There’s more to story than grandmother is being told

Q: My granddaughter has been diagnosed with Lyme disease and her Lyme doctors have done everything possible for her but after a year she is no better. Her mother feels that she has a mold sensitivity which explains her inability to get well. Even the Mayo Clinic won’t see her because she’s been diagnosed with Lyme. I want to see her go to someone who can say with certainty that all that is wrong with her is due, in fact, to Lyme. She sure needs some answers and we would appreciate some also. Thank you.

A: To begin with, I find it incomprehensible that the Mayo Clinic will not see her because she has been diagnosed with Lyme. She’s not contagious. She’s not going to infect the entire facility. There’s more to the issue than what you have apparently been told, so don’t let that influence you.

Further, if she has a mold allergy or sensitivity, that is relatively easy enough to control. Are her eyes red, does she cough or exhibit symptoms of asthma? Does she have a rash, or runny nose? Does she live in a damp house or one that has been exposed to excess moisture? She may need to see an allergy specialist who can test her to determine exactly what, if anything, she is allergic or sensitive to. Testing may be in the form of a blood test to measure her immune system’s response to mold. Or, she may have a skin prick test where substances are applied to the skin of her arm or back. An allergy will result in hives at the test site.

Now, on to the Lyme disease. If she has been diagnosed, she obviously had a blood test for confirmation. Her early symptoms might have included fatigue, headache, and a fever. A rash isn’t always present but occurs in about 60 to 80% of all infected individuals. She may have had a bull’s eye ring, a telltale sign. You don’t indicate what her doctors did for her once she was seen. As a general rule, the infection was hopefully controlled and eliminated by antibiotics such as doxycycline or amoxicillin. If treatment was delayed, it could result in symptoms that may be difficult to treat and in some instances, disabling. Having said this, even Mayo Clinic has determined that the majority of individuals diagnosed with Lyme recover completely with appropriate treatment.

I don’t know where you reside and mention this because some areas of the country are relatively Lyme-free. Nonetheless, your granddaughter should be seen by a specialist in the field who can review what has been done and proceed from there. I recommend you contact your local hospital to determine if they have a Lyme specialist on staff. If not, request a referral to someone with the knowledge you require. A year is much too long to go without improvement. Don’t hesitate any longer.

Leg pain keeps man from exercising

Q: My husband has claudication in the lower part of his left leg that burns when he walks a half to three quarters of a block. His doctor is looking after his aortic aneurysm and tells him he needs to walk at least 30 minutes each day and to keep track of how far he walks before it hurts. Then he wants him to stop and wait until the pain goes away, and do it again.

The problem is he tells his doctor he will, but he doesn’t do it and he has never been a person who exercises. So, I was wondering what else he might do for this until they decide to repair the aneurysm. He is a high risk patient since he’s had the top lobe of each lung removed, has high blood pressure and COPD, so they don’t want to fix the aneurysm until it is larger. I have tried to get him to walk even just out to the mail box but he does it only once in a great while. He doesn’t like to go out in the winter because he was sick one whole winter with a bout of pneumonia.

I’m wondering if one of those pedal machines or a step machine you use sitting down would help his leg problem as walking on a treadmill. Any help you could give me would be greatly appreciated.

A: Because of your husband’s other medical conditions, I would initially make an appointment for a frank discussion to determine his capabilities and limitations. Does he have issues with his breathing because of the lobe resections? Is he on medication for his hypertension and the COPD?

Based on the limited information you provide from his physician, my impression is that he should exercise as much as possible. Perhaps this could be accomplished with the assistance of some stationery equipment at home. I’d hate to think he might be part way down the block without a place to sit to rest until the pain in his leg subsides. Would he consider a stationery bike or a treadmill? Do you have a physical therapy center near your home where he can work out under the watchful eye of the personnel there? To be considered is that he must be willing to undergo some form of exercise if he is to maintain his health. If he won’t, your efforts will be in vain. Do you both walk together around the block or does he prefer to do it alone? He just might enjoy walking at a leisurely pace while having someone to talk with. Or, if he has a male friend as a neighbor, you might consider taking that individual aside in an effort to enlist his help in getting the ball rolling.

