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QUESTION: Our daughter, whose marriage has been on the rocks for two years
now and lives with us, was assaulted on her way home from a date, and was
found unconscious
When she finally came to at the hospital, she could not
remember a thing about the attack, us, her husband or job
Yet the doctors
tell me there is nothing physically wrong with her and that treatment will
gradually restore her memory
We need to know if this is possible, and what
we should do to help her
We don’t have a lot of money.

ANSWER: You won’t need any money for this answer, and the good news is that
if all you have told me in your long letter is correct, the diagnosis and
treatment all sound rational to me
Although psychological diagnosis depends
upon knowing the patient an all the circumstance quite well, my impression of
this situation is that your daughter is suffering from psychogenic amnesia.
This occurs when the patient has been through a traumatic or a very
distressing situation, and can happen even when there are no injuries to the
brain
Although the amnesia is usually just for the short period that covers
the hours after the trauma, it can be more generalized and effect a longer
memory period, as in the case of your daughter
There are many theories to
explain the causes for the memory loss, but it frequently happens in young
adults who have no previous history of mental disease, and may even be caused
by natural disasters such as earthquakes and floods
There are many types of
therapy, including medication, behavioral modification, and psychotherapy,
which is the treatment most frequently used
Many patients recover after a
short time without any special treatment, but all sufferers from amnesia
should be followed closely by a physician who is alert to the possible
complications that can arise
Your description of your doctor convinces me
that he has the situation in hand and the care of your daughter is proceeding
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: With all the medicines available today, there is still nothing as
good for a person as a good cleaning out
When I was younger it was not
infrequent that our own doctor would prescribe a purge, that soon put things
to right
I don’t know of any doctor in my area today that knows about this,
and sometimes wish these younger fellows would take a lesson or two from their
elders
Perhaps many conditions that have no treatments today could be cured.

ANSWER: You are advocating some pretty strong medicine, that may have no
beneficial effects at all to the sufferer
We have learned a great deal since
those days when physicians, just like patients, believed that the inside of
the “bowel” (meant to include the entire digestive system) was filled with
dirty and poisonous material
Daily movements were required to keep the
system “clean,” and constipation was a serious situation
Castor oil and
Epsom salts were administered in huge doses to obtain the desired effects.
The intestine was stimulated, causing forceful contractions to push out all of
the contents, and frequently provoked more harm than good
We now have a more
restrained view of bowel functions, and while daily regularity is a comforting
thing, it is no longer considered a must
A good diet rich in fiber can often
be all that is necessary to keep a person’s bowels in order
It is far more
important that our systems function in a normal and timely way, rather than in
the unnatural fashion provoked by excessive stimulants.

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 was playing around with my neighbor’s dog when it got very
excited, started growling and then bit me on the hand
They weren’t deep
cuts, and my neighbor assures me that the dog has all its shots, but my wife
thinks I should visit the doctor for rabies shots
I don’t want to have a
long series of painful injections if it’s not necessary, so I need a quick
reply from you
What is your advice?

ANSWER: Rabies is not a disease to fool with, for without proper treatment
when indicated, it is still almost always fatal
Rabies is a viral infection
of the central nervous system, and its treatment depends upon the fact that it
has a long incubation period, usually from 20 to 90 days, (although it can
develop in a period as short as 4 days or take more than five years to
develop)
The treatment no longer is quite as painful or as difficult as you
may have heard
The initial treatment requires two injections, one of human
immunoglobulin, the other of rabies vaccine
Four more rabies injections will
be given over the next 28 days, permitting the patient to acquire a resistance
before the disease itself has had a chance to develop
The circumstances of
the bite determine whether or not this series of injections is required
If
the animal is known, as in your case, and when the dog has had all of its
immunizations, it is possible to merely observe its behavior for 10 days, to
see if signs of rabies develop
You should report the incident to your local
Health Department, who will know if rabies is present in your area, and who
can advise you of your best plan of action
They will probably want to
examine the animal for signs of the rabies virus
You’re lucky it was a
domestic animal with a clean history
When the bite is the result of a wild
animal’s actions, a raccoon for example, there is a much greater chance that
rabies is present and treatment should begin at once
Rabies is not a pretty
thing to watch as the first symptoms of fever, nausea, headache, lethargy and
a tingling sensation at the site of the bite, rapidly progress over a ten day
period to hyperactivity, disorientation, hallucination, difficulty in
swallowing, followed by seizures, paralysis and death
Once symptoms start
there is no cure, so get hopping with your investigations of this animal.

