Health information

QUESTION: Winter has barely begun, and already I am feeling the effects of
the shortened days
I am always tired, and lack any motivation or energy
I
have read that this may be the signs of an emotional disorder, but I can’t
believe it may be happening to me
Do you know of any condition that causes
this sort of problem?

ANSWER: I do know the condition of which you speak, although I am not sure
that you have all the symptoms necessary to make the diagnosis in your case.
You are thinking of “Seasonal Affective Disorder” with the descriptive
abbreviation of SAD
SAD is a severe form of depression which occurs each
winter in patients who are afflicted with the disorder
They feel fatigued,
sleep more than usual, can gain weight because of appetite changes, and are
irritable and feel helpless
In a word, they are SAD
To make this
diagnosis, A patient would have a severe depression, with no other
demonstrable causes, have all the symptoms listed, would experience this mood
change during the same period of time in each of the last three years, so that
it is predictable, and have no other seasonal reason to explain a depression
(for example the loss of a job over winter months)
It occurs most frequently
in young women, ages 20 to 30, who express feelings of anxiety and fatigue.
They may also gain enormous amounts of weight, as a craving for carbohydrates
and sweets frequently accompanies this disorder
In addition to psychotherapy
and antidepressant medications, phototherapy may be used
Phototherapy uses a
light box that provides high intensity light of about 2500 lux (ordinary
indoor light is 100 to 500 lux while bright summer sunshine is 50,000 lux).
The patient remains in front of this light box for one hour daily, and is
directed to look directly into the light for 10 to 15 seconds in each minute.
The response is excellent, with up to 85% of the patients reporting reductions
in symptoms
Before rushing to buy a box (they cost about $360), see your
doctor and be evaluated
Other factors may be causing your 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.

Mircette
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Mircette (Ethinyl Estradiol/Desogestrel) is used as contraception to prevent pregnancy.

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QUESTION: Would you please discuss scabies as much as possible? What is it,
Is it a venereal disease, where does it come from and what treatments can be
used? There are several people in our community who need these answers very
badly.

ANSWERS: I can understand your need, so here goes
Scabies is a skin disease
caused by a tiny “itch mite” (Sarcoptes scabiei) that has plagued mankind for
centuries
Scabies outbreaks occur when crowded conditions exist, since the
disease is highly contagious and passes easily from one infected person to the
next
While sexual transmission is common, it is not the only method, since
even simple hand holding games in children can be enough to spread the
condition
Sharing clothing, towels or sleeping in the same bed are other
means of transmission
When the male and female mite mate on the surface of
the skin, the female mite then burrows into the surface layer of the skin to
lay her eggs
the eggs develop into larvae, return to the skin surface,
become mature mites and the whole cycle starts again
Little burrows can be
seen under the skin, along with a red, very itchy rash, which seems to become
worse at night
Frequently your physician may take a painless scraping of
your skin, to examine under the skin to make the diagnosis
Fortunately,
effective medications are available containing lindane (Kwell) which can
eradicate the mite, although the itch may continue for several weeks
Careful
personal hygiene is a must, as the scabies can recur and the body does not
develop an immunity to them
Check with your doctor to confirm your diagnosis
and get the prescription for your medication.

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.

Zerit
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Zerit (Stavudine) helps manage human immunodeficiency virus (HIV) infection.

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QUESTION: When I spoke to my doctor about some recent blood tests, he told me
that my “sed” rate was just a bit high
What is a sed rate, and what am I
going to have to do to make it lower? I am very concerned.

ANSWER: The term “sed rate” is an abbreviation of the name of a blood test
involving red cells called the “erythrocyte sedimentation rate” (also known as
ESR)
If a sample of blood is allowed to stand in a test tube, the red blood
cells will gradually sink to the bottom of the tube, creating a clear layer of
yellowish plasma at the top
Depending upon the method used to perform the
test, this clear layer will measure from 0-20 mm/hour in women
When the
cells descend at a faster rate, producing a larger clear layer, the “sed” rate
is higher
It is a sign that there is an inflammation going on somewhere in
the body, and may require additional tests to locate just where that process
is going on
Usually when the situation is cared for and corrected, the sed
rate returns 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.

Prandin
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Prandin (Repaglinide) is used to treat Type 2 (non-insulin dependent) diabetes.

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QUESTION: my girl friend’s doctor has given her some new medicine that is
supposed to reduce her wrinkles
It is also supposed to be a treatment for
acne
I have spent many a hard earned dollar on creams that were supposed to
help me get rid of some of my age lines, but never really worked; and I am
skeptical about this stuff too
Is there any truth to the story?

