for now, you'll have to scroll and search down the list,,,when I get more time, I'll be making an index
5/15/99
Q. In 'YOUR' doctor opinion, what's
better for my baby,,,,,,,,,,,,,,,,,,,,,,,,, FORMULA or breast milk?
A.
I just happened to be talking about that
subject with one of my patients the other day! For years, I've felt
that breast milk was the best,,, and NOW, there's a recent
study out that agrees with me.
4/12/99
Q.
I was in a discussion with
some people at work about two drugs -- Prozak and Zolof. (Unsure
of spelling.) The question is, if given in the same dose (e.g., mg
and
frequency) to the same person, which drug is
the strongest? Also, if the information the drug isn't too long (in
your PDR), could you send me a synopsis of each drug?
A.
Prozac & Zoloft, both are ANTIDEPRESSANTS,
with Zoloft being the newest.
Both are indicated for Depression, Obsessive compulsive disorder (OCD),
and Bulimia nervosa.
Dosage range Usual / Average
Dose Indications
| Zoloft | 25 - 200 mg/day | 75 - 100 mg | OCD, Depression |
| Prozac | 10 - 80 mg/day | 40 mg | OCD, Depression |
As far as comparing doses,,,, 100 mg's of Zoloft is ~= to 40 of Prozac.
My drug of choice for Depression is Zoloft.
Short of the PDR, you can read THIS
article.
Some FAQ'S on Zoloft
and Prozac
1/3/99
Q.
Can
emotional enzymes from a mother nursing be transferred to the babies and
make them exhibit emotional stresses such as,
stiffing of the body. pulling at
their hair and scratching their face when crying?
Other than that they are
happy congenial babies when they are not crying.
A.
What you're describing, the stiffing, pulling
at the hair at times, also sudden jerking, as if startled, are all
normal
findings in most babies.
It is felt that the nervous system hasn't
quite fully developed. This is especially true for 'primies'
and newborns born before 38 wks. These neurological findings usually
disappear by the age of 3-6 months.
There are similiar findings in 'cocaine' babies
EXCEPT, they don't go away for many months after the typical (as above)!
As far as transferring 'emotional enzymes',,,,,,,,,, well,,, this is
unknown.
Q.
Have you all heard (or am I late??) how
some girls that date and/or go to bed with the athletes will go to bed
with them, and if a condom is used, after the condom is thrown out, will
retrieve it from the garbage and insert it back into themselves (the ladies)
so as to
hopefully get pregnant??
A. I heard about something like that on the Oprah show this past fall. There was a show about NBA 'groupies', and women that got pregnant by NBA players and then would hit them with paternity suits. They talked about what you mentioned above.
Is there a possibility (and how much of one) could a pregnancy take place after this is stupidly done????
A. Well, medically speaking, it's possible! "that
turkey baster" can do all types of things!
the 'critical' matter here is
getting the sperm and instilled/inserted, BEFORE it dies. And if
the sperm has been in a warm, dark environment, in an 'x' amount of semen,,,
the sperm can live for HOURS!
(the more the amount,, the longer it can live) Remembering that
sperm live in semen that is very rich in nutrients, and the more
semen, the longer they live
Q.
What is the best treatment for
sinusitis????
Are there any
medications that you can take (not over-the-counter)
that will not make
you drowsy???? When do you know if you
need surgery for this condition?
A.
the best treatment is prevention.
When you notice symp of facial pressure/congestion, that last
more than a day, I recommend something like SUDAFED, the little
red 30 mg tablets, 2 every 4-6 hrs.
Also you can try DRIXORAL, TAVIST-D, or DIMETAPP. ( for
some, the generics don't work!)
As far as the drowsiness factor,,, it varies
from person to person,, you just have to try one and see.
Now there ARE some prescription remedies that are
touted as non-drowsy.
Claritin, and Allegra are the most popular.
If you're not better after ~5-6 days of OTC (over the counter) self
treatment, or if you develop headaches / purulent mucous (green, yellow,
blood tinged), then it's time to see your Dr.
You'll probably be given an antibiotic for 10 -28 days.
if you're STILL not better, they may give another antibiotic. (this
may go on until you've have as many as '3' different kinds of antib's)
Somewhere along the line, you may get an xray or C.T.
/ MRI scan
THEN,,,,, you may be referred to an ENT specialist that will decide
if surgery is indicated.
My recommendation,,,,,,,,,, catch it EARLY!
Q.
HERNIA
What is it?
What part of body is it found?
What are the risk?
What kind of doctor should do the surgery?
About how long is the hospital stay?
Does Blue Cross Blue shield cover it?
A.
A hernia, is a defect, or weakness, in the muscle
layer, covering the abdominal cavity.
It can be high in the abdominal causing a hiatal
hernia, or very low causing a inguinal
hernia (this is the kind that swells into or around, the scrotum.
If it's around the navel, like in a newborn/infant, it's an umbilical
h., and if it's anywhere else around the mid section, it's simply
called an abdominal h.
To understand a hernia, you need to understand a 'little' anatomy.
Your bowels(guts), are covered by 4 layers.
intestine
membrane layer
fascia layer (tough membrane)
fat layer
and finally, skin.
When the defect in one of the inner layers occurs, the 'pressure' of
the abdominal contests PUSH up & out toward the weakest area.
Think of it like putting on a pair of old, worn pants that are 2 sizes
too
small, and then, you try to sit down,,Rrrrrrrip!
And suddenly you see and feel part of your underwear through
the tear/defect.
Usually, a general surgeon, is the specialist that 'repairs' hernias.
There are MANY ways that a hernia is repaired, but 'basically', THE
DEFECT is reduced (pushed back to where it belongs), and the area is re-inforced
with stitching alone, or using a 'patch'. The repair is call a HERNIORRAPHY
(her-knee-or'-raf-ee).
