health

New COVID-19 Symptoms Discovered as Pandemic Continues

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | June 1st, 2020

Dear Doctor: Every time I turn on the news and hear about the coronavirus, the symptoms keep changing. Why is that? How do we even know when we should go see a doctor?

Dear Reader: It feels like it’s been forever, but news of the virus that causes the disease we now know as COVID-19 first emerged in the U.S. at the start of 2020. (The name is shorthand for “coronavirus disease 2019.”) It’s caused by a novel -- never seen before -- coronavirus, which is the same type of virus that causes upper respiratory infections, including the common cold. This particular virus is brand-new to humans, which means that not only do we lack immunity, but also that we’re learning about its symptoms and effects in real time.

Our first glimmers of understanding came from patients infected in the initial outbreaks. At that time -- and it still is true today -- common symptoms included a new cough, fever and shortness of breath. The severity of the resulting illness ranges from something akin to a mild cold to the devastating pneumonia that has taken so many lives throughout the world. As the number of infections continues to grow, so does the data set used by the medical and scientific communities to understand the virus’s effects and behavior. We learned that older adults and those with underlying health conditions are at greatest risk of becoming gravely ill. Children appear to be somewhat safe from the virus. And as screening got underway, it has emerged that some people who never exhibited any symptoms at all have tested positive.

Now, close to five months into what has become a global pandemic, additional symptoms and effects of COVID-19 continue to emerge. One, noted anecdotally by people who shared their stories after becoming ill, is a sudden loss of the sense of smell. Known as anosmia, it’s believed to occur in anywhere from one-fifth to one-half of all cases. A study in Europe pegged the prevalence of anosmia in COVID-19 patients at more that 85%.

Additional reported symptoms include chills, muscle pain, aching joints, sore throat and persistent headache. The disease is known to cause gastrointestinal symptoms that include nausea, vomiting or diarrhea. In addition to anosmia, neurological symptoms can include tingling or numbness in the extremities, muscle weakness, dizziness, confusion and delirium. Although seizures, stroke and abnormalities in blood clotting have been reported, these symptoms appear to be rare. An effect of the virus, which is widely reported but is not yet part of the Centers for Disease Control and Prevention’s list of symptoms, is extreme fatigue. Some children and a few adults have experienced something dubbed “COVID toes,” which is a red or purple rash similar to frostbite or chilblains.

All of this has prompted the CDC to continually update information pertaining to COVID-19 on its website. The amended guidelines about when to seek emergency medical care now include trouble breathing, persistent pain or pressure in the chest, bluish lips or around the face and the onset of confusion. For more information, visit the CDC website at cdc.gov. Links to a variety of information are on the front page.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

COVID-19
health

Passing Gas Is a Fact of Life

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | May 29th, 2020

Dear Doctor: I’m 102 years old and a World War II veteran. My problem is that I pass a lot of gas. Several days ago, I had an apple and a small piece of sweet potato, and I stunk up the whole house. I had to open all of the windows and doors. Do you have any suggestions?

Dear Reader: We do have some thoughts on your issue, but first we want to congratulate you on a long life. Our readers often include their age in their letters, and you have surpassed them all by several years.

Internal gas is a fact of life. Whether it’s emitted through the mouth as a burp or through the anus as flatulence, it’s actually a sign the body is functioning properly. Gas can accumulate as a result of air ingested while eating, drinking, speaking or swallowing. It’s also a byproduct of digestion, during which gut bacteria help break down food and emit a range of gases as they work. Most flatulence is made up of carbon dioxide, methane and hydrogen, which are essentially odorless. A small percentage of passed gas includes hydrogen sulfide, which has a powerful odor. Believe it or not, we humans pass gas from one dozen to two dozen times per day.

When excessive gas is accompanied by additional symptoms such as bloating, abdominal pain, loose stool or diarrhea, poor appetite, nausea and unexplained weight loss, it can signify the presence of underlying intestinal issues. These can include irritable bowel syndrome, inflammatory bowel disease, celiac disease, Crohn’s disease or small-intestinal bacterial overgrowth. If you do have these additional symptoms, be sure to let your doctor know.

