Adhesions from surgery may require surgery

Q: How does a person find out if they have abdominal adhesions from past surgeries and what, if any, alternative treatments are there other than surgery to have them removed? Would these adhesions cause pain and discomfort up under the rib cage and back up to the bottom of the shoulder blades and across the chest? A lot of people seem to suffer from these, including possibly me.

A: Adhesions are the most common cause of intestinal obstruction in the Western world. Their formation is often unavoidable and unfortunately; the only treatment is more surgery with a procedure known as adhesiolysis. Diagnosis can be made with the assistance of an ultrasound or MRI but a CT or X-ray will not confirm the existence of adhesions. Unfortunately, you have not provided sufficient information for me to answer your questions. You intimate that you have pain and discomfort; however, have you had a surgical procedure that would make you feel you might have adhesions? If you answer yes, where was the site of the surgery? If it wasn’t under your rib cage, at the bottom of your shoulder blade or across your chest, you likely don’t have adhesions; however, the phrenic nerve innervates the rib cage, so pain in the shoulder can emanate from under the rib cage. You need to be seen by a health care professional who can examine you and perhaps order testing to determine why you are having pain. Until then, it’s anyone’s guess.

Internal organs and tissues have slippery surfaces that allow them to move and shift easily as we twist and turn. Post-surgical adhesions are fibrous bands of scar tissue that typically occur when two injured surfaces are close to each other, a situation that causes inflammation and fibrin deposits on the damaged tissue. The fibrin joins the two adjacent structures where the tissue damage occurs, seals the injury and builds an adhesion which can occur anywhere in the body but which is commonly found in the abdomen. An adhesion can begin to form within hours following surgery. With a partial or complete blockage of the intestines, there may be severe abdominal pain, bloating, vomiting and constipation. Some adhesions do not cause any problems at all and need no treatment, while others do.

A condition known as small bowel obstruction is one common consequence of post-surgical adhesions. It may occur 20 years or more following a surgical procedure if a previously benign adhesion allowed the small intestine to twist and obstruct. Depending on the severity of the obstruction, a partial obstruction may disentangle using conservative medical intervention.

The incidence of adhesions may be lowered by the use of adhesion barriers during surgery. Two methods that have been approved by the FDA are Intercede and Seprafilm. Beyond that, laparoscopic procedures that are being performed more frequently have reduced the risk for the formation of adhesions. Lastly on the positive side, surgical humidification therapy has been found to minimize the formation of adhesions.

Reader seeks remedy for eczema

Q: I vaguely remember an article you wrote in my local newspaper several years ago about an unusual remedy for eczema. Would you be able to repeat this?

A: I’m unsure which unusual remedy to which you refer but eczema (atopic dermatitis) is a skin condition that causes redness and itching. It is long-lasting with periods of exacerbation that may be followed by periods when it goes into remission. As with many conditions, signs and symptoms will vary from person to person but generally include red/brownish gray patches often seen on the hands and feet, ankles, wrists, eyelids, and on the inner side of the arm at the elbow; skin that is dry, cracked and scaly; and relentless itching that appears more pronounced at night. Up to 85% of cases may present before the age of about 5 and may continue into adulthood.

While the exact cause for atopic dermatitis to occur is unknown, such conditions as Staphylococcus aureus (a bacteria on the skin) may create a film that blocks sweat glands, while a gene abnormality, an immune system dysfunction and even environmental changes may be contributory. Those factors that elevated a person’s risk factor for development may include being employed in the health care field, having a family history, being African American, having ADHD (attention deficit hyperactivity disorder), and more. Conditions that worsen eczema include stress, bacteria, viruses, variations in heat and humidity, cleaners and detergents, woolen blankets, pollen, dust, and the often uncontrollable urge to scratch that can lead to infection and still further damage to the skin.

Diagnosis is commonly made through a visual examination and by having a physician do a medical history. If any question remains, he or she may order patch or other testing to rule out possible skin diseases other than eczema.

