Category Archives: HOUSE Calls

House Calls – Bone Spurs & Colace for Irritable Bowel Syndrome

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House Calls from the Carrboro Citizen 12.15.11

Dear HOUSE Calls, I have a bone spur on my big right toe. I was told if I had surgery for it, it may grow back. Is that true?
That is a great question, and we think you already have the answer. Bone spurs are usually a reaction to chronic tendonitis or foot deformity, and solving the problem won’t eliminate the cause. It also may not eliminate the symptoms. With bone spurs of the heels and toes, we think it is important to understand the cause and try all possible non-surgical approaches before considering surgery. Anti-inflammatories like ibuprofen can help with pain and inflammation, as can ice. Sometimes the most important thing is wearing shoes that fit well; shoe modifications or custom orthotics can change the way your shoes fit. With toe spurs, the most important thing is often ample room in the toe box, which means no pointy shoes. You may want to see someone who specializes in orthotics, like a physical therapist who can help you with the best shoe fit for your problem. Surgery is a last resort, but if you do need surgery, it is still critical to correct the underlying condition that led to the spur. Hopefully if you do that, it will not recur.
Dear HOUSE Calls, I have irritable bowel syndrome and find that taking a daily colace helps me regulate my bowel movements. Is there any problem with that?
We usually don’t think of colace (generic docusate) for the treatment of irritable bowel syndrome (IBS). Most patients with IBS have diarrhea-predominant IBS or fluctuate between diarrhea and constipation. However, there is a subset with constipation-predominant IBS. We have many patients with chronic constipation that get some relief with daily docusate. It acts by softening the stools and drawing water into the colon. This is actually quite safe; just be sure to take it with plenty of fluids. We do discourage people from taking stimulant laxatives daily, but this type of stool softener (like docusate) has little downside, is cheap and is available without a prescription. So our take on this is if it helps you manage your symptoms, this is a perfectly reasonable approach.

 

House Calls – Posture & Ovarian Cancer

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House Calls from the Carrboro Citizen 12.08.11

Dear HOUSE Calls, My son walks and sits with his shoulders bent forward. Are there any health consequences with his back later in life from slouching?
We all just sat up a little – you sound like our mothers. But seriously, that is a great question. a slouch in the shoulder tends to add tension to the neck and can be related to neck pain or tension headaches. Poor posture in the lower back can be related to pain in the lower back. Really the issue is minimizing tension and strengthening more neutral-posture muscles, like those in the abdomen. Does this cause serious harm in the back like arthritis or bone loss? Probably not. However, improved posture and core strength is an important part of back rehabilitation to remove some muscular stress. All in all, most people have poor posture and most people do not have serious back problems. We would recommend not worrying too much about it.
Dear HOUSE Calls, My doctor told me there was no test for ovarian cancer. Is this true?
We have screening tests for many kinds of cancer (colon, breast, cervical, prostate, etc.). However, we don’t really do any population screening for ovarian cancer, and it is a very serious, if not common, form of cancer. About 21,000 women are diagnosed with ovarian cancer each year in the U.S., and 15,000 die from it. There are some tests for ovarian cancer, but the tests have limitations and they don’t make sense for everybody. Ovarian cancer tests include blood marker tests (CA 125), genetic testing and ultrasounds and other imaging studies. Assuming we are talking about average-risk women, the genetic test (BRCA) rarely would be positive and would only demonstrate a genetic risk of ovarian cancer, not the disease. The other tests, both the CA 125 and ultrasound, fail to diagnose many cancers and have too many false positive tests, resulting in more tests or surgery. This is complicated and based on the fact that ovarian cancer is unusual and difficult to diagnose in the early stage, and the tests themselves are just not very good. The U.S. Preventative Services Task Force and the American College of Obstetricians and Gynecology recommend against routine screening for ovarian cancer for average- risk women. However, if you have symptoms such as early fullness, unexplained weight loss or abdominal bloating, pressure or pain, get to the doctor promptly for an exam.

