I’ve gained 15 pounds, even though my eating habits are the same as before. I always weighed 125 but am up to 140. Can I do anything about the weight problem? I’m 83 and never had a headache before. Is there an operation or anything to fix the arteritis? I’ll be watching the Journal Inquirer for your response.

DEAR READER: I am grateful and fortunate to receive many questions and comments through the Journal Inquirer in Manchester, CT and will do what I can to provide you with information, as well.

Giant cell arteritis (also known as temporal or cranial arteritis) is inflammation of the lining of the blood vessels that carry oxygen-rich blood from the heart throughout the body. The condition most frequently affects the arteries of the head and temples, causing jaw pain, headache, blurred or double vision, and more. While the specific cause of arteritis remains unknown and there isn’t a known cure at this stage, being over the age of 70, female and those carrying a diagnosis of polymyalgia rheumatica increases a person’s risk for the condition. Symptoms may begin with head tenderness and muscle pain throughout the body. Pain may be present in one or both temple areas. Jaw pain, fever, tenderness of the scalp and decreased vision may also be present. If left untreated, complications can include aneurysm, stroke and the permanent loss of vision in one or both eyes.

Diagnosis can be difficult in the early stages because the symptoms experienced resemble those of many other medical conditions. A physical examination and laboratory testing to include a sedimentation rate and C-reactive protein (CRP) will be of great assistance; however, the best method for diagnosis is through biopsy of the temporal artery; yet even that specific testing can provide false results. When questions remain, other possible testing may include an MRI, ultrasound, or PET scan.

Prednisone is in a class of drugs known as corticosteroids. It prevents the release of substances in the body that cause inflammation. Your physician was correct in ordering it as it likely saved your vision, even though the medication is known to cause weight gain, indigestion, nervousness, insomnia, a diminished immune system, elevated blood sugar levels, and easy bruising. To complicate the issue, long-term use of prednisone can lead to hypertension, cataracts, glaucoma, and more. Because of this and as an offset, your physician may choose to pay close attention to your bone density testing and blood pressure readings. He or she may also prescribe calcium with vitamin D supplements and an 81 mg aspirin daily. You may be on prednisone for a year or two, perhaps even longer, under strict medical guidance to prevent a relapse. This will depend on how severe your condition is. Some individuals may even be prescribed a drug known as methotrexate commonly used to treat specific cancers and rheumatoid arthritis for symptom control. Research on this drug has been ongoing and looks promising.

Because of the side effects of prednisone, you should focus your attention on eating a diet rich in fresh fruits, vegetables, whole grains, fish and lean cuts of meat. Take between 1,000 and 1,500 mg of calcium and 800 IU of vitamin D daily. Pass up the sugar, salt and alcohol. Keep in mind that your weight increase will level off once you reduce or discontinue the dosage of the prednisone. You’re on the right track so stick with it.

Readers who would like related information can order my Health Report “Consumer Tips on Medicine” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order directed to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.

DEAR READER: I wish I could, but sometimes the thought process logic eludes me. When a physician or facility agrees to “accept assignment” it is with the unconditional understanding they will likely not get the full asking price, so to speak. There may be instances when an insurance company’s reimbursement is quite close to the amount requested but for the most part, the amount “recognized” and paid is substantially lower and must be written off. The physician or facility receives the rate set by an insurance company as a reasonable one for the service performed. Keep in mind also that if an individual is old enough to be on Medicare, that carrier pays 80% of the recognized amount. Either the member has co-insurance that hopefully picks up the 20% balance, or the balance becomes the responsibility of the person that racked up the bill to begin with.

In the instance of a person without insurance, fees can be far above anything they can even consider paying. There simply aren’t many options. Patients either choose to buy groceries for their family or they dig deeper to pay the medical bill. Try explaining that to a family member who is already stretching the food supply as much as possible, or to the children who often go to school hungry and hopefully receive a meal subsidized by the school system, state, or government. There is an option, but it can be somewhat demeaning unless the people on the other end are extremely understanding. A person visits the doctor, advises he or she cannot pay the requested amount, and signs a waiver of financial hardship that goes on file. The doctor now has the legal right to reduce – not waive – the ordinary fee charged. I don’t know what the reduction rate is but no person – male or female – wants to be humiliated and looked down on because he or she must publicly admit there simply is no money.

I understand every person should have insurance coverage but there are hundreds of thousands of individuals who simply cannot afford the cost, no matter how small it may be. Would it save face? Sure. Is it practical for everyone? Absolutely not.

