Patient’s foot drop is slow to improve

September 16, 2014 By

Q: I am a 75-year-old female and in good health. A neurologist recently diagnosed me with foot drop, telling me it was caused from crossing my legs. It is difficult for me to walk and the more I walk, the more tired I get, like I am dragging a log with me. I have had 10 physical therapy treatment including massage, ultrasound and more. Yesterday I received an acupuncture treatment. This began around six months ago. Two months ago the knee became sensitive when bending it. To date my knee is improving slightly but my foot is still flopping.

Can you put any light on this subject and recommend a cure?

A: Foot drop (or drop foot) is a gait abnormality that occurs because of weakness or damage to the common fibular nerve or paralysis of the muscles in the anterior portion of the lower leg. It can be caused by nerve damage alone, by trauma to the spinal cord, muscle trauma, toxins, or disease. While not a diagnosis, it is most frequently a symptom of an underlying issue. The condition may be temporary or permanent and bilateral or unilateral depending on the extent of paralysis or muscle weakness. When the individual attempts to walk, the raised leg will often be bent at the knee. Because of the bent knee approach, an individual may walk on tiptoes or with a wide outward swing of the affected leg(s). It will be difficult for the individual to walk on his or her heels, simply because of the inability to lift the front of the foot off the ground. Diagnosis may therefore be made during a routine examination when the physician watches the individual walk. If questions remain, testing including an MRI, EMG or MRN may be ordered to help determine the underlying cause for making the diagnosis.

Diseases that can result in foot drop may include amyotrophic lateral sclerosis (ALS), muscular dystrophy, multiple sclerosis, cerebral palsy, Friedreich’s ataxia, Charcot Marie Tooth disease, hereditary spastic paraplegia, and stroke. The condition can even occur following hip surgery and is known to occur following squatting for long periods at a time or from crossing the legs.

Treatment will begin by determining the underlying cause for the foot drop. For example, if it is the result of injury to a peripheral nerve, a relatively simple operation might be performed whereby the pressure on the peripheral nerve is eliminated. If spinal disc herniation in the lower back area is found to be impinging on the nerve that makes the leg function, surgery can be performed to either remove the herniated disc, opening the foramen, or in more difficult instances, a combination of both procedures with or without fusion to avoid movement. If the procedure or procedures are insufficient, nerve transfers might be used by taking branches of the tibial nerve. On the downside, recovery is extensive and may take up to a year.

Non-surgical treatments may include exercise, over-the-counter anti-inflammatory drugs, and functional electrical stimulation, and epidural injections for spinal stenosis. Fractures of the vertebra may include a back brace, while molded plastic devices can stabilize ankles.

Your physician has apparently or hopefully been willing to consider all possibilities of treatment. Make an appointment to speak with him or her to determine if your expectations for recovery are reasonable or if you should consider other options such as a second opinion or need to be patient for a while longer to allow the healing process to be complete.

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Black pepper aggravates woman’s UTIs

September 13, 2014 By

Q: Every time my mother eats black pepper, she gets a bladder infection. Her urologist told her that black pepper pieces travel through the bladder which irritates it and causes the infection. Also, the acid in orange juice has also caused bladder infections for her. Perhaps people who have many infections should try to eliminate this seasoning and/or juice.

A: According to the American Urological Association, the main cause of a urinary tract infection is bacteria. Infections are more common in women than in men, primarily because women have a shorter urinary tract, specifically the urethra (the tube that carries urine from the bladder), which makes them more susceptible. There are several factors other than foods that can increase the risk of a urinary tract infection. They include wiping from back to front, taking multiple courses of antibiotics that causes the hearty bugs to become increasingly resistant to them, having multiple sex partners, and ignoring the urge to urinate instead of emptying the bladder when your body signals. Pepper and other substances may irritate the bladder in some individuals but it doesn’t make them susceptible to UTIs.

For the benefit of other readers, symptoms of a UTI include urine that is cloudy and has a strong odor, frequent urination with pain, voiding a minimal amount at each attempt, burning and abdominal pain.