The risks..........
well, they're not TOO many, and THEY aren't
serious. Most commonly, recurrent hernia AT the repair
site, and infection. (of course the doctor will have
to tell you ALL the other possibilities)
(if you want to know those,,, let me know, they range from 'knicking'
the bowels while sewing/stitching, to complications in using the anesthesia
to put you to sleep).
But again,,,, there aren't many (in the hands a competent surgeon!
The hospital stay,,,,Hummmmmmm that depends on WHAT and HOW they do the repair. Usually, abdominal h. is 2 or 3 days, with is the most complex of the hernia repairs.
Herniorraphies or covered by most all insurances.
For more info go HERE > >
Hernia.com
Q.
If your grandfather and/or grandmother
were infected with TB and not
treated, can it be passed down in-utero and
skip a generation, and
appear in a grandchild on a positive skin
TB test???? In a case like
this, what is the treatment, if any????
A.
No, you can't pass on t.b. via in-utero WITHOUT the newborn
being actively infected with the disease. (and THAT would be obvious in
no time!)
Some can develop a sort of inherited 'sensitivity'
to some chemicals, like the PPD that's use for t.b. testing, and then,
later in life when you get exposed to the PPD, you'll be +.
There are a LOT of folks that test + to PPD, and NOT have the disease
or exposure.
There's a lot that we don't know about
t.b. and PPD testing,,, We in the field take the safe approach and say
"if in doubt,,,,,treat". That's why if you develop a + PPD, most
of us will recommend Rx. for the usual 6 months.
Once +,,,,,,,,,,,,,, ALWAYS + !
Gosh,,,, you
ask HARD ?'s! :-)
Q.
Although shingles is common in the elderly,
what exactly is shingles
and is there any correlation between shingles
and STD's if a young
person is affected by it????
A.
Shingles is HERPES ZOSTER, a virus that infects
the nerve root, in a particular area of the body, and is a chronic, sometimes
recurrent problem. Once infected, it can NOT be cured. Some
meds will control the major symptoms,,,, pain.
We classify Herpes Simplex (on the lips/face), Herpes
Zoster (on the trunk of the body or extremities), and Genital
Herpes
Virus (on your 'stuff').
All are HIGHLY infectious....HIGHLY..
Many of the genital herpes infections are symptomless! and therefore
can be transmitted sexually without being aware. If you develop a
sore in the genital area, and it appears like a fluid filled, or ulcer
like lesion,, but to have it checked out to be sure. It can only
be Dx when it is fairly 'fresh' (usually within a day or so when 1st found)
If the virus comes in contact with OTHER parts of the body, it CAN
become Simplex or Zoster.(and vise versa)
But in general, HSV
is classified as a STD (sexually transmitted disease).
As I tell my pts., when you engage in RISKY SEX, not only do you have
to worry about HSV, but ALSO you can get trichomonas, gonorrhea, syphilis,
Hepatitis B & C, and "HIV"!
Q.
Can repeated episodes of trichimonas
vaginitis
in a young woman
(although treated)lead to cervical cancer
later in life??? What is the
correlation between starting to have sex at
an early age and cervical
cancer???
A.
There's NO evidence that repeated bouts of Trich
will lead to Ca.
There is evidence that having sex at an early age with multiple partner
MAY be related to the development of cervical ca. The studies are
in progress at this time.
But,,, what can you do NOW??
You can get regular pap smears, and THAT will take care of that!
Q.
Do you think that STD's
are the result of the modern teaching that
women do not need to douche (as our grandmothers
and mothers did)?
(Where's the Lysol???) Were our mothers
and grandmothers more "healthy"
in that area than their daughters are today?????
A.
I think it's just the sign of the Modern times,
and the promiscuity in our society.
Maybe the POWERFULL antibiotics that are used for any & everything.
I 'hear' some old wives tales about various remedies for common ailments
that women have.. They most likely work,,, but WHO wants to douche daily
for month with the juice from cranberries????? (when you can just take
a pill).
Medically, we don't recommend douching AT ALL,,
but
if you must, once/month with vinegar & water.
"more healthy in that area?",,,,,,,,, I don't know..
Q.
a "diuretic"
(spelling)...like
coffee. It draws water out of the body...so
one
should drink even more
water to compensate. Now, where does it
draw the water from??? joints,
muscles????
A.
Diuretics work by drawing 'excess' h2o from
the body...
The excess in usually in the tissues (90% of the time).
If you have no excess,,,, you will have no diuresis (that
what the diuretic does).
BUT,, if you take a diuretic in excess and you're of normal
water constitution, you can get dehydrated!
One point to remember, Salt (sodium) HOLDS excess
water! And THIS is the major reason that diuretics
are given!
Q.
Do I have to
have a prescription to get estrogen
cream:-o ?
A.
Yes, if you want one that works!
The OTC's (over the counter) preparations are so LOW in concentration,,,,!
just save your $$.
Q.
Dr...
How can you tell when you need
cataract surgery? Also, I am nearsighted will the
surgery allow me to see distance without
glasses?
anonymous..........
A.
Cataract
Opacity of the lens of the eye, causing impairment
of vision. Most commonly
caused by aging, cataracts may also be congenital or result
from eye inflammations
or certain diseases, such as DIABETES. Cataracts can be
treated by the use of
corrective lenses and, if needed, surgical removal of the lens
and implantation of an
artificial lens.
There are some REALLY good articles out there re: cataracts, here's
one.
Now regarding the correction of nearsightedness
(myopia, and farsightedness, that's hyperopia, and THAT'S another subject
matter)? maybe you want to know about RK (radial keratotomy)?
