Ask Dr. John

Medical Mysteries

Clarice writes: "My husband has severe tremors. Parkinson's has been ruled out. He has tried many medications with no relief. On January 24th or 26th there was a news article on a procedure to stop tremors. Can you tell me more about it?"

Since Parkinson's disease has been ruled out, your husband most likely suffers from what are known as essential tremors. These tremors can range from mild to more severe cases that interfere with everyday living. Although there are a variety of treatment that can help, a new treatment is proving successful. That treatment is deep brain stimulation. A small medical device, called a neurotransmitter, is implanted much like a pacemaker. The wires are implanted in very specific areas of the brain and the stimulation provided by the neurotransmitter cancels out the tremors. This device has been shown to be very successful at reducing tremors in individuals with essential tremors.

Allen writes: "I have a problem with excessive heat in the back of my head. I break out in a sweat at non-predictable times. Doesn't seem to matter whether I'm exerting or not. I am 75 years old."

I'm not sure what specifically causes this localized sweating, but people do have a tendency to sweat in consistent areas. In other words, some are face sweaters, some armpit sweaters, and others had sweaters. I'm not sure if this has happened for most of your life or is a new condition, but excessive sweating goes by the medical term hyperhidrosis. This is a very common condition and although usually harmless by itself, it can lead to social embarrassment so most people having this issue want it eliminated. Some thing to keep in mind are that certain conditions, like a thyroid problem or certain infections, might cause this to come on suddenly. As far as treatment, there are over-the-counter antiperspirants, but they might be difficult to apply to your scalp. Other patients have had success with Botox injections, which eliminate the sweating for months on end. But the bottom line is that this is a condition you shouldn't have to live with, it's just a matter of getting down to the root cause, something your doctor can help you with.

Melody writes: "I have had a lot of trouble with meds that I have been prescribed for various things and I would always get a rash. I have now been tested and I have duplicate genes that will not allow me to metabolize drugs that are processed through the 2C9 pathway. I have not been able to find a doctor in the area that understands this problem and I have suffered with this rash for 12 years now. I have not been able to find out much information on the Internet. I'm not really sure what type of doctor I should seek help from."

Often times finding the cause of an issue is the biggest battle. In your case it took years to find out you had an issue with what's known as your Cytochrome P450 enzyme system. The 2C9 is one of the subsystems of this system and is one way for your body to metabolize and use certain drugs. If you have an issue with this system, your body won't be able to use certain drugs like they were intended. Now that you know this is an issue your regular physician should be able to adjust your drugs so they aren't affected by this issue.

K writes: "I have been in and out of the doctor's office for three months complaining of numb feeling in the back part of my head, severe headaches and I get sharp pain in my ears. My hearing is beginning to be muffled and I also have a rash on my neck that burns. I am on my third round of antibiotics. I start feeling better and it seems to come back a few weeks after being off the antibiotics. I really feel my doctor is over looking something."

With the variety of issues you have going on, it's difficult to pinpoint it to one specific problem so I can see why your doctor is having a hard time figuring it out. Your doctor might be overlooking something, but medical treatment is a team effort. You need to sit down with your doctor to try and figure out where all your symptoms are coming from. One way you can help is by keeping a journal and record what you are doing, eating and drinking when your symptoms get better or worse. Are they different in the morning or evening? Do they get better or worse if you are at home versus work or school? Do the treatments help or not? And if they help, do they get rid of the symptoms or do they just get a little better only to return later? Oftentimes, medicine is like detective work and keeping a tab on what makes specific symptoms different can go along way towards helping you and your doctor figure this out.

Sadie writes: "I am 72 years old. I exercise on a manual treadmill daily for 15 minutes. I take calcium, vitamin D and Crestor daily. I have congestive heart failure and all of my family has heart trouble. I have no energy. What can I take or do to enhance my energy?"

You are doing what you can to keep your healthy up, but sometimes when you have an issue like congestive heart failure, it can really rob you of your energy. With congestive heart failure, also known as CHF, your heart isn't working as efficiently as it should. Because of these, it isn't able to pump all of the amount of blood your body needs to prevent fluid from accumulating in your legs and, in worsening cases, in your lungs. This also means you won't have nearly the energy you did before you started being effected by your CHF. There are medicines that can help remove some of the excess fluids allowing you to breath a little easier and get some of your energy back. In addition, there are medicines that can help your heart work a little better, also giving you back some of the old energy. But the bottom line is to make sure you get your heart thoroughly checked out and treated. Also, you will need to get checked out to make sure there aren't other issues causing your fatigue like anemia or thyroid problem.

