January 10, 2013
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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.