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: Is there a condition where the muscle turns into a bone? A friend
of mine had an x-ray of his arm, and there was a piece of bone seen that
normally isn’t there
The doctor says that the only way to treat it is to
remove it with an operation, but wants to wait a while to see how big it is
going to get
Is this right? Please help us.

ANSWER: The condition is one that is known, and bears the impressive name of
“myositis ossificans”; but it really isn’t muscle turning into bone, although
that is the meaning of the translation of these words which come to us from
the both the Greek (”myo” means “muscle”) and the Latin (”ossificans” means
“to make bone”)
Actually the process begins with an injury, usually a
contusion or strain, in which the muscle is torn, and blood collects in a clot
called a “hematoma”
The most common spot for these types of injuries are the
thigh, followed by the mid arm
The bone formation usually only occurs on
severe injuries, and may also involve a clot infection after a respiratory
infection
Slowly the clot is transformed into bone, possibly from bone cells
which came from an injury to the covering of the bone (periosteum) which might
have occurred at the same time
The bony mass keeps enlarging for as long as
six or seven weeks, after which a process of resorption begins
Small masses
may disappear completely, but when a large bone mass remains after a longer
period of time, the only way to remove it is by using surgical techniques.
Interestingly enough there is another situation in which such benign bone
growth may be seen, and it is called “drug user’s elbow”
Here the process
starts with the injuries to muscles and surrounding tissues that have been
caused by the unskilled use of a needle that was in search of a vein, but
instead ripped the other tissues in the area
The brachialis muscle of the
upper arm is the muscle most commonly injured
If your friend’s doctor
believes that his injury is recent, he is correct in waiting a bit to see
what develops before attempting to remove abnormal bone.

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

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QUESTION: I have a problem that seems to be destroying my toenails, and am
looking for a quick solution before they completely disintegrate
The nails
are thick and dull, and there is a lot of junk under them
Do you know what
this is and what I can do to stop it?

ANSWER: It sounds like a type of onychomycosis (fungal infection of the
nails) to me, sometimes called “tinea ungulum” or “ringworm of the nails”.
This can occur when certain fungi called “dermatophytes,” which only attack
the dead tissues of skin, nails and hair, infect your toe nails
The most
common type is usually of the Trichophyton family
It might also be a candida
infection or the result of psoriasis
You need to be certain, as there are
specific treatments available when the cause is clear, griseofulvin for
trichophyton, for example
However, there is no quick fix; it will take time
before the infection can be conquered and your new nail can grow out.

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 writing concerning an article I read a month ago with news of
a new treatment for bed wetting
My daughter is seven years old and the
problem is very embarrassing
We have tried drops for allergies, which helped
some, but the problem is still there
I can’t find any information on the new
treatment
Can you help me? Thank you.

ANSWER: The medication, which was just recently approved by the Food and Drug
Administration (FDA) is desmopressin acetate (DDAVP Nasal Spray marketed by
Rorer) and may be used in both adults and children
Normally the levels of a
hormone that prevents the kidneys from producing urine (called vasopressin)
rises at night, so little urine is formed or stored in the bladder
However,
in some individuals the quantity of this antidiuretic hormone stays low during
the overnight hours, and the amount of urine produced is much higher, and in
youngsters where the control of the muscles that keep the bladder closed is
not fully developed, results in bed-wetting at night
DDAVP is a synthetic
chemical resembling the hormone and fools the body into thinking that there is
sufficient hormone present, and so urine production is lowered
Although most
children can urinate on command by age four, It isn’t until they have passed
age five or six that they can hold their urine in when there is a bit of
pressure in the bladder
Girls are better at this than boys, and control
urination at an earlier age
When bed-wetting continues past age five in
girls or age six in boys, the new medication, which is expensive, can be
considered for use by your physician (it is “by prescription only”)
One or
two puffs from the nasal spray pump usually is sufficient to control the
problem
Once wetting is under control, the medication may be used on an
every other night basis
It takes about three months of regular use to
achieve regular dryness, and when the medication schedule is interrupted
before that, bed-wetting may recur immediately
A complete study is necessary
to be sure that the problem is only night bed-wetting (or nocturnal enuresis,
if you wish the medical terminology), and not the result of another medical
condition, diabetes or urinary tract obstruction for example.

