Frequently Asked Questions
Questions from visitors to our Ask-an-Expert site might provide the answers you're looking for!
| Q | Is it true that if you have a respiratory illness that produces colored phlegm without fever, it is a virus, therefore untreatable with antibiotics? | |
| A | What you are describing could be symptoms of bronchitis, and it is true, as you said, that the majority of bronchitis infections are viral, but if the symptoms last for more than 3 weeks, chances are higher that it could be a bacterial infection, as viruses usually only last a couple of weeks. | |
| Answered by Lorne Bigley, MD, Family Practice, Eugene, PHMG/FP-South (11/1/2011) | ||
| Q | Does PeaceHealth offer in-patient programs for morbidly obese adults? | |
| A | PeaceHealth Oregon region has an outpatient program through the Oregon Bariatric Center, at 541-222-2700. | |
| Answered at 8/23/2011 | ||
| Q | I have a black bruise around my chin. How can I get rid of it? | |
| A | If this is truly a bruise, it will resolve on its own. This should take at most 2-3 weeks. Sometimes there can be residual pigmentation which can last months after the bruise. It is usually best to allow this to resolve on its own as well. | |
| Answered by Jay Park, MD, Dermatology, Eugene, Jay Park MD (5/31/2011) | ||
| Q | I have questions about keloid scars. I don't know where I should go? What's the best way to deal with these? | |
| A | Treatment of keloids depends on several factors, including where they are, how long they have been there and how thick they are. Keloids are usually treated by dermatologists. | |
| Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (5/16/2011) | ||
| Q | Can a PeaceHealth physician authorize medical marijuana? I know that some medical groups do not allow their doctors to authorize medical marijuana, is PeaceHealth one of those groups? | |
| A | Every physician within PeaceHealth exercises their best professional judgement when they make decisions with patients about evaluation or treatment of any medical problem. A few of those judgements are guided by our Catholic tradition; most pertain to fertility and end of life issues. None of those guide complementary or alternative approaches. Every physician that joins PeaceHealth does so fully aware of this ethical framework. | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (4/30/2011) | ||
| Q | I get severe vertigo episodes which usually come with headaches that last for hours and sometimes days. I also have had problems being able to swallow food and weird vision issues. I have been to the doctor many times with no luck in finding the cause. I am having a major vertigo episode now and I currently do not have a primary doctor. Will Urgent Care or the Emergency Room be able to help with any of this? Or should I wait for the appointment I have at the end of the month? | |
| A | I need to know that you are not having a mild stroke. If there is any question of this, an urgent care visit could be helpful. For help with the vertigo you need to see an ENT doctor or Otologist as soon as possible. Limit salt intake, take an aspirin a day, drink fluids and see the ear doctor. Emil Hecht | |
| Answered by Emil R. Hecht, MD, Otolaryngology, Bellingham, Bellingham Ear Nose & Throat (4/5/2011) | ||
| Q | Is it a common practice for a gynecologist to refuse to give Zovia to a woman over 35 if she smokes 8 cigarettes a day? During a recent visit to a gynecologist it was said that no one would prescribe the pill to her? Is this true? | |
| A | The medical guidelines are to not prescribe oral contraceptives to women over age 35 who smoke. Other methods of contraception should be used. If the woman stops smoking then oral contraceptives may be used, assuming other guidelines are met. | |
| Answered by Linda Frison, MD, Obstetrics/Gynecolog, Eugene, PHMG/OBGYN-Hilyard (3/22/2011) | ||
| Q | Two of my kids have pink eye (I think the bacterial kind). They both have red eyes oozing green and getting crusty. We have no medical insurance and need to know if they have to see a doctor. They have both been running fevers on and off (about 102 degrees) but it comes down with medicine. | |
| A | If you have the diagnosis right you can wait it out. Bacterial (purulent) conjunctivitis is self-limited (it runs its course and goes away). However, with treatment it resolves more rapidly and the contagious period is shorter. Beware though; there are forms of pink eye that can lead to vision loss and require medical treatment. If the symptoms persist or if your children complain of eye pain or vision change a physician should be consulted. | |
| Answered by Bruce Strimling, MD, Pediatrics, Eugene, Oregon Medical Group (3/7/2011) | ||
| Q | My son is color blind and I understand there are glasses available to help with this deficiency. Apparently they have been around for ten years. I can't find anyone that can help in this area. Please direct me to someone who can help. Thank You for your time. | |
| A | What follows is from the website WebMD: Color Blindness - Treatment Overview There is no medical treatment for color blindness that is inherited. Some acquired color vision problems can be treated, depending on the cause. Color blindness that is acquired may sometimes be improved by surgery. For example, if you are having trouble seeing colors because of cataracts, surgery to treat the cataracts may improve color vision. If the problem is caused by a side effect of medicine, color vision may be improved when that medicine is stopped. There may be some things you can do to help compensate for a color vision problem. -Specially tinted contact lenses and eyeglasses may help you see differences between colors. But these lenses do not provide normal color vision and can distort objects. -Glasses that block glare (with side shields or wide temples) are helpful because people with color vision problems can see differences between colors better when there is less glare and brightness. A person with color vision problems can actually see better when the lighting is not bright. If you do not see color at all and rely on rod cells for vision (rod monochromatism), you may need to wear tinted or dark glasses with side shields because rod cells work better in dim light. You may also need corrective lenses (glasses or contact lenses) because vision using only the rod cells is less clear and sharp. Color vision problems cannot be prevented. ********* A good start in your search may be to see a local optometrist and explain the situation. | |
| Answered by David Deutch, MD, Ophthalmology, Eugene, PHMG/Ophth-Hilyard (2/18/2011) | ||
| Q | Three years ago I suffered frostbite damage to my toes. On a recent ice climbing trip my toes were frostbitten again. I would like to know if I should wait before visiting a doctor until the black blisters develop? Are there specialists or ideal doctors that I should see to assist me with this? | |
| A | This is a very good question, and it gave me the opportunity to research this a little more. I would have to assume, based on your question, that the second injury happened more than a day ago. If you have normal color and sensation to your toes now, that is a good sign. If you currently have black toes, it may take 1-3 months for the tissue to fully recover. If you are having some significant swelling in the toes, you would be best served by going to the emergency room. There, the emergency physician can make an assessment and determine if you will need to go further and see a surgeon. If you are at all unsure about where to start, make an appointment with your primary care doctor as soon as possible, and he or she can start sorting this out with you. Good luck, and I hope that your toes survive. | |
| Answered by Lorne Bigley, MD, Family Practice, Eugene, PHMG/FP-South (1/4/2011) | ||
| Q | I have had strep throat twice in the last four months and now I think I have it again. Is it neccessary to see the doctor or can I just call in and ask for a prescription? | |
| A | It is best to be seen by your primary health care provider to confirm you have a bacterial strep infection of the throat. Accurately diagnosing and then treating with the appropriate medication helps to prevent the unnecessary/over use of antibiotics and the creation of resistant bacterial organisms. | |
| Answered by Dennis Diaz, MD, Otolaryngology, Eugene, PHMG/ENT-Hilyard (12/22/2010) | ||
| Q | Does Sacred Heart Medical Center-Riverbend offer a belly band after having a C-section, or do I have to buy my own? I heard it really helps the mother heal quicker and move around easier. | |
| A | Yes- Sacred Heart Medical Center-Riverbend hospital will supply an 'abdominal binder' for any abdominal surgery. It is not automatically ordered, so if you would prefer one, just ask. | |
| Answered by Cristin Babcock, MD, Obstetrics/Gynecolog, Springfield, Women's Care (12/13/2010) | ||
| Q | I was wondering what would work good for constipation? | |
| A | The best first line treatment is a good high fiber diet. Avoid "white" foods like white bread, potatoes, cereals that are not high in fiber. Eat a lot of fresh fruit and vegetables. Pears have more fiber than apples, by the way. Also, there are some breakfast cereals that are high in fiber. Read the labels. Prunes or prune juice really can help many people also. If you have tried all these things, and still have trouble, Metamucil or the generic equivalent of this, called psyllium, is VERY helpful, and should be taken twice a day. There are many other over-the-counter laxatives for short term use, and stool softeners also, but it is hard to recommend them further without knowning more about your particular situation. You may want to ask your family doctor about more specific advice based on your particular situation. | |
| Answered by Lorne Bigley, MD, Family Practice, Eugene, PHMG/FP-South (12/6/2010) | ||
| Q | I am pregnant with no insurance. I do not qualify for state assistance. Are there any programs that PeaceHealth has to help? | |
| A | PeaceHealth does have a program called Bridge Assistance. Their phone number is 541-984-4301. To quote from their cover letter, "Bridge Assistance is a PeaceHealth program through which medically necessary services are provided at a reduced cost or without charge when it has been determined that payment for those services cannot be obtained through insurance, outside agencies, or private means." I hope this helps, and I hope you have a smooth and healthy pregnancy. | |
| Answered by Marjory Muellner, CNM, NP: Women's Health, Eugene, PHMG/OBGYN-Hilyard (11/22/2010) | ||
| Q | I want to know how long after someone has had a mini-stroke can it be detected? I think I may have had one last Thursday morning. | |
| A | Thank you for your question. A transient ischemic attack "TIA" is often called a "mini-stroke" and consists of sudden onset of weakness or numbness (often on one side of the body), or loss of vision, balance, or speech. They usually clear quickly. The history is more important than the examination or any tests. If this is what happened to you, it is something that needs evaluation rapidly as there is up to an 8% risk of a major stroke within 2 days and a 10-17% risk within 90 days. I recommend you call the TIA Clinic at 541-868-A.TIA (that's 541-868-2842) right away and leave a message as instructed. You can do that any time of day and you will receive a call back the next morning to schedule to be seen by a neurologist within a day. Or you can call 541-868-9430 during business hours to schedule to be seen right away in the TIA Clinic. | |
| Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (11/16/2010) | ||
| Q | Is it better to have my child evaluated for autism spectrum disorder by a psychologist or a psychiatrist? | |
| A | Child Development and Rehabilitation Center (CDRC), a division of Oregon Health Sciences University runs an autism clinic in Eugene. They do an excellent multidisciplinary evaluation. I suggest you have your pediatrian refer you there. | |
| Answered by Bruce Strimling, MD, Pediatrics, Eugene, Oregon Medical Group (11/15/2010) | ||
| Q | My 21-year-old daughter who is pregnant, is having some back pain and a toothache. What can she safely take for the pain? | |
| A | Tylenol is safe for pain in pregnancy. Good dental care is very important in pregnancy. Please make sure she sees a dentist about her tooth. | |
| Answered by Cristin Babcock, MD, Obstetrics/Gynecolog, Springfield, Women's Care (10/15/2010) | ||
| Q | I had a complete hysterectomy over 25 years ago. I have not had a pelvic exam since then. Should I have one done? | |
| A | Yes. You need to have your breasts examined and your vulva and your ovaries examined and evaluated every year. Pelvic exams are often done in conjunction with annual exams which can also include evaluating you for various diseases including hypertension, diabetes and high cholesterol. | |
| Answered by Linda Frison, MD, Obstetrics/Gynecolog, Eugene, PHMG/OBGYN-Hilyard (9/27/2010) | ||
| Q | I am a diabetic and have a bunch of needles to dispose of. Where can I drop off these used needles ? | |
| A | Needle disposal is free at all Lane County dump sites. You must have them in a red, hard plastic container (they suggest a liquid laundry detergent container) with the screw on cap. In the recycle section there is a big biohazard container you pitch your container in. | |
| Answered at 7/28/2010 | ||
| Q | Is it ok (within normal limits) to have uneven labia? | |
| A | Yes, It is not uncommon for there to be some asymmetry to the labia. | |
| Answered by Randall S. Lewis, MD, Obstetrics/Gynecolog, Eugene, PHMG/OBGYN-Hilyard (7/26/2010) | ||
| Q | My question concerns the use of Rutin and Horse Chestnut for varicose veins. I would like your advice on whether these supplements are safe in pregnancy. I see conflicting opinions online. Also, how much Vitamin C is currently recommended during pregnancy? I am not currently expecting but hope to be soon. Thank you for your help. | |
| A | I would not take Horse Chestnut during pregnancy as the safety is unknown. It has some compounds similar in molecular structure to coumadin which is known not to be safe. I advise against taking it. Additionally, there are limited tests on its efficacy for treating varicosities. Rutin,being a bioflavanoid of Vitamin C, should be safe along with Vitamin C. However, I would not take mega-doses of it. There have been some reports of early pregnancy termination with high dose Vitamin C. If you are taking a prenatal vitamin, you are most likely getting enough Vitamin C. The recommended dosage during pregnancy is 85 mg daily. Another way to supplement rutin and Vitamin C bioflavanoids is to eat fresh citrus fruit. I would also be careful about taking supplements in general during pregnancy as some can have contaminants. There have been reports of lead found in supplements from China. | |
| Answered by Mary Gabriele, MD, Family Practice, Eugene, PHMG/FM-University Dist (7/8/2010) | ||
| Q | My husband has agreed to look into getting a hearing aid. He would like an exam by someone that does not also sell hearing aids. Where do we go or look for that specialty? | |
| A | Most Ear, Nose, & Throat(ENT) practices also indirectly sell hearing aids through their affiliated audiology department. They can do an examination, an audiogram and then determine if you are a candidate for a hearing instrument. The medical exam part is done by the ENT physician and options for what kind of hearing instrument would benefit the patient most is done by the audiologist. If you just want a clinical exam of the ear, then your primary care physician can do one. | |
| Answered by Dennis Diaz, MD, Otolaryngology, Eugene, PHMG/ENT-Hilyard (6/22/2010) | ||
| Q | My son just turned 3 years old last month. For about the last 2 months he has been refusing to eat his meals and has lost a lot of weight. He will snack throughout the day, but I am extremely concerned that he is not getting the nutrients he needs, which in turn is affecting his mood. He has a harsh mood all the time and is very fussy for a 3-year-old. We always make his plate and we sit together as a family every night. He is the second to youngest in the family of 5 children. What should I do? Should I take away his snacks? | |
| A | It is always a medical problem not a diet problem if a 3-year-old loses significant weight. You must take him to his pediatrician in the next few days for evaluation. Call today for an appointment. | |
| Answered by Bruce Strimling, MD, Pediatrics, Eugene, Oregon Medical Group (4/23/2010) | ||
| Q | I had a hysterectomy 10 years ago. Is it still possible to have PMS? | |
| A | PMS or Premenstrual Syndrome is due to the change in levels of hormones produced by your ovaries. Hysterectomy is the removal of the uterus. So, if your ovaries are still in place, you can have symptoms of PMS. | |
| Answered by Linda Frison, MD, Obstetrics/Gynecolog, Eugene, PHMG/OBGYN-Hilyard (3/8/2010) | ||
| Q | If I become pregnant while on warfarin what other medicine can I take? | |
| A | For women who must be on chronic anticoagulant therapy we switch them over to injectable heparin products. These are usually given to 1-2 times/day. I would recommend you have a consultation with your physician to discuss these issues before you become pregnant. | |
| Answered by Cristin Babcock, MD, Obstetrics/Gynecolog, Springfield, Women's Care (3/8/2010) | ||
| Q | What are treatment options for a woman experiencing extreme PMS symptoms, such as: extreme mood swings, depression, suicidal thoughts, low self-esteem, loneliness, feeling unloved although surrounded by a loving family and friends, quick-tempered, low tolerance, and very negative. Please let me know if there are vitamin supplements or certain foods that are better during this time. Any suggestions would be greatly appreciated. Thank you. | |
| A | As you are probably aware this is a very common problem affecting 30% of women. Dietary changes would include reduction of salt, sugar and caffeine premenstrually and throughout the month. Increasing your calcium intake to at least 1200mg daily and adding 30 minutes of exercise 5 times a week. Stress also plays an important role so delaying major decisions, making sure you have some allocated free time during the premenstrual week is also important. There are also some medications that can be taken just for those few days of symptoms that can be very helpful. | |
| Answered by Randall S. Lewis, MD, Obstetrics/Gynecolog, Eugene, PHMG/OBGYN-Hilyard (3/1/2010) | ||
| Q | Why don't quadriplegics, or anyone with a spinal injury, retain the ability to sweat? | |
| A | This is a very complex question because of the multiple parts of the nervous system affected in spinal cord injury. It also depends on what level of spinal cord injury is sustained and whether it is a complete or incomplete lesion. The autonomic nervous system (ANS) consists of two parts. The sympathetic nervous system component leaves the spinal cord from T1-L2 and is responsible for the "fight" part of the "flight or fight" response. The parasympathetic nervous system leaves the cord at the sacral level and is responsible for "flight". So someone with a cervical or high thoracic lesion would lose control of both functions while a lower level injury would be more mixed. Many bodily functions are modulated by an interplay of these two components including sweating. So, below the level of the lesion there is no sweating but above it there still may be. This is especially important in a rare complication called autonomic dysreflexia which occurs when some irritant (such as a bladder infection, skin irritation or broken bone) sets off a severe reaction in the ANS so that there may be dangerous elevation in blood pressure, headache as well as facial sweating. This generally does not occur in anyone whose injury is below T3. This lack of control and coordination of blood pressure, sweating, shivering and skin blood flow makes people with spinal cord injuries susceptible to any extreme of heat or cold. | |
| Answered by Martha MacRitchie, MD, Phys Med & Rehab, Eugene, Martha MacRitchie MD (2/19/2010) | ||
| Q | My grandson stuck a sunflower seed up his nose. What can I do for it ? | |
| A | You don't indicate his age. If he cannot blow it out. he should have it removed by his pediatrician. | |
| Answered by Bruce Strimling, MD, Pediatrics, Eugene, Oregon Medical Group (2/11/2010) | ||
| Q | Can I set up my own appointment for a tubal ligation or do I need to go through my obstetrician? | |
| A | In general you can set up your own appointment for a tubal ligation. Some insurance companies require that you sign a consent form more than 30 days before the surgery, but less than 180 days. Most physicians want to have a consultation before surgery to meet you and go over the risks and benefits of the surgery. The highest level of regret- women who wish they hadn't had the surgery- is in women less than 30 at the time of surgery with 2 or fewer children. In general, anyone with the Oregon Health Plan insurance will have to be over the age of 21 to be considered for sterilization. | |
| Answered by Cristin Babcock, MD, Obstetrics/Gynecolog, Springfield, Women's Care (2/10/2010) | ||
| Q | I had severe laceration injuries to my fingers in 2008. I had surgery to repair tendons, blood vessels, etc. I now want to figure out when I had my lasttetanus shot. So, is it likely that I received a tetanus shot then? | |
| A | Yes, especially if you where evaluated in Emergency Room or Urgent Care. | |
| Answered by Glenn Ziemski, MD, Emergency Medicine, Eugene, Eugene Emergency Physicians, P.C. (1/19/2010) | ||
| Q | How can I get access to my immunization records? | |
| A | You should contact your primary care physician's office. | |
| Answered at 1/7/2010 | ||
| Q | Our 9-year-old daughter was recently fitted for new shoes. Her left foot is size 1-1/2 and her right is 2-1/2. Should we be concerned about the one inch difference between her feet? Thanks! | |
| A | You should call this to the attention of her pediatrician. If the disparity is only her foot and she has no functional problems there is probably nothing to worry about. If the asymmetry involves her entire lower extremity or more, there may be medical implications. | |
| Answered by Bruce Strimling, MD, Pediatrics, Eugene, Oregon Medical Group (1/6/2010) | ||
| Q | Is there any help for SADSAD other than the light therapy? | |
| A | Antidepressant medication is helpful for Seasonal Affective Disorder (SAD), just like with most depression. The other choices are the cognitive behavioral interventions that also help with depression: exercise, increasing pleasant activities, and stopping negative thoughts. Preventive SAD's actions can be taking a vacation to a sunny place in the first half of the winter, instead of waiting until the depression has hit full force by February or March. It also helps to get outside and expose your face and forearms to the sun here during the mid-morning time, even if it doesn't look sunny out. | |
| Answered by Hallenburg, Kris S. PhD, , Eugene, PHMG/Psy - Hilyard - 420 (12/29/2009) | ||
| Q | How long is shingles contagious? I just broke out with the rash Tuesday but have had pain since a week ago Tuesday. I work in the human services field and have a large number of contacts with people daily and I'm wondering when I can go back to work? | |
| A | Shingles is mainly contagious when there are open sores. Pain syndromes can exist after the skin lesions are gone or even before, but one is not contagious without skin lesions. | |
| Answered by Mary Gabriele, MD, Family Practice, Eugene, PHMG/FM-University Dist (11/5/2009) | ||
| Q | On the average how long is a patient in the hospital after having a knee replacement? How soon afterwards can a patient drive and walk? Thanks. | |
| A | Three days is the usual hsopital stay (i.e., surgery Tueday, discharge Friday). You will "walk" before leaving the hospital but obviously improve over several months, gradually requiring less support of walker, crutches or cane. Driving is usually possible by 4-6 weeks, depending whether the right or left leg had the surgery. | |
| Answered by Tom Hasbach, MD, Orthopedic Surgery, Springfield, PHMG/Ortho-RiverBend (10/29/2009) | ||
| Q | What should we do if we have been exposed to someone that has H1N1, but we are feeling good at this time. | |
| A | If you end up actually getting the influenza, taking Tamiflu will only reduce the time of having symptoms by about a day. If you have a risk factor for influenza complications like diabetes, chronic lung, liver or kidney disease, or a problem with your immune system, I would recommend that you get Tamiflu. If you are otherwise healthy, you will have to weigh the risks of getting the flu (which wouldn't be too much, except feeling crummy for a few days), versus the cost of the medicine, and the potential side effects of Tamiflu which include nausea, vomiting, diarrhea, headache and belly pain, in addition to others. Fortunately, most people don't experience these side effects. | |
| Answered by Lorne Bigley, MD, Family Practice, Eugene, PHMG/FP-South (10/23/2009) | ||
| Q | Is herpes curable? | |
| A | Herpes simplex is usually oral or genital, but may occur on other areas of the body. There is always the possibility that outbreaks may recur. How often recurrences occur may vary from person to person. Herpes outbreaks usually are farther apart as time goes by. Genital herpes may be suppressed by taking oral antivirals daily if it is enough of a problem. In short, the answer to your question is "no", but there are management tools to help with the problem. You can help your provider by keeping an accurate calendar of when occurrences begin and when they end. | |
| Answered by John Wilson, MD, Infectious Disease, Eugene, The Travel Clinic (9/28/2009) | ||
| Q | What Is COPD? | |
| A | Chronic obstructive pulmonary disease is a mixture of chronic bronchitis and emphysema (either or both qualify as COPD). It's almost always a result of smoking. Symptoms can include a chronic productive cough (chronic bronchitis) and shortness of breath (emphysema). | |
| Answered by Mark Lyon, MD, Family Practice, Eugene, PHMG/FP-South (9/23/2009) | ||
| Q | I have a black area in the center of my tongue that will not go away. It's not painful but it varies in size and doesn't seem to be caused by anything I eat or drink. | |
| A | Several things may cause a black tongue. One common cause is a condition called "Black Hairy Tongue", which is caused by using hydrogen peroxide or other oxidizing mouthwash. There are also serious conditions, such as a type of cancer, that can cause black tongue. You should see a doctor for diagnosis and treatment. | |
| Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (8/10/2009) | ||
| Q | I am 17 weeks pregnant. I was sitting on the floor and my two-year-old ran up and sat down really hard on my lap. Did that harm my baby? | |
| A | It is very unlikely that any harm could come from a toddler. Humans are well designed to tolerate normal human events (slipping and falling down, children rough-housing, etc.) We are not designed for automobile crashes, skiing accidents, or other modern inventions. | |
| Answered by Cristin Babcock, MD, Obstetrics/Gynecolog, Springfield, Women's Care (8/6/2009) | ||
| Q | I have been constipated for four days and vomiting for three. What should I do? | |
| A | Go to Urgent Care or the Emergency Room if you can't get in to see your primary care physician. You could very well have a bowel obstruction. This is treated with bowel rest and sometimes surgery. So don't delay. | |
| Answered by Glenn Ziemski, MD, Emergency Medicine, Eugene, Eugene Emergency Physicians, P.C. (8/3/2009) | ||
| Q | My mom has been experiencing all the classic signs of a | |
| A | A tubal ligation can fail, and a patient on medication could possibly have a false negative pregnancy test. I would recommend that your mom see her doctor for a blood test. If she were pregnanct and far enough along to feel fetal movements, a doctor also should be able to tell she is pregnant by doing a physical exam. | |
| Answered by Heather York, MD, Obstetrics/Gynecolog, Eugene, Women's Care (8/3/2009) | ||
| Q | Several years ago I engaged in high risk, unprotected sex with multiple partners I did not know. We didn't have conversations about STDs or HIV. Since then, I have changed my behavior and I don't have any symptoms of an STD, but am now worried that I may have been exposed to one and do not know it. Even if I don't exhibit symptoms is it still a good idea to get tested? Which ones should I be tested for? | |
| A | You should absolutely 100% be tested! You can be asymptomatic for a long period of time with many different STD's that could (in some cases) even kill you. You should be tested for HIV, Hepatitis C, Hepatitis B (if not immunized and have proven immunity), Chlamydia, and Syphillis. It would be unlikely that you have a herpes infection without having had symptoms. You will also be tested for Gonorrhea when the Chlamydia test is done (they are done together). For a woman, a pap smear is also recommended to test for Human Papilloma Virus (causes venereal warts and some strains cause cervical cancer). For a man, a physician inspection of the genitals can help to identify possible venereal warts/HPV. | |
| Answered by Erin Reilly, MD, Urgent Care, Springfield, PHMG/Urgent - RiverBend (7/20/2009) | ||
| Q | How many days can a fever last when you've had influenza? | |
| A | Assuming that the patient has Influenza Type A and has no complications of that infection, the fever associated with flu can last anywhere from 3-8 days (usually running for 5 days or less). Here's some more information about Influnza that may be of help: http://www.peacehealth.org/kbase/topic/major/hw122012/course.htm | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (7/14/2009) | ||
| Q | Ever since my pregnancy and the birth of my son, I have had a "pregnancy mask" all over my face, especially on both sides. It looks ugly, like I took some dirt and smeared it on my temples and cheekbone area. The rest of my face looks like it has dirty freckles. I put cover up on it but it doesn't really help. What can I do to get rid of this? I would really appreciate your advice. Thank you. | |
| A | The mask of pregnancy, called melasma, is caused by a combination of sun exposure and hormones. You will not be able to get an even tan on your face; the darker areas will tan much more quickly and much darker than the rest of your skin. There are products that can fade this. You can buy fade creams (usually containing hydroquinone) at the drugstore. There are prescription strength fade creams (such as Tri-Luma) which are more powerful, but also more expensive. There are also lasers and other light treatments, as well as peels and other therapies, which are sometimes successful in treating melasma. It is critical, no matter what else you do, that you wear a broad spectrum sunscreen and avoid sun exposure all year long. | |
| Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (6/30/2009) | ||
| Q | I have major depression and my doctor is sending me to a psychiatrist. I think she doesn't know what medicine to give me. A friend of mine, who has depression & ADHD, told me that it sounds like I have ADHD and should be tested. My 15-year-old son was just diagnosed with ADD a couple of weeks ago. I know that I have a lot of the symptoms. Would being treated for that help me with my depression? I'm really struggling right now. Please help. | |
| A | Going to a psychiatrist is a good referral. He or she should be able to determine what is going on with you and what medications will work. There are some, such as Wellbutrin, that work with depression and, to a lesser extent, with ADHD, but it is not good with anxiety. General doctors refer to psychiatrists because they are the most up-to-date on these kinds of medications. I suggest being honest about your symptoms and see what they suggest. | |
| Answered by Hallenburg, Kris S. PhD, , Eugene, PHMG/Psy - Hilyard - 420 (4/13/2009) | ||
| Q | I have had a sore throat for 3 or 4 days now, and have been back from Guadeloupe for almost a week now. I fear that it is a case of strep throat or worse, perhaps bacteria obtained in Guadeloupe. Should I be treating this more seriously than just some regular sore throat? Do you recommend I see a doctor as soon as possible? | |
| A | There are lots of causes of sore throats. The causes of sore throats obtained outside the country are pretty much the same as those caught here. The chance that this is serious is low, but not zero. If you are still sick after several days, or are sicker than the usual viral cold, I would see a doctor fairly soon. | |
| Answered by John Wilson, MD, Infectious Disease, Eugene, The Travel Clinic (4/6/2009) | ||
| Q | I had protected sex a week ago with a girl and several days later she found out she had a MRSA infection on her foot. I do not have any symptoms of MRSA, should I go see a doctor anyway? | |
| A | Until you have any symptoms you do not have to go to the doctor. Most likely most of the Staph that we see all around us is the resistant type. So we only need to see you if there are signs of an infection. | |
| Answered by Christa Danielson, MD, Family Practice, Eugene, PHMG/FP-South (3/13/2009) | ||
| Q | My son has had a severe cold for more than two weeks now. For the last two days he has been coughing non-stop all day long. His cough is dry and unproductive and he complains of a sore "mouth". I was wondering if there is anything the doctor can do and if I should take him in. He has chills but no fever, and complains that he hurts. He plays on and off, but takes long breaks while sitting upright on the couch. He is 3-1/2. | |
| A | Yes, you should take your son to the doctor at this point. A child with a respiratory illness that lasts longer than two weeks should be evaluated for more serious illness, expecially with persistent cough. | |
| Answered by Tamara Barstow, MD, Pediatrics, Eugene, PHMG/PED-Barger (1/30/2009) | ||
| Q | My six-month-old son takes very short naps, anywhere from 10 to 45 minutes, rarely longer. This seems to be too short, and he often seems tired. He also has difficulty with self-soothing to go back to sleep. We do a "bedtime routine" every time, but nothing seems to make a difference. I would really appreciate any suggestions! | |
| A | Here is the information on infant sleeping from MD Consult: When putting an infant to bed: Make the nighttime routine consistent and pleasant. Give the last nighttime feeding shortly before putting the baby to bed. Never put the baby to bed with a bottle, as it can cause tooth decay (see baby bottle tooth decay). Spend quiet time with your child by rocking, walking, or simple cuddling. Put the child in bed before he is deeply asleep. This will teach your child to go to sleep on his own. Your baby may cry when you lay him in his bed, because he fears being away from you. This is called separation anxiety. If you ignore his crying, you confirm that his worst fear is true. Simply go in, speak to your baby in a calm voice and rub his back or head. Do not remove him from his bed. Once he has calmed down, leave the room. Your child will soon learn that you are simply in another room. At this point, talking to him from another room will suffice. If your baby awakens in the night for feeding, do not turn on the lights. Keep the room dark and quiet. Use night lights if you must. Keep the feeding as brief and boring as possible. Do not entertain the baby! When the baby has been fed, burped and calmed, return him to bed. If you maintain this routine, your baby will become used to it and go to sleep on his own. If you are still having problems, talk to your baby's doctor at the next Well Child Visit. | |
| Answered by Doug Gamet MD, Pediatrics, , (1/21/2009) | ||
| Q | I am a 59-year-old female that just went through my first bout of Shingles. Can I get Shingles again or has my body built up a tolerance? Should I still get the shot for Shingles...or is it too late. Thanks. | |
| A | Second episodes of Shingles occur, but we don't have good figures on how often. The Shingles vaccine (Zostavax) should not be given for several years. The mild, short-lived increase in antibody levels may inactivate this live attenuated virus vaccine. Good luck on your recovery! | |
| Answered by John Wilson, MD, Infectious Disease, Eugene, The Travel Clinic (1/7/2009) | ||
| Q | Is Autism a nervous disease? | |
| A | Thank you for your question. Autism is a complex disorder that sort of crosses over the disciplines of child psychiatry, child neurology and pediatrics. Autism usually is treated by pediatricians and child psychiatrists rather than child neurologists for a variety of reasons. | |
| Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (12/10/2008) | ||
| Q | I have new insurance and need to choose a new doctor. I am 48 years old and am wondering if I should choose a Family Medicine or Internal Medicine physician. What exactly is the difference, and why would somebody choose one over the other for general health/primary care needs? Thank you. | |
| A | Family doctors train for 3 years learning how to take care of families at all stages, "cradle to grave". They deliver babies, assist at surgery, take care of kids, and do many simple procedures. Many give up the obstetrics (OB) later, but continue to have a broad practice. Internists spend more of their training taking care of sicker adults. They don't do OB or Pediatrics, but can do many procedures, some that Family Physicians don't do often. If you'd like one doctor to know and take care of your whole family including kids, then the answer is simple. If you're just looking for yourself and you're generally healthy (most of your health issues are injuries, the occasional infections, skin things,...) then a Family Physician could still be ideal. If your have more than a couple chronic health problems, take more than a few medications, or have a rare condition then an Internal Medicine physician may be best. Either can do your basic primary care and physical exams and the person may matter more than the specialty! | |
| Answered by Mark Lyon, MD, Family Practice, Eugene, PHMG/FP-South (11/25/2008) | ||
| Q | Both my husband and I woke up this morning with the tops of our tongues black (the night before we each had a bad stomach ache). We both feel o.k. this morning, but the color was a bit alarming. Should we make doctors' appointments for today to have this checked out or wait it out? We were able to wipe some of the black off...but some remained. | |
| A | Did you take Pepto-Bismol? The bismuth in it can cause a black color. There is also a condition called "black hairy tongue", but that does not usually come up overnight. Black hairy tongue is usually caused by prolonged use of presciption mouthwashes or peroxide washes. If you did not take Pepto-Bismol, you should see your family doctor. | |
| Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (11/3/2008) | ||
| Q | What are my alternatives to treating sleep apnea if I can't use a CPAP machine? | |
| A | 1. Weight loss is very effective in improving obstructive sleep apnea. 2. There is no one single surgery that can achieve the success rate of the Continuous Positive Airway Pressure (CPAP) machine. Often patients will need a staged surgical approach. Which surgeries are recommended is dependent on the severity of the obstructive sleep apnea. There is no guarantee that surgery will eliminate the need for CPAP. The worse the degree of sleep apnea...the greater the chance that you will still need CPAP even after surgery. | |
| Answered by Dennis Diaz, MD, Otolaryngology, Eugene, PHMG/ENT-Hilyard (10/28/2008) | ||
| Q | I work on The Safety Committee for our organization, and I was wondering if you could help me out with a question? We are updating our first aid kits and were wondering if it is acceptable to have over-the-counter medications kept in the first aid kit, or in surrounding areas. The over-the-counter medication vary from cough drops, tylenol, airborne, etc. What would you recommend? | |
| A | I think it would be great for you to have a limited number of things in your first aid kit such as Tylenol, Ibuprophen, and Benadryl or another non-sedating antihistamines such as Zyrtec. I wouldn't bother with Airborne (it's useless, in fact there is a law suit against the maker for false claims of effectiveness). You will have to address with your employees whether this is for "emergencies" only or for routine use. Band-Aids might be a good idea as well. | |
| Answered by Glenn Ziemski, MD, Emergency Medicine, Eugene, Eugene Emergency Physicians, P.C. (9/3/2008) | ||
| Q | What could be causing a low (like electricity) humming in my ears/head? It happens infrequently but is concerning. | |
| A | Tinnitus (noises in the head) is a common ear symptom secondary to a great number of causes (hearing loss, ear infection, cerumen [ear wax], whiplash, head injury, diabetes, TMJ, depression, neurologic disease, and medications among others). Noise exposure is the most common cause. Usually it is of no concern if it is intermittent but to alleviate your anxiety you should see your primary care physician. | |
| Answered by Dennis Diaz, MD, Otolaryngology, Eugene, PHMG/ENT-Hilyard (8/27/2008) | ||
| Q | How should we dispose of such items as iodine, mercury-filled thermometers, mercurochrome? | |
| A | Mercury is an extremely hazardous metal and mercurochrome contains mercury. Iodine if in a concentrated form can form lesions on the skin. All three should be taken to a hazardous waste facility for proper disposal. | |
| Answered by Stephen Erfurth, M.D., Pathology:Anatm/Cln, Springfield, Stephen Erfurth PhD (8/27/2008) | ||
| Q | Is it true that menopause and depression are linked together? What is good for menopause symptoms such as hot flashes, night sweats, and moodiness? | |
| A | It is possible for menopause to contribute to depression, especially if it causes insomnia. Over-the-counter products for menopause include, black cohosh, soy, and acupuncture. Prescription products include estrogen and antidepressants. I would recommend you discuss these options with your primary care physician or gynecologist. | |
| Answered by Randall S. Lewis, MD, Obstetrics/Gynecolog, Eugene, PHMG/OBGYN-Hilyard (7/14/2008) | ||
| Q | Does Sacred Heart in Eugene carry those water-proof cast liners? If not, if you personally purchase one, would they approve and put it on? Thank you. | |
| A | Sacred Heart does not, and we do not in our cast clinic. Many Orthopedists, including myself, feel that too often the waterproof liners cause macerated skin because of prolonged moisture contact. They also sometimes encourage patients to pursue a level of activity beyond which their fracture should allow. Sorry for the inconvenience. | |
| Answered by Tom Hasbach, MD, Orthopedic Surgery, Springfield, PHMG/Ortho-RiverBend (7/9/2008) | ||
| Q | Can you take Topamax while pregnant? | |
| A | There has been insufficient clinical experience with Topamax in pregnancy to confirm its safety in that situation. As with many drugs like Topamax in pregnancy, the patient and physician need to weigh the known benefits versus the unknown risks of using the drug. | |
| Answered at 6/26/2008 | ||
| Q | If you are short of breath or stop breathing when someone is smoking, what does it mean? | |
| A | It means that you may have reactive airway disease or asthma. You should see your physician to help make that diagnosis. In the meantime you should not be around that person while they are smoking. | |
| Answered by Glenn Ziemski, MD, Emergency Medicine, Eugene, Eugene Emergency Physicians, P.C. (6/17/2008) | ||
| Q | I had my first two shots for the Gardasil vaccination but I was unable to receive the third vaccination on time. It has now been 4 months past my scheduled time to receive the third vaccination. Is it still okay to get the shot? | |
| A | Yes. I would receive the third vaccine as soon as you can. After 3 vaccinations you should be protected even though the time interval was extended. | |
| Answered by Linda Frison, MD, Obstetrics/Gynecolog, Eugene, PHMG/OBGYN-Hilyard (6/11/2008) | ||
| Q | If a woman goes into the doctor for a possible urinary tract infection, what tests and labs are normally done and what medications are prescribed? | |
| A | Typically, if the patient is a young, healthy woman, a simple urinalysis can be done to confirm the diagnosis. Urinalysis is a test that can be done in the doctor's office and results are typically back within minutes. For a patient that has other ongoing medical issues or is more senior in age, there are potentially other tests and considerations that have to be weighed. Treatment for the young and healthy is typically a 3-day course with an antibiotic, most usually with a "quinolone" type (e.g. Cipro) or a sulfa (e.g. Septra). | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (6/2/2008) | ||
| Q | I have had a two different nodules in my neck that I've felt for about 6 months. One is fairly soft and can be moved around easily. The other one is a bit harder to the touch and harder to move. No other symptoms. One feels like its the same size or even a bit smaller, the other feels pretty much the same, maybe a little bigger. I smoked for about 2 years, have since quit, and now have used chewing tobacco off and on. I want to make sure it's not cancer. How do I go about getting it checked out ? | |
| A | Begin with your primary care physician. They will begin evaluation and decide if you need a referral to a head and neck specialist. Neck masses present for over one month should be checked out. | |
| Answered by Dennis Diaz, MD, Otolaryngology, Eugene, PHMG/ENT-Hilyard (5/20/2008) | ||
| Q | I have severely painful muscle crampsin my lower legs at night. Is there anything I can do about it? | |
| A | This is a challenging problem. My experience has been that daily stretching of the calves and achilles tendon is the most effective approach. Take it slow and easy...be patient and persistent. They should gradually become less severe and less frequent. Good luck. | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (5/4/2008) | ||
| Q | My ears plugged up a few days ago, I think from allergies. I have no other symptoms except a slightly runny nose. I've been taking Sudafed, but it doesn't seem to be making any difference. I play the flute and have several concerts this week, and it's affecting not only my hearing, but also my sense of pitch. I really need to get this taken care of soon! What can I do to unplug my ears? | |
| A | You need to see your primary care provider. There are multiple things that can be going on and most of the time that can be answered by an examination of your ears (are the ear canals plugged with wax, is there fluid behind the ear drum, etc.) These findings will determine the next course. If you have allergies, you need to control the allergies by using approriate medications. Your primary care provider can help with that as well. If the exam is negative then a hearing test may be necessary. | |
| Answered by Dennis Diaz, MD, Otolaryngology, Eugene, PHMG/ENT-Hilyard (5/1/2008) | ||
| Q | Is there a doctor in Oregon who practices minimally invasive laser surgery to treat the pain of a degenerative spine? | |
| A | Thank you for your question. There are many treatments for degenerative disc disease and the treatment has to be matched to the patient. There are many uses of laser in spine surgery. If you are certain your condition requires spine surgery, then I suggest you see a board-certified neurosurgeon or orthopedic spine surgeon to determine which treatment is the best for you. | |
| Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (4/14/2008) | ||
| Q | I was told by my daughter's primary care physician that she has flat feet. He said that the only solution was to use arch supports, even just the store bought brand. I am concerned about her feet and her ankles as they appear to be turning inward quite severely. I have also noticed a hard lump on the inside of each ankle which looks and feels remarkably like a protruding bone pushing out against the skin. This may be normal for someone who is flat-footed but since I have not experienced this type of issue before I am a bit worried. Should I be taking her to specialist or is having flat feet very common and nothing to worry about? | |