Treatment may begin with a topical corticosteroid solution to reduce the level of itching. Drugs known as calcineurin inhibitors help control the itch and flare-ups and help maintain normal skin. Should an infection be determined, oral antibiotics might be just the ticket. Diphenhydramine (Benadryl and others) are available over-the-counter and may be helpful at bedtime. Diphenhydramine can cause drowsiness, thus the bedtime use. For severe cases, wet dressings treated with topical corticosteroids may be appropriate. This therapy may be better managed in a hospital setting but with appropriate training, it may also be accomplished at home. Then there is phototherapy (light treatment) wherein the skin is exposed to natural or artificial sunlight. And one thing we often don’t consider is stress management through such things as biofeedback, behavioral modification, acupuncture, and yoga.

On the home front, using a humidifier, avoiding scented soaps, taking a warm bath with colloidal oatmeal followed by patting dry rather than rubbing the skin, avoiding scratching, and lubricating with a lotion that contains vitamin C twice daily should help. While unproven and only used with the permission of your primary care physician, St. John’s wort, evening primrose oil, rice bran broth applied to the skin, vitamins D and E, zinc and selenium might offer some relief.

If you don’t find improvement, ask your physician for a referral to a local dermatologist who might be able to shed some other ideas on the subject.

Octogenarian suffers from fatigue

Q: My husband, 81 years old, has several health issues but his main problem right now is fatigue. He is exhausted all the time and can hardly walk because of it. The medicines he is taking are Amlopidine for high blood pressure, hydrocodone-acetaminophen for inverted spurs in his back that are rubbing on nerves, Clopidogrel, a baby aspirin to thin his blood, Advair, and Proair HFA for his COPD. He was under pain management until the doctor said he could not be helped any more.

He has a pacemaker and survived bladder cancer twice. He’s been on Androgel since the bladder cancer and is a cancer survivor. He has sleep apnea and uses a CPAP. We are wondering if he could have CFS and if there is anything that could be done to help relieve some of his fatigue.

Could you please do us a favor and in your own words, of course, tell your readers that a badly diseased gallbladder can mimic a heart attack and what looks like rust in the toilet bowl following urinating could be dried blood which is one indication of bladder cancer. This information could one day save one or more of your readers lives and if so, that would be wonderful.

A: I commend your husband for what he has been through, while only complaining of fatigue. He is on a number of medications but I will only hit on those that may have a bearing on his lack of stamina. Amlodipine is a calcium channel blocker used to treat high blood pressure, angina, and for other conditions caused by coronary artery disease. One side effect of the drug is a feeling of fatigue. Clopidogrel (Plavix) reduces a person’s risk of stroke or heart attack in those individuals who have already had either a stroke or a heart attack. A rare side effect is unusual fatigue.

COPD (chronic obstructive pulmonary disease) refers to a group of lung diseases that make breathing difficult and block the flow of air entering the lungs. Symptoms may include shortness of breath – particularly during exercise, lack of energy, a chronic cough, and more. In countless cases, damage to the lungs that leads to COPD is the result of long-term cigarette smoking, yet such things as genetic susceptibility, occupational exposure to chemical fumes, and age must be considered, as well. For all stages of COPD, effective therapy is available that will reduce the risk of complications and improve your husband’s quality of life. If anyone in your household still smokes, the habit should be discontinued or should be restricted to the person or persons going out of doors, away from your husband.

On the home front, he should eat well-balanced meals, exercise regularly under the direction of his physician, avoid second-hand smoke and irritants that exacerbate his COPD, and obtain sufficient rest. You don’t indicate when he last had lab work done. If it has been some time, he should be checked for anemia, thyroid conditions that could lead to his fatigue, and anything else his physician deems appropriate.

And thank you for the tip of blood in the urine as well as your point that gallbladder attacks and heart attacks can present with similar symptoms. They are definitely good ones that should be checked by a physician for anyone who experiences them.

Cigarettes keep woman regular

Q: I am a 57 year-old woman that has tried to quit smoking with the patch. My side effect is constipation. The meds I take are Welchol, Axid and Metoclopram. While I am not smoking, I can’t have a normal movement. My doctor prescribed stool softeners and has sent me for a colonoscopy. No problems there. The last time I tried to stop smoking I thought I would wean myself from the nicotine by reducing the amount of cigarettes to about 13 a day. I became totally constipated again.

My doctor believes the cigarettes are my stimulant. I am taking stool softeners and drinking a lot of fluids, along with fruit and Citracal every night. Ducolax is the only thing that works and I can not keep using it. I do not like prune juice so I have not tried that. When I eat something that normally moves a person, I become bloated and have a lot of burping. The last time I quit smoking I went like this for a month and I couldn’t take it any longer so I started smoking again. Within two weeks I was fine with regular movements every day.

