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QUESTION: I have a mildly elevated blood pressure, and am taking medication
that seems to keep things in order
My doctor thinks I need more exercise,
and that it would be helpful in lowering my blood pressure
My wife says that
your blood pressure goes up when you run or walk fast, and that it would be
dangerous
Whose right? Would using weights be all right instead?

ANSWER: Would you be too confused if I told you that both your physician and
your wife were correct? It is true that your blood pressure may rise during
periods of exercise, but that is a temporary situation, and is not considered
dangerous or harmful
The fact is that a regular schedule of aerobic
exercise, walking, jogging or formal aerobic classes can all lead to a lower
blood pressure, and certainly a healthier you
In fact while aerobic exercise
may temporarily increase your systolic pressure (the higher number in your
blood pressure reading that occurs when the heart contracts), the diastolic
pressure (the lower number which measure the pressure that exists between
heart beats) is generally lower during exercise
This is due to the opening
(dilating) of the blood vessels to allow additional blood to flow to the
muscles that are working
While this diastolic blood pressure lowering does
not occur during an exercise session with weights, it is not considered
dangerous either
Probably the best type of exercise is to add a little
weight lifting or weight training to an aerobic exercise session
There is
one caution, though, that needs to be stated
Exercise is a wonderful health
activity for people with hypertension that is under control and at or near
normal levels
Those who have blood pressure readings that are more than
180/100 mm Hg (millimeters of Mercury, the traditional manner of recording
blood pressure readings) should not indulge in any program of exercise until
proper medical care has reduced their pressure
In your case, with a mild and
controlled hypertension, the choice of exercise programs is up to 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: With all the statistics that appear in television and newspapers
about the deaths caused by all the diseases, its a wonder that anyone makes it
to retirement these days
Just to clear up the confusion, and to help me win
a wager, could you tell me which disease causes the most deaths in the United
States today?

ANSWER: Without doubt, and despite the great progress in fighting the
disease, heart disease is still the number 1 cause of death in the United
States today
Statistics show that as many as 1.5 million Americans will fall
victim to heart attacks in this year and more than one third of them will
succumb to the affliction
Heart attacks are responsible for about 24% of the
deaths recorded in the U.S
in 1987, numbering 513,000 deaths
Other
cardiovascular diseases account for another 22 percent (about 463,000 deaths)
just behind cancer with 477,000 deaths
There has been a drop of more than 40
percent in coronary artery disease deaths since 1970, probably the result of
all the education about the value of healthier life styles, and the new and
very effective treatments for acute heart attacks
While women are less
likely to succumb before menopause, they are twice as likely to die in the
first few days after an attack than men, and heart attacks are the number 1
cause of death for women as well
I hope this wins your bet for 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: My husband had a lump in his testicle
After prolonged nagging he
went to see the doctor
The doctor held a light behind the testicle and said
he could see light through it so it was only a cyst and nothing to worry
about
A couple of years later, without any reason which we can figure, that
testicle has swollen to three times its size and has remained swollen
The
doctor has said by phone that if it doesn’t hurt, don’t worry about it
These
diagnoses sound pretty cavalier to me
I would like him to go to a second
doctor
What do you think?

ANSWER: I suppose we are operating here on the principle “If it isn’t TOO
broken, don’t fix it”, but your desire for a better explanation is certainly
valid
Let us first assume that the mass is in the scrotum or sac, rather
than a part of the testicle
Such “cysts” are common and are known as
“hydroceles,” and are filled with a clear, sterile fluid that results from
overproduction or reduced absorption of the fluid produced by tissues within
the scrotum
This fluid production may become increased when an inflammation
exists, such as follows and infection or trauma
Another type of cyst found
close to the testes is a spermatic cyst or “Spermatocele” which lies adjacent
to the epididymis, a structure that stores sperm
The spermatocele also
contains sperm
It likewise allows light to pass through, as the doctor did
during his examination, and telling this cyst apart from a hydrocele is often
quite difficult
However, most doctors do agree that if these masses are not
too big, and do not cause pain and discomfort, they are best left alone.
Needle aspiration, that draws off the fluid into a syringe, is at best
temporary and may result in an infection
The only totally effective
treatment to remove these liquid filled cysts is surgical removal, and from
the sound of it, plain old fashion nagging isn’t going to get you to convince
your husband to undergo an operation he really doesn’t need.

