When the source of pain is not where you think it is

Dr. Keith Roach M.D.

DEAR DR. ROACH: I am a 79-year-old woman in reasonably good health. I am very active and do everything I can for my health. Whenever I feel a cold coming on (which is rare), I have pain on the left side of my throat when I swallow and get a stabbing pain in my head every 5-10 seconds. I worry about stroke, and my husband thinks I may have a brain aneurysm. My doctor says he never heard of a correlation like that. When my throat feels better, the stabs in my head are gone. What do you think? -- H.B.

       ANSWER: I agree with your doctor that it is very unlikely to be warning signs of stroke or an aneurysm. Stroke warning signs usually involve loss of function: temporary vision loss, difficulty speaking, dizziness, confusion or numbness or weakness, especially on one side of the body. Most unruptured aneurysms have no symptoms, but some of the stroke symptoms above can occur, or headache and visual changes.

       What I think you have is referred pain. The pain in the throat feels like it is coming from a different area, in this case, your head. The fact that it only occurs with a viral infection is strong evidence it is not a warning sign of one of these dreaded conditions.

       DEAR DR. ROACH: A few months ago, you had an article about how the blood vessels going to the penis can be blocked, causing problems with erections. Can you go into it a little more about how to solve that problem and what kind of doctor to see about it? I asked a doctor about it at my Veteran's Affairs hospital and he did not know. As a guy, you do not want to ask too many people. -- J.

       ANSWER: Men should not be embarrassed to ask about sexual problems (neither should women). Sexual function is an important part of human behavior, and problems in sexual function can be a clue to problems that might affect other body systems.

       That is particularly the case with circulatory problems leading to erectile dysfunction. Without adequate blood flow, an erection cannot happen properly. A blockage in one artery means that blockages in other arteries are highly likely. Occasionally, the first sign of atherosclerosis -- blockages in blood vessels due to cholesterol plaques -- in men is erectile dysfunction. Proper treatment can reduce the risk of stroke and heart attack.

       Blockages in arteries, whether in the arteries of the heart, brain or elsewhere in the body, may be treated with medicines to reduce cholesterol, such as statins, or with medicines to help blood flow, such as aspirin or cilostazol, or potentially with surgery. Surgical treatment is often done by a vascular surgeon, but increasingly some interventional cardiologists and interventional radiologists are using balloon procedures and stenting in blood vessels outside the heart. However, a urologist remains the expert in surgical treatment of erectile dysfunction and is usually your best consultant if your regular doctor's treatments have been ineffective.