Can Antacids Help Cure an Ulcer?

QUESTION: Can antacids help cure an ulcer and is diet important?
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ANSWER: Antacids, the oldest of all ulcer medications, are still considered a
valid treatment option. Ulcer healing is directly related to the ability to
reduce acid secretion, and since antacids neutralize acid that has been
secreted into the stomach, they are certainly a safe and effective therapeutic
choice. A seven-times-per-day dosage is usually prescribed and should be
taken one and three hours after meals and at bedtime. However, recent studies
suggest that the final dosage be taken between six and eight p.m. rather than
at bedtime, so check with your doctor and see what he advises. There are a
variety of antacid medications, that come in both liquid and tablet form, some
combined with medication that reduces the gas in your GI system as well.
It's worth mentioning that it is not necessary to combine antacids with
H2-receptor antagonists which reduce the amount of gastric acid secreted into
the stomach. H2-receptor antagonists are a separate treatment option, though
on days when pain and discomfort are particularly severe, patients may wish to
supplement this therapy with a little antacid as well.
Unfortunately, with all the diet testing done on patients with ulcers, no
magic diet has ever been found. The best advice I can offer is to simply
caution patients against eating anything that causes discomfort. For patients
taking antacids, I also advise frequent food intake since the antacids'
ability to buffer acid secretion is not very effective on an empty stomach.

Sore Throats and Strep

QUESTION: How does the doctor know my kids' sore throats are caused by strep?
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ANSWER: As you probably know, most sore throats are caused by viruses, and
viruses are not helped by antibiotics. It is important to identify the
occasional "bacterial" sore throat, which needs antibiotic treatment. Perhaps
the nastiest bacterial sore throat of all is caused by streptococcus. If it
is not treated, the end result may be rheumatic fever, which is a disease of
the heart valves.
Your doctor looks for several signs of strep throat. These signs include
pus on the tonsils, painful swallowing, and enlargement and tenderness of
lymph nodes in the front part of the neck. Strep is highly contagious, so
doctors know when it is "going around" and thus more likely to occur. The
only way, however, to be absolutely certain of the strep throat diagnosis is
to test for the presence of the bacteria. There are several tests available,
some of which can be performed in the office, giving results within minutes.
If the streptococcus bacteria is causing the sore throat, antibiotics are the
only way to cure it. When giving the antibiotics, be sure your children take
all of the pills your doctor prescribes. Don't permit the children to stop
taking them when they begin to feel better--chances are they will fall victim
to the infection again, and it may be harder to control the second time
around.

Is it Possible to Cough Up a Stone?

QUESTION: I couldn't believe it but apparently it's true. My husband had a
severe coughing spell and produced, instead of mucus, a little pebble. Is it
possible to cough up a stone? Where would it come from?
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ANSWER: Lithoptysis, or the spitting up of stones, has been documented since
ancient times and is the result of broncholithiasis, a disorder where
calcified material enters the tracheobronchial tree. Its often linked to lung
infections, such as tuberculosis, since the gravel-like stones, or
broncholiths, are believed to form when lymph nodes that surround the bronchi
(tubes that carry the oxygen to the lung tissue) become saturated with calcium
and calcify during the inflammatory stages of such an infection.
Though the exact biochemistry of tissue calcification is not completely
clear, we do know that once a lung infection develops, the necrotic or dead
tissue in the lung and surrounding lymph nodes become alkaline during the
healing process. This alkaline environment allows calcium phosphate and
carbonate to mass together and form deposits. Then, due to the constant
motion of the cardiopulmonary system, these calcified deposits enter the
bronchial tree by erosion and the stone is formed.
In many cases of broncholithiasis, no treatment is necessary because once
the stone is coughed up, the lung can usually clear itself. However,
broad-spectrum antibiotics may be prescribed for patients who are prone to
lung infections, and routine follow-ups should always be made to check for any
possible complications. I hope you have kept the "pebble" to show to your
physician, and will now seek the necessary professional care.

What Happens When You Don't Get Enough Sleep?

QUESTION: What with studies, a part time job, and just plain too much to do,
I am sure I am not getting the sleep I should. I know it's having a bad
effect on me. What happens when you don't get enough sleep?
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ANSWER: After a couple of days without enough sleep, you get pretty grumpy.
After a longer period, that grumpiness and inability to concentrate become
more pronounced. Neurological, biochemical and hormonal changes occur when
sleep is disrupted; sleep is a powerful synchronizer of many of our body's
functions. Sleep research is difficult to perform because individuals vary
greatly in their need for sleep, and in their reactions to sleep disruptions.
We know that we all react to interrupted sleep with fatigue, inability to
concentrate and a general feeling of discomfort. However, we don't know what
the actual physical effects of sleep interruption can be. Chronic lack of
sleep is believed to have long-term health and psychological effects.
Total lack of sleep for more than four continuous days and nights often
causes psychotic reactions such as hallucinations and paranoid feelings. Some
people react with psychotic disturbances after as little as 24 hours without
sleep.
When you are faced with a lack of sleep, especially over a long period of
time, be sure you eat a balanced diet and get as much rest as possible. Try
to establish a regular pattern of sleep, even if you are not getting as much
sleep as you need. Burning the candle at both ends, and in the middle as
well, can not be helping your studies. Why not try a session with your school
counselor, and see if between you a more logical program can be developed that
can help you attack your problems without killing yourself.

Drug Avoidance for Nursing Mothers

QUESTION: I'm a nursing mother. What drugs should I avoid?
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ANSWER: Fortunately, most drugs taken by a woman who is breast feeding are
not hazardous to the newborn, but there are some drugs that should be avoided
completely.
Lithium, which is used in the treatment of depression, should not be used
while breast feeding as it can cause hypotonia--abnormal muscle tone and
decreased strength.
Antimetabolites (usually used to treat cancer), taken by the mother, may
cause long term anti-DNA activity in the baby.
Radioactive medications will contaminate breast milk with radioactive
substances. Preparations containing iodine can cause goiter and
hypothyroidism.
The anticoagulant Phenindione (hedulin) passes quickly into breast milk
and may slow down the baby's blood coagulation. The antibiotic
Chloramphenicol (Chloromycetin) is very potent, and high concentrations pass
into the breast milk, which may in turn cause bone marrow depression.
These drugs should be avoided completely, but while many medications pass
into breast milk, the excretion of a drug into breast milk does not
necessarily pose a hazard, because usually only 1 to 2% of the dosage will
pass through to the milk. It is wise, however, for nursing moms to use as few
drugs as possible. You would be wise to keep both your physician and your
baby's doctor informed of all that's going on, so that the risks to the baby
can be measured against the benefits the medications provide for the mother.
Nursing moms can also minimize the effects of their medications in their
infants by taking the drugs after breast feeding.

Beer Drinking and Milk Flow of Nursing Mothers

QUESTION: Is there any truth in the old adage that a beer a day enhances the
milk flow of nursing mothers?
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ANSWER: Frequently in any old wives' tale there's a morsel of truth, which
we sometimes too easily dismiss in this age of high-tech medicine. Probably
that small gem is there because the old midwife showed a lot of common sense
in treating the whole person, not just a part.
Don't get me wrong, I'm not advocating inebriation as a state of being
for nursing mothers. But considering the fact that beer is a liquid and
soothing, and lactation depends on both the amount of liquids you consume and
your being relaxed, by all means have a glass of beer, or a glass of wine, a
day. Of course, you might get the same benefits from warm milk, fruit juice,
whatever tickles your palate. Any liquid that both soothes and relaxes you
can cause an increase in your milk flow.
With alcohol, of course, never over do, and be sure to check with your
physician before beginning any beer therapy. There have been some cases where
alcohol intake had the opposite effect for nursing mothers.

