Cost of medication is downright frightening

Q: Why won’t doctors listen to their patients any more? I’m old school and accustomed to a doctor listening to a patient’s concerns when prescribing medicines. Today it seems doctors just prescribe the newest and most expensive medicines on the market without actually knowing much about them. I’m referring to some of the cholesterol medicines out now. Well, I just don’t seem to be a candidate for any of the cholesterol lowering medicines. They seem to cause me more problems than they’re designed to cure.

For example, after only a few days on one drug, I was in so much pain I could barely walk or lift my leg. Can you imagine what it would be like driving and getting pulled over by a cop when all of a sudden sweat just pours off you and runs down your face like a faucet being turned on? Well, that’s what it was like. At first I didn’t connect all the side effects to the cholesterol med. When I did, I stopped taking the drug and the severe muscle pain in my thigh and legs went away within days. I’ve tried to explain this to my doctor, only to be met with a blank stare – and advice to try another medicine which wasn’t any better and even more expensive than the one before. I almost passed out when I took the prescription to my pharmacy and was told what it would cost to be filled.

I’m frustrated and tempted just to stop going to the doctor altogether. It’s as if they want you not to have a say in your own treatment. I tend to suspect doctors may not be reading lab results correctly – as has happened numerous times before – and which led to what could have been some serious complications.

I don’t fit the stereotype of the individual who doesn’t eat right. I don’t eat fattening or junk foods so it’s not a challenge for me to stay away from them. I usually eat lots of fish and vegetables and I love eating fruit. I only cook in olive oil. I exercise. Despite this, my doctor often tells me I’m eating ice cream and chocolates and that’s why my numbers are high. Sign me frustrated.

A: And I don’t blame you for being frustrated. Without knowing what medication you were on, I can only assume you were placed on a statin drug which is designed to block a substance in the body that produces cholesterol. Statins also reduce a patient’s risk for developing cardiovascular disease and countless other disorders, yet they aren’t right for everyone. Common and well-known side effects may include joint and muscle pain, constipation/diarrhea, nausea, type 2 diabetes, and liver damage (which is why physicians order lab work on a periodic basis). Statins can cause an increase in liver enzymes.

There are options to drugs in this category, yet that’s not at the top of your to-do list. First and foremost, you need a new physician. If your doctor is not willing to work with and believe you, find someone else who will. Speak with other family members or neighbors, or telephone your local hospital for a referral. Make an appointment for a get-acquainted visit. Explain your situation. If you don’t like what you see and hear, simply say thank you and walk away. There is help for you. Your problem may have a genetic overtone and have nothing to do with the secret indulgence in ice cream and chocolates your present doctor perceives you have. He’s wrong in not listening and you have every right to find someone in whom you can trust.

Is medication to blame for gynecomastia?

Is medication to blame for gynecomastia?Is medication to blame for gynecomastia?Q: I am a male in my mid 40s. About three or four months ago my breasts began to actually hurt and enlarge. I didn’t want to see a doctor but finally made an appointment because of the pain. He ordered a mammogram which was really embarrassing for me. I’ve always thought that test was just for women and not for men. Anyway, the X-ray was normal and I was told I had gynecomastia. Well, my breasts still hurt.

I’ve since heard through a television ad that if men suffer from painful breasts and have ever taken Risperidone, there may be a connection. I was prescribed Risperidone for a short time several years ago but discontinued the medicine because I didn’t like the way I felt when I was on it. I’m not interested in calling any 1-800 number so I can sue but I’d sure like to know why I’m in such pain all the time. Could this be my problem and where do I go from here?

A: Risperdal/Risperidone is an antipsychotic medication approved for the treatment of bipolar disorder and schizophrenia in adolescents and adults and autism spectrum disorders in children and adolescents. The medication is not approved for use in psychotic conditions with a relation to dementia. The product was initially approved by the FDA to treat schizophrenia in 1993 and later uses for the drug were expanded. Physicians often prescribe drugs for conditions other than which they were intended. Referred to as ‘off label’, this practice has been used to treat ADHD and other disorders. Government regulators and attorneys general in 36 of the United States and the District of Columbia settled a suit in which they determined the manufacturer of Resperdal (Rispirdal) illegally promoted off-label use in children prior to FDA approval for younger patients. Beyond that, hundreds of lawsuits have been filed against the manufacturer by users who claim psychological trauma from breast growth. In 2011, two lots of Resperdal (Rispirdal) were recalled when they were found to be contaminated with chemicals used to treatment pallets manufactured for shipment and in 2013 another injectable Resperidal (Rispirdal) recall occurred because of concerns with mold.

