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QUESTION: As if without warning, my brother has now been informed he is
suffering from cirrhosis of the liver
However he has had no symptoms until
just recently, when he visited his physician because of a weight loss
Do you
feel the doctor was right in his diagnosis, and could you please explain how
this disease developed so quietly?

ANSWER: It is difficult to comment on the correctness of the diagnosis
without more information as to the findings of the examination and laboratory
tests, but I can tell you that the condition of cirrhosis may develop over a
period of time without many warning signs
Cirrhosis is the result of an
ongoing situation during which the liver cells are damaged and replaced by
scar tissue
As the amount of normal tissue decreases, the liver can not
handle the many functions it must perform in the normal individual and the
symptoms become apparent in a gradual fashion
Perhaps the first is a loss of
appetite, which leads to deficient nutrition and a loss of weight, the
situation you allude to in your question
The appetite loss can transform
into actual nausea and then vomiting, further complicating the weight problem.
A physical examination at this time can reveal a liver that is larger than
normal, and close inspection of the skin may show the first signs of yellowing
or “jaundice” which results when the liver can no longer remove certain bile
pigments which are deposited in the skin
As the liver progresses along the
course of the disease, ascites or accumulation of fluid in the abdomen occurs
as blood flow through the liver is reduced
As the liver loses its abilities
to function, these patients may experience an increased sensitivity to
medications and drugs
All symptoms do not appear in all patients, and it is
the task of both patient and physician to deal not only with these symptoms,
but to discover the cause of the cirrhosis and remove it if possible
While
there are many causes for liver disease that produce cirrhosis, including
infections, exposure to toxic chemicals and drugs, as well as drug reactions,
in many cases it is caused by chronic, prolonged and excessive use of alcohol.
Such patients can be helped greatly by avoiding alcohol completely and
consuming a nutritious balanced diet along with necessary vitamin supplements.
This may be easier said than done, but a supportive, concerned family is a
great resource for the patient.

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 been reading about a new development for the deaf in which
an operation provides an artificial ear, which allows them to hear
Our son
is deaf and we were hoping this operation could offer him some hope
Can you
provide us with any information about this development?

ANSWER: I will happily tell you what I have been able to find out
I am
using the recent publication from the National Institute of Health, who
recently sponsored a consensus development conference on this subject
You
are speaking of a cochlear implant, which have been in a development process
for the last 25 years, and still are the subject of a fair amount of
controversy as to their use
As a result of this conference the following
guidelines seem to give us a clearer idea of when the operation should be
considered
The best candidate is an adult, healthy male, who became deaf
after learning to speak
Individuals who have been deaf from birth are
considered poor candidates
The patient should be nerve deaf (sensorineural)
in both ears, with a loss of more than 60 decibels, even with a hearing aid,
score 0% on open-set speech recognition (word test), and failed to have
develop lipreading skills with a hearing aid
Before considering an
operation, there should be a complete evaluation of hearing, and an extensive
trial with a properly fitted hearing aid
If tests indicate that there is a
potential for benefit from a hearing aid, there should be a 30 day trial of
the hearing aid without obligation to purchase it
Should this trial be
unsuccessful, then the patient should be referred to a cochlear implant center
for further review, if the other criteria are met
Even with a cochlear
implant, the skills of lipreading are essential, and patients without
sufficient vision to lip-read may not be a candidate
The implant centers
stress such training in their postoperative programs
All this said and done,
you must now consider the cost, a whopping $20,000 not covered by Medicare,
and only covered by some supplemental or private insurance programs.

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: A lot is written about the dangers of cocaine use, but I have seen
little that describes the problems that go with trying to stop
What happens
to a person who is addicted to the stuff and then tries to stop? If there are
any bad results, are there any treatments to help?

