Health information

QUESTION: My father, who is 86, is in the hospital with what the doctors call
Bacterial Pneumonia
Could you please explain what this is?

ANSWER: Let us first define the term “pneumonia”
Sometimes called
pneumonitis, it is an acute infection of lung tissue
When it is confined to
but one lobe of the lung it may be known as lobar pneumonia, and when it
affects the bronchial tubes, is called bronchopneumonia
The term bacterial
pneumonia tells us that the infection is caused by bacteria, rather than
viruses or fungi
“Bacterial” is the most common kind of pneumonia, and can
be caused by a wide variety of bacteria, including pneumococcus,
streptococcus, staphylococcus, legionella, klebsiella, and hemophilus
influenza
It is a most serious condition
About 2 million Americans get
pneumonia each year, with from 40,000 to 70,000 deaths reported
It ranks
sixth among all categories of disease as a cause of death
Despite many tests
available to physicians, it is sometimes quite difficult to determine just
what germ (bacteria) is causing the illness, and no culprit can be discovered
in up to half the cases
Pneumonia frequently follows and upper respiratory
infection, and may start with shaking chills and a high fever
Patients find
it difficult to breathe, sometimes experience pain when pleurisy develops,
develop coughs and may also experience nausea and vomiting
Both chest x-rays
and blood tests help make the diagnosis
Hospitalization is generally
necessary to properly treat the condition, especially in older folks who lack
the resistance and strength to fight off the infection
Fortunately there are
a large number of powerful antibiotics which are effective in combatting the
infection, and are chosen for their particular ability to kill the germ which
has been identified as the cause of the pneumonia
Other measures used to
treat patients and keep them comfortable are bed rest, fluids (including by
the intravenous route), analgesics for pain, cough medications and oxygen for
patients who may not be able to obtain enough for their systems because of the
pneumonia
It may take a while to a while to subdue the infection and an even
longer period for recovery, but a total cure is possible in most cases.
Hopefully, your father will be one of these.

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 had a terrible time with soreness and aches in my arms and
legs
I tried aspirin and other pain medicines but they don’t work
My
doctors says it isn’t the arthritis I thought I had, but something called
“polymyalgia rheumatica.” He wants to give me cortisone, but I am a bit
reluctant
Would you please advise me what to do?

ANSWER: Although it may be a difficult task to tell the difference between
arthritis and polymyalgia, there are a few clues that can help make the
diagnosis
Polymyalgia rheumatica (PMR) is condition of the muscles rather
than the joints, which are the target of arthritis
The muscles of the upper
arm, neck and shoulder, and hip are sore and tender to the touch, and are
particularly stiff and painful in the morning upon arising
Although you may
have some pain when moving your muscles, they are probably as strong as ever.
This disease is more frequent in older people and strikes women twice as often
as men
About half the patients tell of feeling weak tired and depressed,
while many will also have a fever and weight loss
While it is painful
disease, it is neither life threatening not life shortening
There are
several blood tests that help make the diagnosis, and your doctor may inform
you that you have a high sedimentation rate as that is present in almost all
patients with PMR
This is another disease where we are uncertain about the
cause, and cannot accurately predict the course of the ailment, which is very
variable
Once it starts it can last from six months to a year, but episodes
lasting five years or more are not uncommon
PMR is often associated with
another condition called temporal arteritis, which would provoke headache,
scalp tenderness and vision disturbances as well
The good news is that this
disease responds very well to the medication your physician has advised, and
you should not delay taking it
Corticosteroids (like prednisone) taken
orally can quickly chase those pains away, sometimes in as little as 24 to 36
hours, but you may have to continue taking the medicine for some time
The
results of frequent blood tests will help your physician decide when the time
is ripe to reduce or stop your medication.

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: We are senior citizens and would like to know just what a certain
blood test is for
Some of our doctors have a test taken every six months
when we are in for a blood pressure check
It is usually for “potassium” but
we have no symptoms of a lack of potassium and are not treated for anything
else, so why?