The end result is that people don’t make that necessary call to the doctor or clinic. They self-medicate and hopefully have a healthy enough immune system to carry it off successfully. Heaven help them if they don’t get better, end up in the hospital and spend more time wondering how they can pay the bill.

Some hospitals work with patients to lower fees if there is no insurance and the full amount cannot be paid. When calling one facility to verify this view, I was assured that a person with or without insurance MUST be seen for a screening exam to determine if they have an emergency medical condition. If not, the hospital/ER can send the person away. Without coverage, the patient can provide information regarding income, expenses and numerous other tidbits of information. That’s the hardship waiver I referred to above. The usual amount charged (let’s say it’s $1,000) has a separate schedule that indicates what CAN BE charged according to the hospital’s policy; Let’s say that fee is $520. That’s great but the lesser amount is expected to be paid at the time of service. The patient without coverage can pay $520 instead of $1,000 and walk away with the balance written off. And, what happens if the patient doesn’t have the $520? You guessed it. The fee is automatically raised back to the $1,000. I went so far as to ask if the facility would accept $10 or $20 a week and was informed absolutely not.

When further speaking with a walk-in clinic, I was told again they cannot and do not by law turn anyone away – insurance or no insurance. The uninsured patient signs a waiver indicating he or she is responsible for the charges at a reduced rate of 35%. That patient then is in contact with the hospital that subsidizes the clinic. The staff works with the patient to reach a reasonable payback amount. That I like. So, perhaps uninsured people, while healthy, should do some homework to determine the requirements of both their nearest hospital and walk-in clinic. Then, use the facility that best accommodates the pocketbook.

Since I am symptomatic, my gynecologist is going to remove the cysts along with one ovary.

I have no family history of ovarian cancer but an aunt had breast cancer last year and some other family members have had other types of cancer. I regularly have basal cell carcinomas removed and one dysplastic nevi was found for which I see a dermatologist every six months. I recently had one 3 mm polyp removed during a colonoscopy and it was determined to be the precancerous adenoma type.

My question to you is: should I contact a gynecologic oncologist instead of having surgery and care from my regular OB/Gyn of whom I’ve been a patient for 18 years?

DEAR READER: The only person that can answer your question is you. Are you satisfied and confident with your current physician’s abilities and care? Would you feel more comfortable seeking out a second opinion from a specialist?

I assume you are worried, as would anyone be in this situation, but switching to an unfamiliar specialist may not be in your best interests at this point. I would recommend you stick with your current OB/Gyn and have the surgery. At that time, samples should be sent for testing to determine if your cysts are truly benign. Ovarian cysts are fairly common so in all likelihood, you have nothing to worry about. In the event that one or both of your ovarian lesions isn’t what it currently appears to be, then you should contact an oncologist who may be better able to help you than your current physician.

However, all that said, the decision is still yours. You can postpone your surgery until you find a specialist if you wish. In the meantime, try sitting down with your OB/Gyn and discussing your concerns. He or she will be able to further explain the situation and may be able to recommend an appropriate oncologist should you wish to go that route.

Also, I notice we can have low-fat mayo and soups, but again, I have yet to find a broth-based soup like lentil or veggie that doesn’t have a teeny amount of sugar it. There are no mayo products on the market that are totally sugar free, although the label lists 0 sugar gram so they must use a minute amount. Can I still eat these products? I assume so since you list them but I just wanted to make sure.

DEAR READER: I believe you are having difficulty in determining what is okay and what is not based on what you are reading on the label. When I tell NFNS dieters to read labels, I am referring to the ingredient panel. If flour or sugar is listed there, don’t consume the item. In your case, it appears you are also looking for sugars listed on the nutrition label. This can cause all sorts of confusion because all fruits and vegetables contain natural sugars within them. These sugars are allowed on my diet plan as they are absolutely healthful for the body and not a source of empty calories.

For example, if a soup, such as vegetable, doesn’t list sugar (or any form not allowed) in the ingredient panel but shows X amount of sugar grams on the nutritional panel, these sugars are coming directly from the veggies and you can go ahead and indulge.

As for meat substitutes, I suggest you stick to the ones that don’t contain whole grain flours; however, you specifically state that you only use them once in awhile so the occasional indulgence of a minute amount of flour will not harm your progress. It is important for you to have a healthful intake of protein from a variety of sources such as legumes, nuts, tofu, or other meat substitutes in order to maintain a healthy lifestyle.