ANSWER: It sounds like you are seeking answers that will help you to an
important decision, and though I am going to provide some information for you
here, you are going to need much more good advice, wise counsel, and someone
to help you through
That means finding a family doctor or other physician
with the knowledge, skills and experience needed to assist you
The problem
of cocaine abuse has really grown in the last 15 years, from 5.4 million
people reported to have tried it at least once back in 1974, to an estimated
30 million people in 1989
While the physical dependence on cocaine is less
dramatic than with heroin and other drugs classified as opiates, the
psychologic dependence is severe
This leads to withdrawal symptoms that can
affect both mind and body
The most common and most serious is depression,
but muscle tremors, severe headache, ravenous hunger and a change in sleep
patterns are also frequent
The symptoms of withdrawal usually begin rapidly,
within 24 to 48 hours after the last sniff of cocaine, and they can continue
for as long as seven days
As yet there is no one specific method or
medication to help the patient, but medications which are useful in treating
other types of depression may also be helpful here to relieve the symptoms and
help with lessening the disturbances of the sleep patterns
It may mean a
period of time away from normal activities, but that is a decision for you and
your physician
If you are really hooked, this is not a task to take on
without help, and you may need some additional help to get you started
Try
the national hot line 1 800-COCAINE
If it is busy when you call, don’t quit
trying
There are a lot of people seeking help these days, and you will
eventually get through to a most valuable source of valuable information and
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: I know I catch a cold more than once in a year, probably closer to
three or four attacks
I always thought that when you had an infectious
disease that your system built up an immunity to the bug
How is it possible
then to continue to have these colds year after year? It seems I should be
immune to them by now
Can you clear up this mystery?

ANSWER: I’ll try, and think the statistics will amaze you
You’re right
about building up an immunity, and you would probably be way ahead by now if
the common cold was caused by a single virus, or “bug” as you will have it.
There are probably more than 200 different viruses that cause the symptoms of
the cold, many of them rhinoviruses (”rhino” from the Greek word “rhis”
meaning “nose”)
Other viruses, such as some 35 adenoviruses, 5
parainfluenzae viruses and three or more coronaviruses, also play a role in
bringing you your yearly quota of colds
Actually children and young adults
average about 6 colds per year, but once you pass 30, your body has assembled
a collection of immune responses that help keep the numbers of colds per year
reduced
However, as we get into very old age, the systems seems to forget,
and doesn’t “recognize” the invading viruses, and cold frequency mounts once
again
Cold symptoms from viral infections are generally over within a week
to 10 days time, usually do not cause a fever, and may be accompanied by a
sore throat and a generalized malaise
When the sneezing and runny nose lasts
for a longer period, it’s time to consider an allergy as the cause
Although
in the past, the spread of the cold was attributed to sneezing, and the
presence of the virus in the tiny water droplets left hanging in the air after
a sneeze, present thinking is that the spread of the virus takes place by
direct contact, shaking hands for example
A family can do a great deal to
prevent the spread of the infection from one person to the other by a regular
routine of frequent and rigorous hand washing
Since crowding can contribute
to the spread of the virus, its a good idea to stay out of crowds when the
cold season is in sway, if that is at all possible
However that bit of
advice does not apply to the youngsters who might make that the excuse to skip
school.

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: Would you kindly discuss in your column an infection of the eyelids
called “blepharitis”
The treatment and cure, and also its prevention, would
be most welcome information
Thank you most sincerely.

ANSWER: As you indicated, blepharitis (from the Greek “blepharon” meaning
“eyelid”) is an inflammation of the eyelid margins that provokes redness and
thickening, as well as the formation of crusts and scales or shallow ulcers.
There are two types
Ulcerative blepharitis is the more serious of the two,
is caused by a bacterial infection, usually a staphylococcus, and can result
in the loss of eyelashes and scarring, as well as occasional infections of the
cornea
The other type, nonulcerative blepharitis, has a less evident cause,
although it may be of an allergic origin or associated with a skin condition
such as seborrhea of the face and scalp
You know when you have it as it
produces an itchy “foreign body in the eye” sensation
The eyelids become
swollen and red, and bright light may cause pain and tearing (photophobia).
During the night, crusts form that glue the eyelids together
When the crusts
and scales in the ulcerative type are washed away, they leave a bleeding
surface to contend with
Both types of blepharitis are difficult to treat and
will recur frequently after they have been well treated and apparently cured.
Warm compresses may be needed to wash away the secretions before applying
local antibiotics crams and drops
Erythromycin or bacitracin are usually
effective in treating the infection, and should be used three times a day,
regularly and until the symptoms improve
When severe irritation occurs,
cortisone-like medications may be used in addition to antibiotics for short
periods of time
If seborrhea is one of the possible causes, it too must be
treated.

