Relationship with younger partner collapses bitterly
Dear Dr. Roach: I’m a 71-year-old man, and seven or eight years ago, I was diagnosed with asthma using the challenge test. I was prescribed Symbicort, which helped me exercise a little better. (Exercising is the only time I can tell I have asthma.)
A couple years later, I was diagnosed with paradoxical vocal cord motion disorder (PCVM) by the use of a camera inserted through my nose. The idea recently occurred to me that I may not be getting the full benefit of Symbicort because of PVCM. The primary treatment for PVCM seems to be speech therapy, which did not help at all.
The only other treatment I’ve been able to find are Botox injections into the vocal cords, but there doesn’t seem to be a lot of literature on this procedure. Do you have an opinion on PVCM reducing the effect of Symbicort, and are you aware of other treatments for PVCM? D.D.
Answer: Very early in my career, I had a patient with inducible laryngeal obstruction (ILO, also called paradoxical vocal cord motion) that had been mistaken for asthma until she, like you, had direct observation of the larynx during an episode.
It turns out that she didn’t have asthma at all, but there are people who have both asthma and ILO. When this happens, asthma is still treated the same way it’s treated in everybody else, and inhaled steroids like Symbicort are the usual first-line treatment for people who have more than the very mildest of symptoms.
Normally, the vocal folds (“cords”) open wide when you breathe in. But in people with ILO, the vocal folds come together so tightly that it’s hard to breathe in and out, and a sound very much like wheezing can be heard.
I do not think your ILO is keeping Symbicort from working. If air is getting into your lungs, then Symbicort will, too; it is a powerful anti-inflammatory medicine. The fact that you felt better on it is good evidence of its effectiveness.
With any given episode that you have, though, it may be difficult to tell whether it’s asthma or ILO causing the symptoms. An acute asthma attack is treated with a different inhaler (such as albuterol), whereas an attack of ILO can often be stopped by panting. Very severe episodes can be treated with positive airway pressure (CPAP) or by a helium/oxygen mixture.
If a trigger for ILO can be found, then it should be avoided. Common triggers include airway irritants like cleaning chemicals, dust or smoke, and strong perfumes. Speech-language pathologists have several tools at their disposal to help. This is not the most common diagnosis, so you may do better with a different speech-language pathologist who has more experience with ILO.
I have never seen Botox used for ILO, but in a study on patients who weren’t getting good results with the standard treatment, 85% got better after an average of four injections. There are possible side effects in this case, including voice changes and trouble swallowing.
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 ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
Dear Abby: I am a middle-aged gay man who has never had any serious relationships. A few months ago, I met a 22-year-old guy. He seemed really sweet and nice, and we had good times when we were together, so I let him use me for money. He played on the feelings I thought I had for him, and I think I still do.
The other night, I caught him lying to me again and went off the deep end. He ended up blocking my number, so I know he’s not getting my text messages. I have called him at least 100 times and it goes straight to voicemail. Must I just chalk it up as “lesson learned” and try to go on?
I doubt I will ever forget him. He’s in my head right now and it’s difficult. If it were to happen, I can’t go back to him the way we were. Although this may sound stupid and immature, I think I fell in love with him. I’m not sure. He hurt me badly because I let him use me. Thank you for any advice you can offer. Tricked In Tennessee
Dear Tricked: I’m sorry you’re hurting but, yes, you should chalk this up as a lesson learned. You stated you’ve never had a serious relationship. If you would like to pursue one, meeting someone closer to your age with whom you have more in common would be beneficial. Check in at your nearest LGBTQ community center and sign up for an activity or event and you may meet someone. I wish you luck.
Dear Abby: I am a caregiver for my elderly diabetic mother and my disabled husband, who is an alcoholic and also epileptic. Every single household responsibility falls on me – cleaning, upkeep, shopping, driving, food preparation, etc. My mother refuses to eat right for her medical condition. It’s a daily struggle. I keep everything on hand to make it easy for her, but I still have to beg and plead.
I am not well. I have several autoimmune diseases that zap my strength. I love my mom and my husband, but this has taken every bit of joy from my life. My mother doesn’t have dementia – she’s very aware of what she is doing.
As for my husband, his love for me will never come close to his love of alcohol. He is never abusive, but I have never felt so overwhelmed and alone at the same time. There are no siblings to help, and my children live out of state. Do you have any suggestions on how to keep what is left of my sanity?
Overworked In Virginia
Dear Overworked: Yes, I do, but you may not like what I have to say. It’s time to quit trying to “save” your mother and your husband from the fates they have chosen. Your mother is an adult and in possession of her faculties. Let her assume responsibility for herself and her treatment. (Or not – also her choice.)
As to your husband’s alcoholism, join Al-Anon and start attending meetings. Only he can fix his drinking problem IF HE WANTS TO. Ruining your health trying to help people who don’t want to be helped may be well-intentioned, but it is also misguided.