Ask the Doctor: August 2009

Question: I have been hearing a lot about these “death panels” in the healthcare reform bill.  Does that mean when I need a knee replacement the government will decide whether or not I am too old to get it?

Answer: First of all, let me debunk this misinformation about the “end-of-life” provision in the healthcare reform bill. There is a provision in the bill for reimbursement to physicians when an end-of-life discussion takes place. However, this does not mean that you will have to go in front a panel of government officials to determine if you are worthy of your knee replacement.

Nor will it encourage assisted suicide or euthanasia. In fact, it penalizes doctors for such suggestions. The bill does acknowledge that this conversation is important for you and your doctor (not government officials) to have when, and if, it becomes necessary.

This part of the bill has been terribly misconstrued in the media.

The bill also acknowledges “end-of-life” discussions cannot be reasonably covered in the short 10-15 minute office visit you usually have when you see your doctor.

The last end-of-life conversation I had in my office included my patient, her daughter and her husband. They all needed to be in the room so that the family members (the ones who ultimately need to know what the patient’s decision is), the patient and I could all be on the same page.

First, we addressed her reasons for this visit and adjusted her medications accordingly. That took the usual 15 minutes I am allowed by my schedule for these visits. Then the end-of-life conversation took an additional 30 minutes.  This conversation cannot be rushed. My patient and her family needed to understand that with her medical conditions, if she were to be placed on a ventilator, she may never be able to come off of it.

This by no means meant that I was trying to coerce her into not seeking all measures that could be taken to prolong her life; but she and her family needed to understand what was entailed in life-prolonging measures and have a realistic expectation of the outcome.

No final decision was made in that office visit, but she and her family were going to continue the discussion at home now that they were provided all the necessary information.

Under the the healthcare reform bill, I would be compensated for the time I spent with the patient, and thus recognizing and acknowledging the importance of that conversation. This concept is not new; as a doctor I have this conversation frequently. What is new is the understanding that such a conversation cannot be held in the short time of a traditional office visit.  In direct answer to your question, no one will EVER decide if you are worthy of a knee replacement!

Question: I have been hearing more about preventing Alzheimer’s disease.  My grandfather died of Alzheimer’s. What can I do to reduce my risk?

Answer: There has been some research released about this topic recently.  It turns out that what is good for your heart is also good for your brain, a healthy diet and exercise!  Specifically, in the Journal of the American Medical Association’s most recent issue (August 12, 2009) there is a study that looked at the Mediterranean diet and exercise.

The Mediterranean diet and regular cardiovascular exercise significantly reduced the risk of developing Alzheimer’s disease.

However, DO NOT think that going down to Greektown to have flaming cheese every night constitutes following the Mediterranean diet! The Mediterranean diet consists of no processed food. It consists of whole grains, fresh fruits and vegetables, olive oil and fatty fish like salmon that contain omega-3-fatty acids.

This also does not include lobster dredged in butter! The Mediterranean diet specifically does not include red meat, poultry, or dairy products. This is a strict diet to follow and does not include goodies like Oreos or ice cream from the local dairy treat on a summer day. However, following it closely and combined with cardiovascular exercise, you will be able to live a long and healthy life!  In addition, previously released Alzheimer’s research has shown that the more you use your brain by reading or doing crossword or number puzzles, the lower your risk of developing Alzheimer’s disease.

Ask the Doctor: November 2008

Question: What are the least invasive procedures for breast augmentation?

Answer: Breast augmentation in this day and age should be a minimally invasive surgery. Why would anybody want a large incision on their breast or axilla(armpit)? For the longest time physicians were taught that you needed maximum exposure to all surgeries. The scar was thought of later and the line “it heals pretty well” was always used to tell the patient that the scar was going to be long and obvious.

