Health information

QUESTION: I have acne (boils) on my thighs, but mainly on my buttocks, yet my
face is clear
I recently read an article that said that Accutane, a vitamin
A derived prescription drug, proved successful for treating and clearing these
lesions, but not without side effects
Can you tell me more about this
medication and any concerns I should have by taking it?

ANSWER: My first problem is with your diagnosis of acne on the buttocks.
Acne is an inflammatory disease that affects the skin in areas where there is
hair growth, since the disease affects the glands at the base of each hair
which form a waxlike substance called “sebum.” Acne most always occurs on the
face, but is also common on the neck, chest, shoulders, and upper back
I
suppose it could occur on the buttocks, but it would have to be considered
rare
The medication you referred to is called “isotretinoin” (Accutane)
which is a synthetic derivative of vitamin A
It is specifically indicated
for cystic acne that does not respond to other therapies such as antibiotics
and local lotions or gels such as benzoyl peroxide
Isotretinoin is
administered by the oral route and capsules are taken on a daily basis from
15 to 20 weeks
There are some important side effects with this medication,
and it must never be given to women who are pregnant or who might become
pregnant during the course of treatment
Fertile women must observe strict
birth control measures during the period of time they are on the medication,
for the danger of harming the fetus is a very real one, particularly in the
first three months of gestation
The medication is also prohibited in
lactating mothers.
Constant laboratory testing is necessary during the course of treatment
and must include liver function tests, as well as tests for serum cholesterol
and triglycerides
Frequently, there is an increase of fatty substances in
the blood during treatment and if they reach extremely high levels, then the
medication must be stopped because of the risk of acute pancreatitis.
Another possible consideration for the treatment of acne would be
“tretinoin” (Retin-A) from the same chemical family
It is prepared as a gel,
cream or lotion and is applied locally
Many adverse side effects are
therefore avoided
However the medication can cause skin irritation in
sensitive individuals.
In your particular case, however, I think I’d have another physician take
a look at your rash, as the possibility that it might be folliculitis is a
very real one
This is also an inflammation of hair follicles and a small
pustule or pimple containing pus may form around the opening of each affected
hair
In this case, proper treatment will include a local antibiotic
ointment, or, in the case of severe disease, an injection with either
penicillin or erythromycin.
In any case, you will really have to visit your physician again as either
isotretinoin or tretinoin may only be prescribed by a physician and care
should be closely monitored during the period you are using the medication.
The good news is that if you do have acne, and if your physician does
prescribe one of these medications for you, the hopes that you will have a
positive outcome are very high.

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: As if out of the blue, I have started to have a series of
nightmares
I awaken, frightened out of my wits, but manage to get back to
sleep
I’ve tried to figure out why they are coming on now, but I haven’t got
a clue
Can you help?

ANSWER: Almost everyone experiences a nightmare once or twice a year, with no
lasting serious effects
However, when they begin to occur with greater
frequency, it’s time to take stock
Nightmares will occur with greater
frequency during times of physical or emotional stress, and will disappear
when the situation is resolved
They may also occur during periods of
illness
Since neither seem to be true in your case, is it possible you have
recently started to take medications for high blood pressure, or have you
stopped taking tranquilizers or sleeping pills? Both situations can give rise
to more frequent episodes of nightmares
Reducing a heavy use of alcohol,
leading to subtle withdrawal symptoms, can be another cause in an otherwise
quiet life
There are some tips I can offer which may help
Avoid
cigarettes, caffeine or alcohol after your evening meal
Start a program of
regular evening exercise, a long walk to take the edge off
Do not nap during
the day, and avoid heavy meals
A light snack with a glass of milk at bedtime
is helpful
Try to engage in relaxing mental activity during the evening
hours, and then go to bed on a regular schedule
Don’t force sleep; if you
can’t drift off quietly, get up and read a relaxing novel until sleep calls.
If these tips do not solve your problem, it’s time for a visit with your
physician for more 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 occasionally experience a sleep-disturbing nightmare that hits
right in the middle of the night, and is so vivid that I can still remember
many details in the morning
Can you tell me what causes them, and what I can
do to prevent their recurrence?

