How to Take Your Blood Pressure.

QUESTION: I am one of those people who now monitor their blood pressure at
home. I am getting better at it, but I must admit I get a wide range of
readings that just don't seem to make much sense. Are there any tips you can
offer to me and others in the same predicament that might help straighten us
out?
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ANSWER: There are many things patients and sometimes even doctors and nurses
do wrong when taking blood pressure. The result can be inaccurate and
inconsistent readings. First of all, you should make sure you are comfortable
before taking your blood pressure. The American Heart Association recommends
that prior to taking the measurement, you relax in a quiet room for a half
hour. During that time, avoid anxiety, exertion, eating or smoking, and be
sure your bladder is empty. Wear loose fitting clothes so that the flow of
blood is unrestricted and don't cross your legs or fold your arms. Try to
relax your arm muscles as much as possible as muscle tension can lead to
distorted blood pressure readings.
Always take your blood pressure while you are in the same position,
whether it be sitting, standing or lying down, and use the same arm. Make
sure you have the proper size cuff for your arm. A cuff too narrow could give
you a false high reading, while one that is too wide will give you a false low
pressure reading. Inflate the cuff rapidly (in 7 to 10 seconds) to minimize
trapping of venous blood--a common cause of false readings.
Have a doctor or nurse show you the proper way to read your measurement,
and if you are using a new machine be sure you understand its proper use.
Don't be shy, if you don't understand or need them to show you how to do
something again, ask again--until you get it right.

What Is a Biopsy?

QUESTION: Could you please clear up my confusion about the use of the term
"biopsy". I have seen it in several medical articles, but it seems to have a
different meaning each time. Thank you for your help.
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ANSWER: If we consult a medical dictionary, it will tell us that a biopsy is
the "examination of tissues excised (removed) from the living body".
Different techniques may be used to obtain the tissue and the name of the
technique is used to describe the biopsy (for example "aspiration biopsy" or
"punch biopsy"), which may have led to your confusion. Biopsies are used to
make an exact diagnosis of a tissue growth. A small piece of tissue is
removed from the area suspected to be diseased, and is then processed by a
pathologist. The tissue is fixed, by solutions similar to embalming fluids,
then colored with a variety of chemical stains, and finally, examined under
the microscope. The pattern of the cells, their internal structures and
elements, permit the Pathologist to determine the type of tumor, and whether
it is benign or malignant. This is extremely important, as it is this
diagnosis that determines the type of treatment.

Can Asbestos Cause Breathing Problems?

QUESTION: I am beginning to think I have the disease caused by asbestos. It
certainly could answer many questions about my shortness of breath, just
starting to be a problem. How can I find out what's wrong?
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ANSWER: Asbestos disease (also know as "asbestosis"), one of several
disorders affecting the lungs and surrounding areas, is caused from years of
exposure to asbestos. Asbestos has been used as an industrial material since
the late 19th century. It is a material that consists of long, threadlike
fibers and when it is used commercially, minute particles from these fibers
becomes detached and spread into the air. Health hazards arise from breathing
these invisible fibers into the lungs.
Asbestos disease takes years to develop. Usually people who have had
direct contact with the substance through their occupation are the ones at
risk. The disease can cause many symptoms, one of which is breathlessness. A
dry cough is another typical sign, as is fast, heavy breathing. However,
these symptoms can arise from other disorders, and other clinical findings are
important in the diagnosis of asbestos disease. If your doctor suspects that
you have an asbestos-related disorder, he will ask you for a detailed history
of places where you have lived and worked over long periods. It is extremely
important to be as precise as possible in your recollection, because the
amount of time which has elapsed since exposure is directly related to the
kinds of clinical findings which will appear. Different symptoms show up at
different periods of time after the initial exposure. Chest x-rays are very
important in determining the exact kind of asbestos-related problem you may
have.
The disease can take many forms. Sometimes there is a thickening of the
tissue that encloses the lungs. This reduces the ability of the lung to
expand fully. Sometimes, in workers who have had heavy exposure, there are
incidences of lung cancer.
Not all people who have been exposed to this asbestos will get sick. But
for those who do, early detection is of great importance, so that treatment to
help overcome their breathing difficulty can be promptly started.

What is Anorexia and How Does it Affect the Heart?

