January 10, 2013
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DEAR DOCTOR K: My doctor has prescribed prescription painkillers — opioids — for my severe back pain. They relieve my pain, but how can I reduce my risk of becoming hooked? DEAR READER: Simply being aware of the risk of addiction is a good first step in ensuring that you do not become addicted to prescription painkillers. I’ll explain a little bit about painkillers. Then I’ll describe some steps you can take to prevent addiction.
DEAR DOCTOR K: My son was recently diagnosed with asthma. His doctor wants to put together an asthma “action plan.” What is that? DEAR READER: Asthma is a complicated and serious disease. It can behave differently from hour to hour and from day to day. A person with asthma needs a plan for what to do at each stage of the disease. I’ll describe the elements of the plan in a minute, but first a little background on asthma itself.
DEAR DOCTOR K: After years of living with hearing loss, I am soon going to get my first hearing aid. Anything I should know ahead of time to be prepared? DEAR READER: The first thing many new users of hearing aids notice is that sounds seem strange. Think of how different your own voice sounds when you listen to a tape recording of yourself. You may also be more aware than ever before of your footsteps, your car’s motor, the sounds you make as you chew your food, and just about any other environmental noise. Many hearing aids can be adjusted to lower the volume of unwanted noise. But more important, with time, your brain will get better at tuning it out.
DEAR DOCTOR K: My spouse passed away last year, and I am still grieving. Is this normal? DEAR READER: By coincidence, I’m writing this reply to your question on the 51st anniversary of my father’s death. He died very young. This is a sad day — at least for me, this grief never fully ends.
DEAR DOCTOR K: Does menopause cause weight gain? DEAR READER: In the United States, women typically go through menopause between 47 and 59 years of age. And the average woman gains about one pound per year around the time of menopause. Not surprisingly, we tend to assume that menopause causes weight gain. Research suggests that there is no direct link between menopause and weight gain. But menopause may play an indirect role.
DEAR DOCTOR K: I’m 70 years old. I already had a pneumonia vaccine, back when I was 65. At my checkup last week, my doctor said I need to get another one. Why? DEAR READER: I always like to hear that adults are staying up to date with their vaccinations, as you did when you received a dose of the PPSV23 (Pneumovax) vaccine at age 65. Pneumovax helps protect against pneumonia caused by one common type of bacteria, called pneumococcus.
DEAR DOCTOR K: At my last checkup, my doctor asked if I snore. When I told the doctor that my husband says I snore a lot, the doctor said snoring can be a sign of heart disease, particularly in postmenopausal women. What does snoring have to do with heart disease? DEAR READER: Snoring is not a sign of heart disease, but it can be a sign of sleep apnea. And people with sleep apnea are at greater risk for heart disease. Sleep apnea is a condition that causes brief, repeated pauses in breathing throughout the night. A woman’s risk of sleep apnea rises after menopause.
DEAR DOCTOR K: You recently wrote about e-cigarettes not being safe for teens. What about hookahs? I don’t completely understand what they are. Are they OK for my teen? I think he might be smoking them. DEAR READER: A hookah is a water pipe that people use to smoke a specially made tobacco. Often the tobacco used in hookahs is flavored, which makes smoking it more attractive to some people.
DEAR DOCTOR K: My doctor never recommended statins to me, but he says there are new guidelines, and thinks that I should now start taking one. What do you think of the new statin guidelines? DEAR READER: The new guidelines make a lot of sense, because we’ve learned that statins have more effects on the body than just lowering cholesterol. Statins were developed after a Nobel Prize-winning discovery in the 1970s revealed how the body makes cholesterol. Most of the cholesterol in our body is made by our body, not consumed in our food. Statins slow the production of LDL (“bad”) cholesterol by the body.
DEAR DOCTOR K: For 20 years, I’ve substituted artificial sweeteners for sugar in my coffee, and switched to diet soft drinks to avoid obesity and the diseases that overweight people are prone to, like Type 2 diabetes. Now I hear that new research says that’s a bad idea. What is going on? DEAR READER: Here’s what’s not confusing: More than a modest amount of sugar each day is not good for you. Nothing’s changed there.
DEAR DOCTOR K: My daughter’s pediatrician would like her to have the HPV vaccine. I’m not sure. Is there evidence the HPV vaccine has some real benefit? DEAR READER: Yes, there is evidence — overwhelming evidence. And with this vaccine, the benefit is not that it will reduce the risk of a short-lived illness, like the flu. This vaccine will reduce your daughter’s risk of getting a common and life-threatening cancer.
DEAR DOCTOR K: I have diabetes. My doctor says I’m at risk for diabetic nephropathy. What is that? What can I do to prevent it? DEAR READER: Diabetic nephropathy is kidney disease that is a complication of diabetes.
DEAR DOCTOR K: What should I expect when my daughter goes through puberty? How can I help her as she goes through these changes? DEAR READER: Full disclosure: I don’t have any personal or parental experience to tap into for this question. Experienced colleagues and friends always emphasize how important it is to discuss puberty with your daughter before these changes begin. She needs to know what to expect and also that these changes are perfectly normal. Otherwise, she might be frightened by the first signs of change, such as her first menstrual bleeding.
DEAR DOCTOR K: My doctor told me to check my blood pressure at home, but he didn’t give me many details. Could you provide some guidance? DEAR READER: Keeping your blood pressure in check is vital to maintaining heart health and preventing stroke. But the way most of us monitor our pressure — by trekking to the doctor’s office for occasional blood pressure checks — is far from ideal.
