Dear Dr. Roach: I have had a chronic cough for more than 30 years. As you can imagine, I have seen numerous specialists through the years, and none of the prescribed treatments has worked.
A friend suggested I might have laryngeal neuropathy. My doctor didn't know anything about it. What is the solution for this condition? - A.B.
Answer: I can't blame your doctor for not knowing anything about it. I've never recognized a case of it, though I wonder now, having researched it, whether it might be more common than we think.
The word "neuropathy" just means "a nerve problem," and in this case, it's one of the nerves in the throat, the superior laryngeal nerve or recurrent laryngeal nerve. It's a sensory neuropathy, meaning that the nerve is sending the brain incorrect information, which the brain misinterprets as a need to cough or clear the throat. Most people diagnosed with this condition have sudden onset of cough, often after surgery or viral illness. The condition is diagnosed by an expert ear, nose and throat doctor via a nerve conduction test or a video test of the larynx.
In the largest paper on this syndrome, about two-thirds of study participants were relieved by gabapentin (Neurontin), a medication used for many types of neuropathy. Some physicians choose to try this medication without doing the testing. This approach sometimes makes sense, especially when diagnostic testing is difficult or expensive.
Dear Dr. Roach: I am 85 and in good health, except for dizzy spells. It was said that I have vertigo, but I do not believe this to be the case. Meclizine is of no help.
The symptoms are worst when I close my eyes: When I do, I feel like may fall. Other symptoms are shuffling of feet, dizziness and dizziness on standing too quickly. Is it possible I have Meniere's disease? - A.T.H.
Answer: "Dizziness" is a very nonspecific term. It can mean vertigo, which is a sensation of movement when there isn't any; lightheadedness, such as we all can get sometimes when standing too quickly; or a disorientation that can happen when blood sugar is low. Meniere's disease is a cause of true vertigo, often with ringing in the ears and hearing loss.
Shuffling of the feet is a red flag for Parkinson's disease. Dizziness is a common if not universal symptom in people with Parkinson's. However, only a thorough history and physical exam can make the diagnosis. If your regular doctor hasn't been able to help, you might see a neurologist, who is an expert in making diagnoses about neurologic symptoms such as dizziness. There are many possible causes.
The booklet on vertigo explains this disruptive condition in detail and outlines its treatment. Readers can order a copy by writing: Dr. Roach - No. 801, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.
Dear Dr. Roach: My brother-in-law was prescribed warfarin several years ago after a stroke. He claimed it was made from rat poison and refused to take it. Is it, in fact, made from rat poison? - D.K.
Answer: Yes, warfarin (Coumadin) was used as rat poison. Some rat poisons are still relatives of warfarin.
However, that doesn't mean he shouldn't take it. The difference between a medicine and a poison is often one of dosing. Warfarin is reasonably safe when used correctly, and it can significantly reduce the risk of a second stroke. There are also some newer options, such as Pradaxa and Xarelto. Your brother should reconsider the risks and benefits.
Send questions to ToYourGoodHealth@med.cornell.edu