Unfortunately, what makes Risperdal work is exactly what can cause side effects which may include tremors, agitation, weight gain, extremity pain, headache dizziness, depression, and more. The drug works by altering the levels of serotonin and dopamine in the brain. Unfortunately, a number of complications may be triggered by the abnormal levels of hormones in the body, thus the prescribing physician should be notified if any of the following conditions develop – a high fever, cardiac arrhythmias, breast swelling or tenderness (in men or women) impotence, easy bruising, cough, or shortness of breath. Patients could also experience a reaction if they take specific prescription medications, some over-the-counter substances, vitamins, or herbal products.

So, can I indicate the medication is the result of your breast enlargement? Perhaps so, but the answer is best left to your prescribing physician who can review your medical history and make or rule out the connection. Other possible reasons may include the use of ulcer medication, the excessive use of alcohol/amphetamines/heroin/methadone, hyperthyroidism, kidney or liver failure, tumors, the aging process, the buildup of fatty breast tissue, and many other conditions. Gynecomastia in men generally occurs between the ages of 50 and 80 and at least one in four men in this age group are affected. If you haven’t already, ask your physician to order lab work.

Young doctor’s age off putting for woman

Q: My husband’s feet and lower legs started swelling a few months ago. He went to an internist who is in his second year of practice. He had blood work and several tests to rule out heart trouble and blockages. The doctor said everything came back normal, including the kidneys and thyroid. He prescribed a water pill and it didn’t help. The swelling is still there and my husband is now feeling worse. He has shortness-of-breath.

Do you have any advice as to what we should to next?

A: The causes for foot and ankle edema are many. The most common systemic diseases involve the kidneys, liver and heart – essentially because of the body’s retention of too much sodium. Excess salt can cause the body to retain water which then leaks into interstitial tissue space and results in edema. If the flow of blood to the kidneys is decreased by heart failure, the kidneys react by retaining salt. An inefficient heart cannot pump blood adequately through the lungs, causing a person to become short of breath as fluid accumulates in the lungs.

Other than a water pill, you don’t indicate if your husband is on any other medication such as a calcium channel blocker or NSAIDs (non-steroidal anti-inflammatory drugs) that could have edema as an unwanted side effect. Up to half of all patients on calcium channel blockers develop edema. My guess is that the medication aspect should have been covered when he saw his physician but if not, you should make a list to present to him or her for review.

Then there are bad dietary choices including eating foods such as potato chips or salting foods heavily (sometimes even prior to tasting them), indulging in anchovies, eating canned soups, many of which are high in sodium, consuming cold cuts from the deli on an all too regular basis, and much, much more.

While you indicate his heart was checked, heart failure a/k/a CHF is a condition in which the heart fails to pump blood sufficiently throughout the body. This situation may cause a buildup of fluid in the feet, ankles and legs. CHF is more common in seniors than in younger individuals, in those who have had a heart attack, and in people who are obese. While obesity itself does not cause leg edema, the excess weight can lead to lymphedema, idiopathic edema, chronic venous insufficiency, and more. Men are more likely to develop CHF than are women.

Venous insufficiency presents with pitting edema. The individual with a venous insufficiency may have varicose veins. While most patients remain asymptomatic, a sensation of heaviness can occur. A clinical diagnosis may be made; however, confirmation with imaging testing known as a Doppler ultrasound may be used for confirmation.

I can appreciate that your husband’s doctor indicated his heart and thyroid are working well but patients over the age of 45 who suffer from extremity edema of uncertain etiology might consider having an echocardiogram to rule out pulmonary hypertension, heart failure, or other cardiac abnormalities. Your husband should ask about wearing compression stockings which might help the edema but are contraindicated for arterial insufficiency.

