This blog contains information presented in the live broadcast of Let's Talk Medical with Doctor Gigi on June 1, 2012. Please check out the podcast on www.SkipShow.com if you prefer the audio version.
He Who Pays Chooses How to Play:
The New York mayor has proposed that his city should essentially outlaw large sodas. So what do you think about government taking away your Big Gulp? As a physician, I see the beauty of encouraging people to eat & drink sensible serving sizes, especially as we battle our epidemic of obesity, but I really hate the idea that my dietary habits might be dictated by government! The problem is that as long as government is responsible for our healthcare, they have a vested interest in our health. Thus, they just might be justified in passing laws that seemingly help to keep us healthy. Again, I like the idea of healthy habits, but I despise the idea of government-mandated anything! We as Americans like our freedoms, so how can we think this is a good idea?
Well, the unfortunate truth is that "he who pays chooses how to play." So if government pays for your healthcare, they will dictate how you live your life... perhaps affecting your diet, your exercise habits, your sleep habits, your sexual habits, etc. If that sounds frightening, start paying attention to healthcare policy, & start thinking about the control Big Brother already has... & be leery of giving them more control! This is an aspect of government-provided healthcare which many of us have not considered.
When government or insurance pays the doctor, realize that the doctor actually works for them. When you pay the doctor, he works for you. Which program do you think provides for an appropriate doctor-patient relationship? There are many political policies which might seriously affect your health, as well as your freedoms, so if you care, get involved & realize that "free" healthcare is NOT FREE!
Metastatic Cancer:
A "primary cancer" is the initial cancer that develops, & it is named according to the area in which it first begins. When that primary cancer spreads to a different area, then it is called "metastatic" or "secondary" cancer. So if cancer begins in the breast, it is called a primary breast cancer. If that cancer spreads or metastasizes to the brain, it is still called breast cancer (not brain cancer), but it is metastatic breast cancer which has gone to the brain.
Metastatic cancer is obviously not likely to be as treatable as primary cancer, but it is not by definition terminal! The curability depends on the type of primary cancer as well as the extent of metastatic spread... which is determined by the number of metastases & the organs involved with metastases. It also depends upon the overall health of the patient, & also to a large degree upon the patient's attitude. So never decide that there is no hope just based upon the knowledge that a cancer has metastasized... ask for treatment options & perhaps get several opinions.
During the show someone asked questions regarding a cancer which has just been diagnosed & has already metastasized to the bone. Obviously I cannot say whether this is curable, but certainly the patient should not assume there is no hope! Oncologists are the specialists who treat cancer patients, & they know treatment protocols, expected outcomes, cancer behavior, etc. So obviously this person must see an Oncologist soon! Many cancers like to metastasize to bone, so this could be a primary breast cancer, or perhaps a primary prostate cancer, or even some other cancer. Depending upon the type of primary cancer, the treatment will vary, so the Oncologist will need to diagnosis the primary cancer. The work-up is chosen by the Oncologist based upon the patient's history & a physical exam, & might include x-ray studies like CT scans or PET scans, biopsy of the bone tumor, mammograms, prostate checks, blood tests, & more. Treatment will
depend on the type of primary cancer, but generally the bone lesions are treated with radiation, which shrinks the tumors & helps decrease the pain... & yes, bone cancer is VERY painful! Bone cancer also weakens the bone, thus patients with bone cancer are at risk of breaking those affected bones. This type of fracture is called a "pathologic fracture" indicating that the bone has broken due to a pathologic process (the cancer), not because of trauma or osteoporosis. Radiation also helps to decrease the risk of these pathologic fractures.
As a side-thought, there are primary bone cancers, so not all bone cancer is metastatic. There are
many primary bone cancers, including Multiple Myeloma (which actually is cancer of the bone marrow), Osteosarcoma (which is most common in young people aged 10-25, & saddly is very malignant), Chondrosarcoma (which is cancer of cartilage), & several others. Each cancer has it's own personality & behavior, so I guess it is easy to see why we need Oncologists!!!
If you want to check out a great website with patient-friendly yet thorough cancer information, check out www.AboutCancer.com. It is the website of my friend Dr. Robert Miller who is a Radiation Oncologist in St. Petersburg, FL. Once in the website, go to "Dr. Miller's Web Site," then click on "Cancer Information."
Hurricane Preparedness:
So June 1 has arrived, & with it comes another hurricane season. Those of us who live in coastal states must prepare our homes, our property, & ourselves just in case the next 6 months bring threatening storms.
First it is important to know your evacuation zone, so you will know when it is imperative for you to leave. Have a plan as to where you will go, but pack a road map in case you have to take an alternative route. If you cannot evacuate independently, register with your city so they can get you the help you need. It is best to not depend on a shelter, but if you must, be sure you know where those are. If you require a special-needs shelter to assist with medical issues, be sure to register for that as well.
