Dr. Donohue: Lingering cough can be sign of big trouble

Syndicated Columnist
Published Wednesday, January 29, 2003

DEAR DR. DONOHUE: I have been coughing for three months. I do not smoke and never have. The cough gets worse at night and often wakes me. What should I do? -- R.I.

ANSWER: You should get to a doctor quickly. Coughs that last as long as yours usually indicate major lung problems.

Coughs are protective reflexes. They clear the airways of irritants and germs. A lasting cough is not protective. It is often self-perpetuating because constant coughing irritates airways.

One cause of chronic cough, while not a serious health threat, disrupts sleep. That cause is postnasal drip. Mucus from the nose and sinuses trickles down the throat and sets in motion the mechanism that keeps airways free of mucus. Sometimes something as simple as the use of a saline nasal spray before sleep can thin mucus and put an end to the cough.

Another contender as a cause of a persistent cough is asthma. Asthma does not always begin in childhood. Neither is the typical wheezing noise of asthma quite as typical as it is made out to be. A cough can be its only sign. Today's arsenal of asthma medicines is large, and one of its weapons might get you through both night and day without coughing.

Heartburn, also known as GERD (gastroesophageal reflux disease), is a spouting of stomach juices into the esophagus. Some of those juices can seep into the airways and activate the cough reflex. Medicines that control acid stomach juices put an end to coughs initiated by GERD.

I saved the worst for last. The worst cause is cancer. I don't mean to alarm you, but you cannot duck this possibility. Don't delay any longer. See a doctor.

DEAR DR. DONOHUE: I was horrified by your response to the 32-year-old woman suffering from chronic fatigue syndrome. You wrote that "some doctors feel this is an unfounded condition." I can tell you that chronic fatigue syndrome has made my life a shambles. You have helped perpetuate the ignorance that comes with this syndrome. You owe us a public apology. To do less would be inhuman. -- C.D.

ANSWER: A clarification I can offer. An apology? I don't think so.

It was I who suggested that the letter writer might have chronic fatigue syndrome. To me that is a strong indication that I believe the diagnosis is bona fide.

Whether you like to hear it or not, some doctors do not subscribe to the existence of chronic fatigue syndrome. They feel that there is insufficient evidence to support its diagnosis. That should not send you into a tizzy. The history of medicine is replete with examples of how some doctors have been reluctant to endorse new procedures or to agree that a new illness has been defined. You can rise above ignorance and maintain serenity in knowing that you are right.

Readers interested in learning the ins and outs of chronic fatigue syndrome can order a copy of the newly written pamphlet on this problem. Write to: Dr. Donohue -- No. 304, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 with the recipient's printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have been having trouble speaking for any length of time. If I attempt to have a telephone conversation for any reasonable stretch of time, my voice gets squeaky, and then I lose it completely.

Is there a cure for this condition and a name to go with it? People at work think I am making this up so I won't have to take my turn at the phones. -- N.T.

ANSWER: I can make a suggestion, but it might be off-track. Your symptoms hint that you could have spasmodic dysphonia. It's a condition where the vocal cord muscles cramp up when using the voice for any length of time. The muscle cramps distort the voice and can completely close it down.

An ear, nose and throat doctor can use a scope to watch how your vocal cords behave and confirm or deny my suggestion.

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