Will Quitting Medication After Symptoms Have Disappeared Do Any Harm?

QUESTION: I find that there is still medicine left over in the vial long after my symptoms have disappeared, probably because the doctor orders too many.
If I stopped taking medicine then, would it do me any harm? I don't like taking chances, but I don't want to take these pills if I don't have to any longer.

ANSWER: The safety and success of any treatment depends largely on how closely the patient follows the doctor's instructions.
If your doctor prescribes a particular amount of a drug, he does so for a reason. If you stop taking your medicine without your doctor's knowledge, the condition it was prescribed to treat may get worse.
Feeling better does not always mean that the disease is cured.
Taking too little of a drug can delay or even prevent the beneficial effect your doctor is trying to achieve, and it may even lead him to prescribe a second, stronger drug with more side effects, in the mistaken belief that the first drug wasn't effective.
This is a frequent happening when the patient doesn't tell the physician that he stopped taking his medicine. By the way, it is just as bad to take more of a drug than your doctor prescribes.
The idea that "if one pill is good, two is better" is not only false, it can be dangerous.
It takes a lot of study to keep up with the way medications work, and these indications form part of the doctor's thinking when prescribing medication in certain quantities.
Medicines work best when properly used, in the dosages and for the length of time that are prescribed. When you become a partner in your own medical care, and communicate with your physician, your medicines can do the job for you they were intended to do. Not taking your medicine exactly the way your doctor prescribed it is called "noncompliance." The most common reason for noncompliance is a misunderstanding or a lack of communication, so make sure you understand exactly what your doctor wants you to do, and follow those instructions. Don't be afraid to ask questions or to tell your doctor that you don't understand what he has told you.
He wants to help you get well; that's why he became a doctor in the first place.

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

Weight Gain After Quitting Smoking

QUESTION: Now that smoking is socially unacceptable around my house, I am losing another battle as well; my weight is surging upwards, something I have tried to avoid for my entire adult life.
What's a woman to do? I think I would rather be a thin smoker taking my chances than look like I do now.
Can you please figure a way out for me?

ANSWER: Most experts will agree that, while the amount varies considerably from a low of nothing at all to an unacceptable high, most people who finally stop smoking will average a weight gain of from two to ten pounds in the month that follows quitting.
But the risks of that additional unwanted weight is little compared to the many health risks provoked by continued smoking.
And you can get rid of the extra weight.
Many people crave high calorie sweets when they come off of smoking, so find some low calorie food that will help. Even chewing gum can help you here.
If you can add about an hour a day of some brisk activity (yes, fast walking counts), you can probably stem the tide of weight gain and get things back to normal in a few weeks' time.
However, under no circumstances should you start smoking again as an answer to your controllable weight gain.

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

Failing Vision in Later Years of Life

QUESTION: I believe my vision isn't as good as it used to be, probably because I am getting on in years.
Still I don't want this to put a damper on an otherwise satisfactory way of living.
I am looking to you for some help, perhaps a few tips on how to deal with this problem.
I know there are many other people who could use some good advice about this problem.

ANSWER: Although I can offer you a great deal of advice, probably the first thing on your agenda should be a visit to your eye specialist, who can not only determine the present state of your vision but take the appropriate steps to treat any underlying diseases.
Even if nothing can be done to reverse your vision loss, you may still be able to preserve what vision you have. Here's the first bit of help.
You may qualify for a free medical eye examination, (not an examination for glasses) supported by the American Academy of Ophthalmology.
If you are 65 or older, haven't had an eye exam in the last 3 years, and are in financial need, you may call 1-800-222-EYES to find out if you qualify. Next, understand that you are not alone.
In the United States there are 11.4 million people with visual impairment, which can be defined as not having enough vision to function normally.
Visual impairment varies.
Some people have excellent peripheral vision but cannot read because their central vision is poor.
Others, with good but narrowed central vision, can read but not get around easily.
Still others have completely blurred vision. There are many groups that help people with poor vision.
Two are the National Society to Prevent Blindness: 500 E.
Remmington Road, Schaumberg, IL 60195, (800) 221-3004; and the American Association for the Education and Rehabilitation of the Blind and Visually Impaired: 206 North Washington Street, Alexandria, VA 22314. Visual aids can help you enjoy life and continue to function independently.
These include special glasses, hand-held magnifiers, telescopic lenses that fit on regular eyeglasses, and even computers that talk instead of printing information on a screen.
An optometrist (an O.D.
who deals with nonmedical vision problems) can fit you with special glasses and instruct you on choosing the right visual aids for you.
The American Optometric Association (243 North Lindbergh Blvd.
St.
Louis, MO 63141, (314) 991-4100) can give you the name of an optometrist who specializes in working with low-vision.
Optical aids are also available through the National Association for the Visually Handicapped (22 W.
21 St.
New York, N.Y.
10010, (212) 889-3141) and the American Foundation for the Blind: 15 W.
16 St., New York, N.Y.
10011, telephone; (800) AFB-LIND, in New York State (212) 620-2000. In addition to visual aids, there are many other items that can help you live better.
Many books and magazines are printed in large type or are available on audio cassettes or records.
Most larger libraries now stock large-type books and many bookstores sell audio cassette versions of recent best sellers, some of which are read by leading actors.
Reader's Digest is available in large type, Braille, and talking book editions; and there is a weekly large-type edition of the New York Times.
There are even large-type playing cards and a large-type version of the Scrabble word game.
With all these aids, you may continue your fine lifestyle without allowing your vision problems to decrease your enjoyment.

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

Where Does Edema Come From?

QUESTION: I only thought it was a simple swelling of my ankles like many people get, but when the doctor called it "edema" I got scared.
Could you please explain the difference and what does edema come from?

ANSWER: Edema occurs when there is an abnormal buildup of fluid in body tissues, therefore edema and swelling can often mean the same thing.
There are many possible causes, and it is sometimes a warning sign of a more serious problem in the body.
Most often, edema is noticed in the lower legs, feet and ankles, where fluid accumulates under the skin and causes swelling.
This is sometimes the result of a job that keeps you on your feet all day.
If that's the case, you should take hourly breaks, if possible, and raise the feet for a few minutes. Edema may also occur when the veins in the lower extremities don't keep pace with the arteries, so that it may be a sign of vein disease.
Wearing clothes that are too tight around the upper legs may cause the ankle to swell. This can be remedied by simply wearing looser garments.
Many women have some edema just prior to their menstrual periods.
There may be a fluid buildup in the breasts, legs and abdomen.
Women who are on the pill may experience more noticeable cases of edema.
On the more serious level, edema may be an indication of the beginning of kidney, liver or heart disease.
Therefore, if you notice repeated episodes of swelling that last for more than a day or two, see your doctor.

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

What is Bullous Emphysema?

QUESTION: I have been diagnosed as having Bullous Emphysema (severe) and have been unable to obtain information regarding the disease.
The American Lung Association advised me that they have no literature available and at this point I don't know where to look.
Could you please tell me about this disease and how it differs from emphysema?

ANSWER: All types of emphysema, yours included, belong to a larger classification of lung disease, called chronic obstructive lung disease or COPD for short.
Under this heading you would find information about chronic bronchitis, chronic obstructive bronchitis, persistent asthma, chronic asthmatic bronchitis as well as emphysema, and chronic emphysema.
They are all interrelated, and many of the mechanisms that create problems in one type of illness are found in the others as well.
Their development seems determined by an individual's susceptibility, and the exposure to certain elements that can precipitate the illness.
Emphysema is a condition in which the tiny air sacs (alveolar) which are located at the ends of the tubes that carry air to the lung tissues (bronchioles) are larger than normal, due to the partial destruction of their walls.
This may be the result of frequent or chronic inflammation, and certainly can be the result of smoking.
Large alveolar sacs with damaged walls are not as efficient in transferring the oxygen in the inhaled air over to the blood vessels, and that leads to a reduced supply of oxygen for the entire body.
In advanced cases and severe cases such as yours, bullae may develop.
A bullous is nothing more than a very large sac, a "balloon" if you will, that develops when many enlarged alveolar sacs unite into one single unit large enough to be detected on a chest x-ray.
Such bullae (the plural form of the word) may be either a solitary finding or part of the general disease process found throughout the lung, and may be found in other types of COPD.
There is no special treatment for this type of emphysema, but the presence of bullae should make you take all your doctor's advice very seriously.
Incidentally, my sources at the American Lung Association tell me they do have a Fact Sheet on Emphysema, which contains additional information that may be helpful to you.

