Is There Such a Thing as "Burnout" in Teenage Athletes?

QUESTION: My son is definitely off his feed as far as his baseball is concerned this year.
His coach keeps using the term "burnout," but my son is only 15 years old.
Is there such a thing, and are there any treatments that might help?

ANSWER: Yes, there is such a thing as burnout in teenage athletes.
If your teenager frequently complains of chronic fatigue, and you notice that he is not performing in athletics and/or studies as well as usual, medical attention probably is needed to find out exactly what is occurring in that body.
The driving forces behind all exercise performance are exceedingly complex and involve a great many heart/lung, blood and psychological factors.
Therefore, finding out what really is wrong with a person who suddenly seems to tire easily, experiences frequent headaches, gains or loses considerable weight rather rapidly, has chest pains, lightheadedness and other such symptoms, is a matter for on-the-spot medical professionals to diagnose.
An undetected disease certainly might be impairing the teenager's athletic performance and such a possibility should be explored immediately, even though the reason might only be the normal fatigue seen after intense athletic activity.
Among conditions that frequently result in low energy for teenagers are heart disease, anemia, emotional problems, excessive weight or anorexia nervosa, certain medications taken for chronic conditions, and most important, unrealistic expectations regarding one's athletic abilities.
In addition there are certain infrequent muscular diseases and exercise-induced bronchospasms (coughing, a feeling of chest tightness, wheezing or shortness of breath after a work out). Now all of these symptoms sound like real illness, and can be, but the fact is that they may also arise from prolonged stress and activity required for sports.
I am not trying to hedge your question, but "burnout", in anyone, is poorly understood at this time. Often it is blamed on over training.
When such is the case, early recognition and prevention are truly important since rest is the only effective treatment and recovery may be slow.

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.

Ever Come Across the Term "Boxer's Fracture"?

QUESTION: Ever come across the term "boxer's fracture"? Though I suspect I might figure this one out, I would appreciate your explanation.
Is it difficult to treat?

ANSWER: A "boxer's fracture" is simply cracked knuckles, a common side effect of fist fighting, and is frequently called this even when caused by other circumstances.
There are several options for treating such a fracture, and the final decision on how to treat it depends on the severity of the injury, how important the hand's function is to the patient, and how often he expects to be using the hand as a weapon.
For instance, if he uses his hands in his work or hobbies, he may opt for more aggressive treatment.
And, if the patient is a regular fist fighter, then the possibility of re-injury must be considered before advising extensive and delicate surgical repair.
The choices for treatment of boxer's fracture mainly revolve around whether to operate or treat more conservatively with protective splinting.
More time is lost from work when surgery is chosen, because recovery is slower.
There is some controversy over whether the functional and cosmetic improvements gained in surgery are worth the delayed recovery that it involves. The best results in treating boxer's fracture occur when the extent of the injury is fully evaluated, considering how the hand is used in occupational and leisurely pursuits, and how important cosmetic results are. Based on this information, the patient can decide with the physician on the best course of action.

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 Tests Are Used for a Diagnosis of Coronary Heart Disease?

QUESTION: Could you please explain a bit about the tests that I may be facing with a diagnosis of coronary heart disease? Do any of them cause pain, or are they dangerous? I am more than a little anxious.

ANSWER: Coronary heart disease is the number one cause of death in the United States.
It is the most common form of heart disease, and since treatment is based upon knowing the extent of your problem, testing is very important. Coronary artery disease (CAD) is a condition in which the muscle tissue of the heart is not receiving enough oxygen.
The heart can not take any oxygen from the blood that it pumps.
It gets its own supply through the coronary arteries, a set of arteries that encircle the heart and resemble a crown (coronary means crown-like).
When these arteries become clogged, blocked or narrowed, heart tissue dies from lack of oxygen, and a myocardial infarction (or heart attack) occurs.
Gradual narrowing or spasm of these arteries causes the chest pain known as angina. Your doctor will decide which tests to use to diagnose coronary heart disease based on several factors, the most important of which is your symptoms.
If you feel chest pain on exertion or if you've suffered a heart attack, your doctor will probably have you undergo several tests.
Tests for CAD fall into two general categories, noninvasive and invasive.
Noninvasive testing means that, except for some injections, nothing enters your body. Invasive testing means that a catheter (a very small tube) is placed into a vein or artery and used to inject a contrast medium (which shows up on x-ray), or to measure pressures in the vessel.
Invasive tests are more reliable than noninvasive tests, but they are more expensive and carry some risk. Noninvasive tests include stress or exercise testing, where you walk or run on a treadmill while an electrocardiogram (ECG) is taken.
Your doctor will evaluate how your ECG changes as exercise stresses your heart.
This is an easy, relatively inexpensive test and will probably be the first you undergo. You may need additional tests that can give more information about the condition of your heart.
Some of these tests require an injection with small amounts of radioactive materials.
The amount of radioactivity is very low and passes out of your body quickly. In exercise echocardiography, your doctor will look at an ultrasound picture of your heart as you exercise.
Ultrasound works on the same principle that sonar does and is quite safe. Based on results from noninvasive tests, your physician may ask you to undergo an invasive test for CAD.
The most common one is cardiac catheterization.
A catheter is placed in a small blood vessel and, under local anesthesia, is snaked along into your heart, where a great deal of information about the way your heart pumps blood can be gathered.
This procedure is considered a minor operation and has some risks, but gives your doctor the best information about your coronary arteries. It may seem like a long and complicated process, and it is.
Expensive too.
But it provides all the necessary information that helps the physician help you choose the right therapy to fight your heart 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 There a Simple Answer to Why Women Get Hot Flashes?

QUESTION: Although I am able to cope with most of the feelings that come on with my hot flashes, they have been going on for more than two years now, and I am beginning to wonder when this will all end.
I have tried to find information as to the reason that women are cursed like this, but have never found an explanation that makes much sense.
Is there a possibility you might include a simple answer for me in your column?

ANSWER: Like you, many women are forced to deal with one of the more distressing signs of menopause, the hot flash or flush.
While some of the secrets of the "why's" and "how's" of this most uncomfortable symptom are not clear, a great deal is known, and I will try to tell it to you.
Not all women have severe or annoying episodes; for many the event is mild and infrequent, lasting but a few moments.
They occur during day time hours and disappear after a year or two.
For others however, they can be most severe, lasting up to ten minutes and striking as often as six times an hour.
They may happen frequently at night, destroying sleep and provoking severe night sweats. Statistics show that as many as 25 percent to 50 percent of all sufferers with hot flashes may continue to have them for as long as five years.
The flash, skin flush and perspiration are a result of a temporary imbalance of the system in the body that regulates the body's temperature.
The hot flash attack begins in the hypothalamus, an organ lodged deep with in the brain that is responsible for the temperature control of the body, and also monitors the level of estrogen (female hormone) that circulates in the blood.
When estrogen levels are low, it sends a message to the anterior pituitary gland (using a chemical called gonadotropin releasing hormone).
In turn the anterior pituitary gland sends a chemical messenger (this time it's called follicular stimulating hormone) to the ovaries to produce more estrogen.
When the aging ovaries can not respond (or when the ovaries are missing because of surgery) the hypothalamus next releases a stimulant called free epinephrine, which spills over into the heat regulating area, and starts the reactions in both heart and skin that result in increased circulation and dilated blood vessels in the skin that create all the sensations of a hot flash, skin flushing and the perspiration that accompanies the reaction.
Even though the sensation may last for but a few minutes it takes about a half hour for the body systems to return to normal.
Over time the body and all of the mechanisms that control the body temperature readjust to the new lower levels of estrogen, and the attacks stop.
However other complications that occur with reduced estrogen production, such as osteoporosis, cardiovascular disease and vaginal atrophy and drying, continue to progress over time.
Since the attacks vary in frequency and intensity from woman to woman, the consideration of possible treatment must remain an individual decision.
Hormone replacement therapy can be used to diminish the symptoms, and will also be of considerable benefit in preventing or alleviating the other complications of menopause, but since such a therapy may be necessary for the life of the woman, all the pros and cons should be discussed with the physician.
Hormone therapy can produce other annoying symptoms such as weight gain, swelling, breakthrough bleeding, breast tenderness and abdominal bloating.
The presence of breasts or uterine cancer in the family history can also influence the decision to use hormone treatments.

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.

Do Doctors Still Cut Into the Chest to Massage the Heart?

QUESTION: While watching a television advertisement about CPR (cardiopulmonary resuscitation) I remembered a scene in an old movie where the doctor cut into the chest to massage the heart back into life.
You don't hear much about that anymore and I was wondering if doctors still use that method?