DEAR DOCTOR K: I have a particular disease. A nearby medical school is recruiting people with my condition to participate in a research study. Should I volunteer? DEAR READER There are two good reasons to consider volunteering for a study: It might help you, and it might help others. In some types of studies, there also may be risks to you.
DEAR DOCTOR K: I’ve heard so many conflicting opinions about whether or not to get screened for prostate cancer. Are there official guidelines? What do they recommend? DEAR READER: To say that prostate cancer screening has been controversial is an understatement. I spoke to my colleague Dr. Marc Garnick, clinical professor of medicine at Harvard Medical School, to hear his thoughts.
DEAR DOCTOR K: I caught my son and his friends smoking e-cigarettes. My son tells me I have no reason to worry, and that they’re safer than regular cigarettes. What exactly are e-cigarettes? Are they safe?
DEAR DOCTOR K: I’m a woman in my mid-50s. Lately I haven’t been able to become sexually aroused. What could be wrong? DEAR READER: Sex is complicated. You probably already know that. Sexual desire surely resides in the head, but other parts of the body can affect desire as well. In particular, the genital organs communicate with the brain.
DEAR DOCTOR K: Can lifestyle changes help relieve my heartburn? DEAR READER: Heartburn is an uncomfortable burning sensation that radiates up the middle of your chest.
DEAR DOCTOR K: My father was recently diagnosed with essential tremor. Is this the same thing as Parkinson’s disease? If not, what is the difference?
DEAR DOCTOR K: Can you tell me what happens when someone having a heart attack gets to the hospital?
DEAR DOCTOR K: In a recent column on antibiotics, you didn’t mention their use in meat and poultry as a cause of antibiotic resistance. Hasn’t this contributed to the problem?
DEAR DOCTOR K: As I’ve entered my 70s, I’ve noticed that my eating and bowel habits have changed. Is this normal?
DEAR DOCTOR K: I recently saw a headline that said children who sleep less weigh more. Is that true? How much sleep should my preschooler and first-grader get each night?
DEAR DOCTOR K: Should I request “advanced” cholesterol testing at my next checkup?
DEAR DOCTOR K: I have constant knee and hip pain. How can I relieve my pain without drugs or surgery?
DEAR DOCTOR K: I’m a working mother. I also care for my ill and aging father. Are there professionals or services that can help me care for him? DEAR READER: There can be plenty of rewards in caring for an ailing parent. My parents both died suddenly while apparently healthy, so I never faced this situation. But I’ve had many patients and friends who have told me that they got closer to their parents in the process of caring for them.
DEAR DOCTOR K: My son got a concussion playing football. His doctor said he shouldn’t play again until his symptoms have completely disappeared. What symptoms should we be looking out for?
DEAR DOCTOR K: I recently found out that I’m pregnant. I’d like to continue eating fish, but I understand some fish contain mercury, which could be harmful to my baby. What fish should I avoid?
DEAR READER: Erectile dysfunction (ED) is a problem faced, to one degree or another, by many middle-aged and older men. Since sildenafil (Viagra) was launched in 1998, men have been turning to medication to help address this problem.
DEAR DOCTOR K: I cook with kosher salt, which doesn’t contain iodine. Am I getting enough iodine in my diet? Can I get iodine from other foods?
DEAR DOCTOR K: I have athlete’s foot. How can I get rid of it? And how can I make sure I don’t get it again?
DEAR DOCTOR K: I was recently diagnosed with prostate cancer. My doctor says my cancer is slow-growing and that we should just monitor it for now. Why not treat it right away?
DEAR DOCTOR K: My 7-year-old daughter suffers from allergies every spring and fall. What can I do?
DEAR DOCTOR K: I have poor vision that is making it more and more difficult for me to live independently. Are there tools that can help with my day-to-day activities?
DEAR DOCTOR K: I saw my doctor about a patch of rough, brown skin that I noticed on my upper arm. He said it is actinic keratosis and needs to be removed. Is it cancer? How will it be removed?
DEAR DOCTOR K: I sometimes have dark, strong-smelling urine. Should I be concerned?
DEAR DOCTOR K: What can I expect when my son goes through puberty?
DEAR DOCTOR K: I regularly get terrible migraine headaches. My doctor has prescribed medication, but I still think I should have a brain scan to make sure there’s nothing more serious going on.
DEAR DOCTOR K: I want to go on a diet and am trying to decide between low-fat, low-carb and Mediterranean. What do you think?
DEAR DOCTOR K: My father has Alzheimer’s disease. Is it unsafe for him to drive?
DEAR DOCTOR K: I have never had chickenpox. Do I still need to get a shingles vaccine?
DEAR DOCTOR K: Between my job and kids, I rarely have time to prepare and sit down to a healthy meal. I’ve had my fill of fast food and energy bars. Any suggestions?
DEAR DOCTOR K: My therapist told me that regularly writing in a journal might help ease my stress and improve my mood. Is there any evidence to back this up?
DEAR DOCTOR K: I’m scheduled to have a pacemaker inserted in a couple of weeks. Can you tell me what will happen during the procedure?
DEAR DOCTOR K: I have Type 2 diabetes. Is there anything I can do to cut down on my medications?
DEAR DOCTOR K: You’ve written about “superfoods” that deliver a lot of nutritional bang for their buck. Do you have a list of superfoods for heart health?