QUESTION: I am trying to fully understand the extent of an illness called
"anorexia". Can you tell me something about it and please describe any
actions it might have on the heart. Please consider this question for your
column as it is most important to me.
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ANSWER: Anorexia nervosa is a serious illness. Fifteen percent of all
anorexia sufferers die, which makes it one of the deadliest of all psychiatric
disorders. Sudden deaths among anorexics are often due to the serious damage
that anorexia causes to the heart.
Researchers have known for a long time that anorexics have abnormal heart
rhythms, including heart rates that are too fast or slow or lack the proper
rhythm. Their hearts are also shrunken in size. It had always been thought
that when the body is starved, the heart and the brain are spared at the
expense of other parts of the body, but an anorexic's heart appears to lose
more weight and size proportionately than the rest of the body. The size of
the left ventricle, one of the chambers of the heart, in anorexics is
especially reduced. Bulimia--eating and then vomiting--can also cause heart
problems due to chemical imbalances in the body.
Because of these heart changes, anorexics cannot exercise as long as
normal during exercise stress tests. Their heart rates and blood pressures do
not respond normally to the extra effort of exercise, as a healthy person's
would. It is still not known whether the heart returns to normal after a
treated anorexic returns to a normal weight or whether these abnormalities are
permanent. Some studies have shown that the heart does increase in size as
weight is gained.
As a part of the treatment for anorexia nervosa, anorexics must therefore
be followed carefully with frequent evaluations of their hearts.

Is There Any Help for Allergies?

QUESTION: I am sure that as the season advances, you will be swamped by
letters about allergies. Mine are racing away, and it's still early. Can you
tell me if there is any help for us?
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ANSWER: Of course there is. There are new methods of diagnosing and treating
allergies being developed all the time. Allergies vary widely in the way they
affect people, and many of them are hard to diagnose exactly. The allergy
sufferer who works closely with the doctor to diagnose and treat the allergy
will have the best chance of being helped.
A complete allergy history is still the most important part of finding
the culprit in an allergy problem. In addition to allergy history, a direct
skin test is a reliable, accurate and cost-effective way to test for allergic
reactions to specific products. In vitro tests, called radioallergosorbent
tests (called RAST for short), are run on a blood sample instead of on the
skin. RAST can cost a bit more initially, but it is useful for patients who
have skin infections or who are overly anxious about skin testing, and can
offer another method by which a diagnosis can be obtained. Other tests are
available to supplement direct skin testing and RAST.
The ideal treatment for allergy sufferers is to avoid the substances that
cause them problems. Unfortunately, this is not always possible. Treatment
for allergy sufferers usually involves avoiding the allergen when possible and
taking medication to alleviate symptoms. New antihistamines, called "third
generation H1 antagonists," are very helpful in controlling allergy symptoms.
They don't have the old familiar side effects of drowsiness and
incoordination, and they control the watery, itchy nose and eyes of most
allergy sufferers. The medications work best when they are taken regularly
instead of only when the symptoms are present.
In people whose allergies are severe, sometimes a treatment called
immunotherapy is helpful. Immunotherapy is a process where small doses of the
allergen are given to the patient in an effort to create an immunity to it.
It may offer relief to people who suffer from asthma and respiratory
allergies. Immunotherapy is not helpful to people with rashes. It is most
effective in people who are allergic to house dust, pollen and mold, but it is
reserved for people whose symptoms are severe and who cannot be helped with
other therapy.

How Much Fiber Is Enough In Your Diet?

QUESTION: Could you please explain a bit about fiber. It seems as all the
magazines tell how good it is, but fail to explain just what it is. How much
of this material is enough in your diet? I've had my share of over doing a
good thing and don't want to do that with this.
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ANSWER: In recent years, fiber has been described as the preventative element
in food that may affect the development of many diseases, from cancer of the
colon to atherosclerosis. The most widely accepted definition of fiber is
that it is the portion of food, mostly from plants, that cannot be broken down
by intestinal enzymes, and, therefore, passes through the small intestine and
colon undigested. Experts also agree that dietary fiber is important, in that
it increases the bulk of the stool, and makes it softer by absorbing water as
it passes through the colon. This speeds up the process of eliminating
organic wastes and toxins from the intestinal tract, possibly reducing the
length of time the intestinal wall is exposed to poisonous substances.
The desirable daily fiber intake in the United States is approximated at
somewhere between 25 and 50 grams a day, with 30 grams considered as an
optimum daily portion. Good sources are fruits, vegetables, nuts and whole
grains, especially wheat bran.
Too much fiber, though, can have negative effects because it can reduce
the absorption of minerals, nitrogen and fat. And increasing the amount of
fiber in your diet too rapidly, in your words "over doing it," may lead to
excessive gas, diarrhea and cramps. However, slowly adding fiber containing
food to your diet over a period of time, can gain all of its benefits for you,
with none of the annoying side effects.

Is Exercise Good at Older Ages?

