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Frequently Asked Questions
Questions from visitors to our Ask-an-Expert
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| Q | | Before Halloween, my son, husband and I got a virus(?) that included a day of aching, a day of fever, and then tiredness off and on, we all seemed to get better for a day or two, then came down with a bronchitis-like cough that is just now resolving. We only had the fever at the end of October, but the cough dragged on.
We went to our family's Thanksgiving celebration, still coughing, but with no fevers. Two days later, my grandmother came down with the aches, and chills, similar to what we had had in October, and blames us for making her sick.
I thought that it took 5 to 10 days for symptoms of a virus to show up after exposure, but when I looked online, some febrile illnesses do have a very short incubation period. Grandma has not had the cough that we had (though Mom did develop a cough and runny nose a week later, but got over it quickly).
Is Grandma correct in blaming us for giving her this sickness? I didn't think we were very contagious, having been sick for many weeks at that time.
Thanks | | A | | It's really hard to say for certain as one would need to isolate the virus from both Grandma and you (which, to begin with, is difficult). Then genotypic analysis of both viruses (which is only really done in research settings) would need to be done to compare them. In practical terms; unless Grandma had other potential exposures, you/your family are probably the culprit.
| | | Answered by Glenn Ziemski, MD, Emergency Medicine, Eugene, PHMG/Urgent-Willamette (12/17/2007) | | |
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| 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, PHMG/DEM-Willamette (12/7/2007) | | |
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| 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, Eugene, Oregon Neurology Associates (12/5/2007) | | |
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| 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) | | |
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| 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) | | |
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| 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) | | |
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| 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, Eugene, Oregon Neurology Associates (10/8/2007) | | |
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| 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) | | |
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| Q | | Which ingredient should be in the formula of a disinfectant when dealing with MRSA?
| | A | | This bacteria is not any harder to kill when disinfecting a surface. Any alcohol-based wipes or hand sanitizers should do the trick. There is some data that Hibiclens showers are useful in decreasing skin colonization, at least temporarily.
| | | Answered by Glenn Ziemski, MD, Emergency Medicine, Eugene, PHMG/Urgent-Willamette (9/27/2007) | | |
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| 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, Eugene, Northwest Surgical Specialists (8/24/2007) | | |
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| 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) | | |
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| 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, Eugene, Oregon Neurology Associates (7/25/2007) | | |
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| 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, Eugene, Oregon Neurology Associates (7/20/2007) | | |
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| 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) | | |
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| 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) | | |
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| 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) | | |
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| 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) | | |
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| 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 | | |
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| 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) | | |
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| 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) | | |
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| 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 | | |
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| Q | | Sometimes I wake up at night with a discomfort in my upper back and jaw. I wouldn't label it pain but it does wake me up. This does not happen in the daytime. I am 65, very active, still run some, and have always had excellent health including good dental health. Should this be a concern? | | A | | I think the description of your discomfort bears further evaluation. Any upper back and particularly jaw pain that awakens you at night, even though atypical, has the possibility of being due to heart disease. It needs to at least be considered. You need to see your primary care doctor. If you don't have one, you need to make an appointment with either an Internist or a Cardiologist. I suggest you not delay this evaluation.
| | | Answered by Loren Barlow, MD, Internal Medicine, Eugene, PHMG/IM-Willamette (4/26/2007) | | |
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| 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, PHMG/DEM-Willamette (4/24/2007) | | |
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| 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) | | |
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| 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) | | |
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| 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) | | |
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| 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, Eugene, Oregon Neurology Associates (4/9/2007) | | |
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| 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) | | |
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| 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, Eugene, Northwest Surgical Specialists (4/3/2007) | | |
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| 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) | | |
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| 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, Eugene, Oregon Neurology Associates (3/21/2007) | | |
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| 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 | | |
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| 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) | | |
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| 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 | | |
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| 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) | | |
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| 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 | | |
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| 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) | | |
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| 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, Eugene, Oregon Neurology Associates (1/24/2007) | | |
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| 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) | | |
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| 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) | | |
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| 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) | | |
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| 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, Eugene, PHMG/Hospitalists-Hilyard (11/22/2006) | | |
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| 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) | | |
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| Q | | My stepson has suffered flashburn from his welding job. His eyes are burning and scratchy feeling. What can he do to get some relief? | | A | | Keep the eyes moist with a saline or lubricating drop that can be purchased over the counter. Do not use Visine or its generic equivalent. Ibuprofen may help as well as long as there are no contraindications. The symptoms should last less than three days. If it is going on longer or there is a possibility of a foreign body, he should be evaluated sooner.
