MD STAT: Talk to a doctor.

How would you like to be able to simply ask a physician a question? To actually speak with a doctor regarding your medical and surgical questions? We bet you can't do that anymore. We physicians simply do not have time these days to pick up the phone and talk to you. So why not ask us? All contributors here are board-certified in the United States and we have some fantastic retired docs too. You may read their profiles on our left sidebar. We intend for this to be informative and fun. Welcome.

Saturday, December 31, 2011

Calf Spasms.... Why?

I too have had this 'firework show' in my calves and I know when I am looking at it that I am looking at something called MYOCLONUS, but it sounds like in your case this is a persistent and consistent problem.

So then I wondered if there might be a relation to your Adderall use, and, in fact, two of the side effects are 'nervousness and restlessness', and it's not too hard to imagine that the stimulant effect of the Adderall may, in you, cause the myoclonus. I wonder if you had it prior to using the Adderall?

One other thing that can cause this is simply overdoing it in the gym or or with running or other sports. Buildup of lactic acid in the muscles will cause the myoclonus, and as you say, it IS interesting to watch, but if it is keeping you awake at night or causing other problems in your life it might be worth talking to your doc. I seriously doubt anyone would want to do an EMG on you at age 25 and it is unlikely that this is the result of some rare medical issue, it is, most likely, due to the Adderall in combination with you keeping yourself in good shape.

Docs.... what say you?

________________________________________________________

Friday, December 30, 2011

Does Air Travel Make You Sick?

Our intrepid Space Doc will weigh-in shortly.

As to airline travel, realize this.... even though modern airliners are pressurized, they are pressurized to about 8000 ft AGL (above ground level), so, going up in a commercial jet is putting you, assuming you are a flatlander, in a relatively hypoxic environment for a few hours and much of what you are feeling may be due to Acute Mountain Sickness, which you can read about by clicking the link.

As to the "Airborne" herbal remedy, well, it won't do you any harm... PROBABLY. And if I lined up 100 people and gave them sugar water and told them all they were getting a powerful sleep medicine about 33 of them would go to sleep. This goes for all the 'supplement' market.... We simply have no scientific evidence to validate any of the claims made by these manufacturers, and the FDA is NOT regulating them, so the operative phrases here are 'caveat emptor' and 'placebo effect'.

Thanks for your question and stay tuned....

MDSTAT ER DOC 1

________________________________________________________________

Dear air traveller:

There have been some studies that have shown a slight increase in sinus and cold symptoms during airplane trips, but this would probably be the same if you were confined in a crowded room anywhere.

As Doc 1 mentioned most planes are pressured to an altitude around 8000 ft which most people can tolerate, although some individuals can have altitude sickness symptoms of fatigue, nausea, headache, and shortness of breath as low as 5000 ft. altitude

I totally agree with Doc 1 that there have been no studies to inddicate the Airborne medication prevents any colds, sinusitis, or bacterial infections, and they have had to settle 2 or 3 lawsuits for false advertising.

However, I have been taking both vit. C (2000mg.) and Vit. E (400-800 i.u.) daily and haven't had a cold or sinusitis in over 10 years. The usual Airborne dose has 1000 mg of vit. C so it would probably be safest to take around 3 doses a day (rather than every 3 hrs) to avoid any possible kidney irritations.

Some people swear by the Airborne so it would probably be worth a try, but there are certainly no guarantees' I also have had a number of patients who have had good luck taking Sinutabs before a flight to keep the sinuses clear

Good Luck! Keep us posted.

Space Doc.

Tuesday, December 27, 2011

Hypokalemia mystery

For the past 10 months I have been having trouble keeping my potassium at a normal level (above 3.5). Five times I have ended up in the ED or hospitalized for IV replacement after levels around 2.7

Other times I have caught it earlier around 3.1 and was able to get it back up after ED visits for some oral replacement.

After a the first few times this happened my doctor put me on a high potassium diet, and when it continued to happen I was put on 10meq of potassium daily and then when that didn’t work either it was increased to 20meq daily, however I am still having trouble keeping my potassium at normal level at times.

Most of the time my potassium is around 3.4-3.7, but randomly it will begin to drop and drop quickly to the 2.7. When it gets to around 3.0 I start to get really nauseated, shaky and generally feel like crap, when it gets down to the 2.7 I have usually started vomiting which only makes it drop lower (I do not vomit before it initially starts to plunge though so the low levels isn’t caused by vomiting).

I am normal weight, generally healthy, and my blood pressure always lower, 90/60 ( I know that there is one thing that can cause the low potassium levels but my doctors do not think I have it because it is associated with high blood pressure).

I really want to know why this is happening because when it happens I feel like crap, the IV potassium replacement is not any fun (many of my veins are shot from all the potassium infusions, once they had to use my foot) and I always feel horrible for days afterwards.

Since being on the high potassium diet and 20meq of potassium daily I have had less of these episodes, but they are still happening.