ANSWER: A regular blood test for potassium at six month intervals would make
no sense to me either, if you hadn’t mentioned that it occurred while you were
having your blood pressure checked
Did you forget to tell me that some of
you were being treated for high blood pressure? One classification of
medications commonly used to reduce elevated blood pressure is the “thiazide”
group, also known as “diuretics” or “water pills”
They work to reduce the
pressure by reducing the volume of blood through increased urinary excretion,
but they also provoke a loss of sodium, potassium and chlorides as well
They
are well tolerated as medications, having few side effects and are frequently
chosen as the first medication in the treatment of hypertension
Since they
extract potassium from the body, regular blood tests can be used to check the
levels
Potassium is a most important chemical for the body to have in just
the right amounts, as it can effect the way electrical currents are carried
through the heart, and thus the way the heart beats
In most cases, there is
no need to replace potassium in people who are on diuretics, but when the
levels are low, liquids containing extra potassium can be provided
Bananas
are also an excellent source of potassium, as are prunes, raisins and whole or
skimmed milk
If you are on water pills, and receive no additional medication
after the blood tests, it is because you are maintaining the right levels of
potassium and so have no need for more medication, and certainly nothing to
worry 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: My baby is 5 months old
I started to lose a lot of my hair when
he was 4 months old
My doctor says that this is because of hormones and that
it will stop in 6 to 18 months
Would you please explain why this happens?
Is this a common problem with women who have babies, and is there anything I
can do now to stop it?

ANSWER: Your are experiencing a problem with the improbable name of “telogen
effluvium” which is commonly seen in women after childbirth, and for which the
good news is that “this too will pass.” Hair growth occurs in a cyclical
pattern, with active growth (anagen phase) continuing for from 2 to 6 years.
A brief period of regression (catagen phase) then occurs during which a club
hair is produced instead of the normal long hair you are now wishing for.
Then a rest period of about 3 months takes place (telogen phase)
When
reactivation occurs the club hair falls out (telogen effluvium) and new hair
growth and a new cycle begins
Normally about 85% of scalp hairs are in the
anagen phase while the remaining 15% are resting
Hair shedding may follow
any type of body stress, such as surgery, high fever, crash diets, acute blood
loss and even the use of certain drugs
But as your doctor correctly advised
you, new growth will soon take place and your hair will return to normal.
There really is nothing you need do now, for the process will run its course,
and there are no means of stopping it once it has begun
You can best help
yourself by using this new understanding to reduce the stress and anxiety that
you are naturally experiencing at this time, and turn your energies to your
baby.

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: We have an adorable new, 1 month old daughter, but my wife seems to
have lost interest in the baby
She no longer holds the baby very much, and
neglects all the little things that are necessary to care for the child
My
wife claims she is just too tired, but she now has begun skipping her own
meals and is touchy and irritable
Does this all go along with having the
baby and will it soon pass? I am worried.

ANSWER: While most people recognize the “baby blues” which many women
experience during the first week after childbirth, a more serious type of
“postpartum depression” often goes undiagnosed and untreated
There are many
changes which occur immediately after a baby arrives, including modifications
in a woman’s internal chemistry, brought about by hormones as she gets back to
normal
Certainly life has changed at your house, with feeding schedules and
all the demands on your attention that a baby brings
It can sometimes be
overwhelming to a new mother, and a new father too
However when mood changes
come on from two to six weeks after the birth, when symptoms of irritability,
sleep disturbance, lack of appetite and chronic fatigue continue for more than
just a day or two, medical attention may be in order
While it is not an
uncommon situation, occurring about 10 percent of the time, it is a real
depression, and as such should be treated
It is fortunate that you have
realized that something is wrong, for in many cases the father, reacting to
the mood swings of his wife, can become withdrawn and angry as well
Schedule
a visit with your physician for your wife
It usually only takes a bit of
counseling and therapy for the short term, before things begin to straighten
out
While not always needed, antidepressant medication may be used to help
over this difficult period
The good news is that these treatments are very
effective, and that happy outcomes are the rule.

