Advice for Swollen Ankles

QUESTION: By the end of the day my ankles have swollen considerably, making
it difficult to keep my shoes on. They seem better in the morning but there
must be something I can do to make this problem a bit better. Can you offer
some advice?
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ANSWER: I will be happy to offer some tips, after I have presented a caution
or two. While a frequent cause of swollen ankles and legs may be poor
circulation in your extremities, there are other, medically important reasons
for this accumulation of fluid. If you have not consulted your physician and
if this a new problem, a visit to your doctor is a must. Medications may be
necessary to properly control this aggravating situation. However, if this
has already taken place, be sure to take your medications properly. Here,
now, are a few practical tips that may make the task of keeping excess fluid
out of your legs just a bit easier. First, maintain a low salt diet, for salt
tends to keep fluid in our system. Check all labels and avoid foods that are
high in sodium or preserved in salt. Foods like bacon, corned beef, smoked
fish, pickles and unsuspected foods such as tomato sauces contain high levels
of salt and should be avoided. Sleep with your legs elevated either by
elevating your bed, or by placing your legs upon pillows or cushions. Six
inch wood blocks under the legs at the foot of your bed are recommended, as
the cushions may become displaced during sleep and fail in their mission.
Elastic stockings are great aids, if you use them properly. They should be of
high quality and well fitting, and reach above your knees to the mid thigh.
Take them off only when retiring for the night, but take them off every night.
They should be replaced in the morning, BEFORE you get out of bed and before
you have let your feet dangle, for that is the time when the fluid in your
legs is lowest, and when it is easy to control the situation. A gentle
massage of your legs each night, using an upward, "milking" stroke can help
remove excess fluid as well. Start with short stokes, gradually lengthening
them until your hands are massaging as much of your foot and leg as you can
reach. Of course having a partner to help you with this makes it a whole lot
easier. Remember to report any new developments or pain to your physician.
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The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician. Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

What is "Sweet Syndrome"?

QUESTION: My friend's daughter has been diagnosed as having "Sweet Syndrome".
She can tell my friend nothing about the disease except that she is on
prednisone. What can you tell us about this? Apparently it is not common.
You cannot imagine how important this is to us.
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ANSWER: Described first by Dr. R.D. Sweet in 1964, Sweet's Syndrome is a skin
disease that occurs in women of middle age. An infection usually occurs
before the onset of this condition, which consists of painful eruptions on the
skin of the limbs, face and neck. As the rash progresses the lesions turn
into pustules, and the course of the illness is marked by a high, persistent
temperature. The condition is also known as "acute febrile neutrophilic
dermatosis," because a microscopic examination of tissue from the skin plaques
reveals many white cells (neutrophils) within the cell structure of the skin.
The white cell count in the blood is also elevated somewhat, and at least one
published paper links Sweet's Syndrome to acute leukemia. Research into the
cause of the condition has revealed little, and the current opinion is that
the condition may result from the patient's hypersensitivity to the bug that
caused the original infection. Although antibiotics are apparently
ineffective in treating the syndrome, steroids (prednisone) can be most useful
in controlling the condition, and are effective for as long as they are given.
The illness may last for two weeks or more, and relapses are common, usually
preceded by infections. A call from a concerned parent to the physician
should result in more information about this patient's condition.
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The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician. Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

Information on "Progressive Supranuclear Palsy"

QUESTION: My father-in-law has been diagnosed as having "progressive
supranuclear palsy"--a very frustrating and heart wrecking disease to watch
happen to a once healthy and virile man. Although family members have
searched for information on this disease, we have found none. What can you
tell us and what can we expect?
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ANSWER: This is an uncommon disease that affects men twice as often as women.
It usually begins with complaints of slowness of movement, imbalance and
falling, and impaired vision, and strikes in patients in the 60 to 70 year age
range. They note difficulty in negotiating steps and curbs, and marked
problems in looking upward or down. It is this problem with vertical gaze
that leads physicians to the diagnosis for it is the hallmark of the disease.
As the name indicates the disease is progressive, and leads to difficulty in
moving and turning, an expressionless face, slurred and forced speech
patterns. Though there are no specific laboratory tests available that help
in making the diagnosis, the appearance of the patient and the slow
progression of the clinical symptoms and signs leave little doubt of its
identity. We know that it damages the nerves in the brain, but have no idea
of the cause of this degeneration. The disease progresses steadily over a six
to eight year period, and mental changes of apathy and dementia may occur late
in the course of the affliction. Trials of treatment have left much to be
desired although three classes of medication, dopaminergic, anticholinergic or
antiserotonic drugs have been reported to help some patients. I am sorry I
don't have more hopeful information to give you.
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The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician. Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

Just What Causes "Super" Infections to Develop?

QUESTION: An itchy rash that appeared from nowhere, became quite red and
inflamed after I had scratched it a bit. The doctor was very impressed and
called it a "super" infection. He must have used a super medication to cure
it, judging by the price of it. Just what causes "super" infections to
develop?
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ANSWER: Our English language possess many words that often lead to more than
one interpretation, "super" being one of them. The term in your case did not
mean "super" like in "Super Bowl", but "super" like in "superimposed". The
situation is common enough, and always requires attention. A small, itchy
rash develops either from contact with material that is irritating to the
skin, or because of a viral infection such as chickenpox. The patient
scratches away at the persistent itch, and literally injects dirt and bacteria
in to the wound. The bacteria thrive and grow, creating all the signs of
infection, heat, redness, pain and swelling. This is called a "secondary" or
"superimposed" infection since it occurred after the initial problem had
created the rash, and the effects of the infection lay over the initial rash.
Streptococci and staphylococci are the most common offending organisms, and
can create havoc if they penetrate into the blood stream and carry the
infection to other parts of the body. Generally local or topical antibiotic
creams are not affective and so oral medications are prescribed. Particular
attention must be given to patients who have chronic disorders, such as
diabetes, that can complicate the treatment of any infection, and may help to
explain the use of a costly antibiotic in your case.

Heart Test

QUESTION: Whenever I read of older people taking up new physical activity, it
mentions a heart test that should be taken first. What is the name of the
test, how does it work, and doesn't this all mean that it is dangerous for
older people to start something new that they have done well enough without up
until now?
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ANSWER: If you would believe the experts, it is never to late to start an
exercise program and begin to reap the benefits from it that perhaps are more
important to you now than ever before in your life. It may well be that some
of those stiff joints and muscles, and that huffing and puffing you have
noticed lately, are more due to inactivity than age, and that a bit of regular
exercise can turn back the clock a bit. The test, which should be but one
part of a general check up, is called a "stress EKG" (or cardiogram). It is a
cardiogram that is performed while you walk on a treadmill, and is useful in
determining just how your heart will react to the new activity. It is
particularly recommended for people over 40, those who have a history of heart
ailments, or smoke regularly. It is a precautionary measure, and does not
mean that exercise is dangerous, as most people can participate in simple
program, even if they have been inactive for years. You don't have to become
an athlete, or run a marathon to benefit. Brisk walking, swimming or cycling
can strengthen heart muscles, restore flexibility to unused muscles and
ligaments, build new strength in muscles that have been thinned by age, and
restore coordination and balance. Your "good" cholesterol is increased,
weight control is easier, developing osteoporosis is slowed, and you may walk
off a bit of stress. You can probably find out all you need to know about
warming up and cooling down from your local "Y", Parks and Recreation
Department, or hospital. Why not find yourself an exercise partner and get
started now?

Wart Remedies

QUESTION: I am bothered by flocks of warts on the fingers of both my hands.
I can sometimes pick off one or two, but usually they just grow back. Is it
true that frequently soaking your hands in a solution made from vinegar and
sea water can both make the damn things disappear as well as preventing them
from returning?
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ANSWER: Your "solution" is a new one to me, although the remedies that are
claimed to cure the common wart sometimes defies imagination. Mark Twain used
"spunk water" and a dead cat twirled over your head on the end of a length of
string. The reason that such therapies seem to work can be the due to the
fact that sometimes warts just go away by themselves, but the new "cure" gets
the credit. Warts are caused by a virus, which explains why they sometimes
spread or come in clusters. One thing for sure, picking at them as you do
will only make them spread, and may explain why you seem never to be without
them. Although not all remedies work on all warts, or all the time, medical
science has come up with its own weapons to attack this ever occurring
nuisance. Electrocautery, or burning warts with a controlled electrical
current, may require but a single session to eradicate your warts. Frequently
cryosurgery, or freezing with liquid nitrogen, is effective in treating single
small uncomplicated warts. Several applications of a flexible collodion
solution containing 16% salicylic acid and 16% lactic acid may just peel those
offensive bumps away. The problem is that they may recur if some of the virus
remains in the body. However, a bit of patience and careful, repeated
treatments of one type or another may soon see you rid of your problem.

