Tuesday, October 9, 2007

Is There Anything Wrong with Being Easily Sexually Aroused?

QUESTION: By comparison to some of the women who work with me, it seems that
I get sexually aroused more easily than they do. Does this mean that there is
something wrong with me?
ANSWER: Not necessarily. First, it is really up to you to decide whether you
have a problem. You say you are easily aroused. If you have a cooperative
partner (that is, someone to have sex with), then it is not a problem. If
your arousal interferes with daily life, distresses you, or if you have no
outlet, you have a problem.
Bear in mind that sexual appetites differ from person to person. Also
remember that "nice" women do get sexually aroused. A fallacy held over from
the Victorians said that "ladies" don't enjoy sex. That has changed as
society changes and as new ideas about life become the order of the day.
If your easy arousal (or hyperlibido) is causing a problem, there may be
a physical (as opposed to psychological) reason. A genitourinary infection
can cause irritation that may be mistaken for arousal. In men, priapism (a
persistent erection that has no sexual cause) is often mistaken for arousal.
Neurologic problems, such as encephalitis or a head injury, can also cause
hyperlibido. Curiously, a side effect of untreated syphilis can be nerve
damage in the brain leading to hyperlibido.
Certain endocrine diseases, such as hyperthyroidism, can cause
hyperlibido by elevating blood levels of the thyroid hormones and
testosterone. Treatment for hyperlibido depends on the cause. If the
underlying cause cannot be corrected, a drug called cyproterone is being
developed that may reduce hyperlibido and hypersexuality.
If there are no physical causes, and you are worried about your own
sexuality, a concerned and skilled ethical counselor or physician may provide
the answers you seek.

What Are Ulcerative Colitis, Proctitis, and Proctosigmoiditis?

QUESTION: What is the name of the disease that is like ulcerative colitis but
happens in the rectum? Where does it come from, and how may it be treated?
Thanks for your help.
ANSWER: Ulcerative colitis is an inflammatory disease of the inner lining of
the large intestine, or colon. Ulcerative "proctitis" and
"proctosigmoiditis", on the other hand, are similar inflammations of the
rectum and of the final curve of the colon leading to the rectum. The
symptoms of these two diseases include rectal bleeding and mucus in the stool.
This disease is not to be confused with proctitis caused by infection,
frequently transmitted through sexual contact.
Medical experts disagree on the nature of ulcerative proctitis and
proctosigmoiditis. Some say the two are a mild, limited form of colitis.
Others argue that they are a completely separate disease. However, it has
been shown that if the disease hasn't spread to the rest of the colon after
six months, then it probably never will. Furthermore, the prognosis for
proctitis and proctosigmoiditis is better than the outlook for colitis.
Patients with the more limited disease rarely need to be hospitalized or
treated with system-wide corticosteroids. Therefore, it can be important to
distinguish between the diseases.
In any case, ulcerative proctitis is generally fairly mild. Since most
of the colon is not affected, normal stools are usually formed. In fact, a
patient with the disease may even be constipated. Treatment involves
medication for the inflammation and hydrocortisone or corticosteroid foam

What Are the Causes and Symptoms of Premenstrual Tension?

QUESTION: Do you have any material about premenstrual tension? I think there
are a lot of husbands in your audience who could use a bit more information
than they now have.
ANSWER: The causes of premenstrual syndrome (PMS) are not fully understood.
Many researchers believe the wide ranging symptoms that often occur in the ten
days before a woman menstruates are caused by an imbalance between estrogen
and progesterone during the second half of the menstrual cycle. Another
school of thought is that PMS is associated with a salt imbalance in the body,
resulting in the accumulation of water in the tissues just before
menstruation. Others think nutritional factors play a role. Many doctors
believe a combination of these factors are responsible for PMS, and that's why
the problem manifests itself with such variety among different women.
Some of the common symptoms of PMS include tension, irritability,
depression, anxiety, fatigue, difficulty in concentrating, abdominal cramps,
headache, backache, muscle spasms, breast tenderness, weight gain, swelling of
the joints, especially in the fingers and ankles, bloating, abdominal
heaviness, nausea, constipation and pelvic discomfort. Experts estimate the
condition affects 70 percent to 90 percent of women at some point during their
childbearing years. Few women suffer from all of the symptoms I've mentioned,
and for many, the symptoms and their severity vary from month to month. There
are a variety of ways to manage PMS. Many doctors recommend a change in diet
a week to ten days before a woman expects her period. It often helps to
eliminate caffeine, sugar and salt, as this can help reduce tension,
irritability, bloating and painful swelling breasts. To fight the depression
and fatigue associated with the syndrome, some suggest dividing food intake
into 3 small meals a day, plus 3 high protein snacks. A regular exercise
program can help cut down on water retention and ease premenstrual tension.
Vitamins, especially vitamin B6, are often recommended.
There are several over-the-counter drugs made specifically for relieving
the symptoms of PMS. Aspirin and acetaminophen can be helpful, and in some
cases, a diuretic (water pill) might be prescribed.

What Are Causes of Terrible Skin Reactions?

