Is surgery necessary for this patient’s back pain?

Q: I have been to a spinal surgeon who said I have spinal stenosis and degenerative spondylolisthesis and recommends surgery. I am in constant pain in my butt and legs. I am very limited to doing anything or walking much and just do small things around the house. Would you recommend surgery, too? I have heard so many stores about not getting back surgery because it doesn’t work. What are your thoughts?

A: Spinal stenosis refers to a narrowing of the spaces within the spine that can put pressure on the spinal cord and surrounding nerves. It is most common in the neck and lower back. While some individuals have no signs or symptoms and the condition is discovered on X-rays that may be performed for other issues, the condition may cause pain, muscle weakness, numbness, and bladder/bowel control issues. When the cervical spine is involved, numbness, weakness and tingling of the extremities is common; stenosis in the lumbar region can result in cramping and pain that often follows walking or standing for extended periods of time.

The causes for this condition include injuries such as major trauma from an auto accident, a herniated disk which affects the shock absorber between the vertebrae that tends to dry with age, tumors inside the spinal cord/within the covering of the spinal cord/between the cord and the vertebrae, ligaments that thicken and become stiff as an individual ages, and Paget’s disease of the bone that complicates the body’s normal recycling process. This disease is common in the skull, spine, pelvis and legs.

Diagnosis may be made through MRI or CT myelogram. An X-ray won’t likely confirm the condition but could be a first step in evaluating a back problem or look for diseases or conditions such as spondylosis. Symptoms will depend on the portion of the body that is affected. In the pelvis, hip pain is common. In the spine, pain, tingling and numbness of an arm or leg may occur as nerve roots become compressed. In the leg, bones weaken and become misshapen, causing arthritis of the knee or hip.

Degenerative spondylolisthesis is a spinal condition in which one vertebra slips either forward or backward over the one below it. It generally occurs as a consequence of the aging process when joints, ligaments and bones become weaker and less able to hold the spinal column in its proper position. Spondylolisthesis can lead to spinal deformity and a narrowing of the spinal canal. The most common symptom is lower back pain that worsens following exercise, followed by decreased range of motion, numbness, tingling, and more.

Diagnosis may be made by a lateral X-ray film from the side which will show the slippage of the vertebrae as compared to the alignment of other vertebral bones. Based on the X-ray results, an MRI might be ordered for additional assistance to determine the severity of the disorder.

Treatment may begin with non-surgical options to include ice or heat, pain medication such as OTC ibuprofen or acetaminophen, and a modification of activities that includes rest, avoiding bending backwards/standing or walking for extended periods and more. If these measures provide relief, you may have found an answer to the problem. If not, manipulation by a chiropractor, osteopathic physician, or other appropriately trained health professional might be considered. Then there is the epidural steroid injection to consider. These injections may help curb pain while increasing your ability to function; and, the epidural can be administered up to three times a year, yet there is debate regarding long-term benefits. Without sufficient relief, surgery comes to mind, yet according to some reports, surgery for degenerative spoldylolisthesis is rarely needed; however surgery for spinal stenosis with spondylolisthesis is a different problem. For spondylolisthesis a laminectomy does have limited support in written reports but if the spinal stenosis is at the same level as the spondylolisthesis, the decision to operate is more complicated because it involves which procedure and the possible complications. This decision may require a tertiary care second opinion. . Surgery goals are to realign the segment of the spine to alleviate nerve pressure and provide stability of the area that should be considered if the pain is disabling and the surgeon determines your quality of life will be appreciably increased. Decompression (laminectomy) alone is usually not advisable and in up to 60% of all cases, fusion will be needed.

Have an in-depth discussion with your surgeon regarding conservative non-surgical/ surgical approaches to your condition. Bring a family member with you for the talk.

Hot feet/cold feet – take your pick

Q: My boyfriend has a question about his feet. During the day they are cold and I mean as cold as ice. Then at night after 8:00, they are as hot as fire to him – not to touch as they are cold to the touch but when they are hot you cannot feel the heat. There are many nights when he cannot sleep and this has been going on for years. Please help if you can.