| A | You don't indicate what age your daughter is, that can influence both possible diagnosis and treatment. You also don't indicate whether she is having symptoms of pain from her flat feet or from the protruding bump. Both of these issues can change our recommendations. You really can't go wrong by wearing good supportive shoes and/or a comfortable fitting stock item orthotic. If pain is an issue then seeing a specialist makes sense. Try to encourage her not to spend long days in unsupportive "flip flops" like young women often prefer to wear. Thank you. | |
| Answered by Tom Hasbach, MD, Orthopedic Surgery, Springfield, PHMG/Ortho-RiverBend (3/26/2008) | ||
| Q | My daughter wants the tissue under her tongue clipped. She is 15 and she hates how her tongue can barely come out of her mouth. How safe is this procedure? | |
| A | Akyloglossia (anchored tongue) or "tongue tie" is due to a short lingual frenulum (band of tissue connecting tongue to floor of mouth) and apart from being unable to protrude the tongue, it is almost always symptom-free. Speech defects are rarely attributed to tongue-tie necessitating division of the frenulum. The surgery itself is safe. The biggest risk is in anesthesia and potential for scar formation or poor healing. There is some initial bleeding and short term discomfort afterwards. In young children, surgery is often under general anesthesia. In older children and adults it can often be done in the office with local anesthesia. Sometimes suturing is required. | |
| Answered by Dennis Diaz, MD, Otolaryngology, Eugene, PHMG/ENT-Hilyard (2/27/2008) | ||
| Q | My son has hemophilia. Does that mean I'm a carrier? Should I tell my doctor? | |
| A | I am sorry that you family has to deal with this condition. I know many families with this condition that have done very well. Hemophilia is a genetic condition. Some individuals have inherited from their mother and some have a new mutation. There are ways to determine whether or not you are a carrier and what the risk is for other children. There is a very well known hemophilia clinic in portland @ OHSU. Carriers rarely have any medical problems. I suggest that you meet with someone knowledgable about the disease either in hematology or genetics. | |
| Answered at 2/14/2008 | ||
| Q | My husband and I are considering adoption of a toddler born addicted to methamphetamine. Can you give us a sense of what we might expect in terms of learning disabilities and social difficulties based on research? Is there anything else we should know in order to provide this child with the best home possible? | |
| A | Obviously this is a big subject and as with many things, population trends cannot predict the outcome for a given individual. I would refer you to this web site from the National Library of Medicine as a good starting point to read up on methamphetamine and it's effects. http://www.nlm.nih.gov/medlineplus/methamphetamine.html With a toddler, you are past the time of having to worry about withdrawl. Now the most important thing you can do is provide a stable, predictable, safe, loving environment. | |
| Answered by Doug Gamet MD, Pediatrics, , (1/31/2008) | ||
| Q | Is there anything the emergency room can do for an abscessed tooth? | |
| A | Antibiotics may be helpful but this is not definitive care, as with any abscess it needs to be drained. And this is usually done by a dentist by performming a root canal or pulling the tooth. It is much better to see your dentist for your dental issues. | |
| Answered by Glenn Ziemski, MD, Emergency Medicine, Eugene, Eugene Emergency Physicians, P.C. (1/28/2008) | ||
| Q | I live with my sister & brother-in-law, who has dementia. Is it best to go along with his confusion or should we try to correct him, which seems to me to confuse him more? | |
| A | Thank you for your question. You are in a difficult situation and there really is not a good guideline to follow. I think you have to do whatever seems to work best to maintain safety and calm. Sometimes that may mean playing along with his confusion while at other times you may have to confront him quietly. There are several books available either online or at major bookstores that help with managing your difficult situation. One of the best is "The 36-Hour Day", 4th edition now, which is a manual for caregivers of Alzheimer Disease patients. | |
| Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (1/9/2008) | ||
| Q | Where can I go to get a mobility assessment done? I need a prescription to qualify for a power chair. I have a doctor I see at PeaceHealth. | |
| A | If you have Medicare coverage a rehab physician, a neurologist or an orthopedist is required to sign and justify the prescription for a power chair. It is also helpful to have an evaluation by a physicial therapist who is familiar with all of the special features. That is available through the Outpatient Rehab services at SHMC and is known as a "wheelchair and seating evaluation." | |
| Answered by Martha MacRitchie, MD, Phys Med & Rehab, Eugene, Martha MacRitchie MD (1/9/2008) | ||
| Q | I saw a physician the beginning of November and at the time was just getting over a cold. I thought it was just that a cold. The physician looked at my left ear and it was full of wax. The ear wax was removed and now the left side of my head hurts like an earache and the left side of my throat hurts when I swallow. What could it be and who should I see? | |
| A | You could have developed an external ear infection. If wax is allowed to sit up against the skin of the external ear canal for a long perid of time it can break the skin down and give the bacteria some place to get in and set up an infection. Your regular physician could check and treat you for this. | |
| Answered by Glenn Ziemski, MD, Emergency Medicine, Eugene, Eugene Emergency Physicians, P.C. (1/3/2008) | ||
| Q | Why causes a stroke and how do you prevent it? | |
| A | Thank you for your question. Stroke is an important topic. Most strokes are caused by either a hemorrhage/bleeding into or around the brain or an interruption of blood flow to the brain. They occur suddenly. They can occur at any age from before birth up to any age but become more common as one gets older. Most strokes occur in people over age 50. There is no guaranteed way to be sure you will not have a stroke, but you can reduce your chances of having a stroke. The most important modifiable risk factors (things you need to check or change) are: high blood pressure, smoking, high cholesterol, diabetes, obesity, heart disease, sedentary life style, and recreational drug use. If you want more information, I'd suggest you look at our stroke website: http://www.knowstroke.org | |
| Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (12/5/2007) | ||
| Q | Should my daughter get the Gardisil vaccine after being diagnosed with HPV? At her second exam she was negative for HPV. | |
| A | Gardilsil provides protection from four strains of HPV, so it may be beneficial to her to be vaccinated, even though she has already been exposed to at least one strain. | |
| Answered by Heather York, MD, Obstetrics/Gynecolog, Eugene, Women's Care (11/25/2007) | ||
| Q | When I laugh really hard, I get an ache in the back lower area of my head. What causes this? Where can I look to find an answer? | |
| A | Thank you for your question. "Laughing Headaches" are a known form of headache. More commonly induced headaches are related to coughing or sneezing. The cause is not known but some think it is due to a temporary increase in pressure inside the head. There is one report of a patient who had "laughing headache" in association with an anomaly of brain formation called Arnold-Chiari malformation but generally these headaches are not a cause for concern. If these last a long time or are worsening or associated with any other symptoms, then you should see your physician and ask for a neurologic referral for evaluation. | |
| Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (10/8/2007) | ||
| Q | I have a 10-month-old who often gets colds from daycare, etc. When he gets these colds he tends to cough at night. I have been giving him Tylenol Cold and Cough, but recently in the news they are saying that you should not give this to children under the age of 2. So, is this true, and will it hurt since he has had it in the past. What do they suggest for the cough so that he can sleep at night. Often he coughs so much he ends up vomiting. | |
| A | One of the main reasons that we no longer recommend cough and cold medicine is that studies show that it does no good. I don't think you need to worry that you have done any harm to your child by giving it in the past. There have been children who have been overdosed on cough and cold medicine - another reason not to give it. Sometimes children who have excessive coughing with colds, actually have a mild form of asthma. You might ask your child's doctor, the next time you are in the office, if she/he thinks your child might have some mild asthma. | |
| Answered by Doug Gamet MD, Pediatrics, , (10/2/2007) | ||
| Q | Is there any way to check a surgeon's success rate and patient satisfaction? We have surgery scheduled in the near future and have no idea if we are in good hands. | |
| A | Currently there are only limited options for this. As more institutions publish outcomes research, it will become more commonplace to access an individual surgeon's "success" rate. Be advised that this type of data can be easily skewed and misinterpreted based on the complexity of the procedure and the overall health of the patient population (what we call 'risk-adjusted'). Results are poorer for sick people undergoing big surgeries, and surgeons that are willing to take on the tougher cases will frequently have 'outcomes' that look less than flattering. Your best option at this time is to ask the surgeon a few blunt questions: How many have you done? What is your "success" rate? (you must have some idea of what "success" means, such as how often the operation has the desired outcome) Are your patients satisfied? Can I talk to a patient or two that you have done this surgery on? The answers should be straightforward and willingly given. If not, look elsewhere. | |
| Answered by Charles Stanton, MD, Surgery: General, Springfield, Northwest Surgical Specialists (8/24/2007) | ||
| Q | I am a 23-year-old female with unwanted facial hair on my chin and neck. I recently heard about Vaniqa as a method of reducing facial hair growth. Other than laser hair removal, is this a safe alternative? Is it recommended? | |
| A | Only laser and electrolysis can result in permanent hair removal. Vaniqa is a cream that decreases the thickness and density of the hair growth, but does not remove the hair. It is a long-term treatment, and requires twice daily use for 3 months before significant improvement is seen. It needs to be continued indefinitely. | |
| Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (8/17/2007) | ||
| Q | Is it safe to use over-the-counter teeth whitening systems during pregnancy? | |
| A | These products are safe to use during pregnancy. | |
| Answered by Paula Jewett, MD, Obstetrics/Gynecolog, Eugene, Women's Care (8/17/2007) | ||
| Q | Can a blocked artery in the leg be fixed? | |
| A | The short answer is "yes". Options include balloon angioplasty, with or without a stent, and bypass, using your own vein (preferably) or a synthetic conduit such as GoreTex. A consultation with a vascular surgeon is your best approach. | |
| Answered by Charles Stanton, MD, Surgery: General, Springfield, Northwest Surgical Specialists (8/6/2007) | ||
| Q | Can you get the measles if you only had one vaccination as a child but never received your shot in high school? | |
| A | Most likely you are immune. However, if you are a health care worker you should know your measles immunity. If you believe you have been exposed please call your County Health Department or see your health care professional. There is a simple blood test that can tell you if you are immune. | |
| Answered by Christa Danielson, MD, Family Practice, Eugene, PHMG/FP-South (6/12/2007) | ||
| Q | What is the connection between Eastern Europeans and cystic fibrosis? Are they more exposed to the disease after they come to the U.S.? Why is there a connecion? | |
| A | Cystic Fibrosis (CF) is not a disease that can be caught. Therefore, one cannot be exposed to the disease. The disease is caused by an individual having two abnormal copies of a gene that all people have. This gene enables cells to pass water and salt through the membranes in equilibrium. When both copies of the gene do not work (i.e. mutation), then the lungs are full of mucus; thereby, providing a good environment for infection to flourish. Many genetic diseases, not all, have geographical locations in which the disease is seen more frequently. Having only one abnormal copy of the gene (individuals are called carriers) will not cause disease. However, it may afford some protection to a communicable disease. Therefore, carriers will survive an infection indigenous to a specific region more often and therefore more people are carriers. Hence, there is a geographic advantage to being a carrier. Genes are with us for generations. Therefore, a few generations does not eliminate the gene from the population. The biological advantage to being a carrier is not known. But it is clear that 1 in 25 Caucasians (mostly European) are carriers of CF. | |
| Answered at 5/8/2007 | ||
| Q | My daughter just turned 4, and she has underarm body odor like an adult. It is only noticeable after she has been very active. I'm concerned about early puberty. How valid is this concern? | |
| A | This may be a sign of androgen(a hormone) production and should be evaluated by your pediatrician. | |
| Answered by Bruce Strimling, MD, Pediatrics, Eugene, Oregon Medical Group (4/19/2007) | ||
| Q | My son was given a prescription for fluoride (EtheDent Chew, 1 mg) by his dentist. I want to make sure this is the appropriate dosage for him at 4 years of age (40 lbs) with the knowledge of any naturally occurring fluoride in the water (I don't know if we have any here in Eugene). What is a safe dosage for my 2 year old (25 lbs)? | |
| A | The fluoride dose is 0.25 mg for ages 6 months to 3 years, 0.5 mg for ages 3 years to 6 years and 1.0 mg for age 6 years to 12 or so years. There is no fluoride added to the Eugene city water. | |
| Answered by Doug Gamet MD, Pediatrics, , (4/12/2007) | ||
| Q | Do you have any suggestions for relieving chronic constipation? Also, is soy constipating? | |
| A | There can be many reasons for constipation, including drug side effects, low thyroid hormone levels and other potential bowel problems. It is important that causes of constipation be ruled out. The key to managing constipation through diet is plenty of fluids and natural fiber, as well as foods stimulating to the gut action, including fruits and fruit juices. Stool softeners can be prescribed by a health care provider and laxatives should avoided as much as possible. Soy is not generally considered a constipating food. | |
| Answered by Emily Gibson, MD, Family Practice, Bellingham, Western Washington University (4/4/2007) | ||
| Q | Many symptoms are associated with chronic insomnia - anxiety, lack of concentration, depression, etc. How likely is it that insomnia is itself a symptom of one of these conditions rather than the underlying primary ailment? What's the best way to precisely identify the ailment so as to provide the most effective treatment? | |
| A | Thank you for your question. You have identified the crux of diagnosing and treating insomnia. That is, we need to try to identify the cause of the insomnia. Insomnia often is the result of other conditions including such things as anxiety, depression, chronic pain, some metabolic disorders, other sleep disorders, etc. The nature and characteristics of the insomnia in addition to the history, physical examination, and some laboratory studies typically will allow us to determine if the insomnia is consistent with the diagnosis of "Primary Insomnia". This is the situation in which the insomnia is the primary diagnosis and other symptoms are secondary. Of course, complicating things is the not infrequent situation in which an individual patient has some elements of multiple diagnoses. | |
| Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (3/21/2007) | ||
| Q | What is Rotavirus? What are the dangers for a one-year-old? | |
| A | Rotavirus is a common winter viral illness causing fever, vomiting, and diarrhea. The illness is self-resolving and usually occurs in children under five. The treatment is prevention of dehydration during the illness, which is the only danger. Children may become infected twice, then develop natural immunity. Vaccination beginning in the first six months of life may prevent severe illness. | |
| Answered by Elizabeth Heskett, MD, Pediatrics, Springfield, PHMG/PED-RB Night (3/12/2007) | ||
| Q | How do you know if you have a concussion? | |
| A | A concussion is usually defined as a "mild" head injury usually with brief or no loss of consciousness, typically with some amnesia around the incident, and often with headache or some feeling of dizziness. The symptoms usually clear within a few days to a week. If symptoms persist longer or if there was any loss of consciousness at all, you should be seen by a physician. | |
| Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (1/24/2007) | ||
| Q | Do doctors test infants for the presence of drugs after the birth and discharge from the hospital? | |
| A | Newborns are tested for the presence of drugs of abuse after birth on an "as indicated" basis. If there is a history of drug abuse by the mother, then generally the infant will be tested. If there are issues with the infant's social situation that might put the mother at risk for drug abuse, then the infant will be tested. If the infant shows symptoms of possible drug withdrawal in the first few hours of life, then the infant will be tested. The bottom line is that we do not test every infant for drugs of abuse, but we try to test every infant who may be at risk for drug exposure during the pregnancy. | |
| Answered by Doug Gamet MD, Pediatrics, , (12/28/2006) | ||
| Q | Is Discogenic Disease the same as Juvenile Discogenic Disease (JDD)? | |
| A | No. Discogenic disease refers to any disease process involving the disc between the vertabrae in the spine. Usually, it is referred to as degenerative disc disease and is believed to be a combination of aging, stress and genetics. Juvenile discogenic disease occurs in youth and is frequently related to other diseases (such as Juvenile Rheumatoid Arthritis) or trauma. | |
| Answered by Martha MacRitchie, MD, Phys Med & Rehab, Eugene, Martha MacRitchie MD (12/21/2006) | ||
| Q | The skin around the corners of my right thumb and fingernails and along the top of my right-hand digits very near the fingernails are cracked and splitting. Hand cream has not helped. Vitamin E cream has not helped. pH adjustment cream has not helped. My hands are not in water more than usual, nor am I handling paper more than usual. | |
| A | This is a common problem, particularly on the tip of the thumb and index finger of the dominant hand. It is a form of hand eczema, and is caused by drying and irritation of the skin. If hand cream alone is not working, including Vaseline at bedtime with gloves, see a dermatologist for some prescription strength medications. If you get painful, deep splits of the skin on the fingertips, you may seal them with Superglue; it will make them feel better while they are healing. | |
| Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (12/11/2006) | ||
| Q | How do urinary tract infections develop into kidney infections? How does one prevent a kidney infection? What does a kidney evaluation look for? | |
| A | Once an infection develops in the bladder, the bacteria may advance up the ureter into the kidney which can result in a kidney infection. Preventing a bladder infection is the best way to prevent a kidney infection. To prevent a bladder infection avoid waiting too long to urinate once you feel the urge, minimize time sitting in bath tubs or hot tubs, use cotton rather than synthetic underpants, clean well after sexual intercourse, and consider consuming cranberry (juice or pills) if you already get frequent bladder infections. A kidney evaluation can look for many things (infection, stones, cancer, etc.) depending on the symptoms and type of test ordered. | |
| Answered by Frank Littell, MD, Hospitalist, Springfield, PeaceHealth Hospital Medicine (11/22/2006) | ||
| Q | What is considered "low" blood pressure? At what point should one contact a physician? | |
| A | There actually is not a good answer to this as "low" in some people may be "normal" in others. Generally a systolic blood pressure measurement (the upper number) of below 90 is considered low and may result in some symptoms of lightheadedness or dizziness when moving from lying or sitting to an upright position. "Too low" is generally apparent with near-fainting sensations and head rushes. Increasing fluid consumption is the main remedy. | |
| Answered by Emily Gibson, MD, Family Practice, Bellingham, Western Washington University (11/20/2006) | ||
| Q | My stepson has suffered flashburn from his welding job. His eyes are burning and scratchy feeling. What can he do to get some relief? | |
| A | Keep the eyes moist with a saline or lubricating drop that can be purchased over the counter. Do not use Visine or its generic equivalent. Ibuprofen may help as well as long as there are no contraindications. The symptoms should last less than three days. If it is going on longer or there is a possibility of a foreign body, he should be evaluated sooner. | |
| Answered by Glenn Ziemski, MD, Emergency Medicine, Eugene, Eugene Emergency Physicians, P.C. (10/19/2006) | ||
| Q | I am seven months pregnant and was wondering why I am not supposed to lift heavy objects? Is it because I may hurt myself or hurt my baby, or both? And if so, how would this occur? | |
| A | The ligaments of the back and pelvis soften in pregnancy. This makes the pregnant back more susceptible to injury. In theory, lifting excessive weight could increase the pressure in the abdomen and harm the pregnancy. Usual daily activity such as lifting toddlers is safe. | |
| Answered by Cristin Babcock, MD, Obstetrics/Gynecolog, Springfield, Women's Care (8/21/2006) | ||
| Q | Can you tell me what the progression of vision loss to blindness might be with diabetes? The same with kidney function? I read that these are concerns, but I have found little other information. I assume neither are sudden occurrences. Thank you | |
| A | You are correct that kidney and eye problems can result from having diabetes. The progression varies from person to person. The best preventive for eye and kidney problems is keeping blood pressure and blood sugar near normal levels. In addition, it would be prudent to schedule an annual eye exam and kidney function test. Other preventives are 1) to not smoke, 2) drink very little alcohol, and 3) include healthy foods (whole grains, fruits and vegetables)in your diet. Your ophthalmologist may have additional information for you regarding your eyes. | |
| Answered at 7/21/2006 | ||
| Q | Help! My husband has very bad breath. "Revolting" is a kind description. He has proper oral hygiene and visits the dentist every six months. He brushes and flosses every day. This has been a problem off and on with him over the years but recently it has gotten worse. Do you have any suggestions? | |
| A | The most common causes include tobacco use, periodontal disease, base of tongue debris, chronic tonsillitis, dental decay, Vincent's gingivostomatitis, ulcerative process in the mouth, sinus disease, bronchiectasis (lung disease), and diverticula of the esophagus. You may wish to visit your primary physician for an initial evaluation and they may determine based on what they find, that a visit to an ear, nose, and throat specialist is needed. | |
| Answered by Dennis Diaz, MD, Otolaryngology, Eugene, PHMG/ENT-Hilyard (7/11/2006) | ||
| Q | Like many others, I suffer from heartburn. I was diagnosed with GERD as a baby; however, afterwards never dealt with it until I reached high school. I was wondering if there is anything you could recommend over-the-counter or anything else besides taking the step towards prescription medications. | |
| A | First, here are some helpful lifestyle measures: 1) tilt bed with 4-6 inches of blocks/books/bricks under the frame or box spring, 2) eat a little more protein and 3) avoid excess sugars, caffeine (including chocolate!), mint, alcohol, spicy and acidic foods. To block acid production try Zantac, Pepcid, or Tagamet, which ever is cheaper. If that doesn't work, try Prilosec OTC which is the strongest available without a prescription (but may cost more). If you have frequent heartburn despite simple maneuvers, make an appointment with your physician. | |
| Answered by Mark Lyon, MD, Family Practice, Eugene, PHMG/FP-South (7/7/2006) | ||
| Q | I notice that the vitamin I take advises that it contains chromium It says to discuss eith your doctor if you are diabetic. I am, so I'm curious why chromium is a problem. | |
| A | There are some recent studies that suggest chromium supplementation may decrease insulin resistance, the primary cause of Type II (Adult Onset) diabetes. If you are on medications to help control your blood sugar, it is possible you may need adjustment in the dosages to prevent low blood sugar episodes. So. chromium is not really a "problem" but is potentially a benefit for diabetic patients. However, treatment of your diabetes may need to be adjusted if you are supplementing your chromium. | |
| Answered by Emily Gibson, MD, Family Practice, Bellingham, Western Washington University (6/22/2006) | ||
| Q | My blood pressure used to be 110/70. In the last year its been rising, yesterday reading 155/88. I've been moderately exercising, trying to eat better, so this is surprising to me. Is this part of the aging process? | |
| A | You don't say how old you are, what other risk factors for hypertension you might have, or your family history, but it appears your blood pressure is rising, if this is one of several elevated readings over the past year. Some common things can raise blood pressure: use of caffeinated products, or some over-the-counter cold remedies, nicotine and alcohol. If any of these are part of your life on a regular basis, you need to eliminate them and see if there is improvement in your pressure. Being overweight and sedentary also will cause pressure elevations but it sounds as if you are working on this. Eating lots of salty foods also can complicate it. However, despite your best efforts at healthy lifestyle, your blood pressure may continue to elevate. A physician review of your history, family history and general health is necessary to determine if this is essential hypertension (no known cause) or secondary hypertension (from another cause such as kidney or hormonal problems). Then appropriate treatment can be started so you are back to a normal blood pressure, sparing your blood vessels, heart and kidneys from long-term damage. | |
| Answered by Emily Gibson, MD, Family Practice, Bellingham, Western Washington University (6/6/2006) | ||
| Q | I have had a cold or cough for about three weeks, maybe a little longer. I don't know if I should go to the doctor to be checked or just let the symptoms go away on their own. What would you suggest? | |
| A | I can't comment about your case in particular because I don't know enough about your medical history. In general, my advice to folks with respiratory symptoms is that medical advice should be sought if any of 3 situations arise: (1)If symptoms persist beyond 10 - 14 days, (2) if the symptoms are associated with fevers at any point beyond the first 3 -5 days or (3) if at any point there is difficulty with breathing or shortness of breath. Here's link to more detailed information: Respiratory Symptoms. Good luck! | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (5/19/2006) | ||
| Q | My husband has been complaining that his fingers go numb all the time, especially at night and in the morning. It also happens during the day. He says that most of the time it's just the fingers on his right hand. This morning he said he felt pain in his arm and his fingers were asleep (numb). Sometimes he feels like they are swollen when he can't feel them. This has been going on for about 2 weeks. Sometimes it's only 1 or 2 fingers and sometimes more are involved. Should this be something to worry about? He's 23 years old and seems to be pretty healthy otherwise. | |
| A | There are several common causes of finger tingling and numbness, especially at night and on awakening. The most common is carpal tunnel syndrome, a compression of the median nerve at the wrist. Though initially just annoying, if left untreated for a long time, it can result in permanent nerve damage with numbness and weakness. Most people with carpal tunnel syndrome have no significant associated medical conditions, though some people turn out to have diabetes or thyroid problems or other less common associated medical conditions. I recommend that he either see his physician or a neurologist for evaluation. There are examination findings that can strongly suggest the accurate diagnosis of carpal tunnel syndrome or one of the other conditions that can cause finger tingling and numbness, and there are electrodiagnostic tests that can confirm the cause. | |
| Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (4/19/2006) | ||
| Q | What are my chances for contracting HIV/AIDS from coming in contact with urine on a public toilet seat? | |
| A | About zero. Urine is sterile and does not contain virus, unless there is blood in the urine. Blood, semen, vaginal secretions, vomitus, breast milk or pus from a person who is infected with HIV (human immunodeficiency virus) may contain HIV and may cause infection. The risk of acquiring HIV from a needle-stick injury is less than 1%, and the risk of infection from exposure not involving a puncture or a cut (such as a splash of body fluid onto the skin or the mucous membrane) is less than 0.1%. The risk of HIV infection from a human bite is between 0.1% and 1%. "Clear" body fluids such as tears, saliva, sweat and urine contain little or no virus and do not transmit HIV unless they are contaminated with blood. | |
| Answered by Erin Reilly, MD, Urgent Care, Springfield, PHMG/Urgent - RiverBend (3/8/2006) | ||
| Q | How can I convince a senior that she needs to move into an assisted living facility for health and sanitary reasons? | |
| A | It can be very difficult to see a senior not doing well and needing extra help, especially if they are not willing to make a change. The loss of independence and the thought of moving somewhere new can be very difficult. Friends and family need to be as supportive as possible in assisting the senior make any changes to their environment. It would be important for the primary care physician (PCP) be alerted to your concerns. A visit can be scheduled to have the PCP assess the situation and evaluate if there are any reversible reasons for the decline in health and function. The PCP can also make recommendations regarding future planning or to involve a Clinic Care Coordinator to assist with obtaining resources. If possible, and the patient has given permission, it would be helpful if a family member/advocate is also part of that visit. An assessment with a Geriatric Nurse Practitioner can be very beneficial. This can be arranged with the senior's PCP. Sometimes a family meeting with the patient where concerns are voiced can be effective. It might be advantageous to visit some of the area facilities to have a sense of what is available. A few changes in the home may be enough to make the senior safe. This might involve the use of a private pay care provider, Heartline and/or Meals On Wheels to supplement care and increase safety. Adult Day Care is an option. It is also possible to hire a community case manager to assist with coordinating some the the care aspects. An intake evaluation with Senior and Disabled Services is recommended as the senior may be eligible for some in-home assistance. If there are real concerns for safety, and the senior is not open to any assistance, Adult Protective Services should be notified. In the Eugene area the phone number is (541)682-4038. I would highly recommend beginning with a discussion with the PCP to request the services of the PCP's Care Coordinator, who can discuss options with you and patient. | |
| Answered at 2/9/2006 | ||
| Q | Can a 1-month-old be given Pediacare for nasal decongestion? | |
| A | At 1 month of age, I would suggest just using saline nose drops and a bulb syringe for clearing nasal secretions. Pediacare could be used, but sometimes the side effects like fussiness or wakefulness are worse than just dealing with the cold. If the baby runs a fever, you should see his or her physician. | |
| Answered by Doug Gamet MD, Pediatrics, , (2/7/2006) | ||
| Q | I get a drop of clear fluid from my nose all the time. It is embarrassing. What causes it and what can I do about it? It's been going on for years now. | |
| A | If you also have itching and sneezing then the culprit is allergies, in which case avoidance of the things you're allergic to is important. There are anti-histamines (i.e. generic Claritin/loratidine) and anti-inflammatory nasal sprays that help a lot. If you don't have the additional sypmtoms then it may be vasomotor rhinitis. The cause is less clear and the same treatments don't work quite as well, but are worth trying. | |
| Answered by Mark Lyon, MD, Family Practice, Eugene, PHMG/FP-South (2/1/2006) | ||
| Q | Is it possible to still have hypothyroid symptoms and yet tests show T4 to be within the normal range? If so, what kind of doctor should I see - internist or endocrinologist? | |
| A | If the T4 and the TSH are in normal range you are not hypothyroid. If you have been hypothyroid for some time, and it was quite severe, it takes longer to return to feeling normal. However, the symptoms of hypothyroidism can be mimicked by other disorders and thus may not be due to low thyroid function. I think re-evaluation by a an Internist is your best approach. | |
| Answered by Loren Barlow, MD, Internal Medicine, , (1/17/2006) | ||
| Q | I'm a 57-year-old female and am wondering about taking the low dosage aspirin for stroke prevention, etc. My cholesteral levels are good and I am at low risk for heart disease, although my father and brother have had heart attacks. What are the reasons for taking the low dosage of aspirin and what are possible side effects? | |
| A | The Hippocratic oath starts with "First, do no harm". My own variation on this is "It's hard to make a patient without symptoms any better". Hence, always my bias before prescribing anything is to have a clear understanding of risks and benefits, especially in patients where there is not a clear and apparent need. Ultimately this is a question of risks and benefits. First the risks; I've attached a link that provides some good information about aspirin use in general and provides some detail about who should use it, who shouldn't and the possible hazards of taking it on a regular basis: http://www.peacehealth.org/kbase/multum/d00170a1.htm Secondly, here is a guideline that addresses the benefits associated with the prevention of heart attacks and the use of aspirin: http://www.guideline.gov/summary/summary.aspx?doc_id=3079&nbr=002305&string=aspirin You can see from these that answering the overall question of risk vs. benefit is one that is highly individualized and should be made in consultation with your health care provider who knows the details of your personal medical history. | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (1/5/2006) | ||
| Q | What is the right age to wean a child from a pacifier or bottle? | |
| A | It is generally recommended that children be weaned from the bottle at around 12 to 15 months of age. This is for several reasons. First, milk or juice in the bottle will help to cause cavities in the teeth. Second, children who have a bottle tend to get more of their nutrition from milk and juice and less from solid foods. This tends to lead to poorer nutrition. Pacifiers have no real drawbacks to prolonged use. Some children have very strong sucking urges and seem to be more content with a pacifier. | |
| Answered by Doug Gamet MD, Pediatrics, , (12/13/2005) | ||
| Q | Is it possible for a person whose parents are both 0 positive blood types to have a child with a blood type of AB negative? I am curious about my blood type. | |
| A | Here are the simple rules to follow for blood type: 1. A and B are equal 2. Both A and B are dominant over O 3. Positive is expressed over negative 4. Blood type is carried on 2 markers...you get one marker from your mom and one from your dad So, if both parents are O positive, it is IMPOSSIBLE for them to have a child with AB blood. The parents, if O positive are either O+/O+ or O+/O- for their gene markers and thus can only have children that are "O" because that is the only type of blood gene they have. They cannot give a gene they do not have. If you remember high school biology and genetics: Let's say mom has O positive blood, but she also has a recessive O negative gene and let's say dad tests as A positive blood but has also an O negative recessive gene Mom's blood O+ / O- Dad's A+/ A+/O+ A+/O- blood O- O-/O+ O-/O- Thus, the possible blood types of their children would be expressed (following the rules) as: A+(from the A+/O+), A+(from the A+/O-), O+(from the O-/O+),and O-(from the O-/O-) A and B blood types are equal. So a child who is AB+ has one A gene and one B gene and at least one of those genes also has to be a positive. It is not a medically neccesity for you to know what blood type you have. We can always give someone O negative blood until we identify their blood type. I doubt it is something your insurance will pay for you to get your blood type done "just because you're curious". If you want to know your blood type for free and do a good deed, go donate some blood. They will test your blood for free when they take your donation and you may save a life. | |
| Answered by Erin Reilly, MD, Urgent Care, Springfield, PHMG/Urgent - RiverBend (11/22/2005) | ||
| Q | My son has been running a high fever for 2 days. It has been between 102 and 104.8 degrees today, though it has been mostly 104. At what point should we become worried? He saw his physician today and was told that it was a virus. | |
| A | A normal course for viral infections in children often includes fever for 3-5 days. The height of the temperature itself (i.e. what number) is not a point of concern. A higher temperature may cause him more discomfort, but not danger. Fever may affect children with other special medical problems differently. He should be re-examined should his degree of illness progress to difficulties breathing, taking liquids, skin rash, or a very low level of alertness that persists. Childrens' alertness is normally lower at the time their fever is high, but improves when the fever is lower or absent. A temperature of more than 100.4 degree for more than 5 days should be discussed with his physician by telephone or in the clinic. | |
| Answered by Elizabeth Heskett, MD, Pediatrics, Springfield, PHMG/PED-RB Night (11/19/2005) | ||
| Q | What are the viruses for which mothers are tested if they wish to donate their breast milk? | |
| A | Donors are tested for HIV, Hepatitis B and C, Syphilis, and HTLV (Human T-cell Lymphotrophic Virus). If a donor has spent 2 weeks or more in Europe they are disqualified as there is no test for Mad Cow Disease. | |
| Answered by Bruce Strimling, MD, Pediatrics, Eugene, Oregon Medical Group (11/14/2005) | ||
| Q | Are there any eye exercises (or other alternatives to surgery) that have been proven to reduce hyperopia? | |
| A | No. There are no credible, peer-reviewed studies that indicate that exercises can reduce hyperopia. Short of corrective surgery (such as LASIK), the only other options for correction of hyperopia are corrective lenses, either spectacles or contact lenses. | |
| Answered by I. Howard Fine, MD, Ophthalmology, Eugene, Drs. Fine, Hoffman & Packer, LLC (11/10/2005) | ||
| Q | I became sick last Wednesday. I thought it was a chest cold. However, my cough is hanging around and is very "wet" sounding. There have been a couple cases of bronchitis at my work, and I wonder if that is what I had/have. My question is: if I have bronchitis, do I need to get antibiotics to get rid of it, or will it go away on its own? | |
| A | Most cases of "bronchitis" are due to a virus, especially in smokers. If your symptoms are due to a virus, a course of antibiotics would not help you feel better. That is not to say that if it is viral there is nothing to do about it. Your doctor may be able to help out with some medications aimed at specific symptoms. And,as always, lots of rest and fluids will help improve your immune system so you can fight it off. | |
| Answered by Glenn Ziemski, MD, Emergency Medicine, Eugene, Eugene Emergency Physicians, P.C. (11/8/2005) | ||
| Q | I'm a 35-year-old female who developed adult onset acne at the age of 22-23. I used tea tree oil at first to get rid of the cysts on my face and that was successful. I rarely get any more acne cysts, but when I do it's only one or two at most and tends to clear by itself with spot treatment of Retin-A. My question involves my unrelenting enemy of blackheads. I am unable to get rid of the blackheads on my nose, cheeks, and on my chin. I've tried everything. The only thing that works is Retin-A cream. I use a mild soap (Dove) because my skin is very sensitive (prone to dermatitis of the mouth and hands) and a wash cloth to wash my face every morning. I don't really like having to use Retin-A on the areas prone to blackheads because I am uncertain as to how safe it is. I've been using Retin-A off and on for about five years now. Is there another treatment that would be more effective? Is it safe to continue to use Retin-A to control the blackheads? I use it about every six months for about two to three months at a time. I can't use toners on my skin because it irritates my skin to reddness and sometimes hives. I cannot use anything that has alcohol or peroxide in it because I break out with hives. Anything that strips the oil off my skin irritates it. Any advice or suggestions? Thank you. | |
| A | Blackheads and whiteheads (comedones) can be difficult to control. Alcohol, toners and other products that strip oil are not helpful. The most effective treatments are Retin-A (tretinoin), Differin and Tazorac. These medications are generally safe for long term use, but should not be used in pregnancy. | |
| Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (10/27/2005) | ||
| Q | My grandma and my mother have chronic nasty bad breath even after brushing their teeth. My grandma is a severe diabetic. My mom is a borderline diabetic. I have noticed lately that I have been having problems with bad breath. Is it hereditary? Is it caused by diabetes? Should I get checekd? How can I get rid of it? | |
| A | Bad breath, or "halitosis" is usually caused by bacteria somewhere in your mouth/gums/teeth, throat, nose, or sinuses. Occasionallly it is caused by things you eat (ie. garlic, onions). Chronic users of DMSO (a solvent) used by some people for arthritis also can experience halitosis. Diabetes doesn't alter your breath directly unless you're in a state of very high sugars called "ketoacidosis". Indirectly, diabetes makes it more likely you'll get halitosis because bacteria and other germs do well in high sugar environments. Doctors or dentists can usually help you find your source and treat it. | |
| Answered by Mark Lyon, MD, Family Practice, Eugene, PHMG/FP-South (10/27/2005) | ||
| Q | I found blood in my semen. Why would that happen? I am in good health otherwise. | |
| A | You need to see your doctor for further evaluation. Hematospermia (blood in semen) can have many causes; including a variety of infections along the urogenital tract, trauma or even stones in the tract. It is important for you to see your regular doctor for initial evaluation and you may even need to see a specialist(urologist). | |
| Answered by Erin Reilly, MD, Urgent Care, Springfield, PHMG/Urgent - RiverBend (10/10/2005) | ||
| Q | My dad has been bitten by a spider. The bite has swollen and become very painful. He thinks it was a brown recluse. He hates doctors. What can we do at home to treat this? | |
| A | If it was really a Brown Recluse spider he could be in for real problems. As a home remedy he might try taking an anti-histamine like Benadryl which he can get over the counter. He can take 2 tablets every 8 hours. He could also try making a paste of soda and water to put over the area of the bite. | |
| Answered by Loren Barlow, MD, Internal Medicine, , (9/20/2005) | ||
| Q | My 22-month-old daughter has suddenly started having wild temper tantrums. There seems to have been a sudden switch from the way she used to be when upset to the tantrums she is having now. She now gets extremely upset at the slightest thing. For example, this morning she tried to pet the cat and it ran away from her. She threw herself on the ground and was hysterical--screaming, crying, practically hyperventilating and wouldn't let us come near her to comfort her. It took a good 20 minutes for her to calm down. She never used to get so upset. Previously she would throw the occasional tantrum, but it wasn't nearly as wild. She has also recently become afraid of imaginary tigers in her room at naptime(and occasionally at bedtime) and screams as though terrified out of her mind and tells us "tigers scare me" and "big tigers hiding in room". There have been days when it has taken almost 2 hours to get her down for a nap for this reason. Is this normal behavior or is something wrong? I am really worried that her emotions are completely out of her control and that her imagination is running amok and I am not sure what to do. | |
| A | It sounds to me like it is normal "terible twos" setting in. The best advice is to not overact to her fits and, essentially ignore them, perhaps even remove her from the family environment to her room or crib. Once she realizes there is no secondary gain the fits should settle down. These meltdowns are always worse when children are hungry or tired. I recommend a book by John Rosemond called, "Return to Parent Power" for more information in this regard. As far as the imagination, that also is a normal behvior. I would not ignore the fears but not be overly concerned. Consider having a "protector stuffed animal" or "tiger spray" before naps, but do not let her play off this and let her expand the pre-sleep time. Be careful what she sees on TV as this can really increase the imagination fears. Good luck! | |
| Answered by Doug Gamet MD, Pediatrics, , (9/8/2005) | ||
| Q | Should you use heat or ice for a pulled hamstring? | |
| A | Within 3 days always use ice for acute injuries. After 3 days you can use either. | |
| Answered by Kathleen Hirtz, MD, Family Practice, , (9/2/2005) | ||
| Q | What makes your blood pressure go way down and what could happen if it stays really low? | |
| A | Many things can cause blood pressure to drop below normal. The top number should always stay 90 or above, by the way. Dehydration would be a common cause, as would certain medications (especially heart medications, medications to treat high blood pressure, and certain medications used to treat psychiatric diseases). Problems with the adrenal glands can also do it but those are very rare. | |
| Answered by Frank Littell, MD, Hospitalist, Springfield, PeaceHealth Hospital Medicine (8/29/2005) | ||
| Q | I have had fibromyalgia for several years. In the past two years it has become worse. I am sore most of the time. I have muscle spasms and back pain. I have trouble sleeping well. When I do sleep, I wake up feeling very painful. It takes me over an hour to get going in the morning due to pain and stiffness. I take Flexeril for muscle pain and amitriptyline to help sleep; but things don't seem to be getting any better. I also take ibuprofen and Tylenol for pain. The only time I feel human is when I am on narcotic pain medication and some kind of antispasmodic medication. I am able to do more things like interact more with my kids physically, and help my husband more around the house. Otherwise, much of my time is spent hurting. I don't want to sound like a drug addict, but that is the only thing that seems to help. I do exercises and also do water areobics. Any other suggestions? Any references to a good physician that deals with fibromyalgia? | |
