Ask Dr. John

Diagnosis Questions

Sylvia writes: "We would like to know what exercises the neck?"

That depends on what is causing the neck pain. If it's because of an infection, like strep throat, pharyngitis or even meningitis, antibiotic medication might be needed. If it's due to problems with bones or the spinal column in the neck, then surgery might be needed. However, the majority of neck pain we tend to suffer from is musculoskeletal in nature. In other words, it's due to a strain in the muscles supporting the neck. Things that help relieve this pain include anti-inflammatory medications, ice or warm packs, and not over using the area. Once the pain improves, stretching exercises can help both improve the pain and stop it from returning again. Gently rotating the neck around and from side to side can help stretch it and keep it limber.

Gayle writes: "If you have been diagnosed with polyps in your colon should you stay away from eating nuts, tomatoes or any fruit with seeds?"

I think you are more referring to a condition known as diverticulosis and not intestinal polyps. Polyps are small pieces of tissue found hanging off the inside of the colon on a colonoscopy. Since they can be pre-cancerous they are usually removed and sent OT the lab for an analysis. Diverticulosis, on the other hand, is a condition in where the inside lining of the colon has small pouches that bulge outwards. These small pouches are weak spots in the lining that can cause cramping and bloating although most people with this condition have no symptoms. If these pouches get infected it's then called diverticulitis and people with this condition have abdominal pain, typically on the left side, bloating and possibly fevers and vomiting. This condition requires antibiotic therapy. Diverticulosis can change to diverticulitis if food particles get caught in the pouches, so that is why you are told to avoid nuts, tomatoes or fruits with seeds in them. These small pieces of food can get caught in the pouches which can then lead to an infection.

Janny writes: "I just had surgery for a gastric volvulus and asplenia. How long does full recovery take? I wasn't super active before the surgery, but I'm trying to now."

Recovery after surgery depends a great deal on both the type of surgery and how good of shape you were in going into the surgery. A gastric volvulus is a rare occurrence in adults and happens when the stomach abnormally rotates in the abdomen. When this happens, the intestine can be blocked and that can result in severe vomiting, bloating and pain. It usually requires surgery to fix. Asplenia refers to the removal of a person's spleen, or lack of a spleen because of surgery or trauma. Having both these types of surgeries is a big procedure so recovery can take some time. It might be 6 months to a year before you are fully recovered. Your best course of action is to strictly adhere to your surgeon's post surgical recommendations.

Janny writes: "I'm glad to see recommendations are finally coming out for new moms and blood clots. My sister-in law died 11 days after giving birth from superior sagittal thrombosis."

This is something that happens more often than I think people realize. And it can not only occur while pregnant or delivering, but also even for a few weeks after giving birth. Looking for the warning signs, including leg swelling, shortness of breath or chest pain is important. If any of these are noted then getting to the Emergency Room is crucial to both rule out any type of blood clot and, if found, to start treatment as soon as possible.

Pam writes: "How do you cure black toenail fungus, without it costing a lot of money?"

A toenail fungus can be very difficult to get rid of. Although most toenail fungus conditions do result in yellowed, thickened, cracked nails some do result in a blackening of the nail instead. However, other conditions can also result in a black toenail. Most notably among this is the toenail condition that runners get from constant damage to the nail resulting in blood building up underneath the nail. This nail will usually fall off on its own. Fungal toenail treatment consists of either a liquid applied directly to the nail or anti-fungal medication you take by mouth. Both have to be used for long periods of time to be effective and both can have side effects, especially the oral medications, so you need to check with your doctor before using them. However, there have been some reports of long term use, up to 48 weeks, of Vick's Vaporub, applied to the toenail, helping to get rid of the fungus.

Mary writes: "After surgery in 2009, I have learned that during a surgery I had a nerve was cut. As a result, I have a protrusion (similar to a hernia) in my stomach and loss of mobility. The nerve is part of the rectus and oblique muscle which are either completely or partially atrophy. My right diaphragm was damaged and the abdominal walls are thin. I have been examined by many surgeons including a plastic surgeon. I have extreme discomfort, but have been told that I have to live with it. Physical therapists state that the damage is structural. Is there any recourse? Are there any tests that can be performed to understand the structural change? What, if anything, can I do to remedy the discomfort and increase the mobility?"

Unfortunately if a nerve was cut during surgery, especially a big nerve, this condition is often permanent. In your case it has resulted in the muscle atrophying and shrinking and some discomfort. Since you have been seen by many surgeons, I'm not sure I have any other suggestions other than some additional testing that might help you get a better idea of how much damage was done. It's possible that an EMG test can help determine exactly which nerve was cut. Also, a CT scan might give you a better idea if there is any other issue that could be also contributing to your symptoms.