Pregnancies that Occur Outside the Uterus

QUESTION: How do they detect pregnancies that occur outside the uterus? How
are these pregnancies dealt with?
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ANSWER: Pregnancies that occur outside the uterus are called "ectopic," or
"tubal" pregnancies. If they are undetected, they can cause a
life-threatening emergency when the growing embryo ruptures a Fallopian tube
and causes dramatic hemorrhage inside the abdomen. Early diagnosis and
treatment are important not only to the life of the pregnant woman, but also
to her future fertility. About half the time, however, the ectopic pregnancy
is not diagnosed until it ruptures.
History and physical examination are important to diagnosis. A pregnancy
test is positive with ectopic pregnancy, but menstrual bleeding may be spotty
or irregular. Abdominal pain is usually present. Blood tests to determine
hormone levels in the blood and sonograms are helpful.
Ectopic pregnancies are not healthy pregnancies, and they cannot be
allowed to continue. They are usually surgically removed, either by
laparoscopic surgery (which is done through a small incision below the navel)
or laparotomy, which is through a larger incision in the abdomen. In some
larger research centers, studies are being done on eliminating the pregnancies
by administering drugs instead of doing surgery.

ACROSS MY DESK: Pap Smear

Another related, and frequently asked question about Pap Smears, and just
how often they should be performed, is answered in a recent issue of the
American Family Physician. It reports that the American Academy of Family
Physicians (AAFP) has adopted a new policy on "Screening for Cervical Cancer"
which is consistent with other similar statements issued by The A.M.A., the
American College of Obstetricians and Gynecologists, as well as the American
Cancer Society and the National Cancer Institute. The policy recommends that
"all woman who are or have been sexually active, or have reached age 18 years
have an annual Pap test and pelvic examination. After a woman has had three
or more consecutive satisfactory normal annual examinations, the Pap test may
be performed less frequently at the discretion of her physician." The AAFP
however, recommends that this be "not less frequently than every 3 years."
----------------
The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician. Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

Recurrent Spontaneous Abortions

QUESTION: What can be done for a woman who has recurrent spontaneous
abortions?
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ANSWER: Spontaneous abortions are also called miscarriages by many people,
and they are defined as any loss of pregnancy prior to 20 weeks' gestational
age. Approximately 15 percent of all recognized pregnancies end in
spontaneous abortion. Many more spontaneous abortions occur during the very
early stages of pregnancy, before the pregnancy is recognized. Recurrent
spontaneous abortions are a problem for one in 200 couples. About 60 percent
of these couples have a problem that can be diagnosed.
The reasons for recurrent spontaneous abortions include environmental,
genetic, immune, anatomic or hormone factors, or a combination of these. If a
couple has two consecutive spontaneous abortions, it is time for a careful
history and physical examination to try to determine the cause. Both partners
should be part of this treatment. Tests for infection, hormone balance and
genetic abnormalities may be performed. The couple should be asked about
environmental factors that may be contributing to the problem, and factors
such as diet, activity and smoking should be discussed.
Women with a tendency to abort should make every effort to diagnose a
pregnancy early, so that the pregnancy can be monitored closely. Early and
complete prenatal care is sometimes helpful in avoiding continued problems.
If you have a friends or family members who have suffered a spontaneous
abortion, be sensitive to their feelings. Husband and wife are likely to need
your understanding and support more than they can tell you at this time. Talk
with them. Ask them how you can help. They need to know that you care. It
is amazing how much good just the expression of your concern can accomplish,
and you'll feel better too.

Ovarian Cancer and Marital Problems

QUESTION: After an operation and treatment for ovarian cancer, I have
problems with my marital life. What should I do?
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ANSWER: The best gauge to success of cancer therapy is how well you're able
to resume your normal activities, and that includes your sex life. Sexual
dysfunction is the term used for sexual activity that has been impaired by
physical or mental problems. Some sexual dysfunction is caused by the various
cancer treatments used and some are due to the disease itself.
A common problem among women who have had pelvic surgery--such as for
ovarian cancer--is pain during intercourse. Painful intercourse leads of
avoidance of sex, which hurts a marriage. The shape or size of the vagina may
have been changed or the removal of the ovaries causes vaginal dryness.
Unfortunately, many women are not warned this may happen and then never
mention their sexual problem to their physicians.
Vaginal dryness can be relieved easily by using a lubricant such as KY
jelly or other products specially made for use during sex. Your doctor may
also prescribe creams that contain estrogen that will help keep the vagina
moist. Sometimes changing sexual positions helps, also. Narrowing or
shortening of the vagina after surgery can sometimes be avoided by having sex
regularly or by using a vaginal dilator. Your physician will instruct you on
how to use a dilator. Using a dilator is medically necessary, so don't be
embarrassed either about using it or asking your doctor questions.
Cancer and cancer therapy can also change your own self-esteem or how you
see yourself, which can impair the sex drive. Many people feel stigmatized by
having had cancer. Some people act as if cancer were contagious. Cancer is a
disease, not a punishment. Losing your breast, or your ovaries, or your hair,
or whatever, does not make you any less a woman.
Having had cancer may also change the way your husband treats you.
Sometimes, a husband may avoid having sex because he is afraid of hurting his
"fragile" wife, but the wife sees this as rejection on his part. Many men
have never learned how to discuss their feelings or how to react when someone
they love is ill. They may act gruff or distraught when comforting was
needed.
Discuss your problems openly with your physician. He or she can offer
advice about both the physical and psychological problems you're having. In
some cases, you and your husband can benefit by having specialized marital
counseling.
You have fought hard for your victory over your disease. It may now take
only a few words of discussion, consultation, and conversation to give you
back the full life you wish and deserve.

Cancer and Love Life

QUESTION: After being treated for cancer, I'm afraid my love life will
change. Will it?
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ANSWER: Chances are, it will. During a medical crisis such as the one you've
been through, there are bound to be all sorts of adjustments to be made--both
physical and emotional. However, with good communication between intimate
partners, many of the sexual dysfunctions that result from cancer and its
treatment can be overcome.
For women, gynecologic cancer surgery can cause a reduction in the depth
and width of the vagina, and common problems following chemotherapy can
include vaginal atrophy and loss of vaginal lubrication. Commercial
lubricants can restore the lubrication, and it is recommended that partners
use coital positions that allow the woman to regulate the degree of
penetration. To prevent vaginal atrophy, early resumption of sexual activity
is strongly advised, particularly since it may also help to relieve a
patient's anxiety which can cause sexual problems in itself.
Loss of sexual drive can also occur after cancer treatment. This can
have a biological basis since chemotherapy can cause menstrual abnormalities
and the onset of an early menopause. However, psychological factors such as
cancer-related depression or a difficult adjustment to the changes in one's
body image can certainly reduce one's sexual desire as well. Therefore, the
quality of your interpersonal relationship has a strong bearing on your
adjustment. Nonsexual expressions of love such as touching and prolonged skin
contact can frequently rekindle sexual desire and a healthy, fulfilling love
life can usually be achieved.
For men, erectile impotence is the major type of sexual dysfunction
resulting from prostate cancer. In radical prostatectomy, severed nerves are
responsible for the problem, and until recently, this was a constant
complication. Now, however, there is a nerve-sparing procedure and the
pudendal nerve, which carries penile sensations, lies outside the operative
area. The patient remains unable to gain an erection, but orgasmic function
is retained. For such patients and their partners, mutual intimate touching
is recommended for a continued satisfactory love life.
There are, however, other alternatives for dealing with erectile
impotence. There are a number of drugs that can be taken orally which will
enable a patient to gain an erection, but as a rule, they are only effective
for a few months and only work for a modest number of patients. Intrapenile
injections are successful for a large number of patients and can be easily
administered. However, repeated use may cause penile fibrosis (scarring)
which eliminates the option for a penile implant. Rigid, semirigid, and
inflatable implants are popular alternatives for couples for find penile
injections unacceptable. The inflatable ones are usually the preferred type
since they closely reproduce a physiologic erection.
Male patients, like female ones, often experience a decreased libido, and
frequently for the same reasons. Self-image and psychologic reactions to
cancer and its treatment play a major role in one's sexual image. Explore
new and alternative ways of expressing your affection for each other if the
old ones no longer work. Seek counsel with your doctor. And be assured that
you can still have a fulfilling love life.

