Lessons to be Learned About Reiter's Syndrome

QUESTION: A recent visit to my physician, because of a painful knee, resulted
in an embarrassing set of questions about my sex life. I resisted answering
until the doctor, after looking in my eyes, insisted. When we were through, I
found out a lot about myself, and more respect for your profession. Why not
tell your readers about Reiter's Syndrome; there are a lot of lessons to be
learned.
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ANSWER: Your suggestion is a welcome one, and the disease you suggest
certainly can help to make a lot of very important points about medical care.
Before we start, a complimentary word for your physician (and a personal hello
from me). He was not only astute, but displayed a great many of the qualities
we all desire in our own personal physicians. His persistence in questioning
was appropriate and artful, and when he discovered your conjunctivitis, the
possibility of a diagnosis of Reiter's Syndrome (RS) was increased. RS occurs
primarily in young men between the ages of 20 and 40. Typically it displays
three main symptoms or signs, an arthritis, a conjunctivitis, and a urethritis
(inflammation of the passage within the penis that carries the urine). The
urethritis produces a burning sensation during urination, but not as severe as
when the cause of the inflammation is a bacterial infection. There are some
studies that indicate that there may be an inherited factor which makes some
individuals more susceptible to the disease than others. However, the most
important factor is that this is classifiable as a sexually transmitted
disease, thus the queries put to you by your physician. It probably is
associated with an infection by the C. trachomatis bacteria passed on by a
sexual partner. The symptoms come on 7 to 14 days after contact. Initially
there is a low grade fever, possibly some diarrhea. The conjunctivitis and
arthritis follow over the next few weeks. Occasionally there are small skin
lesions. When trachoma infection can be identified as the source, treatment
with antibiotics, erythromycin or tetracycline is recommended over a 10 day
period. And the sexual partner must be treated as well. The initial episode
will resolve in 3 to 4 months, but over half the patients will experience some
brief arthritic symptoms as well as the other components of this syndrome over
a period that can cover years. A lesson to be learned for sure, good doctors
sometimes ask questions that are difficult to respond to, but the reasons here
are now obvious.

Taking Malaria Medication During Pregnancy

QUESTION: My husband is being transferred by his company to a Latin American
country. I am expecting a baby in a few months, but want to go with him now
to help him start up his new job. He is being put on medication to prevent
malaria. Can I use the same medication that he will be taking, even if I am
pregnant?
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ANSWER: It is always against the rules to take someone else's medication,
even when the circumstances seem so easy to understand, and the problem seems
to be the same. So the answer to your question is a resounding "NO!". The
usual recommendations for malaria prevention utilize a weekly dose of
chloroquine in a dose of 300 mg. Although not available in the United States,
proguanil may also be used, but must be taken every day, dose 100 mg.
However, many sections of South America harbor a chloroquine resistant strain
of P. falciparum, the germ responsible for the disease. (You can check with
the Centers for Disease Control in Atlanta for the latest conditions at your
destination). In such areas a second medicine, combining 25 mg of
pyrimethamine and 500 mg of sulfadoxine (brand name: Fansidar) might also be
considered. However it is plagued by some serious side effects and
complications including fatal skin reactions, and is no longer recommended as
routine prophylaxis. While chloroquine appears to be safe for use during
pregnancy, this is not as clear for Fansidar. Frankly, some of my
knowledgeable colleagues would have me caution you about even going with your
husband at this time, and recommend that you stay put until the baby is born.
It is clear that you run substantial risks from the medications, even if the
threat to your health and that of the baby is greater from the infection. It
is a hard call to make, so employ the counsel of your own physician as well.

Enlightenment About the Diagnosis of a Premature Infant

QUESTION: Can you offer us any enlightenment about the diagnosis of a
premature infant. Is it just their weight that counts, or do you have other
methods of judging? Is the cause for premature delivery understood?
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ANSWER: The strict definition of a premature infant is one that has been born
before 37 weeks of gestation or pregnancy. At one time any baby that weighed
less than 5.5 pounds was considered a premature birth, but a full term infant
of that weight would now be classified as small for gestational age (SGA). To
most experienced physicians, a premature infant just looks it. They are, of
course, smaller than usual, and their skin is shiny and pink, with the blood
vessels easily seen through the skin. They have little fat under their skin,
usually no hair, and the cartilage in their ears is missing. They are quiet
babies, not moving around as much as others, and their muscle tone is reduced.
In males the testicles may not have descended into the scrotum, which is
smooth and does not present the wrinkles of the mature baby. In females the
labia majora are not developed sufficiently to cover the labia minora which
lie beneath. The reasons for premature delivery are poorly understood,
without a clear cause. Premature deliveries are more common in women who have
had little or no prenatal care, who are in the lower socioeconomic classes,
where there is poor nutrition and poor education, and in unwed mothers. We
need to know much more as prematurity is the greatest cause of newborn deaths.