QUESTION: My wife and I are well into our sixties. We're in relatively good
health and tend to take life easy nowadays, but I sometimes wonder if we're
taking it too easy. Do you think exercise can do us any good?
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ANSWER: Exercise can do you a world of good! At any age, unexercised muscles
lose strength and flexibility; in the elderly this often leads to immobility
and isolation from the world at large. A moderate exercise program, designed
by your doctor or a specialist, can postpone or reverse a variety of
conditions associated with aging. Exercise can provide the energy and
satisfaction to fully enjoy your golden years.
The benefits of an exercise program include a reduced heart rate and
lowered blood pressure; increased bone growth to counteract osteoporosis, the
weakened and brittle bone condition so common to the aging; improved success
in dieting; as well as an increase in muscle mass accompanied by a loss of
excess body fat. Taking part in group exercise also provides you with
increased opportunities to socialize with friends and peers. These changes
can add up to an improved appearance, enhanced self-image, and an all-around
sense of accomplishment and pride that will make everything you do more
satisfying.
Before you rush out to sign up for the next triathalon, ask your doctor
for a complete physical checkup, and to help set up an exercise program
designed specifically for you. After checking your heart and respiration
rates and muscle function (both before and after moderate exertion), your
physician or an appropriate specialist will be able to design a regimen of
activities that will exercise your system without taxing it. Such a program
will help your heart reach between 60 and 90 percent of its maximum healthy
functioning rate, and will probably require an hour of your time 2-3 days a
week.
Warm-up and cool-down periods help insure that you will get the full
benefit of working out without the shock to your system of suddenly "switching
gears." Aerobic exercise in the form of walking or swimming is particularly
recommended, but you may also want to consider bicycling, fishing, billiards,
ping-pong, or an easy calisthenics program. Unless you have a specific
go-ahead from your doctor, avoid jogging, skiing, weight-lifting, or other
sports that can subject your body to unnecessary strain and impact. Whatever
you do, choose a program that you will enjoy and look forward to; it will be
a lot easier to stick with, making your goal of improved health and longevity
a pleasure to achieve.

What Causes Epileptic People Trouble In School?

QUESTION: I have just returned from another visit to the school that my 9
year old son attends. He is having trouble keeping up, and I am wondering if
this may not be the result of his epilepsy. His seizures are well controlled
on medication, but he seems to have trouble in his studies. Is this related
to his medical condition, or could it be the medication?
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ANSWER: Several studies have shown that epileptic children have slightly
lower scores on intelligence tests than other children. The epileptic
seizures, however, are not necessarily the cause of intellectual impairment.
Some doctors believe that the differences in intelligence test scores can be
caused by the effects of antiepileptic drugs or by the presence of a brain
disorder before the seizure. Epilepsy is a neurological disorder
characterized by recurrent episodes of convulsive seizures, impaired
consciousness, abnormal behavior, and other problems. The condition is
usually produced by uncontrolled electrical discharges from nerve cells in the
brain.
There are, however, other triggering mechanisms for epilepsy, such as
trauma to the head, brain tumor, or chemical imbalances. But don't lose
heart. If your son is having trouble learning, he needs to be seen by an
epileptic specialist to have his specific problem and case analyzed. The
doctor should also reevaluate the medications your son is on for his problem.
Some researchers believe that antiepileptic drugs are over prescribed and that
the negative side effects sometimes outweigh the benefits. A small adjustment
in dose, or changing the medication may continue to control the seizures, but
allow for greater intellectual activity.

What Is an Ectopic Pregnancy?

QUESTION: Our family always reads your column, and we are amongst your most
loyal fans. Can you offer us a description of "ectopic pregnancy"? This
frightening diagnosis has us all quite anxious for we don't understand just
what the seriousness of this might be, and so we are now turning to you.
Please try to explain all you can.
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ANSWER: Ectopic means "out of place." An ectopic pregnancy is when the fetus
starts to develop anywhere except in the uterus. The most common site of an
ectopic pregnancy is the fallopian tubes, but they can also occur in the
ovary, in the entrance to the tube, at the point the tube joins the uterus,
and at the mouth of the uterus.
Ectopic pregnancies are dangerous because only the uterus can expand to
accommodate a growing fetus. A growing fetus will burst a fallopian tube
within a few weeks. This usually kills the fetus and the bleeding that
results can kill the mother. Although there have been instances of a healthy
baby growing outside the uterus, it is an event bordering on the miraculous.
Ectopic pregnancy is a major cause of death during pregnancy. Less seriously,
it can result in the loss of a fallopian tube and sterility.
Many ectopic pregnancies abort spontaneously, before the tube ruptures.
The embryo is reabsorbed into the body and the woman may never even know she
was pregnant. The symptoms of an ectopic pregnancy include abdominal pain and
bleeding from the vagina, and is often confused with appendicitis, an
intestinal "bug," or a bladder infection.
The incidence of ectopic pregnancies are rising. This is primarily due
to the increase in sexually transmitted diseases, which cause scarring that
blocks the tubes. Improvements in testing are also raising the statistics of
ectopic pregnancy as they are detected earlier.

What Are the Causes of Dry Skin?