Gender: Female
How old are you?: 23
How long has this been going on?: More than a month
Check all symptoms you are currently experiencing: None
Describe associated symptoms not listed above: During these episodes I first feel weak, leg cramps, nauseated then I get shaky, and begin to have muscle contractions in my hands and finally begin to vomit.

What have you done so far to remedy this condition? Please include tests and relevant studies here.

Potassium is generally normal (3.4-3.7) with these occasional drops to 2.7-3.1

Magnesium is always normal.

Thyroid is normal.

Abdominal/Pelvic CT is normal.

Only thing that works once it gets really low (2.7) is a few days in the hospital getting IV potassium infusions.

Please list any chronic medical problems and also list any prior surgery (lacerations don't count!): Hemicrania Continua: treated with an occipital nerve stimulator implant

Neurocardiogenic Syncope: Loop recorder implant and explant surgeries.

Inappropriate Sinus Tachycardia

3 EP studies

Check all conditions present in your immediate family... :

Asthma / Lung Problems
Cardiac Disease
Diabetes
Hypertension
Stroke

Please list any medications you are currently taking (and dosage if known) :: Bisoprolol 10mg 1x a day (for inappropriate sinus tachycardia)

Zoloft 100mg 1z a day (for neurocardiogenic syncope)

Multi-vitamin 1x a day

Potassium 20 meq 1x a day

Vitamin D 50,000IU 2x a week (vitamin D level one month ago was 13)

Ambien CR 12.5mg 1x day

When was your last menstrual cycle?: 1 week ago
Are you currently using or do you have a history of tobacco use?: No
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Occasionally

HOW QUICKLY DO YOU NEED THIS TO BE ANSWERED?: Within the next few days
So that we can serve you best, please try to tell us your top three things you wish to be addressed in our response. You will likely get more than you ask for, but we wish to understand your priorities.

Why does my potassium level drop like this?

My doctors seem to have given up on finding a cause for this and are just treating as it happens, should I be pressing for answers or should I just accept that this is what my body does?

Any additional tests I should ask my doctor for?

_________________________________________________________________

Well, as an Emergency Doctor I see disorders of potassium all the time. But it is rare indeed for me to see someone like yourself.... someone in pretty good health, with persistent, unexplained hypokalemia. And make no mistake.... this is serious business. Hypokalemia in the extreme is terribly dangerous, and you say the only way for you to get repleted and feel well is to have IV runs of potassium. This is going to my contribution here and I'm going to let my good Internal Medicine docs go a little more in depth... It is, after all, what they do. ER docs are shallow, Internal Medicine docs are deep. I am making a bit of a joke but an ER doc knows a little about a lot, and the Internist knows a lot about a little (if you consider all of adult medicine a little.... but I digress).

Disorders of potassium can be disorders of absorption, excretion, or intake. The strange fact about your case is that you do not seem to properly absorb the oral potassium. So I wonder if you have an absorption problem. In the ER if someone is low on potassium then the quickest way to get them back to where they need to be is to give the potassium orally, usually mixed in a liquid.

And by the way, click on this sentence to learn about potassium homeostasis and how physicians try to track down the causes of irregular levels.

The other likely cause would be a problem in the kidney itself, something called 'renal tubular acidosis', and a problem with the kidney's ability to hold onto potassium would also make sense in your case.

So with hope my Internal Medicine colleagues ride to my rescue here, I am concerned about your intestinal absorption of potassium since the oral supplementation does not seem to work AND also concerned this may be a kidney problem. If you have not been referred to a nephrologist then that would be a good next step.

None of the medicines you are on are potassium-wasters but just so you know, people who take certain diuretic pills off label... often to lose weight, can stay very low on potassium. People who self induce vomiting or take laxatives can have this problem too. And, finally, if you live on black licorice then that may honestly be the culprit.

Please feel free to ask questions in the comment section and I will stand by for more insightful commentary from my fellow docs.

MD STAT ER DOC 1

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Saturday, December 24, 2011

Merry Christmas

Wishing you and yours a happy and healthy Christmas.

Thursday, December 22, 2011

High Blood Pressure, Chest Pain, and All that Jazz.....

I AGREE TO USE MD STAT FOR EDUCATIONAL PURPOSES ONLY, THAT NO DOCTOR PATIENT RELATIONSHIP IS FORMED BY MY PARTICIPATION IN THIS EXCHANGE, AND I UNDERSTAND THAT MY QUESTION AND ANSWER(S) WILL BE POSTED ON THE WEBSITE AND WILL BE VIEWABLE BY VISITORS TO THE SITE.: Yes, I agree.

My question has to do with high blood pressure. I have been taking my blood pressure with a home wrist machine. It ranges anywhere between 145/90 and has been as high as 175/110 a few times. Most of the time it ranges in the 150/100 ish. This has been going on for about 2 years now. More recently, I have been experiencing a racing heart when I'm at rest. It's like my heart goes out of control before it corrects itself back to a normal heartbeat. Within the last couple of months, I have been experiencing heart burn. I don't know if it is severe or not because I don't have anything to compare it to as I have never experienced heart burn before. Lastly, and also within the last couple of months, I have experienced pain under my ribcage in the front and up through my right shoulder-blade. I don't know if this is all related or a coincidence that these have all happened about the same time.

