Our reader is suffering from three problems that are intimately linked. He won’t alleviate any of them unless he tackles the fundamental cause rather than the symptoms: heavy snoring, increasing girth and impotence, any of which may torpedo his developing love life.
His crucial comment is that he is overweight. The obligatory diagnostic feature of the metabolic syndrome is that a patient has increased central abdominal obesity. Male girth is measured with the tape held at a point passing through mid points between the bottom of their ribs on both sides of their chest and the tops of the crests of their pelvic bone (the iliac crests). People delude themselves about their size by measuring their waist below their beer belly, or above the bulge where waist size is at its greatest. To avoid our reader’s troubles a male’s waist needs to be under 40in (101cm), preferably under 37in.
The metabolic syndrome is a group of problems associated with an excess of intra-abdominal fat: the type that hangs from the tissues around the guts. This fat is biochemically active and produces hormones that increase the likelihood of heart disease and diabetes, raised cholesterol and triglyceride (blood fat) levels, an increased blood sugar level and high blood pressure. Another consequence of a beer belly, or even of excess midline weight, is that it increases the incidence of impotence.
Either frank impotence, or increasing erectile dysfunction, is an excellent indicator of cardiac or diabetic troubles ahead. Impotence is often the first sign of either of these conditions. Potency difficulties are twice as likely in patients (even when they are still relatively lithe) who later develop metabolic syndrome.
Apnoea is the name given to the momentary cessation of breathing. In an apnoeic patient who snores, the snoring starts relatively quietly but grows louder. At the point when the snoring is at its peak the snorer suddenly stops breathing for a few seconds and momentarily wakes up. The breathlessness (apnoea) is the result of changes in the blood’s oxygen and carbon dioxide levels. The crescendo snoring and sleep apnoea are important for our reader as research published in the Archives of Internal Medicine suggests that the Viagra group of drugs, excellent as they are in the treatment of impotence, increases airway congestion in people with severe obstructive sleep apnoea.
I suggest that our reader lose weight and have a full cardiac and cardiovascular assessment. He should learn what his blood pressure is, the level of his fasting blood sugar and his total cholesterol level, divided into the potentially dangerous low-density lipoprotein cholesterol LDL, and the cardioprotective high-density cholesterol (HDL). The HDL should be high, the LDL low, certainly below three and preferably below two. As our reader is already overweight calories must be reduced and exercise increased. Even if slim and troubled by potency problems, a man should have tests. Treatment for this reader should include a discussion with his GP about having Viagra, Cialis or Levitra, to renounce smoking and to avoid heavy evening meals and drinks.
A READER who runs a busy office has written to say that should there be a major avian flu pandemic her first duty will be to her family. She will therefore stay at home. However, she would welcome advice on how to cut down the risk of catching common flu, as she feels the UK must be due a major outbreak.
Flu jabs are now readily available. They don’t provide total protection but they do reduce the risk of catching flu, and if flu is caught it is likely to be less severe than it would have been without immunisation.
Research has been undertaken to assess the impact of a major avian flu pandemic. Survive, the business continuity group, has collected its conclusions in a booklet, Flu Pandemic Guidelines in Business.
The basic principles of personal hygiene apply to any respiratory-tract infection, whether coughs, colds, standard or avian flu. Frequent hand-washing at work or home is essential. Liquid medicated soaps and spirit-based gels of the type found in plastic dispensers by hospital basins are the principle defence. We should have clean hands and fingernails and need to learn to avoid scratching our faces, rubbing our noses and using filthy handkerchiefs.
In a serious epidemic the observance of a cough etiquette could be life-saving. Noses and mouths should be covered when coughing, preferably with a disposable tissue rather than a bug-soaked handkerchief. The tissue should be discarded in a bag that can be thrown out each evening. Face masks are of doubtful advantage, but in a flu epidemic they should be applied carefully and changed often. Households should have disposable towels or a towel and flannel for each user.
Finally, we should make every effort to persuade our legislators to stockpile more Tamiflu or Relenza, the flu antivirals, just in case an avian flu epidemic erupts. The antivirals keep for five years.
Ask Dr Stuttaford
Send your questions to drstuttaford@thetimes.co.uk or to times2, The Times, 1 Pennington Street, London E98 1TT. Please include the following: the symptoms (and how long they have been present), the person’s age, sex and marital status. Dr Stuttaford’s replies cannot apply to individual cases but should be taken in a general context.
Topic of the week: psychosomatic illness: click here for Medical Q&A with Dr Stuttaford