QUESTION: I have extremely dry skin and I wonder what causes it. I could use
creams and lotions all day, but I still wind up with itchy, dry, rough and
scaly skin. What can I do?
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ANSWER: You may have "atopic eczema" or a condition called "ichthyosis", but
in either case this is just an educated guess on my part since skin conditions
must certainly be seen to be diagnosed properly. Eczema is a superficial
inflammation that causes itching, with a red rash that amy be accompanied by
small blisters. Eczema is often treated with local applications of
corticosteroids. Ichthyosis is a congenital condition, in which the skin is
dry, rough and scaly because of a defect in the way the body processes a
protein called keratin.
Another frequent cause of dry skin is excessive exposure to ultraviolet
(UV) light, leading to thin, inelastic, dry scaling skin. Until you can get
an appointment with your family physician or dermatologist, you may help
yourself by using a lubricant over your entire body after you bathe or shower,
while your skin is still moist. The lubricant helps the hydrated skin to
retain water, resulting in softer skin. Ask your pharmacist for a
recommendation, since many over-the-counter products are very effective.
People with dry skin should use superfatted soaps such as Dove and Tone.
In cold Northern areas, some dermatologists suggest patients with
extremely dry skin limit the use of any soap to only the necessary areas, such
as the armpit and groin.

What Should I Do for My Child's Acute Diarrhea?

QUESTION: I am getting conflicting advice on this question and would be
grateful for your advice. Can you please tell me if you should feed a child
who is having acute diarrhea? Some friends say yes, but mother says no. What
do you say?
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ANSWER: Acute diarrhea in a small child is not the same relatively benign
discomfort it is for an adult. Infants and small children with diarrhea can
become dehydrated extremely quickly and may die. It's always been the
standard treatment to withhold solid food from a baby with diarrhea and give
him or her only water or a rehydration fluid for the first 24 to 48 hours.
However, recent evidence points to the value of giving babies some
lactose-free formula after they've already received some fluids. Babies that
received a soy-based infant formula (not one with milk in it, which can cause
further diarrhea) had diarrhea for a shorter period of time than did babies
treated with just water and rehydration fluid. Because of this finding, it
might be a good idea to start a baby on some formula early in the course of
his or her illness.
Rehydration fluid is water with important nutrients like potassium added.
It's sold in pharmacies under the name Pedialyte. Your doctor can also tell
you how you can make your own rehydration fluid and how to use it. I am sure
your own doctor has some ideas about this, and it would be wise to ask him or
her about this subject and go along with that advice.

How Can I Keep My Blood Sugar Level Under Control?

QUESTION: I am fighting a battle with diabetes. Everything I read about this
disease stresses the need to keep my blood sugar under control. What do you
consider as the best way to do this? I am determined to maintain whatever
schedule I must, to keep my diabetes under control.
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ANSWER: Checking your blood sugar, your urine sugar and your urine ketones at
home is the best way to know whether you are staying under control. Keep
accurate records of these test results, along with a diary that describes your
food and medication intake, exercise periods, as well as any symptoms. Blood
sugar can now be tested with a variety of home monitors that use plastic
strips which react with the sugar in your blood, and change color. The
machine "reads" the color (a process called colorimetry) and translates the
findings into readings that show the level of sugar. Similar strips also are
available to detect the presence of sugar in your urine. Home monitor testing
of blood sugar however, will yield more accurate results.
If you're a newly diagnosed diabetic, or someone whose blood sugar is
especially difficult to control, your doctor may recommend that you test your
blood on arising, before meals, after meals, at bedtime and between 2 A.M. and
4 A.M. Once you and your doctor learn your blood sugar pattern and an
effective way of administering insulin is determined, testing can become less
frequent. Testing blood sugar before each of the three meals and before
bedtime is usually recommended. Anytime you have symptoms of high or low
blood sugar, it's important to check your blood or urine more frequently and
modify your insulin intake as indicated by the test results.

How Effective are Drugs in Fighting Cholesterol?

QUESTION: I have never been much good with diets, and my my attempt to lower
my cholesterol is going nowhere. Aren't there medications that can do this
for me? If they are effective, can you please tell me why my doctor keeps
stressing the diet? I need help. Please?
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ANSWER: Yes, there are drugs that can reduce cholesterol levels in the blood,
but they do not replace a low cholesterol diet and exercise as the main tools
in fighting cholesterol. These changes in your life style can produce long
lasting effects that may improve many aspects of your health.
As you know, people with high blood levels of cholesterol run a greater
risk of arteriosclerosis, where layers of cholesterol build up and clog blood
vessels, leading to heart attacks and strokes. There are several types of
cholesterol, including low density lipoproteins (LDL), high-density
lipoproteins (HDL), and triglycerides. High levels of LDL and triglycerides
are bad, while high levels of HDL appear to have a protective effect that
prevents arteriosclerosis.
Cholesterol-lowering medications all lower the levels of LDL, but they do
have side effects. Some cause gastrointestinal problems such as constipation,
nausea and abdominal pain, while others cause itching and skin rashes. The
cost of these drugs must also be considered, since they will be taken over a
long period of time.
These drawbacks are why most physicians will not prescribe
cholesterol-lowering drugs until the patient has tried lowering LDL levels
through diet and exercise for at least a few months. Establishing a healthy
life style is as important to your overall outcome as just reducing those high
levels. However, for patients at risk of a heart attack, who cannot lower
cholesterol on their own, cholesterol lowering medications can be life savers.

