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Answer: You are correct in that more and more and more people are suffering from diabetes than ever before. This is caused by several things, not the least of which is our diet. Because this problem is so prevalent, I would be happy to furnish a series of questions and answers on "pre-diabetes" and then on the disease itself, over the next several issues.

Question: What is pre-diabetes and how is it different from diabetes?

Answer: Pre-diabetes is the state that occurs when a person’s blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. About 11 percent of people with pre-diabetes in the Diabetes Prevention Program standard or control group developed type 2 diabetes each year during the average 3 years of follow-up. Other studies show that many people with pre-diabetes develop type 2 diabetes in 10 years.

Question: Is pre-diabetes the same as Impaired Glucose Tolerance or Impaired Fasting Glucose?

Answer: Yes. Doctors sometimes refer to this state of elevated blood glucose levels as Impaired Glucose Tolerance or Impaired Fasting Glucose (IGT/IFG), depending on which test was used to detect it.

Question: Why does it need a new name? Has the condition changed?

Answer: The condition has not changed, but what is known about it has. The new name is given for several reasons. Pre-diabetes is a clearer way of explaining what it means to have higher than normal blood glucose levels. It means you are likely to develop diabetes and may already be experiencing the adverse health effects of this serious condition. People with pre-diabetes are at higher risk of cardiovascular disease. People with pre-diabetes have a 1.5-fold risk of cardiovascular disease compared to people with normal blood glucose. People with diabetes have a 2- to 4-fold increased risk of cardiovascular disease. It is now known that people with pre-diabetes can delay or prevent the onset of type 2 diabetes through lifestyle changes.

Question: How do I know if I have pre-diabetes?

Answer: Doctors can use either the fasting plasma glucose test (FPG) or the oral glucose tolerance test (OGTT) to detect pre-diabetes. Both require a person to fast overnight. In the FPG test, a person’s blood glucose is measured first thing in the morning before eating. In the OGTT, a person’s blood glucose is checked after fasting and again 2 hours after drinking a glucose-rich drink.

Question: How does the FPG test define diabetes and pre-diabetes?

Answer: Normal fasting blood glucose is below 100 mg/dl. A person with pre-diabetes has a fasting blood glucose level between 100 and 125 mg/dl. If the blood glucose level rises to 126 mg/dl or above, a person has diabetes.

Question: How does the OGTT define diabetes and pre-diabetes?

Answer: In the OGTT, a person’s blood glucose is measured after a fast and 2 hours after drinking a glucose-rich beverage. Normal blood glucose is below 140 mg/dl 2 hours after the drink. In pre-diabetes, the 2-hour blood glucose is 140 to 199 mg/dl. If the 2-hour blood glucose rises to 200 mg/dl or above, a person has diabetes.

Question: Which test is better?

Answer: According to the expert panel, either test is appropriate to identify pre-diabetes.

Question: Why do I need to know if I have pre-diabetes?

Answer: If you have pre-diabetes, you can and should do something about it. Studies have shown that people with pre-diabetes can prevent or delay the development of type 2 diabetes by up to 58 percent through changes to their lifestyle that include modest weight loss and regular exercise. The expert panel recommends that people with pre-diabetes reduce their weight by 5-10 percent and participate in some type of modest physical activity for 30 minutes daily. For some people with pre-diabetes, intervening early can actually turn back the clock and return elevated blood glucose levels to the normal range.

Question: Will my insurance cover testing and treatment?

Answer: Because all insurance plans are different, this is a difficult question to answer. However, Medicare and most insurance plans cover diabetes testing for people suspected of having diabetes. People at risk for diabetes are also at risk for pre-diabetes. Since the test is the same and the risk factors are the same for both conditions, a pre-diabetes test may be covered. It is best to consult your physician and health insurance representative with specific coverage questions.

Question: What is the treatment for pre-diabetes?

Answer: Treatment consists of losing a modest amount of weight (5-10 percent of total body weight) through diet and moderate exercise, such as walking, 30 minutes a day, 5 days a week. Don’t worry if you can’t get to your ideal body weight. A loss of just 10 to 15 pounds can make a huge difference. If you have pre-diabetes, you are at a 50 percent increased risk for heart disease or stroke, so your doctor may wish to treat or counsel you about cardiovascular risk factors, such as tobacco use, high blood pressure, and high cholesterol.

Question: Who should get tested for pre-diabetes?

Answer: If you are overweight and age 45 or older, you should be checked for pre-diabetes during your next routine medical office visit. If your weight is normal and you’re over age 45, you should ask your doctor during a routine office visit if testing is appropriate. For adults younger than 45 and overweight, your doctor may recommend testing if you have any other risk factors for diabetes or pre-diabetes. These include high blood pressure, low HDL cholesterol and high triglycerides, a family history of diabetes, a history of gestational diabetes or giving birth to a baby weighing more than 9 pounds, or belonging to an ethnic or minority group at high risk for diabetes.

Qustion: How often should I be tested?

Answer: If your blood glucose

levels are in the normal range, it is reasonable to be checked every 3 years. If you have pre-diabetes, you should be checked for type 2 diabetes every 1-2 years after your diagnosis. Question: Could I have pre-diabetes and not know it?

Answer: Yes, people with pre-diabetes don’t often have symptoms. In fact, millions of people have diabetes and don’t know it because symptoms develop so gradually, people often don’t recognize them. Some people have no symptoms at all. Symptoms of diabetes include unusual thirst, a frequent desire to urinate, blurred vision, or a feeling of being tired most of the time for no apparent reason.

Question: Should children be screened for pre-diabetes?

Answer: It is not recommended to screen children at this time for pre-diabetes because there isn’t enough evidence that type 2 diabetes can be prevented or delayed in children at high risk for the disease. However, a study published a few years ago in the New England Journal of Medicine found 25 percent of very obese children and 21 percent of very obese adolescents had pre-diabetes. If future studies show that early intervention also works for children, a recommendation could be forthcoming.

I will be back next month to talk more about diabetes…the disease itself.

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Health & Medicine

Shelly McDaniel

2010-04-01 13:22:00

There are no clinical procedures involved and no preparation is needed for the evaluation. However, the Neuropsychologist may want to discuss any medications being used beforehand and too determine a time for your friend’s visit when she will be functioning at her best.

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Health & Medicine

Dr Galichia

2010-04-01 12:04:00

Answer: Edema is the medical term for swelling. It is a general response of the body to injury or inflammation. Edema can be isolated to a small area or affect the entire body. Medications, infections, pregnancy, and many medical problems can cause edema. Edema results whenever small blood vessels become "leaky" and release fluid into nearby tissues. The extra fluid accumulates, causing the tissue to swell. Causes of Edema Edema is a normal response of the body to inflammation or injury. For example, a twisted ankle, a bee sting, or a skin infection will all result in edema in the involved area. In some cases, such as in an infection, this may be beneficial. Increased fluid from the blood vessels allows more infection-fighting white blood cells to enter the affected area. Edema can also result from medical conditions or problems in the balance of substances normally present in blood. Some of the causes of edema include: • Low albumin (hypoalbuminemia): Albumin and other proteins in the blood act like sponges to keep fluid in the blood vessels. Low albumin may contribute to edema, but isn't usually the sole cause. • Allergic reactions: Edema is a usual component of most allergic reactions. In response to the allergic exposure, the body allows nearby blood vessels to leak fluid into the affected area. • Obstruction of flow: If the drainage of fluid from a body part is blocked, fluid can back up. A blood clot in the deep veins of the leg can result in leg edema. A tumor blocking lymph or blood flow will cause edema in the affected area. • Critical illness: Burns, life-threatening infections, or other critical illnesses can cause a whole-body reaction that allows fluid to leak into tissues almost everywhere. Widespread edema throughout the body can result. • Edema and heart disease (congestive heart failure): When the heart weakens and pumps blood less effectively, fluid can slowly build up, creating leg edema. If fluid buildup occurs rapidly, fluid in the lungs (pulmonary edema) can develop. • Edema and liver disease: Severe liver disease (cirrhosis) results in an increase in fluid retention. Cirrhosis also leads to low levels of albumin and other proteins in the blood. Fluid leaks into the abdomen (called ascites), and can also produce leg edema. • Edema and kidney disease: A kidney condition called nephrotic syndrome can result in severe leg edema, and sometimes whole-body edema (anasarca). • Edema and pregnancy: Due to an increase in blood volume during pregnancy and pressure from the growing womb, mild leg edema is common during pregnancy. However, serious complications of pregnancy such as deep vein thrombosis and preeclampsia can also cause edema. • Cerebral edema (brain edema): Swelling in the brain can be caused by head trauma, low blood sodium (hyponatremia), high altitude, brain tumors, or an obstruction to fluid drainage (hydrocephalus). Headaches, confusion, and unconsciousness or coma can be symptoms of cerebral edema. • Medications and edema: Numerous medications can cause edema, including: - NSAIDs (ibuprofen, naproxen) - Calcium channel blockers - Corticosteroids (prednisone, methylprednisolone) - PPioglitazone and rosiglitazone - Pramiprexole Most commonly, these medications produce no edema, or mild leg edema. Symptoms of Edema Edema symptoms depend on the amount of edema and the body part affected. Edema in a small area from an infection or inflammation (such as a mosquito bite) may cause no symptoms at all. On the other hand, a large local allergic reaction (such as from a bee sting) may cause edema affecting the entire arm. Here, tense skin, pain, and limited movement can be symptoms of edema. Food allergies may cause tongue or throat edema, which can be life-threatening if it interferes with breathing. Leg edema of any cause can cause the legs to feel heavy and interfere with walking. In edema and heart disease, for example, the legs may easily weigh an extra 5 or 10 pounds each. Severe leg edema can interfere with blood flow, leading to ulcers on the skin. Pulmonary edema causes shortness of breath, which can be accompanied by low oxygen levels in the blood. Some people with pulmonary edema may experience a cough with frothy sputum. Treatment of Edema Treatment of edema often means treating the underlying cause of edema. For example, allergic reactions causing edema may be treated with antihistamines and corticosteroids. Edema resulting from a blockage in fluid drainage can sometimes be treated by eliminating the obstruction: • A blood clot in the leg is treated with blood thinners, and the clot slowly breaks down. Leg edema then resolves as fluid drainage improves. • A tumor obstructing a blood vessel or lymph flow can sometimes be reduced in size or removed with surgery, chemotherapy, or radiation. • Leg edema related to congestive heart failure or liver disease can be treated with a diuretic like furosemide (Lasix). When urine output increases, more fluid drains from the legs back into the blood. Maintaining a sodium-restricteddiet will also help limit fluid retention associated with heart failure or liver disease. We will talk more next month on edema and diabetes.

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Health & Medicine

Dr Galichia

2010-03-01 08:47:00

Answer: Most of the time people who take calcium channel blocking drugs such as amlodopine have some swelling, it is often manageable and it is unresponsive to diuretics. In most instances swollen feet and ankles in a person who is taking this kind of medication is not the result of heart failure or other major systemic problems but rather related to the drug itself. I’m sure that you are taking this medication to control your blood pressure and a side effect is simply swelling of the feet and ankles. Dyazide, the diuretic you are taking is a good blood pressure lowering drug but is not effective in treating the swelling we see with calcium channel blocking drugs. Thus taking a diuretic is rarely a benefit. Most patients are worried that they may have heart failure, renal failure or kidney failure or perhaps a problem with blood clots in the legs. Speak with your doctor about these other potential problems. Among those, heart failure is the most common, but in the absence of shortness of breath, this is not likely the cause. There are other calcium channel blocking drugs which create less swelling in the legs and you may speak with your doctor about a substitution with one of those drugs. The drug amlodopine however is an excellent blood pressure medication and the swelling that we see is something that usually is tolerable and it helps the patient to know that there is no other more serious underlying illness causing the swelling. There are about 120 different medicines that one can take for blood pressure. I always tell my patients if they have problems with one blood pressure medication it is highly likely that another one will work with fewer side effects.

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Health & Medicine

Dr Galichia

2010-02-01 08:42:00

Answer: MVP is a common disorder and it is usually congenital in nature. Anywhere between 3 to 8 percent of female population and perhaps half as many males are born with this problem. In most people it will remain silent and cause no side effects their entire life. The mitral valve separates the left ventricle from the left atrium, and in these individuals is large and has redundant tissue. This may set the stage for leakage of the valve, usually slowly progressive over the life time. In many individuals there is no leakage whatsoever or it is very minor, and thus may be graded on a scale of 1 to 4 in severity. A score of 1 over 4 would be minor leakage of the valve on an echocardiogram. Your doctor may have heard a murmur which was very soft and often judged on a scale of 1 to 6. Again this would imply a soft murmur and small amount of leakage. In some individuals the leakage becomes very severe and requires valvular repair or replacement. This deterioration occurs in a minority of patient and most common in older women. Of all the patients with mitral valve prolapse less than 5 percent will ever need valvular surgery. This disorder tends to run in families, being more prevalent in taller, more slender women. It may also cause myriad other symptoms including palpitations, chest pain, fatigue, exercise incapacity, shortness of breath, and episodes of fainting. These symptoms usually occur in the absence of severe valvular leakage, remaining somewhat a medical mystery, unexplained on any defined physiologic basis. These valves can also be infected, particularly at the time of dental work or when one has skin infections. The use of prophylactic antibiotics may be necessary to prevent this serious problem. It is important to know whether one has mitral valve prolapse and to know the severity. An anatomic configuration on the echocardiogram and the degree of leakage will determine whether preventive antibiotics are necessary, and also provide insight into the potential need for valvular surgery. At age 51 with only minimal leakage it has been my experience that rapid deterioration is unlikely and that your prognosis is very good. Long term follow up with your doctor is important, the role of serial echocardiograms to be decided by your cardiologist.

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Health & Medicine

Deb Wetta

2010-02-01 08:42:00

QUESTION: I am needing rehabilitative care and was wondering what is the best type of care and is one better than the other?

ANSWER: When making a choice where to receive rehabilitative care, it is vital to recognize the difference between services available in various settings and how these differences can impact recovery. Probably the most noticeable difference between a rehabilitation hospital and a skilled nursing facility is the amount of therapy a patient will receive. While both types of facilities typically offer physical, occupational and speech/language therapies, a rehabilitation hospital delivers more frequent and longer sessions in a week’s time. In fact, physical, occupational and/or speech language therapy must be delivered a minimum three hours a day in a rehabilitation hospital; there is no defined length of time for these services to be provided in skilled nursing. The amount of therapy is important because more aggressive rehabilitation can make a difference in how quickly someone returns home and is able to enjoy a quality of life comparable to that which they experienced prior to their illness or injury. Additionally, care in a rehabilitation hospital, is delivered by a team of specially trained professionals whose goal is to direct patients in recovery to the independence they once had. In addition to the aforementioned, it’s good to consider the following points when looking at rehabilitation options for your loved one. In a rehabilitation hospital, the attending physician visits daily, in a skilled nursing facility, the physician is only required to visit a minimum of once every 30 days. A multidisciplinary team led by a medical doctor or a doctor of osteopathy is a requirement of a rehabilitation hospital; not so in a nursing home. And registered nurses must provide oversight around the clock in a rehab hospital but only eight consecutive hours a day in a nursing facility. There is also a higher concentration of nurses per patient in a rehabilitation hospital and each of them receives specialized training in the unique needs of patients working to get back on their feet and back home. I recommend a tour of any facility you are considering. When you go, ask about some of the following: Are you assigned a case manager to help you navigate this new world you and your wife have entered? Does the facility offer therapies designed specifically for your wife’s condition? Do they routinely monitor how well patients do as result of their rehabilitation? Are family members involved in the care plan and how often are they included in goal setting? Is there education available to help learn how to deal with your wife’s condition? And be sure to ask about the plan for your wife’s therapy once she is discharged to home, ideally, she will be able to continue her treatment as an outpatient until she is fully recovered.

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Health & Medicine

Dr Galichia

2009-12-01 09:50:00

: How is swine flu treated? Answer: Pandemic H1N1 swine flu virus is sensitive to the antiviral drugs Tamiflu and Relenza. These antiviral drugs are most effective when taken within 48 hours of the start of flu symptoms. It’s resistant to older flu drugs. Not everyone needs treatment with these anti-flu drugs. Most people who come down with H1N1 swine flu recover fully -- without antiviral treatment. But the CDC strongly recommends antiviral treatment for people at risk of severe flu complications who come down with flu-like symptoms. Since it’s very important to start these drugs soon after symptoms appear, doctors should offer treatment to at-risk patients if they suspect they have the flu. Doctors should not rely on rapid flu tests (they are too unreliable for definitive diagnosis) or wait for results of lab-based tests (because they t

Answer: The new H1N1 swine flu virus apparently spreads just like regular flu. You could pick up germs directly from airborne droplets from the cough or sneeze of an infected person. You could also pick up the virus by touching an object contaminated by the cough or touch of an infected person and then touching your eyes, mouth, or nose. That’s why you should make washing your hands a habit, even when you’re not ill. Infected people can start spreading flu germs up to a day before symptoms start, and for up to seven days after getting sick, according to the CDC. The H1N1 swine flu virus, like the seasonal flu virus, can become airborne if you cough or sneeze without covering your nose and mouth, sending germs into the air. Ferret studies suggest that swine flu spreads less easily by small, airborne droplets than does seasonal flu. But it does spread by this route, and it may begin to spread even more readily as the new virus fully adapts to humans. The H1N1 swine flu virus is a human virus spread by people and not by pigs. The only way to get the new swine flu is from another person. Question: How is swine flu treated? Answer: Pandemic H1N1 swine flu virus is sensitive to the antiviral drugs Tamiflu and Relenza. These antiviral drugs are most effective when taken within 48 hours of the start of flu symptoms. It’s resistant to older flu drugs. Not everyone needs treatment with these anti-flu drugs. Most people who come down with H1N1 swine flu recover fully -- without antiviral treatment. But the CDC strongly recommends antiviral treatment for people at risk of severe flu complications who come down with flu-like symptoms. Since it’s very important to start these drugs soon after symptoms appear, doctors should offer treatment to at-risk patients if they suspect they have the flu. Doctors should not rely on rapid flu tests (they are too unreliable for definitive diagnosis) or wait for results of lab-based tests (because they take too long). Early treatment is so important that the CDC suggests doctors offer a Tamiflu or Relenza prescription to at-risk patients. If these patients develop flu-like symptoms, they would call their doctor, and based on the doctor’s clinical judgment, the patient could then simply fill the prescription. Many people who have died of H1N1 swine flu had bacterial co-infections, particularly pneumococcal infections. There’s a vaccine against pneumococcal infections. It’s routine for children and recommended for adults with underlying health conditions, smokers, or people over age 65. If your flu symptoms get worse after getting better, call your doctor. You may need treatment with antibiotic medications. Is there enough Tamiflu and Relenza to go around? Federal and state stockpiles are large enough to treat at-risk patients with flu symptoms. But there isn’t enough to offer treatment to otherwise healthy people who may have the flu. And health officials have asked people not to hoard Tamiflu or Relenza.

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Health & Medicine

Deb Wetta

2009-12-01 08:24:00

QUESTION: My father recently suffered an accident to his arm and hand. He is having difficulty using it and I want to know what are our options considering therapy?

ANSWER: It sounds like your father may benefit from therapy using the Saebo Arm Training Program. Specially trained therapists can use the Saebo system to help your father exercise the muscle groups in his hand and arm. With improved muscle tone, your father may regain function in his hand, allowing him to perform many of the daily tasks of living. The Saebo Arm Training Program is performed with orthotics known as SaeboFlex and SaeboReach, which are custom-fitted to the hand and arm to provide support and resistance during exercise. SaeboFlex features a system of springs fitted to the hand, wrist, and fingers that immediately give the patient the ability to grasp and release while performing various tasks directed by a therapist. SaeboReach extends the system above the elbow, using springs as well as tension cords to strengthen the muscle groups used to bend the arm. Your father does not need to be able to move his fingers to take advantage of this program, it is ideal for patients who have limited movement in their arm or elbow, but minimal or no movement in their hand. It is also suitable for patients who have reached a plateau in their treatment or are years beyond their initial injury. In fact, Saebo has helped patients improve their hand function as much as nineteen years after suffering a stroke. If determined by a Saebo trained therapist to be an appropriate form of treatment, Saebo can be prescribed as part of a home therapy program. In fact, Medicare will pay for all but $375 of the system. Your father’s physician would need to prescribe an evaluation for treatment and his occupational therapist will determine if Saebo is the proper therapy to be used.

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Health & Medicine

Dr Galichia

2009-11-01 15:55:00

: What are the symptoms of H1N1 swine flu? Answer: The symptoms of H1N1 are like regular flu symptoms and include fever, cough, sore throat, runny nose, body aches, headache, chills, and fatigue. Many people with swine flu have had diarrhea and vomiting. Nearly everyone with flu has at least two of these symptoms. But these symptoms can also be caused by many other conditions. That means that you and your doctor can’t know, just based on your symptoms, if you’ve got swine flu. Health care professionals may offer a rapid flu test, although a negative result doesn’t necessarily mean you don’t have the flu. Like seasonal flu, pandemic swine flu can cause neurologic symptoms in children. These events are rare, but, as cases associated with seasonal flu have shown, they can be very severe and often fatal. Symptoms include seizures or changes in mental status (confusion or sudden cognitive or behavioral changes). It’s not clear why these symptoms occur, although they may be caused by Reye’s syndrome. Reye’s syndrome usually occurs in children with a viral illness who have taken aspirin…something that should always be avoided. Only lab tests can definitively show whether you’ve got swine flu. State health departments can do these tests. But given the large volume of samples coming in to state labs, these tests are being reserved for patients with severe flu symptoms. Currently, doctors are reserving antiviral drugs for people with or at risk of severe influenza. Question: Who is at the biggest risk for H1N1? Answer: Most U.S. cases of H1N1 swine flu have been in children and young adults. It’s not clear why, and it’s not clear whether this will change. But certain groups are at particularly high risk of severe disease or bad outcomes if they get the flu: • Pregnant women are six times more likely to have severe flu disease than women who are not pregnant. • Young children, especially those under 2 years of age • People with cardiovascular conditions (except high blood pressure) • People with liver problems • People with kidney problems • People with blood disorders, including sickle cell disease • People with neurologic disorders • People with neuromuscular disorders • People with metabolic disorders, including diabetes • People with immune suppression, including HIV infection and medications that suppress the immune system, such as cancer chemotherapy or anti-rejection drugs for transplants • Residents of a nursing home or other chronic-care facility • Elderly people are at high risk of severe flu disease…if they get it. Relatively few swine flu cases have been seen in people over age 65. People in these groups should seek medical care as soon as they get flu symptoms. A striking number of adults who developed severe swine flu complications have been morbidly obese. However, obesity itself does not seem to be the issue. The vast majority of extremely obese people suffer respiratory problems and/or diabetes, which seem to be the underlying reason for their severe flu complications. Question: I think I have swine flu, what shou

Answer: Swine flu, also known as 2009 H1N1 influenza, is a human disease. People get the disease from other people, not from pigs. The disease originally was nicknamed swine flu because the virus that causes the disease came to humans from pigs. The virus contains genes from swine, bird, and human flu viruses. Scientists are still arguing about what the virus should be called, but most people know it as the H1N1 swine flu virus. The swine flu viruses that spread among pigs aren’t the same as human flu viruses. Swine flu doesn’t often infect people, and the rare human cases that have occurred in the past have mainly affected people who had direct contact with pigs. But the current “swine flu” outbreak is different. It’s caused by a new swine flu virus that has changed in ways that allow it to spread from person to person…and it’s happening among people who haven’t had any contact with pigs. That makes it a human flu virus. To distinguish it both from flu viruses that infect mainly pigs and from the seasonal influenza A H1N1 viruses that have been in circulation for many years, the CDC calls the virus “2009 H1N1 virus.” Many people have at least partial immunity to seasonal H1N1 viruses because they’ve been infected with or vaccinated against this flu bug. These viruses “drift” genetically, which is why the flu vaccine has to be tweaked from time to time. But the H1N1 swine flu is not the usual “drift variant” of H1N1. It’s come to humans from a different line of evolution. That means very few people have any natural immunity to H1N1 swine flu. The normal seasonal flu shot offers no protection against this new virus. Some people who may have had seasonal H1N1 flu before 1957 might have a little bit of protective immunity against the new virus. That’s because seasonal H1N1 flu strains that circulated before 1957 (and which were replaced by the 1957 pandemic flu bug) were genetically closer to the 2009 H1N1 swine flu. This protection, if it truly exists, is not complete. While relatively few elderly people have had H1N1 swine flu, many of those who did get the disease became severely ill. Question: What are the symptoms of H1N1 swine flu? Answer: The symptoms of H1N1 are like regular flu symptoms and include fever, cough, sore throat, runny nose, body aches, headache, chills, and fatigue. Many people with swine flu have had diarrhea and vomiting. Nearly everyone with flu has at least two of these symptoms. But these symptoms can also be caused by many other conditions. That means that you and your doctor can’t know, just based on your symptoms, if you’ve got swine flu. Health care professionals may offer a rapid flu test, although a negative result doesn’t necessarily mean you don’t have the flu. Like seasonal flu, pandemic swine flu can cause neurologic symptoms in children. These events are rare, but, as cases associated with seasonal flu have shown, they can be very severe and often fatal. Symptoms include seizures or changes in mental status (confusion or sudden cognitive or behavioral changes). It’s not clear why these symptoms occur, although they may be caused by Reye’s syndrome. Reye’s syndrome usually occurs in children with a viral illness who have taken aspirin…something that should always be avoided. Only lab tests can definitively show whether you’ve got swine flu. State health departments can do these tests. But given the large volume of samples coming in to state labs, these tests are being reserved for patients with severe flu symptoms. Currently, doctors are reserving antiviral drugs for people with or at risk of severe influenza. Question: Who is at the biggest risk for H1N1? Answer: Most U.S. cases of H1N1 swine flu have been in children and young adults. It’s not clear why, and it’s not clear whether this will change. But certain groups are at particularly high risk of severe disease or bad outcomes if they get the flu: • Pregnant women are six times more likely to have severe flu disease than women who are not pregnant. • Young children, especially those under 2 years of age • People with cardiovascular conditions (except high blood pressure) • People with liver problems • People with kidney problems • People with blood disorders, including sickle cell disease • People with neurologic disorders • People with neuromuscular disorders • People with metabolic disorders, including diabetes • People with immune suppression, including HIV infection and medications that suppress the immune system, such as cancer chemotherapy or anti-rejection drugs for transplants • Residents of a nursing home or other chronic-care facility • Elderly people are at high risk of severe flu disease…if they get it. Relatively few swine flu cases have been seen in people over age 65. People in these groups should seek medical care as soon as they get flu symptoms. A striking number of adults who developed severe swine flu complications have been morbidly obese. However, obesity itself does not seem to be the issue. The vast majority of extremely obese people suffer respiratory problems and/or diabetes, which seem to be the underlying reason for their severe flu complications. Question: I think I have swine flu, what should I do? When should I see my doctor? Answer: If you have flu symptoms, stay home, and when you cough or sneeze, cover your mouth and nose with a tissue. Afterward, throw the tissue in the trash and wash your hands. That will help prevent your flu from spreading. If you can do it comfortably, wear a surgical mask if you must be around others. If you have only mild flu symptoms, you do not need medical attention unless your illness gets worse. But if you are in one of the groups at high risk of severe disease, contact your doctor at the first sign of flu-like illness. In such cases, the CDC recommends that people call or email their doctor before rushing to an emergency room. But there are emergency warning signs. Children should be given urgent medical attention if they: • Have fast breathing or trouble breathing • Have bluish or gray skin color • Are not drinking enough fluid • Are not waking up or not interacting • Have severe or persistent vomiting • Are so irritable that the child does not want to be held • Have flu-like symptoms that improve but then return with fever and a worse cough • Have fever with a rash • Have a fever and then have a seizure or sudden mental or behavioral change. Adults should seek urgent medical attention if they have: • Difficulty breathing or shortness of breath • Pain or pressure in the chest or abdomen • Sudden dizziness • Confusion • Severe or persistent vomiting • Flu-like symptoms that improve, but then come back with worsening fever or cough Keep in mind that your doctor will not be able to determine whether you have H1N1 swine flu, but he or she may take a sample from you and send it to a state health department lab for testing to see if it’s swine flu. If your doctor suspects swine flu, he or she would be able to write you a prescription for Tamiflu or Relenza. These antiviral medications aren’t a question of life or death for the vast majority of people. Most U.S. swine flu patients have made a full recovery without antiviral drugs.

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Health & Medicine

Dr Galichia

2009-10-01 15:50:00

Answer: I can tell you about Graves’ Disease, but I would advise you to see your doctor as soon as possible. These symptoms could be any one of several things. There are several tests your doctor can do to determine exactly what it is. Graves’ Disease is a type of autoimmune disease that causes over-activity of the thyroid gland, causing hyperthyroidism. This over-activity is also sometimes called “toxic diffuse goiter.” The thyroid gland helps set the rate of metabolism, which is the rate at which the body uses energy. When the thyroid is too active, it makes more thyroid hormones than the body needs. High levels of thyroid hormones can cause side effects such as weight loss, rapid heart rate and nervousness. This is an uncommon disease that affects 2 percent of all women at some time in their lives. Graves’ Disease also tends to affect women between the ages of 20 and 40, although it occurs in infants, children, and the elderly. Some of the symptoms of Graves’ Disease and hyperthyroidism: • trouble sleeping • fatigue • trouble getting pregnant • frequent bowel movements • irritability • weight loss without dieting • heat sensitivity • increased sweating • muscular weakness • changes in vision or how your eyes look • lighter menstrual flow • rapid heart beat • hand tremors Graves’ Disease is the only kind of hyperthyroidism that is associated with swelling of the tissue around the eyes and bulging of the eyes. And rare cases, patients will develop a lumpy reddish thickening of the skin in front of the shins called pretibial myxedema. This skin condition is usually painless. The symptoms of this disease can occur slowly or very suddenly and are sometimes confused with other medical problems. Women can also have Graves’ Disease and have no visible symptoms at all. Graves’ Disease can be caused by a group of different factors that come together to cause thyroid problems, including heredity, your body’s immune system, your age, sex hormones, and possibly stress. You can inherit a greater likelihood to have hyperthyroidism, which means that you may develop Graves’ Disease at some time during your life. Your doctor will do a simple blood test that will be able to tell if your body has the right amount of thyroid hormones. This test measures the thyroid hormones Free T4 and TSH (thyroid stimulating hormone) to find out if the levels are in the normal range. There are other tests that your doctor may choose to do, such as blood tests to find out if levels of the thyroid hormones Free T4 and Free T3 are in the normal range. Your doctor also may test how much iodine the thyroid gland can collect and take a scan, or picture, to see how the iodine moves throughout the gland. This test can be helpful in finding out the cause of and treatment for the disease. Another test, called a Thyroid Stimulating Immunogobulin (TSI), might be used if your doctor is unsure about whether you have the disease, or for patients who have a Graves’ Disease eye disorder but normal thyroid function. It can also be used to check a Graves’ Disease patient’s response to treatment. TSI is also measured in pregnant women who have hyperthyroidism to diagnose Graves’ Disease and to assess the risk to the baby. There are three treatments for Graves’ Disease: Medicine. There are some medicines called anti-thyroid drugs that can lower the amount of thyroid hormones made by the thyroid, causing it to make, normal levels. A doctor must give these medicines to you. Some patients who take an acute thyroid drug for 1 to 2 years have a remission from Graves’ Disease; their thyroid function may remain normal even without medication. Radioactive iodine. The radioactive iodine damages thyroid cells, shrinking and eventually destroying the thyroid gland in order to reduce hormone levels. Like surgery, this condition usually leads to hypothyroidism, so that thyroid hormone supplement medication is needed for the rest of the patient’s life. Surgery. All of the thyroid gland will be removed. In most cases, people who have surgery for Graves’ Disease will develop an under-active thyroid (hypothyroidism, the opposite of hyperthyroidism), and will have to take thyroid replacement hormones for the rest of their lives. After a diagnosis is made and a treatment is chosen, you should return to your doctor for regular follow-up visits every year to make sure that your thyroid levels are normal and for adjustments in your medicine dose if need be. If left untreated, Graves’ Disease can lead to heart problems and problems in pregnancy, and an increased risk of a miscarriage. Severe, untreated Graves’ Disease can be fatal. Thyrotoxic storm is a rare life-threatening condition that develops in cases of untreated hyperthyroidism. It is usually brought on by an acute stress, such as trauma surgery or infection. Symptoms are severe, with a pounding heart, sweating, restlessness, shaking, diarrhea, change in consciousness, agitation and confusion. Congestive heart failure can develop rapidly and lead to death. It is important to get checked out by doctors more often if you are pregnant. You will need to see both your obstetrician and an endocrinologist, who is a doctor that treats patients with hormone problems. Pregnancy may cause changes in hormones that affect the thyroid, and thyroid problems can affect a growing baby. As a result, the treatment needs of pregnant women often change, and an experienced doctor is needed to regulate your medication properly.

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Health & Medicine

Dr Galichia

2009-08-01 12:16:00

Answer: We have a saying in cardiology that “time is muscle”. By that, we mean that the sooner we are able to intervene and open up a blocked artery causing a heart attack, the less damage will be done to the heart. In fact, it has been shown in some studies that if we can re-establish blood flow within the first 30 minutes that there is virtually no heart damage in most patients. This certainly has been my own personal experience. There are many logistical reasons however why patients will delay getting to the emergency room. Most of the time, they are simply trying to figure out what is going on themselves and delay calling 911. There are many people in this country who live far away from tertiary care centers where emergency treatment for heart attack is not available. We know from today’s studies that if we have a chance to open the artery within 4-6 hours that we can minimize heart damage and that we also have less likelihood of heart failure in the future. It has also been found that every moment that ticks off the clock following the onset of the heart attack there is more heart damage and more likelihood that the patient will simply die of a heart arrhythmia or pump failure. Getting to the hospital immediately is critical and opening up the artery is critical. Addressing your question regarding what can be done, there are several approaches. There are certainly medical treatments such as clot-busting drugs which we can give intravenously and they tend to dissolve clots in arteries and restore blood flow at least momentarily. This is a strategy we often employ in people from rural areas knowing that it may take several hours for them to get to a heart catheterization laboratory where a balloon or a stent procedure could be done. More and more however, we are inclined to take the patient immediately to the heart catheterization laboratory, give a blood thinner, and immediately open up the artery and address the area of narrowing with a balloon with a stent procedure. In this week’s New England Journal of Medicine there’s a great study comparing bare metal stents to stents that have medication on them, otherwise known as medicated stents. It has been shown that in heart attack patients fewer of them have to return for recurrence if we use a medicated stent, however, it has also been shown that the immediate survival is excellent in this group of patients and that the long-term survival is quite good no matter which type of stent we use. Currently, we are using medicated stents in virtually every patient with a heart attack. The key in this entire situation is to get emergency medical care as soon as possible, to get to the hospital as soon as possible and to get the blood flow restored in the blocked artery as soon as possible to limit the heart attack size. In our community, this almost always means a direct admission to the heart catheterization laboratory with an immediate intervention to open up the blocked artery. We first started doing balloon dilatation of these vessels in the early 1980s and were able to document a tremendous decrease in the risk of dying from a heart attack while in the hospital. Advances have been enormous since then and we are overall quite pleased with our current results. My own personal goal is to have the patient in the catheterization laboratory within thirty minutes to one hour to one hour following the onset of the heart attack and to have a happy, comfortable and minimally injured patient shortly thereafter.

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Health & Medicine

Dr Galichia

2009-07-01 11:56:00

: How is metabolic syndrome treated? Answer: The major goals are to treat both the underlying cause of the syndrome, and also to treat the cardiovascular risk factors if they persist. As has been discussed, the majority of people with metabolic syndrome are overweight and lead a sedentary lifestyle. Lifestyle modification is the preferred treatment of metabolic syndrome. Weight reduction usually requires a specifically tailored multifaceted program that includes diet and exercise. Sometimes medications may be useful. Diet A detailed discussion of diet therapies, pros and cons of various diets etc. is beyond the scope of this article. However, there is now a trend toward the use of a Mediterranean diet - one that is rich in “good” fats (olive oil) and contains a reasonable amount of carbohydrates and proteins (such as from fish and chicken). The Mediterranean diet is palatable and easily sustained. In addition, recent studies have shown that when compared to a low fat diet, people on the Mediterranean diet have a greater decrease in body weight, and also had greater improvements in blood pressure, cholesterol levels, and other markers of heart disease - all of which are important in evaluating and treating metabolic syndrome. Exercise A sustainable exercise program, for example 30 minutes five days a week, is reasonable to start, providing there is no medical contraindication. (If you have any special concerns in this regard, check with your doctor first.) There is a beneficial effect of exercise on blood pressure, cholesterol levels, and insulin sensitivity, regardless of whether weight loss is achieved or not. Thus, exercise in itself is a helpful tool in treating metabolic syndrome. Cosmetic surgery to remove fat Some people may ask: Why not just have liposuction of the abdomen and remove the large amount abdominal fat, which is a big part of the problem? Data thus far shows no benefit in liposuction on insulin sensitivity, blood pressure, or cholesterol. As the saying goes, “If it’s too good to be true, it probably is.” Diet and exercise are still the preferred primary treatment of metabolic syndrome. Question: What if lifestyle changes are not enough to treat metabolic syndrome? Answer: What if changes in lifestyle do not do the trick, what then? Drugs to control cholesterol levels, lipids, and high blood pressure may be considered. If someone has already had a heart attack, their LDL (“bad”) cholesterol should be reduced below 100mg/dl. (Some experts now say it should be under 70mg/dl.) A person who has diabetes has a heart attack risk equivalent to that of someone who has already had one and so should be treated in the same way. What remains controversial is whether metabolic syndrome should be considered a coronary equivalent or not. If you have metabolic syndrome, a detailed discussion about lipid therapy is needed between you and your doctor, as each individual is unique. Blood pressure goals are generally set lower than 130/80. Some blood pressure medications offer more than simply lowering blood pressure. For example, a class of blood pressure drugs called ACE inhibitors has been found to also reduce the levels of insulin resistance and actually deter the development of type 2 diabetes. This is an important considera

Answer: Metabolic syndrome is worth caring about because it is a condition that can pave the way to both diabetes and heart disease, two of the most common and important chronic diseases today. Metabolic syndrome increases the risk of type 2 diabetes (the common type of diabetes) anywhere from 9-30 times over the normal population. That’s a huge increase. As to the risk of heart disease, studies vary, but the metabolic syndrome appears to increase the risk 2-4 times that of the normal population. There are other concerns as well that should be mentioned. Metabolic syndrome is associated with fat accumulation in the liver (fatty liver), resulting in inflammation and the potential for cirrhosis. The kidneys can also be affected, as there is an association with microalbuminuria -- the leaking of protein into the urine, a subtle but clear indication of kidney damage. Other problems associated with metabolic syndrome include obstructive sleep apnea, polycystic ovary syndrome , increased risk of dementia with aging, and cognitive decline in the elderly. Question: How is metabolic syndrome treated? Answer: The major goals are to treat both the underlying cause of the syndrome, and also to treat the cardiovascular risk factors if they persist. As has been discussed, the majority of people with metabolic syndrome are overweight and lead a sedentary lifestyle. Lifestyle modification is the preferred treatment of metabolic syndrome. Weight reduction usually requires a specifically tailored multifaceted program that includes diet and exercise. Sometimes medications may be useful. Diet A detailed discussion of diet therapies, pros and cons of various diets etc. is beyond the scope of this article. However, there is now a trend toward the use of a Mediterranean diet - one that is rich in “good” fats (olive oil) and contains a reasonable amount of carbohydrates and proteins (such as from fish and chicken). The Mediterranean diet is palatable and easily sustained. In addition, recent studies have shown that when compared to a low fat diet, people on the Mediterranean diet have a greater decrease in body weight, and also had greater improvements in blood pressure, cholesterol levels, and other markers of heart disease - all of which are important in evaluating and treating metabolic syndrome. Exercise A sustainable exercise program, for example 30 minutes five days a week, is reasonable to start, providing there is no medical contraindication. (If you have any special concerns in this regard, check with your doctor first.) There is a beneficial effect of exercise on blood pressure, cholesterol levels, and insulin sensitivity, regardless of whether weight loss is achieved or not. Thus, exercise in itself is a helpful tool in treating metabolic syndrome. Cosmetic surgery to remove fat Some people may ask: Why not just have liposuction of the abdomen and remove the large amount abdominal fat, which is a big part of the problem? Data thus far shows no benefit in liposuction on insulin sensitivity, blood pressure, or cholesterol. As the saying goes, “If it’s too good to be true, it probably is.” Diet and exercise are still the preferred primary treatment of metabolic syndrome. Question: What if lifestyle changes are not enough to treat metabolic syndrome? Answer: What if changes in lifestyle do not do the trick, what then? Drugs to control cholesterol levels, lipids, and high blood pressure may be considered. If someone has already had a heart attack, their LDL (“bad”) cholesterol should be reduced below 100mg/dl. (Some experts now say it should be under 70mg/dl.) A person who has diabetes has a heart attack risk equivalent to that of someone who has already had one and so should be treated in the same way. What remains controversial is whether metabolic syndrome should be considered a coronary equivalent or not. If you have metabolic syndrome, a detailed discussion about lipid therapy is needed between you and your doctor, as each individual is unique. Blood pressure goals are generally set lower than 130/80. Some blood pressure medications offer more than simply lowering blood pressure. For example, a class of blood pressure drugs called ACE inhibitors has been found to also reduce the levels of insulin resistance and actually deter the development of type 2 diabetes. This is an important consideration when discussing the choice of blood pressure drugs in the metabolic syndrome. The discovery that a drug prescribed for one condition, and has other beneficial effects is not new. Drugs used to treat high blood sugar and insulin resistance may have beneficial effects on blood pressure and cholesterol profiles. A class of drugs called thiazolidinediones [pioglitazone (Actos) and rosiglitazone (Avandia)] also reduce the thickness of the walls of the carotid arteries. Metformin (Glucophage), usually used to treat type 2 diabetes, also has been found to help prevent the onset of diabetes in people with metabolic syndrome. Indeed, in my practice, I routinely discuss metformin with my patients who have metabolic syndrome. Many of my patients who have insulin resistance associated with metabolic syndrome opt for metformin therapy. However, there are currently no established guidelines on treating metabolic syndrome patients with metformin if they do not have overt diabetes.

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Health & Medicine

Dr Galichia

2009-05-01 11:45:00

Answer: Diabetics are at an increased risk for heart disease as compared to the general population, so it’s important to control cholesterol levels. Since the body can manufacture all the cholesterol it needs, a healthy diabetes diet includes foods low in cholesterol—specifically LDL levels, which have been identified as the main cholesterol-induced risk factor. The LDL deposits in diabetics bond with the excessive glucose and stick to arteries more readily, increasing the chances of plaque deposits and damage to the arterial wall. A healthy amount of LDL in the blood is less than 100 mg/dL. Aside from lowering the LDL levels, raising HDL cholesterol (the “good” cholesterol) also lowers the risk of heart problems, since HDL is responsible for moving cholesterol from all parts of the body back to the liver for eventual removal from the system. People with diabetes have lower HDL levels to begin with. According to the American Diabetes Association (ADA), an HDL level of 40 mg/dL and above for men, and 50 mg/dL and above for women, is considered protective against heart disease. Lowering triglyceride levels is also instrumental. Triglycerides are fats carried in the blood stream that are associated with low HDL levels. The triglycerides should be below 150 mg/dl for both sexes. Since it is more difficult for the cells to interact with insulin in a person who is overweight, a low-fat diet is important for diabetics. The ADA makes some dietary recommendations for maintaining healthy cholesterol and triglyceride ranges: •Eat less fat, especially less saturated fat (found in fatty meats, poultry skin, butter, 2% or whole milk, ice cream, cheese, palm oil, coconut oil, trans fats, hydrogenated oils, lard, and shortening). •Choose lean meats and meat substitutes. •Switch to low-fat or fat-free dairy products. •Eat at least 5 servings of fruits and vegetables each day. •Cut back on foods that are high in cholesterol (such as egg yolks, high-fat meat and poultry, and high-fat dairy products). •Choose the kinds of fat that can help lower cholesterol, such as olive or canola oil. Nuts also have a healthy type of fat. •Eat fish two or three times a week, choosing kinds that are high in heart-protective fat (such as tuna and salmon). •Cook using low-fat methods (such as baking, roasting, or grilling foods or by using cooking sprays). •Eat more foods that are high in fiber (such as oatmeal, oat bran, dried beans and peas like kidney beans, fruits, and vegetables). •Eat less salt and sodium. The ADA’s Diabetes Food Pyramid groups foods according to their carbohydrate and protein content, as well as by frequency of use in meals. The aim is to have about the same carbohydrate content per serving. Paying attention to serving sizes is integral to maintaining healthy blood glucose levels; see the ADA’s website in references & resources. Here is the breakdown of recommended servings per day, from the website: •Grains and starches—6 to 11 servings per day. This group includes bread, cereal, rice, and pasta. The starchy vegetables potatoes, peas, and corn are included here, as are dried beans such as pinto beans and black-eyed peas, because they have a carbohydrate content equivalent to one slice of bread. They should be counted as carbohydrates for the meal plan. •Vegetables—at least 3 to 5 servings per day. Spinach, chicory, sorrel, Swiss chard, broccoli, cabbage, bok choy, brussel sprouts, cauliflower, kale, carrots, tomatoes, cucumbers, and lettuce all belong to this group. •Fruit—2 to 4 servings per day. The ADA emphasizes blackberries, cantaloupe, strawberries, oranges, apples, bananas, peaches, pears, apricots, and grapes. •Milk—2 to 3 servings per day. Again, the emphasis here is on low- or non-fat milk. •Meat and meat substitutes—4 to 6 ounces per day, divided between meals. Cut all the visible fat off the meat before cooking or eating, and keep the portion sizes small (a 3-ounce serving is the size of a deck of playing cards). Meat replacements include tofu, eggs, dried beans, cheese, cottage cheese, and nut butters. •Fats, sweets, and alcohol— Potato chips, candy, cookies, cakes, crackers, and fried foods belong to this group. Keep your servings of these foods small and save them for a special treat. Just remember, Diabetes and the diet do not have to be enemies. They can get along together just fine. In fact, the longer they get along together…the longer they will get along together. I will be back next month for more on this continuing series.

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Health & Medicine

Dr Galichia

2009-05-01 11:45:00

: How is the metabolic syndrome diagnosed? Answer

Answer: The metabolic syndrome is characterized by a group of metabolic risk factors in one person. They include: •Abdominal obesity (excessive fat tissue in and around the abdomen) •Atherogenic dyslipidemia (blood fat disorders - high triglycerides, low HDL cholesterol and high LDL cholesterol - that foster plaque buildups in artery walls) •Elevated blood pressure •Insulin resistance or glucose intolerance (the body can’t properly use insulin or blood sugar) •Prothrombotic state (e.g., high fibrinogen or plasminogen activator inhibitor–1 in the blood) •Proinflammatory state (e.g., elevated C-reactive protein in the blood). People with the metabolic syndrome are at increased risk of coronary heart disease and other diseases related to plaque buildups in artery walls (e.g., stroke and peripheral vascular disease) and type 2 diabetes. The metabolic syndrome has become increasingly common in the United States. It’s estimated that over 50 million Americans have it. The dominant underlying risk factors for this syndrome appear to be abdominal obesity and insulin resistance. Insulin resistance is a generalized metabolic disorder, in which the body can’t use insulin efficiently. This is why the metabolic syndrome is also called the insulin resistance syndrome. Other conditions associated with the syndrome include physical inactivity, aging, hormonal imbalance and genetic predisposition. Some people are genetically predisposed to insulin resistance. Acquired factors, such as excess body fat and physical inactivity, can elicit insulin resistance and the metabolic syndrome in these people. Most people with insulin resistance have abdominal obesity. The biologic mechanisms at the molecular level between insulin resistance and metabolic risk factors aren’t fully understood and appear to be complex. Question: How is the metabolic syndrome diagnosed? Answer: There are no well-accepted criteria for diagnosing the metabolic syndrome. The criteria proposed by the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III), with minor modifications, are currently recommended and widely used. The American Heart Association and the National Heart, Lung, and Blood Institute recommend that the metabolic syndrome be identified as the presence of three or more of these components: •Elevated waist circumference: Men - Equal to or greater than 40 inches (102 cm) Women - Equal to or greater than 35 inches (88 cm) •Elevated triglycerides: Equal to or greater than 150 mg/dL •Reduced HDL (“good”) cholesterol: Men - Less than 40 mg/dL Women - Less than 50 mg/dL •Elevated blood pressure: Equal to or greater than 130/85 mm Hg •Elevated fasting glucose: Equal to or greater than 100 mg/dL AHA Recommendation for Managing the Metabolic Syndrome: The primary goal of clinical management of the metabolic syndrome is to reduce the risk for cardiovascular disease and type 2 diabetes. Then, the first-line therapy is to reduce the major risk factors for cardiovascular disease: stop smoking and reduce LDL cholesterol, blood pressure and glucose levels to the recommended levels. For managing both long- and short-term risk, lifestyle therapies are the first-line interventions to reduce the metabolic risk factors. These lifestyle interventions include: •Weight loss to achieve a desirable weight (BMI less than 25 kg/m2) •Increased physical activity, with a goal of at least 30 minutes of moderate-intensity activity on most days of the week •Healthy eating habits that include reduced intake of saturated fat, trans fat and cholesterol I will be back next month with more.

X

Health & Medicine

Dr Galichia

2009-04-01 14:39:00

Answer: Gestational diabetes is a type of diabetes that starts during pregnancy. If you have diabetes, your body isn’t able to use the sugar (glucose) in your blood as well as it should, so the level of sugar in your blood becomes higher than normal. Gestational diabetes affects between 1% to 3% of all pregnant women. It usually develops in the second trimester (sometimes as early as the 20th week of pregnancy). Most often, gestational diabetes goes away after the baby is born. How can gestational diabetes affect me and my baby? High sugar levels in your blood can be unhealthy for both you and your baby. If the diabetes isn’t treated, your baby may be more likely to have problems at birth. For example, your baby may have a low blood sugar level, jaundice, or your baby may weigh much more than normal. Gestational diabetes can also affect your health. For instance, if your baby is very large, you may have a more difficult delivery or you may need a cesarean section. Gestational diabetes also increases your risk of developing pre-eclampsia, which is a condition that can be serious if left untreated. What can I do if I have gestational diabetes? You will need to follow a diet suggested by your doctor, exercise regularly and have frequent blood tests to check your blood sugar level. You may also need to take medicine to control your blood sugar level. What changes should I make in my diet? Your doctor may ask you to change some of the foods you eat. You may be asked to see a registered dietitian to help you plan your meals. You should avoid eating foods that contain a lot of simple sugar, such as cake, cookies, candy or ice cream. Instead, eat foods that contain natural sugars, such as fruits. If you get hungry between meals, eat foods that are healthy for you, such as raisins, carrot sticks or a piece of fruit. Whole-grain pasta, whole-grain breads and rice are also good for both you and your baby. It’s important to eat well-balanced meals. You may need to eat less at each meal, depending on how much weight you gain during your pregnancy. Your doctor or dietitian will talk to you about this. Why is exercise important? Your doctor will suggest that you exercise regularly at a level that is safe for you and the baby. Exercise will help keep your blood sugar level normal, and it can also make you feel better. Walking is usually the easiest type of exercise when you are pregnant, but swimming or other exercises you enjoy are also beneficial. Ask your doctor to recommend some activities that would be safe for you. If you’re not used to exercising, begin by exercising for 5 or 10 minutes every day. As you get stronger, you can increase your exercise time to 30 minutes or more per session. The longer you exercise and the more often you exercise, the more in control you will be of your blood sugar. You do need to be careful about how you exercise. Don’t exercise too hard or get too hot while exercising. Ask your doctor what activities are safe for you. Depending on your age, your pulse shouldn’t go higher than 140 to 160 beats per minute during exercise. If you become dizzy or have back pain or other pain while exercising, stop exercising immediately and call your doctor. If you have uterine contractions (labor pains), vaginal bleeding or your water breaks, call your doctor right away. What tests will I need to have during my pregnancy? Your doctor will ask you to have regular blood tests to check your blood sugar level. These tests will let your doctor know if your diet and exercise are keeping your blood sugar level normal. A normal blood sugar level is less than 105 mg per dL when you haven’t eaten for a number of hours before the test (fasting) and less than 120 mg per dL 2 hours after a meal. If your blood sugar level is regularly higher than these levels, your doctor may prescribe a medicine called insulin to help lower it. You may be asked to see a specialist if you have to start taking insulin. What happens after my baby is born? You may not need to have blood tests to check your blood sugar while you’re in the hospital after your baby is born. However, it may be several weeks after your baby’s birth before your gestational diabetes goes away. To make sure it has gone away, your doctor will ask you to have a special blood test one or two months after you have your baby. Even if the gestational diabetes goes away after the baby’s birth, it increases your risk for diabetes in your next pregnancy and also later in life. That is why it is important that you continue to exercise, watch your weight and eat a healthy diet after pregnancy. If you do these things, you may avoid diabetes when you’re older.

