Dear Dr. Roach: My mother, who is in her late 70s and who always has enjoyed eating meat, can no longer do so. She says that she just has a hard time getting it down. So sometimes she just chews on a piece of meat (e.g., chicken) and then spits it out. Her teeth are fine, so that's not the issue. She just brushes it off as something that happens when you get older. Is she correct? Or is this a symptom of something else?
J.L.
Difficulty swallowing is NOT a common symptomatic problem with aging, and I take complaints about swallowing very seriously. What you are describing is worrisome. Inability to swallow meat suggests that there may be a mechanical blockage in her esophagus. I wonder if she has had problems in the past swallowing, which is why she isn鈥檛 even trying to swallow now. Often, people complain of food getting 鈥渟tuck鈥� in the throat or chest. If this is the case with her, I would recommend that she have an immediate and thorough workup. Common causes include an esophageal stricture, web or ring. Eosinophilic esophagitis is another reason for swallowing difficulties; this is due to inflammation of the esophagus. However, the most worrisome cause is esophageal cancer, and I would waste no in time getting her evaluated by a gastroenterologist. A barium study or upper endoscopy might be necessary.
Dear Dr. Roach: My husband recently was diagnosed with tinnitus. He also suffers from occasional vertigo. Is there any medical evidence that tinnitus can cause or contribute to episodes of vertigo?
J.S.
Tinnitus is a common problem, with 50 million sufferers in the U.S. alone, 12 million of whom say it affects their daily living. Vertigo also is a common problem. There are many causes of both vertigo and tinnitus, so it鈥檚 entirely possible that the two are unrelated.
However, the combination of the two suggests Meniere鈥檚 disease, also called endolymphatic hydrops. This refers to the swelling of the organ of balance in the middle ear. In addition to tinnitus and intermittent vertigo, people with Meniere鈥檚 disease usually develop hearing loss, especially affecting lower pitches.
Hearing testing and specialized tests of the balance system may be necessary to diagnose Meniere's disease. There are many other causes for both vertigo and tinnitus, as I noted, so I hope your husband will be undergoing further evaluation to look for the cause (or causes), some of which may be serious. 听
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Dear Dr. Roach: Do you know a cure for scabies? I have tried poisons that were prescribed by doctors; they didn't work, but they almost killed me. I tried sulphur soap, which doesn't work.
Anon.
Scabies is an infectious skin mite that causes intense itching. It characteristically occurs in the webs and on the sides of fingers, on the insides of the wrists and in other folds of skin, such as the armpits and groin.
Scabies is treated with five per cent permethrin cream (Elimite or Nix). It needs to be applied thoroughly to the entire body below the neck, including under the nails, and left on for about 12 hours. Another choice is oral ivermectin; an older drug, Lindane, has significant neurological toxicity and is not recommended.
If you have been treated with these agents (and have followed the directions exactly), then I would be concerned that the diagnosis is incorrect. A dermatologist may need to do a skin scraping to be certain.
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 [email protected].
