A couple of months into the marriage I suddenly gained 20 pounds. Then I developed high blood pressure, darkening of the skin, a puffy face, muscle weakness, bruising, nervousness, uncontrollable emotions, back pain and headaches. Over the next seven years I saw six different doctors. All of them gave me a diet sheet, treated my blood pressure and told me to lose weight. They didn’t seem to care about the other symptoms and didn’t understand that I couldn’t lose weight. (I had been trying.)

I started seeing a chiropractor for treatments but that didn’t help. In fact, it made things worse. I didn’t even want to live anymore. Then one day I had such a bad attack of back pain, I was rushed to the ER where I was given a shot of something that put me to sleep for eight hours. When I woke up the pain had dulled and was bearable.

I returned to my chiropractor and described the situation. He said judging by my skin color and the description of the pain, it was a deep inward pain and he made me an appointment with a doctor. This new doctor ordered some tests. When they came back he told me that my adrenal glands were putting out too much hormone. For a woman my level should have been 17 but mine was 37. He gave me the diagnosis of Cushing’s disease.

Some how the University of California Hospital in San Francisco heard about me and wanted me to go to them because I had every symptom of the disease. They were persistent and at that time I was ready to try anything that might help. I agreed to go and become a research patient. I had both of my adrenal glands removed in 1964. I was told I didn’t have Cushing anymore because the offending glands were gone, but now I had Addison’s disease.

Now I take two pills to replace the hormones that my adrenal glands produced. Also, in 1974, I had a pituitary tumor removed.

I live a relatively normal life. I have to be careful to limit my stress but I am happy to be alive. I was told that if I had not had surgery and went untreated, I would have only lived another five years at the most.

My primary reason for writing is to share my story but also to tell anyone out there not to be afraid to be a guinea pig. It was hard for me, but in the end, it was worth it. I had my life back.

DEAR READER:
Cushing’s disease (now known as Cushing’s syndrome) is a condition in which the body is exposed to too much cortisol. This can occur because of abnormalities of the adrenal or pituitary glands, certain tumors that make and release the hormone adrenocorticotropin (ACTH), and more.

Common symptoms include high blood pressure, upper body obesity, severe muscle weakness and fatigue, easy bruising, backaches, high blood sugar, and more. In women it may also be accompanied by excess facial and body hair growth and irregular and absent menstrual periods.

Treatment depends on the cause. Back in the late 1950s and early 1960s, not much was known about this disorder (as you know). I believe you were incredibly lucky to have been diagnosed. Your “experimental” surgery to remove the adrenal glands saved your life but made you rely on medication to do what your body is unable to do. Today, removal of the adrenal glands is a last resort used for persistent cases or those that are the result of tumors.

Addison’s disease is the exact opposite of Cushing’s. It is the result of too little cortisol. Like its antithesis, it can be caused by abnormalities of the adrenal or pituitary glands, certain disorders, chronic infection, cancer, and removal of the adrenal glands.

Symptoms generally include chronic and worsening fatigue, weight loss, muscle weakness, loss of appetite, nausea, vomiting, low blood pressure, and more.

Treatment is simply replacing or substituting the hormones that are not being produced.

In both conditions, if there is an underlying cause, it must be treated. Both also require monitoring by an endocrinologist, a physician who specializes in glandular conditions, such as Cushing’s, Addison’s, diabetes and more.

Thank you for writing to share your experience.

To give you 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 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Is there any reason why I should not let him? After all, I trust him to treat my dog and I love her like one of my family.

DEAR READER:
Wow! I am printing and responding to your letter because it is a first. No one has ever asked me to “cross party lines” before.

Veterinarians are qualified — in their field. Many programs do not require a bachelor’s degree for entrance and prerequisites vary, however all programs require up to 90 semester hours at an undergraduate level. Mandated classes include chemistry, biology, genetics, and microbiology. A four-year degree in the field of animal science and a post graduate degree from a recognized school of veterinary medicine are mandated. By the way, there are 28 colleges in 26 states that meet accreditation standards set by the Council on Education of the American Veterinary Medical Association. A state license is required before practice can begin. Some students prefer to intern in a group practice. Others choose to go solo.

