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QUESTION: My doctor has phoned with a report that my Pap smear is abnormal,
and that he wants to see me again
What next? Does this mean I am sentenced
to surgery and must have my uterus removed? Please answer
I am sick with
fear.

ANSWER: You are a long way from surgery, on the basis of this preliminary
report
While the cells may be abnormal, they may not be precancerous, due
instead to infection or inflammation
Let’s take it step by step
Another
smear may be indicated after treatment for infection, if your physician feels
that this may be the source of the abnormal cells
A colposcopic examination
is in order, the colposcope being an instrument that resembles a pair of
binoculars, and permits the physician to examine the cervix closely
If there
are any suspicious areas seen, the physician may take a small sample of tissue
or “biopsy” for microscopic examination and diagnosis
If the cells are
precancerous (frequently called “dysplasia”), there are several types of
treatment to choose from, all effective in removing the abnormal tissue.
Laser techniques use an intense beam of concentrated light to vaporize and
destroy the affected areas on the cervix
Intense cold may also be used to
destroy abnormal cells with a technique called “cryotherapy”
A portion of
the cervix can be removed surgically, removing a cone shaped portion of tissue
that contains all the abnormal areas
The procedure is called “conization”.
The uterus is removed (hysterectomy) when the dysplasia is advanced or
pronounced, and when other simpler methods have not been successful
The good
news is that more than 90 percent of all cases of cervical dysplasia are
successfully treated using laser therapy, cryotherapy or conization
The
early diagnosis obtained by Pap smears give a bright outlook for patients, who
may have abnormal tissue removed before it has advanced or spread, with
techniques that leave the uterus intact and without major surgery.

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: How long must I continue to have pap smears? I am 45 and have had
normal smears for the last 4 years
I am further concerned because I have
read that these tests are not as reliable as once thought
I would not like
to see the money spent for these tests wasted.

ANSWER: The value of this test which screens for cervical cancer is widely
accepted, as its use is responsible for the decline in the chances of a woman
dying from this disease from 41 in 10,000 to 5 in 10,000
But there is some
discussion as to the frequency of the test needed to maintain this great
record
The American Cancer Society recommends starting when sexual activity
begins or age 18, which ever comes first, and when two consecutive yearly
screenings are negative, continuing every three years and stopping at age 65.
The 1980 Consensus Development Conference on Cervical Cancer Screening held by
the National Institutes of Health removed the limitation on age, continuing
the tests no matter how old the patent was, on an every three year basis.
However, the American College of Obstetrics and Gynecology recommends yearly
screenings, continuing throughout the life of the patient
There is no
question that the smear must be obtained carefully, following a precise
protocol, and then analyzed by a laboratory which is competent and qualified
to perform these evaluations.

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: Although I knew a bit about the thyroid condition that you recently
wrote about, I would now like you to explain a bit about the parathyroid,
which I never heard about until recently when a friend of mine had one
removed
I read your articles regularly and enjoy them very much.

ANSWER: Thank you for your kind words
The parathyroids are glands of the
endocrine system
Normally we have 4 of them, all quite small, 4 to 15 mm in
length and from 3 to 4 mm wide
All together they only weigh about 1 gram.
They get their name because they are attached to the much larger thyroid
gland, two on each side
They produce the parathyroid hormone, which is
important in regulating the amounts of calcium circulating in the blood and
present in the body
When one or more of these glands secrete too much
hormone, a condition known as “hypercalcemia” may result, leading to an
excessive amount of bone resorption in the body
When this condition is
present for a long time, undiagnosed and unchecked, stones may form in the
kidney (nephrolithiasis), and quite often it is this condition which leads to
the diagnosis of hyperparathyroidism
The solution is the surgical removal of
the overactive gland, a delicate operation that removes excess tissue and
allows the body functions to return to normal.

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 close member of our family has a skin disease now diagnosed as
pemphigus
They have put him in the hospital for treatment, but we have not
been given much information
Can you please tell us about the disease, and is
it infectious, and does it turn into cancer?

ANSWER: Your two concerns can be answered with a single “No”, as pemphigus is
neither an infectious disease nor one that becomes cancerous
It is a disease
of the immune system, characterized by skin lesions that look like large
blisters
In fact, the name comes from the Greek word meaning “to blister”,
and Hippocrates himself originally named the disease
Today the term is
applied to several forms of pemphigus, which may be identified by a biopsy, a
technique that uses a small sample of tissue, which is then examined under the
microscope, providing a diagnosis of the exact form of the disease
The
disease is seen most frequently after the age of 40, rarely in children, and
affects both sexes equally
Its incidence is higher in people of Jewish
descent
Early diagnosis is important and the disease is treated with high
levels of corticosteroids, which in serious cases may require hospitalization.
The response is usually good, but this is a serious disease that, if not
treated adequately, may be potentially fatal
I hope your relative will
recover with the treatment being afforded him.