Refusal to Take Vitamins During Pregnancy

QUESTION: My sister, who is 19, is having her first baby. She is three
months along, and although her doctor has told her to take vitamins, iron and
calcium, she refuses. She says it is not necessary! Would you please explain
the situation to her? I am five years older than her and I have tried to talk
with her but she refuses to listen.
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ANSWER: Well young sister, what are we going to do with you? The newspapers
and journals are just full of information that explains the necessity of good
nutrition and health care, particularly during the months of pregnancy.
Surely you are aware that your normal diet, no matter how perfect, will fail
to provide sufficient nutrition for both you and the new life that is now your
responsibility. The fact is that due to the way human physiology works, the
baby will make demands that your body will have to supply. If you do not take
calcium supplements, for example, the growing baby will steal your supplies,
taking the calcium it needs to develop from your bones. The head start to
health that you can provide your child now will affect its entire life. Both
physical and mental development requires that the necessary nutrients be in
place from the very beginning of life, and only you can provide them now.
Perhaps you are having some doubts and fears about now, and are a bit
overwhelmed by this whole process. But it looks like you have a loving older
sister and a concerned physician standing by to offer the answers and help you
need. If it takes a message from me to convince you, that you have, but it is
the circle of family, friends and physician that can really offer the
information you may need. Why not take advantage of the Pre-Natal Classes
that are offered in many hospitals and Health Centers across our country, to
get yourself and your baby back on track? Someday you will be very glad you
did.

Getting Nowhere with Toilet Training, What is a Mother to do?

QUESTION: It feels like a war, and I'm losing. There is seemingly nothing I
can do to get my two year old toilet trained, despite all my efforts. He is a
bright child, and all of his playmates are well on the road to control, but we
are getting nowhere. What is a mother to do?
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ANSWER: Your frustrations are showing, so sit down for a moment, take a deep
breath, and let's talk. Most authorities agree that if you have been trying
for several months, and your child reaches the age of 2 1/2 without
successfully achieving training, you may assume he is resisting in a conscious
way, and you haven't reached that age limit yet. However, it is the time to
change strategy. By now he knows what you want, and is capable of performing,
but will fight your efforts unless you turn over the responsibility to him.
No more scheduled sessions just sitting, no more frequent questions or
reminders. Reminders are just another form of parental pressure. One last
discussion to tell him that "peepee" and "dooty" are his to deal with, and
that you know he doesn't need your help. By withdrawing attention from the
bathroom battle, the need for attention can only be met when performance
merits it. Of course, you must stick by your guns, but offer positive
reinforcement freely; small rewards, like building blocks or pennies may do
it. Create a visual aid, like a poster or calendar, and mark it boldly for
every victory, while you heap on the praise. Even sitting on the potty-chair
counts, for once that routine is established, you are on your way. Don't
stand around while he is on the chair, let him come to you with the story of
his success. Once you have informed him about wet or soiled clothing, have
him help clean them. Having him rinse a soiled garment in the toilet bowel
will keep him aware of his duties and help motivate him to avoid this
unpleasantness. Accidents will happen, but avoid any harsh criticism or
punishment, and do not embarrass him, as it is counterproductive. And don't
be embarrassed yourself, but discuss strategies with the parents of your son's
playmates. Let them know what your situation is and what rules are governing
your actions, so they can use the same guidelines when your child is visiting
with them. They may have developed routines that may be helpful for you, so
discuss it openly. Once you have all your ducks in a row, you may be
pleasantly surprised at the speed of your child's progress. And I will be
happy to pass on to you all the helpful advice that I know my readers will
provide me when they read this answer.

What Would be the Symptoms of Eating Poisonous Mushrooms?

QUESTION: My father in law has just come to live with us and is excited by
the prospects of finding all types of wild mushrooms. I am less than thrilled
by the prospect of some poisonous variety finding its way to the table.
Though Dad is sure he knows the good from the bad, what would be the symptoms
if we had eaten the bad variety.
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ANSWER: Hunting for wild mushrooms may be a wonderful sport for an energetic
senior citizen, but it is not without its risks. Even experts may be fooled,
particularly when dealing with new varieties found in a new environment. You
are right to be cautious, and must stay alert if you are finally convinced to
serve these trophies at your dinner table. The most common type of mushroom
poisoning seen in emergency rooms is caused by the action of muscarine that is
contained in two species of the Amanita type. Symptoms begin about two hours
after eating, and consist of eyes' tearing, salivation, sweating, abdominal
cramps and vomiting, diarrhea, dizziness, confusion and sometimes convulsions
and coma. With appropriate therapy, including the use of atropine, recovery
is usual and occurs in 24 hours. In poisoning due to eating mushrooms
containing phalloidine, symptoms may be delayed as long as six or more hours,
and in addition to the symptoms listed above, causes impairment in urine
production and damage to the liver, resulting in jaundice. This type of
poisoning is far more serious with death occurring in about 50% of the cases
in from 5 to 8 days. It is difficult to predict the potential for poisoning
in these mushrooms as it may vary within the same species at different times
of the growing season, and with different styles of cooking. As you can see,
I cannot paint a glowing picture for you, but perhaps armed with this account
you may convince your father in law that wild flowers are a more appropriate
and satisfying souvenir of his nature jaunts.

