Medical Questions & Answers

Cold Sores

medicalquestions — Fri, 15 Aug 2008 06:00:43 +0000

Question: What are cold sores? I get one every few months, and I hate them, because they look so ugly.
Cold sores are caused by a virus.
About a quarter of the population is susceptible to this condition, while the rest of us are immune. Once the virus is contracted, it settles in the tissue around the lips, nostrils and other areas of sensitive skin. At times when the body’s resistance is lowered, the virus will start rapidly reproducing and an itchy, painful, blistery and later weeping sore will develop. Eventually this dries out and heals, but while in the blistery stage, the virus can be spread to other people in the community.
There are ointments that can be used (eg. Zovirax) in the very early stages of a cold sore to prevent it from developing further. Once the sore is established, only soothing and drying preparations can assist in healing the sore. Tablets are available to prevent cold sores, but these are very expensive, available only on prescription, and must be taken all the time.

Question: What causes a venous lake to appear on the lip? Can it be removed without leaving a scar?
An injury from a blow, bite or burn may damage the lip tissue and allow blood to accumulate under the fine skin on the lip, or any other part of the body. They are caused by the rupture of a very small vein near the surface of the skin, while the skin over it remains intact. Blood leaks out of the vein and accumulates as a dark blue blob under the skin.
They are easily removed by bursting the venous lake with the tip of a needle that has been sterilized by holding it in a flame or soaking in antiseptic. The blood will rapidly come out through the hole made, and healing will occur very quickly, with no scarring, particularly on the lip, which is probably the best healing part of the whole body.

Pros and Cons of Hormone Replacement Therapy

medicalquestions — Fri, 15 Aug 2008 06:00:18 +0000

Question: I am in my fifties and would like to know the pros and cons of hormone replacement therapy. How should I take them and how safe are they? What do you think of vaginal oestrogen creams?
I personally recommend HRT to all my patients, unless there are specific reasons that they should not take hormones. Generally speaking, HRT has E’en a major advance in the health of women, who now outlive men by an average of more than seven years.
The points for and against hormone replacement therapy (HRT) sre outlined as simply as possible in the following points.
PROS:
• Prevents osteoporosis (thinning of bones) and fracture.
• Slows the development of wrinkles and keeps the skin moist and more elastic.
• Lubricates the vagina and enhances sexual pleasure.
• Slows the sagging of breasts by maintaining breast tissue.
• Relieves the hot flushes, depression, bloating and othei symptoms of menopause.
• Regulates irregular periods to make them milder and less painful.
CONS:
• Menstrual periods may restart, or continue, for a year after HRT
commenced.
• May cause breast tenderness if dosage too high.
• Nausea and belly cramps may occur.
• Migraines may be aggravated.

Except under special circumstances, HRT should not be used in women who have had:
• Cancer of the breast, uterus or cervix.
• Hormonal mastitis (breast pain).
• Endometriosis.
• Blood clots (thromboses), liver disease or strokes.

Question: Why can’t all women who have troubles with the menopause have hormone replacement therapy with oestrogen? Why can’t they stay on treatment until they are 60, 70 or indefinitely?
The vast majority of women can take hormone replacement therapy with both an oestrogen and progestogen to overcome their problems. It is necessary to take both hormones to prevent some of the long-term complications of constant oestrogen use. Women who have had a hysterectomy need only take oestrogen.
There are a small number of women who should not use hormone replacement therapy, including those who have had breast or gynaecological cancer, blood clots or liver disease.
Most GPs are sympathetic to these women, who may suffer flooding, cramps, depression, flushes, headaches, irritability etc. etc. etc.!!!
There are a number of different types of oestrogen, and vaning dosage regimes, and it sometimes takes a little trial and error to get the dosage just right for an individual woman. Oestrogens also protect against osteoporosis, heart disease, and dementia, skin ageing and improve the libido (sex drive) of older women.
There is a great deal of controversy about how long this treatment should continue, but there is no reason why they should not be continued beyond 70 years of age. Oestrogens are not a long term ‘youth pill’, but cm certainly help women through a difficult period in their lives and prevent l lot of the complications of ageing.

