Wednesday, October 3, 2007

Will One Dose of Medicine Cure a Bladder Infection?

QUESTION: You wrote that you believe in one dose of medicine to cure a
bladder infection. My doctor says you're wrong. Who should I believe?
ANSWER: This is an area about which there is some obvious disagreement; in
fact, a recent issue of a medical journal featured the question, and had two
doctors address the question, one on the side of one-dose therapy, and one on
the side of several days of therapy for bladder infection. Both sides
presented valid arguments.
The one-dose method has the advantages of reducing the complications of
longer-term therapy, such as stomach upset and yeast vaginitis. Cost is
usually lower and taking one pill is more convenient than taking several a day
for several days. Initial reports about this method of treatment indicated
that cure rates were quite high; now, with more experience with this method,
we are seeing that only about 70 percent of patients are cured using the
one-dose method. In young, healthy people, this is not a significant health
risk; if the problem is not cured, it does not progress to a more serious one
but instead creates uncomfortable symptoms.
Instead of the one-dose method, many doctors are now favoring a
compromise between the one-dose and the longer, more conventional method.
Three days of therapy is effective in most healthy patients, and the cost of
this treatment is comparable to the one-dose cost.
Whether medication is given for one day or for several, it is important
that the correct antibiotic be given. Sometimes the bacteria that causes the
infection is not sensitive to that particular medication, and only a change in
medicine will be effective in curing the infection. In people who have
frequent bladder infections, this can be a common problem because they become
resistant to certain antibiotics. The only way to know for sure whether
bacteria is sensitive to a particular antibiotic is to run a "culture and
sensitivity" test.
Anytime an antibiotic is prescribed, whether for a bladder infection or
any other problem, take all of it as prescribed. Don't stop taking it as soon
as the symptoms disappear, because the bacteria are probably still present.
Once the antibiotics are discontinued, the bacteria will again flourish,
causing symptoms. Taking all the medications will help prevent this from
If you have frequent bladder infections, you may want to evaluate several
habits that may be a factor. Do you empty your bladder every time you
urinate? Bear down after urinating, to ensure that all the urine is emptied
from your bladder. Do you put off urinating? If it is difficult for you to
get to a bathroom, whether because of your job circumstances, a physical
limitation, or maybe the fact that you're traveling, you may be inviting a
bladder infection. Find a way that you can empty your bladder more
frequently. Do you drink at least eight glasses of water a day? Limit your
intake of soft drinks and drink water instead. In females, after using the
toilet, wipe from front to back. This keeps bacteria away from the urethra,
which leads to the normally sterile bladder.
I still hold with the one-dose school of therapy, but am wise enough to
know that no single treatment works for every patient. I am also smart enough
not to argue with a knowledgeable family physician who has examined the
patient, knows the situation, and has the best interests of his patient at
heart. In this case, your doctor is right.

How Can a Man Prevent Impotence After Having Prostate Surgery?

QUESTION: What can be done to prevent impotence after men have surgery for
cancer of the prostate?
ANSWER: After age 50, prostate cancer is among the most common in men, with
about 36 out of every 100,000 men developing it every year. It occurs much
more frequently as we age. Half of those with prostate cancer are 70 or
older; yet very few are under 50 years old.
Many males in that group are much less concerned about erections than
they were when younger. However, each patient is different. When possible,
every effort is made not to interfere with the parts of the body vital to
erections during treatments involving the prostate.
Nevertheless, difficulty with erections occur in about 40 percent of men
with prostate cancer even before they receive any treatment. In many of
those, it is due to other chronic illnesses, not the cancer.
Advances in treating prostate cancer are encouraging. Basically, we use
radiation and surgery.
Surgery usually removes the prostate gland, seminal vesicles and part of
the urinary bladder and often, but not always, causes impotence.
There have been important advances in radiation therapy and it is used
with certain forms of prostate cancer and may not cause impotence.
However, I must point out that one scientific study revealed that smokers
were far more likely to develop impotence following radiation for prostate
cancer than were those who do not smoke.
In one particular form of radiation treatment called brachytherapy, a
radioactive source is placed in close proximity to the cancer. It delivers
only a low dose to the surrounding normal tissues but extremely high ones to
the cancer. Results have suggested that brachytherapy prevents impotence in a
great majority of those treated with it, yet some experts question its
long-term effectiveness against certain types of cancer.

What are the Risks of Teenage Pregnancy?

QUESTION: Our teenage daughter is expecting a child and we are worried about
the risks to both mother and child. What can be done to overcome these
ANSWER: Your concern is not misplaced, for statistics show that there is a
higher risk of serious health problems to babies born of teenage mothers. Of
primary concern is the birth weight, for these babies are often too small and
born too soon. Their organ systems are therefore immature and undeveloped.
The metabolic systems which control body temperature and blood sugar levels
are not yet completely in working order, leading to additional problems and
The mother too, runs additional risks to both her physical and emotional
health. Serious complications of pregnancy, and yes, even death, are higher
in the group of under-15-year-old mothers. Their education and social
development are seriously impaired in most cases, and their future
compromised. But sensitive and caring parents can do much to prevent the
number and severity of these consequences of teenage pregnancy. They can help
guarantee that medical care starts early in the pregnancy and that regular
physician visits are scheduled and fulfilled. Proper nutrition with the
necessary vitamin and calcium supplements are a must, and have substantial
positive results. Make sure that the mother-to-be does not smoke or indulge
in alcoholic beverages. The facts are such, that no drugs can be safely taken
during the pregnancy, particularly the first three months, and all medications
must by supervised by your physician. The fewer taken, the better. In
addition your love and support is essential, and your participation in helping
your child make the right decisions about her child are important
contributions to the welfare of all. Consider taking advantage of counseling
services that may be available through your local school or your local March
of Dimes Birth Defects Foundation. Your letter indicates that you can provide
all of this important support. Good luck.

How Impressionable are Babies at an Early Age?

QUESTION: After delivering our baby, my wife has sunk into a severe
depression. I am worried that the baby will be able to sense this. How
impressionable are babies at this age?
ANSWER: It is possible for even very young babies to sense a mother's
postpartum depression. It is not clear, however, whether there may be any
long term effects because of these negative moods. Studies have found that
infants--even those who are ten weeks old and younger--respond to their
mother's emotions. When a mother looks into a baby's eyes and speaks with
loving, happy or joyful words and expressions, the infant usually responds
with similar expression.
When the mother expresses sadness, babies often turn away and become
quiet. Many try to soothe themselves by sucking on something--a lip or a
finger. The reaction to a mother's anger is often tears on the part of the
baby. Other babies may respond to anger by freezing and a blank stare. Still
other babies may mimic the mother's anger.
Until your wife comes through her depression, you should try to give her
all the support you can and your baby plenty of time, expressing love,
happiness and positive feelings. If this situation is prolonged unduly,
please seek some help from your physician as well.

How Can A Couple Adjust After Becoming Parents?

QUESTION: Please help me. I feel like something has gone terribly wrong with
my marriage, and this is supposed to be a joyful time for my husband and me.
You see, we just had a baby two months ago. Although my husband loves the
baby, he seems jealous. Also, he doesn't seem to understand that I'm
exhausted from working at my new and never ending responsibilities and I'm not
in the mood to have sex as often as we used to before I was pregnant.
ANSWER: Rest assured, your problem is not unusual in couples who have just
become parents. There is a big adjustment to be made now that you are a
threesome. Little attention is paid to the sexual adjustment of the couple.
Instead, the focus becomes the health-care needs of the baby and mother, which
are important, but not to the exclusion of the health of the couple. Some
couples wind up viewing their newborn's arrival as the beginning of the end of
sex, which can have terrible ramifications on the family if not worked
Both parents usually experience sleep disturbances with the baby's
arrival, leading to fatigue. This is a major cause of decreased sexual desire
after childbirth.
Other factors that interfere with the sexual relationship are tension,
anxiety, preoccupation, fear of another pregnancy, career demands, and the
woman's feeling that she is now unattractive due to weight gain.
There is also the very common problem of dyspareunia--an abnormal
condition in which intercourse becomes very painful for the woman.
About 16 percent of women who deliver vaginally report discomfort during
intercourse one year postpartum. Fathers should be informed by doctors that
most couples have a decreased frequency of intercourse from a few months after
conception to at least a year after birth. New parents need to learn to
communicate about their personal problems and fears. You should bring your
husband along with you to the standard exam six weeks after delivery.
Your doctor can then explain that initial lovemaking should be gentle and
lubrication should be used to alleviate the woman's pain or dryness. You
should also know that it is possible for you to get pregnant again very
quickly, another important consideration.
Couples need to learn to shift their attention from intercourse to other
forms of physical pleasure.
Touching, kissing, caressing, massaging will help re-bond the sexual
relationship. Learn to be creative in lovemaking; oral and manual forms of
sex can be exciting and fulfilling if you work at it.
Get your husband involved in caring for the baby, share both the joys and
difficulties with him. His understanding of the reasons for your mood are
important if his actions are to change. Remember, you are now building a
family, a step up from just working at a marriage. The problem of "jealousy"
is resolved when you can respond to his anxiety with the reassurance that a
caring word or a tender gesture can offer. I am sure you feel it, it just
takes a moment of thought to express it.
If you can't seem to work through this problem within a short time, then
see a doctor or counselor to help you and your husband get back on the right

Should Pregnant Overweight Women Worry?

