Health information

QUESTION: I went to my doctor to be treated for back pains, and he
recommended that I “put some heat on it.” However, he was not very specific
as to what kind of heat to use or how to apply it
Can you help?

ANSWER: External applications of heat are an effective way to bring
additional circulation to an injured portion of the body and speed the healing
process
There are different techniques of applying heat to the body, but the
easiest and most convenient devices to use are the heating pad, hot pack, or
the ever-reliable hot water bottle
Infrared sources of heat are easy to use,
but they do not always heat body areas evenly
Both infrared and paraffin wax
are useful in heating irregular-shaped areas of the body (such as the hands
and feet), but you may find the wax a little messy to deal with.
Your doctor, or a specialist in the field can make use of shortwave or
microwave diathermy, literally passing a current through the body to heat
internal structures
Ultrasound is only effective on very small areas, and is
used to treat conditions such as tennis elbow.
Curiously, treating afflicted areas with cold rather than heat
(cryotherapy as opposed to thermotherapy) often achieves the same goal of
relieving pain, although through different bodily processes
Most people
usually prefer heat treatments, probably for the same reason Hawaii is a more
popular vacation spot than Alaska.

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 lumps in my breast that though diagnosed as not cancerous
still cause me moments of terrible pain
What type of treatment is available
to get me some relief?

ANSWER: Treatment depends on the character of the noncancerous lumps, the
discomfort they cause and your family’s medical history
Your doctor will
always want to examine such lumps carefully (and probably will advise you to
do so quite frequently) but may not prescribe any treatment if lumps are few,
small, painless, and usually occur with your menstrual cycle.
If you experience breast pain or tenderness before periods, cutting back
on the amount of salt will help to reduce the amount of fluid your body
retains.
Caffeine, diary products, alcohol and smoking have all been linked to
this condition, and eliminating them, or reducing their intake may afford some
relief when tenderness and pain are the main complaints.
Some authorities state that stress can make symptoms worse and recommend
techniques to reduce it, such as meditation, exercise and biofeedback
Some
also suggest taking vitamins E and B
If your pain persists, your physician
may prescribe hormone medication.
Surgery is performed only if the condition is severe
Lumps can be
removed without disfiguring
At times even large lumps containing fluid can
be drained simply, using a needle and syringe
Reducing the pressure by
removing the fluid may also reduce your pain.

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 had severe chest pains recently that turned out to be
pleurisy
Can you fill me in on this condition or infection? I would like to
know if it’s like a cold that can be cured or if it’s more like a condition
that stays with you.

ANSWER: The pleura is a membrane like tissue that covers the lungs, and also
lines the inside of the chest cavity in which the lungs are found
Between
these two sheets of tissue is a space, normally closed, as the lungs fill and
move against the chest wall
However in certain circumstances the pleura
becomes inflamed, becoming swollen and congested, and produces a thick, liquid
like substance (called a fibrinous exudate) that begins to fill this space.
This fluid is sticky and can cause the tissue that covers the lungs to adhere
or become fixed to the lining of the chest wall
That forms an adhesion, and
causes the pain as the lung moves to and fro as the patient breathes
Pleural
effusions occur when the pleura is injured, usually as a result of a lung
infection, or some type of trauma, but can also be caused by tuberculosis,
uremia, or even asbestos
The pain of pleurisy usually comes on quite
suddenly, and can range from a mild discomfort to a stabbing pain
It is made
worse by deep breathing and coughing
When the physician examines the chest
with a stethoscope, the sound of rubbing can be heard, and helps to make the
diagnosis
Chest x-rays may be of some help in confirming the diagnosis,
particularly when there is a quantity of liquid present
The treatment of
pleurisy depends upon its cause, and may include antibiotics and pain
medications
Chest pain can be relieved in some cases by wrapping the entire
chest with wide elastic bandages, which provides support to the wall of the
chest and reduces the movement it makes during breathing
Pleurisy may take a
while to heal, but it usually does with the proper treatment, leaving but a
small scar on the pleura to mark where the injury occurred
Thus it is not a
condition which stays with you, and your mother can look forward to a normal
existence without pain.

