Dear Dr. Roach: What are the symptoms for cold agglutinin disease, and how is it diagnosed?
P.W.
Cold agglutinin disease is a specific type of anemia where antibodies attack and destroy a person’s own red blood cells. Unlike the usual type of autoimmune hemolytic (“hemolytic” means “destruction of red blood cells”) anemia, the antibodies are only active below a person’s normal temperature, which is where the “cold” comes in. Thus, the red blood cells are destroyed in cool areas, such as the skin.
Symptoms include dark discoloration in the skin, especially in the fingertips, nose and ears; Raynaud’s phenomenon (this can occur with many diseases or by itself); ulceration; and pain upon swallowing cold foods or liquids.
Diagnosis is usually made by an expert (such as a hematologist), as this is not a common disease, and many regular doctors like me are not very familiar with it. Specialized blood testing confirms the diagnosis, but the hard part is thinking about the condition in the first place.
Dear Dr. Roach: I am a 64-year-old healthy female and a big fan of all roller coasters, which I ride often. Recently, I rode an extreme roller coaster. A couple of times during the inversion parts, I felt my eyesight greatly diminish. I recovered in about 5-10 seconds. This experience was a first, and it concerned me.
Is this something I should be concerned about? Are my coaster days coming to an end, or should I just avoid those coasters that feature inversions? I always try to get the front row if possible, since there is less of a chance of feeling head pressure from the g-forces. The steep drops don’t seem to affect me like the inversions do. Thank you for your response.
S.S.
A “greyout” is when the vision dims in light and color. This is due to temporary loss of blood to the brain and is a common finding in people who are on roller coasters with vertical loops and corkscrews. A greyout is well-tolerated by healthy people (military pilots get this frequently), but you are getting to the age where I feel uncomfortable recommending this. Even though it would probably be OK, I would still recommend you stick with coasters that don’t dim your vision.
Dear Dr. Roach: I had my first colonoscopy performed when I turned 50. After I had my last colonoscopy at 60, my doctor recommended I have one performed every three years, rather than the normal five-year schedule, due to my family history. My dad’s father passed away from colon cancer at 50, and my mom passed away from colon cancer at 78. Do you think every three years is necessary, or can I continue with the five-year schedule?
J.B.
For people at average risk with no family history and no history of polyps, a colonoscopy is typically performed every 10 years. However, polyps are common, so more frequent screening intervals are recommended in people who have had polyps. The precise interval depends on the number and size of polyps.
In people with a positive family history, screening begins at age 40 or 10 years before the earliest first-degree family member (parent or sibling) was diagnosed — whichever is earlier. The expert recommendation on screening intervals is every five to 10 years; personally, I prefer every five years in a person with positive family history.
Every three years is not recommended as a screening interval for colonoscopies unless there have been abnormal findings. Some physicians are aggressive about screening, but there isn’t data to support screening every three years.
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 [email protected]
