Health information

QUESTION: When my husband’s hand started to shake, we thought it was a sign
of Parkinson’ disease
However we are now told that it is something called
“essential tremor”
It has gradually become worse and it now affects his
voice
Does this mean he will someday develop a full blown Parkinson’s? Do
you know of any treatments that might help? Thank you.

ANSWER: Some estimates place the number of people with essential tremor to be
in the millions, and certainly it is the most common tremor disorder seen in
the United States
It may start at any age, but usually begins during
mid-life
There is a positive family history in about 50 percent of the cases
which helps to differentiate it from Parkinson’s, where the family history is
most often negative
While it often only affects one side of the body, it can
touch the hands, legs, head and trunk, and the severity varies greatly from
person to person
There is no link between essential tremor and Parkinson’s
disease
A peculiar aspect of essential tremor is that drinking alcohol can
dramatically reduce the shaking, a situation that does not occur with
Parkinson’s
Both propranolol (80 to 320 mg/day) and primidone (50 to 250 mg/
day), alone or together, offer real hopes for improvement.

The material contained here is “FOR INFORMATION ONLY” and should not replace
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Promptly consulting your
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QUESTION: My boy friend claims that his exercise program is good for his
blood
Is it possible that there are changes that are caused by his physical
activity which may be considered to be of benefit to him?

ANSWER: Regular exercise does cause several changes in your blood, but these
are helpful ones
As you know, regular exercise reduces the risk of a heart
attack by lowering blood pressure, reducing body fat and blood cholesterol
levels, and making the heart more efficient
The change that occur to the
blood may also have a role in helping protect the heart.
The major exercise-related changes in blood are a decrease in hemoglobin
concentration, a decrease in platelet activity, and an increase in
fibrinolysis
These changes appear to reduce the risk of thrombosis, the
formation of a clogging blood clot within a blood vessel
A heart attack is a
blood clot within one of the arteries supplying the heart, so any reduction in
the risk of thrombosis is a lessening of the risk of heart attack.
While a decrease in the concentration of hemoglobin in athletes sounds
like bad news, it is not due to a shortage of red blood cells, but to an
increase in the amount, or volume, of blood plasma, the liquid portion of
blood
This increase in plasma volume is a good sign of aerobic fitness.
Increased plasma volume makes blood less viscous, which may decrease the risk
of thrombosis
Any reduction in oxygen-carrying capacity is offset by
increased heart efficiency and sweating during exercise
The drop in
hemoglobin concentration is sometimes called “athletes’ anemia” or
“pseudoanemia,” but these are misnomers.
Regular exercise also appears to decrease the aggregation of platelets,
the cells within blood that forms clots
Platelet aggregation is the first
step in the formation of a blood clot
This effect may also decrease the risk
of thrombosis and may reduce the risk of heart attack.
The third way that exercise changes the blood is by activating
fibrinolysis, the body’s way of getting rid of old blood clots
This increase
in fibrinolysis is greatest in those that exercise most, and so people who are
the most physically fit appear to dissolve clots faster than those who are
less fit.
The key to all this is regular exercise, especially aerobic exercise such
as running, cycling, brisk walking, or aerobic dancing
The word “regular”
cannot be stressed enough
To get the benefits of exercise, you must do it
for at least a half an hour and at least three times a week.

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 never been one with a zest for athletics or exercise, but
with all the articles about the benefits to be gained from a measure of
physical fitness, I have tried to get into it
Although I have purchased a
home exercise machine, and brought all the accepted clothes, I find that, for
a third time, my best intentions have led me nowhere
I want to get this
thing going, and will try one last time
I hope you may have some advice to
help me make this time a success story
How about it?