I am from Louisiana & live in Florida, so I've been through the drill more than a few times. I also recall a hurricane which hit Louisiana when I was 5 years old. Though we were 70 miles from the coast, I still remember the frightening wind & sideways rain. My home was also hit by a tornado which came from Hurricane Andrew as it headed north in the Gulf after having devastated Homestead, FL. To say the least, I have great respect for hurricanes, & as such, I evacuate. I can only hope you will do the same!
As a physician I would strongly encourage you to pack the following:
1) a 2 week supply of your medicines - ask your doctor for samples or a separate prescription which you can purchase on your own if your insurance will not allow an extra or early refill.
2) a list of your medications including the dose of each pill & how you take them.
3) a paper with your medical problems, past surgeries, allergies (to meds & to foods), physicians, & immunizations.
After a bad storm you could be incapacitated & unable to tell rescue personnel this information, & without electricity there might be no access to your medical record if it is electronic. Also, your physician might not be available or reachable. If you have a medical app (like My Medical) on your iPhone, iPod, etc., be sure to update it now.
4) perhaps a copy of your last 1 or 2 office visits from your doctor, as well as your most recent lab tests, including blood tests, x-rays, colonoscopy, mammogram, DEXA, etc.
5) equipment you'll need such as your CPAP machine, oxygen, bandages, crutches, braces, glasses, contac solution, etc.
6) water - plan to need 1 gallon per person per day & prepare for 3-7 days... but don't forget the animals!
If you can, keep the water in plastic jugs, but if you are caught without an adequate storage unit, fill the bathtub with water (after scrubbing it of course). Also, as water is so heavy, you might not be able to take enough with you if you evacuate. In this event, you should pack panty hose to act as a strainer, & bleach to purify water. Bleach should be pure Sodium Hypochlorite 5-6%, & you should mix it as follows: 2 drops of bleach to 1 quart of water, or 8 drops to 1 gallon. If the water is cloudy you should double the amount of bleach: 4 drops to 1 quart of cloudy water, or 16 drops to 1 gallon of cloudy water. Mix the bleach with the water & allow it to sit for 30 minutes before you drink it. Of course, if you have propane or another source of heat, you can boil the water to purify it. Remember however that flood water not only contains bacterial contamination, but also often contains contaminants such as chemicals (from cars, boats, pipelines, etc.). Unfortunately neither bleach nor boiling will help with this issue.
7) NOAA radio which will sound an alarm when a weather emergency happens in your area (such as a change in the hurricane's route or speed, or such as a tornado).
8) food - remember that you can go days without eating, but you won't last long without water!
Consider buying MRE's or similar packaged food from an Army store or camping store. If you pack canned goods, don't forget a hand-held can-opener.
9) a full tank of gas in a well-tuned car.
10) pets, leashes, pet food & medications, crates & beds, shot records, & perhaps towels to dry them off.
If your pet is fearful of bad weather, ask your Veterinarian for "storm pills" & be sure to pack them with your other supplies!
It is a good idea to pack things in advance, & those that cannot be packed early can be written on a list so you can quickly grab & go! I like to keep evacuation supplies in the attic, so if I am caught off guard I can just climb up & honker down. Don't forget, you'll need a ladder to get up there, & you should store an ax or chain-saw in the attic in case you have to cut your way out!
As some last thoughts:
Be sure that you only use a generator in a well-ventillated area; otherwise you might survive the disaster only to die from carbon monoxide poisoning.
Don't walk through storm water. It possibly has contaminants such as sewage & other chemicals, & it might be deeper than you expect. Also, you could be electrocuted if there is a downed power line hidden beneath the water.
And so we conclude another blog. I hope you find the information helpful... & if you do, please consider sharing the blog with your friends & family. You can do that by hitting the "F" or "T" button at the bottom of the blog to share with your Facebook or Twitter connections.
Also, consider listening to the radio program. You can do this by tuning to WTAN 1340-AM in Tampa/St. Pete, FL area, or if you are not local, find us on the web via www.SkipShow.com where you can listen live or check out the recorded podcast. Feel free to call or e-mail questions or concerns: (727)-441-3000 local, or (866)-TAN-1340 toll-free, or DoctorGigi@SkipShow.com.
Stay safe, & here's to our health!
Doctor Gigi
Sunday, June 17, 2012
Tuesday, June 5, 2012
Asthma Awareness Month; Claudication & Vascular Problems.
The following reviews topics discussed on Let's Talk Medical with Dr. Gigi as it aired live on WTAN 1340-AM on May 25, 2012.
Asthma Awareness Month:
May is Asthma Awareness Month, so let's discuss some highlights of this disease. It is basically inflamation of the airways, which results in sputum, spasm, & swelling. The inflamation can be due to infections (viral, bacterial, or fungal), allergens (pets, dust mites, cockroaches), or irritants (like smoke, perfumes, chemicals, or even acid from GE reflux). People with asthma react more vigorously to these triggers than the average person as they have a gene which causes an over-production of inflamatory substances in their airways.