DEAR DOCTOR K: I’d like to strengthen my core. Can you describe some exercises to start? Will I need any special equipment?
DEAR DOCTOR K: My mother was recently diagnosed with a “sliding hernia.” What is this?
DEAR DOCTOR K: I’ve always had seasonal allergies. But over the past few years, I’ve noticed that my lips swell and my mouth gets irritated when I eat certain fruits and vegetables. Have I developed new food allergies as an adult?
DEAR DOCTOR K: I have a teenager, and I’m worried he might try marijuana. I’d like to give my teen some facts about marijuana that will make him think twice about using it. What can I tell him?
DEAR DOCTOR K: My husband suffers from severe depression, and I’m worried he might take his own life. How do I know if my fears are warranted?
DEAR DOCTOR K: I have a very painful ingrown toenail. What can I do?
DEAR DOCTOR K: I think I might be having panic attacks, but I’m not sure. What does a panic attack feel like?
DEAR DOCTOR K: My husband recently had a heart attack. Fortunately, he’s doing well. But I’d like to understand better what happens to the heart during a heart attack.
DEAR DOCTOR K: You’ve mentioned time-outs as an appropriate way to discipline young children. But they don’t work for my son, at least the way I’m doing them. What can I do differently?
DEAR DOCTOR K: As I’ve entered my 50s, I find myself reaching for Tylenol more often for my aches and pains. Should I be aware of any safety precautions?
DEAR DOCTOR K: My son plays a lot of video games. What do I need to know about them? And how can I make sure they don’t become a problem?
DEAR DOCTOR K: I'm in my 60s and already have a lot of wrinkles. What can a dermatologist do for me that will make a difference but not be hugely expensive?
DEAR DOCTOR K: Do the germs that live on or in us affect our health?
DEAR DOCTOR K: Are all germs dangerous to our health?
DEAR DOCTOR K: As I get older, I’ve noticed that I have more trouble remembering certain types of information. But other types of memory are as strong as ever. Is this true, or just wishful thinking on my part?
DEAR DOCTOR K: Is drinking tea good for my health? Which type has the most health benefits?
DEAR DOCTOR K: I’m having cataract surgery in a few weeks. There are so many options for replacement lenses. Which one should I choose?
DEAR DOCTOR K: I’m 68 years old and I take blood-pressure lowering medication. What do the new blood pressure guidelines mean for people of my age?
DEAR DOCTOR K: I am a 52-year-old man. When I finish urinating, I drip much more then I used to. And I have a stinging sensation in my urethra. What could cause this?
DEAR DOCTOR K: My brother is addicted to alcohol. How can I help him overcome his addiction?
DEAR DOCTOR K: I’ve been bothered by vaginal dryness. Sex is painful. My doctor believes it’s vaginal atrophy due to menopause. Can you tell me more about this condition? How is it treated?
DEAR DOCTOR K: I’ve heard it many times: Regular exercise helps prevent cardiovascular disease. But how does it do that?
DEAR DOCTOR K: Two friends recently had stents put in. What exactly is a stent? How does it work?
DEAR READER: Type 1 and Type 2 diabetes are different diseases, but they share many things in common. Both types of diabetes are marked by elevated levels of blood glucose, or sugar. Type 2 diabetes, though, is much more common than Type 1 diabetes.
DEAR DOCTOR K: I watched a documentary about President Kennedy around the 50th anniversary of his death last year. The program mentioned that he had something called Addison’s disease. What is that?
DEAR DOCTOR K: I’m a snorer. I read recently that treating snoring can affect blood pressure. Can you explain the connection?
DEAR DOCTOR K: Is it true that some people are more vulnerable to addiction than others? Why?
DEAR DOCTOR K: My daughter and several of her college friends are on the “paleo” diet. What is that? Is it healthy?
DEAR DOCTOR K: I have carpal tunnel syndrome. How can I relieve the discomfort without drugs or surgery?
DEAR DOCTOR K: How often should I have my eyes examined? What will the doctor check for during the exam?
DEAR DOCTOR K: I have irritable bowel syndrome. Can you explain what has caused it?
In yesterday’s column, a reader asked whether she should be tested for genes linked to Alzheimer’s disease. Today, I thought I’d give you my view on the larger question: Will studies of our genes change the practice of medicine and improve our lives?
DEAR DOCTOR K: Alzheimer’s runs in my family. Will it help to get gene testing for this disease?
DEAR DOCTOR K: I’m a man. Why are my breasts suddenly getting bigger?
DEAR DOCTOR K: What is mononucleosis, and why is it called the “kissing disease”?
DEAR DOCTOR K: I saw my doctor for some problems with my hearing. Why did she want a detailed list of my medications?
DEAR DOCTOR K: My doctor says I have heart failure. Are there symptoms I should be looking out for that would indicate my condition is getting worse?
DEAR DOCTOR K: My father recently had a heart attack. His doctor recommended cardiac rehab, but he refuses to go because he “already has a gym membership.” How important is cardiac rehab?
DEAR DOCTOR K: My 9-month-old daughter had a seizure last time she had a high fever. The pediatrician said it could happen again. What do I need to know?
DEAR DOCTOR K: At my last appointment, my ophthalmologist mentioned something about elevated eye pressure. What could this mean?
DEAR DOCTOR K: A deli sandwich is my go-to lunch most days of the week. Any suggestions for making my sandwiches healthier?
DEAR DOCTOR K: When I’m tired, the last thing I want to do is exercise. But my wife says that exercising will actually boost my energy. Is she right?