Well unfortunately,,, cataract surgery does NOTHING or
vision acuity, it only helps by allowing light into the eye.
Q.
Help,
I have a daughter, that is 7 yrs old, and she is over weight, And she
wets her bed in the middle of the night.
We have tried just about everything,
(we think) we have tried to get her to try and
lose the weight, (thing it
could have something to do with that, because
her other brother and sisters
are not over weight and they have no problems
with bed wetting.) it didn't
work. we have gotten our self up at least 4 to
5 times a night, to wake her up
and go to the bathroom. Didn't work.
We even had someone prescribe a
medicane the is soposed to keep water in and
or something like that, and after
I payed an arm and a leg for it, I thought about
it and with her weight
problem I figured she didn't need that.
We have gone to the point that if she
didn't go to the bathroom in her bed, we would
do something special. that
didn't work. We need help!
A.
WHOA!!
Sounds like the whole house is on edge with THIS one!
How long has this been going on? Usually, the LONGER it's been
going on,, the longer it takes to clear up.
The FIRST thing that needs to be done is a medical history and exam
by a doctor.
Lab studies of urine and blood to detect
diabetes or urinary-tract infection.
Things your Dr. will want to know are:
Has she been SEEN for this problem in the past?
What age was she potty trained?
How long?
Is it EVERY night, or just some?
Any changes in her wt. or appetite?
When this 1st started, was SOMETHING going on in the family dynamics?
(a problem sibling?,,,, one of the parents going through some changes?
Is she spending time in a place that might be causing 'some' emotional
stress?
You have to be REALLY open and truthful about it.
(you've seen the t.v. special on daycare workers that abuse children,
and it doesn't have to be sexual!)
In general,
BedWetting at night while in bed is called enuresis.
The occurrence of bed-wetting in children is:
15% at age 5;
10% at age 6;
7% at age 8;
3% at age 12;
1% at age 18.
In some cases, the cause of bed-wetting is unknown. some causes
could
be a
1. underlying illness, such as diabetes or a urinary-tract infection.
2. A small or weak bladder that cannot hold one night's urine
production.
3. Psychological problems caused by stress in the home, school,
or separation from mother.
4. Or, a child who is a deep sleeper.
There's a HIGHER than average ocurrance if there's a family history
of bed-wetting (44% occurrence if one parent was bed-wetter, 77% occurrence
if both parents were bed-wetters).
I think that the weight could be an
'issue', but the Dr. will have to determine that.
There IS treatment available, and if medicine is necessary, your doctor
may prescribe antidepressant drugs or a prescription nasal spray.
Q.
(How about one of your "Doctor's
Questions/Answers" on post-partum depression?
=========
Wednesday July 8 5:58 PM EDT
Guilty plea ends ``Baby Blues'' trial
FINDLAY, Ohio, July 8 (UPI) -_ A Findlay woman who claimed postpartum
depression
caused her to kill her daughter has
dropped her insanity defense and has pleaded guilty to involuntary
manslaughter.
Kimberly Snyder, 27, of Findlay was sentenced today to serve 15 years
in prison for
the 1996 beating death of her
3-month-old daughter.
Snyder was about to begin the third day of her murder re-trial when
her lawyer
announced she was ready to plead guilty to the lesser charge. In addition,
Snyder also
pleaded guilty to child endangering.
Visiting Judge Richard Parrot of Union County immediately sentenced
Snyder. She has
already spent nearly two years in jail since being charged in connection
with the death
of her daughter Tahlor.
The infant died on July 30, 1996, several days after suffering severe
head injuries.
Snyder admitted throwing the baby to the floor.
Snyder was the first woman in Ohio to use the ``baby blues'' as part
on an insanity
defense. She claimed that a severe form of the depression experienced
by most new
mothers caused her to lose touch with reality.
Prosecutors alleged that Snyder was an unfit mother who wanted her daughter
dead
because the child interfered with the woman's wild lifestyle.
During her first trial last year, Snyder was convicted of murder, but
the judge who
found her guilty had second thoughts about the verdict. He refused
to sentence her,
and that prompted a second trial.
=====
A.
PostPartum Depression occurs in ~ 5% of women.
Usually manifesting within 12 months of their child's delivery.
The majority of the time, the symptoms pass with much 'to-do'. BUT,, in
a small %, the condition requires medical attention.
In MY experience, I'd say of the 5% affected 80% respond to simple
antidepressants for a few months,,, but the OTHER 20% (as the woman in
the above article), need psych help.
The condition is most likely to come to my attention
by the father, or other family members. But a few can be identified
when they present to the office for various medical complaints that strongly
appear to be psychogenic in origin..
Q.
the doctor changed her
blood pressure to something called
accupril 5mg tablet...
what type of medication
is this, and what are some of the expected side effects.... she's
kind of hesitant about
taking it.... should she feel confident
with it....
A.
It's a good medicine!
but you need to be aware of the side
effects.....
below is a excerpt from my 'book'.
See the SIDE EFFECTS below....
generic name: quinapril
BRAND name: ACCUPRIL
DRUG CLASS: Quinapril is an ACE (angiotensin converting enzyme)
inhibitor. ACE is an enzyme in the body which is important for the
formation
of angiotensin II. Angiotensin II causes constriction of arteries
in the body,
elevating blood pressure. ACE inhibitors such
as quinapril lower blood
pressure by inhibiting the formation of angiotensin
II, thus relaxing the
arteries. Relaxing the arteries not only lowers blood pressure,
but also
improves the pumping efficiency of a failing heart and improves
cardiac
output in patients with heart failure.
GENERIC: no
PRESCRIPTION: yes
PREPARATIONS: tablets: 5 mg, 10 mg, 20 mg, 40 mg.
