FAQs: General Medical
The human mouth, as most people know, is teeming with bacteria. This is normal. But what do you suppose happens when a dentist gets into your mouth and drills into the pulp of the tooth, extracts a tooth, or performs any number of other procedures that disrupt the normal barriers between these bacteria and your insides? Well, small amounts of blood usually leak into the mouth, while bacteria in the mouth also have a shot at entering the bloodstream. Indeed, as it turns out, bacteria routinely enter the bloodstream even after normal cleaning by a dental hygienist.
Fortunately, this passage of bacteria into the blood generally causes no harm. The body's immune system is prepared to handle it, and the bacteria are gobbled up and destroyed. The amount of bacteria is small enough that there is no fever, or other sign of infection. But there are exceptions. And the exceptions occur in people with abnormal heart valves. The heart has four valves, and if there are structural alterations of any of the valves (e.g. two leaflets instead of three, a prolapsing valve leaflet, or a narrowed valve opening) then the bacteria that float through the bloodstream are more likely to stick to those valves, causing a heart valve infection known as endocarditis.
Endocarditis can be a serious illness. It is usually successfully treated with weeks of intravenous antibiotics. In severe cases, where the bacteria begin weakening and destroying the valve, surgery to replace the valve must be performed. The diagnosis of endocarditis may be tricky, and the symptoms are varied but might include the ones you have reported, as well as a rash, joint pains, kidney problems, and others.
How worried should you be? And how do you know whether or not you have an abnormal heart valve? Abnormal valves are usually detected during a physical examination. If your health care provider hears a suspicious heart murmur, he or she may order an echocardiogram to look for any structural problems. (Keep in mind that many people have benign, or "functional murmurs" that require no special attention and are of no concern.) If certain valve problems are found, however, it is strongly recommended to take antibiotics just before, and just after all dental work, in order to prevent endocarditis. This approach may seem very sensible, and does represent standard practice, but you should also know that it has been surprisingly hard to prove that the use of antibiotics in this way is actually beneficial.
My advice? Check with your doctor about whether or not you have been noted to have a heart murmur in the past. And have your symptoms evaluated without delay.
-- R. Jandl, 12/1/96, Category: general medical
From what you report, your brother has "coronary artery disease." That is to say, his coronary arteries are partially or completely plugged up. The coronary arteries carry fresh blood to the heart muscle, so that it can continue to pump many times a minute, day after day, month after month, year after year. Why should someone's coronaries become plugged? There are a number of known risk factors, including simply being male, a family history of heart disease at a young age, hypertension, diabetes, high cholesterol, and cigarette smoking. Interestingly, in some people, no risk factors can be identified, although further research will likely reveal explanations. (For example, there is now evidence that elevated levels of homocysteine in the blood may predispose people to heart disease at a young age.) On account of all these factors, plaques of cholesterol begin to form within the arteries, gradually choking them off. Blockages that form slowly over time may result in severe coronary artery disease, such as your brother seems to have, with very few symptoms until it is at an advanced stage.
A heart catheterization -- where a long catheter is threaded into a vein and dye is injected into the coronary arteries -- will reveal where the blockages are located, and how severe they are. If the blockages are severe enough, bypass surgery or angioplasty may be recommended. The exact recommendation for any particular patient depends on many variables such as how good the "run off" vessels are if a bypass is to be performed, whether or not the left ventricle (the main pumping chamber of the heart) has been weakened, what other medical conditions co-exist, and so forth.
The striking thing about your question is the doctors' insistence on urgency. The doctors were saying that there was no time to think about this decision, and no time to seek other opinions or advice. While it is not possible to comment on your brother's particular case without knowing quite a bit more, it is somewhat unusual to have someone so critically ill, or in peril of a fatal heart attack, that there isn't time for consideration of how best to proceed. Certainly other specialists must be available nearby who could have provided a second opinion. Even your personal primary care doctor may be helpful in discussing options. Depending on the level of symptoms, medications and a reduction of work and physical activity can sometimes buy some extra time for thought.
Bypass surgery is routinely done, but it is not routine for the patient. My guess is that the outcome (i.e. surgery) would have been needed anyway, but better communication may have relieved some of your concerns. By the way, it is common to do an extra bypass or two once on the operating table. The surgeon may find that certain arteries were more plugged than was thought from catheterization, or it might be a "as long as I'm in there..." decision done in a young man who is at high risk of future problems from his lesser blocked arteries.
-- R. Jandl, 11/20/96, Category: general medical
One of the common complications of mono is hepatitis, an inflammation of the liver. This occurs because the agent that causes mono -- EBV, or Epstein-Barr virus -- can infect the liver as part of the disease process. When hepatitis is present, the liver will not function normally. This becomes apparent to your doctor when blood tests show that abnormal levels of liver enzymes are being released into the bloodstream. It may even become apparent to you -- you may notice that your skin and the whites of your eyes become yellow with jaundice. Jaundice is caused by the accumulation of bile pigments in the body, pigments that the liver normally clears very efficiently. You may also experience nausea, loss of appetite, abdominal discomfort, and profound fatigue. (Interestingly, for unknown reasons, people with hepatitis may notice a strong aversion to the smell of cigarettes -- it really makes them feel sick.)
The long and the short of it is, the liver is inflamed, and therefore not working properly. If you add alcohol to the mix you will be asking for a bit of trouble. Alcohol, of course, is metabolized by the liver. This means that alcohol will not be cleared from the bloodstream normally and is apt to cause a greater degree of intoxication. Indeed, any medication or street drug that is normally metabolized by the liver, when taken in the setting of hepatitis, has a higher risk of side effects and toxicity. Alcohol has the additional effect of actually being a direct toxin to the liver cells. After a big night out, most of us will have microscopic evidence of liver inflammation. Therefore, the mixture of alcohol and hepatitis is a nasty one for your liver.
If you have had mono and are certain you have not developed hepatitis, does that mean you needn't be concerned? Well, mono itself is quite a stress on the body. You will need all your energy, and a "rested immune system" in order to deal with the infection. Alcohol is apt to aggravate your symptoms, and may set back your overall recovery. I would be careful to avoid alcohol until your symptoms are 100-percent gone.
-- R. Jandl, 11/6/96, Category: general medical
Scarlet fever is a close cousin to the much more familiar strep throat. In fact, it is caused by the same streptococcus bacteria, only in scarlet fever, the particular strain of bacteria produces a toxin within the body. That toxin causes a very distinctive rash.
Sickness usually begins abruptly following an incubation period of 2 to 5 days after exposure. There is typically a high fever, sore throat, and vomiting. The rash begins to appear about 12 to 36 hours after the onset of symptoms. It begins on the trunk and abdomen, and spreads out from there. It has a bright pink-red color that blanches to white if you press on it with your finger. Touching the rash will reveal a rough sand-paper consistency that is very distinctive. For some reason, the rash may be more impressive around the armpits and in the groin. Another interesting feature is the development of a strawberry tongue -- a bright, red, swollen tongue with a spotty white coating.
Although scarlet fever will usually resolve on its own, antibiotics will do a nice job of speeding things up, lessening the duration of illness and the chances of transmission to others. Penicillin is recommended unless there is an allergy. Any close contacts (such as family members) who begin to develop symptoms can be treated early. Isolation is not needed any more than you would isolate a child with strep throat. However, a day or two of antibiotics before returning to the crèche will likely decrease transmission to others.
-- R. Jandl,10/23/96, Category: general medical
How does carbon monoxide poisoning work? It works by binding to the oxygen-carrying protein (hemoglobin) located within the red blood cells. In fact, because it binds to the same site as oxygen -- and two hundred times more tightly -- it actually displaces oxygen from the hemoglobin and won't let go. The more this happens, the less oxygen is delivered to the body's cells. It's a form of chemical suffocation.
The early symptoms include headaches, nausea, vomiting, and drowsiness. Later there may be confusion and disorientation. Finally, in severe cases, coma and death result. Sadly, carbon monoxide poisoning from breathing automobile exhaust has been often used as a way of committing suicide. Anyone who discovers a person who has died in this manner will not forget the bright red cherry color of the skin, even in death. This is caused by the change in the color of hemoglobin when carbon monoxide binds to it. (Everyone is familiar with the notion that fresh blood will be a brighter red color than old blood -- that is because of a similar color change that occurs with the binding of oxygen.)
The treatment is pretty intuitive. Get the person out of the carbon monoxide, and give them as much oxygen as you can (100% concentration). In life-threatening situations, high-pressure oxygen chambers are sometimes used in order to push more oxygen into the tissues. Children, and the fetuses of pregnant women, are more sensitive to the effects of carbon monoxide because their metabolic rate is faster and they suck up more of the carbon monoxide. The symptoms will generally reverse within a matter of hours to days. After a week your child should be pretty much back to normal. Make sure there is no continuing exposure to carbon monoxide. You can buy an alarm to use in the home that will help to tell you whether or not there is still carbon monoxide present.
-- R. Jandl, 10/27/96, Category: general medical
Hemoglobin is a globular protein that contains an atom of iron. Iron is essential to hemoglobin's ability to carry oxygen. If the body is short of iron, than less hemoglobin is made. In iron-deficiency anemia, if you look at the red cells under a microscope you will notice that the cells are small and pale. This occurs because there is insufficient hemoglobin (which gives the cells their characteristic red color) available. If the anemia is mild, you will not notice anything wrong. If it gets worse you may begin to experience fatigue, or poor exercise tolerance. In quite severe cases it causes shortness of breath on exertion, and profound weakness and fatigue.
Young women are prone to iron-deficiency anemia because of their menstrual periods. With every period, some blood is lost from the body, taking the iron with it. Over a period of many months or years this can result in an anemia. Common things being common, if your doctor finds that your red blood count is low, he or she would be right most of the time assuming it is due to iron deficiency. If the machine that analyzes your blood count also indicates that the red blood cells are small and pale, the odds of it being iron-deficiency are increased further. Best of all, your iron stores can be actually measured with another blood test. If this is low, you can be 99.9% sure that iron-deficiency is the cause of your anemia. (Because there are other types of anemia that cause small, pale red blood cells, checking the iron stores may be a good idea.)
Unless your periods are unusually heavy, iron deficiency can be compensated for by eating more foods rich in iron, or by taking iron supplements (available over the counter as ferrous sulfate). Foods that are rich in iron include red meats, liver, clams and oysters, apricots, baked beans potatoes, and grains, breads or cereals that are "enriched" or "fortified." Spinach is not high in iron and will actually impair its absorption. Vitamin C, and foods high in vitamin C, will help your body to absorb iron more readily. Vegetarians must be sure they are eating enough grains and vegetables sufficiently high in iron. And endurance athletes and pregnant women require more daily iron in their diets. Ten to 15 milligrams of iron per day is recommended for all adults.
After a few months on your diet, you might consider repeating the blood test to see if the anemia has gone away.
-- R. Jandl, 10/23/96, Category: general medical
The only bad thing about getting gray hair is the realization that life is short. We'd all love to look and feel youthful forever. Getting gray hair at a relatively young age, at a time when we often still feel young, is disheartening. For men, society accepts this change as a sign of attractive maturity. Men become "distinguished" -- which may not always be desirable for a man in his thirties, but at least it doesn't have negative connotations. Women, on the other hand, are often considered less attractive when their hair turns gray. The physical signs of maturity, along with wrinkles or a change in the figure, are often seen as unattractive. There does not seem to be any recognition that a woman's maturity may mean that she is wiser, more capable, or a better lover. It's unfortunate.
Aside from these cultural biases, there are no health problems that will occur simply because your hair is turning gray.
-- R. Jandl, 10/27/96, Category: general medical
Why does this happen? Well, it seems that physical pressure on the skin will cause the activation of certain immune cells and chemical mediators within the skin. These would include such things as mast cells, histamine, immunoglobulin E, and something mysteriously referred to as Substance P. Why these factors are abnormal in such people is not known, but the result is the rapid appearance of redness, followed by swelling (like a mosquito bite) in the exact area of skin pressure.
Most times it is not possible to identify why it is someone has dermatographia. But if the skin problem started after beginning the medication for ulcerative colitis than it would be reasonable to think that one of the medicines might be the cause. If it's bothersome enough, you might discuss with your doctor whether or not a trial of stopping the medications is a good idea. Don't do this on your own, as stopping the medicines at the wrong time, or in the wrong way, could lead to complications.
Fortunately, the symptoms of dermatographia usually subside in a matter of minutes. No harm will come to the skin, nor to the person. If the symptoms are bothersome enough, antihistamines (both over-the-counter, and the non-sedating prescription types) will help, but of course, must be taken on a regular basis in order to be useful.
-- R. Jandl,10/2/96, Category: general medical
As you may know, the mitral valve is one of four valves in the heart that serves to regulate the direction of blood flow. The mitral valve prevents blood from shooting backwards from the left ventricle into the left atrium when the heart contracts. It forces blood forwards into the general circulation. There are two leaflets to this valve, and on occasion one or both will prolapse into the left atrium causing back-leakage of blood. This back-leakage is often referred to as regurgitation. A small amount of regurgitation is harmless, and that is most often the case with mitral valve prolapse. However, more severe cases of regurgitation can eventually cause heart failure, resulting in the need for medications or surgery.
Okay, so does mitral valve prolapse cause fatigue? Not usually. The vast majority of people are asymptomatic. Some experience unusual palpitations or chest pains -- as you describe in your question -- but these too are usually harmless. Your doctor may wonder whether or not these spells of sudden fatigue are arrhythmias of the heart perhaps related to mitral valve prolapse. If so, there are ways of monitoring the heart rhythm over periods of time to help sort that out.
Whether or not low blood pressure can cause fatigue is another interesting question, one that many people often wonder about. Again, the answer is: usually not. The most common symptom of low blood pressure is dizziness when moving from a lying to a sitting or standing position. You can imagine that if your body didn't do something when you stood up, all your blood would end up pooled in your feet, and you would faint. But by constricting the arteries and speeding up the heart rate, the body's reflexes naturally maintain a normal blood pressure regardless of position.
The blood pressures you reported would actually be considered normal. It is common for healthy women somewhat younger than you to have pressures of, say, 90/50. But blood pressure tends to slowly increase with age. And remember that there is fluctuation in the blood pressure from minute to minute (twenty points is not uncommon) so that it is useful to get multiple readings over time, as you have done.
Now that I haven't diagnosed the cause of your fatigue, you might consider a visit to the doctor, as I suspect he or she will have a few questions to ask you that will hopefully clarify the situation. Good luck!
-- R. Jandl, 9/16/96, Category: general medical
Normal men require about one milligram of iron per day, and normal menstruating women about one and a half milligrams per day. Your body obtains iron from the food you eat, and in order to prevent iron overload the intestines regulate how much iron can be absorbed. In fact, even in conditions of iron deficiency, your intestines will only absorb a limited amount of iron per day, meaning that in most cases it takes up to six months before normal iron stores are replenished.
