San Antonio Express-News (Sunday)
COVID-19 symptoms often similar to a cold
Q: Could you explain the difference between the delta variant and the common cold? How is one to know if an illness is the common cold with cough for weeks or the virus!
A: The virus that causes COVID-19 — SARS-CoV-2 — is a coronavirus that can cause many different symptoms, some of which are similar to the cold. Some people have very mild symptoms that can seem like the cold. The strain that is circulating now, called the delta variant, seems to have somewhat different symptoms from the previous variants.
Cough and loss of taste and smell are reported less frequently, while headache, sore throat, runny nose and fever are more common. Since these symptoms (except fever) are common in the cold, I would encourage people to get tested even if they have only mild symptoms. This will help slow the pandemic by reducing the number of people an infected person could be exposing.
There are many different families of viruses that can cause cold symptoms. This includes rhinoviruses but also, confusingly, different types of coronaviruses, but only SARSCoV-2 causes COVID-19.
Q: I had a colonoscopy yesterday, something I have held off since getting my first one 15 years ago at age 46. The dreaded prep wasn’t as horrible as I remembered, so I am now less resistant to the next one. Is this because I’m getting older and more tolerant, or has the prep process improved? I think it’s the latter but wanted to check with you.
Some of my friends brag that they don’t need to have them done. When I was getting the procedure done, I overheard another patient getting ready for the procedure say he was getting it done because they found blood in his stool test. My primary physician told me that colonoscopy is the gold standard and I’m glad that my insurance supports it.
A: Colonoscopy is indeed what most doctors choose for themselves as a screening test for colon cancer. However, for people at average risk for colon cancer, there are alternatives.
A fecal immunochemical test
looks for blood and has been proven to be better than no screening. A multitarget stool test (such as Cologuard) looks both for blood and for the abnormal DNA associated with colon cancer. A CT colonography, formerly called “virtual colonoscopy,” is an option, but many of my patients noted discomfort with the gas distention used in that procedure.
All of these alternatives, however, will ultimately require a colonoscopy if they are positive, just as the person you overheard did. It is my practice to recommend colonoscopy as the best screening test, but to offer the others as an alternative to a person who really doesn’t want a colonoscopy, while still being sure the person understands that if the screening test is positive, a colonoscopy may still be necessary.
There are many more preparation alternatives now compared with decades ago. My experience has also been that the prep is much less onerous than it used to be, thankfully.
Colon cancer screening in average-risk people should begin
at age 45 and continue at least through age 75, unless there is a reason to stop screening, such as a very serious illness likely to shorten a person’s life.
Q: In a recent column, you wrote that there is no risk to family from shedding after receiving the COVID-19 vaccine. You failed to mention that according to the Centers for Disease Control and Prevention, the grandparents could catch COVID and spread it even after being fully vaccinated. Also, according to the CDC, they might be contagious and have a viral load, even before they start showing any symptoms. Isn’t the only way to ensure they are not contagious is to be tested?
A: The topic of that column was shedding after a vaccine, and it is true there is no risk of shedding COVID-19 from the vaccination. However, you are correct that it is possible for a vaccinated person to have active, asymptomatic infection.
New data from the age of the delta variant shows that asymptomatic, vaccinated people may
indeed by infectious. For this reason, wearing a mask remains important, especially around people at high risk for complications for COVID-19. That includes vaccinated individuals.
It’s very important to note that the risk of asymptomatic infection spreading from a vaccinated person is much lower than from an unvaccinated person, simply because someone who is vaccinated is a lot less likely to get COVID-19.
Q: I’m an 83-year-old woman. Two years ago, I was diagnosed with diverticulitis. It comes and goes. My doctor recommended I see a surgeon, who recommended a sigmoidoscopy. I don’t see what the benefit is. I had two CT scans that showed diverticulitis. The surgeon said he would not do surgery on me.
Do you think I should have the sigmoidoscopy? Is there any risk to this procedure? The doctor said I would be sedated, and I am very reluctant to have it done.
A: All procedures have risks. A sigmoidoscopy generally has fewer risks than a full colonoscopy, but there is still a risk of damage to the colon, and even moderate sedation, by itself, has risks. The likelihood of benefit must be weighed against the risk of harms.
In your case, I think I can guess why the surgeon wants you to get the sigmoidoscopy. The diagnosis really isn’t in doubt — the CT scans you had are definitive. My best guess is that the surgeon wants to be sure there isn’t something else there, especially cancer.
The risk of being diagnosed with colon cancer after diverticulitis is substantially higher than would be expected, especially in a person with recurrent symptoms, as you have had. Unless you had an examination of your colon within the past year, such as a colonoscopy, the guidelines recommend an evaluation. The authorities recommend a full colonoscopy, but I suspect your surgeon wants to look most specifically at the area of the colon with the diverticula, which is usually the sigmoid colon. As I noted, a sigmoidoscopy has fewer risks than a full colonoscopy.
This is my guess, but I recommend that since you are reluctant to have the procedure done, ask the surgeon why you need it. The surgeon shouldn’t get upset by you asking. It’s our job to explain why we recommend what we do and the reasons why we recommend it over the alternatives.
Q: I am a 70-year-old male who has been experiencing an increase in breast size (slightly more on the left than the right) over the past year. I am healthy and have taken no medications for the past six months except sildenafil, on an as-needed basis. I am approximately 10 to 15 pounds overweight, but exercise regularly. Because of male breast cancer of my uncle on my mother’s side, I had a mammogram and ultrasound recently, which was negative. What could be the cause of this condition?
A: Gynecomastia, the development of breast tissue in men, is common among newborns, at puberty and again in adulthood, but all for different reasons.
For older men, breast cancer is indeed a concern. I am glad your doctor sent you for the appropriate diagnostic tests, even though breast cancer in men is uncommon. It’s wise to make sure.
The most likely cause in older men is the lowering of testosterone levels that is normal in a man’s 60s and 70s. This can be tested via a simple blood test. Ideally, the testosterone level should be drawn at 8 a.m. and then repeated if low. A trial of replacement testosterone is appropriate only if the blood level is low. The sildenafil you are taking (usually prescribed for erectile dysfunction) might be a clue that your testosterone is low.