healthmedicinet

By
Dr Martin Scurr

PUBLISHED:

19:36 EST, 10 March 2014

|
UPDATED:

19:36 EST, 10 March 2014

I
am 84 and in pretty good health. However, if I have an anaesthetic for
any sort of operation, will it leave me with Alzheimer’s, as it has
others? I can’t seem to get a straight answer from any other medical
people, so perhaps you can help?

Daphne Middleton, Didcot, Oxfordshire.

Alzheimer’s
is a type of dementia, and as well as memory loss, it can cause
problems with language, information processing, and being able to
organise your life.

Dr Scurr says dementia is not on the cards should you need essential surgery

I understand why you might have been concerned,
as there have been studies suggesting a link between dementia and
general anaesthesia.

Last year, one such study found that people
over the age of 65 who’d had a general anaesthetic in the previous two
years were more likely to develop the condition. The theory put forward
is that it prompts brain inflammation, which encourages the development
of amyloid plaques – clumps of protein – linked to Alzheimer’s disease.

However,
I must stress that this area of research is contentious, and after
taking much expert advice and consulting the relevant literature, I am
unable to find any firm evidence that general anaesthesia promotes or
accelerates dementia. So please rest assured on this.

Sometimes surgery seems to prompt changes in people’s behaviour, but often it’s the illness that’s the root of this.

People
having surgery usually have a significant illness: bowel obstruction,
hip fracture, coronary artery surgery, to name a few. Such conditions in
the elderly may themselves be a cause of decline in brain function,
especially if there are complications.

Furthermore, when senior
people are removed from their own home and catapulted into the noisy and
anxiety-provoking environment of a hospital ward, the consequence can
often be the manifestations of dementia.

But it is possible that the
onset preceded the acute illness, and a quiet life at home, with a
routine in familiar surroundings meant this was not obvious or
recognised.

When senior people are moved from their home to a hospital ward, the consequence can be manifestations of dementia

Another possibility is that it is delirium induced by
infection, or post-operative cognitive decline (POCD). POCD follows
surgery – one theory is that it may be a reaction to the trauma of it –
and as a result some people don’t feel as sharp as they did and may have
some memory loss or behavioural changes.

Generally, either of these two problems will clear up within a few weeks or months.

Dementia
is very different. The symptoms come on gradually and often loss of
memory is the first sign. There may be personality and behaviour
changes, with mood swings, variable emotions, irritability, and
aggression.

Between 65 and 70, 0.6 per cent of people develop
dementia, but 8 per cent of those 85 or over have it. Family history is
also a risk factor – as are high blood pressure, high cholesterol,
diabetes, obesity and smoking. But exercise, maintaining an active
social network, and continuing to engage in mental activity such as
learning new things also seem to ward off this disease.

Be reassured,
dementia is not on the cards should you need essential surgery – I can
detect your good mental function from your well-reasoned inquiry and
perfect handwriting.

My sister has degenerative discs in her back,
which are painful, but it also seems to cause her chronic sciatica. She
has to walk with sticks and it takes her 15 minutes to get up a flight
of 13 steps and down again. She is in constant pain and wakes in the
morning thinking ‘what’s the point of me being here? I can’t do
anything’. Her doctor recommended a four-week course in hospital of
pain management, but that hasn’t helped. The medication they gave her,
which included morphine, did not touch the pain, so she was weaned off
it. She is only 71, with grown-up children and grandchildren that she can’t enjoy. Someone can surely help?

Tina Cashman, by email.

THE
picture you describe is worrying. To have sciatica, which normally
causes pain or numbness radiating through the buttocks and down the
legs, indicates a problem in the lower part of the spine, the lumbar
spine.

This consists of five vertebrae or bones. Between each is a
disc, which acts as a shock absorber. A disc has a tough fibrous outer
ring, and a softer central pulp.

As we age, discs can dry out and
become thinner and scarred; at times they can even rupture, known as a
‘slipped disc’. If some of the disc material gets too close to either
branch of the sciatic nerve as they exit the spine, it results in
sciatica. Another possible cause of the pain and disability you describe
is spinal stenosis.

Contact Dr Scurr

To
contact Dr Scurr with a health query, write to him at Good Health Daily
Mail, 2 Derry Street, London W8 5TT or email [email protected] –
including contact details.

Dr Scurr cannot enter into personal correspondence.

His replies cannot apply to individual cases and should be taken in a general context.

This is where the spinal canal, the space in
the vertebrae through which the spinal cord passes, has become narrowed
due to the formation of new bone – the body’s response to the
inflammation caused by arthritis of the facet joints that sit between
the vertebrae.

The narrow points where the nerves leave the spinal canal can become narrowed by the new bone, leading to sciatic pain.

There is another cause, where the vertebrae themselves collapse due to thinning and weakening of bones with age.

The
only way to be certain of the cause is detailed scans. Plain X-rays are
insufficient as they only show the bones, so magnetic resonance images
(MRI) are vital as these reveal the detail of the discs, the nerves and
other tissues. 

Normally, a pain clinic should be a last resort
after someone has undergone investigations. So I don’t understand why a
spinal surgeon or a neuro-surgeon hasn’t yet been involved in your
sister’s case.
Maybe she should tackle this with her GP?

By the way… We GPs need to be busybodies

The
comedian Billy Connolly recently revealed that it was a chance
observation by a doctor that resulted in him being diagnosed with
Parkinson’s disease.

People with this degenerative neurological
disorder have a very specific walk we medics refer to as  a ‘festinating
gait’, which involves small, shuffling steps; typically the person also
has his arms hanging limp at his sides, with no swing.

It’s not
unusual to see people with these characteristics when out and about.
Billy was in a hotel in the U.S. when a medical specialist spotted him
as he walked across the foyer – he then approached him and advised him
to get checked out.

I am not usually quite as forward as that, but I
was once sitting on the Tube next to a nun who had an obvious malignant
melanoma on the back of her hand. I wrestled with my conscience for a
moment and then, rather apologetically, told her what I thought. I gave
her my card so as to reassure her that I was not a weirdo, and a few
weeks later she wrote to me and thanked me.

The cancer had been removed and the defect repaired with a skin graft.

Years
later, I ran into her at Westminster Cathedral when the Pope visited –
she recognised me and we had a brief reunion; I was delighted that she
was alive and well.

Maybe it’s not good to be backward in coming forward?

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