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QUESTION: I learned from a television show that ovarian cancer can be
detected by using two tests, a sonogram and a CA 125 blood test
I called my
gynecologist and he said I could have the two tests if I had a pelvic
examination first
Because I had my uterus removed due to a class III test
result, I am somewhat cautious about other precancerous cells developing.
Since ovarian cancer is so dangerous and often a killer, shouldn’t these tests
be done on a routine basis like the PAP test?

ANSWER: You are right about the seriousness of ovarian cancer
About 18,500
cases are seen each year, and some 11,000 or more women will die of this
disease
In fact ovarian cancers are responsible for 6 percent of all cancer
deaths in women
That means it deserves some attention
Unfortunately,
neither the CA 125 blood test nor the sonogram are efficient screening tests.
The PAP smear is relatively inexpensive, can be performed in the physician’s
office, is highly reliable, and can detect the presence of abnormal cells
before they actually become cancerous
By comparison, both the CA 125 blood
test and the sonogram are relatively expensive and are not specific for
ovarian cancer
Sonograms just produce pictures of a mass or new growth,
using reflected sound waves without specific diagnosis, and the CA 125 is a
nonspecific marker that can also be elevated in conditions such as cirrhosis
of the liver
Neither test can detect the precancerous state, but are useful
in helping to make a diagnosis of a cancer already present, and then following
the results of therapy and the effectiveness of treatments
Thus the first
line of defense for this condition, as for so many others, remains the careful
and attentive physical examination performed by your physician
When this
evaluation yields indications that more investigation is necessary, the other
tests can then be ordered and interpreted
As to your worries about the
relationship between your previous PAP smear findings and this cancer, there
seems little to concern you, as one condition is not a risk factor for the
other
Incidentally, both child birth and the use of oral contraceptives
seems to lower the chance of ovarian cancer
My advice to you is to follow
the course of action your physician has outlined for you, for it certainly
follows current knowledge about ovarian cancer.

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 do not know where else to turn as this question is even too
embarrassing to ask my own physician
I have noticed lately that when I have
an erection of my private, that is has begun to have a shape with a curving
twist to the side
I never noticed this before, and am worried
Do you know
what causes this, and if anything can be done about it?

ANSWER: There is no cause for embarrassment, as regrettably there is a
condition known as Peyronie’s Disease which can do exactly what you are
describing
This problem is seen in adult men and science does not provide us
a full explanation of its cause
Inside of the penis are two bundles of
tissue that, when filled with blood, produce an erection
In Peyronie’s
disease, these bundles develop scar tissue that replaces the normal spongelike
tissue normally found there
This scarring leads to the curving of the erect
penis towards the side of the scar (which grows shorter as it retracts), which
can be quite painful
This scarring can progress and actually lead to an
inability to have an erection
Surgery can be performed in an attempt to
correct the condition, but more scarring can result from the surgery itself,
which can aggravate the condition further
X-ray therapy has been used with
some success, as have injections of cortisone
Here again, the results are
often not all one could wish for
It is this kind of situation that makes
personal medical care so important, and you may gain a much better
understanding and some real help if you consult your personal family doctor.
I realize that it may take a bit of courage to overcome your reluctance to
discuss this, but it is the only way in which you will get the help I think
you need.

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 old pharmacist used to take a lot of time with me to explain
just how a medication should be used, and provided me with all the cautions I
ever wanted
However, now that I am living in a larger city, my new
pharmacist doesn’t seem so concerned, and just stays in the back where I can’t
talk with him
Isn’t it one of the responsibilities of the pharmacist to
provide you with this information that is needed to take the medicine
correctly?

ANSWER: I certainly agree with you that precise information about your
prescription medication is absolutely essential, so that you will take the
medicine correctly and obtain the greatest benefit from its actions.
Personally, I believe that all members of your personal “health team,”
including your physician, the office nurse, physician assistant and the
pharmacist share in that responsibility
To obtain an authoritative response
to your question about pharmacists I consulted with Dr
John A
Cans,
Executive Vice President of the American Pharmaceutical Association, and here
is his reply:
“In any profession or occupation, you will find those who hold personal
service to the consumer or patient as highly important, and those who view it
as less so
Pharmacists are no different
However, all pharmacists have the
knowledge and training needed to provide invaluable medication advice, and the
vast majority are eager to do so
If the pharmacist in the pharmacy you are
patronizing is physically inaccessible or unwilling to discuss your medication
with you, you have two recourses: first, ask to talk to the pharmacist, and
then ask the questions you need the answers to you have the right to the
information
Second, if you don’t get the answer you are entitled to, and the
pharmacist seems reluctant to discuss your medication questions with you, then
find another pharmacist who will work with you
In larger cities, like the
one you are living in, it is easy to find another conveniently located
pharmacy where the pharmacists are eager to fill your information needs”.
I can not help but wonder how many other readers have had similar
problems with receiving service that meets with their expectations from their
pharmacists
I would be interested in your letters that might tell of your
worst and (to be fair) your best experiences with your pharmacists
I will
be sure to report the results back to all of you.
Thank you Dr
Gans for supporting my frequently stated position that in
health care as with all else, if you are not receiving the attention that you
desire and have the right to expect, you can show your displeasure by voting
with your feet.

