When is the right time for pneumonia shot?

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

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

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

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

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

Alcoholic seeks help through drugs

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

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

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

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

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

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

Young man fights intestinal issues that control his life

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

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

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

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

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

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

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

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

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

Keeping toenail fungus at bay

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

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

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

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

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

Tremor perplexes reader

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

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

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

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

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

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

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

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

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

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

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

Can Parkinson’s patient undergo surgery safely?

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

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

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

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

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

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

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

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

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

Should we vaccinate our children against HPV?

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

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

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

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

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

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

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

Questions remain unanswered regarding hormone therapy

Q: I can’t find any good studies on bioidentical hormone replacement. As a post-menopausal woman who has tried the bioidentical creams, I am thinking about converting to the pellets. Please help a large group of the population understand this confusing dilemma. Thanks.

A: I wish I could, but this is a complex issue. Bioidentical hormone replacement therapy (BHRT) refers to plant-based or compounded estrogen products. These hormones are custom made, often in compounding pharmacies, with information garnered from a test performed on a woman’s saliva. This process isn’t a new one. BHRT was first used for symptoms of menopause in the 1930s when a researcher devised a method to extract an orally active estrogen from the urine of pregnant women.

In the 1980s the British Medical Journal recommended oral bioidentical progesterone as an option when side effects from synthetic progestogens mandated the treatment be discontinued. Today FDA-approved bioidentical hormones and compounded bioidentical hormones has resulted in a great deal of confusion regarding exactly what BHRT really is. What is known is that it is used to reduce the symptoms of menopause and is further promoted by some physicians for anti-aging, despite the fact there is little evidence to support such claims.

Generally speaking, compounded products of bioidentical hormones include estriol, estrone, estradiol, testosterone, progesterone, and sometimes DHEA (dehydroepiandrosterone) which are promoted as natural and safer, yet, there do not appear to be scientific studies to support such claims. These hormones are believed by some researchers to carry the same risks as conventional hormones that are made using the same products. Dosing of BHRT may be ten times higher than the oral dose of comparable HRT regimens and if women are unaware of this, it may be because package inserts do not commonly accompany (nor are they required) with compounded bioidentical preparations.

Bioidentical hormones are derived from soy and plant extracts and are modified to be structurally identical to endogenous hormones. The extracts are no different from what is presently used for most hormone preparations that are approved and commercially available for post-menopausal women (with the exception of conjugated hormones that are derived from urine). At this stage, the safety of bioidentical hormones has not been established. In fact, the FDA has published information for consumers, warning that many claims regarding efficacy and safety of compounded bioidentical hormone products are false and misleading.

Hormones are administered via vaginal creams, topical gels, vaginal rings, transdermal patches, and other methods. Creams and gels applied to the skin enter the blood directly, yet these products can vary from application to application depending on the condition of the skin and the temperature. The FDA has warned several pharmacies regarding making unsubstantiated claims about the safety and effectiveness of compounded hormone products that, by the way, have not been approved by the FDA.

An article first printed in the August 2006 issue of the Harvard Women’s Health Watch indicated many women and health experts continue to struggle with the turnaround in attitude toward hormone therapy in the wake of the Women’s Health Initiative trial of combined estrogen and progestin for preventing the ills women face as they age. The trial was stopped early because hormone users had a higher risk of breast cancer, heart disease, stroke, and blood clots. While the added risks were small, many women and their clinicians concluded they must discontinue hormone therapy. Hormone therapy is believed the most effective treatment for symptoms of menopause but women are not rushing back.

FDA-approved hormones for menopausal symptoms include countless products available on the market, of which a dozen or so are bioidentical. The question is, are bioidenticals safer? It appears no one knows. Studies have indicated they can help relieve symptoms of menopause but as yet, few large studies have investigated sufficiently the differences among the various hormones and methods of administration. And, more research is needed to further understand those differences so the risks and benefits can be compared.

Compounded hormones may help individualize treatment but the user should be aware that there is no evidence to support their safety, effectiveness or dosing consistency, nor is there evidence to prove they have fewer side effects or are more effective than FDA-approved hormone preparations. There is no evidence that hormonal levels in saliva correlate with response to treatment in post-menopausal women, nor is there sufficient evidence that estriol decreases the risk of breast cancer.

As Harvard stated, “just realize that, in a real sense, you’re going to be an experiment of one. Unless your clinician has considerable experience with bioidentical hormones and a particular compounding pharmacy, you’re better off with a prescription for commercially available hormones, many of which are bioidentical”.

Patient has an enormous decision to make

Q: I have no life – can’t do stairs, walk or stand. I spend 90% of each day in bed in order to have a normal life with some of my pain under control. I have one grandchild with another on the way anytime now and I have no idea how I’m going to be any help with the four-level home. My daughter’s 2 ½ year old is very active and he wants me to play with him.

We have tried everything to control my pain – chiropractic, acupuncture, hyperbaric treatments, many many different shots, and I’m on my third spinal stimulator. My pain meds are Fentanyl, Percocet and Neurontin. Please help. I want to try the ketamine coma. I’m 52 and have had this since a horse fell on me in 1997.