I have not met anyone with this problem and am wondering if you have any knowledge of this.

A: Constipation is described as bowel movements that are infrequent or hard to pass. Severe cases include fecal impaction that can progress to a bowel obstruction and obstipation which is a failure to pass stools or gas. Several common causes of constipation are the result of hormonal disorders, diet, hypothyroidism, specific medications and in rare instances, heavy metal toxicity.

Constipation is a symptom, not a disease or disorder, which indicates that the underlying cause can hopefully be determined so steps can be taken to get things back on track. The condition is common and affects up to 20% of our country’s population at one time or another. Guidelines for diagnosis include having to strain during more than 25% of movements, having a sensation of an incomplete movement, and having three or fewer movements per week.

It is well-known that discontinuing smoking can, for some individuals, cause major constipation. Those health care professionals that treat smokers have found a dramatic rise in cases of constipation in people who attempt to kick the habit.

Anti-depressants, antihistamines, opioids, diuretics, antacids that contain aluminum, anti-convulsants, or anti-spasmodics can contribute to or cause constipation. Another consideration is the consumption of a low-fiber diet or failure to drink sufficient amounts of liquids. Specific diseases including hypothyroidism, diabetes, celiac disease and cystic fibrosis must also be considered. Of the medications you are on, Welchol may cause mild constipation. To a lesser degree, Axid may also cause constipation. Citracal is a calcium supplement. It lists constipation as a potential side effect and on the flip side, Metoclopramide may cause diarrhea. It is recommended people not take it for more than 12 weeks. Were I you and with your doctor’s permission, I would temporarily discontinue the Citracal to determine if that over-the-counter alone may be what is causing such chaos in your life. I believe you require lab work because you may have a low magnesium count which could be contributory, as well as a complete examination.

It goes without saying that constipation is much easier to prevent than it is to treat. Exercise, continue the increased fluid intake, add fiber to your daily diet, consider milk of magnesia, and make an appointment with a health care professional such as a gastroenterologist. There may be substitute meds for two of the three prescription drugs you are on that don’t have constipation as a possible side effect. You should discontinue or replace only one medication at a time if you are going to determine the culprit. Good luck.

Wife fears disc fusion and screws in husband’s back

Q: Can you give an opinion about back surgery whereby a doctor would fuse the lower back using screws? At present my husband has reentered physical therapy at a local facility that uses these (unconventional?) methods that are actually starting to help him.

My husband exercises and walks. He does not smoke or drink. Do you think and when do you think back surgery should enter the picture, if ever. From my perspective, it’s hopefully never.

Thank you so very much for your time in answering my questions. The action is very helpful and comforting.

A:The purpose of spinal fusion is to connect two or more vertebrae in the spin and halt the motion between them. There are numerous approaches in which this can be accomplished. The spine is composed of 33 vertebra. At each level in the spine there is a disc space in the front and paired facet joints in the back. When considering a healthy back, this allows motion without pain but this is not the case with your husband. When fusion is accomplished, two vertebral segments get fused together to stop the motion at one of the segments. Spinal fusion involves bone grafting, essentially causing two vertebral bodies to grow together into one elongated bone. Bone graft can be taken from several areas – from the patient’s hip, from a cadaver, or it can be manufactured. During the procedure, a surgeon will place bone or bone-like synthetic material within the space between two spinal vertebrae. He or she may choose to use screws, rods, and even metal plates to hold the vertebrae together so they can heal into a solid unit. This is normal.

Spinal fusion might be recommended by a surgeon because of a fractured vertebrae, spinal weakness such as in the case of severe spinal arthritis, because of scoliosis (curvature of the spine, spondylolisthesis when one vertebra slips out of position and onto the vertebra below it, because of chronic low back pain, and because of a herniated disk. You don’t indicate the reason your husband is considering fusion and I don’t know his medical history, so I cannot project whether surgery is appropriate or not. Generally speaking, the procedure is a safe one; however, this is an invasive process and with any invasive procedure, caution must be taken. Such issues as infection, blood clots, pain and blood vessel injury must be considered as potential complications.