ANSWER: The movie must have been made before 1960, for that is the year in which Dr.
W.B.
Kouwenhoven and his associates published a now famous paper in the Journal of the American Medical Association (JAMA) describing closed chest massage.
Prior to that, open chest massage was the technique used, most often by surgeons during hospital based surgery.
When the heart stopped beating during an operation, the surgeon could quickly make the necessary incisions in the wall of the chest and massage the heart directly.
Investigators who studied the results of such attempts to restore life to the heart report success rates of better than 1 in 4.
However, when the technique of closed chest massage became known, the open chest heart massage was rapidly abandoned.
The standardized procedure was approved by the Red Cross, the American Heart Association and taught to millions of Americans.
A Gallup Poll back in 1977 showed that almost 15 million people had already been trained, and about half the adult population was planning to take a CPR course.
There are some advantages and disadvantages to both open and closed chest methods, the open method providing increased circulation to the body, while the closed method is readily available to all and certainly is a more acceptable concept for general use.
Recently, however, some physicians are advocating a new look at open heart techniques, with the necessary studies that could lead to recommending the open chest procedure in some special cases.

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 Child With "Hyperactive" Condition

QUESTION: My kid just doesn't seem to listen to anything I say, and certainly can't sit still long enough to have a talk with.
Even my neighbors are beginning to make comments and one friend thinks that I am dealing with a child with condition that has the word "hyperactive" in it.
I need some advise and information.
Can you help, please?

ANSWER: I certainly can offer you a few bits and pieces that may help, but this is a condition where the child must be observed and examined by a physician in order to get a clear understanding of the problem, and the information needed to make a correct diagnosis.
I believe your friend is referring to a condition known as "Attention-Deficit Hyperactivity Disorder" (ADHD).
It is a neurological condition that causes a child to be easily distracted from the task at hand, inattentive, impulsive, and hyperactive when compared to other children of the same age.
In some cases, particularly girls, the hyperactivity is less pronounced or noticeable.
With or without hyperactivity, this condition may affect from 2 percent to 10 percent of all children, and hyperactive behavior is the most common problem now being referred for care to child guidance clinics in the United States.
The diagnosis will depend upon the presence or absence of certain behavior patterns, and the severity will be judged by the effect on the child's ability to function.
There are 14 behavioral criteria listed for ADHD and there must be at least eight present for six or more months to make the diagnosis.
Here are but a few for you to use in your own preliminary evaluation of your child. 1: Often fidgets with hands and feet or squirms in seat, 2: has difficulty in remaining seated when required to do so, 3: is easily distracted by things happening outside the immediate area, 4: has difficulty in awaiting turns in games or group situations. As you can see it is not a simple task to arrive at the correct diagnosis, which is a must if an effective therapeutic plan is to be fashioned.
Prescription medications can be one route that is available to you, but this is a problem in which the solution is neither instantaneous nor complete; and you should proceed step by step through all the steps needed for a complete evaluation, meanwhile gathering all the information and resources that you may need to help you cope effectively.
Your ability to help your child is most important in the outcome of any treatment.

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

How Can Doctors Tell What's Wrong Without an Accurate Test?

QUESTION: I am a 29 year old woman.
I recently found a lump in my breast and visited my doctor, who said it could be a cyst.
However, he refused to do a mammogram.
Another doctor who I visited for a second opinion also refused to do a mammogram, saying I was too young and that it was probably a cyst.
My question is this how can doctors tell you what's wrong without an accurate test? I am concerned because my mother had breast cancer and died.

ANSWER: While I understand your anxiety and can sense your frustration, I can only hope that the information I will provide you here will help you understand what is going on.
To start with, most breast lumps are benign; that is, they are not cancerous.
In addition, cancer of the breast in a woman under the age of thirty is rare.
You were certainly correct in consulting your doctor when you discovered your lump, but his examination, including an inspection and palpation, provided him with a great deal of information about your lump, its size and texture, and whether or not it was freely movable under the skin.
By shining a bright light through the breast (diaphanogrophy), it is possible to tell whether the lump is filled with a clear fluid, as in the case of a cyst.
And a fluid filled cyst is not a cancer.
While the combination of a physical examination and mammography can detect the presence of a cancer in about 97% of the cases, only a biopsy can really tell if the tissue is cancerous or not.
A biopsy is the surgical removal of the lump, followed by a careful microscopic examination of the tissue.
Your statement that two physicians have examined this lump and not permitted a mammography leads me to the conclusion that the lump was small and freely movable, probably had the consistency of a cyst, and was filled with fluid when examined with a light.
That's very good evidence that it is not cancer, and that the mammography would show little other evidence that could either help make or change the diagnosis.
Since your family history tells of your mother and her disease, it is clear that you will have to continue to be checked on a regular basis for any changes, but for now I think you safe enough without the unneeded mammography.
All that said, and being perfectly correct from a strict medical perspective, if I felt your anxiety was affecting you too intensely, I would probably order the test for 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.

Just Don't Feel Fit

QUESTION: I am 28 years old and teach aerobics three to four times a week. My weight is about 128 pounds.
The problem is reducing another ten to fifteen pounds.
Even though I am not overweight, I just don't feel physically fit.
I do not over eat and watch my fat consumption, but nothing seems to help.
I have battled my weight all my life and it would be nice to finally win.
Any advice or help would be greatly appreciated.

ANSWER: Without a height measurement, it is hard to completely evaluate your situation, but I probably would agree with you, you do not seem to be overweight.
You would have to be 20 percent over your normal body weight to be considered obese.
And that weight should be in excess fat tissue, rather than in muscle tissue, for it to be significant.
While regular aerobics does not tend to excessively develop your muscles, it would be interesting to know if some of your body weight cannot be due to your frequent workouts.
While you claim you are not overeating, keeping track of everything you consume in a daily diary and then converting those numbers to calories might reveal that even for a person of your age and your (unrevealed) height and physical activity, you are still consuming too many calories for there to be a noticeable weight loss over time.
But my medical sensitivities are alerted by the statement that you "just don't feel fit".
I would want to check out a few possibilities to be sure that both your physical functions and mental state are all functioning as they should.
A thyroid problem can be at the base of your problem, and work and living situations can make a person feel less than fit without any physical basis.
Too many times, a medical situation that is relatively easy to correct is lost in a poorly defined complaint such as yours.
I don't think your answer lies in another diet, but in an overall evaluation of your physical, emotional and social situation.

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.

When An Older Person Falls

QUESTION: My mother lives alone in another city.
We received a call from her neighbors that she fell in her apartment, but now seems well enough.
She refuses to go to the doctor, and we are worried that she may have had a small stroke.
Is this a possibility? Can you please counsel us?

ANSWER: When an older person falls, especially when there are no witnesses present, it may take a bit of detective work to determine just what did happen.
Certainly a small stroke is a possibility, or a T.I.A.
(transient ischemic attack).
In the case of a T.I.A., there may be no signs left after a brief period of time to help clear up the situation, and the mystery may never be completely resolved without medical evaluation.
However, since these attacks may recur a diagnosis and treatment is certainly required now, and it may require a visit from a close member of the family to convince your mother of the seriousness of the problem.
Many older people will not remember all the particulars of an accident or recall the circumstances that preceded the fall.
A careful look around her apartment may reveal the source or potential sources for an accident.
Dark, or poorly lit halls and corridors, slippery floor surfaces or scatter rugs, boxes or other small objects lying about may trip anyone, and should be cleaned up or removed.
More important still, to my medical mind, are all the conditions still undiagnosed that can contribute to these reported falls.
Neurological problems that change the gait or mobility, vertigo or dizziness, failing eyesight (perhaps from developing cataracts), reactions from new medications or even the sudden lowering of blood pressure that occurs when standing or arising too swiftly (postural hypotension) all may be the underlying cause of a "simple" fall.
Muscle weakness, anemia, poor eating habits and emotional problems can also be contributing factors, and the list can go on and on.
While it may be but an isolated accident, it would be unwise to allow the situation to go unexplained, and imprudent to overlook the possibility that there are medical circumstances that caused this episode that can be treated, and so prevent a future fall that could lead to greater tragedy.
My advice, either get someone into that home that your mother respects, or start packing your bags for a most necessary journey.

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 "Rubber-Band Technique" for Curing Hemorrhoids?

QUESTION: I suffer from severe hemorrhoids and have tried all of the creams and lotions to no avail.
My physician tells me that my hemorrhoids can be cured by using a rubber-band technique, but I don't understand what he means. Have you ever heard of this procedure?