Carl writes: "I just had my yearly physical and my PSA was 6. My doctor checked me and he said everything seems to be just fine. What is a reading of 6? I am 72 years young."

The PSA, or prostate specific antigen, measures a substance produced by the prostate gland in men. Elevated levels may indicate prostate cancer or non-cancerous conditions like prostatitis or benign prostatic hypertrophy. There is a big debate in the medical community right now over what to do with PSA values and who needs to get this screening test. Your number of 6 appears to be a little high for your age and is something you should talk with your doctor about, especially considering all the confusing news out lately about this test.

Mary writes: "I contracted shingles three weeks ago. I am healing quite well now. What can be done to prevent the virus from awakening and attacking my system? And upon full recuperation, what can I do to prevent getting them again? Is the shot a cure? Or is there some health prevention I can do?"

Shingles is also known as Herpes Zoster. When we get sick with the chicken pox virus as kids, although the rash goes away, the virus never does. It remains hiding out in our bodies, staying in place because our immune system keeps it at bay. However, once our immune system weakens a little bit, either because of age, illness or even excessive stress, this virus decides to rear its ugly head. Since it's been hiding out in the nerves, it pops out and creates a rash along the skin the nerve attaches to. Sometimes you might feel a burning or tingling sensation for a few days before the rash breaks out, then you might notice small red blisters. One hallmark to this rash is that since it follows the nerves in your body, it doesn't cross the middle part of your body (just like your nerves). It will only stay on one side or the other. Shingles can strike twice or more in the same person, but only around 5% have a reoccurrence. The best ways to prevent shingles, and its possible long-term nerve pain, is to maintain a healthy immune system and, if appropriate, get the shingles vaccine. Your doctor can help you decide if the vaccine is appropriate for you.

Marlene writes: "I have been told I have severe arthritis and a slight tear in my shoulder. My doctor recommends a shoulder replacement. Are there any alternative treatments?"

There are certainly some alternatives you can try, but in some cases surgery is the one option that will provide the most relief. Depending on the severity of your arthritis and tear, certain medications, especially non-steroidal anti-inflammatory ones, might provide some relief. This along with physical therapy has helped many get their pain and immobility under control. Others have gotten relief from steroid injections into the shoulder. If surgery is necessary, there are various options there as well. Shoulder arthroscopy is a less invasive treatment that can help both detect the problem and in some cases relieve the pain. It's a less intense surgery that helps with less extensive forms of arthritis. In more extreme cases, a shoulder replacement surgery is needed. This procedure removes the arthritic cartilage and replaces it with a plastic and metal socket and ball.

Garland writes: "I have tinnitus, ringing in the ears. Is there a cure? (I am in a study taking neramexane mesylate.)"

Tinnitus is a ringing, roaring or buzzing sound in one or both ears. It can either be a low level sound or one that is very load and can sometimes be intermittent and other time be there continuously. It's not usually a sign of anything serious, but can be very annoying, interfering with sleep and some daytime activities. The medication you're on seems to be one from a clinical trial. It's not FDA approved yet, but the company making this drug is conducting trials to see if it can gain approval for use in tinnitus. I'm not sure if it's working for you or not, but hopefully so. Tinnitus usually comes about because the little hairs inside our ear get damaged, usually from lifelong exposure to loud noises. Sometimes it can also be caused by medications you're taking. Go over all your meds with your doctor or pharmacist to make sure you aren't on one that causes this condition. If you are, talk with your doctor first to make sure you can switch to something else. Tinnitus can be treated a variety of ways, although no one way is successful for everyone. Masking devices, which look like hearing aids, produce a low level sound that can help counter tinnitus. Some report great success with this, but others say it either did nothing or made their condition worse. Another treatment is tinnitus retraining therapy (TRT). This basically trains you to ignore the noise in your ear and is done at special centers or audiological practices. It does use an external device generate a noise that helps cancel out tinnitus and it can be a year or two before you don't need that device. Although studies don't confirm much improvement, some tinnitus support groups say their members have been helped by electrical stimulation or acupuncture. Your best bet is to try different therapies to see which one works for you.

Debbie writes: "About 6 years ago, I was diagnosed with osteoporosis. Mr doctor put me on Boniva. I tried to take it, but suffered severe lower spine pain. She then tried a nasal spray, and the same thing happened. I try to eat food rich in calcium, but I can't take calcium supplements because of my diverticulitis. I walk everyday and eat right, but I feel no matter what I do I will most likely end up in a wheel chair and in pain. I am only 54 years old. Is there anything I can do?"

