DEAR READER: Without knowing more, I cannot be certain, but the first thing that comes to mind is angioedema. This is an inflammation of the tissues just under the skin. There are two types — hereditary and acquired. Hereditary angioedema (HAE) is rare and genetic. Acquired angioedema is much more common and often the result of an allergic reaction, and it typically affects the skin around the eyes and lips. I urge you to speak to your physician about this possibility.

For some dumb reason, I stopped taking it, and last year I had another strange episode: This time, it was strong pains in my breasts. It felt as though I was lactating, but I knew I could not be. Again, I had many doctor visits and also underwent a sophisticated mammogram. I was told I had fibromyalgia, because I also had aches and muscle pains. I disagreed with the diagnosis and began researching on my own.

We had gotten a new dog four months earlier, and, after talking to friends, I decided to stay away from the dog. Sure enough, I began feeling better. Then I told my boss at work, a female, about the strange breast pain, and she immediately told me that I must be allergic to the dog because her little boy had similar reactions to his new dog. His underarms swelled up painfully. I was elated to solve this!

We returned the dog to the shelter, and I was immediately tested for allergies. I was allergic to cats and dogs, not to mention many grasses, molds, trees and house dust. I will never stop taking my daily antihistamine, and I have been feeling great ever since restarting it.

DEAR READER: I have printed your letter because I find it interesting that you say you have joint, muscle and breast pain due to allergies.

Most allergies cause itchy, watery, red eyes; a runny nose and/or congestion; coughing, wheezing or other asthma-like symptoms; skin rashes, hives or swelling. The type of symptoms experienced depends on the allergen and how you came into contact with it. Pet dander, for example, is typically inhaled, so skin manifestations, while possible, are not generally seen.

I am unable to find any reliable scientific evidence that shows that any allergen, let alone pet dander, can cause joint, muscle or breast pain. I was able to find personal testimonies that claimed these symptoms due to allergies, but there is nothing to substantiate the claims. Perhaps this is something that should be further investigated by the medical and scientific communities.

I am not in any way dismissing your claims. I am simply stating that at this point there is no hard evidence to back up the claims. The fact that you have experienced relief by taking a daily antihistamine is compelling nonetheless.

To provide related information, I am sending you a copy of my Health Report “Allergies.” Other readers who would like a copy should send a self-addressed stamped envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

My ANA test for three years has come back normal, but I continue to get lesions, my hair falls out, and I get sick easily. I have been to two rheumatologists. Both say I do not have SLE, but my family doctor feels I do. What do you think?

I was also told that because I only have discoid lupus, this would not cause any health problems other than with my skin and hair. So why do I have it in my nose and inside both ears? I’m now 33, my bones are brittle, and I have osteoarthritis in my hands and fingers. Help!

DEAR READER: Whew, where to start? Some children have impaired immune systems, making them subject to numerous disorders. My guess is that you were unfortunate enough to fall into that category.

There are a number of forms of lupus, which is an autoimmune disease. Lupus can affect joints, skin, kidneys, brain, heart, lungs and other parts of the body. Common symptoms include skin rash, kidney problems, arthritis and unexplained fever.

Discoid lupus is a chronic skin disorder that shows as a raised red rash that ordinarily appears on the face and scalp but can appear in other areas of the body, including the nose and ears. The lesions may last for days or years and can recur. Some people diagnosed with discoid lupus may develop systemic lupus erythematosus (SLE) at a later date.

Because arthritis is a common complaint, it’s not at all surprising that you have been diagnosed with fibromyalgia, chronic pain in muscles and ligaments.

Pleurisy is swelling of the lung linings that causes pain and breathlessness during inhalation and exhalation. Causes include acute viral infections, such as influenza, and can be the result of autoimmune disorders, such as lupus.

Kidney stones and related infections have numerous causes, including dehydration, obesity, genetic factors and a diet high in protein/sugar/sodium.

Vertigo can be caused by an inner-ear disorder, migraine headache, acoustic neuroma and other causes.
Depression and anxiety can be caused by lupus, fibromyalgia, kidney stones and vertigo. You have a lot on your plate, and it has obviously resulted in a lot of stress. Osteoarthritis, a breakdown of cartilage, causes pain and stiffness of affected joints. The condition is commonly associated with the aging process, but at 33, you are far from old. Treatment is geared toward controlling pain through medication, rest, exercise and protection of the affected joint(s).