DEAR DOCTOR K: I've recently become sexually active and I'm planning to go on the pill. But there are so many different types of birth control pills. Which one is right for me?
DEAR DOCTOR K: I have seasonal affective disorder so I dread the approach of winter. What can I do?
DEAR DOCTOR K: I have two young children. I know not to buy toys with small parts or keep coins within their reach. What other choking hazards should I be aware of?
DEAR DOCTOR K: A few years ago my doctor told me that C-reactive protein was an important indicator of heart disease risk. At my last checkup, he didn’t mention it at all. Is it still considered important?
DEAR DOCTOR K: After smoking for more than 15 years, I finally quit eight months ago. But I still miss my cigarettes. I recently heard about electronic cigarettes. Are they safe?
DEAR DOCTOR K: I have cirrhosis of the liver. I also get tension headaches. What pain reliever can I take for my tension headaches?
DEAR DOCTOR K: My son suffers from occasional nosebleeds. What's the best way to stop a nosebleed? DEAR READER: Many people suffer from nosebleeds. I tend to get them this time of year when the air is cold and dry, as it irritates the normally warm, moist surfaces inside the nose.
DEAR DOCTOR K: I just found out I'm pregnant with twins. How will this pregnancy be different from my last one?
DEAR DOCTOR K: I’m often bothered by neck pain. What can I do to manage the pain when it strikes?
DEAR DOCTOR K: I was recently diagnosed with relapsing remitting multiple sclerosis. Can you tell me about my treatment options?
DEAR DOCTOR K: I’ve been playing tennis for years, but lately I’ve been sidelined by elbow pain. What can I do? DEAR READER: Elbow pain is the bane of tennis players. It has kept me off the courts for several months at a time. Let’s talk about how to get you back on the court — and prevent a repeat injury.
DEAR DOCTOR K: What is the difference between a food allergy and a food intolerance?
DEAR DOCTOR K: I recently discovered that my teenage son is smoking. How can I help him quit?
DEAR DOCTOR K: I worry a lot. Should I be worried that I worry too much?
DEAR DOCTOR K: I’m drawing up a living will, but I don’t understand many of the medical terms I’m encountering. Can you help? DEAR READER: Many people, certainly including me, have asked themselves how they would want to be cared for if they became very sick and unable to speak for themselves.
DEAR DOCTOR K: My doctor saw something suspicious on my mammogram and wants to do a breast biopsy. I understand there are several biopsy techniques. Can you tell me what they involve?
DEAR DOCTOR K: I’ve been taking levodopa for years to treat my Parkinson’s disease. Lately, though, it hasn’t been as effective. Are there any other treatment options?
DEAR DOCTOR K: I’d like to start doing some core exercises. What do I need to know before I start?
DEAR DOCTOR K: My doctor says I have “functional dyspepsia.” Medications haven’t helped. Could something more serious be wrong?
DEAR DOCTOR K: Lately I’ve been hearing more about the side effects of statins. For example, I’ve heard that they increase the risk of muscle problems and diabetes. How do I know if they’re still worth the risk?
DEAR DOCTOR K: I’m interested in buying a high-quality cardio exercise machine to use at home. Any advice?
DEAR DOCTOR K: What is tooth decay? Is it the same as a cavity?
DEAR DOCTOR K: At 65, I have begun to notice tiny threadlike shapes in my vision. My doctor calls them “floaters.” Should I be concerned?
DEAR DOCTOR K: What’s the verdict on glucosamine and chondroitin? Do they help relieve osteoarthritis pain?
DEAR DOCTOR K: I have asthma. Lately my symptoms have been worse at night. Why is that?
DEAR DOCTOR K: I’ve always worried a lot. I saw a psychologist, but she said I didn’t have anxiety disorder, so she couldn’t help. I can’t believe there’s nothing to do. Can you help?
DEAR DOCTOR K: Recently I’ve been feeling sad and tired. My doctor doesn’t think I’m depressed, but I know something’s not right. What could it be?
DEAR DOCTOR K: In a recent column about abdominal fat, you talked about two kinds of fat — brown fat and white fat. I’d like to hear more about them.
DEAR DOCTOR K: This isn’t a medical question — I’m just curious. How do we see?
DEAR DOCTOR K: You’ve written that abdominal fat is particularly bad for your health. What are the best ways to get rid of it?
DEAR DOCTOR K: I injured my PCL playing football. How long will my recovery take? DEAR READER: Let’s start with some knee anatomy. The posterior cruciate ligament (PCL) and the anterior cruciate ligament (ACL) are two tough bands of fibrous tissue. The ACL is injured more often than the PCL, which is why many people have heard of the ACL but not the PCL. The ACL and PCL connect the thighbone (femur) and the large bone of the lower leg (tibia) at the knee joint. The ACL and PCL form an “X” pattern that stabilizes the knee against front-to-back and back-to-front forces. (I’ve put a detailed illustration of the knee joint on my website, AskDoctorK.com.)
DEAR DOCTOR K: I have hypothyroidism. According to the Internet, there are several supplements that could help my symptoms. Should I be taking a supplement along with my thyroid medicine?
DEAR DOCTOR K: I saw my doctor for a rash on my face. After further tests, she diagnosed me with lupus. What is this? What is the treatment?
DEAR DOCTOR K: I have pain in the ball of my foot. My doctor thinks it is caused by a Morton’s neuroma. How did I get this, and what can I do about it?