| A | I recommend that you consider evaluation by a rheumatologist to confirm that this is the correct diagnosis. Your question about narcotic pain medications is a difficult one. There is no literature to support the use of narcotic analgesics for Fibromyalgia pain, and there is moderate evidence of benefit with low dose Flexeril. Conditioning, including strength-training has evidence of benefit. The book "When Muscle Pain Does Not Go Away", is a good resource for this difficult condition. | |
| Answered by Peter Kosek, MD, Pain Management, Eugene, Pain Consultants of Oregon, PC (8/23/2005) | ||
| Q | Is it possible to have rheumatoid arthritis and it never shows up in your blood? | |
| A | I assume you are talking about the so-called Rhuematoid Factor blood test? Yes, it is possible to have rheumatoid arthritis and have a negative Rheumatoid Factor. It is unusual but it does occur. In order to make a diagnosis of Rheumatoid Arthritis, specific symptoms and physical findings need to be present with or without a positive Rheumatoid Factor. | |
| Answered by Loren Barlow, MD, Internal Medicine, , (8/11/2005) | ||
| Q | What causes ridges on fingernails that run from tip toward hand, not from side to side. Does it signify heart problems? | |
| A | Longitudinal ridging is almost always a normal change associated with age, though it can happen in young adults. It's rarely associated with a skin disease called lichen planus, but you should have other skin or oral rashes if that was true. It is NOT associated with heart disease. | |
| Answered by Mark Lyon, MD, Family Practice, Eugene, PHMG/FP-South (8/9/2005) | ||
| Q | Is there anything I can do to get rid of spider veins all over my legs? | |
| A | Spider veins are not medically of concern. They are harmless. This is good and bad; it's good to know that they are not to be worried about, it's bad because getting them worked on is very likely something that your insurance company is going to view as "cosmetic" and hence something that you'll have to pay for out of your pocket. There are several techniques which can help them go away. Most of these techniques are focused on choking off the main vein which feeds the network of smaller veins which make the "spider". This choking is referred to as "sclerosis" and can be done either with a tiny electric current or through injection of a small amount of a chemical. Check in with your physician to see if s/he can do this for you. Is s/he can't then s/he should be able to recommend a colleague who can. | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (8/7/2005) | ||
| Q | I have been having irregular vaginal bleeding and it has lasted several days. I am on Yasmin. I had a pap smear in June that came back normal. I have been under some stress. I am away from home until September and I am concerned. | |
| A | The irregular bleeding is probably due to the Yasmin as the most common side effect of the birth control pill is irregular bleeding. If you have any concern about pregnancy, you should do a pregnancy test. If it is negative, then you need to take the Yasmin every day at the same time. Because it is a low dose pill, it is more likely to cause irregular bleeding if you go more than 24 hours between doses. The bleeding is a nuisance and annoying, but is not serious (assuming a negative pregnancy test). If your pregnancy test is positive then you need to see your doctor. The irregular bleeding usually resolves within the first 3 to 4 months on the birth control pill. If it does not, then you should see your doctor as well. | |
| Answered by Linda Frison, MD, Obstetrics/Gynecolog, Eugene, PHMG/OBGYN-Hilyard (8/1/2005) | ||
| Q | I have a cough that will not go away. I have been coughing intermittently during the day over the last 2-1/2 years and I do not recall it starting with a cold/flu. I have mentioned it to my doctor each time I go in for my yearly physical and I am told to let her know if it gets worse. My father smoked and my husband smokes. I smoked for approximately 10 years and quit over 20 years ago. I had severe allergies as a child and suffer from two - three bouts of hay fever each year. I have no other symptoms nor am I ill on a regular basis. I may get a serious cold once a year, but some years I even escape that. Are there any tests I should ask my doctor to perform to determine the origin of this cough? Can I demand a chest x-ray? | |
| A | A cough lasting longer than 6 weeks deserves further workup, including chest x-ray to rule out hidden pneumonias or other lung abnormalities, a skin test for tuberculosis and breathing tests to evaluate for asthma presenting as cough. Other common causes of prolonged cough include chronic sinusitis (necessitating sinus x-rays) and esophageal reflux. So yes, you should ask that additional work up be done due to the persistance of your cough. | |
| Answered by Emily Gibson, MD, Family Practice, Bellingham, Western Washington University (7/27/2005) | ||
| Q | If I am taking azithromycin for something other than a sexual transmitted disease, is it okay for me to have intercourse while taking it? | |
| A | There is no problem having intercourse when taking any antibiotic, though you are correct that when the treatment is for an STD, you should abstain until tested as cured. In this case, there is no concern. | |
| Answered by Emily Gibson, MD, Family Practice, Bellingham, Western Washington University (7/27/2005) | ||
| Q | What do I do for a 101.4 temperature? | |
| A | Above 101, it's certainly acceptable for adults to take Tylenol 500-1000mg every 4- hours as needed. Ibuprofen 400-600mg every 6-8 hours is also good if your stomach can take it! If the fever persists more than a few days without obvious explanation or you have other worrisome symptoms (rash, stiff neck, shortness of breath, tummy pain, painful urination, etc... see your Doctor. | |
| Answered by Mark Lyon, MD, Family Practice, Eugene, PHMG/FP-South (7/27/2005) | ||
| Q | My husband has had Juvenile Diabetes/Type 1 Diabetes (since probably age 25). I recently discovered that I am pregnant. Should I be taking any precautions with regard to my sugar intake? | |
| A | Congratulations. Your next step is to determine where you will go for prenatal care, if you haven't already. No, you don't have to limit your sugar intake because your husband has diabetes. You should completely avoid tobacco and alcohol, eat a healthy balanced diet, and your pregnancy doctor or midwife may test you for diabetes if it is needed. They will provide you other recommendations for self care. | |
| Answered by Dickinson, Katherine, M.D. , Family Practice, Bellingham, Katherine Dickinson MD (6/13/2005) | ||
| Q | What is staph infection? What are the signs? My two children have been exposed to this infection through friends of the family, who just found out that they were infected with this certain infection. I have heard that this is a very contagious infection. | |
| A | Staphylococcus is a type of bacteria common to the skin surface. We all carry it around with us every day. Some strains are especially infectious and can cause boils or infect cuts and wounds. This type of bacteria is gaining resistance to many of our best antibiotics worldwide. It sometimes causes deeper infections, like pneumonia, but usually in older adults or immunocompromised patients. | |
| Answered by Frank Littell, MD, Hospitalist, Springfield, PeaceHealth Hospital Medicine (6/4/2005) | ||
| Q | I have a friend who is 37 weeks pregnant, and she has smoked crystal meth off and on during her whole pregnancy. How long does the drug stay in her system, and how long does it stay in the baby's system? If she or the baby tests positive for meth use will the state of Oregon take her baby away from her at birth and keep the baby? Please explain to me how the drug testing laws in Oregon work, and what consequences might she face if the baby tests positive. Does the father have any say in where the child goes? | |
| A | Meth (methamphetamine) shows up on urine drug screens for days to weeks after use, depending on the amount used. If your friend or her baby test positive, a referral to Services to Children and Families (SCF) will be made and a caseworker will determine if the baby is to be removed from its mother. If the father is in a drug free environment and is not in contact with the mother (who uses drugs) he may get custody. | |
| Answered by Heather York, MD, Obstetrics/Gynecolog, Eugene, Women's Care (6/3/2005) | ||
| Q | I am a 24 year old African-American female who suffers from acne. No matter what I do I only have temporary results in my fight against acne. I have been reading about a laser called the Erbium laser for skin resurfacing. I have heard that this laser is okay for people of color, but I am not sure. I am at wits end with my acne; I don't know what to do -- any suggestions? I don't get pimples or zits -- just blackheads and whiteheads that never go away, or if they do they always come back. Do you know of any permanent results, like lasers that can treat this condition? | |
| A | There are many treatments for acne. Blackheads and whiteheads tend to be particularly difficult to control, and often requires ongoing treatment. Microdermabrasion, chemical peels and some lasers may be helpful, but there is a risk of pigment change in people of color; I'd recommend that you see someone who has experience in darker skin tones. | |
| Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (6/1/2005) | ||
| Q | Can you give me information about anxiety attacks --(ie. what they are, what causes them, what happens to a person when having one, etc.)? | |
| A | Anxiety, or panic, attacks are caused by our fight or flight survival system being activated and flooding our bodies with adrenaline in order to escape danger. Unfortunately, most of our percieved danger at this time is emotional, but we stiil get all the physical effects of having a surge of adrenaline in our system (racing heart, shortness of breath,light headedness). Often, we then become afraid of having panic attacks and that can set off the adrenaline reaction also. Anxiety and panic are two things that respond very well to therapy and medication. Medication alone can stop the symptoms, but not change the thinking that gets us into perceiving danger in various situations. That is where therapy is needed. A good book is "Feel the Fear and Do It Anyways." Some good web sites to learn more about Anxiety Disorders are Anxiety Disorders of America and The Anxiety Network International. | |
| Answered by Hallenburg, Kris S. PhD, , Eugene, PHMG/Psy - Hilyard - 420 (6/1/2005) | ||
| Q | My daughter is a minor and has left home and refuses to return. I have been informed by various individuals that she has been smoking meth, which would explain her nasty personality change. She has frequent headaches, has dropped out of school, changed friends, is depressed and sometimes cuts. I know where she is staying; I wonder if I could get Child Protective Services involved. Would a drug test confirm use and is there any way to force her into treatment if needed? | |
| A | I would definetly call Child Protective Services, and if she is a minor and a runaway, the police. To find out about services to teens you can call the Drug and Alcohol Recovery Center at St. Joes by calling 734-5400 and asking to be connected to that unit. Please let us know if you have any further questions. | |
| Answered at 6/1/2005 | ||
| Q | I was diagnosed with Hashimoto's disease and had my entire thyroid removed. My TSH levels never seem stable. I also had a hysterectomy removing my ovaries. (I am on estrogen replacement.)Could this be the cause of the inconsitencies, and what can I do to correct this? While I feel better, I still battle with fatigue as well as other symptoms. | |
| A | As far as the thyroid replacement is concerned I would suggest the following. 1) In my opinion it is best to not use a generic brand of Thyroid. I prefer the brand name of Synthroid, 2) You should be able to stabilize the dose by having periodic Thyroid Stimulating Harmone (TSH) 3) A TSH of from 1.0 - 4.0 can usually be maintained once the proper dose is determined. 4) Dosage changes should be in gradual increments. Finally your fatique is not necessarily related to low Thyroid function. There are lots of factors involved in producing fatique. I don't think also being on Estrogen is a factor in the problem of your Thyroid replacement. | |
| Answered by Loren Barlow, MD, Internal Medicine, , (5/31/2005) | ||
| Q | Can anxiety cause you to have asthma? | |
| A | There's a reliable source that has a great discussion on Stress and Asthma. | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (5/25/2005) | ||
| Q | I recently tested positive for Hepatitis C antibodies..This was a complete shock --I am 54 years old and was never a drug user. However, I did have a blood transfusion 38 years ago. Can this virus have been in me since then? If so, going untreated for so long cannot be good. My doctor will do further testing but so far my ALT and ASL levels are just slightly elevated. Can there be severe liver damage with no treatment for that many years? If so, what are the chances of recovery with treatment? | |
| A | It is possible to have contracted Hepatitis C sexually, though it is not as apt to be spread sexually as it is through direct blood contact such as a transfusion/exposure to another person's blood in a first aid situation. Further testing is necessary for you to know if treatment is warranted as there may not be any active virus or significant liver injury. The complete remission rate with antiviral treatment is variable and depends on many factors about the individual and the extent of viral infection and liver damage. The most important thing is to avoid alcohol and other liver toxins until you know more. You will need to work with a gastroenterologist familiar with Hepatitis C. | |
| Answered by Emily Gibson, MD, Family Practice, Bellingham, Western Washington University (5/23/2005) | ||
| Q | I have recently noticed the onset of many floaters accross my field of vision and the odd shooting flash of light in the periphery of my vision. I only notice them in certain light conditions and when looking at a blank surface or blue sky. Feeling worried, I went to my optician and he performed a dilated pupil exam and declared that my eyes were healthy. In fact he couldn't see the debris in my eye that is causing me to see these 'floaters'. Could this then mean that they represent the symptom of another condition, maybe some sort of scarring? I first noticed these 'floaters' the day after a vigorous bike ride that included many sharp bumps and vibrations. Can this sort of activity cause the onset of eye floaters overnight? | |
| A | Floaters (whether your eye doctor sees them or not) are actually tiny clumps of gel or cells inside the clear jelly-like fluid that fills the inside of your eye. Floaters can have different shapes. When people reach middle age the gel often starts to change, resulting in clumps or strands within the eye. This is more common in people who are nearsighted, have undergone eye surgery, have had inflammation inside the eye, or have had jarring bumps to the head or eye. Flashes of light occur when the gel pulls on the retina. The flashes can occur off and on for weeks or months. Some people experience flashes of light that appear as jagged lines or "heat lines" in both eyes, often lasting 10-30 minutes. These types of flashes are usually caused by migraines, with or without a headache. Though floaters and flashes are usually benign annoyances, they may occasionally be a sign that the retina has torn. Because a torn retina can lead to a retinal detachment, any significant change in floaters and/or flashes should be taken seriously by having the eye examined by your eye doctor. | |
| Answered by David Deutch, MD, Ophthalmology, Eugene, PHMG/Ophth-Hilyard (5/18/2005) | ||
| Q | My mom just had inguinal hernia surgery, and she's having sharp "fireball" pains in her groin area. It hurts for her to walk, sit, go to the restroom. Is that normal, and is there anyway to stop or help the pain? | |
| A | Pain after hernia surgery, for a week or two, is to be expected. Prolonged or excessive pain is not common, and may represent an irritated nerve, bone or muscle inflammation at the repair (or mesh anchoring) site, early hernia recurrence, a deep space infection or hematoma (blood clot). The best place to start getting answers to these types of questions is to ask her surgeon. | |
| Answered by Charles Stanton, MD, Surgery: General, Springfield, Northwest Surgical Specialists (5/18/2005) | ||
| Q | I was in a recent car accident, (rear ended by another driver while stopped at a red light, other driver going 30 mph), and I am noticing a bulge near my belly button that is roughly the size of a walnut. I think that I have a hernia and I am wondering if it could have been caused by my seat belt in the car accident? | |
| A | Based on your description it seems possible that you are experiencing an "umbilical hernia". Certainly a trauma to the belly can play a part in causing an umbilical hernia. Here is a very thorough "Tutorial" from the NIH on Umbilical Hernia that might be helpful as you think this through. | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (5/16/2005) | ||
| Q | What are the treatments for Proteus Syndrome? | |
| A | Since the syndrome presents in multiple ways the treatment depends on its presentation and is guided by how to improve function. I suggest you go to the internet and to the Proteus Syndrome Foundation for more detailed information. You will receive very reliable information at that Web Site. | |
| Answered by Loren Barlow, MD, Internal Medicine, , (5/16/2005) | ||
| Q | I am pregnant and my doctor told me that I have leukocytes in my urine. I would like to know what this means? Is this something I should worry about? | |
| A | It can sometimes be the sign of an asymptomatic bladder infection. Usually the urine is cultured, and if an infection is present, you are treated with antibiotics. In pregnancy, a bladder infection can move up to a kidney infection if untreated. | |
| Answered by Paula Jewett, MD, Obstetrics/Gynecolog, Eugene, Women's Care (5/16/2005) | ||
| Q | I've smoked marijuana approximately once a week in small quantities around two or three times in the last month. I am participating in athletics at my school (everyday) and I consider myself to be in good physical shape (6'2" 175 pounds). I am by no means a chronic user. If I were to take a UA test in the next couple days would I produce a positive result? | |
| A | Occasional users of marijuana can stay positive (in the urine) for 2 or 3 days after the last use. | |
| Answered by Stephen Erfurth, M.D., Pathology:Anatm/Cln, Springfield, Stephen Erfurth PhD (5/16/2005) | ||
| Q | If someone had plastic surgery and they removed 4900 cc's of fat, what is that equivalent to in pounds? | |
| A | A little less than 10 pounds. | |
| Answered by Lee Daniel, MD, Plastic & Recon Srgy, Eugene, Aesthetic Plastic Surgery (5/9/2005) | ||
| Q | As a result of a fall on the stairs at my house, I have a wedge compression fracture of T5 and have been braced. I am 33 years old. It has been four days since the accident and the pain is almost gone (just some "pulling sensation in certain positions"). I never lost any sensations anywhere in my body. I have some basic questions that I have had conflicting answers to: can I sleep in the side position (without a brace on) or should I try to be on my back as much as possible when in bed? Also, what is the percentage rate of sucessful outcomes following bracing in this type of injury? I am really scared of the surgery. Right now they say it is stable. | |
| A | Thoracic compression fractures which are stable are most often treated with a Cash Orthosis or similar "extension" brace. The purpose of bracing is to support the fracture until it is healed and limit the amount of angulation at the fracture site (called kyphosis). In my opinion, the brace should be worn for AT LEAST six (6) weeks to allow time for boney/ligament healing. The most ideal position for sleep is supine (on your back) and the brace should be worn full time and removed for bathing only. In stable fractures, surgery is rarely necessary. As always, close follow-up by your caregiver, with apropiate radiographs (x-rays), are necessary to ensure the best outcome. | |
| Answered by Andrew Boughal, DO, Orthopedic Surgery, Florence, PeaceHealth Medical Group - Siuslaw (5/8/2005) | ||
| Q | I had unprotected sex with my boyfriend and he did not tell me he had herpes. If he wasn't having an outbreak when we had sex, how likely it is that I will get genital herpes? | |
| A | It is possible to get herpes in this situation. The risk depends on several different things. If he had an outbreak within a few days after you had intercourse, the risk was much greater because he was probably "shedding" virus from his genital skin then. If he is taking antiviral medicine, to cut down on shedding, it would reduce the risk greatly. Your own immune system, and how healthy you are, has an effect. If you have AIDS or some other illness that decreases your ability to fight off infection, your risk is much higher. It's time to carefully evaluate your relationship if a partner has sex with you without telling you they have a sexually transmitted infection, especially if the partner does so without the protection of a condom. Does he not care about your health? Is he afraid of telling you? Does he just not know how to raise the subject? Since we often don't know how reliable new partners may be with these hard questions, it is always a good idea to use condoms. Say "I want to protect us both. I've heard that some infections are invisible and people don't even know they have one." Also, say "Before we have sex, why don't we go to the clinic and both get checked? And I'll make sure my birth control is working right." | |
| Answered by Dickinson, Katherine, M.D. , Family Practice, Bellingham, Katherine Dickinson MD (5/6/2005) | ||
| Q | What is going to happen to me when I go to see an endrocrinologist? I have a slightly enlarged pituitary gland and I am scared. | |
| A | Fear not! The evaluation of a slightly enlarged pituitary is usually pretty easy. Depending on what has been done already the endocrinologist will very likely start with some blood tests and maybe some imaging of your skull. In many instances this slight enlargement is found to be harmless and require no treatment. In others there are hormonal abnormalities that need to be addressed and minor types of tumors which most frequently can be treated with medicines. Here's some more information on Pituitary Disorders. | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (5/6/2005) | ||
| Q | What are NEUTRO 's in a CBC test? | |
| A | Neutrophils are granular leukocytes (white blood cells). Neutrophils are phagocytes engulfing bacteria and cellular debris. An increase in the number of neutrophils occurs in acute infections, certain malignant neoplastic diseases, and some other disorders. | |
| Answered by Stephen Erfurth, M.D., Pathology:Anatm/Cln, Springfield, Stephen Erfurth PhD (4/28/2005) | ||
| Q | I had an MRI done of my back in 2003 because of low back pain, tingling in both legs, pain radiating down my left leg. The report findings: The lumbar vertebral bodies are normal in height and alighnment. The bone marrow signal is homogeneous. There is disc desiccation at L5-S1. The conus extends to t12-L1 and appears normal. The L3-L4 and L4-5 discs appear normal. There is a small annular tear at L5-S1 with a very small central disc herniation at that level. There is no lateralization. The neural foramina are widely patent. There is no evidence of spinal stenosis. IMPRESSION: Degerated disc L5-S1 with annular tear and very small central HNP. What does all this mean? Since then I have continued to have severe back pains and in the last four weeks I have had three episodes where I have bent down, or twisted to move, and I have gotten stuck so that I can't straighten back up or move my legs. | |
| A | If you think of your disc as a jelly filled doughnut, the annulus is the dough and the nucleous pulposus is the jelly. IF you have a tear in the annulus, some of the jelly can bulge backwards toward the spinal canal where the nerve roots live. People who experience radiating pain, numbness or weakness down one leg have may have a bulge more to one side, "lateralization", instead of your "central" herniation. This central bulge may cause your symptoms to be a little more subtle. I am assuming if you had this test in 2003, whoever was interpreting it and examining you did not feel that you had any loss of nerve function and that the symptoms could be managed with exercise. If that has not been successful or if you are having different symptoms than in 2003, you should consider a follow-up evaluation. | |
| Answered by Tom Hasbach, MD, Orthopedic Surgery, Springfield, PHMG/Ortho-RiverBend (4/28/2005) | ||
| Q | My son is 17 and has recently begun taking Accutane. He has been taking it for 9 weeks now. Our doctor told us it would not be uncommon for him to have breakouts while on the treatment, but since he has been on Accutane he has had severe breakouts. The doctor put him on a small 10mg twice a day dose of prednisone to help, and this really seems to work, but once off the prednisone the acne came back worse than before. I know we have to be patient since it is a five month course of medication. He is taking 80 mg a day dosage of the accutane. Can you assure me that this is normal? I thought by this time (9 wks) that we would have seen an improvement, not a worsening of the condition. It is so hard for him to go to school, he has acne where he never before had it in massive quantities. Is this the way it will be for the entire treatment? We can see the drying up of the skin as it is peeling. But it seems that when it should be healing, the pimples seem to come back in the same places and everywhere else as well. | |
| A | Accutane will not start working until a few months into treatment. Average improvement is usually about 3 months into treatment, but it varies person to person. In some people, Accutane causes worsening of the acne at first. This is usually treated with prednisone; I often use antibiotics as well. It sounds like your son is having an unusually severe flare of his acne. This may warrant decreasing the dose of Accutane, or increasing the dose of prednisone, or both. Don't wait until his next scheduled visit to talk to the dermatologist about this; call today. | |
| Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (4/27/2005) | ||
| Q | Can I get a paternity test at eight months of pregnancy? I had the amniocentesis done at four months of my pregnancy. | |
| A | Paternity testing requires cells from the mother, the infant, and the man who is being identified as the infant's father. This is normally done after birth with a blood sample from each person. I don't know if there is any way of doing the test on the cells obtained from the infant at amniocentesis. You should ask that question of the doctor who did the amniocentesis, and find out if any cells are actually left now, 4 months later. | |
| Answered by Dickinson, Katherine, M.D. , Family Practice, Bellingham, Katherine Dickinson MD (4/26/2005) | ||
| Q | I woke up 16 days ago to the shock of subconjunctival hemorrhage under the eyelids of my eyes. The blood spread for three or four days, moving into the visible white region of my eye and changed from dark red, due to the higher concentration, to a much brighter red. Since then it has gradually been getting better and reabsorbing. Seeing as it has been 16 days since the hemorrhage and that it seems like my eyes will need at least another week to hopefully heal entirely, is my healing on track timewise? Also, have there been cases where all of the blood has not reabsorbed or dried under the conjunctiva, resulting in less than full healing? | |
| A | The amount of time it takes for a subconjunctival hemorrhage to resorb is dependent upon the amount of blood that has escaped. The larger the amount of blood the longer it will take to resorb. I don't think your situation is unusual. I do not know of any cases of subconjunctival hemorrhages that have not recovered completely. | |
| Answered by David Deutch, MD, Ophthalmology, Eugene, PHMG/Ophth-Hilyard (4/25/2005) | ||
| Q | Once you have been diagnosed with cirrhosis of the liver (alcohol induced), does the disease progress despite treatment and lifesytle changes like stopping drinking and smoking? | |
| A | It can, but would be much less likely to than if alcohol intake continued. Like many other organs, liver tissue can lose function just through the aging process. A person with cirrhosis is also much more likely to have a worse outcome from taking potentially liver-toxic drugs, or acquiring hepatitis. | |
| Answered by Frank Littell, MD, Hospitalist, Springfield, PeaceHealth Hospital Medicine (4/25/2005) | ||
| Q | What does it mean if my TIBC is high and also my SATURATION is low? | |
| A | A high TIBC with a low iron saturation suggests uncomplicated iron deficiency. Your physician may perform additional tests such as ferritin and a complete blood count to confirm iron deficiency. The usual causes of depleted iron stores include blood loss and inadequate dietary iron. | |
| Answered by Stephen Erfurth, M.D., Pathology:Anatm/Cln, Springfield, Stephen Erfurth PhD (4/20/2005) | ||
| Q | What is wrong with eating dinner late at night? | |
| A | While we hear often that it is best not to eat dinner late at night, there is no research to suggest that it is a problem. Latin and European cultures often eat their evening meal at 10PM. However, it is typically a small meal and they usually have "tea" with food at about 4-5PM. Eating dinner late at night is often cited as associated with weight gain; however, there is no research to support this. What is associated with weight gain is the U.S. tradition of eating dinner between 5-7PM and then snacking throughout the evening, unconsciously, while watching TV into the late hours. To keep a healthy metabolism it is best to eat every 4-5 hours. Eating lunch at noon and waiting to eat dinner at 11PM at night could increase the risk that you might overeat because you are extremely hungry after no food for 11 hours. People tend to eat more and faster when they are very hungry. | |
| Answered at 4/20/2005 | ||
| Q | I am 24 years old and have been suffering with acne since I was 17. I have recently tried oral antibiotics and topical medications; while they do not completely get rid of acne, it has controlled it dramatically. My dermatologist raised the question about Accutane. I don't know what to do. On one end, I would like to get rid of acne and with Accutane I know I have a very good chance of doing that, but I don't know if the possible severe (and multiple) side effects are worth it. On the other hand, if I don't do Accutane, I would continue to take oral antibiotics (like Doryx) on a regular basis. My question is which is the lesser of two evils?! I'm thinking I don't want to try the risks involved in Accutane, but how safe and healthy is it to take antibiotics on a regular basis?! Any info would be greatly appreciated! | |
| A | You said a mouthful. Whether Accutane is a good choice for you is a very individual and personal question, which I cannot answer for you. Accutane certainly has some worrisome side effects, but it is the only treatment for acne that is potentially a cure. About half of people who take Accutane for 5 months need no further treatment for acne. So, with Accutane, you will be monitored very closely, with frequent visits and blood tests, but it is often just for the short term. I use a lot of Accutane in my practice. Although it is sometimes the only treatment that is really effective, it is not for everyone. | |
| Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (4/20/2005) | ||
| Q | I have a friend who is 39 weeks pregnant and due any day now. She has been smoking marijuana daily and I'm concerned that the hospital will try to take her baby away from her. What are the hospital's policies on drug testing newborns? Should she be worried? | |
| A | At Sacred Heart Medical Center, the drug testing of mothers and/or infants is ordered by the physicians. This occurs if there is reason to suspect drug abuse by the RN, social worker or physician. A referral to children's services is made by the social worker if the drug test is positive for the mother and/or the infant. The social worker will discuss the mandatory referral with the mother, if possible, prior to the referral call. The call is required by Oregon state law and there is no choice on the hospital's part regarding making this call. If children's services does become involved, this may be a good thing. They can encourage the mother not to smoke marijuana. She may be breastfeeding and continue to transmit the substance to the infant that way. Marijuana IS definitely affecting the unborn child in the womb. The smoke in the home, after birth, will also be detrimental to the infant. The hospital, itself, does not remove infants from the custody of their parents. The local children's services agency is mandated by law to intervene when a child is being harmed. The intervention likely will not involve removal of the infant from the parent's custody. If the parent cooperates and shows good effort to stop the harmful behavior, for the infant's sake, children's services will likely monitor and assist the parent. Please encourage your friend to stop smoking marijuana for the infant's wellbeing. There are no benefits in continuing to smoke marijuana for your friend or the infant, both before birth and after. | |
| Answered at 4/18/2005 | ||
| Q | Why do people take Benadryl for their allergies? What does it do to help stop the effects? | |
| A | Benadryl (generic name diphenhydramine) is an antihistamine. Histamine causes many of the allergic symptoms people experience as a result of allergies to environmental exposure to pollens, animals or dust. Diphenhydramine does not block the release of histamine, but binds to the H1 histamine receptor to block the action of histamine by competitive inhibition. | |
| Answered at 4/18/2005 | ||
| Q | I have a purple bruise under my toenail that has been there for about 8 weeks and I don't recall hitting my toe, at least not hard enough to have a bruise. What can be done to make this go away or should I just go to the doctor? | |
| A | IF it's actually a "bruise" (or hematoma = blood collection) under the nail, you'll be looking at it for 6-10 months as the nail grows out and it finally resolves. You may even lose the nail, with a replacement nail coming in behind it. Very little can be done about that sequence; if it's painful a Doctor can (relatively painlessly) drill or burn a hole in the nail and let out some fluid so the pressure goes down, but the timeline remains the same. The only truly bad thing that can happen in the area is a melanoma under the nail. It's very rare and very rarely mistaken for a "bruise"; see your doctor if you have doubts. | |
| Answered by Mark Lyon, MD, Family Practice, Eugene, PHMG/FP-South (4/15/2005) | ||
| Q | What exactly is ephedra? What is your opinion on ephedra and its effects? Now that ephedra has been taken out of dietary supplements, would you agree that ephedra-free products are more effective? If ephedra is referred to as "natural", why is it still unsafe? Who should avoid ephedra? What are some side effects from taking ephedra? Should dietary supplements be FDA approved? Would you suggest or recommend anyone to take ephedra? | |
| A | Ephedra is a plant, best known as Mahuang, but many others, that contain drugs that stimulate the central nervous system (similar to amphetamines), increase heart rate, and blood pressure. Not surprisingly, especially when used in unsupervised quantities, and some herbal products contained a whopping amount of ephedra, there were bad outcomes in terms of stroke, heart attacks, sudden death, and seizure activity. The FDA responded to a flood of reports from clinics and hospitals reporting serious side effects in patients using the drug as a diet aid. Just about anyone with a history of heart disease (or closely related to someone with heart disease), high blood pressure, a history of stroke or epilepsy, would need to avoid the drug. I really can't comment on medications used as diet aids, as they generally have many of the same side effects as ephedra. Here is a published comment on the FDA action taken. On December 30, 2003, the FDA announced the ban of ephedra products in the US, effective April 2004 (10055). There has been a lot of debate about the safety of ephedra and legal wrangling over its status (8640,8641). In June of 1997, the FDA proposed restrictions on the ephedrine content of dietary supplements, new warning labels for ephedra alkaloid-containing products, and a prohibition on combination products containing ephedra and other natural stimulants, such as guarana and cola nut, both of which contain significant amounts of caffeine (2729). These proposals were dropped after the link between ephedra use and serious adverse effects was challenged by the General Accounting Office (GAO) and the dietary supplement industry (1381). According to the Dietary Supplement Health and Education Act of 1994, FDA must prove a supplement is unsafe before it can be withdrawn from the market (8642). The FDA reviewed numerous adverse event reports involving ephedra alkaloid-containing products, with 140 of the reports receiving in-depth clinical review by FDA and outside experts (1381,5047,6486). Findings from experts outside the FDA support the FDA's initial finding that ephedra is likely the cause of many of the reports (6486). Ephedra use is banned by the National Collegiate Athletic Association, International Olympic Committee, and National Football League (8642). Ephedra is sometimes marketed as a recreational drug "herbal ecstasy." The FDA has announced that ephedra products marketed as recreational drugs are unapproved and misbranded drugs subject to seizure and injunction (5047). Mormon tea and ephedra are often confused. Mormon tea or American ephedra comes from Ephedra nevadensis, and ephedra or ma huang comes primarily from Ephedra sinica. Mormon tea is alkaloid-free and lacks both the therapeutic effects and the toxicity of ephedrine (12). | |
| Answered at 4/14/2005 | ||
| Q | I'm in the military and have severe compartment syndrome in my lower legs. The military misdiagnosed the problem for 6 years and finally did a fasciaotomy last year. There was a little relief after surgery but the condition returned and is worse than ever. What kind of x-ray can be done to see how much tissue and nerve damage there is in my lower legs? Should I ask to get an MRI done on my lower legs? What specialists handle this type of condition? | |
| A | An X-Ray would not be helpful. An MRI might help with delineation of soft tissue damage to muscles, but the best test would be an electrical diagnostic study. It is done by neurologists or specialists in Physical Medicine. | |
| Answered by Alan Wolf, MD, Orthopedic Surgery, Bellingham, Southeast Orthopedic Clinic (4/13/2005) | ||
| Q | I am 17 years old and about three years ago I hurt my back lifting weights. I couldnt even bend over to put on my shoes. I went to a doctor and got x-rays and an MRI and they said something about L4 and L5 -- I can't really remember and all my papers got lost. I went to physical therapy for about a month and it got better. It still hurt, but the doctor said the only cure was surgery and that I was way too young for that. It got to where I could stand it, but two weeks ago the pain started again -- bad, but not as bad as before. I am wondering what I should do and I would greatly appreciate it if someone will advise me? | |
| A | If you have injured a disc in your low back (and you probably have) and it keeps hurting after 4-6 weeks, you should ask for an evaluation by a spine specialist. There are a few reasons for this. You need an accurate diagnosis of the cause of the pain after 6-8 weeks without resolution of the pain. From this diagnosis it can be determined whether spine injections are indicated for relief of pain. The specialist can determine the best rehab program for you to prevent further injury/pain. Also, your activities should probably be adjusted to prevent reoccurance. | |
| Answered by Michael Karasek, MD, Pain Management, , (4/13/2005) | ||
| Q | My wife and I are researching our options at getting pregnant again. She is very fertile, while I have had a vasectomy. What are our options? | |
| A | There are two options if you want to use your own sperm: the first is vasovasotomy (or re-connecting the ejaculatory ducts) and the second option is to obtain sperm from the testicle with a needle and use this sperm to fertilize eggs in conjunction with IVF (in vitro fertilization). The surgery to restore your fertility is a less expensive option. If you are considering this approach I recommend seeing a reproductive urologist to perform your surgery. | |
| Answered by Douglas Austin, MD, Gynecology, Eugene, Women's Care (4/10/2005) | ||
| Q | I am trying to get some information on COPD. I have been diagnosed with it and I am not sure what it really is. Can you please send me some information? | |
| A | COPD stands for Chronic Obstructive Pulmonary Disease and is a "catch all" phrase to describe any form of long standing obstructive process, from asthma to emphysema. There are many components to this disease entity and it is usually found in long term smokers or patients who have had asthma for a long period of time. Perhaps the best place to get accurate, scientific information is the American Lung Association. | |
| Answered by Michael McNellis, MD, Pulmonology, Longview, PeaceHealth Medical Group - Specialty Medicine (4/8/2005) | ||
| Q | I've tested positive for the mononucleosis (EPV) virus. I have two questions. First, at what stage does the virus begin to become contagious? --when symptoms start? before that? Secondly, I've read that the virus eventually goes into a dormant stage, and that traces can re-appear in saliva at a future time. Is that to say that any people I kiss in the future will be at risk, even though I am immune and have no symptoms? | |
| A | An important fact to be aware of is that there is strong evidence that 90 -95% of adults are immune to Mono as a result of previously having been exposed to the virus. Many of these folks had very few (or no ) symptoms when they had the disease. So, in most instances the issue of contagion is not that big of a deal. It certainly has a bad rap on the street, however. Typically Mono symptoms ( if they are going to develop) do so about 4 -6 weeks after exposure. It is clear that viral shedding is present at the time symptoms start but I don't know how long prior to symptom onset it can start. Shedding can continue for as long as 18 months after the onset of symptoms. More commonly shedding stops much sooner - in the range of 6-12 weeks. An informative site is Infectious Mononucleosis on MedlinePlus. | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (4/7/2005) | ||
| Q | I recently had a TB test (on the inside of my arm) and the doctor said that the result was positive. He said it just meant that I've been exposed. The area was a little red and bumpy. I did scratch it when it itched because the doctor didn't tell me not to. Would my scratching or being sick(congested) have any result on the outcome of the test? | |
| A | I doubt that you did anything to cause the positive test. Being positive only means you were exposed some time in your life to tuberculosis. It does not mean you have active TB. Usually a positive test causes us to do an additional study like a chest xray to be sure that the skin test only means previous exposure. | |
| Answered by Hugh Johnston, MD, Hematology, , (4/4/2005) | ||
| Q | I had my gallbladder removed 5 years ago and I still have the same symptoms that I did when I had a gallbladder. Is it possible to have gallstones after your gallbladder is removed? | |
| A | It is possible, though unusual, to have persistent stones after you have had your gallbladder removed. The persistence of symptoms after gallbladder surgery is well described in the medical literature. If you have not been back to your personal physician or the surgeon who originally removed your gallbladder you should do so. There are many approaches to diagnosing and treating your symptoms. | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (3/31/2005) | ||
| Q | Can you get cancer even if no one in your family has cancer? What causes cancer? | |
| A | Yes, cancer is usually not caused by just a genetically inherited predisposition, though that is often a risk factor in some cancers, such as breast, prostate and colon cancer. Some cancers are from environmental exposures, such as the human papilloma virus (a sexually transmitted infection) causing cervical cancer, or tobacco causing oral, throat or lung cancers. Other cancers have no known cause or connection to genetics and just "happen" for reasons medical science cannot yet predict or prevent. | |
| Answered by Emily Gibson, MD, Family Practice, Bellingham, Western Washington University (3/31/2005) | ||
| Q | I have seborrheic dermatitis. I'm 19 years old and need some help controlling this. | |
| A | Seborrheic dermatitis is a very common condition. It is most common in teens, then becomes common again in later life. It consists of redness and flaking of the scalp, face, ears and sometimes the chest and groin. It is not contagious. It is treatable, and can be controlled, but not cured. Treatments are usually a combination of things: medicated shampoos with tar, sulfur, zinc, ketoconazole or tea tree oil; topical cortisone medications; sometimes mild acids, such as salicylic acid, can help with the flaking. Treatment is individualized, depending on the location and severity of the rash. | |
| Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (3/30/2005) | ||
| Q | I am 17 years old and have had sexual intercourse. If my mother takes me to the doctor, can the doctor tell if I have had sex before? | |
| A | It is easier to determine if someone has never been sexually active than if they have been sexually active. That is because the hymenal ring does stretch. So, it is not always obvious if someone has been sexually active. If you are worried about your mother finding out, you could see a health care provider on your own by making an appointment with someone at Planned Parenthood or ask for an exam to be confidential between you and your health care provider. | |
| Answered by Randall S. Lewis, MD, Obstetrics/Gynecolog, Eugene, PHMG/OBGYN-Hilyard (3/21/2005) | ||
| Q | I have been on Levothroid for 2 years. I started at .75 mcg and am now taking 1.25 mcg. With the increased dose my TSH was at .49, which I was told was slightly hyperthyroid. However, I felt much better and had no symptoms of being hyperthyroid so I was continued on the same dose. I have been noticing that my hair is becoming dry and breaking, my mind is "foggy" and I am fatigued even though I am sleeping 8 hours per night. My last TSH was 1.38, which is in the normal range. My doctor feels my symptoms are due to perimenopause, not my thyroid function. I realize the symptoms of both are very similar, but I feel the same way now that I did when I was first diagnosed and again a year ago when my medication was adjusted. How can I know for sure what is causing my symptoms? | |
| A | Your symptoms are most likely not related to your thyroid function/replacement but there is more thyroid testing your physician can do, looking at other aspects of your thyroid function to know for sure. Other symptoms that can happen with hypothyroidism include feeling cold when others do not feel cold, unwanted weight gain, fluid retention, and constipation, but your TSH would argue against that as an explanation. Perimenopause and depression can cause many changes as well, some of which you describe. Let your physician know you are not feeling as well as you had been. | |
