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QUESTION: My Dad lives alone, now that Mother is dead, and tends house for
himself
He is a diabetic, but seems to manage his insulin injections without
any problems
However, during our most recent visit we were horrified to find
he had developed several ulcers on his feet
He is under good medical care
now, but we want to prevent this in the future
Any suggestions?

ANSWER: Several, and I hope they fit in with the advice you are sure to
receive about this from your own (or Dad’s) doctor
Ulcers of the feet in
diabetics are a frequent occurrence, and special attention to a few details
are necessary to prevent recurrence
Diabetics suffer from two complications
of their disease, arterial disease which interrupts the flow of blood to the
feet, and nerve disease which reduces their feeling of minor blows and cuts to
their feet
They can’t sense the discomfort of a tight or poorly fitting
shoe, for example, and ulcers frequently get a foothold (no pun intended)
before they are discovered
Once established they require treatment that will
combat the infection, help return the blood flow to a maximum, and eliminate
any pressure to the susceptible skin of the feet
Since many diabetics try to
reduce their blood sugar through restriction in diet, their nutrition may be
faulty and must also be corrected
Once ulcers are eliminated, prevention is
the order of the day
Patients must be educated to carefully inspect their
feet each day and promptly report any signs of redness or cuts to their
physician
In fact, in cases like your Dad’s, a physician should examine the
feet every three to six months for signs of injury
Feet should always be
kept dry, and properly fitting shoes are a must, even if it means custom made
insoles
Your Dad must never walk about the house barefooted, as this puts
him at risk for cuts and bruises he may not feel
Let’s hope your Dad is not
a smoker, as this is a particular no-no for diabetics with arterial disease.
Last but not least, strict control of blood sugar will help prevent the
further occurrence of a nasty situation, diabetic foot ulcers.

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.

Pamelor
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Pamelor (Nortriptyline) is used for treating depression.

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QUESTION: We recently lost a good friend to a condition called “a Dissection
Aneurysm”
It was sudden and unexpected, and we have been provided very
little explanation by his family
Would you please discuss this condition,
and tell us what might have been done to save his life?

ANSWER: The definition of an aneurysm is “a sac formed by the widening
(dilatation) of the wall of a vein, artery or the heart”
My guess from the
information contained in your letter was that you friend suffered from an
aneurysm of the aorta, the largest artery in the body, and died when the
aneurysm ruptured
This is the most common outcome for such a situation, and
occurs in about 70 percent of the cases
More astounding, the diagnosis of
the aneurysm is usually not known before the life threatening crisis occurs.
There are many causes of aneurysms, most frequently arteriosclerosis in older
people, but a frequent cause of death in younger people who have Marfan’s
Syndrome
Whatever the underlying reason, the wall of the vessel is weakened,
and gradually stretches into a balloon-like formation, pushed by the pressure
of the blood within the vessel
This can occur without symptoms of any kind,
although pain may be felt in the area of the aneurysm
Sometimes symptoms
such as hoarseness and wheezing can result from pressure on the nerves or
other structures caused by the growing sac
X-rays are helpful in diagnosing
the condition, but it takes a special technique called “aortography” to find
the location of a suspected aneurysm
A “dissecting aneurysm” occurs when the
inner lining of the aorta becomes torn
The blood clot which forms pushes its
way between the layers of the weakened wall of the vessel, separating them or
“dissecting” them
This can continue over a period of time, until the outer
wall breaks, and rupture occurs
Dissecting aneurysms are extremely painful
for most patients, who describe the pain as being of a “ripping” or “tearing”
character in the chest for thoracic aneurysms, and frequently taken for a
heart attack
When an acute dissection occurs, the only treatment available
with any chance of saving the patient is surgery to repair the tear, usually
with a graft.

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.

Evista
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Evista (Raloxifene) is used to prevent and treat bone loss (osteoporosis) in women after menopause.

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QUESTION: As a pharmacist, I am at times bewildered by the use of the term
“disease” as it applies to malfunctions of the body organs
Growing up in the
20’s and 30’s as I recall it, diseases were infections, not malfunctions or
deteriorations of an organ
Do you grasp the point I’m trying to make?
Please explain.