DEAR DOCTOR K: What are “superfoods”? Which ones do you recommend?
DEAR DOCTOR K: My son has ADHD. Should I eliminate all foods that contain artificial food coloring from his diet?
DEAR DOCTOR K: I’m 65 and my face is starting to look old. Can you recommend nonsurgical treatments to take a few years off my face?
DEAR DOCTOR K: Why does my stomach sometimes make growling noises?
DEAR DOCTOR K: For years I've heard that chronic stress is bad for your health, but recently I heard something that made me take this seriously: Stress causes our cells to age faster. Is this really true?
DEAR DOCTOR K: You've mentioned biofeedback as a treatment option for several conditions, but I still don't understand what it is. Could you explain?
DEAR DOCTOR K: Could you explain how diabetes affects vision?
DEAR DOCTOR K: I am losing my hearing, and my doctor wants me to get two hearing aids. Is this really necessary?
DEAR DOCTOR K: I was just diagnosed with polycystic ovary syndrome. My doctor said it explains why I haven’t been able to get pregnant. What else can you tell me about this condition? DEAR READER: Polycystic ovary syndrome (PCOS) is a group of symptoms that results from an imbalance of certain hormones in the female body. It is relatively common: About 7 to 8 percent of adult women in the United States have PCOS.
DEAR DOCTOR K: Why do so many people lose height and develop a stooped posture as they get older?
DEAR DOCTOR K: My husband recently had a mild heart attack. He’s never been much of a drinker, but now he wants to have wine with dinner every night because he’s heard that it’s good for the heart. What do you think?
DEAR DOCTOR K: I live in a heavily wooded area, so I’d like to know the best way to remove a tick if you spot one on your skin.
DEAR DOCTOR K: My joints hurt. Does that mean I have osteoarthritis?
DEAR DOCTOR K: What does magnesium contribute to good health? Should I have my magnesium level checked?
DEAR DOCTOR K: A famous actor recently said he got throat cancer from oral sex. Could this be true?
DEAR DOCTOR K: I use a vaginal estrogen cream for vaginal dryness. Does it have the same risks as hormones taken orally or by skin patch?
DEAR DOCTOR K: I have dry eyes. What are my treatment options?
DEAR DOCTOR K: What do you think of the walk-in health clinics that are popping up? Can I use them instead of going to my regular doctor?
DEAR DOCTOR K: I’m a woman in my 50s. I’ve always had a healthy sex drive, but lately it’s gone bye-bye. What could be wrong?
DEAR DOCTOR K: I was just diagnosed with gestational diabetes. What are the risks to my baby? And what do I need to do to keep her safe? DEAR READER: Gestational diabetes is high blood sugar that occurs during pregnancy. Normally, the hormone insulin moves sugar (glucose) from the bloodstream into cells that use it for fuel.
DEAR DOCTOR K: For years I took antidepressants, but they didn’t really help my depression. Then a new doctor diagnosed me with hypothyroidism. Once I started taking thyroid medication, the depression lifted. What’s the connection?
DEAR DOCTOR K: I have risk factors for heart disease. I’ve been dutifully taking fish oil supplements for years to reduce my risk of a heart attack. Now I read that they don’t help. Should I stop taking them?
DEAR DOCTOR K: I love to go outside during a summer thunderstorm, but my sister is convinced I’ll get hit by lightning. Do I really need to head inside when there’s a storm brewing?
DEAR DOCTOR K: You’ve often advised readers to buy supportive shoes that fit properly. Can you be more specific about what to look for in a good shoe?
DEAR DOCTOR K: I’ve heard that tai chi may help people with Parkinson’s disease. Could you please elaborate?
DEAR DOCTOR K: Last year I developed deep vein thrombosis (DVT) — blood clots in my legs — during a long international flight. One of the clots got loose and went to my lungs. I’m fine now and am off all medications. Is it safe for me to fly again?
DEAR DOCTOR K: I fall asleep just fine, but then I wake up around 4 a.m. It’s too early to get up, but I can’t fall back asleep. Help!
DEAR DOCTOR K: I can hear my heartbeat in my left ear. Should I be worried that I might lose my hearing?
DEAR DOCTOR K: I sweat heavily, day and night. With summer here, I’m desperate. I’m in my 70s, well past menopause.
DEAR DOCTOR K: I have diabetes. I read that scientists had made a major discovery about how people with diabetes could naturally make more insulin. How excited should I be about this?
DEAR DOCTOR K: I have a stressful job. I think the stress helps me perform at my best, but my doctor says that in the long run, stress is bad for my health. Is he right?
DEAR DOCTOR K: I have urinary incontinence that started after I was treated for prostate cancer. What can I do?
DEAR DOCTOR K: I can’t sleep. Behavioral changes haven’t helped. Can you tell me about prescription medications for insomnia?
DEAR DOCTOR K: I exercise regularly, running or playing tennis several times a week. I’d like to add strength training to my routine. Anything I should know before I start? DEAR READER: Strength training should be part of everyone’s exercise routine. I ignored it for years and just did aerobic exercise. Despite substantial aerobic exercise every day, and my resulting cardiovascular fitness, I noticed my muscle bulk slowly shrinking.
DEAR DOCTOR K: I’m in my 50s and considering LASIK surgery. Should my age be a factor when deciding whether to have this procedure?
DEAR DOCTOR K: I’m a cancer survivor. Should I be following special guidelines for diet and exercise?
