Frequently Asked Questions Questions from visitors to our Ask-an-Expert site might provide the answers you're looking for! Q Before Halloween, my son, husband and I got a virus(?) that included a day of aching, a day of fever, and then tiredness off and on, we all seemed to get better for a day or two, then came down with a bronchitis-like cough that is just now resolving. We only had the fever at the end of October, but the cough dragged on. We went to our family's Thanksgiving celebration, still coughing, but with no fevers. Two days later, my grandmother came down with the aches, and chills, similar to what we had had in October, and blames us for making her sick. I thought that it took 5 to 10 days for symptoms of a virus to show up after exposure, but when I looked online, some febrile illnesses do have a very short incubation period. Grandma has not had the cough that we had (though Mom did develop a cough and runny nose a week later, but got over it quickly). Is Grandma correct in blaming us for giving her this sickness? I didn't think we were very contagious, having been sick for many weeks at that time. Thanks A It's really hard to say for certain as one would need to isolate the virus from both Grandma and you (which, to begin with, is difficult). Then genotypic analysis of both viruses (which is only really done in research settings) would need to be done to compare them. In practical terms; unless Grandma had other potential exposures, you/your family are probably the culprit. Answered by Glenn Ziemski, MD, Emergency Medicine, Springfield, PHMG/Urgent - RiverBend (12/17/2007) Q Can my 6-month-old daughter get posion oak/ posion ivy if my husband and I have it? If so, how is it spread? A No. Poison Oak can only be spread by touching the oil from the plant. It is possible to spread it initially by touching your daughter immediately after touching the plant. However, it cannot be spread after the rash has started. Answered by Jay Park, MD, Dermatology, Eugene, Jay Park MD (12/7/2007) 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 Could you please give me the symptons for food poisioning? A The classic food poisoning is caused by food left out too long causing a growth of staph bacteria. This germ creates a particularly annoying substance which causes severe belly pain followed by explosive diarrhea. Usually the onset of symptoms is about 4 -8 hours after eating the bad potato salad (mayonnaise is the classic culprit). Sometimes the belly pain symptoms are so severe that patients find their way to Emeergency Rooms and the doctors there get so worried about appendicitis and other problems that they end up in the operating room! The good news...It's usually fast and furious. Please take a look at this information, it provides more detail on this malady: http://www.peacehealth.org/kbase/topic/special/te6322spec/sec1.htm There are many other types of contamination of food that can result in illness: http://www.peacehealth.org/kbase/topic/major/te4626/descrip.htm Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (10/21/2007) Q I recently began dating a woman who was hospitalized for an Methicillin-Resistant Staphylococcus Aureus (MRSA) infection. She was treated with strong antibiotics and appears to have cleared the infection. I am concerned about the level of intimate contact between her and myself. Do I need to be concerned about physical contact with her and the potential that she may be carrying the resistant infection? Thank you so much for taking the time to answer my question. A MRSA is a lot more common in the community than anyone wants to believe, yet invasive MRSA infections are actually rare (compared to the large number of folks who have some MRSA on their skin or in their nose). Despite recent press, the influenza virus kills 60% more folks per year than the MRSA bacteria. So if you're otherwise healthy, wash your hands judiciously, have a healthy lifestyle (adequate rest, nutrition, exercise, and avoidance of drugs), and you avoid taking antibiotics when your life is not really in danger (unlike all the folks who come in asking for antibiotics on day 7 of a cold claiming they have "sinus infection"...), then your chances are really good for not getting an invasive infection. Intimate contact is EXTREMELY unlikely to increase your odds of getting an invasive infection. Yet any contact could allow for some MRSA to colonize your skin. So back to your question: she isn't "carrying resistant infection" since infection means a disease- her disease has been cured. She is still possibly colonized with MRSA and if you've had ANY contact with her so are you (and so am I from taking care of sick folks). There's nothing an individual can do to get rid of ALL risk (everything in life is at least a little risky!) short of locking yourself up in your room and I DO NOT recommend that!!! Please talk to your doctor if you have any difficulty putting it in perspective- you don't want to worry too much or too little. Answered by Mark Lyon, MD, Family Practice, Eugene, PHMG/FP-South (10/19/2007) 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, Eugene, PHMG/PED-Willamette (10/2/2007) Q Which ingredient should be in the formula of a disinfectant when dealing with MRSA? A This bacteria is not any harder to kill when disinfecting a surface. Any alcohol-based wipes or hand sanitizers should do the trick. There is some data that Hibiclens showers are useful in decreasing skin colonization, at least temporarily. Answered by Glenn Ziemski, MD, Emergency Medicine, Springfield, PHMG/Urgent - RiverBend (9/27/2007) 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 My husband has been diagnosed with Central Pain Syndrome. He has had a thalamus injury with a slow brain bleed. His pain is always a 9-10 even with large doses of narcotics. The pain is deep within the left temporal/central brain area. We have tried every antidepressant, antiseizure, and migraine medication as well as many others. Currently he is seeing an anesthesiologist and undergoing nerve blocks that are inefficient. No one seems to understand that this isn't a flare up, it is constant and this has left him depressed and suicidal. We no longer go to the emergency room. He is only left to suffer there, given 5 ml of morphine by I.V., and sent home with still unbearable pain. Is there any specialist that deals with Central Pain Syndrome? Are there any alternative therapies to try? I am afraid I will lose him. We are more than willing to travel. In addition, I cannot get anyone to refer him to a therapist. He went to one, but we later found out that was only to see if the pain was from addiction or from the syndrome. Once it was confirmed the pain was from the syndrome, no one is willing to refer him to another therapist. A Thank you for your question. Central pain or thalamic pain is a serious challenge for us. Many patients can be managed on oral medications including tricyclic antidepressants and anticonvulsants such as your husband's physicians have tried. Narcotics are frequently used with varying success. Two surgical approaches may be helpful in patients who are unresponsive to oral medications. The first is a spinal fluid morphine pump, and the second is deep brain stimulation (DBS). Although, the DBS treatment has not met with very much success in thalamic pain patients such as your husband. I suggest you ask your physician about these treatment options and discuss possible referral to someone who can evaluate your husband for those procedures. We do have specialists who can do the morphine pump evaluation and implantation in Eugene, but a DBS implantation would have to be done in Portland. Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (7/25/2007) Q I get these headaches when I work out; typically when I do bench press or chin-ups, or any of the workouts that require the most effort. They are quick onset and are throbbing and very extreme. I got them last summer, and started getting them this summer, but I have been doing weight training throughout the entire year. What should I do? A There are several causes of exercise-induced headaches such as you describe. Although they are usually benign, there are some significant medical conditions that can cause these headaches. I suggest you have it thoroughly evaluated. Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (7/20/2007) Q My wife has 65% blockage in her left carotid artery for the second consecutive year as verified by angiogram. There seems to be quite a difference of opinion as to when surgery would be beneficial/required. Is there a standard by which one can make that decision? Is it better to have it done now rather than to wait? Is aspirin therapy sufficient to ward off stroke while she waits another year to have another angiogram? A Less than 80% obstruction in the internal carotid artery is generally best managed with medication. Aspirin is the mainstay of treatment, although selected patients may be treated with Plavix. Surgery is generally reserved for patients with 80% or greater stenoses or patients who are symptomatic on medical therapy. These recommendations are based on the relative risks of direct intervention versus medical therapy. Answered by James Douglas MD, Surgery: Thoracic, Bellingham, PHMGW/Cardiothoracic-Squalicum (7/6/2007) 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 the Lane County Health Department at (541)682-4041, 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 usually causes leg twitching at night? The big toe pulls up and then develops cramps. A Usually it's a local (not system-wide) imbalance in certain electrolytes (or "salts") like sodium, potassium, calcium and magnesium. Rarely it can be something more serious so if it gets progressively worse, that would be a bad sign! Sometimes taking a supplement of calcium and magnesium and/or potassium can help. Stretching, yoga, and/or heat might help. Quinine is an old drug with new problems from it, so its use is a little controversial. Answered by Mark Lyon, MD, Family Practice, Eugene, PHMG/FP-South (6/11/2007) Q What are the pros & cons with an angiogram and possible stint for a 95-year-old man with a pacemaker? A The individual issues are, not surprisingly, quite individual. What we do know, however, is that the elderly benefit from angiography and revascularization (for the indications these procedures should be done for) even more than younger individuals with the same indication (cardiac problem) because the baseline risks of the disease are higher in the very old. Nonetheless, doctors tend to underutilize such procedures in those of advanced age. Some risks are higher as well, particularly renal (kidney) risks, because of age associated decline in kidney function. The presence of a pacemaker, per se, does not increase risk. Please ask your cardiologist about your specific circumstance. Answered by Peter Beglin, MD, Cardiology: Interven, Bellingham, North Cascade Cardiology (6/5/2007) Q Where can one properly dispose of unused or out-of-date medication in a safe and ecologically responsible manner? A We're struggling with that question as well. Currently, we are paying quite a lot of money to send our expired medications to a landfill protected from groundwater seepage. Philosophically, when it comes to a person's own med supply, it's probably irrelevant, since we wash the vast majority of drugs (that is what we consume) through our kidneys and into the waste water system. This accounts for far more of the drug than we would actually dispose of, so it's probably no real harm to flush them down the toilet. Remember also that these are, for the most part, organic compounds made up of hydrogen, oxygen, carbon, and sulfur, that degrade fairly soon once they are in solution. Answered at 6/4/2007 Q I recently heard that pneumonia booster shots should not be given to Alzheimer's patients. I'd like to find out if there is any truth to this...or is it a rumor? My husband has Alzheimer's disease and I'm part of a support group that is interested in this information. Thank you! A The Pneumovax should be given to everyone at age 65. If you have a disease that makes you high risk (diabetes, no spleen, heart or lung disease) then you get one at the time of diagnosis AND at 65. The current thinking is that once you've had the shot at 65, you're done. It doesn't prevent pneumonia but it does reduce your risk of serious illness (sepsis and meningitis) from the bacterium: pneumococcus, a species of strep. Your rumor is just that...a rumor. Answered by Mark Lyon, MD, Family Practice, Eugene, PHMG/FP-South (6/4/2007) Q I am a second-time mom who had an emergency C-secton with my first birth, due to a non-dilating cervix. I have recently learned of some midwfery techniques to help ripen the cervix for this time around (e.g., evening primrose oil, etc.) I went back to the same doctor who delivered my first child and wonder now if I should ask her about these techniques, or if I should consult with a midwife. I REALLY don't want to go through that surgery again if it can be helped...suggestions? A My recommendation is that you stay with a physician (OB/GYN) who is well-qualified to take care of you whether you have a vaginal birth or another cesarean section. Of course you should ask your doctor about cervical ripening! Answered by Heather York, MD, Obstetrics/Gynecolog, Eugene, Women's Care (5/23/2007) 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 Sometimes I wake up at night with a discomfort in my upper back and jaw. I wouldn't label it pain but it does wake me up. This does not happen in the daytime. I am 65, very active, still run some, and have always had excellent health including good dental health. Should this be a concern? A I think the description of your discomfort bears further evaluation. Any upper back and particularly jaw pain that awakens you at night, even though atypical, has the possibility of being due to heart disease. It needs to at least be considered. You need to see your primary care doctor. If you don't have one, you need to make an appointment with either an Internist or a Cardiologist. I suggest you not delay this evaluation. Answered by Loren Barlow, MD, Internal Medicine, Eugene, PHMG/IM-Willamette (4/26/2007) Q My son has ringworm of the scalp. There are five other children in his preschool class with ringworm and they were all treated with Griseofulvin-Oral. My son's physician told me to put over-the-counter Lamisil topically on the site for three weeks. Everything I have read on the internet and have heard from others indicates this is only cured by oral antifungals. Is this true and, if so. how do I approach my doctor to get this prescribed for my son. I do not want other kids to get this. A I agree. It will require oral antifungals to clear Tinea capitis. I would be direct with your physician and tell him/her that your research has discovered this to be a fact. If your physician is reasonable, he/she will do the right thing. Answered by Jay Park, MD, Dermatology, Eugene, Jay Park MD (4/24/2007) 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, Eugene, PHMG/PED-Willamette (4/12/2007) Q I had done some research on prolapsed cervical wall and had come to the conclusion this might be what I have. I consulted a doctor about this. She told me it was just a normal part of aging (at the time I was 47), that my "squeeze" was weak, bladders leak, and "have a nice day". Now that I am approaching 50, things seem to be "falling out", and intercourse with my husband is painful at times. This is not a normal part of aging, is it? My last period was in November, 2004, so I'm thinking, "yes" to menopause. What should I tell the next doctor I plan to see? A It does sound like you are menopausal since you have not had a menstrual cycle in over a year. What you describe sounds like uterine prolapse and possibly a bladder prolapse or cystocele. This often occurs as women age, but is not necessarily a consequence of menopause. Your symptoms are not normal and need to be treated. You need to see a gynecologist to have this evaluated and, I would recommend that you tell them just what you have written to me. Describe the sensation of everything "falling out" and the problems you have noted with bladder control and with intercourse. Answered by Linda Frison, MD, Obstetrics/Gynecolog, Eugene, PHMG/OBGYN-Willamette (4/10/2007) Q My husband had triple bypass surgery in November,1998, and has managed his heart care without problems with one exception. He has lost a fair amount of memory. He will turn 69 years old in a couple of months. Originally, I was in denial of this cognitive change, but it has become more obvious and challenging in the past 12 months. Is there a known connection of this problem with the surgical intervention? Is there anything that can be done to slow or reverse any of the symptoms he is experiencing? A Thank you for your question. Yes, this is a known relationship and over the years has been studied a great deal. Many changes in technique have occurred over the years and the incidence of these problems has diminished but it still occurs. The surgeons and anesthesiologists do everything they can to prevent the changes but this remains more common than we'd like. On the positive side, with cognitive rehabilitation and the passage of time the problems get better. In other words, when the problem is strictly due to the heart surgery, the cognitive problems are worst shortly after the surgery and slowly improve (usually not completely). If your husband is actually experiencing a continuing decline over time, as it sounds like he is, then he needs to be fully evaluated for the cause because this is NOT what we'd expect after heart surgery. His physician, a neurologist, or a geriatrician should evaluate him. Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (4/9/2007) 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 I was diagnosed with GERD about two years ago, when I saw a otolaryngologist because of unexplained hoarseness. Even though I am faithfully taking Prilosec, in the prescription dosage, and avoiding chocolate, caffeine, spicy foods, citrus fruits, etc., I still am having difficulty with it. It is damaging my vocal cords. I see my otolaryngologist every three months. I am becoming discouraged. It seems that, for as little good as my dietary restrictions are doing, I might as well be eating all those things. I am ready to give up on singing, which I have spent many years being professionally trained in, because of the damage to my vocal cords. I have given many vocal concerts. Is there a surgical solution to this condition that doesn't involve extended hospital and recovery time, and big abdominal incisions? I do not smoke. I am about thirty pounds overweight. I realize losing weight would help, although it does seem to be difficult for me, as I am almost 60 and postmenopausal. A There is a minimally invasive operation for GERD that is usually considered when other treatments have been less than effective. You are on medication (called PPI's; Nexium, Prilosec, Aciphex are examples) that reduces the stomach acid production that irritates the esophagus and vocal cords. Medicine will not prevent the reflux, only dull the symptoms, but it sounds like you are having significant breakthrough reflux problems, and may very well be a surgical candidate. The diagnosis is usually nailed down by an upper endoscopy and/or 24-hour pH study (done by a gastroenterologist). A patient can then be referred to a surgeon like me to discuss the advisability of the operation. In essence, the upper stomach is wrapped around the lower esophagus to create a new 'valve' to prevent reflux, and any hiatal hernia is repaired. My patients generally spend 24 hours in the hospital, and are back to normal activities in about a week. There are some significant dietary restrictions for a few weeks after surgery, but the operation is 90%+ successful, and folks usually do very well if they have been properly selected for surgery. I would recommend you discuss the option of surgery with your ENT and/or GI doctors, and have them refer you on to see a surgeon that has experience doing the operation. Good luck. Answered by Charles Stanton, MD, Surgery: General, Springfield, Northwest Surgical Specialists (4/3/2007) Q Should I be concerned about my leg bruising around varicose veins from playing basketball with my son when it was never hit by anything. Last month a large bruise developed below my knee, yesterday one developed above my knee. A There are several symptoms which can accompany varicosities which fall into the category of "annoying but harmless". These can include discomfort, discoloration and unsightly swelling. Please take a look at this information for more detailed description of varicose veins: http://www.peacehealth.org/kbase/topic/major/hw113838/descrip.htm As for the bruising that you've experienced, I'm not able to make a judgement about these. You should consult with your personal physician. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (4/1/2007) 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 Why are tablets enteric coated? A The coating prevents the tablet from dissolving in the stomach and allows it to dissolve in the less acidic small intestine. There are two reasons why this is done. One is to protect the stomach from irritation; the other is to protect the medicine from being broken down by stomach acids. Answered at 3/19/2007 Q I have a sore in the crack where my mouth opens (one opening on each side). This sore will not heal. It's in a place where if I yawn, it cracks open after it starts to heal. Do you have any suggestions on over-the-counter medicine I can use to heal this up? A "Angular Cheilitis" could be from specific deficiencies in your diet, lip licking, or just dry mouth/lips. If a balanced diet, daily multivitamin with minerals (including iron and zinc), and some Vaseline lip therapy applied 4 times a day doesn't resolve it in a few weeks then see your doctor. Answered by Mark Lyon, MD, Family Practice, Eugene, PHMG/FP-South (3/14/2007) 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 at 3/12/2007 Q I am a 27yr old male experiencing a rash in my arm pits. I have had it for several months now, and it goes from mild to extremely itchy. When it is itchy it appears as raw red patches, or breaks in the skin, while returning to partial skin color when mild. It is not found anywhere else on my body. A The underarms are a common place to break out with eczema, a sensitive skin condition. Eczema tends to be worsened by heat and sweating, but can also be from antiperspirants. If the rash doesn't clear up by changing to a "sensitive skin" deodorant and using hydrocortisone twice daily for a week, see your doctor. Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (3/12/2007) Q I am looking into the new drug to stop smoking, Chantix by Pfizer Co. Do you know what the results are for getting off this drug after the recommended treatment? It seems there is little information regarding this; a bit like substituting one for the other without ultimate release from addiction to something. A The two studies submitted to the FDA compared Chantix with bupropion, the other non-nicotine smoking cessation drug. Both studies showed Chantix to be superior to both bupropion and placebo; with nearly half of the Chantix subjects still not smoking 12 weeks into the trial (only 15-18% for the bupropion patients). Of course, these drugs only aid in dealing with cravings for nicotine, and ultimately it is the ability to deal with the psychosocial aspects of smoking that determines success, but Chantix appears to be an effective non-nicotine option for those trying to stop smoking. Answered at 3/2/2007 Q I have a small bump just above and adjacent to the cutical of my right middle finger. It fills with a crystal clear viscous fluid/gel which I have to regularly drain via piercing with a needle or it becomes painful. It looks much like a blister. It causes a disfigurement, the same width as the "blister", in the nail immediatly adjacent to the cutical which extends to the end of the nail. I assume this gel is the keratin which eventully becomes the fingernail. Is this true? I assume there is something wrong with the matrix for this nail. Is there anything I can do to resolve this issue? A You almost certainly have a digital mucous cyst. It arises, not from the nail matrix (good guess, though!), but from the joint nearest the nail. That clear/bluish gelatinous material is joint fluid. Often, the pressure of the cyst causes a depression in the nail. Untreated, these typically go away in a few years. If they are painful, they can sometimes be improved with a cortisone injection; these may also be surgically removed. Also, some dermatologists have noticed that these may resolve more quickly by simply applying pressure with the opposite thumb for a few seconds several times a day. Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (2/6/2007) 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, Eugene, PHMG/PED-Willamette (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, Physical Medicine &, Eugene, Rehabilitation Medicine Associates (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 Medical Group - Oregon (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, Springfield, PHMG/Urgent - RiverBend (10/19/2006) Q Last week, about an hour after waking, my husband lost use of his right side. He could move his limbs and digits, but not very well due to weakness/heaviness. Even the right side of his tongue was numb/tingling. I feared Transient Ischemic Attack (he is 38, hispanic, over-weight & diabetic), but he was not disoriented or slurring speech. Five days later, he is no longer dragging his right leg. He can also now touch all his fingers on his right hand to his thumb, the weakness has subsided somewhat, but he can feel a "knot" in his mid-back & shoulder region, plus his neck "cracks" when he turns his head back/forth. He had a neck injury when he was a teen and wore a neck brace for a year. The night before this happened, he was in a very precarious position on the couch playing video games at an odd angle. Could this have set off numbness, or aggravated an old injury, pinched a nerve, or something less severe than my fear that his brain lost oxygen and/or blood flow for a time? We currently have no medical insurance nor available money, so he is being very stubborn about going to the doctor. Is there a simple or inexpensive test that can be done to narrow down the cause of this episode? After five days, his right arm is still weak with limited mobility and his hand is almost useless. His grip is very weak and his arm feels cold to the touch (although color is good). I've been massaging his neck & shoulders. He seems to improve a little every day. How concerned should I be? Thanks in advance for your help. P.S. He has had problems off and on with Tennis Elbow & Carpal Tunnel during the last 7 years. Could this be why his arm is taking longer to recover than the rest of his right side did? A You are right to be very concerned. He most likely had a stroke. It is unlikely this is due to a spine problem but that is also possible. If he had a stroke, he his at high risk of a recurrent stroke and needs to be fully evaluated as soon as possible. He should see his physician, or go the emergency room, the PeaceHealth Medical Group Urgent Care Clinic, or go to the Volunteers in Medicine Clinic right away before a larger stroke occurs. See this website for more information on stroke: http://www.peacehealth.org/Oregon/KnowStroke/ Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (10/5/2006) Q My fiance was admitted to the E.R. a few weeks ago. The doctor at the walk-in clinic thought that it might be appendicitis, so they ordered a CT scan and diagnosed it instead as possibly being colitis. They prescribed some antibiotics and released her and after a few more days of pretty severe abdominal pain she was feeling better. Our question is that she seemed to be displaying all of the symptoms of the E. coli infection that now seems to be all over the news (abdominal cramping, severe diarrhea, blood in stool). She was not tested for E. coli in the E.R. How can we find out if it was an E. coli infection now? If it is/was an E. coli infection, is she still in any danger? A It would have been reasonable for your fiance to have a stool culture test done at the time of her symptoms. Now that she is better and she has been on antibiotics, it is unlikely there would be any positive results from a culture. You may want to check to see if perhaps a sample was sent for culture at the time. E. coli toxin is usually a self-limited illness in otherwise healthy adults, so it is unlikely there would be any long lasting effects if that is what she had. Answered by Emily Gibson, MD, Family Practice, Bellingham, Western Washington University (9/28/2006) 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 My daughter is 21 and has a problem eating beef, butter (margarine is okay), and fatty foods. These foods give her diarrhea. She doesn't seem to have trouble eating a vegan diet and chicken is gentler on her stomach. At first we thought it was just nerves but this has been going on since she was 16. She doesn't want to see a doctor. Does this sound like a condition that could be treated? A It is possible she has a liver, gallbladder, intestinal, or pancreas problem with poor fat digestion or absorbtion. At the very least it puts her at risk for certain vitamin deficiencies/malnutrition. She should see a physician! Answered by Mark Lyon, MD, Family Practice, Eugene, PHMG/FP-South (8/2/2006) Q My husband has an ulcer and has been having problems with it for years. He just recently started vomiting after he eats something that does not agree with him. It looks like there are coffee grounds in his vomit. What does this mean? A He needs to be seen immediately in the Emergency Room. He could have a bleeding ulcer which is quite serious and needs attention now. Answered by Christa Danielson, MD, Family Practice, Eugene, PHMG/FP-South (7/24/2006) 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 My employer requires a TB screening. I do not have a primary care physician. Where in the Eugene-Springfield area can I get this done? A I would contact the Lane County Public Health Department at (541)682-4041. Answered at 7/19/2006 Q I recently had inflamed tonsils for a couple of weeks. Shortly afterwards I noticed bumps on my tongue towards the back of my throat. The bumps are where my tonsils touch my tongue. I was wondering if you could tell me why the bumps are there. A The tongue is covered with taste buds called papillae. They come in various sizes and shapes based on location on the tongue. There are also patches of lymph gland and lingual tonsils along the back of the tongue. Lingual tonsils can become inflamed along with the pharyngeal tonsils with which most people are familiar. Both the lingual tonsils and pharyngeal tonsils are part of our lymphatic system and can increase or decrease in size when irritated or infected. So, you are either looking at the posterior tongue taste buds or patches of lymph tissue or lingual tonsil both of which are of no concern. Both of these are often enlarged in smokers. If you are concerned about them, you should see your primary care physician for an evaluation. Answered by Dennis Diaz, MD, Otolaryngology, Eugene, PHMG/ENT-Hilyard (7/12/2006) 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 What are some signs of heart problems? I have had a lot of heart burn lately and a racing heart, but I do have anxiety attacks. My doctor said to "bear down" when it happens. What are some natural ways to help my panic attacks? A The suggestion to "bear down" is a good one and can help slow rapid heart rate in some instances. The question about "natural ways" to address anxiety and panic is the right one. In my experience, the "natural ways" of treating panic/anxiety are a required part of treatment. Though there are any number of medications that can be of help, they must be part of a more comprehensive approach to the problem. Here's a link to an excellent and reliable resource that describes different natural approachs: http://www.peacehealth.org/kbase/topic/major/hw53796/descrip.htm The challenge with many of the suggested approaches is that they require a commitment of time and with some a significant investment of energy to learn new skills. Also, take a close look at the relationships of which you are a part. Are you supported and accepted by those around you? Do you have close relationships with others who are critical, negative, extremely anxious themselves or who have drug or alcohol problems? For many of us, our emotional state is highly dependent on our families, co-workers or other social support systems of which we are a part. A counselor can be of huge benefit in sorting through this. Good luck! Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (7/7/2006) 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 have an elderly family member who has started taking a nutritional supplement at the recommendation of her friend. The supplement is called Reliv and is very high in many vitamins. She takes 3 doses a day and I am concerned that she may be consuming excess quantities of some vitamins. She is in good health and eats regular, healthy meals but wants to take the supplements as well. Which vitamins can be harmful if taken in excess, and what is considered excess for those vitamins? A B vitamins (thiamine, niacin, riboflavin, folic acid and cyanocobalamin) really have no upper limit of safety to their dosage, as the body simply flushes out excess B vitamins. Vitamin C, likewise, can be taken in very high doses, 5 grams per day or more, without toxicity in most people, although it may effect acidity of the urine which can result in urinary tract problems in some people. This is not to say that more is better. Going beyond the recommended daily allowance (RDA), except for severe deficiencies, while not dangerous for these vitamins, is of no benefit. The fat soluble vitamins, A, E, D, and K, do accumulate in the body, unlike the B vitamins and vitamin C. Vitamin E and K are widely considered to be safe at high doses, beyond the stomach distress and diarrhea that a high dose of Vitamin E can cause. Vitamin A and D, however, can cause mild to severe side effects depending on the dose. The RDA for Vitamin A is 3000 units per day in adults, and severe side effects can occur if someone takes more than 50,000 units per day on a regular basis. The RDA for vitamin D is 400 units per day, and side effects can occur with doses as low as 1600 units per day, with severe side effects if the dose gets above 4000 units per day. In reviewing the Reliv products, I could only find one that contained any vitamins at all, FibRestore. It contained 3500 units of Vitamin A, 300 units of Vitamin C and 200 units of Vitamin E, all very close to the RDA and of no concern. The remaining products in the Reliv line consisted almost exclusively of herbal products with no vitamin supplementation. I suggest reviewing the specific vitamin content of the product your loved one is taking and if you have any other questions, contact us. Answered at 6/28/2006 Q Every time I get a cold or flu virus I end up with either a sinus infection or bronchitis and have to take antibiotics. I took a lot of antibiotics as a child and am wondering when the medicine will no longer help me and then what my options will be? I am also now allergic to sulfa and sensitive to amoxicillin. A The answer is: whenever your infecting bacteria become resistant to all commonly used antibiotics. The chance of this happening soon is slim to none, but increases every time you take them. Current recommendations are to NOT take antibiotics in the first 10 days of a head cold (commonly mistaken for a sinus infection, even if blowing green...) or the first 3 weeks of a chest cold (commonly mistaken for bacterial bronchitis). The less you use them, the better they work, and the fewer chances of an allergic reaction (which can be more dangerous than the above infections), or colitis, or yeast infections, etc. Answered by Mark Lyon, MD, Family Practice, Eugene, PHMG/FP-South (6/26/2006) 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 How long can HIV live on a used syringe (the needle)? A From hours to days. Answered by John Wilson, MD, Infectious Disease, Eugene, The Travel Clinic (6/15/2006) 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, Eugene, PHMG/Admin-Willamette (5/19/2006) Q I've recently started (about one month ago) having left-sided headaches, starting at about the temple or left corner of my eye and extending to the lower back of my skull. This is almost always associated with a feeling of fullness in the left ear. Sometimes my left eye tears from it as well. At first I thought my glasses were just fitted poorly and causing pain, but it happens even if I haven't been wearing them. It's happening at least every other day. Usually it is at least manageable with Tylenol but I'm getting a bit tired of taking that every day. I just noticed today that my skin feels somewhat "odd" on the left side at the same time - tight, heavy. Any ideas? Should I see someone about this? A The answer is yes, any new headache pattern that is unfamiliar and progressing with the kind of frequency and symptoms you are describing should be evaluated by a physician. It is possible this is a type of "cluster" headache that often has eye symptoms and congestion/tearing as part of the syndrome. There is effective medication to prevent and treat it. Answered by Emily Gibson, MD, Family Practice, Bellingham, Western Washington University (5/18/2006) Q I have discovered a small hard lump, about the size of two peas at the rear of my anus. What do you speculate it might be, and/or be due too? I only use alternative medicines. A I suspect hemorrhoids but you should see your personal physician to confirm this. Please see the information on the Healthwise Knowledgebase concerning common treatments for hemorrhoids. Answered by Frank Littell, MD, Hospitalist, Springfield, PeaceHealth Medical Group - Oregon (5/17/2006) 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 I am a black/asian 30-year-old female and I am currently using Retin-A cream for my acne. Will this also help fade the dark spots left behind. I do not want to use bleaching creams. A Retin-A may fade some of the dark spots from acne. If Retin-A alone is not fading them enough, sometimes adding a hydroquinone-based fade cream may help. There is a prescription medication, Tri-Luma, which is a combination of tretinoin (the active ingredient in Retin-A), hydroquinone and a mild cortisone that can help as well. Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (4/17/2006) Q Can ear infections make your neck hurt? If your neck aches like a kinked muscle is that most likely an ear infection? A Pain in any place in your body can radiate (or travel) to nearby parts of your body. And it is not uncommon to have ear pain radiate pain down one's neck. Another possibility is that a lymph node in your neck could be swelling and causing pain. It is pretty uncommon for an adult to develop an ear infection. It is usually swelling in the back of the throat that does not allow the Eustachian tube to work properly and pressure builds up in the middle ear, which causes pain. To help differentiate these causes, you should probably see your primary doctor. Answered by Glenn Ziemski, MD, Emergency Medicine, Springfield, PHMG/Urgent - RiverBend (4/11/2006) Q I had my tonsils out two months ago and since then I cannot taste anything. Everything has a very funny taste to it. A Probably your taste nerve was tethered (stretched) and it will recover just fine, although it may take 4-6 months. Follow-up with your surgeon if it hasn't recovered after that time. Answered by Emil R. Hecht, MD, Otolaryngology, Bellingham, Bellingham Ear Nose & Throat (4/6/2006) Q I was wondering if you could tell me anything I can do to remedy this RLS (Restless Leg Syndrome) that I have. I am currently taking Mirapex 2 a night but I still get the tingling in my toes and it is quite unbearable. I read somewhere that it is something in my diet. Is this true? Anything you can tell me would be appreciated!! A Thank you for your question. The first thing is to be certain that the diagnosis is correct. From what you mention of your symptoms (tingling in toes), other possibilities also need to be considered, particularly polyneuropathy. You might want to be certain that you do not have polyneuropathy or polyradiculopathy. Your physician can help you determine that or can arrange a referral to a neurologist if he/she feels that would be appropriate. If we assume that RLS is the correct diagnosis, then we typically try to determine if there is any specific cause. The most common specific cause is iron deficiency anemia and a simple ferritin blood test and complete blood count can determine if that is the cause. The treatment is different in that instance. There are a few rare other causes. If it's determined that you do not have any specific cause, then most patients are treated either with carbidopa/levodopa if it is NOT a nightly occurrence or with either pramipexole (Mirapex) or ropinirole (Requip) if it is a nightly occurrence. If those are not successful there are a number of other treatments that can be used on a trial and error basis. Again either your physician or a neurologist can help you with all of that. Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (4/4/2006) Q What's wrong if my tonsils are normally large and have small holes in them? A The holes are probably crypts which are just scars on your tonsils from previous infections. Sometimes they get large enough to trap food particles in them and if this happens they can form little stones called tonsiloliths over a long period of time. There really isn't too much to do about them. Having such scarred tonsills may make you more prone to harboring a Strep infection. Answered by Glenn Ziemski, MD, Emergency Medicine, Springfield, PHMG/Urgent - RiverBend (3/16/2006) Q The bottom of my left big toe was swollen for some unknown reason on Sunday. On Monday, I felt more pain and once at home, after removing my shoe and sock, I saw the area of swelling. I iced the toe and went to sleep. Today the swelling continues and my foot is becoming swollen. Any suggestions? A Take some ibuprofen, elevate your foot and avoid rich foods and alcohol. It sounds like you may have gout. Make an appointment to follow-up with your regular doctor. What is gout? Gout is a disease usually caused by having too much uric acid in your body. Too much uric acid may not cause symptoms for years, but after a time it usually causes painful joint inflammation (arthritis). The most common site of inflammation is the joint between the foot and the big toe. Later attacks often affect other joints of the foot and leg. Less often, the arms and hands are affected. In addition to the arthritis, gout causes the formation of tophi. Tophi are lumpy deposits of uric acid crystals just under the skin. Common places for tophi to develop are in the outer edge of the ear, on or near the elbow, over the fingers and toes, and around the Achilles tendon in the ankle. Gout can also cause kidney stones made of uric acid. Most people who have gout are middle-aged men, but it can occur at any age. Only 5 to 10% of cases of gout occur in women, most often after menopause. How does it occur? Gout usually occurs because too much uric acid is in your joints. The uric acid forms crystals in the joints. The crystals cause pain and inflammation. You may have too much uric acid in your joints when your kidney does not eliminate enough uric acid from your body or when your body produces too much uric acid. People who have recently had a serious illness or surgery have an increased chance of having an attack of gout. Some people have gouty arthritis even though they have normal uric acid levels. Most cases of gout are caused by poor elimination of uric acid by the kidneys, but it can be hard to know why it is happening. The specific problem with the kidney is usually never found. You may have inherited a tendency to produce too much uric acid. You may make too much uric acid if you have a disease such as cancer or certain types of red blood cell disorders. A diet high in alcoholic drinks and purine-rich foods (such as meats) can also cause your body to produce too much uric acid. Uric acid levels in men start to go up after puberty. Women's uric acid levels usually do not go up until after menopause. For this reason women are protected from gout until several years after menopause. The uric acid levels have to be high many years before gout develops. Men with gout usually have their first attack when they are middle-aged. Certain conditions, such as dehydration, can cause excess levels of uric acid. Diuretic medicine (also called water pills) can increase levels of uric acid. Other medicines can also affect the level of uric acid in the blood. It is important to make sure your health care provider knows all the medicines you are using, both prescription and non-prescription. What are the symptoms? Some people have high