Sunday 28 May 2017

Dear Dr Nina: I have become very clumsy of late. Should I worry?

Clumsiness can be a sign of stress
Clumsiness can be a sign of stress

Nina Byrnes

I am a man in my late 40s. In the last four to six months, I notice that I have become unusually clumsy - I have knocked glasses over on many occasions, and dropped my phone and other objects with a regularity which is just not typical for me. Throughout most of my life, I have been quite dexterous: my hobbies have included fly tying for fishing, which involves a high degree of precision with small objects. While I know people who are constantly knocking things over and dropping things, I have always had a good sense of spatial awareness. Is this something that comes with getting older or could there be an underlying condition causing this which I might have to get checked out?

A We can all be clumsy from time to time but if you suddenly find yourself lacking co-ordination on a regular basis, it is worth exploring. Co-ordination is a complex process involving input from the eyes travelling to the brain, which sends messages to our various muscles, bones and nerves. Disruption anywhere along this pathway can have a significant impact.

Common culprits include poor vision, strokes, brain or head injury, muscle damage and weakness, arthritis or joint problems, inactivity, infection or illness, drugs and alcohol and, of course, stress or fatigue.

A sudden change in co-ordination may suggest a localised stroke. This is a medical emergency. Brain tissue starts to die at a rate of up to two million brain cells a minute if the blood supply is reduced or cut off. Strokes are most common in those over 60 but can occur at any age, even in children.

Recognising the signs and acting fast can reduce the chance of long-term brain damage and disability. The acronym FAST is used to draw attention to the signs of a stroke and to stress the importance of seeking urgent medical help. 'F' stands for 'face': has the face fallen to one side and can the person smile? 'A' stands for 'arms': can they raise both arms above their head and keep them there? 'S' stands for 'speech': is the person's speech slurred? Finally, 'T' stands for 'time'. Other less classic signs of stroke can include confusion, loss of balance or dizziness, blurring or loss of vision and sudden headache. If blood-thinning medication is given early (within 3-4 hours) in the case of a clot, permanent paralysis or nerve damage may be avoided. Strokes due to a bleed are more difficult to treat.

The risk factors for stroke include a family history of stroke, high blood pressure, heart disease, diabetes, obesity, high cholesterol, smoking and excess alcohol intake. They are very similar to those for other heart and vascular disorders.

Stroke can cause temporary or permanent disability. Unfortunately, in some cases, permanent disability remains. Stroke kills more people each year than breast, lung and bowel cancer combined. Of those who survive, 65pc will make a reasonable recovery. Prevention is best but every minute counts. If you think someone you know is having a stroke, call an ambulance. Don't delay.

If clumsiness onset occurs more gradually but is consistent, other types of brain injury, tumour or illness should be considered.

Your GP can do a full neurological exam and refer you for a brain scan or to see a specialist as appropriate. Clumsiness associated with forgetfulness can be a sign of stress, especially if it is worse in stressful situations. These symptoms, without any obvious link, much more rarely can be a sign of early-onset Alzheimer's.

If no sinister or serious cause is found, it may simply be that the co-ordination between your eyes, brain and musculoskeletal system is not what it should be.

There are physiotherapists who can prescribe specific exercises to improve your eye-muscle co-ordination. In this instance, exercise and a healthy, toned muscle system can improve the situation greatly.

Q My toddler sounds very nasal and when she tries to say 's', the sound seems to come  from her nose. Is there something wrong with her? 

A It sounds as if she may have enlarged adenoids. Adenoids are lymph tissue, similar to tonsils, but are located high at the top of the throat behind the nose. Unlike tonsils, they are not visible on an examination of the mouth. Adenoids, like tonsils, help our bodies fight infection. They are very active early in life and can become quite enlarged. They usually start to shrink from about five years of age, almost disappearing by the teen years. Enlarged adenoids can cause a nasal tone to the voice. Other symptoms may include mouth breathing - leading to a dry mouth and cracked lips - along with snoring, noisy breathing or restless sleep. Those with large adenoids may also get recurrent ear infections or glue ear.

It is worth getting a check-up with your GP. Large adenoids causing glue ear may lead to reduced hearing, which can have a knock-on effect on speech development. A hearing test can assess this. An X-ray of the nasal area and neck may show enlarged adenoids.

In milder conditions, the GP may prescribe antibiotics and nasal drops to help clear any infection and allow the adenoids to shrink. If symptoms are recurrent or not settling, though, or if there is associated sleep apnoea (pausing of breathing in sleep), it is likely that you will be referred to an ear, nose and throat (ENT) specialist, who can confirm the diagnosis. In this instance surgery may be required. The adenoids are removed through the mouth and no scarring results. It is usually performed as a day case procedure. General anaesthetic is required but thankfully complications are rare.

Rarely, nasal speech is not associated with a medical cause. Speech and language therapy can be helpful to improve speech in this instance.

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