| Answered by Emily Gibson, MD, Family Practice, Bellingham, Western Washington University (3/17/2005) | ||
| Q | I have an office job and also quite a long commute to and from work. The bottom line, is that I sit alot. I have noticed that my scrotum is frequently drawn tight, and is sometimes accompanied by a slight, dull ache. I am a seemingly healthy 34yr old with no medical problems. I am concerned about this because my wife and I have tried unsuccessfully to have a child and I am worried about our fertility. I have heard that if the scrotum is too close to the body, sperm count can be affected. I also wear "tighty whitey" style underwear. Would boxers fix this whole problem, or is there something more sinister at work here? | |
| A | Much has been made of the concept of tight fitting clothing influencing sperm counts in men; however, there is little supporting data for this concept. Except for men who work in environments in which the ambient temperature is markedly elevated, sperm count is not impacted by sitting, wearing briefs or riding bikes.... I recommend you have a semen analysis to determine your semen parameters (volume, concentration of sperm, % motility and %normal forms). This test is readily available and is easily ordered by your physician (or your partners gynecologist). | |
| Answered by Douglas Austin, MD, Gynecology, Eugene, Women's Care (3/15/2005) | ||
| Q | I have perioral dermatitis and have been treating it with doxycycline hyclate 100mg 2 times a day. I have had this disease for years without knowing what it was, so it was severe by the time I sought out treatment. The medicine is working, but it is working very slowly. It has been 9 weeks now and the rashes have slightly faded, but they are still there. The main difference is that I am not getting huge pimples any more where the rashes are; I am only getting small little pustules which leave after 2 days, and the flaking is still there, although not as bad. My question is: is it ok to not use any soap on my face for such a long period of time? I am undergoing zero therapy and I was instructed not to use any cleanser -- just wash twice a day with warm water until I am clear of the rashes and inflammation. Could this be slowing the effects of the medicine, or is it ok? | |
| A | Perioral dermatitis is a very common skin condition. It is related to acne rosacea and is a very sensitive skin condition. It is often caused, or worsened, by use of prescription strength cortisone medications on the face.It is most common in adult women in the fall and wintertime. The treatment is usually stopping use of any irritating substances on the face, including soaps, toners, astringents, hot water, witch hazel and anything that stings or burns. Antibiotics, usually tetracycline or its derivatives, are often prescribed. Sometimes a mild cortisone may be used. If you still have problems after nine weeks of doxyccline, you should follow up with the doctor who has been treating you. | |
| Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (3/10/2005) | ||
| Q | I am a 29 yr old African American female. I have had a dry scalp for a while. But recently it has become even more dry and scaly especially in the front of my hair. I am not losing any hair. This is very annoying. What, if anything, can I do for this problem? | |
| A | You may have seborrheic dermatitis, or dandruff of the scalp. For many people, we recommend frequent use of a dandruff shampoo (Head and Shoulders, Selsun Blue, tar shampoo, Nizoral or Tea Tree Oil shampoo); unfortunately, daily shampooing is not a reasonable option for most African Americans. Try a dandruff shampoo as often as you can (at least once a week, if possible), and you can try Hydrocortisone liquid (Scalpicin Maximum strength has this). If this does not help, see your doctor. | |
| Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (3/9/2005) | ||
| Q | I injured my back in October, 2004 and have been receiving physical therapy ever since. I had some improvement, but after taking my vacation the pain feels like I'm back where I started. I had an MRI done and I recived a report as follows: At the L1-2 level, the intervertebral disk is normal. There is a mild bilateral facet hypertrophy, without stenosis or impingement. At L3-4 level there is a broadbased left paracentral disc protrusion which mildly effaces the dural tube anterolaterally impinge on the traversing roots. There is mild bilateral facet and ligament flavum hypertrophy, without significant stenosis. At L4-5 level there is an annular tear and small left paracentral disc protrusion.Moderate bilateral facet and ligamentum flavum hypertrophy is present. No definite neural impingement is identified Could you explain what this means in English, and will the tear heal itself? | |
| A | The "English version" requires an understanding of disc structure. The lumbar disc consists of a gel center, surrounded by a think, ligamentous wall. Trauma may tear the wall, or it may weaken with age. When the wall tears, the gel bulges into the fissure and the disc may bulge or protrude into the spinal canal. Your MRI shows this type of abnormality in two of the lower three discs. 4-6 months of physical therapy is more than enough. Ask your doctor for other options, like spinal injection or referral to a spine specialist. | |
| Answered by Michael Karasek, MD, Pain Management, , (3/9/2005) | ||
| Q | My question has to do with the amount of time that you should wait before taking an HIV test. I dated a guy for 21/2 years and did have unprotected sex with him. Later, I found out that he had not been so honest with me about other people that he'd been with. So, when I ended the relationship in October, I waited 3 months and then took the Home Access HIV test. My results were negative, but I decided to wait another month and take it again. So, at 4 months I got another negative result. Did I wait a sufficient amount of time for those results to be pretty conclusive? I really don't know if I can handle taking yet another test. | |
| A | Probably you should test for up to 6 months. Your results should be confirmed in a professional lab. Was your contact in a risk group for HIV? | |
| Answered by John Wilson, MD, Infectious Disease, Eugene, The Travel Clinic (3/9/2005) | ||
| Q | I have recently been diagnosed with breast cancer and was told by the surgeon to stop my hormone replacement right now. What is the best way to stop? (slowly, every other day, cut pills in half?) I am 57 and went to hormone replacement after a hysterectomy 20 yrs ago. | |
| A | Since you have been diagnosed with breast cancer I would recommend that you stop all hormones at once without tapering off. The concern is that the breast tumor cells could "feed" off of the hormones. | |
| Answered by Linda Frison, MD, Obstetrics/Gynecolog, Eugene, PHMG/OBGYN-Hilyard (3/7/2005) | ||
| Q | My daughter was diagnosed with a colon virus? What is that? | |
| A | I'm assuming she became suddenly ill with diarrhea and/or vomiting. If so, this is caused by a virus passed frequently from person to person by touch that infects your whole body, but primarily disrupts the normal functioning of the digestive tract and causes vomiting and diarrhea. The illness varies in severity from person to person and can sometimes cause a fever for 3-5 days. This kind of virus is very common; almost all children get some form of it once or twice during childhood. It's also very contagious and passes rapidly from one person to another. The infection usually resolves without any treatment. The most common complication is dehydration in young infants. | |
| Answered by Elizabeth Heskett, MD, Pediatrics, Springfield, PHMG/PED-RB Night (2/28/2005) | ||
| Q | I have recently been diagnosed as having molluscum contagiosum and naturally have succumbed to looking online and going crazy. I have found various sites linking MC to HIV and I'm a little freaked out. My girlfriend just tested negative to HIV; I have not been tested in a while. My bumps are limited to the groin and penis area. They have not spread any further; there are only about 15 and they are very small. I have seen my dermatologist and he told me not to worry. I know it doesn't seem likely these would be linked to HIV but I wanted to seek the opinion of another professional. | |
| A | Molluscum Contagiosum can be linked to HIV in that the mode of transmission is similar. It takes skin to skin contact to contract this, just like warts. If you have been monogomous with your girlfriend and she is HIV negative than you have nothing to worry about. The point is Molluscum does not lead to HIV. However, Both are contracted by the same activities. The ultimate test would be to get yourself tested for HIV if there is any doubt about past sexual partners other than your current girlfriend. | |
| Answered by Jay Park, MD, Dermatology, Eugene, Jay Park MD (2/23/2005) | ||
| Q | I have a mole that is rapidly changing -- it is getting crusty and turning darker. I have an appointment with my doctor to have it removed, but he can't see me until next month and I am concerned and a little worried. Is it ok to wait a month? If not, where do I go? A walk-in health clinic or the emergency room? | |
| A | If this is a melanoma I would not wait a month. I would try to get an earlier appointment with your doctor stating your concerns. If this is not possible I would go to Urgent Care. | |
| Answered by Jay Park, MD, Dermatology, Eugene, Jay Park MD (2/23/2005) | ||
| Q | What causes the warm sensation, metallic taste, and urination sensation from iodinated contrast used in radiological imaging studies? | |
| A | Contrast agents have a higher concentration of molecules per volume than your blood does. This is called the osmolality. The warmth and urge to urinate are probably caused by a sudden increase in over-all blood osmolality when contrast agents are adminitered. The metallic taste is likely due to the agent itself (all radiographic contrast agents are based on Iodine) | |
| Answered by Jon Ekstrom, MD, Radiology: Diagnosti, Springfield, Radiology Associates, PC (2/10/2005) | ||
| Q | I contracted genital herpes type 1 through someone giving me oral sex. My current partner has caught it from me also. What is the risk of transferring it to our mouths through either of us giving each other oral sex? There seems to be no direct answers about this, only about transfering it from oral to gential. | |
| A | The risk is undefined, but real. I would plan to have no sex if you and your monogamous partner has a symptomatic herpes sore, either oral or genital. That is not absolute protection, but is a good compromise between quality of life and disease prevention. If episodes are frequent, continuous preventive antiviral treatment could be considered. The situation changes quite a bit if there is HIV diease present. Remember, if you or all of your contact have not been tested for HIV disease, you don't really know whether HIV disease is present or not. STDs tend to run together. | |
| Answered by John Wilson, MD, Infectious Disease, Eugene, The Travel Clinic (2/10/2005) | ||
| Q | My husband has a staph infection and he wants to have sex. Is it safe or can I get also? | |
| A | Close family contacts can catch staph infection from a carrier. His doctor should be able to tell you whether he is still capable of passing it to you. | |
| Answered by John Wilson, MD, Infectious Disease, Eugene, The Travel Clinic (2/8/2005) | ||
| Q | I have developed a cyst in my upper eyelid. I used to get these when I was little. I use a hot wet cloth to try and clear it. Do you know of any contributing factors for this problem so I can avoid getting them? Could my computer be a factor? | |
| A | It depends on what you are watching on your computer. In all seriousness, styes or chalazia of the eyelids are usually secondary to the oil glands not functioning properly. Conditions such as rosacea can create thickened oil secretions leading to the formation of chalazia. Try taking flaxseed oil capsules (3-4 a day assuming you do not have any gallbladder disease). The flaxseed oil can many times improve the consistency of the meibomian gland oil secretion. Also, start the hot compresses as soon as the "cyst" appears (4-6 times a day for 20 minutes). | |
| Answered by Richard Hoffman, MD, Ophthalmology, Eugene, Drs. Fine, Hoffman & Packer, LLC (2/7/2005) | ||
| Q | My 10-year-old son has occasions where he feels short of breath and tries to yawn, but cannot. These spells increase his anxiety to the point that we have gone to the emergency rooms, but so far no one has been able to explain why he gets these or what to do about them. They did the oxygen test for asthma and said the O2 level was good. He also complains of chest pains and EKGs generally suggest no problems (although one test was irregular). What is a pulmonary function test; would this be worth asking for? I am at a loss as to how to help him. We also took him to a psychiatrist to see if he might be having anxiety attacks. The doctor suggested that he was sensitive to too much carbon dioxide. | |
| A | From what you have described there are many possibilities of what might be "wrong". In very general thinking the systems you have describe may involve the pulmonary (lung), cardiac (heart) or nervous systems. An oxygen test only tells you what percentage of the hemoglobin is saturated with oxygen -- it says nothing about asthma. A pulmonary function test can give information with regards to asthma as well as other pulmonary conditions, but it can also be normal even if there is a problem. Asthma would not account for the inability to yawn. I would highly recommend that your son sees a pediatrician, and if he has problems that continue, particularly around his shortness of breath, he should see a pulmonologist (lung doctor) who specializes in pediatrics. | |
| Answered by Michael McNellis, MD, Pulmonology, Longview, PeaceHealth Medical Group - Specialty Medicine (2/7/2005) | ||
| Q | What effect does the use of alcohol have on type 2 diabetics? Is any amount harmful? If not, what amount is safe? | |
| A | Any use of alcohol with diabetes should be discussed with your physcian. Including some alcohol when diabetes is well controlled, and you are not pregnant, may be ok. Alcohol should be consumed only with meals or snacks. It has a tendancy to make insulin reactions harder to recognize and interferes with some medicines. If you are on insulin or sulfonureas you should drink with someone who would recognize an insulin reaction. Use alcohol in moderation ( one drink for women and 2 drinks for men per day). | |
| Answered at 2/4/2005 | ||
| Q | What are hemangiomas in the vertebral bodies T9 and T11? What is a hemangioma? The MRI showed these. | |
| A | These are usually small vascular malformations, or clumps of blood vessels in the vertebrae. They are usually of no clinical significance. You should discuss this with the doctor who ordered the MRI. Hemangioma is not a likely cause of your back problem unless they are very large. | |
| Answered by Michael Karasek, MD, Pain Management, , (2/3/2005) | ||
| Q | I have just been told that I have an L4 disc herniation. I don't really understand that. Would you be able to tell me anything about that type of herniation? | |
| A | Usually, discs are numbered by the vertebrae that they are between. For example the vertebrae in the low back are numbered L1 through L5. Usually the disc between the 3rd and 4th would be called the L3-L4 disc. and the next one down would be L4-L5. Probably your doctor is indicating the one between L4 and L5, which is just below the belt line in your back. It doesn't say anything about the size or side of the herniation or whether the herniation is affecting a nerve or not. More information would be needed to completely characterize the herniation for you. | |
| Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (2/3/2005) | ||
| Q | Recently I took a shower and did my routine ear cleaning with some Q-tips. The problem is that my left ear plugged up and stayed plugged over night. I couldn't seem to hear anything out of it. What should I do to get my ear to unplug? Is this common? Does wetting the Q-tip or maybe sticking the Q-tip too far into the ear cannal contribute at all to this symptom? | |
| A | NEVER PUT ANYTHING IN YOUR EAR EXCEPT YOUR ELBOW!!! Q tips are EVIL! They damage the ear canal and work like a battering ram does in a cannon by packing the wax against your eardrum. If you have the desire to clean your ear canals, or your's are a heavy wax manufacturer, you can get debrox drops to put in the ear canal 2-3 times a week to soften the wax and allow it to be washed out in the shower. Another alternative is a few drops of hydrogen peroxide in the ear canal a few times a week to do the same thing. Again: NEVER USE A Q-TIP IN YOUR EAR! | |
| Answered by Erin Reilly, MD, Urgent Care, Springfield, PHMG/Urgent - RiverBend (1/27/2005) | ||
| Q | If a radioactive tracer is injected into a vein and ends up at a blocked arteriole near the uterus, what are all the body cavities that the tracer travels through, in order? | |
| A | Material of sufficient size injected into the blood stream will distribute to all areas, vessels, organs, etc. This is called a "blood pool" distribution. Radiopharmaceuticals are designed to distribute in this manner innitially. Some have specific target organs where they may preferrentially end up based on thier particle size or metabolic activity. There are two ways to answer your question. One is that the injected material goes everywhere blood is flowing. The other is that the injected material goes into a vein (usually an arm vein) into the central venous system, through the lungs, back to the heart and out the arterial system to the uterus through the uterine artery. | |
| Answered by Jon Ekstrom, MD, Radiology: Diagnosti, Springfield, Radiology Associates, PC (1/25/2005) | ||
| Q | I had genital warts previously. My husband and I have been trying to get pregnant, but have had no luck. Is it more difficult to concieve after having genital warts? | |
| A | Genital Warts are caused by a skin virus that is passed by close contact. They are usually NOT a source of infertility. Infertility is defined as no pregnancy after one year of unprotected sexual intercourse at least 3 times/week. If you and your husband have been "trying" for one year, I recommend evaluation by a gynecologist. In Healthwise there's an informative article on Genital Warts . | |
| Answered by Cristin Babcock, MD, Obstetrics/Gynecolog, Springfield, Women's Care (1/21/2005) | ||
| Q | My mom was in a auto accident a couple of years ago and has recently been suffering from what I believe may be sciatica. She has severe pain in her lower back (primarily her right buttock) that extends down her leg. It is getting worse and now her leg will give out, causing her to fall down. My question is, what type of doctor should she see -- an orthopedic surgeon or a neurosurgeon? Plus, she has high blood pressure and diabetes, so she doesn't think she will be able to get spinal injections or nerve blocks. Is that true? | |
| A | An evaluation by either type of spine surgeon (ortho or neurosurg) is ok. She could also see a non-operative spine specialist/pain medicine physician. Discuss it with her primary care doctor. She probably can have spinal injections, and this therapy is quite good for sciatic pain. | |
| Answered by Michael Karasek, MD, Pain Management, , (1/18/2005) | ||
| Q | Four weeks ago my 87 year old father had a TIA. He has recovered with no problems and is now taking a daily aspirin and simvastatin. He is waiting for an ultrasound examination of the neck to assess the level of plaque. The complication, and our concern, is that he has been waiting for a inguinal hernia operation for some time and this has now been scheduled for next Monday. Is it safe for him to have this operation so soon after the TIA, or is it too risky and likely to cause him problems? He has lived with this hernia for over 20 years. | |
| A | I think the best course would be to evaluate the TIA and identify the cause prior to his surgery. However, hernia surgery should not be a direct risk to him with regard to stroke, but I think the surgeon and anesthesiologist would rather know if he has severe narrowing in his carotid artery prior to surgery. | |
| Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (1/16/2005) | ||
| Q | Does drinking alcohol raise blood pressure? | |
| A | Drinking a lot of alcohol will raise blood pressure but drinking fewer than 6 drinks a week will not. | |
| Answered by Hugh Johnston, MD, Hematology, , (1/14/2005) | ||
| Q | My mother has high potassium levels and the doctor told her to eat less of the types of food with high potassium content. What foods would this be? | |
| A | Primarily, fruits, vegetables and juices. The highest sources of potassium include: potato, tomato, melons, beans (lima, kidney, pinto), pumpkin, spinach, banana, kiwifruit, pomegranate, dried fruit, orange juice, and tomato juice. Milk also has a significant amount of potassium. Also be careful to avoid salt substitutes made with potassium. | |
| Answered at 1/3/2005 | ||
| Q | Can you educate me on who can perform kyphoplasty? Can Pain specialists, who are also Anesthesiologists, perform them, or do you have to go to an interventional radiologist? | |
| A | The kyphoplasty procedure is performed by pain specialists, interventional radiologists, and some spine surgeons. The key is to ask about the doctor's training and experience. How many have they done? How did they train -- a weekend course? | |
| Answered by Michael Karasek, MD, Pain Management, , (12/30/2004) | ||
| Q | When my color vision was tested the physician told me my color vision was 2/14. What does that mean? Is it normal? | |
| A | It means you only were able to see 2 of the 14 color plates correctly. If you are male you probably have red-green color deficiency. Very common. | |
| Answered by Richard Hoffman, MD, Ophthalmology, Eugene, Drs. Fine, Hoffman & Packer, LLC (12/27/2004) | ||
| Q | For about four months I have experienced eye floaters in my left eye, and now I have the same problem in my right eye. And my right eye is itchy. I am wondering if eye floaters are symptoms of diabetes? I have a family history of diabetes. My vision is good and I don't have any other symptoms of diabetes. | |
| A | Floaters in the eye are a rather common symptom for patients in their 60s and 70s. They represent detachment of the vitreous gel from the back of the eye in the central cavity of the eye. They can be associated with diabetes and in that instance, tend to be multiple in nature rather than one or two and usually are the result of bleeding into the back of the eye. They can also be associated with retinal detachment, in which case floaters are accompanied by a shower of multiple floaters as well as a veil covering a portion of the vision coming from the periphery to the center. In most cases, they are harmless, but we always recommend evaluation of patients with the onset of floaters. | |
| Answered by I. Howard Fine, MD, Ophthalmology, Eugene, Drs. Fine, Hoffman & Packer, LLC (12/14/2004) | ||
| Q | I have been diagnosed with severe bullous emphysma of the right upper lung. My PFT tests show that I have borderline obstruction and normal diffusion. My left lung has a few blebs on it also. 5 years ago I had a collapsed right lung that had a plurodesis and a minor bullectomy performed on it. Now my surgeon seems hesitant about going back in and doing a bullectomy on my right lung. The bulla is approx. 10cm in size. The last surgery was done with small incisions. Why the hesitancy in doing the surgery on my right lung but not on my left? I am 42 years old and otherwise in good health. | |
| A | Generally, when patients have emphysematous blebs (this is seen in bullous lung disease) and recurrent pneumothorax, the treatment is usually pleurodesis. This is a procedure where a sclerosing agent, usually an antibiotic or talc powder, is placed into the pleural cavity causing the lung to adhere to the chest wall. Essentially you are causing a large scar to form and this usually keeps the lung from collapsing again. To surgically reenter the chest cavity after pleurodesis is a very difficult operation and fraught with potential complications. In order for the surgeon to perform the bullectomy, he would have to get the lung free of the chest wall and given the formation of the scar this can result in a very bloody operation. Thoracoscopy or thoracotamy is not advised after pleurodesis, particularly for an elective operation. The presence of the bullae is not necessarily dangerous to you, and when compared to the potential risks of complications due to the surgery, a conservative approach is best. This most likely is why your surgeon is hesitant. As a young man, you should also be checked for causes of emphysema, some of which may be due to genetics. You may wish to discuss this with your primary physician or pulmonologist. | |
| Answered by Michael McNellis, MD, Pulmonology, Longview, PeaceHealth Medical Group - Specialty Medicine (12/8/2004) | ||
| Q | My husband had a lumbar epidural steriod injection. The doctor said this injection does not deteriorate bone tissue or the disk. A chiropractor said it does. I believe the doctor. Who is correct? | |
| A | The doctor. There have been studies of tissue in humans after many epidural steroid injections. No significant damage from the steroids has been found. Your chiropractor may be thinking of tissue changes with long term oral steroid use, which may be substantial. | |
| Answered by Michael Karasek, MD, Pain Management, , (12/5/2004) | ||
| Q | What are the side effects for birth control patches? | |
| A | Breast tenderness, nausea, abnormal bleeding, rash at site of patch -- the same side effects essentially that you can have from birth control pills. | |
| Answered by Dan Herron, MD, Obstetrics/Gynecolog, Longview, PeaceHealth Medical Group - Women's Health (12/3/2004) | ||
| Q | I am 32 and in good shape. I started to gain weight (BMI 26), even though I exercise 3 times per week. Feeling hungry all the time makes it extremely difficult to avoid overeating. My doctor advised taking Meridia, for a short time, to help lose some weight and fight food cravings. However, we are considering having a baby. Are there any side effects (especially on conception) I should be aware of? Again, I am in good shape, free of medical problems or other medications and my blood pressure is normal. | |
| A | First of all, Meridia would not be indicated for you. A BMI of 26 is just not that bad. Secondly, I generally frown on using a drug for this purpose unless there is a major current health problem (or risk) due to obesity. I'm not aware of any study showning whether or not Merida affect male fertility. I recommend low carbohydrate diet such as The South Beach Diet. People generally have fewer cravings on a low carb diet and weight loss can progress pretty rapidly in many cases. | |
| Answered by Frank Littell, MD, Hospitalist, Springfield, PeaceHealth Hospital Medicine (12/1/2004) | ||
| Q | I had a mammogram done last week which showed two semi-round masses in my breast. Today I had another that showed the same; however, my ultrasound done also today showed nothing. I have been having pain in the breast area and in the breast bone for a few months now. My doctor wants me to wait and have another mammogram/ ultrasound in 6 months. Is it safe to wait this long, and is it normal for nothing to show up on ultrasound? Why would they appear on mammogram but not ultrasound? The masses were about the size of my thumb and about an inch apart. Should I be concerned it may be cancer? My doctor said he did not know what it was. I'am 60 years old with no history of breast cancer in my family. | |
| A | The most important thing is whether or not anything is changing on serial mammograms going back in time. If these opacities are stable mammographically, I think it is safe to follow them. Mammographic findings do not always show up by ultrasound - when they do, ultrasound can help distinguish between solid and cystic lesions and sometimes can determine malignant characteristics of masses. The bottom line for you would be to determine if the mammographic findings are stable and to correlate that information with the physical examination of your breasts. Any new mammographic opacity or palpable finding may need a biopsy. Close follow-up will be important if a biopsy is not performed. | |
| Answered by Jon Ekstrom, MD, Radiology: Diagnosti, Springfield, Radiology Associates, PC (11/27/2004) | ||
| Q | What could cause bloody semem discharge during intercourse? | |
| A | This is called hematospermia. Hematospermia refers to the presence of blood in the seminal fluid. It almost always results from nonspecific inflammation of the prostate and/or seminal vesicles and resolves spontaneously, usually within several weeks. It frequently occurs after a prolonged period of sexual abstinence. Patients with hematospermia that persists beyond several weeks should undergo further urologic evaluation, because, rarely, an underlying etiology will be identified. A genital and rectal examination should be done to exclude the presence of tuberculosis, a prostate-specific antigen (PSA) and a rectal examination done to exclude prostatic carcinoma, and a urinary cytology done to exclude the possibility of transitional cell carcinoma of the prostate. It should be emphasized, however, that hematospermia almost always resolves spontaneously and rarely is associated with any significant urologic pathology. You should call and make an appointment to see your primary care doctor for an examination. | |
| Answered by Erin Reilly, MD, Urgent Care, Springfield, PHMG/Urgent - RiverBend (11/26/2004) | ||
| Q | My boyfriend is 28 and became HIV positive two years ago. I would like to know what will be approximately his life expectancy with a suitable treatment? | |
| A | The answer to this question is very difficult. Prior to any effective treatment the prognosis was 10 years of life. We now know that there is a variable period of time between a positive blood test, an increased viral load, a decreased lymphocyte count and finally the onset of symptoms. Treatment has some definite side effects but is much, much better than before. I believe you will need to discuss this with your doctor who know all the characteristic of your boyfriend's positive test. You can also learn about HIV on Healthwise. | |
| Answered by Hugh Johnston, MD, Hematology, , (11/18/2004) | ||
| Q | How long does it usually take (ballpark) to recover from sepsis? | |
| A | It really depends on the source of infection. Sepsis due to a heart valve infection can take 6 weeks. Sepsis due to pneumonia or a urinary infection might take two weeks. But I'm just talking about the actual infection. Improvement in strength, appetite, functional abilitiy, etc. can take much longer (even months), and is most dependent on the pre-sepsis condition of the patient. | |
| Answered by Frank Littell, MD, Hospitalist, Springfield, PeaceHealth Hospital Medicine (11/12/2004) | ||
| Q | How is Adderall helpful? | |
| A | In children with hyperactivity or other abnormal behavioral problems, Adderall, combined with with other measures, appears to reduce restlessness. This reduced restlessness, accompanied by improved behavior and improved attention, seems to occur not only in physically inactive tasks (classroom situations) but also physically active tasks (structured sports situations). | |
| Answered at 11/11/2004 | ||
| Q | I had a FNA (fine needle aspiration)on my thyroid. I have a nodule that is 3 cm in size on my right lobe and results state a follicular neoplasm-suspicious. I also have some benign nodules on my left lobe. I am booked for a consult with a surgeon in 2 weeks. With the research I have done, I feel a total thyroidectomy would be the safest choice. How soon should I expect surgery to occur and what is a reasonable amount of time to wait for the surgery? I would like to have it ASAP as I'm concerned about growth and invasion to surrounding tissues. | |
| A | Very well stated question. Thyroid cancer is usually slow growing, minimally invasive, and cure rates are high with surgery. For a 3cm tumor, a total thyroidectomy is the option favored by most surgeons, and the one that I would recommend. A two week wait to see the surgeon should be OK, but for your peace of mind, I think that surgery should be offered within 2 weeks of that visit. That timing is appropriate, and there is really minimal risk of progression. The best of luck to you. | |
| Answered by Charles Stanton, MD, Surgery: General, Springfield, Northwest Surgical Specialists (11/9/2004) | ||
| Q | Our 12 year old daughter has had her contact lenses for almost a year. She hears a lot from her friends at school about how good the hard contact lenses are for kids' vision correction and reduction of nearsightedness. Is it true that hard contact is better than soft contact in the reduction of nearsightedness, or in correcting it? | |
| A | There are now hard lenses that a person can wear at night that flattens their cornea and makes them temporarily less near-sighted. It is best for her to wear her soft lenses and when her prescription stops changing (around age 20) consider refractive surgery. The contact lenses you wear at night can cause infections and the effect is temporary, sometimes only lasting half a day. | |
| Answered by Richard Hoffman, MD, Ophthalmology, Eugene, Drs. Fine, Hoffman & Packer, LLC (11/8/2004) | ||
| Q | My friend is a strong supporter of the "ear candle" for removing ear wax. I was curious to know what the experts recommendation is and if any known problems may occur in the use of these ear candles. | |
| A | We have spent many hours removing melted wax from people's ear canals. It is a bad idea, although usually doesn't cause problems. Use over the counter debrox-like meds or go to your doctor. | |
| Answered by Emil R. Hecht, MD, Otolaryngology, Bellingham, Bellingham Ear Nose & Throat (11/1/2004) | ||
| Q | Is taking two multivitamins beneficial? I take Equate Multivitamins. I also take calcium. I take these in the morning with Zelnorm and Prilosec. Is it beneficial to take two multivitamins, or is that a bad idea? I have always taken two. Someone mentioned that if too many are taken, they can become toxic in the system. I would like to know what guidelines are appropriate. | |
| A | Taking a multivitamin to supplement a healthy diet is neither necessary nor harmful. However, taking two multivitamins could potentially lead to toxicity from the fat soluable vitamins A and D. Exess vitamins accumulate in the liver, and over time, can reach toxic levels if too much is taken. Taking extra calcium, up to twice the recommended amount (2500 mg per day) is probably good. Because Prilosec decreases stomach acid, you might prefer calcium citrate. Calcium carbonate is poorly absorbed without stomach acid. | |
| Answered at 10/28/2004 | ||
| Q | I am curious as to whether or not a corpus lutem is always visualized on ultrasound after ovulation. When a sonogram is performed can it see around the ovary or just the top or bottom? | |
| A | A dominant follicle develops (normally) each cycle. The ovaries often alternate back and forth with regard to which ovary produces the dominant follicle. When the follicle matures, an egg is released. The remaning cavity is the corpus luteum. If you scan with Ultrasound carefully during the phases of a normal cycle, you can usually identify the dominant follicle and subsequently, the corpus luteum. This is often done for infertility patients especially those on fertility medications. The orientation of the follicle to the ovary does not affect its visualization. More often, bowel loops or other pelvic structures like the uterus could obstruct ultrasound visualization. | |
| Answered by Jon Ekstrom, MD, Radiology: Diagnosti, Springfield, Radiology Associates, PC (10/26/2004) | ||
| Q | I worry about my sister's health and her diet pills. My sister is a non-stop dieter although at 5'4" and 130 lbs, she is at a healthy weight. She also walks, runs and lifts free weights regularly. There is a strong history of heart disease in my family. Before ephedra was taken out of Zenedrine (sp?) she was taking it and did have spells of increased heart rate and dizziness. She even tried the non-ephedra version and still had these similar reactions, just not as extreme. She's tried several forms of diet pills since and now she's taking CortiSlim. This morning she had really bad tightness in her chest and felt like she couldn't breathe. She was reluctlant to tell me that she started taking CortiSlim a day or two ago. Would any of the ingredients in CortiSlim cause heart problems or bring on a heart attack? I am concerned for my sister's health. Please provide your opinion on whether CortiSlim can cause health problems or heart problems. | |
| A | I think your concern about your sister is justified. Your sister is smaller than the "average" person, so an "average" dose would be a large dose for her. A person with a family history of heart disease should be very careful about taking supplements containing stimulants. So called "dietary supplements" are not obligated to carry warnings of their side effects and often make unsubstantiated claims of their effectiveness. CortiSlim contains green tea and bitter orange, which can inhibit liver enzymes. Green tea contains caffeine, and bitter orange can also inhibit the metabolism of caffeine. This product also contains the ingredient synephrine. Synephrine is a stimulant similar to ephedrine, which is contained in the herb ephedra (ma huang). Ephedra products were removed from the U.S. market due to safety concerns. Ephedra is linked to stroke, heart attack, seizures, and other serious side effects. | |
| Answered at 10/25/2004 | ||
| Q | Any recommendations for the 'life alert' type of emergency calling buttons seniors can wear? | |
| A | One of the organizations is HeartLine/Lifeline through PeacHealth Center for Senior Health, in Eugene. The phone number is 541-349-7272. If you don't live in the Eugene area, try calling the local hospital and ask for the social work department. They should be able to help you find the local service for personal response service. There is an installation fee and monthly fee for this service. If the senior is low income and has a Senior and Disabled Services caseworker, this person can authorize the service for the Senior who generally could not afford it. Key to the system is reinforcing that the senior needs to wear the button at all times. I've seen quite a few seniors admitted to the hospital after falls in the home. They had Lifeline, but did not have the button on. | |
| Answered at 10/18/2004 | ||
| Q | My friend's father died of heart attack at the age of 35. How much does that put risk my friend at risk? She is in her late 20's and very much worried. Can you suggest anything that will help her? | |
| A | These issues are more frequent than people think. The one proven point in management of first degree relatives is aggressive risk factor modification: identifying and treating hypertension, elevated cholesterol, and diabetes, stopping smoking, and increasing exercise and encouraging weight loss where appropriate -- all save lives and prevent heart attacks. We have learned to be much more aggressive about blood pressure and cholesterol control in individuals at increased genetic risk because it profoundly reduces cardiac risks. Also, for patients with heart attacks at such a young age, we frequently screen for emerging non-traditional risk factors which can have a genetic tendency, such as hyperhomocyseinemia and Lp(a) disorders. All these risk factors are modifiable; your friend should see a health care provider to examine these issues and address any relevant factors so her risk can be controlled and her concern can be comforted. | |
| Answered by Peter Beglin, MD, Cardiology: Interven, Bellingham, PHMGW/NCC-Squalicum (10/6/2004) | ||
| Q | I have a hard, round bump behind my ear, which feels like it is filled with something. Could this be a calcium deposit? | |
| A | More likely a swollen lymph gland --not unusual for these to swell up in response to ear infection, colds or infections of the scalp. Sometimes they will stay swollen even long after the infection has gone away. If the swelling becomes red and painful OR if it grows progressively larger then you should see your doctor for further evaluation. I am assuming that you have one isolated bump - if there are several then you should be seen by your doctor. | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (10/5/2004) | ||
| Q | My boyfriend has emphysema and wants to have lung reduction surgery. A doctor in California said that he could undergo the surgery but at a higher, though not prohibitive risk. Could you explain what this means in layman's language? I've checked on the internet but don't understand it. | |
| A | The risk for lung reduction surgery is very much dependent on the type of emphysema a patient has and the technique to be performed. Studies that have looked at Lung Volume Reduction Surgery (LVRS) have omitted patients that are considered "high" risks, categories which have to do with age, the amount of impairment in the ability to exhale air, and the diffusing capacity. Outside of this, the best candidate who would more likely than not gain a benefit, is an individual who has emphysema affecting predominantly the upper lobes and has a poor exercise tolerance. The technique best used is approaching both lungs by a midline incision or using a fiberoptic scope through each side, removing portions (volume reduction) and patching the "holes" by stapling biological patches to those areas. Laser surgery is not successful in this technique. It is important to understand, LVRS does not cure emphysema, but instead improves some components of function, but only for a period of time (2-5 years) before function returns back to the previous state. So the patient's doctor may have been referring to the fact that the patient may not necessarily be the best candidate for the procedure, but certainly could be an acceptable candidate. | |
| Answered by Michael McNellis, MD, Pulmonology, Longview, PeaceHealth Medical Group - Specialty Medicine (10/1/2004) | ||
| Q | How long does it take a blood clot to resolve itself after getting the heparin injections and starting on coumadin? Is there any danger of the clot breaking loose before it's resolved? | |
| A | I assume you are talking about a clot in a vein in the lower extremity. My answer is predicated on that location. To some extent it depends on whether the clot is in a vein below the knee or above the knee. In a vein below the knee the risk of breaking off is relatively low and above the knee it is higher. Heparin and coumadin reduce the risk significantly. Within 48-72 the risk for below the knee clots is close to zero. In clots above the knee the risk is close to zero in about 3-5 days. In both instances the clot is partially disolved by the heparin. The heparin has an immediate effect of preventing fresh clots from forming. Coumadin also prevents fresh clots from forming but it usually takes about 72 hours for the coumadin to be effective. In addition, the clot that is present adheres to the wall of the vein which prevents it from breaking off. The process of adhering to the wall of the vein isn't affected by either heparin or coumadin. | |
| Answered by Loren Barlow, MD, Internal Medicine, , (9/30/2004) | ||
| Q | What are the side effects of using CortiSlim? | |
| A | CortiSlim is an appetite suppressant. It contains synephrine, an ephedra-like drug, and may cause tremor, anxiety, and insomnia. A better alternative would be a 2000 kcal/day diet and exercise 20 minutes/day. | |
| Answered by John Holroyd, MD, Internal Medicine, Bellingham, Eagle Hospital Physicians (9/30/2004) | ||
| Q | Is fiber contraindicated while taking Coumadin/Tinzaparin injections? I come in to your TCU every day for the above medication, trying to reach an INR goal of 2.5 & after 6 injections, I'm not there yet. I consume 2 to 4 slices of 8-grain, high fiber bread daily, in addition to a large bowl of oatmeal. Does this keep the meds from being absorbed? | |
| A | It is more likely your vitamin K intake. The fiber should not make a difference. Warfarin is in direct competition with vitamin K for vitamin K dependent clotting factors (II, VII, IX, and X). Vitamin K is found in green leafy vegetables, milk, dairy products, meats, eggs, cereals, and fruits. You should talk with the pharmacist about your diet. It is important to keep vitamin K intake consistent. | |
| Answered at 9/27/2004 | ||
| Q | Can Group B streptococcus be transmitted sexually and then passed on to another partner? | |
| A | Group B Strep, is often isolated from the vagina or rectum of healthy pregnant women. This is routinely screened for in these folks because this bacterium can cause significant and potentially dangerous infections to the newborn. There is no evidence that this bacterium is transmitted through sexual contact. An interesting web site that can provide much more detail is GBS: Group B Strep Assn. | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (9/9/2004) | ||
| Q | Where on Internet can I find out about the foods that won't cause gas? I am really in need of help. Would changing my diet to consist of more herbs and/or organic foods make a difference? | |
| A | There are many causes for gas. New medications or significant change in diet, i.e. eating a food (milk, chocolate, beans, fruits and vegetables, low carb breads or cereals) consistently that you had not been eating before, can produce gas. Increased fiber intake can cause gas initally, but if you are consistent, your body will adjust. Also realize that a normal person passes gas about 28 times a day - it is a natural process. Visit The Michigan Bean Commission website at http://www.michiganbean.org/ or Click Here - they promote bean-eating and often address the gas issue. I don't know of any reason why organic foods or herbs would make a difference. Visit Health Links page or Click Here and select "Nutrition" category for more nutrition sites. | |
| Answered at 9/2/2004 | ||
| Q | I have COPD. I have the opportunity to move to any place in the USA that would be of maximum benefit to living with my disease. What is the best environment, the ideal place to go ...I have searched everywhere and can't find the answer. | |
| A | There is not a correct answer to this question. COPD is such a broad disease and may be due to a chronic inflammatory condition such as asthma, or an induced chronic inflammatory state which occurs with smoking. In general, patients with chronic lung disease do better in drier climates, but not necessarily warmer climates, although this may be more comfortable. More damp and humid environments tend to exacerbate COPD particularly in those patients who are susceptible to environmental allergies or molds. Perhaps the best thing to do is visit places you may wish to live, and see how well your lungs do. | |
| Answered by Michael McNellis, MD, Pulmonology, Longview, PeaceHealth Medical Group - Specialty Medicine (8/11/2004) | ||
| Q | During my last period (4 days ago) I had severe abdominal and lower back pain. The doctor has asked me to get a complete GYN checkup. Are there non-invasive methods for GYN checkup (maybe ultrasound)? I'm not sexually active and have never had intercourse. I'm scared of the pain (both physical and psychological). | |
| A | A pelvic ultrasound will show any masses, tumors or abnormal cysts that are involving your uterus or ovaries. Sometimes to get the most accurate pictures they may need to insert a thin instrument into your vagina during the ultrasound to help see the ovaries. For most women, even those that have not had intercourse, a pelvic exam is not a painful experience. | |
| Answered by Dan Herron, MD, Obstetrics/Gynecolog, Longview, PeaceHealth Medical Group - Women's Health (8/11/2004) | ||