Confused by Which Vitamins to Take

QUESTION: Although I realize that vitamins are important things to have in a
good diet, I must admit that I am totally confused as to which ones I need,
and how much to take. One of my friends claims that you can't get enough
vitamins, and takes massive doses to prevent cancer. Can you bring any logic
to all of this disorder and help me chart a sane course?
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ANSWER: If history can help predict the future, this answer will provoke a
wide variety of mail, most of it telling me how little I really know, and
offering to write the column for me. And though I think I have already heard
it all, there will be new stories of how someone escaped sure death by
ignoring the advice of a traditional physician, and accepting the claims of a
modern day snake-oil merchant. Vitamins are truly remarkable chemicals when
used for a specific reason or purpose. They were originally discovered as the
needed component of a diet to cure a deficiency disease, an ailment actually
caused by the lack of sufficient vitamin. Scurvy in sailors on those romantic
old square riggers was over come by citric juice (limes, lemons and oranges)
for it was a fine source of Vitamin C. Incidentally that is how British
sailors and the all English became known as "limeys," as citric fruits were
made part of the marine diet to overcome the disease. Most of the vitamins
were discovered in like manner, as the needed substance in the diet to
overcome a deficiency disease. About 40% of the adult American population
uses vitamins and minerals on a daily basis, and with such a large population,
misuse may often occur. An RDA (or Recommended Daily Allowance) has been
established as "the levels of essential nutrients considered in the judgement
of the Committee on Dietary Allowances of the Food and Nutrition Board on the
basis of available scientific knowledge to be adequate to meet the known
nutritional needs of practically all healthy persons." They provide a solid
base for all needs, as we may then increase the amounts where specific
deficiency conditions exist, as in pregnancy, poor health, or poor nutrition.
Vitamins used in these cases are considered "therapeutic agents" rather than
"nutritional supplements". At present there is no vitamin which is
acknowledged as an agent that either cures or prevents cancer. Your
pharmacist or physician will be happy to indicate the proper quantity of
vitamins that fulfil your personal dietary needs.

Chicken Pox Infections During Pregnancy

QUESTION: I have just learned that I am pregnant and will soon be the mother
of a much desired baby. I have no recollection of ever having chickenpox as a
child, and my physician has warned me about the possible results of an
infection now. I am really worried and wish there was something I could do,
some test I could take to avoid any problems. Can you help me?
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ANSWER: There are many problems that come along with a newborn, and by
staying calm, many problems find solutions that are easier than first thought.
Chickenpox is caused by a virus, the "varicella-zoster virus" (VZV), which is
highly communicable. That probably explains why we find that between 85% to
95% of all young adults living in temperate climates have developed immunity
to the infection. While a history of chickenpox is a reliable indication of
immunity, 75% of adults who have no recollection of ever having had the
disease also display this immunity. A history of shingles would also
indicate that you have an immunity. Unfortunately the test that might predict
your immunity to VZV is not sensitive enough to detect the small amounts that
remain long after the acute infection. The fact is that the subject of the
effect of a VZV infection on a pregnancy is still one of controversy in
medicine. While many authors believe that real risks exist, others cite
studies which do not show a larger number of adverse outcomes after infection.
If they do occur, they don't happen in every case where the mother is
infected, and they are less severe when they occur later in the pregnancy.
Your best defense on behalf of the baby is to stay away from any possibility
of contact with individuals with either chickenpox or shingles. Should you be
exposed to the infection, more than just a casual or brief contact, your
physician might consider the use of varicella-zoster immune globulin, that
could prevent or reduce the severity of your infection. If you did develop a
severe case, treatment with either vidarabine or acyclovir can be used without
danger to the baby. It would seem that both your risks and those of the
infant are quite small, and that there are effective measures that may be
taken should circumstances warrant such action.

Delivering Babies by Vacuum

QUESTION: After the delivery of my baby, the doctor explained that he had
pulled the baby out with a vacuum cleaner. I know that can't be so, but
that's what it sounded like! And the baby's head looked like it might have
happened. Do you know what he was talking about?
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ANSWER: The moments following the birth of a baby are not always the best for
explanations, and sometimes we replace unfamiliar terms with words that make
more sense to us. What he probably told you was that he used a vacuum
extractor to aid in the delivery of your baby. When labor is prolonged, and
not proceeding at the proper pace, or when the mother is exhausted by her
exertions, or when the baby is suffering (fetal distress), the physician must
help with the birthing process. Many physicians use forceps to accomplish
this, but new developments with vacuum extractors have provided a new and
useful technique that may be used instead. A cup made of metal or soft
plastic is carefully placed on the baby's head (that's what caused the
markings you noticed) and connected by a long plastic tubing to a vacuum pump.
During each contraction, pressure is decreased, and additional traction is
provided to aid the mother in delivery. The vacuum extractor is less
traumatic to the baby than forceps, and applies less force to the head. It
can however, take a longer time to deliver using this method than by forceps
delivery. The marking on the head (it's called a caput) usually disappears in
a day or so and has no lasting effects or clinical importance.

About Unna Boots

QUESTION: Could you tell me something about Unna Boots? I have varicose
ulcers, and have to have my legs bandaged every week. Now my legs are weeping
some and my doctor says there is nothing more he can do. I haven't had my
shoes on in months. Is there something you can suggest?
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ANSWER: When varicose veins fail to return the blood towards the heart as they
normally do, a condition known as Stasis Dermatitis may occur in the ankle.
The skin turns brown, becomes scaly and itchy and frequently develops
ulcerations as in your case. Both local therapy as well as elevating the leg
above the heart several times a day, to increase blood flow, are necessary
parts of a total treatment. The Zinc gelatin in the Unna's paste boot is
frequently used with considerable success to treat this condition, but it is a
bit messy to deal with. Of late, the Unna boot is being replaced by more
costly, but more effective, new absorptive colloid dressings used under
elastic support. These dressings may require changing every 2 to 3 days in
the beginning, but as the ulcer heals and the situation improves, you should
be able to return to your weekly routine. Once the ulcers are controlled, you
will still have to maintain an elastic dressing on your ankles to prevent the
recurrence of the ulcers. These dressings should be applied in the morning
while you are still in bed. That means that the swelling that accompanies
this condition will be at its minimum after a night with your legs elevated,
and the elastic support can be truly effective.

Trichomonas Medication for Men

QUESTION: My partner has just seen her gynecologist and been diagnosed as
having trichomonas. She is being treated with medication now, but her doctor
wants me to take medication as well, despite the fact that I have no symptoms.
I thought I would check with you first. What is your advice?
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ANSWER: Your partner's doctor's advice comes right out of the book, and I
agree 100%. Trichomonas vaginalis is common in women, and can be identified
in from 20 to 50 percent of all women treated at clinics for sexually
transmitted diseases. However, half of those women have no symptoms either.
We know that men can be infected with the same organism, and when we examine
the male partners of women with trichomonas infection, we can find the germ up
to 60% of the time. That means there is the possibility of real trouble down
the road, with symptoms of urethral discharge, painful and frequent urination,
followed by the complication of an infection of the prostate. Treatment for
asymptomatic men can consist of a single 2 gram dose of metronidazole, which
will not only clear up your infection, but prevent you from reinfecting your
partner as well. If you delay treatment until symptoms appear, you should
take 250-500 mg three times daily for ten to 14 days. Have a doctor supervise
your course of treatment.

What is a "Tinnitus Masker"?

QUESTION: The noise in my head has been diagnosed as tinnitus. Besides the
use of a hearing aid, my doctor spoke of employing a "tinnitus masker" to
help, but I am not sure I understood what he meant. (Maybe I didn't hear
him!) Can you explain what he meant?
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ANSWER: Although science has not yet discovered the cause of that noise in
your head, tinnitus remains a problem for as many as 30 million Americans.
That constant buzzing, ringing, hissing or roaring noise can be most
distracting and many victims seek methods to overcome the annoyance. Many
people prefer an external sound to the one in their head, and a tinnitus
masker is the device that provides such a sound. It looks much like a hearing
aid, but instead of amplifying sound, it produces a type of sound that
"masks," or covers over, the sound produced in your head. If you have a
hearing loss as well, an amplifying hearing aid and masker can be combined in
a single unit. Maskers do not work for everyone, and some patients can obtain
relief from simple background music, or devices that reproduce the sound of
the wind, waterfalls or surf. You will have to try a masker for yourself to
know if the device can provide you some relief.