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: You recently did a nice summary of symptoms and so forth on
hyperthyroidism
Could you please do the same for hypothyroidism? I could
use a list of symptoms and some general history on the subject
Thank you.

ANSWER: I suppose for completeness sake it is only fair that we deal with the
other side of thyroid activity, the reactions to thyroid deficiency or too
little thyroid hormone (hypothyroidism)
The most common form of this
disease, also known as primary hypothyroidism, is probably an autoimmune
disease, and frequently follows an episode of Hashimoto’s Thyroiditis, which
is an inflammation of the thyroid also thought to be caused by autoimmune
factors
The disease leaves the thyroid gland shrunken and scarred with
little ability to function normally
The second most common cause of thyroid
deficiency follows therapy for hyperthyroidism
When an overactive thyroid is
treated with by surgery or radiation therapy, the result may be a bit more
than desired, and with production of thyroid hormone lowered below normal
levels
The symptoms and signs of low thyroid activity may begin gradually
and are often unnoticed in the early stages
The skin becomes coarse and dry,
scaly and thick
Hair loss is noticed as the hair is affected in a manner
similar to the skin, and it too becomes coarse and dry
Patients become
forgetful, with gradual changes in their personality as the intellect becomes
impaired
Their facial expression becomes dull, enhanced by the swelling and
puffiness that commonly occurs around the eyes
While body temperature is
reduced, women may notice an increase in their menstrual flow
The pulse is
generally slower than normal, and reflexes are altered
Many patients
complain of constipation, which may become quite severe
The condition is
frequently referred to as myxedema, and a condition known as myxedema coma,
while rare in warm climates, can occur in the colder regions
A variety of
laboratory tests are available to help make an accurate diagnosis and to
evaluate the causes for the diminished thyroid function
Once the diagnosis
has been made, the treatment consists of replacing thyroid hormone, often
using synthetic preparations in sufficient quantities to assure normal
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: My mild hypertension was first discovered during an annual checkup
when I was about 45 years old
I have been under treatment ever since for
over 15 years now
I did all the good things you write about, and followed my
physician’s orders through many changes, both in medications and dosages
My
blood pressure has been under control for more than three years now with the
same schedule
But the answer to my question should surely interest many of
your readers
Will I ever be able to stop taking all this medication? Please
give us your thoughts.

ANSWER: The fact that you are asking this question reveals that you are a
success story, and that the long struggle for control has been worthwhile.
Even with the many choices that exist for therapy today, it is not always easy
to reach the ideal combination of factors that can control this disease
Most
physicians use a stepped care plan for therapy, starting with control of all
the possible life style risk factors, such as alcohol use, tobacco use, weight
control, diet and sodium restriction before turning to medications
Then a
single medication is selected from among four categories, diuretics, beta
blockers, calcium antagonists and ACE inhibitors
If the first attempt fails,
either the dosage is increased or another medication is added
With further
evaluation, a third medication may be added from still another class of
medications, or another prescription substituted for one currently being
taken
This may continue in like fashion until three or four drugs are taken,
each from a different class, and in sufficient dosages to control the level of
the blood pressure
Once we have mounted these steps and the hypertension has
been under control for at least one year, the possibilities for marching back
down the steps may be considered
Drug dosage may be reduced, one drug at a
time, and careful evaluation continue for a period of time
It may even be
possible to reduce the number of medications after a time, providing the
pressure remains at normal levels
However, it is rarely possible to stop all
the medications
The step down procedure is most successful in patients who
have mild hypertension and when all those good life style measures are rigidly
maintained.

