Medical Questions & Answers » Doctors

Measles and Chickenpox Vaccine

medicalquestions — Sun, 24 May 2009 06:00:36 +0000

How safe and necessary is the measles vaccine?
It is very safe and very necessary.
Measles is usually a relatively mild disease, but it may cause severe problems in a small number of children. These problems can include brain inflammation, ear infections, pneumonia, eye infections, fitting and (rarely in U.S) death.
The complications of the vaccine are extremely rare, and relatively mild. The most common (3%) is a very mild attack of the measles.
It is a vaccine that is normally combined with that against mumps and rubella, and so is very beneficial. It is normally given at 12 months of age, and again at five years of age.
If for no other reason than to avoid the inconvenience of a child developing the disease the day before you depart for your annual holiday, you should ensure that your child receives this vaccine.
Doctors hope that with intensive vaccination campaigns, measles may be totally eradicated in U.S.

Can you tell me about the new chickenpox vaccine that I have heard is now available. Is it a good idea?
The chickenpox {Varicella zoster) vaccine was first introduced to Australia in 2000 and is obviously a good idea if you want your child to avoid this infection, but it is not yet a routine vaccination, is not subsidized by the government, and is quite expensive (but not as expensive as missing a few days of work to eventually look after your sick child).
It is recommended for children from 9 months to 12 years of age, and only one injection is necessary. Older children and adults require two injections six weeks apart.
It is not for use in pregnancy, and must be used with caution in breast feeding. You should not have the vaccination if you are sensitive to neomycin, have received a blood transfusion recently or are suffering from a high fever.
The only common side effect is local soreness at injection site. Unusual side effects include a rash and a vaccinated person may rarely pass the virus on to an unvaccinated person to cause chickenpox.

Different Vaccinations for Different Countries

medicalquestions — Fri, 22 May 2009 06:00:33 +0000

What vaccinations are available to protect you against diseases when traveling in poorer countries?
There are a wide range of vaccinations available, but not all are necessary for all destinations. You will need to check with your GP to see which ones you need for your itinerary.
A vaccination programmed for overseas travel should commence five weeks before departure but may be completed in two weeks if absolutely necessary. Vaccinations that may be required include:
Cholera. A new oral vaccine now gives good protection for six months.
Hepatitis A. One vaccination of the latest vaccine (Havrix 1440) will give six to twelve months protection. A booster at this time will give long-term protection. Hepatitis A occurs everywhere in the world, but is more common in areas of poor hygiene.
Hepatitis B. Two vaccinations four to six weeks apart will give six months protection. Boosters at six months and five years will usually give long term protection. A combined hepatitis A and hepatitis B vaccine (Twinrix) is also available.
Malaria. Prevention involves taking the appropriate tablets for the areas being visited. Numerous combinations of tablets may be used. Some drug regimes must be taken for up to two weeks before entering a malarious area, and for up to a month after leaving. Dosages vary between a tablet every day to two tablets a week.
Meningococcal meningitis. One injection, five weeks before departure.
Typhoid. Three capsules, two days apart, give 12 months protection, OR one injection gives three to five years protection.
Yellow fever. One injection, five weeks before departure, gives ten years protection.
Immunoglobulin. In situations where there has been exposure to hepatitis A or other serious illnesses, or there is insufficient time for a normal course of vaccinations, one immunoglobulin injection gives protection for 6 to 12 weeks against numerous viral infections, depending on dose.
Japanese encephalitis. Two vaccinations, two weeks apart. It is required only for residence in rural areas of India, Nepal, China and South-East Asia.
All travellers should also ensure that their tetanus and polio (Sabin) vaccinations are up to date.