QUESTION: Just when I thought I had gone through a summer without any health
problems, I came down with a terrible skin reaction after but a few minutes in
the sun. My whole body turned flaming red. Can you figure out what caused
ANSWER: You had a "photosensitive" reaction. That's the simple answer, but
finding out why takes some evaluation by a doctor who is familiar with such
There are different reasons a person may have a very bad reaction to
sunlight. Several medications cause people to react badly to the sun. Then
there are skin diseases within the body that can cause your skin to burn with
only a small amount of exposure to sunlight. Solar energy in large enough
quantities can burn anybody, but in some individuals absorbed light in any
amount may trigger a photochemical reaction, resulting in tissue damage.
When you speak to a doctor and he or she rules out "normal" overexposure
to the sun (think back, you might have been outside longer than you realized)
it is time to start investigating further. The physician should get a full
history of what medications you are on, did you drink alcoholic beverages
while in the sun or just before exposure, did you wear perfume that could have
triggered an allergic reaction? If there isn't a simple answer to what caused
your severe burn, then it's time to do testing for diseases within the body
that make the skin react.
Lupus Erythematosus is a systemic disease that has been found to affect
about 1 in 800 people in the United States, occurring primarily in women.
Exposure to sunlight is a factor that seems to contribute to the development
or onset of this disease. This chronic inflammatory disease can cause injury
to the skin, joints, kidneys, nervous system and mucous membranes. It is
possible to have flare-up periods and remissions with this disease, and LE
patients are instructed to avoid exposure to sunlight as much as possible to
minimize relapses.
Naturally, it is impossible to avoid sunlight altogether, so it is
imperative that LE patients use a sunscreen daily with a sun protection factor
of at least 15. Patients are also treated with topical corticosteroids and,
in rare cases, with oral hydroxychloroquine.
Dermatomyositis (DM) is another inflammatory disease, characterized by
skin rashes. DM may be complicated by lung disease, esophageal problems,
cardiac conditions and arthritis. Myositis may cause progressive muscle
weakness and tenderness. DM is also associated with an increased risk of
cancer. Lab tests that should be done on DM patients include evaluation of
blood in the stool, mammography and chest films.
Another skin disease, porphyria cutanea tarda (PCT) is associated with
alcohol abuse. PCT patients often show a striking improvement when they stop
drinking. Estrogen therapy in postmenopausal women may also exacerbate this
If you haven't already been to a doctor about your strange reaction to
the sun, go. As you can see, the skin rash could be a warning sign of a much
greater problem. But if you are like many of my patients (and family), you
probably just underestimated the time you spent sunbathing, and probably took
your exposure when the suns rays where at their highest intensity. Let's hope
so, for then your doctor's visit will be a fine educational visit, and you
will have no serious worries to concern you.

What Is the Best Form of Birth Control?

QUESTION: I am confused about the many possible choices that I have now that
I have decided to use birth control pills. Is there anything like a "best
choice", and would you consider reviewing the different dose forms which are
now available? I would be most grateful.
ANSWER: Birth control pills, or oral contraceptives, have been around for
over 25 years now and they are still the most effective nonpermanent form of
birth control. Oral contraceptives have changed. The pills that were first
marketed in the 1960's had large doses of estrogen and progestin, whereas
those made today have far lower doses and are still effective.
The best choice for birth control pills--or any other medicine--is the
smallest dose that does the job. Most brands of oral contraceptives today
contain 30 to 35 micrograms of estrogen. Some women have breakthrough
bleeding at this low dose and may need to be switched to brands with 50
micrograms of estrogen. This is still a far lower amount of estrogen than was
once used. Some types of oral contraceptives use slightly different amounts
of estrogen and progestin over the course of the cycle, to mimic the normal
rise and fall of hormones in the body.
The most serious health risks of taking the pill are cardiovascular,
meaning an increased risk of heart attack, stroke, and blood clots. However,
this risk is significant only for women over age 40 or those who smoke. For
most women, the health risks of a possible unwanted pregnancy outweigh the
risks of contraception. The pill can cause nuisance side effects such as
acne, weight gain and headaches, but these are minimized with newer low-dose
versions. There are actually several benefits to taking oral contraceptives.
They appear to prevent formation of ovarian cysts and there is evidence they
protect against endometrial and ovarian cancer.
But please remember, we are all unique individuals, and what may be right
for your neighbor, may not be the best for you. In this case it really is
smart to get the personalized advice of your own physician.

Is There Concern for Elderly Losing Some Speech Ability?

QUESTION: My great-grandmother seems to be losing some of her ability to
speak as clearly as she used to do. I've noticed the same thing has happened
to some of the people she lives with so I wasn't too worried at first. Is
this something I should be concerned with?
ANSWER: Yes, concern is warranted. Sometimes even subtle changes in speech
can be a clue to disease even before other signs are apparent. Elderly people
who retain their young sounding voices are generally in better overall health
than most of their contemporaries whose voices change.
When the change is in articulation (from "articulate", to speak clearly),
it could be due to neurological changes. Damage to different parts of the
nervous system can affect different functions in speech. For example, a
severe articulation problem can be caused by damage or degeneration of the
fifth cranial nerve. That's because when that nerve is unhealthy, it hinders
a person's ability to move his or her jaw up and down. You should make sure
your great-grandmother checks her problem out with a neurologist who has
expertise in speech pathology.
You may observe the physician will listen attentively when your
great-grandmother speaks, for the manner in which she talks, the tone and
quality of her voice, are all important clues which can lead to the diagnosis
of the exact cause. Once the cause is known, there are a number of possible
treatments which can be used to correct the problem.

