluten or lactose allergy. These can be easily tested for.

IBS does not involve true food allergy as such but some patients have one or more food intolerances. These vary from patient to patient and so keeping a food diary for four weeks can help identify possible culprits.

One-third of patients respond well to a wheat-free diet and so it’s worth trying this for two to three weeks.

Recent research suggests that several fermentable sugars and carbohydrates can trigger symptoms in IBS and excluding these, with guidance from a specialist or dietitian, can also be helpful.

Sometimes, however, dietary changes are only part of the management of IBS and need to be supplemented by the likes of probiotics, medications, exercise programmes and/or
stress management.

Sunday 15th May - Football Injury

Mr David Chesney is a Consultant Orthopaedic Surgeon at Spire Edinburgh Hospitals.

Knee injuries are common, and can often involve damage to the meniscus, a piece of cartilage which spreads forces within the knee, protecting the joint surface. The meniscus can be torn following a single injury or several smaller injuries, especially with activities that involve twisting on the knee, such as football. The meniscus can heal spontaneously, but often this is not the case.

A torn meniscus can cause pain, swelling and a loss of confidence in the knee, especially when playing sport. The torn cartilage can also displace causing locking where the knee cannot be straightened, or instability where the knee buckles.

Fortunately, this is a treatable injury. With key-hole surgery to repair or remove the damaged meniscus, usually as a day-case operation, knee function can be rapidly improved, with most patients returning to their sport of choice within three months.

While knee injuries can result in chronic problems, with appropriate treatment there is no reason to have to give up sport.

Sunday 9th May - Bowel Concerns

Mr David Bartolo is a Colorectal surgeon at Spire Murrayfield Hospital.

People are often embarrassed to admit to bowel problems, so they assume they are exceptional and suffer in silence.

Incontinence of faeces may occur as a result of damage to the sphincter from vaginal delivery or prolapse of the lining or the wall of the rectum. Diabetes, nerve damage and surgery are other causes.

Investigation normally entails a physical examination that may include scans of the pelvis and colonoscopy to provide a comprehensive assessment. Treatment is often simple with dietary measures and simple medication. Prolapse of the rectum is normally amenable to repair with excellent outcomes, with operations carried out either through the anal canal or the lower abdomen.

Injuries to the anal sphincter can be repaired with reasonable outcomes even many years after the injury.

Finally, dramatic improvements have been achieved by sacral nerve stimulation. In successful trials, a small pacemaker-like device is inserted deep into the buttock. This modifies nerve conduction in the pelvis and improves control and function.

Sunday 1st May - Cough

We all cough daily, sometimes not even registering that we have done so.

Dry, unproductive, often violent coughing could be a symptom of a viral infection and usually improves within 6 weeks. However, a chronic cough, dry or productive of phlegm, for more than 3 months, often signifies an underlying lung condition: bronchitis, emphysema, asthma or fibrosis - the list is long. Chronic cough requires investigations.

Cigarette smoking is the most common cause of chronic cough. Coughing up clear phlegm is usually “fine”. If the phlegm is yellow or green, it often means infection and will need treatment.

Blood-stained sputum should never be ignored. Its cause could be benign but it could signify growth of cancer in the respiratory system. Lung cancer affects mostly smokers. Coughing up blood might be its early sign and needs to be investigated.

Early lung cancer could be cured.