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 a question of a rather delicate nature, that I would find
too embarrassing to ask my personal physician about
Though not an old man by
today’s standards, I find my sexual ability declining
I know my wife would
appreciate more attention, but don’t know what to do about my situation
I am
hoping you may provide some advice in your column.

ANSWER: I am always a bit disheartened when I learn that someone feels
restrained in discussing an intimate problem with a physician
It means that
the relationship is faulty at a time when it is most needed to help with a
problem that is not easy to correct
While I am happy to offer you some
insight, I truly hope that you will continue your search for a solution with
the consultation and advice that only a personal family physician can offer.
Your problem is not a rare one for impotence, defined as the inability to
achieve and maintain an erection adequate for vaginal penetration to the
mutual satisfaction of both partners, is one of the most common forms of
sexual dysfunction
In one form or another it may be a problem for more than
20 million American men
It may be either a physical or mental problem
One
of the most easily remedied causes of impotence stems from the unwanted side
effects of many prescription medications
Antianxiety, antidepressant and
antipsychotic medications, sedatives, some blood pressure medications, as well
as medication used for stomach ulcers and epilepsy must be included in the
long list of prescription medications that may be causing your situation.
Review any medication you are now on with your physician, as changing or
altering dosages may lead to a remedy
Of course, alcohol, illegal drugs;
marijuana, cocaine, amphetamines, narcotics and yes, nicotine may all be the
culprit
The presence of an erection (nocturnal penile tumescence) is an
indication that the patient is physically capable of a normal erection, and
may be discovered by using one of a number of home monitors which are now
available
You are also entitled to a complete physical examination, and
laboratory workup to assist in determining the reasons for your problem.
There are many causes for impotence, and it is not a condition that is either
all black or all white
Many new effective techniques and treatments now
exist, but you will only discover which is best for you by confiding your
problem to you 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: I have just recovered from a rather nasty infection that my doctor
called “erysipelas”
It was a term I was not familiar with, but antibiotics
brought it under control
An associate from work who visited me, said he had
the same thing but his doctor called it “cellulitis”
From what I have told
you, is it possible to clear this question up for us?

ANSWER: I can if you permit me to stick close to the exact definitions of
these two similar infections
However, I think it is fair to state that in
many cases they are generally both grouped together, and the term “cellulitis”
may be used
They are both infections of the skin
Erysipelas is the most
superficial, confined to the outside layers of the subcutaneous tissues which
lie just beneath the skin
Cellulitis runs deeper in the layer and may
develop following a puncture wound
Although both may be caused by one of the
bacteria in the streptococcus family, they do have different appearances,
which can be readily observed by the physician, and helps with the diagnosis.
The border of the lesion in erysipelas has a distinct edge, which raises up
above the surrounding tissue
Since cellulitis lies more deeply it does not
produce this effect, although it too creates a red, hot and tender area
Both
conditions may be effectively treated with penicillin, usually by injection.

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 notice that your column is headed “Family Doctor”
Why aren’t
there any family doctors to be found anymore? We had a family doctor who
passed away
Since his death we have found that we now have to go to a
different doctor for each different ailment
I know a lot of senior citizens
and other people too, are asking the question “where have all our family
doctors gone?

