Coccydynia is a real pain in the rear

DEAR DR. ROACH: I have pain in my tailbone area and have had a colonoscopy and two pelvic CT scans, but nothing was found. Is there a specialist I can see, and do you have any suggestions? — J.B.

ANSWER: It sounds as though you may have coccydynia, which simply means “pain” (dynia) in the “tailbone” (coccyx). It’s usually associated with abnormal movement of the coccyx on the spine. This is generally treated by an orthopedic surgeon or pain-management specialist. Treatment includes not sitting on hard surfaces, using a specialized orthopedic cushion and the use of anti-inflammatories. Very severe cases may require surgery.

DEAR DR. ROACH: With regard to West Nile virus: If I am one of the majority of people who fight it off with no more symptoms than a cold, have I built up antibodies that prevent me from contracting it again? — P.I.

ANSWER: West Nile virus is a new illness in this country. It is spread by mosquitos. Most people, about 80 percent, have no symptoms at all, and 20 percent will have symptoms resembling flu, including fever, headache, body aches, nausea and vomiting. About 1 person in 150 will develop severe illness, including coma, convulsions, muscle weakness and vision loss. Sometimes the neurologic effects are permanent. Because this disease can be serious, especially among the elderly, prevention is key. Insect repellant, long sleeves and pants (especially if outside at dawn or dusk), and draining standing water where mosquitos can breed are all effective.

It is believed that immunity to West Nile virus is lifelong, but like all diseases, immunity may wane after many years. Also, most people can’t be sure they have had West Nile virus, so it just makes sense to continue to try to avoid mosquito bites.

DEAR DR. ROACH: My daughter has soreness and clicking in her jaw. She said it locked up. She says she can’t chew food normally anymore. The dentist referred her to an oral surgeon, but he wants $5,000 to treat her (including physical therapy and an appliance). What should I do? — R.C.

ANSWER: It sounds like your daughter has a moderately severe case of TMJ syndrome. TMJ stands for “temporomandibular joint,” which is the source of the pain and other problems. Common causes of TMJ pain include tooth grinding at night, which is very common; arthritis in the TMJ; dental problems, which cause the person to overuse the non-affected side; and stress, which may cause clenching of the facial and jaw muscles.

Treatment appropriate for everybody with TMJ pain includes application of an ice pack followed by a warm compress, eating softer foods, careful chewing with up-and-down and not side-to-side movement, and avoiding chewing gum. Anti-inflammatory medications such as ibuprofen also may be helpful. A visit to the dentist is essential to make sure there are no dental issues that need to be corrected.

Physical therapy may be useful for some people, especially if the conservative measures above haven’t done the job. But the appliance the oral surgeon recommended has been very effective for many people. However, $5,000 sounds like it’s out of the range of reasonable. Find another TMJ specialist.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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