Despite the advancement of medicine over the past decades, the prevalence of asthma has been steadily increasing since the 1970's. We are not sure why this disease continues to affect more & more people, but perhaps it is related to poor air quality or perhaps the gene is being passed on to more of our relatives! At present, approximately 20 million people have asthma, & of these 6 million are children. In general, children have worse outcomes than adults, so they must be monitored more closely & treated more aggressively.
There are many medications for treating asthma, but there are basically 2 types of meds: anti-inflamatory meds & anti-spasm meds. The anti-inflamatory meds decrease the inflamation in the airways, so they essentially treat the disease itself, & are thus considered MAINTENANCE meds as they are used daily to maintain control of asthma. Anti-inflamatory products are either steroids (like Asmanex, Azmacort, Q-Var, Pulmicort, Flovent, & Aerobid) or leukotriene inhibitors (like Singulaire, Accolate, & Zyflo).
On the other hand, the anti-spasm meds are also called beta-agonists, & they come in 2 types: short-acting & long-acting. Short-acting beta-agonists are meds like Albuterol & Xopenex, which start to work within several minutes but only work for about 4-6 hours. Long-acting beta-agonists are meds like Foradil & Serevent which take a little while to start to work (15-30 minutes) but then last for about 12 hours. The short-acting meds like Albuterol are used as EMERGENCY (or RESCUE) inhalers as they work so quickly, but if you have good control of your asthma you should not need them very often. In fact, if you use your rescue inhaler more than 2 times per week, you should call your doctor as you might need additional evaluation or treatment. The long-acting beta-agonists can be used as maintenance meds, & are often found combined with steroids in products such as Advair (which is a steroid plus Serevent) or Symbicort (which is a steroid plus Foradil), but as they take a while to work, they are never used as rescue inhalers!
If you take your maintenance inhaler daily but suddenly realize that you are having more shortness of breath or more wheezing (this is actually the noise made by the air passing through an airway which is in spasm), you should start to use your rescue inhaler. Remember however that if you use it more than 2 times per week, you should call your physician. You should consider it an emergency each time you reach for your rescue inhaler. So would you really allow yourself to have more than 2 emergencies in 1 week without calling your doctor for help? The doctor will likely look for factors that cause worsening of asthma such as infection or exposures to allergens or irritants. Depending upon the cause for your worsening asthma (called an "exacerbation" of asthma), the doctor might order a chest x-ray, blood tests, or sputum culture, & might treat you with antibiotics, reflux meds, or oral steroids. Severe asthmatic attacks often require hospitalization for IV fluids, nebulizer treatments, & IV antibiotics.
Many people used to use an over-the-counter rescue inhaler called Primatene Mist as treatment for asthma. This was Epinephrine in an inhaled form. Since January 2012 it is no longer available due to the fact that it was very potent, had many side-effects, & was over-used by people who could be better managed by seeing a physician & getting a maintenance inhaler.
There is a gadget called a peak-flow meter which can be used to assess your lung function. It is an inexpensive plastic device which your doctor can prescribe, & which you can get from the pharmacy. It measures the peak force exerted when you exhale forcefully. There are standards for age & height, but more importantly, if you check your peak flow intermittently, you will be able to determine your own baseline, so you will know when you are deteriorating.
Though asthma is a treatable disease, it is still a deadly disease. In fact during my 20+ years of practice, I have had 2 patients die from asthma. They were only 29 & 45 years old! So if you have asthma, become knowledgable about your disease, take your meds as instructed, & if you have worsening, do not over-use your rescue inhaler! Instead, call your doctor for further evaluation & treatment! After all, if you can't breath, you can't live!!!
Claudication & Vascular Problems:
People sometimes complain of pain in their legs. When the pain occurs with walking or similar exertion, it is generally due to a blood flow problem though sometimes it is caused by a neurologic problem. People with back problems, in particular spinal stenosis, often have pinched nerves in the back which cause a heaviness or pain in the legs which resolves with rest AND sitting. In fact, sometimes this "neurogenic claudication" resolves or abates with simply bending forward at the waist... which unloads pressure on the spine. This is why many people like to lean on a shopping cart while walking, as it relieves stress on the spine.
On the other hand, people with vascular (or blood flow) problems get pain & cramps in their legs, but these resolve with rest alone... sitting is not required. This "vascular claudication" is basically like a heart attack of the leg muscles. The muscles are busy working, but due to blockage of an artery, the blood (& oxygen) cannot get to the muscle, so the muscle cramps up & can no longer function. When you rest, the oxygen demands of the muscle decrease & the blood flow is adequate, so the pain resolves & you can walk a little further before the pain returns. If you do not intervene & re-establish good blood flow, you can end up with limited mobility, but over time you can actually get pain even at rest. This is an indication that the blood flow in that leg is so limited that the muscle does not get enough oxygen even at rest. Usually by this time people & their doctors figure out that there is a real problem & they do a bypass surgery or an angioplasty to improve the blood flow.