ANSWER: If ever I could relate to the problems presented by a reader in a
question, this is certainly true of your example
Actually, I think there are
more of us than those muscular specimens, or the dedicated marathoners who
can overcome the obstacles, and achieve a level of fitness we can only dream
about
But there is help for those who are confirmed couch potatoes, and
there is a richness of rewards to be gathered if we can get a few things in
order and develop a plan that has merit
In your case the first step is to
reflect back over the past failures, and attempt to discover what went wrong.
Then make a determined effort to change those elements that caused you to
abandon your activity so they won’t interfere this time around
Apparently
your equipment wasn’t much fun, so this time chose an activity that you can
enjoy
Walking, roller skating and swimming can often accomplish just as much
as a workout on an expensive apparatus, and may be easier for you to complete.
It is essential that you choose a time for exercise that has no or few
conflicts with other schedules
That will eliminate the excuse that “there
just isn’t time to exercise today”
If you can work out with a partner or
group, the chances are you will stick with it this time
Having an
“accomplice” makes the time pass more rapidly and more pleasantly for someone
who does not derive joy from the mere physical aspects of an exercise program.
The last word of advice is to set reasonable goals for your activities, and
allow enough time, say twenty weeks, for some of the results to show
Once
you note the new spring in your step, the ease with which you accomplish
physical tasks, and the general sensation of well being that exercise can
provide, it will be more difficult for you to abandon your successful
endeavor.

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 you when you encourage us to get more active, and
probably would try, but when I speak to people who seem to know they tell me
that there is “no gain without pain”
Sorry, but I am a coward and can’t see
the sense of damaging my joints and enduring more aches than I already have.
You will have to do a better job to convince me.

ANSWER: You’re right there is no upside to causing yourself injury in order
to improve your health
However, your question is based on some common
misconceptions regarding exercise.
First of all, throw that “no pain, no gain” concept out the window where
it will probably hit one of the masochists who believes in it on the head (a
sensation that person will no doubt enjoy)
It’s simply not necessary to
exercise to and beyond the point of pain to benefit yourself
The best
approach is to condition your muscles slowly to deal with higher levels of
performance
A little soreness in the days after stretching unused muscles is
normal, but pain during exercise is a no-no, and a cue to stop or avoid
putting stress on the tender area.
Nor are the body’s joints automatically subject to damage during
exertion
A variety of low-impact exercises, including swimming, light weight
lifting, and simple aerobics will benefit your health without risking your
body while mixing a variety of options will keep your exercise program from
growing stale and boring.
A little exercise can go a long way too as little as three weekly
workouts lasting 20 to 40 minutes each can extend life and help fight
cardiovascular and respiratory diseases
You can check with your local “Y” or
exercise center to find out about programs that will put your fears to rest
and your body to work
And check with your own doctor, who may be able to
advise you of exercises that may benefit your personal health, as well as the
limits that you should respect.

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 friends are beginning to call me a spoil sport because I refuse
to join in an occasional tennis game, but the fact is I get a terrible
headache every time I play
Naturally when I try to explain this, I am the
subject of a lot of horse laughs and quite a bit of ribbing, not all of it too
good natured
Have you ever heard of a case like mine, and would you please
write about it so that I may have both your good information and an answer for
my friends?

ANSWER: Severe headaches are never a laughing matter, particularly when you
are the one that has it, but I can offer you some reassurance that the
condition does exist
Its called, quite naturally, “exertional headache” but
also bears a few other more descriptive names such as “cough headache”,
“weight lifter’s headache”, “orgasmic headache” and “footballer’s migraine”,
and I guess we might add another in your honor, “tennis headache”! An
exertional headache will occur during or right after a period of physical
activity
It is most frequent in people who are not in great physical shape,
and who most probably have a family history of migraine headaches
In some
cases where the diagnose of migraine was not made, a history of headaches
after skipping meals, after drinking alcohol, headaches when stressed or tired
may be present
Generally the exertional headache will last anywhere from a
few minutes to several hours
A good diagnostic workup is indicated to be
sure that you are really suffering from this type of problem, which is also
labeled “benign” since there are rarely any other serious underlying ailments
associated with it
There are several precautions that can help you.
Avoiding alcohol before your turn on the courts may help
In many cases
taking an short acting anti-inflammatory medication such as ibuprofen or
meclofenate may either prevent or shorten the attacks
If such attacks are
frequent and severe, taking medications such as indomethacin or naproxen
sodium on a regular basis to prevent them can also be considered
Discuss
those possibilities with your own physician, as these are prescription
medications.

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 thirteen year old girl, and have wanted to be a family
doctor ever since I was very young
Could you tell me about how many years of
college I would need, internship and residency?

