Health information

QUESTION: Would you please discuss the technology that involves the use of
magnetism to produce pictures that look like X-Rays? I am about to have one
and could use a bit of information and reassurance.

ANSWER: I think you are referring to MRI, (which stands for Magnetic
Resonance Imaging), an important and relatively new development in medical
evaluation and diagnosis
It uses computers and magnetic fields to create
images of virtually any area of the body, whereas other more familiar
techniques use radiation as in CT scans, or sound waves as in sonograms
For
certain areas, particularly the central nervous system, MRI is perhaps better
than all other imaging techniques
For example, it has become the most single
most sensitive procedure for diagnosing multiple sclerosis
It is also
beneficial for examining the pelvis, muscles, tendons and ligaments, and
various organs such as the kidneys, ovaries, and uterus
And it shows
promise for the heart and abdomen as well.
One of the major advantages of MRI (sometimes called NMR for Nuclear
Magnetic Resonance, the scientific principle upon which the technique is
based) as a diagnostic tool is its ability to create high quality images
directly without the use of invasive procedures such as the injection of
contrast media (dyes) into arteries or joints
Nevertheless, there are
potential risks to the patient which should be recognized
These include the
effects of electric currents, heat, and magnetic fields produced during the
procedure
Patients who have had metallic surgical implants, such as a
pacemaker, are at particular risk.
Despite these important concerns, MRI has shown remarkable advances
within the past years, and its improvement is expected to continue
Some
experts claim, in fact, that MRI may ultimately replace the more conventional
imaging techniques
At present, however, it should be emphasized that MRI is
but one of many diagnostic tools available to the clinician
A medical
history and physical exam, along with the use of other laboratory tests and
imaging techniques as well as MRI, are all considered part of the ever
growing complete diagnostic process.

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: Our son has severe nose bleeds
He doesn’t fall or get into
fights, but these bleeding spells appear to occur spontaneously and regularly.
My husband and I are growing concerned, what can we do to help our son?

ANSWER: Most nosebleeds result from dryness or crusting in the front part of
the nasal passages, or from the occasional playground slugout
However, there
are conditions that can lead to chronic nosebleeds, and most can be identified
and remedied.
Some children may be particularly aspirin-sensitive, and must avoid
aspirin-type compounds before and after tonsil and adenoid surgery
Other
children, mostly boys, may suffer from juvenile angiofibroma, a malignant
tumor that fills one of the nasal passages
Still others may have coagulation
disorders that manifest themselves as nosebleeds, such as Factor XI Deficiency
(also known as Hemophilia C), or von Willenbrand’s disease
These last
disorders can be remedied by administering plasma
Purpuric disorders (in
which blood escapes into tissues below the skin) are treated with
corticosteroid therapy
Leukemia and a hereditary condition known as
Osler-Weber-Rendu disease can also cause nosebleeds
All of these conditions
may account for only a small portion of the number of nosebleeds experienced
by active young people, and may be diagnosed and treated by your physician.
They are listed here for completeness sake and to make you aware that
sometimes nosebleeds require medical attention.
When your child comes home with a nosebleed, have him sit up in a chair,
leaning slightly forward
Apply pressure to the nose by pinching the nostrils
together using a thick, slightly damp washcloth, for between 7-10 minutes.
This maneuver should stop the bleeding
An hour or two later apply some
petroleum jelly deep inside the nostril against the cartilage that forms the
dividing wall between the two sides of the nose, and wait until the next
morning before cleaning the area with a moist washcloth
To play it safe,
reapply, or teach your son to reapply petroleum jelly at bedtime for the next
week
It provides a real protection for the fragile tissue which lines the
nose
If nosebleeds do continue, consult your physician, who can provide more
sophisticated treatment at his office or hospital if necessary.

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 dread the thought that my mother must soon take up residence in a
nursing home
Tell me the horror stories are not true
Are they all terrible
places to live?

ANSWER: Not at all
Even the best nursing homes could probably be better,
but certainly not all of them are deplorable
Many give exemplary care and
residents are treated with compassion
Your mother’s physician can help you
make the necessary choice and probably can relieve some of your and her
concerns.
For many and you and I may well be among them sooner than we like to
think placing someone dear in a nursing home may be the only workable choice
that we have for many good reasons.
Possibly, your mother may make more friends in the right nursing home
than she could living with you
She may get better physical treatment there,
for such reasons as aides who are strong enough to lift her properly if she
falls or who can deal with her more objectively than you can.
She can move from one home to another if you and she feels she must, but
stays in one home for lengthy periods are not uncommon
Long stays will be
expensive and may impoverish her and your Dad (not you, because children’s
assets are not included in government assessments concerning need)
When the
assets are gone, she can still remain in many nursing homes under Medicaid.
Your mother, you, your marriage, and your children at home may all
benefit from having your mother in a location where she is cared for
professionally, safe, and near enough to be visited regularly.
Very probably your mother will not like the food at the home
After all,
she prepared food “her way” for decades, and no institution could possibly
reach her standards of excellence
So you may be able to help her, and feel a
bit better yourself, by preparing a favorite dish for her, and bring it with
you during a frequent visit.