Early on, vascular claudication is treated with medications like Pletal which make the red blood cells (which carry the oxygen) more pliable. Red cells look like frisbees, but they are fairly rigid, so the Pletal allows them to be more flexible so they can fold in half, thus squeezing through the blocked arteries more easily. It is interesting to note that although walking triggers pain, a walking program is actually prescribed as treatment for vascular claudication as the body often responds to this oxygen-deprived situation by growing its own bypasses called "collateral" blood vessels!
Though neurogenic claudication is evidence of a nerve problem, vascular claudication is evidence of a circulation problem. It is a reflection of blocked arteries, so if you have it, you should have a work-up to look for other blocked arteries. This should include a carotid ultrasound to look for blockage that could lead to a stroke, & a stress test or heart catheterization to look for blockage that could result in a heart attack. Remember, the vascular system is one system... if you have blockages in one place you are prone to have blockages elsewhere! Note however, that although you should push through the pain of vascular claudication to stress the body & encourage it to create collateral circulation, never push through chest pain, as the body does not generally create its own heart bypasses!
So we'll end on that note! Hope you learned something, & I hope you'll listen to the live radio broadcast of Let's Talk Medical with Doctor Gigi on Fridays at 1PM Eastern time on WTAN 1340-AM in the St. Pete/Tampa area. Of course you can always catch me on the computer via www.SkipShow.com where you can listen live or to the recorded podcasts. I appreciate any input, & please don't hesitate to call or to e-mail your questions:
(727)-441-3000 local, (866)-TAN-1340 toll-free, or DoctorGigi@SkipShow.com.
Here's to our health!
Doctor Gigi
Asthma Awareness Month:
May is Asthma Awareness Month, so let's discuss some highlights of this disease. It is basically inflamation of the airways, which results in sputum, spasm, & swelling. The inflamation can be due to infections (viral, bacterial, or fungal), allergens (pets, dust mites, cockroaches), or irritants (like smoke, perfumes, chemicals, or even acid from GE reflux). People with asthma react more vigorously to these triggers than the average person as they have a gene which causes an over-production of inflamatory substances in their airways.
Despite the advancement of medicine over the past decades, the prevalence of asthma has been steadily increasing since the 1970's. We are not sure why this disease continues to affect more & more people, but perhaps it is related to poor air quality or perhaps the gene is being passed on to more of our relatives! At present, approximately 20 million people have asthma, & of these 6 million are children. In general, children have worse outcomes than adults, so they must be monitored more closely & treated more aggressively.
There are many medications for treating asthma, but there are basically 2 types of meds: anti-inflamatory meds & anti-spasm meds. The anti-inflamatory meds decrease the inflamation in the airways, so they essentially treat the disease itself, & are thus considered MAINTENANCE meds as they are used daily to maintain control of asthma. Anti-inflamatory products are either steroids (like Asmanex, Azmacort, Q-Var, Pulmicort, Flovent, & Aerobid) or leukotriene inhibitors (like Singulaire, Accolate, & Zyflo).
On the other hand, the anti-spasm meds are also called beta-agonists, & they come in 2 types: short-acting & long-acting. Short-acting beta-agonists are meds like Albuterol & Xopenex, which start to work within several minutes but only work for about 4-6 hours. Long-acting beta-agonists are meds like Foradil & Serevent which take a little while to start to work (15-30 minutes) but then last for about 12 hours. The short-acting meds like Albuterol are used as EMERGENCY (or RESCUE) inhalers as they work so quickly, but if you have good control of your asthma you should not need them very often. In fact, if you use your rescue inhaler more than 2 times per week, you should call your doctor as you might need additional evaluation or treatment. The long-acting beta-agonists can be used as maintenance meds, & are often found combined with steroids in products such as Advair (which is a steroid plus Serevent) or Symbicort (which is a steroid plus Foradil), but as they take a while to work, they are never used as rescue inhalers!
If you take your maintenance inhaler daily but suddenly realize that you are having more shortness of breath or more wheezing (this is actually the noise made by the air passing through an airway which is in spasm), you should start to use your rescue inhaler. Remember however that if you use it more than 2 times per week, you should call your physician. You should consider it an emergency each time you reach for your rescue inhaler. So would you really allow yourself to have more than 2 emergencies in 1 week without calling your doctor for help? The doctor will likely look for factors that cause worsening of asthma such as infection or exposures to allergens or irritants. Depending upon the cause for your worsening asthma (called an "exacerbation" of asthma), the doctor might order a chest x-ray, blood tests, or sputum culture, & might treat you with antibiotics, reflux meds, or oral steroids. Severe asthmatic attacks often require hospitalization for IV fluids, nebulizer treatments, & IV antibiotics.