A: There are a number of reasons for feet to feel extremely hot. Nerve damage known as peripheral neuropathy may be one consideration. Peripheral neuropathy is damage to the peripheral nervous system, a network within the body that transmits information from the brain and spinal cord throughout the entire system and back to the brain and spinal cord. Symptoms can vary from person to person, with some individuals experiencing tingling, temporary numbness, muscle weakness, and sensitivity to touch. Others may have night-time burning pain, paralysis, or organ/gland dysfunction. In extreme cases, breathing may become labored (as in Guillain Bare syndrome) and organ failure may occur. In the case of Guillain Barre and when organs or glands are involved, the type of neuropathy is referred to as autonomic neuropathy, not peripheral neuropathy.

Alcohol neuropathy can result from chronic over-use of alcohol. Alcohol neuropathy is just that – damage to the nerves that results from excessive, chronic use. The cause may include a direct poisoning of the nerve from alcohol and poor nutrition from failure to maintain good dietary habits. Symptoms include numbness of the extremities, muscle cramping and pain, incontinence, impotence, constipation/diarrhea, nausea/vomiting, dysphagaia (difficulty swallowing), and a possible inability to use or store specific vitamins and minerals including A, the B’s, and others. Damage to nerves is usually permanent and may worsen with continued use. While the disorder is not life threatening, it certainly can affect a person’s quality of life.

Tarsal tunnel syndrome affects the medial mallelous (the bump on the inside of the ankle) and the flexor retinaculum (ligaments that stretch across the bottom of the foot. One of the nerves in the tarsal tunnel is known as the tibial nerve that provides sensation to the bottom of the foot. Symptoms include a burning sensation, tingling, numbness and pain.

Hypothyroidism refers to an under-active thyroid gland that fails to produce sufficient certain hormones. The reason for symptoms to occur in the feet in an individual diagnosed with hypothyroidism is not from the disease causing peripheral neuropathy, but from the hypothyroisism causing edema that squeezes the nerves. Symptoms include an increased sensitivity to cold, muscle weakness, muscle aches, joint pain, and a great deal more. On the positive side, laboratory testing can zero in on this deficiency and medication can be prescribed.

Raynaud’s disease affects the supply of blood to specific parts of the body – primarily the fingers and toes. The condition is usually triggered by cold weather, stress, and anxiety when blood vessels temporarily spasm and block the flow of blood. Symptoms include pain, numbness and tingling.

Other possible medical causes include a vitamin B deficiency, diabetes, exposure to toxins, poor circulation, chronic kidney disease, poor circulation, Charcot-Marie-Tooth disease, and more.

As you can see, there are numerous conditions that can cause cold and hot feet. As I see it, your boyfriend should make an appointment with a physician for an examination and lab testing. The history he presents should rule out specific conditions and his physician can then zero in on others he feels may be relevant. He doesn’t have to be concerned about testing for something he doesn’t want but discussion regarding dietary habits, alcohol consumption, and cigarette smoking will provide a great deal of information. Encourage him to make the call or if he allows it, you can do it for him.

Fibromyalgia drug helps patient with fibrocystic disease

Q: I have suffered from fibrocystic breast pain since I was a teenager. I was put on birth control pills at that time for severe, chronic pain. In my thirties the pain became debilitating and I began to lactate, even though I’d had a hysterectomy. I was then diagnosed with severe chronic mastitis. Surgery was performed to remove the inflamed tissue, with no guarantee that I would be pain free. I still suffered with the pain, inflammation, rashes and discharge.

Then in my forties I was diagnosed with fibromyalgia, chronic fatigue and osteoarthritis. My rheumatologist put me on Savella. This drug did help my muscle pain a little but more so the daily breast pain and tenderness. I still get flare ups that can be severe, but have finally gotten some relief from the breast pain that I have suffered from for most of my life. Please let your readers know about this drug and how it can help with chronic breast pain due to inflammation.