What Is the Eye Condition Nystagmus?

QUESTION: My roommate at college has a condition of her eyes that I believe
is called "nystagmus". I have never discussed this with her but would like to
know a bit more about the condition. Will you please help?
ANSWER: Nystagmus is an involuntary, repeated, jittery movement of the eyes.
Sometimes it is caused by a brain lesion, which may have been inherited. It
may be caused by a congenital impairment of vision in the eye or optic nerve.
People with vision problems such as extreme near or farsightedness, scars in
the retina or optic nerve, or albinism may suffer with nystagmus. Rarely, it
can occur from a brain tumor or neurologic disorder. If the cause can be
determined and removed, the condition can be cured but often it is permanent.
Glasses with prisms or eye muscle surgery may improve the head position and
allow better vision in cases where the eyes are more stable when looking in a
certain direction. Low vision aids can help in those cases caused by reduced
vision. Eye medications and biofeedback rarely help control the nystagmus.
With this basic information, you might try discussing it with your roommate.
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

What Can Be Done About Continued Waking for Night Time Feeding?

QUESTION: My five-month old baby still awakens for his 2:00 A.M. feeding.
Although it is tiring for me, I don't mind feeding him if he's hungry. My
older sister also has a baby and she says I'm just spoiling my baby and that I
must phase out this middle of the night feeding. What do you think? Can you
suggest how I might help my baby to sleep through the night?
ANSWER: Most pediatricians would agree with your sister. By 4 months of age,
95 percent of babies can sleep through an 8-hour night without feeding.
Physically they don't need the extra calories anymore by that age. Trained
night feeding is one of 3 clinically observed sleep disorders in babies and
children. The other two problems commonly seen are trained night crying and
fearful night crying. For all three problems, parents must work at changing
their baby's nighttime habits.
Early intervention is important for sleep problems, because infants older
than 6 months begin resisting change. To untrain a baby from nighttime
feeding, it is essential to begin to increase the time between daytime
feedings to four hours apart or more. The baby will then get used to going
for longer periods of time without being fed. You simply cannot expect a
child's nighttime habits to change if his stomach is trained to expect
frequent feedings. A general guide and goal should be 4 meals a day by 4
months, 3 meals a day by 6 months. If your baby seems to be asking for more
frequent meals during the day, give him some extra holding, attention or a
Feed your baby at bedtime, but don't give him the bottle in his bed. If
your baby seems to need extra sucking, you may try using a pacifier.
Once your baby's daytime feeding schedule is where it should be,
nighttime awakening will probably automatically decrease or disappear. Until
that natural change occurs, you might have to get up to feed your baby. But
if you do, make it a small meal.
Put your baby back in his crib when he's slightly hungry. If you breast
feed, nurse him only on one side. If you are bottle feeding, decrease the
amount you put in the bottle every few nights by one ounce. In about two
weeks, your baby should be sleeping through the night.

Can Adults also Get the Kidney Disease Nephrotic Syndrome?

QUESTION: Is it possible for an adult man to develop a kidney disease called
the "nephrotic" syndrome? My reading about this condition led me to believe
it was only seen in children. Will you please straighten me out?
ANSWER: I am happy to see you searching for answers on your own, but I am
happy to help. It is true that the nephrotic syndrome is far more common in
children, where we average about two new cases per hundred thousand people per
year in the U.S.A. and the United Kingdom. Looking at the statistics for
adults, we find only three per million people per year of new cases. The
causes of the nephrotic syndrome are many and varied, and can range from
circulatory causes, the ingestion of certain drugs or chemicals which are
called nephrotoxins, as well as allergic manifestations which come from such
ordinary things as bee stings and poison ivy. The diagnosis of this disease
is based upon its clinical features as well as laboratory findings which
result from testing the urine and blood. However, in most cases of adult
nephrotic syndrome, it is important to have a renal biopsy to obtain a small
piece of tissue. This tissue aids in making an accurate diagnosis and helps
choose the correct treatment. With a clearly established diagnosis and
treatment, physicians can predict the prognosis of the disease with greater
accuracy, and relieve some of the doubt and anxiety of the patient and their

What Are the Causes of Irregularly Menstrual Periods?