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Health & Medicine

Dr Galichia

2009-02-01 14:22:00

: How much and how often should people with diabetes exercise? Answer: Experts recommend moderate-intensity physical activity for at least 30 minutes on 5 or more days of the week. Some examples of moderate-intensity physical activity are walking briskly, mowing the lawn, dancing, swimming, or bicycling. If you are not accustomed to physical activity, you may want to start with a little exercise, and work your way up. As you become stronger, you can add a few extra minutes to your physical activity. Do some physical activity every day. It’s better to walk 10 or 20 minutes each day than one hour once a week. Talk to your health care provider about a safe exercise plan. He or she may check your heart and your feet to be sure you have no special problems. If you have high blood pressure, eye, or foot problems, you may need to avoid some kinds of exercise. Question: What are some good types of physical activity for people with diabetes? Answer: Walking vigorously, hiking, climbing stairs, swimming, aerobics, dancing, bicycling, skating, skiing, tennis, basketball, volleyball, or other sports are just some examples of physical activity that will work your large muscles, increase your heart rate, and make you breathe harder – important goals for fitness. In addition, strength training exercises with hand weights, elastic bands, or weight machines can help you build muscle. Stretching helps to make you flexible and prevent soreness after other types of exercise. Do physical activities you really like. The more fun you have, the more likely you will do it each day. It can be helpful to exercise with a family member or friend. Question: Are there any safety considerations for people with diabetes when they exercise? Answer: Exercise is very important for people with diabetes to stay healthy, but there are a few things to watch out for. You should avoid some kinds of physical activity if you have certain diabetes complications. Exercise involving heavy weights may be bad for people with blood pressure, blood vessel, or eye problems. Diabetes-related nerve damage can make it hard to tell if you’ve injured your feet during exercise, which can lead to more serious problems. If you do have diabetes complications, your health care provider can tell you which kinds of physical activity would be best for you. Fortunately, there are many different ways to get exercise. Physical activity can lower your blood glucose too much, causing hypoglycemia, especially in people who take insulin or certain oral medications. Hypoglycemia can happen at the time you’re exercising, just afterward, or even up to a day later. You can get shaky, weak, confused, irritable, anxious, hungry, tired, or sweaty. You can get a headache, or even lose consciousness. To help prevent hypoglycemia during physical activity, check your blood glucose before you exercise. If it’s below 100, have a small snack. In addition, bring food or glucose tablets with you when you exercise just in case. It is not good for people with diabetes to skip meals at all, but especially not prior to exercise. After you exercise, check to see how it has affected your blood glucose level. If you take insulin, ask your health care provider if there is a preferable time of day for you to exercise, or whether you should change your dosage before physical activity, before beginning an exercise regimen. On the other hand, you should not exercise when your blood glucose is very high because your level could go even higher. Do not exercise if your blood glucose is above 300, or your fasting blood glucose is above 250 and you have ketones in your urine. When you exercise, wear cotton socks

Answer: Physical activity can help you control your blood glucose, weight, and blood pressure, as well as raise your “good” cholesterol and lower your “bad” cholesterol. It can also help prevent heart and blood flow problems, reducing your risk of heart disease and nerve damage, which are often problems for people with diabetes. Question: How much and how often should people with diabetes exercise? Answer: Experts recommend moderate-intensity physical activity for at least 30 minutes on 5 or more days of the week. Some examples of moderate-intensity physical activity are walking briskly, mowing the lawn, dancing, swimming, or bicycling. If you are not accustomed to physical activity, you may want to start with a little exercise, and work your way up. As you become stronger, you can add a few extra minutes to your physical activity. Do some physical activity every day. It’s better to walk 10 or 20 minutes each day than one hour once a week. Talk to your health care provider about a safe exercise plan. He or she may check your heart and your feet to be sure you have no special problems. If you have high blood pressure, eye, or foot problems, you may need to avoid some kinds of exercise. Question: What are some good types of physical activity for people with diabetes? Answer: Walking vigorously, hiking, climbing stairs, swimming, aerobics, dancing, bicycling, skating, skiing, tennis, basketball, volleyball, or other sports are just some examples of physical activity that will work your large muscles, increase your heart rate, and make you breathe harder – important goals for fitness. In addition, strength training exercises with hand weights, elastic bands, or weight machines can help you build muscle. Stretching helps to make you flexible and prevent soreness after other types of exercise. Do physical activities you really like. The more fun you have, the more likely you will do it each day. It can be helpful to exercise with a family member or friend. Question: Are there any safety considerations for people with diabetes when they exercise? Answer: Exercise is very important for people with diabetes to stay healthy, but there are a few things to watch out for. You should avoid some kinds of physical activity if you have certain diabetes complications. Exercise involving heavy weights may be bad for people with blood pressure, blood vessel, or eye problems. Diabetes-related nerve damage can make it hard to tell if you’ve injured your feet during exercise, which can lead to more serious problems. If you do have diabetes complications, your health care provider can tell you which kinds of physical activity would be best for you. Fortunately, there are many different ways to get exercise. Physical activity can lower your blood glucose too much, causing hypoglycemia, especially in people who take insulin or certain oral medications. Hypoglycemia can happen at the time you’re exercising, just afterward, or even up to a day later. You can get shaky, weak, confused, irritable, anxious, hungry, tired, or sweaty. You can get a headache, or even lose consciousness. To help prevent hypoglycemia during physical activity, check your blood glucose before you exercise. If it’s below 100, have a small snack. In addition, bring food or glucose tablets with you when you exercise just in case. It is not good for people with diabetes to skip meals at all, but especially not prior to exercise. After you exercise, check to see how it has affected your blood glucose level. If you take insulin, ask your health care provider if there is a preferable time of day for you to exercise, or whether you should change your dosage before physical activity, before beginning an exercise regimen. On the other hand, you should not exercise when your blood glucose is very high because your level could go even higher. Do not exercise if your blood glucose is above 300, or your fasting blood glucose is above 250 and you have ketones in your urine. When you exercise, wear cotton socks and athletic shoes that fit well and are comfortable. After you exercise, check your feet for sores, blisters, irritation, cuts, or other injuries. Drink plenty of fluids during physical activity, since your blood glucose can be affected by dehydration.

X

Health & Medicine

Dr Galichia

2009-02-01 14:22:00

: How are diabetes and pre-diabetes diagnosed? Answer: The following tests are used for diagnosis: A fasting plasma glucose (FPG) test measures blood glucose in a person who has not eaten anything for at least 8 hours. This test is used to detect diabetes and pre-diabetes. The FPG test is the preferred test for diagnosing diabetes because of its convenience and low cost. However, it will miss some diabetes or pre-diabetes that can be found with the OGTT. The FPG test is most reliable when done in the morning. People with a fasting glucose level of 100 to 125 milligrams per deciliter (mg/dL) have a form of pre-diabetes called impaired fasting glucose (IFG). Having IFG means a person has an increased risk of developing type 2 diabetes but does not have it yet. A level of 126 mg/dL or above, confirmed by repeating the test on another day, means a person has diabetes. An oral glucose tolerance test (OGTT) measures blood glucose after a person fasts at least 8 hours and 2 hours after the person drinks a glucose-containing beverage. This test can be used to diagnose diabetes and pre-diabetes. Research has shown that the OGTT is more sensitive than the FPG test for diagnosing pre-diabetes, but it is less convenient to administer. The OGTT requires fasting for at least 8 hours before the test. The plasma glucose level is measured immediately before and 2 hours after a person drinks a liquid containing 75 grams of glucose dissolved in water. If the blood glucose level is between 140 and 199 mg/dL 2 hours after drinking the liquid, the person has a form of pre-diabetes called impaired glucose tolerance (IGT). Having IGT, like having IFG, means a person has an increased risk of developing type 2 diabetes but does not have it yet. A 2-hour glucose level of 200 mg/dL or above, confirmed by repeating the test on another day, means a person has diabetes. Gestational diabetes is also diagnosed based on plasma glucose values measured during the OGTT, preferably by using 100 grams of glucose in liquid for the test. Blood glucose levels are checked four times during the test. If blood glucose levels are above normal at least twice during the test, the woman has gestational diabetes. A random plasma glucose test, also called a casual plasma glucose test, measures blood glucose without regard to when the person being tested last ate. This test, along with an assessment of symptoms, is used to diagnose diabetes but not pre-diabetes. A random, or casual, blood glucose level of 200 mg/dL or higher, plus the presence of the following symptoms, can mean a person has diabetes: • Increased urination • Increased thirst • Unexplained weight loss Other symptoms can include fatigue, blurred vision, increased hunger, and sores that do not heal. The doctor will check the person’s blood glucose level on another day using the FPG test or the OGTT to confirm the diagnosis. Test results indicating that a person has diabetes should be confirmed with a second test on a different day. Question: Who should be tested for diabetes and pre-diabetes? Answer: The American Diabetes Association recommends that testing to detect pre-diabetes and type 2 diabetes be considered in adults without symptoms who are overweight or obese and have one or more additional risk factors for diabetes. In those without these risk factors, testing should begin at age 45. The Body Mass Index Table can be used to find out whether someone is normal weight, overweight, obese, or extremely obese. BMI is a measurement of body weight relative to height. Adults aged 20 or older can use the BMI Table to find out whether they are normal weight, overweight, obese, or extremely obese. To use the table, find the adult’s height at the top of that column, move down the row to the number closest to that person’s weight. The number in the column is the person’s BMI. The words above the BMI number indicate whether the person is normal weight, overweight, obese, or extremely obese. People who are overweight, obese, or extremely obese should consider talking with a doctor about ways to lose weight to reduce the risk of diabetes. The BMI has certain limitations. It may overestimate body fat in athletes and others who have a muscular build and underestimate body fat in older adults and others who have lost muscle. BMI for children and teens must be determined based on age, height, weight, and sex. The Centers for Disease Control and Prevention (CDC) has information about BMI in children and teens, including a BMI calculator, at www.cdc.gov/nccdphp/dnpa/bmi. The CDC website also has a BMI calculator for adults. In addition to weight, the location of excess fat on the body can be important. A waist measurement of 40 inches or more for men or 35 inches or more for women is linked to insulin resistance and increases a person’s risk for type 2 diabetes. People aged 45 or older should consider getting tested for pre-diabetes or diabetes. People younger than 45 should consider testing if they are overweight, obese, or extremely obese and have one or more of the following risk factors: being physically inactive having a parent, brother, or sister with diabetes having a family background that is African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander giving birth to a baby weighing more than 9 pounds or being diagnosed with gestational diabetes having high blood pressure—140/90 mmHg or above—or being treated for high blood pressure having an HDL, or “good,” cholesterol level below 35 mg/dL or a triglyceride level above 250 mg/dL having polycystic ovary syndrome, also called PCOS having IFG or IGT on previous testing having a condition called acanthosis nigricans, characterized by a dark, velvety rash around the neck or armpits having a history of cardiovascular disease—disease affecting the heart and blood vessels If results of testing are normal, testing should be repeated at least every 3 years. Doctors may recommend more frequent testing depending on initial results and risk status. People whose test results indicate they have pre-diabetes should have their blood glucose checked again in 1 to 2 years and take steps to prevent type 2 diabetes. When a woman is pregnant, the doctor will assess her risk for developing gestational diabetes at her first prenatal visit and order testing as needed during the pregnancy. Women who develop gestational diabetes should also have follow-up testing 6 to 12 weeks after the baby is born. Type 2 diabetes has become more common in children and teens than in the past, and those at high risk for developing diabetes should be tested every 2 years. Testing should begin at age 10 or at puberty, whichever occurs first. Children and teens who are overweight or obese and have other risk factors, such as a family history of diabetes, are at high risk for developing diabetes. Question: What steps can delay or prevent type 2 diabetes? Answer: A major research study, the Diabetes Prevention Program (DPP), confirmed that people with IGT—pre-diabetes—were able to sharply reduce their risk of developing diabetes during the study by losing 5 to 7 percent of their body weight through dietary changes and increased physical activity. Study participants followed a low-fat, low-calorie diet and engaged in regular physical activity, such as walking briskly for 30 minutes, five times a week. These strategies worked well for both men and women and were especially effective for participants aged 60 and older. Here are some points to remember: Diabetes, pre-diabetes, and gestational diabetes are diagnosed by checking blood glucose levels. Tests used for diagnosing diabetes and pre-diabetes include the fasting plasma glucose (FPG) test and the oral glucose tolerance test (OGTT). People aged 4

Answer: In pre-diabetes, blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. However, many people with pre-diabetes develop type 2 diabetes within 10 years. Experts disagree about the specific blood glucose level they should use to diagnose diabetes, and through the years, that number has changed. Individuals with pre-diabetes have an increased risk of heart disease and stroke. With modest weight loss and moderate physical activity, people with pre-diabetes can delay or prevent type 2 diabetes. Question: How are diabetes and pre-diabetes diagnosed? Answer: The following tests are used for diagnosis: A fasting plasma glucose (FPG) test measures blood glucose in a person who has not eaten anything for at least 8 hours. This test is used to detect diabetes and pre-diabetes. The FPG test is the preferred test for diagnosing diabetes because of its convenience and low cost. However, it will miss some diabetes or pre-diabetes that can be found with the OGTT. The FPG test is most reliable when done in the morning. People with a fasting glucose level of 100 to 125 milligrams per deciliter (mg/dL) have a form of pre-diabetes called impaired fasting glucose (IFG). Having IFG means a person has an increased risk of developing type 2 diabetes but does not have it yet. A level of 126 mg/dL or above, confirmed by repeating the test on another day, means a person has diabetes. An oral glucose tolerance test (OGTT) measures blood glucose after a person fasts at least 8 hours and 2 hours after the person drinks a glucose-containing beverage. This test can be used to diagnose diabetes and pre-diabetes. Research has shown that the OGTT is more sensitive than the FPG test for diagnosing pre-diabetes, but it is less convenient to administer. The OGTT requires fasting for at least 8 hours before the test. The plasma glucose level is measured immediately before and 2 hours after a person drinks a liquid containing 75 grams of glucose dissolved in water. If the blood glucose level is between 140 and 199 mg/dL 2 hours after drinking the liquid, the person has a form of pre-diabetes called impaired glucose tolerance (IGT). Having IGT, like having IFG, means a person has an increased risk of developing type 2 diabetes but does not have it yet. A 2-hour glucose level of 200 mg/dL or above, confirmed by repeating the test on another day, means a person has diabetes. Gestational diabetes is also diagnosed based on plasma glucose values measured during the OGTT, preferably by using 100 grams of glucose in liquid for the test. Blood glucose levels are checked four times during the test. If blood glucose levels are above normal at least twice during the test, the woman has gestational diabetes. A random plasma glucose test, also called a casual plasma glucose test, measures blood glucose without regard to when the person being tested last ate. This test, along with an assessment of symptoms, is used to diagnose diabetes but not pre-diabetes. A random, or casual, blood glucose level of 200 mg/dL or higher, plus the presence of the following symptoms, can mean a person has diabetes: • Increased urination • Increased thirst • Unexplained weight loss Other symptoms can include fatigue, blurred vision, increased hunger, and sores that do not heal. The doctor will check the person’s blood glucose level on another day using the FPG test or the OGTT to confirm the diagnosis. Test results indicating that a person has diabetes should be confirmed with a second test on a different day. Question: Who should be tested for diabetes and pre-diabetes? Answer: The American Diabetes Association recommends that testing to detect pre-diabetes and type 2 diabetes be considered in adults without symptoms who are overweight or obese and have one or more additional risk factors for diabetes. In those without these risk factors, testing should begin at age 45. The Body Mass Index Table can be used to find out whether someone is normal weight, overweight, obese, or extremely obese. BMI is a measurement of body weight relative to height. Adults aged 20 or older can use the BMI Table to find out whether they are normal weight, overweight, obese, or extremely obese. To use the table, find the adult’s height at the top of that column, move down the row to the number closest to that person’s weight. The number in the column is the person’s BMI. The words above the BMI number indicate whether the person is normal weight, overweight, obese, or extremely obese. People who are overweight, obese, or extremely obese should consider talking with a doctor about ways to lose weight to reduce the risk of diabetes. The BMI has certain limitations. It may overestimate body fat in athletes and others who have a muscular build and underestimate body fat in older adults and others who have lost muscle. BMI for children and teens must be determined based on age, height, weight, and sex. The Centers for Disease Control and Prevention (CDC) has information about BMI in children and teens, including a BMI calculator, at www.cdc.gov/nccdphp/dnpa/bmi. The CDC website also has a BMI calculator for adults. In addition to weight, the location of excess fat on the body can be important. A waist measurement of 40 inches or more for men or 35 inches or more for women is linked to insulin resistance and increases a person’s risk for type 2 diabetes. People aged 45 or older should consider getting tested for pre-diabetes or diabetes. People younger than 45 should consider testing if they are overweight, obese, or extremely obese and have one or more of the following risk factors: being physically inactive having a parent, brother, or sister with diabetes having a family background that is African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander giving birth to a baby weighing more than 9 pounds or being diagnosed with gestational diabetes having high blood pressure—140/90 mmHg or above—or being treated for high blood pressure having an HDL, or “good,” cholesterol level below 35 mg/dL or a triglyceride level above 250 mg/dL having polycystic ovary syndrome, also called PCOS having IFG or IGT on previous testing having a condition called acanthosis nigricans, characterized by a dark, velvety rash around the neck or armpits having a history of cardiovascular disease—disease affecting the heart and blood vessels If results of testing are normal, testing should be repeated at least every 3 years. Doctors may recommend more frequent testing depending on initial results and risk status. People whose test results indicate they have pre-diabetes should have their blood glucose checked again in 1 to 2 years and take steps to prevent type 2 diabetes. When a woman is pregnant, the doctor will assess her risk for developing gestational diabetes at her first prenatal visit and order testing as needed during the pregnancy. Women who develop gestational diabetes should also have follow-up testing 6 to 12 weeks after the baby is born. Type 2 diabetes has become more common in children and teens than in the past, and those at high risk for developing diabetes should be tested every 2 years. Testing should begin at age 10 or at puberty, whichever occurs first. Children and teens who are overweight or obese and have other risk factors, such as a family history of diabetes, are at high risk for developing diabetes. Question: What steps can delay or prevent type 2 diabetes? Answer: A major research study, the Diabetes Prevention Program (DPP), confirmed that people with IGT—pre-diabetes—were able to sharply reduce their risk of developing diabetes during the study by losing 5 to 7 percent of their body weight through dietary changes and increased physical activity. Study participants followed a low-fat, low-calorie diet and engaged in regular physical activity, such as walking briskly for 30 minutes, five times a week. These strategies worked well for both men and women and were especially effective for participants aged 60 and older. Here are some points to remember: Diabetes, pre-diabetes, and gestational diabetes are diagnosed by checking blood glucose levels. Tests used for diagnosing diabetes and pre-diabetes include the fasting plasma glucose (FPG) test and the oral glucose tolerance test (OGTT). People aged 45 or older should consider getting tested for pre-diabetes or diabetes. People younger than 45 who are overweight, obese, or extremely obese and have one or more additional risk factors for diabetes should consider testing. Many people with pre-diabetes develop type 2 diabetes within 10 years. People with pre-diabetes can delay or prevent type 2 diabetes by losing a modest amount of weight through regular physical activity and a diet low in fat and calories.

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Health & Medicine

Dr Galichia

2008-12-31 10:25:00

Answer: You are correct -- in some populations, it is an epidemic. Americans diet and exercise has a lot to do with this, but much has improved over the past few years with diagnosis and treatment. Let me take your questions one at a time. First, what is diabetes? Diabetes is a disease in which blood glucose levels are above normal. Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies. When you have diabetes, your body either doesn’t make enough insulin or can’t use its own insulin as well as it should. This causes sugar to build up in your blood. Diabetes can cause serious health complications including heart disease, blindness, kidney failure and lower-extremity amputations. Diabetes is the sixth leading cause of death in the United States. What are the symptoms of diabetes? People who think they might have diabetes must visit a physician for diagnosis. They might have SOME or NONE of the following symptoms: Frequent urination Excessive thirst Unexplained weight loss Extreme hunger Sudden vision changes Tingling or numbness in hands or feet Feeling very tired much of the time Very dry skin Sores that are slow to heal More infections than usual. Nausea, vomiting or stomach pains may accompany some of these symptoms in the abrupt onset of insulin-dependent diabetes (now called type 1 diabetes). What are the types of diabetes? Type 1 diabetes, which was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, may account for 5% to 10% of all diagnosed cases of diabetes. Type 2 diabetes, which was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes, may account for about 90% to 95% of all diagnosed cases of diabetes. Gestational diabetes is a type of diabetes that only pregnant women get. If not treated, it can cause problems for mothers and babies. Gestational diabetes develops in 2% to 5% of all pregnancies but usually disappears when a pregnancy is over. Other specific types of diabetes resulting from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses may account for 1% to 2% of all diagnosed cases of diabetes. What are the risk factors for diabetes? Risk factors for type 2 diabetes include older age, obesity, family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity and race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians and some Asian Americans and Pacific Islanders are at particularly high risk for type 2 diabetes. Risk factors are less well defined for type 1 diabetes than for type 2 diabetes, but autoimmune, genetic and environmental factors are involved in developing this type of diabetes. Gestational diabetes occurs more frequently in African Americans, Hispanic/Latino Americans, American Indians and people with a family history of diabetes than in other groups. Obesity is also associated with higher risk. Women who have had gestational diabetes are at increased risk for later developing type 2 diabetes. In some studies, nearly 40% of women with a history of gestational diabetes developed diabetes in the future. Other specific types of diabetes, which may account for 1% to 2% of all diagnosed cases, result from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses. What is the treatment for diabetes? Healthy eating, physical activity, and insulin injections are the basic therapies for type 1 diabetes. The amount of insulin taken must be balanced with food intake and daily activities. Blood glucose levels must be closely monitored through frequent blood glucose testing. Healthy eating, physical activity, and blood glucose testing are the basic therapies for type 2 diabetes. In addition, many people with type 2 diabetes require oral medication, insulin, or both to control their blood glucose levels. People with diabetes must take responsibility for their day-to-day care, and keep blood glucose levels from going too low or too high. People with diabetes should see a health care provider who will monitor their diabetes control and help them learn to manage their diabetes. In addition, people with diabetes may see endocrinologists, who may specialize in diabetes care; ophthalmologists for eye examinations; podiatrists for routine foot care; and dietitians and diabetes educators who teach the skills needed for daily diabetes management.

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Health & Medicine

Dr Galichia

2008-12-01 14:57:00

Question: Is it too late to get a flu shot?

Answer: My best recommendation is to get the flu shot immediately. We have yet to see a flu epidemic in this region and getting this shot now will likely give you immunity to contracting the flu. The flu shot is imperative in my opinion for all adults and everyone over the age of six months with rare exception. I feel that failing to get the flu shot could result in you getting influenza and running the risk of pneumonia or other complications that could result in death. There are thousands of people every year in this country that die from “garden variety” influenza, most of them because they did not get a flu shot. There are some myths regarding flu shots, myth number one, being that a person will actually get the flu from the flu vaccine. The flu vaccine used today is a dead virus and there is no way that a person can get influenza from the flu shot. Some people do however experience some symptoms of nausea, vomiting, and aching muscles but it is not the flu and will not turn into a life threatening illness. A second myth surrounding the flu vaccine suggests that since flu vaccines are grown in eggs, this processing method can actually give a person “bird flu”. This dreaded illness is not transmitted in anyway by the flu shot and in fact, has occurred only because of a rare mutation enabling this virus to spread to humans. This spread has occurred from infected chickens to humans and these were live chickens, not through eating poultry or eggs from the chicken. A third popular myth implies that since the flu vaccine is formulated so far in advance, how do we know it will be effective against the strain we’ll be fighting during peak flu season? Truth of the matter is, the Centers for Disease Control (CDC) and companies that make flu vaccine have been extremely effective in predicting which virus will spread in epidemic fashion. Thus they’ve been amazingly good forecasting which virus’s to protect against. The fourth myth centers around healthy people. The thought here is that healthy people don’t need a flu shot. This is absolutely not true. In fact, the flu spreads through healthy people as fast as it does through elderly people within our population. It is true that older people have more serious complications with the flu but certainly young children and any healthy person can die from influenza. The great flu epidemic of 1918 killed many very young people and in many instances, an entire family was wiped out due to the flu virus. Myth number five, flu vaccines given to young children can cause autism. Scientists became very excited in the 1990’s when there seemed to be a link between autism and the flu vaccine but there is simply no scientific evidence to support this. Groups of thousands of children have been studied in multiple countries and no link has been established thus far. The reasons for getting a flu shot are overwhelming. Getting an annual flu shot is one small bullet to bite for the amount of protection you will receive from taking this precautionary measure.

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Health & Medicine

Shelly Basore

2008-11-01 11:24:00

Question: It’s that times of year when a lot of us that focus on a healthy diet program become concerned what can we do?

Answer: It is almost time; the holidays are right around the corner! Most people today worry about what they are going to eat for the holidays. Many of us will most likely purchase or make some type of holiday food to take to a celebration. As most of us know this can be stressful worrying about the fat and calories in pies and other desserts. Please understand there are several healthy ways of handling this holiday stress. One thing is to have the freedom of choosing foods and even desserts no matter what kind of diet program you may be on. Remember stay focused on healthy foods, education, movement, and motivation. Regarding healthy foods, I have included one of our most popular and delicious pumpkin desserts for you to try this holiday season. Pumpkin Custard 2 egg whites ¾ cups evaporated skim milk 1 cup canned pumpkin ½ tsp. ground cinnamon 1/8 tsp. ground allspice 2 tsp. brown sugar twin 1/8 tsp. ground ginger Dash light salt In a medium mixing bowl, beat eggswhites till foamy. Stir in pumpkin, milk brown sugar, cinnamon, allspice, ginger and salt. Place 4 (6 ounce) custard cups in a shallow baking dish. Pour pumpkin mixture in cups. Place the baking dish containing the cups on a wire rack. Pour boiling water around cups in dish to a depth of 1 inch. Bake in a 325 degree oven for 35-40 minutes or until a knife inserted near the center comes out clean. Remove custard cups from water. Serve warm or chilled with low-fat whipped topping. Serves: 4 Fat grams: less than 1 gram This recipe and others can be found at the Derby Thin and Healthy 838 N. Baltimore (on K-15 across from Blockbuster) you can call us at 788-7200.

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Health & Medicine

Dr Galichia

2008-10-01 15:56:00

Answer: There are many kinds of tumors and cysts that can occur on the kidneys. There are benign tumors which we often see but the most dangerous tumor is a malignant growth known as renal cell carcinoma. This particular kind of cancer often remains a-symptomatic until it has spread to other organs. The treatment of renal cell carcinoma is immediate surgery. If the tumor has spread, certain medications and sometimes radiation may be helpful. Early detection of this cancer usually occurs when a patient notices blood in the urine or as an incidental finding on a CAT scan or sonogram. Symptoms may also include pain in the flank, a lump in the flank, weight loss, fatigue, fevers, night sweats and anemia may also be associated with renal cell carcinoma. There is no known cause of renal cell carcinoma. Cigarette smoking doubles the risk, obesity, occupational exposure to toxins, and occasionally heredity as well as a high fat diet are all implicated in this disease. It is felt that radiation exposure is a risk factor and in your case the treatment of your prostate cancer with cyberknife therapy was itself a high radiation procedure. Most of the radiation using this type of technique was directed in a very specific way to the prostate gland, which is a great advantage of the cyberknife therapy. There is much less scattering of radiation using this technique. Furthermore, neither your hernia operation nor your diet likely contributed to this problem. We do know that one of the great risks of having any kind of cancer is having had a history of previous cancer somewhere else in the body, your prostate cancer having been previously diagnosed. The first step of evaluating any growth in the kidney is to see if it is cancerous or not. Fortunately, the treatment of renal cancer, with early detection renders relatively good prognosis.

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Health & Medicine

Dr Galichia

2008-10-01 08:48:00

Answer: Diabetes is increasingly diagnosed in this country. Many Americans don’t get enough exercise, smoke, have unhealthy diets, are obese or sedentary. Some people also have genetic predisposition toward diabetes, and are susceptible to the disease (especially those of Native American and African American descent). Diabetes must be managed well, and should be monitored by an endocrinologist. Technology for treatment improves all the time, and lifestyle changes can make a huge difference in quality of life and longevity. Diabetic patients are often checked for heart disease, renal disease, and stroke as well; many of the same behaviors and risk factors are present for these as well as diabetes. Other than insulin management as directed by your physician, make sure to have your feet and legs checked every time you see your doctor, and have your eyes checked at least once a year. Changes in pulse rates can mean that the circulation is compromised and care must be provided. Vision changes can indicate that the metabolic and insulin levels are in need of adjustment. I tell many of my patients with diabetes to recognize the disease as a condition that is manageable but also potentially life-threatening; and do whatever possible to alleviate aggravating the situation. Paying attention to your health and respecting the needs of your body are crucial with this diagnosis. Your physician can provide you with treatment options and put you on a regimen that will maximize your health, and minimize the co-occurrence of other diseases.

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Health & Medicine

Deb Wetta

2008-09-01 15:06:00

QUESTION: My wife had a stroke and, as part of her therapy, the doctor has recommended using something called Makoto. What is Makoto?

ANSWER: Makoto is the name of a unit of equipment used in therapy to help patients improve the neurological connection between the brain and the body. Therapy on a Makoto offers more than just physical re-conditioning, it also helps with cognitive processing, reaction time, and proprioception, which is the body’s awareness of its positions and movement. Improvements in these areas can lead to better balance, improved range of motion, and a greater level of consciousness, all elements that are vital to anyone looking to regain their independence. The Makoto unit is composed of three towers that create a triangle-shaped space, or arena. When the patient is inside the arena facing one of the towers, the other two towers can be seen in the peripheral vision. Each tower has ten lights, or targets, that randomly illuminate, sometimes with an audible tone. The patient, using hands, feet, or a lightweight staff, respond to the prompts emitted by Makoto, actually touching the place on the tower that is emitting the signal. The unit electronically measures reaction time and accuracy of the responses, providing the therapist with information about a patient’s condition and abilities, and overall improvements. Patients and therapists often remark that using Makoto makes therapy feel more like a game than exercise. It has been proven very effective for patients dealing with a wide variety of conditions resulting from injury or illness, (stroke, orthopedic injuries, neurological injuries) and it is a great tool to help measure your wife’s progress during her recovery.

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Health & Medicine

Charlie Traffas

2008-08-01 09:35:00

Question: What is congestive heart failure? With the word ‘failure’ in the name, one would think it is an ‘event’ rather than an affliction. Can one ever get cured of it?

Answer: Congestive Heart Failure is an illness characterized by the heart’s inability to work effectively as a pump. Heart failure is not an event but rather an illness with many causes. Congestive heart failure is most commonly due to impairment of function of the left ventricle, the chamber which pumps blood to all parts of the body. This pumping chamber may be made ineffective by damage due to heart attacks, by valvular abnormalities, such as leaking valve or a valve that is tightly narrowed, and sometimes the damage may be related to the viral infections. Long standing untreated blood pressure, metabolic abnormalities and inherited causes are only part of a long list of problems that may lead to heart failure. In some patients, the cause of heart failure is not related to failure of the left ventricle or main pumping chamber but may be related to failure of the right ventricle, the chamber that pumps blood from the heart to the lungs. In this instance, underlying heart disease such as emphysema may be the cause. Patients with heart failure most often complain of shortness of breath usually made worse with exertion. Weakness, easy fatigue ability, swelling, and inability to lie flat in bed are associated symptoms. In more extreme cases, patients may complaint of waking up gasping of air after lying in bed for a while. None of these symptoms are diagnostic of heart failure and a good physical examination and obtaining chest films, and an echocardiogram help us to establish a diagnosis. Congestive heart failure is a serious illness and necessitates understanding what caused the heart to fail. Often, a heart catheterization study will also be necessary to enable us to devise the best treatment plan for the patient. Medications, such as Digitalis and diuretics are standard treatments but the addition of Ace-Inhibitor drugs, Beta-Blockers and most recently pacemakers that pace both ventricles of the heart, have improved the outlook for these patients greatly. There is no “cure” for most patients with heart failure, but occasionally patients with viral illnesses simply get better and replacing a heart valve when appropriate, may resolve in nearly normal heart function. Fortunately, the prognosis for the heart patients continues to improve. Anyone with symptoms of shortness of breath, easy fatigue ability or excessive swelling should seek medical attention early and aggressive evaluation and treatment provide the best chance for long term survival.

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Health & Medicine

Dr Galichia

2008-08-01 09:35:00

Question: I have been taking Vytorin as prescribed by my cardiologist, for my high cholesterol levels. I have had success with it, but now, I am a little worried about taking it. I saw on the news that the FDA was looking into the effectiveness and safety of the drug. Should I quit taking it?

Answer: Vytorin is a medication doctors commonly prescribe for lowering a patient’s cholesterol—especially the LDL (or “bad” cholesterol). Vytorin has been shown to lower these levels very well. However, a study performed on the drug, focusing on the carotid artery (the main artery in the neck), seemed to show that despite lowering the levels of cholesterol, Vytorin had little effect on plaque buildup in the artery. My advice on any medication is to speak with your physician any time you have a question, particularly when a drug is being looked at in this way. I always caution my patients to keep taking medication until we have a chance to discuss it. Sometimes, stopping a medication outright can be dangerous, and your physician or health care provider can come up with a plan that’s right for you. So far, if Vytorin is working for my patients, I am recommending that they stay on the medication. However, there are other alternatives that can be quite effective at lowering cholesterol and are at a lower price. Again, speak with your physician about any changes or concerns you might have in terms of this or any other medication. You may find other treatment alternatives.

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Health & Medicine

Dr Galichia

2008-06-01 13:45:00

Answer: The relationship between alcohol consumption and effects on the heart is perplexed. There are many on going studies to prove risks and benefits of alcohol on health. It varies from person to person according to the age, pattern of drinking, amount of consumption and an individual’s tolerance to alcohol. Excessive drinking can be harmful to health by increasing the chance of high blood pressure, obesity, stroke, breast cancer, suicide, accidents, fetal alcohol syndrome, stomach and liver damage. There have been many studies suggesting that moderate use of alcohol may protect the heart, but for some e.g. with heart disease even moderate amount can be dangerous. AHA recommendation for alcohol consumption is 1-2 drinks per day for men and 1 drink per day for women. If you drink more than 3 drinks a day, speak to your doctor and let him know before he puts you on beta-blockers, aspirin, etc. Drinking too much can increase triglycerides (a cholesterol component) in blood that can cause high blood pressure and obesity. Another risk to the heart is that obesity can make you prone to diabetes. Heavy and long term alcohol use can cause stroke due to blood vessel rupture. Studies suggest that alcohol may provide some level of protection against ischemic stroke while increasing risk of hemorrhagic stroke. Excessive alcohol and drugs, like cocaine and amphetamines, are the most common cause of intracranial hemorrhage for people in their 20’s and 30’s. It causes cardiomyopathy, (a disease of heart muscles) due to poor absorption and storage of a vitamin called thiamine which could eventually cause heart failure. Although in the U.S. deficiency of this vitamin is very rare because of sufficient vitamin supplementation through enriched foods, it is better to have this point in mind. Binge drinking can cause cardiac arrhythmias and sudden cardiac death that has been called ‘holiday heart syndrome’. Again, ongoing studies are clarifying the relationship between alcohol use and peripheral vascular disease. Alcohol causes blood vessel narrowing and thus can be one of the causes of peripheral vessel disease. In the early 90’s, the health promoting properties of red wine gained scientific attention. Experiments showed that red wine led to full platelet aggregation and increased HDL (good cholesterol), but other alcoholic beverages enhanced platelet aggregation. Studies have shown that red wine contains a health-promoting component ‘Resveratrol’ that comes from the skin of the red grapes and also some other biologically effective elements. Resveratrol has been a primary ingredient of a historic oriental drug called ‘kojo-kon’ that was used for skin inflammations, fungal infections and heart and liver diseases. Resveratrol exhibits protection against atherosclerosis by decreasing free radical injury to heart and inhibits platelet aggregation. Besides it has also demonstrated anti- cancerous properties, besides breast cancer. But most of this research is done on an experimental basis. Evidence of these effects of red wine in humans needs more investigation. Although there have been many beneficial effects of red wine pointed out, if you don’t drink alcohol and want the heart benefits, you can get it by eating decent amounts of fruits and vegetables that are rich in anti-oxidants like onions and apples and by drinking green tea. Grapes and peanuts are a good source of resveratrol. Keeping in mind that peanuts are a rich source of cholesterol also. How alcohol affects the cardiovascular system needs further research. Although there are potential benefits of alcohol to the heart, particularly red wine, the American Heart Association does not recommend drinking alcohol for the purpose of protecting the heart. If you have high blood pressure, liver disease, stomach ulcers, severe acid reflux, sleep apnea, diabetes and if you are pregnant or trying to conceive, please be aware that alcohol is a big threat for you. Everyone else should consult their physician for questions about personal health.

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Health & Medicine

Deb Wetta

2008-06-01 13:45:00

QUESTION: My neighbor suffered a minor stroke last year and seems to have recovered enough to consider driving again. Is there a test available to help determine if he’s ready and able to drive a car?

ANSWER: It sounds like your friend would benefit from a driving evaluation. Performed by a specially trained therapist, a driving evaluation is an assessment of a person’s physical and cognitive ability to get back behind the wheel. This type of evaluation is ideal for someone who has temporarily lost their ability to drive as a result of a stroke, spinal cord injury, neurological disease, amputation, head injury, or other conditions that have affected their physical, sensory or motor abilities. It is also a good way to determine if someone is no longer able to safely operate an automobile as a result of the aging process. A comprehensive driving evaluation consists of both off-road and on-road assessments that determine a person’s mental well-being, physical conditioning, and skills as they pertain to the task of driving. Typically, the therapist begins with a series of in-clinic, pre-driving assessments that examine the individual’s mental status and vision as well as muscle strength, balance, and reflexes. If the individual passes these tests, they are placed behind the wheel of a vehicle to perform the specific functions needed to perform the task of driving. These in-automobile tests begin in the safety of a parking lot, advancing to public streets only if testing proves the person capable. In-traffic tests begin at street level before advancing to highway driving. The results of a driving evaluation can also determine if the driver has the ability to return to the road but is in need of some additional training or adaptive equipment. In these cases, the therapist can work with the individual, his or her physician, or any sponsoring agent to connect with the proper programs or adaptive aids. The therapist also uses the outcomes of the driving evaluation to make recommendations regarding the patient’s driving capabilities to the Kansas Division of Motor Vehicles and to the patient’s physician. In Kansas, participation in a driving evaluation requires a person age 18 or older to have a valid driver’s permit or license. Although driving evaluations are not covered by Medicare or private insurance providers, the cost of the service is typically regarded as an affordable option for families concerned about an aging loved ones ability to continue driving as well as for patients recovering from injury or illness who are looking to regain more of their independence.

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Health & Medicine

Dr Galichia

2008-06-01 13:45:00

Answer: A “mini-stroke,” is shorthand for a TIA (transient ischemic event). These terms are synonymous and mean that the patient has suffered a brief period of neurologic dysfunction and has recovered, at least momentarily. In simplest terms, the patient has developed some loss of neurologic function usually for a few minutes, but has recovered with no residual problems. The types of neurological changes may include inability to speak properly, loss of feeling or ability to move an arm or leg, inability to think properly, loss of vision, facial weakness, or any neurologic change. If these symptoms persist, the patient develops a completed stroke. These symptoms should NEVER be taken lightly, and everyone should be as familiar with them as possible. Should any of these symptoms occur, it is imperative to seek immediate medical attention. Even if the symptoms go away completely, they are often the early warning that a full-blown stroke is about to occur. Many patients are so frightened by these events that they try to put the experience out of their minds and go about their lives, hoping nothing will recur. Unfortunately, they usually do and often simply do not go away again. There are many things we can do immediately when a TIA occurs. Immediate evaluation of the carotid arteries in the neck must be undertaken to see if plaque exists that may have broken loose and traveled to the brain. A CT scan is usually performed to see if bleeding may have occurred, and to see if a small stroke can be identified. In other words, a full and immediate neurologic evaluation should be performed and medication should be introduced (as well as aspirin) to help prevent clot formation -- which may lead to a life-threatening stroke. If the patient obtains immediate help and these measures are instituted, most of these patients do not go on to completed stroke. If you or anyone you know experiences these symptoms, call your doctor, or 911. It’s always best for the patient to be seen as early as possible.

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Health & Medicine

Bonnie Stephens

2008-05-01 13:20:00

Question: A friend of mine is having trouble with something called ‘foot drop’ since he had a stroke. What is this condition and is there any treatment for it?

Answer: Foot drop is a condition that causes a person great difficulty in walking because they are unable to lift the front portion of their foot with each step. This typically results in a scuffing of the toes when trying to walk with the afflicted leg, an action that many patients try to avoid by developing an overcompensating gait pattern which includes lifting the knee higher than normal when taking a step. Foot drop is typically caused by an interruption of normal neurological functioning through injury or illness by conditions such as multiple sclerosis, cerebral palsy, brain injury, a spinal disorder, or as in your friend’s case, a stroke. Physical therapy is commonly used to treat patients with foot drop and today, some patients are seeing very good results from a device known as the NESS L300 System, made by Bioness, Inc., of California. A tool used as part of a therapy program, the NESS L300 is a device that straps to the leg and uses electronic stimulation to help retrain a person’s gait, or walking pattern. Small and lightweight, the device consists of three components: a leg cuff, a sensor attached to the shoe, and a hand-held remote. The cuff, an easy-to-remove device that is fitted to the afflicted leg below the knee, contains electrodes that stimulate the muscles in answer to signals sent by the shoe sensor. The sensor, which features Intelli-Sense™ technology, automatically recognizes the foot’s position and adjusts its signal to accommodate various surfaces, elevations, and walking speeds. The remote gives the patient using the device easy-to-use control of the system. The NESS L300 System is programmed by a specially trained therapist, who works with the patient to fit the device and tailor a program for its use. Used regularly, the NESS L300 System can help increase blood flow and range of motion, prevent atrophy and development of abnormal walking patterns, encourage flexibility and inhibit contractures, and enable a patient to walk with greater confidence and thereby regain an increased level of independence.

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Health & Medicine

Dr Galichia

2008-04-01 12:10:00

Question: I came to the hospital with unstable chest pain and hoped to have an angioplasty procedure done. However, when my doctors evaluated me, they found my vessels were blocked in too many places and I was told I was a better candidate for bypass surgery. Is it safe for me to have this surgery?

Answer: Bypass surgery is a very frequently performed procedure in the United States today. The results vary from institution to institution and are generally related to the frequency of procedures performed and skill of the individual surgeon in concert with the skill of the surgical and hospital team. Higher frequency centers tend to have better results and better across the board mortality rates, in the range of 1.5 percent for a reasonably healthy younger patient with good heart function to approximately five percent for older, frail patients who experience other multiple coexisting diseases. The decision to perform angioplasty versus bypass surgery is often a difficult one for the cardiologist and the surgeon to make. Indeed, each of the physicians involved may have a different opinion about the best approach to treating this kind of patient. Most cardiologists would favor a bypass operation in individuals who had multiple heart artery blockages and also multiple heart blockages with particularly complex anatomy. Certainly the incidence of blockages within the heart vascular system plays a major role. Also, if a previous artery has been totally occluded, a physician could assume that it would probably be difficult to balloon dialate that type of vessel and may also direct a physician to make a surgical recommendation. Furthermore, if the main artery of the heart on the left side is severely narrowed, otherwise known as left main disease, most centers would still recommend bypass surgery. We know that patients over the age of sixty five that are scheduled for bypass surgery, particularly in their seventies and eighties are higher risk patients. Interestingly as well, due to their smaller stature and smaller vessels, women are overall higher risk bypass candidates. Yet having coexisting lung disease, cancer or other major health problems may lead a physician to perform a balloon or stent procedure even though the anatomy may favor a bypass operation. In my own practice, patients who are older and with more disease, may actually give us the better opportunity to do a balloon or stent procedure as a low risk intervention. By strategically identifying what we think may be the “culprit” lesion, we may indeed be able to give the patient relief from their angina and provide long term improvement in circulation in that particular area. As a cardiologist, I evaluate all aspects of this individual patient to assess their risk of bypass surgery versus an angioplasty or stent procedure. Interestingly, on some patients with left main disease who previously were an “open and shut” candidate for surgery, now may have a stent placed in this particular vessel, a procedure which we are successfully doing increasingly in our laboratory. A good example would be a patient with severe emphysema, unable to undergo general anesthesia safely, may in fact be able to have a stent placed in the left main artery with what we have defined as a low, less than one percent, risk to the patient. The technology in cardiology has advanced extremely rapidly and continues to do so in cardiac surgery as well. Most of our patients now have their surgery without using a bypass pump, otherwise known as op cab bypass or “beating heart” surgery. This not only lowers the risk of surgery, it also decreases recovery time, lowers the chance of depression, loss of intellect and other problems that we see in patients that are placed on a bypass pump. In my own experience, the risk associated with an angioplasty procedure is less than one per thousand. If one compares this to bypass surgery with an expected 1.5 to two percent overall risk, you can easily see that the risk of surgery, even in the best of circumstances, is about ten times higher than the risk of an angioplasty or a stent procedure. Recent studies show that patients that have bypass surgery actually do extremely well in the long term and fewer of them have to come back to the heart catheterization laboratory for second procedures or admissions for unstable chest pain. Nevertheless, given the risk, the cost and the recovery time, most circumstances favor stenting in conditions where there are one or two blockages. Fortunately, the risk of interventions in a single vessel in cardiac cath labs around the country is low. Further and ongoing studies are being done to define the indications for a bypass procedure versus a stent procedure in these complex patient groups. Both of these procedures provide patients with a high chance of immediate success and good long term results.

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Health & Medicine

Dr Galichia

2008-04-01 12:10:00

Answer: You are describing a common complaint I hear daily in my office, namely that of a skipped beat or a sense of cardiac irregularity that occurs randomly and intermittently. Fortunately, most of these “skipped beats” are benign, but they may also be a sign of significant underlying heart disease. The irregularities are due to irritable areas of electrical activities in either the reservoir or the pumping chambers of the heart. If the heart is normal in its structure and if the blood vessels supplying the heart are normal, the skipped beats are usually of little consequence. Conversely, if the heart is structurally abnormal, the irregular beats may be a sign of serious consequence. I always recommend that these palpitations deserve evaluation. A good physical exam plus a simple EKG, an echo cardiogram and perhaps a stress test help us to better understand the risk imposed by these irregularities. Any associated symptoms such as passing out, chest pain, shortness of breath or fatigue also imply a more serious nature to these complaints. At age 47 an evaluation of this type is extremely important.

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Health & Medicine

Dr Galichia

2008-03-01 09:38:00

Answer: Let me start by explaining what the shingles virus is. Shingles are caused by the same virus that causes chickenpox. The chickenpox virus stays inactive in certain nerves and can become active again, usually later in life causing the shingles virus to appear. Shingles are not contagious and it isn’t clear how or why the same virus that causes chickenpox can come back as shingles after being hidden in the nervous system for many years. There is a shingles vaccine that has been available for about a year now and yet very few people have received the shot. This vaccine is currently recommended for patients over the age of sixty that have never had an outbreak of shingles. That is a very large population of patients but for various reasons this shot has not been utilized in the way we thought it would. Shingles is a very serious disorder and is characterized by a skin rash, pain with burning or itching in the area of the rash. Many patients will present with pain and or itching first and then have the full blown outbreak of shingles in a few days. This disorder tends to follow the lines of nerves and thus we see evidence of the rash located on the chest, face and neck area generally in a linear fashion following the path of nerve distribution. Shingles cause a great deal of pain and discomfort at the time of outbreak and in many patients this discomfort will last forever. About one third of the patients who contract shingles will have persistent pain in the nerve distribution that can last for months and even years. This is known as Postherpetic Neuralgia, (PHN), a serious complication resulting from shingles. PHN can cause disability and a great deal of suffering in patients who develop this complication. Shingles may also involve the eye and even cause nerve damage about the face that can be devastating. Loss of vision is certainly another potential complication of shingles. Most people have either heard of shingles or know someone who has had the virus. The shingles vaccine that is currently available has a low incidence of complications and about an eighty percent success rate in preventing even a single episode of shingles. The vaccine is not covered by Medicare or many insurances at this time and costs a patient approximately $200.00. This is certainly a barrier for some patients and can hinder the widespread distribution of the vaccine. Furthermore, people continue to be worried about vaccines in general and specifically about a new vaccine that could cause harm to them. Even in patients that have received the vaccine, if an outbreak of shingles occurs, the vaccine seems to diminish the chance of getting Postherpetic Neuralgia. There are about one million new cases of shingles each year in the United States and half of those occur in patients over the age of sixty. I believe this vaccine makes a great deal of sense given these numbers. Furthermore, a significant number of people younger than sixty understand this preventive approach and are opting to pay to receive the shingles vaccine knowing that the benefits are twofold. First, the vaccine can potentially keep them from contracting shingles and second, if they do contract shingles, the vaccine can lessen the full blown complications of this virus. I recommend that if you have had an episode of chickenpox in the past or feel you are at risk for having shingles, you should talk to your doctor about having this vaccine. The cost of the vaccination is significant but pales in contrast to an episode of shingles.

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Health & Medicine

Nancy ODonnell

2008-02-01 11:16:00

I suffer from chronic migraines and have never found a medication to relieve my pain. I heard that something called biofeedback therapy might provide me answers—what is this form of treatment?

Answer: Biofeedback therapy is a form of treatment that uses feedback derived from specially designed instrumentation that detects the body’s response to various types of physical activity. During a biofeedback session, the therapist applies sensors to various areas of the body, which monitor the body’s response to physical activity. Measurable responses, such as muscle contractions, alterations in body temperature, or increased levels of perspiration, are provided to both the therapist and patient, giving them with insight into reactions occurring as a result of pain, injury, stress, muscle weakness, or spasms. For instance, through biofeedback, it may be discovered that a migraine headache is triggered by increased muscle tension resulting from the onset of a stressful event. By seeing this increased tension reproduced on a computer screen, the patient becomes more aware of the bodily changes occurring as a result of the triggering event. Aided with this information, the therapist guides the patient in developing a program of muscle strengthening and relaxation techniques, which help the patient learn to regulate the body’s overreactions during daily activities. In addition to chronic headaches and migraines, biofeedback has been proven effective for a wide range of conditions including loss of bladder and bowel muscle control, muscle weakness, paralysis, overuse of pain medications, fibromyalgia and chronic pain, anxiety and stress, work or sports injuries, and complications arising after an automobile or other form of accident. Biofeedback is a good option for a variety of reasons: it can reduce or eliminate the need for medication, it can help conditions that have not responded to medications or other forms of treatment, and it allows you to take a more proactive approach to your health and wellness. In order to receive biofeedback therapy, a patient must first obtain a written referral, including diagnosis, from a physician.

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Health & Medicine

Dr Galichia

2008-02-01 10:12:00

What exactly is PXE (Pseudoxanthoma Elasticum)?

PXE is an inherited systemic disease characterized by changes in the elastic tissue of the skin. This disorder affects mainly the skin, eyes, heart and gastrointestinal system. The skin changes are distributed on the flexor regions of the extremities, in the folds in the skin, at the sides of the neck, under the arm, and behind the knee. Yellowish pebbly bumps give the skin a plucked chicken appearance. PXE appears to be inherited as a dominant gene and affects twice as many females as males. A diagnosis of PXE is determined through biopsy. The basic PXE disorder seems to be characterized by increased amounts of elastic tissue, and a tissue that has a tendency to become calcified. No one knows why the elastic tissue forms as this continues to be a subject of intense research. In the United States, PXE is reported as being prevalent at a level of one in 160,000 births. Many of these people live a normal lifetime but weakening of the blood vessels in the brain, and upper GI tract hemorrhaging are serious complications of PXE due to the degeneration of the elastic tissue of blood vessels and arteries of the gastric wall. Most patients are diagnosed in their thirties or forties. Patients with PXE have progressive involvement of the skin, eyes and other organ systems with extremely stretchable skin being a common characteristic. About 87% of these patients have changes in their retina which is a result of this disease. Loss of vision may occur around the age of 40 and this can tend to be progressive. To date, there is no real treatment for this disease. Patients with PXE should have regular eye exams and see their physician regularly to monitor blood pressure and any vascular changes as hypertension and vascular disease are fairly common in patients with PXE.

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Health & Medicine

Dr Galichia

2008-01-01 11:17:00

I failed to get a flu shot and I think the flu season is too far underway. Should I go ahead and get the shot now or simply pass on it? Also, I’m convinced that several times in the past I’ve actually gotten the flu from the flu shot. What should I do?

Answer: My best recommendation is to get the flu shot immediately. We have yet to see a flu epidemic in this region and getting this shot now will likely give you immunity to contracting the flu. The flu shot is imperative in my opinion for all adults and everyone over the age of six months with rare exception. I feel that failing to get the flu shot could result in you getting influenza and running the risk of pneumonia or other complications that could result in death. There are thousands of people every year in this country that die from “garden variety” influenza, most of them because they did not get a flu shot. There are some myths regarding flu shots, myth number one, being that a person will actually get the flu from the flu vaccine. The flu vaccine used today is a dead virus and there is no way that a person can get influenza from the flu shot. Some people do however experience some symptoms of nausea, vomiting, and aching muscles but it is not the flu and will not turn in to a life threatening illness. A second myth surrounding the flu vaccine suggests that since flu vaccines are grown in eggs, this processing method can actually give a person “bird flu”. This dreaded illness is not transmitted in anyway by the flu shot and in fact, has occurred only because of a rare mutation enabling this virus to spread to humans. This spread has occurred from infected chickens to humans and these were live chickens, not through eating poultry or eggs from the chicken. A third popular myth implies that since the flu vaccine is formulated so far in advance, how do we know it will be effective against the strain we’ll be fighting during peak flu season? Truth of the matter is, the Centers for Disease Control (CDC) and companies that make flu vaccine have been extremely effective in predicting which virus will spread in epidemic fashion. Thus they’ve been amazingly good forecasting which virus’s to protect against. The fourth myth centers around healthy people. The thought here is that healthy people don’t need a flu shot. This is absolutely not true. In fact, the flu spreads through healthy people as fast as it does through elderly people within our population. It is true that older people have more serious complications with the flu but certainly young children and any healthy person can die from influenza. The great flu epidemic of 1918 killed many very young people and in many instances, an entire family was wiped out due to the flu virus. Myth number five, flu vaccines given to young children can cause autism. Scientists became very excited in the 1990’s when there seemed to be a link between autism and the flu vaccine but there is simply no scientific evidence to support this. Groups of thousands of children have been studied in multiple countries and no link has been established thus far. The reasons for getting a flu shot are overwhelming. Getting an annual flu shot is one small bullet to bite for the amount of protection you will receive from taking this precautionary measure.