Most veterinarians diagnose problems, medicate, vaccinate, set fractures, treat and dress wounds, perform surgery when necessary, and dispense advice. They use surgical instruments, stethoscopes and diagnostic equipment. Sounds like a medical doctor, doesn’t it? The only differential is that a pet cannot speak to tell his doctor what hurts. That’s up to the pet’s owner, but it certainly adds a vital element to the necessary examination.

Obviously I cannot endorse having a veterinarian anesthetize, perform surgical excision, suture, send the cyst for analysis if appropriate, and follow the wound for possible signs of infection. Would you consider making an appointment for your pet with your general practitioner or surgeon? Might he or she be put off if you did? Perhaps you should bite the bullet (or dog bone) and make arrangements to pay a surgeon over time through a payment plan to remove your cyst as an office procedure. I recommend you play it safe.

To give you related information (no pun intended), 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 number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Merkel cell carcinoma (also known as neuroendocrine carcinoma of the skin) is a rare skin cancer. It usually is fast growing and can quickly spread to other parts of the body. As with other skin cancers, the number of cases is on the rise.

The first symptom is generally a fast-growing, painless bump on the skin which often appears on the face, head or neck but can occur anywhere on the body. It is usually shiny and may be flesh, red, blue or purple in color. If unchecked, the cancer can spread leading to swollen lymph glands, fatigue or pain. It is important to have any suspicious lesion checked out by a physician who may choose to remove or biopsy it for diagnosis.

It is not currently known what causes Merkel cell carcinoma but there are two leading theories. One is that the cancer arises directly from the Merkel cell which lies in the outmost layer of skin and the other is that certain immature skin stem cells become cancerous and develop features that resemble Merkel cells.

There are several risk factors for developing this type of cancer. As with all others, unprotected exposure to natural or artificial sunlight is one of the leading links. Others include age, having light or fair colored skin, a weakened immune system, or having a history of other types of skin cancers.

There are several treatments available. Several factors come in to play when your oncologist is coming up with a plan. The size and location of the lesion are important. Determining if the cancer has spread and if so, to what extent, is also vital. Small lesions that have not spread can generally be removed by surgically excising the lesion and a portion of the surrounding healthy skin. It may be advised to follow up the surgery with radiation to ensure that all cancer cells were removed or obliterated. Radiation can also be used to shrink the size of the tumor before surgery or as sole treatment in those who refuse surgery. For recurrent or metastasized Merkel cell, chemotherapy may be used.

All skin cancers should be under the care of an oncologist who can monitor and treat the lesions. Once skin cancer is present, the risk of developing more lesions or other types, increases so it is vital to be vigilant about sun protection and self-checking for new or changing lesions on the body.

To give you 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 number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

My wife is 82 years old and has had dementia for many years. She was diagnosed with Alzheimer’s and given many different medications to try but nothing worked. When she started getting worse her physician prescribed Seroquel.
About four or five weeks into taking the medication, she became really confused. She would wake up at night and want to go home without realizing that she already was home. It scared me so much that I was afraid to go to sleep in case I didn’t hear her get up.

After reading your column, I took my wife off the Seroquel and noticed a dramatic change within a week. She has told me that she is feeling better than ever. She now takes 3 mg of melatonin which helps her sleep all night and she has no more confusion during the day.

DEAR READER:
I am glad to hear that my column helped your wife; however, if she has dementia, she should never have been prescribed the medication.

Seroquel is an anti-psychotic medication used to treat conditions such as bipolar disorder, not Alzheimer’s. There is even a black box warning stating that it should not be used in elderly dementia patients. Assuming your wife really has Alzheimer’s, her physician made a potentially dangerous error.

You say that your wife is feeling better, no longer confused and sleeping all night thanks to stopping the Seroquel and starting melatonin. If she is no longer having symptoms of dementia, perhaps she doesn’t really have Alzheimer’s.

There are several disorders that can cause dementia and other neurological changes. Vitamin deficiencies, normal pressure hydrocephalus, Alzheimer’s, even depression or sleeping abnormalities and more are possible culprits. Some are reversible, others are treatable but until there is a positive diagnosis, there is no way to knowing what will help her.

I urge your wife to undergo testing to determine the cause of her dementia. She should also be under the care of a neurologist if she isn’t already. If she is seeing such a specialist, ask for a referral for a second opinion. If it was her primary care physician who prescribed the Seroquel, perhaps it would be appropriate to find another since he or she has already shown disregard for medication warning labels.

