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Medical Edge Newspaper Column from Mayo Clinic

GREEN PHLEGM SHOULD RAISE A RED FLAG: THERE MAY BE INFECTION

DEAR MAYO CLINIC: After I had a bout of laryngitis that hung on for a long time, my voice still cracks and I have to keep clearing my throat. I’ve also been coughing up green phlegm. What’s going on? — St. Cloud, Minn.

ANSWER: The condition you describe is called dysphonia. It’s not unusual for voice problems to develop after a viral infection such as a cold or laryngitis. It may take three to four weeks for the voice to return to normal. Coughing, throat clearing and dislodging, and coughing up whitish phlegm are commonly associated with these types of infections.

However, green phlegm is of more concern. It may be coming from the nose or the lungs. The color suggests secondary infection. You should see your physician about this.

You don’t mention whether you smoke. Cigarette smoking is linked not only to lung cancer, but also to cancers of the throat and mouth. So if you smoke now, or if you were a longtime smoker, I recommend that you see an ear, nose and throat specialist to examine your throat for signs of abnormal cell growth.

Here’s another possibility: Voice problems in nonsmokers that don’t clear up after six to nine months may be a sign that one of the nerves going to the larynx (voice box) has been injured. Symptoms of dysphonia caused by this kind of nerve injury include: softer voice even when the speaker is attempting normal conversation and a sense that the voice is wearing out at the end of the day, or after one has been speaking for a long time. Patients who sing may experience a loss of vocal range (high notes).

This kind of nerve injury is not life-threatening. But if you’re having difficulties six or more months after laryngitis, you may want to be seen by a medical team with expertise in both ENT and neurology to rule out nerve damage.

— Nicolas Maragos, M.D., Otolaryngology, Mayo Clinic, Rochester, Minn.

Additional Resources:
Dysphonia
Appointment Information
More Information on Laryngitis

DEAR MAYO CLINIC: I received a cadaver kidney transplant in December 2000 and have been taking the immunosupressant medications cyclosporine (Neoral) and prednisone ever since. In the meantime, I’ve developed osteoporosis, had one hip replaced and now have problems with the other hip. I just developed a stress fracture in the right pubic bone.
I think prednisone is partially responsible for my problems. I’m considering stopping prednisone and instead taking mycophenolate mofetil (CellCept), another immunosuppressant medication. Is this wise? I have gotten mixed signals from the doctors here. — Norway

ANSWER: After an organ transplant, patients need antirejection medications for the rest of their lives. The medications have side effects, and it’s a balancing act to achieve the needed protection against rejection and minimize side effects.

Long-term use of corticosteroid medications, such as prednisone, can damage bone. But in your circumstances, there is significant risk in stopping prednisone. The risk of acute kidney rejection is low without prednisone, but there is increased risk that the kidney won’t keep working as long as would otherwise be expected.

Taking CellCept instead of prednisone would reduce even further the risk of acute rejection; however, it’s unclear whether CellCept will prolong the life of your kidney.

Talk with you doctor about a better balance in your medications. The prednisone dose shouldn’t exceed 5 milligrams a day. In some circumstances, the dose could be 2.5 milligrams. Reducing the dose of prednisone, even a little, can have very beneficial effects on your bones.

Your doctor should monitor your bone density and your levels of parathyroid hormone, a hormone that regulates bone formation and remodeling. And you and your doctor should develop a specific therapy to prevent further bone loss, which could include bisphosphonates, a group of medications that can inhibit bone breakdown, calcium supplements and exercise.

You also should avoid smoking. Though researchers aren’t sure why, tobacco use contributes to weak bones.

— Fernando Cosio, M.D., Nephrology, Mayo Clinic, Rochester, Minn.

Additional Resources:
Kidney Transplants
More Information on Kidney Transplants

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.