QUESTION: Though most of my girl friends confide that their monthly periods
are like clockwork, mine are never on time, never seem the same, and seem all
wrong. I am becoming very anxious and wonder if there is anything you can
tell me about my condition. What can be done to help me?
ANSWER: It's hard to tell from your question exactly what the problem is. It
sounds like you're complaining of irregularly spaced menstrual periods. If
that's the case, you and your doctor will probably want to evaluate whether
you are ovulating properly, since normal menstrual bleeding follows ovulation
by two weeks if fertilization does not occur.
There are a variety of ways to determine whether you are ovulating. Many
women identify a change in the cervical mucous when ovulation occurs. Some
women spot slightly and feel a pain in the lower abdomen when the ovary
releases its monthly egg. This has been given the descriptive name
of "middleschmertz" ( or "middle pain").
Basal body temperature rises by about 0.5 degrees F. at ovulation, and
remains elevated until menstrual bleeding begins. Taking your temperature
each morning with a basal body temperature thermometer, carefully following
its directions, will help to tell you whether you are ovulating.
There are also several self-test kits on the market which, when used
properly, can tell you whether you are ovulating.
If your doctor feels your problem warrants more investigation, he may
perform blood tests to check your hormone levels. Hormonal therapy can be
ordered to solve the problem, but hormones should be prescribed carefully.
If you're not ovulating, what could the problem be?
Stress, the culprit for so many other ills, can shut down ovulation.
Emotional stress and physical stress, such as that induced by extreme exercise
or illness, can change your hormonal levels enough so that ovulation is often
stopped until the problem is resolved. Women with anorexia nervosa often stop
Obese women often stop ovulating until they lose weight. Body fat can
produce estrogen, and the excess upsets the body's hormonal balance. The
result is no ovulation, irregular periods and an increased risk for cancer of
the lining of the uterus.
Women with abnormal thyroid function, especially those with a low thyroid
production, often do not ovulate. Treatment with thyroid medication usually
solves this problem.
Some women who do not ovulate have polycystic ovaries. Polycystic
ovaries are enlarged and contain many partially mature but unreleased eggs.
Drug therapy can usually correct this problem.
Tumors of the ovary or adrenal glands may cause ovulation problems, but
they're rare. If no other problems are found, this possibility should be
Not ovulating or irregular ovulation obviously causes infertility
problems. Ovulation problems that are causing infertility can sometimes be
treated successfully with hormonal therapy.
As you can see from my answer, irregular periods can be more than just a
nuisance. If you are experiencing irregular menstruation, you should be
thoroughly and completely evaluated, because menstrual problems may often be a
signal that something else is wrong.

What Can Be Done About Memory Loss?

QUESTION: I hate the signs of aging which I can detect in others, and am most
distressed by those same signs when I find them in myself. Now my husband
keeps telling me that I am losing my memory, and I am not sure that he isn't
right. What can one do about this problem? I would appreciate any help you
can offer.
ANSWER: All of us experience moments of forgetfulness from time to time. A
busy schedule, worry over health problems, and just plain "too much on our
minds" can contribute to temporary lapses of memory. This is perfectly normal
and nothing to be alarmed about. But if memory loss becomes noticeable and
troublesome and if (like an estimated 3 to 4 million Americans over age 60)
you find yourself forgetting recent events, it's time to see your doctor.
Some of the early signs of true memory loss which your doctor will be
alert for are repeated forgetting of things like keys, glasses and
appointments, retelling stories or events in the same conversation, problems
recalling new names and places, difficulty learning new facts or skills, and a
progressive lack of interest in appearance and personal hygiene. He'll want
to know if you have trouble getting out words "on the tip of your tongue," if
your attention span is short, and most importantly, if you often forget things
which happen day to day.
The key words to remember are repeated and often. Occasional slips are
inevitable in this hectic world, frequent memory loss is not and could signal
some physical problem. Among the many possible causes are poor nutrition,
diabetes, anemia, thyroid problems, depression, and medications or
combinations of medications you might be taking. Whatever the cause, the
important thing to know is that it's treatable. Early diagnosis can
definitely better the chances for improvement.

What Is Sleep Apnea?

QUESTION: A friend of mine, a notorious snorer, has told me his condition was
do to a life threatening situation he called "sleep apnea". Is this an
exaggeration of the facts? What is sleep apnea, what causes it, and how do
you treat it? There are a few more snorers in this building that would like
to know more about this.
ANSWER: Sleep apnea, a condition which affects up to 4 percent of the adult
population, is a sleep disorder in which the sufferer actually stops breathing
for several seconds during sleep, and during which the heart slows down. This
may be followed by a jerky body movement, respiration resumes and the heart
speeds up considerably.
Subjective symptoms not withstanding, these patients experience no
difficulty sleeping through the night, though they usually complain of fatigue
and headache upon awakening. Objectively, their sleep partners testify that
the symptoms of these disorders are more life-threatening than the patient
For instance, while sleeping, apnea sufferers often stop breathing for 15
seconds to as long as 60 seconds, and these episodes may repeat as frequently
as 4 to 30 times an hour. During this time the oxygen content of the blood is
reduced, taxing both the heart and lungs. They then may seem to fight to
regain their breathe, and then continue with a more quiet sleep. And while
personal problems such as divorce are sometimes credited for the onset, it may
rather be the result of the noisy, on and off pattern of loud snoring that is
so frequently associated with this condition.
Snoring, a sign of temporary and incomplete obstruction of the upper
airway, is very common in patients with sleep apnea syndromes. Obesity,
tonsillitis, and pulmonary problems are only a few of the contributory factors
a physician will be on the alert for.
An accurate diagnosis, however, can best be obtained by requesting that
the patient spend a night or two in a sleep laboratory, where his sleep cycle
can be electronically monitored through polysomonography.
Once a clear picture has been established, a conservative course of
treatment can begin. In obese subjects, unless life-threatening abnormal
heart rhythms are present, weight loss is a good first step. Studies have
shown that even small reductions in weight in grossly obese patients greatly
improves sleep disorder symptoms. Eliminating depressants such as alcohol,
hypnotic drugs, and sedatives also improves control.
If these initial efforts prove unsatisfactory, the use of respiratory
stimulants (such as medroxyprogesterone) or surgery may be necessary. Such
successful surgical procedures range from removal of obstructive tissue to
tracheostomy. However, recent advances in sleep apnea management (Nasal CPAP
or Continuous Positive Airway Pressure) are yielding some dramatic results.
Nasal CPAP involves the use of a tight fitting nasal mask and small
compressor which generates enough constant air pressure to keep open the air
passages and prevent obstruction. The increased pressure takes just a bit of
getting used to, but is rapidly achieved. Admittedly, this "deep sea"
equipment is not the most alluring nightwear, but for many patients it's a
most acceptable alternative to surgery.