In terms of going out in the wintertime, you should have a frank discussion as to whether he is fearful of falling on slippery walkways or if he is afraid of catching pneumonia again. If it is the former, perhaps you can drive him to a local park where the paths are safer. If it is the latter, assure him he can bundle up sufficiently so as to prevent catching a cold or worse. Is he a reader and might enjoy a walk to the local library for a book? If he prefers walking indoors at a mall or museum, that, too can be accomplished.

Claudication is the result of peripheral artery disease, a serious but often treatable problem with circulation. With sufficient treatment, he might be able to achieve an active lifestyle without the involvement of pain. Work together to make this happen. You’ll both be glad you did.

Even winter gloves have their limits

Q: Your article in the paper some time ago concerning cold hands got me thinking. How about the feasibility of yet one more cause that would be a full lifetime of frozen hands and fingers? I’m in my 60s now but have been shoveling and blowing snow in -10 and -20 degree temperatures for long periods of time since I was a teen. Even gloves have limits!

I recall dozens, if not hundreds, of times coming into the house with hands and fingers that were two solid blocks. I’d stand over the kitchen sink and soak them in warm water until life returned to them. I am far more careful now but as a younger man I probably didn’t give it two thoughts. Do you think tissue damage may have been caused? My hands look fine, my blood pressure is great, my arms, legs and feet are fine, also. The only time my cold hands are not a problem for me is during the warm summer months.

Many thanks.

A: I’m sure I’m not telling you anything you don’t already know but may have never considered in your younger years. Frostbite occurs when skin is exposed to extremely cold temperatures. While we consider low temperatures as being the culprit, those temperatures above 32 degrees accompanied by high winds can also cause problems. Frostbite commonly affects the hands and feet but can also be found at the site of the nose, cheeks and ears exposed to the cold. Symptoms of pain, numbness, cold and clammy skin that has a wax-like appearance, and a red appearance of the site (from blood returning to the affected area once the hands or feet are warmed), and blisters. The body has its own method of dealing with the cold by narrowing blood vessels in an effort to preserve heat which forces blood to the core, keeping the heart and lungs warm. Unfortunately, this also prevents the hands and feet from receiving sufficient blood that ultimately causes a worsening effect of the already cold skin. This process of shunting blood and the lack of adequate circulation can cause cell damage. I don’t know how extreme your exposure may have been when you were young but this raises the possibility of you having permanent damage.

If your hands look fine, you may not have suffered any permanent damage. Even so, at this stage there’s not a great deal that can be done to reverse things other than protecting yourself from future frostbite. Remember to wear several layers of warm clothing that will afford protection from the elements. Your gloves and socks should be warm and dry, because your hands and feet literally account for almost 90% of all frostbite injuries. Your head and ears should be adequately covered, since approximately 7 to 10% of heat loss occurs through the head. Remember that when exposed to cold you should not use hot water to immerse your hands in, since the extreme heat may burn your skin. Don’t rub or vigorously massage any extremities in an attempt to promote better circulation because of the potential for permanent damage to the tissue. Be sure to drink a sufficient amount of fluids.

You certainly could now suffer from an increased sensitivity to cold and may experience pain in your hands, as well. Long term symptoms may include a loss of feeling in your hands and fingers, numbness, and nail deformities. Be prepared. Dress well and avoid future issues.

Sciatica plagues patient

Q: I am suffering from sciatica. Tylenol and ibuprofen help a little bit, but not enough. I have been to a chiropractor, also but still don’t have sufficient relief. Please help.

A: The sciatic nerve is the largest nerve in the body. The condition known as sciatica commonly occurs when a bone spur, pelvic fracture or herniated disc compresses a portion of the sciatic nerve that branches from the lower back and continues down one or both legs. The condition typically affects one side of the body only. In rare instances, the sciatic nerve may be damaged by diabetes or a tumor.

Those individuals at an increased risk for sciatica include being diagnosed with diabetes, obesity, age, and leading a sedentary lifestyle. In the instance of diabetes, the risk of nerve damage is elevated because of the way the body uses blood sugar. Obesity is known to increase the stress and pressure placed on the spine. The aging process may lead to a herniated disc or other conditions that can aggravate the sciatic nerve. And lastly, a sedentary lifestyle that may include sitting for extended periods of time may be contributory. Complications may include a loss of bladder or bowel function, a weakened leg, or diminished feelings in the affected leg. Symptoms that may range from mild to severe may include inflammation, pain, and numbness. While one individual may be bothered by pain and weakness, another may experience less severe symptoms that respond well to conservative treatment such as rest.