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 athletic teenage daughter is a leading member of her high school
track team, and we believe she has a real future
However, we are also
concerned that at the age of 15 she has still not started her periods
Mine
began at age 14, and I was taught that daughters follow their mother’s
pattern
Do you think something is wrong with my youngster, and what should
be done?

ANSWER: I think you know even more than you write, and are aware that the is
some relation between a woman’s periods and intense exercise or athletic
involvement
Yes, there may be a connection in your case, as I too was taught
that mothers and daughters share similar experiences where their menstrual
histories are concerned
However, that is not always the case, and the delay
in your daughter’s menarche (the onset of menstruation) could be normal in her
case
We do know that frequently this first happening is delayed when
youngsters of your daughter’s age are deeply involved in strenuous physical
activity
There is an association between thinness, exercise and delayed
menarche, and this may lead to lowered estrogen activity that may be of real
concern
This is a time when bone construction is still going on, and when
bone density is increasing
When there is a lack of estrogen, bone formation
is held back, with consequences of increased osteoporosis or bone thinning
later in life at the time of menopause
Your task is clear
First it entails
a thorough examination for your talented athlete by your physician, including
a pelvic examination to rule out other possible causes of her delayed menses.
A variety of x-ray examinations, to help determine bone age and growth
patterns, as well as blood tests for hormone levels are in order
Once the
diagnosis of menstrual dysfunction due to intense athletic involvement has
been made, the methods of treatment can be discussed and tailored to your
daughter’s special needs
Monthly therapy with progestins, the use of oral
contraceptives may be needed, and, just what you are fearing most, the need to
modify her athletic schedule may be necessary
However the good news is that
this situation can be helped and will have no effects on the future hopes you
may have for grandchildren.

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: Is it possible that a person can think a pain is worse than it
really is? That would make them stay in bed and avoid other activities, and
become an invalid when there is no reason to
The answer to this question is
very important to me.

ANSWER: The mind is a powerful weapon, and it can be used either to fight
illness and pain or to make them worse
Pain is felt because of interactions
of many physical factors
Some people are more sensitive to these factors
than others
But the perception of pain also depends on the mind’s
interaction with the body.
Some people with chronic conditions “learn” a pain cycle that they must
“unlearn” if they are to diminish their pain
Think about it
Once someone
begins to suffer from chronic pain, he may receive some rewards as a result of
it
These rewards are termed “secondary gain” by physicians, and they need to
be recognized by the person who is in pain
Extra attention from loved ones
results from the chronic pain, and in such cases it is not surprising that the
pain seems to continue indefinitely
While this is not the case for everyone,
it is a danger that all persons with chronic pain and their families must be
alert to
The mature, well adjusted person will recognize this behavior and
work to stop it before it creates an unhealthy situation
To break a learned
pain cycle, encouragement from family, friends and physician are essential.
However, before you jump to conclusions consult with your doctor, for constant
pain is a terrible enemy, and sympathy and understanding are great friends.

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: In searching for the perfect method, I have come across some
information about a “morning after” pill to prevent conception
My pharmacist
denies any knowledge of this product, and I am hoping you may have some leads
as to its name and where I can obtain it.

ANSWER: Don’t get down on your pharmacist, he isn’t being difficult
The
Food and Drug Administration has not approved any medication for this purpose,
and none are manufactured or sold for this specific indication
But there are
a number of hormonal and mechanical methods which can be used after the fact
that are apparently very effective in preventing conception
The lowest
pregnancy rates occur by inserting a IUD (Intra Uterine Device) in place
immediately after unprotected intercourse, sometimes a bit difficult to
accomplish
The use of birth control-like estrogen/progesterone hormone
combinations within 12 to 72 hours after intercourse also may be effective
A
single intravenous injection of conjugated estrogens may also be used, and
there are no reports of malformation of the fetus, should one be present if
this hormone treatment fails to act.

The material contained here is “FOR INFORMATION ONLY” and should not replace
the counsel and advice of your personal physician
Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

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QUESTION: I have been having terrible morning sickness with this pregnancy.
I always thought it normally stops after three months, but my girl friend
claims her problems continued past then
Can a woman have morning sickness
after the first three months of a pregnancy?