What patients may not know is that depending on the implant, incisions may be anywhere from about an inch for silicone implants to about one third of an inch for saline implants. Minimally invasive breast augmentation, which is another word for camera-assisted augmentation, is not new. It has been pioneered for about 15 years but what has changed is the relative size of the cameras. They are now down to a quarter of an inch and in fact can go smaller resulting in smaller and smaller incisions. However the limiting step is the actual implants and their respective diameter. The silicone implant can be squeezed through about a one inch incision because they come pre-filled with silicone gel. The saline implant however comes empty and can be squeezed to about one third of an inch and then filled to the desirable volume with saline once inside the breast.

Endoscopic breast augmentation was first used to do the surgery trans-axillary, but it still left about a one to one and a half inch scar. A new procedure called PEBAM uses a miniaturized camera system and surgical tools that allow the trained surgeon to do the surgery with one third of an inch incision. It can also be used to do the surgery through the umbilicus (belly button), placing the implants under the pectoralis muscle.

The less invasive the surgery, the less pain, quicker recovery, and most importantly, the less scarring and visible signs of surgery the patient will experience. These new techniques are usually performed by board certified plastic surgeons who have great experience in the art, form and function of the breast as well being able to handle any complications that may arise.

Typically breast augmentation done with the PEBAM approach allows the patient to resume activities the next day and resume unrestricted activities in a few weeks.

Ayoub Sayeg, MD is a board-certified plastic surgeon currently in private practice in Troy, MI.

If you would like to submit a medical question to Ask the Doctor, please send via email to: askthedoctor@healthandleisureonline.com.

*Advice found within this article is for informational purposes only and should not replace the advice or recommendations of your physician.

Ask The Doctor: October 2008

Question: I had gestational diabetes during both of my pregnancies. What are the chances that I will develop diabetes later in life?

Answer: Gestational diabetes occurs in about 4% of pregnancies. It is due to the hormones produced by the placenta that direct the mother’s nutrients toward the baby. To make up for this redirection, the placenta also makes a hormone that prevents the mother from developing low blood sugar. This can inhibit the function of insulin which can lead to insulin resistance or diabetes in the mother. This can be treated with dietary changes and/or insulin injections.

Gestational diabetes usually resolves after the baby is delivered; your blood sugar should return to normal in about 6 weeks. Your baby’s blood sugar will also need to be tested at birth. Your risk of developing gestational diabetes in following pregnancies is about 40-60%. Your risk of developing diabetes later in life is also elevated, at about 60% according to one source. You should make sure to let your primary care doctor know about your history of gestational diabetes and have your blood sugar monitored on a yearly basis.

To avoid developing type 2 diabetes, you should be sure to follow a healthy lifestyle: maintain a healthy weight, get regular exercise and follow a diet that focuses on whole grains, lean proteins, and vegetables.

Question: I have had symptoms of a bladder infection for about six months, and every time I go to my doctor she says my urine is normal and there is no infection. She thinks I may have interstitial cystitis and has sent me to a urologist. I have never heard of interstitial cystitis. Can you tell me more about it?

Answer: Interstitial cystitis (IC) is a condition that affects about 700,000 people in the US; 90% of these are women. Interstitial cystitis is what we call a diagnosis of exclusion. Since there is no official diagnostic test for IC, the diagnosis is based on symptoms and ruling out other causes that could explain those symptoms.

Most patients with IC have symptoms, as you do, that resemble a bladder infection such as frequency of urination, urgency to urinate and pain with urination. However, with a bladder infection the urine will have signs of bacteria and white blood cells. In IC, the urine is normal.

Your urologist will also want to look inside your bladder with a small camera, called a cystoscope. The urologist would be looking for signs of bladder cancer, but also inflammation or stiffness of the bladder wall. The bladder has a protective layer on the inside wall. Recent research suggests that this lining is defective in patients with IC. Since the bladder wall is not well protected, the bladder is exposed to irritants and toxins, which can cause some of the symptoms that you are having. Also, in some IC patients, the bladder wall is stiff and scarred from the exposure to the toxins.

There is one medication that has been FDA approved for IC, and urologists are also using other drugs known to help with pain syndromes to treat IC. You should talk to your urologist about these options and hopefully you will be able to find something to help with your symptoms.