Beyond that and in the food department, one of the biggest offenders is products that contain sugar which should be avoided during an infection because the bacteria is believed to feed on the sugars contained therein. Tomatoes, grapefruits, oranges, lemons and limes – all high in acids – are also known to irritate the bladder. Beverages and foods that contain caffeine should also be avoided during a UTI but can be consumed once the infection has completely cleared. For those individuals with a sensitive bladder, specific spices including curry and black pepper are known to trigger symptoms. Other food items to avoid may include white flour, corn, oats, onions, beans, and nuts. This may all appear somewhat harsh; however, meat, cheeses, butter, green and root vegetables, and potatoes, can be enjoyed. While we all respond differently, it appears your mother has a sensitivity to pepper and at least some citrus products. For the rest of us, discontinuing some of the other foods mentioned might do the trick.

There are also alternative treatments that might help the symptoms of a UTI. They include drinking more water than usual to help “flush” the system, drinking 100% cranberry juice every day at the first sign of an infection, using UTI-Clear which is an herbal remedy, drinking caffeine-free tea, avoiding douching/using feminine deodorant sprays/wearing scented pads or tampons, wearing cotton underwear rather than synthetic blends, taking vitamin C, eating pineapple that contains bromelain with anti-inflammatory properties that may reduce symptoms, and staying active. Once steps have been taken to combat an existing infection, readers should be sure to continue with steps to prevent future infections.

Thank you for writing. Your letter certainly may have helped other individuals with a similar problem stamp out future infections.

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Neurological disorder presents problems for young woman

September 12, 2014 By

Q: My daughter is 32 years old with ugly feet. She can’t wear shoes because of the bunions and her little toes are turned to the side. She went to her doctor to talk to him about surgery but after an X-ray she was informed that she has a bone disease known as Charcot Marie Tooth disease, she is going to have to wear braces on her feet and she is going to get worse.

What can you tell me about this disease?

A: Charcot Marie Tooth (CMT) disease a/k/a hereditary motor and sensory neuropathy or peroneal muscular atrophy is a rather common inherited neurological disorder that affects about one in every 2,500 individuals in our country and affects the peripheral nerves. Peripheral nerves lie outside the brain and spinal cord. Their purpose is to supply the muscles and sensory organs in the extremities.

The neuropathy of Charcot Marie Tooth affects motor and sensory nerves. The motor nerves in our bodies cause muscles to contract and control voluntary muscle activities such as swallowing, breathing, speaking and walking. Symptoms of CMT disease may include high arches and hammertoes. Weakness of the foot and lower leg muscles may result in foot drop and a high-stepped gait. The individual may trip or fall frequently and as the disease progresses, the hands may be affected with muscle atrophy and weakness.

The onset of symptoms is during adolescence or in early adulthood; however, some individuals may exhibit signs and symptoms during mid-adulthood. The severity of symptoms can vary from person to person. The progression of symptoms is gradual and the pain may range from mild and manageable to severe. Foot/leg braces and orthopedic devices may be necessary in order for the patient to maintain mobility.

Charcot Marie Tooth results from mutations in genes that produce proteins involved in the structure and function of either the peripheral nerve axon or the myelin sheath. The gene mutation of this disorder is commonly inherited and it’s the degeneration of the motor nerves that results in muscle weakness and atrophy in the feet, hands, legs, and arms.

I don’t feel comfortable with your daughter receiving a diagnosis because of one X-ray. More likely, when CMT is suspected, a physician may order electrodiagnostic testing that consists of nerve conduction studies and electromyography. Genetic testing is available for some types of CMT (of which there are several), and the results are often sufficient to confirm the diagnosis. When all diagnostic workups remain inconclusive or if the genetic testing is negative, a neurologist may perform a nerve biopsy for confirmation of the disease. This involves removing a small portion of peripheral nerve through an incision in the skin, such as at the calf of the leg.

There is no cure for CMT; however, treatment in the form of occupational therapy, physical therapy, braces and as you have discovered surgery may be a consideration. If extreme pain is present, medication may be prescribed. Stretching exercises, aerobics, low-to-no impact exercises may be of benefit.

Your daughter should speak with her surgeon to determine if bunion removal will help her ambulate better. And, if her small toes turn outward, there may be a simple procedure to straighten them so she can wear shoes. If the surgeon feels nothing can be done other than braces, she might request a second opinion to be assured all her options have been exhausted. I recommend you take her to a top notch neurologist with previous experience in dealing with the disease.