About Zoonoses

QUESTION: With all the types of colds you mention in your column, you have
still to mention one we heard about the other day. Its called Zoo Noses and
it's caused by animals. Perhaps this is something you would like to warn your
readers about.
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ANSWER: Close, but no blue ribbon! Zoonoses have nothing to do with either
noses or colds, but is the name given to those diseases that are transmitted
from animals to man under normal conditions. There are over 150 such diseases
identified worldwide, and as many as 40 may pose health threats to farmers and
other workers who come in contact with animals on a regular basis in the
United States. Probably the one you know best is rabies, caused by a virus
which may be present in dogs, and squirrels, skunks, foxes and other wild
animals as well. It causes muscle spasms, fever, swollen glands and
hydrophobia. It is passed on in the saliva of the infected animal when a
victim is bitten. Another well known disease in this classification is
anthrax or "woolsorter's disease". It is caused by a bacteria found in cows,
goats, horses and pigs, and can be transmitted by contact on the skin or
inhaling spores. It may attack the skin, lungs or gastrointestinal tract of
its victims. Perhaps you have heard of Statehouses (ornithosis) as a disease
of parrots and parakeets, but it may also be carried by ordinary farm fowl,
such as chickens, ducks and turkeys. Its transmitted by skin touch or
breathing and produces a pneumonia with fever, headache, and cough. To
complete, if only partially, this list of diseases originating in animals is
Rocky Mountain Spotted Fever and Lyme Disease. They are spread by the bites
of infected ticks which may live on rabbits, field mice, dogs and deer,
producing fevers, rashes, arthritis like symptoms and headache. This is an
important classification of infectious diseases, but one that is seldom
written about, except here for you.

Yogurt to Cure Yeast Infections

QUESTION: My girlfriend, who is most knowledgeable about such matters, swears
this is no joke and that it really works. She suffers, as do I and I suppose
many other women, from frequent yeast infections of the vagina. Her cure is
to use cultured, but not pasteurized, plain yogurt in a large syringe, which
is used to put the yogurt in her vagina. She does this once a day for three
to four days, and claims it never fails to cure the yeast infection. Do you
believe this is possible?
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ANSWER: Vulval irritation and vaginal discharge is indeed common in women,
and when caused by a yeast, is named genital candidiasis or monoliasis. It is
noted most commonly in individuals who have take antibiotics for one infection
or another. The medication kills not only the unwanted infection, but also
the bacteria that normally inhabit the vagina. With the extinction of these
harmless bacteria, the yeasts, which also live in this area, begin to
reproduce in an uncontrolled fashion, and soon provoke a vaginitis. Other
contributing factors may be oral contraceptives, diabetes mellitus, pregnancy,
menstruation, steroid medications, and constrictive undergarments. If these
situations can be controlled, yeast vaginitis may be prevented. The yogurt
theory is based upon the fact that yogurt is produced by another harmless
germ, a lactobacillus, and that if this bacteria can be introduced into the
vagina, it might grow and control the over production of yeasts. While it may
sound like a simple solution to a common problem, I failed to find any real
scientific evidence to prove its effectiveness, and so feel unable to
recommend it to you. At any rate, any flavored or pasteurized yogurt
preparations would certainly be a no-no, as they usually contain no useful
living bacteria.

Red Wine and Migraine Headaches

QUESTION: I suffer from migraine headaches on an irregular basis. However,
one little glass of red wine and I am down for the count. What puzzles me
though is that my girlfriend, who also suffers with migraine, can drink
regularly with no ill effects whatsoever. Do you have any explanations for
this puzzle.
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ANSWER: Many migraine sufferers have similar stories to tell, for research
tells us that about 25% of patients with this painful and disabling type of
headache relate the onset of an attack to some specific beverage or food. The
chief culprit is identified as alcohol, but even here there are some notable
differences. Many patients can get by with a drink or two from time to time,
but those who drink red wine are generally the ones with acute onset of
headache, usually within three hours after imbibing. White wine drinkers do
not suffer similarly, nor do those who drink other forms of alcohol, such as
vodka or even beer. We know that red wine contains certain substances not
found in other alcoholic drinks. One such chemical that is frequently thought
to be the cause is tyramine, which has an action in the body similar to
adrenalin. Another group of chemicals found in red wine are the flavonoids,
that produce the color of the wine, and they too can be the cause of your
problem. In general the rule is simple; if a food or drink causes the onset of
a migraine, you should drop it from your diet permanently. It might be
interesting to compare your choices of beverage with your nonsuffering
girlfriend and see if this explanation answers the question in your case.

Aspartame Use and Danger of Mental Retardation from Diabetes

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

Artificial Insemination After Tubal Ligation

QUESTION: Once you have had a tubal ligation (mine were cauterized), can you
get pregnant through artificial insemination? What exactly is the procedure?
Wouldn't this be less costly than an operation to reverse my present
condition? I am 32 years old and healthy.
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ANSWER: Although artificial insemination (AI) is a relatively simple process,
it won't achieve the results you desire while your tubes are closed. In
artificial insemination, the sperm is obtained from a male donor and placed
into the vagina during the short period of ovulation, to yield the greatest
chance for a pregnancy. These sperm then find their way through the uterus up
the fallopian tubes, to meet with the egg, that has been produced by the ovary
a short time before. This method is used when examinations and tests have
determined that sperm from the present male partner is deficient in either
numbers or quality, and has been diagnosed as the reason for the couple's
inability to produce a desired baby. In order for the procedure to be
successful the tubes must be patent (open), with a clear passage for both
sperm and egg to move through and meet. When tubes have been closed
surgically, this is not possible and so AI won't work in your case. You
require an operation to reverse the condition. The surgeon, operating with
the aid of a microscope, would attempt to sew the two ends of the severed tube
back together in a manner which would leave the central canal open. It's a
delicate procedure, and not always successful, for the healing process
sometimes creates a scar which closes the tube again. In some cases where a
woman has diseased Fallopian tubes, a physician may attempt to obtain a ripe
egg from the ovary, using a telescope like instrument inserted into the
abdomen through a small incision. This egg is then fertilized by the sperm in
a "test tube" and the fertilized egg is replanted in the uterus to grow. It
is a most delicate process, performed only by experienced specialists, but has
been successful in a number of instances.

Female Hormone Treatment for "Menopause Arthritis"?

QUESTION: My joints seem a bit stiffer these days, and so during a recent
visit with my physician, I mentioned my problem to him. His diagnosis was a
condition he called "menopause arthritis". The prescription is to be female
hormones, but I would like your opinion before beginning medications that I
might have to take for the rest of my life. What do you think?
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ANSWER: Frankly, I am a bit confused by this diagnosis, as I know of no
condition labeled "menopausal arthritis". While it is true that
osteoarthritis is seen more commonly as we grow older, this is related more to
the years of wear and tear on the joints, rather than to any hormonal changes
which may be occurring at the same time. If x-rays were taken during your
examination, it may be that your physician discovered that your bone
structures were thinning, as a result of a condition called osteoporosis,
which is related to diminishing hormonal flow in women and for which treatment
with female hormones would be indicated. However, osteoporosis is not
considered to be a form of arthritis. I sense a bit of a breakdown in
communications here, and believe that you would be best served by discussing
this problem with your doctor once again. Be sure you get the exact name of
the diagnosis, and his reasons for making it. You are entitled to an
explanation of the benefits of the medications he is prescribing for you, as
well as any side effects you might be on the watch for. When this has been
discussed, you certainly will have a better understanding of what is truly
going on, and the ability to make an educated decision regarding your future
treatment.

Was the Trip to the Doctor's Office Necessary?

QUESTION: When I called my family doctor on the phone and requested that he
call a prescription into the pharmacy for an antibiotic, he asked me to come
to his office first to be examined. While I was there he took a culture, and
told me that it would be several days before he had an answer. Then he
prescribed an antibiotic anyway! Doesn't this mean that the trip to the
office and the culture was all really not necessary, and just another way of
making me spend my money? I suppose you won't answer this question in your
column, or just stick up for the doctor anyway.
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ANSWER: You're wrong about my not using your question. As for "sticking up"
for your doctor, I'll explain what I think happened and let you decide that. I
must suppose you described certain symptoms to your doctor when he spoke with
you on the phone, symptoms which may be caused by any one of a wide variety of
infecting bacteria or viruses. Since different bacteria require different
antibiotics, and viruses do not respond to antibiotic treatment at all, and
since your description of your symptoms may have left him in doubt as to the
cause of your illness, he decided that an examination was necessary for a
diagnoses that could come closer to hitting the mark. The history of your
illness that you provided him at the office, and the findings of his
examination probably cleared up a few things, but the exact nature of the
bacteria must still have been in doubt. If he then prescribed a medication,
without a culture, and your situation did not improve, the treatment might
have interfered with the growth of the bacteria at a later date. So he chose
two courses of action. A culture now to identify the bacteria (even if the
results would take several days) and a prescription for an antibiotic now,
based upon his findings during the examination, his knowledge of the possible
bacterial infections that might be going around in your community, and his
past experiences in the use of the medication he prescribed. Now all the bets
were covered. If the medication was effective, you would be well in the
shortest possible time, and if not, he would then know with some certainty
the identity of the bacteria that was the cause of infection, and so be able
to change to an antibiotic that would be more effective in your case. In my
opinion, he was right on the mark. Now what do you think?

Would Male Hormone Injections Help Regain Vigor and Self Respect?