Cheating for special events or because of a craving, is okay now and then. If you are attending a party and know there will be cake, be strict for a few weeks leading up the event so that you won’t throw off your plan by indulging in a small slice. Everyone will be confronted with a time when that small slice of cake or fresh baked dinner roll is simply irresistible. Let go and have that item as a special treat. Don’t beat yourself up about it but remember that indulging too often will just lead you back to your old eating habits and the weight may return.

Readers who are interested in learning more can order my Health Report “A Strategy for Losing Weight: An Introduction to the No Flour, No Sugar Diet” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Dr. Peter Gott, PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print an order form from my website, www.AskDrGottMD.com.

My book “Dr. Gott’s No Flour, No Sugar Diet is also available directly from me (my NFNS Cookbook is sold out, so contact your local bookstore for that item) for $10 with free shipping and handling. Simply send your request (or order form) and US check or money order to the above address.

DEAR READER: Before I get into the glutamine issue, I will first briefly explain what GN and FSGS are.

First, GN is an abbreviation of glomerulonephritis, a kidney disorder that causes inflammation of the glomeruli. These tiny filters are responsible for removing excess fluid, electrolytes and waste from the bloodstream for excretion through urination.

There are two forms, acute and chronic and a plethora of reasons why either may occur. Certain bacterial or viral infections, such as bacterial endocarditis, streptococcus and hepatitis B or C may be to blame. Some immune system disorders such as lupus, Goodpasture’s syndrome and IgA nephropathy or vascular conditions, such as Wegener’s granulomatosis or polyarteritis may lead to GN.

Symptoms vary in severity and may include hematuria (blood in the urine), high blood pressure, edema (swelling), fatigue due to anemia or kidney failure, and proteinuria (protein in the urine which may present with excessively foamy urine).

Treatment depends on the cause. For example, most acute cases caused by the streptococcus bacteria tend to improve without specific intervention. For those that do require treatment, anti-hypertensive medication may be beneficial. Treatment of the underlying cause, should one be found, will also help. For those with chronic disease dialysis (a procedure with a sort of external mechanical kidney to remove waste from the blood) or transplant may be necessary. Transplant is only an option for those with severe disease but who are still in good health otherwise.

Beyond that, a diet low in salt, potassium and protein is important to reduce the work of the kidneys. Maintaining a healthy weight and if diabetic, controlling blood sugar, will also be beneficial.

FSGS is focal segmental glomerulosclerosis. This condition is characterized by the development of scar tissue within the glomeruli. It is not a single disease, but rather a pattern of damage with several types being differentiated, based on which areas are damaged. It is relatively common, especially in the United States, and can only be diagnosed by kidney biopsy.

There are two forms, primary, which occurs on its own for no obvious reason, and secondary, which is caused by or is in association with another condition such as obstructive sleep apnea, sickle cell anemia, obesity, congenital kidney defects, urine backing up into the kidneys, certain viruses and more.

Many FSGS patients don’t have symptoms. Those that do may experience edema (swelling), increased blood creatinine levels, proteinuria, high blood pressure that is difficult to treat, sudden weight gain, have shoes that no longer fit, and more.

Treating FSGS can be difficult and it is important that those diagnosed be under the care of a competent nephrologist (kidney specialist). Regular monitoring of kidney function is vital. Immunosuppressant medications and/or certain types of anti-hypertensive drugs may be prescribed. With or without treatment, most will eventually require dialysis.

Now on to your question about glutamine. Glutamine is an amino acid, not only found in foods we eat, but that is also produced by our bodies. Deficiency is rare. Supplementation is not recommended for those with kidney disease or for anyone with reduced kidney function — such as the elderly — because it has been found to raise levels of certain substances which indicates stress on the kidneys. Those already experiencing kidney problems may speed worsening of functioning by taking this supplement.

Readers who are interested in learning more about the kidneys can order my Health Report “Kidney Disorders” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Dr. Peter Gott, PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print an order form from my website, www.AskDrGottMD.com.

DEAR READER: In my opinion, 79 isn’t old so your physician shouldn’t consider you to be senile for making one simple mistake while in a rush. We all get forgetful at times, whether we are 29 or 89. It’s a situation I prefer to refer to as overloaded circuits, rather than the early stages of senility. I would hope your physician wouldn’t think you are a doddering old woman who cannot function properly without outside help based on this incident alone. So, on with your concern.

Known as the chemical compound H2O2, hydrogen peroxide appears to be yet another cure-all for everything from cleaning counter tops to fighting fungal infections of the skin or nails. The average bottle contains from 3 to 10% peroxide, while higher concentrations of 30% or greater found in health food stores or cleaning supply companies are used commercially as bleaching agents for textiles and paper, for producing foam rubber, organic chemicals, and the 90% form used as a component of rocket fuel. The 35% “food grade” type is used in the production of such things as cheese, egg, and whey-containing products. H2O2 is also sprayed on the foil linings of aseptic packages that contain fruit juices and milk products.