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

What Causes "Cluster Headaches"?

QUESTION: After a siege of the most terrible headaches you can imagine, I consulted a physician and was told that I had condition known as "cluster headaches".
It was more than a month before I was finally over the attacks. I need to know all I can, and hope you will answer my question.
Can you tell me where these frightful headaches come from, and what can be done to treat them besides antihistamines and pain pills?

ANSWER: This type of headache was named for the manner in which they occur, attacking the patient in episodes that come in groups or clusters.
Their cause remains puzzling to the medical community.
We do know that they seem to be aggravated by certain substances that cause blood vessels to enlarge, like alcohol, nitroglycerin and certain foods.
They affect men more frequently than women and they usually first appear between the ages of 20 and 40.
The headaches themselves come on abruptly, creating a severe burning pain around the eye which can last from a few minutes up to four hours, but usually last for 30-45 minutes.
Sometimes they are accompanied by a drooping of the eyelid, a narrowing of the pupil, sweating, red eye and flushing of the face on the same side as the headache.
In many cases only some, but not all of these symptoms may occur.
Most people will experience the pain a few times a day and this may continue for weeks to months. The two most commonly used therapies to decrease or relieve the pain are ergotamine and oxygen.
Ergotamine is a drug which can be taken under the tongue and is about the easiest to use.
100% oxygen inhaled for about fifteen minutes also seems to provide relief, but this is a cumbersome treatment as it is not easy to carry the necessary equipment about with you.
Various other therapies use beta-blockers (such as indomethacin) and calcium channel blockers.
Lithium carbonate has been used to treat the chronic variety of this distressing disease.
Its not an easy disease to treat and there are moments of frustration for both the patient and physician.
The best counsel I can offer you is to understand your condition thoroughly and follow the advice of your physician carefully.
You will want every possible factor to work in your favor to prevent the frequent reoccurrence of this trying disease.

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

Is it Possible to Have a Heart Attack, Without Pain?

QUESTION: I am afraid that my question is a bit confusing, but I assure you I am telling it the way I heard it.
A close friend relates that he has had a heart attack, without pain or suffering, and that after taking all the tests, his doctor is treating him at home, without hospitalization, with medications and diet.
How can this be? Is my friend in any danger?

ANSWER: In order to put everything into perspective, I am going to change the words "heart attack" to "heart condition", for I believe that more closely describes the situation.
It certainly is possible to suffer from a condition known as Silent Myocardial Ischemia, without pain or symptoms, and still be faced with a serious problem that warrants care and treatment.
In this situation the supply of blood, and therefore of oxygen to the heart, is reduced.
It is probable that this is caused by a narrowing or blockage of one or more arteries that bring blood to the heart (coronary arteries), and that the narrowing is due to atherosclerosis.
Atherosclerosis occurs when the walls of the arteries are thickened by fatty deposits in the artery wall. Despite the fact that this lack of oxygen may cause damage to the heart muscle, and that the same condition in many people causes the pain of angina, there are some individuals who do not experience the stabbing pain that normally occurs when the muscles are deprived of oxygen.
When pain is absent, an important clue to the diagnosis is missing, but the condition may be discovered by taking an electrocardiogram while the patient is exercising on a treadmill, or by recording the heart's activity during 24 to 48 hours using a portable monitor called a Holter monitor.
When the tracings are reviewed, the sign of ischemia, or lack of oxygen is detected.
These tests offer some indication of the extent of the problem, and whether or not there has been damage to the muscles.
Depending upon the patient's condition, treatment may consist of medications that help prevent increasing blockage of the arteries, and include a diet to lower blood levels of cholesterol.
A full program will certainly include a weight loss plan (if that is indicated), an exercise program under medical direction, and help to stop a tobacco habit if that is present.
Your friend may be considered lucky, if the condition was caught before heart muscle damage occurred.
He is in no danger from the treatment, only from failure to follow through.

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

What Research Has Shown That the Effects of Smoking Are Bad?

QUESTION: I am sure that all these new controls on smoking wouldn't have happened without some dramatic proof of the dangers, but I have never seen anything about that.
My father has been a smoker for 40 years and still shows nothing wrong on his medical examinations.
What kind of research has shown that the effects of smoking are as bad as they are made out to be?

ANSWER: Your father is a lucky man and for his sake, I hope he continues to remain untouched by the many ill effects of tobacco.
However, in my mind the proofs of serious diseases that result from the smoking habit are overwhelming.
More than 30,000 studies have been published on the relationship between smoking and disease, and over and over again the connection is made clear.
Statistically, lung cancer is seen in cigarette smokers far more frequently than in the population of nonsmokers.
More important, when an individual finally manages to quit, the chances of developing lung cancer are reduced.
In experiments on animals, cigarette tars painted on the skin result in the growth of cancerous tumors.
When chronic diseases of the lung that diminish the flow of air into the lungs are investigated, the relationship between smoking and emphysema seems clear.
And the numbers indicate that heavy smokers suffer the greatest reduction in their lung function.
The same holds true for heart disease, where those who have smoked more than 2 packs a day have a 200% greater risk for coronary heart disease (CHD) than nonsmokers.
With statistical evidence that goes back to 1954, the link between CHD and smoking reveals that smokers in general have a 70 percent greater chance of dying from heart disease than do those who have resisted temptation.
While it may not be apparent just how the diseases develop in all cases, there is little room for doubt that there is a clear "cause and effect" connection.
What astounds me most is not that we are now trying to help people by preventing them from smoking in public places and on public transportation, but that in view of all the evidence that exists, it has taken us this long to do something important about this avoidable health problem.

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

What Causes Sneezing Episodes and do They Cause Damage to Heart?

QUESTION: My husband claims that when you sneeze, your heart stops.
Isn't this an old wives' tale? He will have sneezing episodes for anywhere from 3 to 15 minutes.
What causes this and what damage is he doing to his heart? He claims he has had such episodes for about 20 years.

ANSWER: Sneezing is an uncontrollable reflex that occurs when something irritates the upper air passages, such as the nose or pharynx.
First a large amount of air is pulled into the lungs and then pushed out by the breathing muscles in a rapid and forceful manner, so that a large volume of air passes through the nose and mouth at great speed.
This is designed to clear the passages of the cause of the irritation.
The heart does not stop during this action, although the rate may be altered by the changes in the timing and pattern of breathing.
Your husband, therefore, is inflicting no damage to his heart, as his 20 years of experiences surely proves.
Sneezing is frequently caused by allergens such as pollen, or the increased mucous flow in the nasal passages provoked by a cold.
However, other irritations may be the root of the problem such as cigarette smoke, an abrupt change in air humidity or temperature, the smell of certain perfumes and even bright light or high pitched sounds in certain sensitive individuals.
No damage occurs, provided the sneeze is not suppressed but allowed to happen, while mouth and nose are gently covered to prevent the spread of germ carrying droplets.

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

Are Ultrasound Tests Bad?

QUESTION: I am about to enter the 4th month of my first pregnancy, and my doctor is suggesting that I have a screening ultrasound examination.
My mother, who is very conservative, tells me she has heard bad things about the tests, and doesn't want me to have it.
Help! I need some information.

ANSWER: Sure, put Dr.
B.
in the soup between your doctor and your mother! Actually both parties have some arguments in their favor, and you are the one that must make the final decision.
In favor of the screening procedure are its ability to diagnose the presence of a multiple pregnancy early on, the ability to date the length of your pregnancy and help predict the due date, and, most important, the early detection of an abnormality in the developing fetus.
Against this impressive array of positives, are considerations of cost, the availability of blood tests to determine some abnormalities, and though at present there is no evidence of ill effects from ultrasound, the possibility of long term effects have not yet been discovered.
Despite Mom's opposition, I think that the secret of a good decision lies in a frank and open discussion with your doctor, to appreciate his reasons and concerns and the information he is seeking to obtain from this examination.

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

Advice on Cancer of the Prostate and Options for Treatment

QUESTION: Although at first I thought it was a simple back ache, the results of many examinations and x-rays have lead my doctors to the diagnosis of cancer of the prostate, which has now spread to my bones.
I don't want to give up hope, and my doctor is offering me several options for treatment including the removal of my testicles.
I need some counsel and advice, which I hope you will provide me, please?

