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Tuesday, April 28, 2009

What is Ischemia?

QUESTION: I read your column each day and today it was about angina.
A mention of myocardial infarction or heart attack was included.
Is this the same as myocardial ischemic disease? If not, what is ischemia? Thank you in advance for your answer.

ANSWER: It is not difficult to get lost in the maze of terms we doctors use about disease, and though I should know better, I guess I wasn't as clear about these conditions as I want to be.
So let's go back and do it again, and hopefully get it right this time.
Ischemia (from the Greek word "ischein" to suppress, and "haima" blood) literally means a deficiency of blood supply to the heart, usually from an obstruction or constriction in the arteries that supply blood to the heart.
Because it is this blood supply that supplies the oxygen that heart cells need to live, ischemia is also used to describe situations in which there is an insufficient supply of oxygen to tissues. When the coronary arteries are the affected vessels, it may be called "coronary artery disease" as well.
When a sudden blockage of these arteries occurs, perhaps due to the formation of a clot inside the artery, the heart muscles are suddenly deprived of their needed oxygen supplies and a "heart attack" occurs, with all the well known symptoms of acute chest pain and shock.
If the situation cannot be speedily reversed (and it can in some incidences, due to new medications and techniques), the muscle tissue dies. And that's when the word "infarct" is used for it means "an area of tissue death due to local ischemia resulting from the obstruction of circulation to the area".
Add the word "myocardial" to the term ("myo" for muscle, "cardio" for heart), and the diagnosis is complete.
In the case of angina, the circulation blockage may not be complete, and the partial reduction of blood flow to the heart is enough to cause heart muscles to suffer an oxygen lack without dying.
The pain that this condition causes may make the patient stop all other activity, reducing the strain on the heart, and giving it a moment or two to catch up on its oxygen requirements.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Balloon Angioplasty

QUESTION: I have increasing difficulty in walking any distances at all because of the pain that develops in my leg.
Although I have been taking special medication my doctor prescribed for me, things have not improved and he now is suggesting surgery to help.
Can you tell me anything about using a balloon to open my arteries, instead of replacing my damaged arteries?

ANSWER: There is increasing interest in medical circles about using the technique you refer to (balloon angioplasty) as a method to deal with the problems caused by atherosclerosis of the arteries in your leg.
When atherosclerosis (a common form of arteriosclerosis or "hardening of the arteries", in which deposits or plaques containing cholesterol form on the insides of the arteries and reduce or block circulation) strikes the arteries of the leg, the blood flow to the muscles is reduced, and the amount of oxygen available for the metabolism of these muscles is just not enough to meet with their demand when they are active.
The suffering muscles let you know, because they become quite painful after just a little exertion.
The condition is known as "claudication", which really means limping or lameness.
After a few minutes of rest, which gives time for the muscles to catch up on their oxygen requirements, the pain subsides.
When medications fail, the treatment, which is still considered to be the standard method, is to replace the blocked arteries with new grafts or replacements, or surgically remove the blocks. Balloon angioplasty, originally developed for use on the coronary (heart) arteries, is now being considered as an alternative treatment for situations such as yours.
A catheter or tube with a balloon at its tip is inserted into the diseased artery, and the tip is positioned in the area where the plaques are obstructing the blood flow.
Then the balloon is inflated, pushing the plaques backward and reforming the space inside of the artery.
The success rate may be as high as 80 percent.
The advantages of balloon angioplasty over other surgical techniques are that it is less costly, keeps you in the hospital for a much shorter stay, does not require general anesthesia, and has fewer complications.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Lithium Treatment for Depression in the Elderly

QUESTION: When my father died, my mother went all to pieces.
After 55 years of being together we thought her depression was understandable, but now the doctor who takes care of all the people at her home wants to put her on lithium as a treatment for depression.
Isn't that kind of strong medicine for a natural reaction? With all the stories about too much medicine for older people, we thought your advice would be most helpful.

ANSWER: Your obvious concern and anxiety, plus the circumstances as you describe them, make a "second opinion" from another physician a wise and appropriate course of action.
This very potent drug can be useful in treating depression in the elderly, but it should be used only for psychiatric conditions that cause depression.
You are right when you say your mother's reaction is understandable after the loss of her husband of many years, and is probably normal, as depression is often a big part of grieving.
The elderly often become depressed because of loneliness, a reaction to loss, or a negative reaction to medications. There are, however, other types of antidepressants besides lithium that can be used effectively at these times. If your mother is indeed found to be suffering from a manic-depressive illness, then lithium can be helpful, as it is being used successfully in some elderly patients.
She should get regular checkups and have follow-up lab work done frequently for the lithium to be used safely. Lithium should not be given to patients with severe kidney or cardiovascular disease, or be taken with diuretics, as the drug could become toxic under these circumstances.
You can see that, when obtaining another opinion, it is most important that you present all the history about your mother, including a list of medications she may be taking presently.
And it is most important in situations such as this that you continue to monitor the progress of your mother.
Your frequent visits may be more therapeutic than the medications, and you can personally verify her mental state more accurately.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Sunday, April 26, 2009

Is Sinusitis a Serious Ailment?

QUESTION: Our new doctor has told us that my six year old son's symptoms may be the result of sinusitis.
He is taking this very seriously, and wants us to bring our child back for frequent visits.
We don't know a lot about this doctor, and wonder whether he is just making a big thing out of a minor ailment.
May we have your opinion and some explanations?

ANSWER: There was a time when the diagnosis of childhood sinusitis might have been passed over as something minor.
The symptoms of runny nose, a post nasal drip, cough and fever are common enough and usually associated with childhood colds and upper respiratory infections, generally of a benign nature.
However when infections of the sinuses are not recognized early on and treated properly, the complications are serious and may even be life threatening.
The sinuses are spaces that are still developing in the skull as the child grows older.
Four pairs, the frontal, sphenoid, ethmoid and maxillary are located in the area of the forehead, nose and cheekbones and are lined with mucous tissues.
They probably serve to help make our voices sound stronger, help with our sense of smell, and reduce the weight of the skull.
When infection strikes, the tissues become swollen and inflamed, produce additional secretions, which must find their way out of the sinus cavity.
When they fail to drain properly, the secretions can stagnate within the sinuses and form a perfect culture medium in which bacteria can easily grow.
The clinical picture changes as the child appears ill, there is tenderness in the area of the sinuses, and the nasal discharge becomes thicker and mixed with pus. Treatment is necessary to maintain and promote drainage from the sinus cavities, relieve the symptoms and fight the infection with the appropriate antibiotics.
Treatment may continue for as long as two weeks in acute sinusitis and three weeks in the chronic disease, with another three weeks added on with a different antibiotic if the first course of treatment is unsuccessful.
With all that in mind, the concern of your physician is certainly correct, and the need for revisits should be evident.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Information About Huntington's Disease

QUESTION: A good member of our church was stricken with a disease called Huntington Disease.
I was present when he had a frightening episode that was most distressing.
Some of our members are afraid that this could be catching, and so we would very much appreciate any information you can provide to us. Please choose this question as it is important for many people.