| | | Answered by Glenn Ziemski, MD, Emergency Medicine, Eugene, PHMG/Urgent-Willamette (10/19/2006) | | |
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| 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, Eugene, Oregon Neurology Associates (10/5/2006) | | |
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| 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) | | |
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| 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, Eugene, Women's Care (8/21/2006) | | |
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| 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) | | |
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| 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) | | |
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| 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 | | |
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| 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 | | |
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| 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) | | |
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| 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) | | |
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| 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) | | |
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| 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) | | |
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| 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 | | |
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| 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) | | |
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| 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) | | |
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| 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) | | |
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| 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) | | |
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| 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) | | |
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| 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, Eugene, PHMG/Hospitalists-Hilyard (5/17/2006) | | |
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| 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, Eugene, Oregon Neurology Associates (4/19/2006) | | |
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| 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) | | |
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| Q | | Can ear infections make your neck hurt? If your neck aches like a kinked muscle is that most likely an ear infection? | | A | | Pain in any place in your body can radiate (or travel) to nearby parts of your body. And it is not uncommon to have ear pain radiate pain down one's neck. Another possibility is that a lymph node in your neck could be swelling and causing pain. It is pretty uncommon for an adult to develop an ear infection. It is usually swelling in the back of the throat that does not allow the Eustachian tube to work properly and pressure builds up in the middle ear, which causes pain. To help differentiate these causes, you should probably see your primary doctor.
| | | Answered by Glenn Ziemski, MD, Emergency Medicine, Eugene, PHMG/Urgent-Willamette (4/11/2006) | | |
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| 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, Eugene, Oregon Neurology Associates (4/4/2006) | | |
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| Q | | What's wrong if my tonsils are normally large and have small holes in them? | | A | | The holes are probably crypts which are just scars on your tonsils from previous infections. Sometimes they get large enough to trap food particles in them and if this happens they can form little stones called tonsiloliths over a long period of time. There really isn't too much to do about them. Having such scarred tonsills may make you more prone to harboring a Strep infection.
| | | Answered by Glenn Ziemski, MD, Emergency Medicine, Eugene, PHMG/Urgent-Willamette (3/16/2006) | | |
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| Q | | The bottom of my left big toe was swollen for some unknown reason on Sunday. On Monday, I felt more pain and once at home, after removing my shoe and sock, I saw the area of swelling. I iced the toe and went to sleep. Today the swelling continues and my foot is becoming swollen. Any suggestions? | | A | | Take some ibuprofen, elevate your foot and avoid rich foods and alcohol. It sounds like you may have gout. Make an appointment to follow-up with your regular doctor.
What is gout?
Gout is a disease usually caused by having too much uric acid in your body. Too much uric acid may not cause symptoms for years, but after a time it usually causes painful joint inflammation (arthritis). The most common site of inflammation is the joint between the foot and the big toe. Later attacks often affect other joints of the foot and leg. Less often, the arms and hands are affected.
In addition to the arthritis, gout causes the formation of tophi. Tophi are lumpy deposits of uric acid crystals just under the skin. Common places for tophi to develop are in the outer edge of the ear, on or near the elbow, over the fingers and toes, and around the Achilles tendon in the ankle.
Gout can also cause kidney stones made of uric acid.
Most people who have gout are middle-aged men, but it can occur at any age. Only 5 to 10% of cases of gout occur in women, most often after menopause.
How does it occur?
Gout usually occurs because too much uric acid is in your joints. The uric acid forms crystals in the joints. The crystals cause pain and inflammation. You may have too much uric acid in your joints when your kidney does not eliminate enough uric acid from your body or when your body produces too much uric acid. People who have recently had a serious illness or surgery have an increased chance of having an attack of gout. Some people have gouty arthritis even though they have normal uric acid levels.
Most cases of gout are caused by poor elimination of uric acid by the kidneys, but it can be hard to know why it is happening. The specific problem with the kidney is usually never found.
You may have inherited a tendency to produce too much uric acid. You may make too much uric acid if you have a disease such as cancer or certain types of red blood cell disorders. A diet high in alcoholic drinks and purine-rich foods (such as meats) can also cause your body to produce too much uric acid.
