Dear Dr. Roach: I have been having weird spells for about six months. They occur only occasionally and last a couple of days and nights. They awaken me out of sleep and are a little frightening. It starts with a burning sensation on the right side of my nose. I feel as if I have to remember something, and a wave of warmth floods over my upper torso, down to my arms. I feel my heart fluttering and am a little sick to my stomach. I also have funny sensations in my right ear. It lasts a few seconds, and I just have to ride it out. When it鈥檚 over, I feel weak for a while.
I saw a neurologist, who mentioned that it might be anxiety, which made me mad 鈥� being awakened out of a sound sleep doesn鈥檛 seem to me that I am anxious, as I have no trouble sleeping! He wanted to put me on a medication with a lot of side effects, such as dizziness and hallucinations. I do not want to be on medication, but I also don鈥檛 want to have a grand mal seizure. He could not tell me if I could have one or not. I only want affirmation that I am not crazy!聽 L.G.
You aren鈥檛 crazy. Your neurologist may be right 鈥� this can be related to anxiety 鈥� but I wouldn鈥檛 jump to that diagnosis without considering a few things first.
A warm sensation over different parts of your body should make your doctor think of conditions such as carcinoid syndrome and pheochromocytoma. These are tumours that secrete hormone-like substances that can cause odd feelings, such as flushing or warmth, in different parts of the body. They can be screened for with simple urine and blood tests. I agree with you that being awakened with this sensation makes anxiety or panic attack less likely. It does not sound like a seizure disorder to me.
Sometimes, people notice sensations that defy medical explanation. In that case, we generally just try to make sure it isn鈥檛 something that doesn鈥檛 threaten life or health and help people minimize and live with the symptoms.
Dear Dr. Roach: I have a problem that I am embarrassed to discuss with my doctor. When I am going to the bathroom and straining with a bowel movement, often recently I will have a major cramp in my abdomen. It used to always occur slightly below my belly button, but now it has moved lower and sometimes to my left side. The cramp is very severe and can be felt and seen on my body surface. Is this something I can do anything about?聽 L.S.
Don鈥檛 be embarrassed. Your doctor needs to know, and needs to do an exam to feel what might be going on. It could be your normal physiology; it could be mild irritable bowel syndrome. It might be a hernia, especially if it can be seen on your body. Doctors aren鈥檛 easily embarrassed, and have heard complaints much, much worse than that.
Dear Dr. Roach: Have you had any experience with mononucleosis in people older than 60? I am 69 and have had mono for two months. I was misdiagnosed for five weeks. My symptoms have been low-grade fever, muscle aches, headache and low energy. I have taken two courses of prednisone, which gave me relief, but the symptoms return after stopping. Any information would be appreciated. T.V.
Classic infectious mononucleosis is caused by the Epstein-Barr virus, a virus in the herpes family. It is spread by intimate contact, such as kissing, and the diagnosis is made most commonly in adolescents. Treatment rarely is required, although symptoms, especially fatigue, can last for months.
In older adults, the symptoms may be different from adolescents. Prolonged fever and muscle aches are more common in adults.
I have two concerns about your story. The first is whether the diagnosis of mono is correct. You already have experienced some problems with getting the diagnosis, and there are many causes of your symptoms. Highly specific blood tests, such as specific IgM antibodies or direct detection of the virus by a DNA test called PCR would be very good evidence for infection.
The second is that prednisone is seldom necessary for treatment of mono, and there are concerns that the virus may not be cleared as completely in someone treated with prednisone. EBV can cause cancer, and there is a theoretical increased risk of cancer after mononucleosis.
I would highly recommend that you have a consultation with an expert in infectious diseases.
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] or write him at P.O. Box 536475, Orlando, FL 32853-6475.
