DEAR READER: Maybe. Ragweed allergy, commonly known as hay fever, presents with itchy eyes, scratchy throat, runny nose and fatigue but not generally hives. Food triggers include sunflower seeds, chamomile, cantaloupe, bananas and some honeys. The most common treatments for hay fever include remaining indoors when the pollen count is high, taking antihistamines and allergy shots. My guess, however, is that you have a true allergy, which is best treated with total avoidance once the offending substance is identified. Good luck.

In 1955, at the age of 2, I contracted polio. I was immediately put in isolation in a children’s hospital, where I remained for several weeks in casts and braces. My left leg was drastically crooked and atrophied in a short amount of time.

I have since overcome most of the setbacks, but in 1985, I was diagnosed with post-polio syndrome. It was like a recrippling and decay of all my energy. Since then, I have gotten progressively worse. I have educated myself by reading much material, visiting polio clinics and attending support groups, so I feel quite knowledgeable on the subject.

My mother and sister now claim they too suffered from polio and have PPS. They were never hospitalized, never had any visible signs, and had no lingering fevers from initial exposure. They have gone for almost 50 years not claiming this. Now, as they age, they want sympathy for their “supposed” polio devastation, and I am furious. They’re claiming I’m not compassionate and think I want the “glory” all to myself.

My dad and older sister never claimed the illness, so how could anyone even want to make such an unsubstantiated claim? Is the theory possible, even without visible signs? My goodness, I would never wish this crooked body and pain-filled life on anyone. It doesn’t make sense to me. I know the entire family did have a fever in 1955, but the germ passed through everyone as diarrhea. My mother now has arthritis, and my sister has bad feet. Do they really have a claim?

DEAR READER: The polio virus can be transmitted through contaminated food or water, or through direct contact with a person infected with the virus. So anyone in close proximity to you at the time you contracted it could have also become infected. And large majorities of people are never aware they’ve become infected, because some people develop a nonparalytic form of the disease. They might experience initial symptoms of fatigue, muscle spasms, meningitis, fever, sore throat and more that can last up to 10 days.

As you are aware, PPS can develop decades after the diagnosis has been made. It can be characterized by a weakening of muscles previously affected and in muscles that were not previously affected. Some patients may develop mild symptoms; others may suffer from joint degeneration, scoliosis and more.

A diagnosis of PPS is made only if certain criteria are met. This includes documented evidence of a positive diagnosis of paralytic polio followed by an extended period (typically 15 years or more) of improvement or stability. Symptoms must begin gradually but be progressive and persistent, lasting for at least one year. Other possible causes need to be ruled out before a diagnosis of PPS can be given.

There are several risk factors for developing PPS. These include experiencing severe symptoms following the initial infection; if the initial infection were acquired as an adolescent or adult; achieving drastic recovery (especially following severe symptoms); and performing physical activities to the point of exhaustion or fatigue.

Once diagnosed with post-polio syndrome, people should be monitored for complications. Severe muscle weakness may result in increased falls. Prolonged inactivity and immobility also increase the risk of developing osteoporosis. Combined with the risk of falling, broken bones may become a major concern. People with weakness of the muscles involved in chewing, swallowing and breathing also need to be especially watchful for signs and symptoms of malnutrition, dehydration, pneumonia and acute respiratory failure. People who experienced weakness of these muscles during the initial infection are more likely to experience these symptoms than those who developed weakness of the arms and/or legs.

You appear to be in a no-win situation. Your mother and sister are convinced they suffer from PPS, and unless they are willing to undergo confirmatory testing, you will likely never convince them otherwise. I don’t know their medical histories, but based on your information, it does not seem likely that they had polio. Even if they did, it was likely so mild that it caused few or no symptoms. This drastically decreases their risks of developing PPS. I don’t understand their comments that you are seeking all the “glory” in regards to your polio status. There is nothing glorious about living with deformity and pain. Both arthritis and foot pain have other, more common causes.

I believe your efforts will be better spent continuing with the positive attitude you are exhibiting, staying abreast of new treatments, attending support groups, and visiting clinics where you can help victims of the disease learn to cope.

DEAR READER: Testosterone is a naturally occurring hormone that stimulates the growth of male characteristics. Testosterone levels normally decrease with age; therefore, it is somewhat difficult to determine a normal level. Generally speaking, the range of total testosterone is 300 to 1,000 mg/dL, with some variation noted between laboratories. Men up to the age of 40 might have a level of 660, but by the time a man reaches 65 or so, his level could be around 525. It’s when that count falls to 300 that something should be done. It is estimated that low T levels affect almost 14 million men 45 years of age and older, with less than 10 percent of them being treated.