Are Colon Polyps Cancerous?

QUESTION: I recently had the same examination as the President (Reagan). I
must have leadership qualities too, as they discovered that I also have polyps
in my colon. My doctor removed them. Does this mean they were cancerous?
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ANSWER: You and many others share this condition with our President, as
polyps of the colon are the most commonly found in the digestive tract. There
are two type of polyps, pedunculated (attached by a thin stem or stalk) or
sessile (attached to the wall of the intestine by a broad base). Although
they occur as a single lesion in most patients, some individuals with a an
inherited syndrome may have literally hundreds of polyps growing. The most
common type of colon polyps are classified as hyperplastic (excessive growth
of normal tissue) or as adenomas (benign growths of glandular tissue). While
hyperplastic polyps probably remain benign, adenomas are considered to be
precancerous. Since these classifications are the result of a microscopic
study of the tissue, and to take no chances of leaving any possible cancerous
growths behind, all polyps are removed and then classified. You will have to
ask your doctor for the tissue report of your polyps to find out just what
they were, but the probability is that they were benign, and your operation
prevented a dangerous cancer from occurring. And as I so frequently write
here, prevention is just about the best kind of medicine there is.

Red Peppers for Pain From Shingles

QUESTION: I suffered from a terrible attack of shingles. While the rash is
now gone, the pain hasn't, and nothing seems to control it, though I have
taken everything. My friend tells me he read where red peppers could do me
some good, but I don't know how to fix them. Is there anything you could tell
me to help me?
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ANSWER: It's not cajun cooking you need, but to know that an oil made from
plants of the capsicum family, a family that includes cayenne or red pepper,
was touted to reduce the pain in cases of shingles (doctors call it herpes
zoster). A purified form of this extract is called capsaicin (sold under the
brand name of Zostrix), and apparently works in these cases. Scientists
believe that a chemical, called Substance P, may play a role in transmitting
pain and that the when capsaicin is used in a cream, applied to the area of
pain, it works to neutralize the action of Substance P. Although the
medication is available in rather low concentrations, reports are that it
works well. At present they are investigating the use of higher
concentrations, which apparently are even more effective in controlling the
pain that becomes chronic in many shingles sufferers.

Educating Youngsters About Reproduction and Sex

QUESTION: I break out into a cold sweat every time my 4 year old son starts
wondering where babies come from. I have doubts that I know enough about
educating youngsters of his age about reproduction and sex, yet feel there
must be an answer both to his question and my problem. I wish you could take
over for me. What do I do?
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ANSWER: If the answer that you are not alone can help you to relax, then be
assured, there are many other parents in this same boat. The hardest part is
overcoming your own doubts of inadequacy; but fear not, you can manage quite
well if you stay calm and follow a few important tips. Stay cool, stay
accessible to your youngster, and stay simple. Don't panic when such
questions arise, but listen carefully. You may be making more out of the
question than Junior is intending. When your reaction shows that you don't
find such discussions difficult, you remain the first person to ask for such
information, an important position you don't ever want to abandon. Once the
intent of the question is understood, answer as fully but as simply as
possible. Don't launch into that complete lecture you have been rehearsing
against this moment, as it is just not necessary. There will be time enough
for that in the future, if you don't lose the thread of curiosity that
promotes the questioning at this time. You are just at the beginning now,
with plenty of time to read up on the advice from the experts, and become
prepared to continue such conversations throughout the emotional, social and
yes, sexual development of your offspring. You have the responsibility to
guide your child through the trials of growing up and teach the ethical
principles that motivate your own life.

What is Strep Latina?

QUESTION: I am sure the diagnoses of a recent infection in my youngster was
called strep latina, but my trips to the library have been in vain. No such
strep! Since everything is now fine, I don't want to bother my own doctor, so
can I please bother you? Have you any idea what this infection is?
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ANSWER: It is no bother, that's why we're here. It was a bit more like a
hunt for a culprit without sufficient clues. Actually I was at a theater,
waiting for the show to begin, and the words of your question kept going
around and around in my mind when, suddenly, the flash came! Not strep
latina, but scarlatina, another name for scarlet fever, which is an infectious
disease caused by strains of Group A streptococci. Once a very common and
frightening disease, it is rather uncommon these days, due to the wide use of
effective antibiotics. It begins, ordinarily enough, with a sore throat and a
fever. In from 1 to 5 days, the characteristic fine sandpaper like red rash
appears on the chest, and rapidly spreads to all other parts of the body.
While there is a pale area around the lips, the rest of the face becomes
flushed and red. The tongue takes on a "strawberry" look, and some of the
creases in the skin show darker red lines. The skin rash is caused by a
toxin, or poison, produced by these special strains of the strep bug. Other
than that, the infection is much like a garden variety strep throat and can be
treated with penicillin, which shortens the course of the illness in young
children. At any rate the fever disappears after a few days, and the
infection will run its course with recovery complete in two weeks. I am sure
your youngster is well now, but certainly provided me with an interesting
puzzle.

