Causes of Jaundice

QUESTION: We visited a friend in the hospital who is distressed not only by
his condition, but by the conflicting information he has been given. He is
all yellow, and was told at first that it was a liver infection. Now he is
being told it is an obstruction and that he must have surgery. Is there
any way you can untangle this situation for us?
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ANSWER: Your "yellowed" friend is displaying the effects of a condition
called jaundice, which occurs when pigments found normally in the bile find
their way into the blood stream and thus to the skin. That's causing the
yellow color, but it only indicates that a disease process is going on without
specifically telling us which one. Jaundice is caused by a large number of
diseases, certainly the most common being viral hepatitis. Most physicians
would rank it the number 1 possible cause of jaundice, and then begin the
difficult process of determining the exact reason for the jaundice. Besides a
variety of infections, such as malaria, mononucleosis, yellow fever and
others, the yellowing condition may be caused by drugs used to control other
medical conditions. More common, though, are those conditions which block the
flow of bile from the liver to the portion of the small intestines known as
the duodenum. These situations range from blockage by gall stones in the
small ducts through which the bile normally flows to the closing of these
small and delicate tubes by cancerous growths of the pancreas and of the ducts
themselves. We can use blood tests to distinguish between this type of
jaundice, called obstructive jaundice, and the type caused by infections.
X-ray procedures help to pinpoint the exact location of the blockage, and then
it is up to the surgeon to remove the cause. This surgery can be long and
difficult, and your friend is entitled to a most careful explanation of all
that is involved.

Use of a Laser to Stop a Bleeding Ulcer

QUESTION: When my husband recently was hospitalized with a bleeding ulcer,
our fine doctor saved him by using a scope and a laser gun to stop the
bleeding, and my husband was able to come home in just a day or two. However,
my son is skeptical, as he says that lasers are used to cut tissue, not to
stop bleeding. He thinks I didn't understand the doctor's explanation. Can
you explain what happened so my son won't think his mother is losing her grip?
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ANSWER: I certainly can describe a procedure that seems to be the one your
doctor used. Of course, we don't call it a "laser gun," but lasers can be
used to stop bleeding in the stomach as well as replacing the scalpel for
cutting in some circumstances. There are two main types of laser equipment
currently available; the argon laser, and the Nd-YAG laser, which uses a
garnet to generate the light beam. Though both types can be used, some
statistics indicate that perhaps the YAG laser is the more effective in cases
like these, and probably stops the bleeding by causing the muscles in the wall
of the bleeding artery to contract and close the vessel, as well as by
clotting the proteins found in the blood and tissues. Since the physician can
see the bleeding vessel through his scope (endoscope), he can apply the laser
beam directly to the spot that is hemorrhaging, stopping the flow of blood.
Another procedure, using an electrocautery system, where electrical current is
used to coagulate blood and tissue, is also available in several forms. In
some cases reported, injections of liquids to sclerose (harden and close) the
bleeding vessels have met with some success as well. If your son still doubts
the truth of your report, he might call your physician directly and prove that
Mom is still on the ball.

Can Older Women Have Bulimia?

QUESTION: You recently wrote an answer about an eating disease called
bulimia. If you hadn't mentioned it as a disease of young girls, I would have
thought that my wife was a sufferer of this problem. Have you ever heard of
an older woman having bulimia?
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ANSWER: The text books still call bulimia (gorging followed by regurgitation
to control weight) a young women's disease. Cases over the age of 45 are
rarely reported, although I have read about this situation in a woman of 56.
It's a difficult disease to detect, for the patients are secretive and do not
readily admit to the act, as they have considerable feelings of guilt. If you
really suspect that your wife is suffering from this condition, medical care
is vital. There are many causes for vomiting that may require immediate
treatment to correct. However, when careful examination and clinical
investigations fail to reveal the cause, the next step is psychiatric
evaluation and care. This is a disease that has only recently, "come out of
the closet," and it may well be that there are more sufferers among older
patients than previously thought.

Can Older Women Have Bulimia?