QUESTION: I'm pregnant and fat. What do I need to worry about?
ANSWER: Overweight women experience more problems during pregnancy than women
of normal weight, and women who are unable to return to their pre-pregnant
weight following delivery may find that having additional children will make
their weight problem worse.
Generally, you are considered overweight if you weighed more than 200
pounds before you were pregnant or 250 or more during pregnancy.
One of the most common complications in overweight women is hypertension
(high blood pressure), which can cause slow growth of the fetus, and may even
result in a stillbirth. One type of hypertension associated with pregnancy is
most common if it is the first pregnancy, and it is more likely to occur if
you are overweight. Another possible problem is gestational diabetes, which
is more likely to occur in pregnant women who are overweight.
Overweight women are also at higher risk of having abnormalities during
labor, such as those necessitating cesarean section, and they are also at
greater risk for postoperative complications.
There is a much lower risk of premature delivery in overweight women than
in normal weight women, but a higher rate of postdate deliveries--deliveries
occurring after 42 weeks gestation.
It is important for you to get early prenatal care so that any
complications can be detected and managed as quickly as possible. Your doctor
probably will not want you to try to lose or maintain your weight during
pregnancy, since weight gain during pregnancy is normal and important to your
baby's development.
Although there are potential complications associated with overweight
pregnancy, most obese women have normal pregnancies and healthy babies

Is It Safe to Use Marijuana During Pregnancy?

QUESTION: It is important for me to get some straight facts. Is it safe to
use marijuana during pregnancy?
ANSWER: No. Aside from legal issues, marijuana poses risks to the baby not
only during but even before pregnancy.
Use of marijuana prior to pregnancy has been associated with decreased
fertility, and should be avoided by both partners if pregnancy is desired. In
men, it can reduce the number of sperm and their ability to move. In women,
it may cause shorter menstrual cycles.
During pregnancy, marijuana consumption poses an increased risk of
spontaneous abortion and adverse effects on the child. Marijuana's main
psychoactive ingredient--which is largely responsible for the "high"
associated with this drug--is known to cross the placenta and affect fetal
development. Its effects are linked to decreased birth weight and early as
well as prolonged labor. Several studies suggest it may even affect the
gender of the baby.
Evidence of marijuana also appears in breast milk of nursing mothers,
which may also pose a risk to the child.
Restrictions on human studies with marijuana make it impossible to obtain
conclusive information on its effects in pregnancy. However, based on animal
studies and the available human information, the best advice to men and women
contemplating pregnancy, and women who are pregnant or nursing, is to abstain
from using marijuana, as well as other drugs and alcohol.

Can Obstetricians Induce Labor with Sexual Stimulation?

QUESTION: I've been told that obstetricians can induce labor with sexual
stimulation. Is this really done?
ANSWER: While it is true that sexual stimulation can cause the uterus to
contract, which in turn helps induce labor, it is not something done in normal
obstetric practice. A woman who is in a delivery room waiting for her labor
to progress is not likely to be in the mood for sexual stimulation, in any
case. Further, stimulation of the genitals after the membranes have broken is
not a good idea since there is the chance of causing an infection.
It has been known for some years that stimulating the nipples can induce
uterine contractions. The trouble is that the effect is unpredictable. There
is no way to gauge how much stimulation will induce how much contraction. The
contractions can be excessive and excessive contractions are more bad than
good. If labor is not progressing, it is better to either wait it out or use
medications to bring it on, since the effect of these drugs can be closely

Does Breast Milk Prevent Cancer in Children?

QUESTION: I read a newspaper article which reported that breast milk prevents
children from getting cancer. I don't understand how this works, or how
important it is. Would you please look this up and report to us?
ANSWER: I missed that newspaper article, but suppose it dealt with some
research recently published in a British medical journal called "The Lancet".
Two groups of children were compared, 201 with cancer, and a group of 181
comparable healthy children. The risk for cancer was 1.8 times greater for
bottle-fed babies than for those who were breast-fed for more than six months.
The difference seemed to be due to the presence of a type of tumor called a
lymphoma, which is frequently associated with infections. Since breast milk
is thought to provide material which helps the underdeveloped immune system of
the baby fight off infection, these infants are not as likely to develop
tumors associated with infections. Cancer is rare in children, occurring only
in about 14 out of every 100,000 children, and lymphoma is rarer still. Even
if these findings are borne out by future research, the dangers are slight.
There are many other proven reasons for breast feeding that are statistically
more important that make it a recommended method for assuring the nutrition
of a newborn.

Questions About Steroids

QUESTION: I have a lot of questions about steroids that come from hearing
all about the things that happened at the Olympics. Are these the same
steroid that are used for skin rashes and allergies? Isn't true that the bad
side effects have probably been overstated by the press? I can't believe any
sane person would take the risks some of the reporters talked about. Please
give us the straight "dope"!
ANSWER: Pun noticed and accepted. To begin with we are talking about another
type of steroid than those included in creams and medications for rashes and
allergies. Such medicines are called corticosteroids, and resemble the
natural hormone "cortisone" produced by the adrenal gland. They have nothing
in common with anabolic steroids, which are more closely related to the male
hormone testosterone. Therefore these drugs have both an anabolic, or
building effect, as well as an androgenic or masculinizing effect. Whether
taken orally or by injection, it is the liver which must handle the chemical
actions and changes that occur within the body. After change, and being used
by the body (metabolized), the left over fragments of the chemical
(metabolites) are excreted by the kidneys, and may be found in the urine tests
used to check the Olympic Athletes. Let's look at some of the side effects,
and I will let you be the judge of the press reportage of possible dangers.
Among the minor side effects are psychological disturbances, including
abnormal aggression, mood swings, and even psychiatric problems. Add in sleep
disturbances, changes in sexual activity and libido, acne, masculine traits in
women (chest and lip hair, enlarged clitoris and baldness) for completeness,
and now to the major side effects. They include liver tumors, peliosis
hepatis (a condition of the liver where many small blood filled cystic spaces
develop in an area that liver tissue has died), hepatitis, leukemia, and
imbalance of the types and amounts of cholesterol in the blood. Overstatement
by the press? Not in my book. Both the press and the International Olympic
Committee are to be complimented in taking the hard stand against the misuse
of potent and dangerous drugs. As to the "why" of these actions by athletes,
take a look at the tremendous dollars involved in product endorsements, and
try to calculate the pressures they exert on many young people who are
striving to rise above their disadvantaged beginnings. I, for one, am glad
this is now in the open, giving us all a chance to re-examine our own

What is Vitiligo?

QUESTION: I know my condition is called vitiligo, but I know little else
about it. I am under treatment that is long, but I can't see any results yet.
Can you offer me some explanations and information?
ANSWER: Your disease is not all that rare as it affects about 1% of the
population, touching patients of all sexes, ages and backgrounds. At least
half the patients report a family history of vitiligo or other problems with
skin pigmentation. Vitiligo is a disorder of the coloring or pigmentation of
skin where the cells which produce color (they are called melanocytes) are
destroyed for reasons which remain unknown. This results in patches of skin
which are lighter than the surrounding areas, and which can occur anywhere on
the body, predominantly on the backs of hands and wrists, face and neck, and
around body openings. Repigmentation may occur without treatment, but when it
doesn't, treatment is directed at stimulating the production of cells that
produce the color. A medication called psoralen is used in conjunction with
ultraviolet light. It's a long process, as you have discovered, and can
require more than 100 treatments in some cases. About 75% of treated patients
will have a satisfactory result, although total recoloring is never achieved.
Cosmetics may help cover the remaining areas or newly developed tanning
solutions that do not wipe off on clothing may be used.

Should Older People Seek Treatment for Skin Growths?

QUESTION: My dad, who is seventy-five, has a number of skin growths. Should
he just leave them be, because of his advanced age, or should be seek some
medical treatment?
ANSWER: Well, a dermatologist friend of mine believes it's never too late to
treat skin growths. In older people, she thinks it's very important from an
emotional standpoint. Some growths are badges of age, which she feels people
don't always wear proudly. So, by all means take your dad to a doctor. The
typical growths found in the elderly are small, discolored skin tags in which
malignant transformation is rare and treatment is relatively simple. Removal
is usually accomplished through scraping, freezing, or acid treatments. Liver
spots, another type of skin growth, frequently go untreated and are waved off
as a sign of aging. But there is no need for this, since they are simple to
treat and respond to bleaching or liquid nitrogen peels. Now the more serious
growths are cancers and must be treated. Basal cell carcinoma, found most
often on the head, neck, or upper trunk, is a slowly advancing cancer which is
easy to remove through cryosurgery. Squamous cell carcinoma developing as a
solitary nodule sometimes necessitates deeper procedures as does malignant
melanoma. Let your father be treated for these growths, either for his ego or
his life.

What is a "Prophylactic Mastectomy"?

QUESTION: It sounded impossible to me when my girl friend told me about it,
so we thought we would write to you for more information. Have you ever heard
the term "prophylactic mastectomy?" Please explain it.
ANSWER: "Prophylactic mastectomy" describes removing a breast in an effort to
prevent--not treat--breast cancer.
Breast cancer appears to be on the increase, and the survival rate has
not improved much. Early diagnosis and treatment are certainly helpful, but
the fact remains that much damage can be done before the cancer is found and
treated. If the disease could be prevented, obviously many lives would be
One way to prevent breast cancer is to identify the women who are at
extremely high risk for developing it and remove their breasts. This is a
controversial treatment that some consider radical while others consider it
prudent and cautious. The women who are most often considered for
prophylactic mastectomy are those who have had breast cancer in one breast,
those with a strong family history of breast cancer, those who have certain
precancerous conditions, and those with a combination of risk factors that
indicate they are at especially high risk for developing breast cancer.
Prophylactic mastectomy should be undertaken only after careful consideration
by patient and physicians, with a full understanding of the risks of the
surgery as well as the risks of developing breast cancer. There are no
clear-cut answers here; weighing all the alternatives, with solid medical
advice from more than one source, is the best course.

