Ask the Doctor: January 2008

Question: I was watching Oprah and Dr. Oz mentioned that his favorite vitamin was vitamin D, and that a lot of people don’t get enough vitamin D. Why is that? I thought we got enough vitamin D from milk and the sun. – D.V., Grand Blanc

Answer: That is a great question! This topic has come up in a lot of conversations between me and my colleagues recently, and I agree with Dr. Oz. Vitamin D has been underrated for sometime.

The most common way that we get vitamin D is from the sun. When the sun hits your skin, it starts the production of vitamin D. Because of the shorter days and decreased intensity of the sun in the northern states and Canada, people living there (including the Detroit metro area) are more likely to be vitamin D deficient. Also, with the concern about skin cancers increasing, more people are using sunscreen and thus preventing the formation of vitamin D in the skin. Most dermatologists recommend a sunscreen with at least an SPF of 15 to prevent skin cancer; however an SPF of 8 will block enough of the sun’s rays that your skin will not make vitamin D.

Vitamin D can also be obtained through the diet. As most people know, milk is fortified with vitamin D. However, the vitamin D in milk breaks down easily, and by the time you have consumed about half of the milk in the carton, the vitamin D is no longer there. The other source of vitamin D in food is fatty fish like salmon or tuna. Of course, salmon and tuna contain many other important nutrients, like omega-3 fatty acids, so anytime you can eat these fish is good.

You can also get vitamin D from your multivitamin or over-the-counter supplement. Most doses of vitamin D in multivitamins are based on the recommended daily allowance, which we are now realizing is too low. The current recommendations for daily vitamin D intake was based on the amount of vitamin D needed to prevent rickets in children, which is not enough to prevent a variety of problems in adults.

The reason that we are so concerned about vitamin D now is that it is related to many common and serious illnesses. Vitamin D deficiency contributes to osteoporosis in post-menopausal women and can explain why some women still have hip fractures even when they are on medications to prevent fractures.

Vitamin D deficiency can cause muscle weakness and may contribute to the symptoms of arthritis. Vitamin D deficiency can also make the achiness that comes with the cholesterol medications known as “statins” worse. Before you stop your cholesterol medication because of aches and pains, ask your doctor to check your vitamin D level and replace the vitamin D if necessary. Your aches should improve as your vitamin D level goes up.

Vitamin D helps to keep cells healthy, and a vitamin D deficiency is linked to an increased risk of cancer. Those cancers that can be affected by vitamin D levels are colon, pancreatic, prostate, ovarian, and breast cancer. The risk of Hodgkin’s lymphoma is also increased by low levels of vitamin D. Vitamin D deficiency increases the risk of diabetes type 1, crohn’s disease and multiple sclerosis. Low levels of vitamin D can increase the risk for heart disease by mildly increasing blood pressure and increase inflammatory markers that are linked to heart disease, such as C-reactive protein.

Vitamin D deficiency can also contribute to depression. One of the theories behind seasonal affective disorder is that it is related to low vitamin D levels in the winter months. Seasonal affective disorder is related more to the amount of light during the day rather than the temperature, so the vitamin D theory may hold to be true.

The next time you go in for a physical or for blood work with your doctor, ask about having your vitamin D level checked. The normal range currently is 20-80, with anything below 10 considered to be severe deficiency. However, we find that people do better with levels higher than 20, so I treat my patients who have vitamin D levels less than 32. With clinically deficient patients, I am replacing their vitamin D aggressively with 50,000 IU once a week for 8 weeks, and then repeating the level check. Once the vitamin D level is above 32, the 50,000 IU tablet only needs to be taken once a month.

If you are vitamin D deficient, you will need to take supplements for the rest of your life. Over the counter formulations of vitamin D come in 1000 IU tablets. The 50,000 IU tablet is available by prescription from your pharmacy. Once you are back into the normal range, you could also take two over-the-counter tablets daily instead of the prescription monthly dose.

If you are not vitamin D deficient, taking the over the counter formulation once or twice a day can help you maintain your healthy levels. It is almost impossible to overdose on vitamin D, so if you want to take the supplement before having your level checked, go ahead. Taking vitamin D is an excellent way to prevent a number of serious diseases with a simple natural supplement a day.

