Tag Archives: Chronic Conditions

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #46: COCCYDYNIA

Pain is the hallmark of Coccydynia (Tailbone Pain). The word can be divided into two parts; the first, coccy, refers to the triangular structure itself, which sits at the bottom of the vertebral column, and comes from the Greek word for ”cuckoo”. I previously thought it translated as “tail”. The second part of the word, -“dynia” translates as “pain”, which is much more appropriate.

The coccyx, or tailbone, is one of those useless vestiges of evolution, joining ranks with the appendix and paranasal sinuses. It sits just above the gluteal cleft on your backside, and  is the conjunction of four or five boney segments which are either fused, or joined by a variety of bony, cartilaginous or fibrous unions.

If these unions are damaged, irritated, or fractured, PAIN can result.
The attached muscles, the anus in front, and the buttocks(gluteus maximus) in back, account for some of the activities that can cause pain when the coccyx is disordered.

The main causes of coccydynia are falling on your backside, sports has bicycling, especially on irregular surfaces, or childbirth, which requires mobilization of the coccyx in order for the baby to exit.

One of my friends recently developed coccydynia from riding for several hours on a very bumpy dirt pathway. She has had the pain for two or three weeks now, has pain while sitting & upon getting up, but can walk without pain. Sleeping, especially on her side, causes no problems.

Ibuprofen affords temporary relief, but she likes to avoid taking it regularly because of side effects. Most people with coccydynia will recover after a few weeks, or occasionally a few months, and will be sufficiently impressed to avoid the causative activities.

If the pain persists for a long time or prevents normal activities, you should visit the doctor for diagnostic tests.

Please refer to the article by the Cleveland clinic for more information.

—Dr. C.

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THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #44: SYPHILIS (STD)

Syphilis is a venereal disease, or STD, that is unusual,  unique in many ways. First of all, it is one of the few major diseases to have originated in the Americas, the New World, and carried back to Europe most likely by Columbus; Popularized by “guns germs and steel”, the infectious disease traffic was almost all the other way, most famously smallpox which decimated the Native Americans.

A second unusual characteristic is that it’s treatment(penicillin) is known, cheap, easy, and yet Syphillis infects millions of people yearly, most commonly to be sure in the developing world, but also large numbers in America where is helped by AIDS, and spread by men having sex with men.

A third unusual characteristic  is that syphilis can mimic practically any disease. There are three stages.  The first stage is a painless ulcer, usually on the genitals.  After a few weeks, the second stage develops, showing a widespread rash and other symptoms.  After a few more months, problems develop in the heart, brain, or growths ( gummas) in many other areas .

When I was in medical school we used to go to an old peoples home to listen for aortic regurgitation, and observe the neurologic symptoms of syphilis patients. Syphilis is still a cause of aortic  insufficiency, if untreated.

Treponema pallidum, The causative agent, is also unusual. It has a very small geome, and has many missing cellular mechanisms, making it dependent upon Homo sapiens, it’s only known Reservoir. The fragile but very active organism will die in a few hours outside of its human host. Like it’s confederate,AIDS, The infection can easily spread from mother to child with devastating consequences. It is one of the major diseases for which pregnant mothers are tested.

Syphilis is one of the best arguments for being monogamous. If this can’t be, remember that syphilis is easily treatable, and that you should report any unusual illnesses to your doctor.

—Dr. C

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #40: HYPOTHYROIDISM

Hypothyroidism is a very common hormonal deficiency where there is an insufficient amount of thyroid hormone, T4. The thyroid gland regulates your metabolic activity. If you have insufficient thyroid hormone, everything seems to slow down; Your energy level, your muscle strength, your heart rate, your brain activity, and even your intestinal activity are all slower.

The causes of thyroid hypothyroidism. Infographics. Vector illustration on isolated background

One of my habits in practice was to check the size of the thyroid, which is an H shaped gland astride the windpipe beneath the voice box. It becomes enlarged in a condition known as Hashimoto’s thyroiditis, the most common cause of adult hypothyroidism.

As you recall from the last posting, when the thyroid function is low, the brain causes a release of TSH, which stimulates the thyroid gland. In order to produce more thyroid hormone, the gland enlarges and the examining physician can feel it.

Babies can be born without a thyroid. I had one such patient when I was in training. The baby was inexplicably limp, and did not cry vigorously like other babies. When given thyroid hormone, she developed normally. Such babies often go undetected, don’t grow and become mentally deficient.

The thyroid gland produces thyroxine, which is T4.  In the tissues, the T4 is converted into the much more active T3. This is often the medication of choice in hypothyroidism. In giving thyroid Hormonal, the physician must adjust the dose, depending on the patients  response. Only after a number of visits is the proper dose found.

Please refer to the Mayo clinic article on hypothyroidism. The use of the TSH as a blood test is also discussed.

—Dr. C.

Mayo Clinic Article

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #38: HEMATURIA

Pink urine! You can imagine my shock. What could it be? I exercise more than 1½ hours a day. Could it be myoglobin? I put beets in my daily osterizer “shake”: could the color be from the anthocyanins from beets?