DEAR DOCTOR K: My father just had a lacunar stroke. I’ve never even heard of this. What can you tell me about it?
DEAR DOCTOR K: Berry season is here again, and I keep hearing that berries are healthy. What’s in them that makes them so good for you? DEAR READER: Here in the Northeast, we’re enjoying strawberries and looking forward to raspberries, blueberries and even blackberries further down the road.
DEAR DOCTOR K: Lately my 4-year-old has started lying to me. She’ll say she didn’t break a toy, or push her brother, when I know she did. How should I handle this?
DEAR DOCTOR K: I’ve heard that when people don’t properly dispose of their medications, they make their way into the drinking water. Should I be worried?
DEAR DOCTOR K: I see lots of products designed to treat foot problems — and I have lots of foot problems. Are the foot care products you can buy in the drugstore worth the money? DEAR READER: For some body parts, the drugstore has little to offer. But you’re right: There are many foot products. To find out if they’re really helpful, I checked with my colleague, Dr. James P. Ioli, assistant professor of orthopedic surgery at Harvard Medical School. Here are our thoughts on some common foot care products.
DEAR DOCTOR K: I have Type 2 diabetes. My doctor said that kidney disease is a potential long-term complication of diabetes. What’s the connection between the two?
DEAR DOCTOR K: I’ve started giving pureed solid foods to my 2-month-old daughter. My sister doesn’t think this is safe. What’s your opinion?
DEAR DOCTOR K: I have an open sore on the bottom of my foot. Can I just cover it with a Band-Aid until it heals, or do I need to see a doctor?
DEAR DOCTOR K: I have heart disease. Will chelation therapy help reduce my risk of a heart attack?
DEAR DOCTOR K: I tend to sprain my ankle fairly often. Are there any exercises that could help me strengthen my ankles and prevent future sprains? DEAR READER: Your ankles are remarkable joints. They must bear the full weight of your body, yet stay nimble and flexible. Every step, every jump, every move puts your ankles through a surprising range of motion. Even when you stand quietly, your ankles are constantly making minute adjustments to help you stay balanced.
DEAR DOCTOR K: My father’s memory has worsened lately, and we suspect he may have Alzheimer’s disease. Can you tell us what is involved in making a diagnosis?
DEAR DOCTOR K: I recently had some blood tests done, and my doctor told me I have “prediabetes.” What does this mean? Do I have diabetes or not?
DEAR DOCTOR K: I have chronic sinusitis and nasal polyps. My specialist suggested trying oral corticosteroids. What do you think?
DEAR DOCTOR K: I recently heard someone discuss “mindful eating” as a weight-loss strategy. Could that help me lose weight?
DEAR DOCTOR K: I hear the phrase “you’re delusional” used so casually. But what does it mean when someone is really, clinically delusional?
DEAR DOCTOR K: Let’s say I stub my toe. How does my brain know where it hurts and how bad?
DEAR DOCTOR K: In a previous column you wrote about the importance of balance exercises as we age. But why does our balance get worse as we get older?
DEAR DOCTOR K: I recently had a PSA test and my levels came back elevated. I’m scheduled to have a prostate biopsy. What can I expect?
DEAR DOCTOR K: I have pain in my kneecap, right in front of my knee. It hurts to walk down the stairs or even sit for too long. What can I do? DEAR READER: It sounds like you have what is called patellofemoral pain. That’s pain where your kneecap (patella) meets your thighbone (femur). It usually results from overdoing exercise. Fortunately, there’s a lot you can do to prevent and relieve this pain.
DEAR DOCTOR K: I’ve been taking Prilosec for years to prevent heartburn. My wife doesn’t think it’s safe to take any drug for that long. What do you think?
DEAR DOCTOR K: I’m 71 years old. My systolic blood pressure is usually in the 150s to 160s, which is high. But my diastolic blood pressure is usually in the 70s, which is normal. Do I need treatment?
DEAR DOCTOR K: I have sleep apnea. My doctor has urged me to use a CPAP machine, but it’s too uncomfortable. Are there other options?
DEAR DOCTOR K: I’m a healthy woman in my 40s. Should I take extra folic acid to boost my immune system?
DEAR DOCTOR K: I’m a nurse who is allergic to latex, so I always use latex-free gloves. But I still occasionally break out in hives. Why?
DEAR DOCTOR K: My father recently saw his doctor, complaining of fever, fatigue, joint pain and rashes. His doctor suspects vasculitis. What is vasculitis? How is it diagnosed and treated?
DEAR DOCTOR K: I recently had an electrocardiogram and my doctor gave me a copy of the tracing. Can you tell me what I’m looking at?
DEAR DOCTOR K: I’m a man in my 60s. I’ve been taking a calcium supplement to protect my bones, but I recently read that men shouldn’t take calcium supplements. Why not?
DEAR DOCTOR K: Today at the playground my toddler bit another child. How can I make sure she doesn’t do this again?
DEAR DOCTOR K: I have mild back pain. I sit at a desk all day and tend to slouch. My mother says that sitting up straight may help. Is she right?
DEAR DOCTOR K: Can you explain the importance of glycemic load, as opposed to glycemic index, when judging carbohydrates? DEAR READER: Carbohydrates, along with proteins, fats, vitamins, minerals, water and oxygen, are nutrients: We need them to live and grow. But even though we need carbohydrates, there still are carbohydrate-rich foods that are “good carbs” and “bad carbs.”
