Health information

QUESTION: We are anxious about a telephone call telling us that our son may
require surgery in his ear for cholesterol
We were unaware that this could
happen, and need further explanations
You seem closer to us than the
children’s doctor, so we thought you might answer our letter.

ANSWER: From your letter, I am assuming your adult son living in another city
is the person facing the surgery, and I will try to give you the explanations
you seek
To start with it is not cholesterol that is the cause of the
problem, but a condition that can result from repeated middle ear infections
that is called “Cholesteatoma”, a name that is easily confused with
cholesterol, but the two conditions are not related in any way
When the
chronic ear infections block the eustachian tube, which leads from the middle
ear to the back of the nose, the air in the middle ear is absorbed by the
body, and a partial vacuum is created
Normally the eustachian tube maintains
the normal ear air pressure necessary for the little bones contained here to
function properly and conduct sounds to the inner ear
When a vacuum forms,
it causes a pouch or sac to form by stretching the ear drum and sucking in the
tissue
As the pouch sheds its outer layers, it creates a skin growth made up
of old cells and tissue debris, and begins to grow much as a tumor might.
When this growing mass presses on the delicate structures contained in the
middle ear the tissues may be destroyed, and hearing loss, dizziness and even
facial muscle paralysis can result
The first symptoms usually are a
discharge from the ear, customarily with a foul odor, and a feeling of
fullness or pressure in the ear
Fortunately, the condition is treatable
At
first, antibiotics are used to stop the infection, and the ear is carefully
cleaned to stop the drainage
If the cholesteatoma is large, it must be
removed surgically, to prevent the complications from progressing
Once the
mass is completely removed and the infection eradicated, there are special
surgical techniques available to reconstruct the middle ear structures and
restore hearing if not completely, at least in part
The sooner the
operation can be performed, the better the results may be
I am sure your son
will do well.

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’re obligated during our church services to shake hands with the
people around us
I have no problem with this except when the people have
been sneezing or coughing into their hand for half an hour, and without even
bothering to wipe it off, extend it to me
I am wondering if after shaking
this person’s hand I wipe my eye or blow my nose, can I get what this person
has? And if so, what diseases can be transmitted this way?

ANSWER: I wonder how many other people have thought about this? I certainly
found your concern understandable and reasonable
I doubt that you can refuse
the handshake of fellowship during a service, so let’s look at some of the
things you might do
First, keep your own hands away from your eyes, and if
you feel the need to blow your nose, use your own handkerchief or tissues.
You might feel a bit better if you placed your hand in your pocket after the
handshake and managed to wipe it off on the handkerchief you had placed there
before church
It probably won’t be of much value, but it can help your
mental state
There are probably no serious diseases that can be transmitted
in the manner you describe, although the common cold is said to be one of the
illnesses that are frequently passed on in this manner
Any individual in
reasonably good health has the necessary defense mechanisms to prevent a
casual contact of this nature from developing into an infection of any
importance
As to diseases other than infectious, such as tumors, cancers, or
growths, there is no evidence that a handshake can transmit the disease
Last
but not least, and though you did not pose this as a part of your question, I
believe it important to state that AIDS cannot be transmitted in this fashion
either
Accept the gesture of good will and fellowship in the manner it is
intended, hopefully relieved of some of your anxiety by this answer.

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: Don’t publish my name, but please answer my question, as there must
be other people who also need this information
I am pregnant, and want to
know if my baby can be hurt if I use drugs (cocaine) during my pregnancy?
Doesn’t the placenta protect the baby from harm?

ANSWER: To your first question, absolutely yes! The baby can be harmed even
if you use cocaine just during your first weeks of pregnancy
To your second
question, absolutely not
The placenta offers no protection to the baby from
your habit
If you take the drug while pregnant, the baby runs the risk of
being born prematurely before it has had the chance to fully develop, can be
smaller and weaker than normal, can be more irritable, crying and disoriented
as a result of neurotoxicity (poisoning of the nerves) from cocaine
In
addition, the baby is at greater risk for serious infections during the first
six months of life
You can avoid most of these troubles by stopping your
habit now and getting real help
It is no longer just a personal decision,
but one that affects two lives
And you will need good prenatal care during
the pregnancy as well, to help assure the health of the baby when it is born.
To you, and the others like you, believe these words
Everything I have
written has been observed in babies born of mothers who had a drug habit
Get
help, get it now, and put your trust in those who are dedicated to helping you
through.