Dr. Karen D. Lockwood is board-certified in Internal Medicine and is currently in private practice in Troy, MI.

If you would like to submit a medical question to Dr. Lockwood, please email your question to: askthedoc@healthandleisureonline.com

*Advice found within this article is for informational purposes only and should not replace the advice or recommendations of your physician.

Ask the Doctor: August 2008

Question: I am a 58 year old man, and was upset by the recent sudden death of Tim Russert. I haven’t been to the doctor in a while and have gained some weight. What do you recommend for me to do so I can get healthy and not have the same fate as Tim?

Answer: This is a question I have been asked more than a few times since Tim Russert’s sudden death. There are quite a few things you should do to take care of yourself. The first thing you need to do is to see a doctor for a routine physical. While all doctors differ slightly in what to they do routinely, there are standard things that all men over 50 should have checked on a regular basis. Your doctor can also help you with your lifestyle changes, so you can have the highest level of success.

First, you need your blood pressure checked every year. High blood pressure is a risk factor for heart disease. Normal blood pressure today is considered to be 120/70 or 115/70 if you have certain other risk factors. Any levels higher than that will increase your risk of a heart attack or stroke in the future. Based on your blood pressure, you can design a treatment plan with your doctor to get you back into the safe range with lifestyle changes and/or medications. The other risk factor for heart disease that needs to be monitored on a yearly basis is your cholesterol. The total cholesterol number is not as important as it used to be. The more important values are the HDL (good cholesterol) and the LDL (bad cholesterol). Your HDL should be more than 40 in order to reduce your risk of heart disease. Your LDL goal will vary depending on your other risk factors for heart disease, including family history, other medical problems like diabetes, and your personal history of smoking. You have to keep in mind that being male and over 50 are two separate risk factors, neither of which you can control. That’s why we have to work to control your other risk factors.

In addition to your blood pressure and cholesterol, smoking and fitness level ARE two things that you can control. If you are a smoker – even if it’s only the occasional cigar on the golf course – you need to quit as soon as possible. The cigarette smoke and the toxins that you inhale add inflammation to the body and the arteries, making any plaques you might have in your arteries unstable. When the plaques are unstable, heart attacks occur. There are many options and programs available to help you quit smoking, and you can talk to your doctor about which option is best for you. As for your fitness level, your heart is a muscle that needs to be worked out on a regular basis like any other muscle in your body. Before you start an exercise program, you need to consult your doctor to make sure you don’t need your heart checked first. Otherwise, regular cardiovascular exercise 3 to 5 times a week for 30 minutes is generally recommended.

There are some other tests that your doctor might order, based on your current symptoms and risk factors like an EKG, stress test, or cardiac calcium score. These heart tests are not done on a regular screening basis and should be ordered in the appropriate clinical setting. Keep in mind; they may not always be covered by insurance either. In addition, your doctor may recommend aspirin therapy with 81mg, or low dose, of aspirin. However, aspirin therapy is not recommended for everyone, so this is something else to discuss with your doctor before getting started.

The most important lesson to learn from Tim Russert’s tragic death is that the first sign of heart disease can be a fatal heart attack. This is why it is SO important to control the risk factors that you can, so that you can live a long and healthy life. Good luck!

Dr. Karen Lockwood is a graduate of University of Oklahoma College of Medicine.  She completed her residency in Internal Medicine at Henry Ford Hospital in Detroit.  She is board-certified in Internal Medicine and is currently in private practice in Troy, MI.

If you would like to submit a medical question to Dr. Lockwood, Please email your question to askthedoc@healthandleisureonline.com.

*Advice found within this article is for informational purposes only and should not replace the advice or recommendations of your physician.

Ask the Doctor: July 2008

Question: I am 23 years old and my pap smear came back positive for HPV and had some abnormal cells. I am very worried about this. Can I still get the vaccine for HPV?

