Health information

QUESTION: I know that headaches are common and frequent complaints that
doctors must hear many times a day
However I know that there are times when
the diagnosis is more serious
How do doctors tell one type from the other?
I think that this information would be helpful for anyone to know.

ANSWER: This is a very good question, and I agree that such information could
be helpful to many people
Here are a few clues
If the patient complaining
of the headache looks sick, I think they deserve a careful examination for
other signs that may lead to a diagnosis
By the same reasoning any other
abnormal signs, changes in their walk, muscle strength size of their pupils,
or other neurological signs may mean the headache is not a simple one
If the
patient also appears drowsy or confused, the headache may be a sign of serious
infection, particularly those that take place within the skull
The same is
true of headaches associated with a fever, which while they may be but the
sign of an oncoming common viral infection, can also be the signs of a serious
infection such as meningitis
This may also cause the neck to become stiff,
so I always check to be sure the patient can lower their chin to their chest
and conduct other tests to be sure the neck is perfectly supple
Some
headaches are provoked by blood leaking in to the brain from aneurysms (a
ballooning out of the artery due to weakness in the wall of the vessel) and
these must be treated as promptly as possible
One sign is when a headache
has started during exercise or exertion
Such patient must be carefully
examined
Another headache that must be taken seriously is the “first”
headache in an adult patient
When this occurs, it too may be the sign of a
leaking aneurysm
Remember, however, most headaches are benign, and pass
over with rest and analgesics, and don’t require intensive care.

The material contained here is “FOR INFORMATION ONLY” and should not replace
the counsel and advice of your personal physician
Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

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QUESTION: Is it all right for my mother’s doctor to discharge her from the
hospital while she is still in need of medications, and continue to prescribe
an I.V
antibiotic medication for her at home? He has assured us that this is
done frequently today, and will provide all the care my mother needs at home.
What is your opinion?

ANSWER: With the development of new and very effective and safe antibiotics
that can be administered by a parenteral route (through an intravenous tube),
the idea of discharging patients from the hospital to continue their
medications as outpatients (outpatient intravenous therapy or OIT) has begun
to catch on
There are some restrictions of course, and this method of
therapy can never be used for patients with life threatening infections.
However, when the infecting bacteria has been identified and the proper
medication selected, and when there is evidence that the antibiotic is working
well, transferring the patient to their own home surroundings can be
considered
It requires that both patient and family thoroughly understand
the requirements for this procedure, and that the family is able to assist and
support the patient
A refrigerator to store the medications must be
available, as well as a telephone to assure communications in the event of an
emergency
Nursing care and home health services can be provided, but there
is a catch to this scheme
While it is most certainly less expensive to care
for a patient at home than in the hospital, many insurance plans (including
Medicare) do not pay for self administered drugs
You would be well advised
to check your insurance coverage and assess your financial obligations before
considering this method of treatment, even if the scientific aspects and
medical outcomes all do make sense.

The material contained here is “FOR INFORMATION ONLY” and should not replace
the counsel and advice of your personal physician
Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

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QUESTION: My husband, who has had severe lung disease for many years,
requires oxygen on a more or less continuous basis
Do you know if such
service is covered by insurance? Our doctor has prescribed it for my husband,
but we have limited income and are worried about the cost.

ANSWER: The use of oxygen for patients in their homes can make life a bit
easier for those who suffer from chronic lung disease, or who have heart
troubles that lower the amounts of oxygen in the blood
Not all insurances
are the same, but in most cases it is a treatment that is covered when certain
laboratory tests prove that it is essential to the patient’s well being.
These blood tests measure the amount of oxygen carried by the blood and
compare it with the amount that is can normally be found by such tests
We
all do well on the oxygen in the air, even though it only represents about 20%
of the air we breathe, but in individual with impaired lung or heart function,
the extra concentration found in containers containing pure oxygen can provide
them with the amounts they need
Several research trials have shown that not
only is there an improvement in their ability to get about, but their mental
and psychological functions improve as well
More important yet, they have a
greater life expectancy
Your doctor can help you by providing your insurance
companies with the laboratory data they require, for I am sure such tests were
used to help make the diagnosis that led to the prescription for home oxygen
therapy your doctor has ordered.