ANSWER: Your doctor is certainly on the right path, and I will try to provide a bit of information that may help you with your decision.
Prostate cancer, unfortunately, is a common disease.
The American Cancer Society estimates 103,000 cases would be diagnosed in 1989.
The symptoms of this cancer are much like those of the benign disease where the prostate gland simply enlarges or hypertrophies.
They include: weak or interrupted flow of urine, inability to urinate or start urination, blood in the urine, painful urination and pain in the lower back, pelvis or upper thighs.
Treatment depends upon the stage of the disease, and when the tumor is limited to the prostate itself, radical surgical removal of the prostate, the seminal vesicles and part of the bladder may be the treatment of choice.
Radiation therapy is an alternative. However, once the cancer has spread beyond the prostate, the goal of the treatment is to control the disease rather than cure it.
Since the progress of the disease appears to be related to the presence of male hormones, surgical castration removing the male glands, or the use of a synthetic female hormone diethylstilbestrol (DES) have been recommended to reduce testosterone (male hormone) levels.
Just recently however, a new treatment has been approved by the Food and Drug Administration called Zoladex.
Manufactured by ICI Pharma, it is an injectable hormone that acts on the pituitary/sex gland system and reduces the production of testosterone to levels that result in a medical castration.
It is administered by your physician in a single injection each month, and can result in reduction of tumor size, and improvement in urological symptoms and bone pain.
It is said to have fewer side effects than other therapies.
Each treatment costs about $400, but since it is administered only by physicians, should be reimbursed by most medical insurance plans.

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

Are There Any Alternatives to a Prostate Operation?

QUESTION: I am a man over 70 years of age, and facing the need for a prostate operation.
However, I witnessed a horror story when a good friend of mine had the same operation, and passed away immediately afterwards from complications. Isn't there some other way to deal with my problem, with less risk and danger, and perhaps less pain as well?

ANSWER: Many men face the same situation with the same apprehensions and fear.
In 1987, prostatectomy (the removal of excess prostatic tissue) was the most common surgery in men 65 years of age and older.
While the condition of benign prostatic hypertrophy (BPH) is rarely seen in men under the age of 40, by the time age 60 rolls around, about half of the men have evidence of the changes that occur.
As men grow older, the tissue of the prostate grows and expands causing an obstruction of the urethra, the tube which passes through the penis and carries urine from the bladder past the prostate, out of the body.
This obstruction produces the symptoms of frequent trips to the bathroom, decreased force of the urinary stream, and incomplete emptying of the bladder.
Once an operation has removed this extra tissue, the symptoms usually disappear, but since most men would rather avoid the surgery, new methods are being sought that could avoid the procedure.
Medications (alpha adrenergic antagonists) that can relax the smooth muscle of the prostate and reduce the pressure that causes the urethral obstruction are now being tested in Europe and the United States, but have not as yet received necessary Food and Drug Administration approval for use in the United States.
Other chemicals that block the action of male hormones are also being tested, as these hormones are thought to play a role in the development of BPH.
A new procedure which inserts a catheter with a balloon at its tip into the urethra is also experimental.
In this technique, once positioned the balloon is inflated under pressure, and forces the urethra open, thus allowing the free flow of urine.
While these new medications and procedures do offer much hope for the future, for the present only a form of prostatectomy can solve the problem in an effective manner.

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

What Causes Muscle Cramps?

QUESTION: I like to exercise, and still enjoy a good game of tennis despite advancing years.
However, I am taken with painful cramps after any decent match that takes away a good deal of the fun.
What causes cramps, and is there any way I can prevent them, and preserve my pleasure?

ANSWER: Don't blame your age, cramps are just as common in younger people when the conditions are right.
A cramp is a painful spasm of a muscle that causes it contract, forming a hard "knot" that may often be felt by an examining hand.
It is probably caused in otherwise healthy people, by a loss of salt in the perspiration provoked by the exercise.
It may happen as well to workers who must labor in hot, steamy environments.
The remedy is to replace the salt, and the liquids, during the match or work period.
While there are commercial "sports" drinks available, orange or grapefruit juice diluted with plain or carbonated water, with a generous pinch of salt added, should do the job.
If the cramp is caused by difficulties with blood circulation, however, prescription medication may be necessary to help.
Don't rub the cramp, it will only increase the pain, but try instead to stretch the muscle.
If it is in your calf, a most common site, pushing the heel down and flexing the toes upwards towards the knee is most effective.
Proceed slowly, maintaining the pressure until you feel the cramp "let go," and then move about slowly, restoring normal muscle function.

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

What is "Creutzfeldt-Jakob Disease"?

QUESTION: I am a state certified nursing assistant.
I work in a nursing home and have had contact with a resident who has "Creutzfeldt-Jakob Disease".
What can you tell me about this disease?

ANSWER: It is also called "subacute spongiform encephalopathy" and was first described by Dr.
H.G.
Creutzfeldt in 1912.
It is defined as a progressive, inevitably fatal, slow viral disease of the central nervous system.
The disease occurs world wide, but how it is spread from person to person is still unknown.
It affects men and women alike, usually past the age of 50.
It is probably due to some infecting organism, but a hereditary familial form has been described.
The first signs of the disease are often self neglect, apathy or irritability, with some patients complaining of weariness and fatigue, while others speak of drowsiness, insomnia or other sleep disorders.
Within a brief time, disorientation and confusion appear, and gradually many of the higher intellectual functions of speech, reading, and writing, as well as smell become affected and are gradually lost.
There may be many ocular disturbances including a dimming of vision, and many abnormalities of movement with rigidity of the limbs, and tremor present along with loss of power and an altered gait.
All these signs and symptoms are a result of the gradual degeneration of many areas in the brain.
Finally a dementia sets in and the disease ends in death, after a brief 3 to 12 month course, commonly as the result of the complication of a pneumonia.
There are no specific treatments for the disease, except for routine care to help reduce symptoms.
Of particular interest to you is the need for caution in handling all fluids or other materials from these patients to prevent transmission.
Many standard methods of sterilization are ineffective, and steam autoclaving at 132 degrees Centigrade for 1 hour, or soaking in sodium hydroxide solution for 1 hour is recommended for all materials.

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

What Does the Word "Delirium" Mean?

QUESTION: We received a phone call from the administrator of the nursing home in which our father now lives.
He told us Dad has become unmanageable, and confused.
He mentioned the word "delirium" as the diagnosis.
What does this mean and what should we do?

ANSWER: I am obliged to make a few guesses about your situation in the absence of more complete information, but the question is so important that it deserves an answer.
Delirium is sometimes used as a diagnosis for a wide variety of symptoms stemming from different causes, but most frequently is applied when the patient becomes confused and disoriented, lacks the ability to concentrate, and shows abnormal thinking and loss of memory.
The pattern of behavior is extremely variable and can change literally from hour to hour depending upon the causes.
And the disorders which can provoke this condition are many, including heart problems: congestive heart failure, rhythm difficulties, and abnormal blood pressure; infections: pneumonia and urinary infections to name but two; metabolic problems: including dehydration, anemia, vitamin and mineral deficiencies, and chemical imbalance of vital elements in the blood.
Problems in the central nervous system and mild strokes may also be underlying cause for delirium, but in an elderly man, who I must suppose takes a number of medications, it is the possibility of drug toxicity and medication side affects that should be explored first. Medications used for sleep, as analgesics, antihistamines, for stomach problems, digitalis, insulin and other medications for diabetes, may all provoke the symptoms of delirium in certain cases.
The good news is that merely stopping these medications or altering the dosages may speedily return the patient to a normal pattern of thinking and behavior.
Your course of action is clear.
Your Dad deserves a first class workup by a competent and concerned physician that has experience in dealing with these problems.
It may mean a trip for you to visit your Dad, but I assure you that the results can be well worth it.

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

What is "Tic Douloureux"?

QUESTION: I have a condition called "tic douloureux" (painful tic).
It took many years before a neurologist finally diagnosed it.
What can you tell me about it and its treatment?

