Dear Dr. Roach: I’m a generally healthy, 63-year-old woman. I haven’t been feeling well for months. I have experienced bloating and a poor appetite, and I’m not eating much. But somehow I am gaining weight. I started having diarrhea, and my doctor did a culture and found that I have E. coli.
They started me on antibiotics, and the diarrhea is a bit better. Does the infection explain my poor appetite and weight gain? My mother said that I look eight months pregnant, and my abdomen is really starting to hurt.
P.G.
The infection might explain the diarrhea. There are some strains of E. coli (called “enteropathogenic” E. coli, or EPEC) that can cause diarrhea, and the new genetic tests are very sensitive. However, the presence of EPEC does not always explain diarrhea, as the test can be positive in healthy people when there may be another underlying reason.
What is much more concerning is the combination of poor eating, weight gain, and a distended abdomen. This suggests fluid in the abdomen, called ascites, which can be associated with liver disease or very low blood protein levels. But cancer is the big concern, particularly ovarian cancer. This combination of symptoms — when new and unexplained by any other obvious cause — should prompt a thorough evaluation, including a CT scan.
Sometimes physicians forget about this possibility, and it’s a good idea to ask your physician to consider ovarian cancer if they do not explicitly bring it up. Although symptoms can be nonspecific, when a woman has new and persistent bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, or urinary symptoms of going more frequently or needing to go right away, she should be considered for ovarian cancer.
Dear Dr. Roach: I’m an 80-year-old woman in pretty good health, except for severe spinal stenosis. My problem is I wake up several times at night with the feeling that I need to urinate. After I get back in bed, my whole body breaks out in a horrendous sweat. I can feel the heat rising in my body.
It’s extremely annoying, as it takes me 15-30 minutes to go back to sleep, and my back itches. What would cause my body to heat up to the point of sweating? This only happens at night.
S.R.
Night sweats are a serious concern, as there are quite a few possibilities — many of them being serious. This is something you should see your doctor about right away.
If you are having frequent episodes of drenching sweats to the point where you have to change your clothes or bedding, this deserves a thorough evaluation. Thyroid disease, blood disorders, infections, liver disease and tumors are all in the long list of serious medical illnesses that need to be considered. There are many less-common issues as well.
Drenching night sweats are a serious symptom that sets off my internal alarm bells, so please go see your doctor right away.
Finally, new urinary symptoms with spinal stenosis need to be evaluated, since it’s possible that the nerves to the bladder are being compressed.
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]
