Tag Archives: The Doctors 101 Chronic Symptoms & 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 #45: SLEEP APNEA

Sleep apnea and obesity are bound together as Charles dickens observed in his Pickwick papers. The Pickwickian syndrome is obesity associated with alveolar hypoventilation(insufficient breathing) with an increase in CO2 in the bloodstream which causes narcosis, or SLEEPINESS, in the daytime.

When I went in for my sleep apnea study, I noticed a number of double wide chairs available for the usual clientele there. OBESITY is one of the major risk factors for sleep apnea. Depositions at the base of the tongue and throat interfere with breathing, and causes snoring to the point of tracheal blockage and apnea at night.

Some people with normal “ BMI”, have sleep apnea. Sleep apnea can run in families, occur when you are older, or have a thick neck. So no matter what your weight, if you have daytime sleepiness after an apparently full night of sleep, you should be considered for a sleep study.

A SLEEP STUDY requires that you go into a sleep center overnight, get hooked up to an electroencephalogram machine, oxygen monitor, chest straps, and the like. This is the gold standard for a diagnosis of sleep apnea, but a recording pulse oximeter will let you know a lot less expensively if you have the critical problem, a drop in oxygen saturation. The type of sleep apnea I have been discussing so far is obstructive sleep apnea. Of course there are other types such as central, or complex sleep apnea.

Most sleep apnea responds to nasal CPAP, if you can tolerate it.
My own sleep apnea was diagnosed as moderate, 15% central and 85%  obstructive in type.  I have a stuffy nose which I believe to be the main problem setting me up for sleep apnea, and I could not tolerate the positive nasal CPAP. There is also a dental apparatus that I tried unsuccessfully. I wound up sleeping on my side, and propping myself in that position with pillows .This seems to help me, but I still wake up several times a night, usually at the end of a 90 minute sleep cycle, and with a full bladder.

I sleep through better on days when I have had more physical or mental exercise. Avoiding a full stomach at bedtime is also helpful with both sleep apnea and GERD.

I do use Afrin on the left side of my nose, which is more obstructed. I restrict the use to every third day, although I have heard that you can use it every other day, alternating sides, if you have a stuffy nose that has resisted other treatments .I have also heard that using corticosteroid nasal sprays makes Afrin better tolerated. Be sure to get clearance with your doctor before trying this.

— Dr. C

Read more at Mayo Clinic

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 #43: CELIAC DISEASE

Celiac disease – I know of no disease more rare that is a fixation for more people. Practically everything I see in the processed food area advertises itself as being gluten free, yet celiac disease affects about only one in 100 people.  Even the dogs that I see on my walk are claimed by their owner to be on a gluten restricted diet.

Celiac disease-it’s hard to imagine a more complicated and variable disease. Although Coeliac Disease runs in families with HLA-DQ2 and HLA-DQ8, having these markers is not alone sufficient to cause Coeliac Disease. Eating gluten is not even sufficient, but requires an enzymatic change via tTG2 to make gluten fire up the immune system. Testing  for an antibody to tTG2 is one of the better tests for celiac disease, and a drug that blocks tTG2 has recently proven helpful as a treatment for celiac disease.

CD often starts in young children, but the disease can begin at any age. Although gastrointestinal symptoms such as diarrhea or constipation, bloating, and bulky, oily stools are typical, even clear-cut cases may have no recognized symptoms at all. In other cases almost any organ can be involved, or the symptoms can be non-specific such as Weight loss, anemia and fatigue.

it is estimated that only about 10% of people with celiac disease are ever proven to have the diagnosis. It Is massively under diagnosed in spite of permeating the popular lore.

A lot of people place themselves on a gluten-free diet and  claim to feel better, but being on a gluten-free diet makes the diagnosis difficult to make; if celiac disease is seriously suspected, the doctor will place the patient on a gluten-containing diet which allows the tests, such as  anti-t-TG2, or villous atrophy of the small bowel to become positive.

Among people who actually have real, valid, proven celiac disease, who have every reason to want to restrict gluten to improve their Disease, 40% of them have great difficulty in adhering to the necessarily draconian gluten free diet.

Even the doctors can have a blind eye to celiac disease, since it is quite rare. A good friend of mine with chronic bloating went to a gastroenterologist who declared her free of disease, without having ruled out celiac disease. One would think that a gastroenterologist  would be tuned in to coeliac disease, given the prominence of gastrointestinal symptoms and pathology.

The patient should be her own advocate.

—Dr. C

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THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #42: HIP JOINT PAIN

Hip pain is a very common condition as one gets older, though it can also occur in younger people. The most common cause of hip pain is OSTEOARTHRITIS , a condition that I discussed a little more than a year ago, mainly in the context of pain in the joints of the hand:  press the search button and type in “osteoarthritis”. I think you’ll enjoy reading it, as I did upon rereading.

Large joint arthritis seems to be a different animal as compared to small joint arthritis, to which I can personally attest; I have had significant arthritis in the joints of my hand and somewhat in my feet for a long time now, while I am fortunate enough not to have any problem with my hips or knees. It may be a coincidence, but I have been taking glucosamine and chondroitin  for sometime now.

It is also of interest that I have stood without sitting down in much of my medical career, and I have continued walking for exercise 1 to 1 1/2 hours a day. This would be against the idea that it is only ordinary wear and tear on the joints that determine the loss of articular cartilage so characteristic of osteoarthritis.