Uric acid levels in men start to go up after puberty. Women's uric acid levels usually do not go up until after menopause. For this reason women are protected from gout until several years after menopause. The uric acid levels have to be high many years before gout develops. Men with gout usually have their first attack when they are middle-aged.
Certain conditions, such as dehydration, can cause excess levels of uric acid. Diuretic medicine (also called water pills) can increase levels of uric acid. Other medicines can also affect the level of uric acid in the blood. It is important to make sure your health care provider knows all the medicines you are using, both prescription and non-prescription.
What are the symptoms?
Some people have high uric acid blood levels for years and never have any symptoms. Only 10 to 20% of people with high levels develop the symptoms of:
sudden, severe pain, especially of just one joint at a time
redness
swelling
The sudden attacks are sometimes related to physical illness, trauma, or excessive alcohol use. The symptoms may last for days to weeks. The arthritis usually occurs before tophi or kidney stones develop.
The tophi do not cause any symptoms unless they open and drain. They are often not painful. Depending on their location, they may limit the movement of joints.
The symptoms of uric acid stones are like those of other kidney stones. They can cause severe abdominal pain and sometimes nausea, vomiting, fever, or blood in the urine.
How is it diagnosed?
Your health care provider will suspect that you have gout if:
Your first toe joint is inflamed.
You have a blood test that shows a high level of uric acid in your blood.
You are developing tophi.
You start taking the drug colchicine and your symptoms of arthritis improve. (Colchicine, an anti-inflammatory drug, is effective only in gouty-type arthritis.)
To confirm the diagnosis, your provider may take a sample of fluid from the affected joint or joints and send it to the lab for tests. If you have uric acid crystals in the fluid, you have gout.
How is it treated?
Usually, if you have high uric acid levels but no symptoms, you will not need treatment. In special cases (for example, if you have a strong family history of gouty arthritis or kidney stones), you may be treated for gout even though you do not have any symptoms.
If you have symptoms of gout, the goals of treatment are:
Treat the gouty arthritis or kidney stones.
Try to prevent the recurrence of these problems by controlling the uric acid levels.
Prevent serious complications such as kidney damage.
Treatment of the arthritis first involves the use of anti-inflammatory medicines, such as colchicine or indomethacin. Your provider may prescribe nonsteroidal anti-inflammatory medicines (NSAIDs) such as ibuprofen or naproxen. Aspirin is not usually recommended because it may keep the urine from taking the uric acid out of the body. Sometimes a corticosteroid drug, such as prednisone, is used. Medicines are sometimes taken daily to prevent recurrent attacks of gouty arthritis.
If the gouty arthritis becomes a frequent problem, allopurinol and probenecid may be used to prevent damaging deposits of uric acid in the joints.
How long will the effects last?
The sooner treatment is started, the sooner the symptoms stop, which may be within 24 to 48 hours. If gout is not treated, it could last a few days to several weeks. A second attack may occur, but usually not for 6 months to 2 years. In other cases another attack may not occur until many years later, or never.
How can I help prevent gout?
There is no sure way to prevent gout. However, you can take these steps to lessen the chance that you will have high uric acid levels:
Eat a diet low in purines and do not overindulge in alcohol. Purine-containing foods include organ meats (such as sweetbreads, liver, and kidney), shrimp, anchovies, sardines, and dried legumes. Your consumption of alcoholic beverages should not exceed 2 ounces a day.
Drink lots of fluids.
| | | Answered by Erin Reilly, MD, Family Practice, Eugene, PHMG/Urgent-Willamette (3/8/2006) | | |
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| Q | | What are my chances for contracting HIV/AIDS from coming in contact with urine on a public toilet seat? | | A | | About zero. Urine is sterile and does not contain virus, unless there is blood in the urine.
Blood, semen, vaginal secretions, vomitus, breast milk or pus from a person who is infected with HIV (human immunodeficiency virus) may contain HIV and may cause infection. The risk of acquiring HIV from a needle-stick injury is less than 1%, and the risk of infection from exposure not involving a puncture or a cut (such as a splash of body fluid onto the skin or the mucous membrane) is less than 0.1%. The risk of HIV infection from a human bite is between 0.1% and 1%.
"Clear" body fluids such as tears, saliva, sweat and urine contain little or no virus and do not transmit HIV unless they are contaminated with blood.
| | | Answered by Erin Reilly, MD, Family Practice, Eugene, PHMG/Urgent-Willamette (3/8/2006) | | |
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| 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 c |
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