STORAGE: Tablets should be stored at room temperature in a tightly closed
container.
PRESCRIBED FOR: Quinapril can be used alone in treating high blood
pressure. Its blood pressure lowering effect can be further enhanced
by the
addition of a diuretic medication. By
reducing resistance in the arteries,
quinapril can be useful in the treatment of congestive heart
failure. In
treating heart failure, quinapril usually supplements conventional
treatment,
including a diuretic and digoxin (LANOXIN). It is also used to treat
kidney
disease associated with diabetes.
PROPER USE: May be taken on an empty or full stomach.
PRECAUTIONS: Quinapril should not be taken by people with a known
allergy to ACE inhibitors. Swelling of the facial tissues and even
the upper
airways has been reported with ACE inhibitors on very
rare occasions, and
can lead to serious breathing difficulties. Quinapril can interact
with diuretics
(water pills) and other blood pressure medicines to cause an excessive
drop in blood pressure, which can cause symptoms of weakness, dizziness
and lightheadedness.
Impairment of kidney function have been reported with
ACE inhibitors, especially in patients with severe heart failure or
pre-existing
kidney disease. Combining quinapril with potassium supplements, potassium
containing salt substitutes, and potassium conserving diuretics such
as
amiloride (MODURETIC), spironolactone (ALDACTONE), and triamterene
(DYAZIDE, MAXZIDE), can lead to dangerously high blood levels of
potassium.
Indomethacin (INDOCIN) and possibly other anti-inflammatory
medications may decrease the blood pressure lowering effect of quinapril.
In
rare instances, low white blood cell counts have been reported with
the use
of ACE inhibitors. Low white blood cells increases the person's chance
of
infections. Anticancer drugs or chloramphenicol taken with quinapril
can
increase the chance of having a low blood cell count. When taken with
lithium, quinapril can increase lithium to toxic levels in the blood.
ACE
inhibitors, including quinapril, can be harmful to the fetus and should
not be
taken by pregnant women. It is also avoided in nursing mothers. Safe
use in
children is not established. It is not habit forming.
SIDE EFFECTS: Quinapril is generally well tolerated
and side effects are
usually mild and transient. A dry,
persistent cough has been reported with
the use of quinapril and other ACE inhibitors. Coughing resolves after
discontinuing the medication. Other side effects
are rare and include
abdominal pain, constipation, diarrhea, dizziness, fatigue, headache,
loss of
taste, loss of appetite, nausea and vomiting, easy bruising or bleeding,
chest
pain, chills, difficulty breathing, severe dizziness or fainting, fever,
numbness
or tingling in the hands or feet, rash, and a sore or swollen throat.
Rarely,
liver dysfunction and skin yellowing (jaundice) have been reported
with ACE
inhibitors.
------------------
Hope that was helpful,,,,,, if you have some SPECIFIC ?'s,,,, let me
know...
5/22/98
Q.
What actually is lymphoma?
A. (from my textbook)
Lymphoma is a broad term encompassing a variety
of cancers of the lymphatic system. The lymphatic system helps filter out
bacteria and is important in fighting disease. Every so often, the lymph
vessels widen into lymph nodes. Most of us have felt these under our arms
or neck (like when sick with mono or an infection).
In lymphoma, some of the cells in the lymph
system multiply uncontrollably. Lymphoma is
differentiated by the type of cell that multiplies and
how the cancer presents itself.
The two main groups of lymphoma in humans are
Hodgkin's Disease http://cancernet.nci.nih.gov/clinpdq/pif/Adult_Hodgkin's_disease_Patient.html
and the Non-Hodgkin's
Lymphomas.
http://cancernet.nci.nih.gov/clinpdq/pif/Adult_non-Hodgkin's_lymphoma_Patient.html
Lymphoma is a serious condition. Unfortunately,
other medical problems often appear as lymphoma
symptoms (infections and "Cat Scratch Fever" are
just a couple of examples)
If you are looking for information on
Lymphedema instead of lymphoma - I suggest the
National Lymphadema Network. Animal lymphomas
are also a separate field.
The best advice is to see a qualified doctor (or
three) and get all the information you can about
your condition. Use the resources listed as an aid
in the quest for information. Informed people make
better decisions.
Q.
My question is: I thought a
male could not have an orgasm
WITHOUT ejaculation!!!!??????
A.
Sure can...
It's like
someone pushing on a door, harder and harder, and when there's enough
pressure built up, it flies open. Now if the room was full of 'water',
it would be released,,,,,,,, Now if the room was EMPTY,,,,, don't
nothing come out BUT,,, the DOE is still open,,,,,,,, and you've had the
'pleasure' of opening it! (where's my cigarette!)
:-)
Now of course you have to deal with the psych of NOT seeing/feeling
the 'actual' physical matter of semen.. But I've heard that if you don't
look for it,,,,,,, you just don't really know...
The ? is, do women actually FEEL the passage
of the semen, or do they feel the rhythmic pulsating of the 'member'??????
Hummmmmmmmmm?
As I mentioned in a previous response,,, if the prostate
is 'damaged', there could be
1. no ejaculation
2. 'backward' ejaculation
3. normal ejac
There's more to ERECTION, CLIMAX, AND EJAC then 'just' the
prostate!
In essence, the prostate just supplies the fluid.
Now,, if you CAN'T reach a climax,,, you can't ejaculate......PERIOD!
It's all in the stimulation. An erection can be of varying degrees
of firmness... Of course the firmer the better for the partner! You
need NERVES (innervation) for an erection.
Now if the NERVES involved in erection are damaged, such as in RADICAL prostate surgery, including radiation,,chemo.... then.... NO NERVES,,,,, NO CLIMAX.
We have medicines to make an ERECTION (including shots, suppositories),,,, but that doesn't mean CLIMAX / EJACULATION!