ANSWER: Yes I have, and it is an acceptable manner of treating certain types of hemorrhoids. Hemorrhoids are actually swollen veins, very much like varicose veins, but that are located around the anus or rectal area.
They are classified into four degrees of severity.
In the first degree, they remain internal, but occasionally bleed and this blood can be observed after straining bowel movements.
The physician diagnoses the situation by using a small instrument called an anoscope to look inside of the rectum and observe the hemorrhoids directly. Second degree hemorrhoids protrude out of the anus when you strain during bowel movements, but retract back inside after the straining is stopped.
In third degree hemorrhoids, the internal hemorrhoids remain outside, even after the straining has been stopped, and must be pushed back inside either using an instrument or fingers.
In the most serious type of hemorrhoids, fourth degree, these internal hemorrhoids remain fixed on the outside and the treatment for such hemorrhoids is the surgical removal of these veins. Elastic-band ligation, which you have termed "a rubber-band technique" is useful to treat third degree hemorrhoids.
The physician will use a special instrument called a ligator and encircle the hemorrhoids snugly with an elastic band.
This stops the circulation into the hemorrhoid and, in effect, solves the problem. I must emphasize that all these procedures are used for internal hemorrhoids.
External hemorrhoids, which may be small and without symptoms, are generally of little concern, but the various degrees of internal hemorrhoids require appropriate treatment that corresponds with their severity.

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.

Routine Care of Human Bite Wounds

QUESTION: While fooling around with some of the boys I was accidentally injured when my hand was cut by his teeth.
Although not a deep cut it was bleeding quite a bit and so I went to the emergency room to have it taken care of.
I was surprised when the doctor did not sew it up but left it with just a dressing.
Was this the right care?

ANSWER: Yes, it was.
The simple fact is that routine care of human bite wounds do not require suturing.
However, they should be scrubbed and cleaned thoroughly to prevent infections, and antibiotics may be prescribed when there seems to be a definite chance of contamination and possible resulting infection.
Despite the fact that some human bite injuries may look fairly trivial, no matter how innocent or superficial the bite appears, a doctor should be consulted.
It is not the extent of the wound that is of chief concern, but the possibility of infection that can follow this type of injury. Untreated wounds often progress to "acute necrotizing soft tissue infections," a condition in which there is much damage from the death of cells which can have devastating effects.
If a bite wound is superficial, the doctor may immobilize the hand after cleaning it, making a splint using a plaster of Paris slab, or using lightweight aluminum or plastic splints.
An oral antibiotic that is effective against the germs that normally are found in such wounds is usually indicated.
The hand should be kept elevated using a sling, and a second visit to the doctor is recommended within 24 hours so that additional evaluation can be be made. If the wound is deeper, treatment begins the same way, with careful cleaning.
If tissue damage has occurred, the dead tissue is removed by a surgical technique called debridement.
Antibiotics are useful here as well. Tetanus vaccination is also administered, to prevent "lockjaw". In the cases where there are severe bites that penetrate a joint or tendon, hospitalization may be required for surgical repair of the wound and the continuous administration of intravenous antibiotics.

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 Are the Causes of Hoarseness?

QUESTION: Can you tell me the causes of hoarseness? Can it ever be anything really serious and how can you tell the serious kind from the ordinary kind?

ANSWER: Most hoarseness comes from a simple viral infection of the larynx or voicebox.
You can tell the common kind because there's no pain and no difficulty in breathing associated with it.
If it has come on suddenly and has only lasted for a short period of time, it is probable that it may pass simply by resting your voice and gargling on a regular basis.
A postnasal drip may create morning hoarseness, resulting from the accumulation of mucous on the vocal cords.
My favorite gargle for these conditions is a teaspoonful of salt and a glass of warm water (except when extra salt is prohibited by other medical considerations).
Frequent gargling brings extra humidity to the larynx and aids in the rapid resolution of the problem.
However, if hoarseness persists for a long period of time, let's say more than two weeks, and doesn't get better with these simple procedures, then your physician will probably perform an examination called an indirect laryngoscopy.
That's the procedure by which he uses a mirror to look down your throat and take a careful look at your vocal cords.
This special examination, plus the presence of other symptoms such as difficulty in breathing, pain in the throat that may be associated with ear pain, fever, cough that can be associated with sputum that is streaked with blood, all indicate the presence of something more serious than common ordinary hoarseness.
The good news is that in 90% of patients who do complain of hoarseness, the diagnosis is the simplest one that has no long lasting ill effects.

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 You List the Causes of Infertility in Women?

QUESTION: Can you list for me the causes of infertility in women? I know that there are many, and that they may frequently be cured, but what type of doctor should I consult for treatment?

ANSWER: You are correct, there are many situations that can disrupt the delicate mechanism that provides for reproduction.
To begin, any disease or process that interferes with the production of eggs (ovulation) must be considered.
If the tubes (Fallopian) that lead to the uterus are blocked by infection, malformations or scars, the egg is unable to reach the uterus. Endometriosis ranks high as a cause of infertility, as does any disease that changes the shape of the uterus.
Fibromas, myomas, and congenital malformation may be the cause of such changes in uterine configuration.
If the production of the cervical mucous is abnormal, fertilization is hampered and impaired.
The type of abnormality causing the problem pretty well dictates the kind of physician who may be able to help you.
If hormonal problems are the primary cause, a gynecologic endocrinologist may be of help, while it takes surgical skills to repair a damaged Fallopian tube or remove a tumor from the uterus.
If you initiate the search for the cause of your problem with your regular family physician, the referral problem will easily be resolved as the cause of the infertility becomes clear.

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.

Nitrous Oxide Use by Adolescents

QUESTION: Our adolescent son has taken to retiring to his room and spending much time alone.
He also has begun to act funny, spaced out, and finally over my protests, his father searched his rooms for drugs.
All we found were some gray tubes that look like the ones used to put bubbles in water, for making sodas.
Does this mean anything? We are desperate for some information and hope you will help us.

ANSWER: You were right in seeking answers for unusual behavior by searching the room of your son.
Forget the guilt feelings, as you have found an important clue that may help you counsel your son, and indeed, may save his life.
You have discovered cylinders of nitrous oxide, or Whippets, which are used by many adolescents to gain a high.
This gas has a legitimate use as a pre-ignition booster in auto racing, or as a propellant for whipping cream, but is also frequently abused to provide a quick "hit", by inhaling the gas either directly from the cylinder or from a balloon which has been inflated with the nitrous oxide.
The intoxication can generate a feeling of exhilaration, lightheadedness and hallucinations.
The abuser's senses become distorted, gradually become lost and with continued inhalation, a loss of consciousness may occur.
The high rapidly disappears as normal room air or oxygen is breathed, but prolonged exposure to the gas can result in coma, seizures and even death.
When this gas is used, many of the skills and senses needed for safe driving become impaired, accidents can occur with the real cause going undetected.
In the long run both the bone marrow and nervous system can become affected.
Your course of action is clear.
You must confront your son with your find, in a considerate and nondamning fashion, offering him professional guidance rather than recriminations.
Inhalant abuse is serious and dangerous, and you must act accordingly.
You took a courageous first step; now follow through, in the best interests of your son and family.

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 Iron Pills Enough Medicine for Anemia Due to Blood Loss?

QUESTION: After feeling listless for some time, and tired of being told how pale I looked, a visit to the doctor revealed an anemia due to blood loss during my monthlies.
I have a prescription for iron pills, but wonder if this is enough medicine? Can you please comment?

ANSWER: It certainly will do the job, if the diagnosis is correct, and I have no reason to doubt a finding of iron deficiency anemia in a woman with excessive blood loss during her periods.
In fact that is the most common cause of this finding.
In men and postmenopausal women, the most common cause is bleeding in the stomach and intestines.
A complete blood count, including hemoglobin testing and blood smears, coupled with a test for blood in the stool is usually sufficient to make a diagnosis, although additional tests may be necessary in some cases.
Capsules of ferrous sulphate should be enough to replenish your iron stores in about three to four months, but your hemoglobin will be close to normal before that, and your listlessness will disappear.
It will be necessary for a few more blood tests to be taken as you continue your medication, as the results obtained will mark your progress and prove that the iron preparation you have been given is being properly absorbed by your 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.

Arthritis of the Spinal Column

QUESTION: My son who is 37 has been diagnosed as having a type of arthritis in which his spinal column may fuse and become one bone.
We are desperate for information that can help him prevent this terrible disease from progressing and robbing him of his youth.
Please help.