Educating Youngsters About Reproduction and Sex

QUESTION: I break out into a cold sweat every time my 4 year old son starts
wondering where babies come from. I have doubts that I know enough about
educating youngsters of his age about reproduction and sex, yet feel there
must be an answer both to his question and my problem. I wish you could take
over for me. What do I do?
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ANSWER: If the answer that you are not alone can help you to relax, then be
assured, there are many other parents in this same boat. The hardest part is
overcoming your own doubts of inadequacy; but fear not, you can manage quite
well if you stay calm and follow a few important tips. Stay cool, stay
accessible to your youngster, and stay simple. Don't panic when such
questions arise, but listen carefully. You may be making more out of the
question than Junior is intending. When your reaction shows that you don't
find such discussions difficult, you remain the first person to ask for such
information, an important position you don't ever want to abandon. Once the
intent of the question is understood, answer as fully but as simply as
possible. Don't launch into that complete lecture you have been rehearsing
against this moment, as it is just not necessary. There will be time enough
for that in the future, if you don't lose the thread of curiosity that
promotes the questioning at this time. You are just at the beginning now,
with plenty of time to read up on the advice from the experts, and become
prepared to continue such conversations throughout the emotional, social and
yes, sexual development of your offspring. You have the responsibility to
guide your child through the trials of growing up and teach the ethical
principles that motivate your own life.

What is Strep Latina?

QUESTION: I am sure the diagnoses of a recent infection in my youngster was
called strep latina, but my trips to the library have been in vain. No such
strep! Since everything is now fine, I don't want to bother my own doctor, so
can I please bother you? Have you any idea what this infection is?
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ANSWER: It is no bother, that's why we're here. It was a bit more like a
hunt for a culprit without sufficient clues. Actually I was at a theater,
waiting for the show to begin, and the words of your question kept going
around and around in my mind when, suddenly, the flash came! Not strep
latina, but scarlatina, another name for scarlet fever, which is an infectious
disease caused by strains of Group A streptococci. Once a very common and
frightening disease, it is rather uncommon these days, due to the wide use of
effective antibiotics. It begins, ordinarily enough, with a sore throat and a
fever. In from 1 to 5 days, the characteristic fine sandpaper like red rash
appears on the chest, and rapidly spreads to all other parts of the body.
While there is a pale area around the lips, the rest of the face becomes
flushed and red. The tongue takes on a "strawberry" look, and some of the
creases in the skin show darker red lines. The skin rash is caused by a
toxin, or poison, produced by these special strains of the strep bug. Other
than that, the infection is much like a garden variety strep throat and can be
treated with penicillin, which shortens the course of the illness in young
children. At any rate the fever disappears after a few days, and the
infection will run its course with recovery complete in two weeks. I am sure
your youngster is well now, but certainly provided me with an interesting
puzzle.

The Risk of Infection and Diarrhea From Raw Eggs

QUESTION: My friend claims he has a great recipe for the "morning after"
blues. He mixes a raw egg with a lot of other junk and claims his head clears
right up. I told him he could catch an infection and diarrhea with this
concoction but he won't listen. Please tell him about the risk he runs.
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ANSWER: The risk of developing a Salmonella intestinal infection from raw
eggs has increased rather dramatically over the last several years. In
Northeastern United States it has jumped five fold between 1975 and 1985.
While not all cases may be blamed on the eating of raw eggs, at least 29
outbreaks of enteritis associated with raw egg consumption were reported in
the same area of our country in a two year period. While the method by which
eggs become contaminated is not always easy to determine, prevention of the
infection is simple enough. Eggs, like other foods that are composed of
animal products, should be cooked thoroughly before eating. A cooking heat
where the internal temperature of the food reaches at least 165 degrees
Fahrenheit is recommended. The myth that raw eggs are somehow a special
"health food", or have specific powers to erase the ill effects of night of
alcoholic indulgence, can be totally discounted, despite the claims for
miracle morning after concoctions. The risk of salmonella infection, with its
symptoms of mild to severe diarrhea, fever, headache and occasionally
vomiting, is far more real, and include the possibility of loss of life. You
are doing your friend a real service with your accurate advice, and perhaps
showing him this answer to your question may help him, and others during this
time of holiday celebration.

Depression During Winter

QUESTION: My husband tells my I'm exaggerating when I tell him I'm feeling
down again, but it's real and it happens every winter. I know there is a
sickness like this because I read about it, and I hope you can include a
description of my problem in your column.
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ANSWER: It is a real disorder, and each winter my mail contains requests
similar to yours just about this time. Its name, Seasonal Affective Disorder
(SAD), and its initials pretty well describe how victims feel when it strikes.
Their depression is marked by impaired performance on the job, problems at
home, diminished sexual drive, increased appetite particularly for
carbohydrates, and a feeling of general sadness and anxiety. It's more common
in women than men, about 6 to 1, and usually first appears when patients are
in their early 20s. Doctors have been advised to look for four criteria
before making this diagnosis. They include a history of at least one episode
of a major depression, depressions occurring during the winter for at least
two consecutive years in which the springs and summers were without problems,
absence of any other major psychiatric problem, and absence of any life
stresses that could explain the depression. While treatment can include the
use of antidepressant medication, exposure to full-spectrum bright artificial
light on a regular basis has also been found to be effective. The patient
receives the bright light treatment for two hours each evening, between 6 pm
and 8 pm, may read or watch television, and generally are helped within 3
days.