How Do You Treat a Leg Ulcer?

QUESTION: I'm sixty-five and I've recently developed a leg ulcer that my
doctor told me was caused by my "bad veins". What are some methods of
treatment and preventing another one?
ANSWER: I'll give you some information as I recount the history of a recent
patient of mine, who also suffered from venous ulcers. Marie was a
grandmother with five grandchildren. She had spent a large part of her life
as a packer in an aeronautics plant, and she also had a history of
hypertension. She visited my office and upon examining her feet and legs I
noticed a patch of scaly, discolored skin on her calf. I immediately
suspected the beginning of a pattern that could lead to a leg ulcer because of
her hypertension and former occupation. People at higher risk for venous leg
ulcers are those over sixty-five, obese people, women who have had children,
and those with some of the accompanying diseases of old age like hypertension,
diabetes, other cardiovascular disease. Smoking is a great risk factor in leg
ulcers. Also people who must stand on their feet a great deal with little
opportunity for moving about seem to be afflicted. And then there is the
natural aging process--the skin loses its ability to heal, plus swelling, poor
circulation, and inadequate nutrition all lead to the skin being easily
I explained to Marie that this type of leg ulcer develops when the deep
veins are not performing properly, and the surface veins become blocked and
cause a lack in blood supply. This is the reason for the discoloration and
tissue death deep in the leg. Beside the discoloration, other warning signs
are scaling and a shape to the leg reminiscent of an upside-down champagne
bottle--wide in the calf and very narrow in the ankle. Some actions can be
taken to reduce the risk of developing another leg ulcer. Wear support
stockings everyday as soon as you get up in the morning. Watch you legs
carefully for any changes in the skin texture and color. Do give up smoking
if you haven't already done so. Lose weight if you are overweight. Try to
keep your feet at about the level of your heart while sitting and raise the
end of your bed so feet and heart are about the same level when you sleep.
These precautions are also the therapy for existing leg ulcers. Also,
never put an over-the-counter ointment on your leg ulcer; this could cause a
severe allergic reaction; your dressing must be changed about once a week. If
there is a leakage of pus, return to your doctor who will change the dressing
and lessen the risk of infection. Once your ulcer is healed, be wary of your
legs. Try not to bang them against furniture and keep in touch with your
physician, who will probably recommend a moderate exercise program of walking.

What are Fibrocystic Breasts?

QUESTION: After much delay, and unnecessary worry, I consulted my doctor who
made a diagnosis of "fibrocystic" breasts. Can you offer me some information
about my condition?
ANSWER: Fibrocystic breasts, although they may cause you concern or
discomfort, are usually considered to be a benign condition that does not
affect your risk for breast cancer. So you should follow the same guidelines
to check for cancer warning signs that are recommended for all women,
regardless of whether they have fibrocystic breasts. Regular breast
self-examination is very important. Your doctor may recommend a breast
screening, including a mammogram, physical exam, and instruction on how and
how often to perform a self-examination.
Some patients with fibrocystic breasts find that the condition disappears
by itself, particularly if you avoid caffeine (although this is a subject of
some controversy) and wear a support bra. Your doctor may also prescribe a
diuretic or, if your condition is relatively severe, the medication danazol.
If your mother, an aunt, or a sister have had breast cancer, or if you
have had a mastectomy or a biopsy that showed a potential for concern, you may
be advised to have an annual mammogram. If no problems appear after two
years, you may only need this test every two to three years.
There is little chance--less than 0.2 percent--of getting breast cancer
in the year after a mammogram indicates no problem. But because 12 percent of
cancers detected by screening clinics are ones that develop between visits,
it's important for you, and for every woman, to practice self-examination.

Can Estrogens Prevent Breast Cancer?

QUESTION: I am approaching menopause, and the question of using estrogens has
me quite perplexed. I've heard the hormone can cause cancer, now the news is
that it doesn't. Help! Can estrogens prevent breast cancer?
ANSWER: Estrogens are often used to counteract the symptoms of menopause by
replacing the estrogen levels found in pre-menopausal women.
A variety of studies have come to a variety of conclusions about the
relationship of estrogens to breast cancer: Estrogens have been associated
with increasing the risk of breast cancer, protecting against it, and having
nothing to do with it.
The concern about estrogens and breast cancer has arisen because of the
association of these hormones with endometrial cancer. However, although both
the breast and the uterus are affected by estrogen, they respond differently.
If you have an intact uterus, your doctor may recommend reducing the estrogen
risk by adding progestins to your therapy.
However, progestins may eliminate the beneficial effect that estrogen has
on cholesterol: estrogens reduce the level of harmful low-density
lipoproteins (LDLs), while progestins increase them. By attempting to reduce
the risk of breast cancer by adding progestin, you may lose the protection
estrogen provides against coronary heart disease--the number one cause of
death among middle-aged and older women.
Some women, such as those with benign breast disease, may be at increased
risk of estrogen-related breast cancer, but for most women, the risk is not
affected by the low-dose estrogen used to control menopausal symptoms. Based
on your own history and your family history of breast cancer and heart
disease, you and your doctor can decide whether estrogen, or a combination of
estrogen and progestin, is best for you.

What is EB?

QUESTION: Doctors have two incredible habits, either they talk in words too
long to understand or they are forever using just initials. Please translate
for me. Just what is EB? A hint: it's a skin disease.
ANSWER: EB stands for epidermolysis bullosa, (which is too hard for even a
doctor to say and so is abbreviated using the initials), an inherited skin
disease affecting children. Because it occurs rarely, we call it an orphan
disease--a disease that lacks a solid research basis with no cure in sight.
Blisters occur constantly on the skin, erupt and then scar. The most gentle
touch of a hand can cause the blisters. Kids with EB must be constantly
protected from everything in the world. Just as we keep babies away from
things that will hurt, everything can hurt the child with EB.
It has its varieties: EB simplex occurs at birth, it is nonscarring, and
may affect nails and mucous membranes. What is heartening in this form of the
disease is that the patient improves with age. Junctional EB is more serious.
It too occurs at birth with blistering, but also produces a tightening and
thinning of the skin. In its severe forms it is a killer through infection or
blistering of the GI tract, kidney, or bladder within the first two months of
life. Dystrophic EB causes blistering in areas of the body where there is
friction: hands, feet, knees. Each of these varieties has a recessive or
dominant form, depending upon the genetic inheritance.
As we said earlier, it is a disease without a cure and treatment methods
are cloudy. Skin grafts as in burn victims have sometimes been helpful. Some
pharmacologic approaches have been tried. Nursing therapy is at the core of
EB treatment, involving the day-to-day decisions about just what can touch
these kids' skin without further harm.

How Long Does Chemotherapy Continue?

QUESTION: I am currently being treated with medicine for my breast cancer.
It's a difficult time, and I am trying to keep calm and not develop any more
anxiety than exists now. I need more information. I would like to know how
long I must endure this.
ANSWER: That's a question physicians and cancer researchers raise often
because not everyone agrees on the answer. The treatment you mention,
chemotherapy, uses combinations of extremely strong drugs that can kill the
cancer cells. Traditionally, a patient with metastatic (spreading) breast
cancer received chemotherapy for as long as no progression of the disease
could be noted. Once additional spread could be detected, medication was
stopped. Now, some oncologists (cancer specialists) prefer using chemotherapy
for six to eight months. The chemotherapy is repeated only if they find a new
outbreak or spread of the cancer.
Although continuous chemotherapy may increase the survival rate more than
shorter courses of drugs, some comparative studies show little or no
difference. The quality of life for cancer patients must be considered, since
chemotherapy can be very difficult to endure. Shorter courses of chemotherapy
(three months), however, do not have as good a response rate. I understand
your moods; hold tight. Since physicians vary in their methods of treatment,
I can only advise you to discuss this matter more fully with your own
physician, who can explain his treatment strategy for your case. You may have
a happy surprise that will tell you that the time of treatment is shorter than
you imagined.

What Causes Cauliflower Ears?

QUESTION: They make us wear ear guards on the wrestling team to protect
against cauliflower ears, but I was never quite sure how the condition
developed. Would you please explain?
ANSWER: Keep those protectors on, a cauliflower ear is not the most
attractive sight in the world. The structure of the ear is formed by
cartilage, which gives it flexibility and shape. Covering this is a tissue
which carries blood to the cartilage called the perichondrium. When a
forceful blow strikes the ear, the blood vessels can rupture, bleed, and form
a clot, which can turn the ear into a swollen, shapeless reddish purple mass.
If allowed to remain untreated, the clot becomes a thick scar and may
eventually become hard as it is slowly transformed into bone-like material by
deposits of calcium. A few such masses, and you have a cauliflower ear.
Proper treatment requires removal of the blood clot using suction drainage
through a cut in the skin.

What Could Cause Terrible Hip Pains?