QUESTION: Though my husband was the greatest of men when we met, and through
ten years of marriage, he has been struck by several disappointments in the
past two years. His only solution has been to take to drinking, and I believe
he now has liver trouble too. We used to solve a lot of his problems
together, as husband and wife, but he now fails at that as well. Would
injections of male hormone help him regain his powers and self respect?
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ANSWER: There are so many aspects to your problem, that I wish we could have
a "set down" to talk and explore the many reasons that the problem has now
reached the seriousness your letter portrays. That will have to remain in the
hands of your own family doctor, but I will give you the information that
answers your specific question. In a recent research project that involved
221 men who suffered from alcohol induced liver disease (cirrhosis) conducted
at the University of Copenhagen, 67% of the men complained of sexual
dysfunction. Attempts to treat their condition with male hormone
(testosterone) failed to improve their sexual performance. However, when the
amount of alcohol consumed was reduced, the men reported significant
improvement in their ability to function, which continued to improve, reported
at 6 month, 12 month and 24 month follow-ups. It's not testosterone that is
the answer to your problem, but attacking the causes of the drinking problem,
and returning your husband to sobriety, health and vigor.

The Truth About Prostate Surgery Survival

QUESTION: So many things happen to you as you grow old, that it is hard to
continue on sometimes. I am almost 91 and now must have surgery for my
prostate. I know my doctor is right, for I can't continue this way. But I am
afraid, and I want you to tell me the truth. What are my chances of surviving
this operation?
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ANSWER: You write with a firm and steady hand, and you are thinking clearly.
I think you must be in pretty good shape. While your anxiety certainly is
understandable, I have all kinds of good new for you. Let's start with a
report from the Mayo Clinic that surveyed 185 patients that were 90 years of
age or older at the time of surgery. Despite the fact that many suffered with
hypertension, and some had past histories of heart attack, or cancer
treatment, 95% survived their surgery, and most went on to do well. In the
specific case of a prostate operation, called a transurethral resection (TUR),
there was a 98% survival rate for the 44 men who had the surgery performed.
The researchers concluded that old age is not a barrier to major surgery, and
noted that the patients did equally well with either local or general
anesthesia. More good news for you, in the new reports of the use of a
special balloon catheter to open the urinary passage, that has been
constricted by your enlarged prostate. After insertion of the catheter, the
balloon is inflated and enlarges the urethra, the tube which carries urine
from the bladder through the penis. This new procedure does not even require
a hospitalization, but does require leaving a catheter in place for a few
days, which may be a bit uncomfortable. You might ask you physician about
this, but in any case your outlook is a good one. Just use a bit of the
courage and grit you must have developed to reach your age, and you will do
just fine.

Side Effects of Medication for Sun Exposure Spots

QUESTION: I noticed several dark, grayish colored spots on my hands and face
and thought they were simply age spots that so many of my friends have
developed with the passing years. My doctor, however, said they were caused
by too much sun exposure, and that they could become cancerous if not treated
now. He has suggested a cream that contains a powerful medication to destroy
the spots, but has warned me that this treatment can have some painful side
effects and cause scars. Can you offer me some advice and counsel?
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ANSWER: Your doctor has made an important diagnosis, and now you must make a
difficult decision, but there is no doubt in my mind that treatment is
necessary and advisable. "Age spots" that you refer to are usually brownish
in color and warty looking, and can occur anywhere on your body, rather than
just on uncovered sites such as hands and face. They are known as seborrheic
keratoses, and though sometimes unsightly, do not become cancerous or
malignant with time. Your problem, usually seen in individuals who have had
chronic or prolonged exposure to damaging sun rays, is called Actinic
Keratosis, and may develop into skin cancer. That is why treatment should be
started now. There are two main routes of treatment. If there are but a few
areas affected, the cells may be destroyed by cryotherapy, a technique that
uses liquid nitrogen to freeze and destroy the cells. It is rapid and
produces satisfactory results. When there are too many lesions for this
method, a cream containing 5-fluorouracil (5-FU) may be used. It is applied
as a cream or lotion twice a day to all the spots. After about 3 to 5 days a
reaction will be noted, as the damaged skin turns red and irritated. Sores
and crusts can develop as treatment continues, and can be painful. The length
of treatment depends upon your progress, but after it is halted, the sores
heal rapidly and new skin will regrow, replacing the potentially dangerous
growths.

Participation in Exercise While on Beta-Blocker Medication

QUESTION: Because of a case of high blood pressure that was difficult to
treat, I am now under control with medication (beta-blocker). I think I would
feel even better if I could participate in an exercise program we have here,
but as you know, my pulse is also lower due to medication. Can I participate
in the program and will it do me any good to try?
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ANSWER: Many people must find themselves faced with your problem, for since
their introduction in 1966, the beta-adrenergic blocking drugs have become
widely used to treat a variety of heart conditions as well as hypertension.
As you correctly note, these medications affect your heart and therefore your
pulse rate, and may lower this rate from 15 to as many as 60 beats per minute
when you are exercising at moderate levels, the amount depending upon your
body's reaction and the dose of medication you are taking. But the effect on
circulation may be less dramatic, for as the heart beat is slowed, the amount
of blood pumped out with each contraction increases, keeping the flow of blood
to the body near normal. The beta-blockers may also lower your breathing or
maximal ventilation capacity, which may in turn diminish your ability to
continue your exercise activity over prolonged periods. However, the results
of a number of investigations that deal with your question would seem to
indicate that you may well derive considerable benefit from a training
program. There are a few precautions for you to take. The amount and type of
exercise should be based upon the results of a treadmill test, which should be
conducted as much as possible in a manner that simulates the conditions you
will be under when exercising. You should be on the type and amount of
medication that you will be taking during the time of your new activity.
Since it is apparent that you had trouble in controlling your blood pressure,
changing medications may not be advisable in your case, but the beta-blockers
that act primarily on the heart allow greater flexibility in planning, and
therefore a greater return from a well considered exercise program.

Shaving Technique for Basal Cancer Removal

QUESTION: The growth on my face has been diagnosed as a basal type cancer.
The doctor has referred me to a specialist who has a new technique that may
require several visits, because he shaves away a little piece of the tumor at
a time, then looks at it with a microscope before doing the next step. Do you
know of such a method, and why can't they just cut the damned thing off?
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ANSWER: Actually, you do have that option, as a surgical procedure (excision)
may be used to remove a basal cell carcinoma quite readily. If the tumor is
small enough, the doctor can then simply close the wound, or it may require a
graft of skin to replace the removed tissue. If enough normal tissue
surrounding the tumor is removed, hopefully eliminating all cancer cells, a
cure is attained in 95% of the cases. The technique to which you refer is
called Moh's Procedure, and can approach a 100% cure rate. It is most useful
when the tumor has a poorly defined border, for tumors located in areas where
recurrence is frequent, or where normal tissue must be preserved. Under local
anesthesia, the tumor is removed but the wound edges are examined with a
microscope to be sure that all the cancerous tissue has been removed. The
procedure is repeated layer by layer, wherever any abnormal cells are found,
until none can be seen. The operation requires special equipment and trained
physicians, but promises the most reliable results.

Morning Temperatures Procedure to Figure Out Time of Ovulation

QUESTION: With a deep desire to have a child, and no success over a long
period of time, I have decided to try a system involving morning temperatures
to try to figure out my time of ovulation. My girl friend was successful, but
she can't explain the procedure to me in a way that I can understand. Can
you?
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ANSWER: I certainly will explain the procedure to you, but the many factors
that affect fertility make this a complex situation to deal with in an
effective manner. Tracking your basal or morning temperature as a means of
establishing your time of ovulation is only one aspect of what should be a
total effort to gain your objectives, and that requires professional advice.
It's going to take some time, and you will need patience and dedication to
evaluate and correct all the possible causes of your infertility. You will
want to keep an accurate record of basal temperature over a three or four
month period, to provide a record that can be interpreted properly. A special
thermometer is used which is marked in a manner that makes the lower body
temperature found at the end of the sleep period easy to determine. Shake the
thermometer down before retiring for the night and keep it by your bedside for
use as soon as you awaken, before you leave the bed. Keep the thermometer in
your mouth for an extended period of time, from 5-10 minutes is required.
Read the thermometer carefully in a good light, to the nearest tenth of a
degree. You must then note this on a special temperature chart that is
usually provided with the thermometer or by your physician. If you have had
intercourse the previous evening or that morning, place a small circle around
that day's temperature reading, as this will provide your physician with the
record needed to counsel you. Usually your temperature will be within narrow
range of two tenths of a degree or so during the first part of your cycle. On
or about the 14th day the temperature will take a dip, to be followed on the
succeeding days by a level that is elevated by as much as a whole degree.
This will form a pattern that is typical for ovulation, and will help you
determine your day when conception is most probable. Both the timing and
frequency of intercourse are important considerations, as too frequent
intercourse may cause the quantity or quality of your partner's sperm to
diminish. This is but another factor to discuss with your physician. Good
Luck.

