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, Urgent Care, 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, Urgent Care, 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, , (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 Hospital Medicine (11/22/2006) Q What is considered "low" blood pressure? At what point should one contact a physician? A There actually is not a good answer to this as "low" in some people may be "normal" in others. Generally a systolic blood pressure measurement (the upper number) of below 90 is considered low and may result in some symptoms of lightheadedness or dizziness when moving from lying or sitting to an upright position. "Too low" is generally apparent with near-fainting sensations and head rushes. Increasing fluid consumption is the main remedy. Answered by Emily Gibson, MD, Family Practice, Bellingham, Western Washington University (11/20/2006) Q My stepson has suffered flashburn from his welding job. His eyes are burning and scratchy feeling. What can he do to get some relief? A Keep the eyes moist with a saline or lubricating drop that can be purchased over the counter. Do not use Visine or its generic equivalent. Ibuprofen may help as well as long as there are no contraindications. The symptoms should last less than three days. If it is going on longer or there is a possibility of a foreign body, he should be evaluated sooner. Answered by Glenn Ziemski, MD, Urgent Care, 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 Hospital Medicine (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, Urgent Care, 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, Urgent Care, 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, Urgent Care, 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, Urgent Care, 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, Urgent Care, 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, , (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, , (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, Urgent Care, 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, Urgent Care, Springfield, PHMG/Urgent - RiverBend (11/22/2005) Q My son has been running a high fever for 2 days. It has been between 102 and 104.8 degrees today, though it has been mostly 104. At what point should we become worried? He saw his physician today and was told that it was a virus. A A normal course for viral infections in children often includes fever for 3-5 days. The height of the temperature itself (i.e. what number) is not a point of concern. A higher temperature may cause him more discomfort, but not danger. Fever may affect children with other special medical problems differently. He should be re-examined should his degree of illness progress to difficulties breathing, taking liquids, skin rash, or a very low level of alertness that persists. Childrens' alertness is normally lower at the time their fever is high, but improves when the fever is lower or absent. A temperature of more than 100.4 degree for more than 5 days should be discussed with his physician by telephone or in the clinic. Answered 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, Urgent Care, 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, Urgent Care, 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, Urgent Care, 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, , (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 Hospital Medicine (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, , (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 Hospital Medicine (6/4/2005) Q I have a friend who is 37 weeks pregnant, and she has smoked crystal meth off and on during her whole pregnancy. How long does the drug stay in her system, and how long does it stay in the baby's system? If she or the baby tests positive for meth use will the state of Oregon take her baby away from her at birth and keep the baby? Please explain to me how the drug testing laws in Oregon work, and what consequences might she face if the baby tests positive. Does the father have any say in where the child goes? A Meth (methamphetamine) shows up on urine drug screens for days to weeks after use, depending on the amount used. If your friend or her baby test positive, a referral to Services to Children and Families (SCF) will be made and a caseworker will determine if the baby is to be removed from its mother. If the father is in a drug free environment and is not in contact with the mother (who uses drugs) he may get custody. Answered by Heather York, MD, Obstetrics/Gynecolog, Eugene, Women's Care (6/3/2005) Q I am a 24 year old African-American female who suffers from acne. No matter what I do I only have temporary results in my fight against acne. I have been reading about a laser called the Erbium laser for skin resurfacing. I have heard that this laser is okay for people of color, but I am not sure. I am at wits end with my acne; I don't know what to do -- any suggestions? I don't get pimples or zits -- just blackheads and whiteheads that never go away, or if they do they always come back. Do you know of any permanent results, like lasers that can treat this condition? A There are many treatments for acne. Blackheads and whiteheads tend to be particularly difficult to control, and often requires ongoing treatment. Microdermabrasion, chemical peels and some lasers may be helpful, but there is a risk of pigment change in people of color; I'd recommend that you see someone who has experience in darker skin tones. Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (6/1/2005) Q Can you give me information about anxiety attacks --(ie. what they are, what causes them, what happens to a person when having one, etc.)? A Anxiety, or panic, attacks are caused by our fight or flight survival system being activated and flooding our bodies with adrenaline in order to escape danger. Unfortunately, most of our percieved danger at this time is emotional, but we stiil get all the physical effects of having a surge of adrenaline in our system (racing heart, shortness of breath,light headedness). Often, we then become afraid of having panic attacks and that can set off the adrenaline reaction also. Anxiety and panic are two things that respond very well to therapy and medication. Medication alone can stop the symptoms, but not change the thinking that gets us into perceiving danger in various situations. That is where therapy is needed. A good book is "Feel the Fear and Do It Anyways." Some good web sites to learn more about Anxiety Disorders are Anxiety Disorders of America and The Anxiety Network International. Answered by Hallenburg, Kris S. PhD, , 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, , (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, Bellingham Asthma Allergy & Immunology Clinic (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, Urgent Care, 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, Urgent Care, 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, , (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, Springfield, 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 Hospital Medicine (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, Springfield, 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 Hospital Medicine (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, , (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, Springfield, Stephen Erfurth PhD (4/20/2005) Q What is wrong with eating dinner late at night? A While we hear often that it is best not to eat dinner late at night, there is no research to suggest that it is a problem. Latin and European cultures often eat their evening meal at 10PM. However, it is typically a small meal and they usually have "tea" with food at about 4-5PM. Eating dinner late at night is often cited as associated with weight gain; however, there is no research to support this. What is associated with weight gain is the U.S. tradition of eating dinner between 5-7PM and then snacking throughout the evening, unconsciously, while watching TV into the late hours. To keep a healthy metabolism it is best to eat every 4-5 hours. Eating lunch at noon and waiting to eat dinner at 11PM at night could increase the risk that you might overeat because you are extremely hungry after no food for 11 hours. People tend to eat more and faster when they are very hungry. Answered at 4/20/2005 Q I am 24 years old and have been suffering with acne since I was 17. I have recently tried oral antibiotics and topical medications; while they do not completely get rid of acne, it has controlled it dramatically. My dermatologist raised the question about Accutane. I don't know what to do. On one end, I would like to get rid of acne and with Accutane I know I have a very good chance of doing that, but I don't know if the possible severe (and multiple) side effects are worth it. On the other hand, if I don't do Accutane, I would continue to take oral antibiotics (like Doryx) on a regular basis. My question is which is the lesser of two evils?! I'm thinking I don't want to try the risks involved in Accutane, but how safe and healthy is it to take antibiotics on a regular basis?! Any info would be greatly appreciated! A You said a mouthful. Whether Accutane is a good choice for you is a very individual and personal question, which I cannot answer for you. Accutane certainly has some worrisome side effects, but it is the only treatment for acne that is potentially a cure. About half of people who take Accutane for 5 months need no further treatment for acne. So, with Accutane, you will be monitored very closely, with frequent visits and blood tests, but it is often just for the short term. I use a lot of Accutane in my practice. Although it is sometimes the only treatment that is really effective, it is not for everyone. Answered by Diane Baird, MD, Dermatology, Eugene, Diane Baird MD (4/20/2005) Q I have a friend who is 39 weeks pregnant and due any day now. She has been smoking marijuana daily and I'm concerned that the hospital will try to take her baby away from her. What are the hospital's policies on drug testing newborns? Should she be worried? A At Sacred Heart Medical Center, the drug testing of mothers and/or infants is ordered by the physicians. This occurs if there is reason to suspect drug abuse by the RN, social worker or physician. A referral to children's services is made by the social worker if the drug test is positive for the mother and/or the infant. The social worker will discuss the mandatory referral with the mother, if possible, prior to the referral call. The call is required by Oregon state law and there is no choice on the hospital's part regarding making this call. If children's services does become involved, this may be a good thing. They can encourage the mother not to smoke marijuana. She may be breastfeeding and continue to transmit the substance to the infant that way. Marijuana IS definitely affecting the unborn child in the womb. The smoke in the home, after birth, will also be detrimental to the infant. The hospital, itself, does not remove infants from the custody of their parents. The local children's services agency is mandated by law to intervene when a child is being harmed. The intervention likely will not involve removal of the infant from the parent's custody. If the parent cooperates and shows good effort to stop the harmful behavior, for the infant's sake, children's services will likely monitor and assist the parent. Please encourage your friend to stop smoking marijuana for the infant's wellbeing. There are no benefits in continuing to smoke marijuana for your friend or the infant, both before birth and after. Answered at 4/18/2005 Q 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, , (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, , (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, Springfield, 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, Bellingham Asthma Allergy & Immunology Clinic (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, Urgent Care, 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 Hospital Medicine (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 primary care physician should be contacted to see what the plan would be to rule out other causes of the symptoms. I would be happy to share with them what I've found about fluoxetine. Likewise, if the symptoms do go away on their own, which is my fondest hope, I would appreciate knowing this. Mike Canton - Oregon - Pharmacy 12/4/2004 Answered at 12/3/2004 Q I'm 17 and I'm having pain in my left leg. They did an MRI, a Bone scan, and blood tests and everything is fine. The pain still remains so they are going to perform a pelvic sonogram and I would like to know how is it done exactly because they haven't explained it to me and I'm scared. A I'm not sure I understand the connection between your leg pain and pelvic sonography but it sounds like your doctors are trying everything. The pelvic sonogram (ultrasound) can be performed two ways. First, scanning through a full bladder, using the bladder as a sound window to see pelvic structures. The ultrasound waves are safe and are not painful. The other way to scan is using a vaginal probe for higher detail of the uterus and ovaries. This is usually not performed in patients who are not sexually active, When scanning this way, a specially designed tubular probe is used with a sterile condom sheath. You will likely be able to see some of the images on the screen as the exam is done. Answered by Jon Ekstrom, MD, Radiology: Diagnosti, Eugene, Radiology Associates, PC (12/1/2004) Q I am 32, in pretty good shape and I have started to take on weight. I am now overweight (BMI 26). Although I exercise 3 times per week, I always feel very hungry and find it extremely difficult to avoid eating during the day. I have also tried to improve what I am eating. On the advice of my doctor, I am now considering taking Meridia for a short period of time, to help loose some of the weight and help me fight my food cravings. However, we are considering having a baby. I am wondering if they are any side effects (especially on conception) that I should be aware of. As said, I am in good shape, no medical problems, no other medication and normal blood pressure. A First of all, Meridia would not be indicated for you. A BMI of 26 is just not that bad. Secondly, I generally frown on using a drug for this purpose unless there is a major current health problem (or risk) due to obesity. I'm doubtful any study has shown whether or not Merida can affect male fertility, but it seems unlikely. I recommend considering a low carbohydrate diet such as The South Beach Diet. People generally have fewer cravings on a low carb diet and weight loss can progress pretty rapidly in many cases, making it especially attractive. Answered by Frank Littell, MD, Hospitalist, Springfield, PeaceHealth Hospital Medicine (12/1/2004) Q I started to exercise after 10 years of a sedentary life and within two months was unable to walk and developed excruciating pain. My doctor diagnosed me with post-traumatic chondromalacia patellae and gave me one exercise to do. After 3 months of doing this physio and a proper intake of chondroitin/glucosamine , I have had no improvement. I have read up on this condition and have found that a proper physio , electrical stimulation, MRI to determine any ripped cartilage and/or arthroscopy can be done to further improve my condition. I am also worried that I may develop early degenerative osteoarthritis. Is any of this true or am I stuck like this forever? A You raise a number of concerns, and I will try to address each one: 1) If, indeed, your proper diagnosis is patellofemoral chondromalacia (literally, softening of the cartilage) then exercises are one of the mainstays of your treatment. Don't be too disappointed that 3 mos. of exercise has yet to "cure" over a decade of inactivity. 2) Although not mentioned in your question, weight loss is an important adjunct as well. The forces that are generated between the knee cap and the femur can reach 4-6 times body weight. Therefore a 10-20 pound (or more!!) weight loss will reduce the stresses by 40-120 pounds. Since you take millions of steps a year, that really adds up!! 3) An MRI for patellofemoral problems is usually a waste of time and money. ONLY get an MRI if there is a significant question about the diagnosis or to look for a specific problem. More likely than not, the MRI will do nothing to change your treatment and only add expense to your medical budget. 4) Arthroscopy can be very helpful especially if there are some malalignment problems with the patella. It can be used to clean up some cartilage lesions, smooth out some of the areas of wear, and often can allow a better alignment of the patella. However, you should have exhausted all other modalities before going to surgery. 5) Chondroitin/glucosamine can be helpful in relieving symptoms, but there are NO published reports that show any change in the course or severity of arthritis with those medications. I tell my patients to try it for about 4-6 weeks and see if there is a difference. If not, save your money. 6) Are you stuck with it forever - probably not, however, patellofemoral problems can be long lasting and difficult to treat. Answered by Thomas Wuest, MD, Orthopedic Surgery, Eugene, Slocum Orthopedics (11/29/2004) Q I had a mammogram done last week which showed two semi-round masses in my breast. Today I had another that showed the same; however, my ultrasound done also today showed nothing. I have been having pain in the breast area and in the breast bone for a few months now. My doctor wants me to wait and have another mammogram/ ultrasound in 6 months. Is it safe to wait this long, and is it normal for nothing to show up on ultrasound? Why would they appear on mammogram but not ultrasound? The masses were about the size of my thumb and about an inch apart. Should I be concerned it may be cancer? My doctor said he did not know what it was. I'am 60 years old with no history of breast cancer in my family. A The most important thing is whether or not anything is changing on serial mammograms going back in time. If these opacities are stable mammographically, I think it is safe to follow them. Mammographic findings do not always show up by ultrasound - when they do, ultrasound can help distinguish between solid and cystic lesions and sometimes can determine malignant characteristics of masses. The bottom line for you would be to determine if the mammographic findings are stable and to correlate that information with the physical examination of your breasts. Any new mammographic opacity or palpable finding may need a biopsy. Close follow-up will be important if a biopsy is not performed. Answered by Jon Ekstrom, MD, Radiology: Diagnosti, Eugene, Radiology Associates, PC (11/27/2004) Q What could cause bloody semem discharge during intercourse? A This is called hematospermia. Hematospermia refers to the presence of blood in the seminal fluid. It almost always results from nonspecific inflammation of the prostate and/or seminal vesicles and resolves spontaneously, usually within several weeks. It frequently occurs after a prolonged period of sexual abstinence. Patients with hematospermia that persists beyond several weeks should undergo further urologic evaluation, because, rarely, an underlying etiology will be identified. A genital and rectal examination should be done to exclude the presence of tuberculosis, a prostate-specific antigen (PSA) and a rectal examination done to exclude prostatic carcinoma, and a urinary cytology done to exclude the possibility of transitional cell carcinoma of the prostate. It should be emphasized, however, that hematospermia almost always resolves spontaneously and rarely is associated with any significant urologic pathology. You should call and make an appointment to see your primary care doctor for an examination. Answered by Erin Reilly, MD, Urgent Care, Springfield, PHMG/Urgent - RiverBend (11/26/2004) Q My boyfriend is 28 and became HIV positive two years ago. I would like to know what will be approximately his life expectancy with a suitable treatment? A The answer to this question is very difficult. Prior to any effective treatment the prognosis was 10 years of life. We now know that there is a variable period of time between a positive blood test, an increased viral load, a decreased lymphocyte count and finally the onset of symptoms. Treatment has some definite side effects but is much, much better than before. I believe you will need to discuss this with your doctor who know all the characteristic of your boyfriend's positive test. You can also learn about HIV on Healthwise. Answered by Hugh Johnston, MD, Hematology, , (11/18/2004) Q How long does it usually take (ballpark) to recover from sepsis? A It really depends on the source of infection. Sepsis due to a heart valve infection can take 6 weeks. Sepsis due to pneumonia or a urinary infection might take two weeks. But I'm just talking about the actual infection. Improvement in strength, appetite, functional abilitiy, etc. can take much longer (even months), and is most dependent on the pre-sepsis condition of the patient. Answered by Frank Littell, MD, Hospitalist, Springfield, PeaceHealth Hospital Medicine (11/12/2004) Q How does Adderall help you? A In children who are hyperactive, or with other abnormal behavioral problems, Adderall appears to be of value in combination with other measures to reduce restlessness. This reduced restlessness, accompanied by improved behavior and improved attention, seems to occur not only in physically inactive tasks (classroom situations) but also physically active tasks (structured sports situations). Answered at 11/11/2004 Q What will happen to the veins in the body if RBCs are not drawn off when you are diagnosed with polycythemia vera? A There is a tendency for clots to form and develope thrombophelbitis Answered by Hugh Johnston, MD, Hematology, , (11/11/2004) Q I had a FNA (fine needle aspiration)on my thyroid. I have a nodule that is 3 cm in size on my right lobe and results state a follicular neoplasm-suspicious. I also have some benign nodules on my left lobe. I am booked for a consult with a surgeon in 2 weeks. With the research I have done, I feel a total thyroidectomy would be the safest choice. How soon should I expect surgery to occur and what is a reasonable amount of time to wait for the surgery? I would like to have it ASAP as I'm concerned about growth and invasion to surrounding tissues. A Very well stated question. Thyroid cancer is usually slow growing, minimally invasive, and cure rates are high with surgery. For a 3cm tumor, a total thyroidectomy is the option favored by most surgeons, and the one that I would recommend. A two week wait to see the surgeon should be OK, but for your peace of mind, I think that surgery should be offered within 2 weeks of that visit. That timing is appropriate, and there is really minimal risk of progression. The best of luck to you. Answered by Charles Stanton, MD, Surgery: General, Springfield, Northwest Surgical Specialists (11/9/2004) Q Our 12 year old daughter has had her contact lenses for almost a year. She hears a lot from her friends at school about how good the hard contact lenses are for kids' vision correction and reduction of nearsightedness. Is it true that hard contact is better than soft contact in the reduction of nearsightedness, or in correcting it? A There are now hard lenses that a person can wear at night that flattens their cornea and makes them temporarily less near-sighted. It is best for her to wear her soft lenses and when her prescription stops changing (around age 20) consider refractive surgery. The contact lenses you wear at night can cause infections and the effect is temporary, sometimes only lasting half a day. Answered by Richard Hoffman, MD, Ophthalmology, Eugene, Drs. Fine, Hoffman & Packer, LLC (11/8/2004) Q I'm new to Eugene. What's the best way to find a new primary care physician (included in my United Healthcare plan)? A I would first decide what kind of primary care physician to chose as your health plan will allow you to see either an internal medicine or a family medicine doctor. An internist is preferable if you have mult/chronic, medical care issues, or are a senior. A family practice physician, would be a great choice if your health care needs are less complex ie, need for routine physical care exams and acute episodes of care. There are 2 large medical groups in Eugene, Peace Health Medical Group and Oregon Medical Group and also there are some independent medical providers potentially available for you to access. The physician directory available on line from United Healthcare www.myuhn.com can assist you in locating a physician in a specific area if that is a factor for you. You can contact PHMG Physician Referral at # 686 7000, to obtain list on doctors with an open practice, and at OMG the person to contact is their New Patient Representative tele # 242 4444. If you pick and independent physician, you will need to contact their office individually to determine if they have an open practice. I hope this information will asssit you in locating a new doctor, and wish you a warm welcome to Eugene. Carolyn St. Clair, RN, CPN, CCM Care Coordination Answered at 11/3/2004 Q May I have some info on Cymbalta(duloxetine)? A It's a new antidepressant very much like one already on the market called venlafaxine (Effexor). Both are in the class of mixed reuptake inhibitors, because they reduce the reuptake of two brain chemicals, norepinephrine and serotonin, into the nerve terminals, thus extending their action in the brain. This results in a substantial reversal of the symptoms of major depression. Side effects are infrequent and consist mostly of insomnia, headache, nausea, dry mouth, and tremor. The nausea often resolves after 1-4 weeks of continued therapy. Duloxetine has also been found effective in reducing symptoms related to nerve damage seen with diabetes, and in relieving stress incontinence in women. Answered at 11/2/2004 Q I'm 28 years old and for the last few years my liver enzymes have been elevated. They were GGT- 329, AST-76, ALT-186, LD-90. I stopped drinking for a few weeks and they dropped down; then I stopped drinking for another month and nothing changed. I need to know if there are any pills I can take to lower them and what else should I avoid? I am back to drinking now about once a week. Please don't tell me I need to stop altogether.... A It's a very good thing that you are taking this problem seriously. The fact that your liver enzymes are elevated lets us know that there is damage happening to your liver. It is vital that you understand what is causing that damage and do everything that you can to minimize further damage. If the damage continues, then over time your liver will be unable to repair itself and will scar, resulting in cirrhosis. It is my experience that once liver enzymes are elevated, from any cause, that it can take months for them to come all the way back to normal. So, it's not surprising that cutting back on alcohol caused some improvement and it's also not surprising that the enzymes didn't come all the way back to normal given that you stopped only for a few weeks. There are lots of things that can cause your liver enzymes to go up - a bunch of different kinds of infections, exposure to various medications, including some over the counters and herbal remedies and exposure to certain chemicals. I would recommend that you make an appointment with your physician who knows your complete medical history and ask the same question that you asked me. Lastly, there's not a pill that I know of that will help bring your liver enzymes down. The liver has an amazing capacity to heal itself but it has to be given the right conditions to do that: good nutrition and no ongoing injury. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (11/1/2004) Q My friend is a strong supporter of the "ear candle" for removing ear wax. I was curious to know what the experts recommendation is and if any known problems may occur in the use of these ear candles. A We have spent many hours removing melted wax from people's ear canals. It is a bad idea, although usually doesn't cause problems. Use over the counter debrox-like meds or go to your doctor. Answered by Emil R. Hecht, MD, Otolaryngology, Bellingham, Bellingham Ear Nose & Throat (11/1/2004) Q My prolactin level is 115.4 ng/ml. I'm not taking birth control & my thyroid is fine. Should I be concerned? A A high level of prolactin such as yours is usually caused by an overactive group of cells in the pituitary gland called a prolactinoma. With a level that high, you should probably have an MRI of the head to rule out a pituitary tumor. High levels of prolactin can also cause significant problems with menstrual irregularities. Answered by Paula Jewett, MD, Obstetrics/Gynecolog, Eugene, Women's Care (10/29/2004) Q I have a question about vitamins. I take Equate Multivitamins. I also take calcium. I take these in the morning with Zelnorm and Prilosec. Is it beneficial to take two multivitamins, or is that a bad idea? I have always taken two. Someone mentioned that if too many are taken, they can become toxic in the system. I would like to know what guidelines are appropriate. A Taking a multivitamin to supplement a healthy diet is probably not necessary, but neither is it harmful. Taking two multivitamins could potentially lead to toxicity from the fat soluable vitamins A and D. These vitamins accumulate in the liver and, over time, can reach toxic levels if too much is taken. Taking extra calcium is probably good as long as not more than 2500 mg calcium per day is not exceeded (twice the recommended intake). Because the Prilosec you take decreases stomach acid, calcium citrate might be the preferred calcium salt, as calcium carbonate is poorly absorbed without stomach acid. Answered at 10/28/2004 Q I was told to get a Nuclear Stress Test (Adenosine). What does that mean, especially Adenosine? A Adenosine is a compound our bodies make all the time in normal cellular metabolism. We use it to create stress conditions for coronary blood flow testing by using a high concentration of it intravenously for a six minute infusion. It reliably recreates exercise blood flow conditions for stress testing when high level treadmill exercise cannot be performed. People often feel unwell during the infusion, but it is very safe and reliable for stress testing, and it goes away immediately when the infusion is over. The only people who should not get it are people with severe asthma and people with heart block who do not have a pacemaker. Answered by Peter Beglin, MD, Cardiology: Interven, Bellingham, North Cascade Cardiology (10/28/2004) Q I'm taking Wellbutrin SR and I was wondering if I could just stop taking the medication, or do I have to wean myself off of it? If so how do I do it? A Generally Wellbutrin (bupropion) is used for the treatment of depression, which, untreated, can be a dangerous condition. The decision to stop taking bupropion should be made by you and your health care provider together. If the decision is made to discontinue the bupropion some people experience uncomfortable side effects with abrupt withdrawl of the bupropion, and find it more comfortable to taper the medication over several days or weeks. Answered at 10/26/2004 Q I am curious as to whether or not a corpus lutem is always visualized on ultrasound after ovulation. When a sonogram is performed can it see around the ovary or just the top or bottom? A A dominant follicle develops (normally) each cycle. The ovaries often alternate back and forth with regard to which ovary produces the dominant follicle. When the follicle matures, an egg is released. The remaning cavity is the corpus luteum. If you scan with Ultrasound carefully during the phases of a normal cycle, you can usually identify the dominant follicle and subsequently, the corpus luteum. This is often done for infertility patients especially those on fertility medications. The orientation of the follicle to the ovary does not affect its visualization. More often, bowel loops or other pelvic structures like the uterus could obstruct ultrasound visualization. Answered by Jon Ekstrom, MD, Radiology: Diagnosti, Eugene, Radiology Associates, PC (10/26/2004) Q My sister is a non-stop dieter although at 5' 4" and 130 lbs, I feel she is at a healthy weight. She also walks, runs and lifts free weights regularly. There is a strong history of heart disease in my family and I worry about her and her "diet-pills". Before ephedra was taken out of Zenedrine (sp?) she was taking it and did have spells of increased heart rate and dizziness. She even tried the non-ephedra version and still had these similar reactions, just not as extreme. She's tried several forms of diet pills since and her new diet excursion is CortiSlim. This morning she had really bad tightness in her chest and felt like she couldn't breathe. She was reluctlant to tell me that she started taking CortiSlim a day or two ago. I know they are being hit hard by the FTC but would any of the ingredients in this cause heart problems or bring on a heart attack? She won't listen to me and says that there was nothing in the information that came with the pills saying anything about causing heart complications. CortiSlim is relatively new and I was just concerned for my sister's health. I can't seem to find anything else on the web about this "supplement" causing any physical health problems. Please provide your opinion on whether CortiSlim can cause health problems or heart problems. A I think your concern about your sister is justified. Your sister is smaller than the "average" person, so an "average" dose would be a large dose for her. A person with a family history of heart disease should be very careful about taking supplements containing stimulants. So called "dietary supplements" are not obligated to carry warnings of their side effects and often make unsubstantiated claims of their effectiveness. CortiSlim contains green tea and bitter orange, which can inhibit liver enzymes. Green tea contains caffeine, and bitter orange can also inhibit the metabolism of caffeine. This product also contains the ingredient synephrine. Synephrine is a stimulant similar to ephedrine, which is contained in the herb ephedra (ma huang). Ephedra products were removed from the U.S. market due to safety concerns. Ephedra is linked to stroke, heart attack, seizures, and other serious side effects. Answered at 10/25/2004 Q I am wondering about a total knee replacement. I am a 70 year old male -- broke my knee 35 years ago and have had pain and stiffness since then. Will I be able to lift heavy things with a new knee? A If the problem you have with your knee is post-traumatic arthritis, then a knee replacement may be a very good option. The definition of "heavy" however is very subjective. Clearly, there will be some limitations on your activites after major joint replacement surgery. If you are planning to return to very strenuous activites, you need to be clear with your expectations when discussing the procedure with your surgeon. The only way to know for sure is to ask specific questions to the operating surgeon. To read about knee problems try The Knee Guru. Answered by Thomas Wuest, MD, Orthopedic Surgery, Eugene, Slocum Orthopedics (10/20/2004) Q My Doctor told me that I am on the border line and at risk for diabetes. She told me about 6.1 something, which should be 6 and below to be normal. Will you please explain to me what she is talking about? I have high cholesterol and tryglicerides, and high blood presure. She put me also on ALTACE 5 MG. A Your doctor is taking about your Hemoglobin A1C. It is a measure of the percent of sugar in the blood stream that is sticking to your red blood cells. The normal range is 4 - 6 % indicating a blood sugar average of 80 - 120. You are at the high end of that range - indicating that your average blood sugars are usually over 100 ( a bit higher than "normal") You also have other risk factors. I would suggest asking your MD for a referral to a Registered Dietitian for help changing your diet and lifestyle to reduce you risk factors. Answered at 10/20/2004 Q Any recommendations for the 'life alert' type of emergency calling buttons seniors can wear? A One of the organizations is HeartLine/Lifeline through PeacHealth Center for Senior Health, in Eugene. The phone number is 541-349-7272. If you don't live in the Eugene area, try calling the local hospital and ask for the social work department. They should be able to help you find the local service for personal response service. There is an installation fee and monthly fee for this service. If the senior is low income and has a Senior and Disabled Services caseworker, this person can authorize the service for the Senior who generally could not afford it. Key to the system is reinforcing that the senior needs to wear the button at all times. I've seen quite a few seniors admitted to the hospital after falls in the home. They had Lifeline, but did not have the button on. Answered at 10/18/2004 Q Please tell me about Dumping Syndrome. The patient is a 60 year old female with no history of chronic illness, other than significant irritable bowel symptoms for the past 25 years, treated with Clidinium/Clindex A Dumping is a condition where the stomach empties food (usually with a high sugar content) quickly or directly into the small bowel absortion area . This causes symptoms of dizziness, rapid heart rate, sweating, and sometimes fainting. It is unusual to occur in someone without prior stomach surgery. It is treated by frequent small low sugar content meals and medications or surgery to slow the bowel down. Answered by Hugh Johnston, MD, Hematology, , (10/14/2004) Q I have herpes and am dating a gentleman who has diabetes. I practice safe sex and do not want to put him at risk. We are concerned how this might affect his health? I have had this for 15+ yrs. I don't break out often.I have had 3 rx's written in the last 2yrs and have not had to have them filled. Am I in a dorment stage? A Yes, you are in a dormant stage, but you could have asymptomatic shedding of the virus. This means you shed the virus without having any symptoms. The chances of that are as high as 25% to 40%. Since your partner has diabetes he is probably more susceptible to infections. I would use a condom just to be safe. You might also consider taking Valtrex or Zovirax on a daily basis to prevent shedding the virus. Answered by Linda Frison, MD, Obstetrics/Gynecolog, Eugene, PHMG/OBGYN-Willamette (10/14/2004) Q I have been troubled with panic attacks and anxiety disorder for the past 5 months, and after several counseling sessions have been advised to try medication. My doctor prescribed Celexa at 10 mg for two weeks, then 20 mg. A family friend who also had this problem (albeit 20 years ago) gave the drug Elavil rave reviews. What is the difference between these two medications? Which has proven to give the fewest side effects? I am not a medication fan and being anxious anyway am, of course, anxious about side effects! A Both are in the broad category of antidepressants, but have many other uses, including anxiety/panic attacks. Elavil (amitriptyline) belongs to a class known as the tricyclic antidepressants (TCAs), while Celexa belongs to a more recently developed class knows as the selective serotonin reuptake inhibitors (SSRIs). The SSRIs have definitely taken over the market over the TCAs, primarily because of fewer side effects. People tolerate the SSRIs far better than the TCAs, even though they are far more expensive. Answered at 10/11/2004 Q What causes migraines? A That's a great question and there are lots of different answers. First, there looks to be a family component,i.e. it's inherited or passed down genetically. Secondly, there are triggers to the migraines which vary from person to person. These triggers included stress, certain food items, excess use of pain medications ( including over the counter medicines) and a long list of other potential triggers - some of which can be unique to the individual migraine sufferer Lastly, there are things that can prolong or intensify the headache - light, noises, smells, etc. For a good general overview of migraine please take a look at Migraine Headaches Additionally I recommend Headache Relief for Women : How You Can Manage and Prevent Pain, by Alan M. Rapoport and Fred D. Sheftell, for folks that have migraines. It has been very helpful to many of my patients who suffer from migraine. Though specifically targeted for women ( the majority of migraine sufferers are women), the recommendations in this book are helpful to men also. Good luck! This is one area where the patients knowledge of their disease can make a huge difference in how well it's controlled. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (10/11/2004) Q My friend's father died of heart attack at the age of 35. How much does that put risk my friend at risk? She is in her late 20's and very much worried. Can you suggest anything that will help her? A These issues are more frequent than people think. The one proven point in management of first degree relatives is aggressive risk factor modification: identifying and treating hypertension, elevated cholesterol, and diabetes, stopping smoking, and increasing exercise and encouraging weight loss where appropriate -- all save lives and prevent heart attacks. We have learned to be much more aggressive about blood pressure and cholesterol control in individuals at increased genetic risk because it profoundly reduces cardiac risks. Also, for patients with heart attacks at such a young age, we frequently screen for emerging non-traditional risk factors which can have a genetic tendency, such as hyperhomocyseinemia and Lp(a) disorders. All these risk factors are modifiable; your friend should see a health care provider to examine these issues and address any relevant factors so her risk can be controlled and her concern can be comforted. Answered by Peter Beglin, MD, Cardiology: Interven, Bellingham, North Cascade Cardiology (10/6/2004) Q I have a hard, round bump behind my ear, which feels like it is filled with something. Could this be a calcium deposit? A More likely a swollen lymph gland --not unusual for these to swell up in response to ear infetion, colds or infections of the scalp. Sometimes they will stay swollen even long after the infection has gone away. If the swelling becomes red and painful OR if it grows progressively larger then you should see your doctor for further evaluation. I am assuming that you have one isolated bump - if there are several then you should be seen by your doctor. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (10/5/2004) Q I'm 25 years old and quit smoking about 2 years ago. I smoked for around 5-6 years and for the past 1-1/2 years I have seen a progressive decline in my health. At first I just sometimes felt chest tightness and lightheadedness, but for the past six months I have been becoming shorter of breath . I mean I can walk easily but if I climb more than 2 floors I am gasping for air. Also my head is numb all the time and my reflexes are slow; my nose is clogged all the time and I clear my throat all the time and have a slight dry cough. How likely am I to have lung cancer? I'm scared to death of going to the doctor. A Congratulations on quitting smoking! Yahoo!! Good work!! I'm doing the wave right here in front of my computer. You have just taken the most important step you could possibly have taken for the improvement of your health. Stay away from them! I'm sorry to hear that you have been feeling poor. The symptoms that you describe are more likely to be as a result of asthma, allergy, deconditioning or possibly depression or anxiety; they are not at all consistent with lung cancer. Though not impossible for some one as young as you to have lung cancer,even with a history of smoking, it is extremely unlikely that this is the diagnosis. Please overcome your fear of going to the doctor and go! You will feel better for it. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (10/5/2004) Q My boyfriend has emphysema and wants to have lung reduction surgery. A doctor in California said that he could undergo the surgery but at a higher, though not prohibitive risk. Could you explain what this means in layman's language? I've checked on the internet but don't understand it. A The risk for lung reduction surgery is very much dependent on the type of emphysema a patient has and the technique to be performed. Studies that have looked at Lung Volume Reduction Surgery (LVRS) have omitted patients that are considered "high" risks, categories which have to do with age, the amount of impairment in the ability to exhale air, and the diffusing capacity. Outside of this, the best candidate who would more likely than not gain a benefit, is an individual who has emphysema affecting predominantly the upper lobes and has a poor exercise tolerance. The technique best used is approaching both lungs by a midline incision or using a fiberoptic scope through each side, removing portions (volume reduction) and patching the "holes" by stapling biological patches to those areas. Laser surgery is not successful in this technique. It is important to understand, LVRS does not cure emphysema, but instead improves some components of function, but only for a period of time (2-5 years) before function returns back to the previous state. So the patient's doctor may have been referring to the fact that the patient may not necessarily be the best candidate for the procedure, but certainly could be an acceptable candidate. Answered by Michael McNellis, MD, Pulmonology, Longview, PeaceHealth Specialty Clinic (10/1/2004) Q How long does it take a blood clot to resolve itself after getting the heparin injections and starting on coumadin? Is there any danger of the clot breaking loose before it's resolved? A I assume you are talking about a clot in a vein in the lower extremity. My answer is predicated on that location. To some extent it depends on whether the clot is in a vein below the knee or above the knee. In a vein below the knee the risk of breaking off is relatively low and above the knee it is higher. Heparin and coumadin reduce the risk significantly. Within 48-72 the risk for below the knee clots is close to zero. In clots above the knee the risk is close to zero in about 3-5 days. In both instances the clot is partially disolved by the heparin. The heparin has an immediate effect of preventing fresh clots from forming. Coumadin also prevents fresh clots from forming but it usually takes about 72 hours for the coumadin to be effective. In addition, the clot that is present adheres to the wall of the vein which prevents it from breaking off. The process of adhering to the wall of the vein isn't affected by either heparin or coumadin. Answered by Loren Barlow, MD, Internal Medicine, , (9/30/2004) Q What are the hospital policies related to health care directives for Oregon? Specifically --if a patient does not have a health care directive, how are decisions made for removal of artificial life support? A The guidelines for a person without a designated healthcare representative (designated in writing by the person), are found in Oregon Statute ORS 127.635. You can read this by accessing Chapter 127. The answer to your question is mandated in this statute, which guides the medical staff with how to proceed. If a person can no longer make their own healthcare decisions, as defined by this statute, the healthcare facility would attempt to locate, with reasonable effort, the following persons and determine if one would be willing to serve as a healthcare representative. This process is under the direction of the attending physician, who will then speak with the accepting designated person(s) about life-sustaining procedures. The designated healthcare decision-maker, as designated by Oregon law, are outlined below in priority order of who is first, second, etc. 1. A guardian who is authorized to make health care decisions. 2. The person's spouse or registered domestic partner. The domestic partner must be registered in a jurisdiction. 3. An adult designated by the others listed in the statute, who can be located, if no person listed objects to the designation. 4. A majority of the adult children who can be located. 5. Either parent. 6. Any adult relative or adult friend. 7. If none of the persons above are available, then life-sustaining procedures may be withheld or withdrawn upon the direction and under the supervision of the attending physician. Sacred Heart Medical Center has a "Palliative Care Team" who can be helpful in this process and in assuring that the person is kept comfortable. The attending physician can write an order for the team to be involved if the healthcare decision-maker requests this. Also, in all hospitals, a medical social worker's assistance can be requested in this difficult situation. I hope this helps clarify for you how the decisions for removal of life-sustaining support would be made if there is no Advanced Directive and the person can no longer make their own decisions. The best situation is for each individual, who does not want full interventions for life-sustaining procedures, to have an Advanced Directive. Anyone with a potentially life-threatening illness, should complete an Advanced Directive if full interventions are not wanted. Copies of this should be given to your physician(s),the healthcare representative and alternate healthcare representative. This is the individual's chance to designate his or her own wishes. Any hospital will be able to provide an Advanced Directive to complete. Answered at 9/30/2004 Q I had blood work done and they said AST and ALT emzymes in my liver were really high. I found out I have chronic hepatitis, but they didn't say what kind. What does this mean and is it curable? A The tests you mention only show some inflamation of the liver. What kind, or is it a chronic disese, and how severe will require additional tests. Only then can one know if it is curable. Once your doctor tells you what kind of hepatitis you have you can learn more about Hepatitis on Healthwise. Answered by Hugh Johnston, MD, Hematology, , (9/30/2004) Q I tried finding the answers on your FAQ but have had no luck. What is the least intrusive way of raising HDL levels? I have made progress in lowering LDL, but haven't seemed to gain ground in raising HDL, I do exercise, I walk 2 miles, 5-days a week during lunch. I am fairly active, do hiking, heavy chores etc. I eat pretty reasonably, (not perfect, but reasonable), I am not grossly over weight. At 44 years, I weigh about 190 pounds, and am 6'2" tall. Any light you can shed on raising HDL levels would be much appreciated. A The best way to raise HDL is exercise, but really probably more aerobic than you are currently doing. There has been some benefit seen with alcohol in raising HDL, but some people dispute that and say it is the wrong type of HDL or that grape juice can do the same thing. In any case raising HDL is difficult. There are some medications that can help, but their effect is relatively minor --estrogens, sometimes niacin, fenofibrate and sometimes the statin drugs. Your doctor would need to determine if these medications are right for you. Answered by Christa Danielson, MD, Family Practice, Eugene, PHMG/FP-South (9/30/2004) Q What are some of the side effects of using Cortislim? A Cortislim and similar products are more accurately classified as appetite suppressants. They are advertised as ephedra free but contain synephrine, an ephedra like drug. Tremor, anxiety, and insomnia may occur with this product. A better alternative would be a 2000 kcal/day diet and 20 minutes of daily exercise. Answered by John Holroyd, MD, Internal Medicine, Bellingham, PHMGW/IM 2A-Cordata (9/30/2004) Q I have a meniscus tear and unstable patella. I am wondering what is the cause of sharp pains in the knee, and how I can ease the pain? I also would like to know, since I do have an unstable patella, how would it be fixed surgically if the knee brace doesn't work? A Let's address these questions one at a time: Meniscus Tear: Treatment options include observation, arthroscopic repair or arthroscopic resection. Unstable Patella: Treatment options here are bracing, exercises, physical therapy, and possibly arthroscopic versus open surgical treatments. The surgical options include a release of some of the tethering structures of the knee cap (patella) and/or a tightening of other structures to allow it to track more midline. To learn more about knee anatomy try the Knee Guru. Answered by Thomas Wuest, MD, Orthopedic Surgery, Eugene, Slocum Orthopedics (9/28/2004) Q I am being treated for a DVT (deep vein thrombosis) in my leg following a knee injury with torn ligaments one month ago. How long do I need to reasonably wait before starting physical therapy? No surgery has been scheduled at this time-- just the PT, but the DVT was discovered & now I'm not sure when I can start the PT. A If the pain and swelling in the calf is gone 4-6 weeks should be adequate. If there is still pain and/or swelling you should consult your physician before starting any exercise. Answered by Martha MacRitchie, MD, Physical Medicine &, Eugene, Rehabilitation Medicine Associates (9/28/2004) Q Is fiber contraindicated while taking Coumadin/Tinzaparin inections? I come in to your TCU every day for the above medication, trying to reach an INR goal of 2.5 & after 6 injections, I'm not there yet. I consume 2 to 4 slices of 8 grain, high fiber bread daily, in addition to a large bowl of oatmeal. Is this keeping me from absorbing the meds? A It is more likely your vitamin K intake. The fiber should not make a difference, but warfarin is in direct competition with vitamin K for vitamin K dependent clotting factors (II, VII, IX, and X). Vitamin K is found in green leafy vegetables, milk, dairy products, meats, eggs, cereals, and fruits. You should talk with the pharmacist about your diet. It is important to keep vitamin K intake consistent. Answered at 9/27/2004 Q My boyfriend and I are very concerned that his 16 year old cousin, who is 5 months pregnant, may get her child taken away due to the fact that she smokes marijuana daily. We were curious as to what will happen if they drug screen her before discharge and find she has marijuana in her system; we're very afraid that she'll have her child taken away from her. We're trying our hardest to inform her of the risks and consiquences of smoking marijuana, but she won't listen. Please inform us on the screening policies, if there are any before discharge from the hospital. A A drug screen before or after delivery requires a physician order, while in the hospital. It is not a regular procedure that would occur. If she does have a physician order a drug screen and it shows positive for marijuana or other drugs of abuse, this will be reported to the local children's services office. The report by hospital professionals is required by law. The local children's services agency then determines what actions will be taken. In Oregon, unless the newborn shows direct signs of the effects of marijuana use during pregnancy, there would likely not be an investigation. A report is kept on record with children's services, in case other reports are received concerning the infant. Most children's services agencies have the goal of assisting the parent to get help. They try to keep the family together, if at all possible. It may not necessarily be a bad event if children's services gets involved, if the cousin is not open to stopping marijuana use. Even if there is a reason for children's services to assume custody of the infant, the mother can work to regain custody by following the plan outlined by children's services. Anyone can call the local children's services agency and report a concern regarding a pregnancy or infant. This can be an anonymous call to express concern for the welfare of the infant. Marijuana use is affecting the developing infant and you are absolutely right to be concerned. I hope this gives you some idea of the process for protecting the infant. There should be a social worker in your local hospital you can contact for additional questions, specific to your geographic area. Another concern would be if the mother plans to breastfeed the infant. You could write "Ask-an-Expert" to have a physician respond to the effects of a mother's marijuana use on a breastfeeding infant. You could also request specific medical information of the effects of marijuana use by the mother on the developing infant. Charlotte Cassaday, LCSW Medical Social Worker Sacred Heart Medical Center Eugene, Oregon Answered at 9/27/2004 Q My question is about chlorzoxazone --would it be considered an opiate? A Chlorzoxazone is a centrally acting muscle relaxant, not an opiate. The mechanism of action of chlorzoxazone is not fully understood. It is a centrally acting muscle relaxant and does not exert a direct effect on the muscles. Chlorzoxazone may act at the spinal cord and the subcortical levels of the brain to inhibit the reflexes associated with muscle spasm. Answered at 9/21/2004 Q I recently had a breast biopsy done and found out that the lumps were caused by cat scratch disease. I have not felt well for a couple of years. I have never had an infected sore from a cat scratch, but I have been scratched many times. My question is: if this disease is causing lumps to grow in my body, how serious is this? A Probably not too serious. Your examining physician would be able to tell you whether there are signs of residual disease and whether antibiotic treatment would be useful. Healthwise has a short article on Cat Scratch Disease and more information is available at PeaceHealth libraries. Answered by John Wilson, MD, Infectious Disease, Eugene, The Travel Clinic (9/20/2004) Q Your website has a section discussing the chemotheraphy medication, daunorubicin. Under the section "What is the most important information I should know about daunorubicin", it states that one of the side effects is "severe heart damage with prolonged use". Could you tell me what "prolonged use" is considered to be? I am 160 lbs, age 38, and am scheduled to get 4 days in a row dosage of daunorubicin. I will get this same dosage of daunorubicin on my next round of concentrated chemo. A You did not mention the dose of daunorubicin that you will be getting, and that is the key to avoiding the heart damage. A lifetime dose of less than 550-600mg/m2 will essentially avoid any damage to the heart. If you have received radiation therapy to the chest, this maximal lifetime dose decreases to 400mg/m2. I cannot calculate your body surface area, which is what the m2 stands for, without also knowing your height, but you can check with your oncologist on the total dose. This information is well known by these specialists, and I'm certain they have taken this into consideration. Answered at 9/13/2004 Q I had a PaP smear done and they found that I have abnormal cells on my cevix. They said I have to do a colposcopy but I don't know how to prepare for it. Can you help me with my problem and get back to me as soon as possible? A The Pap smear detects abnormal cells on the cervix (dysplasia) usually years before a true cancer develops. The colposcopy gives a microscopic veiw of the cervix to determine where the abnormal cells are coming from, how big the lesion is, and does it look worse, the same or better than the pap smear. There is no preparation needed for a colposcopy. The colposcopy is fairly quick -- 5- 10 minutes -- and the biopsy is usually not worse than a menstrual cramp. The results of the colposcopy determine treatment, usually just an office procedure, with a 90+% cure rate. For more information look in Healthwise at the article on Colposcopy for abnormal cervical cell changes. Answered by Cristin Babcock, MD, Obstetrics/Gynecolog, Springfield, Women's Care (9/13/2004) Q Can Group B streptococcus be transmitted sexually and then passed on to another partner? A Group B Strep, is often isolated from the vagina or rectum of healthy pregnant women. This is routinely screened for in these folks because this bacterium can cause significant and potentially dangerous infections to the newborn. There is no evidence that this bacterium is transmitted through sexual contact. An interesting web site that can provide much more detail is GBS: Group B Strep Assn. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (9/9/2004) Q Is there an internet site that I can log on to find out the foods that will be better for my diet --(that won't cause gas)? I am really in need of help, any suggestions is appreciated. I was thinking about changing my diet to consist of more herbs and/or organic foods? Will these types of foods make a difference? A There are many cause for gas. Are you taking any new medications? Have you changed your diet significantly - are you eating a food consistently that you had not been eating before -- milk, chocolate, beans, fruits and vegetables, low carb breads or cereals? A normal person passes gas about 28 times a day - granted it is not usually noticable to the person or those they are with - but it is interesting to realize it is a natural process. Generally the food mentioned above produce gas. If you have increased the fiber content of you diet gas is a likely result initally, but if you are consistent your body begins to adjust. A web site I can think of off hand is michiganbean.org - they promote eating more beans and often address the gas issue. I don't know of any reason why organic foods or herbs would make a difference. There are some good general nutrition sites in the Health Links in the Nutrition category. Answered at 9/2/2004 Q Can injectable testosterone affect dental health, such as breaking down the enamal and increasing risk for tooth decay and breakage? A I could find no evidence that testosterone injection was related to tooth decay or eroding enamal. The only reference to dental health with testosterone products had to do with gum or mouth irritation (9%), bitter taste (4%), gum pain and tenderness (3%), gum edema and taste perversion (2%), and were side effects associated with testosterone buccal (oral release) system during clinical trials. Gum irritation generally resolved in 1 to 8 days and gum tenderness resolved in 1 to 14 days (Prod Info Striant(TM), 2003). Answered at 9/1/2004 Q I am bipolar and am on many drugs. Does Klonopin cause weight gain? A The answer appears to be yes. In two studies, weight gain was seen in all subjects, and was attributed to an increase in appetite. Answered at 9/1/2004 Q What are the side effects from taking metformin 5oo mg four times a day? A Metformin is a valuable medication for the treatment of non-insulin dependent diabetes mellitus. Like all medications, metformin has side effects which may occur during treatment. You and your physician should evaluate the individual risks in your case of the treatment versus the benefit of the treatment with metformin. Lactic acidosis is a rare but potentially fatal complication of metformin therapy. Lactic acidosis may be prevented in most cases by avoiding metformin use in patients with renal impairment, liver disease, or cardiopulmonary insufficiency. Gastrointestinal effects including diarrhea, nausea, vomiting, flatulence, and anorexia are frequent early in therapy but may be minimized by slowly titrating the dose. Other side effects include low vitamin B-12 levels (cobalamin deficiency), headache, agitation, dizziness, tiredness, liver toxicity, and rash. Answered at 8/26/2004 Q To use cantharidin,salicylic acid,podophylin mixture in the treatment of penile warts,how and when do you administer the mixture? A There are many products which include these elements at various concentrations so, the bottom line is: follow the directions provided by the health care provider that prescribed it. If those directions are not clear then please check in with him/her to clarify. I tend to use a product called podocon 25 and advise people to apply it twice daily, just to the wart - being careful to avoid the surrounding healthy tissue- for 3 days, take 4 days off and then repeat the cycle for 4 weeks maximum. The intent of the compound is to provide irritation and inflammation to the area. This can result in sloughing of the wart that it is being applied to. Hence the caution to use it just on the wart itself and to take 4 days off between treatments. I tell my patients that if 2 cycles has generated lots of inflammation then they shouldn't keep going - they should stop and wait to see the result. There's some information on this product in Healthwise at Podophyllin resin... Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (8/17/2004) Q I had a thyroid test which came back in the "normal" range, but I still feel like something is just wrong. I feel tired all the time (no matter if I sleep 4 hours or 10 hours a night), irritable, depressed, chronically constipated, forgetful. No matter how dedicated I am to losing weight, it is impossible. I faithfully did the Atkins diet for 3 months and lost 15 lbs. the 1st month, then nothing. Most recently, I ate 1200-1800 calories a day and walked 3 miles 7 days a week --lost 22 lbs. in the 1st month, then nothing. My PCP says that my thyroid gland is enlarged, and both maternal grandparents had thyroid problems. Is there something I'm missing? A There are a variety of causes of fatigue, irritability, depression, and chronic constipation other than thyroid insufficiency. One of the more common causes of this symptom complex is depression. There are also a variety of other disorders that can produce these symptoms. There is a natural tendency following weight loss to achieve a new "set point" and weight loss becomes more difficult. It is the way the body protects itself against starvation. My advice is to make sure you have had a complete evaluation of your symptoms and not just a thyroid evaluation. I would also suggest you be screened/evaluated for depression. Be persistent in your search for a cause of your symptoms. Answered by Loren Barlow, MD, Internal Medicine, , (8/17/2004) Q I have COPD. I have the opportunity to move to any place in the USA that would be of maximum benefit to living with my disease. What is the best environment, the ideal place to go ...I have searched everywhere and can't find the answer. A There is not a correct answer to this question. COPD is such a broad disease and may be due to a chronic inflammatory condition such as asthma, or an induced chronic inflammatory state which occurs with smoking. In general, patients with chronic lung disease do better in drier climates, but not necessarily warmer climates, although this may be more comfortable. More damp and humid environments tend to exacerbate COPD particularly in those patients who are susceptible to environmental allergies or molds. Perhaps the best thing to do is visit places you may wish to live, and see how well your lungs do. Answered by Michael McNellis, MD, Pulmonology, Longview, PeaceHealth Specialty Clinic (8/11/2004) Q During my last period (4 days ago) I had severe abdominal and lower back pain. The doctor has asked me to get a complete GYN checkup. Are there non-invasive methods for GYN checkup (maybe ultrasound)? I'm not sexually active and have never had intercourse. I'm scared of the pain (both physical and psychological). A A pelvic ultrasound will show any masses, tumors or abnormal cysts that are involving your uterus or ovaries. Sometimes to get the most accurate pictures they may need to insert a thin instrument into your vagina during the ultrasound to help see the ovaries. For most women, even those that have not had intercourse, a pelvic exam is not a painful experience. Answered by Dan Herron, MD, Obstetrics/Gynecolog, Longview, PeaceHealth Women's Clinic (8/11/2004) Q I had my gallbladder taken out several years ago. Some time after the surgery, I had X-rays done for some chiropractic treatment I was receiving and two staples showed up on the X-ray. I was wondering if it is normal for staples to be left in you six or seven years after gallbladder removal surgery, or if they are supposed to be removed after surgery. I have been having abdominal problems as of late and wanted to know if it could be caused by the staples. A Using metal clips to secure the gallbladder duct and artery is standard, and those clips will show up on any future x-ray. They are very small, designed to last a lifetime, and it is very highly unlikely that they are responsible for your abdominal problems. Answered by Charles Stanton, MD, Surgery: General, Springfield, Northwest Surgical Specialists (8/9/2004) Q Would you please advise me of the effects Remicade has on the kidneys? A Remarkably, no effects on the kidneys have been reported with Remicade. The only thing reported is occasional urinary tract infections, possibly related to the drug's effect on the immune system. Even this effect has been rarely reported. Answered at 8/9/2004 Q Does CortiSlim (dietary supplement) interfere with oral birth control pills such as orthotricyclene? A CortiSlim contains green tea and bitter orange, which can inhibit liver enzymes. This could increase the side effects of oral contraceptives. Green tea contains caffeine, and bitter orange can also inhibit the metabolism of caffeine. This product contains the ingredient synephrine. Synephrine is a stimulant similar to ephedrine, which is contained in the herb ephedra (ma huang). Ephedra products were removed from the U.S. market due to safety concerns. Ephedra is linked to stroke, heart attack, seizure, and other serious side effects. Many manufacturers have now substituted synephrine in products that used to contain ephedra. These products are typically promoted for weight loss. Many of these products are now labeled as ephedra-free or ma huang-free, but they often still contain the stimulant synephrine. These synephrine-containing products likely have the same risks as the ephedra-containing products. Synephrine is a constituent of the bitter orange (Citrus aurantium). Products that list bitter orange or Citrus aurantium on the label also likely contain synephrine. Answered at 8/4/2004 Q I would like to know about a certain supplement called chromium. It is offered by health and fittness companies as a digestive aid for weight loss. It is supposed to keep your metabolism working properly so that food is digested better, thus keeping weight down. I wonder if you know what the pros and cons are for taking this supplement? Do you know of any weight loss supplements that are best? Do you have a recommended source for information about them? A There is a lot of anecdotal information available on chromium and its benefit in losing weight and in improving blood sugar control. Generally it is considered safe for short term use. Studies at Yale and U.of Alabama have noted some folks who have problems with irregular heart beat. It is also uncertain if some possible genetic damage may occur that would increase risk of cancer. Because weight control is usually a long term problem it might be better to focus on what is safe and healthy and has been documented to work. The advice I am going to give you is not flashy and probably isn't in the latest book on weight loss, but it works. Start with 30-60 minutes of exercise everyday. If you have not been exercising you will want to start slowly. Walking is good enough. If you have any orthopedic problems you might consider water exercise. This can be as simple as walking in the pool. The food part of almost as simple. You want to have a minimum of three meals a day. These meals should be spread out over the day and should consist of at least 5 servings of vegetables and fruit per day. A serving is about 1/2 cup. Try to eat just a bit less than you want. Avoid all regular soda and juice (4oz of juice once a day is ok). Expect this plan to be a life time plan rather than 2-3 weeks or even months. Weight loss of 2-3 pounds per month is great, imadgine how that works over 2-3 years. You can find additional information on Chromium in Healthwise Alternative Medicine. Answered at 8/4/2004 Q I was wondering if you could give me some information about the sleep disorder known as Sleep Choking Syndrome or any helpful resources that are available. A Sleep Choking Syndrome is currently considered a proposed diagnosis for the "International Classification of Sleep Disorders". There is very little actually published about it beyond case reports due to its rare occurence. It is characterized by frequent (nightly or more often) episodes of awakening with a severe choking sensation that is frightening. The cause is not known. A similar but different disorder, "sleep related laryngospasm" is also being considered as a proposed sleep disorder and is characterized by infrequent (1-3 times a year) awakening with choking and an inability to breath due to laryngospasm. We have all had laryngospasm while awake...it is the feeling of inability to breathe one has after having accidentally aspirated a liquid, and being briefly unable to talk or breathe. Unfortunately, at this time there is not a good reference resource for either of these due to their rarity. If you think you or someone you know has sleep-choking syndrome, he/she should be seen by a sleep specialist to exclude other causes such as obstructive sleep apnea or night terrors. Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (8/2/2004) Q I am having recurrent urticaria -- what shall I do to help myself? A First get rid of what might be causing the problem -- not always the easiest thing --then use an OTC antihistamine such as Claritan on a daily basis. There's some more information in Healthwise on Urticaria and on MedlinePlus at Hives. Answered by Christa Danielson, MD, Family Practice, Eugene, PHMG/FP-South (7/27/2004) Q What is the name of the surgery that cleans the veins in your legs? And what is entailed by the surgery? A There is no surgery to 'clean' the veins. They can be surgically removed (Ligation and stripping), sealed from the inside with a laser or radiofrequency generator, or injected with an agent (sclerotherapy) that will cause them to scar and seal. So called 'spider veins' can be treated with sclerotherapy or external beam laser. Answered by Charles Stanton, MD, Surgery: General, Springfield, Northwest Surgical Specialists (7/26/2004) Q I just found out my blood presure is high -- 160 over 95. I am 45, in good shape, weigh 110lbs. I take Triphasil, Effexor XR and Lorazepam. Could any of these be the cause and what can I do? A Both Effexor and the oral contraceptives can cause an increase in blood pressure, sometimes above the normal range. About 30% of the cases of hypertension are genetically based. Some cases of hypertension are due to medical conditions or lifestyle choices and can be reversed without medication. Answered at 7/26/2004 Q I was adopted and have been trying to find out who my birth parents are for years. I was born at St. Johns, and so they should have the records. I am 20 years old, and would like to meet them one day. I moved from Longview a year ago and live in Portland now. So, my question I have for you is this -- where do I go in the hospital to locate my information, and have them release my parents' names, or what ever it is they do? A If you are in Longview, go to St.John Hospital and have them direct you to the medical records department and they can tell you what you have to do to obtain that information. If you prefer, you can call 1-360-414-2000 and ask for EX 4800 Medical Records Department and they can give you the information as to how you can obtain the information that you are seeking. The Cowlitz County Health Department at 1952 9th Ave. Longview, 360-4145599 is where your birth certificate can be obtained. There is a small fee for a copy of the certificate. Answered at 7/21/2004 Q I saw an advertisement for "Cortislim" and it said that it was an all natural product. I don't know what to believe when I see these claims.I am 42 years old and my metabolism is slowing down. I exercise three to four times a week for 35 minutes at a time. I have cut down the portions that I eat. I can't keep up and I am gaining weight. I would like some added help of some kind and I would like it to be safe. Do you have any ideas about what supplements are safe? A I've seen the advertisement as well. It's well known that age is accomopanied by a decrease in metabolism, but no one has shown that cortisol, the body's own product for increasing fuel production for rapid metabolism, is related to obesity. Unfortunately, we really have no information on this product beyond what the manufacturer cares to share with us. There is a web site that will only tell us that Cortislim contains vitamins, minerals, and herbs. The reason that there is so much advertising of these supplements is that the manufacturer can say pretty much anything, as they are considered nutritional supplements and therefore do not have to live up to the higher standards of products considered "drugs" by the FDA. The sad fact is, that the manufacturers of these supplements don't have to prove a thing. Therefore I have nothing I can share with you as to the effectiveness of this product. My own opinion is that it's just a very expensive vitamin product. PeaceHealth libraries have a subscription to the Natural Medicine Comprehensive Database which will give you some information if you ask there. Answered at 7/19/2004 Q I have a carpal boss on top of my hand (lunate) and the boss is catching on my tendon from my pointing finger and causing the tendon to burn and tingle and cause pain. The surgeon wants to give me a cortisone shot. Will the cortisone shot heal me or is this just a temporary fix, seeing that the tendon will still catch on the bone? A If the tendon, or the area around it, is swollen from inflammation then the injection could be very helpful. If the situation is not improved with the injection you may come to surgery to remove the carpal bossing, but that is usually the last resort. Answered by Thomas Wuest, MD, Orthopedic Surgery, Eugene, Slocum Orthopedics (7/14/2004) Q My rheumatoid factor recently came back positive (252)and also my liver enzymes (ALT,AST, & GGT) were up.Can this be related? If so, which liver diseases specifically could cause this? Does it have to be a chronic one or can it something simpler like a fatty liver? Or can these two things occur and be unrelated? Any info would be great. A Your questions are good and your own answers are also valid. The answer depends to some extent on how how the values are of the abnormal liver functions tests. Only mild elevations (1.5-2.0 x normal) may be of no significance and indicate no abnormality of the liver. If you are on any medicine for your rheumatoid disease then that could be the cause whether it is a prescription drug or so-called over the counter. Some rhuematoid disorders have a systemic component, thus accounting for the liver abnormality. It is possible that the abnormality could be due to some unrelated abnormality such as you have conjectured, e.g. fatty liver, gall bladder abnormalities. For a more definitive evaluation you should see your primary care physician. Answered by Loren Barlow, MD, Internal Medicine, , (7/12/2004) Q What does "elevated enzymes of the liver" mean? A The answer depends on many things. There are four liver enzymes that are commonly measured: The ALT, AST, and GGT are transaminases that participate in metabolism. Their elevation suggests damage or inflammation of the liver itself. This occurs in response to infection in the liver or bile ducts (these drain the liver), hepatitis, and reactions to certain drugs and poisons (especially important with tylenol overdose, certain cholesterol lowering drugs, and some mushrooms). The alkaline phosphatase is another enzyme, and it is predominately elevated when the liver drainage is obstructed. This occurs with gallstones in the bile ducts, and tumors of the liver, bile ducts, and pancreas. Finally, although not an enzyme, the bilirubin is often measured. Bilirubin is a metabolic end product of decayed red blood cells. It is cleared by the liver. An increased bilirubin is an indicator that the liver, as a whole, is not functioning correctly. Accumulation of this substance in the blood is responsible for the jaundice seen in patients with liver disease. Answered by Robert Crochelt, MD, Surgery: General, Ketchikan, Southeast Surgical Clinic (7/9/2004) Q My question is that I feel I am withdrawing from Darvocet. I have been taking it daily for the past 9 months for severe arthritis headaches (from the neck). My headaches have eased and I've been out of the medication now for about 6 days. I feel the effects from the withdrawal --headache, fatique, cannot sit still, cannot sleep, etc. Any advice you can give me would be much appreciated.I am 64 years old. A It sounds like perhaps you are suffering the effects of opiate withdrawl. With a medication like propoxyphene these symptoms will decrease over a period of about a week, so you should be more comfortable now. Should the symptoms persist, you would have a couple of options. One would be to taper the propoxyphene over several days to a week. Another would be to take a medicine like clonidine to try to amilorate the symptoms. Answered at 7/6/2004 Q I got a small, red, bloodshot dot in my eye. From the research I've done it seems as if it's a subconjunctival hemorrhage. I just got some night and day contacts and wore them for 35 hours, and this happened. I took them off for now. Also I did run yesterday; could that have been a problem also? A Most likely that is it. It should resolve in a week; if not see your opthomologist. Answered by Christa Danielson, MD, Family Practice, Eugene, PHMG/FP-South (6/30/2004) Q What is the purpose of the federal mandated medical contract that patients and doctors are signing, re: certain controlled substances? A I can speak to the state of Oregon's laws around the prescription of controlled substances for the treatment of chronic pain not caused by cancer. I am not familiar with federal law. In the state of Oregon, a physician is required, by the administrative rules of the Oregon Board of Medical Examiners to do several things if s/he believes that a patient needs to be on controlled substances on a chronic basis for the control of intractable pain that is not as a result of cancer. There's a link to the Oregon BME website where the detail of this is spelled out at Division 15 In summary this requires a physician to: Confirm the diagnosis, be certain that the patient understands the material risks associated with the chronic use of the prescribed medication and lastly, to keep a clear record of what is being prescribed, in what amount and how often it is being refilled. The BME have some recommendations to physicians in the state as to what the "material risk" form and the tracking form should look like - I suspect it is a version of this forms that you are alluding to. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (6/29/2004) Q I am taking Lamictal and I was offered ecstacy at a party last week. I declined, but I was wondering if it is dangerous to take ecstacy while on Lamictal. A While no information could be found regarding a specific interaction between Lamictal and ecstacy (also known MDMA), it is important to emphasize the dangerous, and occasionally lethal effects of MDMA all by itself. The drug can cause agitation, dangerous increases in blood pressure and heart rate, confusion, and delerium. More severe effects include dangerous elevations in body temperature, formation of blood clots throughout the blood vessels, muscle damage, seizures, and kidney failure. Please refrain from using this dangerous drug on any occasion. Answered at 6/29/2004 Q My question is: if I have tested positive for herpes 2, and have had 2 small outbreaks, and my partner has tested positive for the antibodies for herpes 1 and 2 but never had outbreaks, can having sexual relations with me cause him to become more infected and begin to have outbreaks? Is he immune to getting it worse because he already has the antibodies? Also, can I contract herpes 1 from him if he has never had the outbreaks? A Your partner should not be at risk for herpes type 2 because he has already been exposed to it and has antibodies to it and some immunity. He may, or may not, have a future outbreak, or he may have small outbreaks that are hardly noticeable. So, if you have sex while you have an outbreak it should not cause him to have an outbreak. In terms of herpes type 1, if you have no current antibodies to it or evidence of past exposure it is possible you could contract it from him if he had a genital outbreak from it, or if he had an oral outbreak from it and you have oral sex. Normally herpes type 1 causes oral outbreaks, although it can also occur in the genital area. Answered by Dan Herron, MD, Obstetrics/Gynecolog, Longview, PeaceHealth Women's Clinic (6/28/2004) Q I'm dating a person with diabetes and it seems to get her down. She is very shy about the situation and doesn't like talking to me about it. What can I do to help her cope with living with it? A We know that persons with diabetes are at significantly higher risk of depression. Managing a chronic illness can be overwhelming, taxing and discouraging for many. What helps? If she is depressed, a visit to a counselor may help her identify feelings and cope better. There are also a number of anitdepressant medications that are effective. If she is embarrased about her diabetes and not wanting to talk about it, she may find support and comfort attending diabetes classes (perhaps with you) or a diabetes support group. It is very helpful to be with other persons with diabetes; they can all share in the challenges and learn from each other. Many hospitals offer diabetes classes (that are paid for by insurance companies) and also could direct you to a free support group. If her blood sugars are running high and she is feeling discouraged about her numbers, I would suggest that she see a good endocrinologist or diabetes educator to learn how to be flexible with her management and insulin doses. Modern management of diabetes includes sweets, counting carbohydrates and changing insulin doses. If she has type 1 diabetes, insulin pumps can be wonderful. It is great that you care about her. Listen, ask good questions and let her know that you would like to learn more about diabetes. Try reading Type 2 Diabetes: Living with the Disease to learn more about the possibilities. Answered at 6/28/2004 Q I have been trying for several years and several doctors to find a reason for my severe fatigue. It seems the physicians I have dealt with find no cause other than age (79 although I have friends, my seniors, who do not suffer likewise. Am I wrong to think my problem can be found somewhere other than the calander? A I will assume from your question that the issue is fatigue and not weakness. Weakness is either a localized or a generalized lack of muscle strenth. Weakness is usually a fairly straight forward evaluation and therefore I will limit my comments to the topic of fatigue. The evaluation of chronic fatigue is complex, multifactorial and more often than not the result is less than satisfactory for the patient. The work up and treatment for this problem is still evolving. There's a detailed review of Chronic Fatigue Syndrome in Healthwise. To stay abreast of current developments and to make connections with others that are wrestling with this issue I would suggest that you consider touching bases with this group for Chronic Fatigue Support Good luck. This is a tough issue and gently put we all age differently - it is clear that the normal aging process can results in decreased stamina; how dramatic that change is for any individual can be variable. An appropriate exercise program focused on developing and maintaining lean muscle mass can be helpful; if you haven't pursued this course I would suggest consulting with your physician to see if this is an option for you. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (6/22/2004) Q I have a friend who just gave birth --her baby is just barely 3 months now. She used to smoke methamphetamine before she got pregnant, but stopped while she was. She told me that yesterday she smoked some again and she is currently breastfeeding. I told her that it's dangerous for the baby's health but she won't believe me. Can you give me some pointers that I could use that would make her believe me and encourage her to discontinue this habit? I told her not to give the baby her milk yet but I dont know what to advise her about when to continue giving the baby her milk, or how many days to wait after using the substance. She says she'll be willing to stop using it if it really is bad for the baby. She wants to continue breastfeeding. She really prefers it. I am really concerned about the baby because I read about a mother being found guilty of killing her baby because of meth consumption. A It absolutely is contraindicated for a nursing mother and poses great risk for the baby --agitation, irritability, seizures and yes, even death. It also greatly affects her ability to parent and puts the baby at high risk for child abuse. I find this extremely worrying. The best thing to do for your friend and her baby is to call Child and Family Services. Answered by Paul Bouressa, MD, Pediatrics, Springfield, PHMG/PED-RiverBend (6/22/2004) Q My 8 year old daughter has low blood sugar. We have been feeding her 6 times a day. However, in the morning she wakes up shaking. I test her sugar while this is happening and it is 80. I give her a sugar tablet and then she is fine for the rest of the day. I took her to the doctor today and they want her to see a specialist. I am scared. He said something about her pancreas. She has also lost 2 pounds in 2 months although she eats all the time. Can anyone ease my mind until we see the specialist? A It sounds like you are getting good medical care. While you wait for the specialist visit you could follow this meal plan: Your daughter should have 3 meals and 3 snacks per day. You should try to avoid all simple sugars including fruit (except at mealtimes in small portions). Remember, this is a short term solution until you see the specialist. The meals and snacks should always contain complex carbohydrates( bread, crackers, potato, rice, noodles, cereal, peas, corn). You may also serve protein with the meals and snacks. The meals should have about the same amount of food as she usually eats. If you are familiar with counting carbohydrates you might think in terms of 60 grams/ meal and 15grams per snack. If your daughter can't eat that much that's ok, just try and be as consistent as possible. Some examples of 15 gm carb snacks are 1/2 meat or cheese sandwich, 6 soda crackers with cheese, 1/4 of a large bagel with cream cheese. It might be worth trying a slightly larger snack at bedtime in hopes of avoiding the low in the am. Try 1/2-3/4 cup cold cereal with milk. If unsweeted cereal is not well tolerated try sweetening it with splenda. I'm sure this sounds very complicated but it at least can get you started. Remember this is just until you see the specialist and get some more information. Answered at 6/16/2004 Q Is there any known cure for diabetes? What do you know about apple cider vinegar and brewers yeast as a treatment? A There is no known cure for diabetes at this time. This is a primary focus of the American Diabetes Association. The proven therapies to prevent health problems associated with uncontrolled diabetes,so as to control it, are: 1. healthy eating patterns and food choices 2. exercise and increasing your physical fitness level 3. various prescription medications that have been well studied and have proven to reduce the occurances of heart disease, stroke, blindness, kidney failure and nervous system problems. The American Diabetes Association has many resources available to begin your steps to learn about and control diabetes. You can find a certified diabetes educator in your area to help you with your questions and care plan. The ADA web site is www.diabetes.org and Healthwise has a good article on Type 2 Diabetes: Recently Diagnosed. Apple cider vinegar and brewer's yeast have not been areas that have shown any health benefits for the treatment plan for diabetes management. Including wholesome foods, emphasizing a mostly plant-based diet, is recommended. Answered at 6/15/2004 Q I had been having problems so I went to the doctor. The problems that I've been having are hair loss,extreme fatigue, and pain in legs and arms. The doctor ran blood tests and found that I have a low white blood cell count. What may be the cause of this? A The causes of a low white count are numerous. The exact cause very much depends on your age, medical history, medications that you are on, exposures that you have had and evidence of ongoing infections. In short your personal physician is the only one that is going to be able to put all of these factors together in a way that will give you a meaningful answer. Take a look at this information on CBC (Complete Blood Count) as I think that it might be helpful in your understanding of white blood cells and may help you as you work with your doctor to understand the meaning of this test, in your particular case. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (6/10/2004) Q My father is having Ablation done on his upper heart. Can you tell me what it is and what I can expect in the way of his recovery?. He is 74, and in good health. He doesn't smoke or drink and is normal body weight. He had a heart attack 8 years ago. A Ablation procedures are done to treat rapid heart rhythms by placing several catheters inside different places in the heart, stimulating the heart to trigger the rhythm, and use finely placed energy (heat or cold) to wound or destroy the extra electrical circuit causing the rapid rhythm. The success and risks depend on the specific rhythm being treated; his electrophysiologist can provide details relevant to him. The recovery is usually very quick; most often patients spend one night in the hospital. Answered by Peter Beglin, MD, Cardiology: Interven, Bellingham, North Cascade Cardiology (6/10/2004) Q Do any urologists perform elective Orchiectomies? A Orchiectomy is done electively under several circumstances: As part of gender reassignment surgery for treatment of transgenderism. This is of course the last step in an extensive medical and psychological evaluation. As part of treatment for prostate cancer. There is some detail on the surgery and the situations when it would be considered for the treatment of this sort of cancer in the Healthwise article on Orchiectomy. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (6/8/2004) Q I am 12 and I have already started my menstrual cycle for the first time April 1. It is now June 7 and I have skipped two cycles. I still have cramps and other symptoms you get during your period. I have also told my mom about it, I would like to know if I should see a doctor for this or if it is normal.I am sort of scared and for any information or answers you give me I would be very thankful! A It is very normal to skip periods after you first start. It can take up to 3 years for cycles to become regular. The cramping may mean that you will start soon. I would not worry about this unless the cramping becomes more severe or interferes with your activity. In that case you should see your doctor. Answered by Linda Frison, MD, Obstetrics/Gynecolog, Eugene, PHMG/OBGYN-Willamette (6/8/2004) Q Do you have any facts or an opinion on a supplement called "policosanol"as an alternative to "Lipitor"? A Policosanol is also know as Dotriacontanol, Heptacosanol, Hexacosanol, Nonacosanol, Octacosanol, Tetracosanol, Tetratriacontanol, and Triacontanol, 32-C. It is considered "possibly safe" when used orally and appropriately. Policosanol seems to be safe when used in doses of 10-20 mg per day for up to 2 years. Taking policosanol orally significantly decreases total cholesterol and low-density lipoprotein (LDL) cholesterol, and increases high-density lipoprotein (HDL) cholesterol. Policosanol is derived from sugar cane and refers to a mixture of 24-34 carbon alcohols comprised primarily of octacosanol (28-C) and also including tetracosanol (24-C), hexacosanol (26-C), heptacosanol (27-C), nonacosanol (29-C), triacontanol (30-C), dotriacontanol (32-C), and tetratriacontanol. Policosanol lowers cholesterol levels by inhibiting hepatic cholesterol synthesis and seems to increase the degradation of low-density lipoprotein (LDL) cholesterol. It also decreases platlet aggregation. Theoretically, taking policosanol with other antiplatelet or anticoagulant drugs might increase the risk of bruising and bleeding. Other side effects include erythema, migraines, insomnia, somnolence, irritability, dizziness, upset stomach, polyphagia, dysuria, weight loss, skin rash, and nose and gum bleeding. For hypercholesterolemia, the typical dose of policosanol is 5-10 mg twice daily. Answered at 6/7/2004 Q My daughter had surgery for an ingrown toenail. Is it necessary for us to keep it out of water to speed healing? If so, for how long? A What were the surgeon's post-operative instructions for your daughter's toe? The treatment of your daughter's toe has to do with what type of surgery was performed, how long ago it was performed, and what type of water you are referring to. I routinely have my patients start soaking their foot in warm water with epsom salts the day following toenail surgery and continue this regimen for 2 weeks. I also have my patients dry the surgical area well after the soak, and cover the surgical area with a bandaid. I would recommend against allowing her to put her foot into water that may not be clean, as the surgical wound is able to be contaminated by bacteria until it heals. Bear in mind that most toenail problems are caused by shoes that are not the proper shape of the human foot, which is most types of footwear available. You should have your daughter remove the liners that come in her shoes and stand on them to make sure that they are wide enough for her foot. If her toes go over the liner, the shoe is the likely cause of her ingrown toenail, as is almost always the case in my patients. Please be careful with her future shoe choices. Answered at 6/6/2004 Q I have recently purchased a light box for SAD. It has a blue tone to the light, 7300-7800 degrees kelvin. Since then I heard that blue light encourages formation of cataracts. Is this light box harmful to my eyes? I have an old light box that seems more color balanced. Should I stick with the old one? A I would contact the manufacturer regarding any health risks. Blue light in large quantities can be harmful to the retina. It is impossible to say if any damage would occur with your device. Answered by Richard Hoffman, MD, Ophthalmology, Eugene, Drs. Fine, Hoffman & Packer, LLC (6/4/2004) Q My mother was diagnosed with MRSA recently and I was wondering what precautions we should be taking at home for her care? Can we contract this resistant bacteria also? Does this mean that she will never get rid of the microbes? A The answers to some of your questions depend on whether your mother has a draining wound. If so, she is more infectious, and could pass it on to others. If not, special precautions are probably not needed. MRSA actually acts like normal staph; we just have fewer antibiotics options for treatment. Believe it or not, people with recurrences often carry it in their noses and ordinary antibiotic treatment may not eradicate it from there. Culturing the nose to make sure it is gone may be useful. CDC (Centers for Disease Control) has a Fact Sheet on MRSA that you might find useful. Answered by John Wilson, MD, Infectious Disease, Eugene, The Travel Clinic (6/2/2004) Q I am a newly married 32 year old male. I do get an erection but find it a bit difficult to retain it for long. The moment I think of insertion I lose it most of the time. Can you suggest some natural way of improving penile erection through some exercise or diet? A In the majority of young healthy men that have your same concern the issue is usually one that relates to anxiety about performance or other stressors. There are also physical causes that can contribute to the problem but those are relatively rare for a guy your age. Nevertheless, it is important for you to be checked by your personal physician to evaluate this and to suggest treatment. The good news is that there are many effective treatments out there for this problem. There is some detailed information in Healthwise about Erection Problems. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (6/1/2004) Q Is a cortisone shot under fluoroscopy done for shoulder pain? I have had a Total Hip Replacement; would this shot put my hip at any risk? A The most common injection for diagnosing and treating shoulder pain is in the subacromial bursa for a condition called impingement. It does not need to be done under flouroscopic guidance, and is easily done in the clinic setting. Less commonly, the shoulder joint itself is injected, and that also can be done in the clinic, but is technically a bit more difficult. Neither should put your THR at risk as long as there are no complications - that is, the injection does not produce the transient bacteremia that dental work and other procedures do. Answered by Thomas Wuest, MD, Orthopedic Surgery, Eugene, Slocum Orthopedics (5/27/2004) Q Lately the inside of my nose has become very dry, causing mucus to form and harden throughout my nostrils. Then, with facial movement, the inside of my nose tears from not being able to move. My nose then starts to bleed or run with clear mucus, and this is burning the heck out of my nose. It has been like this for more than a week. It's driving me crazy! A Nasal vestibulitis usually is a staph infection and responds to antibiotic ointment several times a day to the nose. Use at least 5 times a day for a week and if not all resolved, then you may need keflex antibiotic as well. Answered by Emil R. Hecht, MD, Otolaryngology, Bellingham, Bellingham Ear Nose & Throat (5/27/2004) Q I have had tests that show I have a low testosterone level. I am currently getting shots for the deficiency. My Dr. said I already have an enlarged prostate and I have read that taking a supplement of androderm could cause my prostate to further enlarge. What is the likelihood of that happening and are there any good alternatives? I am 63 years old and have some erection problems at this time but no urinary problems at all. A The size of the prostate and serum prostate specific antigen (PSA) levels have been shown to increase in response to testosterone treatment. Usually these things increase, on average, merely to those of age-matched men with normal testicle production of testosterone. However, some men, especially those over the age of 50 years, experience worsening of a syndrome called benign prostatic hyperplasia or BPH. This is certainly not universal and unfortunately I can't cite statistics for your particular case. Please check in with your physician about these questions - they depend on your particular history. Also, the decision may hinge on a decision by you whether the risk of this happening is worth the benefit from the testosterone. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (5/24/2004) Q I have been checked for, and been found to have, a low testoserone level. I am currently on Androderm to bring my testosterone level up to normal. What are the side effects, if any, of this medication? I read that it could increase my prostate size. I have been told previously by my Dr. that it already is enlarged, but I currently have no urination troubles. I am concerned the prostate could further enlarge because of Androderm usage. What are the risks? A To answer your question properly we need to know how low your testosterone really was before treatment and what is the level now after treatment. The prostate responds to testosterone even at normal levels so that it enlarges with age. Testosterone also will make any cancer of the prostate grow faster. As one gets older the level of testosterone drops "normally". The real question is whether taking testosterone really helps you and whether it currently causes any symptoms at the present. I suspect you will have to talk all this over with your doctor Answered by Hugh Johnston, MD, Hematology, , (5/21/2004) Q How do you get colon cancer? What are the symptoms? Are there any treatments for it besides chemotherapy? A Nobody is sure, even in 2004, what causes colon cancer. A person's risk is increased if a first degree relative (parent, sibling, or child) has has it. We believe many cancers develop from small, initially benign growths called polyps. The best way to deal with the concern for colon cancer is to have regular screening tests. The procedure of choice now consists of a colonoscopy (telescopic exam inside the colon) starting at age 50 for those without a family history of colon cancer and at about age 40 for those with a family history. This procedure is usually repeated every ten years if it is normal. Any polyps seen can be removed and analyzed. If polyps are present a repeat colonoscopy is usally done in three years. If colon cancer does develop (and hasn't spread) surgery is often the treatment of choice Answered by Frank Littell, MD, Hospitalist, Springfield, PeaceHealth Hospital Medicine (5/18/2004) Q My 24 year old son is having problems with wetting the bed when he drinks alcohol. Besides the obvious (not drinking) is there anything that could help? A Well, alcohol is the double whammy here - it is a diuretic ( i.e. makes him need to pee) AND it makes him sleep more deeply so that he is less likely to wake up to go pee. The question here is one of quantity: if he is drinking a large amount and then falling into bed the answer is different than if he has a beer at 7PM and then goes to bed at midnight. The answer to the former problem is to call Al - Anon and learn about how to best deal with an alchoholic family member. In either case he should be checked by his personal physician to see if there are anatomic or hormonal problems which may be contributing to this bedwetting. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (5/17/2004) Q I need some advice on corneal transplant. I am told I will be needing one. A A corneal transplant is the most successful type of transplant surgery performed. It will replace your diseased cornea with a cornea from a donor who has died. Better outcomes are achieved when the surgeon is highly experienced, and the follow-up care is also performed by a physician who is well-versed in the nuances of post corneal transplant care. I suggest you ask your physician for his/her advice, follow it, then get a second opinion before proceeding. The follow-up care is as important as the surgical procedure, so make sure you understand who will be caring for you during the post-operative period--which can last for a year. Here's some background reading about Corneal Transplant Answered by David Deutch, MD, Ophthalmology, Eugene, PHMG/Ophth-Willamette (5/17/2004) Q Can an M.D. or optometrist tell that a patient has had PRK corrective surgery by examining the eyes? In other words, are there postop. signs that are specific to PRK surgery in a future exam? A The only way to see that a patient has had PRK is if there is haze or scarring, or by looking at the light reflex coming out of the eye. The definitive way to know for sure is to use a device called a corneal topographer. If a large correction was performed, the central cornea may appear thinned making it obvious to the ophthalmologist that refractive surgery was performed. Answered by Richard Hoffman, MD, Ophthalmology, Eugene, Drs. Fine, Hoffman & Packer, LLC (5/17/2004) Q I just got a HappyLite - HPL2. I need to know if it will cause my cataracts to become worse? A If it has UV wavelengths it could. If no UV, then it's unlikely. Answered by Richard Hoffman, MD, Ophthalmology, Eugene, Drs. Fine, Hoffman & Packer, LLC (5/17/2004) Q I am a 33 year old, 260 pound male recently diagnosed with CHF (congestive heart failure). I try to be active, but I tire out so easily. When I was released from the hospital in January, I was told to take it easy, to go on short walks. My walks have gotten shorter because I can't make it from the car to the grocery store without being winded. When will this improve? I only see a cardiologist every three months. The last thing he told me was that my heart was just as bad as when I was released in January. What can I expect? I am an avid outdoorsman and would hate to miss out on camping, fishing and hunting. The ODF&W offers disabled hunter permits but to qualify you have to be a class 4 or 5. I don't even know what that means. Could someone offer me cardiac rehab? A You are absolutely a candidate for cardiac rehab! A monitored, progressive program of activity will undoubtedly improve your functional abilities AND your quality of life. The program will also serve to educate you about congestive heart failure (CHF) and how to manage it. A physician referral is all you need to get going. Please discuss with either your primary care physician or your cardiologist. Answered at 5/12/2004 Q I am getting ready to have a baby and my soon-to-be pediatrician told me that sometimes Sacred Heart hospital will test babies for drugs. I am not on drugs and don't want any tests done that aren't necessary. What is the hospital's policy on this? Also, can I find out what tests will be done to the baby after it's born and what my rights are? ..will I be notified of any tests that may take place? A Babies are screened for drug exposure at both SH and MW for history of maternal drug use, inadequate prenatal care or late prenatal care, or no prenatal care. This test is not done routinely and if it is done on babies the parents are notified as to the reasons. It is routine for babies to get prophylactic eye antibioics, vitamin k injection, newborn testing- ie PKU, hearing screening and a transcutaneous bilirubin (checks for jaundice). You should be notifed of any testing and none should be done if you request them not to be--however the pediatric community feels all these are important for the health of your baby. Answered by Paul Bouressa, MD, Pediatrics, Springfield, PHMG/PED-RiverBend (5/11/2004) Q I just had a disc pathology and here is what the Radiologist wrote in his report: "A broadbased shallow midline disc protrusion is demonstrated at the L5/S1 level. This is obliterating epidural fat with some indentation onto the thecal sac with the disc touching the exit nerve root bilaterally. The L4/5 and L3/4 dics are within normal limits. Early Osteophyte formation is see at L4 and L5. No significant lesion is seen in the facet joints. There is no paravertebral soft tissue mass lesion. A shallow disc protrusion is confirmed at the L5/S1 erve root. What does this mean in plain English? Am I in trouble? . A It means the lowest disc in your back has a bulge in it and is in contact with the nerve, possibly causing sciatic pain. This is a commmon finding in even non-symptomatic people, so careful evaluation of this disc bulge is necessary. A bulge is a less severe abnormality of the disc than a herniation. Answered by Michael Karasek, MD, Pain Management, Eugene, Northwest Spine Group (5/10/2004) Q I think that I have had gonnorhea for a long time and it's affecting how much I urinate in a 24 hour period. Is there any way that the effects can be reversed, because it has become nearly impossible to control my bladder? A You should click the "close" button on this internet window, pick up your phone and make an appointment to be seen by your physician or other health care provider! Your physician can sort through whether in fact this is gonnorhea and what the treatment should be to address the symptoms that you have been experiencing. If you don't have a personal physician, most towns or counties have a health department that can advise you about where you can be seen to have this problem evaluated. Gonnorhea is a curable disease. Also this is a diseease that you shouldn't put off getting treatment for - it is highly contagious and so you can easily transmit it to anyone that you are having intimate contact with. Also, untreated it can have other consequences for your health in addition to the ones that you are already experiencing. Here is some more detailed information on Gonnorhea. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (5/6/2004) Q I saw my urologist a year ago and he told me I had a hernia. It hasn't bothered me so I've pretty much ignored it, however lately I've been bike riding more and it's a little tender. Also, I'm planning to do some constructing this summer and I'm worried that it will become a problem when I start lifting walls, etc. I'm male, 49 years old. My questions are: 1. Should I deal with it before I start my construction project? 2. If I do have a hernia operation, how long will I have to wait before I can be doing heavy lifting? 