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: December 2007

Question: My doctor just told me I have diabetes. He told me to take special care of my feet. How should I do that? – D.V., Grand Blanc

Answer: If a doctor has ever said you had an elevated blood sugar level (diabetes) – even just once when you were pregnant – you are at risk for diabetes. About 15.7 million people (5.9 percent of the United States population) have the disease. Nervous system impairment (neuropathy) is a major complication that may cause you to lose feeling in your feet or hands. This means you won’t know right away if you hurt yourself. This problem affects about 60 to 70 percent of people with diabetes.

Foot problems are a big risk. Like all diabetic people, you should monitor your feet. If you don’t, the consequences can be severe, including amputation, or worse.

Minor injuries become major emergencies before you know it. With a diabetic foot, a wound as small as a blister from wearing a shoe that’s too tight can cause a lot of damage. Diabetes decreases your blood flow, so your injuries are slow to heal. When your wound is not healing, it’s at risk for infection. As a diabetic, your infections spread quickly because your blood sugar becomes high and that slows down the cells in the body that fight infections.

If you have diabetes, you should inspect your feet every day. Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts and nail problems. Get someone to help you, or use a mirror. Feel each foot for swelling. Examine between your toes. Check six major locations on the bottom of each foot: The tip of the big toe, base of the little toes, and base of the middle toes, heel, outside edge of the foot and across the ball of the foot. Check for sensation in each foot.

If you find any injury – no matter how slight – don’t try to treat it yourself. Go to a doctor right away.

Tips for Taking Care of Your Feet:

• Wash your feet every day with mild soap and warm water. Test the water temperature with your hand first. Don’t soak your feet. When drying them, pat each foot with a towel and be careful between your toes.

• Use quality lotion to keep the skin of your feet soft and moist – but don’t put any lotion between your toes.

• Trim your toe nails straight across. Avoid cutting the corners. Use a nail file or emery board. If you find an ingrown toenail, see your doctor.

• Don’t use antiseptic solutions, drugstore medications, heating pads or sharp instruments on your feet. Don’t put your feet on radiators or in front of the fireplace.

• Always keep your feet warm. Wear loose socks to bed. Don’t get your feet wet in snow or rain. Wear warm socks and shoes in winter.

• Don’t smoke or sit cross-legged. Both decrease blood supply to your feet.

Tips About Shoes and Socks:

• Never walk barefoot or in sandals or thongs.

• Choose and wear your shoes carefully. Buy new shoes late in the day when your feet are larger. Buy shoes that are comfortable without a “breaking in” period. Check how your shoe fits in width, length, back, bottom of heel and sole. Avoid pointed-toe styles and high heels. Try to get shoes made with leather upper material and deep toe boxes. Wear new shoes for only two hours or less at a time. Don’t wear the same pair everyday. Inspect the inside of each shoe before putting it on. Don’t lace your shoes too tightly or loosely.

• Choose socks and stockings carefully. Wear clean, dry socks every day. Avoid socks with holes or wrinkles. Thin cotton socks are more absorbent for summer wear. Square-toes socks will not squeeze your toes. Avoid stockings with elastic tops.

Foot Deformities

When your feet lose their feeling, they are at risk for becoming deformed. One way this happens is through ulcers. Open sores may become infected. Another way is the bone condition Charcot (pronounced “sharko”) foot. This is one of the most serious foot problems you can face. It warps the shape of your foot when your bones fracture and disintegrate, and yet you continue to walk on it because it doesn’t hurt.

A doctor may treat your diabetic foot ulcers and early phases of Charcot fractures with a total contact cast. The shape of your foot molds the cast. It lets your ulcer heal by distributing weight and relieving pressure. If you have Charcot foot, the cast controls your foot’s movement and supports its contours if you don’t put any weight on it. To use a total contact cast, you need good blood flow in your foot. Your doctor monitors it carefully. The cast is changed every week or two until your foot heals.

