Archive for September, 2015

How long do I need to take my antidepressant?

DEAR DOCTOR K: I've been on an SSRI antidepressant for a few months, and it has really helped improve my depression. How long do I need to take this medication?

DEAR READER: If you're fortunate enough to find an antidepressant that lifts your dark mood, and you aren't too troubled by its side effects, your doctor likely will renew the prescription indefinitely. As long as you continue taking the medication, you are unlikely to suffer a relapse of your depression. But perhaps you're having bothersome side effects. Selective serotonin reuptake inhibitor (SSRI) drugs, like fluoxetine (Prozac) or sertraline (Zoloft), sometimes cause side effects.

Surprising number of conditions cause vitamin B12 deficiency

DEAR READERS: In yesterday's column I began to answer a reader's question about the different causes of vitamin B12 deficiency, and whether to treat them with shots or pills. Today, we continue a discussion of the many conditions that can interfere with the ability of the small intestine (the part called the ileum) to absorb vitamin B12 from the foods you eat. As we get older, some people have more trouble absorbing the vitamin B12 in their food during digestion. Vitamin B12 in food is like leaves on a tree: It needs to be shaken loose. Stomach acid (and another stomach chemical called pepsin) are what shake vitamin B12 loose from food, allowing it to be absorbed by the ileum.

Can I take a supplement for my vitamin B12 deficiency?

DEAR DOCTOR K: I was recently diagnosed with a vitamin B12 deficiency. Can I take B12 supplements by mouth? Or do I need the shots?

DEAR READER: Tissues throughout the body need vitamin B12, especially in the brain, spinal cord and bone marrow, where blood cells are made. Vitamin B12 in the diet gets absorbed in the part of the small intestine called the ileum. There, it enters the blood. Vitamin B12 deficiency can cause anemia, and problems with the bones, brain and spinal cord. Low vitamin B12 levels in the blood basically have two causes: Either there is not enough B12 in the diet, or the B12 in the diet has trouble getting absorbed by the ileum. B12 is found naturally only in animal products like meat, fish, poultry, eggs and milk. Many cereals are fortified with it.

I’m seeing my doctor for frequent headaches. What is likely to happen at the appointment?

DEAR DOCTOR K: I've made an appointment to see a doctor because of my frequent headaches. What is likely to happen at the appointment?

DEAR READER: If your headaches are severe, occur often, or are unresponsive to nonprescription pain relievers, it makes sense to see your doctor. He or she will try to determine the causes of your headaches and design a treatment plan. Your appointment is likely to begin with a series of questions about your headaches.

What is a patient-centered medical home?

DEAR DOCTOR K: I've been going to a family medicine practice for years. My doctor just told me the practice is going to become a "patient-centered medical home." What does that mean? How is this going to affect my health care?

DEAR READER: Many family medicine practices across the country are switching to a team-based model of care called a patient-centered medical home (PCMH). The PCMH turns a doctor's practice into a physician-led team. This team will develop a long-term treatment plan for you that focuses on prevention. Basically, the PCMH was born out of the realization that 21st-century medical care has become more complicated.

Should I read with my toddler every day?

DEAR DOCTOR K: My pediatrician has urged me to read with my toddler every day. Why? And where do I begin?

DEAR READER: Reading with children at a young age helps them develop their reading skills and language. A child who reads with his or her parents will learn to enjoy books, learn to read faster and want to read more. But reading to a baby is more than that. It's also a bonding experience. Even though the baby can't really understand, he or she will begin to connect spoken words to the words printed on a page. The baby will enjoy the sound of your voice and start to develop listening skills. And the book will have pictures that awaken the baby's curiosity.

How can I reduce the risk of side effects of new medications?

DEAR DOCTOR K: I need to start taking a new medication to treat a recently diagnosed condition. Is there anything I can do to reduce the risk of side effects?

DEAR READER: My colleague Dr. Gordon Schiff, associate professor of medicine at Harvard Medical School, says it well: "All drugs have effects -- the ones we want and the ones we don't. The unwanted effects are known as side effects." When you take a drug, it is distributed throughout your body, to all your organs and tissues. The drug may do different things in those different organs.

How can we protect our eyes from the sun?

DEAR DOCTOR K: Does spending time in the sun pose a threat to our eyes? What can we do to protect ourselves?

DEAR READER: Yes, it does. And to a large extent, the damage may already be done. I spoke to Dr. Louis Pasquale, an ophthalmologist at Harvard-affiliated Massachusetts Eye and Ear Infirmary. He noted that spending a lot of time in the sun without sunglasses when you're young may put you at risk for developing eye problems when you're older. The damage would probably be done in your 20s and 30s.

Can erectile dysfunction be caused by vascular disease?

DEAR DOCTOR K: My doctor says my erectile dysfunction is most likely caused by vascular disease. Can you explain the connection?

DEAR READER: Erectile dysfunction (ED) -- trouble attaining and sustaining an erection -- is quite common in men over age 40. Why, you might ask, would nature (evolution) not preserve something so important to the continued existence of the human race? The average life expectancy throughout most of human history has been less than 50 years. Guys, we were not built to last!

Can vitamin C boost your immune system and prevent colds?

DEAR DOCTOR K: Whatever happened to the idea that vitamin C can boost your immune system and prevent colds?

DEAR READER: Vitamin C, also known as ascorbic acid, was promoted as a health supplement for decades. It is perhaps best known for its one-time reputation for preventing and treating the common cold. This idea was heavily promoted in the 1970s by one of the 20th century's most celebrated biochemists, Nobel laureate Linus Pauling. But Pauling did not win the Nobel Prize for his theories about vitamin C. Vitamin C is crucial for making collagen, the substance that lends structural support to tendons, ligaments, bones and blood vessels.