The material contained here is “FOR INFORMATION ONLY” and should not replace
the counsel and advice of your personal physician
Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

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QUESTION: I am a 27 year old female in good health
However a recent EKG
turned up a “bundle branch blockage”
The doctor says it is an interruption
in the heart’s electromagnetic field
What else can you tell me about it?

ANSWER: Your question is a difficult to answer in easy to understand language
and I think your physician gave it a good try
Like mud, it’s not too clear
but it covers the ground
The heart muscles contract in response to
electrical impulses which follow specific pathways in the heart itself
The
impulse is first generated in a special tissue area of the heart known as the
sinus node
From there it spreads out through the muscle cells of the atria
(the upper two of the heart’s four chambers)
That causes the atria to beat a
fraction of a second before the ventricles do
The ventricles are the larger
and lower two of the heart’s chambers, the right ventricle pushing the blood
through the lungs, and the left ventricle has the biggest job of all, pushing
blood through the aorta to the entire body
When the nerve impulses have
crossed the atria, they meet at another special area at the junction of the
atria and ventricles
This tissue, not surprisingly, is called the
atrioventricular node
It captures the impulses from the atria, delays them
slightly to allow all the blood to pass from the contracting atria into the
ventricles, and then passes the electrical impulse on
Normally there are two
special tracts (or branches) to carry the impulse throughout the ventricles, a
left bundle branch and a right bundle branch
They carry the impulse to the
ventricles which then contract together, completing the cycle of one heart
beat
Now we come to your problem
One of these branches, although you did
not specify I suspect it is the right one, is not carrying the impulses as it
should, or “blocking” them
Thus the name “bundle branch block”
The reason
I think that it is your right branch that is affected is because this can
occur in people with no other signs of heart problems, and because you mention
no treatment for your problem
When this block occurs, an EKG which charts
the impulses can reveal the blockage by providing a typical tracing that your
physician has used to make the diagnosis
The bottom line; I doubt that you
have any cause for concern, but now that you understand about bundle branch
blocks, check back with your doctor.

The material contained here is “FOR INFORMATION ONLY” and should not replace
the counsel and advice of your personal physician
Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

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QUESTION: Can you explain the origins of a “large heart”
After several
tests, my physician has diagnosed this as the cause of my shortness of breath,
and he kept using the term to tell me why I must remain on my medications and
take them faithfully
I have had high blood pressure for years
Could that
have been the cause?

ANSWER: It appears as though your physician has been carefully following a
philosophy of patient education to help make you aware of your condition and
the reasons for taking your medication
A large heart might be medically
known as “cardiac hypertrophy”, where the muscle cells in the heart have grown
larger as a response to the need to pump harder to meet the requirements of
your body
Just as an athlete’s muscles grow larger with exercise, heart
muscle reacts in the same manner
Your long standing high blood pressure is
most certainly connected to your heart situation, as the force needed to push
the blood through your arteries at higher than normal pressures caused the
heart muscle cells to grow larger (hypertrophy)
It is probable that the
chamber of the heart responsible for pumping blood to the body (the left
ventricle) is most affected and that you may come across the term “Left
Ventricular Hypertrophy” or LVH when your doctors discuss your case with you.
Of the many tests you spoke of, the echocardiogram, which uses sound waves to
create images of the heart, was the most helpful in establishing your
diagnosis, as an ordinary cardiogram (EKG) may sometimes miss this finding.
This is not a diagnosis to take lightly, as it may affect your longevity and
the quality of your life style
There are many medications that may be used
to treat LVH, and they are effective and safe
Your physician will be trying
to get you to lose weight, and will be paying close attention to your blood
pressure
Your shortness of breath may disappear completely and your ability
to get about without difficulty greatly increased
You must report any
episodes of chest pain, dizziness or irregular heart beats to your physician
at once, so that the therapy you are on may be changed to deal with any
situation
This is a time for great cooperation between patient and physician
and the results can be truly rewarding, if you both play your parts to the
fullest.

