Tourette's syndrome not necessarily inappropriate shouting
DEAR DRS. DONOHUE AND ROACH: My great-grandson has been diagnosed with a tic. It seems his eyes open wide and roll around -- what is that? He is 6 years old. -- A.A.
ANSWER: It sounds like Tourette's syndrome, or a closely related neurologic condition. These are usually diagnosed in early childhood. It is a myth that all people with Tourette's shout inappropriate words; this is a small minority of the disorder. Most people with Tourette's might display eye blinking, facial movements, cough, throat-clearing or other behaviors that often can be suppressed, at least for a short while. Most people with tics tend to get better over time, especially through adolescence. There is a strong familial association, with a parent many times recognizing in hindsight tic behaviors.
Recognizing the condition early is important especially to recognize this as a medical condition, so that the child is not punished. Children who live in an understanding and supportive environment do much better than those who are treated poorly or whose condition is misunderstood. Medications are sometimes used, but most often are not necessary. The prevalence of this disorder is much higher than previously thought -- as much as 20 percent of children will have transient tics and 1 percent of schoolage children will have Tourette's. Most of these cases are mild.
DEAR DRS. DONOHUE AND ROACH: I have a lifelong allergy to aspirin. When I take aspirin, I get asthma (I was diagnosed in my late 20s with asthma) and severe hives. I am now in my 50s. If I were to have a heart attack, would it be advisable to take aspirin? Or would doing so put me at greater peril? I have only ever taken acetaminophen for pain/fever since I was diagnosed. -- M.B.
ANSWER: Aspirin intolerance and asthma definitely are linked, and sometimes also associated with nasal polyps. The asthma attacks can be severe, so you should never take aspirin or related drugs. Stick with the acetaminophen (Tylenol). Although aspirin is helpful for most people having a heart attack, the risk is too great for you.
DEAR DRS. DONOHUE AND ROACH: At my semi-annual visit to my dermatologist last week, I had a biopsy of a small lesion on my scalp. It proved to be basal cell carcinoma. The dermatologist suggested Moh's surgery, but said radiation was an option. I always thought surgery was a last resort, and the dermatologist did not explain why surgery was his first choice. I was led to believe that both have a 97 percent to 99 percent success rate. -- L.M.
ANSWER: Basal cell carcinoma is the most common skin cancer, and the most common cancer overall. Although it is a cancer, its potential to spread is quite low, but if neglected it can grow locally.
Thus, removal is recommended. Both radiation and surgery are effective; however, a recent study showed that surgery has a better cosmetic result than radiation. Further, radiation is much more expensive and has a risk for secondary cancers in the distant future. To seal it, 20 or more sessions of radiation are necessary, compared with just doing the surgery and usually only one post-operative follow-up. Moh's surgery is different from regular surgery because, while the patient and surgeon wait, a pathologist immediately evaluates the removed tissue and provides information to the surgeon on where further removal of skin with tumor cells might be necessary.
I agree with your dermatologist that surgery is preferred.
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Drs. Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475 or email ToYourGoodHealth@med.cornell.edu with medical questions. Readers also may order health newsletters from www.rbmamall.com.
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