Because so many of your symptoms involve pain, I’m inclined to suggest that you be referred to a pain clinic for control or request a referral to a larger diagnostic center, such as the Mayo Clinic. You will learn methods for reducing the level of pain you presently experience that may include water aerobics and yoga. Appropriate medication might be ordered. Once you get that aspect under control, the anxiety and stress levels you are under may be reduced.

To provide related information, I am sending you a copy of my Health Report “Fibromyalgia.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

I have constant cramping in my legs, thighs, toes, hands, rib cage and arms. Lately, most of my cramping is happening at night when I go to bed. Both legs cramp up, and one of my feet twists to one side. These cramps are painful. I can turn over in the middle of the night and catch a cramp. I have had all types of blood work performed, and when my potassium was a little low, I was told to take a potassium pill. I cramped twice as much.

I have gone to internal-medicine doctors, rheumatologists, orthopedic specialists, family medical practitioners, OB-GYNs and cardiologists with no resolution.

I am currently taking Celebrex and magnesium oxide — specifically for cramping — which has helped, but not completely. I also take Singulair, Diovan, Prevacid, a garlic pill and Zocor at night only. In the past, I have taken some cramping medications, such as clonazepam, quinine tablets and others I can’t even remember the names of. Can you shed some light on my medical problem that might assist me with these awful cramps?

DEAR READER: You indicate you are in good health with the exception of your allergies. Let’s review your other medications. Celebrex is a prescription medication used to control the pain, stiffness and swelling of osteo and rheumatoid arthritis. Magnesium oxide and Prevacid are commonly used to relieve symptoms of acid indigestion. Diovan helps control hypertension and is sometimes prescribed for patients with heart failure who cannot take ACE inhibitor medications. Zocor is a statin drug designed to reduce bad cholesterol while increasing the good. Garlic is believed to help symptoms of arthritis and lower high-cholesterol and blood-pressure readings. And, when added to many foods, it simply tastes good. So it appears that you have arthritis, acid indigestion, hypertension and hypercholesterolemia (high cholesterol).

Statins have a bad reputation for causing muscle pain, cramping, fatigue, and muscle tenderness and weakness in some people. You appear to be one of them. I cannot clearly state that this is the cause of your problem, but it’s a good place to start. Speak with your physician to determine whether you can take a different cholesterol-lowering medication that isn’t a statin. Perhaps an over-the-counter such as niacin or an OTC with plant stanols and sterols might be effective. Because of your history, my inclination is to have you refrain from red-yeast-rice products only because they include lovastatin-like substances. Try drinking pickle juice or eating dill pickles for relief from your cramps. Last but not least, place one bar of soap (or more) under your bedsheet near the part of your body that cramps for additional relief.

To provide related information, I am sending you copies of my Health Reports “Understanding Cholesterol” and “Compelling Home Remedies.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order for each report to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title(s) or print an order form off my website at www.AskDrGottMD.com.

Can you tell me what could be causing my low vitamin D level? Do you believe that this is the issue, or are the low levels caused by something else?

DEAR READER: Vitamin D is a fat-soluble vitamin that is essential for promoting calcium absorption, maintaining adequate serum calcium and phosphate levels, bone growth and remodeling, reduction of inflammation, and neuromuscular and immune function.

If your levels are low, you are at risk of developing weak, brittle and/or deformed bones. This could also affect your immune system, making you more susceptible to infection, allergens and more. Your low vitamin D level may indeed be the cause of your allergies, which are causing your cold and flu-like symptoms; however, this does not explain why you have a low D level to begin with.

In healthy people, vitamin D deficiency can typically be avoided by adequate sun exposure and a well-balanced diet. Because there are very few foods that naturally contain D, fortified cereals and dairy products are the best way to achieve sufficient dietary amounts.

Older adults, breastfed infants and those with limited sun exposure, dark skin or fat malabsorption are at increased risk of developing deficiency. Obese individuals may have difficulty absorbing vitamin D from sun exposure because the subcutaneous fat essentially blocks part of the D from entering the bloodstream. Those who have undergone gastric bypass may also have difficulty because most forms of this surgery bypass the upper small intestine where D is absorbed.

Symptoms of vitamin D deficiency typically go unnoticed. The most common consequence is weakened bones, also known as rickets in children, osteomalacia in pre-menopausal women and men, and osteoporosis is post-menopausal women. There may be an increased risk of developing cancer, especially that of the digestive tract. There is also research suggesting deficiency may play a role in the prevention and treatment of diabetes types 1 and 2, hypertension, glucose intolerance, multiple sclerosis and more. However, because these studies have not been randomized clinical trials, the implications will continue to be debated until definitive proof is found.