ANSWER: I consulted three dictionaries in my search for your answer,
Stedman’s Medical Dictionary, Webster’s Deluxe Unabridged, and my battered
copy of Dorland’s Illustrated Medical Dictionary
Webster said it most simply
“any departure from health; illness in general” or “a particular destructive
process in the body with a specific cause and characteristic symptoms”
Both
medical dictionaries accept any “deviation from”, “interruption of” or
“perversion” of normal function, as a definition of disease
It would seem
that “infection” is just one of many disease processes.

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.

Ansaid
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Ansaid (Flurbiprofen) is used to treat inflammation, pain caused by rheumatoid arthritis and osteoarthritis, tendinitis and bursitis.

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QUESTION: Regarding diverticulitis, what are the early signs of such, and if
the condition is confirmed, what type of diet is recommended?

ANSWER: To suffer from diverticulitis, which is an acute situation, you must
first have diverticulosis
Diverticulosis is a condition where many small
sacs, or diverticula, push through the muscle wall of the colon
From 30 to
40 percent of persons over the age of 50 may have these small sacs or
herniations protruding through their colons
It is believed that they are
caused by a lack of bulk in the diet, and resulting spasm of the colon
muscles, which produce the pressure necessary to form the sacs
In general,
most people with diverticulosis have no symptoms, and a diet rich in roughage
or fiber is recommended
When diverticulitis strikes, the picture changes
rapidly
It may start with pain and tenderness in the abdomen, usually in the
lower left portion, which rapidly becomes quite severe
Fever may be present,
and sometimes a mass can be felt in the area of the pain
When this occurs,
it is necessary to put the bowel to rest, using hospitalization, intravenous
fluids, bed rest, with no food taken by mouth
Antibiotics are used when the
temperature is high, and when infection is suspected
The danger in
diverticulitis is that the infected sac will perforate and allow the bowel
contents to spread throughout the abdomen
In such cases surgery is usually
required to repair the damage, sometimes by removing a piece of the colon.
Seeking care at the earliest moment can do much to prevent complications.

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.

Prednisone
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Prednisone is a synthetic corticosteroid, used for suppressing the immune system and inflammation.

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QUESTION: I’m confused about the mysterious venereal disease, Chlamydia
Can
it be treated and how? Once you have been treated, can some of the germs
survive and come back at a later date? What’s the latest information? Your
answer would be greatly appreciated.

ANSWER: The group of chlamydial disease have been confusing doctors for some
time, so you are not alone
Originally, they were thought to be viruses, but
now are considered to be more like bacteria
Probably most of the cases of
infection of the cervix (cervicitis) and the urinary tube (urethritis) in
women and urethritis and proctitis (infection of the rectum) in men is caused
by Chlamydia trachomatis
The disease is transmitted sexually, and the first
symptoms appear between 7 and 28 days after intercourse
In men, the
urethritis starts with painful urination, and a penile discharge
Women
frequently have the disease with few symptoms present except for a vaginal
discharge
Since gonorrhea may create the same situation, it is usually
suspected first, but in the past, when the gonococcus bacteria was not found
by microscopic examination of slides of the discharge, or by bacteriologic
cultures, the infection was called “nonspecific” or “nongonococcal”
urethritis
Today we know these conditions are the result of a chlamydial
infection
Treatment consists of a course of antibiotics, with tetracycline
or doxycycline used most frequently, for a period of ten days
Erythromycin
is used for women who are pregnant
When relapses occur, and they do in about
20 percent of the cases, longer periods of treatment lasting up to 28 days is
needed, resulting in a cure
During the period of therapy, patients should
abstain from sexual intercourse until the symptoms subside and the treatment
is completed
Sexual partners should be examined and treated as well if the
infection is present, or the partners can reinfect one another, making it
appear that a relapse has occurred, when it is really a reinfection
Although
this may be a period of some anxiety for the patient, the good news is that
the infection is curable in most 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.

Ismo
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Ismo (Isosorbide-5-Mononitrate) is used for preventing symptoms of angina(chest pain).

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QUESTION: Can you imagine a child of only four years of age developing
dandruff? Well, our son has it and we are not able to stop it with his normal
baby shampoos
Could you please recommend a good shampoo we could use that’s
safe for a child his age, and that doesn’t need a prescription?