Many people used to use an over-the-counter rescue inhaler called Primatene Mist as treatment for asthma. This was Epinephrine in an inhaled form. Since January 2012 it is no longer available due to the fact that it was very potent, had many side-effects, & was over-used by people who could be better managed by seeing a physician & getting a maintenance inhaler.
There is a gadget called a peak-flow meter which can be used to assess your lung function. It is an inexpensive plastic device which your doctor can prescribe, & which you can get from the pharmacy. It measures the peak force exerted when you exhale forcefully. There are standards for age & height, but more importantly, if you check your peak flow intermittently, you will be able to determine your own baseline, so you will know when you are deteriorating.
Though asthma is a treatable disease, it is still a deadly disease. In fact during my 20+ years of practice, I have had 2 patients die from asthma. They were only 29 & 45 years old! So if you have asthma, become knowledgable about your disease, take your meds as instructed, & if you have worsening, do not over-use your rescue inhaler! Instead, call your doctor for further evaluation & treatment! After all, if you can't breath, you can't live!!!
Claudication & Vascular Problems:
People sometimes complain of pain in their legs. When the pain occurs with walking or similar exertion, it is generally due to a blood flow problem though sometimes it is caused by a neurologic problem. People with back problems, in particular spinal stenosis, often have pinched nerves in the back which cause a heaviness or pain in the legs which resolves with rest AND sitting. In fact, sometimes this "neurogenic claudication" resolves or abates with simply bending forward at the waist... which unloads pressure on the spine. This is why many people like to lean on a shopping cart while walking, as it relieves stress on the spine.
On the other hand, people with vascular (or blood flow) problems get pain & cramps in their legs, but these resolve with rest alone... sitting is not required. This "vascular claudication" is basically like a heart attack of the leg muscles. The muscles are busy working, but due to blockage of an artery, the blood (& oxygen) cannot get to the muscle, so the muscle cramps up & can no longer function. When you rest, the oxygen demands of the muscle decrease & the blood flow is adequate, so the pain resolves & you can walk a little further before the pain returns. If you do not intervene & re-establish good blood flow, you can end up with limited mobility, but over time you can actually get pain even at rest. This is an indication that the blood flow in that leg is so limited that the muscle does not get enough oxygen even at rest. Usually by this time people & their doctors figure out that there is a real problem & they do a bypass surgery or an angioplasty to improve the blood flow.
Early on, vascular claudication is treated with medications like Pletal which make the red blood cells (which carry the oxygen) more pliable. Red cells look like frisbees, but they are fairly rigid, so the Pletal allows them to be more flexible so they can fold in half, thus squeezing through the blocked arteries more easily. It is interesting to note that although walking triggers pain, a walking program is actually prescribed as treatment for vascular claudication as the body often responds to this oxygen-deprived situation by growing its own bypasses called "collateral" blood vessels!
Though neurogenic claudication is evidence of a nerve problem, vascular claudication is evidence of a circulation problem. It is a reflection of blocked arteries, so if you have it, you should have a work-up to look for other blocked arteries. This should include a carotid ultrasound to look for blockage that could lead to a stroke, & a stress test or heart catheterization to look for blockage that could result in a heart attack. Remember, the vascular system is one system... if you have blockages in one place you are prone to have blockages elsewhere! Note however, that although you should push through the pain of vascular claudication to stress the body & encourage it to create collateral circulation, never push through chest pain, as the body does not generally create its own heart bypasses!
So we'll end on that note! Hope you learned something, & I hope you'll listen to the live radio broadcast of Let's Talk Medical with Doctor Gigi on Fridays at 1PM Eastern time on WTAN 1340-AM in the St. Pete/Tampa area. Of course you can always catch me on the computer via www.SkipShow.com where you can listen live or to the recorded podcasts. I appreciate any input, & please don't hesitate to call or to e-mail your questions:
(727)-441-3000 local, (866)-TAN-1340 toll-free, or DoctorGigi@SkipShow.com.
Here's to our health!
Doctor Gigi
Sunday, June 3, 2012
Better Hearing Month; Pre-Menopause Symptoms; When Do Meds Expire; Celiac Sprue.
Happy (late) Memorial Day! I hope you found time to enjoy yourself, but more importantly I hope you found time to thank those Americans who have fought to provide us with the freedoms we so enjoy. And while you were contemplating these heroes, I hope you thought gratefully of the families of these soldiers, as they too have given so much to our country & thus deserve our heartfelt thanks as well!
The following is the brief print version of the May 18, 2012 broadcast of Let's Talk Medical with Doctor Gigi.
Better Hearing Month:
As you may know, an Audiologist is a healthcare professional who can diagnose & treat hearing & balance problems. They usually possess a Master's degree or a Doctorate. Unlike an Otolaryngologist (or Ear, Nose, & Throat surgeon), they cannot prescribe medications nor can they do surgery, but they can practice independent of physicians & do not need a doctor's order for their services. My friend Susan Terry is an Audiologist in St. Petersburg, FL. She owns Broadwater Hearing Care, Inc., & she works very hard to educate patients & physicians in regards to hearing issues. May is Better Hearing Month, so she recently sent educational sheets which I found enlightening; thus, I chose to share her information with the audience.