ANSWER: Huntington's Disease was first described by Dr.
George Huntington and his father, who was also a physician, in 1872.
He wrote his paper after observing families living near his home in Long Island, New York.
The disease itself is characterized by involuntary and jerking movements of the arms, legs and face.
These irregular movements lead to difficulty in walking, trouble with speech and lack of coordination of arm movements.
The saddest part of the condition is the associated decline in mental function which parallels the worsening of body movements.
As the disease progresses, thought processes become confused and a type of senility occurs.
All of the changes associated with Huntington's Disease are related to a degeneration or destruction of vital nerve centers in the brain.
This disorder is hereditary (not infectious, so you can't catch it) of a type described in medical terms as "autosomal dominant".
In these cases only one gene needs to be passed from either the mother or the father in order for the child to inherit the disease. Each offspring, therefore, has a 50 percent chance of getting the disease. Even more unfortunate than the disease itself is our present inability to correct the condition.
There are a few drugs which can lessen the jerking movements, but they have significant side effects which limit their use.
In the future, hopefully, we will be able to make some progress in treating these devastating neurological diseases.
To end on a positive note, we know that the later the disease appears in life, the greater the probability that it will be milder.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Answers About "Chronic Fatigue Syndrome"

QUESTION: I am desperate for some easy to understand information about my condition.
I believe I have "chronic fatigue syndrome" but can find little material that makes much sense to me.
I don't want to go on this way, but find little help in what my own physician tells me.
Will you please provide some answers? I know you will help many people if you do.

ANSWER: This syndrome is certainly one of the more perplexing situations that physicians have to deal with.
It's called a syndrome because as yet there are no identifiable causes, and therefore no specific treatments available. The working definition shows our lack of precise knowledge about the ailment. Chronic fatigue syndrome (CFS) is defined as fatigue that occurs fairly acutely in an otherwise healthy individual, reduces their ability to carry on their normal routines by more than 50%, and is of at least six months' duration.
Before a physician can make this diagnosis, a large number of other possible causes must be ruled out, including acute infections, inflammatory diseases, adverse drug reactions and significant psychiatric disorders, particularly depression.
Patients present with a wide variety of symptoms, including headaches and sleep disturbances, confusion and loss of memory, irritability, difficulty with concentrating and performing mental tasks such as arithmetic.
There can be numbness and tingling sensations, muscle weakness, muscle aches and pains (myalgias) and joint pains (arthralgias).
In addition, a low grade fever is present, along with a sore throat and enlarged lymph glands in the neck area or armpits.
Unless nearly all the subjective symptoms are present, at least two of the three physical signs must be present before the diagnosis of CFS can be made.
Despite previous theories, infection with the Epstein Barr virus does not seem to be associated with this ailment. Recent studies seem to indicate that there may be a connection between CFS and fibromyalgia, another condition that is difficult to diagnose and treat. While blood tests may be performed, they are more useful in finding other causes for the fatigue than for diagnosing CFS.
Treatment is pretty much a case of treating the symptoms, with antidepressants used when depression is severe.
The outlook is not promising either, as most patients do not return to their previous levels of energy, but must accept life at a reduced pace, unless a cause and cure can be discovered.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Saturday, April 25, 2009

Rainy Days, Mondays, and Old Bones

QUESTION: There are mornings I just can't get my old bones moving.
Strange as it may seem, they are those proverbial days that either are rainy days or Mondays.
Is there any evidence in medical writings that there is more truth than fiction in this commonly held idea?

ANSWER: While I can't speak for Mondays, researchers are discovering that there may indeed be strong links between the weather and the state of people's emotions.
A new term biometeorology has been coined to describe this field. One theory holds that a falling barometer causes the body to absorb more water from the intestinal tract, leading to swelling that can add up to an inch to the waistline; the retained water also puts extra pressure on tissue in the brain, leading to irritability and depression in many people.
Studies have indicated that people have markedly slower reaction times during cloudy, snowy, or rainy weather than on sunny days; another theory states that electromagnetic waves from storms influence activity in the brain, while still others point to the simple physical discomfort of hot, muggy weather combined with increased outdoor leisure time, as leading to increased crime rates in the summer. Additional studies have linked bad weather with a variety of physical complaints: emergency room records tie the onset of a cold wave with a rise in asthma and migraine attacks, as well as colic and strokes; in cold weather, the body tends to crave more fats and calories in order to keep warm.
As scientists learn more about the way weather affects people, they may be able to anticipate and prevent many health and social problems.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Are There Other Complications From PID?

QUESTION: I have just been cured of my second episode with pelvic inflammatory disease.
Now, the "good news" from my doctor is I'm at greater risk of having an ectopic pregnancy.
Why? Are there other complications from PID?

ANSWER: Unfortunately, with every episode of pelvic inflammatory disease (also known as salpingitis), your risk of ectopic pregnancy or other complications grows.
PID may cause scarring and adhesions in your fallopian tubes which leads from the ovaries to the uterus.
Normally, the fertilized egg becomes implanted in the womb.
But it has to get there by traveling down the Fallopian Tubes.
If it hits a scarred area, where the tube is narrowed or sealed by adhesions, it just gets stuck, and the pregnancy develops outside of the uterus (ectopic pregnancy).
A woman who has had one or more incidents of PID may have a ten times greater chance of ectopic pregnancies. Other frequent complications of PID include infertility, pelvic pain, chronic PID, and pelvic abscess.
Should an abscess occur, patients should be hospitalized and treated with triple antibiotic therapy.
If the abscess isn't properly dealt with, there is a possibility of widespread peritonitis, and it can be deadly.
Your best chances lie in frequent checkups, including pelvic exams and cultures to avoid future problems.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

What Can be Done to Keep Things Out of a Child's Reach?

QUESTION: My two-year old gave me a scare the other day.
I found her putting a strawberry-scented air freshener stick in her mouth! I never thought to keep things like that out of her reach.
What can I do about this problem?

ANSWER: Many supposedly "harmless" items can be lethal for a child who can't yet distinguish between food and inedible objects.
Curious toddlers between the ages of one and three are especially attracted to objects with appealing scents, colors or shapes.
And since, unfortunately, there are no federal regulations governing packaging, manufacturers continue to make products that can be confusing for this age group.
One common pitfall is pills that look like candy.
M & M's, Good 'n Plenti, and Chicklets gum all look like common vitamin supplements or medications which can prove toxic to youngsters.
Toy medicine kits with edible sugar "medicine" only confuse a child further. Never cajole a child into taking medication by telling him it "tastes like candy." And keep all medicines, including over-the-counter drugs, locked away.
Avoid buying novelty candies shaped like batteries or matchsticks; they may tempt a child to eat the real thing later on.
Also, keep out of reach inedible or toxic household items that look or smell food-like; plastic food-shaped toys, or sweet-scented shampoo, mouthwash or household cleaners. Even worse, manufacturers are now packaging many nonfood items in familiar looking food containers which even fool adults.
Report any item you feel is a potential hazard to the Product Safety Commission, 1-800-638-2772.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Thursday, April 23, 2009

Questions About Losing Weight While Breast Feeding

QUESTION: I was told that a woman who is breast feeding her child should, under no circumstances, lose weight.
I am nursing a five month old now and am approximately 25 pounds overweight.
I am seriously considering continuing to breast feed my infant beyond the first 6 months but I cannot live with the extra weight.
If I do lose weight could it possibly harm either the baby or myself? Thank you for your consideration.

ANSWER: I have never heard of the admonition against weight loss that you refer to, and am happy it may not be too wide spread, because it is wrong. The weight gained during a normal pregnancy is there for a special reason, to furnish the mother with the nutritional reserves necessary to provide her baby with the nourishment gained through breast feeding.
Ask any woman who hasn't breast fed her infant about the troubles returning to pre-pregnancy weight levels, and you will understand that your decision has been the right one, and you may certainly continue without danger to yourself or baby.
The only caution I would have is not to try to crash diet to reduce your weight, but to increase your activity gradually and continue to nurse as before.
This will lead to a gradual and safe weight loss.
Just to check my information I contacted La Leche International (P.O.
Box 1209, Franklin Park, ILL 60131-8209 for you and others who may wish more information) and they connected me with Ms.
Doris Esposito, my Area Professional Liaison, who discussed this with me and afforded some additional information.
By providing your infant with its daily need, you are using about 700 calories to provide the nutrition.
That adds up to about a 1 pound weight loss every 5 days, if you eat only the amount of food your body consumes for its own metabolism, your 25 pound excess will just about be gone by the time you complete 4 months more of furnishing your infant with the best nutrition available.
Give or take an extra snack here and there, you will probably come out even after 6 months, and bestow upon your baby the head start that only mothers can give.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

The Causes of Osgood-Schlatter Disease

QUESTION: My 12 year old daughter, with high hopes of an athletic career in tennis, is suffering from a swollen knee that was diagnosed as Osgood Schlatter Disease.
As very concerned parents we have looked up the condition in a medical book at our local public library, and are horrified with what we learned.
Yet our wonderful doctor keeps telling us not to worry, it will all come out fine.
Can you help us with an explanation of the causes, and the proper treatment of this condition?

