Weight Loss Isn't The Cause Behind An Odd Globus Sensation
DEAR DR. ROACH: I was recently diagnosed with diabetes and immediately changed my diet and exercise regimen. I was able to lose 17 pounds in about two months but have started to experience a feeling of something being stuck in my throat. Could the sudden weight loss have brought this on? I was sent to get an ultrasound on my thyroid, and it came back negative. -- V.J.
ANSWER: A sensation of something stuck in the throat is common in clinical practice and can have many causes. It is referred to as a "globus" sensation. An ultrasound is a very reasonable test as a large thyroid mass (goiter) can cause a mechanical effect on the esophagus, leading to this sensation. Similarly, abnormalities in the esophagus, oropharynx and larynx may also lead to this sensation. Most experts recommend an evaluation with an endoscopy and a laryngoscopy for people with a persistent globus sensation.
Unintentional weight loss is a red flag in people with a globus sensation because if the cause behind the globus sensation is also leading people to lose weight, this means that it is more likely to be something serious. But this is not the case with you, so I can't think of how losing weight could have been the cause behind your globus sensation.
If the sensation of something in your throat continues, I recommend further evaluation by an ENT physician.
DEAR DR. ROACH: My in-laws are being evaluated for infertility, and my brother-in-law has a varicocele. They say that he needs an operation. Is this necessary in order for them to have children? -- C.F.
ANSWER: A varicocele is a common enlargement of the veins in the male scrotum. There is some evidence that a large varicocele could reduce fertility in men. However, the repair of a varicocele is usually indicated for fertility only when both the varicocele is large and the man has an abnormal semen analysis.
The benefit in fertility is thought to be small; it is estimated that 17 men need to be operated on to produce one pregnancy, so there's roughly a 6% chance that the operation will help the couple conceive.
DEAR DR ROACH: I have high liver enzymes and bilirubin, most likely due to Gilbert syndrome. I've had elevated numbers since at least 2006 when I started to track them. I was recently prescribed a low-dose statin after receiving a slightly elevated coronary calcium score (49).
The statin did great at lowering my cholesterol but seriously elevated my AST and ALT numbers. (My AST and ALT levels were 12 and 20 U/L, respectively, before treatment, then 41 and 32 U/L while on the statin. Normal is less than 35 U/L.) So, I discontinued its use. Are there any options other than statins to help reduce cholesterol? -- S.M.
ANSWER: Gilbert syndrome is a relatively common liver condition caused by abnormal bilirubin metabolism. People with this condition can get recurrent jaundice and high bilirubin levels.
Statin drugs are generally considered safe in people with Gilbert syndrome. Many people (with and without Gilbert's) will have elevations in their liver enzymes (ALT and AST levels) due to statin drugs. Most authorities recommend reducing the dose or stopping statin treatment if the liver enzymes go over three times the upper limit of normal -- above about 100 U/L -- which yours didn't get close to.
Since the risk to your liver from a statin is small, and the benefit of a statin in a person with even modest coronary calcium is relatively large, there is more benefit than harm for most people in your situation.
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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.
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