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 daughter is now carrying my first grandchild, and I want
everything to be just perfect
However I think she is taking pills that might
be dangerous for the baby
I should like you to publish a list of medications
which are dangerous to take during pregnancy
I think you have many other
readers who would be grateful to you for this information.

ANSWER: Your question has much merit, and as I considered the answer and
began to do my research, I was astonished at both the need for this type of
information as well as the number of medications that would have to be listed.
In consulting my most recent edition of the United States Pharmacopeial
Convention publication, “Advice for the Patient”, I discovered five full pages
of fine print, listing hundreds of therapeutic preparations that require a
long second look
As stated in the preface to this section, “The use of any
medicine during pregnancy must be carefully considered
The physician and the
patient must balance the expected benefits against the possible risks.” To my
thinking, that means any preparation, liquid or in capsule form, injected or
by intravenous administration, eye drops and skin creams, or in fact by any
route of administration must be considered in the light of the possible risks
to the unborn
Each medication should be carefully researched, using the
publications of the US Pharmacopeia Convention, “The Physician’s Desk
Reference” or package inserts provided with the medications
No type of
medication is exempt
My list, which unfortunately is much too long to
reproduce here, includes analgesics, antibiotics, antihistamines, sedatives,
antianxiety agents, antidepressives, cortisone-like medications, laxatives and
douches
No form of medication is excluded, and all the body’s systems are
included
Products used in some forms of radiological imaging as well as
castor oil and caffeine are also listed
During this most important period of
your daughter’s life, all things must be suspect, and that will continue into
the breast feeding period as well, where the list is almost as long
It may
not be unwise to visit your local library to review this publication and the
listings which appear in Appendix IV and V
Perhaps your physician may have a
copy to lend you.

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 was obese (OK, I was fat!) when I became pregnant, but my
physician is driving me crazy with her insistence that I keep watching what I
eat, and keep my weight increase from getting out of sight
Is all this
attention required? I have been overweight most of my life, and probably will
continue to weigh a bit more than average after the baby, so where is the
sense of all this fuss now?

ANSWER: Obesity is always a health hazard, pregnant or not
About 15 percent
to 25 percent of all women age 20 to 29 are obese, a percentage that jumps to
20 percent to 40 percent at ages 30 to 39
If those extra pounds are
generally a reason for attention, they are even more so to the pregnant woman.
Some 37 complications of pregnancy have been reported as related to obesity, a
cause for great concern
During the pregnancy, extra weight may cause
hypertension and problems with blood sugar (called gestational diabetes).
Heavy women give birth to larger babies, that can cause difficult labor and
require the use of instruments (forceps) to aid delivery, which in turn
increases the chances of injury to the baby
Cesarean sections are required
more frequently in heavier women, and that can lead to complications stemming
from excessive blood loss and infection, not to mention unwanted problems with
anesthesia
The eye opener is that both baby deaths as well as death of the
mother result more frequently when the mother is overweight
It may not be
possible to lose weight during pregnancy, but a carefully planned diet can
provide all the nutrition necessary for both you and the baby
However if you
do maintain your weight, you get a unquestionable reward of the chance of
losing up to 20 pounds after the pregnancy is over, which is a great boost
towards achieving your ideal weight, if ever you wish to try to make it.

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 about to enter the 4th month of my first pregnancy, and my
doctor is suggesting that I have a screening ultrasound examination
My
mother, who is very conservative, tells me she has heard bad things about the
tests, and doesn’t want me to have it
Help! I need some information.

ANSWER: Sure, put Dr
B
in the soup between your doctor and your mother!
Actually both parties have some arguments in their favor, and you are the one
that must make the final decision
In favor of the screening procedure are
its ability to diagnose the presence of a multiple pregnancy early on, the
ability to date the length of your pregnancy and help predict the due date,
and, most important, the early detection of an abnormality in the developing
fetus
Against this impressive array of positives, are considerations of
cost, the availability of blood tests to determine some abnormalities, and
though at present there is no evidence of ill effects from ultrasound, the
possibility of long term effects have not yet been discovered
Despite Mom’s
opposition, I think that the secret of a good decision lies in a frank and
open discussion with your doctor, to appreciate his reasons and concerns and
the information he is seeking to obtain from this examination.