QUESTION: You recently wrote an answer about an eating disease called
bulimia. If you hadn't mentioned it as a disease of young girls, I would have
thought that my wife was a sufferer of this problem. Have you ever heard of
an older woman having bulimia?
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ANSWER: The text books still call bulimia (gorging followed by regurgitation
to control weight) a young women's disease. Cases over the age of 45 are
rarely reported, although I have read about this situation in a woman of 56.
It's a difficult disease to detect, for the patients are secretive and do not
readily admit to the act, as they have considerable feelings of guilt. If you
really suspect that your wife is suffering from this condition, medical care
is vital. There are many causes for vomiting that may require immediate
treatment to correct. However, when careful examination and clinical
investigations fail to reveal the cause, the next step is psychiatric
evaluation and care. This is a disease that has only recently, "come out of
the closet," and it may well be that there are more sufferers among older
patients than previously thought.

Von Recklinghausen's Disease Diagnosis

QUESTION: Although we have no history of an illness called Von
Recklinghausen's disease in our family, it has now appeared for the first
time. We have read that it is an inherited condition, and can't understand
how this occurred. Could the diagnosis be wrong? Will you please help us?
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ANSWER: Your information is essentially correct. Von Recklinghausen's
Disease (or neurofibromatosis) is named after the doctor who first described
it in 1882. Although there are many symptoms, the most common is the
development of skin lesions composed of nerve and fiber tissue, which form
into tumors. The disease is mild in most cases, and patients may live a
normal life. It is an inherited condition and is one of the most common of
the diseases classified as genetic disorders. About 1 baby in 3,000 born in
the United States develops neurofibromatosis (NF) and about 100,000 Americans
are affected by it. It is caused by a single abnormal gene, which produces
the disease whenever it is present. It is therefore called a dominant gene,
since it over comes the influence of the normal gene which is also present as
one of the pair of genes that occupy the same place in the genetic makeup.
However, this abnormal gene may have been newly formed by a process known as
mutation, rather than inherited. About 50 percent of NF cases seem to occur
in this fashion, and this is the probable explanation for the circumstances in
your family. The disease produced by a newly mutated gene is in all ways
identical to that which occurs when the gene is inherited. It will also be
passed on in the same way, and each child of a parent with NF has a 50-50
chance of inheriting the disease, and developing at least some of the
characteristics of the disease. While there are no methods to prevent the
disease, and no prenatal tests available to discover its presence in the
unborn, there are procedures and techniques to treat its effects.

Is a Toenail Horn the Result of a Devil's Curse?

QUESTION: Although it started slowly, I guess I have left it go too long, and
now I have a terrible looking horn where my big toe nail used to be. Could it
be the result of a devil's curse? What could a doctor do if I was to visit
with him?
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ANSWER: If you have the condition I think you do, it wasn't a curse that
caused it, but your own neglect. You must have realized that toenails don't
normally grow this way, and should be trimmed on a regular basis. The
condition has a fancy medical name, onychogryphosis, which comes from two
"onyx" meaning "nail" and "gryposis" meaning "hooked or curved". Some times
the horn grows so large that it looks just like a ram's horn, and can be
called "ram's horn nail". At any rate, it has got to go. There are two
possible choices of treatment that your physician may offer you, and the
choice will depend upon the size of the growth and the condition of your feet.
It may be possible to cut it back to size, using the appropriate surgical
instruments. This would cause no pain, but you would have to promise to keep
your nails trimmed. If the nail is really deformed, the physician will have
to remove the nail completely and destroy the tissue from which your toe nail
grows. Just cutting the nail away won't help as a new nail will grow back,
probably more disfigured than before, in four to ten months. The operation
can be performed with an injection of local anesthetic to prevent pain. See
your doctor soon, things won't get better by themselves.

Explanation of an Ear Operation

QUESTION: Following many infections in her nose and throat, my daughter now
needs an operation on her ear, to let out all the fluid that has built up.
Our doctor has carefully explained what he wants to do, including the part
about the tube in the ear, but both my daughter and I are still pretty scared.
Would you please explain this operation to us?
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ANSWER: When frequent and repeated infections leave the middle ear filled
with fluid that persists long after it should, removal is necessary if the ear
is to return to normal. The operation is called a "myringotomy" and consists
of making a small incision in the eardrum, through which the fluid may be
removed. It is a simple procedure, and usually does not require an overnight
stay at the hospital. A light, general anesthesia is ordinarily required for
children, although adults may only need a local anesthetic for this procedure.
After the fluid is removed, a small tube is placed in the incision to permit
drainage of any additional fluid which may develop. The tube generally falls
out by itself, and the ear drum (tympanic membrane) then heals over
completely. You will receive additional instructions from your doctor, but
you must take precautions to keep water out of the ear while showering or
bathing. While complications are infrequent, a fever of over 101 degrees
Fahrenheit, bleeding or a pus-like discharge from the ear, or continuing pain
are all signs that require additional medical attention. Procedures of this
type may make even the bravest flinch, but in this case it is a minor
procedure, and important for the proper healing of your daughter's ear. There
is little to fear, and all will soon be over, with excellent results I am
sure.