Cancer of the Prostrate: Causes and Treatments

QUESTION: I'm worried about cancer of the prostrate. Please explain its
causes and treatments.
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ANSWER: Prostate cancer is the most common malignancy found in older men.
Usually it is first discovered during a rectal examination as a nonsymptom
producing lump or swelling in the prostate gland. The nodule is most often
small (less than 2 cm in diameter), hard, irregular in shape, and
self-contained. Other indicators of prostate cancer are unexplained bone pain
in the pelvis and lower spine, and bladder problems such as painful urination,
dribbling, and straining to void, which might indicate an obstruction.
While the exact cause of this type of malignancy remains a mystery, the
predictable way it progresses helps the physician make an accurate and quick
diagnosis so that proper treatment can begin. Blood tests, a needle biopsy,
x-rays of the kidneys and the urinary tract, and computerized ultrasound
pictures (CT scans) of the lower abdomen to see if the lymph nodes are
involved are useful components of a complete workup that may be performed to
define what stage the carcinoma is in. These stages range from (A) diseased
tissue with no lumps to (B) lesions confined to the prostate capsule to (C)
tumors which cover the outside of the capsule, and finally (D) disease which
spreads to other body parts.
Treatment varies according to the severity of the condition and other
factors such as patient's age (young men tend to develop fast growing
cancers), desire to remain sexually potent, and other medical problems that
may exist. For instance, early stage A cancers are without symptoms and are
discovered when tissue removed during operations for enlarged prostates
considered benign, are examined under the microscope. No further treatment
may be necessary, unless the patient is under 55, and the cancer cells seem
advanced, in which case radiation therapy is suggested. Stages B and C
require either a complete surgical removal of the prostate gland or intensive
radiation therapy, which reaps a similar result. The symptoms of stage D
(advanced) disease can be lessened with hormone therapy as well as surgery.
Though the manner and timing of such therapy remains controversial, its goal
is to reduce symptoms and make the patient more comfortable.
New advances in treatment are being developed every day. For example, a
new surgical technique called a subcapsular prostatectomy (or partial removal
of the prostate gland) seems to be successful in halting some cancers without
causing the patient to become impotent. Unfortunately, long-term results are
not yet known.

Healing Measures for Foot Ulcers

QUESTION: I have developed foot ulcers, which my doctor tells me is a side
effect of diabetes. These ulcers have yet to go away. Is there any way to
speed their healing?
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ANSWER: It is critically important that you take every measure possible to
help heal these ulcers, as infections and foot disorders are the major cause
of death from diabetes. A host of microorganisms make their home in an
ulcerated foot, and can lead to a variety of complications, including possible
infection of the bone and even amputation of the affected limb. Mild
infections can be treated on an outpatient basis, with bed rest and
antibiotics, while moderate and severe cases call for hospitalization. In the
hospital, the ulcer can be directly treated with a variety of antibiotics, and
surgical care, including partial or total amputation, can be employed if
necessary. Careful inspection of the feet, and well maintained footwear are
important to prevent the development or reoccurrence of these ulcers--as is
the careful control of your blood sugar level.

Are Estrogens Safe?

QUESTION: Isn't it dangerous to take estrogens? How do I know they are safe
for me, or when a woman should take them?
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ANSWER: Estrogen replacement has become a leading treatment for hot flashes,
osteoporosis, and other conditions once accepted as the inevitable
consequences of menopause. Although it is not suitable for every woman after
menopause, new combinations of estrogen and progesterone therapy, and the
development of several ways to take these medications, are helping many women.
Estrogen replacement therapy seems to be effective for hot flashes,
making them occur less often and less intensively in 98% of the women treated.
However, there are other therapies that may also be helpful for this problem,
which may last a year a more.
A much more serious problem is osteoporosis, which can lead to bone and
hip fractures and serious complications. Since no treatment can reverse
osteoporosis, prevention is the key. Prevention begins before menopause, and
includes a routine of weight-bearing exercise, a diet with calcium and vitamin
D, no smoking, and little drinking of alcoholic beverages.
Mounting evidence suggests that estrogen replacement therapy, along with
progesterone immediately after menopause, can go a long way in preventing bone
loss. The time to begin is based more on menopause than on age, and even if
therapy is begun late, it can still help slow or stop bone loss. Women who
have stopped menstruating because of hysterectomy would be advised to begin
estrogen and progesterone therapy regardless of their age.
Researchers believe that estrogen delays the beginning of atherosclerotic
heart disease in women, and that estrogen replacement therapy lowers the risk
for heart attack (myocardial infarction).
Estrogen suppositories can improve vaginal lubrication and other changes
associated with menopause that can interfere with sexual interest and comfort.
The impact of estrogen therapy and menopause on a woman's emotional state
is still being studied. Research has shown that women given estrogen had more
restful sleep than untreated women. But it is difficult to measure how much
better a woman's memory is, how much less insomnia she has, or whether she is
less depressed before and after estrogen replacement therapy.
The most potentially serious side effect of estrogen replacement is
endometrial carcinoma, a type of cancer that has a higher incidence in treated
women. Estrogen itself does not cause cancer, but it seems to make the uterus
more likely to respond to something that does. Recent reports suggest that
the risk can be reduced by decreasing the dose of estrogen, shortening the
length of time you take it, and by adding progesterone to the therapy.
In light of our current information on estrogen and the safer and more
pleasant ways we have of taking it, it can help many women feel more like they
did before menopause. As women's life expectancy increases, therapies such as
estrogen replacement can help improve the quality of your life.

Is Low Back Pain Caused by Arthritis

QUESTION: I always thought low back pain was caused by arthritis. Is this
true or not?
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ANSWER: Back pain can certainly be caused by joints that have developed
arthritis, but there are many other possible causes as well. One of the most
common is the overstretching or tearing of the back's sensitive muscles and
ligaments which can make twisting and bending very painful. Muscle weakness
is another common cause. Back muscles become weak from lack of exercise,
making them less effective in resisting the pull of the body's weight on the
backbone.
Posture is another possible source. If a person's center of gravity is
too far forward or backward, that person will tend to lean forward or backward
to maintain their balance. Trying to compensate for bad posture can lead to
spinal problems that result in severe back pain.
Herniated discs and osteoporosis are other possible contributors. The
abnormal loss of bone density caused by osteoporosis can have terribly painful
effects on the back, and if a disc bulges enough to impinge on a nerve, severe
back pain can result.
Intestinal disorders, kidney stones, and various other internal illnesses
can produce back pain as an early symptom. If back pain persists or is
accompanied by an inability to urinate, it's time for professional help.
Emotional stress can produce muscle tension and spasms which will
aggravate backaches as well, even if they aren't a direct cause in themselves.
In many cases where patients are suffering from back pain, the cause
cannot be definitely determined. However, in most instances, these patients
get better on their own and surgery is rarely required. Therefore, I'd
suggest that if anyone is suffering from continued back pain, they should see
a doctor for advice. Exercise to strengthen the back muscles may relieve the
pain and restricting certain activities that aggravate the pain will be
helpful as well.

What is the Drug that Makes Your Skin Look Younger?

QUESTION: What is the drug that makes your skin look younger?
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ANSWER: It's called tretinoin, a derivative of Vitamin A. Tretinoin has been
used for several years to treat acne, and it is still only approved by the
Food and Drug Administration for this purpose. This means that the FDA only
recognizes its effectiveness and safety for the treatment of acne, because
testing has only been done in this area. Doctors are prescribing it to help
improve the texture and appearance of sun-damaged skin, but they are closely
supervising its use. The drug is not without damaging and uncomfortable side
effects, so it should be used only under a qualified doctor's close
supervision.
Some people are claiming the product produces a "chemical facelift,"
deaging the skin and reversing the damage done by years of sun exposure. The
original study that used tretinoin to treat sun-damaged skin reported that the
cream, when used over a 16-week period, reduced wrinkling, lightened age spots
and improved skin tone and texture. Further study showed that the number of
skin cells was increased, and that the "turnover" of the cells was speeded up,
giving the appearance of more youthful skin.
Besides the cosmetic benefits of tretinoin, the researchers found that it
reversed certain precancerous changes in the skin. It will be especially
interesting to learn how the product affects wound and burn healing. Studies
are underway now to learn more about these applications.
Anyone who uses tretinoin, whether for acne or to reverse skin changes
that come with age and sun exposure, should be aware that it is a powerful
drug. Tretinoin should be applied only as directed, which means to skin that
has been washed clean with a mild soap then thoroughly dried. Wait 30
minutes, to be sure that no moisture remains on the skin. Apply the cream as
prescribed. Be very cautious of sun exposure, because tretinoin makes the
skin very susceptible to burning. During the first few weeks, skin will
peel. This is expected. However, if an irritation develops, talk with your
doctor.