ANSWER: The study of the causes and cures for nightmares is an interesting
one, and more has become known as research continues
Many people experience
nightmares on occasion, almost 80 percent of the adult population has had the
fright of the bizarre and vivid stories that can haunt our sleep
The
occasional nightmare is usually associated with increased stress in an
individual’s life, and may be a normal response to the situation
However
chronic nightmares, defined as at least 2 nightmares a week for more than six
months, require careful consideration and diagnosis
Nightmares can be
classified into three categories, nightmare syndrome, night terrors, and
post-traumatic stress disorder
The diagnosis depends in part upon which
sleep stage is occurring when the nightmare strikes
These dreams may take
place during sleep onset (stage 2), delta wave sleep (stages 3 and 4) and
rapid eye movement (REM) sleep
The different classifications each require a
different mode of treatment
There are some general rules and tips which may
help you prevent your occasional experiences
Try to maintain a regular sleep
schedule, retiring and waking at the same hour each day
Avoid caffeine,
alcohol or cigarettes once your evening meal is over
Try to keep regular
evening meals light, and take a small snack and milk before retiring
Instead
of a nap in the early evening hours before really “going to bed”, try a period
of exercise, an energetic walk would do nicely
Avoid stressful mental
activity before bedtime, that includes using television in the bedroom as a
“sleeping aid”
Check with your physician about any medications you may be
taking, as certain types of prescription drugs, beta-blockers, tricyclic and
other antidepressants, reserpine and other blood pressure medications may
cause nightmares
Withdrawal from barbiturates, benzodiazepines as well as
alcohol can also provoke a haunting dream
Last but not least, don’t force
yourself to go to sleep, it doesn’t help
Instead, if sleep won’t come, get
out of bed and read for a while, until you feel tired
Following these tips
should reduce your nightmares to the 2 or 3 occasions each year that most
people experience.

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 friend of mine was banged on the nose while we were shopping
together, and her nose started to bleed
It caused quite a commotion, as
everyone had a different idea about what emergency care could be used
Can
you please tell us what we should be doing if this happens again?

ANSWER: I wasn’t aware that shopping could be so dangerous, but nose bleeds
from an accidental blow are frequent occurrences
The sight of blood dripping
from the nose puts many people in a state of panic, when a little calm and a
few simple maneuvers are all that are needed to put an end to this
inconvenience
Try to find a suitable location away from the crowd, and where
the patient may sit quietly
There is no need for rushing about, as most nose
bleeds which result from accidents of this type will stop by themselves after
several minutes
The bleeding usually occurs in a section of the nasal septum
(the middle “wall” of cartilage that divides the nose into two sides) that has
many small and fragile blood vessels, and which can easily be closed by
pinching the sides of the nose against the middle
With the patient seated
with the head slightly forward, she can use the thumb and index finger to
squeeze the nostrils, which will compress the vessels, and stop the flow of
blood
Maintain this pressure for a full five minutes, keeping the patient
calm and relaxed, helping to keep the blood pressure low
This should do the
trick in most cases, but if it fails after two attempts, seek out the care of
a 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: I am 80 years old and have a problem with wax hardening in my ears.
When I stand up I sometimes will partially lose my balance
What is the best
treatment for this condition?

ANSWER: I doubt that there is one “best” treatment, but I can describe a
number of do’s and don’ts that may help you out of this bothersome situation.
At this stage of the game, when you are already experiencing some balance
problems, you will need the help of your family doctor to extract that wax
plug which may be the cause of the situation
A careful examination of the
ear canal is necessary to help make a proper decision as to the manner of
removing the wax
If all seems in good state, without any injuries to your
ear drum, or any signs of infection, your physician may choose to irrigate
your ear with a jet of warm water, which can dislodge the plug and wash it
out
If it is truly hardened in place, it may be necessary to use an
instrument, called a blunt curet, to roll the wax ball out of its present
location
Sometimes a few drops of glycerin or mineral oil may be placed in
the ear first, followed by a dropper full of 3% peroxide, in an attempt to
soften the wax mass
If this should be unsuccessful, you may have to continue
to use these drops at home for a few days, to soften the wax sufficiently to
enable the physician to remove it without injuring your ear
There are some
“wax softeners” on the market, but many physicians feel that they may damage
the fragile tissue found in the ear canal, or provoke allergic reactions.
After the wax is removed, a full examination should be performed to determine
that it was the wax plug that caused your balance troubles, and a schedule of
regular home treatments with 3% hydrogen peroxide each month can prevent this
from recurring
Whatever you do, don’t try to remove this hardened wax plug
yourself with a paper clip or other such “instrument”
Even cotton swabs can
be dangerous
This is one time when your doctor visit will provide you with
the relief you are seeking, in the safest possible fashion.