Another factor in excessive gas is a person’s age. Due to ongoing changes in our bodies as we grow older, our digestive systems become less efficient at processing the food we eat. Some people may even develop lactose or fructose intolerance.

One approach to the problem is to identify the specific food triggers. You can do this by eliminating all suspected foods from your diet, then gradually reintroducing them one by one. Common culprits include high-fiber foods, certain fruits, cruciferous vegetables, beans and items with the artificial sweetener sorbitol. Keep track of symptoms, and you’ll be able to identify not only the specific foods that lead to excess gas, but also the serving size at which it becomes a problem.

You have several options to manage flatulence. Some people swear by probiotic foods and supplements, which can balance the gut. Your health care provider can help you decide if this is an option for you and advise you on specifics. Over-the-counter anti-gas preparations, such as Beano, or those that contain simethicone (Mylanta II, Maalox II) or bismuth (Pepto-Bismol) can reduce gas. Taking Lactaid, an enzyme supplement, helps people who have trouble with milk products.

And take a look at your prescription medications. Blood pressure drugs, narcotics and allergy meds, which can slow digestion and are associated with excess gas. Always check with your doctor before making any changes to medications.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Physical HealthAging
health

Dropped Bladder Has Different Levels of Severity

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | May 27th, 2020

Dear Doctor: I’m a 75-year-old woman and have been diagnosed with a dropped bladder due to a hysterectomy in my mid-40s. I have discomfort, particularly when I walk a long distance or do heavy lifting; some leakage problems; and frequently have UTIs. What can be done?

Dear Reader: A prolapsed bladder, also known as a fallen bladder, or cystocele, is common after a hysterectomy. It’s due to the drop in estrogen levels that occurs after the uterus and ovaries are removed. Estrogen, the primary female sex hormone, plays an important role in keeping the pelvic tissues toned and strong. Additional causes of the condition can include physical stresses, such as childbirth, frequent straining due to constipation or a chronic cough, heavy lifting and obesity. The decrease in estrogen that accompanies menopause can also contribute to bladder prolapse.

The condition is broken down into four separate stages, from mild to severe, depending on the degree to which the bladder has dropped. Women with a mild case -- Stage 1 -- may not experience any symptoms. When the condition is more advanced, symptoms include the discomfort, stress incontinence and frequent urinary tract infections that you mentioned, as well as lower back pain, difficulty with urination or bowel movements, pain during intercourse and a bulge of tissue from the vagina. In the most advanced cases -- Stage 4 -- the entire bladder protrudes.

Treatment depends on how far the bladder has dropped, as well as variables such as age, medical history, general health and personal preferences. In moderate cases, nonsurgical treatments can help. These include estrogen replacement therapy, which can be administered in a patch, as a pill or in a cream, and is used to strengthen the tissues that support the bladder. Kegel exercises, which are deliberate contractions of the muscles that you use to control urination, strengthen the pelvic floor. Electrical stimulation is used to trigger muscle contractions and build strength and tone, and some women have success with biofeedback.

Another nonsurgical option is a pessary. That’s a rubbery, donutlike device that is inserted into the vagina, much like a diaphragm. The pessary provides physical support. It can ease discomfort and has been shown to help with urinary control. It generally takes just one office visit with a urologist to be measured and fitted with the appropriate device. After that, pessaries require monthly cleaning. Depending on the device, this can be done at home, or it may need to be done in the urologist’s office. Many women do well with a pessary, while others experience discomfort or irritation. Infections are possible, but when a pessary is fitted and cleaned properly, the risk is small.

For severe cases of bladder prolapse, or when the less-invasive methods of managing the condition are not successful, reconstructive surgery may be needed. The goal is to return the bladder to its proper position. Before opting for surgical repair, be sure to learn all about the procedure you will have, as well as the potential risks, benefits and other options available.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Physical Health

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