Cause of Itchy Nipple

QUESTION: What could cause an itchy nipple?
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ANSWER: When a woman who has a persistently itchy nipple, it could be nothing
serious, but it might also be a symptom of the breast cancer called Paget's
disease.
Even if there is no visible change, if you have this problem, you should
have your doctor check it. A physical examination and mammography (breast
x-ray) can reveal any lumps or other causes for concern. If you are pregnant,
your doctor may choose to perform an ultrasound examination instead of
mammography. In addition, a small biopsy, performed under local anesthesia,
can be done safely even if you are pregnant.
These tests will determine whether the cause of your itching nipple is
benign, or provide the early detection of a more serious condition, so
important for effective treatment.

Fat Removal by Suction

QUESTION: Recently in a discussion with friends of mine the topic of dieting
came up and it was suggested that the easiest way to do it was by having the
fat removed by suction. What can you tell me about it and how safe is it?
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ANSWER: The physique conscious American has led to much experimentation into
fast and simple means of improving body image. One of the plastic surgery
techniques that has developed is the removal of fat cells by the use of a
suction instrument. The process has been give many names such as liposuction,
lipolysis, lipodissection and lipoplasty, but they all involve the same
technique. The surgeon makes a small cut in the area of excess body fat,
inserts a tube into the region and applies suction to remove fatty tissue.
People whose skin is elastic enough to shrink back to prestretched size will
have the best results. The most common complications include bruising, skin
discoloration and loss of sensation in the area of fat removal. These should
resolve in a few weeks but skin dents may be permanent. Approximately 15 to
30 percent of the material that is removed is blood. Sometimes transfusions
are necessary if a quart or more of fat is removed. Remember that this is
cosmetic surgery that is used for the removal of localized deposits of fat and
is not a treatment for obesity. Before undertaking this procedure you should
consult with your doctor and have all the details of the risks and benefits
carefully explained.

Mastectomy and Follow-Up

QUESTION: My 73-year old mother has recently had a mastectomy to remove
breast cancer. I'm surprised at the little amount of follow-up care that has
been recommended by her doctor. It seems to me that friends around my age
(mid-50's) who've had mastectomies have had to go for more follow-up exams.
Does this sound right to you? Except for the breast cancer, my mother has led
an extremely active and healthy life.
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ANSWER: You question addresses a problem subject that has received some
careful analysis in recent research.
A recent study has found that elderly patients with breast cancer have
been given less comprehensive therapy than younger cancer victims. Doctors at
the University of California reviewed information of breast cancer patients in
7 California hospitals. They found that there were significant differences in
the way the disease was managed in patients over 70 years old.
The study found less than 64 and one-half percent of patients over 70
received appropriate care. That's compared to almost 82 and one-half percent
of patients aged 50 to 69 who obtained more thorough treatment.
Its time for you to get involved in your mother's care. Start with a
visit to her present physician, and present your concerns. There may be some
legitimate explanations that may satisfy you about the extent of the care. If
not, have your mother see another physician. Go with her and present your
problems to the new physician. You have the right and responsibility to
question the doctor to make sure she's getting appropriately aggressive
treatment.
During the study, significant differences were found between those under
70 and those over 70 with regard to the frequency of lymph node examination.
22% of the older patients did not get nodal examinations, whereas only 6% of
the younger patients did not receive the lymph node tests. So you see, there
are differences in care, and you deserve to get the best for your mother, if
you take the right actions.

Pregnancy and Lifestyle

QUESTION: I'm pregnant and thought it would be fun, but everyone tells me
I'll have to change my whole lifestyle. What makes sense? What should I be
doing?
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ANSWER: First of all, let me say that being pregnant should be a very
exciting time, and though there are clearly things to be aware of to maintain
a sane and comfortable pregnancy, you should be able to continue the lifestyle
you're accustomed to. Some things should be avoided, however, and strenuous
activities such as exercising should not be done to excess. Here are a few
things to keep in mind.
Alcohol consumption and tobacco use should be avoided throughout your
pregnancy. There is no conclusive evidence on exactly what drinking levels
are safe, and smoking has serious proven risks including possible miscarriage,
premature births or stillbirth, low birth weight, sudden death syndrome, and
infant respiratory infections.
Drugs and medications should also be avoided, or at least until the 15th
week when all your baby's organs and structures are well along in their
formation (with the nervous system lagging along behind). Aspirin, because of
its anticoagulant properties, is not recommended either. A daily multivitamin
with iron is frequently prescribed since most women do not store sufficient
levels in their bodies to meet iron needs after pregnancy. If any vitamin
should cause nausea, though, consult your doctor. Too many vitamins can be as
harmful as not taking any.
Swimming and bathing are totally permissible, though douching (especially
with douche kits) is not advisable because the pressure of the douche solution
increases the risk for rupturing membranes. Most infections can be treated
with alternate methods.
Work and travel can be maintained throughout pregnancy unless
complications arise, or if your job involves intense physical labor or
exposure to toxic or dangerous materials. Just keep in mind that you will
fatigue more easily later in the pregnancy, so allow yourself time to rest.
Feel free to engage in sexual intercourse until it becomes uncomfortable.
The same holds true for exercise. Just use your good judgement. Don't
overtax your body and if you did not exercise before, pregnancy is not the
time to start a rigorous regime.
A 24-pound weight gain is suggested for an average-sized woman, but up to
40 pounds is normal depending on your physical makeup. Keep in mind that
pregnancy is not the time to diet, but neither should you "eat for two."
Don't drink too much milk. Your calcium requirements can be met in other ways
and milk can cause unnecessary weight gain.
Bearing these things in mind, relax and enjoy your pregnancy. It can be
fun, just as you thought.

How to Deal with PMS

QUESTION: PMS is driving me crazy. What can I do?
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ANSWER: Janet (I've changed the name, of course) was a tall, slender,
attractive woman in her early thirties. She held a job as an office manager
in an accounting firm, and was happily married with two children. But each
month like clockwork she was in my office, physically bloated, anxious, quick
to anger, and depressed. She too was at wits end, apparently a victim of her
monthly rhythms, and her sex.
But we've come a long way, and we now know that premenstrual syndrome is
a definite and partially physically caused phenomenon. It causes women before
their monthly periods untold grief and anxiety, for themselves as well as
their family and friends. It is a problem that must be attacked from three
angles: the biologic, the social, and the psychologic.
The first thing I did for Janet was listen; she described a monthly
syndrome and I listened. This in itself seemed to relieve her. Acknowledging
PMS as a disease entity seems to ease the burden for many women. They are not
crazy, mean, or selfish; they really are suffering. Their experience is
validated and somehow also their worth as a person.
Our next step together was educational. We discussed the possible
symptoms of PMS and why it can't account for all feelings of depression and
anxiety. What to actually do when PMS actually struck was next discussed.
Much has been proposed: a program of aerobic exercise for 20 to 30 minutes a
day for three to seven days a week, a diet watch to see that the fiber and
protein content remain high while the sugar and carbohydrate content low--a
modified hypoglycemic diet. We talked about getting the cooperation of her
family and friends during these times of the month, as we also spoke of her
learning new mechanisms of coping and dealing with the blows of life.
Finally, we came to medication. Much research needs to be done in this
area. We tried a vitamin, in this case a Vitamin B complex, and a diuretic to
reduce fluid retention, and that seemed to work for her.
It's important to realize that each patient must be treated in ways that
seek to alleviate their unique problems. Your situation deserves its own
personalized workup, and a therapeutic strategy that you and your family
doctor can work out together. Take courage in the fact that you can be helped
and find relief.