I took a urine specimen to the lab, and the color turned out to be from Hemoglobin, the most likely cause all along. There were lots of red blood cells in my urine and the test strip was strongly positive for Hemoglobin. I called a urologist, who said I needed a Urine culture for infection, and a “CT Urogram”, to check for cancer, kidney stones and other problems.

You should always check with your doctor with Hematuria, and I am no exception. My Urology appointment was in 1 week. I got a urine culture, Cell cytology (for cancer), a CT Urogram, and a urine culture before the visit. I wanted to save time by scheduling a Cystoscopy at the time of the first visit, but couldn’t arrange it.

I went for the appointment. They took a blood pressure, but didn’t check my urine, which I thought was negligent. I had been regularly checking my urine for blood by a test strip, and it was negative. The appointment lasted only minutes. My old urologist always checked my urine on every visit, regardless of whether it was a regular check or to consult for a problem. If I were a Urologist, you can be sure I would have my microscope ready, have the nurse collect the urine, spin it down, and put the sediment under the microscope for me to check.

When I was in medical practice as an allergist, I would have my nurse check any sputum the patient produced smeared on a slide, stained and dried. Microscopic examination of urine and sputum takes only seconds and yields lots of information. In my opinion, 50 years of Insurance surveillance and governmental regulations, including restrictions on lab work done in the doctor’s office and Hippa privacy laws, have handicapped Doctors and are partly responsible for the costly, dysfunctional system that is modern medicine.

Sorry for the Sermons. Visible blood in the urine-Gross Hematuria- requires that you see your Doctor and find the cause of that blood. Please see the 2 appended Mayo Clinic articles for more detail.

–Dr. C.

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #37: EYE IRRITATION

‘Something is in my eye” is a feeling that everyone has had, and it doesn’t take much to create that sensation. A speck of dust, a grain of sand, a gnat or an ill-behaved eyelash will do it. Most of the time your eye will tear up and the offender is washed away.

As I get older, this sensation is more frequent. I look at my eyes in the mirror, and there is no one-sided redness, displaced lash or anything else I can see. When I saw the doctor for my cataract surgery a couple of years ago, he took a sample of my tears, and found a deficit in the fatty component. He recommended twice daily, five minute warming of my eyes, but I stopped doing it after a while.

I have so many picky little things I do that this extra time didn’t see worth it. I know that my eyes are dry, which is common in older people, and often use “Refresh-plus” individual, preservative-free ampoules, which seems definitely worth the trouble. It makes my eyes feel better, alleviates the gritty sensation, and even clarifies my vision. I have also resumed warming my eyes with a clean washcloth, moistened with hot water, when I take my shower.

I fancy that I am stimulating my meibomian glands like the eye surgeon intended, to increase the lipid content of my tears. I’ll keep you posted. There are a number of other disorders which can cause the eye symptom, as the accompanying article indicates. Be sure that if the discomfort is more than trivial, or the affected eye is red, or if vision is affected, that you consult your eye doctor, or at least your primary care Physician.

Dr. C.

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THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #31: COLD SORES

“Fever Blisters”, or “Cold sores” are caused by infection, almost always, with the Herpes Simplex 1 virus. Herpesvirus infestations are present in 50% of the population, usually causing little disturbance. The symptoms on first exposure depend on the Age the virus is first acquired.

NEONATAL Herpes can be extremely serious, due to the immaturity of the infant immune system. Herpes acquired in CHILDHOOD, or Primary herpetic Gingivostomatitis, can cause very dramatic FEVER, with blisters in the mouth, that lasts for a week to 10 days, causing lots of misery and hand-wringing but having a good outcome.

I had one such case early in my pediatric residency at Walter Reed Army Hospital, a young French boy named Didier Dupont. He screamed with pain, and wouldn’t eat or drink. His parents thought that he was going to die, and that I saved his life, neither of which was true. My roommate and I lived in the same housing complex as the Duponts, and enjoyed many fine french meals with them, one of the few positive events to result from an encounter with Herpes Viruses.

The first acquaintance with Herpes in ADULTHOOD produces outcomes ranging from no symptoms at all, to a flu like syndrome with mouth blisters. Many people have positive blood tests for herpes, but cannot recall any mucosal burning, blisters or pain, so Herpes can enter the body without producing memorable symptoms.

The Herpes 1 Virus gains entrance to the body through the lining of the lips, mouth or nose(or through broken skin), and travels up the local nerves to the cell body in the local Trigeminal ganglion. There it remains quietly, until some STRESS reduces the resistance, allowing it to awaken and travel back down the nerves to the “mucocutaneous junction”, where the skin thins out into the lining of the nose, mouth, or occasionally the eyes.

There it multiplies and forms painful blisters, or “cold sores”. Sunburning of the lips, a “cold”, or psychological strain are examples of the stresses that can trigger cold sores. Reduced resistance is the common factor.

The Acyclovir family of drugs is usually effective in treatment, and works by inhibiting DNA Polymerase. These oral medications can be given to curtail each episode, if cold sores are infrequent, or continuously to reduce the number of outbreaks.

