Dear Dr. Roach: I am a 76-year-old man in excellent health. I don’t take any medication, except for simvastatin for over 15 years. My cholesterol is now below 200. But, a problem started about eight months ago. When sitting with friends, I’ll have my first drink of beer. Within a minute, my face gets bright red, and I get a feeling of anxiety. It goes away in a few minutes and does not return. If I have a sip, it still happens, just not as severe. It happens every time. I told my primary care physician about this in May at my annual physical, but he had no answer. He didn’t seem too concerned. What do you think about this? Should I worry?
The medical term for the face turning red, usually accompanied by a sensation of warmth, is called flushing. The face is the most common location, but some people will get flushing on their ears, neck, chest, torso or arms. The sudden onset you describe makes flushing the diagnosis, rather than any other causes of facial rash, such as lupus or a photosensitivity rash.
Alcohol alone can cause many people to flush, but since this just started within the last year, I think there is something else going on. By far, I think the most likely diagnosis is rosacea, which usually happens to people in their 60s. Alcohol is a potent trigger for flushing in people with rosacea. A careful skin exam would be likely to prove or disprove my suspected diagnosis, and a dermatologist would be the ideal choice. You might even consider bringing in a beer to demonstrate the effect to the doctor.
Although there are some worrisome causes of facial flushing, such as carcinoid syndrome and pheochromocytoma (both caused by tumours that secrete substances and make blood vessels dilate), the association with alcohol makes rosacea the more likely diagnosis.
Dear Dr. Roach: I am an 83-year-old man scheduled to have my left knee replaced in the next month or two. I have been diagnosed with Ehlers-Danlos syndrome, type 4. Please let me know if you think it wise, or not, to go ahead with the operation.
Ehlers-Danlos syndrome (EDS) is actually a group of genetic disorders of connective tissue. What was formerly called type 4 EDS is now called the hypermobile subtype of EDS (“hEDS”), and it is the most common form. The diagnosis is made clinically: There are no definitive blood tests, X-ray findings or genetic tests that reliably diagnose hEDS.
Because of the hypermobile joints, damage to soft tissue can be extensive in people with hEDS, and joint replacements are more common. They still may be effective, but ideally, they should be done by a surgeon familiar with hEDS. Although the prosthetic joint is very stable, the existing soft tissues and ligaments are at increased risk after replacement surgery, and surgical care needs to be adjusted for your condition.
One of the most important predictors of a good result in joint replacement is the physical therapy done after surgery. This also needs to be tailored to you, as a person with hEDS.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu