Q: My father will be 91 this year, and he enjoys excellent health. He's very physically active, plays golf, splits wood, and has a big garden in Virginia, where he lives. He asked me to send you the following message and question:
"About six months ago, when I got out of bed, I experienced a "hot flash' in the pelvic region without pain.
"My family doctor thought I might have a prostate infection, despite a normal rectal exam, and prescribed an antibiotic. There was no improvement, so I sought the help of a urologist, who prescribed the same antibiotic for 21 days, with no change in the flashes.
"I got a CT scan of the pelvis and an internal exam of my bladder, but both were normal.
"I have coronary artery disease and high blood pressure, both of which are under control. I'm also taking a statin drug to control my cholesterol, thyroid hormone, and 81 mg of aspirin."
- H.T., Gainesville, Fla.
A: Thanks for sending your e-mail about your father's circumstance. It's great that you are trying to help your father to understand his medical dilemma better. Unfortunately, I do not have enough information to make a good guess about what his problem is, but I hope to help him determine a next step and to have him record important information about his problem to share with a physician.
There are two basic types of hot flashes. The first is commonly experienced by women prior to menopause. The person suddenly feels increased temperature over a large part of the body, typically the chest and face. The second is more like the searing pain of being burned, and it is typically located in a very small area anywhere on or in the body. I presume that your father's flashes are of the second type.
This type of sensation is typically caused by trauma to a single nerve, similar to the pain that is caused by a "pinched" nerve in the lower back and buttocks, as seen in sciatica. Why sometimes a pinched nerve causes pain and other times a sensation of heat it not well understood. But sometimes it's related to the sympathetic nervous system being involved.
The sympathetic nervous system is a distinct nervous system in the body that regulates involuntary activities such as heart rate, blood vessel size, and digestion. Damage to this part of the nervous system is the problem in people with reflex sympathetic dystrophy.
Because you first noticed the problem when getting up out of bed, it's important for you to consider a spinal problem. The individual vertebral bones that make up the spinal column are separated by disks made of cartilage. When a disk in the spinal column collapses, the space between the two vertebrae on either side of the disk narrows. Fracturing of vertebrae, primarily due to osteoporosis in older people, will also cause narrowing of the space.
The narrowing of this space presses on a nerve root, which projects from the spinal cord through openings between the vertebrae. This, in addition to scarring, is a common cause of back pain. Compression of the nerve can also be caused by tumors or abscesses.
How badly the nerve is damaged - i.e., the extent of compression - determines the severity of symptoms and how long they last. In most cases, treatment is limited to rest, avoiding aggravating conditions, and easing pain.