DEAR DR. ROACH: I am a healthy 64-year-old man. I got a terrible rash from poison ivy and needed to be put on prednisone. After a few days, I started having terrible hiccups. They’ve been going on for two days, and they are constant. I’ve tried all the home treatments to get rid of them. They haven’t stopped for more than 3 hours. I also have a sore throat and some distention in my abdomen.

What do you think could be going on? The rash is finally starting to get better. — B.M.S.

ANSWER: Hiccups rarely go on for so long. There are many maneuvers that people swear by that often work. Holding your breath (or just breathing very mindfully with careful control of your breath), lemon and/or sugar, pulling your knees to your chest, sucking very hard through a tight straw, pulling on your tongue, and many others are some suggestions from years of practice and readers of this column. However, when these maneuvers aren’t successful and symptoms have persisted for more than 48 hours, it’s time for a thorough evaluation.

The list of potential causes of intractable hiccups is long and contains some very serious illnesses, so it’s not something to take lightly. However, the fact that yours started when taking prednisone, along with a sore throat and abdominal distension, suggests to me that your hiccups could be coming from acid reflux. Systemic steroids are one common medication that causes reflux, even if you’ve never had reflux before.

While you are waiting to see your doctor, you might want to try antacid medication, such as an H2 blocker like famotidine (Pepcid) or a proton-pump inhibitor like omeprazole (Prilosec). These don’t stop reflux, but they reduce or eliminate stomach acid so that the reflux doesn’t damage your esophagus, larynx and pharynx. It often reduces or stops the hiccups.

DEAR DR. ROACH: I am a male who is 74 years old and in good health. I have a bunch of cysts in my kidneys that don’t seem to be doing any harm and probably aren’t due to a polycystic kidney disease. I got an MRI, and they found a 3-cm growth in one kidney. They said it’s probably clear cell renal cell carcinoma. I went to a very good urologist who told me it was very small and that I should get it removed. His reason was that it would probably have to be removed some day, so doing it now was better than waiting, since I’m not getting any younger.

I got a second MRI about a year later (a couple of weeks ago). Everything is the same, except that it has grown to 3.2 cm. I’m getting an opinion from a second urologist soon. I hate the idea of getting a surgery I don’t really need just because I will likely need it in the future and “now is better than later.” If I have to, I will. — J.H.

ANSWER: You shouldn’t have waited a year. Not only are you not getting any younger, the growth in your kidney, which is more than 90% likely to be kidney cancer, isn’t getting smaller. As it gets larger, it’s more likely to spread, so if your second urologist gives you the same advice, I recommend getting a surgery scheduled as fast as the urologist can make room for you.

DEAR DR. ROACH: I recently had a urinalysis done for pain that I usually get from urinary tract infections (UTIs). The results showed that some of the tests were high. My epithelial cell count was 11; my hyaline cast count was 10; and there were both red and white blood cells. There wasn’t any bacteria, and the doctor never contacted me. So, I am assuming things are OK.

The pain subsided after a few days, and now I don’t have any. Should I be concerned about these high results? — B.J.E.

ANSWER: The finding of elevated white blood cells in the urine of a person with a history of UTIs and recurrent symptoms is suggestive of a urine infection. However, with no bacteria seen, this becomes less likely. Red cells are commonly seen in urine infections, while hyaline casts are nonspecific. Epithelial cells come from the lining of the urethra and surrounding area (the vulva in women).

It is primarily symptoms that drive the decision to treat a patient, and with your symptoms gone, treatment isn’t necessary. You could have cleared a UTI on your own. I would consider retesting the urine (being very careful to clean the surrounding area and let some urine drain before collecting the sample) to make sure that the urinary findings have gone. Unusually, kidney stones, tuberculosis of the kidney, and kidney inflammation can result in these findings. When no infection is found, it is prudent to do further investigation if the white cells remain high without bacteria.

DEAR DR. ROACH: Six months ago, my husband had a Whipple surgery for ampullary cancer. He also received chemotherapy. He is 85 and has finally started to live again. However, he gets these shivering and cold feelings, almost like he’s been outside in subzero temperatures, to the point of putting him in bed with a pile of blankets and a heating blanket, too. We have asked the surgeon about this, and he didn’t really have an answer. So, I was wondering what you thought about this situation. — P.T.

ANSWER: Ampullary cancer is located at the ampulla of Vater, a structure where the common bile duct empties into the duodenum. Ampullary cancer sometimes behaves like pancreatic cancer, but it may also be derived from the bile duct or the small bowel, which has a better prognosis than pancreas cancer.

A Whipple procedure removes the gallbladder, as well as parts of the bile duct, pancreas, stomach and duodenum. Then it reconnects the remainder of the organs directly into the jejunum, the next part of the small bowel. A Whipple procedure is a technically difficult surgery, but the surgery is no longer as risky as it used to be, thanks to improved techniques and surgical expertise. Surgery is the only chance of a cure for this cancer.

There are numerous reasons why he may have this sensitivity to cold. Weight loss, which is nearly universal after this procedure and this type of cancer, makes it harder for people to retain body heat. Chemotherapy (especially platinum) can cause damage to the part of the nervous system that regulates temperature, but this should get better over time.

I suspect there are multiple factors working against him, but over time, it should improve. Nutritional support may be very helpful, and if his doctor isn’t available, a registered dietician would be a useful ally. A quick check for other medical conditions, especially anemia and thyroid disease, might be prudent.

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