Because fusion is performed under general anesthesia, your husband would be unconscious during the actual surgery. The technique his surgeon uses will depend on the specific location of the vertebra to be fused and the reason the fusion is being performed. Some surgeons prefer to use synthetic substances to help promote bone growth and to speed the fusion. Your husband’s hospital stay will likely be around three days, after which he will be able to return home. He may find it necessary to wear a brace temporarily in order to maintain proper spinal alignment. He will likely undergo physical therapy and learn different methods of sitting, standing and walking.

In most instances, lumbar spinal fusion is most effective for conditions that involve only one vertebral segment and most patients are unaware of any loss of motion once a one-level spinal fusion is performed. When more than two levels of spine are considered, a reduction of pain is less likely to occur. You both should be made aware of studies with mixed comments and results. In many instances, spinal fusion has been found no more effective than undergoing non-surgical treatment when it comes to non-specific back pain. Then, when spinal fusion provides relief from the pain, it may ultimately result in more back pain in the future. Therefore, the entire process should not be entered into lightly.

You appear apprehensive and make reference to a specific physical therapy facility I have chosen to eliminate from your question. I’m somewhat confused by your statement of unconventional methods used. Don’t let your husband undergo procedures you both don’t completely understand. Educate yourselves. Ask about the pros and cons of anything and everything being done. It may be in both your best interests to request a second opinion from another surgeon if questions remain unanswered. If you do choose to proceed, be sure you have trust in the physician used.

Does patient’s arthritis require surgery for pain relief?

Q: I have severe arthritis in my right hip. I have an appointment with an orthopedic surgeon in November. It will probably take even longer before I can have hip surgery. Meanwhile, I take six ibuprofen 200 mg to tolerate the pain. My problem is that I have elevated kidneys. Is there something I can do for this, like changing pain medication?

A: Individuals who take ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs) other than aspirin may have an increased risk of stroke or heart attack over those that do not take the medication – even though ibuprofen is an over-the-counter pain reliever. NSAIDs may, and I stress may because there is a possibility and not a probability, also cause a bleed, ulcers, or holes in the intestine or stomach. While symptoms can occur without warning, if an individual should experience any unusual symptoms such as heartburn, pass stools that are tarry or bloody, have abdominal pain or should vomit a bloody substance that resembles coffee grounds, he or she should discontinue the ibuprofen and advise a health care provider immediately. If the orthopedic surgeon cannot be reached, he or she should be sure to touch base with the primary care physician who should be made aware of and monitor the symptoms.

Ibuprofen is primarily used for mild-to-moderate pain following surgery, for fever, diseases and disorders such as osteoarthritis, migraine headaches, and countless other issues. In fact, ibuprofen is on the World Health Organization’s list of essential medicines as the most important medication needed in a basic health system. However, its prolonged excessive use is what should be avoided. The usual reported adult dose of ibuprofen for control of osteoarthritis and rheumatoid arthritis begins at between 400 and 800 mg orally every six to eight hours, followed by a maintenance dose of 3200 mg daily based on a patient’s response and tolerance. Keep in mind, however, that a physician-recommended OTC use for management is 1200 mg per day, unless the patient is under a doctor’s care when dosing for severe arthritis may be as high as 3200 mg per day; If renal disease is involved (as is the case with you), the maximum dose is appreciably less and must be carefully monitored.

Common adverse effects of ibuprofen include rash, hypertension, nausea, dyspepsia, the gastrointestinal ulcers/bleed mentioned above, diarrhea, and elevated liver enzymes. Less frequently, unwanted effects may include hyperkalemia and renal impairment, most commonly kidney cancer. The severity of symptoms varies based on the dose ingested and the time lapse between doses, yet each individual responds differently, making individual sensitivity extremely important. As a general rule, symptoms observed with an overdose are similar to those caused by an overdose of other NSAIDs.

As an option, you might consider analgesics such as Tylenol that will fight the pain you experience but won’t control inflammation. Analgesics may be over-the-counter or absorbed through the skin through a transdermal patch. Tylenol is recommended by the American College of Rheumatology as a first-line treatment for osteoarthritis pain.

Then there are corticosteroids that help regulate the immune system fight the inflammation that causes pain. Corticosteroids can be taken orally, as transdermal patches, or injected directly into specific areas of the body.