What is "Myoclonus"?

QUESTION: My grandson has a problem diagnosed as "myoclonus". I've never
heard of it before and we are troubled for lack of knowledge about this
condition. Can you enlighten us?
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ANSWER: Sometimes just knowing what a word means can help, and since that is
all the information you have given me, I will at least provide that. The
Greeks get credit for this one as "myo" means "muscle" and "clonus" comes from
the Greek word for "turmoil". Myoclonus means a brief, shock-like contraction
of a muscle or group of muscles. It may be a normal event, and happens in
many individuals as they are falling asleep. It may also be seen in epilepsy,
and certain slow virus infections like Alzheimer's Disease. Some individuals
develop this symptom after sustaining a head injury, while the cause in others
lies with an imbalance in the body's metabolism. The treatment will depend
upon the cause, and may include the use of medications called anticonvulsants.
I suspect your children may know a bit more about the causes in your
grandchild. Since this is causing you anxiety and anguish, why not give them
a call, and ask for the real lowdown.
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The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician. Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

Tiredness and Dangerous Disease

QUESTION: I have never been athletic, but of late, even the slightest
exercise leaves me weary and tired. Lately my boss has commented how droopy
and tired looking I look, for there are times I can scarcely open my eyes. My
girl friend thinks I am suffering from a weird, but dangerous disease. I
don't want to go to my doctor with a silly complaint like just being tired.
What do you think?
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ANSWER: Though the complaint of fatigue is a frequent one in daily practice
with so many possible causes and explanations, there are a few clues in your
letter that make me side with your girl friend. Fatigue that follows brief
exercise and droopy eyelids (called ptosis) are the signs of a disorder known
as myasthenia gravis, a rare disease that is first seen in women between the
ages of 20 to 40 years of age. The symptoms may come and go over a brief
period, and are sometimes hard to nail down, but can become progressive and
life threatening when the muscles that are responsible for breathing become
affected. It is believed that the condition is the result of an autoimmune
attack on the receptor in the connection between nerves and muscles that
responds to the chemical acetylcholine, and permits the transmission of the
stimulus that makes the muscles contract. When this mechanism fails, muscles
do not contract and the patient experiences the weakness. When it affects the
muscles that control the eyes, double vision may result. The physician may
test for this disease by injecting a substance, edrophonium, into a vein. A
sufferer of myasthenia will experience a sudden, though short lasting,
improvement in muscle function. Other tests may be used to confirm the
diagnoses, and the good news is that a class of medication called
cholinesterase inhibitors are useful oral medications that can successfully
treat the disease. The medications must be carefully dosed and controlled,
and require ongoing evaluation and modification. Take the advice of both your
girl friend and me, get to your physician now, and take this along as an
expression of my opinion.