A custom-walking boot is another way to treat your Charcot foot. It supports the foot until all the swelling goes down, which can take as long as a year. You should keep from putting your weight on the Charcot foot. Surgery is considered if your deformity is too severe for a brace or shoe.

Ask the Doctor: November 2007

Question: I keep hearing about MRSA on the news. What is it and should I be worried? – M.C., Detroit

Answer: MRSA stands for methacillin-resistant staphalococcus aureus. Staph aureus is a common skin bacterium. It lives on the skin and doesn’t really cause any problems unless it gets under the skin and into the tissue below; it usually enters through a cut or a scrape. Often, your body’s immune system can fight off the bacteria, and you won’t have any problems or sign of infection. Other times, the strain is particularly strong, or the person it is infecting has a weakened immune system for some reason and the infection can require antibiotics. The infection may be treated with a topical antibiotic from the drug store or require a prescription from your doctor for an oral antibiotic.

Resistant strains occur because of overuse of antibiotics. When you have a bacterial infection of any kind, the strongest bacteria are the last to die when you are treated with an antibiotic. When these are exposed to the antibiotic for a long period of time they become resistant and are able to survive, even when exposed.

MRSA first developed in hospitals where very strong antibiotics are used all the time. Now, because people who had MRSA in the hospital and people who work in the hospital may be exposed, MRSA has shown up in infections out side of the hospital.

Preventing MRSA is no different than preventing other infections. Wash your hands often. This is BY FAR the most effective way to prevent any disease from spreading. You do not have to use an anti-bacterial soap because the motion of washing your hands and the water removes most of the bacteria. If you get a cut or a scrape, clean it thoroughly with soap and water. Don’t use hydrogen peroxide, as this can break down some of the normal skin cells and make you more prone to infection. Protect the area with a bandage to prevent any new bacteria from getting in and watch closely for signs of infection: redness or warmth of the area, or drainage of pus from the area.

There are antibiotics that treat MRSA, but they should only be used when the infection is known to be MRSA. If you think you need an antibiotic, go to your doctor. If there is pus, your doctor can culture it to determine if it is MRSA and treat you appropriately.

Question: I see so many ads on TV for sleeping pills. They say they are non-narcotic but I have heard that they can be addictive. Which are they? – T.S., Taylor

Answer: Actually, they are both. The term narcotic really refers to pain medications like codeine and morphine. These drugs are addictive. The sleeping medications advertised on TV are not narcotic pain relievers, so the term non-narcotic is correct.

These sleeping medications fall into a group of drugs similar to Valium, called benzodiazepines. They are much milder than Valium and the other drugs in that class, but they can be habit-forming and addictive and have to be used with caution.

Almost all of the medications advertised on TV should be used in the same way. They should not be mixed with any anti-anxiety medications or alcohol. You should take them at home, right before going to bed and when you are going to get 8 hours of sleep. You should not drive until the effects have worn off (essentially 8 hours after taking the medication).

They should be used sparingly, but most that are currently advertised have been approved for long term use, so they are safe to use long term. The risk of addiction or dependency on the medications increases with the length of time you use the drug.

Question: I saw on the news that the diabetes medication Avandia causes heart problems, but I have not seen anything recently. What is the status of this drug and should I keep taking it? – W. L., Bloomfield Hills

Answer: First of all, do not stop the medication until you talk to your doctor. Secondly, the drug has been reviewed by the FDA and the FDA has chosen to leave the drug on the market, albeit with a warning for patients with moderate to severe heart disease.

That being said, here are the details. The warning basically says to use Avandia with caution and monitor patients closely for leg swelling, unexplained weight gain, shortness of breath or other symptoms of congestive heart failure. It is recommended that the dose be adjusted down or the medication be discontinued if those symptoms occur. Avandia should not be used in patients with New York Heart Association class 3 or 4 heart failure. This is a small group of patients with heart failure that have shortness of breath with mild activity.