I have no shortness of breath and can exercise without tiring. My weight is proportionate to my height (5"3, 125 lbs) so my high blood pressure is not a result of being too heavy.

Gender: Female
How old are you?: 52
How long has this been going on?: More than a year
Check all symptoms you are currently experiencing:
Chest Pain
Palpitations

What have you done so far to remedy this condition? Please include tests and relevant studies here.
: Eat healthy and exercise. I typically stay away from junk food except for once in a while. My diet consists of fish and whole foods, not processed. Fruits, vegetables, brown rice and fish make up most of my diet. Vegetables are fresh, not canned.

Please list any chronic medical problems and also list any prior surgery (lacerations don't count!): None.

Check all that apply to you or your immediate family (parents, siblings, grandparents):
Cardiac Disease
Hypertension

Please list any medication allergies that you have : : None.

Please list any medications you are currently taking (and dosage if known) :: Also, please tell us if there is medicine you are supposed to be taking but are not. Thanks! NONE

When was your last menstrual cycle?: I no longer have a menstrual cycle

Are you currently using or do you have a history of tobacco use?: No

Are you currently using or do you have a history of illegal drug use?: No

Please describe your alcohol consumption :: Occasionally

So that we can serve you best, please try to tell us your top three things you wish to be addressed in our response.

My high blood pressure is untreated because I am uninsured. Until I am covered under insurance again, I would like to know what I can do to help prevent a heart attack. I realize that I will need to be seen but at the moment, that is not possible. Other than baby aspirin and my diet/exercise, is there anything else I can do to tide me over until I can be seen? I'm just looking for some advice that can help tip the odds in my favor until I can be seen by a physician.

_________________________________________________________________

Ma'am,

My board certification is in Emergency Medicine. From our perspective and training EVERYONE has a life threatening condition until we prove they don't. Therefore it is from this perspective of 'worst case scenario' that I am going to provide an initial answer. My colleagues will follow, I'm sure, shortly.

Three things.....

1. You are at risk of heart attack and are having some symptoms that might be angina. Your blood pressure is all over the place, and the device you use may be part of the problem. You can get a three day blood pressure check at the health department or even at the fire station down the street using a manual cuff and a set of real human ears. This average measurement will be much more telling of your real blood pressure. Also, you would feel pretty silly if you showed up in heaven and St. Peter said, "Oh! You are here early!" And you found out that the blood pressure medicine you are now missing costs four dollars for a month's supply, and that a visit with a primary care physician who could give you the once-over and get you back on some inexpensive and efficacious medicines would be about $125. Not trying to scare you, just saying that you have some cardiac risk factors and you are taking a gamble waiting for your insurance.

2. A baby aspirin a day and good diet and exercise is great. Keep doing it.

3. You may have a gall bladder problem causing many of your symptoms. If the sharp pain you get is pain that comes particularly after eating then I am even more suspicious of this. Click on this sentence to learn about the symptoms of gall bladder disease and see if you agree. Now here you are really going to run into a money problem and there's nothing you can do, if you have gallstones, to reverse the process apart from having your gall bladder out. Be aware though, that if I am correct about your gall bladder, that you run the risk of developing Cholecystitis

I am going to make room for my colleagues here. Do not put of a primary care visit for the sake of 'waiting on your insurance'. The cost is less than you think for a one time 'howdy do' and some medication prescriptions. The doc could also get an idea about your gall bladder and could form a plan of action with you were it to become worse suddenly.

Thanks so much for your question!

MD STAT ER DOC 1
______________________________________________________________________

1) YOUR BLOOD PRESSURES : The range you describe is not good. (should be around 130/80). The wrist blood press. cuffs are often inaccurate. You can google mayo clinic wrist blood pressure monitors to see if you are doing measurements correctly. Very likely the family history of hi b.p. is partly responsible for your pressures.

2) RAPID HEART RATE (tachycardia) can be related to hi thyroid levels in the blood &/or some changes in the conduction system of the heart.

3) RIGHT SIDED PAIN UNDER RIBS GOING TO RT. SHOULDER BLADE. Could be gall bladder or liver problems.

4) "HEARTBURN". ( Unrelated to the heart). Stomach and esophageal reflux of acid. Tums or over the counter Omeprazole can help.

5) DIET. Low fat intake and avoiding acidic foods might help gall bladder and heartburn

6) SUMMARY:(a) Bl.Press. needs to controlled!! probably with medication since your weight,exercise and eating habits seem good.
(b) Need heart evaluation! (ekg etc} to check out heart rate & rhythm
(c) Need gall bladder evaluation (ultra sound etc.)
(d) One of our docs has a lot of emergency room experience and maybe he can help out on where to get things done that won't cost you an arm and a leg. I would be quite hesitant to continue on without getting these things checked out.