QUESTION: Please help. I am a senior, senior citizen, and can't always
afford medical care all the time. Perhaps you can diagnose my problem. What
could cause terrible pains in my hip?
ANSWER: For one of the most difficult of all diagnosis to make, you have
provided me with far too little information. There are many causes of
"terrible" pains in the hips and, unfortunately, many of them mimic each
other. That made it difficult for doctors to diagnose exact cause of those
pains in the past.
Even with modern technology, accurate diagnoses still rely upon careful
examination and observation by your physician. X-rays are helpful but many
causes relate to the soft tissues which surround your hip joint. All
possibilities must be considered carefully when searching for the cause of
your pain.
Before we discuss some of the possible origins of your pain, here's a
quick description of the hip itself. It is the only true ball and socket
joint in the human body and, except for the knee, is the largest joint. It is
a major source of symptoms of pains in several parts of the body including the
back, legs and buttocks. When you take a step or rise from a sitting
position, a force of 2.5 to 3 times the weight of the body is exerted to the
weight-bearing dome of the hip. So, our hips take a "beating" as we live long
Arthritis is immediately suspected when a patient goes to a doctor
complaining of pain in the hip area. But there are many clinical conditions
that can affect, or be affected by, the hip that do not stem from arthritis.
Nevertheless, osteoarthritis and rheumatoid arthritis cause more than 90
percent of such diagnoses.
The most common causes of hip pain after a fall or some other trauma are
fractures. Next in frequency are synovitis, necrosis (death of cells in the
lining of joints), and avascular necrosis (death of cells caused by a
deficiency of blood supply).
Occult (difficult to see) fractures most frequently occur in elderly
patients with osteoporosis. They are more common in women than they are in
men and usually follow a rather minor fall. Avascular necrosis happens in all
ages and may result from huge corticosteroid intake, excessive alcohol
consumption, drugs that cause the immune system to become weakened, trauma,
and sickle cell anemia. There are, of course, other less frequently occurring
reasons for hip pain such as untreated congenital dislocation of the hip,
metabolic hormonal conditions in children, and other less well understood
There are three major conditions that mimic hip disease. These include
pain caused by pressure on nerve roots, trochanteric bursitis (affects the
upper part of the hip bone), and vascular insufficiency.
Hip disease treatments usually are conservative, using medication to
reduce the pain symptom for as long as patients can tolerate the discomfort
and inconvenience. Using a cane can help relieve some of the pressure from
your hip and reduce the pain.
Though I would love to be a "miracle doctor" for you and my many other
readers, it simply can't be done by answering a question in this column. In
cases such as yours, only the careful examination by a caring physician can
start you on the road to relief.

What is Fibromyalgia Syndrome?

QUESTION: I've been to dozens of doctors with this never relenting problem of
aches and pains. It seemed as no one believed me or knew what I was talking
about. Finally one physician told me I had FS, but was less than hopeful.
What can you tell me about fibromyalgia syndrome?
ANSWER: Fibromyalgia syndrome (FS), also called fibrositis, is a common but
often unrecognized form of rheumatism of unknown cause, characterized by
diffuse aches, pain and stiffness. Patients are often tired, emotionally
distressed or depressed, and may have light, restless sleep, headaches, and
other chronic complaints.
Although millions of patients have FS, it remains a relatively little
known and poorly understood disorder. It occurs about ten times more often in
women than in men, and the age at diagnosis is usually between 35 and 60
Because the symptoms of FS are similar to rheumatoid arthritis,
osteoarthritis, and tuberculosis, and a patient can have one of these problems
as well as FS, confusion can arise as to what the patient is suffering from
and how to treat it. Diagnosis relies upon laboratory tests to rule out other
Among symptoms your doctor will look for are chronic aching; feeling
tired when you wake up; a pattern of stiffness and fatigue in the morning; and
tenderness in a dozen or more specific sites. These symptoms will have been
going on for months, and you may notice that they get worse with certain types
of weather, activity, and stress.
It is important for the patient and family to become actively involved in
the treatment of FS. No single "miracle drug" cures FS, and the approach
varies with each patient. Although FS is not a form of arthritis,
nonsteroidal anti-inflammatory drugs (NSAIDs), which are used for arthritis,
are also effective for some FS patients. Tricyclic antidepressants at bedtime
may help patients sleep better and may also relax muscles.
Changing your lifestyle to reduce stress and set aside time for
relaxation and recreation is advisable, and a psychologist can help you to do
this. Physical therapy, such as massage, acupressure, ultrasound can be
helpful in combination with medication therapy.
Often, relief can also be provided by warm and dry (rather than cold or
humid) weather; hot showers; moderate activity rather than either
overexertion or a sedentary lifestyle; and rest. It's amazing how much better
you may feel after an energetic walk that has not exceeded your abilities or
pain threshold.
In cases that do not respond to these methods, the doctor may inject
local anesthetic into particularly tender muscles.
It is essential that you, your family, and your doctor all recognize that
FS is a real problem--not just something in the patient's mind--and, although
it is a cause for concern, it is not a reason for undue alarm or worry. FS
does not kill or cripple, but it can cause pain that can be intense at times.
The therapy for FS is an evolving one, and more and more doctors now
recognize the syndrome, and diagnose it correctly. Stick with the doctor who
seems to have a handle on your case. Fortunately, there are good treatment
strategies available that can help people with FS.

Can Electricity Heal a Fracture?

QUESTION: It may sound nuts, but I am sure I saw something about this on a TV
program recently. Have you every heard of using electricity to heal a
ANSWER: You are not losing your mind, I have heard of the process you saw
televised. The usual therapy for a broken bone is to immobilize it (with a
cast generally) until the ends knit, or heal together. Most broken bones heal
within six months. However, there are always a few that either heal more
slowly or refuse to heal at all and, for these there is the choice of using
electric bone-growth stimulators or undergoing bone graft surgery.
Back in the 1950's, it was found that bones that were mechanically
stressed (by normal exercise) produced small electrical charges. This
mechanical stress helps bones to grow stronger and researchers theorized that
an external electrical charge would do the same thing, which is how the
stimulators are thought to work. The results from using bone growth
stimulators is roughly comparable to bone graft surgery, with success rates of
between 75% and 85% compared to 85% to 95%.
Because the technique is noninvasive, it is worth a try in those
difficult cases where bones just won't knit.

What is the New Procedure for Dealing with a Ruptured Disc?

QUESTION: I know I must do something to rid myself of the pain that is
keeping me from a normal life. The physician I have been sent to informed me
that it is a "ruptured disc" that is pressing against a nerve and causing my
suffering. He wishes to use a new procedure which will suck the disc out of a
tube placed in my back, and relieve the pressure. Have you ever heard of
this, is it safe and how does it work.
ANSWER: Your physician is describing a new technique that may be used to
treat ruptured disc called "percutaneous automated discectomy" and it could
well be the answer to your problem. A disc is a round cartilage structure
that is sandwiched between two vertebrae in our spinal column. Each disc is
composed of two parts, an outer, tough, elastic, fibrous ring, and an inner,
soft, pulpy nucleus. When the outer ring tears or breaks from pressures
exerted on it by the vertebrae, the pulpy center is squeezed out through the
break and may press upon nerves which lie just outside and next to the disc.
This condition is called a "herniated disc". Older surgical procedures
removed the disc completely and held the two adjacent vertebra in place using
a bridge of bone (laminectomy), a difficult operation, with a long recovery
period. The new procedure uses a probe-like cutting-suction device which is
passed through a small tube that has been placed against your injured disc.
Local anesthesia is used to block the pain at the site of insertion in your
back. The probe is then inserted through the fibrous ring into the pulpy
center and sucks out the nucleus of the disc, relieving the pressure. However
this procedure is only indicated where the fiber ring is stretched out of
shape, before it has torn, a situation identified on X-Ray. The operation is
successful in about 80% of the cases, and greatly reduces pain and costs.

What is a "Muscle Contraction" Headache?

QUESTION: What is a "muscle contraction" headache?
ANSWER: It is one of the most common types of headache, and it is also called
a "tension headache." The muscles of your head and neck are powerful ones
(just think of how powerful your jaw muscles are). When those muscles are
contracted for a long period of time, a headache often results. Add this to
the fact that many of us respond to stress by clenching our jaws, grinding our
teeth, and using our faces to frown our displeasure at the world, and you can
understand how a muscle contraction headache gets started.
How do you know if your headache is of the muscle contraction variety?
It's usually one that is a feeling of tightness and pressure, often feeling
like a tight band is around the head. Women get them more frequently than
men, and the pain is usually on both sides of the head. Many times, the
headache sufferer can identify the stressful situation that has created the
If headaches are more frequent than twice a week, the situation should be
carefully evaluated by patient and physician. If the stressors cannot be
altered, the patient can often learn to react to them in a more healthy
manner. Biofeedback training can be helpful in teaching the headache sufferer
to relax instead of to tense up and get a headache. During biofeedback
training, the patient's head and neck muscles are connected to a machine that
alerts the patient, or gives him "feedback" when the muscles are tense or
relaxed. This helps the patient identify what a tense muscle feels like, so
that he can avoid the habit of tensing that then creates a headache.
The cycle of pain and tension can be a tough one to break. Once the
headache pain starts, the tense muscles are harder to relax. Probably the
most effective way to get rid of a muscle contraction headache is to make a
conscious effort to relax the head, face, neck and shoulders, enjoy some rest
and quiet, and take a mild pain reliever such as aspirin or acetaminophen.
The warmth of a heating pad or hot water bottle also often provides a welcome
relief to aching, tight muscles.

What Can You Do About Back Pain?