ANSWER: Without doubt you are referring to a rheumatic disorder known as ankylosing spondylitis (AS) or sometimes referred to as Marie-Strumpell Disease.
It is a disease that is three times more common in men than in women, and strikes between the ages of 20 and 40 years of age.
The most common complaint of patients with AS is stiffness, particularly in the morning which is gradually relieved by activity.
Although the stiffness may occur in any joint, knees, ankles, shoulders and hips, it is the back that is the eventual target, with back pain of varying intensity, occurring frequently at night.
The term "ankylosis" means stiffening, while "spondyl" refers to the vertebrae and "itis" denotes inflammation.
The disease process is one of inflammation, with the tissues around the joints of the body, particularly the spine, become inflamed and swollen.
This creates the pain, and the patient attempts to reduce the discomfort by keeping the joint immobile, which of course leads to more stiffening.
As the joint attempts to heal, new bone is formed which may eventually join one vertebra to another, but it is the extremely rare case where the whole back bone becomes a single fused bone. Much can be done to help your son.
To begin, the joint pain and stiffness, as well as muscle spasm may, be relieved using NSAIDS (nonsteroidal anti-inflammatory drugs).
In addition a program of daily exercise to maintain both correct posture and flexibility is vital.
The good news is that even in patients who are not correctly diagnosed or treated, the condition may not disrupt their lifestyle or cause a deformity.
However, continued care and attention to therapy can frequently reduce this condition to occasional episodes of back aches and spasm, without deformity or compromised posture.

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.

Frustrated by Problems with Heart and Digestion

QUESTION: I wish I could get an appointment with you just to sit down and talk about my problem, because my own doctor won't.
I am having severe problems with my heart and digestion, and sometimes cannot catch my breath. Instead of dealing with my physical problems, my doctor keeps directing his attention to all types of emotional situations.
Please tell him he is wrong and to pay more attention to me.

ANSWER: I have had to select just a few important sentences from your 8 page letter, but I would like to help you and the many other readers who are experiencing similar problems with themselves and their physician's approach to their problem.
It is pretty clear to me that you are a person who is suffering with a problem you don't quite understand, and feel a bit frustrated that the physician is not dealing with the problems you think you have.
From your long list of complaints that include your stomach, your heart and lungs, your bladder and bowels, and your nerves, it is clear that your problem is a general one that can most probably be related to emotions or, if you will, a psychological problem.
Now, this is not the first diagnosis that must be considered in cases such as yours.
Rather, a complete but delicate consideration of all the possible physical causes of your complaints must be carried through with the laboratory and clinical evaluations that can help to clarify your situation, for anxiety disorders (yes, that is what I think your problem is) can take many forms, and can indeed be provoked by many factors. But your physician by your own account has done just this, and his evaluation has now focused his attention on your problems as they affect your life style. His prescription for "tranquilizers" which you dismiss as being an easy way out is just a beginning of therapy, and the choice he has made for your specific case shows a great deal of insight and thought has gone into the selection.
All tranquilizers are not the same, and until your fears and doubts can be reduced, it is difficult to move forward.
Many other people do have similar problems, and your doctor's statement that he has had success before and his willingness to continue to see you, demonstrates his real concern for your welfare.
When a doctor takes the time to carefully seek out the physical causes for anxiety, prescribe appropriately while continuing ongoing care, and is taking the time to spend with you (no, I don't think a half hour visit is a "brush off"), then you have found a conscientious physician, who can help you if you but give him a chance.

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 Arnold-Chiari Condition?

QUESTION: Would you please give people some information on Arnold-Chiari? I'm 43 and just found out a week ago.
I did have a bone removed 3 years ago that was pinching my spinal cord.
The doctors say they want to wait before they do more surgery.
Can you explain this condition for me and what my outcome will be?

ANSWER: The condition which bears the name of two German physicians who first described it back in the 1890's results from a congenital deformity of the occipital bone, which forms the back of the skull, and the upper end of the spine.
Because the occipital bone is flattened, a portion of the brain may move downward through the large hole in this bone (called the foramen magnum) and come to rest in the neck portion of the spinal canal.
This can provoke a wide variety of symptoms, including headaches, vomiting, visual troubles including double vision dizziness and sometimes weakness of the arms and legs. Although these problems may develop during childhood, the symptoms start most often in adults between the ages of 30 and 60.
It affects both sexes with about equal frequency, and the reason for the changes in these bones is still unknown.
Physicians may use a number of techniques to discover the extent of the condition, including myelography.
This technique uses x-rays and a radio-opaque substance (sometimes misnamed a "dye") injected into the space in the spinal cord to obtain a picture of the location of the brain tissue.
CT scans have also proved useful.
The need for additional surgery will depend upon the findings of these tests and your own condition.
If the first operation was sufficient to remove your symptoms, more surgery may not be necessary, and waiting is just fine.
It is hard for me to predict an outcome, for this varies greatly with the individual and the extent of the changes in your structures; but a frank and open discussion with your physicians, who seem to have the situation in hand, should provide you with their opinion.
I would hope they could give you an optimistic report, for this condition can be helped.

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 MSG?

QUESTION: I've heard that many people get sick after eating Chinese food because they have a bad reaction to monosodium glutamate.
What is MSG? Why isn't it banned if so many people get sick from it?

ANSWER: It has never been proven conclusively that monosodium glutamate makes people sick.
MSG is a popular flavor enhancer, not only used by the Chinese in cooking, but in many prepared foods.
MSG is most often made from molasses derived from sugar beets.
The molasses is fermented to form the flavor enhancer. MSG has gotten a bad name following an outburst of publicity about something known as Chinese Restaurant Syndrome.
After eating at a Chinese restaurant, many people report symptoms such as chest pain, dizziness, lightheadedness, headache, palpitation, weakness, nausea and vomiting. Researchers investigating these symptoms found that MSG in ordinary quantities produced only transient symptoms in a small percentage of problems.
They suggested that many of those experiencing Chinese restaurant syndrome had taken in MSG on an empty stomach, and that may have caused the adverse reaction.
Individuals sensitive to MSG were found to have no reaction to the additive if they ate a carbohydrate, such as bread, before consuming MSG. The Food and Drug Administration has not banned monosodium glutamate because it is not viewed as a health problem affecting a significant percentage of the population. Studies in the early 1980's, in fact, showed that MSG is quite safe. However, I don't doubt that there are a number of people who are sensitive to MSG and who must remain alert to its presence in food to avoid unwanted and unnecessary reactions.
They must firmly request that their choices be prepared without adding this product or, very simply, eat at another type of restaurant.

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 Special About Delayed Muscle Pain After Exercise?

QUESTION: If I exercise for any length of time, I can develop a muscle soreness that doesn't show up for two or three days.
Is there anything special about this pain and what should I do to treat it?

ANSWER: This is called delayed-onset muscle soreness and is thought to be caused by structural damage to muscle fibers after a certain kind of exercise, and this damage takes longer to heal. When you lift a weight your muscles contract and you produce a force to raise the load against gravity, which is called "concentric" exercise.
But when you lower the same weight your muscles produce the same amount of force to slow down the descent of the weight, which is called "eccentric exercise." Sports and exercise physiologists now believe that delayed-onset muscle soreness is caused by structural damage to skeletal muscle after eccentric exercise, in which muscles produce force while lengthening, as in running downhill. This damage may take as long as 12 weeks to be repaired by the body.
So athletes should allow plenty of time for recovery after events that may cause extreme muscle soreness.
Patience, along with heat, the appropriate use of analgesics and rest will be your allies in your recovery. Because training that involves eccentric exercise has been shown to prevent delayed-onset muscle soreness and muscle damage, you should pay special attention to the eccentric part of any exercise or sports you engage in.
For runners this would mean running downhill during training as well as uphill.
This will strengthen the eccentric part of your leg muscles, and thus help prevent structural damage.
And prevention is always the best medicine.

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 Difference Between a "Myomectomy" and a "Hysterectomy"?

QUESTION: It is probably only a difference in terminology and are really the same thing, but I need to know the difference between a "myomectomy" and a "hysterectomy".
My medical dictionary didn't make it clear enough.
Please help.

ANSWER: No they are not the same thing at all, although both are surgical operations, both deal with the same organ, the uterus, and both terms frequently occur in the same discussion.
A hysterectomy refers to the surgical removal of the uterus (the word "hystera" in Greek means uterus). Frequently, the uterus forms benign tumors of muscle and fibrous tissue, in a condition commonly referred to as "fibroids" or "a fibroid uterus".
These tumors are called "myomas" since "mys" in Greek means muscle.
When a patient suffers from this condition, the surgeon has two choices.
If the tumors are small, but creating problems such as cramps and bleeding, only the tumor need be removed (hence myomectomy).
But when the tumors are large, and are continuing to grow and cause suffering and pain, and particularly when the patient no longer wishes to bear children, a hysterectomy may be performed to solve the problem.
A well informed patient may have a choice in the decision, provided these terms are not "Greek" to her.