Edema can be temporary or it may be permanent depending on its cause. Treatment will depend on the underlying cause which must be determined. If your husband smokes, he should discontinue the practice. If he is on medication for high blood pressure, he should speak with his physician regarding the possible side effects. While he may not be able to discontinue the medication, he might be able to substitute it for another drug. He should put a pillow under his legs and feet when lying down so his legs are higher than his heart. In fact if he can do this three or four times each day, it might help.

Ask for a referral to a cardiologist since the odds are that this problem is cardiac related. If it isn’t, then the cardiologist can recommend a pulmonologist, but don’t be put off by the doctor’s age. An older physician may be able to pull a few tricks out of his hat but a younger one has the benefit of newer technology and cutting edge training.

When is the right time for pneumonia shot?

Q: I had my second pneumonia vaccine seven years ago at the age of 64. My family doctor says I don’t need another since I am over the age of 65. My hospital says people over 65 should get a follow-up shot every five years. So who is correct?

A: According to the Centers for Disease Control and Prevention (CDC), there are presently two types of pneumococcal vaccines available – PCV13 (pneumococcal conjugate vaccine) and PPSV23 (pneumococcal polysaccharide vaccine) that protects against, you guessed it, 23 strains. PCV is most commonly given to infants and young children who may have missed their immunization earlier. Those healthy children between the ages of two and four who have not been vaccinated or who have failed to receive the full series of four doses should receive one dose. Children between the ages of two and five with medical conditions that might include chronic heart or lung disease, sickle cell disease, a damaged spleen, HIV/AIDs or who have a compromised immune system and have not completed the full series should get one or two doses. Children 6 through 18 need direction from their pediatrician since specific medical conditions will call for one dose of PCV13 or a dose of PPSV23.

So, what is recommended for adults? According to the CDC, we never outgrow a need for vaccines. Those required by an adult are determined by such things as age, lifestyle, high-risk conditions such as working in a nursing home/hospital/adult day care center, the amount of travel done, and what immunization has been administered to date. All adults 65 and older who have not previously received PCV 13 should be vaccinated. Then between six to 12 months later, a dose of PPSV23 should be administered. You don’t indicate which vaccine you received, nor do you indicate if you have any medical issues that might come into play. If you have already received a dose of PPSV23, a dose of PCV13 should follow at least one year after you received the PPSV23. While you may be scratching your head at this one, essentially the CDC recommends one dose of PCV13 and one dose of PPSV23 for adults 65 or older – unless those adults have certain health conditions. Those are their guidelines and they are sticking to them.

The vaccines we received as children may protect us for a lifetime – providing we know which vaccines we received and immunity can fade as years pass by. We often become more susceptible to serious diseases such as pneumococcus. In fact, there were about 32,000 cases of invasive pneumococcal disease reported in 2012. This disease is serious and many of its strains are antibiotic resistant. Vaccination is available and is the best way to prevent the disease.

Adults over the age of 65 who receive the PPSV23 vaccine prior to the age of 65 should receive a booster shot if it has been more than five years since being vaccinated. Since you have had a 7-year interval and in accordance with the recommendation of the CDC, you are ready for a booster. You could not have been vaccinated against pneumococcal bacteria as a child because the vaccine wasn’t available until 2000; however, you should be guided by what your primary care physician who has access to your complete medical history has to say. The vaccine can be given at any time of year, is approved by Medicare and most insurances, and it is essentially painless.

Alcoholic seeks help through drugs

Q: I’m having a really hard time fighting with alcoholism. I suffer from anxiety and a nip or two, maybe more, calm my nerves some during the day when I have to work. Some of my friends have told me that Campral might be my answer. Can you provide me with any information so I can make a decision if it will be right for me?

A: Acamprosate (campral) works by helping restore the brain’s chemical balance of an alcoholic who has recently stopped drinking. The medication is also combined with counseling and behavioral modifications. To begin with, if you continue to drink or if you may have issues with other addictive substances, it is not likely to be effective. If, on the other hand, you have undergone detoxification or have attended AA meetings successfully, it may be helpful in balancing things and keeping you from drinking. Other than Campral, there are other medications such as naltrexone that may be used to help achieve alcohol abstinence. You might choose to speak with your physician regarding this alternative.