A: Fibromyalgia is a chronic condition that presents with widespread musculoskeletal pain, fatigue, and sleep disturbances, that may be accompanied with possible tension headaches, irritable bowel syndrome, depression, anxiety. and more. Women are more likely to develop the condition than are men. Almost 25 yeas ago the American College of Rheumatology set two criteria for the diagnosis of fibromyalgia – at least 11 out of a possible 18 positive tender points and widespread pain that lasted at least three months. However, because symptoms can come and go, newer diagnostic criteria includes widespread pain that lasts at least three months and the inability of a physician to find any other underlying condition that might cause such pain.

One of the biggest complications of the condition is a lack of sleep that can interfere with a person’s ability to function during normal waking hours. An individual may appear to get sufficient sleep; however, pain takes over and disrupts the sleep pattern throughout the night, leading to exhaustion, depression and anxiety from this poorly understood condition.

Doctors are uncertain just what triggers fibromyalgia but it is believed there may be specific genetic mutations, that physical or emotional trauma may be to blame, and that some illnesses may trigger or aggravate the condition.

Your chronic fatigue may dovetail with your fibromyalgia and your osteoarthritis is yet another painful condition that occurs because of injury, possible obesity, and the aging process that causes the cartilage on the ends of your bones wears down. The joints most commonly affected are the hips, knees and spine. The condition presents with joint pain, tenderness, stiffness, and an inability to have full flexibility of joints. All in all, the three conditions have a common denominator – pain.

Until four years ago, there were only two drugs approved for treatment of fibromyalgia – Lyrica, a nerve pain and epilepsy drug that gained FDA approval in 2007 and Cymbalta an anti-depressant/anti-anxiety drug that followed in 2008. Enter milnacipran, marketed in this country under the brand name Savella, a selective serotonin and norepinephrine reuptake inhibitor (SNRI). The drug is designed to increase the supply of serotonin and norepinephrine (neurotransmitters) in the brain. Dosing begins at 12.5 mg the first day that increases to 100 mg over a one-week period. Based on a patient’s response to the medication, a physician may increase the dosing to 200 mg daily. Side effects may include nausea, constipation, insomnia, vomiting, palpitations, dizziness, excessive sweating, hypertension and dry mouth.

In clinical trials the medication was appreciably better at reducing pain and other physical symptoms than was a placebo for fibromyalgia patients who did not suffer from depression or anxiety. Further studies are being conducted to determine whether Savella may also improve the sleep disturbances common to the condition.

As with all drugs, there are countless questions and a medical history review that should be brought to a physician’s attention before Savella or any other drug is prescribed. I don’t know if this medication is right for everyone but I’m certainly glad you found relief with it. Thank you for sharing your story that may induce other readers to make an appointment with their primary health care provider.

Senior’s jaw pain requires follow-up

Q: I read your column for years in our local newspaper but when cutbacks and staff changes were made, it was dropped. How glad I am to find you on line!

My question is about a pain my mother has. She is 82, healthy and active. She had one minor stroke and has high blood pressure controlled by medications. She also has a family history of both. Several months ago she began being awakened at night with a tightness and pain in her jaw. Sitting upright stopped the sensation. She describes it as feeling as though she has eaten something very sour, or it’s like having the mumps. She did see her physician and had a chemical stress test, on which she did well. His only solution was to increase the amount of nifedipine she takes for circulation because of her Reye’s syndrome. That stopped most of the nightly episodes but now she has begun having episodes during the day. They pass when she sits and rests but they leave her feeling very weak and concerned that they are increasing.

I would appreciate any insight or advice you might be able to offer.

A: The first thing that concerns me is your mother’s jaw pain because it is a classic symptom of heart pain from either angina or a heart attack. Her physician ordered a chemical stress test because of her symptoms. By explanation to other readers, a cardiac stress test requires an individual to walk on a treadmill or ride a stationary bicycle to stress the heart. The test she had literally uses chemical agents injected into the body through a vein to simulate physical exercise. If the chemical test was negative, it was determined she does not have cardiovascular disease and her pain was not a symptom of cardiovascular disease. Nifedipine is prescribed for hypertension and is also used to control angina, chest pain or chest discomfort that occurs if an area of the heart muscle fails to receive sufficient oxygen. It works by relaxing blood vessels which, in turn, increase the supply of oxygenated blood to the heart.