3. I don't go to doctors often and my insurance doesn't require that I get a referral, so should I just schedule an appointment with a surgeon or go to my family doc first? A Your questions are right on the mark for someone with a symptomatic hernia. In general, hernias will get larger and more uncomfortable over time, particularly if one does a lot of physical activity (lifting, pulling, etc). Given your summer plans I would consider getting it fixed before starting the project. Most repairs, whether laparoscopic or traditional open, require some healing time before lifting is advised. I usually tell folks to lift nothing heavier than a fork for 5-7 days, then limit at 25-30 lbs for 2-3 weeks. By 3-4 weeks post-op one can lift pretty much anything if you approach it slowly and with good technique. I would recommend you go thru your regular doctor for a referral, but you generally do have a choice of surgeons, and don't need to feel compelled to only see a surgeon affiliated with your doctor's medical group, Do a little research, and see a surgeon that is experienced, and comfortable doing both open and laparoscopic repairs. Answered by Charles Stanton, MD, Surgery: General, Springfield, Northwest Surgical Specialists (5/5/2004) Q My boyfriend has been getting ring worm around his genital area for a while. I recently went to my gyn doctor and was diagnosed with vaginosis, and told that this was not sexually transmitted. I was prescribed metronidazole and the symptoms went away. I am wondering if he gave it to me with his jock itch since it is a fungal infection, and I had a fungal infection. I would really like to know if jock itch is contagious and if he can take lotrisone cream for this rash on his genitals since he took it for his athelete's foot? A It sounds like you were treated for a bacterial infection called bacterial vaginosis which is not a fungus. It is not considered sexually transmitted and the male sexual partner does not need to be treated. Usually women have a watery grey to yellow discharge and sometimes a fishy odor. It is usually treated with oral or vaginal metronidazole or clindamyacin. Jock itch or ring worm is a fungal infection and could be treated with the lotrimin. It probably is contagious to some degree, so you could potentially develop a vaginal yeast infection which typically would give you a thick white itchy discharge and can be treated with over the counter products like monistat. For some background information on STD's see Exposure to Sexually Transmitted Diseases in Healthwise. Answered by Dan Herron, MD, Obstetrics/Gynecolog, Longview, PeaceHealth Women's Clinic (5/5/2004) Q I am on a fertility workup and I am on my 3rd visit with my doctor. I just got my lab work back and he told me that my progesterone level was too low to even carry a baby. He gave me some clomid to start taking when I start my cycle, which is 3 days late. Can you tell me a little bit more about my progesterone level and can it really prevent me from having kids? A Progesterone is the hormone which maintains the lining of the uterus to allow for implantation. When the progesterone is low, it generally means that a woman has either not ovulated or is ovulating very poorly. To improve ovulation, clomid is given. Make sure that your physician rechecks your progesterone on the clomid to insure that improvement is demonstrated. Answered by Douglas Austin, MD, Gynecology, Eugene, Women's Care (5/1/2004) Q I am 26 years old and have been diagnosed with rheumatoid arthritis. My doctor has put me on Vioxx. Having been on it for a while now, it is getting to be pretty expensive. I was wondering if there was an over-the-counter medicine that I could try instead? A Certainly. Ibuprofen, naproxen, and ketoprofen are examples. For specific dosing instructions please speak with your own physician. The only potential advantages to Vioxx are once-daily dosing and, possibly, a smaller risk of stomach upset, ulcer development, and gastrointestinal bleeding. Answered by Frank Littell, MD, Hospitalist, Springfield, PeaceHealth Hospital Medicine (4/29/2004) Q My son suffers frequently from upper respiratory infections and asthma and is always prescribed "Prednisone 60mg.per day" His allergist told me to decrease this dose by 20-30mg. because his primary care physician had him on too high a dose. But his physician tells me that this is the recommended dose for a 10 year old child weighing 110lbs. Is this the right dose for him or am I giving him too much and damaging his body? I am very scared of this medicine and have heard that it can cause all kinds of problems for my child's organs. Please give me some advice! A 60 mg per day is a reasonable dose (usually 2 mg/kg/day for 5 days with an asthma exaerbation). More important is that if he requires several "bursts of oral steroids" in a given year, he would be better served by being on an inhaled steroid (flovent, qvar, pulmicort) on a daily basis for prevention of asthma exacerbations--you should talk to your doctor about this. Answered by Paul Bouressa, MD, Pediatrics, Springfield, PHMG/PED-RiverBend (4/28/2004) Q Please tell me the basics of a gallbladder removal surgery and what types of narcotics are generally used for pain and sedation. A The gallbladder is usually removed thru a laparoscope via 4 small incisions in the abdomen. Metal clips seal the end of the gallbladder (the cystic duct) and the artery leading to it. Frequently the bile duct that the gallbladder empties into is imaged with an Xray at surgery. There are several good online resources with pictures of this operation. You need to ask an anesthesiologist about specific sedatives and narcotics, but morphine, demerol, fentanyl (IV) and codeine, oxycodone, hydrocodone and darvocet (oral) are commonly used narcotic pain medications. For more information see Open gallbladder surgery for gallstones in the Healthwise Knowledgebase. Answered by Charles Stanton, MD, Surgery: General, Springfield, Northwest Surgical Specialists (4/25/2004) Q When is it necessary to have gallbladder surgery? A That is too general a question for this format, but in general: 1. Infected gallbladder 2. Persistent gallbladder related symptoms with documented gallstones 3. Gallstone pancreatitis 4. Common bile duct stones 5. Gallbladder cancer For general information on gallstones look at the Healthwise articles on it, especially Should I have surgery to treat gallstone attacks? Answered by Charles Stanton, MD, Surgery: General, Springfield, Northwest Surgical Specialists (4/25/2004) Q How do you assist someone with an allergic reaction from eating food? A Get medical attention immediately! If they are having any problems breathing or swallowing, keep them calm, get them to lie down and call 911. Answered by Erin Reilly, MD, Urgent Care, Springfield, PHMG/Urgent - RiverBend (4/19/2004) Q I have a strange discharge in my sperm. It looks like apple jelly. Can you tell me what this could be? A Sperm, under a microscope, looks like tiny minnows; every time you ejaculate there are millions of these guys on a mission to find the egg and fertilize it. Despite these vast numbers they actually are only a very small part of what comes out of your penis when you ejaculate. The rest of what comes out is called semen and is a nutrient rich broth that helps the sperm stay alive and do their job. The semen is typically thick, light tan colored and can be jelly like. Sounds to me like what you are describing is normal ejaculate. Here's some information from Semen Analysis that provides some more detail about the composition of semen. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (4/16/2004) Q I have prostate problems -- no cancer. Is taking Singular and Flonase bad for prostate conditions, and do they contain antihistamine and decongestants? A Singular and Flonase are good choices for allergic symptoms if you have prostate cancer. Many of the antihistamine products may have anticholinergic side effects which make some of them poor choices. Answered at 4/15/2004 Q I'm a male 25 years old. I got oral sex from a man 32 years old. What is the difference between having oral sex with a lady and gent with regard to getting STDs like herpes? A No particular difference: an active herpes lesion on the genitalia or on the oral mucus membranes can be quite infectious and can infect the partner. There is some evidence that even when the herpes is not active that there is still some risk of infectivity. Here is a link to some more information on Genital Herpesthat might be helpful Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (4/12/2004) Q This is in regards to blood tests that are taken during pregnancy -- what are you tested for when the blood is taken? A That is a question with a lengthy answer. Initial blood work includes a blood type, Rubella (measles) immunity, Hepatitis, syphillis, and blood count.These are state mandated tests. Also offered are HIV, and cystic fibrosis. Later in the pregnancy, tests for Down's syndrome are offered, and at 28 weeks a test for diabeties of pregnancy. Your health care provider can explain these in detail if you desire. Answered by Tina Schnapper, MD, Obstetrics/Gynecolog, Eugene, Women's Care (4/5/2004) Q I'm on my third pregnancy. Both of my previous ones were complicated by preterm labor, which as far as I can tell was only diagnosed by frequency of contractions as measured by one of those belts around my belly. A friend told me she had lots of contractions, up to every two minutes, but that her doctor did a test that indicated it wasn't true labor. What test(s) are available to determine if contractions are labor or just Braxton-Hicks. I'm not looking forward to bedrest again, and would like to be certain it is necessary. A This is an important question and needs a longer discussion with your doctor rather than a brief e-mail reply. You should be cared for by an experienced obstetrician who is familiar with high risk pregnancy. The test you are referring to is probably the "fetal fibronectin test" which is a special swab of the upper vagina done between 22 and 35 weeks of the pregnancy. It is only one of a number of variables which diagnose premature labor or the risk of premature labor. Answered by Robert Olson, MD, Obstetrics/Gynecolog, Bellingham, Whatcom Ob/Gyn (4/5/2004) Q I was told (I believe erroneously) by a member of a cystinuria support network that drinking cranberry juice dilates the ureters when attempting to pass a stone. Is this true? I thought that dilation of ureters could only occur surgically by a urologist. A I doubt that cranberry juice has been rigorously studied in treatment of cystinuria as we don't have very good data even with urinary tract infections. You can read a short article in Healthwise about Cystinuria. The complete report from NORD (North American Rare Disease database) is available at the Health Information Libraries or the Hospital Libraries. Answered by Christa Danielson, MD, Family Practice, Eugene, PHMG/FP-South (4/2/2004) Q Why do some doctors prescribe coumadin PLUS an aspirin and others say DO NOT TAKE ASPIRIN when you're taking coumadin? A Each medicine affects the blood clotting system differently. Coumadin inhibits the chemical elements that contribute to clotting. Aspirin inhibits the aggregation of the small blood cells called platelets which is really at the start of the blood clotting process. As an example, a person with an artificial heart valve AND coronary artery disease might need Coumadin to prevent blood clots from forming on the valve and aspirin to prevent blood clotting in the small coronary arteries. Blood clots form on artificial valves not so much because of platelets sticking to them, but because the artificial material stimulates the biochemical clotting cascade (best prevented with Coumadin). Coronary arteries get blocked off when a cholesterol plaque ruptures and releases certain chemicals which then promote platelet aggregation (best prevented with aspirin). Answered by Frank Littell, MD, Hospitalist, Springfield, PeaceHealth Hospital Medicine (4/2/2004) Q I am constantly colder than those around me, and very often my fingernails turn bluish or purplish when I'm experiencing particular coldness. This sometimes happens when it is up to 65 degrees in a room, or more. If I can warm myself quickly, the discoloration goes away, but there have been times where I was unable to get warm again and my nails remained blue for over an hour. I realize this is abnormal, but I don't know what sort of doctor to see about it, or what it might be. I do exercise somewhat regularly, and I'm only 28 years old. A The probable diagnosis is Raynauds. A web site in Healthwise that can help with diagnosis and treatment is Raynaud's Phenomenon. I would say also that you should see your doctor for confirmation. Answered by Christa Danielson, MD, Family Practice, Eugene, PHMG/FP-South (4/2/2004) Q Effexor XR Withdrawal --I have been taking Effexor XR for close to a year at 150mg/day. I recently asked my physician to provide me with prescribing instructions to taper down and dose off. I was given an RX for 75mg/day for seven days, then 37.5mg/day for another seven days. It has been a few days since I have been Effexor free and I have experiencd some really scary "withdrawal" oriented symptoms including: severe dizziness/vertigo,mild confusion, impaired coordination, insomnia (trouble sleeping), nightmares, sensory disturbances, electric shock sensations. I immediately started to do a lot of research and was very suprised to find that this was a major problem for thousands of people. I called my Dr. and he did not know what to do to help with these side effects short of telling me to get some Dramamine. Any ideas or recommendations would be sincerely appreciated. A Withdrawl from the shorter acting antidepressants is not an uncommon occurence. Tapering the medication as you describe is the best way to discontinue these medications. You may have to taper the medication even slower than you describe, and perhaps take one-half (and even one-quarter) of a 25 mg tablet for a week or longer. The recurrance of the symptoms you describe would indicate you might need to taper the medication more slowly, but perhaps you have already recovered, since the withdrawl effects are relatively short lived. Answered at 4/2/2004 Q My daughter is 4 weeks old as of yesterday. We have weaned her to a bottle and she is exclusively on formula. Throughout the day and night, she eats between 3.5 and 4 ounces every three hours. Is this a lot? I've heard of some parents giving younger children cereal earlier than normal if they are big eaters. Should I begin giving her something to fill her stomach a little better? A Your daughter has a healthy appetite, but her intake is in the normal range. I would not recommend starting cereal yet. A 4 week old will not be able to adequately digest the cereal, and she needs the more calorie-dense formula to satisfy her. Contrary to some reports you may have heard, starting cereal is not the magic cure to night time feedings. It may even cause her tummy ache or constipation and she may even sleep less! Her formula is adequate for all her nutrition needs at this age. Answered by Tamara Barstow, MD, Pediatrics, Eugene, PHMG/PED-Barger (4/1/2004) Q I've read a lot of information on snoring. This has been a problem for both myself & my wife for years now. Please explain the proceedures for me to terminate this problem. A There are 3 or 4 different snoring procedures. Injection snoreplasty, radiofrequency snoreplasty , Laser-assisted uvuloplasty, plus nasal and tonsil procedures. Make sure you don't have sleep apnea and follow along with your ENT doctor in your area. To learn more about causes and treatments try the National Library of Medicine consumer page on Snoring. Answered by Emil R. Hecht, MD, Otolaryngology, Bellingham, Bellingham Ear Nose & Throat (3/31/2004) Q My step father has diabetes type 2. The symptoms he has, I have too. They are cold feet, problems with my weight going up and down, kidney problems, mood swings, tiredness. If I use his test meter on myself, what count should I be looking for? I'm 32, male, a non- smoker? A The symptoms you mention could be many things. If you were to use a clean lancet and use his tester your blood sugar should be 60-140. If it is higher than that is does not mean you have diabetes. Home monitors are not accurate enough to diagnose diabetes. If the number is higher you should see your doctor. Maybe you should see your doctor anyway as you have several concerns. Many people at risk for diabetes could avoid or prolong getting it by making some life style changes. Eating three meals per day, spread out with just a bit less than you really want, helps. Also increasing activity, so you are getting 30-60 minutes of even light exercise per day. Avoiding regular soda and fruit juice also help. You are very wise to be a non- smoker -- the combination of diabebes and tobacco is not a good one. Answered at 3/30/2004 Q I have had my right palm/thumb area diagnosed with tendinitis . A side effect of this is that my thumb, at the joint closest to the nail, clicks but never gets stuck. I was given a shot of cortisone and it felt much better for about two days, and I was given 200mg of celebrex to take 1 time a day. I was given a brace to wear, and it does make it more comfortable. But I work in construction and need the use of both hands. I know that surgery can take care of it, but I can't afford it or the time off from work. Any suggestion would be greatly appreciated. A The treatment you are currently pursuing is the course I would recommend. All of what you are doing, combined, should make a difference if you have patience to work with it. Another key element is to look critically at what activites/positions you're putting your thumb through that aggravates the tendon. Tendinitis is a result of overuse or improper positioning which leads to irritation. If you don't stop doing what caused it, or change the method of how you are doing something, the tendinitis won't change. Answered at 3/25/2004 Q I have been having pain in my feet. The pain is on the outside of my feet, near the arches. I would like to know what this might mean? I have good shoes and love to run. A The only way to find out what might be causing this pain in your feet is for you to have a proper examination of your feet and your shoes to determine the problem --if this is a problem with your feet, or perhaps that the shoe that you are running in does not match the structure of your foot and is placing too much pressure on the outside of your feet. Many of the running shoe models of today have features built into them to try to reduce a foot motion called pronation. Pronation is the rolling of your foot to the inside of your arch. If your shoe is an anti-pronation shoe it will cause your foot to bear more weight on the outsides of your arches. Unless your foot needs this type of support, this type of shoe is the cause of pain on the outsides of the arches in many runners that I see. You should learn what type of model of shoe you have and what type of foot it is designed for, to see if it is the type of shoe that is best for your feet. Many runners today are being fitted in shoes that are too restrictive and stiff which is causing pain on the outsides of their feet. If your shoe is an anti-pronation shoe, you should switch to the opposite type of shoe, which is a flexible shoe which easily bends and is not stiff in the arch area. This may take to pressure off of the outsides of your feet and allow you to run more normally. If your pain continues you should be seen by a sports podiatrist or an orthopedic surgeon to determine what the actual cause of the pain might be. Answered at 3/25/2004 Q I have had a recurrent yeast infection for years. I have been to two different gyn, they give me medicine--to no avail. My paps come back normal. Any ideas? I need relief! I've been researching the Yeast Syndrome. A It sounds like you need a thorough evaluation to check the vaginal and vulvar area for not only infections, but possibly other skin irritations. Other systemic problems such as diabetes should be ruled out as well. A gynecologist who has a special interest in vulvar dystrophy should be able to help you. In the Healthwise Knowledgebase there are various articles on Vaginal Yeast Infections. You might find the Home Treatment and Prevention sections useful as well. Answered by Linda Frison, MD, Obstetrics/Gynecolog, Eugene, PHMG/OBGYN-Willamette (3/25/2004) Q What medications are safe to take for a urinary tract infection, while breastfeeding? A Most beta lactams (penicillins, cephalosporins), and trimethoprim/sulfamethoxazole (Bactrim, Septra). Avoid quinalones (Cipro) and tetracyclines (doxycycline). Answered at 3/25/2004 Q How dangerous is high cholesterol? A High cholesterol(or high LDL cholesterol) is one of many factors that increase the risk of coronary heart disease along with high blood pressure , obesity , elevated sugar and high triglycerides. Men with a cholesterol over 240 have a three fold increase in coronary disease compared with men with a cholesterol level below 200. There is a continuous increase in heart diseae risk as the cholesterol level goes up. Answered by Hugh Johnston, MD, Hematology, , (3/23/2004) Q I have a question about getting paranoid at night, so much so that I can not go to sleep. I take meds for bipolar. Could these have anything to do with this? A Yes, some medications taken for bipolar disorder can interfere with sleep by several mechanisms. You should check with your health care provider to see if changing the medication , or changes in the dose of your medication, would help. Answered at 3/23/2004 Q I have an ulcer on my lower leg & the doctor put a boot bandage on it? I am diabetic. The bandage is orange and smells like medicine and then there is gauze on top.Do you know what this bandage is called and what it is really for? I go back to the doctor on Monday to have it debrided. A It is called an unna boot. It acts as both a dressing for your ulcer and compression which is important to help ulcers on the leg heal. Answered by Jay Park, MD, Dermatology, Eugene, Jay Park MD (3/16/2004) Q My 22 year old son fractured his clavicle 2 days ago and is splinted by his family doctor. He was urged to get an x-ray but because he has no insurance he is reluctant to do so. Is this a major concern? Should he get an x-ray and would they repair anything anyway? A Most, and I will stess, MOST, clavicular fractures do NOT need surgery. However, some have non-union (this means the two ends of the break do not ever heal together) and this type of fracture may need surgery. Without knowing the extent or location of the clavicle fracture I cannot give much more advice regarding if, or when, an x-ray might be recommended in follow-up Answered by Erin Reilly, MD, Urgent Care, Springfield, PHMG/Urgent - RiverBend (3/15/2004) Q How frequently should a potassium level be done for a 58 year old woman taking Avalide 300/12.5? What is the standard on this? A The hydrocholothiazide in your medication is low dose so less likely to cause low potassium. The national committee on hypertension recomends getting a potassium 1-2 times a year. I usually will get a sodium , potassium and creatinine (kidney funstion two months after starting the medication and then yearly after that. Answered by Hugh Johnston, MD, Hematology, , (3/15/2004) Q How many platelets is a normal count? A A normal platelet count ranges from 155 to 356. Increased platelet counts, up to twice the upper end of normal, frequently occurs in patients with an inflammatory process. Answered by Stephen Erfurth, M.D., Pathology: Anatomic, Springfield, Stephen Erfurth PhD (3/12/2004) Q I recently have been experiencing burning in the urine for 4-5 days. I had chlamydia probably 28 years ago due to oral sex and these are the same burning symptoms. I read that it takes 1-3 weeks to aquire symptoms. Am I contagious during the 1-3 week period? Is it possible for the partner to get it in her throat from oral sex during that time? Could it spread to her reproductive tract from the throat? What other problems could occur to her from a throat exposure? A The following are true about both chlamydia and gonorrhea: 1. Either can spread FROM the oral or genital tract of a male or female person TO the oral or genital tract of a male or female person via unprotected sex. (OK, genital to genital spread from one woman to another would be pretty unusual.) 2. Either infection in any organ system may be contagious without symptoms being present. 3. Women and their children bear the brunt of serious complication due to these 2 bugs, usually due to tubal scarring and infetility. You need to go to your doctor to arrive at a diagnosis so you can be treated. Answered by John Wilson, MD, Infectious Disease, Eugene, The Travel Clinic (3/4/2004) Q My 8 months baby passed some hard stool and got her anal passage bloody. What can I do? A Your baby has had a small tear in her anus, either on the outside or just on the inside, from passing the hard stool. This is quite common in babies and young children. This tear will heal on its own if the stools are soft from now on. If you can see the tear, you can put some ointment, like Aquaphor, on it to soften up the skin there. If you can't see it, you don't need to use anything. If your baby continues to have hard stools, you should talk to your doctor about ways to help soften the stools. This could delay the healing and re-tear the area. Answered by Tamara Barstow, MD, Pediatrics, Eugene, PHMG/PED-Barger (3/3/2004) Q I am 29 years old and I was involved in a serious auto accident three years ago. I have had ongoing back problems since the accident. I have been on strong pain meds, facet and epidural injections, and nothing has helped for anything long term. I have had MRI's and a discogram to confirm the tear at L5-S1. The recent plan is to do reconstructive surgery on the disc (put some hardware in place of the disc) but I am being told it's not a fusion. My concern is that the majority of my pain is in the mid to low T-spine and then from there to the Lumbar spine. I am being told that the pain is there because it's trying to compensate for the problem. I do not have leg pain. Does this sound reasonable and worthwhile? I am completely unable to work right now and need to do something, but I hear many mixed stories about spine surgery and want to know what the chances of recovery are, and if the symptoms are typical or not. I was also told that the entry would be through the stomach and not the back --so as to not cut the muscles in the back. Any help with this would be greatly appreciated. A It sounds like you are being offered the artificial disc. This is a big surgery, especially for someone so young. The risk of the surgery failing to relieve your pain is increased if the pain centers higher in your back. Consider a second opinion if you are not sure about the surgery. Answered by Michael Karasek, MD, Pain Management, Eugene, Northwest Spine Group (2/23/2004) Q I have been taking Vicodin for back pain. I am going on a job interview and I will have to take a drug test. How long will the drug stay in my system if I stop it today? A Your question is an interesting one for three reasons. First, most people would wash 95% of the drug out of their system within 24 hours of their last dose. But that time frame may be longer with age, or in a patient with liver or kidney disease. Second, many drug assays are very sensitive and may even pick up minute quantities of the drug, so it would be difficult to say how long it would take to wash out all TRACES of the drugs. Third, and most important, most employers will ask about physical ailments and, with any kind of chronic pain condition, will want to know what you take to relieve the pain. If you answer Vicodin, than any traces of Vicodin that show up on the drug test will be considered a negative drug test and will not count against you. Tens of thousands of people are taking pain medication like Vicodin to help them get through their work day, and we are fortunate to live in a time where it is no longer a stigma to be taking strong pain medication when it's required to be productive and pain free. Therefore, I would advise being up front with the interviewer so any trace that does show up would not count against you. Answered at 2/16/2004 Q My 48 year old sister just had an x-ray test reveal a nodule/spot in her lung, near the center. She has always had a bit of a cough for years, perhaps more often in the past year or so. She also just got over a lung infection about 4 weeks ago. This nodule showed up in the x-ray that was taken 2 weeks ago. She has always had normal x-rays before this. The nodule is 1 cm right now. She had a ct scan and we are awaiting those results. She does not smoke and has lived in a smokefree home for years with the exception of an occasional visitor that might have smoked. However, no one has smoked in her home for the past 4 yrs. My sister is also an RN. Her cough isnt "horrible"-- it's just that she seems to cough often. Can you give me a % chance of this being cancer? A Lung cancer in a 48 y/o woman who does not smoke would be very unusual. Indeed, lung cancer as a primary cancer in this population could be termed rare. It is always concerning, however, when a nodule appears that was not there before and this requires some attention. If indeed this woman suffered from a pneumonia, it would acceptable to wait at least 6 weeks to repeat a CXR as the radiographic improvement lags far behind the clinical improvement and this may be a lingering defect from that illness. However, if it is still there, and definitely a new finding when compared to previous chest x-rays, then further work-up is mandated, even up to the point of removing this surgically. There are a number of benign conditions that present like this, and there are also a number of imaging studies that would help evaluate this but, in general, a new nodule will need at least a tissue diagnosis. Answered by Michael McNellis, MD, Pulmonology, Longview, PeaceHealth Specialty Clinic (2/16/2004) Q Your website does not detail or even say anything about your maternity or nursery services in Longveiw...does this hospital have nursery or maternity services? and if so could you please detail them for me? A St. John Hospital has a complete labor and delivery floor along with nursery services. We also have a Women's Health Pavilon that is listed on our Web site under Women's Services. We have family practice doctors at PeaceHealth Medical Group that do OB care and delivery, as well as OB/GYN doctors at the Women's Health Pavilion that do prenatal care and delivery at St.John Hospital. Answered at 2/13/2004 Q I was recently diagnosed with a seizure disorder that has only affected me during my pregnancies. I had my 1st two seizures 8 years ago with my 1st pregnancy -- no seizures with my 2nd pregnancy. But last month I had a seizure the day before I found out I was pregnant. Can you tell me if you have ever heard of such a thing? My EEG was normal. But no one can tell me what is causeing the seizures & why I only have them when I am pregnant. Any information or help you can give would be appreciated. A Thank you for your interesting question. I am not aware of any specific disease entity of seizures ONLY during pregnancy. However, it is well know that some women with epilepsy will have more seizures during pregnancy (and some will have less). It is thought that the hormonal changes and stress of pregnancy has an effect. Some women have seizures only around their periods in a similar fashion. Generally we do not find a cause in most patients for their seizures. In the case of seizures during pregnancy there are some specific conditions that can cause seizures, such as eclampsia (which occurs late in pregnancy), and other very uncommon conditions such as vasculitis or sagittal sinus thrombosis. It is unlikely you have any such condition without many other symptoms. It sounds as though you are being evaluated. I presume you have had some sort of brain imaging study either now, or previously, or both, and have had blood tests also looking for conditions that could cause seizures. You should continue to follow your doctor's advice. It would not surprise me if you eventually have a seizure not during pregnancy. Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (2/12/2004) Q My father-in-law has recently been diagnosed with prostate cancer and his PSA is 1,065. Please tell me what you can assume from this high count? A Prostate Specific Antigen, or PSA, is a chemical that occurs in the blood of all men. The measurement of this is common in screening healthy men for prostate cancer. Levels less than 4.0ng/ml are generally reassuring and levels higher than that generally indicate a need for further evaluation of the prostate. In patients who have already been diagnosed with prostate cancer it is quite common for them to have an elevated PSA. The level of the PSA can be helpful in the prediction of how to proceed with treatment but must be combined with other studies ( e.g. biopsy results, imaging and other diagnostic studies) before a treatment decision can be made. Your father-in-law's urologist or cancer specialist can help him understand how his PSA fits into the larger picture of his care. The PSA level can be followed, along with other studies, to show how effective treatment has been and whether there is any suggestion of recurrence. I have included some more information that could be of help at Prostate Cancer on the Healthwise Knowledgebase. Prostate cancer is the second most common cancer in the US. For further information you might contact: Patient Advocates for Advanced Cancer Treatment (PAACT) International. 150 affiliated groups. Founded 1984. Provides support and advocacy for prostate cancer patients, their families and the general public at risk. Information relative to the advancements in the detection, diagnosis, evaluation and treatment of prostate cancer. Information, referrals, phone help, conferences, newsletters. Group development guidelines. WRITE: PAACT P.O. Box 141695 Grand Rapids, MI 49514-1695 CALL: 616-453-1477 FAX: 616-453-1846 E-MAIL: paact@paactusa.org WEBSITE: http://www.paactusa.org VERIFIED: 4/23/2003 Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (2/5/2004) Q I just found out that I am 3 and 1/2 weeks pregnant. After my first son was born I was diagnosised with a prolactin pituitary tumor. I know that prolactin has to do with milk development. I was just wondering how this was going to affect my pregnacy, and if I should get any test done to see how far along the growth is because I haven't had an MRI in over a year. A If you have a microadenoma, less than 10mm in size, it is extremely unlikely that it will affect your pregnancy. They often do grow a little bit in pregnancy, but usually not enough to cause symptoms ( vision problems or headaches). If you have a macroadenoma, greater than 10mm, they often do enlarge in pregnancy and often require treatment-- medications or surgery. You would need to discuss with your doctor or endocrinologists how frequently they recommned MRI testing for its size. It should not interfere otherwise with the pregnancy or nursing, Answered by Dan Herron, MD, Obstetrics/Gynecolog, Longview, PeaceHealth Women's Clinic (2/4/2004) Q I have just been diagnosed with shin splints for the second time. The last time was nine years ago. For 3 weeks now I have been on crutches as the lower shin is very painful, mostly at night and in the morning. The area is the inner side of the lower shin, with bruising, swelling and also very tender to the touch. I cannot put any weight on the leg for more than a few minutes without the muscle becoming very tight and the toes going numb. When the leg is at rest the muscle is very weak and again the toes are cold and a loss of feeling develops. I no longer run (I stopped about 7 yrs ago). However my job involves standing and walking all day. I've tried the heel arch which has not worked. Now my doctor has referred me to an orthopedic surgeon and has suggested an operation. I am still waiting to see the surgeon. Three weeks have elapsed now and the pain is still severe and I still cannot walk on this leg. Can you advise me on the possible operation? A There usually is not an operation for "shin splints" which is actually an inflammation of the periosteum (the layer around the bone). Treatment for the shin splints is exactly as you have described, i.e. rest, crutches, decrease in activity, icing, etc. until the inflammation subsides and the pain is relieved. What you may have is an "exertional compartment syndrome." That is when the muscle becomes swollen with activity, and the swelling eventually reaches a point where the nerves and vessels are compressed within the muscle compartment. To confirm this diagnosis requires a measurement of the compartment pressure before and after activity. If the pressures are high enough there is a surgical treatment that releases the pressure. An orthopedic surgeon is the proper specialty to consult regarding these problems, and so you are on your way to hopefully getting it resolved. Answered by Thomas Wuest, MD, Orthopedic Surgery, Eugene, Slocum Orthopedics (1/30/2004) Q A 33 yr. old white male complains of having pains in the same area as a woman's ovaries would be. He says it starts on one side and then hurts all the way across. It doesnt' ALWAYS hurt but begins to hurt when he starts pulling on things. He thinks it may swell slightly. He claims the pain has gone on for about 3 years. A It's always tough figuring something like this out without knowing the patient's history and being able to do an examination. The fact that it has gone on for 3 years suggests that it's not a progressive problem ( that's a good thing!) Also, the age of the patient and the worsening with physical activity suggests the possibility of an inguinal hernia. Here's a link to information about that: Inguinal Hernia in the Healthwise Knowledgebase I hope that this is helpful. You should have this problem checked out by your personal physician. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (1/30/2004) Q I have had gestational diabetes and now, three years later, I feel fatigue and nausea. I get pale at times, and I have noticed that if I don't eat snacks between meals I start getting really shaky. My arms and legs tingle and feel as if they are asleep alot, but I'm not really over weight. Are these signs of regular diabetes? A They fit more like hypoglycemia which can be part of early diabetes. I would arrange to get a finger capillary glucose or a blood draw glucose during the time of one of the spells. This will tell if your sugar is below 50. Answered by Hugh Johnston, MD, Hematology, , (1/29/2004) Q I am 27 year old lady. In 2001 I had a 6x3x3 cms large, left sided vulval swelling. I underwent excision drainage. This came back as a cyst and developed into a polyp which was excised. Now 3 years later I have swelling on the vulva (same side). I have been given a course of antibiotics and the doctor says I will need another excision drainage. I know this problem has a reccurent nature but what, in your opinion, is the best way to get rid of this once and for all. I am very,very worried. A I assume by your description this was a Bartholin's gland cyst. However, there are other causes of your symptoms. If a Bartholin's gland cyst is recurrent the best approach is total excision. For more information look at Bartholin Gland Cyst. Answered by Randall S. Lewis, MD, Obstetrics/Gynecolog, Eugene, PHMG/OBGYN-Willamette (1/29/2004) Q My latest blood work-up showed an issue with elevated bad cholesterol level. I started taking 1 300mg. garlic tablet with each meal, 3 times per day. My question is: will garlic affect both good and bad cholesterol? A In general, garlic will improve both the LDL ("bad cholesterol") and HDL ("good cholesterol"). The effect is modest and there is no good evidence that therapy with garlic reduces heart disease or stroke. Most doctors recommend reducing dietary saturated fat and increasing aerobic exercise as the best way to improved cholesterol. It is reasonable to add garlic to this for further benefit, but I wouldn't rely on garlic alone to do the job. Answered by John Holroyd, MD, Internal Medicine, Bellingham, PHMGW/IM 2A-Cordata (1/27/2004) Q How does Peptobismol stop acid indigestion? A Therapeutic effects of BISMUTH SUBSALICYLATE in gastritis and gastric and duodenal ulcer have been primarily attributed to demulcent (coating) and cytoprotective properties, as opposed to the acid neutralization mechanism of antacids. Bismuth also interferes with the cellular structure and the attachment to the gastric cells of the bacteria which causes ulcers (Helicobacter pylori). Answered at 1/26/2004 Q If high blood pressure may be the cause of my tinnitus, how long after I control my blood pressure does it generally take for the tinnitus to go away? A Your tinnitus may not be related to your blood pressure. Tinnitus most often is due to aging of the accoustic nerve(the nerve that has to do with hearing) or damage to the nerve due to noise. There is a high correlation of tinnitus to hearing loss. If the tinnitus does not go away after 3 months of good blood pressure control you should see a ENT (Ear, Nose and Throat) specialist for evaluation. For general information see Ringing in the Ears(Tinnitus) in the Healthwise Knowledgebase . Answered by Loren Barlow, MD, Internal Medicine, , (1/26/2004) Q What would cause an elevated prolactin level? And what can be done? A Prolactin is a hormone produced by the pituitary gland. It's purpose is the stimulation of milk production by the breast in women who are lactating. In non-lactating women, the most common cause of an elevated prolactin level is a microadenoma (or small tumor) of the pituitary gland, which is caused by overactivity of the prolactin producing cells. This can usually be controlled by a medication known as bromocriptine or parlodel. For macroadenomas (or larger tumors) of the pituitary gland, surgery is sometimes warranted. Answered by Paula Jewett, MD, Obstetrics/Gynecolog, Eugene, Women's Care (1/19/2004) Q I have a history of kidney stones and have been urinating blood and experiencing pain. This morning I had the strangest thing happen --I urinated semen. Is this a normal thing for someone who is not sexually active? A As a Family Physician I have had several patients experience semen in their urine. In each of these cases there was nothing unusual discovered and this is not an uncommon experience. With the history you describe, especially with the blood and the pain, it would be extremely important that you be evaluated by your personal physician for this condition. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (1/15/2004) Q I think I have TMJ--what can I do to help this? A Your dentist or ENT Dr. may help diagnose this and put your jaw to rest. An interocclusal splint may help; soft diet, no chewing, heat, massage, and stretching exercises can be helpful. For more information you can read Temporomandibular(TM) the Disorders on Healthwise. Answered by Emil R. Hecht, MD, Otolaryngology, Bellingham, Bellingham Ear Nose & Throat (1/15/2004) Q I have been struggling with allergies for around 5 yrs now. I have daily headaches. I did the shots in the arm & it came out that I was allergic to everything --such as pollen, molds & things of this nature. I have tried every prescription medicine possible and I even did the weekly shots for 2 yrs --still no relief. I read about a chiropractor who said he can help with allergies. I have been going 3 days a week for 3 months now without result. What are your thoughts/knowledge on chiropractors? My main concern is, even if he doesn't help me can he hurt me? A friend is using a neti pot. You fill it with salt water, run it through one nostril & it runs back out the other to clean the sinus cavity. She swears by it. I have not tried it for a few reason: I hate putting things in my nose and when I have used nasal sprays before it has just resulted in sore throat. Will regularly doing this damage or break down the nasal cavity in some way ? A Rhinitis is a condition that is caused by inflammation or swelling of the tissue that lines the nasal passages. The most common type of rhinitis is allergic rhinitis that is caused by exposure to allergens in the air, such as dust mites, mold, animal dander, and during the spring, summer and fall, pollens. Only about 25 to 30 percent of the population suffers from allergy problems including allergic rhinitis. The inflammation that occurs in the mucous membrane involves the immune system, and the production of "allergic" antibodies called IgE. This same class of antibody is involved with most types of asthma, as well as food allergy and severe bee sting reactions. When an aeroallergen such as cat dander attaches to an IgE antibody in the tissue of the nasal passage, histamine is released, along with other substances that lead to an immediate reaction such as sneezing and itching, and to a persistent swelling and inflammation of the tissue if there is repeated exposure to the allergen. There is not good scientific evidence that chiropractic care can suppress the allergic immune reaction that causes allergic reactions and inflammation. The question regarding any side effects or harm from chiropractic care is outside my field of expertise and will be deferred. Salt water, or saline can be helpful for anyone with rhintis. Saline can be sprayed into the nasal passages, or "poured" in by a number of devices, including a bulb syringe, regular hypodermic syringe, the neti pot or other container (see nasalrinse.com and entpray.com ). Saline can be sprayed into one nostril and then the other for a gentle rinse followed by gently blowing the nose into tissue, or can be poured or irrigated into one nostril, and out the other, and the mouth for a more aggressive approach. If done gently, and it does not cause pain, or irritate the nasal passages, it is a safe procedure that can be done regularly. If there is not a lot of mucous to remove from the nasal passage, then often a gentle mist from the over the counter saline nasal spray product can be helpful. Three to five or more sprays in each nostril is usually adequate to rinse the mucous membrane, two or more times a day. Because allergic rhinitis is associated with inflammation of the mucous membrane, the prescription anti-inflammatory nasal sprays have been shown to be the most effective therapy. If one has moderate or severe allergies, then all of the antihistamine and decongestant therapy, including over the counter and prescription medications will often come up short in relieving symptoms. The anti-inflammatory nasal sprays do not work right away and may take several days or even weeks for maximum benefit. Usually, allergic rhinitis can be controlled with proper therapy. As with other medical conditions, if there is not a good response to therapy as expected, then other problems should be considered including sinus/nasal polyps, variation of normal nasal anatomy, and sinusitis. It may be helpful to seek a second opinion regarding chronic rhinitis. Answered by William Anderson, MD, Allergy & Immunology, Bellingham, William Anderson MD (1/13/2004) Q My husband has frequent episodes of PVC's (premature ventricular contractions). He feels the palpitations and I can feel missed beats. His doctor did an EKG and said "don't worry about it". This is a common phrase that is uninformative and unconsoling. Can PVCs progress into a more serious cardiac arrhythmia? A PVC's, premature ventricular contractions, are quite common and are usually very benign. The potentially concerning circumstance is frequent PVC's in an individual with advanced heart disease. Although the likelihood of identifying a worrisome problem is relatively low, we will often get an echocardiogram (an ultrasound exam of the heart) to make sure no significant structural heart problems exist. Answered by Peter Beglin, MD, Cardiology: Interven, Bellingham, North Cascade Cardiology (1/13/2004) Q I have been diagnosed with bone spurs in the area of where the ribs connect to the spine. I can't find anything about "bone spurs" on the Peace Health web site. Are there other titles, names, etc., under which I should look? A Try osteophyte, also spine degeneration changes. Aside from Healthwise a place to check on peacehealth.org is the Health Links. In the category of Orthpedics there's a list of sites related to bones, etc. Spinal Stenosis on Orthospine.com mentions Bone Spurs in Degenerative spine conditions. Answered by Michael Karasek, MD, Pain Management, Eugene, Northwest Spine Group (1/13/2004) Q I have an earache, severe sore throat, runny nose, and my head feels like you could pop it. Our school nurse did not see anything to be concerned about, but when should I see a Dr.? A Given that you saw the school nurse I will assume that you are less than 25 years old ( your age really makes a difference in this case). I also don't know anything about the rest of your specific medical history and so will answer this question is a general way, i.e. not specific to your particular case. The symptoms that you describe are consistent with a cold, also known as an upper respiratory infection ( URI ).If there are other symptoms like productive cough or high spiking fevers then that suggests a diagnosis other than URI and should be evaluated by a physician. There are many different types of viral germs that cause the URI, none of which we have the cure for. So in the general case simply getting plenty of rest, pushing fluids and waiting it out is the best approach as a physician is not going to be able to prescribe anything that will shorten the course of the URI. Generally a URI lasts for a week to 10 days and then resolves entirely within 14 days. If the symptoms of URI persist beyond this time frame then a physician evaluation is indicated. Here is some more information from Healthwise that I hope will be helpful, at Respiratory Problems, Age 12 and Older Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (1/7/2004) Q I am extremely allergic to Sulfa-drugs. I would like to begin taking a supplement, but it contains MSM. Would it be safe? I know sulfur (like in food) is ok and not the same as sulfa, but I don't know much about MSM & where it fits in. Any thoughts would be greatly apperciated. A MSM has a sulfonyl chemical group in its structure. While it is impossible to know if you would have an allergy to MSM, it would be wise to avoid it. Answered by John Holroyd, MD, Internal Medicine, Bellingham, PHMGW/IM 2A-Cordata (1/6/2004) Q Lately I have been experiencing what you would probably call fatigue. I do understand that this is a pretty hard term to define, but I mean I have been sleeping for 10 - 12 hours consistently for the past few weeks. I'm not sure if it might be due to an iron deficiency or perhaps something more serious? When I wake up after sleeping, I don't really feel exhausted --I yawn a few times and then am able to go through the rest of my day without feeling like I need a nap every other hour. I rarely eat red meat, and eggs only a couple of times a month. I also just had my period for this month. Could it be possible that my oversleeping may be due to losing blood or to my avoidance of red meat? What is the likelihood that it could be just mild anemia or SAD (Seasonal Affective Disorder)? A As you know fatigue could have many reasons. It usually covers a whole chapter in medical textbooks. Here's a place to do some reading to help in your search, Weakness and Fatigue in the Healthwise Knowledgebase. You should see a doctor for a complete evaluation of your symptoms. Answered by Christa Danielson, MD, Family Practice, Eugene, PHMG/FP-South (12/30/2003) Q What is the medicine, Evista, and what is it a treatment for? A Evista, brand name for the drug raloxifene, affects the action of estrogen in several areas of the body. Estrogen has its effect by combining with receptors located throughout the body, including uterine tissue, breast tissue, and bone, among others, to produce its various actions. Evista is currently used to mimick the effects of natural estrogen in maintaining bone strength in the prevention and treatment of osteoprosis. Investigation is underway to determine Evista's potential for the prevention of breast cancer in post-menopausal women. Answered at 12/30/2003 Q I have some questions about steroids: How do they build muscle? Is the muscle they enable one to build "real" muscle? Are they addictive? Would it be safe to use steroids only long enough to achieve the desired physique, then discontinue use? A Anabolic steroids have been abused by athletes to enhance strength, performance, and endurance. They do increase lean body mass (muscle) if used in conjuction with an adequate diet and maximal excercise. Despite evidence of benefit in some athletes, the use of anabolic steroids to enhance performance is condemned by the medical community. These agents have also been associated with severe toxicity in athletes, including hepatotoxicity, liver cancer, hypertension, decreased testicular size/spermatogenesis, and lipid abnormalities. Other effects include fluid retention, weight gain, psychiatric symptoms, lipid abnormalities, elevation of liver function tests, hypercalcemia, hypoglycemia, and pain on injection. Even short term steroid use has caused harm. They are not addictive in the same fashion as heroin, but the effects they produce will wane with time after the steroid (or exercise or diet) is stopped. Answered at 12/23/2003 Q What started out as a teenager using marijuana has now escalated my 20 year old into smoking marijuana 10+ times per day -- as well as cocaine, ecstacy, oxycontin or whatever he can get his hands on. He needs serious help right away. He himself is begging for *inpatient* treatment and we are hitting walls here in Whatcom County. Outpatient help at this time will NOT help. He's not cleaning himself up for us, he's doing it for himself, and as long as he doesnt have treatment he WILL continue to use. I am running out of options and his next use may be his last. Please help! A I'm so sorry your family is going through all this. To help, I need to know what the 'block' is for inpatient help.My guess is that the block is that there is no inpatient treatment in Whatcom Co and I'm afraid that is true. The following are some possibilities for your son: Seamar: 647-4266(they say but may be a misprint) Pioneer Center North in Sedro Wooley: 360-856-3186 Evergreen in Everett: 425-258-2407 Providence Hospital in Everett: 425-258-7390 In the meantime I would suggest Alanon for you. It is a wonderful support system for families and friends of chemically dependent people and also provides a fair amount of education. Also, those folks may have some ideas. The number for Alanon is 671-54444. Answered at 12/22/2003 Q In 1999 I had a double mastectomy and reconstruction surgery. Recently I have had a dull pain behind my right breast implant. I saw a doctor in Vancouver and she didn't know what to tell me except that she wanted to refer me to a surgeon. This is without any mammogram or ultrasound. I feel that one of these things should happen before taking such a drastic measure. My problem is this -- I have no insurance and for some reason I am not eligible for Washington State basic health. I'm 36 years old and lost. Could you aid me in finding some help in getting an ultrasound? I would be very grateful. It's taking me a long time to come to terms with what has happened to me and to get my strength back. And now being divorced and having no means to get insurance, I don't know what else to do. A I am sorry for your suffering. I am sure your financial concerns on top of your fears are not helping. You need to see one of our breast specialists at Longview surgery. They specialize in breast complaints, and perform ultrasounds if it will help in determining the cause of your pain. They may do the ultrasound them selves during the exam. I don't know if a mammogram would be helpful, so I might hold off on that. I am sure they will work with you financially and get you the care you need. Peacehealth has a financial assistance program that you may qualify for to help with your bills. Their clinic phone number is 501-3500, Drs. Forte, Katterhagen or Moseson could all help you. Answered by Dan Herron, MD, Obstetrics/Gynecolog, Longview, PeaceHealth Women's Clinic (12/22/2003) Q What are the symptoms of quitting drinking and how long do they last? I'm getting a flushed face and sweating, and I'm very hot and anxious. My MD gave me Wellbutin to cope. Is that a good drug for this? A You describe some of the withdrawal symptoms of drinking excess alcohol. Wellbutrin may be helpful and there are also some anti-anxiety drugs that are useful over a short period of time. Continue to work with your doctor. Answered by Loren Barlow, MD, Internal Medicine, , (12/19/2003) Q I had to have a tonsillectomy 2 yrs ago after many years of tonsillitis. Within months of my healing I began to feel some discomfort, which has now developed into the old symptoms (swelling, fullness, choking pain) in the left side of my throat. I recently saw an ENT who told me a small piece of tonsil had been left behind from my surgery 2 years ago, but that it shouldn't be as painful as I'm describing. I am very insulted by this because I'm the one in pain, not the doctor. Furthermore he says there is nothing he can do because it is so minimal no doctor will perform surgery on it. Is this true? A Tonsil tag inflammation can also be associated with peritonsillar cellulitis with impending abscess, which can be very painful. Tonsil tag surgical removal is pretty easy, and may well help your problem. Answered by Emil R. Hecht, MD, Otolaryngology, Bellingham, Bellingham Ear Nose & Throat (12/17/2003) Q What is the body's defense mechanism against strep throat? A Mobilization of immune globulins and lymphatics. These can be augmented by rigorous throat irrigations and gargles of saline. Culture to see if strep carrier. Consult your regular physician. For more information see the article on Strep Throat on Healthwise. Answered by Emil R. Hecht, MD, Otolaryngology, Bellingham, Bellingham Ear Nose & Throat (12/16/2003) Q I have a white spot on my tonsil. It falls off eventually, but then another one shows up in its place. I do not have a sore throat, but went to an ear, nose and throat doctor last week. He suggested I get my tonsils out. Since this is an invasive surgery, I would like to know your opinion on this. I have known people that have had these white spots and have not had their tonsils removed, so I am confused. A Try irrigating your tonsil daily with water-pik or syringe to try and keep very clean. The white spots themselves may not cause a problem, unless infected. Are you sick with this? The tonsillectomy is a big deal, but also will resolve the problem, if it is enough to merit the surgery. Answered by Emil R. Hecht, MD, Otolaryngology, Bellingham, Bellingham Ear Nose & Throat (12/16/2003) Q Can Polycythemia Vera cause an enlarged heart? A Polycythemia, or excess red cells, can be brought on by a shortage of oxygen as one sees with congenital heart disease with large hearts. But the usual cause of polycythemia is a malignant disease with low white cells and low platlets and sometimes leukemia, and it usually does not cause directly a large heart. To learn more about the condition see the article on Polycythemia Vera at the Leukemia & Lymphoma Society web page. Answered by Hugh Johnston, MD, Hematology, , (12/10/2003) Q I have been getting my monthly injection of Fulvestrant (Faslodex) since September. I have bone mets (metastases) from breast cancer. I have been experiencing hair loss, especially the past month. Is this due to the new therapy? Also, I am due for my every three to four month color treatments on my hair..........is this advised? However, my primary question is if pain is expected, or experienced at the site of bone mets while taking this drug? A Bone pain occurs in about 16%, and injection site pain in 11% of patients receiving Faslodex. Fulvestrant is an anit-estrogen, so hair loss might be expected, although I can find no listing of hair loss in the adverse effects listed in the manufacturer's information. The only hair coloring I have seen warnings on is black. Your hairdresser might be able to give you more complete information. Answered at 12/10/2003 Q I get a white "zit" on my scrotum from time to time. It goes away by itself. It is hard and not something you could drain by popping. What is it? A Without examining you it is impossible to say what this is. However, in general any hair follicle on the body can become obstructed and thus form a "zit". The technical term for a zit is "comedone". An "Open comedone" is what is commonly referred to as a blackhead and a "closed comedone" is generally referred to as a whitehead. Here is a link to more detailed information which may be helpful in your thinking about this -- Acne Vulgaris . Any recurring lump shoud be evaluated by your physician or other healthcare provider. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (12/8/2003) Q When I drink champagne or certain wines, after just a few sips, my forehead starts to swell up and get very red. I'm thinking I might be allergic to sulfites. However not every wine I drink that has sulfites in it causes this reaction. It only occurs with some wines, and all the champagne I've ever had. Could it be something else that I'm allergic to? A It is possible that it is sulfites, and you are reacting with only certain ingestions. It is an unusual allergic type of reaction, as sulfites usually cause more diffuse itching, hives or asthma like reactions. It may be an allergic reaction to an ingredient in the champagne, and also in some wines, but as noted, an unusual manifestation of allergy. Some individuals are sensitive to alcohol in certain beverages, and experience redness about the nasal area and face due to blood vessel dilation from the alcohol. If you are not having allergic type of reactions to other foods or beverages, even those containing sulfites such as some preserved/fermented foods or dried fruits such as apricots, then further diagnostic evaluations are probably not indicated to detect a specific ingredient. There is no treatment for preventing reactions, other than avoidance. Antihistamines such as Benadryl or Loratadine may be helpful if therapy is needed. Benadryl will likely cause sedation and should be avoided if one needs to be awake or alert. Answered by William Anderson, MD, Allergy & Immunology, Bellingham, William Anderson MD (12/8/2003) Q Where in Eugene or can I find a neurologist to see me? A There are 3 groups of neurologists in Eugene: Neurology Associates of Eugene-Springfield,PC...6 neurologists including general neurology as well as subspecialists in neuromuscular disease, multiple sclerosis, stroke, epilepsy, sleep, and child neurology. PeaceHealth Medical group...3 neurologists..general neurology and sleep. Sleep Disorders and Neurology Clinic...2 neurologists practicing sleep medicine and general adult and pediatric neurology. All are listed in the Eugene phone directory. You may need a physician referral. Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (12/5/2003) Q What is H pylori and how do you get it? A You are referring to Helicobacter pylori (H. pylori), and it is an infection, actually, that can cause ulcers and inflamation in the upper gastrointestinal tract. It is the leading cause of ulcers. Nobody is quite sure how someone gets the infection but there has been speculation it could be from simple house flies spreading it. It is treatable with an aggressive antibiotic program and anti-ulcer medication. Answered by Frank Littell, MD, Hospitalist, Springfield, PeaceHealth Hospital Medicine (12/5/2003) Q I have a couple of questions about FDA drug testing: 1. What are the consequences (both good and bad) of keeping a drug from consumers for some required period of rigorous testing? 2. What are the consequences (both good and bad) of allowing drugs to reach consumers with less stingent testing? A The first half of the FDAs mission statement -- "The FDA is responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, our nation’s food supply, cosmetics, and products that emit radiation." This sums up part of the answer to your first question. If stringent testing is not mandatory for new drug products, the consequences would be a lack of good information on the efficacy and toxicity of new drug products. The second half of the FDA's mission statement --"The FDA is also responsible for advancing the public health by helping to speed innovations that make medicines and foods more effective, safer, and more affordable; and helping the public get the accurate, science-based information they need to use medicines and foods to improve their health." This attempts to answer your second question. One might argue the FDA is an impediment to progress, but if you remember the problems with thalidomide in the 50's in England you might reach a different conclusion. Another example of the problems that might arise without the FDA's oversight is seen with the herbs and food suppliments that are on the market. These were assumed to be safe, but many side effects have been reported as a result of an open market and no peer reviewed studies to support their safety and efficacy. Answered at 12/5/2003 Q I have two questions -Why would my physician ask for urine samples collected over a 24 hr period rather than a single sample? I think I have a UTI... What would cause that? Would there be any unusual substances showing up in my urine? A A urinary tract infection can be diagnosed with a simple urinalysis showing white(pus) cells and bacteria. A simple voided urine can be cultured in a special lab test to determine what bacteria is causing the infection. Usually a 24 hour urine is done to determine the amount of protein excreted in a day or to test for the function of a kidney in getting rid of body by-products. I think you best ask your doctor what test he/she is doing and what are they looking for. Answered by Hugh Johnston, MD, Hematology, , (12/4/2003) Q I am a 24-year-old female that has had GI problems for the last 6 months, such as, stomach cramps, diarrhea, constipation, light colored stools, mucous in the stool, and nausea. In addition, I have experienced irritability and depression. My mother recently informed me that I was allergic to gluten as a child. My question is, is a gluten allergy related to celiac disease? A People with celiac disease are, in fact, unable to tolerate gluten. In that sense it is, basically, an "allergy," but there is more to it than that. For information about the condition try Celiac on MEDLINEpus, the consumer health site of the National Library of Medicine. Answered by Frank Littell, MD, Hospitalist, Springfield, PeaceHealth Hospital Medicine (12/3/2003) Q I think I need some mental health counseling. I've been depressed for the past few years and I want to get to the bottom of it. I don't want prescriptions -- I just want to know why I'm a compulsive liar and cannot talk to my wife about how I feel. I'm poor, and cannot afford much, but I want to know what you think I should do? A It sounds like it would be good for you to talk to a therapist, counselor, or psychologist. If you have medical insurance you will have mental health benefits where you will only have to pay a co-pay. If you don't have medical insurance contact the Center For Community Counseling where they will set you up with a therapist at a low cost. It alsways pays to figure out these problems as soon as possible before they go on to become bigger problems. Good luck to you and let me know if you need more suggestions on where to find help. Answered by Hallenburg, Kris S. PhD, , Springfield, PHMG/BHS-Spfld (12/3/2003) Q Should prophylactic use of antibiotics in livestock feed be discontinued? A I can answer your question more comfortably from a health perspective than from an agricultural perspective. I understand that the reasons prophylactic antibiotics are used in large-scale livestock production are to treat sick animals, to promote food animals' growth, to prevent disease in an entire herd or flock, or to protect crops from disease. Part of the need for using these medications results from situations created when these animals live in increasingly confined spaces. I’m guessing your question stems from the concern regarding antibiotic resistance which, according to the Food and Drug Administration, is when antibiotics cannot kill bacteria because the bacteria have become resistant. If this continues indefinitely, some recurring infections may have to be treated with different and stronger antibiotics and there is a strong possibility that eventually no antibiotic will be effective in killing the bacteria. The risks of overuse of these powerful drugs can be through physician prescription to sick patients or from administration to livestock. It is difficult to exactly estimate the use of these drugs, but drug resistance experts estimate that over 40 percent of the antibiotics used in the U.S. are used for farm animals and agricultural crops. Experts already believe that resistant strains of Salmonella, Campylobacter, Enterococcus, and E. coli have been transmitted from animals to people. To address this complex issue, The Alliance for the Prudent Use of Antibiotics (Tuft’s University) published a report entitled FAAIR (Facts about Antibiotics in Animals and Their Impact on Resistance). Here is a selected list of their recommendations, which I think directly answer your original question: >>Antimicrobial agents should not be used in agriculture in the absence of disease. >>Use of antimicrobials in food animal production should be limited to therapy for diseased animals or prevention of disease when it has been documented in a herd or flock. >>Use of antimicrobials for economic purposes such as growth promotion or to enhance feed efficiency should be discontinued (with the exception of ionophores and coccidiostats, because current evidence indicates that use of these antimicrobials does not affect resistance in human pathogens). >>Because of their critical importance to treat human disease, fluoroquinolones and third generation (or higher) cephalosporins should not be used in agriculture except to treat refractory infections in individual animals. >>Antimicrobials should be administered to animals only when prescribed by a veterinarian. For more information, check out APUA. Answered at 12/2/2003 Q I'm a smoker first off, and I've had a persistent cough and am short of breath after very little exertion.... What do you think might possible be wrong? And if I do not quit smoking, what might I expect for my future? A You most likely have chronic bronchitis, a chronic inflammatory condition that manifests itself by cough and phlegm production. It is part of a condition called COPD (Chronic Obstructive Pulmonary Disease) of which the endpoint is emphysema. Damage to your lung cannot be repaired, even if you do stop smoking, but smoking causes the inflammation to continue and accelerates this process, so stopping smoking may help some of your symptoms. If you do not stop smoking you continue to put yourself at risk for lung cancer, heart disease and probably the need for oxygen sooner than would be expected. It is important that you see your primary physician to be evaluted for your shortness of breath to make sure it is due to COPD as other conditions, including heart disease, can cause this as well. Through simple tests, your doctor can clarify this for you. Answered by Michael McNellis, MD, Pulmonology, Longview, PeaceHealth Specialty Clinic (12/2/2003) Q When the Prolactin level is 100 what does it mean? What are the side effects of the proclactin level being high? A Prolactin is a hormone produced by the pituitary gland. It helps regulate breast milk production. Normal levels are usually below 30, depending on the laboratory. Elevations can occur with pregnancy and lactation, in reponse to some medications, (especially antipsychotics) and with pituitary prolactinomas (benign pituitary tumors). A level of 100 is an elevation and needs evaluation to determine the cause. High levels are associated with galactorrhea (liquid discharge from the nipples) and amenorrhea (lack of menstrual cycling). Answered by Linda Frison, MD, Obstetrics/Gynecolog, Eugene, PHMG/OBGYN-Willamette (12/2/2003) Q What is the treament of leukemia? A There are many forms of leukemia, and treatment regimens for each type have evolved by trial and error into complex medication, surgical and radiation therapies that use a number of different modalities in various doses, combinations and schedules. The primary focus of therapy is to restore normal bone marrow function as quickly as possible. Early treatment is very important. Paul Roche - Clinical Pharmacist Answered at 11/24/2003 Q My best friend, age 33, had a tonsillectomy yesterday. She is determined to resume smoking today. I have read that she should not smoke for at least 10 days post-op, but she refuses to accept this. Are there any risks associated with smoking so soon after this procedure? A There is higher risk of non-healing if she is smoking! The smoking decreases the small vessel blood supply and impedes healing, a big deal in tonsillectomy wounds. Very bad idea to smoke, but perhaps not fatal. Answered by Emil R. Hecht, MD, Otolaryngology, Bellingham, Bellingham Ear Nose & Throat (11/21/2003) Q Do patients pressure their doctors to prescribe antibiotics? A An informal poll of my colleagues (I asked 3 over lunch today) comes up with a resounding YES! that is quickly modified by an acknowledgement that patients are becoming more aware of the dark side of taking antibiotics. The primary reason that patients pressure their docs for antibiotics is a mistaken belief that viral infections, most famously the dreaded common cold, will in some way be improved by taking antibiotics. The reality is of course that antibiotics don't help and at the same time can have real and significant side effects and long term problems. These problems can come home to roost for the individual taking the antibiotics. These can include allergic reactions ( from the deadly to the merely obnoxious), stomach upset e.g. diarrhea, sun sensitivity, secondary infections e.g. vaginal yeast infections and, not the least, a serious hole in the pocket book! In addition to the individual hazards, the indiscriminate use of antibiotics has lead to a pattern of decreasing effectiveness of these medications as bacteria mutate and become resistant. We know that this resistance evolves when antibiotics are used for incomplete courses or simply when they are used to excess. I have enclosed 2 links that describe a decision making process for ear infections and for acute bronchitis around the use of antibiotics that may help illuminate more of what I am talking about: Ear Infections Bronchitis The whole issue of developing antibiotic resistance is huge and is being worked on by many agencies in the country. I think that our own Oregon Health Division has done a stellar job in educating people on this issue. Here is the link to their home page article on Antibiotic Resistance: Oregon Health Division Tom Ewing, MD Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (11/19/2003) Q I have diabetes 2 and I was told to test 2 hours after eating. Does that mean to test 2 hours after I've finished eating, or do I count from when I first start eating, then add on 2 hours? A Two hours after the beginning of the meal. Answered at 11/19/2003 Q I have severe Asthma with allergies. I have yet to find a doctor who can get it under control. My feeling is that perhaps allergies may be the culprit in my 2AM asthma attack episodes. I am on an inhaler (Maxair), Saline solution for pulmonary machine, and I also take Zyrtec 10mg. I have tried the Singulair, but, it really didn't do anything for me. Can lack of oxygen make me lightheaded? Is there something out there that can get me through the night without waking up at the same time every morning with breathing problems? A It appears that the severity of your asthma may be underestimated. You are on therapy that matches one with mild asthma, but describe symptoms that are consistent with moderate persistent asthma as defined by the National Asthma Education and Prevention Program. Additional therapy would be helpful including inhaled anti-inflammatory therapy. Allergy may well be an important factor in your asthma, contributing to the inflammation that occurs in the wall of the bronchial tubes. You would benefit from a thorough evaluation of your asthma, including pulmonary function testing and allergy testing to identify specific allergens that are likely associated with your persistent asthma. Most individuals with asthma can experience good control of their symptoms. Nighttime awakening from asthma can be prevented in most cases. William Anderson, MD Answered by William Anderson, MD, Allergy & Immunology, Bellingham, William Anderson MD (11/18/2003) Q I have heard that condyloma can be cancerous. Is this true? A The human papilloma virus (HPV) or the wart virus, or condyloma, is one of the most frequent and common sexually transmitted diseases (STD). Most women and men are asymptomatic, as this is a microscopic virus that you cannot see. Occasionally, this can cause bumps or warts that can be seen and felt. If either partner has a wart, they should seek medical attention. The HPV virus can cause changes on a woman's cervix (the opening to her womb at the top of her vagina). This can be reflected in an abnormal Pap smear. Uncommonly, this can be associated with abnormal cells, which are precancerous. Rarely, these cells can turn into cervical cancer. This takes a long time, and if a woman is visiting her doctor on a regular annual basis, the Pap smear should turn abnormal many years prior to cancer developing. A regular annual exam by a physician is important for all women. Answered by Robert Olson, MD, Obstetrics/Gynecolog, Bellingham, Whatcom Ob/Gyn (11/17/2003) Q I am an old diabetic. My Doctor has told me to take metformin. What is this for and why, when I go to the hospital for tests such as a Cat Scan, do I have to stop taking it? A Metformin is an oral hypoglycemic that is currently among the most widely prescribed oral agents for reducing blood glucose. It works well alone and in combination with other agents, or with insulin. There is a side effect associated with the drug where lactic acid, a metabolic by-product, may build up to harmful levels in the body. It is extremely rare to see this side effect with metformin, but certain situations increase the risk. The best known risk is undergoing some types of scans where the body is