Osteoporosis due to Hormones imbalance

medicalquestions — Thu, 14 Aug 2008 06:00:47 +0000

Question: I heard recently that women who could not produce hormones naturally, either due to the change of life or after a total hysterectomy should have hormone replacement therapy to prevent osteoporosis. What is your opinion?
Women who have a total hysterectomy (removal of the womb and both ovaries) will age prematurely, and have an increased risk of osteoporosis, particularly if the surgery is performed at an early age. Unfortunately, the most common reason for a total (as opposed to sub-total) hysterectomy is cancer in the area of the ovaries or womb.
Any hormones given to these women in the future may rarely cause a recurrence of their cancer. These women are therefore caught in a cleft stick, and will need to discuss their individual problems carefully with their gynecologist. The treatment will depend on what type of cancer they had, where it was, how advanced it was, and how severe the symptoms caused by the lack of hormones. Fortunately, most women who have a hysterectomy have a sub-total one, where at least one ovary is left behind. These women can be treated the same way as those who have never had any surgery.
Women who are going through the menopause and who are suffering from significant effects of this natural change can be helped by regular hormone supplements. This usually involves taking estrogen either constantly or for three weeks a month, and those who have not had a hysterectomy will need a course of progesterone for ten days or so every month.
If the symptoms of the menopause are not severe, the family history should be checked, and if the patient’s mother or grandmothers suffered from osteoporosis, again hormone supplementation is advisable. If there is no history of osteoporosis, and no significant effects from the menopause, hormone supplementation can still be beneficial by reducing the incidence of strokes and heart attacks, and improving skin tone and appearance.

Hysterectomy in Menopause

medicalquestions — Thu, 14 Aug 2008 06:00:12 +0000

Question: If you have a hysterectomy, do you still go through menopause?
In a hysterectomy, it is normal to remove the cervix, uterus (womb), both Fallopian tubes and sometimes one of the two ovaries. The remaining ovary will produce sufficient hormone, in most cases, to maintain the woman’s normal sexual functions and prevent the menopause.
In due course, this remaining ovary will cease its production of female hormone, and the woman will develop the hot flushes, depression, irritability and headaches characteristic of the menopause. Because her uterus has been removed, she will not suffer from the heavy and irregular bleeding or the uterine cramps that can also occur with menopause. If during the hysterectomy it is necessary to remove both ovaries because of disease, the woman will lose her female hormones instantly and go through a premature menopause. It is important for these women to take hormone supplements until they are in their early sixties to prevent premature ageing, bone weakness, facial hair, sagging breasts and the other unpleasant effects of the menopause.
Women who have had cancer of the ovaries that has resulted in both ovaries being removed may not be able to use hormone replacement, but should carefully discuss this option with their gynecologist.

Question: I am 62 and on treatment for blood pressure. I am concerned about osteoporosis and heart disease and I am considering using the oestrogen patch. I finished my menopause 9 years ago. Are hormones going to help me now? What effect will it have on blood pressure?
Hormone replacement therapy (HRT) using oestrogen and progestogen is very beneficial to women during and after the menopause. If you have had your uterus removed in a hysterectomy, only the oestrogen hormone is required.
These female sex hormones not only relieve the symptoms of the menopause such as hot flushes, irritability, irregular bleeding, breast tenderness etc., but protect women against osteoporosis (weakening of the bones), hardening of the arteries and heart disease. It is a treatment that I highly commend to all women, and may be taken until you are well into your seventies. There is absolutely no evidence that it will cause any increase in the incidence of breast cancer.
Your blood pressure may actually improve using HRT, but there is no guarantee of this. It will certainly not get worse or interact with your medication. Both oestrogen and progestogen can be taken as a tablet, a stick-on patch that is replaced twice a week, or as an implant every three months. Oestrogen is also available as a vaginal cream that is used once or twice a week.
I strongly suggest that after further discussion with your general practitioner you commence hormone replacement therapy.

