My husband had a heart attack in Spain in January, but had a stent fitted within 45 minutes and we came home with various medications. Since then, he’s suffered with constant smelly wind, a fat tummy and bad perspiration. A recent urine test showed his creatinine level was high.
Name and address supplied.
Dr Martin Scurr replies: I’m impressed by the speed and efficacy of your husband’s treatment, but I appreciate that these unpleasant symptoms are unsettling.
The raised creatinine is, in my view, a separate issue (and one for his specialist to investigate), as the most likely cause of your husband’s bloating and offensive wind is his medications, listed in your longer letter.
I suspect one of the culprits is lansoprazole, which suppresses the production of acid in the stomach – your husband has been prescribed it because he’s also taking aspirin and ticagrelor (both reduce the stickiness of the blood to prevent clots) which can cause stomach ulcers.
Suppressing acid secretion will reduce inflammation of the stomach lining caused by the two drugs. The problem is that it can also lead to overgrowth of bacteria in the small intestine. This in turn can cause bloating and the excessive production of (more offensive) gas.
The other potential culprit, ezetimibe, works by reducing the absorption of dietary cholesterol (the cholesterol that comes from food itself) in the small intestine – potential side-effects include flatulence.
The excessive sweating, too, may be as a result of the changes to the gut microbiome. These can alter chemical processes elsewhere in the body, including changing the molecules that are secreted in sweat – hence the bad body odour you describe.
Yet the medications your husband is taking are vital for ensuring that his new stent functions well. I’d suggest he does all he can to support his microbiome, with simple steps such as eating foods containing friendly bacteria (i.e. fermented foods such as live yoghurt, sauerkraut and kefir).
It might be wise for him to consider a probiotic supplement (his pharmacist can advise on a suitable option) and reduce his intake of sulphur-containing foods including onions, garlic, beans, pulses and brassicas.
Ever since having a stent fitted, the reader’s husband has suffered with constant smelly wind
When I wake up in the mornings my nose is often blocked in one nostril, unblocks quickly as I get dressed, then streams non-stop for up to two hours. I use a spray to unblock my nose during the night if necessary.
Gordon Rule, Edinburgh.
The obvious explanation is that you have an allergy – to house dust, feathers in pillows, pets – but I assume this has been ruled out (a good way to check this is to take an antihistamine, which should ease symptoms if it is an allergy).
So I suspect you have a variant of perennial non-allergic rhinitis – essentially a very runny nose that’s not caused by an allergy, which is common in older people.
Our nostrils have a natural cycle of rest and filtering air, managed by the blood flow in the membrane that lines the nasal passages. The cycle takes around two hours, but in some people it becomes exaggerated, resulting in excessive discharge.
A key role is played by receptors for acetylcholine (a chemical messenger) in the nasal lining, which stimulate secretions from glands in the nose.
These receptors can become overactive – a response to temperature changes, or even eating – causing that watery discharge many will recognise.
The treatment is a topically applied drug, ipratropium, which blocks the acetylcholine receptors and reduces the watery discharge. Your doctor can prescribe this – use it at bedtime and first thing in the morning. It is safe to use long term.
In my view… Virtual checks can miss infections
This summer I saw three patients with severe respiratory tract symptoms, each of whom was tested and found to have Covid.
In fact, they’d used nasal swab tests that were negative – but I was not convinced, so when symptoms persisted I carried out blood tests. These confirmed very high levels of the relevant antibodies.
Confusingly, immunisation with any of the Covid vaccines would also leave detectable antibodies in the bloodstream for weeks, months or even years after.
In each of the three patients I describe, the levels of antibodies were very high.
So how did I know it was the infection and not the vaccine that was behind these?
Because I saw them in person. That’s why patients with an infection – particularly a respiratory one – must always be examined physically.
There is no case for attempting to deal with this type of illness on the basis of telephone or online consultations – especially with older patients, given their frailty.
I really do worry where we’re going to end up now that so much is being done remotely.
- Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY, or email: drmartin@dailymail. co.uk. Replies should be taken in a general context. Always consult your own GP with any health concerns.