House Calls – Toe Injuries & Flu Shots

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House Calls from the Carrboro Citizen 12.01.11

Dear HOUSE Calls, Last week I smashed my big toe. I don’t think I broke it, but it looks like there is blood trapped under the nail. Will this resolve on its own?
Ouch! the fancy name for this problem is a sub-ungual hematoma. If the hematoma is big and painful, we can relieve it by piercing the nail with a cautery instrument or a hot needle. If it does not hurt much, you can just let it run its course. It may take a month or more to resolve, and you may lose the nail, but it is not dangerous. Of course, we can’t comment on the injury to the toe. Most toe fractures heal without incident, but sometimes big toe fractures need more care, so see your doctor if there is any doubt.
Dear HOUSE Calls, I had a flu shot last month and now I’ve had chest and sinus congestion for a week. Do you think I got a bad shot?
That is a really common question about flu shots. First of all, the flu shot only protects us from influenza though what you have might be the flu, it is more likely a garden-variety viral infection (like an adenovirus or rhinovirus). That does not mean it’s not miserable, just that it’s not the flu. Flu is typically characterized by fever, dry cough and muscle aches. Flu is more likely to result in complications like pneumonia or even death than these other viral infections. That is really the main reason we encourage flu shots. Second, you should know that not all flu shots cover or match with all strains of the flu. Infection experts study trends in circulating flu strains and make predictions six to 12 months before flu season as to what are likely to be the most common circulating strains of flu in the upcoming season. these experts are right most of the time, but not always, and there are always less-common circulating strains. Lastly, not all people will develop a robust immune response to all flu vaccines. the immune response tends to be better if you have received the vaccine in the past. So the short answer to your question is no, we doubt you got a bad shot. However, you probably don’t have the flu. Good for you for getting your flu shot and protecting yourself and those around you from the flu.

House Calls – Insulin Levels & Shin Splints

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House Calls from the Carrboro Citizen 11.23.11

Dear HOUSE Calls, What can I do to control my insulin levels?
Insulin is one of the hormones that regulates blood sugar levels. It’s necessary to get nutrients into the cells to make energy. People with insulin-dependent diabetes make no insulin and need insulin from a shot or pump to survive. People with non-insulin dependent diabetes usually have higher-than-average levels of insulin, but their cells cannot use insulin as well as others. This is known as insulin resistance, and when insulin resistance increases, the body compensates by increasing insulin production. High levels of insulin are often a precursor to diabetes, and controlling your insulin level can prevent diabetes. The best things to do to control your insulin level are exercise daily; eat a balanced, healthy diet; and lose weight. We know that is a tall order, but losing weight if you are overweight is the best way to control insulin levels if you have diabetes or just high insulin. Working with a nutritionist or a specific diet program may be helpful. Foods high in processed carbohydrates (like sugar and white flour) may be particularly likely to increase insulin levels. We would also encourage you to work with your family doctor to set goals and determine appropriate medications.
Dear HOUSE Calls, Sometimes I get shin splints walking to class. What causes that?
Shin splints cause pain near the tibia or shinbone, usually on the inside of the leg. We think of this as an overuse injury, which usually comes from increasing use in a sporadic or intermittent fashion. For example, if you are sedentary over the summer and then start walking several miles a day, you would be at risk for shin splints. This is a fairly common problem in runners, often from a training error in which people increase training volume too quickly. Additionally, people who pronate too much and those with relatively flat feet are prone to shin splints. The good news is that shin splints usually respond well to conservative measures such as relative rest, ice, over the-the-counter arch supports or custom orthotics and more supportive shoes. We encourage you to keep up with the increase in physical activity while giving your shins a break. Try swimming or biking. We hope this helps.

House Calls – Processed Food & Restless Sleeping

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House Calls from the Carrboro Citizen 11.17.11

Dear HOUSE Calls, What is the long-term effect of processed foods on the American public?