| Q | I had my gallbladder taken out several years ago. Some time after the surgery, I had X-rays done for some chiropractic treatment I was receiving and two staples showed up on the X-ray. I was wondering if it is normal for staples to be left in you six or seven years after gallbladder removal surgery, or if they are supposed to be removed after surgery. I have been having abdominal problems as of late and wanted to know if it could be caused by the staples. | |
| A | Using metal clips to secure the gallbladder duct and artery is standard, and those clips will show up on any future x-ray. They are very small, designed to last a lifetime, and it is very highly unlikely that they are responsible for your abdominal problems. | |
| Answered by Charles Stanton, MD, Surgery: General, Springfield, Northwest Surgical Specialists (8/9/2004) | ||
| Q | Would you please advise me of the effects Remicade has on the kidneys? | |
| A | Remarkably, no effects on the kidneys have been reported with Remicade. The only thing reported is occasional urinary tract infections, possibly related to the drug's effect on the immune system. Even this effect has been rarely reported. | |
| Answered at 8/9/2004 | ||
| Q | I would like to know about a certain supplement called chromium. It is offered by health and fittness companies as a digestive aid for weight loss. It is supposed to keep your metabolism working properly so that food is digested better, thus keeping weight down. I wonder if you know what the pros and cons are for taking this supplement? Do you know of any weight loss supplements that are best? Do you have a recommended source for information about them? | |
| A | There is a lot of anecdotal information available on chromium and its benefit in losing weight and in improving blood sugar control. Generally it is considered safe for short term use. Studies at Yale and U.of Alabama have noted some folks who have problems with irregular heart beat. It is also uncertain if some possible genetic damage may occur that would increase risk of cancer. Because weight control is usually a long term problem it might be better to focus on what is safe and healthy and has been proven to work. The advice I am going to give you is not flashy and probably isn't in the latest book on weight loss, but it works. Start with 30-60 minutes of exercise everyday. If you have not been exercising you will want to start slowly. Walking is good enough. If you have any orthopedic problems you might consider water exercise. This can be as simple as walking in the pool. The food part is almost as simple. You want to have a minimum of three meals a day. These meals should be spread out over the day and should consist of at least 5 servings of vegetables and fruit per day. A serving is about 1/2 cup. Try to eat just a bit less than you want. Avoid all regular soda and juice (4oz of juice once a day is ok). Expect this plan to be a life time plan rather than 2-3 weeks or even months. Weight loss of 2-3 pounds per month is great, imagine how that works over 2-3 years. For information on Chromium for Weight Control from Healthwise Alternative Medicine, Click Here, or visit http://www.peacehealth.org/xhtml/content/cam/hn-3910004.html | |
| Answered at 8/4/2004 | ||
| Q | I am having recurrent urticaria -- what shall I do to help myself? | |
| A | First get rid of what might be causing the problem -- not always the easiest thing --then use an OTC antihistamine such as Claritan on a daily basis. There's some more information in Healthwise on Urticaria and on MedlinePlus at Hives. | |
| Answered by Christa Danielson, MD, Family Practice, Eugene, PHMG/FP-South (7/27/2004) | ||
| Q | What does "elevated enzymes of the liver" mean? | |
| A | The answer depends on many things. There are four liver enzymes that are commonly measured: The ALT, AST, and GGT are transaminases that participate in metabolism. Their elevation suggests damage or inflammation of the liver itself. This occurs in response to infection in the liver or bile ducts (these drain the liver), hepatitis, and reactions to certain drugs and poisons (especially important with tylenol overdose, certain cholesterol lowering drugs, and some mushrooms). The alkaline phosphatase is another enzyme, and it is predominately elevated when the liver drainage is obstructed. This occurs with gallstones in the bile ducts, and tumors of the liver, bile ducts, and pancreas. Finally, although not an enzyme, the bilirubin is often measured. Bilirubin is a metabolic end product of decayed red blood cells. It is cleared by the liver. An increased bilirubin is an indicator that the liver, as a whole, is not functioning correctly. Accumulation of this substance in the blood is responsible for the jaundice seen in patients with liver disease. | |
| Answered by Robert Crochelt, MD, Surgery: General, Ketchikan, Southeast Surgical Clinic (7/9/2004) | ||
| Q | I am taking Lamictal and I was offered ecstacy at a party last week. I declined, but I was wondering if it is dangerous to take ecstacy while on Lamictal. | |
| A | While no information could be found regarding a specific interaction between Lamictal and ecstacy (also known MDMA), it is important to emphasize the dangerous, and occasionally lethal effects of MDMA all by itself. The drug can cause agitation, dangerous increases in blood pressure and heart rate, confusion, and delerium. More severe effects include dangerous elevations in body temperature, formation of blood clots throughout the blood vessels, muscle damage, seizures, and kidney failure. Please refrain from using this dangerous drug on any occasion. | |
| Answered at 6/29/2004 | ||
| Q | I'm dating a person with diabetes and it seems to get her down. She is very shy about the situation and doesn't like talking to me about it. What can I do to help her cope with living with it? | |
| A | We know that persons with diabetes are at significantly higher risk of depression. Managing a chronic illness can be overwhelming, taxing and discouraging for many. What helps? If she is depressed, a visit to a counselor may help her identify feelings and cope better. There are also a number of anitdepressant medications that are effective. If she is embarrased about her diabetes and not wanting to talk about it, she may find support and comfort attending diabetes classes (perhaps with you) or a diabetes support group. It is very helpful to be with other persons with diabetes; they can all share in the challenges and learn from each other. Many hospitals offer diabetes classes (that are paid for by insurance companies) and also could direct you to a free support group. If her blood sugars are running high and she is feeling discouraged about her numbers, I would suggest that she see a good endocrinologist or diabetes educator to learn how to be flexible with her management and insulin doses. Modern management of diabetes includes sweets, counting carbohydrates and changing insulin doses. If she has type 1 diabetes, insulin pumps can be wonderful. It is great that you care about her. Listen, ask good questions and let her know that you would like to learn more about diabetes. Try reading Type 2 Diabetes: Living with the Disease to learn more about the possibilities. | |
| Answered at 6/28/2004 | ||
| Q | I have been trying for several years and several doctors to find a reason for my severe fatigue. It seems the physicians I have dealt with find no cause other than age (79 although I have friends, my seniors, who do not suffer likewise. Am I wrong to think my problem can be found somewhere other than the calander? | |
| A | I will assume from your question that the issue is fatigue and not weakness. Weakness is either a localized or a generalized lack of muscle strenth. Weakness is usually a fairly straight forward evaluation and therefore I will limit my comments to the topic of fatigue. The evaluation of chronic fatigue is complex, multifactorial and more often than not the result is less than satisfactory for the patient. The work up and treatment for this problem is still evolving. There's a detailed review of Chronic Fatigue Syndrome in Healthwise. To stay abreast of current developments and to make connections with others that are wrestling with this issue I would suggest that you consider touching bases with this group for Chronic Fatigue Support Good luck. This is a tough issue and gently put we all age differently - it is clear that the normal aging process can results in decreased stamina; how dramatic that change is for any individual can be variable. An appropriate exercise program focused on developing and maintaining lean muscle mass can be helpful; if you haven't pursued this course I would suggest consulting with your physician to see if this is an option for you. | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (6/22/2004) | ||
| Q | My 8 year old daughter has low blood sugar. We have been feeding her 6 times a day. However, in the morning she wakes up shaking. I test her sugar while this is happening and it is 80. I give her a sugar tablet and then she is fine for the rest of the day. I took her to the doctor today and they want her to see a specialist. I am scared. He said something about her pancreas. She has also lost 2 pounds in 2 months although she eats all the time. Can anyone ease my mind until we see the specialist? | |
| A | It sounds like you are getting good medical care. While you wait for the specialist visit you could follow this meal plan: Your daughter should have 3 meals and 3 snacks per day. You should try to avoid all simple sugars including fruit (except at mealtimes in small portions). Remember, this is a short term solution until you see the specialist. The meals and snacks should always contain complex carbohydrates( bread, crackers, potato, rice, noodles, cereal, peas, corn). You may also serve protein with the meals and snacks. The meals should have about the same amount of food as she usually eats. If you are familiar with counting carbohydrates you might think in terms of 60 grams/ meal and 15grams per snack. If your daughter can't eat that much that's ok, just try and be as consistent as possible. Some examples of 15 gm carb snacks are 1/2 meat or cheese sandwich, 6 soda crackers with cheese, 1/4 of a large bagel with cream cheese. It might be worth trying a slightly larger snack at bedtime in hopes of avoiding the low in the am. Try 1/2-3/4 cup cold cereal with milk. If unsweeted cereal is not well tolerated try sweetening it with splenda. I'm sure this sounds very complicated but it at least can get you started. Remember this is just until you see the specialist and get some more information. | |
| Answered at 6/16/2004 | ||
| Q | My father is having Ablation done on his upper heart. Can you tell me what it is and what I can expect in the way of his recovery?. He is 74, and in good health. He doesn't smoke or drink and is normal body weight. He had a heart attack 8 years ago. | |
| A | Ablation procedures are done to treat rapid heart rhythms by placing several catheters inside different places in the heart, stimulating the heart to trigger the rhythm, and use finely placed energy (heat or cold) to wound or destroy the extra electrical circuit causing the rapid rhythm. The success and risks depend on the specific rhythm being treated; his electrophysiologist can provide details relevant to him. The recovery is usually very quick; most often patients spend one night in the hospital. | |
| Answered by Peter Beglin, MD, Cardiology: Interven, Bellingham, PHMGW/NCC-Squalicum (6/10/2004) | ||
| Q | Do any urologists perform elective Orchiectomies? | |
| A | Orchiectomy is done electively under several circumstances: As part of gender reassignment surgery for treatment of transgenderism. This is of course the last step in an extensive medical and psychological evaluation. As part of treatment for prostate cancer. There is some detail on the surgery and the situations when it would be considered for the treatment of this sort of cancer in the Healthwise article on Orchiectomy. | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (6/8/2004) | ||
| Q | My mother was diagnosed with MRSA recently and I was wondering what precautions we should be taking at home for her care? Can we contract this resistant bacteria also? Does this mean that she will never get rid of the microbes? | |
| A | The answers to some of your questions depend on whether your mother has a draining wound. If so, she is more infectious, and could pass it on to others. If not, special precautions are probably not needed. MRSA actually acts like normal staph; we just have fewer antibiotics options for treatment. Believe it or not, people with recurrences often carry it in their noses and ordinary antibiotic treatment may not eradicate it from there. Culturing the nose to make sure it is gone may be useful. CDC (Centers for Disease Control) has a Web Site on MRSA that you might find useful. | |
| Answered by John Wilson, MD, Infectious Disease, Eugene, The Travel Clinic (6/2/2004) | ||
| Q | I am a newly married 32 year old male. I do get an erection but find it a bit difficult to retain it for long. The moment I think of insertion I lose it most of the time. Can you suggest some natural way of improving penile erection through some exercise or diet? | |
| A | In the majority of young healthy men that have your same concern the issue is usually one that relates to anxiety about performance or other stressors. There are also physical causes that can contribute to the problem but those are relatively rare for a guy your age. Nevertheless, it is important for you to be checked by your personal physician to evaluate this and to suggest treatment. The good news is that there are many effective treatments out there for this problem. There is some detailed information in Healthwise about Erection Problems. | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (6/1/2004) | ||
| Q | I have been checked for, and been found to have, a low testoserone level. I am currently on Androderm to bring my testosterone level up to normal. What are the side effects, if any, of this medication? I read that it could increase my prostate size. I have been told previously by my Dr. that it already is enlarged, but I currently have no urination troubles. I am concerned the prostate could further enlarge because of Androderm usage. What are the risks? | |
| A | To answer your question properly we need to know how low your testosterone really was before treatment and what is the level now after treatment. The prostate responds to testosterone even at normal levels so that it enlarges with age. Testosterone also will make any cancer of the prostate grow faster. As one gets older the level of testosterone drops "normally". The real question is whether taking testosterone really helps you and whether it currently causes any symptoms at the present. I suspect you will have to talk all this over with your doctor | |
| Answered by Hugh Johnston, MD, Hematology, , (5/21/2004) | ||
| Q | I need some advice on corneal transplant. I am told I will be needing one. | |
| A | A corneal transplant is the most successful type of transplant surgery performed. It will replace your diseased cornea with a cornea from a donor who has died. Better outcomes are achieved when the surgeon is highly experienced, and the follow-up care is also performed by a physician who is well-versed in the nuances of post corneal transplant care. I suggest you ask your physician for his/her advice, follow it, then get a second opinion before proceeding. The follow-up care is as important as the surgical procedure, so make sure you understand who will be caring for you during the post-operative period--which can last for a year. Here's some background reading about Corneal Transplant | |
| Answered by David Deutch, MD, Ophthalmology, Eugene, PHMG/Ophth-Hilyard (5/17/2004) | ||
| Q | I am getting ready to have a baby and my soon-to-be pediatrician told me that sometimes Sacred Heart hospital will test babies for drugs. I am not on drugs and don't want any tests done that aren't necessary. What is the hospital's policy on this? Also, can I find out what tests will be done to the baby after it's born and what my rights are? ..will I be notified of any tests that may take place? | |
| A | Babies are screened for drug exposure at both SH and MW for history of maternal drug use, inadequate prenatal care or late prenatal care, or no prenatal care. This test is not done routinely and if it is done on babies the parents are notified as to the reasons. It is routine for babies to get prophylactic eye antibioics, vitamin k injection, newborn testing- ie PKU, hearing screening and a transcutaneous bilirubin (checks for jaundice). You should be notifed of any testing and none should be done if you request them not to be--however the pediatric community feels all these are important for the health of your baby. | |
| Answered by Paul Bouressa, MD, Pediatrics, Springfield, PHMG/PED-RiverBend (5/11/2004) | ||
| Q | How do you assist someone with an allergic reaction from eating food? | |
| A | Get medical attention immediately! If they are having any problems breathing or swallowing, keep them calm, get them to lie down and call 911. | |
| Answered by Erin Reilly, MD, Urgent Care, Springfield, PHMG/Urgent - RiverBend (4/19/2004) | ||
| Q | I have a strange discharge in my sperm. It looks like apple jelly. Can you tell me what this could be? | |
| A | Sperm, under a microscope, looks like tiny minnows; every time you ejaculate there are millions of these guys on a mission to find the egg and fertilize it. Despite these vast numbers they actually are only a very small part of what comes out of your penis when you ejaculate. The rest of what comes out is called semen and is a nutrient rich broth that helps the sperm stay alive and do their job. The semen is typically thick, light tan colored and can be jelly like. Sounds to me like what you are describing is normal ejaculate. | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (4/16/2004) | ||
| Q | I'm a male 25 years old. I got oral sex from a man 32 years old. What is the difference between having oral sex with a lady and gent with regard to getting STDs like herpes? | |
| A | No particular difference: an active herpes lesion on the genitalia or on the oral mucus membranes can be quite infectious and can infect the partner. There is some evidence that even when the herpes is not active that there is still some risk of infectivity. Here is a link to some more information on Genital Herpesthat might be helpful | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (4/12/2004) | ||
| Q | My daughter is 4 weeks old as of yesterday. We have weaned her to a bottle and she is exclusively on formula. Throughout the day and night, she eats between 3.5 and 4 ounces every three hours. Is this a lot? I've heard of some parents giving younger children cereal earlier than normal if they are big eaters. Should I begin giving her something to fill her stomach a little better? | |
| A | Your daughter has a healthy appetite, but her intake is in the normal range. I would not recommend starting cereal yet. A 4 week old will not be able to adequately digest the cereal, and she needs the more calorie-dense formula to satisfy her. Contrary to some reports you may have heard, starting cereal is not the magic cure to night time feedings. It may even cause her tummy ache or constipation and she may even sleep less! Her formula is adequate for all her nutrition needs at this age. | |
| Answered by Tamara Barstow, MD, Pediatrics, Eugene, PHMG/PED-Barger (4/1/2004) | ||
| Q | I've read a lot of information on snoring. This has been a problem for both myself & my wife for years now. Please explain the proceedures for me to terminate this problem. | |
| A | There are 3 or 4 different snoring procedures. Injection snoreplasty, radiofrequency snoreplasty , Laser-assisted uvuloplasty, plus nasal and tonsil procedures. Make sure you don't have sleep apnea and follow along with your ENT doctor in your area. To learn more about causes and treatments try the National Library of Medicine consumer page on Snoring. | |
| Answered by Emil R. Hecht, MD, Otolaryngology, Bellingham, Bellingham Ear Nose & Throat (3/31/2004) | ||
| Q | What medications are safe to take for a urinary tract infection, while breastfeeding? | |
| A | Most beta lactams (penicillins, cephalosporins), and trimethoprim/sulfamethoxazole (Bactrim, Septra). Avoid quinalones (Cipro) and tetracyclines (doxycycline). | |
| Answered at 3/25/2004 | ||
| Q | How many platelets is a normal count? | |
| A | A normal platelet count ranges from 155 to 356. Increased platelet counts, up to twice the upper end of normal, frequently occurs in patients with an inflammatory process. | |
| Answered by Stephen Erfurth, M.D., Pathology:Anatm/Cln, Springfield, Stephen Erfurth PhD (3/12/2004) | ||
| Q | My 8 months old baby passed some hard stool and got her anal passage bloody. What can I do? | |
| A | Your baby has had a small tear in her anus, either on the outside or just on the inside, from passing the hard stool. This is quite common in babies and young children. This tear will heal on its own if the stools are soft from now on. If you can see the tear, you can put some ointment, like Aquaphor, on it to soften up the skin there. If you can't see it, you don't need to use anything. If your baby continues to have hard stools, you should talk to your doctor about ways to help soften the stools. This could delay the healing and re-tear the area. | |
| Answered by Tamara Barstow, MD, Pediatrics, Eugene, PHMG/PED-Barger (3/3/2004) | ||
| Q | I have been taking Vicodin for back pain. I am going on a job interview and I will have to take a drug test. How long will the drug stay in my system if I stop it today? | |
| A | Your question is an interesting one for three reasons. First, most people would wash 95% of the drug out of their system within 24 hours of their last dose. But that time frame may be longer with age, or in a patient with liver or kidney disease. Second, many drug assays are very sensitive and may even pick up minute quantities of the drug, so it would be difficult to say how long it would take to wash out all TRACES of the drugs. Third, and most important, most employers will ask about physical ailments and, with any kind of chronic pain condition, will want to know what you take to relieve the pain. If you answer Vicodin, than any traces of Vicodin that show up on the drug test will be considered a negative drug test and will not count against you. Tens of thousands of people are taking pain medication like Vicodin to help them get through their work day, and we are fortunate to live in a time where it is no longer a stigma to be taking strong pain medication when it's required to be productive and pain free. Therefore, I would advise being up front with the interviewer so any trace that does show up would not count against you. | |
| Answered at 2/16/2004 | ||
| Q | My 48 year old sister just had an x-ray test reveal a nodule/spot in her lung, near the center. She has always had a bit of a cough for years, perhaps more often in the past year or so. She also just got over a lung infection about 4 weeks ago. This nodule showed up in the x-ray that was taken 2 weeks ago. She has always had normal x-rays before this. The nodule is 1 cm right now. She had a ct scan and we are awaiting those results. She does not smoke and has lived in a smokefree home for years with the exception of an occasional visitor that might have smoked. However, no one has smoked in her home for the past 4 yrs. My sister is also an RN. Her cough isnt "horrible"-- it's just that she seems to cough often. Can you give me a % chance of this being cancer? | |
| A | Lung cancer in a 48 y/o woman who does not smoke would be very unusual. Indeed, lung cancer as a primary cancer in this population could be termed rare. It is always concerning, however, when a nodule appears that was not there before and this requires some attention. If indeed this woman suffered from a pneumonia, it would acceptable to wait at least 6 weeks to repeat a CXR as the radiographic improvement lags far behind the clinical improvement and this may be a lingering defect from that illness. However, if it is still there, and definitely a new finding when compared to previous chest x-rays, then further work-up is mandated, even up to the point of removing this surgically. There are a number of benign conditions that present like this, and there are also a number of imaging studies that would help evaluate this but, in general, a new nodule will need at least a tissue diagnosis. | |
| Answered by Michael McNellis, MD, Pulmonology, Longview, PeaceHealth Medical Group - Specialty Medicine (2/16/2004) | ||
| Q | How does Peptobismol stop acid indigestion? | |
| A | Therapeutic effects of BISMUTH SUBSALICYLATE in gastritis and gastric and duodenal ulcer have been primarily attributed to demulcent (coating) and cytoprotective properties, as opposed to the acid neutralization mechanism of antacids. Bismuth also interferes with the cellular structure and the attachment to the gastric cells of the bacteria which causes ulcers (Helicobacter pylori). | |
| Answered at 1/26/2004 | ||
| Q | If high blood pressure may be the cause of my tinnitus, how long after I control my blood pressure does it generally take for the tinnitus to go away? | |
| A | Your tinnitus may not be related to your blood pressure. Tinnitus most often is due to aging of the accoustic nerve(the nerve that has to do with hearing) or damage to the nerve due to noise. There is a high correlation of tinnitus to hearing loss. If the tinnitus does not go away after 3 months of good blood pressure control you should see a ENT (Ear, Nose and Throat) specialist for evaluation. For general information see Ringing in the Ears(Tinnitus) in the Healthwise Knowledgebase. | |
| Answered by Loren Barlow, MD, Internal Medicine, , (1/26/2004) | ||
| Q | What would cause an elevated prolactin level? And what can be done? | |
| A | Prolactin is a hormone produced by the pituitary gland. It's purpose is the stimulation of milk production by the breast in women who are lactating. In non-lactating women, the most common cause of an elevated prolactin level is a microadenoma (or small tumor) of the pituitary gland, which is caused by overactivity of the prolactin producing cells. This can usually be controlled by a medication known as bromocriptine or parlodel. For macroadenomas (or larger tumors) of the pituitary gland, surgery is sometimes warranted. | |
| Answered by Paula Jewett, MD, Obstetrics/Gynecolog, Eugene, Women's Care (1/19/2004) | ||
| Q | I think I have TMJ--what can I do to help this? | |
| A | Your dentist or ENT Dr. may help diagnose this and put your jaw to rest. An interocclusal splint may help; soft diet, no chewing, heat, massage, and stretching exercises can be helpful. For more information you can read Temporomandibular(TM) the Disorders on Healthwise. | |
| Answered by Emil R. Hecht, MD, Otolaryngology, Bellingham, Bellingham Ear Nose & Throat (1/15/2004) | ||
| Q | I have been diagnosed with bone spurs in the area of where the ribs connect to the spine. I can't find anything about "bone spurs" on the PeaceHealth web site. Are there other titles, names, etc., under which I should look? | |
| A | Try osteophyte, also spine degeneration changes. Aside from Bone Spurs on Healthwise a place to check on peacehealth.org is the Health Links. In the category of Orthopedics there's a list of sites related to bones, etc. Spinal Stenosis on Orthospine.com mentions Bone Spurs in Degenerative spine conditions. | |
| Answered by Michael Karasek, MD, Pain Management, , (1/13/2004) | ||
| Q | I have an earache, severe sore throat, runny nose, and my head feels like you could pop it. Our school nurse did not see anything to be concerned about, but when should I see a Dr.? | |
| A | Given that you saw the school nurse I will assume that you are less than 25 years old ( your age really makes a difference in this case). I also don't know anything about the rest of your specific medical history and so will answer this question is a general way, i.e. not specific to your particular case. The symptoms that you describe are consistent with a cold, also known as an upper respiratory infection ( URI ).If there are other symptoms like productive cough or high spiking fevers then that suggests a diagnosis other than URI and should be evaluated by a physician. There are many different types of viral germs that cause the URI, none of which we have the cure for. So in the general case simply getting plenty of rest, pushing fluids and waiting it out is the best approach as a physician is not going to be able to prescribe anything that will shorten the course of the URI. Generally a URI lasts for a week to 10 days and then resolves entirely within 14 days. If the symptoms of URI persist beyond this time frame then a physician evaluation is indicated. Here is some more information from Healthwise that I hope will be helpful, at Respiratory Problems, Age 12 and Older | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (1/7/2004) | ||
| Q | I am extremely allergic to Sulfa-drugs. I would like to begin taking a supplement, but it contains MSM. Would it be safe? I know sulfur (like in food) is ok and not the same as sulfa, but I don't know much about MSM & where it fits in. Any thoughts would be greatly apperciated. | |
| A | MSM has a sulfonyl chemical group in its structure. While it is impossible to know if you would have an allergy to MSM, it would be wise to avoid it. | |
| Answered by John Holroyd, MD, Internal Medicine, Bellingham, Eagle Hospital Physicians (1/6/2004) | ||
| Q | I have some questions about steroids: How do they build muscle? Is the muscle they enable one to build "real" muscle? Are they addictive? Would it be safe to use steroids only long enough to achieve the desired physique, then discontinue use? | |
| A | Anabolic steroids have been abused by athletes to enhance strength, performance, and endurance. They do increase lean body mass (muscle) if used in conjuction with an adequate diet and maximal excercise. Despite evidence of benefit in some athletes, the use of anabolic steroids to enhance performance is condemned by the medical community. These agents have also been associated with severe toxicity in athletes, including hepatotoxicity, liver cancer, hypertension, decreased testicular size/spermatogenesis, and lipid abnormalities. Other effects include fluid retention, weight gain, psychiatric symptoms, lipid abnormalities, elevation of liver function tests, hypercalcemia, hypoglycemia, and pain on injection. Even short term steroid use has caused harm. They are not addictive in the same fashion as heroin, but the effects they produce will wane with time after the steroid (or exercise or diet) is stopped. | |
| Answered at 12/23/2003 | ||
| Q | What are the symptoms of quitting drinking and how long do they last? I'm getting a flushed face and sweating, and I'm very hot and anxious. My MD gave me Wellbutin to cope. Is that a good drug for this? | |
| A | You describe some of the withdrawal symptoms of drinking excess alcohol. Wellbutrin may be helpful and there are also some anti-anxiety drugs that are useful over a short period of time. Continue to work with your doctor. | |
| Answered by Loren Barlow, MD, Internal Medicine, , (12/19/2003) | ||
| Q | When I drink champagne or certain wines, after just a few sips, my forehead starts to swell up and get very red. I'm thinking I might be allergic to sulfites. However not every wine I drink that has sulfites in it causes this reaction. It only occurs with some wines, and all the champagne I've ever had. Could it be something else that I'm allergic to? | |
| A | It is possible that it is sulfites, and you are reacting with only certain ingestions. It is an unusual allergic type of reaction, as sulfites usually cause more diffuse itching, hives or asthma like reactions. It may be an allergic reaction to an ingredient in the champagne, and also in some wines, but as noted, an unusual manifestation of allergy. Some individuals are sensitive to alcohol in certain beverages, and experience redness about the nasal area and face due to blood vessel dilation from the alcohol. If you are not having allergic type of reactions to other foods or beverages, even those containing sulfites such as some preserved/fermented foods or dried fruits such as apricots, then further diagnostic evaluations are probably not indicated to detect a specific ingredient. There is no treatment for preventing reactions, other than avoidance. Antihistamines such as Benadryl or Loratadine may be helpful if therapy is needed. Benadryl will likely cause sedation and should be avoided if one needs to be awake or alert. | |
| Answered by William Anderson, MD, Allergy & Immunology, Bellingham, Asthma & Allergy Center of Whatcom County (12/8/2003) | ||
| Q | What is H pylori and how do you get it? | |
| A | You are referring to Helicobacter pylori (H. pylori), and it is an infection, actually, that can cause ulcers and inflamation in the upper gastrointestinal tract. It is the leading cause of ulcers. Nobody is quite sure how someone gets the infection but there has been speculation it could be from simple house flies spreading it. It is treatable with an aggressive antibiotic program and anti-ulcer medication. | |
| Answered by Frank Littell, MD, Hospitalist, Springfield, PeaceHealth Hospital Medicine (12/5/2003) | ||
| Q | I am a 24-year-old female that has had GI problems for the last 6 months, such as, stomach cramps, diarrhea, constipation, light colored stools, mucous in the stool, and nausea. In addition, I have experienced irritability and depression. My mother recently informed me that I was allergic to gluten as a child. My question is, is a gluten allergy related to celiac disease? | |
| A | People with celiac disease are, in fact, unable to tolerate gluten. In that sense it is, basically, an "allergy," but there is more to it than that. For information about the condition try Celiac on MEDLINEpus, the consumer health site of the National Library of Medicine. | |
| Answered by Frank Littell, MD, Hospitalist, Springfield, PeaceHealth Hospital Medicine (12/3/2003) | ||
| Q | What is the treament of leukemia? | |
| A | There are many forms of leukemia, and treatment regimens for each type have evolved by trial and error into complex medication, surgical and radiation therapies that use a number of different modalities in various doses, combinations and schedules. The primary focus of therapy is to restore normal bone marrow function as quickly as possible. Early treatment is very important. Paul Roche - Clinical Pharmacist | |
| Answered at 11/24/2003 | ||
| Q | I have diabetes 2 and I was told to test 2 hours after eating. Does that mean to test 2 hours after I've finished eating, or do I count from when I first start eating, then add on 2 hours? | |
| A | Two hours after the beginning of the meal. | |
| Answered at 11/19/2003 | ||
| Q | I have heard that condyloma can be cancerous. Is this true? | |
| A | The human papilloma virus (HPV) or the wart virus, or condyloma, is one of the most frequent and common sexually transmitted diseases (STD). Most women and men are asymptomatic, as this is a microscopic virus that you cannot see. Occasionally, this can cause bumps or warts that can be seen and felt. If either partner has a wart, they should seek medical attention. The HPV virus can cause changes on a woman's cervix (the opening to her womb at the top of her vagina). This can be reflected in an abnormal Pap smear. Uncommonly, this can be associated with abnormal cells, which are precancerous. Rarely, these cells can turn into cervical cancer. This takes a long time, and if a woman is visiting her doctor on a regular annual basis, the Pap smear should turn abnormal many years prior to cancer developing. A regular annual exam by a physician is important for all women. | |
| Answered by Robert Olson, MD, Obstetrics/Gynecolog, Bellingham, PHMGW-OB Hospitalists-Squalicum (11/17/2003) | ||
| Q | I am an old diabetic. My Doctor has told me to take metformin. What is this for and why, when I go to the hospital for tests such as a Cat Scan, do I have to stop taking it? | |
| A | Metformin is an oral hypoglycemic that is currently among the most widely prescribed oral agents for reducing blood glucose. It works well alone and in combination with other agents, or with insulin. There is a side effect associated with the drug where lactic acid, a metabolic by-product, may build up to harmful levels in the body. It is extremely rare to see this side effect with metformin, but certain situations increase the risk. The best known risk is undergoing some types of scans where the body is injected first with a dye called "contrast". The contrast can occasionally reduce kidney function and allow a buildup of metformin and lactic acid, so it has been recommended that the patient not take their metformin on the day of the test and for 48 hours following the test, to assure that kidney function hasn't been affected. Following the 48 hours, the metformin may be resumed with no more risk than before the test was conducted. | |
| Answered at 11/17/2003 | ||
| Q | My wife is a 22 weeks pregnant lady. We had a scan after 22 weeks. They found mild pyelectasis and calicectasis in the left and right kidneys. What does that mean? In what way will it will affect the child? What do we have to do? | |
| A | Calicectasis is dilation of a calix of a kidney. These are regions that are part of the pelvis of the kidney where urine collects before it exits into the ureter on its way to the bladder. Pyelectasis is dilation of the renal pelvis. So the two terms mean that there is mild dilation of the baby's kidney pelvis. Since you were told the situation was mild, the best thing to do is wait. You should be getting another ultrasound to check again in 3 or 4 weeks. If the measurements are stable there is usually nothing to be concerned about. If, however, they are increasing this could mean obstruction of the kidney. If that occurs you would need to be seen by a perinatologist, a high risk Obstetrics provider. | |
| Answered by Linda Frison, MD, Obstetrics/Gynecolog, Eugene, PHMG/OBGYN-Hilyard (11/16/2003) | ||
| Q | My son, now 19, has suffered from chronic asthma and allergies his entire life. He has taken many meds daily since he was 3 years old. He told me when he was 11 he used to think he was going to die because he couldn't breathe. I believe his emotional response to years of fearing dying has had a traumatic impact on him. I am trying to determine if there is any one specific disorder that is relative to this that I could research. I want to start educating him. He is HIGHLY SENSITIVE and reactive and struggles with his emotions. I think he is a borderline hypochondriac, but that is not so much my concern at this point. I do not know if it is PTSD or something else. I would appreciate any input you can provide. | |
| A | Chronic illness is hard on the body and hard on the psyche. The threat of death is not easy for anyone, including young people, to deal with. Missing school, being unable to exercise as strenously as friends, etc., can reduce self esteem and make kids feel isolated and different from others in ways that are very uncomfortable. Some medications used in the treatment of chronic illness, including asthma, also may have psychiatric effects. These are just a few of the ways in which the effects of asthma may be seen in teens. There is no one specific way these infuences play out - these influences interact with the individual's personality - and all or some can play a role in shaping personality and behavior. PTSD is only one of many possibilities. Have you considered talking with your son about having an evaluation? All psychiatrists and nurse practitioners are medically trained and have spent time dealing with the physical and emotional consequences of chronic illness. Some psychologists and counsellors, but not all, have this training too. If this is not a possibility, his having a frank talk with the family MD, a school counselor or even a minister trained in counseling can help begin to sort things out. Your son is lucky to have a mom tuned in to his physical and emotional well-being. But please remember that at age 19, it may be hard for him to "listen to his mother" about health -and especially mental health - concerns. If your son won't consider the above possibilities, you may find helpful info on the psychological consequences of asthma by contacting the American Lung Association Asthma, or APA Help Center. You can read their materials and then just leave them lying around the house. When he's ready, he'll pick them up and act on them on his own. | |
| Answered by Henry Levine, Psychiatry, Bellingham, 11th Street Offices (11/11/2003) | ||
| Q | I am a 24-year-old Asian man who is quite fair, but the skin on my penis is much darker than the rest of my skin. This also includes my scrotum. I initially noticed this a couple of months back but didn't think much about it. Recently, I think it has been getting darker. Having olive colour skin will be the best way to describe my all-over body colour. My penis is now a very dark brown, close to being black without being black. Should I be worried? | |
| A | Pigmentation of the genitalia is typically much darker than other areas of the skin especially in non-caucasians. There are certain hormonal conditions which can also increase pigmentation but usually it is not just located in one place. This is rare. Barring any other medical problems like diabetes, excessive weight changes, excessive sweating, your pigmentation is probably normal. | |
| Answered by Jay Park, MD, Dermatology, Eugene, Jay Park MD (11/11/2003) | ||
| Q | I have had problems getting a pap smear for the last two years. Can you tell me what is a CLOSED CERVIX? Can you get a true reading from a pap smear taken outside of the cervix? What causes a closed cervix? What are the dangers of having a closed cervix? Can and should this be corrected? | |
| A | It sounds like your endocervix is tucked up in your cervical canal. Many things can cause this including normal anatomy, menopause, scarring from pregnancy and delivery or any surgical procedures, etc. In order to obtain a useful, reliable Pap, the endocervical transformation zone must be sampled. This transformation zone is where the endocervical cells (usually tucked up inside the cervix) meet the surface cervical squamous cells. There are specifically designed tools for sampling the endocervical canal and if these do not provide a good sample, then an endocervical curettage can be done. These procedures can both be done without surgically "opening" the cervix. I would recommend that you have your pelvic exams and pap smears performed by a gynecologist who would have these extra pap equipment items available. | |
| Answered by Linda Frison, MD, Obstetrics/Gynecolog, Eugene, PHMG/OBGYN-Hilyard (10/15/2003) | ||
| Q | I have a radiology question: I had a CT scan today AND an MRI, both with contrast. For the MRI I had 14cc of Optimark and for the CT, I had 100cc of Optiray 320. On the CT, when it was injected, they said that I would feel a warm sensation going through my body. I mainly felt the warmth in the genital area. Later that night, my vaginal area started to feel really sore with a burning to it. Is this a normal reaction from the contrast? I was on my menstrual cycle which I was told that the contrast wouldn't affect. | |
| A | This belated response may not be very helpful to you at this point. Delayed reactions to the iodinated contrast given in CT are not uncommon, although most serious reactions occur within minutes of contrast administration. Most delayed reactions are itching, hives and generally feeling lousy. I have not heard your specific complaint before. The reactions to contrast are self limited and will go away. How long? It may take several days. | |
| Answered by Stephen Quinn, MD, Radiology: Diagnosti, , (10/10/2003) | ||
| Q | I have an allergy question. If you are basically allergic to everything out of doors can allergies cause a pressure feeling in the ears? Also, can allergies cause headaches? | |
| A | Allergic rhinitis is a condition that causes inflammation and swelling of the mucous membranes lining the nasal passage. This is due to exposure to allergens in the air, such as pollens, dust mites, animal dander and mold spores. Other commmon symptoms that are often, but not always associated with allergic rhinitis, included sneezing, runny nose and itching of the nasal passages, eyes, and sometimes throat. In some cases, the swelling can lead to a pressure-like sensation in the ears that typically comes and goes, and feels at times as if one is traveling up a hill or flying in a plane, which can cause a "popping" like sensation in the ears. This is known as eustachian tube dysfunction and is sometimes associated with allergies. It typically involves both ears. Usually treatment of the underlying allergy, with antihistamines, sometimes decongestants and anti-inflammatory nasal sprays, is helpful in reducing symptoms. If there is significant swelling in the nasal passages, headache can also occur. This is not an uncommon complaint in those with allergic rhinitis. | |
| Answered by William Anderson, MD, Allergy & Immunology, Bellingham, Asthma & Allergy Center of Whatcom County (10/7/2003) | ||
| Q | Just recently I noticed that everytime I move my head from side to side I hear a crunching sound in my neck. I have not fallen, have no dizziness or pain -- just a crunching sound. Very strange. What might it be? | |
| A | Arthritis in the small joints of the neck. If it is the only symptom -- no pain, numbness, weakness, etc. -- nothing need be done. | |
| Answered by Michael Karasek, MD, Pain Management, , (10/7/2003) | ||
| Q | How can I tell if there is something in the air of my new home making me sick? I've been noticing when I'm near the garage (where my husband has a project car) that I get a bad taste in my mouth. Today I am noticing the taste while I'm at work, and have a slight headache and a very queasy stomach...should I be worried? | |
| A | There really is no good way to find what is in the air in your home without an environmental company testing air samples within your new house. You may have some mild allergy to a building compound or to a chemical that your husband may be using in your garage, and although this may be detected in an air sample it does not necessarily mean that you have a true allergy to that compound. Most of the symptoms that occur when this happens usually go away when you are removed from that environment and only return when you are exposed to it again. If you are feeling "queasy" at work, there may be some other cause for this outside of what you may be smelling at home and if it continues, then you will want to see your primary physician. | |
| Answered by Michael McNellis, MD, Pulmonology, Longview, PeaceHealth Medical Group - Specialty Medicine (9/30/2003) | ||
| Q | I have a question on allergies and asthma. I have had both for over 30 years. I have dealt more with the asthma problems than I have the allergies. Can asthma and/or allergies make you feel light headed? If so, what causes it -- an allergic reation to something; or lack of oxygen? How can you tell the difference between having a hard time breathing due to asthma, and having a hard time breathing due to anxiety? Can anxiety make you light headed? | |
| A | You ask a number of important questions about symptoms that may be associated with asthma. Light headedness can be associated with asthma but it is an unusual complaint. If one is having a severe, sudden allergic reaction with or without asthma, lightheaded feeling may be noted, but other obvious symptoms would also be experienced in general, such as hives, wheezing, swelling of some tissues such as the lip, around the eye or throat. If one is breathing fast, either due to asthma or anxiety, or both, one often feels lightheaded, dizzy, and can even pass out for a few seconds. It is sometimes very difficult to differentiate between asthma and anxiety as both can cause shortness of breath and a hard time breathing. A breathing test called spirometry, or use of peak flow meter can often help in determing how much of one's difficulty in breathing is due to asthma or anxiety. Some patients with anxiety associated shortness of breath complain of tightening in the throat area with difficulty getting a deep breath of air in. However, this does not necessarily exclude asthma as a factor. In patient's with anxiety as the primary problem, sleep is usually not disrupted due to breathing difficulties, whereas in asthma that is not well controlled, nighttime awakening is common. It is also important to know that other medical problems including heart problems or anemia can cause light headedness. If one has had asthma for many years, experiencing usual symptoms, and a new symptom develops, such as light-headedness that was not experienced before, then medical evaluation should be pursued. | |