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 married daughter is going to have surgery soon, hopefully to
remove the causes of a weakening and chronic illness
I am worried sick about
her and the care she is getting
She doesn’t eat, and they are doing nothing
to build her up
In my day they gave you a transfusion of blood to take care
of the amounts you lost during surgery, but she hasn’t even had that help.
Can you tell me if you think her care is correct?

ANSWER: Since you have omitted many details of her problem and just what care
is taking place, I am not able to comment on all the treatments that may be
going on
However, your call for a blood transfusion does deserve some
explanations which may help restore your confidence in your daughter’s
physicians and surgeons
It is certainly not like the old days, for modern
techniques in surgery have greatly reduced the amount of blood lost during
most operations
No longer is it necessary to administer blood as a
precaution against reduced blood volume
Nor is blood indicated to build up a
person’s reserves as though it were some type of nutritional supplement
With
all the possibilities of reactions to blood transfusions, physicians have
become more and more careful about the circumstances in which blood is given.
Since febrile and allergic reactions can occur in about 1 out of each 100
units transfused, and the possibilities of blood reactions due to
incompatibility are very real, no transfusions are used as preventive
measures
In addition with the possibility of hepatitis, and the remote but
possible chances of an AIDS infection (about 1 for each 40,000-1,000,000
units), “caution” is the new password in transfusion indications.

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 flaky skin in both my ears; it is also very itchy
I also
have a patch in my hair near my neck
A friend of mine said I might have
“barber’s itch”
I never heard of this before
What can I do to cure this?

ANSWER: A cure is generally never much better than the diagnosis that was
made before the treatment was recommended
If your friend’s evaluation is
correct, this answer may help, but I would have a physician look at your
problem first before running off to get a medication
“Barber’s Itch” is a
name used to describe a scaly, round rash that is located in the beard area,
and only affects men
Its medical names are “tinea barbae” and “sycosis
vulgaris” as well as “Alibert’s III”
It is caused by a fungus growth,
usually of the trichophyton family
The rash can also contain small abscesses
with the fungus growing inside, and the physician can make an accurate
diagnosis by looking at this material under the microscope
Treatment
consists of scrubbing thoroughly with soap and water, topical fungistatic
preparations and oral medications
Since your description is not typical, and
since these medications are prescription preparations, my advice to see your
physician should be seriously considered.

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: Would you please help me win a bet? The question is about the
proper treatment of burns
I say they should be left exposed to the air, and
my partner insists they require a dressing to heal properly
Since we have a
lot of minor burns happening in our shop, your answer will not only settle the
bet, but become our rule for burn care.

ANSWER: I may have to hedge a bit, because this answer, like so many in
medicine, depends upon the situation
Let me start with one important rule
for you
All burns should be cooled by applying cold, wet compresses, or if
possible, sticking the injured part into ice water, until proper treatment can
be provided
No butter, no margarine, no grease which can only complicate the
treatment and lead to bacterial infection of the wound
If the burn is truly
minor, that means it is superficial, only causing the skin to become reddened
and tender (the old “first degree” burn), you need only apply a mild emollient
or softening cream to reduce the swelling and pain
Creams which contain aloe
are very helpful
If you consider this a dressing, you have lost your bet.
With more serious burns, which form blisters, or where there is tissue loss,
bandaging is required to keep the wound clean, and protect the area from
further injury, so that healing can proceed without difficulty
In the case
of a blister, the fluid should be removed using a sterile needle, leaving the
skin over the blister in place to protect the underlying tissue and prevent
the wound from drying out
When a burn wound drys out (desiccates), more
cells die, and there is more loss of skin and scarring
Serious burns require
proper dressings that will prevent drying out yet prevent the fluid serum to
accumulate (in which infection may occur), as well as protect the wound, and
not stick to the skin as the healing process progresses
Newly developed two
ply synthetic membrane dressings may be used to accomplish all these goals.
Of course wounds that require such dressings are major and best left to the
care of your physician.