Answer: The vaccine for HPV (human papilloma virus) is marketed under the name Gardasil. When they studied the effectiveness of Gardasil before it was approved by the FDA, they studied women who were already infected with one strain of HPV. Gardasil contains the 4 strains of HPV most likely to cause cervical cancer and genital warts. The women who had previously been diagnosed with one strain of HPV were still protected from the other three strains, and the FDA has approved Gardasil for women who have already been infected with one strain. Make sure you talk to your gynecologist about getting the vaccine series. Also, make sure you are getting treated for the abnormal cells on your pap and you follow through with your repeat pap smears, as they will have to be more frequent than once a year of a while.

Question: Last month when you talked about screening for breast and ovarian cancer, you mentioned the CA-125 test. I have read about this in my women’s magazines, which say I should have it done, but my gynecologist has never ordered that test for me. Do I need this test done?

Answer: This is a great question and my patients ask about this test all the time. Ovarian cancer is a rare cancer, with most women only carrying a 1.7% lifetime risk (compared to 13.2% lifetime risk for breast cancer). Unfortunately, due to the location of the ovaries deep within the pelvis, it is difficult to screen for ovarian cancer, thus ovarian cancer is not usually found until it is at a later stage and is harder to cure. Many studies have been done, and no effective screening test has been found for ovarian cancer. The CA-125 blood test is supposed to be used after a woman is diagnosed with ovarian cancer, to follow to see if the cancer has come back. Not all women with ovarian cancer have a positive CA-125 before surgery, so this does not help all patients. In addition, not all patients with a high CA-125 have ovarian cancer, so the false positive rate is quite high; too high for a screening test. As an example, a patient of mine had severe pelvic pain, an ultrasound was done showing an ovarian mass and the CA-125 was very high, around 1700 (normal is less than 25). However, when she went into surgery the results showed that she did NOT have ovarian cancer, and she had endometriosis instead. She is a very lucky woman, but this just illustrates why we don’t use the CA-125 as a screening test for all women. All of that being said, for the women who are at very high risk for ovarian cancer, we have to screen somehow. For my patients with a first degree relative (mother, sister, or daughter) with ovarian cancer, I recommend a pelvic ultrasound every year to look at the ovaries and the CA-125 blood test. This however is not standard of care and generally not covered by insurance for screening purposes. With women that are such high risk, usually the expense is worth the possibly of early diagnosis and a chance at a cure. I would discuss your personal risk with your gynecologist and determine if the CA-125 is right for you.

Dr. Karen Lockwood is a graduate of University of Oklahoma College of Medicine.  She completed her residency in Internal Medicine at Henry Ford Hospital in Detroit.  She is board-certified in Internal Medicine and is currently in private practice in Troy, MI.

If you would like to submit a medical question to Dr. Lockwood, Please email your question to askthedoc@healthandleisureonline.com.

*Advice found within this article is for informational purposes only and should not replace the advice or recommendations of your physician.

Ask the Doctor: June 2008

Question: What are the terms and rules behind a physician “firing” a patient?

Answer: This is a difficult, but important issue to address. In general, physicians are not happy to have to terminate the doctor-patient relationship, but it is sometimes necessary. There does not have to be a specific reason given to the patient as to why the doctor-patient relationship needs to be ended, but that a breakdown in the relationship has occurred is an adequate reason. A good doctor-patient relationship is very important for both sides and each person should be able to end the relationship if it is not beneficial to them.

The patient must be notified of the decision as per the American Medical Association’s Council on Ethical and Judicial Affairs. Opinion 8.115 “Termination of the Patient-Physician Relationship” states that the physician should provide “notice to the patient, the relatives, or responsible friends sufficiently long in advance of withdrawal to permit another medical attendant to be secured.” Per medical ethics, the physician should not abandon the patient, and so most physicians will provide 30 days of continuing care, which should give the patient enough time to establish with another physician. In addition, providing the patient assistance in locating another physician is recommended; such as providing a referral line to a local medical center or names and phone numbers of specific physicians in the same specialty. Because the doctor-patient relationship is governed by ethics, and not law, the state of Michigan does not have specific recommendations or policies. Physicians should be following the American Medical Association’s Council on Ethical and Judicial Affairs recommendations. More information can be found at www.ama-assn.org under the professional resources link. There is a list of frequently asked questions relating to many ethics issues. You can also order a printed copy of the Code of Medical Ethics. I hope this helps!