| Answered by William Anderson, MD, Allergy & Immunology, Bellingham, Asthma & Allergy Center of Whatcom County (9/23/2003) | ||
| Q | How do you tell the difference between a viral infection and a bacterial infection? When should I be concerned and go to the doctor? | |
| A | There is no hard and fast set of symptoms that distinquish a viral infection from a bacterial infection. There are some distinquishing features depending on the system of the body that is involved. Any symptoms related to the urinary tract (urgency and frequency of urination) associated with fever is almost always related to a bacterial infection. It's almost impossible to distinquish the two when it involves the pulmonary system (bronchial tubes and lungs). These symptoms are the same -- namely a productive cough associated with a fever whether it's a virus or bacteria that is the offending organism. Sore throat with fever is also indistinquishable. A temperature that persists over 101.0 degress for a couple of days, and particularly one associated with a chill, should send you to the doctor no matter what the associated symptoms may be. Loren Barlow, MD | |
| Answered by Loren Barlow, MD, Internal Medicine, , (9/22/2003) | ||
| Q | Can you tell me if fair skinned people heal slower from bruises? I had a CBC done 8 days ago (it came out fine). They took the blood from the "corner" of my arm towards the elbow. I had thought it should have healed by now. My mother says it's because I am fair skinned --is this correct? | |
| A | There is no relationship between fair skin and poor healing. African black people are more prone to make large and dense scars after injury, called keloids. Redheads have the reputation of bleeding more after childbirth, but this is undeserved and has no basis in fact. Adequate protein and Vitamin C in the diet are essential for wound healing. Applying pressure and elevating the puncture site for 20-30 minutes after a blood test is a good idea. | |
| Answered at 9/11/2003 | ||
| Q | If I only have one kidney stone that is 8-9mm in size, can I pass that size of stone? Can a piece of it break off to pass causing extreme pain? | |
| A | It's unlikely you would be able to pass a stone of this size. Yes, the situation might arise that the stone itself might become dislodged from where it is now and cause severe pain. It's unlikely that a piece of the stone will break off. It might be wise for you to discuss the issue with a Urologist. Loren Barlow, MD | |
| Answered by Loren Barlow, MD, Internal Medicine, , (9/10/2003) | ||
| Q | I have been diagnosed with Raynauds Syndrome. Can you tell me of anything that I can do to slow down, or help this syndrome through diet, exercise, etc.? | |
| A | Simply stated, probably not much through diet or exercise. The main thing would be to try and keep your extremities warm under all circumstances. Avoid vasoconstrictive substances such as nicotine. For some people with Raynauds, vibration can also induce symptoms. If that's a problem for you, avoid it. If needed, there is medication which can be used (usually only in the most severe cases, though) to help minimize the symptoms. | |
| Answered by Frank Littell, MD, Hospitalist, Springfield, PeaceHealth Hospital Medicine (8/29/2003) | ||
| Q | How are white blood cells replenished? | |
| A | The white blood cells, of which there are 5 main types (neutrophils, eosinophils, basophils, monocytes, and lymphocytes), are central to immunity to infection. The first 4 types are constantly replenished by the bone marrow, where red blood cells and platelets are also made. Lymphocyte production is more complicated, and some of them emanate from lymph nodes. The spleen generally gobbles up old white blood cells after their short life span. The bone marrow is very capable of pumping out white blood cells unless is it diseased. Many treatments exist for low white blood cell counts (leukopenia). | |
| Answered at 8/27/2003 | ||
| Q | I have been taking levothyroxine for a few years now at the same dosage. I recently had a TSH level of 10.5 and my medication was increased. I had gone to an Urgent Care Clinic and the MD there just told me how much to increase the medication, and to follow up with my PCP in 6 weeks. I have never had any testing done (other than bloodwork) for my thyroid. I don't understand why there is a sudden increase in the TSH level. Do I assume that this is Hashimoto's thyroiditis or should I have further testing done (e.g. ultrasound etc)? Do I need to see a specialist or just follow up with my PCP who is an internist. | |
| A | This is a very common clinical issue. As one ages it is not unusual to slowly require more thyroid hormone replacement. There is an age-related decline in the small remaining thyroid hormone output from the thyroid gland. You do not need to see a specialist but you should see your personal physician within 2-3 months to recheck the TSH once again to confirm you are now on the correct dose. A yearly TSH test is reasonable for people on thyroid hormone replacement. | |
| Answered by Frank Littell, MD, Hospitalist, Springfield, PeaceHealth Hospital Medicine (8/25/2003) | ||
| Q | I have 3 compressed and/or fractured vertabrae after a fall from a horse. My Doctor mentioned the possibility of repairing the one in my upper back by "glueing". Could you possibily explain the procedure, and the pros/cons? | |
| A | For the pain of vertebral compression fractures, vertebroplasty and kyphoplasty are often effective surgical options. These procedures essentially 'splint' a fracture from within by using a bone cement that hardens within the fracture. To undergo these procedures, a patient would have: 1. continued intractable pain that interferes with the activities of daily living due to vertebral compression fracture. Therapy with analgesics and bracing is the first and often effective step at pain control 2. Images (either a bone scan confirming a recent fracture and a CT scan to be certain that there is no spinal narrowing or a MRI with STIR sequence to evaluate for the fracture and narrowing) 3. Absence of active infection or bleeding disorder Vertebroplasty does not regain vertebral body height, but is effective for pain control in over 80 % of patients, and requires only local anesthesia with sedation. This outpatient procedure requires 15-20 minutes, and is done by Pain Mangement Physicians and Radiologists here in Eugene. Kyphoplasty involves first inflating a balloon in the broken vertebral body, and then injecting the same cement as in vertebroplasty. The ability of this procedure to control pain is simular to vertebroplasty. The balloon inflation may help regain vertebral body height. Kyphoplasty requires general anesthesia, and is done by neurosurgeons here in Eugene. Drs Kokkino, Miller and McGirr. You can read about these procedures on Spine-Health.com at Kyphoplasty, Vertebroplasty . | |
| Answered by Christa Danielson, MD, Family Practice, Eugene, PHMG/FP-South (7/30/2003) | ||
| Q | What is a corneal ulcer? How do they treat it? How serious is it? I do not wear contacts. | |
| A | The cornea is the clear covering which is the actual front suface of the eyeball. A corneal ulcer is a sore on the cornea. It may be either infected or not infected. Corneal ulcers may occasionally be vision-threatening urgent problems. There are many different causes of corneal ulcers--use of contact lenses is a frequent cause. These ulcers are treated by first identifying the likely cause, then designing a treatment that usually consists of eye medications in eyedrop form. Anyone with a corneal ulcer needs treatment. Any contact lens wearer who develops a sore eye that does not resolve by removing the contact lens, should be evaluated by his/her eye doctor. | |
| Answered by David Deutch, MD, Ophthalmology, Eugene, PHMG/Ophth-Hilyard (7/10/2003) | ||
| Q | What are the symptoms of a mold allergy? Is rapid heart palpitation one of them? I am used to having heart palpitations once in a while, but for the past couple of months I have been having lots of them and they last a while. | |
| A | Palpitations, or irregular heart beats would be an unusual manifestation of mold allergy. Other, more common causes for this symptom should be evaluated and ruled out before considering mold exposures as a factor. Palpitations can be a sign of a serious medical condition and should be evaluated, especially if there has been a change in the frequency or severity. Mold allergy may cause symptoms that are similar to those caused by exposure to other allergens, such as dust mites or animal dander. A person allergic to molds may experience nasal congestion, runny nose, sneezing. If there is a history of asthma, cough, wheezing and shortness of breath may be noted as well. | |
| Answered by William Anderson, MD, Allergy & Immunology, Bellingham, Asthma & Allergy Center of Whatcom County (7/8/2003) | ||
| Q | My son, age 25, just moved to Eugene this week from Flagstaff, AZ. He is experiencing severe allergic reactions to the "outside" and can only be out 2 hrs without great difficulty in breathing. He's tried Claritan, Sudafed, Benedryl without relief. His landlord advised that Eugene has a "grass manufacturing" plant and that allergens normally at 40 are now 400! He's just graduated from college in Flagstaff and has only had mild allergies there. If you could make any recommendations re: treatment-- or a County Health Dept.-- it would be appreciated. | |
| A | We are the grass seed capital of the world. The Willamette Valley grows 90% of the grass seed for the country. The best thing he can do is leave the valley until after July 4th when the pollen counts will be nominal. Otherwise, we have inhalers for the lungs, nasal inhalers, oral non-sedating antihistamines, and eye drops. He needs to see a doctor and see how his symptoms can be best contolled by medications. If he plans on staying in the valley, he can expect this every May and June. | |
| Answered by Erin Reilly, MD, Urgent Care, Springfield, PHMG/Urgent - RiverBend (6/13/2003) | ||
| Q | Is there liquid oxygen available for out-patients? | |
| A | Liquid oxygen is available for patient's use at home by contacting one of the Durable Medical Equipment providers in the area, with a valid prescription. Some offer it, some don't. If you're in the Lane County area, try contacting Pneu-Med Inc. They have offered it to customers in the past. Good luck, let me know how this turns out! Anton Wade, CRT | |
| Answered at 6/4/2003 | ||
| Q | I'm a 35 year old female, 5'4", 112lbs and I'm concerned that I'm not consuming enough protein to keep up with my exercise routine. I take 4 Power Step classes (with hand weights) per week and weight train with free weights/machines for an hour 4x per week. I also have a Nordic Track ski machine that I use 2 days per week. I generally get home so late 3 nights per week that I eat a small bowl of multi grain cereal. I eat a can of tuna for lunch and plenty of fruits and veggies and water. I'm trying to build more muscle, so I know I need more protein. How can I get more into my diet? I'm concerned about the extra fat/calories/sugar/sodium in the protein bars on the market. What about the protein drinks? Any suggestions? I have to add that I do eat a regular dinner (chicken or fish plus veggies and pasta or rice or potato) three nights per week. I'm not trying to drop any weight but to gain muscle. | |
| A | The recommendation for protein is .8gms per kg. For you that would be 41 gms of protein per day. If you are training, to go up to l.0 would certainly be reasonable. The max would be 1.5gms/kg.-- the kind of training one might do for the Olympics or professional sports. Protein is found in most foods except fruit. The richest sources are milk( 8gms per 8 oz.), meat (7gms/oz), and egg (7gm each). Most portions of starch and vegetable are between 3-5gms per serving. I personally see real food as a better source of nutients than bars. You didn't mention milk but if you had two glasses of milk, 4-5 oz of meal/poultry and 6-8 servings of starch per day that would equal about 65 grams of protein per day. That is about 1.1gms of protein per kg. | |
| Answered at 5/20/2003 | ||
| Q | Recently in my left hand a hard lump that felt like bone formed under the skin. It was above the joint in my middle finger. It went away after a couple of weeks; however, now a small similar feeling bony lump has formed on my middle toe on my right foot. It is painless and not irritating me. I am concerned that it is gout or arthritis. | |
| A | If it is painless and not irritating, the chances of it being gout or arthritis are very low. Both of those conditions usually cause pain. Most commonly, it is a small cyst that can form around the tendons or joints, however (as with all masses or growths) if the size should increase or your symptoms worsen, it should be examined and an x-ray obtained for a complete evaluation | |
| Answered by Thomas Wuest, MD, Orthopedic Surgery, Eugene, Slocum Orthopedics (5/15/2003) | ||
| Q | What can you tell me about the dangers of the Atkin's diet- namely the drawbacks of long-term ketosis on body tissues and systems? | |
| A | Greetings. This information comes from a Physician's Advisory put out by the Physicians Committee for Responsible Medicine. . I will give you the exact paragraph in their paper, Adkins Diet Alert. "High protein, very-low-carbohydrate weight-loss diets are designed to induce ketosis, a state that also occurs in uncontrolled diabetes mellitus and starvation. When carbohydrate intake or utilization is insufficient to provide glucose to the cells that rely on it as an energy source, ketone bodies are formed from fatty acids. An increase in circulating ketones can disturb the body's acid-base balance, causing metabolic acidosis. Even mild acidosis can have potentially deleterious consequences over the long run, including hypophosphatemia, resorption of calcium from the bone, increased risk of osteoporosis, and an increased propensity to form kidney stones." The short answer is that the Adkins diet is usually a short term solution to a long term problem. Most folks have a hard time following it for more than 6 weeks. Dr Atkins does aim at the problem when he advises carbohydrate restriction. Many folks can certainly benefit by reducing carbs, but a reduction to 50% of the calories provides adequate nutrition and can be part of a long term nutrition and fitness plan. | |
| Answered at 5/1/2003 | ||
| Q | I was seen in the ER this week for pyelonephritis, and the doctor I saw said that I had an extremely elevated WBC count and was "pushing out immature WBC's." He told me the medical term but I can't remember what it was. Can you help? I'm a medical assisting teacher and would like to pass it on to my students. | |
| A | Any severe infection or inflammation can produce an elevated white blood cell count (leukocytosis). In the case of a bacterial infection, the white blood cells increased are the neutrophils (neutrophilia). If immature cells are being released from the bone marrow in a serious infection that is often termed a "left shift." If very early cells are found in the blood in significant numbers in a benign inflammatory state, the situation is sometimes called a "leukemoid reaction." The first early cells to emerge are "band" or "stab" cells and a "bandemia" is said to be present. I'm glad that you have recoverd sufficiently that you can be intellecutally curious about your infection! | |
| Answered at 4/7/2003 | ||
| Q | Information on Polycythemia vera? | |
| A | Polycythemia vera is an uncommon disorder in which the bone marrow makes too many blood cells, especially red blood cells. Too many platelets and white blood cells can also be produced. The blood becomes too thick because of the excessive red blood cells, and is prone to clot. The cornerstone of treatment is to take off blood (a blood donor amount each time) to get and keep the red cell amount at normal levels. Drug therapy is also useful. The major concern in diagnosis is to ensure that other conditions that increase the red blood cell count, especially lung and heart disease and other bone marrow disorders, are not mistaken for polycythemia vera. You can read about Polycythemia Vera on MEDLINEplus, the NLM consumer gateway. | |
| Answered at 3/25/2003 | ||
| Q | What does the differential mean in lab values? For instance, how would a high lymphocyte count be considered different when your overall white count is normal? | |
| A | The white blood cells (leukocytes) come in different types. The number and/or percentages of the various types is known as the differential white blood cell count or "differential." Typically, the automated blood counting machine determines a 5-part differential: neutrophils, lymphocytes, monocytes, eosinophils, basophils. Lymphocytes should, depending on age be no more than 50% of white cells, and number no more than 5000 per mm3 or uL. One of the first steps if the lymphocyte count is elevated is to have a pathologist review your blood smear. Many disorders cause increased lymphocytes, some of which go away in short order. Your physician will be able to sort these out or refer you to someone who can. | |
| Answered at 3/25/2003 | ||
| Q | What are the signs of a heart attack? | |
| A | Two points are critical in terms of the signs of a heart attack: first, the signs can be quite variable; secondly, time is critical to minimizing damage or disability and preventing loss of life. Most people experience some form of chest discomfort that does not go away on its own within 5 to 10 minutes. This discomfort can be severe pain or can be more subtle; most frequently it is described as a pressure or squeezing sensation, and it can radiate to the shoulders, the left arm or both arms, into the back, and/or up into the throat and jaw. Shortness of breath is also a frequent sign, and sometimes can be the only symptom. This happens more frequently with women than with men; symptoms are more likely to be less classic in women, and this contributes to a delay in treatment for women, both from women arriving at the emergency department later after symptom onset, and from a longer time to diagnosis in the emergency room. Other symptoms that can occur with chest pain or shortness of breath include nausea, sweating or lightheadedness. | |
| Answered by Peter Beglin, MD, Cardiology: Interven, Bellingham, PHMGW/NCC-Squalicum (3/13/2003) | ||
| Q | How does Vitamin C affect absorption of Iron? | |
| A | That is a very interesting question with a clear cut answer! Vitamin C increases absorption of iron by changing iron from the ferric state to the ferrous state (from a 3+ charge per atom to a 2+ charge per iron atom in a process called reduction by adding an electon). So taking a multivitamin or taking a Vitamin C tablet with an iron tablet (if iron therapy is recommended by your physician) will heighten iron uptake by the intestine. | |
| Answered at 3/12/2003 | ||
| Q | If my Triglyceride count is 264, what are the health risks? What is normal and how do I get back to normal? | |
| A | A fasting trigleceride level of 264 is mildly high. The risk of elevated triglycerides is poorly defined and much less than cholesterol elevation. At most your level implies a small increase in coronary artery disease. Triglycerides are elevated in diabetes, hypothyroidism, and some other disease, as well as with a number of drugs and with obesity. Assumming that the elevation is not secondary to some other disease or drugs, the best approach is diet and exercize. This also helps with cholesterol, which as noted, is more important. Limited alcohol (assuming that you do not have an alcohol problem!) in the form of one or two glasses of wine or equivilent may have some benefit. | |
| Answered by Burton Vanderbilt, Pathology:Anatm/Cln, Juneau, Bartlett Regional Hospital (3/5/2003) | ||
| Q | I was diagnosed with moderately severe osteoarthritis (3 cervical vertebrae) last month. What daily treatment/care is advised? I am taking glucosamine chondroitin and multivitamin each day--as I have been for years. I am doing special stretches for neck/shoulders. I am 58 years old and do ski mountaineering among other sports and am very healthy and fit otherwise. | |
| A | Be careful to avoid reinjury to your neck such as holding a phone between your shoulder and head (I use a headset), prolonged looking up or down, etc. Maintain range of motion gently of your neck daily. Speak to your doctor about the option and safety of anti-inflamatories for pain control. | |
| Answered by April M. Sakahara, MD, Physiatry, Bellingham, Physiatry Associates (2/26/2003) | ||
| Q | My fiancee has been put on Levaquin, one daily along with Proventil inhaler for pneumonia. After 24 hours she had a strong episode of vomiting and diarrhea. Is this an interaction event? | |
| A | Nausea, vomiting and diarrhea are not uncommon side effects in patients taking antibiotics in general. Nausea, vomiting and diarrhea are reported in 5 to 6% of patients taking levofloxacin. Sometimes the nausea can be minimized by taking the levofloxacin with a meal. The diarrhea can be treated with over the counter antidiarrheal medications like loperamide. Avoid taking levofloxacin with cations like iron, calcium or bismuth. | |
| Answered at 2/25/2003 | ||
| Q | I have taken a blood test that included a complement test to establish the level of inflamation in my blood. What is a low - normal - high range? | |
| A | You have asked a very interesting question. Complement is a family of 11 blood proteins involved in immunity and inflammation. The basic purpose of complement is to rupture and destroy bacteria that the immune system has coated with antibody. Activation of complement also causes inflammation, attracting white blood cells to the site of the injury or infection and producing leaky blood vesels and swelling. Complement is a complex topic over which medical students struggle before each exam and then forget until next time! Basically, a low complement level (also called total hemolytic complement or complement activity) is seen in people whose bodies are gobbling up complement because of diseases like rheumatoid arthritis, lupus, and kidney disease. Complement levels can be used to follow activity of these diseases (the lower the more active). Genetic deficiencies of complement can also cause low levels. High levels of complement are noted in infections, inflammations, and tumors generally. A high level is very non-specific and could be seen in anything from pneumonia to lymphoma. A low total complement level may prompt a doctor to order levels of specific complement proteins, typically C2, C3, C4, C5 or factor B. The exact normal ranges for complement will be listed on the lab report and vary from facility to facility. | |
| Answered at 2/21/2003 | ||
| Q | Can I contract HIV/AIDS through saliva? | |
| A | The short answer is no. It is very hard to prove that something never happens. Currently, the best answer is: HIV is transmissible through saliva only in the rare instance that the saliva has visible blood in it. What is really important is how much you pay attention to vanishingly low improbabilities. There has been lots of kissing among households of HIV patients, with only one documented transmission in a patient with bleeding gums. I have shared a beverage with an AIDS patient without worry. I hope that answers your question with the amount of uncertainty that you can tolerate. . | |
| Answered by John Wilson, MD, Infectious Disease, Eugene, The Travel Clinic (2/18/2003) | ||
| Q | What is the purpose of having an annual pap smear when you've already had your uterus, tubes and one ovary removed back in 1976? | |
| A | A pap smear is a screening test for cervical cancer. If your cervix has been removed (not always the case at the time of hysterectomy) then you could have pap smears less often, at the discretion of your physician. It is important however to have a pelvic exam annually to examine the vagina and remaining ovaries. You should also have a rectal exam annually if over age 40. | |
| Answered by Tina Schnapper, MD, Obstetrics/Gynecolog, Eugene, Women's Care (2/12/2003) | ||
| Q | I am considering taking Liptoprin for weight loss. Is it safe? I do have high blood pressure and Type 2 diabetes. I am desperate for help. | |
| A | Leptoprin, or Anorex, has many weight loss claims listed on their web site. It is not clear, however, what exactly this non-prescription supplement is, or how safe it is. A literature search of all recognized medical journals found no information on this supplement. This means that there exists no research on this supplement regarding not only its safety, but if it actually works. I believe the marketing of this supplement is another scam targeted at the desperate overweight community. Weight loss is a challenge for sure. The only weight loss plan that seems to work long term includes regular exercise and a lower fat balanced diet. | |
| Answered at 2/5/2003 | ||
| Q | My husband has a fracture in his foot. X-rays indicated the break yesterday on a visit to his doctor. The doctor said the fracture was caused by "avascular necrosis." What can you tell us about this condition and possible treatments? | |
| A | Avascular necrosis is a term used to describe the death of bone cells due to lack of blood supply. Avascular necrosis usually occurs following an injury/fracture that causes disruption of blood flow to all or part of a bone. The most common sites for avascular necrosis following trauma are: femoral neck (hip), scaphoid (wrist), capitellum (elbow) and the talus (hind foot). Avascular necrosis can also occur with certain metabolic conditions that restrict blood flow to extremities i.e. diabetes. In this case, fracture can occur with minimal or no trauma. Specific reccomendations regarding treatment/ prevention of additional injuries should be directed to your Orthopedic Surgeon. | |
| Answered by Andrew Boughal, DO, Orthopedic Surgery, Florence, PeaceHealth Medical Group - Siuslaw (1/29/2003) | ||
| Q | MY 26 year old son needs surgery on his sinuses for allergic fungal sinusitis. He has been told there is a 5 year waiting list at St Paul's in Vancouver. Do you have someone that could help him, and what is the estimated cost of such surgery. | |
| A | Your son should be evaluated by an ENT in your area -- Bellingham ENT 360-733-0640, or toll free 888 66-laser for Doctor. Please bring CT scans with you if available, and the appropriate recommendations should follow. We have a 2-3 week waiting period and the costs are not prohibitive. | |
| Answered at 1/22/2003 | ||
| Q | Two or three weeks ago our son received a blow to the outside of the ear during wrestling practice, causing swelling and fluid build up in the cartilage area of the ear. We have found one source describing this as "cauliflower ear". I was wondering if this needs immediate treatment, or if it can wait until the end of the wresling season. If he is seen now, can he still wrestle or should he be kept out for a few days? | |
| A | It should be evaluated right away, and may require aspiration and compression treatment. The ear may be permanently deformed and the wrestlers should always use headgear. | |
| Answered by Emil R. Hecht, MD, Otolaryngology, Bellingham, Bellingham Ear Nose & Throat (1/22/2003) | ||
| Q | When patients have Deep Vein Thrombosis , do the clots eventually resolve or do the veins stay blocked? | |
| A | The blocked vein, or veins, may recannalize (open up) partially with time if the length of the blocked vein is not very great. More likely, however, is the persistent obstruction of the vein, with development of alternative routes for blood to travel. This will lead to varying degrees of swelling of the limb affected. Depending on the severity of the presenting symptoms, intervention with potent clot dissolving drugs or various types of surgery may be reccommended. | |
| Answered by Robert Schauer, MD, Surgery: General, Springfield, Northwest Surgical Specialists (1/18/2003) | ||
| Q | How do you get Hepatitis C? | |
| A | Hepatitis C virus is transmitted most frequently by blood (for instance, transfusions before the blood was tested, needle sharing of street drugs, accidents affecting health care workers) and less frequently sexually (any gender to any gender) or at birth from mother to child. Transmission from surgeons to patients has been reported, but is very rare. | |
| Answered by John Wilson, MD, Infectious Disease, Eugene, The Travel Clinic (1/16/2003) | ||
| Q | What is the life expectancy of someone newly diagnoised with AIDS? | |
| A | With proper management and some luck, people with newly diagnosed HIV disease probably have close to a normal life span. | |
| Answered by John Wilson, MD, Infectious Disease, Eugene, The Travel Clinic (1/7/2003) | ||
| Q | What foods cause constipation? What foods are good to eat when constipated? | |
| A | The foods that cause constipation are difficult to list because of individual digestion. It is easier to list for you foods that help with digestion and constipation: fresh fruits, fresh vegetables (especially the cabbage family--broccoli, brussel sprouts, etc), high-fiber foods such as nuts, whole grain breads. Another easy way to get fiber is a bulking agent like Metamucil, Citrocel, Fiberall, Fibercon, etc. Also make sure you drink plenty of fluids, 6 to 8 glasses of fluids a day. This can be juices, soups, water, teas, lemonade etc. | |
| Answered by Glen Hoversten, MD, Surgery: General, , (12/13/2002) | ||
| Q | A friend is on chemotherapy for lung cancer and gets the chemo in his left arm. Ever since the first dose his left side feels cold, especially his left hand. To others, his hand feels warm. Could the chemo procedure cause this symptom? Is there some type of glove that might make the hand feel warmer? | |
| A | I was unable to find anything related to the drug itself that causes a sensation of cold, but evidently the solution itself, because it is room temperature and therefore about 27 degrees cooler than blood temperature, will produce a sensation of cold. Here are excerpts from patient information prior to receiving chemotherapy: >>There's nothing particularly painful about the treatment itself, which feels like any IV procedure. You usually don't feel the medications going inside you, though some patients do feel cold, if the fluids are run very fast or if they're cold to begin with, and if the patient's body is especially sensitive to cold. If you have any discomfort once the needle is inserted, tell your nurse. Patients often feel a cool feeling when the IV is started because the solutions tend to be room temperature and feel cold going into your warmer body.<< © SusanLoveMD.com. | |
| Answered at 12/12/2002 | ||
| Q | Is there some resource out there that would have a healthy diet for someone who has hemochromatosis -- as, foods good and bad, etc.. other than the "Low Iron" foods, that is? | |
| A | Here is a link to the American Hemochromatosis Society web page. This is a highly credible organization. I found this on their FAQ page: Q: Is there a special diet I should eat or foods I should avoid? A: Basically, iron in the diet is not going to make much difference in relation to your treatment, however, it is wise to check the labels of processed foods for their iron content. For instance, certain breakfast cereals contain 100% RDA of iron as do other products. Avoid alcohol and vitamin C which enhance iron absorption, cooking in cast iron cookware, and never take iron pills or supplements containing iron. Hemochromatosis patients should not eat raw seafood or shellfish (cooked is fine) due to a bacteria (vibrio vulnificus) which can kill the patient within hours of ingestion (due to a compromised liver which many HH patients have) unless emergency treatment of antibiotics (tetracycline) is administered. (Note: this can also happen to fishmen who handle and clean fish). Drink tea and coffee with your meals which will help block the iron in the foods you do eat. Hope this helps. The website has an array of interesting resources for further information. Another resource is the Hemochromatosis article in the Healthwise Knowledgebase on the PeaceHealth website. Check the Topic Overview and the Home Treatment section. | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (12/4/2002) | ||
| Q | I am 46 years old and was recently diagosed with hyperthyroid /Graves disease. I am very small framed and was losing a lot of weight, feeling tired, having an upset stomach and a lot of diarrhea. I am on some medication now and already feeling better. What can I expect to happen now and what is the time frame? | |
| A | The effect of antithyroid drugs occurs over 2 to 4 months. During that time the thyroid hormone levels often return to normal. The dose of medication may need to be decreased or increased, depending on the results of blood tests. After the thyroid hormone levels are normal patients can choose to continue on the medications, or consider radioactive iodine. Radioactive iodine is an excellent means to limit excessive thyroid hormone production. Often thyroid hormone replacement is necessary. Most patients have normal hormone levels and normal health lifelong. | |
| Answered by Matthew Davies, MD, Endocrinology, , (12/2/2002) | ||
| Q | What should I do for dehydration? | |
| A | Dehydration usually occurs with a gastrointestinal illness (vomiting and/or diarrhea), which generally resolves spontaneously. Other less common causes include diabetes, and kidney or hormone problems. The treatment of dehydration depends on the severity, and the underlying cause. The normal frequency of urination is about every 4 hours, and when it stretches to every 8 hours, thirst increases. At 12 plus hours between voiding, significant dehydration exists and will be associated with increasing lethargy. The usual treatment for dehydration is done with oral rehydration solutions. Water is appropriate for mild dehydration. Electrolyte solutions such as Pedialyte, Lytren and others are recommended for more significant dehydration. Small amounts given frequently is the way to help hydrate someone with vomiting. Rarely will this not work, and in those cases intravenous fluids are called for. Lastly, please note that it is rarely necessary or appropriate to use suppositories or other medicines such as Emetrol, Kaopectate, etc. Please write back if you have additional questions about this. | |
| Answered by David Miller, M.D., , , (10/28/2002) | ||
| Q | What are the pros and cons to having a breast reduction? Do insurance companies usually cover this surgery? | |
| A | This is a very complex question and will require a specific answer for your particular problems from a personal healthcare provider. However, I can give you a few pointers from my point of view. Usually a breast reduction is desired due to the medical conditions arising out of heavy breasts. These often are chronic back pain, posture difficulties, and other structural physical issues. The purely cosmetic indication that a woman does not like her large breasts is usually not accepted by many insurance companies. If you believe you have these medical issues due to heavy/large breasts, then you should find an experienced plastic surgeon to provide a consultation. They may tell you whether you are a candidate for this procedure. The pros for reduction are that the woman may have fewer back and other aches. However, sometimes there is no benefit for those complaints. The cons are that it is a big operation, with scars that cross the underside of the breasts and surround both nipples. Healing takes some time, and repeat "revision" type surgery may be necessary. This certainly is an individual decision which should be weighed very carefully with plenty of medical advice | |
| Answered by Cary S. Kaufman, MD, Surgery: General, Bellingham, Bellingham Breast Ctr (10/28/2002) | ||
| Q | What causes a UTI in women? | |
| A | There are many causes of bladder infections. In women, the close proximity of the urethra to the vaginal opening increases the risk of infection. If you have frequent infections you should contact your primary care provider. | |
| Answered by Randall S. Lewis, MD, Obstetrics/Gynecolog, Eugene, PHMG/OBGYN-Hilyard (10/8/2002) | ||
| Q | My son is four years old and he is very active. I have been asked a few times in the past year if he has been tested for ADD or ADHD. I ignored it for a while because he never really acted like the typical ADD or ADHD kids do. Now I am noticing a lot of tension and uncooperativeness in him along with other symptoms. What should I be looking for and how can I tell the doctor what I am seeing without sounding like I don't know anything? Should I be worried about something like this and are there any other measures I could take without having to put him on medication? | |
| A | Express your concerns to your child's doctor the same way you expressed them in your note to me, and he/she will be able to help you. You are already two jumps and a conclusion ahead when you talk about medicines. Most behavioral problems are not ADHD and most do not require medications. On the other hand, I would not delay. I recommend you set up a visit to your child's physician now. Most behavior problems do not get better on their own, but many do respond to simple interventions. For some background information on child development you might look at Healthwise, on the PeaceHealth website, at Growth and Development, 2 to 5 Years. | |
| Answered by Bruce Strimling, MD, Pediatrics, Eugene, Oregon Medical Group (10/2/2002) | ||
| Q | My mother has recently been diagnosed with lung cancer. She has has a CT Scan, MRI, Bone Scan, PET Scan and now is scheduled for a quantitative lung function test. Her pulmonary specialist said it is done by injecting radioactive fluid into her veins and then having a scan. Can you please explain how the test is done and what information it provides the doctor? | |
| A | A quantitative lung scan is a test done in Nuclear Medicine. Your mother will be injected in an arm vein with a low dose of radioactive tracer. The tracer will be taken up in the lungs and a nuclear camera will record the activity -- the lungs can be divided so that the relative amount of blood flow to each lobe can be estimated. The test helps to predict how much lung function is present in each lobe of the lung. This knowledge will help your mother's doctors decide if she is a candidate for surgery. The tracer in the lung decays quickly, and is nearly gone within twenty four hours. | |
| Answered by Jon Ekstrom, MD, Radiology: Diagnosti, Springfield, Radiology Associates, PC (8/4/2002) | ||
| Q | An 84 year old female friend is in a Sacred Heart unit getting assistance. She seems pretty alert, but is speaking in gobblygook. What can I do to be supportive of her recovery process? Specific suggestions would be appreciated. | |
| A | It sounds as though she may have had a stroke affecting the speech area of the brain. You are right that she can be very alert and bright and have a communication deficit which does not affect intelligence. You should talk with the speech therapist to learn techniqes to be supportive. Sometimes gestures or printed words or pictures work well. Most important is to remember that she is still "there" and probably very frustrated at the change in her ability to communicate. Her gobblygook may sound normal to her in which case safety is an issue and you need to speak to her physician and the speech therapist. | |
| Answered by Martha MacRitchie, MD, Phys Med & Rehab, Eugene, Martha MacRitchie MD (7/30/2002) | ||
| Q | I have had blood in my stool the last few times I have used the bathroom. I am on coumadin. Is this anything to worry about? | |
| A | There are many harmless reasons why blood can show up in the stool. Examples include local skin irritation, hemorrhoids and small fissures. On the other hand the presence of blood in the stool can be indicators of far more serious conditions including ulcerations,polyps, cancer, vascular abnormalities and diverticula. Please check in with your doctor about this ASAP. This is all the more important because you are on coumadin, and if significant bleeding was to occur, it would be all the more difficult to treat. | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (7/24/2002) | ||
| Q | My Mother is to have a PET scan. I am unable to find information on what the PET scan is, how it is administered, risks, etc. She has been diagnosed with lung cancer (bronchial alveoli cell cancer), with surgery expected soon. | |
| A | A PET scan stands for positron emission tomography. It is a highly sophisticated scan with excellent utility in cancer diagnosis, especially lung, colon, lymphoma and melanoma cancers. The scan entails intravenous injection of a small amount of radioactive glucose (sugar) metabolite. The half-life of this is 2 hours so it is completely gone within 10 hours of injection. Tumor cells have increased glucose metabolism. The radio-tracer highlights areas of this increased metabolic activity. The scan is performed about 45-60 minutes after injection with the total body scan taking about one hour. There are no contraindications or side affects. The PET scan is the best way to determine the extent of the disease (stage) and may help determine the most appropriate treatment. | |
| Answered by Jon Ekstrom, MD, Radiology: Diagnosti, Springfield, Radiology Associates, PC (7/19/2002) | ||
| Q | I have had hematuria the last 3 years off and on. I go to a Kaiser physician and they tell me this is normal. I have a history of bladder and kidney infections. Two years ago I was told I had a slight right hydronephrosis. What does this mean? | |
| A | It is true that a small amount of hematuria can be normal for some people. To feel comfortable saying that this is the case for you I would want to have had a couple of tests that you may have had; specifically a CT of the kidneys or an intravenous pyelogram----which is a series of x-rays of the kidneys after an injection of dye into the bloodstream----and possibly a cystoscopy---a test in which a small scope is placed inside the bladder to inspect the inner lining. Hydronephrosis is an enlargement of the collecting system within the kidney usually due to the back up of urine into the kidney as a result of a blockage down the ureter. To find some general information about urologic topics try the consumer health site of the National Library of Medicine, about Kidney Diseases. There's also a dictionary of terms you may find useful. | |
| Answered by Arthur Willey, MD, Family Practice, Junction City, Junction City Medical Clinic (7/18/2002) | ||
| Q | What are ALT levels and how dangerous are they? What are just some of the things that could make your levels go up? | |
| A | Good question. A high level of ALT (alanine aminotransferase) is not in any way harmful in and of itself. It is not toxic to you and is a natural body chemical. Rather, high ALT is a sign of injury to an organ, almost always the liver. ALT is an enzyme (a protein that the body naturally makes to help chemical reactions take place) that usually stays in liver cells. When liver cells get damaged, ALT gets released. In severe liver injury, ALT levels can go up to 20,000 or more! Besides the liver, problems with muscles or kidneys can occasionally increase ALT levels. Generally, the first thing to do if an unexpected lab abnormality is detected is to repeat the test. If the ALT level remain elevated and no explanation is readily apparent to your physician, then your physician will generally review your medications to see if any could be damaging the liver. Also, the Centers for Disease Control and Prevention recommend testing for hepatitis C in anyone with an unexpected elevation of ALT. In short, an increased ALT is not a reason for panic and may be nothing serious, but it does warrant follow up by you and your doctor. | |
| Answered at 6/17/2002 | ||
| Q | Can you please tell me about "Fifth Disease"? | |
| A | Fifth Disease is usually a mild illness caused by Parvovirus B19. Another name for the the disease is Erythema Infectiosum. The most distinctive feature of the illness is a rash which starts as bright red cheeks, and then spreads down the body, arms and legs in a lace-like pattern. There may be a mild fever, headache, or achiness before the rash appears. Some people, especially adults, also develop joint pain or swelling. The rash can recur for months after the initial illness. For most people, the illness is very mild. For a few people, the illness can be much more serious. The infection can cause severe anemia in people who have disorders of their red blood cells, such as sickle cell anemia or thalassemia. If a pregnant mother becomes infected, the fetus can also develop severe anemia. | |
| Answered by Lauren Herbert, MD, Pediatrics, Springfield, PHMG/PED-RiverBend (6/12/2002) | ||
| Q | My son, age 15, has gall bladder disease. His gall bladder will be removed. I can't find any information about gall bladder disease in kids. Can you direct me? | |
| A | Gall bladder disease is very unusual in teens. Therefore not much is written for the lay public because there is not much of an audience for the material. Very often young adults with gallbladder disease have a predisposing or underlying cause. I’m sure your doctor has investigated this. You don’t mention whether your son has gallstones or not. The causes for gallbladder disease with, versus without, gallstones are distinctly different. You can read about gallbladder disease in any standard textbook of pediatrics. I recommend Nelson's Textbook of Pediatrics. The section is very readable and not too technical. You will find a copy in the library of your hospital or can borrow it from almost any pediatrician. Gallbladder disease is generally cured by surgical removal. If there is an underlying cause, it will have to be addressed also. | |
| Answered by Bruce Strimling, MD, Pediatrics, Eugene, Oregon Medical Group (5/29/2002) | ||
| Q | What is hypoxia? | |
| A | Hypoxia means that the amount of oxygen is too low. The word is used usually to refer to the brain not getting enough oxygen. | |
| Answered by Arthur Willey, MD, Family Practice, Junction City, Junction City Medical Clinic (5/28/2002) | ||
| Q | My son has been diagnosed with phimosis, where the opening at the end of his foreskin is very small and his foreskin cannot be retracted. We've had a couple instances of discomfort, though most of the time everything seems fine. When visiting a urologist, circumcision was recommended as a good way to correct the problem. I'd like to avoid general anesthetic and post-operative trauma for my son if possible. During my searches of the Internet, I ran across this article in the journal for the American Academy of Pediatrics: Cost-effective Treatment of Phimosis Essentially, it recommends the use of topical betamethasone 0.05% cream for 4 to 6 weeks. I've yet to hear any doctor I've seen recommend this. I was interested in a second opinion, and hope you could provide some thoughts on the matter. | |