The material contained here is “FOR INFORMATION ONLY” and should not replace
the counsel and advice of your personal physician
Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

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QUESTION: I suffer from occasional bouts of indigestion
I can’t figure out
if it is a special food that bothers me
However when I do mention this to my
doctor, he just shrugs and tells me not to worry
Aren’t there some special
tests I should have to help figure this thing out?

ANSWER: You call it indigestion, and I call it dyspepsia, but I think we are
speaking of the same thing
You must realize that you are not alone, since
about a third of the population suffers from similar problems
It has been
estimated that as many as 2 million office visits to physicians will be for
consultations about dyspepsia
Even amongst those who are completely
evaluated, no specific cause can be found in many cases
I suppose we could
really break the bank if every patient with indigestion was put through an
expensive medical work up
The American College of Physicians, Health and
Public Policy Committee has suggested an approach to this problem that advises
medical treatment for 6 to 8 weeks, when there is no obvious disease or
complications present
Antacids or medications to stop the flow of stomach
acid may be prescribed, depending upon the nature of the symptoms and the
result of a physical examination
If there is no response and symptoms
continue, then the patient should be tested using a endoscope, a flexible
telescope like instrument which permits the doctor to see the insides of
stomach and intestine
Of course if a patient is more likely to have serious
disease, because symptoms are severe and recurrent, there is weight loss or
signs of intestinal bleeding, an abdominal mass on physical examination,
regular use of aspirin or other medications that irritate the stomach, or
there is a past history of ulcer disease, the test should be performed
promptly
Since your case sounds less serious your physician is trying to be
both reassuring and keep your costs down
Show him this column the next time
you visit, and perhaps he will use the method I have outlined.

The material contained here is “FOR INFORMATION ONLY” and should not replace
the counsel and advice of your personal physician
Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

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QUESTION: I am having a problem with the nail on my left big toe that keeps
cutting into the flesh, causing me much pain
Now I notice that the same
thing is starting on the right side
Is this a sign of any medical condition
that you know of and what should I do to take care of it?

ANSWER: You are describing a condition known as an ingrown toenail, which
occurs when the side edges of a growing toenail grow into the flesh of the toe
and can create a painful problem that can progress into an inflammation or
even an infection with abscess formation
Assuming that you have no
particular deformity of either toe, the problem is probably caused by cutting
the nail incorrectly
The nails should always be trimmed straight across
rather than rounding them to fit the shape of the toe
This allows a natural
growth pattern that allows the nail edges to grow over the surrounding tissue
and prevents them from digging into the flesh
You may be able to correct the
situation by trimming away the portion of the nail that is cutting into the
skin, and by soaking the foot in warm water
It may require that you wedge a
small ball of cotton or gauze under the edge of the nail to help push back the
flesh until the nail grows over the area
If these simple measure do not
remedy the situation for you, a visit to your physician is necessary, as the
nail must then be cut back to relieve the pressure and the pain
Any
infection will also need an antibiotic to treat your problem.

The material contained here is “FOR INFORMATION ONLY” and should not replace
the counsel and advice of your personal physician
Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

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QUESTION: I am annoyed by a constantly itchy skin, that sometimes drives me
to distraction
I am a clean person, and am sure there are no critters
causing my problem, but there must be some advice you can offer me to reduce
my torment, and make life livable.