QUESTION: It would seem that I have lived a life plagued by frequent and
recurring bouts with back pain. I barely bend over to perform the smallest
task and I can feel it go out, and know I am at war again. So it's back to
pills and liniments. What else is there that can help? I would appreciate
any suggestions.
ANSWER: You have read it before, and here I go again. Each case is
individual, and the treatment strategy must fit the circumstances. But here
is a general list of things that can be done and a personal recommendation for
you. First there are oral medications: muscle relaxants, analgesics and
anti-inflammatory agents. They help, but rarely can correct the situation
alone. Next, physical measures: bed rest, massage, heat, corsets and braces,
and exercise. More help, but each must be used appropriately as part of a
complete program. Another treatment, injected drugs: steroids, local
anesthetics only offer temporary relief that is short lived.
Counter-stimulation may be used, employing electrical nerve stimulation to
overcome the pain broadcast by the nerves in the injured muscles. A bit
controversial, and costly. Last, but by no means least in my book, education
and behavior modification: In clinics specializing in these injuries, a team
approach may bring you some new information that will aid you in preventing
injury, and dealing with it when it does occur. A specific program of
exercises that restore the strength to back muscles, increase flexibility, and
help adapt to the tasks you may have in your daily living, in the last
analysis, may be the way for you to escape a life time of repetitive and
frustrating "battles".

Is Arthroscopy Good for Other Joint Problems?

QUESTION: I thought that arthroscopy could only be used for knees. Is
arthroscopy any good for other joint problems?
ANSWER: Arthroscopy is a form of minor surgery. A special instrument called
an arthroscope is inserted into a joint through a small incision. The surgeon
looks through the arthroscope into the joint and diagnoses the problem. In
some cases, surgery on the joint can be performed using special small
instruments while the surgeon views the scene through the scope. Arthroscopy
is usually done on knees, but can also be performed on shoulders, elbows,
ankles, and in a few cases, wrists and hips. Because there is only a small
incision, there is a reduced risk of complication than with normal joint
surgery. Regular surgery leaves much larger scars.
Arthroscopic surgery, which allows the patient to be up and about within
days, has been widely used on many famous athletic knees in recent years and
has gotten a lot of publicity. Unfortunately, now everyone with a bad joint
thinks they're candidates for arthroscopy too. In medicine, however, nothing
is right for everyone.
Some people do not need any kind of joint surgery and simply need to rest
the joint or physical therapy to strengthen the muscles around the joint. In
other cases, arthroscopy will not do the job and full surgery is called for.
A badly injured knee from an accident may require full surgery because
arthroscopy would further traumatize the knee. If there is a superficial skin
infection around the joint, such as an infected scrape or bruise, arthroscopy
is usually delayed until after the infection is gone so that it is not
inadvertently spread into the joint.

How an Arthritic Patient Can Enjoy Sex

QUESTION: I'm an arthritis patient, but I want to continue enjoying sex. Can
you offer advice on how to do this?
ANSWER: Many arthritis patients experience difficulty as they try to have
sexual relations.
Some patients hesitate to ask questions regarding sexual problems they
are facing, yet it is wise to discuss those concerns with your physicians.
While some physicians may lack the time or feel uncomfortable in offering
detailed sexual counseling, they now can make referrals to others who
specialize in such therapy. Among those professional approaches are physical
therapy, arthritis counseling groups and psychotherapy.
Physical performance in sexual relationships may be impaired if some of
the following joints are affected by arthritis including: hips, spine and
hands. Yet, there are treatments for each of those. Concerning hips,
physical therapy can improve hip motion and surgical procedures that restore
movement can improve sexual ability as well. Total hip replacements often
greatly improve the hip motion needed for sex. If the spine is affected,
surgery, anti-inflammatory nonsteroid drugs and physical therapy can help.
When there is difficulty with the hands, certain drugs can help as can
paraffin baths and other physical therapies as well as surgical corrections.
The comfort and closeness that sexual relationships provide and the
excitement accompanying sexual activity ease arthritic pain for long periods
of time. Also, a rewarding sexual relationship frequently decreases self-pity
and provides interludes of normal living that are a delightful change when one
suffers chronic illnesses.
Arthritis may cause major problems for pregnant women. Cesarean sections
may be necessary for delivery. Pregnancy often lessens arthritic symptoms,
especially in those with rheumatoid arthritis but there always is a
possibility of severe symptoms after delivery.
Fortunately, many sexual problems associated with arthritic problems now
are being recognized and defined. Yours is a most legitimate question and the
good news is that there are now answers available for you that can help, if
you ask in the right places.

What Causes Hives?

QUESTION: This may seem like a trivial question, compared to some you answer,
but I hope you will devote some space to it. What causes hives?
ANSWER: It's not a trivial question at all, as you will see. Hives,
technically termed urticaria, can be caused by a wide variety of factors that
involve either internal or external conditions. In many cases, the triggering
agent can remain elusive, but fortunately, hives usually clear up within a few
days and leave no evidence of damage to the skin. Furthermore, there are many
medications currently available that help control the symptoms.
Drug allergies are one possible cause of hives, with penicillin being the
most common agent. Hives will usually occur within thirty minutes of the
initial dose, making the source identification fairly simple. However, drugs
that cross-react with penicillin can delay the onset of a hives outbreak and
patients can frequently develop an allergic reaction to a drug whose prior
exposure did not cause a reaction, thus making positive drug identifications
quite complicated.
Aspirin is another drug that causes hives, though it is frequently
overlooked because patients rarely think to mention it when questioned about
medications they may be taking. Drug additives, such as sulfites that are
used as stabilizers in many liquid medications, can also trigger hives. And,
in some cases, patients can develop a hypersensitivity to an allergy shot
antigen which will result in hives as well.
Skin sensitivity is another source of hive outbreaks. After a walk in a
field, allergens such as pollen can penetrate the skin's surface and cause
welts. The licking or scratching of the skin by a pet can cause hives as
well. Sensitivity to certain materials, such as rubber gloves, can create
local reactions, as can touching certain foods like raw shellfish which may
cause no reaction when eaten in a cooked form. In most cases where skin
sensitivity is the culprit, the hives will develop within minutes and resolve
in a few hours.
Food allergies are yet another common link to hives. Peanuts, fish,
shellfish, milk, and eggs are the most common offenders, and usually produce
additional symptoms such as an itching in the mouth, a swelling in the throat,
cramps, diarrhea, and vomiting which make identification readily obvious.
However, in cases where the food allergy is not clear, testing should be done
before limiting a patient's diet unnecessarily.
Certain external factors can contribute to hive outbreaks as well.
Friction from tight clothing can trigger hives to develop along lines of
pressure, as can sudden exposure to cold air or water. Sweating induced by
heat, exercise, or anxiety can also produce skin lesions.
Whatever the cause, treatment for hives is readily available. Avoiding
offending food or drugs will usually prevent repeat attacks, but in chronic
cases, a daily antihistamine or corticosteroid may be advised. Patients
suffering from hive attacks should still bear in mind that even though the
condition is a puzzling one, it is not permanently damaging.
Sometimes the most elementary questions have complicated answers, and
common problems, like hives, have enormous implications to our health and well
being. That's why I never mind researching out even the simplest questions
you ask.

What is Gardener-Diamond Syndrome?

QUESTION: I have a peculiar pattern of frequent bruising. It doesn't seem to
have anything to do with a knock or bang, but the bruise is painful, and lasts
for several days. My doctor explained it as something to do with gardiners'
red cells, but by the time I arrived home it made no sense. I am truly
worried. Can you help?
ANSWER: When we are under stress, we can easily be confused by an explanation
about a diagnosis that causes us great anxiety. I believe your doctor was
trying to explain Gardener-Diamond Syndrome to you. It is a disease of the
immune system in which the body becomes sensitized to its own red cells and
destroys some of them. Frequently emotional stress plays a part in setting
off the development of these bruises. Usually there is a local sensation of
burning or tingling that occurs from 18 to 24 hours before the bruises
(purpura) appear, which can last for 5 to 7 days. They are most frequently
seen on the extremities and scalp, seldom on the back, and do appear in areas
where there is no history of a bang or knock. However, since they are
painful, patients frequently believe they have had some kind of trauma to the
area. Blood tests to help diagnose this condition, such as coagulation tests
and platelet counts, are normal. It's a diagnosis that is sometimes quite
difficult to make, and once made, it is a discouraging disease to treat.
There are no known cures, and even the use of cortisone-like medications and
antihistamines offer little relief. Attempts to desensitize the body are also
unsuccessful. You may also expect this to recur every now and again, usually
when things are not going your way and you are having some emotional or
psychological problems. With this explanation in hand it might be wise to
return to your doctor so he can discuss your personal situation and offer some
explanations that are particular to your situation.

Should You Panic When Your Baby Gets a High Fever?