Question: I heard that you can get addicted to Afrin nasal spray. Is that possible? – V.V., Brighton

Answer: We usually use the term addicted to mean both psychological and physical dependence. In the case of Afrin, there is a physical dependence because of the way it works, but is not associated with psychological dependence.

Afrin works by constricting the blood vessels in the nose and sinuses. This is a very effective way to stop a constantly runny nose. The problem lies when the Afrin wears off, about 12 hours after the initial use.

When Afrin wears off, the blood vessels dilate again, but they dilate more than they were before the first spray of Afrin. When that happens, your nose is more congested and runny than it was before you used Afrin the first time. We call this a rebound effect. This generally makes people continue to use Afrin because the runny nose never resolves even though the other cold or allergy symptoms may have resolved.

My recommendation is to use it for a maximum of 3 days at a time, or not to use it at all. Otherwise you will just have to go cold-turkey and eventually your runny nose will return to normal.

Dr. Karen Lockwood is a graduate of University of Oklahoma College of Medicine.  She completed her residency in Internal Medicine at Henry Ford Hospital in Detroit.  She is board-certified in Internal Medicine and is currently in private practice in Troy, MI.

If you would like to submit a medical question to Dr. Lockwood, Please email your question to askthedoc@healthandleisureonline.com.

*Advice found within this article is for informational purposes only and should not replace the advice or recommendations of your physician.

Ask the Doctor: May 2008

Question: I am 45 and I see my gynecologist and get my mammogram every year. I have been hearing recently about other ways to screen for breast cancer, like ultrasound and MRI? Should I be getting these tests as well as my mammogram?

Answer: The gold standard for breast cancer screening is still a yearly mammogram after age 40, so I am glad that you are getting yours each year. The ultrasound and MRI are used to improve the sensitivity of the mammogram for women with higher risks and lumps that we can feel on exam. If you, or your doctor, find a lump on the breast exam, you should have an ultrasound to determine if the lump is a cyst or a solid mass.

Rarely, a breast cancer is not seen on mammogram, but can be picked up on ultrasound, especially if your breasts are dense. Breast MRI is currently recommended for a specific group of high risk women. The evidence has not yet proven that it gives any advantage over mammogram in a normal risk woman.

The American Cancer Society guidelines for breast MRI are for women who test positive for the genes BRCA1 and BRCA2. They also recommend breast MRI for women who have a first degree relative (mother, sister, or daughter) who tested positive for BRCA1 or BRCA2, even if the patient has not been tested themselves. Women who carry a lifetime risk of breast cancer of 20-25% based on family history and other factors are candidates for breast MRI. Women who had radiation to the chest between ages 10 and 30 are at higher risk of breast cancer and should also be screened with breast MRI. These women should also continue to have routine mammograms.

Question: My mom and her sister both had breast cancer in their 50s. I am 36. Should I be tested for the breast cancer gene?

Answer: This is a difficult question to answer, because everyone’s risk is different, and only 10% of patients with breast cancer also have a family history of breast cancer, and not all patients with a family history carry the breast cancer gene.

There are two known genes that increase the risk of breast and ovarian cancer, BRCA1 and BRCA2. Testing involves a blood test that can be very expensive and not all insurance companies will cover the cost of testing.

The other issue with the breast cancer genes is that they only increase the risk of getting breast or ovarian cancer; they do not guarantee that a patient who tests positive will get those diseases. Testing positive for either gene will increase the risk of developing breast cancer to a 36-85% lifetime risk, and the risk of developing ovarian cancer to a 16-60% lifetime risk. The large range of risk is due to the information we get from the different studies of women with positive genetic tests, and accounts for the other factors in developing breast cancer including environmental factors.