ANSWER: Gladly
I was thirteen too when after a serious attack of pneumonia
I decided I wanted to be like the doctor who had cared for me, and began to
think about and prepare for my profession
It is not too soon for you to do
the same thing
Following high school, you must attend college
Most premeds
take a four year course, and develop majors in chemistry, biology or sometimes
physics
But it is important to gain a broad education, to better understand
the way people live and act; so studies like sociology, psychology, economics
and even philosophy are important courses to elect
From my personal
perspective a good communications course or some theater can also be helpful.
But don’t neglect the general courses, particularly English and history, for a
family physician must be a well rounded individual (educationally speaking, of
course!)
Then it is on to medical school, for four very long and very hard
years
There is so much to learn, and never enough time to study it all
But
you do get it done somehow
The next choice is postgraduate study
Family
Medicine is taught in approved residency programs throughout our country, and
your course of study there will last three years
During that period of time
you will rotate through different “services” that include Family Medicine,
Internal Medicine, Pediatrics, Obstetrics, Surgery, Psychiatry, as well as
practicing your newly learned skills in an Ambulatory Care Center, where you
care for your own patients under the supervision of your faculty
After the
three years are done, there is an examination given by the American Board of
Family Practice, which once passed, qualifies you as a specialist in Family
Medicine
Now you are ready for practice, but your studies are not done, for
you must retake the examination every seven years to prove that you are
keeping up with the latest developments in medical care
At age thirteen, it
may seem like a long trip, but there are few other professions that offer you
as wonderful an opportunity to serve others, and the satisfactions that are
yours when you do the job 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: I really appreciate your answers to questions about nutrition, fat
and losing weight
My question is: when you lose weight, where does the fat
go? What form is it in when it leaves your body? Please go beyond just
saying that your body burns it
What happens in the burning process?

ANSWER: Fats, to use the term in its broadest chemical sense, are composed of
long chains of carbon and hydrogen atoms, with just an occasional oxygen atom
here or there
In this fashion they resemble both carbohydrates (which
contain more oxygen) and proteins (which contain, in addition, atoms of
nitrogen)
In contrast, coal and fuel oils which also give energy when
burning are simple hydrocarbons, containing only hydrogen and carbon but no
oxygen
And oxygen is needed for the “burning process,” both in and out of
the body
When it occurs the process is known as “oxidation”, and the
chemical reaction provides the heat and energy we need for all body functions.
During this process the fats are broken down, their hydrogen and carbon atoms
combining with the oxygen to form (in the very last stage) water (H2O) and
carbon dioxide (CO2)
Thus you breathe in oxygen but exhale carbon dioxide,
and a great deal of water vapor too
In many ways the process is identical to
burning coal, which produces flame in addition to the heat and energy
In the
body the reaction is not quite as dramatic, and is handled by a wide
assortment of enzymes and other chemicals
When the body requires more
energy, to provide for muscle contractions during exercise for example, the
oxidation process must be turned up
Although the body generally uses its
carbohydrates (sugars) first for this reaction, it must soon use the reserve
energy resources contained in the fat tissue when those carbohydrates are used
up
And when fat supplies are gone, the body starts to burn its proteins
(contained in muscles) as the fuel for the needed energy
That explains the
often written statement about balanced nutrition and regular exercise as the
proper prescription for weight loss
If you keep the fire going, but limit
the amount of coal you shovel on, your “coal pile” will soon disappear!

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 our baby recently had a convulsion during an illness with a
high fever, we were tremendously upset
Although we were told such things are
common, it has left us with a great deal of apprehension
Could you please
discuss this situation and give us the information we should be considering?