ANSWER: Let’s slow down for a moment here
While I can understand the desire
to save the cost of a doctor’s visit, the presence of ugly flakes in a child’s
hair may not be as simple to treat as might wish
A good diagnosis is the
first requirement for any treatment, including an appropriate shampoo, which
must be chosen with the exact knowledge of the problem
The two most common
causes of dandruff in a child are eczema (atopic dermatitis) followed in
frequency by tinea capitis (ringworm of the scalp)
They are quite different
in nature and symptoms
While the eczema can provoke a great deal of itching,
the ringworm can cause hair loss
The ringworm can be detected through a
microscopic examination and culture of some scales scraped from the scalp, but
medication useful for removing the infection will have no effect on dandruff
resulting from eczema
Since psoriasis can also affect young people,
producing scales as well, there is a real need for an accurate diagnosis here
and the possibility that only prescription medications will help solve your
problem
Sorry, but I think a visit to your physician is called for.

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.

Antabuse
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Antabuse (Disulfiram) is used to help treat alcoholism.

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QUESTION: I believe I read somewhere that the test for cholesterol that can
be obtained in some shopping malls and the like were dangerous to your health.
I recently had such a test and am now concerned about the consequences
What
do you know about this and can you offer me some information? I need some
help to put my fears to rest.

ANSWER: I suspect that the information you read was derived from a recent
report compiled by the Office of the Inspector General (OIG) of the Department
of Health and Human Services
While it is generally recognized that high
cholesterol levels may lead to coronary artery heart disease, it is equally
true that you must know about your condition in order to start modifying your
life style and diet in a manner that will help bring these cholesterol levels
down to normal
A great deal of effort has been dedicated towards making the
public understand the relationship of cholesterol and heart disease, and
advertisements have encouraged people to “know their cholesterol level”
With
this in mind, many sponsors have initiated “cholesterol screenings” in some
cases as a marketing or public relations event
The OIG gathered information
on these mobile health services or services offered outside traditional
medical settings
They discovered that information offered and the testing
in many instances was less than accurate, and that the lack of accurate test
results, proper referrals, and correct advice and counseling were possible
sources of confusion and mistakes
Such errors might lead to incorrect
actions by the patients, actions that might be “dangerous” to your health.
Don’t confuse this with a direct threat to your well being, but rather as a
poor method by which to determine this important number
There are new
federal regulations to be implemented in 1990-91 which will control public
testing
Until then it is important that you check to see that the results of
your test were correct, and that you obtain the answers to your questions
about cholesterol, to will enable you to take the right actions.

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.

Cardizem
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Cardizem (Diltiazem) is used for the treatment and prevention of angina (chest pain).

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QUESTION: What are the hopes for a person who has suffered with chronic pain
for so many years now that just looking at another pill is more than I can
bear? Even my precious physician is running out of combinations of
medications to take and is willing to listen to any suggestions
In fact he
suggested that I write to you
Will you please help?

ANSWER: Although each person handles pain in a different manner, it is clear
from your letter that you and your physician have fought the good fight and it
is now time to consider possibilities other than just medications
And there
is an impressive array of techniques for you to consider, all with records of
some success in some people
Depending upon the nature and cause of your
pains, you might consider transcutaneous electrical nerve stimulation (TENS),
trigger point injections, acupuncture and nerve blocks to mention but a few.
TENS is known to be quite useful for short term relief of acute pain, but can
be helpful in cases of tension neuralgia and people with multiple peripheral
nerve injuries
It is an electrical stimulation that diminishes pain signals
and requires an experienced technician to help you, for there is a bit of
trial and error in determining frequency of the current and placement of
electrodes for best results
When there are well localized points of pain or
“trigger points”, destroying the spot of degenerated muscle tissue that is
causing the pain with a hypodermic needle can bring relief
Several
insertions of the needle may be necessary, and the use of lidocaine may reduce
the pain caused by the procedure
Acupuncture may offer temporary relief,
possibly by increasing the level of endorphins (naturally occurring pain
killing chemicals) in the blood
In addition, behavior modification
techniques, physical therapy, relaxation training, biofeedback and family and
vocational counseling all provide other avenues of therapy to deal with the
trials of chronic pain
There are now more than 450 chronic pain treatment
clinics in this country, many of which use a multidisciplinary approach which
provides trained individuals in the areas mentioned above
It may be time now
for you and your physician to search out one of the specialized care centers
in your area, to obtain a new approach for your pain problem.