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Physician has ordered a mammogram for a 91-year-old

September 10, 2014 By

Q: On a visit to my 91-year-old mother, I was surprised to see that she has an appointment to take a mammogram. On the National Cancer Institute’s home page and on a Federal Government home page I see that mammograms are recommended for women up to the age of 74. Nothing is said about taking them after that age.

In view of the fact that my mother never had cancer and indeed has no major health problems – but at 91 is growing feeble and uses a walker – I find it difficult to believe that she needs a mammogram. Naturally I will ask her practical physician but would be interest in your answer to the general question: Does a 91-year old woman with no history of cancer problems need a mammogram?

A: Mammograms are X-rays of the breast(s) that can check for cancer in both sexes who have no signs or symptoms of the disease. They can also be used to diagnose lumps or other signs of breast cancer.
Breast cancer has been reported in women in their 90s. Sadly, one consideration a physician must weigh is the length of time a woman of that age is likely to live. Keep in mind that estrogen levels are lower, and the cancer is likely slow-growing. The American Geriatrics Society encourages screening for women younger than 85 who have at least five years’ life expectancy and for healthy women 85 and older who have excellent functional status or who feel strongly about the benefits of screening.

According to the American Cancer Society guidelines, yearly mammograms are recommended beginning at age 40 and continuing for as long as the woman is in good health. Clinical breast exams are recommended approximately every three years for women in their 20s and 30s and every year for women 40 and over. Obviously women (and men) should report any changes or abnormalities to their physician when discovered, regardless of age.

According to the Mayo Clinic, their physicians begin performing annual mammograms beginning at age 40 but they go on to indicate that when to begin screening and how often the procedure is repeated is a personal decision. Mayo has taken the position that at age 40, mammograms can detect breast abnormalities early. They report findings from a large study in Sweden of women of that age showed a decrease in breast cancer deaths by 29%. Because physicians cannot distinguish dangerous breast cancers from those that are not life threatening, annual mammograms remain the best option for early detection. On the downside, low-level radiation and the probability of false positive test results can lead to additional worries on the patient’s part.

The US Preventive Services Task Force mammogram guidelines recommend screening for women begin at age 50, repeated every two years.

The CDC (Centers for Disease Control and Prevention) promotes mammograms every two years from age 50 to 74 years. Based on history and symptoms, testing may begin prior to age 50. and may be more frequent.

A February 12, 2014 British Medical Journal report questioned the benefit of yearly mammography. It indicated the long-running Canadian study contends that annual screening women aged 40 to 59 does not lower breast cancer death rates; however, Memorial Sloan Kettering’s Deputy Physician-in-Chief for Breast Cancer Programs cautioned women not to be swayed by those headlines. They indicate the study had critical weaknesses that invalidate its conclusions and that regular mammography screening continues to be recommended for women in this age group. The authors of the BMJ study suggest that annual screening mammograms can lead to what they term “over-diagnosis” of breast cancer, causing women to receive surgery or treatments for early-stage breast cancers that never would have progressed. Despite the controversy, doctors at Memorial Sloan Kettering do agree that annual mammograms beginning at age 40 save lives and decrease the likelihood that women will die of breast cancer by at least 25 to 30%.

Speak with your mother’s physician to determine if he or she feels testing will be beneficial or if your mother can pass it up. Were I to make the decision, I would opt for the latter.

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Can alcohol-laden raisins help the pain of arthritis?

September 9, 2014 By

Q: I can’t begin to tell you how much I have learned from your column. I read once about getting pain relief from golden raisins soaked in gin. Is this true? Also, how many would you take each day and how often? I have both RA and osteoarthritis, as well as scoliosis and stenosis. I am hoping the raisins will just give me some relief. I also take prednisone and methotrexate. I hope you will answer this as I have so much faith in you. Thank you for all your help.

A: Thank you for the compliment. I will identify the medications you are taking briefly for other readers who may then have a better understanding of your issue. While countless drugs are used for other conditions than they were originally intended, my guess is that you have been placed on Methotrexate because of your RA (rheumatoid arthritis) and that you take it once or twice each week for control. The prednisone is a corticosteroid is used to treat specific rheumatoid disorders, as well as for COPD, ulcerative colitis, thyroiditis, Meniere’s disease, migraine headaches, and countless other conditions. I’m sorry to learn that your symptoms have not been dramatically reduced by the combination of both medications.

