Dear Dr. Roach: I was diagnosed with white matter disease a few months ago, and I was given Depakote 500 mg to take (at bedtime). What exactly is this disease? Does it progress to dementia? My mother suffered from Alzheimer's disease. I am in my late 60s. Are there any options for my future health care that I need to take care of? I am diabetic and also have high blood pressure and heart problems. All are under control. I take metoprolol and lisinopril.
M.R.
The brain is made up mostly of grey matter and white matter. Grey matter consists of the neurons (nerve cells), while white matter consists of the nerve fibres as well as glial cells, which support the neurons. White matter disease can be caused by many different processes, such as multiple sclerosis or migraine headaches, but one common meaning is damage done to the white matter by damaged blood vessels.
Apart from smoking, high blood pressure, diabetes, and high cholesterol are the biggest factors in ischemic white matter disease of the brain. Improving the control of these factors can reduce the risk of vascular dementia. Vascular dementia is similar in some respects to Alzheimer鈥檚, and often the two are misdiagnosed by patients and families. Vascular dementia, sometimes called multi-stroke dementia, tends to be stable for a while then suddenly get worse. Alzheimer鈥檚 is slowly progressive.
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Dear Dr. Roach: I have a small cyst at the base of my left tonsil. It has been there for six years and appeared after a bad sore throat. I also would like to mention that I work with children and am exposed to a lot of germs. I have no pain and haven鈥檛 had a sore throat in years. I did have this checked out years ago, but I thought it eventually would go away. I recently mentioned it at a checkup, and the doctor would like an ENT to check it out.
What worries me is that they may say I need to remove my tonsils, when for the most part they serve me well, because I rarely get sick. I am a singer and am about to return to my job working with students. If a cyst is asymptomatic, does it have to be removed?
J.P.
Go get it checked out by an ear nose and throat doctor. A very small number of these cases are not cysts at all, but the beginnings of tumors, benign or cancerous. Cancer is extremely unlikely in your case if it has been stable for six years. It also could be a tonsillolith, a stonelike deposit of bacteria and fluid. If it is, as expected, both benign and asymptomatic, then the ENT doctor is unlikely to recommend removing your tonsils.