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 I am about to have my period, I know it because I get tired,
depressed and just can’t sleep
And it always seems worse when I am under
some type of stress at work
I think I have Premenstrual Syndrome, but my
girl friend says that only comes when your periods are crampy and painful.
Can you help us clear up this difference in opinions?

ANSWER: It may be easier to clear up your conflicting viewpoints than it is
to deal with your condition, which seems to be Premenstrual Syndrome (PMS).
The symptoms of this condition may vary greatly from individual to individual,
but usually include depression, irritability, nervousness, agitation, insomnia
and fatigue
Any type of mood alteration may occur, and recent research
reveals that stressful conditions at work or at home can increase the severity
of the symptoms, and so your symptoms may change from month to month depending
upon conditions
However your girl friend is wrong about the symptoms of
cramps and pain that may start with the flow of menses
That is called
dysmenorrhea, or painful periods, and does not have to be present to make a
diagnoses of PMS, although it is common in women with PMS and begins during
their teens and diminishes with age
However PMS may start in the teens and
twenties, and seems to increase in severity with the passing years
Dealing
with the symptoms of the condition depends upon the causes, which may be many
and complicated
If there is an evident increase of weight due to fluid
retention, cutting back on salt and the use of a diuretic (water pill) may be
helpful
In your case, you might consider counseling, and a stress reduction
program seems indicated
Some women respond to the use of hormones and birth
control pills, while still others may require the use of mild tranquilizers,
when other methods fail to control the symptoms during this time of the month,
and when their life style is markedly disturbed.

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 interested to know if you know anything about a disease known
as Polymyalgia Rheumatica (PMR)
Also I want to know is it a form of cancer?

ANSWER: I will be happy to share what I know about this disease with you.
This is a condition which produces severe pain and stiffness in certain
muscles including the neck, shoulder and waist
The stiffness is most evident
in the morning and getting out of bed can be a real trial
Despite the
severity of the pain and stiffness, there is no loss of power in the muscles,
so no muscle weakness is seen
The condition is most often seen in adults
over the age of 50, and women seem to develop it twice as often as men.
Occasionally there are symptoms of fever, loss of appetite, and a general
feeling of discomfort, but they are not always present
The diagnosis is
confirmed by blood tests, particularly the sedimentation rate, as well as
muscle biopsy
The good news is that there is an effective and rapid
treatment
Corticosteroids (cortisone like medications) usually provide a
rapid response, so that symptoms may diminish and disappear within a day or
two
Medication is continued until the blood tests return to normal and all
symptoms are gone
This may require that the medication be taken regularly
over a long period of time, in some cases years
And no, it is not at all a
form of cancer!

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: Here it is with summer over, and I am still getting outbreaks of
poison ivy whenever I try to do a bit of gardening
I thought the plant would
be dead by now, but something is causing these rashes
Can you offer me any
help.

ANSWER: If you can recognize the plant, perhaps you may be able to stay away
from it
I am sure you know about its three shiny leaves at the tip of the
stem, but at this time of year it may also sprout greenish-white berries
It
will be growing right along with other bushes, near the bottoms of fences and
walls and around the bases of trees
The allergic reaction is produced by a
chemical called urushiol, which is the oily part of the resin that this plant
produces
The oil will stick to your clothing, shoes and even your garden
tools and remain potent for weeks
When you do garden, wear protective
gloves, long sleeves and slacks tucked into your socks or shoes
Take a nice
cleansing shower after gardening and be sure to launder those clothes well, to
remove any traces of the resin that may still cling to the cloth
Clean your
tools with strong soapy water (wearing gloves, of course)
If the rash does
break out, and I hope it won’t, applications of ice and taking an oral
antihistamine will help reduce the itch
Your pharmacist may help you with an
over-the-counter cortisone cream as well, and you may speed the drying of the
rash with calamine lotion or hydrogen peroxide
If you are prone to severe
cases, a prescription or injection of cortisone from your physician provides
speedy relief
One last caution
If you burn your leaves and garden trash,
and should there be leaves of poison ivy in the pile, the resin and oil will
be present in the smoke, and a rash can break out if that smoke touches your
exposed skin
This may be a hard diagnosis for your doctor to make, unless
you are sure to remind him of your allergy to poison ivy, and possibly other
plants that produce similar chemicals.