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.

Fear of Returning to a Psychiatrist

QUESTION: A couple of years ago I experienced many symptoms that I let go unchecked for a long time.
I did a lot of crying because I was scared and confused.
I ended up by seeing a psychiatrist who prescribed an antidepressant for depression.
I only took one pill a day because it made me feel different.
I should have taken all the medication that the psychiatrist prescribed but I was scared to, and didn't return to the doctor.
Now I am afraid to return to him and tell him this story, though I still feel foggy. Please help me?

ANSWER: Each time I receive a letter like yours, I too, feel sad and a bit frustrated.
I wish that there was some way to set up a conference call between you and your psychiatrist, so that the lines of communication which have been disrupted can be restored and get you on the road back to health and happiness.
So I will use your letter in an attempt to get the message across to my many readers who are in the same fix.
I think the diagnosis of depression was a correct one, and the medications would probably have worked fine if given the chance.
However, many medications used to combat this problem take a bit of time to work, some as many as three weeks before their effects can be noticed.
But that time can also be used to advantage, for you to express your fears and doubts to your physician, and get another point of view and counsel that can be helpful.
With the medication beginning to help, some of the fears that have been bottled up for so long inside can be brought to light, examined and re-evaluated.
Change comes slowly perhaps, but each small step leads you a bit closer to understanding, and to readjusting what must be fixed so that you can go on alone and independent, with feelings of courage and self confidence.
It isn't easy, but it works for many, many patients.
It may be that you are selling your psychiatrist a bit short.
I sincerely doubt that you will get a lecture on "listening to the doctor", but rather a sensitive and caring discussion about your needs and your fears. Rather than tell you that you were wrong, I would rather look at this situation as something you did right.
You had the courage to seek medical care when you needed it, and you have now reached out to me for more help. Now pick up that phone, and make another appointment with your physician.
No need to apologize, just admit to yourself that you still need help and want to get better.
Then open the lines of communication which are so important in caring for the illness of depression.
Speak of your thoughts and fears, without shame or guilt, and move on with the process of of getting better and grabbing for some of the fun and joy that exists in every life.
Yes, K., I am talking to you in the only way I can, through this column.
I know with absolute certainty that you can be helped, and that you will be better.
More than that, your story can serve as encouragement to many others who feel frightened and depressed, as you do, to reach out for the help that is available to them.
When medications are prescribed that leave you with funny feelings, call the physician promptly.
It may only take a minor adjustment in dose, or the time of day that the pills can be taken, to alter the effects and remove those unwanted feelings.
There are many ways of caring for patients who are depressed, and each treatment must be adjusted to the needs of the individual.
The good news is that they can be, and that they work.
There is no bad news.
Take my advice.
Give both the medication and the physician the opportunity to make you better.

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.

Methods of Taking and Evaluating the Pulse

QUESTION: When my physician finished examining me, he informed me that all was normal, including my pulse and that I was in good physical condition.
Yet he never even took my pulse, and I am wondering about his conclusions.
Can you please comment on this in your column?

ANSWER: I think that many people believe that the only method of taking and evaluating the pulse is by placing a forefinger on the easy to find radial artery located just above the wrist.
After all that is what is shown on television and in the movies.
But there are many places to check a heart rate, by counting the pulse beats, that include not only the wrist, but the upper arm (brachial), the neck (carotid), the groin (femoral) and many others. The pulses are caused in the arteries by a wave of pressure, created by the contraction of the heart, and may reveal the presence of disease of the valves of the heart when they are abnormal.
When the pulse is absent, in the ankle for example, it means the the flow of blood to that area has been shut off or diminished by a disease process, and is an important clue to be followed up by more complicated and revealing tests.
The character of the pulse, tapping, bounding, collapsing, or slapping, the rapidity of the rate, and the comparison of the pulse on one side of the body with its mate on the other all have different meanings to your physician, and their evaluation permit a report, in your case, of "normal".
It is probable that your physician may have checked your pulse several times, while you were unaware that his attention was on this important physical sign, used as part of the total evaluations included in every good physical 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.

Does "Skipping a Beat" Indicate a Future Susceptibility to Heart Trouble?

QUESTION: I'm a 36 year old female in good health.
For the past 3 or 4 years I've been experiencing and irregular heart beat (skips a beat).
This occurs anywhere from 2-3 times a day to 2-3 times per week.
My EKG and blood work were all normal.
Does this "skipping a beat" indicate any future susceptibility to heart trouble or is it damaging of itself?

ANSWER: Any irregularity in the beating of the heart can certainly cause anxiety in the patient and warrants a full work up, which you seem to have already undergone.
An accurate diagnosis of the type of beat which is causing your "skipping" may only be made after studying the the electrocardiogram, and you report this as normal.
That leaves me with the impression that you are experiencing occasional premature beats in the rhythm of your heart, followed by a pause which makes it feel as if a beat was skipped.
Some people describe this as a palpitation, others as a flutter but the most common complaint describes it as a skip.
When the source of the extra beat is in the ventricle; it is named a ventricular premature beat (VPBs), and while this is a frequent finding in many types of cardiac disease, it is also common in people with otherwise normal hearts.
One study has shown at least one such beat in a 6-24 hour EKG in 20 percent of men 35-40 years of age, randomly selected from a population of actively employed American men.
When a complete examination can discover no sign of disease of the valves of the heart, and no evidence of suffering of the heart from a lack of oxygen, there is a general consensus among medical authorities that there is no need to treat the condition, particularly when there are no other symptoms.
The skipping itself is not damaging to the heart, nor does the presence of such a beat now make you any more likely to suffer with "heart trouble" later in life.
However, prudence would indicate regular examinations to keep an eye on the situation and hold your anxiety level down.

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.

Bang's Disease from Raw Cow's Milk

QUESTION: I am a farmer and am having severe chills and heavy sweating at bed time.
My neighbor says I could have Bang's Disease as we use our cow's milk directly from milking.
What do you think?

ANSWER: Sounds like your neighbor knows a thing or two.
Fever, chills and heavy sweating, along with headache, generalized aches and pains and occasionally diarrhea can be the signs of Brucellosis, caused by the Brucella abortus bacteria found in cattle (where it is called Bang's Disease).
It is a disease that is seen in farmers and livestock producers as well as meatpackers who come in contact with infected meat or cows.
It is not usually transmitted from person to person, but by direct contact with the secretions of infected animals.
The fever can last on and off for as long as 5 weeks, then subside for a week or two, only to return again.
It is possible for these cycles to continue for years, causing prolonged ill health, although the disease is rarely fatal.
You have two tasks at hand.
The first is to visit your physician for an accurate diagnosis and treatment, as antibiotics are effective in controlling the disease.
The second task is to have your animals examined by your veterinarian, so that the source of your infection can be removed.
Without this important step, other members of your family may become infected.
Pasteurization of milk removes the danger for those who get their milk at the store.

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 Reddish Colored Urine a Sign of a Tumor?

QUESTION: I have recently noted that my urine has taken on a reddish color, and I am sure that this must be the sign of some type of tumor in my kidney. I don't have the resources to go through a lengthy and costly diagnosis, and I am hoping you might provide me with some idea of how I might find out what's wrong without spending my life's savings.

ANSWER: You are putting the cart before the horse, making the worst possible diagnosis an obstacle to obtaining a few simple and inexpensive tests that might prove that your fears are without foundation.
There are many things that can color your urine that have no serious implications.
Some foods (beets, blackberries and rhubarb) can impart a reddish hue to urine, as well as certain medications (quinine sulfate, Pyridium, and rifampin).
If you are on anticoagulant medication such as coumadin or heparin, they may be the cause of red blood cells in your urine.
Although there are many conditions that may cause bleeding in your urinary tract, tumors are amongst the most rare.
You must see your doctor, and have a simple test performed to determine if indeed there is blood there, and allow him to take a full history and perform an examination that may provide the clues to a diagnosis that is far more benign than you now fear.
An easy to cure bladder infection may be the cause.
There may be no need for expensive tests, but if the situation warrants it, then you are merely sticking your head in the sand if you ignore the warnings.
Of what use are your savings to you, if you are not here to enjoy them?

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

Isn't There Any Simpler Way to Prevent Heart Attacks?