What Are the Different Types of Bowel Diseases

QUESTION: Can you please help me and clear up something that is a bit
confusing. I need to know the difference between "ulcerative colitis" and
Crohn's disease? How does a doctor decide which one you have, and is that
really important?
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ANSWER: Both ulcerative colitis and Crohn's disease are inflammatory diseases
of the bowel. Symptoms of the two diseases are similar--diarrhea, crampy
abdominal pain, fatigue and weight loss are common. The course of each
disease is different, as are the types of lesions each causes in the bowel.
You and your doctor will be managing your disease together, so it is
important that you learn as much about it as possible. Advances in x-ray
technique and instruments used to examine the colon have improved the accuracy
of diagnosis. Double-contrast barium examination utilizes contrast dye as
well as air to produce a clear picture of the wall of the colon, where the
lesions are found. This detailed image helps physicians determine what kind
of inflammatory bowel disease is troubling you. This test is relatively
inexpensive and is available in almost all diagnostic x-ray departments.
Flexible, high-powered instruments called endoscopes allow physicians to
directly observe the walls of the colon. Endoscopy is useful in detecting and
classifying inflammatory bowel disease. Colonoscopy (or endoscopy of the
colon) allows a physician to examine and take a biopsy from any part of the
entire colon. This technique, in the hands of a skillful and knowledgeable
physician, is perhaps the best method for accurate diagnosis of bowel
conditions. Once the diagnosis has been carefully determined, the correct
treatment may be selected that offers the greatest chance of helping the
patient.

Is Alcohol Abuse the Only Cause of Liver Diseases?

QUESTION: Must a person with liver disease (cirrhosis) always be indicted as
an alcohol abuser? Would you please discuss the causes of the disease and
indicate if there are any other possible explanations for the condition.
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ANSWER: Cirrhosis is actually a group of diseases that cause serious damage
to the body's largest organ--the liver.
As cirrhosis progresses, normal liver cells are replaced by scar tissue.
Since the liver provides the body with very important functions, the disease
is often fatal. The liver is involved in producing blood clotting factors,
blood proteins, bile and more than a thousand different enzymes, as well as
performing many other crucial functions.
To be accurate, alcohol abuse is by far the leading cause of this
disease, which kills more than 30,000 Americans a year. There are, however,
several other conditions that lead to cirrhosis. A small percentage of people
who suffer from chronic hepatitis develop cirrhosis. Diseases such as
hemochromatosis--when the body does not handle iron properly; and Wilson's
Disease--when the body handles copper abnormally--can cause cirrhosis.
Congenital and inherited conditions also cause this liver disease. Conditions
in which the body is not able to utilize sugar properly or deficiencies of
specific enzymes in the liver can also lead to cirrhosis. In rare cases, a
severe reaction to drugs, environmental toxins, some forms of heart disease,
parasitic conditions or obstruction of the bile ducts can cause scar tissue to
form on the liver.
When cirrhosis of the liver begins, it is often silent, showing no signs
or symptoms. But eventually, a sufferer may experience a loss of appetite,
nausea, vomiting, weight loss, itching, an enlarged liver, increased
sensitivity to drugs, vomiting of blood, abdominal swelling and jaundice.
Many patients never develop any symptoms, but lab tests may discover the
disease when they are performed for other ailments.
Further deterioration of the liver can often be stopped once cirrhosis is
diagnosed. Proper medications, in addition to total abstinence from any
alcohol containing beverages plus a wholesome diet, complete with needed
nutrients and vitamins, can do much to rectify the situation.

What Is the Difference Between Heart Attack and Myocardial Infarction (MI)?

QUESTION: I am a bit confused about some terms used to explain heart trouble.
I can't distinguish the difference between "heart attack" and "MI". Are they
the same thing? Can you please explain what causes a heart attack? Thank you
for your attention to this question.
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ANSWER: Yes. They are terms used to describe the same problem, and are often
used interchangeably. The term "heart attack" is rather vague, and is often
misused and misunderstood.
A myocardial infarction (MI) starts with an obstruction in an artery
which brings blood to the heart and results in the death of the some heart
muscle which can no longer receive nourishment and oxygen. The obstruction
can be caused by fatty deposits in the walls of the blood vessels or injury to
the walls of a hardened artery that is followed by the formation of a blood
clot. This clot, in turn, reduces or cuts off completely the blood flow to
heart muscle, which then becomes injured and dies. The bigger the area that
is without blood flow, the more severe the damage is. The longer the blood
flow is interrupted, the more damage that is caused. For this reason, heart
attack victims who receive immediate medical attention have the best chance or
recovery.
It's important that you know the symptoms of a heart attack and heed
their warning. They may include pain or pressure in the center of the chest,
often like a belt is being tightened around the chest. Pain in the left arm,
shoulder or jaw may also indicate a developing heart problem. Sweating,
nausea, weakness, dizziness, shortness of breath or rapid heart beats should
all be promptly reported to your doctor. The best treatments now available
should be administered within the first half hour of the attack. The
medications can dissolve a newly formed clot, and restore circulation to the
suffering heart muscles.