According to the Food and Nutrition Board (FNB) at the Institute of Medicine of the National Academies, adequate intakes (AIs) for healthy people between birth and age 50 should be 200 IU of vitamin D daily. Those aged 51 and over should double that. Recently, the American Academy of Pediatrics issued its own recommended intakes that exceed those of the FNB. This led to an expert committee formation by the FNB, which decided that recommended intakes be re-evaluated. To the best of my knowledge, the decision of this committee should be made public later in 2010. Tolerable upper-intake levels (ULs) for those between birth and 12 months is 1,000 IUs; age 1 and older is 2,000 IUs daily. This, too, was challenged and is currently under review.

I suggest that you speak to your physician to request that the underlying cause be found. It may be as simple as not getting enough sun exposure and may be helped by exposure without sunblock for 15 or 20 minutes each day. Longer unprotected exposure is not recommended because of the increased risk of developing skin cancer.

If the cause cannot be found, follow your physician’s advice regarding supplementation and including more vitamin D-enriched foods into your diet.

You should also be watchful for signs of excess intake. Most commonly, these symptoms are nonspecific and include nausea, weakness, constipation, weight loss, vomiting and poor appetite. If healthy people continually take levels above the UL, it may result in elevated blood levels of calcium, which may cause confusion and other mental-status changes, as well as heart-rhythm abnormalities. There is also an increased risk of developing kidney stones, especially when used in conjunction with calcium; however, because you are deficient and under the care of a physician, these are not likely to result.

To provide related information, I am sending you a copy of my Health Report “Vitamins and Minerals.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title. Order forms are also available for printing on my Web site at www.AskDrGottMD.com.

He first began getting the hives while working but now that he is retired, they still occur. He has seen his primary care physician and an allergist, both of whom have not been able to offer any suggestions. After hearing a detailed description of an “attack”, they both said they didn’t believe it was due to food or drug allergies.

He has seen his physician a few times during an attack but all they do is give him some sort of injection and a prescription for prednisone which he doesn’t like to take. He usually has three to four attacks a year but they can occur at anytime. For instance, his last attack was in January and the one before that was in August while we were on vacation in a completely different environment.

His symptoms and the frequency of the attacks seem to be worsening. I have finally decided to write because he is having yet another attack and I feel so helpless. I just want him to be able to have a more normal life. I will describe the January attack (as it is a pretty typical one) in the hopes it will help you help us.

Jan. 2 – woke up at 7 am with his left hand pink and swollen. Throughout the day the swelling and pinkness spread up his arm. He was very tired. That night he developed chills and a fever.

Jan. 3 – woke up at 5 am with sinus drainage and minor coughing. Both hands had become swollen and he had body aches. His top lip was also swollen (never affects throat or breathing) and he had large pink welts over most of his body. His fever had gone down but not away and he was still very tired. By mid-afternoon his bottom lip had become swollen. He slept most of the day due to a combination of fatigue and Benadryl (to try to alleviate the swelling).

Jan. 4 – lips were almost back to normal but he was still tired and achy. He still had the very large pink hives and felt chilly.

Jan. 5 – feeling better but still had large pink blotches.

Jan. 6 – blotches were starting to flatten.

Jan. 7 – hives almost gone.

DEAR READER:
Your husband appears to be having several attacks of acute urticaria (hives) a year. Acute in this instance means that the hives last for less than six weeks.

According to both the American Academy of Dermatology and the American College of Allergy, Asthma and Immunology, there are three common causes of urticaria. These are allergies to foods (such as shellfish, peanuts, dairy or others) and reactions to medications such as penicillin and infections. Insect bites, internal diseases, cold, or sunlight are other, less common causes.

I believe the cause of your husband’s hives is infection. Thanks to your detailed description, it appears that there are two things going on. First, he experienced swelling and redness in a small area that progressed throughout the day. He then developed upper respiratory infection symptoms (which can take 12-36 hours to appear following exposure) followed by worsening hives.

I don’t think there is any coincidence in the fact that his symptoms last approximately seven days, which is the average length of the common cold. Since I am not an allergist, I cannot give specific information about how to treat these hives. I also do not know if there is a way to prevent symptoms from appearing since each infection is likely to be due to a different strain of bacteria or virus.

If your husband improves while using prednisone, I urge him to speak with his physician about using it. Small doses for short periods of time will not cause side effects and long-term damage is avoided. The prednisone probably won’t help the cold but it will be a lot easier to deal with a simple cold by itself without having itchy, swollen blotches all over his body as well.