It is generally recommended that the family member with breast cancer be tested for the genes first, in your case it would be your mom. If she tests positive, you can decide if you want to be tested. If she is negative, then you do not need to be tested.

I recommend genetic counseling by a gene specialist or oncologist before deciding whether or not to be tested. I also recommend careful consideration of your early detection and prevention options if you are positive. Early detection is the most important for the survival rates of breast cancer. As I discussed in the previous reader’s question, you should get a breast MRI and possibly more frequent mammograms and clinical breast exams. You must also consider the increased risk for ovarian cancer and you may chose to screen more aggressively with a yearly pelvic ultrasound and the CA-125 blood test.

The other option is to surgically remove as much of the breast or ovarian tissue as possible with a mastectomy and/or oophorectomy to prevent the cancers. This would be done before you ever show signs of cancer. This is the most effective way of preventing breast or ovarian cancer if you are very high risk. However, it is not a guarantee you won’t develop cancer and it is a very difficult, life changing decision and should not be made without the appropriate counseling.

You may also choose to take tamoxifen to prevent developing breast cancer. Tamoxifen is a drug previously only used for patients who have survived breast cancer to help prevent recurrence, but is now used to prevent breast cancer in high risk women. Tamoxifen is not without side effects and needs to be discussed as one of your options in your pre-testing counseling.

For more information about genetic testing and breast MRI you can visit the American Cancer Society’s website at www.cancer.org or call the National Cancer Institute’s information line 1-800-4- CANCER (1-800-422-6237).

Dr. Karen Lockwood is a graduate of University of Oklahoma College of Medicine.  She completed her residency in Internal Medicine at Henry Ford Hospital in Detroit.  She is board-certified in Internal Medicine and is currently in private practice in Troy, MI.

If you would like to submit a medical question to Dr. Lockwood, Please email your question to askthedoc@healthandleisureonline.com.

*Advice found within this article is for informational purposes only and should not replace the advice or recommendations of your physician.

Ask the Doctor: April 2008

Question: Hi Dr. Lockwood. I am a 60 yr old female who is suffering from insomnia. Last year I visited a holistic physician who said that my Vitamin D reading was 14.5 but told me to take a good multi-vitamin. I have been taking two tablespoons of Cod Liver Oil daily. He is now giving me an intravenous feeding 6 times of Cortisol and B vitamins but I am not seeing much of a change. Can a Vitamin D deficiency cause a sleeping problem? I feel anxious and now worry about not sleeping so I am in a vicious cycle. I’m emotional because I’m tired. Ambien made me very groggy during the day. Benadryl doesn’t help. I would appreciate your thoughts on this. This has been going on for the last five years on and off but now it is severe. I’m not having hot flashes. Thank you for your input. – K.M.

Answer:Your question has multiple issues and I will try and address them all. First, if your vitamin D level is 14, it is well below the level of 32 that I try to get my patients to. You need more aggressive supplementation. Even well-known multivitamins don’t have enough to replace your level back to normal. Centrum Silver has 500 IU per tablet and One-a-Day Women 50-plus has 800 IU. Single tablet vitamin D supplements have about 1000 IU in each one. In order to get your level up to 32 you really should be more aggressive. If you take two over-the-counter supplements plus your vitamin you will probably get your levels back to normal soon. I still recommend the higher doses of 50,000 IU weekly for 8 weeks and then monthly. The 50,000 IU tablet is a little harder to find, however.

It is quite possible that the vitamin D level is affecting your sleep pattern because it does affect mood as well as anxiety. However, there is no direct link between insomnia and vitamin D deficiency to my knowledge. Many other aspects of your health are affected by vitamin D, you can only benefit from getting your level back to normal.

I am concerned about the IV treatments of cortisol and vitamin B that you are getting. If you are not getting better with treatment, I would stop both of the treatments. You should be getting adequate vitamin B levels from your multivitamin and your diet. Any of the B vitamins your body doesn’t use, you will filter them out through your kidneys, thus giving you very expensive urine if you have been getting high doses through the IV treatments.