Know About Tetanus Injection

medicalquestions — Thu, 21 May 2009 06:00:57 +0000

I am 42 years old, and often work in the garden and get small nicks on my hands. Is it still necessary to have a tetanus injection? I have never heard of anyone catching this disease. If so, how often should I have a tetanus injection?
Imagine a disease, the seeds of which are in the soil around us. A disease not restricted to the third world nations of Asia and Africa, but present in Australia. A disease that causes the death of nearly half the people who catch it, and which causes excruciating pain from muscle spasms triggered by the slightest noise. A disease that can be caught by having a relatively small cut anywhere on the body. A disease called tetanus.
We are fortunate in Australia to have access to vaccinations which prevent this terrible disease and the number of people who catch it is not therefore high. In less fortunate countries, the population is not as well educated and medical services are not as readily available. Thousands of people die a terrifying and tortured death because of the unavailability of a simple vaccine. Tetanus vaccination is still necessary, and if you have not had one for ten years, you could catch tetanus!
All children should have a series of vaccinations known as triple antigens at two, four, six and eighteen months of age. This contains vaccines against whooping cough and diphtheria as well as tetanus. A further booster is given prior to school entry at five years of age.
Adults are also at risk. The tetanus vaccine does not give life-long protection, and tevaccination is necessary every ten years. If you have a wound likely to be contaminated by tetanus, the vaccination should be given again after only five years. Deep wounds, such as treading on a nail, are particularly likely to cause tetanus.
The tetanus vaccine is one of the smallest and least painful injections of all, and it has no side-effects. There are no excuses for you and your children not being adequately protected. See your general practitioner soon. Tomorrow may be too late!

Know About Raynaud’s Phenomenon

medicalquestions — Wed, 13 May 2009 06:00:23 +0000

What can be done to help my wife’s Raynaud’s phenomenon?
Raynaud’s phenomenon is often associated with cold weather, and sufferers should choose the warmest climate possible for their home.
The symptoms occur in the hands and feet and are due to spasm of the small arteries in the extremities. Patients have fingers and/or toes that go red, then white and finally blue, while swelling up and causing considerable pain.
Treatment involves wearing gloves, bathing in warm water, and medication to dilate the arteries. There are a number of drugs that can be used. Nicotinic acid is the one most commonly prescribed, but a drug called Adalat also shows considerable promise. These must be used regularly to prevent the problem, and are only available on prescription. An ointment that is used to dilate heart arteries can also be used in very small amounts on the hands to dilate the arteries in the acute situation.

I have had an operation on the salivary gland under my ear for a tumour, and I have been left with Frey syndrome. If I had known this would happen, I would not have had the operation.
Mixed tumours of the parotid gland, the main gland behind the jaw and under the ear that produces saliva for the mouth, are very sinister growths. Although usually not cancerous initially, they may grow to a very large size to cause disfigurement and pain, and may in time turn malignant.
Once one of these tumours is discovered, removal at the earliest opportunity is sensible. Unfortunately, the facial nerve, which controls the muscles of the face and other nerve fibres (sympathetic and parasympathetic nerves) that control blood vessels and sweat glands, runs through the centre of the gland, and an enlarging tumour may engulf more branches of the nerves, making it very difficult for a surgeon to avoid all the tiny filaments when the tumour is removed.
If the nerve or some of its branches are cut, you will lose the ability to move the facial muscles on one side supplied by those nerves, including those that control the lips.
Frey syndrome occurs when the facial and other nerves to the face are damaged by an infection of, or surgery to, the parotid gland. It results in sweating and flushing of the face, and drooling when eating.
It is very unfortunate that you have developed this syndrome as a complication of the surgery, but without the surgery, your life could be even more miserable with a tennis ball sized mass on the side of your face, and an early death from malignant change.

