A Dentists still regularly use sodium hypochlorite for canal irrigation because it is an effective antimicrobial agent. It is the irrigating solution of choice in dentistry, and the conventional view is that it is safe, and no more an irritant than the usual saline solution, provided it is handled with care.

There are dentists who use it with hydrogen peroxide which, they believe, neutralises any dangers. But this might be just wishful thinking. Sodium hypochlorite is the chemical name for household bleach (NaOCl – one atom each of sodium, oxygen and chlorine).

Not surprisingly, some dentists regard it as toxic and dangerous. Common reactions to it include gastrointestinal irritation with nausea, vomiting and diarrhoea, but usually only if the solution is swallowed. A high-concentration solution of sodium hypochlorite can result in corrosive burns to the skin or gums, and eye damage.

However, inhalation of sodium hypochlorite can cause burning in the throat and coughing due to the chlorine gas. High exposure can lead to swelling and obstruction of the airways. Congestive heart failure and pulmonary oedema are rare reactions, but can occur from just inhaling the solution.

Dentists should immediately check a patient’s lung function and carry out a chest X-ray if there is even a moderate reaction to the solution.

Extraordinarily, some dentists inject the solution into the gums. One website warns dentists: ‘There generally is an immediate severe burning sensation often accompanied by very rapid gross swelling.’

Mr C.P. had been stationed in Bosnia-Herzegovina and Kosovo during the recent wars there. I was intrigued to hear that he had passed through the same places that Dr Samuel Hahnemann had observed the effects of ague (now called malaria) and the Cinchona (quinine bark) used to cure it, which led the doctor to discover the historical drug-to-disease similarity principle of homoeopathy.

Malaria, as we know, is transmitted by mosquitoes, and some Balkan areas are still infested with mosquitoes to this day.

The patient described to me how his legs had steadily and inexorably become more and more swollen. He also told me of his many expensive treatments, including some involving hot stones and oils, all in an attempt to rid himself of the lymphoedema in his legs – but to no avail. We discussed various possibilities and he underwent tests, the results of which were all normal.

I then remembered something from my time in Mozambique -Bancroft’s filarial worm (Wuchereria bancrofti). This parasite has only one final host – humans – and causes ‘filariasis’. The adults resemble cream-coloured lengths of coarse sewing thread and live in the lymphatic vessels that conduct lymph from body tissues, through the lymph nodes and into the blood. As they grow in numbers, they eventually clog up the lymph nodes, leading to a condition called ‘elephantiasis’, the distressing and crippling enlargement of various parts of the body, if left untreated. It is found, among several other places, in the Balkans and on the east coast of Africa.

The adult worms lay tiny larvae – microfilariae – which pass from the lymph into the bloodstream, where they circulate near the skin’s surface in the peripheral circulation, but only at night when the victim is asleep. This is when the microfilariae are sucked up together with the victim’s blood by mosquitoes, in which these microfilariae then go on to develop into the infective larval stage.

So, I began to suspect that Mr C.P.’s lymphoedema was actually filariasis, but testing for that was difficult since the blood samples had to be taken at night, immediately upon his being woken up from sleep, if any microfilariae were to be found. On discussion, Mr C.P. expressed his willingness to go through the process, and the laboratory later confirmed the presence of the parasite.

Meanwhile, I had found a report of a study – albeit in dogs and, therefore, not necessarily applicable to humans – in which a 50 per cent ethanol-water extract of the root of Zingiber officinale (common ginger) had shown a markedly beneficial effect in treating the disease when injected daily for three four-day cycles, with seven days in between (J Helminthol, 1987; 61: 268-70).

Mr C.P. undertook this same regime for six four-day cycles, with intervals of three weeks, and his microfilarial count was reduced by 98 per cent. His lymphoedema gradually subsided, and his blood became microfilariae-free after cycle number four. Now, six months after the end of the treatment, he remains worm-free, and all traces of his lymphoedema are gone.

Harald Gaier
Harald Gaier is a registered naturopath, osteopath, homoeopath and herbalist. He can be contacted at The Diagnostic Clinic, London, tel: 020 7009 4650

Commonly prescribed diuretics are bendrofluazide, chlorothiazide, chlorthalidone, cyclopenthiazide, hydrochlorothiazide and indapamide.

That diuretics lower blood pressure was discovered by accident in the 1940s and, even today, it is not known how they work to reduce blood pressure.

