DEAR DR. ROACH: I am a 64-year-old female and weigh 130 pounds. I’m 5 feet, 8 inches tall. For years, off and on, my primary doctor would tell me that my sodium level was low. Recently, my doctor said that if my sodium level is low again, I need to see a kidney specialist. I assumed the low sodium is due to being diabetic and taking metformin. My other doctor also prescribed losartan along with hydrochlorothiazide (HCTZ). I finally went to a nephrologist, who took me off the losartan combo, and now I’m just on losartan. Blood work was ordered. The next doctor then told me to drink less water. I was drinking around 80 fluid ounces, but I have since curtailed my intake.
A friend mentioned that I may have Addison’s disease; she also has it. My symptoms are, at times, debilitating: fatigue, weakness, lack of concentration and focus, heaviness, diarrhea, stomach pain like a punch in the gut, nausea and deep belching. There are some good days.
I have another appointment next year in mid-January, and more blood work is ordered. I have not mentioned Addison’s disease to the doctors. What is your take, and how is Addison’s disease treated? I’m so frustrated. — T.F.
ANSWER: Low sodium levels are extremely common in people taking a diuretic in the thiazide class, like HCTZ. Years of being on HCTZ can also reset the body’s normal sodium level, requiring a person to drink less water in order to keep their sodium level in the normal range.
The symptoms you have are unlikely due to low sodium alone, even with a very low sodium level. None of the symptoms are specific to low sodium or Addison’s disease, which is a cause of low cortisol levels. Addison’s disease is quite rare, on the order of one person per 100,000. The hardest part about making the diagnosis of Addison’s disease is thinking of it in the first place, since the major symptoms of fatigue and abdominal pain are not specific. Low sodium levels do occur with Addison’s, so I think mentioning the possibility to your doctor is a smart idea.
The initial blood testing for Addison’s disease is not routinely done and requires an injection of a medication that should make your cortisol level go up. If it doesn’t, that’s strong evidence of Addison’s disease.
DEAR DR. ROACH: I’ve just been reading in your column about radiofrequency ablation for back pain. I have arthritis in my spine and have been experiencing great pain since August. My problem is in the L4-L5 disc. I had a cortisone injection a couple of weeks ago, which didn’t relieve the pain entirely, but did take the edge off it, so I’m no longer taking pain medication. It has been suggested to me that I consider platelet-rich plasma therapy. I looked it up and read it hasn’t been proven successful. I wonder if you have heard anything about it. — G.M.
ANSWER: Platelet-rich plasma (PRP) comes from a person’s own blood and contains growth factors that are intended to help repair damage, especially to tendons and joints. Initial studies showed short-term benefit, but newer, more-rigorous trials have been unable to show any benefit over placebo injection in six months of the study follow-up. The process is generally not covered by insurance. The process is safe when performed by an expert, but there is always the possibility of infection. Unless new evidence comes out that PRP has benefits over placebo, I do not recommend it for pain due to arthritis.
* * *
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 send mail to 628 Virginia Dr., Orlando, FL 32803.
(c) 2023 North America Syndicate Inc.
All Rights Reserved

Copy the Story Link