JAMA (Sept 12, 2007) has two articles that review the data collected over the years about Avandia and Actos (the other drug in the same class). The review of the Avandia data does show an increased risk for symptomatic congestive heart failure and heart attack, however there was no evidence to show an increase in cardiovascular mortality (death from heart disease) despite the other increases. The review of the Actos data was slightly different. The data did show evidence of increased symptomatic heart failure and so the above warning from the FDA has also been given to Actos. However, there was no increase in the risk of heart attack, stroke or cardiovascular death with Actos.

The most important thing to remember is that uncontrolled diabetes is THE MOST serious risk for heart attack and death from cardiovascular disease. There are other classes of diabetes medication and researchfor new types of diabetes medications is on-going. If you have diabetes, you need to have a discussion with your doctor about which medications are right for you based on your other medical problems and other medications that you are on.

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: October 2007

Question: I have been reading your answers to reader’s questions now for a few months, but the question that I have is what is an internist? I don’t really understand what internists do. – G.S., New Philadelphia, OH

Answer: Dear G.S. – In a nutshell, an internist is a primary care doctor for adults. In the past, primary care was done by a “GP” or a general practitioner. GPs generally only had one year of training past medical school. These days nobody can practice without a full residency. GPs were replaced by family doctors. The difference between family doctors and internists is that internists spend all three years of residency in adult medicine, and family doctors have a three year residency that consists mostly of adult medicine, but also includes pediatrics, OB/GYN, and surgery. As an internist, I treat cholesterol, high blood pressure, diabetes, arthritis, depression, and joint injuries. The list goes on and on. I also do routine health screening exams, such as the Pap smear for women and prostate exam for men. You can also go to an internist for a sinus infection or bronchitis.

Question: Winter is coming up. Should I get a flu shot? I heard they can make you sick. – E.E., Southfield

Answer: Dear E.E. – I actually recommend flu shots for everyone unless there is a contra-indication, because the flu is a severe viral illness that can keep you out of work for 2-3 weeks. Officially, the flu shot is recommended for people 60 and over, pregnant women, people with underlying lung disease, diabetes or heart disease, and health care workers.

The myth that the flu shot can give you the flu is just that: a myth. Years ago the flu shot was made up of a live virus. A vaccine with a live but weakened virus can make you sick. The flu shot we give today is a dead virus. It cannot make you sick. What you can have is symptoms from the increased activity of the immune system that can occur with any vaccine. Those do include low grade fever and mild achiness, but this is nothing compared to the fever and achiness that comes with the actual flu.

The other confusing aspect is that flu and cold season start at the same time, so a cold may occur around the time you get a flu shot. The flu shot does not cause or prevent a cold. Influenza is a viral illness where the fevers are high, accompanied by severe muscle aches and fatigue, a sore throat and a dry cough. You may feel like you can’t get out of bed, but I encourage you to try and see your doctor within 48 hours of the onset of your symptoms and get tested for influenza, as there are drugs that can treat the virus if started early.

Question: When I got my flu shot last year, I heard about the pneumonia shot. Do I need to get it, and if I do, how often do I need it? – M.Y., Grosse Pointe

Answer: Dear M.Y. – The pneumonia shot is for people 65 and older, or younger people with lung diseases like

emphysema, asthma and chronic bronchitis. If you are under 65 and have other chronic illnesses like heart disease or diabetes, you may want to ask your doctor about getting the vaccine. The pneumonia vaccine is made up of about 23 strains of the most common bacterial cause of pneumonia, so it doesn’t prevent them all but it will prevent most cases.

The current recommendations suggest that the pneumonia vaccine be given once after the age of 65, with no further booster shots to be given. If you receive a vaccine before the age of 65, you should be revaccinated once after the age of 65. However, your doctor may choose to give it to you every 5 or 10 years, depending on your individual case. The pneumonia shot is not given yearly like the flu shot and it should not replace the flu shot.

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: September 2007

Question: My doctor told me that my triglycerides are high, and she told me not to eat carbs to bring them down. I thought triglycerides were a type of cholesterol, so I am confused. Can you explain it to me? – D.N., Macomb

Answer: Dear D.N. – You are right. It CAN be confusing when we talk about triglycerides. Triglycerides are a form

of bad cholesterol, however they are what happens to carbohydrates when they turn into fat. We all know that carbohydrates are a form of energy that is readily available but if you don’t burn off all the carbohydrates you ate in a day, your body has to turn them into something that can be stored, and when we check the blood work, that shows up as triglycerides.