It is claimed that diuretics prevent the cardiovascular illness caused by high blood pressure, such as stroke and heart failure, but the actual reduction in death rates appears to be only a modest 10 per cent (JAMA, 1997; 277: 739-45). The picture is further complicated by two recent pieces of evidence.

1. Low blood pressure as well as high blood pressure can lead to cardiovascular problems and premature death – and one cause of low blood pressure is diuretic drugs (Ann Intern Med, 2002; 136: 438-48).

2. Diuretics can have serious side-effects, such as cancer of the kidneys, which may further worsen death rates (Cardiovasc Drugs Ther, 2000; 14: 407-9).

Other side-effects of diuretics include impotence, dizziness on standing up (due to low blood pressure), blood disorders, skin reactions, gout, pancreatitis, and depletion of potassium, magnesium, coenzyme Q10 and zinc. There is also evidence that diuretics may be ‘harmful’ in people with coronary heart disease (J Cardiovasc Pharmacol, 1990; 16: 58-63).

Over 3 per cent of patients on diuretics find the accompanying side-effects intolerable (Pharmacotherapy, 2001; 21: 940-53).

Now, every drug has side-effects, and the COX-2 inhibitors are no different. Their side-effects are . . . gastrointestinal problems, such as ulcers.

Recognising that nobody’s perfect, the pharmaceutical industry and the drug regulators decided to press on with the COX-2 inhibitors, and several are now on the market.

The latest to win its spurs was Bextra (valdecoxib), approved in America by the Food and Drug Administration in 2001, and last summer in Europe by the EMEA.

Unfortunately, the FDA has discovered that Bextra doesn’t just cause gastrointestinal problems, such as ulcers – it also causes life-threatening skin reactions, including toxic epidermal necrolysis, as well as anaphylactic reactions and angiodema. Patients in the US who suddenly start developing a rash are now being told to stop treatment immediately. These reactions, which resulted in several people needing hospital treatment, only came to light once the drug had been approved in the US – around March 2002, in fact.

Interestingly, the recently created EMEA didn’t meet to discuss the drug until last July, five months after people were being rushed to hospital in America.

On approving the drug, the agency was told that Bextra’s side-effects included dry mouth, hypertension, insomnia, anaemia, and so on (regular readers of this column can probably complete the list). But there was no mention that it could cause life-threatening skin reactions. So, is the EMEA now going to issue a warning to doctors in Britain? We watch the space with great interest.

By now, he has largely recovered from the paralysis. During his illness, I sent him a stream of e-mails which I believe contributed to his recovery. I’d like to share them with you in case any of you suffers from similar damage following a paralysis or an illness like meningitis.

This report is empirical medicine in practice: what has worked, and suggesting that others should try it too, even though it is not backed by any scientific studies.

You ask: is this me? You answer yourself: yes it is, but the real me’ll be back! But how do I do that?

You must mentally commit yourself to the best possible recovery you can imagine. Start with a burning commitment and the will to get well follows.

It’s also essential that you hang on to your sense of humour. See if you can make someone smile today.

It will take time and unflagging determination on your part. It’s likely that at the height of your meningitis, major arteries in the brain became blocked because of brain tissue swelling, which cut off the blood supply and resulted in brain cell death.

The good news is that we all have far more brain cells than we’ll ever need. Like a computer, your brain is ‘programmed’ to be either ‘on’ or ‘off’. If ‘on’, the brain cells (neurons) send an electrochemical signal, triggering an action (like moving your leg); if ‘off’, no signal is sent and no change occurs.

Dead or damaged cells wreak havoc on signal transmission but, fortunately, we all have a few billion neurons to spare. To get around the damage, you must train the undamaged and unused brain cells to take on the roles of the dead neurons. This will take a lot of time and determination. Look how long it takes a baby to achieve any such control.

But, to look on the bright side, I can tell you that it will be easier for you than for a baby because the connections between brain cells will have become more sensitive near the damaged area. Nature helps to make recovery easier.

Also, as the swollen cells around the gray matter of your brain gradually subside, the less-damaged neurons will regain their function, making your recovery seem quick at first.

Keep trying to reclaim your faculties until you do. Nothing in the world can take the place of persistence.