Donna writes: "My 11-year-old son has a raised rash on his torso, front and back. He's had it for 2-3 days. Initially he experienced difficulty breathing, so we restarted his recommended inhaler and Zyrtec. He lost his appetite, was tired and slept 12 hours. What could this be (he has not "strawberry tongue" as with Scarlet Fever). Could it be fifth disease?"

As with most skin issues it's difficult to figure out without actually seeing the rash. The fact that it is raised hints towards an allergic type reaction which should respond to Zyrtec or its other non-sedating over-the-counter antihistamines. Diphenhydramine, sold under the brand name Benadryl, is a stronger antihistamine, but it does make one drowsy, so needs to be used with more caution. There have been a few cases of fifth disease lately. This viral illness is caused by the parvovirus B19. It's also called Erythema Infectiosum. This isn't the same parvovirus animals get and can't be gotten or given to a pet. Worldwide, around 50% of people have evidence in our blood of past exposure, so this virus is pretty common, especially in kids between the ages of 5 and 15. As opposed to the rash you are referring to, most kids with fifth disease have a very distinctive red rash on their face that looks like a "slapped cheek." This rash can also spread to the arms, legs and trunk. Usually it's not itchy. The symptoms around this disease start off like most viral illnesses with a low-grade fever, runny nose and possibly a mild cough. The rash usually starts a few days after the symptoms go away. Older kids and adults might also notice some joint pain. Treatment is basically supportive. Plenty of fluids to keep hydrated, lots of rest and acetaminophen or ibuprofen for fever relief. Someone with fifth disease is contagious, but usually only before the rash comes out.

Cassandra writes: "I have these bumps on my face and I don't know what they are. They're not pimples, but they have white heads like pimples. I can't pop them. I have one right on my cheek that's not growing or shrinking. What could they be? Could I have them removed? Also, is it true that you're not supposed to cut a skin tag off?"

When it comes to different rashes or blemishes on the skin, a picture is truly worth a thousand words. In other words, without actually seeing the skin issue, it's very difficult to figure out what is going on. The condition you are talking about could be acne, but it could also be a few other things as well. This condition could be something that's harmless like Keratosis, which affects the skin follicles and is sometimes referred to as "chicken skin" because of its bumpy appearance. Ointments can sometimes help. It could also be something infective like Molluscum Contagiosum, a viral infection that can last for months. It is contagious and someone can catch it if they touch infected skin. There is no cure as the body needs to clear the infection over time. What you describe could also be either a fungal skin infection or a bacterial skin infection. If it's fungal, a simple anti-fungal cream, like we use to cure ringworm, can help. If it's bacterial, like Impetigo, antibacterial ointments or pills are needed. But there are some basic first steps you can take to try and clear this up. First, make sure you are washing your face with basic soap and water. Avoid or minimize makeup for a few days to see if that can help out, and if your hair is long avoid products that can make it oily. If these tips don't help out then having a doctor look at your condition can go a long way towards figuring out what this is and getting you what you need to clear up your skin.

Deborah writes: "A little embarrassing question, but I have recently been getting bad hemorrhoids and am wondering if there might be some underlying reason as to why I get them frequently. Do some people naturally get them frequently?"

Hemorrhoids are very common and tend to happen more often as we get older. A hemorrhoid is basically a bulging vein just below the skin located in the rectal area. They usually happen because of pressure put on this rectal area, which causes the veins to bulge and protrude. They can be painful and occasionally bleed. They can happen because of straining during bowel movements, sitting for long periods of time or an increased pressure on these areas during pregnancy. Hemorrhoids are very common and it's estimated that over half of all adults 50 or older suffer from them at some time or another. Again, these hemorrhoids can bleed from time to time and frequently cause anal itching and pain. The biggest complication happens if the vein forms a blood clot. You can then suffer from what's known as a thrombosed hemorrhoid, which can be very painful and requires surgical removal of the clot. But hemorrhoids can often be effectively treated at home with over-the-counter products. The first step is to make sure you don't have constipation or other issues requiring excessive force during a bowel movement. Over-the-counter creams containing corticosteroids can help shrink hemorrhoids down. Creams with the ingredient lidocaine can help cut down on the pain and those containing witch hazel can help minimize the itching. Also, Sitz baths can help relieve some of the discomfort behind hemorrhoids. A Sitz bath consists of sitting in warm water for 10 minutes. If home treatment doesn't work then you should visit a gastroenterologist or surgeon. They can use various surgical techniques to treat and oftentimes get rid of hemorrhoids.