Hearing impairment affects 10% of the population & is the 3rd most common chronic health condition in the US. Hearing loss increases with age, thus it affects 30-35% of people 65 or older, whereas 40-50% of people 75 or older will be affected.
The onset of hearing loss is insidious, gradually worsening over years, thus it is often not noticed by the patient himself, but more by his friends & family. This is the reason so many people adamantly deny having a problem until they get tested & treated.
Hearing loss can lead to frustration, which in turn can lead to social isolation. This is turn can lead to depression, so we must always consider hearing loss as a possible cause for depression, especially in the elderly.
For each 10 decibels of hearing lost, the risk of dementia increases about 20%. Thus we must also consider hearing loss as a possible cause for dementia.
Diabetes & heart disease both increase the risk of hearing loss, likely due to vascular changes in the ear.
Every person over the age of 40 should have a baseline hearing test. Remember that your risk is higher if you have diabetes or heart disease, so you might get the test earlier & every few years. Quality of life is much better with early diagnosis & treatment, so don't make excuses, just get tested!
Pre-Menopausal Symptoms:
Menopause is the cessation of ovarian function, so it occurs when the ovaries "die" of old age (natural menopause) or when surgery removes them (surgical menopause). The ovaries produce most of a woman's estrogen, progesterone, & testosterone, so with their death, women note many physical & emotional changes. Most women go through natural menopause between the ages of 48 - 52. By definition, a person is menopausal when she has gone 1 year without a menstrual period.
For several years before full menopause, a woman will have pre-menopause. This is a roller-coaster ride hormonally as the ovaries are "sputtering" before they die. Some days they produce too many hormones, some days they produce too few, & some days they produce just the right amount. As you can imagine, this is a hard time for many women as they don't know day to day how they are going to feel... physically or emotionally! Unfortunately this period of pre-menopause can last 5 years!
Pre-menopausal symptoms include: irregular periods, hot flushes, poor sleep, fatigue, moodiness, & vaginal dryness. Initially the periods get closer together... every 2-3 weeks. Later they start to spread out, occuring every 2-3 months. Eventually the periods spread further & further apart & once there is no period for 1 year, we consider that full menopause.
Hot flushes are common, so many people think they are synonymous with menopause, but they are not! Anxiety can cause hot flushes, as can hyperthyroidism, certain cancers, or even excess caffeine. Some anti-depressants cause hot flushes as well. It is interesting to note that the heat associated with a hot flush can actually be felt by other people! If someone touches you during an episode, they can likely feel the excess heat... so it is truly an increase in your temperature & not just in your mind!
Vaginal dryness is the true hallmark of menopause, as it is almost exclusively due to menopause when it occurs chronically! It is not always an early symptom of menopause, but once it starts, it generally worsens. In fact, without estrogen replacement, vaginal dryness often gets worse year after year, even after the other pre-menopausal symptoms have abated.
As for the moodiness, I suppose that if a man felt bad physically & emotionally, & if he couldn't sleep well & found sex to suddenly be uncomfortable, he would likely be very moody! So ladies, we owe no one an apology!
When Do Meds Expire?:
Most medications are labeled with an expiration date that is 2 years after the date that the prescription bottle was filled. But does that really mean that they are unsafe or in need of disposal once that date has passed? First it is important to know that the medication is not likely toxic, but perhaps it has lost some of its potency. So the real question is whether or not you can accept a bit less potency & still be safe.
If the medication is an antibiotic, I would recommend that you NOT take an expired version. If the antibiotic does not work well you could end up with an untreated infection which could kill you.
On the other hand, if you try an old cough medicine, the worse thing that might happen is that you will continue to cough. Certainly if that occurs, you would dispose of the expired med & purchase a new batch. Similarly, if you take an old Valium, you might still feel anxious, but this would simply lead you to get to the pharmacy for a better supply. Even an expired blood pressure pill is okay to try, as long as you follow your blood pressure's response... & get a non-expired version if the expired one doesn't control it properly.
If you can follow your body's response to a medication so you can properly judge it's effect, & if you can afford to have less than perfect control of your problem for a little while, then it is alright to try an expired med. For the record though, I would seldom take one which is more than 2 years post expiration. Also, regardless of the expiration date, if it looks or smells different, don't take it... kind of like milk!
