DEAR READERS: In yesterday's column, I responded to a reader's question about acute pharyngitis -- inflammation of the throat caused by infection with bacteria or viruses. I was taught that diagnosing and treating a patient with a sore throat was not complicated: The sore throat was caused either by Group A streptococcus ("strep," a kind of bacteria) or by a virus. If a throat culture showed strep, you treated it with penicillin. Simple. But in my view (some colleagues disagree), it's not that simple. The risk from an untreated infection with Group A strep is much lower today in the United States than it was 70 years ago. That means that the value of treatment is reduced. But the chance of side effects from the treatment -- antibiotics -- is not reduced.
Archive for June, 2015
DEAR DOCTOR K: I saw my doctor last week, who said I had acute pharyngitis but didn't say what that was. It sounds serious. What is it?
DEAR READER: Good news: It's rarely serious. I know the word "acute" in front of any medical term makes it sound serious. And I know that Latin-based words like "pharyngitis" sound alien. But acute pharyngitis simply means that your throat has become inflamed by something, usually an infection.
DEAR DOCTOR K: I have Peyronie's disease. Are there any effective treatments for this condition?
DEAR READER: Peyronie's disease is, fortunately, relatively uncommon. About 5 percent of men in the United States may have it. The condition affects the penis. It causes inflammation and then scar tissue to form in the area of inflammation. The scar tissue accumulates and hardens, causing the penis to bend when it becomes erect, and potentially keeping it from becoming fully erect. This can make sexual intercourse difficult and painful. (I've put an illustration, below, showing the effect of Peyronie's disease.)
DEAR DOCTOR K: I have Sjogren's syndrome. People tend to dismiss it as a problem with dry eyes, but it's so much more than that. Can you please describe this condition for your readers?
DEAR READER: Sjogren's (pronounced "show grins") syndrome is a lifelong condition. It does tend to be best known for causing dry eyes, but it can cause other problems as well. For example, Sjogren's syndrome can produce dry mouth and affect any of the body's glands, including those that secrete sweat, saliva and oil. About half of people with Sjogren's syndrome also have another connective-tissue disease such as rheumatoid arthritis or lupus. Named after Swedish eye doctor Dr. Henrik Sjogren, this syndrome affects people of all ages and races. However, 90 percent of all cases involve women, most commonly between the ages of 45 and 55.
DEAR DOCTOR K: My grandmother has Alzheimer's disease. Over the past few years I have watched the disease take a toll on her judgment, memory, even her personality. How does Alzheimer's wreak so much havoc in the brain?
DEAR READER: In the past 25 years, medical science has learned a great deal about what causes Alzheimer's disease. Before that, we basically knew just that the brains of people with this disease, viewed with a microscope, had some unusual features. We knew that the disease caused brain cells to die prematurely, but we didn't know why. Today, I think we are closing in on understanding some major causes (if not all of the causes) of brain cell death.
DEAR READERS: Yesterday, I answered a question about treatments for heart failure. It's a big topic, and so today I'm talking about the medicines that are typically used to treat heart failure. As we discussed, heart failure is a condition in which the heart cannot pump efficiently enough to meet the body's need for blood. As a result, tissues and organs throughout the body don't get enough oxygen. Also, fluid builds up in the lungs and other body tissues. Taking heart failure medicines as prescribed is perhaps the single most important thing you can do to feel better and live longer. The medicines available today are dramatically more potent than the medicines that were available when I was in medical school.
DEAR DOCTOR K: I've been diagnosed with heart failure. Thankfully, it is still in the early stages. What can I do to keep it from getting worse?
DEAR READER: The function of the blood is to carry nutrition to every cell in the body and to carry away waste from the cell. The function of the heart is to keep pumping blood so that the blood reaches every cell in the body. Heart failure is a condition in which the heart cannot pump efficiently enough to meet the body's need for blood. As a result, tissues and organs don't get enough nutrition, and fluid builds up in the lungs and tissues.
DEAR DOCTOR K: My doctor advised me to take a vitamin D supplement. Why do I need vitamin D? Also, my pharmacy sells vitamin D in two forms: D2 and D3. What is the difference, and which one should I take?
DEAR READER: This is an area full of controversy because not enough research has been done. I typically recommend getting vitamins from food, but vitamin D is found naturally in only a few foods. Fatty fish is the main dietary source, and milk, many juices and breakfast cereals are fortified with it. We get most of our vitamin D from the sun: When sunlight strikes the skin, skin cells make vitamin D. But these days, people get a lot less sunlight than they used to.
DEAR DOCTOR K: I'm thinking of retiring, but I've always had a very busy and fulfilling career. How will I make the transition to retirement? Or should I continue working until I no longer can?
DEAR READER: This might seem like an unusual subject for a doctor writing a column about medical problems, but I get asked this question all the time. Indeed, the decision you make about it might well affect your future health. I'm assuming from your question that you have no financial need to continue working and that your health allows you to do so. Even if it does, there's no doubt that one's energy declines with age. If your work is intense and involves long hours, there will come a time when it's no longer possible to do that work well.
DEAR DOCTOR K: I think my 9-year-old son may have OCD. How is this condition treated in children?
DEAR READER: Before discussing treatment for OCD, it's important to describe what it is. You know, of course, but other readers may not. Children (and adults) with obsessive compulsive disorder (OCD) are troubled by repeated, intrusive, distressing thoughts (obsessions). These obsessions cause great anxiety. As a result, people with OCD often have a strong urge to repeat certain behaviors (compulsions) in order to reduce the anxiety. For example, people who have obsessive thoughts about germs may repeatedly wash their hands.