As a woman you end up having the most amount of bone by the time you are 30. Even though your bone mass doesn't increase after this, your bones continue to be very active. They are constantly adding on and taking off minerals all your life. But after 30, you start to lose mass which typically accelerates even more after menopause. Treatment for low bone mass is usually a class of medications known as bisphosphonates like Boniva. Like all medications they have side effects which in some cases can be intolerable. There are other medications like this one that you might be able to tolerate. You should talk with your doctor to see if, given your current circumstances, you can try them. If you are unable to take any medications in this class, then one possibility is a low dose estrogen replacement treatment assuming you are either peri-menopausal or post-menopausal. Another is Raloxifene, a medication that mimics estrogen. But these medications should be used only for a short period of time and with the understanding that they can increase your risk of having a stroke or blood clot. And if the medication is a combination estrogen-progesterone treatment, the risk also includes coronary heart disease and breast cancer. Your best bet is to discuss all this with your doctor and jointly decide what is best for you.

Pauline writes: "I found out in October I had thyroid problems. My thyroid is low. The doctor started me out on 25mcg, then to 50mcg. I also tried 75mcg. The 75 is when I started feeling better, not tired and my body didn't hurt and I wasn't crabby. But, when I had my blood test done it came back that the 75 was too high. I was put back on 50mcg. I started feeling really tired again and my body hurt. Why can't I just stay on the 75mcg if it makes me feel so much better?"

This is a very complicated question, but I'll try to keep it brief and hopefully easy to understand. I assume you are taking a medication like Levothyroxine for a hypothyroid condition. Using a blood test that measures your TSH (thyroid stimulating hormone) level is very common when someone is on this medication to make sure the does is correct. The goal in treatment is to get you to a normal TSH blood test level and to get your symptoms under control. In some cases like yours, having a normal TSH doesn't go along with having your symptoms go away. Even though your levels are normal you still feel tired and have body pains. The problem is that too much thyroid medication can also cause problems, particularly with your heart, so your doctor is trying to balance how you feel while keeping you at a safe level of medication. Your thyroid normally puts out both T4 and T3 hormones. The medication you are on replaces only the T4 hormone. Although it is somewhat controversial, there is a class of medication that combines the T4 and T3 hormones. Studies haven't really shown that taking the T3 part of the hormone helps all that much, but some patients do report their symptoms under better control when taking this combination medication. Other patients can tolerate a higher level of the medication you're on and that is certainly something I encourage you to talk with your doctor about. It might be that with careful monitoring you can tolerate higher doses of your thyroid medication. But then again, your body and in particular your heart might not be able to handle doses higher than what your doctor has you on now. Your best bet is to work with your doctor to see what treatment, or combination of treatments is best for you.

Lee writes: "I have Multiple Sclerosis. Can I give blood and/or donate organs? I have heard that whatever triggers MS could be transmitted, but I've also heard the screening and "preparation" of the blood and organs would take care of that."

First off, thanks for asking about blood/organ donation. Both are desperately needed everywhere. Prior to 2007, those with Multiple Sclerosis were not allowed to donate blood. That ban has since been lifted and according to representatives at Bonfils Blood Center, MS itself is not an exclusion criteria for blood donation. The same goes for organ donation. According to the Donor Alliance, those with MS can register for both organ and tissue donation. Like all donors, the decision will be made at the time of death what can and can't be donated based on condition at the time.

Karen writes: "My granddaughter just had her 2-year checkup and was told she is pigeon-toed. Is this a serious problem? Should she receive physical therapy, or will she outgrow it?"

Being pigeon-toed usually isn't a serious issue. It is also called in-toeing and is fairly common in infants and young children. Most cases of this get better on their own as the child grows older. If not, there are special shoes that can be worn to help out, but those usually aren't needed. For some children, they will remain slightly pigeon-toed as they get older. If they are pigeon-toed, that doesn't mean something is necessarily wrong with their feet, just that their toes point in when they walk. Having them checked every year during their physical exam can help you, her parents and the doctor get a better idea of how well she is improving and see if something needs to be done to help out.

Barbara writes: "I had a cystocele repair and vaginal suspension a while back. I believe they used pig skin for the sling. Can the pig skin loosen after a while and cause the same problems again?"

A sling is typically used to help with urinary incontinence. It is placed surgically and can be made of synthetic materials or pig skin. The pig skin slings are sometimes used because they tend to be softer. This is a common surgery that typically goes without issues, but like any surgery problems can happen. That can include a loosing of the sling which can result in problems similar to what you had before the surgery. The best course of action is to revisit the surgeon to see if anything further can be done to improve the situation.

Donald writes: "My lower legs have been swelling up lately since my doctor changed my blood pressure pills. My doctor also started me on water pills and they aren't helping." What vitamins would you suggest I take?"

