DEAR READER: I have never heard of partial sleep apnea, but that does not mean that it isn’t a legitimate diagnosis. However, I have some doubts about your co-worker’s story.
Sleep apnea is a condition in which the sufferer experiences episodes of not breathing while sleeping. This can occur up to several hundreds of times a night and last for a minute or more each time. As a result, the individual may not wake rested and may experience extreme daytime sleepiness, which can lead to falling asleep at inappropriate times. Other symptoms include nightmares, waking gasping for breath, heart problems and more. Sleep apnea does not cause fainting, however.
A related condition, known as narcolepsy, can cause episodes of inappropriate sleep that can occur anywhere, anytime and may resemble fainting because of a loss of muscle control. This complex condition causes severe daytime sleepiness, hallucinations, sudden loss of muscle tone (also known as cataplexy) and sleep paralysis. Sufferers may also have sleep apnea, restless-legs syndrome and even insomnia.
Unless your co-worker is willing to share his medical records, there is no way you will be able to determine whether he is being truthful about his condition or whether he is simply trying to get out of working. If he is indeed being truthful, he likely had to provide his superior with a medical note from a physician, because the condition would necessitate special work considerations.
Bring your concerns to your boss. Be sure that he or she is aware of the situation. If the boss doesn’t know, it will then be up to him or her to confront the employee and determine whether the situation is valid.
To provide related information, I am sending you a copy of my Health Report “Sleep/Wake Disorders.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.
]]>I have been to the emergency room and to my eye specialist, but neither can find anything wrong. I am in sheer agony every day and don’t know what else to do. I even bought an eye-rinse kit that didn’t provide any relief at all. I get about a dozen hairs from each eye every day, and some are still left. Can you please help me?
DEAR READER: I am not sure how I can help if after examination, there doesn’t seem to be a problem. I am baffled as to how the physicians could not find a problem when you can clearly see the hairs.
Because you do not say what type of eye specialist you saw, I suggest that you visit an ophthalmologist, who can use specialized equipment to view your eyes. If you have already done this, perhaps a second opinion from another is in order. In the meantime, avoid rubbing your eyes and use over-the-counter moisturizing eyedrops or artificial tears.
]]>DEAR READER: Bedwetting, also known as nighttime incontinence or nocturnal enuresis, is common in children up to age 6 or 7. This is because bladder control may not be fully established, meaning the bladder may not signal that it is full, causing the child not to know that he or she needs to urinate.
Most children outgrow bedwetting on their own. By age 5, 15 percent of children wet the bed, and this is further reduced to less than 5 percent of children between ages 8 and 11. It affects boy more than girls. ADHD and a family history of bedwetting increase the child’s risk.
Most cases of bedwetting are simply due to a slow development of the central nervous system. It may also be the result of a small bladder, a hormone imbalance, urinary-tract infection, diabetes, sleep apnea, chronic constipation, stress or a defect in the neurological or urinary system. It is never the result of the child being too lazy to get out of bed at night or being unclean.
Because your son is 12 and didn’t previously wet the bed on a regular basis, his pediatrician or a pediatric urologist should examine him to determine whether there is an underlying reason. You said your son had a urine sample taken but don’t mention what he was tested for. There are different types of urine tests with the most basic done in office with the aid of a small testing strip to determine if there are abnormal levels of protein, white blood cells, etc. This test is insufficient at detecting an infection; therefore, he should undergo a clean-catch urine test, which will then be sent to a laboratory to check for bacteria. If present, the lab will then determine which antibiotic will be most effective in eliminating the infection.
It will also be important to notify the physician of any other symptoms he may be having, even if they seem to be unrelated. For example, snoring may be a sign of sleep apnea, which can cause difficulty waking up, resulting in possible bedwetting should the urge occur at night. You should also be prepared for the physicians to rule out sexual abuse, because sudden-onset bedwetting can be a sign in children and teens.
Treatment isn’t necessary in most cases but varies depending on the cause in those instances when it is. It is most important to be calm and understanding with the child, because there is no control of the occurrence that can lead to embarrassment, anxiety and frustration.
Moisture alarms are small, battery-operated devices available at most pharmacies that connect to a moisture-sensitive pad on the child’s bed or pajamas and go off in the presence of moisture. This may help a child wake up in time to stop the flow of urine and get to a toilet before completely emptying the bladder in bed. If the child is a heavy sleeper, he or she may not hear the alarm, nor wake up in the presence of wetness, so a parent should listen in order to get the child awake and cleaned up before any prolonged contact that can lead to skin irritation. Over time, the brain and bladder will begin to retrain to recognize the urgency and awaken the child before an accident can occur. This can take up to 12 weeks, so it is important to be patient.