Good Luck---don't wait too long!!

Space Doc

_______________________________________________________________________

Wednesday, December 21, 2011

Functional Endoscopic Sinus Surgery.... Worth it?

Endoscopic Sinus Surgery (ESS) or Functional Endoscopic Sinus Surgery (FESS) are operations performed using scopes (endoscopes), and special instruments, with the access to the sinuses being from inside the nose (without any external incisions or scars).

FESS can make a very positive difference for some sinus problems. It can be relatively painless and very safe. The recovery can be quite short (2-3 days). However, there are several variables that can make one person’s experience, risk, and outcome very different than another’s. I will discuss some of these further.

First, an understanding of some basic sinus facts is necessary. The sinuses are air-filled cavities within the bones of our face and skull. They have a mucous membrane lining that makes mucous which then drains into the nose through very narrow openings. If these narrow openings are “blocked”, mucous will accumulate in the sinuses, and will virtually always become infected if drainage isn’t restored fairly quickly (days/weeks). When bacterial infection is suspected or confirmed, antibiotic are usually prescribed. Common sinus infection symptoms include, discolored nasal drainage, nasal congestion, post-nasal drainage, sinus pressure/sinus headache, upper tooth pain, fatigue, cough, and plugged ears. Symptoms can vary, often based on the severity of infection and which sinuses are affected. We have 4 sets of sinuses on each side of our face/head. These are named as follows: Maxillary sinuses, ethmoid sinuses (anterior and posterior), frontal sinuses, and sphenoid sinuses. An internet search of “sinus anatomy” can show you the basic locations of these sinuses.

So, what causes the sinus openings to become blocked? Inflammation and swelling are the most common reasons for the openings to become blocked. There are several possible sources of this inflammation. One of the most common is a viral upper respiratory infection a.k.a. “a cold”. Environmental allergies (“hay fever”) is another common source of excessive swelling/inflammation. The swelling of the sinus lining that occurs with bacterial sinus infection can persist for a period of time after the bacterial infection has been treated, leaving the openings still blocked and prone to repeat or further infection. Very severe and chronic inflammation of the lining can result in “polyps” that can block the sinus openings. Lastly, some people are born with abnormal nose or sinus anatomy that can make the openings more narrowed or blocked.

If the use of medications (antibiotics, steroids, allergy medicines, etc.) can not successfully resolve the inflammation and get the sinuses to drain and function normally, surgery may be considered. The basic purpose of the ESS is to create surgical openings into the sinuses so they can drain the mucous they make. Essentially, chronic sinusitis is a medical problem (treated with medicines) in which surgery can sometime play a role. Surgery is just one part of the treatment. How much surgery helps is largely dependent on whether blockage of the sinus is the main problem. Patients that have medical conditions that result in bad chronic nose/sinus inflammation, or those who have problems with their immune system, are the types of patients who may not benefit as significantly from ESS.

With the above information hopefully understood, I will try to answer you main questions and concerns.

Overall, sinus surgery is quite safe with low rates of complications. Surgery to open the maxillary and anterior ethmoid sinuses is the easiest and safest. This limited amount of surgery is often referred to as FESS.

The frontal sinuses, sphenoid sinuses, and posterior ethmoid sinuses are close to several important structures such as the eye sockets, the optic nerves, and the skull base (thin bone that separates nose/sinuses from the brain. The proximity of these things to the sinuses put them at potential risk of injury during surgery. The risk of injury is very low, but important to consider. Having an experienced and well trained surgeon is also an important consideration.

How much pain you have, and how quickly you can return to normal life, is largely based on how much surgery is being done. A patient who is only having one maxillary sinus on one side operated on, will have a very brief surgery, very little pain, and a very quick recovery. On the other hand, a patient who has every sinus, on both sides, operated on, and who also has the nasal septum fixed (septoplasty) and nasal turbinates reduced, will have a significantly longer, more painful surgery, and longer recovery (1-2 weeks, sometimes). So, these two examples are sort of the two ends of the spectrum. The amount of surgery performed can vary greatly, so it’s hard to compare what your doctor plans to do with something someone you know had done, unless you know exact details of the extent of surgery planned or performed. Potential risk or “danger” of the surgery basically follows the same principle, but in the hands of a good surgeon the risk is very low for dangerous complications.

SWB (ENT Surgeon)

Tuesday, December 20, 2011

Sleep, Circadian Rhythms, and Weight Loss

I AGREE TO USE MD STAT FOR EDUCATIONAL PURPOSES ONLY, THAT NO DOCTOR PATIENT RELATIONSHIP IS FORMED BY MY PARTICIPATION IN THIS EXCHANGE, AND I UNDERSTAND THAT MY QUESTION AND ANSWER(S) WILL BE POSTED ON THE WEBSITE AND WILL BE VIEWABLE BY VISITORS TO THE SITE.: Yes, I agree.

Is there a standard amount of sleep folks need? I typically sleep 5.5-6 hours per night and have for years. I do feel better with more but do not noticeably function better (may just be years of kidding myself).