ANSWER: Most patients with this condition would agree that "painful tic" is an appropriate name for what is known medically as trigeminal neuralgia, or "tic douloureux".
Patients complain of sudden and excruciating pain on one side of the face that feels sharp and stabbing, sometimes like an electric shock. The pain occurs in spasms, subsides rapidly, and can be triggered by such activities as talking, eating, feeling the wind blow against the side of the face, seeing flashing lights, or even hearing sudden noises. Although sometimes difficult to identify because of the many conditions which may provoke the symptoms, a careful diagnostic workup usually results in establishing the precise diagnosis.
There are a number of treatments, although some do pose certain risks. Trigeminal neuralgia is often caused by pressure from a blood vessel pulsating against the trigeminal nerve.
Other causes are blamed on tumors, multiple sclerosis, aneurysms, and angiomas. If diagnostic tests rule out causes like tumors that require specific treatment, your doctor will probably try drug therapy first.
Phenytoin or carbamazepine are two of the most popular choices, since both are generally effective with long lasting results, although both can cause side effects. If your pain is especially severe, your doctor can also inject a local anesthesia and/or prescribe a narcotic pain reliever. If drug therapy is unsuccessful in alleviating your pain, other treatments can be used, but these can be risky: Injections of alcohol, glycerol, phenol, and hot water into part of the trigeminal nerve can block the action of the nerve, thereby stopping pain, but this procedure can also cause loss of feeling in the face. Surgically cutting or separating the trigeminal nerve branch relieves pain longer than injections, but again, this is another treatment that can cause numbness. The most common procedure performed today is posterior fossa microvascular decompression.
This operation involves separating the blood vessel that is pressing against the trigeminal nerve by placing a small plastic implant, or similar device, between the vessel and the nerve to keep them apart. About 80 percent of patients find pain relief with this operation for up to five years.
Although this procedure does not cause a loss of sensation in the trigeminal nerve, it can cause problems like hearing impairment and hemorrhage. Another popular procedure is percutaneous trigeminal radiofrequency coagulation.
A general anesthetic is injected through an insulated needle; then a radio frequency current is used to coagulate the branches of the trigeminal nerve. This procedure relieves pain in 80 to 98 percent of patients, but it too, like many of the other treatments, may have complications.
The proper choice of treatment depends upon your special case, and is one that will provide the greatest chance of relief with the least risks.

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

Is "Tin Ear" Something We Have to Accept as Part of Getting Older?

QUESTION: With the passing years I seem to be losing a bit of my hearing as well.
Many people my age, I am 70, seem to be in the same boat.
Is a "tin ear" something we just have to accept as part of getting a bit older?

ANSWER: Recent studies show that about one in three Americans 65 years or older including former President Reagan experience some sort of hearing impairment (defined here as deafness in one of both ears, or any other trouble hearing). The statistics are quite revealing.
In men, from the ages of 65 to 74, almost 30% report some hearing loss, and the number grows to 58% in youngsters over the age of 85.
Women seem to be a bit better off as only 17.5% in the 65 to 74 age group have difficulty.
About 13 percent of males in the 65-74 group reported deafness in one or both ears, compared to 8 percent of the women.
In people over 85, partial or complete deafness was noticed by 38 percent of men and 23 percent of women. About 8 percent of both sexes said they use a hearing aid.
When all those questioned including those with hearing aids were asked to describe their hearing, 61 percent reported no trouble while 5.5 percent indicated they had a "lot of trouble" hearing. So I guess you are not alone, and I'll just shout a bit louder when addressing answers to my older readers!

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

How Can Students Who Are at Risk of Committing Suicide be Spotted?

QUESTION: As a teacher and a counselor in a high school, I am concerned and distressed about all the reports of suicide in teenagers.
There must be more done about this most serious problem.
How can I spot students who are at risk of committing suicide and how can I help them?

ANSWER: You're in an excellent position to be of help to a young person who is contemplating suicide, and your attitude and concern makes you a most potent resource in the war against teenage suicides.
The first challenge is to recognize the student at risk. There are several characteristics that place young people in a "high risk group" for attempting suicide.
I'll list them: - Depression - Impulsive behavior - Early childhood family disruption - Chronic alcohol and drug abuse - Past psychiatric illness in parent, particularly depression while teenager was a young child - Recent death of a friend or a family member - Feeling of being unwanted by family - Feeling of "not belonging" to family - Exposure to repeated violence at home If you are particularly concerned about a young person, talk with him. Ask him if he is considering hurting himself.
There is no evidence that bringing up the subject of suicide will cause it to happen.
On the contrary, ignoring the possibility of suicide may well increase its likelihood. However, it is a myth that people who talk of suicide do not try it.
If a person brings up the idea of suicide, take this as a serious warning. Your sincere interest in the young person will help.
Do not minimize the seriousness of the problem.
Listen to the whole story and resist offering empty reassurances.
Emphasize the importance of the youngster getting professional counseling, and follow-up to ensure that it helps.
Maintain contact with the young person, so that he knows you are still interested and does not interpret your recommendation of a professional counselor as rejection.
It means becoming involved, perhaps above and beyond the call of duty, but the results are certainly worth the effort. It is difficult to know exactly how common suicide is among our young people.
It appears to be declining in older teenage boys, after a peak in the late 1970's, but increasing in older teenage girls.
In 1983, the suicide rate among children of all ages in the U.S.
was 1 per 250,000 among children younger than 15 years and 1 per 8,547 in the older teenage group.
6,000 young people lost their lives to suicide in 1984.
Suicide attempts may be as much as 50 times higher than the number of deaths.
It is important to treat the attempts as a sign of serious problems. There are many community resources which may be of help to you; mental health groups, hospital outreach programs, and even forward looking parent-teacher associations.
However, your close association with the youngsters and your daily opportunities to observe and act puts you right on the front line in this fight against a terrible waste of young lives.
I wish you well and hope many of your colleagues will be inspired by your concern and join in your efforts.

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

How is an Ectopic Pregnancy Detected and How is it Treated?

QUESTION: It seems I hear more and more often about incidents of ectopic pregnancy especially in women around my age (early 30's).
How is an ectopic pregnancy detected and how is it treated?

ANSWER: Ectopic gestation, which can include any pregnancy where the fertilized egg implants itself outside of the uterus, is, as you've noticed, on the rise.
The number of ectopic pregnancies has tripled in the past 15 years, and presently accounts for a significant number of maternal deaths. For these reasons, diagnostic and care procedures are becoming more sophisticated. Ectopic pregnancies have always been difficult to detect.
A number of symptoms occurring together can generate suspicion of an ectopic condition. Delayed menstruation, irregular spotting or bleeding, pelvic pain, possible shock or shoulder pain are some symptoms that might cause a patient to seek the advice of a hospital or physician.
First is the all important history and physical exam.
The next step is for the physician to administer a battery of diagnostic tests.
A pelvic sonogram is one testing technique that is increasingly used, along with other tests, including the vital pregnancy test. Other clues are provided by the woman's gynecological history.
The history of previous pelvic infection is an important clue.
A significant number of women between 80 and 90 percent with ectopic pregnancies have given birth to more than one child previously, and some may have had previous ectopic conceptions.
One very significant factor is the woman's method of birth control, as a retained intrauterine birth control device (IUD), a tubal ligation or tuboplasty can increase the likelihood of ectopic gestation. In 9 out of 10 extrauterine pregnancies the site is the Fallopian tube, usually on the right side.
Other locations include the abdomen, the cervix or the ovaries.
The danger of the condition varies from location to location, with one of the worst being the cervix, due to the likelihood of life-threatening hemorrhage. Treatment of an ectopic pregnancy is surgical.
The type of operation required depends on the amount of blood already lost, on the patient's desire or need for future fertility.
In about 10 percent of cases, the woman can expect the problem to occur again.
Infertility is a problem for half, and 30 percent can expect permanent sterility.

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

The Nature of Kidney Stones

QUESTION: I have just recovered from a bout of kidney stones, which fortunately passed without my having to have surgery.
We never did get a look at the stone, but I am now quite curious as to its nature and whether I may have to go through this thing again.
Can you help?