Rheumatoid arthritis is an autoimmune disease in which the body’s immune system incorrectly attacks a person’s joints. Unfortunately, you are not alone with this diagnosis. There are approximately 1.5 million individuals in our country with the disorder and almost three times as many women than men suffer from symptoms that vary from person to person. Those symptoms may include pain, inflamed, swollen joints and more. While there is no cure for RA, there are a number of medications available on the market to reduce the degree of pain and slow the progression of the disease. On the home front, remain as active as possible in an attempt to keep your joints flexible. Eat a nutritious diet, obtain sufficient rest, and if appropriate, take steps to prevent obesity.

Osteoarthritis is also common, affecting millions of individuals around the entire world. This condition is often referred to as wear-and-treat arthritis, referring to the wearing down of protective cartilage on the ends of the bones as a person ages. Those joints most commonly affected are the ones in the knees, neck, hands, lower back, and hips. The condition frequently worsens with time and again, there are a number of treatments available on the market today to help relieve the pain and improve joint function at the same time.

Quite some time ago a reader wrote in and stated his pain was relieved by soaking raisins in gin and consuming about five each day to help diminish the pain. Other remedies include adding one fourth cup of raw pumpkin seeds to your daily diet, rubbing Castiva onto the affected joints several times a day, and lastly, mixing 8 ounces of 100% purple grape juice with one to two tablespoons of liquid pectin between one and three times daily. As with almost any remedy/supplement/prescription medication, some individuals may find relief and others will not. However, nothing ventured, nothing gained, as they say. Let me know how these possibilities work for you.

Can the consumption of distilled water help this reader? Q: I’m a 74-year-old male who has had sinus and gallbladder surgery. I suffer from chronic dry eyes and frequent constipation. I seem to be adequately medicated. I have been unable to drink the suggested eight glasses of water daily.

One day recently I became so revolted by my tap water that I began drinking the distilled water purchased for my C-PAP machine. I feel my bodily fluids (eyes, sinus, etc.) remarkably improved. I am not drinking any more water than I did before so is it possible to presume my improvement is due to the distilled water? I am not a doctor or scientist, just curious if I’m the only one. I love your column.

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Is it time for a medication change for anxious patient?

September 8, 2014 By

Q: I am a very nervous type of person and get stressed out easily. As backup information, I was in a bad car accident several years ago and had to learn to walk and talk all over again. Two years ago my doctor put me on Effexor to control my anxiety. I also have been prescribed a blood pressure drug. More and more I am having problems walking and doing such things as bending over. I think it is because of the medication but don’t know if I should talk to my doctor about it or not. Can you give me some information on my problem and whether the drug has any bearing on my stumbling and falling more and more frequently?

A: Effexor (venlafaxine) is in a class of drugs known as SSNRIs (selective serotonin and norepinephrine reuptake inhibitors. It is prescribed as an antidepressant, for anxiety and panic disorders, as well as for other conditions a physician may deem appropriate. Physicians should be advised of any history the patient may have of thyroid disorders, seizures, diabetes, heart disease, high blood pressure, kidney disease, bipolar disorder, bleeding/clotting disorders, and more

You should have your blood pressure checked on a regular basis and should keep in mind that the drug can cause what is referred to as a false positive urine drug screen. If for any reason you have periodic urine testing, be sure to advise the laboratory you are on Effexor which may or may not show up in test results. You should also inform your doctor prior to taking any NSAIDs such as ibuprofen, naproxen, indomethacin, meloxicam and others since the combination can increase your risk of spontaneous bruising. You should avoid drinking any beverages that contain alcohol because of an increased risk of side effects which may include hypertension, headaches, sweating and a loss of strength. Less common symptoms may include ringing in the ears, cardiac arrhythmias, blurred vision, and chest pain. In rare instances, a high fever, menstrual changes, nervousness, extreme muscle stiffness, irritability and light-headedness or syncope may result when sitting or standing quickly. Symptoms that could occur often will dissipate as a person’s body adjusts to the medication.

Numerous studies have been conducted on this drug. Musculoskeletal side effects reported have included arthritis, bursitis, leg cramps, hypercholesterolemia, muscle cramps and spasms, rheumatoid arthritis, and more, and while the events have occurred during treatment with venlafaxine, causality has not been determined. Impaired coordination and balance have been reported in some instances. One small study has suggested that the drug may improve concentration, memory, and attention following single oral doses. The use of this medication has been linked with small but significant increases in total cholesterol, HDL and LDL readings.