Campral will not prevent alcohol withdrawal and it should not be taken if you have severe kidney disease. Your prescribing physician should be informed if you relapse and have a drink or several drinks once you are on the medication. Campral should be taken exactly as prescribed – no more and no less — and for the time period indicated. The pills should not be crushed or chewed but should be swallowed whole, since they have a special coating that reduces side effects when it hits the stomach. Side effects may include depression, pain or weakness, anxiety, sweating, insomnia, paresthesias (numbness or a tingling sensation), and more.

While you don’t indicate your age, Campral’s normal dose for adults and geriatric patients is 666 mg three times a day. Geriatric patients are more likely to suffer from a decrease in renal function than are younger individuals. And, if refills have been ordered, there should not be a lapse in time between prescriptions. On another note, my guess is that your primary care physician is aware of your anxiety issues. If not, he or she should be advised prior to you beginning the medication so a determination can be made if Campral is right for you.

Because we all respond differently to almost any drug, you should be well-informed on the symptoms of overdose and potential side effects which may include nausea, a metallic taste in the mouth, incoherent speech, diarrhea/constipation, excessive fatigue, abdominal pain, weight loss, and more. Some of the side effects may dissipate once your body adjusts to the dose you are placed on but a continuation of the drinking habit will not improve with time. You might want to play it safe and keep your doctor informed.

Change isn’t easy and alcoholism is a disease that is extremely difficult to deal with. I commend you on taking an upper hand to get your habit under control. I might also suggest AA if you haven’t attended meetings yet. There are many, many individuals in the same boat as you and a support group may be extremely effective. Find alternatives to drinking by occupying the time spent with other healthier habits. Avoid triggers. If the people you work with stop after work for a drink or two, excuse yourself and head for home, being sure to stay active. Walk the dog, read the newspaper, or catch up on the news on your television instead. If you have a supportive family, tell them of your new goals and plans and ask for their support at what may be difficult times. You’ll be glad you did.

Young man fights intestinal issues that control his life

Q: Hopefully you can give me some direction or advice to help my son out. He was diagnosed with H-pylori bacteria based on his symptoms of severe stomach pain, weight loss and a blood test. Then he was also diagnosed with IBS. After completing a course of antibiotics, his stomach and bowel issues continued to plague him, causing pain in his lower left abdomen. He continues to take Miralax to keep his stools soft and Prilosec to help with acid reflux. His diet is limited and issues seem to flare up a few times a week, either due to the food he’s eaten or possibly because of stress, although he states he doesn’t feel stressed about things. He states the pain gets worse sometimes after a bowel movement. In March he had such discomfort and pain that we visited his pediatrician and an X-ray showed that his bowels were packed. The doctor recommended an enema or suppository. Instead, he took two doses of Milk of Magnesia over a two day period and he was able to empty himself out. He wants to take Milk of Magnesia again but I was told by our pharmacist not to become dependent on it.

In April we visited a pediatric GI specialist and after taking a history, feeling his stomach and getting a blood test, he found nothing. My son has missed more than 20 days of school this year and has missed out on many other outings due to his stomach pain and bowel movements.

Some family history includes anxiety issues and Crohn’s disease, along with IBS but the GI specialist did not find signs of Crohn’s.

Would an endoscopy be recommended? A fiber laxative? Any recommendations, directions or guidance would be appreciated. Thank you. I enjoy reading your column.

A: H. pylori infection is a bacteria that infects the stomach. It is more common during childhood and most individuals are unaware they even have such an infection because they don’t have any symptoms. When they do, they are treated with antibiotics.

IBS (irritable bowel syndrome) is a chronic condition that affects the large intestine, causing abdominal pain, constipation and diarrhea, cramps, bloating and gas. For some, diet modification, avoiding stressful situations and some lifestyle changes will help. For others, medication and perhaps counseling may be more appropriate. Common triggers include stress, specific foods including milk, soda and other carbonated drinks, broccoli, and chocolate.

