What are effective treatments for fecal incontinence?

DEAR DOCTOR K: In an earlier column, you wrote about causes of fecal incontinence. You mentioned that there are effective treatments. Can you tell us about them?

DEAR READER: Although there are surgical treatments for fecal incontinence, simpler treatments usually do the trick. They range from dietary changes to bowel training. Today I'll discuss non-surgical treatments. In tomorrow's column I'll discuss surgical treatments. One of the most effective ways to reduce fecal leakage is to increase your fiber intake.

How do you treat tinnitus?

DEAR DOCTOR K: I have a constant ringing or buzzing sound in my ears. It's been going on for months. What can I do? It's driving me crazy.

DEAR READER: You probably have a condition called tinnitus. It's pretty common. Many of my patients have it. Occasionally, I have it. It doesn't usually affect your hearing. But it can be really annoying and distracting, enough so that it affects people's level of function.

Is a vegetarian diet really better for your health?

DEAR DOCTOR K: I'm thinking of becoming a vegetarian. But I need to be certain -- is a vegetarian diet really better for your health?

DEAR READER: The answer is: it depends. Just avoiding meats and eating only vegetables can be accomplished in both healthy and unhealthy ways. After all, a vegetarian who subsists on meat-free pizza and grilled cheese sandwiches isn't doing himself any favors. And, believe it or not, I've had more than one "vegetarian" patient whose diet was like that. However, for a while now, it's been clear that healthy, plant-based diets may improve long-term health. Such healthy vegetarian diets include proteins from vegetables (peas, spinach, broccoli, Brussels sprouts and many others) and carbs from whole grains.

What are considered bad carbs?

DEAR DOCTOR K: You talk about "good carbs" and "bad carbs" in your column. Since I know new studies sometimes change thinking, I'm wondering if "bad carbs" are still bad -- because I like eating them.

DEAR READER: I've got some bad news for you. If anything, the case against bad carbs is growing stronger. To refresh everyone's memory, let's distinguish good carbs from bad carbs. Carbohydrates are found in a broad range of foods; some are healthy and some aren't. Table sugar, fruits and vegetables, and grains such as rice and wheat are all carbs. But they aren't equal in how they affect your body.

What is intermittent explosive disorder?

DEAR DOCTOR K: My son's doctor thinks he might have intermittent explosive disorder. I know my son has a bad temper, but I was surprised to hear that it might be a "disorder." Can you tell me more about this? What can I do to help my son?

DEAR READER: Under severe enough stress, any normally calm and collected person might become angry -- and might even be provoked to the point of violence. But some people lose their temper easily and repeatedly. In these people, tension mounts until there is an explosive release. This behavior pattern is called intermittent explosive disorder (IED).

What is the treatment for melanoma?

DEAR DOCTOR K: My doctor just discovered that I have melanoma, but didn't really explain the treatment. Can you tell me what I'm in for?

DEAR READER: Melanoma is skin cancer that begins in the melanocytes -- cells that give skin its color. Usually these cells first form a precancerous condition called a dysplastic (diss-PLAS-tik) mole. Then the cells turn cancerous and start to reproduce aggressively.

Risk factors for heart disease determine statin use

DEAR READERS: In yesterday's column I began to answer a reader's question as to what I thought about the new statin guidelines. Today, I finish my necessarily long-winded answer. Statin drugs have (at least) two powerful effects. They lower blood levels of LDL cholesterol (so-called "bad" cholesterol). They also fight inflammation. Old guidelines said doctors should prescribe statins for people whose LDL cholesterol levels were high. New guidelines say that doctors should prescribe statins to people who are at high risk for heart disease, even if their LDL cholesterol levels are not high. These guidelines are controversial.

Are the new statin guidelines better than the ones they replaced?

DEAR DOCTOR K: My doctor put me on a statin in 2013 because the guidelines that came out that year said I should be on them. Are the new guidelines really better than the ones they replaced?

DEAR READER: I'm sorry you asked that question, because any answer I give will be criticized by some of my colleagues on the faculty of Harvard Medical School. This is a very controversial area, and my colleagues all have strong opinions -- just not the same one.

Should you still eat fish even if there’s a chance you could get mercury poisoning?

DEAR DOCTOR K: I've been hearing for years that eating fish is healthy. But I also hear that mercury and other poisons can be in fish. I like the taste of fish, but should I seek it or avoid it?

DEAR READER: Questions from readers so often ask about the benefits versus the risks of lifestyle practices, or medical tests and treatments. That's because most things have both benefits and risks -- and eating fish is no exception. Fish ranks way up there on the list of healthful foods we should be eating.

I’m a healthy 55-year-old man. Should I get the shingles vaccine?

DEAR DOCTOR K: I'm a healthy 55-year-old man. Should I get the shingles vaccine? And while you're at it, what exactly is shingles?

DEAR READER: Shingles is a condition that results in a rash and pain. It is caused by the same virus (called VZV) that causes chickenpox. After a case of chickenpox, the virus can lie dormant inside your nerves for decades. By "dormant," I mean that it is not multiplying -- it just lies there inside the nerve cells.