Health information

QUESTION: I am 26 years of age, married for about 6 years, and wish very much
to have a baby
We have been seeing a doctor for some time now, who has been
very helpful and reassuring
He has been hinting lately that my problem is
not being helped by the 35 pounds or so that I am overweight, and has become
stricter about my diet program
Is there any truth to his opinion, or is this
inspired by general attitude on fitness?

ANSWER: Fitness and normal weight are important factors in just about every
health problem I deal with, and I might be supportive of your physician’s
perspective on this basis alone; but there is now more evidence to consider.
Infertility is not a simple condition, and their are many factors and causes,
both on the father’s side as well as the mother’s
Abnormal ovulation may be
one of those causes, and new research sponsored by the National Institute of
Child Health and Human Development and conducted at the University of
Washington in Seattle would seem to point to excessive overweight or
underweight as a factor in this condition
Weight disorders are generally
accepted as contributing to menstrual disorders, but researchers now estimate
that among women who have never had a child, weighing too much accounts for 6
per cent of infertility related to ovulation problems, and the same number of
cases in women who weigh too little
It would appear that your physician’s
opinion is based upon more than instinct or attitude and has a sound
scientific basis.

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 went to my eye doctor for a new glasses prescription, but after
the examination of only my eyes came away with a diagnosis of high cholesterol
in my blood
When I had my blood test done, it turned out that the eye doctor
was right
He jokingly tells me it is the “magic of medicine,” but there must
have been some clues
Do you know what they might have been? Trying to
figure this out is more trouble than my new diet.

ANSWER: I am half inclined not to answer the question, and preserve a bit of
that mystery that has at least inspired you to a new healthful diet
I can
think of three possible clues that could have been observed during an eye
exam
The presence of small, flat, yellowish growths on your eyelids called
“xanthelasma” could have been the most noticeable
They contain fatty
material and are often associated with high cholesterol
A light colored ring
or part of a ring circling the cornea, called an “arcus senilis,” is another
sign
Last, the appearance of the back of your eye or fundus could have
offered another indication of your cholesterol 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 have difficulty swallowing, and have a condition in my throat
diagnosed as Zenker’s Pouch
Must have had it for 4 years or more and had a
thyroidectomy years ago
I’ve tried to get info on this condition, but all is
unclear and vague
The doctors have suggested surgery and I hate to think of
it
Please write something for me.

ANSWER: Your condition is classified as one of several outpouchings or
“diverticula” that may be found in the esophagus, the long tube that carries
food from the mouth to the stomach
A Zenker’s Diverticulum pushes backward
through the cricopharyngeal muscle, which is located near the thyroid
cartilage
The pouch probably results from a lack of coordination between the
muscles helping to push the food down the esophagus and the loosening of the
cricopharyngeal muscle
This creates the pressure which causes the muscles
which form the wall of the esophagus to push outward and form the pouch.
Sometimes this pouch can fill with bits of the food that is swallowed, and may
be regurgitated when you bend forward or lie down
If this occurs at night
while you are sleeping, the food particles may pass down the breathing tubes
and cause a pneumonia to develop
This type of diverticulum is best diagnosed
by a barium swallow as the barium, which is easily seen on x-rays, flows into
the pouch and makes it simple for the physician to diagnose
Although in many
cases no treatment is required, when the problems and difficulties are too
much to manage surgery can be performed which removes the pouch and restores
the esophagus to normal
If this description is still difficult to
understand, take it to your physician who can add a simple diagram that will
make it all much simpler.

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: Please don’t think that this is just a crank question, for I can
assure you there are a number of people here who feel that your answer will be
most important to us and your many other readers
We wish to know if there is
any scientific evidence that shows that athletic ability is reduced in someone
who has had sexual activity on the night before the game? Is there any
possibility it could be helpful?

ANSWER: Assuming a strictly scientific interest in this subject, I must tell
you that though the topic has been approached from many different
perspectives, there is little in real scientific evidence to prove either side
of the question
You can probably imagine some of the problems encountered in
such a study, and one important factor seems to be the lack of funds available
to support a full study this problem
Although the advice to abstain has been
a stock in trade of many coaches for many years, the origins of this advice
are certainly unclear
One interpretation is that it stems from the vision of
the athlete as a type of hero, unblemished in both body and mind, who gains
victory as a proof of his purity or worthiness
But there is little factual
evidence that points to the activity as using up reserves of physical energy.
In fact some studies on sexual activity in patients after heart attacks would
indicate that these energy levels are really quite low
There are many
anecdotal accounts (that means they are merely stories rather than actual
scientific investigations) which attribute a relaxing benefit to an athlete,
which could enhance performance during competition
In the absence of any
proof that I can find, one way or the other, it is my opinion that the
decisions, which most certainly are personal in any case, must remain with the
athletes, based upon their own perspectives and experiences.