If symptoms persist, but are mild she may be fine without medication, but be sure to speak with her specialist about this. It is also important that you take proper care of yourself. Providing full time care for a dementia patient can be incredibly difficult. You may find it easier and more rewarding if you bring in occasional help from a local visiting nurse association. This type of organization can provide assistance to the care taker as well as the patient.

To give you related information, I am sending you copies of my Health Reports “Alzheimer’s Disease” and “Medical Specialists”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

My physically healthy husband has no memory of our past 59 years, including yesterday. However, he keeps up his hygiene, does his daily chores, fixes his own meals and more. Out sons are not recognized and our dogs are nameless. I am now the “nice lady” who stays here. He refuses all mental tests claiming that all old men have memory problems and periods of confusion. He seems very serene but nearly every evening he makes bizarre exclamations such as “Those two men came in and said I can’t use the shower”, “Am I supposed to stay overnight?”, “Where did my wife go?” or “This building (meaning our home) is condemned, we have to move.” A few minutes later he won’t even remember saying anything.

Dr. Gott, what is causing these “episodes”?

DEAR READER:
Not all memory loss and confusion leads to Alzheimer’s disease. In fact, I highly doubt that this is what your husband is suffering from because Alzheimer’s patients generally remember the past quite clearly but forget names, dates, and current goings-on.

Dementia is defined as an organic loss of intellectual function. This means that, due to natural causes, memory, cognition, personality and other mental changes occur.

Your husband clearly is having some sort of mental faculty change and, in my opinion, needs to be seen by a neurologist. Given his specific symptoms, there are likely only a few disorders that could cause his situation. It is important that you create a list of his symptoms, when they started and if they were preceded by an accident, injury or other abnormal event.

If you have power of attorney, you should have no problem getting him the testing he desperately needs. However, if you do not, this could become a bit of a sticky situation. He clearly does not want to be seen, but in fact, should be. You may need to prove to a judge that he is incapable of making important decisions and should get a court-approved power-of-attorney.

While this does not sound pleasant, it could be the very thing that saves his life. If his memory loss is the result of a simple, reversible disorder, the longer it goes untreated, the more permanent damage he could be inflicting upon himself. If it is not reversible, however, it is still vital to know what the disorder is. You say you have sons. If not for your husband, find out what it is for them, as many types of dementia can be carried down from family member to family member. As with Alzheimer’s patients, close blood relatives (aunts, uncles, mothers, fathers, children, and siblings) could be at an increased risk.

Your husband does not have age-related memory loss and confusion, but without testing, I cannot tell you what the cause is. Get him the help and testing he won’t get for himself.

To give you related information, I am sending you copies of my Health Reports “Alzheimer’s Disease” and “Medical Specialists”. Other readers who would like a copy should send a self-addressed, stamped envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

I am the youngest of 10. My mother passed away at the age of 44 when I was four years old. I’m approaching her age quickly and want to take steps to prolong my life.

DEAR READER:
First, let’s review your conditions.

Kidney stones are a common but extremely painful disorder. Most pass without intervention by physician assistance. Others don’t.

Auto-transplant means relocation of an organ, in your case it was your left kidney. There are a number of reasons that would warrant having this dramatic procedure performed, such as complex renal artery disease.

The most common cause for skin cancer is sun exposure in areas unprotected by sun block or clothing during outdoor or work activities.

Your mini-strokes resulted from blood vessel blockage in the brain. Similarly, a pulmonary embolism is blockage of the pulmonary artery or one of its branches. Both conditions are the result of one or more clots traveling from any part of the body to another.

The pulmonary embolisms likely led to stent replacement when a surgeon attempted to improve blood flow. A stent is simply a mesh tube that helps keep the artery open.

So far, your conditions are fairly easy to explain. Now comes the tricky part.

You say you have a Factor V (FV) clotting disorder. Do you truly mean that or do you mean that you have a Factor V Leiden (FVL) clotting disorder? The process of coagulation requires a delicate balance to ensure just the right amount of clotting power in the blood. Too little leads to bleeding problems; too much can lead to dangerous blood clots.

While both conditions have similar names, they are entirely different. FV is actually a bleeding disorder. It is rare and results from a lack of the protein Factor V which can cause excessive bleeding.