ANSWER: The history of this answer to you took an interesting turn, for when checking my own sources to refresh my memory I found that my material spoke in optimistic terms about the outcome of Osgood Schlatter, a disease that strikes the knees of young teen age boys and girls.
I was all set to provide you with the reassurance that your doctor was correct when my studies took me to our own small public library, and I decided to try to duplicate your experience. Naturally the books available were all a bit dated, and when I read the explanations offered, I quickly understood your anxiety.
The description of the cause was "avascular necrosis of the ossification center of the tibial tuberosity" which translates into "the death of the bone producing center of the tibial bump due to loss of circulation".
While that may have been the accepted cause when Drs.
Osgood and Schlatter first described the condition in 1903, it is a theory that no longer is generally accepted.
Instead it is believed that the condition of a swelling, and very tender and painful area over the bump on the shin bone just below the knee, is most probably due to the strains and stresses that may result from active participation in athletic competition.
While once a condition seen primarily in boys, the gals are now rapidly catching up as their involvement in sports increases.
The good news is that Osgood Schlatter is considered a benign disorder that in mild cases can disappear by itself.
Treatment consists of pain medication as needed and restriction of physical activities, particularly those that require frequent deep knee bending.
Braces on the knee can be used, or even a cast to immobilize the knee if symptoms continue.
A two to four month period of rest, followed by reconditioning and strengthening exercises, will soon have your young athlete back on her feet and playing her favorite sport.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Can a Middle Ear Infection Cause Vomiting and Diarrhea?

QUESTION: Can you help us make some sense out of problem diagnosed as a middle ear infection? We have had a terrible time with our baby boy (age 2) and the doctor feels that this ear infection is causing all of his problems including vomiting and diarrhea.
Is this possible? What should we do?

ANSWER: This is certainly the season for Otitis Media (the medical name for the condition) to rear its head, as it is most frequently seen during the winter months and early spring.
It is more common in younger children under the age of 6, and boys seem to suffer from it more frequently than girls.
As you have probably been told, it is a bacterial infection located in the middle ear, and usually is seen a few days after the beginning of a common cold or other upper respiratory infection.
It is not a pleasant situation for your youngster, who will display all the signs of pain in the ear, crying and even screaming, certainly increased irritability, fever and disturbed sleep.
Yes, acute otitis media may even provoke vomiting and diarrhea.
And it is not a diagnosis that should be treated lightly, as serious complications, including hearing difficulties and language and speech development problems, may occur if proper therapy and follow-up is not carried out.
The first line of defense will be the use of antibiotics, which usually are quite effective.
In the event that the first prescription fails to obtain the desired results, a change may be made, as there are many antibiotics that may be used in these cases.
Your baby should be seen regularly following the conquest of the present acute situation, to prevent possible recurrence.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Monday, April 20, 2009

Care Before and After Surgery

QUESTION: My married daughter is going to have surgery soon, hopefully to remove the causes of a weakening and chronic illness.
I am worried sick about her and the care she is getting.
She doesn't eat, and they are doing nothing to build her up.
In my day they gave you a transfusion of blood to take care of the amounts you lost during surgery, but she hasn't even had that help. Can you tell me if you think her care is correct?

ANSWER: Since you have omitted many details of her problem and just what care is taking place, I am not able to comment on all the treatments that may be going on.
However, your call for a blood transfusion does deserve some explanations which may help restore your confidence in your daughter's physicians and surgeons.
It is certainly not like the old days, for modern techniques in surgery have greatly reduced the amount of blood lost during most operations.
No longer is it necessary to administer blood as a precaution against reduced blood volume.
Nor is blood indicated to build up a person's reserves as though it were some type of nutritional supplement.
With all the possibilities of reactions to blood transfusions, physicians have become more and more careful about the circumstances in which blood is given. Since febrile and allergic reactions can occur in about 1 out of each 100 units transfused, and the possibilities of blood reactions due to incompatibility are very real, no transfusions are used as preventive measures.
In addition with the possibility of hepatitis, and the remote but possible chances of an AIDS infection (about 1 for each 40,000-1,000,000 units), "caution" is the new password in transfusion indications.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

What is "Barber's Itch"?

QUESTION: I have flaky skin in both my ears; it is also very itchy.
I also have a patch in my hair near my neck.
A friend of mine said I might have "barber's itch".
I never heard of this before.
What can I do to cure this?

ANSWER: A cure is generally never much better than the diagnosis that was made before the treatment was recommended.
If your friend's evaluation is correct, this answer may help, but I would have a physician look at your problem first before running off to get a medication.
"Barber's Itch" is a name used to describe a scaly, round rash that is located in the beard area, and only affects men.
Its medical names are "tinea barbae" and "sycosis vulgaris" as well as "Alibert's III".
It is caused by a fungus growth, usually of the trichophyton family.
The rash can also contain small abscesses with the fungus growing inside, and the physician can make an accurate diagnosis by looking at this material under the microscope.
Treatment consists of scrubbing thoroughly with soap and water, topical fungistatic preparations and oral medications.
Since your description is not typical, and since these medications are prescription preparations, my advice to see your physician should be seriously considered.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

A Question About the Proper Treatment of Burns

QUESTION: Would you please help me win a bet? The question is about the proper treatment of burns.
I say they should be left exposed to the air, and my partner insists they require a dressing to heal properly.
Since we have a lot of minor burns happening in our shop, your answer will not only settle the bet, but become our rule for burn care.

ANSWER: I may have to hedge a bit, because this answer, like so many in medicine, depends upon the situation.
Let me start with one important rule for you.
All burns should be cooled by applying cold, wet compresses, or if possible, sticking the injured part into ice water, until proper treatment can be provided.
No butter, no margarine, no grease which can only complicate the treatment and lead to bacterial infection of the wound.
If the burn is truly minor, that means it is superficial, only causing the skin to become reddened and tender (the old "first degree" burn), you need only apply a mild emollient or softening cream to reduce the swelling and pain.
Creams which contain aloe are very helpful.
If you consider this a dressing, you have lost your bet. With more serious burns, which form blisters, or where there is tissue loss, bandaging is required to keep the wound clean, and protect the area from further injury, so that healing can proceed without difficulty.
In the case of a blister, the fluid should be removed using a sterile needle, leaving the skin over the blister in place to protect the underlying tissue and prevent the wound from drying out.
When a burn wound drys out (desiccates), more cells die, and there is more loss of skin and scarring.
Serious burns require proper dressings that will prevent drying out yet prevent the fluid serum to accumulate (in which infection may occur), as well as protect the wound, and not stick to the skin as the healing process progresses.
Newly developed two ply synthetic membrane dressings may be used to accomplish all these goals. Of course wounds that require such dressings are major and best left to the care of your physician.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Sunday, April 19, 2009

Is Testicle Examination Important?

QUESTION: My doctor says that it is as important for me to examine my testicles for cancer as for my wife to examine her breasts.
Isn't he being overly dramatic?