ANSWER: Where else to find a proper response to your question but from my
good friend Dr
Kenneth Whittington, President of the American Academy of
Family Physicians? Here is his reply
“I’m happy to say that family doctors
are very much alive and well! Some 68,000 family physicians, residents and
medical students across the nation are members of the American Academy of
Family Physicians (AAFP) the national medical specialty association
representing family doctors
Family medicine is a unique specialty and treats
all members of the family, regardless of age, from newborn to elderly
In
fact, 85 to 90 percent of a patient’s health care needs can be met by a
trained family physician
As you can see, there is no need to be shuttled
from specialist to specialist if your health care and treatment are managed by
a family physician
Granted, there are times a family physician must refer a
patient to a physician in another medical specialty
And true, increasing
medical liability insurance premiums, along with other factors, have driven
some family doctors to drop obstetrics and other services
But it is
important to remember that by having an established relationship with your
family physician, you and your family will have an advocate who will work to
ensure you receive the best medical care possible
With its emphasis on
preventive, office based care, it is no wonder that family medicine is one of
the few medical specialties for which demand continues to increase
For
patients who feel they have been on a merry-go-round of specialists, the
family doctor is a natural choice
There are many ways to locate a family
doctor who is a member of the AAFP
Ask your friends and relatives, look in
your community’s yellow pages under Physicians, Specialists, or write to the
AAFP, 8880 Ward Parkway, Kansas City, MO
64114-2797 for a list of family
physicians in your area who are members of the AAFP.”
It would seem your search for a new family doctor can now be successfully
completed.

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 know I should have been more careful, but when my 2 year old son
stuffed a small calculator battery up his nose, I did rush him to the
emergency room as quickly as possible
Although the doctor tried to be
polite, I felt that he was uptight, and that he made a bigger thing out of
this than needed be
All I know is that he really made me feel bad
Can you
get inside his head and figure out what was bugging him?

ANSWER: Foreign bodies in every possible body orifice are common enough in
emergency room medicine, not only in children who have the habit of stuffing
small objects where they don’t belong, but in adults too, who play some
unusual games
But the concern you sensed in the physician was appropriate,
and I am happy to make his point of view clear to you
While the usual run of
objects that find their way into noses, mouths and ears may include small
plastic parts from toys, marbles, pencil erasers, nuts, bolts and small
screws, as well as paper clips, hard candy and beans, peas and peanuts, none
of these items possess the same dangerous potential as those small button
batteries used for calculators, watches, games and even greeting cards
The
battery has the added hazard of emitting electricity, capable of destroying
sensitive tissue linings of the nasal and ear passages
In addition, they
also have the potential of leaking alkaline chemical components which can burn
these tissues and kill the cells
They must be removed as promptly as
possible, using methods that reduce the probabilities of these complications.
The best medicine here is of course prevention, clearing the home of all the
small items which children just can not resist poking away in some available
body cavity
While the doctor’s bed side manner may have been unappealing,
his concern was valid.

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: Another of those “unusual diseases” you wish for the public to
submit “The Fifth Disease”
There was a week in which many of those enrolled
in one of our local schools were sent home with this rubella resembling
ailment
I haven’t heard of it since
What was this “measly” ailment?

ANSWER: You are right, it is a disease that resembles measles in that it,
too, is caused by a virus and causes a rash
The fifth such disease to be
recognized (after measles, German measles, chickenpox and roseola), the cause
has recently been discovered to be human parvovirus B19, and this disease is
also known as “erythema infectiosum” (a rash of infection)
The incubation
period is 4 to 12 days and the illness itself is usually mild, with low grade
fever, slight malaise, and a typical blotchy rash that provokes a “slapped
face” appearance over the cheeks, before spreading to the rest of the body,
arms and legs
The condition lasts for from 5 to 10 days, but the rash can
reappear over a period of several weeks, particularly after exposure to bright
sunlight, after exercise, following a hot bath or shower or even during
emotional distress
When the infection strikes adults, as it may do on
occasion, mild joint pain and swelling may sometimes be seen
It breaks out
most frequently during the spring months and is common in children and
adolescents
Special precautions to isolate pregnant women from this
infection are necessary, as fetal abnormalities have been reported in women
who become infected during their first three months of pregnancy
While blood
serology tests exist to establish the diagnosis, the appearance and location
of the rash generally suffices to make the diagnosis
As yet there are no
immunizations available, and the only treatments available or necessary are
those simple procedures necessary to keep the patient comfortable during this
mild illness.

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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