Herpes 1 is a double stranded DNA Virus in a family that includes Herpes 2, Chickenpox, the EB virus of mononucleosis fame, and Cytomegalovirus, which is the bane of organ transplant recipients. A nasty Clan indeed, and very successful in evolutionary terms.

–Dr. C.

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #30: ACNE (Vulgaris)

ACNE is almost a rite of passage in adolescents, although it is not totally restricted to the teen years; women may experience acne during pregnancy, or at the time of menopause. It afflicts about 90% of kids during their PUBERTAL growth spurt, though is moderate or severe in only 15%.

Acne is caused by PLUGGING of the sebaceous glands of the skin. Infection by certain skin BACTERIA follows. Check the accompanying video for a description of the battle between the “Good guys”, Staph epidermidis and Cutibacterium acnes, vs. the bad guy, Proprionibactrium
acnes.

Acne tends to run in families. The steroid HORMONES like Testosterone and Cortisone promote Acne. STRESS tends to chronically raise Cortisol and is a factor in Acne, and many chronic illnesses as well.

A person who is having trouble with Acne should avoid sweets and greasy foods, which is a good idea for everybody. Skin cleansers, using salicylic or azelaic acids and benzoyl peroxide may help, and creams containing retinoic acid derivatives may be useful..

The doctor may prescribe an antibiotic like tetracycline in resistant cases. Cystic acne may be scarring, but otherwise “the zits” depart with the pubertal years.

–Dr. C.

Further reading at Mayo Clinic

THE DOCTORS 101 CHRONIC SYMPTOMS AND CONDITIONS #28: CERVICAL POLYPS

Cervical polyps are fairly common, particularly in young women who have had children. They are rare before periods start, and uncommon after menopause. Polyps are often silent, without symptoms.

Polyps are often silent, without symptoms. Polyps are often associated with INFLAMMATION, and may be discovered because of vaginal DISCHARGE. They may bleed and betray themselves by heavy periods, or BLEEDING between periods.

My Daughter, a Student Health Physician, recently saw a patient who presented with a foul discharge and examination revealed a large polyp. A blood count showed a severe ANEMIA.

Although cancer is rare, the polyp should be biopsied or removed and examined to be sure there is no malignancy. Cervical Polyps are often discovered on a routine Physical Examination. Preventative Physical and Vaginal examinations in young women are important to check for such conditions as Polyps, do PAP smears, and, in sexually active women, screen for STDs.

–Dr. C.

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THE DOCTORS 101 CHRONIC SYMPTOMS AND CONDITIONS #26: HYPERTENSION

Hypertension places an extra load on the blood vessels and heart, and eventually causes them to become diseased. High Blood Pressure is therefore bad for the entire body, which depends on the blood vessels for delivering the nutrients and oxygen necessary for life.

Most hypertension happens from subtle changes in the body’s signalling systems, and often runs in families; This is called “essential hypertension”. Additionally, there are a number of diseases and conditions of which hypertension is a symptom. It is important to know if you have hypertension, and fortunately it is easy to discover.

A visit to the doctor, or even to the pharmacy will make a reading available, and if you are concerned, an automatic cuff is available for $20. A healthy lifestyle and weight Will help prevent and treat hypertension, as in so many other chronic conditions.

A variety of medications are available to treat hypertension, but ANY MEDICATION CAN PRODUCE SIDE EFFECTS. It is rare for an effective medication to produce only a single, desired effect on the body. I have never known a person who at some time did not experience some side effect from antihypertensive medications.

Be sure to maintain contact with your Doctor. The dose may be too high, causing episodes of LOW blood pressure with fainting. When I was in practice, any number of patients came to me with a chronic cough, which I “cured” by having their doctor replace their ACE Inhibitor with another medication.

Please read the accompanying Mayo Clinic article for a complete discussion of this important condition.

–Dr. C.

Mayo Clinic article

THE DOCTORS 101 CHRONIC SYMPTOMS AND CONDITIONS #24: CONSTIPATION

One of my previous posts, “bad breath”, was so well received that I am emboldened to deal briefly with another important, if politically incorrect, topic; Constipation.

I have anemia, and take regular IRON, which produces constipation. A high fiber diet solved it. My bones have also been thinning over the years into Osteopenia, a deficiency of Calcium. I Increased my calcium intake with some CALCIUM citrate powder, and developed one of the worst episodes of Constipation I have ever had, in spite of my high fiber diet.

Stopping the Calcium leaves me with the osteopenia worry, but was a great relief. Many other medications can cause constipation. Ask your Pharmacist for a list.` Hypothyroidism, and a variety of autoimmune, intestinal and neurological conditions have constipation as a symptom.

As I struggled with something that should be automatic, I worried about possibly pushing out a hernia, ballooning out one of my colonic diverticula, or developing hemorrhoids. These are all complications of constipation, not to mention the big waste of time. Regularity is much to be desired.

If you have regular SLEEP and EXERCISE a low Calorie density, high fiber diet, and are not taking a lot of drugs and supplements, you most likely don’t have constipation. If you have constipation, you might consider examining your sleep, diet, exercise and medications. If you don’t want to change your habits and medication, try METAMUCIL and drink lots of WATER.

–Dr. C.

Read more from Mayo Clinic