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 frequently use cold medications that I can buy from my local
pharmacy, but then find that they are not as effective as I need
My nose
still runs, and I have wondered whether I couldn’t just take an extra pill to
get the result I need
I feel that these medications must be pretty safe, or
they couldn’t sell them without a prescription
Have I judged the situation
correctly, or am I being unwise?

ANSWER: Your analysis of the potency of over the counter medications is a
common one
Certainly if they may be obtained without a prescription, they
should be safe for most anyone who needs their remedy for common problems.
And they are safe, when taken as directed, in the recommended dosages and
amounts
When you start making up new schedules and dosages you are playing
with fire
You did not reveal which medication you are using, nor any
personal statistics
Perhaps you are a big 6 foot and then some, 250 pound
young man in perfect health, so that the amount of medication in a cold pill
is really less than optimum for you
But if you are an older reader, of less
imposing proportions, and a metabolism that is more sensitive to the actions
of medications, then increasing medication dosages exposes you to increased
unwanted side effects and reactions
If you are on other medications of any
kind, that risk is dramatically increased
Over-the-counter medications
certainly have their place and value for common complaints, but when your
medical history is complicated by a chronic condition, such as hypertension or
diabetes, all medications should be prescribed after consideration has been
paid to all of the unique factors in your history and situation
I can not
justify your point of view, although I certainly can understand it
The rules
say “Take as Directed” and those words were placed there with your safety and
well being in mind
If the medication in those doses is not doing the job,
perhaps you have misjudged the diagnosis, and and examination and a correctly
prescribed medication can save you much grief.

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: If I have been sitting for a long time, or when I get up in the
morning, I become very dizzy and faint
I don’t actually pass out but I must
hold on to something before I feel sure enough on my feet to begin to move
around
This has only started recently
I would hate to continue the rest of
my life this way
Is there something you know of that can help me?

ANSWER: The general medical term used to describe your condition is
“syncope”
Sometimes called “swooning” and akin to “fainting,” this is a
common condition, and a frequent cause of concern
It occurs when the flow of
blood, with its precious cargo of oxygen, is reduced suddenly, usually as a
result of an abrupt fall in the blood pressure
When you rise suddenly after
a period of rest, the force of gravity pulls your blood down into your legs
and reduces the amount of blood returning to the heart, decreasing the blood
pressure and the amount of blood the heart can pump to the brain and other
parts of the body
Without the needed supply of oxygen, the brain can not
function, the person faints and falls to the floor, which usually places the
head (and the brain) on a level with heart, and effectively restores the
balance of blood flow
When blood pressure falls only when a person assumes
an erect position, from a sitting or reclining attitude, in may also be called
“orthostatic hypotension”
And that can result from a number of causes, but
especially as the result of certain medications
Have you recently started a
new blood pressure medication, or a water pill (diuretic) for edema or leg
swelling? In fact, have you started any new medication lately? This would be
my first line of investigating your problem, and I think the odds are in favor
of finding there the reasons for your condition
There are other reasons of
course, neurological disorders which must be considered, but they are less
common
Until you do find the cause, you must learn to arise carefully, first
sitting up in bed for a while, then letting your feet dangle over the side of
the bed, before standing erect
This slow pace will allow your heart to make
the changes necessary to keep your blood flowing to the brain, by increasing
the strength and speed of its beat.

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 13 year old son is a terrific athlete, but his activities have
been put on hold due to pain that he developed in his left knee
His
physician has diagnosed this as “Osgood-Schlatter Disease,” and we are very
concerned
Would you please discuss this condition and how it might affect my
boy’s hopes for a career as a professional athlete?