What Can Be Done About School Phobia?

QUESTION: My neighbor's boy is already making noises like he won't go back to
school without a fight. Could this be something like a school phobia, if
there is such a thing? How should the child be treated?
ANSWER: If this child is one of thousands of children refusing--for any
reason--to go to school, he could be classified as having school phobia
(better called "School Refusers"). Depending on the severity of each case,
the family, school officials, physicians, including psychiatrists, may have to
become involved.
Some school refusers simply suffer from separation anxiety, usually from
the mothers. Other causes involve threats to the child, bomb scares at their
schools, peer group pressures, as well as recent losses and/or changes in
their families. Children experiencing physical complaints must be examined by
a physician. When no physical problem is uncovered, evaluation by teachers
and other school officials is required. Evaluators work to understand what is
happening to the child and his/her familial and peer relationships. They also
determine if there is an undetected learning disability as well as any hobbies
and interests the child enjoys. School refusers' abilities to play are
carefully examined to determine if normal childhood activities are being
School refusers frequently complain of vague physical symptoms like
stomach or head aches, dizziness, sleep problems and even vomiting.
Histories of past illnesses always are studied to see if hospital stays
created separation anxieties and if other family members have experienced such
Effective treatment depends on many test and evaluation results, severity
and how long the child has had the problem. At times, treatment may be only
discussing separation difficulties with the child, parents and other family
members. In other cases, individual and family psychotherapy might be needed.
Home tutoring may be suggested until the child is capable of agreeably
returning to school. Fortunately, with a little concern, care and treatment,
between 66 and 99 percent of school refusers willingly return to their

How Does One Get Stones in the Salivary Gland?

QUESTION: I have never heard of this before, but that is of little importance
now that I have a case of stones in my salivary gland. Where do they come
from, and how do you treat this strange disease? Any information you can
offer would be immensely appreciated.
ANSWER: Although stones in the gallbladder and kidney are better known,
stones in the salivary glands are not uncommon. Salivary stones (also called
sialoliths--"sialo" means "saliva" and "lith" means "stone") occur in about 1
percent of the population, especially in older individuals, and more often in
men than in women.
Stones can form in any of the saliva glands, but they usually occur in
the submandibular glands, the two located under the jaw with ducts that come
up just where the tip of your tongue rests. Stones usually form in this gland
because of its more viscous, alkaline saliva and higher calcium content. This
gland also has a longer curved duct that leads upward, which means its saliva
must flow against gravity.
A stone that forms or lodges in duct will cause swelling and pain.
Often, the stone can be removed by massaging along the salivary duct, but
sometimes it must be removed through relatively minor oral surgery.

What Exactly Are Risk Factors Concerning Heart Disease?

QUESTION: Almost every article, including some of yours, mentions the effect
of "risk factors" in relation to heart disease. Just what is a risk factor,
and how did doctors discover them? A word or two of explanation would be very
much appreciated.
ANSWER: A risk factor is simply any circumstance or condition (factor) that
causes the possibility (risk) of an injury. When we use the term to discuss
heart disease, we're stating certain facts in a person's history that seem to
be present when heart trouble is diagnosed. A person may have many points
against him or maybe just a few. They may be controllable or not.
For instance, if you are a male under the age of 45 and your father died
in his youth from a heart attack, the chances are you too could develop heart
disease at a very early age. Age, sex, and family history are uncontrollable.
On the other hand, if you're a "workaholic," sedentary, overweight, a
chain-smoker, or subject to high blood pressure or high cholesterol, these are
risk factors that can be controlled.
Risk factors are determined by analyzing various factors associated with
a disease. It is a statistical method of linking associated circumstances,
which then may be further studied to see if there is a "cause and effect"
Changes in lifestyle and diet, coupled with sound medical care, can
change predicted outcomes, prevent the development of heart disease, and
overcome the dangers in of risk factors we cannot change.

Are All the Tests and Treatments for Rheumatoid Arthritis Needed?

