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Persistent Cough Can be Tricky to Treat

I went through many tests for a cough that lasted for 30 years. No treatments worked. The only sign my doctor could find was that my throat had scars from coughing that long. My allergy specialist had tried for years with all kinds of prescriptions, to no avail.
I am now living a normal life since a doctor prescribed tramadol (50 mg) twice a day. What a relief. My wife, grown children, friends and clients are happy. — L.G.

ANSWER: I found only a single case report of tramadol being used for chronic cough, and it was effective in that patient. The authors advised further study on its use.

Tramadol is a pain medication distantly related to codeine. Its abuse potential is low, but there have been overdoses and deaths due to this drug, so I don’t recommend its indiscriminate use. However, I have seen personally and received many letters from people with intractable coughing for years, so much so that I wanted to call attention to this as a possible treatment worth discussing with one’s doctor for people with longstanding cough that has resisted diagnosis or treatment. I previously mentioned taking gabapentin for laryngeal neuropathy, a condition that is often unrecognized and that may present with a prolonged cough. I received many letters telling me it was effective.
Tramadol at the low dose (for an adult) you mention usually is safe.

[question] I have a very dear relative who had radiation seed therapy for prostate cancer in 2003 after a biopsy revealed a Gleason score of 7 (3/4). Afterward, his PSA was only 0.1 to 0.3 the first three years, and it rose only .3 more each year until 2015, when it was 2.7 recently. He is 83. He has been told he must have hormone treatment — shots, pills or both, by his VA provider, who is not a urologist and who says he should see one. He has no symptoms, he says, and he leads a very active lifestyle, with daily walking of 3 miles or more, bowling twice a week and extensive gardening and yard work. Could the rising PSA be due to normal exercise activity, including production from surviving prostate cells? — R.A.

ANSWER: Rising PSA after cancer treatment typically is due to cancer returning, not an increase in normal prostate. However, that does not mean that your friend “must” have treatment. Goals for cancer treatment in an 83-year-old man may be very different from those of a 20-year-old man. In his case, since it took about 10 years to increase by 10 times, it may be a very long time before the probable cancer would be large enough to bother him, and it requires skill and experience to determine whether treatment, which can make quality of life worse, is worthwhile. Many urologists would recommend deferring treatment until and unless he develops symptoms.
I certainly would recommend that he go to see a urologist as his VA provider has recommended. He may be able to learn whether it really is the cancer returning and discuss his options. Shots and pills are options, but so is keeping a careful eye on it and not rushing to treat.

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]

(c) 2019 North America Synd., Inc.

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