Can menopause be controlled?

medicalquestions — Wed, 13 Aug 2008 06:00:42 +0000

Question: As I get older I am scared about the problems of menopause. My mother had a terrible time and I have no desire to follow in her footsteps. Can the menopause be controlled?
I find the biggest problem with the menopause is the failure of my patients to tell me exactly what they are feeling and what affects the menopause is having on them. The first step in treating someone with menopausal symptoms is explanation.
The sex hormones are controlled by the brain, and are released from the ovaries into the bloodstream on regular signals from the pituitary gland, which sits underneath the centre of the brain. Once in the blood, these hormones have an effect on every part of the body, but more particularly the uterus, vagina, breasts and pubic areas. It is these hormones that make the breasts grow in teenage girls, give you regular periods as their levels change during the month, and cause hair to grow in your groin and armpits. For an unknown reason, once a woman reaches somewhere between the early forties and early fifties, the brain breaks rhythm in sending the messages to the ovaries. The signals become irregular and sometimes too strong, at other times too weak. The ovaries respond by putting out the sex hormones in varying levels, and this causes side effects for the owner of those ovaries. The periods become irregular, vary in length and intensity, and may become painful.
Other symptoms can include bloating and associated headaches and irritability as excess fluid collects in the brain, breasts and pelvis; hot flushes, when hormone surges rush through the bloodstream after excess amounts are released by the ovaries; abdominal cramps caused by spasms of the uterine muscles; and depression which can be a reaction to the changes in the body, a fear of ageing or a direct effect of the hormones on the brain.
Menopause cannot be cured, because it is a natural occurrence, but doctors can relieve most of the symptoms. Hormone tablets or patches are the mainstay of treatment. One hormone is taken for three weeks per month, and a different one is added in for the last 7 to 14 days. Minor symptoms can be controlled individually. Fluid tablets can help bloating and headaches, and other agents can help uterine cramps and heavy bleeding. Depression can be treated with specific medications.

Hormone Replacement Therapy

medicalquestions — Wed, 13 Aug 2008 06:00:32 +0000

Question: Should all women use hormones after menopause to prevent osteoporosis?
Women should consider their options at the time of the menopause and discuss them with their doctor. Generally, all women should be on hormone replacement therapy (HRT) after the menopause, not only to prevent osteoporosis, but to also prevent heart disease, strokes, premature ageing of the skin, Alzheimer’s disease and generally protect the body from ageing too quickly.
It always necessary to exclude any contra-indications to HRT, such as liver disease or blood clots.
If a woman is small boned and has a family history of osteoporosis, she has an increased risk of osteoporosis, and HRT is even more important.
The main problem most women complain of with HRT is the continuation of their periods beyond the normal time for their cessation. These periods are usually very light though, and often cease with time. Other side effects are usually related to an incorrect hormone dosage. They include headaches, depression, flushes and pelvic discomfort. As all women are different, finding the correct dosage can sometimes be a matter of trial and error.

Question: I have had breast cancer and a total hysterectomy at a relatively early aqe. I am concerned about premature aqeinq but my doctor says I cannot take hormones. What can I do?
This is an extraordinarily difficult problem to deal with. Most women who have a total hysterectomy take oestrogen to prevent the problems of menopause, but if you have had breast cancer, most doctors believe that you should not use this hormone because it may result in a recurrence of the cancer. More recently, some doctors are using oestrogen in this situation as they argue that oestrogen does not cause breast cancer. I would suggest that you avoid oestrogen unless it is absolutely necessary to use it.
To prevent osteoporosis you should eat plenty of dairy products and take calcium tablets. The premature growth of facial hair can be controlled by a medication called spironolactone. Exercise is important to keep your body toned up as much as possible. A well-fitted bra and possibly plastic surgery may help the sagging breasts and can replace a breast removed for cancer. Skin moisturizers and plastic surgery can be used to control premature skin ageing in all parts of the body.
By being careful with your body and taking the appropriate medical advice there is no reason why anyone should place you in an older age group than you are, and you should live a full and normal life well into your 80s.