uric acid blood levels for years and never have any symptoms. Only 10 to 20% of people with high levels develop the symptoms of: sudden, severe pain, especially of just one joint at a time redness swelling The sudden attacks are sometimes related to physical illness, trauma, or excessive alcohol use. The symptoms may last for days to weeks. The arthritis usually occurs before tophi or kidney stones develop. The tophi do not cause any symptoms unless they open and drain. They are often not painful. Depending on their location, they may limit the movement of joints. The symptoms of uric acid stones are like those of other kidney stones. They can cause severe abdominal pain and sometimes nausea, vomiting, fever, or blood in the urine. How is it diagnosed? Your health care provider will suspect that you have gout if: Your first toe joint is inflamed. You have a blood test that shows a high level of uric acid in your blood. You are developing tophi. You start taking the drug colchicine and your symptoms of arthritis improve. (Colchicine, an anti-inflammatory drug, is effective only in gouty-type arthritis.) To confirm the diagnosis, your provider may take a sample of fluid from the affected joint or joints and send it to the lab for tests. If you have uric acid crystals in the fluid, you have gout. How is it treated? Usually, if you have high uric acid levels but no symptoms, you will not need treatment. In special cases (for example, if you have a strong family history of gouty arthritis or kidney stones), you may be treated for gout even though you do not have any symptoms. If you have symptoms of gout, the goals of treatment are: Treat the gouty arthritis or kidney stones. Try to prevent the recurrence of these problems by controlling the uric acid levels. Prevent serious complications such as kidney damage. Treatment of the arthritis first involves the use of anti-inflammatory medicines, such as colchicine or indomethacin. Your provider may prescribe nonsteroidal anti-inflammatory medicines (NSAIDs) such as ibuprofen or naproxen. Aspirin is not usually recommended because it may keep the urine from taking the uric acid out of the body. Sometimes a corticosteroid drug, such as prednisone, is used. Medicines are sometimes taken daily to prevent recurrent attacks of gouty arthritis. If the gouty arthritis becomes a frequent problem, allopurinol and probenecid may be used to prevent damaging deposits of uric acid in the joints. How long will the effects last? The sooner treatment is started, the sooner the symptoms stop, which may be within 24 to 48 hours. If gout is not treated, it could last a few days to several weeks. A second attack may occur, but usually not for 6 months to 2 years. In other cases another attack may not occur until many years later, or never. How can I help prevent gout? There is no sure way to prevent gout. However, you can take these steps to lessen the chance that you will have high uric acid levels: Eat a diet low in purines and do not overindulge in alcohol. Purine-containing foods include organ meats (such as sweetbreads, liver, and kidney), shrimp, anchovies, sardines, and dried legumes. Your consumption of alcoholic beverages should not exceed 2 ounces a day. Drink lots of fluids. Answered by Erin Reilly, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (3/8/2006) 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, Family Practice, Springfield, PHMG/Urgent - RiverBend (3/8/2006) Q I have had menstrual-type cramps for a few months now. They ease up a little here and there but I have them pretty much all the time. I told my doctor about it in December when I had my physical and she didn't seem too concerned at that point even though it had been going on for about three weeks. I'm not sure if the pain I'm having is really something else and/or if I need to be concerned? A Yes, I would be concerned. You need more evaluation. I can think of several things that could be causing this, including both gynecologic problems and intestinal problems. If there is any chance of pregnancy you should be evaluated for a tubal pregnancy. You should see a gynecologist to rule out ovarian cysts and endometriosis. Answered by Linda Frison, MD, Obstetrics/Gynecolog, Eugene, PHMG/OBGYN-Willamette (2/9/2006) 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 My tonsils are very sore and it hurts up into my ear. It looks as though there are holes in my tonsils. Is there any connection between my sore tonsils and the pain in my ear? A Pain in the back of the throat could be radiated up to the ears. There also may be some swelling in the back of your throat that is affecting the eustachian tube, which usually vents pressure from your middle ear. This could allow preasure to build up and give you the sensation of pressure in your ear, like going up in the mountains and not being able to clear your ears. Your doctor may be able to help bring the swelling down quicker than it would naturally come down. The holes in your tonsils are probably scar tissue from previous infections. Answered by Glenn Ziemski, MD, Emergency Medicine, Springfield, PHMG/Urgent - RiverBend (2/7/2006) 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, Eugene, PHMG/PED-Willamette (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 ok for someone with high blood presure to take Mucinex? A This drug thins sputum to help clear airways with coughing and has no impact on blood pressure. It's fine to take it with high blood pressure. Answered at 1/17/2006 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, Eugene, PHMG/IM-Willamette (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, Eugene, PHMG/Admin-Willamette (1/5/2006) Q Should I contact a doctor about white/cream colored mucus-like stools? This has happened twice in two weeks with only a small quantity of stool. It seems to be in conjunction with some diarrhea and may be associated with eating at restaurants. A I think it would be a good idea to contact a doctor. For the most part mucus in the stool is usually not a serious problem, but it is wise to be cautious. Answered by Loren Barlow, MD, Internal Medicine, Eugene, PHMG/IM-Willamette (12/27/2005) Q I have been exposed to pneumonia, not the viral type. I work with this person in an office only a few feet away. I am told that he is not very contagious. Is there anything I can do besides normal handwashing? Should I wear a disposable mask or should he? Is there a vaccine? A The "pneumonia shot" does not prevent getting pneumonia per se, what it does is prevent sepsis (a severe blood infection) from a particular kind of bacteria which can also cause pneumonia and meningitis. So, no, there is no vaccine that will stop you from getting pneumonia. The Pneumovax shot, however, is still, a good idea. Get plenty of rest, fluids, use good handwashing technique, and don't share phones with other people. That's really the best you can do. Answered by Erin Reilly, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (12/14/2005) 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, Eugene, PHMG/PED-Willamette (12/13/2005) Q I am taking Vicodin and have developed a miserable cold. Is it 'ok' to take a night-time cold pill? A Many of the over the counter cold remedies have acetaminophen. Vicodin also has acetaminophen, so I would avoid most of the proprietary cold remedies and stick with single ingredient medicines. You could use phenylepherine nose drops (if you are not taking medicine for high blood pressure) for nasal congestion. If the Vicodin is not controlling fever and body aches, you could add ibuprofen or naproxen, but only at the labeled doses on the bottle, and only for a short period of time. Answered at 12/1/2005 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. What a great Christmas gift! Answered by Erin Reilly, MD, Family Practice, 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 at 11/19/2005 Q While taking coumadin will drinking beer daily raise or lower the protime reading? A Yes! First of all, alcohol has been reported to increase and to decrease the INR (International Normalized Ratio) when taking coumadin. And, that is just the tip of the iceberg! Alcohol, metabolized by your liver, can cause problems with other bleeding factors and further increase your risk of bleeding. Alcohol also increases your risk of problems with your stomach, ulcers and gastritis. Both of these problems cause bleeding in your stomach--a VERY dangerous problem if you are taking coumadin. Alcohol is not essential to your well being. An OCCASIONAL glass of wine or beer is not too risky, but there is no NEED to drink, ever, and ceratinly, not every day. Please refrain from alcohol in general while you are taking coumadin. Answered by Erin Reilly, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (11/14/2005) 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, Springfield, PHMG/Urgent - RiverBend (11/8/2005) Q How old should a candidate be for a knee replacement? A There is no specific age limit or threshold for total joint replacement. However, the older you are (60's, 70's, etc.) the more likely you are to have an implant that lasts you the rest of your life. Generally, a successful total knee replacement has about a 90% chance of lasting for about 10-15 years. If you have to have the original joint removed and replaced (a total joint revision), the results of each subsequent operation gets worse. That is why waiting as long as possible is usually recommended. Answered by Thomas Wuest, MD, Orthopedic Surgery, Eugene, Slocum Orthopedics (10/31/2005) 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 What do you know about the effectiveness of policosanol as compared to lipitor in lowering LDL cholesterol? A From the Natural Medicines Comprehensive Database: Hypercholesterolemia. Taking policosanol orally 10-20 mg/day seems to significantly decrease total cholesterol and low-density lipoprotein (LDL) cholesterol, and increase high-density lipoprotein (HDL) cholesterol. Policosanol seems to decrease LDL cholesterol by 11% to 31% and increase HDL cholesterol by 7% to 9%. Policosanol 10 mg/day seems to be comparable to fluvastatin (Lescol) 20 mg/day and simvastatin (Zocor) 10 mg/day in cholesterol-lowering ability. The majority of clinical studies on policosanol have been conducted in Cuba by a single research group. These studies used policosanol derived from sugar cane. It is not known if US manufactured policosanol from sugar cane or policosanol from other plant sources is equivalent to the Cuban product. There is some evidence that wheat germ-derived policosanol 20 mg/day does not significantly lower cholesterol after 4 weeks of treatment. The reason for this potential difference is unclear since wheat germ derived policosanol is almost identical to sugar cane derived policosanol. More evidence is needed to determine the effectiveness of non-sugar cane derived policosanol. Answered at 10/19/2005 Q Is acetyl-L-carnitine useful in treating fatigue associated with Parkinson's Disease? My mom's neurologist suggested it as possibly helpful. She is 81, has had Parkinson's Disease for 12 years. A Thank you for your question. There is some literature on the use of acetyl-L-carnitine in Parkinson's Disease, primarily to improve sleep pattern. It is officially considered "possibly effective" and the official rating of the documentation is considered "fair" for this use. I am not aware of literature specifically addressing fatigue though one might hope that if sleep is impaired and acetyl-L-carnitine improves sleep that fatigue would improve. I have no personal experience using it for fatigue. Th most common dosage is 1500 to 2000 mg daily in divided doses with agitation, nausea and vomiting being the most common side effects. Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (10/12/2005) 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, Family Practice, Springfield, PHMG/Urgent - RiverBend (10/10/2005) Q I have a bad ulcer and my esophagus is shot. I eat tons of Rolaids and drink water mixed with baking soda. Will the baking soda hurt me? A Yes, it can throw off your salt and water balance, even in your brain, with bad results. See your doctor soon and, in the meantime, get off the baking soda and try some Prilosec OTC twice a day until your symptoms are relieved (it may take a few days). Then take it daily for 6 weeks to make sure there is healing. Good luck. Answered by Mark Lyon, MD, Family Practice, Eugene, PHMG/FP-South (9/28/2005) 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, Eugene, PHMG/IM-Willamette (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, Eugene, PHMG/PED-Willamette (9/8/2005) Q What is the difference between magnesium citrate and magnesium oxide? A Magnesium citrate is a laxative, generally used to clean out the colon before a medical procedure, such as a sigmoidoscopy. Magnesium oxide is generally used as an antacid and, although less likely to produce diarrhea than magnesium citrate, still potent enough as a laxative that it's often combined with aluminum (another antacid with constipating qualities) to reduce the diarrhea. Magnesium oxide has also been used as a magnesium replacement, but is not well tolerated due to diarrhea. Answered at 9/7/2005 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, Springfield, Kathleen Hirtz MD (9/2/2005) Q I can't stay asleep. I usually awaken 3-5 times during the night. I've been this way for as long as I can remember. I'm almost 24 years old. I've tried over the counter sleep medications but after the first dose it's like I've not taken it. HELP! I've got to get some good sleep. A Trouble with sleep is a common, and complicated problem. A solution can usually be found but with a history like yours it will probably require some help from your personal physician. Here's some information that will help you get a better understanding of how to think about this problem: http://www.peacehealth.org/kbase/topic/symptom/slppb/overview.htm Good luck and be patient in your pursuit of this; in my experience it sometimes takes a while, even with the help of your physician, to get to a good understanding and solution. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (9/1/2005) 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 Medical Group - Oregon (8/29/2005) Q How would they test for ovarian cancer? Would it show a really high white blood cell count? A There is no definite test for ovarian cancer. Screening for ovarian cancer includes a thorough medical history and physical exam, including a pelvic exam. Other tests that are sometimes done include pelvic ultrasound and CT scan. There is a blood test known as CA-125 that is used to evaluate for this as well. High white blood cell counts are associated with infection and not with ovarian cancer. Answered by Linda Frison, MD, Obstetrics/Gynecolog, Eugene, PHMG/OBGYN-Willamette (8/29/2005) Q What are the symptoms of too much Vitamin D and/or Vitamin B? Also, how do you compare IU to mg? A It is not possible to get too much vitamin B from food. Excessive pharmacologic doses of some B vitamins can cause toxicity in the nerves or in the blood. It is possible to get too much vitamin D from some food sources (polar bear liver is usually cited, but not readily available). Excessive doses of vitamin D can cause cardiac arrhythmias, hypercalcemia (an excessive amount of calcium in the blood), nausea, vomiting, constipation, excessive thirst or urination. IU or international units are a biologic measure of the activity of a vitamin used when the chemical structure of a vitamin is not known for certain, or if the activity is due to a mixture of different chemicals. When that vitamin is chemically identified, the dose is usually expressed in milligrams (mg) Answered at 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, Eugene, PHMG/IM-Willamette (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, Eugene, PHMG/Admin-Willamette (8/7/2005) Q What is the safest way to go off of Prozac? What reaction can I expect in discontinuing its use? A Discontinuation of treatment must be individualized. There's no "one size fits all" answer. Any discontinuation should be done with the advice and support of the prescriber. That said, I generally recommend a slow taper with frequent visits to the prescriber to make sure there are no problems, relapses, or recurrences. Visits should continue even after discontinuation. What you may expect entirely depends on you as an individual, and again, can't be generalized. That's why you need your prescriber's help, support, and agreement. Answered by Henry Levine, Psychiatry, Bellingham, 11th Street Offices (8/1/2005) 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-Willamette (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 I have Irritable Bowel Syndrome (IBS). I take Zelnorm but I have more gas and bloating now than before the medication. Is there something I can take that will safely reduce gas and bloating. I also take Prilosec. A Most of the time people with IBS don't actually have more gas than others, they just feel it more. Simethicone (Mylicon) over the counter is the only "anti-gas" agent we know. Other ways to reduce gas are to eliminate difficult-to-digest carbs like beans, cauliflower, dried fruits, others; frequently milk/lactose is a problem and needs to be stopped. If you stop drinking milk, make sure you get plenty of calcium in other ways. Answered by Mark Lyon, MD, Family Practice, Eugene, PHMG/FP-South (7/13/2005) Q I have recently had an EEG that showed left temporal lobe epilepsy. I have been told that the success rate with drug treatment for this kind of epilepsy is only about 50%, and that most people ultimately resort to surgery. I have seizures in which I pass out almost every day, or have altered consciousness at least several times a day. I can't drive and fear losing my job. Where do I start? A Actually, the overall rate of control is higher (more like 60-80%). It sounds like you have frequent events which could make your situation more difficult. I assume you are seeing a neurologist. The typical approach is to go through a minimum of two monotherapy anticonvulsant drug trials (meaning you are on one drug at a time) and 2 or 3 trials of combinations of anticonvulsants before considering surgery. This approach is usually taken because the surgery has significant risks and is only appropriate in certain situations. In the right situation it can be very helpful although most people still take medication after the surgery. You need to work closely and quickly with your neurologist. Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (7/11/2005) Q Is it dangerous to take Aleve before rigorous physical activity (lacrosse game)? I am 47, scheduled to play in an all-star game tomorrow, but my knee is sore. I took one yesterday morning, one last night, and one this morning. I wondered if I should stop now or can I take it through tomorrow's game? I've heard some stuff about naproxen and heart attack issues. To my knowledge, I have no underlying heart issues. A There is no evidence that the intermittent use of anti-inflammatories (e.g. naproxen sodium) causes any increased risk of heart disease. The studies that have been done about heart disease risk were done almost entirely in patients that were taking these medications on a daily basis over a prolonged period of time for the treatment of chronic arthritis. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (6/28/2005) Q What do I need to do about a recluse spider bite that's about one and one-half weeks old? My 8-year-old son wrecked his bike and skinned his arm. I guess his mom and sister thought it was a problem from the wreck. He just let me look at it tonight, and it's not in the same place. It looks to me to be a spider bite. It has a deep hole in the center and is oozing puss. A Your son should be seen by his health care provider to assess the extent of this injury and to confirm the diagnosis. The bite of the recluse can be quite damaging and subject to secondary infection. He should have a physician examination. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (6/28/2005) Q My husband was diagnosed with Type 2 diabetes 8 months ago. He is doing very well on a low carbohydrate diet. What is a healthy total cholesterol number for which he should strive? When last checked, his cholesterol was 136. He is taking Lipitor and has been on high blood pressure medication for several years. A Total cholesterol is more of a screening number. Therapy is based mostly on the LDL-cholesterol. The current treatment targets based on the American Diabetes Association Clinical Practice Recommendations are: Total Cholesterol: Under 200 LDL-Cholesterol: Under 100, best is under 70, and the target is under 70 for patients with diabetes and known heart disease. HDL: Females: Over 50, Males: Over 40 Triglyceride: Under 150. Answered at 6/28/2005 Q I get tiny clear liquid-filled bumps on my fingers, usually when the weather changes and humidity increases. The bumps are on both sides of all my fingers. There are so many of them (maybe 75 on each finger) that it hurts to bend my fingers to make a fist. They pop easily if I scratch them, although they are not terribly itchy. A This sounds like dyshidrotic eczema (old name: pompholyx). It is a sensitive skin condition, and tends to break out when you have your hands in water a lot, or are doing "wet work." It can come up with changes of the seasons, or with stress. If it doesn't itch, it does not need to be treated. Treatment usually consists of topical corticosteroids, which help with itching. Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (6/15/2005) 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 I have an odd mass growing in the tip of my nose. It is hard and is only growing on one side. It started out small, like pin-size, but now has grown to pea size. It has made one side of my nose look very pointy when looked at in a profile. I am wondering what this might be? A It could be any number of things, including cartiledge growing, a mole, various harmless growths, or a skin cancer. The common type of skin cancer, basal cell carcinoma, is caused by sun exposure, so they are very common on the tip of the nose. Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (6/8/2005) 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 Medical Group - Oregon (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, , Springfield, PHMG/BHS-Spfld (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, Eugene, PHMG/IM-Willamette (5/31/2005) Q I have a severe reaction every time I'm bitten by a "no see um" "gnat". I get severe swelling that is disfiguring (swelling makes me literally unrecognizable, especially if bitten in forehead or hairline). It lasts for a week or more. I have been sent to the ER by my PCP more than once because of the pressure from the swelling. Benedryl doesn't help at all. He also sent me to an allergist who has suggested allergy shots for non-biting flies. Will this help? Is there a shot that includes the "no see um" gnat? The allergist is unsure whether they are a part of the non-biting fly allergy shot series, but wants to try. Any information you may be able to provide would be greatly appreciated. At the moment I am unable to stay outdoors for more than a few minutes during the months of May and June. I really don't want to move and uproot my entire family to a drier climate, and I'd like to one day see my son play baseball. A The good news: you don't get acute systemic or anaphylactic reactions to the bites of the "no see-ums". That is the usual indication for treating hypersensitivity reactions to stinging insects. Most of the information we have is related to hymenpteran (bees, yellow jackets), and a little bit is known about mosquitos and deer flies. The bad news: these are true allergic hypersensitivity reactions. The further bad news: I am not aware, nor am I able to readily find, any info regarding the validity or efficacy of allergy shots for "no see-ums". It seems like a lot of time, money, and effort to go thru for an undefined degree of benfit, which could well be zero. And,you'd have to be on the shots for a MINIMUM of 9-12 mos before we could tell if there is any benefit. On the other hand, you are really suffering. Review with your PCP or allergist alternative treatments including daily pretreatment with an antihistamine +/- leukotriene blocker, as well as rapid institution of a short course of oral Prednisone (the most likely Rx to inhibit the severe and protracted swellings that you experience). If you go for shots, you need to have demonstrated (+) skin test reactivity to the "antigens" (allergens) in the specific "immunotherapy extract" (I'm including the technical jargon to help you more fruitfully discuss your problem and treatment options. Answered by David Elkayam, MD, Allergy & Immunology, Bellingham, David Elkayam MD (5/31/2005) Q I am 13 and my teacher was diagnosed with mono and I am wondering -- do you have mono all your life? Can you get rid of it? Like some other diseases can it cause death? A Infectious mononucleosis (also called mono) is a viral infection. It is a common infection, but often it causes no symptoms, especially when children have it. However, for adolescents and young adults it is a frequent cause of illness and missed school. How does it occur? The virus that causes infectious mono is called EBV (Epstein-Barr virus). It is spread mainly through saliva, which is why it has the nickname "kissing disease." What are the symptoms? After the virus enters the body it can take up to a month before symptoms begin. The first symptoms usually are: tiredness, fever, headache, muscle aches. Many people have extreme tiredness and need to sleep 12 to 16 hours a day before they have any other symptoms. After a few days of fever and aches, other symptoms are: sore throat, swollen lymph nodes ("glands") in the neck. You may also have: a loss of appetite, nausea, joint aches, a rash, sometimes including tiny red spots in the mouth. How is it diagnosed? Your health care provider will ask about your symptoms and examine you. Your provider will look for fever; a red throat with enlarged tonsils, sometimes covered with pus; and enlarged lymph nodes in the neck. You may also have a red rash, especially on the chest, and an enlarged spleen (in the upper left abdomen). A blood sample will be taken to test for mono. The first blood test might be negative, but a complete blood count may show that a mono infection appears to be developing. Your provider may ask you to return in a few days for another blood test. If you have mono, this second test is usually positive. How is it treated? There is no specific drug treatment for mono. Because it is a viral illness, antibiotics are not helpful. The most important thing you can do is to get plenty of rest. Take acetaminophen for fever and sore throat. If your symptoms seem to be worsening rather than gradually improving after 1 to 2 weeks, tell your health care provider. You could develop strep throat or a sinus infection. An uncommon complication of mono is an abscess (pocket of infection) on the tonsil. These infections do need to be treated with antibiotics. Sometimes the mono infection causes the tonsils to become so big that they nearly block the throat. Your health care provider might prescribe steroids (Prednisone) to try to decrease the size of the tonsils. The virus might inflame your liver. Do not drink alcohol when you have mono because alcohol could further injure your liver. If your spleen is enlarged, it could rupture if it is hit or strained. A rupture of the spleen causes severe bleeding and is a medical emergency. For this reason, you should avoid heavy lifting and any kind of jarring activity or contact sport until your spleen returns to a normal size. Otherwise, you will gradually be able to return to school, work, and sports. How long will the effects last? Your symptoms may get worse for 2 or 3 weeks after they first appear. Usually the fever, sore throat, and extreme fatigue last about 1 to 2 weeks. The illness is most contagious at this time. It can take several weeks, and in some cases several months, for the body's immune system to overcome the virus, but the illness is less contagious after the fever has been gone a few days. The Epstein-Barr virus stays in the body even after you recover. You could have mono again, but this does not usually happen. Answered by Erin Reilly, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (5/30/2005) Q I am 20 years old with a 1 year old daughter, and I have a problem with my weight. I have always struggled with it. I was reading some stuff online about prescription weight loss medicines, and I am wondering if I could find out more, and if they're available? A I cannot recommend any SAFE prescription weight loss medications. There are some physicians who are still prescribing Fastin and phenteramine. A moderate reduction in caloric intake accompanied by an increase in your aerobic activity (30 min at least 4-5 times a week). It takes 3500 calories to lose a single pound. If you can increase your activity by 500cal a day (that means actually getting your heart rate up, for you in the range of 140-160 beats per minute for 30-45 min)AND reduce your caloric intake by 500 cal/day, then you could lose about 2 lbs a week. This is a safe and healthy way to lose weight, will increase your energy, and you will be MORE likely to actually keep the weight off. You really want to try for a LIFESTYLE modifications, not a "diet" -- you don't want a temporary solution, you want permanent, long term change. Many people make big mistakes in portions. Try to measure your food for a single week to actually get a true perspective of what a "portion" is for you. Look at portion size on the packaging on foods- you'd be amazed! Start making these great changes in your lifestyle now and you will also set a super example for your daughter to make healthy choices in her life! Answered by Erin Reilly, MD, Family Practice, Springfield, PHMG/Urgent - RiverBend (5/30/2005) Q I'm 23 years old and am currently using several products to treat acne -- Minocycline, brevoxyl, and duac gel. I have only been on it for a week so I'm not sure if it is working, but my skin is very dry, red, and peeling. Will this go away after a while, or is there some sort of lotion that may be used without further aggravating things? A Your medications will take at least 4-6 weeks before you even begin to notice improvement. The dryness and irritation are most likely due to the duac gel. You may need to cut back to every other day until your skin gets better acclamated before increasing its use. You can also use a light moisturizer to help with the dryness. Answered by Jay Park, MD, Dermatology, Eugene, Jay Park MD (5/25/2005) Q I am a 24 years old female. About a year ago one day when I woke up I noticed a big white patch( about a quarter size) on my neck and smaller size patches on my face. Later on I was told that I have vitiligo. I'd like to know if there is any treatment for that other than depigmentation, and if it safe for me to tan or use tanning salon beds? A There are various treatments for vitiligo. Most commonly, I use topical corticosteroids or Protopic. There are some other treatments available as well. The most important issue with vitiligo is that the white areas have no natural sun protection, so it is critical to protect these areas from ultraviolet radiation (sun and tanning booths). Spray-on tans are fine. Also, if you don't have a tan elsewhere, the vitiligo is less obvious, so I very strongly recommend against tanning. Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (5/25/2005) 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, Eugene, PHMG/Admin-Willamette (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 My husband recently had a root canal on the upper left side last tooth. While the dentist was doing it he started to feel pain. On the way home his nose started to bleed, but only on the side the work was done on. After a while it only would bleed if he bent over. This went on for 14 1/2 hrs. Then he started to have a clear discharge when he bent over. It has been 4 days, and still if he bends over he has the clear discharge. Through the night he has discharge in the back of the throat while lying down. On the Internet we read about nerve damage and all kinds of problems worse then this from dental work. Can you help with any information on this problem? A It is often times hard to make a diagnosis without actually seeing the patient and/or at least an x-ray of the tooth in question. However, from your description it sounds as if your husband's left antrum( maxillary sinus) was perforated during the root canal treatment( that would also explain the sudden pain). Now I am assuming the nose bleed was from the left nostril, which would make sense --the roots of the maxillary molars can protrude into the sinus with only a thin plate of bone and mucosal lining around them (much like depressing your finger into an inflated balloon- the balloon being the sinus and your finger representing one of the three roots of a standard maxillary molar). However anatomy varies from person to person so in some folks the maxillary molars are not close to the maxillary sinus. Given that there was such prolonged bleeding and that your husband is still having a nasal discharge I would get in to see an ENT physician asap. Even if this was a just a coincidence, which I doubt from your description, the prolonged nose bleed is reason enough to seek further treatment. Answered at 5/23/2005 Q I am bothered increasingly by toenail fungus. What viable options are there for curing this problem? It is the cause of considerable embarrassment and annoyance. A This is a bedeviling problem for many people. There are some antifungal agents available, that if taken by mouth, can, in some cases, get rid of the infection. The downside is that they are expensive, must be taken for a long time ( up to 6 months), can interact with other medications AND in my experience the infection can recur within months of stopping the medication. Here's some more information about Fungal Nail Infections Please check with your physician about options that might work for you. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (5/22/2005) Q I am 21 yrs old. In January of 2005 I had a miscarriage. That same month I was informed that I had an abnormal pap, which led me to get a LEEP surgery in April, 2005. My husband and I are wondering when is the best and safest time for us to start trying to conceive again? It's still very emotionally hard to remember what we've been through these past few months, but we will to do whatever it takes for us to one day be blessed with a child of our own. Please respond to us as soon as you can, to put us both at ease. A After a miscarriage, it is recommended that a couple delay conceiving for about three months. This is partly to recover physically and emotionally, and also because a sooner conception has a slightly higher chance of miscarrying again. After a LEEP, you should delay conception a little bit and it depends on your exact circumstances. I recommend you call or see the doctor who did the LEEP and ask that exact question. Answered by Dickinson, Katherine, M.D. , Family Practice, Bellingham, Katherine Dickinson MD (5/20/2005) 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-Willamette (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 My Grandmother has a feeding tube and can only lie on her right side. She has little padding on her tail and hip bones and I am wondering if you may know of a way to redistribute the weight of her body when she lies down. We've tried traditional store bought pillows and other padding such as blankets and soft sheets, but the weight still rests on the hip bone and tail bone. Have you any suggestions to relieve her discomfort? She has no sores; it is simply that the weight rests directly on the bone. A Buy a piece of foam rubber and cut out an opening the size and location of her hip bone. She can then lie on this when on her right side and the weight will be distributed away from the pressure point. Answered by Martha MacRitchie, MD, Physical Medicine &, Eugene, Rehabilitation Medicine Associates (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, Eugene, PHMG/Admin-Willamette (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, Eugene, PHMG/IM-Willamette (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: Anatomic, Eugene, Stephen Erfurth PhD (5/16/2005) Q I had knee surgery 6 months ago, and this is the 2nd time in 5 years. They repaired the torn meniscus. I was told that I have a Baker's cyst that would take care of itself after the surgery. I have a full body massage once a month and the therapist told me that the Baker's cyst would respond unfavoably to normal massage, so she gentlty takes care of that knee. I was wondering if an elliptical would cause the cyst to fill up again, and cause swelling? We are considering purchasing one for home use, but I do not want to hurt my knee again. I have Fibromyalgia and Arthritis as well. A The ellilptical machine is a great one for fitness with no impact. The chances that it would cause the Baker's cyst to swell are small but since a Baker's cyst is caused from joint fluid (swelling) any activity that uses the knee could cause it to enlarge. I would not be too worried about it and go for the machine. It will also help your Fibromyalgia and arthritis. Answered by Kathleen Hirtz, MD, Family Practice, Springfield, Kathleen Hirtz MD (5/16/2005) Q I am a C-6 quadraplegic due to a car acident. I have had problems with pressure sores on my left ischial on and off for many years. I have had muscle flap surgery and complete bed rest until they heal. Basically now, my left bottom has no more muscle on it to move around. My question is this: Has there ever been any thought about putting a "butt" implant in between the bone and the skin. I have seen people get implants for all sorts of reasons. It makes sense that a silicone or plastic implant, between the bone and skin, would be a lot smoother on the skin than the sharp bone itself. A Interesting concept but I'm not aware of any such use of implants. I will research it further, but the main defense against pressure sores is and always will be strict attention to adequate EXTERNAL padding and off-loading of areas of concern. Answered by John T. Dickinson, M.D., Surgery: General, Springfield, Northwest Surgical Specialists (5/12/2005) Q About a year ago I injured my middle knuckle (at the bottom of the middle finger) when punching a skateboard (yes, ridiculous). Anyway, I am now learning karate and the pain is comming back in the joint. Do you have any ideas why this would be happening? It's the only incident that I can think of that can have triggered it. A Many punching injuries involve a fracture at the end of the metacarpal bone, very near the joint you are describing. If you never had x-rays you should, and you may find that you had a fracture which healed, but with some residual damage to the joint surface that rubs against the first bone in the finger. It would be rather early to develop true post-traumatic arthritis, but even without a fracture there is often a scar that forms in attempting to heal the injury. Now that you are again stressing that joint in karate, you are feeling the effects of that scar tissue more so than in normal daily activities. Answered at 5/12/2005 Q I believe I am currently suffering from a low level allergic reaction to quinine from Tonic Water. I am currently taking prednisone and several other antihistamines to control the reaction. Is there anything further I can do to stop or reverse the allergic reaction? This began happening Friday night and it's affecting my tongue. I’m not in an urgent care sort of situation and that seems to be hindering my ability to get help. Any information would be greatly appreciated. A The first step is being sure of the diagnosis. My experience with allergic reactions is that it's either really obvious,-- " doc, I'm allergic to cats and I just spent the weekend at my sister's and she has a cat", or incredibly challenging to figure out-- " I just started getting this rash and I'm don't think that I've done anything differently". In the "incredibly challenging" category there then ensues a 20 questions process of sorting through to see if there is anything new that might be causing it. The interesting thing here is that people become allergic to things that they've been exposed to previously and so that makes it tougher to sort out. SO, I don't know how you arrived at the conclusion that quinine is the culprit - it may well be, but don't give up on the possibility that it might be something else. So having said that, it's important to identify the allergen so that you can avoid it. If it is quinine then that's easy. Avoidance, plus the combination of medications that you describe, should stop the allergic reaction in relatively short order. Typically it takes prednisone about 48 - 72 hours to really kick in. Here's some more info about Allergic Reactions. If the reaction doesn't improve with meds and allergen avoidance OR if at any point you begin to cough, wheeze or have other breathing troubles then you should get back into see your physician immediately. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (5/11/2005) Q What is the difference between a torn, pulled, or strained quad muscle? How do I know which one applies to me? A All of these things are variations on a torn muscle; it's just a question of degree - a pull or a strain is a minor tearing of the muscle tissue at a microscopic level whereas a "torn" muscle is one that has come apart much more noticeably. With a muscle that has been "torn" there is generally a deformity at the place of tear and usually some ( or a lot) of bruising. To really know the difference would require an examination by your physician. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (5/11/2005) Q I am experiencing an unusual sensation in my left calf. It is a cold sensation in the left side of my calf. I play racquet ball and do remember hitting my shin with the racket. It is still sore where I hit it, but is not painful. There are no signs of any major bruising, the cold sensation has been intermittent throughout the day for five days since it first occurred when I was playing racquetball last week. I am 54 years old and have played ice hockey most of my life- had many injuries over the years, but have never experienced this cold sensation before. Any ideas what could be causing this? A It sounds as though you have injured a sensory nerve branch in your calf. Typically these sorts of things clear, though nerves recover very slowly. If it becomes tremendously annoying, we do have medications that can cover up the discomfort though the medications do not actually help resolve the problem. If you have any weakness in the ankle or foot, you should see a physician. Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (5/11/2005) Q Can you please explain to me what I have and what can I do to alleviate my pain? This is what the doctor said: I have a transitional vertebra at level L5 and an abnormality at L4-5. I also have arthritis in the affected areas. The MRI shows some pressure on the nerve roots --MRI Radiology report: Lumbosacral spine MRI - Normal alignment of the spine with normal vertebra body height. - at the L4-5 level, moderate diffuse disc bulge was identified with anterior indentation of the thecal sac. - no definite neural foraminal narrowing, though the spinal canal was somewhat narrowed by ligamentum flavum hypertrophy at this level, left greater than right. - The remaining disc levels were unremarkable. - The spinal cord ended normally at the level of L1. Impression: - Diffuse disc bulge with anterior indentation of the thecal sacand no definite neural foraminal narrowing. This was exacerbated by ligamentum flavum hypertrophy, left greater than right at this level. A Generally speaking, transitional vertebrae are asymptomatic. The disc bulge at L4-L5 and the other changes at that level are consistent with a degenerating disc and may cause pain. Usually, the pain can be best managed with a combination of appropriate spine physical therapy techniques, including gradual strengthening, along sometimes with medication and possibly spine injections. Surgery is generally not necessary nor does it usually yield good outcomes unless there is nerve root compression. Each case is individual, of course, and so your treatment may vary from this general approach. Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (5/11/2005) 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 & Reconstruc, 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 boy friend 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 I'm a 33 year old woman, otherwise healthy, thin. I discovered four palpable nodes in my groin about six weeks ago when I got a yeast infection. They remain there to this day, unchanged in size, painless. The two on the left feel like baked beans (same texture and size) and the two on the right are much smaller (like a tiny pea). I have no other symptoms or enlarged nodes anywhere else that I can find. I understand that palpable nodes can be normal. Does this sound normal to you? A Yes, palpable nodes can be normal, especially in conjunction with an infection. I typically tell my patients that if the nodes enlarge in response to an infection then they should grow smaller over the six weeks following resolution of the infection. Sometimes the nodes can stay enlarged for much longer than that; in fact may stay permanently enlarged. I encourage my patients to come in and be examined if they don't recede after 6 weeks. I'd encourage you to do the same. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (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, Eugene, PHMG/Admin-Willamette (5/6/2005) Q I had an MVA (motor vehicle accident)on 8/2004, resulting in continued and increased head, neck, upper back, & shoulder pain. I have increasing numbness/tingling and weakness in my arms and hands. My symptoms worsened after five months of PT and two cervical nerve root blocks. Cervical test results are (Xray, MRI, CT scan): mild loss of lordosis; C2-3, C3-4, C4-5 mild disc bulges, uncovertebral & facet joint arthrosis; C5-6 diffuse bulge, bilateral paracentral annular tears, uncovertebral & facet arthrosis, bilateral foraminal narrowing, bilateral uncovertebral-joint arthritis, degenerative disc disease, central stenosis; anterior wedging of C5 vertebral body; grade one anterolisthesis of C7 on T1 approx 5mm. Positive discogram C5/C6 & C6/C7 annular fissures. I was recently evaluated for a two level ACDF by a neurosurgeon, who recommended further evaluation of my shoulders and arms. Results -- MRI of right shoulder: inferolateral sloping of acromion; tendinosis of distal supraspinatus tendon; osteoarthrosis of acromioclavicular joint. A cortisone shot helped relieve some of my pain and I'm beginning another bout of PT. I'm worried that this continued pain, weakness, & numbness could cause permanent damage. Am I being overly concerned? A You mentioned several studies which have been done to evaluate both your c-spine and your shoulder. All of these studies suggest some underlying degree of degenerative changes pre-dating your MVA. For one, it is always hard to discern what symptoms are resulting from an aggravation of these pre-existing problems and what, if anything, is new. Second problem is sorting out what symptoms in your arm are a result of your c-spine, and what are accountable by the abnormalities seen on the MRI of the shoulder. EMG/NCV electrical tests can help to sort out if some of your weakness is simply related to pain, or whether some nerve pressure in the neck is responsible. Numbnesss and weakness distally in your arm (toward the hand) is not likely to be related to any arthritic or tendon irritation you might have in your shoulder. As far as concerns over permanent damage -- no one can ever predict to you with 100% assurance that you will get full recovery of a nerve, even after surgical relief of pressure on the nerve. Answered at 5/5/2005 Q I heard and read that blepharitis is not contagious. Then I read on the internet that some people think it is. Which is true? I have been told that no one should use your pillow and you should wash you hands well. Wouldn't that mean it is contagious? A Some forms of blepharitis are contagious; however, most are chronic and not contagious. You need to be examined by an ophthalmologist to determine which kind of blepharitis you have. Answered by I. Howard Fine, MD, Ophthalmology, Eugene, Drs. Fine, Hoffman & Packer, LLC (5/2/2005) Q A few years ago I hurt my back at the gym. There were never any sharp pains, just tight muscles and aches, so I kept on training. I recently had a CT scan and this is what they said: L3/L4 minor central disc bulge, no evidence of neuroforaminal compromise. L4/L5 - Early OA change at facet joint, mild spinal stenosis due to broad central disc protrusion - L5/S1 - Central disc protrusion indenting into the anterior spinal canal just touching the thecal sac. Can you please explain this to me and give me some treatment options? A The study suggests multiple levels of disc degeneration, meaning the cushions between your lumbar vertebrae are gradually deteriorating and bulging centrally for the most part. If people have discs which bulge to the lateral side, left or right, they might compromise the neural foramen which is the hole through which the nerve runs as it begins it's course from the spine down the leg. Often these people have radiating pain, numbness or weakness in areas of one leg or the other. Central bulging may take longer to generate these type of symptoms, and therefore may be more subtle in its presentation. Your's are described as mild. You also have mention of facet arthritis. These are the actual joints which join one vertebrae to the next below it. This can be a source of pain just like any other arthritic joint. Preferred management at his point would be non-operative including modalities to relax the muscles, lumbar exercise, abdominal toning and maintenance of good back posturing during daily activities. Recreational activities should generally favor unloaded forces to the lumbar discs such as swimming, recumbent bike and eliptical machine as opposed to running, jumping and twisting maneuvers. Answered at 5/2/2005 Q I have back pain and have been doing Physical Therapy for 7 weeks now. I have the following MRI report from 8 months ago when I had pain after a long eight hour flight: Impressions: 1. Diffuse disc bulge at the L4-L5 disc space. There is no significant spinal stenosis or evidence of neuroforminal encroachment. 2. There is right paracentral disc bulge at L5-S1 disc space with disc material abutting the right S1 nerve root. Disc material encroaching on the right S1 nerve root. My pains are getting worse. Six days of oral steroids did wonders but I can't stay on them for fear of pinching the nerve more. What other treatments are available for me? How do I go about considering surgery? I'm 30 yrs old and have no problem jogging, but I can't sit for 5 min before pain starts. A You are probably experiencing pain from one of the lower 2 discs. 7 weeks of PT is more than enough. I wouldn't keep wasting my time there. Oral steroids frequently give a brief response but rarely a lasting one. You should ask your doctor for a referral for an epidural steroid injection -- a much more effective treatment than either of the ones you have mentioned, and basically a very safe one. Answered by Michael Karasek, MD, Pain Management, Eugene, Northwest Spine Group (5/2/2005) Q Does smoking marijuana increase the risk of developing deep vein thrombosis? I know cigarettes increase the risk but I was under the assumption it was because of the nicotine. Any info would be appreciated. A I do not believe smoking marijuana is a specific risk for DVT. Smoking it is, however, a risk for overall development of vascular disease, lung cancer, etc. just like cigarettes. Answered by Frank Littell, MD, Hospitalist, Springfield, PeaceHealth Medical Group - Oregon (4/28/2005) 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: Anatomic, Eugene, Stephen Erfurth PhD (4/28/2005) Q I have Type 2 diabetes and it has been controlled for about 10 years with pills. I recently had a bad cold. Since then I have been hypoglycemic quite a few times. Should I reduce my meds? A Usually blood glucose rises when someone with diabetes is sick. The physical stress causes the liver to produce extra glucose. Blood glucose may fall however, if appetite is poor and carbohydrate is significantly less than usual and medications are maintained as usual. Weight loss can also cause blood glucose to fall; often sickness causes weight loss. These are all reasons why your blood gluocse might be lower now than before. I would suggest you call your physician immediately and see what medication changes he feels would help reduce the hypoglycemia. Make certain that you know how to recognize low blood sugars and how to treat them. Always carry a source of glucose with you and wear some sort of diabetic identification. Friends and family should also be aware of low blood glucose symptoms. Until you are able to talk with your physician be sure and check blood glucose frequently. Answered at 4/28/2005 Q I have been using Drysol for a little over a year for excessive underarm sweating. It worked very well at first, but during the last couple of months I have noticed its effectiveness diminish. Am I becoming immune to it, and if so, what should I try next? A There are lots of treatments for hyperhidrosis. If using Drysol every day is not controlling it, there is also a treatment called iontophoresis which is sometimes effective. This is a home treatment; it is made by a company call Dri-Onics. Your dermatologist may be able to get you information on this. In severe cases, I will sometimes refer people for surgical treatment. Botox is the newest treatment for hyperhidrosis. Although it is usually effective, its effects will only last a few months. Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (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 at 4/28/2005 Q I used to get little strands of hair on my chin and neck and I shaved my chin with a razor. Then I started using Nair, Epilstop, waxing, buffers and all kinds of stuff for hair removal. Recently I got some pimples on my chin and I used alcohol and a face scrub to dry it out, and now its like dead, dry skin on my face in my chin area. What can I do to stop having to shave so much, and to prevent my skin from being hard and scratchy? I am a female I just want a soft, hairless chin. A There are only two ways of permanent, or near-permanent, hair removal. The old tried-and-true is electrolysis. It is slow, as each hair follicle is treated separately. The newer method is laser surgery. There are many different lasers used to remove hair. This is best for people who have large numbers (dozens) of hairs to remove. Either treatment is going to require several sessions, and over time there is likely to be some regrowth in the area. Please stop scrubbing and using alcohol on your skin. It sounds like your skin is just getting irritated by that. Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (4/28/2005) Q I have severe degenerative disc disease, sciatica and migraine/cluster headaches. Are they in any way interrelated? I have had severe migraines since the age of 12, and the sciatica and degenerative disc disease started two years ago, with continuous pain. The pain is so intense it's treated with opioids, that sometimes don't work. A There is no direct causal relationship between migraines and degenerative disce problems. However, people who have chronic pain in one area can get chronic pain in another area. It may be well to have your problems reviewed by a pain clinic. Answered by Hugh Johnston, MD, Hematology, , (4/27/2005) 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 What causes your hands to go sleep and ache? A There are a number of things that can cause nerve damage in the nerves leading to, or in, the hands. The damage can come from diseases such as diabetes, from trauma to the nerves in the arm or in the spinal cord, or from repetitive use of the hands resulting in a thing called carpal tunnel syndrome.Here's some information on Carpal Tunnel. The things that I've listed are just a few of the things that can cause hand numbness. The bottom line is that this is not something that you should ignore: you should check in with your doctor who can help you figure this out. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (4/25/2005) Q My 11 year-old son has flat feet. Up until now his feet have been fine. However, he is now playing both soccer and baseball and sometimes complains that his feet hurt. His running stride seems to have changed a bit and, at times, almost looks a little awkward. This occurs even when he says that his feet don't hurt. I want to have him examined. Should I take him to a podiatrist or an orthopedist who specializes in sports medicine? A He should be examined either by an orthopedist or podiatrist and the prime concern of the examining physician will be whether there is flexibility to his flat foot pattern. If there is, probably exercise and adequate orthotic support of the feet will be recommended to help avoid overload of muscles and tendons around the ankle and foot. If there is stiffness to his pattern, then x-rays or even CT scan may be indicated to rule out other conditions, such as tarsal coalition, that might lead to increasing pain in a growing adolescent and put more load on a foot which has previously been asymptomatic. Answered at 4/25/2005 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-Willamette (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 Medical Group - Oregon (4/25/2005) Q My mom recently went to the doctor and had some blood work done. She found out that her white blood cell count was low (3000). The doctor told her it could have been caused by stress so, as a precaution, the doctor told her to come back in a month and have more blood drawn. She did so, and found out that her white blood cell count went down further, another 200. My mom is 60 years of age and in excellent health; she goes hiking three times a week and also golfs three times a week. I just want to know if there is anything she can do to increase her white blood count, and if there is anything to worry about? A A 3,000 white count can be a normal count for some people. A drop of 200 is within the range normal variation for a blood test. There really isn't anything that can be done to raise the blood count, or at least nothing that is acceptable practice in a healthy woman. There are some very expensive medications that are used for people who have low white counts who are on chemotherapy, but they are never used in healthy people. My only advice to you would be for your mother to have regular follow ups of her blood count for the next year or two to make sure it stays in the same range. Answered by Loren Barlow, MD, Internal Medicine, Eugene, PHMG/IM-Willamette (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: Anatomic, Eugene, 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 I started to work out (running and cycling) after long years of inactivity. But after just three days my last bone in the spinal cord has been sore and painful on doing any movement.The trainer says that bone might be moving up since running fills the gap between the spinal cord bones. I have stopped all excercises now until the pain stops. Is this anything serious and should I go to a doctor for this? A With the onset of any new exercise regimen comes the risk of injury. If the regimen was started slowly and with a physician's approval then most of those injuries turn out to be insignificant and something that needs to be worked around or worked through. I don't know enough about you, your medical history, or even the specifics of your injury to say anything of much value about your case. To get that sort of advice you would need to check in with your physician. In general if a specific activity or set of activities is causing pain I advise my patients to back down to a lower level of intensity or to move to a different sort of activity all together. Runners, esp. new ones, commonly get all sorts of back and lower extremity injuries as a result of the pounding from that activity. I frequently advise those patients to continue their work outs but to do so in a swimming pool. This allows for continued cardio exercise while providing much less intense forces on the back and extremities. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (4/18/2005) Q I am experiencing numbness on the outside of both of my feet, from about the middle of the foot back to just before the heel. This has been persistent for the last couple of weeks. I am 47, good health, 6', 170 lbs, no other health problems. Just looking for some advice on possible causes. A Naturally, it is impossible to give a definitive diagnosis without an examination; however, the distribution you describe is part of the territory of the sural nerve which is a sensory nerve branch that goes down the outer back side of the cald and around to the area you describe. It is possible you have some compression of that nerve though it would be unusual to have it occur simultaneously on both legs. Also, this could be coming from your back where the S-1 nerve root arises. Again unusual to be symmetric. Also could be related to shoes or other footwear. Less likely would be a polyneuropathy which would likely start in the toes. You would need to be examined by a neurologist or other physician to definitively diagnose the condition. Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (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 might have to have a coronary bypass procedure done. My question is about the average cost for this? I would also like to know what the average stay in the facility is for this? I have had great service in the past from your facility, but I have cost concerns now. A The most commmon coronary artery bypass graft performed is a 4-vessel bypass. The average length of stay is 10 days with average hospital charges of $60,900. In addition to the hospital charges, you will receive a bill from Anesthesia Services of Eugene and from the surgeon. To help alleviate cost concerns, please call 686-7191 to speak with one of our financial counselors who can discuss payment options available. They can also screen you for the Oregon Health Plan and for PeaceHealth's own Bridge Assistance Program, which can reduce or eliminate your balance if you meet our hardship criteria. 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 X-Rays would not be helpful. An MRI might help with delineation of soft tissue damage to muscles, but it is not the best test. The best test would be an electrical diagnostic study. These are done by neurologists or specialists in Physical Medicine. Who handles it in future is best determined by the results of the test. It would probably be done by the Physical Medicine doctor. Answered by Alan Wolf, MD, Orthopedic Surgery, Ketchikan, 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, Eugene, Northwest Spine Group (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 Specialty Clinic (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, Eugene, PHMG/Admin-Willamette (4/7/2005) Q My wife has been experiencing a breaking out in what looks like a rash for the past several years every time her heart rate gets up; ie light physical activity, a little amount of stress or worry. It came on suddenly one day while we were playing tennis and it has been a nightmare for her ever since. We have been to a dermatologist and no one seems to be able to help. As a result she has gained weight because she has been restricted to almost no exercise and she is slowly losing hope that she will ever be normal again. When she breaks out it is like red splotches begin to form around her neck, arms, legs and buttocks. There is no visible pattern. If she lets it go too long it gets into her scalp and eyes. My wife desperately needs some one to help her. A There are some exercise related phenomena that occur with certain types of disorders in which the skin is just a reflection of the underlying disorder. I would suggest you see an Internist for futher evaluation. This is a M.D. that specializes in diagnosis. The other type of specialist you might want to consider seeing is an Allergist who is well acquainted with Immunology. I think you are wise to continue to pursue the etiology (cause) of your symptoms. Answered by Loren Barlow, MD, Internal Medicine, Eugene, PHMG/IM-Willamette (4/7/2005) Q Is it ok, or not ok, to consume painkillers a couple hours before getting surgery (tonsils)? A It is probably ok, but be careful not to drink more than a sip of water. Best to avoid unless really necessary. Answered by Emil R. Hecht, MD, Otolaryngology, Bellingham, Bellingham Ear Nose & Throat (4/6/2005) 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 recently got a keloid from wearing stud earrings too tight and sleeping on them. This caused my ear to become inflammed and I eventually developed a keloid. Its the size of maybe an eraser on a pencil. I was wondering if steroid shots will work if it's been there over a year? My dermatologist, and the plastic surgeon I've seen, seem to think I'm prone to keloids. Well if that was the case wouldn't I have formed one after I got my ear pierced? What do you recommend? A Keloid formation is not always predictable, but tends to be a genetically inherited tendency and is more common in some ethnic groups. Steroid injections can be helpful in some circumstances and can be preferable to excision, which can result in more keloid formation. Give it a try. Answered by Emily Gibson, MD, Family Practice, Bellingham, Western Washington University (4/4/2005) Q Would you please explain why, "An ultrasound generally does not replace the need for a mammogram", when it's less invasive and safer to use ultrasound? Is it because insurance companies won't pay for an ultrasound instead of the traditional mammogram? A Ultrasound cannot be considered a primary imaging tool for breast disease, especially detection of breast cancer. Over the past three decades, screening mammography and breast self examination have contributed to statistically significant improvements in breast cancer detection and survival. Mammography is not a perfect tool and does not detect all breast cancers; however, it can detect changes of some early (small) breast cancers by detecting small calcifications. Some early cancers deposit small calcifications in the ductal system. Detecting these is one of the most important things mammography can do and no other breast imaging technique can reliably detect these small calcifications. Breast ultrasound is mainly used as a problem solving technique onece a finding is made mammographically or by physical exam. Women with very dense (glandular) breast tissue are more difficult to evaluate with mammography and sometimes breast ultrasound or MRI is used as an adjunct to mammography in these women, especially if they are considered to be at high risk for breast cancer (usually by family history). Answered by Jon Ekstrom, MD, Radiology: Diagnosti, Eugene, Radiology Associates, PC (4/4/2005) Q I have a question regarding a possible pilonidal cyst. About a year ago I had intense pain around the area of my tail bone. I associated it with a hard fall on ice weeks earlier, but I was told later it could be a cyst. It was heavily aggravated by sitting at the computer at length. ( I have a bad tendency to slouch and put my weight