Erection - needs nerve stimulation OR medication
Climax / ejac - MUST have nerve stimulation..... medicines
WON'T do it!
(and of course an ejaculation can be 0.001cc's
or less!)
Right fellas?
Most men know that after a BUSY a night,,,,There
ain't much there, after the 5th time!
5/18/98
Q.
With all of the talk about the prostate these
days, just what function is the prostate in terms of sexual
performance (i.e.,
can a male perform sexually without a prostate, etc.)???
A.
The PROSTATE (a lot of people mispronounce it and
day PROSTRATE - that's some that happens to you when you're in the
SUN & HEAT too long!)
......anyway before I got side-tracked....
the prostate is one of 4 glands involved
in reproduction. It's ~ the size of a walnut deep inside at the base
of the penis and ~ 3" deep via the rectum (just under the lower wall).
It's major purpose is to supply nutrients
& fluid to the sperm. Thereby forming SEMEN.
The Prostate also acts as a ONE WAY
valve for direction/passage of semen, going up and out of the penis during
ejaculation. If the prostate is surgically removed. the semen,
for the most part cannot exit in the usual way, but instead goes backward
into the bladder (retrograde ejac.)
But,,,,,,, in answer to your ? , YES you
can function sexually without a prostate.
Now if it's diseased, or infected,,,,, that's another story/question..
Q.
What exactly is "water
on the knee"?????
A.
We call it a knee effusion. The inner
knee is a complex structure of ligaments, tendons, and cartilage.
If one of these is injured, say STRAINED, the body dilates the blood vessels
in the vicinity, so as to BATHE the injury with nutrients, to facilitate
healing. If the injury is a TEAR, then the area fills with blood.
A GOOD way to tell if you have some effusion, is when you can't bend your knee all the way back as you usually can..
The amount of effusion is usually directly
related to the amount of injury..
9x out of 10 times, this fluid will re-absorb on its own.,,,,, as long
as you don't aggravate the knee. Maybe a 'mild' effusion might
take a couple wks..(?)
What's important is:
1. Does it lock up when you walk?
2. Does it 'click' or 'pop' ?
3. Does it hurt ALL THE TIME,
even at rest?
If the answer is YES to any/all of these,,,, then it needs to be checked
out.
Q.
Is
there a correlation between severe migraine
headaches and some forms of mental illness
and/or epilepsy?
A.
Not normally,
except they ALL involve the brain. Something like
your car radio volume knob doesn't work right
the car window doesn't go all the way down
and there's a rattle in the trunk.
All these are in the CAR.. but not normally related..
Now if someone has epilepsy (seizures),,
these CAN be triggered by headaches (HA) in some individuals.
Q.
Do
all menopausal women need to take estrogen??
I'm concerned about side
affects.
A.
No..
the MAJOR issues are both +'s and -'s
+ stops hot flashes, and the associated
symptoms
it's cardio-protective
(keeps the heart from aging)
maintains breast
/ vaginal tissue (otherwise, it shrinks and dries) :-(
- slightly higher incidence of
breast masses (sometimes cancerous)
continuation
or resumption of menstrual cycles (unless
you've had a
hysterectomy)
sometimes it takes an office visit with a Pap/pelvic,
to determine if you're REALLY menopausal...
I find that the phrase/symptoms
are being tossed around rather freely. ;-)
There can be OTHER things that mimic menopause...........
5/5/98
Q.
Once a body part has started to atrophy
because of disease or trauma
can it be physically restored once again to its
NORMAL STATE through
physical therapy and/or other treatments?
A.
Rarely,,,, but a LOT has to do with WHAT
has atrophied (as we call it withered & died).
A muscle in the leg, say after you've been in a cast for
an extended period of time,,, it CAN usually be rejuvenated / rehabilitated.
But once 'fibrosis' (scarring and hardening) sets in ,,,,,,,, :-(
An eye............ :-(
There's a point of no return in EVERY organ/body
part when it comes to being 'restored'.
Want to be more specific?? ;->
Q.
Why is it that it seems that very young men contract testicular
cancer??? Is
it a genetic predisposition?
A.
We think it is..
and the younger
the male,,, the more aggressive the cancer seems to be.
But, if caught early,,,, it can be cured. Usually with
an orchiectomy (removal of the testicle) and chemo.
That's why we say men should do self testicular exams..
(and you thought all the while we were playing pocket
pool) :-)
Q.
Books have been written
about the "G" and "F" spots (in a woman) to
derive sexual pleasure during intercourse.
What is the medical term for
this anatomical region of the vagina/uterus?
A.
Called SCORING... just
kidding.
As far as I
know,, it's the clitoris.
Some are VERY, very sensitive,, while others are as dead as knots on
a tree!
The anatomy of the vagina sometimes is variable.
Some women have smooth, less sensitive mucosa in the vaginal vault, while
others have a corrugated, highly sensitive mucosa. This type of mucosa
is similar to wrinkles that are heaped up in rows, if you look closely.
( like the rows you would see in a garden, or a 8 foot runner(rug)
pushed up to 4 ft. )
Plus,, as you know,,, some like ear lobes, the nape of the neck, and
breast tissue
these can be as
sensitive as the 'C' spot.
It's recommended that you know
YOUR
"G" spot and let your partner KNOW!
All in all,,, it's a very difficult issue to study
and get GOOD scientific numbers!
Q.
Dr. I've been on and off diets
for years. Each one has worked but only while I was on
them! Now, I'm off diets and I'm doing
exactly what you tell your patients "...change
the way you eat and the way you do things!"
It really works. However, the important
twist for me is to work on keeping a "feeling
good focus" rather than a "lose weight
focus." I'm re-learning the things to eat that
make me feel my best and re-learning that
moving around more increases the good feelings.