Anti-anxiety Drugs

medicalquestions — Tue, 12 Aug 2008 06:00:38 +0000

Question: I have been prescribed Serepax to help me cope with my divorce. What are the main side effects of Serepax? Are they addictive?
The main problems associated with Serepax and the other anti-anxiety drugs are drowsiness and slowed reflexes. These are usually due to a dosage that is too high, but it may just require a few days on treatment for the side-effects to subside. Care should be taken with driving and operating machinery on the first few days of any tranquilliser course. Alcohol will exacerbate the side-effects, and must be avoided.
The major problem is dependence, when too many tablets are taken for too long. This is different to addiction, where severe withdrawal symptoms occur if the drug is removed. Dependence is easier to deal with, but still requires the cooperation of doctor and patient to slowly reduce the dosage of the medication over many months.
If your doctor prescribes a course of tranquillisers for you, please don’t throw up your hands in horror and refuse to take them. He or she will be doing this for good reason, and will be aware of both the problems requiring their use, and the problems that must be avoided by their use.

Question: I have a daughter who takes Tegretol for nocturnal fits. She has only had three in three years, and they follow overwork and stress. Do these tablets cause any liver or kidney trouble, and if she did not take them and had more fits, would she get brain damage?
Pseudo epilepsy is a term that is sometimes used to describe the type of stress-related fits that affect your daughter.
If the fits are always related to overwork and stress, it may be possible for her to take a medication on only those days when she feels that she may have a fit because of these factors. This would probably be more effective, and less annoying, than taking medication long term. On the other hand, Tegretol is a very safe and effective medication for controlling and preventing many different types of fits, and there are no serious long term effects from taking this medication.
Brain damage from fits only occurs in rare situations if the fits are very prolonged, very frequent, and cause serious side effects. This is not the case with your daughter. Discuss using intermittent medication, rather than constant medication, with your daughter’s doctor.

Medicines for Parkinson’s disease

medicalquestions — Tue, 12 Aug 2008 06:00:05 +0000

Question: What are tranquillisers? The chemist told me that the pills my doctor prescribed for my problem were this type of drug. Are they dangerous?
Serepax, Valium, Ativan, Murelax, Frisium, Xanax, Ducene. These are just a few of the trade names for the tranquillisers marketed in Australia by several pharmaceutical companies. Tranquillisers, or anxiolytics (anti-anxiety drugs) are excellent medications if used correctly. Unfortunately, they have received bad press in recent years because of their abuse by a small number of patients.
Tranquillisers are designed to control the stress associated with short term crises in a person’s life. Loss of job, death in the family, marriage problems, trouble at work, disobedient teenage children, financial shortfalls—the list of stresses experienced in modern life goes on and on. If these problems are causing a patient to have sleepless nights, lose concentration, become tearful, temperamental or just feel that they can’t cope, a course of tranquillisers over a few weeks can enable them to see their problems in a more reasonable light and work to overcome them.
Doctors are very much aware of prescribing these products correctly to avoid their long term potential for dependence.

Question: Can you tell me about a drug called Sinemet? My husband has been taking it for years, and I don’t know why.
This medication is used for only one purposes—the treatment of Parkinson’s disease.
The tablet actually contains two medications, which work together to control the stiffness, tremor and mental deterioration that can accompany this disease. It is important to remember that there is no cure for Parkinson’s disease, only control, so the tablets must be taken for long periods. If they are stopped, the symptoms of the disease may return, and a person who is well controlled may deteriorate rapidly. Unfortunately, the disease tends to worsen with time, so often the dosage of medication must be slowly increased, or other drugs added to maintain control.
It is a very safe drug, and there are no problems in using it long term. Any side effects are usually experienced in the first few weeks of treatment, and then subside. If your husband ever sees a doctor or dentist for any treatment, he must make the practitioner aware that he is taking Sinemet, as it can interact with other medications, and can cause problems with general anaesthesia and some diseases.