It does seem easier to lose weight when sleeping more (diet and exercise staying constant). Does this make any sense or is it my imagination?

Gender: Male

How old are you?: 46

Check all symptoms you are currently experiencing:
None of these
No medications

Are you currently using or do you have a history of tobacco use?: Yes
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Weekly

TOP THREE QUESTIONS:

typical need for sleep
short term impact of lack of sleep
recovery from lack of sleep (1 nights good rest, more?)
__________________________

So Joe,

Your question is very complex. The issue about 'how much sleep is enough' does tend to vary from individual to individual and we are not sure why. First, let me point you to THIS SITE, which is, at least, an interesting read.

Two highlights from this site....

"
Though scientists are still learning about the concept of basal sleep need, one thing sleep research certainly has shown is that sleeping too little can not only inhibit your productivity and ability to remember and consolidate information, but lack of sleep can also lead to serious health consequences and jeopardize your safety and the safety of individuals around you.

For example, short sleep duration is linked with:

Increased risk of motor vehicle accidents
Increase in body mass index – a greater likelihood of obesity due to an increased appetite caused by sleep deprivation
Increased risk of diabetes and heart problems
Increased risk for psychiatric conditions including depression and substance abuse
Decreased ability to pay attention, react to signals or remember new information

According to researchers Michael H. Bonnet and Donna L. Arand, "There is strong evidence that sufficient shortening or disturbance of the sleep process compromises mood, performance and alertness and can result in injury or death. In this light, the most common-sense 'do no injury' medical advice would be to avoid sleep deprivation.
"

And on the other hand....

"
...some research has found that long sleep durations (nine hours or more) are also associated with increased morbidity (illness, accidents) and mortality (death). Researchers describe this relationship as a "U-shaped" curve (see illustration) where both sleeping too little and sleeping too much may put you at risk. This research found that variables such as low socioeconomic status and depression were significantly associated with long sleep. Some researchers argue that these other variables might be the cause of the longer sleep: the fact that individuals with low socioeconomic status are more likely to have undiagnosed illnesses because of poor medical care explains the relationship between low socioeconomic status, long sleep and morbidity/mortality. Researchers caution that there is not a definitive conclusion that getting more than nine hours of sleep per night is consistently linked with health problems and/or mortality in adults, while short sleep has been linked to both these consequences in numerous studies.
"

And as to the weight and sleep part of your question, well, that's a rat's nest indeed, but, as you may guess, there does appear to be a link between not-enough sleep, and obesity. THIS LINK here is pretty in depth and gets all doctor-y, but you will get the idea.

And to open another can of worms, there is a raft of medical evidence out there on CIRCDADIAN DISRUPTION... jet lag if you will.... rotating shift work.... Bottom line. It sucks. In fact, it's probably the main reason that I will pay to get out of night shifts in the ER.

More to follow.... this is hard to do on an Iphone.

Saturday, December 17, 2011

A Circular, Growing Rash

Friday, December 16, 2011

"Chyle" and Serum Cholesterol

Wednesday, December 14, 2011

"Heartburn?"

Tuesday, December 13, 2011

Blood in the Toilet

Sunday, December 11, 2011

Devic's Disease and It's Relation to Multiple Sclerosis

8 minutes ago

I AGREE TO USE MD STAT FOR EDUCATIONAL PURPOSES ONLY, THAT NO DOCTOR PATIENT RELATIONSHIP IS FORMED BY MY PARTICIPATION IN THIS EXCHANGE, AND I UNDERSTAND THAT MY QUESTION AND ANSWER(S) WILL BE POSTED ON THE WEBSITE AND WILL BE VIEWABLE BY VISITORS TO THE SITE. *	Yes, I agree.
The email to which we should send notification of your answer *	XXXXXXXXXXXXXXXX
Ask your medical question here. *	how simalar is Devics disease compaired to MS? I know the treatment is somewhat different. My sister has been dx maybe 2 years.
Gender	Male
How old are you? *	41
How long has this been going on? *	More than a year
Check all symptoms you are currently experiencing	Eye
Describe associated symptoms not listed above	the only symptom she is having now is reoccuring optic neuritis.
What have you done so far to remedy this condition? Please include tests and relevant studies here.	Results of blood tests and Xrays can go here. Results of consultations with specialists as well.
Please list any medication allergies that you have : *	Please do not list any medicines you merely dislike. True allergies produce hives and other symptoms. An upset stomach is not an allergy to a medicine. Thanks!
Please list any medications you are currently taking (and dosage if known) :	Also, please tell us if there is medicine you are supposed to be taking but are not. Thanks!
When was your last menstrual cycle? *	Now
Are you currently using or do you have a history of tobacco use?	No
Are you currently using or do you have a history of illegal drug use?	No
HOW QUICKLY DO YOU NEED THIS TO BE ANSWERED? *	Within the next few days
So that we can serve you best, please try to tell us your top three things you wish to be addressed in our response. You will likely get more than you ask for, but we wish to understand your priorities. *	difference in the two diseases and life expectancy.