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Health & Medicine

Dr Galichia

2007-12-01 10:04:00

ecording star Kanye West’s mother recently died following plastic surgery. There have been questions raised about whether or not she had surgical clearance to have the plastic surgery performed. What does appropriate surgical clearance consist of?

Answer: Surgical specialists are very adamant these days about establishing that a patient who is about to have any surgical procedure is assessed prior to their procedure regarding surgical risk. Doctors such as urologists, plastic surgeons, orthopedic surgeons, general surgeons and many others feel that it’s necessary to have a thorough evaluation of the patient who is about to have an elective procedure by a physician with sound knowledge and experience in general medicine. In short, specialized physicians are asking for assistance in evaluating the surgical risk of the patient. This has become a standard first step in surgical protocol which did not exist 20 to 30 years ago. Furthermore, the age range in which patients are risk evaluated prior to surgical procedures has fallen greatly and around the country is averaging 40 years of age. Patients below the age of 40 may often have a surgical procedure without a thorough medical evaluation prior to surgery. As we become more sub-specialized in medicine, we also understand the limitations within the specialty. Doctors particularly who are doing elective surgery want to make certain that the patient they’re dealing with is capable of undergoing their procedure. It is not always possible to assure that a patient is well and fine and can indeed have whatever procedure has been scheduled. Nevertheless, knowing what risks one might incur and how to deal with these risks is important for the surgeon. Furthermore, a patient’s family physician should always be informed of what surgeries are being planned since they often have special knowledge about their patients which is critical in preventing complications. An example may be a patient who “feels fine” but really has an underlying cardiovascular problem that needs to be dealt with. Often the patient is not totally aware of the magnitude of the problem or what subtleties may occur during a surgical procedure. At that point, thorough knowledge of all potential problems has to be undertaken. This often will consist of some very basic testing such as a good physical exam, a chest x-ray, an EKG or quite possibly a stress EKG and some basic lab work to make certain the kidney functions and other laboratory parameters are within normal range Long gone are the days when a surgeon would whisk a patient to surgery and “hope for the best”. No physician wants to be part of a medical disaster such as Kanye West’s mother experienced at the early age of 58. Many patients will undergo elective procedures because they are strongly indicated and yet also be at significant risk because of underlying health problems. More and more however, we are able to deal with these problems, minimize the risk and get the patient through surgery. This requires a team effort and may in fact necessitate other consultations leading up to the surgical procedure. The post operative care, likewise, is a team effort and is best accomplished with an “eyes wide open” approach. Through the years, surgical outcomes have improved in virtually every surgical procedure. This is a result of thorough preoperative evaluations and attentive postoperative care of patients who are at risk.

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Health & Medicine

Dr Galichia

2007-11-01 09:55:00

Could you please explain to me what a "Mini Stroke" is and what is the significance of them in the long term?

Recent information again emphasizes the importance of "Mini Strokes", or TIAs.

This type of stroke occurs when one experiences any kind of neurological deficit that persists for less than 24 hours. Many of these events occur only for a few minutes and then tend to go away. Symptoms such as facial numbness, slurred speech, paralysis on one side of the body, blurry vision or sudden headache may occur. Often times this type of stroke will go away as quickly and mysteriously as it appeared.

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Health & Medicine

Dr Galichia

2007-10-01 11:09:00

Answer: A study has been released just days ago showing that after a 3-4 year period, medicated stents show a superiority over bare metal stents in both the restenosis rates and are at least as good if not better in terms of overall survival. Only approximately one year ago we had information indicating that medicated stents used in coronary arteries may be related to higher incidence of late clotting problems resulting in heart attacks and sudden death. Although this number was relatively low, ie; less than five per thousand, it was felt that medicated stents posed a specific hazard in this regard. Also it was noted that patients who continued to take Plavix, a blood thinner we always give patients with stents, had almost none of these late clotting problems. The new information is impressive in that it indicates no real difference in clotting problems or heart attack incidents in patients with medicated stents. In fact, the data would tell us that the medicated stents are slightly better in this regard long term and that most importantly the incidence of patients having to come back for a second stent or another procedure such as a bypass operation is markedly less in the patients with medicated stents. Clearly medicated stents protect the artery from recurrences and have only about a five percent recurrence rate within the stented area. This compares to an approximate 25% restenosis rate in patients who have bare metal stents. Our current thinking is that medicated stents are definitely worth the extra cost and that patients that have medicated stents probably should stay on Plavix and aspirin as long as possible. Previous guidelines recommended staying on these medications for three to six months but we are now telling our patients to stay on these drugs indefinitely. This has resulted in highly satisfactory short and long term outcomes when using medicated stents.

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Health & Medicine

Dr Galichia

2007-09-01 09:59:00

Answer: It is true that men and women may present differently with symptoms of coronary heart disease. Men tend to have more “classic symptoms” including chest pains in the center of the chest radiating into the left arm and occurring with exertion and relieved with rest and nitroglycerin. This classic symptom of angina pectoris is definitely more common in men then women. Women may be short of breath, and have fatigue or other softer symptoms, which are often missed. At the time of a heart attack, however, men are more likely as well to have a “Hollywood heart attack” with severe crushing chest pain, drenching sweat, a feeling of impending doom, nausea, and extreme weakness. This pain is usually oppressive and it has a dramatic impact on the patient. Certainly, this is not always the case, but is much more likely to be a presentation in men than in women. Women often have more subtle symptoms. When a heart attack occurs in women, they may have symptoms of shortness of breath or extreme fatigue or chest pain that is less dramatic, often consisting of heart burn or a feeling of fullness, or shortness of breath. These symptoms are often overlooked and may be attributed to “stress” or quite often gastrointralogic complaints. Women with coronary heart disease, in the absence of heart attack, may have extreme fatigue, shortness of breath, or chest pain that is not well located in the center of the chest. These symptoms are easily overlooked both by the patient and their physician unless there is a high level of alertness to the possibility of coronary heart disease. Despite the differences in presentation of symptoms that have been described, I find in my own practice that the difference between men and women, relative to these symptoms, is much less than has been described. In fact, I often find that men have very subtle symptoms, including fatigue and shortness of breath, and that women very often have the same symptoms, including chest pain. In all of my patients I must consider the possibility of coronary disease presenting in a “less than classical way”. By having my antenna stretched to the fullest when evaluating these patients, I have a much better chance of making the correct diagnosis. Remember this description of Cardiac Chest Pain. SAVES: S Sudden onset A Anterior in location V Vague description E Exertion makes it occur S Suddenly goes away with rest and nitroglycerin

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Health & Medicine

Dr Joseph Galichia

2007-07-30 15:23:00

Atrial fibrillation is the most common heart rhythm disturbance that we see in cardiology today. Atrial fibrillation occurs when the reservoir chambers called the right and left atria become irritable and start beating rapidly and irregularly. At this point the atria no longer participate into the pumping mechanism of the heart and blood simply runs passively into these chambers and then eventually crosses into the larger pumping ventricles where it is pumped into the heart, into the lungs and the rest of the body. This results in some decrease in the cardiac output and compromises the function of the heart. At the same time, the regular electrical mechanism, which controls the ventricular response is no longer working, and the larger pumping chambers, called ventricles, then beat more rapidly and completely irregularly. Many patients have no symptoms at all when this occurs, and no awareness that their heart is beating irregularly and rapidly. Other patients notice dramatic changes and find that they feel uncomfortable. They are aware of a rapid heartbeat and feel very weak and rundown. Oftentimes atrial fibrillation occurs intermittently, so that patients may have a period when their heart is beating irregularly and then other periods where they go back into a normal rhythm. Atrial fibrillation may occur completely on its own as an isolated electrical problem. This occurs in approximately 30-40% of patients and is known as “lone atrial fibrillation.” The number one reason for atrial fibrillation is age and it begins to be more and more frequent after age sixty. The second most common cause is hypertension. Aside from that, chronic obstructive lung disease, valvular heart disease, hyperthyroidism, heart failure and enlargement of the atria for any reason may result in atrial fibrillation. The most immediate treatment we have to correct this problem is to do an electrical shock to the heart, called cardioversion. This may or may not be necessary in many patients and is a way of treating the problem immediately. Also, certain medications may help restore the heart rhythm to normal, sparing the need for electrical shock. Unfortunately, in many people, this problem is recurrent and needs to be prevented. Again, there are medications to prevent the recurrence of atrial fibrillation. When medications fail, sometimes ablation procedures may help. A new procedure called Mini Maze has been of great benefit to patients who have a lot of symptoms with atrial fibrillation and multiple recurrences. The Mini Maze procedure will correct this problem in about 80% of cases. It is a minimally invasive surgical procedure which does involve making two small finger size openings in the chest and doing the ablation procedure around the pulmonary veins. Fortunately, most patients do not need either ablation or a surgical procedure, but can be maintained relatively well with medication. It is gratifying to me that we now have the ability to treat this rhythm disturbance in patients who are affected dramatically with this problem and expect a good long term outlook.

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Health & Medicine

Deb Wetta

2007-07-01 16:13:00

QUESTION: My husband is home from the hospital after getting care for a hip fracture followed by a mild stroke. He says he feels fine but he seems to be getting weaker and it is more difficult for him to get out of bed and walk to the bathroom. The doctors expect him to fully recover but I’m concerned about my ability to care for him until he is completely back to his former self. What are my options?

ANSWER: A good way to address your husband’s condition would be to have a qualified professional, often referred to as a nurse liaison, come to your home to perform a free evaluation. This evaluation can help determine if your husband may benefit from a rehabilitative care program that would include such as physical, occupational or speech/language therapies. Through a rehabilitative program tailored to your husband’s needs, he would have a good chance of regaining much of the strength and functionality that he had prior to his stroke. Options for rehabilitative treatment may include scheduled visits for him to receive care in an outpatient facility, visits from home health professionals or a brief stay in an inpatient rehabilitation hospital. If the latter of these options is determined to be most appropriate, then your husband would also receive specialized rehabilitative nursing care. In performing the evaluation, the nurse liaison will ask you and your husband detailed questions about his medical history and his current medical condition. The liaison may also have him perform a few simple physical tests such as walking across the room or standing up from a sitting position. A qualified medical professional such as a physiatrist, who is specially trained in rehabilitative care, will then make a determination on the best course of action for helping your husband return to his former level of independence.

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Health & Medicine

Dr Galichia

2007-07-01 16:13:00

Is it true that a bypass patient can generally expect to need another bypass operation about every 10 years?

In order to understand the bypass surgery we should think of it as a treatment for the blocked arteries and not a cure. In the 1960’s we learned that we can take veins from the leg and use as bypasses from the aorta to narrowed heart arteries successfully. This operation was first done by Dr.Favaloro and by the 1970’s was becoming a frequently performed procedure with excellent surgical outcomes. In those early days we felt patients may be fortunate to live only a few years and we were not even sure that a repeat bypass procedure could be done. Many patients were told that operation might last five years but to expect little more. We discovered early on that many patients lived far beyond without complications and also that if new blockages occurred or the bypasses failed we could safely repeat a bypass operation. Investigations also demonstrated that the need for repeat bypass surgery became greater after five years, and that this risk extended throughout the patient’s life. However, we also began aggressively treating patients for risk factors including smoking cessation, cholesterol reduction, weight loss, exercise, and blood pressure control. Furthermore, annual check-ups including a stress test helped to identify those patients at greater risk for recurrent heart attacks and other coronary events. A major breakthrough occurred in the early 1980’s when the cardiologists began to use balloon angioplasty as a method of preserving bypass grafts and treating new blockages that occurred in the heart arteries. This enabled us to avoid the second bypass operation in a great number of patients. Technology has advanced rapidly in this area and we now have medicated stents, which are highly successful in salvaging old bypasses and treating new blockages in the native arteries. Also, we now are seeing patients who have lived 20 to 30 years following their first bypass procedure with hardly any complications along the way. Thankfully, our advise to patients in the 1960’s and 1970’s that their life expectancy would be short and that their options beyond the first bypass operation did not exist was false. More and more patients are avoiding bypass operations because of the simplicity and safety of balloon and stent procedures. For some patients, however, bypass surgery is the only reasonable option and maybe the only bypass procedure they will ever need.

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Health & Medicine

Dr Galichia

2007-06-01 09:43:00

We now have evidence that lowering your LDL cholesterol to a level far below 100 may slow the progression of atherosclerosis and in fact may cause reversibility of plaque in arteries. A recent study demonstrated a reversal of plaque if LDL was maintained below 62 for a long period of time. We know that by increasing Lipitor to as high as 80 mg per day or, perhaps, changing to a combination of a statin drug plus Zetia, we can very often achieve such a dramatic lowering of cholesterol. The drug Vytorin combines a statin and Zetia in the same pill, at a lesser cost. More than 10 million Americans take statins today and most cardiologists feel that these drugs are underutilized. Lowering bad cholesterol to below 100 had been shown in many studies to reduce the risk of heart attack and stroke. In some of these studies, this risk reduction approaches 35-40% and is easy to achieve. Aggressively lowering the level of LDL cholesterol to below 62 takes careful monitoring, often maximizing the dose of a statin or using a combination therapy. We can only anticipate that one could expect a further reduction for all cardiovascular events if we were able to achieve this goal. Statin drugs do not provide significant risk of liver damage, if the physician carefully monitors liver function tests while upping the dose of the medication. Muscle aches and pains are common side effects of statins and somewhat dose related. Fortunately, most patients now are aware of the side effect of leg pain, back pain, and other muscle discomfort these drugs may cause. Upon stopping a statin drug, muscle aches most commonly go away in 2-4 weeks. All in all, the small risk of statin drug therapy is far outweighed by the benefit of these potent medications.

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Health & Medicine

Dr Chris Kabler

2007-05-01 16:21:00

QUESTION: I have constant back pain and have been told that I have arthritis. Is there anything you can do to help?

Answer: When I was young, I often heard my grandparents refer to “Old Arthur” when they were having achy or painful joints. In those days when you heard “Old Arthur was back in town”, you knew that granddad wasn’t going to be playing much golf that week. There are many misconceptions about the condition termed “arthritis”. Arthritis has become a catchall term for anyone that has chronic joint pain. It is often misdiagnosed and greatly misunderstood. Most patients who suffer from arthritis are told they just have to live with the pain or take drugs. There are better options in many cases. There are different types of arthritis and that creates a lot of the confusion on the subject. Degenerative osteoarthritis is the type that is the most common, and is often confused with other types of arthritis, such as rheumatoid arthritis. Rheumatoid arthritis along with a list of other similar arthritic diseases are caused by our body’s own immune system attacking our joint tissues. These conditions can affect our entire body, as our own immune system goes on the attack. These types of arthritis are truly a disease process which can also cause damage not only to joint tissues but can also cause damage to other organs and tissues in more severe cases. Fortunately, those types of arthritis are not nearly as common as the “Old Arthur” that most people are referring too. Osteoarthritis, which is referred to as OA, is not actually a disease process. More accurately described, OA is actually caused by repeated stress to involved joints. In simpler terms OA is the arthritis that is caused by wear and tear. It will affect all of us in varying degrees, as we continue to log more and more mileage on our bodies throughout our lifetime. Because of this, it is often misrepresented as a normal part of aging. In reality, OA is not a normal part of aging if we make proper decisions throughout our lifetimes to make the health of our joints a priority. It is labeled as a condition affecting the elderly, however if we look closer at this condition we begin to understand that the process of arthritis begins the moment we are born. Since we live in an environment where gravity creates constant loading pressures on our bodies, it is a given that we will have stress on our spines and joints every day of our life. It doesn’t matter if you are sitting, standing, or lying down, pressures are constantly pressing and pulling on us. When you combine the loading pressure that gravity creates with other movements such as lifting, twisting, or stooping, then you can understand how the principles of leverage and force are greatly increased. As force increases, so does the stress on our bodies. Because of this stress, our joints have certain mechanical properties to help us absorb those stresses. Each joint is designed to carry the weight of our bodies in a certain alignment, and each joint is to act like a shock absorber just like on a car. When our joints are healthy and functioning properly, those joints absorb our daily stresses efficiently and move freely. Unfortunately, those mechanical abilities begin to change as we go through life. As joints begin to loose their ability to absorb stress, gravity begins to break down the tissues inside the joints. As this process occurs over many years it eventually shows upon an X-ray as arthritis. In reality, those painful joints that are bothering you today, have actually been slowly developing over many years. Looking at this condition from a broader prospective, it only makes sense that the better our joints work throughout our lifetime, the less wear and tear they will suffer. For over a hundred years, chiropractors have been practicing the science of improving joint mechanics. By improving joint mobility, alignment, and balance, our joints work more efficiently. Better joint function over a lifetime gives us a better chance of slowing or preventing joint stress as we age. Chiropractors are specialists in assessing the body’s mechanics; by finding those joints that are not mechanically sound and correcting those problems, which leads to, increased pressure and stress. Recent advances in technology have given chiropractors another tool to help improve patients suffering from osteoarthritis. Spinal decompression therapy is a treatment designed to reduce pressure inside problematic joints. This reduction in pressure can create dramatic improvement in joint pain and stiffness. The treatments are non-invasive and require no drugs or surgery, and consist of a regimen of approximately 15 sessions on a decompression table. The treatments are very comfortable. Many patients fall asleep during the 20 minute treatments. For those who have put off taking care of their joints and are already suffering from arthritis, there is still hope. Decompression treatments have been proven to provide much relief for these conditions, but can also help with other spinal conditions such as pinched nerves, and bulging discs.

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Health & Medicine

Dr Weaver

2007-05-01 13:27:00

Now offers the most up-to-date treatment for the correction of “out-of-aligned” feet. Previously, patients were told that not much could be done for this potentially painful condition. This excessive rear foot motion is caused by abnormal motion between the heel (calcaneus) and ankle (talus) bones. Symptoms can include: shin splints, growing pains, leg cramping, knee, hip, and/or lower back pain, arch pain, and not being able to stand for long periods. Past treatments included corrective shoes, custom-molded inserts (orthotics), or extensive reconstructive foot surgery. There is a procedure (subtalar arthroeresis), in which, consists of inserting a specialized titanium stent into the foot that limits the excessive motion and restores normal motion. The surgery is performed during a brief outpatient surgery. There is no bone cutting or tendon transfers. In most cases, only a bandage is applied no casting is required. The procedure is usually performed one foot at a time and is already covered by most insurance companies. Normally, the stent will just stay in the foot and never has to be removed. This surgery is completely reversible. The stent can be removed and the foot will be right back to where it started. The results are immediate. The procedure can be performed on patients four (4) years old and older. Additional procedures may need to be performed to achieve the best results.

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Health & Medicine

Bonnie Stephens

2007-05-01 11:11:00

Question: What can you tell me about brain trauma rehabilitation?

Answer: Because the brain regulates everything we do, from walking and talking to eating and thinking, damage to this vital organ can be a potentially devastating experience. That’s why early rehabilitation is crucial to helping patients with brain injury return to the best quality of life they can achieve. More than five million people are living with a disability as the result of a brain injury in this country. Adolescents, seniors and people who participate in high risk activities are especially at risk. Traumatic brain injuries are typically classified as either closed or open, with closed exhibiting little or no physical evidence and open being those that penetrate the skull. The majority of brain injuries are closed, often occurring from a disease, illness, seemingly non-injurious fall, or contact with objects (windshields, falling debris) with no immediate apparent damage. These injuries, the most underdiagnosed condition in adults and children, can go undiagnosed for long periods of time because symptoms such as headaches, dizziness, or nausea may be confused as something else. An accurate diagnosis is important in a closed injury because when there is a blow to the head bruising and swelling can occur inside the rigid skull, causing more damage to cells than the original impact. With an open brain injury, which often occurs as a result of a car accident, fall, or act of violence and which presents apparent damage such as deep cuts, bleeding, or an object penetrating from the skull, time is of the essence in treatment. Regardless of the type of brain injury, symptoms can be broken down into three basic areas: physical, cognitive and behavioral. Physical indications can include seizures or tremors, loss of motor control and coordination, spasticity (tightening of the muscles), speaking and swallowing disorders, and bladder and bowel incontinence. Cognitive symptoms can encompass difficulty with concentration, an inability to plan or complete activities, problems with judgment and perception, a diminished memory or learning capacity, a slowed rate of information processing or problems with language and communication such as difficulty naming objects or slurred speech. Behavioral problems with a brain injury often appear as: a lack of appropriate social behavior, long-term irritability, varying degrees of depression, or an amplification of pre-existing negative actions such as verbal or physical outbursts or impulsive actions. Despite the negative impact of damage to the brain, the good news is that, with rehabilitation, it is possible for a patient to regain most, if not all of their physical functions over time. The right therapies can help a patient re-learn former functions or learn to compensate for permanent changes that have occurred as a result of the injury. There are several components that make a good rehabilitation program. Primary of these is that therapies and treatment should be tailored to the patient’s specific needs. Family involvement and community re-entry planning are also two important parts of the best rehabilitation programs. Other crucial elements of rehabilitation for brain injury include physical therapies that promote strength, endurance, and mobility; occupational therapies that address activities of daily living such as dressing and personal hygiene; speech and language therapies to help with communication or swallowing issues; cognitive activities to help in the recovery of, or compensation for, attention, memory, and problem-solving concerns; psychological programs to deal with management of behavior issues. Finally, a good support group can work wonders with brain injured individuals and their caregivers. Connecting with others in similar circumstances can help alleviate some of the fears, anxieties and sense of loss that accompany brain injuries, sometimes for the rest of a person’s life.

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Health & Medicine

Dr Galichia

2007-05-01 11:11:00

Angina Pectoris is a type of chest pain commonly associated with blocked coronary arteries. Angina Pectoris has been known to be the harbinger of a heart attack for more than 100 years and was described initially as a pain in the center of the chest, brought on by exercise and relieved with rest or nitroglycerin. This condition however, may be related to other heart problems such as aortic valvular disease, mitral valvular disease or sometimes congenital problems of the heart. Often, patients will have symptoms like this that are totally unrelated to the heart such as gall bladder disease or problems with the esophagus or stomach. The list of problems that mimic Angina Pectoris is extremely long. In any event, when you have a direct relative who has a history of Angina Pectoris and in this case, most likely coronary artery disease, or blocked heart arteries, the possibility that others in the family tree will have this problem is extremely great. Furthermore, in our general population, this form of heart disease results in about 40% of all deaths in our country. The prevalence of coronary disease in the general population plus the history of having a direct relative with this problem, does increase the chances that you may also have underlying heart disease. Of course many factors come into play. The other risk factors for coronary disease, besides family history, are smoking, diabetes, being overweight, having high cholesterol, a sedentary lifestyle and hypertension. Age always is a factor as coronary artery disease becomes more prevalent as we become older. My advice would be to see your family physician and have your cholesterol checked and also depending on your age, consider doing a treadmill test. Certainly with any family history of heart disease my strongest recommendation is to do your best to eliminate the other risk factors for coronary disease as we have described above.

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Health & Medicine

Dr Galichia

2007-04-01 16:42:00

We all know that obesity is on the rise. Simply put, how healthy or unhealthy is fat “really”?

ANSWER: All of us know that American people are getting larger all the time. We have gained some inches in height over the years but more importantly our weight and our body mass index (BMI) has grown disproportionately. We now eat too much, have too much body fat, exercise too little and continue to have more problems with diseases such as diabetes, heart disease and strokes. There is no question that the fat content of our bodies is increasing dramatically. This phenomenon has occurred not only in the US but is a developing problem in all parts of the world today, including Asia, where historically people have been much thinner and smaller than we Americans. One of the questions people ask is, if I’m too heavy how does it really hurt me? Certainly we know that obesity puts a greater strain on your heart and leads to high blood pressure, as well. People who are overweight have more joint problems than other individuals. They tend to have higher lipid levels including high cholesterol and triglyceride levels. Certainly, we know that the dramatic rise in the incidence of diabetes is directly related to obesity and a lack of exercise. These are all health problems we can identify almost immediately as being related to being overweight. That is not to mention that there is some evidence that many cancers including breast and possibly prostate cancer are related to having a high body fat content. In the aging process, it definitely appears to many scientists around the world that being overweight accelerates the breakdown of tissue in the body. Unfortunately, obesity is on the rise in our younger children with many overweight children being discovered in early childhood with a continuing rise into the early teen years. Children today, tend to be more sedentary, spending more time with their computers, video games and other electronic pursuits and less time exercising, playing in the yard and having fun playing outdoors. Indeed, there seems to be an increasing anxiety on the part of their parents to allow their children to play alone outside because of what appears to be a risk of sexual predators and other forms of crime in the environment. The government has recently put forth a national initiative to attack the problem of obesity in our society. This is a struggle that has become a worldwide battle with almost every country in the world today experiencing the same phenomenon. We all have to eat less, exercise more and control the amount of fat that we take in. Indeed, losing weight as we age becomes a more and more difficult challenge, as most people simply gain a pound, and half pound, two pounds a year and inexorably become more and more overweight. The challenge we have today is one that is not easily solved by medications and in fact, many medications we commonly take, increase weight even further. No simple solution exists for the problem. There are new drugs on the horizon, but none of them is a magic weapon in the fight against worldwide obesity.

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Health & Medicine

Dr Weaver

2007-04-01 08:09:00

It’s not what fashion-conscious women want to hear—another warning about high heels. But, pump-style shoes often cause significant pain by irritating a common bony deformity on the back of the heel called ‘pump bump.’ In many cases, it can lead to bursitis or Achilles tendonitis if left untreated. Pump bump is common in young women who wear high heels almost every day, and their feet take a beating as a result. The rigid back of a pump-style shoe can create pressure that aggravates the heel bone when walking. The bump or bony protrusion is a hereditary deformity that can cause Achilles tendonitis or bursitis due to constant irritation from pump-style shoes. Those with high arches or tight Achilles tendons are especially vulnerable to developing pump bump if they work in high heels. The medical term for the disorder is Haglund’s deformity. In addition to the noticeable bump, symptoms include pain where the Achilles tendon attaches to the heel, swelling in the back of the heel and redness in the area. In the majority of cases, pump bump is treated non-surgically by reducing inflammation, but this does not get rid of the bony protrusion. Pain relief is the primary treatment goal, so anti-inflammatory medications usually are prescribed. Icing the back of the heel reduces swelling, and stretching exercises can relieve tension in the Achilles. Long-term, however, it’s best to avoid wearing high heels, if possible. When the dress code requires high heels, it is advised that women try heel lifts to decrease pressure on the heel or wear appropriate dress shoes that have soft backs or are backless.

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Health & Medicine

Deb Wetta

2007-03-01 12:49:00

My husband suffered a stroke and I am told he has a higher chance of returning home and regaining a better quality of life if he gets good rehabilitative care. What is the difference between a rehabilitation hospital and a skilled nursing unit?

ANSWER: When making a choice where to receive rehabilitative care, it is vital to recognize the difference between services available in various settings and how these differences can impact recovery. Probably the most noticeable difference between a rehabilitation hospital and a skilled nursing facility is the amount of therapy a patient will receive. While both types of facilities typically offer physical, occupational and speech/language therapies, a rehabilitation hospital delivers more frequent and longer sessions in a week’s time. In fact, physical, occupational and/or speech language therapy must be delivered a minimum three hours a day in a rehabilitation hospital; there is no defined length of time for these services to be provided in skilled nursing. The amount of therapy is important because more aggressive rehabilitation can make a difference in how quickly someone returns home and is able to enjoy a quality of life comparable to that which they experienced prior to their illness or injury. Additionally, care in a rehabilitation hospital is delivered by a team of specially trained professionals whose goal is to direct patients in recovering the independence they once had. There are more measurable differences in the care that is delivered as well. In a rehabilitation hospital, the attending physician visits daily, in a skilled nursing facility, the physician may only be required to visit once every 30 days. A multidisciplinary team led by a medical doctor or a doctor of osteopathy is a requirement of a rehabilitation hospital; not so in a nursing home. And registered nurses must provide oversight around the clock in a rehab hospital but only eight consecutive hours a day in a nursing facility. There is also a higher concentration of nurses per patient in a rehabilitation hospital and each of them receives specialized training in the unique needs of patients working to get back on their feet and back home. I recommend a tour of any facility you are considering. When you go, ask about some of the following: Are you assigned a case manager to help you navigate this new world you and your husband have entered? Does the facility offer therapies designed specifically for your husband’s condition, such as aquatics, swallowing therapy, gait training? Do they routinely monitor how well patients do as a result of their rehabilitation? Are family members involved in the care plan and how often are they included in goal setting? Is there education available to help learn how to deal with your husband’s condition? And be sure to ask about the plan for your husband’s therapy once he is discharged to home, ideally, he will be able to continue his treatment as an outpatient until he is fully recovered.

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Health & Medicine

Dr Galichia

2007-02-01 16:23:00

I have heard it said that almost 100 million Americans do not routinely get a good night’s sleep. Can you explain what causes insomnia and some suggestions as to what to do about it?

ANSWER: It is true that somewhere between 25 and 50% of Americans do not get adequate sleep. Many of these individuals simply do not allocate enough time for sleep, and it has been well proven physiologically that all of us should get at least 8 hours or a bit more of sleep per day. In any questionnaire about sleep, most people respond they get somewhere around 7 hours or less. It is also true that some very highly functioning individuals, Einstein perhaps being the most famous, got by on as little as 2 or 3 hours a night and felt that they were simply wasting time by going to bed. Physiologists now might ask themselves imagine what accomplishments they could have done having gotten adequate sleep. Sleep disorders do account, however, for a great number of us who are not sleeping adequately. Insomnia is a common disorder and is often caused by anxiety or medications one is taking. Furthermore, insomnia may be a primary disorder and not the result of sleep apnea or any major pathologic problem. Unfortunately, people who have insomnia often try numerous remedies and may indeed spend a lifetime trying to find the answer for getting adequate sleep. Some very simple things like establishing quietude in the room, allowing no light in the room, avoiding all stimulants in meals prior to going to bed, help these people a great deal. One can only see the number of advertisements on TV to understand how many of these individuals take some sort of sleep remedy. There are other individuals who have a sleep disorder known as sleep apnea. Sleep apnea is defined as inadequate sleeping pattern caused by irregular respirations and slowing of the breathing pattern causing the individual to wake up briefly, take a deep breath and go back to sleep, only for the cycle to recur. For these people; they never do establish a proper sleep pattern, therefore they are chronically tired and may have trouble falling asleep during the day, may be inattentive at their job and may perform very poorly with mental functions as well. Snoring is commonly described by their spouses. They are often overweight and have high blood pressure or heart conditions which co-exist and put them at risk for heart attack, stroke and sudden death. Recently a great deal of emphasis has been placed on this disorder following the death of pro-football Hall of Famer, Reggie White. We now realize that sleep apnea is truly a dangerous problem and one that can have a tremendous negative impact on one’s quality of life as well as pose the risk of heart attack, sudden death, stroke and heart arrhythmia. Many people with sleep apnea are very overweight and treating this condition by weight loss is helpful. We are fortunate, however, that using breathing support systems such as C-pap or Bi-pap machines can make an immediate impact in their quality of life and also reduce the risk of cardiovascular death. Rarely, but in some instances, an operation to enlarge the breathing area in the back of the throat may be a benefit. All of us would like to sleep like a baby and get at least 8 to 10 hours of sleep a day and that would certainly be desirable. The important thing we should know is that when you feel you are not sleeping well or you are not sleeping enough or if fatigue is a common problem, you should visit with your doctor and raise the question of a sleep disorder and have it treated aggressively. Of course, following the rules of good health, including maintaining a normal body weight, good exercise, a healthy diet, normal blood pressure and finding some time to relax will have a great impact on whether you ever develop this disease.

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Health & Medicine

Dr Chris Kabler

2007-02-01 16:23:00

QUESTION: What is Spinal Decompression Therapy?

ANSWER: Chiropractors have been treating back and neck conditions for over 100 years. By improving the mechanical abilities of the spine regarding alignment and mobility, millions of people have had their lives improved. Now there is a new technology available that has made it possible to treat very difficult spinal conditions that in the past would not have been able to be treated effectively with standard chiropractic care. This new treatment is called Spinal Decompression Therapy. Recent studies have shown it to be a very effective treatment for patients that in the past would have had to consider surgery or injections for their condition. Below are some common questions that I am asked regarding this treatment. QUESTION: How does spinal decompression therapy work? ANSWER: Decompression is defined as a reduction in pressure. Decompression therapy is a non-surgical procedure that effectively treats disabling low back, neck, and radiating leg and arm pain. It effectively relieves pain associated with disc herniation, degenerative discs, and posterior facet syndromes by allowing decompression of spinal discs and facet joints. Decompression therapy causes an unloading of pressure in the spinal joints by creating distraction and proper positioning. Decompression Therapy effectively enhances the healing process and renders quick, effective, and amazing pain relief that enables most patients to return to a more active lifestyle. QUESTION: Why is spinal decompression therapy effective? ANSWER: To understand why Decompression Therapy works, you must first understand the mechanics of the spinal joint. Each joint is composed of three weight bearing structures that allow movements to occur. For simplicity, I will discuss the main bearing structure of the joint, which is the intervertebral disc. The disc is the cartilage pad between each vertebrae. Each disc attaches to the vertebra above and below it. This provides the proper spacing for the nerve roots that pass around the disc as they exit the spine from between each joint. Each spinal disc has a jelly-like center to it. It is often referred to as a "ball bearing" core that is held in position by rings of cartilage tissue. Healthy discs give you flexibility, allowing normal turning, and bending movements, and stress absorption. These movements produce a pumping action that supplies proper disc nutrition and waste removal to the tissue. Discs can become damaged from trauma, such as lifting or falling. However, another cause of disc changes is spinal misalignments that can cause the tissue to change shape. As a result of disc deformation and loss of normal mobility, the cartilage fibers in the disc begin to weaken. This is the earliest stage of disc damage. In this stage of the process most patients have no symptoms and are unaware that such changes are occurring. As the disc tissue continues to stiffen and weaken it begins to develop small fissures and tears that over time will allow the fluid center of the disc to rupture outward. Like a blister, disc tissue can bulge. As the soft nucleus of the disc is compressed, it pushes outward where the disc wall is weakest. If this process of distortion continues outward it can eventually begin to produce symptoms of pain in the back or neck. If the disc protrudes far enough out, it can also compress the nerve root causing radiating pain such as sciatica. Muscles are also affected as they tighten to protect and splint the problematic joint. With its cushioning and separating functions gone, movement is painful and surgical intervention was often required with this type of condition in the past. Decompression Therapy is now able to treat this condition without drugs or surgery. Decompression therapy reduces the pressure inside the spinal joints which creates stress and begins the process of the joint weakening. The bulging that is present is essentially pulled back towards the inside of the disc and away from the nerve by creating a “vacuum effect”. This effect is created by the reduction of pressure that occurs when the disc is distracted. Restoring proper pressure inside the disc also allows for proper circulation to the damaged tissues so they can heal and repair more effectively. As the resiliency and strength of the disc is improved it eventually becomes a more stable joint that is better able to absorb the stresses that will be exerted on it every day. Often times when the pain initially begins, patients will say "I didn't do anything." or "I just bent over to tie my shoes". This is often confusing. Once you understand the mechanics of the condition, you better understand that the pain one is suffering from today is the result of problems that started years before. QUESTION: What is the difference between Decompression and Traction? ANSWER: Different types of traction have been used for years in the treatment of back conditions. Spinal Decompression Therapy takes the benefits of older traction technology and makes it much more effective. Older traction technology was limited in its benefits because of the body’s own guarding reflexes. When you stretch the spine there is a normal reflex which causes our muscles to tighten and guard against such movement. In fact, in some cases that guarding reflex would actually increase the pressure inside the joints, giving the opposite effect to an already damaged joint. Spinal Decompression Therapy uses a computer program which controls the amount of distraction that is being applied to bypass that guarding reflex. The 3D ActiveTrac table is unique in that it allows the doctor to move the components of the table to accommodate proper positioning to focus the distraction on specific parts of the involved joint. This table is one of the few tables that can perform this function. Not all decompression tables are the same. QUESTION: Is it right for you? ANSWER: Decompression Therapy is an effective treatment for patients suffering from herniated or degenerated discs as well as posterior facet syndromes, which respond well to the distraction. A proper examination and case history will determine if a patient is a candidate for treatment. In some cases MRI and X-ray exams may be needed to better assess the condition. Certain conditions such as fractures, severe osteoporosis, and tumors are not candidates for this treatment. Fortunately, the majority of spinal problems are mechanical in nature, and so most post patients suffering from back and neck problems will be able to benefit from this treatment. Once it is determined that the condition is mechanical, you understand that it is necessary to treat the condition mechanically. Chiropractors specialize in the treatment of mechanical spinal conditions. QUESTION: How often do I have to use this therapy? ANSWER: On average, patients will go through a regimen of 10-15, twenty minute treatments to receive the full benefits of Decompression Therapy. Many patients notice an improvement following the initial few treatments. The extent and severity of each individual's symptoms will determine the amount of sessions that will be necessary. Following each session, electrical muscle stimulation is applied to help relax the muscles and ligaments and aid in the reduction of inflammation. After treatment, your doctor may prescribe specific exercises designed to help regain control and strengthen the co-contractor muscles, which are responsible for stabilization.

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Health & Medicine

Dr George Watson

2007-02-01 16:23:00

QUESTION: How is that? ANSWER: The drug companies have slick ads telling you to ask your doctor about such things as the purple pill. That is treating the symptom. The same treatment is recommended for GERD, which can lead to esophageal cancer if gastric (stomach) acid is allowed to reflux into the esophagus. QUESTION: How do you treat indigestion and GERD? ANSWER: If the patient is over forty, or has symptoms that indicate indigestion, they should start with a simple, inexpensive intervention—digestive enzymes with each meal. The patient asks when or if they can stop taking the purple pill. They can stop when they forget for several days. That ends up saving them a lot of money. They also should do the usual things such as not eating within 3 hours of bedtime, consuming viscous fiber AFTER the meal to prevent stomach acid from refluxing into the esophagus, and lose weight if it is indicated. QUESTION: What about gastric ulcers? ANSWER: Most people now know that a large percentage of ulcers are caused by H. Pylori bacteria. In the past, diagnosis involved gastroscopic evaluation with biopsy, and treatment involved at least two weeks of therapy costing in excess of $220 just for th

ANSWER: Indigestion is very common, since, by age 40, some studies indicate that 80% of people have SOME type of digestive enzyme deficiency. So that gives us the choice to treat the symptoms or to treat the cause. QUESTION: How is that? ANSWER: The drug companies have slick ads telling you to ask your doctor about such things as the purple pill. That is treating the symptom. The same treatment is recommended for GERD, which can lead to esophageal cancer if gastric (stomach) acid is allowed to reflux into the esophagus. QUESTION: How do you treat indigestion and GERD? ANSWER: If the patient is over forty, or has symptoms that indicate indigestion, they should start with a simple, inexpensive intervention—digestive enzymes with each meal. The patient asks when or if they can stop taking the purple pill. They can stop when they forget for several days. That ends up saving them a lot of money. They also should do the usual things such as not eating within 3 hours of bedtime, consuming viscous fiber AFTER the meal to prevent stomach acid from refluxing into the esophagus, and lose weight if it is indicated. QUESTION: What about gastric ulcers? ANSWER: Most people now know that a large percentage of ulcers are caused by H. Pylori bacteria. In the past, diagnosis involved gastroscopic evaluation with biopsy, and treatment involved at least two weeks of therapy costing in excess of $220 just for the medication. Now, there is a ONE DAY treatment that is 95% effective for less than $100. Diagnosis can be made with blood or breath test.

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Health & Medicine

Dr Chris Kabler

2007-02-01 16:23:00

Which is better - being healthy or just being pain free?

Would you rather be healthy or just not have any complaints? Seems like a silly question doesn’t it? In the United States we spend more per capita on health care than any other country in the world, yet we ranked 12th in overall health by the World Health Organization’s list of industrialized countries in the world in 2005. How can this be? It is a shocking statistic, but it is reality. We have lost focus on what it means to truly be healthy. We have become a society dependent on drugs to alleviate complaints, versus determining a cause and correcting it. As a chiropractor, I see a multitude of joint and spinal conditions in my office every day. For most, there is a common pattern that is troubling. Many of those patients have a long history of recurring back problems that have been continually swept under the rug until one day it happens. The pain has become more “severe this time” or “this time it; won’t go away”. The negative impact that back problems have on our health has been greatly minimized by society, and modern medicine, -Yet it is an epidemic in our country. Back pain is the most common cause of lost time from work. Back pain is one of the most common reasons to be hospitalized. We spend billions of dollars on back problems every year. In fact it is a cash cow for drug manufacturers. Since we have medications that can make us feel better, what else do we need? It is that line of thought that has created this epidemic. I am not against medicine. In fact there is a time and place for pain medication. But, when medication is the sole source of treatment, I take issue with that. If you were having a heart attack, would you want a pain reliever for that chest pain? If you went to your dentist for a tooth ache and he told you to take some tylenol to see if that takes care of it, you’d think he was crazy? But when we have back pain, then that solution seems to be OK! It is completely illogical, but it happens every day. The problem lies in the perception of the problem. Because we have become a very symptom oriented society, we see the pain as the problem. In fact it is not. We hurt for a reason. It is our body’s way of telling us there is something wrong! Yet we continually try to numb ourselves to relieve ourselves of the warning signal our body is telling us. In nearly all cases of spinal pain, the cause is a break down of the mechanics of our spinal joints. Over time, the stresses from gravity begin to change the function of our joints. As we lose proper mobility and alignment to our joints, we become ripe for painful episodes to occur. Each time we experience a painful episode, the joint becomes more unsound. Ultimately, over many years, a problematic joint will deteriorate and become arthritic. Everyone knows of someone that has a “bad back”. If you look into that persons’ past, you will likely find that they have a long history of back problems that slowly worsened over many years. It’s not that one day things were good, and the next day it was bad. It is a process that occurs over years from poor back mechanics that go unchecked. Its time to start thinking logically regarding the health of our backs. People who invest in the health of their spine earlier in life will reap the benefits later. If you would like to know how healthy your back is, even if you’re not currently in pain, contact our office. We utilize state of the art technology to assess joint, nerve, and muscle function. The testing is non-invasive, and can be completed in less than 20 minutes.

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Health & Medicine

Dr Galichia

2007-02-01 14:25:00

I’ve been told I have angina. How significant is that and should I be worried?

ANSWER: Angina Pectoris is defined as pain coming on with exertion relieved with rest or nitroglycerin and occurring in the center of the chest radiating to the arms, neck or shoulder. This is a classic kind of chest pain that one gets when there’s a blocked artery in the heart. We are well aware, however, that other disorders may cause a similar kind of pain, including disorders of the esophagus, heart, gallbladder and sometimes musculoskeletal problems. The list of medical problems that can masquerade as serious heart disease is indeed quite long. Also, experience tells us that many patients with heart disease do not have angina pectoris or have some variation of this syndrome. Unfortunately, most people with heart disease have no symptoms whatsoever and their first symptom will be a heart attack or sudden death. Angina pectoris when due to blocked arteries in the classical sense, must be evaluated quickly, and in my opinion is definitely a symptom with potentially lethal outcomes. Any chest pain above the waist must be regarded as a potential heart disorder. Evaluation should be carried out immediately and includes a good physical exam, a stress test, possibly a nuclear stress test and often an echocardiogram, chest film and lab work. Depending on the outcomes of these studies, further evaluation with a heart catheterization is most often necessary. If there is a blocked artery, current approaches include using a stent to correct this disorder, managing the patient with medications or doing a bypass procedure. In any event, the finding of a blockage in a coronary artery means that the patient has atherosclerotic vascular disease and will have to cope with this problem for the rest of his life. Reduction of risk factors includes, stopping smoking, losing weight, exercising, controlling cholesterol and managing high blood pressure, diabetes or other co-existing medical problems. It is of the absolute essence that any chest pain be evaluated in any individual with the thought that a potential heart problem exists. It is especially critical that the symptom of angina pectoris as described more than two hundred years ago in 1768 by a physician named Heberdon, be evaluated immediately. The symptom of chest pain brought on with exertion and relieved with rest or nitroglycerin is the classic symptom of coronary heart disease. The situation of coronary heart disease becomes even more complex given the fact that many people do not have this symptom but in fact have some other chest pain above the waist or shortness of breath, weakness, sweating, a feeling of hopelessness or sometimes even back pain. Fatigue also is a very common presentation for patients with coronary heart disease and is second only to shortness of breath in terms of presenting symptoms of our patients. Fortunately, for all of us, we now have the technology to accurately determine the course of angina pectoris and properly treat it. Furthermore, making the diagnosis of coronary heart disease and treating it aggressively, lowers the mortality risk immensely in this disorder.

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Health & Medicine

Dr Weaver

2007-02-01 13:17:00

Why do I have this open sore that will not heal?

ANSWER: Approximately five million Americans suffer from chronic open sores that can become seriously infected, gangrenous and in some cases require amputation. This is often due to limited blood flow which can slow the body’s own healing process. Many patients seek professional help for wounds that have not healed after months of standard wound treatment. In the majority of patients, treatment programs produce complete healing, usually within a few months. There are wounds that are called Chronic Wounds. These wounds do not heal in a normal amount of time; these include: • Diabetic Ulcers • Pressure Sores • Arterial Ulcers • Venous Ulcers • Surgery Wound that does not close • Chemical Wounds Treatment of these wounds is individualized based on the type and severity of the wound. Wound treatment can include removal of unhealthy tissue. The fastest possible healing is achieved through wound treatment programs. Wound treatment and intervention include: • Advanced Wound Dressings • Antibiotic Therapy • Vascular Intervention • Nutrition Counseling • Education/Prevention of reoccurrence • Surgical Debridement • Physical Therapy • Protective Footwear • Advanced Biological • Harvest APC There has been a plethora of advances, especially within the last several years, for the treatment of chronic wounds. This method is called Harvest APC or also known as Autologous Platelet Concentrate. From a small amount of the patient’s blood, growth factors (substances that stimulate healing) are isolated, concentrated and applied topically to the wound. Growth factors can speed and enhance healing of the wound. Not only have platelet-derived growth factors gained notoriety in specialties such as orthopedic, maxillofacial and plastic surgery, the technology is increasingly being recognized as an important modality for accelerating healing in chronic wounds. When it comes to using growth factors to heal wounds, the results have been impressive. We have achieved a 94% success rate using this method on a series of chronic wounds, with the criteria for success being completely healed. This technology has repeatedly proved itself with closure. While this technology is simple to use it is effective in an office-based setting. It is my opinion that widespread use of this technology will become commonplace in other aspects of podiatric surgery.

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Health & Medicine

Asad Ehtisham MD

2007-02-01 13:10:00

I am really afraid of having a stroke, even though I try to eat right and exercise. What can I do if I think I’m having a stroke?

ANSWER: Stroke is a deadly brain attack and America's third-leading killer. It’s also the No. 1 cause of serious, long-term disability. Anyone can have a stroke, regardless of age or gender. Of course, eating a healthy diet and exercising is a good start. But, because strokes can happen fast and the symptoms come on suddenly, be sure to learn these warning signs of stroke: • Numbness or weakness of the face, arm or leg, especially on one side of the body • Confusion, trouble speaking or trouble understanding • Trouble seeing in one or both eyes • Dizziness, loss of balance or coordination or trouble walking • Severe headache with no known cause Fortunately, we have the best stroke care in Kansas right here in Wichita, which has the only Joint Commission on Accreditation of Healthcare Organizations-certified Primary Stroke Center in Kansas. If EMS personnel see you are having a stroke, they will automatically take you there. A lot has been learned about lessening the severity of stroke, including the use of clot-busting medications within three hours of the onset of stroke symptoms. The local Primary Stroke Center, however, can extend that time to six hours by taking the patient into the angio suite and delivering the same “clot buster” medication directly to the clot in the brain. Hence the expression, “Time is brain.” That’s why, in a hospital with an acute stroke response team, members gather in the Emergency Room moments after being notified, to pool their expertise to make important decisions about care when time is critical. Advances in diagnostics, neurosurgery and rehabilitation — all available locally —allow highly skilled specialists to direct the best of care for stroke patients at every degree of severity and level of recovery. If you’d like to learn more about stroke, call 689-5700 to have a copy of “Stroke: Why They Call It Brain Attack,” a free 30-minute audio tape, sent to you.

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Health & Medicine

Dr Chris Kabler

2007-01-01 14:58:00

I've heard of a new technology for treating back pain, what is it?

ANSWER: If you've been reading the newspaper lately then you have likely seen some of the advertisements for the "New technology" in the treatment of back and neck pain. The treatment is called decompression therapy and has proven to be very effective in helping people with conditions that in many cases would have required surgery in the past. The treatment is non-invasive and requires no medications. In fact it is so comfortable that many patients fall asleep during the average 20-minute treatment. The results from this treatment are amazing. Having seen patients experience immediate changes after one treatment. Decompression therapy works by reducing pressure inside the spinal joints. The cartilage pads between each of our spinal vertebra are called discs. These discs have fluid in the center of them and are designed to be shock absorbers for our joints. As we go through our daily routine of standing, walking, bending, and sleeping, we create loading pressures on the discs and other supporting tissues of the spine. When that occurs, pressure begins to increase inside the disc causing the disc fibers to weaken. The combination of a weakened disc and increased pressure inside it, can begin forcing the fluid inside the disc to the outside edges of the disc, and eventually push all the way out of the disc creating a bulge. These bulges can be very painful and can also impinge directly on nerve roots that pass beside the disc, resulting in numbness and pain in our arms and legs. If the pressure and alignment of the problematic discs are not improved, the damage to the disc can continue to worsen, causing more problems later in life. There are new technologies that utilizes the Saunders 3D ActiveTrac therapy table. This table is unique from other tables used to provide decompression treatment. Most decompression tables work in only one plane of movement. Every patient's body structure is different, and the problems creating back pain for each patient are different. The 3D ActiveTrac allows the clinician to position the patient in nearly any range of movement possible to accommodate the alignment and movement specific to each patient's particular problems. Since the release of this treatment, it has been effective, but it has also been very expensive. The good news is that the new technology is being offered for this type of treatment The 3D ActiveTrac can effectively treat back and neck pain, herniated or protruding discs, arthritic conditions of the spine, sciatica, and facet syndrome.

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Health & Medicine

Dr Weaver

2007-01-01 14:58:00

I have noticed that my ankles are turning in toward each other. Why is this and what can I do about it?

ANSWER: A 180-pound person has about 810 pounds of force going through each foot with every step taken. The average person takes 15,000 steps a day. When the talus abnormally deviates (medially, and/or anteriorly, and/or plantarflexes) these forces are transmitted abnormally throughout the foot and eventually pathology ensures. This is what leads to plantar fasciitis/heel spur syndrome, bunions/first ray deformities, tarsal tunnel disorders, lowering of the arch, etc. In addition, the abnormal motion of the talus also leads to excessive motion proximally, leading to knee, hip, and back problems as well. Currently, the treatment of hyperpronation is arch supports or orthotics. Hyperpronation is caused by obliteration of the sinus tarsi, a normal occurring space formed by the talus and calcaneus. This is an internal problem and therefore external measures are ineffective in preventing the obliteration of this space. Orthotics and arch supports will give some relief, but the underlying problem still exists. Inserts are only effective when worn, are difficult to fit into more than one pair of shoes. Imagine if you have a cancer and are only receiving 20% of radiation/chemotherapy to destroy the cancer. Inevitably the cancer will continue to spread. The same thing is occurring in the feet. Patients are given orthotics that can only control a small amount of the problem; coincidently more damage is occurring to the feet, knees, hips, and back with every step. Historically, when orthotics were ineffective, the only other option was rearfoot reconstructive surgery. This modality, however, is usually just too aggressive to address this deformity. Typically, there is four to six weeks of non to partial weightbearing, many complications, extensive recovery (four to eight months), and the results are questionable. This type of procedure is irreversible. Most patients would rather suffer with their current condition than undergo the extensive surgery. Meanwhile, with every step taken further damage is occurring to the feet, knees, hips, and back. The HyProCure is completely different from all of the other stents and implants currently on the market and is tolerated by individuals older than three years of age. It is a fast, reproducible procedure with a quick recovery. Patients are back into regular shoes within a week following placement of the stent. It is a completely reversible procedure and functions all the time, unlike orthotics (have to wear shoes). Most insurance companies cover this procedure. Central Kansas Podiatry Associates is the only podiatry group in the area that is performing this procedure. Call for more information or to schedule your appointment (316) 269-3338.

