For many, autoimmune diseases can run together
DEAR DR. ROACH: In early November 2021 my son, who is 30, was diagnosed with Addison's disease and was treated with cortisol. He was doing well on that regimen. In March 2022 his blood sugar went up (300+), and he was diagnosed with Type 1 diabetes. As late as January his blood sugar was normal! We are told that it happens sometimes with Addison's.
Now I am wondering what is next. The Addison's diagnosis was a long time coming; he had had problems for the past 10 years at least. Anytime we ended up in emergency he would be told to drink fluids and eat the BRAT diet. He was slow to recover from colds and stomach problems. He was always tired, but when we told the doctors that, it was blamed on being a college student and possibly lifestyle and/ or trouble getting enough sleep. I wonder how many people suffer with low cortisol and never reach crisis so that they are diagnosed. — M.L.
ANSWER: Both Addison's disease and Type 1 diabetes are autoimmune diseases, where the body's immune system destroys important tissues. In Addison's disease, it's the adrenal cortex, a gland that sits on top of each kidney and makes cortisol. In Type 1 diabetes, it's the islet cells in the pancreas, which makes insulin.
Autoimmune diseases often run together. Other ones to watch out for include autoimmune thyroid disease and pernicious anemia, caused by destruction of the special stomach cells that make “intrinsic factor” that allows vitamin B12 to be efficiently absorbed. Vitiligo is another common autoimmune disease. In vitiligo, the skin pigment cells are destroyed, and people end up with irregular, patchy loss of skin pigment. In people with an autoimmune disease, physicians will often keep an eye on blood tests to make a diagnosis of a possible other one before too much time has gone by.
The diagnosis of Addison's disease can be tough to make. Fatigue is the major symptom, and so many things can cause that. When symptoms of fatigue persist beyond what is common for college students and others, it should be on the list a physician thinks about. The diagnosis can be made in a straightforward manner by an ACTH stimulation test, but considering the diagnosis in the first place usually is the hardest part of making the diagnosis.
DEAR DR. ROACH: Would you please explain what a fistula is? In the past two years, I have had two friends tell me they have had emergency surgery for a fistula. I may be naive, but have never heard of it and don't understand why my friends are embarrassed to discuss after the surgery. Is it shameful? — ANONYMOUS
ANSWER: A fistula is an abnormal connection between two structures. One common fistula is from the bowel to the skin. This can be deliberately created during surgery (also called a stoma), or it can come as a result of bowel disease, such as Crohn's. Other fistulae can exist between the bowel and the bladder, between the trachea and the esophagus, or practically any other adjacent structures you can think of.
Shame can be a terrible barrier to a person getting medical care. I understand why you might not want to tell your friends the details of your medical condition, but people need not be ashamed of their medical condition.