on the tailbone region.) The doctor examined me but could find no lump nor sinus. I did have mild pain when he pressed on the area but not as much as when I was sitting. It only happened when I was sitting, especially when I went to get up. It was an intense shooting/spasm pain that would be incredibly sharp and painful and last about 5-10 secs. It would then be followed by hours of dull discomfort. The clinic doctor at my university prescribed me a week of antibiotics and I have never had it again. I am, however, worried about a recurrance! I know that my mother and two uncles have had problems with the cysts. Have you heard of the cyst disappearing without drainage, etc., after antibiotic treatment? Has it just gone dormant, or do you think it could have been something else? A Yes, pilonidal problems clear with time. They are relatively common in the 16-30 age group, like acne. Pilonidals start as pimple-like irritations in the bottom of the cleft which can spread infection to deeper fat. Microscopic examination shows they are abscesses, not cysts. They are uncommon in older patients which is a sign of perfect treatment for all, or, more likely, of self-limited disease. Your history suggest that you had a small infection that responded to antibiotics. You may be a slightly increased risk of a repeat. No treatment seems necessary or useful at this point. For more information see the excellent web site,Pilonidal.org. Answered at 4/1/2005 Q Does everybody have a stomach bacteria and can it cause problems because of diet and what not? What are the symptoms if the bacteria irritates the stomach or chest? Can it cause bleeding in the stool? A Everybody does not have a stomach bacteria. The one known bacteria that can cause problems is called H. Pylori. It is known to cause Duodenal Ulcers. It is also sometimes found in the stomach without the presence of ulcers and its significance is debated by experts. If an individual has an ulcer due to H. Pylori it can cause blood in the stool. In that case, if the blood is a large amount, it will cause a black, tar-like stool. Small amounts of bleeding may not be visible to the naked eye, but will give a positive chemical test for blood. It is not bright red blood. Answered by Loren Barlow, MD, Internal Medicine, Eugene, PHMG/IM-Willamette (3/31/2005) Q I am a 27 year old female and I have always struggled with depression and panic attacks. I have never taken medication for it. My anxiety has gotten so bad in the last few months that I can't even leave my house. I am desperate for help and I am not really sure what to do. My husband and I are struggling financially and I have no health insurance. I feel that if I don't take care of my anxiety now it will only get worse. It is affecting my marriage and, worst of all, my son. A It sounds like you are really suffering with this. The good news is that anxiety can be treated very successfully. Anxiety and depression often are present at the same time and the same class of medications work for both, the antidepressants. In addition, therapy alone or with meds can help you conquer depression and anxiety. There are places in town that offer low-cost therapy,starting with The Center For Community Counseling.You might try calling White Bird for other sources of low-cost, or free, counseling. Sometimes the Counseling or Clinical Psychology Dept. of the U. of O offers counseling to the general public for no, or little, cost. Look into the Volunteers in Medicine clinic that PeaceHealth started for a source for medication. Answered by Hallenburg, Kris S. PhD, , Springfield, PHMG/BHS-Spfld (3/31/2005) Q Can the knee become pain free and still be movable after a patellectomy? With a total knee replacement would there be an artifical patella with your own patella on top of that? A Patellectomy is a operation indicated in the younger patient with isolated arthritis of the joint between the patella (knee cap) and the distal femur. Motion is usually not a problem after the operation but re-strengthening the thigh muscles IS difficult and requires significant effort and dedication. In total knee replacements, the patella is usually "resurfaced" with an implant with most of the original knee cap preserved. Answered by Andrew Boughal, DO, Orthopedic Surgery, Florence, PeaceHealth Medical Group - Siuslaw (3/31/2005) 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, Eugene, PHMG/Admin-Willamette (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 My daughter was born in India and she had BCG (Bacillus Calmette-Guerin) at the time of her birth. Now, since we have come to the US, she has had to undergo a TB test as a prerequisite to entring preschool. Her skin test shows positive 17mm. But her chest x-ray is negative. We've been advised to put her on INH for 9 months. Does BCG has anything to do with the skin reaction ? A That is a current standard recommendation as there is no way to prove that her skin reaction is from BCG only, though it is known to cause a positive reaction. She certainly is at risk of exposure to active TB in her birth country, so the cautious action is to treat her preventively with the INH. 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 About 2 years ago my 21 year old daughter got pink blotches around her finger tips. For the past year pink spots have been appearing on her lips. It looks like some vitiligo pictures I have looked up, but her blotches are very pink. She is a dark African-American. Can vitaligo be pink, or what is this? A Vitiligo is a condition where the pigment in the skin is lost. It can occur anywhere on the body, but is especially common around the eyes, around the mouth, and on the backs of the hands. It occurs at any age, and in all races. It is more noticeable in darker skinned people, because vitiligo is white. Vitiligo can look pink if the skin is flushed or sunburned. She should see a dermatologist for diagnosis and treatment. Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (3/23/2005) Q What happens if you go swimming the day after you get your ear pierced? A I've never done any ear piercing so am not the expert on this one! The person that did your piercing should have provided you with an information sheet about "aftercare for your ear piercing". If that sheet doesn't answer the question then you should check in with your piercer. Here is a link to some aftercare information about Piercing that seems very reasonable to me. In general if I do an elective surgery on someone I encourage them to keep the wound clean and dry for at least 72 hours. I make this recommendation because I know that it takes this long for the skin margins of a wound to begin sealing shut and if the wound gets wet prior to this happening that there is an increased risk of infection. Piercings are of course different from a surgical wound, in that the wound is not stitched shut. Also the gauge of the piercing likely influences how long you should keep it dry. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (3/23/2005) 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-Willamette (3/21/2005) Q I have been treated for mild anterior uveitis in my right eye for about six months. The redness in my eyes appears to be under control, but I still have fairly consistent headaches over the eyes that are not consistently on one side. ALL tests are negative including extensive blood tests. I am off the Predforte, and actually just taking ibuprofen right now and the herb, turmeric, three times a day. Is there any benefit to trying anti-viral rx or any other type of medication, or is this likely not from a virus? Finally, does this condition usually resolve spontaneously, eventually, if no systemic problem is found? A An underlying systemic disease (including viral diseases) can be the cause of recurrent anterior uveitis (aka iritis). If you have such a disease, treating it may reduce the severity and/or frequency of the uveitis. Commonly, no associated systemic disease is found (the blood tests are negative), yet the uveitis still recurs. Modern medicine just doesn't know enough about the causes of, and possible treatments for, uveitis. Over time the uveitis may spontaneously resolve-- for reasons unknown. Answered by David Deutch, MD, Ophthalmology, Eugene, PHMG/Ophth-Willamette (3/19/2005) 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 There are so many different forms of magnesuim on the market(example- magnesuim citrate or oxide), which is the best? And how much should an adult (50+) consume on a daily bases? and which is the best one to take if you cannot digest medicine that well? A No good studies exist here. Magnesium is poorly absorbed (30%) and stimulates the intestinal tract, so the salts are frequently used as laxatives. Generally, the limitation to the dose one takes is the point at which diarrhea begins. Up to 100-400mg of elemental magnesium per day has been recommended, and the form that's taken may impact to some degree how much nausea or diarrhea it may produce, but no one form can be recommended over another. There is a slow-release form of magnesium available by prescription, but it is quite expensive. Best to try low doses of an inexpensive OTC supplement and gradually work your way up to about 200mg/day. Answered at 3/14/2005 Q About 4 weeks ago I had stabbing lower back pain at work and my right leg started to cramp up. The next day I took some Aleve and lay down. When I awoke the stabbing pain was gone, but my right leg and foot were numb and my right lower leg was weak. I had an MRI and it showed that I had a huge "extruded disc fragment at L5-S1 on the right, also a herniated disc at L4-5 on the right which has migrated inferiorly, possibly causing an L-5 radiculopathy". Examination showed "an absent right ankle reflex; there is positive straight leg raising sign on the right at 20 deg. while seated; severe weaknes in right gastrocnemius muscle group 30/100." I was told to not do anything but rest. I have received 3 epidural steroid injections. My back pain is virtually gone and my straight leg raise has improved. My outer foot and outer upper leg are still numb, with no strength in the calf and ankle. I have been told to wait 3-4 more weeks before considering surgery, but I am worried about permanent nerve damage if I wait too long. A It is interesting that in the USA we operate rapidly on large herniated discs like yours but in Europe they are generally treated without surgery for long periods of time. The longterm outcome is virtually identical, though with surgery there is often relief of pain sooner. Our professional liability system is one reason we operate sooner so we can't be accused of "not doing anything" if there is a poor outcome with conservative management. But in fact poor outcomes occur just as frequently with surgery as without. A good rule of thumb is that if the symptoms and findings are improving with conservative care, then continue the conservative care. There is always some question whether there is a point in time after which surgical outcomes are not as good. Some literature suggests that after 3 or perhaps 6 months surgical outcomes may not be as good. So, typically I will watch patients conservatively so long as they're improving, until at least 3 months. If improvement ceases and the patient has disabling pain or weakness at that point, then surgery is probably the better choice. But if the patient is continuing clinical improvement, there is no need to do surgery. I can show you many patients with large disc herniations on MRI, with findings similar to yours, who recover well with conservative care, and often the disc fragment will disappear on a follow-up MRI. So, at this point, it seems that your doctor is doing exactly the right thing and that you should remain patient. Certainly if there is any worsening then you may need to make a more rapid decision. In the rare situation of developing any bowel or bladder control loss, then surgery may become emergently necessary. Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (3/14/2005) Q My mother just had a TIA. I understand what that means, but what tests are usually done as a follow up or for more information? A The number of tests done depends on the age and general condition of the patient. Certainly a brain scan or brain MRI is often done, along with a carotid ultasound to look for obstruction. Whether to do heart studies like an echocardiogram is variable. Answered by Hugh Johnston, MD, Hematology, , (3/14/2005) Q My father had an early diagnosis of an aggressive type of prostate cancer a few years ago. His prostate was 'scrapped' and he was under obeservation and checked every three to six months. After experiencing some abdominal pain and going for testing, an x-ray revealed a spot on his lung a few days ago. He is going for a CAT scan to find out more. I'm afraid that the prostate cancer somehow mestastasized. If so, what is the prognosis? Do patients with similar histories get cured? If so, what are the best treatments available today? A The prognosis for metastasized prostate cancer of course varies from person to person and is based, in large part on the particular subtype of cancer that he has. His underlying health is an important element also. Here is my favorite site for detailed information about cancer; this should provide you with the depth of information that should help you understand the options in treatment of Prostate Cancer. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (3/13/2005) Q How many years does it take to be an anesthesiologist, and what classes do you need to take? I'm interested in being one. A A person needs to complete high school and typically 4 years of college. Then you attend 4 years of medical school, one year of internship followed by 3 years of an Anesthesia Residency.Some decide to sub-specialize in a certain area of anesthesia. This requires an additonal 1-2 years of training called a Fellowship. It's a wonderful specialty and I still enjoy it after 20 years. Answered by David Donielson M.D., Anesthesiology, Springfield, Northwest Anesthesia Physicians, PC (3/12/2005) 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 57 year old woman. I had my ears pierced when I was a teenager and for the past few years I haven't worn any earrings. Just recently I decided to begin wearing them again. It was very difficult getting them in and it caused bleeding and some crusting around the holes. Right after doing this one lymph node behind one ear swelled up. I kept the earrings in for a few more days but finally took them out. The node has gone down but hasn't completely disappeared. Why hasn't it gone back to normal again now that the earrings are out? A You developed an ear skin infection from the earrings and may need to use heat, topical antibiotic ointment, and perhaps an antibiotic orally (if necessary). Leave them out until that completely resolves. Then make sure the new earrings are sterile and of good quality gold studs. Answered by Emil R. Hecht, MD, Otolaryngology, Bellingham, Bellingham Ear Nose & Throat (3/9/2005) 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, Eugene, Northwest Spine Group (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-Willamette (3/7/2005) Q I'm a diabetic and have been getting a lot of boils lately. What can I do besides epsom salts baths, hot packs, and antibotics? I had to have two surgically removed. A In a patient with diabetes the control of the blood sugar is a vital part to staying healthy overall and most especially for decreasing the risk and severity of infection. So, a good place to focus is on your sugars: monitoring them, watching your diet and maintaining your prescribed exercise whilst being faithful with your medications. If taking this appoach doesn't help then there are other medical approaches to recurrent skin infections that can be pursued with the supervision of your personal physician Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (3/4/2005) Q I'm a 43 year old white male. I've been a chronic cold sore sufferer since I was a teenager. I've read many times that cold sores do not cause scarring. I would have to differ. My lips show plenty of scarring from recurrent outbreaks over the years. Many of my outbreaks occur in the same place. Recently, I've noticed a small but slowly spreading colony of tiny white spots on my lower lip. Is this related to herpes? They appear in the same spot where I've had some pretty severe outbreaks. Is this a fungus? It looks different than herpes. It does NOT go away (been there for about 6 months). What can I do for this? A "Cold Sores" are due to herpes virus and they occur in the same, or similar, area. However, they should go away after a week. If you have had the same spot for 6 months, this is not a cold sore. You need to get this evaluated by your doctor as it is somthing else, like a skin cancer. Answered by Jay Park, MD, Dermatology, Eugene, Jay Park MD (3/2/2005) Q How is Parkinson Disease passed on? A There is no evidence that I an aware of that supports the idea that Parkinson's runs in families, if I get your drift. There is no clear understanding currently as to what exactly causes Parkinson's. We are more likely to get it as we mature and there are some interesting population studies that suggest strongly that living through the Spanish Flu epidemic of 1918 ( 20 million died in this pandemic), essentially doubled the risk of Parkinson's for this group of people. Here's some more information on Parkinson's which may be of help. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (3/2/2005) Q We have a 14-year-old daughter who is on a self-destructive path. She has had sex, smokes marijuauna, and, we now have discovered, she cuts herself. She hates school and hates most people. She has no outside interests and is very reactive. We had her evaluated by a psychiatrist about one and one-half years ago but he didn't feel she was depressed. We will do anything to get our daughter help. A I would recommend contacting Looking Glass Youth and Family Services Inc. at (541)686-2688. They offer a range of programs for youth and their families to assist with drug and alcohol issues, and anger management. They also provide outpatient mental health counseling. I would anticipate that they would also guide you regarding obtaining appropriate psychiatric care as needed. Answered at 3/1/2005 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 at 2/28/2005 Q What would cause my breath to smell like flatulence after I have eaten a large meal? My theory is that the large meal allows odors from the partially-digested earlier meal of the day to come up from my stomach? A Your theory may be correct; what you are describing is Gastroesophageal reflux, also known as heartburn or GERD. Having said that, there are many explanations for halitosis ( bad breath) and on Healthwiseyou can see the complete rundown on Changed or Bad Breath. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (2/25/2005) Q I have a friend who has been smoking (marijuana) on a daily base for 5 years and weighs about 100 lbs and is 5 feet tall. I know it takes about 30- 60 days for it to be out of the system in order to test negative on a drug test. Would 30 days be good enough? A Most chronic abusers of marijuana require two to three weeks maximum to clear marijuana metabolites after cessation of use. A rare individual will require up to 4 weeks. Answered by Stephen Erfurth, M.D., Pathology: Anatomic, Eugene, Stephen Erfurth PhD (2/24/2005) 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 Can a person stop their addiction to anorexia or bulemia at anytime? A Well, I don't know. I think anything is possible, but not probable. Anorexia, in particular, is quite hard to overcome, expecially if it has been going on for awhile. It sometimes takes on an obsessive/compulsive quality that becomes very out of control and the person usually needs professional help to get over it. Bulemia is easier to stop, but still is difficult. Often if the person can tolerate the first 20-30 minutes after eating without throwing up, then they can start breaking the pattern. In both cases, there are usually two parts to the person, one part that wants to stop the behavior and one part that wants to continue it because they still embrace being thin as the ultimate value of who they are. That is where therapy helps. Answered by Hallenburg, Kris S. PhD, , Springfield, PHMG/BHS-Spfld (2/23/2005) Q Does taking Vicodin affect my blood sugar level? A Vicodin contains both acetaminophen and hydrocodone. Neither medicine will significantly affect blood sugar levels at the doses used clinically. Acetaminophen at the very high blood levels caused by overdose can cause false reading on some hand held glucometers. Answered at 2/18/2005 Q How is compartment syndrome surgery performed and would a person go through physical therapy afterwards? A I will assume you are asking about exertional compartment syndrome of the lower extremity. The surgery details depend on the number of compartments released (1 to 4) in the leg. Usually just a small (1-2") incision is made and then the compartment is released by splitting the fascia (gristle) overlying the muscle compartment. The need for physical therapy is variable and depends on your level of comfort and activity following the procedure. Answered by Thomas Wuest, MD, Orthopedic Surgery, Eugene, Slocum Orthopedics (2/18/2005) Q Can permethrin cream, 5% be used to treat head lice? If so,how do you apply? A No, the permethrin 1% lotion or cream rinse, such as Nix, is used for head lice, as it achieves better coverage over a hairy area. To use, wash hair with shampoo and towel dry, then apply to hair and scalp (especially behind the ears and name of neck), leave on for 10 min, then rinse with water. Answered at 2/17/2005 Q I have itchy rashes that start out looking like a few pin marks (3 or more), then can cover my thigh, calf, back or arms in red masses (forming linear bumps)when I unwittingly scratch them a little. They only occur in the evenings (6pm onward) but my physical location does not appear to make a difference. This has been going on for 1 year, ceased when I was on Prednisone for asthma, and now they are back. A The good news - it sounds like a not-so-typical case of hives (urticaria). It may be a form called cholinergic urticaria - there is a specific test for that type, whereas almost all other varieties of hives are diagnosed by appearance alone. There are many reasons why people have hives, beyond our scope here. Food allergies are actually quite uncommon. Autoimmunity is occasionally noted. Prednisone will very typically suppress them for awhile. There are several