Tiredness and Dangerous Disease

QUESTION: I have never been athletic, but of late, even the slightest
exercise leaves me weary and tired. Lately my boss has commented how droopy
and tired looking I look, for there are times I can scarcely open my eyes. My
girl friend thinks I am suffering from a weird, but dangerous disease. I
don't want to go to my doctor with a silly complaint like just being tired.
What do you think?
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ANSWER: Though the complaint of fatigue is a frequent one in daily practice
with so many possible causes and explanations, there are a few clues in your
letter that make me side with your girl friend. Fatigue that follows brief
exercise and droopy eyelids (called ptosis) are the signs of a disorder known
as myasthenia gravis, a rare disease that is first seen in women between the
ages of 20 to 40 years of age. The symptoms may come and go over a brief
period, and are sometimes hard to nail down, but can become progressive and
life threatening when the muscles that are responsible for breathing become
affected. It is believed that the condition is the result of an autoimmune
attack on the receptor in the connection between nerves and muscles that
responds to the chemical acetylcholine, and permits the transmission of the
stimulus that makes the muscles contract. When this mechanism fails, muscles
do not contract and the patient experiences the weakness. When it affects the
muscles that control the eyes, double vision may result. The physician may
test for this disease by injecting a substance, edrophonium, into a vein. A
sufferer of myasthenia will experience a sudden, though short lasting,
improvement in muscle function. Other tests may be used to confirm the
diagnoses, and the good news is that a class of medication called
cholinesterase inhibitors are useful oral medications that can successfully
treat the disease. The medications must be carefully dosed and controlled,
and require ongoing evaluation and modification. Take the advice of both your
girl friend and me, get to your physician now, and take this along as an
expression of my opinion.

Information on Multiple Sclerosis

QUESTION: Although I scan most health columns, I find little to read about
Multiple Sclerosis. Since we now face the need to deal with this disease, we
are filled with the need for more information to help us cope with the
situation. I am sure you could help us if you will only write something about
this condition.
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ANSWER: Information is our most precious ally when facing an unknown
situation or problem, and we will start with this answer for you. According
to the National Multiple Sclerosis Society, more than 250,000 Americans
currently suffer with multiple sclerosis (MS). One of the tragedies of this
affliction is that it strikes at the young, with most patients being diagnosed
between the ages of 15 to forty, although it can strike people as young as 2
or as old as 60. Women are the victims twice as frequently as men and come
down with the disease at an earlier age. We know some important facts about
MS. It is not an infectious disease and so is not contagious, but probably is
due to an abnormality in the body's immune mechanisms. There is an inherited
predisposition to the disease though, and we see it more commonly in children
of MS sufferers. Finally the disease is not fatal, and patients may lead long
constructive lives. MS is a disease of the central nervous system, where it
attacks the white matter, known as myelin, which sheathes or wraps the nerve
fibers like a type of insulation. When the myelin is destroyed, plaques or
scars develop, and the nerve signals that normally pass along the nerve fibers
are stopped. This creates the symptoms of weakness in the muscles, changes in
feeling with numbness or tingling, double vision, dizziness or
lightheadedness, and many other disturbing symptoms which depend upon the area
of damage in the nervous system. The symptoms may come and go (remission)
only to return again. While there is no specific treatment, many are
currently used with some effect, and more are being developed. Cortisone-like
substances are frequently used during acute attacks.

Do People With Several Personalities Really Exist?

QUESTION: After watching a recent television show about a person with several
different personalities, I began to wonder if such people really exist. It
made for interesting watching but the whole thing seemed quite bizarre. Would
you please provided some clarifications?
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ANSWER: It is a fascinating area of mental care, and yes, such patients do
exist. The condition is called Multiple Personality Disorder (MPD) and
reports of such cases are appearing with ever increasing frequency in the
medical literature. Perhaps the expanding number of diagnoses are the results
of more clearly defined guidelines that help delineate the condition and make
the process of diagnoses just a bit easier, but by no means simple. One of
four conditions in the class of dissociative disorders, MPD sees an alteration
in the area of self identity, and the patient will display characteristics and
expressions of separate and different personalities or identities. Each
personality has its own story and life experiences, but will not remember the
events which occurred in another identity's existence. Physicians may use 4
types of signs to help identify MPD patients: physiological, psychological,
behavioral and environmental signs. For example, when there is a history of
wide ranges in blood pressure, or blood sugar levels from visit to visit
(physiological findings), physicians may be alerted to the possibility of MPD.
Psychological signs include significant time lapses or lack of memory for past
serious illnesses. A patient's behavior may manifest changes by alterations
in voice tone or sound, or the way he stands or walks. Environmental signs
are sought in the history of traumatic life events, child abuse, or changes in
home situations and locations. The treatment of such complex disorders
require specially trained individuals who can understand and deal with the
particular needs of these complicated patients.

Doesn't Anyone Know Anything About Premenstrual Tension?