ANSWER: I am sure you are a meticulous person, but since there are many
causes to a persistent itch, it still may be worth while for you to have a
check up to try to determine some physical cause
Doctors label an itch like
this with the term “pruritus”, and know it may be caused not only by
“critters” but by allergies, parasites and both skin and internal diseases,
but a dry skin is the most common reason
However, there are a few tips I can
offer you that can help reduce the problem, no matter the cause
If dry skin
is the main problem, maintaining a healthy level of moisture in your home will
help, particularly if you live in warm, dry climates, or in a heated apartment
in winter
A humidifier will be of great comfort
Reduce your bathing
habits, as frequent showering with harsh soap can aggravate the condition, as
can the use of water that is too hot
A lukewarm shower, followed by the
application of a moisturizing body lotion is indicated
Stay away from tight
fitting clothes and cotton fabrics may be kinder to your skin than wool or
synthetics
Dry your skin with pats of your towel, instead of vigorous
rubbing
Although it may seem impossible to fight the urge to scratch,
realize that you can injure your already delicate skin if you do scratch hard
with jagged or roughened fingernails
Last, but sometimes the most effective
measure, is to change your laundry detergent to a mild soap, that is less
likely to cause irritation, and to assure that all laundered clothes are well
rinsed
These are all effective actions you may try for yourself, but a
physician’s diagnosis and available medical treatments may result in
completely ridding yourself of this raging itch.

The material contained here is “FOR INFORMATION ONLY” and should not replace
the counsel and advice of your personal physician
Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

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QUESTION: I took a real bang on my knee in a game of touch football
Lucky
for me our local volunteer ambulance guys were there, and the EMT told me he
would use a little “RICE” on my injury
Everyone laughed, but I didn’t get
the joke, then or now
Do you know what they were chuckling about?

ANSWER: It is pretty hard to remember all the elements in treating many
injuries and diseases, and those of us who have to keep these matters fresh in
our minds resort to the use of “mnemonic” devices
These are words or
phrases that use letters as clues to help our memories recall important
information that can be used in a variety of situations
I would suppose your
injury was not too acute, permitting a bit of levity, but “RICE” refers to the
steps in the early treatment of an injured joint
They are Rest, Ice,
Compression and Elevation
This would apply to your situation, placing your
knee at rest, application of a cold or ice pack, applying an elastic bandage
and keeping the leg elevated
Another mnemonic useful in these situations is
PRICEM-M which stands for Protection from stress, Ice, Compression, Elevation,
plus Medical treatment, including pain and anti-inflammatory medications, and
Modalities, the use of electric stimulation or other techniques to help
restore function
In these cases “rest” means the avoidance of any overuse or
abuse of the joint, while normal activities of daily living are encouraged.
RICE is fine for the acute stage, but rehabilitation techniques are used to
promote rapid healing and restoration of function.

The material contained here is “FOR INFORMATION ONLY” and should not replace
the counsel and advice of your personal physician
Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

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QUESTION: Is it possible for something to block the flow of urine and cause
it to back up in the system? Could you explain these causes and if they are
at all serious?

ANSWER
The causes of “urinary tract obstruction” are many, and the resulting
back up of urine is indeed serious and may cause permanent damage to the
kidneys
Urine is produced by the kidney, which then flows down a tube like
structure called the ureter, to the bladder
Here the urine is stored
temporarily, until its capacity is reached and you feel the need to empty your
bladder through another tube, the urethra, which leads to the outside
Many
of the obstructions to this normal flow of urine are mechanical, the most
common in men being an enlarged prostate gland which compresses the urethra,
making urination a more difficult process
Tumors are another frequent cause,
either those which grow within the urinary system, or push upon the structures
from the outside
Kidney stones, formed in the kidney, can become “stuck” in
the ureter as they are pushed towards the bladder causing the flow of urine to
stop
Any stoppage in the urinary flow causes increased “backup” pressure to
be exerted on the delicate kidney tissues, and can impair their function
The
solution is to discover the cause of the obstruction as rapidly as possible
and relieve the blockage, to once again allow the kidneys to perform their
essential function.

The material contained here is “FOR INFORMATION ONLY” and should not replace
the counsel and advice of your personal physician
Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

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