DEAR DR. ROACH: How does a medical condition get named? Once named, can the name be changed? I have a condition called hemiplegic migraines. Many people with the condition feel it should be renamed because the term migraine makes it seem less serious. Some were saying to call it TSS for temporary stroke syndrome, because it presents as a stroke but is temporary. What are your thoughts? E.D.V.
ANSWER: Hemiplegic migraine is a rare disorder that is much more common in women and often runs in families. As its name and you suggest, it is different from a regular migraine because it causes motor weakness during the aura phase. This can be terrifying for both the patient and the physician, as it can be indistinguishable from a stroke.
The symptoms often start in the hand and then move up the arm and into the face. This usually lasts for hours, although time courses of minutes up to weeks have been reported. People also may experience a decreased ability to speak, dizziness, unsteadiness and even mental status changes ranging from confusion to coma during the event.
I guarantee you that anyone, patient or physician, who knows this disease does not minimize its severity. However, I dont expect the powers-that-be who control nomenclature of diseases to be likely to change the name to TSS.
Amyotrophic lateral sclerosis was first described and named in 1874. It is also known as Lou Gehrigs disease because he was such a famous person to be diagnosed with this uncommon disease, so it wasnt exactly renamed. An example of a renamed disease is Reiters syndrome (a type of arthritis sometimes associated with eye and urethra inflammation following an infection), named after Hans Reiter, who was a physician leader of the Nazi Party. The condition he named is now called reactive arthritis, both in condemnation of him as a war criminal, and because it is a more descriptive term.
DEAR DR. ROACH: I am a 64-year-old woman, active and in good health. A friend recently let me use a bit of her ibuprofen topical cream for minor pain associated with an overused muscle. It worked well, without the digestive irritation I often experience with oral ibuprofen. So, I went online and ordered my own tube, which shipped from Macedonia! Do you think this product is safe to use? Why is it not available in the U.S.? M.H.H.
ANSWER: Topical anti-inflammatories, such as ibuprofen, are increasingly recognized as valuable and less-toxic alternatives to oral anti-inflammatories. The only topical such drug available in the U.S. now is topical diclofenac (Voltaren gel is one brand name), and I have had several patients swear by it, even bringing it back from European countries where it is available over the counter. It requires a prescription in the U.S., and the price has dropped considerably. With a coupon from GoodRx, it is about $25 for a 100-gram tube. I dont know whether topical ibuprofen will become available in the U.S. anytime soon.
DEAR DR. ROACH: I am a Type 2 diabetic of 18 years, with pretty good blood sugar control at age 62. My last A1c was 7.3. A previous internist recommended that I take one baby aspirin per day. I discontinued this about two years ago because of minor bleeding issues, and have not restarted. I am very active and not a cardiac patient. Do I need to think about restarting? My current internist seems not to have a preference one way or the other. B.B.
ANSWER: Different physicians will have different opinions, but for a person with a history of even a minor bleeding issue, most authorities would be likely to advise against it, despite the fact that aspirin has a modest benefit in people with diabetes. The benefit in reducing risk for a person without known heart blockages is small, and the risk of a serious bleeding event is probably higher than the benefit. Of course, the more serious the bleeding event, the more dangerous aspirin is.
Most people with diabetes should at least consider the use of a statin to prevent a first heart attack.