Saturday, December 10, 2011

The Vanishing Penis?

Ask your medical question here. *	MD STAT is an educational service. We do not prescribe medication. We do not enter into a doctor-patient relationship with you. We explain, educate, clarify, and suggest possible solutions to your medical questions. Thank you for your interest. I am 43 years old and my penis seems to be shriinking. Why?
Gender	Male
How old are you? *	43
How long has this been going on? *	A week or two
Check all symptoms you are currently experiencing *	Genitourinary
Describe associated symptoms not listed above	You may also use this area to further explain symptoms checked above. This is causing problems with my marriage.
What have you done so far to remedy this condition? Please include tests and relevant studies here.	Results of blood tests and Xrays can go here. Results of consultations with specialists as well.
Please list any chronic medical problems and also list any prior surgery (lacerations don't count!) *	none
Check all that apply to you or your immediate family (parents, siblings, grandparents)	Cardiac Disease Psychiatric Disorders
Please list any medication allergies that you have : *	Please do not list any medicines you merely dislike. True allergies produce hives and other symptoms. An upset stomach is not an allergy to a medicine. Thanks! none
Please list any medications you are currently taking (and dosage if known) :	Also, please tell us if there is medicine you are supposed to be taking but are not. Thanks! gingo boloba
When was your last menstrual cycle? *	I'm a man, baby!
Are you currently using or do you have a history of illegal drug use?	No
Please describe your alcohol consumption :	Occasionally
HOW QUICKLY DO YOU NEED THIS TO BE ANSWERED? *	Within the next few days
So that we can serve you best, please try to tell us your top three things you wish to be addressed in our response. You will likely get more than you ask for, but we wish to understand your priorities. *	Does this question even make sense? Is there anything obvious about this problem? What kind of doctor should I see regarding this problem?

Wednesday, December 7, 2011

Neurological Issue?

Ask your medical question here. *
I keep getting "twitches" in various parts of my body. I mean tiny flutters of muscle contractions. No real pain or even discomfort and they last about 1 - 3 seconds, with intervals of anywhere from 2 minutes to 2 hours. Then I may go a few days with nothing. But it has been going on for months and it seems to be moving around my body. Upper lip for 2 weeks, inner ear for 3 days (most annoying it it like someone doing a soft drum-roll in your ear), eyelash for a day, scalp for 1 week, a different part of the scalp for another week, right hand for 5 days, etc. Just kinda weird. What is it? Anything to be concerned about? Especially since it seems to cover my whole body, but just 1 location at a time.
Gender *	Male
How old are you? *	27
WHEN DID THIS PROBLEM START? *	Wednesday, June 1, 2011
Check all symptoms you are currently experiencing *	Neurological
Describe associated symptoms not listed above	You may also use this area to further explain symptoms checked above.
What have you done so far to remedy this condition? Please include tests and relevant studies here.	Nothing
Check all that apply to you or your immediate family (parents, siblings, grandparents)	Cancer History of Back Pain Psychiatric Disorders
Please list any medication allergies that you have : *	Please do not list any medicines you merely dislike. True allergies produce hives and other symptoms. An upset stomach is not an allergy to a medicine. Thanks!
Please list any medications you are currently taking (and dosage if known) :	Also, please tell us if there is medicine you are supposed to be taking but are not. Thanks!
When was your last menstrual cycle? *	I'm a man, baby!
Are you currently using or do you have a history of tobacco use?	No
Are you currently using or do you have a history of illegal drug use?	No
Please describe your alcohol consumption :	Rarely
HOW QUICKLY DO YOU NEED THIS TO BE ANSWERED? *	Within the next few days
So that we can serve you best, please try to tell us your top three things you wish to be addressed in our response. You will likely get more than you ask for, but we wish to understand your priorities. ---------------------------------------------------------------------------------- Well, pardon the strange format here but we are working on a new way to answer questions and we will figure it out. Sir, the condition you are talking about is most likely MYOCLONUS, and you can read about by clicking on the link preceding. As you can see, this condition, if I am correct about what you have based on this history alone, is almost always benign and rarely is a sign of a central neurological disorder. Multpile sclerosis can have different neurological symptoms over time but muscle twitching and jerking, especially the very short acting bouts you seem to be having, is NOT typical for Multiple sclerosis. However, if your symptoms persists or worsen over the period of the next few months getting in with a Neurologist would be a good idea. I don't think you need to do that now. The rest of your history, your age, and your problem do not lead me to think of any dread diagnosis. Thanks for your question and please come back anytime.	Do I have some whole body problem, disguised as local tremors? Is this something I need to worry about now? Is this some thing that will get worse over time

Saturday, December 3, 2011

A Multi-part Surgical Question

Dear Doctor,

For about 6 months I have had shooting pain down my left leg - it happens about 5 times a day but it REALLY hurts. An xray or mri or something like that showed one of my lower vertabaes is somewhat shifted, the word the surgeon used was something like "sponge hello less he says". Any way we tried a spinal injection to block the pain and i wore a Boston brace for a while. Now the doctor is recommending surgery to fuse my spine. I hate the idea of surgery, it seems so life threatening. So I have a question.