Reye’s syndrome causes swelling in the liver and brain. It is almost always associated with a prior viral infection such as the flu, a cold, or chicken pox. It is not contagious and the cause is unknown. It tends to be more prevalent during the winter months when influenza and other viruses are most common. Symptoms may include mental changes, seizures, confusion, and loss of consciousness or coma. Statistics indicate an excellent chance of recovery if the condition is identified and treated in its earliest stages. Diagnosis of Reye’s may be accomplished through a blood tests, CT or MRI of the head, liver function tests or biopsy, spinal tap, and more. Successful management depends on early diagnosis and is primarily aimed at protecting the brain against irreversible damage by reducing brain swelling and preventing complications in the lungs.

All this makes me lean toward the thought that your mother has an issue that must be further investigated and, which may be linked with her Reye’s diagnosis. I feel she has two very serious conditions that require the assistance of specialists. I urge you to suggest a second opinion with top notch specialists. She should bring her test results for review.

While waiting for her appointment, you may find additional information from the National Reye’s Syndrome Foundation’s website

Talk about a corny question

Q: I have really bad corns on the bottoms of my feet. They hurt! About every three months my doctor will scrape them off but they are soon back. Is there any cure or any way to control them? Thank you for any help.

A: Corns (and calluses) are hardened layers of skin that often develop on the feet and toes,or on the hands and fingers. Healthy individuals can ignore them unless they cause discomfort. However, should a medical condition that causes impaired circulation be present, a person can experience pain and other complications. You don’t ask about calluses, yet the two are often confusing for people to understand. Calluses generally develop on the soles of the feet, on the knees, and palms of the hands. They vary in size and shape, rarely cause pain, and are larger than corns. Corns, on the other hand, are smaller, most frequently develop on non-weight bearing parts of the feet such as the sides and tops of the toes, or even between the toes, and cause pain.

The most common cause for corns and calluses to develop is from wearing poorly fitting footwear, whether that translates to shoes being too tight or too loose. Areas of the foot react to the pressure or sliding, they may become compressed, and a buildup of skin can occur. Going barefoot can lead to rubbing and socks that have seams can hamper the feet. I personally know individuals who wear their socks inside out so the seams cannot be felt as much when shoes are worn. With respect to the hands, any repetitive chore such as digging with a shovel or using garden tools and equipment on the job can cause a callus buildup. Those at an increased risk are diabetics and individuals with circulation difficulties so specific attention must be taken to prevent ulcers from forming because of possible infection and delayed healing.

There are some steps an individual can take for relief. Over-the-counter corn removers are available to lessen the pain; however, most of the OTC corn pads contain salicylic acid that for some individuals can irritate otherwise healthy skin and lead to infection. You might consider using a pumice stone to slough off the dead skin prior to the application of another patch. Don’t attempt to remove the whole corn immediately. Instead, accomplish it over a period of days or weeks, depending on the buildup present, taking extreme care not to compromise the skin. Custom made shoe inserts can be purchased to prevent corns from recurring, and while rare, misaligned bones in your foot/feet foot may require surgery to correct bone alignment causing the friction that leads to corns.

On the home front and with your physicians or a podiatrists approval, soak your feet in warm, soapy water or Epsom salts to soften the corns. This will allow you ease in removing the skin buildup with that pumice stone or an emery board. Wear comfortable, good fitting polyester/cotton blend socks that wick moisture away, thus preventing infection. Wear cushioned shoes that fit your feet and possibly shoe inserts, also. This may sound like a no-brainer but women wear high heeled shoes with pointed toes that place a great deal of stress on the feet, while others wear shoes with worn-down backs that slide as the individual walks. Style and comfort should work hand-in-hand (or foot-to-foot) when it comes to selecting appropriate shoes that will keep your feet healthy and free of corns.

