Dear Dr. Roach: I work with a group for people with a type of cancer resistant to chemo or radiation, and many of the members have had to have numerous, life-altering surgeries, including amputations. A member asked whether others had symptoms of PTSD and said two therapists told her that PTSD could not be caused by medical issues. But I have read a few articles saying that it can be induced by trauma from medical procedures and illnesses. Can it?
T.M.H.
The term “post-traumatic stress disorder” is used informally by nonprofessionals to describe many things, from anxiety to unpleasant tasks. When used in its proper medical sense, it is a complex reaction to psychological trauma, and may have physical, intellectual, emotional and behavioral symptoms. Among the most important diagnostic features of PTSD are intrusive thoughts, nightmares and flashbacks of traumatic events, and these lead to poor function at work or in personal relationships.
A discussion of the formal diagnosis of PTSD is beyond the scope of this column, but to qualify it must include a traumatic event; intrusive symptoms such as flashbacks; a change in behaviour to avoid reminders of the trauma; unpleasant changes in mood or thought; and unpleasant symptoms, such as irritability or poor sleep. It also may include behaviour changes as a result of the trauma.
Your question is about the type of trauma that can lead to PTSD. While we often think of extreme singular events, such as those faced by military personnel or first responders, the trauma in people diagnosed with PTSD may be a series of multiple events, not one particularly horrible one. Sexual assault and mass displacement from famine or warfare are other traumatic events that commonly trigger PTSD.
Medical causes account for approximately 6.5% of PTSD in a recent study. Heart attack, stroke and a stay in intensive care for any reason are the most reported traumatic medical events associated with PTSD. Life-altering surgeries such as amputations certainly could trigger PTSD, and the therapists who denied this were simply wrong.
Dear Dr. Roach: My husband is a diabetic, with neuropathy, retinopathy and high blood pressure. His issue is that he is always “cold to the core” and sweats profusely on his head anytime he eats or drinks. The doctors he sees can’t figure out why. It has greatly impacted his quality of life. Have you heard of such a thing?
M.R.
Yes, this is called “gustatory sweating,” and it is a special type of autonomic neuropathy found in people with diabetes. The word “gustatory” means “having to do with eating,” while “autonomic” refers to the vast part of the nervous system that is not under conscious control.
Among many other functions, the autonomic nervous system controls complex actions like temperature (maybe feeling “cold to the core” is because of this), heart rate, most breathing and gastrointestinal function.
Diabetes, especially if not well controlled, often damages nerves over many years. Neuropathy and retinopathy (damage to the retina at the back of the eye) tend to occur about the same time. Many people are familiar with the numbness and pain of the feet and sometimes hands that can happen with longstanding diabetes, but the autonomic system can be affected as well. Constipation and slow stomach emptying are other common symptoms of autonomic neuropathy.
The topical use of glycopyrrolate on affected areas can be a safe and effective treatment.
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 ToYourGoodHealth@med.cornell.edu