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’ve read all the books, listened to all my friends and cut back on
my daily food intake
I still can’t lose a pound, and I haven’t a clue as to
why
I am even exercising as if I was a teenager, but still have my middle
age figure
Is there anything you can tell me? There must be thousands of
your readers with the same problem
Please help us all.

ANSWER: There are many letters each week that speak of the same frustration.
Having been on a diet or two myself over the years, I know how aggravating the
morning ritual of stepping on an uncooperative scale can be
Though there is
no escape from the need to reduce calories and increase activity to lose those
extra pounds, the choice of the foods included in the diet play an important
role because of the different manner in which our bodies handle fats and
carbohydrates
The statement by many people that the food goes directly from
the mouth to the hips is not entirely wrong
The body coverts the fat in food
into body fat with great ease, particularly when the meal also includes
carbohydrates or sugars that provide the energy
When sugar enters the
bloodstream it stimulates the release of insulin, which then activates the
enzymes which help the passage of fat from the bloodstream into the fat cells.
Even calorie-burning exercise can’t prevent the fat from being stored in this
way, and once it is in the cells it is very difficult to shed
But
carbohydrates are stored first as glycogen, much of it in the liver
Although
the capacity for glycogen storage is limited, the body can expand its capacity
in individuals who exercise
When the maximum is reached, then the body may
increase your metabolic rate and burn off additional carbohydrates
It is
only when these two mechanisms are overburdened by the quantities of
carbohydrates coming into the system, that conversion to fat takes place
So
the answer may be to reduce your fat intake to the minimum, and utilize
carbohydrates to provide the calories you need for energy and work
In
practical terms, you may eat the potato without the butter, and the pasta
without the Alfredo! Add a modest portion of protein, maintain a comfortable
exercise program, stir in a bit more patience, and you have the formula for
beating the battle of the scale.

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 find that there is still medicine left over in the vial long
after my symptoms have disappeared, probably because the doctor orders too
many
If I stopped taking medicine then, would it do me any harm? I don’t
like taking chances, but I don’t want to take these pills if I don’t have to
any longer.

ANSWER: The safety and success of any treatment depends largely on how
closely the patient follows the doctor’s instructions
If your doctor
prescribes a particular amount of a drug, he does so for a reason.
If you stop taking your medicine without your doctor’s knowledge, the
condition it was prescribed to treat may get worse
Feeling better does not
always mean that the disease is cured
Taking too little of a drug can delay
or even prevent the beneficial effect your doctor is trying to achieve, and it
may even lead him to prescribe a second, stronger drug with more side effects,
in the mistaken belief that the first drug wasn’t effective
This is a
frequent happening when the patient doesn’t tell the physician that he stopped
taking his medicine.
By the way, it is just as bad to take more of a drug than your doctor
prescribes
The idea that “if one pill is good, two is better” is not only
false, it can be dangerous
It takes a lot of study to keep up with the way
medications work, and these indications form part of the doctor’s thinking
when prescribing medication in certain quantities
Medicines work best when
properly used, in the dosages and for the length of time that are prescribed.
When you become a partner in your own medical care, and communicate with your
physician, your medicines can do the job for you they were intended to do.
Not taking your medicine exactly the way your doctor prescribed it is
called “noncompliance.” The most common reason for noncompliance is a
misunderstanding or a lack of communication, so make sure you understand
exactly what your doctor wants you to do, and follow those instructions.
Don’t be afraid to ask questions or to tell your doctor that you don’t
understand what he has told you
He wants to help you get well; that’s why he
became a doctor in the first place.