Is CoQ10 a myth or a miracle?

Q: I’m wondering if you have seen or read any positive link between CoQ10 and gum health. Please advise.

A: Coenzyme Q10 is a natural antioxidant synthesized by the body. As with so many conditions, deficiencies can occur for a number of reasons and in this instance can result from either poor dietary habits or because of excessive use of CoQ10 by the body. Depending on the reason for the deficiency, supplements or dietary modifications may be effective.

This antioxidant is vital for the chain of metabolic chemical reactions that generate energy within the cells of the body. It has been used for countless medical issues, including improving heart health, assists in maintaining the normal oxidative state of LDL cholesterol, supporting the function of the heart muscle and promoting better circulation. It is even taken by some people who believe it helps to reduce the severity and frequency of migraine headaches, for strengthening the immune systems of those with HIV/AIDS, male infertility, and even for increasing a person’s life span. Co-Q10 levels are highest in the first 20 years of life. By age 80, levels can fall to lower than they were at birth. Thus, the thought that supplements taken later in life might actually allow people to live longer. Experimentation in this regard works in bacteria; however, not in lab animals. Thus, more research is necessary to determine if it actually will be effective for people.

Deficiencies in some individuals have been associated with cardiovascular problems including hypertension, arrhythmias, angina, and heart failure, as well as for the regulation of blood sugar levels and stomach ulcers. Individuals treated with statin drugs for hypercholesterolemia may be at an increased risk for deficiency because statins block CoQ10 synthesis in the body; however, there is minimal evidence published of the benefits of CoQ10 for statin-caused myopathy, and some practitioners are willing to recommend it to their patients as an option. Low levels in patients on statins may contribute to fatigue and pain in joints and muscles.

Effectiveness may occur for inherited or acquired disorders that limit energy production in body cells. CoQ10 may be effective for congestive heart failure when taken in combination with other heart medications and treatments, myocardial infarction when begun within 72 hours and taken for one year, Huntington’s disease, hypertension, migraine headaches, muscular dystrophy, Parkinson’s disease, and for improving the immune systems of individuals with HIV/AIDS. It is possibly ineffective for decreasing high cholesterol or triglyceride levels, and is likely ineffective for improving athletic performance or periodontal disease when applied directly to the teeth and gums. However, there is early evidence that when taken by mouth, CoQ10 MIGHT, and I stress MIGHT be helpful in treating gum disease. Several small clinical trials have indicated CoQ10 supplements may help prevent and treat gingivitis (inflamed gums); however, more evidence is needed before confirmation can be made. And that’s as close to a positive link as I can offer. At this stage, there is insufficient evidence to rate the effectiveness of CoQ10 for male infertility, breast cancer, diabetes, fatigue, Lyme disease, fibromyalgia and cyclic vomiting syndrome.

CoQ10 appears safe for most adults when taken by mouth or when applied directly to the gums. And, while generally well tolerated, it can cause stomach upset, loss of appetite, vomiting, diarrhea, and nausea in others. Interactions can occur with prescription drugs for hypertension, chemotherapy drugs for cancer, and warfarin which is an anticoagulant.

Because CoQ10 is fat soluble, the supplement should be taken with a meal that contains fat. Dosing depends on the reason for the deficiency and ranges from 100 mg per day divided into two or three doses for heart failure in adults to 2400 mg in three or four divided doses for Parkinson’s disease.

Thus, CoQ10 has been taken for countless medical conditions — sometimes successfully, sometimes perhaps not so successfully. We all respond differently to over-the-counters, herbs, supplements and prescription drugs, so be sure to check with your physician before beginning any regimen.

Abdominal pain requires diagnosis by a doctor

Q: I wonder what chronic pain in my lower left abdomen could be the result of. Could I have strained a muscle and it hasn’t completely healed yet?

