Health information

QUESTION: My husband has an annoying problem, especially for me
After we
are asleep in bed at night, he will suddenly give a jerk that practically
throws him in the air and, of course, wakes me up
He tells me that he is not
doing this on purpose, but I don’t know why this should happen at all
Do you
have any explanations for these disturbing movements?

ANSWER: This type of jerking activity of the muscles of the body is quite
common
It occurs when there is simultaneous contraction of all the muscles
in the body, causing your husband to jump and wake up
Physicians used to
believe that this was provoked by a primitive reflex that has remained with us
from the days of our ancient, tree dwelling ancestors
The theory believes
that the reflex prevented an individual from falling out of the trees once he
had gone to sleep
More recent, and perhaps more scientifically acceptable,
explanations stem from newly gained knowledge about sleep
It is now known
that we pass through different stages of sleep during our rest
There are
four such stages
The first is the lightest, with each successive stage being
a deeper sleep
Sometimes as our body goes from stage three to stage four
sleep there is a sudden surge of electrical activity from our brain which
stimulates all the muscles and makes them contract sharply
This will them
cause the jerking sensation that your husband experiences
Not everyone has
this experience and, of course, it probably isn’t occurring each night, for
which I am sure you are thankful
The most important thing to remember is
that this is not an abnormal situation, and despite its sleep breaking effect
is truly nothing to be concerned about.

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 hypertension
I take note that my physician always
looks into my eyes with his instruments, and tells me he can actually tell the
condition of my arteries
Can you tell me what he is seeing? I am most
curious.

ANSWER: The eye is truly the window of the body
It is the only place
through which the physician can examine the condition of the blood vessels
without actually cutting through the surface of the skin
He can note signs
of hypertension when he sees changes in the size and shape of the blood
vessels at the back of your eyes
Most patients with hypertension don’t
develop significant visual problems, but the eye signs may be helpful in
managing brain and heart complications that may happen
It is often possible
to determine the severity and duration of the hypertension by examining the
eye
Narrow, constricted, thickened vessels, leakage of fluid, hemorrhage
and retinal degeneration can occur at various stages of hypertension
Double
vision, spots in your vision and blurring of vision may be the first sign that
your blood pressure is too high.
Hypertension can also cause damage to the tiny blood vessels
(capillaries) within the retina
The retina, the thin nerve tissue lining the
inside of the back of the eye, receives light images and transmits them to the
brain, creating vision
The first response of the little retinal arteries to
hypertension is narrowing
If high blood pressure quickly returns to normal,
the retinal vessels return to their normal state
Uncontrolled, severe and
long-standing high blood pressure can cause retinal damage and vision loss.
When the tiny retinal blood vessels become hardened from years of
hypertension, the retina cannot get adequate oxygen or nutrition
These
damaged blood vessels can rupture, causing hemorrhage into the eye
A sudden
appearance of spots or streaks in your vision is caused by blood leaking from
the retinal vessels
In addition to blood vessels hardening and narrowing,
vessel walls become thicker after many years, hindering the smooth flow of
blood to the retina and pressing on veins that cross them, thus blocking
normal blood return
Blurring of vision may occur from blockage in either a
retinal artery or vein
Your physician is practicing good medicine with his
regular eye checks.

Resources:

Glasspool, M
Eyes: Their Problems and Treatments
NY: Arco, 1984,
p
98-100.

Michelson, P
Insight into Eyesight: The Patient’s Guide to Visual
Disorders
Chicago, Nelson-Hall, 1980:173,176.

Madias, NE
What You Can Do About High Blood Pressure
Wellesley, MA:
Arandel, 1978:27.

Walsh, JB
The ocular fundus mirrors its severity
Consultant 29:92-104,
1989.

Becker, RA
Hypertension and arteriosclerosis, in: Duane
Clinical
Ophthalmology 1989, (3) 13:1-21.

Hedges, TR
Consultation in Ophthalmology
Phila, PA: BC Decker,
1987:183.

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: Summer is back, and I dread the attacks of every flying thing in my
neighborhood
How can I enjoy this fine weather if I have to fear the
consequences of being very allergic to those dreadful stings? Please offer me
some help and advice.

ANSWER: If you are very sensitive to insect bites, you must learn to take all
the precautions which will help you avoid unnecessary bites and stings
When
the warm weather roles around, begin to think prevention and do those smart
things that will reduce the likelihood of getting bitten
There are measures
you can take to avoid many insect bites, that form a good first line of
defense.

Use screens on all windows and doors.
Limit insect attracting plants and vines in and around the house.
Garbage cans should can be sprayed regularly with insecticide.
When you perform your gardening, wear gloves.
Don’t wear perfumes or colognes, and stay away from brightly colored
clothing as these attract insects in much the same fashion as flowers do.

If you are severely allergic, speak to your doctor about a
desensitization program, that can help make those inevitable bites easier to
endure.

