Ask Dr. Roach: Medication can help identify the cause behind cough with mucus

DEAR DR. ROACH >> I am an 103-year-old woman with a medical problem that I hope you can help me with. I cough up a lot of mucus every day, which is clear with no discoloration.  The cough can start at anytime, but it is more prevalent at night. The mucus starts with the cough and can last anywhere from 15-30 minutes or more.

I don’t know where the mucus is coming from and was wondering if you had any suggestions. My chest X-ray was normal, and my doctor said everything is clear.

— R.S.

Dear Reader >> The mucus has to be coming from above (such as the nose and sinuses) or below (usually the lungs and rarely the digestive tract). If you had other symptoms pointing one way or the other, that could help.

For example, if you had a lot of nasal discharge, this would make post-nasal drip more likely.  However, if you had a history of smoking or wheezing, this would make the lungs a likely cause, even with a normal chest X-ray. Finally, symptoms of heartburn would make reflux disease a strong suspect for mucus production.

There are tests — such as CT scans, pulmonary function tests and endoscopies — that can help make the diagnosis, but often in older people, we try medications as a diagnostic challenge. An antihistamine for a week is pretty safe, and if it helps greatly, the post-nasal drip becomes the likely culprit. Similarly, an inhaler or a medicine to stop acid secretion might lead to improvement right away.

I’d recommend another visit with your doctor, since the X-ray didn’t lead to the diagnosis.  It’s time to try something new.

DEAR DR. ROACH >> I am a 68-year-old man in good health. Last year, the chronic numbness in my left thigh turned into a debilitating pain almost overnight. I could not walk10 feet. An MRI showed a disc protrusion, likely an extruded disc fragment at the L3-L4level, and a diskectomy was scheduled.

Since the pain went away, I sought a second opinion instead of surgery. A second MRI six months later showed that the fragment was gone, apparently absorbed by the body. The pain is largely gone. However, the numbness in my left thigh and leg remains. Is there any way to cure this numbness without surgery?

— O.V.

Dear Reader >> I’m not sure if the original chronic numbness was part of the herniated disk or not. If the numbness has been due to compression on the nerve, then relieving the pressure on the nerve tends to relieve the numbness. Unfortunately, if the pressure was present on the nerve for a long time, there is a chance of long-lasting or even permanent nerve damage.

I have certainly seen numbness that doesn’t go away after the pressure has been relieved, whether by surgery or by the body reabsorbing the disk material, which is common. My experience is that after a year, it’s unlikely to get much better.

However, you might have had a different reason for chronic numbness that had nothing to do with the disks. Chronic thigh numbness gives me suspicions about a condition called meralgia paresthetica, which is caused by pressure on a peripheral nerve. A neurologist or pain medicine specialist can help sort this out. An electromyography might also be diagnostic.

Contact Dr. Roach at ToYourGoodHealth@med.cornell.edu.

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