So how does one get iron overload? First, many cases of hemochromatosis are genetically determined. The defect is not well understood, but somehow too much iron gets absorbed through the intestines resulting in deposits in various parts of the body. In Europe, about one in ten people carry the gene for hemochromatosis, which sits somewhere on the sixth chromosome. Fortunately, because in order to get the disease you need to inherit a copy of the defective gene from both parents, as few as 0.3% of Europeans are actually found to have hemochromatosis. The rest of the cases result from other conditions. For example, there are people who have certain kinds of anemias (low red blood cell counts) who require frequent transfusions. The transfusions help correct the low blood counts. But because red blood cells carry enormous concentrations of iron and because the blood is given intravenously (thereby bypassing iron regulation by the intestines) excess iron begins to accumulate in the body. It takes many transfusions over a long period of time to do this.
The organs primarily affected by hemochromatosis include the liver (cirrhosis), pancreas (diabetes), heart (heart failure), and pituitary gland (growth problems). Although the problem is rare in people younger than the age of twenty, it is important to catch it early, before irreversible organ damage occurs. A blood test for "transferrin saturation," which is an indirect measure of iron stores, will be very high among those affected (greater than 62% is the approximate cut-off for screening purposes). If that is abnormal, than a liver biopsy might be recommended in order to assess whether or not any liver damage has occurred, and in order to confirm the diagnosis. A positive biopsy will show large deposits of stainable iron in the liver.
If caught early, blood is removed at regular intervals, such as every couple of weeks, in order to reduce the body's iron burden. It works well to prevent the long-term complications. Certainly testing of immediate family members of someone with hemochromatosis would be strongly recommended.
-- R. Jandl, 9/16/96, Category: general medical
First, when a mosquito bites, it injects its saliva into the skin. It does not inject blood from a previous victim. Even if a mosquito has HIV contaminated blood in its "sac," this blood is not transferred to the next person. What about spread via a mosquitoes mouth parts? It turns out that HIV lives only a very short time, and does not reproduce when out of the body. Mosquitoes also tend to take a fair amount of time between biting people. Therefore, the odds of transmitting infection this way is very remote.
For more on this, check out information published by the Centers for Disease Control.
-- R. Jandl,9/4/96, Category: general medical
Commonly, swelling of the feet and legs, or what is called edema, is seen in young adults, especially women. A woman may actually see the swelling. Or, her legs may look normal but feel very distended. These changes often occur just before the menstrual period. This type of swelling seems to be hormonally related, and causes no real harm. Occasionally, a low dose of a diuretic is used to relieve the discomfort.
Another type of swelling occurs in people who have day to day edema, whose veins seem to be "leakier" than normal. Often varicose veins (large, visible veins beneath the skin) are present, but not always. These are usually middle-aged or older adults, and they are said to have "venous insufficiency." It's thought that the veins in these cases do not have normally functioning valves -- valves that normally act to reduce the back-pressure of blood returning to the heart. This kind of swelling can cause big, puffy legs and ankles, and can also be associated with blood clots ("phlebitis"), and in more severe cases, skin ulcers and increased pigmentation of the skin of the legs.
Next is a host of illnesses that can cause significant fluid retention. Your body normally works hard to avoid this. It regulates any imbalance in the amount of water in your system, and in the amount of salt (which through osmotic forces always carries water with it). Unless there is a specific disease to disrupt these controls, edema will be almost impossible to get just by drinking too much water or eating too much salt. Therefore, edema is often a sign of trouble for someone with congestive heart failure. Kidney failure, cirrhosis of the liver, hypothyroidism, and even certain medications provide other causes of edema. When edema does occur, it tends to settle by gravity to the lowest places, usually the legs. That's why after a night of bed rest, the swelling usually is less apparent as the fluid shifts to other parts of the body. Shortly after standing up it will be seen again in the legs. An interesting exception to the effect of gravity occurs in certain kidney diseases, where the fluid will stay widely distributed in places such as the hands, legs, and face, no matter what position you are in.
When the doctor is trying to sort all this out, he or she will ask a number of questions that might provide a clue to any of the more serious problems. You will be checked for varicose veins, signs of phlebitis, heart disease, and other diseases, and asked about the use of medications such as oral contraceptives, blood pressure pills, and others.
The treatment depends, of course, on the cause. Certainly if your swelling seems to be getting worse, it is worth further evaluation to make sure nothing serious is being overlooked.
-- R. Jandl,8/21/96, Category: general medical
With any type of contact lens, remember to get an annual eye exam, as there are certain conditions that can occur, unbeknownst to the user, that can result in damage to the eye. Since contact wearers have about a 4% increased risk of eye infections, anytime you experience a red eye, a feeling of something foreign in the eye, or a reduction in vision, you should get them checked. By the way, the incidence of infection is the same whether you use disposable lenses or conventional lenses.
-- R. Jandl, 8/7/96, Category: general medical
In the context of worrying about hypertension, a normal blood pressure for young and middle-aged adults has been defined as anything under 140/90. But it's important to keep in mind that the blood pressure varies a great deal from minute to minute. The body constantly monitors and adjusts the blood pressure to take into consideration many things such as posture, physical activity, stress, and the body's state of hydration, among others. For example, just the act of standing up would cause an immediate drop in blood pressure, with loss of consciousness from inadequate blood supply to the brain, were it not for reflexes that constrict the arteries and speed up the heart rate.
A normal young woman might be said to have a blood pressure of say, 90/60. But in reality she is likely to have pressures that range from 85/50 to 130/80 depending on when you take it. Therefore, the first rule of evaluating someone who thinks they may have high or low blood pressure is to get many different readings, at different times of the day, and even in different places. For most people, the average, or typical, blood pressure is what's important.
Can a normal healthy person have a blood pressure that is too low? The answer is no. By definition, if it is too low, he or she will feel sick. As long as you feel fine, a low blood pressure reading means nothing. For example, in a normal healthy person, even a blood pressure that dips into the 80s could be considered normal as long as he or she has no symptoms. The other point to make is that since there is a wide variation in blood pressure from one person to the next, a normal pressure in one person may actually be low enough to cause symptoms in another. If your blood pressure is normally 140/80, but drops suddenly to 90/60, even though that is still within the range of normal, you're likely to feel it. Everyone has a point at which their blood pressure becomes too low. At that point they will start to have symptoms, and the symptoms might include feeling dizzy when you stand up, heart palpitations, shortness of breath, or weakness. Someone with an accurately measured blood pressure less than 70 is usually critically ill or incapacitated.
In the case of blood donation, the giving of blood often causes a temporary drop in blood pressure when standing up, at least until your body has had a chance to adjust to the loss in blood volume. If you are healthy and your pressures run on the low side, you are likely to make the blood bank nervous for fear that after donation your pressure would drop to a level low enough to cause you to faint.
A decision to treat high blood pressure will, as suggested by the first question, partially depend on other health factors. Keep in mind that the only reason for treating high blood pressure is to prevent future problems such as strokes and heart attacks. Smoking, diabetes, a family history of heart disease, and high cholesterol are among the other risk factors for heart disease and stroke which need to be taken into consideration. When these are present, there is a stronger reason to treat mild elevations of blood pressure. There are a number of other considerations as well, which can be taken up with your doctor when trying to determine whether to treat a pressure of 160/90.
-- R. Jandl, 7/31/96, Category: general medical
These descriptions, of course, are simply guidelines and should not be used for self-diagnosis. Chest pains should always be evaluated. If the doctor is sufficiently concerned, a stress test may be ordered.
A stress test is used to determine whether or not there is evidence for coronary artery disease, a specific type of heart disease. It is done by walking on a treadmill while being monitored, gradually increasing the speed and slope of the treadmill until the person becomes fatigued or has symptoms. Coronary artery disease is the gradual plugging up of blood vessels that normally bring blood to the heart muscle. It is caused by cholesterol plaques. Early on, these occlusions can be the cause of exertional chest pains, or what is called angina. In severe cases, coronary artery disease may lead to a heart attack.
The stress test can be used in a number of ways. It may be used to evaluate someone's chest pain in order to determine whether or not the pain is from the heart. If the test is positive, you would expect the person to experience chest pain and would likely see characteristic changes on the EKG monitor. The test may also be used to screen high risk asymptomatic people for heart disease, and may be used to evaluate the exercise capacity of someone with known heart disease.
A thallium stress test is a variation on the theme. Thallium is a mildly radioactive tracer that is injected into the blood and taken up by the heart muscle. The scan is done both before and after exercise. If there is an area of the heart with diminished blood flow, this shows up as a cold spot during the scan and tells you that they have coronary artery disease.
So what's the persantine-thallium stress test? Well, some people are not able to exercise sufficiently to get a meaningful exercise stress test done. They may have bad arthritis. Or they be bed-ridden and awaiting surgery, but there is reason to suspect they might have underlying heart disease. In cases like these, you can give an injection of persantine which causes temporary constriction of blood vessels in the heart. This is a sort of chemically-induced stress of the heart. The thallium scan will tell you whether or not the test is positive.
-- R. Jandl, 7/29/96, Category: general medical
The thyroid gland is located at the base of the throat partially hidden by the bones found at the top of the breast bone. It acts to regulate the body's metabolic rate. Normally, you cannot feel it -- or you will have a difficult time feeling it -- unless the gland is enlarged. For a variety of reasons, a nodule may develop within a part of the gland. This you will be able to feel. The nodules may be made up of either solid tissue or cysts. They are often noticed by a person who happens to see it while looking in the mirror. It is also commonly detected during a routine physical examination. Ordinarily, it will have a firm, smooth, rubbery feel to it, but sometimes it is associated with many other smaller nodules spread throughout the gland (a "multinodular goiter").
If you want to know more... sometimes thyroid nodules are overactive, sometimes underactive. This means they either produce more thyroid hormone, or less thyroid hormone, relative to the rest of the gland. (Depending on the circumstances, this may or may not translate into having too much or too little thyroid hormone in the rest of your body). Nodules that are underactive, or inactive, appear "cold" on a thyroid scan. There is a small risk of thyroid cancer in cold nodules. Overactive nodules, or "hot" nodules, are much more common and are generally benign. They only require treatment if they are changing the body's metabolism, or cause local discomfort. Currently, where the expertise is available, it is recommended that a biopsy be obtained of all solitary thyroid nodules.
Enough about nodules. If you think you have an enlargement of the thyroid gland, have a doctor check it. Fortunately, in most cases, thyroid problems are relatively easy to treat.
-- R. Jandl,7/6/96, Category: general medical
There do not seem to be any serious problems reported with body waxing. One letter in medical literature described a case of pseudomonas folliculitis -- that is, an infection of the hair follicles due to contaminated wax. But this seems to be very rare. There are a few precautions to keep in mind, however. Waxing should not be done on an area of skin where there is a rash. Also, if the person's skin is very thin and fragile, the skin may occasionally tear, or you may see a small amount of bruising. The redness you describe is to be expected, and I am told, usually goes away within a matter of hours.
-- R. Jandl,7/10/96, Category: general medical/men's health
Melatonin may very well be a great drug for insomnia, jet lag, sexual dysfunction, or any number of other claims made on its behalf. Unfortunately, with the possible exception of sleep induction, it is just not known whether or not it works for any of these indications.
Hormone supplements are routinely used for all kinds of indications. Thyroid hormone is taken by those with hypothyroidism, estrogens for birth control and for after menopause, adrenal hormones for adrenal insufficiency, and growth hormone for problems with growth. All of these supplements have had to pass rigorous tests of their purity, dosage, absorption, metabolism, and therapeutic and adverse effects. They all can be toxic if given to the wrong person, or in the wrong dose, or if the manufacturer prepares it improperly. Why shouldn't melatonin be held to the same standards?
By simply labeling the hormone as a food supplement instead of a drug, the manufacturers have managed to duck regulation by the FDA. This was not done in the interests of promoting good health or finding alternative remedies for many common ailments. It was done for profit. Getting a drug approved by the FDA is a time-consuming, expensive, and burdensome process. Maybe too much so. The scientific community has often had a closed mind to remedies initially introduced by alternative healthcare practitioners. That's a problem too. But let's not be guinea pigs to line someone else's pocket.
Wouldn't it be great if melatonin really lived up to some of its promises? We will never know until careful studies are done. So, to answer your question on side-effects, the anecdotal experience reported so far seems to indicate there are few if any immediate adverse effects. That's good news. Remember though that people are taking different preparations and different doses. That may make it hard to detect infrequent, yet possibly important, side-effects. Melatonin has not been tested over time to know what, if any, long term effects there are. It's messing with brain chemicals, so we should tread carefully.
-- R. Jandl,6/13/96, Category: general medical
Recently, as a result of a liver test
to see if medication I'm taking for elevated cholesterol was
causing any side effects, it was discovered that I have
Hepatitis C. I feel fine and have no symptoms. Don't know
how I got it (I understand it's transmitted via blood), nor
how long I've had it.
Is this likely to develop to the point that I have symptoms,
and I feel sick? Or is it possible that I could live the
rest of my life w/o any problems from it?
Hepatitis A is the virus most often responsible for the transmission of hepatitis through contaminated food products, water, and eating utensils. This is the first way in which hepatitis may be transmitted. In the gross but descriptive parlance of medicine this is called the fecal-oral route. Ingesting the virus causes infection, and an infected person sheds virus in their feces. In the course of routine personal care, one's hands may transmit the virus. Many an epidemic has been reported emanating from the kitchen of a restaurant where one of the chefs had hepatitis but didn't realize he or she was contagious. (Now you'll really notice the hand-washing posters directed at the kitchen staff in the lavatories of your favorite restaurant.) If you live with someone who has active hepatitis A, you must not share eating utensils, drinking glasses, toothbrushes, etc., until they are better, and your doctor should give preventive shots to all household contacts. Hepatitis A gets better all by itself and does not cause chronic liver disease. Hepatitis E, prevalent in Asia and India, is also transmitted this way.
The other way to catch viral hepatitis is through percutaneous exposure. That is, contaminated blood that through a break in the skin, or via a needle stick or transfusion, gets past the skin barrier and causes infection. Hepatitis B and C are the classic examples. Hepatitis B is transmitted a bit like HIV except that it is more contagious. It is easiest to transmit by way of a contaminated needle (in a healthcare setting, or by shooting drugs using shared needles) but can also be transmitted sexually with both vaginal and anal intercourse. Hepatitis C seems to be rarely transmitted sexually. Both hepatitis B and C were significant causes of hepatitis after blood transfusions, but careful screening of blood products for these viruses and for HIV in most developed countries has dramatically reduced transmission by this route.