ANSWER: It may be a bit too soon to be sure, but there is preliminary
scientific evidence to suggest that local applications of a medication called
tretinoin may improve the appearance of skin aged by the sun, and that
wrinkling may be reduced
Tretinoin is a prescription medication, a
derivative of Vitamin A, that is currently used to treat acne
For that
indication, the medication is applied once daily, usually at bed time to
clean, dry skin
It is available in three preparations; cream, gel, and
liquid
While each of these may cause irritation to the skin, that is a side
effect of the medication, the liquid preparation is the most irritating, the
cream the least so
Tretinoin works on the outer layer of the skin, the
epidermis, promotes normal growth, and normalizes the way the skin sheds its
outer layers
Its undesirable side effects include irritation of the skin,
causing it to become red and scaly
It may also heighten a person’s
sensitivity to sun exposure
It may be that it also has an effect on the
dermis, the tissue that lies beneath the epidermis, and there stimulates the
growth of collagen and new vessels, reversing the effects of aging caused by
sunlight
While all this may sound like something you always dreamed of, you
must use this preparation under medical supervision, being aware that there
are cases where the medication has changed the pigmentation of the skin.
Whenever any side effects are discovered, the medication must be discontinued.
Additional investigations are needed to fully evaluate both the potential
beneficial effects, as well as any possible hazards which may result from use
of this medication.

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.

Cyklokapron
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Cyklokapron (Tranexamic acid) is used for short-term control of bleeding in hemophiliacs, including dental extraction procedures.

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QUESTION: My husband suffers from a most embarrassing affliction: smelly
feet
This poor man dare not take off his shoes when others are around, for
fear of losing both family and friends
Surely you must know something about
this condition, and find a solution for my long suffering spouse.

ANSWER: It is a common enough situation, and fortunately one for which a
number of solutions (indeed!) exist
To start with this distressful situation
results from an excessive sweating of the soles of the feet, combined with the
results of the actions of yeasts and bacteria which actively decompose the
dead cells from the soles of the feet and the perspiration
Excessive
sweating is known as “hyperhidrosis”, but when it is accompanied by offensive
odors, as in your husband’s case, it carries the name “bromhidrosis”
And the
answer to your question consists of using a number of solutions correctly.
First is a liquid soap containing an antiseptic, chlorhexidine
Daily washing
is a must, along with a bit of scrubbing and careful drying
Then a solution
of 20% aluminum chloride hexahydrate in absolute ethyl alcohol is applied to
the area
This should be done at bedtime
After application, cover the area
carefully with a thin plastic film (like Saran Wrap), and leave in place
overnight
In the morning, remove the plastic, and carefully wash the area
clear of the medication, and dry the feet carefully
Two successive evening
treatments will usually provide protection for about a week
Another
effective solution is the use of 3% formalin applied twice a day for 1 week,
then once a day for a week, finally just one application every other day for a
week
Try only one solution at a time, then continue with the one that seems
most effective in your case, if the problem recurs.

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.

Lopressor
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Lopressor (Metoprolol) is used for treating high blood pressure, chest pain.

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QUESTION: I have tried repeatedly to stop smoking, using every gimmick and
technique available
I desperately want to quit because I believe it kills
people
(How I wish I had never started!) I can not believe there is not
something available to help “hard core” smokers overcome that incredible
craving?

ANSWER: Actually you are already well on your way
Successful treatment can
occur when the individual understands that there is a real risk from
continuing to smoke, there is a value to stopping and that it IS possible to
quit
While the initial action of quitting is hard enough to take, it is
harder still to maintain that abstinence over the long haul necessary to rid
your self of the habit
There are many deep seated reasons for smoking,
social, psychological and pharmacological, all of which must be addressed in
your hopes of quitting are to be successful
That means that you need more
than just a magic pill to quit, and require the ongoing advice and help from
your family physician or counselor
You will learn of skills that can help
you deal with stress, resist the many stimuli in your environment that prompt
smoking, and overcome some of the withdrawal signs and symptoms that do occur.
They include restlessness, inability to concentrate, sleep disturbances,
feelings of hostility and nicotine craving, that seems to be your chief
problem
In addition to behavioral techniques, many people profit from the
use of nicotine gum (Nicorette) in their comprehensive smoke cessation
program
Each piece of gum contains 2 mg of nicotine, and from 8 to 10 pieces
should be used each day
Heavy smokers who have signs of physical dependence
are excellent candidates for this type of treatment, and it may be the answer
you are seeking
You can obtain much more information by writing to the
National Heart, Lung and Blood Institute, Smoking Education Program, National
Institutes of Health, Bldg
31, Room 4A-18, Dept
A-1, Bethesda, MD 20892.
Your efforts will have tremendous health benefits for you, if you strive for
and achieve your goal.