Treating any underlying cause should also be beneficial in reducing or eliminating bedwetting.
If time and retraining don’t help, medication may help. Desmopressin acetate (DDAVP) can boost natural levels of antidiuretic hormone (ADH), which slows nighttime urine production. It does carry the serious side effect of seizures so it’s not prescribed for minor cases of bedwetting if other remedies are appropriate. Another medication is a class of drugs known as anticholinergics, which calm the bladder and are often prescribed to treat overactive bladder. A final option is imipramine, which may change the child’s sleep/waking pattern and increase the amount of time that urine can be held or reduce the amount of urine produced. Because it is an antidepressant, it may adversely affect mood and overdose can be fatal, so caution must be used.
Home remedies include avoiding caffeinated foods and beverages in the evening, limiting all fluid intake at night, urinating on a schedule during the day and double voiding before bed (once at the start of the bedtime routine and again just before falling asleep).
It may also be helpful to set up a routine for times when there are bedwetting accidents. This includes using plastic covers over the mattress (under the sheets), using thick, absorbent underwear to reduce urine leakage onto the bedding, and keeping an extra set of pajamas and bedding nearby for quick change.
]]>I have been seen by two doctors. Both say I have glaucoma. I would like to know what the devil this is because both doctors said to use Xalatan at bedtime for the rest of my life.
DEAR READER: Glaucoma is a group of diseases that damage the optic nerve in the eye(s) that results in diminished vision, leading to blindness. The light-sensitive optic nerve connects the retina to the brain, transmitting visual information.
There are different forms of the disorder, but the most common is known as open-angle glaucoma. The front of the eye has a space known as the anterior chamber, through which a clear fluid flows, nourishing surrounding tissues. The fluid leaves the anterior chamber and flows through a drain area and leaves the eye. There are times, however, when it passes too slowly through this drain, resulting in a buildup of fluid. The buildup of pressure that results can damage the optic nerve, resulting in open-angle glaucoma and may lead to a loss of vision. It should be noted that an increase in eye pressure is not an indication a person has glaucoma. Rather, it indicates a person is at risk for glaucoma. Then there is the diagnosis of glaucoma without an increase in pressure. This is slightly less common but is known as low or normal-tension glaucoma. Some people are able to withstand higher eye pressure than others. It all depends on how much pressure your optic nerve can handle.
The key is early detection. Eye exams should be performed by an ophthalmologist or optometrist every three to four years for Caucasians and two to four years for African-Americans aged 20 to 39, every two to four years for both races aged 40 to 64, and every one to two years for both races aged 65 and older. Under ordinary circumstances, if a person follows these timelines, visual abnormalities can be corrected and treated early. If glaucoma is discovered, medication in the form of eyedrops or pills can be prescribed to either lower the pressure or cause the eye to make less fluid. It may be necessary to take the prescribed medication several times a day. If you experience burning, stinging or redness, advise your prescribing specialist, who can make a modification.
It is important to understand that glaucoma often has no symptoms, and you may be inclined to discontinue your medication. Continued use is extremely important. The purpose of the medication is to either lower the production of fluid or to reduce the pressure of the fluid.
The Xalatan drops you have been prescribed will reduce the pressure in your eye(s). You should wash your hands before and after use. The medication should be taken in the evening unless your doctor provides other instructions. You may experience blurred vision, and your eyes may become sensitive to light. Refrain from driving or doing detailed work until you determine whether you experience any unwanted side effects. Never use more than the recommended dose.
It appears both physicians you consulted are in agreement. My guess is the Xalatan is a completely appropriate recommendation that you should follow. Many people your age are on more medications every day than I have fingers and toes. You’re one of the fortunate ones that have reached the age of 78 without a plethora of problems.
To provide related information, I am sending you a copy of my Health Report “Medical Specialists.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.
]]>DEAR READER: Plantar warts are benign growths caused by the human papillomavirus (of which there are more than 100 types), which enters the body through cuts or breaks in the skin. These lesions present as small, hard bumps and are most commonly found on pressure points on the heels or balls of the feet.
The virus can spread from person to person simply through touching or scratching. Because each person’s immune system responds differently, some people may not be troubled by warts, while others, such as you, are extremely hampered by them.
Treatment is not necessary in all cases. When intervention is appropriate because of pain or lesions, a physician may choose cryotherapy (freezing). With this treatment, liquid nitrogen is applied directly to the warts, sometimes a blister forms, and the dead tissue sloughs off in a week or more. This therapy can cause pain, so for this reason it isn’t commonly used for young children. Other options include prescription cream, laser surgery, immunotherapy and cutting away of the warts.