This is not to imply that you should consider making any major medication changes. However, because you are suddenly experiencing some alarming symptoms, it may be time for you to return to your prescribing physician to discuss what is occurring and to make a decision together as to whether you should be tapered off this SSNRI and perhaps be placed on a different drug in the same class without the symptoms, or on something else as a means of controlling your issues. And, you might also discuss neurological possibilities for your gait abnormality with him or her.

Anxiety is a normal reaction to stress. Approximately 40 million Americans aged 18 and older suffer from the condition. Women are 60% more likely than are men to suffer from it. Several different areas of the brain are key in the production of such things as anxiety. Through imaging of the brain, scientists have discovered that the amygdala and the hippocampus play significant roles in most anxiety disorders. Emotional memories stored in the central portion of the amygdala may play a key role in anxiety orders that present. Therapy for a variety of anxiety disorders is now available and is proving beneficial in helping most individuals lead a productive lifestyle.

Today anxiety disorders are often treated with medication and psychotherapy or a combination of both. It should be clearly understood that no medication will cure anxiety, however it can keep things under control.

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Fibroids don’t always require surgical intervention

September 6, 2014 By

Q: I know you are not a gynecologist but I have fibroids. The doctor I went to jumped right to a hysterectomy. Is this common treatment because I’ve read there are different options.

My uterus has enlarged and an ultrasound showed at least two 2 cm fibroids. I had two ultrasounds, one internally and one externally. My symptoms are long, heavy menstrual cycles. I’ve gained about eight pounds since this began. Would you have a recommendation?

A: Uterine fibroids are benign (non-cancerous) growths that often appear in women of childbearing years. They almost never develop into cancerous lesions. They develop from smooth, muscular tissue of the uterus when a single cell repeatedly divides and ultimately creates a firm mass. Fibroids may be slow growing or fast and may shrink or go through growth spurts. They can range in size from that of a seedling to the size of a grapefruit. They can be single or multiple. It is believed that as many as three out of four women have uterine fibroids that remain undetected, simply because no symptoms are present. Uterine fibroids are often found by accident when a physician performs a pelvic exam. Causes for fibroids to occur may include hormonal changes, growth factors and genetic changes.

As you have discovered, symptoms may include heavy menstrual cycles. Additional possibilities may include prolonged cycles, frequent urination, backache, leg pain, and more. There are three types of fibroid – intramural, subserosal and submucosal. The first grows within the uterine wall. If it becomes very large it can distort the shape of the uterus, cause pain, pressure, and prolonged cycles. A subserosal fibroid projects to the outside of the uterus. It can press on the bladder and elevate urinary symptoms such as urgency. If this form of fibroid bulges outward from the back of the uterus, it can press on the rectum and cause pressure in the area or on the spinal nerves and cause a backache. The latter type flows into the inner cavity of the uterus. This type of fibroid may cause a heavy menstrual bleed and may cause problems for women who hope to become pregnant.

An increased risk presents when menstruation begins at an early age, when diet is high in red meat and ham, in individuals that drink beverages that contain alcohol, in African American women more than Caucasians, and because of heredity.

Diagnosis is commonly made through physical exam, ultrasound, and an MRI which can determine the size and location of the fibroid(s). There are other tests that utilize sterile saline infusion sonograms, hysteroscopy, and more.

The interesting thing about fibroids is that in many instances they can be present without symptoms – meaning they can be left alone and nothing need be done. They commonly grow slowly, if they grow at all. And, they can shrink on their own without treatment. You don’t indicate your age but it is important you consider that symptoms usually abate with menopause. In the interim, you may be a good candidate for myomectomy and endometrial ablation, a procedure to remove your fibroids without removing your total uterus When symptoms are present, medication is available to regulate the length and intensity of menstrual cycles and shrink the size of the fibroids. Each woman is different and the approach taken depends on whether the woman is willing to put up with minor issues. If this is the case and with the approval of your primary care physician or gynecologist, a wait and watch approach may be best. That decision is best left to you and your health care provider.

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Is a hydrocele is common or rare?