ANSWER: It is really too bad that you didn't manage to recover the stone as it passed, for the first step in deciding upon future treatments and your risks of another episode of renal colic would have been to chemically analyze the stone.
Statistically the most common composition of renal or kidney stones is calcium oxalate, which occurs in 65 percent of the cases.
Next most frequent is struvite (composed of magnesium ammonium phosphate), in 15 percent of the cases.
Other types of stone include calcium phosphate (5%), calcium and uric acid (4%), uric acid (4%), and cystine (about 2%).
Calcium stones are frequent in individuals where the urinary content of calcium is high, with an output of greater than 300 mg per day.
Struvite stones are seen in patients with urinary tract infections caused by bacteria that can affect urea, a chemical normally found in urine.
Uric acid stones are the most common of the noncalcium stones and are seen in conditions which produce high levels of uric acid in the urine, such as gout.
Your chances of recurrence are close to 1 in 10 each year, and 75% of all patients will have at least one recurrence during their lifetime.
You have a high risk of repeat episodes if you a middle aged Caucasian male, if there is a family history of renal stones or gout, or if you have chronic bowel disease or certain kidney disease.
The good news is that you may never need surgery to rid yourself of these painful pebbles.
Between 80 to 85 percent of all stones pass by themselves, and the development of techniques using high power shock waves to disintegrate stones in the body has reduced the use of open surgical procedures to less than 5 percent.
Your best course is to have a complete, relatively inexpensive metabolic evaluation to try and determine the cause of your stones, in the absence of a specimen.
Such an evaluation will provide the information necessary to plan strategies that prevent recurrence.
In the meantime keep fluid intake high, so that production of urine exceeds 2 liters a day.
This will keep the concentration of stone forming materials low and help prevent another painful incident.

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

What's Special About an Exercise Cardiogram?

QUESTION: I think I know what a cardiogram is, but what's special about an exercise cardiogram?

ANSWER: An exercise cardiogram is a test that checks to see how well your heart functions during exercise, rather than at rest.
You may also know it as a stress test, since it shows how your heart responds to exertion.
An exercise electrocardiogram (EECG) can show abnormalities of the heart that a regular ECG won't, and is helpful in evaluating people who have symptoms of heart disease, angina or a past heart attack.
The test is also part of the checkup for older people who are considering starting an exercise program. During an exercise ECG you're attached with cables to the ECG machine while you walk on a treadmill or pedal on a stationary bicycle.
The speed and the incline of the treadmill or the resistance on the bike is increased gradually so that you're continually exercising more strenuously.
Don't eat or smoke for two hours before the test.
Wear loose pants or shorts, and sneakers.
In addition, women should wear a comfortable support bra, a loose front-buttoning blouse, and avoid wearing a girdle or one-piece undergarment. The test takes about 30 minutes.
It may take some time to analyze the findings, but then you can be sure that an exercise program that may be developed just for you will do you more good than harm, and you will derive real benefits from all your efforts.

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

Is an Ingrown Toenail a Sign of Any Medical Condition?

QUESTION: I am having a problem with the nail on my left big toe that keeps cutting into the flesh, causing me much pain.
Now I notice that the same thing is starting on the right side.
Is this a sign of any medical condition that you know of and what should I do to take care of it?

ANSWER: You are describing a condition known as an ingrown toenail, which occurs when the side edges of a growing toenail grow into the flesh of the toe and can create a painful problem that can progress into an inflammation or even an infection with abscess formation.
Assuming that you have no particular deformity of either toe, the problem is probably caused by cutting the nail incorrectly.
The nails should always be trimmed straight across rather than rounding them to fit the shape of the toe.
This allows a natural growth pattern that allows the nail edges to grow over the surrounding tissue and prevents them from digging into the flesh.
You may be able to correct the situation by trimming away the portion of the nail that is cutting into the skin, and by soaking the foot in warm water.
It may require that you wedge a small ball of cotton or gauze under the edge of the nail to help push back the flesh until the nail grows over the area.
If these simple measure do not remedy the situation for you, a visit to your physician is necessary, as the nail must then be cut back to relieve the pressure and the pain.
Any infection will also need an antibiotic to treat your problem.

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

Advice for a Constantly Itchy Skin

QUESTION: I am annoyed by a constantly itchy skin, that sometimes drives me to distraction.
I am a clean person, and am sure there are no critters causing my problem, but there must be some advice you can offer me to reduce my torment, and make life livable.

ANSWER: I am sure you are a meticulous person, but since there are many causes to a persistent itch, it still may be worth while for you to have a check up to try to determine some physical cause.
Doctors label an itch like this with the term "pruritus", and know it may be caused not only by "critters" but by allergies, parasites and both skin and internal diseases, but a dry skin is the most common reason.
However, there are a few tips I can offer you that can help reduce the problem, no matter the cause.
If dry skin is the main problem, maintaining a healthy level of moisture in your home will help, particularly if you live in warm, dry climates, or in a heated apartment in winter.
A humidifier will be of great comfort.
Reduce your bathing habits, as frequent showering with harsh soap can aggravate the condition, as can the use of water that is too hot.
A lukewarm shower, followed by the application of a moisturizing body lotion is indicated.
Stay away from tight fitting clothes and cotton fabrics may be kinder to your skin than wool or synthetics.
Dry your skin with pats of your towel, instead of vigorous rubbing.
Although it may seem impossible to fight the urge to scratch, realize that you can injure your already delicate skin if you do scratch hard with jagged or roughened fingernails.
Last, but sometimes the most effective measure, is to change your laundry detergent to a mild soap, that is less likely to cause irritation, and to assure that all laundered clothes are well rinsed.
These are all effective actions you may try for yourself, but a physician's diagnosis and available medical treatments may result in completely ridding yourself of this raging itch.

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

A Little "RICE" for a Knee Injury

QUESTION: I took a real bang on my knee in a game of touch football.
Lucky for me our local volunteer ambulance guys were there, and the EMT told me he would use a little "RICE" on my injury.
Everyone laughed, but I didn't get the joke, then or now.
Do you know what they were chuckling about?

ANSWER: It is pretty hard to remember all the elements in treating many injuries and diseases, and those of us who have to keep these matters fresh in our minds resort to the use of "mnemonic" devices.
These are words or phrases that use letters as clues to help our memories recall important information that can be used in a variety of situations.
I would suppose your injury was not too acute, permitting a bit of levity, but "RICE" refers to the steps in the early treatment of an injured joint.
They are Rest, Ice, Compression and Elevation.
This would apply to your situation, placing your knee at rest, application of a cold or ice pack, applying an elastic bandage and keeping the leg elevated.
Another mnemonic useful in these situations is PRICEM-M which stands for Protection from stress, Ice, Compression, Elevation, plus Medical treatment, including pain and anti-inflammatory medications, and Modalities, the use of electric stimulation or other techniques to help restore function.
In these cases "rest" means the avoidance of any overuse or abuse of the joint, while normal activities of daily living are encouraged. RICE is fine for the acute stage, but rehabilitation techniques are used to promote rapid healing and restoration of function.

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

Can Colitis Also Occur Only In the Rectum?

QUESTION: I've heard of colitis of the large intestine, but can the disease also occur only in the rectum?

ANSWER: Ulcerative colitis is an inflammatory disease of the inner lining of the large intestine, or colon.
Ulcerative proctitis and proctosigmoiditis, on the other hand, are similar inflammations of the rectum and of the final curve of the colon leading to the rectum, and occur more frequently than colitis. The symptoms of these two diseases include rectal bleeding and mucus in the stool. Medical experts disagree on the nature of ulcerative proctitis and proctosigmoiditis.
Some say the two are a mild, limited form of colitis. Others argue that they are a completely separate disease.
However, it has been shown that if the disease hasn't spread to the rest of the colon after six months, then it probably never will.
Furthermore, the prognosis for proctitis and proctosigmoiditis is better than the outlook for colitis. Patients with the more limited disease rarely need to be hospitalized or treated with system-wide corticosteroids.
Therefore, it is most important to distinguish between the diseases. In any case, ulcerative proctitis is generally a fairly mild disease. Since most of the colon is not affected, normal stools are usually formed.
In fact, a patient with the disease may even be constipated.
Treatment involves medication for the inflammation and hydrocortisone or corticosteroid foam enemas.

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

How Do You Diagnose Cancer of the Prostate?

QUESTION: Women are told to exam their breasts for lumps, and so detect breast cancer.
It isn't that easy for men who are concerned about prostate cancer.
Can you please tell me how you do diagnose cancer of the prostate?