Chronic Fatigue Syndrome or "Yuppie Flu"

QUESTION: Can you tell me how one copes with chronic fatigue syndrome? I
believe you once called it "yuppie flu".
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ANSWER: Chronic fatigue syndrome is a confusing situation for patient and
doctor alike. It's being diagnosed with increasing frequency, and some
physicians are critical of this. The reason for the controversy is the
criteria for the diagnosis are not clear, and many of the symptoms are
subjective in nature. Some physicians blame the syndrome on Epstein-Barr
virus (EBV), while others feel EBV is not the culprit.
Be aware that it may be tempting for doctors and patients to cut short
the thorough evaluation necessitated by the complaints of chronic fatigue,
settling instead for the convenient label of "chronic fatigue syndrome." As
with any complaint, it is important to investigate it fully, before the
diagnosis is made. Fatigue can be a symptom of many different problems, some
of which should not be ignored.
More research is certainly needed to learn more about the syndrome and
thus find the best ways to treat it. But before the syndrome can be studied,
it must be defined closely enough so that all researchers can be assured they
are studying the same disease.
When there is so much uncertainty on the part of the medical
professionals about this syndrome, it is no wonder that you're asking about
how to cope with it. When you're chronically tired, with a vague "unwell"
feeling that your physician can't find a reason for, you may become depressed
and even more fatigued. It may be hard to sort out what is a distinct
physical problem from what is a psychological difficulty. In reality, the two
problems are probably interrelated. The one temptation you must avoid is
getting involved with treatments that are not based on sound medical advice.
Expensive vitamins, untested treatments and therapies can do you and your bank
account more harm than good.
Keep talking with your doctor, and ask his advice regarding treatment. As
new discoveries are made, new treatment strategies can be developed that may
be just right for you. Sometimes treating symptoms to make you more
comfortable is the best plan, along with supportive psychological help for you
and your family.

Carrying Weights to Lose Weight

QUESTION: Does carrying weights while walking help you lose weight?
------------------------------------------------------------------------------
ANSWER: Walking is one of the best exercises going. It is easy, convenient,
cheap, fun, and a great way to burn calories. But, people seem to want to
improve a good thing, in this case, by using weights and doing arm exercises
while walking.
A study published in THE PHYSICIAN AND SPORTSMEDICINE journal found that
using weights does increase the intensity of exercise during a walk. Mildly
obese people who carried one-pound weights and did arm exercises while walking
used up more calories than those who walked normally or those who walked and
did arm exercises without weights. They also increased their heart rates to a
greater extent.
However, the increase in calories expended is small and must be balanced
against the possibility of straining muscles in the arms or upper body. If
you decide to use weights while walking, start slowly and avoid swinging your
arms wildly to avoid getting hurt.

Swimming for Bone Strengthening

QUESTION: My doctor tells me I need to strengthen my bones, and suggested a
swimming regimen. However, the coach at my health club says swimming cannot
help me in this regard. Who is right?
------------------------------------------------------------------------------
ANSWER: In the past, it was thought that only "weight bearing" (walking or
running) or muscle building exercises were capable of increasing bone density.
However, recent research indicates that swimming may also have a beneficial
effect. A Portland, Oregon, doctor measured bone density in the arms and
spines of 57 swimmers (who were not involved in any other form of exercise)
entered in competition for athletes over 40 years of age. Tests revealed a
significantly higher level of bone mineral content than the nonexercising
control group. While the traditional forms of exercise mentioned above are
more effective at increasing bone density, swimming doesn't carry the same
risk of physical injury--making it a perfect form of therapy for the elderly
in treating osteoporosis. While your coach has traditional thinking on his
side, your doctor has been doing his reading lately.

Heel Spurs and Chronic Heel Pain

QUESTION: I have a chronic pain in my heel. I can't tell you what makes it
worse, but nothing makes it better. What causes it? What can I do about it?
------------------------------------------------------------------------------
ANSWER: If you haven't already done so, you should see a your doctor. About
half of people with heel pain have a spur--that is, a tiny projection from the
bottom of the heel bone. The spur can be seen in an x-ray, and although it
may be less than a quarter of an inch long, it can cause you a great deal of
discomfort.
The other main possibility is an inflammation of one of the tissues that
attaches to the bottom of the heel bone. If your problem is caused by
inflammation, your doctor can prescribe pills to reduce the swelling or give
you steroid injections. In order to recover from the problem, you must
relieve the stress on the muscles and other tissue that attach to the heel
bone. You can do this by wearing shock absorbing shoes or heel cushions and
arch supports. In rare cases, surgery may be required for people with heel
spur pain. The best way to treat the pain, however, is prevention. You
should always wear footwear with shock absorbing qualities, and replace them
with new ones before those shock absorbers are worn out. Also, if you
participate in athletic activities such as running or aerobic dancing, it will
be necessary to ease into them gradually to prevent the problem from flaring
up.

What are Shin Splints?

QUESTION: What are shin splints and how do I deal with them?
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ANSWER: Shin splints are one type of overuse injury, but one that is often
misunderstood or misdiagnosed. The condition may actually be a group of
syndromes rather than just one, but most physicians agree that it is stress
injury to the muscles and tendons in front and behind the tibia bone of the
shin. It may be caused by muscle imbalance between the strong muscles of the
calf and the weaker muscles of the shin.
The pain of shin splints starts out mild, gets worse during exercise such
as running or aerobic dance, and goes away with rest. In most people, shin
splints come on after weeks of repetitious exercise, but cases have been known
to appear after one very intense exercise session by an untrained person.
Rest is the best remedy for shin splints, since it allows the inflamed
tendons and muscles to heal. This should be followed by muscle strengthening
and flexibility exercises for the entire lower leg.

Detection of Scoliosis

QUESTION: Our school nurse thinks my daughter, age thirteen, might have
scoliosis. Frankly, I can't see what she is talking about. Is there any way
I can see for myself?
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ANSWER: Scoliosis, a sideways (lateral) curving of the spine, usually appears
in pre- and early adolescence. You, as a concerned parent, can do a
preliminary screening of your daughter.
Have her stand tall with her back toward you. Frequently, in scoliosis,
the head alignment appears to be to one side of the buttocks, one shoulder
appears higher, one hip seems more prominent, and an unequal distance is seen
between the arms and body. Now ask her to bend from the waist: In this
position, both sides of the upper and lower back should appear symmetrical and
the hips level. Any uneven symmetry in the rib cage or lower back is a
possible sign of scoliosis. After these preliminaries, if you at all suspect
scoliosis, call your family physician and tell him your concerns. An
experienced eye always detects this condition a bit more readily. Scoliosis
is most easily and effectively treated in the growing years of adolescence, so
you will want any necessary therapy to start as promptly as possible.

Can Fluoride be Used to Treat Osteoporosis?

QUESTION: I see lots of the results of osteoporosis all around me. Many of
these women are trying calcium to stop some of the results of the condition.
In a discussion someone said they thought that fluoride was a good medicine
for this. Can fluoride be used to treat osteoporosis?
------------------------------------------------------------------------------
ANSWER: Osteoporosis is a loss of calcium in the bone, which leads to
decreased strength and density in the bones. This is a widespread problem in
the United States and Northern Europe, and it is considered to be the most
important factor in fracture of the hip, vertebrae and wrist. Americans have
heard a lot lately about increasing their calcium intake in an effort to avoid
osteoporosis.
Fluoride is being studied as a way to treat osteoporosis, and it appears
to be effective in reducing the risk of fractures in persons with
osteoporosis. These studies are indicating that fluoride may be particularly
helpful in preventing fractures of the vertebrae, but more research is
necessary before this is proven to be true.
As with any treatment, fluoride has its risks. Commonly reported side
effects of fluoride treatment are gastrointestinal problems and ankle or knee
joint pain. Although fluoride is approved for preventing dental decay, it has
not been approved by the Food and Drug Administration for treating
osteoporosis. Until more extensive studies are done that prove fluoride's
effectiveness in treating osteoporosis, it will not be approved for this use.
Calcium, a balanced diet, exercise and good overall health are the best
ways to combat osteoporosis right now. When increasing the calcium in your
diet, take care that you don't increase fat as well. Use low-fat dairy
products and other foods that are rich in calcium.

Knee Braces and Football Injury Prevention

QUESTION: I like to play an occasional game of weekend football, but don't
want to take the chance of hurting my knees. Are knee braces any good to
prevent injury?
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ANSWER: The kind of prophylactic knee braces worn by athletes to prevent
injuries--not the kind that are used to protect injured knees or support weak
knees--may not only be ineffective, they may even be harmful.
A recent study showed four to five times more of certain types of
injuries among athletes who wore knee braces than among those who did not. It
appears that the stress is transmitted by the braced knee to injure the ankle
and foot. The braces also do not appear to be effective in preventing tears
of the anterior cruciate ligament (ACL), the most common type of knee injury
among football players.
However, some experts believe that the braces do protect the knee from a
blow to the outside. And although there is disagreement about bracing normal
healthy knees, most sports physicians agree that it is important to brace an
injured or unstable knee.

