Dr James Le Fanu: 25 April

The pitfalls of medical misdiagnosis, a harmless blackout, and unexpected, but welcome, relief for cracked fingers
It is always heartening to hear of those who make a seemingly miraculous recovery from a fatal illness, as with a 47-year-old woman from Bristol diagnosed with five tumours of the brain and sent home to plan her funeral.

‘I thought I was going to die in a few weeks then suddenly I wasn’t,’ she is reported as saying. And sure enough, a repeat brain scan revealed four tumours had vanished, and a fifth was now ‘no bigger than a pinhead’.

An unusual story one might think, but the same happened to an elderly friend of mine 18 months ago: there was a gloomy prognosis; there was ‘nothing more to be done’; friends and relatives were summoned to make a final pilgrimage – and then there was a spirited recovery.

The Bristol lady’s doctors attributed her ‘miracle cure’ to a course of palliative radiotherapy but, I suspect, as with my friend, they had made the wrong diagnosis: the ‘tumours’ were in fact several small strokes or infarcts that do, gratifyingly, have a habit of getting better.

This, too, must account for the supposed success of those bizarre alternative cancer remedies of shark’s fins and coƒffee enemas. Or, for a family doctor acquaintance, the macrobiotic diet he put himself on after learning he had incurable cancer of the pancreas. After a couple of months of a strict regime of pulses, lentils and uncooked vegetables (and passing a lot of wind), his stomach pains receded and he started putting on weight. A repeat scan showed his cancer had shrunk – although close scrutiny suggested it was more likely to be a cyst caused by chronic inˆ ammation.

Still, very rarely, in about one in 100,000 cases, some cancers may spontaneously regress – as in a 23-year-old woman with a rapidly spreading malignant melanoma who refused a termination when she became pregnant. She went on to have a healthy baby, then a second and third child, before finally succumbing 10 years after her original diagnosis.


The Bristol lady is apparently fearful of celebrating her good news lest her cancer (if indeed it was cancer) returns. She is, however, in a better position than the man reported in the British Medical Journal who, on being told he had no more than a year to live, sold all his possessions for a – literally – once-in-a-lifetime, around-the-world cruise. He returned fit and well but destitute.

This week’s medical query comes courtesy of a lady from Surrey writing on behalf of her 70-year-old husband whom she describes as ‘fit and active for his age’, other than taking pills for his blood pressure and asthma. He enjoys the odd beer at his local pub of an evening and last week on returning home, he dropped in to visit a friend for a cup of tea and a chat.

Shortly after arriving, while sitting in a chair, he had a fit of coughing. ‘Next thing he slumped back in his chair with his eyes closed.’ His friend was about to ring for an ambulance, but, after about four seconds, his eyes opened and he recovered fully. What, she wonders, might be the cause of his blackout and does he require any investigation?

This fainting episode is known as Cough syncope. It is due to the fall in blood pressure caused by pressure changes within the chest cavity brought on by a severe bout of coughing. This was probably prompted by an episode of choking, perhaps from the tea going down the wrong way – and it could have been exacerbated by his having ‘irritable’ airways associated with asthma. It is, however, a benign condition and does not warrant further investigation.

A reader reports that her mother, troubled over the years by painful cracked fingers, recently purchased, when visiting a builders’ merchant, a tub of O’Keeƒ e’s Working Hands Cream – much favoured by those in the building trade for treating chronic dermatitis associated with manual labour. ‘The results were astonishing – her split fingers are healing up extremely well,’ she writes.

Email drjames@lady.co.uk