Dear Dr. Roach: I’m a 74-year-old woman who’s quite healthy (I am active and don’t take any medications), but I have a history of irritable bowel syndrome (IBS-C). Recently, I experienced bad-smelling gas, leg cramps, and finger and toe spasms. I quit eating milk products, and my symptoms almost immediately disappeared. My question is: Do food intolerances increase with age? Also, can leg cramps and digit spasms be attributed to a food intolerance?
— H.W
Dear H.W.: The most likely diagnosis is lactose intolerance. This is caused by a deficiency in the enzyme lactase, which is used to split milk sugar into its constituent simple sugars. This condition is rare in childhood and does increase with age.
I’ve seen people with lactose deficiencies who complain about abdominal cramps, but digit spasms and leg cramps aren’t usually described with this deficiency. I’ve seen these symptoms in people with severe celiac disease due to low calcium levels. Since your symptoms disappeared when stopping milk products, it seems clear that these are, indeed, symptoms of a lactase deficiency, but they’re unusual enough that they aren’t well-described.
Dear Dr. Roach: My husband has had neck pain for over two years. He has been treated with ablation of the neck nerves but hasn’t experienced any significant lessening of the pain. He’s been on oxycodone for at least a year. Nothing seems to be working on lessening his pain on a continuous basis. What’s your opinion on fentanyl patches? He’s 88 and very weak, but he doesn’t have any major physical problems.
— D.S.
Dear D.S.: Fentanyl is a very potent synthetic opiate, and the patch allows continuous absorption through the skin. It’s useful for people who need strong opiates, such as those with cancer. Unfortunately, opiates aren’t always a good choice for muscular or skeletal pain, which is likely the cause of your husband’s neck pain. If oxycodone isn’t working well, fentanyl probably won’t either. The body can quickly get used to high doses of any opiate.
Without knowing a lot more about his neck pain, I can’t make any definitive recommendations. Pain management experts will often try other types of injections (such as epidural steroids), along with different types of medications. Medicines that work on the nerve pain cells (such as gabapentin or duloxetine) can be of benefit in many people. A pain management expert is an essential consultant for your husband.
Dear Dr. Roach: I have slowed gastric motility and would like to draw your attention to a potentially dangerous reply that you gave in a recent column. There was an 85-year-old with a sluggish gut who asked about fiber supplements. You said that it was good to take fiber supplements for diarrhea and constipation, as well as cholesterol reduction. This is usually sound advice; however, in people with gastric motility issues, fiber supplements can be dangerous.
For people with slowed gastric emptying, fiber can increase the risk of bezoars, which can be life-threatening. A person with slowed gastric motility is supposed to limit their fiber intake to no more than 2-3 grams per meal to prevent solid masses from forming in the gut. This may be what they were referring to when they said they heard that fiber supplements mess up your gut.
— A.Y.
Dear A.Y.: I appreciate your writing. You are right that in the case of gastroparesis, too much fiber can lead to a bezoar, which is a nondigestible stone-like mass that can block the gut. People with diagnosed transit problems of the gut should seek specific advice about treatment from their gastroenterologist prior to using fiber supplementation.Readers may email questions to ToYourGoodHealth@med.cornell.edu.
This article originally appeared on The Detroit News: Dr. Roach: Leg cramps and digit spasms occur due to lactose intolerance
Reporting by Dr. Keith Roach, To Your Health / The Detroit News
USA TODAY Network via Reuters Connect
By Dr. Keith Roach, To Your Health | USA TODAY Network