Stay calm, don’t panic, and concentrate on priorities! Never stop expecting to get better! It is probably a mistake to look too far ahead so, for now, take one day at a time. Do your best. Summon the will to recover. Until you are fully committed to recovery, there will be a persistent hesitancy, which will slow down the recovery process.

Here are 12 cardinal tips for coping with your own rehabilitation work:
* Rest before and after every ‘rehab’ session: too much exercise is just as bad as too little. Find a happy medium and stick with it
* Practice any new skills you have acquired
* Enjoy what you are doing and make sure your mind maintains a steady purpose: to enjoy yourself is the expressway to recovery
* Be patient and keep trying: it takes a long time to relearn lost skills, so set yourself realistic goals; faith, which feeds on your actual achievements, is the substance of hope
* When you feel agitated or impatient with yourself, wind down and relax with a favourite piece of music
* At night, or whenever you sleep, beware of spasms: change positions regularly, adopt resting positions that stretch the joints and muscles, and support the weaker side of your body (with pillows, say)
* Don’t lie in bed for long periods at a time
* Establish a routine that aims to help you regain your handgrip fully and reestablish your foot control
* Rediscover, or find, a purpose for your present life (for instance, get yourself a pet to look after). You may find that you possess a hidden talent
* Allow yourself just a little time to grieve in your own special way, but never ever wallow in self-pity
* Avoid watching upsetting dramas on TV or video: opt for a comedy instead
* Always think about getting better: think it, dream it, plan for recovery and strive for it.

All this can be summed up in three key words: persistence, persistence and persistence.

Harald Gaier is a registered homoeopath, naturopath and osteopath.

The type of contrast agent depends on the imaging process and the tissue being examined. For example, barium sulphate is used with X-rays to inspect the oesophagus, stomach, rectum and colon whereas iodinated (iodine-based) contrast agents are used with CT scans to enhance visibility of the gallbladder, urinary tract, blood vessels, liver and spleen. Non-ionic, iodine-based contrast agents are also available and should be opted for whenever possible, as they have fewer adverse reactions, although their high cost prevents them from being commonplace (Am Fam Physician, 2002; 66: 1229-34). Currently, the only agents approved for use with MRI are chelates containing the element gadolinium.

Are they effective?
There is no doubt that contrast agents increase the effectiveness of MRI and CT scans. With them, pancreatic and liver cancers have a 90 per cent detection rate while multiple sclerosis has detection rate of 95-99 per cent (Radiology, 1991, 178: 447-51).

Indeed, contrast agents are limited mostly by the limitations of the imaging technology. CT scans don’t show the brainstem and cerebellum very well, nor are cancers smaller than 1 cm in diameter likely to be picked up. In contrast, MRI may sometimes reveal too much detail, thus complicating the diagnosis.

The main limitation of contrast agents is that they are likely to dissipate if scanning takes too long a time.

Are they safe?
Not always, and the dangers are often underemphasised. Adverse reactions associated with contrast agents range from the commonly seen mildly uncomfortable symptoms to rarer life-threatening events. The overall frequency of such ill-effects is around 5-8 per cent – with the life-threatening ones comprising about 0.1 per cent (Arch Intern Med, 2001; 161: 15-21).

People with poor kidney function or those taking medication that is potentially damaging to the kidneys are most at risk of a serious adverse reaction to contrast agents. Such individuals are five to 10 times more likely to develop kidney failure than the general population (Am Fam Physician, 2002; 66: 1229-34).

The chances of experiencing a serious adverse reaction increases if you have multiple food allergies, anaemia or low blood pressure, epilepsy, sickle-cell disease, asthma, hayfever, a heart condition or diabetes mellitus (especially if metformin is also being taken). Also, contrast agents of any sort are not recommended for pregnant women, and iodine-based contrast agents should be avoided by those who have thyroid disorders such as hyperthyroidism (Eur Radiol, 2004; 14: 902-7).

Adverse reactions with iodine-based contrast agents include:

* Metallic taste in the mouth, hot sensation of the skin and hives. The symptoms usually pass quickly, but can be uncomfortable.

* Kidney failure. The intravenous administration of contrast material is responsible for 12 per cent of cases of hospital-acquired kidney failure in the US (Ann J Med, 1983; 74: 243-8).

* Anaphylactic reactions, which can occur within minutes of the contrast agents being administered. These include swelling of the throat or other tissues, acute bronchospasm, low blood pressure and severe itching. Such symptoms can arise from the use of as little as 1 mL of contrast (Am Fam Physician, 2002; 66: 1229-34).