September 5, 2014 By

Q: I am 75 years old and have been diagnosed with a hydrocele. It is enlarged to the size of maybe a small orange. My doctor says that surgery involves opening the testicle, removing the fluid and lining, and fixing it so no more fluid can to to the testicle. Then, within two or three months, it should return to its normal size.

I have read your column for years and have never seen a question like mine so I’m asking if this is rare situation or common? It’s very uncomfortable and I would like it corrected. At 75 I still get around. I enjoy traveling with my wife but the enlargement slows me down. Is there an alternative treatment other than surgery?

A: For the benefit of other readers, a hydrocele is a fluid-filled sac that surrounds a testicle. As a general rule, a hydrocele isn’t painful, nor is it harmful. A hydrocele is more common in newborns but for the sake of this column, I will refer to the condition as it pertains to adult men who may experience pain and discomfort because of the swelling involved. Causes for development include inflammation from an infection of the small tube at the rear of each testicle, or because of injury to the scrotum. Complications may set in if there is presence of a tumor, infection, or an inguinal hernia.

Diagnosis may be made by shining a bright light into the mass in a procedure known as transillumination. If the hydrocele is believed caused by inflammation, lab and urine testing may help determine whether an infection is present or not. In some instances, the fluid that surrounds the testicle may keep the testicle from being felt. In this case, an ultrasound would be ordered to rule out the presence of a tumor, hernia, or another cause for the scrotal swelling.

In many cases a hydrocele may dissipate on its own within about six months. It’s only when it enlarges to such a degree that it causes discomfort that surgical removal is even considered. When the option of surgery is a consideration, treatment may involve removal of the hydrocele while the patient is under either spinal or general anesthesia. An incision is made into the scrotum or lower abdomen and the hydrocele is removed. This procedure may require the patient have a tube inserted temporarily for drainage and wear a dressing over the incision site for several days following. Risks for this specific form of surgery include infection, scrotal injury, and blood clots.

Then there is needle aspiration which removes the fluid present. Following aspiration, a sclerosing drug is administered to help prevent the fluid from re-accumulating but unfortunately, the fluid does re-accumulate in many cases, making this an unsuccessful procedure. Risks for this specific form of therapy include pain at the site of the scrotum and infection.

I’m sure you are quite uncomfortable moving about with the enlarged hydrocele. You and your surgeon should determine if the swelling is impairing your quality of life, which it appears to be. Therefore, the surgical procedure appears to be a reasonable approach to the situation. If you have any questions and aren’t completely satisfied with what you are told, you might choose to request a second opinion. At 75 you hopefully have many good years ahead and you should be allowed to enjoy them to the fullest. So, become educated, get your questions answered, and plan more trips with your bride.

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Senior has hands that split and hurt

September 4, 2014 By

Q: I am 85 years old and am hoping you can help me. My fingernails are splitting on both hands. I always wear gloves when I have my hands in water. They are very painful. This only happens in summertime but in the winter, the skin around my fingers cracks open and is also very painful, so I have issues year-round.

Is there anything you can suggest to me that I could try? I would appreciate hearing from you.

A: Women are more prone than are men to onychoschizia – nails that split, are brittle, thin or are soft. When fingernails are affected but toenails remain strong, an external factor is most frequently the cause.

The act of running a house involves washing floors and dishes, cleaning sinks, preparing meals, doing laundry, and other tasks too numerous to mention. Hands are in water, subjecting nails to moisture. Then they are dried, subjecting them to becoming too dry. And, it’s this constant process that may cause your nails to respond as they do. While you may wear gloves while doing the dishes, you may not do so when you wipe down the kitchen table or counter or when you rinse out the sponge or cloth you use to perform that act. So, nails can become dry and brittle from too little moisture when exposed to dry heat in the wintertime or soft and brittle from too much moisture or from a reaction to harsh chemicals in detergents or cleaning solutions.

Then, there is the occasional individual who may have a vitamin deficiency such as iron deficiency that causes nails to split, or the person that uses fingernail polish and removes it with a solution that contains acetone. You don’t indicated when you last had lab work drawn. You may choose to speak with your physician to determine if any vitamin deficiencies were present. According to the American Osteopathic College of Dermatology, 2 mg of biotin taken daily will stop nails from splitting and becoming brittle. Women who are pregnant should not take biotin but it should be safe for others.

