Casebook
After listening to a radio interview I am convinced that I have had narcolepsy since childhood. It gave me a crippling complex, added to which I couldn’t play sport, knit or sew or do maths or make relationships easily. Medical books suggested an underactive thyroid, though I didn’t have all the symptoms. I now realise this wasn’t the correct diagnosis. I am retired and realise it is too late to do anything about it, but would like to think this condition could not now go unrecognised for almost a lifetime.
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Narcolepsy causes a sudden and sometimes irresistible urge to fall asleep. People with narcolepsy also sometimes get cataplexy, which causes sudden loss of muscle tone and collapse. A chemical in the brain - orexin - is deficient in people with narcolepsy. There are some drug treatments to help narcoleptics stay awake, but none of them completely solves the problem. The condition is undoubtedly under-diagnosed, and some people who are excessively tired during the day may in fact be suffering from a mild form of narcolepsy. There is a UK support group - the Narcolepsy Association UK - with a website that contains lots of good information and advice: www.narcolepsy.org.uk.
You recently tried to answer a question about grapefruit and simvastatin, but in my opinion you evaded the question. The questioner asked whether half a grapefruit each morning can cause a problem, but you only offered the same old response about a glass of grapefruit juice being potentially harmful. The manufacturers of simvastatin feel obliged to warn against this. Please address yourself to the question: can half a grapefruit each morning cause problems for someone who is taking simvastatin?
To answer this question properly, I bought a medium-sized (300g) grapefruit. I squeezed all the juice out of half of it, producing 70ml of juice. The original research into grapefruit juice and simvastatin looked at the effect of 200ml of grapefruit juice. The juice from half a grapefruit is about one-third of this amount. Even this amount will cause some people problems. The effect of each dose of grapefruit juice lasts for several days, so if you have half a grapefruit every morning the effect accumulates. My advice is to stick to oranges and orange juice if you are taking statins.
Please send your questions and suggestions to A Question of Health, ‘The Independent’, Independent House, 191 Marsh Wall, London E14 9RS; fax 020-7005 2182 or email to health@independent.co.uk. Dr Kavalier regrets that he is unable to respond personally to questions.
Readers write
JH from Cambridge and GM from Wales have the same query: How do you find a good urologist?
A good starting point is your GP. GPs have a lot of experience of local specialists, and if you ask to be referred to someone who is sensible, wise and experienced, most GPs will be happy to oblige.
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