Curious About the Reliability of a Barium Enema

QUESTION: I am curious about the reliability of a barium enema in diagnosing
intestinal disease. If all the stuff they put in you is a dye, how does that
tell the doctors where disease may be present? What do they see on the x-rays
that permits them to arrive at any conclusions?
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ANSWER: Although frequently referred to as a "dye", the truth is barium is a
substance that is not transparent to x-rays, and shows up as a white mass
filling the large intestines. It provides a clear outline of the interior
surfaces of the colon and rectum, and can reveal the presence of growths, such
as cancerous tumors or benign polyps, and areas of inflammation, as well as
the small pockets or pouches that signify diverticulosis. During the
procedure, the barium is allowed to flow out, but some still remains clinging
to the walls of the intestine to provide another view to the examining
radiologist, and help in diagnosing any pathology present. The development of
colonoscopy, in which a flexible telescope-like instrument is used to view the
intestinal lining directly, has replaced the use of the barium enema in many
instances.

Do Hair Products for Balding Really Help Hair to Grow?

QUESTION: I am a young man, and really too young to start balding. But the
hair loss is now pretty visible, and I am confused by all the advertising for
hair products that I see on television. Are any of them proven, and do they
really help hair to grow? I don't want to spend my hard earned bucks for
nothing.
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ANSWER: You pose an excellent question, one that applies as well to many
types of advertising for health products on television. The secret is in the
listening. The ads I've seen do not claim to promote new growth in so many
words, but tell of "stopping the loss" of hair through natural means. By this
they mean that their product is not a medication in the sense that it acts on
disease process through chemical means, and therefore it is not approved by
the Food and Drug Administration. "Natural means" could refer to a cleansing
process that might help the general scalp condition, but these claims are
never quite clear. The one product that does have scientific evidence to back
its claims and an FDA approval is Rogaine (minoxidil is the generic name)
produced by the Upjohn Company. It is an active agent that has been used in
the control of high blood pressure, and was found to promote the hair growth
in balding men. It is indicated for male pattern baldness of the top of the
head (vertex). The medication, obtained with a doctor's prescription, will
cost you about $2.00 a day, must be used continuously for life, and is most
effective in younger men, men with balding of less than ten years duration,
and men whose bald spot area is less than 4 inches. And it doesn't work on
everyone. About 1/4 of men using the medication over a period of 1 year
displayed no growth, or growth of only very fine (vellus) hair. You can
obtain more information directly from the manufacturer by calling the Rogaine
Hot Line, 1-800-635-0655 from 9 A.M. to 8 P.M. Eastern Time, Monday through
Friday. An attentive and polite representative will answer all your
questions.

Is Baker's Cyst Anything to Worry About?

QUESTION: I have a soft lump on the back of my knee, that hurts when I
straighten my leg. My doctor told me it was a Baker's Cyst, but I can't find
anything about it in my medical books. Is this anything to worry about? Can
it turn into cancer? It isn't getting any better and I have had it for six
months.
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ANSWER: It's also called a "popliteal cyst," since the back of your knee is
the popliteal area; and it may be the result of a hernia, or pushing outward
of the fibrous capsule of your knee, or of one of the bursa that are located
in this area. A bursa is a sac or sac like formation that contains the thick,
viscid fluid that helps to "oil" the joint and prevent friction. Although a
Baker's cyst (named, not after the bread makers, but Dr. W.M. Baker who
described it first) may occur at any age, but is seen most frequently in men
aged 15 to 30. Its cause is unknown, although trauma to the knee is
suspected, and it never progresses into a cancer of any type. Conservative
treatment using anti-inflammatory medications or aspirating the fluid out of
the cyst and injecting it with corticosteroids may help reduce the symptoms
temporarily. However, your only hope for a permanent solution is to have the
sac removed surgically. The surgeon dissects the cyst away from the
surrounding tissue, and ties of the neck of the sac. When performed properly,
this has a permanent effect and prevents the cyst from increasing in size and
extending down the leg. The pain will also disappear, and you will regain
normal function in your knee and leg.

Doubts About Diet for Lowering Cholesterole

QUESTION: The doctor has diagnosed all my problems as relating to hardening
of the arteries, and wants me to pay some real attention to lowering my
cholesterol. I have my doubts that this diet is going to get me anywhere. Do
you think it will do some good?
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ANSWER: Toward the end of World War I, a handful of European doctors noticed
a decline in coronary heart disease. The same thing happened following World
War II. Doctors speculated that this happy phenomenon was related to the
relatively small amounts of meat and other fatty foods in spare wartime diets.
Today, researchers using high-tech equipment are coming up with some
pretty reliable evidence that people who lower their blood-cholesterol levels
with diet or drugs can stop heart disease in its tracks. For a small fraction
of especially fortunate people, this kind of intervention even reverses the
damage done, and permits partially blocked arteries to return towards normal.
The proof comes by way of contrast angiography, a method akin to x-ray that
allows us to view the coronary arteries. So far, the regression of coronary
atherosclerosis has been documented in some 100 patients, and the disease has
been stopped in many, many more.
The simplest and safest way to reduce blood cholesterol is via your diet.
You will want to reduce not only the amount of cholesterol you take in, but
also the amount of saturated fats. Beyond this, researchers find that a
relatively high percentage of polyunsaturated fats in the diet help keep blood
cholesterol low. An ideal diet would consist mainly of cereals, legumes,
fruits and vegetables, rich in fiber. Meat may best be used as a condiment;
say, in a tomato sauce over pasta. If you must have cheese, look for low-fat
varieties; save regular cheese, meat, chocolate, candy and coconut for special
occasions.
If diet doesn't do it, your doctor may want to prescribe a medication to
lower your blood cholesterol level. Though many of these are extremely
efficient, their mild side-effects--constipation, heartburn, nausea, belching,
bloating--will probably reinforce your resolve to stick to your diet! In
addition, these drugs can be expensive and we don't know the effects of their
prolonged use.
To be fair, it must be said that some large studies have failed to show
that diet reduces the incidence of coronary heart disease. But you will be
pleased to know that researchers nonetheless estimate that for every 1% you
reduce your blood cholesterol, you will reduce your risk of heart attack by
2%. Stay on that diet; you are on the right track.

Asking About Crohn's Disease

QUESTION: I am writing to ask about crone or crone disease. What is it and
what is the cause of it? A few months ago my brother was sick and he just
told me that the doctor said that he had that disease, but he does not
remember any explanations. He is 71 years old.
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ANSWER: Your letter caught my eye because it expresses a concern that occurs
in so many families that are interested in the welfare of each member. When
the sick individual does not understand the nature of the disease, it is the
right and obligation of any family member to seek the necessary explanations
and gain the knowledge that can help in providing the care needed to alleviate
any suffering and discomfort. The name of this disease is Crohn's Disease,
also know as regional enteritis, one of a group of intestinal diseases
classified as inflammatory bowel diseases. It usually starts with chronic
diarrhea, along with abdominal pain, fever, loss of appetite and loss of
weight. In many cases the first episode may mimic appendicitis, and care must
be used in making the diagnosis. However, a barium enema (x-ray) can clearly
show the ulcerations in the walls of segments of the intestine. These
diseased areas are limited and occur next to parts of the intestines that show
no disease at all, giving rise to the term "regional" used in describing the
disease. A biopsy, where a small piece of tissue is obtained for a
microscopic examination, is often used to help make the diagnosis. The
disease occurs with equal frequency in both sexes, usually begins before age
40, and is more common among Jews, with a tendency to be seen in members of
the same family. The exact causes for any of the inflammatory bowel diseases
remain unclear although immunologic factors, infections and fiber poor diet in
developed countries have all been considered to play a role. Without the
knowledge of a specific cause, there can be no one therapy, so many are used,
depending upon the severity and extent of the disease. These include steroid
therapy (prednisone), antibiotics when infections do occur, antidiarrheal
medications and diet. When all else fails, surgery may be considered to
remove the portion of bowel that is affected.

Crabs, What They Are and How to Get Rid of Them

QUESTION: I guess most people shudder a bit when they think about a condition
called "crabs," but I still think you should offer a bit of information and
advice. Can you tell me what they are and how they arrive on a person, and
most important, how to get rid of them? I sincerely believe that this
question is as important to write about as any other subject you cover in your
column.
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ANSWER: You are right. I suspect there may be a few other people who may be
as interested as you are. Simply speaking crabs are another type of lice
(phthirus pubis), and get their name from the fact that they closely resemble
(but are in no way related to) the crabs seen on the shores and beaches.
Because of their adaptation, they live in only certain hairy areas of the
body, most often the pubic area, but also underarms, eyelashes and even
mustaches. However they do not normally invade the head, the domain of
another critter called the head louse. The need body warmth, about 87 degrees
F. to survive, and live by feeding on your blood. It is their bites which
causes the maddening itch that draws attention to their presence. They are
spread most commonly through sexual contact with an infected individual, but
can be gotten from contaminated toilet seats, clothing, towels and infested
bed sheets. Usually the diagnosis is made easily, by actually detecting a
crab louse on the skin of the patient. Though the condition is frightening,
the cures are both simple and effective. There are a number of
over-the-counter shampoos, lotions and sprays which, when properly used, can
eradicate the lice and their eggs. Your pharmacist or physician can guide you
in their proper choice and use. One additional word of caution. Since, in
the majority of cases, crabs are transmitted through sexual intercourse, it is
a wise precaution to request a complete examination from your physician
checking for the possibility of other sexually transmitted diseases (STD) that
may have been unwanted companions of these more noticeable visitors.