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.

Serevent
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Serevent (Salmeterol) is used for long-term treatment of asthma.

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QUESTION: Would you please discuss a condition called “The Chronic Fatigue
Syndrome”? I am sure that is killing my daughter, but I have yet to find a
doctor who understands just how serious this is or how to treat it
With all
your research, you must surely have found out something that can help us.
Please?

ANSWER: I can understand your frustration and anxiety, for this syndrome is
just as perplexing and difficult for physicians as well
To start with, a
“syndrome” (rather than a “disease”) merely refers to a group of symptoms that
occur together, rather than a defined disease with a known cause and
hopefully, a cure
For the Chronic Fatigue Syndrome (CFS) the symptoms
usually consist of tiredness and fatigue, that may vary in severity or
duration, fever, joint and muscle aches, problems with memory, swollen glands,
sore throat and headaches
All of these symptoms are very common; in fact,
fatigue or tiredness is probably one of the most common complaints patients
bring to their physicians
In addition not all patients who are diagnosed as
suffering from CFS possess all the symptoms I’ve outlined
For some time,
this syndrome was linked with infection by the Barr-Epstein Virus which causes
mononucleosis, but recent studies have failed to confirm this relationship.
Many patients with CFS have no sign of the virus, while others with no
complaints at all show laboratory evidence of previous viral infection
The
syndrome seems most common in women between the ages of 30 and 50, and can be
severe enough in some patients to disrupt their professional and personal
lives
While the medical literature contains conflicting reports, many
physicians now find that their patients improve when placed on medications
(tricyclic antidepressants) and when appropriate medications for pain,
headaches and muscles aches are prescribed
Patients also do better when they
understand that the syndrome is not a fatal or progressive disease, and when
they continue to work with the physician
Your problem seems to be in finding
a considerate and concerned physician who understands the problems of CFS and
is willing to work with the patient
Keep searching, for I can assure you
many such physicians do exist, and will help your daughter overcome.

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.

Phentrimine
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Phentrimine is a pharmaceutical quality appetite suppressant, acting in the same way as Phentermine and Adipex.

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QUESTION: We are having a great deal of trouble with our 12 year old son, and
a constant complaint of chest pain
His father suffers from angina, and we
think that this may have something to do with it, but with athletes in fine
physical condition falling over dead on basketball courts we want to be sure
that nothing is going to happen to our boy
What should we do?

ANSWER: I think the first piece of advice I can offer is to take the
complaints seriously, and have a thorough checkup and evaluation at your
doctor’s office
I say this in the full knowledge that though such complaints
are common in children, they are rarely the result of serious disease
Even
when a complete investigation is over, the cause of the pains will remain a
mystery in from 21 to 45 percent of the cases
The most common problem where
a diagnosis is found turns out to be musculoskeletal pain, or pains of the
muscles, bones and cartilage that forms the chest cage
Injuries that are
provoked by excessive exercise or the minor blows that occur during contact
sports can leave a muscle strained, bruised and more than a bit painful

About 16 percent of chest pains in youngsters are diagnosed with these causes

Pain from coughing, inflammation of the cartilage that forms the end of the
ribs (costochondritis), pneumonia and even problems in the stomach and
intestines all rank well above the possibility that such pains are to due a
heart problem, which accounts for only 4 percent of chest pain in children

The conditions in children may result from birth defects of the heart or
infections, although heart attacks that resemble those in adults are not
unheard of, especially in children with long standing diabetes
About 9
percent of all cases are classified as emotional or psychogenic, and this is
about four times more likely in families where there is a history of chest
pain, as is the case with you
Much of the anxiety and fear can be helped
when the results of the examinations show no disease present
A few rare but
interesting causes are a virus infection that causes spasms of pain in the
chest called “devil’s grip”
It can occur when a coxsackie virus strikes
Another possibility you might check into is cigarette smoking
Be sure to
give your physician an accurate description of the events that lead up to a
painful episode, for a good history is half the battle won towards an accurate
diagnosis.

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.

Risperdal
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Risperdal (Risperidone) is used for treating schizophrenia or bipolar mania.

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