| A | Phimosis is a fairly common problem afflicting the uncircumcised penis of boys, and it can produce varying degrees of difficulties for boys so afflcited. Sometimes the foreskin is merely tethered to the underlying glans penis, and sometime the opening is so narrow that boys can get recurring episodes of infections. The latter is a "true" phimosis, the former will resolve itself. It sounds as though your son's problem was detected on routine exam, and if it has not caused any difficulties for him, then I generally recommend waiting, since the foreskin will often dilate spontaneously during puberty when accelerated penile growth occurs. You do not mention how old your son is, but if he is prepubertal, then this is definitely an option. If you observe the foreskin "ballooning" as he urinates, however, then this is an indicator of more severe phimosis and treatment is indicated. Recurring infections are also an indication for treatment. Topical steroid therapy is not new, and I have used topical Mycolog Cream with success. (I prefer having the antifungal in Mycolog, since betamethasone by itself can predispose to yeast infections. I read the research article you cite with interest. The weakness of the study is short followup. Almost certainly in the cohort that responds to topical steroids there will be relapses, and we are then left with the expense of both steroids and surgery. One is also cautioned not to overuse steroids, since steroid atrophy, a marked thinning of penile skin, may cause problems of its own. However, your concerns about surgery and anesthesia are well-placed, and in your son's case I think that a conservative approach is warranted. | |
| Answered by Roger M. McKimmy, MD, Urology, Springfield, Oregon Urology Institute (5/20/2002) | ||
| Q | What is normal blood sugar level? How much can blood sugar vary from normal before one should be concerned? | |
| A | The normal fasting value for a lab blood glucose (BG) value is 70-109. However, even a fasting BG over 100 can indicate as higher risk of cardiovascular disease. Even mild elevations in BG are of concern, as it it reflective of insulin resistance, or a pre-diabetic state. This means that without some changes in lifestyle, there is a significantly higher chance of having a stroke or heart attack, and developing diabetes. If you have a mildly elevated glucose level, take it seriously! It is a call for change. Consider asking your doctor to send you to an endocrinologist, diabetes specialist, or registered dietitian to get a good start on a healthy future! | |
| Answered at 5/15/2002 | ||
| Q | My grandchild has been diagnosed with "roto virus". I have never heard of this before. What is it? | |
| A | This is the name of a virus that causes a "stomach flu" type of illness. It is one of the most common causes of chilhood vomiting and diarrhea from an infection. It tends to "go around" in the late winter. It seems to take 1-2 weeks to completely resolve and sometimes causes dehydration. It is EXTREMELY contagious--watch out! | |
| Answered by Elizabeth Heskett, MD, Pediatrics, Springfield, PHMG/PED-RB Night (5/14/2002) | ||
| Q | This is embarrassing, but I must ask. I am a 54 yr. old male. The last few years I have been getting a little bit of a breast, suddenly in the last six months I have boobs. Is there anything that I can do for this. Bench presses? Diet? | |
| A | Gynecomastia is the technical term for what you are describing. Gynecomastia has multiple possible causes including obesity, testosterone (male hormone) deficiency, prolactin excess ect. This condition should be evaluated by your primary care physician as it may be signal of a hormone problem. He or she may wish to refer your care to an Endocrinology physician for further evaluation. | |
| Answered by Matthew Davies, MD, Endocrinology, , (5/10/2002) | ||
| Q | My daughter was diagnosed with scoliosis. It is at a 65 degree angle, and the doctor suggested surgery. It is "S' shape. She is 15. She has a deep dimple on the left and her side bothers her when she walks a lot. | |
| A | Your daughter apparently has an advanced idiopathic scoliosis curve. Conservative treatment (exercise, bracing) will not improve the deformity and may NOT prevent continued progression of the curve. Evaluation and treatment by a pediatric spine surgeon is mandatory to prevent long term cosmetic and functional disability. To learn more about this condition try reading Scoliosis at the American Association of Orthopaedic Surgeons web site. | |
| Answered by Andrew Boughal, DO, Orthopedic Surgery, Florence, PeaceHealth Medical Group - Siuslaw (5/10/2002) | ||
| Q | What is a pilonoidal sinus? The pediatrician who checked my healthy new- born grandson last week found this, and suggested an MRI. We would like more information on what it is, and what the effect of this sinus might be in the future. | |
| A | I believe your grandson's doctor was referring to a dermal sinus. It looks like a very deep dimple or pit behind the anus that you can't see the bottom of. It may be attached to the baby's tailbone. There may be an open channel there that can get infected and may be connected to the baby's spinal canal. If it is connected, it could cause what we call a "tethered cord", meaning that it causes traction, or pulling on the spinal cord as the baby grows. Or it could allow infection to spread to the spinal canal, even cause meningitis. The pediatrician is recommending an MRI to see how deep the pit is, or if it is a true sinus, or channel to the spinal canal. If it is attached to the spinal canal, it would require surgery to avoid the potential complications I mentioned. If it isn't very deep, the doctor would likely just watch it. A pilonidal sinus is actually another type of pit in the same area that is acquired, or develops over time. It can get obstructed, causing an abscess, or cyst. Then, if it gets infected, it is really painful and requires drainage or excision (removal). If not infected, it requires no treatment. | |
| Answered by Tamara Barstow, MD, Pediatrics, Eugene, PHMG/PED-Barger (5/2/2002) | ||
| Q | What is a Chalazion and is there any way to treat it rather than debridement? | |
| A | A chalazion is an inflammatory reaction in the eyelid in which the body reacts to the meibomian oils in the oil glands of the eyelid. It can sometimes be treated successfully with hot compresses (20 minutes 4-6 times a day). Some people have had some success with flaxseed oil or cod liver oil taken orally. | |
| Answered by Richard Hoffman, MD, Ophthalmology, Eugene, Drs. Fine, Hoffman & Packer, LLC (4/16/2002) | ||
| Q | What is an ischemic bowel? | |
| A | Ischemic bowel means that the intestine is not getting enough blood supply. There can be acute and chronic types. Acute type is caused by an abrupt interruption of the blood supply to a portion of the intestine. This type can be from a blood clot blocking a major blood vessel to the intestine or from surgical interruption of a part of the blood supply. This most often happens after aortic surgery. Acute occlusions oten require emergency surgery to correct the problem and save as much intestine as possible. The acute type is a very serious problem. The chronic type is caused by a narrowing of the blood supply from atherosclerosis( just as for arteries of the heart or legs vessels). This can cause nonspecific symptoms which are often related to eating, which markedly increases the blood supply requirements of the intestine. The chronic type is not emergent unless the compromised vessel suddenly occludes. This type can be corrected with elective surgery and is treated with a bypass, just as for other types of blocked blood vessels. | |
| Answered by Glen Hoversten, MD, Surgery: General, , (4/16/2002) | ||
| Q | May I please have some basic, general information on degenerative disc disease? | |
| A | The term "degenerative disc disease" refers to deterioration of the disc space between vertebra as a result of aging. Arthritic changes are also usually seen involving the posterior facet joints of the spine. Degenerative dics disease usually occurs in the lumbar spine. Your doctor may prescribe an anti-inflamatory agent for the arthritis. Exercises for toning and stretching are also useful. For general information see the short articles on Degenerative Disk Diseases at MedlinePlus/Herniated Disk | |
| Answered by Andrew Boughal, DO, Orthopedic Surgery, Florence, PeaceHealth Medical Group - Siuslaw (3/28/2002) | ||
| Q | What causes my eye to twitch? It is my left eye. It twitches so badly that I have to hold my finger on the eye lid. I have noticed some electric shock in my left toes. Any relation? | |
| A | This sounds like benign blepharospasm. It is quite common and of no consequence. Sometimes it is associated with stress, eyelid infections (blepharitis), or eye strain, but not always. There is no specific treatment but it usually resolves within a few days. It is unlikely related to shock-like sensations in the toes. For general information about the condition see the BEBRF Blepharospasm Pages | |
| Answered by Frank Littell, MD, Hospitalist, Springfield, PeaceHealth Hospital Medicine (3/15/2002) | ||
| Q | I have found out recently, that I have Fibromyalgia. I would like to find a Doctor in the Eugene area that agressivly treats this problem. I live in a very rural area and have not had much support or offer of any kind of treatments from doctors here. Any help or name of a Doctor would be a help! I did ask my current doc. for a referral name. It was pretty much shrugged off. | |
| A | The specialty that focuses on the diagnosis and treatment of fibromyalgia is rheumatology. Here's a link to our Physician directory. Simply search on arthritis for your location and it will give you a list of these specialists. Good luck with this tough problem | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (3/8/2002) | ||
| Q | I am experiencing problems with my gall bladder and am nutritionally ingorant. I know I eat too many carbohydrates but I need to know what a 40 year old female who is overweight should be eating. Do you have a publication available that outlines what a healthy balance of fat, saturated fat, carbohydrates, etc. is? | |
| A | I'm not sure what to do about your gall bladder, that is in the realm of medicine and I am a dietician. I do know about a healthy balance of nutrients. Most folks can manage quite nicely with about 50% carbohydrate and 25-30% fat. The saturated fat level should be less than 10% but probably not less than 7%. The Mediterranean diet seems to be a healthy approach to eating. It encourages fish, vegetables, fruit and starches but limits fatty meats and high fat dairy. The fat of choice is olive oil. Most of us do best if we exercise daily and cut calories by 200-300 per day if we wish to lose weight. Increasing exercise is seen as better than cutting calories. Most overweight women of average height should probably have more than 1200 calories, but no more than 1600 calories. Good educational materials are available in libraries or on Internet sites like the American Medical Association's Delicious Decisions | |
| Answered at 2/8/2002 | ||
| Q | My 6 and a half month old son has not had a bowel movement for 7 days, though he's eating, passing gas, and urinating regularly. He is breastfeeding only. I have not introduced any solids at this point. He seems in very good spirits (happy, laughing, vocalizing), is very active (cut first tooth a week ago, sitting up on his own, pulling to stand in crib, scooting, rolling, semi-crawling, happily into everything), has no fever, no signs of dehydration or illness, but this is the longest he's gone without a BM. Should I be concerned? Are there any warning signs I need to watch for? | |
| A | While most exclusively breast fed children at six months can be expected to have a bowel movement at least every 3 to 5 days, a child may occasionally go longer. As long as he is acting well with good appetite and no grunting, straining, or fussiness, there is no reason to worry. At about 7 to 10 days I get a bit concerned just because of the unusualness of the time involved and usually recommend an infant glycerine suppository. In my experience the children have invariably pooped and gone on to be fine. The record in my practice has been 15 days. Seven days without stool in a newborn or in an infant on a broad diet has an entirely different significance. | |
| Answered by Bruce Strimling, MD, Pediatrics, Eugene, Oregon Medical Group (1/29/2002) | ||
| Q | My son has had bowel movements in his pants since he was 3. He never goes to the bathroom to do this; it is always in his pants. But he does not do this at school. His doctor seems to think that it is a control issue. | |
| A | The problem of soiling is called encopresis. It is really quite common and is understandably not often talked about. This can usually be dealt with and resolved, but absolutely requires multiple exams/counseling with the pediatrician. Sometimes xrays are done,and various bowel cleanout programs are prescribed. You can read about encopresis at Stool Soiling in Children on Family Doctor. | |
| Answered by David Miller, M.D., , , (1/29/2002) | ||
| Q | What are the symptoms of fiberglass exposure? I've been reading about indoor air quality. We have flu-like symptoms a lot, and I heard that could be the cause of it. | |
| A | There have been two good studies on workers exposed to fiberglass, and there does not appear to be any correlation between fiberglas exposure and lung disease. It does not cause any long term effect, as one might see with asbestos. However, if someone is exposed to any foreign agent, that person could possibly have "asthma-like" symptoms although there is no proof that fiberglass inhalation can cause asthma. If your symptoms persist, it may be best to be seen by your physician, as symptoms that one may have may be due to other causes. | |
| Answered by Michael McNellis, MD, Pulmonology, Longview, PeaceHealth Medical Group - Specialty Medicine (1/29/2002) | ||
| Q | I have had stuffy sinuses since childhood. For years I was taking Chlortrimeton, and I finally stopped taking it as a teenager because it made no appreciable difference. Now I am 51 and my nasal passages are clogged at least half of the time. This causes me to snore at night as well. What can I do? | |
| A | You probably have rhinitis which is inflammation of the mucous membrane lining the inside of the nose. It is associated with any combination of the following symptoms: nasal congestion, runny nose, facial/sinus pressure, sneezing, itching. Most who have rhinitis have allergic rhinitis, the most familiar being hayfever, or seasonal allergic rhinitis. For those with symptoms all year round, perennial allergic rhinitis may be the problem. Exposure to certain allergens such as dust mites, mold or animal dander can lead to inflammation within the lining of the nose, and cause rhinitis. For perennial allergic rhinitis, many do not experience the sneezing and itching that are common in seasonal allergy. There may not even be any hint of "allergic reactivity". Another form of rhinitis is nonallergic rhinitis that may lead to symptons similar to allergic rhinitis, but are not due to exposure to allergens. The cause is unknown but this is treated the same as allergic rhinitis. Allergy skin tests can help determine if symptoms are due to allergy, and identify an individual's specific sensitivity. Treatment usually involves reducing exposure to allergens and using medications. Prescription anti-inflammatory nasal sprays are usually effective in reducing symptoms of rhintis. Antihistamines may be helpful in some individuals but this group of medications is typically not effective in reducing nasal congestion. Sometimes, just nasal saline (salt spray) that can be purchased over the counter is helpful in alleviating symptoms of nasal congestion. If symptoms persist, or worsen then evaluation should be performed to ensure that one does not have a sinus infection or nasal polyps, or other causes of nasal congestion. | |
| Answered by William Anderson, MD, Allergy & Immunology, Bellingham, Asthma & Allergy Center of Whatcom County (1/29/2002) | ||
| Q | I am wondering if Sacred Heart offers a weight loss program that would be regulated by and through a program located within the Hopital. I have heard of such a program in the past but have been unable to locate any information. I would be very interested in this avenue to lose weight in the safest way possiblle. | |
| A | Yes, there is such a program. It is called Weigh To Wellness and is a series of group classes lasting about 10 weeks. For more information please call (541) 222-1964 or Click here | |
| Answered at 1/29/2002 | ||
| Q | From time-to-time, my right testicle "ascends". The height varies. Sometimes during intercourse, at orgasm, it feels as though it has been lifted out of the scrotum and tucked up into the abdominal area -- not painful exactly, but definitely uncomfortable, achy. It also happens at other times, or at least has a similar achy feeling - driving/sitting, can happen standing/walking. When I was about 26-27, I was wrestling and strained myself so hard that I remember feeling that I had injured my right testicle. But the soreness went away and I never followed up on it. Ever since then though, the right testicle has always hung noticably higher than the left | |
| A | This problem, sometimes called "retractile testicles," is found commonly in young boys and is present to some degree in nearly all men. The testicle is suspended in the scrotum by the spermatic cord, which has a muscle called the cremaster muscle. The function of this muscle is to adjust the height of the testicle below the body to the optimal temperature for sperm production. (The ideal temperature for the manufacture of sperm is three degrees lower than body temperature, which is why the testicle hangs below the body in the scrotum.) In some individuals, the cremasteric reflex is more active, and can actually pull the testicle up into the inguinal canal. If this is abrupt, it can be uncomfortable and even painful. In most men, one testicle will rest in a position higher than the other. A prior injury can increase this discrepancy. The problem is not harmful, and most urologists encourage a conservative approach to the problem. If it becomes severely uncomfortable, an operation can be done to strip the cremaster muscle away from the spermatic cord, but this is rarely necessary. | |
| Answered by Roger M. McKimmy, MD, Urology, Springfield, Oregon Urology Institute (1/9/2002) | ||
| Q | How does the body use food? What are the different kinds of nutrients needed to stay healthy? Why is nutrition so important? | |
| A | I did not answer this question initially because it seemed so complicated. Your questions are great but probably require a nutrition text to answer completely. You might start with Jane Brody's Nutrition Book/Cookbook which you should find at the public library. An interesting web site you might try is NUTRITION.GOV Our body is a complicated machine that requires many nutrients to complete its many functions. Appropriate amounts of vitamins, minerals and fuel allow it to do its best work. Excesses and deficits keep it from working efficiently. One example is that extra fuel(food) combined with too little activity and genes for diabetes allow the body to begin the 5-10 year journey towards diabetes. During the process the body ceases to work as effectively and risks for coronary artery disease and stroke increase. Taking good care of the machine (body) helps it to do its best work and avoid some health problems. | |
| Answered at 1/9/2002 | ||
| Q | I want to know about the neonatal heart beat. While still in the womb, which baby has the faster heart beat, a girl or a boy? | |
| A | Usually the answer is that a boy has a slower heart rate and a girl a faster one. This of course is not very accurate, but can be fun when trying to guess the baby's gender. | |
| Answered at 12/14/2001 | ||
| Q | My 2-year old daughter has mild asthma treated with one puff Flovent daily. She was recently accepted into a desirable preschool but I learned that the teachers (husband/wife in their home)have 2 cats in the house which sometimes visit the kids. I've heard that kids with asthma should not be around cats. Is this true? Will 2-3 times per week for 3-4 hours each at this location influence her asthma? What are your thoughts? | |
| A | There is no absolute answer I can give you, but, my strong recommendation would be to keep your young daughter away from cats as much as possible. Why put her in (potential) harm's way? Cat exposure is one of the major causes for allergic inflammation leading to the development of chronic asthma. Few 2 year olds demonstrate clinical allergy, but many are at high risk. If there is ANY history of allergy in mommy or daddy (not just to cats) then the exposure risk, in my estimation, is really too high. Several hours a day for several days a week is a lot; studies show that allergic peoples' lungs can show increased reactivity for up to several weeks after a single point of exposure, so ongoing exposures are even worse. More importantly, try to keep her in a daycare setting where there are only a few (less than 3-4) other kiddos. That will decrease her chances of always catching the "virus of the week", which are the main immediate triggers for asthma episodes. | |
| Answered by David Elkayam, MD, Allergy & Immunology, Bellingham, Bellingham Asthma Allergy & Immunology Clinic (12/11/2001) | ||
| Q | I am a 47 year-old male. I consider myself to be in good health but of late have experienced an unusual problem. I have discovered a brownish red discoloration in my ejaculation/seminal fluid. I assume it is blood but am not certain. I waited two days and had similar but less discoloration in a second ejaculation. I had a vasectomy more than 10 years ago but never experienced any related problems. I do not have problems urinating, frequent urination, or noticeable discoloration in my urine. I plan to schedule an exam with my local physician but would appreciate your input as what I might expect. | |
| A | This is indeed very small amounts of blood in your ejaculate - it's called hematospermia and it quite understandably causes anxiety in otherwise healthy young men. We see men with this fairly regularly in our office, and the happy news is that it is very rarely, if ever, associated with any problem. Hematospermia has been studied very thoroughly, and there simply has not been any disease states associated with it. There simply seems to have been spontaneous rupture of capillaries or blood vessels in the prostate or seminal vesicles, and since it can take weeks for the seminal vesicles to empty completely, the discoloration can persist for a long time. Sometimes men are reluctant to acccept that there is not a hidden problem, but urologic textbooks repeatedly say that no investigation is warranted, so you can relax - it should clear up in a month or two. If it persists longer than that, then a visit to your doctor would be worthwhile. At the age of 47, you are nearing the age where yearly rectal examinations and PSA blood tests are a good idea, particularly if you have a family history of prostate problems. Again, though, the blood in your ejaculate is anxiety provoking, but it does not need to be pursued and should go away. Here's a site where you can read about Hematospermia. | |
| Answered by Roger M. McKimmy, MD, Urology, Springfield, Oregon Urology Institute (11/17/2001) | ||
| Q | Can you provide sources for the latest research into Ulcerative Colitis? | |
| A | The best place for information is the National Library of Medicine's consumer web site called MEDLINEplus.Ulcerative Colitis. This page provides links to articles from major organizations dealing with Ulcerative Colitis, and at the left there is a link to "Search MEDLINE for recent research articles." You can scan citations in recent medical journals to find new research. There is also a web page from the Crohn's and Colitis Foundation of America, which offers a free Research Newsletter on request. The other place to check is with the PeaceHealth community service Health Information Library, which provides Reference services as well as a lending library. Another local resource is to make an appointment with one of the gastroenterologists in the community. I hope this helps. | |
| Answered by Glen Hoversten, MD, Surgery: General, , (10/29/2001) | ||
| Q | What are the pros and cons of surgery for "trigger finger"? | |
| A | "Trigger Finger" is the result of an inflamatory condition affecting the "pulley" system in the fingers/thumb. This "disease" is at times painful and the catching can certainly be an annoyance but does NOT cause any permanent damage. If symptoms of pain, catching and locking do not respond to conservative care then a simple surgical proceedure can be done to relieve the problem. This proceedure is usually done under a local anesthesia and generally takes 10-20 minutes to complete. The risks of surgery include: infection, scar formation as well as possible injury to the digital nerve to the involved finger or thumb. | |
| Answered by Andrew Boughal, DO, Orthopedic Surgery, Florence, PeaceHealth Medical Group - Siuslaw (10/25/2001) | ||
| Q | I have an 8 month old child who is not interested in eating solids! I have tried several things: cereal, veggies and fruits, nothing seems to strike her fancy. She is still breastfeeding, occasional soy formula supplement and is gaining weight (although, slowly). Any suggestions or should I be concerned? | |
| A | There is no reason for worry as long as your child is growing and developing normally. Although most Pediatricians recommend starting solid foods at 6 months, there is no evidence that children require any foods other than breast milk before 9 months of age. In fact, prior to the 1920s children in this country routinely started solids on their first birthday. When the time comes that you want to insist your child start solids you merely have to cut back on the breast feeding and hunger will solve your problem. However in order to limit breast feeding you will have to go from demand feeding to some sort of nursing schedule. Discuss this with your pediatrician. He or she can assure you that your child is healthy and can further advise you regarding this eating problem | |
| Answered by Bruce Strimling, MD, Pediatrics, Eugene, Oregon Medical Group (10/4/2001) | ||
| Q | How can I remove earwax that has clogged my ear? | |
| A | First and foremost, GENTLY! I recommend the over the counter products Debrox, Cerumenex or similar. It is helpful to get the ones packaged with a bulb syringe to gently irrigate the ear with warm water once the product has softened up the wax, which sometimes can take a few days of regular use of the drops. Follow the directions! The ear is meant to be a waxy/oily environment, and these products are oil based, working much better to establish normal wax "flow" than hydrogen peroxide or water. And cotton swabs (e.g. Q-tips) are to be avoided in the ear, as they tend to "pack the wax" into the canal! If this doesn't work, see your primary care doctor for a more vigorous removal, but that shouldn't be necessary. | |
| Answered by Nick Gideonse, MD, Family Practice, Portland, Oregon Health Science University (9/20/2001) | ||
| Q | Years ago I obtained a copy of a diet for quick weight loss prior to heart surgery from Sacred Heart Hospital. Has this diet been updated? Could you please E-mail me a copy? (the diet contained a recipe for cabbage soup). | |
| A | The Sacred Heart Diet is a great urban myth. The diet comes neither from this Sacred Heart nor from the one in Spokane. I don't know if it comes from another Sacred Heart. The diet is a vegetable soup that uses instant onion soup mix as the base. It is not a healthy approach to weight loss and is not recommended or prescribed at this clinic. The best way is to lose weight over an extended period of time by increasing exercise to 30-60 minutes per day and eating less but healthy food. | |
| Answered at 8/17/2001 | ||
| Q | My Father has smoked from youth until now (currently 65 yrs old). He has just been diagnosed in China, and the doctor said that his lungs appeared to have cell collapse and a big bubble. This bubble occupies around 1/3rd of the right lung. This causes him to have short breath and something simmilar to asthma. The Chinese doctor seems uncertain whether to undertake a minor, or major, operation. I have heard that in the USA there is a better place to diagnose and help my father. Would you please advise me what lung specialists are available in the USA? | |
| A | Your father might have Bullous emphysema. This is where the small air sacks break down and cause bigger ones to form (usually due to smoking). These "bullae" take up space and interfere with a persons ability to breathe as air continually becomes trapped within the lung. The operation his doctors refer to is one of two operations: 1. Bullectomy; this is where the large "air bubble" is collapsed or removed and the lung is oversewn. 2. Lung reduction surgery; this is where portions of both lungs are removed, hopefully improving the compliance or elasticity of the lung so air moves in and out better. These operations are not cures, but can help a person breathe a little better for a longer period of time. What operation, if any, is right for your father depends on his health. I would recommend seeing a pulmonologist who could determine the best course of care. | |
| Answered by Michael McNellis, MD, Pulmonology, Longview, PeaceHealth Medical Group - Specialty Medicine (8/7/2001) | ||
| Q | What does it mean when you are told you have had 40 episodes and the oxygen level at the time was 84%? This was following a sleep apnea test. | |
| A | Presumably the "episodes" are your hypopnea/apnea index. This is the number of times your breathing was reduced or absent. If this is the case, then you suffer from sleep apnea. The reference to 84% is the lowest oxygen saturation percentage that you fell to during these episodes (normal being greater than 90%). Most likely, if you underwent therapy for sleep apnea with a breathing device known as continuous positive pressure (CPAP), this would reverse that desaturation. A drop in the oxygen saturation by itself is not dangerous, but over a period of time (years) it can cause chronic heart and lung problems. | |
| Answered by Michael McNellis, MD, Pulmonology, Longview, PeaceHealth Medical Group - Specialty Medicine (7/11/2001) | ||
| Q | My husband has been considering getting a vasectomy. I am supportive of this but am wondering if this will have an impact on our sex life. I have heard that sometimes men do not completely recover from the procedure. Is this true? What are the risks involved? | |
| A | I have been actively doing vasectomies for the past 9 years. I have done over 500 cases and have had no concerns from my patients that the procedure had caused any trouble with their sex life. In fact, I have had any number tell me that their sex life improved once they no longer had to be concerned about contraception! Here is a link to a good site that can give you some more information about vasectomy and the potential risks associated with it. It's called Vasectomy: Permanent Birth Control for Men | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (6/19/2001) | ||
| Q | I'm only 21 and I have gained so much weight in the last year. Is there any way that I can get rid of it?... I tried using coconut butter cream but it doesn't work at all! | |
| A | A person at any age will gain excess weight if more calories are eaten (or drunk), than used up over time. Try to figure out how that balance changed over the past year. Have you had less exercise or physical activity? Have you been eating more in response to stress? Did you start drinking alcohol, or regular soda pop? The ONLY way to reverse the weight you have gained is to eat less and exercise more. Fad diets and items that don't have anything to do with eating less and exercising more are a waste of money. Be sure and eat three meals each day, and try to eat ~5 servings every day from fruits and vegetables! If you need more help, ask your doctor to send you to a registered dietitian. You might want to read Choosing a Safe and Successful Weight-Loss Program. published by the NIDDK Weight-control Information Network. | |
| Answered at 6/18/2001 | ||
| Q | What is the current medical protocol for blood transfusions for people who travel overseas, particularly in developing countries. Most of the literature says avoid it and consider international air ambulance. Have you any good sources to recommned? | |
| A | I have no sources to recommend. You might consider joining IAMAT (www.travelershots.com and go to the Link page). If you are traveling, fall seriously ill and have less than the necessary amount of confidence in your health-care system, consider air evacuation. Unfortunately, developing countries may not TRY to test blood intended for transfusion for as many infectious diseases as in the US, and they may not be as PROFICIENT in testing as US blood banks. In this setting I would probably not agree to transfusion unless it were necessary to save life, usually due to trauma, rarely due to GI bleeding. | |
| Answered by John Wilson, MD, Infectious Disease, Eugene, The Travel Clinic (6/7/2001) | ||
| Q | My father had a stroke about three years ago. The stroke affected the left side of the back of his head, causing loss of acute vision in his right eye and excessive sweating for about two years. The sweating has now stopped. However, he continues to get debilitating migraine headaches about twice a week. He does not want to continue to take pain medication (Ultram), but would rather find out what the cause is and perhaps get rid of, or lessen the headaches. His MRI has not changed since the stroke. I know that you offer the services of pain management physicians, but we are not looking for someone who will give him the best medications - we would like to look for someone who is perhaps a physical therapist who would have the right kind of training and experience to evaluate and treat a stroke patient. He lives in Corvallis and can travel to Eugene for evaluation and treatment. What, and who do you recommend? | |
| A | A physiatrist is a physician who specializes in evaluation and treatment of disability and pain, and works with other physicians and therapists to develop a treatment program using self-care, medication and exercise. I would recommend an evaluation by such a physician in this case. To find a physiatrist, check with your local medical society. You can also check the PeaceHealth Physician Directory. | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (6/6/2001) | ||
| Q | What could cause an acute partial memory loss in an 84 old woman? No stroke or ministroke shows. She still recognizes people but seems lost in a time warp. | |
| A | The causes of sudden memory loss in seniors are numerous. Without complete knowledge of this particular patients history and medical situation, a good answer is practically impossible. Memory loss or confusion can be a symptom of not only stroke, as you noted in your question, but also from infections - urinary and lung being the most common; sudden change in kidney or cardiac function or from a change in medication. Sometimes a stroke too small to be easily detected can cause memory change. The only way to sort through these and come to a good answer is to get her to her doctor! | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (6/2/2001) | ||
| Q | My Dr. is retiring and I have to get another primary care Dr., I have located one, but she is "osteopathic", I'm not sure what that means. | |
| A | There are two types of complete physicians in the United States. Osteopathic Physicians (D.O.'s) and Allopathic Physicians (M.D.'s) are licensed both nationally as well as by the local state medical boards. Osteopathic Medicine is a unique form of Americian medical care that was developed by Andrew Taylor Still M.D. in 1874. Dr. Still was dissatisfied with the effectiveness of 19th Century medicine. The basic philosophy of Osteopathic Medicine focuses on the unity of all body parts and the body's ability to heal itself. Over one-half of all Osteopathic Physicians practice in primary care areas, such as pediatrics, general practice, OB/GYN and internal medicine. D.O.'s practice a "whole person" approach to medicine and receive extra training in the musculoskeletal system. Many D.O.'s use Osteopathic Manipulative Treatment (OMT) to encourage the body's natural tendency towards good health. | |
| Answered by Andrew Boughal, DO, Orthopedic Surgery, Florence, PeaceHealth Medical Group - Siuslaw (5/31/2001) | ||
| Q | Do you know of any other effective treatment for children with asthma other than treating with a nebulizer or an inhaler? My children both have asthma and are under 7 years of age. It seem to get worse when it rains. Could you explain why this happens and what preventative measures or precautions may help? I also give them Benedryl or Zyrtec for their allergies. | |
| A | Asthma is a chronic disease that is caused by inflammation of the airways within the lungs. Because the airways are inflamed they become twitchy, or spastic; we call this bronchospasm. Medications for treating asthma are generaly directed at either treating the inflammation or relieving the spasm or constriction. There are many good and effective medications for treating asthma in children. Which medicines we use is dependent on the age of the child the severity of the asthma. Usually these medicines are delivered via a nebulizer or an inhaler; both bronchodilators (relievers) and anti-inflammatory (treatment) medicines are available in these forms. There are some oral medicines like Singulair or Accolate which may help as well. If your children have allergies, this is most likely playing a role in causing their asthma. Certain molds or dust mites may worsen with humidity, and heavy or humid air may also trigger asthma. I would recommend discussing these issues with your children' pediatrician and consider seeing an allergist. | |
| Answered at 5/21/2001 | ||
| Q | Are there nursing homes in Eugene, OR which can care for mobile seniors who have severe short term memory loss? | |
| A | Here's what I hear from Sandy Sanders who is a Medical Social Worker at The Senior Health and Wellness Center here in Eugene. I hope this is helpful: "For mobile seniors with memory loss, this person could try: Applegate Care Center - 343-3445 Farmington Square - 344-7902 Gateway Living Center - 744-9817 Good Neighbor Eugene - 607-5025 Oaktree Residential Living - 607-0688 Sheldon Park - Kingswood Court - 344-1078 South Towne Living Center - 683-3618 Sweetbriar Villa - 726-5026 Alpine Springs is also building a new locked unit that will specialize in "memory care" - 607-9525. Florence really only has an Assisted living facility (Spruce Point) and they are full and you have to be pretty high functioning to be there." | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (4/24/2001) | ||
| Q | When I fly my ears never pop, resulting in excrutiating pain that lasts for hours after I get off the plane. I've tried all the conventional remedies: swallowing, chewing gum, yawning, and using decongestants. Nothing seems to help. Any suggestions? | |
| A | This is a difficult problem and, unfortunately, effective therapies are limited. Your eustachian tubes are the problem. I have my patients take a 12-hour oral decongestant in the morning and then use topical Afrin before every flight that day . Any allergy should be treated as well. That helps many, but not all, patients. | |
| Answered by Emil R. Hecht, MD, Otolaryngology, Bellingham, Bellingham Ear Nose & Throat (3/29/2001) | ||
| Q | I have a question about low thyroid. I have taken 25 micrograms of Levoxyl for a little more than a year, after a blood test showed elevated TSH. (My main symptom was fatigue.) I just had another blood test (I'd been feeling unusually tired again), and it showed my free thyroid was on the low side, according to my MD (.87) and my TSH was elevated--7.1. I am wondering if increasing my Levoxyl (as my doctor proposed) will make my thyroid lazy, or discourage it from working as well as it could if more Levoxyl weren't added into my system. Also, are there alternative ways to rev up the thyroid--foods, exercise, acupuncture, whatever? (I am below normal weight, and I speed walk for exercise.) My big concern is if the therapy will, in effect, make my thyroid function even less, and I'll need ever-higher doses. Thanks for your insights on this. | |
| A | This is an excellent question. Thyroid failure is very common. When Thyroid failure is partial, as true in your situation, then supplementation less than 100% of complete replacement will not increase the thyroid hormone level. Let's say your body is making 80% of what you need and you give it 30% of your daily requirements. Your body will make less hormone eventually, providing only 50% of your need. The sum of the oral and natural hormone will again be 80% of your daily requirement, with no benefit to using the supplement. The only way to get 100% of your daily requirement is to give the full 100%. The thyroid will shut down, which might prevent enlargement of the thyroid (a goiter). If thyroid hormone replacement is complete there is no down-side to absent gland function. If the thyroid gland could do the job, then you wouldn't be in the position of taking replacement therapy. Most patients need at least 100 micrograms of thyroid as complete replacement. There is no behavior that helps with thyroid function. | |
| Answered by Matthew Davies, MD, Endocrinology, , (3/26/2001) | ||
| Q | There is a family history of asthma. My 19 month old daughter has had a cough and lung congestion since October. I finally got her to take albuterol inhalant treatments and the latest bout of wheezing is gone, but she's still congested. Should I expect to ever get rid of her congestion before the summer? If so, how? | |
| A | Cough and congestion in a pediatric patient is a very common and distressing problem. If she has not had chronic cough in the first 6-8 months of life, it tends to decrease the likeliohood of certain considerations, such as chronic aspiration (swallowing food into the wid-pipe, cystic fibrosis (often associated w/ a salty tasting baby and chronic diarrhea), and other uncommon conditions. Asthma, or Reactive Airways Disease, is a very common disorder in children under 5 years of age. We have learned a lot about its cause and treatment in the past 15 years. The congestion you're hearing probably represents ongoing inflammation (not infection) in her lungs. IF your child has been diagnosed with asthma or RAD, she probably needs ONGOING rather than periodic therapy. Our best therapies work, over time, to bring the condition under control, rather than simply treat the symptoms...this requires you to gain a better understanding of what you're dealing with (the disease), how to monitor it (what's going on; when do I need to worry; how much treatment do I give, and what therapies are most appropriate for her (guided self management). Make SURE she avoids exposure to smoke. In allergically predisposed individuals, animal exposures (esp. cat) at this age can be very bad for later development of more chronic asthma. Try not to have her around other kids with viral infections (good luck!), and get treatment with a CONTROLLER medication (ask your doctor). This will help get her cleared up. It can be done! | |
| Answered by David Elkayam, MD, Allergy & Immunology, Bellingham, Bellingham Asthma Allergy & Immunology Clinic (3/20/2001) | ||
| Q | What are the implications of a cyst on the kidney? What can be done, or should be done, when one has this condition? | |
| A | Renal cysts are a fairly common finding with routine imaging studies of the kidney, such as with ultrasound. Typically, the ultrasound will be ordered to investigate something such as blood in the urine or a possible kidney stone, and the cyst is found incidentally. They can be quite large, in the range of 6 tp 10 centimeters, or very small. In most cases, they produce no symnptoms, and do not produce any problems with overall renal function. Occasionally, large renal cysts can produce some pain and discomfort, but this is more the exception than the rule. Simple renal cysts are simply small subunits of the kidney that became obstructed and filled with urine. If the internal portion of the cyst becomes septated or filled with internal tissue on the ultrasound, then it is referred to as a complex cyst, and these cysts must be followed with serial imaging studies since there is a small but real chance that a malignancy could be associated with them. There is also a genetically inherited disease called polycystic kidney disease (PCKD) which produces innumerable large cysts in both kidneys. In PCKD, the cysts are so numerous that they crowd out the functional subunits of the kidney and there is measurable falloff in kidney function, sometimes to the point of renal failure. The cysts in this case are typically painful and high blood pressure can occur with this disease as well. In most cases, however, a simple cyst on the kidney is harmless. | |
| Answered by Roger M. McKimmy, MD, Urology, Springfield, Oregon Urology Institute (3/15/2001) | ||
| Q | My daughter got RSV at the age of 4 months and she is now 10 months. My question is, could her lungs be scarred for life because of this illness she got? It seems like she's always catching colds, and when she does she always gets a bad cough. | |
| A | I wouldn't think it likely that the infection caused any scarring, but it may indeed predispose her to similar episodes of trouble with viral repiratory (RSV and other viruses)infections. About 25% of children have reactive airways with wheezing associated with viral illnesses in early childhood. The vast majority of these children outgrow their tendency to wheeze and have complicated URI's. Albuterol nebulizer treatments are often prescribed for this. If your child was a premie (less than 36 weeks), or had significant respiratory distress as a newborn (in a NICU), or has heart disease, then she should have the RSV vaccine monthly from November through April. You can greatly reduce the number of complicated or longlasting URI's by breastfeeding to age 1 year, avoiding smoke exposure and limiting your baby's exposure to people - especially preschool age kids. You might have your baby's doctor listen during one of these colds with a bad cough to see if nebulizer treatments for reactive airways is appropriate. | |
| Answered by David Miller, M.D., , , (3/14/2001) | ||
| Q | What is the best way to decaffeinate yourself? I am up to three and sometimes four cups of coffee a day. I also seem to be having increasing mild headaches. I figure the first step is to cut back on caffeine and see if this helps. I drink plenty of water. Should I get half-decaf, or drop to one cup a day, or switch to tea? | |
| A | Caffeine is definitely addictive, and getting away from it can be tough. On the other hand there are some good things about caffeine. (I saw a bumper sticker recently that said, "Caffeine makes you smarter than you are"). There is little evidence that the use of caffeine is bad for your health, despite all the intuition telling you that this black substance which makes you jittery and can give you palpitations is bad. Having said all that, I'm not here to convince you to remain an addict. I think that it is admirable that you are getting away from the stuff because it does stain your teeth, irritate your gastrointestinal tract and likely, in some people, cause significant heart fluttering and elevation of blood pressure. I don't know of any easy way to get over caffeine addiction. As a recovering coffee-aholic myself, I am a proponent of the "cold-turkey" approach. Because of the short half-life of caffeine, withdrawal tends to take only two to three days. If you taper down the dose of caffeine, by drinking tea or part decaf, I think that you are just more likely to prolong the suffering and relapse because you have the precious substance so easily at hand. Caffeine withdrawal typically results in some lethargy, feeling dumb and having a low level headache. The headache generally doesn't get better with usual headache remedies (unless they contain caffeine!). I would encourage pushing fluids and getting lots of sleep during those first few days. Good luck. | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (3/13/2001) | ||
| Q | What is myxedema? | |
| A | Myxedema the term used to decribe severe adult hypothyroidism (low thyroid hormone levels). The skin is seen to be dry, waxy and swollen. The patient may have swollen lips and a thickened nose. The patient is usually very cold, slow to speak, and physically weak. Weight gain is common. | |
| Answered by Matthew Davies, MD, Endocrinology, , (3/9/2001) | ||