Stella writes: "I haven't been able to smell or taste food for a couple of months. Just want to know what's going on."

The medical word for loss of smell is anosmia. This loss of smell can sometimes be temporary and other times permanent. Losing smell can also cause a change in how, or even if, you taste food or drinks you place in your mouth. Sometimes a loss of smell can be caused by things as simple as the common cold, a sinus infection or even seasonal allergies. Other times this anosmia becomes permanent. In this case it can be attributed to aging, diseases like diabetes, medications, head injury or a tumor. Talking with your doctor about when your smell started to go away, how much you can or cannot smell now and what medical conditions you have, can help you both zero in on the cause.

Steve from Colorado Springs: "I have a big knot under my right arm. What could it be?"

There are a few things under your armpit that could be causing this "knot." It could be a lymph node, much like the ones that swell in your neck if you have a throat infection. If you have an infection in or near your armpit, the node could swell. These usually go away when the infection clears up. It is also possible you have developed an abscess or other type of infection in this area. The main thing to do is to keep a close eye on the "knot". If it does not go away, or continues to grow, you need to be checked for conditions like lymphoma, an abscess that needs draining or other more serious conditions. The signs of worsening include redness, pain, fever or an enlargement of the "knot."

Melissa from Divide: "I've been experiencing some burning pain in my fingers in both hands between my pointer fingers and my middle fingers. I'm a very active 37-year-old woman. It doesn't matter what I do, anything sets it off. What could it be and how do I stop it?"

Whenever you experience pain, especially the burning type, you need to think of a couple of different things that may be causing it. A fungal infection, like athletes foot or ringworm might be the cause, but is usually accompanied by scaly, red skin and tends to spread as time goes on. A nerve issue might also be causing this symptom. If it worsens when you raise your arms or seems to get worse the more you use your hands, then this is something to think about and you should follow up with a doctor for a good evaluation, especially if it seems to be worsening. On the other hand, if it's only lasting a few minutes or seems to get better on its own then it might be related to something as simple as a sunburn. The main thing is to look for a condition that doesn't get better or actually starts to worsen, especially if accompanied by weakness. In that case seek immediate medical help.

Richard from Colorado City: "I have severe cramps in my entire body. In fact, I often fall due to cramps in my legs and cannot control my legs. It starts in my groin and gets worse by the second. Is there anything I can do?"

Although there are many things that might be causing this problem, the one that should be checked soon is related to your potassium, calcium and magnesium levels. In particular, low potassium can cause muscle weakness and cramps and if it gets low enough can be life-threatening. A simple blood test can tell your doctor if that is the cause and if it isn't at least help them decide where to look next.

Alan from Colorado Springs: "I'm a 46-year-old man with a head the size of a child, maybe smaller. I have to wear glasses made for kids and can't wear earbuds. Is there anything I can do to make my head larger? Does this condition affect my brain functions?"

First and foremost, head and brain size do not correlate with intelligence. In other words, having a large brain doesn't make someone smarter anymore than having a small brain makes them less intelligent. As for making your head larger, there is nothing you can do. Like most body parts, we live with what we are born with.

Kathie from Colorado Springs: "Every time I'm in the sun, I get these red, itchy bumps that are almost painful. They are not concentrated in one area. I am being treated for eczema on my elbows, but these are different and very itchy. Any ideas?"

Although it is difficult to diagnose any rash without actually seeing it, you do offer a couple of clues. Number one, you have a history of other rashes like eczema. Number two, you seem to only get the rash when exposed to the sun. If this happens only in areas that are exposed to the sun, I would think about a condition known as "photosensitivity reaction." With this type of reaction people break out in red, raised, itchy bumps or even hives when they are exposed to sunlight. A couple of things that might help are covering up skin areas when in sunlight and using a sunscreen with exposure might also help. If you do develop these spots, treating them with an over the counter anti-itch cream might help relieve symptoms. Like most conditions, if it gets worse, doesn't resolve or is accompanied by fever or pain, then you should be checked by a health care provider soon.

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