I’m 83 years old and my doctor is convinced I’m the oldest person in the UK who has glandular fever. No need to tell you what I’ve been going through since the middle of August. But can you tell me when the all-night sweating stops, and when I’m likely to get back to normal?
Vic Borg, Surrey
Dr Martin Scurr replies: Glandular fever is caused by the Epstein-Barr virus, leading to a temperature, swollen glands in the neck and extreme tiredness.
We usually see it in teens and young adults and I don’t think I’ve ever diagnosed it in a patient as old as 50, let alone in their 80s. You have my sympathy, as it can be debilitating.
The infection passes via saliva. One obvious way is by kissing, which explains its colloquial name, the kissing disease. But it’s not just kissing – sharing utensils and possibly even cigarettes, in theory, could allow transfer to an older person.
Why it’s not common in the elderly is unclear but it may be that most people have become immune – many cases are silent, i.e. produce no symptoms, but still provide protection against future exposure. Symptoms can also be different in older people: glands are less obviously swollen, and along with a fever they can experience sweats, weight loss, and general weakness.
Glandular fever is caused by the Epstein-Barr virus and can cause a temperature, swollen glands in the neck and extreme tiredness
It takes around two to four weeks for teenagers to recover – but many patients go on to suffer from post-viral syndrome, characterised by fatigue, aches and pains and sleep problems, which can take weeks, even months, to recover from. In older people, it may be six months or more, as in your experience.
Your doctor will have sent a blood sample for tests to confirm the diagnosis – this condition often disrupts liver function and prolonged sweats could be a sign that yours is not back to normal (as it causes an outpouring of chemical responses that affect how your body regulates its temperature).
I’d be inclined to run follow-up checks on liver function every few weeks. I would also arrange for a chest X-ray, as secondary infection in the lungs may also complicate the picture. Perhaps discuss this with your doctor.
Two weeks ago I banged my coccyx getting into a car when I sat heavily on the seat belt holder. Since then I’ve had terrible pain when sitting, and worse when I try to stand up. Do you think it needs checking out?
Susan Bowers, Derbyshire
Dr Martin Scurr replies: Injuring your coccyx can cause significant pain. The lowest section of your spine, the coccyx, is formed of four bones, joined by fibrous tissue, but without the shock-absorbing discs between them as elsewhere in the spine. From early adulthood the bones become fused, making the coccyx more rigid.
If you fall on it the coccyx can become severely bent, tearing the fused joint, hence the pain.
The added factor is that the muscles of the pelvic floor are attached to the coccyx and so, as you stand, you automatically tighten the pelvic floor muscles, causing even more pain. A scan won’t reveal any damage as we’re talking about something akin to a significant sprain, or at worst, a crack in the bones which may not be visible on X-ray.
Usually the injury heals over some weeks, so for now the key is pain management with paracetamol or ibuprofen, physiotherapy (using technology including therapeutic ultrasound, laser or acupuncture), applying heat to the area, cushioning and rest.
Rarely, a patient may be offered surgery to remove the coccyx (essentially the remnant of our tail from ape antecedents).
However, I’ve never come across anyone who needed this. Patients typically find that the pain improves and settles by the end of the second or third month.
IN MY VIEW: Don’t treat life’s trials as medical problems
There were shockwaves last week following the Secretary of State for Health’s statement that there is an overdiagnosis of mental health problems leading to a vast rise in benefit claims.
The facts are clear: 1.4million people are receiving Personal Independence Payments primarily for mental health problems, which accounts for 40 per cent of all claims.
Health Secretary Wes Streeting last week said there is an overdiagnosis of mental health problems in the UK, leading to a vast rise in benefit claims
The difficulty, as I see it, is that there are no objective tests – no scans, blood tests or other investigations to screen for or confirm a psychological diagnosis. Reaching a conclusion about the cause of symptoms is down to expert judgment and requires training and experience.
Furthermore, health experts are not always in a position to decide whether a patient can cope with work even when a diagnosis is made.
On top of this, we have a shortage of expert personnel in the NHS, and the trend for telephone or online consulting.
No surprise, then, that we’re seeing an escalation in claims for ‘work-limiting’ health conditions and the medicalisation of the normal slings and arrows of life. I fear the numbers will only rise further.
Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London W8 5HY or email drmartin@dailymail.co.uk — include your contact details. Dr Scurr cannot enter into personal correspondence. Replies should be taken in a general context and always consult your own GP with any health worries.
