Dear Dr. Roach: My mother-in-law is 95 and lives in a nursing home. Sometimes when we visit, I can barely stand to be in her presence because she savagely grinds her teeth, making an awful grating, creaking noise. Could there be some medical reason for this?
A: Many conditions common in the elderly are associated with teeth grinding. (We have medical terms for pretty much everything -- teeth grinding is called bruxism.) Alzheimer's disease, Lewy body dementia (a type of memory loss often associated with visual hallucinations and movement disorders), stroke, Parkinson's disease and many medications can cause this problem.
Treatment is difficult. A mouth guard to protect the teeth can be very useful, but some people won't keep them in. Her geriatrician is the right person to discuss this with. Some medications (especially some classes of antidepressants) can cause or worsen daytime bruxism, so stopping those may help. Drug treatment of daytime bruxism is not very helpful. Botulinum toxin (Botox) has been effective in some instances.
Fatty tumor harmless
Dear Dr. Roach: During a checkup with my internist, I was told that I have a rather large lipoma on my back. I was told that it is totally harmless and can be removed if it bothers me. Now I realize that I am somewhat concerned about it, as I had ovarian cancer two years ago.
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Can I really be sure it is benign without a biopsy? I don't want to find out in a few years that it is cancerous.
A: A lipoma is a very common fatty tumor. They almost always are benign. If there is a suspicion of malignancy (called liposarcoma), an MRI scan can be done or a biopsy obtained. Surgery is seldom required, except for cosmetic reasons.
I don't believe that you are at higher risk for this being the rare cancerous type simply because of your history. I would just recommend dutiful follow-up. I have sometimes carefully measured these to see if they grow over time.
Dear Dr. Roach: Could you shed some light on Cushing's disease? Four people in the same family have it. The doctors say it has something to do with the thyroid gland.
A: Cushing's syndrome, which is different from Cushing's disease, is an excess of cortisone or similar corticosteroids. It can be caused by taking too much steroid for too long, usually as treatment for a serious medical condition. Cushing's disease is a special case of Cushing's syndrome, when the excess cortisone is caused by a tumor in the pituitary gland, which spurs the adrenal gland to make excess amounts of hormone. Weight gain, almost exclusively in the abdomen, a striking round "moon" face, a fat pad on the back of the neck and upper back ("buffalo hump"), diabetes, pigmented stretch marks and high blood pressure are common findings in any form of Cushing's syndrome.
It is very unusual for Cushing's disease to run in families. Also, it does not affect the thyroid, although thyroid conditions can sometimes mimic Cushing's (and vice versa). I suspect that what this might be is a rare condition called multiple endocrine neoplasia type I (MEN-1). This does run in families, and combines risk for pituitary, parathyroid and pancreatic islet cell tumors. (The parathyroid glands sit on top of the thyroid gland and secrete parathyroid hormone, responsible for calcium metabolism. The pancreatic islet cells are where insulin is made.) Not everybody with MEN-1 will have tumors in all of these glands. Parathyroid tumors are the most common.
An endocrinologist is the expert in Cushing's and the MEN syndromes.
Dr. Keith Roach writes for North America Syndicate. Send letters to Box 536475, Orlando, FL 32853-6475 or email ToYourGoodHealth@med.cornell.edu.