Some people who develop hepatitis B or C do develop chronic liver disease (up to 10% in hepatitis B, and 50% in hepatitis C). This may result in cirrhosis, or scarring, of the liver. Hepatitis C is a bit puzzling in its tendency to cause cirrhosis even in cases where there is only minor evidence of inflammation on blood tests. A liver biopsy can be helpful in some cases in order to more accurately assess the amount of liver inflammation and scarring. However, there is no clear consensus on how to treat someone with hepatitis C whose blood tests show only minor abnormalities and who feel well. Interferon has been used with some success in both hepatitis B and C.
For more information on hepatitis check out the American Liver Foundation.
-- R. Jandl,6/8/96, Category: general medical
Important causes of hair loss include thyroid disease, recent pregnancy (many women experience hair loss for a period of months after delivery), iron deficiency, skin problems such as fungal infections, numerous medications, crash diets, and diseases such as lupus. Although you may not be excited about having one of these diagnoses, at least in some cases there is the potential to reverse the process. A recent high fever, surgery, stress, or the cessation of birth control pills, can cause temporary hair loss.
However, most men lose hair at a young age because they are genetically and hormonally predisposed to do so. If it happened to your father, there is a pretty good chance it will happen to you too. It's frustrating, but there's not much you can do. Minoxidil provides modest help for some people, but it is expensive, it requires continuous twice-a-day application to work, and hair-loss resumes as soon as the medication is stopped. Hair transplants (your own) can work. It may be painful and is usually not covered by insurance. Don't use artificial hair transplants. You might end up with inflammation, infection, and scarring of the scalp. Avoiding bleaching, straightening, dyeing, permanents, chemicals, and excessive sunlight will help to preserve what you've got.
-- R. Jandl, 5/11/96, Category: general medical
A true mole, or pigmented nevus, is benign and requires no treatment. It may even be considered a beauty spot. But other types of nevi that do increase your risk of melanoma include dysplastic nevi (sometimes recognized by having irregular borders or a mixed black/brown coloration. Congenital nevi (present at the time of birth), and what are called giant hairy nevi (that's right, they are giant -- many centimeters in size -- and have lots of hair growing from them) also increase the risk of cancer.
It is well known that a correlation exists between sunlight exposure and malignant melanoma, but the connection between ultraviolet radiation is actually quite complicated. Other factors seem to be important, such as family history. A person with melanoma will have a close relative with melanoma six to ten percent of the time. And if the mole is located around the finger or toe nails, or the genital area, these should be monitored more closely.
I find that most moles that people ask to have checked are either quite benign looking, or are not moles at all. This is OK. Better to be safe than sorry. In fact early diagnosis is the best hope for curing melanoma. If you can catch it before it is only .85 mm deep (which is found out at biopsy), the five year survival rate is about 99%. But melanomas have a frightening propensity to metastasize early, and to show up elsewhere even many years after the initial lesion appears safely removed. They also have a tendency to grow down into the tissue first, rather than growing up or sideways, making early detection more difficult. More worrisome still is that even experienced melanoma specialists and dermatologists can easily get fooled by a lesion that at first looks benign. Therefore, any concern at all about a mole's appearance should suggest a need to have it removed. The doctor should biopsy the whole thing -- not just shave it off at the surface. In the last ten years, the incidence of melanoma has doubled. This increase is more than any other cancer, so it really pays to be watchful.
Here are some recommendations:
1) Avoid high intensity solar exposure, especially if you are fair skinned, burn easily, or already have evidence of skin damage from the sun.
2) Use a sun-block lotion that blocks most UVB (SPF 15 or greater) and some UVA.
3) Have checked any pigmented skin lesion that is new, growing, has an irregular border, or change or variation in color (especially if you see blue, gray, or black).
Any good primary care provider is a reasonable place to start when getting it checked. If there are any doubts, see a dermatologist.
-- R. Jandl, 5/2/96, Category: general medical
Dear Doc:
I have been diagnosed hypoglycemic. My symptoms are irregular and I find it difficult to predict when I will feel bad. Usually what occurs are the following symptoms: Lightheadedness, an odd sensation in my cheeks (warm and sometimes tingling), a numb feeling in my lips, and shakiness ( as if I had too much coffee). One nutritionist suggested I avoid sweets, which I have, and for one week I felt fine, but thereafter it has been getting worse. Two questions: Am I doing my body lots of harm by not trying to regulate it with my diet (which isn't successful); and what type of diet should I follow? The health center and the nutritionist have not been helpful and therefore I appreciate any suggestion that you may have.
Thank you.
First, a person who has low blood sugar is said to be hypoglycemic. All we are talking about here is a laboratory test. How low does it need to get? Using statistical methods (remember that there is variation in every population) a nominal cutoff level of 50 mg/dl, or 2.8 mmole/L, has been defined.
Second, everyday, patients are seen with complaints of anxiety, tremulousness, headaches, palpitations, sweatiness, fatigue and lethargy. What causes these symptoms? The answer is: many, many things. Sometimes it takes quite a bit of time, patience, and a very careful history to figure out the cause in any given person. Hypoglycemia is but one cause.
Third, whenever you eat, your body responds with an elaborate array of regulatory processes that enable you to absorb and process nutrients without upsetting the chemical milieu of the body. Feeling sleepy or lethargic after a large meal, or feeling a bit irritable, hungry, or shaky several hours after a meal are usually just your body's normal response to eating.
Therefore, hypoglycemia as an actual problem, exists only when symptoms such as those mentioned above occur at the exact time of a documented low blood sugar test. A random low blood sugar obtained when no symptoms are present does not count.
If true hypoglycemia is present, it is important to look for the cause. Although many cases exist with no definable cause, others may be due to an early case of diabetes, tumors of the pancreas gland, kidney or liver problems, previous stomach surgery, and others. It is also important to know that there are two types of hypoglycemia. Postprandial "reactive" hypoglycemia occurs two to four hours after a meal, and may be worse if the meal was high in sweets. Fasting, or "spontaneous" hypoglycemia occurs after not eating for many hours (overnight, for example). Knowing which one you have can be helpful in figuring out the cause.
If you think you have hypoglycemia, what should be done? The main thing is to get a blood sugar at the time of symptoms. This can be done by a conventional blood draw from a vein, or by using a finger-stick home glucose monitor. (One caveat here is that home glucose monitors may be less accurate at low blood sugar levels.) Logistically this can be hard, and may require a carefully timed trip to the doctor's office. A glucose tolerance test is no longer recommended for screening because of the high number of false positive tests. Beware of the trap of being labeled (or labeling yourself) hypoglycemic on the basis of low blood sugar, if other symptoms are not consistently, and simultaneously, present.
Frequent, smaller meals -- six per day -- avoidance of concentrated sweets, and a diet high in protein but low in carbohydrates has been recommended to help alleviate symptoms. On theoretical grounds these recommendations make sense, and they may help some people. However, there are no good studies that document the effectiveness of these measures. Not following this diet will not be harmful to your body, and doesn't make sense anyway if it has not helped you.
-- R. Jandl, 4/26/96, Category: general medical
You have raised a very good question, since in the last few years it has been discovered that many ulcers are associated with infection of the digestive lining by a bacterium called H. pylori. It turns out that many cases of ulcer disease recur even after good treatment with acid blocking drugs (such as Tagamet, Zantac, Prilosec, and others) and the reason appears to be the persistence of this bacteria. How you get it in the first place is not clear. But a biopsy of the lining of the stomach through an endoscope, or a blood test for antibodies to the H. pylori bacteria usually make the diagnosis.
The treatment of H. pylori involves anywhere from two to four drugs depending on the regimen used. As of this writing, the highest cure rates are obtained by using four medications at once for a week, one being Pepto-bismol, one being an acid-blocker, and the other two antibiotics.
For further tips on what else can be done to control acid indigestion, see Tripod's answer to acid reflux symptoms.
-- R. Jandl, 4/11/96, Category: general medical
Chickenpox in adults is more serious than in children. The rash may be more severe, and the profound weakness, malaise, and fever may also be worse. Two important complications of chicken pox are pneumonia and encephalitis -- the latter being an infection of the brain and spinal cord. These, too, are more common in adults.
So, guidelines would suggest that if you are older than the age of 13, you have never had a well-documented case of chickenpox, and you have no medical reason to avoid immunizations, get the vaccine. It is given in two doses, four to eight weeks apart. Some argument can be made to check a blood test before you get the vaccine, to see if you have been infected in the past and just didn't know it. This is fairly common. If the blood test shows you have been infected, you don't need the vaccine.
-- R. Jandl, 4/11/96, Category: general medical
Why is this so? As it turns out, nicotine raises the basal metabolic rate. This is something like setting the throttle of an engine at a higher speed -- more gas is burned up at a faster rate. A person with a higher metabolic rate will burn off more calories, and will therefore be less likely to gain weight. In studies that carefully examine total weight gain after quitting smoking, the weight gained is more than can be accounted for by the number of calories eaten. This is indirect proof that the metabolic rate slowed down once smoking ceased. So, for some people, it really is harder to keep the weight down after quitting.
The average weight gain after quitting smoking is 7-10 lb. Less than 10% of people will gain more than 20 lb. Heavy smokers, and for some reason, women, and African Americans, are more likely to gain larger amounts of weight. Taste preferences may also shift after quitting, with a passion for sweets being common. This makes dieting all the more challenging.
It is interesting to think about the trade-off being made. In a culture that places such a high emphasis on thinness, and where obesity is such a huge problem, it is so tempting to accept the risk of future health problems from cigarettes in return for the short-term benefit of weight control. Unfortunately, the odds of such a trade-off are heavily against the smoker. Everyone knows that smoking constitutes far and away the biggest cause of preventable death and disease. It has been estimated that you would have to gain over 100 lb. after stopping smoking before the risks of obesity outweigh the risks of smoking.
I usually tell my patients who want to quit, to take things one step at a time. Quit first and get comfortable with that. Tolerate a bit of weight gain early on if you have to. Give yourself a break -- it's hard enough to stop smoking as it is. And congratulations on your success!
-- R. Jandl, 4/3/96, Category: general medical
Blood vessel tumors are abnormal clusters of blood vessels that form a growth, or tumor, in various parts of the body. They are usually not cancerous. Most are thought to be present at birth, or in other words, are congenitally acquired, and may either enlarge or grow smaller over time.
There are actually different types of blood vessel tumors. For example, angiomas are tumors that form from the lining endothelial cells of blood vessels. They may be found anywhere from deep within the body's organs, to the surface of the skin. You may be familiar with "strawberry hemangiomas" -- bright red angiomas often seen on the skin of infants. They are harmless and usually disappear over time.
Some blood vessel "tumors" are actually just normal blood vessels marred by many abnormal short circuits between them. These are referred to as "arterio-venous malformations."
Any concern with a blood vessel tumor generally has to do with its size and
location. The concern is not cancer, but bleeding
as the blood vessels tend to be fragile. If
one on the skin begins to bleed, it is usually easy to stop the bleeding using direct pressure. However, if it is in the liver, brain, or bowel, then
bleeding could have more serious consequences. Fortunately, serious bleeding is rather rare, which is particularly good since bleeding may be the first sign that the tumor is there at all.
-- A. Calhoun, 2/14/96, Category: general medical
Also, if there is no salivary contact with someone who has mono,
what are my chances of contracting it through other bodily
secretions (or simply from casual contact)? How long will mono
stay in the body after initial infection?
As it turns out, if you went around the US and tested all adults for antibodies to EBV, you would find that they are present in the blood of about 90 - 95% of people. What that means is that many people were infected with the virus at one time or another, and never knew it, or thought it was a routine cold or flu. And what it means for the average, otherwise healthy person, is that testing for antibodies to EBV is not very useful since most people are positive anyway.
If for some reason, it is very important to know if you are protected against future infection, measuring an antibody called VCA IgG (an antibody to the "viral capsid antigen" of EBV) will tell whether or not you have been previously infected, and that should correlate with immunity.
So, you ask, what if I try to actually culture live virus from my body, will that tell me I have an active infection? The answer is, not really, since many people are found to have live virus in the back of their throat, but have no symptoms. They are simply carriers. And some people who develop mono, continue to have live virus in their bodies for up to 18 months. How infectious are they? I'm not sure, but believe it is very low. For example, there are studies showing no increased spread of the virus among college students to non-intimate roommates.
Mono is spread primarily by saliva. It can also be picked up by blood transfusions. It has been cultured from the uterine cervix, but I am not aware of any evidence that it is sexually transmitted. I am also not aware of any other body fluids that transmit the infection.
An earlier Ask the Doctor column discussed how much sexual contact is advisable with mono.
-- R. Jandl 3/18/96, Category: general medical
Commonly, the sensations will be noticed in the middle of the night. People will describe waking up, shaking their hands for a minute, and feeling better again. Left untreated, the numbness and tingling may also be accompanied by weakness of the fingers and hand, and a sharp observer will notice the hand muscles to be atrophied on the affected side. You want to catch the problem before that happens.
As it turns out, carpal tunnel syndrome is also associated with diabetes, hypothyroidism, pregnancy, and certain kinds of arthritis. Sometimes these other problems are looked for when the diagnosis of carpal tunnel syndrome is made.
A Velcro wrist splint is usually advised, used at nighttime, and during the day if practical. Anti-inflammatory medications such as ibuprofen may also relieve the symptoms. Injections of cortisone may be used. And some cases will require surgery. This is a procedure whereby the median nerve is "released" from the compressing scar tissue. Of course, if you can avoid the kinds of activity that caused it in the first place, that will help too.
-- R. Jandl, 3/7/96, Category: general medical
March 19, 1996:
http://www.cyberport.net/mmg/cts/ctsintro.html
http://pathfinder.com/@@dlOImzIO9QMAQLum/HLC/lookitup/conditions/reps.html
-- R. Jandl, 2/14/96, Category: general medical
Pityriasis is occasionally itchy and uncomfortable but usually is not. It is not associated with any other symptoms either. Pityriasis affects people of any age, but is most common in people between the ages of ten and 35. The cause is unknown, although it is suspected to be of viral origin. The rash is usually cleared up within six weeks, but in some cases takes longer.
There is no specific treatment of pityriasis rosea. Calamine lotion or topical steroids may help any itching, but do not make the rash go away any faster. As with all rashes, it's important not to scratch too much, in order to avoid secondary infection. Patience, and remembering that this condition WILL clear up before long no matter what you do, are key to getting through a bout of pityriasis rosea!
For more information, you can contact the American Academy of Dermatology at 708-330-0230.
