Wry neck disrupts life
DEAR DRS. DONOHUE AND ROACH: I was recently diagnosed with dystonia of the neck. I went to countless doctors before I finally saw a neurologist, who made the diagnosis. Are not very many doctors familiar with this condition? I would appreciate any information you can give on it. -- P.N.
ANSWER: Dystonia is an involuntary and forceful muscle contraction that twists body parts into unnatural, uncomfortable and nonfunctional positions. Dystonia isn't one disease, but many. Some dystonias are genetic. A few dystonias are the result of medicines. Many occur without a cause ever being discovered.
Your dystonia is spasmodic torticollis, a contraction of neck muscles that draws the head to the right or left shoulder, forward to the chest or downward toward the back. At one time, spasmodic torticollis was called "wry neck," wry in the sense of bent to one side, crooked.
This condition is painful and interferes with carrying on a normal life. It's not as uncommon as you might think. Doctors who are not neurologists might not recognize dystonia in its early form, but they wouldn't fail to spot it as symptoms become more pronounced and diagnostic.
Botox has been a breakthrough treatment for many dystonias, like spasmodic torticollis. Injections of Botox into the contracted neck muscles relax them for three to four months. It's not the only treatment. Surgery on the nerves leading to the muscle contraction was once a very popular treatment. It's not used as frequently since Botox arrived on the scene. Deep brain stimulation is another newer treatment for this condition.
Let me introduce you to Spasmodic Torticollis/Dystonia, an organization that will become your best friend. It provides patients with the latest information and the latest treatments for this illness. ST/D will welcome you with open arms. Its toll-free phone number is 888-445-4588, and its website is www.spasmodictorticollis.org.
DEAR DRS. DONOHUE AND ROACH: My husband has hemolytic anemia at the age of 76. He has been hospitalized twice since February 2011. The doctor gave him two blood transfusions the first time, and six this time. Our understanding is that the immune system has caused the problem. Could you add more information? -- B.M.
ANSWER: Anemias -- and there are many different kinds -- are deficiencies of red blood cells, the cells that carry oxygen through the body for cell growth, function and health. Red blood cells have a life span of 120 days. Premature death is called "hemolysis." In your husband's illness, his immune system makes antibodies that stick to red blood cells. In this instance, they're like grenades blowing them up. A rapid destruction of many red blood cells requires transfusion to restore the red blood cell count. Cortisone drugs -- prednisone being the one most often chosen -- frequently are able to stop antibody production.
If prednisone doesn't stop the antibody attack, spleen removal prevents that organ from gobbling up the coated red blood cells.
A new drug, Rituxan, is finding a place in the treatment of this illness.
DEAR DRS. DONOHUE AND ROACH: My wife, the mother of our five children, is 71. Her left leg has veins popping out. They're the size of the little finger. If she elevates the leg, the veins go down. We walk two miles every day. Does that hinder or help? Do surgical stockings help? -- C.H.
ANSWER: Your wife has varicose veins, veins distended with blood. It's due to a failure of the veins' valves, which keep leg blood moving upward and back to the heart. Pooling of blood in the veins stretches them out of shape.
Your walking exercise is good treatment. Have her stay with it. So is leg elevation. That's best accomplished lying on the back with the leg propped up so that it's higher than the heart. Elastic stockings are another big help. The best are ones that have been fitted expressly for your wife's leg
If all of the above aren't relieving your wife of her varicose veins, an astounding number of surgical procedures, much less invasive than former varicose vein removal used to be, are available for her.
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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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