Should a young man develop enlarged breasts, smaller testes or changes in body hair, a physician might order a testosterone level. Without outward signs, however, many younger men go undiagnosed because testing is commonly “reserved” for older individuals.

Low T levels are associated with obesity, diabetes, erectile dysfunction, low libido, irritability, fatigue, an inability to concentrate, a lack of muscle strength and hot flushes.

Hypogonadism, either primary or secondary, is a term defined as a failure of the testes to produce sufficient testosterone, sperm or both. It can be caused by congenital or acquired problems in the testes, pituitary gland or hypothalamus. Primary involves the testes. Common causes include Klinefelter syndrome, undescending testicles, mumps infection, testicular injury, normal aging, chemotherapy and several other reasons. Secondary cases are associated with problems with the pituitary gland or a portion of the brain known as the hypothalamus. This may develop from tumors, HIV/AIDS, medications such as steroids and opioids, obesity, heavy alcohol consumption and more.

Risk factors include cirrhosis, renal failure, Cushing’s syndrome, sleep apnea, HIV/AIDS, sickle-cell anemia, paraplegia and disorders related to depression.

Testing involves simple blood work and should be a part of a comprehensive examination and work-up. If levels are found to be low, there are a number of possibilities for therapy. Pills remain unpopular because of their association with liver failure. Injections can cause variations in levels and involve visiting a physician periodically. Transdermal patches are applied directly to the skin to allow for steady absorption. The patches, similar to large Band-Aids, can cause skin irritation. Still other options include pellets attached to the gum and implants in the upper arm, buttock or abdomen. Both come with their unique issues. The most popular option is a gel rubbed into the skin over several sites such as the upper arms, shoulders and/or abdomen.

On the bright side, successful treatment — by whatever means preferred — should result in increased energy levels, less fatigue and increased sexual vitality. Improvement in bone density and muscle mass has been noted, too. Your husband’s condition is easily treatable via whatever method he and his physician deem appropriate. You will both be glad once his replacement-hormone therapy kicks in.

To provide related information, I am sending you a copy of my Health Report “Erectile Dysfunction.” 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, or download an order blank from my Web site, www.askdrgottmd.com. Be sure to mention the title.

I, too, had the same confusing symptoms and fought them for 11 years. My doctors and I looked at many possible causes, such as depression, endocrine disorders, sleep problems, fibromyalgia, vitamin deficiencies, diabetes and more. I had no energy, always felt as if I had a hangover and was unable to work or even complete simple tasks of daily living. I felt as though I were disabled.

My endocrine specialists wanted me to try the drug acarbose for what I thought was unrelated insulin resistance and low blood-sugar episodes.

The results have been amazing. I now feel energized in the mornings and don’t feel the need to take naps after eating. I am able to work, see my friends, clean my house, and concentrate. It has truly changed my life.

Perhaps this reader should investigate in this direction. I know how disabling this can be, and I hope she can be helped as I was. Please “pay it forward” on my behalf and suggest this to her and all of your readers who may be battling chronic fatigue or know someone who is.

DEAR READER: I have printed your letter in the hopes that my readers will benefit from it.

Chronic fatigue is often difficult to treat because it can be the result of many health conditions, and in some cases it has no known cause. Diabetes, hypoglycemia, fibromyalgia, depression, thyroid disorders, vitamin deficiencies, cardiac insufficiency or other causes might be to blame. You were fortunate to have had a physician who worked with you to find the cause of your fatigue.

I am a 77-year-old male. Last year I was jogging but six months ago I had to stop because I just don’t have the “get up and go” that I used to have. My health checked out fine and the doctor gave me a booster shot of vitamin B12 but it didn’t help me at all. Others have told me that I need a daily vitamin. There are so many on the market today that I don’t know which brand or strength is best.

DEAR READER:
A daily multivitamin may be all you need. I recommend you use one of the better known brands which may be a little more expensive than other brands but often has better quality control. Centrum and One-A-Day should offer you both the quality and variety you need. You may wish to shop around to find the best price or comparable brands.

I also urge you to have a full physical exam including a review of any medications you are taking, as well as testing for anemia, diabetes, congestive heart failure, vitamin deficiencies and more. Fatigue is a common symptom of many disorders. Because yours came on suddenly, I worry about potentially serious causes.