QUESTION: A recent heart attack has me very worried about having another, and I want to do all that is necessary to prevent that from happening.
My problem is that some of the advice I am getting from my doctors seems almost impossible to carry out, since it involves changing so many of the things I was doing before.
Isn't there any simpler way to prevent heart attacks, a pill or something that is a bit "easier to swallow"?

ANSWER: I wish there was some simple way to prevent heart attacks, or for that matter, any disease or condition.
My problem is that I try to address these situations with only the knowledge gained from science, not mere wishful thinking.
It may make my answer a bit harder "to swallow," but at least you know where I am coming from.
Your doctors are probably telling you that a variety of life style changes are effective in reducing the chance of a recurrence of your heart attack.
They include giving up tobacco, lowering your blood pressure, losing those extra pounds, changing your eating habits to lower your cholesterol and decreasing the ratio of total cholesterol to the "good" high-density lipoprotein in your blood, controlling stress, and finally, increasing your level of physical activity by starting an exercise program.
The evidence that reduction of such risk factors will reduce the chances of another attack, as well as the possibility of stroke or other cardiovascular disease, is quite clear.
The problem is developing these actions into a program that you, as the patient, can accept and carry out. That means a bit of work on your part, that can be a bit easier if you will develop the necessary attitudes, and understand the reasons for each bit of advice.
Once you truly believe that the change in behavior will have a positive result for you, you must make a conscious decision to adopt that change and carry it through.
When temptation comes knocking on your door, remember the importance of your newly adopted actions and resist.
While your physicians may counsel and advise you, and prescribe any medication necessary, the responsibility for life style changes must be yours.
I would be the last to tell you that this is all easy, but the importance of such actions is enormous.
It all becomes a bit clearer and simpler when you take a long hard look at the alternative.

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.

Red Nose and Cheeks

QUESTION: I am too embarrassed to ask my boyfriend why his nose is fiery red and swollen.
He also has red splotches on his cheeks.
I don't think he is an alcoholic.
He is elderly, active and to be in good health.
Would you care to offer an explanation?

ANSWER: I am happy that I have an answer for you that can be quite reassuring.
You have clearly described a condition called "rhinophyma;" the term derived from Greek words "rhino" for "nose" and "phyma" meaning "growth". It occurs as a result of a skin condition rosacea which is a chronic inflammatory disorder that affects the central areas of the face, and particularly the nose.
The areas become red, with widened blood vessels apparent, and pustules and papules appearing in the area as well.
The nose tissue begin to grow, appearing swollen and sometimes misshapen.
The cause is still unknown, but it usually appears after middle age and is most common in individuals with fair complexion.
Although commonly thought to be a sign of an alcoholic, this is not true, and many nondrinkers suffer with this condition.
Diet probably has nothing to do with it either.
It can be treated, and long term use of tetracycline antibiotic is frequently recommended and may be quite effective, since a single dose once a day may be enough to keep the condition in check once control has been achieved.
A topical cream of metronidazole may also be applied locally.
If the shape of the nose has become a cause of concern, surgical correction may be used to reshape its form.
The presence of this disorder is not a sign of any other health impairment, and so the good health your boyfriend apparently enjoys is probably real.
Since there are treatments available, I hope he reads this column and avails himself of them.

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

How Accurate Are Home Blood Pressure Monitoring Devices?

QUESTION: I am considering purchasing the equipment to measure the blood pressure of my husband, who has a mild hypertensive condition, and have noticed a number of different devices in the local pharmacy.
How accurate are they, and how can you be sure of getting accurate results when using a home monitoring device?

ANSWER: That is a fine idea, for it can help greatly in helping your husband deal with his condition.
Home blood pressure monitoring devices give hypertensive patients an immediate idea of how well they are doing with their medication program.
They also help the patient's doctor by making creating a record of daily readings so that he can evaluate, in an ongoing fashion, the progress of the patient. Three different types of instruments are currently available for home use.
All three are packaged in kits that contain a blood pressure cuff, and, if necessary, a stethoscope. The first of these devices, the mercury sphygmomanometer, is calibrated by the manufacturer so that the top of the mercury column stands precisely at zero when the cuff is deflated.
This device is considered the most accurate and reliable of the three.
If the mercury column is soiled or does not rest at zero, the instrument should be returned to the manufacturer for recalibration. Nonelectronic aneroid manometers cost less and are accurate if properly calibrated.
They should be calibrated once every year against a standard mercury sphygmomanometer. The newest choice for home blood pressure monitoring is one of the many electronic devices that provide a digital readout and do not require a stethoscope.
Some are fully automated so that the push of a button inflates and deflates the cuff.
These are particularly useful for persons with hearing deficiencies or those anxious about the to use of a stethoscope, or even just for those who wish to have an instrument that is easy to use. Moving the arm, failing batteries or incorrect placement of the cuff can cause erratic measurement, so before an unusual result leads you to assume the worst, be sure to test your pressure a second time.
False readings may also result from an ill-fitting cuff, so choose the right size if you are given a choice.
Also, a noisy environment may cause a high reading.
Recordings more than once or twice a month are generally unnecessary for hypertensive patients, who should expect some normal daily fluctuations in pressure. However it does make sense to check the pressure under the same conditions each time, so that comparisons are valid.
Pick a time of the day when stress is at a minimum to obtain a good base line reading. There is one additional benefit from using these devices which isn't always written about.
Just using the instrument reminds patients that they should be taking their medication on a regular basis, even when they are feeling fine, for that's the best way to keep those readings down!

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.

Haunted by the Fact That Heart Attacks Are Frequent in Family

QUESTION: I am haunted by the fact that heart attacks are frequent in my family.
My father passed away at the age of 52 as the result of a heart attack, and now my older brother has had his first one.
Isn't there anything I can do to prevent it in my case?

ANSWER: Very possibly.
Many doctors believe a person can lower his/her risks of such attacks by following good health rules.
There are some things that cause heart attacks risk factors you cannot change: age, sex, race, and a family history of heart disease.
Nevertheless, there are causes that depend entirely upon you, and those are the ones you will want to work on as they can really make a difference. In the past 20 years, certain types of heart conditions and deaths from them have decreased in this country.
That is due to many things, including: improved diagnostic methods, medications, bypass surgery, and better understanding of what role some risk factors such as age, sex, smoking, high blood pressure, high cholesterol levels, obesity, diabetes, nonexercise, and other things, actually play in heart attacks. About 85 percent of all heart disease cases in the United States may be attributed to modifiable factors, including smoking, high blood pressure, high cholesterol levels, alcohol, salt, oral contraceptives, and obesity. So stop smoking and being around those who do as much as possible. Cigarette smoking is the single most preventable cause of heart diseases and deaths from them in the United States.
If you have tried "everything" to quit smoking but have not been able to do so, talk with your physician. Seriously curtailing excessive alcohol use and eliminating as much salt, sugar and animal fats as possible from your diet also can help decrease chances for an attack by lowering your blood pressure and cholesterol. Increasing consumption of fish some say as many as three meals of fish per week are needed may prove beneficial in lowering cholesterol levels. Also, if you are sedentary, slowly but steadily increasing exercise that you do on a regular basis (try three times each week) can be helpful. Obesity raises blood pressure weight loss helps reverse it.
Also, obesity goes hand in hand with increased cholesterol levels and possibly other heart-damaging conditions. If you are obese, you must lose weight to be healthy.
Weight loss will be easier for you if you increase your exercise at the same time, and stay with the exercise after you have become thin to help you keep the fat off and maintain your health. Additionally, many believe that taking one aspirin daily can help prevent heart attacks in some people suffering from hardening of the arteries who have several known heart attack risk factors. So you see, it may not be the easiest thing to do, but by applying all of the tips I have given you here (or at least some of them) you can actively wage war on the disease you fear, and increase your odds to the point where you may never suffer from 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 the Correct Method for Using Nitroglycerin Ointment?

QUESTION: I have been a sufferer of angina pectoris for several years. Recently, for the first time my doctor prescribed an ointment of nitroglycerin to use for my condition.
When I decided to spread it carefully over my heart where it would do the most good, my wife wanted to put it all over my chest, like some cold medicine.
Which is the correct method?

ANSWER: Nitroglycerin absorbed though the skin uses a route of administration called "transdermal" rather than "oral" or "intravenous", and can afford you its benefits for a longer period of time than the "under the tongue" pills or capsules.
In order for it to be absorbed correctly, you must cover an area of skin that is sufficiently large to do the job, about 6 inches long by 3-6 inches wide.
It doesn't necessarily have to be placed over your heart, for any place on the chest will work just as well.
You might even use the upper portion of your arm or back (but stay away from skin that is too hairy).
The ointment will begin to take effect in about 30 minutes and the effects continue for from six to eight hours.
Use the wax paper that comes with the tube, as it usually has markings that will indicate to you the size of the area that should be covered.
Then attach the wax paper to your skin with adhesive tape.
Try not to get the medication on your fingers since it can be absorbed from there too, and increase or cause side effects.
When you are ready for the next application, remove the wax paper, wash the skin carefully, and then apply the next dose to another site on your chest.
This will help to avoid possible skin rashes that can be caused by both the ointment and the tape.
To keep peace in the family you can alternate sites between your heart area and anywhere else on your chest your wife wishes to place this effective and important medication for your condition.