QUESTION: My sister has been told she has rheumatoid arthritis. From her
story, the doctor is treating this like a disease with dire consequences, and
is ordering all types of tests and treatments. Is all of this necessary? I
want to be a help to my sister and so need to know more.
ANSWER: I'm not sure by what you mean by "dire." It is not a disease to be
ignored, because treatment as soon as possible lessens the damage it does.
Another reason for accurate diagnosis is because the symptoms of rheumatoid
arthritis are often confused with the symptoms of other diseases that also
require early treatment.
Aching, stiff joints may signal a host of illnesses. The alert physician
will be sure to follow up on this, striving for a clear and accurate
diagnosis. There are many kinds of arthritis, and rheumatoid arthritis is
only one of them. Rheumatoid arthritis is seen more often in women than men,
and it most often starts between the ages of 30 and 50. The first indication
may be a stiffness in the hands in the morning, which is relieved after about
30 minutes of activity. Swelling around the joints of the fingers is a sign
that shouldn't be ignored, and some people have hardened knots on their
joints. Rheumatoid arthritis is diagnosed by blood tests, analysis of the
fluid in the joints, and x-rays. Continuous communication between your sister
and her doctor will help in the diagnosis, because rheumatoid arthritis often
starts out with just some vague aches, difficult to describe or pinpoint. Her
doctor may be watching for further development of symptoms, keeping an eye out
for subtle changes in movement and strength. It's not uncommon for patients
experiencing the first aches of arthritis to become frustrated when their
doctor orders many tests to establish a "baseline", or level of findings that
will be used to judge just how much the disease is progressing.
When the diagnosis of rheumatoid arthritis is made, treatment may start
simply with aspirin, for it is an effective anti-inflammatory. Additional
medications are gradually added to the treatment as necessary. Also, we now
know that it may be wise to do surgery on joints affected by arthritis at an
earlier stage, before the joints and surrounding tissue are badly damaged by
the disease. Surgery was once reserved for only the very severe, advanced
case of arthritis. This is no longer the case, and new artificial joints and
microsurgical techniques are making surgery safer and more successful.
Surgery should, however, be delayed until more conservative treatment like
medication and physical therapy is tried. New methods and equipment for
physical therapy have aided the arthritis patient, and a good physical therapy
program should be part of arthritis treatment for most people.
Because arthritis is a chronic, painful and frustrating disease, its
victims fall prey to a particularly distressing situation. They become
victims for a second time, to the exploitation by promoters of quackery. The
promise of a quick cure and the end to pain is difficult to resist when one
is suffering, but caution is a must. Some of these "cures" are inexpensive
and harmless, but many are very expensive and may be harmful. In any case, do
not delay medical treatment while folk or unproven remedies are tried. You'll
be performing an enormous service to your sister if you stay informed, support
her emotionally, and prevent her from straying off into ineffective and
dangerous therapies.

How Are Nasal Decongestants Addictive?

QUESTION: An article in a health magazine stated that the constant use of
nose sprays can be addicting. How is it possible that a nose spray can lead
to an addiction, when there are no narcotics in the liquid?
ANSWER: If you consider the definition of the word "addiction" to mean the
habitual use of a substance upon which the body comes to depend, then we can
proceed with an explanation. I am sure that the article that you read was
referring to a condition called "Rhinitis Medicamentosa". Before I get into
this condition itself let me describe rhinitis. This condition features
runny, stuffy and itchy nose accompanied by a dry mouth and sneezing. It is
caused by inflammation of the tissue's lining the nasal passages along with
enlargement of the blood vessels, that run inside the tissue. Nasal sprays
cause the blood vessels to contract which, in turn, reduces the amount of
inflammation. When the sprays are used constantly over a long period of time,
say 1-2 weeks, the tissues become dependent on the medication to keep the
blood vessels shrunken, and the inflammation controlled. Unfortunately when
you stop using the sprays, control is lost, the vessels will enlarge once
again and the runny nose returns. This time though it is not due to the
illness, but to the nasal tissue's dependence or "addiction" to the nose spray.
This is the condition called rhinitis medicamentosa, more commonly called
"rebound rhinitis". As a matter of fact, if you take the same medicine
(decongestant) that was contained in the spray, in tablet form, the rebound
condition does not occur. People with bad allergies or other medical
conditions that can lead to symptoms of rhinitis should be evaluated by their
doctor and followed closely in order to keep a check on the medications they
use. Remember, while using over-the-counter medications for a short period of
time for minor maladies is safe, long term, continual applications bring on
unwanted and often unexpected side-effects. If that happens to you, or if
runny and stuffy nose symptoms persist far beyond the time you would expect
your cold or allergy to persist, it would be wise to check with your doctor,
to make certain something more serious is not developing.

Ticks and Lyme Disease

QUESTION: I've heard about a Lime disease that's spread by ticks. In the
warmer seasons I often have to pull ticks off my dog. Am I at risk of
contracting this disease? Tell me about the disease.
ANSWER: The ticks that generally cling to dogs are different than the ticks
that cause Lyme Disease (it's spelled with a "Y"). Dog ticks are much larger
than the tiny ticks that lead to this illness.
Generally, the disease causing ticks cling to nonhuman hosts such as
deer, mice and birds, but dogs can sometimes act as hosts. Lyme disease was
first discovered in 1975 in Lyme, Connecticut. Several members of one family
began suffering from fevers, stiff joints, and other symptoms. One of the
children was diagnosed as having juvenile rheumatoid arthritis. Upon
researching the family's problems, the mother found that many residents in the
area were suffering from similar arthritic diseases--in almost epidemic
proportions. A doctor from the Centers for Disease Control investigated, and
true arthritis was ruled out. After several years of investigation, the deer
tick was finally pinpointed as the carrier of the disease. The very first
symptom for many victims of Lyme disease is a slow spreading rash surrounding
a dark bump. It may take a few weeks or even months after the tick bite for
other symptoms to appear. They include persistent fever, severe headaches and
disabling fatigue. Arthritis is only one of the serious complications of Lyme
disease. If untreated, Lyme disease can involve many organs of the body,
including the heart.
It's not the ticks on your dog you must worry about, but those that get
to you. After any session in the fields, caution dictates that you carefully
inspect both your animal and yourself (include clothing) to be sure you
haven't brought home more than you hunted for.