Celiac Sprue:
Celiac sprue is a disease caused by an intolerance to gluten... which is a protein found in wheat, rye, & barley. It is a hereditary disorder & runs in families. Though it often becomes symptomatic during childhood, it can begin later in life. The symptoms of sprue are many: weakness, anorexia, diarrhea, weight loss, iron-deficiency anemia, oral ulcers, Vitamin D & C deficiencies, osteoporosis, reduced fertility, & rashes. There is also an association between diabetes, autoimmune thyroid disease, & Down's syndrome, so if you are diagnosed with either of these diseases, you should have a work-up for sprue.
Recently this disease has gotten a lot of attention, & many people believe that they have it. They often will simply change to a gluten-free diet to see if they feel better, then assume that they likely have the disease if the diet helps. Unfortunately this often leaves them struggling with a miserable diet for the rest of their lives, as there is no treatment for sprue except to avoid gluten; yet a gluten-free diet is pretty restrictive & often expensive.
So I want to propose that if you think you have sprue, you need to see your doctor to have a work-up. In this manner you will know for certain whether or not you MUST follow this diet. The easiest test is a blood test called a tTG IgA... which stands for tissue transglutaminase immuneglobulin A. You must know however that this test is measuring your body's immune response to gluten, so if you have been on a gluten-free diet, it will be negative! Thus you should actually eat a lot of gluten for several weeks BEFORE you have the test drawn. Also, since the test measures IgA, people who have IgA Deficiency will test negative.
To have proper evaluation you should eat a lot of gluten for several weeks, then have the tTG IgA test drawn.
If it is high, you have sprue.
If it is normal or low, you need another blood test... a Total IgA level.
If it is normal, you do not have sprue.
If it is low, you have IgA Deficiency... thus you cannot make IgA, even if you have sprue.
You thus need further testing to evaluate for sprue, so you would need an upper endoscopy
(= EGD) to get into your small bowel and obtain a biopsy.
If the biopsy is normal, you do not have sprue.
If the biopsy is abnormal & consistent with the inflamation caused by sprue, you have
sprue & are stuck with the gluten-free diet!
I hope this has been educational for you! Don't forget you can catch the live show on Fridays on WTAN 1340-AM in the Tampa/St. Petersburg area, or you can use the computer to catch us live or on podcasts via www.SkipShow.com. Please call or e-mail me with questions or comments: (727)-441-3000, or toll-free (866)-TAN-1340, or DoctorGigi@SkipShow.com.
Until the next time, here's to our health!
Doctor Gigi
The following is the brief print version of the May 18, 2012 broadcast of Let's Talk Medical with Doctor Gigi.
Better Hearing Month:
As you may know, an Audiologist is a healthcare professional who can diagnose & treat hearing & balance problems. They usually possess a Master's degree or a Doctorate. Unlike an Otolaryngologist (or Ear, Nose, & Throat surgeon), they cannot prescribe medications nor can they do surgery, but they can practice independent of physicians & do not need a doctor's order for their services. My friend Susan Terry is an Audiologist in St. Petersburg, FL. She owns Broadwater Hearing Care, Inc., & she works very hard to educate patients & physicians in regards to hearing issues. May is Better Hearing Month, so she recently sent educational sheets which I found enlightening; thus, I chose to share her information with the audience.
Hearing impairment affects 10% of the population & is the 3rd most common chronic health condition in the US. Hearing loss increases with age, thus it affects 30-35% of people 65 or older, whereas 40-50% of people 75 or older will be affected.
The onset of hearing loss is insidious, gradually worsening over years, thus it is often not noticed by the patient himself, but more by his friends & family. This is the reason so many people adamantly deny having a problem until they get tested & treated.
Hearing loss can lead to frustration, which in turn can lead to social isolation. This is turn can lead to depression, so we must always consider hearing loss as a possible cause for depression, especially in the elderly.
For each 10 decibels of hearing lost, the risk of dementia increases about 20%. Thus we must also consider hearing loss as a possible cause for dementia.
Diabetes & heart disease both increase the risk of hearing loss, likely due to vascular changes in the ear.
Every person over the age of 40 should have a baseline hearing test. Remember that your risk is higher if you have diabetes or heart disease, so you might get the test earlier & every few years. Quality of life is much better with early diagnosis & treatment, so don't make excuses, just get tested!
Pre-Menopausal Symptoms:
Menopause is the cessation of ovarian function, so it occurs when the ovaries "die" of old age (natural menopause) or when surgery removes them (surgical menopause). The ovaries produce most of a woman's estrogen, progesterone, & testosterone, so with their death, women note many physical & emotional changes. Most women go through natural menopause between the ages of 48 - 52. By definition, a person is menopausal when she has gone 1 year without a menstrual period.
For several years before full menopause, a woman will have pre-menopause. This is a roller-coaster ride hormonally as the ovaries are "sputtering" before they die. Some days they produce too many hormones, some days they produce too few, & some days they produce just the right amount. As you can imagine, this is a hard time for many women as they don't know day to day how they are going to feel... physically or emotionally! Unfortunately this period of pre-menopause can last 5 years!