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

A Question of Ear Protection for High Noise Levels

QUESTION: I've just started a new job, quite different from anything I have done before, where the noise level of machinery is very loud.
It is only a small shop, and one of the older men who has been there for quite a while assures me that I will soon be used to it.
I don't want to make any waves, but do you think I should be thinking of protecting my ears from the sound in some way?

ANSWER: While taking the advice and counsel of a long time employee usually makes good sense, this time you are literally asking for trouble.
The probability is quite high that the reason this man has become "used to it" is that his hearing is already damaged, a condition which is permanent and without effective treatment.
The intensity of sound is measured in decibels, the faintest sound a human ear can normally hear labeled 0 dB, while normal speech or the sound of a typewriter or sewing machine measuring about 60 dB. If you must endure levels of 85 dB or above the chance of hearing lost is there, and with each increase in sound levels the risk increases dramatically. The Occupational Safety and Health Administration requires a hearing test for workers who must labor in environments which average 85 dB or more during an 8 hour work day.
If you're working with shop tools, that level is about 90 dB, while using a chainsaw or pneumatic drill puts you under a 100 dB load.
Work at this level without protection for your ears is legally limited to but 2 hours a day.
If you must stay close to such noise for a longer period of time each day, hearing protectors in the form of either ear plugs or earmuffs must be provided to you without cost.
These devices, when properly fitted so that the ear canal is totally blocked, can reduce sound levels by 15 to 30 decibels and provide you with important protection against hearing loss.
It is not a question of making waves in a new position, but in protecting your valuable hearing against permanent loss.
Proceed diplomatically, but make sure you do obtain the protection that the law provides and that your ears require.

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.

Aren't Heart Murmurs Signs of Serious Heart Disease?

QUESTION: Though I have never been told before that I had a murmur of the heart, at age 78 my physician has now discovered one.
He has been very careful in examining me and taking all types of tests, including a cardiogram, and now assures me that I have nothing to worry about.
I thought that murmurs were signs of heart disease.
Could it be my family physician is just being gentle with an older man?

ANSWER: Not at all; it sounds like he has taken all the steps necessary to satisfy both you and himself of the reasons which provoked the sounds he has detected.
Heart murmurs are merely sounds produced by the flow of blood through the chambers of the heart, and around the valves of the heart which control the direction of blood flow.
When the smooth flow is disturbed by changes in the structure of the heart or its valves, a turbulence is produced which generates the sound that can be heard through the stethoscope.
Not every murmur is caused by a serious disease or pathology.
Many can occur with the changes in the heart configuration that age brings on, and are not a cause for alarm.
However, the reassurance that your family physician has offered you is not based upon chance or speculation, but the test results that can only be evaluated fully when a complete examination and history have been accomplished.
The changes that affect the sounds your beating heart produces may occur in the lungs and chest wall as well as your heart, and may be affected by your posture.
Some sounds can be more clearly heard when you are squatting, or standing, as well as deep inspiration and expiration.
It is only when all possibilities have been explored and carefully considered that a physician may reassure the patient, as was the situation in your case.
He isn't just being nice, he has been careful, concerned and professional as well.
You can trust him.

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.

Aspartame Use and Danger of Mental Retardation from Diabetes

QUESTION: My four year old grandson is an insulin dependent diabetic.
In an effort to keep sugar consumption as low as possible, he is permitted to have desserts and drinks containing aspartame.
I have read that aspartame may interfere with chemical production and control by the brain.
What are the implications for a child already in danger of possible mental retardation as a result of the diabetes itself?

ANSWER: I read your concern and apprehension about the welfare of your grandchild with great sympathy, and will try to present as much information as possible to reduce your anxiety.
While it is true that young patients with insulin dependent diabetes face a lifetime of strict diet control and supervision of medications, and that many complications may lie on their path, the fear of mental retardation is not one of them.
I have tried to link your statement with a long list of possibilities that might occur from the disease, reactions to medications, or periods when control of blood sugar levels is lost, but there are no implications that exist that could be interpreted as producing mental retardation.
I can only interpret that fear as the result of some misunderstanding about the course of the disease.
As for the use of aspartame, the story there is a long one that began when it was first approved as a food additive by the Food and Drug Administration (FDA) in July 1974. Five moths later, in view of questions concerning the possibility of cancer producing effects, approval was withdrawn.
Another long period of testing and questioning continued until 1981, when it was determined that those fears were unfounded, and aspartame was again recertified as a sweetener in certain foods.
It was approved for use in carbonated beverages in 1983.
The process by which the FDA approved aspartame for use was investigated by the United States General Accounting Office which issued a report in 1987.
That report concluded that the FDA followed proper procedures in establishing the safety of the chemical, and that adequate follow up studies were ongoing to monitor its effects.
In 1984 the Centers for Disease Control evaluated over 500 complaints about side effects from aspartame, but could find no specific group of symptoms that might be caused by the use of this sweetener.
I am sure there are many individuals who have had some undesirable results from the use of aspartame, but for the overwhelming majority, the current scientific evidence would indicate that it is safe for use, even for youngsters like your grandchild.

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.

Misled by Needle Biopsy of the Thyroid Gland?

QUESTION: A friend of mine told me of a recent experience with her physician during which he performed a biopsy using a needle which he injected into her thyroid gland.
She was happy that no cancer was found.
I know that a biopsy requires the doctor to cut some tissue, to obtain a sample for testing.
How do I tell my friend that she has been misled?

ANSWER: You don't have to because she hasn't.
In essence, her story is completely understandable when you realize that all biopsies do not require removing tissue by surgical techniques.
The object of course is to obtain cell specimens that may be examined under a microscope, searching for signs of abnormal growth that signal the presence of cancer.
In some cases these cells may occur in urine and sputum, or be obtained by scraping (for example, the technique used for a Pap smear).
When cancer is suspected in the bronchial tubes, a technique known as "washing" is used to gather material for examination.
While the most common use of the word "biopsy" relates to obtaining specimens by excision, it may also apply to the method used by your friend's physician.
It is called "Aspiration Biopsy" and is frequently used to search for cancer in the thyroid.
In this technique, the physician inserts a fine needle into the mass, and rather than injecting anything applies suction through the syringe, while moving the needle back and forth in the suspicious mass.
In this way cells are loosened and sucked back into needle. This material may then be used to prepare a slide for microscopic examination. While the number of cells are few, an accurate diagnosis can be made in most cases.
The procedure is rapid, safe, and does not leave a scar.
If necessary it may be easily repeated, as it does not require hospitalization or special equipment.
You can now relax and be confident that the good news your friend received from her doctor was valid.

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.

Red Wine and Migraine Headaches

QUESTION: I suffer from migraine headaches on an irregular basis.
However, one little glass of red wine and I am down for the count.
What puzzles me though is that my girlfriend, who also suffers with migraine, can drink regularly with no ill effects whatsoever.
Do you have any explanations for this puzzle.

ANSWER: Many migraine sufferers have similar stories to tell, for research tells us that about 25% of patients with this painful and disabling type of headache relate the onset of an attack to some specific beverage or food.
The chief culprit is identified as alcohol, but even here there are some notable differences.
Many patients can get by with a drink or two from time to time, but those who drink red wine are generally the ones with acute onset of headache, usually within three hours after imbibing.
White wine drinkers do not suffer similarly, nor do those who drink other forms of alcohol, such as vodka or even beer.
We know that red wine contains certain substances not found in other alcoholic drinks.
One such chemical that is frequently thought to be the cause is tyramine, which has an action in the body similar to adrenalin.
Another group of chemicals found in red wine are the flavonoids, that produce the color of the wine, and they too can be the cause of your problem.
In general the rule is simple; if a food or drink causes the onset of a migraine, you should drop it from your diet permanently.
It might be interesting to compare your choices of beverage with your nonsuffering girlfriend and see if this explanation answers the question in your case.

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 "Pickwickian Syndrome"?