ANSWER: Yes, the discomfort and unpleasantness of nausea and vomiting can
persist into the second trimester of pregnancy
And it doesn’t mean your baby
is in any trouble
The exact cause of morning sickness hasn’t been determined
yet, but it is believed to be related to the levels of human chorionic
gonadotropin (HCG) in the mother’s circulation
The appearance of symptoms
generally coincides with a rise in the level of HCG, and the symptoms
disappear with the fall of HCG levels
Curiously, however, women with extreme
cases of morning sickness called “emesis gravidarum” often have lower than
normal HCG levels.
Some of the theories that have been suggested to explain the continuation
of morning sickness beyond the first trimester include allergic,
endocrinologic, and psychological factors
Too often in the past most of the
blame was placed on psychological factors, but studies have failed to prove
this to be consistently true.

The material contained here is “FOR INFORMATION ONLY” and should not replace
the counsel and advice of your personal physician
Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

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QUESTION: I have a very severe problem because I get so sick when ever I
travel
The distress is so great that I am limited in my choice of vacations
and can’t even visit friends just a short distance away
What causes this
terrible motion sickness, and what can I do to control it? I certainly need
some help, and hope you will provide it.

ANSWER: Although not usually a serious medical problem, motion sickness is
the most common complaint voiced by travelers
Its symptoms dizziness with
nausea, vomiting or pale clammy skin are caused by an overstimulation of the
balance organs in the middle ear
The sense organs (sight, hearing, and touch
in particular) send messages to the brain whenever our balance is disturbed,
either inside or from outside movements
If these messages come too fast or
are mixed (your eyes see no motion but your body feels it) the brain gets
overwhelmed and sickness results.
To minimize motion sickness, try to avoid lengthy exposure to continuous,
undulating, and rolling motion
Ride with your eyes fixed on a distant
stationary object when possible, so your eyes will see the same motion that
your body and inner ears feel
Do not read when traveling and do not sit
facing backwards
Also avoid heavy, spicy foods that might upset your
stomach
If you are planning a trip by plane, schedule a daytime flight, and
book a window seat, so you have a distant horizon to gaze out upon
When
these simple remedies fail, try some medications that can be recommended by
your physician or pharmacist to alleviate the troublesome results of motion
sickness
Follow directions carefully, for most of these medications should
be used before the journey begins.

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 forty year old woman, I encounter a burning pain, severe at
times, in the right lower abdomen for one to three days, occurring halfway
between my menstrual periods each and every month
Three different doctors
have found nothing wrong, and all said the pain is from monthly ovulation and
is normal
I find this hard to believe
I would certainly appreciate any
comment you can offer on this condition.

ANSWER: With very few exceptions you offer a classical history of a patient
suffering with a condition known as “mittelschmerz”
This word from the
German describes a “middle pain” or pain that arrives each month at the time
of ovulation
In almost all women, ovulation occurs 14 days before the onset
of the next period, and for women with a 28 day cycle, ovulation occurs at
exactly the mid point of their “menstrual month”
During ovulation, when the
mature egg separates from the ovary to begin its journey through the fallopian
tubes to the uterus, the ovary may bleed at the point of egg separation.
Though an insignificant amount of blood escapes, it can fall on sensitive
tissues nearby, where an inflammatory reaction produces the pain
It is
normal, in your case, and may be controlled by using an antiinflammatory
analgesic such as ibuprofen.

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: Could you please be so kind as to explain male sterility due to
mumps contracted during puberty? I have been married 6 years and I haven’t
been able to get pregnant
How does this illness affect the male’s
reproductive system, and is there any cure for it?

ANSWER: Mumps is a disease that is found worldwide, and by fifteen years of
age more than 90 percent of people living in urban areas have blood tests that
reveal that they have been exposed to the disease
It most often occurs in
children between the ages of five to nine years, but those statistics are
changing due to the use of a mumps vaccine that was first available for use in
1967
The cause of the infection is a virus that is passed through contact
with secretions from an infected individual’s nose, mouth and throat
About
one third of the time the disease proceeds with no symptoms at all except for
a slight fever and malaise
However the most noticeable feature of the full
blown attack is swelling of the parotid gland located in the cheek, as well as
other salivary glands
It may also affect the testicles of men past puberty
in from 10 to 20 percent of the cases
It then is called “orchitis” or
inflammation of the testicles
It may touch one or both sides, and according
to some articles in the literature may rarely affect sterility, or according
to other experts produce sterility in as many as half the cases
The viral
infection attacks the sperm producing cells and destroys them, leaving the
testicle atrophied or shrunken
Fortunately the cells which produce the
masculine hormone are not affected, and so levels of male hormone remain
normal throughout life
Once the damage has been done, there is no treatment
available to regenerate the sperm producing cells
When the problem is
sterility, a complete work up must be performed to determine the number and
activity of sperm that may be present, and to evaluate the potential for
fertilization
If the findings indicate that this might occur, you too, must
be examined for possible problems that are standing in the way of pregnancy,
which should then be treated and corrected as well
Although a history of
mumps is important in fertility problems, it must not be considered the
culprit until all the possibilities have been examined.

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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