ANSWER: Not in the least.
Just as a self-examination of the breasts may reveal a tumorous lump beneath the surface, it is also possible for a man to discover a case of testicular cancer in the same way.
A monthly examination of the testes can easily and comfortably be performed while in the bath or shower.
Simply place the index and middle fingers under each testis, and the thumb on top.
Slowly rotate the testis with a gentle motion, feeling for any lumps.
Repeat the process for the epididymis, the small curved structure located atop each testis.
If you discover any small lumps, a slight enlargement or change in the consistency of the testes, consult your doctor immediately.
Testicular cancer is exceptionally treatable, with a combined cure rate of 85% for all forms of the disease; the earlier the condition is uncovered, the more likely a complete recovery and an unhampered sex life. Cancer detection is just as much a personal responsibility and a necessity in a man as it is in a women.
And it is easy to overcome the first few moments of reluctance when you come to realize that it is your own health you are protecting.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Could Neck Tenderness be a Thyroid Gland Problem?

QUESTION: My husband has been complaining about tenderness in his neck for over a month, along with feelings of fatigue and even a slight fever.
Could the problem be in his thyroid gland?

ANSWER: Well, that's one possibility, so let's discuss it.
To determine if the source of your husband's pain is in fact the thyroid gland, a physician will usually inquire if the pain has existed for less than three months, since most conditions which cause thyroid pain rarely last for a longer period. Next, a careful examination of the neck to see if there is tenderness, swelling, or a sensation of warmth in the area of the thyroid. Thyroid conditions can cause considerable discomfort for sufferers. Luckily, however, such disorders are nearly always relatively short-lived, as well as benign and easy to treat.
Among the most common pain-causing thyroid conditions: subacute thyroiditis, Hashimoto's thyroiditis and benign thyroid nodules. Subacute thyroiditis is the most common of the three and often follows an upper respiratory tract infection.
Some characteristics of the disorder, which usually runs its own course within three months with no medication required, include fever, malaise, fatigue and muscle soreness.
The symptoms of Hashimoto's thyroiditis resemble those of subacute thyroiditis although the pain is usually less intense.
This condition also disappears on its own. Benign thyroid nodules can cause patients pain because of hemorrhage into the swollen nodules. Most conditions that cause pain in the thyroid can be helped with relatively little medication and a lot of patience as they run their rapid and benign course.
Just a word: although we have discussed thyroid conditions as the cause of your husband's problems, there are other possibilities which may best be discovered by a thorough examination.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

What do "Follow Up Tests" After a Pap Smear Involve?

QUESTION: The results of a recent pap smear were read as "slightly abnormal." Now my physician is advising "follow up tests".
What does this involve? What could this mean?

ANSWER: The pap test or smear is used most commonly to detect cancer of the uterus and cervix.
The test can reveal abnormalities at a stage at which such changes produce no visible symptoms and have done no damage.
Most often the pap test catches uterine or cervical cancer at such an early stage that the problem can be completely cured.
The next step for your doctor to take is to perform a colposcopy an examination with an instrument that is inserted into the vagina and permits visual examination of the neck of the womb and the upper part of the vagina.
The colposcope has a magnification lens and can detect early malignant changes. If your doctor sees any problem areas, he or she then knows which areas a biopsy sample should be taken from.
If the biopsy turns out to have precancerous tissue, or even malignancies, one relatively simple, painless and inexpensive treatment option is cryotherapy.
This involves the destruction of the abnormal tissue with the application of extreme cold.
About 20 to 25% of patients with an abnormal pap smear require a different procedure because of possible invasive cancer.
The procedure is called cervical conization, which is the surgical removal of a cone of tissue. Another form of treatment is Carbon Dioxide Laser Therapy.
In this method, a laser vaporizes the altered cervical tissue.
Laser therapy may provide a better cure rate than cryotherapy, but it is less widely available, more expensive, and requires anesthesia. Hysterectomy is very rarely indicated, even with extensive changes of the cervix.
In the early stages, relatively simple techniques can accomplish lasting cures, so stay the course.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Friday, April 17, 2009

Can a Skin Rash Develop From Something Carried in the Air?

QUESTION: Although I know you can get all sorts of rashes from touching certain substances, is it possible for a skin rash to develop from something that is carried in the air and comes in contact with your skin?

ANSWER: Yes, a wide variety of airborne particles, especially in the workplace, can cause contact dermatitis, with accompanying itching, stinging and burning sensations of the skin on the eyelids, cheeks, nose, neck, and other exposed areas.
Solid particles can pass under clothing, so even covered parts of the body may also be affected. Fiberglass dermatitis is a classic example.
But other culprits include rock wool fibers, dust from sewage, wood particles, cement, cellulose fibers, mica, food additives, urea formaldehyde insulation foam, alkaline vapors (from ammonia, for example) and acid particles.
All can produce lesions in the form of scratch marks, tiny papules, or discolored, thickened and raised areas of the skin. Such skin eruptions can appear suddenly and briefly or persist for long periods.
Typically they have a regular outline and appear on the face and neck if the offending material is a gas or vapor.
But they occur on other body parts when solid particles get under clothing. The diagnosis is made by patch test.
While antihistamines and corticosteroids are valuable for treatment, the best solution is prevention, wearing protective clothing, using exhaust fans to remove all airborne contamination, and avoiding such harmful environments when possible.
This may even require changing your job, in severe cases, since the same particles causing dermatitis can be especially harmful when inhaled.
Reactions could affect your respiratory system and its vital functions. When it is difficult to discover the relationship between a rash and its specific cause, you may find keeping a "rash diary" helpful in searching for the culprit.
At each appearance of a rash, reflect on all the activities of the past 24-48 hours, where have you been, what substances were in the vicinity, have there been any new materials brought into your environment. There are times when the answers to these questions are the only clues you and your physician will have to solve the mystery of a rash.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

What Do Doctors Perform "Arthroscopy" For?

QUESTION: I thought the pain in my joint came from strain, or perhaps an early case of arthritis.
However my doctor now suggests that an special examination be performed.
I guess he may be on to something, but I need to know more.
What do doctors perform "arthroscopy" for?

ANSWER: Arthroscopy is short for arthroscopic intra-articular examination and treatment, that is, the use of a device that may enter into a joint and examine and treat it.
A surgeon will make a very small cut on, say, the knee, and use the thin, tubelike arthroscope to examine its interior.
A similar device can be inserted through another incision to provide light, and knee surgery can be performed leaving two or so scars less than an inch long. Arthroscopy allows for very rapid recovery and lessened discomfort as compared to other joint surgery. Arthroscopic techniques are now widely used to examine and treat the shoulder, elbow, wrist, and ankle, and they are being experimented with for other joints.
In diagnosis, arthroscopy can be used to determine the causes of swelling, instability or locking of the knee, and therapy can be determined based on the findings.
In surgery, arthroscopy can be used to remove loose or damaged cartilage and tendons, or to remove some joint fluid.
It is not possible for me to speculate on the reasons your physician has for requesting this special examination, and so, now that you understand a bit about the procedure, it is time you posed your questions to him so that you may receive the information you need to make an informed decision about your care.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

An Explanation of "Ascites"

QUESTION: A fellow worker is going through a terrible illness, and most disturbing of all is his need to have fluid removed from his belly at regular intervals.
It sounds horrible, but many of his fellow workers are afraid they may catch the same disease.
Can you help us by explaining just what is going on?