Is there any way to find out the historical risks of surgery - including the risks from a specific doctor? I mean can I find actual statistics about 1) Surgery in general, 2) different types of surgeries (these must be in some database somewhere right)? AND 3) Statistics about a specific hosptial or doctors track record (at least how many people have died during his surgieries)? Are these records even kept, and if they are are they kept secret by hospitals?

Oh 1 more question, if that is ok. If I DONT get surgery, and decide that the pain is better than the risk, am I doing damage - so that the pain will just get worse and worse?

Thank so much for the blog

Gary

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ANSWER TO FOLLOW SHORTLY DOC1

Okay, Gary,

I will be answering this in parts as I am torn between the yard that needs to be cleaned up, the NCAA football on tv all day, and my desire to help you.

First, "sponge hello less he says".... This can only be something called SPONDYLOLISTHESIS.... if you click on the link you can read all about it from the NIH, but it is as you describe, a slipping forward on one vertebra on the one below. It is usually a result of trauma but can also be something you were born with. Either way, instability in the supporting elements of the spine allow for the slippage, and if the slip becomes big enough many more problems occur.

I am not surprised that the shots did not help. They are a temporizing measure at best, in other words, they can buy you some time in advance of surgery with some amount of pain relief, but they are not curative.

And for the moment I am going to end with this to return to your more complicated questions in a bit.... Not to make light of your situation but the surgery for this is routinely performed, and, in fact, you happen to be talking with someone who has actually HAD the surgery, usually a fusion procedure. And, perhaps if you could email me your specific concerns about the surgery being life-threatening then I could address them, but with the state of the science of anesthesia and the techniques now employed by spine surgeons I would not look at this surgery as any more risky than an appendix surgery.

I have much more to ad but hopefully this is a good start for you. Back in a bit.

Doc1

Good morning Gary. I thought the above image would be instructive. As you can see, the defect that allows for the slippage of the vertebrae is in the posterior portion of the spine.

Spine surgeon have a grading system for this defect but it is less important than the symptoms and pain you are having. That alone does indicate that the surgery is probably the way to go, and, as you can see from the reference above, fusion surgery provides great results and relief of pain in 95% of patients. I am in that 95%.

As to your question regarding the historical risks of surgery, again, I would ask for some clarification. If we are going to include surgery performed back in the early part of the 20th century to our database then we will get a decidedly different result than if we use, say, the last ten years. This being said, I'm not sure if these statistics are available, though I will certainly check.

And I have now checked! The thought struck me to search for 'intraoperative mortality in the United States'. The bottom line is this... by far and away the most common cause of death in the operating room is cardiac arrrest.... heart attack, and so while I could not find statistics for TOTAL intraoperative mortality, I did find it for cardiac arrest, and you can view it here. The number is about 4 in Ten-thousand surgeries. I hope that is reassuring to you, and if you are healthy going into the surgery your risks are much lower than this.

As to your question regarding specific surgeons there IS a way to find out what patients think about their doctors and surgeons, I just don't know how accurate and valuable the information is. There are websites like Health Grades.com where you can search for particular doctors or surgeons, or search for a particular TYPE of physician or surgeon in your area.

And for the moment, the one thing I DO know you can do regarding malpractice claims, inquiries to the Medical Board in the state where you physician practices will not get you information about specific problems with specific surgeries, but WILL get you information on your surgeon's track record regarding malpractice.

Gary, I am going to try to finish this up a little later, hopefully this has been helpful so far.

Doc1

Smiling Bob

Hey Docs,

I'm pretty sure I know the answer to this, but is therre any evidence at all that the 'male enhancement' products on the market work at all to increase penis size?

Sheepish in Virginia

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Dear Sheepish,

No need to be sheepish, but you are correct. "Enzyte", "Longinexx" (love that name) and the like are complete scams and the amazing thing is that people actually pay for them. But don't take my word for it, let's check in with the Mayo Clinic. And think of it this way, if they did work, then all of us would have large penises. That WOULD be interesting because we would then actually learn if size matters, but we are as God made us.

Best,

Doc1

Thursday, November 24, 2011

Cat Bite

Hey Docs,

I was at a friends and got but by her cat. I ended up in the ER the next day with a bad infection and they took an X Ray of my hand. I didn't say anything at the time but now I'm wondering if I got ripped off? Why do an X Ray?

Just Curious,
Ben in Portland, ME

Hey Ben,

Great question. Cat bites, as you discovered, are very dirty bites and often get infected. One of the WORST things that can happen is for the cat to break a tooth off under your skin. This is why they did the X Ray... To look for a cat tooth in the wound. Evidently you didn't have one or they would have had to get it out and that can be an unholy mess, but you DID NOT get ripped off. You got good care.

Hope you have fully recovered.