Factor V Leiden is not a lack of the protein but rather, a normal amount of abnormal versions of Factor V. This causes the proteins to work in the opposite way, causing “stickier” blood and, for some individuals, abnormal blood clots. These clots are especially common in the legs (known as deep vein thrombosis) or in the lungs, such as you have experienced during your many attacks of PEs.

With your history, it appears to me you are suffering from a factor V Leiden disorder. This condition can either develop during a lifetime or else it is inherited. A hematologist should be consulted immediately in an attempt to bring the disorder under control. By doing so, he or she should reduce or eliminate a lot of your problems.

Finally, as crass as it may sound, your forgetfulness may be the least of your many problems. Perhaps you are simply over-loaded with so many medical issues you are blanking out on names. Another cause could be damage to the memory storage areas of your brain as a result of your several mini-strokes. I recommend you see a neurologist who can perform appropriate testing to determine the cause.

You should be seeing a top notch primary care physician you trust implicitly who can orchestrate this plethora of problems. He or she should refer you to a number of specialists, including a hematologist, neurologist, pulmonologist, nephrologist, urologist, and/or dermatologist, all of whom can work together to provide you appropriate treatment for each of your problems.

Now, on to your laughter and passing out. Laughing predisposes an individual to an increase in venous pressure within the thorax. That pressure is a mechanism for syncope, a transient form of unconsciousness. Known as laughing syncope, the condition is seen in patients with arterial/vascular disease and not in those who are healthy. Since you have a great deal on your plate already, I’m extremely reluctant to suggest you refrain from laughter. Perhaps moderation is the key. Smile a lot, laugh with a little less vigor, get tapped in to the system of specialists who can provide you the best care possible, get that clotting factor under control, and approach and move beyond your 44th year with the knowledge you are doing all you can to keep things under control.

To give you 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, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

In investigating, I realized glaucoma was sort of like a stroke of the eyes so I decided to test the drink. It tasted delightful and better still, within minutes my partial vision cleared and I was able to read again. A few weeks later my vision worsened so I drank another glass and my vision cleared.

I have since tried altering the drink a bit. I have eliminated the sugar and reduced the coffee to only one cup (but left the instant coffee at one heaping tablespoon). I only drink it when my vision starts to get foggy or I feel uneasy about my eyes and my vision clears. I have only used the drink four times in 10 weeks.

I know this remedy sounds far fetched by since first starting this; I have been seen by two doctors at two clinics within two days of each other. Both times, my eye pressures had dropped to normal and appeared to be holding. I don’t know if this will work for others but it certainly works for me so I hope you will print my letter to share with your readers.

DEAR READER:
Glaucoma is a complex disorder that can cause damage to the optic nerve, resulting in loss of vision and blindness. I must take a moment to state that not all increased eye pressure carries a diagnosis of glaucoma. In fact, glaucoma can develop with normal pressure readings on testing. The optic nerve must be damaged for the condition to occur. Beyond that, individuals vary in their ability to tolerate increased levels, so there is no definitive value for diagnosis.

You do not indicate if you are on any medication. I can only determine you are under the care of an ophthalmologist who has you on drops or pills for control. Should this be the case, you must take your drugs precisely as instructed by your eye care professional. Several of the medications must be taken more than once a day to be completely effective. Side effects from drops can include burning and redness. If you discontinue taking your drops or pills on occasion for this or other reasons, return to your prescribing physician who will be able to switch you to another comparable medication with fewer side effects.

From a medical standpoint, I must agree your remedy is quite far fetched. However, there are possible reasons for the pressure to decrease and your vision to improve. Symptoms can improve when you are in a relaxed stated, such as when you have had a cocktail. Adversely, they can exacerbate in times of increased stress. I suggest you experiment by listening to calming music, walking around the block, or by doing something else that truly relaxes you. If you have positive results, we have the answer.

To give you 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, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER:
I am not an ophthalmologist but will do my best.

Macular degeneration is an age-related disorder of the eye. It causes deterioration of the macula which is located in the center of the retina. It commonly occurs in individuals over the age of 50. The dry variety of this disease simply means the deterioration is not accompanied by bleeding. It is also the more common form.

Macular degeneration does not cause total blindness; rather it affects only central vision. Central vision is what we use for everyday tasks such as reading, driving, detail work and recognizing faces.