ANSWER: The condition your co-worker is suffering from is known as "ascites" (from a Latin word meaning "a bag").
Liquid forms in the closed abdominal cavity and, since there is no way of it getting out, must be removed.
Usually this condition occurs when there is a serious, chronic liver condition.
The commonest cause is cirrhosis, which as you may know, can result from severe alcoholism.
There are other possible causes, including heart failure, kidney disease, and some forms of cancer.
The manner in which the liquid is formed is pretty complex and still not completely understood by scientists.
The fact that is most important to you and the other people in your office is that you can't catch the condition from your friend.
I am also sure, that were there any danger to you or your fellow employees, you friend's physician would have notified family, friends and place of employment.
I believe I can confidently reassure you, so that you may continue to be a support to someone who could use a bit of help in his hour of need with no fear for yourself.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Wednesday, April 15, 2009

Where Does Dandruff Come From?

QUESTION: While it might not be a question of the greatest medical significance, I'll bet a lot of your readers would like to know the answer to a mild dandruff problem.
It is not devastating, but I can't wear a dark suit or jacket.
Where does it come from and what can I do?

ANSWER: You are right in believing that this common problem affects many people.
Since the skin is constantly growing and shedding its outer layers, a light sprinkling of dandruff may be considered normal.
This should be controlled by regular shampooing and thorough, careful rinsing.
The overuse of hair sprays may contribute to the number of unwanted flecks.
Often an intense scaling may be part of a skin condition known as seborrheic dermatitis.
In such cases, medicated shampoos containing tar, selenium sulfide, sulfur and salicylic acid, or pyrithione zinc may be prescribed for regular use.
When there is considerable inflammation, a corticosteroid lotion may be rubbed into the scalp until the situation is controlled.
A caution or two, if you do use medicated shampoos.
Since they too may cause irritation of the skin, it is important to use them only as directed by your physician or pharmacist.
Read the labels carefully and stop using the product if the dandruff situation becomes worse.
Keep coal tar and other medicated shampoos out of your eyes.
Use lots of water to wash out the eyes if you don't.
You should be able to control your problem using these measures.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Confused About the Role Diet May Have in Preventing Cancer

QUESTION: With all the statements made, which incidentally seem to change daily, I am totally confused about the role my diet may have in preventing cancer.
Can you make any sense out of the endless numbers and "facts" that are printed each day, or reported on television?

ANSWER: The topic of health and disease prevention is one that most Americans seem to be very interested in, and the news media is just trying to keep up with all the very latest developments published in medical journals each week. It is hard to report on all of this material, and to keep straight those statistics which apply only to a few cases from those which are generally accepted by many researchers and clinicians.
Reducing the percentages of calories obtained from fats in the diet is recommended by most.
Reducing the amount by about 10%, from 40% to 30%, may provide protection from breast, colon, ovarian and endometrial cancer.
Some experts would like to see that percentage pushed even lower, to about 20% of total caloric intake.
This could reduce the risk of breast and colon cancer by as much as 80%.
To accomplish this, you are going to have to learn the fat content of various food, and keep careful count.
Fiber is another big item in the news these days.
It may decrease the chances of colon cancer by increasing the bulk of stools, diluting possible cancer producing material in the stool and decreasing the time they stay in contact with the cells lining the colon. Fibers are present in cereals, whole grain breads, fruits and vegetables. Calcium is also recommended, not only as a measure to prevent osteoporosis, but also to reduce the chances of colon cancer.
Daily intake of 1200 mg is recommended.
Other dietary items have been linked with cancer in some studies: they are smoked, charred and nitrite cured foods.
Stomach cancer has also been associated with long time use of pickled and salted foods.
If cancer prevention is really your goal, there are two other items to be mentioned, although they do not deal specifically with food.
They are exercise and smoking.
Individuals with active occupations do seem to have a lower risk of both breast and colon cancer.
The use of tobacco can be linked with about 30% of all cancer deaths, and it has been associated with cancer of the lung, pancreas, bladder, kidney and possibly the cervix.
Lung cancer is now the biggest killer of women (21%), even more lethal than breast cancer (18%).
In summary, if you desire to prevent that which might be preventable by consuming a healthy diet, choose foods low in fat and high in fiber, keep your weight down, exercise regularly, and stay away from tobacco.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Are There Any Tests to Predict Drug Allergy?

QUESTION: Having just recovered from the problems of a drug allergy brought on by a prescription medication.
I was wondering if there wasn't some way to have predicted that this might have happened.
Aren't there any tests available, and how does the doctor know that it was an allergy that produced all my symptoms?

ANSWER: As a general rule, it is impossible to predict which patient may have an allergic reaction to a drug, or to any other substance for that matter.
An allergy is an exaggerated sensitivity to a substance that usually produces no reactions in most other people.
A careful case history of previous experiences with medications, or the presence of allergic reactions to pollens, food, or animals may alert a physician to the possibility that the patient is a sensitive individual, but does not guarantee that there will be a reaction to the needed medication.
Of course, any adverse experiences with a medication previously would be sufficient warning not to use that particular medication again.
However, even when a medication has been used successfully in the past, without any trouble, there is still no assurance that it won't provoke a reaction on this new occasion.
When the disease is life threatening, and only one medication can do the job, a skin test may be used to evaluate the sensitivity of the patient, and help in deciding whether or not to use the medication.
Many so called allergic reactions are in reality a side effect, and do not involve the body's immune system; and testing of the immune response to the substance reveals this.
Abdominal upsets (including diarrhea), sleepiness, and jittery feelings are samples of some reactions that are not normally provoked by allergic mechanisms.
When a true allergic symptoms is discovered, such as a rash, hives, swelling, drug fever, or wheezing, the first step is to discontinue the use of the medication immediately.
A careful history is sought to try to link the taking of the medication to the onset of the symptoms.
It is important to report the use of any other medications taken at the same time, including over-the-counter preparations, vitamins, pain killers and the like, as they may have been part of the reaction.
Once the drug has been stopped, the disappearance of the symptoms within 24 to 48 hours makes it highly likely that the new medication was the cause of the reaction, and this fact should not only be noted on the chart, but remembered by the patient, and reported to any physician who is faced with prescribing treatment.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Tuesday, April 14, 2009

What Can an I.Q. Test Really Measure?

QUESTION: There is a lot of discussion about intelligence tests in our school district.
A lot of us don't think they mean very much, and are frequently incorrect in their interpretation.
What can an I.Q.
test really measure?

ANSWER: First let me say that perfect I.Q.
tests would accurately and completely validate and reliably predict a person's intellectual aptitude. But there are no perfect I.Q.
tests.
Controversies about such things as the definition of intelligence and appropriate methods for evaluating that aptitude have been with us for decades (yes, even when I took them!) and even now are still being debated. I.Q.
tests you probably hear the most about are the currently popular Wechsler and the Stanford-Binet.
The latter was the leader in the United States until fairly recently when the Wechsler which measures a wider variety of verbal and performance aptitudes was introduced. Nevertheless, I.Q.
tests particularly those that are given individually as opposed to those administered to groups to people over six years of age can be very helpful in identifying intellectual aptitudes and their relative strengths and weaknesses in specific areas of thinking/learning abilities. Additionally, I.Q.
tests can be very useful in evaluations of patients suspected of being mentally retarded, those having serious learning disabilities and/or attention disorders, or those who are exceptionally talented. One of the most important elements in I.Q.
scores is analyzing the specific conditions under which the test was taken, as well as various parts of the tests.
Also, the tester's degree of skill and rapport with the person taking the test, scoring procedures, and the test taker's motivation to be tested, physical and psychological conditions, fatigue, and understanding of directions are important.
And so you may wish to know that I.Q.
tests only give indications not absolute truths.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

What Does a "Risk Profile" Mean, How Does it Work, and is it Worthwhile?

QUESTION: There have been several times when you have discussed heart disease, where you have mentioned reducing risks, usually by diet or exercise. Recently we were offered the chance to have a "risk profile" developed for us by our company.
What does this mean.
how does it work, and do you think it is worthwhile?