Is Surgical Repair Necessary For a Ruptured Bicep?

QUESTION: Three weeks ago I ruptured my left bicep. Now I get an abnormal
bulge when I flex my arm. It causes no discomfort, but I am wondering if it
is necessary to submit to surgical repair since it does not interfere with my
normal activities. I am 64 years of age.
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ANSWER: The biceps is a most interesting and important muscle. Its name
comes from the fact that it has two major parts, or heads (bi: two; ceps:
heads), separate masses of muscle, which start from two origins in the
shoulder but end in a single ligament attached to the radius, a bone of the
forearm. While its major function is to lift the lower arm towards the body,
it also helps to twist the lower arm. It is a strong muscle, but it was never
designed so that just one head could manage the work normally assigned to two.
You have been fortunate in not taxing the muscle so far, but if we wish to
stay with the warning "If it isn't broken, don't fix it," then we must accept
the need to fix what has been damaged. The operation is not complicated, but
in my opinion it is necessary for a man your age.
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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.

"Runner's Knee" After Long Periods of Driving

QUESTION: I am a salesman, spending long periods driving through my
territory. Lately, after such a drive, I experience a piercing pain around my
left knee when I exit my car. After a careful exam, my doctor called this a
"runner's knee" despite the fact that I do not run or jog and only play tennis
on a rather irregular basis. Is it possible for you to validate my
physician's diagnosis?
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ANSWER: I must assume your physician ran all the necessary tests and x-rays
in addition to the careful examination you mention before making this
diagnosis. If I am correct he probably also discussed some muscle weakness
with you, for runner's knee is a form of anterior knee pain seen frequently in
athletes that causes the type of pain you describe, in which there is a
weakening of one of the muscles of the thigh (vastus lateralis). It falls
into the category of overuse syndromes, but many types of conditions are
grouped together and the rather inaccurate name of chondromalacia patellae is
applied to them all. I know of your complaint as the "theatre symptom," as it
occurs as well after long periods of sitting with the knee flexed at movies or
concerts. Sports physicians believe the pain arises from the imbalance in the
alignment of the patella (kneecap) because the inner thigh muscle is too weak
to keep the cap in its proper place. A series of special exercises are in
order, or the use of a muscle stimulator to get this muscle back in shape. If
both your doctor and I am correct, the condition should improve in two or
three months.

Urine Loss During Coughing or Lifting

QUESTION: I am frequently embarrassed when I lose my urine during a coughing
fit, or when I bend over to lift my grocery packages. I know this frequently
comes on in people my age, but I don't understand why, or if there is anything
I can really do to prevent it. Will you please help?
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ANSWER: I'll do all I can to help you, and then tell you where even more help
is waiting. Your condition is the most common cause of involuntary loss of
urine in women, and is called stress incontinence. It is provoked by almost
any action that causes sudden increases in the pressure in our abdomen, simple
things like sneezing, straining, lifting and of course, coughing. It is due
to the change in position of the tube leading from the bladder to the outside,
the urethra, which falls below its normal place behind the pelvic bone and can
no longer hold back the urine as it should when pressures suddenly increase.
It can also result from the relaxation of the muscles of the pelvic floor,
another result of the aging process. There are several strategies that may be
used to correct the problem and prevent your embarrassment. Sometimes simple
exercises to strengthen the muscles will suffice. (They are called Kegel's
exercises.) Medications to strengthen the actions of the muscles which keep
the urethra closed are available and frequently quite effective. Mechanical
devices, such as a pessary, can be used to restore the correct anatomical
position of the bladder outlet. Finally a surgical procedure may be necessary
to strengthen muscles and reposition the involved organs.

Problems With Snoring

QUESTION: My problem is this: I've had my nose broken 4 times playing
various sports. Now I snore like a herd of stampeding buffalo. My marriage
is suffering because my wife is a light sleeper. Help me, please.
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ANSWER: Snoring is not a matter to be taken lightly, as it may be associated
with a number of quite serious situations, including sleep apnea. That is a
condition in which the sleeper stops breathing for 10 seconds or more up to
300 times a night. Of course, the obvious diagnosis in your case would be to
blame the problem on you poor beat up nose. If the passage through which you
inhale air is obstructed, you have to pull harder to get the air in. This
creates a partial vacuum effect that pulls the soft part of the airway
together and which vibrates as you breathe, causing the snoring. However,
before we condemn just your nose, you require a thorough examination of your
nose, mouth, palate, throat and neck. If your nose is the culprit, there is a
real possibility that only surgery can correct the obstructive conditions that
are causing your sleep symphony.

What Method is Best to Quit Smoking?