Milk of Magnesia is recommended as a laxative to relieve occasional constipation. It should not be used for general stomach pain, nausea or vomiting because the symptoms are vague and could represent an entirely different but critical issue. Further, it is not recommended for longer than seven days without medical advice and should not be taken in conjunction with vitamins or herbal products.

An endoscopy is an instrument with a small camera attached that allows a physician to view what is going on inside your body. An upper GI endoscopy may assist a physician determine the cause of such things as abdominal pain, unexplained weight loss, nausea, vomiting, abnormal growths, and more.

I feel your son should be seen either by his pediatric gastroenterologist or he should seek a second opinion. He may also benefit from stress counseling. His symptoms cannot be treated unless and until they are diagnosed. Until a physician works with you to rule out some disorders and hone in on others, you and your son will continue to have unanswered questions. You know he has bowel issues. You know he needs better control over his diet. And you know he should avoid stressful situations whenever possible. That’s a good start. Now you need to determine what causes him to have the debilitating issues that he constantly suffers from.

Keeping toenail fungus at bay

Q: I recently lost a toenail, probably the result of fungus. Would it help to apply Miranel or some other product on the nail bed to deter the reappearance of the fungus?

A: Yes, it certainly would. A nail fungus is technically known as onychomycosis, a condition that begins as a white or yellow spot under the tip of the nail. As the infection continues, the fungus may have caused your nail to discolor and thicken, become brittle and crumble, and turn dark because of the buildup of debris under the nail. Causes for a fungus to form may include yeasts and molds, both of which love environments such as the feet, simply because warm, dark, moist shoes provide a perfect setting for a fungus to form on toenails. And, the toes have less blood flow than do finger nails, making it more difficult to eradicate the infection. Factors that may increase a person’s risk for developing an infection include walking barefoot in public areas such as a fitness center or gym, near a swimming pool or locker room, wearing socks that hinder adequate ventilation, having diabetes or circulatory problems, being diagnosed with a skin condition, or athlete’s foot. You may also have a suppressed immune system or be older and have diminished circulation to your feet.

There are a number of over-the-counter medications such as the Miranel you mention which should help your new nail grow free of infection. An option is oral anti-fungal drugs that can also be prescribed by your physician. On the downside, oral medications may take up to 12 weeks to be effective and the end result will not be observed until your nail grows in completely which could take an extended period of time. You don’t indicate your age but the success rate with medication is markedly reduced in individuals over the age of 65 and success appears most apparent when a combination of oral medications and OTC Miranel or others are used simultaneously. Oral antifungals have the potential for liver damage so your physician may insist on periodic blood testing to be assured things are okay. Keep in mind that repeat infections are common, so don’t despair.

Antifungal medicated nail polish is now available that can be painted on infected nails. The polish is applied to the nail and surrounding skin once daily for a week. At the end of that time period, the layers are wiped off with alcohol and the process is repeated all over again – for up to a year!

On the home front and to prevent re-infection, keep your nail(s) trimmed. Wear socks that are a blend which will allow the wicking away of moisture and allow for better ventilation. If possible, rotate your shoes so the insides can dry completely between wearings. Treat your shoes with a disinfectant or anti-fungal powder between wearings. Refrain from going barefoot in public areas such as shower rooms and instead, keep a pair of flip flops available for such occasions. Be sure to wash your hands after working on or touching any infected nails.

Tremor perplexes reader

Q: Some years ago in one of your columns you wrote about an ailment that may be due to emotional trauma. I had an experience in 1965 and have had shaking hands since. For example, I have problems putting a screwdriver in the slot of a screw, picking up and putting down a glass of liquid, and writing. And now, I tremble all over.

None of the doctors I have seen have an answer. I remember your column but not what you said. I’m now 72.

A: There are a number of medical issues that can cause a tremor – the muscle contraction and relaxation of one or more areas of the body. A tremor can affect the hands, arms, trunk, head, legs, face, eyes and vocal cords, with the most common area of the body being the hands.

