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Dear Dr. Roach: My daughter, 18, has low immunoglobulin, which was found inadvertently at age 12 while undergoing testing for a different medical issue. Her levels of immunoglobulin G (2.55g/L), immunoglobulin A (0.10g/L) and immunoglobulin M (0.10g/L) are at the lowest level since being tested two years ago. She has no illness, and other than a low iron score (with some fatigue), she feels well overall.

She is interested in getting a tattoo and a cartilage piercing, so I asked her to go to her doctor and make sure that her low immunoglobulin levels would not be contraindicated (as to the risk of infection). She has never had an infection of any kind (not even an ear infection), and has had a normal amount of colds over the years. My daughter has had all recommended vaccinations, including HPV (as per Canadian guidelines), but has not had any blood tests to see if her body has responded to the vaccines.

I’d like to know your opinion in regard to any issues that may arise were she to develop an infection from a tattoo or cartilage (ear) piercing. I’m also interested to know what having low immunoglobulin means for her, since she has no illness or repeated infections arising from this.

J.H.

Dear J.H.: It sounds like your daughter most likely has common variable immunodeficiency. Despite the name, it isn’t really very common, about 1 in 25,000 people, but it is highly variable. It is sometimes never diagnosed, and there is usually a delay in diagnosis when made.

Infections are the most common symptom — for example, pneumonia, sinus infections and gastrointestinal infections such as Salmonella and Giardia. Autoimmune diseases, chronic lung disease and some cancers (especially lymphoma) occur with higher frequency in people with CVID.

I would recommend that she see an immunologist, who is most likely to have expertise in this disease. Your daughter should be checked for evidence of response to the vaccines: Those with no evidence for immunity to these diseases usually are started on replacement immunoglobulin therapy. Higher doses are given to people with serious infections in order to help them fight off the infection.

The question about ear piercing and tattoos is tough to answer. Given that she has never had an infection, it’s unlikely that she will get one with a professionally done tattoo or ear piercing. Even so, most immunologists recommend against them.

The critical issue here is to confirm my suspicion of CVID with an expert. I found much more information at tinyurl.com/jke43jm.

Dear Dr. Roach: My husband suffers from plantar fasciitis. He has had several special orthotic inserts made, and he buys new shoes every six months. Is there anything new on the subject to help the pain go away? What causes it in the first place? Once healed, will it return?

M.

Dear M.: The plantar fascia is a thick, tough connective tissue at the bottom of the foot, attached to the heel bone and to each of the five toes, providing support to the foot. Plantar fasciitis is a common cause of foot pain. The sufferer often describes the first step in the morning being the most painful, then gradually lessening over the day. The cause is unknown.

It is seen in runners, especially those who have recently increased their distances. The go-to treatment is to try the following: rest, ice and anti-inflammatories initially; supportive and cushioned athletic shoes, perhaps with silicone heel inserts; and stretching exercises.

For people with more difficult and prolonged symptoms, custom-made orthotics and steroid injections are options. Surgery is a seldom-used last resort.

Email questions to ToYourGoodHealth@med.cornell.edu.

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