Mitral regurgitation, or mitral insufficiency, are both terms that describe this leak. It turns out that there are a number of different causes, ranging from a congenital leakiness that occurs when the edges of the valves do not form a perfect seal, to "mitral valve prolapse" a condition caused by one of the valve leaflets prolapsing backwards, thereby causing the leak. In other cases, bacterial infections of the valve can occur, and in the days of rheumatic fever (which still occurs but is relatively rare) the mitral valve may become damaged.
Whether or not mitral regurgitation is a problem, depends on how severe the regurgitation is, what the cause is, whether the heart muscle shows signs of weakness or damage, whether there are other illnesses that might aggravate mitral regurgitation, and other factors. But simply having mitral regurgitation does not immediately mean you should worry, as quite often it is asymptomatic. For example, it is quite common to have a prolapsing mitral valve incidentally picked up on a routine examination. When found in otherwise healthy young adults, it rarely causes problems. One caution however: If you do have mitral valve prolapse, you need to take a couple of doses of antibiotics at the time of routine dental work or cleaning in order to prevent bacteria from settling on the valve, causing a serious infection.
It is not clear why diabetes causes peripheral neuropathies, but it may be related to loss of the micro circulation blood supply to the nerves.
Stopping smoking is a good idea since smoking can increase damage to those blood vessels. And improving the control of blood sugar is important, since it has now been conclusively shown that this will lessen the likelihood of diabetic neuropathy. However, once you have the symptoms of a neuropathy, there is little that can be done to make it go away other than medications to reduce any uncomfortable sensations. The symptoms may fluctuate over time, but prevention is really the best approach.
In any case, as you can see, to get at the heart of the problem, it is
necessary to determine what is causing the obstruction of these teeny sinus
openings. The list includes things like environmental allergies (pollens,
molds, animal dander, etc.,) environmental irritants (tobacco and other kinds
of smoke, perfumes, occupational dusts and particulates,) and mechanical problems, either acquired (a broken nose,) or inborn (congenitally deviated
nasal bones or cartilage.)
The treatment, of course, will depend on
the causative factor, or factors, and runs the gamut from environmental measures, to
medicines, to surgery.
For example, Raynaud's phenomenon is a common problem where the fingers of the hands become white and painful when exposed to even mild cold. This could be a day with temperatures in the forties, or may occur even just reaching your hand into a freezer. Within minutes the fingers then turn blue, and later bright red, before returning to normal. These three color changes in response to cold essentially make the diagnosis. It is more common in women, and may be associated with migraines (another "vascular" problem).
Raynaud's can either occur by itself, which it commonly does, in which case it is called Raynaud's disease, or it can occasionally be associated with
one of a number of underlying conditions. These include problems with
blood vessels (blockages, hyperreactivity to chemical stimuli such
as nicotine,) "auto immune diseases" such as scleroderma, repetitive
micro-trauma such as that from typing, piano playing, or certain occupations, neurologic conditions such as nerve compression
syndromes, the presence of abnormal blood proteins (cryoglobulins and others
which congeal in cold temperatures and cause sludging and slow flow through
small blood vessels), certain medications, and others.
If any of this sounds familiar, it would be worthwhile discussing this with your healthcare provider.
If you happen to be the rare individual with a congenital opening between the right and left chambers of the heart (most commonly this would be an "atrial septal defect") these air bubbles could cross over into the arterial circulation which is the part of the blood stream bringing fresh blood to all parts of your body including vital organs. This is a potentially much more serious problem that will result in an air embolus. If that embolus of air blocks the blood supply to a vital organ serious complications or even death could result. Fortunately, this is a very rare event. However, since these congenital problems are not always known, it is best to avoid getting any air at all into the vein.
Unfortunately, some people with shingles will develop a complication. The most common of these is postherpetic neuralgia, defined as pain persisting or recurring over one month after the actual rash has healed. The incidence of this condition increases dramatically with age, particularly over the age of 60. The pain of postherpetic neuralgia can be excruciating and may last for weeks, months, or even years, and may be difficult to control. It is also difficult to tell in advance who will end up with long-term pain, or how long it will last. Commonly employed treatments include pain medications (oral and topical), transcutaneous electrical nerve stimulation (TENS), antidepressant and anti-convulsant drugs (which somehow deaden "nerve pains"), steroid injections, and other experimental modalities.
A great deal of attention is being paid to decreasing the incidence and duration of postherpetic neuralgia. It seems that the use of anti viral agents such as acyclovir or famvir during the initial shingles outbreak may be helpful.
In any case, the answer you seek
is a very, very small number ... something on the order of less than one one
hundredth of one percent. In looking for this bit of data, I came across
several resources which you can access if you are interested in digging
more deeply into this. Jeff Steinhilber, a GBS sufferer, has compiled an
impressive collection of data and links on the syndrome, and this trove can
be reached at:
http://www.adsnet.com/jsteinhi/html/gbs/gbsmain.html.
Also, the Massachusetts General Hospital Neurology Department maintains
a web page where you might be able to reach a neuroepidemiolgist with a
sub-interest in infectious disease who could tell you if the information you
seek is gathered and cached somewhere.
The most common cause of the gland not working right in our
part of the world is thought to be an "autoimmune" disorder called
"Hashimoto's thyroiditis." In this situation the body's own immune system
causes an inflammatory reaction in the gland causing it to scar and cease
functioning. Why this happens is unclear, but there is often a family
history suggesting a genetic predisposition. It also happens more
commonly in women than in men.
Sometimes the treatment of hyperthyroidism, (which is an overactive
gland) leads to hypothyroidism, or an underactive gland. Treatments
such as medications, radioactive Iodine, and surgery, can do this.
Finally, an unusual cause of thyroid failure is the lack
of stimulation by the pituitary hormone TSH (Thyroid Stimulating Hormone) which normally regulates the production of thyroid hormone. If the pituitary gland, which sits at the base of the brain, is damaged then the
thyroid gland shrinks and fails to do its job.
Tripod's Puzzler #4 is a classic case of hypothyroidism, a fairly common problem.
Typically, you sit in the dentists chair, an intravenous line is started, oxygen is given, and some monitors of your heart rate, blood pressure, and blood oxygen content are attached to your body. When everything is ready, an injection of a rapidly-acting (and short-lived) sedative is given. You may be alert enough to hear voices and respond to questions, or you may be briefly unresponsive. In either case, you will not be uncomfortable or frightened.
The teeth are removed with various instruments. Stitches may be needed; and then there is a recovery phase while you "wake up." Although you will quickly regain normal alertness, you should plan on having someone else drive you home. Of course, the routine may vary in different doctor's offices, but this should give you a general idea.
Although it can be very uncomfortable for a period of weeks to months, meralgia paresthetica tends to improve spontaneously.
These types of extra heart beats will be increased by anything that stimulates the heart such as nicotine, caffeine, cocaine, and decongestants, and may be more noticeable under periods of stress or sleep deprivation.
If during these episodes your heart beat is very rapid, or very irregular, or lasts more than a couple of seconds, you should consult with your doctor. There are also underlying or co-existing problems such as coronary heart disease, hyperthyroidism, prescription medicines, and others that would be important to know about.
The number of people affected in the US may be over a million, but the exact number is hard to determine since many people don't realize they have it and have gone undiagnosed. TS is an "autosomal dominant" condition which means that 50% of children of an affected parent
will inherit the gene that causes the disorder. However, there is variable expression of the gene,
so that many people have mild symptoms, while others have more significant symptoms. Males tend to be more
affected than females, an observation that may be related to environmental and cultural
norms, or possibly to the effects of testosterone.
The condition is
probably one variation in a series of related disorders, overlapping with
Attention Deficit Disorder (ADD), Obsessive Compulsive Disorder (OCD),
and some forms of depression. The tics can occur daily or less frequently,
but need to be present for at least a year's duration and develop at a young age (the mean age at presentation is seven years old) to meet the diagnostic criteria.
The best treatment is education and understanding. Many people
with Tourette's blame themselves for things they can't control and many
more without the problem assume those with the disorder can stop their
tics, which just can't happen. There are a number of medications used to
suppress tics such as clonidine, haldol, pimozide, and some of the
antidepressants. It would be a good idea to get in touch with someone
knowledgeable and experienced in the field for guidance with medications. Many people
"grow out" of the tics, or at least have fewer symptoms after puberty.
For more information see http://www.umd.umich.edu/~infinit/tourette.html
or, contact the
I'm not enthusiastic about lasers and possible permanent
black spots in case of misfire, but I've also waited a year now with
my leakages changing in size and shape but never disappearing. This
is especially troublesome because both eyes are affected and where
the vision bubbles overlap, I'm half-blind.
I'm 49, in excellent health otherwise, not overweight, don't
drink or smoke. Do I go under the gun or do I seek holistic treatment
or do I continue waiting?
Thanks for your advice. I'm looking for an informed opinion
and will take yours in the helpful spirit it's offered (meaning I
don't even _know_ a lawyer).
Most central serous chorio-retinopathy does spontaneously resolve and usually within the first four months. Therefore, treatment is often delayed approximately four months, anticipating this spontaneous resolution. But if it persists, or if the patient has lost vision in the opposite eye from the same condition, then treatment is usually initiated. Treatment, of course, as you have indicated, is in the form of laser therapy. Anyone over the age of 45 has an increased incident of other problems that can mimic central serous retinopathy (such as"subretinal neovascularization") and close observation and special photographic evaluation should be initiated to determine the actual diagnosis in these individuals.
For someone in your age group, perhaps the most important thing is to make sure that the diagnosis is correct. Generally, fluorescein angiograms should be done to make the diagnosis, and repeat fluorescein angiograms may be needed to note any progression. When the condition is bilateral, and if it has persisted for over a year, treatment to one eye can be considered. If successful, any reluctance to undergo treatment might be overcome, and treatment to the second eye could then be considered as well.
There are no specific tests available to make the diagnosis. Rather, it is diagnosed by recognizing the typical pattern of highly reproducible areas of exaggerated tenderness or "trigger points" in areas such as the shoulders, neck, elbows, and others. Biopsies of the affected tissues always look normal. Other possible diseases must be excluded such as chronic fatigue syndrome, Lyme Disease, depression, and other "rheumatoid diseases." Associated symptoms often include sleep problems, irritable bowel syndrome, anxiety, depression, and fatigue.
Fibromyalgia is a chronic disorder, with symptoms that wax and wane according to levels of stress, rest, or changes in weather, but it does not predispose you to other diseases. Symptomatic treatment with anti-inflammatory medications (e.g., aspirin, ibuprofen, naprosyn) will often help the pain. Other frequently used medications are tricyclic antidepressants, in low doses (too low a dose to treat depression, but enough of a dose to improve the quality of sleep and sometimes break the cycle of chronic pain.) Gentle aerobic exercise done on a regular basis may aggravate symptoms somewhat at first (a week or two), but later will significantly help reduce the pain.
Fibromyalgia can be a frustrating and debilitating problem for those afflicted. Certainly, it is well worth discussing with your health care provider if you have or think you might have it. Also check out
http://www.hsc.missouri.edu/med_info/fibromyalgia/docs/fm-pt.html
for more complete information.
Most people suffering from reflux complain of "heartburn," a burning type of sensation in the upper abdomen and beneath the breast-bone. It is usually worst an hour or two after eating, and is particularly bad after large meals, or very spicy meals. Lying down (during sleep, for example) and bending over, may increase the discomfort. And in some cases, there may also be chest pain, or even regurgitation of food into the throat.
Reflux may develop if the lower esophageal muscle that prevents reflux of acid from the stomach into the esophagus is not up to par, if peristaltic (wave-like) movement of the lower esophagus is uncoordinated or in the wrong direction, or if there are defects in the inner lining of the esophagus. Inability to clear acid from the esophagus, delayed emptying of stomach contents, and over-production of acid, can also contribute to the problem.
In some individuals, reflux symptoms are associated with an hiatal (hiatus) hernia, and it is popular to consider hiatal hernias as causes of reflux. Normally, the stomach and the esophagus meet at the level of the diaphragm. But with an hiatal hernia, the upper part of the stomach is "herniated" above the diaphragm, a condition that would seem to promote acid reflux. However, many people have these hernias and have no reflux symptoms, while others have plenty of reflux but no hernia, so the association does not always hold.
Most times, no single measure will alleviate all of the discomfort, but when all of the various measures are performed together, relief is likely.
The first and most important step is dietary changes. Avoiding foods high in fat, chocolate, onions, citrus fruit and juices, spicy foods, alcohol, mint, and all sources of caffeine, can help. However, everyone is a little bit different. Trial and error will tell you which foods give you the most problems. Interestingly, tobacco is a contributing factor as well, and should be avoided. Also, avoid eating very large meals, especially near bedtime. Some medications such as non-steroidal anti-inflammatory drugs (such as ibuprofen, aspirin, etc.) should be avoided in those who have acid indigestion problems as they can exacerbate the symptoms. Finally, stress stimulates excess stomach acid production and also contributes to reflux. Dealing with the stress, rather than with the symptoms of reflux, will get at the root of the problem.
Elevating the head of your bed about six inches (to promote normal emptying of the esophagus) can be helpful in controlling nighttime symptoms. This needs to be done using blocks or boards under the bedposts. Using more pillows usually doesn't work because the chest itself is not elevated. Many have tried, and already know that antacids can be helpful when taken with symptoms or at bedtime.
Should these measures not be successful, medications may be recommended. Prescription drugs ("H2-blockers" such as Zantac, Tagamet, and others; and "proton pump inhibitors" such as Prilosec, and others) are very effective, and in general are very well-tolerated even over long periods of time. You can now buy weaker versions of these H2-blockers (such as Pepcid and Tagamet) over-the-counter. They work well but are very expensive.
Keep in mind, all that "burns" is not necessarily "heartburn." For example, cardiac pains, ulcer disease, and other problems can also be confused with reflux. Any new, persistent, unusual, or severe symptoms should always be checked out.
The cause of apthous ulcers is still up for debate. No single infectious agent has been established as the cause of these sores, but rather several different microbes may play a role. And there is some evidence that an immunologic reaction to common bacteria may be involved. Also, nutritional deficiencies such as iron, vitamin B12, and folic acid, as well as mechanical trauma, stress, and hormonal changes may contribute to their cause. There are genetic predispositions, and some rare illnesses (such as Behcet's disease and Reiter's syndrome) that include apthous ulcers as one of the presenting symptoms. Finally, some specific viruses such as "hand-foot-and-mouth disease" and herpes simplex, will also result in mouth ulcerations.
The sores will generally go away by themselves in a matter of days or a week or two. Treatment may include topical cortisone preparations, although their effectiveness is questionable. Occasionally a tetracycline mouth rinse is used. It is important to exclude any more serious disorders such as those mentioned above. If the sores are severe, associated with other symptoms, or prolonged, be sure to check it out with your health care professional.