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Health & Medicine

Dr George Watson

2006-12-01 15:48:00

QUESTION: What do you mean by bio-identical? ANSWER: These are the hormones that are made by humans, not the estrogen in pregnant mares' urine, or the progestins of provera, which were the hormones studied. Needless to say, this has caused a lot of confusion--women and men are asking, "Is it safe to take hormones at all?" To which ANTI-AGING doctors respond, "When your hormones were in balance, about your mid twenties, weren't you about as healthy as ever? Would you like to feel like that again?" Doctors who have not studied the literature in anti-aging medicine will likely respond, "At your age, you don't need any hormones. Just take this pill to keep your bones strong." QUESTION: What other factors might be involved? ANSWER: I have women tell me every week that they do not think it is healthy to have their breasts simultaneously crushed and radiated for their annual mammogram, so they are not getting mammograms yearly. One lady even told me that her skin was torn in the process of her last mammogram and she would never have that done again. Perhaps the decrease in the number of mammograms, and the resulting decreased radiation is part of the answer. QUESTION: So, what is a person to do? ANSWER: Take ownership for your own health. Read books on your health. Do on-line searches for the information you seek to answer your specific problem. Then find a doctor that LISTENS to you, your concerns, your questions, YOUR goals, before he or she tells you what they are going to do. Look up Thermography on the internet. Look up www.acam.org on the internet to find a d

ANSWER: The article goes on to say that perhaps, since women over fifty are taking fewer hormones that might be the reason for the decrease. What the article DOESN'T say is, all of the studies were done with SYNTHETIC hormones or non-bio-identical hormones. QUESTION: What do you mean by bio-identical? ANSWER: These are the hormones that are made by humans, not the estrogen in pregnant mares' urine, or the progestins of provera, which were the hormones studied. Needless to say, this has caused a lot of confusion--women and men are asking, "Is it safe to take hormones at all?" To which ANTI-AGING doctors respond, "When your hormones were in balance, about your mid twenties, weren't you about as healthy as ever? Would you like to feel like that again?" Doctors who have not studied the literature in anti-aging medicine will likely respond, "At your age, you don't need any hormones. Just take this pill to keep your bones strong." QUESTION: What other factors might be involved? ANSWER: I have women tell me every week that they do not think it is healthy to have their breasts simultaneously crushed and radiated for their annual mammogram, so they are not getting mammograms yearly. One lady even told me that her skin was torn in the process of her last mammogram and she would never have that done again. Perhaps the decrease in the number of mammograms, and the resulting decreased radiation is part of the answer. QUESTION: So, what is a person to do? ANSWER: Take ownership for your own health. Read books on your health. Do on-line searches for the information you seek to answer your specific problem. Then find a doctor that LISTENS to you, your concerns, your questions, YOUR goals, before he or she tells you what they are going to do. Look up Thermography on the internet. Look up www.acam.org on the internet to find a doctor that will work with you to provide BIO-IDENTICAL hormones for you. Call Park City Medical Center at 744-3400 to schedule an appointment with a doctor that listens to YOU.

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Health & Medicine

Dr George Watson

2006-12-01 09:28:00

QUESTION: What other preventive things can I do? ANSWER: Good nutrition is the foundation for good health. Eat plenty of fresh fruits and vegetables. Soak them ten to fifteen minutes in water with vinegar to remove toxins and pathogens (bacteria and viruses). If you wonder if you are getting enough, then you probably need to supplement with a high quality anti-oxidant formula. Minimize processed foods. Next, assess your environment. How many people around you are coughing and sneezing? Be sure to wash your hands after handling money or anything they have touched, before you handle any food. If you are the one coughing, do your best not to handle anything that others will have to touch. QUESTION: What is cough etiquette? ANSWER: Cough etiquette is covering the mouth and nose with a tissue or mask to prevent droplets from being sprayed into the air. It is also important to wash your hands after disposing of the tissue. The other aspect of cough etiquette is to isolate yourself from others if you have a persistent, productive cough. Don't expose them unnecessarily to your affliction. QUESTION: What if, despite my best efforts, I contract the flu? ANSWER: Stay home, unless you are going out to seek medical care. Add ¼ cup of hydrogen peroxide to distilled water in a cool mist vaporizer running in the room when you sleep. Gargle with half peroxide, half distilled water severa

ANSWER: You might say that a good stern lecture from Grandma or a review of social graces by Miss Manners would be a good foundation for PREVENTING unnecessary illnesses. Since many of us will be at family gatherings, we need to remember to practice our best manners both for the benefit of ourselves and others. First, picture the spread of food. If you are one of those people who licks every spill of food off your fingers, STOP! Everything you touch from then on has your bacteria and viruses on it. Go wash your hands, and from then on, use a napkin to wipe your hands. Don't drink from the same glass as another person or use the same utensils. These are common sense, but, especially with small children to feed, sometimes we don't think. These are so simple. Why don't people think, and do them? QUESTION: What other preventive things can I do? ANSWER: Good nutrition is the foundation for good health. Eat plenty of fresh fruits and vegetables. Soak them ten to fifteen minutes in water with vinegar to remove toxins and pathogens (bacteria and viruses). If you wonder if you are getting enough, then you probably need to supplement with a high quality anti-oxidant formula. Minimize processed foods. Next, assess your environment. How many people around you are coughing and sneezing? Be sure to wash your hands after handling money or anything they have touched, before you handle any food. If you are the one coughing, do your best not to handle anything that others will have to touch. QUESTION: What is cough etiquette? ANSWER: Cough etiquette is covering the mouth and nose with a tissue or mask to prevent droplets from being sprayed into the air. It is also important to wash your hands after disposing of the tissue. The other aspect of cough etiquette is to isolate yourself from others if you have a persistent, productive cough. Don't expose them unnecessarily to your affliction. QUESTION: What if, despite my best efforts, I contract the flu? ANSWER: Stay home, unless you are going out to seek medical care. Add ¼ cup of hydrogen peroxide to distilled water in a cool mist vaporizer running in the room when you sleep. Gargle with half peroxide, half distilled water several times a day. Do NOT swallow any of it, or you will have a stomach ache. Consume plenty of fluids, including juices. Increased amounts of vitamin C might help. Chicken soup has been shown to be therapeutic. Decongestants, mucolytics, and cough suppressants may help. QUESTION: What about anti-virals? ANSWER: These can be obtained from your family physician if your symptoms are severe enough, particularly when an epidemic of influenza has been reported. The physician will use anti-virals as needed and offer various IV therapies to help support the individual's immune response. QUESTION: Where can I get additional information? ANSWER: The Sedgwick County Health Department has resource information available.

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Health & Medicine

Dr Weaver

2006-12-01 09:28:00

I have a red spot on my foot and it is starting to bleed, what can it be?

ANSWER: An ulceration or ulcer is usually a painless sore on the bottom of the foot or top of toes which results from excessive pressure at that site. Trauma in the form of heat, cold, shoe pressure, or penetration by a sharp object must all be suspected as potential causes. The trauma or injury that causes most of the problems for diabetics' feet doesn't happen all at once, like the injuries that we are most familiar with. Instead, they happen from repeated small injuries, happening over long periods of time; what doctors call "repetitive microinjuries". Ulcers frequently may form under a pre-existing corn or callus which was permitted to build up too thickly. Neuropathy allows these lesions to develop because the normal warning sense of pain has been lost and they go unrecognized. This would be called a Neuropathic ulcer. Continued pressure or walking on the injured skin creates even further damage and the ulcer will worsen. The open sore will frequently become infected and may even penetrate to bone. Poor circulation can also be a predisposing factor for ulcerations, since the skin is often unable to heal minor cuts or blisters. Instead of healing normally, these minor irritations can also worsen into full thickness ulcers in the skin. Treatment relies heavily on early recognition of the ulceration, avoidance of weight bearing (walking), and early intervention by your foot doctor. Debridement, or trimming away callus and dead tissue, is an essential part of ulcer treatment. In fact, frequent debridement has been shown to lead to higher rates of healing than when such frequent care was not given. Newer agents such as topical growth factors or tissue replacements have become available, which can also speed the rate of wound healing when blood supply and good wound care is practiced. Aside from local wound care, dressings, and antibiotics, a variety of other measures may be necessary to adequately relieve pressure from the area. When crutches, wheelchair, or bedrest are not feasible, plaster casts, braces, healing sandals, special shoe inserts or padding may be used to protect the foot while it heals. If circulation is inadequate to allow healing, your podiatrist may recommend that you consult a vascular surgeon for appropriate evaluation and possible vascular reconstructive surgery. Once your wound is healed, it is extremely important to see your foot doctor regularly for check ups and foot care. Special footwear and inserts will be recommended to protect your feet and prevent new or recurrent lesions from deve

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Health & Medicine

Dr Weaver

2006-11-01 16:01:00

I have a large bump on the inside of my foot that seems to be getting larger, what is it, and can it be removed?

ANSWER: A bunion is a bony prominence, along the inside of the foot, at the base of the big toes. This “bump” represents a misalignment of the big toe joint. Bunions commonly occur on both feet, but one foot may be more severe than the other. They tend to be hereditary but can occur without a family history. They are not caused by poor shoe gear, but are often aggravated by the shoe. This deformity is cause by abnormal foot function. A foot that rolls in excessively (pronates excessively) allows abnormal stress to go through the big toe joint to cause the deformity. This is a progressive deformity. The deformity never gets better, only worse. Conservative care consists of decreasing the pressure on the bony prominence by a wider or softer shoe or padding around the deformity. Sometimes good arch support of an orthotic will improve foot function enough to decrease the irritation of the deformity and slow down its progression. If conservative care is not successful, then surgical straightening is the treatment choice. Surgical treatment revolves around realigning the structural deformity. The bony prominence is removed and the joint is realigned. The type of procedure and the length of recovery are determined by the severity of the deformity. In order for your surgeon to establish a diagnosis and determine the severity of the deformity, a health history, physical examination, and x-rays are necessary to evaluate the extent of your bunion deformity. Depending on your individual needs as well as your overall medical condition, your surgeon will recommend the best treatment regimen for you.

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Health & Medicine

Dr Galichia

2006-11-01 08:56:00

I am a college freshman who eats all my meals in the dining hall. I love all the choices, but what can I do when there are so many great foods to try and I don’t want to gain weight? How do I know if my calorie intake is appropriate for my level of exercise as I walk the entire campus but don’t have time for special workouts?

ANSWER: Certainly, it is a well known fact that when students enter college, they tend to gain weight in their freshman year. Not only are they eating “dorm food” which often has a high carbohydrate content, they often start drinking beer and staying up later than usual. Indeed, there are a lot of adjustments to make in the first year of college and they can be very challenging. Furthermore, in many dorm situations, there’s free access to whatever food is on the table and there is a tendency to prolong meals and socialize and perhaps eat more than usual. I’m also concerned that exercise routines often get destroyed by college activities. When one has to decide between studying for a test or doing a one hour workout, studying for the test often prevails. There are many deadlines to meet so the priorities often shift away from taking care of one’s physical being. I recommend to college students that they simply are aware of these potential problems and that they keep track of their weight on a weekly basis. If you gain five pounds then certainly it is time to back off somewhere and make changes. The “freshman fifteen” is a real phenomenon for many people and that weight is hard to get rid of later. Often parents will even say they have a hard time recognizing their child during the semester break because they looked to have gained a lot of weight in a short period of time! That may be an exaggeration but still is something that all parents are concerned about. I also recommend that students be very cautious of consuming alcohol at all. The drinking age in most states is 21 and somehow students tend to learn how to drink beer and other beverages all of which tends to add to the problem. Avoiding alcohol completely, doing daily workouts and eating a healthy diet, including one multi-vitamin a day, will not only provide a healthier body but will usually enable one to do better in the classroom

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Health & Medicine

Dr George Watson

2006-11-01 08:56:00

QUESTION: What is the overall opinion of AAPS regarding single payer? ANSWER: As I have mentioned in previous discussions, it would be a disaster. There is NO WAY that bureaucrats can take YOUR money, then dole it out through insurance companies, and you get the full value of YOUR DOLLARS. QUESTION: So, why do people keep demanding universal health care? ANSWER: They simply have not stopped long enough to THINK about the answer to the previous question. It would make as much sense to pay higher premiums to your auto insurance company, and then expect them to pay for your oil change. What would the oil change cost? At least THREE times as much. QUESTION: What do your MEDICARE patients say about this? ANSWER: It may surprise a lot of people, especially doctors, to know that I see a LOT of Medicare patients. They pay cash at the time of service, can NOT be reimbursed by Medicare, and yet, they come back when they have a problem, because they appreciate being charged a FAIR price, which THEY determine by the amount of time that THEY NEED. I don’t waste valuable time with CPT codes (if the AMA didn’t sell new versions of the CPT codes, they would have to raise the dues of all their members). I spend ten, fifteen, or even thirty minutes with them, depending on their need. One gentleman, in his seventies, asked, “What do you think would happen if Medicare collapsed?” I told him I had an idea, but what did he think. He responded, “All the costs of medical care would go down!!” And he is CORRECT! QUESTION: What about the proposed cuts in Medicare payments to physicians? ANSWER: If we could all remember that the purpose of Congress is “to provide the common defense”, nothing more, nothing less, we would stop looking to government to solve our problems. IF more doctors would OPT OUT of Medicare, and every other insurance company, the FIRST thing they would notice is how much more they enjoy the practice of medicine. If our legislators would stop trying to make everybody dependent on them, and would make it unlawful for insurance companies to require hospitals and doctors to charge the UNINSURED the same high prices that they charge the insurance companies (who then enforce contracted discounts), we wo

ANSWER: There is an excellent position paper, “White Paper on Medical Financing” by Andrew Schlafly, Esq., and Jane Orient, M.D. The entire paper can be read at www.aapsonline.org I will try to summarize some of the main points with feedback I have had from some of my patients. QUESTION: What is the overall opinion of AAPS regarding single payer? ANSWER: As I have mentioned in previous discussions, it would be a disaster. There is NO WAY that bureaucrats can take YOUR money, then dole it out through insurance companies, and you get the full value of YOUR DOLLARS. QUESTION: So, why do people keep demanding universal health care? ANSWER: They simply have not stopped long enough to THINK about the answer to the previous question. It would make as much sense to pay higher premiums to your auto insurance company, and then expect them to pay for your oil change. What would the oil change cost? At least THREE times as much. QUESTION: What do your MEDICARE patients say about this? ANSWER: It may surprise a lot of people, especially doctors, to know that I see a LOT of Medicare patients. They pay cash at the time of service, can NOT be reimbursed by Medicare, and yet, they come back when they have a problem, because they appreciate being charged a FAIR price, which THEY determine by the amount of time that THEY NEED. I don’t waste valuable time with CPT codes (if the AMA didn’t sell new versions of the CPT codes, they would have to raise the dues of all their members). I spend ten, fifteen, or even thirty minutes with them, depending on their need. One gentleman, in his seventies, asked, “What do you think would happen if Medicare collapsed?” I told him I had an idea, but what did he think. He responded, “All the costs of medical care would go down!!” And he is CORRECT! QUESTION: What about the proposed cuts in Medicare payments to physicians? ANSWER: If we could all remember that the purpose of Congress is “to provide the common defense”, nothing more, nothing less, we would stop looking to government to solve our problems. IF more doctors would OPT OUT of Medicare, and every other insurance company, the FIRST thing they would notice is how much more they enjoy the practice of medicine. If our legislators would stop trying to make everybody dependent on them, and would make it unlawful for insurance companies to require hospitals and doctors to charge the UNINSURED the same high prices that they charge the insurance companies (who then enforce contracted discounts), we would level the playing field. QUESTION: So what is your best advice? ANSWER: Go to the www.aapsonline.org website, read the entire White Paper on Medical Financing, and become a part of the solution.

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Health & Medicine

Sue Heersche

2006-10-01 10:54:00

QUESTION: How can we help care for a caregiver?

ANSWER: There are no two caregivers or care giving situations alike. Caregivers come in all shapes, sizes and categories. He or she may be a neighbor next door, a family member or even a professional you have hired. Sometimes, the role of “caregiver” is a choice. Other times, the named caregiver is all a person has. If you are like me, you have raised your kids and feel proficient with the role of caregiver. Just remember, caregiving can look similar to raising a child, but also it can be quite different. You become the nurse, insurance expert, medications manager, gofer, transportation, and social worker, while still managing your own personal needs and family life. The burdens of our health care system have been placed upon the shoulders of caregivers on a daily basis. Keeping up with doctors appointments, medication changes, and dealing with our loved one ’s self care needs is a small sample of these complexities. If caregivers went on strike today, someone would have to find almost 200 billion dollars each year to replace the work caregivers do for no salary and often with little support. According to the latest statistics, there are almost 54 million caregivers in the country today. Who are they? They are you and me. With the growing Baby Boomer population, we will all be exposed to the caregiver role at some level. Caregivers have to acknowledge when their loved one needs increased help. Putting resources in place earlier than later can create a better balance in the caring role. Primary caregivers also need to ask for help from friends, family, or whomever. It is so important that caregivers take care of themselves. You may be able to do a lot, but you may not be able to do it all. Just remember that a sick, injured, or emotionally worn out caregiver is not good for you or the one you are caring for. Here are a few recommendations to help caregivers nurture themselves:. 1. Take one hour each day just to read, enjoy a hot bath, journal your thoughts, or call a friend. 2. Go to a support group meeting, senior fair, or caregiver event. 3. Get away for a while. Make sure your loved one is in trusted hands and step out of the house for a few hours. 4. Go to a museum, shop for yourself, get a manicure, or just sit in the back yard and enjoy the silence. 5. Make a date with a family member or friend. 6. Smile! It’s funny how often we forget to do this simple act and how it lifts our spirits. There are many good community resources for caregivers from private duty care to agencies like Faith Home Health and Hospice, the Alzheimer’s Association, the Department on Aging and many others. These are examples of agencies that can provide various levels of assistance. If you are a family hero, or caregiver, caring for someone you love can be one of the greatest rewards. Keep up the good work!

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Health & Medicine

Dr George Watson

2006-10-01 10:27:00

QUESTION: What is their position on electronic medical records and patient privacy? ANSWER: AAPS sees electronic medical records, with interconnectivity, as a HUGE threat to patient privacy. One only needs look at the recent temporary loss of a VA computer, leaving millions of veterans records at risk of intrusion. ANY PATIENT that thinks their medical records are safe from multiple levels of government snooping is living in a dream world. QUESTION: What is AAPS’ position on national health insurance? ANSWER: Just look at Canada. Why do so many Canadians slip across the border into the U.S. to get surgical procedures THIS WEEK, rather than stay on a SIX MONTH waiting list in Canada? Here is how it works. A surgeon can do, say, ten of a particular type of surgery in a month. When he has done ten, he won’t be paid any more until the next pay period, so he might as well, and usually does, take off until the next pay period, when he can do another ten cases of that type. QUESTION: What was one of the most interesting talks? ANSWER: Dr Cyril Wecht, M.D., J.D., forensic pathologist shared his experiences reviewing, and in some cases, repeating the autopsies, in cases such as JFK, Robert Kennedy, and more recently, O.J.’s trial, Ron Brown and Vince Foster of the Clinton administration, Lacy Peterson, and Jon Bennet. QUESTION: You mentioned price transparency. What do you mean, and how can I find out prices? ANSWER: Try calling any doctor who participates with insurance companies and Medicare. Ask them, “What do you charge, and what does Medicare pay for that service that you provide?” It is rare that you will get more than their standard fee from them. They will not tell you how much Medicare or other insurance plans discount their charge. And the UNINSURED get charged the full price, even though insurance companies get a discount. This is discrimination of the worst kind. We have previously given an example of the hospit

ANSWER: AAPS has been the voice for private physicians since 1943. They were among the first to see the pitfalls of the Medicare Program when it was signed into law by Lyndon Johnson in July, 1965. Today, they are at the forefront of calling for price transparency in hospitals, insurance plans, and doctors’ private offices. They are advocates for free-market medicine. QUESTION: What is their position on electronic medical records and patient privacy? ANSWER: AAPS sees electronic medical records, with interconnectivity, as a HUGE threat to patient privacy. One only needs look at the recent temporary loss of a VA computer, leaving millions of veterans records at risk of intrusion. ANY PATIENT that thinks their medical records are safe from multiple levels of government snooping is living in a dream world. QUESTION: What is AAPS’ position on national health insurance? ANSWER: Just look at Canada. Why do so many Canadians slip across the border into the U.S. to get surgical procedures THIS WEEK, rather than stay on a SIX MONTH waiting list in Canada? Here is how it works. A surgeon can do, say, ten of a particular type of surgery in a month. When he has done ten, he won’t be paid any more until the next pay period, so he might as well, and usually does, take off until the next pay period, when he can do another ten cases of that type. QUESTION: What was one of the most interesting talks? ANSWER: Dr Cyril Wecht, M.D., J.D., forensic pathologist shared his experiences reviewing, and in some cases, repeating the autopsies, in cases such as JFK, Robert Kennedy, and more recently, O.J.’s trial, Ron Brown and Vince Foster of the Clinton administration, Lacy Peterson, and Jon Bennet. QUESTION: You mentioned price transparency. What do you mean, and how can I find out prices? ANSWER: Try calling any doctor who participates with insurance companies and Medicare. Ask them, “What do you charge, and what does Medicare pay for that service that you provide?” It is rare that you will get more than their standard fee from them. They will not tell you how much Medicare or other insurance plans discount their charge. And the UNINSURED get charged the full price, even though insurance companies get a discount. This is discrimination of the worst kind. We have previously given an example of the hospital charging the insurance company $6,000 for CT scans that were done FOR CASH for $1,100. QUESTION: Where can I get more information for myself, and my personal physician about this organization? ANSWER: You can go to www.aapsonline.org or you can call Dr George Watson at 744-3400.

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Health & Medicine

Dr Galichia

2006-09-01 16:04:00

QUESTION: I’ve been told that if I think I am having a heart attack, I should go to the emergency room immediately. My understanding is that they can do something to abort the heart attack and make me better. What is it that can be done?

ANSWER: We have a saying in cardiology that “time is muscle”. By that, we mean that the sooner we are able to intervene and open up a blocked artery causing a heart attack, the less damage will be done to the heart. In fact, it has been shown in some studies that if we can re-establish blood flow within the first 30 minutes that there is virtually no heart damage in most patients. This certainly has been my own personal experience. There are many logistical reasons however why patients will delay getting to the emergency room. Most of the time, they are simply trying to figure out what is going on themselves and delay calling 911. There are many people in this country who live far away from tertiary care centers where emergency treatment for heart attack is not available. We know from today’s studies that if we have a chance to open the artery within 4-6 hours that we can minimize heart damage and that we also have less likelihood of heart failure in the future. It has also been found that every moment that ticks off the clock following the onset of the heart attack there is more heart damage and more likelihood that the patient will simply die of a heart arrhythmia or pump failure. Getting to the hospital immediately is critical and opening up the artery is critical. Addressing your question regarding what can be done, there are several approaches. There are certainly medical treatments such as clot-busting drugs which we can give intravenously and they tend to dissolve clots in arteries and restore blood flow at least momentarily. This is a strategy we often employ in people from rural areas knowing that it may take several hours for them to get to a heart catheterization laboratory where a balloon or a stent procedure could be done. More and more however, we are inclined to take the patient immediately to the heart catheterization laboratory, give a blood thinner, and immediately open up the artery and address the area of narrowing with a balloon with a stent procedure. In this week’s New England Journal of Medicine there’s a great study comparing bare metal stents to stents that have medication on them, otherwise known as medicated stents. It has been shown that in heart attack patients fewer of them have to return for recurrence if we use a medicated stent, however, it has also been shown that the immediate survival is excellent in this group of patients and that the long-term survival is quite good no matter which type of stent we use. Currently, we are using medicated stents in virtually every patient with a heart attack. The key in this entire situation is to get emergency medical care as soon as possible, to get to the hospital as soon as possible and to get the blood flow restored in the blocked artery as soon as possible to limit the heart attack size. In our community, this almost always means a direct admission to the heart catheterization laboratory with an immediate intervention to open up the blocked artery. We first started doing balloon dilatation of these vessels in the early 1980’s and were able to document a tremendous decrease in the risk of dying from a heart attack while in the hospital. Advances have been enormous since then and we are overall quite pleased with our current results. My own personal goal is to have the patient in the catheterization laboratory within ½ hour to one hour following the onset of the heart attack and to have a happy, comfortable and minimally injured patient shortly thereafter.

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Health & Medicine

Dr George Watson

2006-09-01 15:33:00

QUESTION: You have previously written about prolo-therapy.  What are some examples of patients who have had prolo-therapy?

ANSWER: The first case is a gentleman who had left shoulder joint and rotator cuff pain.  He wanted to avoid surgery, if possible.
He has had five injections at 4 week intervals, and has significant improvement in his range of motion and a marked decrease in pain.
Another case is a gentleman who had previously not responded to physical therapy for a right frozen shoulder due to significant degenerative disease.  After his first injection, the physical therapist was able to accomplish so much more in recovery of range of motion.  And it was all the more amazing since he is nearing 80 years of age.
Another case was a badly sprained ankle that was not healing satisfactorily, with continued swelling and instability.  The patient received prolo-therapy injections over the damaged ligaments, promoting healing of the ligaments and improved stability.
A lady 92 years old came in with severe degenerative change in her right shoulder, and terrible grinding in both knees, the right worse than the left.  I injected her right shoulder, and I asked her to move it around through a normal range of motion, while I injected her right knee, then the left knee.  She had been told, “you have bone on bone, and the only thing that can help is knee replacements”, but her daughters did not think she could tolerate the surgery.  After the second knee was injected, she stood up on her own, grabbed her walker, and walked with less pain, while using the right shoulder through greater range of motion.  She will have injections every four weeks, for four to ten months, depending on her progress.  Her seventy year old daughter was so impressed, she made an appointment and had her knees injected with prolo-therapy.
QUESTION: Tell me again, what is the principle of prolo-therapy?
ANSWER: The principle is to cause a brief inflammation to which the body responds, resulting in activation of the chondroblasts, cells that repair the articular surfaces in the joints, and fibroblasts, that repair ligaments.  In the world of professional sports, this is used as part of an aggressive program to speed the healing process, and to make for stronger ligaments.   Prolo-therapy takes the inflammatory approach, whereas steroid injections take the anti-inflammatory approach.  Both have their place in the treatment of acute and chronic injuries.  Many of our patients prefer to avoid steroids, if possible.

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Health & Medicine

Dr Galichia

2006-09-01 15:33:00

QUESTION: When should one go to the emergency room?

ANSWER: There’s definitely no clear cut answer about when one should go to the emergency room, try to find his family doctor or perhaps seek care in a  walk-in clinic.  There are some times that I feel are imperative that one call 911 without hesitation.  Definitely if a person has chest pain and the pain lingers more than a few minutes, particularly if there is any associated weakness or sweating there should be no attempt to call one’s doctor or to drive to the hospital but simply to call 911 to come and pick you up and take you to the hospital.  A heart attack is something that is a common event and time is very precious in the early moments of a heart attack.  People often die before they get to the hospital or while they are trying to make a decision about whether or not to call 911.  Other patients who should seek immediate help are those who have had some signs of a TIA or mini-stroke.  That is the loss of neurologic function, particularly sudden weakness, inability to comprehend or speak properly, loss of vision or inability to understand what is going on around them.  These episodes cannot be treated lightly and must have immediate medical attention.  In this case the decision should be made very early to simply call 911 and not attempt to take yourself or have someone take you to the emergency room.  Severe abdominal pain, loss of consciousness, any kind of severe bleeding event should be dealt with by calling 911.Entirely different situations occur, however, when it is not a clear-cut emergency.  Even as a physician I have often struggled about what to do in the middle of the night with a child who is crying, has a fever and seems to have an earache.  In this instance, I always tell patients it is better to check it out than to try to deal with these some of these problems on your own.  Certainly, it is also often difficult to get in touch with your physician and discuss the matter over the phone.   Children with febrile illnesses, accidents, sprains, suspected fractures, falls and countless other things fall in this category.  Patients often feel guilty or embarrassed if they go to the emergency room and then find they really don’t have a broken bone or they really aren’t having a heart attack or they really didn’t have a stroke.  I tell them always to celebrate the fact that nothing terrible happened and to not feel guilty or embarrassed because it is always better to be seen and understand the basis of the problem than to take chances with either yourself or one of your loved ones.  There are countless other ways that one can get in a situation where you feel insecure and feel that you need immediate medical care.  When it is possible to go to a walk-in clinic or see your family doctor to get counsel urgently, that is certainly something that one should consider immediately.   Physician’s offices however, are very busy during the day and working patients in may be difficult.  Often times, these patients go to emergency rooms to be seen.  This situation happens around the country on a daily basis. Unfortunately, these are often characterized by long waits as more severe patients keep coming in the door.  This remains one of our largest challenges in healthcare in the US today and will continue to be a challenge.  In the meantime, I simply tell everybody, that “When in doubt, check it out”.

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Health & Medicine

Charlotte Buchanan

2006-09-01 15:03:00

: Why is water so important?ANSWER: It helps control body temperature.It promotes good digestion and intestinal function. It carries nutrients to and oxygen to cells and removes waste. It cushions joints and protects organs and tissues. It provides a moist environment for ear, nose and throat tissues.It keeps the urinary tract flushed out, which may help reduce the risk of urinary tract infections. You cannot live more than a week or so without water!QUESTION: What are the signs of dehydration?ANSWER: Thirst – however, our ability to sense thirst declines as we age. Others are: fatigue, dizziness, lightheadedness, infrequent urination, dark colored urine, lack of skin elasticity, dry mouth, headache, increased body temperature and pulse.Check how hydrated you are by taking the pinch test. Grasp the skin on the back of your hand between two fingers.  Hold for a     few seconds and release.  If you are moderately or severely dehydrated, it will take a minute or two for the skin to return to normal.MILD DEHYDRATION MAY BE RESOLVED BY REPLACING FLUIDS QUICKLY.  DEHYDRATION SHOULD BE TAKEN SERIOUSLY AND IF SYMPTOMS DO NOT IMPROVE, YOU SHOULD SEEK MEDICAL ATTENTION.QUESTION: How much water do you need?ANSWER: Make sure your intake of fluids is 48-64 ounces per day.  That’s a minimum of six 8-ounce glasses per day.  Water is the best fluid choice, because it is absorbed faster than any other beverage. Other fluid choices include:  milk, soup, fruit juice, and decaffeinated or non alcoholic drinks.  Note: cool beverages are absorbed better than room temperature or warm beverages.Please consult your physician if you have a special medical condition that requires fluid restriction such as renal failure, congestive heart failu

ANSWER:Water is one of the body’s most essential nutrients. On average, our bodies are made up of 50-75% water (about 10-12 gallons). The specific percentage of water varies from person to person since it is affected by body composition, age, and gender. Because the proportion of water in each of our bodies is different, it makes sense that water needs also vary from person to person. In general, most people need 8-10 cups of water per day.QUESTION: Why is water so important?ANSWER: It helps control body temperature.It promotes good digestion and intestinal function. It carries nutrients to and oxygen to cells and removes waste. It cushions joints and protects organs and tissues. It provides a moist environment for ear, nose and throat tissues.It keeps the urinary tract flushed out, which may help reduce the risk of urinary tract infections. You cannot live more than a week or so without water!QUESTION: What are the signs of dehydration?ANSWER: Thirst – however, our ability to sense thirst declines as we age. Others are: fatigue, dizziness, lightheadedness, infrequent urination, dark colored urine, lack of skin elasticity, dry mouth, headache, increased body temperature and pulse.Check how hydrated you are by taking the pinch test. Grasp the skin on the back of your hand between two fingers.  Hold for a     few seconds and release.  If you are moderately or severely dehydrated, it will take a minute or two for the skin to return to normal.MILD DEHYDRATION MAY BE RESOLVED BY REPLACING FLUIDS QUICKLY.  DEHYDRATION SHOULD BE TAKEN SERIOUSLY AND IF SYMPTOMS DO NOT IMPROVE, YOU SHOULD SEEK MEDICAL ATTENTION.QUESTION: How much water do you need?ANSWER: Make sure your intake of fluids is 48-64 ounces per day.  That’s a minimum of six 8-ounce glasses per day.  Water is the best fluid choice, because it is absorbed faster than any other beverage. Other fluid choices include:  milk, soup, fruit juice, and decaffeinated or non alcoholic drinks.  Note: cool beverages are absorbed better than room temperature or warm beverages.Please consult your physician if you have a special medical condition that requires fluid restriction such as renal failure, congestive heart failure or liver failure.QUESTION: When do you need more fluid?ANSWER: When you have an illness involving fever, diarrhea, nausea and/or vomiting: In very hot weather, during strenuous work or exercise.Maintaining adequate fluids is crucial for those over age 60, because dehydration is one of the most frequent causes of hospitalization for older Americans. So remember to drink, drink, drink (before you are thirsty) and stay well hydrated! 

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Health & Medicine

Deb Wetta

2006-08-01 16:46:00

QUESTION: My husband has just been diagnosed with Parkinson’s disease. What can I expect in the days to come?

ANSWER: Parkinson’s disease is a disorder stemming from massive degeneration of neurons in the brain in the area associated with movement and balance. It is a slowly progressive disease that manifests itself differently from person to person but most generally presents gradually worsening problems over time. Some of the symptoms you may see in the early stages of the disease include: a slow and rhythmic tremor in the hands or other appendages when the person is at rest; a tightness or stiffening of the muscles; a gradual slowing of movement or difficulty in rising, a symptom called “bradykinesia”; and postural instability, which presents as poor balance or lack of coordination. Later symptoms of the disease may also include involuntary movements, changes in sleep patterns, problems with speech or swallowing, and incontinence. While there is currently no cure for the disease, there are a number of treatments producing positive results. In addition to prescription and over-the-counter drugs as well as herbal remedies, physical, occupational and speech-language therapies are helping people with Parkinson’s cope with the uncertainties that accompany the disease. For example, some Parkinson’s patients whose steps have become increasingly shorter and ultimately slowed to a shuffle have shown marked improvement through physical therapy that emphasizes gait training. Others, who have experienced difficulty with speaking because of rigidity in the voice muscles, have found help through the Lee Silverman program, which teaches the person to understand the volume at which they must speak in order to be heard. Meanwhile, those with swallowing issues have found positive benefits from speech-language therapy using VitalStim electrical stimulation to strengthen the muscles used for swallowing. In addition to your family physician, your husband would likely benefit from a visit to a neurologist, especially one trained in movement disorders. You may also want to join the local support group. Through this network of like-minded individuals you will find the common ground both you will need as you face the challenges that lie ahead months.

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Health & Medicine

Francie Ekengren MD

2006-08-01 11:58:00

QUESTION: What is a PCP and why is having one important?

PCP stands for a Primary Care Physician. PCPs are family or general medical practitioners, internists, or pediatricians. It is important to have a PCP because they know your history and can direct your overall care. Family doctors specialize in health and not disease.  Their goal is to help patients have healthy lifestyles and correct minor problems that have the potential to worsen.
   Primary Care Physicians make a living by helping people shop for good medical care. If a specialist is needed, a PCP will know who to contact to better serve the patient. Here are some recommendations for looking for a good PCP:
      ·  Look for a PCP when you’re healthy.
   ·  Make a list of candidates by asking friends,
      family, and coworkers.
   ·  Check credentials of candidates you are  inter
      ested in by going to American Board of Family
      Medicine website: http://www.theabfm.org/.
   ·  Know what doctors accept your health insur-
      ance
   ·  Know what qualities your family needs most in
      a family doctor.
   ·  Contact the doctor’s office to make an
      appointment to meet with the doctor and ask
      questions.
   If a person is unsure if a situation is an emergency the best resource is to contact his or her PCP.  Most have after-hours coverage by phone. You may speak to them or another physician or nurse to ask questions so they can determine if you need immediate care or if it can wait until regular business hours. However, if you are unsure if the situation is serious or if it could become life threatening, you should go to an emergency room. Your family doctor can be contacted from the emergency room and provide the ER doctor with your medical history and help determine what should happen next. When in doubt the emergency room is always there for your healthcare needs.

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Health & Medicine

Dr George Watson

2006-08-01 09:43:00

QUESTION:  There is so much talk about the need for National Health Insurance.  What are your thoughts on this?

ANSWER: The short answer—it would be a disaster!  STOP and THINK!  Would it be more affordable to deal directly with the doctor and the hospital OR send your money to Washington, and let THEM DECIDE what is best FOR YOU?  Are people so gullible that they would believe the likes of Kennedy, Kerry, and Clinton, who have never had a job outside of politics?  Believe the masters of deception, who have a DIFFERENT health plan than the one they want YOU to have?  Again, the short answer is, they would provide “healthcare for everyone (including the 43 million uninsured Americans they whine incessantly about)” by setting a FIXED AMOUNT to be divided up to provide the medical care for each person.  When the fund runs out of money, regardless of whether it is June 30th or September 30th, nothing else will be paid for—unless we come groveling to them to beg them to take more of our money to divide it up in their SOCIALIST WELFARE SCHEME.
QUESTION: Can you be specific how a single payer system would cost MORE of OUR MONEY?
ANSWER: Thank you for asking.  Here is a LOCAL example of how middlemen (insurance companies and government bureaucracies) drive up the cost of health care:  A man came in to get a referral for a CT scan.  He had survived two previous cancers, and had to have a yearly CT of chest, abdomen and pelvis for surveillance, to detect any recurrence.  One year ago, he had a major health plan which DICTATED that he get his scan at a certain hospital in Wichita.  The hospital charged $6,000!  The insurance company paid $3600, leaving the patient to pay 20% of $6,000 (not the $3600) for out of pocket cost of $1200.  Sounds like insurance really helped.  This year, with NO INSURANCE, he was worried what it would cost.  I called a facility, told them I had a CASH patient, and scheduled him for a TOTAL COST of $1100!!  So, exactly what did the insurance company contribute to this man’s health care?  NOTHING!  The $3600 could have gone into HIS PAYCHECK instead of being paid by the employer to the insurance company.  Would you rather pay $1200 (with insurance) or $1100?

ANSWER: IF our elected politicians would rescind the exemptions that permit insurance companies to PENALIZE their subscribers for being good consumers, more patients would obtain affordable, quality services by paying cash, such as the patient above.  If that insurance company was smart they would pay the patient the full $1100 for the CT scans when he was insured by them.  BUT, they are greedy and want CONTROL, so they would rather pay the $3600 and raise the employer’s premiums the next year, perhaps why the patient no longer had insurance.  DOCTORS could stop playing the insurance game.  In our clinic, we charge FAIR prices to everyone, INSURED and UNINSURED.  The patients like getting to spend more DIRECT time with the doctor (and their annual deductible buys so much more care) and are willing to pay at the time of service.  DOCTORS could donate time each week in cooperation with such LOCAL health ministries as World Impact, who positions their Mobile Medical Clinic at specific locations in Wichita each week to serve part of the “43 million uninsured Americans”.  And let’s be clear.  Lack of insurance does not mean medical care is unavailable.  And lack of insurance does not mean the person is poor.  It means the individual must be responsible to get AFFORDABLE care, just like they choose affordable food, shelter, and cars.
If HOSPITALS would ban together to fight the rules that allow Medicare and insurance companies to pay DISCOUNTED rates, while UNINSURED are charged the maximum rate, health care would be more affordable.
QUESTION:  So, what exactly do you do to be sure that ALL AMERICANS have access to quality health care?
ANSWER:  As I said before, we charge fair prices to everyone who comes to our clinics.  I don’t have to employ insurance clerks, so we don’t have to add $40 insurance billing overhead to each visit.  I spend as much time with each patient as they choose to purchase—they determine what their visit will cost.  Every Tuesday, after a full day in the office, I DONATE my services to patients who present to the World Impact Mobile Clinic from 6:30 to 9:30PM at the Tuesday location.  Jesus said, “The poor will always be among you.”  No government program can eliminate all poverty.  WE must do OUR part LOCALLY, and not put our trust and health in the hands of self-serving politicians.
QUESTION:  Finally, what would you recommend a patient do?
ANSWER:  Buy a high deductible, major medical policy to protect you from a health disaster that requires hospitalization.  That way, you OWN your own policy, regardless of where you work.  Then you won’t get caught “uninsured” or bitten by the outrageous COBRA premiums between jobs.  Then find a doctor who is interested in YOU, not your insurance plan.  To find a doctor like that, you can go to http://www.simplecare.com/   Learn to ASK THE DOCTOR, “Is this test really necessary?”  We all know that far too many tests are done, because “it’s covered by your insurance.

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Health & Medicine

Dr Galichia

2006-07-01 09:38:00

Question: What exactly is mitral valve prolapse? I’m 51 year old female, and my doctor said I had a degree of severity of one over six. What would be the significance of that and what could be done about it?

ANSWER: MVP is a common disorder and it is usually congenital in nature. Anywhere between 3 to 8 percent of female population and perhaps half as many males are born with this problem. In most people it will remain silent and cause no side effects their entire life. The mitral valve separates the left ventricle from the left atrium, and in these individuals is large and has redundant tissue. This may set the stage for leakage of the valve, usually slowly progressive over the life time. In many individuals there is no leakage whatsoever or it is very minor, and thus may be graded on a scale of 1 to 4 in severity. A score of 1 over 4 would be minor leakage of the valve on an echocardiogram. Your doctor may have heard a murmur which was very soft and often judged on a scale of 1 to 6. Again this would imply a soft murmur and small amount of leakage. In some individuals the leakage becomes very severe and requires valvular repair or replacement. This deterioration occurs in minority of patient and most common in older women. Of all the patients with mitral valve prolapse less than 5percent will ever need valvular surgery. This disorder tends to run in families, being more prevalent in taller, more slender women. It may also cause myriad other symptoms including palpitations, chest pain, fatigue, exercise incapacity, shortness of breath, and episodes of fainting. These symptoms usually occur in the absence of severe valvular leakage, remaining somewhat a medical mystery, unexplained on any defined physiologic basis. These valves can also be infected, particularly at the time of dental work or when one has skin infections. The use of prophylactic antibiotics may be necessary to prevent this serious problem. It is important to know whether one has mitral valve prolapse and to know the severity. An anatomic configuration on the echocardiogram and the degree of leakage will determine whether preventive antibiotics are necessary, and also provide insight into the potential need for valvular surgery. At age 51 with only minimal leakage it has been my experience that rapid deterioration is unlikely and that your prognosis is very good. Long term follow up with your doctor is important, the role of serial echocardiograms to be decided by your cardiologist

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Health & Medicine

Dr George Watson

2006-07-01 09:38:00

QUESTION: I heard that 38 percent of women compared with 25 percent of men will die within one year after a heart attack.  Why the difference?

ANSWER: There are several reasons for the large difference in mortality.  One of the biggest is perception of risk.  Although cardiovascular disease kills nearly twice as many women each year as cancer, most women are more focused on their annual Pap and mammogram than an annual cardiovascular risk assessment.  Physiology is another important factor.  According to the WISE study, the more diffuse plaques that form in the smaller coronary arteries of women may not be spotted by a coronary angiogram.Question: What are the major risk factors?ANSWER: Dyslipidemia (high cholesterol and triglycerides) is number one, followed by impaired glucose function (including diabetes), high blood pressure, and obesity.Question: What can a woman do to minimize her risks of heart disease?ANSWER: Prevention is the key.  This is accomplished by lowering cholesterol (including homocysteine and C reactive protein) levels, correcting glucose intolerance, lowering blood pressure to 110/70, reducing weight to normal for height, and by stopping smoking.   Regular aerobic exercise and one 81mg dose of aspirin a day add to the benefits.For an evaluation focused on YOU, and a prevention plan tailored to your needs, call 744-3400 today for your appointment.

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Health & Medicine

Dr Galichia

2006-06-01 09:41:00

Question: I’ve heard that once you are diagnosed with hypertension and start medication, you will be on these drugs forever.  Is that true?

ANSWER: Unfortunately, for most patients who are diagnosed with hypertension, there is no cure for this problem and management with medication will be necessary for the rest of their lives.  About 85 % of the patients that we see who are diagnosed with hypertension, have what we call essential hypertension.  This means there is no cause of the blood pressure, that it is simply an illness of its own.  Many of these individuals have a history of hypertension in the family and of course, obesity, smoking, a high fat diet and a sedentary lifestyle all contribute to this form of hypertension.  Other individuals have a cause of their hypertension and we do see this more frequently now as we are more aware of it and as our non-invasive means of diagnosing the problem have improved.  Many patients can have marked improvement in their blood pressure management if they have stenting or balloon dilatation of these arteries.  Most of the patients, however, will continue to be on some medications.  The more unusual causes of hypertension such as various tumors or narrowings in vessels of the aorta and endocrine problems may contribute as well.  Nevertheless, the vast majority of people do have no specific cause of their hypertension and must be managed on medications.There are a few patients, who by losing weight and increasing their exercise capacity, lowering their salt intake and fat intake may be able to come off of these medications.  This however represents a very small population of the patients that I see.  Hypertension affects 1 in every 3 adult Americans in the US today and is a growing problem.The best way to prevent hypertension is to keep your weight down and exercise at least 45 minutes a day, five days a week, restricting salt intake and attempting to manage the stressful aspects of your life, will also help in preventing this problem.

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Health & Medicine

Dr George Watson

2006-06-01 09:01:00

QUESTION: What are some examples of symptoms that your patients have relieved with bio-identical hormone replacement?ANSWER: We have many women who report that hot flashes, mood swings, and sleep disturbances are dramatically improved when their hormones are balanced naturally with bio-identical hormone replacement.  In men, bio-identical hormone replacement results in improved muscle/fat ratio, better control of blood sugars in diabetics, increased stamina, and better mental outlook.  In both men and women, it is much easier to attain ideal weight when the hormones are in the normal range.QUESTION: Where do people get information about bio-identical hormone replacement?ANSWER: Many of our patients have called after reading Suzanne Somers’ book, The Sexy Years: Discover The Hormone Connection.  Others have read the book, The Schwarzbein Princip

ANSWER: : Bio-identical hormone replacement refers to using natural, identical hormones to replace those that are deficient in our bodies.  For many years, physicians have used synthetic hormones to treat thyroid, estrogen, progesterone, and testosterone deficiencies.  There have been recent discoveries of some serious side effects to some of these, especially the female synthetic hormones.  The goal of bio-identical hormone replacement is to restore the levels to the normal range without the side effects of the synthetic hormones.  Bio-identical is just that.  It is identical to the hormones produced in the body.QUESTION: What are some examples of symptoms that your patients have relieved with bio-identical hormone replacement?ANSWER: We have many women who report that hot flashes, mood swings, and sleep disturbances are dramatically improved when their hormones are balanced naturally with bio-identical hormone replacement.  In men, bio-identical hormone replacement results in improved muscle/fat ratio, better control of blood sugars in diabetics, increased stamina, and better mental outlook.  In both men and women, it is much easier to attain ideal weight when the hormones are in the normal range.QUESTION: Where do people get information about bio-identical hormone replacement?ANSWER: Many of our patients have called after reading Suzanne Somers’ book, The Sexy Years: Discover The Hormone Connection.  Others have read the book, The Schwarzbein Principle II, by Diana Schwarzbein, M.D., who is mentioned in one chapter of Somers’ book.  Both books refer the readers to the www.acam.org website for referral to doctors who provide bio-identical hormone replacement.  Another website that has an abundance of information on all aspects of anti-aging, including bio-identical hormone replacement, is www.worldhealth.net   And, locally, people can call Dr George Watson’s office in Park City, at 316-744-3400.  He is a member of ACAM, and is a Diplomate of the American Board of Anti-Aging Medicine.

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Health & Medicine

Jim Vint

2006-05-01 17:10:00

:  My husband is having swallowing problems as a result of a stroke a few months ago. Is there any treatment available for him?

ANSWER:  Yes, having swallowing problems  can resulting from stroke, progressive neurological disorders and aging are a condition known as dysphagia. Symptoms of dysphagia can range from mild discomfort to a complete lack of ability during the swallowing function. While there are a number of therapies available to treat dysphagia, one of the most effective available on the market today is electrical stimulation of the swallowing muscles through a device known as “VitalStim.”  Cleared by the FDA, VitalStim applies mild electrical stimulation to the underside of the jaw and to the front of the throat through specially designed, carefully calibrated electrodes placed on the muscles that control the swallowing function. The current, which is powered by two AA batteries, works like tiny jumper cables to apply just the precise amount of amperes to the appropriate place on the throat. With the current flowing at a comfortable level of intensity, the person attempts to swallow a small volume of food or water. The electrical current flowing through the muscles’ fibers results in a stronger contraction of the muscles than would be the case without the external boost provided by the VitalStim device.In a clinical trial of nearly 900 patients, more than 98 percent showed marked improvement. Of those with severe dysphagia, over 97 percent regained a level of ability to swallow and no longer needed a feeding tube. Nearly 40 percent of the same group regained the ability to swallow normally.  A physician must prescribe a speech-language evaluation for treatment of dysphagia and your speech-language pathologist will determine if VitalStim is the proper therapy to be used.

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Health & Medicine

Dr George Watson

2006-05-01 17:10:00

QUESTION: You are a diplomat of the American Board of Anti-Aging Medicine.  What do you do personally to maintain your health and vitality?

ANSWER: Let’s go back to the day that my own cholesterol went over 200.  I was a flight surgeon in an F-16 fighter unit.  My shield of invincibility was punctured.  So I started then to look for the best options to maintain my health.Step 1 is exactly what the National Cholesterol Education Guidelines call for — A Total Lifestyle Change.  That means better dietary choices, cutting out all the fried foods and sugar-laden soft drinks.  I started a regular exercise program that includes free weights three days a week and aerobics three days a week.To specifically lower the cholesterol, I use a soluble fiber blend that sequesters the bile acids with viscous fiber, inhibits dietary cholesterol absorption with plant sterols, inhibits synthesis of cholesterol in the liver with a natural ingredient, and promotes the conversion of cholesterol to important metabolites.Step 2 is to detoxify my body from all the environmental pollution to which we are exposed.  I use Doctor’s Choice Oral Chelation Formula, and take IV chelation treatments monthly to remove toxic metals such as lead, mercury, and cadmium.Step 3 is a good vitamin, mineral, amino acid, and anti-oxidant formula to provide what is missing from our food sources.Question: Isn’t that a lot of capsules and supplements?ANSWER: I always ask my patients, “Would you rather take illness medicine or wellness medicine?”  I always get a grin, because the answer is so obvious.

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Health & Medicine

Tracy MooneySimon

2006-05-01 16:01:00

Question: I’m overweight. Should I consider having surgery to get rid of my excess fat?

ANSWER: As the number of severely overweight people increases in the United States, so does the number of people who have surgery to help lose weight. The rate of gastric bypass surgery, also called "bariatric" surgery, has grown tenfold in the past 10 years.The main reason for having this surgery is not cosmetic. Obesity can contribute to serious health problems including high blood pressure, heart and pulmonary disease, gallbladder and liver disease, diabetes, osteoarthritis, and sleep apnea. Studies show a sharp drop in these conditions after gastric bypass surgery.Gastric bypass surgery involves permanently stapling or sewing the stomach so that only a small portion, about the size of an egg, is able to hold food. Over the following months, weight loss occurs as the stomach quickly becomes full and appetite is reduced. Also, the body absorbs fewer calories and will not easily tolerate foods high in refined sugars and fats. On average, 60 percent of excess weight is lost within six months after surgery and 80 percent within one year.But gastric bypass surgery is not a magic bullet. Risks include bleeding, infection, stomach inflammation, vomiting, diarrhea, and nutritional deficiencies. Follow-up surgery to resolve complications or reduce excessive skin may be needed. Overeating may eventually stretch the stomach, and the weight is regained. And surgery can be expensive; health insurance sometimes covers the cost, but many patients pay $25,000 or more out of their own pocket.Who qualifies for weight-loss surgery?Generally, the surgery is only for people who meet all of the following criteria:• A body mass index (BMI) of 40 or a BMI of 35 along with one or two weight-related health problems. BMI is determined by comparing weight to height. For example, someone who is 5'8" tall and weighs 260 pounds has a BMI of 40.• Weight of 350 pounds or less. Individuals weighing more than 350 pounds are at a greater risk for complications.  Since this is a laparoscopic surgery, patients are closely evaluated for their weight and weight distribution.  Some weight loss before surgery may be needed.• A documented history of attempts to control weight through a supervised weight-loss program. • Complete medical and psychological evaluations. What happens after surgery?While recovering from the surgery, only low-calorie liquids, pureed foods, nutritional supplements and soft foods that are easily digested can be consumed. Eventually a more normal diet is possible, although in much smaller amounts. Gastric bypass surgery is not a cure; rather, it is a tool to use for a healthier lifestyle. Follow-up nutrition counseling, exercise programs and support groups are available to help make the transition and maintain lifestyle changes.

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Health & Medicine

Dr Joseph Galichia

2006-04-01 11:19:00

QUESTION: Are there any treatment options for a blocked artery?

ANSWER: There are many studies which have shown recently that a blocked artery can actually improve if a statin drug is used to lower cholesterol.  In a study published recently it has shown that in a group of about 500 patients when given a large dose of a statin drug, the lesions actually improved.  There was only modest improvement in the narrowing but definite improvement was noted over a long period of time.In this particular study the drug Crestor was given at 40 mg. This is a large dose of Crestor and it is about the most potent of the statin drugs that we have.  Crestor at this level resulted in LDL or bad cholesterol level of  60.8 in this study.  This is a very low level, given the fact that the average LDL is in the range of 120.  LDL is the ‘bad cholesterol’ in our blood and we have recently felt that getting the level well  below 100 ie in the range of 70 might indeed result in improvement in these blockages.  This study did demonstrate that Crestor at these levels is an extremely effective agent and lowers the LDL cholesterol beyond levels we thought possible only a few years ago.There was a statistically significant improvement in these individuals with very low LDL levels, but of course this was a small study and indeed a study that will only launch future efforts in this area.  My personal feeling is that with a combination of risk factor reduction, i.e., smoking cessation, weight loss, exercise, a low fat diet, achieving a normal body weight,  managing stress and blood pressure as well as possible, is necessary in this equation.  The ability that we now have to make such a large impact on the bad cholesterol is truly a major achievement in medicine and I believe is the cornerstone for lessening the amount of plaque buildup in the walls of arteries and now possibly reversing this plaque formation.There are other drugs including a combination drug known as Vytorin, older drugs such as Lipitor and Mevacor and Zocor which may approximate these changes in LDL cholesterol.  Certainly the drug Vytorin seems capable of getting the LDL to this level or perhaps even lower.  Niacin and fish oil may also help. Much research needs to done in this area, but for the moment it does seem that reversal of lesions with very aggressive cholesterol management is possible albeit, this process is slow and appears not to make a dramatic reversal.  For the moment, treating patients who have extremely narrow vessels and are symptomatic with medicated stents, bypass surgery and other standard procedures is still quite reasonable.  There are now better non-invasive imaging techniques which will enable scientists to study the progression or regression of plaques.