If everything checks out normal, it is then time to look at your diet, lifestyle, exercise and sleep habits, and stressors. These can be benign causes of fatigue and fortunately, are easily correctable with minor changes such as a more balanced diet, increasing exercise and reducing stress.

Start by adding the daily multivitamin followed by an appointment with your primary care physician.

To give you 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 number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

In 1997 I was short of breath, had stress tests and a heart catheter which indicated an 80% blockage in one artery and 50% in the other two. In the artery blocked 80%, I had angioplasty and a stent put in. Relief was immediate.

I felt fine until recently. I have arthritis and attributed the pain my left shoulder and upper arm to that. It started approximately two or three months ago. About three weeks ago I experienced extreme shortness of breath, weakness and fatigue. At the hospital I was diagnosed with blood clots in both my lungs associated with a low INR. I was in the hospital for six days on a course of Coumadin and shots of Lovinox. I was discharged when my INR reached 2.1. I take 10 mg Coumadin daily and felt fine for about a week. Then back to the ER with shortness of breath. Tests showed no clots but my INR had fallen to 1.7. I then consulted with my heart doctor and he ordered another stress test. Again everything was fine.

This leaves me in a dilemma. Chest X-rays and CT scans show nothing relative to the lungs and the stress test shows nothing relative to the heart. However, I still continue to be extremely short of breath, fatigued and weak. As far as I know, I was never diagnosed with asthma or emphysema. I used to be a heavy smoker (2 packs per day), but I stopped more than 12 years ago.

Please give me your expert thoughts on this. Should I opt for a second opinion at a place like the Mayo or Cleveland Clinics?

DEAR READER: Yours is a complicated ailment. For example, why did you develop blood clots in your lungs? Could this be a symptom related to a primary lung disorder or a clotting disorder?

Based on the information you gave, I am fairly confident you have a clotting disorder. Your INR (International Normalized Ratio, higher numbers mean less clotting ability, lower numbers mean more clotting ability) is abnormal despite treatment with an anti-coagulant. I recommend you make an appointment with a blood disorder specialist (hematologist). Bring your lab work and test results with you to the appointment. This will provide background information and aid the specialist in his diagnosis. He or she may choose to order more specific tests. If this specialist doesn’t find anything abnormal, I believe that a visit to a top-notch medical facility is entirely appropriate.

You need to know why you developed blood clots and why your INR is consistently low. In other words, your doctors may be treating your symptoms instead of searching for the cause. This needs to be remedied. Let me know how this turns out.

To give you related information, I am sending you a copy of my Health Report “Blood — Donations and Disorders”. 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.

I’m 61 years old, retired six years and in fairly good health. My blood pressure is very good, usually in the 120-135 over 70-80 range. I have no heart problems whatsoever. I’ve never had any problems with my internal organs, no cancers and no allergies (except to horse dander, so we don’t have one). I have a mild hiatal hernia and take medication for it. I have prostatitis that comes and goes. I take Ditropan when it acts up. I seem to be immune to colds and the flu. It has been about 5 years since my last cold. I am a light smoker. It makes me slightly drowsy so I only smoke when I want to nap and before bedtime. I drink two glasses of wine a day. I am 5 feet 9 inches tall and weigh 160 pounds. I am not a diabetic. I am an above knee amputee.

My cholesterol is normal. My wife and I eat a healthful diet of lean meats and lots of vegetables. We have fish 2-3 times per week on average, year round. Being Atlantic Canadians, we love fish. We don’t go to fast food places and don’t eat or keep junk food in our house.

As for symptoms of my fatigue, I generally get a goodnight’s sleep. At times I do have a problem falling asleep but not very often.

My family doctor thought my fatigue could be due to sleep apnea and I wore a monitor for one night. It was negative. Because my general health is probably better than the average senior citizen he sees daily, he didn’t seem too concerned or suggest anything further.

This daily fatigue usually lasts about an hour; however, some days it can last several hours. It doesn’t seem normal to me. I’m becoming more and more concerned that something is amiss. What should I do?

DEAR READER: Periods of unexplained exhaustion can be caused by many disease states, so before advising you regarding invasive studies, I suggest that you have a thorough exam by your doctor, followed by a full panel of blood tests, including a complete blood count, metabolic profile, thyroid study and cardiogram. This is a good first step and sets up a basic start point for future tests.

To give you related information, I am sending you a copy of my Health Report “Sleep/Wake Disorders”. Other readers who would like a copy should send a self-addressed 4 ¼” X 9 ½” letter-sized stamped envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.