| Q | What are spinal stenosis, central canal stenosis, and degenerative disk desease? | |
| A | Spinal stenosis is a condition where the spinal canal becomes narrowed and squeezes the spinal nerves. When the canal becomes significantly narrowed it can cause symptoms of back and leg pain which are worse with walking or standing, and usually relieved by sitting or stooping forward (leaning on the grocery cart while shopping). The symptoms are often improved with epidural steroid injections. I perform these routinely with very favorable results. Surgery is also successful in alleviating the condition. To read about these conditions try Spinal Stenosis at MedlinePlus. | |
| Answered by Andres Betts, MD, Anesthesiology, , (2/27/2001) | ||
| Q | Is there an eye disease or infection called uveitis which affects the vision and has to do with the eye muscles? | |
| A | Uveitis is an ocular condition wherein the inner tissues of the eye become inflammed. It is not an infection. When this inflammation develops it can cause eye pain, light sensitivity, and blurred vision. The eye muscles inside the eye will many times spasm in response to the intraocular inflammation and this spasming is responsible for the eye pain/ache. | |
| Answered by I. Howard Fine, MD, Ophthalmology, Eugene, Drs. Fine, Hoffman & Packer, LLC (2/26/2001) | ||
| Q | Is a kind of back surgery called IDET available in Eugene? | |
| A | Yes. This is a newer technology designed to treat the painful lumbar disc (the most common cause of low back pain). Michael Karasek, M.D., performs this procedure. His phone number at Northwest Spine Group is (541) 345-9800. | |
| Answered by Michael Karasek, MD, Pain Management, , (2/19/2001) | ||
| Q | How can you get a child to take pills? | |
| A | By age 10, most children can do the "FILL, POP, GULP" method: First practice with water only: superfill the mouth to the point of chipmunk cheeks with the head tipped back. Next, swallow all the water in one giant swallow. When a child can do this, they are ready to pop the pill when their mouth is full and the head is tipped back and swallow all in one gulp. This way they won't feel the pill and separate it from the liquid as they have learned to do when eating cereal. | |
| Answered by David Miller, M.D., , , (2/12/2001) | ||
| Q | Can you recommend a diet to control cholesterol and LDL/HDL? | |
| A | U.S. dietary guidelines to lower LDL cholesterol levels call for a low saturated fat, low cholesterol diet (depending on gender, height, weight, age and activity level, probably under about 12-17gm of saturated fat per day, and under 200mg cholesterol per day). Selecting foods high in fiber content, and including fresh or frozen fruits/vegetables (5-7 servings a day), and eating fish or poultry more often than small portions of red meat can help, too. Fats that come from nuts or olive/canola oil are healthier than animal fats or margarine (unless the margarine indicates "trans-fat free"), but the calories from fat in these foods can add up quickly. About the best LDL-lowering results you can get from dietary measures is a 20-25 point drop over about three months. Raising HDL cholesterol generally takes exercise and weight loss. Improvements of only a few points can make a difference in risk. | |
| Answered at 1/30/2001 | ||
| Q | Why are tears salty? | |
| A | The fluids within our body have a natural salt concentration in addition to all of the other elements contained within these fluids. This includes the blood, cerebrospinal fluid, and all of the fluids within each of our cells. If our cells come into contact with fluid that has a higher salt content than that which naturally is present within our cells, then fluid will try to exit these cells. If our cells come into contact with fluid that has a lower salt concentration, then water tries to enter into our cells to equilibrate the salt concentrations. A low salt concentration is normal for all of our body tissues and has much to do with the natural evolution of one-celled organisms living in the ocean eventually evolving into higher order creatures which live on land. A weak saline concentration optimizes the microscopic electrical and biochemical reactions which takes place in every one of our cells an infinite number of times every second. | |
| Answered by Richard Hoffman, MD, Ophthalmology, Eugene, Drs. Fine, Hoffman & Packer, LLC (1/21/2001) | ||
| Q | Can a diagosis of "GERD" (acid reflux) in a 5-month-old baby possibly be accurate? I know this may sound weird, but this is what I am being told by the baby's doctor. It sounds outrageous to me. | |
| A | This is at times a very appropriate diagnosis for an infant, and certainly not uncommon. This can be present right from the time of birth. All infants have a naturally "loose" opening between the esophagus and the stomach, so food and stomach acid come up much easier. Some infants have this occur much more than usual. The most common symptom is an unusual amount of spitting up, but symptoms can also include a cough, extreme irritability, or wanting to eat more or less than is needed. The treatment depends on severity and how much discomfort the baby has. Some infants throw up so much that they don't get enough to eat; others develop esophagitis, which is a severe irritation of the esophagus. By far the most common situation is a baby who is growing very well but who just throws up more than usual and may at times be a little irritable. Most infants without severe reflux outgrow this gradually in the first year of life. | |
| Answered by Elizabeth Heskett, MD, Pediatrics, Springfield, PHMG/PED-RB Night (1/12/2001) | ||
| Q | I am a 32-year-old female, 5'8" tall, who weighs 245 pounds. I am considering having my stomach stapled and would like names of doctors in the Eugene or Medford areas who speacialize in that proceedure. | |
| A | The Oregon Center for Bariatric Surgery provides this procedure. Browse the center's website or call (800) 440-4988 for further information. | |
| Answered at 1/8/2001 | ||
| Q | My six-year-old daughter has been having what I believe are night terrors for two or three years. At first she would just lie in bed crying with her eyes open but not responding to me, and finally I realized she was still asleep. A year ago she started to sleepwalk. When I wake up and find her (especially if she is crying hysterically), I would put her back in bed and try to console her but she would start shaking (usually her legs) and her arms would spring up into the air as if she were reaching out to someone She rarely, if ever, remembers these episodes. Will she grow out of this? Incidentally, she also has some kind of an allergy/eczema. She is constantly clearing her throat (usually from October through June), and she is itchy on her sides, inside of elbows, back of knees, etc. Could the allergies be connected to the "night terrors"? | |
| A | You have described typical night terrors. They are fairly common in early childhood, peaking in incidence at age seven and usually resolving spontaneously as the child grows older. It is not uncommon to see other sleep disorders such as sleepwalking, sleep talking, or bedwetting in the same children. The good news is that night terrors do not suggest underlying physical or emotional disability. Other good news is that they are usually easy to control with medication if the family considers them enough of a nuisance to warrant treatment. It is unlikely that your child's night terrors are related to her allergies, but both of these problems can be easily treated by your pediatrician. | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (11/20/2000) | ||
| Q | What alcoholism recovery facilities are available in Longview, Wash.? | |
| A | PeaceHealth Behavioral Health has several mental health and chemical dependency programs in Longview. Chemical Dependency: Detoxification services are provided at St. John Medical Center (306/414-4836 or 414-2000) Chemical Dependency Inpatient Services at PeaceHealth Recovery Northwest (360/414-2026) Chemical Dependency Outpatient Services at PeaceHealth Recovery Northwest, Vancouver (360/695-1297) Publicly funded (Medicaid and/or sliding fee) chemical dependency assessments are available at PeaceHealth Access Center (360/414-2020) Non-PeaceHealth outpatient chemical dependency services: Drug and Alcohol Prevention Center Providence Addictions Recovery Center Starting Point First Place Nueva Luz, Ltd. (Spanish-language treatment services) Mental Health: Inpatient mental health services at SJMC (360/414-4836 or 414-2000) Outpatient mental health services (private pay/insurance) at PeaceHealth Behavioral Health Outpatient (360/414-2236) Outpatient mental health services (private pay/insurance/Medicaid) for children and families at PeaceHealth A Child's Place (360/414-2222) Outpatient mental health services/case management (mostly publicly funded, but also private/insurance) at PeaceHealth Center for Behavioral Solutions (360/414-2280) and at PeaceHealth Mental Health Northwest, Vancouver (360/695-1297) Senior services at Solutions for Seniors (360/414-2130) | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (11/16/2000) | ||
| Q | I would like to receive information regarding stroke--how to tell one might be coming on, and how to prevent them. | |
| A | This is a great question. Rapid recognition is one of the keys to successful early intervention. Studies have shown improved outcomes with early intervention in appropriate individuals with stroke, but all too often patients arrive too late. This is a very large topic. We generally break things down into recognizing the risk factors for stroke and modifying them if you find you are at high risk (things like smoking, high blood pressure, diabetes control, obesity, high cholesterol). If you have uncontrolled risk factors you should see your physician for help in reducing your risk. Then, if you have had a Transient Ischemic Attack (TIA), your risk is elevated. A TIA includes temporary symptoms such as paralysis (usually on one side of the body), loss of feeling (usually on one side of the body), loss of speech, loss of vision in one eye, and a few others. These usually last only several minutes. With such symptoms you should see your physician right away. And finally a stroke, which has symptoms like the TIA above, but the symptoms don't clear up rapidly. The American Stroke Association says these are the warning signs of stroke:
For further information I would refer you to the American Stroke Association or to the National Stroke Association. | |
| Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (11/10/2000) | ||
| Q | My daughter is only 8 years old, but I'm wondering if it's possible she could already be entering puberty. I have been noticing mood swings for the past five months, and it seems her worst behavior is during the same 5 to 10 days every month. I've also noticed that she seems to have a headache around the same time and that she sleeps much more or is tired more often. This is all very similar to when I first started my "time of change". She hurt her arm several days ago and needed my help to wash her hair. It was then that I noticed that she is already growing pubic hair as well. Is this normal for a child of 8? | |
| A | Girls are considered to be going through puberty prematurely if they develop breasts and pubic hair before the age of 8, so your daughter would not be considered abnormal if she were starting to develop. However some girls develop early pubic hair but do not develop breasts until much later. I would suggest scheduling an appointment with her physician to determine whether your daughter is starting to go through puberty at this time, or whether she just has early pubic hair. | |
| Answered by Lauren Herbert, MD, Pediatrics, Springfield, PHMG/PED-RiverBend (10/27/2000) | ||
| Q | My father has polymyositis. He takes predisone and methotrexate. He falls easily and has a lot of trouble getting in and out of the house. He also has trouble picking things up. He rides an electric scooter to get around and he doesn't get any exercise. When he falls no one can get him up but himself, which is a real struggle. Is there anything that can be done to help him? Should he be getting therapy of some kind? | |
| A | Polymyositis is an uncommon symmetrical inflamation of the muscles that leave them weak and sometimes completely gone. The cause is unknown and the course of the disease differs considerably from one person to the next. One treats it by giving prednisone to stop the inflamation and also methotrexate to allow one to use less prednisone, since high doses of prednisone can cause lots of side effects including some muscle weakness. Active and passive physical therapy is useful if the inflamation is suppressed and there is enough remaining muscle to work with. Ask his doctor to see if some tharapy would be helpful in his individual case. | |
| Answered by Hugh Johnston, MD, Hematology, , (10/25/2000) | ||
| Q | If protein is found in urine, why should that be checked out by a physician? What's the significance? | |
| A | If protein is detected on a random sample of urine (usually by a dipstick method), it should usually be investigated further. Typically this involves collecting a 24-hour sample of urine and measuring the protein in it to determine exactly how much is present and of what type. Blood tests, including measurement of protein in serum, usually are done at the same time. The causes of protein in the urine are many and range from relatively minor causes like a bladder infection and prolonged standing to serious kidney problems. The only conclusion that can be drawn from the presence of protein on a urine dipstick test is that it should be investigated further. | |
| Answered at 10/23/2000 | ||
| Q | What causes high triglycerides, and how can you lower your level? | |
| A | Triglycerides are fats that circulate in the blood, in particles called lipoproteins. Triglyceride fat is also present in food. When you eat fat, your triglyceride concentration in the blood rises. High triglyceride levels are strongly associated with the development and progression of coronary artery disease and diabetes. Lifestyle factors that contribute to high triglycerides are being overweight, being sedentary, and consuming too much fat, sugar or alcohol. What can you do to lower triglycerides? Exercise daily (walk your dog every day--even if you don't have one!), eat less fat (limit to 30-40 grams per day), lose weight, limit alcohol intake, eat more fiber, and eat less sugar. If these strategies don't work, medication should be considered. | |
| Answered at 10/9/2000 | ||
| Q | Is there any treatment for pain and body temperature changes resulting from spinal cord damage caused by a motorcycle accident three years ago? | |
| A | There are many pain managment options after SCI (spinal cord injury.) I would recommend that you see a physiatrist (a rehabilitation doctor) who specializes in SCI. | |
| Answered by April M. Sakahara, MD, Physiatry, Bellingham, Physiatry Associates (10/9/2000) | ||
| Q | Which vitamin supplements are truly essential to one's health? Is one multivitamin supplement sufficient, or should that be augmented with a supplement of vitamins E and C as well? If so, how many mg. of each daily? | |
| A | Tough question. Many vitamins are promoted as being beneficial for both health maintenance and the treatment of disease. To what extent these claims are true remains unknown. For people with a healthy diet that includes lots of fruits and vegetables, scientific evidence for a benefit from supplementation is lacking for most vitamins. Notable exceptions include viamin D in people over 50 and folic acid in pregnant women. Calcium is also important for all women and men over 50. There is great interest in "antioxidants" such as vitamins A and C. Unfortunately, well done studies have not been able to demonstrate a true benefit for cancer, heart disease or stroke. Many people are starting to take B12 and folate to prevent stroke and heart disease. There are ongoing studies of this, but the results are not yet in. For a 2010 report on B Vitamins and cardiovascular diseases Click Here. In the absence of good scientific evidence, I recommend focusing on a diet with many diverse fruits and vegetables. It also seems reasonable to take a good quality multivitamin once a day, which contains adequate vitamin D for most folks. All postmenopausal women should also take 1200-1500 mg of calcium a day. Men over 50 should take 800-1000 mg/day. I would save your money and not buy separate C and E supplements. | |
| Answered by John Holroyd, MD, Internal Medicine, Bellingham, Eagle Hospital Physicians (9/27/2000) | ||
| Q | What is the standard protocol for follow-up treatment for melanoma? My stage 1 malignant melanoma was 0.67 mm thick; "Tthe atypical cells fill the papillary dermis and extend a short distance into reticular dermal collagen." The re-excision had a width of 1.9 cm and showed no residual melanoma. Other than annual skin checks and self-exams, is there any other follow-up treatment that is called for in this situation? The melanoma was removed in 1997, and I have had no other blood test or x-rays since that time. | |
| A | The short answer is--no. The vast majority of these melanomas are cured with a wide local excision (as you had) only. However, you have an increased risk for new skin cancers (all types) compared to someone without your diagnosis. I think it best to see a dermatologist for a complete skin check on a yearly basis in this situation. | |
| Answered by Thomas Trezona, MD, Surgery: General, Springfield, Cascade Surgical - Oncology (9/14/2000) | ||
| Q | My son has septicemia, and I was wondering if I could get some additional information on it. | |
| A | This link provides more information about septicemia. | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (9/6/2000) | ||
| Q | I am 25 years old, and over the last 3 years I have gained 30-35 pounds. My only child is 6 years old. My activity level has decreased a lot in the past few years, but this is the only factor I can think of that may have contributed to weight gain. I am not an excessive eater, and I don't drink pop or caffeine or eat red meat or too many sweets. Is this normal for my age, or something to worry about? It has also caused me to become quite depressed, and I do not have enough money to go see a specialist. I have been wondering about diets and am doing my best to get more exercise. Can you give me any more advice? | |
| A | Your food intake maybe right for your age to maintain weight, but not to lose it. You need to burn up 3500 calories more than you eat to loose 1 pound of fat. The best way to do that is to increase your exercise and to eat a low fat/calorie diet. It will come off slowly, but it will come off. This is normal for your age, but now's the time to get the weight off and keep it off. The older you get the harder it becomes. | |
| Answered by Kathleen Hirtz, MD, Family Practice, , (9/6/2000) | ||
| Q | What are the signs of depression? | |
| A | Usual symptoms include problems with sleep, appetite/eating, concentration, and/or decision-making, plus low energy, "blue mood," lessened ability to experience pleasure/fun/sex, preoccupation with death, feeling slowed down or agitated, excessive guilt/low self esteem, excessing anxiety, and negative thinking. | |
| Answered by Henry Levine, Psychiatry, Bellingham, 11th Street Offices (8/21/2000) | ||
| Q | What are the symptoms of multiple sclerosis? | |
| A | This question is virtually impossible to answer in a small amount of space. Multiple sclerosis, or MS, is a disease of the white matter of the brain and the spinal cord, and the symptoms vary tremendously from patient to patient depending on the location of the lesion. I would refer you to the National Multiple Sclerosis Society for a fuller description. Here is a brief paragraph from their website: PRIMARY SYMPTOMS are a direct result of demyelination, the destruction of myelin--the fatty sheath that surrounds and insulates nerve fibers in the central nervous system. This impairs transmission of nerve impulses to muscles and other organs. The symptoms include weakness, numbness, tremor, loss of vision, pain, paralysis, loss of balance, and bladder and bowel dysfunction. Since many other problems can have similar symptoms, if you or someone you know is concerned about the possibility of multiple sclerosis, he/she should contact his/her physician for evaluation. | |
| Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (8/18/2000) | ||
| Q | In regard to a sample from the prostate, how serious is a high white blood cell count? | |
| A | White blood cells are one of the body's front lines of defense against infection. Their presence usually indicates that the body is actively fighting an infection, and if they are present in the urine, then antibiotic treatment is usually indicated. White blood cells can be found on a voided urine specimen, but they are more specifically assigned as coming from the prostate when they are obtained from a voided specimen taken AFTER prostate massage by rectal exam. I would not regard the finding as serious, but prostate infections should be treated aggressively with antibiotics, and relapses of infections are fairly common. | |
| Answered by Roger M. McKimmy, MD, Urology, Springfield, Oregon Urology Institute (7/27/2000) | ||
| Q | My 2 1/2-year-old daughter was born with her labia minora "fused." As our doctor expected, once she began walking and becoming more active, they have come apart some, but not all the way. Lately she has complained of pain in that area. It's hard to tell if she's really feeling pain or if maybe she's just becoming aware of having to urinate. She is not yet potty trained. Could that be the reason, or do you think she is feeling pain from her labia separating? I seem to remember the doctor saying it shouldn't be painful and it is just dead skin cells fusing them together. There is no redness or obvious irritation there at all. | |
| A | Labial adhesion is quite common in little girls, and is not generally painful. It often is caused or persists because of minor irritation that improves with a little extra attention to hygeine. Technique might include wiping "front to back", gentle washing with Dove or Lever 2000, then copious rinsing with clear water and drying well (hair dryer). Not using bubble baths, avoiding tights or wet swimming suits for prolonged periods also will help. If the labial adhesion seems uncomfortable, approaches 50% closure or is associated with vaginitis or uninary tract infection, we will often prescribe Premarin to help the adhesion resolve. I suspect your daughter's doctor would be happy to make this available if appropriate. | |
| Answered by David Miller, M.D., , , (7/19/2000) | ||
| Q | What causes my hands to swell when I am going for long walks? | |
| A | It has to do with the dependant position of the upper extremeties during the walking as well as increased blood flow to the upper extremities. It's unusual to have swelling of the lower limbs. Facial swelling may be due to heat and increased blood flow. Retention of fluids is sometimes a factor and has to do with increased sodium (salt) intake. It is not unsuual to have swelling of the hands after a long walk; if you have further concerns, you should see your primary care physician. | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (6/28/2000) | ||
| Q | What can you tell me about a blood disorder called Protein S deficiency? | |
| A | Protein S is one of the body's natural "anti-coagulants," meaning that it is a substance that the body produces to counteract or lessen blood clotting. Such natural anti-coagulants are necessary so that blood clotting remains localized to the site of bleeding and is not excessive. Protein S deficiency is a genetic disorder in which one (rarely both) of the two genes that codes for Protein S is defective. The individual with the deficiency has a tendency to abnormal blood clotting, especially clots in the veins of the legs. These clots may never appear or may only appear alongside another condition that promotes blood clotting, such as pregnancy, estrogen therapy, immobility, or surgery. Assuming that the Protein S deficiency has been confirmed by lab tests, most patients with a Protein S deficiency that has produced blood clots should be on anticoagulant therapy. The duration of treatment (6 months? forever?) is controversial and should be individualized after discussion between the patient and the physician. Birth control pills probably should be avoided. On average, half of the children of an individual with Protein S deficiency will also be deficient. Therefore, genetic counseling and testing of offspring may be in order. | |
| Answered at 6/27/2000 | ||
| Q | What local physicians are knowledgeable about multiple chemical sensitivities? I am looking for help with a diagnosis, advice and treatment options. | |
| A | Two suggestions: James E. Harris, M.D., in the Department of Occupational Health at OHSU in Portland. Dr. Harris has a special interest in toxicology and the effects of chemicals on our health. Adrienne Berg, N.D., a naturopathic physician in Eugene. She has a reputation for being helpful in this sort of challenging situation. | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (5/25/2000) | ||
| Q | I am trying to find the names of physicians who do sexual reassignment surgery. | |
| A | Here are the resources I am aware of, in the northwest and nationally, in researching this for a patient of mine in recent months: 1) Larry Young, social worker for the transgender health clinic, in the San Francisco Bay Area at (415) 554-2691. 2) Shawna Virago, transgender advocate, in the San Francisco Bay Area at (415) 777-5500 x302. 3) Barry Maletsky, M.D., in Portland, (503) 238-5580 (psychiatrist who specializes in transgender issues). He's partially retired; I don't know his availability. 4) Transgender Support Group, in Eugene, (541) 686-1307. 5) Trans-sexual Men's Group, in Eugene, (541) 688-4282. 6) Sexuality Research Information Service. A disclaimer: I don't know how current these are. As far as the two support groups go, I do not know the members of the group nor their expertise as a referral service. | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (5/22/2000) | ||
| Q | I have just been told I have polycystic kidney disease. Can you tell me what I should do to change my diet? Any other information on PKD? | |
| A | Polycystic kidney disease is often inherited. Patients afflicted with it transmit it to their children 50% of the time. Sometimes it occurs as a spontaneous mutation in patients without a family history. Some patients can live out their lives without appreciable symptoms or significant loss of kidney function. Others my inevitably progress to renal failure and require dialysis or transplantation. It is difficult to predict which of these you will fall into, but weight and blood pressure control and, in the later stages, diet management can play a role. Usually the disease will progress at a rate that is predetermined and diet management will only do so much. The cysts in the kidney can occasionally and spontaneously rupture, causing the urine to be bloody for a brief time. The cysts can also cause kidney pain, although many patients can do quite well without symptoms. Since your question focuses on diet, I would merely suggest a calorie-balanced diet with complementary proteins, but not excessive proteins. Fluid intake should be kept up, but do not swamp yourself - just do not let yourself become dehydrated. In the later stages of renal failure, a rigid protein restriction and potassium restriction may be required. For further information look at Polycystic Kidney Disease on the NKUDIC website. | |
| Answered by Roger M. McKimmy, MD, Urology, Springfield, Oregon Urology Institute (4/27/2000) | ||
| Q | What are the long-term complications of glaucoma? | |
| A | If left untreated, glaucoma will ultimately lead to complete blindness by causing loss of the nerve cells in the optic nerve of the eye. There are also complications associated with the treatment of glaucoma from drops and surgery. These can include allergic reactions, cataracts, and serious complications within the eye from glaucoma surgery. | |
| Answered by Richard Hoffman, MD, Ophthalmology, Eugene, Drs. Fine, Hoffman & Packer, LLC (4/20/2000) | ||
| Q | How can I help an 8-year-old boy handle his anger? When I tell him "no," he starts pulling his hair and hitting his head on the floor, etc. | |
| A | It is important to understand the motivation behind the anger. Children become angry for the same type of reasons as adults--thwarted wants and frustrations. Try to approach the situation that is causing anger as a learning experience for the boy. He wants something that can't be had in the way that he wants at this time. Try problem solving. Are there other things that would work? Are there other times? If it is food, are there other acceptable things that would take care of his hunger? If he can't have what he wants, how can he make himself feel better? Is there some other activity that would interest him, make him forget about the thing he wanted, or allow him to work out his anger in a constructive way? The goal of discipline is to teach the child how to manage him or herself and to be successful in situations. Look at anger as an immature attempt to solve a problem. The child needs to learn the next level of developmentally appropriate behavior to solve his problem. Is it the use of words? Actions? Self-soothing? It is easy to start a pattern of power struggles with a child where the object no longer becomes the issue. The issue becomes a parent saying "no" and the child not having his way. Try to avoid the use of direct confrontation and denial and try redirecting the child to another more acceptable solution to his problem want. Sometimes you need to use a time-out with the child to break the power stuggle pattern. The purpose of the time-out is to have the child learn what is acceptable behavior and what is not. It is not a punishment. The chld is removed from the situation in a calm and compassionate way, told what the problem with his behavior is and what could be done instead. Give solutions he can use. Let him know that when he thinks he can try out those solutions he can come out of time-out. There does not need to be an enforced time period to time-outs--only until the child gets control of himself and feels he can handle the situation successfully. | |
| Answered by Hallenburg, Kris S. PhD, , Eugene, PHMG/Psy - Hilyard - 420 (4/18/2000) | ||
| Q | What is a cataract? | |
| A | A cataract is an opacification or generalized hardening of the human crystalline lens inside the eye. It can affect vision by causing blurring, glare, or double vision. When the cataract is affecting your vision significantly, it can be removed by a simple 15 minute operation which usually restores vision to the way it was before the cataract developed. | |
| Answered by I. Howard Fine, MD, Ophthalmology, Eugene, Drs. Fine, Hoffman & Packer, LLC (4/5/2000) | ||
| Q | I have been told I have Hashimoto's thyroid disease. Is it normal to have to regulate the thyroid dose often? | |
| A | Hashimoto's thyroiditis can best be thought of as an inflammation of the thyroid gland caused by the body's own immune system. The inflammed thyroid may either release extra preformed thyroid hormone or fail to produce adequate amounts of thyroid hormone, resulting in too much or too little hormone, respectively. Typically a failing gland will have intermittent shedding of hormone, complicating hormone replacement therapy. The needed dose of thyroid hormone is determined by lab tests as well as physical examination and can be varible for the above reasons. | |
| Answered by Matthew Davies, MD, Endocrinology, , (3/23/2000) | ||
| Q | What is aphasia, and is it reversible? | |
| A | Aphasia is an impairment in the part of the brain that controls language, typically the left cerebral hemisphere. Aphasia varies from person to person, and there are a number of diferent types. Expressive aphasia is one common type and involves difficulty in speaking or writing. Receptive aphasia involves difficulty in reading or in understanding speech. Many people have difficulty in both understanding what others say and in expressing themselves. Aphasia tends to improve over time, especially with speech therapy. Relearning language skills is a slow process, from months to maybe a couple of years. Some people only improve a little. Others improve so much that only the person with aphasia or someone who knows them well notices differences in the way they communicate. It is difficult to predict the amount of recovery an aphasic individual will experience. | |
| Answered at 3/23/2000 | ||
| Q | Where can I get reliable information about vitamins, medicinal herbs, and alternative medicine, including scientific studies? | |
| A | That's a tough question. The vast majority of vitamin and herbal products that are currently being sold in the US lack good, unbiased studies to support the health claims being made for them. The FDA does not regulate the supplements industry, and unless a product is harmful, no regulatory body verifies the accuracy of advertisements. Even most traditional health care providers are at a loss for good sources of reliable information on these products. Probably the best available infomation is from a newsletter called Alternative Medicine Alerts. It is a "for-profit" newsletter intended for physicians. The reviews are concise and conclusions are reached based on a review of available info. It is rather expensive. I believe the National Institutes of Health is also developing a website that will serve as a resource for info on dietary supplements. | |
| Answered by John Holroyd, MD, Internal Medicine, Bellingham, Eagle Hospital Physicians (3/23/2000) | ||
| Q | Please define "anticholinergic agent." | |
| A | Simply put, an anticholinergic agent blocks cholinergic receptors. These receptors are located throughout your body but are in particularly high concentrations in nerves and muscles. They are present also in the gastrointestinal system and the brain. Commonly used anticholinergic agents are atropine and glycopyrrolate. | |
| Answered by David Donielson M.D., Anesthesiology, Springfield, Northwest Anesthesia Physicians, PC (3/22/2000) | ||
| Q | How can you help a person who has tried to commit suicide? | |
| A | The most important things one can do in this situation are: 1) Don't withdraw your support. Stay involved. People who attempt to harm themselves often frighten others away. The resulting isolation can literally be deadly, as it can say to the suicidal individual "no one cares." 2) Take it seriously. Make sure the individual is evaluated by a competent mental health professional experienced with significant psychiatric disorders. All psychiatrists and many clinical psychologists are trained to evaluate such people. If the person attempting self harm isn't cooperative, your local mental health center may be able to recommend a way to arrange such an evaluation without the suicidal person's consent. While voluntary cooperation is always best, sometimes evaluation and treatment, even when coerced, can be life-saving. While most suicide attmpts don't end in death, the vast majority of fatal attempts are associated with diagnosable mental illnesses, and are associated with clues that can be recognized by trained professionals. | |
| Answered by Henry Levine, Psychiatry, Bellingham, 11th Street Offices (3/21/2000) | ||
| Q | Where can I find information about epilepsy? | |
| A | The Epilepsy Foundation of America has a well-developed patient, family, and friend website. For additional information, the Mayo Clinic website has a lot of information plus links to further sites. | |
| Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (3/17/2000) | ||
| Q | I have diabetes type 2. How do you know when the circulation affects your feet or other extremities? | |
| A | The following may be symptoms of nerve or circulation problems. l. Discomfort in your leg when walking. 2. Numbness or tingling in hands or feet. 3. Cuts or sores that stay infected or take a long time to heal. You should make an appointment to see your MD if any of these are occuring. Good glucose control is an important step in preventing nerve disease. Keeping blood vessels healthy will protect the nerves they supply. Nerves need a constant blood supply to function properly. It's also important to exercise regularly, stop smoking and eat healthy meals. Nutritious food, rich in vitamins and minerals, helps keep the nervous system in prime working condition. Alcohol is a direct toxin to nerves, so try to keep alcohol intake to a minimum. Your doctor should do a foot exam at least once a year. Diabetes educators also teach people to do their own foot care, helping them avoid complications down the road. | |
| Answered at 2/22/2000 | ||
| Q | Is Parkinson's disease something that can be passed on by parents? If one parent has it, do the children have a greater chance of getting it? What are symptoms? | |
| A | Generally speaking, Parkinson's disease is not inherited. There is a slight tendency in some families. The major symptoms are tremor at rest, rigidity,a decrease in spontaneous movements, gait difficulty, and postural instability. For further information I would suggest looking at the American Parkinson's Disease Association Web page. | |
| Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (2/20/2000) | ||
| Q | What is a borderline spleen and how can it be treated? In fact, what is the function of the spleen? | |
| A | The spleen is a blood organ in the left upper abdomen which has the following functions: 1) Works as a sieve to filter out bacteria or deformed blood cells. 2) Produces immunity along with other body organs to protect against disease. 3) Produces some blood elements especially when the bone marrow is stressed. People can survive without a spleen. I assume that a borderline spleen is one in which the doctor barely felt it and thought it perhaps could be enlarged. One percent of enlarged spleens are normal, but the rest are due to old or current infections, blood diseases of all types, or congestion from liver disease. It would be important to know if the spleen was definitely enlarged and what was the disease that caused that before deciding on any treatments. | |
| Answered by Hugh Johnston, MD, Hematology, , (2/16/2000) | ||
| Q | How is a diagnosis of Cushing's syndrome made? Are medications available to treat this syndrome? | |
| A | Cushing's syndrome is really a collection of diseases that share excess steroid action on body tissues. Excess steroid action is sometimes a side effect of necessary medications such as predisone, or a result of excessive cortisol production in the body. Excessive cortisol production is suspected based on physical examination finding such as fullness in the face and above the collarbone, thinness of the skin, and large muscle weakness. The diagnosis is confirmed with 24-hour urine collections for cortisol and other laboratory tests. If the diagnosis of excess cortisol production is made, either surgical or medication options are available. A standard approach is to use ketoconazole to stop cortisol production in the adrenal glands. The exact therapy depends on which organ system is responsible. | |
| Answered by Matthew Davies, MD, Endocrinology, , (2/16/2000) | ||
| Q | Please provide information about probable reasons and treatment for irritable bowel syndrome. | |
| A | The reasons some folks suffer from chronic intermitent abdominal crampy pain, related to active bowel, but without anatomic abnormality, are unclear. Partially it relates to the over-refined nature of our modern diet. Sometimes stress adds to symptoms, but often has nothing to do with it. Caffeine or alcohol can make symptoms worse. Many patients worry, mistakenly, that it is their urinary system, or uterus and ovaries, that are causing the problems. The best treatment is to eat fiber regularly. I use a teaspoon of psyllium fiber (e.g. Metamucil) once or twice a day to prevent symptoms. While people think of this as a "laxative," it is not. Most people stool less often with this regimen. Medicines that slow down bowel motion help when one is crampy. My favorite is Imodium (loperamide, an over-the-counter), which is very safe. Common perscription medicines include Levsin and Amitriptylline. Like many chronic but not dangerous syndromes, IBS is best managed by individuals who learn what makes things better or worse for them, using the tools that their health care provider can recommend. | |
| Answered by Nick Gideonse, MD, Family Practice, Portland, Oregon Health Science University (2/10/2000) | ||
| Q | I get kidney pain at night, which slowly abates during the day. Any suggestions? | |
| A | Frequently pain in the joints and the muscles of the low back is interpreted by people as kidney pain. The kidneys are tucked up inside next to the spine right below where the lowest rib attaches to the spine. The pattern of nighttime pain that gets better once you are up and moving about suggests that this may be the case for you. Here is some more information on low back pain from the National Library of Medicine's consumer web site: MEDLINEplus/Back Pain The only way to be certain that the pain is not coming from kidney or from some other cause is to be checked by your health care provider. | |
| Answered by Tom Ewing, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (2/9/2000) | ||
| Q | What is diverticulitis? | |
| A | Diverticulitis is an inflammation and infection of the diverticulae of the colon. Diverticula are small pouches that protrude along the colon, especially on the lower left side of the colon, called the sigmoid colon. These pouches normally do not cause any problems. Sometimes, however, stool or other material can get plugged in these pouches, which are very thin-walled, and then become inflamed. Even more serious is that they can rupture and cause peritonitis, an inflammation and infection of the abdominal cavity. Treatment ranges from antibiotics for less severe cases to hospitalization and sometimes surgery in more severe cases. | |
| Answered by Glen Hoversten, MD, Surgery: General, , (2/9/2000) | ||
| Q | What is morphea? | |
| A | Morphea is a form of scleroderma, which is an autoimmune disease affecting connective tissue. This means that the body's immune system attacks and destroys its own connective tissue, which is present in all tissue such as skin, lungs, gastrointestinal tract, etc. There are systemic and localized forms of scleroderma. Systemic sclerosis and its variants affect internal organs and structures such as the lungs, kidneys, and esophagus as well as skin. Morphea mainly affects the skin but can involve large generalized areas of skin or can involve one individual location. It is much more common in women than men and occurs in all age groups. The lesions of morphea, when fully developed, can look and feel like scars which are depressed slightly below the surface of the skin. | |
| Answered by Jay Park, MD, Dermatology, Eugene, Jay Park MD (2/3/2000) | ||
| Q | What are triglycerides? What is their impact on your cholesterol level? | |
| A | Triglycerides are the major form of fat in our diet (from both animal and plant sources) and in our bodies. Technically, a triglyceride molecule consists of three fatty acids (hence the prefix "tri") linked to a molecule of glycerol (a small alcohol molecule). Triglycerides are measured routinely in the blood (serum, specifically) along with cholesterol. The commonest cause of an elevated triglyceride level is a non-fasting specimen, since a recent meal will cause fat in the form of triglycerides to be transported from the gut to the rest of the body. Once a non-fasting specimen has been eliminated as a cause of increased triglycerides (all blood tests for cholesterol and especially triglycerides should be done after an 8-12 hour fast), other causes should be considered. Genetic disorders of fat metabolism can elevate triglycerides. Frequent non-genetic causes of increased triglycerides include diabetes, obesity, alcohol, estrogen treatment, beta blocking drugs, and kidney failure. The link between coronary heart disease and increased triglycerides is weak but not zero. Increased triglycerides and cholesterol tend to travel together. Very high triglycerides (especially over 1000mg/dL) may cause problems of their own, including pancreatitis, a specific rash (eruptive xanthomas), eye changes, joint pain, and memory impairment. Individuals would generally have to have uncontrolled diabetes or a familial condition before they would get levels that high. Drug treatment is available for increased triglycerides, but weight loss, exercise, avoidance of alcohol, and control of underlying diseases are generally tried first, especially if the elevation of triglycerides is mild. | |
| Answered at 1/24/2000 | ||
| Q | What is the best and safest way to treat children for head lice. I have heard that using tea tree oil in shampoo can reduce the chances of getting head lice; is this true? | |
| A | There are a number of options for treating head lice. The American Academy of Pediatrics Infectious Diseases Committee recommends permethrin (Nix) as the first medication, with lindane and malathion as other options. I do not use lindane because it is more toxic than the other medications, and have not used malathion because other options are available. As you probably know, Nix is used most commonly. The medication is approved for children as young as 2 months, and has been shown to be quite safe. One problem with Nix is that some head lice are becoming resistant, and the Nix treatment is ineffective in these cases. Options then are: leaving Nix on longer (e.g. overnight), using 5% permethrin, changing to another insecticide, or using an alternative method. Some of the alternative methods are very safe, but may not be as effective. One approach is to try to smother the lice with mayonnaise or vaseline. A second is to use an herbal product, such as Hair Clean 1-2-3. This is not FDA approved, but contains only coconut, anise, and ylang ylang oils. Evergreen Nutrition in Eugene has also helped some families make up a mixture of vegetable oil, thyme, and lavender to kill lice. I have had several families use these alternative regimens successfully. I have seen no studies using these methods (except the Hair Clean). Because these methods are not well studied, they are not the treatments recommended by the AAP. Important to any regimen is picking nits. I recommend picking nits daily for a week to make sure all are gone. The National Pediculosis Association recommends using the Licemeister comb (available at Walmart). I have heard very good reports about the comb from families and from people using the comb in school outbreaks. Clothing, bedding and cloth toys also need to be disinfected by machine-washing or drying (hot cycles). If these things cannot be washed, they should be placed in a plastic bag for 10 days. Combs and brushes should be soaked in hot water for 10 minutes, or washed in the Nix creme rinse. | |
| Answered by Lauren Herbert, MD, Pediatrics, Springfield, PHMG/PED-RiverBend (1/20/2000) | ||
| Q | My mom has been having chemotherapy for the past 5 months. Now her CA125 results are reading at a 9. The doctors tell her that is normal, but what does this mean? What does the CA125 read? | |
| A | CA125 is a protein found in increased amounts on the cell surface in many ovarian cancers. The CA125 test is a useful tumor marker for monitoring the course of disease in patients with ovarian cancer. Some patients with ovarian cancer will have elevated CA125 results above 35. Persistently rising CA125 values may be associated with malignant disease and poor response to therapy, while decreasing CA125 results may indicate a favorable response to therapy. Healthy individuals also have CA125 in their blood. A CA125 result less than 35 is considered "normal". CA125 levels are one way physicians monitor patients for reoccurence of ovarian cancer. CA125 levels that exceed 35 suggest return of ovarian cancer or poor response to chemotherapy. | |
| Answered by Stephen Erfurth, M.D., Pathology:Anatm/Cln, Springfield, Stephen Erfurth PhD (1/19/2000) | ||
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