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.

Adalat
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QUESTION: This information is extremely important to me, and though I realize
you cannot respond to all inquiries I hope you can respond to my inquiry.
What is a “Rotator Cuff Tendonitis” and are there any objective medical
findings for this condition?

ANSWER: The question is a frequent enough one and most appropriate during the
football season
The shoulder is a wonderful joint, as it has the capacity to
move in many directions, including the ability to swing in an overhead
movement
It is this motion that is blamed for most of the injuries that
occur
The head of the humerus (upper arm bone) fits into a narrow cup
located in the scapular (shoulder bone)
It is the tendons and muscles
attached to these bones that keep the arm in place, and are prone to the
injuries and strains that occur with repeated overhead arm movements, such as
performed by quarterbacks, baseball players, tennis players and swimmers
An
injury can range from a mild tendonitis, where there is an inflammation in the
tendons that make up the cuff-like tendon attachments of the bones and which
surround the shoulder joint, to a severe tear in the tendons
The first sign
of the problem is pain or tenderness, frequently referred to as just a “sore
shoulder”, but when both the range of motion and the power of the arm become
limited, remedial treatment must be initiated at once
There is some
controversy among those who treat professional athletes, with some advocating
conservative treatment, exercise and physiotherapy first, while others believe
that surgery is indicated at once to repair any tears
X-rays, magnetic
resonance imaging and arthroscopic examinations may all be used to evaluate
the extent of the injury and aid in the development of a treatment plan,
calculated to restore motion and strength to the arm as rapidly as possible.

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.

Zyprexa
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QUESTION: It seems that I suffer from pain in different ways, and the hurt
feels different at various times
What causes pain? Is it possible that
there are different nerves involved?

ANSWER: Pain is caused by overstimulation of nerves that may or may not
conduct the stimulus to the central nervous system, meaning the brain and
spinal cord.
Depending on the type of stimulus, pain impulses can travel through two
different types of nerves that are quite different in structure and entirely
independent
For example, a pinprick sensation (also called fast pain or
first pain) travels through small nerve fibers with a myelin sheath or
covering like an insulated cable
Deep pain (also called muscle pain or
second pain) occurs when you have a muscle cramp or more severe muscle damage.
This type of pain travels slower and is conducted by larger nerve fibers that
lack the myelin sheath or covering found on smaller nerve fibers.

Thus there are two types of pain receptors, and the two types of fibers
are specific for such pain
Pain is never due to overstimulation of other
types of receptors.

The different types of pain may be demonstrated by inflating a blood
pressure cuff (or tourniquet) around a limb to restrict its blood flow, then
inducing pain first by a pinprick (first pain), then by pinching a full
thickness fold of skin (second pain)
If the lack of blood flow (ischemia) is
maintained by the cuff, the pinprick sensation will disappear while the
pinching or muscle cramp type pain will remain, and is usually increased and
feels more painful.

Because there are two different reflex actions a rapid withdrawal after
pinprick and muscle contraction and immobility after pinching it is obvious
the central circuits from two different types of fibers for two different
types of pain must be different.

It would be impossible for the same circuit to produce reflex responses
that are almost opposite in nature: immediate withdrawal and fairly rapid
loss of pain versus a dull cramp-like pain that persists associated with
muscle contraction and actual tissue damage.

This information helps physicians prescribe the most effective analgesic
for the particular type of pain that is causing the misery.

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: There is not much written on the artificial heart these days
Were
the decisions about recipients too complicated, and what where they? I am
sure a lot of your readers would be interested.