Lastly and not a favorite recommendation are opioids that are ideally taken short-term only, since they . carry serious side effects including dependence and constipation. However, slow-acting patches may be good for the pain of arthritis according to some physicians because the medication is delivered in small doses.

You don’t state who recommended you take the ibuprofen for pain control. If it was a physician, you should make an appointment and provide an update. Ask if another medication via prescription or an over-the-counter might be more appropriate until you can get to the orthopedic surgeon in November. I also cannot determine if you have already seen a surgeon who has indicated you require surgery for pain relief or if this is something you have taken for granted. If the latter is the case, there may be other possibilities to consider. Weigh all your options before making the decision to have a surgical procedure done.

Woman’s episodes of depression occur all too often

Q: I am a 43-year old woman with bipolar disease. I have been treated with it for the last 23 years. For the last 7 I have mainly experienced more severe episodes of depression and no major highs. Is this because of age or could it be due to fine tuning of my medications? I ask because I have perimenopause. Could this and menopause completely mess up my mood levels?

Mental illness runs on both sides of my family. We are all well-educated and always keep up to date on our illness.

I have been reading your column for a long time and think you are soooo intelligent and kind with your words. Thank you.

A: Thank you for the compliment. Bipolar disorder a/k/a manic depressive disorder causes serious mood swings that cover the gamut from depression to mania. Mood shifts may occur several times each day, or several times a year; there is no specific pattern. In some instances, symptoms of depression and mania can occur simultaneously.

Episodes are characterized by mania, hypomania and major depression; the subtypes include bipolar I and bipolar II. Patients who suffer from bipolar I disorder experience manic episodes and almost always experience hypomania as well as major episodes of depression. Bipolar II is defined when an individual has at least one hypomanic episode, at least one major depressive episode, and an absence of manic episodes. As you can determine, each subtype has a pattern that is different from the others. Bipolar I may cause problems with other individuals at home or in the workplace. Bipolar II is less severe, may encompass elevated mood swings and irritability, yet the individual will likely be able to function normally throughout the day. .

The manic phase of the disorder may include poor judgment, states of euphoria, aggressive behavior, rapid speech, elevated self-esteem, poor performance at work or school, and a great deal more.

On the flip side, the depressive phase may include a lack of interest in things that were once very important, anxiety, hopelessness, sadness, sleep abnormalities, difficulties concentrating, and more.

Numerous situations or conditions may modify a person’s outlook. For example, seasonal affective disorder may cause manic episodes in the spring and summer or depressed episodes in the fall or winter. There may be the loss or illness of a loved one to consider. Then there’s age. I am not implying that 43 is old by any means yet we find we might have to wear glasses, we are more concerned about diseases and disorders, we may gain or lose weight, and require medication because of medical conditions such as hypertension or hypercholesterolemia. These things may be managed with the assistance of medication, yet if we are already on one medication, there could be a crossover effect between two or more that cause symptoms we don’t completely understand.

On to the possible menopause connection. In a 2012 Psychiatric Times article, a professor at Harvard Medical School and Director of the Women’s Mental Health Division in the Department of Psychiatry at Brigham and Women’s wrote that the menstrual cycle and menopause can cause complications. Of the 2,524 women studied, 65% of women with type I and 70% of women with type II reported increased premenstrual mood symptoms. She went on to add there are a number of well-documented cases showing a clear exacerbation of mood symptoms associated with the menstrual cycle.

Speak with your therapist or prescribing physician to determine if your current medication could have any bearing on your increased depressive states, or if another tried and true medication might be more appropriate.

Controlling hot flashes with home remedies

Q: Several years ago an article of yours talked about taking garlic and parsley for hot flashes. A specific formula was not listed for each of the ingredients. Should the garlic and parsley be equal mgs or should there be more of one ingredient than another?

Thank you for your reply.

A: Hot flashes are a characteristic of menopause and are believed to occur because of hormonal changes that accompany the aging process — particularly the reduced levels of estrogen as a woman approaches menopause. While less common, they can also occur in men. They may be the result of specific medications or with severe infections.

Hot flashes are ideally brief, lasting from 30 seconds to several minutes. The skin may become flushed and excessive perspiration may occur. Common treatment options may include hormone therapy, bioidentical hormone therapy, phytoestrogens, black cohosh and other home remedies, as you have pointed out. While some of the therapies are recognized by the FDA, others such as home remedies have not been tested, nor have they been FDA approved.