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 been prescribed a medicine called prednisone for some time
now
I am beginning to worry about some of the long term side effects which
might occur, and which I should be on the lookout for
Would you please
provide a list of them for me?

ANSWER: You question is similar to many others I receive asking about this
class of medications
Prednisone is only one of a group of medications which
I frequently refer to here as “cortisone like” medications, and which are
classified as adrenocorticoids (also corticosteroids or anti-inflammatory
steroids)
They are all used to reduce the swelling, redness, itching and
pain that may occur with inflammations or allergic reactions
They may be
used to treat a wide variety of conditions such as severe allergies, skin
problems, asthma or arthritis, to name but a few
These are indeed strong
medicines, and while they may be quite helpful in overcoming the problems
brought on by disease, they do have a number of serious side effects, for
which you must ever be on the alert
While many side effects are rare when
these medicines are used for short periods of time, a number can occur after
prolonged usage, and for which you must immediately contact your physician.
Here is a partial list of those I consider most important; abdominal or
stomach pain or burning, bloody or black tarry stools, irregular heart beats,
menstrual problems, muscle cramps or pain and muscle weakness, nausea or
vomiting, swelling of the feet or lower legs, unusual bruising, unusual
tiredness or weakness or wounds that will not heal
Since these medications
come in many forms, and bear many differing brand and generic names, it is
important to know when you are taking a medication from this classification of
drugs
Check with your doctor, nurse or pharmacist, and learn both the
generic and brand names of your medicines, and then write them down for future
use.

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: While it might not be a question of the greatest medical
significance, I’ll bet a lot of your readers would like to know the answer to
a mild dandruff problem
It is not devastating, but I can’t wear a dark suit
or jacket
Where does it come from and what can I do?

ANSWER: You are right in believing that this common problem affects many
people
Since the skin is constantly growing and shedding its outer layers, a
light sprinkling of dandruff may be considered normal
This should be
controlled by regular shampooing and thorough, careful rinsing
The overuse
of hair sprays may contribute to the number of unwanted flecks
Often an
intense scaling may be part of a skin condition known as seborrheic
dermatitis
In such cases, medicated shampoos containing tar, selenium
sulfide, sulfur and salicylic acid, or pyrithione zinc may be prescribed for
regular use
When there is considerable inflammation, a corticosteroid lotion
may be rubbed into the scalp until the situation is controlled
A caution or
two, if you do use medicated shampoos
Since they too may cause irritation of
the skin, it is important to use them only as directed by your physician or
pharmacist
Read the labels carefully and stop using the product if the
dandruff situation becomes worse
Keep coal tar and other medicated shampoos
out of your eyes
Use lots of water to wash out the eyes if you don’t
You
should be able to control your problem using these measures.

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 statements made, which incidentally seem to change
daily, I am totally confused about the role my diet may have in preventing
cancer
Can you make any sense out of the endless numbers and “facts” that
are printed each day, or reported on television?