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Health & Medicine

Dr George Watson

2006-03-30 14:20:00

: Where can I get more information?ANSWER: An exhaustive amount of information can be obtained at www.cdc.gov/flu/avian. QUESTION: What can I do to prevent myself from getting Bird Flu? ANSWER: The following is practical information that you can use to protect yourself and your family.1.  Do not pick up diseased or dead wildlife.  Report it to the Kansas Fish and Game.2.  Wash your hands thoroughly with soap and water after cleaning wild game or domestic poultry.3.  Cleanse all counter surfaces with Clorox after preparing wild game or domestic poultry.4.  Cook all game and poultry thoroughly.5.  If you are traveling to areas where H5N1 virus outbreaks have occurred, review CDC Travelers’ Health.6. Take the regular flu shot to minimize the risk of having two different viral infections at once.7.  If you are ill with fever, respiratory symptoms, and conjunctivitis, practice Respiratory Hygiene and Cough Etiquette (see CDC site).  Basically, “Cover your mouth” when you cough or sneeze, and “Wash your hands with soap and water” before touching anything.8.  Remember, you are contagious until free of fever 24-hours.  Be free of fever 24-hours before returning to work or school!9.  Prevention is the key!  There are numerous ways to prevent illness. Vitamin C at levels of four to five grams per day helps increase immunity and Beta Glucan 500mg one to three times daily also enhances immunity.A good multivitamin/mineral and anti-oxidant enhances immunity.  10. Treatment—hydrogen peroxide has been used to kill bacteria and viruses.  It is used intravenously with great results in all sorts of infections, both viral and bacterial.  Read the book, Hydrogen Pero

ANSWER: Wild birds worldwide carry the viruses in their intestines, especially waterfowl and shorebirds.  These viruses are very contagious and cause sickness and death in many domesticated birds, especially poultry.QUESTION: Where can I get more information?ANSWER: An exhaustive amount of information can be obtained at www.cdc.gov/flu/avian. QUESTION: What can I do to prevent myself from getting Bird Flu? ANSWER: The following is practical information that you can use to protect yourself and your family.1.  Do not pick up diseased or dead wildlife.  Report it to the Kansas Fish and Game.2.  Wash your hands thoroughly with soap and water after cleaning wild game or domestic poultry.3.  Cleanse all counter surfaces with Clorox after preparing wild game or domestic poultry.4.  Cook all game and poultry thoroughly.5.  If you are traveling to areas where H5N1 virus outbreaks have occurred, review CDC Travelers’ Health.6. Take the regular flu shot to minimize the risk of having two different viral infections at once.7.  If you are ill with fever, respiratory symptoms, and conjunctivitis, practice Respiratory Hygiene and Cough Etiquette (see CDC site).  Basically, “Cover your mouth” when you cough or sneeze, and “Wash your hands with soap and water” before touching anything.8.  Remember, you are contagious until free of fever 24-hours.  Be free of fever 24-hours before returning to work or school!9.  Prevention is the key!  There are numerous ways to prevent illness. Vitamin C at levels of four to five grams per day helps increase immunity and Beta Glucan 500mg one to three times daily also enhances immunity.A good multivitamin/mineral and anti-oxidant enhances immunity.  10. Treatment—hydrogen peroxide has been used to kill bacteria and viruses.  It is used intravenously with great results in all sorts of infections, both viral and bacterial.  Read the book, Hydrogen Peroxide, Medical Miracle to understand how this works.11. Stop smoking, minimize alcohol intake, and exercise 20 to 30 minutes, six days per week.

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Health & Medicine

Charlie Traffas

2006-03-30 14:20:00

Answer: Infusion therapy involves putting fluids, including drugs, directly into the bloodstream. It is also called intravenous infusion. Many people may require infusion therapy at some time in their lives. Drug therapies commonly administered by infusion therapy include antibiotics, chemotherapy, pain management, IV nutrition, hydration, and immune globulin (blood transfusion). Diagnoses commonly requiring infusion therapy include infections that are unresponsive to oral antibiotics; cancer and cancer-related pain; gastrointestinal diseases or disorders which prevent normal functioning of the gastrointestinal system; congestive heart failure; immune disorders; anemia; and growth hormone deficiencies. Infusion therapy can be provided in the hospital or on an outpatient basis. Working with their doctor, people who are well enough to leave the hospital can get the medications they need in a physician’s office or in an outpatient infusion center. Nationwide, there are approximately 4,500 infusion therapy sites of service, including local and national organizations, hospital-affiliated organizations, and national home infusion organizations. Outpatient infusion centers are becoming more popular with patients because it usually takes less time to receive treatment than in a hospital setting and is more convenient to use. Health care providers like outpatient infusion centers because it frees up beds needed for patients who require an inpatient stay. As we learn more about what helps people relax and be comfortable, the newer outpatient infusion centers are designed for increased patient comfort and convenience. Patients have more control over their treatment schedules. Parking is nearby. Recliners are usually provided within the center, and the person can relax and watch television or chat with other patients while receiving treatment. If privacy is desired, curtains can be pulled to separate people.Registered nurses who have extensive experience in starting IVs and caring for IV patients staff outpatient infusion centers.  People who have the occasion to use an outpatient infusion center are usually pleased with the care they have received and the way they can fit infusion therapy into their schedules.

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Health & Medicine

Dr Galichia

2006-03-30 14:20:00

Question: What is meant by the term 'congenital heart disease'? How common are they? Why do they occur? Is a child with a heart condition at increased risk from infection?

ANSWER: Congenital heart defects are anatomical defects that occur at birth. The term congenital means a trait one is born with. There are numerous types of heart abnormalities of varying degrees of severity. More common defects include holes between the chambers of the heart, which can cause flow disturbances and increased heart work. If these holes are large enough, heart failure can ensue. Other defects include an undersized heart, abnormal heart valves, abnormal connections between heart arteries and arteries that supply the lungs with blood, and strictures (narrowing) of the main arteries including the aorta resulting in a condition known as coartation of the aorta. The list of these abnormalities is very long and sometimes children are born with multiple abnormalities resulting in even greater disability and early mortality.No one is sure why these abnormalities occur but they are more common in individuals who have other developmental abnormalities including Down syndrome. In most instances there is a simply an isolated genetic abnormality which results in one of these problems. They are usually detected at birth but sometimes not until teenage or adult years when heart murmurs become more manifest. Echocardiography has helped identify these problems and define their significance, giving us a great tool to make a simple non-invasive and yet thorough evaluation of most of these individuals. There is one defect which is gained much attention lately in the medical literature. This defect is called a PFO, or Patent Foramen Ovale. There is an area in the wall separating the two atrial chambers of the heart, which should close at birth. In some individuals this does not happen, setting the stage for possible strokes and infections. Rarely these small defects create heart murmurs and they are poorly seen on routine echocardiography. We now realize that they are much more common that we have ever thought, perhaps effecting about 15-25% of the population. For most individuals, a PFO is a no consequence and can only be diagnosed by placing an echo probe in the esophagus next to the heart. In individuals with unexplained stroke, we now always look for this problem. It also sometimes manifests itself in older individuals and was identified as the cause of the stroke in Ariel Sharon. Also, PFO have been implicated as a cause of migraine headaches.All congenital heart defects can result in serious infections, heart failure, strokes, arrhythmias, and sudden death. However, for most individuals the severity and type of the lesion has to be evaluated and can often times be managed without any surgical intervention. We are excited that we now have new ways of repairing holes in the heart without surgery by providing safer options to the patients.

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Health & Medicine

Dr George Watson

2006-03-01 13:04:00

QUESTION: What is the TACT study group?

ANSWER: This study is designed to show, by double blind method, if chelation is beneficial for the treatment of vascular diseases, as well as the FDA approved treatment of lead toxicity.  The TACT study group had a nationwide conference in Miami February 10 and 11 to update physicians and coordinators on the progress of the study.question: What was most impressive about the meeting?answer: There were several things.  We heard one lady speak, who, even though it is a double-blind study (she has not been told nor does her physician know whether she received the EDTA or placebo), has done so well by the end of her treatment phase, that she has become a Coordinator and recruiter for the clinic where she went through the program.Another amazing thing was having dinner with a cardiovascular surgeon from another state who gives his patients the option of bypass surgery or chelation.  As we do in our clinic, he has them read the book, Bypassing Bypass Surgery, by Elmer Cranton, M.D., so that the patient can read about the Coronary Artery Surgery Study (CASS Study), which compares the risks and benefits of angioplasty with stent, bypass surgery, and aggressive medical therapy.  Then, the patient can make an informed decision about what is best for them in their own circumstances.question: How can people obtain information about being a part of this landmark study?answer: If they (or someone they know) is over 50, has had a heart attack, and is a non-smoker, have them call 316-744-3400 so they can be interviewed to see if they are a candidate for the TACT study.  And be sure to tell them that they will receive all of the testing, evaluation, and monitoring at no cost to them.

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Health & Medicine

Francie Ekengren MD

2006-03-01 12:58:00

QUESTION: What is a hospitalist?

ANSWER: If a hospital stay is in your future, don’t be surprised if you’re cared for by a kind of doctor you’ve never heard of: a hospitalist.Unlike traditional doctors, this new type of physician doesn’t see patients away from a hospital. In fact, the hospitalist’s responsibility is to care for hospitalized patients from admission to discharge—hence the name.Although the public may not yet be aware of hospitalists, these specialists belong to the fastest-growing field in medicine. Five years ago there were only a few hundred hospitalists in the entire country. Today, there are as many as 12,000 practicing hospitalists, and it’s plausible that within a decade every hospital will have at least one hospitalist on staff.Typically hired directly by hospitals, these doctors practice exclusively on site, ordering appropriate diagnostic tests, monitoring patients’ conditions, making treatment decisions with input from primary care doctors and coordinating patient care among members of the hospital staff. Their surge in popularity is fueled by several factors:· Hospitalists—most of whom are either trained as internists or pediatricians—become especially skilled at treating health problems common among hospitalized patients, such as pneumonia, infections, heart attacks and congestive heart failure.· Hospitalists are readily available to their patients. Because they are hospital-based, they generally can respond quickly whenever a patient or family member has a question or concern. This contrasts with traditional doctors who often see their hospitalized patients only during morning or evening rounds. · Because they are near their patient’s bedside, hospitalists can recognize and react quickly to any changes in their patient’s condition—a real advantage.A growing body of research suggests that hospitalists improve the overall quality of patient care. There have been more than 100 studies published on the impact of hospitalists, and the results are generally quite positive. Most studies show that hospitalists help reduce the risk of medical errors, reduce the length of patient stays and reduce hospital costs.

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Health & Medicine

Sandra Rader

2006-03-01 10:28:00

QUESTION: I’ve been having some problems with my arms swelling. Could this be lymphedema? What causes it?

ANSWER: Lymphedema is a swelling in the arms or legs caused by the accumulation of lymphatic fluid in the body. This often occurs when venous and/or lymphatic vessels become restricted to the point that fluid does not flow freely through them. There are two types of lymphedema: primary and secondary. Primary lymphedema can occur secondary to lymph system abnormality in newborns or later in life. Secondary lymphedema may occur as a result of injury, scarring or excision of the lymph nodes. This latter type of the disease may occur following radiation, surgery or treatment for cancer. In addition to decreased flexibility or feelings of heaviness or discomfort, lymphedema can cause cosmetic deformity or repeated episodes of infection in the skin tissues. If left untreated, lymphedema can lead to the hardening of underlying soft tissue and overall bulkiness in the arms or legs. Because it also reduces the level of oxygen flowing to the tissues, it can interfere with wound healing as well. Treatment for lymphedema varies but the most effective and least invasive approach recommended by physicians today is Combined Decongestive Therapy. This type of therapy includes: hygiene/topical skin care to control infection and promote cleanliness, manual lymphatic drainage to release and empty obstructed lymph vessels, bandaging and compression to prevent lymph fluid from re-entering the affected arm or leg after the drainage session, and remedial exercise to activate muscle groups and improve the lymph flow in swollen arm or leg joints. This method of therapy has proven to maximize functionality and return patients to a better quality of life. In the United States, some 2.5 million people suffer from lymphedema. But there are a number of preventive measures one can take to decrease the risk of developing this condition. These precautions include avoiding extreme temperatures, preventing infections caused by punctures or injury to the skin and reducing the risk of blunt trauma caused by anything from lifting heavy objects to wearing tight fitting clothes. Certain lifestyle choices can also help prevent lymphedema. From practicing meticulous skin and nail care, to reducing alcohol and nicotine, to maintaining a healthy diet and exercise program, anyone can learn to reduce their risk of developing lymphedema.

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Health & Medicine

Charlie Traffas

2006-03-01 08:45:00

Question: I’ve heard that it’s now possible to do a coronary angiogram or heart cath without having a catheter put into the artery. Is that true?

It is true that new technology now provides us with the ability to look at the coronary arteries and other structures surrounding the heart non-invasively. We no longer have to place a catheter in the heart arteries to visualize them. There will continue to be instances when this procedure is necessary but rapid cat scanning with a 64-slice CT scanner will enable us to make these pictures with virtually no risk to the patient. Approximately 700,000 people each year die of heart attacks in the US. Most of these deaths could be prevented if we had a simple method of making the diagnosis of a blocked artery earlier rather than later. Treadmill testing and other forms of non-invasive evaluation have often been inaccurate in detecting arterial narrowing. Our only method of looking at the coronary anatomy until now has been to do a heart catheter study. Heart catheterization has proven to be safe with a major complication risk of less than 1 in 1,000; and a minor complication risk such as bleeding or pain in the groin of about 1 in 100. Furthermore, patients are advised to limit their activity during subsequent 24 or 48 hours after the procedure and it is also relatively costly. The huge advantage of the 64-slice CT scanner is that no catheter insertion is necessary, there is no time loss from work, and the risk appears to be very minimal. This procedure takes less than 15 minutes and gives an accurate portrayal of the anatomy of the heart and surrounding structures. Other vessels in the body could be imaged in a similar way. The fact that there is no discomfort and no risk is extremely attractive to patients, families and physicians. Of all of the advancements in cardiology in the last 50 years, this appears to be as exciting to me as anything I have seen. This technology will enable us to screen patients at risk for heart attack, make diagnosis earlier, and treat most patients with stent-procedures, avoiding or delaying bypass surgery. The 64-slice CT scanner will be available at the Galichia Heart Hospital starting in March of 2006. We feel the opportunity to diagnose “silent heart disease“ has taken a giant step forward.

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Health & Medicine

Dr Joseph Galichia

2006-02-01 15:22:00

QUESTION: Lately I’ve been getting short of breath when climbing stairs and walking fast.  I’ve heard that this could be more of a sign of heart disease than other symptoms.

ANSWER: You are correct. We now find that more patients with coronary artery disease and other heart illnesses  present with shortness of breath than chest pain.  We used to feel that the absence of chest pain was important and implied that there were no blocked arteries in the heart.  We now know however, that the symptom of shortness of breath is of great concern and should be evaluated in all patients.  Many people feel that they’re ‘getting old’ and “out of shape.’   Making this assumption without a good evaluation is unwise and in my opinion often leads to a missed diagnosis of problems which could lead to a heart attack.  Certainly the list of things that causes shortness of breath is extremely long and does include deconditioning, overweight and loss of vigor due to aging.  Also, primary lung disease such as emphysema, bronchitis, asthma, and lung tumors can cause one to be short of breath.  Furthermore, anemia and other blood disorders and malignancies virtually anywhere in the body can cause a feeling of shortness of breath and easy fatigability.In our effort to understand why people are short of breath, we find that in patients with coronary artery blockages, the heart simply cannot get enough blood during exercise causing the pumping chamber to work inefficiently.  This results in the feeling of breathlessness.  Other symptoms associated with coronary artery blockages are a feeling of fatigue, unusual sweating, inability to sleep, chest pain and sometimes nausea.  These symptoms may be brought on by exertion but can occur at rest.  Pain radiating to the arm, chest, upper chest, shoulders and neck area may also be associated with coronary artery blockages.My advice to people who feel they have breathlessness or shortness of breath on exertion, is that this problem should be evaluated immediately.  There usually is some cause for the shortness of breath, but in the absence of any heart, lung or other abnormalities, embarking on an exercise program, changing one’s diet and losing weight will almost always improve exercise tolerance and result in a feeling of improved fitness and quality of life.

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Health & Medicine

Torey Shackelford

2006-02-01 15:06:00

What is a driving evaluation and why would I need one?

ANSWER: A driving evaluation, which is performed by a specially trained therapist, is an assessment of a person’s driving capabilities to determine if it is safe for them to get back behind the wheel. This type of evaluation is ideal for someone who is unable to drive because of disabilities resulting from stroke, spinal cord injury, neurological disease, amputation, head injury, or any other conditions that have affected physical, sensory or motor abilities. Driving evaluations typically assess a person’s mental and physical conditioning as well as their on-the-road capabilities. For example, a pre-driving evaluation may examine an individual’s muscle strength, balance, reflexes and coordination as well as their mental status and vision. If a person passes these off-road tests, they are placed behind the wheel of a vehicle to perform the specific functions involved in driving. In this level of testing, the person will be required to perform driving tasks in a parking lot as well as in traffic. If the person being evaluated successfully passes all tests, the therapist works with the individual, his or her physician, and any sponsoring agent to determine an appropriate training program and/or commercially available adaptive driving equipment. In Kansas, participation in a driving evaluation requires a person age 18 or older to have a valid driver’s permit or license.

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Health & Medicine

Dr Galichia

2005-12-29 14:04:00

: I have swollen feet and I don't know why.  I am taking amlodopine for my blood pressure and a diuretic called dyazide.  What can I do?

ANSWER: Most of the time people who take calcium channel blocking drugs such as amlodopine have some swelling, it is often manageable and it is unresponsive to diuretics.  In most instances swollen feet and ankles in a person who is taking this kind of medication is not the result of heart failure or other major systemic problems but rather related to the drug itself.  I'm sure that you are taking this medication to control your blood pressure and a side effect is simply swelling of the feet and ankles.  Dyazide, the diuretic you are taking is a good blood pressure lowering drug but is not effective in treating the swelling we see with calcium channel blocking drugs.  Thus taking diuretic is rarely a benefit.Most patients are worried that they may have heart failure, renal failure or kidney failure or perhaps a problem with blood clots in the legs.  Speak with your doctor about these other potential problems. Among those heart failure is the most common but in the absence of shortness of breath this is not the likely the cause.  There are other calcium channel blocking drugs which create less swelling in the legs and you may speak with your doctor about a substitution with one of those drugs.  The drug amlodopine however is an excellent blood pressure medication and the swelling that we see is something that usually is tolerable and it helps the patient to know that there is no other more serious underlying illness causing the swelling. There are about 120 different medicines that one can take for blood pressure.  I always tell my patients if they have problems with one blood pressure medication it is highly likely that another one will work with fewer side effects.

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Health & Medicine

Dr Amirani

2005-12-29 10:52:00

: Why is my cholesterol level important?

ANSWER: Over half of Americans will die of arthrosclerosis, also known as, hardening of the arteries. An individual with a high serum cholesterol level will have an increased risk of heart attacks, strokes, and sudden death. Cholesterol levels above 200 increase these risks as much as 1% for every 2 points of elevation. What is the difference between cholesterol, triglycerides, HDL and LDL? Total serum cholesterol is a combination of all fats. These fats play a large role in maintaining bodily functions such as making hormones, repairing artery walls, protecting nerve cells, making bile acids and more. • Triglycerides are a particular type of cholesterol made up of a combination of fats and carbohydrates. These triglycerides help provide energy for the body.  • LDL is a type of cholesterol that can build up in artery walls, and is considered to be the "lousy" cholesterol because it is so atherogenic. • HDL can be thought of as the "healthy cholesterol" because it has the unique ability to clean bad cholesterol from artery walls.When total cholesterol, triglycerides, and LDL are in high enough quantities they can lead to arterial atherosclerotic plaques (fatty deposits in arteries).  What should my cholesterol levels be?A total cholesterol level of less than 200 is desirable. A triglyceride level of 150 or below is optimal. An HDL (healthy cholesterol) level of above 45 is good. An optimal LDL (lousy cholesterol) level of below 100 is recommended. What can I do to lower my cholesterol?Eating foods low in fat is one way to lower your cholesterol. We need to eat some fat in our diet to remain healthy.  A person should eat 25 to 30% of their total caloric intake in fats. A person who eats a 2000-calorie diet should be eating approximately 45 to 75 grams of fat daily. But, not all fats are the same. Saturated fats can be found in beef, dairy products, butter, lard, poultry, lamb, and pork. Saturated fats are the single biggest cause of rising cholesterol, triglyceride, and LDL levels.

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Health & Medicine

Tina Lohrman

2005-12-29 10:13:00

: Can you explain how CPAP therapy is used to treat Sleep Apnea ?

ANSWER: Sleep apnea is a condition which occurs when a person stops breathing for a period of time during sleep. The most common type of sleep apnea is called OSA, otherwise known as obstructive sleep apnea. During sleep, a portion of the airway collapses causing an obstruction. This obstruction impedes air movement to and from the lungs resulting in a lack of oxygen to the body. OSA is treated through the use of CPAP. CPAP is a noninvasive therapy which stands for Continuous Positive Airway Pressure. The CPAP machine is preset to a patient specific pressure setting. During sleep, air flows from the CPAP machine into a mask or nasal device placed on the face. The air flow provides pressure to the airway to keep the obstruction from occurring resulting in proper oxygenation. Once sleep apnea has been diagnosed, it is important for the patient to work closely with the sleep technician and physician to find a device that is tolerable for them. Device discomfort is the number one reason patients discontinue CPAP. It is of the upmost importance to wear the CPAP device each time sleep occurs including naps. If the CPAP is not being used, the patient will experience some or all of the following: excessive tiredness which may result in vehicle crashes, loud snoring, headache, memory/concentration problems, personality changes. The long term risks of not treating sleep apnea through the use of CPAP include high blood pressure, irregular heartbeat, heart disease and stroke.

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Health & Medicine

Dr George Watson

2005-12-29 08:44:00

QUESTION: I know many people who swear by Chelation, but I have heard some medical people say that it is unsafe and unproven. What exactly is Chelation?

ANSWER: Chelation generally refers to the use of intravenous EDTA to remove heavy metals from the body. EDTA is the abbreviation for Ethylene Diamine Tetra Acetic Acid and is FDA approved for the treatment of lead poisoning. In the same way that heme binds iron to form hemoglobin, EDTA binds heavy metals such as lead, mercury and cadmium, which exist as metal ions with a positive charge of 2. These bound metal ions are eliminated in the urine. Calcium also has a positive charge of 2, and is bound by EDTA, molecule by molecule, resulting in a gradual decrease in calcium deposits in arteries. As to safety, read the labels on canned foods. Many times you will see EDTA listed as an ingredient used to preserve the food. EDTA orally is only absorbed up to 5%, whereas intravenous EDTA is 100% available to carry toxic metal ions to the kidney to be flushed out of the body. We have people read "Bypassing Bypass Surgery" or "Forty Something Forever," so they can make their decision based on facts, not wives’ tales. Unproven? Thousands of people have benefited from Chelation therapy, just as thousands have benefited from angioplasties and bypass surgery. But, there have been no double blind studies in any of these treatments - until now. The National Institute of Health (NIH) is sponsoring a double blind study of Chelation. It is open to individuals nationwide, including the Wichita area. For more information call 316-744-3400.

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Health & Medicine

Colin Parry

2005-12-01 14:36:00

: What should I look for in choosing a hospital and where can I get objective  information?

ANSWER: The Internet has opened up a whole new world for consumers. At the touch of a keyboard we can compare cars, vacations, colleges and even healthcare facilities. Several Web sites now offer ratings and comparisons of quality at various hospitals. Though information on these sites is limited, it can be useful.Two major sites that report hospital quality data are http://www.hospitalcompare.hhs.gov/ and www.jcaho.org/quality+checkHospital Compare is a joint project of the federal Centers for Medicare and Medicaid Services and the Hospital Quality Alliance, a public-private collaboration of healthcare providers, employers, consumers, accrediting organizations and federal agencies. The site compares hospital quality "measures" related to treatment in four areas: heart attack, heart failure (sometimes called congestive heart failure), pneumonia, and prevention of infection in surgery patients. The measures include recommended practices such as giving aspirin to a heart attack patient upon arrival at the hospital or administering preventive antibiotics to patients before surgery. The JCAHO site is sponsored by the Joint Commission on Accreditation of Healthcare Organizations, the primary accrediting body for hospitals. While the site reports similar criteria for heart attack, heart failure and pneumonia, it also rates performance related to JCAHO safety goals to prevent medical errors. These include steps to prevent surgery on the wrong leg, for example, by marking the correct leg while the patient is awake. Other safety measures focus on eliminating medication errors, preventing infections acquired in a health-care facility, verifying the accuracy of medical technology, and ensuring that physicians' orders are communicated correctly.Your health insurance provider may limit the hospitals you can use. But some providers, such as Medicare, have few hospital restrictions. When choosing a hospital, Internet research is a good starting point.But you should also talk to your primary care and specialty physicians, as well as former patients. The bottom line: don't be afraid to ask questions. You should look for a hospital that:• Is approved by your health insurance plan• Is accredited by the Joint Commission on Accreditation of Healthcare Organizations• Has experience with your condition• Provides care in a broad range of services from routine to high risk• Has emergency services and operating rooms available at all hours• Checks and works to improve its own quality of care• Has patient representatives to help with patient concerns and social workers to help provide discharge planning• Is associated with a medical college that keeps up with the latest in care and technology.

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Health & Medicine

Dr Francie Ekengren

2005-11-01 16:19:00

: What are the warning signs of a heart attack?

ANSWER: While everyone can experience a heart attack in different ways, the American Heart Assoc-iation offers this de-scription: an uncomfortable pressure, squeezing, fullness or pain in the center of the chest that lasts more than a few minutes or goes away and comes back. Signs of a heart attack can also include an uncomfortable feeling in the upper body, including the arms, back, jaw or stomach. Sometimes patients have difficulty breathing, begin sweating or feel light-headed or nauseous.If you think you're having a heart attack, don't waste time. Call 911 immediately.Once a patient gets to a hospital the coordination of care between the EMS professionals and the hospital is an important first step. Accredited Chest Pain Centers work to reduce heart attack deaths through a system that reduces the time between when a patient is first seen and treated. It is important for personnel to be trained and meet certain competencies, and the hospital itself must have design and technology that allows quick movement and response. Among the improvements important for a hospital to have is a cardiac alert system that is activated as soon as a patient is diagnosed in the emergency room. This can provide easier communication between labs, cardiac care units and other locations within a hospital and reduce the all-important response time. In addition, a recent new technology called a "Biosite Triage Cardiac System" can test blood at a patient's bedside. The blood test looks at certain "markers," which are elevated when heart muscle is damaged. The difference is a bedside test that takes 15 minutes versus one that could take 40 minutes or longer. For patients suffering from a heart attack, these steps improve their chances of not only surviving, but returning to a normal life once their recovery is complete. With heart attacks, fast response is vital. For people suffering a heart attack, the first hour is critical. Seconds count, which is why hospitals and emergency response teams consistently look for ways to reduce the time it takes to respond to and treat a patient in crisis. New technology and improved management techniques once a patient enters a hospital are among two of the recent developments that improve the chances of surviving a heart attack.

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Health & Medicine

Dr Galichia

2005-11-01 16:19:00

: I have asthma and I've been told that there are certain things that I should avoid that  might make my asthma worse. Can you explain what they might be?

ANSWER: Yes, there are many things that cause asthma attacks, such as pollen, dust and mold. Here are some ways that you may stay clear of them. If you have asthma and are allergic to pollen, dust, mites, animal dander or mold, exposure to these things may cause asthma symptoms.Pollen - microscopic male cells of flowering plants that travel through the air to fertilize other plants. People with pollen allergy, often referred to as hayfever, may experience sneezing, congestion, runny nose, itchy mouth, throat, eyes and ears. The pollen season generally lasts from February or March through October. To reduce your exposure to pollen keep your house and car windows closed, use a/c as needed, don't hang sheets or clothing outside to dry as pollen may collect on them and be brought into the house.  Avoid mowing the lawn and being around freshly cut grass and, in addition, limit your outside activities in the early morning when the pollen levels are the highest.Dust mites - these microscopic creatures live around the house and can cause stuffy or runny nose, sneezing, itchy or watery eyes, coughing or wheezing. Dust might thrive on moist warm air, so keep the humidity in your home below 50%.  Dust often with a clean cloth and have upholstery and carpet cleaned weekly. Animal dander - many people are allergic to the protein in the saliva, dander or urine of animals with fur or feathers. These allergies can cause sneezing, wheezing, itchy or runny nose, itchy or swollen eyes or throat. The most effective way to avoid these allergies is not to have a pet at all or to keep the pet outdoors. It is possible to enjoy pets but only if they are not allowed in your house. Molds - mold can grow on wet surfaces and cause a skin rash, other allergic symptoms, and may be the cause of some serious illnesses. Frequent cleaning, where molds can grow, such as bathrooms and other wet surfaces may help to prevent this problem. Basement, shower curtains, and other moist areas must be cleaned frequently.  There are also many irritants in the air, such as smog, air pollution, and other toxic substances including tobacco smoke, which may make asthma worse. Air quality index is a good indicator of air pollution. The ozone alert may also help warn of increased asthma risks. Staying indoors may help to prevent problems. Strong odors and exposure to the cold air may precipitate asthma as well. If you have asthma, being aware of allergens and irritants in your area, may diminish asthma attacks and decrease their severity.

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Health & Medicine

Dr George Watson

2005-11-01 16:19:00

QUESTION: Lately I’ve been hearing a lot about Thermography.  What exactly is it?

ANSWER: Digital infrared thermal imaging (Thermography) is a totally non-invasive clinical imaging procedure for detecting and monitoring a number of diseases and physical injuries by showing thermal (heat) images of any abnormalities present in the body. It's used as an aid in diagnosis and prognosis as well as for monitoring therapy progress.Through Thermography, various conditions and injuries can be detected, including: arthritis, back injuries, headaches, nerve damage, unexplained pain, artery inflammation, vascular disease, breast disease, carpal tunnel syndrome, disc disease, inflammatory pain, skin cancer, sprains and strains, stroke screening, whiplash, digestive disorders, and more.  Images can be taken of the whole body or just specific areas being investigated. The digitized images are stored on a computer and sent electronically to a Thermologist for interpretation and reporting. Reports can then be color printed and sent to your health care professional. Unlike most diagnostic tests, Thermography is non-invasive, painless, involves no radiation or contact with the body and is F.D.A. approved. Standard exams usually take 15 to 30 minutes. Whereas X-Ray, C.T. Ultrasound and M.R.I. are all tests of 'anatomy' that measure the structures of your body, Thermography is unique in its capability to show physiological change and metabolic processes.  Thermography detects the subtle physiologic changes that accompany breast pathology, whether it's cancer, fibrocystic disease, an infection or a vascular disease. It takes years for a tumor to grow, thus the earliest possible indication of abnormality is needed to allow the earliest possible treatment and intervention. Your doctor can then plan accordingly and lay out a careful program to further diagnose and/or monitor you during and after treatment. All breast thermograms are kept on record and once your stable thermal pattern has been established any changes can be detected during your routine annual checkup. All women can benefit from Thermography breast screening.  However, it is especially appropriate for younger women (30-50) whose denser breast tissue makes it more difficult for mammography to be effective. And also for women of all ages who, for many reasons, are unable to undergo routine mammography.  Thermography can provide a 'clinical marker' to the doctor or mammographer that a specific area of the breast needs particularly close examination.  Current Early Detection Guidelines:One day there may be a single method for early detection of breast cancer. Until then, using a combination of methods will increase your chances of detecting breast cancer in an early stage. These methods include:• Annual Thermography screening for women of all ages.• Mammography, when considered appropriate for women who are aged 50 or older.  • A regular breast examination by a health care professional.• Monthly breast self-examination.• Personal awareness for changes in breasts.• Readiness to discuss quickly any such changes with a doctor.

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Health & Medicine

Dr Galichia

2005-10-01 14:59:00

: I've heard that women live longer than men and have better overall health. Is that true?

ANSWER: On the average, the American man lives 5.4 years fewer than does the average women. In 2002, male life expectancy was 74.5 years, while female life expectancy was 79.9 years. Why men come out on the short end of this equation is not clear. Men tend to accumulate fat around the abdomen, which we know is associated with increased risk of diabetes, heart disease, cancer, stroke, and high blood pressure. Heredity, hormonal effects and possibly stress also seem to play a role. Women on the other hand, are more likely to take better care of themselves, share their stress with others, and tend to gain weight around the hips rather than around the abdomen. We also know that men are more likely to smoke, use elicit drugs, and take more health risks in general. This may explain why they have a higher risk of dying from accidents, suicide and homicide.According to a recent Mayo Clinic article, in 2002 nearly 2 million men died - more than half due to heart disease and cancer. This is a breakdown of the 10 leading killers of American men in 2002 based on statistics from the Center for Disease Control and Prevention, 2004:RANK CAUSE % MALE DEATHS 1 Heart Disease 28.4 2 Cancer 24.1 3 Unintentional injuries 5.8 4 Stroke 5.2 5 Chronic obstructive 5.1  pulmonary disease (COPD) 6 Diabetes 2.8 7 Influenza and 2.4  pneumonia 8 Suicide 2.1 9 Kidney disease 1.6 10 Chronic liver disease 1.5  and cirrhosisThe good news for men is that by doing some very simple, common sense things they can reduce their risk for all of these causes. Maintaining healthy life style is incredibly important and following these preventive measures:• do not smoke or use other tobacco products• do not drink alcohol in access• eat a varied diet, rich in fruits, vegetables, and low-fat foods• maintain a healthy weight• get at least 30 minutes of exercise most days of the week• keep your cholesterol levels in normal ranges• control your blood sugar if you have diabetes• control your blood pressure• talk to your doctor about a low daily dose of aspirinIf we add to this list some very simple measures, we can reduce the risk even further. These would include:• always wear a seatbelt• do not drive if sleepy or under the influence of alcohol or drugs• take precaution with all toxic substances• wear a helmet when riding a motorcycles, bicycles or four-wheelers, and snow skiing• get a flu shot every year• share your worst moments with someone else (pastor, friend, psychologist)• never use street drugsKnowing your hereditary risks is extremely important and something you should discuss annually with your personal physician. A good physical exam, knowing your blood pressure, cholesterol, weight, PSA level, and exercise capacity can help you and your doctor outline a better strategy to live better and longer and enjoy a more fruitful life.

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Health & Medicine

Don Morris

2005-09-01 14:36:00

:  Why is there a nursing shortage?

ANSWER: For those of us in the health care industry, the nursing shortage is something we've been living with for a number of years. However, as bad as it seems today, a worse crisis is looming in the near future, as baby boomers reach the age where they will need more health care services. In some ways, the answer is as simple as too many people retiring and not enough young people entering the field. The average age of nurses is over 40. According to one survey, the number of registered nurses (RNs) under age 30 decreased from 25.1 percent in 1980 to 9.1 percent in 2000.At the same time, fewer young people have been entering the nursing field for the past two decades. By some estimates enrollment in nursing programs would have to increase by at least 40 percent each year to replace those who are retiring. Compounding the issue is a decreasing number of faculty members to teach nursing students. So, while the number of nursing students has slowed, the pipeline itself is congested by academic programs with too few faculty members. The result is potential nurses are being turned away by many programs throughout the country.Finally, among nurses currently working in the field, job burnout, exhaustion, stress and general dissatisfaction are common complaints that need to change so we can retain our current staff and attract new professionals.

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Health & Medicine

Dr Galichia

2005-09-01 11:22:00

:  My mother has had two TIAs over the last 6 years. Neither have left any permanent damage. Does this most probably mean the 'big one' is coming unless we do something?

ANSWER: A TIA or Transient Ischemic Attack is a major warning sign for a stroke. TIAs are like mini-strokes, where there is a loss of neurologic function that quickly returns, usually over a period of a few minutes to a couple of hours. The loss of neurologic function may manifest itself by paralysis of one side or the other, facial weakness, inability to speak properly, inability to comprehend, a loss of vision, or severe headache. If a loss of neurologic function improves completely and a full blown stroke does not occur, we refer to this as a TIA. Unfortunately, most patients dismiss the event as a scary episode and do not seek immediate medical attention, only to later develop a completed stroke. A full evaluation consisting of a complete cardiovascular examination and neurologic evaluation is necessary. Looking at the carotid arteries in the neck with ultrasound and doppler should be done in all patients with TIAs. About 40% of these events occur because of plaque built up in the neck which may break off and travel to the brain or may be a place where clots form and travel to the brain. Strokes or mini-strokes may also be a result of heart rhythm problems, blood clots within the heart, or blockages in the small arteries in the brain. About 15% of all strokes are caused by bleeding within the brain but these events are rarely transient and do not manifest themselves as TIAs. Blood thinners and finding the cause of the mini-stroke enables the physicians to take a proper course of action to avoid the tragedy of a completed stroke. Stroke is the third leading cause of death in the United States today and the major cause of disability. We must do everything we can to heed the early warning signs and prevent strokes whenever possible.

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Health & Medicine

Don Morris

2005-09-01 07:39:00

: What does the nursing shortage mean for patient care?

ANSWER:  We are fortunate to have extremely caring individuals who enter the nursing profession. Their dedication to patient care, particularly in light of the stresses inherent in the field, is uplifting. Still, there are systemic problems that this nursing shortage poses. Among them are decreased access to health care, including hospitals and long-term care facilities. Some of the highest vacancy rates across the country are found in critical care and medical-surgical care units. In some severe cases, medical facilities have had to close beds due to a lack of nursing staff. What can be done to improve this nursing shortage? First, the issue of education needs to be addressed. Federal funds are being earmarked to increase the number of faculty. More grants, loans, scholarships and other incentives are needed to help attract faculty and students to nursing programs.Next, we need to make the field of nursing more attractive. Flexibility in scheduling already is being addressed through creative solutions like shift-bidding, which allows employees to compete for unfilled shifts through a computerized system - something they can do through the internet at home. On a national level, there are media campaigns designed to increase awareness and improve the image of nursing. But much more needs to be done to attract and retain nursing staff. From policies and procedures in the hospital to creating an environment built on a team approach, there are many creative solutions that everyone in health care needs to explore. The bottom line is that the quality of health care rests in the hands of a caring, capable and committed nursing staff. It will take all of us to find ways to make sure the best and brightest are caring for us all in the future.

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Health & Medicine

Dr Galichia

2005-07-01 11:46:00

: What is an Abdominal Aortic Aneurysm (AAA)?

ANSWER: AAA is a weakening of the arterial wall, which can eventually lead to rupture of the blood vessel. Many of these occur in the abdomen below the umbilicus and are a common cause of death. These weakened areas expand over time and eventually rupture abruptly with only about 20% chance of survival. The anatomical effect on the artery is reminiscent of an old inner tube in a tire with the bubble ready to burst. AAA's tend to occur more often in men who are older and who have a history of hypertension, atherosclerosis, coronary heart disease, smoking, or a family history of AAA.  Most often, they are difficult to diagnose by direct examination and usually a-symptomatic until the time of rupture. At the time of rupture, most patients experience severe abdominal pain radiating to the back, and associated with complete vascular collapse. When the diagnosis is made before rupture it is usually an incidental finding at a time of a cat scan, sonogram, or other imaging study, done primarily for another reason. Thus, the challenge lies in early diagnosis of the silent but ever dangerous problem. There has been a push by the American Heart Association to provide screening for people at risk for AAA, including those with the family history. So far this type of screening has not been approved by Medicare despite some 60,000 deaths per year in the US alone. Once the AAA reaches the size of 5.0 cm to 5.5 cm in diameter, we usually recommend surgical resection or the implantation of a stent graft. The stent graft is a relatively new procedure. A stocking like device with stents on either end is attached to the aorta and the vessels below the aorta in a minimally surgical procedure. Patients usually leave the hospital the next day and the operative risk is low. Furthermore, the risk of male sexual dysfunction is less with stent graft treatment than with surgical resection. Nevertheless, there had been incidents of leaking of the stent grafts over time and they must be followed carefully by sonography or cat scanning. Despite the newer and safer treatments for AAA, the challenge remains in identifying patients who have this problem and providing careful surveillance of their progression. It is my personal feeling that we have to find a way to provide sonography as a screening tool to those who are at risk, given the fact that sonography is cheap, totally safe to perform and without any pain what so ever. If you think you are at risk for this problem, you should visit with your physician about a possibility of an imaging test to rule it out.

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Health & Medicine

Dr Galichia

2005-06-01 11:06:00

:  What is ‘capsule endoscopy’ and may this be used instead of looking in my stomach with a tube?

ANSWER:  It is now possible to evaluate the esophagus, stomach and the small bowel by simply swallowing a capsule.  The capsule is about the size of a large vitamin pill and contains an imaging system which provides images of the entire-gastro intestinal system to the physician.  The recorder records these images for an excellent portrait of the lining of the esophagus, stomach and small bowel.  After about 24 hours most people simply pass the capsule in their stool.This technology is felt to be a real breakthrough mainly because it allows us to look at an area of the gastro-intestinal system that  previously was difficult to visualize, that being the small bowel.  Many patients have mysterious bleeding which occurs in some area of this part of the gastro-intestinal system.  Also, of course being able to look at ulcers in the stomach, esophagus and the duodenum is an extremely important contribution of this technology.  Unfortunately, it does not allow us to do a biopsy, but it certainly gives us a non-invasive, very simple, very comfortable look at a great deal of the anatomy of the human GI tract.This type of high technology is now available and something that we are using frequently.  Certainly, there does not seem to be any risk involved in swallowing this capsule, there is no discomfort and the ability to make a diagnosis, multiple GI problems have been made easier by this system.We are also excited because this technology gives us the opportunity to follow the healing of an ulcer or perhaps an area of inflammation of the lining of the stomach that we know is not cancerous but may be healing slowly or may be getting worse.  The comparison with scope technology will continue to favor the capsule simply because of the comfort of the patient.  However, many endoscopies will continue to be done because of the necessity of making a tissue biopsy.

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Health & Medicine

Dr Galichia

2005-04-01 10:50:00

: What are the risks of taking statin drugs to lower your cholesterol?

ANSWER: The most commonly used drugs to lower cholesterol today are called statin drugs. Approximately, 10 million Americans are taking these drugs and most of them have no side-effects at all. All of these drugs, have the potential of liver damage and muscle damage. However, only one of the drugs, namely Baycol, has been actually taken off the market for these problems. In almost all instances the benefits in reducing heart attacks and strokes far outweigh the risks, which themselves are quite low.  Many patients do complain of leg pain, back pain and generalized muscle aching. Most often these are not symptoms of severe muscle damage but are important symptoms not to ignore. In all patients with muscle aching I recommend checking muscle enzymes, and often stop the drug altogether. This indeed is the most common reason that people stop taking statin drugs and approximately 10% of people have some form of muscle discomfort. Nevertheless, this problem rarely results in severe muscle damage or kidney failure, but it is still a concern. Indeed, Baycol was removed from the market because it caused muscle damage that eventually affected the kidneys of several patients and caused renal failure. Of the drugs currently on the market the risk of developing muscle damage known as rhabdomyolysis is extremely rare and being carefully monitored by the FDA.Occasionally, this class of drugs which includes Lipitor, Zocor, Crestor, Mevacor and Pravochol, can cause liver damage as well. This occurs in less of 1% of patients taking these medications and necessitates careful monitoring of liver enzymes during the entire time of patient is on the drug. Liver enzymes should be checked six weeks after starting the medication and at least yearly thereafter. If the liver enzymes start to rise, stopping the drug will almost always result in return to normal liver function. Thus, we have nearly eliminated liver toxicity as a major factor in taking statin drugs. Statin drugs have been shown to reduce the risk of heart attack and stroke by 35% in large population studies. Given the millions of people who are taking the drugs today the safety record is truly remarkable and the benefits are huge.

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Health & Medicine

Dr Galichia

2005-02-01 11:24:00

: I have a blocked artery in my neck and surgery has been recommended to prevent a stroke. I have heard recently that a balloon or a stent procedure may work just as well. Is this a possibility?

ANSWER: The FDA recently has approved the use of balloon angioplasty and stenting for patients who have blocked carotid arteries, which supply blood to the brain. These blockages account for between 25% and 40% of all strokes, and are common in the population. Stroke continues to be the third leading cause of death in the United States. Our approach to this problem has changed dramatically in the last decade. It was formally felt that surgery should be done only in patients who had symptoms of an impending stroke. Subsequently, we have done surgery known as carotid endarterectomy (CEA) earlier, and often in the absence of symptoms. Narrowings of 70% or greater now are usually addressed as a measure to prevent strokes. The surgical procedure (CEA) had low incidence of strokes or other complications. The long-term results also have generally been favorable. However, many of these patients have systemic illnesses such as coronary artery disease, heart disease, heart failure, kidney failure, diabetes, and lung disease. For these patients general anesthesia alone provides increased risk, and is commonly administered to patients undergoing carotid surgery. Comparison studies have been done in these high-risk patients and show that placing a stent in the vessel to correct the problem is actually slightly safer and has somewhat better long-term results. The carotid stent procedure is done with the use of a catheter placed in the groin and requires no incision. Technology has improved rapidly in this area and has been greatly simplified. We now identify the narrowed segment and place a filter wire across the blockage to prevent debris from flowing into the brain. This is followed by an initial short balloon dilatation and immediate stent placement across the area. This procedure usually takes between one half an hour and one hour and can be done with a short overnight stay. Most patients return to full activity within 48 hours, and their long-term risk of stroke is greatly reduced. Certainly, carotid stenting is rapidly gaining favor with patients and also appears to be less costly. Recurrence over a long period of time appears to be less as well. Medicare has funded this procedure to be performed in very few facilities in the country. Training programs are currently under way to teach physicians across the nation.

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Health & Medicine

Dr Galichia

2004-10-01 15:07:00

: How can alcohol consumption be a risk to your heart?

ANSWER:  The relationship between alcohol consumption and effects on the heart is perplexed. There are many on going studies to prove risks and benefits of alcohol on health. It varies from person to person according to the age, pattern of drinking, amount of consumption and an individual's tolerance to alcohol. Excessive drinking can be harmful to health by increasing the chance of high blood pressure, obesity, stroke, breast cancer, suicide, accidents, fetal alcohol syndrome, stomach and liver damage.                 There have been many studies suggesting that moderate use of alcohol may protect the heart, but for some e.g. with heart disease even moderate amount can be dangerous.AHA recommendation for alcohol consumption is 1-2 drinks per day for men and 1 drink per day for women. If you drink more than 3 drinks a day, speak to your doctor and let him know before he puts you on beta-blockers, aspirin, etc. Drinking too much can increase triglycerides (a cholesterol component) in blood that can cause high blood pressure and obesity. Another risk to the heart is that obesity can make you prone to diabetes. Heavy and long term alcohol use can cause stroke due to blood vessel rupture. Studies suggest that alcohol may provide some level of protection against ischemic stroke while increasing risk of hemorrhagic stroke. Excessive alcohol and drugs, like cocaine and amphetamines, are the most common cause of intracranial hemorrhage for people in their 20's and 30's. It causes cardiomyopathy, (a disease of heart muscles) due to poor absorption and storage of a vitamin called thiamine which could eventually cause heart failure. Although in the U.S. deficiency of this vitamin is very rare because of sufficient vitamin supplementation through enriched foods, though it is better to have this point in mind. Binge drinking can cause cardiac arrhythmias and sudden cardiac death that has been called 'holiday heart syndrome'. Again, ongoing studies are clarifying the relationship between alcohol use and peripheral vascular disease. Alcohol causes blood vessel narrowing and thus can be one of the causes of peripheral vessel disease.In the early 90's, the health promoting properties of red wine gained scientific attention. Experiments showed that red wine led to full platelet aggregation and increased HDL (good cholesterol), but other alcoholic beverages enhanced platelet aggregation. Studies have shown that red wine contains a health-promoting component 'Resveratrol' that comes from the skin of the red grapes and also some other biologically effective elements. Resveratrol has been a primary ingredient of a historic oriental drug called 'kojo-kon' that was used for skin inflammations, fungal infections and heart and liver diseases. Resveratrol exhibits protection against atherosclerosis by decreasing free radical injury to heart and inhibits platelet aggregation. Besides it has also demonstrated anti- cancerous properties, besides breast cancer. But most of this research is done on an experimental basis. Evidence of these effects of red wine in humans needs more investigation.Although there have been many beneficial effects of red wine pointed out, if you don't drink alcohol and want the heart benefits, you can get it by eating decent amounts of fruits and vegetables that are rich in anti-oxidants like onions and apples and by drinking green tea. Grapes and peanuts are a good source of resveratrol. Keeping in mind that peanuts are a rich source of cholesterol also.How alcohol affects the cardiovascular system needs further research. Although there are potential benefits of alcohol to the heart, particularly red wine, the American Heart Association does not recommend drinking alcohol for the purpose of protecting the heart. If you have high blood pressure, liver disease, stomach ulcers, severe acid reflux, sleep apnea, diabetes and if you are pregnant or trying to conceive, please be aware that alcohol is a big threat for you. Everyone else should consult their physician for questions about personal health.

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Health & Medicine

Dr Galichia

2004-10-01 10:31:00

: It seems that after every flu-type illness I catch, I end up with inflammation around the outer lining of my lung. What causes this and why is it so painful? Could this be the beginning of something serious?

ANSWER: Inflammation of the outer lining of lungs is called PLEURITIS. Pleuritis usually occurs in otherwise healthy individuals after viral respiratory infections or pneumonia. It causes pain because this lining is right under the chest wall that is supplied by lots of nerves. Thus, inflammation of the outer lining of the lungs, irritates these nerves and causes pain. This pain is localized and sharp and is made worse be coughing, sneezing, taking deep breaths or by movement. Sometimes the lower most part of the lining (that which touches a muscle called the diaphragm) becomes inflamed and irritates a nerve that causes referred pain in the shoulder.This is usually not serious if it is limited to inflammation of the lining.  But sometimes complicated pneumonia or viral respiratory infections result in fluid or air between the linings of the lungs or thickening of the linings. This is a matter that requires further investigation and treatment measures. Pleuritis is treated with pain medications and anti-inflammatory drugs. If you have more serious symptoms like difficulty breathing or cough or pain with normal breathing patterns, refer to your doctor. QUESTION: I see many children taking prescribed medications on a daily basis. Are we starting our children on a course of prescription drug overdose?ANSWER: It is believed that generally antibiotics are being abused. That is why scientists have begun worrying about suspected 'antibiotics resistant era' in the future. But most of the doctors are aware of this fact and tend to avoid antibiotics until or unless they determine that it has to be given in order to treat the child. Nowadays, parents even are a bit more cautious about putting their child on an antibiotic. It's true that conventional measures are a better way to go, and most of the doctors try other measures like suggesting humidifiers, Vicks, and over the counter cold medicines and waiting for a certain period of time to let cold-like illnesses resolve on their own, before starting antibiotics. Then, if they don't work, of course prescription drugs are the choice.If you think your child is being given prescription drugs frequently, it is a matter of concern, ask your doctor about it. QUESTION: What is Celiac Disease? I hear it's very common and a lot of people have it but don't know it.ANSWER: Celiac disease is a disease in which an individual is sensitive to a protein called "Gluten "that is present in certain grains such as wheat, rye barley, but not oats, rice or corns. In this disease the proximal part of small intestine, which is a passage way for food, gets damaged leading to decreased absorption of most nutrients. It is hypothesized that gluten stimulates an immune response in the lining if the small intestine that destroys the covering layer cells of the small intestine. Symptoms of the disease are diarrhea, weight loss, abdominal distention, and weakness or growth retardation in children. Typical symptoms commonly show between 6 months to 2 years of age when weaning is started, half of the cases present with atypical symptoms in childhood or adulthood. Children or adults usually present with chronic diarrhea, abdominal discomfort and flatulence. Many adults have very few gastric complaints but present with fatigue, reduced fertility, menstrual problems, short height, bone fragility and possibly some symptoms of vitamin deficiencies. It's true that most people don't know that they have it. The ratio of clinical diagnosis in the United States is 1: 5000. This shows that most of cases are undiagnosed. Essential treatment for this disease is "Gluten free diet ". Improvement in symptoms should be evident in a few weeks.

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Health & Medicine

Dr Galichia

2004-08-01 11:28:00

Question:  Since Naomi Judd went public with having Hepatitis C, I have heard of many people being diagnosed with the virus or has it just become more recognized?  What are the symptoms, treatments and signs as it progresses. 