QUESTION: With all the advice saying the same thing (including material in
your column), I've decided to quit smoking. Now that the decision is made, I
don't think I can take it cold-turkey. What method do you think is best and
do you think I can manage it by myself?
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ANSWER: Different folks need different strokes, but self-help programs have a
very low success rate, and I don't advise them. I prefer some more structured
situation, with your physician or counselor to keep tabs on you and offer
support, advice and suggestions if the going gets rough. If you are truly
physically addicted to nicotine, then perhaps using a medication, nicotine
polacrilex, may be the best route for you. Answering a few simple questions
contained in the Fagerstrom nicotine tolerance scale will help your physician
determine level of addiction. Using medication in a well designed program
that includes counseling and behavior modification training will provide the
best odds in your favor. There are two such techniques that may interest you.
A rapid smoking technique requires that you inhale once every six seconds
until you just don't want any more, frequently brings on all the unpleasant
symptoms you first experienced when you started smoking, nausea, dizziness and
general discomfort. When you begin to associate the smoking with all the bad
effects, it may help you quit. Another technique, called satiation smoking,
requires that you triple the number of cigarettes you normally smoke over a
20-45 minute period. Other techniques, such as hypnotism, electroshock and
acupuncture do not show great effectiveness in controlled clinical trials,
though I know of some individuals who credit their successful battle against
nicotine to their use. Actually it is up to you, and with a little help from
your friends, you can succeed.

Sinus of the Heart

QUESTION: I am told I am suffering from a sick sinus in my heart. It may
mean that I must have a pacemaker put in to keep my heart beating, and I need
to know all I can about this. I thought sinuses were in your nose; can you
tell me about this sinus in my heart?
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ANSWER: Though the words are they same, the anatomical structures are quite
different. Sinuses in the head are open spaces in the bones of the head. The
sinus in the heart is called the "sinus node", and is made up of cells that
are responsible for kicking off the nerve impulses that control the beat of
your heart. These impulses travel along a conduction system within the heart
and assure that the rhythm and sequence of the heart muscle contractions will
propel the blood through the heart and thus through the entire body. The
"sick sinus syndrome" (SSS) is the condition in which the system of impulse
formation and conduction fails to operate properly, slowing the heart beat or
reducing its effectiveness. It is most common in patients over the age of 60
and is the reason for the placing of about half of the permanent pacemakers in
use in the United States. There are a number of diseases that can cause SSS,
including situations where the blood flow to the heart is reduced, infections
of the heart and rheumatic heart disease.

Do You Have any Suggestions that Might Help with My Problem Itch?

QUESTION: It probably is associated with the seasons, because it happens each
year at the same time, but I develop a terrible itch throughout my body that
is often more than I can bear. I've tried a number of antihistamines with
little success. Do you have any suggestions that might help?
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ANSWER: Your description, the time of the year and, incidentally, your
postmark all help me to determine that you are probably suffering from the
effects that cold winter weather may inflict on your skin. The colder air of
winter fails to hold the amount of humidity or moisture that the warmer
breezes do, and as a result our skin literally "dries out", becoming itchy as
a result, and often making our fingertips crack and our lips chap. If, in
addition, your sweat glands are a bit less active, or your body oils are
decreased due to your own body chemistry or advancing years, your
susceptibility to this annoyance is increased. The problem may run in
families, particularly where there is a history of allergies, asthma and skin
problems. It may be aggravated by a commonly used remedy for aches and pains
that come on with cold weather, soaking hands and feet in warming baths or
tubs. This extracts the oils in the skin even more, as can over frequent
bathing and washing, and the use of too much soap. When winter skin dryness
strikes, there are a number of ways you can help yourself, but antihistamines
is not one of them. Try to limit your washing and bathing, and switch to a
mild soap, one with low alkaline content that may contain oil or skin
moisturizers. Use specifically prepared skin moisturizers and lotions after
bathing. The over-the-counter products do just fine. Protect damaged skin
from additional exposure; use moisturizers to treat chapped lips. If winters
truly get to you beyond your ability to endure, and your life style and
circumstances permit, you might consider spending this time of the year in
climates that are more considerate of your skin.

What is the Cause of Sinus Headaches?

QUESTION: Every time a get a slight cold, it seems as if my sinuses fill and
I develop a sinusitis. The pain is often very severe, and I have a headache
that won't quit. I've always wondered what caused this, and what treatments
are available to help me at times like these. Please explain.
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ANSWER: Although the diagnosis of sinusitis may be made too frequently by
patients who are merely suffering from a runny nose, you certainly have
symptoms that go with the ailment. The sinuses are actually cavities in the
skull, and we have four pairs of them. They are all lined with a tissue that
becomes swollen and produces a thick mucous when allergies or a common cold
strikes. The channels that provide drainage of these cavities into the back
of the nose become blocked, and the mucous backs up and becomes infected,
producing the condition known as sinusitis. And with that come the splitting
headaches, tenderness and pain. The usual first line of attack against this
infection are antibiotics, along with antihistamines to reduce the congestion
and pain medicines to alleviate the pain. Frequently this will suffice to
successfully control the condition, but when medical treatment fails, surgery
may be necessary. A new development in sinus surgery is Functional Endoscopic
Sinus Surgery, that utilizes a small telescope-like instrument to enlarge the
area where sinuses drain into the nose. It is a lot less traumatic than
previous surgical techniques and shortens the time of recovery. Sinuses lie
close to vital brain structures, and sinusitis can spread into these areas if
not treated properly or in time. If pain persists longer than 24 hours,
worsens, or fever develops, it's time to consult your family physician.