What Can Be Done for Hearing Loss?

QUESTION: I guess my advancing age is the reason I am losing the edge on some
of my senses. The eyes are just a bit worse, things don't smell as they once
did, and now the hearing is going. It is such an important sense that I
wonder if there is anything new to help people who lose their ability to hear.
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ANSWER: How right you are! The sad part is that we can lose some of our
hearing acuity from so many causes. But there is good news. Thanks to
advances in medicine, surgery, and technology over the past 30 years, nearly
all can improve their hearing. The most significant advances have been for
disorders of the middle ear. One of the most common problems is middle ear
effusion which has typically been treated medically with one or more drugs,
including antihistamines, decongestants, steroids, and antibiotics. Not all
patients, however, respond to such treatment. Now, some of these patients,
particularly those with chronic otitis media, can be treated surgically. The
procedure involves inserting a ventilation tube into the ear to relieve
symptoms as well as prevent permanent ear damage, until the eustachian tube
can function completely.
Researchers are beginning to make progress in managing problems of the
inner ear, as well. One of the most exciting and promising developments in
this area is the cochlea implant. A small, self-contained device is
surgically placed in the portion of the ear called the cochlea. The patient
wears another device which transmits sound through electrical impulses to the
implant. The use of this procedure is generally limited to those who once had
normal hearing but are now totally deaf and cannot benefit from a conventional
hearing aid. Although the procedure cannot restore normal or near normal
hearing, it can restore some degree of usable hearing.
Progress has also been made in the treatment of sensorineural hearing
loss, caused by aging, genetics, infections, and injuries, particularly loud
noises. Currently, only a limited degree of medical and surgical treatments
are available. However, improvements in technology have resulted in new,
high-fidelity hearing aids that can substantially improve the hearing of
nearly all patients.
With all these new and exciting developments, and the many causes of
deafness or hearing loss, it's important to have the right diagnosis for your
particular problem, so just the right remedy may be applied to help you.

Are Frequent Headaches a Sign of Impending Stroke?

QUESTION: I get frequent headaches, as many as one or two a month. I am
worried that it may mean I will have a stroke. How can I be sure?
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ANSWER: Headaches are only one symptom of a stroke--the interruption of blood
supply to a part of the brain, or inflammation or rupture of a blood
vessel--but not all headaches mean that a stroke is coming on. Considering
the vast number of headaches in the United States in a given year versus the
number of strokes, the odds are pretty much against an occasional headache
being the first sign of an impending stroke. However, because headache CAN be
an important warning of a stroke, it is wise to be cautious about certain
types of headaches. Beware of any extremely severe headache--one far worse
than any other you ever had. Take note of a headache brought on by exertion,
a severe headache that lasts more than a day, one that gets gradually worse,
or any headache that is accompanied by reduced consciousness. If you notice
any neck stiffness or experience any changes in vision during the headache,
then it is time for fast action, with a quick call to your doctor, or a visit
to the nearest emergency room.

What Are the Meanings of Numerical Heart Failure Classifications?

QUESTION: I suffer from heart failure. During his discussion with me, my
doctor told me I am a 2B classification, but he didn't explain what that term
means. Could you please provide that information for me?
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ANSWER: It is pretty complicated, but if you follow along carefully, you can
learn the meaning and reasons for these classifications. Congestive heart
failure is a condition in which the heart's pumping ability is impaired. The
heart is unable to maintain circulation sufficient to meet the body's needs.
Doctors call this "low cardiac output" and it affects people in different
ways, and to different degrees. This led the New York Heart Association to
classify the various ways that you could be affected. The numbers 1 to 4 are
used for a functional classification. The letters "A" through "E" serve as a
therapeutic classification, and serve as a guide to the management of a
patient's activities. The letter classifications also provide for
recommendations as to the amount of physical activity advisable for those in
each class. Patients with Class 2 congestive heart failure have a disease
resulting in slight limitation of physical activity. They are comfortable at
rest, but ordinary physical activity results in fatigue, palpitations, dyspnea
of anginal pain.
The "B" classification means ordinary physical activity need not be
restricted, but the patient is advised against severe or competitive efforts.
These classifications are especially helpful to doctors trying to monitor
changes in a patient's condition.

How Should Developments In Genetics Affect How Doctors Treat Patients?

