DEAR DR. DONOHUE: My husband had terrible neck pain. He saw three different specialists, who could not help him. The fourth specialist, a neurologist, made a diagnosis of dystonia. That is something we have never heard of. What makes it appear? My husband got a shot of Botox, and it has helped a lot. – D.B.

ANSWER:
Dystonia is a painful, sustained muscle contraction that twists people into contorted postures and can keep them locked in those postures.

Torticollis, for example, is the kind of dystonia that draws a person’s head so far to one side that it almost touches the shoulder.

What causes dystonia is a matter of conjecture. When the process begins early in life, genes play a major role. Dystonia that comes on later in life is also influenced by genes, but the exact genetic mechanisms are as yet unexplained and often complicated.

Botox is the toxin from the most serious kind of food poisoning, botulism. The toxin causes muscle paralysis. When used in medicine, it comes in a purified form and in a dose that can relax muscle contraction without paralyzing the muscle.

Dystonia is not Parkinson’s disease and is not a form of epilepsy, but the drugs used to treat those two illnesses meet some measure of success in treating dystonia.

The best advice I can give to dystonia patients is to contact the Dystonia Medical Research Foundation, which stands ready to provide the latest information to dystonia patients and to guide them to the best care available in their locations. The U.S. number is (800) 377-3978, and the Canadian number is (800) 361-8061. Contacting the foundation is the wisest move a dystonia patient can make. The foundation’s Web site is www.dystonia-foundation.org.

DEAR DR. DONOHUE: I have had high blood pressure for 10 years. I am 40 now. My doctors have had to change my medicines and doses many times to keep my pressure controlled. My current doctor had me get an ultrasound picture of my kidneys. It showed a narrowed artery leading to my right kidney. After more tests, I was told I needed an angioplasty on the narrow artery. Can’t I leave things as they are and continue with medicines only? – K.R.

ANSWER:
You are one of the few high blood pressure patients who can be cured. You have a form of high blood pressure called renovascular hypertension – “hypertension” being the medical word for high blood pressure.

The kidneys are intimately involved in blood pressure control. They manufacture a substance that raises blood pressure when the occasion calls for it.

The narrowed artery to your right kidney makes that kidney think you have low blood pressure. It therefore keeps up a nonstop production of the blood-pressure-raising substances. It does so because it has been tricked by the narrow kidney artery.

Enlarging the narrow artery with a balloon – angioplasty – eliminates the error that tricks your right kidney into the inappropriate production of blood-pressure-raising chemicals. Blood pressure returns to normal, and you can stop taking medicines. You should have no hesitation to have this procedure.

DEAR DR. DONOHUE: What makes me urinate so often at night? I don’t do so during the day. It’s not prostate trouble, since I’m a woman. What can a do about it? – D.P.

ANSWER:
Normally, more urine is produced during the day than at night. With age, however, kidneys sometimes shift into nighttime production, and that’s one cause that forces you out of bed and into the bathroom.

There are also illnesses where nighttime urine production rises. Three examples are diabetes, heart failure and kidney disease. Have the doctor look for such problems.

If no medical condition is the cause, you can sometimes end the nocturnal journeys from bedroom to bathroom by eschewing caffeinated beverages and alcoholic drinks after 3 p.m.. From dinnertime on, cut back on all fluids. Reduce your intake of salt, which retains fluids that are then filtered into the urine during the night.

DEAR DR. DONOHUE: Twenty years ago, I was told that the numbness in my right arm and hand was caused by thoracic outlet syndrome. The symptoms are now becoming more of a problem. I mentioned the situation to my physician but did not receive much feedback. Any suggestions? – F.C.

ANSWER:
The thorax and the chest are one and the same. On a skeleton you see ribs encircling the chest and creating a structure similar to a dome. Like many domes, the chest dome has an opening at its apex – the thoracic outlet. Nerves and blood vessels arising in the chest pass through the opening on their way to the arms and hands.

Thoracic outlet syndrome results when structures adjacent to the outlet narrow it and compress nerves and blood vessels.

An extra rib, a band of scar tissue or overly large neck muscles are examples of things that compress nerves and blood vessels as they exit the chest.

Symptoms depend on which structures the narrowed outlet squeezes. If arteries are squeezed, the wrist pulse becomes faint and the arms pale. If veins are the target, pain and swelling of the arm and hand is the consequence. Nerve compression gives rise to weakness, pain or numbness of the arm and hand.

Physical therapy and exercises designed for each patient’s particular problem can often relieve thoracic outlet symptoms. Sometimes correction of faulty posture produces a cure. Surgery is reserved for extreme cases that do not respond to physical therapy.

Some doctors don’t subscribe to thoracic outlet syndrome as an explanation for the above symptoms. They say something else must be the cause of these symptoms. Those doctors have a point. Many conditions produce similar symptoms, so all causes of such symptoms need investigation.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible.

Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.


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