Symptoms can include needing increasingly brighter lights for reading or close up work, difficulty recognizing faces, increasing difficulty adapting to low light levels, a gradual increase in haziness of overall vision, increasing blurriness of printed words, a decrease in the brightness of colors and a blurred or blind spot in the center of the visual field. Sufferers may also notice one eye is affected more than the other or one is not affected at all. Early in the disorder this may not be noticeable because the stronger eye compensates for the weaker one. Some individuals may even start having hallucinations. Known as Charles Bonnet syndrome, these common visual abnormalities are not a sign of mental illness in individuals with macular degeneration. These “visions” can appear as unusual patterns, animals, geometric shapes or faces.

It is important to have regular eye screenings, especially after the age of 50. Don’t be afraid to tell your eye doctor about your symptoms, including hallucinations. The ophthalmologist can perform specialized testing to determine the cause of the problem.

Currently there is no treatment available to reverse dry macular degeneration. However, because it progresses slowly, most individuals can lead fairly normal lives. It is important to be checked regularly because of the increased risk of developing the more rapidly progressing, severe form, wet macular degeneration.

Most eye specialists recommend high doses of antioxidants and zinc to reduce progression. Speak to your physician about this possibility if you are not already taking a formulation. You may also be helped by getting glasses, using magnifiers, increasing lighting in the home and purchasing house-hold items, such as clocks, telephones and more with extra-large lettering and numbering.

For others interested in learning more about this common, age-related disease, I recommend you go online to www.MayoClinic.com/health/macular-degeneration/DS00284. The Mayo Clinic does a spectacular job of explaining the disorder, possible causes, symptoms, tests, treatment and self-help techniques. The websites covers many disorders, common to uncommon in an easy-to-understand way.

To give you 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 number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER:
Myasthenia gravis is a chronic autoimmune disease that causes muscle weakness that can increase during periods of activity and decrease following rest.

Initial symptoms can be an eyelid that droops, blurred or double vision, slurred speech, weakness of the extremities, shortness of breath, or unsteady gait.

It is caused by a defect in the transmission of nerve impulses to voluntary muscles. Impulses travel down a nerve in a healthy individual. Nerve endings release a neurotransmitter substance known as acetylcholine. This substance then travels through the neuromuscular junction and binds to acetylcholine receptors that are activated and produce a muscle contraction. With myasthenia gravis, antibodies block these receptors and prevents muscle contractions from occurring.

A complete history, physical examination and evaluation by a neurologist should be conducted. If myasthenia gravis is suspected, several tests (to include blood work, nerve conduction studies, single fiber electromyography, and more) can be conducted. Therapy may help improve muscle weakness. Medication, removal of an abnormal thymus gland and plasmapheresis (removal of the plasma portion of the blood which is then replaced with saline or donor plasma) can be coordinated.

To give you 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 number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

I’m on Enalapril, HCTZ, Requip, Simvastatin, Terazosin, Temazepan, Propoxyphene, aspirin, fish oil, and calcium daily.

What is causing the problem?

DEAR READER:
Whew, that’s a lot of medication.

There are numerous causes for black stool. For example, the condition often indicates a disorder or bleeding in the digestive tract. As a rule of thumb, black stool comes from the upper digestive tract, while red or maroon colored stool comes from lower gastrointestinal bleeding.

Stomach ulcers caused by aspirin and ibuprofen are common causes of a GI bleed. Unless there is a reason for taking aspirin every day, you should probably discontinue it, at least for a trial period.

Other causes of dark stool can include the consumption of black licorice, blueberries, iron pills, Pepto-Bismol and similar medicines. Gastritis, trauma, hemorrhoids, intestinal infection, polyps, and other conditions will also cause stool to darken.

You need to be seen by your primary care physician. He or she can do a simple examination and a fecal blood test in the office. If the history given is suspicious or the fecal blood test results are positive, referral to a gastroenterologist would be appropriate. The specialist might choose to order blood work, stool culture, colonoscopy, tests for H-pylori infection, and more. Treatment will depend on the cause and severity of the bleed.

Make an appointment with your doctor and get to the bottom of the matter. You have several medical conditions on your plate already and certainly don’t need one more. While you are there, ask if any of your medications might be causing the problem and if so, can they be eliminated.

To give you 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, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.