A: Left lower abdominal pain has numerous possible causes, including a pulled muscle, diverticulitis, an intestinal obstruction, Crohn’s disease, kidney infection or stones, an inguinal hernia, ulcerative colitis, and more. I will mention a few possibilities but there are so many from which to choose that I would be hard pressed to zero in on just one.

For example and while unlikely, a urinary tract infection (UTI) could cause severe lower left abdominal pain in both men and women. That pain may be accompanied by fever, frequent urination with a burning sensation, and blood or pus in the urine.

Diverticulitis is an inflammatory disorder of the digestive tract. It often presents with severe pain in the left lower portion of the abdomen and may be accompanied by constipation or diarrhea, fever, nausea, and vomiting.

Kidney stones are hardened minerals and acid salts in the kidneys. Pain is common in the left lower quadrant but can also be present in the groin, side, or lower back. It may be accompanied by painful urination, nausea, vomiting, and discolored urine from blood.

Crohn’s disease is an inflammatory bowel condition. Signs and symptoms may include loss of appetite and weight, fatigue, fever, arthritis, eye or liver inflammation, and bloody stool. Ulcerative colitis affects the digestive tract as an inflammatory bowel disorder. Severe lower left abdominal pain may be present and may be accompanied with constipation, bloody diarrhea, fatigue, cramps, and weight loss.

For women, causes of lower left abdominal pain can include ovarian cysts, ovarian cancer, endometriosis, and other gynecological issues.

Intestinal obstruction can prevent food from passing through the digestive tract, causing intermittent lower left abdominal pain. Abdominal tenderness, constipation, nausea, vomiting, and an inability to pass gas are but a few of the symptoms.

Then there’s an inguinal hernia, aortic aneurysm, and numerous other possibilities.

You need to be seen by a health care professional who can take a complete medical history, perform an examination, and perhaps order some imaging testing and lab work in an attempt to rule out some medical issues and concentrate on others. The testing is not as complex as it appears but the key to diagnosing abdominal pain is to identify the underlying cause for it. Your explanation of when the pain occurs, what precedes it and precisely where it is will help narrow the field. If your physician deems it appropriate, he or she may refer you to a specialist. Clearly you need help so don’t delay. Make an appointment now so you can either put the issue behind you or take steps to have it remedied.

Another OTC remedy for mouth lesions

Q: This is not really a question but a suggestion I have. Years ago I learned a very simple way to get rid of a mouth sore or any case mild or severe of gingivitis. Gargle with Vince Solution Oral Dentifrice. Use lukewarm water and a half teaspoon of Vince Solution in three ounces of water. Immediate results occur. The product is not easy to find but some drug stores still carry it or can order it. It is over-the-counter and very inexpensive.

I thought I would share this with you and your readers.

A: Being unfamiliar with this product, I Googled it for educational purposes to find this oral rinse and dentifrice is used to clean and refresh the gums. It is buffered for safe daily use and the product claims to release oxygen, making it a helpful adjunct in promoting better oral hygiene for the mouth, teeth and gums. It is also purported to promote healing of the mouth and gums and to relieve occasional soreness and irritation from dentures, braces, canker sores, wounds, and mouth sores.

The ingredients are sodium alum, calcium carbonate, sodium perborate monohydrate, sodium carbonate, magnesium trisilicate, tricalcium phosphate, sodium saccharin, flavor, and D&C red 28. Sodium alum is a form of alum used in the acidity regulator of food, as well as in the manufacture of baking powder. Calcium carbonate is a dietary supplement and is used as an antacid to relieve heartburn, acid indigestion and upset stomach. Sodium perborate monohydrate is a solid form of hydrogen peroxide, used chiefly as a bleaching and disinfecting agent. Sodium carbonate is known as a water softener. Magnesium trisilicate is an inorganic compound used as a food additive to absorb fatty acids and remove impurities that form in edible oils during the frying process. Sodium saccharin is a salt of the artificial sweetener saccharin. Lastly, D&C Red No. 28 aluminum lake is a dye for use in drugs and cosmetics but not for use in foods, yet it may be used as a color additive for coating tablets. The exact amount of each ingredient is not identified and for those individuals who question D&C Red No. 289, dyes are commonly added to products and are safe to ingest.