Assistance for Constipatione

QUESTION: It seems you only choose questions for your column that deal with
exotic diseases that no one ever has and don't care much about anyway. Why
not use your knowledge to help us common people and talk about real subjects
like constipation? I know I could use some assistance.
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ANSWER: Commoner or king, constipation can be a problem for anyone. You are
right, it is a subject that should be discussed. For an understanding of the
causes of this annoying condition, you must first understand how the large
intestine, or colon, works. After our foods have been digested, and the
nutrients absorbed by the small intestine, the remaining waste reaches the
colon, the last section of the intestinal system before the rectum. The colon
moves the waste along with rhythmic contractions, called peristalsis, driving
the fecal material towards the rectum. At the same time it reabsorbs the
excess fluids, making the stool firmer and firmer as it reaches the last
sections of the bowel. If the muscle contractions are slow, or irregular, the
stool spends too much time in the colon and too much water is removed, forming
hard or dry stool. If peristaltic rhythm is too swift, the stool will be
loose and watery, leaving as diarrhea. Constipation is therefore best
prevented by assuring that these contractions (called involuntary as we have
no control over them) remain normal. They can be affected by illness, stress,
poor bowel habits, lack of exercise, and above all improper diet and eating
habits. The object is to have the stool arrive at the rectum in a form that
makes your voluntary efforts to pass your stool easy and normal. Here are
some tips for you. Eat at regular times, taking pleasure in your meals and
chewing your food thoroughly. Make sure your diet contains sufficient bulk
fiber that is present in cereals, fruits, raw vegetables, and cooked high
residue vegetables such as corn, potatoes, spinach, string beans and turnips,
to name a few. Be sure to include plenty of fluids in your daily diet. When
the urge to move your bowels arrives, pay attention and try to move your
bowels without straining, letting nature proceed normally. Adding a brisk
walk and sufficient exercise to daily activity may just make the difference
that changes your problem of constipation into an unpleasant memory

High Blood Pressure Brought On by Cold Medicine

QUESTION: As usual, I have had my one bad cold this year, but the experience
became a frightening one when I developed a terrible headache, became upset
and jittery to the point where my hand trembled. I visited my physician who
discovered that my blood pressure was high. He told me that all of the
symptoms were brought on by the cold medicine I had been taking. He was
right, too, for they all disappeared when I stopped the medicine. I think you
should warn your readers about this danger.
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ANSWER: That is an excellent suggestion, although all who take over the
counter cold medications may not undergo the number or extent of the side
effects which you experienced. In fact most cold preparations are very safe
and side effect free when taken as directed and when the patient is not unduly
sensitive to a chemical that is commonly found in nonprescription cold
preparations. Its called phenylpropanolamine, and it is used in over 100
different medications; used as an appetite suppressant for weight control, in
nasal decongestants and cold medications, and for the premenstrual syndrome.
Some times it is passed as a "street drug" as a substitute or combined with
amphetamines. When cold sufferers mix several combination preparations in the
hopes of a speedier recovery, they run the risk of taking too much of this
ingredient, which may be a component of all--or at least some--of the over the
counter products. Like any other medication, phenylpropanolamine must be used
with respect, and only in doses indicated on the bottle. Patients with
hyperthyroidism, hypertension or other heart related disease or diabetes
should be most cautious. Of course if you are taking any other medication you
should consult your pharmacist or physician before adding additional
medications to your routine. The adverse effects associated with this
medication most commonly affect the cardiovascular system, but can even
include severe psychological disturbances, bizarre behavior and
disorientation. To avoid these risks, read the label carefully, and be sure
not accidentally "overdose" on a medication which can offer relief when
properly used.

Understand More About Congestive Heart Failure?

QUESTION: I am caring for my husband who suffers with congestive heart
failure. He has both good and bad days, no matter what I do. I just wish I
could understand a bit more about this disease, so I could help better. Can
you please offer me some help?
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ANSWER: The heart has as its most important role the pumping of blood to all
the parts of the body that require the oxygen and nutrition carried in the
blood. When the heart no longer is capable of accomplishing all that the body
requires of it, it is said to "be failing". This can be caused by damage to
the heart from a past heart attack, or because the arteries which supply blood
to the heart itself are narrowed by coronary artery disease. It can also be a
result of hypertension, infections to the heart muscle, and damage to the
valves of the heart. When the heart begins to fail the blood begins to back
up, causing fluids to accumulate in the lungs as well as the legs and feet
(congestion). As a result, breathing may become more difficult and the feet
and ankles may swell. Such patients tire easily, and find that even the small
tasks of life become difficult to perform. When they become discouraged, they
blame everything and everyone about them, even those most devoted to their
care. But there are some ways of helping and making life better for all. Be
sure you understand which medications are being prescribed, and why they are
being used. There is usually a heart medication, which helps the strengthen
the heart beat and make it function more efficiently. Diuretics are used to
reduce the amount of fluid in the body. Make sure these medications, and any
others, are taken on schedule each day. Check the foods you are serving to be
sure they are low on salt, since salt can retain fluid in the body. While
moving about too quickly or for too long a period can make symptoms worse, a
restricted program of short slow walks can be just the ticket to keep the body
in reasonable condition, and to provide your husband the opportunity to get up
and around. Changing the scenery a bit can change ideas and reverse some of
the negative thinking that may be going on. You are apparently doing a
wonderful job; I hope these tips help a bit.

Is There Any Remedy for "Claudication" Besides Bypass Surgery?

QUESTION: Would you please discuss a condition called "claudication". I am a
sufferer, and wonder if there is any remedy to the problem other than bypass
surgery?
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ANSWER: A symptom of intermittent claudication results from a deficient blood
supply in an exercising muscle. After but a brief period of walking the limb
becomes "tired," or a pain, ache or cramp may be felt. Usually it occurs in
the calf, but can also affect the foot, hips, thighs or buttocks. After a few
moments of rest, from 1 to 5 minutes, the pain abates, and the patient can
walk on for about as much time or distance as originally, when once again the
symptoms recur. The distress is greater when walking rapidly or walking
uphill, and the ever diminishing distances that a person may cover during the
painless periods indicates that the disease is progressing. True intermittent
claudication never occurs at rest, and does not require that you sit for the
pain to disappear. The underlying cause is the presence of atherosclerotic
plaques which develop in the arteries of the extremities, and block the
passage of blood needed to carry oxygen to the working muscles. The amount of
pain and the distances you can cover will depend upon the extent of the
disease, and if there are other open arteries in your legs to help carry the
blood. Exercise is recommended to overcome some of the restriction. Walk for
about 60 minutes each day if possible, stopping when the pain occurs until it
disappears, and then moving on again. This can improve your condition
measurably and provided you with the ability to cover considerable distances
without pain. A medication called pentoxifylline (Trental) that increases the
ability of red cells to pass through narrowed arteries and capillaries may be
used to improve the circulation in your legs and reduce the symptoms. It is
only when these techniques fail to improve your situation that you may have to
consider surgery to bypass the blocks present in your arteries which are the
cause of your problem.

Does Finger Stick Cholesterol Testing Have Any Value?

QUESTION: I recently had my cholesterol tested during a "Health Fair". They
just stuck my finger and paid no attention to the fact that I had eaten but a
few hours before. I was told that everything was O.K., but wonder if this
type of testing has any value? Do you think I need a regular blood test?
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ANSWER: Screening tests using a finger stick are great for getting some
information about their blood cholesterol levels to a large number of people,
and to provide these answers without an excessive cost. While the accuracy
may not be the greatest, the initial evaluation can be used to determine
whether any additional testing is required. Anything under the 200 milligram
per deciliter (mg/dl) is considered good, with the range from 200 to 239
established as borderline high and more than 240 mg/dl a cause for real
concern. You must have been below 200 mg/dl to have been informed that all
was O.K., but if you had been in the high borderline range, for example, a
more precise test would have been indicated. In this case the blood is drawn
from a vein, following an overnight fast. Testing for high density (the good
guys) and low density lipoproteins as well as triglycerides are generally
included, as well as evaluating your level of cholesterol. Even this test
should be taken a couple of times to obtain a valid average upon which to base
recommendations for diet and treatment. I think I would be satisfied with the
results you obtained, but might be on the lookout for another opportunity to
have my cholesterol tested again in this fashion. I have a feeling you need
to be reassured about your good report, and a second "passing grade" might be
just the answer you require.