QUESTION: It is our first baby, and my husband and I are spending this time
in reading everything about babies and the genes we provided to its
development. We think this is a fascinating subject. Now we would like to
know if all the recent developments in the field of genetics have changed the
way doctors treat patients?
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ANSWER: That's a loaded question. The science of genetics is relatively new,
but genetic screening is moving so rapidly that some experts predict that
there'll be a test for any gene within the next five years. A simple
definition of genetics would be the science of inheritance and the study of
inherited diseases. Because the technology of genetics is advancing so
quickly, scientists working in the field say doctors cannot keep up with the
advances. Doctors that are keeping pace are being confronted with many new
legal, social, and moral questions related to genetics. Who should be
screened? Is confidentiality guaranteed? If a disease that will occur in the
future is detected, how will this affect the person's whole outlook on life,
his or her employment and health insurance? Are doctors prepared to properly
counsel those with a grim diagnosis so many years in advance? What is the
point of screening for a disease for which there is no treatment? As the
number of prenatal tests grow, how will this affect decisions to abort? You
see, the questions multiply as the number of diseases that can be tested for
increases.
Just a few of the prenatal genetic tests widely available today are for
forms of cystic fibrosis, muscular dystrophy, hemophilias, thalassemias,
sickle cell disease, and phenylketonuria.
Scientists have learned to track the inheritance of disease from one
generation to the next by finding genetic markers. Each marker defines a
specific site on the human chromosome where a variation in the DNA sequence
occurs. If the marker is located close to a disease-causing gene, the
inheritance of the marker may predict the passing on of the gene from parent
to child.
One of the biggest problems with the science of genetics is that tests
are being developed for diseases well before cures and treatments are found.
For example, the genetic test for Huntington's disease is 95 percent accurate.
Having the test can let someone known decades before they are likely to come
down with the disease that this fatal ailment lies in their future. Doctors
at Boston General Hospital doing the testing for Huntington's are being
careful to only screen people with stable personal situations who have not
been coerced into participation, since the knowledge that the effects of this
neurological disease lie just down the road is not easy to accept.
Many geneticists say their tests are moving from the laboratory stage to
the clinic very slowly because the tests are very tricky, and primary care
physicians are hesitant to discuss them with patients. The screens are
becoming more reliable though, and are covering a wide range of diseases.
Therefore, some geneticists believe it's only a matter of time before the
tests become so routine that doctors who don't perform them will be open to
lawsuits from patients who feel they were improperly informed. Of course the
next important development to look for is the ability to treat or change the
genetic makeup of an individual, to prevent the evolution of the disease.
This too, will pose many ethical and moral questions for medical
practitioners.

What Is the Relationship of Pregnancy and Diabetes?

QUESTION: What can you tell me about the relationship of pregnancy and
diabetes? My daughter is expecting my first grandchild, and has been told she
has "sugar". This is something new for she never had this condition before.
Can you please explain what is going on? Thank you for your help, from a very
anxious mother and grandmother to be.
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ANSWER: Some women who get pregnant get diabetes, but this type of diabetes,
called "gestational" diabetes, usually goes away when the baby is delivered.
The physical changes of pregnancy cause the diabetes in some women.
Women who get gestational diabetes usually have at least one of these
characteristics: they have had a previous stillbirth; they have had babies
that weigh more than nine pounds; they have had babies with birth defects;
they have a family history of diabetes; they have had obstetric complications,
such as high blood pressure; they have had gestational diabetes with a
previous pregnancy. Of course it is also possible that even when none of
these are present, the condition may still develop.
It is especially important for a woman with this type of diabetes, or any
form of this disease to get early prenatal care. The doctor will require a
thorough history, so he can spot any of the risk factors and test and treat
your daughter accordingly. Uncontrolled diabetes is not healthy for the baby
or the mother. It can cause birth defects and death for the baby if it is not
fully treated. The good news is that proper treatment can prevent such
tragedies.
Of course, a woman who had diabetes before she becomes pregnant will not
be "cured" by the delivery of her baby--she will still be diabetic afterwards.
Since there is no history of this disease in your daughter, it is likely that
her sugar problem will disappear after the birth of your grandchild.

What Is a Fever of Unknown Origin or "FUO"?