Insight Into Sinus Trouble

QUESTION: Although my wife believes that sinus trouble is very much like a
common cold, I have always thought that this was a most serious disease, and
that it can easily cause death. Can you offer us some insight?
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ANSWER: There is a bit of truth in both positions in this friendly family
health discussion. While every common cold does not become a sinus infection,
sinusitis is a complication of upper respiratory tract infections in about 1%
of the cases. When the normal defenses of the sinus break down, bacterial and
viral infections can penetrate into these normally sterile spaces and create
quite a problem. The tissue lining the sinus spaces becomes inflamed,
producing a thick secretion which may block the normal flow of secretions from
the sinus and create painful pressure in the sinus. As the bacteria continue
to grow, this pressure increases and with it, pain and tenderness, fever and
purulent (pus) discharge. Since the sinuses lie so close to the brain and
other very sensitive nerve structures, any spread through the thin bony walls
of a sinus can produce infections of the brain's coverings (the meninges) and
to the brain itself. Fortunately this is a rare occurrence, and generally is
not seen in otherwise healthy individuals. Rapid diagnosis has been advanced
by using the CT scanner, which can accurately reveal the presence of infection
as well as any damage to the sinus walls. Intensive use of antibiotics and
surgical drainage can usually control these life endangering complications.

Is There a Shy-Drager Disease?

QUESTION: A member of our family has been diagnosed as having Shy-Drager
Syndrome. I have been unable to find this in any medical reference book. In
response to my questions, the doctors tell me that they are doing all they can
and that this is a very rare disease. Can you explain and tell me if there
even is such a disease?
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ANSWER: Indeed there is, and it is a rare disease. It occurs in adults,
coming on slowly and gradually. It's major problem is that the blood pressure
drops when the patient attempts to stand, but other symptoms such as visual
troubles, tremor, and muscle wasting form part of the syndrome. Although the
cause is still unknown, it is a generally progressive degenerative process of
the central nervous system, that eventually severely incapacitates the
patient. Cortisone derivatives and salt are used to try to correct the low
blood pressure, but there are no effective treatments known that can halt the
progress of the neurological changes.
----------------
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.

Has Tuberculosis Been Wiped Out?

QUESTION: In my day Christmas Stamps supported the Tuberculosis Foundation,
and there were always x-ray vans around for free x-rays to locate the disease.
The fact that they are no longer with us tells me that tuberculosis has been
wiped out like polio. Help me win a bet by telling me I'm right?
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ANSWER: I hope your wager was a small one, for tuberculosis (TB) is still
with us, and after many years of fewer and fewer cases, the numbers have
suddenly begun to increase again, with a total of 22,575 cases reported in
1985. And according to at least one expert, it may be more difficult to
diagnose these days, as the symptoms are less dramatic than before.
Classically, a patient would suffer from a history of cough and would produce
sputum, frequently blood stained. There was also the complaint of weakness,
fever, loss of appetite and weight loss, and night sweats. But TB may occur
in adults today with few or no lung symptoms at all, and the typical picture
of the disease may first be diagnosed on x-ray picture of the chest, possibly
taken for totally other reasons. But even x-rays can be deceiving, and
physicians rely on other diagnostic procedures, such as skin tests, and
microscopic examination of the sputum to locate the bacteria. Cultures and
immunological tests help round out the array of diagnostic techniques. The
good news is that the treatment of tuberculosis, which in the past could
prolong for as much as 12 to 18 months, may now be accomplished in as little
as 6 to 9 months. Several potent antibiotics are available, including
isoniazid, rifampin, pyrazinamide, streptomycin and ethambutol. Various
protocols exist, using two or three drugs simultaneously to assure the cure of
this infection.
----------------
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 Causes Loss of Taste Sense?

QUESTION: It seemed to come on gradually, but now I find that I have lost my
sense of taste. My food no longer has the kick it once had, and I guess I am
eating less because of this. Can you explain the cause of this, and what may
be done to help me?
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ANSWER: You are not alone, for taste and smell disorders are common problems
and may afflict as many as two million Americans. Since taste may depend upon
our ability to smell, both senses require careful evaluation in the search for
the explanation for a loss of taste. The cells which are responsible for
detecting odors and tastes are stimulated by molecules contained in foods we
eat and substances we smell. These cells transmit the sensations to the brain
for identification. However the ability of the cells to function properly
declines with advancing years. The sense of smell for example is most acute
between the ages of 30 and 60, then diminishes so that many older people are
affected as you are. There are other reasons to explore though, since loss of
smell and taste may be caused by dental problems, during upper respiratory
infections, after injuries to the head, and exposure to certain chemicals. If
you are a smoker, your ability to distinguish between different tastes and
detect odors may suffer as well. While some medications reduce abilities
others, such as antiallergy drugs, may improve the senses of taste and smell.
You may help yourself considerably if you can determine circumstances that
seem to affect your tasting abilities, and making note of it. Do seasonal
changes or exposure to chemical sprays seem to make a difference? Take these
important notes along with a listing of all the medications you are taking to
your physician at your next visit. They will help in the complete history and
examination that may lead to the solving of this problem.