ANSWER:  Hepatitis C is a viral infection which primarily affects the liver.  In recent years, there has been a tremendous increase in the incidents of this problem.  There are 3 types of  Hepatitis.  Hepatitis A is a more common, acute hepatitis often occurring in epidemics and is easily transmittable from person to person.  This is usually however, a self-limiting illness and patients revert to normal without treatment over a several day period of time.Hepatitis B is a more complicated illness usually transmitted by blood transfusions, needles or body fluids.  Hepatitis B rarely becomes chronic but often may result in severe liver damage.  Hepatitis C however, often has no symptoms or very vague symptoms and more frequently becomes a chronic infection resulting in severe liver damage.Many patients with Hepatitis C complain of fatigue or very non-specific symptoms usually including a feeling of tiredness.  They may have overt signs of hepatitis   including jaundice and may have liver enzyme rises.  Most patients with Hepatitis C are asymptomatic.  Other patients may go through a long period of time being asymptomatic and then experience weight loss, fatigue, and joint complaints.  This has become a relatively common illness and certainly now part of a ‘workup’ for any one who complains of generalized fatigue.This disease is transmitted by blood transfusions, needle sticks and sometimes by sexual contact.  Hepatitis C in some individuals has no known origin and does often occur in people who seem to be at low risk for developing this illness.Recent treatments have become more sophisticated.  Drug treatment is used in some patients, and new treatments are being looked at in many studies.  Interferon is a drug which may help tremendously and in some cases seems to virtually cure this disease with a complete resolution of the liver function test abnormalities and clearing of the immunologic markers which indicate the presence of the disease.  Overall, it is only about 50% effective.This is a major public health problem and major research is continuing to develop new therapies.

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Health & Medicine

Dr Galichia

2004-07-01 10:05:00

Question:   What is pleurisy?

ANSWER:  Pleurisy occurs when there is  inflammation of the pleura, the tissue which lines the lungs. The pleura protects the lungs from infection and provides more freedom of motion of the lungs within the chest cavity.  Ordinarily, there is no awareness of lungs motion within the chest, and no discomfort caused by the pleura. There are instances however when the pleura is affected by an inflammatory process, known as pleuritis. Pleuritis may occur in the course of a common illness, such as influenza or bronchitis. Pleuritis also occurs in the setting of more serious illnesses such as pneumonia, tuberculosis, fungal infections, and some rheumatic like illnesses. Pulmonary embolus, which occurs when clots migrate to the lung, may also cause pleuritis. Furthermore, there are certain kinds of tumors of the lung and malignant tumors, known as mesotheliomas, which can primarily affect the pleura. As you can see the list of causes of pleuritis is extremely long. Pleurisy is clinically categorized by a sharp pain occurring in the chest and becoming worse on inspiration. The pain is often described as a "knife like" sensation, which may stop in the middle of the deep breath. There may be associated fever, chills, sputum production, and occasionally blood-tinged sputum. If a mild degree of "pleurisy" occurs in the absence of any symptoms, it is unlikely to be a major clinical problem. However, if fever, chills, or particularly blood-tinged sputum is present, you should see your doctor immediately. In this case, a good physical examination, a chest film, and other more extensive testing may be necessary to rule out more serious causes. A recurrence of frequent episodes of pleurisy, in my opinion merits, a full evaluation as well. Fortunately, most bouts of pleuritis are related to minor viral illnesses and get better on their own. Any episode of pleurisy that lasts longer than 24 hours or has a recurrent component should be evaluated in depth.

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Health & Medicine

Dr Galichia

2004-06-01 09:59:00

Question:  What is fibromyalgia? What caused it and can it be cured?

ANSWER:    This disorder (Fibromyalgia) is characterized by general pains, aching and tenderness often involving entire body. There is no known cause for this disorder and no known cure. Many of these patients have progressive weakness and fatigue resulting in a severe deterioration in the quality of their lives. They often present with complaints resembling arthritis or different autoimmune disorders such as lupus erythematosis. Nevertheless, this illness remains a diagnosis of exclusion, and the testing for more serious disorders is entirely normal. Fibromyalgia can occur at any time in life but it is more common after the age of 30. Patients are often bewildered by muscle pains that have occurred without known injury or trauma. The physical exam is entirely normal, except for some muscle tenderness. The joints are not inflamed and not usually the source of greatest pain. Over activity may make these symptoms worse. Laboratory data and x-rays are characteristically all normal. Some patients experience symptoms transiently and without any treatment may simply return to a normal state of being over a period of months or years. For the majority of patients, however, these symptoms persist for a long period of time and despite treatments with painkillers, anti-inflammatory drugs and rest, relief is hard to obtain. Some antidepressant drugs may be a benefit along with controlled exercise programs and psychotherapy may provide an additional benefit. Patients do not die from fibromyalgia but unfortunately many have prolonged disability and frustration regarding their condition.

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Health & Medicine

Dr Galichia

2004-05-01 08:19:00

:  What is a PET scan and what is its use?

ANSWER:  Positron Emission Tomography (PET) is a non-invasive early detection medical diagnostic imaging technology.  It is currently used for the detection of certain cancers, cardiac disease and neurological disorders.  This technology enables doctors to diagnose and accurately stage life-threatening diseases earlier, often enabling them to forego more expensive, more invasive procedures.  This technology is relatively old, having first been developed in l973.  This scanning technique looks at the metabolism of cells in the body, and is especially useful in identifying cells that have increased cellular activity, such as cancer cells.  Using PET imaging, for instance, may identify a mass, which shows up on a chest x-ray or a CAT scan as either a cancer, or a benign tumor.  Furthermore, many patients with known cancer may have spread of the disease to other parts of the body, but without evidence on an x-ray or other more conventional scan.  Knowing that the cancer has spread may avoid costly and painful biopsy procedures.  Redirecting the therapy is a major contribution gained from this technology.PET technology also has value in treating cardiac patients.  The process of identifying tissue that is alive, or demonstrating ongoing cellular activity, helps the cardiologist to know if he is dealing with scar tissue from an old heart attack or tissue that is still alive.  Knowing that we are dealing with viable heart muscle enables us to make better decisions regarding bypass surgery or doing a balloon or stent to better supply the area with blood.  Doing the procedure is risk free and painless, but does add significantly to the cost of analyzing the patients problems.  Recently there has been a lot of interest in using PET scanning in the early phases of Alzheimer's disease.  This diagnosis is often difficult to make and there is no specific test for it.  Many neurologists feel that the diagnosis can be made earlier and more accurately from the PET scan.  PET scanning for ruling out Alzheimer's disease is not yet covered by the insurance or Medicare but is currently under review by these payers.The use of PET scanning is growing rapidly and provides a new frontier in earlier and more accurate diagnosis of many problems.  We will learn a great deal more in the next few years regarding this exciting addition to our analysis of patients with a wide array of medical problems.

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Health & Medicine

Dr Galichia

2004-04-01 13:46:00

Question: What is congestive heart failure?  With the word 'failure' in the name, one would think it is an 'event' rather than an affliction.  Can one ever get cured of it?

ANSWER:  Congestive Heart Failure is an illness characterized by heart's inability to work effectively as a pump. Heart failure is not an event but rather an illness with many causes. Congestive heart failure is most commonly due to impairment of function of the left ventricle, the chamber which pumps blood to all parts of the body. This pumping chamber may be made ineffective by damage due to heart attacks, by valvular abnormalities, such as leaking valve or a valve that is tightly narrowed, and sometimes the damage may be related to the viral infections. Long standing untreated blood pressure, metabolic abnormalities and inherited causes are only part of a long list of problems that may lead to heart failure. In some patients, the cause of heart failure is not related to failure of left ventricle or main pumping chamber but may be related to failure of right ventricle, the chamber that pumps blood from the heart to the lungs. In this instance, underlying heart disease such as emphysema may be the cause.Patients with heart failure most often complaint of shortness of breath usually made worse with exertion. Weakness, easy fatigue ability, swelling, and inability to lie flat in bed are associated symptoms. In more extreme cases, patients may complaint of waking up gasping of air after lying in bed for a while. None of these symptoms are diagnostic of heart failure and a good physical examination and obtaining a chest films, and an echocardiogram help us to establish a diagnosis. Congestive heart failure is a serious illness and necessitates understanding what caused the heart to fail. Often, a heart catheterization study will also be necessary to enable us to devise the best treatment plan for the patient. Medications, such as Digitalis and diuretics are standard treatments but the addition of Ace-Inhibitor drugs, Beta-Blockers and most recently pacemakers that pace both ventricles of the heart, have improved the outlook for these patients greatly. There is no "cure" for most patients with heart failure, but occasionally patients with viral illnesses simply get better and replacing a heart valve when appropriate, may resolve in nearly normal heart function. Fortunately, the prognosis for the heart patients continues to improve. Anyone with symptoms of shortness of breath, easy fatigue ability or excessive swelling should seek medical attention early and aggressive evaluation and treatment provide the best chance for long term survivor.

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Health & Medicine

Wallace Maclaskey

2004-03-01 15:44:00

:  Can you tell me the benefits of 'Oral Chelation?'  

ANSWER:  Chelation therapy is used to rid the body of unnecessary and toxic metals and to reverse the process of atherosclerosis (hardening of the arteries). This is accomplished (in part) through the removal of the calcium content of plaque from the artery walls. By restoring good circulation to all tissues of the body, chelation therapy can help to avoid by-pass surgery, reverse gangrene, alleviate intermittent claudation (cramps) of the legs, and restore memory.Chelation (pronounced key-LAY-shun) comes from the Greek word chele meaning "to claw" or "bind."  The U.S. Navy began using ethylene diamine tetra-acetic acid (EDTA) in the mid-1940's to safely and successfully treat heavy metal poisoning. The doctors soon discovered that chelation did more than just remove heavy metals. The cardiovascular benefits of EDTA intravenous chelation were discovered! It was met with enthusiasm, and even conventional physicians embraced it.... for a time. However, as the treatment of heart disease gained popularity so did the promotion of new drugs and surgical procedures. Chelation therapy fell out of favor, even though (and possibly because); it offered a viable alternative to surgery. In 1988 a study of 2,870 cases, performed by the Department of Applied Science, School of Public Health and Tropical medicine at Tulane University, documented that EDTA chelation therapy brought about significant improvement in 93.9% of patients suffering from coronary artery blockage. Elmer Cranton, M.D., points out that during all the time that chelation therapy has been administered according to established protocol, not one serious side effect has been reported. He concludes, "Chelation therapy can help avoid by-pass surgery in 85% of cases." The use of oral chelation (tablets) is a firmly established alternative practice. EDTA itself, when taken orally, provides most of the chelation effects in the body, only less dramatic and slower than when received by intravenous chelation. However, oral chelation has several major advantages, including convenience, potential long-term continuous health maintenance, and lower cost. The continuous nutritional protection found in oral chelation can do more for overall longevity than even the most prudent lifestyle. Chelation offers protection against a stressful and polluted world by reducing serum cholesterol, which may decrease the likelihood of atherosclerosis. Oral chelation can be an effective, noninvasive, inexpensive choice.Robert Haskell, M.D. wrote, "Of all the regimens you can use to help combat degenerative disease and restore health, chelation therapy is the most powerful. It produces the greatest number of benefits to the body - far beyond those of improved blood flow. If you want to get prescribed nutrition to those parts of the body in which they must work…chelation therapy is the way to do it".

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Health & Medicine

Dr Galichia

2004-03-01 14:01:00

Dr, Galichia Question:  I have been taking an appetite suppressant for a diet. Recently I have been experiencing what feels like a racing heart rate, and the sensation that my heart is going to come through my chest. I exercise routinely, but these symptoms are limiting my workout even when I do not take the pill. What can I do?

ANSWER:  Many appetite suppressants contain Ephedra or amphetamine like drugs, which cause tachycardia or rapid heart beating. The compound Ephedra has recently been associated with dangerous cardiac arrhythmias, which could lead to sudden death. Anyone who has a tendency to this kind of rhythm problems, in my opinion, should not take these products. There is a great deal of concern being raised in the medical community today about the safety of these agents in general. Many physicians feel that there is no safe usage of appetite suppressants in anyone. You are complaining of accentuation of the symptom of a rapid heart beat during your workouts. Certainly, your heart rate should rise during heavy exercise. The presence of these types of stimulants in your body may indeed lower your exercise tolerance by causing your heart rate to elevate too quickly. The effect of these drugs should go away in 24 hours. The fact that you continue to have this exercise intolerance and the feeling that your heart is beating too rapidly in the absence of taking the appetite suppressant, gives me a cause for concern. There may be an underlying heart abnormality or other metabolic or blood abnormality that may be causing these symptoms. For that reason, I recommend a good physical examination, some blood tests, including a blood count and a thyroid test. Also, a treadmill EKG may help to better understand these problems.  Discuss your concern with your family doctor and ask for his or her suggestions regarding other ways to achieve weight loss and establish a good exercise program.

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Health & Medicine

Bridgette Rupp

2004-03-01 14:01:00

Bridgette Rupp Question:  What are the risk factors for breast cancer? At what age should I start having a mammogram?

ANSWER:  Breast cancer is the 2nd most common cancer in women and the leading cause of cancer-related deaths in women ages 40-55. The American Cancer Society estimates that 193,000 women will be diagnosed with breast cancer and at least 40,000 will die from the disease this year. Through mammography breast cancer is highly detectable. The earlier it is diagnosed, the greater the chance of survival. The precise cause of breast cancer is unclear. However, risk factors have been identified and are: female gender, increased age, family history, Caucasian women, and menstruation before age 12 or menopause after age 55. You can reduce your risk of breast cancer by having children before age 30, breast feeding, limiting alcohol to one drink daily, maintaining healthy weight, exercise regularly and of course pursuing mammograms as recommended by your physician. A mammogram is a radiograph of the breast. Although the radiation exposure for a mammogram is greater than from a regular chest x-ray, it is still low and comparable to the annual radiation exposure from environmental sources. It is recommended to get a baseline mammogram between ages 35-40 or sooner if risk factors exist. Then every 1-2 years from age 40-50 and yearly for ages 50 and up. Additional reasons for obtaining a mammogram at any age include palpable lumps, skin changes, nipple discharge or inversion, breast pain or swollen armpit lymph nodes. Women with breast implants should also have regular mammographic screening. Breast implants have not been associated with an increased risk of cancer, but the opacity of implants may make cancer less likely to be detected.Many patients are concerned and apprehensive about the amount of pain associated with the mammographic procedure. It can be uncomfortable but very much tolerable. The exam takes 10-15 minutes and includes two mammograms of each breast from different views. To make your experience as pleasant as possible, here are a few tips: • Avoid wearing deodorant the day of your mammogram• Wear a two-piece outfit to undress from the waist up• Schedule shortly after period ends to decrease breast tendernessRemember, the temporary discomfort of a mammogram far outweighs the possibility of saving your life in the long run! Please, keep performing self-breast exams preferably the same day of each month after your period has ended to decrease the likelihood of tenderness. If you are unsure of how to perform your self-breast exam, contact your physician.

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Health & Medicine

Dr Joseph Galichia

2004-02-01 15:36:00

QUESTION:  Glyco-nutrients seem to be one of the hottest topics in the country… I was wondering what a cardiologist has to say about them.

ANSWER: In order for cells in our body to function correctly, four major classes of biomolecules are needed. These include proteins, nucleic acids, lipids, and carbohydrates. Proteins are primary communication molecules for cells. In recent years it has been learned that not enough protein configurations existed and that another code was needed. It has been discovered that glycoproteins, protein molecules bound with carbohydrate molecules provided the extra substances needed for cellular function. It has been hypothesized that carbohydrates other than glucose were needed for this process. A great deal of interest had been placed in other sugars such as mannose, fucose, and xylose. These other sugar molecules may be important in providing enough components for glycoprotein molecules. It has not been firmly established that supplementary sugars in the forms other than glucose are needed to maintain normal cellular function.  Nevertheless, the number of nutraceutical companies have promoted these products as a treatment for many illnesses including arthritis, diabetes, cardiovascular disease, and cancer. These glyconutritional supplements may or may not be helpful but their value remains questionable in the eyes of most physicians. A great deal of research is being done in this area, which may give us more confidence in recommending these substances in the future.

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Health & Medicine

Jesse Hidalgo

2003-12-01 13:02:00

: What are  signs and types of hearing loss?  How do I know if my hearing loss is permanent?

ANSWER: While there are many signs of hearing loss, some of the most common are: Using "huh" and "what", asking people to repeat more often, playing the radio/television too loud for others, people sound as if they're mumbling, difficulty hearing conversations, hissing, roaring, or ringing in the ears (tinnitus), impatience with interruptions, avoiding groups, fatigue/irritation caused by the effort to hear, more misunderstandings and arguments, dizziness or problems with balance. There are three basic types of hearing loss:Sensorineural Hearing Loss:   Sensorineural hearing loss is caused by deterioration of the inner ear and/or the hearing nerves. It can be caused by the degenerative process associated with aging, by noise exposure, or by illness. Persons with this type of hearing loss may have difficulty understanding speech and may also be sensitive to loud noise.Conductive Hearing Loss:  Conductive hearing loss is evidenced when a person has trouble with volume as opposed to understanding ability. It stems from blockages between the inner and the outer ear. The blocks can be caused by ear infections, wax buildup or any number of problems that prevent the transmission of sound from the inner to outer ear.Mixed Hearing Loss:   Mixed hearing loss is evidenced by a mixture of the symptoms of both sensorineural and conductive types of hearing loss.   To establish if your hearing loss is permanent,  see your doctor. Your condition may be obvious to them, or they may refer you to an ENT (a doctor trained in treating diseases of the ear, nose, and throat). Hearing loss of a sensoinueral type is usually permanent.  If you are diagnosed with this, you will probably need a hearing aid.  Always remember that while your quality of life is going to be much improved, a hearing aid will not restore the same hearing God gave you at birth any more than eyeglasses will restore the same vision He gave you at birth.

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Health & Medicine

Wallace Maclaskey

2003-12-01 13:02:00

: How do I know when to add vitamin and/or mineral supplements to my diet?

ANSWER: The basic rule for good health is a good nutritional program made up of healthy foods. However, this is not as easy as it sounds. So much of the food, available to us today, has much of the nutritional value removed to build-in shelf life. Many preservatives that are foreign to our bodies are without nutritional value, as well as additives that supposedly enhance the taste. The evidence of this is overwhelming. Just look at a majority of the U.S. population that remains overweight after many billions of dollars are spent on pharmaceutical drugs and surgical procedures. Tens of millions of people don't feel good.   Nutritional science is the overlooked foundation of good medical care. In an acute care situation it appears that nutrition is not the predominant concern. Administer the drugs, perform the surgery, and deal with the situation. On closer examination, however, most acute medical situations arise out of neglect for optimal nutrition. While many factors increase the risk of illness, the universal common denominator is poor nutrition.   Pharmaceutical drugs can go a long way toward relieving acute suffering by blocking pathological mechanisms in the body. However, drugs do nothing to help the body restore true health and vitality. Cells cannot live on artificial chemicals. Cells require an array of biochemicals (vitamins and minerals) from living natural foods to sustain life. When nutrients are lacking, or toxins have accumulated beyond the body's ability to clear them efficiently, then illness and disease emerge.   Good medical care should be an attempt to correct that nutritional imbalance. To ignore nutrition at any age is to ignore basic biology. Without proper attention to the fundamental needs of the human organism for quality nutrition, health is almost certain to decline. As time passes and your health declines, it certainly indicates that your diet does not have all of the biochemicals needed to sustain a healthy body. To make up for the lack of some of the biochemicals in your diet, it becomes necessary to add a good supplement program. This gives your body an opportunity to have vitamins and minerals needed to restore and maintain good health.   Don't forget exercise! Walking can improve poor circulation, heal a sick heart and make one healthier and happier. The most important ingredient in regard to walking is to walk every day. If you aren't in the habit of taking daily exercise, start slowly, maybe 15 minutes each day. After a couple of weeks, increase the time to 30 minutes each day, and increase the pace. Two weeks later increase walking time to 45 minutes and then to one hour. Increased stamina will eventually allow you to walk 3 or 4 miles each hour. Walking calms the nerves increases circulation and lowers blood pressure.

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Health & Medicine

Dr Joseph Galichia

2003-12-01 09:52:00

: I have had a constant buzzing/pulsating sound in my head and  dizziness for  8 months. My carotid arteries and my blood pressure are fine. I was diagnosed as having a 22% discrepancy in my inner ear and have started vestubular rehabilitation and balance retraining exercises. Is my ear problem causing the sounds?

ANSWER: I'm always concerned when patients tell me they have a constant sound in their head, particularly if it's a pulsating. A constant buzzing  or tinnitus is relatively common and usually does not have any significant pathology related to it.  There are simply individuals who hear a sound or roaring noise in their head in the absence of any defined pathology. Not uncommonly inner ear problems may result in such sounds and occasionally a benign tumor called an acoustic neuroma may be the culprit. You already had an evaluation for these problems, and are being treated appropriately.     The pulsating component is always of concern.  Occasionally, blocked arteries in the neck will result the sounds which occur with each heartbeat. You have already had a Doppler Test with no evidence of carotid artery blockage, but this test does not evaluate the smaller arteries in the brain, which can also be the culprit.    Finally, irregular heart beats and high blood pressure can also cause a pulsating sound in the head. Further evaluation in my opinion should be carried out.  You have already seen an ear specialist but certainly a neurologist may be a benefit. The neurologist may recommend further testing consisting of an MRI scan of the brain combined with another test called MRA,  a type of study that can be done to look at the vessels within the brain. 

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Health & Medicine

Dr Michael Esparza

2003-12-01 09:52:00

QUESTION: Is it true that Chiropractors cannot prescribe medication? Are they real doctors?

ANSWER: Yes and yes. Chiropractors do not include medication in their treatment program. Chiropractors maintain that the body has a built-in innate capacity to restore health.   The education received by chiropractors is extremely thorough and demanding. Aspiring doctors of chiropractic receive extensive teachings in the structure and functioning of the human body, the disease processes, and how health is achieved and maintained. Chiroprac-tors are real doctors, and the modern term used for these physicians is, Doctors of Chiropractic. In chiropractic care, an emphasis is placed on the management of spinal disorders and their role in overall health and wellness.   Similar to the requirements of medical schools, prior to entering chiropractic college students must first complete 2-4 years of premed undergraduate studies - depending on the chiropractic college and state one wishes to practice in. During this time there is an emphasis on basic sciences including organic chemistry, general chemistry, physics, biology, and psychology.     Upon successful completion of the undergraduate studies, those students who are accepted to a chiropractic college enter a 4-5 year academic program, which is similar in content to medical school.    Upon graduation from a chiropractic college and the passing of all national board exams, students undergo state board examination for the state that they wish to practice in. If successful, the new doctor of chiropractic will receive his or her license for the practice of chiropractic in that state.    Once licensed, most states require the doctor of chiropractic to attend annual seminars in order to maintain a high level of competency and keep technical skills sharp and as current as possible. Failure to do so will result in the revocation of the doctor's license.   As with most Doctors of Medicine, Doctors of Chiropractic also further their knowledge and skills by completing additional studies after graduation. These 1-3 year programs provide the information to place the doctors at the top of the health care field in specific areas. Some of the areas of study include orthopedics, neurology, radiology, sports, rehabilitation, nutrition, pediatrics and research.    You may be surprised to learn that chiropractic doctors receive more class and study time in many important subjects compared with their medical counterparts. Also, currently the area of chiropractic care is the fastest growing branch of medicine. Next month we'll talk more about this, and will compare the education requirements of Doctor of Chiropractic and Doctors of Medicine.

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Health & Medicine

Beth Ellis

2003-12-01 09:34:00

: Sometimes I wake up at night soaking wet and cold. My friend told me it is probably night sweats (nighttime hot flashes), but I'm only 40. Does this mean early menopause?

ANSWER: Premenopause or Perimenopause, is the transition time between a woman's reproductive years and menopause. Typically, premenopause occurs between the ages 40 to 51, the average age is 47. But, hormonal changes may start as early as the late 30s. Premenopause is associated with a wide range of symptoms such as fatigue, mood swings, loss of sex drive, depression, cold hands and feet, irritability, headaches, weight gain, very heavy or light periods, and hot flashes. Often, a woman is prescribed estrogen by their primary care giver, when in fact what is actually needed is progesterone. When a woman enters premenopause, ovulation on a regular basis stops, which causes the body to stop producing progesterone, which creates a condition known as estrogen dominance.   Supplementing with natural progesterone cream will help bring a woman's hormones into balance. Some of the intrinsic effects of progesterone are protection against breast fibrocysts, endometriosis, as well as breast and ovarian cancer. It acts as a natural diuretic, a natural antidepressant, and relieves anxiety. Progesterone also helps thyroid function, stimulates osteoblast-mediated new bone formation, reverses osteoporosis, and reduces incidences of autoimmune disorders.   When a woman is nearing menopause, her estrogen levels start to decline. She still benefits from using progesterone cream, but may need to add phytoestrogens to help alleviate symptoms of vaginal dryness and night sweats. Phytoestrogens, including Black Cohosh bind to estrogen receptors and create a weak estrogen-like effect in the body and reduce the frequency of hot flashes. Phytoestrogens are safe, and without the side effects of synthetic estrogens.   As women, we are normally taking care of everyone else; during this transition we need to start taking care of ourselves.

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Health & Medicine

Tracy Ramsey MD

2003-12-01 08:41:00

:  With winter coming on, so does cold and flu season. How can I avoid getting sick?Answer: Tis the season for various colds and flus, although interestingly, the season never really goes away, it just gets worse around this time of year.   Colds and flus are caused by viruses.  Except for confirmed cases of influenza, there is no pill to help the virus go away faster. And for the influenza pill to be effective, it has to be diagnosed with a laboratory test within 12-24 hours within the onset of symptoms!  It does not 'kill' the virus, but in most people it does shorten the duration of flu symptoms by 24-48 hours.     There are several forms of illnesses that are generically referred to as 'the flu'.  The first is a severe cold, perhaps with bronchitis.  The second is the real 'flu' caused by the Influenza virus.  The third is a range of  intestinal viruses which is commonly referred to as 'the stomachflu'.  The 'bugs' that cause these ills are different and the symptomatic treatments vary.   Prevention is the key to all of these viruses.  The Influenza vaccine is widely available, well-tolerated and very effective.  Years ago, Influenza vaccine was made using inactivated live virus.  Unfortunately, this caused many people to get flu symptoms within a week or two of receiving the vaccine, and because of this they say, "I won't get the flu vaccine, because it gave me the flu!"  The new vaccine that is the most widely available, is made from parts of the virus that our bodies recognize andreact to - they are not 'live' so, symptoms are less likely.  Also, keep in mind, especially this far into the season, is that if you do get 'flu' symptoms after the flu shot, there are two explanations:  1) you had the virus exposure before the vaccine could take effect; or, 2) you got a different virus that has the same or similar symptoms.  The nasal form of the vaccine (a spray) is a nice thought for many who do not like needles, but unfortunately is not appropriate for those who need it the most (i.e. anyone younger than 5, older than 65 or anyone with chronic health problems.  Which brings me to ’Who needs a vaccine?’  Everyone under the age of 2, over the age of 65 and anyone with chronic health problems (even if they are under control).  as well as anyone who has any interaction with the above mentioned 'risk population.'  Why are they considered a 'risk population'?  Because they are the ones most likely to die or have complications if they get influenza.  So, even if you aren't likely to die from influenza, people around you may if you pass it on! The vaccine is available from October-March.   Last but not least, WASH YOUR HANDS frequently with soap and water!  This is a major prevention, easy to do, readily available, does not take a doctor's order or prescription and WORKS!  Intestinal viruses are mostly spread by the 'fecal-oral' route which means someone doesn't wash their hands (or doesn't wash them thoroughly), touches their hands on the doorknob or countertop, you come along and innocently pick up your food order (or someone brings it to your table), you eat and within a few days to a week or so, you have the 'stomach flu,'  or a cold, or a flu, because you rubbed your eye, or touched your mouth or swiped you nose!  See how easily this spreads?   For all of these viruses or any other illness, you should call or see your doctor if the ill person cannot keep fluids downs for more than 12 hours (if a person is vomiting, don't keep forcing stuff into their mouth and expect them not to keep vomiting.)  Sucking on ice chips or popsicles is usually enough for awhile. Giving medicines by mouth to keep someone from throwing up doesn't make sense either, but if they can keep it down, over-the-counter medicines are OK within the instructions on the box. Fevers are not bad.  If someone has a fever (>100.5 if you 1-year-old or less, >101.5 for all others), but they feel just tired, they don't need acetaminophen (generic Tylenol) or ibuprofen (generic Motrin).  Never give a child aspirin unless instructed by a physician.  But, often a person has achiness with the fever (or even increased body temperature) and needs the pain relievers.  Often, children are cranky with fevers, and so they do better with pain relievers, but what they can't tell us, probably is that they feel achy and that's why the acetaminophen or ibuprofen works.  If a child is less than 2-months-old and has an increased temperature, their doctor needs to be notified.  People who have diabetes (children and adults) whether or not they need medicine for it need to dig out a glucometer when they are sick.  Make sure they are drinking plenty of fluids, because the stress of illness can make a diabetic's  liver make more glucose, regardless of what is being eaten.  A diabetic should never stop taking their insulin because they are sick and "not eating well or throwing it all up."  Call your doctor's office for further instructions (or call the nurses hotline if your insurance offers such a service).   There is much to say about such common illnesses, much more detail than what can be covered here.  My main word of advice, is to rest (sleep when at all possible), drink at least two liters of fluids a day (unless you're not suppose to drink that much), and don't take your virus to work/school with you!  Call your doctor with any questions or concerns! ©

Tracy Ramsey, MD QUESTION:  With winter coming on, so does cold and flu season. How can I avoid getting sick?Answer: Tis the season for various colds and flus, although interestingly, the season never really goes away, it just gets worse around this time of year.   Colds and flus are caused by viruses.  Except for confirmed cases of influenza, there is no pill to help the virus go away faster. And for the influenza pill to be effective, it has to be diagnosed with a laboratory test within 12-24 hours within the onset of symptoms!  It does not 'kill' the virus, but in most people it does shorten the duration of flu symptoms by 24-48 hours.     There are several forms of illnesses that are generically referred to as 'the flu'.  The first is a severe cold, perhaps with bronchitis.  The second is the real 'flu' caused by the Influenza virus.  The third is a range of  intestinal viruses which is commonly referred to as 'the stomachflu'.  The 'bugs' that cause these ills are different and the symptomatic treatments vary.   Prevention is the key to all of these viruses.  The Influenza vaccine is widely available, well-tolerated and very effective.  Years ago, Influenza vaccine was made using inactivated live virus.  Unfortunately, this caused many people to get flu symptoms within a week or two of receiving the vaccine, and because of this they say, "I won't get the flu vaccine, because it gave me the flu!"  The new vaccine that is the most widely available, is made from parts of the virus that our bodies recognize andreact to - they are not 'live' so, symptoms are less likely.  Also, keep in mind, especially this far into the season, is that if you do get 'flu' symptoms after the flu shot, there are two explanations:  1) you had the virus exposure before the vaccine could take effect; or, 2) you got a different virus that has the same or similar symptoms.  The nasal form of the vaccine (a spray) is a nice thought for many who do not like needles, but unfortunately is not appropriate for those who need it the most (i.e. anyone younger than 5, older than 65 or anyone with chronic health problems.  Which brings me to ’Who needs a vaccine?’  Everyone under the age of 2, over the age of 65 and anyone with chronic health problems (even if they are under control).  as well as anyone who has any interaction with the above mentioned 'risk population.'  Why are they considered a 'risk population'?  Because they are the ones most likely to die or have complications if they get influenza.  So, even if you aren't likely to die from influenza, people around you may if you pass it on! The vaccine is available from October-March.   Last but not least, WASH YOUR HANDS frequently with soap and water!  This is a major prevention, easy to do, readily available, does not take a doctor's order or prescription and WORKS!  Intestinal viruses are mostly spread by the 'fecal-oral' route which means someone doesn't wash their hands (or doesn't wash them thoroughly), touches their hands on the doorknob or countertop, you come along and innocently pick up your food order (or someone brings it to your table), you eat and within a few days to a week or so, you have the 'stomach flu,'  or a cold, or a flu, because you rubbed your eye, or touched your mouth or swiped you nose!  See how easily this spreads?   For all of these viruses or any other illness, you should call or see your doctor if the ill person cannot keep fluids downs for more than 12 hours (if a person is vomiting, don't keep forcing stuff into their mouth and expect them not to keep vomiting.)  Sucking on ice chips or popsicles is usually enough for awhile. Giving medicines by mouth to keep someone from throwing up doesn't make sense either, but if they can keep it down, over-the-counter medicines are OK within the instructions on the box. Fevers are not bad.  If someone has a fever (>100.5 if you 1-year-old or less, >101.5 for all others), but they feel just tired, they don't need acetaminophen (generic Tylenol) or ibuprofen (generic Motrin).  Never give a child aspirin unless instructed by a physician.  But, often a person has achiness with the fever (or even increased body temperature) and needs the pain relievers.  Often, children are cranky with fevers, and so they do better with pain relievers, but what they can't tell us, probably is that they feel achy and that's why the acetaminophen or ibuprofen works.  If a child is less than 2-months-old and has an increased temperature, their doctor needs to be notified.  People who have diabetes (children and adults) whether or not they need medicine for it need to dig out a glucometer when they are sick.  Make sure they are drinking plenty of fluids, because the stress of illness can make a diabetic's  liver make more glucose, regardless of what is being eaten.  A diabetic should never stop taking their insulin because they are sick and "not eating well or throwing it all up."  Call your doctor's office for further instructions (or call the nurses hotline if your insurance offers such a service).   There is much to say about such common illnesses, much more detail than what can be covered here.  My main word of advice, is to rest (sleep when at all possible), drink at least two liters of fluids a day (unless you're not suppose to drink that much), and don't take your virus to work/school with you!  Call your doctor with any questions or concerns!

X

Health & Medicine

Dr Joseph Galichia

2003-11-01 14:34:00

: I had an allergic reaction to an antibiotic on the 10th day of treatment, is it possible that I can take it again just not a full 10 days?

ANSWER: An allergic reaction to an antibiotic on the 10th day of treatment will likely recur if you take the drug again. Most of these reactions are characterized by skin rashes, occasionally more serious problems occur. A difficulty breathing due to bronco spasm or swelling of the throat may result in life threatening allergic responses. Shock and vascular collapse may also complicate the allergic reaction. For these reasons, we are not inclined to challenge patients with antibiotic they have been allergic to under any circumstances.    Fortunately, we usually have a number of antibiotics to choose from when treating any given infection. It is very important to share any suspected allergic reactions with your physician and make sure this information gets to your medical record. In a rare instance, an antibiotic with known allergic response maybe given in a life threatening situation. Full knowledge of the risk is important, as accompanying drugs may be given to blunt the allergic response.

X

Health & Medicine

Wallace Maclaskey

2003-11-01 09:16:00

: Can you tell me about Oral Chelation and the health benefits it provides?

ANSWER: Chelation (pronounced key-LAY-shun) comes from the Greek word chele meaning "to claw" or "bind." Chelation therapy is used to rid the body of unnecessary and toxic metals. The Untied States Navy started using ethylene diamine tetra-acetic acid (EDTA) in the mid-1940's to safely and successfully treat heavy metal poisoning. The doctors soon discovered that chelation did more than just remove heavy metals. Today, chelation is used to reverse the process of atherosclerosis (hardening of the arteries), which is accomplished in part through the removal of the calcium content of plaque from the artery walls. By restoring good circulation to all tissues of the body, chelation therapy can help to avoid by-pass surgery, reverse gangrene, alleviate intermittent claudation (cramps) of the legs, and restore memory.   When the cardiovascular benefits of EDTA intravenous chelation were discovered, the therapy was met with enthusiasm, and for a time, even conventional physicians embraced it. However, as the promotion of new drugs and surgical procedures for the treatment of heart disease gained popularity, chelation fell out of favor and there it has remained. Even though chelation therapy offers a viable alternative to surgery. In 1988 a study of 2,870 cases, by the Department of Applied Science, School of Public Health and Topical medicine at Tulane University, documented that EDTA chelation therapy brought about significant improvement in 93.9 percent of patients suffering from coronary artery blockage. Elmer Cranton, M.D., estimates chelation therapy can help avoid by-pass surgery in 85 percent of cases. He points out that during all the time that chelation therapy has been administered according to established protocol, not one serious side effect has been reported.   The use of Oral Chelation (tablets) is a firmly established alternative practice. EDTA itself, when taken orally, provides most of the chelation effects in the body only less dramatic and slower than when received by intravenous chelation. However, oral chelation has several major advantages, including convenience, potential long-term continuous health maintenance, and lower cost.   An oral chelation program can do more for your overall longevity than you can do even with the most prudent lifestyle possible because of the continuous nutritional protection chelation offers against a stressful and polluted world. People who use oral chelation have consistently observed a reduction of serum cholesterol, which may decrease the likelihood of atherosclerosis. For those who want to safeguard themselves against free radicals and plaque buildup, oral chelation can be used as an effective, non-invasive, inexpensive choice.   Robert Haskell, M.D. wrote, "Of all the regimens you can use to help combat degenerative disease and restore health, chelation therapy is the most powerful. It produces the greatest number of benefits to the body - far beyond those of improved blood flow. If you want to get you prescribed nutrition to those parts of the body in which they must work…chelation therapy is the way to do it".

X

Health & Medicine

Dr Michael Esparza

2003-11-01 09:16:00

: What is a vertebral subluxation complex (vsc)?  How does it affect the body?

ANSWER: The vertebral subluxation complex (vsc) is defined as: A misalignment of one or more of the vertebrae in the spinal column, which causes alteration of nerve functions and interference to the transmission of nerve impulses resulting in a lessening of the body's ability to adapt and express its maximum health potential.   Simply put, a vsc is a pinched nerve.  Over the years, the term "pinched nerve" has developed into a catch-all phrase for neck and back pain.  It is important to understand that this term in accurate in describing the actual mechanism that creates nerve impulse interference.  You see, nerves are not really pinched, since that would imply that the nerve impulse is cut off completely.  A more accurate description is that the nerves are compressed or compromised.   Let’s review a little anatomy.  Your nervous system consists of the brain, spinal cord and nerves.  It is what controls and coordinates all the functions of your entire body.  The spinal cord is protected by a "tunnel" of small, interlocking bones called the spinal column.  The individual bones of the spinal column are called vertebrae.  Nerves branch off from the spinal cord through small openings between the vertebrae.     When each vertebra is properly aligned, the nerve fiber passes through without a problem and nerve impulses can flow freely, racing to and from the brain at incredible speeds.  When the vertebra are not properly aligned, the openings between them can narrow and put pressure on the nerves exiting at that level; hence the term "vertebral subluxation complex".   These subluxations prevent the body from working at it's maximum ability, by interfering with the normal flow of messages along the nerve fibers.  These messages traveling along the nerve fibers will now be distorted.  If the correct message cannot pass to and from the brain, some part of the body will be adversely affected and can lead to pain and/or disease.   Medical doctors refer to this as "nerve encroachment" or "neuro spinal compression".  Doctors of chiropractic refer to this as "vertebral subluxation complex".   Chiropractic is the only health care profession whose primary emphasis is on locating, understanding and correcting the vertebral subluxation complex.  The spinal manipulation, properly administered by a licensed doctor of chiropractic is generally relied upon as the most effective treatment for the "vertebral subluxation complex". Don't let your bones get on your nerves!!  Don't delay, seek chiropractic treatment today! More on this silent killer next month.

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Health & Medicine

Dr Joseph Galichia

2003-10-01 11:35:00

:  Are there different kinds of strokes? Is a TIA considered a stroke?  What is a mini stroke? Are all mini strokes TIAs? I've read where you can do something to prevent damage from a heart attack if attended to quickly enough. A stroke on the other hand does its damage immediately doesn't it?

ANSWER: There are two types of strokes that we commonly see. Most strokes are due to a clot, which forms in a vessel within the brain, interrupting a blood flow to a part of the brain. This results in a loss of neurologic function in that area. This occurs in about 80-85% in all stroke patients. In another 15-20%, the underlying problem is due to bleeding into the brain tissue. This is known as hemorrhagic stroke. This type of stroke occurs when there is a rupture of an aneurysm within the brain or leakage of a blood vessel.  It is important for us to determine immediately which type of stroke we are dealing with because the treatment is entirely different.  In the case of a blocked artery due to a clot formatting, clot busting drugs and blood thinners are initiated immediately. These measures are strongly contra-indicated when a hemorrhagic stroke has occurred.   A mini stroke or TIA is also known as a transient ischemic event.  These terms are synonymous and mean that the patient has suffered a brief period of neurologic dysfunction and has recovered, at least momentarily.  In simple terms, the patient has developed some loss of neurologic function usually for a few minutes, but has recovered with no residual problems.    The types of neurologic changes may include inability to speak properly, loss of feeling or ability to move an arm or leg, inability to think properly, loss of vision, facial weakness, or any neurologic change. If these symptoms persist, the patient develops a completed stroke. It is important for all of us to understand the importance of these symptoms.  Should any of these symptoms occur, it is imperative to seek immediate medical attention. Even if the symptoms go away completely, they are often the early warning that a full-blown stroke is about to occur. Many patients are so frightened by these events that they try to put the experience out of their minds and go about their business and hope the symptoms never recur. Unfortunately, they usually do and often simply do not go away again. There are many things we do immediately when a TIA occurs. Immediate evaluation of the carotid arteries in the neck must be undetaken to see if plaque exists that may have broken loose and traveled to the brain. A cat scan is usually performed to see if bleeding may have occurred and to see if a small stroke can be identified. In other words, a full and immediate neurologic evaluation should be performed and blood thinners should be started as well as aspirin to help prevent clot formation. If the patient obtains immediate help and these measures are instituted, most of these patients do not go on to completed stroke.

X

Health & Medicine

Wallace Maclaskey

2003-10-01 09:00:00

: I’ve heard some things about ‘Oral Chelation,’ but I’m still not certain what it is.  Can you tell me more?

ANSWER:  Chelation (pronounced key-LAY-shun) comes from the Greek word ‘chele’ meaning "to claw" or "bind." Chelation therapy is used to rid the body of unnecessary and toxic metals. The Untied States Navy started using ethylene diamine tetra-acetic acid (EDTA) in the mid-1940's to safely and successfully treat heavy metal poisoning. The doctors soon discovered that chelation did more than just remove heavy metals. Today, chelation is used to reverse the process of atherosclerosis (hardening of the arteries), which is accomplished in part through the removal of the calcium content of plaque from the artery walls. By restoring good circulation to all tissues of the body, chelation therapy can help to avoid bypass surgery, reverse gangrene, alleviate intermittent claudation (cramps) of the legs, and restore memory.   When the cardiovascular benefits of EDTA intravenous chelation were discovered, the therapy was met with enthusiasm, and for a time, even conventional physicians embraced it. However, as the promotion of new drugs and surgical procedures for the treatment of heart disease gained popularity, chelation fell out of favor and there it has remained, even though chelation therapy offers a viable alternative to surgery.  In 1988, a study of 2,870 cases by the Department of Applied Science, School of Public Health and Tropical Medicine at Tulane University, documented that EDTA chelation therapy brought about significant improvement in 93.9 percent of patients suffering from coronary artery blockage. Elmer Cranton, M.D., estimates chelation therapy can help avoid bypass surgery in 85 percent of cases. He points out that during all the time that chelation therapy has been administered according to established protocol, not one serious side effect has been reported.   The use of Oral Chelation (tablets) is a firmly established alternative practice. EDTA itself, when taken orally, provides most of the chelation effects in the body only less dramatically and slower than when received by intravenous chelation; however, oral chelation has several major advantages, including convenience, potential long-term continuous health maintenance, and lower cost.   An oral chelation program can do more for your overall longevity than you can do even with the most prudent lifestyle possible because of the continuous nutritional protection chelation offers against a stressful and polluted world. People who use oral chelation have consistently observed a reduction of serum cholesterol, which may decrease the likelihood of atherosclerosis. For those who want to safeguard themselves against free radicals and plaque buildup, oral chelation can be used as an effective, noninvasive, inexpensive choice.   Robert Haskell, M.D. wrote, "Of all the regimens you can use to help combat degenerative disease and restore health, chelation therapy is the most powerful. It produces the greatest number of benefits to the body - far beyond those of improved blood flow. If you want to get your prescribed nutrition to those parts of the body in which they must work…chelation therapy is the way to do it.”

X

Health & Medicine

Dr Michael Esparza

2003-10-01 08:27:00

: What is Chiropractic?

ANSWER: Chiropractic is a branch of the healing arts, which is based upon the understanding that good health depends in part upon a normally functioning nervous system (especially the spine, and the nerves extending from the spine to all parts of the body). "Chiropractic" comes from the Greek word ‘Chiropraktikos,’ meaning "effective treatment by hand." Chiropractic stresses the idea that the cause of many disease processes begins with the body's inability to adapt to its environment. It looks to address these diseases not by the use of drugs and chemicals, but by locating and adjusting a musculoskeletal area of the body, which is functioning improperly.   The conditions that doctors of chiropractic address are as varied and as vast as the nervous system itself. All chiropractors use a standard procedure of examination to diagnose a patient's condition and arrive at a course of treatment. Doctors of chiropractic use the same time-honored methods of consultation, case history, physical examination, laboratory analysis and x-ray examination as any other doctor. In addition, they provide a careful chiropractic structural examination, paying particular attention to the spine.   The examination of the spine to evaluate structure and function is what makes chiropractic different from other health care procedures. Your spinal column is a series of movable bones, which begin at the base of your skull and end in the center of your hips. Thirty-one pairs of spinal nerves extend down the spine from the brain and exit through a series of openings. The nerves leave the spine and form a complicated network which influences every living tissue in your body.   Accidents, fall, stress, tension, overexertion, and countless other factors can result in a displacement or derangement of the bones in the spinal column known as vertebral subluxations, causing irritation to spinal nerve roots. These vertebral subluxations are often what cause malfunctions in the human body. Chiropractic teaches that reducing or eliminating these subluxations to the spinal nerves can cause your body to operate more efficiently and more comfortably.   Chiropractic also places an emphasis on nutritional and exercise programs, wellness and lifestyle modifications for promoting physical and mental health. While chiropractors make no use of drugs or surgery, doctors of chiropractic do refer patients for medical care when those interventions are indicated. In fact, chiropractors, medical doctors, physical therapists and other health care professionals now work as partners in occupational health, sports medicine, and a wide variety of other rehabilitation practices.  Chiropractic is one of America's fastest growing health care fields today. It has become the largest drugless health care profession in the world because it has helped millions of people recover from sickness, disease and disability by minimizing the use of drugs and surgery in their lives!   In the November issue, we will discuss further, vertebral subluxations, and how it works.

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Health & Medicine

Dr David A Jernigan

2003-08-01 13:57:00

:  I recently read about a woman who had an illness that was being treated with conventional medicine and not getting better.  She started a program call ‘circuit healing’.  What is it?

Dr. David A. Jernigan Question:  I recently read about a woman who had an illness that was being treated with conventional medicine and not getting better.  She started a program call ‘circuit healing’.  What is it?Answer:  Perhaps the following example can help best in answering your question.  If you were to take the back off of a Swiss watch, you would see an incredibly complex system of gears. The precision that has made these watches famous, is created by many gears meshing together. Each of the gears is a separate piece, but each gear is interconnected with the rest of the gears through a complex system to ultimately achieve perfect time keeping.What would happen if you removed or damaged one gear? The precision would be lost and the watch would be completely useless. Not one gear out of the dozens of gears in a Swiss watch can perform its function if even one gear is missing or damaged.The human body is much more complex than the most intricately designed Swiss watch. Similarities can be made however. The circuits of the body can be likened to the various gears in the watch. Bach circuit in the body must work in unison with all of the other circuits of the body. The precision of the watch is determined by the perfect timing and rhythm of every single gear. The precision of the body is determined by the perfect function and rhythm of every single circuit,Imagine if you will, that the circuits of the body were simply gears that fit together and all had to be turning at the same time in order to function. Can you see if all of the gears were stuck, then repairing one gear will never get the body functioning? This is way most medicine is practiced today. The "Specialist" doctor attempts to get his "gear" unstuck. He can't tell that the gear is stuck because of something gone wrong far removed from his stuck gear because he is focusing only on his specialty...that one gear.Circuit Healing is used to find the cause of the symptoms. Unlike traditional medicine that specializes on one aspect of the circuit, for example, a heart doctor.  One needs to look at the whole circuit and identify the primary problem. Once the problem is identified and corrected the entire circuit goes back to 100% or maximum electrical capacity. Optimal health is achieved and maintained by keeping all of the body circuits functioning as close to 100% as possible.

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Health & Medicine

Dr John Wheeler

2003-08-01 11:02:00

: I’ve heard about Acupuncture in the news lately, and that it may help my arthritis.  I’d like to know more about Acupuncture and if it really works.

ANSWER: Acupunc-ture first made American headlines in 1971 during President Nixon’s visit to China.  While there, visiting columnist James Reston received an emergency appendectomy performed successfully under Acupuncture anesthesia.  Since that time, Acupuncture has remained in the headlines because of the numerous studies and reports that have been published documenting the success of Acupuncture with a variety of conditions.Simply stated, Acupuncture is a health science, which is used to successfully treat both pain and dysfunction in the body. Authorities agree the science is between 5,000 and 7,000 years old with deep roots in China.Early Chinese physicians discovered there is an energy network traversing just below the surface of the skin that communicates from the exterior to the internal organs and structures at over 1,000 “Acupoints” on the body.  This energy flow courses over twelve main meridians or channels in the body that are normally well balanced.  If a disruption of energy flow exists, it can alter the entire system, producing pain or symptoms in the body.  Much like a seesaw that is out of balance with a heavy and light person at opposite ends, Acupuncture helps bring the body’s energy back to a balanced point.This is the goal of Acupuncture, to restore normalcy to the body’s energy balance by utilizing a combination of Acupoints located on the twelve main meridians.  This is accomplished by a variety of means, the needle is just one.  In fact, many physicians certified in Acupuncture and licensed Acupuncturists are employing electronic and laser stimulation to the Acupoint with equal effectiveness as the needle.  Both of these procedures are painless and are quickly becoming standard worldwide.The World Health Organization has indicated Acupuncture is effective for acute and chronic pain relief, migraine, tension cluster and sinus headaches, trigeminal neuralgia, bladder dysfunction, bed wetting, neck and back pain, shoulder and tennis elbow, post-operative pain relief, gastric problems, asthma, allergies, skin conditions, hemorrhoids, abnormal blood pressure, fatigue, anxiety, various eye problems, etc., etc.There are other situations in which Acupuncture may be useful according to the National Institutes of Health, such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, asthma, low back pain, carpal tunnel syndrome, and osteoarthritis.In summary, Acupuncture is effective for a variety of health related conditions, including arthritis.  The number of treatments required will vary depending upon your unique condition.  Some patients notice immediate improvement after their first visit, while others may not notice any effect until the seventh or eighth visit.  Ask your practitioner to develop a treatment plan and explain it thoroughly during your initial visit.  If the treatments are recommended and the result occurs in just a few visits, the doctor may elect to discontinue further treatment.

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Health & Medicine

Dr Galichia

2003-08-01 09:57:00

: What exactly is PVD and what are its symptoms?

ANSWER:  Peripheral Vascular Disease (PVD) is a common form of atherosclerosis, or disease that causes blockages in arteries. Peripheral Vascular Disease refers to blockages in arteries outside of the heart, i.e. kidneys, legs, neck, brain and arteries in the arms. Most of these patients have generalized atherosclerosis involving all of the arteries in their bodies, including heart arteries or coronary arteries. Although, the majority of the problems occur in the lower extremities, these patients are at greater risk for heart attack, stroke and kidney failure. 48% of the patients have blockages in all major vascular beds. And 68% of patients with Peripheral Vascular Disease also have heart disease. PVD of the lower extremities is the most common form of Peripheral Vascular Disease. It effects 12% of the adult population and 20% over the age 70. It is more common in men than women under age 65, but over age 65, the incidents are equal. In our experience, 65% to 70% of patients are smokers. While most patients have symptoms, one third of all patients have no symptoms at all. The most common symptoms include pain in the hip, buttocks or calf brought on by walking and relieved with rest. This pain tends to be reproducible as patients often say they know exactly how far they can walk before they develop pain. This symptom is known as claudication in the medical literature. Most patients state that these symptoms interfere with their daily activities, as the disease progresses skin discoloration, non-healing ulcers and limb loss become major problems. Risk factors for PVD in addition to smoking include diabetes and advancing age beyond 65. Other risk factors include: high blood pressure, high cholesterol, sedentary life style, heredity, and known existing coronary artery disease. The diagnosis is made from the history of claudication or leg pain, decreased pulses in the legs, abnormal leg blood pressures, decreased walking ability, and abnormal doppler (wave form) studies of the legs. Ultimately, angiography or the injection of dye in the arteries is used to define where blockages occur and a possibility for treatment. Understanding all these components, including patients' symptoms and the anatomy of vascular abnormalities helps us to establish the best treatments. There are some fundamental treatments that all patients with Peripheral Vascular Disease should undergo. These include diet, daily walking, smoking cessation, and the management of diabetes or another underlying illnesses. Stopping smoking may improve the symptoms associated with this disease tremendously and as a first step treatment for all smokers.  Walking until pain develops and then performing this exercise repetitively is another mainstay of treatment. The use of Aspirin and other platelet inhibitors such as Plavix also improve symptoms.  A drug specifically designed for patients with PVD known as Pletal may help dramatically. The use of non-surgical procedures such as balloon angioplasty or arterial stent placement is a way of improving the anatomy and restoring the blood flow to the legs by decreasing the amount of blockage. We have been doing these procedures for over 20 years in the Galichia Medical Group and continue to be impressed by the short-term and long-term results.  The use of stents, or small wire mash devices deployed in the arteries to keep them open after a balloon procedure has helped improve the chances of a good long-term result in these patients. As a last resort, surgery may also be a great value to improve symptoms and spare limb loss. Employing all of these modalities and opting for early non-surgical intervention greatly improves the outlook for these patients.