Neurodegenerative disease, Parkinson’s, stroke, multiple sclerosis and numerous other conditions might be considered. Then there is always the excessive use of drugs such as corticosteroids, caffeine, amphetamines, cocaine, and alcohol. Hypoglycemia can cause tremors, as can stress, extreme fatigue, and a vitamin deficiency such as magnesium and thiamine which, by the way, will subside once the deficiency is corrected. A tremor can occur at any age; however, they are most common in the age group between 52 and 61. They may be temporary or occasional and affect men and women equally.

Let’s consider a few of the more common tremors. An intentional tremor may be caused by lesions in or damage to the cerebellum resulting from chronic alcoholism, overuse of specific medications, stroke, a tumor, an inherited degenerative disorder, or multiple sclerosis.

Benign essential tremor may be mild and non-progressive in some individuals, while in others it may progress slowly. It begins on one side of the body and will cross over to affect both sides within about three years. A gait abnormality may be observed. An exacerbation may be noted following stress, physical exhaustion, and low blood sugar levels. The onset of essential tremor generally begins after the age of 40.

A Parkinson’s tremor is often a precursor to Parkinson’s disease which is caused by damage to portions of the brain that control movement and a loss of dopamine. This tremor may affect the legs, trunk, chin and lips and can be exacerbated by stress or emotions. This tremor begins around the age of 60, begins in one of the extremities and commonly progresses to the opposite side.

An orthostatic tremor will reveal rhythmic muscle contractions that occur in the legs and trunk when an individual stands. The tremor will halt as soon as the individual sits back down or is lifted off the ground.

A rubral tremor presents as a slow tremor. It may be associated with conditions that affect the red nucleus in the center of the brain.

I don’t know how many physicians you have seen,or if you have had any testing performed but I urge you to make an appointment at a neurology clinic at a nearby teaching hospital where they can perform an extensive examination to determine if your tremors occur during rest or when you are active. Following a complete history and neurological examination, they may find your tremor may be inherited, your medications could be interacting, or the emotional trauma you experienced in 1965 may have some bearing that should be addressed. The specialists should recommend you have blood drawn which might determine abnormal vitamin/thyroid/chemical levels, and more. Your nerve function should be assessed.

Until the underlying cause for your tremors can be determined, they will likely continue. And while this may appear overwhelming, consider that an essential tremor may be controlled with an oral beta blocker; a Parkinson’s tremor may respond well to an oral dopamine-like drug; an orthostatic tremor may be treated successfully with Gabapentin or a combination of drugs; and so it goes. The bottom line is that you need a diagnosis which will then allow your physician(s) to help you. Don’t let things progress further. Call for an appointment today or ask your primary care physician for a referral.

Can Parkinson’s patient undergo surgery safely?

Q: I have recently been diagnosed with early stage Parkinson’s. I’m taking Mirapex three times daily and propranolol twice a day. I’m having a total hip done soon due to cysts on the acetabular and arthritis. Should I be concerned about something going wrong under anesthesia or about the Mirapex due to the Parkinson’s?

I’m 62 years old, tall, slim and otherwise in good health. I had an X-ray and MRI already and would appreciate any information on Parkinson’s and hip replacement. Thank you.

A: As I am sure you are aware, Parkinson’s is a progressive nervous system disorder. It develops gradually and may cause stiffness, slowed movements, gait abnormality, tremors, changes in writing habits, rigid muscles in any part of the body, and more. Symptoms vary from person to person.

Specific nerve cells known as neurons in the brain break down and die. The symptoms that appear are because of a loss of neurons that produce dopamine. When dopamine levels decrease, abnormal brain activity results, leading to the specific symptoms an individual may have. While there is still much to learn about the disorder, age, sex, and genes are known to increase an individual’s risk factor for development. Extended exposure to pesticides and herbicides may also be contributory.

According to the BMJ (formerly known as the British Medical Journal), individuals who undergo surgery are at an increased risk because of the missing dopaminergetic medication during a period of perioperative starvation, an issue that can be further compounded if the absorption of drugs is impaired. Based on a 2010 study, the consequences of a lack of medication can vary dramatically from patient to patient. Some individuals are able to tolerate the lack, while others may become immobile. In some situations, missing dopaminergetic medication can precipitate a condition known as neuroleptic malignant-like syndrome and exhibit symptoms of fever, elevated concentrations of muscle enzyme, and more. Keep in mind this study is four years old and research often provides newer techniques and better outcomes.