DEAR DOCTOR K: I brush and floss regularly. Do I need to use mouthwash too?
DEAR DOCTOR K: My doctor thinks I may have hypothyroidism. How will he make the diagnosis?
DEAR DOCTOR K: I’m a man in my 70s with spinal stenosis. What are my surgical options?
DEAR DOCTOR K: I’m a healthy young person, but I tend to have a lot of gas, bloating and diarrhea. Could a gluten-free diet help me?
DEAR DOCTOR K: I know fruits and vegetables make the healthiest snacks. But can packaged foods also be part of my healthy snack arsenal?
DEAR DOCTOR K: I’m scheduled to have a corneal transplant. What can I expect during this procedure?
DEAR DOCTOR K: My 14-year-old daughter got the Gardasil vaccine, which protects her from cervical cancer caused by HPV. But boys can get HPV, too. Should my teenage son also get the vaccine?
DEAR DOCTOR K: My husband has Alzheimer’s disease. Last week he left the house, and it took us hours to find him. How can I prevent him from wandering again? DEAR READER: One of the most dangerous and distressing symptoms of Alzheimer’s is wandering. It may seem unfathomable that a person might suddenly get up at night to go to the post office, or leave home at any hour for no apparent reason. The inability to control wandering is what often drives families to decide to place a loved one in a nursing home.
DEAR DOCTOR K: My neck hurts, but my doctor hasn’t been able to figure out why. I think if I had the words to better describe my pain, it might give him the clues he needs. Can you help? DEAR READER: Many of my patients have trouble describing their discomfort beyond telling me “it hurts.”
DEAR DOCTOR K: I’m a woman in my 30s, and I’ve never had an abnormal Pap test. Do I still need one every year? DEAR READER: The answer used to be yes. This helped ensure that you had regular Pap tests to screen for cervical cancer. But new guidelines recommend less frequent Pap tests for younger women, and no Pap tests for many older women.
DEAR DOCTOR K: I have osteoarthritis of the knee. Are there ways to relieve my knee pain without drugs or surgery? DEAR READER: Osteoarthritis is a degenerative disease of the joints. If you were to take an X-ray of every bone in the bodies of people over 50, probably most of us would have some degree of osteoarthritis in some joints.
DEAR DOCTOR K: I’ve heard there’s a new test that can help doctors diagnose a heart attack more quickly. Can you tell me about it? DEAR READER: A heart attack is instantly recognizable on TV and in the movies: The actor breaks into a sweat and clutches his heart. But in real life, a heart attack isn’t always so easy to identify.
DEAR DOCTOR K: These days everything in the supermarket claims to contain whole grains, from sugary cereals to my favorite chips. How do I know which foods are healthy whole grains? DEAR READER: “Whole grain” has become a healthy-eating buzz-phrase, and food companies aren’t shy about using it. But some of the products we buy may not deliver the healthful whole-grain goodness we’re expecting. And if sugary cereals can tout themselves as a whole-grain food, there’s something amiss.
DEAR DOCTOR K: Winter has wreaked havoc on my skin. It’s dry, itchy and cracked. What can I do to restore it, now that spring is here? DEAR READER: When the air is dry, it sucks moisture away from our skin. Our skin is built to retain moisture, but as we grow older it doesn’t do as good a job. Wintertime poses a special problem because humidity is low both outdoors and indoors. The combination of unusually dry air and aging leads to dry skin.
DEAR DOCTOR K: For months, my mouth has been painfully burning and tingling. What could be causing my symptoms? Are there any treatments for it? DEAR READER: Several conditions can cause a burning sensation in the mouth. Some nutritional deficiencies — particularly of B vitamins, iron and zinc — can cause it.
DEAR DOCTOR K: I often feel lightheaded when I stand up, especially first thing in the morning. Why does this happen? DEAR READER: You are probably experiencing a drop in blood pressure when you stand up. This is called orthostatic hypotension. As a result, not enough blood reaches your brain, and you feel lightheaded or dizzy.
DEAR DOCTOR K: My husband and I both have quick tempers. Before we know it, a simple observation turns into an argument. Any advice for keeping our conversations civil? DEAR READER: Everyone gets angry from time to time, but anger comes more easily to some people. Two married friends, call them Kevin and Jane, recently recounted the following exchange to me:
DEAR DOCTOR K: What are the benefits of breast-feeding? And if I do decide to breast-feed, how will I know if my baby is getting enough milk? DEAR READER: Breast milk provides all the calories and nutrients that a baby needs for the first six months of life. It also helps protect babies from illnesses such as ear infections, lung infections, vomiting and diarrhea. That's because for the first months of life, a baby's immune system is not fully developed. Breast milk contains antibodies that the mother has made, plus several other infection-fighting substances and cells.
DEAR DOCTOR K: A friend has a condition called gastroparesis. Could you explain what it is and how it can be treated? DEAR READER: Gastroparesis is the term used for sluggish emptying of food from the stomach into the small intestine. Normally, your stomach moves about half of an average meal into the small intestine within two hours after you eat. Within four hours, about 90 percent of your meal is in the small intestine. If you have gastroparesis, food stays in the stomach much longer.
DEAR DOCTOR K: I’ve always had motion sickness while traveling. Now I’ve started to get it at the movies. What causes motion sickness? And what can I do about it? DEAR READER: Lots of people get dizzy or nauseated, and even vomit, when traveling by boat, airplane, car or bus. And as you’ve found, even watching a movie can bring on motion sickness — especially the action scene.