injected first with a dye called "contrast". The contrast can occasionally reduce kidney function and allow a buildup of metformin and lactic acid, so it has been recommended that the patient not take their metformin on the day of the test and for 48 hours following the test, to assure that kidney function hasn't been affected. Following the 48 hours, the metformin may be resumed with no more risk than before the test was conducted. Answered at 11/17/2003 Q My wife is a 22 weeks pregnant lady. We had a scan after 22 weeks. They found mild pyelectasis and calicectasis in the left and right kidneys. What does that mean? In what way will it will affect the child? What do we have to do? A Calicectasis is dilation of a calix of a kidney. These are regions that are part of the pelvis of the kidney where urine collects before it exits into the ureter on its way to the bladder. Pyelectasis is dilation of the renal pelvis. So the two terms mean that there is mild dilation of the baby's kidney pelvis. Since you were told the situation was mild, the best thing to do is wait. You should be getting another ultrasound to check again in 3 or 4 weeks. If the measurements are stable there is usually nothing to be concerned about. If, however, they are increasing this could mean obstruction of the kidney. If that occurs you would need to be seen by a perinatologist, a high risk Obstetrics provider. Answered by Linda Frison, MD, Obstetrics/Gynecolog, Eugene, PHMG/OBGYN-Willamette (11/16/2003) Q I just received a pamphlet on Interex from Benson-Pendant,for impotence. Since I take Viagra and this is much less expensive I was wondering if you have any information on this product. It is guaranteed with total satisfaction or Money Back. No prescription is required. Is there any thing you can recommend that is cheaper and just as good as Vigara? A An internet search has not come up with a product by the name of Interex, although the term Interex has come up in reference to a number of products containing the herb yohimbine. This is the most common ingredient in over-the-counter products for erectile dysfunction (ED). A number of studies have shown that yohimbine is an effective agent in treating ED. While considered as safe as Viagra, this drug should not be used without consulting your physician. There are medical conditions and drug interactions that can produce severe side effects. For your information, there are other prescription agents, similar to Viagra, being released on the market. These new products should drive the price of Viagra down. Answered at 11/13/2003 Q My son, now 19, has suffered from chronic asthma and allergies his entire life. He has taken many meds daily since he was 3 years old. He told me when he was 11 he used to think he was going to die because he couldn't breathe. I believe his emotional response to years of fearing dying has had a traumatic impact on him. I am trying to determine if there is any one specific disorder that is relative to this that I could research. I want to start educating him. He is HIGHLY SENSITIVE and reactive and struggles with his emotions. I think he is a borderline hypochondriac, but that is not so much my concern at this point. I do not know if it is PTSD or something else. I would appreciate any input you can provide. A Chronic illness is hard on the body and hard on the psyche. The threat of death is not easy for anyone, including young people, to deal with. Missing school, being unable to exercise as strenously as friends, etc., can reduce self esteem and make kids feel isolated and different from others in ways that are very uncomfortable. Some medications used in the treatment of chronic illness, including asthma, also may have psychiatric effects. These are just a few of the ways in which the effects of asthma may be seen in teens. There is no one specific way these infuences play out - these influences interact with the individual's personality - and all or some can play a role in shaping personality and behavior. PTSD is only one of many possibilities. Have you considered talking with your son about having an evaluation? All psychiatrists and nurse practitioners are medically trained and have spent time dealing with the physical and emotional consequences of chronic illness. Some psychologists and counsellors, but not all, have this training too. If this is not a possibility, his having a frank talk with the family MD, a school counselor or even a minister trained in counseling can help begin to sort things out. Your son is lucky to have a mom tuned in to his physical and emotional well-being. But please remember that at age 19, it may be hard for him to "listen to his mother" about health -and especially mental health - concerns. If your son won't consider the above possibilities, you may find helpful info on the psychological consequences of asthma by contacting the American Lung Association Asthma, the American Academy of Child and Adolescent Psychiatry Facts for Families, the American Psychiatric Association Medem or APA Help Center. You can read their materials and then just leave them lying around the house. When he's ready, he'll pick them up and act on them on his own. Answered by Henry Levine, Psychiatry, Bellingham, 11th Street Offices (11/11/2003) Q I am a 24-year-old Asian man who is quite fair, but the skin on my penis is much darker than the rest of my skin. This also includes my scrotum. I initially noticed this a couple of months back but didn't think much about it. Recently, I think it has been getting darker. Having olive colour skin will be the best way to describe my all-over body colour. My penis is now a very dark brown, close to being black without being black. Should I be worried? A Pigmentation of the genitalia is typically much darker than other areas of the skin especially in non-caucasians. There are certain hormonal conditions which can also increase pigmentation but usually it is not just located in one place. This is rare. Barring any other medical problems like diabetes, excessive weight changes, excessive sweating, your pigmentation is probably normal. Answered by Jay Park, MD, Dermatology, Eugene, Jay Park MD (11/11/2003) Q Can taking atenolol (beta blocker) cause a man's sperm to become infertile? A The only studies found on the affects of atenolol on sperm have to do with sperm motility, a key function to the sperm's effectiveness. The results are inconclusive. In an animal study in rats, atenolol was found to reduce sperm motility, as well as decrease the level of testosterone, both reversible effects when the atenolol was discontinued. One study using human sperm found no affect of atenolol, while two other beta blockers, not available in this country, did affect sperm motility. Therefore, it cannot be said conclusively that atenolol will have any affect on sperm count or function, but the possibility does exist. Mike Canton, Pharmacy Department Answered at 11/7/2003 Q I am wondering is there ever going to be a cure for anxiety and panic disorder anytime in the future??? If there is will it actually cure the disorder, do you think???? I am wondering because I am one of the people who deal with anxiety and panic... A This is a great question! It turns out it helps to think of anxiety (and panic, really) in two ways. There are the predictable times when any of us might have such symptoms, say when a family member dies, we have an accident, we lose a job, etc. But then there's the type of anxiety and panic that stems from biochemical abnormalities we know can cause this in the brain. Some people seem to have an ongoing abnormality in this biochemistry that leads to recurrent symptoms, almost always unrelated to any of the usual anxiety-provoking things. People with both understandable symptoms, as well as those with symptoms due to biochemical changes, can receive help through the appropriate use of various medications. Those with the biochemical variety often need ongoing, even lifelong, medication, which can control symptoms but not really "cure" the biochemical abnormality. Think of it like someone with high blood pressure --a person with high blood pressure may very well need to take medication forever, which normalizes the blood pressures, but doesn't "cure" the underlying problem. Answered by Frank Littell, MD, Hospitalist, Springfield, PeaceHealth Hospital Medicine (11/3/2003) Q What if any, are known causes of Restless Leg Syndrome? A There is not a specific known cause, though there are several associated conditions and in some cases a positive family history. Iron deficiency, pregnancy, kidney failure and others are frequently mentioned as related conditions. There are many treatments that usually work pretty well in classic restless leg syndrome. If you wish to keep up to date, I suggest you go to The Restless Leg Syndrome Foundation. Join to receive the newsletter electronically or by mail. Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (10/27/2003) Q I am homeless and unemployed. I have a history of depression and alcohol addiction. Is there a doctor or counselor in Eugene who can provide no-cost counseling to help me through this difficult time? I am a 33yr old male, and currently sober and not thinking of harming myself. I am new to Eugene, and don't know the area or anyone. Trying to find a job and any services that may be available is almost overwhelming. A I'm sorry to hear of the difficulties you are facing at this time but really congratulate you on wanting to take steps to deal with your issues. If you need to have ongoing support regarding your sobriety you can contact AA at 342 4113 for a list of meeting times. I do not know off any free counseling services but am aware of several with very minimal sliding scale payments that might meet your needs. Options 687 6983 Center for Family Developement342 8437 Center For Community Counseling 344 0620. If you are ever in crisis you may speak to someone at The White Bird Crisis line telephone #687 4000. I am not certain if you are eligible for The Oregon Health Plan {OHP}. At this time there is not a mental health benefit but it does give you access to medical care. Telephone # for an application is 1 800 621 5260 or, if you do not have any way to receive mail, you could get an application from one of the Adult and Family Services branches. The Main Branch telephone # is 686 7878 You may also be eligible for free medical care at The Volunteers in Medicine Clinic {VIM} telephone #685 1800. Or you may be eligible to receive care from Peace Health Medical Group via The Bridge Program.{for this service you would need to contact one of our financial counselors at telephone # 687 6215.} A financial counselor at PHMG or an intake counselor with The VIM could also assist you with information about OHP. If you are receiving medical care, I would recommend that you discuss issues of depression with your doctor. A primary care physician may be able to prescribe antidepressant medication, which could possibly assist you. There are also programs available to help patients obtain medications so that you would be able to receive any that were prescribed. If you are a Veteran services would also be available to you at the local clinic, telephone # 607 0897. If you are seeking shelter you could contact The Eugene Mission at 344 3251. Food is also available via several programs in town.I would recommend calling Food For Lane County at 343 2822. An important resource, if you have not already located it, is St. Vincent dePaul Eugene Service Station 485 HWY 99, Eugene telephone # # 461 8688. The station has day access for laundry facilities,showers, brown bag lunches, job networking, information and referrals. Answered at 10/27/2003 Q I am trying to find a treatment center in Lane County that accepts OHP Plus and Medicare for inpatient (& outpatient follow-up)treatment for a person with paranoid schizophrenia and concurrent drug and alcohol addiction. Can you provide any information? A Willamette Family Treatment Services do provide in-patient treatment with out-patient follow up for men and women who have OHP Plus coverage. I spoke to an intake coordinator at Willamette Family Treatment Center today regarding the issues you raise of a concurrent mental health illness. Part of an intake assessment would be evaluating if the client was actively/effectively being treated by a mental health provider. The facility may ask for release of information from the patient to their mental health provider so that the treatment center could coordinate care with the mental health specialist, which would be an important aspect of the care plan. I would recommend that the patient call for an intake assessment and any further questions. The Intake Coordinator I spoke to today was from the men's residential program, and indicated that if an assessment was completed which would also include TB clearance, bed availability could be as soon as 3 to 5 days. The men's residential program contact # is 338 9098 The women's residential program # is 343 2993. Carolyn St.Clair,RN,CPN,CCM Answered at 10/16/2003 Q I have had problems getting a pap smear for the last two years. Can you tell me what is a CLOSED CERVIX? Can you get a true reading from a pap smear taken outside of the cervix? What causes a closed cervix? What are the dangers of having a closed cervix? Can and should this be corrected? A It sounds like your endocervix is tucked up in your cervical canal. Many things can cause this including normal anatomy, menopause, scarring from pregnancy and delivery or any surgical procedures, etc. In order to obtain a useful, reliable Pap, the endocervical transformation zone must be sampled. This transformation zone is where the endocervical cells (usually tucked up inside the cervix) meet the surface cervical squamous cells. There are specifically designed tools for sampling the endocervical canal and if these do not provide a good sample, then an endocervical curettage can be done. These procedures can both be done without surgically "opening" the cervix. I would recommend that you have your pelvic exams and pap smears performed by a gynecologist who would have these extra pap equipment items available. Answered by Linda Frison, MD, Obstetrics/Gynecolog, Eugene, PHMG/OBGYN-Willamette (10/15/2003) Q I have a radiology question: I had a CT scan today AND an MRI, both with contrast. For the MRI I had 14cc of Optimark and for the CT, I had 100cc of Optiray 320. On the CT, when it was injected, they said that I would feel a warm sensation going through my body. I mainly felt the warmth in the genital area. Later that night, my vaginal area started to feel really sore with a burning to it. Is this a normal reaction from the contrast? I was on my menstrual cycle which I was told that the contrast wouldn't affect. A This belated response may not be very helpful to you at this point. Delayed reactions to the iodinated contrast given in CT are not uncommon, although most serious reactions occur with minutes of contrast administration. Most delayed reactions are itching, hives and generally feeling lousy. I have not heard your specific complaint before. The reactions to contrast are self limited and will go away. How long? It may take several days. Answered by Stephen Quinn, MD, Radiology: Diagnosti, , (10/10/2003) Q I have an ENT question....What causes a pressure feeling for just a short second in one ear? Can that cause a headache or dizziness? A That pressure sensation usually represents some form of eustachian tube dysfunction and inability to equalize pressure in the middle ear space. Sometimes a decongestant or nasal steroid type spray may help that, if it persists. Headache or dizziness would be very transient. Answered by Emil R. Hecht, MD, Otolaryngology, Bellingham, Bellingham Ear Nose & Throat (10/10/2003) Q I have an allergy question. If you are basically allergic to everything out of doors can allergies cause a pressure feeling in the ears? Also, can allergies cause headaches? A Allergic rhinitis is a condition that causes inflammation and swelling of the mucous membranes lining the nasal passage. This is due to exposure to allergens in the air, such as pollens, dust mites, animal dander and mold spores. Other commmon symptoms that are often, but not always associated with allergic rhinitis, included sneezing, runny nose and itching of the nasal passages, eyes, and sometimes throat. In some cases, the swelling can lead to a pressure-like sensation in the ears that typically comes and goes, and feels at times as if one is traveling up a hill or flying in a plane, which can cause a "popping" like sensation in the ears. This in known as eustachian tube dysfunction and is sometimes associated with allergies. It typically involves both ears. Usually treatment of the underlying allergy, with antihistamines, sometimes decongestants and anti-inflammatory nasal sprays, is helpful in reducing symptoms. If there is significant swelling in the nasal passages, headache can also occur. This is not an uncommon complaint in those with allergic rhinitis. Answered by William Anderson, MD, Allergy & Immunology, Bellingham, William Anderson MD (10/7/2003) Q Just recently I noticed that everytime I move my head from side to side I hear a crunching sound in my neck. I have not fallen, have no dizziness or pain -- just a crunching sound. Very strange. What might it be? A Arthritis in the small joints of the neck. If it is the only symptom -- no pain, numbness, weakness, etc. -- nothing need be done. Answered by Michael Karasek, MD, Pain Management, Eugene, Northwest Spine Group (10/7/2003) Q I have recently been diagnosed as diabetic. My doctor is recommending no medication at this time but I do want to start eating correctly. I was told that I would be contacted by someone regarding education. How long does this process take for someone to contact me? A I am not sure where you were referred. The way PHMG Diabetes Education works is that we receive a referral from your MD and then we call and schedule an assessment visit. At that time we give patients a meter and a meal plan and ask some assessment questions. You are always free to call and ask if we have received the referral. Our number is 686-7029. If you have been referred to McKenzie I am not sure of their procedures but I would encourage you to call them and see if the referral has been received. At the classes we will teach you the blood glucose targets and how to know if your diabetes is well controlled. Many folks manage with excellent blood glucose control without medication for some time. Another source of help is Diabetes Resources on the PeaceHealth website. Answered at 10/7/2003 Q Can you tell me what causes the eye muscles to be imbalanced? Can this condition cause dizziness/and or headaches? This is a problem that was discovered 5 years ago (the vison part of it) and sometimes the bad eye feels "heavy" -- like it's trying to focus and just can't. That's when I feel sort of dizzy. Is it likely that's from my imbalanced eyes trying to focus? A Eye muscle imbalance is almost always the result of a genetic predisposition However, it can also occur as the result of either insult or injury to the nerves, and enervate the muscles that move the eye or the muscles themselves. Usually a person who is born with such a condition is asymptomatic with respect to symptoms like dizziness or headache. However an imbalance that develops can contribute to those symptoms, although both dizziness and headaches are complicated symptoms which can be related to many other intracranial or neurological etiologies. Answered by I. Howard Fine, MD, Ophthalmology, Eugene, Drs. Fine, Hoffman & Packer, LLC (10/6/2003) Q I work for a construction company and it is now my job to make sure that the employees are protected against the threat of hepatitis. The one question that I can not seem to find an answer for is what is the difference between strain A & B? Do I need to have the employee's vaccinated for both strains? I am currently just having them take the shots for the B, but am worried that they also need to have the A shots as well. A There are several viruses which cause what seems to be the same end result: liver inflammation. However, the viruses causing hepatitis A, B and C are very different. The only one which would put people working construction at increased risk (and for which we have a vaccine)is hepatitis B, and that only if an injured person carrying hepatitis B bleeds into an open wound of another person. The vaccine series can protect against this unlikely event. Hepatitis A is transmitted by contaminated food and water and there is a vaccine. Hepatitis C, like hepatitis B, is transmitted by blood and needles, but we have no vaccine. Since there are several viruses which may be transmitted by blood, and we only have a vaccine for one, teaching personnel how to respond to a bleeding wound is as important as any vaccine. Paying for your employees to receive hepatitis A vaccine would be generous, but not necessary. They will be more at risk from hepatitis A because of where they choose to eat lunch than from any workplace activities. The Center for Disease Control provides background information at the Hepatitis Resource Center Answered by John Wilson, MD, Infectious Disease, Eugene, The Travel Clinic (10/6/2003) Q I would like information about Urgent Care -- how the services are accessed (walk in, referral, appointment), the hours of operation, the type of health care worker it employs (list the careers), the goals of the organization, an explanation of the types of services it offers, who it serves (population types)? A Urgent Care is the place for "today's non-emergent problem today". We see a wide range of acute medical problems that would typically be treated in your physician's office -- for example: sore throats, bronchitis, coughs, colds, sprains, minor cuts and broken bones. We ARE NOT an Emergency Room and no one should ever come here who is experiencing shortness of breath, chest pain, or thinks they may have a problem that could potentially need a surgical intervention or hospitalization (ie. heart attack, stroke, meningitis, obvious fracture). We serve all patients on a walk in, first come, first serve basis, unless our triage nurse deems the patient in need of immediate attention (these would be people who shouldn't have come here to begin with because they are that ill or injured). We do not treat chronic problems, or do physicals, or manage any long term problems (ie. medication refills, treatment of chronic pain, hypertension or high cholesterol). We are open from 7a -MN (almost every day of the year). We have on-site x-ray, limited CT and ultrasound as well, can draw labs (blood work) but do not have an on site laboratory, and often need to have patients who need these types of diagnostic tests after 10:30pm go to the ER. We accept all the insurances accepted by PeaceHealth, as well as private pay. Referrals are dependant upon your insurance carrier and their requirements. We are staffed by 1 or 2 physicians during our office hours. Our physicians vary in their training from Emergency Room trained, to Family Practice trained, to Internal Medicine trained, and most are Board Certified. Sometimes we are very busy and our waits can easily be as long as 2-3 hours. Answered by Erin Reilly, MD, Urgent Care, Springfield, PHMG/Urgent - RiverBend (10/2/2003) Q How can I tell if there is something in the air of my new home making me sick? I've been noticing when I'm near the garage (where my husband has a project car) that I get a bad taste in my mouth. Today I am noticing the taste while I'm at work, and have a slight headache and a very queasy stomach...should I be worried? A There really is no good way to find what is in the air in your home without an environmental company testing air samples within your new house. You may have some mild allergy to a building compound or to a chemical that your husband may be using in your garage, and although this may be detected in an air sample it does not necessarily mean that you have a true allergy to that compound. Most of the symptoms that occur when this happens usually go away when you are removed from that environment and only return when you are exposed to it again. If you are feeling "queasy" at work, there may be some other cause for this outside of what you may be smelling at home and if it continues, then you will want to see your primary physician. Answered by Michael McNellis, MD, Pulmonology, Longview, PeaceHealth Specialty Clinic (9/30/2003) Q This is a question for an asthma Dr. I was in today to get a breathing treatment for my asthma. I felt uncomfortable putting my mouth on the nebulizer mouth piece as it was not disposable. They said that they clean it with Sporax (if I remember that right, maybe that wasn't it) after each patient and that they throw away the tubing after each patient. I thought in today's world that most practices use disposable mouth pieces, etc... Do you find it odd that a very known practice in an area would do this? If so, is it really sanitary for the patient? I tried to just breathe the vapors but they checked on me, they insisted that I tightly close my lips around the "sanitized" mouth piece. A I believe that there are guidelines for proper infection control as it applies to nebulized therapy. These are most likely to be published by the Centers for Disease Control (CDC), and the American Association of Respiratory Care (AARC). However, from my experience, most practioners, including myself, utilize disposable nebulizer cup, mouth pieces and tubing. If re-usable mouth pieces or nebulizer parts are being used, then there should be a documented protocol for sanitizing the equipment and this should be based on establised guidelines provided by the CDC or other agency. The medical office should have the protocol readily available and should be able to provide it on request. Such a request is reasonable to ensure that proper infection control is being performed. Answered by William Anderson, MD, Allergy & Immunology, Bellingham, William Anderson MD (9/26/2003) Q I would like to know the normal size or CT criteria for a normal sized lymph node in the porta hepatis region. And in general, what is the size of a normal lymph node, and is there a study that we could read that has this kind of information? A Lymph nodes are distributed all over the body but are concentrated in several areas. By CT, we generally desribe the short axis diameter (the node may be bigger but we measure it in the transverse plane). In the abdomen, the normal size for lymph nodes is usually up to 10 but occassionally up to 15 millimeters. Some anatomic areas have larger lymph nodes, like in the groin. In the porta hepatis region, nodes are usually around 10 mm. There can be a slightly larger node nearby, next to the inferior vena cava, sometimes referred to as a Virchow's node (Virchow has his name on many things - including normal and abnormal lyph nodes). It can normally be up to 15 millimeters. Answered by Jon Ekstrom, MD, Radiology: Diagnosti, Eugene, Radiology Associates, PC (9/25/2003) Q I have a question on allergies and asthma. I have had both for over 30 years. I have dealt more with the asthma problems than I have the allergies. Can asthma and/or allergies make you feel light headed? If so, what causes it -- an allergic reation to something; or lack of oxygen? How can you tell the difference between having a hard time breathing due to asthma, and having a hard time breathing due to anxiety? Can anxiety make you light headed? A You ask a number of important questions about symptoms that may be associated with asthma. Light headedness can be associated with asthma but it is an unusual complaint. If one is having a severe, sudden allergic reaction with or without asthma, lightheaded feeling may be noted, but other obvious symptoms would also be experienced in general, such as hives, wheezing, swelling of some tissues such as the lip, around the eye or throat. If one is breathing fast, either due to asthma or anxiety, or both, one often feels lightheaded, dizzy, and can even pass out for a few seconds. It is sometimes very difficult to differentiate between asthma and anxiety as both can cause shortness of breath and a hard time breathing. A breathing test called spirometry, or use of peak flow meter can often help in determing how much of one's difficulty in breathing is due to asthma or anxiety. Some patients with anxiety associated shortness of breath complain of tightening in the throat area with difficulty getting a deep breath of air in. However, this does not necessarily exclude asthma as a factor. In patient's with anxiety as the primary problem, sleep is usually not disrupted due to breathing difficulties, whereas in asthma that is not well controlled, nighttime awakening is common. It is also important to know that other medical problems including heart problems or anemia can cause light headedness. If one has had asthma for many years, experiencing usual symptoms, and a new symptom develops, such as light-headedness that was not experienced before, then medical evaluation should be pursued. Answered by William Anderson, MD, Allergy & Immunology, Bellingham, William Anderson MD (9/23/2003) Q How do you tell the difference between a viral infection and a bacterial infection? When should I be concerned and go to the doctor? A There is no hard and fast set of symptoms that distinquish a viral infection from a bacterial infection. There are some distinquishing features depending on the system of the body that is involved. Any symptoms related to the urinary tract (urgency and frequency of urination) associated with fever is almost always related to a bacterial infection. It's almost impossible to distinquish the two when it involves the pulmonary system (bronchial tubes and lungs). These symptoms are the same -- namely a productive cough associated with a fever whether it's a virus or bacteria that is the offending organism. Sore throat with fever is also indistinquishable. A temperature that persists over 101.0 degress for a couple of days, and particularly one associated with a chill, should send you to the doctor no matter what the associated symptoms may be. Loren Barlow, MD Answered by Loren Barlow, MD, Internal Medicine, , (9/22/2003) Q This is a GYN question. Can you tell me what causes clitoral pain or spasm? Is this common in women? A Clitoral spasm is not common. It can be caused by many different factors, including infection, vascular (blood supply problems), diabetes, tumors, etc. I would recommend you see your Gynecologist to evaluate this. Answered by Linda Frison, MD, Obstetrics/Gynecolog, Eugene, PHMG/OBGYN-Willamette (9/22/2003) Q Can you tell me what causes the tongue to be sore just in one spot? You can't see anything from just looking at the tongue, but when I "scrape" it with my finger nail, it seems like one of the taste buds hurt. Can you have an irritated taste bud without its' being red, or do you feel that this is a more serious problem? I get this periodically; it comes and goes from time to time. I did have some gum irritation when it started because, where I once had a tooth in the back of my mouth, there is now just gum and if I eat hard foods (chips, pretzels, etc..)my gum gets raw from irritation. A You should have a Dental evaluation, and perhaps adjust your occlusion or grind an irregular tooth. Acid oral conditions foster ongoing tongue irritations as well, so it may be good idea to rinse your mouth 4 times a day with water and a pinch of baking soda. If symptoms persist, see your otolaryngologist. Answered by Emil R. Hecht, MD, Otolaryngology, Bellingham, Bellingham Ear Nose & Throat (9/22/2003) Q If a homosexual man, "A", has sex with a man infected with AIDS/HIV and on medication, does that lower the "A's" resistance to medication should he develop aids? A Let me rephrase your question: If gay men A and B have sex, and A does not have HIV disease, and B has HIV disease being treated with medications, what are the possible effects on the health of A and what can be done to prevent them? Uganda has had incredible success in reducing the rate of all STDs, including HIV disease, using an educational program emphasizing the ABCs of STD prevention: Abstinence; if you can’t do that, Be faithful; if you can’t do that, use Condoms. A and B have the option, even the responsibility, to prevent transmission of HIV disease by using condoms. To answer your question, if B is under treatment, he could be harboring a strain of HIV which is resistent to some drugs. If A gets HIV disease despite condom use, yes, it is possible that a drug resistant strain could be transmitted, and medications used to treat A may not be effective, whether given in a preventive or in a therapeutic sense. Answered by John Wilson, MD, Infectious Disease, Eugene, The Travel Clinic (9/17/2003) Q Can you tell me if fair skinned people heal slower from bruises? I had a CBC done 8 days ago (it came out fine). They took the blood from the "corner" of my arm towards the elbow. I had thought it should have healed by now. My mother says it's because I am fair skinned --is this correct? A There is no relationship between fair skin and poor healing. African black people are more prone to make large and dense scars after injury, called keloids. Redheads have the reputation of bleeding more after childbirth, but this is undeserved and has no basis in fact. Adequate protein and Vitamin C in the diet are essential for wound healing. Applying pressure and elevating the puncture site for 20-30 minutes after a blood test is a good idea. Answered at 9/11/2003 Q If I only have one kidney stone that is 8-9mm in size, can I pass that size of stone? Can a piece of it break off to pass causing extreme pain? A It's unlikely you would be able to pass a stone of this size. Yes, the situation might arise that the stone itself might become dislodged from where it is now and cause severe pain. It's unlikely that a piece of the stone will break off. It might be wise for you to discuss the issue with a Urologist. Loren Barlow, MD Answered by Loren Barlow, MD, Internal Medicine, , (9/10/2003) Q I need information on Vacterl syndrome. A Vacterl syndrome is an acronym for a nonrandom collection of abnormalities which are often seen together more commonly than pure chance alone would predict. It's also called: vater association; v-vertebral defects; a-imperforate anus; c-cardiac anomilies; t,e-for tacheoesophogeal fistula; r-renal or kidney abnormalitis; l-limb anomilies You can find out more at the web site Vater Connection. Answered by Paul Bouressa, MD, Pediatrics, Springfield, PHMG/PED-RiverBend (9/5/2003) Q I have been diagnosed with Raynauds Syndrome. Can you tell me of anything that I can do to slow down, or help this syndrome through diet, exercise, etc.? A Simply stated, probably not much through diet or exercise. The main thing would be to try and keep your extremities warm under all circumstances. Avoid vasoconstrictive substances such as nicotine. For some people with Raynauds, vibration can also induce symptoms. If that's a problem for you, avoid it. If needed, there is medication which can be used (usually only in the most severe cases, though) to help minimize the symptoms. Answered by Frank Littell, MD, Hospitalist, Springfield, PeaceHealth Hospital Medicine (8/29/2003) Q How are white blood cells replenished? A The white blood cells, of which there are 5 main types (neutrophils, eosinophils, basophils, monocytes, and lymphocytes), are central to immunity to infection. The first 4 types are constantly replenished by the bone marrow, where red blood cells and platelets are also made. Lymphocyte production is more complicated, and some of them emanate from lymph nodes. The spleen generally gobbles up old white blood cells after their short life span. The bone marrow is very capable of pumping out white blood cells unless is it diseased. Many treatments exist for low white blood cell counts (leukopenia). Answered at 8/27/2003 Q I have been taking levothyroxine for a few years now at the same dosage. I recently had a TSH level of 10.5 and my medication was increased. I had gone to an Urgent Care Clinic and the MD there just told me how much to increase the medication, and to follow up with my PCP in 6 weeks. I have never had any testing done (other than bloodwork) for my thyroid. I don't understand why there is a sudden increase in the TSH level. Do I assume that this is Hashimoto's thyroiditis or should I have further testing done (e.g. ultrasound etc)? Do I need to see a specialist or just follow up with my PCP who is an internist. A This is a very common clinical issue. As one ages it is not unusual to slowly require more thyroid hormone replacement. There is an age-related decline in the small remaining thyroid hormone output from the thyroid gland. You do not need to see a specialist but you should see your personal physician within 2-3 months to recheck the TSH once again to confirm you are now on the correct dose. A yearly TSH test is reasonable for people on thyroid hormone replacement. Answered by Frank Littell, MD, Hospitalist, Springfield, PeaceHealth Hospital Medicine (8/25/2003) Q I have 3 compressed and/or fractured vertabrae after a fall from a horse. My Doctor mentioned the possibility of repairing the one in my upper back by "glueing". Could you possibily explain the procedure, and the pros/cons? A For the pain of vertebral compression fractures, vertebroplasty and kyphoplasty are often effective surgical options. These procedures essentially 'splint' a fracture from within by using a bone cement that hardens within the fracture. To undergo these procedures, a patient would have: 1. continued intractable pain that interferes with the activities of daily living due to vertebral compression fracture. Therapy with analgesics and bracing is the first and often effective step at pain control 2. Images (either a bone scan confirming a recent fracture and a CT scan to be certain that there is no spinal narrowing or a MRI with STIR sequence to evaluate for the fracture and narrowing) 3. Absence of active infection or bleeding disorder Vertebroplasty does not regain vertebral body height, but is effective for pain control in over 80 % of patients, and requires only local anesthesia with sedation. This outpatient procedure requires 15-20 minutes, and is done by Pain Mangement Physicians and Radiologists here in Eugene. Kyphoplasty involves first inflating a balloon in the broken vertebral body, and then injecting the same cement as in vertebroplasty. The ability of this procedure to control pain is simular to vertebroplasty. The balloon inflation may help regain vertebral body height. Kyphoplasty requires general anesthesia, and is done by neurosurgeons here in Eugene. Drs Kokkino, Miller and McGirr. You can read about these procedures on Spine-Health.com at Kyphoplasty, Vertebroplasty . Answered by Christa Danielson, MD, Family Practice, Eugene, PHMG/FP-South (7/30/2003) Q What is a corneal ulcer? How do they treat it? How serious is it? I do not wear contacts. A The cornea is the clear covering which is the actual front suface of the eyeball. A corneal ulcer is a sore on the cornea. It may be either infected or not infected. Corneal ulcers may occasionally be vision-threatening urgent problems. There are many different causes of corneal ulcers--use of contact lenses is a frequent cause. These ulcers are treated by first identifying the likely cause, then designing a treatment that usually consists of eye medications in eyedrop form. Anyone with a corneal ulcer needs treatment. Any contact lens wearer who develops a sore eye that does not resolve by removing the contact lens, should be evaluated by his/her eye doctor. Answered by David Deutch, MD, Ophthalmology, Eugene, PHMG/Ophth-Willamette (7/10/2003) Q What are the symptoms of a mold allergy? Is rapid heart palpitation one of them? I am used to having heart palpitations once in a while, but for the past couple of months I have been having lots of them and they last a while. A Palpitations, or irregular heart beats would be an unusual manifestation of mold allergy. Other, more common causes for this symptom should be evaluated and ruled out before considering mold exposures as a factor. Palpitations can be a sign of a serious medical condition and should be evaluated, especially if there has been a change in the frequency or severity. Mold allergy may cause symptoms that are similar to those caused by exposure to other allergens, such as dust mites or animal dander. A person allergic to molds may experience nasal congestion, runny nose, sneezing. If there is a history of asthma, cough, wheezing and shortness of breath may be noted as well. Answered by William Anderson, MD, Allergy & Immunology, Bellingham, William Anderson MD (7/8/2003) Q How can I locate a neurologist specializing in Parkinsons? We are relocating to Cottage Grove,OR. A There are currently no neurologists actually practicing in Cottage Grove at this time. Neurology Associates of Eugene-Springfield used to go there on a weekly basis and then Cottage Grove had its own neurologist for a while, but he has since left. There are 10 neurologists in Eugene who accept new adult patients. None is specifically and only doing Parkinson's Disease but all of us see may Parkinson patients. We interact on a regular basis with the Movement Disorder specialists at Oregon Health Sciences University. Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (6/23/2003) Q Can you give me an internet contact address to make a commment on the recent studies on HRT? There are a couple of areas I have not seen addressed that may influence women's choices. A Yes, an internet site is American College of Obstetricians and Gynecologists . You can also contact NAMS with questions re hormones and menopause at North American Menopause Society Answered by Christa Danielson, MD, Family Practice, Eugene, PHMG/FP-South (6/18/2003) Q How do I get a copy of my medical records? A Just go to your medical clinic and sign a release. It is a part of new federal regulations that you can have a copy. At sometime here at Peacehealth our patients may be able to view their medical record on-line with a web service called PatientConnection, but that is not available as yet. Answered by Christa Danielson, MD, Family Practice, Eugene, PHMG/FP-South (6/13/2003) Q My son, age 25, just moved to Eugene this week from Flagstaff, Az. He is experiencing severe allergic reactions to the "outside" and can only be out 2 hrs without great difficulty in breathing. He's tried Claritan Sudafed benedryl without relief. His landlord advised that Eugene has a "grass mfg" plant and that allergens normally at 40 are now 400! He's just graduated from college in Flagstaff and has only had mild allergies there. If you could make any recommendations re: treatment-- or a County Health Dept.-- it would be appreciated. A We are the grass seed capital of the world. The willamette Valley grows 90% of the grass seed for the country. The best thing he can do is leave the valley until after July 4th when the pollen counts will be nominal. Otherwise, we have inhalers for the lungs, nasal inhalers, oral non-sedating antihistamines, and eye drops. He nees to see a doc and see how his symptoms can be best contolled by meds. If he plans on staying in the valley, he can expect this every May and June. Answered by Erin Reilly, MD, Urgent Care, Springfield, PHMG/Urgent - RiverBend (6/13/2003) Q I would like to receive a listing of all of the Diabetes Resources in Eugene. I was diagnosed in Ocober of last year and am at a loss as to the what or where of this disease. A I would first make an appointment to speak with your Primary Care Physician about your concerns. The most important step you can take at this time is to obtain education about diabetes so that you can manage your care with confidence. We have two excellent diabetic centers in this community, and depending on your medical insurance requirements and limitations, your physician will be able to make a referral for diabetic education for you. Peace Health Medical Group: Diabetes, Endocrine and Metabolism Service tele# 686 7029 McKenzie Willamette Hospital: Center For Healthy Living tele# 726 4544 PeaceHealth also has a Health Information Library which loans books and videos, and has a web page on Diabetes Resources. Other community resources for diabetes include: American Diabetes Assoc. tele# 343 0735 Diabetes Support Group tele# 736 4444 Centro Latino Americano offers diabetic resources and education to clients of Hispanic origin. tele# 687 2667 Gales Creek Camp is a diabetic camp for children in grades 1 through 12. tele# 503 699 8433. The Volunteers in Medicine Clinic offers group education for their patients with diabetes. Care is provided to low income, uninsured working people who cannot qualify for government assistance. tele# 685 1800. Other services do become available in the community and I would recommend calling the American Diabetes Association for possible changes and updates to this list. I hope this information is helpful to you, and wish to congratulate you for taking this first very important step. Answered at 6/12/2003 Q Is there liquid oxygen available for out-patients? A Liquid oxygen is available for patient's use at home by contacting one of the Durable Medical Equipment providers in the area, with a valid prescription. Some offer it, some don't. If you're in the Lane County area, try contacting Pneu-Med Inc. They have offered it to customers in the past. Good luck, let me know how this turns out! Anton Wade, CRT Answered at 6/4/2003 Q Have there been any studies that show some blood pressure medications can push the patient into Diabetes 2? My diabetes 2 only showed up after several years of treatment for high-blood pressure with atenolol & Hydrochlorathiazide. A It is common for diabetes to show up after blood pressure medicine is started. Often high blood pressure is an early sign of insulin resistance and type 2 diabetes. There have been suggestions in the past that both atenolol and HCTZ might worsen insulin resistance. This effect has not been found after repeated efforts to document it. Answered by Matthew Davies, MD, Endocrinology, , (5/29/2003) Q I have been cutting myself for more than half my life. I am in counseling at this time and this is helping but would also like to know if you know of any support groups for people like myself? I am not wanting to kill myself but do wish to get rid of the need or desire to do this. Please let me know if you can refer me. A I don't know if there are any support groups for this. I haven't heard of any. The only place locally I would guess would be the U of O Counseling Center and that would be for students. There are programs in Portland under Marsha Linnahan's treatment centers ( I don't know the name of that particular organization). This is from the Go Ask Alice website at Columbia University: >>Self-Abuse Finally Ends Alternatives Program located at MacNeal Hospital in Berwyn, Illinois. S.A.F.E. offers a variety of services for people who self-injure, including group and individual therapy, in- and out-patient treatment, and a partial, or day, hospital. S.A.F.E. also provides education and support for people who self-injure. In particular, you may be interested in their therapy groups. At the present time, S.A.F.E. may be the only center in the U.S. to offer therapy groups dealing specifically with self-injury. Even if you are not located near them, you can contact their information line at (800)-DON'T-CUT / -366-8288. You can also check out the S.A.F.E. website for more information about the S.A.F.E. Alternatives Program , which is in the process of branching out nationwide. << Answered by Hallenburg, Kris S. PhD, , Springfield, PHMG/BHS-Spfld (5/23/2003) Q I'm a 35 year old female, 5'4", 112lbs and I'm concerned that I'm not consuming enough protein to keep up with my exercise routine. I take 4 Power Step classes (with hand weights) per week and weight train with free weights/machines for an hour 4x per week. I also have a Nordic Track ski machine that I use 2 days per week. I generally get home so late 3 nights per week that I eat a small bowl of multi grain cereal. I eat a can of tuna for lunch and plenty of fruits and veggies and water. I'm trying to build more muscle, so I know I need more protein. How can I get more into my diet? I'm concerned about the extra fat/calories/sugar/sodium in the protein bars on the market. What about the protein drinks? Any suggestions? I have to add that I do eat a regular dinner (chicken or fish plus veggies and pasta or rice or potato) three nights per week. I'm not trying to drop any weight but to gain muscle. A The recommendation for protein is .8gms per kg. For you that would be 41 gms of protein per day. If you are training, to go up to l.0 would certainly be reasonable. The max would be 1.5gms/kg.-- the kind of training one might do for the Olympics or professional sports. Protein is found in most foods except fruit. The richest sources are milk( 8gms per 8 oz.), meat (7gms/oz), and egg (7gm each). Most portions of starch and vegetable are between 3-5gms per serving. I personally see real food as a better source of nutients than bars. You didn't mention milk but if you had two glasses of milk, 4-5 oz of meal/poultry and 6-8 servings of starch per day that would equal about 65 grams of protein per day. That is about 1.1gms of protein per kg. Answered at 5/20/2003 Q Recently in my left hand a hard lump that felt like bone formed under the skin. It was above the joint in my middle finger. It went away after a couple of weeks; however, now a small similar feeling bony lump has formed on my middle toe on my right foot. It is painless and not irritating me. I am concerned that it is gout or arthritis. A If it is painless and not irritating, the chances of it being gout or arthritis are very low. Both of those conditions usually cause pain. Most commonly, it is a small cyst that can form around the tendons or joints, however (as with all masses or growths) if the size should increase or your symptoms worsen, it should be examined and an x-ray obtained for a complete evaluation Answered by Thomas Wuest, MD, Orthopedic Surgery, Eugene, Slocum Orthopedics (5/15/2003) Q What can you tell me about the dangers of the Atkin's diet- namely the drawbacks of long-term ketosis on body tissues and systems? A Greetings. This information comes from a Physician's Advisory put out by the Physicians Committee for Responsible Medicine. . I will give you the exact paragraph in their paper, Adkins Diet Alert. "High protein, very-low-carbohydrate weight-loss diets are designed to induce ketosis, a state that also occurs in uncontrolled diabetes mellitus and starvation. When carbohydrate intake or utilization is insufficient to provide glucose to the cells that rely on it as an energy source, ketone bodies are formed from fatty acids. An increase in circulating ketones can disturb the body's acid-base balance, causing metabolic acidosis. Even mild acidosis can have potentially deleterious consequences over the long run, including hypophosphatemia, resorption of calcium from the bone, increased risk of osteoporosis, and an increased propensity to form kidney stones." The short answer is that the Adkins diet is usually a short term solution to a long term problem. Most folks have a hard time following it for more than 6 weeks. Dr Atkins does aim at the problem when he advises carbohydrate restriction. Many folks can certainly benefit by reducing carbs, but a reduction to 50% of the calories provides adequate nutrition and can be part of a long term nutrition and fitness plan. Answered at 5/1/2003 Q Do you know whether Peace Health currently participates in the REMEDY program for recovering unused medical supplies to send to developing nations? I became aware of REMEDY at the Rolex Enterprise awards site for 1996 and Peace Health was listed as a participant. I am a student in the Master Recycler Program in Lane County. We are committed to educating the public and raising awareness about what is being done, and can be done, to reduce, reuse and recycle, as well as holding zero waste as our ultimate aim. I am personally interested in developing an awareness and proactive association with meeting human (and planetary)needs, and reducing and eliminating waste. I am addressing this question to you because of your availability on Peace Health's web site to answer questions. If you are not familiar with REMEDY do you know who might be familiar with it? The person who started REMEDY is Dr. William Rosenblatt of Yale University School of Medecine. The website is REMEDY . This is an exciting program and I think it would be useful and interesting to discover more and to share information about recycling and helping the community at large, from the perspective of those who are locally active. A The first reply is from Brenda Shearer, the second from Alice Wagner, staff members at Sacred Heart Medical Center. "We do participate in collecting reusable items for Northwest Medical Team. I must admit I don't know the volume, and I am sure it could be increased if we had someone who could get the education out to the units." Alice Wagner, Environmental Services "I looked at the Website and they want items on their wish list that I do not usually have to recycle. I donate, recycle and sell already." Brenda Shearer, Materials Management Answered by Christa Danielson, MD, Family Practice, Eugene, PHMG/FP-South (4/29/2003) Q What are the pros and cons of collection of umbilical cord blood as seen by the medical community? It's expensive at onset, but is that cost negligible if ever needed? A Umbilical cord blood storage is an interesting issue. It is one of the most common medical issues that I am asked about by my non-medical friends. I should start off by stating that none of my 5 children (ages 1-9) have had umbilical cord blood stored. This is not because I have serious objections to the process, but basically I have just been more lazy than neurotic! The premise is that the umbilical blood, which will just get discarded, can be saved (specifically the stem cells it contains) for possible transplantation in the future. Two types of storage are possible: donation to a public umbilical cord blood bank and private storage for personal, or directed use, with a 'for profit' company. The first is logistically difficult. Only a small number of hospitals and blood banks participate. Donation requires advance planning, a maternal interview, and blood sample, etc. Several 'for profit' companies are happy to supply kits and store the blood. Initial fees I've heard run from $250 - $1500 with about $100 a year for storage. The amount collected from one placenta, to my understanding, would be sufficient for a donation to a child, but not an adult. Only about 2000 umbilical blood transplants have been performed in the history of the world, so even if the procedure has theoretical merit practical limitations remain substantial. I think storage may have special justification in families with rare genetic disorders that can be treated with bome marrow transplants or who come from ethnic groups that are very uncommon in the US. Having said that, I do not know of anyone personally or professionally who has stored umbilical blood, let alone anyone who has been treated with it. Answered at 4/21/2003 Q What is the difference between panic and anxiety attacks? Is there an association with agoraphobia? A There's not a diagnosis of anxiety attack, only panic attack. There is generalized anxiety where the person is constantly worried and anxious about things that others would take in stride with everyday life (such as family members driving home from work). Panic attacks are when there is a sudden and increasing feeling of fear or wanting to escape, usually with physical features such as a racing heart, difficulty breathing, light-headedness, weakness, or GI problems. It ususlly comes in a rush and lasts less than 30 minutes. Agoraphobia is when the fear of panic keeps people from going places. It often starts with fear of going to the mall or grocery store and will generalize to other places and/or fear of driving. Both are very treatable with cognitive-behavioral therapy, sometimes with the help of medication. To learn more about these disorders try Internet Mental Health/Disorders or go to the National Institute of Mental Health to read about Anxiety Disorders Answered by Hallenburg, Kris S. PhD, , Springfield, PHMG/BHS-Spfld (4/18/2003) Q Please provide a definition and resources for Pelizaeus Merzbacher. A As you undoubtedly know, Pelizaeus-Merzbacher Disease is a very unusual condition. It is in the group of diseases known as "leukodystrophies", meaning it is a degenerative disorder of the white matter of the central nervous system. The myelin (the material that insulates the nerve fibers) cannot grow normally. It is a genetic disorder and most forms occur in infancy though there is a very rare adult form. Sadly, there is no effective treatment and the prognosis is poor. As to resources, I would suggest you start with a website which is at the National Institutes of Neurological Diseases and Stroke: NINDS Pelizaeus-Merzbacher Information Page. There is some basic information and several links out to organizations. Another resource is the National Organization for Rare Diseases. The medical librarians at the Health Information Library at the PeaceHealth Barger Road Clinic, or at the Annex HIL Downtown, can access that information online for you. Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (4/11/2003) Q I was seen in the ER this week for pyelonephritis, and the Dr. I saw said that I had an extremely elevated WBC count and was "pushing out immature WBC's." He told me the medical term but I can't remember what it was. Can you help? I'm a medical assisting teacher and would like to pass it on to my students. A Any severe infection or inflammation can produce an elevated white blood cell count (leukocytosis). In the case of a bacterial infection, the white blood cells increased are the neutrophils (neutrophilia). If immature cells are being released from the bone marrow in a serious infection that is often termed a "left shift." If very early cells are found in the blood in significant numbers in a benign inflmmatory state, the situation is sometimes called a "leukemoid reaction." The first early cells to emerge are "band" or "stab" cells and a "bandemia" is said to be present. I'm glad that you have recoverd sufficiently that you can be intellecutally curious about your infection! Answered at 4/7/2003 Q Information on Polycythemia vera? A Polycythemia vera is an uncommon disorder in which the bone marrow makes too many blood cells, especially red blood cells. Too many platelets and white blood cells can also be produced. The blood becomes too thick because of the excessive red blood cells, and is prone to clot. The cornerstone of treatment is to take off blood (a blood donor amount each time) to get and keep the red cell amount at normal levels. Drug therapy is also useful. The major concern in diagnosis is to ensure that other conditions that increase the red blood cell count, especially lung and heart disease and other bone marrow disorders, are not mistaken for polycythemia vera. You can read about Polycythemia Vera on MEDLINEplus, the NLM consumer gateway. Answered at 3/25/2003 Q What does the differential mean in lab values? For instance, how would a high lymphocyte count be considered different when your overall white count is normal? A The white blood cells (leukocytes) come in different types. The number and/or percentages of the various types is known as the differential white blood cell count or "differential." Typically, the automated blood counting machine determines a 5-part differential: neutrophils, lymphocytes, monocytes, eosinophils, basophils. Lymphocytes should, depending on age be no more than 50% of white cells, and number no more than 5000 per mm3 or uL. One of the first steps if the lymphocyte count is elevated is to have a pathologist review your blood smear. Many disorders cause increased lymphocytes, some of which go away in short order. Your physician will be able to sort these out or refer you to someone who can. Answered at 3/25/2003 Q What should a hospital do when a patient does not have an advance directive and the family members disagree about what should medically be done for their loved one? For example, would the family members be encouraged to participate in mediation? What would PeaceHealth suggest? A This is a complex question, so I got opinions from 2 people that work at SHMC and are knowledgeable on this topic. This from Dan Reece MSW who is the director for Social Work at Sacred Heart: It is not unusual for family members to disagree on medical decisions when the patient does not have an Advanced Directive, or even more importantly, when the patient has not discussed their feelings and beliefs with them. Physicians and SHMC staff, including social workers and chaplains, are available to assist families in coming to agreement. In addition, the SHMC Bioethics Committee is available on request to consult with both the family and the professional medical caregivers. The Bioethics Committee is not a decision-making body, but it can help the parties develop an ethical framework for making decisions. In cases where agreement cannot be reached, there is a legal hierarchy of family decision-makers. . . . and this from Bob Scheri of pastoral care services at Sacred heart. Dan's response is very good. Ultimately, the question family members must ask is not "what do we/I think should be done for my family member?" From an ethical perspective the better question is, "what would my family member want done if he/she could speak for themselves?" The answer to this question is more often than not, quite different from the answers given to the first question. This question often prompts a shift in thinking among family members. Conflict is still present, but the focus is on one person's values and feelings: the patient. As Dan stated, we have a variety of resources and supports available to families in such a conflict to think through the issues and discover the most helpful questions. Our goal would be to assist families in moving towards understanding and ultimate agreement. Within this process there is another key question that must be addressed: Who is the decision maker? Obviously, the patient is, but when the patient can no longer speak for themselves, who will voice or be the spokesperson for the patient's wishes? Ultimately, the law outlines who this would be without an advance directive. This person would be responsible in the end to reach a conclusion and make a decision consistent with the patient's values. While we prefer that we succeed in helping families come together, having clarity on who the legal decision maker is provides an ultimate framework for decision making. This also helps families in extreme conflict to realize that there is a legal framework within which they must work. What would PeaceHealth suggest? That the caregivers first clarify the question about who the ultimate decision maker is, and second to facilitate discussion about what the patient's wishes would be given the medical condition and prognosis. If conflict proves to be an obstacle, call a chaplain, social worker or request support from the ethics committee. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (3/19/2003) Q I'm a student at Spencer Butte Middle School. I'm doing a debate about legalizing marijuana and I am wondering what your thought is about this. Do you think we should legalize marijuana? I'm on the Pro side of this arguement and I'm wondering if you agree with me? A The federal goverment, through the Drug Enforcement Administration (DEA), classifies marijuana as a Schedule I drug. This means that marijuana has NO medical or clinical use. Physical dependence and toxicity are not the only factors that are considered in determining a substances abuse potential. Frequent use of marijuana can result in harmful consequences such as failure to fulfill major obligations at work or school, physical risk-taking or even substance-related legal problems. There is evidence that some individuals do use marijuana in amounts sufficient to create a hazard to their health, to the safety of other individuals, or to the community. Mental and behavioral effects of marijuana can vary widely among individuals but common responses are dizziness, nausea, exhilaration, disinhibition, time distortions, illusions, delusiions, impaired judgement, dysphoria and short term memory impairment, among many other effects. Marijuana has many cardiac (heart), respiratory (lung), endocrine (hormone) and immune system effects. For the above reasons the federal government, through the DEA, has kept marijuana as Schedule I drug i.e. it has no medical or clinical use. Cocaine, Phencyclidine (PCP), heroin and LSD are all in the same Schedule I category. Due to the many social and physical effects or marijuana it is highly unlikely that it will be legalized in the future. Answered by Stephen Erfurth, M.D., Pathology: Anatomic, Springfield, Stephen Erfurth PhD (3/17/2003) Q What are the signs of a heart attack? A Two points are critical in terms of the signs of a heart attack: first, the signs can be quite variable; secondly, time is critical to minimizing damage or disability and preventing loss of life. Most people experience some form of chest discomfort that does not go away on its own within 5 to 10 minutes. This discomfort can be severe pain or can be more subtle; most frequently it is described as a pressure or squeezing sensation, and it can radiate to the shoulders, the left arm or both arms, into the back, and/or up into the throat and jaw. Shortness of breath is also a frequent sign, and sometimes can be the only symptom. This happens more frequently with women than with men; symptoms are more likely to be less classic in women, and this contributes to a delay in treatment for women, both from women arriving at the emergency department later after symptom onset, and from a longer time to diagnosis in the emergency room. Other symptoms that can occur with chest pain or shortness of breath include nausea, sweating or lightheadedness. Answered by Peter Beglin, MD, Cardiology: Interven, Bellingham, North Cascade Cardiology (3/13/2003) Q How does Vitamin C affect absorption of Iron? A That is a very interesting question with a clear cut answer! Vitamin C increases absorption of iron by changing iron from the ferric state to the ferrous state (from a 3+ charge per atom to a 2+ charge per iron atom in a process called reduction by adding an electon). So taking a multivitamin or taking a Vitamin C tablet with an iron tablet (if iron therapy is recommended by your physician) will heighten iron uptake by the intestine. Answered at 3/12/2003 Q I am doing a research paper on the benefits of smoking medicinal marijuana. I would greatly appreciate it if you would send me some feedback on your opinion, and if there are any benifits or any alternatives. A In March 1999, the Institute of Medicine released a report, titled Marijuana and Medicine: Assessing the Science Base," which concludes: "Until a non-smoked, rapid-onset cannabinoid (marijuana) drug delivery system becomes available, we acknowledge that there is no clear alternative for people suffering from chronic conditions that might be relieved by smoking marijuana, such as pain or AIDS wasting. One possible approach is to treat patients as n-of-1 clinical trials, in which patients are fully informed of their status as experimental subjects using a harmful drug delivery system, and in which their condition is closely monitored and documented under medical supervision, thereby increasing the knowledge base of the risks and benefits of marijuana use under such conditions." The side effects of marijuana use are remarkably similar to other drugs that affect the nervous system, and include, dry mouth, nausea, impairment of reaction time, panic reactions, hallucinations, and sexual dysfunction. Side effects associated with smoking the drug includes laryngitis and bronchitis. Alternatives depend on what the drug is being used for, but exist for most disease states. I would need to be given a particular condition to list alternative remedies. Answered at 3/12/2003 Q If my Triglyceride count is 264, what are the health risks? What is normal and how do I get back to normal? A A fasting trigleceride level of 264 is mildly high. The risk of elevated triglycerides is poorly defined and much less than cholesterol elevation. At most your level implies a small increase in coronary artery disease. Triglycerides are elevated in diabetes, hypothyroidism, and some other disease, as well as with a number of drugs and with obesity. Assumming that the elevation is not secondary to some other disease or drugs, the best approach is diet and exercize. This also helps with cholesterol, which as noted, is more important. Limited alcohol (assuming that you do not have an alcohol problem!) in the form of one or two glasses of wine or equivilent may have some benefit. Answered by Burton Vanderbilt, Pathology: Anatomic, Juneau, Bartlett Regional Hospital (3/5/2003) Q I am looking for information regarding AVM screening. My mother was afflicted by a brain aneurysm four years ago, and did not survive this ailment (she was 46).I am wondering if I should be screened for a possibility of having inherited her neural condition. Can you recommend any new research journals to read? I read that I am not at high risk for having this condition since my mother was the only one in our family to have been afflicted with this. I have discussed my feelings surrounding this issue with my primary care providers. One has suggested I look into AVM screening, if there is any need for it. A This is an area that is constantly undergoing reconsideration. I am not clear from your question if your mother had an aneurysm or an AVM. Those are 2 different conditions with different risks. In general children of one parent with aneurysm are at low risk, especially if they do not have some of the lifelong risk factors like smoking and hypertension.. Screening is not usually recommended. There is constantly new medical literature trying to address this issue. Probably the best large review was in the New England Journal of Medicine a few years ago and I'll copy the abstract below for you. You are still left having to decide for yourself where your comfort level is. Pretty good screening can be undertaken with an MRA test which would cost somewhere between $1000 and $2000. I think it's likely that insurance would not cover it in your situation. Here is that abstract: Risks and benefits of screening for intracranial aneurysms in first-degree relatives of patients with sporadic subarachnoid hemorrhage. The Magnetic Resonance Angiography in Relatives of Patients with Subarachnoid Hemorrhage Study Group. BACKGROUND: The first-degree relatives of patients who have subarachnoid hemorrhage from ruptured intracranial aneurysms are themselves at risk for subarachnoid hemorrhage. We studied the benefits and risks of screening for aneurysms in the first-degree relatives of patients with sporadic subarachnoid hemorrhage. METHODS: We screened 626 first-degree relatives (parents, siblings, or children) of 160 patients with sporadic subarachnoid hemorrhage, from a prospective series of 193 consecutive index patients. Magnetic resonance angiography was the screening tool, and conventional angiography was used as the reference test in subjects thought to have aneurysms. Six months after elective operation, outcome was assessed by means of the modified Rankin scale of neurologic function. This observational study design was combined with a decision-analysis model to estimate the effectiveness of screening. The efficiency of screening was defined by the number of relatives who needed to be screened in order to prevent one subarachnoid hemorrhage. RESULTS: Aneurysms were found in 25 of 626 first-degree relatives (4.0 percent; 95 percent confidence interval, 2.6 to 5.8 percent). Eighteen underwent surgery, which resulted in a decrease in function in 11 (disabling in 1). Five had aneurysms that were 5 to 11 mm in diameter, 11 had aneurysms that were less than 5 mm, and 2 had both small and medium-sized aneurysms. On average, surgery increased estimated life expectancy by 2.5 years for these 18 subjects (or by 0.9 month per person screened), at the expense of 19 years of decreased function per person. The number of relatives who would need to be screened in order to prevent 1 subarachnoid hemorrhage on a lifetime basis was 149, and 298 would have to be screened in order to prevent 1 fatal subarachnoid hemorrhage. CONCLUSIONS: Implementation of a screening program for the first-degree relatives of patients with sporadic subarachnoid hemorrhage does not seem warranted at this time, since the resulting slight increase in life expectancy does not offset the risk of postoperative sequelae. Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (3/3/2003) Q What is a normal range for a thyroid? A The thyroid at first glance would seem to be a simple unit, located in the lower neck over and on either side of the windpipe, and its only function being to pump out thryroid hormone. Basically only two categories of diseases afflict the thyroid: lumps (tumors) and too much/too little thyroid hormone. Unfortunately, testing thyroid function is much more complicated (although mercifully less so than it was 10-20 years ago). Usually the first blood test to check the thyroid is a thyroid stimulating hormone (TSH) level. This is a hormone actually not produced by the thyroid but by the pituitary. In MOST cases of thyroid dysfunction TSH level is inversely related to thyroid hormone level. A high TSH is usually seen in an underactive thyroid; a low TSH is usually seen in an overactive thyroid. Normally the TSH is between 0.4 and 5.0 mU/L, although each laboratory has slightly different TSH ranges. If the TSH is normal, usually that is the end of the line for testing. If it is high or low, the next test is typically a measurement of one of the thyroid hormones, most often free T4. Normal values are about 0.8-1.5 ng/L. Further blood tests, nuclear medicine scans, and other investigations may be required for exact characterization of a thyroid disorder. Most physicians are very comfortable with basic thyroid testing, refering only complicated cases to endocrinologists. Answered at 3/1/2003 Q I recently visited a doctor for a pressure in my lower back on both sides and an upset stomach and hard stools. He said I was constipated and suggested that I try Citrocel and maybe a laxative. I used Citrocel for one week, three times a day, and bumped my water intake up significantly. While I was using Citrocel the pressure in my lower back went away. I stopped using Citrocel, my bowel movements are no longer hard, and I am having two a day instead of my usual one. The pressure has come back though it is in the lower part of my back on the left hand side now. Can you tell me how long it takes to get over a bout of constipation? I have also bumped up my grains and fruit and veggie intake. I have been constipated before(with the same pressure in my lower back on the left hand side) and saw my doctor. She said that I should drink lots of water and I would get over it, and I did right away. The pressure went away and I felt fine. Can you become constipated even though you are having bowel movements -- maybe you just go a little instead of totally? Because when I become constipated I don't know it --it just hits me even though I am having bowel movements. A Constipation is most often caused by inadequate fiber and water intake. A bulking agent such as Citrocel supplies the extra fiber. Fresh fruits and most vegetables also contain fiber, which is undigestible cellulose. These agents are not laxatives as they do not stimulate bowel function. The increase in the number of stools is due to the increased bulk of the fiber and absorbed fluids. Constipation means a hard stool. It has nothing to do with frequency or amount of stool. I would recommend using a bulking agent every day regardless of whether you feel constipated or not as this will decrease your risk of constipation. If you are not having any bowel movement and not passing any gas, this is called obstipation and can be due to a serious problem and you should see your doctor as soon as possible. Answered by Glen Hoversten, MD, Surgery: General, , (2/27/2003) Q I was diagnosed with moderately severe osteoarthritis (3 cervical vertebrae) last month. What daily treatment/care is advised? I am taking glucosamine chondroitin and multivitamin each day--as I have been for years. I am doing special stretches for neck/shoulders. I am 58 y/o and do ski mountaineering among other sports and am very healthy and fit otherwise. A Be careful to avoid reinjury to your neck such as holding a phone between your shoulder and head (I use a headset), prolonged looking up or down, etc. Maintain ROM gently of your neck daily. Speak to your doctor about the option and safety of anti-inflamatories for pain control. Answered by April M. Sakahara, MD, Physical Medicine &, Bellingham, Physiatry Associates (2/26/2003) Q Everyone in my family has been diagnosed with ADHD. We are relocating to Bellingham this summer and I need help with my 16-year old son. He seems pretty depressed. I understand that there is a brain scan to distinguish between ADHD and Bi-polar Disorder. Who would be a mental health person in Bellingham knowledgeable about this? (I heard on the news that St. Joseph's there does the brain scan.) A The diagnoses of ADHD and of Bipolar Disorder are made on "clinical" grounds. That means that the history and examination of the patient are the tools we use to diagnose them. There is no test, brain scan, or other procedure which is capable at this time of separating these diagnoses. PET and SPECT scanning procedures of the brain (SPECT is available in Bellingham) are research tools only in psychiatry. Changes in these scans can be seen in patients who have ADHD and/or Bipolar Disorder, but these changes do not necessarily correlate to behavioral problems the patient may have. Changes on scans also do not point to particular treatments that might work. Furthermore, these scans are very expensive and require exposure to radiation. I would not recommend them as part of an initial evaluation for a patient who may need to see a psychiatrist for diagnostic purposes. Answered by Henry Levine, Psychiatry, Bellingham, 11th Street Offices (2/25/2003) Q My fiancee has been put on Levaquin, one daily along with Proventil inhaler for pneumonia. After 24 hours she had a strong episode of vomiting and diarrhea. Is this an interaction event? A Nausea, vomiting and diarrhea are not uncommon side effects in patients taking antibiotics in general. Nausea, vomiting and diarrhea are reported in 5 to 6% of patients taking levofloxacin. Sometimes the nausea can be minimized by taking the levofloxacin with a meal. The diarrhea can be treated with over the counter antidiarrheal medications like loperamide. Avoid taking levofloxacin with cations like iron, calcium or bismuth. Answered at 2/25/2003 Q I have taken a blood test that included a complement test to establish the level of inflamation in my blood. What is a low - normal - high range? A You have asked a very interesting question. Complement is a family of 11 blood proteins involved in immunity and inflammation. The basic purpose of complement is to rupture and destroy bacteria that the immune system has coated with antibody. Activation of complement also causes inflammation, attracting white blood cells to the site of the injury or infection and producing leaky blood vesels and swelling. Complement is a complex topic over which medical students struggle before each exam and then forget until next time! Basically, a low complement level (also called total hemolytic complement or complement activity) is seen in people whose bodies are gobbling up complement because of diseases like rheumatoid arthritis, lupus, and kidney disease. Complement levels can be used to follow activity of these diseases (the lower the more active). Genetic deficiencies of complement can also cause low levels. High levels of complement are noted in infections, inflammations, and tumors generally. A high level is very non-specific and could be seen in anything from pneumonia to lymphoma. A low total complement level may prompt a doctor to order levels of specific complement proteins, typically C2, C3, C4, C5 or factor B. The exact normal ranges for complement will be listed on the lab report and vary from facility to facility. Answered at 2/21/2003 Q Can I contract HIV/AIDS through saliva? A The short answer is no. It is very hard to prove that something never happens. Currently, the best answer is: HIV is transmissible through saliva only in the rare instance that the saliva has visible blood in it. What is really important is how much you pay attention to vanishingly low improbabilities. There has been lots of kissing among households of HIV patients, with only one documented transmission in a patient with bleeding gums. I have shared a beverage with an AIDS patient without worry. I hope that answers your question with the amount of uncertainty that you can tolerate. . Answered by John Wilson, MD, Infectious Disease, Eugene, The Travel Clinic (2/18/2003) Q What is the purpose of having an annual pap smear when you've already had your uterus, tubes and one ovary removed back in 1976? A A pap smear is a screening test for cervical cancer. If your cervix has been removed (not always the case at the time of hysterectomy) then you could have pap smears less often, at the discretion of your physician. It is important however to have a pelvic exam annually to examine the vagina and remaining ovaries. You should also have a rectal exam annually if over age 40. Answered by Tina Schnapper, MD, Obstetrics/Gynecolog, Eugene, Women's Care (2/12/2003) Q I am considering taking Liptoprin for weight loss. Is it safe? I do have high blood pressure and Type 2 diabetes. I am desperate for help. A Leptoprin, or Anorex, has many weight loss claims listed on their web site. It is not clear, however, what exactly this non-prescription supplement is, or how safe it is. A literature search of all recognized medical journals found no information on this supplement. This means that there exists no research on this supplement regarding not only its safety, but if it actually works. I believe the marketing of this supplement is another scam targeted at the desperate overweight community. Weight loss is a challenge for sure. The only weight loss plan that seems to work long term includes regular exercise and a lower fat balanced diet. Answered at 2/5/2003 Q My husband has a fracture in his foot. X-rays indicated the break yesterday on a visit to his doctor. The doctor said the fracture was caused by "avascular necrosis." What can you tell us about this condition and possible treatments? A Avascular necrosis is a term used to describe the death of bone cells due to lack of blood supply. Avascular necrosis usually occurs following an injury/fracture that causes disruption of blood flow to all or part of a bone. The most common sites for avascular necrosis following trauma are: femoral neck (hip), scaphoid (wrist), capitellum (elbow) and the talus (hind foot). Avascular necrosis can also occur with certain metabolic conditions that restrict blood flow to extremities i.e. diabetes. In this case, fracture can occur with minimal or no trauma. Specific reccomendations regarding treatment/ prevention of additional injuries should be directed to your Orthopedic Surgeon. Answered by Andrew Boughal, DO, Orthopedic Surgery, Florence, PeaceHealth Medical Group - Siuslaw (1/29/2003) Q My left ear has had a "plugged" feeling for several weeks. I used sudafed for about 2 weeks, although it didn't seem to help. I finally went to the Doctor and he presribed rhinocort aqua (budesonide) nasal spray and said it didn't look like an infection, but that there was fluid in my ear. It still does not seem any better. I called his office eventually and the nurse said it soemtimes takes awhile, and to give it a month or so. The last few days I have been using both the spray and sudafed. It is making me absolutely crazy. Do you have any suggestions? A If indeed you have middle ear fluid confirmed by an otolaryngologist (ENT) then you should also do valsalva manuevers and gently pop your ears 2-3 times a hour or 20 times a day. You may require the middle ear fluid removal, done in the Doctor's office easily. Sometimes steroids and antibiotics are used but it's probably not important in your case. See the Ear Dr. and get this resolved if it's a problem. Answered by Emil R. Hecht, MD, Otolaryngology, Bellingham, Bellingham Ear Nose & Throat (1/28/2003) Q How can I get a copy of my Medical Records, and how much does it cost? A This answer from Suzanne Simmons who is the Manager for Health Records at PeaceHealth Medical group in Eugene: You can call the Main Medical Records department at 541-687-6125 and they will direct you from there. You will need to fill out a release of information for any copies received. You can obtain this release by calling the Main Medical Records Department. The cost is $21.00 plus 0.65 cents per page plus shipping and handling. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (1/28/2003) Q Is it unethical and/or unlawful for a psychiatrist to knowingly misdiagnose a patient? Please indicate the ethics code. A This is a tough question. Clearly it's wrong to knowingly misdiagnose a patient because treatment would then be inappropriate, and not serve the patient's needs with regard to the actual diagnosis and treatment plan. Knowingly misdiagnosing would seem to go against a psychiatrist's professional duty. However, there are many situations where a physician will make an initial "working diagnosis" and then as more information comes in the diagnosis gets refined. In many specialties that information includes the results of lab tests, x ray studies, response to treatment and/or consultation with other specialists. In the instance of psychiatry this additional information is frequently further history ( either the patient's or the patient's family history) and response to treatment. This is the case because there are few specific diagnostic tests, e.g. lab or xray that can be used to help confirm or deny a specific diagnosis. I hope this helps. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (1/28/2003) Q My daughter and I both have shoulders that pop and crack when you move them in assorted ways. Do we have crepitus, and if we do, what is it? A It may, or may not, be crepitus. You need to be examined so that in your own unique medical situation, history, and exam your doctor can help answer your question. For a definition see the MEDLINEplus Medical Encyclopedia at Subcutaneous Emphysema , where "crepitus" is listed as an Alternative name for the condition. Answered by April M. Sakahara, MD, Physical Medicine &, Bellingham, Physiatry Associates (1/24/2003) Q MY 26 year old son needs surgery on his sinuses for allergic fungal sinusitis. He has been told there is a 5 year waiting list at St Paul's in Vancouver. Do you have someone that could help him, and what is the estimated cost of such surgery. A Your son should be evaluated by an ENT in your area -- Bellingham ENT 360-733-0640, or toll free 888 66-laser for Doctor. Please bring CT scans with you if available, and the appropriate recommendations should follow. We have a 2-3 week waiting period and the costs are not prohibitive. Answered at 1/22/2003 Q Two or three weeks ago our son received a blow to the outside of the ear during wrestling practice, causing swelling and fluid build up in the cartilage area of the ear. We have found one source describing this as "cauliflower ear". I was wondering if this needs immediate treatment, or if it can wait until the end of the wresling season. If he is seen now, can he still wrestle or should he be kept out for a few days? A It should be evaluated right away, and may require aspiration and compression treatment. The ear may be permanently deformed and the wrestlers should always use headgear. Answered by Emil R. Hecht, MD, Otolaryngology, Bellingham, Bellingham Ear Nose & Throat (1/22/2003) Q My father-in-law had bypass surgery done about 5 months ago. Since then,he has passed out about 10 times and his body builds up fluids. Every two weeks he has to go to the hospital to get the fluid drained, and the doctors don't know what's wrong with him. He is a diabetic and I think they said that only 15% of his heart works since his heart attack 3 years ago. A Your father-in-law has what sounds like severe congestive heart failure from what we call severe ischemic cardiomyopathy - meaning that because of damage from one or more heart attacks, his heart is severely impaired in its ability to function as a muscular pump. This is a serious problem and the leading cause of hospitalization and debility in our society. Fortunately, his doctors bypassed the blocked arteries, which has been shown to greatly improve survival in his condition. However, it sounds like the stress of the operation has been very difficult for him, and the fact that he has required frequent hospitalizations for (presumably) heart failure and that he has been blacking out are very bad prognostic signs. I hope your father-in- law is seeing a cardiologist regularly because he obviously is in a dangerous predicament, and there are several therapies that have been developed in the last several years that have revolutionized the care of such patients and greatly increased survival and quality of life. However, these are elaborate treatment plans for the sickest patients, and they each need to be applied to the appropriate patients and with painstaking, frequent care. Such treatments (depending on his specific issues) can include angiotensin converting enzyme inhibitors or angiotensin receptor blockers, beta blockers, digitalis drugs, diuretics including spironolactone, anticoagulants, statin (cholesterol lowering) drugs, changes to his diabetic medicines, cardiac rehabilitation or cautiously progressive exercise training, sophisticated implantable pacemaker therapy called biventricular pacing, the use of an implantable defibrillator (which is also a pacemaker), external pulsatile compression therapy, nutrition counseling, evaluation for and treatment of sleep apnea, correction of low blood counts (anemia), aneurysm (an area of dead heart muscle) resection surgery, and other possibilities that I haven't thought of. I can't go into more detail without knowing him personally, but I would encourage you to look into the patient's information website at The American College of Cardiology ; there, you can enter many details specific to your father in law's condition and receive directed information. Also, if he is not being cared for regularly by a cardiologist with training in heart failure, or access to a sophisticated heart center (such as where I would assume he had his heart surgery),I would encourage you to have him evaluated in such a setting. There are even cardiologists who specialize in heart failure care now; we have two such specialists here in Bellingham now where I live, and more cities are getting such expertise every year as the need continues to rise. Lastly, although heart transplantation is a last-ditch option that only a small percentage of heart failure patients are appropriate for, transplant centers are very experienced in heart failure management and being evaluated at such a center may help your father-in-law. Good luck and thank you for asking a question about a condition that plagues millions of patients and their families. Answered by Peter Beglin, MD, Cardiology: Interven, Bellingham, North Cascade Cardiology (1/21/2003) Q When patients have Deep Vein Thrombosis , do the clots eventually resolve or do the veins stay blocked? A The blocked vein, or veins, may recannalize (open up) partially with time if the length of the blocked vein is not very great. More likely, however, is the persistent obstruction of the vein, with development of alternative routes for blood to travel. This will lead to varying degrees of swelling of the limb affected. Depending on the severity of the presenting symptoms, intervention with potent clot dissolving drugs or various types of surgery may be reccommended. Answered by Robert Schauer, MD, Surgery: General, Springfield, Northwest Surgical Specialists (1/18/2003) Q How do you get Hepatitis C? A Hepatitis C virus is transmitted most frequently by blood (for instance, transfusions before the blood was tested, needle sharing of street drugs, accidents affecting health care workers) and less frequently sexually (any gender to any gender) or at birth from mother to child. Transmission from surgeons to patients has been reported, but is very rare. Answered by John Wilson, MD, Infectious Disease, Eugene, The Travel Clinic (1/16/2003) Q My son was diagnosed with AIDS in the Fall. At the time his CD4 cell count was 2 and is now 30. His viral load was 50,000 + and is now around 9,000. He also has Hepatitis B. Could you comment on prognosis and quality of life. He is 26 and is conscientious about his meds and nutrition. A Many people in his situation have a lower viral load than that by now. Depending on all the medical details, he has a good chance for decades of comfortable life. I don't have enough information to even guess at numbers. His best chance will be to establish a solid therapeutic alliance with his doctor. Luck and good management help a lot. His doctor will best be able to provide more specific answers to your questions. Answered by John Wilson, MD, Infectious Disease, Eugene, The Travel Clinic (1/13/2003) Q My question is this --I have been a smoker for 30 years and after quitting I have started gaining weight at a phenomenal rate, and it won't stop. I do not eat that much-- as a matter of fact I eat healthier now than when I smoked. I think now that my body is not getting the chemicals from the cigarettes, it is going berserk and the weight keeps piling on. I am not just talking weight gain, but about massive weight gain, and no one seems to have a reasonable idea on what to do about it. Please help, before I pop. A Weight loss (or weight stabilization)is easy to talk about but very hard to accomplish. People put on fat when they are consuming more calories than they are burning and/or wasting. This is true even in disease states (like low thyroid function). To lose weight you have to burn/waste more calories than you are taking in (sounds simple). Many people don't have a good idea about the number of calories they consume in a day or the number of calories that they can expect their body to burn. A fifty year old female who is 5'8" and weighs 200 lbs burns about 1600 calories a day sitting on the couch doing nothing. Thats not many calories. Vigorous excercise (running, biking, swimming) for a hour may increase this to 2000 a day. Still not much when you look at the average american diet. I would recommend that you start a food diary. Write down everything you eat and the amount for two weeks. Then buy a diet book that contains calorie info on common foods. Figure out how many calories a day you are consuming. Take this info to your doctor who can tell how many calories you are allowed to effectively lose weight. If you are able to follow his/her advice you will stop gaining and start losing. Answered by John Holroyd, MD, Internal Medicine, Bellingham, PHMGW/IM 2A-Cordata (1/7/2003) Q My 47 year old husband just had a repeat cardiac panel. Results of 2001 -- T: 306, HDL: 46, LDL: 219, Trig: 203. Results of 2002-- T: 292, HDL: 51, LDL: 203, Trig: 168. This was after a year of major diet changes and significant weight loss (around 20 lbs--he now weighs 190 at 5'8" and rides his bike 1 hr 3-4 times a week) His b.p. is in the normal range. History of 1 grandparent with cardiac disease/M.I.. No familial high cholesterol. The doctor is now talking medication, which seems reasonable. However I want to continue with the diet changes. I'm frustrated by resources which list fat intake as a percent of daily calories. I have no idea how many calories he does, or should, eat. This information would be much more practical listed as grams. I want to include/exclude the right and wrong kinds of fat but am finding little practical help. Do you have information, or can you direct me to any resources? Also I'm wondering about the triglycerides. He has been drinking 1-2 glasses of red wine a day, having heard that it had cardiac benefits. However I'm wondering if,in his case, this is contributing to the still elevated triglycerides. I also seem to remember a connection between sugar and elevated triglycerides. Am I accurate in this recollection? A Our typical approach to treating hyperlipidemia is to give folks fat and sat fat targets. It seems like more work at first but you at least can figure out where you are. If his calorie level is 1800 cal,you might figure 50%carb, 30%fat and 7% saturated fat. After figuring the percent, divide by 4 for carb and 9 for fat and saturated fat. The carb target would be 225 grams during the day and total fat 60 grams, saturated fat 14 grams. These are the gram numbers that are on the label. Current recommedations also suggest decreasing/avoiding trans fats, found in many foods that include hydrogenated fats. Apparently no one has decided yet how much is ok. Generally speaking most folks cannot get much more than 10-20% decrease in lipids from dietary change, although that is an average. With all your good questions you and your husband might benefit from a consult with a Registered Dietitian. You will need to discuss the alcohol issue with your MD. Answered at 1/7/2003 Q What is the life expectancy of someone newly diagnoised with AIDS? A With proper management and some luck, people with newly diagnosed HIV disease probably have close to a normal life span. Answered by John Wilson, MD, Infectious Disease, Eugene, The Travel Clinic (1/7/2003) Q Please advise when PeaceHealth will again be offering the prostrate screening exams. A I talked to Bev Cridland in the Center for Senior Health this morning. Historically, they've had free prostate screenings each fall in late Sept. to correspond with Prostate Cancer Awareness Week. They might do so again this fall, but haven't made definite plans yet. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (1/7/2003) Q My sister and her family have been exposed to over 13 toxins that were found in an apartment she rented in 1999. The left-side of her body has been affected. Her joints and extremities are swollen and in pain. Her chest, spleen area, lymph nodes, hip joint and lower back are very painful. She has absesses in her jaw bone, a lump on her lower front left-side rib. She lives in Astoria, OR and cannot find a doctor that specializes in her problems. She has been referred from one doctor to another. Is there any clinic that specializes in these areas that she might be able to go to? She is 39 years old and she feels that she is going to die. Your assistance would be greatly appreciated. A From the symptoms that you describe I would suggest that your sister consult with a physician who specializes in the care of arthritis ( also know as a rheumatologist). Here is a link to our physician directory. This should allow you to find the names of physicians close to your sister that specialize in arthritis. Physicians Directory Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (12/31/2002) Q I'm 66 years old and have peripheral neuropathy, numb feet. I have been to Doctors in the past. They seem too busy to tell me if there are any new studies regarding this problem. I do not have diabetes. A The major issue for initial decision-making is whether you have "axonal" or "demyelinating" neuropathy. Most likely you have an axonal neuropathy. The cause of that is not found in over half the patients. However, there are many known causes that need to be excluded; the common ones being inherited, diabetes (or minimal glucose intolerance), alcohol consumption, other toxic exposures (certain inhaled chemicals and some medications), B12 deficiency, folic acid deficiency, hypothyroidism, and MGUS. If you have an axonal neuropathy and if all those conditions have already been excluded then probably further work-up would not be helpful. If you either don't have an axonal neuropathy or haven't had all the above possible causes excluded, then additional work-up may be worth doing. Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (12/26/2002) Q How safe is Melatonin to use as a sleep aid? What is it made from, how long should one take it, and is 3 mg. the dose to take? Are there other things that would be better to take to help one to sleep? A Melatonin appears to be safe. There have been no reports of significant side effects. For people taking prescription drugs, however, supplement use is not recommended because of the potential for drug interactions. Though safe, melatonin does not appear to work very well. The only well done studies have shown no benefit over placebo. Despite this it is widely taken for treatment of insomnia and some people swear by it. Whether you decide to use melatonin of not, good sleep habits are essential to the treatment of insomnia. Avoid napping. No caffeine after noon. Get out of bed if you don't fall asleep within 30 minutes, then return to bed when you think you are ready for sleep. You can get some additional general information about Melatonin on the Healthwise Knowledgebase in the Medications section. Answered by John Holroyd, MD, Internal Medicine, Bellingham, PHMGW/IM 2A-Cordata (12/26/2002) Q Can you tell me how many "Continent Urinary Diversion" (Urostomy) surgeries have been performed at Sacred Heart hospital in the last 2 years? If there have been, are there any statistics on them? A Sorry that I have taken so long to get back to you on this, but I had to do some research. At Sacred Heart Medical Center in Eugene, between the dates of July 2000 and June 2002, there were 28 Cases done with an average length of stay of 12 days. This is all I can tell from the data that were available to me. I hope that this is of some help. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (12/17/2002) Q I have taken an MRI and they found 2 bulging disks. They want to give me a nerve root blockage shot. I would like information on this shot in the spine. A Nerve root blocks are a way of giving an epidural steroid injection. This is a common treatment for bulging disc, especially when leg pain is present. The shot is usually only mildly painful, and should be done under xray guidance for targeting of the site for injection. Complications are rare, but you should discuss this with the doctor who will give the shot. These injections are commonly performed by pain management specialists, who may be neurologists, anesthesiologists, physiatrists, or radiologists. Answered by Michael Karasek, MD, Pain Management, Eugene, Northwest Spine Group (12/17/2002) Q What is the very best medicine for arthritis? A The answer to your question very much depends on the type of arthritis that you have. There are mild, non crippling forms of arthritis that can be treated very effectively with over the counter medicines, e.g. acetaminophen or ibuprofen, and there are other types which are very crippling and need to be treated aggressively with injections and therapies. I have included a link to some information about the most common type of arthritis. It is Osteoarthritis, from PeaceHealth's Healthwise Knowledgebase. The right hand menu will tell you how to find more information about other kinds of arthritis. If you are experiencing joint trouble, then the best thing to do is to consult with your personal physician for a diagnosis and treatment recommendations. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (12/17/2002) Q I have recently been diagnosed with PBC, Primary Billiary Cirhhosis. I just got the result of my liver biopsy and I was told this: I have chronic hepatitis secondary to the PBC with fibrosis and bridging. I have a follow-up appointment with my gastroenterologist on Dec 26. My immediate question is this: How serious is this condition? What kind of prognosis do I have? How many years of healthy living are before me? As you can see I am a little freaked by this. Any information you can give me would be appreciated. A As a family physician I encounter this condition only very rarely. Here is some reliable information about this disorder. Hopefully this will help you begin to understand PBC and help you formulate some questions for your gastroenterologist. Start with Cirrhosis, Primary Biliary, in the Heathwise Knowledgebase. Then another source of information is the American Liver Foundation article on PBC. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (12/13/2002) Q I am concerned because I am seeing blood in my ejaculate. A There are many potential causes for this problem. Here is an article from the National Institute of Health that helps outline some of those causes, called Blood in the Semen. It is not unusual that no specific cause is discovered for this problem and therefore no treatment needed. However it is important that you be evaluated by your personal physician, so I would encourage you to make an appointment. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (12/13/2002) Q What foods cause constipation? What foods are good to eat when constipated? A The foods that cause constipation are difficult to list because of individual digestion. It is easier to list for you foods that help with digestion and constipation: fresh fruits, fresh vegetables (especially the cabbage family--broccoli, brussel sprouts, etc), high-fiber foods such as nuts, whole grain breads. Another easy way to get fiber is a bulking agent like Metamucil, Citrocel, Fiberall, Fibercon, etc. Also make sure you drink plenty of fluids, 6 to 8 glasses of fluids a day. This can be juices, soups, water, teas, lemonade etc. Answered by Glen Hoversten, MD, Surgery: General, , (12/13/2002) Q A friend is on chemotherapy for lung cancer and gets the chemo in his left arm. Ever since the first dose his left side feels cold, especially his left hand. To others, his hand feels warm. Could the chemo procedure cause this symptom? Is there some type of glove that might make the hand feel warmer? A I was unable to find anything related to the drug itself that causes a sensation of cold, but evidently the solution itself, because it is room temperature and therefore about 27 degrees cooler than blood temperature, will produce a sensation of cold. Here are excerpts from patient information prior to receiving chemotherapy: >>There's nothing particularly painful about the treatment itself, which feels like any IV procedure. You usually don't feel the medications going inside you, though some patients do feel cold, if the fluids are run very fast or if they're cold to begin with, and if the patient's body is especially sensitive to cold. If you have any discomfort once the needle is inserted, tell your nurse. Patients often feel a cool feeling when the IV is started because the solutions tend to be room temperature and feel cold going into your warmer body.<< © SusanLoveMD.com. Answered at 12/12/2002 Q Is there some resource out there that would have a healthy diet for someone who has hemochromatosis -- as, foods good and bad, etc.. other than the "Low Iron" foods, that is? A Here is a link to the American Hemochromatosis Society web page. This is a highly credible organization. I found this on their FAQ page: Q: Is there a special diet I should eat or foods I should avoid? A: Basically, iron in the diet is not going to make much difference in relation to your treatment, however, it is wise to check the labels of processed foods for their iron content. For instance, certain breakfast cereals contain 100% RDA of iron as do other products. Avoid alcohol and vitamin C which enhance iron absorption, cooking in cast iron cookware, and never take iron pills or supplements containing iron. Hemochromatosis patients should not eat raw seafood or shellfish (cooked is fine) due to a bacteria (vibrio vulnificus) which can kill the patient within hours of ingestion (due to a compromised liver which many HH patients have) unless emergency treatment of antibiotics (tetracycline) is administered. (Note: this can also happen to fishmen who handle and clean fish). Drink tea and coffee with your meals which will help block the iron in the foods you do eat. Hope this helps. The website has an array of interesting resources for further information. Another resource is the Hemochromatosis article in the Healthwise Knowledgebase on the PeaceHealth website. Check the Topic Overview and the Home Treatment section. Answered by Tom Ewing, MD, Family Practice, Eugene, PHMG/Admin-Willamette (12/4/2002) Q I am 46 years old and was recently diagosed with hyperthyroid /Graves disease. I am very small framed and was losing a lot of weight, feeling tired, having an upset stomach and a lot of diarrhea. I am on some medication now and already feeling better. What can I expect to happen now and what is the time frame? A The effect of antithyroid drugs occurs over 2 to 4 months. During that time the thyroid hormone levels often return to normal. The dose of medication may need to be decreased or increased, depending on the results of blood tests. After the thyroid hormone levels are normal patients can choose to continue on the medications, or consider radioactive iodine. Radioactive iodine is an excellent means to limit excessive thyroid hormone production. Often thyroid hormone replacement is necessary. Most patients have normal hormone levels and normal health lifelong. Answered by Matthew Davies, MD, Endocrinology, , (12/2/2002) Q My father was diagnosed with ITP -- however, not only are his platelets low, but all his blood counts. His bone marrow is normal, so Leukemia has been ruled out. Is there any other disease that can be causing this? The doctors are recommending his spleen be removed. Could this also correct the low white and red cell counts? A This is a very interesting question. I am happy to provide general background information, but I defer to his physician's judgment about his particular situation since I do not have a physician-patient relationship with your father, and do not know his situation. Having all three blood counts down (red cells, white cells, and platelets) is called pancytopenia. Pancytopenia has a list of causes, many of which are excluded by a normal bone marrow examination. The non-bone marrow causes of pancytopenia include anything which enlarges the spleen. The spleen then traps and destroys blood elements. ITP alone does not cause pancytopenia. Patients with true ITP have a positive test for antibodies against platelets. Some patients with lupus may have antibodies against all 3 types of blood cells. The lupus would usually be clinically obvious in that situation. Removing the spleen usually cures ITP and will stop the pancytopenia if a big or hyperactive spleen is the cause. The spleen in ITP is usually nor significantly enlarged, just hyperactive. A rare cause of pancytopenia that can have a normal appearing marrow is paroxysmal nocturnal hemoglobinuria, for which a special blood test is available. Having said all that, pancytopenia with a normal bone marrow exam usually does result from a problem with the spleen. It is usually good to be sure of a diagnosis before proceeding to therapy. Answered at 11/26/2002 Q I want to find out more about lupus. What is it, who does it usually affect, what types of conditions result from it, and how is it diagnosed? Does early diagnosis make a difference in its effects on the body? A This is a disease of unknown cause in which tissue and cells in several areas of body are damaged by immune antibodies. This usually occurs in young women. It affects many areas of the body including muscles, nerves, skin and vascular structures. It is always best to diagnose early -- this is a disease that has no cure but can be controlled by various medications. To learn more you could go to the PeaceHealth Health Information Library, or read the Healthwise article on Lupus on the PeaceHealth web site. Answered by Hugh Johnston, MD, Hematology, , (11/15/2002) Q What does the colon do? Can headaches and fatigue be related to a colon problem? A The function of the colon is to reabsorb water from the intestinal stream. When fluid enters the colon from the small intestines, it is very watery. The colon's job is to reabsorb most of the water and let the waste products continue on through the colon. It does the latter by a process we call peristalsis. Headaches and fatigue are not related to colon problems. 75-100 years ago there was some thinking that colon problems could cause headaches and fatigue. It takes a long time for some ideas to run their course, but there is absolutely no evidence to support the idea that colon problems cause headaches or fatique. Answered by Loren Barlow, MD, Internal Medicine, , (11/13/2002) Q I want to do some research about sleep disorders. I know that St John's Hospital, in Longview, has a Sleep Disorders Clinic. I read that there are many different sleep disorders that have been identified. Please provide one or more links to sites for this research. A There are numerous web sites. Try American Academy of Sleep Medicine . They have links to other sites. You might also try: American Sleep Apnea Association, Narcolepsy Network, National Sleep Foundation, or Restless Legs Syndrome Foundation. A more general page of interest is Sleep Disorders on NLM's consumer site, MEDLINEplus. Referred to Dr. Amy Aronsky Medical Director The Center for Sleep Disorders 414-7800 Answered by Michael McNellis, MD, Pulmonology, Longview, PeaceHealth Specialty Clinic (11/12/2002) Q How do I find out if my surgeon will put my health at risk? I have found out that my surgeon has a negative history in Idaho and in Oregon. He has lost his surgical priviledges at OHSU and now at Sacred Heart. How do I find out why this happened, and if I follow him to another hospital am I at risk? Is my father, who is a post op patient, at risk? A The most practical way to find out is to ask your surgeon for details of his past practice. If he is currently under investigation in Idaho or Oregon this would be considered confidential information until a final decision is reached. The Board of Medical Examiners in Oregon publishes the final decision regarding a physician's license after extensive investigation (which may take up to a year). THe details of the investigation are not usually available to the public. You could contact the Board of Medical Examiners in Idaho to learn what their policy is. This is also the indication for a second opinion and I suggest you see another surgeon for detailed evaluation and recommendations before you make up your mind. Answered by Martha MacRitchie, MD, Physical Medicine &, Eugene, Rehabilitation Medicine Associates (11/4/2002) Q <