QUESTION: I panic when my baby gets a high fever. Help!
ANSWER: You are not alone. Fever is one of the most common reasons for a
call or visit to the doctor, and that's the way it should be--even though the
cause of the fever may not be serious, only your physician can determine that.
It may reassure you to realize that the majority of children with fevers
do not have any serious disease, and all you need to do is make the child feel
more comfortable. The only time fever is dangerous, and requires treatment,
is if your child is prone to fever-related seizures. In that case, it helps
to cover the child with only a very light blanket and give him or her plenty
of fluids.
Otherwise, your "fever phobia" may be more of a problem than your child's
fever itself. It may be helpful if you learn to recognize what to look for,
when to worry--or not worry--when you child has a fever, and what to do.
First of all, a fever is defined as a temperature over 100 degrees F
taken orally or 100.5 degrees F rectally. Because the body has its own
temperature-controlling mechanisms, you don't need to provide any treatment
for fevers unless they are over 102 degrees F and your child is uncomfortable.
You can treat the child using medication containing acetaminophen, but avoid
aspirin in babies and young children and safeguard against Reyes Syndrome.
If your baby's temperature goes over 104 degrees F and does not respond
to medication, try sponging with lukewarm water.
Allow your baby to sleep--there's no need to awaken him to take his
temperature or give him medicine. In fact, even if he's awake, you don't need
to keep rechecking his temperature unless he seems very hot or uncomfortable.
It's more important to report your child's signs and symptoms to your
doctor than it is to record his temperature. And bear in mind that the most
important thing is for you to stay calm. Urgency is appropriate only for
temperatures higher than 106 degrees F or for long-lasting convulsions. But
in most cases, your job is simply to comfort your baby until the fever

What Is the Mary Tooth Disease?

QUESTION: We are a long way from our family, and probably have the story all
wrong, but we are worried and seeking help. It seems our granddaughter has
the Mary Tooth disease, and now is going to a medical specialist for care.
Shouldn't she be seeing a dentist? What is it our children are keeping from
ANSWER: It isn't hard to become confused when doctors keep using the names of
the discoverers of a disease when discussing it with patients, instead of
something more descriptive. Dr. H.H. Tooth, an Englishman, along with two
French physicians, P. Marie and J. M. Charcot, described a condition of muscle
weakening in the legs in 1886. Today the the disease is frequently called
Charcot-Marie-Tooth. And neurologists and orthopedic surgeons frequently work
together to combine their skills in fighting the effects of "hereditary
sensory-motor neuropathy;" another, more descriptive name of the disease. It
starts at puberty or young adulthood, usually with weakness and changes in
feeling in the foot, then the legs. It is genetically transmitted disease,
and other similar diseases can frequently be found in the family pedigree. It
is slowly progressive, altering the gait and reflexes of the affected part.
It is seldom totally incapacitating, and frequently becomes stationary. The
diagnosis is confirmed by using electrical test of the muscles, and conduction
in the nerves. There is no specific treatment for the disease, but bracing
may help the weakness in the foot, and surgery can be used to help stabilize
the affected foot. Maybe your children are trying to keep some of the pain
from you, but now that you know what I can offer, perhaps you can add your
strength to theirs, and a phone call seems in order.

What is Youth "Sports Burnout"

QUESTION: My husband says there's no such thing, and that our son is just
lazy. The coach has another term for it. What is youth "sports burnout?"
ANSWER: Although for most children involvement in sports provides an
opportunity to have fun and learn new skills, for some youngsters, the sports
environment can have a negative effect causing low self-esteem, depression,
and anxiety.
It is important to recognize early signs of competitive stress that can
lead to "burnout"--loss of energy and enthusiasm for sports. The child no
longer has fun, becomes overwhelmed by the demands, and seeks to escape the
Symptoms include signs of agitation such as sleep disturbances, skin
rashes, nausea, headaches, and muscle rigidity. Signs of depression are lack
of energy, sadness, frequent illness, and a loss of interest in training and
competing. These conditions make the child more susceptible to injury,
because injury provides a socially acceptable way to escape the pressure.
Burnout often comes from excessive pressure exerted by adults to push the
youth to win or excel. The parents or coaches are likely to criticize the
child's performance rather than be supportive. They may give inconsistent
messages, such as saying that winning isn't everything and then expressing
anger when the child loses. Adults who are always hovering and overprotecting
may cause the child to panic in competition.
The best way to handle youth sports burnout is to prevent it. Adults
need to de-emphasize winning, and instead encourage development of skills.
Find ways to encourage improvement and effort. Try to match the child's
ability with the sports environment--being on the "top" team may be a mistake
for a child who is not as skilled as the other children.
Be careful to have realistic expectations and goals for the child, and
create opportunities for children to feel successful, such as lowering the
rims in basketball, or setting up small playing fields in soccer.
Fun-oriented competition can begin at any age, but as a general rule, a
child is not ready for intense competition and training until about age 14.
Let the child play a variety of sports to maintain interest and develop
Back off, Dad, and give the kid a chance. Listen to the coach. If you
and your child maintain a healthy attitude and reasonable perspective, sports
can help strengthen and preserve the family, promote individual growth, and
provide a lot of fun.

A Question About "Anencephaly" concerning Donation

QUESTION: I have read a great deal lately about the use of babies born
without heads, for organ donations. There seems to be a discussion that I
can't understand. If they are born this way, aren't they dead anyway? It
would be a good idea to give some other child a chance by using the organs
from the dead child. Why don't they just do it?
ANSWER: A clarification or two first. These babies are born with a
malformation called "anencephaly" or congenital absence of the brain. A head
is present, though misshapen and shrunken. The part of the brain which
controls respiration and basic functions, the brain stem, is also present.
While the brain stem functions, the child can not be pronounced "brain dead,"
and until brain death occurs, no organ donations can be recovered. However,
the organs that could be used as donor organs, such as the liver, heart and
kidneys, must be kept alive if they are to be used, and the procedures
necessary for this may also give life to the brain stem. The problem of
proper clinical management of these dying babies still has not been solved.
The ethical problems of treating these children as different from other
seriously ill newborns also warrants careful consideration and study. I agree
with you, I too would like to see a way in which these organs could be used,
but the rights of all, even these doomed babies, must be respected.

What Can Be Causing My Shoulder Pain?

QUESTION: The pain is always there, but dull. What can be causing my
shoulder pain?
ANSWER: The shoulder joint is the most versatile joint in the body,
possessing an enormous range of motion. It allows us to perform strenuous
tasks such as lifting and throwing, as well as simple manual tasks like
writing or sewing. Because of its anatomical complexity, however, a tradeoff
is made. The shoulder's extraordinary range of motion, a great advantage for
many activities, is counterbalanced by an instability that makes it subject to
To diagnose the cause of shoulder pain, a great many factors must be
considered, including bones, muscles, tendons, ligaments, vessels, and nerves.
Since countless causes can be involved, the first step in diagnosing the
problem is to determine the exact location of the pain. The more acute the
problem, the more likely the patient can pinpoint it. How the pain started is
important to determine as well. Knowing if there was an injury or if the pain
came on gradually is a key point in a diagnostic evaluation. If certain
movements cause pain or are impossible to perform, they should be noted, as
should any movements that relieve the pain. Swelling, burning, tingling, or
numbness in the arm will influence the diagnosis as well. Knowing the type of
activity a person engages in is also a key factor when diagnosing a shoulder
ailment. For example, sedentary activities such as writing, typing, or sewing
force shoulder muscles to contract, and prolonged engagement in such tasks can
cause shoulder spasms. Exercising to stretch the muscles can prevent the
problem and should be performed because if the joint is not allowed to move
freely, it can "freeze" and cause the formation of fibrotic adhesions. On the
other hand, strenuous activities such as swimming or overhead work causes
certain tendons to stretch and compress. Such violent, repetitive action may
traumatize the tendon and its sheath, producing pain. Other possible causes
of shoulder pain can include chronic inflammation of a shoulder joint that may
develop if a shoulder injury doesn't heal properly or if the joint is
strenuously worked and abused. Even years after an injury, simple activities
such as rolling on the shoulder during sleep may cause pain, tenderness, and
spasms. Arthritis, tension, fibrositis, and bone calcification are still
further possible causes of chronic shoulder pain. If you are suffering from
undiagnosed shoulder pain, I suggest that you see a physician in hopes of
determining the cause. Simple, five-minute examinations have been designed to
quickly pinpoint possible causes, and it's certainly worth your while to
investigate them. Relief can be readily achieved in many cases.

Is the Phrase "No Pain, No Gain" a Valid One?

QUESTION: I know you have heard the phrase "No pain, no gain," applied to
exercise and muscle development. That's all well and good, except when the
pain is yours and you would rather get rid of it to allow your life and your
work to continue. I'm all for training, but what is your advice for me when I
push it too far, and just start hurting?
ANSWER: It looks like I am too late to use my favorite phrase "Prevention is
the best medicine". Yet it is time you looked at your program, to see if it
is too intensive or too long for your body type, your age, or your present
state of development. Making the necessary modifications may not only help
now, but prevent recurrences of pain from your problem, which I would classify
as an overuse syndrome. When you over do, a micro trauma occurs in your
muscle and tendon tissues. This leads to actual destruction of tissue, and
results in an inflammatory process which produces pain. There are 4 classes
of pain, and therefore 4 kinds of advice I might give you. Type 1 pain comes
on only after activity or exercise, while type 2 is present during activity,
but doesn't hurt enough to hamper your performance. When you can't perform
fully because of pain you have type 3, type 4 classification is reserved for
pain that is chronic and won't go away. For type 1, cut your activity by 25%,
use ice massage after activity, start a stretching program and physical
therapy. Cut your workload by 50% for type 2 pain, and in addition to the
above, you need treatment with nonsteroidal anti-inflammatory drugs (NSAID).
With type 3 pain, complete rest is mandatory, that means you're out of any
competition, and your physician will have to consider injections of cortisone
like medication to reduce the inflammation in addition to NSAIDs. Treatment
for type 4 pain uses everything above, and if unsuccessful, requires
consideration of surgery. If your physical activity is an important part of
your life style, you may well need continuing advice from your physician and
physical therapy counselor to help you develop a program that will increase
your fixable tissue as well as strengthen muscles. But first, take my tip,
and get rid of the pain.