ANSWER: As medical insurance costs to companies continue to mount, some clear thinking has made prevention of disease an important goal, rather than just financing the cost of care for disease when acute crises develop.
A careful history, an examination, and a few tests are necessary to construct a risk profile that provides an individual with some conclusions upon which to change a style of life and activity, and thereby prevent the onset of heart disease. There are several factors that are considered, some of which you may not be able to change, others that require your decision and actions.
A family history is taken, and if early heart disease runs in your father, mother or brothers or sisters, then you must consider the changes you can control even more seriously.
The other risk factors include smoking, high blood pressure, elevated cholesterol levels, diabetes, obesity, an abnormal electrocardiogram, and certain behavioral characteristics (such as extreme emotional reactions and anxiety responses to life's stressful situations).
You can understand just by by scanning this list that there are elements that can be changed by proper medication or activity.
In some risk profiles, numerical scores are calculated and can be used as indicators of the chances that you will fall victim to heart disease.
Lower the numbers and you reduce that probability. I think that this approach to disease prevention makes great sense, because it reduces a lot of complicated considerations into some simple numbers, and offers you a realistic evaluation of your chances of living a longer, more enjoyable life, but that doesn't of necessity make it "worthwhile".
All the numbers and calculations are worthless unless you decide that they have a meaning for you, and that you accept the challenge of changing those factors which may be altered.
Your employers, as many concerned health providers, consider these evaluations most important, but their true worth depends upon you.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

What Makes a Person's Skin Turn Yellow?

QUESTION: Please settle an argument I'm having with a friend about what makes a person's skin turn yellow.
She says it means liver disease.
I say it means jaundice.
Who's right?

ANSWER: Actually, both of you are correct.
"Jaundice" merely means that the skin is tinted yellow.
The color comes from certain pigments contained in the bile, and it's a sure sign something has gone wrong.
Most frequently it is a disease affecting the liver, but can also be caused by problems in the "biliary tree" (the tubes leading to and from the gall bladder). There are some clues doctors use to tell the conditions apart.
For one, an individual with obstructive jaundice, caused by a blockage in the biliary tree, usually notes the changed color of the skin before being aware of feeling under the weather.
In fact, jaundice patients often discover their condition accidentally, when a friend or family member comments on the change in their complexion.
In contrast, patients suffering from hepatocellular diseases (a fancy name for liver disease) the most common variety is viral hepatitis usually complain early on of such concerns as weight loss, fever, or a sensation of itching. When a doctor suspects an obstruction in the biliary tree, a series of noninvasive radiologic tests to discover the location of the blockage is usually recommended.
Ultrasonography can show dilated bile ducts; CT scans are useful in providing more detailed data.
For true liver disease, there are a wide variety of blood and chemical tests to help determine the exact diagnosis, and it sometimes take quite an effort before the exact cause of the jaundice can be determined.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Sunday, April 12, 2009

The Safety of Exercise During Pregnancy

QUESTION: I am a bit of an exercise fanatic, but now the welcome news that I am pregnant is causing me to rethink my training program.
I would appreciate any information you may have concerning the safety of exercise during this period of my life.
I would hate to lose all of the progress I have made, but will doing nothing to hurt the baby.

ANSWER: This is a most common situation, and the question of exercise during pregnancy still remains one of controversy and discussion in the medical literature.
The basic concerns relate to the way your body is changing as you progress in your pregnancy, and whether the modifications that occur because of intensive training can affect these changes.
It seems as there is no absolutes; with many differing opinions, I can only point out some basic considerations.
You realize that as you as the baby grows bigger, your own balance and center of gravity will change, and throw your coordination off. Your body is even now preparing for the delivery, and changes in your hormones are loosening your ligaments and other tissue.
That may cause increased mobility in your joints that could lead to an exercise injury.
There is concern that the increased demand for oxygen for exercising muscles may diminish the available oxygen for the baby.
In an attempt to bring some order to the situation, the American College of Obstetricians and Gynecologists developed guidelines which suggest that you only participate in exercise designed to keep your pulse rate under 140/min and that you limit your sessions to only 15 minutes.
Any complications in the pregnancy would require you to stop all extra exertion.
But when you reflect on the reasons, I am sure you won't mind.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Antibiotic Treatment During Pregnancy

QUESTION: During a regular check up for my pregnancy, my doctor discovered bacteria in my urine.
Though I have no symptoms, my physician claims that it must be treated and wants to use an antibiotic.
I am against all medicining during the time I am carrying the baby, and feel he is being over cautious. May I have your opinion, please?

ANSWER: Your point of view that resists medications of any kind during early pregnancy is a fine one, and I wish more mothers-to-be understood the principles.
However, your physician is aware of the dangers of urinary infection to both you and your baby, and is not merely playing it safe but is most wise in his advice to you.
During your pregnancy your body undergoes many changes, including alterations in both the structure and function of your urinary system.
Urinary tract infections can be far more dangerous now than under other conditions, and can lead to a condition called pyelonephritis which is one of the most frequent reasons that pregnant women require hospital care.
Though you may have no symptoms now, if left untreated, symptoms can develop 30 to 40% of the time.
Your physician has a wide choice of medications that can be used.
Penicillins, cephalosporins and erythromycin type medications are considered safe.
Others, such as sulfonamides, nitrofurantoin, metronidazole, aminoglycosides and isoniazid may be used with caution.
I doubt that your doctor will chose a tetracycline or chloramphenicol, which are contraindicated for you.
His choice will depend upon the type of infection you have as well as your own sensitivities, tolerance to the medication, and any possible allergies to medications. Though you are to be complimented on your caution, this is one time when your physician's advice is right in line with the best of current medical practice for situations such as yours, and should be carefully followed.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Ways to Prevent Cancer

QUESTION: Your advice is always so welcome in our home, for it always rings true.
I know many people write to you to ask about cures for disease, but we think your emphasis on prevention is most important.
Now if you could discuss ways to prevent cancer, you would be doing everyone a service.

ANSWER: If ever I wished I had a simple and complete answer for a question, this would be the one.
The problem is that there are so many cancers, so many causes, that there are no simple answers.
The basic rules of good health are always a fine starting point, and must be emphasized over and over again, for they help prevent illness of all kinds.
Regular physical checkups, exercise and diet are always in order.
And the researchers have given us some specific tips that may be useful.
Foods high in fiber are not merely the latest fad, but help to lower the risk of colon cancer.
Keep the fat content in your diet low to reduce risks of breast, prostate colon and rectal cancer.
Avoid unnecessary X-rays, but be quick to permit those that are important for diagnosis, recommended by your physician.
There are so many risk factors that exist in the workplace that you must become knowledgeable about the materials that you come in contact with, and the safe procedures that must be used in handling them.
Excessive exposure to the harmful rays of the sun may lead to skin cancer, so keep covered or use the appropriate sun screens when out in the open.
The evidence for the harm that smoking does is dramatic, and our new turn to a no smoking society is one that may prevent thousands of needless cases of lung cancer, heart disease and emphysema.
There may be many more such tips, each directed at a specific cancer, but the call for moderation in all things, which I call for here on frequent occasions, must still be amongst the most valuable tips one can offer to prevent cancer, and in fact all disease.
One day, I hope, I will be able to answer your question more directly, but until then, give these tips a try.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Friday, April 10, 2009

Morning Temperatures Procedure to Figure Out Time of Ovulation

QUESTION: With a deep desire to have a child, and no success over a long period of time, I have decided to try a system involving morning temperatures to try to figure out my time of ovulation.
My girl friend was successful, but she can't explain the procedure to me in a way that I can understand.
Can you?