My weight loss is slow but what a
treat to actually see my clothes getting loose
and to feeling peppier, all while just living
normally NOT on a diet. ...I'm
hooked on feeling good (withhold name please!)
A.
I had to add this one.............
You said it best
"feeling good focus" rather than a "lose
weight
focus."
and
just living
normally NOT on a diet.
We have ENOUGH to worry
about besides thinking DIET, DIET, DIET,
all day long!
4/29/98
How Is High Blood Pressure Treated?
Salt restriction is the VERY first thing. By eliminating table and cooking
salt and salty
foods, can reduce blood pressure by about 5 points in 50% of patients.
Regular exercise and weight loss can each result in a similar
decrease in blood pressure. If these don't work, medication will be
needed,
to reduce the risk of stroke, heart disease, blindness, and kidney
failure.
There are numerous blood pressure medications of different
classes. Each class acts in a different way to lower the pressure.
It is,
rare to be unable to find an effective drug or drug combination
that will bring a patient's blood pressure into the normal range.
Most doctor use approximately 15 - 20 different high blood pressure medications, and tailor them to each individual, to find the BEST control WITHOUT (or with minimal) side effects.
Diuretics, also called "water pills", are commonly used to treat mild
hypertension. Examples of diuretics include hydrochlorothiazide (HYDROCHLORTHIAZIDE),
triamterene, (MAXZIDE), and furosimide (LASIX). Diuretics increase
work by increasing urination and lowering the blood pressure by decreasing
blood volume and by dilating the arteries. Diuretics are frequently combined
with other anti-hypertensive medications to achieve blood pressure control.
Beta blockers decrease the force of heart contraction, thereby reducing
the
pressure that the heart generates in our arteries. These medications
include
atenolol (TENORMIN), propranolol (INDERAL), and others. Common side
effects include depression, fatigue, nightmares, and difficulty obtaining
an erection (impotence).
Calcium Channel Blockers lower blood pressure by decreasing the force
of heart contraction and by relaxing the muscle walls of the arteries.
Examples of calcium channel blockers are verapamil (CALAN), diltiazem
(CARDIZEM), nifedipine (PROCARDIA), and others. Side effects include fatigue,
ankle swelling, flushing, headache, and constipation.
Angiotensin Converting Enzyme, (ACE) inhibitors, are the newest
class of
medication. They prevent the production of a chemical (angiotensin
II),
which is a potent constrictor of blood vessels. As the vessels relax,
blood
pressure decreases. These medications include enalapril (VASOTEC),
captopril (CAPOTEN), and lisinopril (ZESTRIL, PRINIVIL). The
anti-hypertensive effect of ACE inhibitors is increased by the addition
of
diuretics. These medications are especially beneficial to the
kidneys in patients that are diabetic. Side effects are infrequent
with these medications, but at times, they can affect the kidneys and increase
the level of potassium in the blood. These medications require periodic
blood chemistry checks to watch for
these problems. A peculiar side effect of 'some' of the ACE inhibitors,
is a dry cough that disappears when the medication is discontinued.
Additional non drug therapy such as acupuncture, various relaxation
techniques, and bio-feedback, can be effective in certain patients
and are gaining more widespread acceptance.
Treating hypertension significantly reduces the risk of stroke, heart
attack
and kidney failure. The most important approach remains EARLY detection
of this "silent killer," thereby allowing proper treatment BEFORE damage
has occurred.
April 28, 1998
Q.
1. We often hear of cases where
calcium deposits have caused some health
problems. Are calcium deposits the result
of one eating or drinking too
much calcium into their systems? What do
calcium deposits look like???
A.
When talking about Calcium, you also have to talk about Uric
acid (u.a.). And when there's a build up of Ca+, this substance
comes around in abnormal amts. (I'll just refer to it as Ca+ from this
point)
Uric acid and Calcium are minerals that when
combined, it looks like chalk. When
a surface is abnormal, this substance, will STICK, and slowly build up
over time. The kidney is the regulator if Ca+ balance.
If for some reason, the kidney isn't handling Ca+ properly, a state of
excess Ca+ is noted in the blood, and THIS is what tends to build up in
certain area of the body. Usually this is in the small, distal (far)
joints of the body,,, and in some cases, the kidney itself! (and THAT ain't
good!)
The jts affected are usually the big toe, and the fingers,
GOUT!
Most folks, with normal kidney function should have
NO concern re: their Ca+ levels UNLESS you are supplementing with
Ca+ tablets/capsules, in serious amounts!
(now if you want to know the RDA (recommended daily amts), let me know.
Q.
2. Is it true that one can 'catch'
herpes simplex virus (the sexually
transmitted one) from toilet seats?
A.
Yes,,, the HSV(herpes simplex
virus), is a described a group of weepy, tender pimples, that are HIGHLY
contagious,
when in that stage.
Usually when there's an outbreak, first there's
an irritation in the affected area, then a burning/irritating sensation,
soon followed by pimples (we call them papules/pustules) that form, and
THESE contain the active virus.
If the skin comes in contact with this,,,,,
:-(
the virus can live on any common surface for a period of time
(notice I said a period of time because we don't know for sure how
long)
Medically speaking, I would say ~ an hour...(?)
Use those toilet seat covers, or just do as the ladies do, as I hear,,,,,,squat!
Now should we talk about the door handle to the john or
the lock on the door? Not to mention the sink faucet handles,
etc........Hummmmmmmm?
I ran across this on the WEB:
Genital Herpes
SEEK MEDICAL ATTENTION:
If you are pregnant! Genital Herpes can be
transmitted and
infect newborns!
It is important to have your yearly pap test as
there is a possible
link between Genital Herpes and Cervical Cancer.
