Simple procedures can help people with spinal cord injuries

Darek Fidyka: a revolutionary technique was used to help reconnect his severed spinal cord Photo: BBC

Life, gratifyingly, is full of surprises. It is not in the least obvious that

nerve cells taken from the nose might act as a scaffold to rewire a severed

spinal cord, and thus permit Darek

Fidyka to rise from his wheelchair and tentatively step out.

Professor Geoff Raisman’s ingenuity and persistence in bringing this

pioneering treatment to fruition over the past 30 years is most admirable,

though the prospect that it might provide a realistic therapeutic option for

the tens of thousands of people with spinal cord injuries is still a long

way off.

In the meantime, it is just as important to ensure that those with severe

neurological conditions have access to the treatments that are available,

particularly for controlling the involuntary contractions of “spastic”

muscles, and fixed flexion contractures of the hands and feet.

This usually involves a combination of stretching exercises, splints and a

range of antispasmodic drugs but, observes orthopaedic surgeon Robert

Freeman, writing in the British Medical Journal, many more would benefit

from simple surgical procedures, such as muscle lengthening and tendon

transfers, that can “transform patients’ lives”.

Then there is the vexed question of medicinal cannabis, in the form of the

spray Sativex, licensed in Britain for the alleviation of painful muscle

spasms. As one patient puts it, the drug “makes the difference between being

able to reach for a drink and take a few steps, and being confined rigid as

concrete in a wheelchair”.

Sativex is, however, inordinately costly, at £500 for a month’s treatment.

Thus it has been decreed that it should not be routinely available on the

health service. It can only be obtained on private prescription. The

chemical composition of Sativex is identical to that of home-grown cannabis,

suggesting another much cheaper source for this most useful remedy.

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A demented incentive

Family doctors, like everyone else, are responsive to financial incentives.

They are therefore unlikely to pass up the prospect of the opportunity of

enriching themselves by labelling as many of their patients as possible as

having dementia, under the scheme announced last week.

Most patients, of course, won’t have dementia at all, but there is no

difficulty in fudging the General Practitioner Assessment of Cognition

(GPCOG) test of memory impairment to claim their 55 pieces of silver.

The predictably adverse consequences for those so diagnosed are

well-documented, including “anxiety and loss of self-confidence, resulting

in the abandoning of social activities”. It is difficult (impossible) to

imagine a more idiotic initiative.

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The foot of the matter

The lady with the “fizzing” nocturnal pain always in the same toe has prompted

several further reports, including that of another woman who, like her,

finds that downloading the Telegraph and reading it on her iPad

provides some solace by “pushing the pain to the back of her mind”. She

attributes her “electric shock syndrome”, as she calls it, to damage to the

sensory nerves from her belatedly diagnosed Vitamin B12 deficiency.

It would seem that arthritis of the toe joints can cause the same (or,

certainly, similar) symptoms, with a reader reporting being woken by the

pain at three in the morning which lasts for up to an hour.

Coincidentally, a friend advised she give up on potatoes (and other members of

the solanaceae family, such as the tomato and aubergine) – since when, she

has slept soundly through the night.

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Any answers?

This week’s medical query comes courtesy of Mr HE from Leeds, troubled over

the past couple of years by recurrent abdominal pain, vomiting and

diarrhoea. These can be of sufficient severity to warrant him attending the

local casualty department, but despite extensive investigations, the

specific cause remains elusive.

Might it be, he wonders, that the high-concentration fluoride toothpaste

Duraphat recommended by his dentist could be the culprit? Surfing the web,

he has found several anecdotal reports implicating fluoride toxicity in

digestive problems. Has anyone had a similar experience?

Email medical questions confidentially to drjames@telegraph.co.uk. Answers

will be published on The Telegraph website every Friday, at telegraph.co.uk/health

Source

Simple procedures can help people with spinal cord injuries