ANSWER: I certainly will explain the procedure to you, but the many factors that affect fertility make this a complex situation to deal with in an effective manner.
Tracking your basal or morning temperature as a means of establishing your time of ovulation is only one aspect of what should be a total effort to gain your objectives, and that requires professional advice. It's going to take some time, and you will need patience and dedication to evaluate and correct all the possible causes of your infertility.
You will want to keep an accurate record of basal temperature over a three or four month period, to provide a record that can be interpreted properly.
A special thermometer is used which is marked in a manner that makes the lower body temperature found at the end of the sleep period easy to determine.
Shake the thermometer down before retiring for the night and keep it by your bedside for use as soon as you awaken, before you leave the bed.
Keep the thermometer in your mouth for an extended period of time, from 5-10 minutes is required. Read the thermometer carefully in a good light, to the nearest tenth of a degree.
You must then note this on a special temperature chart that is usually provided with the thermometer or by your physician.
If you have had intercourse the previous evening or that morning, place a small circle around that day's temperature reading, as this will provide your physician with the record needed to counsel you.
Usually your temperature will be within narrow range of two tenths of a degree or so during the first part of your cycle.
On or about the 14th day the temperature will take a dip, to be followed on the succeeding days by a level that is elevated by as much as a whole degree. This will form a pattern that is typical for ovulation, and will help you determine your day when conception is most probable.
Both the timing and frequency of intercourse are important considerations, as too frequent intercourse may cause the quantity or quality of your partner's sperm to diminish.
This is but another factor to discuss with your physician.
Good Luck.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Shaving Technique for Basal Cancer Removal

QUESTION: The growth on my face has been diagnosed as a basal type cancer. The doctor has referred me to a specialist who has a new technique that may require several visits, because he shaves away a little piece of the tumor at a time, then looks at it with a microscope before doing the next step.
Do you know of such a method, and why can't they just cut the damned thing off?

ANSWER: Actually, you do have that option, as a surgical procedure (excision) may be used to remove a basal cell carcinoma quite readily.
If the tumor is small enough, the doctor can then simply close the wound, or it may require a graft of skin to replace the removed tissue.
If enough normal tissue surrounding the tumor is removed, hopefully eliminating all cancer cells, a cure is attained in 95% of the cases.
The technique to which you refer is called Moh's Procedure, and can approach a 100% cure rate.
It is most useful when the tumor has a poorly defined border, for tumors located in areas where recurrence is frequent, or where normal tissue must be preserved.
Under local anesthesia, the tumor is removed but the wound edges are examined with a microscope to be sure that all the cancerous tissue has been removed.
The procedure is repeated layer by layer, wherever any abnormal cells are found, until none can be seen.
The operation requires special equipment and trained physicians, but promises the most reliable results.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Participation in Exercise While on Beta-Blocker Medication

QUESTION: Because of a case of high blood pressure that was difficult to treat, I am now under control with medication (beta-blocker).
I think I would feel even better if I could participate in an exercise program we have here, but as you know, my pulse is also lower due to medication.
Can I participate in the program and will it do me any good to try?

ANSWER: Many people must find themselves faced with your problem, for since their introduction in 1966, the beta-adrenergic blocking drugs have become widely used to treat a variety of heart conditions as well as hypertension. As you correctly note, these medications affect your heart and therefore your pulse rate, and may lower this rate from 15 to as many as 60 beats per minute when you are exercising at moderate levels, the amount depending upon your body's reaction and the dose of medication you are taking.
But the effect on circulation may be less dramatic, for as the heart beat is slowed, the amount of blood pumped out with each contraction increases, keeping the flow of blood to the body near normal.
The beta-blockers may also lower your breathing or maximal ventilation capacity, which may in turn diminish your ability to continue your exercise activity over prolonged periods.
However, the results of a number of investigations that deal with your question would seem to indicate that you may well derive considerable benefit from a training program.
There are a few precautions for you to take.
The amount and type of exercise should be based upon the results of a treadmill test, which should be conducted as much as possible in a manner that simulates the conditions you will be under when exercising.
You should be on the type and amount of medication that you will be taking during the time of your new activity. Since it is apparent that you had trouble in controlling your blood pressure, changing medications may not be advisable in your case, but the beta-blockers that act primarily on the heart allow greater flexibility in planning, and therefore a greater return from a well considered exercise program.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Thursday, April 9, 2009

Refusal to Take Vitamins During Pregnancy

QUESTION: My sister, who is 19, is having her first baby.
She is three months along, and although her doctor has told her to take vitamins, iron and calcium, she refuses.
She says it is not necessary! Would you please explain the situation to her? I am five years older than her and I have tried to talk with her but she refuses to listen.

ANSWER: Well young sister, what are we going to do with you? The newspapers and journals are just full of information that explains the necessity of good nutrition and health care, particularly during the months of pregnancy. Surely you are aware that your normal diet, no matter how perfect, will fail to provide sufficient nutrition for both you and the new life that is now your responsibility.
The fact is that due to the way human physiology works, the baby will make demands that your body will have to supply.
If you do not take calcium supplements, for example, the growing baby will steal your supplies, taking the calcium it needs to develop from your bones.
The head start to health that you can provide your child now will affect its entire life.
Both physical and mental development requires that the necessary nutrients be in place from the very beginning of life, and only you can provide them now. Perhaps you are having some doubts and fears about now, and are a bit overwhelmed by this whole process.
But it looks like you have a loving older sister and a concerned physician standing by to offer the answers and help you need.
If it takes a message from me to convince you, that you have, but it is the circle of family, friends and physician that can really offer the information you may need.
Why not take advantage of the Pre-Natal Classes that are offered in many hospitals and Health Centers across our country, to get yourself and your baby back on track? Someday you will be very glad you did.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Enlightenment About the Diagnosis of a Premature Infant

QUESTION: Can you offer us any enlightenment about the diagnosis of a premature infant.
Is it just their weight that counts, or do you have other methods of judging? Is the cause for premature delivery understood?

ANSWER: The strict definition of a premature infant is one that has been born before 37 weeks of gestation or pregnancy.
At one time any baby that weighed less than 5.5 pounds was considered a premature birth, but a full term infant of that weight would now be classified as small for gestational age (SGA).
To most experienced physicians, a premature infant just looks it.
They are, of course, smaller than usual, and their skin is shiny and pink, with the blood vessels easily seen through the skin.
They have little fat under their skin, usually no hair, and the cartilage in their ears is missing.
They are quiet babies, not moving around as much as others, and their muscle tone is reduced. In males the testicles may not have descended into the scrotum, which is smooth and does not present the wrinkles of the mature baby.
In females the labia majora are not developed sufficiently to cover the labia minora which lie beneath.
The reasons for premature delivery are poorly understood, without a clear cause.
Premature deliveries are more common in women who have had little or no prenatal care, who are in the lower socioeconomic classes, where there is poor nutrition and poor education, and in unwed mothers.
We need to know much more as prematurity is the greatest cause of newborn deaths.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Taking Malaria Medication During Pregnancy

QUESTION: My husband is being transferred by his company to a Latin American country.
I am expecting a baby in a few months, but want to go with him now to help him start up his new job.
He is being put on medication to prevent malaria.
Can I use the same medication that he will be taking, even if I am pregnant?