There are medications available on the market that specifically target triglycerides and can bring them down, but the first thing to do before starting a medication is to try dietary changes. You need to cut back on the sugars and “white” carbohydrates like white bread, potatoes, pasta and rice. Whole wheat bread, wheat pasta, and brown rice are ok in moderation. You also want to avoid fruit juices and sugary sodas when trying to lower your triglycerides.

Very high triglycerides can cause problems with your pancreas as well as your arteries, so if you can’t bring them down with diet, talk to your doctor about a medication. Some people have a genetic condition that causes them to make too many triglycerides, so diet wouldn’t be helpful for those patients.

Question: My daughter is going to be a freshman in college in the fall. She is required to have the meningitis vaccine before she lives in the dorms. Why is this vaccine required for her? – A.P., Plymouth

Answer: Dear A.P. – The meningitis vaccine has recently been required for all freshmen living in the dorms in

colleges around the country. It protects against a very deadly bacterial meningitis caused by the bacteria Neisseria meningitides. This form of meningitis spreads very quickly through respiratory droplets (coughing, sneezing) when people live in close quarters. Dorm living is a perfect place for this bacteria to spread quickly with the community bathrooms and two to three students sharing a small room.

The initial symptoms can be vague and ignored by students not under the watchful eye of their parents; headache, neck stiffness, fever and fatigue. If not recognized and treated quickly, this form of meningitis can be fatal within 48 hours. Students who are commuting to school from an apartment or their parents’ house are not at any more risk than anyone else in the community and are usually not required to have the vaccine.

I would strongly encourage getting this vaccine for your daughter, even though she probably does not want another shot, because this disease is so rapidly fatal. I grew up in a college town, and when I was in high school (before the vaccine was recommended for college students) a couple of students in the dorms on campus died of meningitis, and I remember how the community was devastated.

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: June 2007

Question: I have been smoking a pack of cigarettes a day for too long. I am ready to quit, but I don’t know what will work best. Do you have any suggestions?

Answer: First of all, congratulations on the decision to quit smoking! That is the first step. If you are not fully committed to quitting smoking, it is more likely that you will not be as successful. Smoking is the leading cause of preventable premature death. We all know that smoking increases your risk of lung cancer; 80% of lung cancer deaths are smoking related. However, a lot of people don’t know that smoking also increases your risk of bladder cancer, cervical cancer, and mouth cancers. Smoking also increases your risk of emphysema and bronchitis.

There are more options to help you quit smoking now than ever before. There are two prescription drugs available, Chantix and Zyban, which you can ask your doctor to prescribe for you and there are over the counter nicotine replacement products that you can get at any pharmacy without a prescription. In addition, the more support you can get from friends and family, the more successful you will be. The companies that make the products to help you quit smoking have web sites that can offer you supportive tips and on-line support groups as well.

The newest drug to the market is Chantix. It is unique because it is the first drug designed specifically to help you quit smoking. When you smoke cigarettes, your brain makes receptors for the nicotine. These receptors are not there in non-smokers. When you smoke, the nicotine receptors are full and you feel relaxed. When you haven’t smoked in a while, these receptors are empty, and you might feel agitated or irritable until you smoke again to fill up the receptors. Chantix is not nicotine, but the molecule is shaped so it fits perfectly into the nicotine receptor. When you take Chantix, you don’t feel the urge to smoke, since your receptors are full.

In addition, if you do smoke, there is nowhere for the nicotine to go, so you don’t get the relaxed feeling that you were used to when you smoked before. Chantix, like any drug, has side effects. Between 30% to 40% of patients studied experienced nausea. This is usually transient, and will go away. If it doesn’t, you can ask your doctor for a lower dose. Other side effects reported: insomnia – 18%; abnormal dreams – 13%.

In my personal practice, most patients tolerate Chantix very well and only a few have experienced the side effects. Those patients have also told me that the side effects didn’t bother them because they were so happy that they were able to finally quit smoking.