ANSWER: The simplest and best technique for early detection of prostate cancer is for the physician to insert a well-lubricated and gloved finger into the rectum and gently feel the prostate gland for any nodules or hard lumps, which if detected could then be followed up with additional tests. But since more than 60% of all prostate cancers go undetected until further symptoms develop, such as urinary problems or spread of the cancer, approximately 25,000 American men die from the disease each year for lack of adequate early screening.
It is the leading cause of death in black men and the third leading cause of death in all American men. These figures should convince even the most squeamish male to have regular yearly screening exams after the age of 40, for prostate cancer is rare in men under 50 years.
The fact that an estimated 36% or so male readers of a popular health magazine over 40 years of age had never had a rectal exam indicates their aversion to what should be a relatively uncomfortable but painless procedure. Other tests such as measuring the serum acid phosphatase are widely and readily available.
This blood enzyme test has an accuracy of 84%, and can be used to confirm a diagnosis made by physical examination. Less widely used tests use ultrasound, computerized tomography (CT), and magnetic resonance imaging (MRI), but the last two are not sensitive enough to pick up early tumors, and are relatively expensive. If a nodule is found during the finger exam and the serum alkaline phosphatase is positive, to clinch the diagnosis your physician may insert a very fine hairlike needle in the nodule to remove a sample of cells which he can be stained and quickly examined under a microscope.
This exam needs no anesthesia.
Interpretation of the removed cells requires an experienced pathologist. The digital rectal exam, however, remains the cornerstone of screening, since it is highly accurate, cost-effective and takes only a few minutes.
The technique detects all but very small or hidden cancers which occur in 5% to 21% of cases and are revealed only after the prostate has been removed for what appeared to be benign enlargement.

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

Can Dry Mouth and Dry Eyes be Related?

QUESTION: I have suffered from dry mouth for several years, but only recently have become aware that my eyes always seem too dry as well.
My neighbor believes that these two conditions are related and that there may be some help available.
Can you tell me what this might be and what I must do to correct it?

ANSWER: The combination of these two symptoms, dry eyes and a dry mouth, may well indicate that you have a condition known as Sjogren's Syndrome (SS).
SS is, after rheumatoid arthritis, the most common disease of the connective tissues.
It either occurs on its own in its primary form or in its secondary form accompanying another specific and well defined rheumatic disease such as rheumatoid arthritis or systemic lupus erythematous. The condition is caused by lymphocytes and antibodies from the bloodstream infiltrating the glands that produce tears and saliva and in effect drying them up.
Loss of tears is known as xerophthalmia, and lack of salivation is called xerostomia.
In tandem, the two are referred to as the "sicca complex." (Other conditions may cause this complex, including aging and drug use.) Women sufferers of the syndrome outnumber men by nine to one.
While the condition usually occurs in the individual's fifties, it may develop during adolescence or early adulthood.
The syndrome is more readily diagnosed in its secondary form, where the presence of a recognizable rheumatoid condition helps tip doctors off to its presence.
In its primary form, it may come and go and be hard to pinpoint. As you can imagine, lacking the ability to shed tears or produce saliva can lead to more than a small amount of discomfort.
The eyes may be subject to a gritty or filmy sensation from real or imagined foreign particles, as well as to general eye fatigue.
As the xerophthalmia develops, erosions and ulcerations can develop in the surface of the unprotected eye. A dry mouth can lead to a sense of burning discomfort, and a decreased ability to chew and swallow food.
The tongue and lips can develop fissures, while the senses of taste and smell can diminish or vanish entirely.
The dryness can also spread to nose and throat, compounding the discomfort experienced.
All this in addition to a variety of other pains and aches that may occur in connection with the syndrome. In primary cases of the syndrome, artificial tears can help minimize the discomfort of xerophthalmia; diving goggles are even worn at night to help retain eye moisture.
When this does not help, soft contact lenses, kept well hydrated by frequent applications of saline drops, may yield the necessary relief.
Xerostomia is easier to treat by sipping fluids throughout the day, chewing sugarless gum or using a a 2% solution of methylcellulose as a mouthwash.
It would be wise to increase the level of humidity in your home by using a humidifier. In cases of secondary Sjogren's syndrome, the main line of attack is to treat the specific disease the syndrome accompanies.
This requires a complete history and examination by your physician.
He or she may find that you have some involvement of your joints, as this occurs in about 1/3 of all patients with SS.
The good news is that this form of arthritis is milder than rheumatic arthritis, and rarely leads to joint destruction.

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

Is Cancer an Inherited Disease?

QUESTION: In the last three years, I have lost two brothers and a sister to one form of cancer or another.
Although I am not sure, I believe my father died from cancer as a young man.
It looks like the odds are stacking up against me if cancer is an inherited disease.
Is it?

ANSWER: It appears likely according to some research.
However, don't panic and live the rest of your life constantly fearful that you are going to develop cancer.
A great deal of scientific progress is being made these days in preventing, diagnosing, and treating cancer. In your case, one of the most important things that you can do is to see your doctor one that you trust and can talk with easily regularly. Your physician will discuss your family's medical history thoroughly.
It is highly important that you tell the doctor all details about your family and yourself, and that you follow the doctor's directions PRECISELY. With knowledge that the possibility of hereditary cancer exists, your physician can give special attention during regular exams to those organs that may be most vulnerable.
There are several procedures that may be indicated, such as colonoscopy, that will search out any new growths in your large intestines (such as polyps), and allow treatment before any cancer can get a foothold.
Though there is some discussion about the value of yearly or routine physical examinations, they are most important in your case.
Good health should become your byword, with attention to diet and exercise and the knowledge that your best defense is one that allows for early detection and treatment.
With all these positive steps taken, you probably will live a longer and healthier life than many of your associates and friends, who are not as attentive to their health needs.

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

What is the Name of the Artery Operation to Prevent Stroke?

QUESTION: What is the name of the artery operation to prevent stroke? Is it safe? There is someone in our family who may be in need of such an operation.

ANSWER: Although I'm not sure from your letter just what information you are seeking, I suspect you mean a surgical procedure called "carotid endarterectomy".
I'll proceed on that assumption and answer your questions, because I believe many other readers may also be interested.
When performed under optimum conditions, carotid endarterectomy can prevent stroke.
Those conditions include operating on patients that exhibit the traditional symptoms of ischemia (when there is a lack of oxygen being delivered to the brain because of obstructed or blocked blood vessels) or impending stroke: partial paralysis or numbness in the limbs on one side of the body, speech loss, and partial vision loss.
For these patients, carotid endarterectomy is considered a safe and straightforward procedure.
The operation attempts to clean out the passage of the obstructed vessels, allowing the blood to flow freely towards the brain. But for patients who exhibit widespread symptoms, such as overall paralysis or total vision loss, or for those who exhibit no symptoms at all, the procedure can be dangerous.
At best, under these conditions, there is no guarantee that the procedure will prevent stroke.
At worst, the operation itself could prompt stroke.
In these cases, the physician relies upon the patient's past history of stroke and evaluates the possibility of a future stroke against the potential danger involved in performing the endarterectomy.

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

Is There Anything to Get Rid of Cellulite on the Hips?

QUESTION: I am basically a thin person, but have cellulite on my hips and thighs.
Is there anything special I can do to get rid of this? Can you explain what cellulite is?

ANSWER: Cellulite is really no different from regular fat.
It is a word used to describe the bumpy orange peel appearance of fat that most frequently appears on women, on their hips, thighs and buttocks.
Researchers have compared fat biopsies taken from people with cellulite deposit areas with fat taken from people free of cellulite.
They found that the fat is essentially the same.
The ripple-like appearance is thought to be the result of the connective tissue that envelops each fat cell and separates the cells into compartments.
These cells bulge as more fat is stored in them due to weight gain. Although some men are afflicted with cellulite, more women develop the problem because their outer layer of skin is thinner and female areas of fat are larger and more rounded. If you are thin, but have patches of cellulite in the common areas, then it will be tough if not almost impossible to get rid of it.
Unfortunately, fat does not always accumulate evenly over the entire body, but in areas of high concentrations in some anatomical areas.
There is no such thing as spot reduction, and I advise you against believing any advertisements that promise such results.
In reality, exercise along with a low calorie diet will help take fat off from all areas of your body, and may be of some help.
Exercising the areas where you have cellulite will tone the underlying muscles, but it won't necessarily remove fat from that area of the body.

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

How Does an Echocardiogram Work, and is it Safe?

QUESTION: Although I think I know what a cardiogram involves, I am less certain about the way an Echocardiogram works.
A member of my family is to have one, and I am both curious as to why as well as concerned with the safety of this test.
Would you please shed some light on this question?