Diagnosis may require medical imaging that includes an X-ray of the spine, an MRI or CT. The X-ray may reveal a bone spur that has the potential to press into a nerve. The MRI may show herniated discs and nerves, so it is good in demonstrating nerve compression. A CT is less helpful for diagnosing sciatica but is very good in revealing the specifics of spine disease.

On the home front, cold packs may be used for relief following an attack. If they fail to provide any relief, hot packs may be used, or alternating cold and hot packs may do the trick. Over the counter ibuprofen may also be considered.

Since you have already attempted to find relief through over-the-counter anti-inflammatories, your next step may be in the form of prescription narcotics, perhaps coupled with anti-seizure drugs or tricyclic anti-depressants. Or, corticosteroids injected into the area near the nerve foot may diminish the pain by suppressing inflammation around the nerve. While the steroid may reduce the pain experienced, it will not be a permanent solution and may have to be repeated. However, and as I have stated previously in other columns, the risk of serious side effects must be avoided so repeat injections are recommended very sparingly. Lastly, when conservative treatment fails to diminish the symptoms present, surgery may be considered.

Discuss all your options with your physician who will be your best source of information for how best to help you. Ask if physical therapy that will include stretching exercises might help and be sure to ask about chiropractic manipulation or even acupuncture.

A new home remedy for Grover’s Disease

Q: My dermatologist diagnosed me with Grover’s disease and my symptoms were as you described in the past, except they were in my scalp. Her comments paralleled yours. My problem was exceedingly annoying but after a while I discovered that if I coated the itching spots with mentholated petroleum (Vicks VapoRub) two things happened. First, the itching was immediately eased. Second, in one to three days, the red spots disappeared. This has been a consistent result for several years. Best of all, it’s inoffensive and inexpensive.

A: I last wrote about Grover’s disease on January 15, 2015. This may be the article to which you refer but even if it were, I failed to mention mentholated petroleum (Vicks and other mentholated petroleum products) as being possible home remedies. Vicks, as you likely know, was designed for fighting the common cold by rubbing it on the chest and throat area for cough suppression. The formula was developed in 1894, some 121 years ago, by Lunsford Richardson who created the salve for his children. As a point of trivia, it is currently manufactured and packaged in both Mexico and India. Because the ointment has an oil base, it is recommended it not be used inside the mouth or nose, nor should it be swallowed — simply because any product with an oil base can enter the lungs through improper use. The active ingredients include eucalyptus and cedar leaf oils, menthol, special petrolatum, spirits of turpentine, thymol, and myristica oil. The camphor, menthol and eucalyptus are all designed as cough suppressants.

The Mayo Clinic has taken a position that Vicks doesn’t relieve nasal congestion; however, the strong odor of menthol tricks our brains into thinking so. However, a differing point of view comes from Dr. Ian Paul, a professor of pediatrics and public health sciences at Penn State Hershey College of Medicine. He led a study of 138 children ages 2-11 with URIs. The study published in the journal Pediatrics last year stated a single application of Vicks VapoRub at bedtime provided more relief than plain Vaseline-like ointment or no treatment at all. On the downside, 28% of parents in the VapoRub group said their children complained of a burning sensation in the skin.

Many chain stores have their own brand of mentholated petroleum products. For example, pramoxine with menthol is marketed for use in treating the itch and pain caused by minor irritations, such as eczema and chapped or cracked skin. It falls into a class of drugs known as local anesthetics. The recommendation is to apply a thin layer on affected areas up to four times a day, or according to the directions provided by a physician. Individuals are warned regarding potential side effects that while rare, may occur and may include rash, dizziness, dizziness, and itching – the last thing an individual in your position needs.

Then there is Bag Balm, a medicated salve often used for irritated skin on humans. Its uses are countless and include cracked fingers, psoriasis, dry facial skin, bed sores, and radiation burns. Its ingredients include 8-hydroxyquinoline sulfate, petroleum jelly, and lanolin.