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 couple of years ago I experienced many symptoms that I let go
unchecked for a long time
I did a lot of crying because I was scared and
confused
I ended up by seeing a psychiatrist who prescribed an
antidepressant for depression
I only took one pill a day because it made me
feel different
I should have taken all the medication that the psychiatrist
prescribed but I was scared to, and didn’t return to the doctor
Now I am
afraid to return to him and tell him this story, though I still feel foggy.
Please help me?

ANSWER: Each time I receive a letter like yours, I too, feel sad and a bit
frustrated
I wish that there was some way to set up a conference call
between you and your psychiatrist, so that the lines of communication which
have been disrupted can be restored and get you on the road back to health and
happiness
So I will use your letter in an attempt to get the message across
to my many readers who are in the same fix
I think the diagnosis of
depression was a correct one, and the medications would probably have worked
fine if given the chance
However, many medications used to combat this
problem take a bit of time to work, some as many as three weeks before their
effects can be noticed
But that time can also be used to advantage, for you
to express your fears and doubts to your physician, and get another point of
view and counsel that can be helpful
With the medication beginning to help,
some of the fears that have been bottled up for so long inside can be brought
to light, examined and re-evaluated
Change comes slowly perhaps, but each
small step leads you a bit closer to understanding, and to readjusting what
must be fixed so that you can go on alone and independent, with feelings of
courage and self confidence
It isn’t easy, but it works for many, many
patients
It may be that you are selling your psychiatrist a bit short
I
sincerely doubt that you will get a lecture on “listening to the doctor”, but
rather a sensitive and caring discussion about your needs and your fears.
Rather than tell you that you were wrong, I would rather look at this
situation as something you did right
You had the courage to seek medical
care when you needed it, and you have now reached out to me for more help.
Now pick up that phone, and make another appointment with your physician
No
need to apologize, just admit to yourself that you still need help and want to
get better
Then open the lines of communication which are so important in
caring for the illness of depression
Speak of your thoughts and fears,
without shame or guilt, and move on with the process of of getting better and
grabbing for some of the fun and joy that exists in every life
Yes, K., I am
talking to you in the only way I can, through this column
I know with
absolute certainty that you can be helped, and that you will be better
More
than that, your story can serve as encouragement to many others who feel
frightened and depressed, as you do, to reach out for the help that is
available to them
When medications are prescribed that leave you with funny
feelings, call the physician promptly
It may only take a minor adjustment in
dose, or the time of day that the pills can be taken, to alter the effects and
remove those unwanted feelings
There are many ways of caring for patients
who are depressed, and each treatment must be adjusted to the needs of the
individual
The good news is that they can be, and that they work
There is
no bad news
Take my advice
Give both the medication and the physician the
opportunity to make you better.

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 physician finished examining me, he informed me that all
was normal, including my pulse and that I was in good physical condition
Yet
he never even took my pulse, and I am wondering about his conclusions
Can
you please comment on this in your column?

ANSWER: I think that many people believe that the only method of taking and
evaluating the pulse is by placing a forefinger on the easy to find radial
artery located just above the wrist
After all that is what is shown on
television and in the movies
But there are many places to check a heart
rate, by counting the pulse beats, that include not only the wrist, but the
upper arm (brachial), the neck (carotid), the groin (femoral) and many others.
The pulses are caused in the arteries by a wave of pressure, created by the
contraction of the heart, and may reveal the presence of disease of the valves
of the heart when they are abnormal
When the pulse is absent, in the ankle
for example, it means the the flow of blood to that area has been shut off or
diminished by a disease process, and is an important clue to be followed up by
more complicated and revealing tests
The character of the pulse, tapping,
bounding, collapsing, or slapping, the rapidity of the rate, and the
comparison of the pulse on one side of the body with its mate on the other all
have different meanings to your physician, and their evaluation permit a
report, in your case, of “normal”
It is probable that your physician may
have checked your pulse several times, while you were unaware that his
attention was on this important physical sign, used as part of the total
evaluations included in every good physical 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: I’m a 36 year old female in good health
For the past 3 or 4 years
I’ve been experiencing and irregular heart beat (skips a beat)
This occurs
anywhere from 2-3 times a day to 2-3 times per week
My EKG and blood work
were all normal
Does this “skipping a beat” indicate any future
susceptibility to heart trouble or is it damaging of itself?