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 grandson was diagnosed with the Pena-Shokier Syndrome when he
was first born, which we were told was always fatal
He is 20 months old now
and is very smart
He is ahead in all his mental development but has a lot of
physical problems
It may be possible he doesn’t have the syndrome and we
can’t find much needed information
He is a wonderful child and I do so want
him to live
Can you help us?

ANSWER: This is a rare inherited condition, which affects the lungs, facial
and finger bones, knees and hips
It first shows its effect while the baby is
still in the uterus, and can touch either boys or girls
Occasionally there
are changes in brain growth which your grandson seems to have escaped
All
the material I have been able to gather indicates that it is a fatal disease
during the first months of life, but perhaps it is in modified form in your
grandson
It is also listed in some textbooks under the name of Bowen’s
Disease
Its rather long medical name is Pulmonary faciocamptodactyly
ankyloses, which may help you in your search for more information
I wouldn’t
give up hope, in view of his progress.

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: Do you know of a condition called “phantom limb pain”? Is it real
or imaginary? Our young son, a victim of an automobile injury, is said to
have such pain and we don’t know how to deal with it
Please help us.

ANSWER: The term “phantom limb pain” is used to describe the pain experienced
by some patients after an amputation has been performed
The word “phantom”
refers to the missing member, not to an imaginary pain
It is a difficult and
frustrating problem to treat, for the location of the pain is usually in the
part of the limb that has been removed
Experts on this problem feel that the
pain is caused by a combination of several causes, some involving the nerves,
some involving the psychological
While pain medications are tried at first,
including narcotics to help break the cycle of pain perception, it frequently
requires a considerable amount of psychological counseling to achieve results.
This demands an understanding of the patient’s emotional perception of the
loss, and discovering ways that address his needs
Medical treatments include
injecting the stump to block impulses that can be originating in a neuroma or
nerve tumor
When the pain is caused by a nerve that has become compressed by
surrounding tissue, it may be eliminated by surgically relieving the pressure.
Your role in supporting all these efforts and remaining compassionate and
sympathetic during this trying time may be the essential ingredient that leads
to the relief of the pain, and the return of your son to a normal and
productive life
Your letter reveals that he has great talent, and much to
live for; now help him see this.

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 are getting all types of confusing details about our son’s
condition (he is 34) called a pheochromocytoma
He is having terribly high
blood pressure, and we want to know the cause and cure of this disease
Will
you please help two distressed parents?

ANSWER: I will do my very best
Pheochromocytomas are tumors of certain
cells called chromaffin cells (because they stain strongly with solutions
containing chromium salts)
Most frequently they occur in the adrenal gland,
but may be located in other parts of the body as well
These tumors are able
to produce, store and release chemicals called catecholamines, which can cause
the blood pressure to rise rapidly and excessively
These tumors are quite
rare, occurring in only about 0.1 percent of individuals with high blood
pressure (hypertension)
Although they may occasionally be malignant and
spread, they are almost always benign, about 95 percent of the time
While
either sex may be affected, they occur in young people, as with your son
In
about 15 percent of the cases the blood pressure remains constantly elevated,
but more commonly the hypertension occurs during an attack, a “crisis” or
“paroxysm”
These attacks occur suddenly, and may last from a few minutes to
several hours
The patient experiences headache, profuse perspiration,
palpitations of the heart and a feeling of apprehension and anxiety
They
appear pale, and may have pain in the chest or abdomen, occasionally with
nausea and vomiting
As time goes on these crises become more frequent, and
are more severe, lasting longer
The diagnosis may be made by finding the
presence of the catecholamines in a 24 hour urine specimen
The treatment of
choice is to remove the tumor surgically
Newer imaging techniques such as
Computed Tomography (CT Scan) and Magnetic Resonance Imaging (MRI), among
others, permit the radiologist and surgeon to locate the tumor precisely
before the operation, and help plan the surgery
The results are dramatic and
the surgery has a high rate of both success and safety.

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: Although all my doctors have agreed with me that I suffer from
premenstrual syndrome, I still can not seem to get a straight answer on its
cause, or any agreement on its treatment
It is very frustrating to have the
same set of problems each month with no relief in sight
Perhaps you have
some of the answers so many of your readers need
How about it?

