San Antonio Express-News (Sunday)
Painful ear cartilage that prevents sleep can have a number of causes
Q: The rims of my ears both get so sore I can’t even sleep on them. What can I do?
A: There are many causes for pain in the cartilage of the ear, including trauma and infection. However, when both ears are involved, it raises the concern for a rare but serious disease called relapsing polychondritis. This is an inflammatory and degenerative disease of unknown cause.
It is most common in people of European ancestry and is often diagnosed between ages 40 and 60, but it can occur at any age. As the “relapsing” in its name suggests, symptoms can come and go.
The ears are the most affected site in RPC, but anyplace there is cartilage, there can be inflammation. This includes the nose, eyes and joints. The disease may also affect the heart and kidneys, which is why it’s so important to get a diagnosis. The severity can range from so mild as to escape diagnosis to life-threatening.
There are other causes — one is a skin condition called chondrodermatitis helicis nodularis — but your next step should be to see your regular doctor for an examination and possible referral.
Q: Is it true that eating raw clams or oysters with alcohol can cause acute gastritis? I thought I read this somewhere.
A: Alcohol can cause acute gastritis (“gastrum” is the Greek word for “stomach,” and “-itis” always means “inflammation”) all by itself, especially when imbibed in large amounts, and almost exclusively in people drinking distilled spirits (as opposed to wine or beer).
Raw shellfish, such as clams or oysters, do not usually cause inflammation of the stomach unless they are contaminated with bacteria. Several species of bacteria are common, but the most worrisome are in the Vibrio genus.
Vibrio parahaemolyticus causes nausea and cramping, often with diarrhea, sometimes with bloody diarrhea and fever. Vibrio vulnificus can cause sepsis, especially in people with liver disease, including alcoholic liver disease, which predisposes to very severe disease with high mortality. People with any kind of chronic liver disease should not consume raw or undercooked shellfish of any kind.
Q: My local hospital told me that I can’t donate blood because I have a pacemaker and had me sign a form acknowledging that I’ve been told that. My cardiologist said he never heard of this. What is your opinion?
A: I’m with your cardiologist. A bit of research shows that although some people with pacemakers have been turned down from donating blood, there is no need to do so unless the person has another reason not to donate. This includes some medications used to decrease blood clotting. The American Red Cross specifically allows people with pacemakers to donate blood, so long as their pulse is normal. The maker of one brand of pacemakers noted that the pacemaker is shielded from any machines used during blood donation — meaning it’s safe for YOU to donate
blood.
Some blood banks want people to wait for a period of time after the pacemaker is placed, perhaps because of the very unlikely event of a blood infection. Each blood bank has its own rules to protect the safety of the blood supply and the donors. Most blood banks allow healthy people with pacemakers to donate.
Q: I am a 69-year-old woman in good health. For a couple of years, I have had increasing trouble sleeping because of having to get up during the night to urinate. It is now four to eight times per night. I am careful not to drink much after early afternoon. I have a healthy diet and get plenty of exercise. My primary physician treated me for overactive bladder,
which did not work.
I have seen two urogynecologists. They both told me that I am producing way too much urine at night because my antidiuretic hormone levels are very low. They also told me that the medication normally given for that cannot be given to people over 65 due to cardiac side effects. Do you have any ideas? Should I see a kidney specialist? This is seriously affecting my quality of life. I feel that if I have to live with this for the rest of my life, it may be a short one.
A: The body has several systems in place to allow people to sleep through the night without having to get up to urinate. One of these is a hormone called arginine vasopressin, also called antidiuretic hormone. It is usually at a high level at night. Unfortunately,
this system doesn’t work so well in many older people, and can sometimes invert entirely so that the levels are low at night, and people need to urinate more.
One treatment for this is to give the hormone in a form called desmopressin, often abbreviated DDAVP. It is given by injection, or via nasal spray or oral tablet.
The side effect your urogynecologists are concerned about is low sodium levels (hyponatremia), which is extremely common in people over age 65 when
taking this medication, and most experts will not prescribe it for older people. Women are at even higher risk than men. The Food and Drug Administration has a black box warning, the highest level of concern, that DDAVP is recognized to “cause hyponatremia” and that “severe hyponatremia can be life-threatening, leading to seizures, coma, respiratory arrest, or death.” Even in studies with people who were carefully monitored and where lower doses were tried, participants still developed serious hyponatremia at a rate that was concerning (up to 30 percent).
Other options include using a dose of a diuretic in the afternoon so your body is as “dry” as it can be before bed, sleeping medications and a newer treatment called posterior tibial nerve stimulation.
Q: I was hospitalized and put on IV antibiotics two weeks ago, and followed it up with another week of oral antibiotics, amoxicillin. Since getting this treatment, I have had diarrhea. Is this a result of the antibiotics?
A: The diarrhea is very likely to be related to the antibiotics. Antibiotics destroy much of your healthy bacteria living in the colon, which often leads to diarrhea. Most of the time, the normal bacteria will come back after finishing the antibiotics, and the diarrhea goes away.
Diarrhea with fever or blood, or that persists, should prompt evaluation for a serious infection, Closteroides dificile, which needs urgent treatment. C. diff is resistant to most antibiotics, so virtually any antibiotic predisposes to this dangerous infection, as the C. diff takes over the intestine after the healthy bacteria have been killed off by the antibiotics.
Many people will treat antibiotic-associated diarrhea with probiotics (healthy bacteria), either as food (such as yogurt) or as a supplement. It’s not clear how effective this is.