Q: I am a 75-year-old male in fairly good health. I don’t drink or
smoke and am not overweight. I cross-country ski every day in winter
and ride my bike in summer on dirt roads, as I live on a farm. About 12
years ago an examination revealed a hiatus hernia. I have had heartburn
all my life.
About three weeks ago, I started waking up at night after sleeping for
only two hours. My mouth is dry, I shiver, have cold feet, but my face
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is burning. These symptoms lasted for about an hour. I went to the
hospital emergency where
the nurse told me my blood pressure was high. I had no chest pain, but
the next day, the doctor I saw suspected a heart problem. Various tests
including
a monitor to record the heartbeat for 24 hours did not show anything
wrong. Can a liver malfunction be painless like prostate or pancreas
cancer?
A: This is a complicated question so you may have to undergo more
medical tests before you find the answer.
I will answer the last part of your question first. Yes, liver diseases
such as hepatitis are often painless, unless the problem is due to
gallstones or inflammation of the gall bladder, which is definitely
painful. Pancreatic cancer is often painful and both it and prostate
cancer cause other serious symptoms that you do not mention. I doubt if
you have either of these diseases.
With your active lifestyle, I do not think that you suffer from any
type of serious heart condition or you would become light-headed or
have angina chest pains when you are riding your bicycle.
The best clue you have given me is the high blood pressure. I assume
you have not been diagnosed with this before and had not been taking
any medications to lower it. It is a little unusual to start having
high blood pressure for the first time at your age, unless there is
something else wrong.
There are a couple of areas your doctor should look into. One is to see
if you have any kidney disease, because the kidneys and the adrenal
glands near them regulate blood pressure as well as removing wastes.
There can also be a benign tumour on the inside part of the adrenal
gland. This is quite rare, but it can cause sudden sharp rises in blood
pressure on a periodic basis. It can cause palpitations associated with
high blood pressure, anxiety, headache and flushing of the face.
Sometimes these tumours can be located elsewhere in the body, such as
the large intestine. The only treatment is surgical removal.
Another possibility is that acid reflux due to your hiatus hernia is
waking you up at night as you slide down the pillows and lie in a
flatter position.
Thinking you are seriously ill could have caused you to panic, leading
to a temporary rise in blood pressure when you were tested in the
emergency department.
A hiatus hernia is a weak spot or gap in the diaphragm muscle that
separates the lungs and heart from the abdominal cavity. This allows a
portion of the stomach to slip up into the chest, allowing acid to
regurgitate into the esophagus. This is more likely to happen when you
lie flat or bend over. Try sleeping with more pillows so you are in a
more upright position.
Clare Rowson is a medical doctor with a practice near Belleville, Ont.
Her columns are intended for general information only. Individuals are
encouraged to also seek the advice of their own doctor regarding
medical questions and treatments.
