To Your Good Health: Thigh Pain Could Be Caused by Many Reasons

Dear Dr. Roach: I am a 66-year-old white female, 5 feet, 5 inches tall (was 5 feet, 6 inches), weighing 170 pounds. Even though I use gym weight machines for upper and lower body three times a week, walk daily for two miles and spend 15 minutes on a motion trainer at the gym, I cannot stand up easily after gardening on my knees or getting on my knees on the floor. Is there anything I can do to regain the ability to get up off the floor/ground without a struggle? — S.C.

Answer: It sounds to me that despite your good exercise regimen, you may have weakness specifically in your thighs — what we call “proximal muscle weakness.” There is a very long list of medical illnesses that affect these muscles specifically (my textbook lists 28 different diagnoses), including common conditions such as low thyroid levels and vitamin D deficiency. I would recommend a visit to your doctor for a careful exam of your nerves and muscles to see if my suspicion is correct. Your doctor may suggest a trial of vitamin D.

If no medical cause is found, I would work specifically on strengthening the hip muscles, which extend the thighs. A trainer at the gym can show you those exercises.

Dear Dr. Roach: Would you discuss laryngeal spasm? I’ve had these since I was in my 30s, just a few times each year. For a long time I didn’t know what to call them or what was happening, but I was abruptly unable to breathe. It even woke me, a couple of times, from a deep sleep. The most my doctor told me in those days was “My mother gets those, too,” which was no help.

They’re terrifying. So far they’ve lasted only a minute or two, but that’s hard to remember while one is going on. Could I die of this? Lose consciousness? Do you know of anything useful to do when one hits?

I used to worry about one happening while I was diving, but my scuba days are over anyhow. I’m 88 now, and for the first time I’ve wondered what I’d do if one happened while I was driving. — E.L.

Answer: Laryngeal spasm, also called paradoxical vocal cord motion or vocal cord dysfunction, is probably more common than is recognized. It is often misdiagnosed as asthma, since both can cause sudden shortness of breath and both include abnormal airway noises. In asthma, the noise (wheezing) is made in the small airways due to constriction, but in laryngeal spasm, the noise (stridor) is made because the vocal cords are clenched tightly together. They should be wide apart when breathing in.

The diagnosis is made by looking at the vocal cords during an attack. This usually is done by an ENT physician with a flexible laryngoscope. The condition may be suspected due to history or exam and sometimes by the result of pulmonary function tests to evaluate asthma. I can reassure you that people seldom die or even lose consciousness from this. If you do lose consciousness, the vocal cords tend to relax, allowing the airway to open up again. If you were to have an attack while driving, my advice would be to pull over the car safely, then pant, which usually opens up the vocal cords.

Speech therapy is the most common treatment of paradoxical vocal cord movement.

Dear Dr. Roach: I have a bone-on-bone ankle and I have a blood disorder, Christmas disease (factor 9 deficiency), which makes an operation more difficult. I saw an advertisement for an orthopedic surgeon who draws your blood, spins it, separates red and white blood cells from the platelets, and then injects the platelets with the blood plasma they are floating in back into an injury or diseased area, and the site begins to heal. He says it has excellent results. Have you heard of this, and would it work for me? — B.D.

Answer: I have heard of this. It’s called platelet-rich plasma (PRP) injection, and the initial results are promising for a variety of soft-tissue injuries. I am not ready to recommend it in general, but for people who can’t have surgery for a medical reason, it makes sense to consider while we wait for further studies. That being said, bone-on-bone disease generally does not respond to conservative treatments. I have no experience with PRP in this situation. It’s not unreasonable to consult with the orthopedic surgeon, but I would be a little skeptical. Certainly in your case, due to the Christmas disease, I would talk to your hematologist before proceeding any further.

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