Having said that, deep brain stimulation or DBS for short is a surgical procedure used to treat some forms of the disabling neurological symptoms of Parkinson’s, including tremor, gait abnormalities, rigidity, and movement issues and unrelated Parkinson issues of essential tremor and dystonia. At present, this procedure is only used for Parkinson’s patients whose symptoms cannot be controlled sufficiently by medication. DBS utilizes a surgically implanted battery operated device similar to a pacemaker to deliver electrical stimulation. It is targeted toward specific areas of the brain that control movement. The decision is best left to a patient’s surgeon who has complete knowledge of his or her full medical history.

Hip replacement surgery uses metal, ceramic or plastic parts to replace the ball at the upper portion of the femur to remove damaged cartilage and replace it with new joint material. Cemented joints are attached to existing bone with cement, while joints that are not cemented will be attached with the use of a porous coating designed to allow the bone to adhere to the artificial joint. With time, new bone grows, fills the opening in the porous coating, and attaches the joint to the bone.

General or regional anesthesia are commonly used for hip replacement. The choice will depend on your surgeon who will obviously take your Parkinson’s into consideration before making the decision.

If you and your physician agree the procedure is sufficiently safe with your medical history, be sure to follow his instructions to the letter to avoid issues down the road.

Should we vaccinate our children against HPV?

Q: I continue to see ads on television regarding young children receiving an HPV vaccine. Well, I have an 11 year old son and really want to know what this is and what the ads are all about. Can you fill in the blanks?

A: HPV is an acronym for for human papillomavirus, the most common sexually transmitted infection in our country. Anyone who is sexually active can get HPV, even if they only have relations with one person since symptoms my develop literally years after having relations with an individual who is infected. So, do we know who is infected and who isn’t? No, we don’t. You see, HPV can be spread even when an infected individual is symptom free and has no signs of the disease whatsoever. Individuals with a compromised immune system such as HIV or AIDs are at an increased risk and less likely to fight many conditions, becoming more likely to develop health issues as a result.

Almost 80 million – yes million — individuals in our country are presently infected with HPV and 14 million new infections are reported annually. Consider that almost 360,000 Americans run the risk of getting genital warts each year and more than 10,000 women get cervical cancer each year,. If they were to be vaccinated, 21,000 HPV cancers could be wiped out. So why vaccinate our precious children when they are so young? The answer is to provide protection prior to them becoming sexually active and additionally to protect against mouth and throat cancers. There is a high incidence of oropharyngeal and penile cancers related to HPV so treating boys not only helps stop the spread of HPV among females but it helps protect boys from HPV related cancers.

HPV vaccination is safe and effective. It is given in three separate doses over a six month period and it is extremely important that all three doses are given in order to assure effectiveness. In fact, even the CDC, (the Centers for Disease Control and Prevention) urges parents to have their children vaccinated. It is also recommended for gay men and gay women and bisexuals through the age of 21 and for females through the age of 26 if not vaccinated earlier. Lastly, the vaccine is recommended for men and women through the age of 26 who have a compromised immune system.

There is testing that can be performed to screen for cervical cancer but even these tests are recommended for women 30 years of age and older. They are not recommended for adolescents or for women under the age of 30. And surprisingly, the condition is so common that near all sexually active men and women will develop HPV at some point during their lifetime. Cancer may take years and even decades to develop following being infected with HPV. .

Gardasil, the current HPV vaccine, is effective against 70% of cervical and other HPV-related cancers. It also protects against most cases of genital warts. And with research comes progress. An even more effective vaccine may be on the horizon, according to new research published in Cancer Epidemiology, Biomarkers & Prevention. It will protect against nine types of HPV and 90% of cervical cancers according to an associate professor of gynecology at the Medical University of Vienna in Austria. The information is being reviewed by our FDA before a decision is made, hopefully by the end of 2014 with a newer, more effective vaccine to follow shortly thereafter.

Speak with your child’s pediatrician to determine his or her views on protecting your children. Together you can make the right decision.