Treatment of Stress

medicalquestions — Sat, 09 May 2009 06:00:06 +0000

How can stress, as a diagnosis made by my GP, be treated?
There are four ways to treat stress:
• The obvious, most successful, but hardest to achieve, is removing the cause of the stress. If your mortgage repayments are in arrears, winning the Pools will solve your problems and remove the stress, but this is a solution for the minority, not the majority. Marriage stress is probably one of the most difficult forms of stress to remove, as bitterness and wrangling over children and property may last for many years after a divorce.
• The next and most practical way to deal with stress is to rationalize it. This can involve a combination of several different techniques. Talking is an excellent way of relieving anxiety. Discuss the problem with your spouse, relatives, friends, doctor, work mates or anyone else who will listen. Problems often do not appear as insurmountable once bought into the open. Writing down the details of the problem is another excellent way of relieving anxiety. An insurmountable problem in your mind often appears more manageable on paper, particularly when all your possible options are diagrammatically attached, to enable a rational view of the situation to be obtained.
• Professional assistance in discussing your problems is also very helpful. This may be given by your own general practitioner (who can often be a friend as well as counselor), a psychiatrist (not because you may be insane, but because they have specialist skills in this area), a psychologist, marriage guidance counselor, child guidance officer or social worker. Many people are reluctant to seek this type of assistance, but it is far preferable to the fourth type of treatment for stress.
• Drugs that alter your mood, sedate or relieve anxiety are very successful in dealing with stress, but should only be used in a crisis, intermittently or for short periods of time. Some antidepressant drugs and treatments for psychiatric conditions are designed for long term use, but most of the anxiety relieving drugs can cause dependency if used regularly. When prescribed and taken correctly they act as a very useful crutch to help patients through a few weeks of extreme stress, and allow them to cope until such time that the cause of the stress is removed or counseling can be started.

Lost Sense of Smell After Heart Attack

medicalquestions — Fri, 01 May 2009 06:00:06 +0000

After having a heart attack, my brother has been left with no sense of smell for hot foods. Doctors have come up with all sorts of suggestions to explain this, but no help. He is getting despondent and I hope you can help.
Your sense of smell comes from a nerve that sends tiny sensitive hairs into the top of your nose. These detect certain different odours, and convey the sensation back down the nerve to the part of the brain that can recognise them as particular smells.
During a heart attack, the heart stops working as an effective pump, and some parts of the body may be deprived of an adequate blood supply. When this happens, the more sensitive parts of the body (eg. the brain) may be permanently damaged.
It is also possible for a small stroke to accompany a heart attack.
In either case, it is probable that the part of your brother’s brain that is responsible for the sense of smell has been partly damaged, so that he can no longer smell as well as he could previously.
Unfortunately, brain damage is usually permanent, and although some recovery may occur by new nerves taking on old tasks, once a few months has passed, no further improvement can be expected. There is no effective treatment available.

Everything I eat and drink tastes of salt. Chocolate is the worst. The only thing that is not bad is milk. Have you ever heard of a case like this?
I must admit that I haven’t heard of a case like this, so I have been scouring my . medical texts and cross examining my colleagues to find some answers for you. A wide range of conditions have come to my attention, some very rare, some probably too simple to account for your symptoms, but I will list them all for you.
The most likely cause is the side effects from a medication, and this includes many herbal and ‘natural’ preparations. These medications, or their breakdown products, can be secreted as a salt in your saliva, and the more you salivate (eg. with something tasty like chocolate) the saltier the taste.
Tongue infections such as thrush can alter your taste sensations.
A chronic postnasal drip can affect taste as the phlegm slides down the throat past the back of the tongue.
Poisoning from heavy metals such as lead and mercury can cause abnormal tastes. If you have ever worked with these metals (eg. in a battery factory) you should have the levels of these metals in your blood checked.
There are a number of rare diseases that can affect taste including liver failure and the syndrome of inappropriate antidiuretic hormone secretion (SIADH), which causes a build up of the salt levels in your body.
You will need to discuss these options with your own general practitioner to have them investigated, excluded or treated.

Know About MRI Scan

medicalquestions — Wed, 01 Apr 2009 06:00:48 +0000

What is involved in an MRI scan? I have seen numerous doctors about my headaches and fainting, and now a neurologist wants me to have one of these tests.
Magnetic resonance imaging (MRI), or nuclear magnetic resonance (NMR) as it is sometimes called, is a new technique of scanning the body. It is based on the fact that living tissues give off their own special electromagnetic signals, depending largely on their water content, and if the tissues are exposed to a magnetic field the signals can be picked up and read. Hence, a very strong magnetic field is created by special magnets, and different areas of the body absorb different amounts of magnetism according to their water content. A magnetic absorption photograph is then built up, and can be seen and analysed, slice by slice, on a computer screen in much the same way as a CT scan. MRI is particularly useful as it ignores bones (which contain little water) and shows up soft tissue, which is the opposite of X-rays.
MRI is especially helpful in diagnosing diseases in the brain and spinal cord. The picture obtained by MRI of the brain clearly shows the difference between the white matter (nerve fibres) and the grey matter (nerve cells). Tumours that are not apparent on a CT scan are sometimes revealed by MRI, not only in the brain but in organs deep within the abdomen such as the liver.
MRI is completely safe. Its main disadvantage is that the equipment is enormously expensive (approximately twice as expensive as a CT scanner) and must be housed in a special magnetically sealed room. As a result, high fees must be charged for its use, and not all of these are covered by Medicare or private health insurance.