Pre-menopausal symptoms include: irregular periods, hot flushes, poor sleep, fatigue, moodiness, & vaginal dryness. Initially the periods get closer together... every 2-3 weeks. Later they start to spread out, occuring every 2-3 months. Eventually the periods spread further & further apart & once there is no period for 1 year, we consider that full menopause.
Hot flushes are common, so many people think they are synonymous with menopause, but they are not! Anxiety can cause hot flushes, as can hyperthyroidism, certain cancers, or even excess caffeine. Some anti-depressants cause hot flushes as well. It is interesting to note that the heat associated with a hot flush can actually be felt by other people! If someone touches you during an episode, they can likely feel the excess heat... so it is truly an increase in your temperature & not just in your mind!
Vaginal dryness is the true hallmark of menopause, as it is almost exclusively due to menopause when it occurs chronically! It is not always an early symptom of menopause, but once it starts, it generally worsens. In fact, without estrogen replacement, vaginal dryness often gets worse year after year, even after the other pre-menopausal symptoms have abated.
As for the moodiness, I suppose that if a man felt bad physically & emotionally, & if he couldn't sleep well & found sex to suddenly be uncomfortable, he would likely be very moody! So ladies, we owe no one an apology!
When Do Meds Expire?:
Most medications are labeled with an expiration date that is 2 years after the date that the prescription bottle was filled. But does that really mean that they are unsafe or in need of disposal once that date has passed? First it is important to know that the medication is not likely toxic, but perhaps it has lost some of its potency. So the real question is whether or not you can accept a bit less potency & still be safe.
If the medication is an antibiotic, I would recommend that you NOT take an expired version. If the antibiotic does not work well you could end up with an untreated infection which could kill you.
On the other hand, if you try an old cough medicine, the worse thing that might happen is that you will continue to cough. Certainly if that occurs, you would dispose of the expired med & purchase a new batch. Similarly, if you take an old Valium, you might still feel anxious, but this would simply lead you to get to the pharmacy for a better supply. Even an expired blood pressure pill is okay to try, as long as you follow your blood pressure's response... & get a non-expired version if the expired one doesn't control it properly.
If you can follow your body's response to a medication so you can properly judge it's effect, & if you can afford to have less than perfect control of your problem for a little while, then it is alright to try an expired med. For the record though, I would seldom take one which is more than 2 years post expiration. Also, regardless of the expiration date, if it looks or smells different, don't take it... kind of like milk!
Celiac Sprue:
Celiac sprue is a disease caused by an intolerance to gluten... which is a protein found in wheat, rye, & barley. It is a hereditary disorder & runs in families. Though it often becomes symptomatic during childhood, it can begin later in life. The symptoms of sprue are many: weakness, anorexia, diarrhea, weight loss, iron-deficiency anemia, oral ulcers, Vitamin D & C deficiencies, osteoporosis, reduced fertility, & rashes. There is also an association between diabetes, autoimmune thyroid disease, & Down's syndrome, so if you are diagnosed with either of these diseases, you should have a work-up for sprue.
Recently this disease has gotten a lot of attention, & many people believe that they have it. They often will simply change to a gluten-free diet to see if they feel better, then assume that they likely have the disease if the diet helps. Unfortunately this often leaves them struggling with a miserable diet for the rest of their lives, as there is no treatment for sprue except to avoid gluten; yet a gluten-free diet is pretty restrictive & often expensive.
So I want to propose that if you think you have sprue, you need to see your doctor to have a work-up. In this manner you will know for certain whether or not you MUST follow this diet. The easiest test is a blood test called a tTG IgA... which stands for tissue transglutaminase immuneglobulin A. You must know however that this test is measuring your body's immune response to gluten, so if you have been on a gluten-free diet, it will be negative! Thus you should actually eat a lot of gluten for several weeks BEFORE you have the test drawn. Also, since the test measures IgA, people who have IgA Deficiency will test negative.
To have proper evaluation you should eat a lot of gluten for several weeks, then have the tTG IgA test drawn.
If it is high, you have sprue.
If it is normal or low, you need another blood test... a Total IgA level.
If it is normal, you do not have sprue.
If it is low, you have IgA Deficiency... thus you cannot make IgA, even if you have sprue.
You thus need further testing to evaluate for sprue, so you would need an upper endoscopy
(= EGD) to get into your small bowel and obtain a biopsy.
If the biopsy is normal, you do not have sprue.
If the biopsy is abnormal & consistent with the inflamation caused by sprue, you have
sprue & are stuck with the gluten-free diet!
I hope this has been educational for you! Don't forget you can catch the live show on Fridays on WTAN 1340-AM in the Tampa/St. Petersburg area, or you can use the computer to catch us live or on podcasts via www.SkipShow.com. Please call or e-mail me with questions or comments: (727)-441-3000, or toll-free (866)-TAN-1340, or DoctorGigi@SkipShow.com.
Until the next time, here's to our health!
Doctor Gigi
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