My wife has suffered from a persistent cough over the past 12 months, which has got worse – occasionally leading to her almost choking and regularly disturbing her sleep. She says it’s as if there is a sensitive spot at the back of her throat which reacts to food, drink, saliva and even the simple act of bending forward. She’s seen various consultants and an endoscopy identified a hiatus hernia, but this isn’t the cause of the cough. No treatment has been offered.Mike Rice, Lincoln.Dr Martin Scurr replies: It appears your wife’s symptoms have been carefully and thoroughly investigated, but the lack of a definite diagnosis is clearly worrying you. A hiatus hernia – where the top of the stomach protrudes through the diaphragm – often causes acid reflux and, in turn, coughing. However, as you say, this has been ruled out.This leads me to wonder whether your wife’s problems are due to age-related changes in the neck – specifically the formation of bony growths on the front of the neck bones (typically as a result of arthritis).These bone spurs, called anterior cervical osteophytes, jut into the back of the throat and could be irritating that area, triggering severe coughing fits (or coughing when swallowing, or coughing and choking at night, and even a sensation of food getting stuck) as well as disturbing sleep.Less commonly, a slipped disc in the neck can sometimes cause similar symptoms.The fact that your wife’s coughing can be triggered by simply leaning forwards suggests physical changes in the neck are the key here, although this would need to be confirmed with an X-ray of the neck taken from the side, possibly followed by a CT scan.If this was confirmed, speech and swallowing therapy would be the first treatment and can be very effective. Surgery is occasionally needed, depending on the severity; this can be particularly important for patients who are accidentally inhaling food or drink into their lungs when they swallow. The reader's wife has seen various consultants and an endoscopy identified a hiatus hernia, but this isn’t the cause of the cough (picture posed by model)A year ago I had a ‘funny episode’ – pounding heart, aching chest. I went to A&E but all the tests were normal, although I was put on amlodipine for high blood pressure. Now I’m tired, breathless, with a burning tongue, palpitations, indigestion, occasional twinges above my left breast, pins and needles in my arm and weight piling on.I’m in my early 60s and have always been big but fit. I won’t go to the doctor as I’m so scared. I’ve always been tough as old boots, but now I feel like everything is going downhill.Name and address supplied.Dr Martin Scurr replies: My great concern is that your anxiety, your fears about your health, might stand in the way of you getting the further investigation you need. In your early 60s there is still everything to live for and a correct diagnosis and suitable further preventive treatment will be transformative.You mention in your longer letter confiding in a friend who said you must see a GP. I agree. Talk to your GP, or perhaps take a nurse at the practice into your confidence.I’d suggest asking your friend to go with you to provide the security and confidence you need.Explain that following a reasonable year after starting on the amlodipine, you’re now experiencing the cascade of symptoms you describe, and tell them of your great concern about a potential diagnosis.It will take some courage and that kind of support, but hopefully you will be referred for an immediate cardiac assessment – and the correct, detailed investigations.In my view... Is this why so many of us eat too much? On the London Tube recently I noticed an advert – for one of the biggest drug companies in the world – stating that obesity is a complex disease influenced by many factors, and that if you’re one of those affected, it’s not your fault.I agree: in my view weight gain is a disease of appetite, not a matter of willpower.Somehow the natural mechanisms that regulate our hunger have been undermined; something in the world we live in today has disrupted them.Appetite is controlled by the hypothalamus, a small area in the brain that also regulates thirst, body temperature, sleep, sexual behaviour and drives many hormones. This area is also closely linked to the limbic system, a hub for emotions, the feelings of reward and pleasure and motivation.While it’s good we now have drugs that can effectively suppress appetite, the real prize is in prevention – finding what it is that’s got into us this mess.Some experts point to the effect of ultra-processed foods, and if I was a betting man, I’d be backing that horse. Watch this space.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 health concerns.