A: It is somewhat difficult for me to offer help because other than the extreme pain you are obviously experiencing, I don’t know the extent of your injuries. Did you suffer any bone fractures, loss of consciousness, severe injury to any internal organs, or a brain injury during your accident and where is the location of your pain?

I surmise you live with your daughter and want to participate in the care of her children. As uncaring as this may appear, you must consider yourself first and will have to explain to your grandson that you are unable to play with him as much as you would like. As active as he is, perhaps you can involve him in listening to the stories you read him or movies you may watch together, help him draw on a sketch pad, and choose some games that are not so physically demanding.

The Fentanyl you have been prescribed is an opioid used to control pain and is 80 to 100 times more potent than morphine and substantially more potent than heroin. Percocet is a combination of acetaminophen and oxycodone which is another opioid taken for break- through pain. It should not be used by individuals who have recently used sedatives, tranquilizers, or other narcotics. Neurontin is an anti-convulsant prescribed for seizure activity and for some types of pain such as from herpes zoster (shingles). I cannot determine if you take the neurontin because of seizures or if this is another form of pain control but either way, you are really on some strong pain relievers that should be carefully monitored because of the potential for addiction.

It’s important to understand that a ketamine coma is an experimental treatment that has been used mostly outside the United States to treat chronic, severe pain. The studies have been quite contradictory with varying results and without any doubt more research is needed before we can conclude whether or not this is a treatment modality that could help.

Some facilities in the US are now providing ketamine infusions which are costly and may have to be repeated because of some purported low doses being administered. It appears the more consecutive days of infusions received (at about $1,000 a day), the better the results will be.

To be considered is that some reports indicate some patients have found relief from their chronic pain and have been able to completely wean themselves from using opiate narcotics altogether. However, a factor that remains unknown for each individual is the duration of any relief obtained and those results are not available. Having said that, you must consider that ketamine infusion therapy (or any other for that matter) comes with no guarantee of success, regardless of which provider is used and individual responses may vary. It is possible to undergo therapy and come away without any beneficial results. Thus, substantial thought should be made prior to undergoing such a procedure. Have a frank talk with your physician regarding the next logical step in your plan of care. There are other options that may be more appropriate so personally speaking, I cannot endorse this management treatment at this time. Ask for a second opinion at a pain clinic before making this potentially critical decision.

Obesity and being overweight are not the same

Q: I began your diet in March 2010. By Christmas of that year I had achieved my goal of 56 pounds lost. I no longer need meds for diabetes, high blood pressure or high cholesterol. My doctor is thrilled and so am I! I am maintaining my weight very easily and still follow the No Flour, No Sugar rule.

I just wanted to share my success story and tell you how grateful I am to you. My husband and I read your column faithfully.

A: Thank you and I’m glad you have had success with the No Flour No Sugar diet program. As I am sure you have discovered, diets are difficult. They are demanding. They are frustrating, and that’s not half the story. The last thing any man or woman needs to deal with is the fact that no matter how hard he or she may try, the weight doesn’t come off easily, nor does it stay off in many instances. Weight is lost, it is gained back, lost again, and so forth; these individuals are resigned to this pattern for the indefinite future. Being obese and being overweight are not the same. Those individuals diagnosed as being obese have too much body fat, while being overweight implies a person weighs too much. Both utilize specific definitions that consider a person’s height and weight to determine a person’s BMI (body mass index). .

Family history may play a role, as can poor eating habits. If our parents are overweight, we may run the risk of following suit – regardless of how little we eat or how much we exercise. Children may have a tendency to become obese if they patronize fast food restaurants regularly. As we age and become adults, we accept the perceived realization that our parents and family members may be overweight so we will be, also. And, what a downer this is to our egos. We tend to wear baggy clothing to hide those extra pounds, make friends with other individuals who are overweight, feeling that thin individuals simply don’t understand what we are going through. And, they may be right.

Beyond having poor self esteem, there is the consideration for overall health. When we carry extra pounds, we set ourselves up for such medical conditions as type 2 diabetes, cardiovascular disease, asthma, obstructive sleep apnea, stroke, hypertension, elevated cholesterol levels, and more – all conditions that have been found to reduce a person’s life expectancy. For those individuals who carry extra pounds, losing 5 or 10 percent of a person’s body weight can at least delay if not prevent some diseases and disorders. Sound impossible? Well, for an individual who weighs 200 pounds, a loss of 10 or 20 pounds – and keeping it off – can be extremely rewarding and is possible. Countless studies have determined that obesity is one of the leading, preventable causes of death not only in our country, but worldwide.

A Forbes article from 2009 revealed more than one third of all adults in this country were obese. What is more astonishing is the cost in medical care – some $152 billion reported. The key is to stick with your diet and not become a statistic. Because of your diligence, you have eliminated medications that were once necessary. Congratulations. Be proud of your weight loss and more important, know you are doing everything you can to maintain good health.