Dear Dr. Roach: I am a 67-year-old woman. For the past year, at least twice a month for three or four days, I am sick with nausea, diarrhea, chills and feverishness, lower-left abdominal discomfort and no appetite. During those days, if I do have any intake, it is liquids. I take Compazine and Imodium as needed. Prilosec is my only other GI-related medicine; I take 40 milligrams, twice a day. My doctor increased the Prilosec two months ago in hopes that this thing would go away, but it has not. I had a colonoscopy, which showed a couple of benign polyps and diverticulosis. I have been on the Prilosec for gastroesophageal reflux disease (GERD) for several years. I have not had X-rays or a CT scan. My gallbladder and my appendix have been removed. I stopped taking the Prilosec to see if that helps. Any thoughts?
C.L.
You are describing the classic presentation of acute diverticulitis. The diverticulosis seen on your colonoscopy revealed the presence of diverticula, saclike protrusions of the wall of the colon 鈥� mostly the sigmoid colon, which is in the lower left of the abdomen. Nausea and vomiting are common symptoms, in addition to fever and chills. Diarrhea is present in about a third of people.
I have to say that I am surprised you haven鈥檛 had a CT scan or some other diagnostic test, such as an ultrasound, a contrast enema or an MRI. These are very good for confirming the diagnosis. Since I certainly can鈥檛 be sure that you have had recurrent diverticulitis, a CT scan in particular can show other possible etiologies of your symptoms.
Sometimes, we physicians get stuck on a particular diagnosis (error analysis has come to medicine, and I am concerned that your doctor has what is called an anchoring heuristic error). Omeprazole (Prilosec) is a good treatment for GERD, and it is part of the treatment for stomach ulcers. However, a year is way too long to have had these symptoms without a proper evaluation, and it is past time to get another opinion. A careful history and physical exam during the time you have symptoms is one place to start, and imaging tests might be appropriate afterward.
If this is diverticulitis, antibiotics are the usual treatment for an acute case. With as many recurrences as you seem to be having, it is worthwhile to consider surgical treatment to remove the diseased portion of your colon.
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Dear Dr. Roach: I have heard of people whose hair turned white overnight due to some traumatic event. Is there any truth to that?
H.M.
The sudden change of hair colour is called canities subita. There was a review of literature published in 2013 with 44 well-documented cases of sudden colour change, 21 of which were associated with an episode of emotional stress. Think Sir Thomas More or Marie Antoinette before their respective executions. However, while rapid colour change is certainly documented, it is exceedingly rare.
What probably is more common is the sudden loss of pigmented hair in someone who already has some grey hair. Sudden loss of pigmented hair, in a condition called alopecia areata diffusa, can lead to an apparent colour change. Hair lost during chemotherapy or radiation sometimes can come back with a different colour or texture.
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Dear Dr. Roach: Last year, I was treated for gout and was prescribed allopurinol (100 mg) once a day. Approximately five to six months after I started taking it, I became lethargic and was not feeling myself (I am a very young 77 years old) and suddenly lost my sense of taste. I was taken off the medicine and still have little taste sensation other than citrus fruits, apples and spices. I was told that this could last for months, years or forever. Do you have any suggestions for me? I am eating as before, hoping that I will recover my taste.
N.K.
I certainly found that allopurinol can cause loss of taste sensation, but the U.S. Food and Drug Administration case reports don鈥檛 say how long it can last. Unfortunately, I can鈥檛 find any reliable way (or even plausible way) to increase the likelihood of getting your taste sensation back.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