QUESTION: Can you please explain the use of the letters "FUO" in describing
an illness. I am sure it has nothing to do with "UFO" but my curiosity has
been provoked, and I hope you will be able to provide me with the answer I
seek. Thank you for your help.
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ANSWER: "FUO" stands for Fever of Unknown Origin, not for UFO or Unknown
Flying Objects. In this age of superb diagnostic abilities on the part of
physicians and relatively new aids to diagnosis--such as CT scans, magnetic
imaging and a whole host of other laboratory tests, there are fewer fevers for
which the cause cannot be determined. Yet, some FUO's occur. They can be of
real concern especially in older patients, the poorly nourished and in those
whose bodies have decreased natural abilities to fight disease.
FUO's are fevers (temperatures elevated above the normal) that last for
several weeks and for which patients and their doctors can find no cause.
Medically, before a patient is diagnosed as suffering from FUO, three points
must exist: (1) fever must have lasted for one to three weeks; (2) body
temperature must have been greater than 101 F on several occasions; and (3)
diagnosis of the cause of the fever has not been possible after one week.
Normal human body temperature ranges from 96.8 to 100.4 F; the lowest
daily temperatures usually occur in the early morning upon awakening, while
the highest are found in the late afternoon or early evening, and following
exercise. Persons whose usual body temperature is at the upper end of the
range and in whom temperatures are taken late in the afternoon may appear to
have a low fever when, for them, it is really normal.
Yet, when a fever for which no cause can be found persists for several
weeks, the sufferer and his/her doctors often become quite anxious.
Through careful diagnostic procedures, many and possibly most, FUO's
prove to be caused by some sort of bacterial infection (possibly tuberculosis,
gonorrhea, appendicitis, abscessed teeth, fungus, or sinusitis to name but a
few). In addition there are certain virus-caused illnesses, tumors,
connective tissue diseases (partial list includes: lupus, rheumatic fever,
and rheumatoid arthritis), endocrine diseases (certain thyroid malfunctions
among them), alcohol, drugs (both those prescribed to treat other conditions
and those that are illegal), and/or psychological conditions.
Among people most prone to FUO's are: the elderly, travelers, recent
immigrants, homosexuals, patients who have undergone surgery recently, those
at risk for AIDS, and those who bodies cannot fight disease in a normal way
because of illness or treatment (such as cancer and chemotherapy).
Nevertheless, whatever the reasons, prolonged fevers are serious and are
cause for concern. Young patients who are otherwise healthy, but with fevers
slightly above the normal range that continue for sometime with no detectable
reason even after a full series of diagnostic tests, usually do relatively
well in spite of their FUO's. Some of these fevers disappear in time; in
others, fevers continue on and off over long periods of time without
developing into a serious disease. Such patients usually remain under close
medical observation, to be sure that the situation is not the beginning of
another, treatable infection.

What Is a "Frozen" Shoulder and What Can Be Done About It?

QUESTION: I am confused by the term "frozen" shoulder. Can it be a serious
problem, or is there help available? The patient in question is an older man,
but he is far too young to put up with this problem, that is affecting his
daily existence. Please give us some help.
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ANSWER: You've heard the phrase "use it or lose it"? That is what a frozen
shoulder is most often all about. Any joint can stiffen or freeze up if it is
not used for long periods of time. A frozen shoulder sometimes occurs after a
persistent shoulder problem, either arthritis, tendinitis, or trauma to the
joint. It has also been known to occur after a heart attack when the patient
has been bedridden for a time. Essentially, any long period of immobility of
the shoulder joint can lead to calcification in the soft tissues that form
part of the joint, a narrowing of the joint space, and/or osteoporosis of the
bones.
In some cases, the patient will slowly recover function in the frozen
shoulder without treatment as the stiffness diminishes with time. This is
most probably due to the gradually increasing use of the shoulder as pain
diminishes and the needs of daily living require some motion of the joint. In
other cases, corticosteroid drugs will reduce the inflammation so that an
exercise program can be started. To prevent a frozen shoulder, most
physicians will prescribe exercises as part of the treatment for shoulder
injury. Exercise also forms an important part of any rehabilitation treatment
that seeks to return both strength an mobility to this joint.

What Is a Ferritin Blood Test?

QUESTION: My doctor sent me to a lab for a blood test. The slip was marked
"ferritin". Can you tell me what this ferritin is and why this test would be
ordered in a patient?
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ANSWER: Ferritin is a large molecule containing variable amounts of iron and
most of the iron which is stored in the body and used to build hemoglobin is
composed of ferritin. This ferritin is usually stored in liver cells.
Doctors use laboratory tests for ferritin to determine whether or not a
patient has sufficient iron reserves in their system, and sufficient supplies
to produce hemoglobin. A low serum ferritin concentration indicates iron
deficiency and probably is one of the best tests for identifying this
condition. When ferritin values are high, it may be an indication of liver
injury, and in some cases, of a neoplasm and therefore must be interpreted
with great care. For you to be properly informed about your situation, you
will have ask your own doctor.

Are Bites from People Worse than Animal Bites?

QUESTION: We were a bit puzzled by the statement of a doctor, who was giving
a talk at our community center, when he stated that we have more to fear from
the bite of a human than we do from an animal bite. Was this a bit of
melodramatic over emphasis or do you too believe that human bite is more
dangerous? I would very much like to know.
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ANSWER: Yes, I agree with your lecturer, such bites are more likely to become
infected than those from animals, and from that point of view are more
dangerous. Every year about 60 out of each 100,000 (mostly young males)
people are bitten by other humans. Bites most frequently occur in summer and
on weekends. They often result from fights. Hands are the most likely sites
for bites. Additionally, abused children often have bites on various parts of
their bodies. Some bites are even self-induced, as with children who suck
their fingers.
In treating bites from humans, wounds are cleaned thoroughly, tetanus
shots (if the patient has not had one recently), penicillin and other potent
drugs are administered, and the area affected often is immobilized and
elevated for some time. Doctors usually require patients to return for
observation several times as complications from human bites occur frequently
and can be decidedly serious. Also, doctors may require more detailed
information about the person who inflicted the bite, as they may have
infections they could be passed on.