Prevention & Treatment of Myelogram

medicalquestions — Tue, 31 Mar 2009 06:00:29 +0000

My husband had a myelogram three weeks ago and has suffered from severe headaches and nausea ever since. Is this a normal side-effect of a myelogram? Can these side effects be prevented or treated?
Myelograms have largely been superseded by CAT and MRI scans, which give much the same information with fewer side effects, but sometimes a myelogram is still necessary to diagnose particular problems.
When a myelogram is performed, a needle is pushed through the skin low down on the back, and between two vertebrae so that the tip of the needle is in the spinal canal. This canal contains the spinal cord (which carries all the nerves from the brain to the body) and a fluid called cerebrospinal fluid.
A small amount of fluid is removed, and an equal amount of a dye is injected into the spinal canal. The patient is then tilted so that the dye runs up the canal. This dye is visible on X-rays, and as the patient is tilted backwards and forwards, numerous X-rays are taken of the back to see where the dye moves to. If there is a blockage in the spinal canal caused by a slipped disc, or any abnormality of the spinal cord, it should show up on the X-rays. At the end of the procedure, the dye is run back down to the area where the needle has been inserted, and as much dye as possible is removed, and an equal amount of saline solution is injected to keep the volume and pressure of the cerebrospinal fluid constant.
If the pressure changes significantly, a headache will occur. A headache (sometimes quite severe) is normal for a few days after the procedure, and these headaches are notoriously resistant to any treatment, but three weeks is excessive. It may be that too much or too little fluid was injected into, or removed from, the spinal canal, and this change in fluid pressure is causing the headache.
The other possibility is that the disease leading to the myelogram being performed may be responsible for the headache. In either case, you should return to see the specialist who ordered the myelogram as soon as possible for further assessment.

Mammography – One Type of X-ray

medicalquestions — Sun, 29 Mar 2009 06:00:52 +0000

Can you explain what happens in mammography? My doctor has suggested I have this done, but it scares me.
Mammography is merely an X-ray of the breasts, and there is no reason for concern. During the procedure, the breasts will be X-rayed from top to bottom and side to side. There may be some discomfort as your breasts are squeezed between the X-ray plates, but it only takes a few seconds, and the results can be life-saving.
There are now many doctors who believe that all women of 40 years should have a routine mammogram, and this should be repeated every five years. Combined with monthly breast self-examination, mammography is an extremely effective way of detecting breast cancer at an early stage. Women are now having tiny breast cancers removed, without disfiguring scarring, before they or their doctor can feel any lump or discomfort.
Early detection is the key to successful cancer treatment, and if you are concerned about your breasts, or if there is a family history of breast cancer, do not hesitate to have a mammogram arranged by your general practitioner.

I have an X-ray request slip from my doctor to have an air-contrast barium enema done. What will happen to me?
This is an X-ray that shows the lower part of the gut from the anus up to the appendix, and sometimes the last part of the small intestine. This part of the gut is about one and a half metres long in an adult.
The day before the X-ray, you will have to use special medicines to clean out all the faeces from the gut. When you go to the radiologist’s rooms, you will be undressed and lie on your side on a rather narrow table. A small tube will be placed in your back passage, and through this a mixture of barium will be run into the large gut. You may be given injections in the arm to relax you and the gut during the procedure.
You will be rolled around from side to side while X-rays are taken, and air will be introduced into the gut to display any abnormalities more readily. The procedure may be a little uncomfortable when your gut is inflated with air, but this settles rapidly.
After half to one hour, all the pictures necessary will have been taken, and you will be asked to go to the toilet to pass the barium mixture that was previously introduced. Your bowel function will return to normal after a couple of days.
The procedure can diagnose most diseases of the lower gut, and will only be requested if your doctor considers there are good reasons for doing it.