San Antonio Express-News (Sunday)
Headache at onset of cold not likely stroke, aneurysm
Q: I am a 79-year-old woman in reasonably good health. I am very active and do everything I can for my health. Whenever I feel a cold coming on (which is rare), I have pain on the left side of my throat when I swallow and get a stabbing pain in my head every 5-10 seconds. I worry about stroke, and my husband thinks I may have a brain aneurysm. My doctor says he never heard of a correlation like that. When my throat feels better, the stabs in my head are gone. What do you think?
H.B. A: I agree with your doctor that it is very unlikely to be warning signs of stroke or an aneurysm. Stroke warning signs usually involve loss of function: temporary vision loss, difficulty speaking, dizziness, confusion or numbness or weakness, especially on one side of the body. Most unruptured aneurysms have no symptoms, but some of the stroke symptoms above can occur, or headache and visual changes.
What I think you have is referred pain. The pain in the throat feels like it is coming from a different area, in this case, your head. The fact that it only occurs with a viral infection is strong evidence it is not a warning sign of one of these dreaded conditions.
Q: A few months ago, you had an article about how the blood vessels going to the penis can be blocked, causing problems with erections. Can you go into it a little more about how to solve that problem and what kind of doctor to see about it? I asked a doctor about it at my Veteran’s Affairs hospital and he did not know. As a guy, you do not want to ask too many people.
J.
A: Men should not be embarrassed to ask about sexual problems (neither should women). Sexual function is an important part of human behavior, and problems in sexual function can be a clue to problems that might affect other body systems.
That is particularly the case with circulatory problems leading to erectile dysfunction. Without
adequate blood flow, an erection cannot happen properly. A blockage in one artery means that blockages in other arteries are highly likely. Occasionally, the first sign of atherosclerosis — blockages in blood vessels due to cholesterol plaques — in men is erectile dysfunction. Proper treatment can reduce the risk of stroke and heart attack.
Blockages in arteries, whether in the arteries of the heart, brain or elsewhere in the body, may be treated with medicines to reduce cholesterol, such as statins, or with medicines to help blood flow, such as aspirin or cilostazol, or potentially with surgery. Surgical treatment is often done by a vascular surgeon, but increasingly some interventional cardiologists and interventional radiologists are using balloon procedures and stenting in blood vessels outside the heart.
However, a urologist remains the expert in surgical treatment of erectile dysfunction and is usually your best consultant if your regular doctor’s treatments have been ineffective.
Q: I am 81 years old and was diagnosed with
shingles at the end of October 2020. After taking famciclovir, I am healing, but still have a scaly rash and shooting pains on the right side of my head where the shingles occurred. I was told that the pain could last for a year or more. Is this true? The initial outbreak was on my scalp, forehead, brow and eye area. I did see my ophthalmologist and was fortunate that the shingles did not get into my eye, just on my eyelid.
I also saw my physician, who recommended I get the shingles vaccine in February 2021. My eye doctor disagrees and said to wait six to nine months. What is the recommended time span between the onset of shingles and getting the vaccine? How long does the vaccine protect someone? Once you have the vaccine, can you ever get shingles again?
L.H. A: Both your doctors are right. Your regular doctor who recommended a four-month time span is correct, but your eye doctor, who said six to nine months, is right also. In fact, the vaccine may be given at any time after the shingles lesions are healed (crusted over).
Getting shingles again within a year is very unlikely, so it is fine to wait up to a year after the bout of shingles.
The length of protection seems to be long. But this is still a new vaccine, and it is unclear how long the protection will last.
Unfortunately, no vaccine is perfect — even our best vaccines. Some people will get shingles despite getting the vaccine. Fortunately, the vaccine is even better at preventing the worst complication of shingles, persistent pain called postherpetic neuralgia. Trials have shown 89 to 100 percent protection against this terrible complication. In people in their 80s, it can indeed last up to a year and occasionally longer.
Q: My 34-year-old son who has Crohn’s disease told me he is using pure 91 percent bottled alcohol to cleanse his hands because of possible contact with coronavirus when he has to go out. He is being careful especially since he is being treated with Remicade. I want to know if this alcohol use is safe for him. Doesn’t isopropyl alcohol get absorbed into the bloodstream? Could this poison him? I asked him to stop using it too, since it will make his hands cracked and dry for winter.
Anon. A: Hand sanitizers may be made from wither isopropyl alcohol (rubbing alcohol) or ethanol (the kind in alcoholic drinks). Both can be absorbed to some extent through the skin, but the amount absorbed through the hands is not enough to cause toxicity. However, using isopropyl alcohol as a fever reducer all over the body CAN cause enough absorption into the body to cause toxicity. It is not recommended.
You are quite right that any alcohol can remove the skin’s natural protective layers and make the hands dry and susceptible to cracking. Rather than using plain alcohol, I recommend using a commercial hand sanitizer product that contains emollients to protect the hands. There are many brands.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGood Health@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.