* Local tissue damage, such as skin necrosis (death), can result from leakage of contrast fluid from veins.

* Severe lactic acidosis (when lactic acid builds up in the cells and bloodstream, resulting in nausea/vomiting, abdominal pain, difficulty breathing, and severe weakening of arm and leg muscles) has been reported with intravenous contrast agents in diabetics taking metformin (Clin Radiol, 1999; 54: 29-33).

Barium sulphate can cause:

* Delayed reactions, including constipation and flu-like symptoms with fever, chills, nausea/vomiting, abdominal pain and fatigue.

* Hypotension, sepsis (overwhelming infection), disseminated intravascular coagulation (abnormal bloodclotting, tissue damage and abnormal bleeding), and liver problems, from abscesses to deterioration of liver function (Hosp Physician, 2004; March: 26-8).

* Oedema (swelling) and embolism (bloodclots) of the lung (Arch Bronconeumol, 2003; 39: 531-4).

* Suffocation. If barium sulphate is taken orally, there is a small possibility of breathing it in which, in large amounts, can block the airways.

If you must use contrast agents

* Ensure that you drink enough water – 500 mL before taking a contrast agent and 2500 mL in the 24 hours afterwards – to flush the agent from the body.

* Opt for the newer non-ionic, iodine-based contrast agents (in the case of CT scans) and use the lowest dose possible.

* Leave a two- to five-day gap between scans if more than one is required to give the body time to recover.

* Stop taking any drugs that are potentially toxic to the kidneys for at least 24 hours before undergoing the procedure (Am Fam Physician, 2002; 66: 1229-34).

* Stop taking metformin (if you have diabetes) before the procedure and for at least 48 hours afterwards.

Michelle Clare

Reports from the US, where the technique has been tried in private clinics for the last five years or so, reveal that patients are dying or suffering a serious adverse reaction, including pulmonary oedema.

The technique, called rapid anaesthetic-antagonist opiate detoxification, is supposed to put the drug user through the pain of drug withdrawal while he is asleep so that, when he awakes, he no longer has the desire to take drugs.

Despite the dangers, the treatment continues to be used across the USA (Acad Emerg Med, 2002; 9: 63-8).

Candesartan, eprosartan and telmisartan have all been shown to enter breast milk. In fact, most drugs in this class are contraindicated during pregnancy, especially in the second and third trimesters, as they can cause birth defects.

This is a drug that should be prescribed with great care. Its serious side-effects include seizures, bronchospasms, new or worsening ventricular arrhythmias, and an increased risk of death among patients with cardiac arrhythmias that were not previously life-threatening.

But it also comes with a range of lesser side-effects, some of which you have. For example, its common side-effects include both fatigue and insomnia, which explains your disturbed sleeping patterns, and skin rash and other disorders affecting the skin, which could be the cause of your distressing fungal rash, and swollen feet, ankles and legs.

The website http://www.wholehealthmd.com contains the warning that swollen feet, or shaking and trembling in the lower extremities, are serious enough side-effects for you to call your doctor immediately.

Although it seems clear that Tambocor is the cause of most of your debilitating symptoms (other than the sudden weight gain), you should not stop treatment without first consulting your doctor. Nevertheless, your story is yet another example of where doctors either don’t read the drug reference books, or ignore the warnings in them if they do.

Ten cases of pulmonary oedema – where fluid collects in the lungs – have been reported to the UK drug regulators following one of the tests, and three people died from the reaction. In all, it is estimated that 0.04 per cent of these tests can result in a serious reaction, although up to 10 per cent report mild effects, such as a heat sensation.

These reactions came to light when two doctors investigated the safety of the procedure after one of their patients died when she was given iopamidol, a radiopaque contrast medium, before having an X-ray.

The patient, a 72-year-old woman with a history of bladder cancer, was to have a urograph, an X-ray that checks the urinary system, after she found blood in her urine. Doctors at Horton Hospital in Banbury, where she went for the X-ray, said she was in good health and had no allergies.

However, within five minutes of being given the iopamidol, she complained of feeling hot and being unable to breathe. She was taken to the emergency room, where they found that she had acute pulmonary oedema, but she died an hour later (Lancet, 2002; 359: 1037-8).