Dear Dr. Roach: When I sit and take a meal or drink coffee, my eyes slowly close! But Iím not asleep. My daughter or son-in-law will speak my name or bump my foot to get me to open my eyes. I was having coffee the other day and dropped my cup. I am getting worried. Iím 80 years old and in good health.
Dear Anon.: The most concerning condition that comes to mind would be myasthenia gravis. Itís caused by antibodies at the site where the nerve tells the muscle what to do (called the neuromuscular junction). The eyelids are the classic involved body site, with more than 50 percent of people affected predominantly in the eyelids. Double vision also is common in this condition.
Early on, myasthenia gravis has intermittent symptoms, but over time they become more persistent. I would recommend that you visit a neurologist. Physical exam, blood tests and sometimes an EMG (a test of nerve and muscle activity) and a trial of medication in the office make the diagnosis.
Early symptoms of myasthenia gravis can be subtle, and itís entirely possible that what you have is something much simpler.
Dear Dr. Roach: I have cutaneous T-cell lymphoma ó Sezary syndrome. CTCL is a cancer of the lymphocytes (white blood cells) that primarily involves the skin. I am at advanced stage 4A, and it has involved my lymph nodes. After three years of treatment, I am now on chemotherapy.
Please inform your readers about this disease, because early detection by doctors is so important.
Dear I.: Sezary syndrome is a rare disease (less than 1 case per million people yearly). It is a type of skin lymphoma, but it also has malignant T-cells in the blood (leukemia). It is almost always found in people over age 30.
The hallmark of Sezary syndrome is a diffuse red rash covering more than 80 percent of the body. The diagnosis is made via skin biopsy and sophisticated blood testing. It must be suspected in order to make the diagnosis.
Email questions to ToYourGoodHealth@med.cornell.edu.