QUESTION: I know that something is wrong, for my life before my period is due
is truly hell. Yet when I try to get help from my physician, I am left
frustrated and as unhappy as before my visit. Why is this? Doesn't anyone
know anything about premenstrual tension?
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ANSWER: Although much has been written and many studies conducted to
investigate premenstrual syndrome, the origins and best ways to treat still
defy attempts to classify this disturbing ailment. It may be that there is no
single syndrome, and that the physical, emotional and behavioral changes that
occur just prior to the menses may be due to a variety of different factors
that affect each woman in a unique fashion, and with differences in intensity
and timing. Since the symptoms vary, it is clear that it is important to
document these premenstrual changes (PMC) and to be certain that other
conditions that could cause these problems are not the real reason for the
symptoms. The symptoms of premenstrual syndrome (that's PMS) are many and
varied, but can be placed into nine categories. I'll list them for you, and
provide a few samples. AFFECTIVE symptoms include anxiety and irritability,
while BEHAVIORAL problems include decreased motivation and efficiency. The
AUTONOMIC nervous systems may provoke diarrhea, nausea and palpitations, while
symptoms from the CENTRAL nervous system include clumsiness, dizziness and
tremors. DERMATOLOGICAL symptoms include acne and dry hair, while
disturbances in FLUID/ELECTROLYTE balance cause bloating, edema and weight
gain. COGNITIVE symptoms include indecision, paranoia and even suicidal
thoughts, while the NEUROVEGETATIVE system sees changes in libido, food
cravings and lethargy. PAIN symptoms can cause breast tenderness, headache,
and joint and muscle pain. Most clinicians agree that to make a diagnosis of
PMC, symptoms should begin during the luteal phase of the menstrual cycle,
which occurs after ovulation, and usually lasts for about 14 days during the
last half of the cycle, the symptoms should disappear shortly after the start
of menstrual flow, and there should be a symptom free period during each cycle
that lasts for at least one week. Treatment should be attempted when the
symptoms occur during almost every period and when there is some impairment in
normal function. The symptoms that accompany menstruation are experienced by
almost all women (97% in one study), but are severe in only 2% to 10% of women
of reproductive age. Getting a handle on a condition as perplexing as this
one requires a thorough history and physical exam as a starting point. You
may want to keep a symptom diary to aid the physician in understanding the
frequency and severity of each symptom, when they occur, and what may have set
them off. Daily morning weights are useful in calculating water retention
problems. A complete record of this type should be kept during a minimum of
two cycles. Treatment will have to be highly individualized to be effective
and may use both nondrug strategies as well as medications. Relieving stress
by changing life styles, particularly during the second half of the cycle, may
be an important first step, while eating nutritionally balanced meals may
help. These actions may play an important role in overcoming some of the
symptoms, so that consideration of possible medications for the remaining
complaints may become a bit simpler. Properly used hormones, diuretics,
antidepressants and antianxiety agents may offer the relief you are seeking.
It is a long and difficult road, without the knowledge we need, but the
outcome may make it worthwhile.

What is "Pickwickian Syndrome"?

QUESTION: As you once observed in one of your columns, much can be overheard
when doctors discuss medical affairs. Such a situation recently occurred when
I heard the term "Pickwickian syndrome" mentioned. As a lover of the works of
Charles Dickens, I know there must be a "tale" here somewhere. Do you know
it, and will you share it with your readers?
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ANSWER: Yes, I am aware of the syndrome, as are most physicians; for it is a
commonly encountered situation in practice. The condition, which consists of
obesity, sleep apnea (a sleep disturbance in which breathing stops for 10
seconds or more, sometimes more than 300 times a night), impaired respiration,
heart failure and daytime drowsiness, occurs in about 10% of obese adults, but
is rare in obese children. The name for the syndrome was first suggested by
Sir William Osler and was more fully described by Drs. C.S. Burwell, E.D.
Robin and R.D. Whaley in a paper that appeared in the American Journal of
Medicine in 1956. It is based upon the Charles Dickens novel, "The Posthumous
Papers of the Pickwickian Club" written in 1837, in which he describes a
character that goes by the name of Joe, a "fat, red faced boy in a state of
somnolency". Joe goes to deliver a message, knocking loudly at the door. By
the time the occupants answer the summons Joe has fallen asleep, and is found
standing at the entrance snoring. Since heavy snoring, as well as compulsive
eating and headache, all form part of the symptoms of the syndrome, Dickens'
description seemed appropriate and Osler's suggestion has been widely
accepted. We know know that the condition is more than just a drowsy,
snoring, fat boy, yet the name is firmly fixed, and medical students still
dutifully memorize and remember all the signs and symptoms involved as the
Pickwickian Syndrome.