Aren't Radon and Radium the Same Thing?

QUESTION: Aren't radon and radium the same thing?
------------------------------------------------------------------------------
ANSWER: No they are not, but they are part of the same complex process.
Radon is a gas, radium a solid. Radon-222 is a by-product of a naturally
occurring phenomenon that takes place in the earth's crust. Radon gas is
produced by the decay of uranium-238. During the decaying process, the radium
is transformed to radium-226. This radium turns into radon-222 when alpha
particles are emitted. The entire process is an integral part of life on
earth. But radon gas can be dangerous when the levels are abnormally
increased in concentrations. Radon attaches itself to particles in the air.
When people breathe in these particles, they deposit themselves in the lungs.
Once they embed themselves there, alpha decay causes damage to lung tissues.
The resulting damage can lead to a higher risk of lung cancer. The risk of
lung cancer is greatly increased for smokers who are exposed to high levels of
radon. If you suspect a radon problem at your home, you can contact the
regional office of the environmental protection agency and/or the state public
health agency for help.

How to Use Condoms

QUESTION: I'm too embarrassed to ask my doctor, but all this talk about
condoms has me baffled. How do you use them?
------------------------------------------------------------------------------
ANSWER: This question, in one form or another, is a most frequent one in my
mail. Despite the enormous importance of preventive measures to control the
spread of sexually transmitted diseases, particularly AIDS, information of the
type sought here seems difficult to obtain. In the interest of the health of
those who need this information, and trusting that it is understood that the
information is medical in nature and implies no moral judgements, I shall
answer it as precisely as possible.
Condoms, sheaths of very thin rubber that fit closely onto the penis and
prevent the escape of semen, are an old and reasonably effective form of birth
control. More important, in these days, latex condoms are effective in
reducing the spread of sexually transmitted diseases, including AIDS.
There are two types of condoms, latex or rubber condoms and natural
condoms made of sheep gut. Only the latex type has been shown to stop the
transmission of the AIDS virus. In order to be effective as either birth
control or disease protection, a new condom must be used each and every time
you have sex, no ifs, ands, or buts.
A condom comes rolled up. It is placed on the head of the erect penis
leaving a bit of space at the tip to catch the semen, and then unrolled down
the shaft all the way to the base. A condom must be in place before
intercourse. After intercourse, the male partner must withdraw carefully to
avoid dislodging the condom, after which it may be removed and disposed of.
The American College of Obstetricians and Gynecologists estimates that
condoms cost about $30 a year and are 90% effective at preventing pregnancy.
Most failures are due to forgetting to use a condom or tearing it while
putting it on. Additionally, they are almost universally recommended as a
means of promoting "safe sex", and preventing the spread of sexually
transmitted diseases.

Is There Danger In Eating Freshly Caught Fish?

QUESTION: Is there any danger in eating freshly caught fish this spring and
summer?
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ANSWER: Well we all know about the mercury tainted waters and the carcinogens
in the air we breathe. We seem to be a people bent on the destruction of our
natural environment. But one of the dangers in eating certain fish has
nothing to do with the pollution of their habitat. The fish affected are
tuna, albacore, mackerel, bonito, dolphin, bluefish, and some other darkmeated
fish. The disease associated with eating such fish is called scombroid
poisoning, its name derived from scombridae, meaning mackerel-like fish. The
poisoning has been linked to restaurant-prepared meals and canned tuna, as
well as freshly caught fish. What seems to happen is that the amino acid
histidine, abundant in darkmeated fish, is converted to histamine when these
fish are improperly handled and refrigeration is delayed. And we all know
what histamine causes in our bodies--a full-blown allergic reaction. Symptoms
of scombroid poisoning are like an acute allergic reaction. Facial flushing,
a burning of the mouth and throat, diarrhea, dizziness, nausea, abdominal
cramps, headaches, and skin rashes can occur. So do take care when fishing
this summer that you refrigerate the varieties we've mentioned immediately.

Why You Should Put Up with Cycling Helmets

QUESTION: I participate in cycling for pleasure and relaxation, not as a
competitive sport. Helmets are really annoying while bicycling, and greatly
diminish my enjoyment. Can't I do without one?
------------------------------------------------------------------------------
ANSWER: If you're such a good cyclist that you know you will never, ever fall
off your bike, and if you're positive that you will never hit a pothole, be
jumped at by a dog, or hit by a car, by all means, don't wear a helmet.
Otherwise, wear one.
Each year, 1,000 people die in bicycling accidents, and 75% of those
deaths are attributable to head injuries. Whether you ride a bike with
dropped handlebars or touring handlebars, you know that if anything stops your
bike suddenly, momentum will send you straight forward with your head leading
the way. A helmet may be your only protection.
If your helmet is annoying, get a new one. The best cycling helmets have
a hard outer shell and an inner padded lining that allows you to hear, see,
speak, and move your head, and is not too heavy or hot. It should fit snugly
and not flop around. Look for a helmet with a decal from the American
National Standards Institute or the Snell Memorial Foundation. These helmets
have met standardized impact tests.
I sympathize with your sentiments, and understand your desires for a
free, unrestrained ride, with the breeze blowing across your face and through
your hair. But I have seen too many injuries as the result of abandoning
safety equipment to put those sentiments against the cold reality of good
safety sense in all recreational and athletic activity.

Is There Really Such a Thing as a Yuppie Flu?

QUESTION: Is there really such a thing as a Yuppie flu? Why do yuppies get
it? How is it different from regular flus?
------------------------------------------------------------------------------
ANSWER: "Yuppie flu" is a nickname for a mysterious syndrome that leaves its
victims with a chronic feeling of fatigue. Unlike regular flus, which only
last a few days or weeks, this syndrome lasts for months.
It has been called the Yuppie flu because it seems to commonly affect
upscale young professionals. The Federal Centers for Disease Control has just
given a new name to the ailment--Chronic Fatigue Syndrome.
Victims of chronic fatigue syndrome suffer from at least 8 symptoms,
which may include mild fever, sore throat, painful lymph nodes, muscle
weakness and muscle pain, headaches, insomnia and other sleep problems,
neurological problems and extreme fatigue. Doctors are still puzzled as to
what causes this condition. The cause has been attributed to the Epstein-Barr
Virus, which causes mononucleosis. Other suspected triggers are thyroid
problems, fungal infections, low blood sugar, among other possible culprits.
However, none of these explanations has been found to be the definitive
cause.

How to Stop Sucking Your Thumb

QUESTION: Our six-year old still sucks his thumb, in spite of our pleas to
act more mature. My mother suggests an old-fashioned solution of painting his
thumb with a bitter liquid, but this sounds terribly old-fashioned to me.
What do you think?
------------------------------------------------------------------------------
ANSWER: A recent study conducted at the John Hopkins University School of
Medicine in Baltimore suggests that your mother's time-honored solution may
still be applicable in our modern day and age. Seven thumb-sucking children
who were otherwise emotionally and developmentally normal had their offending
thumb or finger coated with a bitter-tasting, commercially available solution
after waking and before bedtime. All the children quickly stopped the
offending habit, and did not resume it even when their parents ceased applying
the liquid once five continuous days of nonsucking had passed. As long as
there is no underlying emotional reason for your child's thumb sucking, your
mother's solution, while a bitter pill to swallow, is effective.
----------------
The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician. Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

What Makes Artificial Sweeteners Sweet?

QUESTION: What makes artificial sweeteners sweet? And after all the
discussion in recent years about cyclamates and saccharin, can we be sure
they're safe to use?
------------------------------------------------------------------------------
ANSWER: A variety of synthetic and natural substances are used to sweeten
foods, and are classified as nutritive or nonnutritive, depending on whether
they add calories to the diet or not.
Sugars are the most common sweeteners, and are found widely in nature,
including glucose, fructose (which together compromise sucrose--in granular
form, the stuff you and I put on our corn flakes), lactose (present in milk),
maltose, honey and maple syrup.
Aspartame (well known by its NutraSweet trade name) is a nutritive
(caloric) sugar made from two amino acids. While the equal of sucrose in
calories, it is over 200 times sweeter; the tiny amount needed to sweeten any
food is calorically insignificant.
Saccharin, the most widely known nonnutritive sweetener, has been around
since 1879, and is 300 times sweeter than sucrose. While a 1977 study that
fed megadoses of the substance to laboratory rats prompted health warnings on
saccharin-bearing products, to date no proof has been found that a normal
level of saccharin consumption is dangerous.
Possibly because of those health warnings (and because of a lack of any
aftertaste), aspartame has replaced saccharin in a wide variety of sweetening
applications. However, aspartame contains a chemical called phenylalanine,
dangerous to individuals with the inherited disease phenylketonuria.
Cyclamate sweeteners were not as lucky. Popular in the 1960's,
cyclamates were removed from the market in 1969 after one test showed a
possible cancer link. This link has never been confirmed, and cyclamates may
one day return to the market in the U.S., joining the 40 countries around the
world that approve their use.