tiers of therapy, starting with antihistamines, and layering on other meds if necessary. Talk to your doctor. Answered by David Elkayam, MD, Allergy & Immunology, Bellingham, David Elkayam MD (2/16/2005) Q I broke my clavicle in a car accident 3 years ago. I was told to do nothing and that it would heal by itself. I am able to move freely, and except for the occasional snap out of place or soreness, in the morning I am ok. The problem is that it was broken in two and that the right part of the bone overlaps the left one. It looks like I have something coming out of my shoulder. I was told that I would need surgery. I don't have health insurance. How much are we talking about? A You apparently have an established "non-union" of your clavicle fracture. After three years, it is unlikely that spontaneous healing of the fracture will occur. There are options for treatment that are non-surgical including direct current electrical stimulation as well as a newer form of ultrasound therapy for fractures. Surgical intervention with application of a metal plate/screws and bone grafting is in my opinion the "gold standard". This type of surgery would require admission to a hospital, surgical time in an OR, cost of implants and an overnight stay (at least). A first step in resolving this problem is to visit an Orthopedic Surgeon to examine you, review your x-rays and recomend a specific course of treatment. Answered by Andrew Boughal, DO, Orthopedic Surgery, Florence, PeaceHealth Medical Group - Siuslaw (2/16/2005) Q When I go to sleep at night after awhile I get this pain in my chest, in between both my rib cages at the top. It just hurts for a few seconds and I have to massage right there to make it stop hurting; then I can go back to sleep and I feel fine. I don't think it's any respiratory problem because I don't have trouble breathing. I am twenty years old. A Any chest pain needs an evaluation by a doctor. However the fact that the symptoms come on with lying down make the diagnosis of esophageal reflux come to mind. There's a web site on Healthwise that deals with GERD. Answered by Christa Danielson, MD, Family Practice, Eugene, PHMG/FP-South (2/16/2005) Q I am a baseball pitcher and I have been experiencing severe pain in my shoulder. I was wondering how I can tell if it is just a torn or pulled muscle or tendon; or if the problem is more related to the labrum area? A A torn tendon or muscle, i.e. a rotator cuff problem, can easily be diagnosed with an ultrasound study and a good physical exam. You generally do not need to have an MRI scan to diagnose most rotator cuff problems. I would suggest starting in that direction. Labrum (the liner of the socket of the shoulder) problems/injuries can be more subtle and often require more advanced imaging (e.g. MRI) or arthroscopy to diagnose. As a pitcher you are at risk for either problem. Make an appointment with an orthopaedic surgeon who has an interest in shoulder problems and go from there. Often times a concerted effort to strenghten the rotator cuff muscles and attention to better pitching mechanics can resolve your pain. Answered by Thomas Wuest, MD, Orthopedic Surgery, Eugene, Slocum Orthopedics (2/16/2005) Q Does ibuprofen contain aspirin? A No. Both aspirin and ibuprofen are in a class of drugs known as nonsteroidal anti-inflamatory agents, but there is no aspirin in ibuprofen. Answered at 2/14/2005 Q I had a hammertoe corrected on my right foot. Upon the doctor's suggestion, I let him inject that toe with a cortisone shot, due to inflammation. It's been 9 months, and though I have had minimal pains in that foot, the cortisone shot has left my foot with a discoloration around the area where I was injected. Does anyone know if this is only temporary, or if this is a permanent thing? Also, the lighter area is more sensitive than the rest of my foot, and immediately burns under the sun. Plus, some veins are more visible in that light-colored area. A I am assuming you are asking your question on this forum because you have not yet heard back from your doctor regarding your skin discoloration? If you haven't asked your doctor yet, that is the place to start. Your doctor will probably tell you that injectable steroids are capable of causing hypo(lighter)pigmentation of the skin surrounding your injection site, or hyper(darker)pigmentation. Sometimes the topical refrigerants/cold sprays placed on the injection site, prior to injection, can also leave a discolored area. Different ethnic groups and skin variations in humans are responsible for a wide range of skin reactions to injectable steroids(cortisone). Sometimes the changes in coloration are permanent and sometimes they are temporary. This is why you need to discuss this with your own doctor and have him/her examine these skin changes that you are describing. Answered at 2/12/2005 Q I am a healthy, 60 year old female who works out at a gym 4 to 5 days a week and lives a happy life. I have been disgnosed with lichen planus for the third time in 20 years. I do not fit into any of the criteria for getting the disease. I had a skin biopsy in October and tried topical steroids for the itch along with mega acidophilus, high doses of zinc & vitamin C. Nothing seemed to help, so my doctor put me on 40 Mg a day of predisone for 2 weeks then 30, 20 & 10. After 11 days I am not seeing a lot of improvement. The last time I had it the predisone definitely helped. I have it on my hands, arms, back, stomach, legs and feet. The last two times I had it it lasted 6 to 8 months. My doctor said I could take the 40 mg another week if necessary. Although I haven't had any side effects I'm concerned since I only weigh 105 lbs. I do take prempro, fosamax, and calcum. Do you have any suggestions? A Lichen planus is a chronic skin disease. The cause is unknown. There are no criteria for getting the disease. Prednisone helps most cases in the short term, but the side effects limit its usefulness. There are many long term treatments, including phototherapy (ultraviolet light therapy), plaquenil and some other treatments. In my experience, this usually comes back after the prednisone is stopped, and you will likely need another treatment. Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (2/11/2005) Q What causes the warm sensation, metallic taste, and urination sensation from iodinated contrast used in radiological imaging studies? A Contrast agents (even the newer ones) 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, Eugene, 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 I get what seem to be inflamed taste buds on my tongue, up to appoximately 5 at a time. They are extremely painful, making it very difficult to eat, drink, speak, and even to not drool. They are extremely difficult to locate as there is little or no discoloration or any other visible difference. They stay affected for 5-7 days at a time and go away. The oddest part is that they are, without any question, occuring in the exact same place every single time without exception. I also often have canker sores, perhaps they are related? I suspect I go through 75% of my life with these maladies in my mouth. A You need help from oral medicine or ENT asap. Alkalize your mouth with Milk of Magnesia (half and half with water) mouth rinse 4 times a day and avoid acid products. Rinse with water after you eat or brush teeth. Be gentle with your mouth. You probably need Valtrex antiviral meds if your ENT doctor agrees. Answered by Emil R. Hecht, MD, Otolaryngology, Bellingham, Bellingham Ear Nose & Throat (2/10/2005) Q I was diagnosed with polymyositis in April 2003 after a muscle biopsy and started treatment immediately with prednisolone. I have made a very good recovery since then. I am on still on prednisolone --just a much lower dose -- as well as azathioprine and calcium, etc., to counter the side effects of prednisolone. I do find that my facial muscles, especially around my mouth, have taken a long time to recover and are still a bit weak at times in terms of the strength to blow up a balloon. This weakness even affects my smile. Are there exercises that I could do that would stimulate and strengthen these muscles? I also heard towards the end of last year that there is apparently a new treatment out for polymyositis that works quickly and effectively, and multiplies the chances of total recovery. I do believe it is very expensive, though. Do you know of this medication? If so, could you please be so kind as to forward me information. Furthermore do you have exercises programs that you could mail? A As you know, polymyositis can take a long time to recover. Some patients do not recover completely. It is possible that your facial muscles will not recover completely, though they may still improve beyond the present stage. The treatment you are getting is appropriate. I believe the new treatment you refer to is probably IVIG (intravenous gamma globulin) which we use for a number of neuromuscular disorders. To my knowledge, at this point in time, steroids like prednisolone remain the primary initial treatment, often supplement by azathioprine or methotrexate to help reduce the steroid dose. Sometimes cellcept and cyclosporine are used in the same way. The IVIG is mostly used in refractory cases currently and it's used as acute treatment, not chronic treatment. I am not aware of any specific exercises for the facial muscles but generally any exercise stimulates the recovery process. Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (2/9/2005) 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 Specialty Clinic (2/7/2005) Q My husband is 29 years old and has high cholesterol --total cholesterol 279, HDL 55, LDL 191 and triglycerides 162. He has a family history of high cholesterol. Our family doctor just says to follow a low cholesterol, low saturated fat diet. That's it. We are not even sure what he should be eating or what all to do. We need some help on what to do --take classes, read books, educate ourselves? We just don't know where to start because of his age. And how do I get him to understand that it is serious! A LDL cholesterol greater than 160 is worthy of treatment. Often that treatment is life style. Life style means getting regular physical activity (60-90 min/day) and following an American Heart Association diet. That diet recommnends calories to maintain a healthy weight and 30% total fat and 7% saturated fat. A diet high in fiber is beneficial as well as avoiding trans fats (foods made with margarine and shortening and fried foods). Losing weight, if you are overweight, often improves cholesterol. Actually folks often experience significant benefit from losing only 5-10% of their weight if they are overweight. Cholesterol information may be obtained from the American Heart Association as well as other online sources. There are articles and books published by knowledgable people. It is very important to make small long term sustainable changes as the problem does not usually get better with age. Many people benefit from an appointment with a Registered Dietitian. It might be worth working with your MD by making some lifestyle changes and then asking the MD to recheck the risk panel after 4-6 months. That will certainly let him or her know that you are serious about improving your risks of heart disease. Answered at 2/4/2005 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, Eugene, Northwest Spine Group (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 What are the step-by-step procedures to remove pins or wires or rods from a a healed facture in my elbow? What does it involve? How long after the pins are removed until I can play golf? A Usually the operation can be done on a short stay basis -- that is, you come in and go home the same day. Sutures/stitches/staples are removed from the skin wounds at about 10-14 days after surgery. Depending on the amount of hardware removed, you can usually advance your activities over the next 4-6 weeks. Generally some restriction of activity for about 6 weeks is typical. Answered by Thomas Wuest, MD, Orthopedic Surgery, Eugene, Slocum Orthopedics (2/2/2005) Q I have a rash around my crotch area and am concerned as to what it could be. I am an 18 year old male who has never had sex, so its not an STD. I have a family history of psoriasis, but it usually goes away after a while. I've had this rash for about a year. Also, I have what seems to be a lack of sexual drive and have trouble ejaculating. Are these in any way related? A The most common rash that occurs in the groin is "jock itch" or the technical term, tinea cruris. Here's a good article about Jock Itch. It's unlikely that this rash would be tied in with your sexual drive and/or ejaculation problems. You should consult with your personal physician about these issues as it is not typical for a guy your age to be having these complaints. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (2/2/2005) Q Years ago I received a series of epidurals for my chronic back problem. Depomedrol was injected into my lower back approximately 30 times over 10 years. The pain was almost entirely eliminated but the side effects are a concern. My blood has thinned and my bone density is less than what it should be. I also bruise easily, especially on my outer hands and shin area. The bruises go away within 2 weeks but I wanted to know if there is anything I can take to prevent this from happening and, secondly, when it does happen what can I take to heal faster than 2 weeks? I've tried arnica and other herbs but nothing really helps. A The issues that you describe, especially the decreased bone density and the thinning of the skin can be a side effect of depomedrol exposure. The bone issue, if dramatic enough, is called "osteoporosis" and you can read about Osteoporosis in Healthwise. The bottom line is that there are effective medical strategies for helping with the bones and, to a certain extent, the skin complications of this medicine. You should consult with your physician about which of these might work for you AND be safe given your medical history. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (2/2/2005) Q Can one have surgery for heel spurs and if so, what does it entail? A Yes, one can have surgery for heel spurs. Prior to considering heel spur surgery, one should attempt to determine the cause of the heel spur, and more importantly, try preventive or conservative treatments for up to a year. There are 2 common types of heel spurs. The most common is a spur that originates from the bottom of the heel bone (calcaneus). This type of spur generally does not cause pain or require surgery. The spur is an indication that some of the muscles and ligaments, especially the plantar fascial ligament, are pulling excessively on the bottom of the heel bone. The pain that results from this pulling is called plantar fasciitis. It used to be called heel spur syndrome. We no longer focus attention to the fact that a "heel spur" is present on the x-ray, but rather concentrate on identifying the reasons why the muscles and ligaments are unnaturally pulling on the heel bone. The most common cause of this unnatural pulling is the fact that nearly all footwear is not shaped as a human foot is shaped. Most footwear holds the toes above the support surface(toespring) and squeezes the toes together(tapering). The reason this causes plantar fasciitis is that the plantar fascial ligament and muscles in the bottom of the foot attach to the toes. Try to find shoes that are wide at the ends of the toes and that do not elevate the toes above the ball of the foot, or heel above the toes. Examples are: Birkenstock, Keen, Crocs, some sandals and some slippers. Ice is recommended for 6-10 min. several times per day. If the spur is occuring on the back of the heel bone(calcaneus)it could be from rubbing of some shoes or boots on the back of the heel bone. This is very commonly a cause, although it may not seem to be noticed by many individuals. Examaning the inside of the heel counters of your footwear may show signs of rubbing or wearing away of the material, which is an important clue that rubbing from the footwear should be eliminated by moving up in size of footwear, or having the heel counter stretched or modified. Nearly all Americans have some degree of achilles tendon and calf tightness from the elevated heels on most of the footwear available to us. This causes a gradual contracture, or shortening, of all of the muscles on the back of the lower leg, including the achilles tendon, which attaches to the back of the heel bone. Stretching of the heel below the ball of the foot and toes, such as on a stair, can dramatically help heel spur problems on the back of the heel. Choosing shoes with lower heels can bring about the same positive effect, but should be done slowly and carefully, as most of us are tight and weak in the muscles on the back of the lower leg. Bear in mind that each of us has learned to walk with nearly an inch of heel elevation on our shoes, since as early as early childhood. After a period of adaptation, which varies with each individual, you will find greater comfort with your heels lower to the ground. Mechanical problems, which cause heel spurs, as discussed above, are only one of many causes of heel spurs, so each individual should have a full medical evaluation, and appropriate laboratory testing to ensure the correct cause of the heel spur is identified. Heel spur surgery on the back of the heel bone has an average healing time of 8-12 months. The type of surgery and what it entails, should be discussed with your surgeon after appropriate medical evaluation and treatment have been carried out. Hopefully we addressed your question effectively. Please feel free to contact us if you have further questions, or would like referrals to appropriate specialists in your area. You probably need to be evaluated by: 1. your primary care provider. 2. rheumatologist. 3. podiatric surgeon, or orthopedic surgeon specializing in foot and ankle care. Answered at 2/2/2005 Q I have been diagnosed with Lichen Planus on my legs (shins). I started taking Lipitor about 2 months ago. Is there any corolation? I read that some medications can cause this. A Lipitor (atorvastatin) has not been reported to cause Lichen Planus. Lichen planus is characterized by flat-topped, violaceous, pruritic papules. The drug-induced form of this disorder usually develops insidiously and can affect any area of the body surface. Oral lesions occur in 30 to 70 percent of cases; the mucosa may be painful and ulcerated. Beta-blockers, methyldopa, penicillamine, quinidine, NSAIDs, and quinidine may cause this disorder. Case reports have also been described with ACE inhibitors, sulfonylurea agents, carbamazepine, gold, and lithium. Answered at 2/1/2005 Q I have an odor coming from my mouth when I speak. DO you think this is due to acid reflux? My dentist said my hygiene is ok. My sinus is also fine. A The official term for bad breath is "halitosis" and can be caused by an array of things, several of which you've identfied i.e. sinuses and teeth. Here's some more information on other causes that you might want to think about for Bad or Changed Breath Certainly acid reflux is on this list but as you can see there are other things that your personal physician can help you sort through. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (1/31/2005) Q I am 33 yrs old and had a tubal ligation done in 1995. I am wanting to get a reversal done now because my fiance is coming home from Iraq. I am starting to research everything now..dr's, procedure etc. My operative report states thet I had the Pomeroy technique (it mentioned bipolar cauterization and the measurement of 2cm). I have 3 healthy girls, and never had trouble conceiving. My questions are this --How soon after the procedure should a couple begin trying to conceive? Should the attempts be EVERY month until conception? (he may have to go back to Iraq 4 months after the procedure but he'll stay for 2-3 months). On average, how long does it take to ovulate after the reversal? I want to get the procedure done prior to his homecoming so we can try to conceive when he gets back. Should I get the procedure done a month prior? two months? A I recommend you have hormone levels check prior to undergoing tubal reversal. If all is well, have the procedure done about 6-8 weeks prior to attempting conception. The procedure should not affect your menstrual cycle Answered by Heather York, MD, Obstetrics/Gynecolog, Eugene, Women's Care (1/28/2005) 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, Family Practice, Springfield, PHMG/Urgent - RiverBend (1/27/2005) Q I had a total hip replacement 9 months ago. I am 42 years old and have been diagnosed with osteoporosis. I have been having mild thigh pain when walking. Is this normal or could my implant be loose? I just need to know if this is a normal part of healing. A If you have an uncemented femoral component, it is not uncommon to have thigh pain for quite some time. If your femoral component is cemented it is less likely to be painful. Regardless, if you are still having pain, you should schedule a follow-up appointment and x-rays with your operating surgeon. Answered by Thomas Wuest, MD, Orthopedic Surgery, Eugene, Slocum Orthopedics (1/25/2005) 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, Eugene, 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 I am a 25 year old female who has aortic valve insufficency. I have been told that I will be going on medication and at some point will need a valve replacement to ease the regurgitation in the heart. I have two questions: currently, I have experienced quite a bit of being short of breath and passing out. My spells of dizziness are wearing me out, how will medication help this? And my second question is, if I opt to have the valve replaced while I am still young and before I have children, what would my concerns about having children be? A If you have significant aortic valve disease and shortness of breath and blackout spells, you should be seeing a cardiologist regularly. You may need rhythm monitoring in addition to the usual surveillance tool, the echocardiogram. Excellent question about childbirth. This is difficult. A tissue valve (pig, cow, tissue banked cadaveric human, or your own pulmonary valve) doesn't offer a known long-term durable solution for someone your age, as future reoperation with its increased risks would be almost certain at some point. However, the management of anticoagulation during pregnancy, when you would not be able to take warfarin for a good part of the time, is also fraught with difficulty. It's a hard and very individual decision. Answered by Peter Beglin, MD, Cardiology: Interven, Bellingham, North Cascade Cardiology (1/20/2005) Q My husband had adenocarcinoma of the prostate. He had surgery done that removed the prostate and all surrounding tissue. The nodes were negative one year ago. He recently had surgery and standard x-ray showed 3 nodules in the left lung. He's an ex-smoker (used for 35 years). CT is being done next week. Should we request that a biopsy be done as well? Can this type of cancer spread through body fluids? A The CT will help define the nature of the nodules and sometimes determines the diagnosis. After the CT they can indeed get a tissue biopsy via the bronchoscope or a skinny needle by the radiologist. Cancer of the prostrate usually re-occurs in the bones. Answered by Hugh Johnston, MD, Hematology, , (1/20/2005) Q Can you please tell me if there is any new treatment for carpal tunnel? A The treatment of carpal tunnel syndrome has not changed significantly in recent years. There have been some variations in surgical technique but not a major change. Physical therapy, splints, steroid injections, and surgical decompression remain the major treatment options. Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (1/20/2005) Q What kind of tests are there to test for mold/fungus in the human body? A Mold and fungal microorganisms are present in our indoor and outdoor environment, just as bacteria are. Even in homes with dry indoor environments, parts of mold and fungal growth structures including spores can be found on surfaces and in and around damp areas or objects. These can be detected by wiping a surface with a culture swab and then wiping the swab on a sterile semi solid culture medium specifically formulated to support mold and fungal growth and then incubating this to produce mold colonies that can be seen on the culture medium. Sometimes, if enough spores are present, a piece of scotch tape can be placed on the surface, sticky side down and then viewed under a microscope. Certain culture medium is available that can also be pressed onto surfaces directly, and then incubated to detect mold sprores. Because mold and fungal spores are present in our environment they are also present on our skin and mucous membranes. And some such yeast organisms including Candida are present in our mouths and intestinal tract, just as some bacteria are. They do not cause disease unless there is severe immune deficiency such as that which can occur from chemotherapy. Fungal and mold organisms can be cultured from our bodies in the same way they can be cultured from the environment, using a sterile swab and swabbing an area and then swabbing the culture medium. Body fluids, such sputum can also be cultured to detect mold/fungi. For some individuals with asthma or sinus problems, a blood test can be performed to determine if ones immune system is acting against fungal proteins. This test may detect antibodies, which is an indirect test for possible fungi in the body. In this type of medical problem, the fungi are not causing an infection and are not invasive, but are triggering an immune response and inflammation which can cause respiratory disease. Answered by William Anderson, MD, Allergy & Immunology, Bellingham, William Anderson MD (1/20/2005) Q I have DSAP lesions on my forearms. I have heard from another patient that a course of accutane has greatly inproved the appearance of her lesions by smoothing the characteristic raised border. However it has not helped with the redness inside the border. Is there any laser treatment that can help with the redness? If so, would it be advisable to first laser, then do a course of accutane because of the healing issues involving post accutane treatment? Have you heard of any other DSAP treatments? A Many different treatments have been used for DSAP (Disseminated Superficial Actinic Porokeratosis) over the years: Retin-A, 5-Fluorouracil, Lactic Acid (Lac-Hydrin), Dovonex and others. These treatments may decrease the scaliness of the lesions, but none seem to clear them, or even help much long-term. Individual lesions may be treated with cryotherapy (freezing) or with laser, but this may leave some discoloration. It is important to know that DSAP runs in families, and is caused by sun exposure. It is important to carefully protect the areas (usually the arms and legs) from the sun, both with clothing and daily use of sunscreen. Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (1/20/2005) 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, Eugene, Northwest Spine Group (1/18/2005) Q I have black heads under my arms along with boils; they also appear between my thighs. Also, the skin is dark under my arms and between my thighs. I don't know what to do and it's also very embarassing. What is this condition and is there a cure? I'm a 27 year old Hispanic woman and my skin is light. My mom doesn't have this problem and neither does my sister. What should I do? A Boils under the arms, under the breasts and between the thighs may be hidradenitis suppurtiva, or acne inversa. It is a form of acne. There are treatments available, commonly long-term antibiotics, or sometimes Accutane. You should see a dermatologist for diagnosis and treatment. Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (1/17/2005) Q I'm 17 years old and having severe pains in my lower right side. At times they are very sharp, but there is pain at all times. I'm also having excruitiating pains when I have a bowel movement. What is this and what can I do for it? A I could be a muscle pull or, by your description something worse, like appendicitis. You need to get in to a doctor and be checked. Here is some more infromation about the Appendixand its diseases. Answered by Christa Danielson, MD, Family Practice, Eugene, PHMG/FP-South (1/17/2005) Q I see flashes of light (only in the dark) with both eyes. Flashes look identical in each eye and are usually a solid dot about the size of a pea. I do have some floaters. I have had two very comprehensive eye exams and both MDs said my eyes were perfect and that it could be a "brain thing". What does that mean and who should I see next? A If your ophthalmologists have said they could find nothing wrong, then I would suggest either a neurology consultation, or a neuro-ophthalmology consultation. Your ophthalmologists could guide your selection for you in this regard. Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (1/16/2005) 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 What are the newborn screening tests? Please give me a list of what my child will be tested for. A Oregon has always been a leader in the country in Newborn Metabolic Screening, and the list of screened disorders is always growing. The best resource is the Oregon Department of Human Resources web site for the current list of tests performed for Newborn Screening. You can also view the pamphlet they have prepared for parents to explain the program at their web site. Answered by Doug Gamet MD, Pediatrics, Eugene, PHMG/PED-Willamette (1/16/2005) Q For the last year now I've had red eyes --basically the eye lid itself and a bit of the eyeball. I sometimes am made fun of because of it and I can't figure out what causes it. I had a cat for a period of time but it's gone now, so it isn't pet-related. If you could suggest some help to me I would be most appreciative. A First off, if your vision is affected it would be best for you to be evaluated by an ophthalmologist or optometrist. If your vision is essentially unaffected, then I suspect this is a disorder of the eye surface and eyelids. The two conditions that immediately come to mind are: 1. Blepharitis: inflammation of the oil glands that line the edges of the 4 eyelids, causing annoying redness and vague discomfort of the eyelid margins and surface of the eye. 2. Dry eye: Insufficient tears to adequately lubricate the eyes. I suggest you do two things: 1. Pick up some artificial tears (over the counter) and put a drop in each eye 4-5 times each day. 2. Begin taking measures to wash the edges of each eyelid (an area most people ignore). First, apply a hot compress to your closed eyes for 3-4 minutes. Second, place a few drops of a baby shampoo on the hot compress and, with your eyes closed, gently wash the eyelids near the eyelashes for 15-20 seconds on each eye. Finally, rinse off the shampoo with fresh water. Repeat those 3 steps twice a day for a couple weeks. If there is no improvement you should see an eye doctor. Answered by David Deutch, MD, Ophthalmology, Eugene, PHMG/Ophth-Willamette (1/14/2005) 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 Can I use citrucel as a colon cleanser? What other brands or products can be used as a safe and effective colon cleanser? A I don't routinely recommend colonic cleansing. Some of the regimens that I have seen pose some risk and there is no clear evidence that cleansing affords any benefit. On the other hand, I certainly think that having soft regular bowel movements that don't require straining is the desired state. There is pretty clear evidence that this is better in the long run, especially if this is a sign that you are getting enough exercise,fluids, fruit and vegies. If, despite doing all these you are still having trouble with constipation then I think that citrucel and fiber products similar to it are fine to use. Healthwise has some more detail on a more comprehensive approach to Constipation Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (1/12/2005) Q I was hoping I could get a second opinion. A few months ago I was injured at work, after doing some lifting. I had pain in my lower back and tingling and numbness all down my leg. After a month of not improving, my doctor sent me to get an MRI. It turns out that I had 2 bulging discs. But he didn't offer me any treatment for that. He just said, it would heal on its own. So I'm wondering if that's true? Since then I've had very little back pain, but I still feel a bit of tingling in my legs, especially at night. Plus I've also noticed that sometimes when I cough, I am unable to control my bladder. A Without more information and an examination and review of your imaging studies, I cannot give you an informed second opinion. However, I can tell you that overall 80% of patients with problems such as you describe improve with conservative care. This generally means avoiding things that increase symptoms, using mild analgesics or anti-inflammatory agents are helpful, and beginning a specific exercise program at the appropriate time. In addition to the high recovery rate with conservative care, the longterm outcome of patients treated conservatively is at least as good as those treated more aggressively. It sounds as though you are making very gratifying progress for the length of time that has passed. More than likely continued patience will result in a good outcome without more needing to be done. Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (1/5/2005) Q How long does oxycontin stay in your system? A 18-30 hours, with an average of 22 hours. Answered at 1/5/2005 Q Does a rheumatoid arthritis patient need to be on medication if there is little pain involved? A Not necesarily pain medications or anti-inflamatory agents, but rather a medication which can slow the progress of the condition such as methotrexate, Arava, Remicade, etc. These are called "DMARD's," or disease-modifying antirheumatic drugs. Answered by Frank Littell, MD, Hospitalist, Springfield, PeaceHealth Medical Group - Oregon (1/5/2005) Q I have a friend who seems to be suffering from a lot of signs of depression. She does not have insurance. What can she do and who can she see about getting help? A The Family Health Center and Lower Columbia Mental Health both have funding to see patients without insurance. They are both listed in the yellow pages of the telephone book. Family Health Center is 360-636-3892 Lower Columbia Mental Health Center 360-423-0203 The emergency department at St.John Hospital is open 24 hours a day/365 day a year. No one is turned away that is need of physical or mental health treatment. Answered at 1/5/2005 Q Does HIV spread through the penis muscle? A HIV is present in prostatic fluid and semen. It is certainly present in ejaculation fluid, and is probably also present in any fluid which leaks out of the penis (urethra) before ejaculation. Answered by John Wilson, MD, Infectious Disease, Eugene, The Travel Clinic (1/4/2005) Q I have tested positive for HPV. I am 18 and only have had one sexual partner. My doctor tells me the probability is high that my immune system can fight it off within two years. I have high grade lesions CIN 2 or 3. I'm going to have the LEEP procedure done in about one week. What is the success rate for no reoccurance of HPV? Did my partner cheat on me if I only had sex with him and contracted this disease? A I agree that having a LEEP sounds like the correct procedure and it has about a 90% chance of curing you. But you need to be sure and have the recommended follow up after the procedure and be sure and have pap tests on a regular basis throughout your lifetime. HPV is a sexually transmitted disease. Therefore if you have only had one partner, you got it from him. He could have contracted the HPV at any time as it can lie dormant. It is impossible to say when he contracted it, so he could have gotten it before he was involved with you. Answered by Linda Frison, MD, Obstetrics/Gynecolog, Eugene, PHMG/OBGYN-Willamette (1/3/2005) 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, Eugene, Northwest Spine Group (12/30/2004) Q I have a question regarding BCG (Bacillus Calmette-Guerin)treatment for the bladder and precautions for the toilet. I have been helping someone who is getting BCG in the bladder and I have not been putting bleach in after each void and not wearing anything to change the soiled bedding. Is this something I need to be concerned about for protecting myself and my family? A Here's a web site advising on using this treatment safely. Infection Precautions. Answered by John Wilson, MD, Infectious Disease, Eugene, The Travel Clinic (12/27/2004) 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 Are there certain types of x-rays or images that a doctor can take to check for any possible problem with your heart before starting an exercise program? I don't want my heart to stop. Is it best when done /evaluated by a cardiologist? I am considered morbidly obese so I know know my heart isn't the healthiest it can be, plus I had sharp pains on the left part of my chest, inside, about 2-3 times this year. A The answers are yes and yes. Although the resources are more limited in SE Alaska, the doctors there are very good at assessing risk and can do imaging stress testing, and can refer to a cardiologist when necessary. Excellent questions. Answered by Peter Beglin, MD, Cardiology: Interven, Bellingham, North Cascade Cardiology (12/23/2004) Q I have some inflammation in my rectum that causes some discomfort, mostly when I'm sitting. The inflamation is present as a small swelling, maybe like a hemorrhoid, on my anus, and some constipation. There is no bleeding. Should I be overly concerned yet and see a doctor, or should I try some diet changes, etc., for a few days to see if it improves? A Hemorrhoids are the bane of the western lifestyle - not enough fiber, a tendency to being overweight and insufficient drinking of plain ole water. Here's some background reading of the subject of Hemmorhoids In general with symptoms that you describe, increasing your water intake, eating a high fiber diet, perhaps even using a stool softener is a safe approach to try. Additionally "sitz" baths can be helpful as well as some of the over the counter medications. I frequently recommend Anusol. I use the words "in general" when making the above recommendations because I don't know your medical history, age or even gender! So, you should take the above information as general education on the topic and consult with your personal physician for advice specific to your case. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (12/22/2004) Q I have an occasional problem with the lateral aspect of my thigh going numb, or having a burning sensation shooting down toward my knee. This can happen in bed, at rest, or even when I am hiking or active. I don't have any back problems that I know of. I was wondering, after doing some reading, if it could be sciatica. Or maybe I do have a back problem that I don't know about. I am presently being treated for HTN, GERD, and Anxiety (HCTZ, lisinipril, prilosec, and lexapro). I do have a primary here in Bellingham and I will consult him as well, but saw your name here and wanted to pick your brain if you had time. A The most common cause for your symptoms is a condition called "meralgia paresthetica". It is not caused by a back problem but rather by a "pinched nerve" (the lateral femoral cutaneous nerve of the thigh) where it exits the pelvis or goes through some fascia farther out. The usual pattern is the front/outside of the thigh. The symptoms can be mimicked by a nerve root problem in the back. If that nerve root is pinced in the back there usually is back pain also. Meralgia paresthetica is more commonly seen in heavy individuals and sometimes is associated with tight belts, heavy tool belts, girdles and other things that pinch the tissues where the leg joins the body. Typically we confirm the diagnosis and usually just try to avoid compression of the nerve, and then only do more aggressive treatment if the symptoms are particularly bothersome to the patient. Treatment can include nerve blocks and even decompressive surgery on occasion. Usually it is only a minor annoyance and no treatment is needed. You may want to see your doctor to confirm the diagnosis and then be ready for treatment if needed. Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (12/16/2004) Q Please inform me if a physician can fire a patient? Does the patient have any recourse? Is the doctor's "refusal to treat order" placed with in the patient's file? A In answer to your question. Physician's do have the right to dismiss patients for a variety of reasons. Some of reasons for dismissal include: Not keeping appointments, failure to follow a recommended treatment plan, abusive or threatening behavior towards physician and/or clinic staff, or misuse of prescriptions. If a patient wishes to appeal this decision they may write a letter regarding their concerns to: PHMG Administration 1162 Willamette St Eugene, OR 97401 Once a patient has been formally dismissed from PHMG their medical chart is noted with this information. Carolyn St Clair, RN, CPN, CCM Care Coordinator Answered at 12/15/2004 Q I have a male friend and he smokes weed. The girl he had got pregnant had a miscarriage. Could that (marijuana) keep you from having kids at all in any way ? A I am not aware of marijuana causing miscarriages. It may cause some decreased fertility or ability to get someone pregnant, although this is not clear. Answered by Dan Herron, MD, Obstetrics/Gynecolog, Longview, PeaceHealth Women's Clinic (12/15/2004) 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 a 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 Specialty Clinic (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, Eugene, Northwest Spine Group (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 Women's Clinic (12/3/2004) Q I have been off Prozac for 5 weeks now but am still getting twitches! I am also getting electric shocks, like zaps, mostly in my hands but sometimes in my head together with some ringing in my ears! Please comment on whether these are anything to be concerned about and whether they are temporary? I have heard of rare cases of movement disorders in people who have been on SSRI's! Could the amount of stress I am in be making this worse? Second follow-up question: In the answer it says that these side effects should go away within 2/7 days of stopping prozac but this seems odd as prozac is long acting and stays in the body for some weeks. Also could you please explain more on what you mean by 'something more could be going on and what is really meant by nerve irritation? Will this go away and is it dangerous? A test on my relexes was ok; what other tests could I do? A While the effects you have described are similar to effects seen with Prozac, in every case I can find described in the literature, they go away in 2-7 days after stopping the drug. If they are still going on 5 weeks later, I would be concerned that something else may be going on, causing nerve irritation. Second anwer: You're certainly correct in your statement that fluoxetine remains in the body for a number of weeks. However, for most people, the drug level in the blood drops by 50% every 6-7 days after stopping the drug. For side effects that accompany fluoxetine, we would expect the severity to decrease in proportion to the blood level. So, for example, if your blood level at the time you stopped the fluoxetine was the usual 400-500 nanograms per cc, a week later, it would be down to 200-250; 2 weeks later it would be 100-125, etc. At 5 weeks, based on the half-life of the drug, you should have less than 2% of the drug left. If you perceived no reduction in the severity of the twitches and shock-like symptoms by that point, than your experience runs counter to every report I can find published. With regard to these reports, unfortunately, most of what we know about side effects come from reports of single cases. It's often hard to judge in a single case if a drug was actually involved, since most involve patients taking more than one drug and with one or more disease states that may be causing the problems. Likewise, most people that truly have side effects are never reported so that we don't have the benefit of this experience. That being said, the several cases I have found, where there was any mention of the time course of the muscle or nerve invovlement going away, 2 days was most commonly mentioned, consistent with a reduction of 75% in the fluoxetine level.I cannot rule out that fluoxetine either caused or made worse your symtpoms. If it eventually goes away, yours' may actually be a reportable case. I did want to share my findings with you so you can assess with me the liklihood that the symptoms could still be considered due to fluoxetine after 5 weeks off the drug. My concern is that, if it is not fluoxetine, that someone caring for you is investigating other causes. While it's encouraging that your reflexes are good, there are other more specific tests of nerve and muscle function. Not being a physician, I'm not qualified to discuss these intelligently, but your p