What Can Cause Neck Pains?

QUESTION: I have terrible neck pains. What can be causing them?
ANSWER: Many things could be causing your neck pains and only a detailed
physical examination by a physician can tell you exactly what makes yours so
I do not know how old you are, but neck pain is common in elderly people,
possibly as frequent as low back pain.
Among the numerous possible causes are degenerative changes in vertebral
column tissues called cervical spondylosis. That occurs to a greater or
lesser degree in everyone, usually beginning in middle age. One estimate is
that neck pain caused by this condition occurs in more than 50 percent of the
working population.
Another cause of neck pain is rheumatoid arthritis, which can affect the
cervical spine in much the same way that it does other joints of the body.
A rupture in a cervical disk often causes sudden neck and arm pains.
Such pains frequently begin after a neck strain or injury. The injuries do
not have to be recent, at times necks begin to ache after a strain or injury
have been forgotten.
Posterior longitudinal ligament ossification (forming of bone, or bony
substance in place of a supporting ligament) can cause neck pain as can
different types of tumors on or near the spinal cord.
Among several other possible things that can cause your neck to be
painful are myofascial syndromes which are pains that originate in some other
part of the body yet may produce pain in a wide area, and the well-known
whiplash that often occurs after an automobile rear-end accident.
As with many other conditions, early detection and treatment of the
problem can both relieve your suffering and possibly prevent later

What is a Wilm's Tumor?

QUESTION: We are devastated. The daughter of a close friend has been
diagnosed as having a Wilm's tumor. We think this is a fatal disease but do
not wish to discuss it with the parents. Can you give us some information?
ANSWER: Wilm's tumor is the single most common cancer of the kidney in
children. There are no special symptoms to alert the parents or child,
although a common sign is swelling of the abdomen or a lump that can be felt
in this area. Blood appears in the urine of about 25% of children afflicted
with the disease, but sometimes the quantity of blood is so little as to go
unnoticed. The disease can cause any one or all of the common symptoms of
cancer, weight loss, anemia, fatigue or low grade fever. It takes a good
physical examination to put the doctor on the right track, but usually a
battery of special x-ray tests will be necessary before the diagnosis is made.
But there is some really good news for you. Treatment, which may combine
radiation therapy with anticancer drugs can achieve a long-term disease free
status (the equivalent of a cure) in more than 8 out of 10 young patients, and
there are also newly developed surgical procedures which may now be used in
children and infants that add to the chances of success. While side effects
from these treatments can be expected the successful outcome makes it all
worth while

What Can Be Done About Heavy Sweating?

QUESTION: I have a terrible problem with sweating and I don't know what to
do. I try extra showers and I constantly use antiperspirants, but nothing
seems to work. I've been to a doctor who prescribed a cream that only worked
a little. What can I do? I really sweat buckets.
ANSWER: You may need a second opinion from another doctor who knows more
about the problem of hyperhidrosis (profuse sweating). It is, at best, a
difficult situation to manage. Sometimes this problem is a symptom of another
problem. Other times it is not as serious and can be controlled with topical
medications. If you have a case of primary hyperhidrosis, then it may be
idiopathic--a problem that is self-contained within the skin. Trials with
various medications may largely control the problem.
If, however, you have a secondary case, then further examination will be
necessary to to see if you have an underlying disease. In rare cases, profuse
sweating can be a symptom of a blood disease, including hematologic
Pituitary problems could also be the culprit. Acromegaly--the abnormal
enlargement of the extremities, nose, jaw, hands and feet is due to
hypersecretion of the pituitary gland, but it can also lead to severe
sweating. Fungal infections within the body may also cause hyperhidrosis, as
can overactivity of the thyroid and other endocrine glands.
If you are on medications for other problems, check with your doctor to
find out if you may be having a bad reaction to one of them--that could also
be causing you to spout geysers of perspiration.

How Does Sleepwalking Occur?

QUESTION: Until we began experiencing sleep walking episodes with our own
son, we thought those stories were pretty funny and exaggerated. Now we know
for ourselves how upsetting it can be. Would you please discuss this problem
for us and suggest how we may deal with it?
ANSWER: As frightening as it may seem now, the good news is that this common
childhood problem usually disappears as the child grows, and has no serious
consequences. Somnambulism (sleep walking) is grouped with a number of other
conditions involving partial arousal from sleep called parasomnias and is the
result of central nervous system activity expressed in actions such as
walking. They may last as long as 30 minutes, but generally are finished in a
few minutes. Ranging from simply sitting up in bed, to actions that include
eating, opening doors, a stop at the bathroom for bodily functions, to actual
strolls around the house, the child rarely remembers all that happened when
awakening in the morning. It starts in children at about 4 years of age, and
reaches its peak in the 11 to 12 year old range, when up to 16% of children
may have one or more episodes. Frequently it runs in families where deep,
sound sleep is common. It occurs more frequently when the patient is
fatigued, after long periods without sleep, or strenuous physical activity, or
the use of alcohol or sedatives. Frequently it is precipitated by a
frightening dream. As parents you should try to discover the types of
experiences or activity that may take place during the day preceding sleep
walking episodes. Then take steps to avoid these circumstance. The second
and most important task is to provide a safe sleeping environment for your
son. Make sure windows and doors are locked, and that sharp objects,
particularly glass, are removed from the room. Sleeping quarters at ground
level are advisable if possible. Don't try to awaken a sleep walker, but
gently lead them back to bed. Some medications, such as imipramine and the
benzodiazepines, are helpful in suppressing the stages of sleep in which
somnambulism occur, but can produce a hangover on the next day. All
medications must be administered with the counsel of a physician, are not
recommended in younger children or for prolonged use, and only in cases where
the situation is severe and there is great risk for injury. If research
statistics are correct, this strange activity will disappear by itself before
your son is much older.

What Can You Do For a Red Nose?

QUESTION: I'm not a drinker, but I have beezer that would put W.C. Fields to
shame. It's embarrassing, and I am at a loss to explain it. What can I do
for my red nose that's growing?
ANSWER: There are number of treatments that may help your red nose condition
known as rhinophyma. The antibiotic tetracycline may be useful, as may the
vitamin A acne treatments Retin-A (applied to the skin) and Accutane (pills).
If medicines don't work, surgery and other medical procedures, such as laser
surgery and peeling of the skin surface, may be effective.
It's true that there is a common impression that this is an "alcoholic's
nose," but there is little scientific evidence to back that up. Many doctors
believe that avoiding spicy foods and caffeine can stop or slow the redness
and swelling. Although, here again, there are not yet any solid studies to
prove that these foods are truly the culprits, it's certainly worth a try to
eliminate them from your diet and see if it helps.
If all else fails, and surgery is not for you, you might consider using
cosmetic make-up and powder to reduce the redness, and diminish the attention
your nose may be getting.

What is "Peyronie's Disease"?

QUESTION: My condition is an embarrassing one, since it deals with my sexual
organ. I have been to several doctors, received some treatment and
explanations, but still find it difficult to understand what is happening to
me. The condition is called "Peyronie's Disease" and I would be most grateful
for any help or explanations you could write in your column. I can't be the
only one suffering from this, and perhaps you can help lots of men who are
ashamed of their situation.
ANSWER: You are not alone. It is rare that a week goes by without some
letter requesting information on this most distressful disease of adult men,
and so it is time for a few explanations from me. Peyronie's Disease is an
affliction of the male organ, that causes the erect penis to curve,
occasionally causing painful erections, and preventing normal function during
intercourse. Anatomically, the penis is composed of three long spongy tubes
(corpora cavernosa), each enclosed in an elastic sheath or covering. For
reasons still unknown, these sheaths may thicken as the tissue becomes
fibrotic (scar like), and then shorten. The affected section of the sheath
loses its elasticity, and can't stretch properly during erection, and so the
penis bends in the direction of the scarred area. Treatment is difficult and
not always successful. Local injections of corticosteroids (cortisone-like
medication) may help, but doesn't work when the medication is taken orally.
The scarred area can be removed surgically, and replaced by a graft, but that
may result in even more scarring during the healing process. Some symptomatic
relief can be obtained through the use of local ultrasound treatments, and
there are cases where, after many months, the disease just goes away by
itself. I truly hope you fall into this last classification.

What is a Penicillin Allergy?