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 have a condition called “tic douloureux” (painful tic)
It took
many years before a neurologist finally diagnosed it
What can you tell me
about it and its treatment?

ANSWER: Most patients with this condition would agree that “painful tic” is
an appropriate name for what is known medically as trigeminal neuralgia, or
“tic douloureux”
Patients complain of sudden and excruciating pain on one
side of the face that feels sharp and stabbing, sometimes like an electric
shock.
The pain occurs in spasms, subsides rapidly, and can be triggered by such
activities as talking, eating, feeling the wind blow against the side of the
face, seeing flashing lights, or even hearing sudden noises.
Although sometimes difficult to identify because of the many conditions
which may provoke the symptoms, a careful diagnostic workup usually results in
establishing the precise diagnosis
There are a number of treatments,
although some do pose certain risks.
Trigeminal neuralgia is often caused by pressure from a blood vessel
pulsating against the trigeminal nerve
Other causes are blamed on tumors,
multiple sclerosis, aneurysms, and angiomas.
If diagnostic tests rule out causes like tumors that require specific
treatment, your doctor will probably try drug therapy first
Phenytoin or
carbamazepine are two of the most popular choices, since both are generally
effective with long lasting results, although both can cause side effects.
If your pain is especially severe, your doctor can also inject a local
anesthesia and/or prescribe a narcotic pain reliever.
If drug therapy is unsuccessful in alleviating your pain, other
treatments can be used, but these can be risky:
Injections of alcohol, glycerol, phenol, and hot water into part of the
trigeminal nerve can block the action of the nerve, thereby stopping pain, but
this procedure can also cause loss of feeling in the face.
Surgically cutting or separating the trigeminal nerve branch relieves
pain longer than injections, but again, this is another treatment that can
cause numbness.
The most common procedure performed today is posterior fossa
microvascular decompression
This operation involves separating the blood
vessel that is pressing against the trigeminal nerve by placing a small
plastic implant, or similar device, between the vessel and the nerve to keep
them apart.
About 80 percent of patients find pain relief with this operation for up
to five years
Although this procedure does not cause a loss of sensation in
the trigeminal nerve, it can cause problems like hearing impairment and
hemorrhage.
Another popular procedure is percutaneous trigeminal radiofrequency
coagulation
A general anesthetic is injected through an insulated needle;
then a radio frequency current is used to coagulate the branches of the
trigeminal nerve.
This procedure relieves pain in 80 to 98 percent of patients, but it too,
like many of the other treatments, may have complications
The proper choice
of treatment depends upon your special case, and is one that will provide the
greatest chance of relief with the least risks.

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 the passing years I seem to be losing a bit of my hearing as
well
Many people my age, I am 70, seem to be in the same boat
Is a “tin
ear” something we just have to accept as part of getting a bit older?

ANSWER: Recent studies show that about one in three Americans 65 years or
older including former President Reagan experience some sort of hearing
impairment (defined here as deafness in one of both ears, or any other trouble
hearing).
The statistics are quite revealing
In men, from the ages of 65 to 74,
almost 30% report some hearing loss, and the number grows to 58% in youngsters
over the age of 85
Women seem to be a bit better off as only 17.5% in the 65
to 74 age group have difficulty
About 13 percent of males in the 65-74 group
reported deafness in one or both ears, compared to 8 percent of the women
In
people over 85, partial or complete deafness was noticed by 38 percent of men
and 23 percent of women.
About 8 percent of both sexes said they use a hearing aid
When all
those questioned including those with hearing aids were asked to describe
their hearing, 61 percent reported no trouble while 5.5 percent indicated they
had a “lot of trouble” hearing.
So I guess you are not alone, and I’ll just shout a bit louder when
addressing answers to my older readers!

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: As a teacher and a counselor in a high school, I am concerned and
distressed about all the reports of suicide in teenagers
There must be more
done about this most serious problem
How can I spot students who are at risk
of committing suicide and how can I help them?