Hunting and Lyme Disease Prevention

QUESTION: I like to go deer hunting, but my wife says I can catch something
called Lyme disease from the deer. Is this true? Please explain and tell me
if there's a way to avoid it.
ANSWER: Lyme disease is spread by infected deer ticks. It is a growing
problem, especially in the Northeastern part of our country. Lyme disease is
serious, and it can lead to chronic arthritis, cardiac problems, and
neurological disorders.
The organisms that cause the disease--called spirochetes--look like
wiggling corkscrews when under a microscope. The disease was first observed
in 1975 in the village of Old Lyme, Connecticut, where the first cluster of
cases was discovered.
The deer tick is much smaller than dog ticks. When an infected deer tick
comes in contact with humans, the infecting wiggling organisms are spewed into
the victim's skin.
Most people develop a round rash at the site of the bite. Few people,
however, realize they have been bitten by the little pests, because you don't
often feel the bite.
Scientists still don't know for sure how the spirochetes move from the
bite to the spinal chord, brain and other organs, where the damaging sickness
sets in. Doctors believe that the body's protecting cells kill off some of
the invading bacteria. It is theorized that the surviving bacteria travel
through the blood, cross the blood-brain barrier and damage parts of the body
that are normally well protected.
The fact that the infection crosses the blood-brain barrier makes it more
difficult to fight. Doctors have had success treating Lyme disease victims
with an antibiotic called ceftriaxone. Injections of this potent drug do
cross the blood-brain barrier and it can, therefore, get to the same
hard-to-reach places as the damaging infection.
A lot more research must be done in order for doctors to fully understand
this tricky disease. Right now doctors aren't sure if any treatment fully
wipes the system clean of the invading spirochetes.
If you go hunting and come in contact with deer, then you are naturally
at higher risk of being bitten by an infected tick, or bringing them into your
home on your clothing, shoes, hunting gear, etc.
To help prevent tracking the ticks into your home, change out of your
hunting clothes before entering your house, if possible. Then check your
garments, inch by inch, for the ticks.
If you spot the insects, use tweezers or fine tipped forceps to grasp the
tick and dispose of it in a container where it can't escape. Save it to show
your physician. Use the same procedure to remove a tick from the skin. Apply
an antiseptic immediately afterwards to prevent infection, and let your doctor
know you've come in contact with the deer tick.

Can Herpes Cause a Brain Infection?

QUESTION: I am aware of the sexual disease of herpes and know that cold sores
can also come from this virus, but I have just learned of a new herpes
disease. A fellow employee has just been hospitalized for a brain infection
diagnosed as Herpes. Can herpes cause a brain infection?
ANSWER: Yes, it can. But it is not a new disease, just a different organ
attacked by the already known viruses. Herpes simplex encephalitis
(encephalitis means brain infection) is the most common form of nonepidemic
encephalitis in the United States.
Herpes infections are harbored in the nerve tissue and skin, and may lie
there in a dormant or "sleeping" stage for long periods of time. The sores
caused by the infection are often brought on by physical or emotional stress.
Why a small percentage of people who have a herpes infection come down with
encephalitis rather than the typical and common cold sore is not known. As
you know, up to 95% of the people in America have been exposed to one of the
two herpes simplex viruses (HSVs). Cold sores or fever blisters are usually
caused by HSV-1 and sores on the genitals are usually caused by HSV-2, but his
doesn't always hold true, as both varieties may attack either site.
The symptoms for herpes simplex encephalitis are headache, nausea,
vomiting, fever, and lethargy, symptoms which are commonly seen in
encephalitis from whatever cause, or infecting bug or virus. Unless the
disease is properly diagnosed and treated, it can progress to coma and death.
This encephalitis is especially dangerous in infants who may be infected with
HSV-2 during birth.

Herpes Medication Use and Dependency

QUESTION: I was recently diagnosed as having herpes and was given medication.
Just how dependent will I become on this drug? Will I be taking it forever?
ANSWER: Any doctor worth his salt knows that for any drug therapy to be
effective in the treatment of herpes, there must be a period on and a period
off the medication; and this is how it works.
A first bout with herpes demands immediate action and medication. It is
called a primary episode, meaning it is the first time you have been exposed
to one of the two herpes viral strains. You feel rotten, are in pain, and
have genital lesions. Your doctor prescribes a drug that will shorten the
period of illness and hasten the drying of the lesions and sores. At this
juncture when the active phase is over, and with your physician's consent, you
can now safely stop your medication.
But keep it on hand in your medicine cabinet. Herpes recurs: these
frequent outbreaks are called nonprimary, because they're not the first time
your body has dealt with the virus. Your timely use of medication can stop a
full-blown attack in many cases (prevent lesions from appearing at all in most
cases). If you can tell when your herpes will show itself (you might know for
certain that you have bouts with herpes every four to six weeks) again take
your medication before it is due to appear. If there is some important
occasion in your life--business trip, honeymoon, vacation--take the drug in
advance as a precautionary measure to spare yourself undue embarrassment. So
the answer is no, you won't be on the drug forever, but it can be at your
disposal, under your physician's guidance, to stop the severity of recurrent