Doc1

Monday, November 7, 2011

An APP for healthy choices

Hi Doc1,

I was reading your blog today and wonder you could give me an opinion
on a diet/fitness app I'm making right now ?

For me, I think the problem with being healthy is motivation. It's an
abstract, overwhelming goal. I think the best way to counter this is
to have concrete, winnable games and small victories.

So, this app will makes living healthy, and fitness into a RPG game,
where users earn points, and "level up' as they achieve their goals.
Everytime they eat something healthy like vegetables, they earn
points. Everytime they complete a workout, they earn points. Each
level will present different challenges.

The challenges will follow a certain structure. First will come
changing your environment such as getting rid of junk food. Then,
reducing stress, as stress leads to eating comfort food. Then concrete
goals like keeping track of everything you eat, or taking the stairs
for a week. Small, concrete goals rather than abstract ones like "be
healthy" or "exercise more".

The whole point is to create a holistic framework/game so people will
rely less on willpower, and more on fun, achievement, and changing our
environment.

What's your opinion on this idea? Would you want to know when I'm done
with it? If this sounds too silly, or absurd, just ignore what I just
said, hehe =)

Best,
Christine

Hi Christine, Doc 2 here. That is a GREAT idea. There are tons of health and fitness apps out there for this thing or that thing. One of the most popular that I see and sometimes use in my weight loss practice is "MyFitnessPal" and the "C25K" (aka Couch to 5K). However, I don't think that there is one with a roll-playing game approach. That would be VERY cool. When I was in medical training, I lost weight because I was in a competition with a patient who was a newly-diagnosed diabetic. The camaraderie and competition that we had in the process gave us BOTH benefit. Perhaps a mode of partnering or grouping people together (just like in an RPG) for a common goal is ALSO something to think about. I personally think that this is a GREAT idea.

I would be interested in collaborating with you on such a project if you are game for it. (No pun intended.) Think about it and get back with me.

-Doc 2

Thursday, October 20, 2011

Post Mortem Question

A friend of mine just died in a car crash. It was a terrible crash and evidently not survivable under any circumstance. The cause of death was confusing to us, 'uncal herniation causing respiratory arrest'. What does this mean?

Jim S.

Phoenix

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Jim, so sorry about your friend. An 'uncal herniation' is merely describing a situation in the head where pressure builds up, usually from bleeding (in the case of trauma), and this pressure forces the brainstem down into the formen magnum, and when this happens our brains can no longer instruct the lungs/ diaphragms to breathe, so breathing stops and the person dies. THIS link is a pretty good one to describe this process in more detail. Again, so sorry to hear about your friend.

Doc 1

Wednesday, October 5, 2011

Plantar Fasciitis and its Consequences (pending question)

I was diagnosed with Plantar fasciitis June 2010. The doctor gave me some excersises to do and then said stay off of it as much as possible. So I spent the summer not really over stressing my foot and doing the excersises.

I'm a teacher and school started in September and I'm back on my feet and it's still sore. Sore enough that it takes me a while to get down the stairs in the middle of the night to get to the bathroom. Again this summer I didn't do much walking or over excert myself but I kept busy.

So now I'm gaining weight because I'm trying to keep the foot from getting worse. So this September after all summer of being a slouch (again more or less) I got back on the treadmill and am running again. but it really really agravates the foot. I can't keep babying this foot it's been long enough so I just run through the pain. The first ten minutes are pretty painful and then it smooths out. But when I sit later it's very, very stiff. I'm told theres nothing else to do for this other than Aleve. I can't take Aleve every day it upsets my stomach.

I own the treadmill and can't afford a gym membership. We also have a great bike trail nearby and I bike that as well but it doesn't tone like running does. Is there anything else I can do and why doesn't this get better? I would think after a year and a half it should have improved somewhat. Am I missing something? I'm a 55 year old woman who is about 30 lbs overweight which I can get off but just need to be active. I have no other illnesses. It may sound trivial and not dramatic enough for your blog but it's really starting to get to me.

Thanks for your input.

Renee

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Dear Renee,

Doc1 here, and this is a great question. I think my friend Doc2 can add some to this but you have clearly failed to improve with the conventional therapy for plantar fasciitis.

In my current practice I see tons of young folks with this problem. Recently I learned that our friends in Podiatry have a new weapon against this sometimes debilitating problem and it is borrowed from the Urologists. It's called ECSWT (extra corporeal shock wave therapy), and uses focused sound waves to promote healing of the inflammation in the plantar fascia.

This therapy, by report from patients of mine who have had it, can be dramatic and curative. So, I would recommend seeing a Podiatrist to see if this might be an option for you

Also, a more traditional therapy which DOES work but can only be done once or twice is injection of steroids into the plantar (bottom) surface of the foot.

In any case, take a good look at the Mayo Clinic link I sent and look how many options for treatment there are. There is hope and there's more to do for you. Time to step up the treatment regimen.

Will let Doc2 weigh in (no pun intended) on the weight issue.

Thanks!