COVID diagnosis without test
DEAR DR. ROACH
>> I'm a 71-year-old male in excellent health, and I don't take any medications. Recently, after experiencing mild headaches, mild muscle aches, a runny nose, sneezing, coughing and a sore throat, I went to an urgent care facility near me to find out which of the viruses I had been infected with. After listening to my lungs and asking me if I had had any fever, difficulty breathing, nausea, or a loss of taste or smell (which I did not), the doctor told me I had COVID.
Knowing that all of the symptoms that I experienced can also be associated with the flu, respiratory syncytial virus (RSV), and colds, I asked him how he can be sure without testing me for it. He responded, “Because it's the most prevalent, and even if you tested negative, I still think it's COVID.” Needless to say, I was surprised to hear him say this and told him that I wanted to take a polymerase chain reaction (PCR) test just to be sure.
Turns out, he was right! I tested positive for COVID for the first time, even though I was vaccinated for COVID, the flu and RSV. My symptoms only lasted three days. My question is, was his conclusion an educated guess, or was there something he heard in my lungs that convinced him it was COVID?
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DEAR READER >> COVID symptoms are variable, depending on the person, the variant, whether the person is vaccinated, and if (and how recent) they had the disease. There are no specific findings to look for when listening to the lungs, but I would take the doctor at his word. During times of high prevalence, pretty much everyone you see with respiratory symptoms has COVID. People with a high fever and muscle pains that start suddenly are more likely to have the flu, but there really aren't findings by a history review or an exam that are definitive.
Finally, your story proves again that the PCR test is more sensitive than athome tests, but at-home tests can be very specific. If you have symptoms and the at-home test is positive, you really do have COVID.
DEAR DR. ROACH >> I am 68 years old and did not have any erectile dysfunction (ED) issues until recently. For the past 18-24 months, I have been taking 0.4 mg of tamsulosin, and roughly two weeks ago, I stopped it, as I was beginning to experience the onset of some ED problems. Now, my ability to have sex has been hampered by my mental anxiety compounding the situation. Previously, I did not have any problems and had sex on a weekly basis.
I also wondered if my use of marijuana gummies has exacerbated the issue. Could this particular gummy brand be the issue?
— P.R.
DEAR READER >> Ten percent (or more) of men who take tamsulosin may develop sexual side effects, but ED is not common. Decreased libido and ejaculation failure are the commonly reported problems.
Cannabis, whether smoked, vaped or ingested, decreased testosterone in some studies, but increased it in others. Cannabis also increases estradiol, and high levels of estradiol can cause ED. However, the preponderance of the data does not show a significant decrease in erectile function among cannabis users. Still, if you noted the onset of ED at about the same time you started the gummies (after more than 18 months after you started tamsulosin), I say that cannabis is more than likely the culprit.
What may be more likely is that men in their late 60s do get ED for no discernable reason. Worse yet, becoming anxious about sexual function can dramatically worsen things, as you say. I have prescribed ED medications like Viagra to many men, who try it once, find it effective, then never need it again because they have less anxiety.
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By Russell Myers
By Dave Blazek