There are a variety of reasons legs swell up. This can happen normally, especially if we are on our feet for a considerable time. We've all noticed our feet or hands getting bigger after a long day hiking or standing around. That is our bodies working against gravity, and after a long day, gravity wins a little bit. But in some cases, especially if someone has heart problems, leg swelling can be because of a condition known as congestive heart failure. What happens with this condition is the heart gets to a point where it isn't strong enough to fully counter the pull of gravity on the body. Fluid then builds up, especially in the arms and legs, and swelling occurs. Typically medicine is used to either get the heart to work better or to help the body eliminate more of the fluid. I do not know of any vitamins that would directly help in this case. If one medicine doesn't work, then perhaps another will. Talking with your doctor about how this current medication is affecting you can help both you and your doctor figure out if a different medication is needed.

Julie from Colorado Springs: "My 24-year-old son is suffering with esophagitis. He has crushing heart and chest pains, trouble breathing and sleeplessness due to anxiety. Test confirm his heart is strong, no blood clots and biopsies are clear. He's been prescribed Hydrocodone, Prevacid and Flovent. Are we on the right track with the medicine? Will the steroid eventually ease the pain so he can quit or reduce the pain meds? How long does it usually take to start seeing the results of the steroid?"

I am guessing the Hydrocodone was prescribed for his pain, the Prevacid for his stomach and esophagus and the Flovent for his breathing issues. If he has esophagitis, especially if it is accompanied by reflux, known as GERD, then the Prevacid should help relieve all his symptoms. This medication can take a week or two to fully kick in and provide maximum relief. The Flovent, again assuming it was given for his breathing issues, should take effect after a dose or two. Hopefully the medication will get rid of his symptoms so he can get off the pain medication soon, especially since it is addictive in nature.

Joslyn from Colorado Springs: "I'm 32 years old and being actively treated for Rhuematic Fever. I was recently diagnosed with Acute Pericarditis. I work 10-hour days as a Physical Therapist. Should I be limiting my activity?"

This depends on the extent of your Pericarditis. Pericarditis is inflammation of the tissue that surrounds your heart. When this gets inflamed, it can cause heart and chest pain. You will need to limit your activities if it seems to be affecting you and your heart. In other words, if you are able to do your normal daily routines, then it should be alright to continue. But, keep in mind that if you seem to be tiring more easily or experiencing more pain, then you should slow down.

Melanie from Colorado Springs: "I wanted to ask you a question about Left Bundle Branch Block. My 85-year-old mom has been diagnosed with this. What is it and what is the treatment?"

Left Bundle Branch Block is a condition where the electrical signal sent through your heart gets blocked at a certain spot. The signal still gets through, but has to take a slower and longer route. Most people with Left Bundle Branch Blocks don't even realize they have this condition. In your mom's case, unless she is having symptoms, there is probably nothing that needs to be done. But, do her and her doctor a favor. Get a copy of her most recent EKG and have your mom carry it with her. If she were to ever show up at teh Emergency Room with chest pain, having the EKG already showing a Left Bundle Branch Block will help the doctors there with their diagnosis.

Calvin from Colorado Springs: "What can I do for Restless Leg Syndrome?"

Restless Leg Syndrome, or RLS, is a condition where your legs feel uncomfortable, especially when you're sitting or lying down. Because of that, you constantly move them. It can happen during the night, and can disrupt your sleep and the sleep of anyone in the same bed. Scientists haven't been able to pinpoint the exact cause, but some believe it has to do with iron levels or with a chemical in the brain known as dopamine. And just like we don't know the cause, we also don't have one treatment that works for everyone. Warm baths and stretching before bedtime might help along with meditation. Also, make sure you avoid caffeine before going to bed. Taking iron if your blood iron levels are low is also a good step to take. Beyond these basic steps, there are medications that help some, including those sometimes used for Parkinson's or Epilepsy.

Terri from Divide: "My husband suffers from gout. He's 68 years old and has one kidney. We've lived at this altitude for a little over a year. The flair ups are coming more often. He's taking his prescribed medications and drinking lots of water. He eats well and doesn't drink alcohol. However, he's still having flair ups every other week. It starts in the left foot and moves to the right and starts over again. What is it we're not doing? Is having one kidney an issue?"

Eating well is key to keeping gout under control. That means having a low fat, low alcohol diet much like the one your husband is already on. Stress, like from a new move, can also bring on gout attacks. There are two basic types of medication used to treat gout. Medicines like steroids, Indomethacin and Colchicine are used to stop an attack once the pain, swelling and redness start. Once an attack is under control, other medicines like Allopurinol, Febuxostat and Probenecid are used to keep gout from coming back. Even with these medications, you can still have breakthrough gout attacks. One thing to realize is that some of these medicines do affect the kidneys, so your husband will have to be extra careful. He needs to mention to his doctors about his kidney issue so they can take that into consideration when prescribing a treatment for his gout.

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