Врач объяснил причины метеоризма и хруста в шее, а также раскрыл финансовую модель работы семейных врачей

I suffer from a very embarrassing wind problem... what should I do? DR SCURR reveals the little-known condition to blame, how it leads to gas and abnormal bloating and the test you should ask your GP for For the past two years, I have suffered from very bad flatulence, which is embarrassing. I read recently that it could be a sign of something called SIBO. What is that? J. Macey, Salisbury, Wiltshire. Dr Martin Scurr replies: SIBO – or small intestinal bacterial overgrowth – is where too many, or an abnormal mix of, bacteria normally found in the large bowel move into the small bowel. These ferment the carbohydrates from your diet, leading to the formation of gases, including hydrogen, methane and hydrogen sulphide. This causes abnormal bloating and malodorous flatulence. What causes SIBO is not fully understood, but often it is due to another problem (e.g. surgery or illness) that damages the cells involved in gut motility. Apart from SIBO, excess gas can also be due to diverticular disease – which you have, as you say in your longer letter. This is where small pouches form in the colon, usually as a result of age and lack of fibre – any material inside these pouches ferments, causing gas. Your flatulence may even be down to the extra fibre you’ve been advised to consume to combat the constipation caused by diverticular disease. For this reason, I often suggest patients increase intake of fibre – from, for example, bran, grains and vegetables – slowly, over several weeks and months, rather than overnight. SIBO – or small intestinal bacterial overgrowth – sees bacteria normally found in the large bowel move into the small bowel, fermenting carbohydrates and causing gases to form I’d suggest discussing your gas problems with your GP, with a view to being tested for SIBO. This involves having a breath test to measure levels of hydrogen and methane. If SIBO is diagnosed, you may need to see a dietitian for advice (one approach is a low FODMAPs diet – which involves gradually identifying, then eliminating, foods that are not absorbed properly by the small intestine and may cause gas). In exceptional cases, GPs may prescribe antibiotics to reduce bacteria in the intestine. In the meantime, try a more soluble form of fibre, such as psyllium husk. It’s available in health food shops and is better tolerated than, say, wheat bran, because it gets only minimal fermentation by gut bacteria – producing less gas. I have (self-diagnosed) crepitus in my neck – and neck exercises hurt every time. Is this just something to accept at 74, or is there anything that can ease the stiffness and ache? Debra Arnell, Alicante, Spain. Dr Martin Scurr replies: ‘Crepitus’ is the term for crunching, grating or cracking sounds in a joint. In the neck, it’s usually caused by cervical spondylosis – age-related arthritis affecting the small joints between the vertebrae. Small bony spurs (osteophytes) often develop as part of the body’s response to the inflammation in the arthritic joints. The crunching or grating noise is caused by the bones grinding against each other. You don’t mention how much pain you’re experiencing and there is a difference between mild pain during exercise that eases quickly, and constant, more severe pain – the latter is a sign you should see a doctor. Applying heat, such as a hot water bottle wrapped in a towel for 20 minutes, before exercising can help, and taking two 500mg paracetamol tablets at the same time may also ease things. You might also consider the Alexander Technique, a posture-focused approach for improving movement and stance through guided exercises and breathing. It has encouraging evidence for chronic neck pain. It won’t reverse the arthritic changes, but it can reduce muscular tension and improve how you move. An MRI scan is only needed if the pain gets worse, spreads down your arm – or if your hands are becoming less dexterous. These could be a sign that nerves are being irritated and would need to be investigated. You certainly should not just ‘accept’ this discomfort as there are measures you can take to improve matters. In the neck, crepitus is usually caused by cervical spondylosis – age-related arthritis affecting the small joints between the vertebrae In my view... why GPs should work for the NHS Did you know that GPs are not NHS employees? Unlike hospital doctors, each GP practice is a subcontractor to the state, a small business responsible for income and expenditure, contracted to provide services. Each GP is a partner, paid a salary out of the profits of that small business. According to a report from the charity the Health Foundation, a GP practice receives £219 per year per patient, which makes up the bulk of its income – there are 18,000 GP partners in England and 1,000 are paying themselves over £300,000 annually; 4,000 draw more than £200,000. That’s an astonishing amount. Surely, as with any owner-operated small business, there’s an incentive to minimise expenditure to maximise profit? Take the example of the fact that GPs no longer provide out-of-hours care – seven-day and night cover was expensive and reducing it to a five-day daytime-only service inevitably meant that each GP business now has funds for higher salaries. If GPs were employed like hospital consultants we might see a return to out-of-hours cover – as consultants provide. This system must be changed. - 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 worries.