ANSWER: Febrile seizure is a convulsion (a violent and involuntary
contraction of the muscles of the body and limbs) caused by a fever in
otherwise healthy children, usually between the ages of three months and five
years
It can last anywhere from under two minutes to over fifteen, and can
occur more than once in a twenty four hour period.
While convulsions of this type are common during childhood bouts of flu,
colds, ear infections and other infections which produce a high fever, parents
have a right to be concerned, for it is a frightening experience
Let me
reassure you
In the great majority of cases there really is nothing to fear,
and reducing the child’s fever will usually prevent a reoccurrence of the
seizure
However, any incident of febrile seizure should be brought to the
attention of the family physician to rule out more serious causes such as
encephalitis, meningitis, and epilepsy.
If there is reason to suspect that the seizure may have other causes than
just fever, a full examination is recommended
Post-seizure evaluation begins
with thorough history-taking and physical examination
Anticonvulsant
medication, further testing, and x-rays are ordered only if the seizures are
complicated
For instance, an EEG or brain wave scan to detect structural
disease such as tumors would be indicated for seizures that may have lasted a
long time or affected just one part of the body
It sounds as if you have no
cause for worry, but it is advisable to check it 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
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QUESTION: When I called my doctor recently to ask for help with a high fever
during a bout with a serious throat infection, he told me that the high
temperatures were helping me fight the infection
I always thought a high
fever was bad for you, so I don’t understand what he was trying to tell me.
Have you any information that can explain his comment?

ANSWER: The normal body temperature is considered to be 98.8 degrees
Fahrenheit (37 degrees Centigrade)
When it exceeds 100 F (37.8 C) orally or
100.8 F (38.2) rectal, it is considered to be a “fever”
This elevation can
be caused by many illnesses, but when there is an infection attacking the
body, the higher temperatures do indeed have a role in fighting the invading
bacteria
Bacteria thrive best at the normal body temperature, and they are
slowed down by higher levels
The higher the temperature, or more pronounced
the fever is, the more vulnerable the bacteria become
That makes it easier
for the body’s own defenses, such as the protecting white blood cells, which
literally eat up the bacteria to reduce the spread of the infection and
eradicate the foreign bacteria
Unless the fever becomes uncomfortably high
or provokes a convulsion, it can be allowed to run its course
Fevers are
generally higher in the afternoon or early evening and are higher and more
frequent in children than adults
As you get older, the body reaction to
infection is lessened and the level of the temperatures are also reduced.
There are a few things you can do to make a fever more tolerable
Drink
plenty of liquids when a fever is present
Bathing in a tub of warm water is
helpful, and it is unnecessary to subject yourself to the uncomfortable
experience of a cold or lukewarm sponge bath
When considering children or
teenagers and infections, particularly those caused by viruses (such as
chickenpox or flu) aspirin is a no-no as it can lead to a serious condition
known as Reye’s Syndrome
Acetaminophen, in tablet or liquid form, is
preferred
Dress in light, loose fitting sleepwear, and allow the evaporation
of perspiration to help make you more comfortable
Usually when intense
sweating develops, the infection is just about conquered, and you are on the
road to rapid recovery.

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 on medicine for my hypertension for a long time
It’s
a pill called a water pill, and my old doctor was satisfied with the results.
Since moving and changing physicians, I am now advised to use another
medication because these pills raise cholesterol and could be bad for me,
according to my new doctor
Do you have an opinion about this?

ANSWER: I have opinions about most things, but unfortunately, according to my
wife, they are not always correct
On the question of diuretics (that’s a
fancier name for water pills) however, there is much controversy and
disagreement
According to recent studies it does seem clear that diuretics
have a negative effect on fats (lipids) in the blood and will raise the level
of cholesterol as well as the low density lipoproteins (the “bad” ones) while
not increasing HDL cholesterol (the “good” ones)
In addition, diuretics seem
to lower insulin sensitivity which could increase the risk of developing
diabetes in some individuals
However, physicians with a favorable opinion
about diuretics claim that there is no proof that the effects on cholesterol
remain true over the long haul, or that the changes in insulin sensitivity are
clinically significant
Many physicians believe that the newer medications
for hypertension, beta blockers, calcium channel blockers and angiotensin
converting enzyme inhibitors (ACE inhibitors for short), are medications that
should be used in the initial treatment of the condition
And there is good
proof to support that position as well
In individual cases, it is the
personal history and physical condition of the patient that may lead the
physician to consider the use of one type of medication over the other
It
may be unwise to use a diuretic in a patient who already has an elevated
cholesterol, or is a diabetic depending upon insulin to manage that condition.
As in so many situations in medicine, it takes a complete knowledge about the
patient and concern for their well being to make a decision of this nature
I
would talk it over with your new doctor, find out why he is advising a change
in a medication you seem to be satisfied with, and then participate in the
decision based upon your new knowledge.

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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