If you have not yet seen a doctor or are experiencing
many
recurrences. Your doctor may want to prescribe
Acyclovir.
Cotton Underwear
Exposure to air promotes healing of lesions.
Synthetic
underwear does not allow the skin to breathe, and
synthetics
can increase perspiration to the groin area which
leads to
increased itching. Loose fitting cotton underwear
allows air to
circulate and aides in the healing process.
Keep The Area Clean & Dry
Use a mild soap and water to gently clean the affected
area a
couple of times per day. Be sure to pat dry
or use the blow dryer
(see below). Keeping the area clean will prevent
sores from
developing a bacterial infection.
Ointments & Cremes
You should avoid ointments and cremes. Oil
based creams &
ointments do not allow air to reach the sores and
thus prohibits
healing. Cortisone creams can actually cause
the reaction to
worsen.
Use Your Blow Dryer
To dry your skin and provide soothing warmth, try
using your
blow dryer. The warmth of the air is soothing
and the air
promotes healing. Caution: Set dryer on low
and hold far
enough away from skin to keep from burning yourself.
Warm Water
Taking a warm shower or bath can provide soothing
relieve
during a bad attack.
Q.
3. What causes a person to have frequent
bouts of canker sores in the
mouth? (An old wives remedy is to apply
a dash of EAR WAX on the sore
inside the mouth) What is the best prescription
or over-the-counter
treatment for the canker sores? Are these
sores in the herpes simplex
virus family? Why are some people more prone
to be bothered with them
than others?
A.
Apthous Stomatitis
Thought to be caused
by a VIRUS. Not related to HSV (herpes) at all.
Small, ulcerated, painful lesions ranging in size from pin-point to
1/2 inch! Ouch!!
and can come as a single lesion or multiple (I've seen as many as 40+
in a young child)
Usually found on the inner cheek and lips, also on the gums
and tongue.
VERY common in folks that put their hands in their mouth.
.. . . .PHoughy!
There's no definite cure known, but a variety of substances are said
to help. (ear wax,,,? that's a NEW one on me)
More commonly, crushed aspirin tablets, ambisol
(sp)(that stuff used for baby's sore/teething gums). Or Lidocaine solution
(a prescription)
I usually recommend
Frequent rinsing of the mouth
after eating
Using one of the above
Take tylenol/ibuprofen for the
discomfort/pain
See me in a week if it's still
there (haven't had anyone yet come back!)
from 4/18/98
Q.
We are told that there are certain organs of the body,
though they
are there, are not 'missed' when or if they have
to be removed because
of disease, etc.
(such as the gallbladder or the appendix). However, in
the case of the gallbladder, what are some of
the symptoms or illness
that one can get because of the gallbladder not
being there to collect
the excess bile, and in the case of the appendix,
well, it must have
been there for some reason???
A.
The GALLBLADDER is
used to store bile for use in digestion. When fat, and complex proteins
pass through the duodenum, the gallb. is stimulated to 'empty' the bile
into the duodenum. If the gall bladder isn't there,,, then the bile is
secreted directly in the duodenum, more or less as a little more than a
'trickle'.
The food that consists of compl.
proteins/fat must be broken down 'before' it enter the middle small bowel,,,
otherwise,,,,,,BURPpppppp! (and alike).
That's why if your gall bladder is gone,,,,, you
have to be careful when eating foods that are high in fat/protein.
Over time however, the ducts in the lower liver 'learn' how to deliver
bile in amounts very similar to the way the gall bladder did! It
varies from person to person....
You'll find some folks without a gallbladder, can eat a 5 piece
KFC
dinner with NO problem.,,,,while others,,, can try to eat a sliver of cheese,
and BURPpppppp!
Most people without a G.B. 'know' what and what
they can't eat... Just ask them!
Now another ? would
be, "How do you know if your G.B. is acting up?" If you'd like to know,,,
just ask me...
The appendix,,
well, we're not sure WHAT it's for. But we think it had some function thousands
of yrs ago... Perhaps it was used in response to the kind of diet that
we used to have. (you know,,, raw meat, leaves, and perhaps some beetles
here and there!)
All in all most can get by without 'either'..
============================================================
Q.
You know I keeps up with this kind of stuff.
My question to you is:
since they took Redux and Phen-Phen
off of the market, what have you
been prescribing to those morbidly obese patients
that you had that were
on that stuff??? I read somewhere about
a new drug that was accepted by
the FDA - - I think it is called MERIDIAN.
Have you heard about it????
So, what are you prescribing to those patients
that were on the other
stuff?????
"Curious"
A.
Meridia,,,,,,,,,,, From MY reading,,,,,,, it's nothing
new! :-( Just a reformulation of
the same stuff that's out there!
I STILL tell my patients,,, "You
have to change the way you eat and the way you do things!"
BEHAVIOR modification.......
That's the ONLY true treatment/cure for obesity [ Now notice
I didn't say anything about it being EASY!]
When they're doing ALL they can with their eating changes and tolerable
exercises,, and they need something,,,,, I will give either FASTIN
or IONAMIN...
They're taken once a day and cost ~ $35-45/month...
These drugs, as with most appetite suppressants, only work for a few
months, then your body get acclimated to them.
There's STILL a lot of discussion re: fenphen,,,,
new studies say it's not as bad as the studies first said! If you're interested,,,,,
check out the site.. below..
The fenphen HOT line
Q.
"With all the hip surgeries
being performed nowadays -- what is the
reason for this and what usually precipitates
needing hip surgery??? A
fall? arthritis? poor gait????"
A.
In a nut shell,,,,,, PAIN!
To understand the hip joint (jt),,,,, you need to also understand
the concept of a ‘ball and socket’ joint.