On the home front, over-the-counter salicylic-acid solution or patches, duct tape and cryotherapy products are available. There are a number of brands available, but if the medication or patch is used, it should be a 40 percent salicylic-acid solution. Duct-tape therapy involves covering the wart for about a week, then soaking the area in warm water. This is followed by gently rubbing the lesion with a pumice stone or emery board. The process may require repeating once or twice before it is entirely gone. Cryotherapy products are also available without prescription; however, they don’t appear to be as effective as the freezing process done in a physician’s office.
There are preventive steps people can take to reduce their risk of getting plantar warts. Initially, keep your feet clean and dry, since warts thrive in a damp, warm environment. Wear flip-flops or another form of foot coverage when around public swimming pools or in locker rooms. Wash your hands thoroughly after touching any warts. Avoid direct contact with another person’s feet or hands if they have warts. If you use an emery board or pumice stone to file off lesions, do not use that same equipment on your fingernails.
To provide related information, I am sending you a copy of my Health Report “Compelling Home Remedies.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.
]]>DEAR READER: As you are aware, herbals, OTCs and prescription medications are not always effective. However, ginkgo biloba, lemon balm, valerian, hawthorn, lobelia, oat straw and German chamomile are but a few of the herbals thought to assist with ADHD. An important consideration is the avoidance of sugar, because it may result in aggressive and restless behavior in some children.
]]>Twelve years ago, I had radial-nerve surgery, which was successful. I was able to use my arm and hand without any problems. However, if I engaged in an activity such as playing cards or knitting, where my hand was in the same position for any length of time, my hand cramped up and was painful. I tried the vitamin E capsule (400 IU) twice a day and very rarely have cramping anywhere in my body. If I do have a problem, I take an extra capsule immediately with the same result.
During a recent physical examination, I discussed this “remedy” with my doctor, who also reads your columns, and he said he thought you might be interested in this remedy. He said he had no idea why it works but since it does, to continue with the regimen, as this relatively small dose will not harm me. Because it is a blood thinner, I have been advised to stop taking it seven to 10 days prior to any surgery.
I am a 78-year-old Caucasian woman; however, I assume age and race have nothing to do with the results that I have had. I hope this will work as well for others.
DEAR READER: Vitamin E is a fat-soluble vitamin with antioxidant properties. It is used for the treatment and prevention of many health conditions. In fact, research remains ongoing regarding its value in treating heart conditions, Parkinson’s, diabetes, anemia, cancer and a host of other diseases and disorders. However, no conclusive studies are available for these and other conditions.
The recommended long-term daily allowance of E is between 15 and 20 IU daily; however, many experts claim it is safe when consumed in larger amounts.
Deficiency of E is rare with a proper diet that includes broccoli, spinach, kiwi, fortified cereals, whole grains, fruits, vegetables and vegetable oils, and also because it is stored in the body for extended periods of time.
There is concern regarding the safety of E in high doses because of the potential for an increased risk of bleeding, particularly in patients on anticoagulants or with a vitamin K deficiency. Excesses have been known to also cause headache, fatigue, blurred vision, diarrhea, flatulence and bloating.
If your physician thinks the 800 IU daily regimen is OK for you, stick with it, especially if it relieves your pain. Other readers should consider a modification in their diet and a discussion with their primary-care physician before taking the supplement. Medications, even those available over the counter, can interact adversely. The safest bet is to get the go-ahead first rather than backtrack after the fact.
To provide related information, I am sending you a copy of my Health Report “Vitamins & Minerals.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.
]]>I recommend your daughter request that the situation be looked into further with blood tests to check various hormone levels to check for a thyroid condition, polycystic ovary syndrome (PCOS), low estrogen or progestin levels and perhaps an ultrasound to check for physical abnormalities such as deformity or cysts.
Birth-control pills are often prescribed in order to regulate hormone levels, which can then regulate cycles in those whose hormones fluctuate or are consistently low. Unless an underlying cause of your daughter’s lack of menstruation can be found, this may be an option to consider.
Tell your daughter to insist on further testing to get to the bottom of the situation.
]]>To provide related information, I am sending you a copy of my Health Report “A Strategy for Losing Weight: An Introduction to the No Flour, No Sugar Diet.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure mention the title or print an order form off my website at www.AskDrGottMD.com.
]]>DEAR DOCTOR: I apologize for any errors that may have appeared, but your brief note is not very helpful in explaining how and where I went wrong, if indeed I did. Perhaps next time you want to tell someone he did wrong, you could elaborate just a bit.
For my readers, an epileptologist is a neurologist who specializes in epilepsy.
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