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 have been a diabetic for many years and am used to giving myself
my insulin injections
I have been on the same dose for several years now,
without the need to change my routine
Recently I read that altering the
manner in which I inject the insulin, such as changing the location of the
injection, can change the way the insulin works in my body
Is that true, and
how can that change the potency of the insulin?

ANSWER: The effect of the insulin injection can be dependent upon a number of
factors that concern how and where you inject your dose, but it isn’t the
potency of the insulin that changes, it’s the speed of the absorption into the
blood stream that can be different
For example, insulin gets into the blood
stream fastest when it is injected into the abdomen, with the upper arm next,
and then thigh and buttock in descending order
The rate of absorption can be
changed if you massage the site of the injection, and speeds up with exercise
as well as your body temperature
Of prime importance is the depth at which
the insulin is delivered, and varying the angle of the needle as it enters the
skin can alter the depth of the injection even when the needle length is
always the same
If you change your injection device from your current
syringe, you may also change the speed of absorption
I am sure you are aware
that injection sites should be rotated to prevent causing changes in the skin
which may result from repeated insulin injections
In some cases the skin may
become scarred, with the tissue turning fibrous and the number and caliber of
the blood vessels diminishing
This causes the area to become less sensitive,
in effect it is anesthetized and therefore a temptation to use over and over
again
However because of the tissue changes, the insulin is absorbed in an
irregular fashion
Although it doesn’t affect your absorption rate, the
timing of your dosage is also important if the insulin is to arrive in your
blood stream when it is needed, at the time of eating for example
Changing
your schedule of injections or your time of eating so that the relationship
between the two is altered may also modify the effect of insulin upon the
system, which is reflected in your blood sugar levels.

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 have seen the term “interval training”, most recently on a
television commercial, but I can’t figure out what it means
It must have
something to do with aerobic exercise, but I would like more information than
that
Can you please explain this term for me?

ANSWER: While this type of training scheme may be applied to aerobic
exercises, it is also used by many athletes to increase their ability to
achieve greater abilities for competition
Interval training requires that
you alternate periods of work, or high intensity effort, with periods of
relief, where the pace of activity is reduced
This pushes your endurance to
higher levels as it increases the amount of energy that can be developed
before your muscles run out of available oxygen
Since both the pace and
effort is increased for periods during any workout, this method is also called
“speed work”
While interval training has many advantages it can also lead to
overtraining, and may lead to more than the usual number of injuries.
However, when your goals are clear and you have good counseling available
about your training or exercise program, this method may be of great help in
achieving your objectives.

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 read your column each day and today it was about angina
A
mention of myocardial infarction or heart attack was included
Is this the
same as myocardial ischemic disease? If not, what is ischemia? Thank you in
advance for your answer.

ANSWER: It is not difficult to get lost in the maze of terms we doctors use
about disease, and though I should know better, I guess I wasn’t as clear
about these conditions as I want to be
So let’s go back and do it again, and
hopefully get it right this time
Ischemia (from the Greek word “ischein” to
suppress, and “haima” blood) literally means a deficiency of blood supply to
the heart, usually from an obstruction or constriction in the arteries that
supply blood to the heart
Because it is this blood supply that supplies the
oxygen that heart cells need to live, ischemia is also used to describe
situations in which there is an insufficient supply of oxygen to tissues.
When the coronary arteries are the affected vessels, it may be called
“coronary artery disease” as well
When a sudden blockage of these arteries
occurs, perhaps due to the formation of a clot inside the artery, the heart
muscles are suddenly deprived of their needed oxygen supplies and a “heart
attack” occurs, with all the well known symptoms of acute chest pain and
shock
If the situation cannot be speedily reversed (and it can in some
incidences, due to new medications and techniques), the muscle tissue dies.
And that’s when the word “infarct” is used for it means “an area of tissue
death due to local ischemia resulting from the obstruction of circulation to
the area”
Add the word “myocardial” to the term (”myo” for muscle, “cardio”
for heart), and the diagnosis is complete
In the case of angina, the
circulation blockage may not be complete, and the partial reduction of blood
flow to the heart is enough to cause heart muscles to suffer an oxygen lack
without dying
The pain that this condition causes may make the patient stop
all other activity, reducing the strain on the heart, and giving it a moment
or two to catch up on its oxygen requirements.

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 have increasing difficulty in walking any distances at all
because of the pain that develops in my leg
Although I have been taking
special medication my doctor prescribed for me, things have not improved and
he now is suggesting surgery to help
Can you tell me anything about using a
balloon to open my arteries, instead of replacing my damaged arteries?