ANSWER: Since the first artificial heart was implanted in Barney Clark in
1983, medical professionals have had to consider a number of factors when
deciding who would get the benefit of medicine’s latest technology.
Complicating the decision-making process was the high cost of the procedure
and the close scrutiny of the news media and the public.
Here are some of the issues that were considered:

* Medical indications
The drastic measure of replacing someone’s own
heart with a mechanical device should be reserved for the patient who is about
to die from severe heart disease (usually atherosclerosis, or blocked
arteries) that has damaged the heart’s ability to function.
The artificial device is also useful for the patient waiting for a heart
transplant, especially since transplant candidates may deteriorate rapidly
from depending on their own weak, diseased heart before a donor heart is
found.
Patients who have had open heart surgery and cannot be taken off the
heart-lung machine afterwards could also be saved with the artificial heart.
* The number of potential candidates
Studies have shown that 17,000 to
35,000 patients under the age of 70 could be possible candidates each year for
the artificial heart!
* Cost
Although using the artificial heart is extraordinarily expensive,
so is the cost of keeping a critically ill patient dying of heart disease
alive.
Estimates put the cost for the first year of using the artificial heart
at around $150,000
But the artificial heart was expected to extend life by
four years for the patient dying of heart disease, at an annual cost of
$28,000
That same patient would run up bills of $22,000 in the last six
months of life.
And if you compared the cost of the artificial heart to other procedures,
it didn’t seem so outrageous: a heart transplant costs around
$90,000 to $100,000 for the first year, a liver transplant $150,000 to
$200,000, and bone-marrow transplant for a leukemia patient more than
$100,000.
* Quality of life
A number of complications like blood clots are
possible for artificial heart recipients
Were the patient and family members
able to understand and accept these risks and limitations?
* Role of family
The patient’s family must be able to provide the
emotional support necessary for someone undergoing this procedure
Could
family members cope with the intense coverage by the news media?
* Ethical issues
Because of the public’s failure to understand the
experimental nature of the new procedure, medical professionals had to be
prepared to explain the decisions and choices that were made.
What if the patient chose to discontinue using the artificial heart and
to die? How do you convince the public that the extraordinary cost of the
artificial heart does not rob other persons of medical resources?

There is much that is positive about artificial heart surgery, and much
yet remains to be accomplished
It will take study, funds, and the desire of
us all to see that the problems which exist today are solved, so that those
who truly need this miracle of medicine may have it available to them.

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 father is to undergo a heart test where a tube is to be placed
in his arm and various examinations performed
What can you tell me about
this process? We are concerned about Dad’s well-being.

ANSWER: In cases where doctors need to test for heart disease, “cardiac
catheterization” is often performed
A small, thin tube known as a catheter
is inserted into a vein or artery in either the arm or groin, and and slowly
advanced into the heart itself
(Since the interior of blood vessels have no
nerve endings, this process is all but painless.)
Once positioned in the heart, the doctor uses the catheter to inject a
harmless contrast material also called a “dye” into the heart that will show
up on x-ray films and permit filming the heart in action
(The injection of
the dye itself may trigger a warm, flushing sensation.) This movie, known as
a ventriculogram, reveals the heart’s pumping action, a key indication of that
critical muscle’s health
This same method can also be used to inject dye
into the arteries in order to create a similar x-ray record known as a
coronary arteriogram.
It may also be necessary to inject a variety of other medications through
the catheter depending upon your Dad’s medical condition, from heparin to thin
blood, to nitroglycerin to dilate coronary arteries and reduce strain on the
heart, as well as other drugs to control its rhythm and relieve angina
These
tests can do much to evaluate your father’s condition and assure that his
treatment will be correct and effective.

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: It is hard to find good information about laxatives, but when you
need them they are important
Would you please discuss them in you column,
and tell us how they work, and which ones are safe to use?

