Dear Dr. Roach: For about the past year, I have had mouth movements that I do not intend to make. I can stop them if I really concentrate on doing so, but as soon as I think of something else, they resume. Lately, I also have involuntary movements on the left side of my mouth when I am about to fall asleep, or maybe when I have already fallen asleep. I make a loud noise, which wakes me up. The left side of my face is twitching wildly. Sorry, I don’t know how to better explain this, but I am partly asleep when it happens and don’t know anything else. Do you have any idea what could be going on?
L.S.
There are several different movement disorders that affect the face, some of which can cause tics, which is what it sounds like you are describing. Tics can occur by themselves, or in the context of another neurological condition. A good example of this is Tourette’s syndrome, which has a wide range of clinical expressions and does not always look the way it is portrayed in movies.
Some movement disorders are related to medication use, so a neurologist evaluating you would do not only a careful exam, but a thorough review of past medication use.
Dear Dr. Roach: I’ve heard of a new treatment for enlarged prostate. It’s called PAE. I understand it is a procedure that restricts blood flow to the prostate, causing it to shrink. Have you heard of it and any downsides?
W.G.
Prostate artery embolization uses plastic beads to block the arteries in the prostate, causing cell death and shrinkage of the prostate. In theory, that will improve symptoms of enlarged prostate.
It is a new procedure, and the benefits and risks are not as well understood as they are for more commonly used procedures. Complications, especially urinary retention, can happen up to 26 per cent of the time. Post-PAE syndrome has been described. It includes a burning sensation, nausea and vomiting. Given the lack of certainty about the relative effectiveness about this procedure compared with traditional options, the American Urological Association has recommended PAE be used only in the setting of a clinical trial.
Dear Dr. Roach: Can you get irritable bowel syndrome by living in a tropical climate? I moved to South Florida 15 years ago and have had this problem ever since. When I go up North, I have no symptoms within 24 hours. My gastroenterologist, who moved his practice from Pennsylvania to Florida, said he has never seen so many patients with IBS since his move. He has said he suspects there may be an irritant in the air or water that causes this. Any thoughts?
Anon.
IBS is a very common condition and is frequently not formally diagnosed. Ten to 15 per cent of North Americans meet criteria, and more women have it than men in North America. There have been several studies looking at geographic distribution of IBS, but there is no definitive increase in warmer climates.
The underlying causes of IBS are not known precisely, and no clear irritant in food or water has been found. Stress might cause IBS to worsen, so that’s a possibility. You might also be eating differently when you go back to Pennsylvania.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers can email questions to ToYourGoodHealth@med.cornell.edu
