Dr James Le Fanu

Studies have shown that a more condensed approach can work just as well as protracted treatment

Fearfulness in children is a desirable trait. All parents would want their children to possess a healthy fear of railway crossings, strangers with sweets or walking across frozen lakes. Inappropriate fearfulness, however, can be very problematic. This most commonly manifests as the tantrums of separation anxiety prompted by worries that a parent may not return or a refusal to sleep alone. 
More difficult to explain, and of considerable psychological interest, are phobias. Here proximity to (or even thinking about) dogs or spiders or potentially threatening situations – heights, confined spaces – invokes panic, crying and trembling impervious to adult reassurance.
These phobias are remarkably stratified by age – in preschool children, the most common are the dark, animals or insects. For older children their imagination broadens the range to include the supernatural of ghosts and monsters. 
For most, phobias tend to peter out after a couple of years but if not – and if they are associated with excessive avoidance rituals – then a gradual process of desensitisation to the feared object or situation is commended. This can however be time consuming, the sessions stretching over months with consequently a high dropout rate. 
Lockdown rendered this form of therapy impossible, prompting those offering it to experiment with a different approach – a single protracted session of four hours including both assessment and treatment. The outcomes have recently been evaluated and, if surprisingly, this condensed format of a single session turns out to be similarly ‘clinically efficacious’  with obvious implications for other prolonged forms of psychotherapy.   
The muscles of facial expression are “fascinating”, noted the distinguished Victorian anatomist Sir Charles Bell, not least in their ability to convey “both the gentlest emotions of the spirit and lowest pleasures of the body”. Hence his interest in the paralysis that carries his name, Bell’s palsy, whose sudden lopsided appearance causes much distress to those afflicted. While this tends to resolve completely within a few months, in some it does not so the (disputed) issue of its optimal treatment is important.
Bell’s palsy has long been attributed to a viral infection of the facial nerve as it passes through the middle ear causing it to become swollen and inflamed. Thus logically a combination of high dose steroids to reduce the inflammation together with an antiviral drug such as (acyclovir) should hasten recovery – as indeed it does.
But the evidence for a viral cause is equivocal and since a major review four years ago of the relevant trials it is now advised that a course of high dose steroids alone is sufficient. Not so, argue neurologists at South Korea’s Kyung Hee University Hospital who have treated almost two thousand patients with Bell’s palsy over the last 20 years. They report that in severely affected patients over the age of 40, antivirals offer a definite advantage boosting the likelihood of their full recovery to over 80 per cent.   
The additional merits of massaging the paralysed muscles is illustrated by the experience of a family doctor with the misfortune to have had two attacks of Bell’s palsy – on either side – in just three years. The first time round, it took almost four months to recover, despite the steroids. So during the second episode he also massaged the affected muscles several times a day, and his lopsided appearance resolved within just four weeks.
The gentleman troubled by “burningly cold” legs’ has prompted a retired anaesthetist to report likewise. This proved to be caused by impaired functioning of the sensory nerves (peripheral neuropathy). Magnesium and vitamin supplements, he finds, provides some relief as does holidaying in the tropics.
More prosaic explanations should not be overlooked, as for a reader whose legs became icy cold when watching television in the evening. “Placing a thermometer at ankle level I realised I was sitting in a ‘door to window’ draught line which at 12C was considerably lower than the room’s ambient temperature.”
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