Explanation of Sheehan's Syndrome

QUESTION: Could you explain Sheehan's Syndrome to me?
------------------------------------------------------------------------------
ANSWER: Often associated with difficult deliveries, Sheehan's Syndrome occurs
in women who have experienced shock and hemorrhage. It is a relatively rare
condition; about one case in 10,000 deliveries is reported. What happens is
that during delivery not enough blood gets to the pituitary. Damage occurs,
and the result is a variety of hormonal deficiencies and some strange
symptoms. If you know a woman with Sheehan's Syndrome, she may show signs of
mental deterioration and perhaps complain of other symptoms such as shrinking
breasts, an inability to lactate (breast-feed), loss of hair in the pubic
region and under the armpits, her period may have stopped, and she could be
infertile. The syndrome can happen even when there has been no hemorrhage
during a difficult delivery. A person can have Sheehan's and there may be no
symptoms because the disease may be at an early stage or in a less severe
form. In these instances, the disease will manifest itself if the person is
under a great deal of stress. Other people prone to the disease are diabetics
who have cerebrovascular disease. Doctors can accurately diagnose Sheehan's
with the help of hormone-level lab tests and stimulation tests. Successful
treatment involves hormone replacement therapy, carefully tailored to each
patient's needs. However, it is essential that the patient continue to have a
thorough follow-up of lab tests and clinical results so that she may lead a
relatively normal lifestyle.

Are There Any Warning Signs to Predict a Suicide?

QUESTION: We realize that this is a difficult question, but hope you provide
a simple answer, that we hope we don't really need. Are there any warning
signs to predict a suicide?
------------------------------------------------------------------------------
ANSWER: Researchers believe that most individuals who are contemplating
suicide show some warning signs before they take action. But, even with
knowing these signs, it is not easy to identify a suicidal person. If someone
you love is showing signs of considering suicide, he or she is looking for
help and needs your care and attention.
The most important indicator for suicide is a previous suicide attempt.
Up to 50% of suicide victims have tried to kill themselves once before.
Another important sign is talking about suicide, even with veiled language
like "They'd be better off without me" or "I've had it." Some people
considering suicide make arrangements, such as writing a will or giving away
prized possessions.
Personality or behavioral changes can be an important clue toward
suicidal thoughts since it is a symptom of depression. Most suicidal people
are clinically depressed. Treating depression can prevent suicide. If you
are going to make any mistakes in dealing with your problem, make them on the
side of doing a bit too much, rather than ignoring the situation that I sense
you believe may be brewing.

Are There Any Warning Signs to Predict a Suicide?

QUESTION: We realize that this is a difficult question, but hope you provide
a simple answer, that we hope we don't really need. Are there any warning
signs to predict a suicide?
------------------------------------------------------------------------------
ANSWER: Researchers believe that most individuals who are contemplating
suicide show some warning signs before they take action. But, even with
knowing these signs, it is not easy to identify a suicidal person. If someone
you love is showing signs of considering suicide, he or she is looking for
help and needs your care and attention.
The most important indicator for suicide is a previous suicide attempt.
Up to 50% of suicide victims have tried to kill themselves once before.
Another important sign is talking about suicide, even with veiled language
like "They'd be better off without me" or "I've had it." Some people
considering suicide make arrangements, such as writing a will or giving away
prized possessions.
Personality or behavioral changes can be an important clue toward
suicidal thoughts since it is a symptom of depression. Most suicidal people
are clinically depressed. Treating depression can prevent suicide. If you
are going to make any mistakes in dealing with your problem, make them on the
side of doing a bit too much, rather than ignoring the situation that I sense
you believe may be brewing.

What are the Pros and Cons of the Whooping Cough Vaccine?

QUESTION: I'm terribly confused, and know that many other mothers have a
similar problem, as we face decisions about vaccinations. Would you please
discuss the pros and cons of the whooping cough vaccine?
------------------------------------------------------------------------------
ANSWER: Recent news about some of the serious consequences of the pertussis
or whooping cough vaccine has led to worldwide controversy over its "benefits
versus risks" standing. Frankly, the risks of immunizations which contain the
pertussis vaccine are greater than those of any other vaccine available today.
Usually the vaccine is given as part of an immunization injection containing
diphtheria and tetanus vaccine, known as DTP vaccine. However, proponents of
the pertussis vaccine point out that the results seen even when it is given to
so-called "high risk" children (those who previously have had seizures or have
a family history of seizures) are actually less than the bad consequences that
arrive after an actual bout of pertussis. Among the serious side effects that
result in every one out of 7,000 vaccine doses given, are high fever (over 103
degrees F), convulsions, irritability, a deep lethargy, or shock, which is
characterized by difficult breathing, paleness, and a lack of response to
stimuli. Permanent brain damage occurs in one out of every 310,000 children
vaccinated. Even rarer, death is a possibility. Before the DTP was developed
in the early 1940's, death was significant due to pertussis. Still today,
brain damage and seizures happen when children have a pertussis episode. One
study reveals that one out of every 4,000 pertussis victims suffers brain
damage. By contrast only one out of every 100,000 doses of DTP produces
similar problems. Seizures occur in one out of every 225 pertussis victims,
yet one out of every 950 DTP doses may provoke such seizures in a child. A
further complication in the controversy over the vaccine is the fact that the
age at which an infant receives its series of pertussis shots is also the age
when symptoms of an underlying neurological disorder show themselves for the
first time. Research is now geared to predicting which children will suffer
neurological damage from the vaccine. There is also testing of a new vaccine
in Japan. (The United Kingdom and Japan have taken on nonimmunization trends
due to the controversy, but pertussis outbreaks have resulted there.) More
testing and results are needed before any definitive solution comes about. In
the meantime, parents have to weigh the pros and cons of the DTP and decide
not only what they think is best for their children, but for the community as
well.

Why Hasn't Penicillin Wiped Out All Pneumonias?

QUESTION: If antibiotics are so effective, they should be capable of
destroying all the germs responsible for disease. Why hasn't penicillin wiped
out all pneumonias?
------------------------------------------------------------------------------
ANSWER: Although the penicillin antibiotics are effective against many forms
of pneumonia, it won't treat them all. Before antibiotics were invented,
almost all cases of pneumonia were attributed to streptococcal bacteria
(Streptococcus pneumoniae), which respond well to penicillin. Now, strep
pneumonia accounts for only 55% to 76% of cases. Other causes include
Legionella (which causes Legionnaire's disease) and mycoplasma, a fungus. An
additional problem is that pneumonias that were once susceptible to penicillin
antibiotics are growing increasingly resistant.
To diagnose pneumonia, a physician tests a sample of sputum coughed up
from the lungs searching for the bacterial culprit. Many physicians treat
most pneumonia cases empirically, that is they administer an antibiotic such
as penicillin to kill the most likely causes before they get the test results
back. If the first antibiotic doesn't work, then the test results are used to
help choose a more specific or stronger antibiotic.
Despite research, which continues to discover new and more affective
antibiotics, I doubt that the day will ever arrive when a single medication
will totally eradicate an infectious disease. Prevention is the name of the
game.

