Is fatigue part of Reynaud's picture?
DEAR DRS. DONOHUE AND ROACH: My 19-year-old was diagnosed with Raynaud's disease. Because of her age, they have not prescribed anything for this. At present, she gets cold hands and feet that turn colors, and she finds it too cold to go swimming. She also is always tired.
Can you tell me a bit more about this, and why she would get so tired? Would you prescribe something for this at her age? -- D.C.
ANSWER: Raynaud's phenomenon is a common condition where blood vessels have an exaggerated response to cold and sometimes to stress. The hands or toes turn color (white and/or blue) with cold, and then red upon rewarming. Raynaud's phenomenon can happen by itself, with no associated condition. When this happens, we call it primary Raynaud's phenomenon, or it may be associated with other conditions such as autoimmune diseases like scleroderma, lupus or Sjogrens.
The diagnosis sounds correct, but you've raised two concerns. The first is whether she should have medication for her condition, and the second is should the tiredness cause you or her concern.
Deciding to treat with medications depends on how well non-medication treatment is working. Avoiding cold, dressing warmly and using mittens or electric hand warmers are critical. But if she is still having frequent episodes despite these measures, I would indeed consider prescribing a medicine, like nifedipine (Procardia or Adalat).
The second concern is her fatigue, and although this is very nonspecific in a 19-year-old, I would make sure she has been carefully evaluated for other causes, such as lupus and related disease, thyroid disease and abnormal cold-sensitive proteins such as cryoglobulins. It may be advisable for her to consult with an expert, such as a rheumatologist.
DEAR DRS. DONOHUE AND ROACH: I had my first-ever summer cold, which caused viral meningitis. For seven days I was in excruciating pain in the neck, shoulders and upper back. I was hospitalized for three days. I was treated with antibiotics and many pain-relief medications, including oxycodone and morphine. Kindly explain why viral meningitis causes such excruciating pain, like no other! -- G.B.
ANSWER: Meningitis is an infection of the meninges, the lining of the spinal cord and brain. It can be caused by either viruses or bacteria.
Bacterial meningitis is one of the most important emergencies that we see in medicine, one in which even a half-hour's delay in antibiotics can mean the difference between life and death.
Viral meningitis initially can look very similar to bacterial, and often is treated with antibiotics until the results of the spinal tap are known. The difference usually can be told then. Antibiotics are lifesaving in bacterial meningitis, but most cases of viral meningitis get better without specific treatment. Fever, back pain and/or "the worst headache of your life" are suspicious for meningitis and ought to be brought to medical attention immediately.
The brain has no pain sensation itself; however, the meninges that line it have abundant pain fibers. In most people, these pain fibers never send a message, but in the case of meningeal inflammation, the pain message is intense and unmistakable. Perhaps this is why the pain is so memorable.
DEAR DRS. DONOHUE AND ROACH: I take Plavix. I went to a new dentist for my gum treatment and bled heavily. I came home sick from so much bleeding. I called my doctor, and he said that the next time I should not take Plavix the day before I go. Is one day sufficient? -- E.L.
ANSWER: Plavix lasts about eight hours in the body, so 90 percent of it is gone within 24 hours.
One day should be enough. Careful brushing and especially flossing can make your visits to the dentist less traumatic.
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