Many portions of the body can reflect a person’s health, and fingernails are no exception. For example, white nails could be an indication of liver disease. Pale nail beds may be an indication of anemia. Nails that are yellow in color, that thicken and are slow-growing may indicate emphysema or another lung disorder. Diabetics are prone to fungal infections and brittle nails. Therefore, if you can identify and address any underlying conditions, you may be on your way back to healthy nails and a healthier body.

I recommend you limit the amount of time your nails are exposed to water. This may not be when you are washing dishes and wearing gloves, but when you shower or sink into a tub of hot water at the end of a long day. The water should be lukewarm rather than hot to prevent drying and flaking. Keep your nails well-lubricated with a moisturizer by applying hand cream to your hands, nails, and the cuticle area. The lotion used should contain lanolin or alpha hydroxy acids. File your nails to prevent them from getting too long and breaking.

If you have any questions as to why your nails split, speak with your primary care physician. He or she may have some ideas based on your medical history that can get you back on track.

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Reader’s mucus production is out of control

September 3, 2014 By

Q: I have been dealing with sticky mucus for about two years now. It gets into the back of my throat and bronchial tubes and is very hard to cough out. I went to a pulmonologist who suggested I try Mucinex and if that didn’t work, to use my Albuterol inhaler every four to six hours to open the airways so I could get rid of it. However, nothing seemed to help. He diagnosed it as an asthma condition. It even affects my voice at times. When I try to cough it out, it’s like a rubber band that snaps right back in. I also use an inhaler to prevent inflammation in my lungs due to my asthma.

What else could I possibly do? I’ve made an appointment with an ENT specialist to see if it could be due to post nasal drip.

A: I must begin by indicating that mucus – to a degree – is good. It acts as protection for the tissues that line the mouth, nose, throat, lungs, and GI tract. Mucus actually contains antibodies that help the body identify viruses and bacteria, as well as enzymes and antibodies that kill the invaders it traps. These tissues should not dry out but should act as protection for the areas. As I have indicated in the past, a healthy body produces between one and one and one half liters of mucus each and every day, most of which goes down the throat without notice or concern. Unfortunately, the body is complex and when too much mucus is produced, we do notice it and spend countless sums of money purchasing over-the-counter and prescription products in an attempt to bring things back to normal.

It’s important to consider that anything that irritates the mucus membranes can actually cause them to produce an abundance of mucus. Asthma, a sinus or bacterial infection, allergies, or the excessive use of a nasal spray might cause a buildup of mucus. If you can identify the possible cause(s), you might then be able to ease the condition by using an over-the-counter antihistamine in proper doses, drinking additional water, learning to recognize an allergen such as tobacco smoke, or even by using a humidifier in the home to keep the air moist.

One method of ridding excess mucus is with a netti pot that resembles a small tea pot. A saline solution is introduced into one nostril and it ultimately drains out the opposite nostril. Irrigation is good but shouldn’t be overdone since all too frequently, the process may wash away some of the protective substances that help prevent a person from getting ill.

So, let’s hit on some possible reasons for your excess mucus. Initially, your excess mucus may be related to cigarette smoking, the foods you consume and the beverages you drink – things that vary from person to person. For example, soy milk is known to cause excess mucus, as is orange juice, lemonade, coconut, dairy products and the various edibles that contain soy products. One method of determining if specific food items are the culprit is to eliminate one product at a time to find if there is any variation in the amount of mucus developed. This will likely require that you keep a log of what you consume so you will ultimately know what to eliminate from your diet. And, should this be the cause for your excess mucus, remedies might include ginger tea, ginger ale that actually contains real ginger and not an extract or ginger flavoring, ginger root capsules, and an old standby for other readers but apparently not you, Mucinex.

On a different note, coughing up mucus (phlegm) is a common symptom of COPD (chronic obstructive pulmonary disease). Then there is the possibility of nasal polyps, asthma, acute bronchitis, and more. Any change in the amount or color of the mucus may indicate the presence of a bacterial or lung infection.

If you are so hampered that your quality of life is affected, it’s time to be more aggressive in getting the answers you need. Keep your appointment with the ENT specialist who can sort out what has been suggested by your pulmonologist and who can make further recommendations. Be sure to ask about allergy testing that may be appropriate in your case. Good luck.

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