DEAR DOCTOR K: I see advertisements about various treatments that stop your cells from aging. Is there anything to that? What happens to our cells as we age? DEAR READER: There are no treatments that can stop our cells from aging. But in the past 10 years scientists have made giant steps in understanding what causes cells to age. That knowledge could lead to true “anti-aging” treatments.
DEAR DOCTOR K: Why do I get a hangover when I drink? What’s the best way to get rid of it? DEAR READER: Last night was great — friends, food, fun and wine. Lots of wine. But this morning your head is pounding and your mouth is dry. The lights are too bright and every noise sounds like a jackhammer. Breakfast? You can’t bear the thought of it. There’s a lot we don’t know about hangovers — but we do know about the effects of alcohol on the body. And what we know may explain some of your hangover symptoms.
DEAR DOCTOR K: It’s obvious that there are some health problems that affect only women, and others that affect only men. But for the health problems that affect both women and men, are there differences in symptoms, or in reactions to treatments? DEAR READER: That’s an interesting question. Perhaps surprisingly, the answer is yes. Heart disease is a good example. Angina and heart attacks occur when too little blood flows to the heart through arteries. The classic symptom is chest pain or pressure that travels to the left arm, jaw or neck when you exert yourself.
DEAR DOCTOR K: I have heard that tai chi can have a profound impact on the body and mind. What gives this exercise so much power? DEAR READER: Tai chi is a Chinese martial art made up of a series of graceful movements, one transitioning smoothly into the next. Tai chi is said to be good for both body and mind; in fact, it’s been called “meditation in motion.” My Harvard Medical School colleague Dr. Peter Wayne, with Mark Fuerst, has written an informative new book about tai chi called “The Harvard Medical School Guide to Tai Chi.” (You can learn more about this book at AskDoctorK.com.) Dr. Wayne discusses the “Eight Active Ingredients” of tai chi. He explains how, individually and in concert, they influence the body and mind. These active ingredients are:
DEAR DOCTOR K: I was recently diagnosed with early-stage breast cancer. My doctor wants me to consider a lumpectomy plus radiation. But wouldn’t a mastectomy be more effective? DEAR READER: In a lumpectomy, just the cancer and tissue immediately around it are removed, and radiation therapy is used to kill any nearby cancer cells that might not have been removed. In a mastectomy, the whole breast is removed. Since sometimes breast cancer cells (invisible to the eye of the surgeon) can spread into the surrounding breast, it’s plausible to think that a mastectomy might have a better cure rate than just a lumpectomy.
DEAR DOCTOR K: I have bipolar disorder. I’ve experienced the highest highs and the lowest lows. How can one medication — lithium — treat both extremes? DEAR READER: Bipolar disorder is certainly a condition of extremes — extreme opposites.
DEAR DOCTOR K: You’ve mentioned nuts as a healthy snack in previous columns. I thought nuts were high in fat and calories. DEAR READER: Nuts are high in fat and calories, and they are also a great food. Am I nuts?
DEAR DOCTOR K: My husband and I have been happily married, more or less, for 25 years. But lately we’re fighting more. A friend suggested couples therapy. Can you tell me more about it? DEAR READER: I don’t feel as comfortable answering questions about relationships as more traditionally “medical” problems. I’m not Dr. Phil or Dr. Ruth. That said, here are my thoughts.
DEAR DOCTOR K: I’ve always enjoyed my food well-seasoned. Now my doctor wants me to cut down on my salt intake. Any suggestions? DEAR READER: Salt (sodium chloride) is like many other things in our food: We need it, just not in the amounts we take in. For most of us, the salt in our diet is too much of a good thing.
DEAR DOCTOR K: A few months ago I was in a serious car accident. Since then I’ve been incredibly jumpy and have trouble sleeping. My wife thinks I may have PTSD. Could she be right? DEAR READER: Post-traumatic stress disorder — PTSD — is a condition in which distressing symptoms occur after a major trauma. PTSD is often discussed in the context of troops who have served in war zones, but you don’t have to see battle to get PTSD.
DEAR DOCTOR K: My daughter has just been diagnosed with Crohn’s disease. What is it, and what is the treatment? DEAR READER: Crohn’s disease is an inflammatory bowel disease that causes abdominal pain, diarrhea, loss of appetite, joint pains, weight loss, weakness and fatigue. It’s caused by inflammation of the small (and sometimes the large) intestine.
DEAR DOCTOR K: I take a daily aspirin to prevent a heart attack. I just read that aspirin can cause macular degeneration. Should I stop taking it? DEAR READER: No, you shouldn’t stop taking aspirin. Medicine — and life — is full of trading off one risk for another. Doctors and medical scientists aren’t (yet) smart enough to discover or invent treatments that have absolutely no risks, only benefits. So you have to compare the risk of a treatment against your risks if you don’t take it.
DEAR DOCTOR K: I was diagnosed with ER-positive breast cancer a few years ago. My doctor told me to take tamoxifen for five years to prevent my cancer from coming back. I recently read that taking tamoxifen longer further decreases the risk
DEAR DOCTOR K: I have a friend with epilepsy. Can you explain what happens in her brain? DEAR READER: Epilepsy is a condition that causes repeated seizures, but sometimes seizures are not caused by epilepsy. It’s not uncommon, for example, for very young children to have seizures when they get a high fever. Called febrile seizures, they usually occur once or a few times and go away forever.