Distribution of the rash follows a very specific pattern related to the distribution of the involved nerve ("dermatomal distribution"), and it occurs only on one side of the body (i.e., right or left) in the vast majority of cases. In the initial phase, the affected area may feel hot or painful; often, a "burning" sensation is described. This may last a few hours to a few days. No rash can be seen during this phase. In the following days, small blisters usually develop at the site. These may become blood- or pus-filled in three to four days. Gradually, crusts will form. Resolution of the rash will occur in 14 to 21 days. However, the pain often associated with shingles, while it usually resolves with the rash in younger people, may persist for months or even years in older individuals (e.g. in your 70's or 80's). In some elderly people, the pain can be debilitating. Unfortunately, apart from age, and perhaps the intensity of the pain during the rash, there is no way of predicting who will go on to have long-term pain.
Shingles occurs more frequently as age increases. There is no true preventive therapy, but there are a couple of (very expensive) drugs available that can help shorten the course of the illness in some people, and may perhaps lessen the liklihood of chronic pain
It is not known whether repeated exposure to scenes of trauma and tragedy, as happens with emergency medical personnel, firefighters, police officers, etc., increases the risk to these individuals. But early intervention and support is important to prevent maladaptive responses, and to help people cope with the psychological responses that emanate from identification with the victims, feelings of impotence and guilt, and confrontation with their own mortality.
Further information may be obtained by contacting the American Red Cross or by contacting Federal Emergency Management Agency (FEMA ).
Another source of support and information has been recommended to us as well:
"PTSD: The victims' guide to healing and recovery"
Ramond Flannery, Ph.D. Crossroad Publishing, 1994
There are many unknowns with regard to MS. It appears that there are a combination of factors involved in the development and progression of the disease: Genetic susceptibility, defective regulation of the immune response, and possibly environmental exposures. The disease involves the nerves of the central nervous system (the brain and the spinal cord) with progressive demyelinization (loss of the myelin sheaths covering nerves, resulting in dysfunction of the nerves). This nerve damage results, as in your case, in the development of a wide range of symptoms. Symptoms tend to come and go, and may vary a great deal from one time to the next. The type of symptoms you have are determined by the area of the brain or spinal cord that is being affected at any one time.
So, to more directly address your question, it does appear that genetic susceptibility does play a role in the development of MS. Children of parents with the disease are at higher risk but this should not be viewed as a certain outcome by any means. Also, the enormous variability in the course of this disease makes it impossible to predict the outcome in any individual, but many people will go on after diagnosis to lead active, productive lives with little if any incapacitation and with prolonged remissions. The degree of independence one can maintain is obviously dictated to a great degree by the progression of the disease and likewise cannot be predicted. Heat exposure can transiently exacerbate symptoms, and should probably be avoided as much as possible. Avoiding overwork and fatigue as much as possible is important as well.
Multiple sclerosis is a disease in which the immune system is integrally involved. It is becoming increasingly apparent that one's state of mind and emotions play a significant role in the functioning of the immune system, and this has been borne out in MS patients. Patient morale appears to be very important in affecting outcome, and the value of supportive friendships and community as well as a hopeful perspective cannot be over-emphasized. Knowing as much as possible about MS is usually of tremendous value as well. I would strongly recommend finding a health care provider with whom you feel very comfortable and cultivating that relationship. In addition, there are many other resources you can turn to including:
The Multiple Sclerosis Foundation
Or write or call:
In addition, participating in a local support group may be really valuable. Good luck.
Obstructive sleep apnea is by far the most common
type. This occurs most often in moderately or severely obese persons, most
of whom attempt to sleep on their backs (instead of sleeping on their
sides). Extreme obesity can lead to mechanical obstruction of the flow
of air as the muscles relax during sleep. The problem is more common as
people age, and as weight increases, but can also occur in slimmer individuals with other medical problems who have decreased muscle tone in the upper airways.
Many people are unaware they have a problem with sleep apnea unless a family member
or roommate observes them actually stop breathing during sleep, frequently
noticed because they stop snoring. Common symptoms include heavy snoring, restless
sleep, and marked daytime fatigue (e.g. falling asleep in the middle of meals or conversations), and there are many physical problems such as heart failure that may occur. Severe sleep apnea can be fatal, but if
recognized, can be treated and fatalities prevented. Weight loss, sometimes as little as 15 or 20 lbs., can stop the sleep apnea in some cases. The diagnosis is made
with a "sleep study" during which oxygen levels are measured while
patients are under close observation. It would be best to discuss any personal
concerns regarding sleep apnea with your health care provider as this can
be a confusing topic.
Macular degeneration may basically be divided into the "wet form" where abnormal blood vessels grow into this area causing the visual damage, and the "dry type" which is a gradual degeneration of the macular zone.
Laser therapy has been used in the wet form to burn and prevent the abnormal blood vessels from doing further damage in the macular zone. This treatment has been moderately successful at preventing further loss of vision from the wet type of macular degeneration in some patients. The dry type cannot be treated with laser. There is some evidence that vitamin therapy can help prevent the occurrence of progression of macular degeneration. It also appears that increasing ones intake of vegetables, especially the dark leafy green vegetables, will be equally if not more effective in the prevention of macular degeneration than the specific antioxidant vitamins. Although some research appears encouraging there is no current way to reverse the damage from macular degeneration, however.
Drug therapy has not been found to be successful. Research has been initiated with the use of a medication called Interferon, but there has only been limited success. The hemorrhagic, or sub-retinal neovascularization, type of macular degeneration has been extensively treated with laser therapy. Laser, whether it be krypton dye, or argon green, is the standard modality to treat macular degeneration secondary to neovasculariztion. The location of the neovascularization will determine the success of the laser therapy. For example, some cases cannot be treated with laser since the center zone of the vision which gives you your detailed visual acuity is already involved, and the damage is already too extensive for laser to be utilized.
There have been investigations into other areas for treatment of this problem. More recently sub-macular surgery has been performed. Published studies to date indicate that it does have some success but may be of some limited value. It appears to be best for those patients who have had recurrences of the sub-retinal neovascularization membrane than for those who experience a first episode of the problem.
You may wish to contact The American Academy of Ophthalmology at 655 Beech Street, P.O. Box 7424, San Francisco, CA 94120-7424 for further information.
There are, however, numerous reasons for having iritis and there are many diseases that can cause it. It is impractical and costly to test for every possible disease that might cause iritis. With a careful history and review of all other problems that the patient might have, the doctor can usually limit the number of diseases that might be causing the problem. Frequently, iritis is seen in patients who have rheumatoid arthritis, childhood arthritis, sarcoidosis, ankylosing spondylitis, trauma and herpes simplex and zoster. By far, however, the most common cause of iritis is unknown. Many patients have one bout of it and will never have it recur.
Treatment is usually very successful with full recovery and no loss of vision. Treatment is usually directed towards reducing the inflammation and relaxing the iris to relieve the pain. The treatment is usually in the form of eye drops, and although some of the eye drops can actually increase the blurring of the vision, once the inflammation has been treated and the drops are withdrawn, vision returns to normal in the vast majority of cases.
It is important to accurately diagnose
the thalassemias, especially the heterozygous thalassemia, to differentiate
it from the other causes of anemia (such as iron deficiency) and to identify people in need of
genetic counseling to prevent the most severe form of the disease which may occur when two people who are both heterozygous for the disease try to have a baby.
-- C. Ebelke, 10/17/95
Using a deodorant soap may be helpful. After showering, an anti-perspirant deodorant is a good idea, and some people like to use a skin powder (you may choose one that contains a deodorant or baking soda) as well.
Foot odor can be a real problem, especially if your feet tend to sweat a great deal. The more your feet can breathe, the better, so choose your shoes accordingly. Foot deodorant powders, shoe inserts, or deodorant socks are available but are of dubious effectiveness.
Some women may develop unpleasant odors from vaginal secretions. If there is any abnormal discharge get it checked out. If the odor is normal for you, wearing all cotton underclothing may be helpful, and it is advisable to allow as much air to reach the area as possible -- try to go without any underclothing altogether at bedtime.
We do live in a society that is very body odor-conscious. Everyone has odors, some of which may be inoffensive, or may even have very pleasant associations. Having body odor is as normal as growing hair, or breathing, or anything else. Advertisers would have us compulsively disinfect and deodorize everything. Unless you have a rather extreme problem, that may not be necessary.
As you are probably aware, antibiotics never cure infected kidney stones. Recurrent infection is the rule unless the stone is removed. Good luck with the weight loss!
Norm is still in constant discomfort. Talking irritates the tongue, and eating and drinking soothes it temporarily. He cannot eat anything abrasive, and no spicy foods. After talking, the tongue becomes very painful and a yellow layer appears on the sides, and the tip of the tongue appears to be raw. Even pinching the tongue makes it unbearably painful. He also believes that his bad breath is caused by this condition.
Burning or pain of the tongue suggests several diagnostic possibilities. Vitamin B12 deficiency, iron deficiency, and oral candidiasis (a yeast infection of the mouth), are three of the most commonly considered possibilities. A severe lack of saliva production, as is present in certain rare diseases, can also cause a burning of the tongue.
Unfortunately, there seem to be many cases where these types of tongue symptoms cannot be readily explained. Zinc supplementation has been recommended, just to treat the symptoms, but the results do not seem to be very impressive. Obviously, the more that can be done to avoid food or mechanical irritants, the better.
Of course, migraine headaches are very common. Whether or not your headaches are related to these cysts is a complicated question best directed to your doctors.
Generally, the cysts require no intervention unless they begin to cause symptoms. The decision on whether or not to get periodic MRI exams is also highly individual. There may be cases where an enlarging cyst needs to be watched closely because of some early problems. In other cases where there are no signs of problems, it may make sense not to do any further scans unless symptoms develop.
Distribution of the rash follows a very specific pattern related to the distribution of the involved nerve ("dermatomal distribution"), and it occurs only on one side of the body (i.e., right or left) in the vast majority of cases. In the initial phase, the affected area may feel hot or painful; often, a "burning" sensation is described. This may last a few hours to a few days. In the following days, small blisters usually develop at the site; these may become blood- or pus-filled in 3-4 days. Gradually, crusts will form. Resolution of the rash, including separation of the crust, will occur in 14 to 21 days. However, the pain often associated with shingles, while it usually resolves with the rash in younger people, may persist for months or even years in older individuals (e.g. in your 70's or 80's).
Shingles occur more frequently as age increases. There is no true preventive therapy but there are a couple of (very expensive) drugs available to possibly help shorten the course of the illness. Sleeping, exercising and eating well - and not being too stressed out, may help decrease occurrences.
-- Cathy Ebelke, 10/10/95
There is no question that daily binging and purging is hard on the body, never mind the emotional and psychological factors that are so important. There is some risk of esophageal (the swallowing tube) rupture, but at least on a statistical basis it is quite small, and it is certainly not something you need to be afraid of on a day-to-day basis. Other physical problems you may be familiar with include altered blood chemistries (e.g. low potassium, and abnormal acid/base balance), and deterioration of teeth which occurs due to the effects of stomach acid in the mouth.
It can be very difficult getting over bulimia. It is a good idea to be monitored by a physician who can speak to you more directly about the level of risk of esophageal rupture, and other medical complications, in your specific case. It is important to find someone you trust, and with whom you can be honest without fear of being stigmatized or criticized. If you don't have such a physician now, perhaps your therapist can make a recommendation.
-- R. Jandl, 10/10/95
Of course, in a person who does not have documented heart disease, using a medication to prevent the disease is fraught with uncertainty. As an individual, it is impossible to predict whether or not you will benefit from taking the medication (since not everyone will benefit), and of course you will be exposed to the costs and potential for side-effects. It's a question of playing the odds: The odds that you will develop heart disease if you do nothing, and the odds that the medicine will actually do what it is supposed to do at an acceptible risk and cost.
There is some disagreement in the medical community about how aggressively cholesterol-lowering medications should be used, but there are concensus statements to look at generated by national expert panels who have formulated recommendations for when to use these drugs. Your doctor or health center should be able to give you a copy. Ultimately, the exact type of medication(s) to use must be determined on an individual basis.
-- R. Jandl, 10/10/95
Protecting your eyes is mostly common sense. Use safety glasses for any occupation or job where small objects or particles might get into your eyes, use safety glasses for indoor racket sports, use goggles for swimming in chlorinated water, and use sunglasses when skiing, at the beach, or in any other bright sun situation, to protect your eyes against sunburn. Also be careful of chemicals that might splash into your eyes, and if you use contact lenses, care for them properly to avoid getting eye infections.
-- R. Jandl, 10/10/95
What happens is, at the time of infection, your body mounts an immune response. For reasons that are not fully understood, this immune response sometimes causes inadvertant damage to your kidneys. This damage shows up clinically as post-strept glomerulonephritis within about two weeks of the initial infection. It occurs much more commonly in children than adults. In addition, it turns out only some strains of strept bacteria trigger this type of damaging immune response, and of course the vast majority of people who are infected by strept never get the kidney disease at all. Treatment of your initial strept infection with antibiotics will prevent you from getting the glomerulonephritis.
As you have suggested, hypertension is typically present in this disease, and you will also see swelling, or fluid retention. The urine shows protein leakage as well as red blood cells under the microscope. The urine itself may look very dark brown or bloody in color. The reason for the elevated blood pressure has to do with the fact that your kidneys normally work to regulate your blood pressure. The type of damage caused by this glomerulonephritis disturbs this regulatory mechanism, causing your blood pressure to go up.
If you look under the microscope at the kidneys of someone who has post-strept glomerulonephritis, you will see lots of "immune deposits" and a great deal of inflammation that goes with it. The damage can be quite impressive, and as the kidney's primary function is to filter your blood, heavy damage by the immune deposits can cause temporary kidney failure.
Fortunately, the vast majority of people recover completely from this type of glomerulonephritis. The kidney function and blood pressure completely return to normal. There are cases of slowly progressive kidney failure, and hypertension, in those who have previously had post-strept glomerulonephritis. This is not very common, but makes it a good idea to get follow-up doctor appointments.
There are two types of diabetes mellitus: Type I, or Insulin Dependent Diabetes Mellitus (IDDM) and Type II, or Non-Insulin Dependent Diabetes Mellitus (NIDDM). These are actually quite different from one another. In Type I diabetes, the age of onset is usually between 8 - 12 years old, peaking in adolescence. People who develop this condition are usually normal to thin in weight. The onset is usually rapid and includes symptoms such as weight loss in spite of normal eating habits, increased thirst, increased urination, fatigue, nausea, and headaches among many others. Upon being diagnosed with this disease, a person will usually be put on self-injections of insulin with the aim of stabilizing blood sugar levels. Most people will have to stay on insulin for the rest of their lives. Once blood sugar levels are under control, these folks can be fully active and participate in sports and recreational activities without significant restrictions.