ANSWER: I would be pleased to, for I can certainly reassure you as to the safety of this procedure.
It is simple and noninvasive, and uses very fast sound waves which pass through the patient's chest to the heart and bounce back (echo) to produce a record or graph which forms an image that the physician can use to evaluate the walls and chambers of the heart, as well as the valves which control the flow of blood through the heart as it beats. While an electrocardiogram produces the pattern of electrical flow through the heart and may be used to evaluate changes in rhythm, for example, and blood tests may show the alterations in enzymes produced by a heart during a heart attack, an echocardiogram may yield early information on the size and extent of the attack, the location, as well as the presence of clots or masses, while measuring heart function and the condition of the valves.
Sometimes a chest x-ray shows the heart to be enlarged, and the "echo" will reveal whether the heart wall has become stretched or thickened due to disease.
It may detect the presence of fluid in the sac that covers the heart, and is a useful tool to measure the effect of medications and treatment on the heart muscle mass and size.
There is little preparation necessary, and there is no pain nor discomfort while the test is being conducted.
The patient remains totally awake and conscious while the probe that both sends and receives the sound signal is moved about the chest to obtain the best "picture" of the heart in action.
The test has been in use for more than twenty years, is relatively inexpensive when compared to other tests, and is free from side effects, both physical as well as psychological.
While I can not offer you more information as to why the test is being conducted for your family member, you may be confident as to their well being.

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

Is Emphysema a Rare Disease and is There Hope for Improvement?

QUESTION: Now that a cause for some of my shortness of breath has been diagnosed as emphysema, I want to find out all I can about a condition I have never really understood.
Is this considered a rare disease, and is there any hope for any improvement in my condition?

ANSWER: I don't believe that you can classify a disease that affects between one and two million Americans as a rare disease, and it is a problem for an ever increasing number of people.
It generally begins to show its symptoms of increasing breathlessness between 40 to 60 years of age, and may be attributed to both age and obesity by new sufferers of the disease.
Yet a healthy person approaching retirement age should still be able to breathe with ease of a 20 year old, even when in involved in moderate activity such as a brisk walk along level paths.
The causes of emphysema are poorly understood, particularly why certain individuals seem to develop a more severe type of disease than others.
Smoking is definitely linked to the disease in nine out of ten cases.
The walls of the little sacs at the end of the air tubes leading into the lungs (alveoli) lose their elasticity, and cannot contract and force the air out of the sac with each expiration, resulting in trapped air within the lungs.
This lowers the amount of air flowing in and out of the lungs each time a breath is taken and reduces the lungs ability to exhale the carbon dioxide built up in the blood stream by the body's metabolism, as well as reducing the amount of oxygen in freshly inhaled air that can be delivered to the blood stream.
That results in the feeling of being smothered that so many emphysematous patients experience.
There is no cure for this chronic obstructive lung disease, and recurring bacterial and viral infections may aggravate both the disease and its symptoms, leading to the development of an aggravating cough.
The best way to slow the progress of emphysema is to stop smoking once and for all time.
Avoid areas where other smokers may be filling the air with fumes that are truly hazardous to your health.
A supervised exercise program and the prompt treatment of any respiratory infections will also help you reduce the complications of this common illness.

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

What is the "Cut" a Doctor May Make During Birthing?

QUESTION: With the arrival day for my first baby fast approaching, it seems that all the conversations with my girl friends now turn to the "cut" the doctor may make during the birthing.
Can you tell me the scientific name for it, and explain its use? Does it cause a lot of pain?

ANSWER: When a delivery can be helped by providing a bit more room for the baby's head to pass, a physician may elect to perform an "episiotomy".
The term is from a Greek word "epision" describing the region of the pubes and it is through this area that an incision is made.
There are several advantages to the procedure, as it can allow a quicker and easier birth and reduce pressure on the baby's head.
Since the forces pushing the baby through the birth canal are powerful enough to both stretch and tear vaginal tissues, making a clean surgical cut at the appropriate moment avoids the complications that torn tissue can provoke.
With all else that is going on at that moment, many women are unaware that the "cut" has been made.
After the birth the incision is repaired as with any other surgical incision and permitted to heal.
While the swelling and pain passes in a few days to a week, the area may remain tender for a month or so.
Total healing is usually completed in about six weeks.
The mainstay of care is hygiene, keeping the area clean and free from any possible contaminating elements that cause irritation or infection.
Your own physician will guide you through this period as well as counseling you about resuming normal activities and relations.

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

What Method is Best to Quit Smoking?

QUESTION: With all the advice saying the same thing (including material in your column), I've decided to quit smoking.
Now that the decision is made, I don't think I can take it cold-turkey.
What method do you think is best and do you think I can manage it by myself?

ANSWER: Different folks need different strokes, but self-help programs have a very low success rate, and I don't advise them.
I prefer some more structured situation, with your physician or counselor to keep tabs on you and offer support, advice and suggestions if the going gets rough.
If you are truly physically addicted to nicotine, then perhaps using a medication, nicotine polacrilex, may be the best route for you.
Answering a few simple questions contained in the Fagerstrom nicotine tolerance scale will help your physician determine level of addiction.
Using medication in a well designed program that includes counseling and behavior modification training will provide the best odds in your favor.
There are two such techniques that may interest you. A rapid smoking technique requires that you inhale once every six seconds until you just don't want any more, frequently brings on all the unpleasant symptoms you first experienced when you started smoking, nausea, dizziness and general discomfort.
When you begin to associate the smoking with all the bad effects, it may help you quit.
Another technique, called satiation smoking, requires that you triple the number of cigarettes you normally smoke over a 20-45 minute period.
Other techniques, such as hypnotism, electroshock and acupuncture do not show great effectiveness in controlled clinical trials, though I know of some individuals who credit their successful battle against nicotine to their use.
Actually it is up to you, and with a little help from your friends, you can succeed.

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

Problems With Snoring

QUESTION: My problem is this: I've had my nose broken 4 times playing various sports.
Now I snore like a herd of stampeding buffalo.
My marriage is suffering because my wife is a light sleeper.
Help me, please.

ANSWER: Snoring is not a matter to be taken lightly, as it may be associated with a number of quite serious situations, including sleep apnea.
That is a condition in which the sleeper stops breathing for 10 seconds or more up to 300 times a night.
Of course, the obvious diagnosis in your case would be to blame the problem on you poor beat up nose.
If the passage through which you inhale air is obstructed, you have to pull harder to get the air in.
This creates a partial vacuum effect that pulls the soft part of the airway together and which vibrates as you breathe, causing the snoring.
However, before we condemn just your nose, you require a thorough examination of your nose, mouth, palate, throat and neck.
If your nose is the culprit, there is a real possibility that only surgery can correct the obstructive conditions that are causing your sleep symphony.

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

What is Stargart's Disease?

QUESTION: My 15 year old son was just diagnosed as having Stargart's Disease. He is legally blind in his left eye and the retina specialist is watching his right eye.
There is some scar tissue here.
Can you tell me about this disease?

ANSWER: The disease is also know as Juvenile Macular Degeneration and was first described by Dr.
F.
Stargardt in a German ophthalmological journal in 1909.
It comes on between 6 and 20 years of age in children who have been normal until then, and is marked by a gradual decrease of vision in both eyes. At first there are no signs on examination of the retina, but then changes in the pigmented epithelium at the back of the eye occur, assuming a "beaten bronze" atrophy.
It is this defect in the pigmented epithelium that causes the vision loss.
It is an inherited disease, normally a recessive gene (not showing in each individual), but may be dominant in some families.
Gradually the visual elements in the area of high vision (the macular) and the areas that surround it (the peri-macular area) disappear, making this condition a gradually progressive one.
At present there are no effective therapies available, but you seem to have the treatment in appropriate hands, and should new developments occur, a Retinal Specialist would be the first to be aware of new treatments.
Current research in the transplantation of healthy retinal cells into eyes suffering from inherited retinal degeneration has been successful in rats, a breakthrough, but still a long way from use in humans. The work is being carried on by Drs.
James E.
Turner and Linxi Li at the Bowman Gray School of Medicine, Winston Salem, N.C., and provides the first ray of hope for suffers of inherited retinal degenerative disease.

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

Treatments for Genital Warts

QUESTION: I am plagued by genital warts, and feel there must be some treatment that can offer me the hope of being rid of this hateful situation. What should be done to remove these things from my body?

