To Your Good Health:Granddaughter’s common symptoms are uncommonly frequent
BY KEITH ROACH, M.D.
DEAR DR. ROACH: I am a 71-year-old grandmother who is very concerned about the health of my 18-year-old granddaughter. She has had the following symptoms for the past seven years, at least: earache, headache, swollen glands, sore throat and cough.
I have accompanied her to many doctor visits, and talked to the doctors and the ear specialist about how often our granddaughter has had to miss school due to her symptoms. She has been out of school about once a month for years. In the beginning, she was prescribed antibiotics, which did not seem to help her much. She then was told to take ibuprofen, and that is basically what she does when these symptoms occur.
Two years ago, she had bloodwork done, and the doctor reported that her white blood cells were normal. I asked both the specialist and her doctor just last week if they have any idea why she continues to have these symptoms. The stock answer is that most children get sick from being in contact with students at school. I cannot, in good faith, accept these responses, but I do not know where to turn, particularly when she will be going off to college in September.
I write this with tears in my eyes due to sheer frustration at not being able to do anything for her. Can you help, please? — A.M.
ANSWER: The symptoms she has are very common and are not specific to any particular disease. However, the frequency with which she has had them is not. While her doctors may be correct that this is just from being exposed to many different germs (both bacteria and viruses), I would be concerned about the possibility of common variable immunodeficiency. CVID should be considered in any child or adult with a history of recurrent bacterial infections, especially those involving the sinuses, lungs, ears or bronchi. The screening blood test is simple: an immunoglobulin level. IgG levels are always low in this condition, and IgA and IgM also might be affected.
There are other, rarer kinds of immune deficiencies with these symptoms. An immunologist is the expert in evaluating these conditions.
DEAR DR. ROACH: My doctor tells me that I have valvular heart disease with “trace MR and trivial TI.” She doesn’t seem too worried about it. Could you explain? Should I worry about it, and is there anything I can or should do? — B.R.
ANSWER: There are four valves in the heart: the mitral and aortic valves on the left side, and the tricuspid and pulmonic valves on the right. Valves can fail to open completely, which we call “stenosis,” or they can allow blood to leak back the wrong way, which we call “regurgitation” or “insufficiency.” The degree of valvular disease usually is characterized as trivial, mild, moderate, severe or critical. “MR” in this context is “mitral regurgitation,” and “TI” is “tricuspid insufficiency.” Both of these indicate backward flow from the ventricles into the atria.
A small amount of regurgitation is very common. In a study from 1990, 58 percent of people over 50 had trivial or mild mitral regurgitation, and 74 percent had trivial or mild tricuspid insufficiency. This degree of valvular insufficiency rarely if ever causes any problem; there usually is nothing that needs to be done, and I don’t think you should worry about it.