ANSWER: Now included in a group of conditions considered to be “overuse”
injuries frequently seen in children and adolescents, Osgood-Schlatter Disease
(also know as tibial tubercle osteochondrosis, another mouthful to say)
generally occurs in youngsters between the ages of 11 and 15, and is seen most
frequently in boys
The pain is felt over a bump of cartilage and bone (the
tibial tubercle) which is located just under the knee cap (patellar), where
the tendon of the big thigh muscle (called quadriceps because it is made up of
4 large “heads” or masses of muscle) attaches
The more activity or
participation in sports, the more intense the pain becomes, until it begins to
hamper the athlete and reduce his ability to play
Every walking, running or
kicking movement puts additional pressure on this area and aggravates the
condition
There are no other problems, such as clicking, locking or buckling
of the knee associated with the condition
In addition to pain and tenderness
at the location of the tubercle which may be enlarged, there is generally
swelling in acute cases
An x-ray of the knee may show some irregularity in
the bone formation of the tubercle as well
There is no doubt that rest is
the most important element of treatment, but rehabilitative exercises are
needed as well to help stretch the tendon, and relieve some of the stress and
tension that is causing the pain
Any activity which causes pain must be
avoided until all the symptoms are absent
Stretching the quadriceps by
slowly bending the leg until the heel can touch the buttock is followed by
applications of ice to the tender and swollen area
Once the pain is gone,
your son may return to athletics, and can use a neoprene sleeve to protect the
area from additional injury
The condition may leave an enlarged bump in its
wake, but full range of activity can be recovered and permit your son to
pursue his athletic dreams.

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 osteoporosis and have been taking 1000 mg of calcium a day
for four years
My doctor tells me it isn’t doing me any good since I am not
taking hormones, and that I am just wasting my money
Can you tell me if it’s
true and if there is any harm from taking calcium?

ANSWER: Let us start with the easy part of your question
No, you are not
harming yourself in any way with the dosage of calcium you are now taking.
Only individuals with certain kidney diseases, and who have a tendency to form
kidney stones, require special consideration
But merely taking a calcium
supplement will not cure your osteoporosis either, although it is a fine idea
to take enough calcium to prevent the development of the condition
Most
women consume less than 500 mg of calcium each day, while scientists recommend
at least 1200 mg/daily for youngsters 10-18 years of age, 1000 mg/ daily for
premenopausal women, or women taking estrogen treatment, 1500 mg/day for
postmenopausal women NOT on estrogens
This provides the body with sufficient
calcium reserves to create bone, or help stop the loss that occurs due to
osteoporosis
The hormone estrogen slows bone loss and improves the body’s
absorption and retention of calcium
During menopause, production of estrogen
diminishes and then stops
As a result women lose bone rapidly in the early
menopausal years
In order to slow this process many doctors, including your
own, recommend estrogen replacement therapy at the time of menopause,
especially for women at high risk for osteoporosis
I imagine that in
evaluating your personal situation, your physician has determined that your
benefits from estrogen therapy outweigh its risks, and therefore is
encouraging you to start the treatment
You will still need your daily
calcium though, to obtain the best possible results.

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 was one of the most energetic and successful women of her
generation
I am saddened as I see her become stooped and stunted by the
effects of what her doctor calls “osteoporosis”
Since I see much of my
mother in myself, I am wondering if I, too, am more prone to develop this
condition because of my genes?

ANSWER: Although there are many factors that put you at risk for
osteoporosis, women who have mothers or sisters that have already developed
the condition are certainly at an increased risk
Osteoporosis is a disorder
in which bone tissue is gradually lost from the skeleton, making it more
fragile
Other recognized risk factors include thin or petite women of small
stature, blond, blue eyed “Nordic” types, and those with early menopause
If
in addition, you have exercised very little, used cigarettes regularly, abused
alcohol, consumed a diet poor in calcium during your formative years, or used
certain medications such as corticosteroids, your risk factors are increased.
I’ll bet your mother was a smoker, as many of the business women of her day
affected the habit, and spent more time at her desk than on an exercise cycle,
for who knew of the benefits of regular physical activity then? Hopefully it
is not too late for you to change those life style factors that will diminish
the possibility of you developing this condition, and even now begin to offset
your inherited risks
One of the problems with osteoporosis is that you don’t
know you have it until the bones become so weakened that fractures occur with
little external trauma
Still there is much you can do.

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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