Pleurisy is inflammation of the lung coverings
DEAR DR. ROACH: Would you please write about pleurisy? I suffered from it 30 years ago, and now I have it again. Are there any medications that will help me? Aspirin seems to work. -- R.L.
ANSWER: "Pleurisy" is a term for inflammation of the pleura, the lining of the lungs. The major symptom is pain in the chest that worsens in certain positions or when breathing. There are many causes of pleurisy, and treatment depends on the diagnosis.
Infection probably is the leading cause, and it can be via viruses or bacteria. Viral pleurisy can be mild or severe, and I have seen many cases so severe that we were concerned about very serious illness, like heart attack or blood clots in the lung. An old name for viral pleurisy is "devil's grip," which gives some idea of how bad it can make you feel.
Bacterial pleurisy usually is associated with pneumonia, with its attendant fever and cough. Tuberculosis used to be a common cause, but is not so anymore.
Pleurisy with fever or other worrisome symptoms should be evaluated right away, as should pleurisy that lasts more than a few days. You are taking aspirin, an anti-inflammatory medicine, which can be useful for non-urgent cases of pleurisy. However, I still would recommend getting this evaluated if it isn't getting better.
DEAR DR. ROACH: In 2010, I was diagnosed with a pituitary tumor, found after an MRI for vision problems. I had surgery, showing a benign tumor, but the tumor regrew, requiring another surgery. My neurosurgeon now wants to treat the remaining tumor with gamma knife surgery. I am concerned about the long-term effect of radiation on the pituitary gland. Can you discuss the risks (greater than 10 years) on the pituitary? -- D.B.
ANSWER: The pituitary gland sits right above the optic nerve, and tumors of this gland usually are benign, as in your case. They almost always cause symptoms through pressing on the optic nerve, causing specific visual problems, or through secreting hormones.
Surgery or medication is usually first-line treatment, but neither is effective 100 percent of the time. Gamma knife is a way of delivering radiation to the tumor while minimizing the amount of radiation damage to surrounding structures of the brain.
I was able to find one Swedish study that showed good results, both in terms of controlling the tumor as well as side effects, up to eight years after surgery. Since gamma knife is relatively new, longer-term results are hard to come by. However, based on the principles, I would expect that the good results would continue long term, although lifetime follow-up is necessary. The brain is relatively resistant to the effects of radiation, and gamma knife is designed to focus the radiation precisely on the tumor.
All that being said, your neurosurgeon knows far more about you, about pituitary tumor and about gamma knife than I do. While I applaud your desire for knowledge and to find out for yourself, there comes a time when you have to trust your doctor and that he has your best interests firmly at heart.
READERS: The booklet on urinary tract infections provides a summary of typical signs and symptoms of UTI and the appropriate treatment. Readers can order a copy by writing: Dr. Roach -- No. 1204, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.
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