Lastly, I will mention Vaseline that may also be used as a lubricant for skin conditions characterized by tissue dehydration. It is marketed to help treat minor cuts and burns. This petroleum jelly is a non-polar mixture of hydrocarbons that does not oxidize on exposure to thee air, and is insoluble in water. The product is used as an ingredient in skin lotions and cosmetics. It reduces moisture loss and prevents chapped hands and lips.

All in all, readers appear to have a choice in keeping Grover’s at bay. Those individuals who have used other home remedies, are encouraged to forward their success (and failure) stories and I will do a follow-up.

Are gastric polyps worrisome?

Q: After endoscopy I was diagnosed with having between 50 and 60 slightly inflamed gastric polyps. The doctor said there was no treatment for my condition.

I believe the Prevacid I have been taking for over 10 years may have caused my condition. I have tried aloe juice and digestive enzymes for my condition. Do you have other information for me?

A: Gastric polyps a/k/a stomach polyps are masses of cells that form on the stomach lining. Their presence is rare. They don’t ordinarily cause any signs or symptoms which may be why your physician feels no treatment is necessary and why it took so long for your physician to suggest undergoing endoscopy. They are often only discovered if a physician is checking for another condition. Symptoms may include internal bleeding, pain, tenderness, and anemia.

The most common forms of gastric polyps are hyperplastic, adenomas and fundic. Hyperplastic polyps are often found in individuals who have gastritis (stomach inflammation). Adenomas are the least common form of gastric polyp but are most likely to ultimately advance to stomach cancer. They are associated with inflammation and familial adenomatous polyposis. Lastly, fundic gland polyps have been discovered in individuals who frequently take specific medications that are purported to reduce stomach acid (proton pump inhibitors). These polyps aren’t of concern unless they are larger than one centimeter (2/5 of an inch). While the risk of cancer in these polyps is minimal, some physicians advise eliminating proton pump inhibitors, removing the polyp(s) surgically, or both.

Factors that may increase a person’s risk for developing gastric polyps include being 50 years of age or older, being diagnosed with H. pylori bacteria, being diagnosed with familial adenomatous polyposis, and through the long-standing use of specific medications prescribed for such disorders as gastroesophageal reflux disease which has been linked to fundic gland polyps.

Treatment will depend on the type of gastric polyps discovered. For example, small fundic polyps rarely become cancerous and a physician may take a wait-and-see approach. On the other hand, large polyps, hyperplastic polyps or adenomas need to be removed. Many procedures are often accomplished during endoscopy. Familial adenomatous polyps are likely to be removed because they are at a higher risk for becoming cancerous.

Proton pump inhibitor use has been associated with fundic gland polyps. Therefore, the use of medications in this category should not be taken without the advice of a person’s family physician. In fact, medical conditions that include liver disease, having low levels of magnesium, metabolic disorders, stomach pain and much more are clearly outlined as disorders in which Prevacid and other proton pump inhibitors should not be taken. Further, taking a proton pump inhibitor long term and at high doses may increase a person’s risk of bone fracture(s) of the spine, wrist or hip in individuals 50 years of age or older. It remains unclear if Prevacid is the precise cause for the increased risk of fractures. Further testing is necessary before this can be determined.

Bursitis causes unhappiness for senior

Q: I am 67 and was diagnosed approximately two months ago with bursitis. I have some good days and some bad ones. Are there any other treatments available besides injections?

A: Bursitis commonly occurs in the shoulder, elbow and hip areas of the body; however, it can also be present in the knee, heel and base of the great toe. The condition may be the result of excessive pressure, trauma, overuse and repetitive movement. Other possible causes may include having rheumatoid arthritis, scleroderma, gout, systemic lupus erythematosis, and more. The purpose of the small fluid-filled sacs (bursae) at joint areas is to cushion bones, tendons and muscles; the condition known as bursitis is the result of inflammation of those mall fluid-filled sacs.

Bursae are lined with a synovial membrane that secrete lubricating synovial fluid and allow healthy bursae to create a smooth gliding surface when an individual moves the affected joint. In the instance of bursitis, however, the inflammation present prohibits easy, pain free movement and instead causes pain and stiffness.

Symptoms of bursitis may include the joint pain and inflammation mentioned, as well as restricted range of motion, stiffness and a feeling of warmth when movement is attempted. The pain experienced increases in intensity with movement, exercise and activity of the affected joint.