ANSWER: It is always against the rules to take someone else's medication, even when the circumstances seem so easy to understand, and the problem seems to be the same.
So the answer to your question is a resounding "NO!".
The usual recommendations for malaria prevention utilize a weekly dose of chloroquine in a dose of 300 mg.
Although not available in the United States, proguanil may also be used, but must be taken every day, dose 100 mg. However, many sections of South America harbor a chloroquine resistant strain of P.
falciparum, the germ responsible for the disease.
(You can check with the Centers for Disease Control in Atlanta for the latest conditions at your destination).
In such areas a second medicine, combining 25 mg of pyrimethamine and 500 mg of sulfadoxine (brand name: Fansidar) might also be considered.
However it is plagued by some serious side effects and complications including fatal skin reactions, and is no longer recommended as routine prophylaxis.
While chloroquine appears to be safe for use during pregnancy, this is not as clear for Fansidar.
Frankly, some of my knowledgeable colleagues would have me caution you about even going with your husband at this time, and recommend that you stay put until the baby is born. It is clear that you run substantial risks from the medications, even if the threat to your health and that of the baby is greater from the infection.
It is a hard call to make, so employ the counsel of your own physician as well.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Sunday, April 5, 2009

Physician Warnings about Diabetes Control

QUESTION: I suffer from diabetes and visit my physician regularly.
He constantly scolds me and warns me that if I don't control things better, the complications of diabetes will get me.
I've a little knowledge of these problems, but are they really as bad as my doctor makes them out to be?

ANSWER: I think you want me to reassure you, so that you may continue to take some of the admonitions of your physician lightly.
I can't do that in good conscience, for all the statistics reveal that the results of poorly controlled diabetes are frightening indeed.
Here are just a few from some recent publications and research.
Patients that suffer from diabetes are more than twice as likely to suffer from coronary artery disease than the general population.
More than half of all amputations that are not the result of injury are in diabetic patients.
Kidney disease is prevalent in as many as 10% of diabetics within 20 years of the diagnosis, and patients who have diabetes comprise about 25% of all patients in programs that treat end-stage (the most severe) renal disease.
And your eyes may suffer, with diabetes as the leading cause of blindness in adults.
Almost 50% of patients with the noninsulin dependent form of diabetes show retinal disease within 10 years of diagnosis.
And I could go on and on with statistics about nerve disease, circulatory problems, foot problems and impotence.
The answer to all of this remains with preventive actions, early diagnosis, well planned therapies that include not only medication but exercise and diet as well, and an understanding between patient and physician that aids people like you in carefully managing their disease.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Tips on Caring for Every Day Diarrhea

QUESTION: Although many articles appear about taking care of diarrhea that comes on when traveling, little is said about the every day homegrown variety. Surely many more of us suffer from this inconvenience than the other kind. Won't you please give us some tips on caring for the problem?

ANSWER: You know, you are right.
The fact is that most questions that are addressed to me do express anxiety about meeting up with diarrhea while voyaging to foreign countries.
Actually the information that is contained in answers to those questions contain important tips about your "homegrown" variety, but I am happy to address that problem now.
The most common cause of diarrhea, with its frequent large amounts of loose and watery stools, is viral infection.
However, the same symptoms can be caused by bacterial infections, allergies to certain food products, or digestive intolerance to certain foods.
The dangerous effect of prolonged and excessive watery movements is the loss of body fluids and dehydration, much more serious in children.
Therefore we pay a lot of attention to the replacement of liquids. Fruit juices and sweet liquids are NOT a good idea, and can make the condition worse.
Water is not too helpful either, for it lacks some of the important chemicals, sodium and potassium (electrolytes) that are lost in the liquid stool.
Nonfat chicken soup is a good replacement fluid, as is Gatorade, and children may be given special solutions prepared for them after checking with the physician.
Stay away from spicy or hard to digest foods.
Stay at home and rest, for you may easily pass on your condition to fellow workers or family you may come in contact with.
When you begin to feel better, resume your normal diet gradually, starting with rice, crackers and toast, cooked potatoes and carrots, then on to broiled skinless chicken and fish.
It may take a while to get everything back to normal, but slow progress is better than the discomfort of a recurrence because your battered system needs more rest.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Dieting Problems

QUESTION: I am forever dieting, between small losses and big gains.
Each morning I weigh myself, but the scale never reflects the effort I felt I put in the day before, even going up after a day when I practically fasted.
Why can't I be like the girl in the ad in the paper and on TV?

ANSWER: The weight never seems to drop as fast as we would like it to; and even the reminder that the weight, which represents years of over eating, can't be lost overnight doesn't help much.
No matter what the fad diets offer, the simple fact is that the body must burn between 3000 and 3500 calories more than it receives through eating for you to lose a pound.
Your daily caloric need, the amount you burn by daily activities, will vary as it reflects your weight, age and the amount of physical activity you perform. Sorry, mental work doesn't count, or there would be a great many skinny folks around.
The morning scale weigh, in addition to the benefit of helping you track your progress, does have a negative side as well.
Frequently you may be discouraged as you see a weight gain, when the previous day was one of great self control and food restriction.
This may be a reflection of the amount of salt you ingested, for the salt provokes water retention, and leads to the message from your scale.
Many home electronic scales can only show weight in pounds, and can not reflect a loss of less than a whole pound from the previous day's weigh in, though you may have made important progress.
As for the gal in the ad, why do you suppose she is there? Few people achieve those extreme results, and you will realize your goals if you persist and are patient.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Saturday, April 4, 2009

How Safe are Car Seat Belts for Small Children?

QUESTION: I read an answer about crossing seatbelts over to take care of three kids in your column.
However, I have another real concern that stemmed from your answer.
How safe are car seat belts for small children?

ANSWER: Seat belts are not particularly safe for small children, but they are safer than nothing.
Small children (those under age 4 or under 40 pounds in weight) should be strapped into federally approved child car seats.
These seats will help keep a child from being thrown violently within the car during an accident.
Children's car seats are available in sizes to fit infants and toddlers and should be used each time the child is in a car.
In some states, it is the law that a child must be in a car seat or strapped in at all times. If a car seat is not available, strapping a child in with a lap seat belt is better than not using anything.
A small child is very top heavy.
Their heads are the heaviest part of their bodies.
If a car is stopped suddenly, the unrestrained child is thrown forward and a serious head injury or death is often the result.
In a severe accident, an unrestrained child can fly around the car like a rag doll.
Remember, car accidents are one of the leading killers of our children. The best answer, of course, is to do the right thing, do it right, and do it regularly.
That may mean buying an extra child's car seat or two, but it's the only way I know of preventing the tragedy that can occur when youngsters are not properly buckled up in devices that have been engineered to protect them.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Drug Information

Drug Information It is very apparent to all who read the daily press, that an all out war on drug abuse is a vital necessity for our society.
The cost in human suffering, lives lost, as well as real dollars may well be incalculable, yet we see little progress in stemming the increasing flood of addiction and drug abuse.
If any weapon is important, knowledge about the problem and all its aspects, must rank high on any list, and there is at least one precious resource already available to all who would avail themselves of its assistance.
It is the National Clearinghouse for Drug Information, P.O.
Box 416, Kensington, MD 20795 (telephone number 301-443-6500 normal working hours Monday-Friday Eastern Time.) The Clearinghouse collects and disseminates information about the problem of Drug Abuse to consumers and health professionals alike, and may start you on the path to obtaining the knowledge you need to fight the problem in your community, schools and home.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.

Maternal and Child Health

Maternal and Child Health There really are many services provided to us by our Federal Government, although at times we all have our moments of doubt as to the truth of such statements, but it all comes down to knowing where they are and how to obtain their benefits.
That's why I have decided to include a variety of "clearinghouses" in this part of my column each week.
A clearinghouse is a service that collects all sorts of data and information about an area of concern, of some special health problem or condition.
They have the telephone numbers and addresses of resources and self-help groups, bulletins and publications, brochures and information sheets.
Its a great way to begin any search for help and knowledge, and can hasten the journey to obtaining the important facts you may need for an important health decision.
Today's clearing house information is an extremely important one.
The National Maternal and Child Health Clearinghouse, 8201 Greensboro Drive, Suite 600, McLeen, VA 22102 (telephone 703-821-8955) will provide its information to consumers and health professionals alike, and is an address you will want to keep for present or future reference.


The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.