Patient is diagnosed with COVID without being tested for it

Dear Dr. Roach: I’m a 71-yearold 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. 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 all the symptoms that I experienced are also associated with the flu, respiratory syncytial virus (RSV), and colds, I asked him how he could be sure without testing me. He responded, “Because it’s the most prevalent, and even if you tested negative, I still think it’s COVID.” I was surprised 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, even though I was vaccinated against COVID, 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?

Anon.

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.

Dear Dr. Roach: I am 68 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.

Ten per cent (or more) of men who take tamsulosin might 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. 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 might be more likely is that men in their late 60s do get ED for no discernible 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.