ANSWER: There are several possible treatments that you can obtain to help you, though I must warn you that there is no one perfect solution to your problem.
Genital warts (and anal warts too) are the result of an infection by a virus, the human papilloma virus (HPV).
Some recent research has linked this condition to the development of genital cancers, and it is recommended that you have a Pap smear before any treatment is started so that the results may be used to help guide the physician in deciding upon the best treatment in your case.
The most widely used treatment is the use of podophyllin and tincture of benzoin, a solution which may be applied directly to the lesions. Several applications may be necessary before all the warts have been destroyed.
If after 4 treatments the area is still not free of lesions, an alternative procedure may be tried.
These include cryotherapy (freezing the warts with liquid nitrogen or solid carbon dioxide), burning the lesions with electrosurgery, or surgical removal.
Some physicians advise using cryotherapy as a first line of attack, but in any case, the treatment should be individualized, taking into consideration the number of warts, their location, whether or not the patient is pregnant, and the failure of any other type of treatments that might have been tried.
None of this is too pleasant, so you will need some patience and fortitude to see the process through to the end, for it is important that you have the condition cared for.

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

Hypertension Medicine and Loss of Sexual Drive

QUESTION: In talking with several women recently, it appears that several husbands have lost interest and ability for sex after being diagnosed for hypertension.
The common denominator seems to be their medicine.
The men apparently are reluctant to pursue the problem.
As a doctor, what route would you take to correct this problem? These men are not too old!

ANSWER: Nowhere have I seen the power of communication more dramatically demonstrated than in your question, with all its implications.
Sharing information makes us all wiser and sometimes leads to the discovery of problems that are frequently not discussed, and from there to solutions. While male impotence may stem from many causes, both physical and psychological, there is no question that medications are frequently the culprits.
While the prescribing information may fail to take note of this unwanted side effect, there isn't a textbook worth its cost that doesn't include an impressive list of medications that reduce sexual ability.
The largest number are found under the heading "antihypertensives" with psychotropic medication, both antidepressives and antianxiety agents, next in line.
Central nervous system depressants, including alcohol, as well as sedatives and narcotics all are there as well.
Now to the route to take, and let us use the same technique to solve the problem that led to its discovery, communication.
If your husband has suddenly found himself deprived of powers he had possessed formerly, and is unaware that his medications may be doing him in, he must be suffering emotionally from this unexpected loss of his manliness.
This is kept locked up inside, frequently denied, but usually not addressed openly.
By sharing your knowledge (and this answer) with him, you can take the first step on the path that can lead to the solution you seek. Next step: the physician, who has heard this all before, but since not all men have the same reaction, is also unaware that this problem now exists. Communication, again.
Last step, a change in medication for one which will still control the hypertension, but does not generate this problem.
There are several such medications to chose from.
I hope this answer will cause many of my readers to stop and think, to determine whether or not they may be unknowing passengers in the same boat.

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

Aspirin and Persistent Severe Headache

QUESTION: I have arthritis, for which I take 8 aspirin a day.
I also have severe headaches, for which I take fiorinal.
Why am I still getting headaches? With all the aspirin I take I feel that every pain in the body should be suppressed.
Do you have an answer?

ANSWER: I wish it really was that easy.
A simple medication for every health complaint that worked perfectly, and without side effects every time.
Have a pain, any pain at all, take an aspirin, or one perfect antibiotic for any infection.
However, the complex and wonderful workings of our bodies do not permit us the luxury of relying on such one to one relationships.
Pain is the body's response to many different situations, requiring diligent investigations and diagnoses of the cause, before the choice of an appropriate medication to remedy the situation can be made.
I do not know the cause of your headache, but your letter makes it clear that aspirin is not the solution.
It may mean that in your specific case aspirin is just not effective for your headaches, although it might work quite well for someone else with the same problem.
More important, however, is the possibility that your headaches are a symptom of a situation for which aspirin is never the medicine of choice.
An example, to help make my point.
Your headaches may be the sign of an elevated blood pressure.
Reducing this pressure would most certainly put an end to the headache problem, but the medicine to achieve that would not be aspirin, but one selected from a group of possible choices, all of which have very different chemical formulas and different actions than aspirin.
I hope you now realize that you require a bit of personalized medical attention, for the possibility of a serious condition does exist in your case, and I would not delay a visit to the physician if I were you.

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

Treatments for Dermatitis

QUESTION: Our young son, age 9, suffers with a terrible, itchy rash, that our doctor calls a dermatitis.
We have been using creams and salves which work sometimes, but the rash keeps returning.
I want to be sure I am doing everything I can.
Can you please tell me what to do?

ANSWER: It sounds like you are on the right path, combatting the chronic and difficult to manage skin disease that from your description I believe falls into the classification of an atopic dermatitis.
Sometimes called eczema, it is one of the most common skin disorders affecting children, with from 3% to 5% of all children in the United States affected.
Generally there is a history of allergy, either in the child or family, problems such as asthma, allergic runny noses and allergic conjunctivitis.
The skin tends to be dry and scaly, and of course the itch is ever present.
The use of emollient creams or skin softeners can be combined with hydrocortisone that is useful in reducing both the rash and itch.
The medicines to be effective must be applied frequently (as many as 5 to 6 times a day) and regularly.
Skipping an application or two, or forgetting to apply medications regularly, is a most common reason for treatments to fail.
A few other precautions may help. Don't use harsh or drying soap, but try Dove or Neutrogena instead.
Be careful in the choice of clothing as wool and some synthetic fibers may irritate sensitive skin.
Observe carefully to see if particular foods, such as eggs, milk or peanuts may be causing allergic reactions that increase the rash problem.
Stress and emotional upset can also trigger an acute episode. When the itch is so severe that sleep is disturbed, the use of an antihistamine as bedtime medication is indicated, and can be most helpful. But the good news is that about 80% of patients with this affliction are symptom free by age 20.
Until then your care, understanding of the proper usage of medications, and consultations with your physician when flare ups occur can make the course of the disease easier and more bearable.

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

Safety of Sonography for the Newborn

QUESTION: There are some problems with my newborn baby, and the doctor we use has advised us to allow examination of the baby's head with a machine that passes sound through the brain to make a picture.
We are concerned that this may make things worse since we have read that sound waves can kill.
Can you explain if this is a safe thing for us to do?

ANSWER: You didn't explain your baby's condition in your letter, but the fact that your own physician is advising you to undertake these procedures would indicate that there must be good reasons for them.
The good news is that the examination, utilizing a technique called sonography, is a very safe one, with no known harmful effects, and even more important, no pain to the child. These sound waves are quite different from the harmful ones you've read about, differing in both frequency and intensity, and there is no possible chance of changing them by mistake.
Sonography is particularly useful in children and can provide fine details of the anatomy of the area being evaluated.
There is no radiation either, as would be the case if x-rays were used.
The physicians are able to "see" the image as it is being created, and can move the instrument, called a transducer, in different directions, or can change the angle to get just the right picture they need to help discover the problem your child may have.
Since a baby's head is not fully formed or calcified, the examination uses the soft spots in the head, called fontanelles, as a location for the transducer, and thus can obtain the clearest possible pictures.
This can provide your physicians with an enormous amount of vital information necessary to diagnose your infant's ills in the shortest possible time and in a manner that is not the least traumatic to the infant.

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

Hints for Dealing with Back Pain

QUESTION: A bad back is not an affliction with me, it's a way of life.
I've had the usual treatments, taken all the pain killers they make, but the problem never goes away for very long.
My doctors say I must live with it, there is nothing dramatically wrong, but I thought you might have a suggestion or two that could help.

ANSWER: I am going to assume that all the causes of back pain have been investigated, and that essentially nothing was found.
That means that some simple tips which look at the way you are using your back may help.
At any rate I hope so.
Don't sleep on your stomach, it's no help for your problem. Try to make it on your back, legs drawn up, but sleeping on your side is all right too.
And don't use too many pillows that may stretch neck and back muscles.
An orthopedic neck pillow may help, should this be the problem.
Do you watch TV lying on your side, propping up your head with an arm? That's another no-no, as it puts your spine into a curve that stretches and abuses your muscles.
If you are one of those people who stick your telephone between your shoulder and your ear, you may be provoking neck problems that affect your back.
Use a speaker phone if you need to keep your hands free.
Take some of the stress off your back when standing at a wash basin or table, by placing one foot on a foot rest or box.
Alternate your foot placement from time to time to get the maximum benefit.
These are all little hints that may help in a situation like yours.

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