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Health & Medicine

Dr Joseph Galichia

2003-07-01 13:54:00

:  I have on again, off again chest discomfort. I am concerned that it may be angina? But, I also have a "pre-ulcer" in the esophageal lining to my stomach, so I have a lot of heartburn trouble? It's difficult to determine which is which. Should I be concerned?  If I exert a fast run to the mail box, I do experience discomfort in the chest. I know I need to reduce my weight and start an exercise program. I had heart exams (cardiac) in 1996 and again in 2000, they couldn't find anything. However, my cholesterol has risen to 195, from 155 a year ago. I am a 46 year. old female. I weigh 210 pounds.  I'm 5'9” tall. I feel a dull, pressure under my left breast.  When I put my hand over it and push down it feels better. I wonder if this is the start of something?

Dr. Joseph Galichia Question:  I have on again, off again chest discomfort. I am concerned that it may be angina? But, I also have a "pre-ulcer" in the esophageal lining to my stomach, so I have a lot of heartburn trouble? It's difficult to determine which is which. Should I be concerned?  If I exert a fast run to the mail box, I do experience discomfort in the chest. I know I need to reduce my weight and start an exercise program. I had heart exams (cardiac) in 1996 and again in 2000, they couldn't find anything. However, my cholesterol has risen to 195, from 155 a year ago. I am a 46 year. old female. I weigh 210 pounds.  I'm 5'9” tall. I feel a dull, pressure under my left breast.  When I put my hand over it and push down it feels better. I wonder if this is the start of something?Answer:  Any pain above the waist is potentially related to the heart.  However, the strict definition of angina pectoris is pain in the center of the chest brought on by exertion and relieved with rest or nitroglycerin.  The pain may radiate to the neck, jaw or left arm and is most often a pressing sensation or a burning pain.  The significance of this type of symptom is that it best correlates with chest pain of cardiac origin.  Your complaint of pain running to the mailbox is certainly suggestive of cardiac pain by this definition.  Like most patients, however, you do not present with a simple situation.  You have a known gastrointestinal problem, possibly esophagitis which may cause similar symptoms.  People with ulcers, gastritis, or esophagitis may also experience chest pain, sometimes with exertion.  In this regard, I always tell my patients that no one ever read the textbook and told me a perfect story for one condition or the other and thus, I must always get more objective information.  A good physical exam and some basic tests such as a treadmill test, echocardiogram and a chest film may steer me towards the diagnosis of heart disease.  Looking into the stomach and esophagus with an endoscope and doing a gallbladder sonogram are usually part of a good examination of the G.I. tract.Certainly, losing weight and lowering your cholesterol are part of a good long-term strategy for wellness, but establishing a diagnosis of your condition now is critical.  Missing the diagnosis of heart disease could result in a heart attack or sudden death.  Failure to diagnose a gastrointestinal problem or other cause of your pain could result in bleeding or a host of other serious problems.  Making the diagnosis early is always to your advantage.Question:  I am 68 years old and I noticed that I get short of breath when I try to do anything quickly.  Also, I am more fatigued than I have ever been in my life. Could this be my heart?Answer:  Increasingly, we find that people with shortness of breath do indeed have underlying heart disease.  There are many other things that can cause us to feel short of breath and fatigued, including anemia, chronic lung disease, a lack of physical conditioning, or being overweight to name a few.  However, in my practice I have found that when people come to me with this complaint, there is usually something serious going on.  I always look to see if the patient has anemia and evaluate for lung disease.  But in many instances, we find that, indeed, the problem lies in the heart.  Most of these patients have blocked arteries that are causing their heart to function poorly when they exercise, thus causing them to get short of breath.  Similarly, a feeling of extreme fatigue may be the first warning sign that you have heart disease.   Many of our patients have heart murmurs caused by valvular problems, which may also cause these symptoms. A thorough evaluation is always indicated, in my opinion, if someone even thinks they are more short of breath than they have been in the  past.  A good physical examination, a Treadmill test, chest x-ray, and quite often, an echocardiogram, help to rule out heart disease and a pulmonary function test helps us understand if the lungs are functioning properly. These are all simple tests with little or no risk to the patient.  Of course, a simple blood test, including a blood count to rule out anemia, and a quick assessment of the kidney function, liver function and the patient's cholesterol level, help guide me towards a more complete understanding of why the patient is experiencing shortness of breath.  Question:  I have had high blood pressure for 15 years and I have faithfully taken my medications maintaining my blood pressure.  Recently, however, for no reason whatsoever, my blood pressure has started to get out of control and my doctor  had to add a new medication.  Still my blood pressure tends to run high and I am worried that something new may be going on to cause this.  What should I do next?Answer:  I view a sudden change in blood pressure as a tip off that something new is happening in the body to cause this problem.  One in every four American adults has high blood pressure and 9% of those patients have what we call essential hypertension.  Essential hypertension simply means that there is no known cause of the blood pressure elevation.  No tumor, no blocked artery and no other underlying condition exists to cause the blood pressure to go up.  In many of these patients, it is hereditary and in some individuals, it may be related to inactivity or being overweight.However, in a smaller number of patients in my own practice, in about 15 to 20 percent, there is indeed something causing the blood pressure to be elevated.  In many instances, we are dealing with a blocked artery in the kidney that is narrowed and disturbs the blood flow to the kidney. This causes the rise of certain hormones that are produced by the kidney and they cause vasoconstriction (narrowing of the cavity of a blood vessel) and the retention of sodium in the body, which tends to raise the blood pressure. This condition is known as renal artery stenosis and must always be considered in someone who suddenly has a rise in his or her blood pressure.  I find that it is something I consider in all patients who present me with new onset hypertension, including younger patients, even in their teen's and twenties.  In older patients, particularly those who have been stable for some period of time and have a sudden change in their blood pressure, I am always concerned about the possibility of renal artery stenosis (narrowing of the arteries to the kidney).Renal artery stenosis can cause both the top number (systolic pressure) and the bottom number (diastolic pressure) to rise dramatically.There is a non-invasive test, which is called a renal Duplex scan, used often in our clinic to help make this diagnosis.  In some instances, the renal Duplex scan simply cannot see the artery well enough for us to be certain about it and a dye test may be necessary to make the diagnosis.  Fortunately, balloon dilatation of the narrowed vessel, most often also entailing putting a stent in the artery, will usually cause the blood pressure to be more manageable.  A second benefit of finding a blocked kidney artery and addressing the problem is that, in many instances, we actually save the kidney and also enable to the patient to prevent kidney failure.If your blood pressure is difficult to manage, or if you have new onset of high blood pressure, you should ask your doctor about the possibility of a blocked kidney.

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Health & Medicine

Jennifer Ferguson

2003-04-01 10:06:00

:  We have just recently received a diagnosis on our 4-year old son that he has cystic fibrosis.  For a long time we thought it was asthma... so did the doctors.  We have heard so many horror stories, are there any other parents out there who can help us realize what is ahead for us and him?

ANSWER:  From one parent of a child with Cystic Fibrosis (CF) to another, I understand how scared you must be. The diagnosis of any chronic disease for a child can be devastating. I clearly remember that my family felt that the world was crashing in on us when the neonatologist told us that our son, Ashton, had CF. He was born 11 weeks premature due to a blocked intestine which we later learned was caused by CF. We went through a stage of disbelief, then anger and now acceptance. Our lives now revolve around caring for our son and trying to raise money for a cure. Cystic Fibrosis causes the body to produce an abnormally thick, sticky mucus which obstructs the lungs and pancreas making it hard to breathe and gain weight. Persistent coughing is another common symptom.  Many children are misdiagnosed with asthma or allergies. The bad news is that your son has CF. The good news is, you can start treating him and getting adjusted to your new life. Now that your son has been diagnosed, you can be proactive in his treatment by educating yourself. Learn as much as you can about Cystic Fibrosis, the medications he will be taking and the therapy you will give him. Your son has a few changes in store for him. First, at every meal, he will need to take digestive enzymes that will help him absorb the nutrients. Your CF dietician will help you determine how many pills he will need to take and draw up a meal plan. Second, he will need extra fat and calories in his diet. CF kids have a hard time gaining weight so the more fat he can have, the better. Third, your son will need Chest Percussion Therapy (CPT). This requires vigorous percussion (by using cupped hands) to dislodge the thick mucus from the lungs. Fourth, do everything you can to keep your son healthy and active. Try to avoid others who are ill and encourage frequent hand washing.  And finally, your son will experience periodic infections that may require hospitalizations and IV antibiotics. Always remember that your son is a child first and a child with CF second. Allow him to have as normal a childhood as possible. Keep a positive attitude and love him with all your heart. For more information about CF, visit the Cystic Fibrosis Foundation website at http://www.cff.org/ 

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Health & Medicine

Dr George Watson

2003-04-01 10:06:00

QUESTION:  I had a heart attack 16 years ago, then 5 bypasses 10 years ago. I have been taking heart medications for many years. If one was to use chelation therapy, does he quit taking his medications? If he continues, how does he know whether or not chelation will work with them?

ANSWER:  You are definitely a good candidate for EDTA chelation therapy. I am sure you know that, statistically, there is a 50-60% chance that your bypasses were already blocked just five years after surgery. I am sure your lifestyle change, genetics, medications and Creator's blessings have all contributed to your continued health. If you were to add chelation therapy to your regimen, do NOT quit taking any of your medications. Only when we can document a significant change in a measurable parameter would we begin to gradually reduce your medication. For example, if your blood pressure was consistently below 110/70 with a regular heartbeat rhythm, then we would discuss slowly decreasing blood pressure and cardiac medications with the physicians who prescribed these medications. Doppler studies demonstrate improved blood flow, and increased walking distance before leg pain is a measurable demonstration of improvement.  There are many other ways to MEASURE your improvement with chelation therapy. Again, we don't want anyone to rush to make a decision without being able to think about their options. And no doctor should make these important decisions for you. The Coronary Artery Surgery Study, with eleven major cardiac hospitals participating, followed 780 patients for more than twelve years. They found that the death rate for patients who did NOT have surgery or angioplasty was only 2 percent per year, and the researchers concluded that tens of thousands of bypass operations every year were unnecessary and could be eliminated. Recommendation: Read Bypassing Bypass Surgery, by Elmer Cranton, M.D. Then, decide for yourself what is best for YOU.

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Health & Medicine

Pam Harjo

2003-04-01 05:59:00

:  What are autoimmune diseases? Are they more prevalent today? Once contracted, are they forever?

ANSWER:  As I have previously stated, I am not a medical doctor, but I will attempt to explain in layman terms what I have learned through my work as an HIV/AIDS educator and counselor, and because of my ethnicity... the things I have learned about autoimmune diseases. There is a complex network of cells and molecules that work to defend the human body against infections caused by viruses, bacteria, or anything foreign that may invade the human body, this network is called the immune system, the immune system lives in the human blood. When the immune system identifies a foreign substance it will send out cell "warriors" to attack the foreign substance and kill it. When a person has an autoimmune disease, their immune system mistakenly identifies and attacks it's own human body cells, organs, or tissues as if they were foreign invaders that don't belong. It is as if a person becomes allergic to parts of their own body. There are many autoimmune diseases (over 30), some examples are; lupus, multiple sclerosis, Crohn's disease, psoriasis, and rheumatoid arthritis. Autoimmune diseases cause inflammation, pain and damage that can effect different parts of the body and the damage may be permanent. There are millions of Americans who are diagnosed with autoimmune diseases, however it has been noted that women, and especially minority women are more likely to be diagnosed with an autoimmune disease. Can you catch an autoimmune disease? No. These diseases are not spread to other people like infections, and they are not related to AIDS. However, members of the same family may have autoimmune diseases because they have inherited a gene or set of genes that has predisposed them to develop certain diseases. Now, take the predisposed genetic makeup and add in chronic stress, environment, aging, some viral infections, hormones, or pregnancy, any of these could trigger a person to develop an autoimmune disease.Once you have been diagnosed with an autoimmune disease, it is chronic.  This means you will always have the disease. The good news is, for some of the autoimmune diseases, if caught early enough and with very aggressive treatment, you can control the symptoms, or even go into remission (as if you don't even have the disease). However, you will always have to be followed by a doctor to be monitored and given appropriate medications.There are increasing cases diagnosed of rheumatoid arthritis, scleroderma, and lupus affecting more Native Americans than the general U.S. population, which includes all other minorities.HIV is a virus that causes AIDS, and as I mentioned above AIDS (an acquired immune deficiency) is not related to autoimmune diseases. However, if a person with an autoimmune disease contracts HIV, they will progress into an AIDS diagnosis faster, because their immune system is already compromised. 

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Health & Medicine

Dr George Watson

2003-03-01 11:49:00

QUESTION:  Why can't chelation therapy be done with a pill instead of intravenously?

ANSWER:  When we ingest a pill, it is digested in the stomach, absorbed through the intestine, and metabolized in the liver. Let's look at two natural chelates. Chlorophyll, the plant-greening pigment, is a chelate of magnesium. Hemoglobin, the oxygen-carrying pigment of red blood cells, is a chelate of iron. Free hemoglobin (outside the red blood cell) is metabolized by the liver (broken down) to iron and bilirubin, which, in excess causes the yellow color of jaundice. So, it should be clear that the best route to achieve consistent, effective, and SAFE concentrations of EDTA, is the intravenous route. That way, we get the BENEFIT before the liver has a chance to break it down and the kidney has a chance to excrete it.

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Health & Medicine

Dr Joseph Galichia

2003-02-01 15:30:00

:  Has technology gotten to the point where one can get heart bypasses without it being so invasive?

ANSWER:  Coronary bypass surgery is most commonly done by a sternal splitting procedure and the putting the patient on a machine, which does the work of the heart while the surgeon performs the bypass procedure.  Recent efforts have been made to reduce the extent of the surgery and cause less trauma to the body.  "Beating heart" surgery and more recently robotic surgery attempt to address the problem."Beating heart" procedures can be done without putting the patient on a bypass machine and is now being performed in about 15% of cases in many centers.  This cuts down on the time of the procedure and in most cases reduces the risk with a lesser amount of recovery time.  Nevertheless, there are many patients who are not candidates for this type of procedure.  The use of this technique is growing.A new frontier is emerging with the use of robotics.  This approach will enable the surgeon to forego the sternal splitting part of the operation and use a robotic device to place the bypass grafts in the right position.  Many patients can go home in a couple of days and the risk appears to be less.  Again, not all patients are candidates for this procedure and it is not available in more than eight or ten centers in the U.S. today.  Certainly we will see great progress in the next few years in the entire field of robotic surgery.

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Health & Medicine

Dr Holly Alexander

2003-02-01 15:30:00

:  What is Sickle Cell Anemia?  What causes it?

ANSWER:  Red blood cells are an important component of blood that transport oxygen from the lungs to all the cells of the body.  Hemoglobin, the molecule in a red cell that actually carries the oxygen, is made up of 2 pairs of smaller molecules called alpha globin and beta globin.  Everyone inherits one gene for alpha globin and one for beta globin from each of his or her parents.When a person inherits an abnormal alpha or beta globin gene from one parent and a normal gene from the other parent, the person may not realize that he or she is a "carrier" of the disease.  These individuals rarely have symptoms, but they could pass the abnormal gene to their children.  However, when a person inherits an abnormal gene from each parent, the abnormal hemoglobin molecule doesn't carry oxygen as efficiently as the normal molecule. There are many different abnormal alpha or beta globin genes.  Sickle Cell disease is due to one of the most common abnormalities in the beta globin gene. It changes the shape of the hemoglobin molecule and causes the red blood cell containing it to change from the normal doughnut shape to a sickle shape, hence the name.  These abnormally-shaped cells are more likely to be destroyed as they pass through the blood vessels and organs of the body.  This causes severe pain and damages organs such as the lungs, kidney, liver and spleen.  The abnormal hemoglobin associated with Sickle Cell disease is most common in equatorial Africa.  That is why it is most common in African-Americans, but people from the Middle East, India and the Mediterranean regions also  have an increased prevalence of abnormal hemoglobin diseases, including Sickle Cell disease.  These abnormal hemoglobins seem to offer some protection against malaria, which is thought to be the reason they developed in this part of the world.In the US, Sickle Cell disease occurs in about 1:15,000 babies, but African Americans have a higher incidence of about 1:4,000.  Most states, including Kansas, have a program to screen babies at birth to detect abnormal hemoglobins (as well as several other genetic diseases) so that the child can be cared for to try to decrease the long-term complications of the disease.  These screening programs have been very successful in providing care to those who are affected and in decreasing deaths due to Sickle Cell disease.

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Health & Medicine

Kelly Guthrie

2003-01-01 12:18:00

:  I have a problem in my lower back on the right side.  It is from golf.  It goes out quite frequently and I have to have it put back in by a chiropractor.  My question is... will this eventually get worse or can one's joints get put back into place an unlimited number of times?

ANSWER:  It is first important to understand what adjustments are.  Chiropractic adjustments, or manipulations, remove restrictions in joint motion.  · A joint is formed when:  two bones, that have motion, meet.  · Restrictions are due to:  joint (bone) misalignment and/or from tissue injury (joint capsule, ligaments, muscles)· Tissue:  holds the joints together.Bones do not generally hurt.  More often, it is the tissue around and connected to bones that causes pain.  It is this same tissue that can cause joints to become misaligned.  For the most part, during a chiropractic adjustment, it is the soft tissue that is being treated.  The popping sound normally associated with an adjustment is due to the vacuum that is created when joints are slightly separated (not crunched or cracked).The key considerations for answering your question are frequency and duration.  Receiving too many adjustments over a long period of time is sometimes referred to as being over-adjusted.  The primary risk of being over-adjusted is joint hypermobility.  Hypermobility occurs when the tissue connected to the bones allows the joint to bend too far.  If a joint is hypermobile, it should NOT be adjusted; if it is, it will very likely worsen.So, how much is too much?  There isn't a magical number and it depends upon the person's age, the joint itself, and the type of injury.  Receiving an adjustment five days a week for one to two weeks, immediately following certain injuries, could be beneficial.  I would not advise though, that you continue with that frequency beyond 4 to 6 weeks.  If over a year's time, someone averaged one to two adjustments a week - you wouldn't normally expect problems; three a week - caution may be warranted; five or more a week - not a good idea.  The aforementioned frequencies are based on the assumption that the adjustments are administered to the same joint repeatedly.

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Health & Medicine

Robert Scheibmeir

2003-01-01 12:18:00

:  What are orthotics? 

ANSWER:  Orthotics are orthopedic devices designed to treat or adjust various biomechanical foot disorders. They may be simple, commercially made devices, such as cushioned heel cups or insoles for shoes. These are sold over-the-counter in drug stores or other retail establishments. The best orthotics, however, are custom-tailored devices specifically crafted to meet the needs of a particular individual. This is done by making an impression of the foot called a cast. The impressions in the cast duplicate any misalignments in the foot. Specialists in an orthotic laboratory can then correct the misalignments with compensation and stabilization techniques. The finished orthotic is then placed in the patient's shoe and helps keep the foot in proper alignment. Depending upon the patient's needs, the orthotic may have padding to cushion the foot against the weight of the body. In general, podiatrists group orthotics into four broad categories. Functional orthotics incorporate special wedges to adjust the heel or forefoot, correcting defects in the arch that cause poor shock absorption, such as excessive pronation (flattening of the arch) or supination (an arch that is too high). Weight-dispersive or accommodative orthotics typically feature padding designed to relieve pain caused by excessive pressure on the metatarsal heads. Other accommodative orthotics are designed to treat pain and pressure on the sesamoid bones, collapsed tarsal bones, sores and chronically inflamed toes. Supportive orthotics are arch supports usually prescribed to treat problems of the plantar arch. Early childhood orthotics are special devices designed to correct biomechanical walking problems identified in young children. They include splints, gait plates and night bars - devices used to hold a child's feet and legs at a proper angle while sleeping, thus promoting corrective adjustment for excessive toe-in or toe-out walking.  Next time we will talk about who should use an orthotic.

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Health & Medicine

Robert Scheibmeir

2002-12-01 09:36:00

:  What are calluses?  Are some people more prone to getting them than others?

ANSWER:  Calluses are areas of skin that thicken in response to repeated pressure and friction. They are the body's way of protecting the skin and the structures beneath it from injury. Calluses can form on the skin of any part of the body that is exposed to excessive pressure or friction.Sometimes they are useful. People who work hard with their hands typically develop thick calluses that protect their fingers and palms from nicks, scratches, and cuts. Playing a stringed musical instrument is a painful process until strong calluses develop on the fingertips.In parts of the world where people commonly go barefoot for much of the year, a thick layer of callus along the plantar (bottom) surface of the feet provides protection. In areas of the world where wearing shoes predominates, calluses on the feet can be a problem.Calluses typically occur on the sole of the foot, on the heel or under the five metatarsal heads (i.e., the area where the long inner bones of the toes extend into the foot). These areas typically bear most of the pressure and friction from standing and walking. As the callus thickens, it causes more pressure against the skin inside the shoe, causing pain.Calluses on the hands reflect normal wear and tear, but calluses on the feet usually indicate a biomechanical problem, resulting in excessive pressure between the skin and the underlying bone.Calluses can develop under the metatarsal heads for two reasons. In many cases, one or more of the metatarsal heads (usually the first or fifth) is too low, causing it to bear more pressure than the others. In other cases, calluses indicate that one of the metatarsals is unstable and shifts weight to those adjacent to it. This is commonly seen in people with flat feet (pes planus). Because the plantar arch is too low, the foot is unstable. The first metatarsal (the one connected to the big toe) is also unstable and when weight is applied to this area, the first metatarsal drifts upward, causing the second metatarsal to accept the extra weight. The second metatarsal is not capable of supporting this extra force and a callus forms where the skin tries to protect the bone.This process can happen with the other metatarsals as well, and more than one callus often forms on the foot at the same time. In many cases, a single large callus develops across the entire metatarsal pad on both feet.

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Health & Medicine

Dr Galichia

2002-12-01 09:12:00

: I am a 42 year old male. 13 years ago a routine blood test revealed that I had a very high platelet count (700,000 to 900,000). I have no symptoms, so they have just monitored me.  My heart rate for years has been in the low 60's when resting. In January, when I saw my oncologist, it was normal, low 60's.  Recently, I went to the Dr. because of a slow heart rate 42 BPM. The blood test was normal for me. They have monitored my heart rate/blood pressure weekly for a couple months. No change in heart rate. My blood pressure is usually about 129/78. My EKG was normal. Should I be concerned? I am moderately fit, but not one who exercises other than walking several times per week. I am not overweight. 

ANSWER: Your platelet count is high and is being monitored by an oncologist.  Certainly this is very important to you because if the platelet count were to get much higher some treatment may be initiated to lower this count and prevent clotting within your blood vessels.  The normal platelet count is around 400,000 or less. Your slow heart rate of 42 is of concern to me.  The fact that you are fit and well and exercise several times a week tells me you are tolerating this rate relatively well.  There is always a concern when the heart rate falls below 50 or 45 and certainly 42 is a rate that is slower than normal for a patient your age.  Younger and extremely fit athletes may have rates as low as mid 30's or sometimes even lower but these individuals are usually long distance runners or athletes who have achieved and extraordinary level of physical fitness.  Furthermore, this level of fitness does not usually result in such a low heart rate, when one reaches age of the late 30's or early 40's.  Further evaluation should be made to see what your response to exercise is i.e., a treadmill test would be good in this regard.  Furthermore, a 24-hour EKG would be helpful to see if there are periods when your heart rate is even slower.In short, a good physical exam and some basic tests are indicated to make sure that you do not have a blocked artery or some other major problem to cause your rate to slow to cause your slow heart rate. Making sure that the blood flow to your heart is adequate is imperative, especially given the fact you have a high platelet count. If it is deemed, that your rate is too slow, a pacemaker maybe needed to keep your rate within a normal range.  Pacemakers are relatively easy to install and are very helpful to keep your heart rate at the normal level.

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Health & Medicine

Dr George Watson

2002-11-01 16:36:00

:  What is Chelation or Chelation Therapy?  Who would benefit from it?  Is it accepted by most doctors?

ANSWER:  Many people have heard friends' stories about it, but don't know what it is.  Scientifically, chelation is the non-surgical treatment that improves metabolic and circulatory function by rebalancing and removing metal ions in the body using EDTA, a synthetic amino acid in an intravenous solution. Who would be a candidate for chelation therapy? Some people choose chelation as an anti-aging strategy to prevent problems.  They believe that aggressive prevention is far better than the best intervention. Others use chelation as a therapeutic option for free radical diseases including diabetes, arthritis, atherosclerosis, and metal toxicity.  And finally, some people do chelation as a treatment of last resort.  They are too ill to risk angioplasty or bypass surgery. Chelation might help some  prevent amputations due to diabetes.  Here are some examples:  One individual had had multiple angioplasties and stents plus coronary bypass surgery and had "no circulation"  in his leg.  He had significant pain relief during the first chelation.Another individual requested hydrogen peroxide as part of his chelation therapy.  He was free of angina after his fifth treatment.  Another individual was angina free after his first treatment.Is this accepted by the majority of doctors?  No!  That is why people must educate themselves, and then decide what is the best course for them.   Must reading includes:  Bypassing Bypass Surgery, by Elmer Cranton, M.D. and Hydrogen Peroxide, Medical Miracle, by William Douglass, M.D.  The following are a couple of quotes from one of the best books on the subject... ‘Bypassing Bypass Surgery’:  "As a practicing cardiovascular surgeon, I and many of my associates have patients who are not surgical candidates.  Those of us in academic medicine and surgery should put aside our blinders, open our minds and delve further into any promise of improvement for those unfortunates who have no other hope.  Everyone interested in the betterment of life should read Dr Cranton's book."  Signed... Ralph Lev, M.D., Vascular Surgeon.   "Bypassing Bypass Surgery is a book that will help patients to take responsibility for their own health, and it must be considered required reading for every serious student of preventive medicine, physician and patient alike."  Signed... H. Richard Casdorph, M.D., Professor of Medicine, UC Irvine. 

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Health & Medicine

Robert Scheibmeir

2002-11-01 16:36:00

:  What is a condition called Brachymetatarsia? Other than wait until one gets older, how does one know he or she has it?

ANSWER:  Brachymetatarsia is a condition in which one of the metatarsals (the five long bones of the foot) is abnormally short, resulting in a short toe. This condition commonly occurs bilaterally, in the fourth toe. If more than one toe is short, the condition is called brachymetapody. In most cases, brachymetatarsia is caused by the growth plate of the metatarsal closing too early. Once the growth plate closes, the bone can no longer grow. This may be caused by a genetic factor or by trauma to the foot. Typically, a fracture of one of the metatarsals goes through the growth plate, preventing further growth. A shortened metatarsal can cause several problems. Normally, in walking, the weight is transferred from the fifth toe to the fourth, then to the third, and so on until it reaches the first (hallux). This is because the toes are gradually longer and as weight is transferred to the forefoot, the next longest toe takes over. Brachymetatarsia disrupts this process. Biomechanically, it is like having no toe at all. If the fourth toe is shorter than the fifth, it never receives the weight of the body and cannot transfer it appropriately to the third. As a result, the fifth and third toes receive extra weight, causing pain in those areas. An unnaturally short toe also tends to drift upward, causing problems wearing shoes. Treatment options for brachymetatarsia are limited. Conservative treatment involves wearing shoes with extra depth to allow the shortened toe more room. Padding can keep the toe from ulcerating due to pressure and friction against the top of the shoe. Orthotics can help ease the pressure under the other toes. Another treatment option is surgery to lengthen the short toe. This usually is accomplished by cutting the short metatarsal and grafting a piece of bone between the two ends. When the graft heals, the metatarsal and toe are the correct size. Some lengthening of the toe's extensor tendons and surrounding skin usually is necessary to accommodate the repaired toe. An exceptionally short metatarsal may make grafting impossible. In this case, the two metatarsals flanking it may be shortened slightly to correct the arc of the toes. The two shortened toes are then proportionate to the original short toe, restoring the foot's ability to transfer weight sequentially. Follow up treatment typically involves keeping all weight off the surgically repaired foot for 3 months, after which the patient wears a snug-fitting lace-up shoe (an oxford or a jogging shoe) for about 6 weeks. A new technique uses an external device that is attached to the metatarsal with pins. The bone may be gradually drawn out to the appropriate length by this method.

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Health & Medicine

Pam Harjo

2002-11-01 16:36:00

:  What is ESRD? Who is most susceptible?

ANSWER:  I must remind you that I am not a medical doctor and my answers are coming from my own experience and in layman terms. ESRD stands for end-stage renal disease. This is the diagnosis given to a person who has permanent, total (or almost total) kidney failure. With ESRD, kidneys are no longer able to properly clean out the harmful wastes that build up in the blood, and those diagnosed with ESRD are put on kidney dialysis in order to stay alive. Many of these people are put on a waiting list for kidney transplants after they are placed on dialysis. The people who are most susceptible to ESRD are persons who have had chronic, long-term diseases that are debilitating to the normal function process of the kidneys. The more common diseases that come to mind are diabetes, hypertension, urinary stone disease, polycystic kidney disease. Many HIV/AIDS patients can over a long period of time have kidney and liver damage because of highly toxic medications they must take to fight HIV. Native Americans are the race in the U.S. most likely to develop ESRD because of diabetes. All communities of color in the U.S. put on transplant lists, (especially Native Americans) have a very hard time finding matching donors, this translates to high rates of death from kidney failure or complications due to dialysis in the Native American community. The United States has 5% of the population (more than 13 million) who are effected with kidney and urologic diseases, and claim about 260,000 lives each year.

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Health & Medicine

Dr Galichia

2002-11-01 14:20:00

:  What are the latest and most non-invasive ways to correct a blockage in an artery?

ANSWER:  Previously when arteries were blocked in various parts of the body the only way to correct the blockage was to do something known as endarterectomy where by the plaque narrowing the artery was actually cut out and removed, or to bypass the blocked arteries using another structure such as a vein from the leg.  It was soon learned that cutting the plaque out of a smaller artery, such as a coronary artery, was fraught with great danger and often resulted in acute blockage of the artery.  Thus, bypass procedures became very common in the late 1960s and remain an important way of treating patients with coronary blockages.  Blockages in larger arteries may be bypassed, still, but vessels, particularly the arteries in the neck, are more amenable to endarterectomy or plaque removal.  Beginning in the late 1970s and early 80s, more non-invasive approaches have been attempted and have met with enormous success.  The first procedure to remedy blockages within arteries was performed by Dr. Andreas Gruntzig in Zurich, Switzerland in 1977.  He was able to pass a small balloon through an artery that was narrowed in the heart and expand the balloon resulting in improved blood flow and less restriction in the area of plaque formation.  This procedure quickly became known as balloon angioplasty, or PTCA (Percutaneous Transluminal Coronary Angioplasty).  This procedure has spawned a tremendous amount of investigations dealing with plaque removal and restoration of blood flow in blocked arteries.  We quickly became enamored of the idea of using clot busting drugs to open up arteries that were completely blocked and then doing a balloon procedure.  Later, much work was done with lasers to open arteries, and a procedure known as a Rotablator was performed where some of the plaque was actually ground away and it restored blood flow.  None of these techniques, however, resulted in long term improvement.  The latest, and by far the safest mechanism for non-surgical interventions in blocked arteries is to combine the balloon procedure with a stent.  In this procedure, the area of plaque formation, which has caused the artery to narrow, is either balloon dilated first, or, at the same time as the stent is implanted, the lesion is crossed, a balloon is expanded and the small wire mesh stent is left to scaffold the artery and keep it open.  This has resulted in several wonderful improvements in an angioplasty procedure.  First of all, the safety of this procedure has gone up immensely because in the simple balloon procedure a number of patients had to go to surgery emergently because the artery would not stay open.  This problem has virtually been eliminated by the use of stents.  Secondly, and perhaps more importantly, is the fact that the rate of restenosis, or recurrence of blockage, has fallen from about 42% with a simple balloon procedure now to the range of about 22%.  This nearly 50% reduction in restenosis has made this procedure more viable for the long term and more attractive to a greater number of patients.  On the horizon are yet new improvements in the stent procedure.  Stents have been developed which are coated, and the coated stents have a much lesser recurrence rate decreasing the rate of restenosis in early investigations in the range of five to 7%.  In some studies, the restenosis rate has approached 0% at the end of one year.  Certainly, the future looks to be very bright in the area of coated stents, and is an area that we are quite enthusiastic about doing research.  It only stands to reason if the restenosis becomes lower and if there is a virtual 0% risk of blockage or clot formation within the stent that more difficult lesions will be approached and many patients who ordinarily would have had bypass surgery will benefit from this non-invasive procedure

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Health & Medicine

Dr Qizhi Gao

2002-11-01 14:20:00

:  What is the difference between Traditional Chinese Medicine (TCM) and conventional western medical care (WM)?

ANSWER: Traditional Chinese Medicine (TCM) has been developing for over two thousand years. Guided by holistic concepts and based on clinical observation and experience Chinese medical experts have developed a unique system of health care with its own characters for the prevention and treatment of disease. There are four distinct areas of difference between TCM and WM: Theory - TCM and WM have their own unique theories for disease detection and treatmentDiagnosis methods - WM primarily uses lab testing for disease detection whereas TCM uses observation, ausculation (hearing), olfaction (smelling), interrogation (asking) and palpation (pulse examination) Treatment methods - WM uses drugs and surgery and TCM uses acupuncture, herbal medicine, massage and Qigong exercise Preventive health care is not generally emphasized in WM. For example, in WM, Carpal Tunnel Syndrome is usually treated with corrective surgery. TCM will use a combination of Acupuncture, Massage and Qigong exercises to relieve the symptoms and work with the patient to modify their behavior to prevent further repetitive injury. Let's use a sample case to demonstrate these four differences.A patient complains about palpitation, insomnia, dizziness, blurred vision, numb hands and feet, scanty menstruation and irregular menstrual cycle.In WM medical system the patient may see her family doctor for palpitation, insomnia and dizziness, visit her optometrist for blurred vision, receive an adjustment from her chiropractor for numb hands and feet and consult her OBGYN concerning her scanty menstruation and irregular menstrual cycle.In the TCM medical system the TCM physician believes all the complaints from this patient are related. The TCM physician also observes the patient has a pale complexion, light-colored lips, pale tongue and feeble pulse. In TCM the patient's symptoms are diagnosed as blood deficiency syndrome. The syndrome is often related to a number of causes such as chronic or acute bleeding in various forms, hypofunction of the spleen and stomach, weariness resulting from overthinking, impairment of prolonged illness, homatopoietic disorder due to internal blood stagnation and so on.Dizziness, blurred vision, pale complexion and light colored lips may appear when deficient blood fails to nourish the head, eyes and face. These factors often lead to palpitation and insomnia due to a lack of blood flow to nourish the heart. A malnourished meridian (vessel) leads to numb hands and feet. Additionally, when the meridian is not enriched with blood, the pulse becomes feeble. Finally, when the tongue is not nourished by blood, it becomes light-colored. At this point in the diagnosis, a treatment plan is provided to tonify the blood in accordance with the causes mentioned above, the condition of the patient and the severity of the chief complaint. The treatment may consist of herb remedies (single or mixed herbs), diet, acupuncture or some form of Qigong exercise.

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Health & Medicine

Dr Qizhi Gao

2002-10-01 13:43:00

: What is the history of Acupuncture? Will it work for any type of illness, injury or affliction? Do you have to stay on a program forever?

Dr. Qizhi Gao Question: What is the history of Acupuncture? Will it work for any type of illness, injury or affliction? Do you have to stay on a program forever?Answer:  To treat and prevent disease, the Chinese Medicine practitioner or Acupuncturist inserts one or more fine needles into the patient's body to adjust the energy flow. This is called Acupuncture, only one of the many aspects of Chinese Medicine.  Acupuncture has long history. As early as the New Stone age (between 5000-10,000 years ago), primitive man used a bian stone, the earliest Acupuncture instrument, to treat diseases. The book Yellow Emperor's Internal Classic, the earliest classic of Traditional Chinese Medicine (TCM) written approximately 2,500 years ago, generally discussed basic TCM theory and listed the treatment for over 100 symptoms/diseases treated by Acupuncture. For Example, many of the symptoms of fibromyalgia are described in the book and the related treatment for these symptoms was given. Acupuncture has contributed to health care not only for the Chinese but also other countries. In the last six centuries the use of Acupuncture spread to Korea and Japan. In the late 17th century, Acupuncture came to Europe and finally, in 1972, A U.S. reporter's personal Acupuncture experience in China brought Americas attention to this remarkable form of medicine.   In 1979 the World Health Organization (WHO) recommended Acupuncture treatment for 43 diseases in five categories: 1. Ear, Nose and Throat Disorders, 2. Respiratory Disorders, 3. Gastrointestinal Disorders, 4. Eye Disorders and 5. Nervous System and Muscular Disorders.  These are only a few of the over four hundred symptoms/diseases treated by Acupuncture in China.The number of treatments a patient receives depends upon the duration, severity and nature of their complaint. A single treatment may be required for an acute condition or a series of five to fifteen treatments may resolve many chronic problems. Some degenerative conditions may require many treatments over time. Your practitioner will explain the nature of your problem and what treatment is recommended.     Patients often experience the most dramatic results in the first treatment. Some patients experience an immediate total or partial relief of their pain or other symptoms. This relief may last or some pain may return. In a few cases, there may be no immediate relief only to notice the pain diminish over the next couple of days.

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Health & Medicine

Robert Scheibmeir

2002-10-01 12:20:00

: What causes feet to sweat and smell excessively?

Robert Scheibmeir Question: What causes feet to sweat and smell excessively? Answer:  Hyperhydrosis is the clinical name given to excessive perspiration. The feet contain an estimated quarter of a million sweat glands, and under normal conditions they can excrete up to a pint of moisture daily. In some persons, these glands, particularly those on the soles of the feet and between the toes, generate perspiration in greater than normal volumes. The causes can be many: Stress and nervousness, especially in young people, and socks or tight-fitting shoes made of synthetic materials that do not "breathe" well enough to let the moisture evaporate freely are the most common factors. In some cases, however, hyperhydrosis can result from more serious causes, such as anemia and hyperthyroidism. Apart from their discomfort, sweaty feet may cause rashes and eczema. Also, the warm, moist environment they produce provide an ideal environment for fungi and bacteria. As these die and decompose, they can produce a characteristic unpleasant smell. This condition is known as bromhidrosis. Perspiration and foot odor usually can be controlled by switching to better footwear, such as thick cotton socks and leather shoes. Odor-causing bacteria can be killed by soaking the feet in a solution of warm water and baking soda or a mild antibacterial soap. Absorbent foot powder and antiperspirant deodorants containing aluminum chloride also help. If these treatments and self-help measures fall short of success, your podiatrist may be able to prescribe a stronger antiperspirant medication.

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Health & Medicine

Lisa Reyes

2002-10-01 12:03:00

:  Does smoking really make that much difference?  How does smoking effect the health of  Latinos?

Lisa Reyes Question:  Does smoking really make that much difference?  How does smoking effect the health of  Latinos?Answer:  Cigarette smoking is the single most preventable cause of disease and premature death in the U.S.  Smoking is related to a variety of health problems, including cancers, cardiovascular disease, and respiratory diseases.  This is significant since the leading causes of death for Latinos include heart disease, pulmonary/ respiratory problems.  Smoking has also been linked to asthma, and it is estimated that one-half million Latino children have symptoms of asthma; two-thirds of these children are Puerto Rican.  Puerto Rican children have the highest prevalence of active asthma (11 percent) of any racial/ethnic group of children in the U.S.   Puerto Ricans have also been found to have the highest rate of smoking among Latino subgroups. In addition, teens who smoke are also more likely than non-smoking teens to use alcohol, marijuana, cocaine, and to have seen a health professional for mental health issues.   Young people vastly under estimate the addictiveness of nicotine.  Of daily smokers who think that they will not smoke in five years, nearly 75 percent are still smoking five to six years later. Smoking may also be an indicator of underlying mental health problems, such as depression.  For example, high school seniors who are regular smokers and began smoking by grade 9, are three times more likely than their non-smoking peers to have seen a health professional for an emotional or psychological complaint.  A study of Latino boys found that a high level of depression significantly predicted the quantity of cigarettes smoked and the frequency of smoking. Among Mexican American Women ages 40-59 years, those who smoked cigarettes also had more depressive symptoms than those who did not smoke. The relationship between smoking and mental health can have implications for Latinos, as Latino adults are more likely than Whites to report a major depressive episode.  For example, in 1993, more than one-half (53 percent) of Latina women reported severe chronic depression. Tobacco use remains a significant threat to the health of the Latino population, especially for certain subgroups, despite some data suggesting Latinos fair better than other racial/ethnic groups regarding smoking prevalence.   In general, the prevalence of cigarette smoking among Latino adults has decreased over the last 10-15 years.  Between 1978 and 1995, the prevalence of smoking among Latino men and women decreased from 30.1 percent (1978-1980) to 18.9 percent (1994-1995).   However, these trends do not reflect long-term smoking prevalence rates for Latinos as a whole,  by  ethnicity and gender.  Although, the current picture of tobacco use among Latinos remains unclear and perhaps misleading. We do know that many of the health concerns that Latinos have can be attributed to tobacco use.Compiled by information obtained from the National Latino Council on Alcohol and Tobacco Prevention(LCAT). 

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Health & Medicine

Dr Mark Stovak

2002-10-01 11:28:00

: Our son is 14. He is 6' 2" and still growing. He has knots on the front of each knee. When he plays sports and happens to bump them, they get very sore. What are they? Should we be concerned that they could be bone cancer?

Dr. Mark Stovak Question: Our son is 14. He is 6' 2" and still growing. He has knots on the front of each knee. When he plays sports and happens to bump them, they get very sore. What are they? Should we be concerned that they could be bone cancer?Answer: Your son most likely has Osgood-Schlatter's disease. This is really a common problem that occurs in growing adolescents that occurs because the patellar tendon attaches at an apophysis (growth plate of sorts) at this location. When the patellar tendon is tight because your son's bones are growing faster than the muscle-tendon complex, there is a pulling at this area especially during running & jumping activities. This tendon is stronger than the bone during this time when the apophysis is open to allow growth. The pull causes a traction injury to the apophysis causing the pain & the bump.It is very unlikely that this is cancer, especially since it is bilateral, but the only way to be certain is with an XR.I would recommend quadriceps stretches & hip flexor stretches daily. He can participate up to the point of pain but if the pain limits his ability to play or he limps then he should quit for that day. Over the counter medications are desirable after activity as well as ice. If this does not help then there are straps available as well that are similar to tennis elbow straps but they are made for this problem. If this does not allow him to participate without limitations then I would seek further treatment through your physician.

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Health & Medicine

Dr Joseph Galichia

2002-10-01 11:28:00

:  What is a mini stroke? Are all mini strokes TIAs? I've read where you can do something to prevent damage from a heart attack if attended to quickly enough. A stroke on the other hand does its damage immediately doesn't it?

Dr. Joseph Galichia Question:  What is a mini stroke? Are all mini strokes TIAs? I've read where you can do something to prevent damage from a heart attack if attended to quickly enough. A stroke on the other hand does its damage immediately doesn't it?Answer:  A mini stroke or TIA is also known as a transient ischemic event.  These terms are synonymous and mean that the patient has suffered a brief period of neurologic dysfunction and has recovered, at least momentarily.  In simple terms, the patient has developed some loss of neurologic function usually for a few minutes, but has recovered with no residual problems.  The types of neurologic changes may include inability to speak properly, loss of feeling or ability to move an arm or leg, inability to think properly, loss of vision, facial weakness, or any neurologic change.  If these symptoms persist, the patient develops a completed stroke.It is important for all of us to understand the importance of these symptoms.  Should any of these symptoms occur, it is imperative to seek immediate medical attention.  Even if the symptoms go away completely, they are often the early warning that a full-blown stroke is about to occur.  Many patients are so frightened by these events that they try to put the experience out of their minds and go about their business and hope the symptoms never recur.  Unfortunately, they usually do and often simply do not go away again.There are many things we do immediately when a TIA occurs.  Immediate evaluation of the carotid arteries in the neck must be undertaken to see if plaque exists that may have broken loose and traveled to the brain.  A cat scan is usually performed to see if bleeding may have occurred and to see if a small stroke can be identified.  In other words, a full and immediate neurologic evaluation should be performed and blood thinners should be started as well as aspirin to help prevent clot formation.  If the patient obtains immediate help and these measures are instituted, most of these patients do not go on to completed stroke. 

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Health & Medicine

Scott Tatge

2002-09-01 11:00:00

: Why is it that airplanes use re-circulated air instead of bringing in fresh air from outside? Doesn't the engine exhaust and everyone's exhaled air make a lot of people sick?

Scott Tatge Question: Why is it that airplanes use re-circulated air instead of bringing in fresh air from outside? Doesn't the engine exhaust and everyone's exhaled air make a lot of people sick?Answer:  This question comes from a news story that was aired a couple of years ago. The story went that people were getting sick from air that was re-circulated inside the airplane cabin. This news story was not correct. That is not how air is used in pressurized airplanes. Outside air is used through the engines, sent into the cabin, then out what we call an outflow valve. So the air is continually refreshed from outside then sent back outside. That is the short answer. The second part of your question is about the engine exhaust. That is a common misunderstanding about how the airflow comes into the cabin. In order to understand how and why air comes from the engines, you need to understand the basics of how an aircraft is pressurized, and why. First let's talk about how our bodies work. We breathe air into our lungs. This air has oxygen in it that our body requires to live. Down here at the lower altitudes, there is enough pressure all around us that it is easy to breathe it in. As we go higher, the pressure all around our body reduces, thus we cannot breathe as much air into our lungs and we do not get enough oxygen into our bodies. Try running a mile at sea level, then going up to Denver at 5,650' above sea level and running that same mile. You will notice that you are breathing much harder in order to stay conscious. That's because there is so much less pressure at that altitude. The amount of oxygen is the same throughout our atmosphere; it is just that there is not enough pressure to breath it in. Now let's take our bodies to 45,000'. The time of useful consciousness at this altitude is about 5 seconds simply because there is so little pressure way up there. Now most airliners fly at only 35,000', so your time of useful consciousness is increased to about 10-12 seconds. So, the environment that airplanes fly in is not hospitable for human, or any mammal's survival. Most airplanes fly around with a cabin altitude of about 2000' to 4000' even though the airplane is flying at 35,000'. That is why your ears "pop" while climbing and descending. The airplane cabin altitude is changing in order to maintain a proper pressure. This is the secret to our survival in this hostile environment. As you recall, there is plenty of pressure at these lower altitudes to inhale the required oxygen into our lungs. So the trick is to get enough compressed air into the cabin of the airplane, then regulate the air inside the cabin to a proper pressure. This is where the engines come in. Jet engines operate on similar principles as your car engine, except at much higher levels of pressure torque and thrust. First the outside air is brought into the engine at the front. Then it is highly compressed, so much so that it becomes extremely hot (in the neighborhood of 400-800 degrees). Then fuel and ignition is added creating an "explosion". This "exploding" air expands rapidly and is sent out the back as thrust/exhaust. This thrust pushes the airplane forward, and drives the front part of the engine. Notice that the outside air is compressed prior to making exhaust. It is at this point where the air is compressed that we tap some of it off and send it into the cabin. That is why there is no exhaust in the cabin. Remember, the air still has the same amount of oxygen in it at these high levels of compression. This air is also very hot. So, the air first goes through an air conditioning unit that cools it down to whatever level is requested by the pilots, or flight attendants to warm you up or cool you down. Now, we are forcing all this air into the cabin. The cabin is very tightly sealed (notice how big those entry doors to the airplanes are) so that it can hold the pressure required to inhale sufficient oxygen. Since we are forcing all this compressed air into our tightly sealed cabin, we must let it out or the airplane will explode, like blowing up a balloon too much. In order to control how much air is let out, we have a pressurization system. In the older airplanes, the pilot's had to set the cruising altitude into the system. This system regulates what we call an "outflow valve" that lets the air out of the cabin and maintains the proper pressure inside the cabin. So, as you can see, there is always a constant supply of fresh air from outside the airplane brought in through the engines, then allowed to escape back outside through the outflow valve. The air coming out of the vents above your passenger seat is actually coming from the engines, cooled, then sent into the cabin. That is why the airplane does not cool down until the engines are started. While the airplane sits at the gate and before engines are started, the air comes from a ground air conditioner that is hooked to the airplane.

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Health & Medicine

Robert Scheibmeir

2002-09-01 09:27:00

: What is Tailor's Bunion?

Robert Scheibmeir Question: What is Tailor's Bunion? Answer:  Most bunions occur on the inside side of the foot, near the base of the first toe, and are caused by a misalignment of the metatarsal-phalangeal joint. Tailor's Bunion, is a deformity that develops on the outside of the foot, where the fifth metatarsal head becomes inflamed and enlarged. The primary causes are faulty foot mechanics and shoes with excessively tight toe boxes. These compress the tips of the toes inward , splaying the metatarsal bone laterally and causing inflammation of the soft tissue, which produces a characteristic bump, sometimes called a bunionette. Pressure exerted by the shoe against the bunion can be painful. Treatment for Tailor's Bunion typically begins with switching the patient to wider shoes to relieve the compression and prevent further irritation. A procedure called PAB, or puncture aspiration of the bursa, may be necessary to relieve pressure on the bunionette by drawing off any fluid that has built up in the area. Afterward, ultrasound physical therapy, special pads, toe spacers and/or orthotic appliances may help prevent the problem from recurring. In severe cases, surgery may be required to eliminate the bunion

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Health & Medicine

Pam Harjo

2002-09-01 09:13:00

:  Are Native American women a higher risk for obesity than any other group? Are they a higher risk group For any other condition or illness?

Pam Harjo Question:  Are Native American women a higher risk for obesity than any other group? Are they a higher risk group For any other condition or illness?Answer:  It is well known that all of the United State's populations are getting out of shape because of low level physical activity and improper diets, At our clinic, we are seeing men, women, and children of all races and ethnic groups who are overweight. Native women don't have a comer on the obesity market- Native American populations do have high incident rates with diseases that are directly or indirectly relate to diet. The refined sugar, flow, alcohol and fried food that were introduced to the Native populations after European contact have had an effect on the health of the Native American people. These new foods coupled with the change in lifestyle and the lack of ability to care for their illnesses with natural herbs and remedies developed over thousand of years has resulted in many of the health problems now effecting the Native culture today.European culture began influencing the Native American culture approximately 12 generations ago, the Native Americans have been here for 12,000 generations. The Native American population was hit very hard because of the diseases brought over by the Europeans, and within two generations, our Native American population was reduced by 80%, that began the destruction of a very well balanced system that had served the Native American people for thousands of years. It is reported that Native Americans have higher incidence of heart disease than any other culture or race of people in the world. Native American people have higher rates of diabetes than any other culture or ethnic group in the United States, and three times the rate of liver disease. Native Americans have the lowest life expectancy of any population in this hemisphere except Haitians; the average age of death for Native Americans is 47.6 years of age. The Native American's body and digestive system has not had time to adapt to the current American way of eating. It is believed that if the Native American people could prepare and eat foods in the traditional manner, they would have a favorable outcome in redaction of some health problems, including diabetes, heart disease, liver disease, and obesity.

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Health & Medicine

Robert Scheibmeir

2002-08-01 12:24:00

:  Do pregnant women have any special foot-related problems?

Robert Scheibmeir Question:  Do pregnant women have any special foot-related problems? Answer:  Unfortunately, yes. Not only does the extra weight caused by pregnancy increase pressure on an expectant mother's feet, but the concentration of that weight in the belly changes her center of gravity and affects her balance. Most pregnant women compensate by altering their gait. They tend to walk in a toe-out fashion, which puts additional stress on the ligaments of the feet. Meanwhile, hormonal changes occur in the body which relax the ligaments in preparation for the birthing process. While these changes are normal and necessary, they also tend to make the plantar fascia - the foot's arch ligament - stretch under the body's extra weight. This causes the arch to lose some of its supporting strength. The feet grow flatter and wider - often by as much as a full shoe-size - particularly if the woman begins to retain fluid, a common complaint during the latter stage of pregnancy. During this time it is important for the woman to wear shoes that will accommodate her changed balance and provide relief and support for her feet and ankles. Good running shoes are a wise choice. At the opposite end of the shoe spectrum, narrow-toed and high-heeled shoes can cause foot pain and greatly increase the chance of foot and ankle injury during pregnancy. After childbirth, it can take up to six months for these changes to reverse themselves and the feet to return to their normal size and shape. In cases where the plantar fascia has been stretched excessively, the foot changes can become permanent.

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Health & Medicine

Dr Qizhi Gao

2002-08-01 11:48:00

: What is Bigu Qigong for Weight Management? How does it work? What are the advantages of this method of weight loss?

Dr. Qizhi Gao Question: What is Bigu Qigong for Weight Management? How does it work? What are the advantages of this method of weight loss? Answer: Qigong pronounced "chee gong" is an energy exercise that originated in China over 2000 years ago. The philosophical foundations of Qigong stipulate that a vital energy called Qi "chee" flows along pathways called meridians that link the internal organs with the other parts of the body. The meditation, visualization, breath and movement exercises used in Qigong seek to restore balance, break down blockages in the flow of Qi and re-establish a healthy supply of energy to diseased or distressed parts of the body. Bigu "Bee-goo" translates literally as "avoid (bi) the grain (gu). In practice it reflects the ability to live solely on energy without food. Bigu Qigong is a specific exercise designed for Weight Management. It consists of two exercises, one to control appetite and the other to assist the practitioner in retaining vital energy, relaxing the mind and body to overcome anxiety and mental stress. Bigu Qigong is a safe and effective method for weight that combines reducing caloric intake, non-strenuous exercise and behavior modification to achieve weight loss. Most people can practice Bigu Qigong and achieve good results under the guidance of an experienced practitioner. 