Treatment is often in the form of rest, ice, elevation, anti-inflammatories and pain medication. Should the bursae be infected, antibiotics may be ordered. As you apparently have discovered, injected corticosteroids are often prescribed in an effort to reduce the pain and inflammation present. While repeat injections may be allowed on a very restricted basis, they are not endorsed for chronic use because of the potential side effects, yet it is generally felt that low, intermittent doses pose little risk of significant side effects.

You don’t mention where the bursitis is. Nonetheless, options to injections might include physical therapy at your local hospital or clinic and range of motion exercises. It goes without saying that resting the affected joint as much as possible to allow it to heal on its own, using over-the-counter anti-inflammatory drugs, and applying cold compresses are all essential since lastly and when all else fails, surgery may follow.

Speak with your primary care physician to get an idea of what might be the best option(s) for you based on your physical condition and other possible health issues. He or she may also have other options for your consideration such as acupuncture. If you are dissatisfied with the options presented, request a referral to an orthopedic specialist who just might have a trick or two up his or her sleeve that will get you on the road to recovery.

Woman suffers from severe, unnamed itch

Q: I have an intense itching on my body I think might be scabies. Right now I have outbreaks on the back of my neck into my hair, on my buttocks, calf of one leg, and on my stomach. I have been treated four times with Permethrin 5% cream that I left on 12 hours then washed off. Then I used another topical cream but that didn’t working either. I don’t seem to itch so much when I am busy but when I sit down or go to bed, the itching is horrible. No one else in my family has this. I sleep in the same bed as my husband.

My first symptoms appeared two months ago. When one spot clears up, I seem to break out elsewhere. My skin is very sensitive and has a prickly feeling. Do you think this could be something else?

A: There are countless causes for skin to itch that surprisingly enough may include medical conditions such as celiac disease, diabetes, fungal infections such as candida and ringworm, polycythemia, eruptive xanthomatosis (caused by diabetes),allergies, dry skin, eczema, scabies, bed bug bites medications, and still more. Having said this, most itching does not have an underlying, serious condition. A generalized itch is most often more difficult to treat than a localized itch. And, itches of any kind may occur with or without blisters, rashes, lesions, or abnormalities. Some itches may be psychological in nature and the result of stress and anxiety.

As you have considered, topical creams and lotions are commonly prescribed — some of which may be helpful and others which may not be. Any over-the-counter products may include such ingredients as diphenhydramine, camphor, benzocaine, or pramoxine. Keep in mind that some ingredients may cause drowsiness so thought should be given as to when to use them. While products that contain hydrocortisone may be promoted as reducing or controlling an itch, hydrocortisone only helps those itches caused by rashes that are responsive to cortisone such as eczema or seborrhea. The application of cold can often deaden an itch. Thus, placing a cold compress against the back of your neck or other areas of your body or taking a cool shower may lessen the degree of the itch. You may prefer a hot shower or compress that will feel good initially but can exacerbate symptoms later on. Thus, heat should be avoided.

The scabies to which you refer is a highly contagious skin disease that results from infestation of the itch mite known as Sarcoptes scabiei. Because you indicate no one else in your family suffers from your symptoms, you might be able to safely rule this one out, but to be certain, a simple exam with scraping and a microscopic exam might be performed. As a point of information, treatment commonly includes oral or topical drugs, since over-the-counter remedies are ineffective for scabies. Scabies are relatively common and often occur in such areas as nursing homes, schools, long-term care facilities, and in homeless populations.

Your itching and rash can only be diagnosed and hopefully prevented in the future when the underlying cause is determined. Therefore, in my opinion, you should be seen by a top notch dermatologist at the time of an outbreak when he or she can examine the lesions, perhaps take a scraping for analysis under a microscope, and hopefully zero in on whether the condition is from something mentioned or from something else not yet identified.

Iron deficiency anemia blamed for seemingly healthy female

Q: A few years ago there was a question about tinnitus in your column and the reader asked if there were any recent developments. I’d like to add my experience.

I am 48-year-old very healthy female who developed a humming in my right ear two years ago. It started out low enough that I only heard it at night when I was lying in bed and the house was silent. The humming grew worse over the past few months, so I finally got a referral to an otolaryngologist as you then suggested. They ran all the tests you described in your article, including the brain wave tests, but could find no reason for my humming. I figured I would just have to live with it.