Folk Medicines for Constipation

QUESTION: I think my Mexican neighbors have a great way to treat
constipation. Do you know of it and what do you think of it?
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ANSWER: Almost every ethnic group in our country has folk medicines for
common illnesses. Although some folk medicines are often rooted in
superstition, some are based on centuries of experience with certain
conditions. Some folk medicines are useless and some may be dangerous since
they interfere with more practical medical care, but some can be beneficial
and your Mexican neighbors have a couple.
Many Mexicans refer to the symptoms of constipation as empacho, or
blocked intestine, and it is believed to be due to food that is stuck to the
wall of the intestines caused by eating improperly cooked food or eating
certain foods at the wrong time of the day. Symptoms of empacho include
diarrhea, indigestion, vomiting, and loss of appetite. In mainstream
medicine, these conditions may be due to infections, lack of fiber in the
diet, or other causes, not just to an intestinal blockage.
Common folk medicines for empacho include drinking mint tea or chamomile
tea or taking small doses of olive or other vegetable oil. Mint and chamomile
tea are both useful in soothing indigestion and nausea, and drinking any
liquid helps relieve constipation. Vegetable oil will also relieve
constipation within a few hours.
The only potentially dangerous folk medicines for empacho are remedies
known as azarcon and greta. These compounds frequently contain lead oxide
that is poisonous.

Colic and Crying

QUESTION: My baby has colic. I feel if I hear her cry one more time, I'll be
judged an unfit mother through neglect. I'm at my wit's end. What can I do?
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ANSWER: Let me tell you the story of one of my patients. I think it will
help, and I'll change enough details and the name to maintain her privacy.
Donna came into my office a while back. That bundle of joy in her arms was
causing incredible anxiety and stress. She and her husband were on the verge
of separation, ready for divorce court. They had both been joyous during the
pregnancy, planning their new baby's whole life for the first eighteen years,
including the scholarship to Harvard. Then reality loomed its ugly head. This
new life demanded their constant and undivided attention. Perhaps no moment
in mankind's strange history on earth is as forceful as when a parent realizes
that her infant is totally and completely dependent.
Donna was 32 and had given up a career in advertising to stay at home
with her baby. But motherhood was a harsh taskmaster, and there were no
immediate rewards in terms of paychecks and promotions. Her visit was not a
routine well baby one; Donna complained that the baby had prolonged periods of
crying for no apparent reason. During these times, she had looked for all the
obvious causes. Was the baby hungry, wet, did she want to be held? Nothing
seemed to work.
The onset of colic varies, but usually occurs between two to three weeks,
and is marked by rhythmic attacks of screaming without known cause. Each
attack can last for several hours and can't always be distinguished from the
ordinary daily periods of crying common in infancy. Usually the
distinguishing factor is the length of the attack. So a diagnosis of colic
occurs by ruling out other possibilities.
Many theories have been posed as to the cause of colic: food allergy,
immaturity of the G.I. tract, progesterone deficiency, improper feeding
techniques, emotional factors. The truth is that medicine isn't quite sure
and attacks the problem using many different therapies.
I'm sure you, like Donna, have tried the obvious remedies. Talk to your
pediatrician about a formula change or a pharmacologic approach. Both these
methods are hit-or-miss. And do follow these maxims: create an emotionally
stable environment for your baby, never overstimulate her in the evening near
bedtime. A pacifier may help to calm her and satisfy her need for
nonnutritive sucking. Improve your feeding techniques by holding her at a
45-degree angle while sucking and taking constant breaks to burp her. If you
are bottle feeding, make sure the nipple hole is neither too big nor too small
and the formula neither too hot nor cold. If you are breast feeding, consult
your physician about omitting allergenic foods from your diet. A swing, a
rocking chair, a clock, a mobile might help to calm her also.
And if all else fails, remember that the baby will outgrow colic around
10-12 weeks of age, so hang in there for the duration. Colic will never hurt
your baby and it's not your fault that she has it. Make sure that you plan
periods away from your baby, either alone, with friends, or with your husband.
These periods away are as important to your baby as the loving care and
attention that you shower on her.
Donna made it, and I am sure you will too.

Pap Smear Classification

QUESTION: I have been required to return to my physician on several occasions
because my Pap smear is a "2". He keeps treating me and then taking another
smear. I am afraid I have cancer, because I don't understand what's going on.
Can you help?
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ANSWER: I believe I can, and the news is good. You most probably do not have
cancer. Since Dr. George Papanicolaou published his paper in 1941 describing
the value of vaginal smears to detect cancer of the uterus, the technique has
been used routinely to discover early abnormal changes of the cells of the
cervix (the entrance to the uterus). The cells are scraped from the cervix by
the physician, placed on a glass slide and then stained. When these cells are
examined under a microscope, the subtle changes from normal can be detected,
and graded against a classification of results which allow an interpretation
to be made. There are 5 such classifications from I to V (we use Roman
Numerals as did Dr. Papanicolaou). Class I means there are no suspicious
cells that reveal any changes and is interpreted as negative for cancer. In
Class II ( as in your case) there are some changes in the cells, which can be
caused by an inflammation, but are not considered to be changes that are due
to or lead to cancer. Usually when the inflammation is treated and has
cleared up, the cells return to normal. Class III is made up of cells that
show mild or moderate changes that are suspicious of cancer, but for which a
diagnosis can not be made with certainty. It is Class IV that is used to
indicate that a cancer has started in the cervix, and Class V which tells of
malignancy and invasive carcinoma, that has attacked the uterus.
There are varying recommendations as to the frequency that the test
should be taken, or repeated, and it is a test that must be performed
correctly to obtain results that are accurate. The best time to obtain cells
for examination is at day 14 of the menstrual cycle when the hormone effect of
estrogen is at its maximum. Any patient with a classification of Class III or
higher should have a biopsy of the cervix performed, since this is a more
reliable test, and affords a more dependable diagnostic interpretation. When
inflammatory changes are noted, the Pap report may note the presence of an
infecting bacteria, which can help the physician determine the treatment.
Most physicians agree that Class II smears should be repeated three months
after treatment. It looks like your doctor is following this appropriate
course.

Is There Such a Thing as a Male Contraceptive?

QUESTION: Is there such a thing as a male contraceptive?
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ANSWER: Except for condoms, there is no reversible form of male
contraceptive--yet. Research is, however, underway to find one.
One male contraceptive that is currently under investigation is
luteinizing hormone-releasing hormone (LHRH), which is a natural hormone
secreted by the hypothalamus gland. Researchers at Vanderbilt University have
been testing LHRH on male volunteers and found that it does suppress the
production of sperm when taken for at least three months. They will begin
further testing soon to evaluate LHRH for side effects.
The LHRH they are using must be injected daily, which will not make it
either popular or cost effective. If the drug were to be developed
commercially--something that won't happen for more than 10 years even if all
goes well--it would probably be a monthly injection or be administered in some
other way.

Are Estrogens Used to Treat Osteoporosis?

QUESTION: I know there is a lot of disagreement about this question because
two doctors have given me different answers, but I would like to read your
opinion. Do you use estrogens to treat osteoporosis?
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ANSWER: In a word, "yes," as do many other, but not all, physicians.
Although there is still much we don't know about osteoporosis, two important
facts have come to light in recent years: a lack of estrogen in women results
in bone loss, and adding estrogen improves the situation. Since the ovaries
are the prime source of estrogen, it's believed ovarian failure (menopause)
should always warrant treatment.
Support for these conclusions is based on a variety of research and
statistical information. One of the most important studies was conducted in
the late 1960's among women whose ovaries (for various reasons) had been
surgically removed. Through specialized x-rays, researchers were able to
prove that those women given replacement estrogen shortly after surgery
retained bone mass, those not treated with estrogen lost skeletal density.
Added to this are statistics which rate menopausal women 12 times more likely
to have a vertebrae collapse and 2 times more likely to suffer a broken hip
than their male counterparts. If estrogen therapy is begun early and
continued for at least five years, say the experts, these kinds of fractures
can be significantly reduced.

Communicating Pain to Your Doctor

QUESTION: My doctor never understands me when I tell him I'm in real pain.
How can I get the message across?
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ANSWER: Pain is difficult to experience and, unfortunately, it can be
difficult to talk about. The way you experience pain is unique to you.
It may help to bring a checklist of information about your pain to your
physician. Write down when the pain started, whether there was a specific
cause, or whether it developed gradually. Is the pain intermittent or
constant? Are you in worse pain in certain positions, such as sitting or
laying down? How has the pain affected the quality of your life? Have you
taken any pain medications and have they helped at all?
Don't just say you are in pain, describe your pain. Words like cramping,
sharp, throbbing, aching, all give different information to your physician.
If, after you have tried this, your physician still does not understand, you
may have to consider finding a physician whose pain "vocabulary" matches
yours.