ANSWER: The topic of health and disease prevention is one that most Americans
seem to be very interested in, and the news media is just trying to keep up
with all the very latest developments published in medical journals each week.
It is hard to report on all of this material, and to keep straight those
statistics which apply only to a few cases from those which are generally
accepted by many researchers and clinicians
Reducing the percentages of
calories obtained from fats in the diet is recommended by most
Reducing the
amount by about 10%, from 40% to 30%, may provide protection from breast,
colon, ovarian and endometrial cancer
Some experts would like to see that
percentage pushed even lower, to about 20% of total caloric intake
This
could reduce the risk of breast and colon cancer by as much as 80%
To
accomplish this, you are going to have to learn the fat content of various
food, and keep careful count
Fiber is another big item in the news these
days
It may decrease the chances of colon cancer by increasing the bulk of
stools, diluting possible cancer producing material in the stool and
decreasing the time they stay in contact with the cells lining the colon.
Fibers are present in cereals, whole grain breads, fruits and vegetables.
Calcium is also recommended, not only as a measure to prevent osteoporosis,
but also to reduce the chances of colon cancer
Daily intake of 1200 mg is
recommended
Other dietary items have been linked with cancer in some
studies: they are smoked, charred and nitrite cured foods
Stomach cancer
has also been associated with long time use of pickled and salted foods
If
cancer prevention is really your goal, there are two other items to be
mentioned, although they do not deal specifically with food
They are
exercise and smoking
Individuals with active occupations do seem to have a
lower risk of both breast and colon cancer
The use of tobacco can be linked
with about 30% of all cancer deaths, and it has been associated with cancer of
the lung, pancreas, bladder, kidney and possibly the cervix
Lung cancer is
now the biggest killer of women (21%), even more lethal than breast cancer
(18%)
In summary, if you desire to prevent that which might be preventable
by consuming a healthy diet, choose foods low in fat and high in fiber, keep
your weight down, exercise regularly, and stay away from tobacco.

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: Having just recovered from the problems of a drug allergy brought
on by a prescription medication
I was wondering if there wasn’t some way to
have predicted that this might have happened
Aren’t there any tests
available, and how does the doctor know that it was an allergy that produced
all my symptoms?

ANSWER: As a general rule, it is impossible to predict which patient may have
an allergic reaction to a drug, or to any other substance for that matter
An
allergy is an exaggerated sensitivity to a substance that usually produces no
reactions in most other people
A careful case history of previous
experiences with medications, or the presence of allergic reactions to
pollens, food, or animals may alert a physician to the possibility that the
patient is a sensitive individual, but does not guarantee that there will be a
reaction to the needed medication
Of course, any adverse experiences with a
medication previously would be sufficient warning not to use that particular
medication again
However, even when a medication has been used successfully
in the past, without any trouble, there is still no assurance that it won’t
provoke a reaction on this new occasion
When the disease is life
threatening, and only one medication can do the job, a skin test may be used
to evaluate the sensitivity of the patient, and help in deciding whether or
not to use the medication
Many so called allergic reactions are in reality a
side effect, and do not involve the body’s immune system; and testing of the
immune response to the substance reveals this
Abdominal upsets (including
diarrhea), sleepiness, and jittery feelings are samples of some reactions that
are not normally provoked by allergic mechanisms
When a true allergic
symptoms is discovered, such as a rash, hives, swelling, drug fever, or
wheezing, the first step is to discontinue the use of the medication
immediately
A careful history is sought to try to link the taking of the
medication to the onset of the symptoms
It is important to report the use of
any other medications taken at the same time, including over-the-counter
preparations, vitamins, pain killers and the like, as they may have been part
of the reaction
Once the drug has been stopped, the disappearance of the
symptoms within 24 to 48 hours makes it highly likely that the new medication
was the cause of the reaction, and this fact should not only be noted on the
chart, but remembered by the patient, and reported to any physician who is
faced with prescribing treatment.

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 father is in a nursing home, and we were recently called because
he had started to act peculiar and strange
After many phone calls and much
anxiety, it was discovered that his medications had been changed and he was
having an effect from his new drug
Could you please publish a list of
medications that can cause these frightening symptoms in older people? You
would be doing your readers a great service.