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 mother, who now lives in an adult home, suffered a stroke
recently
When we made the trip back home to visit with her, we were shocked
to find her crying, refusing to eat, and unable to sleep properly
When we
pointed this out to the people who manage the home, they told us it was
normal, and that this happens to many older people after stroke and that there
was nothing to be done
What is your opinion?

ANSWER: Hogwash! Your mother is suffering from a real illness, called
post-stroke depression
While it is true that many people with stroke do
experience this problem, it does not have to be accepted as normal, and there
is a great deal that can be done about it
There are several theories about
its cause
One possibility is that it is psychological reaction to the
disability
Other research points to the damage the brain sustained after the
stroke as the basis for the mood change
The depression may come on between 6
months to two years after the stroke episode, and may last for as long as a
year if untreated
But it can and should be treated as any other depression,
with appropriate antidepressant medications in the correct dosages for your
mother’s age and physical condition
Get your mother to a caring physician;
she needs help.

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: At age 29 I have a pea-sized lump above my navel which hurts when
pressed
A friend, an EMT, suggested that it is a “strangulated navel” which
surgery could correct
Could you please explain the term and give me an idea
as to what could be done?

ANSWER: Whenever a loop of bowel, a bit of tissue, or organ protrudes through
an abnormal opening, the abdominal wall in this case, it is called a “hernia”.
If the blood supply to the protruding tissue becomes cut off because of
swelling or constriction, it is called “strangulated”
This is a serious
condition, for if it is not corrected rapidly, the tissue may become
gangrenous
An ordinary hernia through the navel is known as an “umbilical”
hernia, and is most frequently seen in newborns, rarely becomes strangulated,
and closes by itself after several years, rarely requiring surgery
If this
hernia exists in an adult, it could become strangulated, and depending upon
the size of the opening, could be closed using simple surgical techniques.
Another condition that can develop in hernias is a situation where the loop of
bowel gets “stuck” in the opening and can not be pushed back into the abdomen.
This is classified as an “incarcerated” hernia, and may or may not be
strangulated
As with so many questions, the answer can only be determined
after a careful examination
It is possible that in your case little need be
done, as the hernia seems quite small
However, I should advise you not to
let the condition go any longer without real medical attention, for the
results could be serious.

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: Our son the weekend athlete informed us that he has suffered a
“stress fracture” in his foot, but that everything is alright and he is up and
about
My daughter in law says the x-rays were negative and that even a cast
wasn’t needed
Of course none of this makes sense to us
Can you please
explain?

ANSWER: Your son isn’t using a made up condition to extract sympathy, and all
the details you provided do make sense
There is no cause for alarm, but
stress fractures are a common enough occurrence to warrant a word or two.
Although they may affect any bone of the foot, the metatarsals (the bones that
form the broad part of the foot between the heel and the toes) are the most
common site for these injuries
Such fractures are also named “march
fractures” as they can frequently be diagnosed in soldiers after prolonged,
forced marches
Stress fractures develop when activity is suddenly increased,
and overcomes the ability of the bone to respond to these increased forces.
The first sign is pain and tenderness over the site of the fracture, and it is
common for the initial x-rays to be “negative”, or fail to show the fracture
line, for it is a thin hairline type of break
In general, repeat x-rays
after 2 to 6 weeks will eventually show the fracture
In some cases, however,
other tests such as bone scanning or computer tomography (CT scan) are
necessary to detect the fracture
Casting is only required in a few cases, as
a stress fracture will heal if the patient will back off from excessive
activity and stress and provide a relative rest to the foot
I am sure your
son will do just that, and then return to his weekend activities with just a
bit more caution.

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 mother has been taken to the hospital several times because her
heart, all of a sudden starts beating out of control
She called it “tack”
something and said that her heart beat was 200 beats per minute
Could you
please tell me more about this disease? What should she do?