Why is HDL the "Good Cholesterol"

QUESTION: Whenever the question of cholesterol is discussed, you read about
the importance of the HDL. I know that this is the "good cholesterol," but I
don't understand why. Can you enlighten me?
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ANSWER: HDL or high density lipoprotein is considered good because it has two
important actions that help when you have a high level of cholesterol. It has
the ability to carry excess cholesterol found in body tissue back to the
liver, where it undergoes a process of metabolism. It also helps remove
another type fatty substance called triglycerides by improving the process by
which they are removed from the blood circulation and oxidized by skeletal
muscle. You can improve your HDL with a regular exercise program, which is
even more effective if you are a nonsmoker. Alcohol in moderation (and I
stress the word "moderation") is also known to elevate HDL, but physicians
rarely recommend this as a means of increasing HDL levels because of the
possibility of alcohol abuse. While we are becoming evermore aware of our
cholesterol levels, many physicians now believe that the HDL level is equally
important in the consideration of an individual's overall health appraisal and
recommend blood tests which evaluate all of the blood lipids (fatty
materials).

Worried About Flushed and Feverish Son

QUESTION: There have been three separate occasions when my son returned from
playing with his friends when he was flushed and feverish. I don't mean just
hot and sweaty, but actually had a temperature of over 100 degrees when I took
it with an oral thermometer. My doctor advised me to just watch him, and of
course it went away without any medication. However I am still worried, and
hoped that you might be able to offer some explanation.
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ANSWER: You sound very much like a normal, caring mother, for many parents
worry about elevated temperatures when they occur in their children. In this
case, however, I doubt that there is cause for concern. There is really no
such thing as a "normal" temperature, for even in normal individuals it may
vary as much as 2 to 3 degrees in a 24 hour period, with the lowest reading
being found during sleep and the highest temperature recorded during the late
afternoon. When fever is noted after a healthy workout or period of play, it
is not a cause of concern, especially when it descends after a short period
without medication. It that case it is considered to be a normal variation in
the constantly changing level of body temperature. It may interest you to
learn that the so called "normal" body temperature of 98.6 degrees F was
determined by averaging the levels found in just a few individuals in a study
conducted in the 19th century. Most doctors therefore do not react too
strongly to brief variations from this level. And that is good advice for you
as well. Any serious conditions usually produce fevers that are both higher
and sustained over a longer period of time. It is generally conceded that a
rectal temperature over 101 degrees F (38.3 degrees C) is abnormal.

Is Motor Oil a Proven Treatment for Burns?

QUESTION: I work with an older man in a garage. The other day, he burned his
arm on a hot exhaust pipe. After a few unprintable words, he reached for an
emptied can of motor oil, and used the remaining drops to rub into his burn.
He claims that this is a treatment, one he has used successfully for years. I
tend to believe him, do you?
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ANSWER: I'll add your story to my list of "no-nos", but it is just one of the
many examples of tales of treatment that can lead to rather serious and
unwanted outcomes. If he has been successful for years, he has also been
remarkably lucky. I doubt that his "burn treatment" meets with the
requirements of sterility that applies to other types of medications that may
be used in promoting the healing that is so important after a minor burn. A
burn, even a minor one, will damage tissue, and in many cases actually kill
the cells. This dead (necrotic) tissue makes a perfect environment in which
bacteria, which are always present on the skin, can grow, producing infections
that may be extensive, serious and sometimes life threatening. The proper
treatment for burns is to first apply cold, wet compresses or immerse the burn
in ice water. This can retard the process of cell injury. Then a sterile
burn cream may be applied to reduce swelling and pain. If extensive blisters
develop, or skin has been burned away, professional treatment is indicated to
remove dead tissue and provide the right kind of dressing. Auto oil belongs
in crankcases, not on people.

What is the Condition of Burning Red Feet?

QUESTION: I have a condition that I am told is rare, in which my feet become
burning red and hot. My friends here says that everyone has the same thing
and my problem is not so special. The doctor gave me a long name for my
diagnosis, and if could remember the name, I could convince my friends that I
did not make it all up. Can you help?
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ANSWER: It is true that many people suffer from burning of the feet, usually
due to standing too long, or walking too far in badly fitted shoes. There are
also many medical conditions that can produce the symptoms. The one I think
you mean though, is rare, and is called "erythromelalgia". When it occurs
there is a burning pain, the feet turn bright red and the skin temperature
actually rises. It is the result of the blood vessels in the foot (sometimes
the hands) dilating and allowing more blood to flow through the area. No one
knows what causes it, and although it may remain mild for years it can become
so severe that disability may result. You can avoid an attack by elevating
the feet and applying cold packs. 600 mg of aspirin 1 to 4 times a day can
also produce prolonged relief, as can other medications. Stay away from
alcohol or other vasodilators. He is not kidding, fellows, the disease does
exist.
----------------
The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician. Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

What is the "Cut" a Doctor May Make During Birthing?

QUESTION: With the arrival day for my first baby fast approaching, it seems
that all the conversations with my girl friends now turn to the "cut" the
doctor may make during the birthing. Can you tell me the scientific name for
it, and explain its use? Does it cause a lot of pain?
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ANSWER: When a delivery can be helped by providing a bit more room for the
baby's head to pass, a physician may elect to perform an "episiotomy". The
term is from a Greek word "epision" describing the region of the pubes and it
is through this area that an incision is made. There are several advantages
to the procedure, as it can allow a quicker and easier birth and reduce
pressure on the baby's head. Since the forces pushing the baby through the
birth canal are powerful enough to both stretch and tear vaginal tissues,
making a clean surgical cut at the appropriate moment avoids the complications
that torn tissue can provoke. With all else that is going on at that moment,
many women are unaware that the "cut" has been made. After the birth the
incision is repaired as with any other surgical incision and permitted to
heal. While the swelling and pain passes in a few days to a week, the area
may remain tender for a month or so. Total healing is usually completed in
about six weeks. The mainstay of care is hygiene, keeping the area clean and
free from any possible contaminating elements that cause irritation or
infection. Your own physician will guide you through this period as well as
counseling you about resuming normal activities and relations.

Is Emphysema a Rare Disease and is There Hope for Improvement?

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QUESTION: Now that a cause for some of my shortness of breath has been
diagnosed as emphysema, I want to find out all I can about a condition I have
never really understood. Is this considered a rare disease, and is there any
hope for any improvement in my condition?
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ANSWER: I don't believe that you can classify a disease that affects between
one and two million Americans as a rare disease, and it is a problem for an
ever increasing number of people. It generally begins to show its symptoms of
increasing breathlessness between 40 to 60 years of age, and may be attributed
to both age and obesity by new sufferers of the disease. Yet a healthy person
approaching retirement age should still be able to breathe with ease of a 20
year old, even when in involved in moderate activity such as a brisk walk
along level paths. The causes of emphysema are poorly understood,
particularly why certain individuals seem to develop a more severe type of
disease than others. Smoking is definitely linked to the disease in nine out
of ten cases. The walls of the little sacs at the end of the air tubes
leading into the lungs (alveoli) lose their elasticity, and cannot contract
and force the air out of the sac with each expiration, resulting in trapped
air within the lungs. This lowers the amount of air flowing in and out of the
lungs each time a breath is taken and reduces the lungs ability to exhale the
carbon dioxide built up in the blood stream by the body's metabolism, as well
as reducing the amount of oxygen in freshly inhaled air that can be delivered
to the blood stream. That results in the feeling of being smothered that so
many emphysematous patients experience. There is no cure for this chronic
obstructive lung disease, and recurring bacterial and viral infections may
aggravate both the disease and its symptoms, leading to the development of an
aggravating cough. The best way to slow the progress of emphysema is to stop
smoking once and for all time. Avoid areas where other smokers may be filling
the air with fumes that are truly hazardous to your health. A supervised
exercise program and the prompt treatment of any respiratory infections will
also help you reduce the complications of this common illness.

How Does an Echocardiogram Work, and is it Safe?

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QUESTION: Although I think I know what a cardiogram involves, I am less
certain about the way an Echocardiogram works. A member of my family is to
have one, and I am both curious as to why as well as concerned with the safety
of this test. Would you please shed some light on this question?
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ANSWER: I would be pleased to, for I can certainly reassure you as to the
safety of this procedure. It is simple and noninvasive, and uses very fast
sound waves which pass through the patient's chest to the heart and bounce
back (echo) to produce a record or graph which forms an image that the
physician can use to evaluate the walls and chambers of the heart, as well as
the valves which control the flow of blood through the heart as it beats.
While an electrocardiogram produces the pattern of electrical flow through the
heart and may be used to evaluate changes in rhythm, for example, and blood
tests may show the alterations in enzymes produced by a heart during a heart
attack, an echocardiogram may yield early information on the size and extent
of the attack, the location, as well as the presence of clots or masses, while
measuring heart function and the condition of the valves. Sometimes a chest
x-ray shows the heart to be enlarged, and the "echo" will reveal whether the
heart wall has become stretched or thickened due to disease. It may detect
the presence of fluid in the sac that covers the heart, and is a useful tool
to measure the effect of medications and treatment on the heart muscle mass
and size. There is little preparation necessary, and there is no pain nor
discomfort while the test is being conducted. The patient remains totally
awake and conscious while the probe that both sends and receives the sound
signal is moved about the chest to obtain the best "picture" of the heart in
action. The test has been in use for more than twenty years, is relatively
inexpensive when compared to other tests, and is free from side effects, both
physical as well as psychological. While I can not offer you more information
as to why the test is being conducted for your family member, you may be
confident as to their well being.