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 quite concerned about the health of our first lady, Barbara
Bush, and do not understand the use of radiation treatments for her thyroid
condition
Can you also explain the relationship of her eye symptoms with her
other problems with the thyroid?

ANSWER: Although I have not been consulted by the White House about Mrs.
Bush’s condition (although I would gladly make a house call) there have been
sufficient detail reported in the press for me to understand what has been
going on and explain it to you
The first lady suffers from an overactive
thyroid (also called hyperthyroidism, Grave’s Disease and goiter)
Grave’s
disease may cause a swelling in the neck (goiter) which is the enlarged
thyroid gland itself, rapid heart beat (tachycardia), tremor, increased
nervousness and sweating, weight loss, as well as a typical bulging of the
eyes, excessive tearing and photophobia (eye pain from bright light), although
I do not know that Mrs
Bush has all of these
What is clear is that she was
treated with radioactive iodine on April 12 to destroy some of the thyroid
tissue
Following that she was treated with prednisone, a cortisone-like
medication, to help reduce the irritation and swelling
Reportedly, her
response to these medications was not satisfactory
The muscles which lie
behind the eyeball and which control the movement of the eye were swollen, a
common situation in Grave’s Disease
This swelling causes the eyes to bulge
forward, but also puts pressure on the optic nerve which is in the same area,
and may impair the vision
The course of daily low intensity radiation, which
is scheduled for 10 days, is aimed at the muscles behind the eye, and
hopefully will reduce the swelling
This treatment has been used for a number
of years at Walter Reed Hospital, where Mrs
Bush is being treated
This
should help alleviate some of the discomfort and symptoms that were of concern
to Mrs
Bush
Incidentally, the disease is named for Robert Graves, an Irish
physician, who first described the condition in 1835, in the London Medical
Surgical Journal.

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 the ever present headlines about cancer, and the knowledge
that my father was operated on for colon cancer when he was my age (I am now
52), I am troubled by a gnawing fear that I too may become a victim
Can you
provide me with any information that might ease my mind?

ANSWER: I certainly can provide you with the information, but I doubt that it
will put you at ease
The only source for that good news will come from your
doctor after you follow some suggestions I am going to make
The truth is
that, because of your family history, you probably have double the risk of
developing colorectal cancer than someone whose history shows no close
relatives with the disease
More than that, while there is a significant risk
of this form of cancer at age 40, it doubles every 10 years after age 50 and
reaches its peak at age 70
You are a prime candidate for the screening tests
recommended by the American Cancer Society
They consist of: 1) an annual
digital rectal examination after age 40; 2) an annual test for hidden blood in
your stool specimen after age 50 (fecal occult blood test); 3) a sigmoidoscopy
every 3-5 years after age 50, following 2 normal annual examinations.
Sigmoidoscopy employs a flexible, telescope-like instrument which affords the
examining physician a direct look at the inside of your bowels
A word about
the stool test
For three days before you should refrain from eating red
meat, avoid iron containing medications, vitamin C, and any nonsteroidal
anti-inflammatory drugs (NSAIDs like ibuprofen) as they may give false
positive results
The experts also advise eating popcorn during the same
three day period to irritate any polyps present in your colon, causing them to
bleed and reveal their presence
Seems to me you have a bit of catching up to
do
But since you presented me with no symptoms that suggest the problem,
such as a change in bowel habits, abdominal pains or colic, or cramping made
worse by eating, you are probably still in fine shape
Thus the reassuring
answer you have sought from me will be yours when all this testing has been
accomplished, and that gnawing fear can be put to rest.

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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