Are sleeping pills harmful?

medicalquestions — Mon, 11 Aug 2008 06:00:27 +0000

Question: Are sleeping pills harmful?
Most sleeping pills are very safe, provided they are taken in the recommended manner, but if used constantly for many weeks or months, patients may find it very difficult to stop them as they become dependent upon them. The greatest problem with the use of sleeping pills is that they are taken unnecessarily, particularly by elderly people who do not need large amounts of sleep. These pills are better taken intermittently when really needed, and they will work far more effectively.

Question: As a 77 year old, my doctor has suggested that I take 100 mg of aspirin every day to reduce my risk of having a stroke or heart attack, but I have had a stomach ulcer in the past and take Zantac every day. I was told that I should never take aspirin again because of my ulcer. What should I do?
Aspirin is a marvelous medication, and one of the oldest in current medical use, having being first marketed by a German chemist (Bayer) in 1899. It may be used to relieve pain, reduce inflammation (eg. in arthritic joints), decrease the risk of bowel cancer and reduce the ability of blood to clot.
This last use makes it suitable to reduce the risk of blood clots in the brain (stroke) or coronary arteries (heart attack), and as a result it is widely recommended by doctors to be taken regularly by all patients over 50. When used to relieve pain, aspirin is taken in doses of 600 mg (two tablets), four times a day, but when used to reduce blood clotting, only a very small dose of 75 to 100 mg a day is necessary, and strangely, higher doses may be less effective in reducing the risk of clots.
Aspirin also has side effects, most commonly resulting in stomach pain, and sometimes bleeding from the stomach, but this effect is dose dependent, and the higher the dose, the greater the risk of side effects. Low-dose aspirin is available in special formulations that reduce, but do not entirely eliminate, the risk of stomach side effects. These are marketed as Astrix, Cartia and Cardiprin, and are subsidised by the government for pensioners under the pharmaceutical benefits scheme.
It is possible that you will suffer stomach side effects from taking low dose aspirin long term, and if this occurs there is a substitute medication (Plavix), that is much more expensive than aspirin, but it does not have some of the added benefits of aspirin (eg. against bowel cancer). It is only subsidized by the government under very stringent conditions.

Drugs for High Blood Pressure

medicalquestions — Mon, 11 Aug 2008 06:00:06 +0000

Question: Eight years ago, a blood test showed an excess of uric acid, and although I had no problems with gout or arthritis, my doctor put me on Zyloprim each day, saying failure to take the tablet could result in gout. A health shop proprietor said Zyloprim could actually cause problems if taken long term. Can you advise me?
High levels of uric acid in the blood stream can cause recurrent attacks of gout. Because of the severe pain associated with gout, these attacks are very obvious to the sufferer. Uric acid has another more sinister effect on the kidneys. These can be slowly damaged, and unless kidney stones form, the presence of excessive levels of uric acid may not show up until the kidney starts to fail, and the patient presents with a totally different set of symptoms.
Zyloprim (also known as Progout and allopurinol) is a drug that lowers the amount of uric acid in the blood stream. It has been available for over 40 years, so a great deal is known about its side effects and complications. A very small number of patients do have long-term problems with its use, but the risks of using Zyloprim are far less than the risks of high uric acid levels.
Regular blood tests should be performed every year while you are taking the medication to check the level of uric acid, and the liver and kidney function. Some patients require only a low dose of Zyloprim to reduce their uric acid levels, and this can be judged by the blood test results. The drug is available in both 100 and 300 milligram sizes, so reduction of dosage in those patients who can be controlled more readily can be easily achieved. Follow the advice of your doctor rather than a ‘health’ shop proprietor, whose advice may be biased by a desire to sell you his products.

Question: Can you tell me about a drug called Capoten that my doctor has prescribed for me?
Capoten (also known as captopril) is a quite modern drug that is widely and successfully used to treat high blood pressure and heart failure. Its only absolute contraindication is pregnancy, but it should be used with caution in patients with poor kidney function, and care must be used if the patient has a general anaesthetic.
It has few side effects, the most common ones a being a cough and lightheadedness because the blood pressure has dropped too far. Anyone on treatment with blood pressure medication should be checked regularly by a doctor, and provided no problems are found, this medication can be used confidently for many years.