Type II diabetes tends to affect folks who are in their forties or older. Many people who develop NIDDM are heavier in weight and may not be getting regular exercise. Frequently, this condition will respond well to diet modification and regular exercise. If this is ineffective, an oral medication is used which will often bring blood sugars under control. Sometimes insulin injections are necessary.
Diabetes may have significant long-term complications which are due primarily to protracted high blood sugar levels. These may include eye disease, kidney disease, and early hardening of the arteries and heart disease among others. It appears that the incidence and severity of these complications decrease with better blood glucose control.
Diabetes is not a contagious disease, but rather seems to be determined genetically in large part. People are at somewhat higher risk if they have a first-degree relative (parent or sibling) with the disease. You can be evaluated for diabetes by checking your blood glucose level and with a simple urinalysis. If you have any questions about diabetes, contact your health care provider .
-- Cathy Ebelke
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I recently had a tooth extracted and I have had about four weeks of lethargy, weight loss, fever and shortness of breath. My ankles have become swollen. What's wrong with me?
-- CV
The symptoms you report are potentially worrisome. Although it is not possible to make a diagnosis since your symptoms could be due to many different things, there is an important complication of dental extractions you should probably be aware of.
My brother had chest pain and went to the hospital, where they informed him that he had had a silent heart attack. On further tests they told him that one of his arteries was 100% blocked, another one 90%, and a third one 80%; and that he would need immediate bypass surgery. He is only 39 years old, a non-smoker, and has no family history of heart attack. We wanted to have a second opinion but the hospital convinced us that this was a black and white case, and in such cases you can not have a second opinion; and also he was like a walking time bomb and needed surgery right away. After the operation, they said he really did not have a heart attack, and his fourth artery needed a bypass also. We are confused. Could you tell us more on this please as soon as you can. Was surgery an immediate requirement and also should we have insisted on a second opinion?
-- NS
I can see why you might feel confused. And scared too, when it involves someone close to you who is so young. Everyone hears a lot about heart disease, hardening of the arteries, high cholesterol, and blood clots. But there is often a lot of confusion about what all these things mean. The management of these problems may also become complicated. Here are some general comments that I hope will be helpful.
What affect could alcohol have on me if I have mononucleosis, but have recovered, all except the sore throat?
-- BC
It is important to be aware of the potential interaction between alcohol and infectious mononucleosis, or "mono."
A child at the crèche where my daughter goes has been diagnosed with scarlet fever. Could you please tell me how long the incubation period is?
Scarlet fever brings to mind images of epidemics sweeping through the town, causing the children of a community great sickness and suffering. At one time, before the advent of antibiotics, scarlet fever was much more common than it is now.
A disconnected furnace pipe caused my family's exposure to carbon monoxide for almost 3 weeks unnoticed. Only my youngest son at 135 lbs was affected by feeling lethargic and sleepy. The family physician ran a mono test and blood count that came back normal -- before we realized the furnace problem. It's a week since the furnace was fixed and my son is still a little tired. Should I be concerned? Does he need to go back to the physician? Are there long-term effects I should look for?
-- RO
Carbon monoxide poisoning often does go unnoticed at first. It has no odor, no taste, and no color, so the body has a hard time knowing it is there. The smoke and fumes produced by the burning of wood, oil, gasoline, even cigarettes, result in the production of carbon monoxide. Therefore, if the smoke and fumes are not adequately vented away, poisoning may result.
Before coming to college I was required to have a doctor's checkup. I did and the nurse notified me that I am anemic and suggested that I eat beef. What are the causes of anemia, and are there other foods besides beef I can eat to decrease my anemic condition? What are the signs of anemia?
-- MML
A little background will probably help in answering your question. When someone is told they have an anemia, it means that they have low red blood cell counts. Red blood cells are one of the three basic types of cells that circulate in the bloodstream: white blood cells (the immune system) and platelets (for clotting) are the other two. Red blood cells are red because they are packed full of a protein called hemoglobin. The main purpose of red blood cells is to carry oxygen to all parts of the body. In fact, red cells are so specialized that they are the only cells in the body to have given up their nucleus. They therefore cannot reproduce once released into the bloodstream. They live out their 120 days in the circulation as oxygen-carrying workhorses, then die an exhausted death. The bone marrow cranks out fantastic numbers of new red blood cells every day.
What causes gray hair? Is it bad for a young person to get gray hair?
Hair begins to turn gray for a very simple reason: the pigment that gives hair its color simply stops getting produced in the hair follicles. One by one, the follicles stop making pigment, and gray or white hair (the color that is left once added pigment is gone) results. Unfortunately, like wrinkles in the skin, stiff joints, and reading glasses, we seem to be genetically programmed to age in this way. On the average, Caucasians will begin to turn gray at the age of thirty-four; for blacks the average is forty-four.
My husband has been experiencing severe and unusual skin redness when he dries with a towel, rubs, or scratches his skin. The marks show up after a few seconds and will last several minutes. We were wondering if this could be medication-related (he is taking medication for ulcerative colitis) or if it is a symptom of something else?
You may be describing an interesting type of hypersensitivity reaction of the skin. In particular, what comes to mind is something called "dermatographia." People who have this condition will develop hives, redness, or welts after physical stimulation of the skin. These changes show up within a matter of seconds, and only in the precise areas of skin where the physical stimulation occurred. You can actually write your name on someone's skin, if they have dermatographia.
Can mitral valve prolapse affect blood pressure? I've known I had the prolapse for 15 years and have had little trouble with it (heart "flutters," irregular beats, and occasionally achy pain when tense, don't sleep on left side due to LOTS of heart flutters), but lately I've been AWFULLY tired. The fatigue hits suddenly and I'll feel like I am going to fall over. Last checkup at my doctor's office, they asked if I was still alive, as my blood pressure was so low (110 over ?). I've kept check on it at the little kiosks at stores and it stays very low (114/69, 112/88 etc.), when for years it was always around 120-125/72-80. I am a 45 year old white female and not exactly physically fit (that would qualify me for lovely low blood pressure) but I'm not a couch potato either. Should I have some tests to check this out? I don't feel ill, just can't explain the sudden fatigues.
-- JS
Could mitral valve prolapse or low blood pressure be a cause of fatigue? In your case, the evaluation of fatigue would actually require a more extensive series of questions and answers, but here are some general concepts that I hope will help.
Earlier on this year, my brother in Australia was diagnosed as having hemochromatosis. I know this is an iron overload in the system and that blood must be taken from the body every two weeks. My brother did mention that it could be hereditary and that all the immediate members of the family should be checked out. As I have suffered from anemia for most of my life, would you suggest that I get a test done? Also I have a sixteen year old son and wondered if he would eventually have to have a test done. He couldn't take it now as he is overly sensitive to anything gory and is given to passing out at the mere mention of it. Do you feel that it is something to worry about? My niece and my other brother have come up negative. Also, what causes this rare blood disease?
-- PC
Hemochromatosis is also known as an "iron storage disease." For a variety of reasons, not all of which are known, the body accumulates too much iron, which in turn leads to the damage of a number of critical organs.
Can AIDS be transmitted by mosquitoes?
-- DT
There is no evidence AIDS can be transmitted by mosquitoes. In spite of intensive surveillance -- even in areas where there are many people infected with HIV and mosquitoes are prevalent -- no cases of HIV transmission by biting insects has been reported. The concern, of course, is that a mosquito could bite a person infected with HIV, move on and bite the next person, causing spread of the infection, and possibly an epidemic. Why doesn't this actually happen?
Over a period of time my feet and ankles have swelled up, but before the day was over they would return to normal. Lately my feet and ankles have been swelling up and have taken days before subsiding only to swell again. I am male, generally vegetarian and non-salt eater. I have gained weight recently since I stopped smoking.
--TK
What does it mean when the feet and ankles swell up? Is it a sign of serious disease, or is it nothing to worry about? In your case it would be impossible to say without more information. But here are some general concepts that I hope will be of some use.
Are disposable contact lenses harmful to your eyes if you sleep in them? I have heard conflicting stories from different optometrists about the risks (if any). What is the real story?
-- NS
Disposable contact lenses offer some conveniences with regards to the need for proper cleaning and storage. Some are designed to last a few months (flexible wear contacts). Others are meant to be used for only a couple of weeks after which they should be tossed out. According to Tripod's eye specialist Dr. Provenzano, the question as to whether or not it is safe to wear disposable contacts while sleeping rests with the contacts' manufacturer. Some will tell you it is okay, others will tell you not to do it. The issue has to do with the amount of oxygen permeability afforded by the lens, and this differs from one manufacturer to another. Unless told otherwise by your eye doctor, you can simply follow the recommendation of the manufacturer.
I am a female in good health with a blood pressure of 160/90 and a family history of strokes and heart attacks. Do you feel this should be treated?
-- SB
What does low blood pressure mean? I recently went to the hospital to donate my blood, but the doctor said that I am not healthy enough because my blood pressure below average!!! I've heard of high blood pressure, but what IS low blood pressure?
-- SP
There is high blood pressure and there is low blood pressure. So what is normal?
Dr. Bob, I'm a 35 yr. old male smoker (pack a day for 15 years). Over the last several years I've experienced chest aches and pains, sometimes several times a week. This pain is not sharp, incapacitating, or long lived, and is more of an ache than anything else. Sometimes this chest ache is accompanied by a similar ache in my left arm which goes from the arm pit to the elbow. It usually lasts 10 seconds, but can last as long as a minute. I do not have high blood pressure, but don't know about cholesterol levels as they've never been checked. Is this something that I should be concerned about?
-- WE
What is a persantine-thallium stress test and why do they consider it a stress test?
If you are having chest pains, how do you know whether or not it is from the heart? That's the critical question for many people. There is no simple answer. Heart disease can present itself in so many different ways that it truly does take a great deal of practice and experience before a doctor becomes expert in this. However, there are a few concepts that are worth trying to remember. The classic chest pain of a heart attack is a crushing chest pressure -- "like an elephant sitting on my chest." Heart pains typically occur with exertion, and are relieved by rest. They do not last seconds, but rather minutes to hours. A fleeting, or momentary chest pain, even if it is severe, is almost never cardiac. If at the time of the pain you also experience a cold sweat, nausea and vomiting, dizziness, heart palpitations, or radiation of the pain into the arms, throat, or jaw, then heart disease is more likely.
What gland is in the center, lower part of neck, just above the ribcage, and what is its function? What would cause it to painlessly swell?
-- SB
I have a knot in the thyroid gland. What is the recommendation? Is an operation to remove it the best way?
Thank you!
-- HM
Here are two questions related to the thyroid gland, providing a good opportunity to talk about what are referred to as thyroid nodules. Nodules are discrete lumps, and should be distinguished from goiters which are more diffuse enlargements of the gland.
What do you think of body waxing as a hair-removal process? Specifically, I had some hair on my back (I'm male) waxed "off" recently. It was an uncomfortable procedure, of course, but the redness is going down somewhat. Otherwise, I'm happy with the results. Is body waxing harmful? Thanks!
Body waxing seems to be a very reasonable way to remove body hair. For those who are not woolly enough to be in the know, body waxing is a popular way of removing unwanted body hair from legs, backs, faces, or elsewhere. Warm wax is applied to the furry areas, and then peeled off after it cools, pulling the hair out with it. It may be a little painful, but most people who have it done regularly do not seem to mind.
What are the side-effects of melatonin?
-- RK
Good question, since not much is known. This may be a good time to elaborate on a previous answer concerning the proper dosage of melatonin. It is also a good opportunity to vent some frustration on certain groups within the food supplement industry.
How easy is it to catch hepatitis, and once you have it, how do you get rid of it?
-- TC
-- DH
Hepatitis, from the Greek, simply means "inflammation of the liver," and does not refer to a specific cause. But in common usage, a person with hepatitis usually means they are thought to have a viral infection of the liver. Most people have heard of hepatitis types A, B, and C. These are all slightly different forms of viral hepatitis. (There are more types than this -- a type D, an E, etc.) They are all a little bit different but it is helpful to make two generalizations about how they are transmitted.
Dear Doc,
I'm 22 and I have a hair-loss problem. However, it is not the classical male-pattern
hair. It is getting weaker and falling from all over my head.
The problem is not visible, yet, but when I look at almost all
my friends' hair, I know that my hair is LESS DENSE. I have tried an
expensive and boring MINOXIDIL 4% treatment, and wasn't very
satisfied with the results. My hair is now slightly oily, straight, and
very fine (like baby hair) but when I was about 13 (nine years ago) my hair
was thicker and a bit wavy/curly. I don't know why it changed. Anyway I want to ask you, if with today's technology, there is something
not very expensive and worthwhile to try. At the moment, I am doing
nothing on my hair; no conditioners and no gel, sprays, etc. just
wash it (KMS UltraVol) once every two days.
Whenever there is significant hair loss, or a dramatic change in your hair, and before hair transplants and miracle remedies are purchased, it is worth looking for any treatable or reversible causes. Rather than try and figure it out on your own, this is a good time to take a trip to the doctor. There you should be asked a number of questions, about such things as your health history, family history, skin problems, and personal hair and skin care. The pattern of hair loss is important, underlying skin problems are important, and the ease of pulling a small number of hairs out should be tested. (As a rule of thumb, when about a dozen hairs are pulled gently, if no more than two come out, than hair loss is probably not excessive.)
I have just noticed the mole in my right underarm is swelling and sensitive to the touch. It looks more like an inflamed pimple now. I am a healthy male. Should I have it looked at, and by what kind of doctor? Thanks.
A changing mole is one of several signs to look for when concerned about the skin cancer malignant melanoma, and usually means it should be checked. Other changes to look for include an enlarging size, variations in color, an irregular border, bleeding, pain, or inflammation. If you notice any of these, have it checked.
After doing a recent test on my blood glucose level in Biology, I found that my blood glucose count was 3.0 mmol/l and I was wondering if you could tell me if it was too low. I did not have anything to eat for about 10 hours before the test and the sample was taken accurately. What does it mean if I have a low blood glucose count and what should I do about it? --KT Ask the Doctor recently received these two questions about hypoglycemia. As this is an area full of misconceptions, as well as frequent tension between patients and healthcare providers, let's start with some basic concepts.
I am suffering from gastric ulcers or what is called gastric acidity.
For the last four months I have undergone treatment for this.
But still I have not fully recovered from it. I usually get pain
in the early morning once in a fortnight. Is it that acidity can not
be cured totally? Can I can get rid of acidity by controlling
my diet? If yes, how?