ANSWER: There is increasing interest in medical circles about using the
technique you refer to (balloon angioplasty) as a method to deal with the
problems caused by atherosclerosis of the arteries in your leg
When
atherosclerosis (a common form of arteriosclerosis or “hardening of the
arteries”, in which deposits or plaques containing cholesterol form on the
insides of the arteries and reduce or block circulation) strikes the arteries
of the leg, the blood flow to the muscles is reduced, and the amount of oxygen
available for the metabolism of these muscles is just not enough to meet with
their demand when they are active
The suffering muscles let you know,
because they become quite painful after just a little exertion
The condition
is known as “claudication”, which really means limping or lameness
After a
few minutes of rest, which gives time for the muscles to catch up on their
oxygen requirements, the pain subsides
When medications fail, the treatment,
which is still considered to be the standard method, is to replace the blocked
arteries with new grafts or replacements, or surgically remove the blocks.
Balloon angioplasty, originally developed for use on the coronary (heart)
arteries, is now being considered as an alternative treatment for situations
such as yours
A catheter or tube with a balloon at its tip is inserted into
the diseased artery, and the tip is positioned in the area where the plaques
are obstructing the blood flow
Then the balloon is inflated, pushing the
plaques backward and reforming the space inside of the artery
The success
rate may be as high as 80 percent
The advantages of balloon angioplasty over
other surgical techniques are that it is less costly, keeps you in the
hospital for a much shorter stay, does not require general anesthesia, and has
fewer complications.

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: When my father died, my mother went all to pieces
After 55 years
of being together we thought her depression was understandable, but now the
doctor who takes care of all the people at her home wants to put her on
lithium as a treatment for depression
Isn’t that kind of strong medicine for
a natural reaction? With all the stories about too much medicine for older
people, we thought your advice would be most helpful.

ANSWER: Your obvious concern and anxiety, plus the circumstances as you
describe them, make a “second opinion” from another physician a wise and
appropriate course of action
This very potent drug can be useful in treating
depression in the elderly, but it should be used only for psychiatric
conditions that cause depression
You are right when you say your mother’s
reaction is understandable after the loss of her husband of many years, and is
probably normal, as depression is often a big part of grieving
The elderly
often become depressed because of loneliness, a reaction to loss, or a
negative reaction to medications.
There are, however, other types of antidepressants besides lithium that
can be used effectively at these times.
If your mother is indeed found to be suffering from a manic-depressive
illness, then lithium can be helpful, as it is being used successfully in some
elderly patients
She should get regular checkups and have follow-up lab work
done frequently for the lithium to be used safely.
Lithium should not be given to patients with severe kidney or
cardiovascular disease, or be taken with diuretics, as the drug could become
toxic under these circumstances
You can see that, when obtaining another
opinion, it is most important that you present all the history about your
mother, including a list of medications she may be taking presently
And it
is most important in situations such as this that you continue to monitor the
progress of your mother
Your frequent visits may be more therapeutic than
the medications, and you can personally verify her mental state more
accurately.

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 brother looks terrible; he is very thin and refuses to eat a
thing
And just a few years ago he was overweight
His doctor told my
parents that he is suffering from anorexia, but I always thought that was a
disease of women
Is it possible for a young man to have this disease?

ANSWER: Absolutely
Although it is a fact that most cases of anorexia
nervosa are seen in women, about 5 percent to 10 percent of the time it is a
man with the disorder
And the numbers are growing by leaps and bounds with
the number of cases reported in the general population almost doubling over
the last 20 years
The first notation of male anorexia was published by Dr.
R
Morton in England back in 1689, and many other articles describing the
condition in males have been published since then
Your brother’s case is
typical, as in many cases anorexia is seen in young men who were overweight
teenagers
Although they begin by dieting normally, this changes into the
type of behavior that results in serious weight losses
They believe that
their body weight is not correct for their appearance, and that they are not
too thin
This differs a bit from women who try for excessive thinness, and
diet to attain that state
Some experts believe that the reason for anorexic
behavior in males represents an attempt to establish their own sense of
identity
Men are affected less frequently than women, probably due to the
fact that there is less social pressure on them to be slim
The normal
adolescent male is more concerned with muscle mass and a well formed body than
just being slim
However, this condition should be treated seriously, for it
may have dramatic effects upon the heart and hormone systems, as well as the
kidney and blood
And males are more difficult to treat than women
Therapy
may include nursing care and nutritious diets, tube feeding if necessary,
behavior modification, psychotherapy and the use of medications
In some
cases the use of antidepressants has met with success, including tricyclics
and more recently fluoxetine
The course of therapy may be long, but
certainly hope for a good outcome is both reasonable and rational.

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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Would a MedicAlert Bracelet be a Good Thing?

QUESTION You recently mentioned a MedicAlert bracelet in your column
I have
both an allergy to penicillin and diabetes
Would this be a good thing for me
to have? Can you please tell me where to get more information?

ANSWER: I am happy to provide this for you and the many others who also wrote
requesting the information
Nothing is simpler, for they have a call free
number to make things easy for you
It is 1-800-ID-ALERT
But a MedicAlert
identification is more than just a bracelet with a notation of your condition.
It provides a 24 hour-a-day worldwide hot line which can provide important
information about you to those who may have to administer emergency treatment
when you are incapable of communicating
The emblems are individually
engraved to meet your special needs, and can contain multiple conditions
And
you can update your personal information as your condition and the medications
you are taking change
Many pharmacies are now cooperating in an effort to
distribute information about the service
The Medic Alert Foundation
International is a nonprofit organization.

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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