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 at first I thought it was a simple back ache, the results
of many examinations and x-rays have lead my doctors to the diagnosis of
cancer of the prostate, which has now spread to my bones
I don’t want to
give up hope, and my doctor is offering me several options for treatment
including the removal of my testicles
I need some counsel and advice, which
I hope you will provide me, please?

ANSWER: Your doctor is certainly on the right path, and I will try to provide
a bit of information that may help you with your decision
Prostate cancer,
unfortunately, is a common disease
The American Cancer Society estimates
103,000 cases would be diagnosed in 1989
The symptoms of this cancer are
much like those of the benign disease where the prostate gland simply enlarges
or hypertrophies
They include: weak or interrupted flow of urine, inability
to urinate or start urination, blood in the urine, painful urination and pain
in the lower back, pelvis or upper thighs
Treatment depends upon the stage
of the disease, and when the tumor is limited to the prostate itself, radical
surgical removal of the prostate, the seminal vesicles and part of the bladder
may be the treatment of choice
Radiation therapy is an alternative.
However, once the cancer has spread beyond the prostate, the goal of the
treatment is to control the disease rather than cure it
Since the progress
of the disease appears to be related to the presence of male hormones,
surgical castration removing the male glands, or the use of a synthetic female
hormone diethylstilbestrol (DES) have been recommended to reduce testosterone
(male hormone) levels
Just recently however, a new treatment has been
approved by the Food and Drug Administration called Zoladex
Manufactured by
ICI Pharma, it is an injectable hormone that acts on the pituitary/sex gland
system and reduces the production of testosterone to levels that result in a
medical castration
It is administered by your physician in a single
injection each month, and can result in reduction of tumor size, and
improvement in urological symptoms and bone pain
It is said to have fewer
side effects than other therapies
Each treatment costs about $400, but since
it is administered only by physicians, should be reimbursed by most medical
insurance plans.

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 man over 70 years of age, and facing the need for a prostate
operation
However, I witnessed a horror story when a good friend of mine had
the same operation, and passed away immediately afterwards from complications.
Isn’t there some other way to deal with my problem, with less risk and danger,
and perhaps less pain as well?

ANSWER: Many men face the same situation with the same apprehensions and
fear
In 1987, prostatectomy (the removal of excess prostatic tissue) was the
most common surgery in men 65 years of age and older
While the condition of
benign prostatic hypertrophy (BPH) is rarely seen in men under the age of 40,
by the time age 60 rolls around, about half of the men have evidence of the
changes that occur
As men grow older, the tissue of the prostate grows and
expands causing an obstruction of the urethra, the tube which passes through
the penis and carries urine from the bladder past the prostate, out of the
body
This obstruction produces the symptoms of frequent trips to the
bathroom, decreased force of the urinary stream, and incomplete emptying of
the bladder
Once an operation has removed this extra tissue, the symptoms
usually disappear, but since most men would rather avoid the surgery, new
methods are being sought that could avoid the procedure
Medications (alpha
adrenergic antagonists) that can relax the smooth muscle of the prostate and
reduce the pressure that causes the urethral obstruction are now being tested
in Europe and the United States, but have not as yet received necessary Food
and Drug Administration approval for use in the United States
Other
chemicals that block the action of male hormones are also being tested, as
these hormones are thought to play a role in the development of BPH
A new
procedure which inserts a catheter with a balloon at its tip into the urethra
is also experimental
In this technique, once positioned the balloon is
inflated under pressure, and forces the urethra open, thus allowing the free
flow of urine
While these new medications and procedures do offer much hope
for the future, for the present only a form of prostatectomy can solve the
problem in an effective manner.

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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