Unusual wear and tear, such as in football, soccer and Long term running on a hard surface, is a different matter, however. Pain in the groin is the most characteristic location for hip-joint arthritis. Pain in the side of the hip joint may be trochanteric bursitis, and that in the buttocks area could be from the nerve root compression of sciatica. Knee pain can refer to the hip. Rheumatoid arthritis, and even rheumatic fever in younger people can also cause hip inflammation and pain.

Sports injuries and falls can cause a hip fracture or a tear in the hip labrum that can declare as pain, but here’s the problem is more about how to treat it, rather than the diagnosis. As you get older, remember to take your calcium and vitamin D to prevent osteoporosis, and maintain your muscle strength and balance to prevent falls. Please type in “falls” for a discussion on how to prevent this often devastating problem in the elderly.

The hip joint can actually get infected with a septic arthritis, which is more typical of younger individuals, and those with immune deficiency. Cancer and infection of the hip bone can also be quite painful. The hip bone can suffer a loss of arterial supply, causing avascular necrosis in the process. Adolescents can get a slipped epiphysis.

When hip pain interferes with your exercise routine and ordinary life activities, it is time to check with the doctor to see what is going on and what can be done about it. If you have not already decided upon surgery, I would suggest a family practitioner or internist as your first stop.

Please refer to the mayo clinic article for more information.

—Dr. C.

Read Mayo Clinic article

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #41: COCCIDIOIDOMYCOSIS

Coccidioidomycosis, also called Valley Fever, is a silent epidemic in the western hemisphere between 40° north and 40° south. Hot summers and mild winters with an annual rainfall of 10 to 50 cm is typical.

The Fungus grows in the soil that is moist, but the soil must dry out and Be disturbed, such as  by digging, and the wind speed must pick up before you can get the arthrospores into the air so that they can be taken into the lungs.

Most infected people have minimal symptoms. Among those infected, some get a fever and a cough and recover promptly. 3 to 5% of individuals develop a chronic infection. Infected patients with a weak immune system can have disseminated coccidiomycosis affecting virtually any tissue in the body.

Notable coccidiomycosis symptoms include a profound feeling of tiredness, fever, cough, headaches, rash, muscle and joint pain. A loss of the sense of smell is also described, raising some confusion with COVID-19.

Coccidiomycosis can cause a characteristic painful bump in front of the lower leg called erythema nodosum. People with a combination fever, joint pain, and erythema nodosum are said to have “desert rheumatism”.
20% of community acquired pneumonia can be due to coccidiomycosis in endemic areas such as Phoenix Arizona and the San Joaquin Valley.

Immunizations have been evaluated for cost-effectiveness, and the results were not encouraging. More recently, A modification of the coccidiomycosis genome which prevents growth and multiplication of the spore has been tried as a vaccine in mice and found effective.

It is planned to try this noninfectious spore on dogs, who are also very susceptible to the disease. Dogs are a good choice because Government  restrictions and requirements are not so severe, and because people would do almost anything to protect their animals, promising a good market for the vaccine.

A year ago last spring, my brother had a protracted problem which involves his lungs and even his heart, and was admitted to a hospital in Phoenix. Apparently COVID-19 was ruled out, and Coccidiomycosis was diagnosed. The Doctors declined to give him amphotericin or an Azole, the  usual treatments. He recovered, was discharged, and currently is doing well with no residual symptoms.

I was planning to visit him last spring, but I’m glad I stayed home; our immune system‘s are too similar.

–Dr. C

Mayo Clinic article

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 #33: The Common Cold’

The common cold is one of the most frequent of human diseases, and causes billions of dollars in lost work yearly. I haven’t heard of many cases of colds or flu recently, in the Era of Covid.

Distancing, mask wearing, and hand washing prevents colds too. The common cold spreads by AEROSOL transmission, and autoinnoculation into the nose from contaminated surfaces, just like Covid.

By far the most common cause of the Common Cold is the RHINOVIRUS, of which there are 100 serotypes. Coronaviruses, Influenza, Parainfluenza, RSV and enteroviruses also produce cold-like symptoms. The large number of viruses causing the Common cold makes developing an effective vaccine difficult.

Adults eventually encounter most of the serotypes prevalent in their community, and don’t catch many colds. However, when adults travel, they experience a new, unfamiliar group of viruses endemic to their destination. How often do we take a trip and come back with a Cold, or worse. We lack immunity to the microorganisms we have not yet encountered, just like children.

When I was in pediatric allergy practice, I feared nothing so much as the cold temperatures in October. The kids would come back to school, and start getting colds, averaging 7-8 per year. It is commonly thought by researchers that cold symptoms are not produced so much by viral damage to the respiratory membranes, as by the body’s immune response to those viruses.

My experience confirms that opinion. A cold was a worry for my patients. Rhinovirus infection often triggered a severe ashmatic response, sometimes sending the children to the ER if not the Hospital ICU.

It was the allergic reaction to the virus that caused the severe wheezing. After the epidemic of Covid subsides, and becomes endemic, don’t give up all of your newly-acquired habits. Hand-washing, distancing, and even masks prevent other respiratory disease transmission too.

–Dr. C.