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In sickness and in health (Filed: 15/07/2001)

Click here for an insider's view of illness, says Dr James Le Fanu

SOON after writing a chapter entitled "The benefit and burden of breasts" for a BBC book and giving an interview on breast cancer and the pill in younger women, Dr Ann McPherson discovered she, too, had a tiny lump in her own breast.

An Oxford family doctor and medical writer, she soon began to realise - as doctors invariably do whenever afflicted by some malady or other - how difficult it can be to imagine what her patients are going through without having experienced it herself.

The first step was the local screening clinic, which was friendly and efficient, although the mammogram was much more painful that she had expected. "At least I could now tell my patients what it is really like, and that it hurts," she says. Then there was an ultrasound and a biopsy which revealed some malignant cells, following which she had the curious sensation that this must all be happening to someone else. She even found herself ringing her surgeon the next day to make sure the bad news was for real.

After the lump had been removed, then what? Should she have chemotherapy to knock out any further malignant cells that might be lurking elsewhere in the body, or a blast of radiotherapy? Should she take the hormone-blocking drug tamoxifen? While wrestling with these questions, it occurred to Dr McPherson that although the results of the many trials comparing one treatment with another were readily accessible, she knew nothing about what effects they might have on her quality of life: her energy levels, sense of well-being and intellectual function.

That was six years ago, since when Dr McPherson has been kept busy filling this lacuna of knowledge by the obvious expedient of asking people to talk about their medical experiences, the better to inform others. She and Prof Andrew Herxheimer, who had similar thoughts following a knee replacement, have raised the funds to launch a website on which, inter alia, patients talk about how their illness affected them, the drugs they took and their side-effects.

The first two topics could have been chosen with me in mind, as I have one of them, hypertension, and am a candidate for the other, prostate cancer. So, in anticipation, I chose the second and learnt all about what it is like having one's prostate removed: the discomfort but reassuringly little pain following the operation; coping with a catheter; the need to take Viagra; and much else besides.

There were others who had had radiotherapy, and one patient who had decided to take his chances and just "wait and see". As a result, I am almost infinitely better informed than before, as indeed will be anyone who types in www.dipex.org (Database of Individual Patient Experiences). Later this year patients' descriptions of having cancers of the breast, colon and cervix will come on-line - but these, I am sure, will be only the beginning.

Inspired by my recent comments on the hidden dangers of caffeine, a reader writes to say he resolved to try doing without his eight to 10 mugs (!) of instant coffee a day with "astonishing results".

"For years I've had problems with really frequent loose bowels," he writes, "but since switching to tea, they are now completely normal."

Meanwhile, we have the first independent confirmation of the fortuitous observation that the gin-and-raisins remedy for arthritis may also alleviate psoriasis. "I noticed positive results within 10 days," writes Mr Andrew Blank from The Hague, who has had continuous psoriasis for the past 12 years. There has been some reduction in the area affected, but the main benefit has been in the texture and colour of his skin, which is much less inflamed than before. "The effect seems genuine enough to warrant a clinical trial," he suggests.

I am still waiting to hear whether anyone has found a similar benefit from the other suggested remedies - cod liver oil or a wheat-free diet - but here is another possible remedy, from a reader in Essex who has had psoriasis in all the usual places for the past 35 years. Last summer, at the age of 67, he spent three weeks in hospital with a liver abscess for which he was given a cocktail of antibiotics - Amoxil metronidazole and Ciproxin - together with the anti-ulcer drug Losec. By the time he was ready to be discharged, his psoriasis had "almost totally disappeared". So which should take the credit - the antibiotics, the Losec or the hospital diet?

It is tempting to dismiss such stories as "mere anecdotes", on the grounds that there should really be only one effective remedy for any given condition. But this is simply not the case. Many things cause migraine, for which there are numerous treatments that work in various ways; so why should psoriasis be any different?

-- Anonymous, July 20, 2001