QUESTION: As you once observed in one of your columns, much can be overheard when doctors discuss medical affairs.
Such a situation recently occurred when I heard the term "Pickwickian syndrome" mentioned.
As a lover of the works of Charles Dickens, I know there must be a "tale" here somewhere.
Do you know it, and will you share it with your readers?

ANSWER: Yes, I am aware of the syndrome, as are most physicians; for it is a commonly encountered situation in practice.
The condition, which consists of obesity, sleep apnea (a sleep disturbance in which breathing stops for 10 seconds or more, sometimes more than 300 times a night), impaired respiration, heart failure and daytime drowsiness, occurs in about 10% of obese adults, but is rare in obese children.
The name for the syndrome was first suggested by Sir William Osler and was more fully described by Drs.
C.S.
Burwell, E.D. Robin and R.D.
Whaley in a paper that appeared in the American Journal of Medicine in 1956.
It is based upon the Charles Dickens novel, "The Posthumous Papers of the Pickwickian Club" written in 1837, in which he describes a character that goes by the name of Joe, a "fat, red faced boy in a state of somnolency".
Joe goes to deliver a message, knocking loudly at the door.
By the time the occupants answer the summons Joe has fallen asleep, and is found standing at the entrance snoring.
Since heavy snoring, as well as compulsive eating and headache, all form part of the symptoms of the syndrome, Dickens' description seemed appropriate and Osler's suggestion has been widely accepted.
We know know that the condition is more than just a drowsy, snoring, fat boy, yet the name is firmly fixed, and medical students still dutifully memorize and remember all the signs and symptoms involved as the Pickwickian Syndrome.

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.

Doesn't Anyone Know Anything About Premenstrual Tension?

QUESTION: I know that something is wrong, for my life before my period is due is truly hell.
Yet when I try to get help from my physician, I am left frustrated and as unhappy as before my visit.
Why is this? Doesn't anyone know anything about premenstrual tension?

ANSWER: Although much has been written and many studies conducted to investigate premenstrual syndrome, the origins and best ways to treat still defy attempts to classify this disturbing ailment.
It may be that there is no single syndrome, and that the physical, emotional and behavioral changes that occur just prior to the menses may be due to a variety of different factors that affect each woman in a unique fashion, and with differences in intensity and timing.
Since the symptoms vary, it is clear that it is important to document these premenstrual changes (PMC) and to be certain that other conditions that could cause these problems are not the real reason for the symptoms.
The symptoms of premenstrual syndrome (that's PMS) are many and varied, but can be placed into nine categories.
I'll list them for you, and provide a few samples.
AFFECTIVE symptoms include anxiety and irritability, while BEHAVIORAL problems include decreased motivation and efficiency.
The AUTONOMIC nervous systems may provoke diarrhea, nausea and palpitations, while symptoms from the CENTRAL nervous system include clumsiness, dizziness and tremors.
DERMATOLOGICAL symptoms include acne and dry hair, while disturbances in FLUID/ELECTROLYTE balance cause bloating, edema and weight gain.
COGNITIVE symptoms include indecision, paranoia and even suicidal thoughts, while the NEUROVEGETATIVE system sees changes in libido, food cravings and lethargy.
PAIN symptoms can cause breast tenderness, headache, and joint and muscle pain.
Most clinicians agree that to make a diagnosis of PMC, symptoms should begin during the luteal phase of the menstrual cycle, which occurs after ovulation, and usually lasts for about 14 days during the last half of the cycle, the symptoms should disappear shortly after the start of menstrual flow, and there should be a symptom free period during each cycle that lasts for at least one week.
Treatment should be attempted when the symptoms occur during almost every period and when there is some impairment in normal function.
The symptoms that accompany menstruation are experienced by almost all women (97% in one study), but are severe in only 2% to 10% of women of reproductive age.
Getting a handle on a condition as perplexing as this one requires a thorough history and physical exam as a starting point.
You may want to keep a symptom diary to aid the physician in understanding the frequency and severity of each symptom, when they occur, and what may have set them off.
Daily morning weights are useful in calculating water retention problems.
A complete record of this type should be kept during a minimum of two cycles.
Treatment will have to be highly individualized to be effective and may use both nondrug strategies as well as medications.
Relieving stress by changing life styles, particularly during the second half of the cycle, may be an important first step, while eating nutritionally balanced meals may help.
These actions may play an important role in overcoming some of the symptoms, so that consideration of possible medications for the remaining complaints may become a bit simpler.
Properly used hormones, diuretics, antidepressants and antianxiety agents may offer the relief you are seeking. It is a long and difficult road, without the knowledge we need, but the outcome may make it worthwhile.

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.

Do People With Several Personalities Really Exist?

QUESTION: After watching a recent television show about a person with several different personalities, I began to wonder if such people really exist.
It made for interesting watching but the whole thing seemed quite bizarre.
Would you please provided some clarifications?

ANSWER: It is a fascinating area of mental care, and yes, such patients do exist.
The condition is called Multiple Personality Disorder (MPD) and reports of such cases are appearing with ever increasing frequency in the medical literature.
Perhaps the expanding number of diagnoses are the results of more clearly defined guidelines that help delineate the condition and make the process of diagnoses just a bit easier, but by no means simple.
One of four conditions in the class of dissociative disorders, MPD sees an alteration in the area of self identity, and the patient will display characteristics and expressions of separate and different personalities or identities.
Each personality has its own story and life experiences, but will not remember the events which occurred in another identity's existence.
Physicians may use 4 types of signs to help identify MPD patients: physiological, psychological, behavioral and environmental signs.
For example, when there is a history of wide ranges in blood pressure, or blood sugar levels from visit to visit (physiological findings), physicians may be alerted to the possibility of MPD. Psychological signs include significant time lapses or lack of memory for past serious illnesses.
A patient's behavior may manifest changes by alterations in voice tone or sound, or the way he stands or walks.
Environmental signs are sought in the history of traumatic life events, child abuse, or changes in home situations and locations.
The treatment of such complex disorders require specially trained individuals who can understand and deal with the particular needs of these complicated patients.

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.

Colonoscopy Procedure Recommendation

QUESTION: I have been having an ongoing problem with my bowels, and have been most diligent in following my physicians' (I now have more than one) instructions.
We have been through a barium enema and a sigmoidoscopy, and now a colonoscopy is being suggested.
My problems are real ones, and I will go forward, but can you tell me the reasons this test may be necessary.

ANSWER: You sound like a reasonable patient, and your physicians appear to be doing a step by step evaluation of your problem.
That's fine; it's the best way to get to the answers you need for a diagnosis and proper treatment.
I can't second guess your doctors, nor would I want to, so my answer will be straight from the text book.
Please don't interpret any of these indications as a diagnosis, for that you must obtain directly from your personal counselors.
Colonoscopy is an excellent procedure for diagnosing difficult cases of bowel trouble, since it enables the physician to directly view almost the entire length of the colon.
It is particularly valuable to clarify findings of a barium enema which may have been too indistinct to interpret with any degree of certainty.
It is possible to obtain tissue samples during the colonoscopy (a biopsy) that may be analyzed under a microscope.
When chronic, slight bleeding is the worrisome sign, the exact site may be located through the scope.
Should the source of the bleeding be from a small polyp, it can be easily removed during the examination.
Some individuals with chronic situations such as ulcerative colitis and inflammatory bowel disease may require colonoscopy to discover the extent of their disease, or if changes that could lead to malignancy are occurring.
Many physicians develop methods of evaluation and diagnosis that use their personal skills most effectively, and will recommend procedures that are of the greatest benefit to their patients.
You have apparently come a long way, hopefully the answers you seek are just around the corner.

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.

Colposcopy Confusion

QUESTION: The results of my recent PAP smear were not all that either my physician or I could have wished for.
Now he is proposing a colposcopy examination, but I thought that was for rectal cancer.
Can you please explain what he is suggesting, what he hopes to accomplish and if you think it is a good idea?

ANSWER: You have got your scopes just a bit confused, but that's understandable.
It is a colonoscope that is used for rectal and colon examinations.
The colposcope (from the Greek word kolpos referring to the vagina) is very much like a binocular microscope with special ability to light the vagina and particularly the cervix at the end of the vagina.
The tissue that forms the covering of the cervix may be clearly seen, and it was this tissue covering that gave rise to the cells seen on your pap smear that are causing the anxiety.
With this instrument, your physician can identify any abnormal patches of tissue, take small pieces for examination (biopsy), and determine the presence of any precancerous growth or an actual cancer.
Since it is performed in the office, it is much cheaper than a hospital stay, and the side effects are minimal.
Your physician is attempting to make an accurate diagnosis in a manner that is least disturbing to you, to plan his therapy.
I think it is a fine idea.

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.