Special Infections of Intravenous Drug Users

QUESTION: Is it true that drug users can become infected with special
infections? What are they? What makes infections in intravenous drug abusers
differ from those in the general population?
ANSWER: Infections in intravenous drug abusers can differ from those in the
general population in a number of ways. The type of infection or the
infecting organism itself can vary, as can the signs and symptoms.
One of the most common infections associated with drug abuse is soft
tissue infection, usually found at the site of injection. If superficial,
soft tissue infections appear to be very similar to patients who do not abuse
drugs, but in more serious cases, gram-negative bacteria tends to be present.
Swelling and tenderness in the extremities, fever, and signs of systemic
illness may then develop. Mortality rates can be fairly high, and treatment
requires aggressive culturing of the blood, administration of broad-spectrum
antibiotics, and possible surgery. Gram-negative bacteria is rarely present
in soft tissue infection in the general population.
Lung abscesses, tuberculosis, and aspiration pneumonia are other serious
infections in narcotic addicts. They can develop as the result of acute
overdose, injection of talc, or from drug-induced stupor or coma. In many
cases, there are complicating infections in the bronchial tree. Poor dental
hygiene, common in addicts, increases the bacterial content in oral
secretions, and contributes to aspiration pneumonia. Such infection differs
in addicts in that the lower lobes of the lungs are involved more than the
upper ones, and the right side is affected more than the left.
Cardiac problems amongst drug abusers can be distinguished from those in
the general population by the type of infecting organisms and the valves that
are involved. Intravenous drug abusers have a high incidence of staph aureus
infection, not usually found in nonabusers, which attacks right-sided cardiac
valves. This, and the acute onset of infection, are peculiar to drug-related
Hepatitis, the leading cause of hospitalization among drug abusers,
differs in addicts and nonaddicts in the type that develops. Hepatitis B,
delta hepatitis, and non-A, non-B hepatitis are most common in drug addicted
patients, with delta hepatitis found almost exclusively in drug abusers in the
United States.
AIDS, tetanus, septic arthritis, and various strains of bacteremia are
other infections which plague drug abusers and each exhibits symptoms that
vary from the general population. For example, one-fourth of all AIDS
patients are drug abusers who have no other risk factors for the disease.
It's clear that I.V. drug abusers expose themselves to risks beyond their
imagination. As if addiction was not problem enough, we now find that the
entire area of infectious disease presents new, special problems for the
addict. Although many infections may be mild and without acute episode, it is
also true that many infections can be life threatening, requiring the utmost
in prompt, intensive care to cure. Because narcotic addiction is so
prevalent, infectious problems in these patients need careful detection and
management. Unfortunately these are just the patients that avoid medical
attention, until it is too late.

Chicken Pox Vaccine

QUESTION: I've heard that scientists have developed a vaccine for chicken
pox. When I asked my daughter's pediatrician about it, he said he wasn't in
favor of using it. Why wouldn't he want to prevent such a common childhood
disease? Should I find a doctor who will give her the vaccine?
ANSWER: Your daughter's doctor's decision is a sound one. In healthy
children, chicken pox is normally a mild disease. It rarely causes serious
side effects other than the typical fever and discomfort caused by the chicken
pox rash. Once a child gets chicken pox, they can't get it again. But if
someone doesn't get chicken pox as a child, they can come down with it as an
adult--and the effects can be far more serious.
Adults with chicken pox may come down with viral pneumonia. Pregnant
women may infect their unborn children, causing brain damage, mental
retardation, or even miscarriage.
Right now, it's not known how long the vaccination will prevent a person
from getting chicken pox. Extensive studies will have to be done to determine
the long-term effectiveness of the vaccine. Right now, the vaccine is being
used on children who have serious health problems which compromise their
immune systems. This includes children with AIDS or leukemia or some other
serious disease.
Assuming that your little girl is otherwise healthy, there is no reason
for her to get this vaccine. If she comes down with chicken pox, she will be
uncomfortable for a few days, and you'll likely lose several days of work
staying home to care for her. But usually, the disease is mild, and the
immunity it provides is life long.

Pros and Cons of the Insulin Pump

QUESTION: Why can't I seem to get a straight answer about the use of the
insulin pump? One doctor praises it and yet another puts it down.
ANSWER: Well, medicine is a divided nation right now on the use of the
insulin pump. Its advocates think its $3000 price tag is well worth the
investment. They point out that it is a much more reliable and natural way of
supplying insulin, the closest to the body's own. It delivers a continuous
rate of insulin that can be adjusted to meet between-meal and overnight
requirements. At meals the pump can deliver whatever dose is judged
necessary, and during exercise it can adjust the insulin delivery rate. Its
convenience is applauded because a patient can key in mealtime doses rather
than drawing them up in a syringe and injecting them. Many patients feel
much freer not having to take multiple daily injections.
But it has its detractors as well, who say that frequently a skin
infection occurs at the insulin infusion site. A most feared risk, which is
rare, is that the pump will malfunction during the night, and the patient can
die from hypoglycemia. No long-term studies have been done as of yet on
patients using a pump, but physicians are not increasing their use of it on
the whole. The cost consideration might be a prime factor. Also many
diabetics object to the external placement of it, which seems to mark them
somehow. They've also objected because it must be removed while bathing or
swimming, and the constant placement of a needle in the subcutaneous tissue
occasionally causes discomfort.
So we have a house divided, and the ultimate decision must be the
patient's, after consulting with physicians both pro and con and reading all
the available literature. You're the person who must live with it.
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