ANSWER: It seems as though you may have been making the rounds, and have now
become aware that the frustration with premenstrual syndrome (PMS) is not the
patient’s alone, but affects the medical profession as well
Though the
magazine articles you may be reading seem to provide a clear definition of the
problem, our medical literature is just not that helpful
The discussions of
the syndrome are controversial and incomplete, and though the pattern of
symptoms and complaints are well described, the causes and the cures still
elude the researchers
We know that PMS is characterized by the monthly
presence of physical, psychological and behavioral symptoms that include
depression, anxiety, feeling out of control, anger, irritability, and even the
craving for certain foods, like chocolate and sweets
Physical complaints
include bloating, painful breasts, swollen ankles, headache, fatigue and even
acne
The symptoms may range from mild to disabling, and it is believed that
from 70% tom 90% of women of reproductive age have some regular premenstrual
symptoms
Although the cause of PMS is still unknown, many physicians believe
it is caused by many factors, and may be made worse by certain environmental
and emotional situations
While a variety of medications may be used to treat
specific symptoms, perhaps it may be more helpful to know that you are not
dealing with imaginary problems, and that neither mental illness or cancer is
a factor
Relaxation techniques are useful during stress days, aerobics have
proven helpful, and some dietary changes such as salt reduction, elimination
of caffeine, alcohol and nicotine sometimes provide positive results
Of some
small consolation is the fact that symptoms tend to disappear as you reach the
late 30’s and early 40’s
You also might try to stick it out with one
physician managing your problems and resolving your problems, symptom by
symptom
It is a more rational approach than the course you are now on.

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 close member of our family recently had a frightening experience
as he developed an allergic reaction to an injection of penicillin
We
wondered how that could happen when he was never allergic before
Does it
mean he will have another problem if he ever takes penicillin again? Do any
other members of the family have to worry about the chance that they might
also be allergic to this medicine?

ANSWER: Although the exact number of cases of allergic reactions to
penicillin are not known, estimates place it at from 1 percent to as many as
10 percent of all people treated
While most of the reactions take the form
of skin rashes and hives, they can be so severe as to cause the death of the
patient
Though there are many hundreds of different medications used to
treat disease and illness in the United States, penicillin is the most common
drug causing allergic reactions
Perhaps 400 to 800 deaths per year may be
due to these reactions, and 75 percent occur in people who had no history of a
previous problem
There is no evidence of family tendency to these allergic
reactions, so you and the other members of your family have nothing special to
fear
The sensitivity to penicillin develops most frequently when penicillin
has been used in ointments or creams, or when treatment with this antibiotic
has been given for many short periods of time
It usually happens in adults
between the ages of 20 and 40, but can develop in people of all ages
While a
reaction may occur even when the medication is taken by mouth, it is more
severe and happens most frequently when it has been given by injection
When
the history is uncertain but the possibility of an allergy does exist,
physicians may either use another antibiotic with a similar action, or in the
cases where only penicillin will do, perform a skin test to detect the
possibility that an allergy exists
There are several methods used to reduce
the patient’s sensitivity to penicillin by starting with very small doses
initially, then gradually doubling the amount until the full dose needed can
be given safely
My advice would be that this family member stay away from
penicillin and obtain a Medic-Alert bracelet to prevent the chance of ever
receiving this medication while unable to give a history.

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 long time friend says he has good authority for a statement that
the nicotine in smoke is good for lowering cholesterol
He claims he read
this in a medical magazine but can’t find the clipping to prove it
Do you
have any information that can help us figure this out?

ANSWER: You have to be careful when you read material about health and
medicine
Many words seem so alike, but are in fact quite different
This is
a real case of mistaken identity
It is most probable that your friend was
reading about nicotinic acid, but though the name is similar, it has nothing
to do either with smoke of the nicotine found in tobacco
Nicotinic acid is
also called niacin as well as vitamin B3
While niacin is commonly used to
treat a vitamin deficiency disease called pellagra, it is also known to be
effective in lowering the cholesterol levels in the blood
Niacin is found
naturally in meats, eggs milk and dairy products, and is not lost from the
food during the cooking process
The recommended dietary allowance (RDA) for
an adult male is about 18 mg per day, while women should have 13 mg daily
(unless they are breast feeding in which case they should have 18 mg daily as
well)
To treat pellagra, doses in the range of 300 mg to 1000 mg are used.
However, some people take much higher doses when using niacin to treat high
cholesterol, as much as 3 grams a day (that’s 3000 milligrams), and at that
level side effects are common
These side effects include flushing, a redness
of the skin especially the face and neck, and headaches
Although niacin is
available over the counter as a vitamin supplement, it should only be used
under the supervision of a physician when high doses are required for
cholesterol control
Your friend won’t have to search for his clipping now.
His claim, based upon a bit of misreading, has just gone up in smoke.

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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