By way of background, a gastric ulcer is an erosion in the lining of the stomach, associated with excess stomach acid production. Symptoms of excess stomach acid include indigestion, heartburn, and gas. In mild cases of acid indigestion all you have are the symptoms -- there is no ulcer. In more severe cases an ulcer forms; and in the worst cases, these ulcers can erode into a blood vessel causing internal bleeding, or perforate through the stomach wall -- a surgical emergency.
Dear Doc,
What do you think about the new chickenpox vaccine?
A vaccine to prevent chickenpox has been available for the past year or so. Chickenpox, caused by the varicella zoster virus (the same one that causes shingles) is an infection that usually affects kids. It causes fever, a red spotty rash with central fluid-filled blisters, malaise, and itching. It is highly contageous. If you have managed to get to adulthood without ever having had chickenpox, then the vaccine is something to consider.
I quit smoking one year ago, and I since gained almost 20 lb. Although I know my diet has been poor, it seems harder than ever to lose weight. As a smoker of 2 packs per day, the pounds seemed to fall off easily. How significant is the change in metabolism from 40 cigarettes per day to none?
-- MEL
Good question. Many people find, like you, that smoking helps to keep them thin. In fact, the fear of weight gain is so strong that many people actually prefer to continue smoking than face the prospect of putting on weight --even if they stopped enjoying cigarettes a long time ago.
What is a blood vessel tumor and how is it caused?
Is there a concern?
Okay, I've read the previous responses regarding mono (infectious
mononucleosis). Since I don't know if I have had previous
exposure to mono (and therefore immunity), is there a way
for me to find out?Your question points out some very interesting characteristics of infectious mononucleosis. "Mono" is caused by the Epstein-Barr virus (EBV) and triggers a positive "monospot," also known as a heterophile antibody blood test, in about 90% of people infected. This test is used to make the diagnosis. The monospot becomes negative again some months later, so if you want to know if you have ever been infected with EBV, you must look for some other marker.
I'm a 29 year old computer professional and have been
experiencing numbness and pain in my arms, hands and
fingers. Even tasks such as cutting food can cause a
pins-and-needles sensation. Should I be concerned with
this?
-- PA
There are lots of reasons why you may be having a pins-and-needles sensation in your hands. Some of the reasons are important to know about since they may be an early sign of a more serious problem. Other causes are not so worrisome. For example, carpal tunnel syndrome is a very common problem, familiar to people who use their hands and fingers a lot. Your computer work would put you in that category. With repetitive motions, scar tissue builds up in the wrist area, causing pressure on the median nerve. Classically, this causes numbness and tingling in the thumb and first two fingers of the hand, but may also involve the other fingers as well as the forearm.
Recently, some of our very astute Ask the Doctor readers have pointed out
that the above answer was not a thorough review of carpal tunnel syndrome. Well, they're right of course, since the answer was only intended to introduce one of the more likely possibilities for this person's symptoms, not to be a comprehensive review. Nonetheless, for those interested in learning more, please check
out these sites:I am a healthy 26 year old female who has had juvenile-onset diabetes since the age of 11. I would very much like to give blood. I
understand that because I use syringes (for taking insulin)
I would be a risk to give blood. Are there any studies being
done that would eventually let diabetics give blood if they
want to?
-- LI
In order to try and answer your question, we contacted the American Red Cross. They have assured us that as long as your blood sugars are adequately controlled (and assuming there are no other reasons why you may not donate blood) that you may go ahead and donate blood just as well as the next person. It is assumed in this policy that diabetics who are on insulin are using sterile, disposable needles -- in other words, not sharing dirty needles as is common for heroin or other injectable drug users, where blood-borne diseases such as hepatitis B and HIV can be transmitted.
I am interested in what you know about the skin disease
pityriasis rosea. I don't know if that is spelled right but
any info and treatment would be greatly appreciated.
Pityriasis rosea (definitely an oft-misspelled word!) is a skin rash. The skin lesions are raised reddish to brown or salmon-colored "spots" with fine, white scaling. It may cover the entire body, but usually spares the face, hands and feet. Interestingly, the spots often follow a "skin-fold distribution," so that on the trunk they are spread out like the branches of an evergreen tree with the spine as the trunk. The rash frequently begins with a "herald patch" -- a single, often larger lesion, frequently found on the trunk, appearing days to weeks before the generalized rash.
-- C. Ebelke, 1/29/96, Category: general medical
How serious is mitral valve regurgitation?
The mitral valve is one of four valves in your heart. It acts to keep blood from being pumped backwards when the heart contracts. For various reasons, the mitral valve is often found to be a bit leaky, and when the leak is small, no harm is done. If, however, the leak is big, then your heart loses pumping efficiency, and heart failure (with fluid congestion in the lungs and elsewhere in the body) can result.
-- R. Jandl, 1/29/96, Category: general medical
The information I have received from our doctor on diabetic neuropathy
is that after I quit smoking and have everything under control
that the neuropathy will subside.... the question I have is
how long will it take before I see any results? The neuropathy
is in my feet and legs.
-- TS
One of the potential complications of diabetes mellitus is peripheral neuropathy. In this condition, nerves become damaged, leading to symptoms such as numbness and tingling of the hands or feet. Eventually, all sensation may be lost, and there may be a sense of clumsiness from not being able to sense where your hands or feet are located; and there is the possibility of injuring those areas without knowing it, which can lead to serious infections.
-- R. Jandl, 1/29/96, Category: general medical
I have been suffering from acute sinusitis for almost seven years.
Is there any cure for it? I suffer from severe headaches, cold, cough
and congestion. I've tried all kinds of medicines with no effect.
Please advise.
The collection of symptoms which you describe can occur in someone who has recurrent sinus infections, although this is not the only possibility. The sinuses are seven
cavities within the bones of the skull. They are lined with "mucosa," which is a
moist tissue similar in appearance to that which lines the inside of your nose. The sinuses' only connection with the outside world is
through tiny openings into the nasal passages. Thus, it does not take much
swelling of the nasal lining to cause these openings to become blocked, which
can lead to a mismatch between the pressure in the outside world (the atmospheric
pressure) and the air pressure inside a sinus cavity. This results in
pain over the area of that particular sinus. And if certain viruses or bacteria are stuck inside one or more of these sinuses, pain may also occur from the accumulation of byproducts from the war your immune system
is waging against the invaders -- "purulent mucus" might be the polite term
here.
-- B. Kopynec, 1/9/96, Category: general medical
During mild winters my palms (especially fingers) and
feet become abnormally cold as compared to the rest of
the body. Most of the time I do not feel cold anywhere else
but my palms and feet are ice cold and freezing. Soaking in
hot water, covering with woolen gloves/socks, etc., helps
only temporarily and marginally. Is this abnormal?
What could be causing it? (less hemoglobin, low blood pressure ?????)
What can be done to improve the condition?
Thanks.
Many individuals have a higher sensitivity of the extremities to cold
temperatures. The extremities get cold simply because they are the most distant
from the central, warmth producing and retaining "core." This is very common, and although uncomfortable, is not associated with other problems. However, other possibilities are worth considering.
-- B. Kopynec 1/9/96, Category: general medical
What are potential consequences, during blood donation, when air bubbles are present in blood flow?
-- JM
Sometimes, when donating blood, or receiving intravenous fluids or medications of any kind, air bubbles may be flushed from the intravenous tubing into the vein. If you think about what veins do, they transport blood from all areas of the body back to the heart, and from there to the lungs to pick up oxygen. So, what usually happens is those air bubbles travel through the veins and get trapped in the lungs. In small amounts this is harmless. However, in very large amounts it could be dangerous, so you will usually see the nurse or technologist flush most of the air out of the tubing before it is connected to the intravenous needle.
-- R. Jandl, 1/8/96, Category: general medical
How long do the residual effects of shingles last after all the lesions have disappeared, i.e., sharp pains that are present long after the rash is gone?
Shingles is a painful rash which actually represents a reactivation of the chickenpox virus that has lain dormant in the body for many years. It affects people with increasing frequency as age increases and is associated in some cases with a weakened immune system. About 300,000 cases occur annually in the US. The initial rash consists of clusters of blisters on a reddish base (this is sometimes described as "dewdrops on a rose petal"), following the distribution of a cutaneous nerve (a sensory nerve to the skin). Usually, only the right or left side of the body is affected. The accompanying discomfort may actually precede the rash by a couple of days. The sensation occurring with the lesions is usually described as burning, tingling, sharp, pricking, or deep. The lesions crust over and will generally heal within 14 - 21 days.
-- C. Ebelke, 12/29/95, Category: general medical
What is the percentage of people who will contract Guillain-Barre syndrome after receiving the flu vaccine?
-- SE
One would think that it should be
relatively easy to find the answer to your question, but it's not. Such a number would be imprecise and suspect in any
case, as Guillain-Barre Syndrome (GBS) can follow a number of viral and bacterial infections, the
symptoms of which have usually resolved weeks before GBS symptoms
begin to occur. Thus, at the time GBS appears, any of a number of
preceding events may be suspected as the inciting cause, with flu
vaccination having been only one of them.
http://dem0nmac.mgh.harvard.edu/neurowebforum/neurowebforum.html
-- B. Kopynec, 12/21/95, Category: general medical
What causes a thyroid gland to cease its function in the body?
-- O.D.
The thyroid gland sits just below your "Adam's Apple" and above the sternum in the neck. It produces thyroid hormone which regulates the
body's metabolism. If you have too much hormone everything speeds up, too
little hormone and everything slows down. The mineral Iodine is an
essential element of the hormone and, hence, not having enough of it is
one reason the gland might not work right. It turns out that Iodine
deficiency is very rare in our country because food is regularly
supplemented with Iodine. However, in some parts of the world it is still
common.
-- A. Calhoun, 12/18/95, Category: general medical
I have wisdom teeth coming in, and my dentist says that they have to come out. What is the least painful way to have them removed? And what is the process?
-- OB, Southern Illinois University
Today, most doctors will take out wisdom teeth in the office unless they are severely impacted, or there are other reasons for a more complicated procedure. This can be done using "conscious sedation" which is a way of providing enough anesthesia to do the procedure, but not so much that you require life support as in "general anesthesia."
-- R. Jandl, 12/13/95, Category: general medical
I would like information on meralgia paresthetica.
Meralgia paresthetica is a fancy name for pain and discomfort caused by a nerve located on the outside, or lateral aspect, of your thigh. The word
"meralgia" comes from two Greek words meaning thigh pain. And "paresthetica" refers specifically to paresthetic type discomfort -- that is, a tingling, stinging, pins and needles, or numbness sensation. The problem is associated with obesity, wearing a very tight-fitting waistband, belt, or corset (all of which put undo pressure on the nerve) and is more common in diabetics. The nerve in question is called the lateral cutaneous nerve of the thigh, a nerve that supplies sensation to that area. Injury to this nerve will not cause any loss of strength.
-- R. Jandl, 12/13/95, Category: general medical
Should I worry about my heart fluttering occasionally?
Sometimes when I go to bed at night my heart flutters
uncomfortably when I lie on my right side only. It started
6 years ago after the birth of my first child. Should this
be looked at?
-- VG
Most often, the feeling of palpitations, or of your heart fluttering for only a second or two, are perfectly benign. In fact, the heart normally has some irregularity which most people experience as a skipped beat. It tends to occur both day and night, but may be more noticeable at night when you are lying quietly in bed, or sitting in a chair. What actually happens is that there will be a premature heart beat, which because it happens before the heart chamber has a chance to fill, pumps very little blood. Most people either do not feel that extra beat, or experience a momentary flutter sensation. For the next couple of beats, the heart has to catch up by pumping more blood than usual, giving rise to the pounding sensation in the chest.
-- R. Jandl, 12/15/95, Category: general medical
What exactly is Tourette Syndrome? Do genetics play a part in it and to what extent? What treatments are available
for TS? Is this a condition that can go away with time or
at least get better?
Tourette Syndrome is a surprisingly common genetic disorder. It is defined by the presence of multiple
motor and vocal "tics." Typical tics
include repetitive eye blinking, head turning, lip smacking, sniffing,
throat clearing, and grunting. The much rarer "coprolalia" or involuntary
and inappropriate swearing as a manifestation of Tourette's has been
exploited by Hollywood in a number of films and TV shows. The condition is
thought to be caused by problems with neurotransmitters in the brain,
especially dopamine and serotonin.
Tourette Syndrome Association,
42-40 Bell Boulevard, Bayside, New York, 11361
(718-224-2999.)
-- A. Calhoun, 12/10/95; Category: General Medical
For about a year now, I've been plagued with central cirrus
retinopathy. I've been to the eye specialists here in Hong Kong--who
seem quite professional enough--have had the photos taken and the
pronouncements made and have been given two options: live with it and
hope it goes away (as it used to, but is not now doing) or have laser
treatment.
"Central serous chorio-retinopathy" had usually been thought to be a fairly benign condition of the eye. However, as the medical experience with this condition has increased, certain patients have developed changes on the retina (the back of the eye) that have gone on to cause a reduction of vision.
--R. Provenzano, 12/11/95; Category: General Medical
What is fibromyalgia? What is the best form of treatment
for this condition? How destructive can this become?
Fibromyalgia is a poorly understood problem characterized by aching pain and stiffness in areas such as the neck, shoulders, back and pelvis. It is typically worse in the morning, and may be intensified by factors such as physical or emotional stress, poor sleep, cold weather or humidity. The cause is unknown. It occurs most commonly in young women, and has often been confused with psychosomatic pains. It has been speculated that viral infections or Lyme Disease may cause fibromyalgia, but this has not been borne out by research.
--A. Calhoun, R. Jandl, 12/7/95; Category: General Medical
Are there other alternatives to the use of Zantac for treating reflux?
Any holistic approaches or advantageous dietary changes that would be beneficial?
Does Zantac pose any potential long-term threat when used for extended periods?
We received a number of questions this week concerning "reflux", or acid indigestion. Simply speaking, this refers to reflux of stomach acid into the lower portion of the "esophagus," or food tube. Nearly everyone has had reflux at one time or another, but for some it can cause a great deal of discomfort.
--C. Ebelke, R. Jandl, 11/25/95; Category: General Medical
About a week ago I had a cold. The cold is pretty much gone
but the other day my gums and the roof of my mouth got very sore and
inflamed. My mom had the same set of symptoms and she said she could see little white bumps on her gums and inside of her mouth. We don't have a rash anywhere else or any other symptoms. What could be causing this?
Although it would be impossible to make a diagnosis without actually looking in your mouth, sores that are found along the gums or lining of the mouth around the time of a "cold," are often what are called canker sores, apthous ulcers, or apthous stomatitis. They are usually painful, small, shallow ulcerations consisting of a grayish-white base surrounded by an area of inflamed (reddened) tissue. They can occur singly, or in groups, and take about 10 to 14 days to heal.
--A. Calhoun, 11/29/95; Category: General Medical
How long do shingles last?