Chantix is expensive but some insurance companies cover the cost. If you have to pay cash, always call different pharmacies, you might find a significant difference in cost and be able to save some money. However, if you keep in mind that a pack of cigarettes is almost $5 the Chantix will pay for itself in the money you save by not buying cigarettes everyday.

Zyban is the other prescription drug. Zyban has been around a little longer than Chantix and works differently in the body. The generic drug buproprion that is in Zyban is marketed under another name, Wellbutrin, as well, so you cannot take Zyban and Wellbutrin together.

Wellbutrin is an anti-depressant medication that increases the dopamine and norepinephrine in the spaces between the nerve cells in the brain. The doctors doing the initial studies on depressed patients noticed that the patients who were smoking at the beginning of the trial weren’t smoking by the end of the trial. They then tried the drug on non-depressed patients and found that it worked just as well to help those patients quit smoking. It was given a new name, Zyban, so that doctors could prescribe it for smoking cessation to patients who weren’t depressed.

It is unclear to researchers exactly how Zyban works to help patients quit smoking, but it is thought that the neurotransmitters dopamine and norepinephrine play a role in nicotine addiction as well as depression. If you have clinical depression and want to quit smoking, this is a great option for you, and you can talk about it with your doctor.

As I already said, no drug is without side effects. Zyban and Wellbutrin have a small but serious risk of seizure. This risk is dose dependent (higher risk with higher doses of the drug), and higher in patients with a history of seizure, a closed head injury, brain tumor, liver cirrhosis, or anorexia nervosa. Otherwise, Zyban is safe and well tolerated.

The most common side effect is headache, reported in about 30% of patients. Tachycardia (fast heart beat) was noted by 11% of patients and insomnia was noted in 11-20% of patients. My own patients have noted these side effects as well. Some patients decided to come off the medication and some elected to stay on. In addition, Zyban causes weight loss in about 20% of patients, which although listed as a side effect, can be a benefit when trying to quit smoking. Zyban and Wellbutrin are available in their generic form, so ask your pharmacist about that option. As with Chantix, some insurance companies will cover Zyban; some will not. With the generic option, your out-of-pocket cost will be lower.

Most people make multiple attempts to quit smoking. These options can help you be more successful in this attempt, but if you are not successful, try again. You can ask your pharmacist about the over-the-counter nicotine replacement products if that option is right for you. Good luck!

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: May 2007

Question: I am a 62-year old woman and my doctor just told me I have osteopenia. What is osteopenia and how can I treat it?

Answer: Osteopenia is an early stage of bone thinning that occurs as we age. Osteopenia is a precursor to osteoporosis which can lead to bone fractures. Osteopenia and osteoporosis effect menopausal and post-menopausal women most commonly, but can happen to men also as they age as well as anyone who has been on high dose steroids to treat asthma, arthritis or other conditions. To treat osteopenia, I recommend calcium and weight-bearing exercise. Menopausal and post-menopausal women and anyone diagnosed with osteopenia or osteoporosis should get about 1500 mg of calcium daily in divided doses. This generally means that you should take one calcium supplement in the morning and one at night, plus one serving of a low-fat dairy product a day. Your calcium supplement should contain vitamin D, since it helps calcium to be absorbed. Everyone else (men and pre-menopausal women) should get 1000 mg of calcium a day. Weight-bearing exercise includes walking, running, aerobics, yoga and Pilates. Lifting weights is also beneficial. Ask your doctor if they recommend a bone building medication in addition to calcium and exercises. These medications are not for everyone, so this should be discussed individually with your doctor.

Question: I have heard so much about hormone replacement therapy, and I am very confused. What are bio-identical hormones and are they safe?