Treatment was traditionally centered around either oral or transdermal (patch) forms of estrogen. Hormone replacement therapy (HRT) has consistently been comprised of estrogens alone or as a combination of estrogens and progesterone. Available through prescription, they are effective in reducing the frequency and severity of hot flashes. Unfortunately, long-term studies on women receiving combined estrogen and progesterone had been halted when it was determined that a risk of heart attack, stroke and breast cancer were heightened, when compared with women who chose not to receive HRT. Later studies found that women taking estrogen alone had an increased risk for stroke but not for either heart attack or breast cancer. And to complicate and confuse things, estrogen therapy alone causes an increased risk of endometrial cancer in post-menopausal women who have not had their uterus surgically removed.

Bioidentical hormone therapy is becoming more popular with perimenopausal women. It is medication that contain hormones with the same chemical formula as those hormones produced naturally in the body. Advocates of this form of therapy feel the creams and gels available are absorbed into the body in their active form without affecting the liver and their use may avoid those potentially dangerous side effects of synthetic hormones. The jury remains out on this one since studies to establish long-term safety have not been conducted.

Then there are prescription drugs, including Neurontin, Begace, Depo-Provera and Catapres, but on to herbs and alternative treatments.

While there are no recognized test studies for confirmation of effectiveness or a lack thereof, some individuals report plant estrogens, black cohosh, vitamin E, evening primrose oil, licorice, dong quai (angelica sinensis), wild yam, and red clover have been used for control. They even feel women who closely follow a Mediterranean diet of garlic peppers, mushrooms, strawberries, pasta and red wine are less likely to have hot flashes. This implies that the garlic to which you refer can be consumed with a variety of foods for control. It is believed that parsley is filled with vitamins and nutrients, is a cleanser for the liver and gallbladder, and is a beneficial when it comes to controlling hot flashes. I don’t recall recommending a mixture of garlic and parsley but may have implied the two products do have properties that will lessen symptoms. And, having listed some of the possible aids for hot flashes, it must be said that they are not FDA approved and should only be taken under a physician’s guidance. Herbs are not subject to any guidelines; therefore, I cannot give you a specific amount to use.

One tea recipe I found for hot flashes includes ¼ cup parsley, ¼ cup sage, and ¼ cup fennel. Because sage is bitter, rosemary or anise may be substituted. Crush the anise or fennel; combine all ingredients in a sterile glass jar with a tight-fitting lid. Shake well to mix. To make a medicinal tea, use one teaspoon of the mixture to each cup of hot water. Steep for 10 minutes. Strain and drink one to three cups each day. It is recommended the tea be consumed within 24 hours of making it and the product that has been steeped can be used at least three times. Good luck.

Plethora of issues plagues man

Q: I do not recall any articles dealing with cures for sinus infections or on fungus.

I have lifelong recurring sinus infections which seem triggered by winter colds that won’t go away and develop into sinus or upper respiratory infections. My current diagnosis is a fungus infection for which I am taking Itraconazole.

My wife tells me my sinuses often smell when I breathe out. I constantly fight toenail fungus/crotch and foot rashes. Sweating frequently causes a rash under my armpits. I cannot tolerate an electric blanket in the winter for fear of making these issues worse. I use Vicks VapoRub, wash and dry my feet daily, then treat them with hydrogen peroxide. I irrigate my sinuses with salt water and bicarbonate of soda.

Thank you for any help you might provide.

A: You might compare your medical conditions with an automobile in the back yard that doesn’t want to start or run as smoothly as you would like it to but until you check things out and eliminate those things you know are not causing the problems, you cannot zero in on those that truly require attention. Therefore, I feel you need a complete physical examination, lab testing and possible X-rays. The lab work should be quite complete and include a vitamin panel, thyroid studies, testing for anemia and anything else your physician deems appropriate. Essentially, he or she needs a basis to determine what is going on with your body that causes so many recurring issues. It may be that something as simple as a vitamin deficiency or a thyroid abnormality is to blame, or it may be something more complex.