My biggest concern for your health is the IV cortisol. If you are clinically deficient in cortisol, you should be seeing an endocrinologist because there may be other hormones you are deficient in that are made by the adrenal glands. If you are not clinically deficient and he is using the IV cortisol for other reasons, you are putting yourself at risk for side effects of having too much cortisol in your body, including osteoporosis. Excess cortisol increases the rate of bone loss. Increased cortisol can also raise your blood sugar and lead to diabetes, which sometimes resolves when the cortisol is stopped, but not always.

As for your insomnia, there are a couple of things that you can do to help break the cycle. It definitely gets harder to sleep if your insomnia is persistent because of the anxiety you mentioned and the fear of not being able to fall asleep.

The first thing you need is good sleep hygiene. This means no naps during the day so you are tired at night. Do not go to bed until you are completely tired, so if you need to read or watch TV, do it in another room so the brain is not confused about the purpose of the bedroom. The bedroom is only for sleeping and sex, so no eating, reading or watching TV in there if you are having trouble sleeping.

A warm bath or shower before bed may help you to relax. Meditation techniques can help you to relax when you are in bed, also. Try counting slowly backwards from 10. Count once for each breath in and out, make sure you fill up your lungs completely and exhale completely. While you are breathing, concentrate on relaxing each body part, starting with your toes and working your way up. This will help the anxiety component.

Another option is melatonin, which is an over the counter supplement. Melatonin is a substance produced naturally by your brain in response to lower levels of light, which is how your body tells when it is night. The over the counter supplement can help increase these levels. There are two prescription medications you might want to ask your doctor about, as they work differently than Ambien. Rozerem is a newer drug that increases melatonin levels in the brain (much like the supplement, only it is FDA approved). Rozerem takes a little time to kick in, so you have to be patient. The other drug that may help is Trazadone. Trazadone is an older antidepressant that can cause you to be sleepy. The insomnia dose is much lower then the dose used for depression and when taken at night, can really help. I have recently had good responses in my patients to Trazadone.

I hope you are able to resolve some of these problems you are experiencing.

Dr. Karen Lockwood is a graduate of University of Oklahoma College of Medicine. She completed her residency in Internal Medicine at Henry Ford Hospital in Detroit. She is board-certified in Internal Medicine and is currently in private practice in Troy, MI.

If you would like to submit a medical question to Dr. Lockwood, Please email your question to askthedoc@healthandleisureonline.com.

*Advice found within this article is for informational purposes only and should not replace the advice or recommendations of your physician.

Ask the Doctor: March 2008

Question: In your recent article about Vitamin D, you mentioned that once a person goes on Vitamin D that will need to be on it for the rest of their life. Why is that? Thank you. – T. F.

Answer: Usually people who are vitamin D deficient are so because of where they live and/or their lifestyle. If you live in Michigan today and are vitamin D deficient, chances are if you continue to live in Michigan you will never get enough sun to make enough of your own vitamin D. Since vitamin D is so important, it’s best to stay on the supplement long term. However, if you are lucky enough to move to a sunny state, then you can have your levels rechecked and stop the supplement if you get more sun. Keep in mind, a sunscreen with an SPF greater than 8 will prevent your body from making vitamin D. Most dermatologists recommend SPF of 15 or more to prevent skin cancer. I would rather that my patients take the supplement and wear sunscreen than take the risk of skin cancer just to make their own vitamin D. It’s also nearly impossible to overdose on vitamin D, so there are no long term problems with vitamin D supplementation, only benefits.

Dr. Karen Lockwood is a graduate of University of Oklahoma College of Medicine.  She completed her residency in Internal Medicine at Henry Ford Hospital in Detroit.  She is board-certified in Internal Medicine and is currently in private practice in Troy, MI.

If you would like to submit a medical question to Dr. Lockwood, Please email your question to askthedoc@healthandleisureonline.com.

