Dr Martin Scurr has been treating patients for morethan 30 years and is one of the country’s leading GPs. Here he answers your questions…
Felix de Havilland, Ongar, Essex.
Uphill struggle: Dr Scurr says you should not listen to people who claim they can get rid of gallstones with natural remedies
Yi Dan is a form of herbal medicine and, as regular readers will know, I am no fan of alternative therapies. But before I explain why, first to the gallstones.
About 20 per cent of people over the age of 65 have them, and in most cases they’re not a problem. however, in some cases they cause pain, infection in the gallbladder (cholecystitis) or bile-duct system (cholangitis), or even an inflamed pancreas (pancreatitis), a common and potentially very serious complication.
There are different types of gallstones. The most common are formed of cholesterol; there are also black or brown ‘pigment’ stones, made up of waste products excreted by the liver. Stones grow about 1mm to 2mm each year, taking some years to become big enough to cause problems.
Why do gallstones form? The process starts with bile, which is made by the liver and carries away unwanted waste such as cholesterol. Bile travels from the liver via the common bile duct. some is then diverted up a short tube, the cystic duct, into the gallbladder, which acts as a storage reservoir.
The wall of the gallbladder absorbs 90 per cent of the water from the bile, concentrating it. When you eat, the gallbladder empties the stored bile back into the common bile duct.
But if the gallbladder is diseased — common risk factors include obesity, genetics and a rich, fatty, over-calorific diet — waste products such as the pigments formed by the breakdown of old blood cells collect into small stones.
Gallstones can be dissolved by taking bile acids orally for many months, though this is only effective for cholesterol stones. And the success rate with large stones is poor; even in the best cases, less than half are dissolved after two years of treatment.
The stones can also recur — around 50 per cent of patients suffer again within five years.
A bigger worry is that stones made smaller by dissolution can become small enough to be squeezed down the cystic duct into the common bile duct and cause a blockage — a considerable problem. in more than 30 years as a GP, I’ve never had a patient deal successfully with gallstones in this way.
Alternative treatments: Dr Scurr has never met anyone who cured their gallstones with olive oil or lemon juice
The gold-standard treatment is cholecystectomy — removal of the gallbladder. this is offered once symptoms occur and is usually a keyhole procedure. it does not affect digestion, although some patients develop chronic diarrhoea.
My patients often mention the alternative method you describe and always seem to know somebody who knows somebody for whom it worked. But I’ve never managed to speak to an actual patient who’s had it, and frankly I think it’s a fairy story, perpetuated by the internet.
In any case, it’s difficult to imagine how Yi Dan would help flush your 2cm stone down the common bile duct, which is just 5mm in diameter.
I receive many readers’ letters seeking advice on alternative treatments. I do sympathise, as I think it’s essentially a quest for being listened to with patience, kindness and understanding: these can be in short supply in the hard-pressed world of high-tech medical care.
However, don’t confuse this with efficacy: alternative treatments are ‘backed’ only by anecdote.
But it works, people say. Well, that’s the magic of the placebo effect.
Nowhere is this more true than with homeopathy, which James Delingpole recently wrote about in these pages.
Homeopathy is based on the joke principle that like treats like — giving minute doses of a poison which, in larger amounts, apparently produces the symptoms from which the patient suffers.
This is not the same as herbal medicine (heroin, from the opium poppy, is a herbal medicine and really works for pain). in homeopathy, the substance used is so diluted there’s none left.
Put a sugar lump in the sea at Portsmouth and take a spoonful of seawater at Penzance and you’ll understand the sort of dilutions being employed. Sure, homeopathy is well meaning, but it’s based on wishful thinking and, as such, is dishonest.
Just like the loony Yi Dan treatment proposed for your gallstones. Disappointing I know, but please don’t waste your time. as for the olive oil and lemon juice, I’m afraid that won’t help either.
G Pattenden, Eastbourne, East Sussex.
The phrase ‘hardening of the arteries’ refers to the process of atherosclerosis, when deposits of fatty cholesterol material build up inan artery. Risk factors include high cholesterol, raised blood pressure, smoking, diabetes and obesity. Any artery in the body can be affected: in your case, it was the carotid artery.
CONTACT DR SCURR
To contact Dr Scurr with a health query, write to him at Good Health, DailyMail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk -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.
Always consult your own GP with any health worries.
The two carotid arteries, one on each side of the neck, are the most important arteries supplying blood to your brain.
The risk is that a clot forms on a section narrowed by a fatty build-up. The clot then detaches and is carried up into the brain, whereit eventually blocks a smaller artery, reducing blood supply and damaging the area of brain cells the vessel was supplying — causing an ischaemic stroke.
In patients with at least 50 per cent narrowing of the artery, surgery is used to remove the fatty build-up. however, studies suggest there’s no benefit in operating on those with 30 to 49 per cent narrowing; and surgery is actually harmful in those with less than 30 per cent.
That’s why you’ll have been advised to take a small daily dose of aspirin, as this makes the blood less sticky and reduces the chances of aclot. It’s also advisable to control blood pressure meticulously; buy your own machine and use it once a week.
Most important, taking a statin is essential, preventing further cholesterol build-up and even shrinking the blockage.
In your letter, you also mention suffering neck pains with small amounts of alcohol. this, I suspect, is unrelated to your arteries and may be due to a creaky old neck, which blights many of us.
Save your pennies: Private health insurance doesn’t cover primary care
Just at the moment financial cutbacks and a major re-organisation put the NHS under huge strain, up pop those seductive ads for private healthcare. they imply any illness will be paid for, and you can bypass the NHS. Ah, such peace of mind.
But there’s not one policy anywhere that covers primary care (GP care), and yet 90 per cent of anything that might happen to you is treated in general practice. Your attention is craftily distracted by the promise of cover for osteopathy, physiotherapy and other more peripheral treatments — but before anything can be treated, you need a diagnosis!
My other concern is insurers will attempt to hijack your medical care by ‘helping you find a consultant’. since when have clerks at the big insurance providers had the training in medical care to select specialists?
Furthermore, and even more insidious, is that insurers tell the specialists what fee they may charge: anyone who doesn’t sign up to this is not registered by the insurer. not only does this improperly suggest to the layman that ‘unregistered’ consultants have not passed muster in some way, but patients see specialists chosen on the basis of cost, not excellence.
Meanwhile, the specialists themselves have to do more work in less time; the only way to cover their overheads is to squeeze in more consultations. why go privately if you don’t then get to spend time with the specialist and receive a detailed opinion?
Note: insurance companies are commercial organisations dedicated to making money for their investors.
My approach is to opt for in-patient cover only. this means the insurer re-imburses the fees when the problem is so serious you must be in hospital, but keeps the premiums down. otherwise it’s just a rip off.