Dear Dr. Roach: I’m 82, and I just found out that I have chronic lymphocytic leukemia. I have had it for almost four years, but I didn’t find out until I changed doctors. Should I have done something about it by now? They tell me there is nothing they can do.
Dear E.A.: I am surprised to hear that there are still some physicians out there who don’t tell their patients their diagnoses and their options for treatment. I have always felt that it is our obligation to share our knowledge so that the person can make the best decision for him- or herself, which may include no treatment.
The treatment for CLL recently and dramatically has improved, with the arrival of a powerful new treatment, ibrutinib. Nonetheless, not every person with CLL needs treatment or would even benefit from it. Age is a factor for choosing treatment, but not the only one. Because CLL is a condition with a wide range of severity, it is absolutely imperative that you speak with a hematologist who treats CLL to hear what your options are.
Dear Dr. Roach: I had my annual mammogram yesterday. While my left breast was being compressed (front view), my left jawbone up to my temple suddenly started to tighten. I told the technician, who immediately stopped the compression. After a few seconds, the pain stopped, and she was able to continue. The same thing happened to the left breast when doing the side view. What would have caused this tightening of the jawbone? Should I be concerned?
Dear M.L.: Seventy-two percent of women report pain during their mammogram, usually rated at less than 4⁄10 on a standard pain scale. However, the pain usually is described as being in the breast, rib or breastbone, or with movement. I’ve never heard the complaint of jaw and face pain during a mammogram. It could be “referred pain,” where pain in one part of the body is misinterpreted by the brain as coming from an entirely different part. In any event, I don’t think it should be a cause for worry. I specifically don’t think it’s heart pain, which sometimes feels like it is coming from the face or jaw.
If any readers have had this sensation during a mammogram, please let me know.
Dear Dr. Roach: Today, in our local paper, you indicated that psyllium, which is in Metamucil, is used to relieve constipation. I have pancreatic insufficiency as a result of surgery that removed the tail of my pancreas. Since surgery in January, I have had problems with uncontrolled diarrhea. I have been advised by several doctors to take psyllium to “bulk up” my stool and decrease the diarrhea problem. If this is used for constipation, I do not see how it will help my diarrhea problem. This seems counterintuitive. Please comment.
Dear B.G.: You are completely right that it sounds counterintuitive, but I assure you that psyllium often is used for diarrhea, as well. Psyllium absorbs a great deal of water, which can make stools firmer and move more slowly, allowing the body more time to absorb water from the colon. It works for mild or, at most, moderate diarrhea.
Diarrhea due to pancreatic insufficiency normally is treated with replacement pancreas enzyme, as well as medicine to reduce acid digestion of these enzymes in the stomach.
Email questions to ToYourGoodHealth@med.cornell.edu.