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Health & Medicine

Dr Joseph Galichia

2002-08-01 10:47:00

: My wife is having some problems within the last few weeks. Several times a day she feels as though her heart skips a beat or two. She says it feels as if she is in an elevator that descends suddenly and rapidly. She is 47 and of normal height and weight. What could this be?

Dr. Joseph Galichia Question: My wife is having some problems within the last few weeks. Several times a day she feels as though her heart skips a beat or two. She says it feels as if she is in an elevator that descends suddenly and rapidly. She is 47 and of normal height and weight. What could this be? Answer:  You are describing a common complaint I hear daily in my office, namely that of a skipped beat or a sense of cardiac irregularity that occurs randomly and intermittently.  Fortunately, most of these "skipped beats" are benign, but they may also be a sign of significant underlying heart disease.  The irregularities are due to irritable areas of electrical activities in either the reservoir or the pumping chambers of the heart.  If the heart is normal in its structure and if the blood vessels supplying the heart are normal, the skipped beats are usually of little consequence.  Conversely, if the heart is structurally abnormal, the irregular beats may be a sign of serious consequence.I always recommend that these palpitations deserve evaluation.  A good physical exam plus a simple EKG, an echocardiogram and perhaps a stress test help us to better understand the risk imposed by these irregularities.  Any associated symptoms such as passing out, chest pain, shortness of breath or fatigue also imply a more serious nature to these complaints.  At age 47 an evaluation of this type is extremely important.

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Health & Medicine

Pam Harjo

2002-08-01 10:25:00

: Are Native American men and women more susceptible to HIV/AIDS than any other ethnic group?

Pam Harjo Question: Are Native American men and women more susceptible to HIV/AIDS than any other ethnic group?Answer:  The answer is both yes and no to this question. To clarify... you need to understand that the Human Immunodeficiency Virus (HIV) does not target any particular race or ethnic group to infect more than any other. The virus is spread through having unprotected sex, or sharing needles with an HIV infected person. An HIV infected mother can transmit the virus to her baby through breast-feeding, or during birth through blood to blood transmission. The Acquired Immunodeficiency Syndrome (AIDS) is when your immune system can no longer effectively fight off diseases. AIDS is the result of an HIV infection. Native Americans are more likely to receive an AIDS diagnosis sooner than any other ethnic group after being infected with HIV. Due to high rates of diabetes, alcoholism, liver disease, hypertension and sexually transmitted disease (STD) in the Native American population, an HIV infection progresses into AIDS sooner because of an already compromised immune system. Some of the contributing factors leading to HIV/AIDS in the Native American community include substandard health care when compared with all other races in the United States, this translates to less HIV and STD prevention education by health care officials. Native Americans have the lowest life expectancy of any population in this hemisphere except Haitians, the average age of death for Native Americans is 47.6 years of age.Because the rate of STDs in the Native American community is extremely high compared to the rest of the U.S. population, STD infected Native Americans are three times more likely to contract HIV when exposed to the virus. Grossly inadequate health care and the inability for many Native Americans to access any health care, because of tribal / village isolation, is placing whole Native communities at risk of eradication much like smallpox once did. Many believe that only the tip of the iceberg is being seen with the devastation HIV/AIDS will do to Native communities in the U.S.   Dr.David Satcher, the U.S. Surgeon General, is concerned by the effects of AIDS in the Native Communities said "we, as a community of Americans cannot afford to lose more lives or cultural riches from American Indian and Alaska Native cultures ...[and how] HIV/AIDS is a significant threat to these communities."

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Health & Medicine

Annette Lindal

2002-07-01 16:13:00

Question: What kinds of specific health problems may develop after cancer treatment? How soon after cancer treatment can these problems develop?

Answer:  Cancer treatment includes surgery, chemotherapy, radiotherapy, hormone therapy, and biological therapy. The side effects of cancer treatments and when they occur depend mainly on the type and the extent of the treatment.Also, the effects may not be the same  for each person or they may change for a person from one treatment to the next.Common side effects from cancer treatment include fatigue, nausea and vomiting, hair loss, lowered blood cell counts, mouth sores. Most side effects resolve after treatment is completed, and can be managed in a variety of ways. Medications and acupuncture are used to control nausea and vomiting. Mouth sores can be managed with rinses and diet changes.Because many treatments result in decreased blood counts, the cancer patient will be at an increased risk for any kind of infection.Protective measures include good hand washing, avoiding crowds, and wearing a surgical mask. The physician will closely monitor the course of treatment, any associated side effects, and provide information for the management of any problems associated with treatment.There are some long-term health issues associated with certain cancer  treatments. Cancer survivors deal with a variety of adjustment issues that may include: living with artificial limbs, ostomies, breast changes, energy loss, and chronic pain. Some cancer treatments result in a change in sexuality and/or fertility. Your health care provider is the primary source of information, and can refer you to other professionals for additional care.

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Health & Medicine

Dr Joseph Galichia

2002-07-01 12:22:00

Question:  What is bradycardia or near bradycardia?  What are the symptoms?  How does it differ from other heart conditions?

Answer:  Bradycardia is defined as a slow heart rate. When the heart rate falls below 45 in most adults, we are concerned that the rate may be too slow to effect a normal heart output. There are exceptions to this standard in that well trained athletes and some other individuals may function well at rates of between 40 to 50, or even slower. For most older adults, rates below 40 to 45 often result in lightheadedness, weakness, fatigue or even passing out. For these individuals, pacemakers are extremely effective in establishing a higher rate, often in the high 60's or low 70's. This usual results in a dramatic turnaround in symptoms and a feeling of well being for the patient. Near bradycardia is a term that may be used to define the group of patients who may have a worrisome slow rate in the absence of any symptoms. More recently, pacemakers have been found to help not only patients with slow rates, but also patients with heart failure. Newer pacers may come with automatic defibrillators to shock the into a normal rhythm if too rapid a rate develops. These newer pacemakers then can pace the heart when it is too slow, shock the patient if sudden death occurs due to a rapid ineffective beat, or simply pace the heart to beat more synchronously if it is failing. Interestingly, what is a normal rate for one individual may be a life threatening rate for another. The specialty of cardiology has a special group of individuals trained to handle these disorders called electro physiology. This area is one of the most rapidly growing areas of science today and the technology is proceeding at a very rapid pace.

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Health & Medicine

Robert Cusick MD

2002-06-01 15:05:00

Question:  I am having lots of pain on the inside of my knee but I can't remember doing anything to aggravate it.  How do I know it's my knee and not my foot or ankle that's causing the problem?

Answer:  There are two locations away from the knee that are known to frequently produce pain which may mistakenly seem to be in the knee.  The more common of the two is pain radiating from the lower back down the back of the leg and affecting the knee.  This pain is usually the result of either arthritis in the lower spine which constricts the space available for the nerves, or from a bulging disc in the lower spine.    The best way to differentiate the source of this type of pain is by a careful physical examination.   The second place away from the knee where knee pain may arise is in the hip.  A branch of one of the primary nerves which travels down the leg is located directly in front of the hip joint.  In a situation where a patient may be able to manage some long-standing hip pain due to osteoarthritis, the local inflammation surrounding the hip may affect the nerve which travels to the knee.  In this situation, it is very easy for a physician to focus on the knee pain, and ignore the hip X-rays.  Again, a very thorough physical examination should help the physician decide on the source of the knee pain.   It is fortunately rare for pain from the foot or ankle to be interpreted by a patient as knee pain.  Because of the way we bear weight on our legs, pain starting in the ankle or foot will usually be felt in that same location.  It should be understood, however, that a deformity of the foot or ankle, such as very flat feet or a poorly healed fracture, can throw off the overall alignment of the lower leg and lead to knee pain over time.   Outside of a situation of poor alignment for other reasons, pain felt deep inside the knee with no predisposing injury can be a result of several conditions.  Wear and tear can affect the cartilage on the ends of the bones and produce arthritis over time, or can affect the soft cartilage of the knee, the meniscus, and produce degenerative tears over time.  One of the four main ligaments of the knee can suffer a tear or sprain, leading to lots of pain, but will usually be associated with an injury.  It is important that significant pain inside the knee which is not relieved by rest, ice or anti-inflammatory medication be evaluated by a qualified physician who may prevent you from doing any further damage to your knee.

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Health & Medicine

Dr Joseph Galichia

2002-04-01 14:47:00

Question:  I am taking Toprol XL, 50 mg a day, for rapid heart rate.  My problems began while taking Claritin-D for sinus congestion.  It has continued for over a month after I have stopped taking the Claritin and I can't seem to stop the Toprol without it racing again.  Do you thing the Claritin could be the underlying problem with my heart rate?  Question #2:  My other question is: if I have to stay on Toprol forever to control my heart rate, can I still safely use it during a pregnancy?

Answer:  The problem of a rapid heart rate always should be evaluated and medications are always a consideration as a cause of this problem.  However, it is also true that Claritin-D can cause your heart rate to go up, but having stopped this drug even for as long as 48-hours, your heart rate should return to normal.  Thus, I am concerned that there may be some other reason for a racing heart rate.  Heart rates of greater than one hundred at rest are always of concern to me and should be evaluated in depth.  Problems such as a hyperactive thyroid, underlining heart disease, high blood pressure, and a host of other medical problems can cause your heart to beat too fast.  Certainly, even a chronic state of anxiety could cause such a problem.  Toprol XL is a Beta-blocker which does tend to slow the heart rate.  You have been on this drug for a while and is seems that you still need it to keep your rate under control.  Leaving someone on a drug like this indefinitely without searching for further causes for the rapid heart rate is not reasonable, in my opinion.  Looking for other abnormalities and finding some explanation for the elevation in your resting heart rate should be pursued further.Toprol is a drug that you could conceivably use during pregnancy, but no medication is completely safe in this regard.  My recommendation would be to have an in-depth analysis of your rapid heart rhythm and try to solve this problem without taking medication over a long period of time.  In unusual circumstances, we have given patients Beta-blockers throughout the duration of their pregnancy and have seen very few problems.  At the time of delivery, however, it is important for your doctor to know that you are on these medications because they should be withdrawn prior to delivery because they may cause the fetal heart rate to be slow at the time of delivery.  Beta-blockers are generally very safe medications, but there are some long-term side effects including insomnia, fatigue, sexual dysfunction, and weight gain which make it difficult to use these drugs long term.Angina pectoris occurs when the blood supply to the heart is impaired.  There is an inadequate amount of oxygen and other metabolites to supply the heart muscle.  Often, there are enough nutrients when the heart is resting, but when the workload of the heart is increased, the blood supply is inadequate to meet these demands.  Exercise, excitement, increased blood pressure, or increased heart rate is common events that create this kind of  "starving effect" that results in the chest pain of angina pectoris.The clinical syndrome of angina pectoris consists of chest pain often consisting of a pressing or burning sensation in the center of the chest radiating to the left shoulder, jaw or arm brought on by exertion and relieved with rest or nitroglycerin.  Many variants may occur including shortness of breath, weakness or sweating and the pain may occur at rest.  In short, any pain or discomfort above the waist may be a variant of this syndrome and thus may be a manifestation of coronary insufficiency.  I have often said that few patients have read the textbook on angina pectoris and few stories I hear are classic descriptions.  The job of a good clinician is like that of Sherlock Holmes sorting through lots of misleading information to arrive at an answer.  Technology, fortunately has come to our rescue and provided us with more scientific data in the form of treadmill tests, nuclear stress tests, stress echoes and, most important of all, angiography to give us a definitive diagnosis in almost all cases.  Indeed, the saying, "an ounce of dye is worth a roomful of cardiologists" is often reflective of our need to ultimately proceed to these tests in a timely manner. 

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Health & Medicine

Robert Cusick MD

2002-04-01 12:14:00

Question:  If a person has a knee replaced at age 60, what are the chances he or she will need the same knee replaced again?

Answer:  The chances of requiring a second surgery after an original total knee replacement, a procedure we term 'revision of a total knee,' is quite variable and dependent on several main factors.  Probably the most important factor affecting the longevity of a total knee is patient activity following the replacement surgery.   A knee replacement is a mechanical device made of metal and plastic, and as a result will tend to wear out over time based on how it is used.  A younger patient who enjoys athletics will likely wear out the plastic portion of the replacement much faster than an elderly patient who leads a more sedentary lifestyle.  Likewise, a patient who is overweight will also tend to wear out the device faster than a smaller, lighter patient.  These are the reasons we often encourage our patients to lose weight and give up their more demanding activities following replacement surgery.Other factors which can have a significant effect on durability of a total knee prosthesis include: surgical technique, postoperative rehabilitation, damage to the device through injury, or late infection of the knee.  Each of these factors can significantly limit the life expectancy of a total knee and cause wear of the parts requiring revision.In today's environment, using the most modern techniques and materials, it is felt that a total knee replacement should last at least 12-15 years before requiring a second surgery for worn out plastic.  Fortunately, the devices are now designed in a way that allows for simple removal of the plastic liner and replacement with a new liner without removing the well-fixed metal pieces.  The materials used in these replacements have certainly improved over the years, and a high percentage of the knee replacements done today never require a second surgery for worn plastic.  It is important, however, to remember that these devices have certain limitations, and one should be prepared for revision if wear of the plastic ever becomes apparent. 

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Health & Medicine

Janet M Cusick RN MS

2002-04-01 11:59:00

Question:  What happens to the body and skin with a third degree burn on a small area of the body? What should one watch for during its healing?

Answer:  A simple definition for a burn is "damage to the skin and underlying tissue caused by heat, chemicals, or electricity"--- a very simple description of an extremely complex injury that effects every major organ system of the body. The person with burn injuries must overcome both physical and emotional obstacles during what typically is a long road to recovery. Fortunately, almost every burn survivor is able to return to his or her home, family, work, school, leisure activities, and enjoy an excellent quality of life.The depth of burn is determined primarily by two different factors.First, the temperature to which the skin is exposed--the hotter the burning agent, the deeper the burn. The patient, family, rescuers, or health care providers have no control over this factor. The second factor--the duration the burning agent is in contact with the skin--can be controlled. If the person immediately moves away from the heat source, removes any smoldering clothing, jewelry or metal, and cools the burn for three to five minutes, the duration of contact is shortened and the burning process (and tissue destruction) ceases.To understand depth of burn, a person must have a basic knowledge of skin anatomy. The skin is divided into two layers, the epidermis and dermis. The epidermis is the thin outer layer. The dermis is the deeper, thicker layer. Under these layers lie the fat, muscle and bone. Partial thickness burns include first- and second-degree burns. Because the epidermis will regenerate, partial thickness burns will heal without surgical intervention. Full thickness burns, also known as third-degree burns, destroy both the epidermis and dermis including the cells necessary to grow new skin. Full thickness burns may appear charred, whitish, gray or leathery. Because the nerve endings have been destroyed, the person with deep burns may not have feeling or sensation in those areas. Full thickness burns will require surgical removal of the dead tissue and skin grafting for those areas to heal.Although there are many new products and techniques available to burn centers that facilitate healing, the "Gold Standard" for the healing of full thickness burns is autografting, which is transplantation of the person's own unburned or healed skin onto the area of full thickness burn.The person is taken to the operating room where all the dead tissue is surgically removed. Skin is taken from an unburned or healed part of the person's own body and grafted or transplanted to the clean burn area. In seven to fourteen days, this grafted skin adheres and becomes the person's permanent skin. The donor site (the place from which the skin was harvested) is treated like a partial thickness burn and heals in 10 to 14 days.Small, half-dollar-size, full thickness burns may eventually heal without surgical intervention. Because both layers of the skin have been destroyed, the healing process will take many weeks, leading to an increased risk of infection because the area is open for a long period of time. The area is more prone to develop scarring, limiting motion and function of the affected area, especially if the burn is over a joint.  Cosmetically, the slow healing may lead to a less attractive appearance in that area. All full thickness burns should be seen by a burn care physician.Deep partial thickness burns that heal slowly and full thickness burns that require grafting will have permanent scarring to varying degrees. How much a person scars depends on many factors including genetics, heredity, the area burned, infection, and the rate of healing. Donor sites may also leave minor scars.

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Health & Medicine

Angela Zhu

2002-03-01 17:37:00

Question:  It is possible to have surgery after radiation treatment.

Answer: In some situations, radiotherapy is preferred over surgery. For example, in the case of the cancer of the tongue or voice box, removal of these organs by surgery can significantly affect the patient's quality of life.Radiotherapy can provide similar cancer cure rate compared to surgery while preserve the function of these important organs. Chemotherapy is sometimes used along with radiation treatment to make radiotherapy more effective.Surgery can still be performed if cancer returns later.In other situations, the treatment involves both surgery and radiation treatment. Radiation treatment is given before the surgery to make the cancer smaller so the surgery will be less extensive. An example of this type of treatment is the cancer of the lower rectum, or a tumor of the muscle of the arm or leg. A colostomy or amputation may be necessary to remove the cancer without any treatment before surgery. However, by giving radiation treatment first and sometimes with chemotherapy, the cancer shrinks. Surgery then can remove the cancer and reconnect the bowels so the patient does not have to wear the bag, or in the case of arm or leg, remove only partial muscle and avoid the amputation. With this type of treatment, a short course of approximately five weeks of radiation treatment before the surgery can preserve the function of the organ and improve the quality of the life after the cancer treatment.

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Health & Medicine

Dr Joseph Galichia

2002-03-01 16:32:00

Question: Are there any new risk factors for heart disease?  I am not a smoker, my blood pressure is OK, my cholesterol is pretty good, and I am not diabetic.  I am, however, about 60 lbs. overweight.  Does this mean I am relatively safe from developing heart disease or is my being overweight enough to put me in the same 'high risk' class?

Answer:  There are definite known risk factors of heart disease and weight is one of them.  It has been shown that people who are mildly overweight have some increased risk of heart disease, but patients who are more than 20% above their normal body weight have an unusual risk for heart disease, stroke, high blood pressure, joint problems, and particularly diabetes.  Thus, the need to make some lifestyle changes to get your weight back within a normal range becomes extremely great.  One of my major concerns always is that patients who are overweight at this level will eventually become diabetic.  About twenty million Americans have diabetes today and it is felt that a lack of exercise and being overweight are the main risk factors for diabetes, which, itself, is a precursor to heart disease and stroke.  There are genetic factors that relate to diabetes, but certainly being sedentary and overweight are the main risks for developing this problem. The other risks for heart disease include high blood pressure, smoking, high cholesterol, diabetes, a sedentary lifestyle, and having a lot of stress in your life.  These are problems that do not seem to plague you at the moment, but your perception that being overweight puts you in a high-risk class is absolutely correct.  Recognizing this problem is the first step, but I would recommend getting some counseling regarding your diet, and also that you have an exercise test before going on an exercise program which will be necessary in your long term management as well.  Good luck in these endeavors.  

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Health & Medicine

Robert Cusick MD

2002-03-01 15:09:00

Question:  I am 51.  I played football until I was 24.  I had three knee surgeries on my right knee and one on my left knee.  I have had fluid drained off my knee several times and have taken cortisone shots quite often.  I am now living with all of the pain and discomforts.  My doctor mentioned doing a bursa sac removal.  He did not explain it that well, preferring instead to let the specialist do so.  I have not seen him yet.  What kind of procedure is a bursa sac removal?

Answer:  Among today's active but aging population, painful knees are a very common problem, which can cause great discomfort on a daily basis.  Certain activities such as competitive football, heavy manual labor, weightlifting, or injury to the knees can accelerate the natural process of 'wear and tear' arthritis, or osteoarthritis.  This disease affects millions of Americans of all ages, but is most common after the age of fifty.  There are several treatment options for this fifty-one year old patient with painful knees, which are likely the result of osteoarthritis accelerated by years of competitive football, several minor injuries and several subsequent surgical procedures.  The first line of defense is typically an anti-inflammatory medication such as ibuprofen.  Once these medications become less effective, a patient may be offered cortisone shots.  These steroid injections placed directly into the knee joint will often alleviate a patient's pain and allow a higher level of activity for several months, if not longer.  The downside to these injections, however, is that they tend to become less effective with each subsequent administration, and can only be given up to three times per year.  Any patient who experiences frequent, painful swelling of a knee as a result of arthritis may benefit from drainage of the fluid on an occasional basis.  Removing the fluid from the knee, however, does not address the underlying problem of osteoarthritis, and is considered a symptomatic treatment.  As the arthritis remains after the fluid is removed, it is likely that the swelling will recur as the patient's activity increases.  In a similar way, surgical removal of the bursa sac does not address the basic arthritis, and may only provide short-term relief.  The bursa sac is a small, flat, water-containing sac which sits in front of the knee and serves to keep the skin from adhering to the underlying muscles and tendons.  The bursa sac is quite sensitive to direct trauma such as a fall on the knee, and can become very swollen and tender.  A bursa sac, which remains inflamed and painful over a prolonged period of time, and does not respond to conservative treatments such as anti-inflammatory medication, ice packs and compressive wraps, may require surgical exploration and removal, but this is rare.  Knee replacement may be an option for you, but only as a last resort.  The indications for total knee replacement have been steadily growing over the past ten years, but fifty-one is still considered quite young to contemplate this type of surgery.  A patient of this age would have to display advanced arthritis affecting most of the knee on X-rays, severe pain in the knee, which has failed conservative treatments such as medication, physical therapy, and injections, and extreme limitation of activities due to pain and loss of motion.  A motivated patient in this situation may be expected to do quite well after a total knee replacement.Your knee, which has had several surgeries, requires cortisone shots and occasional removal of fluid, and which is constantly painful, would be expected to continue to worsen slowly over time.  The body's natural process of osteoarthritis will cause your knee to swell, and will lead to a smaller range of motion with time.  As discussed, there are many treatment options available which can make this type of situation manageable for you until knee replacement is appropriate. 

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Health & Medicine

Dr Joseph Galichia

2002-02-01 16:18:00

Question:  How important is diet and exercise to the avoidance of cardiovascular problems. I've read about and have known those who do so and have a heart attack at a young age anyway. Of course there are the other cases too. It just seems like it's so much to give up when you never know for sure.

Answer:  Cardiologists around the world have long felt that diet and exercise were important in preventing heart disease and stroke.  Furthermore, emerging evidence would tell us that maintaining a normal body weight and doing adequate exercise daily helps in the prevention of diabetes, a common precursor to heart attack and stroke.  Of course, maintaining a normal blood pressure, not smoking, and trying to manage stress in your life are important, as well as management of cholesterol abnormalities.  These abnormalities can occur even in the setting of a good diet and exercise program and must be followed.  There are many studies that demonstrate the value of exercise in preventing coronary heart disease.  One of the earliest studies showed that dock workers who moved about carrying heavy objects all day doing their job had a lesser incidence of heart attacks than office workers in a direct comparative study.  The body of evidence has continued to grow that exercise not only helps prevent heart attack but also helps one maintain a normal body weight and helps somewhat in the prevention of hypertension or high blood pressure.  Furthermore, we know that patients who have had heart attacks do better if they are placed on an exercise program.  Despite the advantages of exercise, we do know that for heart patients periods of heavy intense exercise put them at the greatest risk of having a heart attack.  For that reason, we recommend that patients who have been sedentary and who have risk factors for coronary heart disease, including family history, should have a treadmill test prior to beginning an exercise program.  Patients are always asking, "How much is enough exercise?"  My response generally is to keep it very simple and to simply walk briskly 45 minutes, five days per week.  Almost all studies have shown that this amount of exercise and this intensity of exercise will give you all of the risk reduction, all the benefits of exercise, and not subject you to the risk of sudden death or heart attack while doing intense exercise activities.  Of course, swimming, biking and other dynamic activities can play the very same role.  Aside from that, I do recommend light to moderate weight lifting three to four times per week.  We also remain convinced that diet is an important part of any program to prevent heart attack.  Certainly monitoring the quantity of food we eat is important because no matter what sort of fat-free diet we may ascribe to, too much food leads to weight gain and puts us at risk of heart disease.  However, there is a good correlation between the amount of fat consumed, one's body weight, and the degree of cholesterol elevation.  Thus, maintaining a low-fat diet is important in maintaining a normal serum cholesterol level.  Still in all, there are individuals who simply have a high cholesterol despite being on what seems to be a good diet.  My best recommendation for an appropriate diet is to be on a very well balanced diet with five servings of fruits and vegetables daily and to restrict the portion size considerably.  The amount of food that we should eat should be just adequate to keep our body weight within the normal range.  Interestingly, all studies that look at ageing in the human body have shown us that people who eat less food tend to live longer no matter what other dynamics come in to play.  In other words, people who are somewhat underweight and who have restricted their caloric intake age less quickly and live longer.  Maintaining a healthy diet and exercise program will likely lead to a longer lifetime, but also for most individuals creates more enjoyment and satisfaction, and adds to the joy of living.By Dr. Joseph Galichia

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Health & Medicine

Wendy Mosiman

2002-02-01 15:35:00

:  My 85-year-old mother was recently in the hospital for a broken hip. She was discharged before we felt she was ready. The nurse who assisted us was talking something about DRG days or something. What is DRG and how does it affect a person’s stay in the hospital?

Question:  My 85-year-old mother was recently in the hospital for a broken hip. She was discharged before we felt she was ready. The nurse who assisted us was talking something about DRG days or something. What is DRG and how does it affect a person’s stay in the hospital?Answer:  In the past, most health care was on a fee-for-service basis. It was referred to as retrospective payment because the fee for health care services was paid after all the needed services were provided.   During the 1970s, a period of high inflation, health care costs skyrocketed. Most Americans had health insurance and were not worried about costs because the insurance company or Medicare and Medicaid would pay for all services provided.     There was unprecedented growth in the types of services and therapies available, some of which were necessary for certain illnesses and some that were not. Long hospital stays, admissions for check-ups or leaving a child in over the weekend so the parents could have some time to rest are examples of how hospital services sometimes were used inappropriately. As a result, several cost containment and cost limiting programs were introduced in the 1980s.     One such program was the prospective payment system initiated by Medicare and other payer groups. Each illness or disease is assigned a Diagnosis Related Group (DRG) and the doctor and hospital receives a fixed payment for the hospitalization no matter how many days the patient stays or how many services are required. The payment is based on an average length of stay in the hospital, a limited number of laboratory tests and a certain amount of nursing and other care. The doctor, hospital and/or the patient must absorb any additional costs themselves.     It is in everyone's best interest to get patients well enough to go home or to another level of care as quickly as possible. However, their own physician evaluates each patient's care and the dismissal is based upon the physician's best medical knowledge, rather than on DRG guidelines alone. It is important for the patient and the family to discuss reasons they feel the patient isn't "ready" to go home, but to understand that there may not be anything we are doing for them that has to be done in the hospital. However, in some cases the patient may qualify for additional care outside the hospital, such as the services provided by a skilled nursing facility, rehabilitation hospital or home health agency.

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Health & Medicine

Dr Galichia

2001-12-01 14:55:00

Question: Are the symptoms of heart attack different for men and women?

Answer:  It is true that men and women may present differently with symptoms of coronary heart disease.  Men tend to have more "classic symptoms" including chest pains in the center of the chest radiating into the left arm and occurring with exertion and relieved with rest and nitroglycerin.  This classic symptom of angina pectoris is definitely more common in men then women.  Women may be short of breath, and have fatigue or other softer symptoms, which are often missed.  At the time of a heart attack, however, men are more likely as well to have a "Hollywood heart attack" with severe crushing chest pain, drenching sweat, a feeling of impending doom, nausea, and extreme weakness.  This pain is usually oppressive and it has a dramatic impact on the patient.  Certainly, this is not always the case, but is much more likely to be a presentation in men than in women. Women often have more subtle symptoms.  When a heart attack occurs in women, they may have symptoms of shortness of breath or extreme fatigue or chest pain that is less dramatic, often consisting of heart burn or a feeling of fullness, or shortness of breath.  These symptoms are often overlooked and may be attributed to "stress" or quite often gastrointralogic complaints.   Women with coronary heart disease, in the absence of heart attack, may have extreme fatigue, shortness of breath, or chest pain that is not well located in the center of the chest.  These symptoms are easily overlooked both by the patient and their physician unless there is a high level of alertness to the possibility of coronary heart disease.   Despite the differences in presentation of symptoms that have been described, I find in my own practice that the difference between men and women, relative to these symptoms, is much less than has been described.  In fact, I often find that men have very subtle symptoms, including fatigue and shortness of breath, and that women very often have the same symptoms, including chest pain.  In all of my patients I must consider the possibility of coronary disease presenting in a "less than classical way".  By having my antenna stretched to the fullest when evaluating these patients, I have a much better chance of making the correct diagnosis.      Remember this description of Cardiac Chest Pain.SAVES:S Sudden onsetA Anterior in locationV Vague descriptionE Exertion makes it occurS Suddenly goes away with rest and nitroglycerin

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Health & Medicine

Dr Galichia

2001-11-01 14:47:00

Question: What is atherosclerosis? What are the options if one has been diagnosed with this condition? Is chelation therapy and option? What is it?

Answer:  Atherosclerosis is a build up of fatty material in the walls of arteries.  This causes the artery to narrow and causes stiffness and resistance to flow within the arteries.  The plaque in the artery may itself become unstable and close the artery off resulting in catastrophic events such as heart attack and stroke, or the diminution in flow itself may result in chronic symptoms due to lack of oxygen and blood flow in various organs.  These arteries are also subject to closing off abruptly.  Because any organ system can be effected and the body can be effected, the specific treatment depends on which organ is effected.  For instance, blocked arteries in the heart are extremely common and often lead to balloon dilatation procedures, stenting, or bypass surgery in an attempt to mechanically correct the problem.  However, we are more concerned now about trying to stabilize this disease process with measures such as diet, exercise, and the use of statin drugs and other cholesterol lowering agents.  The use of anti-platelet drugs, such as aspirin, and newer drugs, such as Plavix, has been found to help greatly.  Furthermore, ACE inhibitors, commonly used to treat hypertension, and beta-blockers may provide more stability to the plaques.  Simple measures such as not smoking, maintaining a normal blood pressure, getting plenty of exercise, eating a healthy diet, and maintaining a normal cholesterol are extremely important in this equation.  Chelation therapy is a treatment designed to reduce plaque formation or attempt to reduce the amount of plaque that already exists.  This therapy has never been proven scientifically and, thus, is not funded by insurance companies or Medicare in this country.  Nevertheless, thousands of Americans undergo this treatment, often with anecdotal success.  The treatment consists of weekly infusions of IV medication and is relatively costly.  Most chelation therapists charge in the neighborhood of $100 per session.  This treatment is not entirely safe in that some individuals develop renal failure while taking the medication, but by in large, the index of safety is relatively high.  The lack of firm scientific evidence and the cost of this intervention, both in terms of time loss from work and the cost of the infusions themselves, have made this a therapy not considered to be mainstream by American physicians at this time.  There are scientific studies being done to look at chelation therapy and evaluate it more objectively.    

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Health & Medicine

Dr Holly Alexander

2001-11-01 14:21:00

Question: What is staph infection?

Answer:  S. aureus can cause a number of types of infection. Skin and wound infections are most common, but it also can cause bone and joint infections and blood stream infections. Blood stream infections usually are the result of release of organisms from another infected site, so it is important for a physician to determine and treat the source of the infection.Question:  I am told you can only get it in a hospital. Is this correct?Answer:  No, you can (and probably already have) had staph infections that you got after you had an accident or had some damage to your skin such as a cut or insect bite. This may happen anywhere: at home, at work, at play, or in the hospital. Usually these infections don't spread; however, S. aureus can be a very aggressive organism, especially in those who are immunocompromised. In addition, S. aureus produces a number of toxins that can have severe effects such as Toxic Shock Toxin or enterotoxins that cause one type of food poisoning.Question:  Can you get rid of it?Answer:  Staphylococcal infections can be treated with several types antibiotics  However, there is a great deal of concern about antibiotic resistance in this organism. Currently many immunocompromised patients and some individuals in long-term care facilities are colonized with staphylococci resistant to methacillin, the class of drug usually used to treat infections. Although they remain susceptible to vancomycin, physicians and laboratories throughout the world are monitoring for resistance to this antibiotic.

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Health & Medicine

Dr Joseph Galichia

2001-09-01 11:03:00

Question: I am a 23-year-old female who was diagnosed with a heart murmur at birth. Recently, I have noticed palpitations during periods of high caffeine intake or stress. Could these things or others be in any way related to these palpitations? And if so, are they a life threatening risk? Are there any preventive measures? What happens when the heart palpitates?

Answer:  Palpitations occur when one feels a fluttering or irregular feeling in the chest. Usually the sensations are related to cardiac irregularities. Most often the rhythm changes are minor consisting of an occasional PVC or irritable beat that arises in one of the pumping chambers. These beats may also arise from the reservoir chambers known as atria. Most of these are benign but they may be related to significant underlying disease and should be evaluated.Other more serious rhythm changes may evoke the same sensation and have more serious implications. These disturbances include atrial fibrillation, atrial tachycardia, ventricular tachycardia and a host of other rhythmdisturbances. In my opinion, all of these should be evaluated and understood completely. In the absence of underlying heart disease, many of the causes of palpitation may not need further treatment, but the moreserious causes need aggressive management.Simple PVCs or PACs are usually benign and are not life threatening. They are often made worse by caffeine consumption, alcohol, or nicotine. Stress and a lack of sleep may also make the symptoms worse. Heart murmurs and sounds created by blood flow within the heart or blood vessels can be heard with a stethoscope. Many are benign and have no significance.  Others are related to minor alular abnormalities, but I strongly feel thatany adult with a murmur should have an echocardiogram to rule out more serious causes. In your particular situation, any murmur present since birth deserves such a study. Mitral valve prolapse is a common finding of this type, but still deserves a comprehensive understanding.

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Health & Medicine

Dr Joseph Galichia

2001-07-01 09:02:00

:  What causes blockages to form in arteries?

Dr. Joseph Galichia Question:  What causes blockages to form in arteries?Answer:  The build up of plaque can occur in any artery of the body.  However, in the United States these blockages are prone to occur in the small arteries of the heart.  These small arteries are called coronary arteries.  Blockages can also form in the arteries in the brain, the neck, the legs, and any other organ system.  We do not understand all of the reasons for the build up of plaque or blockages, but we do know that some factors predispose us to having this problem develop.For example, we know that smoking puts us at a high risk for developing vascular disease of all types, and in particular, coronary artery disease.  It is felt that smoker's may have 5 times greater risk of having a heart attack or stroke than their counterparts who do not smoke.  Furthermore, a combination of other risk factors makes smoking even more of a lethal problem.  Aside from that, high cholesterol levels, particularly if the LDL, or bad cholesterol, level is elevated, makes us more susceptible to vascular disease.  Diabetes, smoking, a lack of physical activity, being overweight, and high blood pressure also predispose us to developing blockages within our arteries.There are some risk factors which can be altered, including the ones mentioned above. However, a family history of heart disease also puts us at greater risk, and being of the male gender creates a risk earlier in life for developing plaque within arterial walls.  For instance, men tend to have heart attacks about 10 years earlier in life than women and it is felt that the difference is due to estrogen production in women prior to menopause.  After menopause, things even out and the risk of heart disease in women approximates men for the rest of their lives.There are certainly things we can do to lower our risk factors, including maintaining a normal blood pressure, maintaining a normal body weight, exercising at least 45 minutes five days a week, and doing our best to handle stress in our lives.  Unfortunately, no simple formula will eliminate the risk of atherosclerosis (hardening of the arteries), and as one ages, the probability of developing changes within the arterial walls becomes greater.  Being aware of the risk factors, maintaining close contact with you doctor, and developing a sound surveillance system is absolutely crucial to minimize the risk of heart disease and stroke.Question:  I have been on Lipitor for several months and my cholesterol has come down. When can I stop taking this drug?Answer:  Drugs like Lipitor, Zocor, Pravachol and other drugs, which we call statins, are very short acting drugs and do not give any long term protection.  The cholesterol lowering affect only happens while you are taking the medications.  Unfortunately, upon stopping the drug, the cholesterol will zoom back to its previous level.  There is no long term or curative affect from any of the drugs available to us today to treat cholesterol. Thus, it becomes a problem of daily maintenance including dietary restriction of fat and continuing to take your medications.If you are taking a drug like Lipitor, or one of the other statins, you should monitor cholesterol at least once a year and also have monitoring of your liver function tests.  The possibility of developing liver disease due to these drugs is extremely low, but nevertheless, long-term surveillance is strongly indicated.   Question:  I recently had a frightening experience of being unable to move my right hand for approximately 10 minutes.  The symptom passed and I was able to regain the use of my hand without any problems whatsoever and I have not experienced the immobility since.  I told my doctor a couple of weeks later about the episode and he became very alarmed and ordered some tests. He said he thought I had a TIA.  Can you explain the significance of a TIA?Answer:  What you described is an example of a TIA, or in medical terms, a transient ischemic attack.  It simply means that you lost some neurologic function momentarily.  People who have TIA's are often very frightened, and unfortunately, fail to seek urgent medical care for this problem.  Either a small clot passing through an artery or some other problem, often consisting of a spasm in an area of a blocked artery in the brain, usually cause these problems.  Unfortunately, a TIA is simply a warning sign that you may be about to have a serious and completed stroke.  The significance of this event is that very strong efforts need to be undertaken to find out if there is some correctable anatomical problem that will lead to a major stroke.   People with arterial narrowing in their neck arteries may have a part of the plaque break off and go to their central nervous system causing an event just like you described.   Small clots in the heart or even clots that come from the legs can, in some cases, migrate into the brain causing such a reaction. Fortunately, in your case, your body helped dissolve this clot quickly and you did not proceed to have permanent neurologic damage. It is best to think of a TIA as merely a warning signal that you are about to have a stroke. I recommend the following to all patients:1. If there is any question about the loss of any neurologic function, even for a period so brief as a minute or two, call 911 and go to the hospital immediately.2. Physicians who see patients with these complaints must be very cognoscente (a person having expert knowledge) of any findings on the examination, such as sounds called bruits in the neck arteries, or the presence of a heart murmur or any defect in the cardiovascular system.  Such an evaluation most often consists of a Duplex scan or Doppler study of the neck and also an echocardiogram.  Furthermore, an MRI or CAT scan of the brain, and often a relatively new test called MR-angiography, a test used to look at the smaller arteries in the brain, may also help us understand this problem.People who have blocked arteries in their neck may benefit tremendously from surgery to eliminate the plaque in these vessels and that will decrease their risk of a stroke immensely.  In other situations, we are unable to correct the problem anatomically but may be inclined to give drugs to prevent clot formation including aspirin, a newer drug called Plavix or perhaps cholesterol lowering drugs to stabilize the lining of the blood vessels.  Fortunately, if you have a TIA and you heed the warning signs, most people can avoid proceeding towards a major stroke.Question:  I have been very sedentary most of my life but I recently had bypass surgery and was told by my doctors to exercise daily.  I can't seem to carry out their instructions because I get pain in my right leg when I walk quickly.  I have spoken with my doctor and he says I simply need to "get in shape".  What should I do?Answer:  The symptom of pain in the leg on exertion, relieved with rest, is known in the medical world as claudication.  This is simply a medical term that implies to your doctor that there is most likely a deficit of blood flow to your leg.  Classically, this pain occurs in the calf but may also occur in the buttocks or the thigh area.  Most people can walk a certain distance, then experience cramping in their leg to the point where they have to stop walking.  If they rest for a while, they can usually walk about the same distance before the symptom recurs.  This complaint is highly significant as it implies that there is a blocked artery to that extremity and immediate evaluation is indicated. In our clinic, we begin by feeling for the pulses in the legs, but proceed almost immediately with a test called a Doppler examination where we can ascertain whether or not there is a blood flow deficiency in an extremity. This is a very simple, non-invasive test and can be done in a few minutes.  If blockages exist in the legs, most of the time they can be improved markedly by doing balloon dilatation or stenting of one of the vessels. In certain instances, a bypass procedure can be done in the leg to restore blood flow to the leg.It is very common with people who have heart disease, namely blocked arteries in their heart, to have blocked arteries in other areas including the legs.  By the same token, most people who have a blocked artery in the leg,  neck or a part of the body away from the heart, do have underlying heart disease.You should have an immediate evaluation for this problem. Fortunately for you, most of the time these arteries can be repaired non-surgically. By Dr. Joseph Galichia

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Health & Medicine

Dr Galichia

1969-12-31 18:00:00

: How much of a risk are H1N1 vaccination side effects? Answer: According to recent Center for Disease Control and Prevention (CDC) reports, the risk of severe side effects of any sort is about 82 per million. This doesn’t sound like much, but it is nearly double the rate from seasonal flu vaccines, which were 47 per million. This does raise the question, “How is it that the side effects are twice as common, if the vaccines are virtually identical as health officials claim?” Statistics released by the CDC on December 5th, current through November 28th, show that all key indicators for H1N1 symptoms during the week of November 22-28 have decreased from the previous week; however, most remain highly elevated for this time of year. Question: What is the latest update on the spread of H1N1 symptoms? Answer: During week 47, the following influenza activity was reported: Widespread influenza activity was reported by 25 states (Alabama, Alaska, Arizona, California, Connecticut, Delaware, Florida, Indiana, Kentucky, Maine, Maryland, Massachusetts, Michigan, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Utah, Vermont, and Virginia). Regional influenza activity was reported by 17 states (Arkansas, Georgia, Hawaii, Idaho, Illinois, Kansas, Louisiana, Mississippi, Missouri, Montana, North Dakota, Oklahoma, Oregon, South Carolina, Tennessee, Texas, and Washington). Local influenza activity was reported by the District of Columbia, Puerto Rico, and six states (Iowa, Minnesota, Nebraska, South Dakota, West Virginia, and Wisconsin). Sporadic influenza activity was reported by Guam, the U.S. Virgin Islands, and two states (Colorado and Wyoming). Question: What are the latest st

Answer: In a press release on December 5th, the US Department of Health and Human Services (HHS) released a video of people talking about why they got the H1N1 vaccine, mostly centered around not wanting to get other people sick. However, there is little information given as to why so many Americans are avoiding it — all of the known and possible swine flu shot side effects. According to the World Health Organization (WHO), the most common symptoms of the H1N1 vaccinations reported are swelling, redness or pain at the injection site, which usually go away rather quickly. Also common, though less so, are fever, headache, fatigue, and muscle aches shortly after receiving the swine flu vaccine, which usually go away within 48 hours. Allergic reactions of various sorts have also been seen, but they are “well within the expected range”. There have also been a handful of severe side effects from the H1N1 vaccines, including Guillain-Barre, anaphylaxis (severe allergic reaction), and unexplained deaths shortly after receiving the swine flu vaccine. And, rumors persist about possible long-term effects from the thimerosal preservative, which is up to 50% mercury. Although officials insist that it is safe, many aren’t so sure. Question: How much of a risk are H1N1 vaccination side effects? Answer: According to recent Center for Disease Control and Prevention (CDC) reports, the risk of severe side effects of any sort is about 82 per million. This doesn’t sound like much, but it is nearly double the rate from seasonal flu vaccines, which were 47 per million. This does raise the question, “How is it that the side effects are twice as common, if the vaccines are virtually identical as health officials claim?” Statistics released by the CDC on December 5th, current through November 28th, show that all key indicators for H1N1 symptoms during the week of November 22-28 have decreased from the previous week; however, most remain highly elevated for this time of year. Question: What is the latest update on the spread of H1N1 symptoms? Answer: During week 47, the following influenza activity was reported: Widespread influenza activity was reported by 25 states (Alabama, Alaska, Arizona, California, Connecticut, Delaware, Florida, Indiana, Kentucky, Maine, Maryland, Massachusetts, Michigan, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Utah, Vermont, and Virginia). Regional influenza activity was reported by 17 states (Arkansas, Georgia, Hawaii, Idaho, Illinois, Kansas, Louisiana, Mississippi, Missouri, Montana, North Dakota, Oklahoma, Oregon, South Carolina, Tennessee, Texas, and Washington). Local influenza activity was reported by the District of Columbia, Puerto Rico, and six states (Iowa, Minnesota, Nebraska, South Dakota, West Virginia, and Wisconsin). Sporadic influenza activity was reported by Guam, the U.S. Virgin Islands, and two states (Colorado and Wyoming). Question: What are the latest statistics regarding hospitalization and death due to H1N1 Swine Flu symptoms? Answer: The number of deaths attributed to Pneumonia and Influenza (P&I) continues to decline, but still squeaked by just above the epidemic level of 7.1% for week 47, at 7.2% of all deaths. This includes 17 pediatric deaths, of which 12 were confirmed to be caused by pandemic 2009 influenza A H1N1 symptoms, and five with an influenza A virus of undetermined subtype. This brings the total flu-related child deaths since the beginning of flu season to 189, and the total laboratory-confirmed H1N1 deaths in children to 210. Hospitalizations also continued to drop across all age groups, but is well above the level expected for week 47, especially young children, ages 0-4. Other H1N1 Statistics Included in the Report were: There was a sharp decline in the percentage of tested samples that showed positive for influenza, down to a mere 15.4%. Novel 2009 H1N1 remains by far the most common influenza virus circulating; of those samples that had both type and subtype confirmed, there were 6 influenza B, 1 seasonal influenza A H3, and the remaining 708 cases were H1N1 swine flu.

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Health & Medicine

Torey Shackelford

1969-12-31 18:00:00

Answer: A driving evaluation would give you a good idea about your mother’s ability to continue operating a vehicle. Performed by a specially trained therapist, a driving evaluation assesses a person’s physical and cognitive capabilities behind the wheel. In addition to being an ideal way to verify whether an aging parent or someone with declining health or vision is still able to drive, a driving evaluation can determine if a person can be on the road after recovering from an illness such as a stroke, amputation, head injury, or a condition affecting the body’s neurological system. Such conditions often reduce the physical, sensory, or motor abilities needed to get behind the wheel, but through rehabilitative therapies, many patients can regain their independence, including the ability to drive. A comprehensive driving evaluation consists of in-clinic, behind-the-wheel, and post-driving assessments that gauge a person’s mental status, physical conditioning and coordination, and overall skills as they pertain to the task of driving. The evaluation typically begins with a series of in-clinic assessments that examine the individual’s mental status, vision, muscle strength, reflexes, range of motion, balance, and coordination. If the individual passes these tests, they advance to in-automobile tests that begin in the safety of a parking lot and progress to more complicated and challenging driving situations on public streets and highways. These more advanced tests occur as the individual proves capable at each level of testing. After completion of the evaluation, the driving specialist meets with the individual and family members to discuss results and to make recommendations regarding driving status or adaptive aids that may be needed. A copy of the evaluation is also sent to the individual’s physician. Although driving evaluations are not covered by Medicare or private insurance providers, the cost of the service is typically regarded as an affordable option for determining an individual’s ability to continue driving. An individual’s physician must prescribe a driving evaluation in order for the assessment to be performed.

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Health & Medicine

Dr Galichia

1969-12-31 18:00:00

:  Is it true that a bypass patient can generally expect to need another bypass operation about every 10 years?

ANSWER: In order to understand the bypass surgery we should think of it as a treatment for the blocked arteries and not a cure. In the 1960's we learned that we can take veins from the leg and use as bypasses from the aorta to narrowed heart arteries successfully. This operation was first done by Dr. Favaloro and by the 1970's was becoming frequently performed procedure with excellent surgical outcomes. In those early days we felt patients may by fortunate to live only few years and we were not even sure that a repeat bypass procedure could be done. Many patients were told that operation might last five years but to expect little more. We discovered early on that many patients lived far beyond without complications and also that if new blockages occurred or the bypasses failed we could safely repeat a bypass operation. Investigations also demonstrated that the need for repeat bypass surgery became greater after five years, and that this risk extended throughout the patients' life. However, we also began aggressively treating patients for risk factors including smoking cessation, cholesterol reduction, weight loss, exercise, and blood pressure control. Furthermore, annual check-ups including a stress test helped to identify those patients at greater risk for recurrent heart attacks and other coronary events. A major breakthrough occurred in the early 1980's when the cardiologists began to use balloon angioplasty as a method of preserving bypass grafts and treating new blockages that occurred in the heart arteries. This enabled us to avoid the second bypass operation in a great number of patients.  Technology has advanced rapidly in this area and we now have medicated stents, which are highly successful in salvaging old bypasses and treating new blockages in the native arteries. Also, we now are seeing patients who have lived 20 to 30 years following their first bypass procedure with hardly any complications along the way. Thankfully, our advise to patients in the 1960's and 1970's that their life expectancy would be short and that their options beyond the first bypass operation did not exist was false. More and more patients are avoiding bypass operations because of the simplicity and safety of balloon and stent procedures. For some patients, however, bypass surgery is the only reasonable option and maybe the only bypass procedure they will ever need.

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Health & Medicine

Glen Mathis

1969-12-31 18:00:00

Question: I am 8 weeks along in my first pregnancy. What do I need to be aware of with medications and is there anything that helps with nausea?

Answer: When you are pregnant, it is important to understand that everything you take into your body passes from your blood to the baby’s blood; therefore, it is best to avoid all over-the-counter medicines especially in the first eight weeks of pregnancy. This period is particularly important because it is during the first eight weeks when your baby’s heart, lung and brain systems are being formed. Remember that no medication is safe for 100 percent of the people, however there are times when the benefits of a medication far outweigh any risks. Nausea, most known as morning sickness, is a very common symptom of pregnancy affecting the majority of pregnant women, although not every woman will experience it in the same way and to the same degree. For women who are eager to alleviate their symptoms, it’s important to note that there is no way to totally eradicate the symptoms of morning sickness, but there are ways to minimize their effects. •Eat and drink frequently, but in small amounts as soon as you are hungry or thirsty. An empty stomach is more likely to get “upset” than one that is full. •Avoid foods that are spicy. •Drink clear cold liquids (such as lemonade, ginger ale). •Take vitamins that trigger nausea at bedtime rather than at the start of the day. •Cook with ginger (which has been found to alleviate nausea and vomiting). If you are really struggling through your pregnancy because of your bouts with nausea and vomiting, medications are indeed an alternative. There are certain medications that may alleviate all or some of these symptoms, and they are considered relatively safe to both you and your baby during your pregnancy. Speak to your physician about the various alternatives and their potential side effects and risks. Some of these medications include: Doxylamine, Promethazine, Metoclopramide and Ondansetron. For those women who develop heartburn during pregnancy, there are also antacids to help curb reflux symptoms, which may trigger morning sickness symptoms. Remember to follow any directions given to you by your physician or pharmacist carefully. Also, it is very important that you try very hard to get all you prescriptions at the same pharmacy. This way, your pharmacist will be able to warn you of potential drug interactions.

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Health & Medicine

Dr George Watson

1969-12-31 18:00:00

What is the difference between thermography, X-ray, and mammography?

ANSWER: First, let’s look at the similarities.  All of these imaging techniques are designed to provide diagnostic information.  Used separately or in combination, they allow physicians to determine structural changes so that appropriate interventions can be made.Both X-ray and mammography involve radiation.  X-rays are helpful when there is a question of a bone fracture or a metallic foreign body in soft tissues.  Mammography is designed to evaluate soft tissues, such as the breasts.  Over time, individuals can have significant cumulative radiation exposure.Thermography is also very good for evaluating soft tissues.  One of biggest advantages is that there is no radiation.  Also the tissue is not touched or crushed in the exam like it is in mammography.  The thermography camera captures infra-red radiation from the patient’s body.  Suspicious areas in the breast appear on thermography as much as six to twelve months before they are visible on the mammogram or palpable to the patient. Thermography is also very good at showing the soft tissue injuries that many people suffer in falls or auto accidents.  These painful areas don’t show up on X-ray, but are very clearly demonstrated by thermography.  We recently had a man who had suffered exposure to Agent Orange, and had had neck and lower back disc surgeries.  Thermography showed the specific areas where directed therapy will be more effective in treating his chronic pain.Thermography can be used to evaluate peripheral blood vessels in a non-invasive exam to check for poor circulation, blood clots, and other blockages.

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Health & Medicine

Dr Joseph Galichia

1969-12-31 18:00:00

: Can you explain the similar symptoms of a heart attack and acid reflux? How will you know the difference?

ANSWER: The symptoms of a heart attack and the symptoms of acid reflux often overlap.  Heart attacks can have many varied presentations including chest pain, often described as the worst pain one could imagine.  The pain usually is located in the center of the chest and may radiate to the left arm, neck or jaw.  The pain may be described as a pressure sensation, "like an elephant sitting on my chest". Other patients may describe a severe burning in the chest or an aching sensation.  On the other hand, many patients may not have symptoms of chest pain at all.  Women for example, are less likely to have the "Hollywood heart attack", but are more likely to have more subtle symptoms.                                                                                                               Other symptoms of heart attack include shortness of breath, excessive sweating, weakness, nausea, vomiting, a feeling of faintness, or a feeling of impending doom.  One can see that these symptoms are complex to assess and may present with varying severity.  I am very humble about making this diagnosis and always tell my students that no patient ever read the textbook on how to present with a heart attack.  We also tell all of our patients to mistake on the side of seeking help if they have these symptoms or even the feeling that something is wrong with their body.  Early intervention is critically important and may be a life or death matter.  A recent study has shown that most women in fact, do not have chest pain at all and usually present with fatigue, shortness of breath, or other more subtle symptoms. Now compare these symptoms to patients with acid reflux, or GERD.  Most of these patients complain of "heartburn", a symptom that may also be a symptom of heart attack.  These patients may also complain of nausea and vomiting and often a sense of anxiety.  The worst mistake a patient can make is to mistake the symptoms of a heart attack for GERD.  We often see patients with severe unrelenting heartburn who try to talk themselves out of going to the ER and then die of a heart attack.  Needless to say, given the fact that patients may present so differently, doctors and patients must always be on alert for a clue that a heart attack is in the making.  If you make a trip to the ER with a simple attack of heartburn, you can celebrate that no heart damage occurred.