Are There Pills That Can Give a Tan and Are They Dangerous?

QUESTION: The most important thing in the world to my girlfriend is a glowing
tan. Although she knows about the skin cancer scare, she claims she can
develop her tan from lotions and pills. Are there really pills that can give
you a tan, and are they dangerous?
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ANSWER: At least your friend has taken heed to the many warnings about
excessive exposure to sunlight and its relationship to skin cancer. But her
hopes for the tan color she is seeking to achieve may not be quite as easy to
achieve as she has been led to believe. It is true that both lotions and oral
chemicals exist which affect our skin color. The creams and liquids applied
directly to the skin contain an active ingredient called dihydroxyacetone,
which stains the outer layer of our skin (the stratum corneum). While this
chemical may occasionally cause a skin rash, the incidence is relatively low.
However this is not a true tan, in that the skin has not produced any
additional pigments itself, therefore the coloration is no protection against
sun burn. Rather than the tan-bronze look that is so desired, it creates an
orange-yellow coloration, a bit unnatural looking. As for the pills, they are
composed of beta-carotene, which also finds its way to the outer skin layer to
produce a coloring effect, concentrating the most where that layer is
thickest, the soles and palms of the hands. It is used medically to treat
light skinned persons suffering from vitiligo, a condition that causes loss of
color in the skin through the loss of the color producing cells called
melanocytes. There are few serious side effects from these pills but though
it may give your friend a color, but I have real doubts that her new hue will
meet with her esthetic expectations.

Tetanus-Diphtheria Injection for Older People

QUESTION: I was visiting with my daughter and grandson and tagged along when
they visited their physician. As the doctor was vaccinating the baby, he told
me that it might be a good idea for me to get a tetanus-diphtheria injection
from my physician. Before I spend the money, I thought I'd get your opinion.
Is this a good idea?
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ANSWER: It certainly is. Although the number of cases of diphtheria have
declined steadily because of routine immunization of children, there are still
from 200 to 400 cases reported each year. As serious as this infection is in
children, the prognosis in older people is much worse. Due to lack of routine
adult immunization programs, less than 40% of adults are protected against
these diseases. Yet the adult tetanus-diphtheria booster injection is almost
100% effective, with only mild reactions. About half the time there is local
redness and tenderness at the site of the injection, but rarely do we see
fever or generalized reactions. The current advised schedule of routine of
booster injections only requires one injection every ten years. It is
suggested that by having it on every birthday ending in a "5" (such as 45, 55,
65 etc.), it may be easier to remember. Of course, if a doctor's visit on
your birthday is not a way you wish to celebrate, anytime during the year will
do. While on the subject of immunizations, there are two other vaccines to be
considered at this time of year, influenza vaccine and pneumococcal vaccine.
New "flu shots" are produced each year in anticipation of the strain expected
to attack our population. Now is the right time for this protection which
will be effective about two weeks after the injection and continue for six
months. Pneumococcal vaccine is also advised for older citizens, and one of
these will last you for a lifetime, according to current recommendations. It
too can be given now, at the same visit when you are getting your flu
injection. The pneumonias that can result from infections of Influenza and
pneumococcus are particularly severe in persons over the age of 65, and
protecting yourself now really makes good sense.

Opinion on Sexual Activity in Older Persons

QUESTION: You recently discussed sexual activity in an older person, and gave
your opinion that you never became too old for sex. I think you are wrong,
from my own personal observations, and are giving your readers a bum steer
just to satisfy your own personal and hidden feelings. I bet you never
publish this letter.
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ANSWER: I suppose when you are wrong, you might as well be totally wrong, and
so I will publish your letter and respond to your concerns. Family physicians
are becoming more and more aware that they must consider the possibility of
sexual desire and sexual activity in even their most elderly patients. This
is not a moral or social judgement, or even an expression of personal
sentiment, but merely acknowledges the facts as we are beginning to understand
them, and the fulfillment of our responsibilities to our patients. A recent
study conducted by the San Francisco State University, as reported in the
Archives of Sexual Behavior, surveyed 202 healthy retirement home residents,
ages 80 to 102. They discovered that while 62% of the men and 30% of the
women actually experienced intercourse, 88% of the men and 72% of the women
thought about it in daydreams and fantasy. The most common sexual activity
was touching and caressing without actual coitus, for many men expressed fears
of poor performance and inability to maintain an erection, while the women
lacked vaginal lubrication and drive. Though orgasm was difficult to attain,
it is clear that the will was still there, and the desire to express their own
humanness was still aglow. My answers respond to the requests for
information of my readers, based upon the facts as I find them. You need not
feel threatened by my findings or your feelings, but are free to live your
life as you choose, and in a manner that brings you happiness and joy.