A Run Down of Peripheral Vascular Disease

QUESTION: It is just another case of simply not understanding what my doctor
tried so hard to describe while I was in his office, but I felt good that I
could turn to you for more answers and explanations. Therefore, would you
please give me a run down of a condition called Peripheral Vascular Disease.
All I am sure of is that it effects my arteries.
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ANSWER: Here is a case where the name of the condition does a fair job of
describing its nature. The word "peripheral" applies to the "outer" portions
of our bodies, thus the arms and legs. Peripheral Vascular Disease (PVD)
encompasses a number of long term or chronic diseases of the arms or legs that
arise from the fact that the arteries which bring blood to these areas have
become narrowed, due to disease, and fail to provide sufficient blood supply.
The most common cause of this narrowing is arteriosclerosis, which accounts
for almost 95% of all cases. Older people are the most common victims, as PVD
usually strikes after the age of 50, and men are the sufferers 6 to 7 times
more frequently than women. A high number of PVD patients are smokers (almost
90%) and about 25% of all patients have diabetes. But our old enemies, high
blood pressure, high cholesterol, and high weight, do their share of the
damage as well, causing arteriosclerosis, not only in the peripheral arteries,
but the vessels in the brain and heart as well. The most common symptom of
PVD is pain on effort that grabs at the calves of the legs after a short
stroll, but that eases up when the effort is stopped. Arms and legs feel
cold, wounds take longer to heal, and gangrene may develop in the final stages
of the disease. While the physician may prescribe medications to help the
blood circulate and reduce cholesterol, there is much you must do for
yourself. Smoking must go, absolutely, and a regular walking program should
be developed and carried out regularly. Good foot hygiene is a must; clean
socks, comfortable shoes, and attention to toe nails, corns and calluses.
Surgical procedures do exist to widen the arteries, or replace those that are
totally blocked, but you have a 75% chance of bringing the condition under
control by following the advice offered by good medical care.

Parkinson's Disease and Walking

QUESTION: I suffer with Parkinson's disease. While the medication helps
somewhat, I can not walk as I wish, and I know my family must hang back and
wait for me on many occasions. I am embarrassed and wish I could do better.
Can you please offer me any suggestions that might help?
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ANSWER: I'll do all I can, short of a personal house call. The truth is that
a few sessions with a talented Physical Therapist may do you more good, but as
for some helpful suggestions, here goes. Most patients with Parkinson's
Disease walk with a stooped, forward bent position, and walk on the balls of
their feet. This induces a type of gait called shuffling, steps that grow
smaller and swifter as the distance increases. It is to this shuffling gate
that we must direct our attention. If shuffling begins while you are walking,
stop walking, and reorganize. Place your feet about eight inches apart, and
stand as straight as you can. Then think about your next step. You will take
a large step, bringing your foot up as if marching. Point your toes up and
place your heel on the ground first, as the foot strikes, then roll forward
onto your toes. Now the next foot, same procedures. Swing the opposite arm
forward when taking that step, to improve your rhythm and your appearance.
Don't be embarrassed, but look proud, as proud as your family is to be walking
with you.

Other Tests in Addition to a Pap Smear

QUESTION: At my most recent yearly examination, I asked my doctor to perform
a Pap smear to check on the possibility of infections that might have been
picked up during the year. He insisted on a batch of other tests in addition,
including blood tests. Was he correct in doing this, or was this just another
way of increasing my bill?
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ANSWER: I wish I could always be a strong in my support of physician's
actions as I am in this case. Your physician's actions were totally correct
and deserve your complete cooperation. I read into your letter a life style
that may expose you to infections known as Sexually Transmitted Diseases
(STDs). Many of these infections produce no symptoms, but can be dangerous to
both you and your sexual partners. A Pap smear is an excellent way to screen
for cancer, but is a poor test for infections compared to others, including
blood tests. Since early diagnosis of STD's leads to early treatment, you can
prevent the complications that often accompany these infections. If the tests
prove positive, be sure to complete the course of treatment your physician
will recommend. If they are negative, a discussion with your physician about
safe sex precautions and life style modifications may be just the thing in
your situation.