ANSWER: There are more than 100 different kinds of laxatives available in the
United States as over-the-counter medications
The purpose of a laxative is
to relieve common constipation, prevent straining when defecating in the
postoperative or cardiovascular patient, accelerate the excretion of
parasites, speed up the elimination of poisons taken either accidentally or
intentionally, or to help empty the bowel before radiologic or colonoscopic
tests are performed on a patient
That’s an impressive list of good reasons
to use laxatives.
Unfortunately, many people abuse them, mistakenly believing that because
they are over-the-counter preparations, they are harmless
Indeed, American
spend close to $400 million a year on laxatives.
There are five different classifications for laxatives
They are:
stimulant, saline, emollient, hyperosmolar, and bulk forming laxatives
They
all work by influencing fecal consistency and accelerating the passage of
feces through the colon to help eliminate the stool from the rectum.
Stimulant laxatives, such as castor oil, impair water absorption in the
ileum (the lowest portion of the small intestine) and in turn speeds the
passage of feces
Five to seven percent of users develop a pink to deep
purple rash, which may persist for years after use of the drug is
discontinued
Some people are allergic to stimulant laxatives and may
experience complications ranging from skin lesions to gastric irritations to
death
Stimulant laxatives should be used for no longer than a week at a
time.
Saline laxatives include such products as magnesium salts, enemas, and
rectal suppositories containing sodium
The contents of the suppositories
react to form carbon dioxide and produce the urge to defecate
Up to a fifth
of the magnesium from the saline laxative may be absorbed and a patient with
kidney problems should use with caution for side effects may be pronounced and
dangerous.
Emollient laxatives, such as mineral oil, soften the stool, and increase
mucous production
Mineral oil decreases the body’s ability to absorb such
important nutrients as Vitamin A, D and K, and may also impair absorption of
medications, including oral contraceptives.
Hyperosmolar laxatives, such as polyethylene glycol and glycerin, are
mainly used to clean out the bowel before some type of medical testing
They
may cause side effects, including bloating, nausea, vomiting or local
irritation.
Bulk forming laxatives absorb water and increase the bulk of the stool.
People using them should drink at least 8 ounces of water with each dose.
Patients with problems of the esophagus, small intestine or colon may develop
obstructions when using bulk laxatives.
Clearly, laxatives are not harmless medications
Package directions
should be followed to the letter, and you might want to consult your doctor
for a recommendation as to which product is best for you.
Pregnant or breast-feeding women should definitely speak to their doctors
before using a laxative.

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 life has been a constant battle against the scales and I have
used diets, medications, and purchased everything in sight
Still the weight
returns
A new counselor is suggesting “life style changes”
Just what does
this entail? Does it help?

ANSWER: Changing lifestyle means exactly what it sounds like: changing the
style in which you live
For people with weight problems, the change most
often has to do with how active you are
Dieting alone is not the best way to
reduce weight
A very low calorie diet slows your metabolism (the rate at
which your body uses calories), an ancient response that helped our ancestors
survive famine
Moreover, many people just like you gain weight rapidly after
stopping the diet.
Modifying your lifestyle by adding exercise can balance the equation.
Exercise uses up calories, offers health benefits, confers a feeling of
psychological well-being, and, perhaps most important, sustains your metabolic
rate.
Other lifestyle changes:

- ALTER YOUR ENVIRONMENT: For example, keep “problem” foods in a closet
beyond easy reach, or out of the house altogether.
- ARRANGE FOR REWARDS: Keep in mind the idea that you are moving toward
a smaller clothing size, for example
Weight loss can also be its own
reward.
- TELL OTHERS OF YOUR PLAN: Family members, friends, physicians,
nurses knowing they are watching and hoping can motivate you when your
own motivation flags.
- SUBSTITUTE HEALTHY BEHAVIORS FOR TEMPTATIONS
- MAKE A DEAL: It can be verbal or written; with someone else or with
yourself
The key elements are rewards for achievements and consequences
for failure.
- USE SMALL STEPS TOWARDS SUCCESS: Slow but sure wins the race.

It’s really never easy to lose weight, but by attacking the problem using
a bit of each of these strategies, you may attain that very important victory
that has been eluding you.

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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Nimotop (Nimodipine) is used to improve symptoms caused by spasms as a result of a brain hemorrhage (ruptured blood vessels).

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QUESTION: It sounded like the name of a mouth wash, but our doctor assured us
that “listis” something was nothing to kid about
Can you figure out what he
meant? It is very important to many members of our family and we hope you can
help.

ANSWER: I believe he spoke of Listeriosis, a serious disease caused by the
bacterium Listeria monocytogenes
In adults, it can cause meningitis
(inflammation of the meninges, the tissue around the spinal cord and brain),
meningoencephalitis (inflammation of the meninges and brain), a flu-like
illness, or even death
In a pregnant woman, it can also infect the fetus and
kill it, causing miscarriages
Listeriosis occurs mostly in adults over 40,
pregnant women, and people who have a poor immune system.
The bacteria that cause listeriosis is all around us normally, and many
people carry it in their intestinal tract with no harm
However, several
outbreaks of the disease have been linked to contaminated food products,
notably soft unpasteurized cheeses
In a 1985 outbreak in California, 86
cases and 29 deaths resulted.
Listeriosis can be treated effectively with antibiotics and prompt
treatment of a pregnant woman can keep her baby from becoming infected
To
keep from catching the disease, pregnant women and people with poor immune
systems should stay away from people known to be infected with listeriosis and
from potentially infected materials
Pay strict heed to your doctor’s
recommendations.

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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Herbolax is used to treat chronic constipation and pre-radiographic abdominal preparation.

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