ANSWER: You’re in an excellent position to be of help to a young person who
is contemplating suicide, and your attitude and concern makes you a most
potent resource in the war against teenage suicides
The first challenge is
to recognize the student at risk.
There are several characteristics that place young people in a “high risk
group” for attempting suicide
I’ll list them:

- Depression

- Impulsive behavior

- Early childhood family disruption

- Chronic alcohol and drug abuse

- Past psychiatric illness in parent, particularly depression while
teenager was a young child

- Recent death of a friend or a family member

- Feeling of being unwanted by family

- Feeling of “not belonging” to family

- Exposure to repeated violence at home

If you are particularly concerned about a young person, talk with him.
Ask him if he is considering hurting himself
There is no evidence that
bringing up the subject of suicide will cause it to happen
On the contrary,
ignoring the possibility of suicide may well increase its likelihood.
However, it is a myth that people who talk of suicide do not try it
If a
person brings up the idea of suicide, take this as a serious warning.
Your sincere interest in the young person will help
Do not minimize the
seriousness of the problem
Listen to the whole story and resist offering
empty reassurances
Emphasize the importance of the youngster getting
professional counseling, and follow-up to ensure that it helps
Maintain
contact with the young person, so that he knows you are still interested and
does not interpret your recommendation of a professional counselor as
rejection
It means becoming involved, perhaps above and beyond the call of
duty, but the results are certainly worth the effort.
It is difficult to know exactly how common suicide is among our young
people
It appears to be declining in older teenage boys, after a peak in
the late 1970’s, but increasing in older teenage girls
In 1983, the suicide
rate among children of all ages in the U.S
was 1 per 250,000 among children
younger than 15 years and 1 per 8,547 in the older teenage group
6,000
young people lost their lives to suicide in 1984
Suicide attempts may be as
much as 50 times higher than the number of deaths
It is important to treat
the attempts as a sign of serious problems.
There are many community resources which may be of help to you; mental
health groups, hospital outreach programs, and even forward looking
parent-teacher associations
However, your close association with the
youngsters and your daily opportunities to observe and act puts you right on
the front line in this fight against a terrible waste of young lives
I wish
you well and hope many of your colleagues will be inspired by your concern and
join in your efforts.

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.

Coumadin
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Coumadin (Warfarin) treats or prevents blood clots that may occur in the veins and lungs.

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QUESTION: I’m too embarrassed to discuss this with any of my friends, but I
suffer from severe diarrhea whenever I travel
What causes this condition,
and how can I overcome it?

ANSWER: You may be suffering from enteritis, an inflammation of the intestine
that usually manifests itself in diarrhea in your case, the commonly known
traveler’s diarrhea
If your work often takes you to undeveloped third world
countries, you may unwittingly be exposing yourself to a specific
enteritis-causing agent on a repeated basis.
The most common cause of traveler’s diarrhea is the bacteria known as
Escheria coli, although other factors may be at root cause, including viruses
and protozoa
The condition is usually acquired from local food or water
contaminated by feces: raw leafy vegetables, unpeeled fruits, raw meat and
seafood, unpasteurized milk and impure water are most often at fault
(If you
order bottled water while abroad, make sure the ice originates from an equally
protected source.)
There are a number of ways of avoiding traveler’s diarrhea, varying in
effort and effectiveness
Although it’s no guarantee, watch what you eat and
drink, especially when venturing away from tourist or business circles
You
may also want to consider a preventative approach; a daily two ounce dose of
bismuth subsalicylate (impractical for longer trips) greatly reduces the risk,
while antibiotics such as doxycycline, trimethoprim, or
trimethoprim-sulfamethoxazole can reduce the risk by between 60 and 90%
Such
a regimen of antibiotics needs to be initiated a day or two prior to leaving,
and continue through to the first day or two after returning; furthermore, it
should be restricted to individuals with underlying medical problems which may
be aggravated by a case of traveler’s diarrhea.
If you should come down with the condition, try treating it by consuming
sugar-containing drinks, to replace fluids you may have lost, as well as
crackers to replenish salts
Keeping your fluid intake up is essential in any
effective treatment
Antibiotics may be necessary, particularly if nausea,
vomiting, abdominal cramps or fever are present, and if bloody stools are
passed in addition to the diarrhea
Two to five days of taking double
strength trimethoprim-sulfamethoxazole or doxycycline is usually effective
against the E
coli bacteria
You can probably out last a mild case, but if
things get severe, check into a local hospital or cut your trip short and head
back home.

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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Prometrium (Progesterone) is a female hormone used to protect the lining of the uterus in women on estrogen replacement therapy.

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