What Causes Paget's Disease?

QUESTION: I am a long time sufferer from Paget's Disease, and find it
difficult to believe that all that can be offered as treatment are some simple
pain pills. Can you tell me a bit about this disease, what causes it and what
medications can possibly help me?
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ANSWER: Your desire to know more about your condition makes you the kind of
reader I enjoy responding to, in the hopes that this information can be of
help to you. Paget's disease of the bone (also called osteitis deformans) is
a chronic disease occurring in adults where hyperactive bone is replaced by a
softer bony like structure in various parts of the skeleton, such as the
pelvis, thigh bone and skull. Bone is in a constant state of remodeling, a
process of breakdown and build up. However in Paget's, the new bone is faulty
and can not perform all the duties of normal bone. The cause is unknown, but
about 3% of adults over the age of 40 suffer from the condition, with men more
commonly affected in about a 3 to 2 ratio over women. Many times there are no
symptoms, but when they do occur they include pain, stiffness, headaches, some
loss of hearing, increasing skull size and a general feeling of weariness and
loss of energy. The diagnosis is often made by chance on an x-ray, taken for
other reasons, which shows the typical pattern of bone growth. Generally pain
may be controlled by salicylates and nonsteroidal anti-inflammatory
medications such as ibuprofen. Two other medications are used to successfully
treat and control the condition. Etidronate disodium may be taken in a dose
of 5 to 10 mg per kilogram of body weight, in a single dose each day for 6
months. Synthetic salmon calcitonin may also be effective.

"Debrox" vs. Hydrogen Peroxide for Ear Wax

QUESTION: I have an 11 year old child with a hearing impairment, He also has
a problem with frequent build of earwax. His ear specialist recommends that
we use hydrogen peroxide, slightly diluted, to cleanse his ears about once a
month to avoid wax build up. His pediatrician says that peroxide frequently
can cause its own problems, and to use "Debrox" as needed. Do you have an
opinion on this matter?
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ANSWER: I always have a point of view that translates into an opinion. It's
pretty hard to choose between the advice of two physicians, both of whom you
trust, and it's too bad they are not in communication with one another so that
you would only have to deal with one consensus opinion. I have used both
methods in my practice, both with equal success and both without problems.
They are both quite effective in softening and loosening the wax (cerumen) and
keeping the ear canal clean. I believe the hydrogen peroxide (3% solution)
slightly diluted is a bit cheaper, and can perform the job adequately and
efficiently. I am unaware of the problems your pediatrician is concerned
about (but would like to learn). Provided you use neither solution when there
is drainage or discharge from the ear, when there is ear pain, if there is any
sign of irritation or a rash, or when you child complains of dizziness, you
can pretty well "pay your penny and take your pick". My personal opinion?
OK! I use hydrogen peroxide to keep the wax out of my own ears, and I guess
what is good enough for me can be good enough for my readers.

Which Operation is the Most Common?

QUESTION: Like two teenagers sharing personal secrets, my girl friend and I
were comparing our experiences with recent surgery. She had a gall bladder
removed and I had a hysterectomy. A discussion developed and we now have a
bet going as to which operation is the most common operation performed in the
United States. Can you provide us with the answer?
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ANSWER: I would be glad to. Of the two operations you mention, and according
to the statistics provided by the Commission on Professional and Hospital
Activities of the American College of Surgeons, cholecystectomy ranks before
abdominal hysterectomy, at least in the 1986 statistics which are currently
available. Now that would make your girl friend the winner, unless you bet
on the most frequently performed procedure of all operations, in which case
you both lose, as the most frequently performed surgery is the cervical
cesarean section, which ranks first, with a total of 820,960 operations
reported. Gall bladder removal ranked second with 534,767, and hysterectomy
third, with 468,022. If your personal experiences match the statistics, your
friend stayed in the hospital longer than you did, as cholecystectomies
average a stay of 7.9 days, compared to 5.9 days for hysterectomies. The next
three, of the top six, in rank order, are number 4; left cardiac
catheterization, number 5; transurethral prostatectomy (partial removal of the
prostate gland through the urinary passage), and in sixth place appendectomy.