Your chronic sinusitis may be caused by an infection. However, it can also be the result of polyps. You may also have a deviated septum or repeated allergic reactions that can trigger fungal infections of the sinuses. I strongly urge you to follow up with a health care professional because something is definitely amiss that should not be occurring and it is critical to resolve the issue. If you suffer from hay fever, a sensitivity to aspirin that causes respiratory issues, asthma, or the habit of smoking or being exposed to second hand smoke from those around you who smoke, you are at a greater risk for developing sinusitis. A visit to an otolaryngologist might shed some light onto the basis for your continued problem.

Fungal infections are rather common. They include jock itch, yeast infections, athlete’s foot, and even ringworm. Athlete’s foot is caused by a fungus that lives on dead tissue of a person’s skin, toenails, and hair. Your physician can examine a section of the scaling skin to make a proper diagnosis. While you appear to be doing all of the correct things to keep your feet healthy, you might consider wearing socks made of wicking material that allow your skin to breathe.

Jock itch is a fungal infection that affects the outer layers of skin. It thrives in warm, moist areas of the body such as under the arms, in the groin, and inner thighs. If you are a member of an athletic club where you might use public showers and towels you dry off with are damp, you may unknowingly be increasing your risk of developing jock itch.

Toenail fungus is just that – a fungus under the surface of a nail. Again, warm and moist areas you frequent may be a haven for someone as susceptible as you. While a nail fungus will not disappear by following my recommendations, they should go a long way toward further prevention once your fungus is under control: try changing your socks twice daily and rotating the shoes you wear. This will allow them to dry out sufficiently, making the fungus more difficult to grow. You might even consider putting your shoes out in the sunshine to dry between wearings whenever possible. Purchase socks that are made of synthetic fibers that wick moisture away from your feet.

Get some testing done. Review it with your physician. Based on the results, ask if visiting a specialist such as an infection specialist or perhaps even a homeopath is appropriate. Get answers so you can get on with your life. Good luck.

Lipoma removal considered cosmetic

Q: I enjoy your column and find it very helpful in learning about various health problems.

I have lipomas on my chest and hips and wonder if you could write about these. I am told by my doctor that insurance companies usually don’t cover them because they are considered cosmetic surgery unless they are causing trouble (which incidentally, mine are not). A distraction, if anything. My daughter also has a rather large one on her upper arm.

A: A lipoma is a fatty mass or lump that is slow-growing and is most frequently situated between the skin and the underlying muscle layer of the arms, thighs, neck, shoulders and back. The mass is benign and often harmless. As you have pointed out, it/they are more unattractive than anything else. They can present at any age but are most frequently seen in individuals of middle age.

While anything that appears when and where we feel it shouldn’t is upsetting, lipomas are generally less than two inches but have the capability of growing larger. They don’t cause pain when touched and may move freely when pressure is applied.

Those individuals at increased risk include being middle aged and having other disorders including Gardner’s syndrome, Madelung disease or Cowden syndrome. And, genetics play a strong role so I am not surprised that your daughter also has one on her arm.

Diagnosis is commonly made through a visual examination. When a physician has questions, he or she may remove a tissue sample for biopsy. If there is any question, a biopsy or other tests may be ordered. to rule out such things as liposarcomas which are cancerous lesions. If nothing is suspect, no treatment is generally necessary. Such procedures as steroid injections are available to shrink the tumor(s) but this procedure will not completely eliminate it. Liposuction might also be attempted.

And, as you have indicated, insurance is considered – unless the lesion grows or becomes painful. Should that occur, you should speak with your physician to determine if you should attempt to receive clearance to have them removed.

As a point of information, Gardner’s syndrome is an autosomal dominant form of polyposis. It presents with multiple polyps within the colon as well as outside of it. Those polyps may also grow in the spleen, kidneys, liver, small bowel, and other areas. The number of polyps increase with age, with hundreds to thousands developing primarily in the colon. Treatment is difficult but chemotherapy has been attempted with some success for this condition.

Madelung disease is a rare condition that presents with the growth of fatty tumors. It frequently affects men of Mediterranean ancestry in middle age who have a history of alcohol abuse, yet non-alcoholics and women can also be affected. The lesions can increase progressively and often lead to pain and a loss of mobility in the neck. In the majority of cases, the lesions are benign.

Cowden syndrome also presents with growths known as hamartomas but which carry a risk of developing into specific cancers. The growths are commonly found on the skin and mucous membranes like the mouth and nose linings, in the intestine, and other areas of the body. This condition generally presents when an individual is in his or her late 20s.