Shingles is the name given to a painful rash caused by one of the viruses in the Herpes family. When a person develops chickenpox, very often as a child, the virus which causes the disease may sequester itself in a nerve bundle in the spinal cord for decades to follow. For reasons which are not fully understood, the virus may be reactivated in adulthood in the form of Varicella zoster, or shingles.
--C. Ebelke, 11/25/95; Category: General Medical
Can you direct me to some information sources regarding critical incident stress, or post-traumatic stress disorder?
Specifically as it relates to first responders?
-- DL
Post-traumatic stress disorder (PTSD) may be caused by many types of trauma. There is very little literature on the incidence and prevalence of PTSD in first responders (i.e. in those who arrive first at the seen of a catastrophe). But it is clear from research and clinical observation, that only about 20 percent of all persons exposed directly to severe traumas actually develop PTSD.
-- Howard Blue, M.D., 11/15/95
--R. Jandl, 11/20/95; Category: General Medical
My skin is very sensitive to jewelry. I have tried to wear better jewelry (at least 14 carat gold), but my ears continue to get infected when I wear earrings. I really enjoy wearing nice jewelry. Is there anything I can do to decrease my skin sensitivity?
Unfortunately, there is nothing currently available to decrease skin sensitivity to jewelry. Avoidance is the only real option for freedom from reactions You might try to use clip-on earrings and in doing so at least avoid infection, which can sometimes be confused with sensitivity. Cortisone creams can decrease inflammatory skin reactions resulting from wearing jewelry you are sensitive to, but will not cure an infection. Nickel, often a component of watch casings, is frequently a culprit in these reactions; you can try applying a backing such as moleskin or cloth on contact points (e.g., the back of your watch) to decrease reactivity.
-- C. Ebelke, 11/10/95; Category: General Medical
I was recently diagnosed with mulitple sclerosis. I am 34 years old. My symptoms are fatigue, right-sided weakness and numbness,
visual problems with right eye. Questions: What are my
prospects for a normal life; life span; will it affect my
work ( I've a desk job ); will I remain independent, etc.
I have two children three and six. Are they at increased risk for
MS? I understand heat causes problems for MS patients, is
this just symptoms, or does heat speed the progression of
disease? What can I do to slow the progression?
Thank you.
-- JN
Multiple sclerosis is a disease of the central nervous system with a highly variable course. More females are affected than males, and the predominant age range is between 16 and 40 years. There are approximately 25,000 new cases diagnosed in the United States each year.
National Multiple Sclerosis Society
205 E 42nd Street
New York, New York 10017
800-624-8236
-- C. Ebelke, 11/10/95; Category: General Medicine
How serious is obstructive sleep apnea?
-- JC
Sleep apnea is really a group of disorders defined when breathing
stops during sleep for long enough periods to cause a measurable drop in blood oxygenation, or when breathing stops for more than 10 seconds, more than 30 times per night. These disorders are grouped into "obstructive" or upper airway blockage, "central" or those caused by problems with the brain's respiratory control center, or "mixed" when both obstructive and central causes combine.
--A. Calhoun; 11/15/95, Category: General Medical
Is the damage from macular degeneration reversible ?
The macula is the part of the retina (the back of the eye) that is able to discern the highest level of detail and is the area, therefore, responsible for giving you 20/20 vision. It is a very small part of the retina with the rest of the retina responsible for peripheral vision. The macula can be damaged for many reasons. Macular degeneration is the most common reason for loss of function in this 20/20 vision zone.
-- R. Provenzano, 10/27/95
What is the current therapy for hemorrhagic macular degeneration? Any drug therapy useful? At what point is the laser used? What is the percent of success with the laser? Where may I find more information on this condition? Thank you.
Since the most frequent cause of blindness among people age 60 years and older is macular degeneration, there has been significant research into the treatment, as well as possible preventative measures, for this devastating problem.
-- R. Provenzano, 10/27/95
I have been given scientific explanations of how watching
television and looking at monitors causes damage to the proteins that form the fluid in the lens of your eye and eventually causes cataracts. Is there anyway to prevent or reduce this if you do not already wear glasses (glass being a shield to the gamma rays that do the damage)?
There are a number of theories and speculations alleging that the radiation from television and computer monitors can cause ocular (eye) damage. However, no study to date has proven or documented an increased incidence of either cataracts or retinal damage. Therefore, at this time, there appears to be no scientific evidence to indicate that television or computer monitors as they are currently used pose a health risk to your eyes.
-- R. Provenzano, 11/7/95
I was told that I have iritis. What is it and will my
vision be affected?
The iris is the part of your eye that gives it color. It is a delicate colored diaphragm in front of the lens. When there is inflammation in the front of the eye around the iris it is termed iritis. The inflammation causes irritation of the diaphragm. Many patients experience a dull aching pain around the eye with some gradual decrease in vision and are usually bothered by lights. The diagnosis of iritis is usually not difficult to make and is rarely in question.
-- Richard Provenzano, M.D., 10/27/95
My daughter needs information on the rare disease "Kikuchi". She may be suffering from that disease. Are there any good references on this disease?
-- RH
Our research tells us that Kikuchi's disease is a rare disease, first recognized in Japan, and now reported in the United States. It is usually seen in young women (under 30 years of age). It's features are similar to those of infectious mononucleosis. Typically, there is a "prodrome" characterized by fever and symptoms of an upper respiratory tract infection (sore throat, runny nose, etc.). The most notable finding is enlargement of the lymph nodes of the neck. In more severe cases, lymph node enlargement occurs elsewhere in the body, and sometimes enlargement of the liver and spleen is seen. Other symptoms may include nausea, vomiting, weight loss, and night sweats. When present, these additional findings, in conjunction with the appearance of the lymph node cells on biopsy, can suggest the diagnosis of a lymphoma. Lymphomas are cancerous growths of the lymph nodes. However, Kikuchi's disease is not a cancerous condition, and the symptoms usually go away within one or two months. Therefore, it is very important to be able to distinguish between the two conditions. In terms of treatment, antibiotics are of no use. The cause is presumed to be a virus based upon the clinical features, but this has not been proven. There are many references in the medical literature but they are fairly technical. If you are interested, I would suggest doing a Medline search (or other search engine) availablefor example, through your local hosptial library and through some proprietary networks.
-- R. Jandl, 10/25/95
What is thalassemia? Does anyone with low RBC blood count mean he is suffering from this disorder ?
The thalassemias are a
complex group of inherited disorders of hemoglobin synthesis. Hemoglobin is the oxygen-carrying protein in red blood cells, and is the substance that gives red cells their characteristic color. The clinical
manifestations of the thalassemia syndromes vary widely depending on the
nature and severity of the defect. In mild cases, abnormalities can be seen in blood tests, and under the microscope, but there is no anemia (a reduction in red blood cells). In more severe cases, anemia exists; and in the most severe cases the disorder is lethal.
-- R. Durning, M.D., 10/30/95
One of my lymph nodes and one of my two tonsils is occasionally swollen without causing fever or throat pain. Does this mean I have an infection or a virus?
Swollen or enlarged lymph nodes can be due to many things. For example, because lymph nodes function as an important part of your immune system, an enlarged or tender node is very often a sign of an infection nearby. Of the nearly 600 lymph nodes in our bodies, those in the front portion of the neck are among the most commonly affected. As you suggest, this is most often due to upper respiratory infections of one sort or another. Lymph node enlargement may be detected very eary in the course of an illness, and for a time after you no longer feel sick. And although in some cases the lymph nodes are reacting to infections that are not readily apparent, if a lymph node anywhere in your body becomes significantly enlarged, whether it is painful or not, if the swelling does not subside within a couple of weeks, or if the swelling keeps recurring, it is very important to have a professional examine it to rule-out malignancies, more serious infections, and other problems.
What can you do about persistent body odor?
Body odor can originate from many sources. Often the smell comes from bacteria that grow as a result of sweat or dampness. Not surprisingly, the single most important thing to do on a regular basis is to bathe carefully.
-- C. Ebelke, 10/11/95
I have an infected stone in my left kidney, and am still around 430 lbs., down from nearly 500, over the past 10-11 months. The only antibiotic that has helped is maxaquin. My goal is to lose enough weight, and have a lithotripsy procedure done. Do we know if there is any danger taking a powerful antibiotic like maxaquin for such a long period of time? I figure it will be at least another year, if I work hard, and am lucky. Thank-you.
Maxaquin is one of a relatively new group of antibiotics called quinilones, that can be particularly helpful for difficult urinary tract infections. By and large, it is well-tolerated. Some of the possible adverse reactions include photosensitivity, which is a skin problem that occurs after exposure to routine amounts of direct or indirect sunlight; headaches, dizziness, nausea, and diarrhea. For any antibiotic taken over a long period of time, there is the possibility of bacteria emerging that are resistant to that antibiotic, and these can become difficult to treat. As a general rule of thumb, if an antibiotic can be taken for a short period of time without side-effects, it is likely that it can be taken for a longer period of time relatively safely. Like many antibiotics, the dose needs to be adjusted for kidney failure, as the kidneys are involved in metabolizing (getting rid of) the antibiotic. Certainly, if you notice any unusual symptoms that might be related to an antibiotic, be sure and get it checked out.
-- R. Jandl, 10/16/95
Eleven years ago, after brushing his teeth with liquid soap (no toothpaste available), Norm drank a cup of instant coffee (not hot) with "sweet and low" and milk. At first sip, his tongue became covered with small bubbles. Within a few days, the surface of the tongue looked like a strawberry, symptoms similar to an allergic reaction to antibiotics, but he was not on any medications, and the conventional medicines which should alleviate this type of situation were useless. There is no pathological indication. He has tried a variety of medications (anti-fungal drops, creams, glycerin, etc.), but nothing helps.
-- EHG
Well, this is a very challenging question. Certainly from your description it sounds as though there was a rather severe chemical reaction or burn on the tongue at the very beginning. And it is certainly conceivable that some long-term irritation could remain. But could this really be causing problems 11 years later? It's awfully hard to say.
-- R. Jandl, 10/14/95
I am a 40-year-old male who has been prescribed cortisone (by inhaler) for asthma and wheezing.
Must I take it all the time, or can I only take it for a few days
when I feel that I need it?
-- ES, Intel Israel
Steroid inhalers such as Azmacort act by decreasing inflammation in the bronchial tree, and thereby reduce wheezing. They are intended for use only by people who require daily, long-term, treatment of their asthma and are often highly effective. They must be used on a regular and continuous basis. Sporadic use is not recommended, and indeed, is not effective. The idea of these medications is to prevent the asthma, rather than treat the symptoms after they start. It is important to recognize that these drugs are not to be used in any acute (i.e., sudden onset) asthma attacks to control wheezing, as they won't be effective, and may even aggravate the problem.
-- C. Ebelke, 10/13/95
I am considering dental implants rather than a lower dental plate. I have seven lower teeth (two caps -- the other five in jeopardy
due to gum disease). Limited income makes price a major consideration. I am age 64. Should I have remaining teeth pulled? Should I choose implants or full plate? What should it cost?
The choice of having the remainder of your lower teeth pulled, versus having implants, or a full plate, is complex and really must be done on an individualized basis. The actual condition of the teeth, their chances of remaining healthy over a long period of time, and as you mention, the cost and inconvenience of having implants, or dealing with a plate, are all important considerations. Your final decision will likely reflect your personal values. Some people want to keep their original teeth as long as possible; others would prefer to have everything pulled so they don't have to deal with more dentist visits or more expenses. When considering an irreversible procedure such as dental extractions, it is wise to move cautiously so that you are sure you are doing the right thing. A second opinion from another dentist may be worth considering.
-- R. Jandl, 10/14/95
On an MRI it was recently revealed that I have two subarachnoid cysts. One is located in the region between my left eye and the left temporal lobe, the other in the right lower occipital lobe. The question is, could my predominately left-sided migraine headaches be aggravated by this? On a whole, are they benign? How frequently, if any, should my follow-up MRI's be?
Arachnoid cysts are congenital cysts that form in various parts of the brain. They are not malignant (i.e. cancerous). Even though you are born with them, it is not until later years that in some cases they begin to enlarge enough to begin to cause symptoms. The symptoms are due primarily to increased pressure within the skull ("increased intracranial pressure") or to pressure on adjacent parts of the brain or nervous system. Headaches are one of the important signs of increased pressure, as are an unsteady gait, unexplained vomiting, changes in mentation, and others.
-- R. Jandl, 10/16/95
How long do shingles last?
Shingles is the name given to a painful rash caused by one of the Herpes viruses. When a person develops chickenpox, very often as a child, the virus which causes the disease may sequester itself in a nerve bundle in the spinal cord for decades to follow. For reasons which are not fully understood, the virus may be reactivated in adulthood in the form of Varicella zoster, or shingles.
I've been a practicing bulimic for three years and although in therapy am still binging and purging daily. I'm terrified that my esophagus is going to rupture and I'm going to die ... I'm not ready to die, I'm just going through a hard time in my life. How dangerous is my behavior?
My cholesterol is high (291) even after taking 1500 mg of niacin a day. My doctor gave me 20 mg Pravachol to be used in addition to 1000 mg of niacin. Is this a good idea?
-- RH, San Luis High School
We are really not able to provide advice on what medications are best, or even whether they are indicated, for a specific individual through "Ask the Doctor." However, in general terms, it is now known that taking cholesterol-lowering medications can help reverse blockages of the coronary (heart) arteries, so that among high risk individuals (such as someone who has known coronary heart disease, or someone who is a smoker, has high cholesterol, and a family history of heart disease) it is something to consider.
What are some ways to keep your eyes safe?
-- FS, Chandler Elementary School, Newburgh, IN
Your eyes can be injured or damaged in a variety of ways. Approximately 35,000 people each year sustain eye injuries serious enough to bring them to the emergency room. Most often, accidents occur from sports such as racketball or squash, or foreign bodies get into the eyes in the course of work, or home projects.
I read the question about strep throat, and I would like to know what what post strep nephritis is and how it effects the kidneys and your blood pressure. Also, please let me know what the long-term and short -term effects are from having this disease.
-- C.O. of Clemson University
Post-streptococcal glomerulonephritis is a type of kidney disease that occurs following a strept throat or strept infection of the skin.
-- R. Jandl, 10/4/95
A friend of mine was just diagnosed with diabetes. What can you tell me about the disease? How does someone get it? And how would I get checked?Diabetes mellitus is a complex chronic disease which affects many systems of the body but originates in the endocrine system. The major underlying problem is with insulin produced in the pancreas; either insulin is not manufactured or secreted or else it does not work properly once it is secreted. Insulin is the key element in how our bodies utilize glucose, and when it's not working properly glucose cannot be metabolized. This can lead to many very serious complications.