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: Now that smoking is socially unacceptable around my house, I am
losing another battle as well; my weight is surging upwards, something I have
tried to avoid for my entire adult life
What’s a woman to do? I think I
would rather be a thin smoker taking my chances than look like I do now
Can
you please figure a way out for me?

ANSWER: Most experts will agree that, while the amount varies considerably
from a low of nothing at all to an unacceptable high, most people who finally
stop smoking will average a weight gain of from two to ten pounds in the month
that follows quitting
But the risks of that additional unwanted weight is
little compared to the many health risks provoked by continued smoking
And
you can get rid of the extra weight
Many people crave high calorie sweets
when they come off of smoking, so find some low calorie food that will help.
Even chewing gum can help you here
If you can add about an hour a day of
some brisk activity (yes, fast walking counts), you can probably stem the tide
of weight gain and get things back to normal in a few weeks’ time
However,
under no circumstances should you start smoking again as an answer to your
controllable weight gain.

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 believe my vision isn’t as good as it used to be, probably
because I am getting on in years
Still I don’t want this to put a damper on
an otherwise satisfactory way of living
I am looking to you for some help,
perhaps a few tips on how to deal with this problem
I know there are many
other people who could use some good advice about this problem.

ANSWER: Although I can offer you a great deal of advice, probably the first
thing on your agenda should be a visit to your eye specialist, who can not
only determine the present state of your vision but take the appropriate
steps to treat any underlying diseases
Even if nothing can be done to
reverse your vision loss, you may still be able to preserve what vision you
have.
Here’s the first bit of help
You may qualify for a free medical eye
examination, (not an examination for glasses) supported by the American
Academy of Ophthalmology
If you are 65 or older, haven’t had an eye exam in
the last 3 years, and are in financial need, you may call 1-800-222-EYES to
find out if you qualify.
Next, understand that you are not alone
In the United States there are
11.4 million people with visual impairment, which can be defined as not having
enough vision to function normally
Visual impairment varies
Some people
have excellent peripheral vision but cannot read because their central vision
is poor
Others, with good but narrowed central vision, can read but not get
around easily
Still others have completely blurred vision.
There are many groups that help people with poor vision
Two are the
National Society to Prevent Blindness: 500 E
Remmington Road, Schaumberg, IL
60195, (800) 221-3004; and the American Association for the Education and
Rehabilitation of the Blind and Visually Impaired: 206 North Washington
Street, Alexandria, VA 22314.
Visual aids can help you enjoy life and continue to function
independently
These include special glasses, hand-held magnifiers,
telescopic lenses that fit on regular eyeglasses, and even computers that talk
instead of printing information on a screen
An optometrist (an O.D
who
deals with nonmedical vision problems) can fit you with special glasses and
instruct you on choosing the right visual aids for you
The American
Optometric Association (243 North Lindbergh Blvd
St
Louis, MO 63141, (314)
991-4100) can give you the name of an optometrist who specializes in working
with low-vision
Optical aids are also available through the National
Association for the Visually Handicapped (22 W
21 St
New York, N.Y
10010,
(212) 889-3141) and the American Foundation for the Blind: 15 W
16 St., New
York, N.Y
10011, telephone; (800) AFB-LIND, in New York State (212)
620-2000.
In addition to visual aids, there are many other items that can help you
live better
Many books and magazines are printed in large type or are
available on audio cassettes or records
Most larger libraries now stock
large-type books and many bookstores sell audio cassette versions of recent
best sellers, some of which are read by leading actors
Reader’s Digest is
available in large type, Braille, and talking book editions; and there is a
weekly large-type edition of the New York Times
There are even large-type
playing cards and a large-type version of the Scrabble word game
With all
these aids, you may continue your fine lifestyle without allowing your vision
problems to decrease your enjoyment.

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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