ANSWER: Any irregularity in the beating of the heart can certainly cause
anxiety in the patient and warrants a full work up, which you seem to have
already undergone
An accurate diagnosis of the type of beat which is causing
your “skipping” may only be made after studying the the electrocardiogram, and
you report this as normal
That leaves me with the impression that you are
experiencing occasional premature beats in the rhythm of your heart, followed
by a pause which makes it feel as if a beat was skipped
Some people describe
this as a palpitation, others as a flutter but the most common complaint
describes it as a skip
When the source of the extra beat is in the
ventricle; it is named a ventricular premature beat (VPBs), and while this is
a frequent finding in many types of cardiac disease, it is also common in
people with otherwise normal hearts
One study has shown at least one such
beat in a 6-24 hour EKG in 20 percent of men 35-40 years of age, randomly
selected from a population of actively employed American men
When a complete
examination can discover no sign of disease of the valves of the heart, and no
evidence of suffering of the heart from a lack of oxygen, there is a general
consensus among medical authorities that there is no need to treat the
condition, particularly when there are no other symptoms
The skipping itself
is not damaging to the heart, nor does the presence of such a beat now make
you any more likely to suffer with “heart trouble” later in life
However,
prudence would indicate regular examinations to keep an eye on the situation
and hold your anxiety level down.

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: It is hard not to become involved particularly when you are a
teacher involved with children each day and you suspect something is not
right
How can you be sure that there is a case of child abuse going on right
under your eyes, and don’t wish to falsely accuse anyone of a crime?

ANSWER: Teachers are in an ideal position to observe the differences in the
appearance and behavior of pupils suffering from child abuse
Despite recent
backlash against overzealous reporting due to occasional false reports, the
fact remains that over one million children each year in the United States are
abused physically, emotionally and sexually
And teachers can do much to help
prevent this human tragedy and stop further injury or death by judicious
intervention when warranted.
Because you suspect child abuse you must have a reason or evidence.
Visible physical signs, such as bruises, welts, burns, scratches, blackened
eyes, etc., if they occur often or are severe, should make you suspicious.
Sometimes children get hurt while playing, but not every day or week or even
month
Besides, physical abuse leaves telltale evidence on the skin from
either the implement used (whip marks, cigarette burns) or the person who
inflicted the wounds (bite marks, hand imprints).
This evidence, if overwhelming and conclusive, should be reported without
delay to the school nurse or physician, because the child’s life may be in
danger
But if still unsure then tactfully take the child aside and carefully
inquire how the injury occurred
This should help confirm or refute your
suspicions, or it may signal the need for continued observation or further
evaluation by other professionals.
Emotional or psychological abuse may require more expertise and time to
detect
And you might find that the same student is being abused both
physically and emotionally
Comparing the student’s appearance, behavior and
interactions with fellow students and adults will give you an indication of
whether he is withdrawn, nervous, has a poor image of himself, lacks trust in
others, etc
A child who often comes to school hungry, inadequately clothed,
unwashed and unkempt clearly suffers from neglect that borders on emotional
abuse
Check the child’s eyes
If they are red and swollen, the result of
prolonged crying, you may have your first important clue
Take the child
aside and ask some simple questions about home-life which may result in
important and revealing responses
Dysfunctional families often call their
children derogatory names (”Dum-Dum”), and blame their children for everything
that goes wrong
The children believe that they are always at fault and
deserve to be blamed.
When in doubt, you can get a good idea of how the child relates to its
parents and their opinion of their child during a parent-teacher conference
without being confrontational.
Sexual abuse is probably the most difficult to detect
If the child
behaves provocatively, is more sexually explicit or knowledgeable than his
peers, this may indicate need for further observation and evaluation
In the
same fashion, withdrawal from usual boy-girl relationships, normal for the age
group, may be another clue
The key is to approach all suspected child abuse
tactfully and with discretion because lives are at stake
But once you are
sure any form of child abuse exists, then you are duty bound to report it
confidentially, for the good of all concerned.

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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