DEAR DR. DONOHUE: My voice got hoarse last week. I thought it might be due to yelling and screaming during my son’s high-school football game. After whispering for a week, I’m not any better. What can I do? – C.C.

ANSWER:
For one, stop whispering. Whispering is a greater strain on the voice than is normal speech, but limit your speaking. Carry a pad, and write things on it instead of using your voice. You have to give your vocal cords a rest.

There’s a rule for hoarseness: Don’t let unexplained hoarseness go longer than two weeks without a doctor identifying the cause. It has many causes. Vocal abuse is one, but not the only one.

Laryngitis is a possibility. It’s a viral infection of the voice box, and there may be no other symptoms of it, like a sore throat. It should clear in two weeks.

A seldom-appreciated cause is gastroesophageal reflux – GERD, better known as heartburn. Stomach juices can spurt upward as far as the voice box and cause irritation and voice changes. And this can happen without typical heartburn pain. Treatment is slowing the production of stomach acid with medicines.

Vocal-cord polyps bring on a raspy voice. So does the most important cause – cancer.

If the family doctor can’t track down the cause, an ear, nose and throat doctor can. He or she can take a look at the voice box and the vocal cords with a scope and identify the problem promptly.

DEAR DR. DONOHUE: I have not left my house for more than a year. Many times, I have gotten dressed to visit friends, but when I reach the front door, I freeze.

I feel sick to my stomach and think I am about to pass out. I’ve been told this is a phobia. What kind of phobia is it, and how can I get over it? – R.Z.

ANSWER:
It’s agoraphobia – fear of the agora, the Greek’s marketplace, a place as crowded with people then as are malls today. The fear is actually a fear of having to interact with people.

For many, agoraphobia has its roots in panic attacks. You might remember being in a public place when your heart started to race, you were sweating, you felt nauseated and you believed you were on the verge of dying. Associating a panic attack with a crowd leads to a fear of ever being in a crowd. The fear makes you a prisoner of your own home.

You would be surprised to learn how many people suffer the same crippling fear. Your family doctor can refer you to a professional who will work with you on how best to lose this fear.

Early in the course of treatment, anti-anxiety medicines can calm you when you’re going to places where panic sets in. The therapist will gradually desensitize you to public appearances. There are many ways of accomplishing that. Then the medicines can be stopped.

DEAR DR. DONOHUE: I badgered my doctor into giving me a stress test. I had no symptoms, but I do have a family history of heart attacks. I flunked the test. The doctor thinks I’ll need to have my heart arteries catheterized and possibly have to have an angioplasty and a stent. I feel great. Why should I agree to these dangerous tests? I wish I had never asked for the stress test. – R.R.

ANSWER:
Be glad you asked for the test. It revealed hidden heart disease in the form of blocked or partially blocked heart arteries. Not having any symptoms isn’t always a good thing. For example, people who have no pain sensation injure themselves without knowing that damage has been done. You were content to live in la-la land, not knowing you have a heart problem.

No medical procedure comes free of the possibility of complications. Thousands of times, every day, catheterizations are done for pictures of heart arteries, angioplasties to squash artery buildup, and insertions of metallic stents to keep heart arteries open. Few disasters result from these procedures.

You have much more to fear from a blockage in a heart artery than you do from any of those tests.

DEAR DR. DONOHUE: At bedtime I have to take a large pill. I can’t get it down. I take a swig of water and throw my head back while swallowing. The darn thing sticks in my throat every time. Any hints? – W.P.

ANSWER:
Stop the head throwing. It’s making it impossible for the pill to go down freely. If you want to bend your head, bend it slightly downward toward your chest when you swallow. That opens up the throat, and the pill can slip down.

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. Readers may also order health newsletters from www.rbmamall.com


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