There are instances where full-strength peroxide can be used successfully in the home, to include washing down a kitchen counter or wooden cutting board and for soaking toothbrushes. When kept in a dark bottle in the absence of light and contamination, it breaks down at a rate of about 10% each year. Therefore, if a bottle remains in your house under ideal conditions for several years, it is essentially still good, albeit not totally as powerful as it was a year or two prior.

My guess is that you likely purchased a 3% solution that, for most purposes, should be diluted with an equal amount of water. Higher concentrations taken by mouth or through injection into veins can be dangerous. For example, drinking “food grade” hydrogen peroxide can result in vomiting and severe burns of the throat and stomach. The product is odorless and colorless but not tasteless. Your note doesn’t indicate you suffered any unpleasant side effects, other than the perception of still tasting it. The splash you put in a drinking glass (with or without water?) likely did no harm. Once realizing your mistake, you took appropriate precautions to dilute the solution. This was certainly a good learning experience that you won’t likely repeat in the near future.

Even if you were to advise your physician today, the incident is more than six weeks behind you. Hopefully the taste sensation will diminish soon and you can get on with the more important things in your life, like getting to church on time.

Readers who may be interested in other household hints can order my Health Reports “Compelling Home Remedies” and “More Compelling Home Remedies” by sending a self-addressed, stamped number 10 envelope and $2 US or money order for each report ordered to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title(s) when writing or print out an order form from my website www.AskDrGottMD.com.

Second: The TV in the waiting room always has Fox news on, with pundits arguing with each other, criticizing the President and other elected officials, and generally raising the blood pressure of most of the older people in the waiting room. When I asked the office staff to change the channel, they said they could not find the remote control, then laughed when I sat back down. When I complained to my doctor, he exploded, accusing me of trying to “drag me into your politics”. My complaints had to do with the type of programming in general. Older people are a little more respectful of public officials, even when they do not agree with them. Most find this current “in your face” politics stressful and to force them to watch it while waiting seems indicative of an uncaring attitude on the part of the doctor and his young staff. Am I over-reacting? Should I find another physician who seems a bit more attuned to the sensibilities of his older patients?

DEAR READER: First, let me address the issue of a phone call vs. a face-to-face visit. People have different views. Some insist on a visit to the doctor so questions can be asked. Then, there is the patient who is satisfied with a postcard or letter indicating tests are within normal range. Unless a physician asks each patient his or her preference and makes a note of it in the chart, there could be unwanted results. The wait you experience represents poor planning on the part of the office staff.

Let’s move on to the television. When hospitals or medical offices have TVs in reception areas, the station is generally a generic one, such as a news channel since the news is of greater interest than a soap opera or game show. The problem is that the network has to keep viewers interested and this often occurs when discussing politics and repeating the news, over and over again. I personally feel there is nothing more unpleasant than political mud slinging and I find that type of reporting offensive.

My office has a fireplace. Whenever the weather dictated (which was often), it was lit, the magazines were current (a novelty in a physician’s office), relaxing music (jazz or classical) was playing and the wait was brief. President bashing and controversial issues were put on the back burner and not discussed. I often said patients simply got better because they were surrounded by pleasantries rather than strife. Often the wait was so short a patient would return to his or her seat in the waiting room following the visit to finish an article they hadn’t had the time to complete when they entered. It was a win-win situation and I loved it, as did my patients.

If you are one of those patients who find you are influenced by your surroundings, then perhaps you should consider making a change to another cardio-vascular specialist. If you choose to do so, make an appointment for a get acquainted visit so you can openly discuss issues such as wait time. There is someone out there who can appreciate what you expect of a physician, one who will embrace the ideas you feel are appropriate. Don’t settle for less.

Readers who would like related information can order my Health Report “Hypertension” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.

DEAR READER: This simple question may be difficult to answer because I am unsure just what the lesion looks like and there are a number of different possible conditions; however, my initial reaction is to diagnose you with repeat canker sores. However, keep in mind you may have candidiasis, lichen planus, recurrent herpes, and more so an examination of the lesion is necessary prior to making the proper diagnosis.