The next time you separate the leg from the thigh with a chicken
or a turkey, look at how the bone is connected and ‘feel’ the surfaces
of the leg and thigh bone. (I hear that some folks like to eat the ‘gristle’
around that jt)
Most of the MAJOR ‘weight bearing’
jts, are subject to excessive wear and tear.
Jts like the ankle, knee and hip.
The joint is protected with a ‘thick’ fluid and the bony surface
of the involved surfaces are covered with special tissue called meniscus
and cartilage.
Over time, these surfaces wear. The wear is ‘directly’ related
to the stress/pressure that one places on the jt itself. Some jt
surfaces are better suited for this wear in some folks.
Look at the 75 y/o jogger, and then look at the 40 y/o that just had
a knee/hip replacement!
It’s ALL in the genes…. All in the genes!
Over time,,,, the surface breaks down, and arthritis sets in. (this type of arthritis is called OSTEOARTHRITIS, or degenerative arthritis, or degenerative joint disease (DJD)
We do know that there are some things that you can do to help with the longevity of these major jts. Good nutrition, regular exercise and plenty of H2O. By the way, plenty of H2O is anywhere from 48-64 ounces + per day..
When the jt is Kaput!,, then replacement is need. You usually know when it gets to this point because of P A I N!
As you can gather from the above, weight, poor nutrition, bad ‘genes’,
and of course accidents, can ALL lead to my operating room!
Anything that causes ‘unusual’ wear on the jt. And yes, a bad
gait will put MORE than the usual stresses on a jt. You know,,, like
putting up with a ‘bad’ bunion problem for TOO long.
Unusual wear & tear on one jt will inevitably effect OTHER jts
in the body. Like the old adage, “the ankle bone is connected to
the leg bone, the leg bone is connected to the hip bone, the hip bone is
connected to the back bone”,,,,,,,,,etc.
And how long will a ‘replacement’ jt last??????
Now-a-days, you can expect ~7-15 yrs with a hip/knee.
A few yrs ago when “I” was in school,,,, you could only expect 5-8 yrs, AND you could expect to still have significant discomfort too!
But now in the 90’s, the quality of life (less pain and more mobility)
is MUCH better than in yrs past..
Q.
Dr. every morning all fingers (not my thumb!)below
my knuckle are stiff and they hurt.
After stretching them out a few seconds they
are just fine. I feel like my blood is
settling in my fingers at night due to poor
circulation.
This has been going on now for about
2 months.
I'm active -- 30+ min jogging 5 days
week (since January).
40+ years old.
What do you think???
"Stiff fingers”
-------------- ----------------
------------ ---------- --------- ------ ------------
A.
Sounds like a few
things that ‘could’ be in action here:
-- an inadequate amount of water in your system
-- overuse of your hands (are you USING your hands in a ‘different’ way
then
usual?)
-- early arthritis?
I’d recommend extra H2O, and give that at least 3-4 wks to make a difference.
Also try soaking the hands in warm water
for ~ 5", FIRST THING in the AM to see if THAT helps, if it does, then
its most likely a ‘USE’ problem.
But if neither the H2O or the soaks help,,, then a doctor visit would
be recommended..
4/11/98
Here's an article that I thought was interesting.......
Is it possible for a woman whose
uterus and ovaries
have been removed to
lead a normal sexual life?
Yes, for many women it is possible, but unfortunately
there is no guarantee.
Let's first consider the uterus. Removal of the uterus is
done either through an incision in the lower abdominal
wall or through the vagina. When the entire uterus is
removed it is called a total hysterectomy, in contrast to a
partial hysterectomy which involves removal of the body
of the uterus leaving the cervix intact.
(when the ovaries are removed, usually along with the tubes, its called
a Total hyster. with a bilateral salpingo-oopherectomy, yeah,,,, a mouth
full! We in the business just say a TAH with a BSO.
People today are familiar with mind/body interactions as
it pertains to their health. But this is not a new notion.
The uterus and the psyche are historically intertwined,
though few today would grant it any credence. In ancient
times hysteria was regarded as a disease of women due
to a disturbance in the uterus. An hysteric is one who is
overly dramatic, susceptible to suggestion, who has
shallow but volatile emotions. Over-excitability, tremors,
even fainting may occur. Removal of the uterus via
hysterectomy honors this ancient misconception through
its word origin.
Most often there are no serious consequences of a
hysterectomy. After the surgery, most of the vagina is
left intact, forming a blind pouch. With many women this
allows for normal sexual relations and penile penetration.
There might be some discomfort with deep penetration
because the vagina is foreshortened, so greater restraint
may be needed. The capacity to have an orgasm, to
become aroused, and to fully enjoy sex is not invariably
maintained, however, and some women report profound
changes in their sex life after hysterectomy, and are
bitterly disappointed. There may be a psychological
adjustment needed after a hysterectomy as well. After
all, it marks the end of reproductive life. Even for women
who have had all the children they want, it marks the
passing of an era. Some women will grieve, and yet
others don't seem to care in the least. An incidental
benefit of a total hysterectomy is that there is no longer
any need to be concerned about cancers of the uterus,
endometrium, or cervix; and many women are thrilled to
learn that Pap smears are no longer required.
The removal of the ovaries and fallopian tubes is often
done during hysterectomy, though in premenopausal
women every effort is made today to leave the ovaries
intact in order to provide the normal hormonal milieu for
as long as possible. Emotional changes, irritability, and
moodiness may occur in a premenopausal woman after
removal of the ovaries because she has gone through a
surgically-induced menopause. Hormone supplements
including estrogen, progesterone, and sometimes
testosterone, may be used to help alleviate these
symptoms, and the results are often very good. But there
is a great deal of variability and for some women it may
be hard to get the mix right.
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