*Advice found within this article is for informational purposes only and should not replace the advice or recommendations of your physician.

Ask the Doctor: February 2008

Question: I am 36 and have been trying to get pregnant for about 6 months, and we have not yet been successful. I haven’t decided if I want to go through fertility treatments yet. Do you have any suggestions? -L.D., Troy

Answer: There are a few things you can do on your own before consulting with your gynecologist. You can start by determining when you ovulate. First of all you need to know your cycle length. This is the number of days between the first day of one period and the first day of the next. If your periods are not regular and you can never predict them, there is a good chance that you are not ovulating and you should talk to your gynecologist about the reasons why you might not be ovulating.

Most women have cycles ranging from 26-31 days. It doesn’t matter if your cycle is long or short, if you are regular; you are most likely ovulating on schedule. Most women average about 28 days, so I will use that as my example. If the first day of your period is day 1, you are most likely to ovulate on day 14.

There are commercially available ovulation monitors that can help you predict when you are going to ovulate, but there is also a technique you can do yourself called basal body temperature. Your normal body temperature will go up around the time of ovulation and back down after ovulation. If you plot your temperature every day you should be able to tell when you will ovulate.

For an accurate basal body temperature, you must take your temperature at the same time every day – first thing in the morning. You should use a digital thermometer to be accurate to the decimal point, because the rise in temperature that you are looking for is very subtle. You should keep the thermometer right next to your bed and take your temperature as soon as you wake up, BEFORE you get out of bed or have any water or coffee.

Like I said, the difference in temperatures is small and different for everybody, but if you are ovulating you will begin to notice a pattern, and then can try to get pregnant around your time of ovulation. The last patient I explained this too got pregnant within a few months!

Question: My New Years Resolution is to lose weight, as it is every year. THIS year however I don’t want to give up! I already think I eat healthy but I am not losing weight! Can you help? – R.A., Utica

Answer: It’s great that you are already eating healthy, but unfortunately, healthy is not always enough to lose weight. It is really about calories. Healthy food will give you all the vitamins and minerals that you need but can have the same amount of calories as junk food if you are not careful. To lose weight successfully you really need to understand the math of calories.

There are 3500 calories in a pound. This means to gain a pound you have to eat an extra 3500 calories and to lose a pound you must burn off that same amount. I have 2 examples for you. One banana is about 100 calories and two Oreo cookies are 100 calories. The banana is much healthier and provides the nutrients that we need. But, if you give up your snack of two Oreos in the afternoon for a banana and think that will help you lose weight, it will not since the calories are the same.

My other example is those “Big Grab” bags of potato chips you can find in the convenience stores. You think that they are one serving size and that they are a good value since they are usually 99 cents. If you read the nutrition information on the back you find out there about 3 servings in one bag, for about 450 calories. So, if you are in the habit of picking up a bag of chips for a snack, and if you have eaten one bag a day, you can almost gain a pound a week!

There are a lot of other foods that are packaged in a way that makes you think they have fewer calories. The muffins at Starbucks are another example. I try to think of them as cupcakes and not muffins because the term muffin implies that they are healthy, when they really have about 500 calories each.

So, if you want to lose a pound a week, which is realistic, you need to get rid of about 500 calories per day in either exercise, cutting back on food or a combination of the two (the better choice). I know this sounds a little overwhelming but there is a lot of information out there about calorie counts and I would start by figuring out how much you are eating now and then seeing where you can cut back. You would be surprised to find out how much you might be eating and how easy it is to get rid of some of the unnecessary foods you put in your mouth every day. Good Luck!

Dr. Karen Lockwood is a graduate of University of Oklahoma College of Medicine.  She completed her residency in Internal Medicine at Henry Ford Hospital in Detroit.  She is board-certified in Internal Medicine and is currently in private practice in Troy, MI.

If you would like to submit a medical question to Dr. Lockwood, Please email your question to askthedoc@healthandleisureonline.com.

*Advice found within this article is for informational purposes only and should not replace the advice or recommendations of your physician.

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