Bring my response to his allergist and ask his opinion. He or she should also be able to provide possible treatment options at that time.

To give you related information, I am sending you a copy of my newly written Health Report “Allergies”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

My 41-year-old daughter was diagnosed with this. She is married, has a daughter and lives in London. Her condition prevents her from working fulltime at any job. Please help!

DEAR READER:
Vasomotor rhinitis is a condition that causes a constant runny nose, sneezing, and nasal congestion. It is not caused by an infection or allergy. Symptoms are often triggered by certain medications, air pollution, strong emotions, dry atmosphere, spicy foods, or other irritants.

The condition is similar to that associated with minor upper respiratory infections and allergies but without an obvious cause. Without knowing what the triggers are, treatment can be difficult.

I suggest your daughter keep a journal of her daily activities and substances to which she is exposed. For example, are her symptoms worse when the air is dry or if she is upset? By keeping a daily record, she may be able to spot patterns that will then allow her to reduce or prevent contact with the offending trigger(s).

Decongestants and antihistamine or steroid nasal sprays may bring symptoms under better control. Your daughter should be under the care of an otolaryngologist (ear-nose-and-throat specialist). He or she can then help her develop a treatment plan.

Now to a related, but perhaps not medical, topic. You claim your daughter cannot hold down a full time job because of this condition. I find this incredibly hard to believe. She appears to be using this benign, yet annoying condition as an excuse. No one likes having a drippy nose or sneezing, but to claim it prevents full-time employment is, in my opinion, rubbish.

To give you related information, I am sending you a copy of my Health Report “Allergies”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Over the last eight years I have had numerous expensive medical tests, some two or three times, and all were negative. I am female, 5’ 8” and weight 115 pounds, that is 50 pounds less than what I used to be. When I mentioned to my primary care physician that I thought this problem may be related to a food allergy, he shrugged it off and continued to set me up for tests. I was labeled with IBS, given prescriptions and shunted to the side. It didn’t matter that I still had stomach problems and the prescriptions were not helping.

After eight years of this, I had had enough and went “out of network” to a doctor. I was asked to keep a food log for five days but kept one for a month. This doctor, after seeing the food log and examining, all in one visit, told me I had a classic case of gluten/wheat sensitivity.

I followed a somewhat strict gluten/wheat free diet for one week and noticed a difference. After receiving my proper diagnosis, I started doing some of my own research. I found that skin conditions, such as psoriasis and eczema (which I had had for eight years also) may be directly caused by a food allergy, as are excessive diarrhea, unexplained weight loss and IBS.

I knew there was something wrong with other than IBS but I couldn’t get my primary care doctor or the numerous specialists I had seen to acknowledge this. No one every asked me what my regular diet was. I don’t expect you to print this letter but hope you will because I know it will help others who have been labeled as having IBS but don’t get better on appropriate medication.

DEAR READER:
When I received your letter, I was dismayed that you had had to suffer for eight years because your physicians simply wouldn’t listen. I was also incredibly pleased to hear that you decided enough was enough and took your care into your own hands. In this way, you not only received an appropriate diagnosis but you also found a caring, attentive physician.

I have said this before, but based on the increasing number of letters I receive from disgruntled patients, I feel it is necessary to say again. Physicians need patients; they are their livelihoods. It is therefore in the physician’s best interests to treat every patient with kindness and respect. Patients also need to take responsibility for their health and stand up for themselves. Most common ailments, such as high blood pressure, high cholesterol, arthritis and others can be improved by taking simple steps to modify weight, diet and exercise.

For the past two or three years he has had an itch primarily on his back and shoulders but sometimes is all over. The dermatologist has tried many salves, creams, cortisone and other things. He also ordered a biopsy which turned out normal. What do you advise?

DEAR READER:
Itchy skin can be difficult to treat. It is often caused by irritants and is accompanied by a rash. Your husband appears to have run the gamut of dermatologic causes and now needs to move on.

First, I recommend that he stop swimming for two or three weeks. Many people experience skin dryness, itchyness and/or rash because of some of the chemicals in the pool. This is especially true for public pools where chemical levels are often higher than home pools, due to the fact that more people use it therefore more bacteria and contaminates must be eliminated.

Another possible cause could be an environmental allergy. Perhaps a trial of over-the-counter antihistamines such as Claritin or Zyrtec is appropriate. If all else fails, your husband should see an internist who can further test him and if necessary refer to other specialists.