Answer: Bio-identical hormones are natural supplements for estrogen and progesterone, the female hormones that decrease in our system after menopause. The lack of estrogen and progesterone are responsible for the changes in our bodies during and after menopause, including hot flashes, mood irritability, insomnia, and night sweats. These symptoms vary in intensity and duration in all women. Bio-identical hormones are considered to be natural supplements and are not regulated by the FDA in the same way that synthetic hormones (the ones your doctor can prescribe) are. Therefore, nobody has studied bio-identical hormones the same way the synthetic hormones have been. Estrogens of any type have certain risks associated with them. We know this from the large Women’s Health Initiative trial that was stopped early about 5 years ago due to the increased risks of breast cancer, blood clots and heart attacks in women taking the hormones. This study specifically looked at the synthetic hormones, but to be as cautious as possible with these life-threatening issues, we have to assume that the bio-identical hormones carry the same risks. This also goes for supplements found in the vitamin aisle of your pharmacy that are called “plant estrogen” or “soy estrogen”. The risks of hormone replacement therapy are dose related, so the longer you are treated and the higher the dose, the greater the risk. Every woman’s risk is different for breast cancer, blood clots, and heart disease, so this should be discussed with your doctor. The bottom line is that bio-identical hormones are an option for treating the symptoms associated with menopause but are not any safer than traditional synthetic hormones.

Question: I want to start an exercise program for my health. How much exercise should I get a week?

Answer: The first thing you should do is to see your doctor to determine if you are healthy enough to start an exercise program. Once you and your doctor have determined that you are healthy enough for exercise, the Centers for Disease Control and Prevention (CDC) recommend that most Americans get 30 minutes of moderate to vigorous exercise 5 or more days per week. For weight loss, the time or intensity should be greater. Moderately intense exercises are walking briskly, mowing the lawn, dancing, swimming for recreation, or bicycling. Vigorous exercise includes jogging, engaging in heavy yard work, participating in high-impact aerobic dancing, swimming continuous laps, or bicycling uphill.

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 information purposes only and should not replace the advice or recommendations of your physician.

Ask the Doctor: March 2007

Question: I am a 57-year old male and have just started to get heartburn over the last few months. I was wondering, should I be concerned about anything more serious?

Answer: Heartburn is a very common problem and usually easily treated by diet, lifestyle changes and/or medications. However, there are some signs that should prompt you to see a doctor and be evaluated with an EGD (stomach scope). In your case, one of those factors is that you are over 55 years old.

Other “red flag” signs and symptoms are unexplained weight loss, persistent vomiting or vomiting blood, painful swallowing, and a feeling of being full after only a small amount of food. If you are using NSAIDs such as ibuprofen or naproxen, you should also tell your doctor. These signs and symptoms are concerning for ulcers, esophageal cancer, stomach cancer, or esophageal stricture, and you should be evaluated as soon as possible.

Question: Is there a way to “cure” athlete’s foot? I have recurring bouts and am not sure what to do to stop it.

Answer: Chronic athlete’s foot is difficult to treat but can be cured. However, if untreated, it can persist indefinitely. Over the counter creams are the standard treatment and will work, but you have to use them consistently for four weeks. If you don’t improve with the topical treatments, you can see your doctor for an oral medication. If you also have a fungal toenail infection, you should be treated with oral medications; topical will not work for you. In addition, treating your shoes with foot powder can help. You should also make sure that you get rid of any shoes you wear without socks (including your flip-flops you wear in the gym shower) because the athlete’s foot can live there.

Question: At what age should I have my skin examined for any signs of skin cancer? I am 32 but have not noticed any changes in my skin or any moles.

Answer: The current recommendations suggest that high risk people have yearly skin checks by a physician, with careful attention to the skin between checks, and evaluations sooner if moles change. However, the US Preventative Task Force guidelines do not suggest an age at which to start screening.

High risk patients include patients with fair skin, over the age of 65, a personal history of atypical moles or previous skin cancer diagnosis, or more than 50 moles on their body. Patients who do not fall into these groups should monitor their own skin for warning signs of skin cancer and seek evaluation for biopsy as soon as possible. The ABCDs of melanoma are: Asymmetry of the mole, Border irregularity, Color variability, or Diameter greater than 6mm (about the size of a pencil eraser).

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 information purposes only and should not replace the advice orrecommendations of your physician.

Ask the Doctor: February 2007

Question: My mom was recently diagnosed with diabetes. When should I be tested?