ANSWER: I wish the answer could be a simple as your request, for certainly
the circumstances you describe are a common and unfortunate occurrence, and
occur with greater frequency in older patients than younger folk
The truth,
however, is that the list of medications I would have to include would fill
pages of text, for the emotional and psychological effects you noted can occur
with many types of medications
The symptoms may range from depression and
anxiety to confusion, memory impairment, paranoia, irritability, rage,
insomnia, hallucinations, and even states resembling psychotic diseases.
Though many types of medications may be at fault, remember that each person
reacts differently to medications, and that in the greatest majority of cases,
all of the types of medications I will mention are safe and very effective for
the purposes they are prescribed
Anticholinergic drugs used for stomach
cramps and antiparkinsonian medications are one group of medications with such
side effects, along with tranquilizers, sleep preparations and medications
used for depression
Some medications useful in controlling asthma, others
commonly used for treating stomach ulcers may occasionally bring on spells of
disorientation and confusion
Pain medication of various sorts, even over the
counter ibuprofen, may in certain sensitive individuals cause depression and
paranoia, though the numbers of such cases are low
The point that must be
made here is that careful and close observation must be accorded to anyone who
is taking medication, and must be even more diligent when medications are
changed or added to their therapy
Since older people are more sensitive,
dosages should be low in the beginning, gradually working upward until the
desired effect is obtained
Whenever a change in the behavior pattern of an
older patient occurs, the first action is to review their medication list and
to discontinue the newest addition, while examining the patient for signs of
other new problems that might be causing the situation.

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 that when a pregnancy develops outside of the womb it may be
a dangerous thing
But how do you know it’s happening, and what causes this
to occur? My sister just went through this experience, and I am wondering if
it can happen to me as well?

ANSWER: Let’s start with your last question first, for I sense your anxiety
and wish to quiet your fears
There is nothing inherited about ectopic
pregnancy (the name of the condition when the fertilized egg fails to nest in
the uterus or womb), so the fact that you may share some your sister’s genes
does not place you at greater risk for an ectopic pregnancy
Frankly, we
don’t always know the cause, although the situation does seem to befall women
between the ages of 20 and 29 more frequently
There are some factors that do
seem to increase the risk, such as infections in the fallopian tubes (which
lead from the ovary where the egg is formed to the uterus), which make the
passage of the egg more difficult
When the tubes have been narrowed by
previous surgery or when tumors block the passage, the egg may not be able to
make its way to the uterus
When there is tissue that normally forms the
lining of the uterus present in or around the tubes (endometriosis), this too
can form barriers that prevent the normal transit of the egg
It is sometimes
difficult to make an early diagnosis of the condition, but some signs to look
for are a missed period, followed by abnormal or acute abdominal pain or
abnormal vaginal bleeding, which while sometimes scant is often heavy and
lasts for far longer than a normal period
Other signs that may be a clue to
an ectopic pregnancy after a missed period are dizziness, headache, weakness
or just a feeling that all is not right
In any case, an early visit to the
doctor will lead to the necessary tests than can diagnose the condition
Once
discovered, the only treatment is surgical, to remove the egg which has no
chance to develop, and to correct a situation which is life threatening
Even
after such surgery, it is still possible for a woman to conceive just about as
easily as in normal circumstances.

The material contained here is “FOR INFORMATION ONLY” and should not replace
the counsel and advice of your personal physician
Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

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QUESTION: I am a woman past menopause, and have been put on estrogen by my
doctor
Although I was sure it was being prescribed to prevent osteoporosis,
I was informed that it would help with my cholesterol level, and protect me
against heart attack
Would you comment on this, please?

ANSWER: For a long time physicians have been aware that prior to menopause
heart attacks were rare in women
However, once past menopause, and in the 6
to 10 years that follow, the chance of heart attack in women gradually
approaches that of men
Now researchers are saying the most important benefit
of estrogen replacement therapy (ERT) is protection against cardiovascular
disease and heart attack
The risk of death from cardiovascular disease in
women on ERT is but a third of that of women who do not take estrogen
Women
on ERT have higher levels of high-density lipoprotein (HDL, frequently
referred to as the “good” cholesterol) than postmenopausal women who on not on
this therapy
However this beneficial effect disappears when the therapy is
discontinued
There is still some controversy as to whether this therapy
should be combined with the use of another female hormone, progesterone, or
whether the therapy may be used in women with the history of blood clots
(thrombophlebitis, for example) or in women with fibrocystic breast disease.
There is no question about its value in preventing osteoporosis, and the
serious fractures that may result from that disease.

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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