The mouth is a haven for bacteria and other unwanted conditions, so the action taken and products used to combat lesions depends on what is going on inside the mouth. For example, mouth sores (ulcers or canker sores) are common and often disappear in as little as 10 to 14 days, even if no action is taken. However, that can be a long time if the lesion is painful. Individuals might try using a salt water gargle to speed up the healing process.

For canker cores, a thin paste of baking soda mixed with water has been found effective. Or, mix equal parts of hydrogen peroxide and water applied to the lesion with a cotton swab. Then there is over-the-counter Blistex or Campho-Phenique that might be used at the first sign of a canker sore. If readers are prone to frequent canker sores, they might choose to speak with their primary care physician regarding the possible use of vitamin B12 and folate to prevent outbreaks.

Then there is gingivitis, a common form of periodontal (gum) disease that causes bad breath, inflammation, irritation and redness of the gums. The gums may be tender and will generally bleed easily when flossing or brushing teeth. Healthy gums are pink and firm. Because the condition is commonly without pain, an individual can have gingivitis and be completely unaware of the fact.

The most common cause for this condition is poor oral hygiene that causes plaque to form. Plaque cannot be seen, yet it is a sticky substance that forms on teeth when the sugars and starches in foods interact with bacteria that is generally found in the mouth. Plaque can be dealt with simply by brushing and flossing daily. When an individual fails to perform this daily oral hygiene procedure for two or three days, the plaque will harden under the gum line and become extremely difficult to remove through dental cleaning. The risk of developing gingivitis is increased if an individual smokes, has poor oral hygiene, is older, is on specific medications, has a compromised immune system, has substance abuse issues, and is prone to specific fungal and viral infections. Without proper care and flossing, the condition can advance. However, daily brushing and flossing, periodic cleaning by a dentist to remove plaque and tartar, and possibly using an antiseptic mouthwash to fight bacteria should keep your mouth healthy. There is no need to purchase or use a hard toothbrush, nor should you rely on a toothpaste that promotes tartar control. Instead, purchase a soft-bristled brush that should be replaced every three or four months and go with your favorite brand of toothpaste.

If your lesions appear frequently, visit your dentist for his or her input. And, by all means if Vince Solution works for you, stick with it. Thank you for sharing this remedy.

The perils of cigarette smoke

Q: My grandkids, ages 10 and 7 are around cigarette smoke at their mom’s house and at their dad’s house, also. There are four smokers in the two houses and the kids always have a cough, ear infection and colds. It seems like they are always sick. Could it be the cigarette smoke? I think it should be unlawful to smoke around kids.

A: It’s a known fact that parents who smoke cause health problems for their children that includes ear infections, chronic coughs, colds, bronchitis, pneumonia, and worsening asthma. In fact, five states have bans on driving and smoking if there children in the car. Second-hand smoke is just that – an adult or child breathing in smoke that comes from someone in the household puffing on a cigarette, cigar, or pipe. Cigarettes contain more than 4,000 chemicals and more than 50 of those chemicals are known to cause cancer. It’s simply not healthy to inhale benzene, formaldehyde, hydrogen cyanide or carbon monoxide, yet that is what every individual does when he is subjected to someone smoking nearby. Thirty-five percent of children in our country live in homes where parents, visitors or other residents smoke in the home on a regular basis. Up to 75% of those children have detectable levels of cotinine (a breakdown product of nicotine) in their blood. The smoke that is exhaled from a smoker’s lungs is inhaled into the lungs of everyone around. Smoke gets into the air we breathe. It clings to draperies and curtains, couch and chairs. It collects on walls. Then there is third-hand smoke – the residue that permeates the clothes a smoker wears and the upholstery in an automobile the smoker leans against. A 2006 surgeon general’s report confirmed that second hand smoking is harmful, can kill, and there is no amount of exposure that is safe. The more smoke that is inhaled, the greater the health risk.