Recurrent aphthous stomatitis, otherwise known as a canker sore, appears as an oral ulcer and is characterized by recurring, painful single lesions that are typically white or yellowish in color, on or under the tongue, inside the cheeks or lips, at the base of the gums, or on the soft palate. They may be painful but are not contagious. There are three clinical forms – minor, major, and herpetiform, with the minor form being most common. Most patients with minor canker sores will not require medical assistance. Those that do may be treated with periodic topical therapy such as corticosteroids, fluocinonide gel and other medications; however, their effectiveness is uncertain. Major sores are larger, deeper, may scar, and take up to six weeks to heal. Herpetiform canker sores have irregular edges, heal without scarring, and are pinpoint in size with up to 100 lesions in each cluster.

Causes for canker sores include stress, H-pylori, cheek biting, sensitivity to specific foods such as eggs, coffee, cheese, nuts, pineapple, or toothpaste and mouth rinses that contain sodium lauryl sulfate and a deficiency of vitamin B12, zinc, folic acid or iron. Some medical conditions such as celiac disease and HIV/AIDS can also cause canker sores to appear.

It would be in your best interests to either see your primary care physician or dentist for a specific diagnosis. Either might recommend an over-the-counter such as Anbesol, Aphthasol and others that should reduce the pain you experience and hasten the healing process. Or, prescription oral medications taken for heartburn and gout may even help. Be sure to visit the medical professional of your choice only when you have an active lesion. If you haven’t had recent lab work, ask your doctor’s opinion on ordering a vitamin B panel and zinc and folic acid levels so you can determine if there is a deficiency there worth pursuing. While you are waiting for your appointment, make a paste of baking soda and water to dab on the lesion, or dab milk of magnesia on it. Purchase a new tube of toothpaste without sodium lauryl sulfate. These simple remedies, or a combination thereof, might provide relief from the pain and irritation of the lesion.

Readers who would like related information can order my Health Report “Vitamins & Minerals” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.

DEAR READER: Struma ovarii is a rare type of ovarian tumor, accounting for only 1% of all ovarian tumors. It is characterized by the presence of thyroid tissue as a major cellular component of the tumor. Because this is a cancer of the female reproductive tract, only women are affected, with those between the ages of 40 and 60 most commonly affected.

The condition typically presents with a pelvic mass and signs and symptoms similar to those of other types of ovarian and female reproductive tract tumors/lesions. Rarely, but in a few instances, some sufferers may develop hyperthyroidism (which disappears following treatment) and ascites (a buildup of fluid in the abdomen). Some women may also present with an elevated CA-125 level.

Surgical removal of the lesion is definitive first step in every case; benign (noncancerous), malignant (cancerous), and recurrent tumors. For those with recurrent or malignant tumors, radio iodine therapy may be beneficial, due to the presence of the thyroid tissue. For some, complete hysterectomy to include the ovaries and thyroidectomy may be appropriate. Recurrence is uncommon.

Those individuals diagnosed with this type of tumor should be under the care of a specialist familiar with treating it, such as a gynecologist or gynecological oncologist.

Readers interested in learning more can order my Health Report “Medical Specialists” by sending a self-addressed, stamped number 10 envelope and a $2 to US check or money order to Dr. Peter Gott, PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print an order form from my website, www.AskDrGottMD.com.

DEAR READER: For years I have said that patients need to be responsible for their own health and well-being. Part of that is keeping track of all medications (both prescription and over-the-counter) and ensuring that all their physicians are up-to-date. It is also important to write down the prescribing physician’s name (if applicable), the date started, the dosage, and the reason it is taken. A copy should be kept in the car, on your person (wallet, bag, etc.) and in plain view at home.

This is especially true in cases where a patient has several conditions and is on several medications, often prescribed by more than one physician. For example, if an individual has atrial fibrillation, hypothyroidism, and rheumatoid arthritis he or she may be under the care of a cardiologist, endocrinologist and rheumatologist who will each prescribe medication to control the condition they specialize in. If they are unaware of the other physicians and what they are doing, medication interactions are much more likely to occur, or a medication that could worsen the symptoms of one of the others could be prescribed.

Another aspect of keeping a list on hand is that in the event of a medical emergency, first responders will be better able to provide help. In the case of a natural disaster in which temporary relocation is necessary or major damage is done, it will be easier to maintain your health because you will have all the pertinent medical information on hand.

Thank you for writing to remind me and my readers about this important issue. Knowing what medications you are taking and why is vital to good health and responsibility.

Readers who are interested in learning more about the different types of medicines can order my Health Report “Consumer Tips on Medicine” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Dr. Peter Gott, PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print an order form from my website, www.AskDrGottMD.com.