Archive for 2012

Can pelvic inflammatory disease affect fertility?

DEAR DOCTOR K: I have pelvic inflammatory disease, and I'm worried this could affect my fertility.

DEAR READER: You're right to be concerned. Pelvic inflammatory disease (PID) is the most common preventable cause of infertility in the United States. The more often a woman gets PID, the greater her risk of becoming infertile. Most cases of PID develop from sexually transmitted diseases (STDs), usually gonorrhea or chlamydia.

Should I have a C-reactive protein test?

DEAR DOCTOR K: The last time I had blood work, my doctor didn't check my CRP level. Wouldn't my CRP level have given him a better idea of my risk of heart disease?

DEAR READER: You ask a good -- and controversial -- question. Let me say up front that this test has been developed and studied by a colleague of mine at Harvard Medical School, and revenue from the test comes to my colleague and to the hospital where I practice. Also, I'm talking only about the use of the CRP test to screen for future heart disease in people who are not known to have heart disease. I'm not talking about using the test in people who already have heart disease.

Is smokeless tobacco safe?

DEAR DOCTOR K: Is smokeless tobacco safer than cigarettes? What about other non-cigarette tobacco products?

DEAR READER: It's tempting to think so, but there is no safe way to use tobacco. Any level of tobacco, in any form, increases your risk of heart attack, stroke, emphysema, chronic bronchitis, pneumonia, lung cancer and other cancers. Don't fool yourself into thinking that any tobacco products are safe to use.

What should I know before entering a clinical trial?

DEAR DOCTOR K: I have prostate disease and treatment hasn't worked. My doctor suggested I participate in a clinical trial. I'd like to know more before I give him an answer.

DEAR READER: When established treatments aren't effective, participation in a clinical trial can be a good option. Such trials give you access to promising treatments that might work better than one already on the market. On the other hand, clinical trials test treatments that are still under investigation. There may be unpleasant or serious side effects. Clinical trials are designed to minimize risks to participants, but they cannot completely eliminate them.

What can I do about resistant hypertension?

DEAR DOCTOR K: I've made lifestyle changes and take three blood pressure medications, but my blood pressure still isn't where my doctor wants it to be. What else can I do?

DEAR READER: Sometimes high blood pressure (hypertension) doesn't respond to lifestyle changes and medications. This is called resistant hypertension. It is blood pressure that lingers above target levels despite the use of three medications.

What should I know about being treated for breast cancer?

DEAR DOCTOR K: I was just diagnosed with breast cancer. I've found an oncologist, and she's great. Now what can I do?

DEAR READER: I'm glad you've found a great doctor. The choice of treatments depends both on the details of your cancer and your own values. For example, how important is it to preserve your breast if the doctor says removal of the whole breast has a slightly better prognosis than just removing the cancer from the breast? So I hope your doctor will take the time to get to know you and your priorities. You should feel comfortable asking your doctor questions and making decisions with her.

Do vitamin C or milk have an effect on colds?

DEAR DOCTOR K: My mom always told me to take vitamin C and not to drink milk when I had a cold. Is this true or just an old wives' tale?

DEAR READER: The idea that vitamin C supplements might prevent the common cold, or shorten the duration and reduce its symptoms, was popularized by the biochemist Linus Pauling. Randomized controlled trials involving thousands of people were conducted. My interpretation of the results of those studies is that they showed no evidence that vitamin C supplements reduced the duration or severity of the common cold. There was weak evidence that they might reduce the risk of catching it.

Can vibration therapy prevent osteoporosis?

DEAR DOCTOR K: I've heard that vibration therapy can help to improve bone density. Can you tell me more about it?

DEAR READER: Our bones are in constant flux, as old bone is broken down and new bone is created. If old bone is broken down faster than new bone is created, low bone density and eventually osteoporosis develops. After menopause, women are more prone than men to develop osteoporosis. One reason is that their natural estrogen levels drop, and estrogen helps preserve bones. Women are advised to stimulate their bones through physical activity, particularly weight-bearing and resistance exercise. That's because stress placed on the bones through activities such as running and weightlifting makes bones denser and stronger. Many drugs are also used to prevent and treat osteoporosis.

What are some non-dairy sources of calcium?

DEAR DOCTOR K: I need to get more calcium, and I'd like it to come from foods rather than supplements. I'm a vegan, so dairy products aren't an option for me.

DEAR READER: When most people think of food sources of calcium, they think of milk and cheese. Vegans can't eat food that comes from animals, so those sources of calcium aren't available to you. But getting calcium from food sources is becoming easier for vegans. There are many vegan foods that are naturally rich in calcium, and more foods than ever are fortified with calcium, including some cereals and orange juices.

What is an autoimmune disease?

DEAR DOCTOR K: I keep hearing the term "autoimmune disease." What does it mean?

DEAR READER: In most people, the immune system does a good job of protecting them from infection. But sometimes the immune system mistakenly turns against the very body it's designed to protect. When this happens, the resulting conditions are known as autoimmune diseases.