That is no small question. First off, let’s recognize that not all processed foods are the same, and some companies are making a real effort to decrease the processed carbohydrates, trans fat and sodium contents in processed foods. Most of what we eat is processed. At the grocery store, usually the stuff around the edges is whole food (produce, meat, dairy) and everything else is processed to some extent. about 90 percent of the American diet is processed, and what may be worse is that 25 percent of Americans eat fast food every day, and 30 percent of children do so. Why do we eat processed foods? It is easier, cheaper and may taste better, but excess fat and carbohydrates can lead to obesity, diabetes and heart disease. Excess sodium can lead to high blood pressure. And there are countless artificial additives with lesser-known long-term health effects, though most are probably safe. One of the important points about processed food is that your diet is made up of what you eat and also what you don’t eat. If you are eating out of a box, you are eating less from the produce aisle. Half our plate should come from the produce aisle in order to get a diet high in fiber, lower in calories and rich in vitamins and minerals. Lastly, not to get too sentimental, but eating out of a box or at the drive-through may reflect a cultural or social change from eating with families and talking.
Dear HOUSE Calls, I roll around a lot in my sleep, often keeping people awake. Is there a reason for that? Is it a problem?

That is a really interesting question. First, everybody moves in their sleep. We have studied people during sleep with video and find that sleep movement is universal and more frequent than most of us think. However, if sleep movement is causing problems for you or your bed partner, you may want to talk to your doctor about it. Sleep movement can interfere with deep sleep and leave the person feeling poorly rested after sleep. Often it is accompanied by an uncomfortable feeling in the legs known as restless leg syndrome. Sometimes sleep movement can be a real problem for bed partners, actually hurting them or just interfering with their sleep. We hope that helps you get started.

House Calls – Back Pain & Sleep Apnea

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House Calls from the Carrboro Citizen 11.03.11

Dear House Calls, I have degenerative disc disease in my lower back and I am in constant pain. I am now seeing five different doctors; I am looking for some help in dealing with this chronic pain.

We are so sorry that you are suffering. Degenerative disc disease refers to the discs in between the vertebrae getting worn down over time. This is extremely common. It is the reason most of us lose about 1 inch of height in our later years. It is not well understood why some people with this condition will have a great deal of pain and others will not. Living with chronic pain can be really difficult. The good news is that for most people, it will not get worse and can be controlled to a tolerable level. Five doctors sure sounds like a lot. We won’t have a magic answer for you that all of these doctors could not give you. For most people, treatment of lower back pain includes staying as active as possible. Lying in bed or sitting on the couch is quite bad for your back, not to mention the rest of your health. We also would encourage you to work on strengthening your core, including your abdominal muscles, back muscles and oblique muscles. Swimming can be great core exercise. Physical therapy can help with core and back strengthening and stretching exercises. Medicines can help as well, especially anti-inflammatory medicines like ibuprofen. We usually avoid stronger medicines, such as oxycodone (Percocet) and hydrocodone (vicodin), for long-term treatment of back pain. Over time, they don’t do much good and they cause many other problems. A team approach is important for you. That team should involve your primary-care doctor, probably a physical therapist, possibly a pain specialist and possibly a mental health specialist who can help with coping with chronic pain. Good luck, and we hope you get some relief.
Dear House Calls, I am currently losing weight and wondered if that is likely to help my sleep apnea.

Congratulations that you are working on losing weight. The good news is, yes! We talk about sleep apnea machines that help keep a relaxed airway open, but two of the most common reasons people get sleep apnea are excess weight and smoking. So working on either one of these problems, or both if they apply, can make a big difference. Not to mention that losing weight will improve your overall health and may, in and of itself, help with daytime sleepiness and fatigue. Congratulations again, and thanks for sharing your good news.

HOUSE Calls: Questions answered about Tdap vaccine, cholesterol

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Read questions and answers about the Tdap vaccine and cholesterol in The Carrboro Citizen – June 2, 2011

My daughter had a baby last week and she had to have a Tdap vaccine. I’m going to be visiting. What is a Tdap vaccine and do I need one?
I just moved here from Atlanta and had a physical with lab work from my new doctor. He just gave me a sheet with a bunch of numbers and not much explanation. It says my HDL is 37, and that that’s low, and that my LDL is 102, and that that’s normal. So is this good? What is the good and bad cholesterol? I am used to a little more explanation.