A month later my female gynecologist was doing some routine tests for me at my age (being pre-menopausal) and found that I was anemic. She prescribed prescription iron and within a few days of taking the iron pills, the humming became much quieter. I can, on occasion, still hear tiny blips of this humming but it is nowhere near as bad as it used to be. I’m very lucky to have such a thorough gynecologist because had she not run the test for anemia, I would still be dog tired, besides having ringing in my ear. Perhaps this will help some of your readers.

A: Yes, perhaps it will, indeed.

Anemia is a condition in which an individual fails to have sufficient healthy red blood cells to carry adequate amounts of oxygen to bodily tissues. And, as you can attest, the condition can make an individual ‘dog tired’. Depending on the form of anemia, and there are several forms, there are a variety of causes with a loss of blood being most common. There are other instances when the body is unable to produce sufficient red blood cells, or the body incorrectly destroys red blood cells. The condition can be temporary to long-term and minor to severe.

The body produces three types of blood cells: white to fight infection, platelets that help blood to clot, and red to transport oxygen throughout the body. Most blood cells are produced normally in bone marrow which is a red substance found within the cavities of many of the large bones of the body. In order for this to occur, the body requires vitamin B12, folate, iron and other nutrients that are commonly supplied through the foods we eat. Your condition of iron deficiency anemia, therefore, may be the result of too little iron in the body caused by heavy menstrual cycles, the long-term use of aspirin or NSAIDs (non-steroidal anti-inflammatory drugs), an ulcer, or from other causes.
Symptoms other than fatigue may include shortness of breath, heart arrhythmias, headache, pale skin, cold extremities, headache, and more. And despite the myriad of symptoms, some anemias can be so mild that they remains unnoticed or undiagnosed for years – unless someone such as your gynecologist runs routine testing.

If an individual has a severe iron deficiency, he or she may complain of noise in the ears which is not true tinnitus, but rather a roaring sound caused by an accelerated blood flow through the ears. Specific steps include iron supplements and ingesting more iron-rich foods such as dark, leafy green vegetables or beans daily to raise iron levels back to within normal readings.

Another progressive step for medicine

Q: My father is a diabetic and has been self-injecting for more years than I can remember. My next door neighbor, however, tells me she has an insulin pump which eliminates needles and syringes. Can you tell me what this is all about?

A: Surprisingly, insulin pumps have been in existence for about 30 years now and are growing in popularity because of their ease of use. There are several manufacturers and the devices, much like a new style automobile, offer easy-to-use instructions and more options than ever before. The pump actually helps a diabetic manage insulin levels, blood glucose and carbohydrates with less effort than ever before.

The pump is small — about the size of a deck of cards or pager. Its purpose is to store and deliver insulin. It is carried in a pocket or worn on a belt to allow for a constant flow of rapid acting insulin that is released into the body through a catheter (a small tube) inserted under the skin of the abdomen) and taped in place. The unit works 24 hours a day based on a plan the diabetic programs into the unit. Further, the user is able to change the amount of insulin administered. For example, between meals and while sleeping, a small amount of insulin is delivered to the body so blood sugar levels can remain within the desired range. This is referred to as a ‘basal rate’. Then when food is consumed, a bolus dose of insulin can be programmed into the pump, with the calculation based on the grams of carbohydrates consumed. While this may sound rather confusing, a physician will help determine dosing amounts based on sugar levels, the time of day, the amount of activity encountered, and insulin needs.

An insulin pump requires monitoring, for lack of another word, by the user who must fill the insulin reservoir periodically and to alternate the location of the pump every two to three days in order to avoid infection. The user has to understand how to manage activity levels and to count carbohydrates so a determination can be made as to how much insulin will be required at meal times.

The pump mimics the methods by which a healthy pancreas releases insulin to the body. Interestingly, while the pump eliminates finger pricking and injecting, studies vary on whether the pump actually provides better control than multiple daily injections. Monitoring of blood sugars by the user must be done at least four times each day. Any necessary adjustments to dosing again depends on food intake and the amount of exercise a person performs. During times of bathing or showering, the pump must be disconnected so the protective tape that holds it in place will not loosen and dislodge the cannula, after which the pump is re-applied. However, the needle is left in place and protected, meaning the patient only has to change it every few days.