Foot Swelling During Air Travel

QUESTION: Why do my feet swell when I travel by air? This scares me. I am
66, in good health otherwise. Will I get an embolism--or something awful?
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ANSWER: Let me make a few assumptions. One, that this only occurs when you
fly, and that for two hours or more, and two, that you are truly in good
health. By doing so I won't have to consider all the possibilities for
swollen ankles and feet and thus provide you with a simple and easy to
understand answer to your question. Air travel is not much fun anymore. It
seems as though those cabins get more crowded all the time, and that we can
barely find an opportunity to take a stroll, however brief, up and down the
aisle. Too bad, for it would most certainly help solve your problem. But
once you get settled in your seat, you are "planted" for the duration. Your
feet hang down, the seat places pressure on under your upper legs, and without
some muscle movements to aid the circulation in your legs, the blood can't
flow back up the veins in your legs as it should, and swollen feet and ankles
develop as a result. There are several strategies you can try. The best is
to always obtain an aisle seat, and take a brief walk up and down the aisle
once or twice each flight, when the flight attendants will allow you to.
Second, keep your legs as elevated as possible. If you have placed some carry
on luggage under the seat in front of you, slide it back a bit and perch your
tootsies on that for a while. And third, while you have your feet up, wiggle
your feet back and forth, so that you can feel your calve muscles tighten.
This will really help your circulation and prevent the swelling. An embolism
or something awful? I really don't think so. Now you can fly at least
without that anxiety. Getting there on time? Well, that's something else
again.

What Does "In Vitro" and "In Vivo" Mean?

QUESTION: I have been reading more and more medical material, to better
understand my own health status. I keep coming across reports of a medicine's
effectiveness "in Vitro" and "in Vivo". I think I understand what it means,
but will you explain this concept?
------------------------------------------------------------------------------
ANSWER: I am sure you have already consulted your medical dictionary (and
I'll bet you have one), but for everyone's benefit, a few definitions first.
Both terms are derived from the Latin, "vitro" referring to glass, and "vivo"
to life. When a medication is effective in vitro it means it has been shown
to have an action in an artificial or "glass" environment, a test tube being
the example, representing laboratory investigation. Usually this occurs in
the first stages of developing a new medication, when testing reveals that a
possible benefit can be achieved. These laboratory experiments give
scientists the first lead towards a new discovery or breakthrough. Yet that's
a long way from providing a usable ingredient for medication, for there are
still safety tests needed to prove that there are no harmful effects
associated with the new chemical or agent. This experimentation must first be
conducted in animals, and then human volunteers, in living subjects or "in
vivo". When safety has been demonstrated, testing in actual patients may then
be started, and the long process of proving that the good or beneficial
outcomes seen in the first stages of investigation actually occur in real,
live patients. Many times the hopes influenced by the initial results can not
be demonstrated in actual situations, and the research must be abandoned.
Developing safe and effective medicines is a long and costly process which
explains, in part, why medications are sometimes so expensive.

Normal Delivery After Previous Cesarean Section

QUESTION: I need more information about a normal delivery after a previous
cesarean section. My doctor has told me that it would be safe, but I thought
you had to have a cesarean once you were delivered that way. Is there
something new I should know about?
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ANSWER: It was once thought that abdominal deliveries were the only safe
route after previous cesarean deliveries, but opinions are beginning to
change. Cesarean deliveries have been constantly on the rise in the United
States, reaching more than 20% of all deliveries in 1984. Almost half of
these women were repeaters, but recent developments have demonstrated that a
vaginal delivery may not only be safe but preferable in carefully selected
patients. Some of the advantages are a shorter recovery period, less cost,
and avoiding the risks of anesthetic and postoperative complications. There
are some guidelines developed by the Committee on Maternal and Fetal Medicine
of the American College of Obstetricians and Gynecologists that are useful
when making this decision. First on their list is the recommendation that the
patient and physician discuss fully all of the pro's and con's of this option.
The classic, previously used midline abdominal incision is still considered a
contraindication to a trial of normal labor, and continuous fetal monitoring
throughout labor is considered a must. If you are only carrying one baby, and
don't expect the weight to be more that 8 lb. 11 oz., you may be an excellent
candidate.

Misled by Needle Biopsy of the Thyroid Gland?

QUESTION: A friend of mine told me of a recent experience with her physician
during which he performed a biopsy using a needle which he injected into her
thyroid gland. She was happy that no cancer was found. I know that a biopsy
requires the doctor to cut some tissue, to obtain a sample for testing. How
do I tell my friend that she has been misled?
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ANSWER: You don't have to because she hasn't. In essence, her story is
completely understandable when you realize that all biopsies do not require
removing tissue by surgical techniques. The object of course is to obtain
cell specimens that may be examined under a microscope, searching for signs of
abnormal growth that signal the presence of cancer. In some cases these cells
may occur in urine and sputum, or be obtained by scraping (for example, the
technique used for a Pap smear). When cancer is suspected in the bronchial
tubes, a technique known as "washing" is used to gather material for
examination. While the most common use of the word "biopsy" relates to
obtaining specimens by excision, it may also apply to the method used by your
friend's physician. It is called "Aspiration Biopsy" and is frequently used
to search for cancer in the thyroid. In this technique, the physician inserts
a fine needle into the mass, and rather than injecting anything applies
suction through the syringe, while moving the needle back and forth in the
suspicious mass. In this way cells are loosened and sucked back into needle.
This material may then be used to prepare a slide for microscopic examination.
While the number of cells are few, an accurate diagnosis can be made in most
cases. The procedure is rapid, safe, and does not leave a scar. If necessary
it may be easily repeated, as it does not require hospitalization or special
equipment. You can now relax and be confident that the good news your friend
received from her doctor was valid.

Treatment for "Lazy Eye"

QUESTION: We were a bit shocked to learn that our child's vision in one eye
was not up to standard. However, instead of glasses, the physician is
suggesting putting a patch on the good eye, leaving our son to navigate with
only the vision from his bad eye. That doesn't make much sense to us. Can
you explain what would be accomplished by this treatment.
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ANSWER: The common name for your child's problem is "lazy eye" which is
certainly easier to say than "amblyopia" which is the medical term given to
this situation, in which the vision in one eye is poor. It may affect as many
as 1 person in 400, and if not corrected during childhood, can become
permanent. As with so many other functions of our marvelously constructed
body, we must learn to use its capabilities in order to obtain the most from
it. Proper vision is gradually attained as the baby learns to fix on objects,
and focus properly using both eyes to achieve three dimensional vision. A
number of conditions, including near sightedness, crossed eyes, or
astigmatism, can prevent both eyes from working together. In many such cases
the weaker eye gives up and becomes "lazy". Since it no longer functions it
becomes weaker and weaker, turning into an amblyopic or "eye with dull
vision". Your physician's strategy is a well accepted one. By placing a
patch over the good eye, he will force the amblyopic eye into working harder,
gaining strength and acuity. When both eyes are about equal, either with or
without corrective lenses, the patch may be removed. It is well that you
understand the importance of the maneuver, since keeping the patch in place on
an active youngster is a quite a task, and will require a lot from you.
However, by following the directions of your eye doctor to the letter, your
youngster may soon see all the "letters" using both eyes, as normal vision is
acquired and maintained.

Alcoholism in Older People

QUESTION: Why would a woman, who virtually never took a hard drink in her
life, suddenly become an alcoholic? On a regular visit to my mother, we
became aware of a change in her living habits, and discovered a trash can full
of empty bottles, mostly vodka, hidden in the basement. Her neighbors have
also noted unexplainable actions that just don't fit. What is happening here
and how can we help?
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ANSWER: Obviously, there may be many explanations for changes of behavior in
an older woman, but I will go along with your supposition, based on the
unusual findings in the basement trash can. Alcoholism in older people
differs greatly from the disease we find in younger people, and there is a
classification of people who start drinking in later life called "reactors"
who use alcohol as a response to the stresses that accompany aging. It is
more frequent in women than men and about one third of drinking problems of
the elderly fall into this category. They do not obtain the "high" that young
drinkers seek, but may have memory lapses, headaches and confusion as a reward
for their alcohol intake. Their response to alcohol is also much stronger
because of their age-changed physical make up and physiology. The most
difficult part in the process of diagnosis and treatment is recognizing that
the problem is not simply a change of aging, but has an actual basis in the
overuse of alcohol. Once you can get your mother to admit to the practice,
she probably will do well with therapy. She may be reluctant to enter an
institution for care, and persuasion is a better tactic than confrontation;
but once in counseling programs, older people tend to be reliable about
attending meetings and sessions. You may also have to examine her current
life style and its implications as part of the cause of the problem. Changes
may be required, but with the knowledge of family support, careful attention
to her personal needs and expectations, and professional assistance, the
chances of beating this late blooming problem are optimistic.