Children are more vulnerable to second-hand smoke than are adults, because their bodies are still growing and they breathe at a faster rate than do adults. Your grandchildren aren’t alone in this dilemma. It is estimated that 126 million people in this country who are non-smokers are exposed to second hand smoke at home and in the workplace. And, that smoke dramatically increases a person’s risk of developing lung cancer and heart disease. We may find fault with the seemingly uncaring smoker but it’s likely we don’t begin to realize the full impact of the act because each year it is estimated that almost 60,000 deaths occur in non-smokers who live with or work with smokers.

In this, as well as many more instances, an ounce of prevention is worth a pound of cure. Smoking should not be allowed in the home or around others. Many states have passed laws that prohibit smoking in public places. Restaurants, offices, bars and other facilities are banning smoking. Sound mean? Not at all. Sounds safe to me. Thank heavens towns, cities, and governments have stepped up to the plate and prohibit smoking in many public places.

There are ways individuals can continue the smoking habit if they so desire. They can step out of doors, onto a porch, or take a walk around the block while puffing away. This keeps the family or household members healthy, and the smoker happy. We need to protect our children in every possible way. We help them across the street, attempt to feed them well-balanced meals, and dress them warmly in cold weather, so I recommend we all step up to the plate and make our homes smoke-free facilities. We’ll all be better off for it.

Smoking is an addiction and it isn’t an easy one to give up but there is help available. Additional information and methods of kicking the habit can be found through the American Lung Association’s website

The heart is one remarkable muscle

Q: My friend is 50 years old and has had a series of medical issues over the past year. On his last trip to the hospital he was ultimately found to have a weak lower portion of his heart. I don’t understand how such a small organ can malfunction in one area and be healthy in another. Can you fill in the blanks?

A: The heart is a hollow muscular organ that pumps blood throughout the body. The average human heart beats 72 times each minute, pumping up to 5.7 liters of blood during that same period. It has four chambers, two upper atria and two lower ventricles. The right atrium receives blood from the veins and pumps it on to the right ventricle. The right ventricles then pumps that blood to the lungs where it receives oxygen and releases carbon dioxide. The left atrium receives the oxygenated blood and pumps it, in turn, to the left ventricle that pumps it to the rest of the body. Long-standing failure can occur on the left, right, or both sides of the heart but typically the left side, and specifically the left ventricle (the main pumping station) being the chamber affected. Left sided failure may cause shortness of breath and fluid to back up into the lungs. Right sided failure may cause edema because of fluid backing up into the feet, legs and abdomen.

Coronary artery disease (CAD) is the most common form of heart disease and one of the most common reasons for heart failure to occur. This is often a condition that develops over time from a buildup of fatty deposits within the coronary arteries. Areas of the heart deprived of oxygen-rich blood cause symptoms to occur. Faulty heart valves can prevent blood from flowing in the proper direction, forcing the heart to work harder than it was intended in an attempt to keep blood flowing as it was meant to. With time, this can weaken the heart. Hypertension also causes the heart to work hard and is a common cause of heart failure. The heart muscle may thicken and weaken. Cardiac arrhythmias (abnormal beating) may create additional work for the heart. Over time, failure can result. Then there are countless conditions such as emphysema, infection, blood clots in the lungs and more that can aggravate the heart.

Diagnosis can be made through an echocardiogram that can help a physician determine how well the heart pumps, lab testing to check for kidney function and heart failure, an electrocardiogram (ECG) that can detect arrhythmias, CT scan or MRI, or angiogram that can help identify arterial narrowing.

Treatment depends on the cause for the failure. Lifestyle changes that may include dietary modifications, discontinuing smoking/drinking/weight reduction if appropriate and remaining active will go a long way toward improving his health. Valves can be repaired, medication can be prescribed, and devices that include an implantable pacer or defibrillator can get your friend back on the right track.

Your friend should be under the care of a good cardiologist who can detect the cause for the failure and make the appropriate recommendations for getting him back on the road to recovery. You indicate other medical conditions that could impede his progress but hopefully those are also being addressed.