ANSWER: Your word “tack” comes from the Greek “tachy” which means “swift” and
the name of the medical condition is “tachycardia,” or the rapid beating of
the heart
Generally this term is applied to any heart rate over 100 beats a
minute
There are many types of tachycardia, depending upon their cause,
which is usually determined by carefully examining the heart and evaluating
the electrocardiogram (EKG)
It is called “paroxysmal” when the condition
starts suddenly without warning
The patient may feel faint and weak, but
rarely passes out completely
The patient should lie down immediately and
remain quiet and calm, to offset the effects of a lowered blood pressure which
may be present during the attack of this rapid heart beat
There are a number
of techniques called “vagal maneuvers” that may be attempted by trained
personnel to break the rapid rhythm
The patient may attempt a forcible
exhaling effort against a firmly closed mouth and glottis to increase the
pressure in the chest area (Valsalva’s maneuver) or the carotid sinus, located
on the side of the neck, may be massaged
I stress this should only be
attempted by trained personnel while the heart is being monitored by an EKG.
Frequently this is all that is required to restore the heart beat to normal.
When this is unsuccessful, various medications including verapamil or
edrophonium may be used
Digoxin may also be used when emergency treatment
fails, and it is possible to return the beat to normal using electrical
stimulation (electrical cardioversion)
Although this condition may be seen
in younger people with no evidence of heart disease, in older people, like
your mother, arteriosclerotic cardiovascular disease may be present.

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: During a recent screening I had a tuberculosis skin test which
showed positive
After a more thorough examination, during which I was found
to be in pretty good health, my doctor decided to put me on regular
medication, but then decided that a chest x-ray was unnecessary
This doesn’t
make a lot of sense to me, does it to you?

ANSWER: It took a bit of reflection and some reading, but I think I can make
a case for your doctor’s position, and explain a few things to you while I am
at it
To make it all come out right I am going to assume that you are under
the age of 35, which seems likely from the rest of your letter
The purpose
of the skin test screening for tuberculosis is to find people who might obtain
some benefit from a course of therapy with an antituberculosis medication
which will prevent the disease from progressing beyond its first stages or, in
fact, ever developing at all
Screening tests merely reveal that the patient
has been exposed to the disease and has generated antibodies to the bacteria.
The type of therapy recommended by your physician is called “prophylactic
therapy” and is used to prevent the bacteria from ever gaining a foothold in
your body
Tuberculosis develops slowly, and wiping out the bacteria with
proper medications prevents damage to the lungs and other organs.
Prophylactic therapy with isoniazid is very effective, and presents little
risks for the young patient
Since you fit the picture of a young patient in
apparent good health with a positive screening test, the decision to prescribe
prophylactic therapy to you was already made, and the results of a chest x-ray
probably would not alter that conclusion
While the American Thoracic Society
does recommend a chest x-ray in cases such as yours, recent investigations
have shown that x-rays rarely show findings that reveal active disease, and
may be of little help in caring for the patient
In these days when medical
costs are constantly under review, your physician may be practicing in a
system where costs are kept low by avoiding tests that are of questionable
value
For sure, your therapy is correct; the question of a chest x-ray is
one that may be debated.

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: Although my 15 year old daughter has started her periods already,
they seem different than mine were at her age, and I fear they may be a sign
that something is wrong
Our doctor agrees that an examination is in order,
but when I try to speak to my daughter about it we end up in a screaming
match
How can I overcome her fears?

ANSWER: This would be an easier question for both of us to answer if we could
determine just what your daughter was frightened about
Perhaps it is a fear
provoked by the thought that something is indeed wrong with her periods, and
by implication, her budding sexuality
Since the onset of the menses may
differ substantially in each individual, even in mother and daughter
comparisons, this may be a needless fear from the outset, and the chances
certainly favor the possibility that she is but in a stage of developing her
normal pattern
It is more than possible that the idea of an examination of
her sexual organs and the lack of understanding of just what will take place
would be enough to panic any young girl
Providing precise information about
the examination and how it will be conducted may solve the problem, and your
physician should be able to provide you with that information, perhaps in
written form
Perhaps she is just afraid of the doctor
That certainly has
been known to happen, and a quiet discussion of her feelings on that matter
and your willingness to hear her out could be the key answer to this question.
Another delicate matter for you to discuss is the possibility that she may be
reluctant to discuss her personal matters in your presence
She is a growing
young lady in her own eyes, and now that she requires medical attention on
matters such as this, could feel that she has now entered the stage of life
when she would like to be treated like an adult
An open discussion between
you and the physician can do much to provide just the right amount of
independence for your daughter, with the continuing respect for your position
as a caring and concerned parent to permit even these feelings to be
successfully addressed in a professional and ethical manner
This is
certainly a difficult time for both parents and teenagers, but the manner in
which you solve the problem can set the stage for many vital discussions in
the future.

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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