FOR 50 years, I worked outside with machinery and, during the winter, I’d warm my hands around the exhaust of one of the big diesel tools we used.
A few years ago, a scan showed the left ventricle of my heart only worked at 40 per cent capacity and my heart rate was so slow, I had to have a pacemaker.
I’ve since read that diesel fumes could have damaged my heart. Is that true? And am I right to push myself to exercise to help my heart? I’m 74 years old.
Don McCallum, Eastbourne, East Sussex.
The combustion of diesel fuel produces soot, fine particles and gaseous contaminants, which are implicated in cancer, heart and lung damage, as well as impaired mental function.
It’s likely that these effects are due to some of these compounds being endocrine disruptors (in other words, they have damaging effects on hormone systems).
Warning: UK research presented at the European Society of Cardiology in 2017 found there was ‘strong evidence’ that diesel pollution in particular leads to heart attack and heart failure
Others may cause inflammation in the lungs, heart and probably other organs — and some of the compounds are know to be directly carcinogenic, or cancer-causing.
As you’ve read, studies have shown that diesel pollution may damage the heart muscle — UK research presented at the European Society of Cardiology in 2017 found there was ‘strong evidence’ that diesel pollution in particular leads to heart attack and heart failure.
Currently, there is insufficient research to say whether heart damage from diesel pollution is limited to specific parts of the heart, such as the area that acts as the pacemaker, or whether there is more widespread damage that impacts on the effectiveness of the heartbeat.
Research is complicated by the fact that heart disease is multifactorial — risk factors include smoking, hypertension (high blood pressure), obesity and alcohol consumption.
This makes it difficult to isolate the potential damage from an environmental factor such as diesel fumes as being the only reason for a heart condition.
You’ve been told that your heart is working at 40 per cent of its capacity, which means that the output volume of each heartbeat is under half what it should be — a condition known as heart failure. Symptoms include breathlessness, ankle swelling and fatigue.
Research is complicated by the fact that heart disease is multifactorial — risk factors include smoking, hypertension (high blood pressure), obesity and alcohol consumption
However, your slow heartbeat, known as bradycardia, will be due to a problem with the pace-making area of the heart that sets the heart rate by triggering each beat. That’s why you received a pacemaker.
The bradycardia might have been caused by your exposure to contaminants in diesel fumes, but it is impossible to prove that this was the case.
In terms of future lifestyle, as well as regular exercise, refraining from exposure to tobacco, alcohol, diesel fumes and other atmospheric pollutants — such as wood-burning stoves — along with controlling your cholesterol levels and blood pressure (with your doctor’s help), will help to protect against any further deterioration of your heart function.
Do make sure your exercise isn’t overly intense as, in theory, this could trigger an abnormal heart rhythm. Talk to your GP or cardiologist about your regimen or seek the advice of a qualified fitness trainer.
MORE than two months ago, I had shingles and, although the rash (on my left shoulder) disappeared after two weeks, I still have severe pain in my shoulder and neck.
My physiotherapist believes I have osteoarthritis in the AC joint in my shoulder.
But I never had this pain before the shingles, so think it unlikely that osteoarthritis is to blame. I would be grateful for your opinion.
Mrs J. Shankland, Kilbarchan, Renfrewshire.
I thinkit is most likely that your ongoing pain is a continuation of your shingles.
The acromioclavicular, or AC, joint is at the junction of the shoulder blade and collarbone.
Arthritis of the shoulder is not uncommon and, while it can cause considerable discomfort, it does not usually cause the severe pain you describe.
Shingles is caused by the reactivation of the varicella zoster virus — the same virus that causes chicken pox and which can then lie dormant in nerve fibres for many years.
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Always consult your own GP with any health worries.
Usually, an attack of shingles, which is essentially an infection of the nerve and surrounding skin, causes a rash and pain that clears within four weeks.
Sometimes, the nerve cells become damaged and inflamed and this can lead to enduring pain that interferes with sleep and normal activities. If the pain continues for three months, this is known as subacute herpetic neuralgia — pain persisting for longer is called post-herpetic neuralgia. The pain is often burning or stabbing, unlike the characteristic ache of osteoarthritis.
Shingles nerve pain may be constant or intermittent. Another defining characteristic is pain in response to light touch and, where the rash occurred, there may be numbness.
You mention in your longer letter that you are taking amitriptyline to help with the pain. This is an antidepressant used at a smaller dose for pain — usually 10 to 25 mg daily; for depression doses, up to ten times that is needed.
There can be side-effects, such as dry mouth, constipation and drowsiness. However, these effects are minimal or absent at the small doses required for post-herpetic neuralgia.
If your pain is post-herpetic neuralgia, then physiotherapy will not help. A higher dose of amitriptyline might be needed.
Capsaicin cream (derived from chili peppers), which causes skin sensations that interfere with the pain signals, may also help. I suggest you talk to your GP.
IN MY VIEW: Give family doctors the tools we need to beat cancer
Diagnosing cancer early equates to a better chance of survival — that is a fact that needs no explanation or embellishment.
To measure how well we are doing that, doctors record the proportion of those with a particular cancer who are still alive five years post-diagnosis — and, here in the UK, we are far further down the rankings compared with other countries.
Take colon cancer. A report by The Health Foundation published last November found that the five-year survival rate in the UK is 60 per cent — in Australia, it’s 71 per cent. Survival rates have improved here, but they have improved more elsewhere.
The reason? Delayed diagnosis is a key problem, with a number of causes.
When I was speaking recently at a literary festival on the subject of general practice, and fielding questions from the audience, I struggled to defend the NHS, as many present quoted their experiences of being ‘fobbed off’ when they presented with symptoms to their GPs. A GP from Turkey spoke with enthusiasm about her country’s superior cancer survival statistics, making the point that GPs there refer patients directly for scans and investigations with far easier access than her UK colleagues.
The problem is rationing: there are numerous roadblocks to discourage GPs from investigating their patients promptly and thoroughly.
While GPs are trained to conduct many of the investigations needed to determine if someone has cancer, currently their hands are tied by the system. So, rather than, say, taking a biopsy of a suspicious skin lesion or arranging a CT scan for a patient with weight loss and a cough — all of which GPs in other countries can do — we must instead refer them on to a consultant.
To achieve a tsunami of change requires the equipment and the expert personnel to make it happen. There will be no mileage in enabling patients to bypass their GPs and thereby place a greater load on specialist hospital consultants — a suggestion made last year by the former National Cancer chief Sir Mike Richards.
I paraphrase Sir Winston Churchill: give GPs the tools and we will finish the job.