QUESTION: I have a deathly fear that I may be allergic to penicillin and that
some day it may be the drug that can save my life. I need more information.
Please discuss penicillin allergy.
ANSWER: Although penicillin, the first antibiotic to be discovered, is
effective in treating such infections as pneumonia, strep throat, and urinary
tract infections, many people are allergic to it, and can have very severe
reactions. Because of this, it is important to check for allergy before you
take this drug.
Tell your doctor if you have ever had an unusual reaction to any drug, so
he or she can determine whether that drug is a member of the penicillin
family. In addition, tell your doctor what other medications you are
taking--some can interact with penicillin.
If you are unsure about whether you are allergic to penicillin, your
doctor may decide to do a skin test to be sure--or he or she may select a
different kind of antibiotic for you. If the skin test suggests that you are
allergic to penicillin, but the doctor feels that that is the best way to
treat your infection, a desensitization procedure may be necessary so that you
can take the drug without getting an allergic reaction.
In general, the closer the time of reaction is to the first dose, the
more likely it is to be related to the penicillin, rather than to the
infection itself. If you are taking penicillin and develop a skin rash,
wheezing, or hoarseness, stop taking the drug and call your doctor for advice.
However, some symptoms, such as diarrhea, nausea and vomiting, may be side
effects of taking the medicine, rather than signs of allergy, and usually
disappear as your body adapts.
If you know you are allergic to penicillin or other medication, you may
want to wear an identification tag or bracelet that warns medical
professionals of your allergy.
Whenever you take an antibiotic, it is particularly important to follow
directions exactly. Penicillin and other antibiotics are prescribed in the
amount necessary to get rid of the infection. Even if you feel better after a
few days of taking the medication, it's important to continue taking it until
it is used up in order to clear up the infection completely. If you stop too
early, your infection may return, and you may have to start taking the
medicine all over again.
Also follow the instructions on the label about how many doses to take
each day, and make an effort to take them at regular intervals. If you forget
to take a dose at the proper time, take it as soon as you remember, even if
you have to take two doses at once.
Most kinds of penicillin should be taken on an empty stomach, either one
hour before a meal or two hours after, with a full glass of water.
If you take penicillin as directed, you shouldn't have any left over, and
you should never give it to anyone else without consulting a doctor. Never
keep penicillin or any antibiotic on your medicine cabinet shelf for longer
than six months. Actually, if you and your physician are working together and
are in step, there should only be enough medication prescribed for your actual
needs and your medicine bottle should be empty when your treatment ends.
That's called "cost-effective" care, for you will receive all the benefits
from this powerful antibiotic, and never spend a nickel more than you need

What is a "Norwalk Tummy Ache"?

QUESTION: A friend of mine when complaining of stomach upset uses the term
Norwalk tummy ache. What does it mean?
ANSWER: In 1968, in Norwalk, Ohio, an outbreak of gastroenteritis in a school
was attributed to a virus that has since been called the Norwalk virus. Stool
samples were obtained and found negative for bacteria, so a search for a
possible viral agent was begun, and when it was found it was named after the
town where the outbreak first occurred. The term has become popular in
describing viral stomach upset. Outbreaks of this type of gastroenteritis
occur in all seasons of the year and among every age group. Outbreaks seem to
spread through a number of different ways, including food, drinking water, and
infected people. The duration of the infection lasts from several days to
several weeks, and those most susceptible seem to be the younger age group.
Since you gain no immunity with the first bout, you may experience its effects
more than once in your life. It is definitely a disease that is highly
infectious, so if your friend does have a Norwalk-type virus, she would be
well advised to take precautions against re-infections. Symptoms of this
virus are the same as all of the other that cause stomach problems, flu-like
aches pains and fever, and include vomiting, diarrhea, chills, headache.
Specific remedies are just not available at the present time, so your
physicians advice would be the rest, fluids, and the "waiting it out" regimen.
Incidentally, eating raw clams has been attributed as a cause of the
Norwalk-like virus in some cases, so be on guard.

If You Have Never Had a Headache, Is Something Wrong With You?

QUESTION: Perhaps you will think this is a silly question but will be kind
enough to answer it anyway. I am well into my 80's now and have never had a
headache. Is there something wrong with me?
ANSWER: I don't think your question is silly at all, although I will admit it
brought a smile to my lips. Any legitimate question that is of concern to you
is entitled to consideration for an answer in this column. We concentrate so
much on explaining symptoms and their causes that it may seem that everyone
must have something wrong with them to be normal. While almost everyone I
know has had a headache at one time or another in their lives, you are under
no obligation to suffer this most common complaint. Even the mildest of
infections, troubles with sight, and the daily stesses in life are capable of
causing this ache, but the absence of this annoying pain in your life is a
blessing, and not a sign of any abnormality I know of.

Do Large Vitamin Doses Make You Healthier?

QUESTION: Do large doses of vitamins really help you be healthier?
ANSWER: Despite the beliefs of some, the only answer I can give that respects
current medical knowledge is "No". In fact, large doses of some vitamins can
hurt you. Vitamins, like anything else, are helpful when taken in moderation.
Be informed about vitamins and what they can--and can't--do for you.
Vitamins are naturally-occurring substances that, in certain amounts, are
essential to good health. The Recommended Daily Allowance (RDA) has been set
for all vitamins by the National Institutes of Health, and the RDA indicates
the minimum amount of each vitamin that is required to avoid a deficiency.
Vitamins are usually used in small amounts; vitamins can be powerful "drugs"
if they are used in large amounts. Anytime vitamins are administered in
excess amounts, the patient should be carefully monitored for signs of vitamin
overdose. Regularly exceeding the RDA by prescribing vitamin supplements to
yourself is not wise, because vitamins can have profound side effects.
The fat-soluble vitamins, especially A and D, are maybe the best known
for their toxicity in large doses. However, the water-soluble vitamins can be
toxic in large doses also. It seems that the quickest way to learn about the
toxicity of large doses of a vitamin is to follow the health and diet fads--if
a particular fad calls for large amounts of vitamins, you can be sure that
toxicity will soon follow.
Beware of anyone, in or out of health care, who advocates large amounts
of vitamins to "cure" a health problem. Besides the health problems it can
cause, taking large amounts of vitamins can be an enormous waste of money. If
you are eating a well-balanced diet, you're probably getting plenty of
vitamins every day. If you're not sure, keep track of your food intake for a
few days, and consult a registered dietitian or your physician. Chances are
any vitamin deficiencies can be made up with a modification in your diet.
There are a few vitamins that are useful in large amounts to certain
people. At no time should these vitamins be self-administered without the
guidance of a physician.
Niacin, or nicotinic acid, has a healthy effect on the blood fats, which
is important to the person with coronary artery disease. Niacin can lower the
"bad" cholesterol in the blood, elevate the "good" cholesterol and decrease
triglycerides. Its toxic effects range from nuisances such as flushing of the
skin to more infrequent but serious hepatitis and hyperglycemia.
Pyridoxine has been used to treat premenstrual syndrome (PMS), carpal
tunnel syndrome and asthma. Toxic effects center on the central nervous
system, and they may range from mild sensory loss to inability to walk.
Vitamin A is well-known for its role in good vision and in healthy skin
and membranes. It can be helpful in treating psoriasis, acne, ichthyosis and
Darier's disease. The oral as well as the topical (lotion) forms are used.
The main problems with Vitamin A toxicity are severe liver problems as well as
swelling of the brain. Both problems can result in death, so Vitamin A should
only be used with great caution.
Popular but of questionable value in large doses are Vitamin C,
pantothenic acids and Vitamin E. Remember that these vitamins, like any
substances taken in large amounts, can cause as many problems as they solve.
Instead of spending money on large amounts of vitamins, spend your money on a
variety of nutritious food. You'll enjoy it and chances are you'll be
healthier, too.

What is "Meckel's Diverticulitis"?

QUESTION: You have discussed diverticulosis and diverticulitis on several
occasions in your column, but you always forget to mention the type of
diverticulitis I suffered from called "Meckel's Diverticulitis," and was so
serious I needed an operation to correct it. I think your readers should be
told about this condition as well, if their understanding is to be complete.
ANSWER: You have an interesting and personal perspective on diverticulitis,
and perhaps I can add a little to your knowledge as well. Meckel's
diverticulitis is rather rare, only 1% to 2% of the population have a
"Meckels". It's formed by a congenital "left over" from our fetal
development, and occurs when the embryonic yolk stalk does not close up, as it
does in most people; but when it does remain, it can cause a number of
problems. Frequently it develops an infection, much the same as the appendix,
and must be removed. If there are remnant of gastric (stomach) tissue in the
pouch that comprises the diverticulum, peptic ulceration and perforation can
occur. It it becomes chronically infected, adhesions may develop leading to
stricture of the intestines and lower obstruction of the bowel. As a routine
procedure in all bowel surgery, the surgeon will check to see if a Meckel's
diverticulum exists, frequently removing it to prevent future complications.
The common diverticulosis and diverticulitis develop later in life, and
usually contain main out croppings of intestinal lining that form the sacs
called "diverticulum". Since the cause of these are so different than of a
Meckel's they are not usually considered, or discussed, as if they were the
same disease.

Should Women Limit Their Sports Activity?

QUESTION: I have a young granddaughter who is very interested in gymnastics.
She is just entering her womanhood, and I am afraid that she will be injured
by all the strenuous activity involved. Shouldn't women limit their sports
ANSWER: I think you're suggesting that sports and exercise are somehow bad
for women. Nothing could be further from the truth. Exercise and sports
participation can help anyone, male or female, maintain fitness and bring on
an increased sense of well-being. To talk about limiting women's athletic
participation because of risk of injury is as silly as limiting men's
participation because they need to wear athletic supporters.
There is still the lingering myth that exercise will hurt women or impair
their femininity or reproductive health. Yet, women were once expected to run
a household at a time when water had to be hauled up from a well, laundry had
to be physically scrubbed and wrung out, and rugs had to be beaten clean. If
a woman was lucky enough to have a servant to do this heavy work, that servant
was usually a woman too.
A fit woman is not more likely to be injured when participating in sports
than a fit man. There are a few accommodations that women athletes must make
to participate in sports, however. A large-breasted woman should wear a
comfortable sports bra that will give her support for jumping or running.
Women are more prone to knee and ankle injuries because of their wide pelvis,
but proper stretching before exercise along with good shoes will reduce this
risk. There is no reason why a healthy pregnant woman should not continue to
participate in sport or exercise. She should be careful of her changing
center of balance and of her lowered target heart rate, however.
As for your young granddaughter, she will gain much from her sports
participation, as she is watched closely by her coaches, who will assure that
her activity is appropriate for her age and build. And you will enjoy every