Answer: You should be tested for diabetes once a year if you have any risk factors such as family history (like your mom’s diagnosis), if you have had gestational diabetes, or steroid-induced diabetes. You should also be tested if your waist size is greater than 35 inches for women or 40 inches for men.

In addition, symptoms such as unexplained weight loss, blurry vision, frequent urination, increased thirst, or unusual fatigue could be signs you may have diabetes.

Remember, diabetes is an important risk factor for heart disease, kidney problems and blindness. Therefore, it is important to diagnosis and treat diabetes as early as possible so you can minimize these serious complications.

Question: I just turned 50. Do I need a stress test?

Answer: A stress test is a very important test for detection of possible heart disease, but only if you have symptoms of chest pain or shortness of breath during activity or at rest. However, if you are not having these symptoms, I do not usually recommend a routine stress test for screening purposes because the test could give you a false negative result. Therefore, it is not always reliable.

If you are concerned about your risk for heart disease due to age, high cholesterol, or family history, a better test for you is the cardiac calcium score. This is a new technology that allows a CAT scan to detect blockages in you coronary arteries before they become symptomatic. If your test is positive, your doctor may want to perform additional tests to assess the severity of your heart disease.

Question: My doctor said that my total cholesterol was okay, but that my good cholesterol was too low. Is there a way to increase my good cholesterol?

Answer: Good cholesterol (HDL) is important because it removes the bad cholesterol particles from the blood and decreases your risk for heart disease. Your good cholesterol should be at least 40mg/dL, but the higher the better.

You can increase your good cholesterol by exercising regularly and by eating a diet low in saturated fats and high in omega-3 fatty acids. Foods containing omega-3 fatty acids are salmon, almonds and some margarine spreads. You can also take omega-3 fatty acid supplements, which are available over the counter.

In addition, a B-vitamin, niacin can also raise your good cholesterol and is also available over the counter. If this doesn’t work, prescription versions of both omega-3 fatty acids and niacin are also available. Check with your doctor to see which would be best for you.

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 information purposes only and should not replace the advice or recommendations of your physician.

Ask the Doctor: January 2007

Question: I continue to hear different reports on whether mammograms are necessary, or can truly help you detect breast cancer. What are the recommendations?

Answer: Yes, mammograms are necessary, because mammograms are designed to detect breast cancer in its earliest stages, before you or your doctor can feel the lump. Breast cancer has a higher likelihood of cure if detected early. In addition, early detection makes your treatment options easier on you and your family. One in eight women will develop breast cancer in their lifetimes, which is why it is important to screen all women over the age of 40. Mammograms are recommended yearly for women starting at age 40. Some groups also recommend a baseline mammogram at age 35. Depending on the results of that baseline mammogram, some women may need to start yearly screening earlier. As long as a woman is healthy, she should continue to have yearly mammograms. The decision to stop yearly mammograms is between the woman and her doctor. If a woman has a family history of breast cancer, her doctor may recommend earlier mammograms, more frequent mammograms, or different screening techniques, such as breast MRI or breast ultrasound.

Question: My friend recently had a colonoscopy. At what age should I consider one for myself?

Answer: Colonoscopies can detect colorectal cancer before any symptoms develop. Signs and symptoms of colorectal cancer usually are found in patients with more advanced stages of colorectal cancer. You should discuss undergoing a colonoscopy with your doctor if you have rectal bleeding or blood in the stool, change in bowel pattern from your usual, change in the stool size or thickness, or unexplained weight loss. In addition, if you have been diagnosed with iron-deficiency anemia you should talk to your doctor about having a colonoscopy. For both men and women, a screening colonoscopy should be done first at age 50 and then every 3 to 5 years if you had any polyps, and every 10 years if you had no polyps. If you have a first-degree relative (parent, sibling, child) with colorectal cancer, you need to be screened when you are 10 years younger than the relative was at his/her diagnosis. For example, if your father was diagnosed with colorectal cancer at age 45, you need your first colonoscopy at age 35. In addition, you need to be screened every 5 years, instead of every 10 years, even if you didn’t have any polyps on your first colonoscopy.

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

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